Hospital based nutrition

Question 1

1. Describe an approach to deciding when to begin feeding a hospitalized patient who cannot feed themselves. (8 things)

Answer 1

nutrional assessment
History of etoh, homeless, unsusal diet, elderly, disabled
chronic medical problems: GI, pulm, renal, cancer
prior wt loss
BMI under 19
thenar and temporal wasting
low albumin
low white cell count

Question 2

2. Describe an approach to estimating the number of calories per day that a sick patient in the hospital will need.

Answer 2

• energy in should equal energy out
• Harris Benedict eqn–> estimate resting metabolic rate
• indirect calorimetry
• swan Ganz AV 02 balance using fick principle

-25-35 kcal/kg/day, the sicker the patient the greater the energy requirment, the bigger the person the greater the energy requirment

Question 3

how do you want to feed peope IV or Enteral?

what are advantages and disadvantages

Answer 3

if gi tract is working feed them enteral
-enteral nutrition may improve gut barrier function
-risk of aspiration pneumonia
IV works but it has complications and risks

Question 4

4. Describe an approach for determining if a person who is getting long term nutritional support is being fed adequately.

Answer 4

• check and record total calories per day
• overfeeding causes hyperglycemia
• check nitrogen balance 1 week after you get to your target infusion (look at protein in, and urine urea out (there will be insensible losses-that cant be calculated) look for urea stability
• vitamins-> what is pool size
• -look for deficiency symptoms like wernicke..etc

Question 5

5. List some of the special issues associated with feeding a hospitalized patient with pulmonary, liver or kidney disease.

Answer 5

Respiratory failure- diaphragmatic weakness
-if someone is on a ventilator u dont want to overfeed them, because high carb diet it increases work of breathing (use high fat diet)

Liver failure- diets lower in aromatic AA and higher in branched chain AA may be helpful in not causing more encephalopathy

Renal failure- **volume (Na and Water) overload is a problem
-protein oxidation can lead to more urea production

Question 6

normal not sick
normal pretty sick, nutrition depleted not sick
nutritionally depleted and sick

Answer 6

10-14 days
5-7 days
3-5 days

Question 7

D5

Answer 7

5% dextrose- 240 cal per day

Question 8

Special diets

Answer 8

Special diets

Arginine- Jevita doesnt have any–> precursor for NO, stimulates insulin production and growth hormone

Glutamine- conditionally essential- preferred nutrient for gut epithelium, immune function etc. “immune funtion diet”

***very little omega 3 fatty acids in standard house formulas-precursor for leukotrienes and prostaglandins

Question 9

how many calories per day does juvita have?

Answer 9

Jevity- 1300 calories for 70kg person