hospital based nutrtion Flashcards
- Describe an approach to deciding when to begin feeding a hospitalized patient who cannot feed themselves.
Depends on: 1. The patient’s preexisting nutritional status, 2. The patient’s level of illness 3. The consequences to the patient of inadequate nutrition
What kinds of conditions require more nutrients
A person who is quite ‘catabolic’ from a pneumonia, abscess, untreated cancer, or has had a major operation will consume more nutrients each day than someone who has had a drug overdose and is unconscious but does not have a fever
Which conditions will have worse outcomes if nutrients are restricted
Pts with infections or major surgery as opposed to someone with a stroke who is unconcious but has few other problems
How long can a Previously well nourished adult who cannot eat but who has minimal acute medical illness go without food
Might go 10-14 days without food before they begin to develop potentially serious nutritional deficiencies
What labs can be done to check for pre-hospital nutrition
low albumin, lymphocyte count <1500, thenar and temporal wasting
How long can a Previously undernourished adults with minimal medical illness, or previously well nourished individuals with serious acute medical illness go without food
Might go 5-7 days without food before they begin to develop potentially serious nutritional deficiencies
How long can Previously undernourished adults with serious medical illness go without food
may develop potentially serious nutritional deficiencies in 3-5 days if they are not fed.
How often do children need food in hospital
more often than adult counterparts
risk of parenteral feeding
Higher risk of infection of central line. This is why enteral feeding by mouth is preferred
How to initiate enteral tube feedings
nasogastric tube- start slow (10-20ml/hr) and check for residuals after 5-10 hrs. Gradually incrase flow rate and if residual > 100ml, reduce. If residual persists, have pt lie with elevated head in right lateral decubitus.
Typical energy density of hospital formulas
1kcal/ml
- Describe an approach to estimating the number of calories per day that a sick patient in the hospital will need.
Total energy expenditure ranges from 22-25 kcal/kg/day for someone who is not that sick to 30-32 kcal/kg/day for someone who is very sick. Also can use Harris Benedict equation, indirect calorimetry, and Swan Ganz AV O2 balance
What else should be given to patients in the hospital
Thiamine, folate, vitamins and IV glucose if Pt cant tolerate enteral diet at the volume needed to meet total energy needs
- Describe an approach for determining if a person who is getting long term nutritional support is being fed adequately.
Over feeding may be indicated by hyperglycemia. Underfeeding may be indicated by muscle breakdown (as measured by urinary nitrogen over 24 hrs- multply grams of urinary nitrogen by 6.25 to calculate grams of protein catabolized)
How to calculate protein loss
(2g (skin) + 2g (stool) + 24 hr UUN) x 6.25
