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
Average protein requirement for sick patients
0.8-1g/ Kg/ day
symptoms of zinc, Fe, chromium and selenium deficiency
zinc: diarrhea. Fe: anemia, immune dysfunction. Chromium: insulin resistance. Selecium: CHF (Keshans dz)
special neutrients required
arginine- precursor for NO and stimulates GH and insulin secretion. Glutamine- increases immune function, gut histology and barrier function. Plus gluconeogenic precursor. Omega 3 fatty acids- precursors for leukotrienes and prostaglandins, improves tissue perfusion, reduces cytokines
nutritional support in respiratory failure
Overfeeding may lead to more O2 consumption and more CO2 production due to burning all the nutrients. For a person on a ventilator, avoid overfeeding (More Co2 increases need for ventilation) and underfeeding (weakened respiratory muscle)
What diet is considered in people with respiratory failure
high fat diet- . It turns out that there is more CO2 produced for each O2 consumed when glucose is burned as compared to fat
nutritional support in liver failure
Limit protein, salt and water intake b/c liver is unable to incorporate ammonia into urea (can lead to encephalopthy) and pts have ascites from salt/water retention.
What diet is considered in people with liver failure
Diet high in BCAA to give adequate protein without fostering production of false neurotransmitters in brain (which can come from high levels of aromatic amino acids)
nutritional support in renal failure
Limit protein b/c kidneys are not able to excrete urea (which can lead to elevated BUN)
What is a cardiac diet
Fat, sodium, saturated fat and cholesterol restricted diet
What is a diabetic diet
restrictions in calories, fat and simple sugars
Burns/trauma diet
increased energy requirement as high as 35kcal/kg/day and increased protein requirement of 1-1.5g/kg/day
