Hospital Nutrition

Question 1

days before nutritional deficiency:

well nourished with minimal acute illness

Answer 1

10-14

Question 2

days before nutritional deficiency:

undernourished with minimal illness

Answer 2

5-7

Question 3

days before nutritional deficiency:

well nourished with serious acute illness

Answer 3

5-7

Question 4

days before nutritional deficiency:

undernourished with serious medical illness

Answer 4

3-5

Question 5

what method of feeding is preferred in people who cannot feed themselves?

Answer 5

enteral: tube to GI tract
- mimics physiological route to deliver nutrients to nourish GI epithelium
- lower risk than parenteral (infection)

Question 6

main sources of macronutrients in formula

Answer 6

corn oil, maltodextrin (starch), & casein (milk protein)

Question 7

typical energy density in formula

Answer 7

1kcal/mL

Question 8

range of TEE in sick people

Answer 8

22-25 –> 30-32 kcal/kg/day

Question 9

how to calculate daily energy needs?

Answer 9

TEE kcal/kg/day X weight in kg = kcal/day =ml/day

Question 10

hourly infusion rate calculation

Answer 10

daily energy need divided by hours in day

(kcal/day = ml/day) divided by 24

Question 11

body position to facilitate gastric emptying

Answer 11

right lateral decubitus

facilitate gastric emptying

Question 12

minimum requirements

Answer 12

multi-vitamin, thiamine, folate included with D5

Question 13

how to calculate glucose intake

Answer 13

dextrose= 5%
100ml/hr X 5% = 5 g/hour =20calories
24hours X 20 calories/hour = 480 calories of 100% carb

Question 14

overfeeding

Answer 14

• before glycogen stores full- fine
• after glycogen stores full–> hyperglycemia that may be difficult to control with insulin
• may take several days to correct and reverse situation

Question 15

underfeeding

Answer 15

negative nitrogen/ protein balance

-break down muscle to AA for gluconeogenesis for glucose for the brain –> lose weight

Question 16

how to estimate how much protein is broken down?

Answer 16

grams of urinary nitrogen over 24hours X 6.25

Question 17

how to estimate how much protein you are feeding?

Answer 17

(grams protein/L) X (#L/day)

Question 18

negative protein balance

Answer 18

(grams urinary nitrogen X 6.25) > (grams protein/L X #L/day)

Question 19

average protein requirement for sick people

Answer 19

0.8 to 1g protein/kg body weight/day

Question 20

why would you not want to overfeed a patient trying to get off mechanical ventilation?

Answer 20

if overfed, they increase the rate of oxidation of nutrients –> consuming more O2 and producing more CO2

Increased CO2 production –> Increased need for ventilation

Question 21

What type of special diet has ben suggested for a person with respiratory failure?

Answer 21

HIGH FAT DIET:
glucose use produces more CO2 per O2 consumed than fat use

allow adequate energy (to prevent weakness of respiratory muscles) while minimizing CO2 production

*Evidence is lacking

Question 22

Why might a limited intake of protein, salt and water be indicated in a patient with hepatic encephalopathy?

Answer 22

patient is unable to incorporate ammonia into urea–> toxic levels in blood

ascities due to salt and water retention

Question 23

What type of special diet has been suggested for patients with hepatic encephalopathy?

Answer 23

High BRANCHED CHAIN AA

Altered mental status may also be due to accumulation of false NT in brain from high levels of Aromatic AA

Diets high in branched chain AA may provide adequate energy without contributing to false NT in brain

*Evidence is lacking

Question 24

feeding considerations with renal failure

Answer 24

Kidneys should excrete urea : nitrogen from protein catabolism

Kidney failure: BUN increases

Some suggest limiting protein but patients are usually malnourished

Don’t overfeed protein and don’t overly restrict

Question 25

CAD diet

Answer 25

restrict saturated fats

Question 26

Overweight/ Obese diet

Answer 26

energy restriction

Question 27

CHF

Answer 27

restrict salt

Question 28

Cardiac Diet

Answer 28

low fat, low sodium, low saturated fat

Question 29

most important factor for insulin dosing in diabetes

Answer 29

carb intake

Question 30

diabetic diet

Answer 30

restrict calories, fat, simple sugars

Question 31

why opt for a patient chosen diet over a diabetic diet?

Answer 31

so adjusted meds are more valid when then transfer to home