Hospital Nutrition Flashcards
days before nutritional deficiency:
well nourished with minimal acute illness
10-14
days before nutritional deficiency:
undernourished with minimal illness
5-7
days before nutritional deficiency:
well nourished with serious acute illness
5-7
days before nutritional deficiency:
undernourished with serious medical illness
3-5
what method of feeding is preferred in people who cannot feed themselves?
enteral: tube to GI tract
- mimics physiological route to deliver nutrients to nourish GI epithelium
- lower risk than parenteral (infection)
main sources of macronutrients in formula
corn oil, maltodextrin (starch), & casein (milk protein)
typical energy density in formula
1kcal/mL
range of TEE in sick people
22-25 –> 30-32 kcal/kg/day
how to calculate daily energy needs?
TEE kcal/kg/day X weight in kg = kcal/day =ml/day
hourly infusion rate calculation
daily energy need divided by hours in day
(kcal/day = ml/day) divided by 24
body position to facilitate gastric emptying
right lateral decubitus
facilitate gastric emptying
minimum requirements
multi-vitamin, thiamine, folate included with D5
how to calculate glucose intake
dextrose= 5%
100ml/hr X 5% = 5 g/hour =20calories
24hours X 20 calories/hour = 480 calories of 100% carb
overfeeding
- 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
underfeeding
negative nitrogen/ protein balance
-break down muscle to AA for gluconeogenesis for glucose for the brain –> lose weight
how to estimate how much protein is broken down?
grams of urinary nitrogen over 24hours X 6.25
how to estimate how much protein you are feeding?
(grams protein/L) X (#L/day)
negative protein balance
(grams urinary nitrogen X 6.25) > (grams protein/L X #L/day)
average protein requirement for sick people
0.8 to 1g protein/kg body weight/day
why would you not want to overfeed a patient trying to get off mechanical ventilation?
if overfed, they increase the rate of oxidation of nutrients –> consuming more O2 and producing more CO2
Increased CO2 production –> Increased need for ventilation
What type of special diet has ben suggested for a person with respiratory failure?
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
Why might a limited intake of protein, salt and water be indicated in a patient with hepatic encephalopathy?
patient is unable to incorporate ammonia into urea–> toxic levels in blood
ascities due to salt and water retention
What type of special diet has been suggested for patients with hepatic encephalopathy?
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
feeding considerations with renal failure
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
