Hospital Nutrition

Question 1

Previously well nourished with minimal acute medical illness can go how long without food before severe nutritional deficiencies

Answer 1

10-14 days

Question 2

previously undernourished with minimal illness can go how long without food before severe nutritional deficiencies

Answer 2

5-7 days

Question 3

previously well nourished with serious acute medical illness can go how long without food before severe nutritional deficiencies

Answer 3

5-7 days

Question 4

previously undernourished adult with serious medical illness can go how long without food before severe nutritional deficiencies

Answer 4

3-5 days

Question 5

people at risk of undernutrition

Answer 5

alcoholic, homeless, underweight, muscle loss/cachexia, chronic diarrhea/other GI disturbances, self-report poor dietary intake, chronic conditions that increase energy expenditure, insensible losses from proteinuria, mucous production, bleding

Question 6

what do you have to do before feeding

Answer 6

decide when to feed, place feeding tube or IV line for parenteral feeding, make sure tubes in right place

Question 7

Risk of enteral feeding

Answer 7

aspiration into lungs

Question 8

risk of parenteral nutrition

Answer 8

risk of placing central venous catheter, risk of infection from central line containing nutrients in high concentration

Question 9

preferred route of administration of nutrients

Answer 9

enteral when possible. Risks are lower and benefits to delivering by normal GI route (nourishing GI epithelium important in long term nutrient absorption and acts as a barrier to colonic flora)

Question 10

typical density of standard liquid nutritional feeding formula

Answer 10

1 kcal/ml

also a number of types that can be used for unique needs

Question 11

TEE for someone in hospital

Answer 11

general range is 22-25 kcal/kg/day for someone not that sick to 30-32 kcal/kg/day for someone very sick

Question 12

how to get infusion rate

Answer 12

take persons weight (kg) times it by number of kcal/kg/d you think is appropriate to calculate daily energy needs. Number of kcal/day = ml/day, so divide that by number of hours for total infusion rate

Question 13

starting infusion

Answer 13

start with lower infusion rate and gradually increase flow rate over days. This is because they may have trouble emptying their stomach –> can vomit and aspirate. You can check residuals periodically

Question 14

what vitamins do you give with glucose

Answer 14

thiamine, folate adn multiple vitamin to potentially malnourished ppl

Question 15

what happens if you overfeed someone

Answer 15

will be fine for several days as they fill up glycogen stores but then tend to develop hyperglycemia that can be difficult to control since stores of glycogen are full. Can reduce calories but may take several days for situation to reverse.

Question 16

what happens when you underfeed someone

Answer 16

these individiuals will lose weight as they break down more protein for gluconeogenesis. Can estimate how much protein broken down by measuring urinary nitrogen over 24 hours

Question 17

where does urine nitrogen come from

Answer 17

catabolism of amino acids

Question 18

how to estimate grams of catabolized protein

Answer 18

take grams of urinary nitrogen and multiply by 6.25 (empirically derived number)

Question 19

avg protein requirement for sick pts

Answer 19

0.8-1g protein/kg body weight/d

Question 20

nutrition in respiratory failure

Answer 20

overfeed: pt tries to increase rate of oxidation of nutrients and will consume more oxygen/produce more CO2. More CO2 –> need more ventilation

don’t want to overfeed or underfeed (could cause weak respiratory muscles)

more CO2 produced for each O2 consumed when glucose burned than fat. Some people say to minimize CO2 production while still giving adequate energy to consider higher fat diet for respirator pts

Question 21

nutritional support in Liver failure

Answer 21

end stage liver disease pts can develop hepatic encephalopathy party from high ammonia in blood since liver can’t incorporate it into urea. They may also have ascites from salt/water retention

may want to limit protein, salt and water in these individuals but weigh against possible deleterious effect of underfeeding someone who could be already malnourished

Question 22

nutritional support Renal Failure

Answer 22

if can’t excrete urea, get high BUN, which comes from protein catabolism. Some limit protein a person with renal failure gets but must weigh against risk of too little protein to already undernourished person.

Don’t want to overfeed someone in end stage renal dz but don’t want to overly restrict. Nitrogen balance hard to calculate

Question 23

nutritional support in Cardiac Disease

Answer 23

hospitalization good opp for those with CAD to discuss sat fat restriction with nutritionist

overweight/obese pts, energy restriction may be important

CHF: restrict NA

Have “cardiac diet” for hospitalized pts– typically low fat, low sodium, low saturated fat

Question 24

nutritional support in pts with Diabetes

Answer 24

insulin used in hospital to control glucose;

ideally offer a diabetic diet with controlled carb content at each meal

can adjust meds for diabetes in hospital based on blood sugars in hospital but can be problem if pt goes home and eats more than in hospital