Hospital nutrition - bessensen

Question 1

How can you determine how much to feed someone?

Answer 1

Body weight and how sick they are.

Sick-o-meter: 25-35 kcal/kg/day, the sicker the person, the greater the energy requirement. The bigger the person the greater the energy requirement.

Question 2

What route to feed?

Answer 2

If the GI tract works, feed entrally (eg GI). Even a small amt of food in the gut can help prevent gram (-) sepsis and preserve gut function.

Parenteral nutrition is higher risk.

Question 3

When does nutritional depletion occur?

Answer 3

Normal, not sick..10-14 days
Normal and pretty sick..or nutritionally depleted and not sick..5-7 days.
Nutritionally depleted and sick..3-5 days
Need to assess pre-morbid nutritional state.

Question 4

How can you initiate feeding?

Answer 4

1) Place nasogastric tube, make sure it is in the proper position (x-ray, generally)
2) Start tube feeding slowly 10-20 ml/hr, check for residuals after 5-10 hours (otherwise can fill up leading to vomiting and aspiration).
3) Gradually increase flow rate and continue to check residuals (volume left in stomach). If the residual > 100 ml reduce the flow rate.
4) If residuals persist, have patient repositioned, elevate head of bed, right lateral decubitus position.

Question 5

One clue that you are overfeeding someone might be….

Answer 5

hyperglycemia after several days (after glycogen stores have been filled).

Question 6

After 1 week, how can you test your patient’s nitrogen balance?

Answer 6

Measure urine nitrogen (urea) and compare against the total consumption of protein per ng tube.

Don’t memorize the formula, but
g protein out= (2g skin + 2g stool + 24 hr UUN) x 6.25

**Must account for other protein losses (eg ascites/chest tube, proteinuria, losses through skin).

Question 7

In hospitalized patients, are you generally more worried about water or fat soluble vitamin deficiency?

Answer 7

Water soluble vitamins have smaller stores, so in the short term they are more concerning.

“IF you think they look malnourished or might be deficient, just give them a bag of vitamin.”

Question 8

What are some essential nutrients not typically found in standard hospital tube food?

Answer 8

Arginine (NO precursor)
Glutamine
Omega-3 FA (prostaglandin/leukotriene precursor)

**These might be important in boosting/maintaining immune function

Question 9

What is an important dietary consideration for a patient on a ventilator?

Answer 9

High carbohydrate diet and overfeeding increase Respiratory Quotient/ Respiratory Exchange Ratio (CO2/O2 production rates)
Increased CO2 production increases minute ventilation, work of breathing and vent pressures

Higher fat and less calories may be beneficial

Question 10

For burn and trauma victims, how might nutrition requirements change?

Answer 10

Increased energy requirement may be as high as 30-35 kcal/kg/day
May have an increased protein requirement 1-1.5 g/kg/day