Hospital nutrition - bessensen Flashcards

1
Q

How can you determine how much to feed someone?

A

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.

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2
Q

What route to feed?

A

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.

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3
Q

When does nutritional depletion occur?

A

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.

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4
Q

How can you initiate feeding?

A

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.

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5
Q

One clue that you are overfeeding someone might be….

A

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

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6
Q

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

A

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).

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7
Q

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

A

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.”

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8
Q

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

A

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

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

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9
Q

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

A

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

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10
Q

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

A

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

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