Met 2: Hospital Nutrition

Question 1

Do nutritional requirements increase or decrease with illness?

Answer 1

Nutritional requirements increase with illness, surgery, healing, stress

Question 2

A healthy person (no pre-existing nutrition concern) would need to be fed after _____ days

Answer 2

A healthy person (no pre-existing nutrition concern) would need to be fed after 10-14 days

Question 3

A healthy person who becomes sick or a nutritionally-depleted person who is not actively sick needs to be fed within ____ days

Answer 3

A healthy person who becomes sick or a nutritionally-depleted person who is not actively sick needs to be fed within 5-7 days

Question 4

A person who is actively sick and had nutritional depletion before illness needs to be fed within ____ days.

Answer 4

A person who is actively sick and had nutritional depletion before illness needs to be fed within 3-5 days.

Question 5

For generalized poor nutrition,

Name 1 physican exam finding

Name 2 lab values affected

Answer 5

• Thenar or temporal wasting
• Decreased albumin
• Decreased lymphocytes

Question 6

How much should you feed someone?

Answer 6

• 25-35 kcal/kg/day
• Higher end if sicker and/or bigger person

Question 7

What route should you use to feed?

Why?

Answer 7

• Feed enterally (normal oral feeding)
  
  • Important to keep GI tract itself fed
  • This helps maintain the gut barrier function
  • Parenteral nutrition also has increased risk of infection b/c need central IV catheter

Question 8

What are the major risks with feeding? (2)

Answer 8

Risk when placing a GI tube

aspiration pneumonia

Question 9

Enteral formula typically has ___ kcal/ml

Answer 9

Formula typically has 1 kcal/ml

Question 10

D5 is 5% glucose, so it has ___ g of glucose per 100 ml

That is ___ kcal of glucose per 100 ml

Answer 10

D5 is 5% glucose, so it has 5 g of glucose per 100 ml

That is 20 kcal of glucose per 100 ml

Question 11

How do you know if the ng tube rate of feeding is too fast?

Answer 11

If the residual is over 100 ml, reduce the rate of feeding

Question 12

Overfeeding can cause ________

Answer 12

Overfeeding can cause hyperglycemia

Question 13

Typical protein requirement is ____ g/kg/day

May be increased to ____ g/kg/day if sick

Answer 13

Typical protein requirement is 0.5-0.8 g/kg/day

May be increased to 0.8-1.8 g/kg/day if sick

Question 14

If the ____ is stable, then oxidation (breakdown) of protein can be estimated by ___________

Answer 14

If the BUN is stable, then oxidation of protein can be estimated by urine urea nitrogen

Question 15

Which has larger stores: fat soluble or water soluble vitamins?

Answer 15

Fat soluble vitamins (AKED)

Question 16

Name 4 nutrients that are not present in typical formula and you may need to add.

(2 AA’s, 2 fats)

Answer 16

• Arginine and Glutamine
  
  • both conditionally essential
• Omega 3 fatty acids
• Medium Chain triglyerides

Question 17

How does respiratory failure affect feeding? (2)

What diet is preferred

Answer 17

• Increased risk of aspiration
• Overfeeding with carbs leads to increased work of breathing and ventilation needs (because more CO2 produced)
• Higher fat, lower calorie diet preferable

Question 18

How does liver disease affect feeding? (2)

What diet is preferable

Answer 18

• Already nutritionally deficient usually
• Hepatic encephalopathy is due to increased ammonia and abnormal neurotransmitter production (related to aromatic AA’s)
• Diets with fewer aromatic AA’s and more branched AA’s preferable

Question 19

What is the preferred diet for renal failure?

What should you do for proteins?

Answer 19

• Give less water and salt (prevent volume overload)
• Do NOT restrict protein just to prevent BUN elevations

Question 20

Diet considerations for burns/trauma?

Answer 20

Increased energy requirement (30-35 kcal/kg) and increased protein requirement (1-1.5 g/kg)

Question 21

4 symptoms of refeeding syndrome

Answer 21

• Hypophosphatemia
  
  • B/c suddenly all the pathways start phosphorylating their substrate, depleting the free phosphate
• Hypokalemia
• Diarrhea
  
  • poor absorption
• Wernicke’s encephalopathy
  
  • acute thiamine deficiency

Question 22

What should be added to the diet of a malnourished patient? (3)

Answer 22

• Thiamin
• Folate
• Multivitamin