nutrition

Question 1

caloric needs

Answer 1

30-35 kcal/kg body weight to sustain

hospitalized patients need double (60-70)

even if morbidly obese!!!

Question 2

NUTRIC score

Answer 2

used to ID patients at high risk for malnutrition

considers age, comorbidities, days in hospital, APACHE, SOFA, IL-6

Question 3

lab test for nutrition

Answer 3

serum albumin - most diagnostic of protein malnutrition (but may be low in liver disease and severe illness)

short term - pre-albumin, transferrin, transthyretin

Question 4

who needs nutritional support

Answer 4

inadequate bowel syndromes

prolonged, hyper catabolic states

prolonged, therapeutic bowel rest

severe protein caloric malnutrition w treatable disease who have lost 25% TBW

Question 5

NG vs nasoduodenal/nasojejunal vs enterostomal tube

Answer 5

increased risk of aspiration - ND/NJ

> 6 weeks - enterostomal

<6 weeks, no aspiration risk - NG

Question 6

malnutrition diagnosis

Answer 6

2 or more of the following:

insufficient energy intake
weight loss
loss of muscle mass
loss of SQ fat
localized or gen fluid accumulation
deceased functional status

Question 7

CM of protein-energy malnutrition

Answer 7

growth restriction
weight loss
cachexia
loss of muscle mass (temples, clavicles, shoulder, scapula, hands, thigh , calves)
SQ fat loss

Question 8

timing of enteral nutrition

Answer 8

24-48 h after admission

unless not hemodynamically stable, adequately resuscitated, or the GI tract is believed to be not functioning

Question 9

absolute contraindicates to EN

Answer 9

intestinal instruction
splenic ischemic
small bowel fistula
hemodynamic instability
hypo perfusion of the gut

Question 10

relative contraindications of EN

Answer 10

active GI hemorrhage
early stages of short bowel syndrome
severe malabsorption (c.diff)

Question 11

complications of EN

Answer 11

diarrhea - slow down the rate and add soluble fiber

high gastric residual volume (>250 x2) - add metoclopramide and erythromycin (check QTC)

Question 12

parenteral nutrition access recommendation

Answer 12

< 2 weeks - peripheral
> 2 weeks - central

Question 13

TPN timing

Answer 13

well-nourished - after 7 days of intolerance via PO/EN

at risk- 3-5 days

moderate to severe. malnutrition - ASAP

Question 14

TPN complications

Answer 14

catheter related - CLABSI, thrombosis, pneumothorax

metabolic - referring, glc abnormalities, HLD, LIVER DYSFUNCTION, electrolyte abnormalities, vitamin/mineral deficiencies, METABOLIC BONE DISEASE (osteoporosis)

circulatory - volume overload

adverse reactions

GALLBLADDER DYSFUNCTION (RUQ) - cholelithiasis, gallbladder sludge

Question 15

jl;

Answer 15

ulj;l

Question 16

TPN monitoring

Answer 16

electrolytes, glc, BUN/crt daily until stabilized then twice weekly

triglycerides

Question 17

nitrogen balance

Answer 17

assess how pt is responding to nutritional therapy (are they getting the right amount?)

intake = output: nitrogen equilibrium

intake>output: positive nitrogen balance; growth (pregnancy, trauma)

intake<output: negative nitrogen balance; - never normal, response to trauma/infection

Question 18

wt gain causing meds

Answer 18

steroids
oral contraceptives
antihtn/antidiabetics
antidepressants
antipsychotics
antiepileptics
antihistamines

Question 19

FDA approved obesity meds

Answer 19

for BMI >30, or >27 w comorbidities

phentermine-topiramate (CI in CVD)
semaglutide (wegovy) - CV, long term GLP-1

Question 20

bulimia tx

Answer 20

CBT
SSRI - fluoxetine

Question 21

older adult consideration

Answer 21

lack of access
loss of strength/motor function
decreased salivation
decreased taste buds
emotional variances
medication effects

Question 22

TPN protein requirements

Answer 22

1.2-1.5 g/kg/day

2.5 g/kg/day if moderate- severe distress