nutrition Flashcards
caloric needs
30-35 kcal/kg body weight to sustain
hospitalized patients need double (60-70)
even if morbidly obese!!!
NUTRIC score
used to ID patients at high risk for malnutrition
considers age, comorbidities, days in hospital, APACHE, SOFA, IL-6
lab test for nutrition
serum albumin - most diagnostic of protein malnutrition (but may be low in liver disease and severe illness)
short term - pre-albumin, transferrin, transthyretin
who needs nutritional support
inadequate bowel syndromes
prolonged, hyper catabolic states
prolonged, therapeutic bowel rest
severe protein caloric malnutrition w treatable disease who have lost 25% TBW
NG vs nasoduodenal/nasojejunal vs enterostomal tube
increased risk of aspiration - ND/NJ
> 6 weeks - enterostomal
<6 weeks, no aspiration risk - NG
malnutrition diagnosis
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
CM of protein-energy malnutrition
growth restriction
weight loss
cachexia
loss of muscle mass (temples, clavicles, shoulder, scapula, hands, thigh , calves)
SQ fat loss
timing of enteral nutrition
24-48 h after admission
unless not hemodynamically stable, adequately resuscitated, or the GI tract is believed to be not functioning
absolute contraindicates to EN
intestinal instruction
splenic ischemic
small bowel fistula
hemodynamic instability
hypo perfusion of the gut
relative contraindications of EN
active GI hemorrhage
early stages of short bowel syndrome
severe malabsorption (c.diff)
complications of EN
diarrhea - slow down the rate and add soluble fiber
high gastric residual volume (>250 x2) - add metoclopramide and erythromycin (check QTC)
parenteral nutrition access recommendation
< 2 weeks - peripheral
> 2 weeks - central
TPN timing
well-nourished - after 7 days of intolerance via PO/EN
at risk- 3-5 days
moderate to severe. malnutrition - ASAP
TPN complications
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
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TPN monitoring
electrolytes, glc, BUN/crt daily until stabilized then twice weekly
triglycerides
nitrogen balance
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
wt gain causing meds
steroids
oral contraceptives
antihtn/antidiabetics
antidepressants
antipsychotics
antiepileptics
antihistamines
FDA approved obesity meds
for BMI >30, or >27 w comorbidities
phentermine-topiramate (CI in CVD)
semaglutide (wegovy) - CV, long term GLP-1
bulimia tx
CBT
SSRI - fluoxetine
older adult consideration
lack of access
loss of strength/motor function
decreased salivation
decreased taste buds
emotional variances
medication effects
TPN protein requirements
1.2-1.5 g/kg/day
2.5 g/kg/day if moderate- severe distress
