Nutrition Flashcards
What do you monitor for TPN daily, weekly and monthly?
Daily: I/O, blood glucose, electrolytes(calcium, magnesium, phosphate, renal function)
Weekly: LFT, TG, 24 hour urine(make sure not spilling protein)
Monthly: RBC, copper, zinc, folate
How do you calculate ideal body weight?
Males: 50kg +2.3kg for every in over 5 feet
Females: 45.5kg + 2.3kg for every in over 5 feet
What does glucagon do?
Increases: -rate of glycogenolysis & release of glucose from the liver -rate of gluconeogenesis -use of fatty acids in respiration intead of glucose
What are the final products of carb digestion?
-fructose, glucose, galactose
What is gluconeogenesis? What stimulates?
-synthesis of glucose form noncarbohydrate precursors (like amino acids) -stimulated by glucagon, epic, cortisol
Pts. with HTN, what is the recommendation to lower?
lose weight, decrease sodium intake, DASH Diet, increase physical activity, decrease ETOH
What are the lab test indicators of poor nutritional status?
CBC: anemia
Serum albumin < 3.4
Total cholesterol < 160
Very low LDL
How are proteins metabolism?
–broken down to AA in GI tract and absorbed into blood –most of AA in blood enter cells and for new proteins but few free AA exist in blood with plasma proteins -constant equilibrium between cell proteins and free AA and plasma proteins
What is glycogenesis?
Glycogen made by glucose in the liver-stored
What do you limit and what is the rationale behind the limits for patients with chronic kidney disease?
- Sodium restriction (1500-2000mg/day) – Na can build up and cause fluid retention and HTN
- Protein restriction (.6-.8g/kg/day) –waste products are not processed properly: ammonia, urea, uric acid
- Lower potassium intake (oranges, nectarines, rasins, bananas, etc) – K levels increase and can lead to arrhythmias
- Lower phosphate intake (asparagus, avacoado, potatoes, tomatoes, pumpkin, spinach) –Phos levels increase and can cause Ca to leach from bones and lead to osteoporosis and hypercalcemia
- Add Ca, Vit D, and iron supplements
What do you emphasize with Type I DM?
Stress basic healthy guidlines with emphasis on:
weight loss, healthy exercise, carb counting
What does growth hormone do to proteins and glucose?
–increases synthesis of cellular proteins –decreases glucose release and uses fatty acids for energy
Discuss SFA, MUFA, PUFA, and TFA
saturated fats (SFA) = animal sources, solid at room temp (exception = coconut & palm oils)
unsaturated fats (PUFA and MUFA) are the best for you, found in plants and usually liquid at room temp
SFA raise blood cholesterol, while PUFA and MUFA lower it
trans fats TFA (hydrogenated unsaturated fats) are the worst = increase LDL and lower HDL
What are some complications and risks of TPN?
- catheter infections
- refeeding syndrome(abrupt decrease in K, Mg &/ phosphorus from pancreatic stimulation and insulin secretion)
- Metabolic related complications (hyperglucemia, electrolyte abnormalities= Na, Ca, K, Mag, Phos)
- Hepatic dysfunction
With Type II DM, what are the things you shoot for? (ABCs) and 5 things
BMI greater than or equal to 25:
- Reccomend 30 min of physical activity 5 days per week
- lose 5-10% of body weight
- limit caloric intake and time meals to stabilize sugar
- carb consistency (45-55% of daily calories divided up into meals)
- of daily calories: saturated fat <7%. total cholesterol <200mg, protein 15-20%, 14g of fiber per 1000kcal, 1500mg daily sodium limit
- TIME MEALS
What do glucocorticoids do to proteins?
–decrease proteins in tissue
For TPN, critically ill patients need how many calories per day?
18kcal/kg per day
then incrrease to a goal of 25-30kcal/kg per day over the course of a week
Discuss what occurs with fat metabolism. What can be broken down, how fats can be synthesized, when it is broken down, and what hormones are involved.
–FA and TG can be synthesized from carbs–stored in adipose tissue
–FA and glycerol can be used for E (FA and glycerol make triglycerides)
- carbs down = LACK OF INSULIN, reduces rate of glucose use and increase fat metabolism
- epi, norepi, corticotropin, glucocorticoids, GH = horomone sensitive TG lipase
- TH can cause rapid mobilzation of fat
for TNP, how many grams of protein do patients need a day?
(moderate, critical and burn)
mild-moderate illness: .8-1.2g/kg/day
critically ill: 1.2-1.5 g/kg/day
severe burns: 2g/kg/day
What weights do you use for TPN?
Use current body weight UNLESS patient is obese
Obese patients = use IDEAL body weight
What does testosterone do to protein?
–increases protein in the tissue
What does cortisol do?
increases blood AA, decreases muscle protein
What does insulin do to protein, fat, and blood sugar?
Protein: -promotes uptake of AA by muscle and other tissue -promotes protein synthesis -inhibits protein degredation Fat: -increase transport to adipose cells -promotes TG synthesis -inhibits lipolysis Blood sugar: -increases absorption of glucose into cells -stimulates glycogenesis -inhibits glycogenolysis -inhibits gluconeogenesis
After absorption from the intestine fructose and galactose are converted in the liver to? Stored as? By what process?
-glucose, glycogen, glycogenesis
