Nutrition and Specific Disease States Flashcards
role of fiber in diabetes
slows down gastric emptying to reduce spike in blood sugar, reduces LDL and increases satiety
Is fiber recommended in gastroparesis
No
Probiotics mechanism of action
when probiotics reach the ileum/colon, endogenous bacteria consume and ferment pre biotics and produce short chain fatty acids which increases bacterial mass and enzyme activity
Uses for probiotics
help reduce flatulence, bloating, abdominal pain
What is the recommended fiber intake daily
20-35/day
detriments of too much protein
pre-renal azotemia, kidney stones, increased risk of osteoporosis
______ based sterols lower cholesterol absorption and are recommended as cholesterol lowering agents
soy based
Are immune modulating enteral formulas with omega 3 fatty acids and antioxidants recommended for Acute Respiratory Distress Syndrome or Severe Acute Lung Injury?
No
Which EN formulas should be considered for patients with traumatic brain injury
Formulas containing fish oil, arginine, omega 3 fatty acids with DHA (immune modulating)
What causes high creatinine loss
diarrhea, high output fistula or ostomy losses
Which populations are immune modulating EN formulas appropriate for per ASPEN
SICU
an amino acid which functions in immune function, wound healing, synthesis of nitrous oxide and plays roles in respiratory and cardiac function
arginine
hydroxy beta methylbutyrate (HMB) protein is shown to
increase lean muscle mass
HMB protein has been studied in which populations
AIDS, ALS and muscular dystrophy
symptoms of fatty acid deficiency
scaly rash, color spots, alopeica, dull/easily plucked hair, xerosis, follicular hyperkeratosis
Patients with liver cirrhosis are at risk for what deficiencies
fat soluble vitamins (ADEK) and thiamine
what is the recommended modality of artificial nutrition for an open abdomen
EN, when the peritoneum is left open and the viscera are protected with a temporary dressing
what type of EN feeding tube is recommended for gastroparesis in the setting of postprandial nausea and vomiting
jejunostomy
what mode of artificial nutrition is recommended in hyperemesis gravidarum
EN in conjunction with anti-emetic therapy
what are 3 parameters for assessing EN efficacy in pregnancy
maternal dry weight gain, fetal growth, nitrogen balance
what items should be labeled on an enteral product
Patient Name Product Name Strength Additives Volume Expiration Date and Time
advantages of a ready to hang enteral formula
decreases risk of infection (less to handle)
longer hanging time
decreased RN time
disadvantages of ready to hang EN formula
decreased individualization
could be accidentally be administered into IV tubing (sentinel event)
what is the most likely source of EN formula contamination
organisms on the hands of healthcare workers
what are 2 potential points of contamination of EN formulas
preparing and dispensing
in order to ensure feeding tube patency flush the tube how often for continuous/intermittent feedings
every 4-6 hours
in order to ensure feeding tube patency when giving medications flush ___ to ___mL of formula before/after each med using a ____ to ___mL syringe
15-30mL of water with a 50-60mL syringe
why shouldn’t small syringes be used to flush tubes
may cause rupture from too much pressure
if a fiber rich formula is being used, what is the recommended French size range
10-12 French
advantages of an open enteral feeding system
can be more individualized with the volume
reduces waste
what is the hang time for an open enteral feeding system
8-12 hours
what are the disadvantages of an open enteral feeding system
uses bags
only 8-12 hour hang time
higher risk of contamination than RTH
requires additional RN time
to minimize infections, enterally fed patients (open system) should have bags and tubing changed
every 24 hours
in a closed system enteral feeding what is the hang time/how long can it last after being opened
48 hours
what is the optimal storage temperature for EN formulas to prevent microbial growth and contamination
39 degrees F, 4 degrees C
the most likely formula to become contaminate is
blenderized
SIBO can cause
enteritis, marked diarrhea, abdominal cramps, hypoalbuminemia, protein catabolism, cachexia, fever, sepsis
what are potential causes of SIBO
altered GI anatomy, Roux-en-Y bypass, ileal resection
is PN in patients for chemo/radiation recommended for routine use per ASPEN
no, can cause infectious complications and no clinical improvement
ASPEN recommends thorough assessment of a cancer patients _________ and only use PN when ___ and ____ for __ to __ days
nutrition status
malnourished AND unlikely to use gut in 7-14 days
what is the preferred nutrition method for patients with cancer and a functional GI tract
enteral nutrition
PN as a primary treatment for ulcerative colitis has shown _____ benefit
NO
a patient with a high output ostomy of 3 liters, with an elevated BUN/Cr should have a treatment plan of while on PN
increased sodium fluids
sodium loss from a high output fistula can be up to
100 mEq/L
a high BUN:Cr ratio indicates
volume depletion
patients with ____ and ____ disease are more prone altered protein metabolism due to decreased excretion of urea
hepatic/renal disease
In a patient with elevated ammonia what is used for treatment and prevention
reduce total amino acids
restrict protein in refractory encephalopathy
