Nutrition Lecture Flashcards
malnutrition is associated with what
1) increased morbidity and mortality
2) increased cost and length of stay in hospitals
3) decreased wound healing
4) decreased immune function
to classify someone with severe malnutrition
acute
less than 50% for greaterthan or equal to 5 days
2,5,7.5 for 1 week 1 month and 3 month weight loss
fat loss, muscle loss, fluid accumulation mod or greater
grip streth, measurably reduced
chronic
less than 75% for greater than ewual 1 month
weight loss 5, 7.6, 10 (1,3,6 months)
severe fat loss, muscle loss, fluid accumulation, and grip strength measurably reduced
what are the other malnutrition codes for protein-calories malnutrition
1) Albumin 7% pre-illness or usual wt.
3) Wt. <75% standard wt.
4) Poor intake for 3 or more days
5) BMI 16.1-18.4
malnutrition of mild degree
1) wt. 75% to 90%of standard wt.
2) wt. loss of 5-10% pre-illness or usual wt.
3) Albumin 3.5-5gm/dl
unspecified protein calorie malnutrition
Albumin <3.5gm/dl
7 days of poor intake, NPO or clear lqd.
Delay wound healing
Stress factors: injury, infection or surgery
cachexia
Wt loss of >5% in 1 month; >7.5% in 3 months; >10% in 6 months
Depletion of serum protein
Depletion of fat tissue and muscle mass
Related to chronic diseases: Cystic Fibrosis, CP, Cancer, AIDS, CHF, end stage organ failure
#1, #2 & #3 must be present
albumin should not be used as the SOLE indicator for visceral protein status when
pt has liver dis. infection, postop, fluid imbalance and nephrotic syndrome
how much cholesterol should you have
200 mg/day
saturated fat
increases LDL and cholesterol
lowers LDL, HDL and cholesterol
polyunsaturated fat
lowers cholesterol and LDL, increases HDL
monounsaturated fat
trans fat
increases cholesterol and LDL, decreases HDL
helps lower triglycerides and decreases inflammation
omega 3 fatty acids
helps decrease cholesterol
soluble fiber
roughage for regularity
insoluble fiber
how much sodium should be consumed for DASH diet
1500 mg
CHF diet
low sodium (2,000) fluid restriction (6-8 cups/day)
if a patient with pancreatitis is unable to tolerate oral foods then
Enteral nutrition is preferred OVER TPN
what should a diet for pancreatitis
clear liquids and low fat
enteral nutrition
place feeding tube beyond the ligament of treitz, reduces pancreatic secretions, low fat tube feeding formula
TPN
last resort, can cause pancreatic pseudocyst, fistula, abscess, no pancreatic secretion
what should be the diet of kidney disease
high calorie 30cals/kg
low protein sodium and potassium (.8,2.2)
fluid restriction of 500-1000ml+urine output
hemodialysis
High calorie (30 cals/kg) High protein (1.2 - 1.5 g/kg) Low sodium (2 g/day) & potassium (2 g/day) Fluid restriction (500-1000 ml + urine output)
peritoneal dialysis
High calorie (30 cals/kg) High protein (1.2 – 1.5 g/kg) Non restrictive
continuous renal replacement therapy
High calorie (30 cals/kg) Very high protein (2 – 2.5 g/kg)
when is low protein appropriate
hepatic encephalopathy
liver failure diet
Dietary protein does not cause alterations in mental status. Most patients can tolerate .8 – 1 g/kg and up to 1.2 – 1.5 g/kg
cancer patients diet
Increases calorie and protein needs
30 – 40 cals/kg; protein is 1.2 – 2 g/kg
diverticulitis
low fiber
diverticulosis
high fiber (25g or more)
IBS diet
high fiber
low fat
soft
bland foods
chron’s diet
low fiber
no alcohol/caffeine
bland foods
ulcerative colitis
low fiber
no alcohol/caffeine
bland foods
illeostomy
high risk for malabsorption, B12 deficiency
colostomy
Lower risk for malabsorption
High fiber foods may cause obstruction
To decrease odor: cranberry juice, butter milk, yogurt, parsley
To decrease diarrhea: bananas, applesauce, peanut butter, rice
what are the three objectives of nutrition support
preserve lean body mass
maintain immune function
avert metabolic complications
Nutritional modulation of the stress response to critical illness includes:
Early enteral nutrition
Appropriate macronutrient and micronutrient delivery
Meticulous glycemic control
refeeding syndrome
metabolic consequences of depletion and repletion of nutrients. shift of stored fat to carb as primary fuel source increases insulin and causes decrease of magnesium, potassium, phosphorous and glucose
branched chain amino acids are reserved for
hepatic encephalopathy
indications of parental nutrition
nonfunctioning gut
can’t gain access to gut
continued interolance to enterlal nutrition
duration to be more than 5 days, need access PICC,
use caution with St. Johns wart because
it increases sensitivity to sunlight
cholesterol lowering drugs use caution with
red yeast rice echinacea astragalus licorice alfalfa
breast cancer use caution with
black cohosh, soy, ginsing
nilk and calcium juices may do what to antibiotics
decrease
grafruit juice, pomegranate, cranberry do what to some statins
increase
chocolate ansd tyramine foods do what to antidepressants
increase
blood thiners affected by
leafy greens (decreased drug effect)
american academy of pediatrics has stated that
children should not consume energy drinks
qualifications of gastric bypass
BMI-greater than 40 or BMI 35-40 with comorbidities
