Nutrition Malnutrition/Metabolic Stress

Question 1

What happens in moderate-to-severe stress metabolism?

Answer 1

Neuroendocrine and intrinsic mediator systems modulate metabolic machinery to mobilize fat and amino acid stores to provide a continuous supply of substrate for production of stress protein. Increased urinary nitrogen excretion is one result of process. There is increased use of carbohydrate, fat, and amino acids as fuel sources. If stimulus persists, result of a rampant form of acquired protein-calorie malnutrition

Question 2

What is the nutrient consideration for bruising?

Answer 2

Vitamin K, Vitamin C

Question 3

What is the nutrient consideration for bleeding gums?

Answer 3

Vitamin C, Riboflavin

Question 4

What is the nutrient consideration for goiter?

Answer 4

Iodine

Question 5

What is the nutrient consideration for Dementia?

Answer 5

Thiamin, Niacin, Vitamin B-12

Question 6

What is the nutrient consideration for Diarrhea?

Answer 6

Protein, Niacin, Folate, Vitamin B-12, Zinc

Question 7

What is the nutrient consideration for Anemia?

Answer 7

Vitamin E, Vitamin B-12, Folic Acid, Iron, Pyridoxine

Question 8

What weight change indicates a high probability of undernutrition?

Answer 8

Unintentional loss of >10% of usual body weight during a 6-month period

Question 9

What is the formula for IBW in men?

Answer 9

50kg + [2.3kg x (inch > 5ft)]

Question 10

What is the formula for IBW in women?

Answer 10

45.5kg + [2.3kg x (inch > 5ft)]

Question 11

When is adjusted body weight used? What is the formula?

Answer 11

Obese patients. Adj = [(actual - ideal) x 0.25] + ideal

Question 12

What levels are often used to assess nutritional status, as decreased levels may indicate protein deficiency?

Answer 12

Albumin. Transferrin. Prealbumin. Retinol binding protein

Question 13

What is the normal BMI range?

Answer 13

19-24

Question 14

What is the normal albumin range?

Answer 14

3.5-5

Question 15

What is the normal Serum transferring range?

Answer 15

220-400

Question 16

What is the total lymphocyte count?

Answer 16

2000-3500

Question 17

For nitrogen balance, what is the “in” and “out”?

Answer 17

In: oral intake, enteral tube feedings, parenteral nutrition. Out: urinary, fecal, skin, other loses

Question 18

What is the waist to hip ratio for men and women?

Answer 18

Men: 0.9 or less. Women: 0.8 or less

Question 19

At what 25-hydroxyvitamin D levels are you insufficient and deficient?

Answer 19

Insufficiency < 30. Deficiency < 20

Question 20

What are the two types of malnutrition?

Answer 20

Marasmus and Kwashiorkor

Question 21

What is Marasmus?

Answer 21

Protein-calorie malnutrition. Chronic semi-starvation over prolonged period in absence of stress. Peripheral fat and somatic muscle stores mobilized for energy and cell regeneration. Visceral protein mass may be spared. Patient appears thin or cachectic

Question 22

What is CHRONIC Kwashiorkor?

Answer 22

Protein malnutrition. Protein deficiency (low intake or poor quality) in presence of adequate or deficient calorie intake. Depletion of visceral protein mass. Peripheral fat and somatic muscle stores may be spared. Patient may appear obese or edematous

Question 23

What is ACUTE Kwashiorkor?

Answer 23

Protein malnutrition. Result of catabolism secondary to metabolic stress (i.e. sepsis, trauma, burns, disease). Body derives energy from breakdown of visceral protein mass and fat stores

Question 24

What are risk factors for malnutrition?

Answer 24

Infancy and childhood. Pregnancy and breastfeeding. Aging. Medical conditions and medical procedures. Vegetarian diets. Fad diets. Medications and nutritional supplements. Alcohol or drug dependency

Question 25

What is Cachexia?

Answer 25

Ongoing wasting: loss of weight, fat, and muscle mass. Fatigue, weakness, progressive functional impairment. Associated with long-standing disease: AIDS, COPD, CHF, TB, other conditions. Associated with reduction in treatment response, response to therapy, quality of life, duration of survival. Role of inflammatory cytokines. not same as anorexia (loss of appetite), but may be associated with anorexia. Not same as starvation (adaptation can occur with starvation)

Question 26

What are some of the physiological consequences of malnutrition?

Answer 26

QT prolongation. Bradycardia. Pneumonia. Anemia. Reduced GFR. Depressed enzymatic activity in the GI. Decreased visceral protein synthesis in the liver. Anergy, increased infection rate

Question 27

What are some indications for Enteral Nutrition (EN) via feeding tube?

Answer 27

Functioning GI tract. To supplement oral feeding or to replace it entirely. Preferred route (vs. parenteral) when integrity of GIT is preserved, if not contraindicated

Question 28

When is Enteral Nutrition (EN) often used?

Answer 28

Prolonged anorexia. Severe protein-calorie malnutrition. Trauma to head and neck. Neurological disorders preventing satisfactory oral feeding. Coma. Depressed mental state. Hepatic failure. Serious illness (e.g. burns) with high metabolic requirements

Question 29

What are some complications of Enteral Nutrition (EN)?

Answer 29

Gastrointestinal (Diarrhea, Abdominal distention). Aspiration. Metabolic (similar to those seen with parenteral nutrition)

Question 30

What are the indications for Parenteral Nutrition (PN)?

Answer 30

Inability to absorb nutrients via GIT. Severe malnutrition with nonfunctional GIT. Severely catabolic patient with GIT not usable within 5-7 days. Adequate enteral/oral nutrition cannot be established within 7-10 day period of hospitalization

Question 31

What are the contraindications of Parenteral Nutrition (PN)?

Answer 31

Enteral route functional and accessible (can be used together if you can't get the nutritional goals with EN alone). Potential risks outweigh potential benefits. Nutritional support not desired

Question 32

For PN, when is using the peripheral vein indicated?

Answer 32

Inadequate enteral intake or tolerance. Short period of inadequate enteral nutrition expected

Question 33

What are the limitations to peripheral vein PN?

Answer 33

Osmolarity (very high osmolarity requires central vein administration). Frequent IV site changes (necessary to minimize phlebitis). Volume limitations (high volumes required to meet needs vs. tolerance). Hypocaloric without lipids (low dextrose concentration)

Question 34

What are the contraindications for peripheral vein PN?

Answer 34

Peripheral venous access unavailable. Long-term use of PN required: weeks to months to years. Total nutritional support required parenterally. Increased nutritional requirements. Lipid intolerance. Fluid restriction

Question 35

What are the potential complications for peripheral vein PN?

Answer 35

Mechanical: catheter related (phlebitis, loss of peripheral venous access (e.g. infiltration). Metabolic (fluid intolerance/overload, lipid intolerance)

Question 36

What are the indications for central vein PN?

Answer 36

Total nutritional support required parenterally. Long term PN required. Lack of peripheral venous access. Fluid restriction desired

Question 37

What are the potential complications of central vein PN?

Answer 37

Mechanical: catheter related (improper placement, pneumothorax). Infectious. Metabolic

Question 38

What equation determines caloric (energy) requirements?

Answer 38

Harris-Benedict Equation x Factors. (weight in KG, height in cm, age in years)

Question 39

What are the normal protein requirements?

Answer 39

0.8-1.0 g/kg/day

Question 40

What is Anorexia Nervosa?

Answer 40

Patient develops bizarre food habits and REFUSE to eat. Usually exercise vigorously and may abuse laxatives or diuretics and voluntarily vomit to decrease the energy they retain in their system. Without intervention, disorder may progress to starvation. Psychologically, anorectics have an abnormal fear of being fat; they exhibit distortions of body image and other perceptions

Question 41

What is the treatment outline for Anorexia Nervosa?

Answer 41

Treatment incorporates psychotherapeutic, nutritional, and medical components

Question 42

What is Bulimia?

Answer 42

Periodically stuff themselves with food and then force themselves to vomit or take laxatives to purge themselves. As opposed to Anorexia, the bulimic will usually be close to normal weight

Question 43

What are the physical complications of Bulimia?

Answer 43

Damage to teeth, irritation of throat, esophageal inflammation - caused by exposure of the unprotected tissue to acidic vomit

Question 44

What is one of the chief psychological characteristics of bulimia?

Answer 44

Guilt over cycle of binging and vomiting she carries out in secret, even while her life may seem ideal to those around her. Usually unable to tolerate frustration and attempts to dull various feeling states by gorging and vomiting behavior