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SMP - MNE Exam 2 > Nutrition Module 12: Nutrition Support > Flashcards

Nutrition Module 12: Nutrition Support Flashcards

1
Q

What 4 events are bypassed during IV feeding?

A
  1. Stimulation of mucosal cells
  2. Stimulation of GI hormonal response
  3. Direct transport to the liver (first pass)
  4. Packaging of lipids in chylomicrons
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2
Q

What are some of the long term complications of IV feeding associated with?

A

Lack of stimulation of GI tract and CKK

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3
Q

What happens to the lumen of the GI tract when it does not receive nutrients for a while?

A

Atrophy with:

  1. Decreased overall weight of tissue
  2. Shortened microvilli
  3. Decreased absorptive area
  4. Openings on surface
  5. Impaired barrier function
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4
Q

What ion causes CKK secretion?

A

H+

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5
Q

What GI tract hormone stimulates pancreatic secretions?

A

Secretin

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6
Q

What AA is an important oxidative fuel for the intestinal mucosa?

A

Glutamine

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7
Q

What is glutamine a precursor for?

A

Nucleotides

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8
Q

Why is glutamine conditionally essential?

A

Because needed in diet in severe illness

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9
Q

What causes large amounts of glutamine to be released for gluconeogenesis? From where?

A

Hypercatabolism

From lungs and skeletal muscle

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10
Q

What would a lack of glutamine in the intestine cause?

A

Deterioration of mucosal barrier

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11
Q

What foods contain glutamine?

A

All natural proteins

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12
Q

Is glutamine used in enteral formulas?

A

YUP

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13
Q

Is glutamine used in parenteral formulas? Why?

A

NOPE because short-lived in solution (but can be added individually)

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14
Q

What are the 3 functions of short-chain FAs?

A
  1. Energy source for intestinal enterocytes and liver
  2. Maintain integrity of large intestine by stimulating proliferation and increasing blood flow
  3. Stimulate intestinal water and sodium absorption
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15
Q

What are short FAs produced by in the intestine?

A

Bacteria from dietary fiber

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16
Q

What 10 conditions require specialized nutrition support?

A
  1. Unconscious
  2. Intubated
  3. Unable to swallow
  4. Vomiting (eg: pregnant)
  5. Malabsorption
  6. GI obstruction
  7. Premies
  8. Very high energy demands: trauma, major surgery, burns, sepsis
  9. Failure to thrive
  10. Eating disorder
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17
Q

What organ gets first access to most nutrients?

A

Liver

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18
Q

Why can parenteral feedback affect lipid clearance and metabolism?

A

Because lipids enter the circulation directly as droplets instead of having the liver control distribution and having normal packaging and apoproteins to regulate absorption

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19
Q

Where is food received in enteral feeding?

A

Stomach or small intestine

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20
Q

When should supplemental nutrition be initiated?

A

When inadequate oral intake is expected over a 7 to 14 day period

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21
Q

What are the 3 compartments the body can be divided in? How do these differ between men and women? Include % and acronyms for each.

A
  1. Bone mass (3% lower in women): 12-15%
  2. FM = Fat mass (10% higher in women): 15-25%
  3. LBM = Metabolic tissues and water (7% lower in women): 63-70%
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22
Q

What does FFM stand for?

A

Fat Free Mass = body mass - FM

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23
Q

What is a good predictor of basal metabolic rate?

A

LBM

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24
Q

What is one way of estimating LBM? Why?

A

Creatinine index because it’s produced by muscle at a rate proportional to muscle mass and is only excreted in urine

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25
Q

How to calculate the creatinine height index?

A

CHI (%) = measured 24h urine creatinine / ideal 24h creatinine for height/gender based on healthy young adults *100

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26
Q

For what patients does the creatinine height index grossly overestimates LBM?

A

Stressed patients where muscle metabolism is high

27
Q

For what patients does the creatinine height index grossly underestimates LBM?

A

Vegetarians because of low creatinine intake

28
Q

What does the amount of increased energy needs depend on in stressed patients?

A

Degree of illness

29
Q

What is one way of measuring total energy expenditure?

A

Indirect calorimetry

30
Q

How does indirect calorimetry estimate TEE?

A

Measured CO2 production or O2 uptake

31
Q

When is indirect calorimetry used?

A

To prevent over or under feeding of critically ill, malnourished, or extremely obese patients

32
Q

How can the precise TEE be calculated with indirect calorimetry?

A

By estimating the actual nutrient mix from the respiratory quotient = CO2/O2

33
Q

What is the RQ of carb oxidation?

A

1

34
Q

What is the RQ of fat oxidation?

A

0.7

35
Q

What is the RQ of protein oxidation?

A

0.8

36
Q

What fuel source produces the least amount of CO2 per O2 consumed?

A

Fat

37
Q

What is the normal total RQ?

A

0.8

38
Q

How will starvation affect the RQ?

A

Lower it

39
Q

How high is variability of RQ in stressed patients?

A

Up to 50%

40
Q

3 steps to calculate TEE with indirect calorimetry?

A
  1. Measure urine nitrogen to determine amount of protein oxidized
  2. Measure RQ
  3. Use 3 linear equations to calculate TEE, carb oxidation, and fat oxidation
41
Q

Why can carb and fat oxidation be predicted only with RQ?

A

Because they are completely oxidized

42
Q

Are DRI equations appropriate for the critically ill?

A

NOPE

43
Q

What 2 equations to use to calculate BEE?

A
  1. Harris-Benedict equation

2. Penn State 2003

44
Q

What are 2 reasons for why stressed patients have increased TEE?

A
  1. Hypermetabolism

2. Fever

45
Q

What 3 conditions cause hypometabolism?

A
  1. Starvation
  2. Spinal cord injuries
  3. Some cancers
46
Q

By how much does fever increase the metabolic rate?

A

By 10% for each degree above 37

47
Q

Explain the pathophysiology of refeeding syndrome.

A

Aggressive oral, enteral, or parenteral carb feedback following a period of nutritional deprivation => sudden glucose influx in cells => sequestration of magnesium, potassium, and phosphorus => dangerously low blood concentrations => cardiac arrest, neuromuscular complications, and respiratory dysfunction

48
Q

What is cachexia?

A

Accelerated breakdown of muscle and adipose tissue often observed in patients with advanced cancer

49
Q

What are the 8 patients at risk for refeeding syndrome?

A
  1. Old pts with depression or dementia
  2. Anorexic
  3. Cachexia
  4. Malnutrition due to hunger, stress, or fasting
  5. Marasmus or Kwashiorkor
  6. Chronic alcoholism
  7. NPO status for over 7 days
  8. DKA
50
Q

What are the 5 ways of preventing refeeding syndrome?

A
  1. Start low and go slow with calories
  2. Avoid excess glucose
  3. Measure and provide P, Mg, and K
  4. Restrict fluid intake and initiate Na-containing fluids slowly
  5. Thiamin supplement
51
Q

What are the 3 veins through which parenteral feeding can be administered? Which one delivers nutrients at a lower concentration?

A
  1. Subclavian vein
  2. Internal jugular vein
  3. Peripheral vein (lower concentration)
52
Q

What is short-bowel syndrome? When does it occur? Treatment?

A

Occurs following removal of a large portion of the bowel and results in reduced absorption => malabsorption requiring parenteral support until adaptation happens over months and sometimes years

53
Q

What % loss of our bowel can we tolerate?

A

Up to 50%

54
Q

Where does adaptation of short-bowel syndrome occur? What will never adapt fully though?

A

Adaptation and improved nutrition in ileum and jejunum but jejunum will not develop active absorption of bile acids and VB12

55
Q

What are 4 complications of long-term parenteral feeding?

A
  1. Catheter-related infection leading to sepsis
  2. Liver disease
  3. Metabolic bone disease
  4. Micronutrient deficiencies
56
Q

What parts of the GI tract need to be preserved to avoid indefinite parenteral feeding?

A
  1. Terminal ileum
  2. Ileocecal valve
  3. Colon
57
Q

What are 2 ways of administering the enteral feeding? When do we use each?

A
  1. Nasoenteric tube: less than 1 month duration

2. Gastrostomy tube: more than 1 month duration

58
Q

What are the 4 complications of enteral feeding?

A
  1. Reflux of stomach contents into the lungs => aspiration pneumonia
  2. Diarrhea
  3. Refeeding syndrome
  4. Altered glucose, lipid, acid-base balances
59
Q

How do we know when to start feeding a patient normally again?

A

We hear bowel movements

60
Q

What can underfeeding cause?

A
  1. Protein used as energy
  2. Poor wound healing and decubitus ulcers
  3. Low energy levels and weakness
  4. Protein calorie malnutrition
61
Q

What can overfeeding cause?

A
  1. Hyperglycemia
  2. CO2 retention: acidosis
  3. Hepatis steatosis = fatty liver
62
Q

What can overfeeding cause in patients on mechanical ventilators?

A

Difficulties with ventilator support and weaning off it

63
Q

How to minimize risks of refeeding syndrome?

A

Start feedings at 20% of BEE calculated using actual body weight

SMP - MNE Exam 2 (17 decks)

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