Nutrition Overview

Question 1

malnutrition definition

Answer 1

undernutrition or overnutrition
inability to meet metabolic demands and weight loss
organ function changes that inc morbidity and mortality

Question 2

disease states that predisponse someone to malnutrition

Answer 2

cancer, AIDS, critically ill, bowel diseases, surgery

Question 3

malnutrition causes__________

Answer 3

nosocomial infections, complications, inc length of stay and mortality

Question 4

starving-associated malnutrition

Answer 4

anorexia nervosa or compromised intake with depression
chronic starvation without inflammation
causes are behavioral, socioeconomic and environmental as well

Question 5

chronic disease associated malnut

Answer 5

inflammation is chronic and mild-moderate
organ failure, pancreatic cancer, RA, sarcopenic obesity, CF, chronic lung disease
>/= 3 months
mild-mod inflammation

Question 6

acute disease assoc malnutrition

Answer 6

major injection, burns, trauma or closed head injury

marked inflammation

Question 7

labs when a patient has increased inflammation

Answer 7

decreased alb, transferrin, prealbumin, nitrogen balance

elevated CRP, glucose neutrophils

fever, hypothermia, infection, trauma, burns

Question 8

basics of nutritional support

Answer 8

determine nutritional risk
assess nutrition status
calc protein and Kcal requirements
eval routes available
identify special nutritional requirements
select appropriate formula
evaluate for drug-nutrient interactions
devise monitoring plan

Question 9

MST

Answer 9

malnutrition screening tool
lost weight without trying = 2 pts
eating poorly d/t dec appetite = 1pt
how many kg lost? 
    1-5 = 1pt
    6-10 = 2pts
    11-15 = 3 pts
    >15 = 4 pts
  score of 2+ = risk of MN

Question 10

NUTRIC
stands for ______
low risk vs high risk

Answer 10

ICU nutritional risk tool
low risk: normal baseline, NUTRIC , 5, may withhold up to 7d
high risk: compromised baseline, NURTIC >/=5
>80% of estimated or calculated goal energy and protein within 48-72h, monitor closely for refeeding syndrome

*** HIGH risk is >/=5 without IL-6; >6 w/ IL-6

Question 11

important PMH to assess history

Answer 11

body weight
medical and surgical conditions
chronic diseases
constitutional sx
difficulty eating, swallowing, GI issues
dietary practices/substance abuse
emotional status
physical findings too

Question 12

physical findings suggestive of malnutrition

Answer 12

general appearance
skin and mucous membranes dry
musculoskeletal 
neurologic AMS
hepatic (inc LFTs, dec albumin)

Question 13

SGA

Answer 13

subjective global assessment
classifies patients subjectively on the basis of data from Hx and PE
assessment tool for MALNUTRITION, not detecting nutritional risk

weight loss, dietary intake, GI sx, functional status, disease state affecting nutritional requirements, muscle wastage, fat stores, edema, nutritional status

Question 14

anthropometrics

Answer 14

body weight (BMI, %IBW, %UBW, fluid excess and edema)

body composition (bioelectric impedance [BIA], body measurements)

functional assessment (hang-grip strength)

BIA and grip strength not good for states where fluid is inconsistent

Question 15

visceral proteins

Answer 15

hepatically synthesized, reflect organ fxn and mass

inflammation–> inc (-) acute phase reactants–> artificially inc visceral proteins

Question 16

what increases albumin

Answer 16

dehydration, anabolic steroids, insulin, infection

Question 17

what decreases albumin

Answer 17

fluid overload, edema, renal dysfxn, nephrotic syndrome, poor intake, indigestion, burns, HF, cirrhosis, thyroid, trauma, sepsis

Question 18

what increases transferrin

Answer 18

Fe deficiency, preggo, hypoxia, chronic blood loss, estrogens

Question 19

what decreases transferrin

Answer 19

chronic infection, cirrhosis, burns, cortisone, testosterone

Question 20

Marasmus

Answer 20

inadequate access to food, eating disorder
dec somatic proteins, dec adipose tissues, dec immune fxn, “pure starvation”
a form of protein MN

Question 21

Kwashiorkor

Answer 21

inflammatory state, protein MN

dec visceral proteins, e=dec immune fxn when severe, excessive requirements, acute illness, hypermetabolic

Question 22

Immune function

TLC < _____________

Answer 22

MN results in total lymphocyte count <1.2 x10 9 cells
MN causes delayed cutaneous hypersens.
–> check for anergy/lack of reaction to Ags like mumps, candida

Question 23

s/sx in patients with fat malabsorption secondary to orlistat use

Answer 23

essential fatty acid deficiency
dermatitis
alopecia

Question 24

s/sx of vitamin B12 deficiency in a pt with previous gastrectomy

Answer 24

paresthesias

Question 25

list disease states in order of lowest to highest requirements for energy and protein

Answer 25

starvation, elective operation, skeletal trauma, sepsis peritonitis, major burns

Question 26

which BMIs have which kcal requirements/kg/day

Answer 26

see notes sheet

Question 27

what to consider when estimating resting energy expenditure (REE)

Answer 27

height, weight, gender, age, multiply by stress or activity factor

Question 28

protein requirements:
stress level determines g/kg/day
what factor do we multiply this by in critically ill? burns?

Answer 28

critically ill –> multiply by 1.2-2

burns –> multiply by 2.5-3.5

Question 29

GI losses _________ protein requirements

Answer 29

increase

Question 30

renal and liver failure __________ protein metabolism

Answer 30

have variable effect on

Question 31

UUN + _____ = protein

TUN x _____ = protein

Answer 31

UUN + 4 = protein

TUN x 1.05 = protein

Question 32

total fat is ___% of total daily calories in adults and prevents ______________________________

Answer 32

10-35%

essential fatty acid deficiency (EFAD) and PN complications

Question 33

factors that increase requirements

Answer 33

Warmer temp, excessive sweating
D/V, ostomy, fistula drainage
nasogastric tube suction
glycosuria
diuretics
diabetes
hyperthyroid
hyperventilation
phototherapy

Question 34

factors that decrease requirements

Answer 34

heat shields, high humidity, HF, renal failure, SIADH, hypoalb w starvation, humidified air via mechanical ventilation

Question 35

usual fluid requirements

Answer 35

30-40mL/kg/day or 1mL/kcal/day