Nutrition Overview Flashcards
malnutrition definition
undernutrition or overnutrition
inability to meet metabolic demands and weight loss
organ function changes that inc morbidity and mortality
disease states that predisponse someone to malnutrition
cancer, AIDS, critically ill, bowel diseases, surgery
malnutrition causes__________
nosocomial infections, complications, inc length of stay and mortality
starving-associated malnutrition
anorexia nervosa or compromised intake with depression
chronic starvation without inflammation
causes are behavioral, socioeconomic and environmental as well
chronic disease associated malnut
inflammation is chronic and mild-moderate
organ failure, pancreatic cancer, RA, sarcopenic obesity, CF, chronic lung disease
>/= 3 months
mild-mod inflammation
acute disease assoc malnutrition
major injection, burns, trauma or closed head injury
marked inflammation
labs when a patient has increased inflammation
decreased alb, transferrin, prealbumin, nitrogen balance
elevated CRP, glucose neutrophils
fever, hypothermia, infection, trauma, burns
basics of nutritional support
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
MST
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 MNNUTRIC
stands for ______
low risk vs high risk
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
important PMH to assess history
body weight medical and surgical conditions chronic diseases constitutional sx difficulty eating, swallowing, GI issues dietary practices/substance abuse emotional status physical findings too
physical findings suggestive of malnutrition
general appearance skin and mucous membranes dry musculoskeletal neurologic AMS hepatic (inc LFTs, dec albumin)
SGA
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
anthropometrics
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
visceral proteins
hepatically synthesized, reflect organ fxn and mass
inflammation–> inc (-) acute phase reactants–> artificially inc visceral proteins
what increases albumin
dehydration, anabolic steroids, insulin, infection
what decreases albumin
fluid overload, edema, renal dysfxn, nephrotic syndrome, poor intake, indigestion, burns, HF, cirrhosis, thyroid, trauma, sepsis
what increases transferrin
Fe deficiency, preggo, hypoxia, chronic blood loss, estrogens
what decreases transferrin
chronic infection, cirrhosis, burns, cortisone, testosterone
Marasmus
inadequate access to food, eating disorder
dec somatic proteins, dec adipose tissues, dec immune fxn, “pure starvation”
a form of protein MN
Kwashiorkor
inflammatory state, protein MN
dec visceral proteins, e=dec immune fxn when severe, excessive requirements, acute illness, hypermetabolic
Immune function
TLC < _____________
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
s/sx in patients with fat malabsorption secondary to orlistat use
essential fatty acid deficiency
dermatitis
alopecia
s/sx of vitamin B12 deficiency in a pt with previous gastrectomy
paresthesias
list disease states in order of lowest to highest requirements for energy and protein
starvation, elective operation, skeletal trauma, sepsis peritonitis, major burns
which BMIs have which kcal requirements/kg/day
see notes sheet
what to consider when estimating resting energy expenditure (REE)
height, weight, gender, age, multiply by stress or activity factor
protein requirements:
stress level determines g/kg/day
what factor do we multiply this by in critically ill? burns?
critically ill –> multiply by 1.2-2
burns –> multiply by 2.5-3.5
GI losses _________ protein requirements
increase
renal and liver failure __________ protein metabolism
have variable effect on
UUN + _____ = protein
TUN x _____ = protein
UUN + 4 = protein
TUN x 1.05 = protein
total fat is ___% of total daily calories in adults and prevents ______________________________
10-35%
essential fatty acid deficiency (EFAD) and PN complications
factors that increase requirements
Warmer temp, excessive sweating D/V, ostomy, fistula drainage nasogastric tube suction glycosuria diuretics diabetes hyperthyroid hyperventilation phototherapy
factors that decrease requirements
heat shields, high humidity, HF, renal failure, SIADH, hypoalb w starvation, humidified air via mechanical ventilation
usual fluid requirements
30-40mL/kg/day or 1mL/kcal/day
