Nutritional Assessment Flashcards
Whithout life sustaining nutring, what can happen to the body?
All organ system become compromised, including Respiratory System.
Malnutrition is common on critically ill patients, now what can happen to these patients, if nutritionals needs are no met?
- Prolong duration on mechanical ventolators
- ↑ hospital Stay
- ↑ morbidity and mortality
- Respiratory Muscles Strength and endurance
- The immune system respond
On the other hand OVERNUTRITION (overfeeding), may also affect the patient but in the negative way, and this can lead to:
- ↑ PaCO2 production
- ↑ ventilator demand
Why critically ill patients with respiratory failure require specialized nutrition support?
- To prevent muscle wasting
- Avoid complication associated with malnutrition care
Lack of malnutrition can affect:
- Respiratory muscles strength and endurance
- The immune system respond
What are the waste products of metabolisims, and who are responsable for the removing of this?
CO2 and nonvolatile acids are the waste products of metabolisms.
- Kidney remove 2% o
- Lungs remove 98%
Overfeeding Carbohydrates will produce excessive …? causing what effect on the patient?
If we ↑ carbohydrates diet, this will ↑ CO2 production, afecting the ventilatory demand by increasing it.
If we have a patient with limited ventilatory reserve, overfeeding may lead to respiratory failure or prolong mechanical ventilation.
How muscles will be affect with prolong Undernutrition?
- Catabolism will occurs (breakdown of complex moleculas)
- Protein Calorie Malfunction (PCM), this can occurs in days in critically ill patients.
- Depletion of phosphors and magnesium can also lead to respiratory muscle weakness
Prorein Calori Malnutrition (PCM) causes impared immune function, making the patient more susceptible to:
Bacterial colonization and infection
Reduce aveolar stability affects:
Zise, number, and surface area is reduce, ↑ WOB
Hypoalbuminemia is the result of:
Poor nutrition, resulting in low levels of albumin in the blood
What happen if the body does not produce enough Albumin?
Oncotic pressure will decrease and fliud will beging to move into the intertitial space, increasing risk for Pulmonary Edema.
Is nutritional status important when we have an Obese patient?
Yes it is, Obesy patients will produce a restrictiction to lungs, ↓ FRC, leading to V/Q mitmach, ↑ WOB, ↑ metabolism. ↑ CO2 production and CO2 retention.
The Hypercatabolic Phase or Stress response can last for:
7 - 10 days
This phase will ↑ O2 demad, CO, and CO2 production. Also, the calori needs may be increased up to 100% during this phase.
Resting Energy Expediture (REE) can stimate:
The amount of energy expended by a person at rest, can be measured Direct or Indirect
What is the problem about predicted equations?
It work well to predicted REE in healthy nonobesy subjects, but less well on obese or critically ill patients.
How does Indirect Calometry works?
It works by measuring the amount of inhaled O2 and exhaled CO2.
By knowing this we are able to know how much energy the patient needs to provide their minimun metabolic requirements
What device can be use on indirectly calometry
- Ventilated Canopy
- Mask
- Mothpiece/nose clip
what is the respiratory Quotient, and what is the normal range?
Is the CO2/O2 consumption
this basically said, if we doing the right calometry the range should be between : 0.67 - 1.3
TRUE or FALSE
The caloric equivalence of CO2 and Oxygen can be used to calculate an estimate of REE
TRUE
Each class of food staff has a unique respiratory quotient:
- Carbohydrates: 1.0
- Protein: 0.80
- Fat: 0.71
If you have a patient that is respiratory compromise, what type of food you want to avoid and why?
Avoid Carbohydrates, because this type of food increase the CO2 production, as a consequence respiratory rate will increase too.
For respiratory compromise patients we try to give them food that produce the minimum amount of CO2, like Fat (0.71)
What is the primarily goal of nutritional support?
Is to improve respiratory function through the prevention or minimization of the loss of muscle mass.
Other goals of nutritional support?
- Preevent Infections
- To enhance te immune system
- To increase exercise tolerance
- To improve patient’s quality of life
What are some ways to feed a patient?
- Oral ( through mouth)
- Enteral (This food is directally place in the stomach)
- Parenteral (Through CPV line)
What is the preferred way to feed a patient in hospitals?
Oral
Oral Route
- Is convenient
- Difficult on severe respiratory disease to comsume enough to mantain their wieght and increase nutrients needs.
- Prevent instestinal atrophy
- Mantain absortion capacity of GI mucosa
- Preserve normal gut flora and gastric PH
- Stimulate feeding dependance.
Here we are talking about what route?
Enteral
what are some devices use on Enteral feeding?
Short term tubes:
- Nasogastric tubes
- Orogastric tubes
- Pospyloric feeding tubes (Jejenum tube or J-tube)
long Term tubes:
- Percutaneous endoscopy gastrostomy (PEG) tube
If you have a patient with severe pancreatitis, gastrointestinal fistula, cancer, short bowel syndrome, prolonged ileous… what route of feeding would you prefere in this case?
Pareteral (CVP)
What are some complication of Parenteral route?
- Catheter placement
- Pnemothorax
- Arterial puncture
- Catheter malposition
- Catheter embolization
- site of infection
- Air embolus
- Gut atrophy
- Mucosal compromise
What are the three critically objective on nutritional support:
- To preserve lean of mass
- To maintain immune mass
- To avert metabolic complication
what is the food that we want to avoid for critically ill patinets
Food that are hiegh on Carbohydrates
Bc ↑ CO2 production leading on an ↑ in ventilatoery demand
What are the benefits of early enteral nutrition within 24 - 48 hours after intubation?
- Reduced disease severety
- Diminish complication
- Decrease length of stay in ICU
- Improve patient outcomes
Poor nutricion can adversally affects patient with:
- Exercise Tolerance
- Reduces body ability to regenerate healthy muscle
- Increase susceptibility to infection
- May prevent successful progresion through the program
What is the most accurate method to determine energy expenditure?
Indirect Calometry is the most accurate on hospitalized critically ill patients.
When alternative methods for estimating energy expenditure should be considered ?
When Indirec Calometry are not available
Why Enteral delivery of nutrients is prefered over Parenteral nutrition?
Because it has fewer risks for infection, may have a protective effects on the gastriontestinal mucosa, and is less costly.
Normal albumin range
3.5 - 5.0 g/dL
In what type of patient, overfeeding may lead to respiratory failure or prolong mechanical ventilation?
On patient with limited respiratory reserve.
This mean that this patient is already too weak, and overfeeding this patient will create and ↑ on CO2 production, increasing ventilatory demand, eventually this patient will get into respiratory failure bc his respiratory muscle need to work more to get rib of the excess of CO2
What condition may increase the calori needs up to 100%?
The Hypercatabolic phase, and this can last up to 7 - 10 days
The Equation needed to to determine the amount of energy need to mantain the most basic bodily function is?
Basal Metabolic Rate (BMR)
Other equation:
- Ireton-Jones
- Estimated
