Nutritional Requirements

Question 1

Total amount of energy expended per day

Answer 1

Total Energy Expenditure (TEE)

Question 2

Resting energy expenditure (REE): ______%
Activity thermogenesis: _____%
Thermic effect of food (TEF): ___%

Answer 2

60-70
15-20
10

Question 3

Energy expended in the activities to sustain normal body functions and homeostasis

Answer 3

Resting Energy Expenditure (REE)

Question 4

REE Represents the largest portion of _____________
Measurement of REE=> ______________

Answer 4

total energy expenditure (TEE)
Resting Metabolic Rate (RMR)

Question 5

Factors Affecting REE

Body Composition=> _____
Age
Body size
Gender (_____ more)

Hormonal Status:
- ________ disorders
- metabolic stress: __________
Climate

Body temperature
Fever=> increases metabolic rate by _____ for each degree above _____

Injury and some diseases (NOT all) - they ones that do usually involve ______ or ______

Answer 5

LBM
women

endocrine disorders - hyperthyroidism requires more energy
catecholamines - increases cell metabolism, use more energy

7%
98.6F

inflammation or breathing difficulty

Question 6

Methods of measuring energy expenditure

Answer 6

Direct Calorimetry
Doubly Labeled Water (DLW)
Indirect Calorimetry

Question 7

Indirect Calorimetry Estimates energy expenditure by measurement of ______________

Used to determine _____
Advantage: _______
Disadvantages: ________

Answer 7

respiratory gas exchange=> O2 consumption & CO2 production are quantified over a given period of time

RMR
Very accurate
Cost; expertise required

Question 8

Indirect Calorimetry – Prior to Measurement

Fast for at least ________
No caffeine for _______
No nicotine for ______
No moderate to vigorous exercise for _________
Rest for _______ before test to achieve steady state

Answer 8

7 hours (4 hr before if low blood sugar issue)
4 hours
2.5 hours
12-48 hours
30 min

Question 9

Indirect Calorimetry – Procedure
Measurement:
Breathe into __________________ to collect gases
Test for _________; throw out the 1st ________ of data

During measurement:
_______________
________ position
____________ environment

Answer 9

a mouthpiece or ventilated hood
10 minutes
5 minutes

Relaxed & not moving
Supine
Thermoneutral

Question 10

Indirect Calorimetry - Calculation
Uses the _____ equation to estimate energy expenditure from gas exchange data

REE (kcal/d) = [(3.94 x VO2 L/min) +(1.11 x VCO2 L/min)] x 1440

Answer 10

Weir

Question 11

Mifflin-St. Jeor Equation (MSJE)
Two equations because _____
wt in ____ and ht in ____

Weight:
If hypervolemia, edema=> use __________
If individual has obesity=> use ________

Answer 11

different for Make and female
Kg cm

dry weight or usual wt
actual wt

Question 12

Calculating TEE using MSJE

Mifflin-St. Jeor Equation=>_____
TEE = REE x AF x SF (if applicable)

Activity Factor:
Critically ill: 1.05-1.1
Confined to bed: 1.2
Moderately active: 1.25-1.40
Very active: 1.45-1.60

Answer 12

REE

Question 13

Stress Factors

Disease/condition dependent
Surgery: _______
Infection: _______
Skeletal or blunt trauma: ______

Answer 13

1.0-1.3
1.0-1.4
1.2-1.4

Question 14

To promote weight loss or weight gain=> subtract/add_______ kcal to ____ as appropriate

Note: the “______ kcal= 1 lb rule” is common practice but lacks _____

Answer 14

250 – 1000
TEE

3500
validity

Question 15

_______ is used for when they are on ventilators to measure indirect calorimetry

Answer 15

metabolic cart
- need respiratory therapist
- very expensive

Question 16

Adjusted Weight for Obesity (ABW)
- Often used in clinical practice to calculate nutritional needs for adults who are obese, but lack of evidence to support use
- Rationale: Adipose tissue is ______ metabolically active
- However, its estimated that ____ of excess weight is LBM

• formula : __________________
• Often used by clinicians for individuals with obesity (who are not critically ill) to calculate _________ needs and in some energy equations (e.g., kcal/kg)

Answer 16

less
25%

[(CBW- IBW) X 0.25] + IBW
protein & fluid

Question 17

Estimating Protein Requirements

Based on body weight
- DRI/RDA: _____g/kg for well-nourished, healthy adults; OR
- Disease/condition

Answer 17

0.8

Question 18

Factors to Consider When Estimating Protein Requirements

Increased needs for=> _____________
Increased protein losses=> __________________
Increased protein catabolism=> _____________
Evidence of protein malnutrition
Renal status

Answer 18

growth, wound healing
burns, wounds, malabsorption
infection, trauma, burns

Question 19

Based on Disease/Condition

Postoperative ________ g/kg BW
Infection; Sepsis ________ g/kg BW
Multiple trauma ________ g/kg BW
Catabolism ________ g/kg BW
Major burn ________ g/kg BW

Answer 19

1.0-1.5
1.2-1.5
1.3-1.7
1.2-2.0
1.5-2.0

Question 20

Calculating Protein Needs
Note: Use actual weight, except for:
If hypervolemia or edema=> use _____________

For adults who have obesity, most appropriate wt to use is uncertain=> actual wt vs. ABW vs. IBW
Common practice is to use ______

Answer 20

dry weight or usual weight

ABW

Question 21

Nitrogen Balance
- Used to assess _______ status and also to determine ______ needs
- Determine the amount of nitrogen required to maintain nitrogen equilibrium by assessing _____________

Calculation _____________

Answer 21

protein
protein
urinary nitrogen losses

[Protein intake (g) / 6.25] – [UUN g/day +4]

Question 22

Interpretation of Nitrogen Balance

Nitrogen balance “0”=> ________

Positive balance=> _______
Goal for repletion/healing: _________

Negative balance=> ____________

Answer 22

equilibrium (the amount of nitrogen consumed = the amount excreted)

anabolism
+2 to +4 g

inadequate intake of protein, increased needs, or excessive losses of protein

Question 23

Limitations of Nitrogen Balance
- Need an accurate ________ and _________ collection.
- Cannot be accurately calculated in patients with ______ disease or those who have large ________ which are difficult to measure (e.g., wound exudate).

Answer 23

protein intake
24-hour urine

renal
protein losses

Question 24

Estimating Fluid Requirements
- Based on age & weight:

Average adult ______ ml/kg BW
55-65 yrs ______ ml/kg BW
>65 yrs ______ ml/kg BW

Answer 24

30-35
30
25

Question 25

Fluid requirements minimum of _______ ml/d (unless fluid restriction is required for medical reasons)

Answer 25

1500

Question 26

For estimating fluid requirements, use ______ body weight, except for:

If hypervolemia or edema=> use ___________

For individuals with obesity, the most appropriate wt to use is uncertain=> common practice is to use _____

Answer 26

actual
dry weight or usual weight
ABW

Question 27

other fluid requirement formulas

____ ml per kcal

Answer 27

1 ml

Question 28

Factors that Increase Fluid Requirements

GI losses=>___________
______ or Excessive sweating

______ drainage
______ drainage

High _____/high ________ load feedings

Answer 28

vomiting, diarrhea
Fever

Wound
Tube

protein
renal solute

Question 29

Factors that Decrease Fluid Requirements

Answer 29

Renal Failure
Congestive Heart Failure (CHF)