Nutritional Requirements Flashcards
Total amount of energy expended per day
Total Energy Expenditure (TEE)
Resting energy expenditure (REE): ______%
Activity thermogenesis: _____%
Thermic effect of food (TEF): ___%
60-70
15-20
10
Energy expended in the activities to sustain normal body functions and homeostasis
Resting Energy Expenditure (REE)
REE Represents the largest portion of _____________
Measurement of REE=> ______________
total energy expenditure (TEE)
Resting Metabolic Rate (RMR)
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 ______
LBM
women
endocrine disorders - hyperthyroidism requires more energy
catecholamines - increases cell metabolism, use more energy
7%
98.6F
inflammation or breathing difficulty
Methods of measuring energy expenditure
Direct Calorimetry
Doubly Labeled Water (DLW)
Indirect Calorimetry
Indirect Calorimetry Estimates energy expenditure by measurement of ______________
Used to determine _____
Advantage: _______
Disadvantages: ________
respiratory gas exchange=> O2 consumption & CO2 production are quantified over a given period of time
RMR
Very accurate
Cost; expertise required
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
7 hours (4 hr before if low blood sugar issue)
4 hours
2.5 hours
12-48 hours
30 min
Indirect Calorimetry – Procedure
Measurement:
Breathe into __________________ to collect gases
Test for _________; throw out the 1st ________ of data
During measurement:
_______________
________ position
____________ environment
a mouthpiece or ventilated hood
10 minutes
5 minutes
Relaxed & not moving
Supine
Thermoneutral
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
Weir
Mifflin-St. Jeor Equation (MSJE)
Two equations because _____
wt in ____ and ht in ____
Weight:
If hypervolemia, edema=> use __________
If individual has obesity=> use ________
different for Make and female
Kg cm
dry weight or usual wt
actual wt
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
REE
Stress Factors
Disease/condition dependent
Surgery: _______
Infection: _______
Skeletal or blunt trauma: ______
1.0-1.3
1.0-1.4
1.2-1.4
To promote weight loss or weight gain=> subtract/add_______ kcal to ____ as appropriate
Note: the “______ kcal= 1 lb rule” is common practice but lacks _____
250 – 1000
TEE
3500
validity
_______ is used for when they are on ventilators to measure indirect calorimetry
metabolic cart
- need respiratory therapist
- very expensive
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)
less
25%
[(CBW- IBW) X 0.25] + IBW
protein & fluid
Estimating Protein Requirements
Based on body weight
- DRI/RDA: _____g/kg for well-nourished, healthy adults; OR
- Disease/condition
0.8
Factors to Consider When Estimating Protein Requirements
Increased needs for=> _____________
Increased protein losses=> __________________
Increased protein catabolism=> _____________
Evidence of protein malnutrition
Renal status
growth, wound healing
burns, wounds, malabsorption
infection, trauma, burns
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
1.0-1.5
1.2-1.5
1.3-1.7
1.2-2.0
1.5-2.0
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 ______
dry weight or usual weight
ABW
Nitrogen Balance
- Used to assess _______ status and also to determine ______ needs
- Determine the amount of nitrogen required to maintain nitrogen equilibrium by assessing _____________
Calculation _____________
protein
protein
urinary nitrogen losses
[Protein intake (g) / 6.25] – [UUN g/day +4]
Interpretation of Nitrogen Balance
Nitrogen balance “0”=> ________
Positive balance=> _______
Goal for repletion/healing: _________
Negative balance=> ____________
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
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).
protein intake
24-hour urine
renal
protein losses
Estimating Fluid Requirements
- Based on age & weight:
Average adult ______ ml/kg BW
55-65 yrs ______ ml/kg BW
>65 yrs ______ ml/kg BW
30-35
30
25
