Nutritional Support of Hospitalized Patient Flashcards
what are the physiological consequences of inadequate nutrition
what does protein malnutrition cause (2)
- low muscle mass
- hypoproteinemia
what does energy malnutrition cause (3)
- reduced body weight
- loss of body fat
- low CHO stores
what are consequences of inadequate nutrition (3)
- poor tissue repair
- immune dysfunction
- altered drug metabolism
what are the consequences of inadequate nutrition
when is it necessary to intervene
- prolonged anorexia (partial or complete) for > 5 days
- anticipated ongoing inadequate food intake of > 3 days
- evidence of poor nutritional status
- concern for development of hepatic lipidosis
how is poor nutritional status (4)
- BCS <3/9
- hypoalbuminemia
- recent weight loss of >10% of body weight
- severe generalized muscle wasting
what are the risk factors for hepatic lipidosis
obestiy
inflammatory conditions
what are the types of hepatic lipidosis
primary vs secondary
what are the reasons a patient could be anorexic
- physical inability to eat?
- underlying disease process?
- nausea?
- pain?
- impaired olfaction/taste? (cats)
what are enteral nutrition options (4)
- NO or NG tube
- esophagostomy tube
- gastronomy tube
- jejunostomy tube
why is enteral nutrition preferred over parenteral if it is possible
better outomces
vili and enterocytes will get nutrition from local contents
if withholding food for a long time can lose the barrier function of the intestine and pre-dispose to infection
what are parenteral nutrition options (3)
- total parenteral nutrition (TPN)
- partial parenteral nutrition (PPN)
- peripheral parenteral nutrition (PePN)
what are contraindications of NO or NG tubes
facial traumas
what are indications for PEG tube placement (4)
- esophageal disease
- esophagitis
- esophageal stricture
- megaesophagus
what are indications for semi permanent low profile tubes
- dysphagia: neurological dysfunction of the pharynx
- adipsia
- practical admin of medications (feline)
what are some questions that would help you decide which method of feeding to use
what are some factors that will determine what diet you will use (3)
- underlying disease process (fat restriction with pancreas)
- practicalities (gauge of feeding tube)
- stage of illness (acute vs adaptive)
what does arginine help with
immune function –> reduced infection rates
what is the purpose of glutamine
conditionally essential –> reduced infections/mortality rate
what is L-carnitine essential for
B-oxidation of NEFAs in mitochondria
what is the purpose of B vitamins
co-enzymes essential for hepatic metabolism of glucose, fat and protein
how do you calculate energy requirements
resting energy requirements = (30 x 30kg) + 70 kcal/day
or
resting energy requirements = 70 x BWkg^0.75 kcal/day
what are the resting energy requirements for patients that have been anorexic for several days
begin with 25-50% of RER and then incremental increases to RER over the following 2-3 days (1/3, 2/3 etc)
