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Module 14 > Nutritional Support of Hospitalized Patient > Flashcards

Nutritional Support of Hospitalized Patient Flashcards

1
Q

what are the physiological consequences of inadequate nutrition

A
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2
Q

what does protein malnutrition cause (2)

A
  1. low muscle mass
  2. hypoproteinemia
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3
Q

what does energy malnutrition cause (3)

A
  1. reduced body weight
  2. loss of body fat
  3. low CHO stores
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4
Q

what are consequences of inadequate nutrition (3)

A
  1. poor tissue repair
  2. immune dysfunction
  3. altered drug metabolism
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5
Q

what are the consequences of inadequate nutrition

A
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6
Q

when is it necessary to intervene

A
  1. prolonged anorexia (partial or complete) for > 5 days
  2. anticipated ongoing inadequate food intake of > 3 days
  3. evidence of poor nutritional status
  4. concern for development of hepatic lipidosis
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7
Q

how is poor nutritional status (4)

A
  1. BCS <3/9
  2. hypoalbuminemia
  3. recent weight loss of >10% of body weight
  4. severe generalized muscle wasting
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8
Q

what are the risk factors for hepatic lipidosis

A

obestiy

inflammatory conditions

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9
Q

what are the types of hepatic lipidosis

A

primary vs secondary

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10
Q

what are the reasons a patient could be anorexic

A
  1. physical inability to eat?
  2. underlying disease process?
  3. nausea?
  4. pain?
  5. impaired olfaction/taste? (cats)
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11
Q

what are enteral nutrition options (4)

A
  1. NO or NG tube
  2. esophagostomy tube
  3. gastronomy tube
  4. jejunostomy tube
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12
Q

why is enteral nutrition preferred over parenteral if it is possible

A

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

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13
Q

what are parenteral nutrition options (3)

A
  1. total parenteral nutrition (TPN)
  2. partial parenteral nutrition (PPN)
  3. peripheral parenteral nutrition (PePN)
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14
Q

what are contraindications of NO or NG tubes

A

facial traumas

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15
Q

what are indications for PEG tube placement (4)

A
  1. esophageal disease
  2. esophagitis
  3. esophageal stricture
  4. megaesophagus
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16
Q

what are indications for semi permanent low profile tubes

A
  1. dysphagia: neurological dysfunction of the pharynx
  2. adipsia
  3. practical admin of medications (feline)
17
Q

what are some questions that would help you decide which method of feeding to use

18
Q

what are some factors that will determine what diet you will use (3)

A
  1. underlying disease process (fat restriction with pancreas)
  2. practicalities (gauge of feeding tube)
  3. stage of illness (acute vs adaptive)
19
Q

what does arginine help with

A

immune function –> reduced infection rates

20
Q

what is the purpose of glutamine

A

conditionally essential –> reduced infections/mortality rate

21
Q

what is L-carnitine essential for

A

B-oxidation of NEFAs in mitochondria

22
Q

what is the purpose of B vitamins

A

co-enzymes essential for hepatic metabolism of glucose, fat and protein

23
Q

how do you calculate energy requirements

A

resting energy requirements = (30 x 30kg) + 70 kcal/day

or

resting energy requirements = 70 x BWkg^0.75 kcal/day

24
Q

what are the resting energy requirements for patients that have been anorexic for several days

A

begin with 25-50% of RER and then incremental increases to RER over the following 2-3 days (1/3, 2/3 etc)

25
Q

what does re-feeding syndrome result in (3)

A
  1. intracellular shifts of K+, PO4-, Mg2+
  2. CHO intolerance
  3. diarrhea
26
Q

what does hypokalemia cause

A

profound weakness including myocardial and GI dysfunction (decreased motility which can exacerbate problems)

27
Q

what does hypophosphatemia cause

A

severe hemolysis and hepatic lipidosis

28
Q

what does hypomagnesemia cause

29
Q

how does re-feeding syndrome cause CHO intolerance and how do you prevent it

A

leads to insulin resistance

hyperglycemia

prevented by limiting the CHO of diets until adaptive changes have resolved

30
Q

how does re-feeding syndrome cause diarrhea with liquid diets

A

high osmolarity of liquid diets

31
Q

what is parenteral nutrition

A

admin of dextrose/lipid/amino acid solutions

32
Q

how is parenteral nutrition administered

A

IV catheter

33
Q

why do parenteral nutrition need to be administered through the jugular

A

because they are hyperosmolar solutions –> can lead to phlebitis

34
Q

what are potential catheter related issues associated with parenteral nutrition (4)

A
  1. phlebitis
  2. thrombosis
  3. infection (bacteremia)
  4. mechanical failure of catheters (kinking)
35
Q

what are potential metabolic related issues associated with parenteral nutrition (4)

A
  1. re-feeding syndrome
  2. hyperglycemia
  3. hypertriglyceridemia
  4. hyperbilirubinemia
36
Q

what are the contra indications of parenteral nutrition (3)

A
  1. liver dysfunction
  2. lipid abnormalities
  3. diabetes mellitus

Module 14 (29 decks)

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