P and N nutrition Flashcards
Examples of Short-Term Enteral Nutrition
Nasogastric; Nasoenteric (duodenum/jejunum); Orogastric; Oroenteric (duodenum/jejunum)
Examples of Long-term nutrition
PEG; Gastrostomy; jejunostomy
Examples of Peripheral Parenteral Nutrition
Peripheral Vein; Midline catheter access
Examples of Central Parenteral Nutrition
Central venous catheter; Peripherally inserted central catheter
Which has to be more dilute: Peripheral Parenteral or Central Parenteral
Peripheral
What are things that are risk factors for malnutrition
- NPO for > 7 days
- 20% under IBW
- unintentional weight change (drop 10% in 6 months or drop 5% in 1 month)
- increased metabolic needs (trauma/burn)
- inadequate nutrient intake
What is used to measure someones nourishment status
SGA - subjective global assessment
Acute vs Chronic malnutrition
Acute - still has fat reserves - PROTEIN DEPLETED
Chronic - does not have fat reserves AND protein depleted
Things to use to assess someones nutritional status (which one is most important to pharmacists)
- Nutrition hx
- med hx
- Anthropometric measurements (skin fold thickness, circumference of waist and mid-ar muscle)
- biochemical/lab assessments (VISCERAL PROTEINS, NITROGEN BALANCE STUDIES, SERUM CONCENTRATIONS of trace elements/vitamins/minerals)
Main visceral proteins to look at while assessing someones nutrition status
albumin and pre-albumin (PT/INR also important)
Protein demands are ________ (increased or decreased) during stress
increased
Nitrogen is excreted in the _______ as ______
urine; urea
Nitrogen IN equation
24 hour protein intake (grams)/ 6.25
Nitrogen OUT equation
24 hour UUN (grams) + 4
Goal for nitrogen balance
zero for maintenance OR positive for repletion
kcal/gram values for:
Protein:
Carbohydrate:
Lipids:
P: 4
C: 3.4
L: 10
Stress on the body causes hyper_______ and hyper________ and increased stimulation of __________
metabolism; catabolism; sympathetic nervous system
What are the end results of the body being under stress (what “processes”?)
lipolysis; proteolysis; glycogenolysis; insulin resistance; gluconeogenesis
Harris-Benedict Equation is related to what?
BEE - basal energy expenditure
BEE = ? = ?
Basal energy expenditure; BMR/basal metabolic rate
Definition of BEE
metabolic activity required to maintain life (respiration and temperature)
Definition of REE
of calories needed during a 24 hr of non-active state
REE is ___ higher than ____
10%; BEE
TEE = _____ x ______
BEE; activity or stress factor
TEE = ?
total energy expenditure
Activity cofactor:
Bedrest: ____
Ambulatory: ____
Anabolic: ____
Bedrest: 1.2
Ambulatory: 1.3
Anabolic: 1.5
Stress cofactor:
Non-malnourised/ minor surgery: ___
Ongoing sepsis/thermal injury/severe malnutrition: ____
1.2; 1.4 - 1.5;
Goal Daily Calories: UNITS in kcal/kg/day
Non-stressed/Non-depleted: ____
trauma/stress/surgery/critically ill: ____
major burn: ____
obesity: _____
nsnd: 20 - 25;
tssc: 25 - 30;
m. b: 35 - 40;
o: 22 - 25; (IBW)
Goal Daily Protein: (g/kg/day)
Maintenance: ___
Mild - moderate (repletion/medical floor): ___
Moderate - Severe (ICU, trauma, surgery) : __
Burn: ___
Obesity: (IBW) ___
Severe obesity: (IBW) ____
0.8 - 1 1 - 1.5 1.5 - 2 2 - 2.5 2 2.5
If actual weight is 130% LESS than IBW - use what weight?
actual
If actual weight is 130% MORE than IBW - use what weight?
Nutritional Body weight (NBW = IBW + 0.25 (actual wt - IBW))
If patient is obese (wt is 150% over IBW) use ______
ideal BW
Standard ratio for Dextrose/Fat
aka distribution of Non-Protein calories
70:30
RQ = ?
respiratory quotient
RQ Goal = ?
0.85 - 0.95 (want in more O2 than CO2 leaving…)
RQ = ____ / _____
VCO2 / VO2
When is EN indicated
dysphagia; CVA; dementia; head/neck surgery; trauma/burn; esophageal obstruction;
When is EN Contraindicated
need is for less than 5 - 10 days; severe acute pancreatitis; no access; GI ischemia; intractable vomiting/diarrhea; ileus
Types of EN adminstration
continuous; bolus; intermittent; cyclic