Parenteral nutrition,

Question 1

what is the diagnostic criteria for needing parenteral nutrition

Answer 1

2+ of the following:
1. Insufficient caloric (energy) intake (estimated from dietary recall)
2. Weight loss (based on objective measurement of weight)
3. Loss of muscle mass (temporal/interosseous muscle wasting; clavicular prominence)
4. Loss of subcutaneous fat (cheeks/orbital area, or space between thumb and forefinger)
5. Localized or generalized fluid accumulation, that may mask weight loss (pitting edema)
6. Diminished functional status (assessed by handgrip strength with a dynamometer)

Question 2

what can happen when you give excess carbohydrates to patients with lung disease

Answer 2

increased carbs = hyperglycemia = excess carbon dioxide production.

can cause respiratory acidosis

Question 3

what equations can be used to determine nutrition requirements

Answer 3

• Harris Benedict Equation
• Mifflin-St. Jeor Equation

Question 3

what can long-term overfeeding lead to

Answer 3

• hepatic steatosis
• ureagenesis
• immunosuppression (esp with lipid overload)

Question 4

how much protein is required for the typical patient who is hospitalized

Answer 4

between 1.2 and 1.5 g/kg/day

Question 5

how much protein is required for burn patients? what about critically obese patients?

Answer 5

• burn patients - up to 2 g/kg/day
• critically obese - up to 2.5 g/kg/day

Question 6

when should you initiate parenteral or enteral nutrition?

Answer 6

Only after 7-10 days with no oral intake, and only if its going to be used for at least 5-10 days

Question 7

what is enteral nutrition

Answer 7

tubes entering the GI system directly at the stomach or small intestines

if the gut works, use it!!

Question 8

what are contraindications to enteral nutritions

Answer 8

• GI hemorrhage
• peritonitis
• severe ileus
• bowel obstruction
• fistula distal to access site
• intestinal ischemia
• malabsorptive disorders with high volume diarrhea

Question 9

what are possible symptoms of intolerance for enteral nutrition

Answer 9

• N/V
• diarrhea
• abdominal pain
• bloating

Question 10

if symptoms of intolerance develop, what is the treatment

Answer 10

hold feedings until symptoms resolve.

if symptoms persist an alternate route must be explored

patients who cannot tolerate enteral nutrition should be considered for parenteral nutrition

Question 11

why is enteral nutrition preferred over parenteral nutrition

Answer 11

PN is associated with high rates of infectious and metabolic complications such as volume overload, hyperglycemia, and electrolyte abnormalities

Question 12

what is refeeding syndrome

Answer 12

characterized by electrolyte abnormalities that occur during the reinstitution of carbohydrate calories to a starved patient.

serum mag, phos, potassium depletion

Question 13

what protein measurement best assesses short term nutritional status?

Answer 13

prealbumin.