Specialized Nutrition Support Flashcards
1
Q
Define specialized nutritional support (SNS)
A
Provision of specially formulated and/or delivered parenteral or enteral nutrients to maintain or restore optimal nutrient status
2
Q
What are the main types of SNS?
A
- Oral nutritional supplements (ONS)
- Enteral nutrition (EN)
- Parenteral nutrition (PN)
3
Q
When are ONS prescribed to patients?
A
Prescribed when oral diet is tolerated but there is inadequate ingestion of nutrients in the form of a standard oral diet
4
Q
In which patient population will ONS have a role in improving the nutrition status
A
Homebound elderly
5
Q
(T/F) ONS are known to improve nutritional parameters after GI and/or hip fracture surgery patients
A
TRUE
6
Q
Define EN
A
Nonvolitional delivery of nutrients by tube into the GI tract
- Nonvolitional: without deliberative intention (done out of necessity)
7
Q
When are ENs prescribed to patients?
A
Prescribed when oral intake is inadequate while GI function is intact and accessible
8
Q
What enteral feeding(s) can be given long-term?
A
Feeding enterostomy
9
Q
Give 4 examples of feeding enterostomy
A
- Gastrostomy (g-tube)
- Jejunostomy (j-tube)
- Percutaneous Endoscopic Gastrostomy (PEG)
- Percutaneous Endoscopic Jejunostomy (PEJ)
10
Q
What feeding enterostomy’s are surgically placed ONLY?
A
- Jejunostomy
- Gastrostomy
11
Q
What feeding enterostomy’s are placed surgically or at bedside?
A
- PEG
- PEJ
12
Q
What enteral feeding(s) can be given short-term?
A
Nasal tube feeding
Oral tube feeding
13
Q
Give 3 examples of nasal tube feeding
A
- Nasogastric (NG)
- Nasoduodenal (ND)
- Nasojejunal (NJ)
14
Q
Oral tube feeding are generally reserved for which patient’s?
A
Patient’s with endotracheal intubation
15
Q
What is a disadvantage for patients when they get extubated?
A
Oral tube feeding is usually removed also
16
Q
Give 3 examples of oral tube feeding
A
- Orogastric (OG)
- Oroduodenal (OD)
- Orojejunal (OJ)
17
Q
List 4 advantages of EN compared to PN
A
- Reduces rate of infection
- Reduces cost
- Decreased hospital length of stay
- Better maintenance of gut integrity
18
Q
(T/F) - EN causes GI and mechanical complications
A
TRUE
19
Q
What are some GI complications that could occur in EN?
A
- Abdominal cramping
- Nausea/Vomiting/Diarrhea
- Malabsorption
20
Q
(T/F) - mechanical complications are only caused by nasogastric tubes and jejunostomy, but not gastrostomy
A
FALSE - ALL 3 (nasogastric tubes, jejunostomy, gastrostomy) cause mechanical complications
21
Q
What are some mechanical complications that could occur in nasogastric tubes? HINT: 6 Sx
A
- Mucosal ulceration
- Clogging
- Pneumothorax
- Esophageal ulcerations
- GI bleed
- Pulmonary aspirations
22
Q
What are some mechanical complications that could occur in gastrostomy? HINT: 7 Sx
A
- Aspirations
- Dislodgement
- Bleeding
- Wound infection
- Stomal leakage
- Tube occlusion
- Pneumoperitoneum
23
Q
What are some mechanical complications that could occur in jejunostomy? HINT: 7 Sx
A
- Pneumatosis intestinalis
- Dislodgement
- Bleeding
- Wound infection
- Bowel obstruction
- Stomach leakage
- Volvulus
24
Q
Name 8 contraindications for EN not to be given
A
- Diffuse peritonitis
- Intractable diarrhea
- Intractable vomiting
- Intestinal obstruction
- Paralytic ileus
- Gastrointestinal ischemia
- Intestinal discontinuity
- Open abdomen
25
Define PN
Administration of nutrients done intravenously (IV)
26
When are PNs prescribed to patients?
When patients oral intake is inadequate and cannot be fed via the GI tract
27
What are the two types of PN?
1. Total parentaral nutrition (TPN)
| 2. Peripheral parenteral nutrition (PPN)
28
(T/F) - Total parenteral nutrition is also called total admixture nutrition
FALSE - TPN is also called total nutritional admixture (TNA)
29
How are TPNs administered?
By a central venous catheter (CVC)
30
What two advantages could be done with TPNs?
- Ability to maximize caloric intake
| - Ability to volume restrict patients
31
What are three disadvantages with using TPNs?
- CRBSI (catheter related blood stream infections)
- CLABSI (central line related blood steam infections)
- Central venous thrombosis
32
How are PPNs administered?
By a peripheral line
33
What is the difference between PPNs vs. TPNs?
- Limits energy intake due to concentration restrictions
| - Inability to volume restrict
34
(T/F) - SNS is always given during emergencies
FALSE - it's never given during emergencies
35
In which patients is SNS indicated for?
- Individuals who should not, cannot, or will not eat adequately
- Individuals who are malnourished or at significant risk of being malnourished
- Benefits of improved nutrition outweighs the risk
36
What are the 8 steps in a nutrition care process?
1. Nutritional Screening
2. Formal nutritional assessment
3. Formulation of a nutritional care plan
4. Implementation of the plan
5. Patient monitoring
6. Reassess of the care plan
7. Reevaluate of the care setting
8. Reformulation of the care plan or termination of therapy
37
What is the purpose of nutritional screening?
- To identify changes in patient's condition due to an effect in nutritional status
- To identify risk factors that could lead a patient at nutrition risk or lead to nutrition related problems
- To identify individuals who are malnourished or risk of being malnourished
38
Define malnutrition
A disorder of nutrition status - a deficiency of nutrient intake, impaired nutrient metabolism, or over nutrition
39
Name 3 consequences of malnutrition
- Premorbid condition
- Extra and length of time nutrient intake is inadequate
- Concurrent presence of illnesses/diseases
40
What are 5 objective indicators to screen malnutrition?
- Height
- Weight
- Weight change
- Primary diagnosis
- Presence of comorbidities
41
What factors are indicative of malnutrition? HINT 4 factors
- Involuntary loss or gain of 10% or more of usual body weight within 6 months
- Involuntary loss or gain of 5% or more of usual body weight within 1 month
- Body weight of 20% or more over or under IBW
- Inadequate nutrition intake
42
Define nutrition assessment
A comprehensive approach defining nutrient status
43
What does a nutrition assessment collect?
- Medical, nutritional, medication histories
- Physical examination
- Anthropometric measurements
- Laboratory data
44
What are the 2 components that evaluate nutrition status?
- Nutrition and metabolic assesment
45
There are 3 goals for the nutrition assessment, what are they?
- To identify patients who are malnourished or risk of being malnourished
- To collect the information necessary to create a nutrition care plan
- To monitor the adequacy of nutrition therapy
46
What tools do you use for the nutrition assessment? HINT: 4 tools
1. BMI
2. Patient history
3. Physical assessment
4. Serum protein levels
47
What is collected during patient history?
- Weight (IBW, Adj. BW, Act. BW, recent weight loss)
- GI function
- Changes in eating habits
- Nature/severity of underlying diseases
- Unusual personal dietary habits/restrictions
48
What is collected during physical assessment?
- General appearance
- Musculoskeletal
- Areas with notable changes
49
What is considered general appearance information?
Such as edema, ascites, cachexia, obese, skin changes, poor healing wounds
50
What areas are considered notable changes?
Such as hair bearing areas, oral mucosa, peripheral sensation, and gravity dependent areas
51
In serum protein levels, what are the most analyzed visceral proteins? HINT: 3 proteins
- Prealbumin
- Albumin
- Transferrin
52
(T/F) - Albumin has a prognostic value and may help assess in nutrition status changes in response to therapy
FALSE - Albumin does have a prognostic value but it does not help assess in nutrition status changes in response to therapy [only prealbumin]; instead, it's a helpful marker of nutrition status of admission.
53
(T/F) - Transferrin will more accurately reflect acute protein depletion and replenishment (more than albumin) AND will increase in iron deficiency anemia
TRUE
54
(T/F) - Prealbumin is used to assess nutrition status changes in response to therapy
TRUE
55
What should be considered in the nutrition care plan?
- Nutrition goals
- Route of administration (Oral, Enteric, Parenteral)
- Goals of nutrition care/intervention
- Monitoring should be done at regular intervals
56
For nutrition management, what should be collected in individual patients?
- Dosing weight
- Energy requirements
- Three macronutrients to provide kcal (Calories)
57
What are the energy requirements?
That the administered kcal should be adequate to meet the basal energy expenditures
58
What are the estimated basal energy requirements?
25 - 35 kcal/kg/day
59
What are the three macronutrients that are needed to provide kcal?
- Protein
- Carbohydrates
- Fat
60
How are proteins, carbohydrates, and fats provided in PN formulations?
Proteins -> amino acids
Carbohydrates -> dextrose
Fats -> lipids
61
What are the gm/kg/day requirements that can be given for amino acids?
0.8 - 2.0 gm/kg/day
62
How many kcal are in one gram of amino acids?
4 kcal/gm
63
What are the gm/kg/min requirements that can be given for dextrose in a PN infusion?
3-5 mg/kg/min (DO NOT EXCEED 5 mg/kg/min)
64
How many kcal are in one gram of dextrose?
3.4 kcal/gm
65
What are the gm/kg/day requirements that can be given for lipids?
2. 5 gm/kg/day
| * Critically ill patients can start at 1 gm/kg/day*
66
For intralipids, how many kcal are in one gram of lipids?
10 kcal/gm
67
(T/F) - There is such thing as 10, 20, 30 percent of intralipids available in market
TRUE
68
How many kcal are in one mL of 10, 20, 30 percent of intralipids?
10% - 1.2 kcal/mL
20% - 2 kcal/mL
30% - 3 kcal/mL
69
(T/F) - Amino acids, dextrose, and lipids should be included in all forms of PN
FALSE - only amino acids and dextrose (lipids are not)
70
(T/F) - SNS complications can occur in oral, enteral and parenteral nutrition
FALSE - only in parenteral and enteral nutrition
71
Name some complications of SNS (12 included)
- Hypertriglyceridemia
- Hyperglycemia
- Hypoglycemia
- Vascular access sepsis
- GI complications
- Acid/Base abnormalities
- Gastroesophageal reflux
- Excessive CO2 production
- Thrombosis
- Pulmonary aspiration
- Hepatic steatosis
- Refeeding syndrome
72
What is refeeding syndrome?
A life-threatening complication that occurs within the first few days after refeeding of starved adult patients
73
What are 3 biochemical findings (lab findings) that could indicate refeeding syndrome?
- Low potassium, phosphate, and magnesium
74
What are 3 symptoms for refeeding syndrome?
- Respiratory distress
- Hemolytic anemia
- Cardiac arrhythmias
75
(T/F) - In at risk patients, refeeding syndrome can be prevented if initial intake of carbohydrates is limited to 100 gm/day and fluid to 500 mL/day.
FALSE - In at risk patients, limit initial carbohydrate intake to 150 gm/day and fluid to 800 mL/day
