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Nutrition > Specialized Nutrition Support > Flashcards

Specialized Nutrition Support Flashcards

1
Q

three major types of SNS

A
  1. oral nutrition supplements
  2. enteral nutrition
  3. parenteral nutrition
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2
Q

SNS is defined as

A

the provision of nutrients orally, enterally, or parenterally with therapeutic intent

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3
Q

ONS is usually prescribed for patients in which

A

in which oral diet is tolerated but there is an inadequate ingestion of nutrients in the form of a standard oral diet

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4
Q

ONS has a major role in

A

improving homebound elderly persons and nutrition after GI and hip fracture surgeries

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5
Q

EN is defined as

A

nonvolitional delivery of nutrients by tube into the GI tract

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6
Q

EN is usually prescribed for patients in which

A

oral intake is inadequate while GI function is intact and accessible

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7
Q

is feeding enterostomy long term or short term?

A

long term and typically requires a surgery

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8
Q

examples of feeding enterstomies?

A

gastrostomy
jujunostomy
percutaneous endoscopic gastrostomy(PEG)
percutaneous endoscopic jujunostomy (PEJ)

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9
Q

which feeding enterostomies can be placed at bedside?

A

PEG and PEJ

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10
Q

is nasal tube feeding short term or long term?

A

short term

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11
Q

examples of nasal tube feeding

A

nasogastric (NG)
nasoduodenal (ND)
nasojejunal (NJ)

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12
Q

is oral tube feeding short term or long term?

A

short term

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13
Q

oral tube feeding is generally reserved for what patients?

A

patients with endotracheal intubation

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14
Q

examples of oral tube feeding

A

orogastric (OG)
oroduodenal (OD)
orojejunal (OJ)

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15
Q

advantages of EN

A
  1. reduced cost compared to PN
  2. better maintenance of gut integrity
  3. reduced rate of infection
  4. decreased hospital length stay compared to PN
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16
Q

nasogastric tube complications

A
  1. mucosal ulceration
  2. clogging
  3. esophageal perforation
  4. pneumothorax
  5. GI bleeding
  6. pulmonary aspiration
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17
Q

gastrostomy complications

A
  1. aspiration
  2. dislodgements
  3. bleeding
  4. wound infection
  5. stomal leakage
  6. tube occlusion
  7. pneumoperitoneum
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18
Q

jejunostomy complications

A
  1. pneumatosis intestinalis
  2. bleeding
  3. dislodgement
  4. bolvulus
  5. bowel obstruction
  6. stomach leakage
  7. wound infection
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19
Q

contraindications of EN

A

diffuse peritonitis, intestinal obstruction, intractable vomiting, paralytic ileus, intractable diarrhea, and gastrointestinal ischemia

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20
Q

diffuse peritonitis

A

acute widespread attack of the peritoneum and usually caused by infection or perforation of an abdominal organ

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21
Q

PN is prescribed for patients in which

A

oral intake is inadequate and who cannot be fed via the GI tract

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22
Q

two types of PN

A

total parenteral nutrition (TPN) and peripheral parenteral nutrition (PPN)

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23
Q

TPN is administered via

A

central venous catheter (CVC)

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24
Q

TPN has the ability to

A

maximize caloric intake and volume restrict patients

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25
Q

disadvantages of TPN

A

CRBSI and central venous thrombosis

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26
Q

CRBSI

A

catheter related blood stream infections; TPN is an independent risk factor for this

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27
Q

central venous thrombosis

A

most commonly reported complication with BSI, occurs in 45% of patients with CVC’s

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28
Q

PPN is administered via

A

peripheral catheter

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29
Q

energy intake and PPN

A

limited energy intake due to concentration restrictions (unable to volume restrict)

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30
Q

can SNS be treated as an emergency

A

NEVER

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31
Q

indication of SNS

A
  1. individuals who cannot, should not, or will not eat adequately
  2. benefits of improved nutrition outweigh the risks
  3. patients who are malnourished or at significant risk for becoming malnourished
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32
Q

nutrition screening identifies

A

changes in a patient’s condition that effect nutritional status, risk factors that place a patient a nutrition risk and that may lead to a nutrition related problem, and identifies individuals who are malnourished or at risk for malnutrition

33
Q

malnutrition can be considered

A

deficiency of nutrient intake, impaired nutrient metabolism, or over-nutrition

34
Q

consequences of malnutrition are generally related to

A

premorbid condition, extent and length of time nutrient intake is inadequate, or concurrent presence of other diseases/illnesses

35
Q

factors indicative of malnutrition

A
  1. involuntary loss/gain of 10% or more of usual BW within 6 months
  2. involuntary loss/gain of 5% or more of usual BW within 1 month
  3. BW of > 20% or more over or under IBW (especially in the presence of chronic disease or increased metabolic requirements)
  4. inadequate nutrition intake (impaired ability to ingest/absorb food)
36
Q

objective indicators to screen for malnutrition

A

height, weight, weight change, primary diagnosis, and presence of comorbidities

37
Q

nutrition assessment is defined as

A

a comprehensive approach to defining nutrition status

38
Q

nutrition assessment includes

A

medical, nutrition, and medication histories; physical examination; anthropometric measurements; lab data

39
Q

evaluation of nutrition status consists of two components

A

nutrition assessment and metabolic assessment

40
Q

nutrition assessment

A

utilizes static measurements of body compartments and examines the alteration caused by undernutrition

41
Q

metabolic assessment

A

includes analysis of the structure and function of organ systems; altered metabolism; metabolic response to nutrition intervention

42
Q

goals of nutrition assessment are

A
  1. to identify patients who are malnourished or at risk for malnutrition
  2. to collect the information necessary to create a nutrition care plan
  3. to monitor the adequacy of nutrition therapy
43
Q

BMI of 14-15 kg/m2

A

increased mortality

44
Q

BMI < 18.5 kg/m2

A

underweight

45
Q

BMI > 25 kg/m2

A

overweight

46
Q

BMI < 30 kg/m2

A

obese

47
Q

patient history you should ask about

A

weight, changes in eating habits, GI function, nature/severity of underlying disease, or unusual personal dietary habits/restrictions

48
Q

what is the best marker of nutrition status on admission?

A

albumin

49
Q

when a patient is stressed does albumin increase or decrease?

A

decrease - this makes it a poor marker of changes in nutrition status

50
Q

half life of albumin

A

15-20 days

51
Q

transferrin is typically elevated in

A

iron deficiency anemia

52
Q

half life of transferrin

A

7-8 days

53
Q

prealbumin is used to

A

assess nutrition status changes in response to therapy

54
Q

half life of prealbumin

A

2-3 days

55
Q

what should be included in a nutrition care plan?

A

nutrition goals, ROA of nutrition support, and goals of nutrition care/intervention

56
Q

nutrition monitoring should be done how often in a hospital? in outpatient?

A

daily in hospitals

every week or month in outpatient

57
Q

nutrition management is based off of

A

nutrition status, disease, organ function, metabolic condition, medication use, and duration of nutrition support

58
Q

dosing weight is ideally based on

A

lean body mass

59
Q

dosing weight equation

A

IBW + 0.25 (ABW-IBW)

60
Q

are energy requirements patient specific?

A

yes

61
Q

range of energy requirements

A

20 to 35 kcal/kg daily

62
Q

protein range

A

0.8 gm/kg daily to gm/kg daily

63
Q

protein provides how many kcals?

A

4 kcal/gm

64
Q

final protein concentrations in PN formulation range from

A

2 to 7%

65
Q

carb requirements should not exceed

A

7/gm/kg daily

66
Q

dextrose provides how many kcals?

A

3.4 kcal/gm

67
Q

final concentrations of dextrose in PN formulation ranges from

A

10% to 35%

68
Q

Lipid requirements should not exceed

A

2.5 gm/kg daily

69
Q

how many kcals do lipids provide?

A

10 kcal/gm

70
Q

1) 10% of intralipids provides..
2) 20% of intralipids provides..
3) 30% of intralipids provides..

A

1) 1.1 kcal/mL
2) 2 kcal/mL
3) 3 kcal/mL

71
Q

what to monitor to determine efficacy of SNS

A

repletion of lean body mass, reduction in morbidity, optimization of clinical outcomes, improve quality of life, utilize surrogate markers

72
Q

surrogate markers of nutrition status

A

energy balance, body composition analysis, body weight measurements, serum protein concentrations, protein balance, and nitrogen balance

73
Q

the ultimate goal of SNS is

A

to improve clinical outcomes such as, quality of life, morbidity/mortality, length of hospital stay, and cost

74
Q

complications of SNS

A
  1. refeeding syndrome
  2. hyperglycemia
  3. hypoglycemia
  4. acid-base abnormalities
  5. hypertriglyceridemia
  6. excessive CO2 production
  7. hepatic steatosis
  8. vascular access sepsis
  9. thrombosis
  10. gastroesophageal reflux
  11. pulmonary aspiration
  12. GI complications
75
Q

refeeding syndrome presents as

A

fluid, micronutrient, electrolyte, and vitamin imbalances

76
Q

refeeding syndrome may involve..

A

hemolytic anemia
respiratory distress
cardiac arrhythmias

77
Q

lab findings in refeeding syndrome

A

decreased phosphate, magnesium, and potassium

78
Q

prevention of refeeding syndrome

A

replete serum electrolytes prior to SNS, limit initial carb intake to 150 gm/day and fluid to 800 mL/day, provide adequate amounts of electrolytes in the initial formation, increase carb-dependent minerals in proportions to increased carbs when SNS is advanced (K, Mg, PO, Zn)

Nutrition (2 decks)

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