Therapeutics Exam 3 (Parenteral and Enteral Nutrition) Flashcards
What is the equation for ideal body weight?
Male= 50 kg + (2.3 x inches over 60’’)
Female= 45.5 kg + (2.3 x inches over 60”)
What is the equation for Nutrition Body Weight (NBW)?
NBW= IBW + 0.25(wt - IBW)
When do you use NBW?
If actual body weight is 130% or more of IBW
When conducting a nutritional assessment, what do we take into consideration?
-Risk factors for malnutrition
-History
-Anthropometrics
-Classifications of malnutrition
-Nitrogen balance
UBW (Under Body Weight) is considered what?
20% below IBW
***What are the risk factors for malnutrition?
UBW (under body weight) =20% below IBW
Involuntary weight loss >10% in 6 months
NPO > 10 days*
(clinically use > 7 days)
Gut malfunction*
Mechanical Ventilation*
Increased Metabolic Needs (trauma/burn, high dose steroids)
Alcohol/substance abuse (empty calories)
Protracted nutrient losses (chronic disease)
.
.
.
** refers to ICU patients
When a patient is expected to be NPO, what amount of days of NPO would we want to start nutrition?
Start nutrition if patient is expected to be NPO for >7 days
All hospitalized patients should receive nutrition within how long after hospitalization?
48 hours
What are the 2 main screening tools used for nutritional risk screening?
NUTRIC
Nutritional Risk Score (NRS-2002)
What NUTRIC score indicates that a patient is at high nutritional risk?
6-10
(5-9 without IL-6)
What NUTRIC score indicates that a patient is at low nutritional risk?
0-5
(0-4 without IL-6)
Which part of supplemental nutrition is the most important?
Protein, most patients do not get enough
When doing a nutritional assessment, what does anthropometrics refer to?
Somatic (muscle) protein status
*most patients do not receive enough protein
*look at trends
Why is albumin not used as a nutritional marker?
It has a long half-life and most patients are in the hospital for only a few days
What nutritional monitoring parameters do we use to assess visceral protein status?
Transthyretin (prealbumin)
**but never used alone
C-Reactive Protein (CRP)
***What is the normal serum concentration of prealbumin?
15-40 mg/dL
What does an increased CRP mean?
The body is in an inflammatory state
When CRP goes up, what does prealbumin do?
Goes down
What is a normal CRP?
< 1 mg/dL
If prealbumin decreases as CRP increases, what does this mean?
Inflammation
If prealbumin decreases as CRP is normal, what does this mean?
Malnutrition
What are the 3 classifications of malnutrition?
Marasmus
Kwashiorkor
Mixed
What is Marasmus?
Protein-Calorie malnutrition
(both protein and calories are low)
What is Kwashiorkor?
Protein malnutrition
(only protein is low)
Regarding nitrogen balance, what does high urea in the urine indicate and why?
High urea= High protein breakdown
When protein is broken down (catabolized) it is converted to nitrogen which gets converted to urea and excreted in the urine
What does UUN stand for?
Urinary Urea Nitrogen
Over how long do we measure Urinary Urea Nitrogen?
24-hour urine collection
Urinary Urea Nitrogen (UUN) represents what % of total nitrogen excretion?
85-90%
What is a nitrogen balance study used to assess?
The adequacy of protein repletion
What is the ideal goal nitrogen balance?
+3 to +5 grams
*want more protein going in than going out, do not want a balance of 0
What is the formula for nitrogen balance?
Nitrogen Balance= (N in) - (N out)
N in= (24-hr protein intake [g])/ 6.25
N out= 24-hour UUN (g) + 4 g
How do we give someone nitrogen if they are not receiving enough?
Cannot give someone nitrogen alone, have to give it in the form of amino acids/protein
When estimating caloric needs, what does the Harris-Benedict Equation give you?
Basal Energy Expenditure (BEE)
or
Resting Energy Expenditure (REE)
What is Basal Energy Expenditure (BEE)?
Bare minimum amount of energy/calories to maintain life
(if you are laying there doing nothing)
What is Resting Energy Expenditure (REE)?
Energy being spent by a person at rest
1 inch= how many cm?
2.54 cm
What is the equation for Total Energy Expenditure (TEE)?
TEE= REE x stress or activity factors
What is the recommended amount of calories per day for a Non-stressed, Non-depleted patient?
20-25 kcal/kg/day
What is the recommended amount of calories per day for a Stressed/Hospitalized patient?
25-30 kcal/kg/day
*note that this applies to trauma/stress/surgery patients, critically ill, and major burns
What is the most specific method to calculate caloric requirements?
Indirect Calorimetry
When would we use indirect calorimetry to estimate calorie requirements?
For critically ill patients
What two pieces of data does indirect calorimetry give you?
REE (resting energy expenditure)
RQ (respiratory quotient)
What is an RQ?
Respiratory quotient
(How much CO2 is produced vs how much oxygen is consumed)
*****What is the equation for TEE?
TEE= REE x 1.2
What is the goal range for the RQ?
0.85-0.95
(Above this is overfeeding)
(Below this is underfeeding)
How often do we monitor RQ?
Once weekly
What is the recommended amount of protein per day for a mild to moderate stress patient (floor patients)?
1-1.5 gm/kg/day
What is the recommended amount of protein per day for a moderate to severe stress patient (ICU, trauma, surgery, burn)?
1.5-2 gm/kg/day
How do calories affect protein utilization?
Adequate calories must be present for appropriate protein utilization
*ensure patient is receiving enough non-protein calories
True or False: We usually include protein in calculation of total calories
True
*we subtract protein for Non-Protein Calories (NPC)
What is the standard distribution of dextrose to fat in non-protein calorie distribution?
70% dextrose
30% fat
(70/30)
During sepsis or bloodstream infections, what is the standard calorie distribution of dextrose and fat?
100% dextrose
0% fat
-Used in blood stream infections/fungal infections
(putting fat in the blood stream would feed the infection)
What is parenteral nutrition (PN)?
The process of supplying nutrients via an IV delivery system
What are the synonyms for parenteral nutrition (PN)?
TPN
PN
TNA (total nutrient admixture)
3-in-1
**What are the indications for parenteral nutrition?
Anticipated prolonged NPO course >7 days
Inability to absorb nutrients via the gut
-Ileus
-Small bowel resection
-Malabsorptive states
-Intractable vomiting/diarrhea
Enterocutaneous fistulas
Inflammatory Bowel Disease
Hyperemesis Gravidum
Bone Marrow Transplantation (mucositis)
What total osmolarity should you restrict peripheral PN to?
< 900 mOsm/L
(because if it is super concentrated then it will not be accepted by the body)
What are some limitations to using peripheral PN?
-Requires large volumes of liquid (may not be good for HF or AKI/CKD patients)
-Limited in calories
-Short-Term Access (<7-10 days) *put a central line in ASAP
**Many hospitals do not do the peripheral route
What are the advantages of central PN?
-Allows for administration of hypertonic solutions
-More calories can be delivered
What are the disadvantages of central PN?
Infection risk
Not a benign procedure (risky)
What are the insertion sites for a central venous catheter?
Subclavian (SC) [Chest]
Internal Jugular (IJ) [Neck]
Femoral [Groin]
What are the long-term central venous access options?
PICC (peripherally inserted central catheter)
Tunneled
Implanted Port
What are the 3 main components of nutrition?
Protein
Carbohydrates (Dextrose)
Fat
**One gram protein= how many kcal?
One gram protein = 4 kcal
What is the maximum concentration of dextrose available?
D70% (D70W)
*we dilute this, do not put it directly into a vein
