Exam 3 lecture 1 Parenteral and Enteral Nutrition

Question 1

How to calculate IBW

Answer 1

Male- 50 Kg + (2.3 x inches over 60”)
Female- 45.5 + (2.3 x inches over 60”)

Question 2

How to calculate DBW (dosing body weight)? When to use it over IBW

Answer 2

DBW= IBW + 0.4 (wt-IBW)
use if body weight is 130% or more of IBW
APplies for certain drugs (antibiotics)

Question 3

How to calculate nutritional body weight (NBW)

Answer 3

NBW= IBW + 0.25 (wt-IBW)

Use if actual body weight is 130% or more of IBW

APplies for calculating fluid, electrolytes, and nutrition parameters (FEN)

Use this if drug isnt antibiotic and is >130% of actual body weight

Question 4

What is one of the most common indications for parenteral nutrition

Answer 4

small bowel resection

Question 5

benefits of early initiation of nutrition

Answer 5

decrease disease severity, complications and ICU length of stay. Increases patient outcomes

Question 6

what are some risk factors for malnutrition

Answer 6

-under body weight (UBW) = 20% below IBW
-Involuntary weight loss >10% within 6 months
-NPO> 7 days
-gut malfunction
-mechanical ventilation
-increased metabolic needs (trauma or burn pts, high dose steroids)
- alcohol/substance abuse
- protracted nutrient loss

Question 7

time frame to start nutrition in hospital

Answer 7

eithin 48 hours of hospitalization

Question 8

What are screening tools used in nutrition

Answer 8

NUTRIC
Nutrition risk score (NRS)

Question 9

What is the score hugh risk patients have for NUTRIC? Low risk?

Answer 9

High risk- 6-10 (5-9 without IL-6)
low risk- 0-5 (0-4 without IL-6)

Question 10

WHat are things to consider when doing a nutritional assessment

Answer 10

Risk factors for malnutrition
History
Anthropometrics
Classifications of malnutrition
Nitrogen balance

Question 11

What are things in pateintsbhistory we use when ding a nutritional assessment

Answer 11

1. Dietary- intake, swallowing, ulcers, anorexia, vomiting diarrhea
2. medical- surgical history , PMH
3. Medications- decrease nutrient absorption, alter taste, N/V

Question 12

what is anthropometrics

Answer 12

somatic (muscle) protein stats
- weight
-triceps skin fold
-arm muscle circumfrence

Question 13

WHat are labs that show visceral protein status. WHat is the best MP listed (marker point)?

Answer 13

albumin
transferrin
transthyretin (prealbumin)
retinol binding protein

the best is transthyretin

We do not just use prealbumin to make decisions in ICU

Question 14

What is the relationship between prealbumin and CRP (c-reactive protein)? What is CRP? use? Normal level of CRP? What happens to prealbumin during inflammation?

Answer 14

prealbumin decreases as CRP increases–> inflammation
Prealbumin decreases as CRP normal—> malnutrition

CRP is an acute phase reactant that increases during inflammation

normal < 1 mg/dl

used to assess accuracy of prealbumin

prealbumin is falsely decreased in presence of inflammation

Question 15

classifications of malnutrition

Answer 15

1. marasmus- protein-calorie malnutrition. Decreased total intake and/or utilization of food
   Wasting of skeletal muscle and sq fat
   Immunosuppression in severe cases
2. Kwashorkor (protein malnutrition). Adequate caloric intake, relative protein malnutrition
3. mixed- chronically ill starved patients who are metabolically stressed. decreased visceral proteins, poor wound healing, immunocompromised

Question 16

symptoms of marasmus and kwashorkor? treatment?

Answer 16

kwashorkor symptoms- large belly, diarrhea, change in skin pigment, decreased muscle mass, failure to gain weight, hair changes

wasting of muscle not as evida=ent as marasmus

treatment- provide carbs followed by high protein

marasmus symptoms- Peeling and alternatively pigmented skin, hair loss, edema, swelling, skin folds are formed. Wasting of muscles are quite evident. Treatment provide a balanced substrate

Question 17

What is nitrogen balance? How is nitrogen excreted? In what form? What increases the nitrogen balance? WHat percent of total nitrogen excretion.

Answer 17

it is a measurement of urinary excretion of nitrogen as urea nitrogen (urinary urea nitrogen; UUN)

• nitrogen released from protein catabolism. It is converted to urea and excreted in urne.

stress increases nitrogen balance. So does protein catabolism

Measured from 24 hr urine collection

represents 85-90% of total nitrogen excretion

Question 18

What is the goal nitrogen balance

Answer 18

+3 to +5 grams

Question 19

how to calculate nitrogen balance?

Answer 19

Nitrogen balance= (N in)- (N out)

N in= 24 hour protein intake (g)
——————————-
6.25

N out= 24 hour UUN + 4
(we use 4 because goal is between 3-5 g)

Question 20

What is TEE?

Answer 20

total energy expenditure

Question 21

caloric requirements based on condition of patient

Answer 21

a) non-stressed/non depleted- 20-25

b) Trauma/stress/surgery
critically ill 25-30 (EXAM)
major burns

c) Obesity: BMI 30-50 11-14 kcal/kg/day
actual body weight

d) Obesity: BMI>50 22-25 kcal/kg/day
ideal body weight

Question 22

Calories needed for hospital stay patients XEAM

Answer 22

25-30

Question 23

how to get a TEE from an REE

Answer 23

TEE= REE x 1.2

Question 24

What is indirect calorimetry?

Answer 24

Preferred method for critically ill patients

Provides energy expenditure (REE, RQ) at that one pount in time, then extrapolated to 24 hrs

Question 25

What is RQ? how do we calculate it?

Answer 25

For all energy production, oxygen is consumed and co2 is produced RQ= Vco2/Vo2

Question 26

What is a normal RQ? What does it mean if it is above or below the normal range?

Answer 26

0.85-0.95 if it is above 0.95- overfeeding below 0.85- underfeeding monitor once weekly