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Dems Unit 2 Part 2 YAAAY > Hospital Nutrition > Flashcards

Flashcards in Hospital Nutrition Deck (31):
1

days before nutritional deficiency:
well nourished with minimal acute illness

10-14

2

days before nutritional deficiency:
undernourished with minimal illness

5-7

3

days before nutritional deficiency:
well nourished with serious acute illness

5-7

4

days before nutritional deficiency:
undernourished with serious medical illness

3-5

5

what method of feeding is preferred in people who cannot feed themselves?

enteral: tube to GI tract
- mimics physiological route to deliver nutrients to nourish GI epithelium
-lower risk than parenteral (infection)

6

main sources of macronutrients in formula

corn oil, maltodextrin (starch), & casein (milk protein)

7

typical energy density in formula

1kcal/mL

8

range of TEE in sick people

22-25 --> 30-32 kcal/kg/day

9

how to calculate daily energy needs?

TEE kcal/kg/day X weight in kg = kcal/day =ml/day

10

hourly infusion rate calculation

daily energy need divided by hours in day
(kcal/day = ml/day) divided by 24

11

body position to facilitate gastric emptying

right lateral decubitus
facilitate gastric emptying

12

minimum requirements

multi-vitamin, thiamine, folate included with D5

13

how to calculate glucose intake

dextrose= 5%
100ml/hr X 5% = 5 g/hour =20calories
24hours X 20 calories/hour = 480 calories of 100% carb

14

overfeeding

-before glycogen stores full- fine
-after glycogen stores full--> hyperglycemia that may be difficult to control with insulin
-may take several days to correct and reverse situation

15

underfeeding

negative nitrogen/ protein balance
-break down muscle to AA for gluconeogenesis for glucose for the brain --> lose weight

16

how to estimate how much protein is broken down?

grams of urinary nitrogen over 24hours X 6.25

17

how to estimate how much protein you are feeding?

(grams protein/L) X (#L/day)

18

negative protein balance

(grams urinary nitrogen X 6.25) > (grams protein/L X #L/day)

19

average protein requirement for sick people

0.8 to 1g protein/kg body weight/day

20

why would you not want to overfeed a patient trying to get off mechanical ventilation?

if overfed, they increase the rate of oxidation of nutrients --> consuming more O2 and producing more CO2

Increased CO2 production --> Increased need for ventilation

21

What type of special diet has ben suggested for a person with respiratory failure?

HIGH FAT DIET:
glucose use produces more CO2 per O2 consumed than fat use

allow adequate energy (to prevent weakness of respiratory muscles) while minimizing CO2 production

*Evidence is lacking

22

Why might a limited intake of protein, salt and water be indicated in a patient with hepatic encephalopathy?

patient is unable to incorporate ammonia into urea--> toxic levels in blood

ascities due to salt and water retention

23

What type of special diet has been suggested for patients with hepatic encephalopathy?

High BRANCHED CHAIN AA

Altered mental status may also be due to accumulation of false NT in brain from high levels of Aromatic AA

Diets high in branched chain AA may provide adequate energy without contributing to false NT in brain

*Evidence is lacking

24

feeding considerations with renal failure

Kidneys should excrete urea : nitrogen from protein catabolism

Kidney failure: BUN increases

Some suggest limiting protein but patients are usually malnourished

Don't overfeed protein and don't overly restrict

25

CAD diet

restrict saturated fats

26

Overweight/ Obese diet

energy restriction

27

CHF

restrict salt

28

Cardiac Diet

low fat, low sodium, low saturated fat

29

most important factor for insulin dosing in diabetes

carb intake

30

diabetic diet

restrict calories, fat, simple sugars

31

why opt for a patient chosen diet over a diabetic diet?

so adjusted meds are more valid when then transfer to home