Hospital Nutrition Flashcards
(24 cards)
Previously well nourished with minimal acute medical illness can go how long without food before severe nutritional deficiencies
10-14 days
previously undernourished with minimal illness can go how long without food before severe nutritional deficiencies
5-7 days
previously well nourished with serious acute medical illness can go how long without food before severe nutritional deficiencies
5-7 days
previously undernourished adult with serious medical illness can go how long without food before severe nutritional deficiencies
3-5 days
people at risk of undernutrition
alcoholic, homeless, underweight, muscle loss/cachexia, chronic diarrhea/other GI disturbances, self-report poor dietary intake, chronic conditions that increase energy expenditure, insensible losses from proteinuria, mucous production, bleding
what do you have to do before feeding
decide when to feed, place feeding tube or IV line for parenteral feeding, make sure tubes in right place
Risk of enteral feeding
aspiration into lungs
risk of parenteral nutrition
risk of placing central venous catheter, risk of infection from central line containing nutrients in high concentration
preferred route of administration of nutrients
enteral when possible. Risks are lower and benefits to delivering by normal GI route (nourishing GI epithelium important in long term nutrient absorption and acts as a barrier to colonic flora)
typical density of standard liquid nutritional feeding formula
1 kcal/ml
also a number of types that can be used for unique needs
TEE for someone in hospital
general range is 22-25 kcal/kg/day for someone not that sick to 30-32 kcal/kg/day for someone very sick
how to get infusion rate
take persons weight (kg) times it by number of kcal/kg/d you think is appropriate to calculate daily energy needs. Number of kcal/day = ml/day, so divide that by number of hours for total infusion rate
starting infusion
start with lower infusion rate and gradually increase flow rate over days. This is because they may have trouble emptying their stomach –> can vomit and aspirate. You can check residuals periodically
what vitamins do you give with glucose
thiamine, folate adn multiple vitamin to potentially malnourished ppl
what happens if you overfeed someone
will be fine for several days as they fill up glycogen stores but then tend to develop hyperglycemia that can be difficult to control since stores of glycogen are full. Can reduce calories but may take several days for situation to reverse.
what happens when you underfeed someone
these individiuals will lose weight as they break down more protein for gluconeogenesis. Can estimate how much protein broken down by measuring urinary nitrogen over 24 hours
where does urine nitrogen come from
catabolism of amino acids
how to estimate grams of catabolized protein
take grams of urinary nitrogen and multiply by 6.25 (empirically derived number)
avg protein requirement for sick pts
0.8-1g protein/kg body weight/d
nutrition in respiratory failure
overfeed: pt tries to increase rate of oxidation of nutrients and will consume more oxygen/produce more CO2. More CO2 –> need more ventilation
don’t want to overfeed or underfeed (could cause weak respiratory muscles)
more CO2 produced for each O2 consumed when glucose burned than fat. Some people say to minimize CO2 production while still giving adequate energy to consider higher fat diet for respirator pts
nutritional support in Liver failure
end stage liver disease pts can develop hepatic encephalopathy party from high ammonia in blood since liver can’t incorporate it into urea. They may also have ascites from salt/water retention
may want to limit protein, salt and water in these individuals but weigh against possible deleterious effect of underfeeding someone who could be already malnourished
nutritional support Renal Failure
if can’t excrete urea, get high BUN, which comes from protein catabolism. Some limit protein a person with renal failure gets but must weigh against risk of too little protein to already undernourished person.
Don’t want to overfeed someone in end stage renal dz but don’t want to overly restrict. Nitrogen balance hard to calculate
nutritional support in Cardiac Disease
hospitalization good opp for those with CAD to discuss sat fat restriction with nutritionist
overweight/obese pts, energy restriction may be important
CHF: restrict NA
Have “cardiac diet” for hospitalized pts– typically low fat, low sodium, low saturated fat
nutritional support in pts with Diabetes
insulin used in hospital to control glucose;
ideally offer a diabetic diet with controlled carb content at each meal
can adjust meds for diabetes in hospital based on blood sugars in hospital but can be problem if pt goes home and eats more than in hospital
