Medical Nutrition Therapy Flashcards
(88 cards)
What does a low CBC tell us?
Anemia
What should our albumin levels be?
lower than 3.4
What should our cholesterol levels be?
lower than 160
With a very low LDL
WHat are some instances where we would need to supply nutirtional support to patients?
- Bowel not functioning normally
- Severe prolonged hypercatabolic states (burns, multiple trauma, mechanical ventilation- all change metabolic state significantly-ICU patients)
- Prolonged bowel rest required
- Severe protein-calorie malnutrition who have had a loss of over 25% of body-weight
What is hypercatabolic and what kind of situations would it occur?
- breakdown of molecules in the body to produce energy
- Severe prolonged hypercatabolic states (burns, multiple trauma, mechanical ventilation- all change metabolic state significantly-ICU patients)
Where does IV nutrition (parenteral) from a central line dump into?
dumps right into the right atrium
When determining the need for a enterostomy what perameters would you need?
2
The GI tract works and is it safe to use
Nutritional support needed for longer than 6 weeks
When detemining the need for a nasogastric tube what parameters would you need?
3
The GI tract works and is it safe to use
Nutritional support needed for less than 6 weeks
The patient is not at a high risk of aspiration
When detemining the need for a nasoduodenal tube what parameters would you need?
3
The GI tract works and is it safe to use
Nutritional support needed for less than 6 weeks
The patient is at a high risk of aspiration
When determinging the need for parenteral nutrition what parameters would you need?
The GI tract is does not work and/or not safe to use
If you determined the need to parenteral nutrition what procedure would you do?
Placement of a central venous catheter
When do we start enteral nutrition?
within 48 hours (of whatever condition started the patients problem)
What have studies shown about introducing enteral nurition earlier rather than later?
may decrease the incidence of infection in critically ill patients if provided early in the course of the critical illness.
When do we start parenteral nutrition?
Exact timing when to start parenteral nutrition is unclear but the optimal time is within 1-2 weeks unless otherwise indicate
What have studies shown about introducing parenteral nutrition earlier rather than later?
Early TPN in critically ill pts may increase the incidence of infection and does not reduce mortality.
Indications for eneteral nutrition?
Oral intake insufficient to meet estimated nutritional needs with a functional GI tract
Contraindications for enertal nutrition?
7
- Hemodynamically unstable and have not been fully volume resuscitated (due to risk of bowel ischemia) - not increasing blood pressure because youre thinking they might have a bowel ischemia so you dont want blood flowing to the Intestines. Which it is not doing when you have low blood pressure.
- Bowel obstruction
- major upper GI bleeding
- intractable vomiting (just vomit it back up)
- diarrhea (same with vomiting)
- GI ischemia
- GI fistula
Complications that could arise with enteral feeding
9
- Diarrhea (most common)
- Inadequate gastric emptying, 3. emesis,
- esophagitis,
- occasional GI bleeding
- Aspiration
- Dehydration
- Electrolyte abnormalities
- Mechanical obstruction of the tube
When would you use a nasogastric tube and when would you use a nasoduodenal tube?
Nasogastric tube
-Need to be able to sit up in bed and protect airway
Nasoduodenal tube
-If unable to sit up in bed and/or unable to protect airway
When would you use a Gastroenterostomy and when would you use a Jejunostomy?
Gastroenterostomy
-Bolus feeding, need to be at low risk for aspiration
Jejunostomy
-Distal placement so better for people who are high risks for aspiration
What does a commercially prepared enteral solution include?
7
- Water,
- energy,
- amino acids,
- electrolytes,
- vitamins,
- minerals,
- essential fatty acids
What kind of diseases need specific enteral solutions?
4
- Renal disease
- Malabsorption
- respiratory failure (> 50% of calories from fat)
- hepatic encephalopathy (increased BCA’s)
Why would people with respiratory failure need a diet high in fat?
carb metabolism byproduct is CO2
give them less carbs more fat
What are we monitoring daily with enteral nutrition feeds?
7
Daily 1. electrolytes, 2. glucose, 3. phosphorus, 4. magnesium, 5. calcium, 6. BUN and 7. creatinine until the levels are stable then you can start doing it a few times a week
