Resting energy expenditure
Energy needed to consume over a 24 hr period for a body to maintain all it’s internal working activities while at rest.
Basal metabolic rate
Energy needed to maintain life sustaining activities.
How many kcal is 1 gram go carbs?
4 kcal
What are mono saccharides and disaccharides classified as and where are they found?
Simple carbohydrates found in sugars
Simplest form of protein?
Amino acid
Where do you get amino acid?
Diet
What are albumin and insulin?
Simple proteins because they contain only amino acid.
What combination produces a complex protein?
Simple protein with a non protein substance
What kind of protein is best for growth and nitrogen balance?
Complex protein
When is nitrogen balanced?
When intake and output are equal.
What conditions would require more protein?
Infection, sepsis, burns, fever, starvation, head injury and trauma
Most calorie dense food how many kcal/ g?
Fats 9 kcal /g
What is chemical make up of saturated and unsaturated fatty acids?
Saturated; carbon in chain has two hydrogens
Unsaturated; unequal hydrogens attached to carbon w a dbl bond.
How many bonds for mono saturated?
One
Active transport?
Energy dependent, concentration moves from greater area of concentration to lesser, carrier is needed to move partials accross cell membrane .
Passive transport?
Force where particles move from greater to lesser concentration. Does not need a carrier.
Osmosis
Movement of water through me brain to equalize concentrations.
Pinocytosis
Engulfing of large molecules by absorbing cell
Drug nutrient interactions, Analgesic ( actaminophen, aspirin) ?
Decreased drug absorption with food, overdose associated with liver failure
Absorbed directly through stomach; decreases drug absorption with food ; decreased frolic acid, vitamins c and k and iron absorption.
Drug nutrient interaction Antacid (aluminum hydroxide, sodium bicarbonate).
Aluminum hydroxide: decreased phosphate absorption
Sodium bicarbonate: decreased frolic acid absorption.
Drug nutrient interaction with Antiarrhythmic ( amiodarone, digtalis ).
Amiodarone: taste alteration
Digitalis: anorexia, decreased renal clearance in older person.
Drug nutrient interactions with Antibiotic ( penicillins, cephalosporin, rafampin, tetracycline, trimethoprim/ sulfamethoxazole)
Penicillins; decreased drug absorption w food, taste alterations
Cephalosporin: decreased vitamin k
Rifampin: decreased vitamin B6, niacin, vitamin D
Tetracycline: decreased drug absorption w milk and antacids, decreased nutrient absorption of calcium, riboflavin, vitamin C , due to binding.
Trimethoprim / sulfamethoxazole: decreased frolic acid.
Drug nutrient interaction for Anticoagulant (coumarin)
Acts as antagonist to vitamins k.
Drug nutrient interaction for Anticonvulsant (carbamazepine, phenytoin)
Carbamazepine: increased drug absorption w food.
Phenytoin: decreased calcium absorption, decreased vitamins D, K, and frolic acid, taste alteration, decreased drug absorption w food.
Drug nutrient interactions for Antidepressants (Amitrityline, Clomipramine, Fluoxetine).
Amitrityline: appetite stimulant
Clomipramine: taste alteration, appetite stimulant
Fluoxetine: taste alteration, anorexia
Drug nutrient interactions for Antihypertensive (Captopril, Hydralazine, Labetalol, Methyldopa).
Captopril : taste alterations
Hydralazine: enhanced drug absorption w food, decreased vitamin B6
Labetalol: taste alteration ( weight gain for all beta blockers)
Methyldopa: decreased vitamin B 6 , frolic acid, iron
Drug nutrient interactions with Antiinflammatory ( all steroids).
Increased appetite and weight, increased frolic acid, decreased calcium ( osteoporosis with long term use ), promotes gluconeogenesis of protein.
Drug nutrient interaction for Antiparkins ( levodopa)
Levodopa : taste alteration, decreased vitamin B6 and drug absorption w food.
Drug nutrient interaction with Antipsychotic ( chlorpromazine , thiorhixene)
Chlorpromazine: increased appetite
Thiorhixene: decreased riboflavin, increased need
Drug nutrient interaction for Bronchodilator (albuterol sulfate, theophylline)
Albuterol sulfate: appetite stimulant
Theophylline: anorexia
Drug nutrient interaction with Cholesterol lowering ( cholestyramine).
Cholestyramine: decreased fat soluble vitamins A,D,E,K, vitamin B12, iron
Drug nutrient interaction with Diuretic ( Furosemide, Spironolactone, Thiazides)
Furosemide: decreased drug absorption with food
Spironolactone: increased drug absorption with food
Thiazides : decreased magnesium, sink, potassium
Drug nutrient interaction with laxative ( Mineral oil).
Mineral oil; decreased absorption of fat soluble vitamins A,D,E,K and carotene.
Drug nutrient interactions with platelet Aggregate Inhibitor ( Dipyridamole).
Dipyridamole; decreased drug absorption with food.
Drug nutrient interaction with potassium Replacment ( Potassium chloride).
Potassium chloride; decreased vitamin B 12
Drug nutrient interaction for Tranquilizer ( Benzodiazepine )
Increased appetite.
Clients who are malnourished on admission are at greater risk for?
Arrhythmia, sepsis, or hemorrhage
Lactose intolerance from high to low on ethnic groups.
Asian pacific African Native American Mexican Middle eastern Whites
Anthropometric
Measure system of size and makeup of body.
How many ml per pound?
500 ml = 1 pound
Why would frequent weights for a renal failure pt be important?
To know weather they are retaining fluid.
Albumin level is a better indicator for what?
Chronic illnesses
Per albumin leaves is best indicator for?
Acute conditions
A positive nitrogen balance is necessary for?
Anabolism
Dysphasia
Difficulty swallowing
What can dysphasia lead to?
Malnutrition
TPN
Total parent earl nutrition
What are things you can do to promote appetite in a sick client?
Keep environment free from odor
Provide oral hygiene to remove bad taste.
Maintain comfort
What meds affect metabolism?
Insulin, glucocorticoids, and thyroid hormones
What meds affect taste?
Antifungal agents
Some psychotropic meds affect what?
Appetite
Cause nausea
Alter taste
EN
Enter all nutrition
How does enteral fed pt receive formula?
Nasogastric
Jejunal
Gastric tube
What reason would someone receive a gastric feeding vs a jejunal?
If they have low risk of gastric reflux
How can you verify placement of tube?
X ray
What are the 4 types of formulas?
Polymeric, pt must be able to absorb whole nutrients
Modular formula, has to be added to other foods to be fully nutritious
Elemental formula, specifically nutritious to fit need of pt
Tube feeding are typically started?
At full strength at slow rates
If no sight of intolerance when do you increase rate?
Ever 8 to 12 hrs
What does feed by tube help?
Reduce sepsis
Minimize hyper metabolic due to trauma,
Maintain structure and function
Why does nasointestinal or jejunal tubes allow successful post pyloric feeding?
Because formula is placed directly into small intestines or jejunum
Or beyond the pyloric sphincter of stomach
What does aspiration of formula into tracheobronchial lead to?
Necrotizing infection
Pneumonia
Potential abscess formation
Acute respiratory distress syndrome is an outcome from?
Pulmonary aspiration.
What common conditions increase risk for aspiration w feed tube?
Coughing Nastracheal suctioning Artificial airway Decreased level of consciousness Lying flat
How much to elevate head?
30 degree or higher
Hoe often to measure GRV?
Every 4 to 6 hr for continuous feeders
Immediately before the feeding for intermittent feeders
What recommendations are made for gastric residual volumes?
Stop feeding if aspiration occurs
Withhold feelings and reassess pt tolerance to feelings if GRV is over 200 ml for two successive measurements
Routinely eval pt for aspiration , reduce risk if GRV is over 200 ml
Can’t eat food but can absorb nutrients, what kind of feeder?
Enteral tube
Feeding tubes are inserted where?
Nose
Surgically
Endoscopic ally
What kind of feeder for long term? What is considered long term?
Surgical or endoscopic ally placed tubes
Long term is more than 4 wks
The measurement of PH of secretions withdrawn from feeder helps what?
Differentiate location of the tube.
For measuring PH what must be done 1st?
Inject 30 ml of air into tube
pH of gastric aspiration range?
1 and 4
Pt who takes acid inhibitor med will have acid range?
4.0 after 4 hrs of fasting to 6.0 with continuous EN infusion
Intestinal aspiration range PH?
7.8 to 8.0
What blue dye for formula?
Assists detection of aspiration in lung
Is dye still used?
Nope so never mind the last flash card!
Severely malnourished feeder pt are at risk for ?
Electrolyte disturbances from reseeding syndrome
PN
Par enteral nutrition for pt unable to absorb enteral nutrients
Pt who suffer from sepsis, head injury or burns get what kind of feeder?
PN therapy
What provides supplement kilocalories and prevents fatty acid deficiencies?
Lipid emulsions
Addition of lipid emulsion to PN is called?
3 in 1
What to do if you see lipid emulsion in oil droplets ?
Do not use
What is a puncture insult to the pulmonary system? What results from it?
Pneumothorax
Results in accumulation of air in pleural cavity, collapsed lung, impaired breathing
When does pneumothorax most often occur?
During CVC placement
Hat helps prevent air embolus?
Pt holding breath while bearing down (vassal a maneuver)
Client suffers fever, chills, glucose intolerance. What do you suspect?
Catheter sepsis
How often do you change TPN infusing tubing?
Every 24 hrs
Limit for lipid hang time?
No more than 12 hr
What’s refeeding syndrome?
In malnourished pt resulting low serum levels of electrolytes and edema caused cardiac days rhythmical,congestive heart failure, respiratory distress, convulsions, coma or death
Should nurse increase rate if infusion falls behind schedule?
No it can result in osmosis dieresis and dehydration
What is goal of PN feeding future?
To move to EN feeding to oral feeding
When is PN discontinued?
When 75%of needs are being met by reliable dietary intake.
Medical nutrition therapy MNT
Use of specific nutrition therapies to treat an illness, injury or condition.
What are the 10 problems that can occur for enteral tube feeding?
- Pulmonary aspiration
- Diarrhea
- Constipation
- Tube occlusion
- Tube displacement
- Abdominal cramping, nausea/vomiting
- Delayed gastric emptying
- Serum electrolyte imbalance
- Fluid overload
- Hyperosmolar dehydration
What is intervention of hyperosmolar dehydration?
Slow rate of delivery, dilute, or change to isotonic formula
What is intervention for, restrict fluids if necessary, and use either a specialized formula or a diluted enteral formula at first?
Fluid overload
What are 5 problems with par enteral nutrition?
- Electrolyte imbalance
- Hypercapnia
- Hypoglycemia
- Hyperglycemia
- Hyperglycemia hyperosmolar nonketotic dehydration/coma