Nutrition Flashcards
how does bedrest affect nutrition
for every day of bedrest there is a 3% loss of muscle mass
Why is nutrition so important?
high stress and critically ill patients have increased metabolic demand
catabolism(break down) exceeds anabolism (build up) - because they need so much energy they start breaking down muscles
nutrition may help correct low protein states, repair muscle, and replenish nutritional stores
what are some nutritional goals?
supply substrates necessary to meet the metabolic demands
minimize the effects of hypermetabolism
prevent nutrient deficiency
why do we want a nitrogen balance
nitrogen a byproduct of protein synthesis
relationship between the amount of nitrogen that we consumer verses what we excrete
What are the important facts about parenteral nutrition?
high osmotic load, central line preferred
multiple lumen CVC with dedicated lumen
femoral vein not preferred because of increased risk of infection
composition and infusion rate is individualized to each patient
What are some considerations with parenteral nutrition?
hyperosmolality
hyperglycemic
electrolyte abnormalities
volume overload
elevated triglycerides which could lead to acutes pancreatitis
would not start if patient is able to be fed enterally in a couple of days
important facts about lipids
infused separately
some meds are in lipid solutions, so the lipid component of tpn might be held. even if you are just bolusing propofol
provides a rich environment for bacteria and fungi
bottle, tubing changes 12-24 hours due to high infection risk
increased risk of hyperlipidemia
What are some complications of tpn therapy
bloodstream infection fungal infection risk 4-5x greater metabolic abnormalities hyperglycemia treated with separate insulin infusion electrolyte imbalances elevated triglycerides
Advantages of enteral feeding
protects gut mucosa
prevent bacterial translocation (prolonged gut rest causes loosening of the tight junctions due to inflamation)
attenuates hypermetabolic response (stop catabolism)
more complete nutrition
fewer infectious complications
feeding within 24 hours is proven to show improved patient outcomes
preservation of gut andi mmune functions
contraindications of enteral feeding
hymodynamically unstable patient gi ischemia gi obstruction severe and protracted ileus major upper gi bleed intractable vomitting if NJ not effective
What are some standard icu tubing feeding formulas?
isotonic to serum
mixture of simple and complex carbs
protein and fatty acids
essential vitamins, minerals, micronutrients
not suitable for all patients - special formulas for pts such as renal, ards, fluid restriction,
we do not meet daily water needs of the patient with this formula alone, and often will have a free water flush adjunct order
What is the pathophysiology of refeeding syndrome?
associated with chronic malnutrition, acute malnutrition (npo >7 days) and ETOH abuse
the reintroduction of carbohydrates leads to increased insulin because the glucose is being stored rather than being used
production and increased for demand for electrolytes
insulin release causes large, rapid shifts in fluids and electrolytes from extracellular to intracellular spaces for storage
results in glyconeogensis of muscle, fat and protein
leads to cardiac arrest and respiratory arrest
high risk of vtach
How can we prevent refeeding syndrome?
screen patients at risk for malnutrition start feeds slowly 10ml/hr for 24 hours monitor blood glucose levels monitor serum electrolytes monitor fluid overload supplemental vitamins and electrolytes
