Nutrition Deck Flashcards
(37 cards)
When is measurement of energy expenditure by indirect calorimetry clinically useful?
To accurately estimate energy needs of hospitalized patients who need nutrition support and are at high risk of stress hypermetabolism (severe burns or trauma) or have severe obesity.
What effect does fever have on energy expenditure and therefore caloric requirements?
Basal metabolic rate increases 10-12% with each °C increase in body temperature.
Oxidization of what macronutrient produces the highest RQ (or the most CO2 per O2 used)?
Carbohydrates. By definition, carbohydrates are made of hydrates carbons (CH2O)n. Therefore, they require the least amount of O2 to fully oxidize to CO2 (and produce the least amount of energy).
How is measurement of the Respiratory Quotient (RQ) helpful in the clinical environment?
It indicates what combination of macronutrients is being oxidized. For example, an RQ of 0.7 indicates that a patient is almost entirely oxidizing fats, which occurs if their metabolic needs are not being appropriately met.
Why does measurement of O2 usage provide a reliable estimate of energy expenditure?
About 90% of the O2 utilized by the body is used to drive nutrient oxidation and ATP production. In other words, the O2 is a substrate for Complex IV (Cytochrome c oxidase) of the electron transport chain, which is the basis of our metabolic rate and allows for all of our energy expenditure
The smallest contributor to Total Energy Expenditure (TEE) in a healthy child is most commonly:
A. Basal energy expenditure
B. Growth
C. Physical activity
D. Thermal effect of food
B. Growth
How can a measurement of O2 utilization be useful in the clinical setting?
A. Demonstrates whether a patient has adequate calories for healing.
B. Demonstrates whether a patient is breathing well.
C. Indicates that a patient is ready to move from parental nutrition to enteral feeding.
D. Provides a reliable estimate of a patient’s energy expenditure
D. Provides a reliable estimate of a patient’s energy expenditure
About 90% of O2 used is for the oxidation of macronutrients and production of ATP, and therefore O2 usage allows one to reliably estimate metabolic rate (energy expenditure).
What information does the respiratory quotient (CO2 produced/O2 consumed) provide?
A. Indication that a patient is ready to move from parental nutrition to enteral feeding.
B. Mix of the macronutrient fuels being utilized
C. Reliable estimate of a patient’s energy expenditure
D. Thermic effect of food
B. Mix of the macronutrient fuels being utilized
For a person with a typical basal metabolic rate (BMR) of 1400 kcal/day and body temperature of 37 °C, how would a fever of 39.0°C affect their BMR?
A. -280 kcal/day
B. -140 kcal/day
C. no major impact
D. +140 kcal/day
E. +280 kcal/day
E. +280 kcal/day
Which of the following is a significant complication of enteral feeding?
A. Aspiration pneumonia
B. Ketoacidosis
C. Liver damage
D. Pancreatic atrophy
E. Sepsis
A. Aspiration pneumonia
Enteral feeding can lead to reflux of stomach contents into the lungs, which can lead to aspiration pneumonia.
A 73-year-old woman is admitted to the rehab unit for evaluation after suffering a cerebral infarction. She is alert and oriented but unable to swallow. How should she be fed?
A. Orally
B. Enterally
C. Parentally
D. Both enterally and parentally
B. Enterally
She has normal bowel function, but cannot maintain adequate oral intake. Therefore, she should be fed via a GI tube.
A 38-year old man was admitted following a major car accident 5 days ago. He suffered severe head and neck injuries, several broken bones and numerous lacerations. He has undergone 3 surgeries and has not yet regained consciousness. How should he most likely be fed?
A. Orally
B. Enterally
C. Parentally
D. Both enterally and parentally
D. Both enterally and parentally
His GI tract is intact and his nutritional needs are most likely very high due to the extent of his injuries. Therefore, following a full nutritional assessment, he will most likely be fed both enterally (to maintain his GI tract and prevent atrophy of the mucosa) and parentally to ensure adequate nutrition to fully support healing.
Mr. Parsons, an 81-year-old man with a history of type 2 diabetes, is admitted to the ICU following a heart attack. He will undergo pacemaker insertion surgery tomorrow, and later this week will have cardiac catheterization to determine the need for a coronary artery bypass graft. He has been NPO (nil per os = nothing by mouth) for the past 4 days due to procedures, and with upcoming surgery, his status remains NPO. Concerned about his nutritional status, you interview his family and review his labs.
He has had a steady weight gain over the past three years, has obesity, and has had an adequate diet. His laboratory values that were checked indicate adequate protein status. He is likely to remain NPO after surgery. Which of the following actions is most appropriate to take?
A. None, his IV dextrose provides the energy he requires
B. Order a clear liquid diet
C. Order a nutrition consult
D. Start him on enteral nutrition
E. Start him on parenteral nutrition
C. Order a nutrition consult
Though he is well nourished now, he is at risk for malnutrition due to NPO status. Not eating for over 4 days is especially significant for people with marginal nutritional status. All patients in this situation should be monitored. If nutritional status is already compromised, beginning early (pre-operative) nutrition support is appropriate. If a patient with good baseline nutritional status remains NPO for more than 5 to 7 days, survival and recovery are best with careful nutritional assessment and initiation of nutritional support (oral, enteral, or parenteral) as indicated.
One week later, Mr. Parsons is still in the intensive care unit following a coronary artery bypass graft operation. His post-operative course was complicated by infection and ileus. His transthyretin has decreased from his admission level. What should you do?
A. Nothing, he has adequate energy and protein stores
B. Start him on parenteral nutrition with simultaneous slow infusion of enteral feeding.
C. Monitor his nutrition and order a nutrition consult if his nutrition status declines.
D. Start him on parenteral feeding only.
E. Place a tube and begin enteral feeding only.
B. Start him on parenteral nutrition with simultaneous slow infusion of enteral feeding.
Since this patient’s nutritional status is already compromised, beginning early enteral nutrition support is appropriate. You could not feed him solely by enteral means as his gastrointestinal tract is not functioning normally. Feeding him parenterally to meet his nutritional requirements while stimulating his intestines with a small amount of enteral formula is the best option. Remember, use the gut if possible. You do want to continue to monitor his nutritional status, but it is important to initiate adequate nutrition support before his nutritional status declines further. And, yes, you would also probably order a nutrition consult.
If Mr. Parsons’ nutritional support is delayed, evidence indicates that which of the following will likely result?
A. Dehydration
B. Essential fatty acid deficiency
C. Hair loss
D. Hepatomegaly
E. Increased hospital stay
E. Increased hospital stay
Early and appropriate nutrition support is associated with decreased length of hospital stay. Acute complications of malnutrition include impaired wound healing, increased incidence of infection, and edema. Dehydration would only occur with restriction of fluids or increased fluid loss; this is why fluid intake and output are closely monitored in the ICU. Hepatomegaly, hair loss, and essential fatty acid deficiency are long-term complications of severe malnutrition.
A 14-year-old girl was admitted to the hospital with purpura, edema and generalized weakness. On physical examination she was found to be emaciated, weighing only 28 kg (BMI of 14.1 kg/m2). Her parents indicated that she had been suffering from anorexia for the past 1.5 years. Why will it be important to slowly and carefully provide nutrition support, while carefully monitoring her blood chemistry?
A. Rapid refeeding can cause severe nausea and vomiting
B. Rapid refeeding can sepsis due to intestinal atrophy
C. Rapid refeeding can cause electrolyte imbalances
C. Rapid refeeding can cause electrolyte imbalances
Refeeding syndrome is characterized by shifts of potassium, magnesium, and phosphorus moving into cells upon a sudden influx of glucose. If the change from starvation metabolism to abundant glucose occurs too quickly, a dangerous electrolyte imbalance can occur.
Tyler Gordon, a 10-year-old boy, suffered an accidental gunshot wound to the abdomen several days ago. He was normally nourished prior to his accident; ht: 132 cm, wt: 30 kg, BMI 17.2 (normal for age). During surgery 70% of his small bowel was resected, he was given a partial colectomy and his stomach, duodenum and vena cava were repaired. What form of nutritional support is most appropriate at this time?
A. Continue present regimen of dextrose in saline
B. Feed him when he is able to eat again
C. Start feeding him by vein and J-tube.
C. Start feeding him by vein and J-tube.
Supplemental nutritional support should be initiated in patients who are expected to have inadequate oral intake over 7 to 14 days.
A 57-year-old male was admitted to the hospital with severe confusion. He had a severe memory defect, ataxia, upbeat nystagmus, double vision, and signs of peripheral neuropathy. He has been a heavy drinker of alcohol for over 25 years. This Patient is most likely to be deficient in which of the following?
A. Vitamin B1
B. Medium Chain acyl CoA Dehydrogenase
C.Glucose-6-Phosphatase
D. Glucose-6-Phosphate Dehydrogenase
E. Vitamin C
Vitamin B1 Deficiency
Thiamine deficiency is relatively common in alcoholics, often resulting in neuropathy and confusion. This is much more likely than a rare genetic defect in a metabolic enzyme, such as ornithine transcarbamoylase (urea cycle). Glucose 6-phosphatase deficiency and Medium chain acyl CoA dehydrogenase deficiency each result in fasting hypoglycemia, not neuropathy. Glucose 6-phosphate dehydrogenase deficiency results in oxidant-induced hemolysis. Vitamin C deficiency results in scurvy, characterized by blood vessel and connective tissue breakdown.
Two weeks after his accident, Tyler’s mother wants to know if she can feed him a milkshake. What sign will indicate that he is recovering enough to consider slowly increasing the enteral feeding, followed by slow oral feeding?
A. When he feels hungry
B. When bowel sounds can be heard
C. When his respiratory quotient has normalized at about 0.85
B. When bowel sounds can be heard
His intestines will be essentially paralyzed for weeks/months after his accident/surgery. Normal bowel sounds and passing of gas will indicate that his ileus is beginning to resolve. A slow increase in enteral feeding rate will likely be tried to determine how well he can tolerate the change.
What does amylase primarily digest?
Starch (into di-, tri- and small poly-saccharides of glucose)
Why are beans the musical fruit? (Why do they cause gas?)
They contain polysaccharides that we lack digestive enzymes to hydrolyze. Intestinal bacteria catabolize these polysaccharides into gases.
Which monosaccharide is most commonly malabsorbed, causing flatulence, bloating, cramping, diarrhea, and/or constipation?
Fructose. Up to 40% of people experience some amount of abdominal distress after consuming a diet high in fructose.
High FODMAP foods should be avoided by most people
A. True
B. False
B. False
Many nutritious vegetables, fruits, legumes and whole grains are high in FODMAPs, and therefore are an important part of a healthy eating pattern. However, when someone experiences irritable bowel symptoms, they are often prescribed to eat a specific restrictive diet for several weeks that is low in FODMAPs to see if their symptoms resolve; this is effective in the majority of patients. Then specific foods and food groups can be re-introduced to identify the specific problematic food(s).
