Flashcards in Nutrition Malnutrition/Metabolic Stress Deck (44):
What happens in moderate-to-severe stress metabolism?
Neuroendocrine and intrinsic mediator systems modulate metabolic machinery to mobilize fat and amino acid stores to provide a continuous supply of substrate for production of stress protein. Increased urinary nitrogen excretion is one result of process. There is increased use of carbohydrate, fat, and amino acids as fuel sources. If stimulus persists, result of a rampant form of acquired protein-calorie malnutrition
What is the nutrient consideration for bruising?
Vitamin K, Vitamin C
What is the nutrient consideration for bleeding gums?
Vitamin C, Riboflavin
What is the nutrient consideration for goiter?
What is the nutrient consideration for Dementia?
Thiamin, Niacin, Vitamin B-12
What is the nutrient consideration for Diarrhea?
Protein, Niacin, Folate, Vitamin B-12, Zinc
What is the nutrient consideration for Anemia?
Vitamin E, Vitamin B-12, Folic Acid, Iron, Pyridoxine
What weight change indicates a high probability of undernutrition?
Unintentional loss of >10% of usual body weight during a 6-month period
What is the formula for IBW in men?
50kg + [2.3kg x (inch > 5ft)]
What is the formula for IBW in women?
45.5kg + [2.3kg x (inch > 5ft)]
When is adjusted body weight used? What is the formula?
Obese patients. Adj = [(actual - ideal) x 0.25] + ideal
What levels are often used to assess nutritional status, as decreased levels may indicate protein deficiency?
Albumin. Transferrin. Prealbumin. Retinol binding protein
What is the normal BMI range?
What is the normal albumin range?
What is the normal Serum transferring range?
What is the total lymphocyte count?
For nitrogen balance, what is the "in" and "out"?
In: oral intake, enteral tube feedings, parenteral nutrition. Out: urinary, fecal, skin, other loses
What is the waist to hip ratio for men and women?
Men: 0.9 or less. Women: 0.8 or less
At what 25-hydroxyvitamin D levels are you insufficient and deficient?
Insufficiency < 30. Deficiency < 20
What are the two types of malnutrition?
Marasmus and Kwashiorkor
What is Marasmus?
Protein-calorie malnutrition. Chronic semi-starvation over prolonged period in absence of stress. Peripheral fat and somatic muscle stores mobilized for energy and cell regeneration. Visceral protein mass may be spared. Patient appears thin or cachectic
What is CHRONIC Kwashiorkor?
Protein malnutrition. Protein deficiency (low intake or poor quality) in presence of adequate or deficient calorie intake. Depletion of visceral protein mass. Peripheral fat and somatic muscle stores may be spared. Patient may appear obese or edematous
What is ACUTE Kwashiorkor?
Protein malnutrition. Result of catabolism secondary to metabolic stress (i.e. sepsis, trauma, burns, disease). Body derives energy from breakdown of visceral protein mass and fat stores
What are risk factors for malnutrition?
Infancy and childhood. Pregnancy and breastfeeding. Aging. Medical conditions and medical procedures. Vegetarian diets. Fad diets. Medications and nutritional supplements. Alcohol or drug dependency
What is Cachexia?
Ongoing wasting: loss of weight, fat, and muscle mass. Fatigue, weakness, progressive functional impairment. Associated with long-standing disease: AIDS, COPD, CHF, TB, other conditions. Associated with reduction in treatment response, response to therapy, quality of life, duration of survival. Role of inflammatory cytokines. not same as anorexia (loss of appetite), but may be associated with anorexia. Not same as starvation (adaptation can occur with starvation)
What are some of the physiological consequences of malnutrition?
QT prolongation. Bradycardia. Pneumonia. Anemia. Reduced GFR. Depressed enzymatic activity in the GI. Decreased visceral protein synthesis in the liver. Anergy, increased infection rate
What are some indications for Enteral Nutrition (EN) via feeding tube?
Functioning GI tract. To supplement oral feeding or to replace it entirely. Preferred route (vs. parenteral) when integrity of GIT is preserved, if not contraindicated
When is Enteral Nutrition (EN) often used?
Prolonged anorexia. Severe protein-calorie malnutrition. Trauma to head and neck. Neurological disorders preventing satisfactory oral feeding. Coma. Depressed mental state. Hepatic failure. Serious illness (e.g. burns) with high metabolic requirements
What are some complications of Enteral Nutrition (EN)?
Gastrointestinal (Diarrhea, Abdominal distention). Aspiration. Metabolic (similar to those seen with parenteral nutrition)
What are the indications for Parenteral Nutrition (PN)?
Inability to absorb nutrients via GIT. Severe malnutrition with nonfunctional GIT. Severely catabolic patient with GIT not usable within 5-7 days. Adequate enteral/oral nutrition cannot be established within 7-10 day period of hospitalization
What are the contraindications of Parenteral Nutrition (PN)?
Enteral route functional and accessible (can be used together if you can't get the nutritional goals with EN alone). Potential risks outweigh potential benefits. Nutritional support not desired
For PN, when is using the peripheral vein indicated?
Inadequate enteral intake or tolerance. Short period of inadequate enteral nutrition expected
What are the limitations to peripheral vein PN?
Osmolarity (very high osmolarity requires central vein administration). Frequent IV site changes (necessary to minimize phlebitis). Volume limitations (high volumes required to meet needs vs. tolerance). Hypocaloric without lipids (low dextrose concentration)
What are the contraindications for peripheral vein PN?
Peripheral venous access unavailable. Long-term use of PN required: weeks to months to years. Total nutritional support required parenterally. Increased nutritional requirements. Lipid intolerance. Fluid restriction
What are the potential complications for peripheral vein PN?
Mechanical: catheter related (phlebitis, loss of peripheral venous access (e.g. infiltration). Metabolic (fluid intolerance/overload, lipid intolerance)
What are the indications for central vein PN?
Total nutritional support required parenterally. Long term PN required. Lack of peripheral venous access. Fluid restriction desired
What are the potential complications of central vein PN?
Mechanical: catheter related (improper placement, pneumothorax). Infectious. Metabolic
What equation determines caloric (energy) requirements?
Harris-Benedict Equation x Factors. (weight in KG, height in cm, age in years)
What are the normal protein requirements?
What is Anorexia Nervosa?
Patient develops bizarre food habits and REFUSE to eat. Usually exercise vigorously and may abuse laxatives or diuretics and voluntarily vomit to decrease the energy they retain in their system. Without intervention, disorder may progress to starvation. Psychologically, anorectics have an abnormal fear of being fat; they exhibit distortions of body image and other perceptions
What is the treatment outline for Anorexia Nervosa?
Treatment incorporates psychotherapeutic, nutritional, and medical components
What is Bulimia?
Periodically stuff themselves with food and then force themselves to vomit or take laxatives to purge themselves. As opposed to Anorexia, the bulimic will usually be close to normal weight
What are the physical complications of Bulimia?
Damage to teeth, irritation of throat, esophageal inflammation - caused by exposure of the unprotected tissue to acidic vomit