Nutrition Module 12: Nutrition Support Flashcards Preview

SMP - MNE Exam 2 > Nutrition Module 12: Nutrition Support > Flashcards

Flashcards in Nutrition Module 12: Nutrition Support Deck (63)
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31

When is indirect calorimetry used?

To prevent over or under feeding of critically ill, malnourished, or extremely obese patients

32

How can the precise TEE be calculated with indirect calorimetry?

By estimating the actual nutrient mix from the respiratory quotient = CO2/O2

33

What is the RQ of carb oxidation?

1

34

What is the RQ of fat oxidation?

0.7

35

What is the RQ of protein oxidation?

0.8

36

What fuel source produces the least amount of CO2 per O2 consumed?

Fat

37

What is the normal total RQ?

0.8

38

How will starvation affect the RQ?

Lower it

39

How high is variability of RQ in stressed patients?

Up to 50%

40

3 steps to calculate TEE with indirect calorimetry?

1. Measure urine nitrogen to determine amount of protein oxidized
2. Measure RQ
3. Use 3 linear equations to calculate TEE, carb oxidation, and fat oxidation

41

Why can carb and fat oxidation be predicted only with RQ?

Because they are completely oxidized

42

Are DRI equations appropriate for the critically ill?

NOPE

43

What 2 equations to use to calculate BEE?

1. Harris-Benedict equation
2. Penn State 2003

44

What are 2 reasons for why stressed patients have increased TEE?

1. Hypermetabolism
2. Fever

45

What 3 conditions cause hypometabolism?

1. Starvation
2. Spinal cord injuries
3. Some cancers

46

By how much does fever increase the metabolic rate?

By 10% for each degree above 37

47

Explain the pathophysiology of refeeding syndrome.

Aggressive oral, enteral, or parenteral carb feedback following a period of nutritional deprivation => sudden glucose influx in cells => sequestration of magnesium, potassium, and phosphorus => dangerously low blood concentrations => cardiac arrest, neuromuscular complications, and respiratory dysfunction

48

What is cachexia?

Accelerated breakdown of muscle and adipose tissue often observed in patients with advanced cancer

49

What are the 8 patients at risk for refeeding syndrome?

1. Old pts with depression or dementia
2. Anorexic
3. Cachexia
4. Malnutrition due to hunger, stress, or fasting
5. Marasmus or Kwashiorkor
6. Chronic alcoholism
7. NPO status for over 7 days
8. DKA

50

What are the 5 ways of preventing refeeding syndrome?

1. Start low and go slow with calories
2. Avoid excess glucose
3. Measure and provide P, Mg, and K
4. Restrict fluid intake and initiate Na-containing fluids slowly
5. Thiamin supplement

51

What are the 3 veins through which parenteral feeding can be administered? Which one delivers nutrients at a lower concentration?

1. Subclavian vein
2. Internal jugular vein
3. Peripheral vein (lower concentration)

52

What is short-bowel syndrome? When does it occur? Treatment?

Occurs following removal of a large portion of the bowel and results in reduced absorption => malabsorption requiring parenteral support until adaptation happens over months and sometimes years

53

What % loss of our bowel can we tolerate?

Up to 50%

54

Where does adaptation of short-bowel syndrome occur? What will never adapt fully though?

Adaptation and improved nutrition in ileum and jejunum but jejunum will not develop active absorption of bile acids and VB12

55

What are 4 complications of long-term parenteral feeding?

1. Catheter-related infection leading to sepsis
2. Liver disease
3. Metabolic bone disease
4. Micronutrient deficiencies

56

What parts of the GI tract need to be preserved to avoid indefinite parenteral feeding?

1. Terminal ileum
2. Ileocecal valve
3. Colon

57

What are 2 ways of administering the enteral feeding? When do we use each?

1. Nasoenteric tube: less than 1 month duration
2. Gastrostomy tube: more than 1 month duration

58

What are the 4 complications of enteral feeding?

1. Reflux of stomach contents into the lungs => aspiration pneumonia
2. Diarrhea
3. Refeeding syndrome
4. Altered glucose, lipid, acid-base balances

59

How do we know when to start feeding a patient normally again?

We hear bowel movements

60

What can underfeeding cause?

1. Protein used as energy
2. Poor wound healing and decubitus ulcers
3. Low energy levels and weakness
4. Protein calorie malnutrition