Nutritional Assessment

Question 1

Whithout life sustaining nutring, what can happen to the body?

Answer 1

All organ system become compromised, including Respiratory System.

Question 2

Malnutrition is common on critically ill patients, now what can happen to these patients, if nutritionals needs are no met?

Answer 2

• Prolong duration on mechanical ventolators
• ↑ hospital Stay
• ↑ morbidity and mortality
• Respiratory Muscles Strength and endurance
• The immune system respond

Question 3

On the other hand OVERNUTRITION (overfeeding), may also affect the patient but in the negative way, and this can lead to:

Answer 3

• ↑ PaCO2 production
• ↑ ventilator demand

Question 4

Why critically ill patients with respiratory failure require specialized nutrition support?

Answer 4

• To prevent muscle wasting
• Avoid complication associated with malnutrition care

Lack of malnutrition can affect:

• Respiratory muscles strength and endurance
• The immune system respond

Question 5

What are the waste products of metabolisims, and who are responsable for the removing of this?

Answer 5

CO2 and nonvolatile acids are the waste products of metabolisms.

• Kidney remove 2% o
• Lungs remove 98%

Question 6

Overfeeding Carbohydrates will produce excessive …? causing what effect on the patient?

Answer 6

If we ↑ carbohydrates diet, this will ↑ CO2 production, afecting the ventilatory demand by increasing it.

If we have a patient with limited ventilatory reserve, overfeeding may lead to respiratory failure or prolong mechanical ventilation.

Question 7

How muscles will be affect with prolong Undernutrition?

Answer 7

• Catabolism will occurs (breakdown of complex moleculas)
• Protein Calorie Malfunction (PCM), this can occurs in days in critically ill patients.
• Depletion of phosphors and magnesium can also lead to respiratory muscle weakness

Question 8

Prorein Calori Malnutrition (PCM) causes impared immune function, making the patient more susceptible to:

Answer 8

Bacterial colonization and infection

Question 9

Reduce aveolar stability affects:

Answer 9

Zise, number, and surface area is reduce, ↑ WOB

Question 10

Hypoalbuminemia is the result of:

Answer 10

Poor nutrition, resulting in low levels of albumin in the blood

Question 11

What happen if the body does not produce enough Albumin?

Answer 11

Oncotic pressure will decrease and fliud will beging to move into the intertitial space, increasing risk for Pulmonary Edema.

Question 12

Is nutritional status important when we have an Obese patient?

Answer 12

Yes it is, Obesy patients will produce a restrictiction to lungs, ↓ FRC, leading to V/Q mitmach, ↑ WOB, ↑ metabolism. ↑ CO2 production and CO2 retention.

Question 13

The Hypercatabolic Phase or Stress response can last for:

Answer 13

7 - 10 days

This phase will ↑ O2 demad, CO, and CO2 production. Also, the calori needs may be increased up to 100% during this phase.

Question 14

Resting Energy Expediture (REE) can stimate:

Answer 14

The amount of energy expended by a person at rest, can be measured Direct or Indirect

Question 15

What is the problem about predicted equations?

Answer 15

It work well to predicted REE in healthy nonobesy subjects, but less well on obese or critically ill patients.

Question 16

How does Indirect Calometry works?

Answer 16

It works by measuring the amount of inhaled O2 and exhaled CO2.

By knowing this we are able to know how much energy the patient needs to provide their minimun metabolic requirements

Question 17

What device can be use on indirectly calometry

Answer 17

• Ventilated Canopy
• Mask
• Mothpiece/nose clip

Question 18

what is the respiratory Quotient, and what is the normal range?

Answer 18

Is the CO2/O2 consumption

this basically said, if we doing the right calometry the range should be between : 0.67 - 1.3

Question 19

TRUE or FALSE

The caloric equivalence of CO2 and Oxygen can be used to calculate an estimate of REE

Answer 19

TRUE

Each class of food staff has a unique respiratory quotient:

• Carbohydrates: 1.0
• Protein: 0.80
• Fat: 0.71

Question 20

If you have a patient that is respiratory compromise, what type of food you want to avoid and why?

Answer 20

Avoid Carbohydrates, because this type of food increase the CO2 production, as a consequence respiratory rate will increase too.

For respiratory compromise patients we try to give them food that produce the minimum amount of CO2, like Fat (0.71)

Question 21

What is the primarily goal of nutritional support?

Answer 21

Is to improve respiratory function through the prevention or minimization of the loss of muscle mass.

Question 22

Other goals of nutritional support?

Answer 22

• Preevent Infections
• To enhance te immune system
• To increase exercise tolerance
• To improve patient’s quality of life

Question 23

What are some ways to feed a patient?

Answer 23

• Oral ( through mouth)
• Enteral (This food is directally place in the stomach)
• Parenteral (Through CPV line)

Question 24

What is the preferred way to feed a patient in hospitals?

Answer 24

Oral

Question 25

Oral Route

Answer 25

* Is convenient * Difficult on severe respiratory disease to comsume enough to mantain their wieght and increase nutrients needs.

Question 26

* Prevent instestinal atrophy * Mantain absortion capacity of GI mucosa * Preserve normal gut flora and gastric PH * Stimulate feeding dependance. ## Footnote ***Here we are talking about what route?***

Answer 26

Enteral

Question 27

what are some devices use on Enteral feeding?

Answer 27

**​Short term tubes:** * Nasogastric tubes * Orogastric tubes * Pospyloric feeding tubes *(Jejenum tube or J-tube)* **long Term tubes:** * Percutaneous endoscopy gastrostomy (PEG) tube

Question 28

If you have a patient with severe pancreatitis, gastrointestinal fistula, cancer, short bowel syndrome, prolonged ileous... **what route of feeding would you prefere in this case?**

Answer 28

**Pareteral** *(CVP)*

Question 29

What are some complication of Parenteral route?

Answer 29

* Catheter placement * Pnemothorax * Arterial puncture * Catheter malposition * Catheter embolization * site of infection * Air embolus * Gut atrophy * Mucosal compromise

Question 30

What are the three critically objective on nutritional support:

Answer 30

* To preserve lean of mass * To maintain immune mass * To avert metabolic complication

Question 31

what is the food that we want to avoid for critically ill patinets

Answer 31

Food that are hiegh on Carbohydrates *Bc ↑ CO2 production leading on an ↑ in ventilatoery demand*

Question 32

What are the benefits of early enteral nutrition within 24 - 48 hours after intubation?

Answer 32

* Reduced disease severety * Diminish complication * Decrease length of stay in ICU * Improve patient outcomes

Question 33

Poor nutricion can adversally affects patient with:

Answer 33

* Exercise Tolerance * Reduces body ability to regenerate healthy muscle * Increase susceptibility to infection * May prevent successful progresion through the program

Question 34

What is the most accurate method to determine energy expenditure?

Answer 34

**Indirect Calometry** is the most accurate on hospitalized critically ill patients.

Question 35

When alternative methods for estimating energy expenditure should be considered ?

Answer 35

When Indirec Calometry are not available

Question 36

Why Enteral delivery of nutrients is prefered over Parenteral nutrition?

Answer 36

Because it has fewer risks for infection, may have a protective effects on the gastriontestinal mucosa, and is less costly.

Question 37

Normal albumin range

Answer 37

3.5 - 5.0 g/dL

Question 38

In what type of patient, overfeeding may lead to respiratory failure or prolong mechanical ventilation?

Answer 38

**On patient with limited respiratory reserve.** *This mean that this patient is already too weak, and overfeeding this patient will create and ↑ on CO2 production, increasing ventilatory demand, eventually this patient will get into respiratory failure bc his respiratory muscle need to work more to get rib of the excess of CO2*

Question 39

What condition may increase the calori needs up to 100%?

Answer 39

The **Hypercatabolic phase**, and this can last up to 7 - 10 days

Question 40

The Equation needed to to determine the amount of energy need to mantain the most basic bodily function is?

Answer 40

**Basal Metabolic Rate (BMR)** **Other equation:** * Ireton-Jones * Estimated