nutra: nutrition support

  1. two markers for malnutrition (from class).
    • albumin
    • transferrin
  2. indication for nutrition?
    • w/o nutrition for 10 days
    • duration of illness >10days
    • malnourished ( >10% body weight dec in 3 months)
  3. normal basal metabolic rate?
    normal 25 kcal/kg/d
  4. BMR if you have fistula?
    normal 25 kcal/kg/d
  5. BMR if you have peritonitis?
    > 25%
  6. BMR if you have long bone fracture?
  7. BMR if you have severe injury?
    50% greater
  8. BMR if you have sepsis?
    50% greater
  9. BMR if you have multiorgan failure?
    50% greater
  10. BMR if you have burn >40%?
    wow 100% greater
  11. how much protein needed in normal people?
  12. protein need in critically ill or SIRS?
    1.5 - 2.0g/kg/d
  13. protein need if renal or hepatic failure? why decreased amount?
    • 0.6 g/kg/d
    • hepatic: potential hepatic encephalopathy, altered mental status
    • renal: cannot eliminate protein
  14. nitrogen to calorie ratio in most feeding formula?
    name of the supplement.
    where is it stored?
    what is it used for?
    • Juven
    • stored in skeletal muscle. most abundant.
    • used in gut, immune cells, kidneys.
    • good for chemotx patients, would heal, prevent fistula.
  16. Juven is supplement of...
  17. arginine is required for...
    • cell growth
    • enhance cellular immunity
  18. purine and pyrimidine is important b/c...
    precursor of DNA and RNA.
  19. what does carnitine do?
    • transport fatty acid into mitochondria during lipid breakdown.
    • promote acetyl coA
  20. what does taurine do?
    • detoxification
    • protect cell
    • increase fat reabsorption.
  21. folic acid is important in preg women. why?
    prevent neural defect
  22. B12 benefits?
    • from meat
    • help brain
    • antioxidant
    • anti-inflam
  23. vitamin A benefit? how much should you give per day?
    • wound heal
    • 2500 Units.
    • b/c fat soluble, don't give for more than 3-4days
  24. manganese is good for...
    muscle cramp
  25. when do you decide to give enteral nutri?
    when GI output is <600 ml/24h
  26. should i give EN?
    hemodynamically unstable.
  27. should i give EN?
    abdominal distention.
  28. should i give EN?
    intestinal obstruction
  29. should i give EN?
    massive GI bleed
  30. should i give EN?
    • no
    • happens in diabetic
    • sometimes Reglan is given to correct gastrparesis and then EN may be given.
  31. should i give EN?
    paralytic ileus
    why does this happen? what can you do?
    • no
    • B/c opioids
    • give IV narcan orally to mute mu-receptor on GI tract and give EN.
  32. should i give EN?
    antibiotic induced colitis (i.e. c.diff)
  33. should i give EN?
    severe diarrhea. how can you manage this?
    • nope
    • give kaolin, pectin and fiber to help with diarrhea
  34. should i give EN?
    initial short bowel syndrome.
    • no
    • you need life long TPN b/c no small intestine to absorb nutrients.
  35. should i give EN?
    severe pancreatitis
    nope b/c no lipase to break down fat so no EN
  36. how much fluid can you give if you give via duodenum/jejunum route?
  37. when would you prefer duod/jeju route over stomach?
    • gastric impair
    • risk of aspiration
  38. short duration. why?
    a) NG tube
    b) PEG or PEJ
    • a) nasal
    • b/c sinusitis if more than 4 weeks.
  39. associated with trauma, sinusitis, pharyngitis, ostitis media.
    a) nasal tube
    b) feeding ostomie
    a) nasal tube
  40. need a lot of vaselin/gel for small tube b/c of trauma.
    a) nasal tube
    b) feeding ostomie
    a) nasal tube
  41. trauma from NG tube is due to ...
    a) pressure
    b) duration of length.
    a) pressure
  42. which is preferred for gasterectomy pt?
    a) PEG
    b) PEJ
    b) PEJ
  43. which to use for cancer patient?
    a) NG
    b) PEG/PEJ
    b) PEG/PEJ
  44. which to use for GI bleeding patient?

    B) PEJ
  45. for long term EN.
    a) NG
    b) PEG/PEJ
    b) PEG/PEJ
  46. for liver failure patient, don't give a lot of __ or ___.
    • glutamine
    • amino acid
  47. three formulas available to select.
    • polymeric formula
    • oligomeric formula
    • specialize formula
  48. pt must have full digestive capability

    A) polymeric
  49. polymeric formula is divided based on
    • 1. nutrient source
    • 2. calorie density
    • 3. fiber
    • 4. protein content
  50. if you have carb as main caloric source, you have increased ____ b/c of inc osmolarity.
  51. FIBER:
    women need ____ g/d
    men need ___g/d
    • 25
    • 40
  52. which to avoid in diabetic pt?
    calorie standard
    calorie moderate
    calorie dense
    calorie dense
  53. if you give ___ g of glucose, you get ___. why?
    • >40g glucose
    • diarrhea!!! b/c glucose determines osmolarity.
  54. for polymeric formula, you give low nitrogen (6-9&) to which pt?
    liver fail, renal fail, high bilirubin
  55. for polymeric formula, you give high nitrogen (16-25%) to which pt?
    • ICU pt b/c a lot of protein is broken down.
    • but caution! not for renal fail pt.
  56. disaccharide goes down when....
    • you are fasting
    • GI disease (celiac disease, IBS)
  57. polymeric/balanced diet has fat of ___% of total calorie.
  58. which fat is more desirable for polymetric diet?
    medium chain triglyceride vs. long chain. why?
    • medium chain
    • b/c better absorbed and metabolized.
  59. which pt population may benefit from medium chain TG?
    • septic pt
    • pancreatitis
    • inflam of intestine.
  60. polymeric diets are...
    • isotonic
    • lactose free
    • ready to be used as liquidi
  61. modified or oligomeric diet is used in which pts?
    • pancreatitis (b/c no lipase thus cannot break fat)
    • short bowel sndrome
  62. 2 types of oligomeric formulas?
    • elemental
    • peptide based
  63. describe elemental oligomeric formual diet
    • free amino acids
    • low fat
  64. describe peptide based oligomeric formula diet.
    oligo, di and tripeptides and free amino acids
  65. oligomeric formula is __ tonic.
  66. if you have GI dysfx, what is modified in oligomeric diet? explain importance
    • modified nitrogen and fat
    • short peptide rather than free aa: b/c nitrogen transport needs short peptides
    • glutamine: maintain GI tract, inc neutrophil, dec bacteria in colon, dec inflam/infxn
    • MCT: irritable bowel and celiac dz.
  67. how is specialized diet for renal failure pt?
    • enriched amino acid
    • essential a.a. if CrCl <25ml/min
    • use lower NPC:N ratio of 140:1
    • use Nepro
  68. what kind of amino acid to use in liver failure pt? what does this improve?
    • highly branched, non-aromatic
    • hepatic encephalopathy.
  69. NPC:N ratio <100:1 used for...
    • stress or critically ill
    • b/c high nitrogen needed. more cal from protein.
  70. for stress/crit ill pt, you need what kind of a.a.?
    • highly branched
    • reduced aromatic amine
  71. what things you want for stress/crit ill pts?
    • omega 3 (dec inflamm, vasodil)
    • high nitrogen
    • high branched a.a.
    • glutamine
    • carnitine
  72. what to avoid if crit ill/stress pt?
    • avoid arginine
    • avoid omega 6: more inflam, vasoconstrict, platelet aggreg
  73. when is arginine helpful
    when is arginine bad
    • helpful: septic, burn, cellular growth
    • bad: stress, crit ill, AVOID if sepsis or pneumonia (b/c it is substrate for NO, causes SIRS)
    • use for septic pt with burn, open wound, and cell growth.
  74. what kind of diet for pulmonary disease patients?
    • high calories in FAT
    • low carb!
    • long chain TG
  75. when do you use long chain a.a.? (rest is medium chain TG)

    C) pulmonary
  76. which can start faster?
    isotonic vs. hypertonic.
    • isotonic
    • hypertonic has diarrhea issue
  77. can you do bolus feed in jejunum?
    nope b/c can't hold as much as stomach.
  78. if you have GI dysfx, how to modify diet?
    modify nitrogen and fat
  79. if you are hypercatabolic, what should you give more?
  80. what are increased risks for aspiration?
    • altered mental status
    • GERD
    • hx of aspiration
    • medication
  81. when should you use isotonic?
    a) gastric
    b) jejunal
    c) duodenum
    jej and duo
  82. if pt develops diarrhea, what should you do?
    • dec rate
    • change feed
    • dec osmolality
    • give kaolin/pectin
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nutra: nutrition support
nutra: nutrition support