-
two markers for malnutrition (from class).
-
indication for nutrition?
- w/o nutrition for 10 days
- duration of illness >10days
- malnourished ( >10% body weight dec in 3 months)
-
normal basal metabolic rate?
normal 25 kcal/kg/d
-
BMR if you have fistula?
normal 25 kcal/kg/d
-
BMR if you have peritonitis?
> 25%
-
BMR if you have long bone fracture?
>25%
-
BMR if you have severe injury?
50% greater
-
BMR if you have sepsis?
50% greater
-
BMR if you have multiorgan failure?
50% greater
-
BMR if you have burn >40%?
wow 100% greater
-
how much protein needed in normal people?
0.8g/kg/d
-
protein need in critically ill or SIRS?
1.5 - 2.0g/kg/d
-
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
-
nitrogen to calorie ratio in most feeding formula?
1:150.
-
GLUTAMINE:
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.
-
Juven is supplement of...
glutamine.
-
arginine is required for...
- cell growth
- enhance cellular immunity
-
purine and pyrimidine is important b/c...
precursor of DNA and RNA.
-
what does carnitine do?
- transport fatty acid into mitochondria during lipid breakdown.
- promote acetyl coA
-
what does taurine do?
- detoxification
- protect cell
- increase fat reabsorption.
-
folic acid is important in preg women. why?
prevent neural defect
-
B12 benefits?
- from meat
- help brain
- antioxidant
- anti-inflam
-
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
-
manganese is good for...
muscle cramp
-
when do you decide to give enteral nutri?
when GI output is <600 ml/24h
-
should i give EN?
hemodynamically unstable.
no
-
should i give EN?
abdominal distention.
no
-
should i give EN?
intestinal obstruction
no
-
should i give EN?
massive GI bleed
no
-
should i give EN?
gastroparesis
- no
- happens in diabetic
- sometimes Reglan is given to correct gastrparesis and then EN may be given.
-
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.
-
should i give EN?
antibiotic induced colitis (i.e. c.diff)
nope
-
should i give EN?
severe diarrhea. how can you manage this?
- nope
- give kaolin, pectin and fiber to help with diarrhea
-
should i give EN?
initial short bowel syndrome.
- no
- you need life long TPN b/c no small intestine to absorb nutrients.
-
should i give EN?
severe pancreatitis
why?
nope b/c no lipase to break down fat so no EN
-
how much fluid can you give if you give via duodenum/jejunum route?
120ml/hr
-
when would you prefer duod/jeju route over stomach?
- gastric impair
- risk of aspiration
-
short duration. why?
a) NG tube
b) PEG or PEJ
- a) nasal
- b/c sinusitis if more than 4 weeks.
-
associated with trauma, sinusitis, pharyngitis, ostitis media.
a) nasal tube
b) feeding ostomie
a) nasal tube
-
need a lot of vaselin/gel for small tube b/c of trauma.
a) nasal tube
b) feeding ostomie
a) nasal tube
-
trauma from NG tube is due to ...
a) pressure
b) duration of length.
a) pressure
-
which is preferred for gasterectomy pt?
a) PEG
b) PEJ
b) PEJ
-
which to use for cancer patient?
a) NG
b) PEG/PEJ
b) PEG/PEJ
-
which to use for GI bleeding patient?
B) PEJ
-
for long term EN.
a) NG
b) PEG/PEJ
b) PEG/PEJ
-
for liver failure patient, don't give a lot of __ or ___.
-
three formulas available to select.
- polymeric formula
- oligomeric formula
- specialize formula
-
pt must have full digestive capability
A) polymeric
-
polymeric formula is divided based on
- 1. nutrient source
- 2. calorie density
- 3. fiber
- 4. protein content
-
if you have carb as main caloric source, you have increased ____ b/c of inc osmolarity.
diarrhea!
-
FIBER:
women need ____ g/d
men need ___g/d
-
which to avoid in diabetic pt?
calorie standard
calorie moderate
calorie dense
calorie dense
-
if you give ___ g of glucose, you get ___. why?
- >40g glucose
- diarrhea!!! b/c glucose determines osmolarity.
-
for polymeric formula, you give low nitrogen (6-9&) to which pt?
liver fail, renal fail, high bilirubin
-
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.
-
disaccharide goes down when....
- you are fasting
- GI disease (celiac disease, IBS)
-
polymeric/balanced diet has fat of ___% of total calorie.
10-15%
-
which fat is more desirable for polymetric diet?
medium chain triglyceride vs. long chain. why?
- medium chain
- b/c better absorbed and metabolized.
-
which pt population may benefit from medium chain TG?
- septic pt
- pancreatitis
- inflam of intestine.
-
polymeric diets are...
- isotonic
- lactose free
- ready to be used as liquidi
-
modified or oligomeric diet is used in which pts?
- pancreatitis (b/c no lipase thus cannot break fat)
- short bowel sndrome
-
2 types of oligomeric formulas?
-
describe elemental oligomeric formual diet
-
describe peptide based oligomeric formula diet.
oligo, di and tripeptides and free amino acids
-
oligomeric formula is __ tonic.
hypertonic
-
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.
-
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
-
what kind of amino acid to use in liver failure pt? what does this improve?
- highly branched, non-aromatic
- hepatic encephalopathy.
-
NPC:N ratio <100:1 used for...
- stress or critically ill
- b/c high nitrogen needed. more cal from protein.
-
for stress/crit ill pt, you need what kind of a.a.?
- highly branched
- reduced aromatic amine
-
what things you want for stress/crit ill pts?
- omega 3 (dec inflamm, vasodil)
- high nitrogen
- high branched a.a.
- glutamine
- carnitine
-
what to avoid if crit ill/stress pt?
- avoid arginine
- avoid omega 6: more inflam, vasoconstrict, platelet aggreg
-
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.
-
what kind of diet for pulmonary disease patients?
- high calories in FAT
- low carb!
- long chain TG
-
when do you use long chain a.a.? (rest is medium chain TG)
C) pulmonary
-
which can start faster?
isotonic vs. hypertonic.
- isotonic
- hypertonic has diarrhea issue
-
can you do bolus feed in jejunum?
nope b/c can't hold as much as stomach.
-
if you have GI dysfx, how to modify diet?
modify nitrogen and fat
-
if you are hypercatabolic, what should you give more?
nitrogen
-
what are increased risks for aspiration?
- altered mental status
- GERD
- hx of aspiration
- medication
-
when should you use isotonic?
a) gastric
b) jejunal
c) duodenum
jej and duo
-
if pt develops diarrhea, what should you do?
- dec rate
- change feed
- dec osmolality
- give kaolin/pectin
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