Week 13 Nutrition

dinosaur1234's version from 2015-04-16 23:38

Definitely know this section

Question Answer
Indications for enteral nutrition inability to swallow, face or jaw injuries, head or neck cancer, endotracheal intubation; if the gut works, use it!
Indications for PNmassive bowel resection, intractable vomiting, sever complicated pancreatitis, major organ failure/burns, hyperemesis gravidarum, severe D, bowel obstruction, GI fistulae, perioperative, eating disorders
When to use IBWuse when actual body weight is less than IBW; this is when you want patient to gain weight
When to use ABWused in most cases; use when patient weighs between IBW and 130% IBW
When to use adjusted body whenused if patient weighs >130%IBW; for “obese patients”; want patients to lose weight
Severe malnutritionABW < 70%IBW
Moderate malnutritionABW 70-79% IBW
Mild malnutritionABW 80-89%IBW
NormalABW 90-120% IBW
OverweightABW >120%IBW
ObeseABW > 150%IBW
Morbidly obeseABW > 200%IBW
Parenteral routes of administrationperipheral and central
Peripheral administrationused if function of GIT is expected to return in 10-14 days; must have a lower [ ] of aa, dextrose, and micronutrients; larger volumes necessary; only used it quick, short, or patient has infection in central line
Central administrationused much more often than peripheral; goes into main vessel of heart; used when PN required for >7-14days during hospitalization or indefinitely at home; highly concentrated hypertonic solutions; PREFERRED choice for PN
Short term EN access info and typesused if EN needed for <4-6 weeks; easier to initiate, less invasive, and less costly; types include Nasogastric (NG)/orogastric (OG), and nasoduodenal (ND)/nasojejunal (NJ)
NG/OG infoleast expensive, least labor intensive; not well tolerated in patient with impaired gastric motility
ND/NJ infomore challenging to place; beneficial for patients unable to tolerate gastric feeding
Long-term EN info and typesused if EN needed for 4-6 weeks; more comfortable, more reliable, fewer long-term complications; types include- gastrostomy/percutaneous endoscopic gastrostomy (PEG), jejunostomy, and pharyngostomy/esophagostomy
PEG infomost common, relatively easy to place; large bore means less risk of clogging
Jejunostomy infobetter for patient at high risk of aspiration or GERD; appropriate for pateitn unable to tolerate gastric feeding; smaller bore means easier to occlude
Pharyngostomy/esophagostomy infohigh complication rates, rarely used
Population estimate for energy requirement in healthy, normal nutrition status, minimal illness severity20-25 kcal/kg/day
Population estimate for energy requirement in illness, metabolic stress, BMI <3025-30 kcal/kg/d
Population estimate for energy requirement in illness, metabolic stress, BMI >3011-14 kcal/kg/d (ABW) OR 22-25 kcal/kg/d (IBW)
Total energy expenditure BEE x stress or activity factor
Protein (aa) conversion and solution1 gram protein = 4kcal; 10g protein/100mL solution
Carbohydrates (dextrose) conversion and solution1 g carbs = 3.4 kcal; 70 g dextrose/100 mL; this is 70% of non-protein calories!!!!!
Lipids (IV fat emulsion) conversion and solution1 g lipids = 9 kcal; depends on what type of emulsion to get kCal… 10% emulsion = 1.1 kcal/mL, 20% emulsion = 2 kcal/mL, 30% emulsion = 3 kcal/mL; this is 30% of non-protein calories!!!
Micronutrients infovitamins, trace elements, and electrolytes; comes out to be about 150mL total
Overall fluid requirements30-35 mL/kg/day… “1500 rule” 100 ml/kg/d for first 10 kg + 50 ml/kg/d for second 10 kg + 20 ml/kg/day for additional kg
Monitoring of PNq shift – POC blood glucose; QD- BMP, Mg, Phos, weight, I/Os; weekly- prealbumin, LFTs; PRN- lipid panel, UUN
Complications of PNmechanical/technical, infectious, metabolic/nutritional; refeeding syndrome- severe and rapid declines in serum phosphate, K, Mg []; fluid retention and other micronutrient deficiencies
CI of enteral nutritiondistal mechanical intestinal obstruction; necrotizing enterocolitis
Standard formula to get mL in EN1.2 kcal/ml of solution
Continuous infusion of ENfor adults, initiate at 20-50 ml/h and increase by 10-25 ml/h q4-8h until goal rate is reached
Monitoring of ENQD- weight I/Os; weekly- prealbumin, LFTs, BMP; PRN- lipid panel, UUN
Continuous infusion rate of PNinitiate at 40 ml/hr and increase gradually over 12-24 hr to goal rate
Things to tell you if patient is getting enough proteinis prealbumin is low or UUN is negative, patient may not be getting enough protein
General steps to calculating PNcalculate calories; then protein, lipids, and carbs; finally fluid volume and rate

Not as important

Question Answer
Signs that patient is not tolerating feedingD, abdominal pain, cramping
When to use cyclic feedingtypically reserved for patients who can still take some calories PO during the day and then the rest at night
What to do if you want to switch administration timingif patient is on continuous, go to intermittent, then to bolus; don’t go right from continuous to bolus or patient will likely experience SE
For patients who are hyperglycemic and on TPN canstart basal-bolus insulin, add insulin to TPN, start insulin drip
When and how to correct calcium concentrationin patients with LOW ALBUMIN, you need to correct their calcium concentration; [(4 – albumin) x 0.8] + Ca = corrected Ca concentration
When you would use cyclic infusion for PNuseful for patients with limited venous access; may prevent or treat hepatotoxicities associated with long-term PN; accommodates “normal” lifestyle for patients receiving PN at home; given over 12-18 hours
Continuous EN administrationstart at 20-50 ml/h and increase by 10-25 ml/h every 4-8 h until goal rate is reached
Cyclic EN administrationfeeding held during the day and only administered at night; more convenient for ambulatory patients
Bolus EN feedingdelivered over 5-10 min 4-6x daily; poorly tolerated in patients with duodenal or jejunal access; avoid in patients with delayed gastric emptying or high risk of aspiration
Intermittent EN feedingdelivered over 20-60 minutes 4-6x daily; option for patients unable to tolerate faster bolus administration; more consistent physiologically with normal eating patterns
Intermittent/bolus administration initiation and advancement in adultsstart with 120 mL every 4 hours; increase by 30-60 mL every 8-12 hours