CMN E1- Nutrition

What % of cal/day should added sugar make up?

less than 10% (starting at 2 yo)

What % of cal/day should sat. fat make up?

less than 10% (starting at 2 yo)

How much sodium should be consumed per day?

less than 2,300 mg

How much caffeine should not be exceeded per day?

400 mg (less than 300 mg if pregnant)

How much water should 18-55 yo consume per day?

35 mL/kg body weight

How much PTN should we consume per day?

0.8 g/kg

What pts may require more PTN in their diet?

malnourished, stage 3-4 pressure wounds, post-op, hx of CHF, COPD

What is the gold standard for assessing critically ill pts caloric needs?

indirect calorimetry

What equations can be used to calculate BMR?

Mifflin St. Jeor OR Harris Benedict

How do you assess caloric needs outpt?

BMR x activity factor

What is PTN restricted to in pts w/ renal failure since nitrogen cannot be eliminated properly?

0.6-0.8 g/kg

What is enteral nutrition?

tube feeds

What type of enteral feedings are for long term use?

percutaneous endoscopic gastrostomy (PEG)

percutaneous endoscopic gastro-jejunostomy (PEGJ)

percutaneous endoscopy jejunostomy (PEJ)

What type of pts need tube feeds?

not able to eat or use GI tract: intubated, AMS, dysphagia, gastroparesis, pancreatitis, chronic inadequate intake

Why is EN > PN (given IV)?

stimulates GI tract → prevent gut atrophy, better nutrient availability, better immune response

When is EN contraindicated?

bowel obstruction/perf, paralytic ileus, high output bowel fistula, bowel discontinuity, mesenteric ischemia, hemodynamic instability

What types of EN formulas are there?

disease specific (DM, renal), standard polymeric, high PTN, fluid restricted, immune enhancing, vegan, real food, child vs adult, semi-elemental vs elemental

Which mode of EN is MC in hospitalized pts?

continuous

Which mode of EN is faster and mimics meal patterns?

bolus

Which mode of EN takes 12-16 hrs/day and can be done overnight?

cyclic

Which mode of EN aims to mimic meal patterns and is given ~5 times throughout the day?

intermittent

What is parenteral nutrition?

bypasses GI tract via IV catheter

What are the 2 types of PN?

total PN (complete)

Peripheral PN (partial)

Who should receive TPN?

pts who cannot use their GI tract at all

What vein is usually used for TPN?

superior vena cava under collarbone

*must be central and have large diameter

What pts should receive PPN?

pts who need supplement for an insufficient oral diet OR to bridge until central line is placed

*temporary < 2 weeks

What are the ASPEN guidelines for who should receive TPN?

EN contraindicated, severely malnourished, unable to meet EN goal after 7 days, paralytic ileus, mesenteric ischemia, SBO, GI fistula

What are contraindications of PN?

no prior malnutrition (wait 7 days), immediate post op and not malnourished (wait 7 days), GI tract is functioning & accessible, severe acute pancreatitis, pts deem warranted for comfort care

What are the components of PN?

CHO (dextrose), PTN, fat, electrolytes, vitamins, minerals

What are the types of PN?

2-in-1: dextrose-AA formulation

3-in-1: total nutrient admixture (TNA) dextrose-AA-ILE

Why can lipids only be hung a max of 12 hrs for PN?

risk of bacteria or fungal overgrowth

What are potential complications of PN?

hyper/hypoglycemia, re-feeding syndrome, hypertriglyceridemia, azotemia, essential fatty acid deficiency, immunosuppression

What is first choice before a PEG tube for treating malnutrition?

appetite stimulants

What is a serious and potentially fatal metabolic condition that occurs when dietary intake is resumed after an individual has not consumed PO for an extended period of time?

Re-feeding syndrome

Triglycerides need to monitored for hypertriglyceridemia in pts that are inpt and on what medication?

Propofol (provides 1.1 calorie/mL)

What lab monitor for azotemia in pts on TPN?

BUN

What labs need to be monitored to watch for re-feeding syndrome?

phosphorus, potassium, magnesium, glucose

What labs can be used to monitor hydration?

Na, osmolality, BUN, Cr