Critical Care

What is the primary nutritional focus for cancer patients to combat weight loss?

The focus should be on adequate calories and protein intake.

According to the source, should cancer patients avoid sugar because it 'feeds' cancer cells?

No, the source states that sugar feeds all cells and does not need to be avoided.

What food safety precaution is recommended for meats and fish for patients with compromised immune systems?

Avoid raw meats/fish and ensure all foods are cooked thoroughly, with reheated foods reaching over 140°F.

What amino acid supplement is recommended for managing mouth sores in cancer patients?

Lysine is recommended for mouth sores.

What is the relationship between weight loss and mortality risk in cancer patients?

Greater weight loss is associated with a greater risk of death.

Cachexia is a wasting syndrome primarily characterized by muscle wasting, fat loss, and what two other key factors?

Inflammation and anorexia (a complete lack of appetite).

A cachexia diagnosis requires weight loss of at least 5% in 12 months (or BMI < 20 kg/m²) plus how many additional diagnostic criteria?

At least 3 out of 5 additional criteria must be met.

List three of the five diagnostic criteria (besides weight loss) for cachexia.

Any three of: decreased muscle strength, fatigue, anorexia, low fat-free mass index, or abnormal biochemistry (e.g., increased CRP, anemia, low albumin).

Loss of 10% of total Lean Body Mass (LBM) is associated with what complications?

Impaired immunity and increased infection, with a 10% mortality risk.

A 30% loss of total Lean Body Mass (LBM) can lead to what severe complications and mortality rate?

Being too weak to sit, pressure ulcers, pneumonia, and wound healing stops, with a 50% mortality rate.

According to the provided chart, what is the expected outcome of a 40% loss of total Lean Body Mass (LBM)?

Death, usually due to pneumonia, with a 100% mortality rate.

What is the first question to ask in the nutrition support decision flowchart when a patient's GI tract is functional?

Is their appetite satisfactory and are they physically able to eat?

If a patient has a functional GI tract but their intake is inadequate, what is the next step after an oral diet with supplements fails?

Enteral nutrition by feeding tube should be considered.

Parenteral nutrition by a _ is used for long-term support in patients without a functional GI tract.

central vein

What is the fundamental principle of nutrition support often summarized by the phrase, 'If the gut works, ?'

use it

What are two primary benefits of using enteral nutrition (tube feedings) when the gut is functional?

It helps maintain the integrity and function of the small and large intestine.

Which enteral feeding route is indicated for short-term feeding (<4 weeks) in a patient who cannot safely consume an oral intake but has a functional GI tract?

Nasogastric (NG) tube.

For a patient with a high risk of aspiration, which short-term enteral feeding route is preferred over a nasogastric tube?

Nasointestinal (NI) tube.

What enteral feeding route is indicated for long-term use in patients with a functional GI tract, often used for those with impaired swallowing?

Gastrostomy.

A _ tube is indicated for long-term use in patients at high risk for aspiration pneumonia.

Jejunostomy

What is a major disadvantage of nasogastric (NG) tubes, especially for uncooperative or confused patients?

They may be removed by the patient and are contraindicated for those at high risk for aspiration.

A potential disadvantage of jejunostomy tubes is that the small-diameter tubes can easily become ____.

clogged

What is the general guideline for daily protein intake for older or ill adults receiving tube feeding?

1.2-2.0 grams of protein per kilogram of body weight.

Patients with severe burns or multi-trauma may require how much protein per day via tube feeding?

Greater than 2.0 grams of protein per kilogram of body weight.

What is a standard formula in enteral nutrition?

It is a general-purpose formula that can be standard, high protein, high calorie, or fiber-enriched.

A hydrolyzed enteral formula contains protein that has been 'pre-digested' into what forms?

Peptides or free amino acids.

Disease-specific enteral formulas for diabetes are typically formulated with a lower percentage of and a higher percentage of .

carbohydrates; fat

What are the components of an immune-modulating enteral formula?

Arginine, glutamine, omega-3 fatty acids, and nucleotides.

What are the four primary methods for administering tube feedings?

Continuous drip, overnight, intermittent, and bolus.

To prevent aspiration in a tube-fed patient, the head of the bed should be elevated to what angle during and after feeding?

30-45 degrees during feeding and for approximately one hour afterward.

If a tube-fed patient experiences diarrhea due to a feeding rate that is too rapid, what is the recommended nursing intervention?

Decrease the rate to the level tolerated and then advance at half the original increment (e.g., 12 mL/hour instead of 25 mL/hour).

What intervention can help with diarrhea caused by infusion of a formula that is too cold?

Give canned formulas at room temperature or warm refrigerated formulas in a basin of warm water.

A patient on enteral feeds develops dehydration. Besides providing additional water, what change to the formula might be considered?

Switch to a formula with less protein to decrease nitrogenous wastes, and increase water intake if possible.

How often should a feeding tube and bag be replaced to prevent bacterial contamination?

Every 12-24 hours.

What is the recommended intervention for a clogged feeding tube after flushing with warm water fails?

The tube must be removed and replaced.

Which medication is known to bind with protein in feeds, cause tube clogging, and predispose to the formation of bezoars?

Sucralfate.

For medications like Fluoroquinolones and Phenytoin, what is the recommendation regarding enteral feeds to ensure proper absorption?

Hold enteral feeds for 2 hours before and 2 hours after medication administration.

Parenteral nutrition provides nutrients intravenously and is composed of a solution containing dextrose, amino acids, and electrolytes, along with a separate emulsion for what macronutrient?

Lipids.

What are three indicators of malnutrition risk that should be checked before surgery?

Unintentional weight loss, poor appetite, and a BMI less than 18.

True or False: A low serum albumin level is a definitive diagnosis for malnutrition.

False; the source explicitly states 'low albumin DOES NOT EQUAL malnutrition'.

What is the recommended protein intake for a patient at each main meal (breakfast, lunch, dinner) after surgery?

30 grams of protein per meal.

The pre-operative nutrition graphic suggests consuming a meal with 30g of protein how many hours before surgery?

12 hours before surgery.

The post-operative nutrition graphic suggests consuming a drink with 12g EAA and 50g CHO at what point?

Soon after surgery.

What are three primary nutrition-related complications of HIV?

Inadequate food intake, malabsorption of nutrients, and disordered metabolism leading to lean tissue wasting.

The main objective of HIV medical nutrition therapy (MNT) is to reduce or eliminate _ and correct nutrition problems.

malnutrition

In the ICU, if a patient has an intact GI tract and is expected to tolerate enteral feeding, when should feeding begin?

Within 24-48 hours.

For an ICU patient with sepsis, septic shock, or ARDS, what type of specialized enteral formulation is recommended?

An anti-inflammatory formula containing omega-3 fatty acids and antioxidants.

For an ICU patient who has undergone surgery or experienced trauma or burns, what type of specialized enteral formulation is recommended?

An immune-modulating formula containing omega-3s, arginine, glutamine, and antioxidants.

What is refeeding syndrome?

A metabolic complication that occurs when nutrition repletion is introduced too quickly to a critically ill or malnourished patient.

Refeeding syndrome is characterized by what three critical electrolyte disturbances?

Hypophosphatemia (low phosphorous), hypokalemia (low potassium), and hypomagnesemia (low magnesium).

What is the general approach to initiating feeding to prevent refeeding syndrome?

Start with a slow, gradual increase in calories, typically beginning at 20% of needs or around 1000 calories/day.

Why is increased protein needed for wound healing?

To replace lean body mass lost during stress, restore blood volume/plasma proteins, and meet needs for tissue repair.

A deficiency in which vitamin can lead to impaired/delayed wound healing due to its role in collagen formation and capillary integrity?

Vitamin C.

Which mineral is crucial for protein synthesis and wound healing, as well as for normal lymphocyte and phagocyte response?

Zinc.

According to the intervention table, what is the recommended protein intake for a patient with a Stage II wound?

1.2-1.5 grams per kilogram of body weight.

What is the recommended calorie intake for a patient with a Stage IV (or complex) wound?

35-40 kilocalories per kilogram of body weight.

For a patient with a Stage III wound, when should supplementation with 25-50 mg of elemental zinc be considered?

It should be considered if the patient is deficient or has poor intake, and limited to 7-10 days.

What is the minimum amount of protein needed (in g/kg) for the prevention of skin breakdown?

1.0-1.2 grams per kilogram of body weight.