Nutritional Support & Assessment – Lecture Review

These flashcards cover key points from the lecture on nutritional assessment, enteral and parenteral support, GI anatomy, malnutrition, screening tools, immunonutrition, energy calculation, formulas, and administration techniques.

What does the acronym PAN stand for in clinical nutrition?

Proceso de Atención Nutricional (Nutrition Care Process).

Is nutritional screening the same as a full nutritional evaluation?

No. Screening only identifies risk; evaluation provides a comprehensive assessment.

List the five ABCDE components of a full nutritional evaluation.

A: Anthropometrics, B: Biochemical tests, C: Clinical examination, D: Dietary assessment, E: Energy-related & lifestyle factors

Which anthropometric measure compares weight to height to screen for obesity or underweight?

Body Mass Index (BMI).

Name two common visceral proteins used in biochemical nutritional assessment.

Albumin and transferrin.

What clinical signs suggest loss of subcutaneous fat?

Hollowed eyes, sunken cheeks, and prominent ribs or scapulae.

Which 24-hour food-intake method is often used in dietary assessment?

24-hour dietary recall.

Why should physical activity and sleep be recorded in a nutritional evaluation?

They affect energy expenditure, metabolism, and overall nutritional status.

After assessment, what is the second step of the Nutrition Care Process?

Establishing a nutrition diagnosis (problem statement).

In hospitalized adults, why is follow-up and monitoring critical for tube-fed patients?

Because access devices may be permanent and complications can arise over time.

Define ‘optimal nutritional status’.

A state where current intake meets requirements and risk of deficiency or excess is minimal.

Give two core functions of the clinical dietitian during nutrition support.

Estimate patient requirements and document each step of the care plan.

What is the goal of nutrition support in critically ill patients?

Maintain or restore nutritional status and improve clinical outcomes.

List the four basic functions of the digestive system.

Digestion, absorption, elimination, immune barrier.

What is the functional cell of the small intestine?

Enterocyte.

Which part of the small intestine is primarily responsible for nutrient absorption?

Jejunum and ileum.

Give three major functions of the large intestine.

Absorb water/electrolytes, form/store feces, allow bacterial fermentation.

Which accessory organ secretes bile?

Liver (stored in the gallbladder).

What is enteral nutrition (EN)?

Delivery of nutrients into the GI tract via oral intake, tube, or stoma when the gut is functional but oral intake is unsafe or insufficient.

How long is a nasogastric tube typically intended for use?

Short term: 4–6 weeks maximum.

Name two long-term enteral access devices.

Gastrostomy tube (PEG) and jejunostomy tube.

Define parenteral nutrition (PN).

Intravenous administration of nutrients when the GI tract cannot be used adequately.

Differentiate between central and peripheral PN in terms of duration.

Central PN: >2 weeks (long-term); Peripheral PN: <2 weeks (short-term).

State one infectious risk associated with PN.

Higher catheter-related bloodstream infection risk.

Give the prevalence range of hospital malnutrition reported in Latin America.

Approximately 25–50% at admission; up to 78% in ICU.

How does ASPEN define malnutrition?

Acute, sub-acute, or chronic altered nutritional state with reduced intake ± inflammation leading to body composition changes and diminished physical function.

Name the three forms of malnutrition (by duration/characteristics).

Acute, chronic, and mixed malnutrition.

List four common complications of malnutrition.

Poor wound healing, immune dysfunction, pressure ulcers, increased hospital stay and costs.

What grade of pressure ulcer is characterized by skin redness without an open wound?

Grade 1.

Give two medication classes that often reduce appetite in hospital patients.

Chemotherapy agents and opioids (e.g., morphine).

Which screening tool is recommended for older adults?

Mini Nutritional Assessment (MNA).

After a negative screen, how often should low-risk inpatients be re-screened?

Weekly.

What is immunonutrition?

Use of specific nutrients to modulate immune response, inflammation, and tissue damage.

Name three nutrients commonly included in immunonutrition formulas.

Arginine, omega-3 fatty acids, glutamine.

Give two aims of immunonutrition.

Improve cellular immunity and balance pro/anti-inflammatory cytokines.

List the primary contraindication to gastric tube feeding.

Non-functional or unsafe stomach (e.g., severe gastroparesis, high-risk GERD, gastric obstruction).

Why are jejunal feeds preferred in severe pancreatitis?

They bypass pancreatic stimulation, reducing pain and complications.

Define bronchoaspiration.

Passage of gastric or pharyngeal contents into the airway, risking pneumonia.

When should enteral nutrition ideally start in ICU patients?

Within 24–48 hours of admission or initiation of mechanical ventilation.

State one advantage of starting EN early.

Preserves gut integrity and reduces infectious complications.

Which two factors determine selection of enteral access route?

GI functionality and expected duration of feeding.

Why are intestinal tubes usually narrower than gastric tubes?

To pass pylorus; however, narrower lumens increase clog risk and often require pumps.

Give one contraindication for jejunostomy placement.

Diffuse peritonitis or high-output proximal intestinal fistula.

Write the formula for Total Energy Expenditure (TEE) in hospitalized patients.

TEE = Resting Energy Expenditure (REE) × Stress Factor (FE) × Activity Factor (AF).

Provide typical stress factors for mild, moderate, and severe illness.

Mild 1.1; Moderate 1.2–1.3; Severe 1.4–1.5.

What is the gold standard method to measure energy expenditure?

Indirect calorimetry.

State the protein requirement for severe burns >20% TBSA.

Approximately 2.5 g protein/kg/day.

How many grams of protein correspond to 1 g of urinary nitrogen?

6.25 g protein.

What nitrogen balance indicates anabolism?

Positive nitrogen balance (intake > losses).

Recommended carbohydrate percentage of TEE for most patients?

45–55% of total energy.

Name two situations that increase fluid requirements.

Fever and profuse sweating.

Define a nutritionally complete enteral formula.

A formula meeting 100% of macro- and micronutrient needs when given in prescribed volume.

Differentiate polymeric from semi-elemental formulas.

Polymeric contain intact nutrients; semi-elemental have hydrolyzed proteins and simpler carbs for easier absorption.

When are high-calorie (dense) formulas indicated?

Patients needing fluid restriction or high energy in low volume (e.g., CHF, renal failure).

Give the kcal/mL density cut-off for ‘high-calorie’ formulas.

1.2 kcal/mL.

What is the main risk of using blenderized (homemade) tube feeds?

High contamination and viscosity leading to tube clogging.

State one advantage of a closed-system enteral container.

Reduced risk of microbial contamination; ready to hang.

Which administration method most closely mimics normal meal patterns in gastric feeding?

Bolus or intermittent feeding.

Why is continuous feeding required for jejunal routes?

Small intestinal reservoirs are limited; slow drip improves tolerance and prevents dumping.

Describe cyclical enteral feeding.

Formula delivered less than 24 h/day (e.g., nocturnal) to allow daytime oral intake or mobility.

What patient position reduces aspiration risk during gastric feeding?

Fowler or semi-Fowler (head elevated 30–45°).

List two common causes of tube occlusion.

Viscous formula residue and improper medication crushing.

For a patient with severe GERD and high aspiration risk, which tube route is safest?

Post-pyloric (nasoduodenal or nasojejunal).

What does CONUT stand for?

Control Nutricional (nutritional control screening tool).

Give one indication for switching from EN to PN.

Non-functional GI tract (e.g., bowel obstruction) preventing adequate enteral intake.

What percentage of total energy is typically supplied by lipids in standard formulas?

30–35%.

Which fatty acids provide anti-inflammatory benefits in formulas?

Omega-3 fatty acids (EPA/DHA).

State two contraindications to gastric access placement post-surgery.

Recent abdominal surgery with peritonitis, or existing peritoneal dialysis catheter.

What is the recommended daily glutamine dose in critical care?

Approximately 0.5–0.8 g/kg/day (enteral or parenteral).

Name one immunological benefit of arginine supplementation.

Precursor of nitric oxide, enhancing wound healing and immune response.

Which screening tool is most commonly used in ICU to predict nutritional risk?

NUTRIC score.

What is the maximum recommended duration for a clear-liquid hospital diet?

48 hours.

Define hyperosmolar jejunal formula intolerance symptom.

Diarrhea shortly after rapid infusion due to high osmolality.

State one reason peritonitis is a contraindication for PEG placement.

Risk of spreading infection and poor wound healing.

Which electrolyte elevation often accompanies uncontrolled hyperglycemia from excessive dextrose infusion?

Hypertriglyceridemia.

What parameter distinguishes severe from moderate malnutrition under GLIM?

Severity of weight loss, low BMI, or marked muscle mass reduction.

Give the formula to convert urinary urea to BUN.

BUN = Urinary urea / 2.14.

Provide one advantage and one disadvantage of cyclic feeding.

Advantage: daytime mobility and oral trials; Disadvantage: requires high infusion rates, increasing intolerance risk.

What is the usual French size range for nasogastric tubes in adults?

12–20 Fr.