fund 1 nutrition - medical nutrition therapy

what does PO mean?

through the mouth

what does NPO mean?

nothing through the mouth or GI tract even (so nothing through a tube either)

what does nasogastric mean?

from nose to stomach

what does nasoduodenal mean?

from nose to duodenum

what are some things you must obtain from a diet/nutrition history?

• current diet

• diet changes

• food preferences

• deficiences

• food diary

• supplementation

• alternate modes of nutrition (nutrition support)

• activity level

what is important when asking about weight changes?

whether is was intentional or unintentional

what should we determine about height and weight?

• current weight

• usual weight

• weight changes (intentional/unintentional)

• height

• body changes (i.e. amputations)

what is body mass index?

a weight-stature index, used both as a measure of obesity and malnutrition

what is considered an underweight BMI?

less than 18.5

what is a normal weight BMI?

18.5-25

what is an overweight BMI?

25-29.9

what is an obese BMI?

> 30 obese

what are 3 ways to determine energy needs? which is the best way?

1) using standard equations to calculate basal energy expenditure (BEE) plus additional calories for activity and illness

2) applying a simple calculation based on calories per kilogram of body weight

3) measuring energy expenditure with indirect calorimetry

what is the most commonly used predictive equation?

harris-benedict equation

what 4 things does the harris-benedict equation take into account? what factors are added to determine total daily calorie requirements?

• gender, age, weight, and height

• activity and/or illness factors

what are maintenance calorie needs?

25–30 kcal/kg

Repletion/Weight gain calorie needs?

30–40 kcal/kg

Weight loss calorie needs?

20–25 kcal/kg

How are protein needs estimated?

Grams of protein per kg body weight

Protein needs for a healthy person?

0.8–1 g/kg

Protein needs during stress?

1.2–2 g/kg

What is Dysphagia Diet Level I?

Puree food

What is Dysphagia Diet Level II?

Mechanical altered (requires some chewing)

What is Dysphagia Diet Level III?

Soft foods (require more chewing ability)

Types of liquid consistency for a dysphagia diet?

Thin, nectar thick, honey thick

Most restrictive dysphagia diet?

Dysphagia I with honey thick liquids

Least restrictive dysphagia diet?

Dysphagia III with thin liquids

How are nutrients delivered?

Enterally (oral supplements/feeding tubes) or parenterally (veins)

Forms of oral nutritional supplements?

Milkshake style, juice based, pudding style, powders

what type of nutritional delivery is preferred?

enteral - don’t want to bypass the GI unless it is not working. even if stomach doesnt work, can go into small intestines (can’t feed into ileum or colon though)

When is enteral nutrition used?

GI tract is functional but patient can’t meet needs by mouth

Can enteral nutrition be temporary or indefinite?

Yes – temporary, recurrent, or indefinite. If longer than 6 weeks, would put tube directly into the GI tract

Indications for patients who can’t take food by mouth?

Intubated, severe dysphagia, oropharyngeal cancer, stroke

Indications to bypass part of the GI tract?

Gastric outlet obstruction, esophageal stricture, severe gastroparesis

Indications for supplementation?

Poor PO intake (e.g., dementia), high need (e.g., trauma, burns)

What are short-term feeding tubes?

Tubes placed via nose into stomach, duodenum, or jejunum

What are long-term feeding tubes?

Tube enterostomies (gastrostomy, jejunostomy)

Why feed post-pylorically?

For patients who can’t protect their airways

How can tube feedings be given?

Continuously (up to 24h) or bolus

Types of tube feeding formulas?

Standard, diabetic, wound healing, renal, fluid restriction, semi-elemental/elemental

Steps to start tube feeding?

1. Place tube

2. Pick formula

3. Calculate needs

4. Determine daily volume

5. Start feeding (usually continuous)

Rule of thumb for starting rate of tube feeding?

Never faster than 30 mL/h

Safe starter rate for tube feeding while waiting for dietitian?

Basic formula at 30 mL/hr x 24h

GI complications of feeding?

Aspiration, gastric residuals, N/V, diarrhea, constipation

Metabolic complications of tube feeding?

Hyperglycemia, electrolyte abnormalities

Feeding tube complications?

Sinus infection, sore throat, epistaxis, nasal erosion, cellulitis, dislodgement

What is PN?

Nutrition directly into the bloodstream, bypassing GI tract

Where is PN infused?

Central vein (commonly subclavian vein)

Duration of PN use?

Temporary, recurrent, or indefinite

What is PPN?

Peripheral parenteral nutrition – short-term via peripheral line

What is TPN?

Total parenteral nutrition – longer term via central line

When can’t the GI tract be used?

IBD flare, malabsorption, perforation, obstruction, fistula

What are PN components?

Dextrose, amino acids, lipids

How is dextrose started?

Gradually over 2–3 days

How are amino acids started?

At goal (1–2 g/kg depending on stress)

When are lipids added?

After 24–48h (held if TG > 400–500 mg/dL)

What labs are monitored for PN?

Electrolytes, glucose, magnesium, phosphate (daily); TG (weekly); LFTs (weekly)

What else is monitored with PN?

Central line site and maintenance, fluid balance (I/O, daily weights)

When to discontinue PN?

When enteral/oral intake meets ≥60–75% of needs

Criteria before stopping PN?

• GI tract functional

• Electrolytes/glucose stable

• Condition improving

• No bowel rest, obstruction, or high-output fistula

Why taper TPN?

To prevent hypoglycemia

How to taper TPN?

• Reduce rate over 4–6h OR

• Half rate overnight, stop in morning

When are glucose checks needed after stopping PN?

Before and 2–4h after stopping

How are lipids discontinued?

Can stop without tapering (unless continuous)

Metabolic complications of PN?

Hyperglycemia, hypoglycemia, hypertriglyceridemia, liver dysfunction, volume overload

Infectious/mechanical complications of PN?

Bloodstream infections, catheter injury, thrombosis, CLABSI

What is refeeding syndrome?

Life-threatening shifts in fluids/electrolytes when feeding is restarted

What triggers refeeding syndrome?

Reintroduction of carbs → insulin spike

What shifts into cells during refeeding syndrome?

Phosphate, potassium, magnesium