Exam 1

calories

estimated calorie needs per day decreases with age resulting from a decrease in energy expenditure

the decrease in needed calories is from

lower basal metabolic rate

less physical activity

healthy older adults need

1-1.2g/kg/protein/day

Prot-age study group

provided an evidence based recommendation for a higher protein intake for healthy adults

fiber recommendation

decreases overall as you age

needed fiber after age 51

men: 30 grams/day

women: 21grams/day

types of food in the Mediterranean diet

fish (salmon)

monounsaturated fats from olive oil

fruits and veggies

whole grain

legumes/nuts

moderate alc consumption

benefits of the Mediterranean diet

lowers risk of cog. impairment and Alzheimers

less age related brain shrinking

prolonged survival

reduced risk of frailty, even into later life

great chance of living past 70 and still being healthy

MIND diet

Mediterranean-DASH Intervention for Neurodegenerative Delay Diet

What is the MIND diet

a combination for the MedDiet and the DASH diets which both lower BP and reduce the risk of heart disease and diabetes

Potential age related benefits of the MIND diet

some indication that the diet substantially slows cognitive decline

linked to a 53% decrease in the rate of Alzheimers

Vitamin A

green and orange veggies (especially leafy greens), orange fruits, liver, milk

Vitamin D

milk, fortified cereal and soy milk, fatty fish

Vitamin E

veggie oils, margarine, salad dressing with veggie oil, nuts, seeds, whole grains, green leafy veggies, fortified cereals

Calcium

milk, yogurt, cheese, fortified oj, green leafy veggies, legumes

magnesium

green leady veggies, nuts, legumes, whole grains, seafood, chocolate, milk

Potassium

fruit and veggies, legumes, whole grains, milk, meats

fiber

whole grains, legumes, fruits and veggies (especially skin and seeds)

benefits of regular exercise

reduces risk of falls

lowers risk of death from heart disease, HTN, type 2 diabetes, dyslipidemia, some cancers, and dementia

encourages weight loss

reduces osteoarthritic pain

reduces risk of anxiety and depression

malnutrition risk factors for elderly

lack of food

embarrassment

mental health

social isolation

depression

chronic diseases

repeated hospitalization

financial constraints

poverty

food insecurity

interventions to improve food intake and increase weight

increase the nutrient density of foods eaten by adding ingredients that provide calories and or protein

protein supplements

Foods to help with malnutrition (adds protein or calories)

casseroles, soups, rice noodles, mashed potatoes, milk (add nonfat dry milk powder), oatmeal (add butter, nonfat dry milk, sugar), and scrambled eggs

Sarcopenia

a progressive and generalized skeletal muscle disorder characterized by accelerated loss of muscle mass and functional decline

one cause of sarcopenia

inadequate intake of protein

adverse outcomes of sarcopenia

physical disability

frailty

falls resulting in fractures

poor quality of life

death

Frailty

a medical syndrome with multiple causes and contributors that is characterized by diminished strength and endurance

nutritional therapy for frailty

high proteins

high calories

vitamin D supplements

goal for long term care residents

maintain or improve quality of life

nutritional considerations for long term care residents

adopt a liberalized eating pattern

restrictive diets only when benefits will greatly improve life

mealtime should be made enjoyable

honor food preferences

prevalence of malnutrition in hospitalized patients

estimated at 30-50%, depending on the patient population and how malnutrition is defined

malnutrition puts patients at risk for

increased risk for a pressure ulcer

impaired wound healing

increased rate of infection

muscle wasting

prolonged hospital stay

higher healthcare cost

increased mortality

nutritional risk is

compromised intake or loss of body mass

nurses part in nutritional screening

screen all patients

function as liaison between healthcare specialties and patient

can provide nutritional education and reinforce patient counseling

advocate for nutritional needs and desires

help clients plan meals

screeing protocol

the joint commission mandates that screen must be done within 24 hours of admission

nutritional risk factors

history, lifestyle, and environment

malnutrition

calorie or protein deficit

feeding method: unable to consume at least 50% of their protein or calories goals

dietician does assessment when

patient is at moderate to high risk

role of a dietician

calculate estimated calorie and protein requirements based on the assessment data

determine nutrition diagnoses that define the nutritional problem, etiology, and signs and symptoms

may also determine appropriate malnutrition diagnosis

formulate nutrition interventions

contribution factors to malnutrition

medical, social, psychological

medical factors relating to malnutrition

chronic disease states

medications

GI disturbances

Social factors relating to malnutrition

poverty

inability to shop or cook

inability to feed self

living alone

psychological factors relating to malnutrition

alcoholism

bereavement

depression

dementia

food aversions

assessment of nutrition

height, weight, BMI

weight loss assessment

unintentional-losing weight without trying

determine by a percent of weight loss in a giver period of time

dietary intake assessment

ask questions but don’t make them feel bad about themselves

good dietary intake questions

do you avoid any particular foods?

has the amount or type of food you usually eat changed?

bad dietary intake questions

are you on a diet?

how is your appetite?

physical findings assessment

weight loss over time

inadequate food and nutrition intake compared to requirements

loss of muscle mass or fat

local or generalized fluid accumulation

measurable reduced hand grip strength

lab data assessment

albumin levels: major cause of low albumin is inflammation

serum levels may be maintain until is chronic malnutrition

Implementation strategies to promote optimal intake

continually assess

screen all patients

advocate for reduced NPO time

replace meals held for tests

order snacks in between meals

encourage pts to get out of bed for meals

oral diets can be categorized as

regular

modified consistency

therapeutic

best meals are

small

frequent

nutrient dense

regular diets

used to achieve or maintain optimal nutritional status

no alterations to consistency

have to be able to chew and swallow

can be modified to meet diets or culture

modified consistency

clear liquid

pureed

mechanically altered

soft diet

clear liquids

clears juices and liquids

pureed diet

everything is allowed but is pureed

liquids may be thickened

mechanically altered diet

excludes most raw fruits and veggies

sticky foods are avoided

usually chopped or ground

soft diet

regular diet that features soft textured foods that are easy to chew and swallow

therapeutic diet

prevent and treat disease or illness

examples of therapeutic diets

regular

liquid

soft

diabetic

calorie controlled

low chol

low fat

Na restricted

protein diet

bland

low residue

nutritional supplements

used for inadequate intake or to treat malnutrition

provides calories and proteins and micronutrients

taste better cold and with ice cream

stress response occurs in critically ill patients

infection

burn

multiple fractures

major surgery

extensive bleeding

trauma

bodys response to stress

intensity of the stress response depends to some extent on the cause or severity

body focuses on immediate survival

the body becomes overwhelmed due to high levels of stress and is sometimes unable to respond appropriately

the body does not utilize nutrients properly the demand for calories and protein increases

nutritional needs

consider after hemodynamically stable

protein catabolism can lead to

impaired immune system functioning

increased risk of infection

impaired or delayed wound healing

increased mortality

oral diet is preferred

when there is functioning GI tract and no risk for vomiting or aspiration

Enteral nutrition

next best choice

if oral is not possible

ideally within first 24-48 after stable

calories

weight based calorie calculation

protein is needed for

wound healing

immune function

maintain lean body mass

BMI <30

admission weight

25-30 cal/kg/day

BMI 30-50

actual body weight

11-14 cal/kg/day

BMI >50

ideal body weight

22-25 cal/kg/day

refeeding syndrome is seen in

chronic alcoholism

chronic undernutrition

morbid obesity

prolonged fasting

long term use of IV hydration

cardiac and cancer cachexia

enteral is recommended over

parenteral who are stable and have a functioning GI tract

does put them at risk for refeeding syndrome

when calorie needs are not being met through oral diet

use complete or supplemental tube feeding

most severe type of metabolic stress

severe burns

with burns enteral nutrition is preferred if

>20% of body surface area is affected and started within 4-6 hours

Respiratory stress

increases need for calories and protein

types of severe respiratory stress

ARDS and acute lung injury

may be on vent

aspiration risk increases with jejunum tube

symptoms of respiratory stress

inflammation, low O2, cardiac arrhythmias, confusion

enteral nutrition goes

through the GI tract

parenteral nutrition

through venous system

NG tube

nose to stomach

short term (2-3 weeks or less)

big risk for aspiration

Percutaneous endoscopic gastrostomy (PEG)

tube through the skin into the stomach

used long term ( weeks to months)

big risk for aspiration

Percutaneous endoscopic jejunostomy (PEJ)

tube through the skin into the jejunum

used longer (weeks to months)

types of formulas

standard and hydrolyzed

Standard formulas

mimics body

carbs protein and fat

can be harder to digest

hydrolyzed formula

broken down into amino acids

low residue/almost completely absorbed

enteral nutrition calorie density

about 1 cal/mL

osmolality

concentration/number of particles in a solution

isotonic formulas

same as blood

hypertonic formulas

greater concentration of particles than blood

side effect: diarrhea

with enteral nutrition most patients still need

free water

enteral feeding methods

tube feeding pump

continuous drip

cyclic (12 hours/day)

intermittent-bolus (in syringe and push it right in)

biggest risk with enteral nutrition is

aspiration

ways to prevent aspiration

keep HOB 30-45 degrees

check residuals

confirm placement of tube with x-ray before using it

Adverse S&S of enteral

NV

abdominal distention/bloating

dehydration or fluid overload

parenteral nutrition is used when

GI is not functioning

a central line is used of peripheral IV

central lines allow for

hypertonic formula to be used

has a higher osmotic pressure than body fluid

refeeding syndrome

caused by a dramatic increase in carbs leading to an increase in insulin

potentially life threatening

higher risk for starved patients

rapid changes in infusion rate can cause this