CMN E1- Diets

BMI < 15 =

starvation

BMI < 17.5 =

Anorectic

BMI < 18.5 =

Underweight

BMI 18.5-24.9 =

Ideal weight

BMI 25-29.9 =

Overweight

BMI 30-39.9 =

obese

BMI > 40 =

Morbidly obese

Which type of malnutrition is d/t inadequate intake?

*more of a problem in developing countries where food shortages are a problem

Primary PEM

What type of primary malnutrition is d/t deficiency of PTN & non-PTN nutrients → loss of muscle and body fat & exhibit extreme wasting?

Marasmus

What is the hallmark biochemical feature of refeeding syndrome?

Hypophosphatemia

What potentially fatal complication can occur if feedings (tube or PO) are reintroduced too quickly resulting in a shift of fluids and electrolytes?

*abn Na, hypokalemia, hypomagnesemia, hypophosphatemia

Refeeding syndrome

What pts are at risk for Refeeding Syndrome?

pts w/ poor nutrition > 7-10 days

What type primary malnutrition is d/t poor nutritional intake resulting in failure to thrive and frequently occurs after a child is weaned?

*diet deficient in PTN & micronutrients → energy deficiency

Kwashiorkor

How does Kwashiorkor present?

edema, hypoalbuminemia, skin lesions, fatty liver results, proturberant abd, muscle & fat wasting

What are the 2 forms of primary PEM?

Marasmus & Kwashiorkor

What type of malnutrition occurs when illness or other factor impair the uptake or utilization of nutrients → inc PTN & energy requirements or inc metabolic loss > nutrient availability?

*malabsorption syndromes, CA, post-gastrectomy

Secondary PEM

What are sx of protein energy malnutrition?

hair changes, mental changes, wasting, anemia, diarrhea, osteopenia, edema, immunosuppression

Why is pre-op nutritional assessment important?

helps determine a pt's surgical outcome, inc malnutrition = inc mortality

What anthropometric measures are used to assess nutritional status?

Ht, Wt, BMI, tricep skinfold with calipers (SQ fat), arm-muscle circumference, handgrip or forearm dynamometry

What is body composition analysis most often measured by?

BIA (bioelectrical impedance analysis)

How does BIA work?

measures conductivity relative to fat; muscle = conductor, fat = insulator

*adequate hydration is very important for accurate results

What lab value is a poor indicator of short term nutritional support secondary to being an acute phase reactant and long t1/2?

** LOW pre-op level = STRONG predictor of surgical complications (<2.8)

Albumin

What lab value that is a good indicator of short term nutritional support and is used to monitor the effectiveness of TPN?

Prealbumin

What MUST be present in a standard post-op assessment for a pt to be taken off NPO?

+ bowel sounds x 4 quadrants

+ passage of flatus

What is allowed on a clear liquid diet?

water, apple/cranberry/grape juice, gatorade, black coffee or tea, clear broth, ginger ale/sprite, jello, Italian ice

*what you can “see” through

What are the surgical diet nutritional requirements?

normal: 25-30 kcal/kg/day; PTN = 1g/kg/day

stressed: 35-40 kcal/kg/day; PTN 1.5-2 g/kg/day

How do you calculate N intake?

PTN (g) per 24 hours / 6.25

How do you calculate N output?

24 hour urine collection to measure urea nitrogen (g/day)

What is a negative N balance associated with?

N balance = intake - output

malnutrition

What nitrogen balance is seen when there is a higher use of PTN?

Positive N balance, Nitrogen takes in > Nitrogen excreted

What nitrogen balance is seen when the body is undersupplied with PTN?

Negative N balance, Nitrogen takes in < Nitrogen excreted

What is the correction factor for basal metabolic requirements?

+ 15% for normal activity and work of breathing

+ 10% in post-op patients

+ 10-30% in peritonitis

+ 30-50% in trauma, sepsis, respiratory failure

+ 60-110% in burns

+ 5% for every degree Centigrade over normal

What does inadequate caloric intake lead to?

delayed wound healing, reduced ventilatory capacity, reduced immunity, inc risk of infection

When must a decision be made whether a pt will eat or not?

post-op day #4 — if they are unable to eat → begin nutrition support

What is the first route of nutritional therapy?

PO — Oral supplementation or Appetite stimulants

What is the goal of nutrition support?

for pt to be able to consume adequate PO nutrition

What type of feeding is used when the gut is working?

*also the preferred method

Enteral

(NG, G, or J tube)

What type of feeding is used when the GI tract CANNOT be used?

Parenteral

(via Internal jugular vein or Subclavian vein)

What are the SE of parenteral nutritional support?

GI tract permeability changes, dec in villus height, dec in enzymes, dec in absorption, inc rate of infection & complications

Which enteral feeding is best for short-term use?

NG tube

Which enteral feeding is used for longer term feeding in those with swallowing difficulties?

G tube

Which enteral feeding is used for long term feeding in those w/ poor gastric emptying, inc risk for regurgitation, & abn gastric anatomy or function?

J tube

What should sudden unexplained hyperglycemia in a patient who had previously been tolerating TPN should alert for?

possibility of infection

(line sepsis, indwelling catheter)

What is the leading cause of death & disability in the US?

CV disease (23.5% of all deaths)

What negates the advances that were being made to reduced CV disease?

inc prevalence of DM and obesity

What greatly influences CV health?

lifestyle (72% of CV mortality is d/t poor lifestyle choices)

Which dietary fat is dec by Omega-3 & exercise and inc by diet high in saturated fats and simple sugars?

*want low levels

VLDLs & LDLs

Which dietary fat is included in by Omega-3 & exercise?

HDLs

Which diet emphasizes fruit, vegetables, and low-fat dairy and is low in saturated and total fat & cholesterol?

DASH diet (dietary approaches to stop HTN)

What are the recommendations of the DASH diet?

high in Ca, Mg, K

low-mod fat intake

inc complex carbs

severe Na restriction

What are the goals of a High fiber diet?

promote more frequent BM, softer stools, inc transit time

-for pts w/ diverticulosis, IBS, hemorrhoids, constipation

Which diet is recommended when patients need to avoid food which may obstruct narrowed intestinal areas or irritate an inflamed colon (limits fiber)?

Low residue diet

-for pts w/ IBD flare, acute diverticulitis

Which diet is historically prescribed for GI distress, allowing the GI tract to rest, and is primarily focused on bananas, rice, applesauce, & toast?

BRAT diet

What are the potential deficiencies in vegetarian diets?

Vit B12, Vit D, Riboflavin (B2), Iron, Calcium, Zinc

What are some of the physiologic changes of aging?

Inc body fat, dec muscle mass (sarcopenia)

Dec Vit B12

Dec GI motility

loss of total bone mass/Ca

What can reverse the effects of sarcopenia?

exercise (esp resistance training)

What can improve the dec GI motility seen in elderly?

inc fiber in the diet to combat constipation & exercise