Nutrition Final Eam

Dysphagia

GI tract condition that makes swallowing difficult

Why Enteral feeding is preferred over Parenteral nutrition

Enteral feeding is physiologically beneficial in maintains the integrity and function of the gut and less costly.

Types of Enteral Formulas

1. Polymeric Formula
2. Hypercalorie Formula
3. Elemental Formula
4. Modular Formula
5. Specialty Formula

Polymeric Formula

1. Blenderized Food
2. Milk Based
3. High Kilocalories
4. Lactose free normoclalori
5. Lactose-free (isotonic, hypertonic, high-nitrogen, and fiber containing)
6. Modified nutrients (Carbs, Fat, Protein, Vitamins, Minerals)

Hypercalorie Formula

(1.5-2 kcal/ml) designed to meet calorie and protein needs in reduced volume and have a moderate to high osmolality

Elemental Formula

(Predigested or hydrolyzed) composed of partially or fully hydrolyzed nutrients

Modular Formula

Single macronutrients added to other foods or enteral products

Specialty

Designed to meet specialized nutrient demand for specific disease states

Types of enteral feeding routes

1. Nasogastric
2. Nasoduodenal
3. Nasojejunal
4. Esophagostomy
5. Gastostomy
6. Jejunostomy

Nasogastric feeding

Tube is passed through nose to stomach

Nasoduodenal feeding

Tube is passed through nose to duodenum (small intestine)

Nasojejunal feeding

Tube is passed through nose to jejunum (small intestine)

Esophagostomy feeding

Tube is surgically inserted into neck and extends to stomach

Gastrostomy

Tube is surgically inserted into stomach

Jejunostomy

Tube is surgically inserted into small intestine

Types of administration of enteral feedings

1. Continuous
2. Intermittent
3. Bolus

Continuous feeding

constant rate over 24-hour period

Intermittent feeding

Specific 4-6 intervals throughout the day

Bolus

Short periods of time by syringe

Proper Positioning of patient on enteral feeding

Position with head of bed elevated 30-45 degrees

Complications that can occur when administering Parenteral nutrition

1. Diarrhea
2. Nausea/Vomiting
3. Cramps/Bloating
4. Regurgitation/aspiration
5. Constipation

Two Stages of metabolic changes during stress

Ebb Phase and Flow Phase with increase metabolic rate

Ebb Phase

1. Decrease: Oxygen Consumption, Cardiac Output, Plasma Volume
2. Increased: Insulin levels, lactate, Free Fatty Acids, Catecholamines, Glucagon, Cortisol
3. Hypothermia, Hyperglycemia, Hypovolemia, Hypotension

Flow Phase

1. Increased: Oxygen Consumption, Cardiac Output, Plasma Volume, Nitrogen Excretion, Free Fatty Acids, Catecholamines, Glycogen, Cortisol
2. Hyperthermia, Normal or Elevated insulin levels, hyperglycemia, usual blood pressure, normal lactate

Four Adaptation of metabolic changes during starvation

1. Adaptation Mechanisms
2. Success Adaptation
3. Between Adaptation
4. Failed Adaptation

Adaptation Mechanisms

1. Reduced Protein Store
2. Decreased: Skeletal muscle mass, Heart muscle mass, Respiratory muscle mass, Protein reserve
3. Hypotension
4. Bradycardia
5. Hypothermia

Success Adaptation

1. Zero protein
2. Energy balance
3. Hypothermia

Between Adaptation

1. Metabolic Stress
2. Macronutrient deficiency
3. Starvation

Failed Adaptation

1. Continuing protein
2. Fat loss
3. Hypoalbuminerria

Uncomplicated Stress

Present when patients are at nutritional risk

Severe stress

Brought about by trauma, disease, and some type of surgeries

Stress effects on protein metabolism

1. Protein/Skeletal muscle mobilized for energy .
2. Decreased uptake of amino acids by muscle tissue
3. Increased urinary excretion of nitrogen
4. Glutamine used as fuel source for intestinal cells
5. Maintaining intestinal immune function
6. Enhancing wound repair

Stress impacts on body fluid status

1. Increase Fluid losses possible from fever
2. Urine output
3. Diarrhea
4. Draining wounds
5. Diuretic therapy

Systemic inflammatory response syndrome

Inflammatory response that occurs in infection, pancreatitis, ischemia, burns, multiple traumas, shock, and organ injury

Diagnosis of Systemic inflammatory response syndrome Site of infection is established along with at least two of the following

1. Temperature is greater than 38 degrees Celsius or less than 36 degrees Celsius
2. Heart rate is greater than 90 beats per minute
3. Respiratory rate is greater than 20 breaths per minute (Tachypnea)
4. White blood cell count is greater than 12,000 per mm3 or less than 4,000 per mm3
5. Hypermetabolic and nutritional needs increase significantly

Multiple Organ Dysfunction Syndrome

1. Progressive decline of two or more organ systems at the same time
2. May follow trauma, severe burns, infection, or shock
3. Usually results initiation of stress response and release of catecholamines
4. Can progress to organ failure and death

First degree burn (Partial-thickness injury)

Reddening of the area/epidermis with no injury to dermal or subcutaneous tissue; take 3-5 days to heal without scarring

Second degree (Superficial partial-thickness injury and deep partial-thickness injury)

Reddening and blistering of dermis, and underlying subcutaneous tissue; don’t heal, and skin grafts required

Fourth degree

Muscle

Nutritional needs of burn patients

1. First 24-48 hours dedicated to fluid and electrolyte replacement
2. Total body surface area (TBSA) used to estimate extent of burn
3. Rule of nines

Goals of burn patients

1. Meets nutrient needs
2. Improves feeding tolerance
3. decreases incidence of bacterial translocation
4.Decreases number of infectious episodes
5. Decrease need for antibiotic therapy
6. Improves nitrogen balance
7. Reduces urinary catecholamines
8. Diminishes serum glucagon
9. Suppresses hypermetabolic response
10. Enhances visceral protein status
9.

Cardiovascular disease noncontrollable risk factors

1. Age
2. Ethnicity
3. Family History
4. Gender
5. Genetics
6. Hyperlipidemia

Cardiovascular disease controllable risk factors

1. Diet Lifestyle
2. Lipoprotein
3. BMI
4. Exercise
5. BP
6. Inflammation
7. Glucose

Four BMI Categories

1. Underweight
2. Normal Healthy
3. Overweight
4. Obese

Underweight BMI

Below 18.5

Normal/Healthy BMI

18.5 to 24.9

Overweight BMI

25 to 29.9

Obese BMI

30 or greater

Classification of serum lipid Values

1. Normal
2. Borderline High
3. High
4. Very High

Normal Serum lipid value

Less than 150

Borderline High serum lipid value

150-199

High serum lipid value

200-499

Very High serum lipid value

Greater than or 500

Four types of dietary fats

1. Trans Fats
2. Saturated Fats
3. Polyunsaturated Fats
4. Monounsaturated Fats

Three most oils and fats percentage saturated Fats

1. Coconut oil- 91%
2. Butter- 61%
3. Palm oil- 51%

Three most oils and fats percentage Polyunsaturated

1. Sunflower- 71%
2. Corn oil- 57%
3. Soybean and Cottonseed oil- 54%

Three most oils and fats percentage monounsaturated

1. Safflower oil- 77%
2. Olive oil- 75%
3. Canola Oil- 61%

Three most oils and fats percentage trans fats

1. Flaxseed oil- 57%
2. Canola oil- 11%
3. Soybean- 8%

Four types of Nutrient Content Claims used on food labels

1. Free Fat
2. Low Fat
3. Light or lite Fat
4. Reduced or Less

Free Fat must be

Fat: Less than 0.5g per serving
Saturated Trans Fat: Less than 0.5mg per serving
Cholesterol: Less than 2 mg per serving
Sodium: Less than 5 mg per serving
Calories: Less than 5 kcal per serving

Low Fat must be

Fat: Less than or 3g per serving
Saturated Trans Fat: Less than 2mg per serving
Cholesterol: Less than or 20mg per serving
Sodium:Less than or 140mg per serving
Calories: Less than or 40 kcal per serving
Calories:

Light or Lite much be

A product has 1/3 fewer kcal thanks a comparable product or 50% of the fat found in a comparable product, or the sodium content of a low-kcal, low-fat food has been reduced by 50%

Reduced or Less

A nutritional altered product that contains 25% less of a nutrient or kcal than the regular product

Essential Hypertension (Primary)

Elevated blood pressure for which the cause is unknown

Secondary Hypertension

A specific cause of elevated blood pressure can be identified

Causes of Secondary Hypertension

1. Cushing’s syndrome
2. Primary Aldosteronism
3. Renal insufficiency

Causes of Essential Hypertension

Causes unknown or social, genetic, environment determinants

Classifications of blood pressure for adults

1. Normal
2. Elevated
3. High Blood Pressure (Hypertensions Stage 1)
4. High Blood Pressure (Hypertensions Stage 2)
5. Hypertension Crisis

Normal Blood pressure

Systolic: Less than 120 mmHg
Diastolic: Less than 80 mmHg

Elevated Blood pressure

Systolic: 120-129 mmHg
Diastolic: Less than 80 mmHg

High blood pressure (Stage 1)

Systolic: 130-139 mmHg
Diastolic: 80-89 mmHg

High Blood pressure (Stage 2)

Systolic: 140 or higher mmHg
Diastolic: 90 or higher mmHg

Hypertensive Crisis

Systolic: Higher than 180 mmHg
Diastolic: Higher than 120 mmHg

The nine claims on nutrient content claims

1. High, rich in, excellent source of
2. Good source, contains, provides
3. More, fortified, enriched, added, extra, plus
4. Lean
5. Extra Lean
6. High potency
7. Modified
8. Fiber
9. Antioxidant

High, rich in, excellent source of must

Contain greater than or 20% of the daily value and may be used to indicate food contains a nutrient that meets definition but may not be used to describe meal

Good source, contains, provides

Contains 10%-19% of daily value and may be used to indicate food and meets definition but not used to describe meal

More, fortified, enriched, added, extra, plus

Contains greater than or 10% of the daily value may only be used for vitamins, minerals, protien, dietary fiber, and potassium

Lean

On seafood or game meat products that contain less than 10 g total fat, 4.5 g or less saturated fat, and less than 95 mg cholesterol per 100g

Extra lean

On seafood or game meat products that less than 5 g total fat, less than 2g saturated fat and less than 95mg cholesterol per 100 g

High Potency

May be used on foods to describe individual vitamins or minerals that are present at 100g

Modified

May be used in statement of identity of a food that bears a relative claim

Fiber

If food is not low in total fat, then label must disclose the level of total fat per labeled serving

Antioxidant

RDA must be established for each of the nutrients that are the subject of the claim. Each nutrient must have existing scientific evidence of antioxidant activity. Level of each nutrient must be sufficient to meet the definition for high, good source, or more. Beta carotene may be. Subject to antioxidant claim.

Nephrotic Syndrome

Collection of symptom that can occur after damage to the capillary walls of the glomerulus

Nephrotic syndrome symptoms

Proteinuria, Hypoalbuminemia, Hyperlipidemia, edema

Causes of Nephrotic Syndrome

Glomerulonephritis or nephropathy secondary to amyloidosis, diabetes mellitus, systemic lupus erythematosus (SLE), or infectious disease

Nutrition Therapies of Nephrotic Syndrome

1. Needed Monitoring of body weight and intake and output every shift
2. Patient education to reduce intake of food choices high in sodium
3. Protein: 0.7 to 1.0g/kg/day
4. Calories: 35 kcal/kg/day
5. Total fat: less than 30% of energy
6. Complex Carbohydrate: most of energy needs
7. Sodium: Limit; check for hidden sources of sodium (e.g. medications, toothpaste, mouthwash, water)

Acute renal failure

Characterized by abrupt loss of renal function; may or may not coexist with oliguria or Anuria.

Acute renal failure symptoms

1. Two-thirds of patients experience three stages
2. Oliguric Phase- appears 24 to 48 hours after injury; lasts 7 to 21 days with azotemia, acidosis, hyperkalemia, hyperphosphatemia, hypertension, anorexia, edema, risk of water intoxication
3. Diuretic Phase- Lasts approximately 2 to 3 weeks: output of urine gradually increases
4. Recovery Phase- 3 to 12 months; some damage may be permanent

Acute failure causes

Acute tubular necrosis: post-ischemic or nephrotoxic

Acute Failure Nutrition

1. Intake and output must monitored each shift and must be weighed daily to help differentiate between fluid shifts and loss of lean body mass
2. Education involves reduced proteins, sodium, potassium, and fluid, constipation can occur as result of dietary restrictions, inactivity, medication, and fluid restriction.

National Renal Diet Background

1. Diet guidelines and meal plans for pre-ESRD period, hemodialysis, and peritoneal dialysis
2. Individualized to include ethnic and geographically unique foods
3. Vegan choices not included because vegan proteins have low biologic value

National Renal Diet Individual Needs

1. Calories
2. Fluid
3. Potassium
4. Protein
5. Phosphorus
6. Sodium

National Renal Diet Nutrition Therapy

1. Diet depends on method of treatment and medical and nutritional status of the patient
2. No guidelines for when medical Nutrition Therapy (MNT) should begin

RDA or recommended dietary intake for protein for non disease individuals

0.8 g/kg

Acute Renal Failure RDA for protein

Non-Dialysis: 0.6 g/kg
Dialysis: 1.0 to 1.4 g/kg

Complete protein

Contains all nine essential amino acids in sufficient qualities that best support growth and maintenance of our body

Complete protein food sources

Meat, poultry, fish, and eggs and human milk are the highest complete protien

Incomplete Protein

Lacks one or more of the time nine essential amino acids

Incomplete Protein food sources

Vegetables, Fruits, Oats, and Rice