Exam 2 - Nutrition

Created by toriabbie 

Upgrade to
remove ads

anthropometry

measurement system of size and makeup of body

MAC

mid-upper arm circumference

TSF

triceps skinfold

MAMC

mid-upper arm muscle circumference

study of metabolomics

concentration of small molecules that are the result of metabolic processes. Create metabolic profiles to id molecular level differences - who will benefit from losing weight.

dietary needs of COPD pts

Protein is most important bc they need to pdc RBCs so that there's something for O to attach to. Unfortunately, they have little appetite.

anabolism

building of more complex biochemical substances by syn of nutrients.

catabolism

breakdown of biochemical substances into simpler substances. Worst environment for pts who are sick -- leads to imbalances in body -- incr difficulty in healing

catabolism and injury

malabsorption (missing Es); Obstruction (peristalsis stopped, no nutrients); Liver/pancreas disease; Diminished perfusion (gut mesentery); Immobility (muscle wasting, bone resorption); Gastroparesis (paralyzed stomach); Inflammatory processes (infxn, autoimmune); Critical illness/injury

GI mucousal integrity

Inner-most endoth layer, responsible for GI secretions and sensitivity to chemicals and mechanical stimuli. Different areas have columnar epith cells. These cells, along with mucous, make mucosa impermeable to HCl

Increased energy needed for healing

Normal: Post-op; +10-30: Multiple fractures; +30-50: Severe infection; +50-110: 3rd degree burns

Metabolic Support

Big picture slide on pg. 10

mouth

produces saliva

esophagus

produces mucus

stomach

mucous, HCl, intrinsic factor, pepsinogen, gastrin

sm. intestine

digestive Es and mucous

lg. intestine

mucous

Gut Translocation

Mucosal lining b/down leads to translocation of B into bloodstream and the beginning of overwhelming infxn - immune response - organ failure - death from sepsis. Normally E. Coli. Needs to protect GI lining

Outcome of Gut Translocation

Bowel is resevoir of B, normal flora. If enter portal of systemic circulation, initiate sepsis or perpetuate on-going process

EBP w/ gut translocation

Early and continued enteral feeding promotes mucosal integrity, minimizing gut breakdown. Limit IV feeding! Switch to enteral or normal food ASAP.

Nurse's role with nutrition

Positive comments about trays, intake flow sheets, consult RD for diet instructions, poor appetite, suspected malnutrition, alternate nutritional support

Factors for diet selection

Diagnosis, age, diet order, albumin levels, pressure ulcers, food/drug interactions, length of stay. High risk - consult RD.

NPO

nothing by mouth, nothing pre-op

anorexia in in-patients

ill pts often have poor appetite. ketosis (linked to starvation) suppresses appetite, diagnostic tests and NPO can disrupt meal times. Watch that folks don't miss meals

Signs of malnutrition

pressure ulcers, pitting edema, dry skin, thinning/dry hair, temporal muscle wasting, ascites, hepatomegaly, excess/deficient subq fat, muscle wasting, bone pain

High-Risk for Malnutrition

Surgery, NPO, diagnosis, vent support >24hr, Albumin <3, Prealbumin <18, Braden <14, Wt loss >5 lbs/mo, diarrhea >24h, poor eating, inappropriate diet orders (prolonged clear liquids)

Labs for Malnutrition

Hgb, TIBC, transferrin, retinol binding protein, prealbumin, albumin

Albumin vs. prealbumin

Albumin - nutritional status over last 3 mos; Prealbumin - previous week (for nutritional status)

Albumin

Carrier protein (zinc, Ca, etc) - necessary for maintaining oncotic pressure. Low - malnutrition, increased risk for morbidity, chronic rather than acute depletion

Advantages of Albumin

Prognosis indicator, inexpensive, long-term assessments

Limitations of Albumin

Long half-life (20d) so insensitive to acute, large body pool, affected by fluid status, not definition measure

Prealbumin

Carrier protein for retinol-binding protein and transport protein for thyroxine. Sensitive indicator of visceral protein status. Acute

Advantage of prealbumin

Half-life of 2-3 d so sensitive for acute, better indicator of dietary change, not affected by fluid status

Limitations of prealbumin

Ltd. use in situations where there is a sudden demand for protein synthesis. More expensive

How to prevent malnutrition

Deliver meals hot, Help with tray set-up, oral care before/after, help them sit-up in chair, help with calorie count, consistently record height/weight on chart

Diet Progression

clear liquid - full liquid - pureed - soft mechanical - soft - regular

Tube vs. IV

Tube - gut functioning but can't eat. ST: NG, ND. LT: gastrostomy or jejunostomy tube. IV - gut not functioning. TPN/hyperalimentation

duodenal tube

For longer-term feeding. Weight at end drops through stomach to duodenum. Stays for months. Inserted by nurse. 2 tubes. Top - sucks out juices to prevent vomiting. Bottom - allows to feed past motility problems. Push to stomach, then peristalsis pulls further. Can't use until xray confirms.

PEG

percutaneous endoscopic gastroscopy

Advantages of enteral nutrition

Physiologic and easier, preserves immune fxn, preserves gut barrier fxn, cheaper than TPN, fewer complications

GRV

gastric-residual volume. how much fluid we put in and how well body is tolerating it. estimates for liquid amts aren't EB. should be <200 but be really concerned if >400

Preventing infxn with enteral feeding

Clean top of formula can with alcohol wipe before opening, switch bedside container every 24 hrs, replace formula every 4 hrs

TPN Contents per day

Yellow. Liquid: (30-40 mL/kg); Energy: (30-60 kcal/kg); AAs (1-2 g/kg, depending on catabolism); essential fatty acids, vitamins, minerals. Rely on lab values!

Who is involved in selecting TPN diet?

RD, RN, Dr, Pharmacy

Lipid Emulsion

Milky. Provide supplemental kilocalories and prevent essential fatty acid deficiencies. Normally separate bc don't mix well. Select line based on tonicity -- higher tonicity reqs central line.

Central vs peripheral veins for TPN

<10% dextrose - peripheral in combo with AAs and lipids. >10% central vein

TPN Protocols

Start slow and incr if they tolerate. 40-60 mL/hr. Too quick - osmotic diuresis/dehydration

TPN and causes of death

Gall stones bc too much pdxn of bile in relation to diet. Or, immune cells in liver become too fatty and don't work.

Short-Gut Syndrome

Chroris. Ulcerative colitis. Gut stops working. Parts are removed.

Complications of TPN (1-4)

Things that we can control: 1) Pneumothorax, 2) Air embolism; 3) Catheter occlusion; 4) Catheter sepsis

Complications of TPN (5-10)

Metabolic things that can happen that we can anticipate - check lab values every few hours. 5) thrombosis of central vein; 6) hyperglycemic hyperosmolar nonketotic dehydration/coma; 7) electrolyte imbalance; 8) hypercapnia; 9) hypoglycemia; 10) fatty liver

Please allow access to your computer’s microphone to use Voice Recording.

Having trouble? Click here for help.

We can’t access your microphone!

Click the icon above to update your browser permissions above and try again

Example:

Reload the page to try again!

Reload

Press Cmd-0 to reset your zoom

Press Ctrl-0 to reset your zoom

It looks like your browser might be zoomed in or out. Your browser needs to be zoomed to a normal size to record audio.

Please upgrade Flash or install Chrome
to use Voice Recording.

For more help, see our troubleshooting page.

Your microphone is muted

For help fixing this issue, see this FAQ.

Star this term

You can study starred terms together

NEW! Voice Recording

Create Set