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34 Cards in this Set
- Front
- Back
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what weight factors would place someone at nutrtional risk
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involuntary loss or gain
>10% in 6 months >7.5% in 3 months >5% in 1 month 20% above or below IBW |
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aside from weight what are some other factors that would place someone at nutritional risk
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currently on PN, EN nutrition, surgery, illness
inadequate nutrition intake (inadequate PO/enteral intake > 7 days, malabsorption syndrome - small bowel) |
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what are some of the clinical presentations seen in a pt with malnutrition
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delayed wound healing
decreased resistance to infection decrease drug responsiveness impaired collagen formation |
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what happens in 0-12 hrs of starvation
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glycogen break down to glucose
brain, RBC/WBC, renal medulla need glucose |
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what happens 12-72 hrs of starvation
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break down of BCAA (LIV)
-AA used in gluconeogenesis -skeletal muscle break down |
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what happens over 72 hrs of starvation
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shift from protein break down to fat break down
fat becomes primary energy source keton bodies are main medium of exchange |
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what is seen in starvation related malnutrition
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chronic starvation WITHOUT INFLAMMATION
anorexia |
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what is seen in Acute disease or injury related malnutrition
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marked inflammation or inflammatory response
ex: trauma, major infection, BURNS, closed head injury |
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what is seen in Chronic disease related malnutrition
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mild/moderate sustained inflammation
ex: diabetes, malignancies, organ failure, rheumatoid arthritis SLOW DETERIORATION OF LEAN BODY MASS |
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what are some things seen in the nutrition physical exam
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loss of subcutaneous fat @ triceps/palms
muscle wasting @ deltoids, quads, temporals edema ascites mucosal lesions (glossitis, skin lessions) tumor burden poor wound healing peripheral neuropathy (common in alcoholics and diabetics) |
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what are the anthropometric measurements
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weight and height (dry weight)
wrist circumference (can determine CV risk) BMI mid arm circumference |
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what are some of the laboratory assessments for nutrition
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cell mediated immunity
total lymphocyte count (WBC x %lymphocytes > 2000 means adequate reserve) albumin/prealbumin levels |
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what is the issue with total lymphocyte count
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many drugs/disease states can alter this
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what is the t1/2 of albumin and prealbumin and when is it considered depleted
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albumin 3 weeks depleted value <3.5
prealbumin 2 days depleted value <22mg/dl |
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what is the issue with looking at albumin and prealbumin
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they are negative acute phase proteins and in times of stress/inflammation the liver will decrease their production so don't expect to see increase in values till improvement of condition
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what can also be drawn with prealbumin to see if the inflammation is subsiding
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C reactive protein
decrease CRP increase prealbumin |
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what are the dietary reference intake for macronutrients
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45-65% carbs
20-35% fat 10-35% protein |
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what is the clinical caloric estimates
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20-25 kcal/kg/day for healthy/normal
25-30 kcal/kg/day for malnurished/mildly stressed 30-35 kcal/kg/day for critically ill, hypermetabolic 35-40 kcal/kg/day for major burn injury |
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what is the harris benedict equation for men and women
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women 655 + 9.6w + 1.7H - 4.7A
men 66+ 13.7w + 5H - 6.8A then multiply by stress factor (burn = 2, confined to bed = 1.2, not in bed = 1.3) |
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what is the equation of Indirect calorimetry and what does it measure
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measures O2 consumption and CO2 production
REE (kcal/day) = 3.9VO2 + 1.1VCO2x1.44 |
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when would you do protein restriction in liver disease
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when there are signs of encephalopathy
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what does protein requirement depend on
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liver and kidney function
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a BMI of what is classified as obese
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>30
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obese pts are at risk for what other commorbidities
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insulin resistance
sepsis(infection) DVT organ failure |
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what are the caloric requirements for Obese pts
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60-70% of target energy requirements
22-25 Kcal/kg IBW/day |
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what are the protein requirements of obese pts
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BMI 30-40 2g/kg IBW/day
BMI > 40 2.5g/kg IBW/day |
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what lab is an indicator of Essential fatty acid deficiency
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triene:tetraene ratio > 0.4
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what are the minimal requirements to prevent EFAD
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100g IV fat emulsion per week
20% of 250 cc IV 2x per week |
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what are the macronutrient ranges
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dextrose 2-7 g/kg/day
protein 0.8-2g/kg/day fat emulsion 0.5-1.5g/kg/day |
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what are the fluid requirements
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30-40 ml/kg/day
remember to account for all piggy backs they're receiving |
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what are some factors that make you need LESS fluid
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SIADH
renal failure cardiovascular failure fluid overload |
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what are some factors that make you need MORE fluid
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nasogastric suction
diuretics BURN INJURY diabetes insipidus hyperventilation prematurity |
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what vitamin are alcoholics at a risk of being deficient in
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thiamine (B1)
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what are situations that you would have to adjust trace elements
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renal failure - hold selium
hepatic failure - hold copper and manganese severe diarrhea/fistula - additonal zinc |
