Term
| Calculate Ideal Body Weight (IBW) |
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Definition
IBW=50+2.3(inches>60") for males
IBW=45+2.3(inches>60") for females |
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Term
| Calculate Dosing Body Weight (DBW) |
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Definition
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Term
| Calculate Nutrition Body Weight (NBW) |
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Definition
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Term
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Definition
use if dry weight is greater than 130% of IBW
generally use the same weight for all calculations in order to be consistent for FEN management |
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Term
| Risk factors for malnutrition |
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Definition
UBW; 20% below IBW
involuntary weight loss>10% within 6 months
NPO>10 days (clinically we use ~7 days)
Increased metabolic needs
Protracted nutrient loss-->chronic disease stat |
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Term
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Definition
| diet PTA, intake, swallowing, ulcers; h/o weight loss, anorexia, vomiting, diarrhea |
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Term
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Definition
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Term
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Definition
| decreased nutrient absorption, alter taste; increase or decrease appetite; N/V |
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Term
| Anthropometrics-Somatic(muscle) protein status |
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Definition
weight
trceps skin fold
arm muscle circumference
physical appearance |
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Term
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Definition
half life 18-21 days
NL serum concentration: 3.5-5 gm/dL |
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Term
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Definition
half life: 8-10 days
NL serum concentration: 250-300 mg/dL |
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Term
| Transthyretin (prealbumin) |
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Definition
half-life=2-3 days
NL serum concentration: 15-40mg/dL |
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Term
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Definition
half-life=0.5 days
NL serum concentration: 2.5-7.5 gm/dL |
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Term
| Protein-calorie malnutrition (marasmus) |
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Definition
decreased total intake and/or utilization of food
wasting of skeletal muscle and subcutaneous fat
immunosuppression in severe cases
cachectic appearance |
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Term
| Protein malnutrition (Kwashirokor) |
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Definition
adequate calorie intake; relative protein malnutrition
catabolic trauma patients; burn patients |
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Term
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Definition
chronically ill starved patients who are metabolically stressed
decreased visceral proteins, poor wound healing, immunocompromised |
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Term
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Definition
| measurement of urinary excretion of nitrogen as urea nitrogen (urinary urea nitrogen) |
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Term
| Non-urinary sources of nitrogen loss |
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Definition
| sweat, feces, respirations, GI fistulas, wound drainage, skin exfoliation, burns |
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Term
| Nitrogen balance study used to assess the adequacy of protein repletion |
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Definition
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Term
| Formula for nitrogen balance |
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Definition
Nitrogen balance = (N in ) - (N out)
N in = 24 hour protein intake (g) / 6.25
N out = 24 hour UUN(g) + factor (3-5g)
use 4 g clinically |
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Term
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Definition
Harris-Benedict Equation- Basal Energy Expenditure (BEE)
Include "stress" or activity factory with Harris-Benedict Equation |
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Term
| General guidelines (total kcal/kg/day) |
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Definition
non-stressed, non-depleted: 20-25 kcal/kg/day
trauma/stress/surgery/critically ill: 25-30 kcal/kg/day
major burn: 35-40 kcal/kg/day or more
obesity (above 150% IBW): 22-25 kcal/kg/day (IBW) |
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Term
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Definition
for all energy production, oxygen is consumed and carbon dioxide is produced
abbreviated weir equation:
REE=[39(VO2)+1.1(VCO2)]x1.44
multiply the REE by ~1.2 to calculate the total EE
provides energy expenditure at that ONE point in time; then extrapolated to 24 hrs: RQ=VOC2/VO2
Goal RQ 0.85-0.95 |
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Term
| Protein requirements for maintenance, mild to moderate stress, moderate to severe stress, burn, obesity, and severe obesity |
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Definition
maintenance (non-hospitalized pts): 0.8-1gm/kg/day
mild to moderate stress(floor pts): 1-1.5gm/kg/day
moderate to severe stress, repletion, (ICU, trauma, surgery pts): 1.5-2gm/kg/day
burn: 2-2.5gm/kg/day (may require more based on clinical trials)
obesity (BMI>30): 2gm/kg/day(IBW)
severe obesity(BMI>40):2.5gm/kg/day(IBW) |
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Term
| Adequate calories must be present for appropriate protein utilization |
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Definition
adequate NPC
protein "tolerance" may be decreased in some disease states (i.e. renal and hepatic failure) |
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Term
| Non-protein calorie (NPC) distribution |
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Definition
standard distribution (70/30)
70-85% dextrose. 15-30% fat
adjust based on tolerance: BS, TG, RQ
100/0 may be utilized during sepsis and bloodstream infections |
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Term
| Parenteral nutrition- definition |
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Definition
parenteral nutrition is the process of supplying nutrients (i.e. protein, carbohydrates, fat, electrolytes, vitamins, minerals) via an IV delivery system
synonyms: hyperalimentation, HA, HAL, HAF, TPN, IVH, IVA, CHA(central), PHA(peripheral), PPN, total nutrient admixture, TNA, 3-in-1, triple-mix |
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Term
| Indications for parenteral nutrition |
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Definition
anticipated prolonged NPO course (>7 days)
inability to absorb nutrients via the gut, such as secondary to: small bowl or colonic ileus, extensive small bowel resection, malabsorptive states, intractable vomiting/diarrhea
enterocutaneous fistulas
inflammatory bowel disease
hyperemesis gravidum
bone marrow transplantation (mucositis) |
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Term
| Routes of administration--Peripheral TPN |
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Definition
dextrose and amino acid solutions are hypertonic-->not well tolerated via a peripheral vein
restrict final dextros conc to 5-10%, or total osmolarity to <900 mOsm/L
addition of lipid or heparin to solution may enhance vein tolerance
requires large volumes of fluids--> may not be the best choice for HF or RF patients
limited in calories-->secondary to osmolality AND fluid
short term access(<7-10 days)-->does this patient need TPN at all? |
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Term
| Routes of administration--Central TPN |
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Definition
advantage-->allows adminstration of hypertonic solutions
disadvantages: risk of infection->appropriate central line care is key to prevention; central line is not a benign procedure: pneumothorax, air embolus, thrombus |
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Term
| Central Venous Access: central venous catheter(CVC) insertion sites, short term, long term |
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Definition
subclavian (SC), internal jugular (IJ), femoral
short-term: percutaneously inserted
long-term: PICC(peripherally inserted central catheter), tunneled, implanted port |
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Term
| Meeting protein requirements |
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Definition
one gm protein=4kcal
many hospitals actually order protein in gm/day
standard amino acid products: Travasol, FreAmine III, Aminosyn II |
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Term
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Definition
max concentration available: D70% (D70W)
one gram dextrose=3.4 kcal
maximum carbohydrate utilization: 4-5 mg/kg/min (double check if needed) |
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Term
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Definition
prevents essential fatty acid deficiency
provides a concentrated source of calories: ~10 kcal/gm of lipids
remember: propofol is a 10% lipid solution; provides 1.1 kcal/mL
fat emulsion 30%: must be incorporated into a total nutrient admixture |
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Term
| IV fat emulsion max intake-- do not exceed |
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Definition
60% of caloric intake as lipid
2.5 gm/kg/d of lipid in adults
4g/kg/d of lipids in infants and children |
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Term
| Essential fatty acid (EFA) requirements |
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Definition
estimated to be 4-10% of daily calories
EFAs include linoleic acid and probably linolenic acid |
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Term
| Essential fatty acid deficiency (EFAD) mechanism |
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Definition
continuous infusion of hypertonic dextrose will increase circulating insulin levels
inhibitors lipolysis and fatty acid mobilization |
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Term
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Definition
several weeks on a fat-free TPN regimen (10-14 days)
dry, scaly skin, brittle hair, lack of luster |
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Term
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Definition
| provide at least 500mL of 10% fat emulsion or 250mL of 20% fat emulsion twice weekly |
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Term
| Total Nutrient Admixture (TNA) |
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Definition
| dextrose, AA, and lipids in one bag--> "3 in 1" = TPN |
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Term
| Conventional administration |
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Definition
dextrose and AA in one bag
lipid 2-3 times a week as separate IVPB |
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Term
| Premix solution for injection |
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Definition
with or without electrolytes
no lipids |
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Term
| Initiation and discontinuation guidelines |
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Definition
start at ~25% of goal and achieve the final rate within 24 hrs
check BS q4-6h before each increase in rate, if BS>200, continue at same rate x 4 hrs and recheck, if repeat BS>200, consider insulin therapy
cessation: decrease rate by half every 2 hrs until rate <50mL/hr, then dc |
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Term
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Definition
infusion over 10-18 hours per day
patients who desire time free from infusion pump-->home TPN patients
rate of infusion generally cut back (taper) during the last hour of infusion to prevent hypoglycemia |
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Term
| IV fat emulsion max intake-- do not exceed |
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Definition
60% of caloric intake as lipid
2.5 gm/kg/d of lipid in adults
4g/kg/d of lipids in infants and children |
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Term
| Essential fatty acid (EFA) requirements |
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Definition
estimated to be 4-10% of daily calories
EFAs include linoleic acid and probably linolenic acid |
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Term
| Essential fatty acid deficiency (EFAD) mechanism |
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Definition
continuous infusion of hypertonic dextrose will increase circulating insulin levels
inhibitors lipolysis and fatty acid mobilization |
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Term
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Definition
several weeks on a fat-free TPN regimen (10-14 days)
dry, scaly skin, brittle hair, lack of luster |
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Term
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Definition
| provide at least 500mL of 10% fat emulsion or 250mL of 20% fat emulsion twice weekly |
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Term
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Definition
adult--> 10mL/d of injectable adult multivitamin-12; contains small amount of vitamin K(150mcg)
pediatric (3kg-35kg)--> 2mL/d of injectable pediatric multivitamin; contains vitamin K |
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Term
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Definition
Mechanical (catheter-related): clotting of line, displacement
Infectious: catheter-related sepsis, solution contamination, bacterial translocation
Metabolic: electrolyte imbalance, fluid imbalance, hyper and hypoglycemia, liver function abnormalities, steatosis (fatty liver), intrahepatic cholestasis, cholelithiasis |
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Term
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Definition
| chem 7, Mg, Phos, Ca, hepatic function panel, prealbumin, PT/INR |
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Term
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Definition
vital signs, intake/output
electrolytes (sodium, potassium, chloride, bicarbonate), glucose, BUN/Scr
may decrease frequency when stable |
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Term
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Definition
weight, CBC, magnesium, phosphorous, calcium, prealbumin
ICU setting--> increase monitoring to daily |
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Term
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Definition
albumin, transferrin, nitrogen balance, liver function test (alkaline phosphatase, AST, ALT, LDH, bilirubin), triglycerides, PT/INR
Respiratory Quotient (RQ)/indirect calorimetry |
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Term
| Enteral nutrition-Indications |
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Definition
Remember: "if the gut works, use it"
oral consumption inadequate
oral consumption contraindicated: esophageal obstruction, head and neck surgery, dysphagia, trauma, cerebrovascular accident, dementia |
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Term
| Advantages of enteral nutrition |
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Definition
provides GI stimulation: decreases changes for bacterial translocation, stimulates biliary flow through biliary tract
avoids risks associated with IVs: non-invasive placement at bedside, line infections, pneumothorax, etc.
physiologic
bolus feeds are more physiologic than continuous infusion
less stringent protocol for administration
less expensive (depending on formula) |
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Term
| Contraindications for enteral nutrition |
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Definition
mechanical obstruction
non-mechanical obstruction-ileus
intractable vomiting
severe malabsorption
severe GI hemorrhage
certain types of fistulas-high output, proximal small bowel |
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Term
| Routes of administration-EN |
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Definition
nasogastric (NG)/Orogastric(OG)
nasojejunal(NJ)/orojejunal(OJ)--Dobhoff, Cortrak/Corpak
gastronomy: percutaneos endoscopic gastrostomy (PEG), surgical placement
jejunostomy; PEG/PEJ |
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Term
| Determining route of access for EN |
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Definition
Risk of aspiration: if low risk utilize gastric, if high risk-jejunal is preferred
tolerance: vomiting, gastric residuals
duration of therapy: long term-PEG or PEJ |
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Term
| methods of administration for EN-Bolus |
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Definition
administer >200mL formula over 5-10 min
requires minimal equipment (syringe
used primarily for patients with gastrostomy-cannot feed into small bowel
more convenient for pts-->nursing facilities, ambulatory settings
higher risk of aspiration and intestinal SE? |
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Term
| methods of administration of EN-Intermittent |
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Definition
administer >200 mL formula over 20-30 minutes (gravity drip)
4-8 feedings per day
requires use of reservoir bottle or bag |
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Term
| Methods of administration of EN-continuous infusion |
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Definition
administer continuously over 12-24 hours/day
requires use of infusion pump
preferred method when feeding into the jejunum
gastric distention and aspiration risk may be lower
better tolerated by the patient |
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Term
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Definition
| patient characteristics: functional capacity of GI tract, underlying disease, nutritional requirements |
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Term
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Definition
adult--> 10mL/d of injectable adult multivitamin-12; contains small amount of vitamin K(150mcg)
pediatric (3kg-35kg)--> 2mL/d of injectable pediatric multivitamin; contains vitamin K |
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Term
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Definition
Mechanical (catheter-related): clotting of line, displacement
Infectious: catheter-related sepsis, solution contamination, bacterial translocation
Metabolic: electrolyte imbalance, fluid imbalance, hyper and hypoglycemia, liver function abnormalities, steatosis (fatty liver), intrahepatic cholestasis, cholelithiasis |
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Term
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Definition
| chem 7, Mg, Phos, Ca, hepatic function panel, prealbumin, PT/INR |
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Term
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Definition
vital signs, intake/output
electrolytes (sodium, potassium, chloride, bicarbonate), glucose, BUN/Scr
may decrease frequency when stable |
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Term
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Definition
weight, CBC, magnesium, phosphorous, calcium, prealbumin
ICU setting--> increase monitoring to daily |
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Term
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Definition
albumin, transferrin, nitrogen balance, liver function test (alkaline phosphatase, AST, ALT, LDH, bilirubin), triglycerides, PT/INR
Respiratory Quotient (RQ)/indirect calorimetry |
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Term
| Enteral nutrition-Indications |
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Definition
Remember: "if the gut works, use it"
oral consumption inadequate
oral consumption contraindicated: esophageal obstruction, head and neck surgery, dysphagia, trauma, cerebrovascular accident, dementia |
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Term
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Definition
adult--> 10mL/d of injectable adult multivitamin-12; contains small amount of vitamin K(150mcg)
pediatric (3kg-35kg)--> 2mL/d of injectable pediatric multivitamin; contains vitamin K |
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Term
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Definition
Mechanical (catheter-related): clotting of line, displacement
Infectious: catheter-related sepsis, solution contamination, bacterial translocation
Metabolic: electrolyte imbalance, fluid imbalance, hyper and hypoglycemia, liver function abnormalities, steatosis (fatty liver), intrahepatic cholestasis, cholelithiasis |
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Term
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Definition
| chem 7, Mg, Phos, Ca, hepatic function panel, prealbumin, PT/INR |
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Term
|
Definition
vital signs, intake/output
electrolytes (sodium, potassium, chloride, bicarbonate), glucose, BUN/Scr
may decrease frequency when stable |
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Term
|
Definition
weight, CBC, magnesium, phosphorous, calcium, prealbumin
ICU setting--> increase monitoring to daily |
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Term
|
Definition
albumin, transferrin, nitrogen balance, liver function test (alkaline phosphatase, AST, ALT, LDH, bilirubin), triglycerides, PT/INR
Respiratory Quotient (RQ)/indirect calorimetry |
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Term
| Enteral nutrition-Indications |
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Definition
Remember: "if the gut works, use it"
oral consumption inadequate
oral consumption contraindicated: esophageal obstruction, head and neck surgery, dysphagia, trauma, cerebrovascular accident, dementia |
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Term
| Nutrient composition- protein |
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Definition
intact protein->requires complete digestion into smaller peptides
partially digested (peptide-based)-->elemental; may be beneficial for pts with malabsorption, diarrhea |
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Term
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Definition
long-chain fatty acids
medium-chain fatty acids- more water soluble; rapid hydrolysis, little or no pancreatic lipase for absorptin |
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Term
| Nutrient composition-carbohydrates |
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Definition
glucose polymers primarily used for tube feeding formulas
simple glucose used for oral supplements (higher in osmolality) |
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Term
| Initiation and advancement of EN |
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Definition
initiate at full strength at 25mL/h
advance 25mL/h q4-6h as tolerated up to goal rate
check residuals q4-6h
hold for residuals>400-500mL
dilution of formula has limited benefit-->do not recommend |
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Term
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Definition
high gastric residuals
diarrhea->check meds, formula
constipation->check meds
NV->metoclopramide, erythromycin(prokinetic) may be given
abdominal distention
aspiration->increase HOB 30 degrees to prevent aspiration |
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Term
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Definition
hyper-or hypoglycemia: check meds, insulin regimen, stress, infection
overhydration; dehydration->monitor fluid status
electrolyte imbalance->hyponatremia is most common |
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Term
|
Definition
clogging of feeding tube: poorly crushed meds, inadequate flushing, give on pancreatic enzyme tablet and one sodium bicarbonate tablet in 10mL of warm water, clamp for 15-30 min, then flush with 15-30mL of warm water when complete
tube malposition
rhinitis: reposition daily, use smaller bore tube
sinusitis |
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Term
|
Definition
gastric residuals;emesis
check q4-6h
stools daily (frequency of stools, volume of stools)
bloating/distention
bronchial/tracheal aspirate |
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Term
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Definition
intake/output (I/Os)
weight->2-3times per week
serum electrolytes, glucose, BUN/Scr->daily until stable->twice weekly->weekly
Mg, Phos, Ca, TG, LFTs->weekly
Albumin, transferrin/prealbumin, nitrogen balance-> weekly
Mechanical: feeding tube placement, feeding tube patency |
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Term
| Drug delivery via Enteral feeding tubes procedure guidelines |
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Definition
if oral dosage forms are used, crush the tablets to a fine powder or empty the contents of a capsule and mix in water
Do not crush sustained-release or enteric coated formulations
administer each drug separately, flush with at least 5mL o |
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