Fats

Proteins

Carbs.

glucose, fructose, and galactose.

***After absorption from the intestinal tract, fructose and galactose are converted to glucose

In very active tissues—such as those of the liver, kidney, and gastrointestinal mucosa—protein turnover occurs every few days.

If inadequate nutrition is provided then theses organs are at high risk of dysfunction.

gastrointestinal mucosa dysfunction= bacteria trans-location

If the rate of gluconeogenesis rises,

urinary nitrogen excretion also increases.

the amount of nitrogen excreted compared with that consumed.

urinary nitrogen excretion is measured (preferably over a 24-hour period).

Proteins- increas to 30% from 15%

Lipids- decreases to 20% from 30%

What lab assessment will best tell you about an acute malnutrition?

What is the normal range?

Prealbumin (PAB)

(20 - 40 mg/dL)

What lab finding will tell you about chronic malnutrition?

what is the normal range?

Albumin

(3.5 - 5.0 g/dl)

The pt is malnursished and is breaking down protien for energy. 

BUN (8 - 23 mg/dL)- pt is wnl

Creatinine (.5 - 1.5 mg/dL)- pt high

You have a critically ill pt with a nitrogen balance of +4.

What is your best nursing action at this time?

the lace of quality energy supply

lack of quality foods

The lack of energy resorses and Kcals.

Lack of quality and quantity

What are the two phases of the

Metabolic Stress Response

EBB  phase

FLOW phase

When pts are first injured they enter the ebe phase of the Metabolic Stress Response. 

In this phase would you expect to see hyper or hypo metabolism?

how does matabolisum change when pts enter the flow phase of the Metabolic Stress Response

What determines the length of time in the flow phase of the Metabolic Stress Response?

PO4

K

Mg

NPO > 7 days

ETHO abuss

eating disorders

CA cachexia

TPN is recommended for pts at risk of refeeding syndrome as it carries less risk to the pt then starting a pt out on foods or TEN feedings. 

True or False?

False

TPN is high in CHO and has the same risk as oral and TEN feedings.

start pt on 25-50% of CHO needs.

Careful monitering of labs 

Wound dehiscence, pressure ulcers, sepsis, infections, respiratory failure requiring ventilation, longer hospital stays, and death

higher incidences of complications, increased mortality rates, increased length of stay, and higher hospital costs.

What MANIFESTATIONS  MAY INDICATE

PROTEIN-CALORIE MALNUTRITION

Hair loss; dull, dry, brittle hair; loss of hair pigment

• Loss of subcutaneous tissue; muscle wasting

• Poor wound healing; decubitus ulcer

• Hepatomegaly • Edema

MANIFESTATIONS OFTEN PRESENT IN VITAMIN 

DEFICIENCIES are....

• Conjunctival and corneal dryness (vitamin A)

• Dry, scaly skin; follicular hyperkeratosis, in which the skin appears to have gooseflesh continually (vitamin A) 

• Gingivitis; poor wound healing (vitamin C)

• Petechiae; ecchymoses (vitamin C or K)

• Inflamed tongue, cracking at the corners of the mouth (riboflavin [vitamin B2], niacin, folic acid, vitamin B12, or other B vitamins) 

• Edema; heart failure (thiamine [vitamin B1])

• Confusion; confabulation (thiamine [vitamin B1])

• Blue sclerae; pale mucous membranes; spoon-shaped nails (iron)

• Hypogeusia, or poor sense of taste; dysgeusia, or bad taste; eczema; poor wound healing (zinc)

designed to reduce angina, cardiac workload, and risk of dysrhythmia.

Small, frequent snacks are preferable to larger meals

Aviod caffeine

Very hot or very cold foods should be avoided because they can potentially trigger vagal or other neural input and cause cardiac dysrhythmias.

A balanced low-fat, low-calorie diet.

a lowsaturated-fat and low-cholesterol diet.

sodium chloride restriction

Dietary Approaches to Stop Hypertension (DASH)  DASH  rich in fruits, vegetables, and low-fat dairy products, low cholesterol. It is rich in potassium and calcium content. Dietary sodium  100 mmol per day (2.4 g of sodium).

Alcohol men- no more than 1 ounce (30 mL)

women- no more than 0.5 ounce 

reduced sodium- 5 g a day or less

fluid  restriction- 1.5 to 2 L/day

concentrate nutrients into as small a volume as possible

serve small amounts frequently

enteral tube feeding may be necessary- use with caution can give pt fluid overload.

LOW CHO diet

small frequent meals

adiquate protein- prevent albumen loss and prevent infection 

decreased lipids- Excessive lipid intake can impair capillary gas exchange in the lungs.

Pt may need fluid restiction 

What should the nurse know about

energy needs and renal failure?

Energy needs are not increased by renal failure, but adequate calories must be provided to avoid catabolism.

Adults with renal insufficiency need about 30 to 35 calories/kg/day to prevent catabolism

potassium and phosphorus 

possible - vitamins A, E, and K,

What diet is best for a pt in Hepatic failure. 

WHY?

a diet lower in protein.

They are unable to convert the ammonia waste to urea

↓ glucose production by the liver, no reserves- needs adiquite intake.

↓ production of albumen - need some protein to prevent

Soft foods- the patient may have esophageal varices

resting the pancreas- NPO 

give tube feeds that bypass the jejunum or TPN

highest coloric needs of all pt types 

BMR 2-3X the norm

Fluid and electrolite shifts

soft moist foods

thickened liquids 

initaly may be hypermetabolic #2 highest demand

latter on reduced cal. to prevent weight gain

What are the advantages of Parenteral Nutrition

custom mix of nutrients

able to give nutrients despite of GI integrity 

sepsis

pneumothorax

air emboli

rapid changes in serum glucose

What are the advantages of Enteral Nutrition

maintains GI integrity

decrease risk of bacteria translocation

 fewer complications

less expensive

When pt needs bowl rest

intractable vomiting

paralytic ileus

GI Bleed

What are the complications that can arise with

the use of enteral nutrition 

N/V/D

inadiquate calories

tube occusion

aspiration