Term
| Role of Diet in Low-Risk Disease Management |
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Definition
| diet & lifestyle changes tried before drugs are used |
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Term
| Role of Diet in High-Risk Disease Management |
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Definition
| diet & drug therapy are started simultaneously |
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Term
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Definition
| protein-energy malnutrition; decreased protein intake & decreased energy; decreased fat, somatic protein, and immune function with normal visceral protein; EX: wasting syndrome, cancer cacchexia |
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Term
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Definition
| protein malnutrition; decreased albumin & protein; normal somatic protein & fat; decreased albumin & immune function; distention of stomach; EX: catabolic states (burn, trauma) |
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Term
| Mixed Marasmus-Kwashiorkor |
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Definition
| combination of protein & energy malnutritions; decreased fat, somatic protein, visceral protein (albumin), and immune function; EX: hypermetabolic states in critically ill |
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Term
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Definition
| identifies patients who are overweight, obese, malnourished, or at risk of malnutrition; simple checklists administered within 72 hrs of admission by clinicians and/or non-clinicians; refer at-risk patients to clinicians who can do something about it (PMD, RD, etc.) |
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Term
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Definition
| usually performed by a dietician; physical assessment: anthropmetrics (BMI), lab data, general appearance, skin & mucous membranes, musculoskeletal system, neurologic, hepatic; weight changes in previous 6 months: 1-2% in 1 wk, 5% in 1 month, 7.5% in 3 months, 10% in 6 months; dietary intake changes; GI symptoms; functional capacity of GI tract; presence of disease states |
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Term
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Definition
| Male (kg) = 50 + 2.3*(every inch > 5 ft); Female (kg) = 45 + 2.3*(every inch > 5 ft); Obese (kg) = [0.25(ABW-IBW)] + IBW |
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Term
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Definition
| undernourished = < 18.5; normal weight = 18.5 - 25; obese = > 30 |
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Term
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Definition
| 30-40 mL/kg/day; Replace: diarrhea, fistulas; Increase: fever; Decrease: HF, fluid restriction; Peds: weight dependent, increase with fever |
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Term
| Adult Energy Requirements |
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Definition
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Term
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Definition
| 3.4 kcal/gm; < 7 gm/kg/day; start low & slowly increase as tolerated; 70-85% of non-protein calories |
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Term
| Protein Calorie Requirements |
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Definition
| 4 kcal/gm; 6.25 gm protein = 1 gm nitrogen; usual range: 0.8 - 2 gm/kg/day; catabolic range: 1.2 - 2 gm/kg/day |
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Term
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Definition
| 9 kcal/gm; 15-30 % of non-protein calories; omit on first day just in case patient has a reaction; < 2.5 gm/kg/day |
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Term
| To gain or lose 1 lb (0.45 kg) per week: |
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Definition
| add or subtract 500 kcal/day |
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Term
| Reasons patients are underfed |
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Definition
| obesity, multiple organ dysfunction, uncomplicated infection, hypermetabolism |
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Term
| Reasons patients are Overfed |
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Definition
| underlying malnutrition, severe traumatic injury, sepsis |
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Term
| Consequences of Underfeeding |
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Definition
| decreased respiratory muscle strength, impaired organ function, immunosuppression, poor wound healing, increased risk of HCA infection |
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Term
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Definition
| hyperglycemia, azotemia, hypertriglyceridemia, electrolyte imbalance, immunosuppression, altered hydration status, hepatic toxicity |
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Term
| Macronutrient Components of Nutrition Formula |
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Definition
| protein, dextrose, lipids, fluids |
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Term
| Indications for Enteral Nutrition |
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Definition
| dysphagia (inability to swallow); obstruction of mouth, throat, esophagus, stomach; major burns, trauma, organ system failure; radiation/chemotherapy; fistulas |
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Term
| Contraindications for Enteral Nutrition |
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Definition
| disease states or pre- or post-surgery requiring GI rest; increased chance for aspiration, coughing, vomiting; non-functioning GI tract; obstruction of ileus; severe GI bleed; severe, intractable diarrhea; need < 5-7 days |
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Term
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Definition
| important in enteral feeding; maintenance of normal bowel habits, lowers BP & cholesterol; degraded by colon bacteria into short-chain fatty acids |
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Term
| Continuous Enteral Administration |
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Definition
| administered over 10-24 hrs via pumps or gravity systems; preferred for critically ill patients; start at 20-50 mL/hr & advance by 10-25 mL q4-8 hrs until desired rate is achieved |
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Term
| Intermittent Enteral Administration |
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Definition
| 8-16 oz. infused over 20-60 min; start with 120 mL every 4 hrs and advance by 30-60 mL every 8-12 hrs; assure bag/syringe hygiene & adequate flushing with water; more consistent physiologically with normal eating patterns; not appropriate for duodenal or jejunal feedings |
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Term
| Types of Enteral Feeding Routes of Administration |
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Definition
| nasogastric tube; nasoduodenal tube; nasojejunal tube; percutaneous endoscopic gastrostomy (PEG) tube; |
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Term
| Drug-Nutrient Interactions |
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Definition
| minerals/electrolytes <-- diuretics; hyperglycemia <-- corticosteroids, cyclosporine; hypoglycemia <-- insulin hypoglycemics; decreased folic acid <-- sulfasalazine; pyrodoxine deficiency <-- isoniazid; decrased thiamin <-- furosemide; decreased methotrexate effect <-- folic acid; altered warfarin effect <-- vitamins K & E; drug vehicles --> volume & calories |
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Term
| Medications & Enteral Nutrition |
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Definition
| know where the tip of feeding tube is (antacids should not be given thru J-tube); use liquid dosage forms if possible; when liquid dosage forms are not available: crush solid meds & mix with 20-30 mL H2O, flush with 5 mL H2O between meds, DON't crush SR & XL forms; DO NOT place meds directly in EN formula |
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Term
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Definition
| Phenytoin: seizure med, decreased bioavalability, Hold EN x 2 hr around dose, increase dose; Select antibiotics (quinolones & tetracyclines): decreased bioavailability, hold feeding prior to & after dose; Warfarin: anticoagulant, decreased absorption, adjust based on INR; PPIs: crushing granules leads to degradation by stomach acid, omeprazole may clog, don't crush pantoprazole, lansoprazole & omeprazole suspension administer via tube |
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Term
| Peripheral Administration of PN |
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Definition
| short peripheral, midline; < or = to 10% Dextrose final concentration; dilute solutions may not be complete PN; osmolarity of blood = 280-300 mOsm/L |
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Term
| Central Venous Catheters in PN |
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Definition
| tunneled catheters, ports, PICC; into right vena cava; osmolarity 1500-2250 mOsm/L; |
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Term
| Parenteral Nutrition Indications |
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Definition
| non-functioning GI tract; prolonged bowel rest requireed; severe malnutrition; hypermetabolic states (no PO intake for 7-14 days) |
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Term
| Parenteral Nutrition Contraindications |
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Definition
| short term, functioning GI tract, lack of venous access, hemodynamic instability, poor prognosis where aggressive treatment is not desired |
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Term
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Definition
| Chromium: insulin-mediated reactions, renal excretion; Copper: transferrin reactions, RBC/WBC formation, biliary excretion; Manganese: enzyme activation, biliary excretion; Selenium: cell protection from oxidative damage, renal excretion; Zinc: enzyme cofactor, wound healing, excreted via GI tract |
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Term
| Mechanical Complications of PN |
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Definition
| pump failure, tubing failure, catheter malposition/misdirection/migration; air embolism; catheter occulusion; catheter puncture or breakage |
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Term
| Physiological Complications of PN |
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Definition
| infection (most frequent occurring); Metabolic complications: hyperglycemia, hypoglycemia, electrolyte imbalance, fluid overload, dehydration, refeeding syndrome, allergic reactions, overfeeding, hypertriglyceremia, liver toxicities, aluminum toxicity, bone disease, FA deficiency, gall bladder complications |
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Term
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Definition
| severe malnutrition with significant weight loss causes pt to receive aggressive nutrition supplementation; at risk: cancer, cardiac cachexia, COPD, cirrhosis, previous morbid obesity, massive weight loss; causes hypophosphatemia, hypokalemia, & hypomagnesemia |
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Term
| Minimizing Refeeding Syndrome |
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Definition
| identify high risk pts before initiating NST; start carbohydrate infusion at 1.25-1.5 g/day; feed 25% of calorie needs days 1-2, increase gradually to goal caloric requirements over 7 days by 10%/day; correct phosphorus, potassium, & magnesium abnormalities prior to initiating nST; maintain weight gain < 1 kg/week; restrict fluid to 25 mL/kg; restrict Na to 30-60 mEq/day |
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