Nutrition - EXAM 3

what is the formula for % weight loss?

(wt loss)/original x100

what are the indications for enteral nutrition?

- functioning GI tract -PO intake deemed unsafe - PO intake deemed insufficient - PO intake deemed impossible

what are the complications of EN?

-GI, metabolic, and respiratory complications -Aspiration.

how is environment involved in obesity?

-Growing portion size of restaurant meals -Low levels of physical activity increases in television watching -widespread use of electronic devices in the home, such as computers and video games

what are the 5 standard formulas for enteral nutrition?

-Polymeric -Routine -High protein -High Calorie -Fiber enriched

what is the diagnostic criteria for Anorexia nervosa?

-Restriction of energy intake leading to a significantly low body weight -Intense fear of gaining weight or 'becoming fat' -disturbance in the way in which one's body weight or shape is experienced or undue influence of weight on self-evaluation.

When should feeding tubes be flushed?

-before and after medication administration -before starting EN and before stopping EN

What are important jobs as the nurse to promote optimal nutrition?

-educate and reinforce -communicate with dietitians -promote optimal intake of food and oral nutrition supplements.

what are the questions from the MST (malnutrition screening tool)?

-have you lost weight recently without trying -if yes, how much weight (kilograms) have you lost? -Have you been eating poorly because of a decreased appetite

how are genetics involved in obesity?

-how likely a person is to gain or lose weight -where body fat is distributed -response to overeating

Indications for PN nutrition?

-malabsorption - occurs when the GI tract is unable to absorb nutrients -Prolonged ileus -ischemia/ thrombus -intestinal fistula -short gut syndrome -small or large bowel obstructions.

what are the six criteria for assessing malnutrition?

1. instability/unwillingness to eat 2. moderate or severe weight loss 3. loss of sub-q fat 4. muscle wasting 5. fluid accumulation 6. functional status

IBW for a female calculation

100 + 6 (for every other inch)

IBW for a male calculation

106 + 6 (for every other inch)

calorie needs - ICU patients: BMI 30-50

11-14 kcal/kg actual BW

BMI chart: Healthy

18.5-24.9

how many of the criteria are needed to diagnose as malnutrition?

2 out of the 6

how many cm in an inch?

2.54

calorie needs - ICU patients: BMI >50

22-24 kcal/kg ideal BW

calorie needs - ICU patients: BMI <30

25-20 kcal/kg actual BW

BMI chart: overweight

25-29.9

BMI chart: Obesity Class 1

30-34.9

BMI chart: Obesity Class 2

35-39.9

How many calories does it take to burn 1 pound

3500 calories

BMI chart: Obesity Class 3

40+

what is the traditional goal of weight loss for obese individuals?

5-10%

how much of a calorie deficit will result in 1lb loss per week?

500kcal/day deficit

BMI chart: Underweight

<18.5

interpretation for severe weight loss: 1 week

> 2%

interpretation for severe weight loss: 1 month

> 5%

interpretation for severe weight loss: 6 months

>10%

interpretation for severe weight loss: 1 year

>20%

interpretation for severe weight loss: 3 months

>7.5 %

What is the most serious EN complication? How do you prevent this?

ASPIRATION - elevate the HOB (30-45% to prevent)

what is the more common form of PN?

CPN (central parenteral nutrition) is more common then PPN (peripheral parenteral nutrition)

what are the three lifestyle approaches for traditional weight loss treatment approaches?

Diet modification, Exercise, and Behavior modification

What condition falsely suggests improvement in nutritional status?

Edema

what are the factors that influence obesity?

Genetics and enviroment

what formula contains very little residue and is intended for clients with impaired digestion or absorption, such as people with inflammatory bowel disease, CF, and pancreatic disorders?

Hydrolyzed formula

what is the goal weight loss for obese patients?

Lose 5%

Is weight gain a good indicator of malnutrition?

No, Weight gain may be an unreliable indicatory of improvement for unintentional weight loss related to malnutrition.

what are the sub-types for Anorexia Nervosa?

Restricting type: individuals who lose weight is primarily through dieting, fasting and/or excessive exercise over the last 3 months Binge/Purge type: within the last 3 months, the individual has engaged in recurrent episodes of binge eating and/or purging behavior

what are hydrolyzed formulas? - used for what kinds of patients?

This is used for patients who lack ability to digest or have small absorptive ability. they contain little residue , best suited for patients that need bowel rest malabsorption disorders such as pancreatitis and short gut.

when must the nutrition screening be completed?

Within 24 hours of hospital admittance

what is a nutrition screening?

a checklist on what to look for if a patient has malnutrition (it is a quick look at a few variably to identify risk for malnutrition.

Describe Refeeding syndrome.

a range of metabolic and electrolyte abnormalities occurring as a result of the reintroduction and or increased provision of calories after a period of decreases or absent calorie intake.

what does someone have to score on the malnutrition screening tool to classify the patient as at risk for malnutrition?

a score of 2 or more

what is severity of Anorexia Nervosa based off of?

based off of BMI even through this is no longer in the diagnostic criteria.

what is a common example of diet modification?

consuming fewer calories, having a low fat diet, a balanced diet.

What action can the healthcare team take to improve an older clients compliance to taking liquid supplements?

cool down the supplement

How can we help patients consume their nutritional supplement ?

cool down the supplements

What are specialty formulas?

created for specific medical conditions

what is the focus of nutritional support for a client with pulmonary disease?

do not overfeed them

what are some behavioral changes that can help with weight loss?

environmental changes, shopping smart, and eating wisely

what is a major factor that skews the weight of a patient dealing with inflammatory processes?

fluid

what are modular formulas?

incomplete liquid or powder supplements that contain specific nutrients.

what population is it best to use a polymeric formula in?

it is best for those with no digestion or absorption deficits.

at what point can TPN be discontinued and transition to EN ?

once the patient can meet 50% of nutritional needs through PN to EN

What is OSFED? and what are some examples?

other specified feeding or eating disorder -- the s/s do not meet the complete critieria of AN or BN. such as PICA, Rumination disorder, avoidant/ restrictive food intake, and unspecified feeding or eating disorders.

What is the diagnostic criteria of Bulimia Nervosa?

recurrent episode of binge eating: eating in a discrete period of time an amount of food that is larger that may typically eaten, a sense of loss of control overeating -also recurrent inappropriate compensatory behaviors to prevent weight gain : laxative use, diuretics, and vomiting

what are some examples of behavior modification?

self monitoring, goal setting, and stimulus control

What is refeeding syndrome?

syndrome caused by aggressive feeding of a malnourished pt characterized by a drop in K+, mag and phos.

What is the stress response dependent on?

the intensity is dependent on the initial injury

What are the 2 criteria that the malnutrition screening tool (MST) looks at?

the weight loss and how much of a decrease in appetite there is

what kind of access is needed for concentrations of carbohydrates >10%?

they require central access.

what is the long term nutrition goal for clients?

to reduce chronic disease, and if it is in the hospital focus, it is to decrease incidence of malnutrition.

How can a nurse monitor a clients nutrition if you can't record food intake?

track daily weights

What are the nutrition related outcomes for outside of the hospital?

we are focusing on long term goals that focus on the prevention of chronic illnesses after the short term goals are met.

What are the nutrition related goal outcomes in the hospital?

we are looking at the short term goals: to alleviate the symptoms or side effects, or disease and treatments

why is parental nutrition never stopped abruptly?

we should never just stop feeding because of the risk of hypoglycemia.

when would nutritional supplements be recommended for patients? (3 reasons)

when a patient has high metabolic demands, inadequate PO intake, and poor appetite