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DU PA Surg Nutr

Duke PA Surgical Nutrition

High prevalence of __ deficits in hospitalized patients nutritional
__ % of hospitalized patients suffer from some degree of malnutrition (depending on disease and population) 15 - 50
Loss of weight, appetite, muscle atrophy, and weakness in someone not trying to lose weight, usu. signifies an underlying disease Cachexia
acute visceral protein depletion (chronic protein intake insufficiency), usually affects young childrenedema, pigmentation, pot belly Kwashiorkor
Simple starvation (chronic caloric intake insufficiency)loss of lean body mass, fat, and visceral proteins Marasmus
40% in liver (rapidly depleted) Glycogen stores
60% in muscle Glycogen stores
Obligatory gluconeogenesisProtein catabolismIncreased nitrogen lossUnresponsive to glucose administrationMagnitude of loss proportional to injury Adrenergic/Corticoid phase of Stressed Starvation (Surgery, Trauma)
__ common finding with deficiencies in niacin, thiamine, vitamin B6, vitamin B12 peripheral neuropathy
Represents the critical cellular mass necessary for cellular structure as well as function lean body mass
Represents 40% of total body weight lean body mass
Depletion is severe insult and defines patient morbidity and mortality lean body mass
60% skeletal muscle lean body cell mass
20% red blood cells and connective tissue lean body cell mass
20% cell mass lean body cell mass
Utilized for clinical determination of total body fat and skeletal muscle storeSimple, inexpensive, non-invasive technique Anthropometric measures
__% of the total body protein is contained in skeletal muscle 60
this is major site of protein catabolism during starvation and/or illnes skeletal muscle
Most widely used biochemical marker of muscle mass 24-hr urine creatinine
Creatinine is degradation product of creatine,__ an energy storage compound located in skeletal muscle
Maintains plasma oncotic pressure and is a carrier for enzymes, drugs, hormones, etc. Serum albumin
Serum albumin Serum albumin
Carrier for ironLimited use because level fluctuates with iron stores Serum transferrin
Carrier for thyroxine and retinol-binding proteinSensitive to acute changes in nutrient intake Serum prealbumin
Resting energy expenditure calculated by using the __ equation Harris-Benedict
Nitrogen Balance N intake - N loss
Nitrogen Balance (N intake - N loss):If positive (goal +2 to +4), net state of __ anabolism
Nitrogen Balance (N intake - N loss): If negative, net state of __ catabolism
Nitrogen Intake (enteral and parenteral)(1 gm N/__ g Protein 6.25
Estimates severity of lean body mass catabolism and quantifies severity of metabolic stress Catabolic Index (CI):
In general, adults will require nutritional support if NPO for greater than __ days 7
if the gut works use it
contraindications to enteral nutrition gastroparesis, intestinal obstruction, ileus, high-output fistula, short bowel syndrome
Used for conscious patients; preferred for short-term feeding (< 30 days) Nasoenteric Tube Feeding
Nasogastric: adequate gastric emptying require; maintain gastric residuals < __% of total infusion over prior 4 hours 50
Nasoenteric Tube Feeding:used in patients with high aspiration risk (neurological impairment; poor gastric motility) Nasointestinal
tube feeds cause diarrhea
in a patient with tube feeding and diarrhea check for __ before changing anything else C. dif
Involves continuous infusion of hyperosmolar solution containing carbohydrates, proteins, fats, and other necessary nutrients through an indwelling catheter inserted into the superior vena cava Total Parenteral Alimentation/Nutrition (TPN)
Any patient who will not have functioning GI tract for __ days should be considered for TPN 5-7
Principal indication for __ are found in seriously ill patients suffering from malnutrition, sepsis, or surgical or accidental trauma when use of the GI tract for feedings is not possible parenteral alimentation
1. Intravenous vitamin preparations should be added 2. Vitamin K and folate should be administered once a week 3. Vitamin B12 is given once a month intramuscularly Parenteral Alimentation
May present as dry, scaly dermatitis and loss of hair - Syndrome may be prevented by periodic infusion of a fat emulsion equal to 4 - 5% of total calories Essential Fatty Acid Deficiency
- Most frequent trace mineral deficiency is __, which presents as an eczematoid rash developing both diffusely and at intertriginous areas zinc
Created by: bwyche