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Nutrition - Absite

Jennifer Huber Surgery - Absite Review Inglés 115 fichas

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  1. 1Caloric Need~20-25cal/kg/day
  2. 2Fat Calories9cal/g
  3. 3Protein Calories4cal/g
  4. 4Carbohydrate Calories4cal/g
  5. 5Dextrose Calories3.4cal/g
  6. 6Nutritional Requirement of Protein20% protein
    1g protein/kg/day
    (20% of these should be amino acids)
  7. 7Nutritional Requirement of Fat30% Fat
    important for essential fatty acids
  8. 8Nutritional Requirement of carbohydrate50% carbohydrate
  9. 9Trauma, Surgery and sepsis increase the kcal requirement by how much?20-40%
  10. 10Pregnancy increases kcal requirement by how much?300kcal/day
  11. 11Lactation increases kcal requirement by how much?500kcal/day
  12. 12Calorie requirements for burn victims25kcal/kg/day + (30kcal/day x %burn)
  13. 13Protein requirements for burn victims1-1.5g/kg/day + (3g/d x %burn)
  14. 14Fever increases basal metabolic rate by how much?10% for each degree above 38C
  15. 15Equation to calculate caloric need if overweightweight = [(actual wt - ideal body wt) x 0.25]
    + Ideal Body Wt
  16. 16Harris Benedict Equation for MenBMR = (10 × weight in kg) + (6.25 × height in cm) - (5 × age in years) + 5
  17. 17Harris Benedict Equation for WomenBMR = (10 × weight in kg) + (6.25 × height in cm) - (5 × age in years) - 161
  18. 18Central Line TPNglucose based; max glucose administration 3g/kg/h
  19. 19Peripheral Line Parenteral NutritionFat based
  20. 20Fuel for ColonocytesShort chain fatty acids
    ex butyric acid
  21. 21Fuel for small bowel enterocytesglutamine
  22. 22Primary Fuel for neoplastic cellsGlutamine
  23. 23MC amino acid in blood stream and tissueGlutamine
  24. 24Approximate half life of albumin18 days
  25. 25Approximate half life of Transferrin8 days
  26. 26Approximate half life of Prealbumin2 days
  27. 27Normal Protein Level6.0-8.5
  28. 28Normal Albumin level3.5-5.5
  29. 29Normal Pre-albumin Level15-35
  30. 30Acute indicators of nutritional status#1 pre-albumin
    retinal binding protein
    transferrin
  31. 31Equation for Ideal Body Weight for Men106lbs + 6lb for each inch over 5feet
  32. 32Equation for Ideal Body Weight for Women100lb + 5 lb for each inch over 5 ft
  33. 33Preoperative signs of severe malnutritionAcute Weight Loss >15% in 6months
    Albumin <3.0
  34. 34Indication for pre-op nutritionPatients with severe malnutrition undergoing major abdominal or thoracic procedures
  35. 35Respiratory Quotient (RQ) > 1Lipogenesis (overfeeding)
  36. 36Respiratory Quotient (RQ) <0.7Ketosis and Fat Oxidation (starving)
  37. 37Treatment if RQ > 1decrease carbohydrates and caloric intake
  38. 38Treatment RQ < 0.7increase carbohydrates and caloric intake
  39. 39RQ = 0.7Pure Fat Utilization
  40. 40RQ = 0.8Pure Protein Utilization
  41. 41RQ = 1.0Pure Carbohydrate Utilization
  42. 42RQ = 0.825Balanced Nutrition
  43. 43What are the 3 Postoperative Phase?1) Diuersis
    2) Catabolic
    3) Anabolic
  44. 44Diuresis PhasePost-op days 2-5
  45. 45Catabolic PhasePost-op days 0-3
    negative nitrogen balance
  46. 46Anabolic PhasePost-op days 3-6
    positive nitrogen balance
  47. 47How long does it take for glycogen stores to be depleted?24-36hrs of starvation
    (2/3 skeletal and 1/3 in liver)
  48. 48Gluconeogenesis precursorsAmino acids (esp alanine)
    lactate, pyruvate, glycerol
  49. 49What is the primary substrate for gluconeogensis?Alanine
  50. 50Amino Acids that increase during times of stressalanine and phenylalanine
  51. 51In late starvation, where does gluconeogenesis occur?kidneys
  52. 52What is the main source of energy in starvation and in trauma?Fat (Ketones)
  53. 53How long can people tolerate without eating?7days, after that place a Dobbhoff tube or start TPN
  54. 54When to place a PEG tubewhen regular feeding isn't possible or predicted to not occur for >4weeks
  55. 55Feeding through gut as opposed to TPN helps prevent what?bacterial translocation
    (bacterial overgrowth, increased permeability d/t starved enterocytes, bacteremia)
  56. 56What do you do when patient develops diarrhea while on tube feeds?Slow the rate, add fiber,
    less concentrated feeds
  57. 57What do you do for patient with high gastric residuals while on tube feeds?Reglan, Erythromycin
  58. 58Name 4 Obligate Glucose Usersperipheral nerves
    adrenal medulla
    RBCs, WBCs
  59. 59What is refeeding syndrome? what day do you usually see symptoms?occurs when feeding after prolonged starvation/malnutrition
    shift from fat to carbohydrate metabolism
    symptoms usually on day 4
  60. 60Effects of Refeeding Syndrome on electrolytesDecreased K, Mg, PO4
  61. 61Patients with refeeding syndrome can develop what?cardiac dysfunction, profound weakness, encephalopathy, CHF,
    failure to wean from ventilator
  62. 62How to prevent refeeding syndromere-feed at a low rate (10-15kcal/kg/day)
  63. 63Cachexiaanorexia, weight loss, wasting
    thought to be mediated by TNF-alpha
    glycogen breakdown, lipolysis, protein catabolism
  64. 64KwashiorkorProtein Deficiency
    edema, and an enlarged liver with fatty infiltrates. Sufficient calorie intake
  65. 65Marasmussevere undernourishment
    look emaciated
  66. 66Effects of Major Stress on the Bodyincrease catecholamines, cortisol, cytokines
    protein breakdown - negative nitrogen balance
    hepatic urea formation
  67. 676.25g of protein equals how much nitrogen?1g of nitrogen
  68. 68Protein synthesis in a health 70kg male250g/day
  69. 69Majority of protein breakdown from skeletal muscleglutamine (#1)
    alanine
  70. 70What accounts for 90% of nitrogen loss?Urea cycle
  71. 71What is the primary NH3 donor?Glutamine
  72. 72What are Micelles?aggregates of bile salts, long-chain free fatty acids, and monoacylglycerides
    enters enterocytes
  73. 73Fat Soluble VitaminsA, D, E, K
  74. 74Chylomicrons90% TAGs,
    10% phospholipids/proteins/cholesterol
    enters lymphatics
  75. 75Fats that enter the portal systemmedium and short chain fatty acids
  76. 76Lipoprotein Lipaseon endothelium of liver and adipose tissue
    clears chlyomicrons and TAGs from blood
    breaks them down to FAs and glycerol
  77. 77Saturated Fatty Acidsused for fuel by cardiac and skeletal muscles
  78. 78Unsaturated Fatty Acidsused as structural components for cells
  79. 79Hormone Sensitive Lipase (HSL)in fat cells
    breaks fown TAGs to FAs and glycerol
    (sensitive to GH, caetcholamines, glucocorticoids)
  80. 80Essential Fatty AcidsLinolenic and Linoleic Acids
    needed for prostaglandin synthesis (LCFA)
    important for immune cells
  81. 81Glucose and GalactoseCarbohydrates
    absorbed by secondary active transport
    Na gradient formed by ATPase
    released into portal vein
  82. 82Fructosecarbohydrate
    facilitated diffusion
    released into portal vein
  83. 83SucroseFructose + Glucose
  84. 84Lactosegalactose + glucose
  85. 85Maltoseglucose + glucose
  86. 86Protein DigestionBegins with stomach pepsin, then trypsin, chymotrypsin and carboxypeptidase
  87. 87Trypsinogenreleased from pancreas and activated by enterokinase (released from duodenum)
    activates other pancreatic protein enzymes
  88. 88Branched Chain Amino AcidsLeucine, Isoleucine, Valine
    Metabolized in muscle
    they are essential AA
  89. 89Name the Essential Amino AcidsLeucine, Isoleucine, valine, histidine, lysine, methionine, phenylalanine, threonine, tryptophan
  90. 90Non-essential Amino AcidsThose that start with A, G, or C plus serine, tyrosine and proline
  91. 91Central Venous TPN General Composition10% amino acid solution
    25% dextrose solution
    Na, Cl, K, Ca, Mg, PO4, acetate
    Minerals and Vitamins
  92. 92Lipid supply separate from TPN10% lipid solution (1.1kcal/cc)
    20% lipid solution (2kcal/cc)
  93. 93Purpose of Acetate for TPNbuffer to increase pH of solution
  94. 94Vitamin to add separately from TPNVitamin K
  95. 95Vitamins to add to patient with ETOH abuse while on TPNThiamine
    Folate
    Multivitamin
  96. 96Long term TPN complicationCirrhosis
  97. 97Short term TPN complicationline issues like ptx or infxn
  98. 98Chromium Deficiencyhyperglycemia, encephalopathy, neuropathy
  99. 99Selenium DeficiencyCardiomyopathy, weakness
  100. 100Copper Deficiencypancytopenia
  101. 101Zinc DeficiencyPoor Wound Healing
  102. 102Phosphate DeficiencyWeakness, encephalopathy, decreased phagocytosis
  103. 103Thiamine deficiencyWernicke's Encephalopathy
    Cardiomyopathy
    Beriberi
  104. 104Pyridoxine (B6) DeficiencySideroblastic Anemia
    Glossitis
    Peripheral Neuropathy
  105. 105Cobalamin (B12) DeficiencyMegaloblastic Anemia
    Peripheral Neuropathy
    Beefy Tongue
  106. 106Folate DeficiencyMegaloblastic Anemia
    Glossitis
  107. 107Ascorbic Acid DeficiencyScurvy, poor wound healing
  108. 108Niacin DeficiencyPellagra (diarrhea, dermatitis, dementia)
  109. 109Essential FA DeficiencyDermatitis, Hair Loss, Thrombocytopenia
  110. 110Vitamin A DeficiencyNight Blindness
    Bitot Spots
  111. 111Vitamin K DeficiencyCoagulopathy
  112. 112Vitamin D DeficiencyRickets, Osteomalacia, Osteoporosis
  113. 113Vitamin E DeficiencyNeuropathy
  114. 114What is the Cori Cycle?lactate from anaerobic glycolysis in muscles moves to the liver and is converted to glucose, which then returns to the muscles and is metabolized back to lactate
  115. 115Metabolic SyndromeNeed 3
    Obesity, insulin resistance (glucose >100), High TAGs (>100), Low HDL (<50), HTN

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Surgery - Absite Review Fichas sobre Nutrition - Absite, creado por Jennifer Huber el 10/06/2018.
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Jennifer Huber
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