Egan’s Chapter 21 Practice Questions:
1. Calorimetry– what is it when is it used what does it tell you: is the estimation of energy expenditure by measurement of 02 consumption and co2 production used when you want to assess pts metabolic state, to determine nutrition needs, or to assess response to nutrition therapy.
2. Describe how a comprehensive nutrition assessment is conducted: medical chart, anthropometrics, clinical lab tests, dietary hx, total caloric requirements, access to food, (The purpose of this is to gather data to develop a nutrition care plan that ensures adequate nutrition for health and well-being when implemented).
3. Describe how to calculate and interpret BMI: Healthy is 18.5-24.9 for adults and between 10th and 85 percentile for children. BMI= actual body weight (kg)/ height^2 (in^2)
4. Describe how to distinguish 2 forms of protein-energy malnutrition from each other: kwashiorkor- results from a sudden lack of protein and calories e.g. child weaned off breastfeeding to fast. protruding belly and trematodes face and limbs result from lack of circulating proteins needed to maintain fluid balance and to transport fat out of the liver. Enlarged belly may be due to infections and parasites. Marasmus- matchstick arms results from an extreme lack of calories and protein over a long period of time e.g. starvation. Lack of muscle and fat in child or adult.
5. Describe how to estimate daily resting energy expenditure: daily energy requirements kcal/day. predicted equations such as harris benedict equation can be used to estimate REE
6. Describe how to identify and minimize the common respiratory complications of enteral feedings: pulmonary aspiration- raise the head of the bed 45 degrees, use the continuous drip method, saxing can help too, patients at greatest risk are pts with et tubes in- use of especially et tubes may help
7. Describe how to interpret the results of indirect calorimetry: Results are used to assess metabolic status and to plan nutrition support. The first step is to compare REE. if it is within 10% predicted its considered normo-metabolic. 2nd step is to interpret the RQ aka ratio of moles of Co2 expired.
8. Describe how to obtain and evaluate a nutrition history: Review the patient’s chart.
9. Describe how to properly prepare a patient for indirect calorimetry: 21-4 box pg 489
10. Describe how to REE values are adjusted to reflect the pts actual energy needs: energy needs vary according to activity level and state of health.
11. Explain how common pulmonary medications affect nutrition: table 219 pg 498
12. How to identify pts at high risk for malnutrition: box 21-7 pg 491
13. List the biochemical indicators of nutritional status: includes serum proteins. albumin- protein in plasma. half life is 14-21 days. transferrin- transport protein for iron. half life of 8-10 days better indicator of nutrition status than albumin. transthyretin- half life of 2-3 days, costly retinol-binding protein- 12 hr half life, costly
14. List the indications contraindications hazards and limitations of indirect calorimetry: indications- pts with morbid obesity, difficult to wean from the vent, who weight estimate is uncertain, severe malnutrition, high levels of stress, extreme of weight or age, failing to respond to nutrition support. Contraindication- when it is needed there are no contraindications unless short-term disconnection of vent leads to hypoxemia, bradycardia, or other effects. Hazards comps-safe and non-invasive sometimes: all have to do with vent problems.
15. Respiratory medication interactions with food: Correlate treatments in between feedings.
16. State the effects of malnutrition and on the respiratory system: 1/3 of pts with respiratory failure have malnutrition. Loss of diaphragmatic and accessory muscle mass and contractility, decreased hypoxic and hypercapnic response, decreased lung clearance mechanisms, decreased secretory IgA, increased bacterial colonization, reduced production of surfactant.
17. SIRS: systemic inflammatory response syndrome underlies much critical illness such as sepsis and ARDS. Can cause 25% decrease in protein lean body and anorexia
18. State what to observe clinically in the malnourished patient: physical findings often appear first in selected tissues such as hair eyes lips mouth and gums and skin and nails. However in addition to malnutrition other causes of these abnormalities might be medical therapies, anemia, allergies, sunburn, medication, poor hygiene etc. Patients with severe malnutrition often appear very thin to the point where their bones are sticking out these patients are said to be cachexic.
19. State when enteral nutrition and parenteral nutrition are needed: pg 493 box 21-11
20. The types of diets respiratory patients should be eating and why: high-fat low carb feedings in pts with hypercapnia. COPD – eat frequent small meals, restrict carb intact. increase nutrient intake without overfeeding. exercise. Asthma – small meals that are high in protein calories vitamins and minerals during prolonged asthma attacks. Foods that cause allergies should be avoided such as milk eggs and seafood. Saturated fats may aggravate the airway, omega 3 may help. Cystic Fibrosis – increase nutrition intake through calorically dense food (box 21 12) provide a nutrition plan.