Calculations III

Question 1

What are the 2 types of PN admixtures that are used?

Answer 1

• 2-in-1: Dextrose and Amino Acids
• 3-in-1: Dextrose, Amino Acids, Lipids

Question 2

What is the equation to help with calcuating daily fliuds?

Answer 2

• 1500 ml + (20ml)(weight kg - 20)

Question 3

Example Question 1

GG is a 57 yo female admitted to the hospital with bowel obstruction. She will be NPO for the next 5 - 7 days. The decision was made to start PN therapy. She weighs 65 kg. Her SCr is 1.3 mg/dL. Calcualte GG’s Daily Fluids?

Answer 3

• 2400 ml/day

Question 4

Example Question 2

A 76 yo, 154 pound patient is NPO and needs hydration. She is afebrile and does not have Heart Failure, Renal Disease or ascites. What volume of fluid should the patient receive per day?

Answer 4

• 2500 ml/day

Question 5

Example Questoin 3

Using the Harris-Benedict Equation, calculate the Basal Energy Expenditure for a 66 yo male with major trauma (stress factor 1.5). He weighs 174 pounds and is 5’10”. Activity factor 1.2. Round to the Nearest whole number.

Answer 5

• 1597 kcal/day

Question 6

Example Question 4

Calculate the total energy expenditure for a major trauma patient (stress factor 1.5, activity factor 1.2) who is a 66 yo male, weighing 174 pounds and measuring 5’10” in height. (Use BEE of 1597 kcal/day). Round to the nearest whole number.

Answer 6

• 2875 kcal/day

Question 7

Example Question 5

A 25 yo female major trauma patietn survives surgery and is recovering in the surgical intensive care unit. The Medical team wants to start PN therapy. She is 122 pounds, 5’7” with some mild renal impairment. Calculate her BEE using the Harris-Benedict Equation and her TEE (Stress Factor 1.7; activity factor 1.2). Round each to the nearest whole number

Answer 7

• BEE = 1385 kcal/day
• TEE = 2825 kcal/day

Question 8

How may kcal/grams are in Carbs, Fats, and Proteins

Answer 8

• Carbs: 4 kcal/g
• Fats: 9 kcal/g
• Protein: 4 kcal/g

Question 9

What is the purpose of protein in the body?

Answer 9

• Helps repair or build up protein
• Or is used as energy

Question 10

What is the Protein Requirements for someone that is Non-Hospitalized and Hospitalized

Answer 10

• Non-Hospitalized: 0.8 - 1 g/kg/day
• Hospitalized: 1.2 - 3 g/kg/day

Question 11

Example Question 6

MK is a 62 yo female who has been admitted with enteritis and pneumonia. SHe has a history of Crohn’s disease and COPD. Her IBW is 54.7 kg. The Staff gastroenterologist has ordered PN therapy with 1.5 g/kg IBW/day if protein. How many grams of protein will MK receive per day? Round to the nearest whole number?

Answer 11

• 82 g protein/day

Question 12

Example Question 7

PP is a 46 yo male who weights 207 pounds. He is admitted for bowel resection surgery. Post surgery, he is to be started on PN therpay. The physician wants the patient to receive 1.3 g/kg/day of protein. Calcaulte his protein, requirements. Round to the nearest whole number

Answer 12

• 122 g protein/day

Question 13

How many gram of nitrogen are from protein

Answer 13

• 1 g of nitrogen = 6.25 g of protein

Question 14

Example Question 8

A patient is receiveing PN containing 540 ml of 12.5% amino acid per day. How many grams of nitrogen is the patient receiveing? Round to the nearest tenth.

Answer 14

• 10.8 g of Nitrogen

Question 15

What is the way to find the Non-protein calorie to Nitrogen Ratio

Answer 15

• Calculate grams of nitrogen per day
• Divide the total non-protein (dextrose + lipids) by the grams of nitrogen

Question 16

What are the desirable ratios for NPC:N

-

Answer 16

• Most severely Stressed: 80:1
• Severely Stressed: 100:1
• Unstressed: 150:1

Question 17

Example Question 9

A pateint is receiving PN containing 480 ml of 50% and 50 g of amino acids plus electrolytes. Calculate the non-protein calores to nitrogen ratio for this patient?

Answer 17

• 816:8 or 102:1

Question 18

What are some of the Amino Acid Brands and what are some Strengths

Answer 18

• Aminosyn, FreAmine, Travasol, TrophAmine, Clinisol
• 5%, 8.5%, 10%, 15%

Question 19

Example Question 10

If the pharmacy stock Aminosyn 8.5%, how many milliliters will needed to provide 108 g of protein. Round to the nearest whole number

Answer 19

• 1271 ml

Question 20

Example Question 11

How many calories are provided by 108 grams or protein

Answer 20

• 432 kcal of protein

Question 21

Example Question 12

The pharmacy stock FreAmine 10%. A patinet requires 122 grams of protein per day. How many milliliters of FreAmine will the patient need

Answer 21

• 1220 ml

Question 22

Example Question 13

JR is a 55 yo male (Weight 189 pounds) who is confined to bed (activity factor 1.2) due to his current infection (stress factor 1.5). JR requires 1.4 g/kg/day of protein and the pharmacy stocks Aminosyn 8.5%. Calculate the amount of Aminosyn, in milliliters JR should receive. Round to the nearest whole number?

Answer 22

• 1415 ml

Question 23

Example Question 14

JR is receiving 97 grams of protein in an Aminosyn 8.5% solution on day 8 of his hospitalization. How many calories are provided by this amount of protein.

Answer 23

• 388 kcal of protein

Question 24

Example Question 15

A PN order is written to include 800 ml of 10% amino acid solution. The pharmacy only has 15% amino acid in stock. Using the 15% amino acid solution instead. how many milliliters should be added to the PN pag? Round to the nearest whole number

Answer 24

• 533 ml

Question 25

What is the **k cal/g** for **Dextrose monohydrate**

Answer 25

- 3.4 kcal/g

Question 26

# Example Question 16 Using **50% dextrose in water**, how many **milliliters** are required to fulfill a PN order for **405 g of dextrose**

Answer 26

- 810 ml

Question 27

# Example Question 17 DF, a 44 yo male, is receiving **1235 ml of D30W**, **1010 ml of FreAmine 8.5%**, **200 ml of Intraliopid 20%** and **50 ml** of electrolyte/minerals in his PN How many calories from dextrose is DF receiving from the PN? roud to the nearest whole number.

Answer 27

- 1260 kcal/day

Question 28

# Example Question 18 A pharmacist mixed **200 ml D20%** with **100 ml D5%**. What is the percentage strength of dextose in the fnal bag?

Answer 28

- 15% w/v

Question 29

# Example Question 19 If a **50% dextrose** injection provides **170 kcal** in each **100 ml**, how many **milliliters** of a 70% dextrose injection would provide the same caloric value? Round to the nearest tenth

Answer 29

- 71.4 ml

Question 30

# Example Question 20 AH is receiving **640 ml of D50W** in her PN. How many calories dose this provide?

Answer 30

- 1088 kcal

Question 31

# Example Question 21 A PN order is written for **500 ml of 50% dextrose**. The Pharmacy only has **D70W** in stock. How many **milliliters** of D70W should be added to the PN bag? Round to the nearest whole number.

Answer 31

- 357 ml of D70W

Question 32

What are the **four types** of fats?

Answer 32

- Saturates - Trans - Monounstaturated - Polystaturated

Question 32

What is **Injectable Lipip Emulsion (ILE)** and what are the **kcal/ml** they provide

Answer 32

- ILE: fat source - 10% = 1.1 kcal/ml; 20% = 2 kcal/ml; 30% = 3 kcal/ml

Question 33

# Exampe Question 22 A patient is receiving **500 ml of 10% lipids**. How many **calories** is the patient receiving form the lipids? Round to the nearets whole number?

Answer 33

- 550 kcal

Question 34

# Example Question 23 The total energy expenditure (TEE) for a critically ill patient is **2435 kcal/day**. The patient is receiving **1466 kcal** from dextrose and **810 kcal** frin protein. In the critical care unit, clinicians do not incllude protein calores in TEE extimation. How many **kcal** should be provided by the lipids?

Answer 34

- 989 kcal remaining from lipids

Question 35

# Example Question 24 Using **20% Smoflipid**, how many **milliliters** are required to meet **989 calories**? Round to the nearest whole number?

Answer 35

- 495 ml

Question 36

# Example Question 25 A patient is receiving **660 ml of 10% intralipid** on saturdays along with his normal daily PN therapy of **1420 ml of D20W**, **450 ml Aminosyn 15%** and **30 ml** of electrolytes. What is the daily amount of calories provided by the lipids? Round tot he nearest whole number.

Answer 36

- 104 kcal/day

Question 37

# Example Question 26 A patient is receiving **180 ml of 30% lipids**. How many calories is the patient receiving form the lipids?

Answer 37

- 540 kcal

Question 38

# Example Question 27 A PN order calls for **475 calories** to be provided by lipids. The Pharmacy has **10% lipid emulsion** in stock. How many **milliliters** should be administered to the patient? round to the nearest whole number

Answer 38

- 432 ml

Question 39

What are some of the Sodium **types** that can be added to a PN?

Answer 39

- Sodium **Chloride** - Sodium **Acetate** [best for acidosis] - Sodium **Phosphate** - Or a combo of all 3

Question 40

# Example Question 28 The pharmacist is going to add **80 mEq** of sodium to the PN; half will be given as **sodium acetate (2 mEq/ml)** and half as **sodium cholride (4 mEq/mL)**. How many **milliliters** of sodium chloride will be needed?

Answer 40

- 10 ml

Question 41

# Example Question 29 The pharmacist is making PN that needs to contain **80 mEq** of sodium and **45 mEq** of acetate. The available pharmacy stock solutions in **sodium chloride (4 mEq/ml** of sodium) and **sodium acetate (2 mEq/ml** of sodium). the final volume of the PN iwll be **2.5 liters** to be infused at **100 ml/hr**. what is the quantity, **in milliliters**, of each stock solution should be added to the PN to meet the requirements? Round ot the nearest hundredth

Answer 41

- 8.75 ml of sodium chloride

Question 42

# Example Question 30 A **2 liter** PN solution is to contain **60 mEq of sodium** and **30 mEq fo acetate**. The pharmacy has in stock sodium chloride (4 mEq/ml) and sodium acetate (2 mEq/ml). what quantity in **milliliters** of each solution should be added to the PN? round to the nearest tenth.

Answer 42

- 15 ml of acetate - 7.5 ml of chloride

Question 43

What are some of the potassium **types** that are used

Answer 43

- Potassium **chloride** - Potassium **Phosphate** - Potassium **Acetate**

Question 44

# Example Question 31 The pharmacist has calculated that a patient requires **30 mmol** of phosphate and **80 mEq** of potassium. The pharmacy has stock solution of Potassium Phosphate (**3 mmol of phosphate with 4.4 mEq of Potassium/ml**) and potassium chloride (**2 mEq k/ml**). how many **milliliters** of potassium phophate and potassium chloride will be requried to meet the patients needs.

Answer 44

- 18 ml of KCl

Question 45

What is important to know about **albumin and calcium**?

Answer 45

- Half of Ca binds to albumin - So if low albumin then the Ca will be falsely low

Question 46

What is the **equation** for corrected Calcium?

Answer 46

- Ca(reported) + [(4.0 - Albumin) x (0.8)]

Question 47

# Example Question 32 Calculate the **corrected calcium** value for a patient with the following reported lab values ## Footnote Ca (normal 8.5 - 10.5): 7.6 Albumin (normal 3.5 - 5): 1.5

Answer 47

- 9.6 mg/dL

Question 48

# Example Question 33 A patient is to receive **8 mEq of calcium**. the Pharmacy has calcium gluconate **10%** in stock which provides **0.465 mEq/ml**. How many **milliliters** of calcium gluconate should be added to the PN? round to the nearest whole numbers

Answer 48

- 17 ml calcium gluconate

Question 49

What is important to know about **Calcium and Phosphorus**

Answer 49

- Can Precipitate if mixed

Question 50

# Example Question 34 A patient is receiving **30 mmol** of phosphate and **8 mEq** of calcium. The volume of the PN is **2000 ml**. There are **2 mEq PO4/mmol**. Confrim that the sum of the calcium and phosphorus does not exceed **45 mEq/l**

Answer 50

- 34 mEq/L; which is less than 45 mEq/L

Question 51

What are the **4 fat solube** vitamins

Answer 51

- A, D, E, K

Question 52

What are some of the **advantages** of using Enteral Nutrition over PN?

Answer 52

- Lower Cost - It uses the gut (preventing atrophy) - Lower risk of complications

Question 53

What are a few examples of EN Formula products?

Answer 53

- Ensure - Osmolite - Jevity - Glucerna - Novasouce

Question 54

What are some of the medicaitons that **CANNOT** go into a feeding tube?

Answer 54

- **Warfarin**: hold tubes 1h before and after - **Tetracyclines, Quinolones, Levothyroxine**: separte from tubes - **Cipro**: No to suspension but yes to crushed and mix tabs - **Phenytoin**: separte for 2h

Question 55

# Example Question 35 (35 -37 are related) What precent of calories wil WT receieve from the Portein component? What is the Precentage of Kcal?round to the nearest whole number ## Footnote Calories: 356 kcal Total Fat: 17.8 G Protein: 19.6 G Total Carbs: 31.5 G Fiber: 3.8 G L-Carnitine: 51mg Taurine: 40 mg m-Inositol: 205 mg

Answer 55

- 78.4 kcal - 22%

Question 56

# Example Question 36 (35 - 37 are related) How many calories will WT receive from the fat component of one (8 fl oz) shake? Round to the nearest whole number? ## Footnote Calories: 356 kcal Total Fat: 17.8 G Protein: 19.6 G Total Carbs: 31.5 G Fiber: 3.8 G L-Carnitine: 51mg Taurine: 40 mg m-Inositol: 205 mg

Answer 56

- 160.2 kcal

Question 57

# Example Question 37 (35 - 37 are related) What percent of calories are derived from the fat component? Round to the nearest whole number. ## Footnote Calories: 356 kcal Total Fat: 17.8 G Protein: 19.6 G Total Carbs: 31.5 G Fiber: 3.8 G L-Carnitine: 51mg Taurine: 40 mg m-Inositol: 205 mg

Answer 57

- 45%

Question 58

# Example Question 38 (38 - 40 are related) How many calories will JB receive from the carbohydrate component if he receives 4 lf oz? Round to the nearest whole number. ## Footnote Calories: 285 kcal Total Fat: 9.2 G Protein: 13.2 G Total Carbs: 37.4 G L-Carnitine: 36 mg Taurine: 36 mg

Answer 58

- 75 kcal from 4 fl oz

Question 59

# Example Question 39 (38 - 40 are related) What percent of calories will JB receive from the carbohydrate components? Round to the nearest whole number? ## Footnote Calories: 285 kcal Total Fat: 9.2 G Protein: 13.2 G Total Carbs: 37.4 G L-Carnitine: 36 mg Taurine: 36 mg

Answer 59

- 52%

Question 60

# Exampe Question 40 (38 - 40 are related) The nurse was administering one carton (8 fl oz) of Osmolite to JB when she accidentally spilled 2 fl oz on the floor. The remain amount in the caton wa accurately delivered to the patient. How many calories did he actailly receive? Do no round the answer. ## Footnote Calories: 285 kcal Total Fat: 9.2 G Protein: 13.2 G Total Carbs: 37.4 G L-Carnitine: 36 mg Taurine: 36 mg

Answer 60

- 213.75 kcal