Ch 22: Neurologic Impairment

Question 1

What are protein requirements for patients with a stroke?

Answer 1

Protein requirements should be determined by assessing patient’s pre-stoke nutrition status and renal/liver function immediately following stroke; recommended goals rate from 1.0-1.5 kg/kg/d

Question 2

SCI patients have an elevated risk of what?

Answer 2

Obesity; • A modified BMI scale has been proposed for individuals with SCI, with normal weight being 18-22, overweight as 22-25, and obese as BMI > 25

Question 3

What are the general energy recommendations for weight maintenance in quadriplegic patients?

Answer 3

20-22 kcal/kg/day or 55-90% of energy goal estimated by HBE.

Question 4

What electrolyte disturbance is common in TBI?

Answer 4

Hyponatremia (Na < 135 mEq/L). Fluid restriction in the primary method of treatment; however, use caution in acute phase of neuro insult b/c volume restriction may be inappropriate; treatment using demeclocycline, sodium supplementation, or vasopressin antagonists should only be used in refractory cases

Question 5

SCI patients often have ____ energy requirements when compared to patient’s with a TBI

Answer 5

Lower–SCI patients may have 48% lower energy need compared to patients with TBI; extent of injury seems to affect energy need in patients with SCI; measure REE is lower in patients with higher and more complete SCI

Question 6

How should protein needs be calculated for patients with ALS?

Answer 6

0.8-1.2 g/kg/d

Question 7

What are the protein requirements for a patient with a TBI?

Answer 7

1.3-2.5 g/kg/d

Question 8

Which micronutrient deficiencies are common in patients with neurologic injury?

Answer 8

folic acid, zinc, selenium, vit D

Question 9

What are the general energy energy recommendations for weight maintenance in paraplegic patients?

Answer 9

22-24 kcal/kg/d

Question 10

How should energy needs be calculated for patients with ALS?

Answer 10

Energy needs should be adjusted to 130% of what HBE calculates; pt’s wit ALS may require 34-35 kcal/kg/day

Question 11

How should protein/energy be estimated for a SCI patient with a wound?

Answer 11

30-35 kcal/kg and 1.25-1.5 g/kg/day (NPUAP guidelines). Also provide enough fluid, and vit/mineral supp is poor intake or deficiencies suspected

Question 12

What factor is associated with reduced mortality in patients with a TBI?

Answer 12

Provision of early nutrition (with 24-72 hours of injury) is associated w/ trend towards reduced mortality– given poor outcomes associated w/ delayed nutrition in TBI, a low threshold for using PN if patient does not tolerate EN is advised

Question 13

How should energy needs be estimated for a patient with a TBI?

Answer 13

When available, IC is recommended; otherwise, use 140% of what the HBE predicts

Question 14

In TBI, which medications are associated with a reductions in energy expenditure?

Answer 14

Neuromuscular blocking agents, non-selective beta blockers, morphine, and barbiturates

Question 15

What are the protein requirements for patients with a SCI?

Answer 15

Comparable to healthy individuals, 0.8-1.0 g per kg IBW per day

Question 16

The acute phase of TBI can be categorized as what?

Answer 16

Hypermetabolic, catabolic–it is proportion to severity of injury

Question 17

What are protein needs for SCI patients immediately after injury?

Answer 17

1.5-2 g/kg/d

Question 18

What is the “gold standard” to diagnose oropharyngeal dysphagia

Answer 18

Modified Barium Swallow Study

Question 19

How should energy needs be estimated for patient with ischemic stroke?

Answer 19

HBE or PSE seems to provide energy prediction closest to actual energy expenditure as measured by IC in ischemic stroke

Question 20

What ratio of fat to CHO and protein is recommended to decrease frequency of seizures in ketogenic diet?

Answer 20

4:1

Question 21

Valproic acid has been shown to induce a deficiency in which nutrient?

Answer 21

Carnitine