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Additional CSO Cards > Chapter 12: Nutrition Support > Flashcards

Chapter 12: Nutrition Support Flashcards

1
Q

Prevalence of malnutrition in the oncology population has a wide range, ____ - _____%

A

30-85%

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2
Q

EN is most appropriate for those who are ___________ or unexpected to be able to ingest/absorb adequate nutrients for more than ____ - _____ days

A

7-14

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3
Q

T/F: According to ASPEN patients undergoing major cancer operations do not benefit from routine use of EN

A

True

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4
Q

Perioperative nutrition may be beneficial in those malnourished if administered _____ - ____ days preoperatively, but this must be weighed against potential risks of delayed surgical intervention

A

7-14

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5
Q

EN uses first-pass metabolism in the __________, which can promote more efficient nutrient utilization and reduces the risk of bacterial translocation when compared with PN

A

liver

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6
Q

T/F: GI obstructions, GI bleeds, bowel ischemia, and active peritonitis are contraindications for EN

A

True

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7
Q

The ligament of Trietz is the landmark area of separation between ____ & _______

A

Duodenum & jejunum

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8
Q

PEG-J - benefits and how do you feed into it?

A

Feed into the jejunum only, must use a continuous pump. The g tube is used to reduce stomach contents. This can decrease risk for aspiration of gastric contents.

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9
Q

Short-term enteral access (NG & NJ) are intended for how long?

A

~4-6 weeks

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10
Q

These 2 feeding tubes must be placed surgically

A

j tube (not PEJ) & low-profile button

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11
Q

Low profile button (MIC-KEY) feeding tubes are less obtrusive but require ___________ for administration

A

Extension sets

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12
Q

Standard formulas AKA _______________ formulas are appropriate for the majority of cancer patients

A

Polymeric

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13
Q

All tubes into the intestine decrease the risk for….

A

Aspiration of gastric contents

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14
Q

Most EN formulas provide _______ - ______% of the body’s required free water

A

70-85%

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15
Q

Provide a minimum flushes of ______ mL at least every _____ hours during continuous feeds for patency

A

30 mL q 4 hours

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16
Q

Blenderized tube feeding requirements:
-Hang time:
-Type of tube:
-Side of tube
-Method of administration

A

Hang time: 2 hours
Type of tube: G
Size of tube: at least 14 French
Method: must be able to tolerate bolus

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17
Q

4 primary methods of EN administration

A
  1. Bolus
  2. Intermittent (gravity)
  3. Cyclic
  4. Continuous
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18
Q

Semi-elemental formulas are AKA

A

Peptide-based

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19
Q

Standard EN formulas provide ~15-25% kcal from protein while renal formulas provide….

A

7-18% kcal from protein

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20
Q

Renal formulas are more concentrated (lower in water), and have reduced amounts of these 4 minerals

A

Sodium, potassium, phosphorus, calcium

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21
Q

Pulmonary formulas are lower in ______ but higher in _____

A

lower in CHO, higher in fat
moderate protein (16-18%)

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22
Q

Immune-modulating formulas are often higher in _______

A

Protein

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23
Q

The 2 most commonly use modular components are

A

Protein & fiber

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24
Q

Refeeding syndrome can occur when malnourished patients are initially fed full-energy feeds or high ______ diets

A

carbohydrate

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25
Q

Hallmark signs of refeeding
– _____ retention
- ______ dysfunction
- _______ failure

A

Fluid retention, cardiac dysfunction, respiratory failure

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26
Q

Taking NPO for > _____ days increases risk for refeeding

A

7

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27
Q

_____ is an important cofactor in CHO metabolism, thus supplementation of ______ mg for ____ - ____ days can help prevent refeeding syndrome

A

Thiamine
100
5-7 days

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28
Q

ASPEN recommends not routinely monitoring for residual volumes. Do not hold if GRV is < _____ mL in the absence of other symptoms

A

500 mL

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29
Q

Recommended initiation rate for bolus or intermittent feeds

A

60-120 mL

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30
Q

Initiation rate for cyclic or continuous feeds

A

10-40 mL/hour

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31
Q

Advancement schedule for bolus/intermittent feeds

A

Increase by 60-120 mL every 8-12 hours (or every 1-2 feeds)

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32
Q

Advancement schedule for cyclic/continuous feeds

A

Increase by 10-20 mL/hour every 8-12 hours or 4-24 hours (respectively)

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33
Q

If dehydrated, you may wish to switch to a less _____ formula

A

concentrated (thus higher in free water)

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34
Q

Hypernatremia is caused by one of 2 causes:

A
  1. Inadequate free water
  2. Excessive diuresis
35
Q

SIADH causes low _______
2 ways to correct _________

A

Sodium

Restrict free water & diuresis`

36
Q

Supplement w/ sodium if the cause of hyponatremia is ________

A

GI losses

37
Q

Metabolic acidosis _______ concentration of potassium in the blood

A

increases

38
Q

T/F: Insulin raises phosphorus & potassium in the blood

A

False, lowers and could cause hyponatremia/hypophosphatemia

39
Q

Tumor lysis syndrome is characterized by (high/low) levels of potassium & phos

A

High

40
Q

To prevent aspiration, the HOB should be

A

30-45 degrees

41
Q

Small bore tubes may increase risk for clogs but decrease risk for

A

Aspiration

42
Q

_______ agents are beneficial for aspiration, GERD, and nausea

A

Prokinetics

43
Q

If bacterial contamination is the cause of diarrhea….

A

Educate on hang times, change tubing frequently, switch to a closed system

44
Q

Is prune juice appropriate for constipation with EN?

A

Yes

45
Q

Suspend EN for constipation when _______ is supected

A

Obstruction or illeus

46
Q

Small diameters tubes are considered

A

8-10 French and increase risk for clogs

47
Q

The most common G-tube complication is….

A

Peristomal infection (leakage is also common but underreported)

48
Q

5 strategies for managing a clogged EAD

A
  1. Warm water instillation for up to 15 minutes
  2. Push pull method with syringe
  3. Pancrealipase + sodium bicarb mixture (baking soda)
  4. Commercial unclogging device (mechanical)
  5. Commercial unclogging solution (i.e TubeClear or Clog Zapper) - use under medical supervision
49
Q

Hyperosmolar meds (>1000 mg/kg) through tube

A

dilute with 10-30 mL water to reduce GI effectd

50
Q

Instead of cholestyramine through feeding tube for anti-diarrhea, use hydrolyzed _______ ____

A

Guar gum to thicken the stool)

51
Q

These 2 anti-emetics can not be put through the feeding tube

A

Aprepitant and orally disintegrating Ondansetron

Put ondansetron in mouth to dissolve or use alternatives

52
Q

These antibiotics cannot but put through feeding tube and there’s no alternatives

A

Fluoroquinololones (Cirpofloxacin, Levofloxacin)

53
Q

This appetite stimulant cannot be put through the feeding tube

A

Dronabinol

54
Q

This solid form of opiod cannot be put through feeding tube

A

Oxycodone (switch to liquid)

55
Q

Should you put psyllium or methylcellulose through feeding tube?

A

NO nor should you put bisacodyl tables (consider suppository or liquid forms)

56
Q

Avoid these tablet forms of PPIs through feeding tube

A

Pantoprazole & Rabeprazole (Lansoprazole & Esomperazole OK)

57
Q

This H2 agaonist may bind to protein left in feeding tube and create clogs

A

Sucralfate

58
Q

Those who would die from __________ before tumor progression could be considered for EN

A

Malnutriiton

59
Q

Is central parenteral nutrition or peripheral parenteral nutrition preferred?

A

Central

Lower infectious rate, better for long term. Usually already have central access via port but would benefit from a separate line. PICC = peripherally inserted central catheter

60
Q

5 Reasons for PN

A
  1. Illeus (possibly post-op)
  2. Malignant bowel obstruction
  3. High output distal GI fistula (>200 mL/day)
  4. Inability to tolerate EN for > 7-14 days
  5. Refractory diarrhea, large volume
61
Q

_______ is the primary source of energy source with PN and a minimum of _________ g/day is needed to prevent ketosis

A

Dextrose
50 g
(but ideally no less than 100-150 g/day is recommended)

62
Q

SMOFlipid was approved in 2016 as an alternative to soy-based only lipid emulsions. This contains

A

Soybean, MCT oil, Olive oil, Fish oil

Higher in vitamin e but not excessive

63
Q

Omegaven was approved in 2018 and contains 100% ______ oil, which has shown to improve PN liver disease in the pediatric population

A

fish oil

64
Q

ASPEN recommends providing at least ______% energy from linoleic acid & ______% energy from linolenic acid to prevent deficiency

A

1-2%
0.5%

65
Q

PN products are often deficient in vitamin ________

A

D

66
Q

_____ is not routinely added to PN d/t concern for adverse reactions and incompatibility issues

A

Iron, thus periodic iron infusions mahy be needed

67
Q

It’s acceptable to mix some medications into PN including

A

Regular human insulin, famotidine, and heparin

68
Q

2 in 1 vs 3 in 1 PN mixtures

A

2 in 1 is dextrose + AAs, then “piggyback” of fats
-lipids are less stable (12 hour hang time)

3 in 1 is “total nutrient mixture” (fat, cho, amino acids) - longer hang time but next to mix the lipids in right before

69
Q

kcal/kg recommendation for PN with refeeding syndrome risk

A

15 kcal/kg (20-30 kcal/kg if stable)

70
Q

To prevent hyperglycemia, EN should be provided with _____ - _____ g dextrose or ______ for those with already poor glycemic control

A

150-200
100

71
Q

When PN has started, begin with 24 hour infusion. Then can consider a cyclic regimen of ______ - ____ hours/day

A

12-16

72
Q

Long-term PN complications

A

Mirconutrient toxicities or deficiencies, organ dysfunction, metabolic bone disease

73
Q

Short-term PN complications

A

uncontrolled BG, hypertriglyceridemia, fluid/electrolyte imbalances

(more common w/ PN than EN)

74
Q

Once the patient is meeting ______% needs via enteral or oral route, the PN can be safely discontinued

A

60%

75
Q

Daily monitors w/ new PN

A

weight, i/os, BMP + phos & mg, glucose (q6 hours until stable)

76
Q

Weekly labs w/ new PN

A

CBC, LFTs

77
Q

If unable to tolerate fats in PN, consider these alternative modes of administration

A

Topical & oral ingestion

78
Q

Define Azotemia

A

Excessive BUN & protein components in blood

(may be d/t dehydration or excess amino acids)

79
Q

Soy-based fat emulsions may cause liver disease & ________

A

Immunosuppression (increased infectious risk)

*avoid lipids with critically ill during week 1

80
Q

If experiencing hyperglycemia, limit CHO to ____-_____ mg/body wt or ___ - _____ kcal/kg

A

4-5 mg/kg
20-25 kcal/kg

81
Q

Hypertrigylceridemia w/ PN may be d/t ________ or ________

A

excess dextrose OR rapid infusion of lipids

82
Q

Rise of these enzymes within the first 2 weeks of PN is normal and should be monitored

A

Liver (ALT & AST)

83
Q
A
84
Q

minimum requirement for lipids

A

250 ml of 20% IVFE twice per week

Additional CSO Cards (26 decks)

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