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cnsc all modules Flashcards

1
Q

what is the first step in refeeding management?

A

correct deficiencies of potassium, phosphorus, magnesium

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2
Q

When a patient is at risk for refeeding syndrome, initiate dextrose at ____ or initiate kcal provision at ___ kcals/kg.

A

initiate with 100-150 grams dextrose or 10-20 kcals/kg

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3
Q

total body water females + elderly

A

50% of LBM

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4
Q

total body water males <70 years old

A

60% of LBM

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5
Q

ECF (extracellular fluid)

A

1/3 TBW

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6
Q

ICF (intracellular fluid)

A

2/3 TBW

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7
Q

water gain (sensible)

A

800-1500 ml from oral fluid, 500-700 ml from solid food

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8
Q

water gain (insensible)

A

250 ml from water oxidation

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9
Q

water loss (insensible)

A

600-900 ml via lungs/skin

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9
Q

weight/age based fluid requirement 18-55 years old

A

35 ml/kg

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9
Q

water loss (sensible)

A

800-1500 ml urine, 0-250 ml GI

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10
Q

weight/age based fluid requirement 56-75 years old

A

30 ml/kg

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11
Q

weight/age based fluid requirement >75 years old

A

25 ml/kg

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12
Q

holliday-segar method for fluid (adults)

A

1500 ml fluid for first 20 kg, then add:
</= 50 years: 20 ml/kg remaining
>50 years: 15 ml/kg remaining

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13
Q

factors that increase fluid needs

A

fever, vomiting, NGT output, ostomy/fistula output, hyperventilation (10-60%), excessive sweating, burns
***fluid needs increase by 12.5% for each 1 degree above normal (fever)

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14
Q

factors that decrease fluid needs

A

fluid overload, HF, renal failure, SIADH, ascites, anasarca

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15
Q

estimating minimal adult IV fluid needs

A

1000 ml urine output, add 500 ml for insensible loss, add net GI loss or subtract net GI gain

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16
Q

maintenance fluids

A

hypotonic (1/2 NS)

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17
Q

resuscitation fluids

A

isotonic (0.9% NS, LR, plasmalyte)

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18
Q

electrolyte losses in the stomach

A

Na: 60
Cl: 130
K: 15
HCO3: 0

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19
Q

electrolyte losses in the duodenum

A

Na: 140
Cl: 80
K: 5
HCO3: 0

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20
Q

electrolyte losses in the pancreas

A

Na: 140
Cl: 75
K: 5
HCO3: 115

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21
Q

electrolyte losses in the bile

A

Na: 145
Cl: 100
K: 5
HCO3: 35

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22
Q

electrolyte losses in the ileum

A

Na: 140
Cl: 104
K: 5
HCO3: 30

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23
Q

electrolyte losses in the colon

A

Na: 60
Cl: 40
K: 30
HCO3: 0

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24
Q

gastric fluid loss replacement

A

1/2 NS + 10-20 meq KCl/L

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25
Q

small bowel fluid loss replacement (duodenum, pancreas, bile, ileum)

A

balanced crystalloid (LR, plasmalyte), bicarb or acetate based customized fluid, 0.9% NS

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26
Q

normal serum sodium

A

135-145

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27
Q

normal serum potassium

A

3.5-5

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28
Q

normal serum chloride

A

98-108

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29
Q

normal serum CO2

A

23-30

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30
Q

normal serum calcium

A

9-10.5

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31
Q

normal serum phosphorus

A

2.5-4.5

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32
Q

normal serum magnesium

A

1.7-2.4

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33
Q

measure plasma osmolality

A

2 x (serum Na) + (glucose) / 18 + BUN / 2.8
<280 mOsm/kg = hypotonic
>280 mOsm/kg = isotonic

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34
Q

Na correction in hyperglycemia

A

((glucose -100) x 0.016) + Na

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35
Q

urine osmolality

A

> 100 mOsm/kg = inappropriate renal dilution
<100 mOsm/kg = appropriate renal dilution (excessive water intake, polydipsia, beer potomania, low solute intake)

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36
Q

anti-diuretic hormone (ADH)

A

increases water reabsorption in the kidneys
- pain, stress r/t surgery causes a sustained release of ADH in the first 1-2 days post op causing Na to drop

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37
Q

hypertonic hyponatremia treatment

A

insulin, dc mannitol

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38
Q

hypotonic hypovolemic hyponatremia treatment

A

isotonic fluids (0.9% NS, LR), dc diuretics, steroids

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39
Q

euvolemic hyponatremia treatment

A

fluid restrict +/- loop diuretics, isotonic fluids, NaCl tablets, urea, concentrate PN

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40
Q

hypervolemic hyponatremia treatment

A

Na and fluid restriction, diuretics, concentrate PN

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41
Q

free water deficit

A

TBW x ((current Na-140)/140)

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42
Q

what regulates entry of potassium into the cell?

A

Na-K-ATPase pump

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43
Q

what is responsible for an intracellular shift of potassium?

A

insulin, catecholamines, alkalosis

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44
Q

what is responsible for an extracellular shift of potassium?

A

glucagon, acidosis, aldosterone
*acidosis = high serum potassium

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45
Q

10 meq of IV potassium increases serum potassium by ___

A

0.1 meq/L

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46
Q

management of hyperkalemia

A

K cocktail if potassium is > 6 meg/L or ECG changes, cellular incorporation (insulin +/- D50, sodium bicarbonate, albuterol), increase elimination (furosemide, HD, Na polystyrene sulfonate)

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47
Q

what increases calcium levels?

A

vitamin d, PTH

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48
Q

what decreases calcium levels?

A

calcitonin, phosphorus, pH

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49
Q

peripheral calcium supplement

A

calcium gluconate
1 gram = 4.65 meq Ca

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50
Q

central calcium supplement

A

calcium chloride
1 gram = 13.6 meq Ca

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51
Q

hypercalcemia

A

acute: malignancy
chronic: hyperparathyroidism
treatment: hydration +/- loop diuretics, calcitonin (rapid onset), biphosphonates (slower onset), steroids

52
Q

magnesium

A

absorbed in the jejunum and regulated by the kidney, enzyme cofactor, calcium channel blocker, neuromuscular transmission, CV tone, metabolism

53
Q

long term PPI use (years) effects the active transport/absorption of ___ in the GI tract

A

magnesium

54
Q

parenteral magnesium dosing

A

serum mg: 1-1.5 mg/dl = 8-32 meq, up to 1 meq/kg

serum mg: < 1 mg/dl = 32-64 meq, up to 1.5 meq/kg

55
Q

parenteral magnesium infusion rate

A

</= 8 meq/hr - prevents renal wasting and infusion reactions

56
Q

parenteral phosphorus dosing

A

serum P: 2.3-3.7 = 0.08-0.16 mmol/kg
serum P: 1.5-2.2 = 0.16-0.32 mmol/kg
serum P: <1.5 = 0.32-0.64 mmol/kg

57
Q

parenteral phosphorus infusion rate

A

</= 7 mmol/hr

58
Q

loss of night vision

A

vitamin a

59
Q

angular stomatitis, cheilosis

A

riboflavin (vitamin b2), pyridoxine (vitamin b6), niacin, iron

60
Q

glossitis (inflammation of the tongue/magenta color)

A

riboflavin, pyridoxine, niacin, folate, iron

61
Q

poor nail blanching

A

vitamin a or c

62
Q

PPN Osmolality calculations

A

AA (1 gram = 10 mOsm)
Dextrose (1 gram = 5 mOsm)
IV lipids (1 gram = 0.71 mOsm)
electrolytes (1 meq = 1 mOsm)

63
Q

pinch off syndrome

A

CVC compressed between the clavicle and the first rib, catheter malposition

64
Q

thrombotic occlusions

A

formation of thrombus within surrounding or at the tip of the catheter
push-pause flushing method helps prevent

65
Q

fibrin sheath

A

tail extends from the catheter tip but is drawn inward blocking the opening of the catheter lumen on aspiration, resulting in an ability to infuse fluids but inability to withdraw blood

66
Q

crohn’s disease key features

A

transmural, small bowel involvement, fistulas, granulomas, skip lesions, 25-30% have no bleeding

67
Q

ulcerative colitis key features

A

mucosal disease, starts from rectum up, colonic involvement only, bleeding common

68
Q

sites of absorption: duodenum

A

iron, folate, calcium, fat soluble vitamins

69
Q

sites of absorption: lower jejunum

A

water soluble b vitamins

70
Q

sites of absorption: terminal ileum

A

vitamin b12, bile salts

71
Q

sites of absroption: ileum

A

magnesium

72
Q

sites of absorption: colon

A

short chain fatty acids

73
Q

autonomy

A

right of individuals to make their own decisions

74
Q

beneficence

A

doing the right thing for the patient

75
Q

nonmaleficence

A

doing no harm

76
Q

justice

A

acting fairly, providing similar treatment to patients in similar situations

77
Q

protein:nitrogen

A

6.25 grams protein = 1 gram nitrogen

78
Q

manifestations of essential fatty acid deficiency

A

scaly dermatitis, alopecia, poor wound healing, thrombocytopenia, triene to tetraene ratio of more than 0.2

79
Q

sodium maintenance dosage

A

1-2 meq/kg/day

80
Q

potassium maintenance dosage

A

1-2 meq/kg/day

81
Q

calcium maintenance dosage

A

10-15 meq/day

82
Q

magnesium maintenance dosage

A

8-20 meq/day

83
Q

phosphorus maintenance dosage

A

20-40 mmol/day

84
Q

celsius to fahrenheit conversion

A

(C x 1.8) + 32

85
Q

base component

A

HCO3

86
Q

acid component

A

PCO2

87
Q

arterial blood gas normal values

A

pH: 7.4 (7.35-7.45)
PCO2: 35-45
PO2: 80-100
HCO3: 22-26

88
Q

respiratory acidosis

A

PCO2 is elevated (>40 mmHg)

89
Q

respiratory alkalosis

A

PCO2 is reduced (<40 mmHg)

90
Q

metabolic acidosis

A

HCO3 is <24

91
Q

metabolic alkalosis

A

HCO3 is >24

92
Q

medicare guidelines to cover home EN

A

> 3 months, non-function or disease of the structures that normally permit food to reach the small bowel, dysphagia, esophageal cancer, gastroparesis, disease of the small bowel which impairs digestion/absorption, sole source of nutrition

93
Q

nutritionally at risk child

A
  • weight for length, weight for height <10th percentile, -1.28 z score
  • bmi for age/gender <5th percentile, -1.64 z score
  • increased metabolic requirements
  • impaired ability to ingest/tolerate oral feeding
  • documented inadequate provision of or intolerance to nutrients
  • inadequate weight gain or significant decrease in usual growth percentile
94
Q

low birth weight

A

<2500 grams

95
Q

very low birth weight

A

<1500 grams

96
Q

extremely low birth weight

A

<1000 grams

97
Q

micronate

A

<750 grams

98
Q

pediatric bmi classifications

A

<5th percentile: underweight
5th-85th percentile: normal
85th-95th percentile: overweight
>95th percentile: obese

99
Q

protein requirements 0-3 mos

A

1.5 grams/kg

100
Q

protein requirements 4-12 mos

A

1.5 grams/kg

101
Q

protein requirements 13-36 mos

A

1.1 grams/kg

102
Q

protein requirements 4-13 yrs

A

0.95 g/kg

103
Q

protein requirements 4-18 yrs

A

0.85 grams/kg

104
Q

fluid requirements children (holliday-segar)

A

1-10 kg: 100 ml/kg
10-20 kg: 1000 ml + 50 ml/kg >10 kg
>20 kg: 1500 ml + 20 ml/kg >20 kg

105
Q

EN initiation and advancement guidelines (infants)

A

bolus: initiate at 25% and divide by # of preferred feeds, increase volume by 25% daily
pump: initiate at 1-2 ml/kg/hr and advance by 0.5-1 ml/kg/hr every 6-24 hrs to goal

106
Q

vitamin d in infants

A

supplement 400 IU/day in those exclusively breastfed

107
Q

iron in infants

A

fortify in breastfed infants by 4-6 months
*formula contains iron

108
Q

no cows milk before 1 year because

A

low in iron, low in vitamins c and e, low in essential fatty acids, high renal solute load

109
Q

sodium needs in preterm neonates

A

2-5 meq/kg

110
Q

sodium needs in infants/children

A

2-5 meq/kg

111
Q

sodium needs in adolescents and children >50 kg

A

1-2 meq/kg

112
Q

potassium needs preterm neonates

A

2-4 meq/kg

113
Q

potassium needs infants/children

A

2-4 meq/kg

114
Q

potassium needs adolescents + children >50 kg

A

1-2 meq/kg

115
Q

calcium needs preterm neonates

A

2-4 meq/kg

116
Q

calcium needs infants/children

A

0.5-4 meq/kg

117
Q

calcium needs adolescents + children >50 kg

A

10-20 meq

118
Q

phosphorus needs preterm neonates

A

1-2 mmol/kg

119
Q

phosphorus needs infants/children

A

0.5-2 mmol/kg

120
Q

adolescents + children >50 kg

A

10-40 mmol

121
Q

magnesium needs preterm neonates

A

0.3-0.5 meq/kg

122
Q

magnesium needs infants/children

A

0.3-0.5 meq/kg

123
Q

magnesium needs adolescents + children >50 kg

A

10-30 meq

124
Q

trace element deficiency associated with microcytic anemia and neutropenia

A

copper

125
Q

trace element deficiency associated with growth failure and hair loss

A

zinc

126
Q

neonate

A

first 28 days of life

127
Q

neonate parenteral calorie goals

A

preterm: 85-111 kcals/kg, 3-4 grams pro/kg
late preterm: 100-110 kcals/kg, 3-3.5 grams pro/kg
term: 90-108 kcals/kg, 2.5-3 grams pro/kg

128
Q

neonate enteral calorie goals

A

preterm: 110-130 kcals/kg, 3.5-4.5 g pro/kg
late preterm: 120-135 kcals/kg, 3-3.2 g pro/kg
term: 105-120 kcals/kg, 2-2.5 g pro/kg

129
Q

cyclosporine commonly used after solid organ transplantation for immune suppression may cause

A

hyperkalemia, hypomagnesemia, hyperglycemia, hypercholesterolemia

cnsc exam aspen modules (1 decks)

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