Condition Specific Nutrition Support Flashcards
ERAS is a care program that has been shown to improve outcomes after major surgery. The key mechanism behind ERAS effectiveness:
Decrease the stress of surgery and support recovery.
What is the inpatient glycemic target for critically ill patients?
140-180
Under conditions of sepsis and stress, what metabolic alterations are most likely to occur?
Increased glucose production and decreased glucose uptake
What immunomodulating nutrient may be harmful in patients with sepsis/septic shock?
Arginine
What best describes enteral glutamine supplementation in the critically ill?
Enteral GLutamine decreases nosocomial infections
What are counter regulatory hormones responsible in the hypercatabolism observed in critically ill trauma patients?
Glucagon, epinephrine, cortisol
In patinets with. burns, providing caloric support above energy exenditure has benn found to:
Have no effect on preservation of lean body mass
In pulmonary insufficiency, excessive calorie administration may cause increase blood PCO2 resulting in ?
Respiratory acidosis
What is true of EFAD in patients with CF?
EFA profiles have been shown to improve in CF patients after lung transplantation
What has not been shown to delay weaning from mechanical ventilation in patients with chronic obstructive pulmonary disease who are receiving EN?
Trophic feeds
What is the best choice for feedings a pancreatic insufficient infant with CF?
Human milk
Patients with chronic heart failure are typically on a loop diuretic. These patients are at risk for:
Azotemia
A CHF patient on high dose furosemide is started on EN for inability to consume adequate oral nutrition. Despite slow advancement to goal feeding rate, he suffers from electrolyte imbalance and peripheral neuritis. Deficiency of which vitamin should be suspected?
Thiamin
A patient with AKI who requires ON would most likely benefit from a solution containing what amino acid formula?
Essential and non essential amino acids
What is the GFR of a patients with end stage renal disease?
<15 ml/mi/1.73m2
What is the recommended maximum dietary protein intake in critically ill adult patients receiving continuous renal replacement therapy?
2.5 g/kg per day
What are the protein requirements for a stable patient receiving PD?
1.2-1.3 g/kg/day
Increased mortality in maintenance HD patients has been associated with?
Low baseline body fat percentage and low muscle mass
Hypoglycemia, requiring dextrose infusions to maintain euglycemia, is most likely to occur in what type of liver disease?
Fulminant hepatic failure
What is not a cause of PEM in a patient with liver disease?
Reduced energy expenditure
In cirrhotic patients, which of the following should be implemented to assist in avoiding fasting associated starvation during the night?
Late evening snack
PEM in the most common in which types of liver disease?
Cirrhosis
What is an important indicator of PEM in chronic liver disease?
Muscle wasting
Treatment for patients with overt hepatic encephalopathy who have impairments in cognitive and neuomuscular function does not include:
Low protein diet
The highest prevalence and severity of weight loss is found in patients with what types of cancer?
Pancreatic and gastric
What best describes the benefit of megestrol acetate in patients with cancer related cachexia?
Improves appetite and ameliorates weight loss
In the first 1-3 months after a bone marrow transplant the nutritional needs of a patients are best met with:
30-35 kcals/kg/day with >=1.5 g/kg protein
Supplementation with which nutrient is routinely restricted during the early stages following hematopoietic stem cell transplantation?
Iron
What acute changes in the serum chemistry profile would be expected in a patients who is experiencing tumor lysis syndrome?
Hyperkalemia and hyperphosphatemia
What best describes the treatment of diarrhea in inflammatory bowel syndrome?
Start antidiarrheal agents once infections etiology is ruled out
A patient with Crohn’s disease that involves the distal ileum should be closely monitored for malabsorption of:
B12
What is a major contributing factor in the development of MBD in patients with IBS?
Corticosteroid use
In patients with acute pancreatitis, the use of EN via NGT rather than PN is associated with:
A lower risk of developing infectious complications
Gastric hypersecretions following significant small bowel resection can become problematic. What medication has been shown to be the most successful in suppressing gastric hypersecretions?
Proton pump inhibitors
What metabolic complication may occur in patients with short bowel syndrome and small bowel intestinal bacterial overgrowth?
Metabolic acidosis
Patients with short bowel syndrome would benefit most from octreotide injections in the presence of:
refractory diarrhea not controlled with diet and medication
What diet should be recommended to patients with short bowel syndrome (ileal resection) and colon in continuity?
High complex carbohydrate
Calcium oxalate nephrolithasis can occur in patients with SBS with an intact colon who:
Do not maintain adequate hydration
What type of fistula will result in the greatest degree of nutritional loss?
Proximal high output
A pregnant woman present with persistent N/V for the past 6 weeks associated with a 10% weight loss. Her symptoms were refractory to a 48 hour trial of antiemetics and IV fluids.A decision to made to initiate nutrition support. What vitamin should be supplemented in this patient before providing nutrition support?
Thiamin
A pregnant woman present with persistent N/V for the past 6 weeks associated with a 10% weight loss. Her symptoms were refractory to a 48 hour trial of antiemetics and IV fluids.A decision to made to initiate nutrition support. What is the most appropriate initial nutrition therapy to implement?
EN with polymeric formula via NGT
A critically ill hyperglycemic patient receiving continuous EN with a history of insulin dependent DM should ideally be placed on:
Continuous IV insulin infusion
HIV associated lipodystrophy syndrome is most commonly associated with what class of agents used to treat HIV?
NRTIs
A 51 yo female who is 10 years s/p gastric bypass for obesity presented with numbness and tingling in her distal lower extremities that had progressively worsened. She had been on an oral MV supplement. She was significantly anemia and neutropenic. Her vitamin B12, iron, ferritin and transferrin levels were all normal. What nutritional deficiency is most likely the cause of all these symptoms?
Copper
What is the most appropriate feeding strategy for morbidly obese trauma patient?
High protein, hypocaloric feeding
Zinc supplementation should be considered for patients:
with unexplained skin rashes and alopecia
Nutrition support for solid organ transplant patients receiving cyclosporine need to be modified due to the presence of:
Hyperkalemia
