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PHRM864 > Critical Care > Flashcards

Critical Care Flashcards

1
Q

Do infants or adults have a higher caloric reserve?

A

adults

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2
Q

Do infants or adults have a higher metabolic rate?

A

infants

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3
Q

Do infants or adults have a higher growth rate?

A

infants

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4
Q

Do infants or adults have higher demands during illness?

A

infants

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5
Q

How much do infants grow in weight by 4-6 months?

A

doubles

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6
Q

How much do infants grow in weight by 12 months?

A

triples

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7
Q

How much do infants grow in length by 12 months?

A

50%

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8
Q

What is the typical newborn weight?

A

2.5 to 4 kg

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9
Q

What age is classified as preschool?

A

2 to 6 years old

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10
Q

What age is classified as middle childhood?

A

7 to 10 years old

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11
Q

What age is classified as adolescence?

A

11 to 18 years old

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12
Q

Which growth chart is used for patients < 2 years of age?

A

WHO

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13
Q

Which growth chart is used for patients 2 to 20 years of age?

A

CDC

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14
Q

How much of a neonate’s basal energy expenditure is used by their brain?

A

~50%

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15
Q

What classifies as failure to thrive (growth faltering)?

A

-fall of 2 major percentiles
-weight < 3rd to 5th percentile

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16
Q

What is the caloric density of breastmilk?

A

20 kcal/oz

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17
Q

What are the AAP recommendations for breastfeeding if there are no contraindications?

A

-exclusive breastfeeding for first 6 months
-optimally continue for at least 1 year
-may extend beyond 1 year if desired

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18
Q

How long does WHO recommend breastfeeding for?

A

up to 2 years

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19
Q

What are contraindications for breastfeeding?

A

-active, untreated maternal TB
-HIV positive
-human T-cell lymphotropic virus (type I and II)
-ebola infection (suspected or confirmed)
-untreated brucellosis
-use of illicit drugs
-drugs

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20
Q

What drugs can harm the infant directly?

A

-immunosuppressants
-chemotherapy
-radioactive agents

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21
Q

What drugs can reduce milk production?

A

-ergots
-decongestants

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22
Q

Is low or high oral bioavailability of a medication that the mother takes more likely to be absorbed by the infant?

A

high

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23
Q

What PK characteristics of a drug increases absorption into the breastmilk?

A

-non-ionized
-small molecular weight
-low protein binding
-high lipid solubility
-long half-life
-low volume of distribution

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24
Q

How often will healthy infants feed on average per day?

A

6 to 9 times per day

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25
Q

How often should a newborn be feeding each day?

A

every 2 to 4 hours

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26
Q

How much should a newborn be feeding each time?

A

~2 oz per feed

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27
Q

How often should a 2 to 4-month-old infant be feeding each day?

A

5 to 8 times per day

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28
Q

How much should a 2 to 4-month-old infant be feeding each time?

A

3 to 6 oz per feed

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29
Q

How often should a 6 to 8-month-old infant be feeding each day?

A

3 to 5 times per day

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30
Q

How much should a 6 to 8-month-old infant be feeding each time?

A

6 to 8 oz per feed

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31
Q

How much should a 12-month-old infant be feeding each day?

A

3 to 5 times per day

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32
Q

How much should a 12-month-old infant be feeding each time?

A

~8 oz per feed

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33
Q

Who does the CDC recommend cholecalciferol supplementation to?

A

all breastfeeding infants

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34
Q

What is the conversion for cholecalciferol between international units (IU) and mcg?

A

400 IU = 10 mcg

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35
Q

What is the dosing recommendation of cholecalciferol for premature neonates < 1.5 kg?

A

200 IU QD

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36
Q

What is the dosing recommendation of cholecalciferol for premature neonates > 1.5 kg?

A

200 to 400 IU QD

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37
Q

What is the dosing recommendation of cholecalciferol for partially or fully breastfed term infants?

A

400 IU QD

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38
Q

What is the dosing recommendation of cholecalciferol for formula fed infants?

A

200 to 400 IU QD until receiving 1000 mL/day of formula

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39
Q

Who is iron supplementation indicated for?

A

-premature neonates
-iron-deficient term infants

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40
Q

What is the dosing recommendation of elemental iron for premature neonates?

A

2 mg/kg/day

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41
Q

What is the dosing recommendation of elemental iron for term infants?

A

3 mg/kg/day

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42
Q

What is the common ferrous sulfate concentration?

A

75 mg/mL

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43
Q

What is the common elemental iron concentration of ferrous sulfate?

A

15 mg/mL

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44
Q

What is the conversion between zinc sulfate and elemental zinc?

A

44 mg of zinc sulfate = 10 mg of elemental zinc

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45
Q

What patients may require zinc supplementation?

A

-premature infants
-prolonged exclusive breastfeeding after > 6 months of age
-parenteral nutrition
-IBD/intestinal failure
-vegan or vegetarian diets
-generalized malnutrition

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46
Q

What are the fluid requirements for a patient weighing <10 kg according to the Holliday-Segar Method?

A

100 mL/kg

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47
Q

What are the fluid requirements for a patient weighing 10 to 20 kg according to the Holliday-Segar Method?

A

1000 mL + 50 mL/kg for every kg >10 kg

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48
Q

What are the fluid requirements for a patient weighing >20 kg according to the Holliday-Segar Method?

A

1500 mL + 20 mL/kg for every kg >20 kg

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49
Q

What is the IBW equation for males?

A

50 kg + 2.3 x inches over 60”

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50
Q

What is the IBW equation for females?

A

45.5 kg + 2.3 x inches over 60”

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51
Q

What is the equation for NBW?

A

IBW + 0.25 (weight - IBW)

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52
Q

When should NBW be used instead of ABW?

A

ABW ≥130% of IBW

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53
Q

What are the risk factors for malnutrition?

A

-UBW
-involuntary weight loss >10% within 6 months
-NPO > 10 days
-gut malfunction
-mechanical ventilation
-increased metabolic needs
-alcohol/substance abuse
-protracted nutrient losses

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54
Q

What is categorized as UBW?

A

20% below IBW

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55
Q

What score on the NUTRIC scale is classified as low risk for malnutrition?

A

0 to 5

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56
Q

What score on the NUTRIC scale is classified as low risk for malnutrition without IL-6?

A

0 to 4

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57
Q

What score on the NUTRIC scale is classified as high risk for malnutrition?

A

6 to 10

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58
Q

What score on the NUTRIC scale is classified as high risk for malnutrition without IL-6?

A

5 to 9

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59
Q

What is the normal serum concentration of transthyretin (prealbumin)?

A

15 to 40 mg/dL

60
Q

What other lab value needs to be assessed with prealbumin to determine malnutrition?

A

C-reactive protein (CRP)

61
Q

If prealbumin decreases and CRP increases, what does this indicate?

A

inflammation

62
Q

If prealbumin decreases and CRP is normal, what does this indicate?

A

malnutrition

63
Q

What is marasmus?

A

protein-calorie malnutrition

64
Q

What is kwashiorkor?

A

protein malnutrition

65
Q

What is the ideal goal of nitrogen balance?

A

3 to 5 grams

66
Q

What is the nitrogen balance formula?

A

(nitrogen in) - (nitrogen out)

67
Q

What is the nitrogen in formula?

A

24-hour protein intake (g) / 6.25

68
Q

What is the nitrogen out formula?

A

24-hour UUN + 4 g

69
Q

What is the recommended daily caloric intake of non-stressed or non-depleted patients?

A

20 to 25 kcal/kg/day

70
Q

What is the recommended daily caloric intake of trauma/stress/surgery, critically ill, or major burn patients?

A

25 to 30 kcal/kg/day

71
Q

What is the recommended daily caloric intake of obese patients with a BMI of 30 to 50?

A

11 to 14 kcal/kg/day

72
Q

What body weight should be used to estimate caloric intake of obese patients with a BMI of 30 to 50?

A

ABW

73
Q

What is the recommended daily caloric intake of obese patients with a BMI >50?

A

22 to 25 kcal/kg/day

74
Q

What body weight should be used to estimate caloric intake of obese patients with a BMI of >50?

A

IBW

75
Q

What is the formula for total energy expenditure (TEE)?

A

resting energy expenditure (REE) x 1.2

76
Q

What is the goal for the respiratory quotient (RQ)?

A

0.85 to 0.95

77
Q

What does an RQ >0.95 indicate?

A

overfeeding

78
Q

What does an RQ <0.85 indicate?

A

underfeeding

79
Q

What does an overfed patient need more of?

A

carbohydrates

80
Q

What does an underfed patient need more of?

A

proteins

81
Q

What is the recommended daily protein intake for maintenance?

A

0.8 to 1 gm/kg/day

82
Q

What is the recommended daily protein intake for floor patients?

A

1 to 1.5 gm/kg/day

83
Q

What is the recommended daily protein intake for ICU, trauma, surgery, or burn patients?

A

1.5 to 2 gm/kg/day

84
Q

What is the recommended daily protein intake for obese patients with a BMI >30?

A

2 gm/kg/day

85
Q

What is the recommended daily protein intake for obese patients with a BMI ≥40?

A

2.5 gm/kg/day

86
Q

What body weight should be used for obese patients when calculating daily protein intake?

A

IBW

87
Q

What is the standard non-protein calorie distribution of dextrose to fat?

A

70/30

88
Q

When can a non-protein calorie distribution of 100/0 be used?

A

-sepsis
-bloodstream infections

89
Q

What are the indications for parenteral nutrition?

A

-anticipated NPO >7 days
-small bowel or colonic ileus
-extensive small bowel resection
-malabsorptive states
-intractable vomiting/diarrhea
-enterocutaneous fistulas
-IBD
-hyperemesis gravidum

90
Q

What solutions are not tolerated via a peripheral vein for parenteral nutrition?

A

dextrose and amino acid solutions

91
Q

What should the total osmolarity of a solution be for peripheral parenteral nutrition?

A

<900 mOsm/L

92
Q

Where can central venous catheter (CVC) insertion sites be?

A

-subclavian (SC)
-internal jugular (IJ)
-femoral

93
Q

How many kilocalories is 1 gram of protein?

A

4 kcal

94
Q

How many kilocalories is 1 gram of dextrose?

A

3.4 kcal

95
Q

How many kilocalories is 1 gram of lipid?

A

10 kcal

96
Q

What two ingredients in intralipid 10% need to be checked for allergies?

A

-glycerin 2.25%
-egg yolk phospholipid 1.2%

97
Q

What does SMOFlipid consist of?

A

-soybean oil 30%
-medium-chain triglycerides 30%
-olive oil 25%
-fish oil 15%

98
Q

What is the maximum lipid intake for adults?

A

2.5 gm/kg/day

99
Q

How many kilocalories per milliliter does propofol contain?

A

1.1 kcal/mL

100
Q

At what CrCl can electrolytes not be administered in a standard parenteral formula?

A

<50

101
Q

How should parenteral nutrition be initiated?

A

start at ~25% of goal and achieve final rate within 24 hours

102
Q

How often should BG be checked when initiating parenteral nutrition?

A

Q4-6H and before each increase in rate of PN

103
Q

What should you do if the BG >200?

A

continue PN at same rate for 4 hours and recheck BG

104
Q

What should you do if the BG >200 after rechecking?

A

initiate insulin therapy

105
Q

How should parenteral nutrition be discontinued?

A

decrease rate by 50% Q2H until rate <50 mL/hr, then D/C

106
Q

What medication can be added to parenteral nutrition?

A

famotidine

107
Q

What type of insulin can be added to parenteral nutrition?

A

regular insulin

108
Q

What is the common dosing regimen for regular insulin added to parenteral nutrition?

A

0.1 units/gm of dextrose

109
Q

What is the common dosing regimen for regular insulin added to parenteral nutrition if BG >150 mg/dL?

A

0.15 units/gm of dextrose

110
Q

What is the common dosing regimen for regular insulin added to parenteral nutrition if BG >300 mg/dL?

A

do not initiate until BG <200 mg/dL

111
Q

What is the maximum amount of regular insulin that can be added to parenteral nutrition?

A

0.3 units/gm of dextrose

112
Q

What is the recommended daily volume of maintenance IV fluids?

A

30 to 40 mL/kg/day

113
Q

How many mEq/L are in NS?

A

154 mEq/L

114
Q

How much potassium should a patient be started on?

A

0.5 to 1 mEq/kg

115
Q

How much calcium should a patient be started on if serum calcium is normal?

A

10 mEq/day

116
Q

How much magnesium should a patient be started on if serum magnesium is normal?

A

8 mEq/day

117
Q

How much phosphorus should a patient be started on?

A

0.3 mMol/kg

118
Q

How many mEq is 1 mMol of phosphorus?

A

1.4 mEq

119
Q

What are the positive ions?

A

-sodium
-potassium

120
Q

What are the negative ions?

A

-chloride
-acetate
-phosphorus

121
Q

How do you calculate how much chloride AND acetate should be given to a patient?

A

sodium (mEq) + potassium (mEq) - phosphorus (mEq)

122
Q

What is the ratio of chloride to acetate?

A

2:1

123
Q

How many mL of multivitamin should be added to a patient’s parenteral nutrition?

A

10 mL

124
Q

How many mL of multi-trace elements should be added to a patient’s parenteral nutrition?

A

1 mL

125
Q

What are the mechanical complications of parenteral nutrition?

A

-clotting of line
-displacement

126
Q

What are the infectious complications of parenteral nutrition?

A

-catheter-related sepsis
-solution contamination
-bacterial translocation

127
Q

What are the metabolic complications of parenteral nutrition?

A

-electrolyte imbalances
-fluid imbalance
-hyper- and hypoglycemia
-liver function abnormalities

128
Q

What are the baseline monitoring parameters for parenteral nutrition?

A

-CMP (magnesium, phosphorus, calcium)
-hepatic function panel
-prealbumin/CRP
-PT/INR

129
Q

What are the daily monitoring parameters for parenteral nutrition?

A

-vital signs
-intake/output (stools)
-CMP (electrolytes, glucose, BUN/SCr)
-feeding tube placement and patency

130
Q

What are the twice weekly monitoring parameters for parenteral nutrition?

A

-weight
-CBC (magnesium, phosphorus, calcium)
-prealbumin/CRP

131
Q

What are the weekly monitoring parameters for parenteral nutrition?

A

-albumin, transferring, nitrogen balance
-LFTs
-TGs
-PT/INR
-RQ

132
Q

What are the key clinical findings of refeeding syndrome?

A

-hypophosphatemia
-hypomagnesemia
-hypokalemia

133
Q

What should the carbohydrates amount be limited to on day 1 of initiating parenteral nutrition for a patient with refeeding syndrome?

A

100 to 150 gm

134
Q

What should the fluids amount be limited to on day 1 of initiating parenteral nutrition for a patient with refeeding syndrome?

A

800 mL/day

135
Q

What should the caloric intake be limited to on day 1 of initiating parenteral nutrition for a patient with refeeding syndrome?

A

50% of total caloric needs

136
Q

What complication of parenteral nutrition can be prevented?

A

essential fatty acid deficiency

137
Q

What are contraindications for enteral nutrition?

A

-mechanical obstruction
-non-mechanical obstruction (ileus)
-intractable vomiting
-severe malabsorption
-severe GI hemmorrhage
-fistulas

138
Q

What are GI complications of enteral nutrition?

A

-high gastric residuals
-aspiration
-nausea/vomiting or decreased motility
-abdominal distention
-diarrhea
-constipation

139
Q

What are metabolic complications of enteral nutrition?

A

-hyper- or hypoglycemia
-overhydration/dehydration
-electrolyte imbalances

140
Q

What are mechanical complications of enteral nutrition?

A

-clogging of feeding tube
-tube malposition
-rhinitis
-sinusitis

141
Q

What are medication-related complications of enteral nutrition?

A

-clogged feeding tubes
-drug-tube feed interactions

142
Q

What dosage form of medication is preferred for enteral feeding tubes?

A

liquid

143
Q

How can oral dosage forms be used for enteral feeding tubes?

A

crush tablet to fine powder (or empty capsule contents) and mix in water

144
Q

What medications should not be crushed for enteral feeding tubes?

A

SR or EC formulations

144
Q

Should medications be administered separately or together for enteral feeding tubes?

A

separately

145
Q

What should be done between administration of each medication through enteral feeding tubes?

A

flush feeding tube with water

146
Q

How much water should hypertonic medications or those irritating to the gastric mucosa be diluted in before administration through enteral feeding tubes?

A

≥30 mL

PHRM864 (6 decks)

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