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CNSC Exam > Disease Specific Nutrition Overview > Flashcards

Disease Specific Nutrition Overview Flashcards

1
Q

what is the inpatient glycemic target for critically ill patients

A

140-180 mg/dL

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2
Q

Under conditions of sepsis and stress, glucose production will ____ and glucose uptake will ____

A

increased blood glucose production & decreased glucose uptake

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3
Q

during sepsis and stress hormones induce ____ resistance and ____

A

insulin resistance

hyperglycemia

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4
Q

what immunomodulating nutrients may be harmful in patients with sepsis/septic shock

A

arginine

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5
Q

Arginine is considered beneficial for immune function because

A

it increases tissue oxygenation

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6
Q

what is a benefit of enteral glutamine supplementation in the critically ill patient with multi organ failure

A

decreases nosocomial infections

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7
Q

what are the counter regulatory hormones responsible for hypercatabolism in critically ill trauma patients?

A

Glucagon
Epinephrine
Cortisol

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8
Q

Glucagon, epinephrine and cortisol are hormones released during _____ and lead to these four metabolic processes

A 
traumatic injury
glycogenolysis
gluconeogenesis
proteolysis
free fatty acid release
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9
Q

What is the goal of releasing hormones such as epinephrine, cortisol, and glucagon during trauma

A

maintain survival and homeostasis and promote recovery

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10
Q

In a trauma patient, after timely resuscitation, restoration of perfusion, oxygenation and hemodynamic stability, what is the next important component of supportive therapy

A

early initiation of nutrition

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11
Q

In patients with burns, providing caloric support above energy expenditure has been found to have ____ effect on preservation of lean body mass

A

have no effect

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12
Q

although patients with burns have increased caloric needs, feeding in excess is still not recommended because it may cause

A

hyperglycemia, hepatic steatosis, or prolonged ventilatory dependence

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13
Q

In pulmonary insufficiency, excessive calorie administration may cause increased blood pCO2 resulting in

A

respiratory acidosis

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14
Q

respiratory acidosis results from disorders producing alterations in ventilatory control due to the increased production of

A

CO2 and respiratory muscle weakness

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15
Q

Essential fatty acid deficiency in patients with cystic fibrosis is rare after _____ because EFA profiles have been shown to improve after it

A

lung transplantation

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16
Q

In cystic fibrosis, disruption of the exocrine function of the pancreas contributes to malabsorption of

A

fat, protein and fat soluble vitamins

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17
Q

EFAD status is usually evaluated by measuring

A

triene: tetraene ratio

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18
Q

clinical trials have ____ results in using omega 3 fatty acids in routine supplementation in the management of CF

A

mixed

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19
Q

what is the best choice for feeding a pancreatic insufficient infant with CF and why

A

Human Milk with enzymes because it has good immunologic properties, growth factors, pre and probiotics

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20
Q

Protein hydrolysate or free amino acid formulas with MCT are not indicated in infants with CF unless

A

there is another medical reason such as bowel resection leading to malabsorption or liver abnormalities

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21
Q

What is the glomerular filtration rate (GFR) for a patient with ESRD?

A

<15mL/min/1.73m2

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22
Q

a GFR indicating stage 1 kidney damage equates to

A

> 90mL/min/1.73m2

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23
Q

what is a GFR of Stage 2 Kidney damange

A

60-89mL/min/1.73m2

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24
Q

what is a GFR of Stage 3 Kidney Damage

A

30-59 mL/min/1.73m2

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25
Q

what is a GFR of Stage 4 kidney disease

A

15-29mL/min/1.73m2

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26
Q

Increased mortality in maintenance of HD patients has been associated with

A

low baseline body fat percentage and low muscle mass

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27
Q

low muscle mass reflects poor ____ status and ______

A

nutrition status

inflammation

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28
Q

low fat mass reflects low body stores of _____

A

energy

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29
Q

Elevated CRP levels in HD can cause

A

weight loss
decreased albumin
decreased appetite

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30
Q

which BMI is considered protective in HD patients

A

30-34.9

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31
Q

A BMI less than ____ and hypoalbuminemia are strong indicators of mortality in HD patients

A

< 23

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32
Q

What has been shown to delay weaning from mechanical ventilation in patients with chronic obstructive pulmonary disease who are receiving enteral nutrition

A

refeeding syndrome
underfeeding
overfeeding

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33
Q

Hypophosphatemia can delay weaning from mechanical ventilation because

A

hypophosphatemia exacerbates respiratory dysfunction, diaphragmatic weakness and decreased cellular energy production

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34
Q

_____ feeds are defined as feeding in an amount of substrate enough to provide gut stimulation and are typically at a rate of 10-20mL/hr of EN

A

trophic feeds

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35
Q

What is the maximum dietary protein intake in critically ill adult patients getting continuous renal replacement therapy (CRRT)

A

2.5 g/kg/day

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36
Q

high protein needs of 2.5g/kg/day in the critically ill adult on CRRT is due to

A

hyper-catabolism, obligatory use of protein as preferred fuel source during the stress response and the likelihood of significant protein losses in CRRT effluent

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37
Q

Typical protein losses in CRRT equate to

A

10-17%

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38
Q

what are some disadvantages of going over 2.5g/kg/day of protein in CRRT

A

uremia
increased hepatic and renal demand
increased costs

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39
Q

what are the protein requirements for a stable patient getting peritoneal dialysis

A

1.2-1.3 g/kg/day (when clinically stable)

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40
Q

what are some causes of protein energy malnutrition in liver disease

A 
malabsorption
decreased kcal intake
abnormal fuel metabolism
early satiety
fat malabsorption from altered bile acid circulation
increased protein and fat oxidation
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41
Q

Energy expenditure is ___ in patients with infections and ascites with liver disease

A

increased

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42
Q

Protein energy malnutrition is most common in which of the following types of liver disease

A

Cirrhosis

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43
Q

patients with viral disease such as hepatitis B and C are not susually

A

severely malnourished

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44
Q

Patients with chronic heart failure are typically on a loop diuretic. These patients are at risk for

A

azotemia

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45
Q

Loop diuretics cause electrolyte imbalances as a result of decreased urine output, so azotemia is caused by

A

volume depletion

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46
Q

hypoglycemia requiring dextrose infusions to maintain euglycemia, is most likely to occur in which type of liver disease

A

Fulminant Hepatic Failure from impaired glycogenolysis, gluconeogenesis, and hyperinsulinemia requiring aggressive glucose administration

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47
Q

which metabolic derangements are common in fulminant hepatic failure

A

impaired glycogenolysis
hypoglycemia
impaired gluconeogenesis
hyperinsulinemia

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48
Q

patients with fulminant hepatic failure are in a ____ state with increased energy ____ and can rapidly become ____

A

hypercatabolic
expenditure
malnourished

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49
Q

In cirrhotic patients, which of the following should be implemented to assist in avoiding fasting association starvation during the night

A

late evening snack

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50
Q

Cirrhotic patients have ____ glycogen stores and utilize more ____ as fuel during periods of prolonged starvation (usually seen in an overnight fast of 12-18 hours)

A

depleted glycogen stores

fat as fuel

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51
Q

what is an important indicator of protein energy malnutrition in chronic liver disease

A

muscle wasting & subcutaneous fat

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52
Q

in patients with chronic liver disease, using triceps skin fold and mid arm circumference can possibly be skewed by

A

fluid retention

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53
Q

Treatment for patients with overt hepatic encephalopathy who have impairments in cognitive and neuromuscular function include

A

supplementing zinc, thiamine, b6 and b12, use lactulose, provide a meal pattern of 3 meals and 3 snacks

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54
Q

______ is no longer restricted in patients with advanced liver disease

A

protein restriction

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55
Q

what micronutrients are common deficiencies in chronic liver disease due to poor intake and decreased absorption

A 
thiamine
vitamin B6
B12
Folate
zinc
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56
Q

which types of cancer have the highest prevalence & severity of weight loss

A

pancreatic and gastric cancer

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57
Q

what types of cancer have the lowest prevalence of weight loss

A

sarcomas, breast cancer, hematological cancers

58
Q

that is the benefit of megesterol acetate in patients with cancer associated cachexia?

A

improves appetite and ameliorates weight loss

59
Q

______ is a synthetic progestational agent that promotes weight gain and helps to stimulate the appetite

A

megace

60
Q

In the first 1-3 months after a bone marrow transplant the nutritional needs of a patient are best met with

A

30-35 kcal/kg body weight

>/= 1.5 g protein/kg body wt

61
Q

Which nutrient should NOT be supplemented routinely in the early stages following hematopoietic stem cell transplantation (HSCT)

A

Iron

62
Q

in Hematopoietic Stem Cell Transplantation, blood products and transfusions are required before, after, and during HSCT and can cause an overabundance of which nutrient

A

iron

63
Q

Iron overload in HSCT patients can increase the chance of

A

acute graft vs host disease
blood/fungal infection
sinusoidal obstruction of liver

64
Q

What acute changes in serum chemistry profile would be expected in a patient who is experiencing tumor lysis syndrome?

A

hyperkalemia

hyperphosphatemia

65
Q

_____ is caused by massive tumor cell lysis with the release of large amounts of potassium, phosphate and nucleic acids into systemic circulation

A

Tumor Lysis Syndrome

66
Q

Tumor Lysis Syndrome is common after

A

initiation of cytotoxic therapy

67
Q

What is the best treatment of diarrhea in inflammatory bowel disease

A

Start anti-diarrheal agents once infectious etiology is ruled out

68
Q

Anti-diarrheal medication should not be given to patients with IBD until what has been ruled out. Why?

A

infectious diarrhea such as CDiff. If to they can develop toxic megacolon

69
Q

In patients with extensive bowel resection ______ can be given in conjunction with anti diarrhea medications

A

Cholestyramine to help with bile salt malabsorption

70
Q

how much stool output is concerning for possible electrolyte deficiencies and volume depletion

A

> 500mL for 2 consecutive days

71
Q

there are currently no evidenced based recommendations for using ___ or ____ as standard therapy with diarrhea

A

prebiotics & probiotics

72
Q

A patient with Chron’s Disease that involves the distal ileum should be closely monitored for malabsorption of which micronutrient

A

vitamin B12

73
Q

what is a major contributing factor in the development of metabolic bone disease in patients with IBD?

A

corticosteroid use

74
Q

complications of metabolic bone disease is associated with IBD are

A

osteopenia and osteoporosis

75
Q

when patients are on long term steroids, what should be supplemented to reduce osteopenia

A

calcium & vitamin D

76
Q

what is commonly found in patients with IBD?

A 
malnutrition
vitamin D deficiency
corticosteroid therapy
magnesium deficiency
chronic inflammation
77
Q

____, ____ and _____ may be associated with PN associated MBD

A

aluminum toxicity, hypercalciuria, magnesium deficiency

78
Q

In patients with severe acute pancreatitis, the use of enteral nutrition via naso-jejunal feeding tube rather than PN is associated with

A

a lower risk of developing infectious complications, maintained equal nitrogen balance and reduced incidence of hyperglycemia than those with PN

79
Q

when is PN recommended in severe acute pancreatitis

A

when EN is not available, tolerated or patient is not meeting nutritional requirements via EN alone

80
Q

A patient with chronic heart failure on high dose furosemide is started on EN for an inability to consume adequate oral nutrition. Despite a slow advancement to goal feeding rate, he suffers from electrolyte imbalance and peripheral neuritis. Deficiency of which vitamin should be suspected in the cause of his symptoms

A

Thiamine

81
Q

which two medications are known for decreasing thiamine by uptake of cardiac cells in heart failure patients

A

furosemide and digoxin

82
Q

Thiamine deficiency is a form of _____ which is characterized by an enlarged heart, electrolyte alterations, vasodilation and peripheral neuritis

A

Wet BeriBeri

83
Q

gastric hypersecretions following significant small bowel resection can become problematic. Which of the following medications have shown to be the most successful in suppressing gastric hypersecretion

A

Proton Pump Inbitors

84
Q

What metabolic complication may occur in patients with short bowel syndrome and small bowel intestinal bacterial overgrowth

A

metabolic acidosis

85
Q

intestinal resection involving removal of the terminal ileum and or the ileocecal valve with the colon in continuity predisposes patients to

A

small intestinal bacterial overgrowth

86
Q

in rare instances patients with short bowel syndrome can develop ____and encephalopathy. D lactate producing bacteria thrive in an acidic environment which is common in SBS as a result of metabolism of unabsorbed carbs leading to the production of lactate and decreases the pH

A

metabolic acidosis

87
Q

patients with short bowel syndrome would benefit most from octreotide injections in the presence of

A

refractory diarrhea not controlled with diet and medication

88
Q

what medication reduces the production of a variety of GI secretions and slows jejunal transit

A

octreotide

89
Q

why should Octreotide by reserved only for patients with large volume stool loss whose fluid & electrolyte management is problematic

A

increases the risk for cholelithiasis
expensive
can inhibit bowel adaptation
has not been shown to improve absorption or eliminate the need for PN

90
Q

what diet should be recommended to patients with short bowel syndrome (ileal resection) and colon in continuity

A

high complex carbohydrates 50-60% of total calories, low fat (20-30%) to increase energy absorption, optimize SCFA production & reduce instance of steatorrhea

91
Q

a high complex carb diet low in fat helps reduce

A

magnesium & calcium losses, decreases oxalate absorption

92
Q

oxalates bind to ____ and are excreted in the stool

A

calcium

93
Q

patients with SBS who have a colon in continuity should restrict dietary oxalate intake & consume high calcium food or calcium citrate supplements to avoid

A

oxalate nephrolithiasis

94
Q

A patient with SBS (regardless of bowel anatomy) complex carbs are important in the diet becuase

A

they reduce the osmotic load & may help with intestinal adaptation

95
Q

Why are complex carbs recommended in SBS verses simple sugars

A

they take longer to break down than simple sugars which improves tolerance

96
Q

why should concentrated sugars be avoided in short bowel syndrome

A

they can generate a high osmotic load and increase or promote stool output

97
Q

calcium oxalate nephrolithiasis can occur in patients with short bowel syndrome with an intact colon who

A

don’t maintain adequate hydration

98
Q

patients with short bowel syndrome are at a high risk for oxalate stones because

A

there is increased availability of oxalate absorption in the colon as patients with SBS usually have steatorrhea

99
Q

normally, oxalates bind to ____ and are excreted through the stool

A

calcium & magnesium

100
Q

in patients with SBS and steatorrhea, why are oxalates absorbed at an increased rate?

A

calcium binds to fatty acids, allowing excess and unbound oxalate to be absorbed from the colon & be filtered through the kidneys leading to stone formation also exacerbated by dehydration

101
Q

to avoid calcium oxalate nephrolithiasis, maintaining hydration with a goal urine output of _____ is important, with oral calcium supplements between ___ and ___ mg/day not exceeding ___ mg a a time is recommended

A

> 1200mL a day

800-1200mg/calcium a day at does of no more than 500mg at one time

102
Q

low dietary fat intake of 20-30% of total kcals is important in SBS in order to

A

minimize steatorrhea
minimize oxalate absorption
minimize loss of calcium & magnesium

103
Q

SBS patients with less than ____ cm of terminal ileum resected are at lower risk of bile salt malabsorption & steatorrhea

A

100

104
Q

what types of fistulas will result in the greatest degree of nutritional loss

A

proximal high output

105
Q

the higher a fistula occurs in the GI tract, the ____ the output and risk of metabolic derangements

A

higher (more proximal)

106
Q

patients with proximal high output fistulas in their GI tract will reuqire

A

increased protein/calorie needs

close monitoring of fluids & electrolytes

107
Q

patients with low output fistulas less than ____mL/day of stool loss will decrease the possibility of enteral nutrition

A

500mL/day

108
Q

to minimize fistula output in distal ileal or colonic fistulas, what type of enteral nutrition formula should be used as high up as possible to increase surface area for absorption

A

fiber free or low fiber

109
Q

A 24 year old, 10 week pregnant woman presents with persistent nausea & vomiting for the past 6 weeks associated with a 10% wt loss. Her symptoms were refractory to a 48 hour trials of anti-emetics & IVF. Given mother’s nutritional status, decision was made to initiate nutrition support. What vitamin should be supplemented in this patient before providing nutrition support

A

thiamine

110
Q

A 24 year old, 10 week pregnant woman presents with persistent nausea & vomiting for the past 6 weeks associated with a 10% wt loss. Her symptoms were refractory to a 48 hour trials of anti-emetics & IVF. Given mother’s nutritional status, decision was made to initiate nutrition support to minimize further deterioration of the mother’s nutritional status & possible negative side effects on the fetus. What is the most appropriate initial nutrition therapy to implement

A

EN with polymeric formula via NG tube

111
Q

severe, intractable nausea and vomiting complicated by dehydration, electrolyte imbalance, nutrition deficiencies and weight loss in pregnant women is called

A

hyperemesis gravidarum

112
Q

because constipation is often a problem in pregnancy, what type of formula should be considered in EN

A

fiber

113
Q

A 14 year old with a 4 month history of intentional weight loss of 15% of her usual weight & a BMI < the 5th percentile is diagnosed with anorexia nervosa. She is admitted to the hospital for medical stabilization and is unwilling to consume enough food to meet her nutritional needs. A 24 hour calorie count reveals that the patient is consuming a very restricted diet averaging 850 calories a day. Which is the most appropriate nutrition intervention at this time

A

structured meal plan with supplemental enteral feedings

114
Q

what is the preferred modality for nutrition rehabilitation

A

oral refeeding

115
Q

a critically ill hyperglycemic patient receiving continuous enteral nutrition with a history of insulin dependent diabetes should ideally be placed on

A

continuous IV infusion

116
Q

in the critical care setting, _______ has been shown to be the best method for achieving glycemic targets and allows for off cycles during the 24 hr period when EN is held or discontinued

A

continuous IV insulin infusion

117
Q

Human Immunodeficiency Virus (HIV) associated lipodystrophy syndrome is most commonly associated with which class agent to treat HIV infection

A

nucleoside reverse transcriptase inhibitors (NRTI’s)

118
Q

_____ is manifested by subcutaneous adipose tissue loss with visceral adipose tissue sparing or accumulation

A

HIV associated lipodystrophy syndrome

119
Q

where is subcutaneous tissue loss often seen in HIV

A

face, buttocks, lower extremities

120
Q

Patients with lipodystrophy are at increased risk of being

A

insulin resistant

121
Q

what is the most appropriate feeding strategy for a morbidly obese trauma patient

A

hypocaloric high protein

122
Q

zinc supplementation should be considered for patients with

A

unexplained skin rashes & alopecia

123
Q

Zinc is an essential trace element for ____ and ___

A

cell replication & growth

124
Q

Zinc is a cofactor for ____ & ____ synthesis and proliferation of inflammatory cells/epithelial cells

A

collagen & protein synthesis

125
Q

zinc deficiencies usually occur from

A

GI surgery
diseases that impair intestinal absorption
diseases that increase zinc loss es
Celiac, CF, IBD, Chron’s

126
Q

Chronic diarrhea &exudate from large wounds cause ___ deficiency

A

zinc

127
Q

why are zinc levels not always reflective of zinc status?

A

the presence of inflammation and are dependent on albumin for transport, so interpret cautiously in presence of hypoalbuminemia & inflammation

128
Q

what are the symptoms of zinc deficiency

A

rash, alopecia, impaired night vision, alterations in taste & smell, impaired immune function, anorexia, and diarrhea

129
Q

Nutrition support for solid-organ transplant patients receiving cyclosporine may need to be modified due to the presence of

A

hyperkalemia

130
Q

Cyclosporines, medications used after solid organ transplantation for immune suppression can cause electrolyte imbalances including

A

hyperkalemia, hypomagnesemia
hyperglycemia
hypercholesterolemia as it effects the renin angiotensin aldosterone system altering potassium homeostasis as well as decreased renal excretion of potassium

131
Q

A patient with AKI who requires PN would most likely benefit from a solution containing

A

essential and non essential amino acids

132
Q

A 51 year old F who is 10 years post gastric bypass surgery presents w/ numbness & tingling in her distal lower extremities that had progressively worsened. She had been on an oral MVI supplement. She was significantly anemic & neutropenic. Her vit B12 level was normal as were her serum iron, ferritin and transferrin levels. What nutritional deficiency is the most likely cause of all of these symptoms

A

Copper deficiency

133
Q

Vitamin B12 deficiency in gastric bypass can cause

A

anemia & peripheral neuropathy (numbness & tingling in lower extremities)

134
Q

Iron & Folate deficiencies cause ____ in gastric bypass patients

A

anemia

135
Q

Thiamin deficiency can cause peripheral neuropathy but not _____ in gastric bypass patients

A

not anemia

136
Q

what are the symptoms of copper deficiency

A

anemia
leukopenia
neutropenia
peripheral neuropathy

137
Q

ERAS (Enhanced Recovery After Surgery) is a care program that has been shown to improve outcome after major surgery. The key mechanisms behind the ERAS effectiveness is

A

decrease the stress of surgery and support recovery

138
Q

what are the objectives of ERAS

A

avoid starvation before surgery

limit post op IVF

optimize GI function & mobilization

139
Q

What is done as part of ERAS protocol

A

avoid preop fasting by providing CHO nutrition/fluid and withholding routine bowel prep

140
Q

ERAS was originally designed for which types of surgeries

A

colon resection

CNSC Exam (32 decks)

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