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CNSC > Disease States > Flashcards

Disease States Flashcards

1
Q

Valproic acid

A

Depletes hepatic carnitine stores

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2
Q

Treat gastric phytobezoar

A

Coke, cellulase, removal

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3
Q

RQ

A

CO2/O2
1 = CHO
0.8 mixed
0.7 fat

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4
Q

NUTRIC aspects

A

ICU patients who could benefit nutrition therapy

Age, APACHE II, SOFA (organ failure assessment), # comorbidities, days from hospital to ICU admit, IL-6

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5
Q

Excess tension external/internal bolster leads to

A

Erosion/bleeding and ulceration of gastric mucosa

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6
Q

Glucolipotoxicity

A

High glucose and FA has negative effect on pancreatic beta cells

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7
Q

Chronic Intestine Pseudo Obstruction MNT

A

Motility disorder of peristalsis

Small frequent meals with low fat/fiber and increase liquids

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8
Q

Octreotide used for

A

Diarrhea, severe dumping syndrome

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9
Q

Contraindications using IC

A 
Air leak 
ECMO
HD (during and hours after)
Supp O2
FIO2 >60%
Inability cooperate
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10
Q

Glycolysis (type, location, product)

A

Anaerobic
Cystoplasm
Pyruvate

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11
Q

Kcals released per mole ATP

A

7 kcal

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12
Q

Pyruvate -> Anaerobic and Aerobic conditions

A

Aerobic: TCA for max energy production
Anaerobic: Lactate (less)

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13
Q

Where is TCA cycle

A

Mitochondrial membrane

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14
Q

1 glucose produces how many ATP

A

36

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15
Q

After 24 hours starvation, glucagon promotes

A

FA oxidation

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16
Q

After 14 days of starvation, adipose provides

A

90% of EER

High FA oxidation -> ketogenesis

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17
Q

Fiber DRi

A

14 g/1000 kcal

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18
Q

Beta oxidation yields

A

1/2 amount of acetyl co-a as # of carbon

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19
Q

Acceptable TAG 4 hours after ILE piggyback infusion

A

<250 mL

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20
Q

EFAD indicator

A

Triene:tetraene ratio >0.2

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21
Q

Conditionally essential AA

A

Tyrosine, taurine, glutamine, histidine, cysteine

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22
Q

Alter reliable N balance

A

BUN fluctuates >10/day
Cr clearance <50 mL/min
Low UO
Muscle atrophy

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23
Q

Only AA that undergoes oxidation via acetyl Co A in muscle

A

Leucine

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24
Q

Structure/function claim

A

Describes roles intended maintain structure or function

Doesn’t require FDA

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25
Q

Health Claim

A

Effect on decreasing risk of disease

Requires FDA

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26
Q

Phenytoin interacts with

A

Folic acid

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27
Q

Treat dehydration at home

A

1L x3 days

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28
Q

Relative risk ratio tends to

A

Overestimate treatment effect

Likelihood of outcome effect in study group compared to control - if 1.00 outcome is equal

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29
Q

Large RCT may flaw in

A

Generalizing to patient care (external validity)

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30
Q

Folate pregnancy

A

60 mcg

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31
Q

NG in pregnancy increased risk for

A

Reflux/delated gastric emptying

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32
Q

N balance pregnancy

A

4-6

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33
Q

Important vitamin/mineral in wounds

A

A, D, E, K, C, Zinc, Iron, Ca

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34
Q

Decrease energy expenditure (3)

A

Barbituates, Propranolol, Rocuronium

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35
Q

Needs in TBI if no IC

A

140% harris benedict

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36
Q

Mannitol causes

A

Low K, Mag and volemia

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37
Q

SCI protein immediately following

A

1.5-2.0

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38
Q

Quadriplegia/Paraplegia kcal needs

A

Quad: 20-22
Para: 22-24

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39
Q

Normal BMI for SCI

A

18-22

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40
Q

Stroke protein

A

1.0-1.5

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41
Q

ALS/Lou Gehrigs

A

Hypermetabolic: 34-35 kcal, 0.8-1.2

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42
Q

Carbidopa/Levodopa competes with ___ for transport

A

Protein

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43
Q

Protein for sepsis and stressed trauma

A

1.5-2.0

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44
Q

NRS 2002

A

BMI <20.5
Weight loss
Reduced intake weight
ICU pt

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45
Q

Burn protein

A

1.5-2.0 stressed

20% obese

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46
Q

Fluid burns >15% TBSA

A

4 mL of LR/kg x TBSA

1/2 in 1st 8 hours
Rest in rest 16 hours

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47
Q

Burns >20% TBSA: vitamins/minerals

A

Vitamin A, Zinc, VIt C, Copper, selenium

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48
Q

ASPEN recommends formula with omega 3 and arginine for

A

post op trauma and ICU

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49
Q

Prevent risk vent associated pneumonia

A

Elevate HOB 45 degree
Oral care with chlorohexidine
Limit broad spectrum abx
Suction

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50
Q

Meds delay gastric empty

A

Aluminum antacids, anticholinergics, lithium, octreotide, zofran, sucralfate, antidepress/SSRI

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51
Q

Crohns MNT (3)

A

1.0-1.5
Increase Ca/Vit D
Zinc if diarrhea

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52
Q

CF Ideal weight

A

Children >50% weight for length
Men: 23 BMI
Women: 22 BMI

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53
Q

CF MNT

A

35-40% fat

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54
Q

Protein losing gastroenteropathy MNT

A

Low fat diet

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55
Q

Food protein enterocolitis syndrome (FPIES)

A

Children wean from BM/formula - allergy, eventually grow out

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56
Q

Hereditary Hemochromatosis MNT

A

Limited iron alcohol and vitamin C intake

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57
Q

Wilsons disease symptoms and MNT

A

Resting tremor, ataxia, dystonia, rigidity

Chelation Therapy (oral penicillamine and zinc salts)
Avoid high copper food (fish, nuts, chocolate, mushrooms)
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58
Q

Fat malabsorption usually associated with decreased ___ absorption which increased ___

A

Calcium

Oxalates

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59
Q

Octroetide can cAuse

A

Hyperglycemia

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60
Q

Ascites: Mild to Severe

A

Mild 3-5 kg
Moderate: 7-9 kg
Severe: 14-15 kg

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61
Q

Cirrhosis MNT

A

REE x1.2-1.4, 30-40% fat

Pro 1.0-1.5

62
Q

Vitamins/Minerals in alcoholics

A

1, 2, 6, 12, folate, zinc, mag, C

63
Q

Esophageal varices and TF

A

OK to use soft/fine bore tube if not bleeding

64
Q

If Alk Phos, AST, ALT are high in pancreatitis, like ____ cause

A

Biliary

S/p high fat meal

65
Q

APACHE II in Pancreatitis

A

most predictive of severity/clinical outcomes
< or equal 9: mild/mod
> or equal 10: severe

66
Q

Acute pancreatitis is more ____ than chronic

A

Hypermetabolic/catabolic

67
Q

Gastric outlet syndrome

A

Obstruction interferes with gastric emptying

N/V, pain, early satiety

68
Q

Pancreatitis protein

A

1.5 g pro

69
Q

If have ____ () in pancreatitis, lower risk for high TAGs

A

Lipids <1 g/kg/d and glucose control

70
Q

Steatorrhea dx

A

> 7 g fat after eating 100 g

71
Q

Pseudocyst: What is and what it can cause

A

Lesion looks like cyst but fluid on tissue

SBO or GOO

72
Q

Do not put ____ in J tube d/t risk for clogging

A

Pancreatic enzymes

73
Q

GFR Stage 4 and 5

A

<29

<15

74
Q

CKD Non HD MNT

A

30-35 kcal

0.6-0.8 g pro, 1.0 in illess

75
Q

CRRT needs

A

30-35

1.0-2.5

76
Q

Potassium recommendation if high in HD

A

40 mg/kg/d

77
Q

PD can provide ____ kcal

A

500-1000 kcal

~40% uptake

78
Q

Dont restrict na or water in nonoliguric AKI unless

A

Hypernatremia or fluid overload

79
Q

Oral citrate can ___ aluminum absorption

A

Increase

80
Q

Measure iron status

A

Iron, TBC, Ferritin, Iron saturation

81
Q

SI length

A

400-800 cm

Absorb 6-8 L /day

82
Q

Ileum absorbs __ (2)

A

Bile and hormones

Bile in colon -> watery diarrhea
Hormones -> dumping

83
Q

Supplement ___ if at least 50 cm of ileum is resected

A

b12

84
Q

Low K, Mag and Ca common in

A

SBS

85
Q

Urine Na Goal SBS

A

> 20

86
Q

SBS, GB, and PNand Dual X ray

A

2-3 years sbs

1-3 others

87
Q

SBS MNT

A 
35-45 kcal, 1.5-2.0 pro
10-15 g fiber
Small, frequent meals
Isotonic ORS separate from meals - limit water
Limit simple sugars
Liberal salt

W/ Colon: 20-30% fat
W/o colon: 40-60% fat

88
Q

EN in SBS formula type

A

Isotonic polymeric

May need semi elemental

89
Q

Oley Foundation

A

Home NS patients

90
Q

Wean PN in SBS need at least ___ cm

A

Jejunostomy: 100 cm
Colon: 30 cm

91
Q

Most medications absorb in

A

Jejunum

92
Q

Loperamide

A

Anti diarrheal

93
Q

Avoid cholestyramine in

A

SBS

94
Q

Lack of ileocecal valve increases risk for

A

SIBO

95
Q

Tegludatide used for

A

Improves gastric emptying and decreases GI secretions

96
Q

Cyclosporine and tacrolimus cause ___ and increase risk for ___

A

Hyperglycemia, hyperkalemia, and hypomagnesemia

new onset diabetes after transplant

97
Q

S/p organ and bone marrow transplant protein

A
  1. 5-2.0 acute

1. 0 chronic

98
Q

Abx decrease

A

E, K, Folate

99
Q

PN usually after ___ transplant

A

SI

100
Q

HIV metabolic changes

A

Increased REE
Inappropriate substrate use
Futile cycling lipids
Increased lipogenesis

101
Q

Food Insecurity assessment

A

USDA questionnaire

Radimer Cornell

102
Q

Waist circumference and waist to hip ratio to differentiate between

A

Wasting and lipodystrophy

MUAC and NHANES as reference

103
Q

Ca, Mag, and Aluminum decrease absorption of what meds

A

Azithromycin and Levafloxin

104
Q

Thiazide diuretics increase

A

Calcium excretion -> Increased calcium levels

105
Q

EN in cancer for

A

Active treatment and malnourished who unable ingest/absorb for >7-14 days

106
Q

Mineral deficiency risk when bypass duodenum and proximal jejunum (5)

A

Iron, Ca, Zn, Cu, Se

107
Q

S/p hematopoietic stem cell transplant MNT

A 
No iron
Low microbial diet
30-35 if malnourished
1.5-2.0 protein
Maybe parenteral glutamine
108
Q

Tumor Lysis Syndrome labs (3)

A

Hyperkalemia
Hyperphosphatemia
Hyperuricemia

109
Q

Loop diuretics can cause

A

Azotemia, hypomag, hypokalemia

110
Q

Insulin sensitivity factor

A

1500 or 1800/sensitive factor = x mg/dL

Premeal glucose - goal = y

y/x = units needed

1500 for regular, 1800 for rapid

111
Q

Correct Na for hyperglycemia

A

Na + [0.016 x (glucose - 100)]

112
Q

Max dex rate for DM or critically ill

A

4 mg/kd/min

113
Q

Find desired g dextrose based on goal

A

goal (3-5) x wt x 1440 / 1000

114
Q

Vitamins/minerals s/p GB

A

MVI, D, Folate, Cal citrate, Iron, B12

115
Q

EN increase QOL and survival in

A

Head/neck cancer
CVA with dysphagia
Neuromuscular dystrophy
Growth failure children

116
Q

J tube typically placed by

A

Witzel technique

Greater freedom movement and prevent irritation

117
Q

S/p esophogastectomy may cause

A

Loss peristalsis
Smaller stomach, need softer food
Risk chylothorax

118
Q

Gastric surgery complication

A

Anastomotic stricture, Anastomotic ulcer, SBO

119
Q

Chylothorax and MNT

A

Chyle in pleural space

High protein, very low fat, MCT

120
Q

Ileostomy output shoudl be less then ___/24 hours

A

1L

121
Q

____ most common s/p gastric resection

A

Iron deficiency anemia

122
Q

Ebb phase

A

3-5 days

Decreased energy, hyperglycemia, decreased temp, decreased volume

123
Q

IC measures

A

REE and RQ
Gas exchange
Using Weir equation

124
Q

What factor other than overfeeding increases RQ

A

Excess buffer like bicarb

Hypoventilation decreases RQ

125
Q

Stress phase response to illness

A

First 24 hours

126
Q

FA greater than ___ carbona requires bile acids

A

10

127
Q

Urea accounts for about ___ of urine nitrogen loss

A

80%

128
Q

After 2 days of starvation brain uses ___ as fuel

A

Ketones

129
Q

Prolonged NG output decreased

A

K, Cl, Na

130
Q

Copper deficiency can cause ____ anemia

A

Microcytic hypochromic

131
Q

What type of malnutrition - hypoglycemia, ketosis, lipolysis?

A

Starvation

132
Q

What type of malnutrition - hyperglycemia, hypermetabolism, lipolysis?

A

Stress

133
Q

SGA good for what populations

A

GI surgery
Liver transplant
Dialysis

134
Q

Frailty

A 
Sarcopenia
Weight loss
Exhaustion
Weakness
Slow walking
Low PA
135
Q

Reverses effect levodopa

A

B6

136
Q

Decreases appetite in older adult

A

Narcotics
Histamine receptor antagonists (H2 blocker)
Antihypertensive

137
Q

Contributes to Digoxin toxicity (3)

A

Hypercalcemia, hypokalemia, hypomag

138
Q

SF 36 vs Katz ADL vs Lawton Brody vs FIM

A

Health related QOL

ADLs

Instrumental ADLs

Functional independence in rehab setting

139
Q

Marasmus and whose at risk

A

Loss fat and somatic muscle

Illness, starvation, elderly

140
Q

Kwashiorkor

A

Visceral muscle loss cause low albumin -> edema

141
Q

Hypothyroidism can cause

Hyperthyroidism can cause

A

Hypoglycemia

Hyperglycemia

142
Q

Low Mg can lead to

A

Na/water depletion

143
Q

Superior vena cava syndrome

A

compression of the SVC characterized by shortness of breath, dyspnea, cough, cyanosis of face, neck, shoulder and arms, and distended chest or neck veins.

144
Q

Mural thrombus

A

when fibrin builds up inside the vein and causes the vascular access device to adhere to the vessel wall

145
Q

Intraluminal thrombus

A

clot within the catheter lumen and caused by inadequate flushing and blood reflux

146
Q

Which type of diuretic induces hyponatremia?

A

Thiazides

147
Q

High Risk Compounding

A

involves using nonsterile ingredients or nonsterile devices prior to terminal sterilization (i.e. extemporaneously compounded L-glutamine for supplementation in a PN formulation).

148
Q

Define cracking of a TNA mixture/visual signs

A

yellow-brown oil droplets at or near the TNA surface.
a continuous layer of yellow-brown liquid at the surface of the TNA.
marbling or streaking of the oil throughout the TNA.

149
Q

Typical osmolality of formulas based on cal/mL

A

1.0 kcal/mL (300-350 mOsm/kg), 1.2 kcal/mL (400-450 mOsm/kg), 1.5 kcal/mL (500-650 mOsm/kg), 2 kcal/mL (700-800 mOsm/kg).

150
Q

PN requirements

A

Complete patient identifiers (patient name, medical record number or other unique identifiers, patient location)

Birth date and/or age

Allergies and associated reactions

Height and dosing weight in metric units

Diagnosis/diagnoses

Indication(s) for PN

Administration route/vascular access device (peripheral vs central)

Contact information for prescriber

Date and time order submitted

Administration date and time

Volume and infusion rate

Infusion schedule (continuous or cyclic)

Type of formulation (dextrose/amino acids with separate infusion of IVFE or total nutrient admixture)

Ingredients ordered as amounts per day (for adult patients) or amounts per kilogram per day (for pediatric and neonatal patients)

Electrolytes salt form rather than the individual ion.

generic name for each ingredient

151
Q

Zollinger Ellison

A

disorder in which too much gastric acid

CNSC (7 decks)

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