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PHRM 864 > E3 nutrition > Flashcards

E3 nutrition Flashcards

1
Q

IBW male

A

50 kg + (2.3 x inches over 60)

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2
Q

IBW female

A

45.5 kg + (2.3 x inches over 60)

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3
Q

DBW

A

IBW + 0.4 (weight-IBW)

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4
Q

when to use DBW

A

if actual body weight is 130% or more of IBW

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5
Q

NBW

A

IBW + 0.25 (weight-IBW)

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6
Q

when to use NBW

A

if actual body weight is 130% or more of IBW

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7
Q

what does NBW apply to?

A

fluids, electrolytes, and nutrition parameters

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8
Q

benefits of early initiation (4)

A

dec disease severity
dec complications
dec ICU stay
inc patient outcomes

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9
Q

in risk factors for malnutrition, what is considered UBW (under body weight)

A

20 % below IBW

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10
Q

risk factors for malnutrition:
involuntary weight loss of >__% within _ months

A

10
6

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11
Q

risk factors for malnutrition:
NPO > _ days

A

10, clinically we use inadequate intake > 7 days *

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12
Q

3 other risk factors for malnutrition with asterisks in the slides

A

gut malfunction
mechanical ventilation
inc metabolic needs (burn or trauma)

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13
Q

NUTRIC is what?

A

nutritional risk assessment

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14
Q

nutric high risk range

A

6-10

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15
Q

nutric low dose range

A

0-5

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16
Q

wtf is anthropometrics?

A

somatic (muscle) protein status
- weight
- triceps skin fold
- arm muscle circumference
- physical appearancee

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17
Q

what is transthyretin

A

prealbumin

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18
Q

normal serum conc of transthyretin

A

15-40

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19
Q

what is CRP

A

C-reactive protein.
Positive acute phase reactant used to assess accuracy of prealbumin

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20
Q

normal CRP

A

<1 mg/dL

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21
Q

T or F:
Prealbumin is falsely decreased in the presence of inflammation

A

True

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21
Q

Prealbumin decreases as CRP increases ->

A

inflammation

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22
Q

prealbumin decreases as CRP normal ->

A

malnutrition

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23
Q

marasmus

A

protein-calorie malnutrition

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24
Q

Marasmus:
- dec total intake and/or utilization of food
- wasting of skeletal muscle and _____
- ________ in severe cases
- cachectic appearance

A

SQ fat
immunosuppresion

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25
Q

Kwashiorkor

A

protein malnutrition

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26
Q

Kwashiorkor (protein malnutrition)
- _______ caloric intake; relative protein malnutrition
- catabolic ______ and _____ patients

A

adequate
trauma and burn

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27
Q

Protein/Calorie
A. Kwashiorkor
B. Marasmus

A

B

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28
Q

protein
A. Kwashiorkor
B. Marasmus

A

A

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29
Q

wasting of muscle
A. Kwashiorkor
B. Marasmus

A

B

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30
Q

provide carbs followed by high protein
A. Kwashiorkor
B. Marasmus

A

A

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31
Q

large belly, diarrhea, decreased muscle mass

A. Kwashiorkor
B. Marasmus

A

A

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32
Q

consider addition of vitamin B
A. Kwashiorkor
B. Marasmus

A

B

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33
Q

nitrogen balance:
measurement of _______ _______ of nitrogen as _____

A

urinary excretion
urea

(UNN = urinary urea nitrogen)

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34
Q

ideal goal of nitrogen balance study

A

+3 to +5 grams

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35
Q

Nitrogen balance equation thing

A

(N in) - (N out)

no. way.

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36
Q

N in =

A

24-hour protein intake (g) / 6.25

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37
Q

N out =

A

24-hour UUN (g) + factor (3-5g) (generally use 4 as estimate *

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38
Q

what is harris-benedict equation used for/

A

estimating caloric needs

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39
Q

what is TEE?

A

total energy expenditure

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40
Q

% of REE (resting energy expenditure):
% of REE and activity factor
maintenance

A

120-130 % of REE
1.2-1.3

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41
Q

% of REE (resting energy expenditure):
% of REE and activity factor
mild;moderate

A

150 % of REE
1.5

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42
Q

% of REE (resting energy expenditure):
% of REE and activity factor
severe;thermal burn

A

200+ % of REE
2

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43
Q

TEE = REE x ____

A

stress activity factor(s)

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44
Q

general guidelines:
20-25 kcal/kg/day
A. Non-stressed/Non-depleted
B. Trauma/Surgery/Major burns
C. BMI 30-50
D. BMI >50

A

A

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45
Q

general guidelines:
25-30 kcal/kg/day
A. Non-stressed/Non-depleted
B. Trauma/Surgery/Major burns
C. BMI 30-50
D. BMI >50

A

B

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46
Q

general guidelines:
11-14 kcal/kg/day (ACTUAL body weight)
A. Non-stressed/Non-depleted
B. Trauma/Surgery/Major burns
C. BMI 30-50
D. BMI >50

A

C

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47
Q

general guidelines:
22-25 kcal/kg/day IDEAL body weight
A. Non-stressed/Non-depleted
B. Trauma/Surgery/Major burns
C. BMI 30-50
D. BMI >50

A

D

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48
Q

BMI =

A

weight in kg / ht in m2

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49
Q

when is indirect calorimetry the preferred method

A

for critically ill patients

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50
Q

TEE = REE x ?

A

1.2 (said this will be a question from slide 45)

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51
Q

for all energy production, oxygen is _______ and carbon dioxide is ______

A

consumed, produced

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52
Q

what is RQ?

A

respiratory quotient

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53
Q

goal RQ for overfeeding vs underfeeding

A

0.85-0.95

this is paired with mixed substrate

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54
Q

what does an RQ < 0.85 mean?

A

underfeeding

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55
Q

what does an RQ >0.95 mean?

A

overfeeding

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56
Q

Protein general guidelines:
0.8-1 gm/kg/day
A. Maintenance
B. Mild-Moderate stress
C. Moderate-severe stress
D. BMI >30
E. BMI >40

A

A

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57
Q

Protein general guidelines:
1-1.5 gm/kg/day
A. Maintenance
B. Mild-Moderate stress
C. Moderate-severe stress
D. BMI >30
E. BMI >40

A

B

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58
Q

Protein general guidelines:
1.5-2 gm/kg/day
A. Maintenance
B. Mild-Moderate stress
C. Moderate-severe stress
D. BMI >30
E. BMI >40

A

C

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59
Q

Protein general guidelines:
2 gm/kg/day (IDEAL BW)
A. Maintenance
B. Mild-Moderate stress
C. Moderate-severe stress
D. BMI >30
E. BMI >40

A

D

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60
Q

Protein general guidelines:
2.5 gm/kg/day (IDEAL BW)
A. Maintenance
B. Mild-Moderate stress
C. Moderate-severe stress
D. BMI >30
E. BMI >40

A

E

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61
Q

what does standard distribution of non-protein calorie distribution entail?

A

70/30.
70 % dextrose
30% fat

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62
Q

when could 100% dextrose and 0% fat be utilized for NPC distribution

A

during sepsis or bloodstream infections **

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63
Q

PN or EN?
ileus or
small bowel resection

A

PN

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64
Q

PN or EN?
fistulas

A

PN

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65
Q

PN or EN
hyperemesis gravidum

A

PN

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66
Q

PN or EN
bone marrow transplantation

A

PN

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67
Q

Peripheral PN:
dextrose and AA solutions are ____tonic. what does this mean?

A

hyper. not well tolerated via a peripheral vein

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68
Q

Peripheral PN:
restrict final dextrose conc. to 5-10% or, total osmolarity to < ___ mOsm/L

A

900 *

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69
Q

Peripheral PN or central PN?
requires large volumes of fluid

A

Peripheral

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70
Q

in NICU all TPNs are (peripheral/central)

A

peripheral

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71
Q

2 advantages of central TPN

A

allows admin. of hypertonic solutions

more calories can be delivered

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72
Q

2 disadvantages of central TPN

A

risk of infection
central line is not a benign procedure (just means putting it in sucks and you can push air where you dont want air)

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73
Q

are TPNS central or peripheral in the NICU?

A

all peripheral

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74
Q

what are the 3 insertion sites for central lines?

A

subclavian
internal jugular
femoral

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75
Q

Is PICC (peripherally inserted central catheter) central or peripheral

A

central, ignore the P

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76
Q

one gram protein = _ kcal

A

4

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77
Q

T or F:
many hospitals order protein in gm/day

A

true

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78
Q

what are
travasol
freamine
aminosyn

A

standard amino acid products

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79
Q

one gram dextrose = _ kcal

A

3.4

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80
Q

when should final dextrose concentration not be infused peripherally?
adults:
pediatrics:

A

> 10%
12.5%

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81
Q

maximum carbohydrate utilization = - mg/kg/min

A

4-5 (max a person can actually absorb)

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82
Q

1 gram lipids = _ kcal

A

10

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83
Q

what does IV fat emulsion - intralipid prevent?

A

fatty acid deficiency

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84
Q

two allergens you should check for in intralipid thing

A

glycerin and egg

85
Q

what is SMOFlipid?

A

soybean oil
medium-chain TGs
olive oil
fish oil

86
Q

general lipids for adults:
__-__ gm/kg/day
MAX of __ gm/kg/day if tolerated

A

1-1.5
2.5

87
Q

T or F:
propofol is a lipid solution

A

true

88
Q

propofol provides _kcal/mL for lipid shit

A

1.1

89
Q

Must be incorporated into a total nutrient admixture for administration
A. IV fat emulsion 10% and 20%
B. IV fat emulsion 30%

A

B

90
Q

hang-time of IV fat emulsion by itself should be limited to how many hours after opening of manufacturer packaging?

A

12

91
Q

if IV fat emulsion being hung is added as TNA what is the new hang time limit from 12 hours to ?

A

24 hours

92
Q

dextrose, AA, and lipids
A. total nutrient admixture
B. Conventional admin
C. premix for injection

A

A

93
Q

Dextrose and AA
A. total nutrient admixture
B. Conventional admin
C. premix for injection

A

B

94
Q

no lipids
A. total nutrient admixture
B. Conventional admin
C. premix for injection

A

C

95
Q

with or without electrolytes
A. total nutrient admixture
B. Conventional admin
C. premix for injection

A

C

96
Q

can be used for all TNAs or 3-in-1
A. 1.2 micron filter
B. 0.22 micron filter

A

A

97
Q

used only for 2-in-1 (no lipids)
A. 1.2 micron filter
B. 0.22 micron filter

A

B

98
Q

T or F:
you are able to customize clinimix

A

false

99
Q

“standard’ TPN name

A

clinimix

100
Q

T or F:
Clinimix contains AAs + dextrose + electrolytes

A

false kinda because it can be with or without electrolytes

101
Q

what CrCL do you avoid adding electrolytes with clinimix?

A

CrCl <50 is bad

102
Q

when discontinuing PN you should consider starting at __% of goal and achieve final rate within __ hours

A

25
24

103
Q

when initiating PN how often should you check blood glucose

A

every 4-6 hours

104
Q

if BG > 200 after initiation of PN what do you do?

A

continue at same rate and recheck. if it is >200 after that consider insulin

105
Q

T or F:
There is no specific guideline for cycling PN

A

True

106
Q

max __ mL/hr for cycling PN

A

200

107
Q

standard daily range for phos
__-__ mMol (or __ mMol/kg to start)

A

15-45
0.3

108
Q

what 3 electrolytes should be used in caution with renal disease?

A

potassium
phos
magnesium

109
Q

which two electrolytes do you avoid mixing together due to risk of precipitation

A

calcium and phos

110
Q

avoid going over ___ for calcium x phos

A

150

111
Q

when do you avoid giving trace elements

A

liver dysfunction

112
Q

what two trace elements do you supplement individually in liver dysfunction

A

zinc and selenium

113
Q

which 2 trace elements should be used in caution with renal disease?

A

selenium and chromium

114
Q

T or F:
the addition of iron is recommended for most patients

A

false it can destabilize iv fat emulsion and contribute to infectious complications

115
Q

what med may be utilized for gerd or stress ulcer prophylaxis with PN

A

famotidine

116
Q

T or F:
PPIs are compatible with PN

A

false

117
Q

what insulin options do you have in PN?

A

regular only*

118
Q

MIVF is __-__ mL/kg/day

A

30-40 good review

119
Q

“average” = _ mMol phos = _ mEq phos

A

1=1.4

120
Q

what balances against chloride?

A

acetate

121
Q

what are the positive ions for ion balance (2)

A

sodium
potassium

122
Q

what are the negative ions for ion balance? (3)

A

chloride
acetate
phos

123
Q

2 complications of mechanical PN

A

clotting of line
displacement

124
Q

highlighted infectious complication of PN

A

catheter-related sepsis

125
Q

what is bacterial translocation?

A

Time-dependent passage of bacteria or endotoxins from GI tract to extra-intestinal sites

126
Q

highlighted metabolic complication of PN

A

hyper and hypoglycemia

127
Q

4 things under baseline monitoring for PN

A

CMP, Mg, Phos, Ca
hepatic function panel
prealbumin/crp
PT/INR

128
Q

1 highlighted thing to monitor twice weekly during PN and niche thing in ICU setting

A

prealbumin/CRP
daily in ICU

129
Q

2 things to monitor weekly on PN

A

TG
RQ

130
Q

T or F
Refeeding syndrome can be life-threatening

A

true

131
Q

what is the most likely clinical finding of refeeding syndrome

A

hypophosphatemia

132
Q

3 highlighted clinical findings of refeeding syndrome

A

hypophos
hypomag
hypokalemia

133
Q

some general risk factors for refeeding

A

low BMI
rapid feeding
excessive weight loss
low levels of K, phos, mag prior to feeding

134
Q

3 high risk comorbidities for refeeding

A

alcoholism
anorexia
marasmus

135
Q

Prevention of refeeding syndrome:
Initiation recommendations (Day #1):
- Limit carbohydrates (dextrose) to ___-___ gm
- Limit fluids to ___ mL/day
- Provide adequate amounts of ________
- Provide approximately __% of total caloric needs

A

100-150
800
electrolyts
50%

136
Q

essentia fatty acid (EFA) are estimated to be -% of daily calories

A

4-10

137
Q

what is the mechanism for EFA deficiency?

A

cont. infusion of hypertonic dextrose increases insulin levels and inhibits lipolysis and fatty acid mobilization

138
Q

clinical onset of EFA deficiency

A

10-14 days on fat-free PN regimen

139
Q

3 sxs of EFAD

A

dry scaly skin
brittle hair
lack of luster

140
Q

there are two ways to prevent EFAD with fat emulsion and shit but i think he just wanted us to know how often. so, how often?

A

twice weekly

141
Q

Decreased chance for bacterial translocation.
A. PN
B. EN

A

B

142
Q

Provides GI stimulation.
A. PN
B. EN

A

B

143
Q

More physiologic.
A. PN
B. EN

A

B

144
Q

contraindications to EN (few highlighted ones just know the first couple that i put in there)

A
  • non-mech obstruction -> ileus
  • severe GI hemorrhage
  • certain types of fistulas (high output, proximal small bowel)
  • vomiting intractable
  • severe malabsorption
145
Q

what are the routes of admin for EN? (4)

A

nasogastric
nasojejunal
gastrostomy
jejunostomy (PEG/PEJ)

146
Q

nasogastric

A

nose to stomach

147
Q

orogastric

A

mouth to stomach

148
Q

nasojejunal

A

nose to duodenum

149
Q

orojejunal

A

mouth to duodenum

150
Q

gastrostomy

A

percutaneous
surgical placement

151
Q

PEG/PEJ inserted how?

A

percutaneously

152
Q

determining routes of EN access:
risk of aspiration:
low risk ->
high risk ->

A

low -> gastric
high -> jejunal is preferred

153
Q

determining routes of EN access:
tolerance:
vomiting ->
gastric residuals ->

A

use jejunal for both

154
Q

determining routes of EN access:
duration of therapy:
long term ->

A

consider PEG or PEJ

155
Q

Methods of Admin EN:
Mimics meals
A. Bolus
B. Intermittent
C. Continuous infusion
D. trickle or trophic

A

A. Bolus

156
Q

Methods of Admin EN:
admin > 200 mL formula over 5-10 min. max volume 300-400 mL
A. Bolus
B. Intermittent
C. Continuous infusion
D. trickle or trophic

A

A

157
Q

Methods of Admin EN:
Primarily for pts with gastrostomy
A. Bolus
B. Intermittent
C. Continuous infusion
D. trickle or trophic

A

A

158
Q

3 advantages of bolus

A

convenient
minimal equipment
less med interactions

159
Q

2 disadvantages of bolus

A

cannot feed into small bowel
higher risk of aspiration and intestinal side effects

160
Q

Methods of Admin EN:
admin >200 mL formula over 20-30 min (gravity drip)
A. Bolus
B. Intermittent
C. Continuous infusion
D. trickle or trophic

A

B

161
Q

how many feedings a day for intermittent admin in EN?

A

4-8

162
Q

1 advantage of intermittent admin in EN

A

helps tolerance

163
Q

1 disadvantage of intermittent admin in EN

A

more equipment required (needs reservoir bottle or bag)

164
Q

Methods of Admin EN:
admin cont over 12-24 hours/day
A. Bolus
B. Intermittent
C. Continuous infusion
D. trickle or trophic

A

C

165
Q

Methods of Admin EN:
requires use of infusion pump
A. Bolus
B. Intermittent
C. Continuous infusion
D. trickle or trophic

A

C

166
Q

Methods of Admin EN:
Preferred method when feeding into the jejenum
A. Bolus
B. Intermittent
C. Continuous infusion
D. trickle or trophic

A

C

167
Q

2 advantages of continuous infusion

A
  • lower risk of gastric distention and aspiration
  • better tolerated by patient
168
Q

2 disadvantages of continuous infusion

A
  • problematic for medication admin
  • requires infusion pump
169
Q

Methods of Admin EN:
slow cont infusion at 10-30 mL/hr
A. Bolus
B. Intermittent
C. Continuous infusion
D. trickle or trophic

A

D

170
Q

2 advantages of trickle or trophic admin in EN

A
  • prevent mucosal atrophy and bacterial translocation
  • may shorten time on ventilator and decrease mortality
171
Q

1 disadvantage of trickle or trophic admin in EN

A

Difficult to achieve sufficient calorie delivery

172
Q

Initiation & Advancement of Tube Feeding:
- initiate full strength at __ mL/hr
- advance __ mL/hr q4-6 hrs as tolerated up to goal rate

A

25
25

173
Q

EN – ICU Initiation Points:
- achieve __-__% goal calories within first week (if you dont, consider PN instead)

A

50-60 %

174
Q

EN – ICU Initiation Points:
do not initiate if hemodynamically unstable. why?

A

concern for intestinal ischemia

175
Q

T or F:
EN promotes gut motility

A

true, youre using it still so

176
Q

2 reasons to minimize holding times in NPO

A
  • inadequate nutrient delivery (duh)
  • may stimulate ileus development (bad)
177
Q

EN Nutrient Composition:
protein:
- _______ protein -> requires complete digestion into smaller peptides
- partially digested (peptide-based) -> ________; may be beneficial for pts with ________ or ________**

A

intact
elemental
malabsorption, diarrhea

178
Q

EN Nutrient Composition:
Fat:
- long-chain fatty acids
- ______-chain fatty acids -> more water soluble, rapid _______, little or no pancreatic lipase for absorption

A

medium
hydrolysis

179
Q

EN Nutrient Composition:
Carbohydrates:
- ________ polymers primarily used for tube feeding formulas
- simple glucose used for _____ supplements (higher in osmolality)

A

glucose
oral

180
Q

what does modular mean in the context of this exam

A

added onto EN or PN

181
Q

what are the key contents in the modular supplement pro-stat?

A

15 g protein
72 kcal
3g CHO

182
Q

when would you give Juven as a modular supplement?

A

wound care/HIV/AIDs/Cancre

183
Q

glutamine (modular supplementation):
- may reduce ___ or ___
- reduces mortality in ____ pts
- no systemic effect when give by _____ route
- do NOT supplement if already receiving glutamine via immune-modulating formula

A

hospital/ICU length of stay
burn
enteral

184
Q

Probiotics:
- Inhibit _______ ________ growth
- Block _______ attachment
- Eliminate toxins
- Enhance host inflammatory response

A

pathogenic bacterial
pathogen

185
Q

Vitamins and trace elements:
- used for _______ effects and/or repletion
- Vitamin _ and vitamin __
- beneficial in most ____ patients

A

antioxidant
E and C
ICU (burn/trauma/mech ventilated)

186
Q

6 complications for gastrointestinal

A
  • high gastric residuals
  • aspiration
  • N/V or decreased motility
  • Abdominal distention
  • diarrhea
  • constipation
187
Q

T or F:
lower cut offs protect patient from high gastric residuals

A

false

188
Q

High gastric Residuals:
< 500 mL: (do/ do not) hold unless intolerance signs
200 to 500 mL: implement risk reduction measures to avoid ________
Cutoffs may vary by site

A

do not
aspiration

189
Q

what are the 4 drug options for decreased motility from enteral feeding?

A

metoclopramide (most common)*
erythromycin
naloxone
methylnaltrexone

190
Q

when to consider hyperosmolar meds and meds with sorbitol

A

diarrhea, said we didnt need to know the meds that fall under those categories tho

191
Q

3.5 metabolic complications

A
  • hyper/hypo glycemia
  • overhydration/dehydration
  • electrolyte imbalance
192
Q

what is the most common electrolyte imbalance from the metabolic complications slide

A

hyponatremia **

193
Q

goal blood glucose in ICU

A

<180

194
Q

2 mechanical complications (the others are common sense)

A

rhinitis
sinusitis

195
Q

some of the general guidelines for med delivery via enteral feeding tubes (just give it your best shot)

A
  • liquid meds pref
  • crush oral dosage forms
  • DO NOT crush sustained-release or enteric coated shit
  • admin meds separately
  • ensure adequate flushing
196
Q

what 2 things do you mix and put into water to unclog feeding tubes

A

1 sodium bicarb tab and 1 pancreatic enzyme cap

197
Q

some monitoring things for gastrointestinal

A

gastric residuals
emesis
stools daily
bloating/distension
bronchial/tracheal aspirate

198
Q

metabolic monitoring:
how often should you check for each?
- weight
- electrolytes/BUN/Scr
- Mg/Phos/Ca/TG/LFTs
- Albumin/CRP/Nitrogen

A
  • 2-3 times/week
  • daily until stable->twice weekly-> weekly
  • weekly
  • weekly
199
Q

consideration for acute renal failure:
use a ?

A

Use a normal EN formula unless electrolyte profile dictates otherwise**

200
Q

Acute renal failure special considerations:
CRRT (cont renal replacement therapy):
increased protein requirement to prevent ______ deficit

A

nitrogen

201
Q

Acute renal failure special considerations:
Hemodialysis -> __-__ g/kg/day protein

A

0.8-1.2

202
Q

Acute renal failure special considerations:
loss of water soluble micronutrients (3)

A

selenium, zinc, thiamine

203
Q

Acute renal failure special considerations:
_______ accumulates due to it being cleared renally

A

prealbumin, this makes it falsely high

204
Q

what kind of failure do you incorporate fluid-restriction, calorically dense formulations 1.5-2.0kcal/mL

A

pulmonary

205
Q

what failure do you watch and monitor phosphate closely

A

pulmonary (important for breathing)

206
Q

T or F:
Parenteral nutrition does not affect pancreatic secretion and function

A

true

207
Q

what acute disease state do you consider lipid infusions and adding glutamine

A

acute pancreatitis

208
Q

Burn pts:
metabolic changes
- (inc/dec) basal metabolic rate and nitrogen loss
- glycolysis, proteolysis, lipolysis

A

increase

209
Q

burn pts:
nutritional requirements:
- high in protein (__-__g/kg/day) and calories
- early feeding with __

A

2-2.5
EN

210
Q

burn pts:
supplements:
- adult multivitamin
- If TBSA >10% ->
- If TBSA > 20% ->
- Vitamin __ (if deficient), Vitamin __ (if on steroids)

A
  • ascorbic acid, zinc, vitamin e, selenium
  • oxandrolone/ growth hormones
  • D, A

PHRM 864 (28 decks)

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