Exam 3 - Nutrition Walroth (not done; on slide 62) Flashcards by Rehman Hameed

IBW formula for males

50 kg + (2.3 * inches over 60”)

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IBW formula for females

45.5 kg + (2.3 * inches over 60”)

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dosing body weight (DBW) equation

DBW = IBW + 0.4(wt-IBW)

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nutrition body weight (NBW) equation

NBW = IBW + 0.25(wt-IBW)

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applies for dosing certain drugs

a. DBW
b. NBW

a. DBW (dosing body weight)

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applies for calculating fluid, electrolyte, and nutrition (FEN) parameters

a. DBW
b. NBW

b. NBW (nutrition body weight)

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risk factors for malnutrition:
-under body weight (UBW) = ___% below IBW
-involuntary weight loss > ___% within 6 months

20%; 10%

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risk factors for malnutrition in ICU pts (4 of them; slide 15-16)

-NPO > 10 days
-gut malfunction
-mechanical ventilation
-inc metabolic needs

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two highlighted screening tools for determination of nutrition risk

-NUTRIC
-nutritional risk score (NRS-2002)

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high risk NUTRIC score range

6-10

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4 things measured for somatic (muscle) protein status (slide 24)

-weight
-triceps skin fold
-arm muscle circumference
-physical appearance

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T or F: when prealbumin decreases as C-protein increases, this is a sign of inflammation

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T or F: when prealbumin decreases as C-protein is normal, this is a sign of malnutrition

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prealbumin decreases as CRP _____ -> malnutrition

a. increases
b. stays normal

b. stays normal

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which of the following is protein and calorie malnutrition?

a. Marasmus
b. Kwashiorkor

a. Marasmus

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which of the following is protein malnutrition with adequate caloric intake?

a. Marasmus
b. Kwashiorkor

b. Kwashiorkor

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is wasting of muscles evident in marasmus or kwashiorkor, or both?

marasmus

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tx of marasmus

a. provide well-balanced substrate, consider vit B
b. provide carbs followed by high protein

a. provide well-balanced substrate, consider vit B

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tx of kwashiorkor

a. provide well-balanced substrate, consider vit B
b. provide carbs followed by high protein

b. provide carbs followed by high protein

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ideal goal for nitrogen balance (range)

+3 to +5 grams

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measurement of urinary excretion of nitrogen as urea nitrogen

UUN (urinary urea nitrogen)

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formula for Nitrogen balance

(N in) - (N out)
(N in) = 24 hr protein intake/6.25
(N out) = 24 hr UUN + 4

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TEE (total energy expenditure) equation

TEE = REE * 1.2

(total energy expenditure = resting energy expenditure * 1.2)

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caloric needs for non-stressed, non-depleted pt

a. 20-25 kcal/kg/day
b. 25-30 kcal/kg/day
c. 11-14 kcal/kg/day (actual BW)
d. 22-25 kcal/kg/day (IBW)

a. 20-25 kcal/kg/day

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caloric needs for trauma/stress/surgery pt, critically ill, major burns a. 20-25 kcal/kg/day b. 25-30 kcal/kg/day c. 11-14 kcal/kg/day (actual BW) d. 22-25 kcal/kg/day (IBW)

b. 25-30 kcal/kg/day

caloric needs for pt with BMI 30-50 a. 20-25 kcal/kg/day b. 25-30 kcal/kg/day c. 11-14 kcal/kg/day (actual BW) d. 22-25 kcal/kg/day (IBW)

c. 11-14 kcal/kg/day (actual BW)

caloric needs for pt with BMI > 50 a. 20-25 kcal/kg/day b. 25-30 kcal/kg/day c. 11-14 kcal/kg/day (actual BW) d. 22-25 kcal/kg/day (IBW)

d. 22-25 kcal/kg/day (IBW)

BMI equation

wt (kg)/ht (m^2)

indirect calorimetry provides energy expenditure (___, ___) at that ONE point in time, then extrapolated to 24 hrs

REE; RQ

what is indirect calorimetry? (from internet)

Indirect calorimetry is a method used to measure the amount of energy (calories) a person burns by analyzing their oxygen consumption (O2) and carbon dioxide production (CO2)

what does the RQ (respiratory quotient) measure?

The ratio of CO2 produced to O2 consumed (Vco2/Vo2)

goal range for RQ

0.85-0.95

how often should RQ be monitored?

once weekly

RQ > 0.95 indicates __________ a. underfeeding b. overfeeding

b. overfeeding

RQ < 0.85 indicates __________ a. underfeeding b. overfeeding

a. underfeeding

37 YOM burn pt has been on EN for 6 days (providing 1800 kcal/day). Their indirect calorimetry report shows an REE of 1950 and an RQ of 0.74. Calculate TEE, and what recommendations would you make?

TEE = 1950 * 1.2 = 2340 kcal/day RQ 0.74 -> underfeeding He is receiving 1800 kcal/day and needs 2340 kcal/day. RQ is low indicating he is being underfed. Increase the rate of his EN to provide more calories

general protein range for ICU, trauma, surgery, or burn pts a. 0.8-1 gm/kg/day b. 1-1.5 gm/kg/day c. 1.5-2 gm/kg/day d. 2 gm/kg/day

c. 1.5-2 gm/kg/day

standard distribution for non-protein calories

70/30 (70-85% dextrose; 15-30% fat)

when would we use a 100/0 non-protein calorie distribution?

during sepsis or bloodstream infections (don't want to put fat into their bloodstream)

the process of supplying nutrients via an intravenous delivery system (i.e. protein, carbohydrates, fat, electrolytes, vitamins, minerals)

parenteral nutrition (PN)

PN indications (slide 55; 9 things; MEMORIZE)

-NPO > 7 days -small bowel or colonic ileus -extensive small bowel resection -malabsorptive states -intractable vomiting/diarrhea -enterocutaneous fistulas -IBD -hyperemesis gravidum -bone marrow transplantation (mucositis)

for peripheral PN, restrict final dextrose conc to 5-10%, or total osmolarity to < _____ mOsm/L

< 900 mOsm/L

which of the following is FALSE about peripheral PN? a. requires large volumes of fluid, so not best choice for HF or AKI/CKD b. limited in calories c. long term access (> 10 days)

c. long term access (< 7-10 days)

2 advantages to a central PN

-allows admin of hypertonic solutions -more calories can be delivered

2 disadvantages of a central PN

-risk of infection -central line is not a benign procedure

3 central venous catheter (CVC) insertion sites

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

is a PICC line short or long term?

long

one gram of protein = ____ kcal a. 3.4 b. 4 c. 10 d. 30

b. 4

one gram of dextrose = ____ kcal a. 3.4 b. 4 c. 10 d. 30

a. 3.4

1 gram of lipids = ____ kcal a. 3.4 b. 4 c. 10 d. 30

c. 10

trace element adjustments in liver dysfunction (chronic liver disease or LFTs > 2x ULN) (2 things to know; slide 92)

-d/c trace elements -supplement individually; zinc 5 mg (1 mL), selenium 60 mcg (1 mL)

trace element adjustments for renal disease (CKD/ESRD on dialysis) (3 things to know; slide 92)

-consider checking serum levels if use expected beyond 14 days -use selenium and chromium with caution -different rules apply for CRRT

MIVF normal range (mL/kg/day)

30-40 mL/kg/day

ICU/surgery pt needs ___-___ kcal/kg/day

25-30

"average" = 1 mMol Phos = ___ mEq Phos

1.4

which is NOT a clinical finding of refeeding syndrome? a. hypocalcemia b. hypophosphatemia c. hypomagnesemia d. hypokalemia

a. hypocalcemia

day 1 recommendations for prevention of refeeding syndrome: limit carbs (dextrose) to ___-___ gm limit fluids to ___ mL/day provide adequate amounts of __________ provide approx. ___% of total caloric needs

100-150 800 electrolytes 50%

contraindications to EN (6 of them; slide 134)

-mechanical obstruction (hernia, tumor, etc) -non-mechanical obstruction - ileus -intractable vomiting -severe malabsorption -severe GI hemorrhage -certain fistulas (high output, proximal small bowel)

what does a KUB abdmonial X-ray check?

kidneys, ureters, bladder

EN bolus administration a. Administer > 200 mL formula over 5-10 min b. Administer > 200 mL formula over 20-30 minutes (gravity drip) c. Administer continuously over 12-24 hours/day d. Slow continuous infusion at 10 – 30 mL/hr

a. Administer > 200 mL formula over 5-10 min

EN intermittent administration a. Administer > 200 mL formula over 5-10 min b. Administer > 200 mL formula over 20-30 minutes (gravity drip) c. Administer continuously over 12-24 hours/day d. Slow continuous infusion at 10 – 30 mL/hr

b. Administer > 200 mL formula over 20-30 minutes (gravity drip)

EN continuous infusion a. Administer > 200 mL formula over 5-10 min b. Administer > 200 mL formula over 20-30 minutes (gravity drip) c. Administer continuously over 12-24 hours/day d. Slow continuous infusion at 10 – 30 mL/hr

c. Administer continuously over 12-24 hours/day

EN trickle or trophic administration a. Administer > 200 mL formula over 5-10 min b. Administer > 200 mL formula over 20-30 minutes (gravity drip) c. Administer continuously over 12-24 hours/day d. Slow continuous infusion at 10 – 30 mL/hr

d. Slow continuous infusion at 10 – 30 mL/hr

which of the following is NOT a general guideline for medication delivery via enteral feeding tubes? a. liquid medications are preferred whenever possible b. crush all tablets, including sustained-released or enteric coated c. administer each medication separately d. flush with water between each medication e. dilute hypertonic meds or irritating ones to gastric mucosa in at least 30 mL of water before administering

b. crush all tablets, including sustained-released or enteric coated (crush all tablets except sustained-release or EC)

unclogging the feeding tube involves mixing what TWO pills in 10 mL of warm sterile water? a. 1 sodium bicarb tab b. 1 glycerin tab c. 1 pancreatic enzyme tab d. 1 ammonium tab

a. 1 sodium bicarb tab c. 1 pancreatic enzyme tab