Final Details Part I Flashcards
Standard EN administration rate
Initiate at 50ml/hr and increase by 15ml/hr q4h until goal rate i reached, Meet needs within 24-48hrs with goal of providing 80% of needs in 48-72 hours
Risk of re-feeding administration rate (General)
Initiate between 25-50% of needs or 15 kcal/kg/day and ensure that less than 100 g of CHO
–> Then meet needs within 4-7 days
EN risk of refeeding administration rate
10-25 ml/hr and increase q12hr over 4-7 days to reach target
Max fat infusion rate?
- 5 g/kg/day or 0.11g/kg/hour
- -> 1 g/kg/day if in ICU, HyperTG or pancreatitis
ICU En administration rate and initiation?
10-40 ml/kg/day and increased 10-20ml/hr q8-12hrs and reach goal in 24-48 hours.
–> Always no more than 3 mg/kg/CHO and 1 g/kg/day of fat
Best practice PN protocol on day 1?
Less than 50% of needs, and between 150-200 g of CHO or 100 g of CHO if poor glycemic control or low BMI
Energy when BMI >30?
IBW
Energy when IBW <90%?
Use IBW or ABW depending on range
Energy when ABW >125%?
Use IBW
Fluids when IBW >125%?
Use Adj. BW
Fluids when IBW <90%?
Use IBW
Protein when IBW >125%?
Use IBW
In high conjugated bilirubin, albumin is high/low/normal
Likely normal. issue with perfusion or liver function
Nitrogen balance equation?
=Input-(Output+4)
Input = total protein/6.24
Output = 24hr urea/35.7
Pale skin? pale tongue? Papillary atrophy?
- BICF
- RIBN
- FIRNB12
Severe manifestation of vitamin A ?
Bigots spots or Xerophthalmia
NS indications (I-AI-PISS)
- Inadequate oral intake unexpected to resolve in 7-14 days
- Altered GI Functions
- Impaired nutrient utilization
- PEM
- Increased nutrient needs unable to meet orally
- Significant involuntary weight-loss
- Swallowing or chewing difficulty
EN indications (FGT+UUHD)
Function GI tract AND:
- Unable or Unexpected to meet oral needs in 7-14 days
- Hemodynamically unstable
EN Contraindications (MISS-A-SHIP)
- Mechanical Obstruction
- Intractable N/V
- Severe GI bleed
- SBS
- Aggressive care not warranted
- Short-supply period
- High output GI fistula
- Inability to gain access to GI tract (PMSG)
- Paralytic Ileus
When is there inability to gain access to the GI tract?(PM)
- Paralytic Ileus
- Mesenteric Ischemia
- Short bowel obstruction
- GI High output fistula
Contraindications to PEG? (VAG-CIN)?
- Varice
- Ascites
- Gastroparesis
- Coagulopathy
- Inflammation of GI/Abdo
- Neoplasia
Diarrhea algorithm? (DM-SC-SFA)
- Distended/Painful abdo
- Medical or Sx reason
- Stool impaction
- Cathartic agents (sorbitol)
- C.Diff
- Fibre
- Anti-diarrheal agent
Cathartic agents which may cause diarrhea?
-Docusate, oral electrolyte rehydration solutions, lactulose
GRV Monitoring algorithm? (ECEM)
- Evaluate all gastric fed patients
- Confirm feeding tube in place prior to starting fees
- Elevate HOB 30-45 degrees
- Monitor q4h
