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Clinical Nutrition 2 > Final Details Part I > Flashcards

Final Details Part I Flashcards

1
Q

Standard EN administration rate

A

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

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2
Q

Risk of re-feeding administration rate (General)

A

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

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3
Q

EN risk of refeeding administration rate

A

10-25 ml/hr and increase q12hr over 4-7 days to reach target

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4
Q

Max fat infusion rate?

A
  1. 5 g/kg/day or 0.11g/kg/hour

- -> 1 g/kg/day if in ICU, HyperTG or pancreatitis

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5
Q

ICU En administration rate and initiation?

A

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

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6
Q

Best practice PN protocol on day 1?

A

Less than 50% of needs, and between 150-200 g of CHO or 100 g of CHO if poor glycemic control or low BMI

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7
Q

Energy when BMI >30?

A

IBW

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8
Q

Energy when IBW <90%?

A

Use IBW or ABW depending on range

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9
Q

Energy when ABW >125%?

A

Use IBW

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10
Q

Fluids when IBW >125%?

A

Use Adj. BW

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11
Q

Fluids when IBW <90%?

A

Use IBW

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12
Q

Protein when IBW >125%?

A

Use IBW

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13
Q

In high conjugated bilirubin, albumin is high/low/normal

A

Likely normal. issue with perfusion or liver function

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14
Q

Nitrogen balance equation?

A

=Input-(Output+4)
Input = total protein/6.24
Output = 24hr urea/35.7

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15
Q

Pale skin? pale tongue? Papillary atrophy?

A
  • BICF
  • RIBN
  • FIRNB12
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16
Q

Severe manifestation of vitamin A ?

A

Bigots spots or Xerophthalmia

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17
Q

NS indications (I-AI-PISS)

A
  • 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
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18
Q

EN indications (FGT+UUHD)

A

Function GI tract AND:

  • Unable or Unexpected to meet oral needs in 7-14 days
  • Hemodynamically unstable
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19
Q

EN Contraindications (MISS-A-SHIP)

A
  • 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
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20
Q

When is there inability to gain access to the GI tract?(PM)

A
  • Paralytic Ileus
  • Mesenteric Ischemia
  • Short bowel obstruction
  • GI High output fistula
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21
Q

Contraindications to PEG? (VAG-CIN)?

A
  • Varice
  • Ascites
  • Gastroparesis
  • Coagulopathy
  • Inflammation of GI/Abdo
  • Neoplasia
22
Q

Diarrhea algorithm? (DM-SC-SFA)

A
  • Distended/Painful abdo
  • Medical or Sx reason
  • Stool impaction
  • Cathartic agents (sorbitol)
  • C.Diff
  • Fibre
  • Anti-diarrheal agent
23
Q

Cathartic agents which may cause diarrhea?

A

-Docusate, oral electrolyte rehydration solutions, lactulose

24
Q

GRV Monitoring algorithm? (ECEM)

A
  • Evaluate all gastric fed patients
  • Confirm feeding tube in place prior to starting fees
  • Elevate HOB 30-45 degrees
  • Monitor q4h
25
Q

GRV <250 ml?

A
  • Re-instill aspirate
  • Progress feeds
  • -> ICU monitor q4h, if non-ICU now monitor q8h
26
Q

GRV 250-500 ml no intolerance?

A
  • Re-instill 250 ml aspirate

- Keep feeds at same rate

27
Q

GRV 250-500 ml with tolerance?

A
  • Re-instill 250 ml aspirate

- Inform MD, consider post-pyloric or pro-kinetic agents

28
Q

GV >500ml?

A
  • Discard aspirate
  • Inform MD and RD
  • Consider continuous feeds, post-pyloric
29
Q

Diarrhea definition?

A

750 ml per day or >3 stools per day for 3 days

30
Q

Examples of pro-kinetic agents?

A
  • Erythromycin
  • Neomycin
  • Metoclopramide
31
Q

Hypercapnia?

A

Low phosphate formula

32
Q

PN Indications??

A
  • Malnourished at baseline
  • EN Contraindication OR has failed EN which is not expected to resolve in 7-14 days
  • HD Stable
33
Q

PPN Contraindications? (SSL-FPR)

A
  • Significant malnutrition
  • Severe stress
  • Large fluid/electrolyte needs
  • Fluid restriction
  • PN > 2 week
  • Renal or Liver Dysfunction
34
Q

TG limit with PN? Normal?

A
  • PN: <4.52

- Normal: 0.4-2.29

35
Q

Glucose limit with PN? Normal?

A
  • PN: <10 mmol/L

- Normal: 3.3-6.4mmol/L

36
Q

How can we avoid rebound hyperglycemia in d/c PN?

A
  • Taper PN by increasing EN or infuse 10% dextrose

- D/c PN completely when we are confident that glucose can be maintained with EN or oral feeds

37
Q

What is azotemia?

A

Increased levels of nitrogen in blood, complication in PN

  • -> High BUN, high creat, high protein, dehydration
  • -> Associated with decreased renal function
38
Q

Target population in critical care?

A
  • Adults >18
  • LOS greater than 2-3 days
  • At least one organ failing
39
Q

CI Obese energy BMI 30-50

A

22-25 kcal/kg ABW

40
Q

CI Obese energy BMI >50

A

11-14 kcal/kg IBW

41
Q

CI Obese protein BMI 30-40

A

2.0 g/kg/day of Adj.BW or IBW

42
Q

CI Obese protein BMI >40

A

2.5 g/kg/day

43
Q

Trophic feeds?`

A

10-20kcal/kg or 500 kcal per day

44
Q

What is early EN needed for?

A

Not so much for energy, but for modulation of the immune response
–> When NRS >/5

45
Q

If diarrhea is suspected _____ fibre should be used

A

mixed

46
Q

In refeeding, feeding stimulates ____ which promotes ____, and therefore feeds should be started from 25-50%

A
  • insulin

- anabolism

47
Q

What is another way of calculating obese energy needs in the ICU?

A

Take 65-70% of requirements as per IC

48
Q

When does propofol get d/c?

A

We CANNOT d/c as it’s what is keeping them sedated

We have to consider kcals and fluids when we do our prescription, and potentially withold IVFE

49
Q

Beneprotein administration?

A
  • 6 g of protein each

- Mix with 60-120ml of H2O and flush with 30-60 ml of H20

50
Q

When to initate PN in critical care?

A

In a previously WELL-NOURISHED patient, initiate when (1) failure of EN to meet 60% of needs in 7-10 days (2) When EN contraindicated and NRS >3 Initiate PN right away

Clinical Nutrition 2 (21 decks)

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