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NNP Board Exam Review > Fluid & Electolytes / Nutrition > Flashcards

Fluid & Electolytes / Nutrition Flashcards

1
Q

Weight gain per day calculation

A

difference in weight / current weight / number of days
preterm infant: 15-20g/kg/day

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2
Q

Plasma Triglyceride levels should be measured with each ______ in _________; a serum triglyceride level less than _____ indicates lipid tolerance.

A

w/ each increased in lipids
should be <200

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3
Q

decreased _________ and __________ or increased ____________ are indicators of bone demineralization

A

decreased calcium and phosphorous levels or increased alk-phos levels

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4
Q

Alk-Phos Levels indicative of bone demineralization

A

levels greater than 500 mg/dL

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5
Q

Serum Phosphorous level indicative of bone demineralization

A

<4 mg/dL

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6
Q

Estimated Endogenous glucose production

A

4mg/kg/day

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7
Q

Appropriate GIR for term infant

A

4-5 mg/kg/min

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8
Q

Appropriate GIR for Preterm Infant

A

6-10 mg/kg/min

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9
Q

1 gram of dextrose is _____ kcal

A

3.4 kcal

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10
Q

Breastfed infants require slightly _____ caloric requirement due to the amount of energy required to metabolize formula

A

less

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11
Q

Mature human milk has _____ g of protein per 100mL

A

0.9g of protein per 100mL

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12
Q

Term Protein Requirements (Enteral and Parenteral)

A

Enteral: 2 - 2.5g/kg/day
Parenteral: 1.5-2.5g/kg/day

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13
Q

Term Lipid Requirements (Parenteral and enteral)

A

Parenteral: 2-4 g/kg/day
Enteral: 3-4 g/kg/day

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14
Q

Term Calorie Requirements (same for enteral and parenteral)

A

100-120 kcal/kg/day

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15
Q

Term Fluid Requirements

A

Parenteral: 100-120 ml/kg/day
Enteral: 120-150 ml/kg/day

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16
Q

Preterm Fluid Requirement (parenteral and enteral)

A

parenteral : 120 to 150 ml/kg/day
enteral: 150-200 mg/kg/day

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17
Q

Preterm Caloric requirement (parenteral and enteral)

A

Parenteral requirements 80-100 kcal/kg/day (goal calories for extreme premature infants on full PN 90-100kcal/kg/day)

Preterm infants on parenteral nutrition have a slightly lower caloric requirement than enteral feeds due to lower activity levels and fecal losses

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18
Q

Preterm Protein Requirements

A

Preterm infants less than 30 weeks - 3.5g/kg/day

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19
Q

The use of larger fluid volumes in a preterm infant increases the risk of _________.

A

PDA, cerebral IVH, BPD, and NEC

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20
Q

Mature human milk has ____ g of fat per 100 mL.

A

3.5g of fat per 100 mL

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21
Q

Neonatal Amino Acid solutions have a _______ pH allowing for greater concentrations of ________ and __________.

A

lower pH allowing for greater concentrations of phosphorous and calcium

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22
Q

purpose of acetate in PN

A

aids with correction of hyperchloremic metabolic acidosis

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23
Q

Addition of chloride to PN

A

aids with correction of metabolic alkalosis

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24
Q

addition of cysteine to PN

A

improves the calcium and phosphorous solubility by lowering the pH

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25
Q

PN recommendations for infants with impaired biliary excretion or liver function

A

omit copper and manganese

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26
Q

Peripherally infused PN should not exceed an osmolality of _____

A

900 mOsm/L (which can limit carb and AA delivery)

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27
Q

Recommended vitamin D supplementation for term and preterm infants

A

400mg

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28
Q

IV Lipids can displace __________ from binding sites on ___________ therefore should be used in caution in patients with significant _______________.

A

IV Fats displace bilirubin from binding sites on albumin ; use cautiously in patients with hyperbilirubenemia

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29
Q

Enteral protein sources include ______ and ______

A

whey and casein

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30
Q

Preterm infant enteral carbohydrate requirement

A

8 to 12g/kg/day

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31
Q

Optimal Feeding tube size

A

infants <1000g require a 5 french

>1000g - #6-8 french

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32
Q

Caloric density can be advanced from 20kcal/oz to 24 kcal/oz in preterm infants when the feeding volume reaches ________

A

100ml/kg/d

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33
Q

Preterm maternal milk in comparison to term maternal milk

A

preterm milk is higher in cholesterol, phospholipids, and very long chain PUFAs than term milk

Preterm milk has higher sodium content chloride levels

as lactation progresses, total fat content increases and cholesterol and phospholipid content decreases.

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34
Q

Changes in whey:Casein ratio as lactation progresses

A

The whey casein ratio changes from 80:20 at the start of lactation to 55:45 in mature milk

whey decreases and casein increases as lactation progresses

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35
Q

leading whey protein in human milk

A

∝lactoferrin which is high in AA

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36
Q

Mature milk has a fat content of _____g/dL

A

4-5g/dL

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37
Q

primary component of human milk fat

A

Triglycerides

38
Q

Primary carbohydrate in human milk

39
Q

Preterm formulas are ______ predominant

40
Q

soy protein formulas are not recommended due to….

A

their low calcium and phosphorous content (increased risk of developing ostopenia of prematurity)

41
Q

Formula for Cystic Fibrosis AND/OR hepatic insufficiency

A

semi-elemental formula containing reduced LCTs w/ supplemented MCT OR standard formula with pancreatic enzyme supplementation

due to impaired digestion and absorption of long-chain fats

42
Q

Formula for galactosemia

A

soy protein-based formula b/c it is lactose free

43
Q

Formula for lactose intolerance

A

low lactose formula

44
Q

formula for lymphatic anomalies

A

significantly reduced LCT with supplemented MCT

45
Q

Formula for NEC

A

preterm formula or semi-elemental formula if indicated r/t impaired digestion

46
Q

Formula for renal insufficiency

A

standard formula

47
Q

Fat soluble vitamins

A

vitamins A, D, E, K

48
Q

Water Soluble vitamins

A

vitamin c and B

49
Q

Vitamin A in milk

A

colostrum contains the highest amounts of vitamin A

vitamin a content in preterm and term milk are equal but decrease as milk matures

50
Q

Improving vitamin A levels in the preterm infant decreases incidences of _______ or ______.

A

Chronic Lung Disease or BPD

51
Q

Iron Supplementation

A

should receive at 2-4 weeks of age; infants receiving an erythrocyte stimulating agent require hire dosing

52
Q

Nutritional Considerations for BPD

A

fluid restriction with increased metabolic demand (must increase caloric density to meet caloric needs while restricting total fluid)

53
Q

ECG changes with Hypocalcemia

A

prolonged ST and QT

54
Q

ECG changes with hypokalemia

A

Depressed ST, flat or inverted T, Prominent U wave

55
Q

ECG changes with hypercalcemia

A

shortened ST, wide T

56
Q

ECG changes with hyperkalemia

A

tall, peaked T waves, Flat P waves, wide QRS

57
Q

ECG changes with hypomagnesia

A

tall T, depressed ST

58
Q

ECG changes with hypermagnesia

A

long PR, Wide QRS

59
Q

Fetal swallowing of amniotic fluid starts by ________

A

8-11 weeks

60
Q

goals for length and head circumference

61
Q

Subobtimal head circumference has an association with ______

A

higher neurodevopmental risk

62
Q

Kcals in 1 gram of protein

63
Q

kcal in 20% lipid emulsion solution

A

2kcal/mL or 10kcal/gram

64
Q

kcal in 1 gram dextrose

65
Q

impaired biliary excretion - limit _______ in tpn

A

copper and manganese

66
Q

vitamin D is known to prevent __________; Dose _______

A

osteopenia, 400 IU per day

67
Q

Iron Dosing needs to be higher in __________

A

infants receiving an erythrocyte-stimulating agent such as erythropoietin

68
Q

Infants born to diabetic mothers often present with transient _________

A

hypomagnesia

69
Q

oxytocin and maternal diuretic use may result in fetal and maternal __________

A

hyponatremia

70
Q

Antenatal steroids can enhance lung maturation and skin maturation which decreases _________ and reduces risk of ___________.

A

decreases IWL, and reduces risk of hyperkalemia

71
Q

Severe hypoxia or asphyxia at birth can lead to __________________, requiring a lower ______________.

A

can lead to renal tubular necrosis, requiring a lower TFG

72
Q

Fractional excretion of sodium - definition and calculation

A

reflects balance between GFR and tubular reabsorption of Na+

calculated:

FENa = (urine sodium x plasma Cr) / (plasma Na x urine Cr) x 100

73
Q

Treatment of edema

A

Na+ restriction and/or fluid restriction in cases of low serum sodium

74
Q

Normal sodium requirements

A

2-4 meq/kg/day or greater with renal Na+ losses from renal immaturity

75
Q

Hyponatremia r/t ECF volume depletion symptoms

A

tachycardia, rising BUN, metabolic acidosis.

76
Q

Sodium deficit calculation

A

Sodium defecit = (sodium desired - actual serum sodium) x 0.6 x weight (kg)

77
Q

Hyponatremia with normal ECF volume

A

can result from excess fluid admin; If sodium >120, restrict fluids. If sodium <120, diuretics

78
Q

Hyperlipidemia can cause a fictitiously low ________

A

serum sodium

79
Q

Hypernatremia Differential (3)

A
  1. Excess Na intake
  2. Drug induced (albumin, NaHCO3, Antibiotics)
  3. Hypovolemia
80
Q

Hyponatremia Differential (5)

A
  1. Inadequate intake
  2. SIADH ( increased weight, low urine output, high urine osmo)
  3. Drug induced
  4. Volume Overload (increased weight, high urine output, low urine osmo)
  5. False low
81
Q

Symptomatic Hyponatemia with seizures for Na <120, treatment

A

Hypertonic NaCl (3) 6ml/kg over 1-2 hours

82
Q

Hyperkalemia Differential (5)

A
  1. False high
  2. increased intake
  3. Endogenous K+ release
  4. Ionic Shifts
  5. Impaired excretion
83
Q

Hyperkalemia with EKG changes treatment

A
  • Calcium gluconate
  • Sodium Bicarb
  • Insulin / Glucose push / drip
84
Q

Hyperkalemia without EKG changes treatment

A
  • stop K+ admin
  • adequate fluid intake
  • Consider lasix
  • Keep calcium in normal-high levels
85
Q

Hypokalemia Differential (3)

A
  1. Decrease Intake / GI Losses ( i.e. NEC)
  2. Renal Losses
  3. Ionic shift (insulin, metabolic alkalosis, meds, hypothermia)
86
Q

How does insulin decrease potassium levels

A

enhances intracellular uptake of K+ by stimulating the membrane-bound NA-K ATPase. (MUST ALWAYS ACCOMPANY WITH GLUCOSE TO MAINTAIN GLUCOSE LEVELS)

87
Q

Respiratory Acidosis causes

A

inadequate alveolar ventilation, leading to an excess of CO2 and decrease in pH

88
Q

Respiratory Alkalosis causes

A

r/t alveolar hyperventilation, leading to a decrease in CO2 and increase in pH. f

89
Q

Metabolic acidosis causes

A

r/t an excess of acid in the ECF or a loss of buffer, leading to a decrease in pH. Conditions such as hypoxia, immature renal tubular function, or diarrhea; The presence of anion gap helps to differ between conditions

90
Q

Metabolic alkalosis

A

vomiting or diarrhea, or continuous gastric suction can induce (acid losses)

91
Q

Metabolic acidosis in presence of anion gap (>15)

A

acute renal failure, inborn error of metabolism, lactic acidosis, toxins

92
Q

IWL calculation

A

Fluid intake - urine output + weight change

NNP Board Exam Review (19 decks)

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