Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

PR4152 > IC7 > Flashcards

IC7 Flashcards

1
Q

What is the role of nutrition support in multi-morbid patients

A

prevent malnutrition which prevents
1. increased complications
2. poor wound healing
3. compromised immune status
4. impairment of organ functions
5. increased mortality
6. increased use of healthcare resources

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

nutrition screening

A

using 3min-NS, to all patients,
weight loss, daily intake, muscle wastage

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

routes of nutrition administration

A
  1. enteral nutrition
    - pre-pyloric(nasal/stomy)
    - post-pyloric(nasal/stomy)
    - bolus/ continuous
  2. parenteral access
    - peripheral
    - central
    a) non-tunnelled central venous catheter
    b) tunnelled central venous catheter
    c) peripherally inserted central catheter
    d) port-a-cath
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

nutrition assessment

A

using the -point subjective global assessment(SGA)
- A(height and weight)
- B(biochem- electrolytes, albumin)
- C(clinical - PMH/Med/PE)
- D(Diet history)

1 is the worst

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

monitoring parameters

A
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

potential complications of nutrition therapy

A
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

common causes of malnutrition

A
  1. cancer - chemo, taste alteration, n/v
  2. ascitis - pressure on GI, stomach cannot expand
  3. conditions that affects nutrients absorption
  4. body under stress from surgey/burn
  5. increased nutrients loss from renal dialysis
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

energy requirements

A

in kcal
depends on resting, physical activity, stress factor
measurement: indirect calorimetety, weight based(25-35 for general hospitalized), predictive(only basal)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

protein requirements

A

in g

healthy adult: 0.8g/kg/day

trauma/surgery/burn: 1.5 - 2g/kg/day

sepsis/critical illness: 1.5 - 2, up to 2.5g/kg/day

CKD (not on dialysis): 0.6-0.8

CKD(on HD/PD): 1.2

CKD(CRRT): up to 2

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

pre-pyloric pros and cons

A
  1. more physiologic
  2. high tolerance to bolus feeding
  3. wide range of enteral products
  4. used for venting to remove gastric

cons: not used for feeding in those with delayed gastric emptying

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

post pyloric pros and cons

A
  1. smaller bore, less discomfort
    2.. used when there is dysfunction of GI
  2. minimize aspiration risk

cons: higher risk of tube clogging

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

pros and cons of bolus administration

A
  1. more physiologic
  2. no pump required
  3. greater freedom for ambulation
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

pros and cons of continuous administration

A
  1. pump assisted at a constant rate
  2. better tolerated(less bloating/discomfort)
  3. lower risk of aspiration
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

examples of disease specific formulas

A

DM - glucerna 1kcal/ml

conditions with increased energy and protein needs - Fresubin protein energy 1.5kcal/ml

Renal, on dialysis - Nepro HP 1.8kcal/ml

Renal, not on dialysis - Nepro LP1.8kcal/ml

Inflammatory diseases, cancer - NutriFriend 1kcal/ml

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Types of EN formula

A
  1. modular - to enhance a specific nutrient component
  2. (Semi) elemental - for impaired GI
  3. Polymeric - with sufficient GI function
  4. disease-specific
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

administration of incompatible drugs in EH feed may cause

A
  1. precipitation
  2. curdling, clumping of protein in acidic
  3. alteration of dosage form
  4. DDI with fluroquinolone(cipro)
16
Q

common complications of EN feeding

A
  1. occlusion of feeding tube
  2. tube migration
  3. infections esp if dilute feed with h20
  4. aspiration
  5. nausea and vomiting
  6. diarrhea and constipation
  7. Refeeding syndrome
17
Q

how to prevent and mitigate DNI

A

flush access before and after administration, use alternatives

18
Q

strategies to maximise tolerance to EN

A
  1. continuous instead of bolus
  2. use of prokinetic agents(metoclopramide, domperidone, IV erythromycin)
  3. Post-pyloric
  4. use of isotonic formula
  5. semi-elemental/ elemental feeds for those with malabsorption issue
19
Q

why is EN preferred over PN

A
  1. maintain functional integrity of the gut
  2. undergo first pass metabolism, promote efficient nutrient utilization
  3. maintains normal gallbladder function
  4. maintain gut-associated lymphoid tissues
  5. less complications than PN - IFLAD
  6. Less expensive
20
Q

peripheral parental access VS central access

A

P:
- tip is outside of central vessels
- requires freq resite
- nutrient delivery limited by osmolarity and concentration

C:
- position in large bore blood vessels
- can be use in long term care

21
Q

which electrolytes are known to cause precipitation

A

calcium and phosphate

22
Q

what make lipid solution not stable

A

acidic ph, esp in dextrose solution which is pH2

23
Q

administration of incompatible drugs in PN feed may cause

A
  1. precipitation
  2. loss of drug activity
  3. phase separation of lipid emulsions
  4. toxicity
24
Q

device related complications

A
  1. Occlusions in IV catheter
  2. Mal-positioning
  3. Catheter-related bloodstream infection
25
Q

metabolic complications

A
  • refeeding syndrome
  • hyper/hypoglycemia
  • fluid overload
  • intestinal failure associated liver disease(IFALD)
  • metabolic bone disease
26
Q

refeeding syndrome

A

hypokalemia
hypomagnesemia
hypophosphatemia
thiamine deficiency
salt and water retention - edema

27
Q

complications of refeeding syndrome

A

arrhythmias, cardiac failure, neuromuscular complications

28
Q

Management of refeeding syndrome

A
  1. identify high risk patients
  2. check serum electrolytes at baseline
  3. correct deficiencies prior to feeding
  4. administer thiamine vit B1 - 100mg od 5/7
  5. initiate slow and low
  6. continue to monitor electrolytes
29
Q

what is determined as high risk patients

A

one of the following:
1. BMI<16
2. unintentional weight loss>15% in past 3-6 months
3. little/no nutritional intake > 10 days
4. low levels of K, Mg, Phosphate before feeding

at least 2 of the following:
1. BMI<18.5
2. unintentional weight loss > 10% in past 3-6 months
3. little/no nutritional intake > 5 days
4. History of alcohol misuse OR Drugs(insulin, antacid, chemo, diuretic)

30
Q
A
30
Q

TPN and TNA

A

TPN: bags w/o fats
TNA: 3 in 1 TPN - more incompatible as it has lipids

PR4152 (3 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions