Jesus lord of glory help me

Question 1

how to get fat mls from kcals

Answer 1

divide by 1.1

Question 2

Osmolarity

Answer 2

dextose grams x 5 + protien grams x 10 / volume if given

Question 3

dextrose load

Answer 3

dextrose grams x 1000/ weight in kg/ min in a day 1440

Question 4

fat load

Answer 4

fat grams / weight in kg

Question 5

normal range of fat load

Answer 5

1 - 2.5

Question 6

normal range of dextrose load

Answer 6

2-5

3.5 for diabetes

Question 7

Enteral versus parenteral characteristics

Answer 7

Enteral nutrition: provision of nutrients into the GI tract through a tube or catheter when oral intake is inadequate (may include formulas as oral supplements or meal replacements)
Parenteral nutrition: provision of nutrients intravenously

Question 8

Enteral formula characteristics/types

Answer 8

Standard polymeric formulas
Lactose-free, 1 kcal/mL with a balanced CHO, fat, and protein
Concentrated standard formulas: 1.5 to 2 kcal/mL for fluid restriction
High-nitrogen formulas (18%‒25% of calories
Increased protein requirements: burns, fistulas, sepsis, trauma
Elemental or predigested formulas
When the GI tract is compromised and polymeric formula is not tolerated
Specialized or disease-specific formulas
Aimed at a specific disease associated problem (e.g., renal products)
Predigested formulas
Fat is primarily MCT
Protein fragments: dipeptides, tripeptides, or oligopeptides
Disease specific (can be polymeric or predigested)
Modular components

Protein
Intact vs. hydrolyzed affect osmolarity
High protein
Glutamine and arginine
Carbohydrate
30% to 90% of kilocalories
Source and degree of hydrolysis affect osmolarity
Lactose is not used
Addition of fiber
lipid
1.5% to 55% of kilocalories
2% to 4% as linoleic acid
Vitamins, minerals, and electrolytes
DRIs; modified for specific formulas
Fluid
1 kcal/mL formulas are about 80% water
Amount of water depends on calorie density
Provide additional water via tube as needed

Question 9

When to use parenteral over enteral nutrition and vice versa

Answer 9

Enteral nutrition
For those who can’t eat or can’t eat enough
Should be first consideration
Parenteral nutrition
Reserved for nonfunctional or severely diminished small bowel

Question 10

RQ

Answer 10

Over feeding intake of carbon dioxide over outtake

Question 11

Common causes of TF intolerance

Answer 11

High residual
Abdominal dissention
Pain
Diarrhea

Question 12

When is elemental formulas recommended?

Answer 12

Elemental or predigested formulas

When the GI tract is compromised and polymeric formula is not tolerated

Question 13

300-500mOsm = isotonic know the difference between iso & hypertonic (which is
better tolerated?)

Answer 13

iso

Question 14

Enteral tube options, and their characteristics

Answer 14

NGT: normal digestive, hormonal and bactericidal processes of stomach. Less risk complications

Tubing: soft, flexible and well-tomerated polyurethan or silicone tubes

Placed at bedside by nursing or possibly trained RD. Check placement by aspirating GI contents or XR confirmation.

Post-pyloric tube (NDT or NJT) = more complicated to insert (intraoperative, endoscopic or fluroscopic guidance, spontaneous placement via peristalsis, bedside with computer guidance)
Indicated if problems with gastric feeding: abdominal distention/discomfort, vomiting, persistent high gastric residuals (>400 ml). ? Higher risk for aspiration pnemonia

Question 15

How you can maintain the patency of enteral access devices?

Answer 15

Flushing
No food
Nothing that’s not reccomened

Question 16

When is the post-pyloric TF recommended?

Answer 16

Gastric motility disorders, esophageal reflux, or persistent nausea and vomiting
Gastric pyres is
Stomach not emptying
High residuals or nausea 
Unable to be elevated

Question 17

Labs for monitoring enteral and parenteral complications

Answer 17

weight
Signs and symptoms of edema (daily)
Signs and symptoms of dehydration (daily)
Fluid intake and output (daily)
Adequacy of enteral intake (at least two times/wk)
Abdominal distension and discomfort
Gastric residuals (every 4 hr) if appropriate
Serum glucose, Calcium, electrolytes, blood urea nitrogen, creatinine (two or three times/wk)
Stool output and consistency (daily)

Question 18

Peripheral vs. central catheters for parenteral feeding.

Answer 18

Central parenteral nutrition ( CPN): catheter in large, high-blood-flow vein such as superior vena cava
Peripheral parenteral nutrition (PPN): catheter in small vein, typically the arm
Short term
Cannot tolerate concentrated solutions

Question 19

Explain the complications of feeding excess fat to a patient on parenteral feeding

Answer 19

Fatty liver

Question 20

What are some strategies to avoid aspiration?

Answer 20

Nevertheless, to minimize the risk of aspiration, patients should be posi- tioned with their heads and shoulders above their chests during and immediately after feeding.

Question 21

How many days a patient can be NPO or inadequate oral intake before ASPEN
recommends to initiate nutrition support?

Answer 21

5-10 days

24-48 critical ICUs

Question 22

How you will taper a TF to oral intake? (starting and stopping guidelines)

Answer 22

Parenteral to enteral
Takes 2 to 3 days
Stop parenteral when enteral reaches 75%
Parenteral to oral
Stop parenteral when oral reaches 75%
Enteral to oral
Reduce enteral to night only to reestablish hunger or satiety cues

Question 23

Know when bolus feeding or continuous feeding is recommended?

Answer 23

bolus is the _feeding modality of choice when patients are clinically stablewith a functional stomach is the syringe bolus method.
continuous drip infusion of formula requiresa pump. This method is appropriate for patients who do not tolerate large-volume infusions during a given feeding such asthose occurring with bolus or intermittent methods.

Question 24

Reefeding syndrome

Answer 24

Caused by overly aggressive parenteral nutrition, specifically carbohydrate
Potentially lethal
Cardiac and pulmonary complications from fluid overload
Monitor serum magnesium, potassium, and phosphorus
Start with 25% to 50% of goal parenteral nutrition in those at risk

refeedingsyndromelowserumlevelsofpotassiumm,agne- sium, and phosphoruswirh severe,potentially lethal out- c o m e t h a t r e s u l t sf r o m t h e t o o - r a p i d i n f u s i o n o f s u b s t r a t e s , particularlycarbohydrate,into the plasmawith the conse- quent releaseof insulin and shift of electrolytesinto the intracellularspaceasglucosemovesinto the cellsfor oxida- tion andthereis reductionin saltandwaterexcretio

Question 25

Ileus

Answer 25

Ileus (lack of peristalsis); enteral feeding restores gut function

ileus lossofintestinal peristalsisor lackof effectivecoordi- nated peristalsis

Question 26

Diarrhea

Answer 26

high osmolarity

Question 27

Hyperglycemia

Answer 27

too many carbs

Question 28

1. Know the characteristics of ebb and flow phase

Answer 28

ebb
Immediate: hypovolemia, shock, tissue hypoxia
Decreased cardiac output
Decreased oxygen consumption
Lowered body temperature
Insulin levels decrease because glucagon is elevated

flow phase
Follows fluid resuscitation and restoration of oxygen transport
Increased cardiac output begins
Increased body temperature
Increased energy expenditure
Total body protein catabolism begins
Marked increases in glucose production, FFA release, circulating insulin, catecholamines, glucagon, and cortisol

Question 29

Explain the difference between stress and starvation

Answer 29

Metabolic response to stress differs from the responses to starvation
Starvation = decreased energy expenditure, use of alternative fuels, decreased protein wasting, stored glycogen used in 24 hours
Late starvation = fatty acids, ketones, and glycerol provide energy for all tissues except brain, nervous system, and RBCs

Question 30

Know the classifications of Glasgow Coma Score

Answer 30

A score of 13 to 15 indicates minor head injury; 9 to 12 corresponds to moderate injury; and a less than 8 reflects severe injury

Question 31

Burns:
Use 1997 Ireton-Jones formula, protein requirements: 1.5-2
gm/kg. Also what percentage of the total calories should come
from protein? Know how to calculate extra protein based on the
wound nitrogen losses

Answer 31

Ireton-Jones calculation for estimated energy expenditures
EEE = 1784 – 11(A) + 5(W) + 244(G) + 239(T) + 804(B)
A = age
W = weight (kg)
G = gender (female = 0; male = 1)
T = diagnosis of trauma (absent = 0; present = 1)
B = diagnosis of burn (absent = 0; present = 1)

20% to 25% kcal as protein needed; high BV
Estimation of wound nitrogen losses when calculating nitrogen balance
– 31% open wound = 0.12 g N/kg/day
answers are in the notebook

Question 32

What are cytokines and which are elevated during stress?

Answer 32

The response to injury is also regulated by metaboli- cally active cytokines (proinflammatory proteins) such as interleukin-1, interleukin-6, and tumor necrosis factor,

Question 33

What is sepsis?

Answer 33

the systemic response to an identifiable infectious agents

Question 34

What is bacteria translocation?

Answer 34

morphologic changes from acute insult to the gastrointestinal uact that may allow entry of bacteria from the gut lumen into the body; associatedwith a systemic inflammatory response that may contribute to multiple organ dysfunction s1’ndrome

Question 35

What is SIRS?

Answer 35

SIRS is the inflammatory response that occurs in infection, pancreatitis, ischemia, burns, multiple trauma, hemorrhagic shock, and organ injury

Question 36

What is the type of diet recommended before surgery?

Answer 36

well nourished or w/e

Question 37

For how many hours the person should be NPO before

surgery?

Answer 37

6