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NUTR 442 > Krause ch 13: Nutr support > Flashcards

Krause ch 13: Nutr support Flashcards

1
Q

what is EN?

A

nutr provided thru GI tract via catheter/tube or stoma that delivers nutrients distal to oral cavity

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2
Q

in ICU pt, feeding the GIT has been shown to attenuate ____ and preserve ____ function

A

catabolic response; immune

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3
Q

less septic morbidity, infectious complications, cost in critically ill who receive ____ instead of ___

A

EN; PN

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4
Q

undesirable risks/outcomes referred to as:

A

sentinel events

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5
Q

EN access selection depends on:

A

1) anticipated length of time required 2) degree of risk for aspiration/displacement 3) clinical status 4) adequacy digestion/absorption 5) pt anatomy 6) future surgery planned

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6
Q

one french size is ___ mm

A

0.33

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7
Q

potential complications of nasoenteric tubes

A

esophageal strictures, gastroesophageal reflux resulting in aspiration pneumonia, fistula, injury, mucosa damage, nasal irritation, paralysis, inflammation, varices, ulcerations

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8
Q

nonsurgical technique for placing tube directly into stomach thru ab wall using endoscope

A

PEG/PEJ

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9
Q

PEG tubes flush to the skin (low profile) known as:

A

buttons

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10
Q

PEG can be converted to ____ using fluoroscopy or endoscopy by threading small bore tube thru larger tube into jejumum

A

gastrojejunostomy

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11
Q

alternative options for EN access:

A

laparoscopic/fluoroscopic techniques

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12
Q

tubes used for pt where prolonged gastrointestinal decompression is anticipated

A

gastrojejunal dual tubes

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13
Q

how does multiple lumen tube work?

A

one lumen for decompression, one to feed into small bowel

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14
Q

blendereized (homemade) tube feeds are contraindicated for these pts:

A

immunocompromised, infusion thru tube smaller than 10 French, continuous feeding, fluid resctriction <900mL/d, multi food allergies, JT is used

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15
Q

what is PBGT diet?

A

specialized balanced blended food feeding given by g tube in small boluses to decrease symptoms of retching/gagging which can be complication of certain surgery, improve tolerance of bolus feeds for ppl who are volume sensitive

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16
Q

____ (a.a.) has been added to formulas marketed for critically ill pt

A

arginine

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17
Q

CHO in EN is usually ____ in standard, ___ in flavoured formulas, _____ for hydrolyzed

A

corn syrup solids; sucrose; cornstarch/maltodextrin

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18
Q

these prebiotics have been added to EN formulas in combo with diet fibre cuz stim production of beneficial bacteria (good changes in colon pH , microbiota, SCFA)

A

fructooligosaccharides (FOS)

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19
Q

elemental formulas contain less fat, usually in this form:

A

MCT

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20
Q

____ lipids are absorbed more readily/better tolerated than LCT/MCT combos

A

structured

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21
Q

does MCT have essential fatty acid?

A

nope

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22
Q

what is a fibre bezoar?

A

hard ball of hair/veg fibre that can develop in stomach

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23
Q

closed vs open EN system?

A

container is prefilled with sterile liquid formula by manufacturer, ready to feed after connection; contents of formula poured into separate empty container and then connected

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24
Q

length of time EN formula hanging at room temp is considered safe for delivery

A

hang time

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25
Q

how to do gravity feeding?

A

pour formula into feeding bag equipped w/ roller clamp, adjusted to desired drips per min.

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26
Q

pt with feeding tube tip in ____ should be fed ONLY by continuous or cyclic

A

small intestine

27
Q

in critically ill tube fed pt the best methods for reducing aspiration risk is:

A

HOB elevation, continuous subglottic suctioning, oral decontamination

28
Q

why predigested formula not best first line option for diarrhea?

A

formula often not cause of diarrhea

29
Q

how can diarrhea and constipation coexist?

A

fecal impaction cuz liquid stool can get past impaction

30
Q

CPN refers to catheter tip placement in ____ whereas PPN is catheter tip placement in ____

A

large, high blood flow vein (eg. superior vena cava); small vein (eg. hand/forearm)

31
Q

ppl who are not good candidates for PPN?

A

volume-sensitive, cardiopulmonary, renal, hepatic failure

32
Q

osmolarity is used to calculate ____ while osmolality is used for body fluids

A

IV fluids

33
Q

PPn most often provided thru catheters called _____ catheters

A

midline; midclavicular

34
Q

this type of catheter needs a large vein

A

extended dwell catheters

35
Q

is single lumen or multi lumen catheter best for CPN?

A

single lumen

36
Q

this catheter inserted into vein in antecubital area of arm, threaded into subclavian vein (catheter tip placed in superior vena cava)

A

peripherally inserted central catheter (PICC)

37
Q

commonly used long term catheter for CPN?

A

tunneled catheter

38
Q

a.a. conditionally essential in infants:

A

taurine

39
Q

CHO in PN supplied as ___ which yields ____kcal/g

A

dextrose monohydrate; 3.4

40
Q

max rate of CHO administration:

A

5-6 mg/kg/min (critically ill)

41
Q

^ CHO admin can lead to:

A

hyperglycemia, hepatic probs, ^ ventilatory drive

42
Q

lipid admin should not exceed ____g/kg/d

A

1-1.5

43
Q

10% lipid emulsion contains ___kcal/mL, 20% has ___kcal/mL

A

1.1; 2

44
Q

all lipid emulsions should be administered thru ___ micron filter set

A

1.2

45
Q

monitoring of ____ and ___ status recommended for pt receiving PN >6 months

A

manganese; chromium

46
Q

why iron not normally part of PN infusion?

A

not compatible with lipids, may enhance certain bacterial growth

47
Q

PN solution can be ____ or use ___ bags

A

compounded; multichamber bags

48
Q

most common drug additives to PN:

A

insulin; histamine-2 agonists

49
Q

why not abruptly stop CPN with high dextrose concentration?

A

potential for rebound hypoglycemia

50
Q

primary complication of PN?

A

infection

51
Q

signs of infection:

A

tachycardia, sudden hyperglycemia, elevated WBC, chills, fever

52
Q

maintenance of adequate BP is called:

A

hemodynamic stability

53
Q

types of PN complications:

A

mechanical, infection/sepsis, metabolic, GI

54
Q

why refeeding syndrome happen?

A

new tissue requires ^ amt glucose/K/P/Mg for growth but if intracell electrolytes not supplied sufficiently to keep up with growth, low serum K/P/Mg develop; also CHO metabolism cause shift of electrolytes to intracellular space as glucose moves into cell for oxidation

55
Q

rapid infusion of CHO stim ___ release, which reduces ____ excretion and increases chance of cardio/pulmonary complications (fluid overload)

A

insulin; water/sodium

56
Q

common nutr diagnoses for refeeding syndrome:

A

excessive CHO intake or excess infusion from EN or PN

57
Q

initial oral diets in transitional feeds should be low in ____

A

simple CHO and fat, lactose (reduce chance osmotic diarrhea)

58
Q

at least ___% of nutr needs should be met consistently by oral intake before PN d/c

A

75

59
Q

why move from continuous feed to 12- and 8- hour formula admin cycle?

A

reestablish hunger/satiety cues for oral intake during day

60
Q

fat sources in ONS are often ____

A

long chain TG

61
Q

health care in LTC focuses on:

A

QoL, self determination, management acute/chronic disease

62
Q

legal docs that residents use to state preferences about aspects of care, including those regarding use of nutr support

A

advance directives

63
Q

best tube for home feed?

A

not nasal, use PEG (PEJ good for ppl who need postpyloric feedings)

64
Q

best admin for home feed?

A

bolus (if not tolerated, then gravity)

NUTR 442 (34 decks)

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