MNT 2 - Final Exam

Question 1

What is the mortality of CVD with Renal Dz?

Answer 1

• More likely to die from CVD than progress to stage 4 CKD
• Approx. 50% deaths due to CVD in HD & PD pts.
• NO Statin drugs with Dialysis
• High rates: Heart failure, LVH, atherosclerosis
• Accelerated atherogenesis with dialysis

Question 2

What are the “non-traditional” risk factors with dialysis?

Answer 2

• Abnormalities in lipid metabolism
• Hyperparathyroidism
• Ca & P imbalances
• Vascular Calcification
• Malnutrition
• Oxidative stress/ inflammation

Question 3

Why is CRP elevated with dialysis?

Answer 3

• reflects pro-inflammatory cytokines which predict decreased ser alb/ assoc. with malnutrition in dialysis
• Assoc. with increased CV mortality

Question 4

What is the additional MNT recommendation with CVD and dialysis?

Answer 4

-Additional MNT recommendations: omega-3 foods twice/week

Question 5

What can Secondary Hyperparathyroidism (SHPT) progress to?

Answer 5

• Can progress to severe, intractable forms of bone disease
• Phosphorous is NO longer being removed
• Parathyroid gland may need to be removed to limit complication’s

Question 6

What is Osteitis Fibrosa?

Answer 6

• *Prolonged PTH exposure
• Rapid bone turnover
• Excess collagen/ inadequate mineralization
• More prone to fracture
• Vascular & soft tissue calcification

Question 7

How is SHPT managed?

Answer 7

• Restrict dietary phosphorus
• Phosphate binders
• Vitamin supp. (oral or IV)- dosed to prevent over/under suppression of PTH
• Close monitoring serum levels

Question 8

What causes Anemia with Renal Dz?

Answer 8

Low Hgb due to:

• Inadequate synthesis
• Blood loss w/ HD

Question 9

How is anemia treated?

Answer 9

• Treatment with rHuEPO and iron
• Administration IV or SC- HD vs PD
• Adequate Fe important

Question 10

What can result from EPO unresponsiveness?

Answer 10

• Fe deficiency
• Malnutrition
• Infections
• Chronic inflammation
• SHPT
• Chronic blood loss
• Folate / B12 deficiency

Question 11

What are sources of IRON for with Peritoneal Dialysis?

Answer 11

• Ferrous gluconate
• Ferrous sulfate
• Ferrous fumarate
• Polysaccharide-iron complex
• Heme iron polypeptide

Question 12

What must be considered with iron supplementation?

Answer 12

• Directions for administration
• Effect of Fe stores on absorption
• Side effects of oral Fe supplements

Question 13

What is Parenteral Nutrition?

Answer 13

-Feeding a person intravenously, bypassing the usual process of eating and digestion. The person receives nutritional formulae that contain nutrients such as glucose, amino acids, lipids and added vitamins and dietary minerals.

• When it was developed: 1960’s
• Alternate names: TPN, CVN, IVH

Question 14

What is Peripheral Parenteral Nutrition?

Answer 14

• Provided through a PERIPHERAL VEIN → amino acids, electrolytes
• More dilute, lge volume solutions than TPN

Question 15

What is Total Parenteral Nutrition?

Answer 15

• Provided through a CENTRAL VEIN
• Large Volume of blood can dilute conc.
• Provides Amino Acids, Dextrose, Lipids, Electrolytes, MVI

Question 16

What formula is used for PPN?

Answer 16

• *ProcalAmine
• formula via IV – peripheral vein;
• Used for
  1. maintenance electrolytes
  2. improved nitrogen balance in mildly catabolic patients

Question 17

What is provided by 1 liter of ProcalAmine?

Answer 17

• 29 g protein
• 130 kcals
• Standard electrolytes
• 735 mOsm

Question 18

When should TPN be used?

Answer 18

For FLUID RESTRICTED patients who cannot be fed via GI tract (food or EN) = MUST use TPN

• This is because:
  1. Decreasing the fluid will increase the osmolarity = inappropriate to use PPN
  2. PERIPHERAL veins are SMALL = must limit to 900 mOsm/L.
  3. CENTRAL veins are much LARGER and can handle much higher osmolarity.

Question 19

What are Normal Saline IV Fluids?

Answer 19

NS = normal saline
— Contains 0.9% NaCl in water
— 280-300 mOsm/L

Question 20

What are D5W IV Fluids?

Answer 20

D5W = 5% dextrose in water
— Provides 50 g dextrose/L
— 250 mOsm/L

Question 21

What are D5W 1/2 NS IV Fluids?

Answer 21

D5W ½ NS = 5% dextrose in ½ normal saline
— Contains 0.45% NaCl
— Provides 50 g dextrose/L
— 400 mOsm/L

Question 22

What must be considered with IV Fluids?

Answer 22

Osmolarity from IVFs may count toward osmolarity for PPN → if the IVFs and PPN are going into the same vein!

Question 23

Why can water NOT be used in IVs?

Answer 23

**FYI – pure water CANNOT be used for IVFs because the osmotic pull of fluid into RBCs would cause the cells to swell and burst

Question 24

What should be considered when determining needs for PN?

Answer 24

1. Functional GI tract?
2. Are complete nutrition needs being met via oral diet or TF?
3. Can patient afford to wait to see if oral/TF is possible before initiating PN?
4. Does patient already have a central line? (Could be the difference between choosing PPN and TPN)

Question 25

What are the needs for patients on PPN?

Answer 25

• Patient needs supplemental nutrition now, but EN not feasible/ risk for TPN is too high
• PN needed for 2 weeks or less
• Adjunct to oral/enteral feeds (complete needs can’t be met via GI tract)
• *ProcalAmine is sometimes an easy option if you only need to sustain your patient for a few days

Question 26

What are the needs for patients on TPN?

Answer 26

• Oral/EN likely not feasible to meet full nutritional needs > 2 weeks
• Need for nutrients outweighs risks of TPN (severe protein-energy malnutrition)

Question 27

What medical conditions would warrant used of PN?

Answer 27

• Short bowel syndrome
• Small bowel resection
• Bowel obstruction
• Ileus
• Intractable vomiting
• Risk for aspiration – even with EN (rare)
• IBD

Question 28

What nutrition diagnoses would require PN use?

Answer 28

• Altered GI function
• Impaired nutrient utilization
• Inadequate/excessive parenteral nutrition infusion (use only when changing infusion)