Need to study! Flashcards
What is included in the SGA? 8 items
wt history, dietary intake, functions status, metabolic demand, GI symptoms; fat stores, muscle stores, and edema
What is included in the Comprehensive Geriatric Tool?
anthropometrics, biochemical markers, and medications. NOT exercise level
Nitrogen end product waste is removed by ___ and ___.
alanine and glutamine
Total body water distribution for extracellular and intracellular? Interstitial and intravascular?
33% and 66% respectively. 75% and 25% respectively
Normal Anion Gap
12 +/- 4
What acid-base disorder is seen with overfeeding?
Respiratory Acidosis
What acid-base disorder is seen in AKIs?
metabolic acidosis
What is the relationship with hyperglycemia and sodium?
Hyperglycemia causes shift of water to outside the cell, leading to dilutional hyponatremia
Which micronutrients are involved in converting homocystine to methionine?
B12, folate, and choline
What inhibits Calcium absorption?
phosphate and oxalates
Vit D supplementation in adults? Pediatrics?
800-1000 IU. 400 IU in Pediatrics
What is a low 25OH-D value?
<20ng/dL
Which vitamin is surprisingly involved in prevention of osteoporosis?
Vitamin K
What is choline used for?
fatty acid transport and metabolism. Low levels seen in hepatic steatosis
Chromium helps with this medication’s action.
Insulin
What is the relationship between Zn, Cu, and Fe?
Zn inhibits copper absorption. Low copper leads to low iron value since it is needed for activation.
Symptoms of low zinc
dysgusia, loss of appetite, poor wound healing
___ and ____ are primarily absorbed in the duodenum.
Iron and Calcium
Folate absorption is decreased with ___ deficiency
Zinc. Folate is absorbed via enterohepatic system.
Cardiomyopathy may be due to deficiency of which micronutrients?
carnitine, Co Q10, thiamine, taurine, selenium, niacin
Methotrexate side affects and main nutrient interaction
can lead to mucocitis, osteoporosis. Needs folate supplementation
Cisplatin- monitor for which electrolyte abnormalities?
Hypokalemia and hypomagnesemia
Tacrolimus is associated with what electrolyte and lab alterations?
low Mg, low K, high gluc; Nephrotoxic
Sirolimus has what effect on lab values?
hypertriglyceridema
Which medications interact with divalent and trivalent minerals, resulting in poor absorption of the medication?
Tetracycline and ciprofloxacin (fluroquinolones)
Valporic acid can lead to a ___ deficiency.
Carnitine (used for transports long-chain fatty acids into the mitochondria so they can be oxidized)
Lab alterations from cyclosporin
hyperkalemia, hypomagnesemia, hyperglycemia, and hypercholesterol
Which medications can have an anorexic affect?
narcotics, histamine receptor antagonists, and antihypertensives
Zinc drug interactions
Floxacins, phos binders, corticosteroids, HCTz; propofol increases Zn losses
Magnesium drug interactions
diuretics, PPI, cyclosporin and cisplatin
What tube materials for TFs have a higher risk of clogging?
silicone
Pros and cons of balloon bolster vs. solid?
Balloon bolster is more comfortable, can be changes at home, but has a shorter life
Goal UOP
1ml/kg/hr
Acetate Cloride ratio goal for PN
1:1
Do not exceed ___ lipid infusion
0.11g/kg/hr; 2.5g/kg/d
What increases Ca Phos solubility in PN?
increase AA, use of CaGluc, lower temp, lower pH.
Lower pH is not suitable for lipids, use a 2 in 1 then
Daily electrolyte requirements in PN
o 1-2mEq/kg Na
o 1-2mEq/kg K+ (goal of <40mEq/L)
o 10-15mEq/d Ca++ (goal of <5mEq/L)
o 8-20 mEq/d Mg
o 20-40 mmol/d Phos
Composition of parenteral vitamin
A: 1mg, D: 5mcg, E: 10mg, K: 150mg
Vitamin C 100mg-200mg
What percent of macronutrients are needed in a PN for stability?
at least 10% dextrose, 4% AA, and 2% lipid
Which drugs are compatible with PN?
Insulin and famotidine
What is included in the Central Line Placement Bundle?
Hand hygiene, maximal barrier precautions, skin antisepsis with chlorhexidine gluconate, optimal catheter site selection, daily review of line necessity
What action do you take if there is or isn’t purulence at the catheter exit site?
Topical antimicrobial agent can be used if there is no purulence from the catheter exit site and no clinical signs of sepsis.
Systemic antimicrobial treatment is used in the presence of purulent drainage
Most common infections for tunneled and non tunneled CVCs?
Tunneled- catheter hub and intraluminal
Nontunneled- extraluminal
Increases risk of PN bone disease?
Aluminum toxicity, low Ca, hypercalciuria, Mg deficiency, high AA provision, Hypo/Hyper Vit D
Signs and treatment of SIADH
euvolemic hyponatremic. Treat with fluid restriction
Signs and treatment of Cerebral salt wasting
hypovolemic hyponatreima; treat with IV Na
Treatment for diabeties insipidus
free water and vasopressin
Ratio for ketogenic diet?
4 fat:1 CHO; monitor Bhydroxybutyrate levels
____ is the most predictive for both severity and outcome of pancreatitis
APACHE II
How long does intestinal adaptation take for SBS?
1-2 years
What diet is recommended for oxalate stones? Why?
low oxalate, low fat, high Ca, increase fluids. Fat competes with oxalate to bind to calcium; unbound oxalate absorbed in colon and excreted in kidney; therefore increases risk for kidney stones
Which micronutrients are of concern for gastric surgery?
B12, Vit C, Vit D; watch for anemia and bone disease
Method to treat proctitis?
SCFA enemas
What is a randomized control trial?
Most rigorous. Random allocation to groups with blinding and equal treatment
What is a case control study?
studies that assess whether exposure is disproportionately distributed between cases and controls
What is an observational study?
relies on studying variables as they naturally occur, without any manipulation from researcher
What is a cohort study?
aka longitudinal study. Group participants have the dependent variable measured several times over time
What is a cross over study?
longitudinal study in which subjects receive a sequence of different treatments. All participants receive the same treatments but differ groups in the order in which they receive them.
What is reliability? Validity?
Reliability is measure of consistent data using the same method. Validity is accurately measures what is trying to be represented
What is specificity vs sensitivity?
Ability of a test to correctly identify people without the disease vs those with the disease
Sensitivity (true positive rate). Specificity (true negative rate)
Type I error?
Conclude a difference exists when it doesn’t. False Positive
Type II error?
Conclude a difference doesn’t exist when it does. False Negative. As sample size increases, type II error decreases
What is considered low birth wt?
<2500g
What is considered SGA?
<10th%
Which growth chart for which age?
Fenton: premature; WHO infant to 2yo; CDC 2yo and up
When can you start using BMI in pediatrics
2 years old
Which group has the highest growth velocity?
Infants
What is the the best marker of nutritional status in pediatric liver disease?
Upper arm circumference
When can kids start drinking cow’s milk?
12months
When start iron supplementation on exclusively breast fed infant?
4-6 months
Protein needs in PICU/NICU?
1.5g/kg for peds; up to 3g/kg for neonates
Neonate nutrition recommendation with chylothroax?
Skimmed HBM or MCT
What is added to ped PN to decrease the pH to allow for more Ca and Phos?
Cystine
What AA is considered essential in infants?
Taurine
Zinc dose in PN
2.5-5 mg/d
Selenium dose in PN
20-40 mcg/d for burns, malabsorption, and critically ill
What percentage of fat needed in diet to prevent EFAD?
4-10%. Need 2-4% linoleic and 0.25-0.5% alpha linolenic
Upper limit of TG for pedicatric pts on ILE
200
Signs of thrombosis
chest pain, ear ache, jaw pain, swelling of arm, shoulder, neck or face
Superior vena cava syndrome signs
SOB, dyspnea, cough, cynosis of face, neck shoulder, arm
If a pt is on this medication and hypokalemic and hypomagenemic, there is a high risk of toxicity
Digoxin because depletion of K and Mg will sensitize the myocardium to digoxin
What medication is associated with SIADH
Setraline (SSRI)
Signs of Mg deficiency
twitches, tremors, cramps
Signs of Vit A deficiency
night blindness
Sulfasalazine drug nutrient interaction
inhibits folate absorption whereas iron inhibits drug absorption
What do you need to supplement if a pt is on phenobarbitol?
Vitamin D
Phenytoin inhibits ___ absorption
folate
Loop diruetics can lead to ___ and ___ losses; and what acid base disorder
Ca and K+; metabolic alkalosis
Digoxin toxicity watch for ___
hypercalcemia; recommend low K+ diet and folate supplementation
Vanco is a ____ medication; if clog IV line need to use ___ to unclog
acidic; HCl acid
Phenytoin is a ____ medication; if clog the IV line, need to use ____ to unclog
basic; NaBicarb
Overfeeding leads to what acid base disorder
respiratory acidosis
Renal failure is associated with what acid base disorder
metabolic acidosis
Use of diuretics can lead to what acid base disorder
metabolic alkalosis from Cl losses
