Need to study! Flashcards by DJ Shaw

What is included in the SGA? 8 items

wt history, dietary intake, functions status, metabolic demand, GI symptoms; fat stores, muscle stores, and edema

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What is included in the Comprehensive Geriatric Tool?

anthropometrics, biochemical markers, and medications. NOT exercise level

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Nitrogen end product waste is removed by ___ and ___.

alanine and glutamine

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Total body water distribution for extracellular and intracellular? Interstitial and intravascular?

33% and 66% respectively. 75% and 25% respectively

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Normal Anion Gap

12 +/- 4

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What acid-base disorder is seen with overfeeding?

Respiratory Acidosis

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What acid-base disorder is seen in AKIs?

metabolic acidosis

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What is the relationship with hyperglycemia and sodium?

Hyperglycemia causes shift of water to outside the cell, leading to dilutional hyponatremia

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Which micronutrients are involved in converting homocystine to methionine?

B12, folate, and choline

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What inhibits Calcium absorption?

phosphate and oxalates

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Vit D supplementation in adults? Pediatrics?

800-1000 IU. 400 IU in Pediatrics

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What is a low 25OH-D value?

<20ng/dL

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Which vitamin is surprisingly involved in prevention of osteoporosis?

Vitamin K

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What is choline used for?

fatty acid transport and metabolism. Low levels seen in hepatic steatosis

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Chromium helps with this medication’s action.

Insulin

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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.

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Symptoms of low zinc

dysgusia, loss of appetite, poor wound healing

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___ and ____ are primarily absorbed in the duodenum.

Iron and Calcium

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Folate absorption is decreased with ___ deficiency

Zinc. Folate is absorbed via enterohepatic system.

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Cardiomyopathy may be due to deficiency of which micronutrients?

carnitine, Co Q10, thiamine, taurine, selenium, niacin

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Methotrexate side affects and main nutrient interaction

can lead to mucocitis, osteoporosis. Needs folate supplementation

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Cisplatin- monitor for which electrolyte abnormalities?

Hypokalemia and hypomagnesemia

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Tacrolimus is associated with what electrolyte and lab alterations?

low Mg, low K, high gluc; Nephrotoxic

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Sirolimus has what effect on lab values?

hypertriglyceridema

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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