nutrition

Question 1

what is the function of electrolytes

Answer 1

-maintain electrical neutrality and conduct action potentials in nerves and muscles
-help move nutrients into body cells and move waste out of the body
-maintain a healthy water balance
-help stabilize the the bodies’ acid/base pH

Question 2

what is the function of Na

Answer 2

-main extracellular ion
-maintains fluid balance
-plays a major role in action potential of nerve and muscle cells
*regulation: RAAS causes Na reabsorption
natriuretic hormone causes Na excretion
135-145 mmol/L

Question 3

what are the signs and causes of hyponatremia

Answer 3

causes: low Na intake, vomiting, diarrhea, SIADH, diuretics, renal and liver disease
signs: seizures, come, vomitng, headache, respiratory arrest

Question 4

what are the causes and signs of hypernatremia

Answer 4

-unreplaced fliud loss via skin
-fluid loss via GI tract
-hypertonic saline administration
-hypertonic tube feeding
-OTC meds with lots of salt
signs: dehydration, tachycardia, disorientation,

Question 5

what is the function of K

Answer 5

-intracellular
-3.5-5.3
-maintain cell function
-Na K ATPase (pumps K into the cell)
-regulates heart and muscle contraction
*regulation: insulin and beta 2 agonists shift K into cells
-stimulation of alpha adrenoceptors release K from cells

Question 6

what are the causes and signs of hypokalemia

Answer 6

• hyperaldosteronism (thiazide/loop diuretcis, heart failure, cirrhosis)
  -K moves into cells (beta agonists, metabolic alkalosis)
  signs: bradycardia, low BG, fainting, muscle weakness

Question 7

what are the causes and signs of hyperkalemia

Answer 7

-kidney disease
-crush injury
-drugs (ACEi, angiotensin agonists, potassium sparing diuretics, aldosterone blockers)
-metabolic acidosis
-signs: bradycardis, low BG, respiratory failure, diarrhea

Question 8

what is the function of calcium

Answer 8

-help release hormones and neutransmiters
-muscle contraction, enzyme activity, nerve function, blood clotting, cell division,
-most calcium is incorporated in bones
-10% is complexed with phosphate and citrate and the remainder is bound to albumin
-levels controlled by PTH and Vit D
-2.2-2.6

Question 9

what are the causes and signs of hypocalcemia

Answer 9

-low PTH or Vit D
-sepsis
-alcoholism
-acute pancreatitis
signs: spasms, seizures, anxious, dermatitis, impetigo, cardiomyopathy

Question 10

what are the causes and signs of hypercalcemia

Answer 10

-Vit D overdose
-hyperparathyroidism
-malignancy
-carcinoma of lung
-chronic kidney disease
sign: kidney stones, dehydration, constipation, bone pain

Question 11

what is the function of phosphate

Answer 11

-anion located in bone
-strength and rigidity to bone and teeth
-energy production (component of ATP)
-Cellular signaling (activation of enzymes and regulation of gene expression)
-acts as a buffer for hydrogen

Question 12

what are the causes and signs of hyposphatemia

Answer 12

-nutritional deficiency
-meds (antacids, diuretics, chemotherapy)
-alcoholism
-hormonal imbalances (hyperparathyroidism, growth hormone deficiency)
-malabsorption syndromes (chrohn’s disease)
-respiratory alkalosis
signs: constipation, muscle weakness, bone pain, respiratory and cardiac issues

Question 13

what are the causes and signs of hyperphosphatemia

Answer 13

-hypoparathyroidism
-hypothyroidism
-excessive phosphate intake
-meds that contain phosphate
-tumor lysis syndrome
-signs: calcium imbalances, renal complications, boe and joint issues, cardiovascular complications, neuromascular abnormalities

Question 14

what is the function of Mg

Answer 14

-intracellular cation that acts as a cofactor in enzymatic reactions
-involved in ATP metabolism
-involved in neurological functioning and neurotransmitter release
-muscle contraction (Mg makes Ca uptake by sarcoplasmic reticulum)
-DNA and RNA stability

Question 15

causes and signs of hypomagnesemia

Answer 15

-inadequate intake
-malabsorption disorder
-alcoholism
-diuretics and PPIs
signs: muscles and nerves more excitable
-abnormal eye movement
-seizures
-abnormal heart rhythm

Question 16

what are the causes and signs of

Answer 16

-excessive Mg intake
-Mg containing medications
-hypothyroidism
-kidney dysfunction
signs: nausea and vomiting
weakness, hypotension, confusion, respiratory depression, abnormal heart rhythm

Question 17

what is the physiology of fluid overload

Answer 17

-ascites (peritoneal cavity fills with fluid)
-pleural effusion (lungs)
-pericardial effusion
-joint effusion
treatment: draining and furesomide

Question 18

what are the symptoms of fluid overload

Answer 18

-tachycardia
-hypertension
-wet mucous membrane
-warm oedematous skin
-increased peripheral and pulmonary oedema
-weigh gain

Question 19

how to assess if patient is hypo or hypervolimic

Answer 19

-fluid balance (fluid hey drink and excrete)
-blood pressure, heart rate
-capillary refill time
-NEWS score
-passive leg raising (if it fixes blood pressure, it’s a fluid issue)
-serum electrolytes

Question 20

what are the resuscitation steps

Answer 20

-isotonic fluids: 500ml over 15 minutes, repeat up to 4 times
-use crystalloids that contain sodium in range 130-154
-consider human albumin solution only in severe sepsis

Question 21

what are the routine maintenance steps

Answer 21

-25-30ml/kg/day of water
-1 ml/kg/day of K, Na, Cl
-50-100g/day of glucose
-give less fluids to older patients, cardiac failure or renal impairment
-re-assess daily

Question 22

what is the treatment of hyperkalemia

Answer 22

-calcium gluconate: reduce arrythmias by antagonizing 30ml over 5 minutes (protect cardiac myocytes)
- rapid acting insulin (10 units in 50ml of 50% over 15 minutes)
-salbutamol 10-20mg to be nebulised
-sodium zirconium cyclosilicate 10mg PO

Question 23

what is the composition of TPN

Answer 23

-Dextrose (D-glucose)
-lipids (soybean, glycerol and egg phospholipid)
-proteins (aminosin, travasol, novamine, heptamine)
L-amino acids and glitamic acid (no glumate)
-electrolytes (Mg, K, Ca, Cl, Na)
-phosphate
-vitamins
-Zinc (co-factor for enzymes), copper (iron transporter), magnese (activator of enzymes), chromium (net function)

Question 24

what are the challenges of PN

Answer 24

-solubility
-stability (sedimentation, coalescencse, flocculation
-osmolarity (limited- in PPN large amounts of nutrients can cause inflammation and thrombosis)-CPN there’s higher flow rate so TPN is diluted rapidly
peripheral,<900, central: 1500-2800
-multi-chamber bags
-sterility

Question 25

what is the TPN packaging

Answer 25

-transparent material to allow the contents to be visually inspected
-light-protected infusion bags (light-sensitive solutions-lipids, vitamin and oncology meds
-effectively sealed
-PVC used to be used-insulin become absorbed onto the plastic and react, monomer and plasticizers can leach out and become toxic
-polyolefin: less reactive
-EVA: permeable to air (oxidation)

Question 26

what is the labeling of TPN

Answer 26

-patient’s name
-day of administration
-rate and duration of infusion
-concentration and dose of components
-strength
-lot identification
-expiration date
-instruction for use
-expiration date
storage conditions

Question 27

what are multi-chamber bags

Answer 27

-each component goes to each chamber
-provide extended microbial stability
-protective wrapping with air-tight plastic foils
-before administration, seal is physically broken and mix together in closed bag system

Question 28

what is the mixing order

Answer 28

-dextrose
-amino acids
-lipids
-electrolytes (phosphate first, calcium end)
-trace and vitamins

Question 29

what are TPN complications

Answer 29

-serious infection with central lines (prepared in sterile conditions, tubing and dressings should be changed
-gut bacteria can translocate into circulation (can cause liver failure)