Brainscape's Knowledge GenomeTM


Top Flashcards (Certified)
All Flashcards

PHRM 864 Exam 3 > Nutrition > Flashcards

Nutrition Flashcards

1
Q

Risk Factors for Malnutrition

A

UBW (under body weight) =20% below IBW

Involuntary weight loss >10% within 6 months

NPO > 10 days: clinically we use inadequate > 7 days

Gut malfunction

Mechanical ventilation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Risk Factors for Malnutrition (cont.)

A

Increased metabolic needs: trauma or burn patients, high dose steroids

Alcohol/substance abuse

Protracted nutrient losses

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Determination of Nutrition Risk

A

All hospitalized patients within 48 hours

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Screening Tools

A

NUTRIC

Nutritional Risk Score (NRS-2002)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

NUTRIC

A

High risk: 6-10 (5-9 w/o IL-6)

Low risk: 0-5 (0-4 w/o IL-6)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

History

A

Dietary: intake, swallowing, ulcers, weight loss, anorexia, vomiting, diarrhea

Medical: surgical history, PMH

Medications: decrease nutrient absorption, alter taste, increase/decrease appetite, N/V

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Anthropometrics (look at protein stores)

A

Somatic protein status: weight, triceps skin fold, arm muscle circumference, physical appearance

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Preablbumin

A

Half life: 2-3 days

Normal concentration: 15-40 mg/dL
In real-life: > 10 mg/dL

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

C-Reactive Protein (CRP)

A

Normal concentration: < 1 mg/dL
Assess accuracy of pre-albumin

Pre-albumin decreases as CRP increases–> inflammation

Pre-albumin decreases as CRP normal–> malnutrition

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Marasumus

A

Protein and calorie malnutrition–> decrease in total intake or utilization

Characteristics: wasting of skeletal and subQ fat, immunosuppression, cachectic appearance

Treatment: well-balanced substrate + Vitamin B

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Kwashiorkor

A

Protein malnutrition–> adequate calorie intake

Characteristics: large belly

Who? Catabolic trauma or burn patients

Treatment: carbohydrates followed by high protein

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Mixed

A

Chronically ill starved patients who are metabolically stressed

Characteristics: decrease in visceral proteins, poor wound healing, immunocompromised

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Nitrogen balance

A

Measurement of urinary excretion of nitrogen as urea nitrogen (UUN)

Nitrogen released from protein catabolism that is converted to urea and excreted in the urine

Goal: +3 to +5

N(in)-N(out)
N(in)=24-hr protein intake/6.25
N(out)=24-hr UUN +4

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Kcal requirements

A

Trauma/stress/surgery/burn/illness: 25-30 kcal/kg/day

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Indirect Calorimetry (preferred in critically ill patients)

A

Provides energy expenditure at that ONE point in time and then extrapolated to 24 hours

TEE=REE x 1.2
RQ=Vco2/Voz
Goal: 0.85-0.95

< 0.85–>underfeeding
> 0.95–> overfeeding

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Protein requirements

A

Mild/moderate (FLOOR PTs): 1-1.5 g/kg/day
Moderate/severe (ICU/SURGERY/TRAUMA/BURN): 1.5-2 g/kg/day

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

Non-Protein Calorie Distribution

A

Standard: 70/30
70% dextrose
30% fat

Sepsis/bloodstream infections (fungal) : 100/0
100% dextrose
0% fat

Adjustments:
Blood sugar: reduce dextrose
Triglycerides: reduce fat

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

Parenteral nutrition indications

A

Anticipated prolonged NPO > 7 days

Small bowel or colonic ileus–>bowel stomachs moving

Extensive small bowel resection

Malabsorptive states

Intractable vomiting/diarrhea

Enterocutaneous fistules

Inflammatory bowel disease

Hyperemesis gravidum

Bone marrow transplantation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

PN initiation and discontinuation

A

Start at 25% of goal and titrate up to goal within 24 hours
Check BG every 4-6 hours

BG > 200: continue x 4 hours and repeat
BG < 200 after repeat: insulin

Cessation: decrease rate by 50% every 2 hours until < 50 mL/hr THEN d/c

Cycling: infusion over 12-18 hours/day
Max rate: 200 mL/hr

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

Peripheral Route of Administration

A

Barriers:
-Solutions are hypertonic (dextrose,AA)
-Requires large volumes of fluid (not best for HF, AKI)
-Limited in calories
-Short term access ( < 7-10 days)

Solutions:
-Restrict dextrose concentration to 5-10%
-Total osmolarity < 900 mOsm/L

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

Central Route of Administration

A

Advantages:
-Administration of hypertonic solutions (dextrose, AA)
-Larger amounts of calories

Disadvantages:
-Risk of infection
-Not a benign procedure (pneumothorax, air embolus, thrombus, etc)

Access:
-Subclavian (SC)–> in the chest
-Internal jugular (IJ)–> in the neck
-Femoral–> in the groin

Short-term: percutaneously

Long-term:
-PICC, tunneled, implanted port

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

Protein

A

1 gram- 4 kcal

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

Carbohydrates

A

1 gram= 3.4 kcal

Maximum carb rate=4-5 mg/kg/min

Restrictions: dextrose concentration must be < 10% in adults for a peripheral vein

Dextrose concentration must be < 12.5% in pediatrics

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

Fat (lipid)

A

1 gram=10 kcal: prevents essential fatty acid deficiency

DO NOT EXCEED 60% of calorie intake
DO NOT EXCEED 2.5 g/kg/day
4 g/kg/day in pediatrics

PROPOFOL IS 10% LIPID–>1.1 kcal/mL

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Intralipid 10%
Soybean oil 10%--> high in linoleic acid (omega-6) Glycerin 2.25%--> CHECK ALLERGIES Egg yolk phospholipid 1.2%--> CHECK ALLERGIES Water for injection
26
SMOFlipid
Soybean oil 30%-->high in linoleic acid Medium-chain triglycerides 30% Olive oil 25%-->omega-9 Fish oil 15%-->omega-3-CHECK ALLERGIES
27
Advantages of SMOFlipid
Improved liver function Lower increase in TG levels Less pro-inflammatory Reduced risk of infection and decrease length of hospital stay
28
Administration of lipids
IV Fat Emulsion 10 and 20%-->peripheral vein, piggyback in PN, admix into dextrose/AA solution Max hang-time: 12 hours IV Fat Emulsion 30%-->total nutrient admixture (3-in-1) Max hang-time: 24 hours
29
Electrolytes
Considerations: -Renal disease: caution K+, Phos, Mg+ -Avoid Ca x Phos > 150-->precipitation
30
Sodium
1-2 mEq/kg
31
Potassium
0.5-1 mEq/kg up to 2 mEq/kg
32
Calcium
10-20 mEq
33
Magnesium
8-24 mEq
34
Phosphorus
15-45 mMol 1mMol=1.4 mEq
35
Chloride/Acetate
Cl: 2/3 Acetate: 1/3
36
Vitamins
Adult (>40 kg): 10 mL of multivitamin -Small amount of Vitamin K (150 mcg) Pediatric (3-40 kg): 2 mL of multivitamin -Small amount of Vitamin K (150 mcg)
37
Trace Elements
Considerations:
38
Mechanical complications of PN
Clotting of the line Displacement of the line
39
Infectious complications of PN
Catheter-related sepsis Solution contamination Bacterial translocation: if you stop feeding the gut, you stop making the acid to suppress bacteria allowing bacteria to go from below diaphragm to above diaphragm -pneumonia, central line infection, abscess, multi-organ dysfunction syndrome
40
Metabolic complications of PN
Hyper/hypoglycemia Electrolytes imbalances Fluid imbalance Liver dysfunction -Steatosis -Intrahepatic cholestasis -Cholelithiasis
41
Clinical Signs of Refeeding Syndrome
Hypophosphatemia, hypomagnesemia, hypokalemia Respiratory distress-->phos controls muscle contraction in diaphragm Cardiac arrhythmia's--> potassium controls Anemia Paraesthesia Tetany
42
Risk factors of refeeding syndrome
Rapid feeding and excessive dextrose infusion Low BMI ( < 16-18.5) Excessive weight loss Insufficient caloric intake Low levels of Phos, K, Mg prior to feeding Loss of subQ fat or muscle Alcoholism, anorexia, marasmus
43
Prevention of Refeeding syndrome
REPLETE ELECTROLYTES BEFORE FEEDING Day #1 Limit carbs to 100-150 gm Limit fluids to 800 mL/day Give only 50% of caloric needs Thiamine 100 mg daily x 5-7 days
44
Essential fatty acid deficiency
Goal: 4-10% of daily calories Onset: 10-14 days on fat-free nutrition Symptoms: dry scaly skin, brittle hair, lack of luster Prevention: At least 500 mL of 10% fat emulsion at least 3-5 hours twice weekly OR At least 250 mL of 20% fat emulsion over at least 5-9 hours twice weekly
45
Baseline monitoring
CMP, Mg, Phos, Ca Hepatic function Pre-albumin/CRP PT/INR Blood glucose every 4-6 hours Residuals, distention, vomiting, aspiration 4-6 hours
46
Daily monitoring
Vital signs Intake/outtake CMP Feeding tube placement and patency
47
Twice weekly monitoring
Weight CBC Mg, phos, Ca Prealbumin/CRP
48
Weekly monitoring
Albumin, transferrin, nitrogen balance Liver function Triglycerides RQ PT/INR
49
Clinimix/Clinimix E
Dextrose + AA +/- electrolytes With or without electrolytes CrCl < 50: clinimix CrCl > 50: clinimix E Peripheral or central
50
Indications for EN
if the gut works, use it Oral consumption inadequate Oral consumption contraindicated Esophageal obstruction Head and neck surgery Dysphagia Trauma Cerebrovascular accident Dementia
51
Contraindications to EN
Mechanical obstruction-->hernia, tumor, adhesions, scar tissue Non-mechanical obstruction-->ileus Intractable vomiting Severe malabsorption Severe GI hemorrhage Fistulas
52
Advantages of EN
Provides GI stimulation -Decreased chance for bacterial translocation -Stimulates biliary flow Avoids line injections and pneumothorax MORE PHYSIOLOGIC THAN PN
53
Initiation of EN
Start at full strength at 25 mL/hr Increase 25 mL/hr every 4-6 hours up to goal rate in 24 hours Achieve 50-60% of goal calories within the first week DO NOT START IF HEMODYNAMICALLY UNSTABLE--> intestinal ischemia Monitor residuals every 4-6 hours Hold for residuals > 500 mL
54
Which type of administration for EN
Low risk of aspiration: gastric High risk of aspiration: jejunal Vomiting: jejunal Gastric residuals: jejunal Long-term: PEG or PEJ
55
Bolus administration
Who? Patients with PEG/PEJ (nursing home, ambulatory) What? > 200 mL formula over 5-10 minutes Max volume 300-400 mL Advantages: more convenient, requires minimal equipment, less interactions Disadvantages: must be gastric tube, higher risk for aspiration
56
Intermittent administration
Administer > 200 mL formula over 20-30 minutes: 4-8 feedings per day Advantage: helps tolerance Disadvantage: more equipment required-->reservoir bag/bottle
57
Continuous infusion administration
most common Who? Patients with jejunal tube What? Administer continuously over 12-24 hours/day Advantages: Low risk of gastric distention or aspiration, better tolerated Disadvantages: More equipment required-->infusion pump, medication administration issues
58
Trickle or Trophic
What? Administer slow continuous infusion at 10-20 mL/hr Advantages: prevent mucosal atrophy and bacterial translocation, shorten time on ventilator Disadvantages: difficult to achieve sufficient calorie delivery
59
Types of formula
Jevity-->standard Impact 1.5-->sepsis Glucerna-->diabetes Nepro--> renal disease
60
Carbohydrates
Glucose polymers in tube feed Simple glucose for oral supplements
61
Protein
Intact and partially digested Intact: requires complete digestion Partially digested (elemental): beneficial for malabsorption or diarrhea
62
Fat
Long chain fatty acid Medium-chain fatty acid: more water soluble leading to rapid hydrolysis--> no lipase
63
Fiber
Who? constipation What? 1 packet/tbsp How much? 3 g
64
Protein (prostat)
Who? Burn, trauma, etc What? 30 mL tube How much? 15 g
65
Juven
Who? Wound care, HIV/AIDS, Cancer
66
Glutamine
Who? Burn patients What? 0.3-0.5 g/kg/day over 2-3 doses DO NOT GIVE IF ON IMPACT 1.5-->already receiving
67
Probiotics
Who? Diarrhea Inhibit pathogenic bacterial growth, block pathogen attachment, eliminate toxins, enhance host inflammatory response
68
Vitamins
Vitamin E and Vitamin C
69
Trace Elements
Who? burn, trauma, mechanically ventilated
70
Mechanical complications of EN
Clogging of the feeding tube Tube malabsorption Rhinitis: reposition daily, use smaller bore tube, change from NG to OG Sinusitis
71
Metabolic complications of EN
Hyper/hypoglycemia Goal: 140-180 mg/dL Electrolytes imbalances--> hyponatremia is the most common Fluid imbalance
72
Aspiration
Elevate the head of the bed by 30-45 degrees Post pyloric delivery Continuous tube feed at smaller volume Prokinetics: metoclopramide or erythromycin, naloxone, methylnaltrexone
73
Nausea/vomiting
metoclopramide or erthyromycin
74
Diarrhea
Change to fiber-containing or small peptide Consider C.diff Evaluate medications: hyperosmolar meds, liquid formulations containing sorbitol, bowel regimen, broad spectrum antibiotics

PHRM 864 Exam 3 (10 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2025 Bold Learning Solutions. Terms and Conditions