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PHRM 864 > Nutrition > Flashcards

Nutrition Flashcards

1
Q

IBW equation

A

male: 50 +(2.3 x in over 60)
female: 45.5 + (2.3 x in over 60)

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2
Q

nutrition body weight equation

A

NBW = IBW + 0.25(wt-IBW)

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3
Q

when to use nutritional body weight

A

if actual body weight > 130% IBW

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4
Q

nutrition support has switched to what

A

nutrition therapy

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5
Q

when do we start enteral nutrition

A

as early as possible
all pts within 48 hours

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6
Q

malnutrition risk factors (8)

A

20% below IBW
invol weight loss >10% within 6 months
NPO > 7 days
gut malfunction
mechanical vent
increased metabolic needs: trauma/burn, high dose steroids
alcohol / substance abuse
nutrient losses: chronic disease states

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7
Q

what level of weight loss would be a risk factor for malnutrition

A

> 10% weight loss in 6 months

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8
Q

where are pts most at risk for malnutrition

A

ICU

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9
Q

what is NUTRIC

A

nutritional risk assesment score for ICU patients

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10
Q

NUTRIC high risk score

A

6-10
5-9 w/o IL-6

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11
Q

how to check protein status

A

weight
tricep skin fold
arm muscle circum
physical appearance

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12
Q

what is anthropometrics

A

protein stores

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13
Q

what is the best protein to measure

A

pre-albumin

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14
Q

prealbumin range

A

15-40 mg/dL

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15
Q

normal albumin level

A

3.5-5

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16
Q

if prealbumin low is pt malnourised?

A

not exactly, need to look at other factors

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17
Q

if prealbumin is decreased, what is CRP if pt is malnourished

A

CRP normal, <1

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18
Q

if prealbumin is decreased and patient just has inflammation what is CRP

A

elevated

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18
Q

what is protien-calorie nutrition called and what is it

A

Marasmus
decrease intake of food
some chronic dx pts

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19
Q

what is protien malnutrition called and what pts is this

A

Kwashiorkor
trauma / burn pts, catabolic and breaking down proteins

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20
Q

what is UUN

A

urinary urea nitrogen
measure of nitrogen released from protein catabolism
85-90% total excretion

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21
Q

what increases UUN

A

stress
increased protein catabolism

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22
Q

where do we lose nitrogen other than urine

A

sweat, feces, respirations, GI

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23
Q

what do we measure UUN for ?

A

measure the protein repletion adequacy

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24
Q

ideal nitrogen balance goal

A

+3 to +5 grams

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25
Q

nitrogen balance equation

A

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

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26
Q

trauma/stress/surgery
critically ill
burns kcal
(hospital patients)

A

25-30 kcal/kg/day

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27
Q

TEE equation

A

REE x 1.2

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28
Q

goal RQ

A

0.85-0.95
mixed substrate

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29
Q

what RQ is overfeeding

A

> 0.95

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30
Q

what RQ is underfeeding

A

RQ <0.85

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31
Q

protein requirement for floor pt (mild to moderate stress)

A

1-1.5

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32
Q

NPC is what

A

non protein calories
carbs and fat

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33
Q

goal distribition for non-protein calories

A

70/30
70 from dextrose
30 from fat

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34
Q

patient with diabetes non protein calorie distribution

A

60/40
50/50
lower carbs

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35
Q

100/0 used when

A

100 percent from dextrose
used in bloodstream infection / sepsis

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36
Q

parenteral nutrion is given how

A

IV

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37
Q

parenteral nutrion other names

A

TPN, 3 in one, PN, TNA

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38
Q

parenteral nutrition indications

A

anticipated NPO > 7 days
can’t absorb nutrients through gut
small bowel/colonic ileus
small bowel resection
intractable vomit/diahrrhea
IBD
enterocutaneuous fistulas
hyperemesis gravidum (pregnancy sick)

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39
Q

peripheral PN, osmolarity restriction

A

total osmolarity < 900 mOsm/L

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40
Q

when do we do peripheral?

A

not much, should be short term and switched to central line
NICU is all peripheral

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41
Q

advantages and disadvantages of central line

A

adv: hypertonic, more calories
disad: infection risk, thrombus, air embolus, pneumothorax

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42
Q

CVC (central venous catheter) insertion sites

A

subclavian (SC)
inter jugular (IJ)
femoral

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43
Q

whats a PICC

A

peripherally inserted central catheter
longer term access

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44
Q

whats a triple lumen

A

three ports
one port used for TPN

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45
Q

where is subclavianh

A

chest

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46
Q

where is internal jugular

A

neck

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47
Q

where is femoral

A

groin

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48
Q

1 gram of protein = kcal

A

4 kcal

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49
Q

1 gram of carb = kcal

A

3.4 kcal

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50
Q

what do we use for carb source

A

D70W but dilute it so no more than 10%

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51
Q

maximum carb per min

A

4-5 mg/kg/min

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52
Q

1 g lipid = kcal

A

10 kcal

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53
Q

what do we need to check for with intralipid

A

soybean
egg allergy
glycerin

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54
Q

what do we need to check for with smof lipid

A

fish allergy
soybean allergy

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55
Q

SMOF lipid contents

A

soybean oil
medium chain triglycerides
olive oil
fish oil

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56
Q

types of fat lipids

A

SMOF lipid
intralipid

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57
Q

which lipid should we give most pts

A

SMOF lipid

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58
Q

max lipid per day

A

2.5 g/kg/day

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59
Q

how much lipid in propofol

A

1.1 kcal/mL
subtract from lipid requirements

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60
Q

risk with IV lipid and length we can hang

A

infection, pathogens can grow
only hang 12 hours by itself or 24 hours in TPN

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61
Q

TPN types

A

3 in 1 (carb, prot, fat)
2 in 1 (carb and protein, fat sep)
premix (no lipids)

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62
Q

whats an in line filter

A

filters TPN
catches pathogens, particulates

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63
Q

filter sizes for 3 in 1 and 2 in 1

A

3 in 1: 1.2 micron
2 in 1: 0.22 micron

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64
Q

premix TPN called what

A

Clinimix/Clinimix E

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65
Q

whats in Clinimix

A

dextrose, amino acid
no fat but compatible
electrolytes (E)

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66
Q

Can Clinimix be given peripheral

A

yes

67
Q

who cant get ClinimixE

A

CrCl < 50
cant process electrolytes

68
Q

CrCl formula

A

(140 - age) x IBW / 72 x SCr
x 0.85 if female

69
Q

how do we titrate PN

A

start at 25% flow rate goal and titrate to final within 24 hours

70
Q

what should we check when we are initiating PN

A

check blood glucose q4-6 h
before each increase

71
Q

how do we adjust rate if BG >200

A

> 200 continue same rate x 4 hr
if still > 200 then start insulin

72
Q

how do we stop TPN

A

decrease rate by half every 2 hours until < 50 mL/hr then discontinue

73
Q

what is cycling PN

A

transitioning to EN/PO
patients want free time from pump
infusion over 12-18 hours

74
Q

max rate for cycling PN

A

200 mL/hr

75
Q

what electorlytes should we avoid in TPN for pt with renal dx

A

mag, phos, potassium

76
Q

what electrolytes should we watch for in acid base disorder

A

acetate and chloride

77
Q

what electrolytes do we need to avoid precipitate

A

calcium and phos
Ca x Phos > 150 BAD

78
Q

what electrolytes go in a TPN

A

calcium
phos
mag
potassium
sodium
chloride
acetate

79
Q

what vitamins go in a TPN

A

thiamin
riboflavin
niacin
folic acid
pnathotenic acid
pyroxidine
cyanacobalmin
biotin
ABCDEK

80
Q

what product has all vitamins

A

multivitamin 12

81
Q

which weight pts get adult multivitamin

A

> 40 kg

82
Q

consideration with multivitamin 12

A

VIt K, warfarin

83
Q

do we need trace elements

A

YES

84
Q

who shouldnt get trace elements

A

liver dysfunction (liver disease or LFTS >2 x ULN)
supplement zinc and selenium seperately
CKD ( caution, check serum)

85
Q

what is not part of trace elements in PN

A

iron
- destabilizes fat
- infection

86
Q

can we give meds in TPN

A

no, only famotidine
NO PPIS

87
Q

what kind of insulin can be added to TPN

A

regular only

88
Q

MIVF

A

30-40 mL/kg/day

89
Q

how much sodium goes in bag

A

77 mEq/L

90
Q

how much potassium goes in bag

A

0.5-1 mEq/kg

91
Q

how much calcium in bag

A

10 mEq/day

92
Q

how much mag in bag

A

8 mEq/day

93
Q

how much phos in bag
phos conv

A

0.3 mMol/kg
1 mMol phos = 1.4 mEq

94
Q

how much acetate / chloride

A

2/3 chloride
1/3 acetate
LESS BASE

95
Q

which ions are already balanced

A

calcium
magnesium

96
Q

positive ions

A

potassium
sodium

97
Q

negative ions

A

chloride
acetate
phos

98
Q

how do we balance ions and decide acid /base

A

balance positives and negatives
convert phos to mEQ
subtract negs from pos
2/3 acid 1/3 base

99
Q

mechanical complications of parenteral nutrition

A

line clotting
displacement

100
Q

infectious complications of parenteral nutrition

A

sepsis
solution contamination
bacterial translocation

101
Q

what is bacterial translocation and what can it cause

A

GI bacteria move to extra intestinal
can cuase pnemonia, central line infection, abcess

102
Q

metabolic complications of parenteral nutritioon

A

imbalances
hyper/hypo glycemia
liver abnormalities

103
Q

what do we need to baseline monitor in parenteral nutrition

A

CMP
mag
phos
calcium
hepatic function panel
prealbumin/CRP
PT/INR
glucose

104
Q

how often do we get prealbumin/CRP

A

twice weekly

105
Q

how often do we get triglycerides and respiraotry quotient

A

weekly

106
Q

daily monitoring items parenteral nutrition

A

vital signs
ins/outs
CMP (electrolytes, glucose, BUN/SCr)
feeding tube placement

107
Q

twice weekly monitoring parenteral nutrition

A

weight
CBC
Mag, phos, calcium
prealbumin/CRP

108
Q

weekly monitoring parenteral nutrition

A

albumin, transferin, nitrogen balance
LFTs
triglycerides
INR
RQ/ indirect calorimetry

109
Q

refeeding syndrome clinical findings

A

hypophosphatemia *** most likely
hypomagnesia
hypokalemia
resp. distress
arrythmias
anemia

110
Q

how do we prevent refeeding syndrome in high risk?
dextrose
fluids
calories

A

limit dextrose to 100-150
limit fluids to 800 mL/day
calories 50%
provide adequate electrolytes

111
Q

essential fatty acids are how much of daily calories

A

4-10%

112
Q

what are essential faty acids

A

linoleic and linolenic acids

113
Q

when does essential fatty acid deficiency happen

A

after 10-14 days on a fat free PN

114
Q

what happens in essential fatty acid deficiency

A

inhibits lipolysis and fatty acid mobilization

115
Q

how do we prevent essential fatty acid deficiency

A

give fat emulsion twice weekly
500 mL 10% or 250mL 20%

116
Q

oral nutrition contraindications / enteral indiacations

A

esophageal obstruction
head / neck surgery
dysphagia
trauma
cerebrovascular accident
dementia

117
Q

advantage of enteral nutrition

A

decreased chance of bacterial translocation
stimulates the GI
avoids IV line risks, pneumothorax
bolus is more physiologic

118
Q

infectious morbidity and mortality is decreased with what kind of nutrition

A

enteral

119
Q

enteral nutrition contraindications

A

mechanical obstruction
ileus
intractible vomiting
severe malabsorption
GI bleed
fistula

120
Q

types of enteral nutrition tubes

A

naso/oro gastric
naso/oro jejunal
PEG/PEJ

121
Q

when to use jejunal over gastric

A

most pts
risk aspiration
vomiting, gastric residuals

122
Q

when to use PEG/PEJ

A

long term

123
Q

ways to confirm placement of tube

A

auscultation
abdominal x ray
cortrak

124
Q

4 ways to administer enteral nutrition

A

bolus
intermittent
continuous
trickle

125
Q

what is bolus enteral feeding

A

mimics meals
primarily PEG tubes
200-400 mL over 5-10 min

126
Q

bolus feeds adv and disadv

A

adv: easy, onhly need syringe
dis: can’t feed to small bowel, higher risk aspiration

127
Q

intermittent feeding given over what time and how much

A

20-30 mins
>200 mL

128
Q

intermittent feeding adv and disadv

A

adv: helps tolerance
dis: more equipment

129
Q

continuos infusion given how

A

over 12-24 hours per day

130
Q

continuous infusion preferred tube

A

jejunum

131
Q

continuous infusion adv and disadv

A

adv: lower risk aspiration, better tolerated
dis: med admin hard, need infusion pump (kangaroo)

132
Q

trickle feed used why

A

stimulate the gut
prevent mucosal atrophy and bacterial translocation
shorten ventilator time

133
Q

trickle feed infusion rate

A

10-30 mL / hour
not enough to meet calorie goals

134
Q

initiation goal in enternal nutirtion

A

50-60% of goal calories within firrsst week
do not initiate if hemodynamically unstable (heart, lung, brain)

135
Q

what is Impact formula used for

A

in ICU, immune support
trauma, burn, intubated, surgery, cancer

136
Q

what is protien in tube feeds made of

A

intact protein: requires digestion
partially digested - elemental, beneficial for pts with diarrhea

137
Q

what is fat in tube feeds made of

A

long chain and medium chain fatty acids

138
Q

tube feed carbs are made of

A

glucose polymers

139
Q

who shouldnt get glutamine

A

if getting Impact, immune formula

140
Q

who benefits from glutamine

A

burn patients (reduce mortality)

141
Q

do probiotics help with diarrhea?

A

could cause more

142
Q

GI complications with enteral

A

aspiration
N/V
decreased motility
diarrhea
constipation

143
Q

when can we hold for residuals

A

> 500 mL

144
Q

how to prevent aspiration

A

elevate head
continuous infusion
prokinetic agent

145
Q

what prokinetic agents can we use with decreased motility

A

metoclopramide
erythromycin
naloxone
methylnaltrexone

146
Q

what if pt is having diarrhea

A

change to soluble fiber containing or small peptide formulations
check for c diff
evaluate the meds

147
Q

what kinds of meds cause diarrhea

A

hyperosmolar
sorbitol liquids
bowel regimen
broad spectrum antibiotics

148
Q

most common electrolyte disturbance

A

hyponatremia

149
Q

blood glucose goal in ICU

A

< 180

150
Q

what dosage form preferred via enteral tubes

A

liquid

151
Q

how to give capsule/tablet with enteral tube

A

crush tablet, open capsule and mix in water

152
Q

which meds can we not crush

A

sustained or enteric coated
SL/buccal
hazardous

153
Q

can meds be given together in feeding tube

A

no, give seperately

154
Q

what to do in between meds with enteral tube

A

flush with water

155
Q

how do we give hypertonic meds with enteral feed tube

A

dilute them in at least 30 mL of water before

156
Q

what kinds of dosage forms to avoid in enteral

A

syrups
mineral oil
granules

157
Q

correct flushing method to avoid tube clog

A

flush 15-30 ml water before and after admin
flush 5-10 in between

158
Q

how to unclog the tube

A

slurry
10 mL warm sterile water + 1 bicarb tab + 1 pancreatic enzyme
clamp tube for 15 mins and flush

159
Q

what meds interact with tube feed

A

fluoroquinolone
itraconazol
tetracyclines
penicillin
didanosine
-virs
levothyroxine
phenytoin
theophilline
warfarin

160
Q

how to give meds that interact with tube feeds

A

hold tube feed
wait 1 hr
give med
wait 2 hr
resume feed
(will need to adjust feed rate)

161
Q

in acute renal failure how much protein do they need

A

up to 2.5 g/kg/day

162
Q

pts in hemodialysis need how much protein

A

0.8-1.2 g/kg/day less

163
Q

pulmonary failure considerations

A

monitor phos closely
fluid restriction

164
Q

acute pancreatitis considerations

A

can feed enterally
need more protein (1.2-1.5 g/kg/day)
parenteral nutrition does not affect pancreatic secretion and function

165
Q

burn pt considerations

A

increased metabolic rate
start tube feeds in 12 hours
need more protein and calories
supplement vitamins

PHRM 864 (23 decks)

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