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Nutrition Flashcards

1
Q

What is a Calorie?

A

Unit of energy equivalent to the heat energy needed to raise the temperature of 1 kg of water by 1 degree C

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2
Q

What is the primary source of energy?

A

Carbs

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3
Q

What are proteins essential for?

A

Growth, repair and enzyme function

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4
Q

What are fats (lipids) essential for?

A

Energy storage, cell membrane structure and hormone production

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5
Q

What is water essential for?

A

Hydration, metabolism and temperature regulation

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6
Q

What is the percentage of calories from Carbs, Proteins, and Fats?

A

Carbs- 45-65%
Proteins- 10-35%
Fats- 20-35%

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7
Q

What metabolic fuels must our diets provide?

A

Protein, fiber, minerals, vitamins, and essential fatty acids

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8
Q

What are the main metabolic fuels?

A

Mainly carbs, lipids and protein

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9
Q

What is protein needed for?

A

Growth and turnover of tissue proteins

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10
Q

What is fiber used for?

A

Bulk in intestinal lumen

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11
Q

What do minerals contain?

A

Basic elements needed for metabolic functions

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12
Q

What are vitamins and fatty acids?

A

Organic compounds needed for life sustaining metabolic and physiologic functions

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13
Q

What is the GI system?

A

The portal through which nutritive substances enter the body

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14
Q

What are digested in the GI system?

A

Proteins, fats, and complex carbs

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15
Q

What crosses the gut mucosa and enters the lymph system or the blood?

A

The products of digestion along with vitamins, minerals and water

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16
Q

What type of digestion occurs in the mouth?

A

Mechanical & chemical

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17
Q

What is mechanical digestion in the mouth?

A

Chewing (mastication)

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18
Q

What is chemical digestion in the mouth?

A

Salivary amylase begins carb digestion (starches to maltose)
Lingual lipase (minor role) starts lipid digestion

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19
Q

What can be absorbed in the mouth?

A

Mineral, but small molecules like certain drugs (e.g., nitroglycerin) can be absorbed sublingually

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20
Q

What is the function of the esophagus?

A

Transport

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21
Q

How is food moved in the esophagus?

A

By peristalsis (coordinated muscular contractions)

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22
Q

Does digestion or absorption occur in the esophagus?

A

No

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23
Q

What type of digestion occurs in the stomach?

A

Protein & Lipid Digestion

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24
Q

What is mechanical digestion in the stomach?

A

Churning mixes food with gastric secretions

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25
Q

What is formed when food is mixed with gastric secretions?

A

Chyme

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26
Q

What enzymes are involved in chemical digestion in the stomach?

A

Pepsin and gastric lipase

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27
Q

What activates pepsin and begins protein digestion?

A

HCL

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28
Q

What does gastric lipase play a minor role in?

A

Lipid digestion

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29
Q

What is the absorption in the stomach?

A

Minimal; alcohol and some small molecules (e.g., aspirin) can be absorbed.

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30
Q

What is the primary site of digestion and absorption?

A

Small Intestine

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31
Q

What is the function of the duodenum?

A

Digestion

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32
Q

What are the pancreatic enzymes?

A

Amylase, Proteases, Lipase

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33
Q

What does amylase convert?

A

Starch → maltose

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34
Q

What are examples of proteases?

A

Trypsin, chymotrypsin, carboxypeptidase

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35
Q

What do proteases break down?

A

Proteins into peptides/amino acids

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36
Q

What do lipases break down?

A

Triglycerides → monoglycerides + fatty acids

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37
Q

What does bile from the liver/gallbladder do?

A

Emulsifies fats, aiding lipase action

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38
Q

Where are brush border enzymes produced?

A

Intestinal mucosa

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39
Q

What do brush border enzymes include?

A

Maltase, sucrase, lactase, Peptidases

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40
Q

What do maltase, sucrase, lactase convert?

A

Disaccharides → monosaccharides

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41
Q

What do peptidases convert?

A

Small peptides → amino acids

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42
Q

What is the major site of nutrient absorption?

A

Jejunum

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43
Q

What carbohydrates are absorbed in the jejunum?

A

Monosaccharides (glucose, fructose, galactose) absorbed via active transport and facilitated diffusion.

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44
Q

How are proteins absorbed in the jejunum?

A

Amino acids and small peptides absorbed via active transport.

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45
Q

How are lipids absorbed in the jejunum?

A

Free fatty acids and monoglycerides form micelles, absorbed into enterocytes, then packaged as chylomicrons for lymphatic transport.

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46
Q

How are water-soluble vitamins absorbed in the jejunum?

A

Via transporters

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47
Q

How are fat-soluble vitamins absorbed in the jejunum?

A

With lipids

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48
Q

How are water and electrolytes absorbed?

A

Via osmosis and active transport.

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49
Q

What does the ileum specialize in absorbing?

A

Vitamin B12, bile salts, remaining nutrients and water.

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50
Q

How is Vitamin B12 absorbed?

A

With intrinsic factor

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51
Q

How are bile salts reabsorbed?

A

Via enterohepatic circulation

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52
Q

What is the primary function of the large intestine?

A

Water & Electrolyte Absorption

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53
Q

What is the ascending colon also known as?

A

Right Colon

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54
Q

What does the ascending colon receive chyme from?

A

Ileocecal valve

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55
Q

What is the major site for water absorption in the ascending colon?

A

Approximately 80% of remaining water to solidify stool

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56
Q

What electrolytes does the ascending colon absorb?

A

Na+, Cl- through active transport

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57
Q

What is fermented in the ascending colon?

A

Undigested carbohydrates (e.g., fiber) by gut microbiota produces short-chain fatty acids (SCFAs), which serve as an energy source for colonocytes.

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58
Q

What are byproducts of bacterial metabolism in the ascending colon?

A

Gas: Hydrogen, methane, and CO2

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59
Q

What is the transverse colon also known as?

A

Middle Section

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60
Q

What occurs in the transverse colon?

A

Continued water and electrolyte absorption.

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61
Q

What does bacterial metabolism in the transverse colon produce?

A

Vitamins

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62
Q

What vitamins are produced in the transverse colon?

A

Vitamin K, Biotin and some B vitamins

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63
Q

What is Vitamin K important for?

A

Clotting

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64
Q

What are Biotin and some B vitamins important for?

A

Metabolism

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65
Q

What does the transverse colon store?

A

Semi-formed stool before it moves into the descending colon.

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66
Q

What is the descending colon also known as?

A

Left Colon

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67
Q

What occurs in the descending colon?

A

Final water reabsorption, concentrating the stool.

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68
Q

What does the descending colon store?

A

Formed feces before moving to the sigmoid colon.

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69
Q

What is the peristalsis like in the descending colon?

A

Slower compared to the ascending/transverse colon to allow more absorption.

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70
Q

What regulates motility in the descending colon?

A

Gastrocolic reflex and defecation reflex

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71
Q

What triggers the gastrocolic reflex?

A

Eating

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72
Q

What does the gastrocolic reflex stimulate?

A

Mass peristalsis

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73
Q

When is the defecation reflex initiated?

A

When stool accumulates in the rectum

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74
Q

What is the sigmoid colon’s function?

A

Acts as the final holding chamber for stool before defecation

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75
Q

What signals the brain when it’s time for elimination?

A

Stretch receptors

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76
Q

What controls defecation?

A

Internal (involuntary) and external (voluntary) anal sphincters

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77
Q

What is the composition of feces?

A

Water, undigested fiber, bacteria, and metabolic waste

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78
Q

What is the RDA of protein?

A

0.8-1.0 g/kg/day

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79
Q

Where does digestion of protein begin?

A

In the stomach when pepsin cleaves some peptide linkages

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80
Q

Where does further digestion of protein occur?

A

In the small intestine through proteolytic enzymes from the pancreas and intestinal mucosa

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81
Q

What does protein metabolism depend on?

A

Both kidney and liver function

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82
Q

What are dietary sources of protein?

A

Fish and meats, soy, casein, and whey

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83
Q

How many calories are provided from protein?

A

4 kcal/gram

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84
Q

What is found only in protein?

A

Nitrogen

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85
Q

What is the constant ratio of nitrogen to protein?

A

1 g of nitrogen per 6.25 g of protein

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86
Q

How can the adequacy of protein intake be assessed clinically?

A

By a nitrogen balance study

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87
Q

What does a nitrogen balance study measure?

A

Urinary nitrogen excretion compared to nitrogen intake

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88
Q

What does nitrogen intake equal?

A

g of protein intake / 6.25

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89
Q

What is the RDA for carbohydrates?

A

45-65% of calories (~130 g/day)

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90
Q

What are the principal dietary carbohydrates?

A

Polysaccharides, Disaccharides, Monosaccharides

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91
Q

What is an example of a polysaccharide?

A

Starch

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92
Q

What are examples of disaccharides?

A

Lactose (milk sugar), sucrose (table sugar)

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93
Q

What are examples of monosaccharides?

A

Fructose and glucose

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94
Q

What are the only polysaccharides that are digested to any degree in the human GI tract?

A

Starches

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95
Q

What are dietary sources of carbohydrates?

A

Bread, rice, corn syrup

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96
Q

How many calories are provided from carbohydrates?

A

4 kcal/gram

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97
Q

What is the RDA for lipids?

A

Alpha-linolenic acid, aka Omega-3

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98
Q

What is the lipid RDA for men and women?

A

Men: 14-17 g/day
Women: 11-12 g/day

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99
Q

Where does most fat digestion begin?

A

In the small intestine

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100
Q

What are the types of fatty acids?

A

Saturated, unsaturated, essential

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101
Q

What are examples of saturated fatty acids?

A

Animal fats, dairy products

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102
Q

What are examples of unsaturated fatty acids?

A

Linolenic acids, oleic acids

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103
Q

What are essential fatty acids?

A

Not synthesized by our bodies (linoleic acid, DHA, EPA)

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104
Q

What are dietary sources of lipids?

A

Butter, oils

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105
Q

How many calories are provided from lipids?

A

9 kcal/gram

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106
Q

What are fluid needs in general?

A

30-40 mL/kg of body weight (adults)

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107
Q

What is the Holliday-Segar Method?

A

4-2-1 rule

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108
Q

What must all sources of fluid (and Na) be considered for?

A

Vehicles for IV medications, IV or feeding tube flushes

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109
Q

What is the target urine output (UOP) for adults?

A

0.5 mL/kg/hr

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110
Q

What is the target urine output (UOP) for pediatrics?

A

1 mL/kg/hr

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111
Q

What is the definition of minerals?

A

Inorganic elements required by the body for various physiological functions

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112
Q

What are major macrominerals?

A

Calcium, magnesium, phosphorus

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113
Q

What are trace minerals/elements?

A

Zinc, copper, iron, selenium

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114
Q

What are the functions of minerals?

A

Bone health, enzyme activation, metabolism

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115
Q

What are electrolytes?

A

A subset of minerals that dissolve in body fluids to produce charged ions (cations & anions)

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116
Q

What is the function of electrolytes?

A

Maintain osmotic balance, acid-base homeostasis, fluid balance, nerve function and muscle contraction

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117
Q

What are examples of electrolytes?

A

Sodium, potassium, chloride, calcium, magnesium, phosphorous

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118
Q

What is the relationship between electrolytes and minerals?

A

Most electrolytes are minerals but not all minerals are electrolytes

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119
Q

How do calcium and magnesium function?

A

As both minerals (bone health) and electrolytes (nerve/muscle function)

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120
Q

What is the relationship between iron and zinc?

A

Iron and zinc are both minerals but not electrolytes

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121
Q

What is bicarbonate (HCO3-)?

A

An electrolyte but not a mineral

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122
Q

What is hyponatremia?

A

<135 mEq/L

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123
Q

What is hypernatremia?

A

> 145 mEq/L

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124
Q

What are the standard daily requirements for sodium?

A

1-2 mEq/kg

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125
Q

What are primary causes of hyponatremia?

A

GI losses, Fistula drainage, Diuretics, Adrenal insufficiency

126
Q

What is the serum potassium concentration?

A

3.5-5.3 mEq

127
Q

What are the standard daily requirements for potassium?

A

0.5-1 mEq/kg

128
Q

What are common losses of potassium?

A

GI fluid losses, hypomagnesemia, diuretics, polyuria, renal excretion

129
Q

What are the evaluations for hyperkalemia?

A

Traumatic blood draw, excessive intake (IV), altered distribution-acidosis, cellular breakdown (burns, crush injuries), renal excretion

130
Q

What is the serum magnesium concentration?

A

1.8-2.4 mEq

131
Q

What is the preferred magnesium cation?

A

Magnesium sulfate

132
Q

What are the usual daily magnesium requirements?

133
Q

What is the function of magnesium?

A

Acts as a coenzyme in metabolism of carbs and protein and needed in ATP reactions

134
Q

What are common losses of magnesium?

A

Diarrhea and alcohol use disorders (Renal excretion) are major, sepsis, pancreatitis, refeeding syndrome, thermal injuries/TBI

135
Q

What is phosphorous?

A

Primary intracellular anion

136
Q

What is the serum phosphorous concentration?

A

2.5-4.5 mEq

137
Q

What is the usual daily IV dose for phosphorous?

A

20-40 mmol (27-53 mEq)

138
Q

How is the usual daily IV dose of phosphorous given?

A

As sodium or potassium salt

139
Q

What is phosphorous a constituent of?

A

Nucleic acids, phospholipid membranes and nucleoproteins

140
Q

What role does phosphorus have?

A

Key role in macronutrient metabolism

141
Q

Where is the majority of calcium stored?

A

Bones and teeth

142
Q

What percentage of calcium is extracellular and how much of that is bound to albumin?

A

1% of calcium is extracellular and 60% of that is bound to albumin

143
Q

What is the usual IV dose of calcium?

A

10-15 mEq/day given as gluconate

144
Q

What is the normal range for ionized calcium (iCal)?

A

1.12-1.30 mmol/L

145
Q

What is calcium used for?

A

Protein synthesis

146
Q

What is calcium essential for?

A

Normal muscle contraction, nerve function, blood coagulation, and bone formation

147
Q

What role does iron have?

A

Critical role in oxygen transport, energy production, and immune function

148
Q

What do iron deficiencies result in?

A

Fatigue, anemia, decreased resistance to infection

149
Q

Where is iron found?

A

In most foods and is best obtained in a well-balanced diet

150
Q

What are dietary sources of copper?

A

Shellfish, nuts, seeds, whole grains

151
Q

What are common signs of iron deficiency?

A

Anemias, neutropenia

152
Q

What are dietary sources of iodine?

A

Iodized salt, seafood, eggs

153
Q

What are common signs of iodine deficiency?

A

Goiter, hypothyroidism

154
Q

What are dietary sources of selenium?

A

Seafood, eggs, meat, whole grains

155
Q

What is a common sign of selenium deficiency?

A

Cardiomyopathy

156
Q

What are dietary sources of zinc?

A

Meat, shellfish, legumes, nuts, dairy

157
Q

What are common signs of zinc deficiency?

A

Dermatitis, alopecia, anorexia, impaired wound healing

158
Q

What is the definition of vitamins?

A

Organic dietary constituent necessary for life, health and growth that does not function by supplying energy and which cannot be synthesized endogenously in adequate amounts

159
Q

Where are most vitamins absorbed?

A

In the upper small intestine

160
Q

How are water-soluble vitamins absorbed?

A

Directly into the bloodstream through the digestive system

161
Q

How are water-soluble vitamins stored?

A

Not stored in the body, excessive amounts are excreted in the urine

162
Q

When do deficiency symptoms of water-soluble vitamins typically appear?

A

Quickly when intake is inadequate because the body cannot store these vitamins

163
Q

What is the toxicity characteristic of water-soluble vitamins?

A

Rare, since excess are excreted but can occur with high doses of specific B vitamins (B6)

164
Q

Where are most vitamins absorbed?

A

Upper small intestine

165
Q

How are water-soluble vitamins absorbed?

A

Absorbed directly into the bloodstream through the digestive system

166
Q

What is the storage characteristic of water-soluble vitamins?

A

Not stored in the body, excessive amounts are excreted in the urine

167
Q

When do deficiency symptoms of water-soluble vitamins typically appear?

A

Typically appear quickly when intake is inadequate because the body cannot store these vitamins

168
Q

Is toxicity common with water-soluble vitamins?

A

Rare, since excess are excreted but can occur with high doses of specific B vitamins (B6)

169
Q

What are examples of water-soluble vitamins?

A

Vitamin C (ascorbic acid), B vitamins (B1, B2, B3, B5, B6, etc)

170
Q

What are fat-soluble vitamins?

A

Vitamins that dissolve in fat and are typically stored in the liver and adipose tissues

171
Q

How are fat-soluble vitamins absorbed?

A

Absorbed along with dietary fat and can be stored in the body for longer periods

172
Q

Are deficiencies common with fat-soluble vitamins?

A

Deficiencies are less common than with water-soluble vitamins but toxicity can occur if they are consumed in excess

173
Q

What can alter nutrient absorption, metabolism, or utilization in the body?

A

Medications

174
Q

What effect do antacids have on nutrient absorption?

A

Can reduce the absorption of vitamin B12 by altering stomach acidity

175
Q

What do anticonvulsants increase the metabolism of?

A

Folate, leading to potential folate deficiency. They may also interfere with vitamin D metabolism

176
Q

What is the effect of chronic alcohol consumption on thiamine?

A

Can interfere with the utilization of thiamine (vitamin B1), leading to Wernicke-Korsakoff syndrome

177
Q

What is the effect of angiotensin converting enzyme inhibitors (ACEi)?

A

Increased urinary zinc losses

178
Q

What is the effect of corticosteroids on vitamins?

A

Decreased vitamins A, D, and C

179
Q

What is the impact of malnutrition on function?

A

Results in changes in subcellular, cellular, or organ function that increases morbidity and mortality

180
Q

What are examples of severe acute diseases related to malnutrition?

A

Major infections, burns, trauma

181
Q

What are examples of chronic diseases related to malnutrition?

A

Crohn’s disease, organ failure, cancer

182
Q

What does malnutrition encompass?

A

Undernutrition and overnutrition (obesity)

183
Q

What is malnutrition a consequence of?

A

Nutrition imbalance

184
Q

What do deficiency states involve?

A

Protein, energy, or single nutrients such as vitamins or trace elements

185
Q

What can cause malnutrition to develop?

A

Acute or chronic conditions/diseases

186
Q

What percentage of hospitalized patients experience malnutrition?

187
Q

What is the direct cost of malnutrition?

A

$15.5 billion

188
Q

Who is at the highest risk for malnutrition?

A

Critically ill patients

189
Q

What are the impacts of malnutrition?

A

Respiratory and cardiac dysfunction, prolonged LOS, increased costs, reduced immune function, increases infections, compromised musculoskeletal strength, impaired wound healing

190
Q

What does nutrition screening identify?

A

Patients at nutritional risk

191
Q

What should an effective nutrition screening process be designed to do?

A

Identify those patients most at risk

192
Q

What is the ideal nutrition screening tool?

A

Quick, simple, non-invasive

193
Q

What is a requirement for nutrition screening since 1995?

A

Joint Commission

194
Q

When must nutrition screening be performed after inpatient admission?

A

Within 24 hours

195
Q

What are risk factors for undernutrition?

A

Recent unintended weight loss, presence and severity of acute/chronic diseases, medications/medical treatments, socioeconomic factors, altered nutrient absorption or metabolism

196
Q

What are risk factors for overnutrition?

A

Family history of obesity, medical diagnoses (PCOS, Cushing’s syndrome), poor dietary habits, inadequate exercise, medications

197
Q

What is nutrition assessment?

A

A comprehensive medical, surgical, and dietary history

198
Q

What does an MST score of 2 or more indicate?

199
Q

What should at-risk patients receive promptly?

A

Assessment by nutritional support

200
Q

What are the variables of the NUTRIC score?

A

Age, APACHE II, SOFA, number of co-morbidities, days from hospital to ICU admission, IL-6

201
Q

What NUTRIC score range is high and associated with worse clinical outcomes?

202
Q

What NUTRIC score range is low and indicates low malnutrition risk?

203
Q

What does an MST score of 0 or 1 indicate?

A

Not at risk

204
Q

Who typically performs nutrition assessment?

A

Registered Dietitian (RD)

205
Q

What does Nutrition-Focused Physical Examination (NFPE) identify?

A

Nutrition related problems including anthropometrics, patient history, current clinical presentation, biomarkers/laboratory data, nutrition intake data, functional status

206
Q

Are serum visceral proteins a definitive diagnosis of malnutrition?

A

No, there are many reasons these values could vary

207
Q

What are examples of serum visceral proteins?

A

Albumin, Prealbumin, Transferrin, C-Reactive Protein

208
Q

What is the definition of food?

A

Any nutritious substance that people or animals eat or drink or that plants absorb in order to maintain life and growth

209
Q

What is the definition of dietary supplements?

A

Products that contain nutrients, such as vitamins, minerals, herbs, or amino acids, intended to supplement the diet

210
Q

What is the definition of Food for Special Dietary Use (FSDU)?

A

Food that’s specially processed to meet the specific dietary needs of a person

211
Q

What is the definition of medical food?

A

A specially formulated food intended to meet the nutritional needs of a specific disease or condition

212
Q

What are medical foods?

A

A food which is formulated to be consumed or administered enterally under the supervision of a physician, intended for the specific dietary management of a disease or condition

213
Q

Is nutrition a patient right?

214
Q

What do patients of all ages, demographics, ethnicities, and backgrounds need to live?

215
Q

When is nutritional support needed?

A

When an individual cannot eat enough (or any) food to maintain proper nutrition status and overall health due to an illness or medical condition

216
Q

What are the two main support therapies for nutritional support?

A

Enteral (via a feeding tube) and Parenteral (via an intravenous catheter)

217
Q

What is enteral nutrition support?

A

Method of nutritional support that uses the GI tract through an enteral access device (EAD)

218
Q

What is microbiologically diverse in healthy patients?

A

The gut microbiome

219
Q

What compromises the gut microbiome in critical illness?

A

Decreased diversity and opportunistic pathogens

220
Q

What medications can compromise the gut microbiome?

A

Antibiotics and vasoactive agents

221
Q

What is a determinant of the gut microbial composition?

A

Enteral nutrition

222
Q

What does enteral nutrition maintain?

A

Immune integrity and function

223
Q

What does enteral nutrition decrease?

A

Bacterial translocation

224
Q

What does enteral nutrition blunt?

A

Inflammatory response

225
Q

What are the benefits of enteral nutrition?

A
  • Maintains functional integrity of the gut
  • Efficient nutrient utilization
  • Maintains normal gallbladder function
  • Supports immune function
  • Reduces infectious complications
  • Cost-effective
226
Q

What are the indications for enteral nutrition?

A
  • Oral intake is impossible, inadequate, or unsafe
  • Poor appetite due to chronic conditions
  • Dysphagia
  • Major trauma, burns, wounds, or critical illness
  • Severely malnourished preoperative patients
227
Q

What are gastrointestinal risks of enteral nutrition?

A

Nausea, vomiting, diarrhea, abdominal distention, constipation

228
Q

What are pulmonary aspiration risks of enteral nutrition?

A

Supine position, reduced level of consciousness, gastroparesis

229
Q

What are metabolic complications risks of enteral nutrition?

A

Refeeding syndrome, hyperglycemia, dehydration

230
Q

What are contraindications for enteral nutrition?

A
  • Bowel obstruction
  • Bowel discontinuity
  • Active resuscitation
  • Severe malabsorption syndromes
  • Intestinal ischemia or bowel necrosis
231
Q

What defines active resuscitation?

A

MAP <50 mmHg, worsening acidosis on vasopressor, ischemic bowel concerns, HOB < 30 degrees, increasing or addition of vasopressor

232
Q

What is the duration for short-term enteral nutrition therapy?

A

<4-6 weeks

233
Q

What is the duration for long-term enteral nutrition therapy?

A

> 4-6 weeks

234
Q

What considerations are there for enteral access?

A
  • Gastric motility
  • Aspiration risk
  • Alterations in GI anatomy
235
Q

What determines the type of enteral access device?

A

Length of need for enteral nutrition and aspiration risk

236
Q

What types of tubes can be placed at bedside by nursing staff?

A

Orogastric (OG) and nasogastric (NG) tubes

237
Q

What types of tubes must be placed by trained clinicians?

A

Nasoduodenal (ND) and nasojejunal (NJ) tubes

238
Q

What are gastrostomy tubes?

A

Tubes placed surgically or with percutaneous techniques that terminate in the stomach

239
Q

What are J-tubes?

A

Tubes placed surgically directly into the jejunum for feeding only

240
Q

What are continuous feedings?

A

Administered with an enteral feeding pump over a set period of time with a constant rate

241
Q

In which patients are continuous feedings preferred?

A

Patients who are critically ill or have poor metabolic stability

242
Q

What are bolus feedings?

A

Administered via gastrostomy with a syringe or via gravity in < 30 minutes

243
Q

Which feeding resembles an oral diet?

A

Bolus feedings

244
Q

What are intermittent feedings?

A

Delivered from an EN container or bag over 30 minutes to an hour

245
Q

Which feeding may benefit patients who do not tolerate bolus feeds?

A

Intermittent feedings

246
Q

What are cyclic enteral feedings?

A

Administer nutrition over < 24 hour time period, allowing patients to attempt some oral intake during the day

247
Q

What minimizes inconveniences associated with the pump and continuous feeds?

A

Cycled schedule

248
Q

What are adverse events for administering medications in enteral access devices?

A
  • EAD obstruction
  • Altered medication pharmacokinetics or efficacy
  • Increased risk for toxicity
249
Q

What are immediate release oral preparations?

A

Film and enteric-coated tablets that can hinder the ability to crush the tablet into a fine powder

250
Q

What is a modified release preparation?

A

Crushing can release a total daily dose instantly instead of over time, leading to toxicity

251
Q

What are solutions in medication administration?

A

Homogeneous liquid mixtures where active medication is uniformly dissolved in a diluent, at risk for instability

252
Q

What are suspensions in medication administration?

A

Heterogeneous liquids containing active medications floating in a liquid medium, at risk for inadequate delivery

253
Q

What are implications of tube type for drug administration?

A
  • Site of drug delivery
  • Size of lumen and length of tube
  • Function of the enteral tube
  • Multilumen tubes
  • Confirmation of position
254
Q

What are reasons to not crush solid dosage forms?

A
  • Extended-release, controlled-release, prolonged-action, and sustained-release formulations
  • Enteric-coated or protective medications
  • Sublingual or buccal absorbent medications
  • Medications that irritate the oral cavity
  • Carcinogenic and/or teratogenic medications
  • Medications created to prevent misuse
255
Q

How to unblock nasogastric feeding tubes?

A

Use 15-30 mL warm or cold water in a 50 mL syringe with a pull/push action

256
Q

What syringe should be used with caution if the above fails?

A

A smaller 5 mL syringe

257
Q

What device can be used for mechanical de-clogging of the correct size?

A

Mechanical de-clogging device for gastrostomy/jejunostomy tubes

258
Q

When to use pancreatic enzymes?

A

Only if activated to the correct pH and able to deliver close to the occlusion

259
Q

What do standard, polymeric formulas contain?

A

Intact macronutrients and require normal digestive and absorptive function

260
Q

What do elemental and semi-elemental formulas contain?

A

Partially or fully hydrolyzed macronutrients for easier digestion

261
Q

What are disease-specific formulas?

A

Examples include renal (low in electrolytes), hepatic (modified amino acids), diabetic (low in carbs and high fiber)

262
Q

What are modular formulas?

A

Contain individual macronutrient components for customizing nutrition

263
Q

What is the water content by volume in standard formulas?

264
Q

What is Jevity 1.5?

A

A standard formula containing 1.5 kcal/mL and fiber

265
Q

What is Osmolite 1.5?

A

A standard formula without fiber

266
Q

When are disease-appropriate formulas appropriate?

A

If failed trial with standard formulas

267
Q

What is Pivot 1.5?

A

An immune modulating formula with Arginine, Glutamine, Omega-3 FA, and scFOS

268
Q

What is Vital AF 1.2?

A

Contains Omega-3 FA (EPA/DHA) and 75 g protein/L

269
Q

What is Vital High Protein?

A

A low fat formula with 87 g protein/L

270
Q

What is parenteral nutrition (PN)?

A

An important, life-saving therapeutic modality for patients unable to maintain adequate nutrition through the GI tract

271
Q

How many ingredients can PN prescriptions contain?

A

Up to 40 different ingredients

272
Q

What is PN classified as by ISMP?

A

A high-alert medication

273
Q

What is the CSP Category for PN according to USP 797?

274
Q

What does TPN stand for?

A

Total parenteral nutrition

275
Q

What does CPN stand for?

A

Central parenteral nutrition

276
Q

What does PPN stand for?

A

Peripheral parenteral nutrition

277
Q

What is ILE?

A

IV lipid emulsion, the preferred term for oil-in-water emulsions for IV administration

278
Q

What is 2-in-1 PN?

A

Dextrose, amino acids, electrolytes, vitamins, and minerals in one bag with ILE administered separately

279
Q

What is 3-in-1 PN?

A

Total nutrient admixture (TNA) with all macronutrients in the same bag

280
Q

What is Intralipid?

A

Soybean oil-based, provides linoleic acids, and is pro-inflammatory

281
Q

What is SMOF lipid?

A

Contains soybean oil, olive oil, fish oil, and medium-chain triglycerides (MCTs)

282
Q

What conditions may require PN?

A
  • Impaired absorption of nutrients
  • Mechanical bowel obstruction
  • Need for prolonged bowel rest
  • Motility disorders
  • Inability to maintain sufficient oral or enteral access
283
Q

What are additional conditions needing PN?

A
  • Small bowel obstruction
  • High-output enteric fistula
  • Intractable vomiting or diarrhea
  • Inoperable obstruction
  • Severe GI bleeding
  • Mesenteric ischemia
  • Severe GI dysmotility
  • Short bowel syndrome
  • Paralytic ileus
  • Refractory nausea/vomiting
284
Q

Where does central access for parenteral routes go?

A

Superior vena cava

285
Q

What is the osmolarity range for hyperosmolar parenteral routes?

A

1300-1800 mOsm

286
Q

What affects parenteral routes?

A

Short-term vs long-term use

287
Q

What can IVC be used for?

A

If upper veins are not available

288
Q

What is the caloric requirement for critically ill, trauma, or sepsis patients?

A

25-30 kcal/kg/day

289
Q

What is the target blood glucose range for hyperglycemia?

A

140-180 mg/dL

290
Q

What should be monitored in cases of hypoglycemia?

A

If PN formulation must be discontinued abruptly, begin dextrose infusion for 1-2 hours

291
Q

When can essential fatty acid deficiency occur?

A

Within 1-3 weeks in adults receiving ILE-free PN

292
Q

What to do if serum triglycerides are >400 mg/dL?

A

Hold ILE from PN regimen

293
Q

What are the normal ranges for azotemia?

A

BUN: 7-18 mg/dL, sCr: 0.6-1.1 mg/dL

294
Q

What is steatosis?

A

Modest elevations of serum aminotransferase concentrations that may return to normal

295
Q

What is PN-associated cholestasis (PNAC)?

A

Elevation of alkaline phosphatase and GGT, conjugated bilirubin >2 mg/dL

296
Q

What to do if using 100% soybean-based ILE?

A

Do not exceed 1g/kg/day and consider changing to mixed oil source

297
Q

What can gallbladder sludge/stones benefit from?

A

Providing any nutrition via enteral route

298
Q

What may be necessary for fluids and electrolytes?

A

Separate IV fluids outside of the PN formulation for excessive losses

299
Q

What should be monitored for vitamins in PN?

A

Excessive intake of fat-soluble vitamins A, D, E, K can lead to toxicity

300
Q

What is the standard daily multivitamin for PN?

A

To prevent deficiencies

301
Q

What trace elements may require more zinc?

A

High intestinal losses

302
Q

What can selenium deficiency induce?

A

Cardiomyopathy

303
Q

What can patients on long-term PN develop?

A

Manganese toxicity

304
Q

What are the PN macronutrient dosing steps?

A

1) Determine total kcal need
2) Determine protein needs
3) Determine lipid needs
4) Subtract protein and lipid calories from total calories
5) Determine fluid requirements

305
Q

What is the stable calorie requirement?

A

20-30 kcal/kg/day

306
Q

What is the maximum dextrose for hyperglycemia?

A

150 g/day; cautious initiation if BG >180

307
Q

What is the refeeding risk on day 1?

A

No greater than 75% of goal calories and max of 150 g dextrose

308
Q

What is the TEE formula?

A

BEE x activity factor x stress factor

309
Q

What is refeeding syndrome?

A

A condition that occurs when reintroducing nutrition after starvation, leading to electrolyte imbalances and potential complications

310
Q

What are one or more refeeding risk factors?

A
  • BMI 15% past 3-6 months
  • Little or no nutrition for >10 days
  • Low levels of K, P, or Mg before feeding
311
Q

What are two or more refeeding risk factors?

A
  • BMI 10% past 3-6 months
  • Little or no nutrition for >5 days
  • History of substance abuse or certain medications
312
Q

Which electrolytes are of concern with refeeding?

A
  • Potassium (hypokalemia)
  • Magnesium (hypomagnesemia)
  • Phosphate (hypophosphatemia)

PP2 (16 decks)

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