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Acute Care 1 > Nutrition > Flashcards

Nutrition Flashcards

1
Q

Daily amount of calcium gluconate

A

0.25-0.5 mEq/kg

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2
Q

What can inadequate protein intake lead to?

A
  1. Failure to thrive
  2. Hypoalbuminemia
  3. Edema.
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3
Q

Normal Lab Values for Children Glucose

A

70-110

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4
Q

How much Folic Acid?

A

140 mcg

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5
Q

What does enteral nutrition improve?

A
  1. Epithelial structure and function
  2. Enhance mucosal immunity
  3. Reduce the risk of bacterial translocation
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6
Q

How much of endogenous protein can low birth weight infant lose daily?

A

1%

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7
Q

Short term complications related to excess protein administration

A
  1. Azotemia

2. Hyperammonemia

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8
Q

Hypernatremia Treatment

A

Treatment will involve replacement of BOTH water and electrolyte defecits

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9
Q

Holliday-Segar Method
ml/kg/day
Each Additional kg

A

20 ml/kg/day

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10
Q

What should be monitored on TPN?

A
  1. Weight
  2. CBC
  3. Electrolytes
  4. BUN
  5. Plasma glucose
  6. Accurate I and O
  7. Liver function
  8. Calcium
  9. Magnesium
  10. Phosphorus
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11
Q

How can burns affect energy requirements?

A

Up to 100% more

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12
Q

Why are carbohydrates initiated like they are?

A

To allow an appropriate response to endogenous insulin and prevent hyperglycemia and osmotic diuresis

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13
Q

Normal Lab Values for Children WBC

A

5,000-10,000

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14
Q

How to initiate enteral feeding while weaning TPN?

A

Enteral feedings can be tolerating initially with slow continuous drips with age appropriate elemental formula

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15
Q

Administration of Resuscitative Fluids

A

Warmed crystalloid fluids (Lactated Ringers or 0.9% Normal Saline)

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16
Q

Severe Volume Depletion Symptoms

A
  1. Near shock presentation
  2. Decrease peripheral perfusion with capillary refill >3 seconds
  3. Cool and mottled extremities
  4. Lethargy
  5. Increased respiratory rate
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17
Q

Goal and max of (GIR)

A

5 – 8 mg/kg/min

Maximum: 13 mg/kg/min

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18
Q

What to use for greater than 6 weeks of parenteral nutrition?

A
  1. Hickman

2. Broviac

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19
Q

Holliday-Segar Method
ml/kg/day
Second 10 kg

A

50 ml/kg/day

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20
Q

Normal Lab Values for Children Creatinine

A

0.7-1.3 (Kidney)

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21
Q

Holliday-Segar Method
Electrolytes (mEq/100 ml H2)
First 10 kg

A

Na+ 3

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22
Q

Normal Lab Values for Children RBC

A
  1. 7-6.1 (M)

4. 2-5.4 (F)

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23
Q

Hypokalemia Treatment

A
  1. Potassium supplement
  2. Potassium sparing diuretics
  3. IV potassium
    (Do not use Dextrose base solution because it stimulates the release of insulin, which drives extracellular potassium into the cells)
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24
Q

How much Selenium?

Recommended/Protocol Dose/Maximum

A

Recommended: 2 mcg/kg/day
Protocol Dose: none
Maximum: 30 mcg/day

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25
Q

Hypokalemia

A

Serum or plasma levels <3.5 mEq/L

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26
Q

Daily Energy Requirements
(Non-protein kcal/kg)
13-18 years

A

30-60 kcal/kg/day

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27
Q

Normal Lab Values for Children Hgb

A

14-18 (M)

12-16 (F)

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28
Q

Holliday-Segar Method
ml/kg/hr
Each Additional kg

A

1 ml/kg/hr

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29
Q

Normal Lab Values for Children Hct

A

42-52 (M)

37-47 (F)

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30
Q
  • Placement requires surgical or interventional radiology procedures
  • Used for long term use of TPN
A

Implanted Ports

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31
Q

What do you do if additional losses need to be replaced in addition to daily maintenance?

A

Use non-TPN fluid and piggyback into line

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32
Q

Types of Catheters used for TPN

A
  1. Percutaneous nontunneled central catheters
  2. Tunneled cuff central catheters
  3. Peripherally Inserted Central Catheters (PICC)
  4. Implanted Ports
  5. Peripheral catheters
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33
Q

What to monitor with fat infusion?

A

Monitor tolerance closely with triglyceride (TG) levels.

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34
Q

Daily protein requirements (g/kg)

Infants

A

2-2.5 gm/kg

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35
Q

Types of Fluid Therapies

A
  1. Maintenance Therapy
  2. Repletion Therapy
  3. Administration of Resuscitative Fluids
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36
Q

Maximum dextrose concentration in peripheral?

A

10-12% (Greater than 12% is associated with increased phlebitis)

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37
Q

How much Vitamin E?

A

7 mg equals 7 USP units

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38
Q

Holliday-Segar Method
Electrolytes (mEq/100 ml H2)
Each Additional kg

A

K+2

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39
Q

Normal Lab Values for Children BUN

A

10-20 (Kidney)

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40
Q

Daily amount of potassium

A

2-5 mEq/kg

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41
Q

Long term complications related to excess protein administration

A
  1. Abnormal plasma aminograms

2. Cholestolic jaundice

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42
Q

MVI dosing for greater than 3 kg and less than 11 years

A

5 ml daily

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43
Q

How many kcal/gram does dextrose provide?

A

3.4 kcal/gram

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44
Q

How much Vitamin B12?

A

1 mcg

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45
Q

Normal Lab Values for Children Cl+

A

98-106

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46
Q

Repletion Therapy

A

Corrects water and acute electrolyte deficits caused by illness or physiologic abnormality

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47
Q

How much Niacin?

A

17 mg

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48
Q

Daily protein requirements (g/kg)

Adolescents

A

0.8-2 gm/kg

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49
Q

Daily amount of phosphorus

A

1-2 mmol/kg

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50
Q

Normal Lab Values for Children PTT

A

60-70 (Heparin)

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51
Q

Why is the osmolality of fats important?

A

Low osmolality makes them useful in peripheral TPN

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52
Q

How often should liver function, calcium, magnesium, and phosphorus be monitored during TPN?

A

Twice weekly

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53
Q

How much should carbohydrates provide in total non-protein calories?

A

50-60%

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54
Q

How much Vitamin B6?

A

1.0 mg

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55
Q

Normal Lab Values for Children Platelets

A

150,000-400,00 (ASA)

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56
Q

How often should plasma glucose be monitored during TPN?

A

Every 6-8 hours until patients and glucose levels are stable

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57
Q

Fluid requirements per day for body weight greater than 20 kg

A

1500ml plus 20 ml/kg for each kg greater than 20 kg

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58
Q

What does the administration of fats prevent?

A

Fatty acid deficiency

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59
Q

Normal Lab Values for Children PT

A

11-12.5

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60
Q

Holliday-Segar Method
ml/kg/day
First 10 kg

A

100 ml/kg/day

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61
Q

How much Vitamin D?

A

400 USP units

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62
Q

Hyperkalemia

A

Serum or plasma levels > 5.5 mEq/L

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63
Q

Nutritional assessment in considering TPN

A
  1. Goals for calories, protein, fat, non-protein calories to nitrogen ratio
  2. Plot growth history on growth curve
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64
Q

Recommended non-protein nitrogen ratio

A

150-100:1

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65
Q

Normal Lab Values for Children INR

A

0.9-1.2 (Coumadin)

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66
Q

How to infuse fats?

A

Start infusing fat over 20-24 hours to improve clearance

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67
Q

How can fever affect energy requirements?

A

12% increase for each degree about 37

68
Q

Moderate Volume Depletion Symptoms

A
  1. Tachycardia
  2. Orthostatic hypotension
  3. Dry mucous membranes
  4. Irritability
  5. Delay in capillary refill
  6. Increase respiratory rate
  7. Decrease urine output
  8. Open fontanelle will be sunken on infants
69
Q

How much Biotin?

A

20 mcg

70
Q

Maintenance Therapy

A

Normalizes and preserves homeostasis through replacing normal daily losses of water and electrolytes (urine, sweat, respiration, & stool)

71
Q

Daily Energy Requirements
(Non-protein kcal/kg)
7-12 years

A

60-75 kcal/kg/day

72
Q

How to maintain calories while weaning TPN?

A

Maintain calories by calculating adjusts of enteral and parenteral fluids

73
Q

How can cardiac failure affect energy requirements?

A

5-25% increase

74
Q

Daily Energy Requirements
(Non-protein kcal/kg)
Less than 6 months

A

90-120 kcal/kg/day

75
Q

Hyponatremia Treatment

A

Treatment choices (oral or IV)

  1. Hypertonic saline 3% for symptomatic patients
  2. Fluid restriction for patients with ADH release
  3. Treatment of the underlying disease
76
Q

Hypervolemia

A

Decrease in water loss leading to water retention. These patients will have decrease serum sodium levels, postive net volume balance, and increase body weight

77
Q

How many kcal/gram do fats provide?

A

9 kcal/gram

78
Q

Protein administration

A

Begin with 2 gm amino acids (except children with renal insufficiency)

79
Q

Euvolemia

A

No change in serum sodium levels or body weight and the patients will have a neutral net volume balance

80
Q

How can protein calorie malnutrition affect energy requirements?

A

50-100% more

81
Q

Estimation of duration of parenteral nutrition in considering TPN

A
  1. Peripheral access for short term use

2. Central access for long term use

82
Q

Hypernatremia

A

Serum or plasma >150 mEq/L

83
Q

Daily amount of magnesium

A

0.25-0.5 mEq/kg

84
Q

What are maintenance requirements for fluids based on?

A

Weight

85
Q

Identification of primary objective for parenteral nutrition in considering TPN

A
  1. Supplemental
  2. Maintenance of present body stores
  3. Repletion of malnourished patient
  4. Promotion of catch up growth
86
Q

Normal Lab Values for Children Na+

A

136-145

87
Q

Fluid requirements per day for body weight 11-20 kg

A

1000 ml plus 50 ml/kg for each kg greater 10 kg

88
Q

Prolonged period of time for children and adolescents unable to meet nutritional requirements

A

4-5 days

89
Q

How much Dexpanthenol?

A

5.0 mg

90
Q

Prolonged period of time for infants unable to meet nutritional requirements

A

1-3 days

91
Q

Who should receive pediatric multi-vitamins?

A

Infants and children up to 11 years of age

92
Q

Normal Lab Values for Children Ca+

A

9.0-10.5

93
Q
  • Inserted peripherally but more commonly in the antecubital

* Used for medium term use of TPN (several months)

A

Peripherally Inserted Central Catheters (PICC)

94
Q

How much Vitamin A?

A

2300 USP units

95
Q

How much Vitamin C?

A

80 mg

96
Q

When should iron not be used?

A

Patients with gastrointestinal problems

97
Q

How much Thiamine?

A

1.2 mg

98
Q

Severe Volume Depletion

A

> /= 10% volume loss

99
Q

Goal of weaning TPN?

A

Goal is maintenance of optimal nutrition while progressing from parenteral to enteral feeding

100
Q

How much Chromium?

Recommended/Protocol Dose/Maximum

A

Recommended: 0.14 to 0.25 mcg/kg/day
Protocol Dose: 0.17 mcg/kg/day
Maximum: 5 mcg/day

101
Q

Normal Lab Values for Children AST

A

12-31 (Liver)

102
Q

How much Zinc?

Recommended/Protocol Dose/Maximum

A

Recommended: 100-400 mcg/kg/day
Protocol Dose: 100 mcg/kg/day
Maximum: 5000 mcg/day

103
Q

What can early use of proteins stimulate?

A

Endogenous insulin secretion

104
Q

How are carbohydrates initiated?

A

In a slow stepwise manner

105
Q

Who should receive adult dosage of vitamins for IV use?

A

Children above age 11

106
Q

MVI dosing for less than 3 kg

A

3.25 ml daily

107
Q

Mild Volume Depletion

A

3-5% volume loss, minimal changes in clinical findings

108
Q

How many cal/ml does 20% Intralipids provide?

A

2 cal/ml

109
Q

Glucose Infusion Rate (GIR) Formula

A
  1. Glucose concentration (as a decimal) x Volume (mL/kg/d) ÷ 1.44
  2. (IVR × % Dextrose solution) ÷ (6 × Weight)
  3. IV rate (mL/hr) x Dextrose concentration (g/dL) x 0.167 Weight (kg)
110
Q

Preliminary factors in considering TPN

A
  1. Nutritional assessment
  2. Identification of primary objective for parenteral nutrition
  3. Estimation of duration of parenteral nutrition
111
Q

How much of total calories as fat are recommended?

A

20-30%

112
Q

Maximum dextrose concentration in central?

A

30%

113
Q

How should dextrose be increased?

A

Increase dextrose 2-5 gm/100ml per day as tolerated

114
Q

Fat administration rates for older children

Initial/Daily increase/Maximum

A

Initial: 1gm/kg/day (5ml/kg/day)
Daily increase: 1 gm/kg/day (5ml/kg/day)
Maximum: 2 gm/kg/day (10 ml/kg/day)

115
Q

Normal Lab Values for Children K+

A

3.5-5.0

116
Q

Hyponatremia

A

Serum or plasma sodium levels <135 mEq/L

117
Q

Normal Lab Values for Children ALT

A

10-40 (M)
7-35 (F)
(Liver)

118
Q

How can major surgery affect energy requirements?

A

20-30% increase

119
Q

Normal Lab Values for Children Albumin

A

3.5-5.0 (Liver)

120
Q

How much Copper?

Recommended/Protocol Dose/Maximum

A

Recommended: 20 mcg/kg/day
Protocol Dose: 20 mcg/kg/day
Maximum: 300 mcg/day

121
Q

Daily Energy Requirements
(Non-protein kcal/kg)
1-7 years

A

75-90 kcal/kg/day

122
Q

Fluid requirements per day for body weight 1-10 kg

A

100 ml/kg

123
Q

Holliday-Segar Method
ml/kg/hr
First 10 kg

A

4 ml/kg/hr

124
Q

When should you further investigate glucose needs?

A

In excess of 24g/kg/day

125
Q

Daily Energy Requirements
(Non-protein kcal/kg)
Preterm

A

120-140 kcal/kg/day

126
Q

Holliday-Segar Method
Electrolytes (mEq/100 ml H2)
Second 10 kg

A

Cl- 2

127
Q

Hypovolemia

A

Unreplaced water losses leads to volume depletion. These patients will have increase serum sodium levels, negative net volume balance, and decrease body weight

128
Q

How much Manganese?

Recommended/Protocol Dose/Maximum

A

Recommended: 1-10 mcg/kg/day
Protocol Dose: 5 mcg/kg/day
Maximum: 50 mcg/day

129
Q

Hyperkalemia Treatment

A

Therapies removing potassium from the body:

  1. Diurectics
  2. Enteral cation exchange resins
  3. Dialysis
130
Q

Who should be given fats cautiously?

A

Patients with elevated bilirubin levels.

There is competitive binding between bilirubin and fats to albumin. Watch those indirect bilirubin levels.

131
Q

Daily protein requirements (g/kg)

Critically ill child

A

1.5-2 gm/kg

132
Q

What kind of osmolality is fats?

A

Low osmolality

133
Q

How can long term growth failure affect energy requirements?

A

50-100% increase

134
Q
  • Only appropriate for TPN use with osmolarity between 900-1000
  • Needs to be replaced frequently (days to 1 week)
  • Limits the use of how much TPN can be given
A

Peripheral Catheters

135
Q

How much Riboflavin?

A

1.4 mg

136
Q
  • Inserted through the subclavian, jugular, or femoral veins

* Used for short term TPN (1-2 weeks)

A

Percutaneous Nontunneled Central Catheters

137
Q

Why are fats essential?

A
  1. For normal body growth and development
  2. Cell structure and function
  3. Retinal and brain development
138
Q

Fat administration rates for full-term AGA infant

Initial/Daily increase/Maximum

A

Initial: 1gm/kg/day (5ml/kg/day)
Daily increase: 0.5 gm/kg/day (2.5ml/kg/day)
Maximum: 4 gm/kg/day (20 ml/kg/day)

139
Q

How much Vitamin K?

A

200 mcg

140
Q

What does early enteral nutrition lead to?

A
  1. Quicker advancements in feedings
  2. Fewer infections
  3. Lower costs
  4. Decreased hospital stays
141
Q

Fat administration rates for premature SGA infant

Initial/Daily increase/Maximum

A

Initial: 0.5 gm/kg/day (2.5ml/kg/day)
Daily increase: 0.25 gm/kg/day (1.25ml/kg/day)
Maximum: 3 gm/kg/day (15 ml/kg/day)

142
Q

How to calculate neonatal daily fluids?

A

Based on birth weight until back to birth weight or 7-10 days
(There are exceptions to this rule)

143
Q

When to wean TPN and why?

A

Wean TPN as soon as possible to minimize cholestatic liver disease

144
Q

Daily Energy Requirements
(Non-protein kcal/kg)
6-12 months

A

80-100 kcal/kg/day

145
Q

Daily protein requirements (g/kg)

Neonates

A

2.5-4 gm/kg

146
Q

Moderate Volume Depletion

A

6-9% volume loss

147
Q

Indications for TPN

A
  1. Severe chronic intestinal failure
  2. Neonates who cannot be fed enterally because of necrotizing enterocolitis
    3 Stages of Crohn’s disease or ulcerative colitis
  3. Bowel Obstruction
  4. Short bowel syndrome due to surgery
  5. Congenital gastrointestinal anomalies
  6. Prolonged diarrhea
  7. Prematurity
148
Q

How to give dextrose centrally?

A
  1. Usually begin with 15% dextrose
  2. Check blood sugars to evaluate tolerance of dextrose increase
  3. Increase dextrose 2-5 gm/100ml per day as tolerated
149
Q
  • Inserted surgically, commonly in the jugular or cephalic veins
  • Used for long term TPN
A

Tunneled Cuff Central Catheters

150
Q

How to calculate daily fluid allowance?

A

Based on maintenance requirements

151
Q

When should fat infusions be adjusted?

A

If triglyceride levels are greater than 400 IL

152
Q

Benefits of fats

A

A great source of concentrated calories, especially during times of fluid restriction

153
Q

Holliday-Segar Method
ml/kg/hr
Second 10 kg

A

2 ml/kg/hr

154
Q

Daily amount of chloride

A

2-5 mEq/kg

155
Q

Daily protein requirements (g/kg)

Children

A

1.5-2 gm/kg

156
Q

What to use for less than or equal to 6 weeks of parenteral nutrition?

A

PICC line

157
Q

Daily amount of sodium

A

2-5 mEq/kg

158
Q

When to increase protein?

A
  1. Stress events
  2. Sepsis
  3. Thermal injury
  4. Surgery
  5. Trauma
  6. Stomal loss
  7. Urinary excretion of nitrogen related to steroids, diuretics, or primary renal disease
159
Q

When to decrease protein?

A
  1. Renal disease
  2. Hepatic failure
  3. Metabolism issues
160
Q

Intralipids and infants with jaundice

A

Icteric premature newborns should be started on 0.5 g/kg/day doses, increasing after bilirubin levels fall or on determination of free fatty acid levels
Due to increased risk of kernicterus, as fatty acids compete with bilirubin for binding sites on albumin

161
Q

Osmolarity limits peripheral lines

A
  1. For peripheral vein tolerance, total osmolarity per liter is limited to 700 to 900 mOsm.
  2. Solutions with osmolarity > 600 mOsm/L should be administered in a central vein to lower risk of plebitis
162
Q

Indications for TPN

A
  1. Nonfunctional or inaccessible GI tract
  2. Cannot meet their nutritional requirements by enteral intake alone
  3. Intestinal disorders for which PN has been proven effective
163
Q

Examples of nonfunctional or inaccessible GI tract

A
  1. Intestinal failure (short gut)
  2. Severe malabsorption
  3. Obstruction or ileum
  4. Intractable vomiting or diarrhea
  5. Necrotizing enterocolitis
  6. Congenital anomalies of the GI tract
  7. Bowel ischemia
164
Q

Extra-intestinal Disorders/Therapy for TPN

A
  1. Malignancies
  2. Body surface burns
  3. Cardiac failure
  4. Kidney failure
  5. Chylothorax
  6. ECMO
165
Q

How to treat hypernatremia?

A

150 to 170 mEq/L: correct over a 48-hour period.
Greater than 170 mEq/L: correct over a 72-hour period.
Greater than 200 mEq/L: consider dialysis.

The goal in treatment is to avoid cerebral edema or herniation by decreasing serum sodium slowly, by 1 mEq/L/h with acute hypernatremia or by 0.5 mEq/L/h with chronic hypernatremia.

Administration of free water

166
Q

Free water formula

A

(Current Na+ − Desired Na+) × 4 mL/kg × Patient weight (in kg)

Acute Care 1 (2 decks)

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