Nutrition and Fluids

Question 1

Most commonly used tube for nutritional intervention that is simple to insert and for short term use.

Answer 1

nasogastric tube (NG)

Question 2

Tube that can also be used for enteral nutrition short term. Less risk of aspiration

Answer 2

nasojejunal tubes (NJ)

Question 3

Tube that can be used for an extended period of time. Inserted through wall endoscopically/surgically.

Answer 3

percutaneous endoscopic gastrostomy (PEG)

Question 4

Can follow the rapid infusion of feeds via jejunal tubes or rapid gastric bolus feeds. Sx include: faintness, palpitations, diaphoresis, pallor, tachycardia, hypoglycemia

Answer 4

dumping syndrome

Question 5

Treatment for dumping syndrome

Answer 5

slow rate of feeding or change formula to one w/ more complex carbohydrates

Question 6

Tonicity of solutions used for parenteral nutrition

Answer 6

hypertonic

Question 7

Potential complication in surgical patients due to stress response with concurrent fluid/electrolyte therapy

Answer 7

volume overload

Question 8

Fluids containing larger molecular weight particles with plasma oncotic pressures similar to normal plasma proteins

Answer 8

colloids

Question 9

Examples of colloids

Answer 9

albumin, FFP, hetastarch, dextran

Question 10

noting or pertaining to a solution containing the same salt concentration as blood

Answer 10

isotonic fluids

Question 11

Examples of isotonic solutions

Answer 11

0.9% NS or lactated ringers

Question 12

a solution of lower osmotic pressure than blood

Answer 12

hypotonic fluids

Question 13

examples of hypotonic fluids

Answer 13

0.45% NaCl and D5 0.45% in NaCl

Question 14

most osmotically active electrolyte in the body

Answer 14

sodium

Question 15

easiest way to monitor net gain/loss of fluids

Answer 15

daily weights

Question 16

tells you the patient has adequate water balance

Answer 16

normal serum sodium

Question 17

obligate fluid loss of normal adults

Answer 17

1600 ml/day

Question 18

Ideal fluid to use for maintenance therapy since the kidneys will regulate Na, K, and H20 retention

Answer 18

0.45% NaCl + 20 mEq KCl

Question 19

Estimate of daily fluid requirements (from ALL sources) in adults without fever/sweats

Answer 19

1500ml + 20ml/kg for each kg >20

Question 20

How much does water requirement increase for each degree of fever > 37C?

Answer 20

100-150 ml/day for each degree above 37C

Question 21

Earliest sign of hypovolemia due to the kidneys conserving sodium and water

Answer 21

decreased urine Na (<25 mEq/L)

Question 22

What is the BUN/Cr ratio with hypovolemia?

Answer 22

> 20:1

Question 23

What is the initial cause of hypovolemia related to general anesthesia?

Answer 23

loss of vascular tone

Question 24

Treatment for hypovolemia due to decreased intake of excess excretion while waiting for labs

Answer 24

0.45% NaCl

Question 25

Treatment for hypovolemia due to decreased intake of excess excretion if serum Na > 145

Answer 25

0.25% NaCl

Question 26

Treatment for hypovolemia due to decreased intake of excess excretion if serum Na < 138

Answer 26

0.9% NaCl (NS)

Question 27

Minimum amount of urine that should be made per hr

Answer 27

30cc

Question 28

Treatment for hypovolemia due to vomiting or diarrhea until labs are back

Answer 28

0.9% NaCl (NS)

Question 29

Treatment for hypovolemia due to vomiting or diarrhea if serum Na > 145

Answer 29

0.45% NaCl

Question 30

Treatment of hypovolemia due to hemorrhage until labs are back

Answer 30

bolus 1-2 liters 0.9% NS or LR through large bore IVs

Question 31

How do you determine how much IV fluid to give burn victim?

Answer 31

4 x weight in kg x % TBSA burn. Give ½ of that volume in first 8 hours. Give other ½ in next 16 hours

Question 32

What patient population are you most likely to see sodium deficit?

Answer 32

pediatrics

Question 33

Maintenance fluid volume 24 hr period for kids <10kg

Answer 33

100mL/Kg

Question 34

Maintenance fluid volume 24 hr period for kids 11-20kg

Answer 34

1000mL for first 10kg of body weight plus 50mL/kg for any increment of weight over 10kg

Question 35

Maintenance fluid volume 24 hr period for kids 20-80kg

Answer 35

1500mL for first 20kg of body weight plus 20 mL/kg for any increment of weight over 20 kg