Nutrition and Specific Disease States

Question 1

role of fiber in diabetes

Answer 1

slows down gastric emptying to reduce spike in blood sugar, reduces LDL and increases satiety

Question 2

Is fiber recommended in gastroparesis

Answer 2

No

Question 3

Probiotics mechanism of action

Answer 3

when probiotics reach the ileum/colon, endogenous bacteria consume and ferment pre biotics and produce short chain fatty acids which increases bacterial mass and enzyme activity

Question 4

Uses for probiotics

Answer 4

help reduce flatulence, bloating, abdominal pain

Question 5

What is the recommended fiber intake daily

Answer 5

20-35/day

Question 6

detriments of too much protein

Answer 6

pre-renal azotemia, kidney stones, increased risk of osteoporosis

Question 7

______ based sterols lower cholesterol absorption and are recommended as cholesterol lowering agents

Answer 7

soy based

Question 8

Are immune modulating enteral formulas with omega 3 fatty acids and antioxidants recommended for Acute Respiratory Distress Syndrome or Severe Acute Lung Injury?

Answer 8

No

Question 9

Which EN formulas should be considered for patients with traumatic brain injury

Answer 9

Formulas containing fish oil, arginine, omega 3 fatty acids with DHA (immune modulating)

Question 10

What causes high creatinine loss

Answer 10

diarrhea, high output fistula or ostomy losses

Question 11

Which populations are immune modulating EN formulas appropriate for per ASPEN

Answer 11

SICU

Question 12

an amino acid which functions in immune function, wound healing, synthesis of nitrous oxide and plays roles in respiratory and cardiac function

Answer 12

arginine

Question 13

hydroxy beta methylbutyrate (HMB) protein is shown to

Answer 13

increase lean muscle mass

Question 14

HMB protein has been studied in which populations

Answer 14

AIDS, ALS and muscular dystrophy

Question 15

symptoms of fatty acid deficiency

Answer 15

scaly rash, color spots, alopeica, dull/easily plucked hair, xerosis, follicular hyperkeratosis

Question 16

Patients with liver cirrhosis are at risk for what deficiencies

Answer 16

fat soluble vitamins (ADEK) and thiamine

Question 17

what is the recommended modality of artificial nutrition for an open abdomen

Answer 17

EN, when the peritoneum is left open and the viscera are protected with a temporary dressing

Question 18

what type of EN feeding tube is recommended for gastroparesis in the setting of postprandial nausea and vomiting

Answer 18

jejunostomy

Question 19

what mode of artificial nutrition is recommended in hyperemesis gravidarum

Answer 19

EN in conjunction with anti-emetic therapy

Question 20

what are 3 parameters for assessing EN efficacy in pregnancy

Answer 20

maternal dry weight gain, fetal growth, nitrogen balance

Question 21

what items should be labeled on an enteral product

Answer 21

Patient Name
Product Name
Strength
Additives
Volume
Expiration Date and Time

Question 22

advantages of a ready to hang enteral formula

Answer 22

decreases risk of infection (less to handle)
longer hanging time
decreased RN time

Question 23

disadvantages of ready to hang EN formula

Answer 23

decreased individualization

could be accidentally be administered into IV tubing (sentinel event)

Question 24

what is the most likely source of EN formula contamination

Answer 24

organisms on the hands of healthcare workers

Question 25

what are 2 potential points of contamination of EN formulas

Answer 25

preparing and dispensing

Question 26

in order to ensure feeding tube patency flush the tube how often for continuous/intermittent feedings

Answer 26

every 4-6 hours

Question 27

in order to ensure feeding tube patency when giving medications flush ___ to ___mL of formula before/after each med using a ____ to ___mL syringe

Answer 27

15-30mL of water with a 50-60mL syringe

Question 28

why shouldn't small syringes be used to flush tubes

Answer 28

may cause rupture from too much pressure

Question 29

if a fiber rich formula is being used, what is the recommended French size range

Answer 29

10-12 French

Question 30

advantages of an open enteral feeding system

Answer 30

can be more individualized with the volume | reduces waste

Question 31

what is the hang time for an open enteral feeding system

Answer 31

8-12 hours

Question 32

what are the disadvantages of an open enteral feeding system

Answer 32

uses bags only 8-12 hour hang time higher risk of contamination than RTH requires additional RN time

Question 33

to minimize infections, enterally fed patients (open system) should have bags and tubing changed

Answer 33

every 24 hours

Question 34

in a closed system enteral feeding what is the hang time/how long can it last after being opened

Answer 34

48 hours

Question 35

what is the optimal storage temperature for EN formulas to prevent microbial growth and contamination

Answer 35

39 degrees F, 4 degrees C

Question 36

the most likely formula to become contaminate is

Answer 36

blenderized

Question 37

SIBO can cause

Answer 37

enteritis, marked diarrhea, abdominal cramps, hypoalbuminemia, protein catabolism, cachexia, fever, sepsis

Question 38

what are potential causes of SIBO

Answer 38

altered GI anatomy, Roux-en-Y bypass, ileal resection

Question 39

is PN in patients for chemo/radiation recommended for routine use per ASPEN

Answer 39

no, can cause infectious complications and no clinical improvement

Question 40

ASPEN recommends thorough assessment of a cancer patients _________ and only use PN when ___ and ____ for __ to __ days

Answer 40

nutrition status | malnourished AND unlikely to use gut in 7-14 days

Question 41

what is the preferred nutrition method for patients with cancer and a functional GI tract

Answer 41

enteral nutrition

Question 42

PN as a primary treatment for ulcerative colitis has shown _____ benefit

Answer 42

NO

Question 43

a patient with a high output ostomy of 3 liters, with an elevated BUN/Cr should have a treatment plan of while on PN

Answer 43

increased sodium fluids

Question 44

sodium loss from a high output fistula can be up to

Answer 44

100 mEq/L

Question 45

a high BUN:Cr ratio indicates

Answer 45

volume depletion

Question 46

patients with ____ and ____ disease are more prone altered protein metabolism due to decreased excretion of urea

Answer 46

hepatic/renal disease

Question 47

In a patient with elevated ammonia what is used for treatment and prevention

Answer 47

reduce total amino acids | restrict protein in refractory encephalopathy