Nutrition (Walroth) Flashcards
IBW formula
- Male: 50 + (2.3 x inches over 60)
- Female: 45.5 + (2.3 x inches over 60)
When should you use NBW over actual body weight?
If actual body weight is 130%+ IBW
NBW formula
IBW + 0.25 (weight - IBW)
What is the normal rannge for transthyretin (prealbumin)?
15-40 mg/dL
How often should prealbumin be checked?
Biweekly
Which malnutrition classification occurs due to decreased total intake and/or utilization of food?
Marasmus
Which malnutrition classification is the result of adequate caloric intake, but relative protein malnutrition?
Kwashiorkor
Which malnutrition calculation has evident muscle wasting?
Marasmus
What are some non-urinry sources of nitrogen loss?
- sweat
- feces
- respirations
- GI fistula
- wound drainage
- skin exfoliation
- burns
What is the goal nitrogen balance?
+3 - +5 grams
N2 balance formula
N2 in - N2 out
How do you calculate N2 in?
24-hr protein intake (g) / 6.25
How do you calculate N2 out?
24-hr UUN (g) + 4
TEE formula
REE x 1.2
What is the goal RQ?
0.85-0.95
How often should you monitor RQ?
once weekly
What range should be used to calculate total daily calories?
25-30 kcal/kg/day
What is the protein range for mild-moderate stress (floor) patients?
1-1.5 g/kg/day
What is the protein range for moderate-severe stress (ICU, trauma, surgery, burn) patients?
1.5-2 g/kg/day
In what situations may a patient’s protein “tolerance” be decreased?
renal and hepatic failure
What is the standard NPC distribution?
70% dextrose/30% fat
In what scenario may a patient require 100/0 NPC distribution?
sepsis or bloodstream infections
List some indications for parenteral nutrition.
- anticipated NPO > 7 days
- inability to absorb nutrients via the gut (small bowel/colonic ileus, SMB, malabsorptive status, intractable V/D)
- enterocutaneous fistulas
- IBD
- hyperemesis gravidarum
- bone marrow transplant (mucositis)
What should final destrose concentration be restricted to in peripheral PN?
5-10%
What should total osmolarity be restricted to for peripheral PN?
< 900 mOsm/L
What are some advantages of using central PN?
- can give hypertonic solutions (dextrose and amino acid solutions)
- can give more calories
What are some disadvantages of using central PN?
- infection risk
- invasive-ish procedure
- pneumothorax
- air embolus
- thrombus
Where are the accepted CVC insertion sites?
- subclavian (SC)
- internal jugular (IJ)
- femoral
How will central venous access be inserted if short-term?
percutaneously
How will central venous access be inserted if long-term?
- PICC
- tunneled
- implanted port
How many kcal per gram of protein?
4 kcal
How many kcal per gram of carbohydrates (dextrose)?
3.4 kcal
What is the maximum carbohydrate utilization for PN?
4-5 mg/kg/min
When should you give a Clinimix WITHOUT electrolytes?
CrCl < 50
What is the general guidance for starting PN?
start at 25% and achieve final rate within 24 hours
What measurement should you be sure to check before each rate increse when titrating PN?
blood glucose
What amount of injectible MVI is appropriate to add to PN?
10 mL/day
What complications can arise from PN?
- mechanical (line clotting, displacement)
- infection
- metabolic issues (electrolyte imbalance, fluid imbalance, glycemic issues, liver function abnormalities)
How often should we do indirect calorimetry monitoring for PN?
weekly
What three electrolytes are low with Refeeding Syndrome?
- phosphates
- magnesium
- potassium
What are some indications for EN?
inadequate/contraindicated PO consumption
When would EN be contraindicated?
- mechanical obstruction (hernia, tumors, adhesions, scar tissue)
- non-mechanical obstruction (ileus)
- intractable vomiting
- severe malabsorption
- severe GI hemorrhage
- high output/proximal small bowel fistulas
What EN route is preferred if a patient has high risk of aspiration?
jejunal
What route of access is preferred for long-term EN?
PEG or PEJ
Continuous infusion EN is the preferred method when feeding into what part of the colon?
jejunum
What GI complications can arise from EN?
- high gastric residuals
- diarrhea
- constipation
- N/V
- abdominal distention
- aspiration
What metabolic complications can arise from EN?
- hyper- or hypoglycemia
- over- or dehydration
- electrolyte imbalance
What mechanical complications can arise from EN?
- tube clogging
- tube malposition
- rhinitis
- sinusitis
True or false: drugs can be administered together with EN.
false; administer separately, with at least 5 ml water between each medication
What type of drug should be diluted in at least 30 ml of water before administering?
hypertonic or irritating to gastric mucosa (i.e. KCl)
