Nutritonal needs in special populations

Question 1

For a patient with diabetes what is the most glucose that can be given in parenteral nutrition

Answer 1

150 grams of glucose or 1.5mg/kg/min

Question 2

What type of insulin should be in a TPM

Answer 2

glargine (long lasting)

Question 3

For patients with diabetes what percent of calories should come from carbohydrates, continuous or bolus

Answer 3

no more than 50% (high fiber), continous

Question 4

T/F: When fulfilling nutritional needs for patients who have renal disease azotemia,uremia and fluid balance must be considered

Answer 4

True

Question 5

T/F: Patients with renal problems may have a risk of only hypoglycemia

Answer 5

False: They could be at risk for hyperglycemia and hypoglycemia

Question 6

When a patient has renal disease and is non-dialyzed what is the replacement requirement for protein

Answer 6

0.6-1.0 g/kg/day

Question 7

When a patient has renal disease and is intermittent hemodialysis, CAPD what is the replacement requirement for protein

Answer 7

1.2-1.4 g/kg/day

Question 8

When a patient has renal disease and is on continuous renal replacement therapy what is the replacement requirement for protein

Answer 8

1.8-2.5 g/kg/day

Question 9

What should be closely monitored when it comes to fat with regards to patients with renal disease

Answer 9

triglyceride and phosphorous levels

Question 10

If a patient has oliguric renal failure how should water be monitored, sodium

Answer 10

restrict water to 1500ml/day, provide less than 0.5mEq/kg/day

Question 11

If a patient has dilutional hyponatremia how should water be monitored, sodium

Answer 11

restrict water to 1500ml/day, 1mEq/kg/day

Question 12

T/F: Standard vitamins is fine for patients with renal disease, while selenium must be cut in half unless they are one chronic renal replacement therapy

Answer 12

True

Question 13

T/F: When fulfilling energy needs infusions usually cause hypoglycemia

Answer 13

False: glucose infusions typically cause hyperglycemia in patients with hepatic disease

Question 14

Which amino acids contribute to hepatic encephalopathy

Answer 14

aromatic amino acids (AAA)

Question 15

When a patient has hepatic disease in the form of compensated cirrhosis with no hepatic encephalopathy what is the protein requirement

Answer 15

1-1.2 g/kg/day

Question 16

When a patient has hepatic disease in the form of decompensated cirrhosis with grade 1 to 2 encephalopathy what is the protein requirement

Answer 16

Start 0.5 g/kg/day and slowly advance

Question 17

When a patient has hepatic disease in the form of decompensated cirrhosis with severe Grade 3 to 4 encephalopathy, what is the protein requirement

Answer 17

Start less than 0.5 g/kg/day

Question 18

If a patient has a hepatic disease how is water restricted, sodium

Answer 18

restrict water to 1500ml/day, 0.5-1.0mEq/kg/day

Question 19

T/F: The most amount of protein is removed is due to CVVHD causing more protein that needs to be replaced

Answer 19

True

Question 20

If a patient has hepatic disease what type of hepatic disease and/or conditions would cause the use of of specialty amino acid solutions, what are the specialty solutions

Answer 20

hepatic encephalopathy with decompensated mental status, HepatAmine 8% and Aminosyn HF 8%

Question 21

What is the water and sodium restriction for patients with hepatic disease

Answer 21

Restrict to 1500ml/day, start at 0.5 to 1mEq/kg/day

Question 22

Patients with hepatic disease will need in an increase in which electrolytes

Answer 22

potassium, phosphate, magnesium

Question 23

T/F: Patients with renal disease usually need an increase in all of their electrolytes

Answer 23

False: The only electrolyte that may need an adjustment is sodium

Question 24

What would cause a decrease in most trace elements

Answer 24

biliary disease

Question 25

For critically ill patients what is the best way to feed them, how soon should they be feed within entering the ICU

Answer 25

Enteral feeding, starts within 24 to 48 hours

Question 26

Using the NRS 2002 screening tool what scores lead to different amounts of feeding for ICU patients

Answer 26

score greater than 5 equals the patient should be provide with greater than 80% of their estimated needs within 48 hours to 72 hours, other patients should receive 500 kcal/day (trophic feeding)

Question 27

T/F: Withold parenteral nutrition for the first 7 daysunless NRS 2002 is greater than 5 or the patient is severly malnourished

Answer 27

True

Question 28

T/F: Soy based products can be used for critically ill during the 1st week of parenteral nutrtion thearpy

Answer 28

False: can cause system inflammation and immune status

Question 29

What population should get specialty amino acids

Answer 29

hepatic disease patients

Question 30

If a obese patient has no renal or hepatic dysfunction what type of feeding therapy should they recieve

Answer 30

a hypocalorie and high calorie feeding

Question 31

If a obese patients has hepatic dysfunction or renal dysfunction what type of feeding therapy should they recieve

Answer 31

calorie intake estimated by the Penn state and MSJ equation, protien should be based on the type of organ dysfunction

Question 32

For an obese patient with no renal or hepatic dysfunction what will be the calorie and protein intake

Answer 32

11-14 kcal.kg, over 2 grams/kg/day

Question 33

For a morbidly obese patient with no renal or hepatic dysfunction what will be the calorie and protein intake

Answer 33

11-14 kcal/kg, over 2.5 grams/kg/day

Question 34

T/F: When figuring out calorie requirements always used ideal body weight and for protein requirements use actual body weight

Answer 34

False: When finding the calorie needs always use actual body weight and for proteins use actual body unless the patient is obese, then use ideal body weight

Question 35

What are some of the low electrolytes seen in patients with hepatic disease

Answer 35

Hypokalemia, hypophosphatemia, and hypomagnesemia

Question 36

How are obese patients fed without renal or hepatic disease

Answer 36

high protein, hypocalorie feeding

Question 37

How are obese patients fed with renal or hepatic disease

Answer 37

calories based on Penn state or MSJ, protein based on organ dysfunction