Nutritonal needs in special populations Flashcards
For a patient with diabetes what is the most glucose that can be given in parenteral nutrition
150 grams of glucose or 1.5mg/kg/min
What type of insulin should be in a TPM
glargine (long lasting)
For patients with diabetes what percent of calories should come from carbohydrates, continuous or bolus
no more than 50% (high fiber), continous
T/F: When fulfilling nutritional needs for patients who have renal disease azotemia,uremia and fluid balance must be considered
True
T/F: Patients with renal problems may have a risk of only hypoglycemia
False: They could be at risk for hyperglycemia and hypoglycemia
When a patient has renal disease and is non-dialyzed what is the replacement requirement for protein
0.6-1.0 g/kg/day
When a patient has renal disease and is intermittent hemodialysis, CAPD what is the replacement requirement for protein
1.2-1.4 g/kg/day
When a patient has renal disease and is on continuous renal replacement therapy what is the replacement requirement for protein
1.8-2.5 g/kg/day
What should be closely monitored when it comes to fat with regards to patients with renal disease
triglyceride and phosphorous levels
If a patient has oliguric renal failure how should water be monitored, sodium
restrict water to 1500ml/day, provide less than 0.5mEq/kg/day
If a patient has dilutional hyponatremia how should water be monitored, sodium
restrict water to 1500ml/day, 1mEq/kg/day
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
True
T/F: When fulfilling energy needs infusions usually cause hypoglycemia
False: glucose infusions typically cause hyperglycemia in patients with hepatic disease
Which amino acids contribute to hepatic encephalopathy
aromatic amino acids (AAA)
When a patient has hepatic disease in the form of compensated cirrhosis with no hepatic encephalopathy what is the protein requirement
1-1.2 g/kg/day
When a patient has hepatic disease in the form of decompensated cirrhosis with grade 1 to 2 encephalopathy what is the protein requirement
Start 0.5 g/kg/day and slowly advance
When a patient has hepatic disease in the form of decompensated cirrhosis with severe Grade 3 to 4 encephalopathy, what is the protein requirement
Start less than 0.5 g/kg/day
If a patient has a hepatic disease how is water restricted, sodium
restrict water to 1500ml/day, 0.5-1.0mEq/kg/day
T/F: The most amount of protein is removed is due to CVVHD causing more protein that needs to be replaced
True
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
hepatic encephalopathy with decompensated mental status, HepatAmine 8% and Aminosyn HF 8%
What is the water and sodium restriction for patients with hepatic disease
Restrict to 1500ml/day, start at 0.5 to 1mEq/kg/day
Patients with hepatic disease will need in an increase in which electrolytes
potassium, phosphate, magnesium
T/F: Patients with renal disease usually need an increase in all of their electrolytes
False: The only electrolyte that may need an adjustment is sodium
What would cause a decrease in most trace elements
biliary disease
For critically ill patients what is the best way to feed them, how soon should they be feed within entering the ICU
Enteral feeding, starts within 24 to 48 hours
Using the NRS 2002 screening tool what scores lead to different amounts of feeding for ICU patients
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)
T/F: Withold parenteral nutrition for the first 7 daysunless NRS 2002 is greater than 5 or the patient is severly malnourished
True
T/F: Soy based products can be used for critically ill during the 1st week of parenteral nutrtion thearpy
False: can cause system inflammation and immune status
What population should get specialty amino acids
hepatic disease patients
If a obese patient has no renal or hepatic dysfunction what type of feeding therapy should they recieve
a hypocalorie and high calorie feeding
If a obese patients has hepatic dysfunction or renal dysfunction what type of feeding therapy should they recieve
calorie intake estimated by the Penn state and MSJ equation, protien should be based on the type of organ dysfunction
For an obese patient with no renal or hepatic dysfunction what will be the calorie and protein intake
11-14 kcal.kg, over 2 grams/kg/day
For a morbidly obese patient with no renal or hepatic dysfunction what will be the calorie and protein intake
11-14 kcal/kg, over 2.5 grams/kg/day
T/F: When figuring out calorie requirements always used ideal body weight and for protein requirements use actual body weight
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
What are some of the low electrolytes seen in patients with hepatic disease
Hypokalemia, hypophosphatemia, and hypomagnesemia
How are obese patients fed without renal or hepatic disease
high protein, hypocalorie feeding
How are obese patients fed with renal or hepatic disease
calories based on Penn state or MSJ, protein based on organ dysfunction
