P and N nutrition Flashcards
1
Q
Examples of Short-Term Enteral Nutrition
A
Nasogastric; Nasoenteric (duodenum/jejunum); Orogastric; Oroenteric (duodenum/jejunum)
2
Q
Examples of Long-term nutrition
A
PEG; Gastrostomy; jejunostomy
3
Q
Examples of Peripheral Parenteral Nutrition
A
Peripheral Vein; Midline catheter access
4
Q
Examples of Central Parenteral Nutrition
A
Central venous catheter; Peripherally inserted central catheter
5
Q
Which has to be more dilute: Peripheral Parenteral or Central Parenteral
A
Peripheral
6
Q
What are things that are risk factors for malnutrition
A
- NPO for > 7 days
- 20% under IBW
- unintentional weight change (drop 10% in 6 months or drop 5% in 1 month)
- increased metabolic needs (trauma/burn)
- inadequate nutrient intake
7
Q
What is used to measure someones nourishment status
A
SGA - subjective global assessment
8
Q
Acute vs Chronic malnutrition
A
Acute - still has fat reserves - PROTEIN DEPLETED
Chronic - does not have fat reserves AND protein depleted
9
Q
Things to use to assess someones nutritional status (which one is most important to pharmacists)
A
- Nutrition hx
- med hx
- Anthropometric measurements (skin fold thickness, circumference of waist and mid-ar muscle)
- biochemical/lab assessments (VISCERAL PROTEINS, NITROGEN BALANCE STUDIES, SERUM CONCENTRATIONS of trace elements/vitamins/minerals)
10
Q
Main visceral proteins to look at while assessing someones nutrition status
A
albumin and pre-albumin (PT/INR also important)
11
Q
Protein demands are ________ (increased or decreased) during stress
A
increased
12
Q
Nitrogen is excreted in the _______ as ______
A
urine; urea
13
Q
Nitrogen IN equation
A
24 hour protein intake (grams)/ 6.25
14
Q
Nitrogen OUT equation
A
24 hour UUN (grams) + 4
15
Q
Goal for nitrogen balance
A
zero for maintenance OR positive for repletion
16
Q
kcal/gram values for:
Protein:
Carbohydrate:
Lipids:
A
P: 4
C: 3.4
L: 10
17
Q
Stress on the body causes hyper_______ and hyper________ and increased stimulation of __________
A
metabolism; catabolism; sympathetic nervous system
18
Q
What are the end results of the body being under stress (what “processes”?)
A
lipolysis; proteolysis; glycogenolysis; insulin resistance; gluconeogenesis
19
Q
Harris-Benedict Equation is related to what?
A
BEE - basal energy expenditure
20
Q
BEE = ? = ?
A
Basal energy expenditure; BMR/basal metabolic rate
21
Q
Definition of BEE
A
metabolic activity required to maintain life (respiration and temperature)
22
Q
Definition of REE
A
of calories needed during a 24 hr of non-active state
23
Q
REE is ___ higher than ____
A
10%; BEE
24
Q
TEE = _____ x ______
A
BEE; activity or stress factor
25
TEE = ?
total energy expenditure
26
Activity cofactor:
Bedrest: ____
Ambulatory: ____
Anabolic: ____
Bedrest: 1.2
Ambulatory: 1.3
Anabolic: 1.5
27
Stress cofactor:
Non-malnourised/ minor surgery: ___
Ongoing sepsis/thermal injury/severe malnutrition: ____
1.2; 1.4 - 1.5;
28
Goal Daily Calories: UNITS in kcal/kg/day
Non-stressed/Non-depleted: ____
trauma/stress/surgery/critically ill: ____
major burn: ____
obesity: _____
nsnd: 20 - 25;
tssc: 25 - 30;
m. b: 35 - 40;
o: 22 - 25; (IBW)
29
Goal Daily Protein: (g/kg/day)
Maintenance: ___
Mild - moderate (repletion/medical floor): ___
Moderate - Severe (ICU, trauma, surgery) : __
Burn: ___
Obesity: (IBW) ___
Severe obesity: (IBW) ____
```
0.8 - 1
1 - 1.5
1.5 - 2
2 - 2.5
2
2.5
```
30
If actual weight is 130% LESS than IBW - use what weight?
actual
31
If actual weight is 130% MORE than IBW - use what weight?
Nutritional Body weight (NBW = IBW + 0.25 (actual wt - IBW))
32
If patient is obese (wt is 150% over IBW) use ______
ideal BW
33
Standard ratio for Dextrose/Fat
| aka distribution of Non-Protein calories
70:30
34
RQ = ?
respiratory quotient
35
RQ Goal = ?
0.85 - 0.95 (want in more O2 than CO2 leaving...)
36
RQ = ____ / _____
VCO2 / VO2
37
When is EN indicated
dysphagia; CVA; dementia; head/neck surgery; trauma/burn; esophageal obstruction;
38
When is EN Contraindicated
need is for less than 5 - 10 days; severe acute pancreatitis; no access; GI ischemia; intractable vomiting/diarrhea; ileus
39
Types of EN adminstration
continuous; bolus; intermittent; cyclic
40
Bolus has a higher risk for?
aspiration - because so much volume so fast
41
EN formulations: Caloric density is ___ kcal/mL
1 - 2 (if fluid restricted 2 kcal/mL)
42
Common drug-nutrient interactions
phenytoin; fluoroquinolones; tetracyclines; warfarin; PPIs (proton pump inhibitors)
43
Contraindications for PN
functioning GI tract; treatment anticipated to be less than 7 days; cant gain vein access; more risks than benefits
44
If a pt has kidney disease: how to adjust their enteral nutrition
calorie dense; low electrolytes; var. protein
45
If a pt has liver disease: how to adjust their enteral nutrition
high calories; high BCAA/AAA ratio
46
If a pt has lung disease: how to adjust their enteral nutrition
high fat; low carb
47
If a pt has DM disease: how to adjust their enteral nutrition
high fat; low carb
48
What are MECHANICAL complications of EN vs
| MECHANICAL complications of PN
EN: feeding tube misplacement; clogging; aspiratoin; airway/GI injury --> infection
PN: Infusion pump failure; catheter related issues = pneumothorax/migrating to the wrong vein/ puncturing..
49
what are INFECTIOUS complications of PN
CVC infection (central venous catheter);
50
What are MECHANICAL complications of EN
feeding tube misplacement; clogging; aspiratoin; airway/GI injury --> infection
51
What are MECHANICAL complications of PN
Infusion pump failure; catheter related issues = pneumothorax/migrating to the wrong vein/ puncturing..
52
What are the complications of EN (3 main groups)
metabolic, mechanical, GI
53
what are the complications of PN (3 main groups)
mechanical; infectious; metbolic
54
What are GI complications of EN
gastroparesis, GERD
55
what are metabolic complications of EN
hyperglycemia; elecotrolyte/vitamin/ and mineral deficiencies; refeeding syndrome, dehydration
56
Ways to unclog a feeding tube
pancreatic enzyme tablet; sodium bicarb tablet; 10 mL water
57
Giving drugs with EN:
| Continuous feeds vs bolus feeds
Contin: must interupt to give meds
Bolus: space meds btwn tube feeds
58
Fat in PN:
| Max: ___ g/kg/day or no more of ___% of daily calorie intake
2.5; 60
59
Egg allergy warning - related to?
fat! - egg yolk phospholipid
60
why give essential fatty acids in TPN?
EFAD = essen. f.acid disease - kids need fat for brain development!!
61
Max carbohydrate rate utilization = ?
4 - 5 g/kg/min
62
Ratio of chloride to acetate salts to add to TPN bag
2/3 of chloride and 1/3 acetate
63
When to increase chloride salt use (usually 2/3 chloride and 1/3 acetate)
- metabolic alkalosis bc of low K+; loss of gastric contents from vomiting or gastric decompression
64
When to increase acetate salt use (usually 2/3 chloride and 1/3 acetate)
- metabolic acidosis due to lots of bicarb loss via renal, diarrhea, small bowel, pancreatic fistula
- acetate is converted to bicarb in the body with a ratio of 1:1
65
How is calcium added to the body and what to look out for when giving calcium
- as gluconate
| - watch for Ca-Phos precipitation
66
what trace elements can be added to TPN bags
zinc, copper, manganese, chromium, selenium
67
Appropriate filter for 2 in 1 bag
0.22 mictron
68
Appropriate filter for 3 in 1 bag
1.2 micron
69
Nutritional precautions for cardiac disease patients
avoid overfeeding and FLUID restriction
70
Nutritional precautions for diabetic patients
- give 30% of kcal as fat
maintain glucose levels at 110 - 220 mg/dL
- delayed emptying and gastric atony is common in Type 1 diabetes
71
What supplement should be considered with short bowel disease
Vit. B12
72
Nutritional precautions for short bowel syndrome patients
high carb - low fat - WITH COLON
73
Nutritional precautions for (PRE-DIALYSIS) renal disease patients
```
- fluid restricted: 2 kcal/mL
LOW PROTEIN
- Renal insufficiency:
-"normal": 0.5 - 0.8 g/kg
-"post-op": 0.5 - 1 g/kg
```
74
Nutritional precautions for (DIALYSIS) renal disease patients
Intermittent: 1 - 1.3 g/kg
Continuous: 2 g/kg
75
Nutritional precautions for Pulmonary failure patients
| calories, fat, protein...
Calories: 20 - 30 kcal/kg
Fat: 30 - 50% of total kcal of fat
Protein: 1 - 2 g/kg
LIMIT CARBS and AVOID OVERFEEDING!!
76
Nutritional precautions for hepatic disease patients
- High calorie intake (35 kcal/kg/day)
- If no encephalopathy: standard protein
(1 -1.2 g/kg/day)
- If encephalopathy: protein restricted
(0/6 g/kg/day)
- Sodium restrict if edema or ascites
77
Clinical Considerations for Special Populations:
| If patient has GERD...
give H2 antagonist or PPI
78
Clinical Considerations for Special Populations:
| If patient has NG suctioning
pt could become low on Na, K, and Cl
79
Clinical Considerations for Special Populations:
| If patient has N/V
can lead to hypovolemia/ Na imbalance, and low K+
80
Clinical Considerations for Special Populations:
| If patient has dialysis
10 - 20% of amino acids are removed
81
Clinical Considerations for Special Populations:
| If patient has wound healing
add zinc or vit. c
82
Clinical Considerations for Special Populations:
| If patient has loop diuretics
low k or Na imbalance
83
Clinical Considerations for Special Populations:
| If patient has steroids
may increase blood sugars - add insulin
84
Should you try to correct acute electrolyte disturbances via TPN
NO
85
When the body is stressed is more or less nitrogen excreted (via urine)?
More! because more stress = more protein catabolism = more urinary nitrogen
86
what too look at for refeeding syndrome
low Mg, Phos, K
87
If RG is > ___ = overfeeding and lipogenesis
1
88
If RG is > 1 = ?
overfeeding and lipogenesis
89
Types of protein supplements for EN
Prostat; beneprotein
90
Types of carbohydrate supplements for EN
Polycose, duocal, benecalorie
91
Types of fiber supplements for EN
benefiber
92
since dextrose solution is __________ it should never be run alone!
hyperosmolar
93
Magnesium is needed in high levels for patients that are what?
in catablic/malnourished patients
94
What serious complications can hypophosphatemia lead to
coma, seizure, death
95
What serious complications can hypomagnesemia lead to
coma, seizure, death
96
what serious complications can hypokalemia lead to
cardiac arrhthymias, atrial trachycardia; sudden death
97
What serious complication can sodium retention lead to
fluid overload; pulmonary edema; cardiac decompensation
98
What serious complication can vitamin/thiamine deficiency lead to
lactic acidosis; death
99
Ways to reduce destabilization of TPN
- keep pH above 5 (bc lipids destabilize at low pHs)
- avoid mixing dextrose and lipid directly
- avoid trivalent cations (iron)
- ADD LIPID LAST (except vitamins)
- keep final amino acid concen. at 2.5% or more
- keep dextrose concen above 3.3%
