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Therapeutics I - Spring 2017 > P and N nutrition > Flashcards

P and N nutrition Flashcards

1
Q

Examples of Short-Term Enteral Nutrition

A

Nasogastric; Nasoenteric (duodenum/jejunum); Orogastric; Oroenteric (duodenum/jejunum)

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2
Q

Examples of Long-term nutrition

A

PEG; Gastrostomy; jejunostomy

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3
Q

Examples of Peripheral Parenteral Nutrition

A

Peripheral Vein; Midline catheter access

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4
Q

Examples of Central Parenteral Nutrition

A

Central venous catheter; Peripherally inserted central catheter

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5
Q

Which has to be more dilute: Peripheral Parenteral or Central Parenteral

A

Peripheral

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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
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7
Q

What is used to measure someones nourishment status

A

SGA - subjective global assessment

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8
Q

Acute vs Chronic malnutrition

A

Acute - still has fat reserves - PROTEIN DEPLETED

Chronic - does not have fat reserves AND protein depleted

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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)
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10
Q

Main visceral proteins to look at while assessing someones nutrition status

A

albumin and pre-albumin (PT/INR also important)

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11
Q

Protein demands are ________ (increased or decreased) during stress

A

increased

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12
Q

Nitrogen is excreted in the _______ as ______

A

urine; urea

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13
Q

Nitrogen IN equation

A

24 hour protein intake (grams)/ 6.25

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14
Q

Nitrogen OUT equation

A

24 hour UUN (grams) + 4

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15
Q

Goal for nitrogen balance

A

zero for maintenance OR positive for repletion

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16
Q

kcal/gram values for:
Protein:
Carbohydrate:
Lipids:

A

P: 4
C: 3.4
L: 10

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17
Q

Stress on the body causes hyper_______ and hyper________ and increased stimulation of __________

A

metabolism; catabolism; sympathetic nervous system

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18
Q

What are the end results of the body being under stress (what “processes”?)

A

lipolysis; proteolysis; glycogenolysis; insulin resistance; gluconeogenesis

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19
Q

Harris-Benedict Equation is related to what?

A

BEE - basal energy expenditure

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20
Q

BEE = ? = ?

A

Basal energy expenditure; BMR/basal metabolic rate

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21
Q

Definition of BEE

A

metabolic activity required to maintain life (respiration and temperature)

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22
Q

Definition of REE

A

of calories needed during a 24 hr of non-active state

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23
Q

REE is ___ higher than ____

A

10%; BEE

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24
Q

TEE = _____ x ______

A

BEE; activity or stress factor

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25
Q

TEE = ?

A

total energy expenditure

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26
Q

Activity cofactor:
Bedrest: ____
Ambulatory: ____
Anabolic: ____

A

Bedrest: 1.2
Ambulatory: 1.3
Anabolic: 1.5

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27
Q

Stress cofactor:
Non-malnourised/ minor surgery: ___
Ongoing sepsis/thermal injury/severe malnutrition: ____

A

1.2; 1.4 - 1.5;

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28
Q

Goal Daily Calories: UNITS in kcal/kg/day
Non-stressed/Non-depleted: ____
trauma/stress/surgery/critically ill: ____
major burn: ____
obesity: _____

A

nsnd: 20 - 25;
tssc: 25 - 30;
m. b: 35 - 40;
o: 22 - 25; (IBW)

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29
Q

Goal Daily Protein: (g/kg/day)
Maintenance: ___
Mild - moderate (repletion/medical floor): ___
Moderate - Severe (ICU, trauma, surgery) : __
Burn: ___
Obesity: (IBW) ___
Severe obesity: (IBW) ____

A 
0.8 - 1
1 - 1.5
1.5 - 2
2 - 2.5
2 
2.5
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30
Q

If actual weight is 130% LESS than IBW - use what weight?

A

actual

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31
Q

If actual weight is 130% MORE than IBW - use what weight?

A

Nutritional Body weight (NBW = IBW + 0.25 (actual wt - IBW))

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32
Q

If patient is obese (wt is 150% over IBW) use ______

A

ideal BW

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33
Q

Standard ratio for Dextrose/Fat

aka distribution of Non-Protein calories

A

70:30

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34
Q

RQ = ?

A

respiratory quotient

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35
Q

RQ Goal = ?

A

0.85 - 0.95 (want in more O2 than CO2 leaving…)

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36
Q

RQ = ____ / _____

A

VCO2 / VO2

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37
Q

When is EN indicated

A

dysphagia; CVA; dementia; head/neck surgery; trauma/burn; esophageal obstruction;

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38
Q

When is EN Contraindicated

A

need is for less than 5 - 10 days; severe acute pancreatitis; no access; GI ischemia; intractable vomiting/diarrhea; ileus

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39
Q

Types of EN adminstration

A

continuous; bolus; intermittent; cyclic

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40
Q

Bolus has a higher risk for?

A

aspiration - because so much volume so fast

41
Q

EN formulations: Caloric density is ___ kcal/mL

A

1 - 2 (if fluid restricted 2 kcal/mL)

42
Q

Common drug-nutrient interactions

A

phenytoin; fluoroquinolones; tetracyclines; warfarin; PPIs (proton pump inhibitors)

43
Q

Contraindications for PN

A

functioning GI tract; treatment anticipated to be less than 7 days; cant gain vein access; more risks than benefits

44
Q

If a pt has kidney disease: how to adjust their enteral nutrition

A

calorie dense; low electrolytes; var. protein

45
Q

If a pt has liver disease: how to adjust their enteral nutrition

A

high calories; high BCAA/AAA ratio

46
Q

If a pt has lung disease: how to adjust their enteral nutrition

A

high fat; low carb

47
Q

If a pt has DM disease: how to adjust their enteral nutrition

A

high fat; low carb

48
Q

What are MECHANICAL complications of EN vs

MECHANICAL complications of PN

A

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
Q

what are INFECTIOUS complications of PN

A

CVC infection (central venous catheter);

50
Q

What are MECHANICAL complications of EN

A

feeding tube misplacement; clogging; aspiratoin; airway/GI injury –> infection

51
Q

What are MECHANICAL complications of PN

A

Infusion pump failure; catheter related issues = pneumothorax/migrating to the wrong vein/ puncturing..

52
Q

What are the complications of EN (3 main groups)

A

metabolic, mechanical, GI

53
Q

what are the complications of PN (3 main groups)

A

mechanical; infectious; metbolic

54
Q

What are GI complications of EN

A

gastroparesis, GERD

55
Q

what are metabolic complications of EN

A

hyperglycemia; elecotrolyte/vitamin/ and mineral deficiencies; refeeding syndrome, dehydration

56
Q

Ways to unclog a feeding tube

A

pancreatic enzyme tablet; sodium bicarb tablet; 10 mL water

57
Q

Giving drugs with EN:

Continuous feeds vs bolus feeds

A

Contin: must interupt to give meds
Bolus: space meds btwn tube feeds

58
Q

Fat in PN:

Max: ___ g/kg/day or no more of ___% of daily calorie intake

59
Q

Egg allergy warning - related to?

A

fat! - egg yolk phospholipid

60
Q

why give essential fatty acids in TPN?

A

EFAD = essen. f.acid disease - kids need fat for brain development!!

61
Q

Max carbohydrate rate utilization = ?

A

4 - 5 g/kg/min

62
Q

Ratio of chloride to acetate salts to add to TPN bag

A

2/3 of chloride and 1/3 acetate

63
Q

When to increase chloride salt use (usually 2/3 chloride and 1/3 acetate)

A
  • metabolic alkalosis bc of low K+; loss of gastric contents from vomiting or gastric decompression
64
Q

When to increase acetate salt use (usually 2/3 chloride and 1/3 acetate)

A
  • 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
Q

How is calcium added to the body and what to look out for when giving calcium

A
  • as gluconate

- watch for Ca-Phos precipitation

66
Q

what trace elements can be added to TPN bags

A

zinc, copper, manganese, chromium, selenium

67
Q

Appropriate filter for 2 in 1 bag

A

0.22 mictron

68
Q

Appropriate filter for 3 in 1 bag

A

1.2 micron

69
Q

Nutritional precautions for cardiac disease patients

A

avoid overfeeding and FLUID restriction

70
Q

Nutritional precautions for diabetic patients

A
  • 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
Q

What supplement should be considered with short bowel disease

72
Q

Nutritional precautions for short bowel syndrome patients

A

high carb - low fat - WITH COLON

73
Q

Nutritional precautions for (PRE-DIALYSIS) renal disease patients

A 
- fluid restricted: 2 kcal/mL
LOW PROTEIN
- Renal insufficiency:
-"normal": 0.5 - 0.8 g/kg
-"post-op": 0.5 - 1 g/kg
74
Q

Nutritional precautions for (DIALYSIS) renal disease patients

A

Intermittent: 1 - 1.3 g/kg

Continuous: 2 g/kg

75
Q

Nutritional precautions for Pulmonary failure patients

calories, fat, protein…

A

Calories: 20 - 30 kcal/kg
Fat: 30 - 50% of total kcal of fat
Protein: 1 - 2 g/kg

LIMIT CARBS and AVOID OVERFEEDING!!

76
Q

Nutritional precautions for hepatic disease patients

A
  • 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
Q

Clinical Considerations for Special Populations:

If patient has GERD…

A

give H2 antagonist or PPI

78
Q

Clinical Considerations for Special Populations:

If patient has NG suctioning

A

pt could become low on Na, K, and Cl

79
Q

Clinical Considerations for Special Populations:

If patient has N/V

A

can lead to hypovolemia/ Na imbalance, and low K+

80
Q

Clinical Considerations for Special Populations:

If patient has dialysis

A

10 - 20% of amino acids are removed

81
Q

Clinical Considerations for Special Populations:

If patient has wound healing

A

add zinc or vit. c

82
Q

Clinical Considerations for Special Populations:

If patient has loop diuretics

A

low k or Na imbalance

83
Q

Clinical Considerations for Special Populations:

If patient has steroids

A

may increase blood sugars - add insulin

84
Q

Should you try to correct acute electrolyte disturbances via TPN

85
Q

When the body is stressed is more or less nitrogen excreted (via urine)?

A

More! because more stress = more protein catabolism = more urinary nitrogen

86
Q

what too look at for refeeding syndrome

A

low Mg, Phos, K

87
Q

If RG is > ___ = overfeeding and lipogenesis

88
Q

If RG is > 1 = ?

A

overfeeding and lipogenesis

89
Q

Types of protein supplements for EN

A

Prostat; beneprotein

90
Q

Types of carbohydrate supplements for EN

A

Polycose, duocal, benecalorie

91
Q

Types of fiber supplements for EN

92
Q

since dextrose solution is __________ it should never be run alone!

A

hyperosmolar

93
Q

Magnesium is needed in high levels for patients that are what?

A

in catablic/malnourished patients

94
Q

What serious complications can hypophosphatemia lead to

A

coma, seizure, death

95
Q

What serious complications can hypomagnesemia lead to

A

coma, seizure, death

96
Q

what serious complications can hypokalemia lead to

A

cardiac arrhthymias, atrial trachycardia; sudden death

97
Q

What serious complication can sodium retention lead to

A

fluid overload; pulmonary edema; cardiac decompensation

98
Q

What serious complication can vitamin/thiamine deficiency lead to

A

lactic acidosis; death

99
Q

Ways to reduce destabilization of TPN

A
  • 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%

Therapeutics I - Spring 2017 (17 decks)

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