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Pharmacy > Y4 IC7 > Flashcards

Y4 IC7 Flashcards

1
Q

What is the role of nutrition support in multi-morbid patients

A

prevent malnutrition which prevents
1. increased complications
2. poor wound healing
3. compromised immune status
4. impairment of organ functions
5. increased mortality
6. increased use of healthcare resources

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2
Q

nutrition screening

A

using 3min-NS, to all patients,
weight loss, daily intake, muscle wastage

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3
Q

routes of nutrition administration

A
  1. enteral nutrition
    - pre-pyloric(nasal/stomy)
    - post-pyloric(nasal/stomy)
    - bolus/ continuous
  2. parenteral access
    - peripheral
    - central
    a) non-tunnelled central venous catheter
    b) tunnelled central venous catheter
    c) peripherally inserted central catheter
    d) port-a-cath
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4
Q

nutrition assessment

A

using the -point subjective global assessment(SGA)
- A(height and weight)
- B(biochem- electrolytes, albumin)
- C(clinical - PMH/Med/PE)
- D(Diet history)

1 is the worst

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5
Q

common causes of malnutrition

A
  1. cancer - chemo, taste alteration, n/v
  2. ascitis - pressure on GI, stomach cannot expand
  3. conditions that affects nutrients absorption
  4. body under stress from surgey/burn
  5. increased nutrients loss from renal dialysis
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6
Q

energy requirements

A

in kcal
depends on resting, physical activity, stress factor
measurement: indirect calorimetety, weight based(25-35 for general hospitalized), predictive(only basal)

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7
Q

protein requirements

A

in g

healthy adult: 0.8g/kg/day

trauma/surgery/burn: 1.5 - 2g/kg/day

sepsis/critical illness: 1.5 - 2, up to 2.5g/kg/day

CKD (not on dialysis): 0.6-0.8

CKD(on HD/PD): 1.2

CKD(CRRT): up to 2

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8
Q

pre-pyloric pros and cons

A
  1. more physiologic
  2. high tolerance to bolus feeding
  3. wide range of enteral products
  4. used for venting to remove gastric

cons: not used for feeding in those with delayed gastric emptying

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9
Q

post pyloric pros and cons

A
  1. smaller bore, less discomfort
    2.. used when there is dysfunction of GI
  2. minimize aspiration risk

cons: higher risk of tube clogging

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10
Q

pros and cons of bolus administration

A
  1. more physiologic
  2. no pump required
  3. greater freedom for ambulation
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11
Q

pros and cons of continuous administration

A
  1. pump assisted at a constant rate
  2. better tolerated(less bloating/discomfort)
  3. lower risk of aspiration
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12
Q

examples of disease specific formulas

A

DM - glucerna 1kcal/ml

conditions with increased energy and protein needs - Fresubin protein energy 1.5kcal/ml

Renal, on dialysis - Nepro HP 1.8kcal/ml

Renal, not on dialysis - Nepro LP1.8kcal/ml

Inflammatory diseases, cancer - NutriFriend 1kcal/ml

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13
Q

Types of EN formula

A
  1. modular - to enhance a specific nutrient component
  2. (Semi) elemental - for impaired GI
  3. Polymeric - with sufficient GI function
  4. disease-specific
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14
Q

administration of incompatible drugs in EH feed may cause

A
  1. precipitation
  2. curdling, clumping of protein in acidic
  3. alteration of dosage form
  4. DDI with fluroquinolone(cipro)
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15
Q

common complications of EN feeding

A
  1. occlusion of feeding tube
  2. tube migration
  3. infections esp if dilute feed with h20
  4. aspiration
  5. nausea and vomiting
  6. diarrhea and constipation
  7. Refeeding syndrome
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16
Q

how to prevent and mitigate DNI

A

flush access before and after administration, use alternatives

17
Q

strategies to maximise tolerance to EN

A
  1. continuous instead of bolus
  2. use of prokinetic agents(metoclopramide, domperidone, IV erythromycin)
  3. Post-pyloric
  4. use of isotonic formula
  5. semi-elemental/ elemental feeds for those with malabsorption issue
18
Q

why is EN preferred over PN

A
  1. maintain functional integrity of the gut
  2. undergo first pass metabolism, promote efficient nutrient utilization
  3. maintains normal gallbladder function
  4. maintain gut-associated lymphoid tissues
  5. less complications than PN - IFLAD
  6. Less expensive
19
Q

peripheral parental access VS central access

A

P:
- tip is outside of central vessels
- requires freq resite
- nutrient delivery limited by osmolarity and concentration

C:
- position in large bore blood vessels
- can be use in long term care

20
Q

which electrolytes are known to cause precipitation

A

calcium and phosphate

21
Q

what make lipid solution not stable

A

acidic ph, esp in dextrose solution which is pH2

22
Q

administration of incompatible drugs in PN feed may cause

A
  1. precipitation
  2. loss of drug activity
  3. phase separation of lipid emulsions
  4. toxicity
23
Q

device related complications

A
  1. Occlusions in IV catheter
  2. Mal-positioning
  3. Catheter-related bloodstream infection
24
Q

metabolic complications

A
  • refeeding syndrome
  • hyper/hypoglycemia
  • fluid overload
  • intestinal failure associated liver disease(IFALD)
  • metabolic bone disease
25
Q

refeeding syndrome

A

hypokalemia
hypomagnesemia
hypophosphatemia
thiamine deficiency
salt and water retention - edema

26
Q

complications of refeeding syndrome

A

arrhythmias, cardiac failure, neuromuscular complications

27
Q

Management of refeeding syndrome

A
  1. identify high risk patients
  2. check serum electrolytes at baseline
  3. correct deficiencies prior to feeding
  4. administer thiamine vit B1 - 100mg od 5/7
  5. initiate slow and low
  6. continue to monitor electrolytes
28
Q

what is determined as high risk patients

A

one of the following:
1. BMI<16
2. unintentional weight loss>15% in past 3-6 months
3. little/no nutritional intake > 10 days
4. low levels of K, Mg, Phosphate before feeding

at least 2 of the following:
1. BMI<18.5
2. unintentional weight loss > 10% in past 3-6 months
3. little/no nutritional intake > 5 days
4. History of alcohol misuse OR Drugs(insulin, antacid, chemo, diuretic)

29
Q

TPN and TNA

A

TPN: bags w/o fats
TNA: 3 in 1 TPN - more incompatible as it has lipids

Pharmacy (35 decks)

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