Module Test 4 Set 3

Front 1

Pts @ high-risk for malnutrition (8)

Back 1

1)underwt (less than 80% IBW)
2)overwt (over 120% IBW)
3)recent wt loss (greater than 10%)
4)substance abusers
5)npo for more than 7-10days
6)incr needs due to trauma,burns
7)pharmacologically induced by steroids, chemo
8)abnormal losses via malabsorption, dialysis

Front 2

Daily recommendation of fruits

Back 2

2 cups (4 servings)

Front 3

Daily recommendation of veggies

Back 3

2.5cups (5 servings)

Front 4

Daily recommendation of grain

Back 4

6 ounces

Front 5

Daily recommendation of meat and beans (protein)

Back 5

5.5 ounces

Front 6

Daily recommendation of milk

Back 6

3cups

Front 7

Daily recommendation of oils

Back 7

24g (6tsp)

Front 8

Deficines in ___ result in...
a)vit A
b)vit D
c)vit E
d)vit K
e)vit C

Back 8

a)eye stuff
b)bone stuff
c)hemolysis
d)bleeding
e)gum bleeding

Front 9

Nutritional needs per the body wt method?

Back 9

20-25kcal/kg

Front 10

Balanced diet (3)

Back 10

1)45-65% carbs
2)20-35% fat
3)10-35% protein

Front 11

2 ways to estimate daily fluid needs

Back 11

1)30-35mL/kg/day
2)1mL/kcal of energy requirements

Front 12

Daily protein needs equation

Back 12

0.8-1.0g/kg

Front 13

Drug-nutrient risk factors (6)

Back 13

1)polypharmy
2)long term therapy
3)pre-existing disease
4)poor nutrition
5)herbal products and supplement use
6)pediatrics and elderly

Front 14

Clinical implications of drug-nutrient interaxns (3)

Back 14

1)sub-therapeutic response to medications
2)drug toxicity
3)drug-induced nutritional deficiencies

Front 15

Indications for Enteral nutrition (3)

Back 15

1)unable/willing to eat sufficient calories
2)fxning GI tract
3)if enteral access can be safely obtained

Front 16

Benefits of enteral vs. parenteral nutrition (3)

Back 16

1)less chance of infectious complications b/c EN prevents bacterial translocation
2)reduced metabolic complications (EN is more physiologic than PN in terms of nutrient utilization)
3)less costly

Front 17

Methods of administering EN (4)

Back 17

1)continuous
2)cyclic
3)bolus
4)intermittent

Front 18

Continuous EN (2)

Back 18

1)given 24h/day
2)common in hospitalized and critically ill

Front 19

Cyclic EN (2)

Back 19

1)continuous infusion over a fixed period (not @ all hrs)
2)good for home EN pts or pts in rehab

Front 20

Bolus EN (2)

Back 20

1)rapid delivery (over 5-10min) 4-6 times a day
2)useful in LTC facilities

Front 21

Intermittent EN

Back 21

same as bolus but over a longer period of time

Front 22

Different classifications of EN formulas (7)

Back 22

1)standard polymeric
2)high protein
3)high caloric density
4)elemental/peptide based
5)disease specific
6)oral supplements
7)modular products

Front 23

Standard polymeric EN (4)

Back 23

1)1kcal/mL
2)mix of carbs, fat, protein
3)isotonic
4)not sweetened

Front 24

High protein EN (3)

Back 24

1)nonprotein:nitrogen ratio greater than 125:1
2)for pts w/ protein needs greater than 1.5g/kg/day
3)trauma, burns, critical illness

Front 25

High caloric density EN (3)

Back 25

1)osmolality is 2x that of standard isotonic formulas
2)for pts w/ F&E restrictions
3)renal insufficiency, heart failure

Front 26

Elemental/peptide based EN (2)

Back 26

1)protein/fat is hydrolyzed into predigested form
2)partially hydrolyzed protein sources are better than free AAs

Front 27

Oral supplements EN (4)

Back 27

1)sweetended
2)hypertonic
3)not used w/ tube-fed pt
4)best used w/ fxning GI

Front 28

Modular products EN (3)

Back 28

1)powder/liquid that adds nutrients
2)achieves nutrient balance not available w/ EN formula
3)mixing incr risk for bacterial contamination

Front 29

Formulary considerations for EN (7)

Back 29

1)one product per EN category
2)nutrient requirements of your population
3)open system increases risk of contamination
4)closed system allows longer hang times
4)reconstitution
5)shelf-life
6)cost

Front 30

Monitoring parameters for EN (10)

Back 30

1)wt
2)intake/output
3)bowel fxn
4)glc
5)electrolytes
6)Mg, Phos, Ca
7)liver fxn
8)albumin
9)prealbumin
10)N balance

Front 31

Metabolic complications of EN (3)

Back 31

1)similar to PN but much less frequent
2)hydration, electrolyte imbalance, glc complications in pts w/ underlying organ dysfxn
3)supplementing F&E may be needed

Front 32

GI complications of EN (5)

Back 32

1)high gastric residuals
2)n/v/c/d
3)abdomen distension
4)cramping
5)aspiration

Front 33

How to avoid aspiration pneumonia w/ EN (2)

Back 33

1)keep bed elevated to 30-45 degree angle
2)IS MOST SERIOUS SIDE EFFECT OF EN

Front 34

How is diarrhea caused by EN (4)

Back 34

1)too rapid delivery
2)intolerance
3)contamination
4)admin large volumes

Front 35

Mechanical complications of EN (3)

Back 35

1)feeding tube occlusion (via improper admin of meds/improper flushing technique)
2)inadvertent tube removal or displacement
3)use x-ray to confirm proper positioning prior to feeding

Front 36

Concomitant Drug admin w/ EN considerations (4)

Back 36

1)position of tube
2)timing of meds w/ EN
3)crushing meds/use of liquid meals
4)flushing of tubes (use 30mL of water b4 and after admin of meds)

Front 37

Admixture of drugs w/ EN considerations can cause... (7)

Back 37

1)physical incompatibilites like:
1a)granulation
1b)gel formation
1c)separation
1d)precipitation

2)may clog tubing
3)more common w/ intact proteins

Front 38

Drug-Nutrient Interactions w/ EN? (3)

Back 38

1)reduced F of phenytoin
2)reduced F of Abx
2)decr absorption of warfarin

Front 39

Pts most likely to benefit from PN? (9)

Back 39

1)inability to absorb nutrients from GI
2)cancer pts
3)pancreatitis
4)critical care
5)perioperative
6)hyperemesis gravidarum
7)eating disorders
8)low birth weight (premature)infants
9)inborn errors of metabolism (no tolerate EN)

Front 40

Why might a person be unable to absorb nutriets from GI? (5)

Back 40

1)massive small bowel resection
2)severe diarrhea failing EN
3)inflammatory bowel disease
4)bowel obstruction
5)GI fistulae

Front 41

How many days til starting of PN?

Back 41

no enteral intake for 7-14 days

Front 42

Peripheral route of PN characteristics (5)

Back 42

1)dilute solution b/c it is limited by tolerance of veins to hypertonic solutions
2)pts who are NOT candidates for central line
3)duration of therapy is LESS than 1 wk
4)lower risk of infectious, metabolic, technical complications
5)thrombophlebitis when osmolarity is greater than 600-900

Front 43

Central route of PN characteristics (4)

Back 43

1)use highly []ed hypertonic solutions
2)risks of catheter insertion
3)greater risk of infection vs. peripheral
4)multiple sites for central access

Front 44

AA caloric contributions to a TPN?

Back 44

4kcal per 1 gram

Front 45

Dextrose caloric contributions to a TPN? (and 1 other)

Back 45

1)1g = 3.4kcal
2)max infustion rate is 4-7mg/kg/min (matches the dextrose oxidation rate)

Front 46

IVLE (IV lipids) caloric contribution to a TPN (4)

Back 46

1)1g = 9kcal
2)10% lipids = 1.1kcal/mL
3)20% lipids = 2kcal/mL
4)30% lipids = 3kcal/mL

Front 47

Baseline monitoring parameters for PN (10)

Back 47

1)wt
2)vitals
3)current nutritional intake
4)CBC
5)electrolytes
6)glc
7)albumin
8)LFT
9)BUN/Scr
10)I/O

Front 48

Daily monitoring parameters for PN (7)

Back 48

1)wt
2)vitals
3)current nutritional intake
4)I/O
5)capillary blood glc
6)electrolytes for first 3 days then 2-3x weekly
7)glc for first 3 days then 2-3x weekly

Front 49

Weekly monitoring parameters for PN (3)

Back 49

1)peralbumin
2)serum triglycerides
3)LFT

Front 50

Factors enhancing risk of Ca-P precipitation? (8)

Back 50

1)high [] of Ca and P salts
2)use of chloride salt of Ca
3)decr AA and dextrose []s
4)incr solution temperature
5)incr solution pH
6)improper mixing of Ca and P
7)presence of other additives incluidng IVLE
8)BEING A BABY

Front 51

4 ways to prevent refeeding syndrome

Back 51

1)evaluate CV fxn
2)correct abnormal plasma electrolytes
3)watch for abnormal wt gain
4)slowly advance calories over several days

Front 52

BMI equation

Back 52

(Wt in lbs / ht in inches^2) x 703

Front 53

BMI values for
a)healthy
b)overweight
c)obese
d)morbidly obese

Back 53

a)19-25
b)25-30
c)30-40
d)40+