Nutrition Exam 3

Front 1

Respiratory quotient (RQ) is the ratio of CO2 produced to oxygen consumed. Excess CO2 production and increased RQ can lead to what adverse effect?

Back 1

difficulty weaning from the ventilator

Front 2

What would most likely contribute to weight loss in patients with COPD?

Back 2

increased energy expenditure due to work of breathing

Front 3

What potential side effect of medication used to treat COPD may limit dietary intake?

Back 3

diarrhea, gastric irritation, dry mouth, and dysgeusia

Front 4

MNT for patients with OSAS should focus on what?

Back 4

weight reduction

Front 5

What is a common complication of prednisone therapy that may require nutritional intervention?

Back 5

hyperglycemia

Front 6

GR is a 10y/o girl with cystic fibrosis complaining of weakness and lethargy and weight loss. In addition to adjusting oral enzyme supplements, what dietary recommendations would be appropriate?

Back 6

extra salt, addition of vitamins and mineral supplements, high calorie intake

Front 7

How much of an increase in energy expenditure has been reported in patients with COPD?

Back 7

ten-fold increase

Front 8

DR is hospitalized for pneumonia requiring ventilation >14days. What type of nutritional support should she receive given a normal GI function?

Back 8

enteral nutrition via NG tube

Front 9

What vitamin deficiency may occur in a patient taking long-term abx?

Back 9

vit K

Front 10

In addition to malabsorption, what factors contribute to osteopenia seen in pts with cystic fibrosis?

Back 10

malabsorption, vit D deficiency, delayed puberty

Front 11

What is considered first-line tx for pts with OSAS?

Back 11

CPAP

Front 12

a 9y/o girl with cystic fibrosis is brought to her PCP for foul-smelling stools and weight loss. What is the most likely cause of her weight loss?

Back 12

malabsorption

Front 13

What increases resting energy requirements and promotes los of weight and lean body mass in COPD pts?

Back 13

increase in cytokines, decrease in levels of cell derived proteins, frequent and recurrent respiratory infections

Front 14

What is the most likely etiology of elevated H&H in pt with COPD?

Back 14

chronic hypoxia

Front 15

What metabolic complications are patients with COPD and CHF on furosemide and prednisone at risk for?

Back 15

hyperglycemia, hypokalemia

Front 16

What calorie requirement should be used for individuals with acute renal failure?

Back 16

20-35kcal/kg/day

Front 17

MNT for patients prior to initiating dialysis restricts protein, why?

Back 17

to slow progression of renal disease

Front 18

What foods contain the highest amount of oxalate and should be limited in pts with calcium oxylate stones?

Back 18

dark green, leafy vegetables

Front 19

Side effects related to some immunosuppresive (post renal transplant) agents would require dietary recommendations including what?

Back 19

hyperlipidemia

Front 20

Restricting phosphate intake for those with chronic kidney disease may decrease severity of what?

Back 20

vascular and soft-tissue calcificatons

Front 21

Patients in chronic kidney disease taking what to control blood pressure may be at risk for developing hyperkalemia?

Back 21

dietary salt substitutes, ACE inhibitors, Potassium sparing diuretics

Front 22

A patient getting dialysis 3x/week with a BUN 65mg/dL, albumin 3.7g/dl, and creatnine 9.2mg/dl should consume how much protein daily?

Back 22

60-65g/day

Front 23

The kidney is essential in the metabolism of what metabolic conversion?

Back 23

25(OH)D3 to 125(OH2)D3

Front 24

What mechanism explains why moderate protein intake is advised for pts with nephrotic syndrome?

Back 24

to reduce amino acid load in the glomerulus

Front 25

What mechanism most likely explains anemia associated with chronic kidney disease?

Back 25

decreased erythropoietin production

Front 26

What is "dry weight" with regards to patients with chronic kidney disease?

Back 26

weight of the pt minus the estimated amount of fluid retention

Front 27

What are the daily protein requirements for the following pt?
46/m stage 4 CKD. Weighs 200lbs (90.7kg), an ideal BW and is not retaining fluid. Urine indicates protein loss of 2.1g/24h.

Back 27

56.5g/day

Front 28

What is likely to be tested with a 24h urine collection in a pt with Type 2 DM with elevated creatinine and BUN levels with suspicion of renal disease?

Back 28

presence of RBCs, Protein excretion, Creatinine excretion

Front 29

Who has the highest risk of developing breast cancer:
- pre-menopausal, BMI of 30
- pre-menopausal, BMI of 22
- post-menopausal, BMI of 30
- post menopausal, BMI of 40

Back 29

post-menopausal, BMI of 40

Front 30

What is the strongest and most consistent predictor of breast cancer risk?

Back 30

weight gain during adulthood

Front 31

Weight gain in what body area poses highest risk of colon cancer?

Back 31

Abdomen

Front 32

Dietary recommendations to reduce the risk of colorectal cancer include what about red meat intake?

Back 32

maximum of 18oz cooked red meat per week with no processed meat consumption

Front 33

Flavanoids are found in high concentrations in what foods?

Back 33

- grapes and wine
- berries
- green tea

Front 34

Consumption of foods made with soy may be protective against what type of cancer?

Back 34

Breast

Front 35

What is a good source of selenium to meet the 55mcg/day RDA?

Back 35

Brazil nuts

Front 36

An 84/m admitted to hospital with dehydration and pneumonia. At what point should cancer cachexia be suspected?

Back 36

if he experienced unintentional weight loss greater than 5% over the previous month

Front 37

What side effect of radiation treatment is most likely to affect a patient's nutritional status?

Back 37

nausea and vomiting

Front 38

What nutrition recommendation could help control nausea after treatment with chemotherapy?

Back 38

consume clear or ice-cold drinks, eat small and more frequent meals

Front 39

Alcohol users experience what types of cancers six times more often than non-drinkers?

Back 39

oral cancer

Front 40

RT is a 45/m with fam hx of cancer. He recently quit smoking and is eating healthier. What else can be recommended to reduce risk of developing cancer?

Back 40

begin a regular physical activity program for 30 mins/day

Front 41

In which of the following would tube feeding be useful?
- 2 days post coronary bypass in well-nourished pt
- folowing surgery for ischemic bowel with 50cm remaining
- seven days after a stroke in pt with aspiration when swallowing
- crohn's disease with small bowel obstruction

Back 41

- Seven days post stroke in pt with aspiration

Front 42

When is a surgically placed feeding tube, such as a jejunostomy indicated in a patient requiring long-term feeding?

Back 42

When other abdominal surgery is scheduled.

Front 43

When a pt is ambulatory and eating small amounts of food, what is the best method for administering supplemental tube feeding?

Back 43

nocturnal cycle

Front 44

What test is indicated when a pt receiving tube feeding and abx develops diarrhea?

Back 44

stool for clostridia difficile

Front 45

What is a proposed benefit of pre-biotics in enteral formulas?

Back 45

normalizes intestinal flora

Front 46

Which antioxidants are added to some enteral formulas?

Back 46

Vitamins C and E

Front 47

What is the preferred feeding tube placement in an ICU pt with a large hiatal hernia and documented GERD?

Back 47

nasoenteric (nasojejunal or nasoduodenal)

Front 48

Lack of enteral stimulation may contribute to what?

Back 48

gut atrophy and higher infection risk

Front 49

What formula density is appropriate for pt with normal fluid requirements?

Back 49

1.0-1.2 kcal/mL

Front 50

Formulas supplemented with glutamine are designed to accomplish what?

Back 50

assist in controlling blood sugar

Front 51

What is recommended for home infusion of an enteral formula via a jejunostomy?

Back 51

cycled over 12 hours at night

Front 52

Which of the following does NOT increase fluid requirements in pts receiving tube feeding?
- fiber-enriched formulas
- fistula poutput
- nausea
-diarrhea

Back 52

Nausea

Front 53

MNT for a pt with odynophasia (painful swallowing) includes which of the following?
- low-fat foods
- raw fruits and veggies
- spicy foods
- soft, blended foods

Back 53

soft, blended foods

Front 54

Parenteral nutrition is utilized in pts in what situations? (select 2)
- diminished motor capacity makes eating difficult
- GI tract is not funcitonal, accessible, or safe to use
- When pt has dementia
- enteral nutrition is not possible.

Back 54

- GI tract is not functional, accessible, or safe to use
- Enteral nutrition is not possible

Front 55

Central parenteral nutrition is indicated in which of the following?
- long-term parenteral nutrition support >7 days
- poor peripheral access
- moderate-to-severe elevated metabolic rate
- all of the above

Back 55

All

Front 56

When using peripheral parenteral nutrition solutions, what is the maxiumum allowable concentration to prevent vascular damage?

Back 56

900 mOsm/Liter

Front 57

According to ASPEN, what range is most commonly recommended when determining energy needs for parenteral nutrition?

Back 57

20-35kcal/kg daily for adults

Front 58

What range is recommended for protein needs for parenteral nutrition in severely stressed patients?

Back 58

1.5-2.0 kcal/kg per day

Front 59

In order to limit the potential side effects of linoleic acid on prostaglandin metabolism in pts receiving parenteral nutrition, soybean or sunflower lipid emulsions shoudl be limited to what?

Back 59

<1g lipid/kg/24 hours

Front 60

What is most likely the cause of complications in parenteral nutrition such as change in body temp, new onset shaking chills, leukocytosis, unexplained hyperglycemia?

Back 60

catheter related blood stream infection

Front 61

Potential complications of parenteral nutriition that must be monitored closely include what?

Back 61

hyperlipidemia,
electrolyte imbalances
dehydration or fluid overload

Front 62

What is the most common cause of large intestinal obstruction in an adult patient?

Back 62

Hernia

Front 63

What is the most common cause of large intestinal obstruction in an elderly patient?

Back 63

colon cancer

Front 64

What explains why low serum calcium levels must be adjusted in pts who also exhibit hypoalbuminemia?

Back 64

calcium is bound to serum albumin

Front 65

When a pt transitions from parenteral nutrition to oral feeding, when should parenteral nutrition be discontinued?

Back 65

When the pt tolerates 75% of daily nutrition requirements through the oral diet.

Front 66

What are the three major causes of malnutrition in COPD?

Back 66

1. ppor nutritional intake
2. altered protein metabolism
3. hypermetabolism

Front 67

Poor nutritional intake in COPD includes what?

Back 67

- swallowing dysfunciton,
- decreased appetite,
- depression,
- med induced GI symptoms
- dyspnea

Front 68

What causes altered protein metabolism in COPD?

Back 68

increased inflammatory mediators,

altered leptin and anabolic hormone levels

Front 69

___ in COPD is due to increased work of breathing, respiratory exacerbation, and medication

Back 69

hypermetabolism

Front 70

Factors causing poor nutritional intake in COPD are:

Back 70

1. appetite reduced
2. frequent cough results in poor swallowing
3. severe dyspnea and fatigue = inability to prepare meals
4. depression from illness
5. hyperinflation of lungs - pressure on abdominal cavity and early satiety
6. oxyhemoglobin desat during eating.
7. medication side effects
8. medication causing inc. need for protein, calc. vit A, folic acid
9. medication alters levels of K+, Mg, cholesterol

Front 71

What contributes to weight loss in COPD?

Back 71

Multiple causes due to hypermetabolic state, altered protein metabolism, poor nutritional intake

Front 72

What are ways of providing proper nutritional support to a ventilated patient?

Back 72

1. enteral support
2. parenteral support

Front 73

Why is it important that ventilated patients get nutritional support?

Back 73

1. undernutrition leaves the susceptible to infections
2. undernutrition can make weaning from ventilator difficult due to decreased respiratory muscle strength for breathing.

Front 74

Nutritional deficiencies in Cystic Fibrosis patietns include:

Back 74

- kcals
- protein
- essential fatty acids
- fat-soluble vitamins
- beta-carotene
- zinc
- iron
- sodium

Front 75

Patients with cystic fibrosis have ____ nutrient needs.

Back 75

Increased - due to high protein catabolism, and energy exposure due to infections and malabsorption.

Front 76

Nutritional deficiencies in cystic fibrosis are largely due to ___

Back 76

malabsorption

Front 77

What are salt and kcal needs for cystic fibrosis pts?

Back 77

- added salt, high kcals, balanced meals, and nutrient-dense foods are important
- nutrition supplements between meals.

Front 78

Pancreatic enzyme replacement in cystic fibrosis patients should include:

Back 78

500-2500 units lipase per meal

Front 79

What are the recommended needs of vitamins in cystic fibrosis?
- vit K, A, D, E

Back 79

*often need 2x RDA to prevent deficiency due to malabsorption

- K: 2.5-5 mcg/week
- A: 10,000 IU/ day
- D: 800-1000 IU/day
- E: 200-400 /day

Front 80

___ is usually caused by fat occlusion of upper airway.

Back 80

Obstructive sleep apnea (OSA)

Front 81

What are appropriate weight loss goals for pts with OSA?

Back 81

- 5-10% loss can improve breathing and sleep patterns, also benefit from RD referral
- increase activity should start with low-intensity then build

Front 82

What are common SxS of OSA?

Back 82

-snoring
-excessive sleepiness

Front 83

How does weight influence a woman's risk of breast CA?

Back 83

- obesity linked to breast CA
- increased risk if weight gain post menopause. (none for pre-menopausal women)
- Women with BMI>40 had 60% inc. risk of dying formc cancers.
**Weight gain during adulthood is most consistent and strongest predictor of breast cancer**

Front 84

What is the most consistent and strongest predictor of breast cancer?

Back 84

Weight gain during adulthood

Front 85

___ is strongly associated with inc. risk of colon, kidney, pancreatic, esophageal, endometrial, and post-menopausal breast CA

Back 85

obesity

Front 86

There is a 200-400% increase in occurance of endometrial cancer associated with BMI >than ??

Back 86

25

Front 87

Colon cancer occurs more frequently in ___

Back 87

obese patients (abdominal fat seems to have signficant role)

Front 88

Describe the impact of diet (meats and protein) vs cancer.

Back 88

Red meat intake significantly increases risk of colorectal cancer.

Processed meats have been linked to increased risk stomach cancer

Front 89

WHere are nitrates found?

Back 89

cancer causing ntirosamines (nitrates and nitrites) are added to meats for preservation

Front 90

Intake of red meat should be limited to how much to decrease risk of cancer?

Back 90

18oz cooked red meat weekly

Front 91

What meat sources should be excluded from a diet to aid in cancer prevention?

Back 91

Avoid processed meats completely

Front 92

___ are associated with inc. risk of colorectal, panreatic, and breast ca

Back 92

HCAs (those who have high intake of well-done, fried, or bbq foods)

Front 93

Total fat intake (does/ does not) alter cancer risk?

Back 93

Does not

Front 94

Diets high in animal fat are ____ associated with colorectal and prostate ca.

Back 94

Positively

Front 95

What is a phytochemical?

Back 95

Chemical that protects plants against disease and bacterial or fungal infection (liek antioxidatns)

Front 96

What role doe phytochemicals play in cancer?

Back 96

may prevent tumor growth in humans

Front 97

What foods are rich in phytochemicals?

Back 97

plant based foods (fruits, veggies)...

grapes, apples, berries, green tea, red wine.

carotenois: carrots, tomatoes, spinach

Front 98

What are the two main classes of plant phytochemicals?

Back 98

carotenoids, flavenoids

Front 99

What is soy's role in breast cancer?

Back 99

several studies have shown that consumption of soy reduces women’s risk of developing breast cancer, especially in pre-menopausal women. … somewhat controversial

Front 100

What is soy's role in prostate cancer?

Back 100

- controversial: studies suggest reduced PSA with soy intake.

Front 101

What berries are high in ellagic acid and anthocyanidins?

Back 101

ellagic acid (may prevent cancer): raspberries, strawberries, pomegranites

anthocyanidids (most potent antioxidens ever - may stop cancer): raspberries, blueberries

Front 102

What is cancer cachexia?

Back 102

- loss of muscle mass, visceral protein, and body fat in cancer pts.

- weight loss >5% pre-morbid wieght in past month

Front 103

Describe MNT for cancer patietns.

Back 103

- maintain nutritional status during cancer treatment.

Front 104

What are protein needs for cancer patients?

Back 104

1-1.5 g/kg

Front 105

Kcal nees in cancer patients are often ____.

Back 105

Elevated

Front 106

How much omega-3 FFA should be consumed?

Back 106

2.1g/day

Front 107

What are the two basic components of MNT for cancer pts?

Back 107

1. maintain energy and protein intake
2. manage GI side effects

Front 108

Should patients on chemo or radiation for cancer be given Multivitamin or individual vitamins?

Back 108

No, vitamins contribute to cell growth and are contraindicated in radiation or chemotherapy.

Front 109

When is EN needed?

Back 109

- 100cm+ working small bowel
- oral intake not possible for 7-14 days or so
- contraindicated in peritonitis, obstruction, vomiting, diarrhea, ileus, ischemia or pt refusal.

Front 110

When should a more permanent (than NG) feeding tube be placed?

Back 110

- EN >4-6 weeks,
- tolerance problems
- when other abd. surgery is being done

Front 111

WHat are the various feeding tube places?

Back 111

- nasogastric, nasoduodenal, nasojejunal
- PEG or PEG in jejunum (PEG/J)
- surgical to stomach (g-tube) or jejunum (Jtube)

Front 112

When is a jejunal tube placement indicated?

Back 112

due to reflux, aspiration risks, tolerance problems

Front 113

Describe dumping syndrome with regards to EN.

Back 113

Too much carbohydrate results in the contents of teh gut being hypertonic and cells lining the gut dump all their water content into the gut to dilute it... results in abdominal cramping, nausea, and severe diarrhea.

Front 114

What is residual with regards to EN?

Back 114

amount of formula being held in the stomach - can be used as measure of tolerance by withdrawing and measuring it

Front 115

Know how to calculate fluid needs/ flushes.

Back 115

1. given fluid requireent, calculate total fluid needs by multiply x kg
2. subtract formula free water from total need
3. divide remainder by increments to establish q4h flushes....

Front 116

How would you initiate continuous TF orders and advancement?

Back 116

COntinuous: start at 30mL/hr, advance 20-30mL q 6-8h up to goal rate depending on tolerance

Front 117

How do you establish a goal rate for continuous EN?

Back 117

total volume needeed/ total # hrs

Front 118

What is appropriate TF orders for intermittent or bolus feeding and advancement?

Back 118

- initial rate of 150-200mL over 20-40 mins.
- advance by 50-100mL each feeding depending on tolerance and up to goal

Front 119

How do you establish goal volume in intermittent feeding?

Back 119

total volume needed/ #feedings

Front 120

WHat is the osmolality of a EN formula for general purposes?

Back 120

300-500

Front 121

400-700 osmolality is considered ___ EN formula.

Back 121

Nutrient dense

Front 122

Give 1 example of formula for each:
- renal failure
- diabetic
- need for high cal

Back 122

RF: Nepro
DM: Glucerna
Cal: Nutren

Front 123

Describe how to prevent aspiration:

Back 123

1. elevate head 30-40deg
2. monitor for content in lungs
3. monitor residuals
4. consider dual lumen tubes with poor gastric emptying
5. radiography
6. observation of pulled fluid from feeding tube.
7. check pH of fluid aspirated from tube (gastric vs abdominal)
8. monitor and maintain adequate airway cuff pressure

Front 124

What is c-dif and who is at risk?

Back 124

opportunistic GI infection due to bacteria overgrowth. Common in pt’s with recent abx treatment and inpatient hospital stays.

Front 125

What is ASPEN?

Back 125

American Society for Parenteral and Enteral Nutrition

Front 126

When is PN indicated?

Back 126

- nonfunctioning GI tract
- intractable vomiting
- ileus
-GI ischemia
- diffuse peritonitis
- unable to access GI tract
- duration of 7+ days
- venous access available.

Front 127

Where is CPN given? PPN?

Back 127

CPN: central vein such as subclavian

PPN: peripheral vein

Front 128

When is CPN indicated?

Back 128

- concentrated formula,
- long term
- >7days PN requirement
- elevated metabolic rate
- poor peripheral access

Front 129

When is PPN indicated?

Back 129

- dilute concentrations
- short term to give GI rest
- unable to obtain central access

Front 130

What is the maximum osmolality that can be given via PPN?

Back 130

900 mOsm/L

Front 131

What are the main components of PN soultions? (3)

Back 131

1. CHO
2. Protein
3. Lipids (IVFE)

Front 132

What is the most common CHO in PN?

Back 132

dextrose monohydrate

Front 133

What is refeeding syndrome and who is at risk?

Back 133

- If pt has not eaten for a while (risk) electrolytes, glucose, osmolality, etc can easily be thrown off by PN therapy. Risk = malnourished. Causes severe problems.

Front 134

What would you try to do PRIOR to initiating PN in a pt at risk for refeeding syndrome?

Back 134

- replace deficiencies as much as possible

Front 135

How would you initiate PN in a pt at risk for refeeding syndrome?

Back 135

Begin with goal proteins and lipids with low calories (25-50% goal) at normal goal rate.

Adcance q6-8 hours until goal cal reached

Start with 100-150 g CHO/ day, then work up.

Front 136

What labs should be monitored to determine tolerance of PN?

Back 136

1. glucose
2. BMP (electrolytes, Mg, Phos, pH)
3. TUN, prealbumin (PAB), CRP, BUN, ammonia
4. Triglycerides
5. liver function
6. vitamins

Front 137

What labs are most likely to be abnormal in refeeding syndrome?

Back 137

1. K+
2. Phos
3. Mg
4. Ca

Front 138

Why would a person be hypokalemic in refeeding syndrome?

Back 138

insulin forces extracellular K+ into cell

Front 139

What ist he predominant feature of refeeding syndrome?

Back 139

Hypophosphatemia (inc. anabolism = inc. phosphorylation)

Front 140

What labs would you monitor for tolerance of protien in PN?

Back 140

UUN, TUN, PAB, CRP, BUN, ammonia

Front 141

What is the relationship between PAB and CRP?

Back 141

?????

Front 142

What labs would you monitor for tolerance of lipids in PN?

Back 142

Triglycerides

Front 143

When would you hold IVFE in PN?

Back 143

Triglycerides >400

Front 144

Glucose should be measured how often in PN?

Back 144

4-6 h

Front 145

What is the goal prior to initiating PN for glucose?

Back 145

<300, if >180 keep at minimal dextrose concentration until corrected

Front 146

What ist he goal for glucose values during PN?

Back 146

100-150mg/dL

Front 147

What rate should EN be at before reducing PN when transitioning to tube feeding?

Back 147

15-20mL/hr

(keep total goals consistent between both)

Front 148

What is the goal PO intake prior to d/c of PN when transitioning to oral intake?

Back 148

60% of goal before stopping PN, minimum of 500kcal/day

Front 149

What diet factors are recommended in pulmonary patients (COPD, Pulm fibrosis, etc)?

Back 149

High calorie, high protein, modify textures as needed for ease of eating

Front 150

Ptients with renal stones shoudl consume how much oxylate daily?

Back 150

<40 to<50 mg/day

Front 151

What is the difference between HD and PD?

Back 151

HD= hemodialysis: 3-5 hrs long usually 3 days/week. BLood is pumped out of the body, through a filter, and back in...

PD = peritoneal dialysis: 10-12h/day 3x/week... solution is pumped into peritoneum, tonicity collects wastes in the fluid through the peritoneal membrane as a filter, and then is drained back out with wastes

Front 152

Describe MNT considerations for dialysis pts: (4)

Back 152

- protein equillibrium important, avoid excess weight gain
- Keep serum Na and K normalized
-Keep other serum electrolytes normalized to avoid osteodystrophy
- enable pt to eat palatble attractive diet that fits their lifestyle

Front 153

What is important considering protein needs in dialysis pts?

Back 153

needs increase when dialysis is initiated, it is measured by monitoring serum albumin and intake

Front 154

What is adequate protein in HD, PD, CAPD?

Back 154

HD: 1.2g/kg/day
PD: 1.2-1.3g/kg/Day
CAPD: may be more!

Front 155

What formula should be checked to assure chance of calcification is low can be used when managing calcium and phos?

Back 155

Serum calcium x serum phos should be less than 55.

Ca x Ph <55

Front 156

What is the goal of iron levels in iron deficiency anemia due to CKD?

Back 156

- iron sat >20%
- ferritin> 200ng/dL

Front 157

When should you hold iron supplementation in CKD?

Back 157

Ferritin >500

Front 158

What vitamin should be avoided in supplementation with pts at risk for kidney stones?

Back 158

Vitamin C (breaks down into oxalate acid)

Front 159

How do you correct serum calcium?

Back 159

correction factor x (nml alb- serum alb)

CF= 0.8
Nml alb = 4.0mg/dL

Front 160

What are protein needs for pts with ARF and GFR<10?

Back 160

-restrict to 0.8mg/kg if not on dialysis or catabolic.
- on PD: 1.2-1.3g/kg
-on HD: 1.2g/kg

Front 161

When should protein intake be restricted in pts with ARF?

Back 161

GFR<10, not catabolic, and not on dialysis

Front 162

What are kcal needs in a pt with ARF?

Back 162

35kcal/kg standard but depends on level of hypermetabolism (some only 20-30kcal/kg)

Front 163

In ARF, which is better? Slight over feeding or slight underfeeding.

Back 163

Under

Front 164

What are the differnet stages of CKD and their associated GFRs?

Back 164

stage 1: >90 (proteinuria)
Stage 2: 60-90 (mild damage)
stage 3: 30-59 (mod damage)
stage 4: 15-29
stage 5: <15

Front 165

WHat is the MNT goal for predialysis? (stages 1-4)

Back 165

- slow progression of ckd
- provide adequate kcal
- prevent uremia
- restore biochem, calci/phos, vitamins, and iron balance

Front 166

What is the MNT suggestion for protein in CKD?

Back 166

- control intake to avoid neg. nitrogen balance
- stage 1-3: 0.75g/kg/day
- stage 4-5: 0.6g/kg/day
**use ABW if needed**

Front 167

What type of pts in CKD may protein restriction be contraindicated for?

Back 167

Catabolic states

Front 168

What is the MNT recommendation of kcal for CKD?

Back 168

30-35kcal/kg/day

Front 169

MNT for CKD regarding lipids is:

Back 169

- MUFAS and PUFAS
- monitor lipid levels for common dyslipidemia
- keep serum lipids WNL

Front 170

Sodium restrictions in CKD recommend how much?

Back 170

<2.4g/day

Front 171

What does MNT for CKD say regarding Potassium?

Back 171

- restrict in later stages
- meds can elevate K+ levels
- restriction needed if levels >5 consistently
- restrict to 2-3g/day

Front 172

Phosphorus restriction in CKD shoudl be:

Back 172

- 800-1000mg/day
- if serum phos>4.6mg/dL
- may be difficult when trying to get adequate protein

Front 173

MNT for calcium in CKD suggests:

Back 173

1.5-2g/day stages 3-4, 1.5-1.8g/day in stages 4-5 not on dialysis
- caution with hyperparathyroidism that can lead to hypercalcemia

Front 174

What is secondary hyperparathyroidsim?

Back 174

Calcium levels drop too low (CKD) resulting in parathyroid glands prducing excess PTH.

Front 175

What should be restricted, and how much, if PTH levels are too high?

Back 175

- monitor calcium levels
-restrict phosphate to 800-1000mg/day

Front 176

What foods are sources of potassium?

Back 176

artichockes, beans, carrots, potatoes, spinach, tomato, bananas, cantaloupe, many many more (table 10-3)

Front 177

WHat foods contain phosphorus?

Back 177

cheese, dairy products, beef, whole eggs, liver, peanut butter, soybeans, (more on p 401 table 10-2)

Front 178

Describe vitamin/iron needs for pts with CKD.
Folic acid:
Pyridoxine:
Ascorbic acid:
ETC

Back 178

Folic: 1mg/day
Pyridoxine: 5mg/day
ascorbic: 60-100mg/day
- vitamin D also required due to poor kidney function
- do not supplement vitamin A
-iron supplementation may be needed, based on labs

Front 179

What vitamin should not be supplemented for pts in CKD?

Back 179

Vitamin A

Front 180

What are examples of loop diuretics (or K+ wasting diuretics)?

Back 180

furosemide, HCTZ = useful in later CKD when potassium is elevated and still need to shed water

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What are examples of ptoassium sparing diuretics?

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Spironolactone - may be used with K+ depleting diuretics to prevent too much K+ loss.