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47 Cards in this Set

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Indications for protein restriction
CHRONIC renal failure
ACUTE hepatic encephalopathy
the following are all ______:
Acute trauma,surgery,infection
Wound healing / burns
ESLD
ESRD on renal replacement therapy
Traumatic brain injury, SCI
Promote growth in “at risk” neonates and pediatric patients
Pregnancy and lactation
Chronic steroid use
Sports nutrition
Severe caloric restriction for weight loss
Malabsorption/pancreatic insufficiency
Indications for increased protein intake
this essential fatty acid forms IL-6,IL-10 and is pro-inflammatory
Omega-6 (linoleic)
this essential fatty acid forms Anti-inflammatory cytokines
Omega 3 (alpha-linolenic)
Coenzyme in ATP synthesis
Thiamine
Essential as hydrogen donors/electron acceptors in myriad metabolic reactions
Niacin
Essential in nucleotide synthesis and amino acid metabolism
Folate
Biosynthesis of collagen,bile acids and norepinephrine.
Vitamin C
Coenzyme in ATP synthesis
Thiamine
Essential as hydrogen donors/electron acceptors in myriad metabolic reactions
Niacin
Essential in nucleotide synthesis and amino acid metabolism
Folate
Biosynthesis of collagen,bile acids and norepinephrine.
Vitamin C
Essential component of more than 100 enzymes including DNA/RNA polymerase (test)
Zinc
Micronutrients in wound healing
vit A, Bs, Cs & zinc
starved pt is put on enteral nutrition and develops hypophospatemia,hypokalemia, hypomagnesemia. what is going on?
Refeeding syndrome
clavicular prominance in men indicates _______
malnutrition
most sensitive marker of protein levels
SIRS-CRP
Gap between total protien (high) in albumen(low): can be 3 things what are they
1)multiple myaloma 2) renal failure 3) liver failure
does BMI account for mm mass
no
These people have a WHR(waist-hip-ratio) > 80%
android obesety, a strong correlation multiple medical problems & poor clinical outcome. e.g.,metabolic syndrome & NASH
Apples
these people have a WHR < 80%
gynoid obesity, less association with CAD,HTN, dyslipidemia, increased muscle mass
Pears
carbohydrate counting
2000 kcal/day->divide by 8 = 250 grams CHO
divide by 15 =17 CHO servings
divide by 3 meals/day=
5 CHO per meal
A cluster of symptoms that increase risk of CAD. Includes high TG, low HDL, HTN, hyperinsulinemia, high BG
Metabolic syndrome
what is less expensive enteral or parenteral nutrition
enteral
when should you start nutrition in pts
earlier the better the outcome
In Critical illness, how earlier should you start enteral nutriton
at hemodynamic stability (ideally w/in 48 h)
Absolute contraindications to EN
Bowel obsxn
Decreasing aspiration risk
HOB >30-45 degrees
Optimal N-6:N-3 ratio is from ________
2:1 to 4:1
Excessive ______ can be pro-inflammatory & immunosuppressive.
N-6
ideal IV lipid dosing
~1g/Kg IDEAL for most
On giving PN pt presents w/ hypo K, Mg, P, with fluid compartment shifts. What is going on?
Refeeding Syndrome
The Choice- EN or PN?
Enteral should generally be used in preference to PN
The following are examples of:
Severe short bowel syndrome
Complicated high output GI fistulas
Severe gut ischemia
Inability to gain enteral accessDiffuse perionitis, Intestinal obstruction, intractable vomiting or diarrhea, ileus, GI ischema
When PN istruly indicated?
In Celiac disease wheat shold be avoided as should these othe two grains.
rye and barley
pts with chronic pancreatitis often need more or less nutrients
more - Patients are often hypermetabolic/hypercatabolic
often times pt w/ chronic pancreatits require supplimentation of these vitamens
fat soluable
In acute pancreatitis, CMP, & lipid panel will often show
Hyperglycemia common
Hypertriglyceridemia
giving parenteral feeding and labs show TG>400 what do you do?
hold IV feeding
Ascites Necessitates a ___ restricted diet. However do not hold _____ unless hyponatremia is present
Na
fluids
guidelines suggest use of _______ for Porto-systemic encephalopathy refractory to conventional therapy.
Branched chain amino acids (BCAA )
_________ therapy allows protein sensitive patients with Porto-systemic encephalopathy (PSE) to eat a more liberal diet
Lactulose
________ may help stabilize cardiac arrhythmias in ischemic cardiac disease. Decrease platelet aggregation. Improve blood pressure via endothelial relaxation
Omega 3 fats
In pts with advanced cardiac dysfunction restrict ____ to facilitate diuresis, improve hypertension, and encourage foods high in
Na+
K+
in nutritionally managing pts with COPD do this
lots of calories cuz often takes a lot of work to breath and restrict carbs cuz have to blow off the CO2
pts with CF have an extremely (high or low) nutrient demand
high
in pts w/ acute renal failure you may need to restrict Na, K, and _____
phos