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82 Cards in this Set
- Front
- Back
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Define marasmus
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Overtly malnourished
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Define Kwashikor's.
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'chubby cheekers'
malnourished, but do not necessarily look malnourished Assess by looking at anthropometrics |
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Central line feeding: what are the options?
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Subclavian artery: might not be far enough, greater chance of phlebitis
Superior vena cava: can give more irritating solutions 3000-5000 mOsm solution |
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How long can you leave the peripheral TPN in befor irritation/phlebitis develops?
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Can take 2 days but can extend to 4 days (if you use subtherapeutic intervention with HC succinate which is water soluble)
Could even last 7 days in patient with a strong bundle where vein is huge |
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Inflammation leads to _____
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infection
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What is the size difference in Dobhoff tube verse NG tube?
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Dobhoff is smaller tube, NG tube is larger and can cause irritation and inflammation quickly
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Define graft versus host disease.
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Cells grow really fast here:
1. Liver 2. Diarrhea 3. Dermatitis |
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Name the 8 important things in nutrition support.
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Fluid status,
Macronutrients: AA, CHO, fat Micronutrients: electrolytes, trace elements and vitamins Pharmacy: meds |
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Daily urine output.
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1.5-2L
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Normal/Average BSA = ?
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1.5-2 m2
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Normal bowel movement = ? g
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200 g/day
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What is BUN?
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urea
High or Low BUN is not really concerning Can indicated pre-renal problems |
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What is fractional Sodium excretion? What are poor values?
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=[(urea sodium/plasma sodium)/(urea creat/plasma creat)]
<1 then prerenal >1 then nephrosis |
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What are the main pathophysiologic features of re-feeding syndroms?
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Abnormalities in fluid balance
Abnormaliities in glucose metabolism Vitamin deficiency (eg thiamine) Hypophosphatemia Hypomagnesemia Hypokalemia |
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What is roux-en-y?
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A small stomach pouch is created with a stapler device. After the stomach pouch, the small intestines are divided and one end brought up and connected o the small stomach pouch using the stapler. The intestines are reconnected.1 The pouch is too small to hold large amounts of food, but fat absorption is substantially reduced as food bypasses the duodenum.2
Several studies have shown that people who experience significant weight loss can develop gallstones, often do not suffer any consequences or even know they have them |
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T/F Low BUN is pathognomic.
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False
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If a patient were to aspirate, what lung is it likely to go to?
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Right
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You need ____ and _____ to push amino acids into the cell.
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Carbohydrates and fat
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What happens when phosphate level is less than 2?
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pulmonary compromise
2,3-diglycerophosphate is low, so there is a shift to the Left on the oxygen-hemoglobin curve |
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What happens when phosphate level is less than 1?
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thrombocytopenia and leukopenia
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What causes a LEFT shift in oxygen-hemoglobin dissociation curve?
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alkalosis and hypothermia
decreasing pCO2, low PO4, sepsis |
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Adjust phosphate by _____ and magnesium by _____.
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phosphate by 3 and magnesium by 4
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What is a new medication for gout?
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Etoricoxib: a COX-2 elective inhibitor
Febuxostat: 2nd line xanthine oxidase inhibitor |
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T/F TPN and fat are filtered
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False, TPN is filtered, fat is not
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What can cause hypertriglyceridemia?
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DM, pancreatitis, sepsis, renal failure
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What is AEIOU?
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Reasons why we use dialysis:
A: Acid/Base E: Electrolytes I: Intoxication O: Overload U: Uremia |
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What is the amount of aa for a patient undergoing CVVHD?
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1.7-2.5 g aa/kg
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What is the time for recovery for stomach and small intestine after abdominal procedures (where surgeon may have handled/touched GI tract)?
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Stomach: 1-3 days
Large intestine: 3-5 days |
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What is the green field filter used for?
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Trap clots in the vena cava
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What is a new treatment for paroxysmal hemoglobulinuria
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Eclulizumab: IV infusion that works as a monoclonal antibody that binds to the human C5 complement protein to reduce hemolysis
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______ or midline catheter can lead to vena cava syndrome (unilateral swelling on one side of the body).
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subclavian
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STAMP out hypoglycemia....stands for?
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S: Salicylates
T: Theophylline A: Anabolic, Alcohol M: MAO inhibitors P: Papaveridine |
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What are the effects of steroids?
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Cataracts
Catabolic in tissue Stimulate thyroid and albumin synthesis Hyperglycemia Buffalo hump (redistrib TG) Losses of K+, Ca++, Zn, Vit C |
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What happens if hyperglycemia >180? >220 for 16 hrs?
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1) >180: Polyuria
2) >220 for 16 hrs: complement fixation; glycation |
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What is glycation?
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non-enzymatic glycosylation
the result of a sugar molecule, such as fructose or glucose, bonding to a protein or lipid molecule without the controlling action of an enzyme |
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What is the minimum level of cholesterol necessary?
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25 mg/dL for LDL to bind to LDL receptor
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A neutrophil:lymphocyte ratio >2.2 indicates what?
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inflammation
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What could indicate viral or fungus infection?
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elevated monocyte level
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An elevated neutrophil level could indicate?
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bacterial infection
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CPAP and PEEP ventilators require that you multiply BEE by?
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15%
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What is ECMO ?
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extracorporeal mechanical oxygen
ie Iron lung if pt is in repiratory failure |
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Name 2 problems with ranitidine?
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1) Tachyphylaxis
2) Immune-mediated thrombocytopenia |
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What can occur with patients that are on TPN for extended periods of time?
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Gallbladder stasis (Cholestasis)
>30 days: 75% of patients have >45 days: 100% of patients have |
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What can cause contraction of the gallbladder?
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CCK: cholecystokinin
Cauruelin Erythropoietin Cisapride Bethanechol Prostigmine Cholestyramine |
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What are the risk factors for lactobacillemia?
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immunocompromised
persistent, prolonge neutropenia Broad-spectrum ABx use DM Corticosteroids Organ transplants cancer (more common with AML) Roux-en-y can distrub flora |
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How can you tell if patient is contracted?
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Na,, BUN, insulin
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If you leave ___ out of solution, then you can increase phosphate.
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Calcium
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Triglyceride level > 400 could indicate ....?
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pancreatitis
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How much nitrogen is there in blood?
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31-34 g N per L of blood
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What is the volume of one unit of blood?
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500 mL
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How much amino acids is there in blood?
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100 g amino acids per unit of blood
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At what age is there a decline in cellular immunity?
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> 60 years old
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What could cause different bp readings in different arms?
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coarction of aorta
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What antibiotics cause spuriously high creatinine?
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Cephalosporins, if you pull SCr 30 min to 2 hrs around administration of ABX, will have spuriously high creatinine.
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When would you not increase carbohydrates?
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hypophosphatemia
steatosis (fatty liver) Hypercapnea risk (eg COPD) >60 units insulin/day |
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Insulin can cause _____ and _____
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microalbuminuria and hypernatriuresis
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What is an ilealconduit?
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Ilial conduit is diversion of the urine due to diseased or injured bladder. The procedure consists of using a short part of the small intestine to which the ureters are attached and the other end is placed at the surface of skin (forming stoma).
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With morbid obestiy, how would you calculate kcal to start TPN?
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15-20 kcal/kg
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When should you be concerned about BUN?
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When it is 2x admitting BUN +20 (Really contracted when admitted) or when it is 80-90 as there is the possibility of encephalopathy
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Iron: what is the side effect you are concerned with? where is it absorbed?
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nausea (although IV iron anaphylaxis is possible) and duodenum, but can still absorb in short-gut patients.
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What is the % absorption of iron?
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10% normally
20% if anemia |
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What is the RDA for iron?
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10 mg
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What would be an indication of low copper?
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Neutropenia
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How quickly can a duodenal ulcer heal?
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6 weeks
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What is the enteral progression?
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clear liquids (>1000 kcal to D/C TPN???)
full liquids Soft foods Mechanical |
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What are the vitamins that you are concerned with in alcoholism?
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Vitamin B12: 1-2 yr stores, but depleted by cirrhosis
Folate: 2-3 month stores, but depleted by cirrhosis Thiamine: 3 wks in WBC, 1 wk RBC??? Can quickly get Wernicke's encephalophathy, and can have brain death in 21 days without thiamine |
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What is the smallest measure that can be seen with the eye?
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50 microns
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What are Peyer's patches?
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immune surveillance in intestine
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What are Kupfer cells?
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Macrophages in the liver
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What happens if patient does not receive fat?
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34% loss of phase 1
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Tell me about GVHD.
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Graft versus Host disease
Look at: dermatits, diarrhea, and liver |
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What are the three vitamins that can cause allergies?
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B1, K1 and B12 (parabens)
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What is pre-albumin?
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transthyretin
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What are Shistocytes?
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degraded RBC
are at the site of insertion |
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If Ca-PO4 range is less than 30, that could indicate...?
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hypoparathyroidism
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If Ca-PO4 range is greater than 70, that could indicate...?
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precipitate of CaPO4 in soft tissues, starting with kidney
Kidney shuts down first |
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What are the hallmarks of renal failure in dialysis patients?
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High vitamin A and high aluminum
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Define morbid obsesity and obesity.
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Morbid obesity is 2xIBW and obesity is 30% over IBW
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What are the kcal goals for patients in the hospital?
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On floor: BEE*1.5
In ICU but not on vent or on A/C: BEE*1.15 In ICU on vent: BEE*1.3 |
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What albumin levels would indicate a 'boggy gut'?
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<2.2
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How can you tell if patient is anabolic?
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prealbumin should increase by 4 mg% per week
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What is the gold standard for hypermetabolism?
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VO2/m2
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