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24 Cards in this Set
- Front
- Back
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albumin and prealbumin normal range
crp normal range what type of malnutrition lowers these? (2) |
albumin- 3.5-5
prealbumin- 25-50 crp- 1-3 stress and inflammation lowers these |
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when to add fiber?
USDA recommendation |
Fiber for enteral because part of a balanced diet for normally fxn GI tract- always want to add- USDA recommends 14 gm / 1000 kcal
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benefits of fiber in enteral (3) particularly in what disease state
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helps to maintain normal bowel health and elimination patterns
• Fecal incontinence sometimes issue after stroke • May help stool consistency and prevent diarrhea |
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how to avoid fiber clogs in high fiber formulas (2)
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• Flush the feeding tube with 30ml of water before each instillation of diluted
medication and after the final medication administration. • Add 240ml of water by feeding tube every 8 hours to provide additional fluid and help keep the tube patent. |
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why elevate head of bed
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• Elevate the HOB at 30 to 45 degrees for any patient at risk for aspiration.
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Adults: continuous enteral feeding- how to initiate (rate /hr)
how to advance (rate) |
• Adults*: Continuous typically starts at 20 to 50 ml/hour
• Advance by 10 to 25 ml/hour every 4 to 8 hours until goal rate achieved |
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Adults: intermittent enteral feeding- start at what rate and frequency
advance by what rate to what freq |
• Adults*: Intermittent starts at 120ml every 4 hours
• Advance by 30 to 60ml every 8 to 12 hours |
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advancement of feeding rate based on...
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GI tolerance
• Abdominal distention, cramping, high residual volumes, aspiration, diarrhea |
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most 1kcal/ml enteral formulas are approximately what % water (so 1 mL not equal to 1 mL of fluid)
how to use this % to calculate how much extra water to add (water flushes) |
In contrast to parenteral nutrition, 1ml of enteral nutrition is not 1ml of fluid. Most 1kcal/ml enteral formulas are approximately 84% water.
multiply 0.84 with total enteral formula amount being given- then take the difference between his fluid req- and give as water flush (q 6h, or w/e- subtract out his med flushes) |
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when to use peripheral for parenteral? (2)
when you CAN'T use peripheral |
• Central access not available
• Expect GI function to return within 10 to 14 days (short duration) • Cannot be fluid restricted to use peripheral- have to give a lot of fluid to dilute in order to not destroy veins |
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poor peripheral vein tolerance - causes... (2)
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• Thrombophlebitis
• Infiltration |
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who's at risk for refeeding syndrome? (5)
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• Severe malnutrition with significant weight loss (more than 10% weight loss in past 3-6 mths)
• Evidence of stress or nutritional depletion in patients unfed 7 to 10 days or more • Chronic disease causing malnutrition • Chronic alcoholics • Post-operative patients |
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refeeding syndrome results in what? (5)
cause |
hypokalemia
hypomag hypophos thiamine deficiency salt/water retention = edema fast switch from catabolism to anabolism |
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3 chronic diseases that put pt at risk for refeeding syndrome
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(Cancer
• COPD • Cirrhosis |
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how to prevent refeeding syndrome (3) - watch which element of PN?
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start out really slow- 1/4 to 1/2 of energy reqs-->advance over 3-4 days
major issue with refeeding is DEXTROSE- so limit that (100-200 g/day) full protein is ok |
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propofol- lipid content identical to what?
monitor which lab |
Lipid content identical to
that of Intralipid 10% TGs |
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What are acceptable levels of TG for patients receiving lipids via nutrition or from propoful (DIFFERENT FROM NORMAL) (separate/bolus vs. continuous)
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• < 250mg/dL 4 hours after separate lipid infusion
• < 400mg/ dL when continuous lipid infusion |
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how many kcal per ml of propofol
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1.1 kcal/mL
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Elevated levels of lipids from propofol due to either (2)
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excessive rate of lipid administration or defective clearance of lipids
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desired glycemic control lvls
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Somewhere in 100 to 200mg/dl range
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risks for hyperglycemia (2)
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• Stress response to the acute injury or chronic disease
• High glucose load of the parenteral nutrition |
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risk for hypoglycemia
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Too much insulin administered
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cyclic infusion concerns (2)
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• Higher rate of dextrose administration over shorter time frame (giving same amt over shorter time) so increased insulin needs during infusion
• Pancreas secretion does not respond quickly enough when infusion stopped, resulting in post infusion hypoglycemia |
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cyclic admin of parenteral- infuse over what duration
how to avoid hypo/hyperglycemia (3 steps) |
• Typically still infuse over at least 12 to 14 hours
• Taper rate up to allow body to handle the increased insulin needs, so often use ½ rate for the first hour. • Run at full rate for the majority of the infusion cycle. • Taper rate down at the end of the infusion to allow pancreas to adjust to lower insulin needs, so often ½ rate for the last hour. |
