Reading...
Play button
Play button
Use LEFT and RIGHT arrow keys to navigate between flashcards;
Use UP and DOWN arrow keys to flip the card;
H to show hint;
A reads text to speech;
33 Cards in this Set
- Front
- Back
|
when is assessment of nutritional risk factors done
|
within 24hrs of ICU admission
|
|
|
what are the factors that put a pt at nutritional risk
|
involuntary weight loss or gain of:
>10% in 6 months >7.5% in 3 months >5% in 1 month pt receiving EN, PN, surgery, or critically ill inadequate nutritional intake for 7 days (unable to eat) |
|
|
what is standard therapy
|
pt able to feed themselves
|
|
|
what is the preferred method of nutritional support
|
EN feeding
|
|
|
why is early enteral nutrition recommended
|
maintains GI integrity (villi)
attenuates disease severity (causes release of IgA) and adverse changes in GI permeability are time dependent so want EN ASAP |
|
|
what is meant by the clinical benefits of EN are dose dependent
|
tropic feeding (10-30ml/hr)
-ONLY prevents atrophy of villi -NO survival benefits or immune benefits |
|
|
Jane requires 80 cc/hr of EN but can only tolerate 50 cc/hr what can be done
|
supplement with PN
if unable to meet 100% of EN goal within 7-10 days supplemental PN therapy is indicated |
|
|
T/F EN can ONLY be initiated if bowel sounds are present
|
F can initiate EN without bowel sounds
|
|
|
other than the small bowel where else can EN be initiated
|
stomach
|
|
|
when would you withhold EN
|
MAP < 60
initiation and/or UPWARD titration of vasopressors Signs of intolerance |
|
|
what are signs of intolerance to EN
|
decrease/loss of bowel sounds
increase NG output abdominal distention metabolic acidosis +/- base deficit |
|
|
mechanical ventilation, endotracheal and nasoenteric tube put you at risk for
|
aspiration
|
|
|
patients older than ___ are at risk for aspiration
|
>70 years
|
|
|
what are used for markers of aspiration
|
blue dye
gastric residual volumes glucose oxidase test |
|
|
Blue dye is safe in normal patients but why is it not safe in patients with SIRS
|
under normal circumstances the body doesn't absorb it but when inflammation occurs it gets absorbed and enters enterohepatic circulation where it can lead to mitochondrial toxicity, metabolic acidosis, blue discoloration, and DEATHHH
|
|
|
what does the gastric residual volume measure
|
the amount of fluid within the stomach at a specific time
|
|
|
Jane gets a GRV done and it comes back >500 ml what do you do
|
hold/DC EN if GRV consistently >500ml
|
|
|
Jane gets a GRV done and it comes back >=250 mL 2 times
|
if GRV >=250 after 2nd check add prokinetic agents
|
|
|
what are the prokinetic agents
|
metoclopramide
erythromycin metoclopramide + erythromycin enteral naloxone |
|
|
what are the cautions with prokinetic use
|
CNS SE (metoclopramide)
DDI/QT prolongation/increase risk of C Diff/microbial resistance (erythromycin) |
|
|
what can be done to decrease the risk of aspiration in intubated patients
|
Head of Board should be greater than 30-45 degrees
|
|
|
what can be done to prevent Ventillator associated pneumonia (VAP)
|
chlorhexidine mouthwash BID
|
|
|
what are the major instances in which PN would be indicated
|
malnutrition at ICU admission
prolonged duration of critical illness upper GI surgery |
|
|
Jane is admitted to the ICU and has not been eating for the past 3 days what should you do
|
PN ASAP after admission and adequate resuscitation
(malnutrition at ICU admission) |
|
|
Jane is admitted to the ICU and has become severely ill but prior to admission was healthy, what should you do?
|
PN itiated after 7 days in previously healthy patient with no evidence of malnutrition
(prolonged duration of critical illness) |
|
|
Jane reports to the ICU and has not eaten in 3 days and is scheduled for excission of her pancreas what should you do?
|
if malnurished PN 5-7 days pre-op and continued during peri-operative period till you can do EN
|
|
|
Jane reports to the ICU and previously had no health issues, she is now schedules for excission of her pancrease what should you do?
|
Delay PN 5-7 days and begin it immediately post operative setting
|
|
|
Jane reports to the ICU and is going to get her pancrease removed the doctor says she will be NPO for 9 days what should you do?
|
PN should be initiated if anticipated need at least 7 days
|
|
|
read list of when EN is not feasible/possible
|
read list of when EN is not feasible/possible
|
|
|
what are possible complications from EN/PN feeding
|
hyperglycemia
refeeding syndrome fluid overload metabolic disorders |
|
|
what is the max glucose intake in adults, max infusion rate, and goal for glucose control in ICU
|
max glucose intake: 7g/kg/day
max infusion rate <5mg/kg/min goal for glucose control in ICU: <150mg/dL |
|
|
read up on refeeding syndrome complications
|
read up on refeeding syndrome complications
|
|
|
sepsis patients are at risk for what EN/PN complication
|
fluid overload
|
