thera test 1 nutrition

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thera test 1 nutrition
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2014-02-17 00:52:03
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thera test 1 nutrition
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  1. subjective parameters for nutrition assessment
    • FAMA
    • functional GI tract
    • ability to swallow
    • medical history
    • assessment of oral intake
  2. risk factors for poor nutrition
    • DETERMINE
    • disease
    • eating poorly
    • tooth loss/mouth pain
    • economic hardship
    • reduced social contact
    • multiple medicines
    • involuntary weight loss/gain
    • needs assistance in self care
    • elderly (>80 yo)
  3. objective measurements for nutrition assessment
    • anthropometric measurements - fat stores
    • body weight
    • serum proteins (TRAP)
    •   transferrin
    •   retinol-binding protein
    •   albumin
    •   prealbumin
    • immunocompetence
  4. BMI equation
    weight/height2 (kg,meters)

    • < 18 = malnutrition
    • > 30 = obesity
  5. normal values of albumin, prealbumin & transferrin
    • 3.5 - 5
    • 15 - 40
    • 200 - 400
  6. what is subjective global assessment
    • functional nutrition assessment that entails physical, medical, nutrition
    • stage A = well nourished
    • stage B = suspected or moderate malnutrition
    • stage C = obvious malnutrition or significant weight loss
  7. equation for estimation of caloric need for men
    66 + 13.7(W) + 5(H) - 6.8(A) * stress factors
  8. equation for estimation of caloric need for women
    655 + 9.6(W) + 1.8(H) - 4.7(A) * stress factors
  9. 1g to kcal for protein, carbs, fat
    • 4
    • 3.4
    • 9
  10. nutritional component percentages for  protein, carbs, fat
    • 16%
    • 64%
    • 20%
  11. average protein requirements
    • unstressed 0.8gm/kg/day
    • catabolic 1.2-2 gm/kg/day
    • 1.2 max in renal failure
  12. average calorie requirements
    • unstressed 25 kcal/kg/day
    • catabolic 25-50 kcal/kg/day
  13. average fluid requiremets
    30-35 ml/kg/day
  14. pt with increased fluid needs
    • fever
    • diarrhea
    • excessive sweating
  15. pt with decreased fluid needs
    • fluid overload
    • cardiac failure
    • decreased urine output
    • kidney failure
    • SIADH
  16. normal electrolyte levels added of Ca, Mg, PO4,K, Na, Cl, acetate
    • 5 mEq/L
    • 12 mEq/L
    • 15 mM/L
    • 40 mEq/L
    • 40-80 mEq/L
  17. advantages of enteral nutrition over parenteral
    • preserves gut function
    • lower risk of infection
    • preserves natural nutrient utilization
    • less expensive
  18. disadvantage of enteral nutrition over parenteral
    • risk of aspiration
    • tube occlusion
    • difficulty with medication administration
  19. difference between short and long term enteral feeding
    • short < 3 weeks
    • long > 3 weeks
  20. short term feeding tubes
    • nano-gastric
    • naso-jejunal
    • surgically placed
    •   gastrostomy
    •   needle catheter jejunostomy
  21. long term feeding tubes
    • percutaneous endoscopic gastrostomy (PEG)
    • percutaneous endoscopic jejunostomy (PEH)
    • button
  22. drug-nutrients that CAN'T be given enterally
    • enteric coated medications
    • sublingual or buccal medications
    • sustained release medications
    • syrups
  23. 4 drug-nutrient interactions to watch for
    • phenytoin, carbamazepine - highly protein bound
    • fluoroquinolones and tetracyclines - bind to cations (electrolytes)
    • PPI's - inactivated by gastric acid
    • warfarin - decreased absorption, may hold EN, adjust dose based on INR
  24. TPN specific for acute renal failure
    nephramine 5.4%
  25. TPN specific for liver disease with grade II hepatic encephalopathy
    hepatamine 8%
  26. TPN specific for hypercatabolic & stressed pts
    FreAmine-HBC 6.9%
  27. respiratory quotient indications
    • < 0.7 = starvation
    • 0.7 = fat oxidized as energy
    • 0.8 = protein oxidized as energy
    • 1 = CHO is the fuel source
    • >1 = you won't be able to get them off ventilator

    optimal = 0.85 = mixed substrate of energy source, their own and what we are giving them
  28. 4 estimates of caloric needs
    • healthy = 25 kcal ABW/day
    • BMI < 30 kg/m2 = 30 kcal ABW/day
    • BMI > kg/m2 = 11-14 kcal ABW/day
    • major burn (>50%) = 30 kcal ABW/day
  29. when would you add Na to EN
    • high output EC fistula
    • short bowel syndrome
    • jejunostomy or ileostomy
    • severe diarrhea
  30. when would you add K in EN
    • metabolic alkalosis
    • severe diarrhea
  31. when would you restrict K in EN
    • metabolic acidosis
    • ACE inhibitors
    • trimethoprim
  32. when would you add Mg in EN
    • ETOH abuse
    • severe diarrhea
    • CRRT - continuous renal replacement therapy
  33. when would you restrict PO4 in EN
    • kidney stuff
    • long term immobilization
    • CaPO4 > 60
  34. when would you add PO4 in EN
    • ETOH abuse
    • refeeding syndrome
    • chronic malnutrition
  35. when would you restrict Ca in EN
    • hyperphosphatemia
    • CaPO4 > 60
    • metastatic cancer
    • prolonged immobilization
  36. when would you add Ca in EN
    • severe pancreatitis
    • parathyroidectomy
  37. when would you restrict Cl in EN
    • metabolic acidosis
    • severe diarrhea
  38. when would you add Cl in EN
    • metabolic alkalosis
    • nasogastric losses
    • high output EC fistulas
    • refractory vomiting
  39. when would you restrict acetate in EN
    • metabolic alkalosis
    • dehydration
  40. when would you add acetate in EN
    • severe diarrhea
    • short bowel syndrome
    • metabolic acidosis (anion gap)
    • renal HCO3 wasting
  41. four types of enteral nutrition feeding
    • continuous
    • continuous cyclic
    • bolus
    • intermittent
  42. 12 indications for TPN
    • hypercatabolic state
    • malignant disease
    • multisystem organ failure
    • anorexia nervosa
    • severe small bowel ileus
    • extensive bowel loss
    • severe intractable vomiting
    • small bowel obstruction
    • significant GI bleeding
    • recent GI anastomosis
    • high output fistula
    • severe pancreatitis
  43. 5 complications of TPN
    • intestinal atrophy
    • central line - infection or venous thrombus
    • biliary stasis
    • liver dysfunction
    • immunosuppression
  44. what is the max dose of glucose in a TPN
    5mg/kg/min
  45. 3 pt populations that are at risk of refeeding syndrome
    • severe malnutrition w/ weight loss
    • NPO 7-10 days with stress & decrease nutrition
    • chronic disease, previously morbidly obese with excessive wt loss
  46. what is the first sign of infection with nutrition support pts
    spike in blood glucose then the next day you will see a spike in WBC's
  47. what is a sign of cholestasis
    increase in serum alkaline phosphatase
  48. formula for nitrogen balance
    • protein intake in grams/ 6.25 then subtract (UUN + 3)
    • ideal range +4 - +6

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