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Flashcards in Chapter 3: Nutrition Deck (10):
1

You are currently treating an 85kg, 20yo female who is 5’4” tall for perforated duodenal ulcer and sepsis. This pt is classified as which of the following:

Obese-high risk of nutritional deficiency

2

A 47yo pt underwent major bowel resection approx 7mo ago. The patient has been doing well, overall, until recently when he has been feeling tired. A CBC is done on this pt and reveals a microcytic anemia. Which region of the GI tract was most likely resected?

Jejunum (malabsorption of iron)

3

A 33yo man is being treated w/ a 35%TBSA burn over the course of the last 3 weeks. He has now completed all of his skin grafting and no longer appears to have any evidence of sepsis or a need for further direct therapy for his burns. At this point you are intested in identifying whether he’s beginning to lay down structural proteins and has turned the tide from catabolism to anabolism. Which of the following lab measurements most likely reflects the return to normal protein anabolism?

Pre-albumin

4

A 62yo man is in the ICU following surgery for a shotgun wound to the abd 2 weeks ago. He remains intubated and is being treated w/ TPN. He has developed a resp quotient and you believe this is result of excessive caloric intake. In order to decide which compoent of the nutritional formula may have the greatest impact on caloric intake, you need to be able to evaluate the relative impact of each caloric source on total caloric intake. Which of the following sequences represents the nutritional value in kilocals from lowest to highest?

Lipids, proteins, carbs

5

A 58yo man comes to you s/p stomach resection for perforated ulcer in the past. He thinks part of his stomach was resected and reconnected to his jejnum. He takes warfarin b/c of chronic afib. He is currently having difficulty maintaining his INR w/ warfarin and the dosages have ben consistently increased. You believe that this may be due to his surgery and think that he may not be adequately absorbing his warfarin. You surmise this b/c most oral meds are absorbed in the:

Duodenum

6

A 37yo man is admitted w/ several-week hx of abd pain, dehydration and HoTN. He is found to have perforated gastric ulcer and undergoes a partial gastrectomy. He is begun on TPN on post-op day 2 and over the next 3 days develops anemia and resp distress. The most likely cause of his sxs is:

Re-feeding syndrome

7

A 49yo man has been sent to you by a PCP w/ presumptive dx of short bowel syndrome b/c of decreasing wt and apparent cachexia. He has multiple active sxs and findings. Which of these tx/findings is major cause of cachexia in a pt w/ short bowel syndrome?

Malabsorption

8

A 53yo man presents to your office w/ diffuse diarrhea and a fever. Currently undergoing nutritional replacmenet via tube feedings b/c of gastric outlet obstruction. The possible causes for his D include either infxious cause or complication oftube feeding. Which of the following indicates that this diarrhea my be result of tube feedings?

High osmolarity feedings

9

A 42yo woman is being transitions from PN to EN and she is requiring approx 1900 cals/day/ Nurse caring for her wishes to know when to stop the PN. Her PN can be safely stopped when her EN caloric intake reaches what % of her current PN?

66%

10

A 45 yo man has a hx of gastric outlet obstruction secondary to chronic ulcer disease and is referred to you for tx. He is 5’9 and wts 135 lbs. He has lost 25% of his body mass over the last 3 months and needs nutritional repletion. What are his calculated body weight and caloric needs?

160lbs/1545 Kcal