Nutrition Flashcards
(312 cards)
1
Q
What is a Calorie?
A
Unit of energy equivalent to the heat energy needed to raise the temperature of 1 kg of water by 1 degree C
2
Q
What is the primary source of energy?
A
Carbs
3
Q
What are proteins essential for?
A
Growth, repair and enzyme function
4
Q
What are fats (lipids) essential for?
A
Energy storage, cell membrane structure and hormone production
5
Q
What is water essential for?
A
Hydration, metabolism and temperature regulation
6
Q
What is the percentage of calories from Carbs, Proteins, and Fats?
A
Carbs- 45-65%
Proteins- 10-35%
Fats- 20-35%
7
Q
What metabolic fuels must our diets provide?
A
Protein, fiber, minerals, vitamins, and essential fatty acids
8
Q
What are the main metabolic fuels?
A
Mainly carbs, lipids and protein
9
Q
What is protein needed for?
A
Growth and turnover of tissue proteins
10
Q
What is fiber used for?
A
Bulk in intestinal lumen
11
Q
What do minerals contain?
A
Basic elements needed for metabolic functions
12
Q
What are vitamins and fatty acids?
A
Organic compounds needed for life sustaining metabolic and physiologic functions
13
Q
What is the GI system?
A
The portal through which nutritive substances enter the body
14
Q
What are digested in the GI system?
A
Proteins, fats, and complex carbs
15
Q
What crosses the gut mucosa and enters the lymph system or the blood?
A
The products of digestion along with vitamins, minerals and water
16
Q
What type of digestion occurs in the mouth?
A
Mechanical & chemical
17
Q
What is mechanical digestion in the mouth?
A
Chewing (mastication)
18
Q
What is chemical digestion in the mouth?
A
Salivary amylase begins carb digestion (starches to maltose)
Lingual lipase (minor role) starts lipid digestion
19
Q
What can be absorbed in the mouth?
A
Mineral, but small molecules like certain drugs (e.g., nitroglycerin) can be absorbed sublingually
20
Q
What is the function of the esophagus?
A
Transport
21
Q
How is food moved in the esophagus?
A
By peristalsis (coordinated muscular contractions)
22
Q
Does digestion or absorption occur in the esophagus?
A
No
23
Q
What type of digestion occurs in the stomach?
A
Protein & Lipid Digestion
24
Q
What is mechanical digestion in the stomach?
A
Churning mixes food with gastric secretions
25
What is formed when food is mixed with gastric secretions?
Chyme
26
What enzymes are involved in chemical digestion in the stomach?
Pepsin and gastric lipase
27
What activates pepsin and begins protein digestion?
HCL
28
What does gastric lipase play a minor role in?
Lipid digestion
29
What is the absorption in the stomach?
Minimal; alcohol and some small molecules (e.g., aspirin) can be absorbed.
30
What is the primary site of digestion and absorption?
Small Intestine
31
What is the function of the duodenum?
Digestion
32
What are the pancreatic enzymes?
Amylase, Proteases, Lipase
33
What does amylase convert?
Starch → maltose
34
What are examples of proteases?
Trypsin, chymotrypsin, carboxypeptidase
35
What do proteases break down?
Proteins into peptides/amino acids
36
What do lipases break down?
Triglycerides → monoglycerides + fatty acids
37
What does bile from the liver/gallbladder do?
Emulsifies fats, aiding lipase action
38
Where are brush border enzymes produced?
Intestinal mucosa
39
What do brush border enzymes include?
Maltase, sucrase, lactase, Peptidases
40
What do maltase, sucrase, lactase convert?
Disaccharides → monosaccharides
41
What do peptidases convert?
Small peptides → amino acids
42
What is the major site of nutrient absorption?
Jejunum
43
What carbohydrates are absorbed in the jejunum?
Monosaccharides (glucose, fructose, galactose) absorbed via active transport and facilitated diffusion.
44
How are proteins absorbed in the jejunum?
Amino acids and small peptides absorbed via active transport.
45
How are lipids absorbed in the jejunum?
Free fatty acids and monoglycerides form micelles, absorbed into enterocytes, then packaged as chylomicrons for lymphatic transport.
46
How are water-soluble vitamins absorbed in the jejunum?
Via transporters
47
How are fat-soluble vitamins absorbed in the jejunum?
With lipids
48
How are water and electrolytes absorbed?
Via osmosis and active transport.
49
What does the ileum specialize in absorbing?
Vitamin B12, bile salts, remaining nutrients and water.
50
How is Vitamin B12 absorbed?
With intrinsic factor
51
How are bile salts reabsorbed?
Via enterohepatic circulation
52
What is the primary function of the large intestine?
Water & Electrolyte Absorption
53
What is the ascending colon also known as?
Right Colon
54
What does the ascending colon receive chyme from?
Ileocecal valve
55
What is the major site for water absorption in the ascending colon?
Approximately 80% of remaining water to solidify stool
56
What electrolytes does the ascending colon absorb?
Na+, Cl- through active transport
57
What is fermented in the ascending colon?
Undigested carbohydrates (e.g., fiber) by gut microbiota produces short-chain fatty acids (SCFAs), which serve as an energy source for colonocytes.
58
What are byproducts of bacterial metabolism in the ascending colon?
Gas: Hydrogen, methane, and CO2
59
What is the transverse colon also known as?
Middle Section
60
What occurs in the transverse colon?
Continued water and electrolyte absorption.
61
What does bacterial metabolism in the transverse colon produce?
Vitamins
62
What vitamins are produced in the transverse colon?
Vitamin K, Biotin and some B vitamins
63
What is Vitamin K important for?
Clotting
64
What are Biotin and some B vitamins important for?
Metabolism
65
What does the transverse colon store?
Semi-formed stool before it moves into the descending colon.
66
What is the descending colon also known as?
Left Colon
67
What occurs in the descending colon?
Final water reabsorption, concentrating the stool.
68
What does the descending colon store?
Formed feces before moving to the sigmoid colon.
69
What is the peristalsis like in the descending colon?
Slower compared to the ascending/transverse colon to allow more absorption.
70
What regulates motility in the descending colon?
Gastrocolic reflex and defecation reflex
71
What triggers the gastrocolic reflex?
Eating
72
What does the gastrocolic reflex stimulate?
Mass peristalsis
73
When is the defecation reflex initiated?
When stool accumulates in the rectum
74
What is the sigmoid colon's function?
Acts as the final holding chamber for stool before defecation
75
What signals the brain when it's time for elimination?
Stretch receptors
76
What controls defecation?
Internal (involuntary) and external (voluntary) anal sphincters
77
What is the composition of feces?
Water, undigested fiber, bacteria, and metabolic waste
78
What is the RDA of protein?
0.8-1.0 g/kg/day
79
Where does digestion of protein begin?
In the stomach when pepsin cleaves some peptide linkages
80
Where does further digestion of protein occur?
In the small intestine through proteolytic enzymes from the pancreas and intestinal mucosa
81
What does protein metabolism depend on?
Both kidney and liver function
82
What are dietary sources of protein?
Fish and meats, soy, casein, and whey
83
How many calories are provided from protein?
4 kcal/gram
84
What is found only in protein?
Nitrogen
85
What is the constant ratio of nitrogen to protein?
1 g of nitrogen per 6.25 g of protein
86
How can the adequacy of protein intake be assessed clinically?
By a nitrogen balance study
87
What does a nitrogen balance study measure?
Urinary nitrogen excretion compared to nitrogen intake
88
What does nitrogen intake equal?
g of protein intake / 6.25
89
What is the RDA for carbohydrates?
45-65% of calories (~130 g/day)
90
What are the principal dietary carbohydrates?
Polysaccharides, Disaccharides, Monosaccharides
91
What is an example of a polysaccharide?
Starch
92
What are examples of disaccharides?
Lactose (milk sugar), sucrose (table sugar)
93
What are examples of monosaccharides?
Fructose and glucose
94
What are the only polysaccharides that are digested to any degree in the human GI tract?
Starches
95
What are dietary sources of carbohydrates?
Bread, rice, corn syrup
96
How many calories are provided from carbohydrates?
4 kcal/gram
97
What is the RDA for lipids?
Alpha-linolenic acid, aka Omega-3
98
What is the lipid RDA for men and women?
Men: 14-17 g/day
Women: 11-12 g/day
99
Where does most fat digestion begin?
In the small intestine
100
What are the types of fatty acids?
Saturated, unsaturated, essential
101
What are examples of saturated fatty acids?
Animal fats, dairy products
102
What are examples of unsaturated fatty acids?
Linolenic acids, oleic acids
103
What are essential fatty acids?
Not synthesized by our bodies (linoleic acid, DHA, EPA)
104
What are dietary sources of lipids?
Butter, oils
105
How many calories are provided from lipids?
9 kcal/gram
106
What are fluid needs in general?
30-40 mL/kg of body weight (adults)
107
What is the Holliday-Segar Method?
4-2-1 rule
108
What must all sources of fluid (and Na) be considered for?
Vehicles for IV medications, IV or feeding tube flushes
109
What is the target urine output (UOP) for adults?
0.5 mL/kg/hr
110
What is the target urine output (UOP) for pediatrics?
1 mL/kg/hr
111
What is the definition of minerals?
Inorganic elements required by the body for various physiological functions
112
What are major macrominerals?
Calcium, magnesium, phosphorus
113
What are trace minerals/elements?
Zinc, copper, iron, selenium
114
What are the functions of minerals?
Bone health, enzyme activation, metabolism
115
What are electrolytes?
A subset of minerals that dissolve in body fluids to produce charged ions (cations & anions)
116
What is the function of electrolytes?
Maintain osmotic balance, acid-base homeostasis, fluid balance, nerve function and muscle contraction
117
What are examples of electrolytes?
Sodium, potassium, chloride, calcium, magnesium, phosphorous
118
What is the relationship between electrolytes and minerals?
Most electrolytes are minerals but not all minerals are electrolytes
119
How do calcium and magnesium function?
As both minerals (bone health) and electrolytes (nerve/muscle function)
120
What is the relationship between iron and zinc?
Iron and zinc are both minerals but not electrolytes
121
What is bicarbonate (HCO3-)?
An electrolyte but not a mineral
122
What is hyponatremia?
<135 mEq/L
123
What is hypernatremia?
>145 mEq/L
124
What are the standard daily requirements for sodium?
1-2 mEq/kg
125
What are primary causes of hyponatremia?
GI losses, Fistula drainage, Diuretics, Adrenal insufficiency
126
What is the serum potassium concentration?
3.5-5.3 mEq
127
What are the standard daily requirements for potassium?
0.5-1 mEq/kg
128
What are common losses of potassium?
GI fluid losses, hypomagnesemia, diuretics, polyuria, renal excretion
129
What are the evaluations for hyperkalemia?
Traumatic blood draw, excessive intake (IV), altered distribution-acidosis, cellular breakdown (burns, crush injuries), renal excretion
130
What is the serum magnesium concentration?
1.8-2.4 mEq
131
What is the preferred magnesium cation?
Magnesium sulfate
132
What are the usual daily magnesium requirements?
8-20 mEq
133
What is the function of magnesium?
Acts as a coenzyme in metabolism of carbs and protein and needed in ATP reactions
134
What are common losses of magnesium?
Diarrhea and alcohol use disorders (Renal excretion) are major, sepsis, pancreatitis, refeeding syndrome, thermal injuries/TBI
135
What is phosphorous?
Primary intracellular anion
136
What is the serum phosphorous concentration?
2.5-4.5 mEq
137
What is the usual daily IV dose for phosphorous?
20-40 mmol (27-53 mEq)
138
How is the usual daily IV dose of phosphorous given?
As sodium or potassium salt
139
What is phosphorous a constituent of?
Nucleic acids, phospholipid membranes and nucleoproteins
140
What role does phosphorus have?
Key role in macronutrient metabolism
141
Where is the majority of calcium stored?
Bones and teeth
142
What percentage of calcium is extracellular and how much of that is bound to albumin?
1% of calcium is extracellular and 60% of that is bound to albumin
143
What is the usual IV dose of calcium?
10-15 mEq/day given as gluconate
144
What is the normal range for ionized calcium (iCal)?
1.12-1.30 mmol/L
145
What is calcium used for?
Protein synthesis
146
What is calcium essential for?
Normal muscle contraction, nerve function, blood coagulation, and bone formation
147
What role does iron have?
Critical role in oxygen transport, energy production, and immune function
148
What do iron deficiencies result in?
Fatigue, anemia, decreased resistance to infection
149
Where is iron found?
In most foods and is best obtained in a well-balanced diet
150
What are dietary sources of copper?
Shellfish, nuts, seeds, whole grains
151
What are common signs of iron deficiency?
Anemias, neutropenia
152
What are dietary sources of iodine?
Iodized salt, seafood, eggs
153
What are common signs of iodine deficiency?
Goiter, hypothyroidism
154
What are dietary sources of selenium?
Seafood, eggs, meat, whole grains
155
What is a common sign of selenium deficiency?
Cardiomyopathy
156
What are dietary sources of zinc?
Meat, shellfish, legumes, nuts, dairy
157
What are common signs of zinc deficiency?
Dermatitis, alopecia, anorexia, impaired wound healing
158
What is the definition of vitamins?
Organic dietary constituent necessary for life, health and growth that does not function by supplying energy and which cannot be synthesized endogenously in adequate amounts
159
Where are most vitamins absorbed?
In the upper small intestine
160
How are water-soluble vitamins absorbed?
Directly into the bloodstream through the digestive system
161
How are water-soluble vitamins stored?
Not stored in the body, excessive amounts are excreted in the urine
162
When do deficiency symptoms of water-soluble vitamins typically appear?
Quickly when intake is inadequate because the body cannot store these vitamins
163
What is the toxicity characteristic of water-soluble vitamins?
Rare, since excess are excreted but can occur with high doses of specific B vitamins (B6)
164
Where are most vitamins absorbed?
Upper small intestine
165
How are water-soluble vitamins absorbed?
Absorbed directly into the bloodstream through the digestive system
166
What is the storage characteristic of water-soluble vitamins?
Not stored in the body, excessive amounts are excreted in the urine
167
When do deficiency symptoms of water-soluble vitamins typically appear?
Typically appear quickly when intake is inadequate because the body cannot store these vitamins
168
Is toxicity common with water-soluble vitamins?
Rare, since excess are excreted but can occur with high doses of specific B vitamins (B6)
169
What are examples of water-soluble vitamins?
Vitamin C (ascorbic acid), B vitamins (B1, B2, B3, B5, B6, etc)
170
What are fat-soluble vitamins?
Vitamins that dissolve in fat and are typically stored in the liver and adipose tissues
171
How are fat-soluble vitamins absorbed?
Absorbed along with dietary fat and can be stored in the body for longer periods
172
Are deficiencies common with fat-soluble vitamins?
Deficiencies are less common than with water-soluble vitamins but toxicity can occur if they are consumed in excess
173
What can alter nutrient absorption, metabolism, or utilization in the body?
Medications
174
What effect do antacids have on nutrient absorption?
Can reduce the absorption of vitamin B12 by altering stomach acidity
175
What do anticonvulsants increase the metabolism of?
Folate, leading to potential folate deficiency. They may also interfere with vitamin D metabolism
176
What is the effect of chronic alcohol consumption on thiamine?
Can interfere with the utilization of thiamine (vitamin B1), leading to Wernicke-Korsakoff syndrome
177
What is the effect of angiotensin converting enzyme inhibitors (ACEi)?
Increased urinary zinc losses
178
What is the effect of corticosteroids on vitamins?
Decreased vitamins A, D, and C
179
What is the impact of malnutrition on function?
Results in changes in subcellular, cellular, or organ function that increases morbidity and mortality
180
What are examples of severe acute diseases related to malnutrition?
Major infections, burns, trauma
181
What are examples of chronic diseases related to malnutrition?
Crohn's disease, organ failure, cancer
182
What does malnutrition encompass?
Undernutrition and overnutrition (obesity)
183
What is malnutrition a consequence of?
Nutrition imbalance
184
What do deficiency states involve?
Protein, energy, or single nutrients such as vitamins or trace elements
185
What can cause malnutrition to develop?
Acute or chronic conditions/diseases
186
What percentage of hospitalized patients experience malnutrition?
30-50%
187
What is the direct cost of malnutrition?
$15.5 billion
188
Who is at the highest risk for malnutrition?
Critically ill patients
189
What are the impacts of malnutrition?
Respiratory and cardiac dysfunction, prolonged LOS, increased costs, reduced immune function, increases infections, compromised musculoskeletal strength, impaired wound healing
190
What does nutrition screening identify?
Patients at nutritional risk
191
What should an effective nutrition screening process be designed to do?
Identify those patients most at risk
192
What is the ideal nutrition screening tool?
Quick, simple, non-invasive
193
What is a requirement for nutrition screening since 1995?
Joint Commission
194
When must nutrition screening be performed after inpatient admission?
Within 24 hours
195
What are risk factors for undernutrition?
Recent unintended weight loss, presence and severity of acute/chronic diseases, medications/medical treatments, socioeconomic factors, altered nutrient absorption or metabolism
196
What are risk factors for overnutrition?
Family history of obesity, medical diagnoses (PCOS, Cushing's syndrome), poor dietary habits, inadequate exercise, medications
197
What is nutrition assessment?
A comprehensive medical, surgical, and dietary history
198
What does an MST score of 2 or more indicate?
At risk
199
What should at-risk patients receive promptly?
Assessment by nutritional support
200
What are the variables of the NUTRIC score?
Age, APACHE II, SOFA, number of co-morbidities, days from hospital to ICU admission, IL-6
201
What NUTRIC score range is high and associated with worse clinical outcomes?
5-9
202
What NUTRIC score range is low and indicates low malnutrition risk?
0-4
203
What does an MST score of 0 or 1 indicate?
Not at risk
204
Who typically performs nutrition assessment?
Registered Dietitian (RD)
205
What does Nutrition-Focused Physical Examination (NFPE) identify?
Nutrition related problems including anthropometrics, patient history, current clinical presentation, biomarkers/laboratory data, nutrition intake data, functional status
206
Are serum visceral proteins a definitive diagnosis of malnutrition?
No, there are many reasons these values could vary
207
What are examples of serum visceral proteins?
Albumin, Prealbumin, Transferrin, C-Reactive Protein
208
What is the definition of food?
Any nutritious substance that people or animals eat or drink or that plants absorb in order to maintain life and growth
209
What is the definition of dietary supplements?
Products that contain nutrients, such as vitamins, minerals, herbs, or amino acids, intended to supplement the diet
210
What is the definition of Food for Special Dietary Use (FSDU)?
Food that's specially processed to meet the specific dietary needs of a person
211
What is the definition of medical food?
A specially formulated food intended to meet the nutritional needs of a specific disease or condition
212
What are medical foods?
A food which is formulated to be consumed or administered enterally under the supervision of a physician, intended for the specific dietary management of a disease or condition
213
Is nutrition a patient right?
Yes
214
What do patients of all ages, demographics, ethnicities, and backgrounds need to live?
Nutrition
215
When is nutritional support needed?
When an individual cannot eat enough (or any) food to maintain proper nutrition status and overall health due to an illness or medical condition
216
What are the two main support therapies for nutritional support?
Enteral (via a feeding tube) and Parenteral (via an intravenous catheter)
217
What is enteral nutrition support?
Method of nutritional support that uses the GI tract through an enteral access device (EAD)
218
What is microbiologically diverse in healthy patients?
The gut microbiome
219
What compromises the gut microbiome in critical illness?
Decreased diversity and opportunistic pathogens
220
What medications can compromise the gut microbiome?
Antibiotics and vasoactive agents
221
What is a determinant of the gut microbial composition?
Enteral nutrition
222
What does enteral nutrition maintain?
Immune integrity and function
223
What does enteral nutrition decrease?
Bacterial translocation
224
What does enteral nutrition blunt?
Inflammatory response
225
What are the benefits of enteral nutrition?
- Maintains functional integrity of the gut
- Efficient nutrient utilization
- Maintains normal gallbladder function
- Supports immune function
- Reduces infectious complications
- Cost-effective
226
What are the indications for enteral nutrition?
- Oral intake is impossible, inadequate, or unsafe
- Poor appetite due to chronic conditions
- Dysphagia
- Major trauma, burns, wounds, or critical illness
- Severely malnourished preoperative patients
227
What are gastrointestinal risks of enteral nutrition?
Nausea, vomiting, diarrhea, abdominal distention, constipation
228
What are pulmonary aspiration risks of enteral nutrition?
Supine position, reduced level of consciousness, gastroparesis
229
What are metabolic complications risks of enteral nutrition?
Refeeding syndrome, hyperglycemia, dehydration
230
What are contraindications for enteral nutrition?
- Bowel obstruction
- Bowel discontinuity
- Active resuscitation
- Severe malabsorption syndromes
- Intestinal ischemia or bowel necrosis
231
What defines active resuscitation?
MAP <50 mmHg, worsening acidosis on vasopressor, ischemic bowel concerns, HOB < 30 degrees, increasing or addition of vasopressor
232
What is the duration for short-term enteral nutrition therapy?
<4-6 weeks
233
What is the duration for long-term enteral nutrition therapy?
>4-6 weeks
234
What considerations are there for enteral access?
- Gastric motility
- Aspiration risk
- Alterations in GI anatomy
235
What determines the type of enteral access device?
Length of need for enteral nutrition and aspiration risk
236
What types of tubes can be placed at bedside by nursing staff?
Orogastric (OG) and nasogastric (NG) tubes
237
What types of tubes must be placed by trained clinicians?
Nasoduodenal (ND) and nasojejunal (NJ) tubes
238
What are gastrostomy tubes?
Tubes placed surgically or with percutaneous techniques that terminate in the stomach
239
What are J-tubes?
Tubes placed surgically directly into the jejunum for feeding only
240
What are continuous feedings?
Administered with an enteral feeding pump over a set period of time with a constant rate
241
In which patients are continuous feedings preferred?
Patients who are critically ill or have poor metabolic stability
242
What are bolus feedings?
Administered via gastrostomy with a syringe or via gravity in < 30 minutes
243
Which feeding resembles an oral diet?
Bolus feedings
244
What are intermittent feedings?
Delivered from an EN container or bag over 30 minutes to an hour
245
Which feeding may benefit patients who do not tolerate bolus feeds?
Intermittent feedings
246
What are cyclic enteral feedings?
Administer nutrition over < 24 hour time period, allowing patients to attempt some oral intake during the day
247
What minimizes inconveniences associated with the pump and continuous feeds?
Cycled schedule
248
What are adverse events for administering medications in enteral access devices?
- EAD obstruction
- Altered medication pharmacokinetics or efficacy
- Increased risk for toxicity
249
What are immediate release oral preparations?
Film and enteric-coated tablets that can hinder the ability to crush the tablet into a fine powder
250
What is a modified release preparation?
Crushing can release a total daily dose instantly instead of over time, leading to toxicity
251
What are solutions in medication administration?
Homogeneous liquid mixtures where active medication is uniformly dissolved in a diluent, at risk for instability
252
What are suspensions in medication administration?
Heterogeneous liquids containing active medications floating in a liquid medium, at risk for inadequate delivery
253
What are implications of tube type for drug administration?
- Site of drug delivery
- Size of lumen and length of tube
- Function of the enteral tube
- Multilumen tubes
- Confirmation of position
254
What are reasons to not crush solid dosage forms?
- Extended-release, controlled-release, prolonged-action, and sustained-release formulations
- Enteric-coated or protective medications
- Sublingual or buccal absorbent medications
- Medications that irritate the oral cavity
- Carcinogenic and/or teratogenic medications
- Medications created to prevent misuse
255
How to unblock nasogastric feeding tubes?
Use 15-30 mL warm or cold water in a 50 mL syringe with a pull/push action
256
What syringe should be used with caution if the above fails?
A smaller 5 mL syringe
257
What device can be used for mechanical de-clogging of the correct size?
Mechanical de-clogging device for gastrostomy/jejunostomy tubes
258
When to use pancreatic enzymes?
Only if activated to the correct pH and able to deliver close to the occlusion
259
What do standard, polymeric formulas contain?
Intact macronutrients and require normal digestive and absorptive function
260
What do elemental and semi-elemental formulas contain?
Partially or fully hydrolyzed macronutrients for easier digestion
261
What are disease-specific formulas?
Examples include renal (low in electrolytes), hepatic (modified amino acids), diabetic (low in carbs and high fiber)
262
What are modular formulas?
Contain individual macronutrient components for customizing nutrition
263
What is the water content by volume in standard formulas?
70-85%
264
What is Jevity 1.5?
A standard formula containing 1.5 kcal/mL and fiber
265
What is Osmolite 1.5?
A standard formula without fiber
266
When are disease-appropriate formulas appropriate?
If failed trial with standard formulas
267
What is Pivot 1.5?
An immune modulating formula with Arginine, Glutamine, Omega-3 FA, and scFOS
268
What is Vital AF 1.2?
Contains Omega-3 FA (EPA/DHA) and 75 g protein/L
269
What is Vital High Protein?
A low fat formula with 87 g protein/L
270
What is parenteral nutrition (PN)?
An important, life-saving therapeutic modality for patients unable to maintain adequate nutrition through the GI tract
271
How many ingredients can PN prescriptions contain?
Up to 40 different ingredients
272
What is PN classified as by ISMP?
A high-alert medication
273
What is the CSP Category for PN according to USP 797?
2
274
What does TPN stand for?
Total parenteral nutrition
275
What does CPN stand for?
Central parenteral nutrition
276
What does PPN stand for?
Peripheral parenteral nutrition
277
What is ILE?
IV lipid emulsion, the preferred term for oil-in-water emulsions for IV administration
278
What is 2-in-1 PN?
Dextrose, amino acids, electrolytes, vitamins, and minerals in one bag with ILE administered separately
279
What is 3-in-1 PN?
Total nutrient admixture (TNA) with all macronutrients in the same bag
280
What is Intralipid?
Soybean oil-based, provides linoleic acids, and is pro-inflammatory
281
What is SMOF lipid?
Contains soybean oil, olive oil, fish oil, and medium-chain triglycerides (MCTs)
282
What conditions may require PN?
- Impaired absorption of nutrients
- Mechanical bowel obstruction
- Need for prolonged bowel rest
- Motility disorders
- Inability to maintain sufficient oral or enteral access
283
What are additional conditions needing PN?
- Small bowel obstruction
- High-output enteric fistula
- Intractable vomiting or diarrhea
- Inoperable obstruction
- Severe GI bleeding
- Mesenteric ischemia
- Severe GI dysmotility
- Short bowel syndrome
- Paralytic ileus
- Refractory nausea/vomiting
284
Where does central access for parenteral routes go?
Superior vena cava
285
What is the osmolarity range for hyperosmolar parenteral routes?
1300-1800 mOsm
286
What affects parenteral routes?
Short-term vs long-term use
287
What can IVC be used for?
If upper veins are not available
288
What is the caloric requirement for critically ill, trauma, or sepsis patients?
25-30 kcal/kg/day
289
What is the target blood glucose range for hyperglycemia?
140-180 mg/dL
290
What should be monitored in cases of hypoglycemia?
If PN formulation must be discontinued abruptly, begin dextrose infusion for 1-2 hours
291
When can essential fatty acid deficiency occur?
Within 1-3 weeks in adults receiving ILE-free PN
292
What to do if serum triglycerides are >400 mg/dL?
Hold ILE from PN regimen
293
What are the normal ranges for azotemia?
BUN: 7-18 mg/dL, sCr: 0.6-1.1 mg/dL
294
What is steatosis?
Modest elevations of serum aminotransferase concentrations that may return to normal
295
What is PN-associated cholestasis (PNAC)?
Elevation of alkaline phosphatase and GGT, conjugated bilirubin >2 mg/dL
296
What to do if using 100% soybean-based ILE?
Do not exceed 1g/kg/day and consider changing to mixed oil source
297
What can gallbladder sludge/stones benefit from?
Providing any nutrition via enteral route
298
What may be necessary for fluids and electrolytes?
Separate IV fluids outside of the PN formulation for excessive losses
299
What should be monitored for vitamins in PN?
Excessive intake of fat-soluble vitamins A, D, E, K can lead to toxicity
300
What is the standard daily multivitamin for PN?
To prevent deficiencies
301
What trace elements may require more zinc?
High intestinal losses
302
What can selenium deficiency induce?
Cardiomyopathy
303
What can patients on long-term PN develop?
Manganese toxicity
304
What are the PN macronutrient dosing steps?
1) Determine total kcal need
2) Determine protein needs
3) Determine lipid needs
4) Subtract protein and lipid calories from total calories
5) Determine fluid requirements
305
What is the stable calorie requirement?
20-30 kcal/kg/day
306
What is the maximum dextrose for hyperglycemia?
150 g/day; cautious initiation if BG >180
307
What is the refeeding risk on day 1?
No greater than 75% of goal calories and max of 150 g dextrose
308
What is the TEE formula?
BEE x activity factor x stress factor
309
What is refeeding syndrome?
A condition that occurs when reintroducing nutrition after starvation, leading to electrolyte imbalances and potential complications
310
What are one or more refeeding risk factors?
- BMI 15% past 3-6 months
- Little or no nutrition for >10 days
- Low levels of K, P, or Mg before feeding
311
What are two or more refeeding risk factors?
- BMI 10% past 3-6 months
- Little or no nutrition for >5 days
- History of substance abuse or certain medications
312
Which electrolytes are of concern with refeeding?
- Potassium (hypokalemia)
- Magnesium (hypomagnesemia)
- Phosphate (hypophosphatemia)
