Nutrition (Walroth)

Question 1

IBW formula

Answer 1

• Male: 50 + (2.3 x inches over 60)
• Female: 45.5 + (2.3 x inches over 60)

Question 2

When should you use NBW over actual body weight?

Answer 2

If actual body weight is 130%+ IBW

Question 3

NBW formula

Answer 3

IBW + 0.25 (weight - IBW)

Question 4

What is the normal rannge for transthyretin (prealbumin)?

Answer 4

15-40 mg/dL

Question 5

How often should prealbumin be checked?

Answer 5

Biweekly

Question 6

Which malnutrition classification occurs due to decreased total intake and/or utilization of food?

Answer 6

Marasmus

Question 7

Which malnutrition classification is the result of adequate caloric intake, but relative protein malnutrition?

Answer 7

Kwashiorkor

Question 8

Which malnutrition calculation has evident muscle wasting?

Answer 8

Marasmus

Question 9

What are some non-urinry sources of nitrogen loss?

Answer 9

• sweat
• feces
• respirations
• GI fistula
• wound drainage
• skin exfoliation
• burns

Question 10

What is the goal nitrogen balance?

Answer 10

+3 - +5 grams

Question 11

N₂ balance formula

Answer 11

N₂ in - N₂ out

Question 12

How do you calculate N₂ in?

Answer 12

24-hr protein intake (g) / 6.25

Question 13

How do you calculate N₂ out?

Answer 13

24-hr UUN (g) + 4

Question 14

TEE formula

Answer 14

REE x 1.2

Question 15

What is the goal RQ?

Answer 15

0.85-0.95

Question 16

How often should you monitor RQ?

Answer 16

once weekly

Question 17

What range should be used to calculate total daily calories?

Answer 17

25-30 kcal/kg/day

Question 18

What is the protein range for mild-moderate stress (floor) patients?

Answer 18

1-1.5 g/kg/day

Question 19

What is the protein range for moderate-severe stress (ICU, trauma, surgery, burn) patients?

Answer 19

1.5-2 g/kg/day

Question 20

In what situations may a patient’s protein “tolerance” be decreased?

Answer 20

renal and hepatic failure

Question 21

What is the standard NPC distribution?

Answer 21

70% dextrose/30% fat

Question 22

In what scenario may a patient require 100/0 NPC distribution?

Answer 22

sepsis or bloodstream infections

Question 23

List some indications for parenteral nutrition.

Answer 23

• anticipated NPO > 7 days
• inability to absorb nutrients via the gut (small bowel/colonic ileus, SMB, malabsorptive status, intractable V/D)
• enterocutaneous fistulas
• IBD
• hyperemesis gravidarum
• bone marrow transplant (mucositis)

Question 24

What should final destrose concentration be restricted to in peripheral PN?

Answer 24

5-10%

Question 25

What should total osmolarity be restricted to for peripheral PN?

Answer 25

\< 900 mOsm/L

Question 26

What are some advantages of using central PN?

Answer 26

* can give hypertonic solutions (dextrose and amino acid solutions) * can give more calories

Question 27

What are some disadvantages of using central PN?

Answer 27

* infection risk * invasive-ish procedure * pneumothorax * air embolus * thrombus

Question 28

Where are the accepted CVC insertion sites?

Answer 28

* subclavian (SC) * internal jugular (IJ) * femoral

Question 29

How will central venous access be inserted if short-term?

Answer 29

percutaneously

Question 30

How will central venous access be inserted if long-term?

Answer 30

* PICC * tunneled * implanted port

Question 31

How many kcal per gram of protein?

Answer 31

4 kcal

Question 32

How many kcal per gram of carbohydrates (dextrose)?

Answer 32

3.4 kcal

Question 33

What is the maximum carbohydrate utilization for PN?

Answer 33

4-5 mg/kg/min

Question 34

When should you give a Clinimix WITHOUT electrolytes?

Answer 34

CrCl \< 50

Question 35

What is the general guidance for starting PN?

Answer 35

start at 25% and achieve final rate within 24 hours

Question 36

What measurement should you be sure to check before each rate increse when titrating PN?

Answer 36

blood glucose

Question 37

What amount of injectible MVI is appropriate to add to PN?

Answer 37

10 mL/day

Question 38

What complications can arise from PN?

Answer 38

* mechanical (line clotting, displacement) * infection * metabolic issues (electrolyte imbalance, fluid imbalance, glycemic issues, liver function abnormalities)

Question 39

How often should we do indirect calorimetry monitoring for PN?

Answer 39

weekly

Question 40

What three electrolytes are low with Refeeding Syndrome?

Answer 40

* phosphates * magnesium * potassium

Question 41

What are some indications for EN?

Answer 41

inadequate/contraindicated PO consumption

Question 42

When would EN be contraindicated?

Answer 42

* mechanical obstruction (hernia, tumors, adhesions, scar tissue) * non-mechanical obstruction (ileus) * intractable vomiting * severe malabsorption * severe GI hemorrhage * high output/proximal small bowel fistulas

Question 43

What EN route is preferred if a patient has high risk of aspiration?

Answer 43

jejunal

Question 44

What route of access is preferred for long-term EN?

Answer 44

PEG or PEJ

Question 45

Continuous infusion EN is the preferred method when feeding into what part of the colon?

Answer 45

jejunum

Question 46

What GI complications can arise from EN?

Answer 46

* high gastric residuals * diarrhea * constipation * N/V * abdominal distention * aspiration

Question 47

What metabolic complications can arise from EN?

Answer 47

* hyper- or hypoglycemia * over- or dehydration * electrolyte imbalance

Question 48

What mechanical complications can arise from EN?

Answer 48

* tube clogging * tube malposition * rhinitis * sinusitis

Question 49

True or false: drugs can be administered together with EN.

Answer 49

false; administer separately, with at least 5 ml water between each medication

Question 50

What type of drug should be diluted in at least 30 ml of water before administering?

Answer 50

hypertonic or irritating to gastric mucosa (i.e. KCl)