Malnutrition, Labs, and Estimating Needs
What is unintentional weight loss and deterioration of physcial condition?
Cachexia
CARB COUNTING!! How many grams are in:
Starch =
Fruits =
Milk =
Non starchy vegetables =
Sweets, Desserts, and other carbohydrates =
Starch = 15 grams
Fruits = 15 grams
Milk = 12 grams
Non starchy vegetables = 5 grams
Sweets, Desserts, and other carbohydrates = 15 grams
What are the two types of formulas?
_____ requires digestion and contains CHO, protein, and fats
_____ requires little to no digestion and contains peptides or amino acids
Intact and elemental
What is the most accurate method to determine a patients needs that has experienced trauma or burns?
Ireton-Jones
Inflammation of the gallbladder secondary to obstruction, infection and ischemia. Can be acute or chronic. Can be due to bacterial infection, chemical expsoure, obstruction, fasting, or trauma.
What type of gallbladder disease is this?
Cholecystitis
What type of disease does this patient have?
Elevated: AST, ALT, Direct Bili
Normal Creatinine, K+
Low Albumin, Na+, Hct, and Hgb
Fasting Glucose = 95; Total Cholesterol = 195
Liver Disease
- Exercise will generally mean that _____ insulin is needed
- Infections/stress will generally mean that _____ insulin will be needed
- Weight gain will often cause _____ _____, so more insulin will be needed and visa versa for weight loss
- less
- more
- insulin resistance
Name the access route that matches the indications.
Normal GI function =
Normal GI function but need to bypass upper GI tract, longer-term feeding access =
Nasogastric
PEG/Gastrostomy
Your patient is on a 2 gram sodium restriction/day, a fluid restrcition of 1.2-1.5 L/day, and on a diuretic. What is their diagnosis?
Ascites
To locate and remove stones in the ducts, which diagnostic test would you perform?
ERCP
What type of malnutrition does this patient have?
Elevated: CRP and WBC
Normal: AST, ALT, Creatinine
Low: Albumin, Na+, BUN, Hgb, Hct
Fasting Glucose= 130; Total Cholesterol = 140; Tiglycerides = 125
Acute/Disease specific malnutrition
Your breakfast dose of rapid-acting insulin is 1:10.
Calculate how many grams of CHO were eaten and then calculate the units of insulin needed.
1/2 cup shredded wheat
2 cups of whole milk
1 cup of coffee with Splenda
1/2 cup = 1 starch 15 grams
2 cups of milk = 2 milk 24 grams
1 cup of coffee with splenda = 0
39/10 = 3.9 = 4 units
Match the following: Choices (Polymeric Concetrated (A), Polymeric High Protein (B), Elemental Immune System Support (C), Polymeric Chronic Kidney Disease (D), and Polymeric Glucose Intolerance (E)
Diabetes =
Pre-dialysis =
Weakened Immune System with malabsorption =
Pressure Ulcers =
High calorie needs and fluid restricted =
E
D
C
B
A
What stage of stress is the patient in?
- 2-48 hours after injury
- Decreased cardiac/urine output
- Decreased BP
- Decrease body temperature
Ebb Phase
Which pancreatic cancer treatment removes the tail of pancreas and the spleen?
Distal pancreatectomy
Your patient is burning body fat and has a higher urinary glucose excretion. What is their RQ?
0.71
DM Mangement oral medications
1. Sulfonylureas, symlin, and victoza may cause _______ reactions
2. Name one non-insulin based injection
1. Hypoglycemia
2. byetta, victoza, bydureon, adlyxin, tanzeum, trulicity
Calculate the Tube Feeding calories and grams of protein:
You patient is receiving Pivot 1.5 at 60 ml/hr, fluid needs are 1800 mL per day
Calories = 1,440 ml/d x 1.5 Kcal/ml = 2,160 kcal/day
Grams of Protein = 1.440 ml of TF x 93.8 g protein /L = 135 g protein/ day
Your patient has a heart rate of 123, increased respiratory rate, high WBC, 32 breaths per minute, increased temperature, and an infection.
What does this indicate?
Sepsis
Which pancreatitis diagnosis has the following MNT:
-Early EN
-Calories: 25-35 kcal/kg per ASPEN
- Protein: 1.2-1.5 g/
Severe Acute Pancreatitis
A malnurished patient is being started on PN and is at risk for refeeding syndrome. Which labs should we monitor. Name ALL
Potassium, magnesium, phosphorus and thiamin depletion
The patient has a blood glucose over >250, dehydrated, acetone breath, severe ketosis, and is experiencing nausea. What does this indicate? Give me one intervention/treatment that you would do.
Diabetic ketoacidosis
Immediate treatment, insulin therapy, IV fluid and electrolyte replacement, bicarbonate to treat acidosis, and treat underlying cause
PN, Calculate the calories, grams and mOsm/L for Amino Acids:
Your patient is receiving 1200 mL 12.5% Amino Acid. Total volume is 2775 mL. Your patient weighs 90 kg.
Grams = 150
Calories = 600
mOsm/L = 540
Which of the following are treatment for Curling's ulcer?
1.Administer Nexium or a proton pump inhibitor
2.Have NG decompression in the stomach
3.Start early enteral nutrition into the duodenum or jejunum
All of the above!!
What is the MNT for Chronic Pancreatitis? Name the calories, protein, any multivitamin/mineral supplement, and one other recommended nutrition intervention
calories = up to 35 kcal/kg/day
protein = 1.2-1.5 g/kg body wt
multivitamin/mineral supplement = vitamin K, A, D, and E IF fat malabsorption, calcium, B-12, and antioxidants.
Avoid all alcohol and smoking. fluid between meals (1-2 hours after meals), may avoid irritants and caffeine, limit simple sugars, and may recommend MED diet