amandakzinn's version from 2015-04-20 00:29

Section 1

Question Answer
when to use actual body weight?actual is between ideal and obese
when to use ideal body weight?actual body weight less than ideal
when to use adjusted body weight?over 130% of IBW
population estimate for health normal nutrition status minimal illness severity20-25 kcal/kg/day
population estimate for illness, metabolic stress (BMI under 30)=25-30 kcal/kg/day
population estimate for illness, metabolic stress (BMI over 30) 11 to 14 kcal/kg/day (ABW) or 22 to 25 kcalkg/day (IBW)
population estimate for severe stress, major burn injury30 kcal/kg/day
before give potassium must fixmagnesium
corrected calcium[(4-albumin)X 0.8] +measured serum calcium
amino acids (protein) 1 gram=4kcal
volume for protein10 grams every 100 ml (10% soln)
lipids are what percent of nonprotein calories?30%
lipids 1 gram=9 kcal (no need convert to grams tho for lipids)
10% emulsion lipids=1.1 kcal per 1ml
20% emulsion lipids=2 kcal per 1 ml
30% emulsion lipids=3ckal per 1 ml
carbs (dextrose) 1 gram=3.4 kcal
carbs volume70% soln so 70 grams per 100 ml
electrolytes, vitamins, and trace elements150 ml volume
calculating fluids100 ml first 10 kg then 50 ml second ten kg then 20 ml per kg
volume enternal1.2 kcal per 1ml

Section 2

Question Answer
massive small bowel resectionparenteral
intractable vomitingparenteral
severe diarrheaparenteral
bowel obstructionparenteral
GI fistulaeparenteral
severe pancreatitisparenteral
critical care organ failure or burnsparenteral
post and pre operativeparenteral
hyperemesis gravidarumparenteral
eating disordersparenteral
premautre infants parenteral
pediatric patients within 5 to 7 daysparenteral (enteral not likely provide adequate nutrition)
inability to swallowenteral
facial or jaw injuryenteral
head and neck cancerenteral
CI to enteraldistal mechanical intestinal obstruction, necrotizing enterocolitis

Section 3

Question Answer
parenteral peripheralfunction of GI tract expected to return within 10 to 14 days. larger volumes necc.
parenteral centralparenteral required for more than 7 to 14 days
types of infusion for parenteralcontinuous (preferred for patients with unstable fluid blance or glucose control) or cyclic over 12-18 hours(receiving at home, may prevent or treat hepatotoxicity long term PN, useful patients limited venous access)
monitoring for parenteralvital signs and fluid balance at baseline then daily, electrolytes baseline then daily to 2-3 x weekly, renal and hepatic fxn basline then 1-3 x weekly, weekly= albumin, prealbumin, nitrogen balance
benefits for enteraldecrease infectious complications, fewer metabolic complications, less costly
short term enteral for how longless than 4 to 6 weeks
enteral access sites short termNG (nasogastric), OG (orogastric), nasoduodenal (ND), NJ(nasojejunal)
avoid gastric if impaired motility
long term enteral if how longgreater than 4 to 6 weeks
enteral access sites long termPEG(most common, easy to place and clogs less), jejunostomy (impaired gastric use jejun)
admin methods enteralcontinuous, cyclic, intermittent, bolus
continous enteral infusionusually better tolerated but inconvenient abulatory patients
cyclic enteral feeding only admin at night. more convenient amb patients
bolus enteraldelivered over 5 to 10 mins four to six times a day. poorly tolerated jejun or duod, avoid in patients with delayed gastric emptying
intermittent enteraldelivered over 20 to 60 mins four to six times a day. option ppl unable tolerate faster.
adults start enteral continous at20 to 50 ml per hour then increase 10 to 25 ml/hr every 4 to 8 hours until goal rate reached
intermittent/bolus enteral start at120 ml every 4 hours. increase 30 to 60 every 8 to 12 hours

Section 4

Question Answer
dosage forms avoid for drug admin through feeding tubesublingual, sustained release capsules, eneteric coated
solid dosage forms crushed and mixed with15 to 30 ml of water before admin . flush with at least 15 ml of water before and after admin
meds with special consids for enteral feeding tubephenytoin, quinolones, omeprazole, warfarin, lasnoprazole, tetracycline

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