Transcript Therapeutics IV - 4-16

Therapeutics IV Tutoring
Nutrition
Lisa Hayes
[email protected]
April 16th 2016
Outline
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Nutrition Support – Renal Failure
Nutrition Support – Hepatic Failure
Nutrition Support – Geriatrics
Nutrition Support – Obesity
Drug Nutrient Interactions
Which formula is more appropriate for
a patient with CKD on HD?
• A – concentrated, polymeric, nutritionally
complete
• B – concentrated, low-protein, low/no
electrolyte
• C – concentrated, low-protein, moderate
electrolyte
Unfortunately, you miscalculated the number of dextrose calories to
be provided to patient CG. CG has been receiving twice the daily
recommended amount. What will likely happen to their RQ?
• A – RQ will remain unchanged
• B – RQ will increase
• C – RQ will decrease
Which of the following is the best
indicator for acute changes in
nutritional status?
• A – albumin
• B – prealbumin
• C – transferrin
Which of the following is not a way to manage
hyperglycemia associated with TPN
administration?
• A – Add long-acting insulin to TPN bag
• B – start patient on sliding scale insulin
• C – decrease dextrose concentration of bag
• D – start patient on insulin drip
What can be done when elevated gastric residuals are
noted in a patient on EN?
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A – half the rate of EN
B – metoclopramide 20mg IV q12 hours
C – erythromycin 50mg IV q6hours x 48hours
D – change to PN
How would you treat hyperglycemia
associated with EN?
• A – add regular insulin to EN formula
• B – look for other sources of dextrose in
patient’s regimen and eliminate
• C – consider long-acting insulin
• D – change to high-carb formula
• E – B and C
LF is a patient who you are monitoring TPN for. Her SCR has jumped
from 1.1 to 1.7 overnight. She is in AKI. Based on this information.
What would be an appropriate energy and protein requirement for
her TPN?
• A – 1.2 BEE, 1.5g/kg protein
• B – 25kcal/kg/day; 2g/kg/day protein
• C – 30kcal/kg/day; 1.2g/kg/day protein
What mineral/electrolyte is often held prior to the
start of dialysis in HD patients?
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A – potassium
B – phosphorus
C – selenium
D – multivitamin
RD has cirrhosis secondary to alcohol use. He currently has Stage III
hepatic encephalopathy despite lactulose administration. EN is to be
started. What should be recommended to the team?
• A – protein restrict at 0.5g/kg/day
• B – use 30-35kcal/kg/day
• C – transition to BCAA formulation if moves to
stage 4
• D- no recommendations
Hyperglycemia associated with cirrhosis is due
to which of the following dysregulations?
• A – decreased glucagon, increased insulin
resistance
• B – decreased insulin concentrations but
increased glucagon
• C – increased glucagon + increased insulin
resistance
WC arrives to the ED in a severe stupor. It is determined that he is
drunk. He will be admitted for observation as it is possible he has
aspirated during his episode. Before administering nutrition, what
should you recommend to the team?
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A – intubation to protect airway
B – thiamine
C – vitamin D
D – vitamin C
FT is a patient admitted to the TSICU at UTMC s/p MVC with multiple
traumas. He is 115kg. Hgt: 6ft. IBW: 78kg. Determine the number of
calories and protein appropriate for his TPN. Enteral nutrition not
indicated at this time due to severe bowel injury and open abdominal
wounds.
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A – 1950kcal/day + 156g/day protein
B – 2875kcal/day + 230g/day protein
C – 1950kcal/day + 230g/day protein
D – 2875kcal/day + 156g/day protein
If hypocaloric feeding is chosen, it is ok
to limit protein and fat also.
True
False
Determine if the following patient is classified as “frail”. FC is a
81year old female who has generalized weakness, typically
spends her days at home and does not enjoy traveling outside
her home, she reports exhaustion on physical activity, and
shuffles at a slow speed as she ambulates.
• A – yes frail
• B – no not frail
CV is a patient diagnosed with dementia. He is
malnourished and the team would like to recommend
tube feeds. What should you tell them?
• A – Recommend cycling at night
• B – avoid TFs due to risk of aspiration in
demented patients, recc assisted hand feeding
• C – change to PN
BH is a 87y/o patient with severe pancreatitis. The
medicine wishes to start her on TPN since she has not
eaten in 7 days. Which of the following calculations
would be most appropriate for a calorie calculation?
Weight: 60kg IBW: 54kg
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A – 25kcal/kg/day
B – 1.2 x BEE
C – 1.5 x BEE
D – 35 kcal/kg/day
How much protein should be added to BH’s TPN? Additional
information: it was determined today she has a Stage III ulcer on her
buttocks due to poor turning and nursing care at her SNF.
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A – 1g/kg/day
B – 1.2g/kg/day
C – 1.4g/kg/day
D – 2g/kg/day
Which electrolyte abnormality is
common due to aging?
• A – B12 deficiency secondary to atropic
gastritis
• B – increased calcium levels due to super
therapeutic dosing of supplements
• C – increased sodium due to increased water
losses
VF is a patient on EN who is also receiving all his medication via tube.
Medications include metoprolol tabs, lisinopril tabs, furosemide tabs,
APAP elixir, nexium powder. He is experiencing severe diarrhea. What
would you recommend to the medicine team?
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A – check stool for Cdiff
B – consider changing APAP to tabs
C – add peptobismol
D – change nexium powder to suspension
Hyponatremia can be associated with
which of the following drugs?
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A – Prozac
B – Tegretol
C – Paroxetine
D – all of the above
B12 deficiency is common with which
of the following drugs?
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A – Omeprazole
B – Metformin
C – Glimepiride
D–A+B
The addition of grapefruit juice to the administration of many drugs
(felodipine, buspirone, CSA, CBZ) can cause which of the following by
interacting with the 3A4 system?
• A – decreased concentrations of drug
• B – increased concentrations of drug
BR is a patient admitted to your unit on chronic phenytoin therapy secondary
to epilepsy. However, he has failed his barium swallow test and is on EN + all
meds per tube. BR is taking phenytoin suspension 200mg TID. What do you
recommend about the administration of his phenytoin?
• A – Hold EN 2 hours before and after each
dose. No change in EN rate.
• B – Hold EN 1 hour before and after each
dose. Increase EN rate to give total dose over
18 hours.
• C – Hold EN only before doses. No change in
EN rate.
• D - Hold EN 1 hour before and after each dose.
Decrease EN rate.
In an unfortunate turn of events, BR has develop a DVT and
needs to be anticoagulated. The attending wishes to use
coumadin. What should you recommend about the
administration of the coumadin in regards to tube feeds?
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A – no need to change or hold EN
B – hold EN 2 hours before and after dose
C – hold EN 1 hour before and after dose
D – increase coumadin dose 10% to account
for interaction, no holding of EN
A patient, NH, has the following formula for their TPN. Calculate the
number of dextrose calories that come from their TPN. 240g
dextrose, 40g lipid, 140g protein.
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A – 960kcal
B – 2400 kcal
C – 816kcal
D – 840kcal
How many calories come from fat? What percentage of
daily calories is this?
(reminder: 240g dextrose, 40g lipid, 140g protein. )
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A – 400kcal; 15%
B – 400kcal; 22.5%
C – 136kal; 4%
D - 136kcal; 8%
THANKS!
• [email protected]