Critical Care

Question 1

Goal reach 80% TF goal x

Answer 1

48 hrs

Question 2

pSBO what enteral tube to use

Answer 2

feed distally, and decompress proximally

Question 3

Ileus

Answer 3

takes a mix of fluid/nutrients and air to make BS

Question 4

TF factors for pts with aspiration risk include:

Answer 4

HOB 30-40 degrees, slow continuous rate, prokinetics, post pyloric

Question 5

Diarrhea

Answer 5

investigate cause (drug/infectious), antidiarrheals/fiber

Question 6

Best outcomes with TF providing this amt

Answer 6

33-65%

Question 7

Acute pancreatitis with EN

Answer 7

proximal feeds do not exacerbate, reduces mortality

Question 8

Distal Jtube used for

Answer 8

obstruction UGI, pancreatic rest, suppression of pancreatitis

Question 9

Mild-Moderate Trauma –resume po 3-5 days

Answer 9

No Nutrition support

Question 10

Severe Trauma (burns 20% BSA or MOSF), anticipate no po 5-10 days

Answer 10

YES Nutrition support

Question 11

Cascade

Answer 11

SIR-neuroendocrine and cytokine response to maintain O2 delivery

Question 12

SIR catabolic state

Answer 12

store substrates,increase insulin, inc HR, minute vent

Question 13

Increase GI blood flow with

Answer 13

presence luminal nutrients

Question 14

Nutrients effect lumin

Answer 14

Dextrose: inc bld flow, improve gut dysfx, AA: amplify injury, Glutamine: enhance neutrophil fx and prevent damage, IVF: ?

Question 15

Primary Nutrition Support plan for trauma, surgery and burn with intact GI

Answer 15

EN

Question 16

Early Feeding

Answer 16

within 2 hrs of injury to 5 days

Question 17

G tubes predisposed to (may cause)

Answer 17

aspiration/PNA

Question 18

Aspiration seen with these tubes

Answer 18

G/J despite low residuals

Question 19

Advocate for J tubes

Answer 19

Dec GE regurg, dec rate vent assoc PNA, Inc nutrient delivery, short time to get to TF goal

Question 20

Fewer post-op infections with this type of feeds

Answer 20

EN, preserved GI immunity, mucosal barrier function, dec pulmonary infections in trauma pts

Question 21

Uncomplicated Malnutrition markers

Answer 21

normal visceral proteins

Question 22

Hyperglycemia with PN may cause

Answer 22

negative outcomes

Question 23

Gastric and Colorectal Cancer significant dec post-op intra abdomenal abscesses with

Answer 23

Pre-operative EN

Question 24

Post-op PN highest M/M over how long

Answer 24

over 14 days

Question 25

J tube oncology pts no advantages over

Answer 25

IVF

Question 26

GI not functioning over 2 weeks post-op

Answer 26

PN regardless of M/M

Question 27

Pre-op EN in malnourished pt

Answer 27

elective surgery maybe beneficial to outcome

Question 28

Post-op Nutrition support 7-10 days

Answer 28

regardless of all info

Question 29

1 liter of fluid=

Answer 29

1 kg body wt

Question 30

Prealbumin

Answer 30

synthesized in liver, limited by fluid/liver dysfx, inflammation (CRP)

Question 31

Penn State Equation

Answer 31

valid in ICU/vented pts

Question 32

PRO in Burn

Answer 32

3-4g/kg/day in Large SA Burn

Question 33

PRO in CVVHD

Answer 33

2-2.5g/kg/d

Question 34

CHO metabolic stress

Answer 34

4-7mg/kg/min=MAX

Question 35

LIPIDs in Critically Ill

Answer 35

Lipid metabolism is altered d/t hormonal/mediator alterations, mobilize adipose tissue TG stores

Question 36

Lipid free PN in Critically Ill

Answer 36

fewer complications

Question 37

Fat facilitates

Answer 37

protein sparing, dec risk CHO overload, limits tv and provides EFAs

Question 38

IV Fat negatively causes

Answer 38

Dec immune fx, inc TG, hypoxemia

Question 39

Minimal complications with IV Fat

Answer 39

18-24 hr infusions, .1g/kg/hr, Omega 3

Question 40

REactive Oxygen Sepcies (ROS) generated during Critical Illness

Answer 40

tissue injury–SIRS–Dec Vit C & E

Question 41

Early Vit C &E decreases

Answer 41

organ failure and ICU stay (DRI amt)

Question 42

Burns decrease which vitamin

Answer 42

Vit D