Nutrition Screening and Electrolyte Balance

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Questions and Answers

What is the indication for increasing protein in the patient with an albumin level of 2.8?

To promote weight gain

To enhance immune function

To improve glucose metabolism

To correct hypoalbuminemia (correct)

What is the primary reason for Ron's weight loss prior to his transplant?

Side effects of chemotherapy and radiation therapy (correct)

Poor appetite due to transplant procedure

Graft versus host disease

Inadequate nutrition support

What is Ron's measured resting energy expenditure (REE)?

3000 calories

3500 calories

2800 calories (correct)

2500 calories

What is a nutritional risk factor associated with graft versus host disease (GVHD)?

Impaired nutrient absorption Signup and view all the answers

What percentage of calories should come from fat in Ron's TPN recommendation?

25% Signup and view all the answers

How should Ron's fat infusion be considered in his TPN recommendation?

It should not be included as part of his 3000 mL fluid allotment Signup and view all the answers

What is the likely diagnosis of a patient with a BMI of 17, potassium level of 2.1, phosphorus level of 1.9, and magnesium level of 1.1?

Refeeding syndrome Signup and view all the answers

What is the primary treatment for a patient with refeeding syndrome?

Electrolyte repletion followed by slow advancement of feedings Signup and view all the answers

What is the primary purpose of nutrition screening?

To identify patients who may be at nutritional risk Signup and view all the answers

Which of the following is a consequence of not performing nutrition screening?

Malnutrition may go undiagnosed Signup and view all the answers

What is the most likely cause of tachycardia and fluid retention in a patient with a BMI of 17?

Electrolyte imbalance Signup and view all the answers

What is the correct management of a patient with hypokalemia, hypophosphatemia, and hypomagnesemia?

Electrolyte repletion followed by slow advancement of feedings Signup and view all the answers

What is the primary role of an RD in nutrition screening?

To perform a comprehensive nutritional assessment Signup and view all the answers

What is theinterpretation of the lab profile pH-7.3, HCO3-35, and PaCO2-47?

Metabolic alkalosis Signup and view all the answers

Which of the following electrolyte cations exists primarily extracellularly?

Sodium Signup and view all the answers

What is the primary cause of metabolic alkalosis?

Hypokalemia Signup and view all the answers

What is the main difference between nutrition screening and a comprehensive nutritional assessment?

The level of detail in the assessment Signup and view all the answers

When is a comprehensive nutritional assessment typically performed?

After nutrition screening Signup and view all the answers

What is the effect of refeeding syndrome on electrolyte levels?

Causes an electrolyte imbalance Signup and view all the answers

What is the primary goal of electrolyte repletion in refeeding syndrome?

Prevention of electrolyte imbalance Signup and view all the answers

What is the primary goal of a comprehensive nutritional assessment?

To diagnose malnutrition Signup and view all the answers

Which of the following is a potential consequence of malnutrition?

Weakened immune system Signup and view all the answers

What is the recommended protein intake for Ruth based on her usual body weight?

1.5 gm/kg Signup and view all the answers

What is the estimated energy requirement for Ruth based on her REE and stress factor?

2334 kcal Signup and view all the answers

What is the recommended type of tube feeding for Ruth?

Jevity 1.0 Signup and view all the answers

What is the calculation for Ruth's REE?

10 x weight (kg) + 6.25 x height (cm) - 5 x age (y) - 161 Signup and view all the answers

What is the recommended fluid intake for Ruth?

at least 2400 mL Signup and view all the answers

What is the calculation for Ruth's protein goal?

1.5 gm/kg x usual body weight Signup and view all the answers

What is the recommended rate of tube feeding for Ruth?

97-100 mL/hr Signup and view all the answers

What is the total amount of protein provided by Jevity 1.0 in Ruth's tube feeding?

106 gm Signup and view all the answers

What is the patient's protein goal in grams per kilogram?

2.2 gm/kg Signup and view all the answers

What percentage of kilocalories come from fat?

25% Signup and view all the answers

What is the total volume of the final solution in liters?

3.06 L Signup and view all the answers

What is the concentration of dextrose in the final solution?

20% Signup and view all the answers

What is the patient's glucose infusion rate (GIR)?

4.52 Signup and view all the answers

What is the total kilocalorie intake from protein?

718 kcal Signup and view all the answers

Study Notes

Nutrition Screening and Assessment

Nutrition screening is used to identify patients who may be at nutritional risk, diagnose malnutrition, and identify patients who should receive a comprehensive nutritional assessment by an RD.

Electrolytes and Fluid Balance

Sodium is an electrolyte cation that exists primarily extracellularly.
Patients with a BMI of 17 and clinical profile (K-2.1, Phos-1.9, Mg-1.1, tachycardia, and fluid retention) may require electrolyte repletion followed by slow advancement of feedings to prevent refeeding syndrome.

Lab Profiles and Acid-Base Balance

A lab profile with pH-7.3, HCO3-35, and PaCO2-47 may represent respiratory acidosis with compensation.

Therapeutic Diets and Nutrition Support

A patient with Stage V CKD with HD requires a therapeutic diet with 1.2 gm pro/kg, 50% high biological value, 3-4 gm Na, and restricted fluid intake.

Patient Case Studies: Ruth

Ruth requires a feeding tube and a method of feeding that provides 1.5 gm pro/kg, with a weight-based calorie goal and fluid intake of at least 2400 mL.
The MSJ REE formula is used to calculate energy and protein goals: REE = 10 x weight (kg) + 6.25 x height (cm) - 5 x age (y) - 161.
Jevity 1.0 is recommended as the tube feeding formula, providing 16% of total calories from protein.
The goal rate of feeding is 100 mL/hr, with a total of 2400 mL or 2400 kcal/day.
Based on Albumin levels (2.8) and UUN (10), the protein intake may need to be increased.

Patient Case Studies: Ron

Ron, a 56-year-old male, requires nutrition support after a hematopoietic stem cell transplant and graft-versus-host disease of the GI tract.
His nutrition support goals include:
- Energy needs: 3360 kcal/day (MEE x 1.2)
- Protein needs: 178 gm/day (1.8-2.5 gm/kg)
- Fat infusion: 25% of total calories, with a volume of 420 mL over 12 hours
- TPN recommendation: D20AA6.8 in 2.58 L with 420 mL 20% IL over 12 hours, or D20AA6.8 at 110 mL/hr with 35 mL/hr 20% IL.
- Final solution provides 3.06 L fluid, 3353 kcal, and 180 gm pro/day.

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Description

This quiz covers nutrition screening and assessment, as well as electrolyte balance and fluid management in patients. Topics include identifying nutritional risk, diagnosing malnutrition, and managing electrolyte imbalances.