36 Questions
What is the indication for increasing protein in the patient with an albumin level of 2.8?
To correct hypoalbuminemia
What is the primary reason for Ron's weight loss prior to his transplant?
Side effects of chemotherapy and radiation therapy
What is Ron's measured resting energy expenditure (REE)?
2800 calories
What is a nutritional risk factor associated with graft versus host disease (GVHD)?
Impaired nutrient absorption
What percentage of calories should come from fat in Ron's TPN recommendation?
25%
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
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
What is the primary treatment for a patient with refeeding syndrome?
Electrolyte repletion followed by slow advancement of feedings
What is the primary purpose of nutrition screening?
To identify patients who may be at nutritional risk
Which of the following is a consequence of not performing nutrition screening?
Malnutrition may go undiagnosed
What is the most likely cause of tachycardia and fluid retention in a patient with a BMI of 17?
Electrolyte imbalance
What is the correct management of a patient with hypokalemia, hypophosphatemia, and hypomagnesemia?
Electrolyte repletion followed by slow advancement of feedings
What is the primary role of an RD in nutrition screening?
To perform a comprehensive nutritional assessment
What is theinterpretation of the lab profile pH-7.3, HCO3-35, and PaCO2-47?
Metabolic alkalosis
Which of the following electrolyte cations exists primarily extracellularly?
Sodium
What is the primary cause of metabolic alkalosis?
Hypokalemia
What is the main difference between nutrition screening and a comprehensive nutritional assessment?
The level of detail in the assessment
When is a comprehensive nutritional assessment typically performed?
After nutrition screening
What is the effect of refeeding syndrome on electrolyte levels?
Causes an electrolyte imbalance
What is the primary goal of electrolyte repletion in refeeding syndrome?
Prevention of electrolyte imbalance
What is the primary goal of a comprehensive nutritional assessment?
To diagnose malnutrition
Which of the following is a potential consequence of malnutrition?
Weakened immune system
What is the recommended protein intake for Ruth based on her usual body weight?
1.5 gm/kg
What is the estimated energy requirement for Ruth based on her REE and stress factor?
2334 kcal
What is the recommended type of tube feeding for Ruth?
Jevity 1.0
What is the calculation for Ruth's REE?
10 x weight (kg) + 6.25 x height (cm) - 5 x age (y) - 161
What is the recommended fluid intake for Ruth?
at least 2400 mL
What is the calculation for Ruth's protein goal?
1.5 gm/kg x usual body weight
What is the recommended rate of tube feeding for Ruth?
97-100 mL/hr
What is the total amount of protein provided by Jevity 1.0 in Ruth's tube feeding?
106 gm
What is the patient's protein goal in grams per kilogram?
2.2 gm/kg
What percentage of kilocalories come from fat?
25%
What is the total volume of the final solution in liters?
3.06 L
What is the concentration of dextrose in the final solution?
20%
What is the patient's glucose infusion rate (GIR)?
4.52
What is the total kilocalorie intake from protein?
718 kcal
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.
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.
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