Crohns.docx

**Part A**: Multiple Choice (1 points each) Choose the best possible answer. PLACE ANSWER IN BOX TO THE LEFT OF QUESTION UNDER THE QUESTION NUMBER. +-----------------------------------+-----------------------------------+ | 1 | Nutrition screening is used to: | |...

**Part A**: Multiple Choice (1 points each) Choose the best possible answer. PLACE ANSWER IN BOX TO THE LEFT OF QUESTION UNDER THE QUESTION NUMBER. +-----------------------------------+-----------------------------------+ | 1 | Nutrition screening is used to: | | | | | D | a. Identifies patients who may | | | be at nutritional risk | | | | | | b. Diagnose malnutrition | | | | | | c. Identify patients who should | | | receive a comprehensive | | | nutritional assessment by an | | | RD | | | | | | d. A and C | +===================================+===================================+ | 2 | Which of the following is an | | | electrolyte cation that exists | | B | primarily extracellularly? | | | | | | a. Potassium | | | | | | b. Sodiu | | | | | | c. Magnesium | | | | | | d. Phosphorus | +-----------------------------------+-----------------------------------+ | 3. | A patient admitted with a BMI of | | | 17 and the following clinical | | B | profile: K-2.1 (L), Phos-1.9 (L), | | | Mg-1.1 (L), tachycardia and fluid | | | retention may require: | | | | | | a\. A sodium restriction | | | | | | b\. Electrolyte repletion | | | followed by slow advancement of | | | feedings (refeeding syndrome) | | | | | | c\. IV correction using a | | | hypotonic solution | | | | | | d\. A and C | +-----------------------------------+-----------------------------------+ | 4 | The following lab profile pH-7.3 | | | (L), HCO3-35 (H) PaCO2-47 (H) may | | D | represent: | | | | | | a\. Metabolic alkalosis | | | | | | b\. Metabolic acidosis with | | | compensation | | | | | | c\. Respiratory alkalosis | | | | | | d\. Respiratory acidosis with | | | compensation | +-----------------------------------+-----------------------------------+ | 5-9 | Match the following condition | | | with the most appropriate | | A | therapeutic diet: | | | | | E | \_\_\_Stage V CKD with HD a. 1.2 | | | gm pro/kg, 50% high biological | | C | value; 3-4 gm Na;\ a. Do you agree with the need to place a feeding tube? What method of feeding do you recommend for Ruth? What weight would you use? b. Calculate her energy and protein goals based on her usual body weight using MSJ REE formula and the appropriate stress factor. Provide her with 1.5 gm pro/kg. Her fluid intake should be at least **REE = 10 x weight (kg) + 6.25 x height (cm) -- 5 x age (y) -- 161** REE = (10 x 65) + 6.25 (166) -- 5(66) -- 161= 1197 650 + 1038 -330 -- 161=1197 REE:1197 x 1.5 x 1.3 = 2334 65 x 1.5 gm/kg = 98 gm protein c. What type of tube feeding would you recommend for Ruth? 98 gm protein x 4 = 364 kcal/2334 = 16% Jevity 1.0 2334/1.0 kcal/mL = 2334 mL needed 2334/24 = 97\~ 100 mL/hr 24 x 100mL/hr = 2400 mL or 2400 kcals 2.4 x 44.3 gm protein in Jevity = 106 gm protein (sufficient!) d. A week after surgery her feedings have reached goal rate. She has a lab work-up. Her Albumin is 2.8 and her UUN is 10 on a 24 hour protein intake of 100 gm protein. Based on her albumin, the fellow wants to increase the protein in her feedings. What is your recommendation? Provide your rationale. 2. Ron is a 56 yo male who is 45 days out from receiving a hematopoietic stem cell transplant. Prior to his transplant he underwent conditioning treatment of high dose chemotherapy followed by radiation therapy. During that time he lost 16% of his usual body weight due to significant nausea, vomiting, diarrhea and poor appetite which he continues to experience. He presents to the hospital with graft versus host disease of his GI tract. You are consulted for nutritional support of this patient. Height 182 cm Admit Weight: 81 kg His Measured REE by indirect calorimetry = 2800 calories Protein needs per RD for HSCT a. What do you recommend for nutrition support of this patient? What is your rationale? (5) b. Describe nutritional risk factors associated with GVHD. (5) c. Provide a TPN recommendation that provides 25% of his calories as fat. His fluid requirement for TPN is 3000 ml. His fat infusion should not be included as part of his 3000 mL allotment. Be sure to show your work and his GIR. (15) Determine Energy and Protein Needs Energy MEE x 1.2 = 2800 x 1.2=3360 Protein Goal: 1.8-2.5 = Use 2.2 gm/kg 81 kg x 2.2 = 178 gm protein 25% kcal as fat: 3360 x.25 = 840 kcals. 840/2 kcal/mL = 420 mL (run over 12 hours) 3000-420 = 2580 mL (volume for dextrose/amino acid) Kcal from fat = 840 Kcal from pro = 178 x 4 = 712 kcal Kcals from cho = 3360-840-712 = 1808 \% dextrose 532/2580 = 20% solution \% amino acid 178/2580 = 6.8% aa Final order D20AA6.8 in 2.58 L with 420 mL 20% IL over 12 hrs OR: D20AA6.8 at 110 mL/hr with 35 mL/hr 20% IL CheckBack: Fluid 2640 + 420 = 3060 mL fluid Kcals from Dextrose 2640 x 20% dextrose = 528 gm CHO 528 x 3.4 = 1795 Kcal from Protein 2640 x 6.8 = 179.5 gm pro (2.2 gm/kg) 179.5 x 4 kcal/gm = 718 kcal Total cal = 1795+ 718 + 840=3353 kcal GIR: 528/1.44./1 = 4.52 ok!) Final solution provides 3.06 L fluid 3353 kcal with 180 gm pro (2.2 gm/kg) GIR of 4.52