BCNSP flashcards
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- Ideal body weight formula
- For males: 50 kg + 2.3 kg per inch over 5 feet. For females: 45.5 kg + 2.3 kg per inch over 5 feet. Used for caloric and protein dosing when actual weight is unreliable.
- Nitrogen balance equation
- Nitrogen balance = (protein intake in grams / 6.25) minus (urine urea nitrogen in grams + 4 g). A positive value indicates anabolism; negative indicates catabolism.
- Indirect calorimetry
- Measures resting energy expenditure by analyzing oxygen consumption and carbon dioxide production. Respiratory quotient >1.0 suggests overfeeding; <0.7 suggests underfeeding or fat oxidation.
- Albumin and prealbumin
- Negative acute-phase reactants. Albumin half-life ~20 days; prealbumin ~2 days. Low levels reflect inflammation, not necessarily malnutrition, and are not reliable markers of nutritional status.
- Enteral nutrition indications
- Preferred when the gastrointestinal tract is functional but oral intake is inadequate. Examples include dysphagia, anorexia, critical illness, burns, and malabsorption with a working gut.
- Enteral nutrition contraindications
- Mechanical bowel obstruction, severe ischemic bowel, uncontrolled GI bleeding, high-output proximal fistula, severe malabsorption, and hemodynamic instability with gut hypoperfusion.
- Parenteral nutrition indications
- Short bowel syndrome, high-output fistula, severe pancreatitis with enteral intolerance, prolonged ileus, severe mucositis, and malnutrition when enteral nutrition is not feasible or contraindicated.
- Gastric versus post-pyloric access
- Gastric access (NG, PEG) is preferred when stomach and small bowel function. Post-pyloric (NJ, PEJ) is indicated for gastroparesis, severe GERD, pancreatitis, or high aspiration risk.
- Peripheral parenteral nutrition limit
- Peripheral PN osmolarity should not exceed 900 mOsm/L to avoid phlebitis. Central PN is required for higher osmolarity formulas and long-term therapy.
- Refeeding syndrome risk factors
- BMI <16, weight loss >15% in 3–6 months, negligible intake >10 days, low baseline electrolytes, and alcoholism. Start feeding low and monitor phosphate, potassium, and magnesium.
- Standard polymeric formula
- Enteral formula with intact protein and 1.0–1.2 kcal/mL. Requires normal digestion and absorption; used for most patients with a functioning GI tract.
- Elemental formula
- Contains free amino acids or peptides and is low-residue. Used for malabsorption, short bowel syndrome, pancreatic insufficiency, and when digestion or absorption is impaired.
- Enteral feeding initiation
- Start at 10–30 mL/hr and advance by 10–20 mL/hr every 4–8 hours to target over 24–48 hours. Check tube position before use and monitor tolerance.
- Gastric residual volume
- Routine checking is not required unless the patient is at high risk for aspiration or intolerance. Elevated residuals may prompt holding feeds and reassessment.
- Head-of-bed elevation
- Elevate the head of the bed 30–45 degrees during and after enteral feeding to reduce aspiration risk. Post-pyloric feeding further reduces aspiration risk.
- Enteral formula hang time
- Open-system formulas should hang no longer than 4 hours; feeding sets should be changed every 24 hours to reduce contamination and infection risk.
- PN macronutrient caloric values
- Dextrose provides 3.4 kcal/g; amino acids 4 kcal/g; 20% lipid emulsion provides 2.0 kcal/mL (10 kcal/g). These values are used to calculate total calories.
- PN calcium-phosphate precipitation
- Calcium and phosphate can precipitate in PN solutions. Use compatible salts, check for precipitate, and avoid adding calcium to phosphate-containing solutions without compatibility data.
- Lipid emulsion limits
- Limit lipid emulsions to ≤1 g/kg/day (or ≤2 g/kg/day in some settings). Monitor triglycerides, especially in hypertriglyceridemia or pancreatitis.
- Cycled parenteral nutrition
- PN infused over 12–16 hours rather than 24 hours. May reduce hepatic steatosis and improve mobility; taper to avoid rebound hypoglycemia.
- PN compounding aseptic technique
- Compounding requires a laminar flow hood, aseptic technique, order verification, labeling, and expiration dating. 2-in-1 and 3-in-1 admixtures have different stability considerations.
- Catheter-related bloodstream infection
- A serious complication of parenteral nutrition. Prevention includes strict aseptic technique, chlorhexidine skin prep, minimizing line accesses, and removing unnecessary catheters.
- Hyperglycemia management in nutrition
- Target glucose 140–180 mg/dL. Use insulin infusion or sliding scale and avoid overfeeding dextrose. Monitor glucose frequently during initiation and adjustment.
- Enteral feeding diarrhea
- Evaluate formula osmolality, infusion rate, medications (sorbitol, antibiotics), and infection such as C. difficile. Adjust rate, formula, or medications as indicated.
- Hepatic complications of PN
- Elevated transaminases, steatosis, and cholestasis. Strategies include cycling PN, limiting dextrose, and using fish-oil-based lipid emulsions.
- Monitoring frequency in nutrition support
- Daily weights and electrolytes during the acute phase; weekly labs once stable. Reassess nutritional goals regularly and adjust the regimen.
- Diabetes nutrition support
- Use consistent carbohydrate intake, monitor glucose, and adjust insulin. Enteral formulas with lower glycemic index may help control blood glucose.
- Renal failure nutrition support
- Pre-dialysis: restrict protein to 0.6–0.8 g/kg/day, potassium, phosphorus, and fluid. Dialysis patients need higher protein (1.2–1.5 g/kg/day).
- Liver disease nutrition support
- Provide adequate protein (1.2–1.5 g/kg/day) and calories. Do not restrict protein in encephalopathy; consider branched-chain amino acids.
- Pancreatitis nutrition support
- Enteral nutrition (nasojejunal) is preferred over parenteral. Start with a low-fat formula; use parenteral nutrition if enteral is not tolerated.
- Short bowel syndrome diet
- High-calorie, low-fat, low-oxalate diet with supplemental vitamins and minerals. Parenteral nutrition may be needed long-term depending on remaining bowel length.
- Critical illness feeding
- Start early enteral nutrition within 24–48 hours. Use trophic feeding if full feeds are not tolerated and avoid overfeeding to prevent complications.