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Surgery I -
Nutrition
| Question | Answer |
|---|---|
| * What percentage of hospitalized patients suffer from malnutrition? | 15-50% |
| What patients are at risk for malnutrition? | 1. weight loss >10% over last 3-4 mo. 2. serum albumin in hydrated state <3g/100mL 3. serum tranferrin <220mg/100mL |
| Define the following: 1. Cachexia 2. Kwashiorkor 3. Marasumus | 1. loss of wt, mm atrophy due to underlying disease 2. acute visceral protein depletion in young children 3. simple starvation |
| What is a common finding in patients with deficiencies in niacin, thiamine, Vit B6 or Vit B12 | Peripheral neuropathy |
| Important marker for significant nutritional depletion | Current body wt less that 90% of the usual or ideal body wt |
| What is the importance of lean body mass? | It represents the critical cellular mass necessary for cellular structure and function; depletion is a severe insult and defines patient morbidity and mortality |
| * What % of total body wt does lean body mass represent? | 40% |
| * What composes lean body cell mass? | 60% skeletal mm 20% RBCs and connective tissue 20% cell mass |
| Identify the major site of protein catabolism during starvation or illness | skeletal mm - contains 60% of the total body protein Note: Measurement of skeletal muscle mass estimates major protein reserves |
| What are anthropometric measures? | Utilized for clinical determination of total body fat and skeletal muscle stores. 1. skin fold thickness - calipers used to measure total body fat 2. mid-arm muscle circumference and area- used to measure skeletal muscle protein |
| What is the most widely used biochemical marker of: 1. skeletal muscle mass 2. Visceral protein mass | 1. 24 hr urine creatinine Note: creatinine is product of creatine degradation located in skeletal muscle. 2. serum proteins including albumin, tranferrin, prealbumin |
| * How does one determine protein balance (to determine if protein intake is sufficient to maintain lean body mass)? | 1. Nitrogen balance = N intake - N loss; (+) value - net state of anabolism (goal is 2-4) 2. N intake (enteral and parenteral)N intake = g protein x (1g N/6.25g protein) 3. N loss (from urine, GI and skin) N loss = UUN 4g UUn - 24 hr urine urea nitrogen |
| *What is catabolic index and how is it calculated? | Estimates serverity of lean body mass catabolism and quantifies severity of metabolic stress. CI= UUN - 0.5 (Diestary N intake) + 3 g <0 no significant stress 0-5 moderate stress >5 severe stress |
| IN general, when will adults require nutritional support? | If NPO for greater than 7 days |
| Cit indications for the following methods of feeding: 1. nasoenteric tube 2. gastrostomy tube 3. jejunostomy tube | 1. concious pt, short term (<30 days) 2. Long term or permanent, adequate gastric emptying required 3. obtunded pt or high GI fistula or obstruction |
| What is total parenteral nutrition (TPN) ? | Continuous infusion of HYPERosmolar solution containing all necessary nutrients through an indwelling central venous catherter |
| What pt population should be considered for TPN? | Any pt who will not have a functioning GI tract for 5-7 days |
| What are the recommended measurements in nutritionally depleted patients | 1. daily weigh-ins 2. weekly serum visceral proteins and Nitrogen balance 3. monthly anthropometrics |
| What type of IV fluid would you give to a pt with the following symptoms 1. burns or ascites due to liver disease 2. dehydration 3. hypervolemia | 1. albumin (colloid) 2. D5W 3. 0.9% NS |
| What type of IV fluid would you give to a patient with the following problems? 1. s/p small bowel resection 2. NPO, night before surgery 3. Maintenance fluid, K of 5.1 | 1. D5-LR 2. D5 1/2 NR + 20 mEq KCL (house wine) |
| What type of IV fluid would you give to a patient with the following problems? 1. Hypovolemia d/t blood loss 2. On coumadin, INR = 2, scheduled for surgery | 1. PRBC 2. FFP |
| List common causes of hyponatremia | 1. excess fluid volume 2. hyperglycemia 3. hyperlipidemia, hyperproteinemia |
| List common causes of hypernatremia | 1. water loss- burns, diabetes insipidus 2. adequate intake failure |
| State Henderson-Hasslebach equation | H2O+ CO2 ↔ H2CO3 ↔ H+ + HCO3- |
| What is the physiologic pH of extracellular fluid? | 7.35-7.45 |
| List common causes of metabolic acidosis | 1. Diarrhea 2. Excess chloride 3. DKA |
| List common causes of metabolic alkalosis | 1. vomiting 2. diuretics |
| List common causes of respiratory acidosis | 1. COPD 2. Aspiration 3. Pneumothorax |
| List common causes of respiratory alkalosis | 1. hyperventilation 2. Sepsis 3. Atelectasis |
Created by:
eedavila
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