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Duke PA Surgical Nutrition

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Question
Answer
High prevalence of __ deficits in hospitalized patients   nutritional  
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__ % of hospitalized patients suffer from some degree of malnutrition (depending on disease and population)   15 - 50  
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Loss of weight, appetite, muscle atrophy, and weakness in someone not trying to lose weight, usu. signifies an underlying disease   Cachexia  
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acute visceral protein depletion (chronic protein intake insufficiency), usually affects young childrenedema, pigmentation, pot belly   Kwashiorkor  
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Simple starvation (chronic caloric intake insufficiency)loss of lean body mass, fat, and visceral proteins   Marasmus  
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40% in liver (rapidly depleted)   Glycogen stores  
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60% in muscle   Glycogen stores  
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Obligatory gluconeogenesisProtein catabolismIncreased nitrogen lossUnresponsive to glucose administrationMagnitude of loss proportional to injury   Adrenergic/Corticoid phase of Stressed Starvation (Surgery, Trauma)  
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__ common finding with deficiencies in niacin, thiamine, vitamin B6, vitamin B12   peripheral neuropathy  
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Represents the critical cellular mass necessary for cellular structure as well as function   lean body mass  
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Represents 40% of total body weight   lean body mass  
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Depletion is severe insult and defines patient morbidity and mortality   lean body mass  
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60% skeletal muscle   lean body cell mass  
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20% red blood cells and connective tissue   lean body cell mass  
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20% cell mass   lean body cell mass  
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Utilized for clinical determination of total body fat and skeletal muscle storeSimple, inexpensive, non-invasive technique   Anthropometric measures  
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__% of the total body protein is contained in skeletal muscle   60  
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this is major site of protein catabolism during starvation and/or illnes   skeletal muscle  
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Most widely used biochemical marker of muscle mass   24-hr urine creatinine  
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Creatinine is degradation product of creatine,__   an energy storage compound located in skeletal muscle  
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Maintains plasma oncotic pressure and is a carrier for enzymes, drugs, hormones, etc.   Serum albumin  
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Serum albumin   Serum albumin  
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Carrier for ironLimited use because level fluctuates with iron stores   Serum transferrin  
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Carrier for thyroxine and retinol-binding proteinSensitive to acute changes in nutrient intake   Serum prealbumin  
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Resting energy expenditure calculated by using the __ equation   Harris-Benedict  
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Nitrogen Balance   N intake - N loss  
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Nitrogen Balance (N intake - N loss):If positive (goal +2 to +4), net state of __   anabolism  
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Nitrogen Balance (N intake - N loss): If negative, net state of __   catabolism  
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Nitrogen Intake (enteral and parenteral)(1 gm N/__ g Protein   6.25  
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Estimates severity of lean body mass catabolism and quantifies severity of metabolic stress   Catabolic Index (CI):  
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In general, adults will require nutritional support if NPO for greater than __ days   7  
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if the gut works   use it  
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contraindications to enteral nutrition   gastroparesis, intestinal obstruction, ileus, high-output fistula, short bowel syndrome  
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Used for conscious patients; preferred for short-term feeding (< 30 days)   Nasoenteric Tube Feeding  
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Nasogastric: adequate gastric emptying require; maintain gastric residuals < __% of total infusion over prior 4 hours   50  
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Nasoenteric Tube Feeding:used in patients with high aspiration risk (neurological impairment; poor gastric motility)   Nasointestinal  
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tube feeds cause   diarrhea  
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in a patient with tube feeding and diarrhea check for __ before changing anything else   C. dif  
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Involves continuous infusion of hyperosmolar solution containing carbohydrates, proteins, fats, and other necessary nutrients through an indwelling catheter inserted into the superior vena cava   Total Parenteral Alimentation/Nutrition (TPN)  
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Any patient who will not have functioning GI tract for __ days should be considered for TPN   5-7  
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Principal indication for __ are found in seriously ill patients suffering from malnutrition, sepsis, or surgical or accidental trauma when use of the GI tract for feedings is not possible   parenteral alimentation  
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1. Intravenous vitamin preparations should be added 2. Vitamin K and folate should be administered once a week 3. Vitamin B12 is given once a month intramuscularly   Parenteral Alimentation  
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May present as dry, scaly dermatitis and loss of hair - Syndrome may be prevented by periodic infusion of a fat emulsion equal to 4 - 5% of total calories   Essential Fatty Acid Deficiency  
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- Most frequent trace mineral deficiency is __, which presents as an eczematoid rash developing both diffusely and at intertriginous areas   zinc  
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