ASPEN core curriculum- parts 2 and 4
can medical foods make structure/function claims? - ANSWERyes, without FDA
approval
how much of enteral formulas are CHO - ANSWER40-70%
principle CHO in polymeric formulas - ANSWERcorn syrup solids (also fructose,
oligosaccharides)
principle CHO in hydrolyzed formulas - ANSWERhydrolyzed cornstarch, maltodextrin
(also FOS, inulin, guar gum)
principle CHO in oral products - ANSWERsucrose
do most formulas contain lactose? - ANSWERno
common fiber in enteral formulas - ANSWERguar gum, soy fiber
ASPEN and society of critical care recommendations for fiber in TF - ANSWERconsider
fiber formulas if pt has diarrhea but avoid both soluble and insoluble fiber if pt at risk for
bowel ischemia
what types of Tg are added to enteral formulas - ANSWERLCT, MCT
common sources of LCT in enteral formulas - ANSWERcorn and soybean
(safflower, canola, fish also used)
common sources of MCT in enteral formulas - ANSWERpalm kernal, coconut oil
do MCTs require chylomicrons, pancreatic enzymes, bile salts, or carnitine for
digestion/absorption - ANSWERno
common protein sources in enteral formulas - ANSWERcasein and soy (also
lactoalbumin, whey, egg albumin)
how much water do enteral formulas contain - ANSWER70-85%
the more energy dense a formula the less free water it contains
osmolality range of enteral formulas - ANSWER280-875
do hydrolyzed formulas or intact formulas have a higher osmolality -
ANSWERhydrolyzed
,what osmolarity is considered a hypertonic enteral formula - ANSWER320 (serum osmo
is 275-300)
recommended blood glucose levels in hospital setting - ANSWER140-180
are diabetes-specific formulas recommended amongst either hospitalized or critically ill -
ANSWERno
according to ESPEN, is the routine use of elemental formulas for Crohns , colitis, or
SBS disease indicated - ANSWERno
according to ASPEN, should routine elemental and disease-specific formulas be used in
critically ill patients? - ANSWERno (this includes vital, peptamin, vivonex... ?)
why are BCAA beneficial in hepatic encephalopathy - ANSWERBCAAs clear ammonia
(increased in HE) in skeletal muscles which decrease cerebral ammonia and reduce the
uptake of AAA across the blood-brain barrier
explain what happens w liver failure patients, BCAA, AAA - ANSWERpt w liver failure
may have higher AAA than BCAA; more AAA will enter the brain and contribute to sx of
HE
is protein restriction indicated for hepatic failure? what about a high BCAA formula? -
ANSWERNO
is the metabolism of arginine the same or different in surgical vs nonsurgical patients -
ANSWERdifferent- this is why immune enhancing formulas can be used in SICU
ASPEN recommendations for immune enhancing formulas - ANSWERthey SHOULD
NOT be used with severe sepsis
can be used for post-surgical pts in the ICU
ie pivot
are specialty formulas recommended for ARDS/ALI - ANSWERno
is routine use of renal specific formula necessary in pt w CKD - ANSWERno
is routine use of renal specific formula necessary in pt w AKI - ANSWERno
would a patieNt w high lytes benefit from renal specific formula - ANSWERmaybe
what formula is recommended for patients w acute respiratory failure -
ANSWERconcentrated formula
because the presence of fluid overload, pulmonary edema, and renal failure are
associated w poor clinical outcomes
,what disease states/clinical conditions might benefit from a concentrated formula -
ANSWERacute respiratory failure, liver failure, heart failure, hypervolemic
hypernatremia
what is HMB - ANSWERbeta hydroxy beta methyl butyrate is a metabolite of BCAA
leucine that promotes anabolism and increases protein synthesis, therefore, promoting
LBM accrual
what products marketed for wound healing and muscle repair contain HMB -
ANSWERensure
juven
argainaid
what macro/micronutrients improve wound healing (10) - ANSWERenergy
protein
omega 3
glutamine
arginine
zinc
selenium
vit ACE
what nutrition intervention is recommended for pressure ulcers - ANSWERhigh protein
with adequate vitamin A and zinc
ASPEN critical care calorie recs - ANSWERBMI <25 = 25-30 kcal/kg
BMI 25-29.9 = 20-25
BMI 30-50 = 11-14
BMI >50 = 22-25 kcal/kg IBW
ASPEN critical care protein recs - ANSWERBMI <25 = 1.2-2
BMI 25-29.9 = 1.2-2
BMI 30-50 = >2 IBW
BMI >50 = >2.5 IBW
the ASPEN standards state that EN should be initiated within ____ hrs of ICU
admission - ANSWER24-48
what should the goal for energy provision be for obese patients - ANSWER65-70%
how should modulars be administered w TF - ANSWERw separate flush via tube
hang time for closed system/ready to hang - ANSWER24-48 hr
hang time for open system/ready to feed - ANSWER4-12 hr
, hang time for powdered formula that must be reconstituted - ANSWER<4 hr
hang time for human breast milk - ANSWER4 hours
how long should short term enteral access be in place - ANSWER<4-6 wks
ng/nj feeling tube material - ANSWERpolyurethane; less comfortable, more stiff, thin
percutaneous feeding tube material - ANSWERsilicone; more comfortable, less stiff,
and thicker
surgical jejunostomy tube and catheter material - ANSWERrubber
how many ports can a nasoenteric feeding tube have. what are ports used for -
ANSWERcan have 1 or 2 ports, both compatible w syringes or a feeding set. used for
meds and feeds and or irrigation
if a polyurethane tube and a silicone tube have the same outer diameter, which will
have a larger internal diameter - ANSWERpolyurethane
what are percutaneous enterostomy internal retention bolsters made of - ANSWERsolid
material (silicone or polyurethane)
or silicone balloons
what internal bolster is most commonly used for initial percutaneous enterostomy
placement that is done laparoscopically - ANSWERsolid d/t greater longevity
what internal bolster is most commonly used for radiologic and surgical tube placement
as well as a replacement device - ANSWERballoon type d/t ease of placement
what is the lifespan of a balloon internal bolster - ANSWER4-6 months
what internal bolster is preferred for direct jejunal placement - ANSWERnon-balloon
tube to avoid occluding the narrow lumen
how many ports are present for an internal bolster tube - ANSWER3- one for food,
meds or irrigation, balloon inflation
when are low profile tubes used - ANSWERfor better cosmetic appearance, active
patients, stomach sleepers, those who only require intermittent therapy
what is the gold standard for NG/NJ confirmation placement - ANSWERplain abdominal
or chest radiography
what determines french size - ANSWERexternal diameter
can medical foods make structure/function claims? - ANSWERyes, without FDA
approval
how much of enteral formulas are CHO - ANSWER40-70%
principle CHO in polymeric formulas - ANSWERcorn syrup solids (also fructose,
oligosaccharides)
principle CHO in hydrolyzed formulas - ANSWERhydrolyzed cornstarch, maltodextrin
(also FOS, inulin, guar gum)
principle CHO in oral products - ANSWERsucrose
do most formulas contain lactose? - ANSWERno
common fiber in enteral formulas - ANSWERguar gum, soy fiber
ASPEN and society of critical care recommendations for fiber in TF - ANSWERconsider
fiber formulas if pt has diarrhea but avoid both soluble and insoluble fiber if pt at risk for
bowel ischemia
what types of Tg are added to enteral formulas - ANSWERLCT, MCT
common sources of LCT in enteral formulas - ANSWERcorn and soybean
(safflower, canola, fish also used)
common sources of MCT in enteral formulas - ANSWERpalm kernal, coconut oil
do MCTs require chylomicrons, pancreatic enzymes, bile salts, or carnitine for
digestion/absorption - ANSWERno
common protein sources in enteral formulas - ANSWERcasein and soy (also
lactoalbumin, whey, egg albumin)
how much water do enteral formulas contain - ANSWER70-85%
the more energy dense a formula the less free water it contains
osmolality range of enteral formulas - ANSWER280-875
do hydrolyzed formulas or intact formulas have a higher osmolality -
ANSWERhydrolyzed
,what osmolarity is considered a hypertonic enteral formula - ANSWER320 (serum osmo
is 275-300)
recommended blood glucose levels in hospital setting - ANSWER140-180
are diabetes-specific formulas recommended amongst either hospitalized or critically ill -
ANSWERno
according to ESPEN, is the routine use of elemental formulas for Crohns , colitis, or
SBS disease indicated - ANSWERno
according to ASPEN, should routine elemental and disease-specific formulas be used in
critically ill patients? - ANSWERno (this includes vital, peptamin, vivonex... ?)
why are BCAA beneficial in hepatic encephalopathy - ANSWERBCAAs clear ammonia
(increased in HE) in skeletal muscles which decrease cerebral ammonia and reduce the
uptake of AAA across the blood-brain barrier
explain what happens w liver failure patients, BCAA, AAA - ANSWERpt w liver failure
may have higher AAA than BCAA; more AAA will enter the brain and contribute to sx of
HE
is protein restriction indicated for hepatic failure? what about a high BCAA formula? -
ANSWERNO
is the metabolism of arginine the same or different in surgical vs nonsurgical patients -
ANSWERdifferent- this is why immune enhancing formulas can be used in SICU
ASPEN recommendations for immune enhancing formulas - ANSWERthey SHOULD
NOT be used with severe sepsis
can be used for post-surgical pts in the ICU
ie pivot
are specialty formulas recommended for ARDS/ALI - ANSWERno
is routine use of renal specific formula necessary in pt w CKD - ANSWERno
is routine use of renal specific formula necessary in pt w AKI - ANSWERno
would a patieNt w high lytes benefit from renal specific formula - ANSWERmaybe
what formula is recommended for patients w acute respiratory failure -
ANSWERconcentrated formula
because the presence of fluid overload, pulmonary edema, and renal failure are
associated w poor clinical outcomes
,what disease states/clinical conditions might benefit from a concentrated formula -
ANSWERacute respiratory failure, liver failure, heart failure, hypervolemic
hypernatremia
what is HMB - ANSWERbeta hydroxy beta methyl butyrate is a metabolite of BCAA
leucine that promotes anabolism and increases protein synthesis, therefore, promoting
LBM accrual
what products marketed for wound healing and muscle repair contain HMB -
ANSWERensure
juven
argainaid
what macro/micronutrients improve wound healing (10) - ANSWERenergy
protein
omega 3
glutamine
arginine
zinc
selenium
vit ACE
what nutrition intervention is recommended for pressure ulcers - ANSWERhigh protein
with adequate vitamin A and zinc
ASPEN critical care calorie recs - ANSWERBMI <25 = 25-30 kcal/kg
BMI 25-29.9 = 20-25
BMI 30-50 = 11-14
BMI >50 = 22-25 kcal/kg IBW
ASPEN critical care protein recs - ANSWERBMI <25 = 1.2-2
BMI 25-29.9 = 1.2-2
BMI 30-50 = >2 IBW
BMI >50 = >2.5 IBW
the ASPEN standards state that EN should be initiated within ____ hrs of ICU
admission - ANSWER24-48
what should the goal for energy provision be for obese patients - ANSWER65-70%
how should modulars be administered w TF - ANSWERw separate flush via tube
hang time for closed system/ready to hang - ANSWER24-48 hr
hang time for open system/ready to feed - ANSWER4-12 hr
, hang time for powdered formula that must be reconstituted - ANSWER<4 hr
hang time for human breast milk - ANSWER4 hours
how long should short term enteral access be in place - ANSWER<4-6 wks
ng/nj feeling tube material - ANSWERpolyurethane; less comfortable, more stiff, thin
percutaneous feeding tube material - ANSWERsilicone; more comfortable, less stiff,
and thicker
surgical jejunostomy tube and catheter material - ANSWERrubber
how many ports can a nasoenteric feeding tube have. what are ports used for -
ANSWERcan have 1 or 2 ports, both compatible w syringes or a feeding set. used for
meds and feeds and or irrigation
if a polyurethane tube and a silicone tube have the same outer diameter, which will
have a larger internal diameter - ANSWERpolyurethane
what are percutaneous enterostomy internal retention bolsters made of - ANSWERsolid
material (silicone or polyurethane)
or silicone balloons
what internal bolster is most commonly used for initial percutaneous enterostomy
placement that is done laparoscopically - ANSWERsolid d/t greater longevity
what internal bolster is most commonly used for radiologic and surgical tube placement
as well as a replacement device - ANSWERballoon type d/t ease of placement
what is the lifespan of a balloon internal bolster - ANSWER4-6 months
what internal bolster is preferred for direct jejunal placement - ANSWERnon-balloon
tube to avoid occluding the narrow lumen
how many ports are present for an internal bolster tube - ANSWER3- one for food,
meds or irrigation, balloon inflation
when are low profile tubes used - ANSWERfor better cosmetic appearance, active
patients, stomach sleepers, those who only require intermittent therapy
what is the gold standard for NG/NJ confirmation placement - ANSWERplain abdominal
or chest radiography
what determines french size - ANSWERexternal diameter
