RD CDR (MNT) EXAM STUDY
QUESTIONS AND ANSWERS RATED A.
Elemental/Semi elemental formulas?
Macronutrients hydrolyzed for max absorption
Intended for pts with malabsorptive disorders
Enteral delivery should not excess 60-70% total daily needs
Ex: Peptamen, Vital AF, Vivonex
Renal formulas?
Fluid restricted with lower conc of electrolytes
Protein content varies
Used until electrolyte imbalance is resolves then switch back to standard formula
Ex: Nepro, Novasource; Suplena and Renalcal for CKD stages 3-4 pts with no dialysis
Immune modulating formulas?
Beneficial for those undergoing elective surgery
Ex: Oxepa, Nutren pulmonary, Tolerex, Perative, Pivot 1.5, Impact
Hepatic formulas?
Lower protein formulas with high% BCAAs and low% aromatic AA's to prevent
hepatic encephalopathy.
Fluid and sodium restriction (ascites)
Difficult to meet protein needs
Should use formula if antibiotics and lactulose dont improve encephalopathy
Ex: Nutrihep
What are the components of bariatric formulas?
Higher in protein to maintain nitrogen balance
Carb load modest of glucose control
,EPA/DHA to modulate inflammatory response
For pts with BMI>30
What should be the initiation rate for EN?
10 to 20 ml/hr then increase q 8 h
What is the protocol for weaning TPN or EN?
reduce to 1/2 goal rate
TPN can be reduced by 1/2 of goal or to less than 24 hr infusion time
EN can be cycled to 12 hr nighttime cycle to encourage appetite during day
What are Ebb and flow phases?
ebb is immediately after injury
flow is following fluid resuscitation and restoration of oxygen transport
What are the characteristics of the ebb phase?
hypovolemic shock
decreased tissue perfusion
decreased metabolic rate
decreased O2 consumption
decreased blood pressure
decreased body temp
What are the characteristics of the acute response flow phase?
catabolism predominates
increased: glycocorticoids, glucagon, catecholamines, release of cytokines, lipid
mediators, production of acute phase proteins, excretion of nitrogen, metabolic rate,
O2 consumption, impaired utilization of fuels
What are the characteristics of the adaptive response flow phase?
anabolism predominates
hormonal response gradually diminishes
decreased hypermetabolic rate
, associated with recovery, potential for restoration of body protein
wound healing depends in part on nutrient intake
What are the nutritional needs of a metabolically stressed patient?
more severe the injury, greater release of catecholamines and cortisol
Decreased serum levels of B vits, Vit C and zinc
nutrition support needed to maintain lean body mass and immunosuppression
energy needs up to 40% greater than normal
protein needs: 1.5-2.2 g/kg
What are the energy needs for burn patients? What is the Curreri formula?
Curreri formula
(25 X body weight (kg) + 40 X % BSA burned)
20-30% increase in needs
25-30 kcal/kg
TBSA >50% have minimal increased in energy expenditure
TBSA <20% oral intake of high cal/protein foods
Protein and nutrient needs for burn patients?
Pro: 1.5-2 g/kg
Vits and minerals: Daily MVI, Vit C: 500 mg/d, Vit A: 10000 IU/d
Arginine and glutamine
Nutritional needs for spinal trauma pts?
once stabilized, pts are hypometabolic; lower energy needs
Paraplegia- 10-15 lb less than IBW--> 28 kcal/kg
quadraplegia- 15-20 lb less than IBW--> 23 kcal/kg
Pro: Following acute injury: 2 g/kg, Maintenance: 0-1 g/kg, if pressure ulcers/infection
present: 1.2-1.5 g/kg
Nutritional needs for SIRS?
Sepsis- documented infection and identifiable organism
SIRS- widespread inflammation that can occur in infection, pancreatitis, trauma,
QUESTIONS AND ANSWERS RATED A.
Elemental/Semi elemental formulas?
Macronutrients hydrolyzed for max absorption
Intended for pts with malabsorptive disorders
Enteral delivery should not excess 60-70% total daily needs
Ex: Peptamen, Vital AF, Vivonex
Renal formulas?
Fluid restricted with lower conc of electrolytes
Protein content varies
Used until electrolyte imbalance is resolves then switch back to standard formula
Ex: Nepro, Novasource; Suplena and Renalcal for CKD stages 3-4 pts with no dialysis
Immune modulating formulas?
Beneficial for those undergoing elective surgery
Ex: Oxepa, Nutren pulmonary, Tolerex, Perative, Pivot 1.5, Impact
Hepatic formulas?
Lower protein formulas with high% BCAAs and low% aromatic AA's to prevent
hepatic encephalopathy.
Fluid and sodium restriction (ascites)
Difficult to meet protein needs
Should use formula if antibiotics and lactulose dont improve encephalopathy
Ex: Nutrihep
What are the components of bariatric formulas?
Higher in protein to maintain nitrogen balance
Carb load modest of glucose control
,EPA/DHA to modulate inflammatory response
For pts with BMI>30
What should be the initiation rate for EN?
10 to 20 ml/hr then increase q 8 h
What is the protocol for weaning TPN or EN?
reduce to 1/2 goal rate
TPN can be reduced by 1/2 of goal or to less than 24 hr infusion time
EN can be cycled to 12 hr nighttime cycle to encourage appetite during day
What are Ebb and flow phases?
ebb is immediately after injury
flow is following fluid resuscitation and restoration of oxygen transport
What are the characteristics of the ebb phase?
hypovolemic shock
decreased tissue perfusion
decreased metabolic rate
decreased O2 consumption
decreased blood pressure
decreased body temp
What are the characteristics of the acute response flow phase?
catabolism predominates
increased: glycocorticoids, glucagon, catecholamines, release of cytokines, lipid
mediators, production of acute phase proteins, excretion of nitrogen, metabolic rate,
O2 consumption, impaired utilization of fuels
What are the characteristics of the adaptive response flow phase?
anabolism predominates
hormonal response gradually diminishes
decreased hypermetabolic rate
, associated with recovery, potential for restoration of body protein
wound healing depends in part on nutrient intake
What are the nutritional needs of a metabolically stressed patient?
more severe the injury, greater release of catecholamines and cortisol
Decreased serum levels of B vits, Vit C and zinc
nutrition support needed to maintain lean body mass and immunosuppression
energy needs up to 40% greater than normal
protein needs: 1.5-2.2 g/kg
What are the energy needs for burn patients? What is the Curreri formula?
Curreri formula
(25 X body weight (kg) + 40 X % BSA burned)
20-30% increase in needs
25-30 kcal/kg
TBSA >50% have minimal increased in energy expenditure
TBSA <20% oral intake of high cal/protein foods
Protein and nutrient needs for burn patients?
Pro: 1.5-2 g/kg
Vits and minerals: Daily MVI, Vit C: 500 mg/d, Vit A: 10000 IU/d
Arginine and glutamine
Nutritional needs for spinal trauma pts?
once stabilized, pts are hypometabolic; lower energy needs
Paraplegia- 10-15 lb less than IBW--> 28 kcal/kg
quadraplegia- 15-20 lb less than IBW--> 23 kcal/kg
Pro: Following acute injury: 2 g/kg, Maintenance: 0-1 g/kg, if pressure ulcers/infection
present: 1.2-1.5 g/kg
Nutritional needs for SIRS?
Sepsis- documented infection and identifiable organism
SIRS- widespread inflammation that can occur in infection, pancreatitis, trauma,
