The following statement(s) characterize recent changes in the ICU pop’n
D – all of the above
In addition to an elevated HR ( >90 bpm), clinical s/s of systemic inflammatory response syndrome (SIRS) include all of the following except
D – urinary WBC >1000/dL
Sepsis definition
Characterized by fever, leukocytosis or leucopenia, elevated cardiac output w/ reduced systemic vascular resistance in presence of severe infection. Pro-inflammatory and anti-inflammatory mediators are present in sepsis, working to rid the body of the foreign antigens. Sepsis can result in multiple organ dysfxn syndrome
s/s of SIRS includes:
·Body temperature less than 36°C or greater than 38°C
·Heart rate greater than 90 beats per minute
·Tachyapnea (high respiratory rate), with greater than 20 breaths per minute; or, an arterial partial pressure of carbon dioxide less than 4.3 kPa (32 mmHg)
·White blood cell count less than 4000 cells/mm³ (4 x 109 cells/L) or greater than 12,000 cells/mm³ (12 x 109 cells/L); or the presence of greater than 10% immature neutrophils (band forms)
In addition to evidence of infection, the following must also be present in order to dx sepsis:
B – 2 or more of the components of SIRS
The first phase of the metabolic response to sepsis, the stress phase, occurring immediately after injury and lasting 24-48 hours is characterized by
B - Hemodynamic instability, hypo metabolism, hypo catabolism
Which of the following has not been proposed to reduce the risk of ON associated liver dz?
D – Infuse PN over 24 hours
Initiation of enteral nutrition within 24/48 hours of injury or admission to the ICU can impact
B – Infectious complications
Postpyloric enteral feedings should be considered for
A – All critically ill pts
B – pts w/ gastric residuals >150 mL
C – pt who require prolonged supine positioning
D – all trauma pt w/ head injury
C – pt who require prolonged supine positioning
The acute phase responses is associated w/ providing in all of the following benefits except:
A – enhances antimicrobial and antioxidant activity
b- fosters wound healing/removes damaged tissue
c – maintain fluid balance
d – provides fuel and substrate
c – maintain fluid balance
The catabolic phase ensues after the following stress phase and usually lasts 7-10d, and is characterized by:
A – fever, hypercatabolism, increases lipolysis
the anabolic phase can last up to several months after the catabolic phase of injury and is characterized by all of the following except:
D – hypometabolism
If SIRS continues unabated, the potential exists for this serious and immunosuppressive condition
B – counter anti-inflammatory response syndromes (CARS)
Hyperglycemia d/t insulin deficiency is observed w/ all of the following conditions except:
B – excessive glycogenesis
hyperglycemia d/t insulin resistance is observed w/:
D – all of the above, + uremia, catecholamine infusion, cirrhosis
Besides its role in decreasing glc, insulin may offer benefits as a:
D – potent anti-inflammatory agent
The following statement (s) describes the utilization of hospital resources by persons with DM:
D – all of the above
Improved glycemic control has been shown to offer benefits in the following pop’ns
D – all of the above
According to consensus of recommendations from the American college of Endo, the goal glc level for ICU pts should be (in mg/dL)
B – 110
In a landmark study comparing conventional glc control to intensive glc control, the pts in the intensively controlled glc group
D – all of the above
Parenteral dextrose infusion should not exceed this threshold in adults (in mg/kg/min)
B – 7
Calculate the dextrose infusion rate for a 70 kg pt receiving PN containing 15% dextrose at 100 mL/hr (in mg/kg/min)
A – 3.6
To calculate mg/kg/min
1.take % PN solution delivery and multiple by length of time 9i.e. 24 hours)
2.multiple total delivery x % dextrose
3.Multiple that number by 1000 mg/ 1 gram
4.Divide by kg wt of pt
5.Divide by 24 hours
In preventing and treating hyperglycemia in a pt receiving PN, all of the following are true except
A – macronutrient provision should always be increased to goal as quickly as possible
In the setting of critical illness such as sepsis, the following statements are true:
C – endogenous glc production will not be suppressed by aggressive nutrition support
The following statement(s) describe hypocaloric feeding
B – total kcal delivery is less than measured or estimated with generous protein provision (1.5 g/kg)
In the setting of this condition(s), short term hypocaloric nutrition support may offer some benefit
D – all of the above
For pts w/ acute long injury or adult respiratory distress syndrome, supplementation with EPA, gamma-linolenic acid, and antioxidants may provide the following benefit(s)
D – all of the above
The following scoring scale is used to predict risk-adjusted mortality in ICU pts using components such as temp, HR, age, Glasgow coma scale
B – apache II
In which phase(s) of sepsis should hypocaloric feeding (~20 kcal/kg w/ 1.5 – 2 g pro/kg) be considered
B – catabolic phase
In interpreting serum protein, ___ is a negative acute phase reactant; ___ is a positive acute phase reactant.
B – prealb, CRP
Negative acute phase reactants
Assimilated during non-stressed times
Prealb, albumin, transferring, retinol binding protein
Positive acute phase reactants
Elevated in times of stress
Haptoglobulin, CRP, ceruloplasmin, fibrinogen
Anabolism would be indicated by the increase of ____ and the decrease and subsequent normalization of _________
D – CRP, prealb
B – prealb, CRP
All of the following statements describe gln except for
C – it is an essential AA
The following describes gln supplementation in critical illness:
C – parenterally administered gln may be most beneficial
All of the following describe the benefits of n-3 FA except for:
D - n-3 FA stimulate increased cytokine production
Arginine is important in times of severe stress b/c:
D – all of the above
The following statement is true re: supplementation of arginine in septic pts
D – none of the above
B – arginine supplementation may be harmful in the septic population
Regarding the supplementation of antioxidants in times of stress and injury
D – all of the above
Research on immune enhancing formulas in stress, sepsis and critical injury has demonstrated
C – no clear consensus or recommendation for the provision of immune enhancing nutrients
