nutrition support

  1. The following statement(s) characterize recent changes in the ICU pop’n



    D – all of the above
  2. 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
  3. 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
  4. 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)
  5. In addition to evidence of infection, the following must also be present in order to dx sepsis:



    D – 2 or more of the components of SIRS
  6. The first phase of the metabolic response to sepsis, the stress phase, occurring immediately after injury and lasting 24-48 hours is characterized by



    C - Hemodynamic instability, hypo metabolism, hypo catabolism
  7. Which of the following has not been proposed to reduce the risk of ON associated liver dz?



    D – Infuse PN over 24 hours
  8. Initiation of enteral nutrition within 24/48 hours of injury or admission to the ICU can impact



    D – Infectious complications
  9. 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
  10. 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
  11. The catabolic phase ensues after the following stress phase and usually lasts 7-10d, and is characterized by:



    D – fever, hypercatabolism, increases lipolysis
  12. the anabolic phase can last up to several months after the catabolic phase of injury and is characterized by all of the following except:



    C – hypometabolism
  13. If SIRS continues unabated, the potential exists for this serious and immunosuppressive condition



    A – counter anti-inflammatory response syndromes (CARS)
  14. Hyperglycemia d/t insulin deficiency is observed w/ all of the following conditions except:



    B – excessive glycogenesis
  15. hyperglycemia d/t insulin resistance is observed w/:



    D – all of the above, + uremia, catecholamine infusion, cirrhosis
  16. Besides its role in decreasing glc, insulin may offer benefits as a:



    D – potent anti-inflammatory agent
  17. The following statement (s) describes the utilization of hospital resources by persons with DM:



    D – all of the above
  18. Improved glycemic control has been shown to offer benefits in the following pop’ns



    D – all of the above
  19. According to consensus of recommendations from the American college of Endo, the goal glc level for ICU pts should be (in mg/dL)



    D – 110
  20. 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
  21. Parenteral dextrose infusion should not exceed this threshold in adults (in mg/kg/min)



    C – 7
  22. Calculate the dextrose infusion rate for a 70 kg pt receiving PN containing 15% dextrose at 100 mL/hr (in mg/kg/min)



    B – 3.6
  23. 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
  24. In preventing and treating hyperglycemia in a pt receiving PN, all of the following are true except



    B – macronutrient provision should always be increased to goal as quickly as possible
  25. In the setting of critical illness such as sepsis, the following statements are true:



    D – endogenous glc production will not be suppressed by aggressive nutrition support
  26. The following statement(s) describe hypocaloric feeding



    C – total kcal delivery is less than measured or estimated with generous protein provision (1.5 g/kg)
  27. In the setting of this condition(s), short term hypocaloric nutrition support may offer some benefit



    D – all of the above
  28. 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
  29. 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
  30. In which phase(s) of sepsis should hypocaloric feeding (~20 kcal/kg w/ 1.5 – 2 g pro/kg) be considered



    B – catabolic phase
  31. In interpreting serum protein, ___ is a negative acute phase reactant; ___ is a positive acute phase reactant.



    C – prealb, CRP
  32. Negative acute phase reactants
    • Assimilated during non-stressed times
    • Prealb, albumin, transferring, retinol binding protein
  33. Positive acute phase reactants
    • Elevated in times of stress
    • Haptoglobulin, CRP, ceruloplasmin, fibrinogen
  34. Anabolism would be indicated by the increase of ____ and the decrease and subsequent normalization of _________



    D – CRP, prealb
    B – prealb, CRP
  35. All of the following statements describe gln except for



    B – it is an essential AA
  36. The following describes gln supplementation in critical illness:



    A – parenterally administered gln may be most beneficial
  37. All of the following describe the benefits of n-3 FA except for:



    C - n-3 FA stimulate increased cytokine production
  38. Arginine is important in times of severe stress b/c:



    D – all of the above
  39. 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
  40. Regarding the supplementation of antioxidants in times of stress and injury



    D – all of the above
  41. Research on immune enhancing formulas in stress, sepsis and critical injury has demonstrated



    A – no clear consensus or recommendation for the provision of immune enhancing nutrients
Author
jksrd
ID
140676
Card Set
nutrition support
Description
nutrition support
Updated