ACNP I Midterm Exam with Complete
Solutions
Nutrition Assessment Correct Ans-• Determine: trouble chew/swallow
• Weight history
• Skin integrity
• Edema present
• Electrolyte abnormality
• Hand grip strength
nutrition for Patients in
Hepatic Failure Correct Ans-• No protein
restriction in
hepatic
encephalopathy
Nutrition for Patients in Pulmonary Failure Correct Ans-• Monitor phosphorus
• 30% of ICU patients have
hypophosphatemia
• Energy dense formula 1.5-2 kcal/ml
• Decreases amount of extra fluid
,nutrition for Patients in Renal Failure Correct Ans-Electrolyte restricted
• HD/CRRT increases protein
requirement
• 10-15 gm protein per day is lost in
CRRT
nutrition for Patients with
Acute
Pancreatitis Correct Ans-• Mild- oral diet
• Moderate to Severe
• Trophic feeds via enteral
• No need for post pyloric
• However if intolerance is noted,
may try post pyloric
• Consider use of probiotic
nutrition for Patients with Sepsis Correct Ans-• GI dysfunction in septic
shock/severe sepsis is thought to
be as high as 60% of patiens
• Do not use Parental support even
if Enteral support is not able to be
advanced to >60% of needs in
,the acute phase of severe sepsis
or septic shock
• Trophic feeds in the initial phase of
sepsis : 10-20 kcal /hr or up to 500
kcal per day
• Advance to >80% of needs by the
first week
nutrition for Surgical Patients Correct Ans-• Trauma
• Feed within 24-48 hours after
resuscitation
• Consider immune modulating
formulas containing arginine,
glutamine, EPA, and DHA
• Open abdomen
• Should be initiated within 24-48
hours in the absence of bowel
injury
• Suggest addition of 15-30 gm
protein for every liter of exudate
lost from abdomen
• Burns
, • Goal of initiation of enteral support
within 4-6 hours
Nutritional Screen Correct Ans-• Identify malnourished
• Complete within 24 hours
• Communicate to Registered Dietician (RD)
Other Tests to Consider for AMS Correct Ans-•Ammonia (NH3)
•VDRL/RPR
•R/o syphilis
•Vitamin B12
•Folate
•Tests for specific toxic ingestions, if indicated
•Acetaminophen
•Salicylic acid
•And many others
•CT head
•MRI head
•EEG
•Lumbar puncture
Parenteral iron therapy Correct Ans-• Use
Solutions
Nutrition Assessment Correct Ans-• Determine: trouble chew/swallow
• Weight history
• Skin integrity
• Edema present
• Electrolyte abnormality
• Hand grip strength
nutrition for Patients in
Hepatic Failure Correct Ans-• No protein
restriction in
hepatic
encephalopathy
Nutrition for Patients in Pulmonary Failure Correct Ans-• Monitor phosphorus
• 30% of ICU patients have
hypophosphatemia
• Energy dense formula 1.5-2 kcal/ml
• Decreases amount of extra fluid
,nutrition for Patients in Renal Failure Correct Ans-Electrolyte restricted
• HD/CRRT increases protein
requirement
• 10-15 gm protein per day is lost in
CRRT
nutrition for Patients with
Acute
Pancreatitis Correct Ans-• Mild- oral diet
• Moderate to Severe
• Trophic feeds via enteral
• No need for post pyloric
• However if intolerance is noted,
may try post pyloric
• Consider use of probiotic
nutrition for Patients with Sepsis Correct Ans-• GI dysfunction in septic
shock/severe sepsis is thought to
be as high as 60% of patiens
• Do not use Parental support even
if Enteral support is not able to be
advanced to >60% of needs in
,the acute phase of severe sepsis
or septic shock
• Trophic feeds in the initial phase of
sepsis : 10-20 kcal /hr or up to 500
kcal per day
• Advance to >80% of needs by the
first week
nutrition for Surgical Patients Correct Ans-• Trauma
• Feed within 24-48 hours after
resuscitation
• Consider immune modulating
formulas containing arginine,
glutamine, EPA, and DHA
• Open abdomen
• Should be initiated within 24-48
hours in the absence of bowel
injury
• Suggest addition of 15-30 gm
protein for every liter of exudate
lost from abdomen
• Burns
, • Goal of initiation of enteral support
within 4-6 hours
Nutritional Screen Correct Ans-• Identify malnourished
• Complete within 24 hours
• Communicate to Registered Dietician (RD)
Other Tests to Consider for AMS Correct Ans-•Ammonia (NH3)
•VDRL/RPR
•R/o syphilis
•Vitamin B12
•Folate
•Tests for specific toxic ingestions, if indicated
•Acetaminophen
•Salicylic acid
•And many others
•CT head
•MRI head
•EEG
•Lumbar puncture
Parenteral iron therapy Correct Ans-• Use
