ASPEN Self-Study CNSC

ASPEN Self-Study CNSC Modular products are used to enhance the nutrient profile of a feeding regimen. Which of the following combinations represents modular products? 1. Safflower oil, protein, glucose and selenium 2. Glucose, glutamine, water and MCT oil 3. Protein, cholecalciferol, fiber and safflower oil 4. MCT oil, glucose, fiber and protein - 4. MCT oil, glucose, fiber and protein Protein powders, carbohydrate powders, fat emulsion, MCT oil, fiber and specific amino acids are examples of what? - Modular products Early initiation of enteral feeding has been suggested to benefit ICU patients by reducing infectious complications, length of hospital stay and even possibly reducing mortality. Which group of patients might be at significant risk from early enteral feeding? 1. Cancer patients who underwent surgery of the GIT 2. Patients with increasing vasopressor support 3. TBI patients with intracranial pressure controlled by hypertonic saline 4. Patients admitted to the hospital with acute on chronic pancreatitis - 2. Patients with increasing vasopressor support What is the risk of feeding a patient before hemodynamic stability has been achieved? - May increase the risk of intestinal ischemia as blood perfusion of the gut may be compromised in a patient who is still requiring high doses of vasopressor drugs to maintain blood pressure When should EN be initiated in the hemodynamically unstable patient? - EN should be delayed until fluid resuscitation is complete A patient with acute respiratory distress syndrome (ARDS) may benefit from a feeding formula containing supplemental 1. arginine 2. glutamine 3. nucleic acids 4. omega-3 fatty acids - 4. omega-3 fatty acids Define ARDS. - Acute respiratory distress syndrome - inflammatory response leading to diffuse alveolar damage and lung capillary endothelial injury. Why are formulas containing omega-3 fatty acids recommended in ALI and ARDS? - Inflammatory mediators, including prostaglandins and leukotrienes derived from arachidonic acid metabolism have been implicated in both ALI and ARDS. Formulas containing omega-3 fatty acids may down regulate the inflammatory response through the production of less inflammatory prostaglnadins and leukotrienes What is the evidence for use of omega-3 fatty acids in ARDS and ALI? - Based on 3 level 1 studies the Guidelines for the Provision and Assessment of Nutrition Support Therapy in the Adult Critically Ill Patient in 2009 recommended patients with ARDS and severe ALI be placed on an enteral formulation characterized by an anti-inflammatory lipid profile. Subsequent to the publication of those guidelines and recommendations have been studies published in 2011 showing that enteral supplementation of omega-3 fatty acids did not result in improved biomarkers of inflammation or clinical outcomes The use of enteral nutrition formulas enriched with BCAAs is best used for patients with: 1. cirrhosis 2. hepatic failure 3. liver transplantation 4. refractory encephalopathy - 4. refractory encephalopathy What is the theory behind use of BCAAs in hepatic encephalopathy? - There is believed to be an increased ratio of aromatic amino acids to BCAAs in patients experiencing hepatic encephalopathy. The decrease in BCAA is suspected to be due to an increased breakdown in BCAA from skeletal muscles and utilization.