When preparing a patient for home enteral nutrition therapy, initial written discharge information should include all of the following EXCEPT:
1: Type and location of feeding tube.
2: Name of formula and daily volume.
3: Volume, frequency of administration, times for tube flushes.
4: Daily p...
When preparing a patient for home enteral nutrition therapy, initial written discharge information should
include all of the following EXCEPT:
1: Type and location of feeding tube.
2: Name of formula and daily volume.
3: Volume, frequency of administration, times for tube flushes.
4: Daily protein content of the formula. correct answers4 Detailed information and recommendations
provided to home care agencies allow for continuation of patient education in the home, set monitoring
and troubleshooting parameters, and expedite the claim process. The daily protein content of the
formula, although useful, is not required. At a minimum, the following information should be provided:
site, brand and external length of feeding tube, formula type and concentration, total daily formula
volume, method and rate of administration, feeding frequency schedule (times), volume and times of
tube flushes, dose and time of medications, and guidelines for oral intake.
A long-term home enteral patient suddenly develops nausea and vomiting. Possible causes include all of
the following EXCEPT:
1: Gastric outlet obstruction.
2: Decrease in feeding rate or volume.
3: Rapid administration of bolus feeds.
4: Gastroparesis. correct answers2 Causes of nausea and vomiting in the enterally fed patient may
include: too rapid a rate of bolus infusion, gastric outlet obstruction caused by feeding tube migration,
excessive feeding volume, and gastroparesis. Gastric irritation or atony, distal obstruction, anxiety, other
diseases, and medication may also cause these symptoms. Nausea and/or vomiting may be prevented or
resolved by decreasing the rate or volume of enteral infusion.
The clinical manifestations of copper deficiency can be similar to what other micronutrient deficiency?
1: Vitamin B12
2: Manganese
,3: Vitamin E
4: Zinc correct answers1 Assessing micronutrient status in long-term home parenteral nutrition
consumers is challenging, requiring astute symptom observation. This may be complicated when one
deficiency mimics another. Clinical manifestations of copper deficiency include pancytopenia as well as
neurological deterioration with sensory ataxia, lower limb spasticity, and acral parethesias. These
neurological presentations are also associated with vitamin B12 deficiency.
Which of the following is true concerning manganese and long-term parenteral nutrition patients?
1: Manganese deficiency occurs with prolonged parenteral nutrition infusion
2: Hypermanganesemia has been reported only in patients with cholestasis
3: Manganese contamination in commercial trace element preparations may result in
hypermanganesemia
4: The best indicator of manganese status is serum manganese correct answers3 The AMA-NAG
recommendation for manganese in parenteral nutrition solutions for adults is 60-100 mcg/d. However,
over recent years there have been several reports of hypermanganesemia in patients on long-term
parenteral nutrition infusion who were receiving the AMA-NAG recommendations. Hypermanganesemia
and deposition of manganese in the brain have been reported in patients with and without cholestasis.
An article by Berger & Shenkin states that since manganese is a contaminant of parenteral nutrition
solutions, ideally there should be a manganese-limited trace element preparation for patients without
cholestasis and a manganese-free trace element preparation for patients with cholestasis. The best
indicator of manganese status is manganese superoxide dismutase on mononuclear cells. There is
relatively little risk of manganese deficiency for long-term parenteral nutrition patients.
Which of the following is the best way to determine chromium deficiency?
1: Serum chromium levels
2: Empiric treatment when deficiency suspected
3: Urinary chromium levels
4: Serum glucose to insulin ratio correct answers2 Treating patients with hyperglycemia with chromium
supplementation and watching for resolution of symptoms empirically is the best way to determine if the
patient was chromium deficient. There are no known reliable indicators of chromium status
Which of the following is true concerning zinc status in long-term parenteral nutrition patients?
, 1: Serum zinc is a reliable indicator of zinc status
2: Parenteral doses of 50 mg/d have been proven safe
3: Parenteral zinc interferes with copper bioavailability
4: Zinc deficiency is the most common suspected trace element abnormality correct answers4 Most
patients who require long-term parenteral nutrition have a dysfunctional GI tract that can contribute to
increased GI losses. These GI losses can increase zinc losses and thus increase zinc requirements.
Therefore, it is not surprising that zinc is the most commonly suspected trace element abnormality in
long-term parenteral nutrition patients. Serum zinc is not a reliable indicator of zinc status. It can be
within normal limits, and the patient may be in negative zinc status. Parenteral zinc doses 30 mg and
greater have been shown to produce adverse effects and toxicity. The interaction between zinc and
copper occurs when taken through the GI tract, not when infused intravenously.
Which of the following is true concerning the risk of aluminum toxicity from long-term parenteral
nutrition?
1: The amount on the manufacturer's label is greater than measured amounts
2: Each parenteral nutrition bag must provide the amount of aluminum per liter
3: The clinical manifestations of aluminum toxicity are specific and sensitive
4: Aluminum toxicity is the primary etiology of metabolic bone disease correct answers1 Manufacturer's
of large volume, small volume, and pharmacy bulk packages of components for parenteral nutrition must
label each with the amount of aluminum anticipated to be in the product when the product expires. The
amount on the label has been shown to be approximately 10 times more than what was actually
measured in a bag prepared according to a patient's prescription. Pharmacies are not required to list the
aluminum content on each patient's parenteral nutrition bag. The clinical manifestations of aluminum
toxicity (neurological, hepatic, hematologic, and skeletal) are neither specific nor sensitive for aluminum
toxicity alone. The etiology of metabolic bone disease is multifactorial. Aluminum toxicity is only one of
many potential contributors.
Which of the following is the most practical approach for managing micronutrients in long-term
parenteral nutrition patients?
1: Obtain serum values for all vitamins and trace elements yearly
2: Perform a micronutrient assessment every 6 months
3: Provide micronutrients only when laboratory values indicate declining levels
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