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Chapter 10. Surgical Metabolism & Nutrition

Which of the following is not an indicator of malnutrition?

A. Unintentional weight loss.

B. Prolonged inadequate energy intake.

C. Albumin.

D. Fat wasting.

The correct answer is C. Albumin. Albumin is a poor indicator of nutrition status, as it is a negative acute-phase protein and may be low because of an underlying inflammatory process. Albumin is also sensitive to volume status and may be inaccurate because of dehydration or volume overload. The 2012 Academy of Nutrition and Dietetics/ASPEN clinical characteristics to identify malnutrition in adults specifically do not use circulating proteins because of these issues. Unintentional weight loss, prolonged inadequate energy intake, and fat wasting (as well as muscle wasting, presence of edema, and reduced functional status) are all more reliable markers of malnutrition.

Which of the following stressors results in the greatest increase in energy expenditure above basal metabolic needs?

A. Sepsis.

B. Trauma.

C. Elective operations.

D. Burns.

The correct answer is D. Burns. Energy requirements above basal needs are approximately 10% for elective operations, 10% to 30% for trauma, 50% to 80% for sepsis, and 100% to 200% for burns. Burns covering more than 40% total body surface area (TBSA) are typically followed by a period of severe stress, characterized by an exaggerated catabolic state. Increases in catecholamine, glucocorticoid, glucagon, and dopamine secretion are thought to initiate the cascade of events leading to the acute hypermetabolic response with its ensuing catabolic state. Appropriate nutrient delivery can be accomplished by feeding 1.2 to 1.4 times the measured resting energy expenditures (REEs).

Which of the following is true?

A. Gastric residuals should routinely be checked when administering tube feeds, as this has been shown to reduce aspiration risk.

B. Gastric residuals of 100 mL should prompt holding of tube feeds.

C. When gastric residuals are checked, tube feeds should only be held if the residual volume is greater than 500 mL.

D. Enteral nutrition carries a technical complication rate of 10%.

The correct answer is C. When gastric residuals are checked, tube feeds should only be held if the residual volume is greater than 500 mL. A major change in monitoring tolerance to EN is the approach to monitoring gastric residual volumes ...

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