Which factor is related to the quality of a food protein?

Answer to #1

A

Answer to #2


Although home nutrition support can help to improve health and extend life, users of these services and their families may struggle with the lifestyle adjustments required. In addition to the high costs of nutrition support, home infusions are often time consuming and inconvenient. Activities and work schedules must be planned around feedings. Extra planning is necessary and precautions must be taken when a person wants to travel or participate in sports activities. Explaining one's medical needs to friends and acquaintances may be embarrassing. Among physical difficulties, people receiving nocturnal feedings often cite disturbed sleep as a major problem. Disruptions may be due to multiple nighttime bathroom visits, noisy infusion pumps, or difficulty finding a comfortable sleeping position when hooked up. People using parenteral support sometimes prefer infusing solutions during the day to improve their sleeping patterns. Among social issues, the inability to consume meals with family and friends is often a great concern. Many individuals miss the enjoyment, comfort, and socialization they previously experienced from food and mealtimes. Joining friends at restaurants and attending certain types of social events may become a source of stress for individuals who cannot consume food.

Answer to #3

A

Answer to #4

Hyperglycemia most often occurs in patients who are glucose intolerant, receiving excessive energy or dextrose, undergoing severe metabolic stress, or receiving corticosteroid medications. It can be prevented by providing insulin along with parenteral solutions, avoiding overfeeding or overly rapid infusion rates, and restricting the amount of dextrose in the solution. Although uncommon, hypoglycemia sometimes occurs when parenteral nutrition is interrupted or discontinued or if excessive insulin is given. In patients at risk, such as young infants, feedings may be tapered off over several hours before discontinuation. Another option is to infuse a dextrose solution at the same time that parenteral nutrition is interrupted or stopped. Hypertriglyceridemia may result from dextrose overfeeding or overly rapid infusions of lipid emulsion. Patients at risk include those with severe infection, liver disease, kidney failure, or hyperglycemia and those using immunosuppressant or corticosteroid medications. If blood triglyceride levels exceed 400 milligrams per deciliter, lipid infusions should be reduced or stopped.

Answer to #5

C

Answer to #6


Severely malnourished patients who are aggressively fed may develop refeeding syndrome, characterized by fluid and electrolyte imbalances and hyperglycemia. These effects occur because dextrose infusions raise levels of circulating insulin, which promotes anabolic processes that quickly remove phosphate, potassium, and magnesium from the blood. The altered electrolyte levels can lead to fluid retention and life-threatening changes in various organ systems. Heart failure and respiratory failure are possible consequences. Refeeding syndrome generally develops within 2 weeks of beginning parenteral infusions. The patients at highest risk are those who have experienced chronic malnutrition or substantial weight loss. Symptoms include edema, cardiac arrhythmias, muscle weakness, and fatigue. To prevent refeeding syndrome, health practitioners may provide only half of the patient's energy requirement when they initiate nutrition support and gradually advance the dose over several days while monitoring (and possibly correcting) electrolyte levels.

Answer to #7

A

Answer to #8

In peripheral parenteral nutrition, nutrients are delivered using only the peripheral veins. The peripheral veins can be damaged by overly concentrated solutions, though. To prevent complications, the osmolarity of PPN is kept below 900 milliosmoles per liter, a concentration that limits the amounts of energy and protein the solution can provide. PPN is most often used in patients who require short-term nutrition support and who do not have high nutrient needs or fluid restrictions. Most patients meet their nutrient needs using the larger, central veins, where blood volume is greater and nutrient concentrations do not need to be limited. This method can reliably provide all of a person's nutrient requirements and therefore is called total parenteral nutrition (TPN). Because the central veins carry a large volume of blood, the parenteral solutions are rapidly diluted; thus, patients with high nutrient needs or fluid restrictions can receive the nutrient-dense solutions they require. TPN is also preferred for patients who require long-term parenteral nutrition.

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