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22 Cards in this Set
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fluid requirements per day for patient on TPN?
increase if decrease if |
1500mg + 20 x (wt in kg-20)
~30 mLs per day increase if fistula, fever, diarrhea, NG suction decrease if CHF, renal failure, cirrhotic ascites |
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calorie requirement for patient on TPN?
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30 kcal/kg/day of IBW
~75% from carbs ~25% from lipids anhydrous carbs are 4kcal/gram; however, when hydrated only account 3.4kcal/gram |
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What is the name of a standart commercial form of IV lipid?
uses EFAD FIlter Liposyn II - Labs? |
Intralipid, Liposyn, Nutrilipid
Uses - TPN EFAD - Essential Fatty Acid Deficiency Filter 1.2 micron filter for lipids to avoid clogging Lipsoyn II - steril non-pyrogenic fat emulsion. 10% saffleower oil, 10% soybean oil, 1.2% egg phosphatides and 2.5% glycerin; sodium hydroxide to adjust PH Labs - hemogram, blood coagulation, LFT, platelet count and plasma lipid profile |
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TPN administration
Peripheral Vein maximum glucose concentation? maximum hypertonicity? Central vein Stantard glucose conc? Max? |
Peripheral TPN administration
max glucose is 10-12.5% max hypertonicity is 10% Central vien usually 20% glucose standard; can go up to 40% if pt fluid restricted |
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what are the protein requirements for TPN in adults?
What is the nitrogen content in amino acids? What is the target ratio of non-protein calories to grams of nitrogen? |
1-1.5 gm/kg/day
0.8 gm/kg/day for normal 1.0 gm/kg/day if hospitalized, minor stress 1.5 gm/kg/day if moderate to major trauma 2.0 gm/kg/day if sever burns, trauma amino acids are 16% nitrogen target ration of nonprotein calories to grams of nitrogen is 150:1 |
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What is the best way to mix a phosphate and calcium.
if precipatates occur what usually happens? |
1. agitate solution during compounding process
2. ALWAYS add Ca last to make sure the solution is as diluted as possible 3. use an in-line filter can lead to crystalization and pulmonary embolism and death |
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Incompatabilities in TPN
Iron, why? Ways to avoid? |
IRON
they can crack the emulsion ways to avoid 1. separate, short infusion while PN is NOT hanging 2 add 25-100 mg of iron 3x week to PN solution with lipid omitted |
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What vitamin is omitted from TPN?
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vitamin K
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What is special about pts with pulmonary disease?
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avoid excess carbs because this can lead to an increase in CO2
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TPN for diabetics
insulin? trace elements? |
insulin can be added
trace elements: copper, mag, Zn, chrominum, selenium, molybdenum, idoine, iron can be added if renally impaired may need to omit chromium, selenium and molybdenum |
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Name 4 drugs commonly added to TPN?
What is their purpose? |
Heparin - DVT proph
Cemetidine - Ulcer proph Insulin - Control glucose Ranitidine - ulcer proph and simplify cluid and electrolye changes by decreased Cl content of gastric secretions |
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What needs to be done for pts with renal failure?
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minimize volume
minimize protein correct electrolyte imbalances use low nitrogen, high calorie density formula (eg. 2% amino acids/47% carbs NPC:N ratio 500:1) |
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What needs to be done for pts with hepatic failure?
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due to a change in liver metabolism, we have decreased serum levels of branced chain ammio acids and increased levels of aromatic amino acids
enrich TPN with branched-chain amino acids (36%) and give low aromatic amino acids |
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What needs to be done for ARDS (acute respiratory distress syndrome) pts?
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avoid over feeding; this can lead to lipogenesis, increased CO2 and respiratory acidosis
suggest 4.5% aa/ 15% dextrose/ with lipid emulsion where lipid component constitutes 40-50% of total NPC |
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What needs to be done for cardiac failure pts?
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restrict fluids and sodium
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What needs to be done for pancreatits?
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TPN to give pancreas a break
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What needs to be done for stress/critial care?
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enrich with branch chain amino acids
monitor hyperglycemia |
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What needs to be done for stress/crital care with thermal injury
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increase kcal by (25 x body surface area burned)
protein requirements 2-2.5 kcal/kg |
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What needs to be done for pregnant women?
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daily protein - 1 kcal/kg
weight gain of 11.5-16 kg monitor serum glucose |
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What needs to be done for IBS?
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PN has no role as primary therapy
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What needs to be done for SBS (short bowel syndrome)
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TPN is used until normal bowel function returns
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Whats important to do for bariatric surgery patients?
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watch for malnutrition and make sure all vits and minerals are supplemented
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