Cnsc - Pn Primer

Front 1

PN usually delivered into where?

Back 1

superior vena cava
(it's high flow - adjacent to R atrium)

Front 2

peripheral PN usually delivered into where?

Back 2

peripheral vein - hand or forearm

Front 3

PN previously known as:

Back 3

hyperalimentation
and
TPN

Front 4

PN indications - 6

Back 4

GI tract non functional:
1. diffuse peritonitis
2. Obstruction (unable to bypass)
3. intractable vomiting or diarrhea
4. gut ischemia (sever)
5. inadequate absorption area
6. Ileus

GI tract not accessible.

Nutrient needs are greater than what can be met through GI tract.

Front 5

PN criteria for utilizing PN:

Back 5

1. 7+ days
2. venous access available
3. hemodynamically stable
4. can tolerate necessary fluid

Front 6

% concentrations for dextrose in PN

Back 6

5% - 70% concentrations

Front 7

Alternate source of CHO in PN:

Back 7

glycerol (glycerin). A sugar alcohol.

kcal/g?

Hint 7

4.3 kcal/g

Front 8

When is glycerol used as CHO source?

Back 8

in pre mixed PPN formulations

Front 9

Protein source in PN:

Back 9

crystalline aa

Front 10

% concentrations of aa in PN?

Back 10

8.5 - 20%.

What is standard?

Hint 10

8.5% or 10%

Front 11

What are the most concentrated % for aa?

Back 11

15% or 20%

Why maybe not used?

Hint 11

may be more costly.

Front 12

Benefit of using more concentrated aa solutions?

Back 12

Good for fluid restricted pts.

Front 13

2 things that can vary in aa concentration variations:

Back 13

acetate and chloride

Front 14

Renal PN protein specialization:

Back 14

essential aa

Front 15

Hepatic specialized PN and protein?

Back 15

high BCAA with low aromatic aa

Front 16

Stress pts specilization and protein in PN?

Back 16

high BCAA with normal aromatic aa

Front 17

Pediatric PN and protein (specialized formulas)

Back 17

amniogram of post breast feeding (~2 hrs post bf baby)

Front 18

fat concentrations

Back 18

10 - 30%

Most common?

Hint 18

20%

Front 19

risk of 30% fat concentration?

Back 19

cannot be infused alone. too concentrated.

Front 20

calories come from what 2 sources in fat?

Back 20

fat and glycerin

Front 21

what allergy be careful of with IV fat?

Back 21

egg allergy

Front 22

how long can you have fat not be in PN for a pt?

Back 22

2-3 wks... then you really n eed to add it.

Front 23

food allergy "precaution" for PN fat?

Back 23

soy... the allergen is in the protein, not the fat. So it's something to be cautious about.

Front 24

How long does fat hang?

Back 24

12 hrs for piggy back (when separate)

24 hrs per day when mixed into the whole thing.

(microbial safety guidelines)

Front 25

What kinds of fat do we have in PN fat?

Back 25

only soybean.

(not the case outside the US)

Front 26

standard trace elements

Back 26

5 standard trace elements:

Zn, Cu, Chromium, Maganese, Selenium

Front 27

Single trace elements available:

Back 27

(it's the standard 5 trace ones + 2 others)

chromium
copper
*iodine
manganese
*molybdenum
selenium
zinc

Front 28

When would you give extra Zinc?

Back 28

diarrhea,
decub ulcers, \
wound healing,
GI fistula closure,
drug therapy (Ampho B, Cisplatin, Diuretics)

How much Zn would you give?

Hint 28

Extra 4 - 30 mg/day

Front 29

what vitamin is sometimes not included in PN?

Back 29

vit K

Front 30

divalent cation:

Back 30

Zinc

Front 31

What nutrient can't you add to fat or TNA?

Back 31

iron...

b/c it destabilizes the fat.

Front 32

What to know about glutamine and PN?

Back 32

unstable in solution.

4-6 wk shelf life.
high risk, high cost

Dosage?

Hint 32

0.2 - 0.6 g/kg
(usually less than 40 g/d)

Front 33

2 random things that can be added to PN?

Back 33

cysteine and carnitine

Front 34

what about sodium ferric gluconate in PN?

Back 34

no data.
(usually can't add iron to fat containing PNs)

Front 35

Iron sucrose in PN?

Back 35

Seems to be stable if:
0.25 mg/dL or less.

When it's in what?

Hint 35

2 in 1 neonatal aa w/ cysteine.

Front 36

Filter sizes used

Back 36

0.2 micron for 2 in 1 (dex + aa)
1.2 micron for fat or TNA

Front 37

Benefits of doing 2 in1 w/ piggyback?

Back 37

better stability an compatibility
improved visual inspection

Front 38

Benefits of doing TNA

Back 38

Decreased nsg time
Decrease touch contamination
Easier administration for home pt
Better fat utilization

Front 39

Osmolarity limits for PPN

Back 39

600 - 900 mOsm/L

Front 40

How long for PPN?

Back 40

3-7 days

Front 41

Risks of PPN?

Back 41

1. thrombophlebitis risk
2. requires more fluids to meet nutr needs
3. Not ok if organ dysfunction present (RF or CHF)

Front 42

CPN stands for

Back 42

central parenteral nutrition.

Front 43

Central PN length of time?

Back 43

days - months

Front 44

Central PN entry options:

Back 44

PICC, Port, Hickman

Front 45

Heparin and PN

Back 45

may not be stable in PN

Front 46

Osmolarity in Central PN:

Back 46

rapidly diluted on infusion

Front 47

highest osmolarity of macronutrients?

Back 47

amino acids.

What is osmolarity for each macro?

Hint 47

aa: 1 g = 10 mOsm
dex: 1 g = 5 mOsm
fat: 1 g ~ 0.71 mOsm

Front 48

Osmolarity of Calcium gluconate, Mg sulfate, K and Na salts.

Back 48

Mg sulfate: 1

Caclium gluconate: 1 mEq = 1.4 mOsm

K and Na salts: 1 mEq = 2 mOsm

Front 49

glucose amount start max for general hospital pts

Back 49

150 - 200 mg/d

Front 50

Glucose amount start max for DM or stresshyperglycemia pts

Back 50

100 - 150 g/d

Front 51

___ g/kg/day
glucose rec per safe practice guidelines

Back 51

7

Front 52

Increase dextrose/PN to goal, when blood glu is less than:

Back 52

<180 mg/dL

Front 53

GIR:

Back 53

3-5 mg/kg/min

Front 54

Don't exceed this limit in fat:

Back 54

2.5 g/kg/d