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37 Cards in this Set
- Front
- Back
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What EN admin route is used for short term EN feeding? |
nasogastric |
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What EN admin rough is used for long term feeding? |
PEG tube -percutaneous endoscopic gastrostomy tubes |
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What volume of gastric residual volume should EN feeding be discontinued or held? |
250 - 500 ml |
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What promotility agents can be given to facilitate gastric emptying and decrease residual volume? |
erythromycin or metoclopramide |
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How can one determine caloric requirements? |
25-30 kcal/kg/day ex: 60 kg pt 60 kg x 25 kcal/kg/day = 1500 kcal/day |
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How much free water should be given w/ EN feeding? |
~1 ml per calorie |
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How much water should be mixed w/ meds if they will be given through EN tub? |
flush before and after admin w/ 20 ml water mix med w/ 10-15 ml of water |
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When SHOULD tpn be initiated? |
pts w/ nonfunctioning or inaccessible GI tract in which duration of TPN is anticipated to be at least 7 days or it is anticipated that the patient will not be able to be given oral nutrition for 7 days |
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What are some indications for TPN? |
severe pancreatitis peritonitis severe inflammatory bowl disease (crohns, UC) extensive bowl resection causing malabsorption severe N/V |
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What does 2-1 PN refer to? |
all nutrients are mixed in the same bag and lipids are in a separate bag Lipid should be administered over 12 hours or less; microbial growth increases after 12 hours |
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Why can 3-1 PN be given over 24 hours when the lipids in 2-1 must be given over less than 12 hours due to increased microbial growth after 12 hours? |
when lipids are mixed w/ dextrose and AAs in 3-1 bags microbial growth is reduced due to reduced pH (more acidic) and increased osmolarity |
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How many kcal/g are contained in the following: Dextrose? Lipids? AAs? |
1 gm of 70% dextrose = 3.4 kcal/gm 1 gm of 10-20% lipid = 10 kcal/gm 1 gm of 3-20% AAs = 4 kcal/gm |
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How are caloric requirements calculated? |
BMI < 30 -25 to 30 kcal/kg/day BMI > 30 -11 to 14 kcal/kg/day or -22-25 kcal/kg/day of IBW |
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How are fluid requirements calculated for TPN? |
30-35 ml/kg/day or 2500-3500 ml/day for pts w/out fluid restriction -maintain urine output at 0.5-2 ml/kg/hr |
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What are AA requirements? |
BMI < 30 i. maintenance: 0.8-1 g/kg/day ii. moderate stress: 1.3-1.5 g/kg/day iii. severe stress: 1.5-2 g/kg/day BMI 30 - 40 i. 2g/kg/day based off IBW BMI > 40 i. 2.5g/kg/day based of IBW Ex: 60 kg pt w/ mod to severe stress i. 60 kg x 1.5 g/kg/day = 90 g/kg/day |
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What percentage of TPN should be: AA? Lipids? Dextrose? |
AA conc. should be 2.5-4% of TPN Lipids should be 20-30% of total cals Dextrose should be the rest |
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What rate should dextrose be administered? Why? |
dextrose should be administered at a rate of 4-6 mg/kg/min to reduce risk of hepatic oxidation |
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How should electrolyte requirements be determined? Na? K? Phosphate? Ca? Mg? |
Na: 1-2 mEq/kg/day K: 40-80 mEq/day (1 mEq/kg/day) Phos: 10-40 mmol/day (or 15mmol/1000 kcal) Ca: 10-15 mEq/day (gluconate formulation prefered) Mg: 8-20 mEq/day (sulfate preferred) Never too worried about Cl |
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What else should be provided in a TPN besides macro and micro nutrients? |
trace elements: -selenium, chromium, copper, manganese, and zinc Parental multivitamin |
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When should zinc be increased? |
in pts w/ high out-put fistulas, severe burns, large open wounds |
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When should copper and manganese be restricted in a TPN? |
pts w/ severe cholestasis to prevent accumulation and toxicity |
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What are the safest Ca and Phos concentrations to reduce risk of precipitation? How do AA play in to this? |
Ca less than 6 mEq/L - gluconate preferred Phos less than 30 mmol/L AA concentration should be 2.5-4% (or higher) to prevent precipitation -AAs form soluble complexes w/ Ca and phosphate -AAs provide a buffer system to maintain a lower pH which helps minimize precipitation |
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Why should TPNs be refrigerated? |
as temp increases, risk of CaPhos precipitation increases |
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What insulin is compatible w/ TPN? |
ONLY REGULAR INSULIN |
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How should drugs be administered if pt is on TPN? |
Through a separate IV catheter or separate lumen if given through central line Or hold drug and flush after administration |
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What antibiotic should not be given in TPN? |
ceftriaxone; it precipitates w/ Ca |
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What other drugs should not be added to tpn? |
phenytoin meds containing proplyene glycol -lorazepam, furosemide, digoxin iron dextran |
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What bacteria primarily cause catheter related complications? |
S. aureus Candida albicans |
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Why should hyperglycemia be monitored and corrected if pt on TPN? |
can in increase risk for nosocomial infections and wound infections |
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What can happen to electrolytes during refeeding syndrome? |
Hypophosphatemia Hypomagnesemia Hypokalemia |
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What can happen if pt is overfed? |
steatosis (fatty liver) -watch for increased LFTs |
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What can conjugated bilirubin concentration indicate? |
if > 2mg/dL it could indicate cholestasis and lead to cirrhosis and liver failure |
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Why is serum Cl monitoring necessary? |
Cl and acetate salt forms can be adjusted to maintain acid-base balance |
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What can prealbumin values indicated? What are important levels? |
prealbumin can help one determine how nourished or malnourished a pt is Normal range: 16-40 mg/dL Moderate malnutrition: 11-16 mg/dL Severe malnutrition: less than 11 mg/dL |
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What salt form should be given for metabolic alkalosis? |
chloride |
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What salf form should be given for metabolic acidosis? |
acetate |
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What can too much lipid in a TPN cause? What medications should be accounted for? |
hypertriglyceridemia if preTPN trigs are over 400 mg/dL don't add lipids to TPN propofol and clevidipine have lipids in the formulation |
