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54 Cards in this Set
- Front
- Back
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Provision of nutrients intravenously
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parenteral nutrition
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Rational and Criteria for parenteral nutrition
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reserved for nonfunctional or severely diminished GI tract
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Conditions that often require parenteral nutrition
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-GI incompetence
-Critical illness with port enteral tolerance or accessibility |
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Types of PN access
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-Central Parenteral nutrition (CPN)
-Peripheral parenteral nutrition (PPN) |
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Catheter placement in large, high blood flow vein (super vena cava)
A. central B. peripheral C. nasogastric D. nasoduodenal |
A. central parenteral nutrition
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True or false. Central parenteral nutrition is short term and long term
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True
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Catheter placement in small vein, typically the hand or arm; CAN NOT tolerate concentrated solutions
A. central B. PEG tube C. nasogastric D. peripheral |
D. peripheral
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True or False. Peripheral Parenteral Nutrition is usually used for long-term use
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False, short term
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What is osmolarity?
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-refers to milliosmoles per liter of entire solution (TPN)
-used to calculate IV fluids rather than osmolality which is used for body fluids |
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True or False. Osmolarity is used to calculate body fluids
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False, osmolarity is used to calculate IV fluids. Osmolality is used to to calculate body fluids
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Why is osmolarity relevant to parenteral nutrition?
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Osmolarity of parenteral nutrition is used to determine the location of the catheter (central catheter placement allows for higher calories and therefore greater osmolarity)
calculating osmolarity of PN is important to ensure tolerance |
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Name the types of parenteral nutrition routes
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-Peripheral access (PPN)
-Short-term central access -Short or moderate term -Long-term central access |
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True or False. Thrombophlebitis is a principal complication of peripheral access (PPN)
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True
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True or False. Peripheral access is safe forever
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False. Safe or 3-6 weeks
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Catheter is inserted into subclavian vein and advanced until catheter tip is in superior vena cava.
A. Short or moderate term B. peripheral access C. Long-term central access D. Short-term central access |
D. Short-term central access
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True or False. Peripheral access uses a large enough vein to extend 5-7 inches into vein
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True
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Involves using a peripherally inserted central catheter (PICC) which is inserted into anticubital vein in arm and threaded into subclavian vein until catheter tip is in superior vena cava
A. short-term central access B. short-or moderate term C, peripheral access D. long term central access |
B. short-or moderate term
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Uses a "tunneled" catheter or a surgically placed port
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long-term central access
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Tunneled cathether is placed in cephalic, subclavian, or internal jugular vein and fed into the superior vena cava
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long-term central access
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Concentration of AA is generally between _____ for a parenteral nutrition solution and is ____kcal/g protein
A. 5-10%; 5 B. 3-20%; 4 C. 3-90%; 6 D. 10-20%; 4 |
B. 3-20%; 4
*ex. 10% solution of AA supplies 100g protein per liter |
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How much calories should come from protein?
A. 15-20% B. 10-20% C. 3-20% D. 5-25% |
A. 15-20% kcal should come from protein
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Carbohydrate in parenteral nutrition comes from
A. lactose B. protein C. glucose D. dextrose monohydrate |
D. dextrose monohydrate
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Concentration of carbohydrates is generally between _____. And is _______kcal/g CHO
A. 55-60%; 3.4kcal/g B. 3-20%; 4kcal/g C. 5-70%; 4kcal/g |
C. 5-70%; 4kcal/g/CHO
*10% solution of dextrose yields 100g CHO per liter * max rate should not exceed 5-6 mg/kg/min in critically ill patients |
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Lipid emulsions come in _______ concentrations
A. 10, 20, 30% B. 20, 50, 70% C. 5, 10%, 30% |
A. 10, 20, 30% concentration
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Fat emulsions conversions
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10%= 1.1 kcal/mL
20%= 2 kcal/mL 30%= 2.9 kcal/mL |
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True or False. Providing 20-30% of total kcal as lipid should provide about 1g fat per kg/body weight
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True.
*SHOULD NOT exceed 2.5g of lipid/kg of body weight per day |
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True or False. 10-20% of fat in 10% emulsion is linoleic acid, which is pro-inflammatory
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False. 2-4% of fat in 10% emulsion is linoleic acid, which is pro-inflammatory
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True or False. Iron is not compatible with lipids and may enhance bacterial growth
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True
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How much fluid is typically prescribe?
A. 1.5-3L day B. 5-10L/day C. 2-4L/day |
A. 1.5-3 L/day
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What is method 1 of compounding parenteral nutrition solutions to patient?
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Method 1: all nutrients are compounded except for fat emulsion which is infused separately
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What is method 2 of compounding parenteral nutrition solutions to patient?
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Method 2: Total nutrient admixture or three-in-one solution of lipid, amino acids, and glucose
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Can medications be compounded with PN solutions
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Yes, medications can be compounded with parenteral nutrition solutions but it is rarely done
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What are the two administration methods?
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Continuous infusion
Cyclic infusion |
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True or False. Abrupt cessation of continuous infusion can cause rebound hypoglycemia
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True
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True or False. Continuous infusion involves increasing the amount of solution given incrementally over 2-3 days to reach goal rate
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True
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True or False. Cyclic infusion is given 8-12 hours per day (usually at night)
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True
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True or False. Cyclic infusion is often used for those requiring PN at home
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True
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Complications of parenteral nutrition
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Metabolic, infections (sepsis), metabolic, and GI complications
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What are some mechanical complications that can occur with parenteral nutrition?
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-air embolism
-central vein thrombophlebitis -cardiac perforation |
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What are come infections or sepsis complications that can occur with parenteral nutrition?
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-catheter site entrance
-contamination during insertion -solution contamination |
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What are some metabolic complications that can occur with parenteral nutrition?
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-Electrolyte imbalance
-Rebound hypoglycemia |
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What are some GI complications that can occur with parenteral nutrition?
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-GI villous atrophy
-Hepatic abnormalities |
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What are some things you should monitor daily in parenteral nutrition?
A) weight B) serum electrolytes C) serum glucose D) catheter site E) all of the above |
E. all of the above should be monitored daily at initial period of parenteral nutrition
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This syndrome occurs in patients who have had poor oral intake and are moderately or severely malnourished
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refeeding syndome
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True or False. Refeeding syndrome is common in parenteral nutrition
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True
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What causes refeeding syndrome
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Refeedining syndrome is caused by overly aggressive enteral or parenteral nutrition, specifically carbs
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True or False. Refeeding syndrom is not lethal
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False. Refeeding syndrome is lethal
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What should you monitor for refeeding syndrome?
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serum magnesium, potassium, and phosphorus
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What should you do to avoid refeeding syndrome?
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start with 25-50% of goal dextrose and increase it slowly in those at risk
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Transitional feeding from enteral to oral
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reduce enteral to night only to reestablish hunger or satiety cues
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Transitional feeding from parenteral to oral
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decrease parenteral as oral intake improves
stop parenteral when oral reaches 75% |
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Transitional feeding from parenteral to enteral
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-Takes 2-3 days
-start enteral at 30-40ml/hr and increase by 25-30ml/hr every 8-24hrs while reducing parenteral -STOP parenteral when enteral reaches 75% |
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Home nutrition support criteria
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-Appropriate candidates
-feasible home environment with responsible caregivers -suitable nutriton support regimen -training of patient and family -interdisciplinary team -plan for follow-up with physician and RD |
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What are some ethical issues with parenteral nutrition?
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-end of life decisions, terminal illness
-advance directives -persistent vegetative state -surrogate decision makers -living will |
