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23 Cards in this Set
- Front
- Back
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If the GI works, does the patient get total parenteral nutrition?
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no, use a feeding tube
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What are advantages of enteral feeding?
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preserves structure and function of gut, provides more complete range of nutrients (iron, fiber), associated with improved outcomes (fewer infections, cost effective, fewer complications)
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What is an enterocutaneous fistula?
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abnormal communication between bowel and skin
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What are the 7 essential ingredients of TPN?
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protein, carbs, fat, electrolytes, vitamins, trace minerals, water (30mL/kg + more to cover losses)
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What kind of proteins and how much is yielded?
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crystalline amino acids, essential and non-essential amino acids, yields 4kcal/g
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What kind of carbohydrate?
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hydrated dextrose, 3.4 kcal/g
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What kind of fat?
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safflower or soy oil, 10kcal /g; provides linoleic, arachadonic, linolenic acids. + emulsifier (egg yolk phosphatides and glycerol)
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What does giving fat prevent? What are the clinical presentations of this?
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essential fatty acid deficiency: dry, flaking skin, thrombocytopenia, impaired wound healing, hair loss
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What are some clinical consequences of fluid and electrolyte disturbances?
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neurological and cardiopulmonary effects (heart rhythm changes, hypotension, respiratory failure)
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Why are TPN vitamin doses different than oral doses?
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oral doses are typically larger due to inefficient (not 100%) vitamin absorption through the gut
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During a nationwide shortage of IV vitamins, there were case reports of _______.
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acute beriberi
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____ deficiency was previously unknown.
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zinc
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What is the Harris-Benedict Equation?
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estimation of basal energy expenditure
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What is the rule of thumb for kcal/kg?
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25-30kcal/kg
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T or F, it's better to overfeed the patient just in case he/she isn't getting enough calories.
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false, DO NOT OVERFEED, correlation of excessive calories and increased infections, hepatobiliary, and respiratory complications
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What % of total kcal/day should be protein? What is the range in g/kg?
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15-30%. Range: 0.8 - 2 g/kg
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How do we check for nitrogen balance?
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measure urinary N2 + 4g (insensible losses) over 24 hrs, and compare with nitrogen intake (protein g/6.25)
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What is the goal, positive or negative nitrogen balance?
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positive! Negative would mean that there is muscle breakdown.
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___% of total calories is dextrose, ___% of total calories is lipid
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50-60%, 15-30%
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Should all patients be given the same exact "standard" TPN?
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no, it should be individualized to meet the patient's needs
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What is the most serious complication related to TPN?
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infections in the line or bloodstream.
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What are some metabolic complicaions?
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hyperglycemia, fluid and electrolyte disturbances, hepatobiliary complications, metabolic bone disease
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What is refeeding syndrome?
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after long periods of malnutrition, refeeding of carbohydrates causes sudden drops in blood levels of phosphorus, potassium, and magnesium
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