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81 Cards in this Set
- Front
- Back
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intravenous provision of macronutrients and micronutrients to patients whose GI tract is nonfunctional, inaccessible, or unsafe to use
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parenteral nutrition
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ways that parenteral nutrition can be administered
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centrally or peripherally
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what does TPN stand for?
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total parenteral nutrition
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type of catheter in central TPN
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Hickman catheter
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when TPN is administered through a large diameter central vein
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central administration
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what does PICC line stand for?
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peripherally inserted central catheter
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Type of administration with TPN
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central or PICC line
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length of time TPN can be used
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indefinitely
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Where are PICC lines inserted
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through a peripheral vein to a central location near the heart
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advantages to PICC line
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less costly
lower risk of insertion complications |
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disadvantages to PICC lines
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higher rate of malfunction
patient can't care for on their own |
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What does PPN stand for?
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peripheral parenteral nutrition
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advantage to PPN
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less risk of infection than TPN
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where is PPN inserted
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a smaller peripheral vein
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How long can PPN be used?
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2 weeks or less
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limits on osmolality of PPN
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900 mOsm/L
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reason for osmolality limits on PPN
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damage to access vein and risk for thrombophelbitis
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inflammation of a vein caused by or associated with formation of a blood clot
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thrombophelbitis
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Difference between PPN and TPN solutions
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PPN solutions are lipid based and may provide fewer kcals, protein and electrolytes. PPN provides greater fluid volume
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Patients who should not use PPN
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severely malnourished
hypermetabolic fluid restrictions |
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an abnormal tube like opening between 2 internal organs or between an organ and the body surface
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fistula
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high output fistula
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high rate of discharge through the opening
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indication for use of parenteral nutrition
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a non-functioning GI tract. (If the gut works, use it.)
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what does PN stand for?
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parenteral nutrition
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When should PN not be used
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- functional GI tract
- when nutrition support is needed for less than 5 days -if PN will delay a critical operation or procedure - when aggressive therapy is not warranted - when risks outweigh the benefits |
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simple estimate for PN calorie needs
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25-30 kcals/kg
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maximum calories recommended/kg to prevent overfeeding
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35 kcals/kg
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CHO distribution recs for PN
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45-65% of kcals
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fat distribution recs for PN
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20-30% of kcals
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Protein distribution recs for PN
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10-35% of kcals
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what does the typical ready made PN solution consist of?
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CHO, protein, vitamins, minerals, medications, sterile water
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what does MVI stand for?
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multiple vitamin infusion
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What does TNA stand for?
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total nutrient admixture
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What is TNA?
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PN solution with added lipids
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what amount of CHO does the average adult require daily to spare protein?
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100 grams
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Current RDI guidelines for CHO
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130 grams daily
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maximum glucose oxidation rate
(maximum tolerable PN infusion rate for CHO) |
.36 grams/kg body weight/hour
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what are the CHO's in PN solution
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dextrose
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how many kcals does dextrose provide
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3.4 kcals/gram
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contribution of dextrose to osmolarity of PN solutions
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5 mOsm/g
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how is concentration of dextrose expressed?
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X% dextrose solution = X g dextrose/100ml water
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result of excess carbohydrate infusion
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hyperglycemia, increase of lipid synthesis, and risk of fatty liver
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test results that are indicative of excessive lipid synthesis
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elevation in liver function tests
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reason excess CHO can increase stress in patients with compromised respiratory function
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glucose oxidation increases CO2 production
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what does EFA stand for?
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essential fatty acids
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kcals provided by lipids
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9 kcals/gram
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when are lipids administered with PN
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short-term: not daily or possibly not at all. Long-term: EFA's to prevent deficiency
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function of EFA's
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cell membranes, prostaglandin synthesis, immune function
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what can excessive intake of omega 6's do?
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hinder immune function
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what does a 10% lipid solution mean?
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provides 1 kcal/cc
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what does a 20% lipid solution mean?
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provides 2 kcal/cc
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what does a 30% lipid solution mean?
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provides 3 kcal/cc
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cc equivalent in ml
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1 cc = 1 ml
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contribution of lipids to osmolarity
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1.7 mOsm/g
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make-up of PN lipids
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isotonic made of long-chain tryglycerides from soybeans
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amount of EFA needed to prevent deficiency
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4% of kcals
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administration schedule of lipids
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seperately once a week, three times a week, or daily as part of TNA
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allergy risk with lipid PN solutions
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emulsified using phospholipids so you can't use it in patients with egg allergies
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risk of lipid PN solutions
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may cause hypertriglyceridemian
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patients at risk for hypertriglyceridemia
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pancreatitis, familiar hyperlipidemia, liver disease, severe metabolic stress
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at what serum level should lipid infusion be stopped?
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400 mg/dl
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what are protein requirements based on?
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age, gender, nutrition status, disease state, stress, wound status, kidney and liver function
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protein requirements for healthy adults
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0.8 g/kg/day
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how much nitrogen does protein contain
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6.25 grams protein = 1 gram nitrogen
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reason kcals from amino acids aren't used to contribute to kcal requirement of the patient
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amino acids should be used for protein synthesis
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protein requirements for critical illness and moderate malnutrition
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1.2-1.5 g/kg/day
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protein requirements for trauma and severe malnutrition
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> 1.5 g/kg/day
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protein requirements for renal/hepatic impairment
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possibly reduced
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contribution of protein to osmolarity
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10 mOsm/g
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what type of amino acids will accumulate in the liver in hepatic failure leading to hepatic encephalopathy
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aromatic amino acids
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type of amino acids that are oxidized primarily by muscle this reducing amino acid load in the liver
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branched chain amino acid
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in cases of acute renal failure how long may essential amino acids be given when dialysis is not possible
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2 weeks
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vitamin not included in the MVI
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vitamin K
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mineral not added to PN solutions and reason
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iron
it is oxidative and will destabilize lipids |
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minerals that are ommited from PN solutions in cases of hepatic failure
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copper
manganese |
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reason you must use caution with calcium and phosphorous supplementation in PN solution
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it can cause crystalline precipitation which can block the catheter
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what can mask calcium deficiency
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albumin status
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contribution of vitamins and minerals to PN osmolarity
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300 to 400 mOsm/L
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estimated fluid needs for adults
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30-35 cc/kg body weight
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a metabolic complication that can occur when nutrition is reintroduced for patients who are severely malnourished
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refeeding syndrome
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primary problem in refeeding syndrome
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significant shift in intracellular ions. Glucose stimulates the production of insulin which promotes cellular intake of ions. Serum levels of ions drop drastically.
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