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23 Cards in this Set
- Front
- Back
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Identify the members of the nutrition support team
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physician, nurse, dietitian, pharmacist
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Parental Decision: Indications
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GI incompetency- short bowel syndrome, small bowel ischemia, total bowel obstruction, ileus, severe malabsorption, intactable n and v. Hypermetabolic state with poor enternal tolerance. no GI access
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Contraindications
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Functional GI tract, inability to obtain access, short term treatment, harm exceeds benefit for patient, aggressive support not warranted or desired
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PN Checklist
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Indications/Contraindications, Access available(where?). formulation based on nutritional needs(what), administration, reassessment follow up
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Delivery: continuour infusion
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via either Total parenternal nutrition-TPN, or concentration not a certain
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Delivery: peripheral parental nutrition
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administered limited by: osmolarity, fluid administration, NOT COMMON
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Components: protein
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all essential AA and various nonEAA: Similar to egg protein, 4calories/gram, ordered as grams per day
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Components: fat
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lipid emulsion (triglyceride)- essential FAs, sow or safflower oil, phospholipids, 10 caleries/g
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Components: CHO
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Dextrose
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Components: Fluid
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30-35m/kg/d must calculate fluid requirements. 3 in 1 solutions- all three macronutriends. 2 in 1 solutions- protein and carb provided
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Minerals added
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Calcium, Mg, phosphate
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Trace elements added
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zinc, chromium, manganese, selenium, copper
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Electrolytes added
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Na, K , Cl, and acetate
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Additives
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Insulin, other
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Continuous administration
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24hrs/day. promote best tolerance
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cyclic infusion
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8-16h/day. usually at night. ideal for longterm TPN
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Pump used?
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Always
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Monitor
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Daily, i/os, electrolytes, blood glucose, renal fxn, fat tolerance
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Consequences of TPN
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expensive! many possible risks and complications
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GI Consequences of TPN
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immune fxn, GI mucosa integrity, mucosa enzyme content, gallbladder contraction(gallstones), fatty liver-> abnormal liver function tests
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Complications-catheter placement
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pneumothorax, hemothorax, vessel laceration and or thrombosis, air embolism
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Metabolic complications
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hyperglycemia, high triglycerides, gallbladder diseas, electrolyte imbalances, potassium, sodium, other
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TF is always
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PREFERABLE OVER TPN IF POSSIBLE!
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