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35 Cards in this Set
- Front
- Back
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Who should receive parenteral nutrition?
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patients who cannot, will not, or should not eat for >7 days
- those without a functional or accessible GI tract "If the gut works, use it" |
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Who should receive peripheral parenteral nutrition?
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may be used for up to 1 week
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When is Central PN (parenteral nutrition) used?
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when GI tract is not accessible/functional for >2 weeks
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CHO
- 1 gr CHO = _____ kcal |
Carbohydrate
1 gram CHO = 3.4 kcal |
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Max oxidation rate of IV dextrose: _________
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5 mg/kg/min
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Protein:
1 gram = ______ kcal doses range from ____ to _____ 1 gr nitrogen = ______ gram protein |
1 gram = 4 kcal
doses range from 0.8 to 2 g/kg/day 1 gr nitrogen = 6.25 gram protein |
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IV Fat
1 gram = ______ kcal Infuse _______ of total daily kcal as IV fat over 24 hr or _______ g/kg/hr |
1 gram = 10 kcal
Infuse <30% of total daily kcal as IV fat over 24 hr or < 0.11 g/kg/hr |
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energy range of patient: __________ kcal/kg/day
in burn patient or severe head injury: _________ kcal/kg/day |
normal: 25-35 kcal/kg/day
burn/head: 40 kcal/kg/day |
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BMI formula
what represents obesity? |
BMI = weight (kg) / height^2 (m^2)
obesity: BMI > 30 kg/m2 |
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Ideal Body Weight formulas
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Men: 50 kg + 2.3 kg / in over 5'
Women: 45.5 kg + 2.3 kg / in over 5' |
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Weight loss guidelines for Nutritionally at Risk
1 month: 6 months: |
1 month: > 5% UBW
6 months: > 10% UBW or > 20% IBW |
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What is the difference between enteral and parenteral nutrition?
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enteral: oral and tube feedings into GI
parenteral: administered intraveneously |
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Why should nutrition be administered enterally unless it is not possible?
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1. GI tract tends to atrophy when not used
2. Gut bacteria can translocate to the circulatory system through an atrophied GI tract and increase risk of infection |
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What are the advantages and disadvantages of PPN/PVN?
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Peripheral Parenteral/Venous Nutrition
Advantages: - avoid central catheter-related complications - avoid hyperosmolar complications Disadvantages: - thrombophlebitis (due to hypertonic solution) - frequent vein rotation - caloric intake is limited - fluid restriction is NOT possible |
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What are the advantages and disadvantages of TPN?
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Advantages:
- long-term catheter maintenance - maximum caloric intake - fluid restriction IS possible Disadvantages: - mechanical complications of catheter - potential hyperosmolar complications - infectious complications |
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Where is a TPN catheter placed?
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the superior vena cava
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What are the nutritional components of TPN?
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- dextrose
- protein - fat - electrolytes - trace elements - vitamins - water - other ingredients |
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What are the adverse effects of excessive glucose provision?
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- phagocytic dysfunction
- glycemic control - respiratory decompensation - hepatic steatosis - fluid/electrolyte imbalance |
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What are the two commercially available IV Lipid Emulsion Products available and what is their fat content?
How are IV lipids packaged? |
Linoleic Acid (Omega-6) 49-65.8 %
Linolenic Acid (Omego-3) 4.2-9 % IV lipids come in bottles of 10%, 20%, and 30% emulsions |
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How are lipids administered traditionaly vs new method?
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traditionally, lipids administered in a bottle that is Y-connected/piggybacked
TNA's (3 in 1 systems) allow lipids to be administered with amino acids and dextrose |
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What are the advantages and disadvantages of TNA's?
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Total Nutrient Admixtures (lipids administered with aa's & dextrose)
Advantages: - decrease touch contamination - simplify administration - cost effective Disadvantages: - instabilities - microbial growth potential - limits use of filters |
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How often are lipids administered?
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typically 2-3 times per week, giving the body a chance to clear lipids from the blood
can be provided daily should not exceed 2.5 g/kg/day |
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What are the three methods of evaluating lipid tolerance?
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1. Test Dose Method
2. Serum Triglyceride Method 3. Plasma Turbidity Method |
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What are the contraindications for Lipid Emulsions?
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- abnormal lipid metabolism
- lipid nephrosis - acute pancreatitis - severe egg allergies Caution: - a blood coagulation disorder - moderate to wevere liver disease - compromised pulmonary function |
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When can Albumin be added to PN solutions?
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if serum albumin levels are very low
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When can Heparin be added to PN solutions?
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to prevent blood clots from forming on the IV catheter
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When can Insulin be added to PN solutions?
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if needed to regulate blood glucose levels
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What proportion of body weight is water?
What are the fluid intake needs of an adult? |
50% of body weight
~ 35 mL/kg/day |
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mOsmol/L =
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wt (g/L) / MW X # ions X 1000
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how many mOsmol are in a liter of 0.9% NaCL?
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308 mOsmol/L
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What are the two common culprits of precipitation in TPN?
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- phosphates
- calcium |
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What is the relationship between amino acid concentration and risk of precipitation of CaHPO4?
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higher aa = less likely to precipitate
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Examples of drugs compatible/incompatible with 2-in-1
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Compatible:
- fentanyl - iron dextran - aminophylline - insulin - H2-antagonists - heparin - vitamin K hydrocortisone Incompatible: - amphotericin B - midazolam - Cefazolin - NaHCO3 - Cyclosporin A - ganciclovir - proton pump inhibitor |
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Examples of drugs compatible/incompatible with 3-in-1
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Compatible:
- diphenhydramine - H2-antagonists - Dexamethasone - hydrocortisone - regular human insulin - vitamin k Incompatible: - Amophotericin B - Dopamine - Hydromorphone - Iron dextran - Lorazepam - Ondansetron |
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What are the 4 possible physical changes in TNA?
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- creaming
- aggregation/flocculation - coalescence - breakage/cracking |
