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CNSC EXAM 2020 > Ch: 17 Complications of Parenteral Nutrition > Flashcards

Ch: 17 Complications of Parenteral Nutrition Flashcards

1
Q

What causes prerenal azotemia?

A

Dehydration, excess protein, and/or inadequate energy from other nonprotein sources

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2
Q

To reduce risk of hypertriglyceridemia, how should ILE be given/infused

A

ILE should be restricted to <30% of total energy or 1 g/kg/d; also, if ILE is administered separately, it should provide slowly over at least 8-10 hours

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3
Q

What is the most common complication of PN administration?

A

Hyperglycemia

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4
Q

How much phosphorus does APSEN recommend be put in PN?

A

20-40 mmol/d

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5
Q

The FDA establishes labeling requirements for ______ contamination or large volume, small volume, and pharmacy bulk packages used in PN compounding?

A

Aluminum

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6
Q

To avoid metabolic acidosis, what should be added to TPN in adequate amounts?

A

Acetate

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7
Q

When should patients/caregivers add MVI to their PN

A

just prior to administration of the PN

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8
Q

How should PN be initiated?

A

At ½ of the estimated energy needs or approximately 150 to 200 g dextrose for the first 24 hours. Delivery of less dextrose (~100 g) may be warranted if pt has low BMI or poor glycemic control

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9
Q

What generally causes osteomalacia?

A

Vit D deficiency

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10
Q

How much vitamin K is included in the 13 vitamin preparation for PN?

A

150 mcg; this interacts with warfarin and can cause treatment failure

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11
Q

How much calcium does ASPEN recommend in PN to offset higher ca urinary losses?

A

10-15 mEq calcium gluconate from PN formula

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12
Q

In acutely ill patients, CHO administration should not exceed what?

A

Rate of 4-5 mg/kg/min or 20-25 kcal/kg/d in acutely ill patients

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13
Q

How much vit D is contained in a PN adult MVI prep?

A

200 IU of vit D (ergocalciferol or cholecalciferol)

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14
Q

What are the three types of hepatobiliary disorders?

A

Steatosis (more common in adults), cholestasis (more common in childern), and gallbladder sludge/stones

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15
Q

How is risk of hypoglycemia in PN patients reducted

A

To reduce risk of hypoglycemia, 1-2 hour taper down of the infusion or half the infusion rate may be necessary

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16
Q

What are some clinical manifestations of a EFAD?

A

Alopecia, hepatomegaly, thrombocytopenia, fatty liver, and anemia

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17
Q

What kind of insulin should be added to PN

A

Regular insulin

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18
Q

What insulin regimen is common in adding insulin to PN

A

In initial insulin regimen of 0.05-0.1 units per gram of dextrose in the PN is common, or 0.15 to 0.2 units per gram of dextrose may be used in patients who are already hyperglycemic

19
Q

Can ILE be given to a patient with pancreatitis?

A

ILE is considered safe for use in patients with pancreatitis without hypertriglyceridemia

20
Q

What is the primary factor that causes steatosis?

A

excessive energy intake

21
Q

In patients with hepatobiliary disease, which trace elements should clinicians consider reducing/removing?

A

manganese and copper

22
Q

What are some stratagies to manage PN related hepatobiliary complications?

A

Rule out non PN etiologies (hepatoxic meds), consider PN modifications (decreasing dex or ILE, cyclic infusion), maximize enteral intake, prevent/treat bacterial overgrowth, prescribe meds (ursodiol, cholestyramine)

23
Q

What is a prominent manifestation of a magnesium deficiency?

A

Hypocalcemia should be related with magnesium supplementation b/c it is often refractory to calcium therapy alone. Magnesium deficiency can also lead to hypophosphatemia b/c of increased phos excretion

24
Q

What is the prime indicator for diagnosing cholestasis?

A

An elevated serum conjugated bili (greater then 2 mg/dL is considered the prime indicator for cholestasis

25
Q

Aside from PN, what are some other risk factors for developing cholestasis?

A

include bacterial/fungal infections, sepsis, SIBO, massive intestinal resection and small bowel remnant < 50 cm have been associated w/ chronic cholestasis

26
Q

What should be given to all adult patients receiving PN?

A

A standard daily dose of PN MVI

27
Q

Chronic metabolic acidosis is associated with what?

A

Hypercalciuria and metabolic bone disease

Excess chloride, diarrhea and acute renal failure are also common causes of metabolic acidosis.

28
Q

A long-term PN patient presents with involuntary movements, tremor, and rigidity. What etiology may explain these symptoms?

A

Manganese toxicity

29
Q

Catheter related thrombosis caused by fibrin build up within blood vessels adhering to a central venous catheter is called

A

Mural thrombus

30
Q

The best approach to prevent PN-induced cholelithiasis is what?

A

Early initiation of oral or enteral feeding, even in small amounts, to stimulate cholecystokinin secretion, bowel motility and gallbladder emptying. Injections of CCK-OP to induce gall bladder contractions and reduce biliary sludge have yielded mixed results and caused gastrointestinal intolerance in some patients

31
Q

What is most likely responsible for elevated serum bicarbonate levels in a home parenteral nutrition (PN) patient?

A

Excess acetate salts in the PN

An elevated serum bicarbonate level is one of the markers of metabolic alkalosis. Metabolic alkalosis may be caused by nasogastric suctioning, volume depletion and diuretic use. In a PN patient, excess use of acetate, which is metabolized to bicarbonate, may precipitate a metabolic alkalosis.

32
Q

What feature of a Groshong® Central Venous Catheter reduces the risk of catheter occlusion?

A

Pressure sensitive three-way valve

33
Q

What is the only FDA-approved thrombolytic agent for CVAD occlusions?

A

Cathflow (Alteplase)

34
Q

The most common route of infection for a tunneled central venous access device (CVAD) is what?

A

Contamination of the catheter hub

35
Q

The most common route of infection for a nontunneled CVAD is what?

A

Extraluminal colonization of the catheter or intraluminal colonization of the hub and lumen of the CVAD.

36
Q

What is pinch off syndrome?

A

Pinch-off syndrome occurs when the catheter is being compressed between the first rib and the clavicle, causing intermittent compression and pinching.

This can lead to intermittent occlusion of infusion and aspiration and an increased risk of catheer fracture. Changes in the patient’s position can widen or narrow the angle between the rib and clavicle, usually by raising or lowering the arm, which can relieve occlusion of the catheter

37
Q

How is superior vena cava syndrome characterized?

A

Superior vena cava syndrome is characterized by shortness of breath, dyspnea, cough, cyanosis of face, neck, shoulder and arms, and distended chest or neck veins.

38
Q

Rapid intravenous infusion of potassium phosphate may result in what

A

thrombophlebitis; Infusion rates of phosphate should not exceed 7 mmol/h because faster infusion rates can often cause thrombophlebitis (ie, potassium phosphate) and metastatic calcium-phosphate deposition with potential resultant organ dysfunction.

39
Q

In a patient with hepatobiliary disease, which trace elements should be withheld or requires a dosage reduction when prescribing parenteral nutrition?

A

Copper and manganese

40
Q

When compared to the Dietary Reference Intakes (DRIs) for fat- soluble vitamins given orally, the DRIs for parenterally administered fat-soluble vitamins are _____

A

Equal

41
Q

When compared to the Dietary Reference Intakes (DRIs) for water-soluble vitamins given orally, the DRIs for parenterally administered water-soluble vitamins are ____

A

Higher

42
Q

According to United States Pharmacopeia (USP) Chapter 797, a PN solution prepared from 8.5% amino acid solution with electrolytes and 70% dextrose, with multivitamins, trace elements, and famotidine added would be classified as ____ risk

A

Medium

43
Q

How does creaming of a TNA appear?

A

a translucent band at the surface of the emulsion separate from the remaining TNA dispersion.

In general, light creaming is a common occurrence and not a significant determinant of infusion safety except in extreme cases.

44
Q

Rapid intravenous infusion of sodium or potassium phosphate may result in what?

A

Tetany; Rapid infusion of phosphate can result in tetany due to an abrupt decrease in serum calcium concentration.

CNSC EXAM 2020 (42 decks)

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