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CNSC Modules > Complications of Parenteral Nutrition > Flashcards

Complications of Parenteral Nutrition Flashcards

1
Q

Which factor is most likely to contribute to metabolic bone disease (MBD) in ON dependent patients?

A

Aluminum toxicity

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2
Q

What is a risk factor for the development of PN associated liver complications?

A

Prolonged soybean based lipid injectable emulsion (ILE)

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3
Q

A PN patient presents with mild to moderate aminotransferases and mild elevations of bilirubin and serum alk phos. This patient is most likely exhibiting what type of PN associated liver disease (PNALD)?

A

Hepatic steatosis

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4
Q

A Crohn’s patient is found to be at high risk for refeeding syndrome. Which micronutrient should be supplemented?

A

Thiamine

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5
Q

Hyperglycemia in a patient receiving PN is associated with what type of sodium/fluid imbalance?

A

Hypertonic hyponatremia.

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6
Q

In order to prevent rebound hypoglycemia upon discontinuation of PN, it is recommended the PN infusion rate be reduced over what time span?

A

1-2 hours

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7
Q

A 68 yo female with normal liver function and a lactate of 1 mmol/L is in AKI status post colon resection and is receiving PN. She has the following ABGs: pH = 7.31, PCO2 = 36 mm Hg, and bicarb = 20 mEq/L. What is the most appropriate PN intervention?

A

Decrease chloride:acetate ratio

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8
Q

A PN dependent patient with an average daily ileostomy output of 3L presents with BUN/serum Cr ratio of 30:1 and mild hyponatremia. What is the most appropriate PN intervention?

A

Increase sodium, decrease fluid

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9
Q

A 50kg patient is initated on PPN solution of 125 ml/hr. This formula contains 210 grams dextrose, 75 grams amino acids and 45 grams of fat. What is a major complication she is at the greatest risk for developing?

A

Fluid overload

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10
Q

What are the clinical presentations of refeeding syndrome?

A

Respiratory failure, seizures, and cardiac arrthmias

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11
Q

What is most likely responsible for elevated serum bicarb levels in a home PN patient?

A

Excess acetate salts

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12
Q

A 40 yo male patient receiving chronic PN secondary to a massive bowel resection develops metabolic bone disease. His current cyclic ON formula provides 5g/kg/d dextrose, 2g/kg/day protein and 1 g/kg/d of fat. What is the most appropriate intervention to reduce hypercalcuria.

A

Decrease amino acid content of PN solution

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13
Q

The best approach to prevent PN induced cholelithasis is administration of?

A

Oral or enteral feeds

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14
Q

What would be the most serious complication of hypertriglyceridemia in a patient receiving PN?

A

pancreatitis

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15
Q

A 65 yo female with moderate malnutrition is status post radical cystectomy w/ ileal conduit. She is initiated on PPN solution at 125 ml/hr. This formula contains 210 g dextrose, 75 g amino acids, and 45 g fat. What is the osmolarity of the PPN solution?

A

600 mOsm/L

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16
Q

A patient with refractory hypokalemia should be assess for what related electrolyte disorder?

A

Hypomagnesemia

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17
Q

Manganese toxicity is a concern for long term PN patients due to trace element mixtures and as a contaminant from other PN solution components. Symptoms of manganese toxicity are associated with mineral accumulation in what organ?

A

Brain

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18
Q

A critically ill 75 yo male with pneumonia and sepsis who weighs 63 kg is receiving PN containing 2800 kcal, 100 g amino acids per day. He has the folowing ABGs: pH = 7.32, PCO2 = 49, and bicarb = 25.What is the most appropriate PN intervention?

A

Decrease calorie content of PN.

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19
Q

The most accurate method of diagnosing PN associated MBD is to measure?

A

Bone mineral density

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20
Q

Which comorbidity is not a risk factor for the development of MBD for a patient on long term PN?

A

Hypothyroidism

21
Q

A rise in which lab values would most likely indicate cholelithasis?

A

Direct bilirubin

22
Q

During long term PN administration, heptobiliary complications can best be prevented by

A

Converting to cyclic administration

23
Q

What is the most common electrolyte imbalances observed in patients with refeeding syndrome?

A

Hypokalemia, hypophosphatemia, hypomagnesemia

24
Q

A critically ill patient has been receiving PN providing 45 kcals/kg. The consequences of providing excessive calories to a critically ill patient are?

A

Fatty liver, vent weaning failure, elevated blood sugar

25
Q

Excessive carbohydrate administration in PN has been associated with?

A

Hepatic steatosis

26
Q

Patients with diabetes receiving PN:

A

Have increased risk of catheter related infections

27
Q

A critically ill 42 yo male status post small bowel resection for Crohn’s disease is receiving PN for severe post operative ileus with NG tubes output of 2.5-3 liters per day. He has the following ABGs: pH = 7.49m PCO2 = 45, and bicarb = 34. What is the most appropriate PN intervention?

A

Increase chloride:acetate ratio

28
Q

What are risk factors for rebound hypoglycemia?

A

Malnutrition, hepatic dysfunction, renal insufficiency

29
Q

A patient has been receiving PN through a CVC for the past week while in the hospital. They now present with SOB, cough, and cyanosis of the neck, face, shoulder and arms. What type of device complication is characterized by the patient’s symptoms?

A

Superior vena cava syndrome

30
Q

A patient presents to the clinic with a suspected catheter occlusion. What are appropriate initial actions?

A

determine is the occlusion is relieved with postural changes, remove the dressing and check for kinks in the tubing, review recent flushing techniques with patient.

31
Q

A home PN patient with a PICC presents with arm, shoulder, and neck swelling. What is the most likely cause?

A

Catheter related venous thrombosus

32
Q

What is an etiology of a thrombotic catheter occlusion?

A

Fibrin sheath formation

33
Q

Your patient develops sudden chest pain an SOB following the placement of a central line for PN support. A pneumothorax is suspected and radiographically confirmed. This situation should be viewed as a:

A

Sentinel event

34
Q

The use of 70% ethyl alcohol is the most effective for clearing catheter occlusions due to precipitation of?

A

Lipid residue

35
Q

Catheter related thrombosis caused by fibrin build up within blood vessels adhering to CVC is called:

A

Mural thrombosis

36
Q

What feature of a Groshong CVC reduces the risk of catheter occlusions?

A

Pressure sensitive three way valve

37
Q

A patient receiving chronic PN therapy develops an intralumenal clot in his CV access device. What is the most appropriate pharmacological intervention to clear this access device?

A

Alteplase 2mg/2ml

38
Q

A patient arrives in your clinic complaining of intermittent catheter malfunction. You identify that the catheter malfunction is relieved by raising the patients arm where the catheter is located. Which condition should be suspected?

A

Pinch off syndrome

39
Q

The use of 0.1N HCl is most effective for clearing catheter occlusions due to precipitation of?

A

Calcium phosphate.

40
Q

A 60 yo female (ht 152 cm, 45 kg) is receiving PN for a retrovaginal fistula. the PN formula consists of 10 g protein, 400 g dextrose, 35 g fat in a total volume of 1.5 liters. What is she at greatest risk for developing?

A

Hyperglycemia

41
Q

What are short term complications of home PN?

A

Dehydration, refeeding syndrome, catheter malposition.

42
Q

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

A

Manganese toxicity

43
Q

DIscontinuation of ILE is recommended treatment for catheter related bloodstream infection due to?

A

Malassezia furfur

44
Q

The most effective strategy to decrease the risk of catheter related sepsis is use of?

A

Full barrier precautions during catheter insertion

45
Q

A patient in an acute care hospital has undergone placement of a CVAD for PN. What evidenced based intervention should be implemented to reduce the risk of CVAD related infection?

A

Training of nursing staff to maintain CVAD

46
Q

A patient receiving ON that has chills, fever, positive blood cultures, but no redness or purulence at the catheter exit site probably has which catheter infection?

A

Catheter related bloodstream infection

47
Q

The most common route of infection for a tunneled CVAD is

A

Contamination of the catheter hub

48
Q

A patient receiving PN through a tunneled catheter in the IJ. He has a low grade fever and is mildly tachycardic but blood cultures are negative. There is some mild redness and tenderness but no purulence at the catheter exit site. How is this exit site infection best managed?

A

Initiate systemic antimicrobial therapy

CNSC Modules (8 decks)

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