Enteral feeding

Question 1

What is TPN

Answer 1

concentrated solution of dextrose and amino acids that must be administered through a central venous catheter

Question 2

What is a PPN

Answer 2

Less concentrated solution of dextrose and amino acids that may be administered through a peripheral venous catheter

Question 3

What is enteral nutrition

Answer 3

Provision of nutrients via the GI tract

Question 4

What are benefits of enteral feeding

Answer 4

better supports viscera, cheaper, support the GI tract

Question 5

What type of ailments would lead to PN

Answer 5

massive small bowel resection, intractable vomitting, chronic malabsorption , severe diarrhea, enterocutaneous fistula, chemotherapy, eating disorder

Question 6

What are benefits of TPN

Answer 6

Allows for the provision of complete energy and protein needs, indicated for long term supplementation (greater than 1-2 weeks) allows for fluid restriction if necessary

Question 7

What are benefits of PPN

Answer 7

short term use (less than seven days), fat is maximized

Question 8

What are complications for a TPN, PPN

Answer 8

pneumothroax, higher infection rate, more care for line maintenance/ high incidence of phlebitis, frequent IV site changes

Question 9

What are advantages of 3-in-1

Answer 9

all components are aseptically compounded, less line manipulation, less risk of contamination, less nursing time, can be used at home

Question 10

What are the steps to designing a PN regimen

Answer 10

1) Determine fluid, calorie and protein requirements 2) Start with 30% of calories from fat unless contradiction 3) Calculate kcal from protein 4) Calculate grams of glucose based on kcal left 5)Calculate % dextrose and % protein 6) Add electrolytes, MVI and trace elements

Question 11

What is the most common reason for a liver abnormality after feeding (increased ALT/AST, ALK PO4, Bilirubin)

Answer 11

Overfeeding

Question 12

What are the benefits of cyclic administration

Answer 12

minimize hepatotoxicity, better appetite, increased mobility

Question 13

What are the major risk factors for refeeding syndrome

Answer 13

BMI less than 16kg/m2, unintentional weight loss greater than 15% in the last 3-6 months, little to no nutrient intake for over 10 days, low levels of phosphate, magnesium and potassium

Question 14

What is the best way to prevent refeeding syndrome if a patient is at risk

Answer 14

give half the amount of glucose