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NRSG 102: Med Surg 1 > Exam 1: Parenteral Nutrition > Flashcards

Exam 1: Parenteral Nutrition Flashcards

1
Q

Parenteral Nutrition (PN)

A

A method of providing nutrients to the body by an IV route

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2
Q

Preferred site for PN?

A

Superior Vena Cava

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3
Q

Indications for PN include

A

inability to ingest adequate oral foods or fluids within a 7-10 day time frame

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4
Q

How much formula is given?

A

1 - 3 L over a 24 hour period

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5
Q

Intravenous fat Emulsions (IVFEs or Lipids) may be…

A

infused simultaneously with PN through a Y connector close to the infusion site and should not be filtered

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6
Q

How much IVFE is normally given?

A

500 ml of 10% or 250 mL of 30% over 6-12 hours

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7
Q

IVFE can provide how much of daily caloric intake?

A

30%

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8
Q

What is a TNA?

A

A total nutrient admixture, where IVFEs and other mixtures can be added to the PN

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9
Q

What are the Standing Orders for PN?

A

Weighing the patient, monitoring I/O, Blood Glucose, And periodic monitoring of blood count, platelet count, and chemistry panel including serum CO2, Mg, P, and Triglycerides

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10
Q

How can PN be given?

A

Through Peripheral or Central IV Lines

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11
Q

What is PPN?

A

Peripheral Parenteral Nutrition, and is given through a peripheral vein. Given to supplement oral intake. This is possible because the solution is less hypertonic than a full-calorie PN solution. Have low dextrose content

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12
Q

Length of PPN?

A

5-7 Days

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13
Q

What is CPN?

A

Central Parenteral Nutrition, and solutions have 5-6 times the solute concentration of blood. Isotonic levels in the blood cause this to be very rapidly diluted.

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14
Q

What types of Central Venous Access Devices are there?

A

Percutaneous (Nontunneled)
Peripherally Inserted Centeral Catheters (PICCS)
Surgically Placed Catheters
Implanted Vascular Access Ports

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15
Q

Percutaneous Centeral Catheter duration

A

Used for short time (less than 6 weeks)

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16
Q

Vein for Percutaneous Centeral Catheter?

A

Subclavian vein because this provides a stable insertion site to which the catheter can be anchored.

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17
Q

Percutaneous Centeral Catheter: When shoudl the subclavian access site be avoided?

A

Avoided in patients with advanced kidney disease and those on hemodialysis to prevent subclavian vein stenosis.

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18
Q

Percutaneous Centeral Catheter: Second most common site?

A

Basilic, brachial, or cephalic veins in the arms followed by jugular vein.

Femoral vein should be used as last resort.

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19
Q

What would be used for a patient with limited IV access?

A

Triple-Lumen Catheter, because it offers three ports for various uses.

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20
Q

Duration for PICCS?

A

Used for intermediate term , days to months) , IV therapy in the hospital, long-term care or home setting

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21
Q

Who can insert a PICCs?

A

Primary provider bedisde or even by a specially trained nurse

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22
Q

Where does a PICC go?

A

The basilic, brachial, orcaphalic vein is accessed above the antecubital space, adn catheter is threaded to the superior vena cava.

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23
Q

What should you not do with a PICC

A

Taking blood pressure and blood specimens form the extremity with the PICC is avoided

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24
Q

Surgically Placed CentralCatheters Duration

A

May remain in place for many years

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25
Q

How are Surgically Placed Central Catheters inserted?

A

Inserted surgically, threaded under the skin to the cubclavian vein and advance dinto the superior vena cava

26
Q

What makes a Implanted Vascular Access Port Different?

A

Still used for long term but instead of exiting from the skin, the end of the catheter is attached to a small chamber that is placed in a subcutaneous pocket on the anterior chest wall or on the forearm.

27
Q

Why is a PN solution discontinued gradually?

A

To allow the patient to adjust to decreased levels of glucose. This will prevent rebound hypoglycemia.

28
Q

PN Complications: Pneumothorax: CAuse

A

Impropr catheter placement and inadvertent puncture of the pleura

29
Q

PN Complications: Pneumothorax: Treatment

A

Place platietn in Fowler position

30
Q

PN Complications: Pneumothorax: Prevention

A

Assit patient to remain still in Trendelenburg position during catheter insertion

31
Q

PN Complications:Air Embolism: Cause

A

Disconnected tubing, cap missing from port

32
Q

PN Complications:Air Embolism: Treatment

A

Replace tubing immediately and notify primary provider

33
Q

PN Complications:Air Embolism: Prevention

A

Examine all tubing connection siters for their security

34
Q

PN Complications: Clotted Catheter Line: Cause

A

Inadequate/infrequent saline/heparin flushes

35
Q

PN Complications: Clotted Catheter Line: Treatment

A

At direction of primary provider, lfish with thrombolytic medication as prescribed

36
Q

PN Complications: Clotted Catheter Line: Prevention

A

Flush lines per established protocols. Monitor infusion rate

37
Q

PN Complications: Catheter Displacement and Contamination: Cause

A

Excessive movement, possibly with a nonsecured catheter

38
Q

PN Complications: Catheter Displacement and Contamination: Treatment

A

Stop the infusion and notify the primary provider

39
Q

PN Complications: Catheter Displacement and Contamination: Prevention

A

Examine all tubing and connection sites

40
Q

PN Complications: Sepsis: Cause

A

Separation of dressings

41
Q

PN Complications: Sepsis: Treatment

A

Reinforce or change dressing quickly using aseptic technique

42
Q

PN Complications: Sepsis: PRevention

A

Maintain sterile technique when changing tubing

43
Q

PN Complications: Hyperglycemia: Cause

A

Glucose Intolerance

44
Q

PN Complications: Hyperglycemia: Treatment

A

Notify primary provider. Additional insulin may be prescribed

45
Q

PN Complications: Hyperglycemia: Prevention

A

Monitor glucose levels

46
Q

PN Complications: Fluid Overload: Cause

A

Fluid infusing rapidly

47
Q

PN Complications: Fluid Overload: Treatment

A

Decrease infusion rate. Monitor vital signs

48
Q

PN Complications: Fluid Overload: Prevention

A

Use infusion pump

49
Q

PN Complications: Rebound Hypoglycemia: Cause

A

Feedings stopped too abruptly

50
Q

PN Complications: Rebound Hypoglycemia: Treatment

A

Monitor for symptoms

51
Q

PN Complications: Rebound Hypoglycemia: Prevention

A

Gradually wean patient from PN

52
Q

Nutrients in PN are a complex admixture containing

A

proteins, carbohydrates, fats, electrolytes, citamins, trace minerals, and sterile water

53
Q

What happens when highly concentrated dextrose is given?

A

Caloric requirements are satisfied and the body uses amino acids for protein syntehsis rather than for energy

54
Q

Why should enteral nutrition be considered before parenteral?

A

Assists in maintaining gut mucosal integrity and improved immune function and asocited with fewer complications

55
Q

PN solutions are initiated slowly and advanded how?

A

gradually each day to the desired rate as the patietns fluid and dextrosetolerance permits

56
Q

Examples of Surgically Placed Central Catheters?

A

Power Line
Hickman
Groshong
Permacath

57
Q

Examples of Implanted Vascular Access Ports?

A

Power Injectable Port-A-Cath
Mediport
Hickman Port
P.A.S Port

58
Q

Symptoms of rebound hypoglycemia? Seen when PN solution discontinued too rapidly

A

WEakness, Faintness, Sweating, Shaking, Feeling Cold, Confused, Increased HR

59
Q

Continuous infusion of PN solution is recommended for how long?

60
Q

What happens if the PN solution runs out?

A

10% dextrose and water is infused at the same rate to prevent hypoglycemia

NRSG 102: Med Surg 1 (52 decks)

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