Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

BCPS Exam > FEN: Parenteral Nutrition > Flashcards

FEN: Parenteral Nutrition Flashcards

1
Q

List two components when deciding whether parenteral nutrition is needed

A
  1. Timing and duration

2. Indication

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

What is the timing and duration of administering PN

A

It is anticipated that the patient will be unable to be fed orally or enterally for at least 7 days

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

When should PN be initiated as soon as possible?

A
  1. High nutritional risk OR
  2. Severely malnourished AND
    cannot tolerate EN
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

List three inflammatory disorders which are indications for PN

A
  1. Severe pancreatitis in patients who cannot tolerate EN
  2. Peritonitis
  3. Severe inflammatory bowel disease
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

List three medication conditions that are not principally inflammatory that are indications for PN

A
  1. Extensive bowel resection (e.g. short bowel syndrome) causing malabsorption or maldigestion
  2. Complete bowel obstruction
  3. Severe intractable vomiting or diarrhea
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

A seventh indication for PN is for patients who are unable to meet full nutritional needs by ____ route alone

A

Enteral

  1. Can use PN as a supplement to EN
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

What are two principle types of access routes for PN?

A
  1. Peripheral

2. Central

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Define peripheral access

A

Peripheral access is defined as the catheter tip position outside the central vessels or inferior or superior vena cava. This includes midline catheters.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Peripheral administration of PN can be used when three conditions are met (indication, circumstance, duration)

A
  1. Used in patients with an appropriate indication for PN
  2. When central IV acess is unavailable
  3. The need for PN is expected to be less than 2 weeks.
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Special considers for peripheral PN formulations: Dextrose must not exceed

A

10% or less

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Special considers for peripheral PN formulations: AA concentration must not exceed

A

2.5% to 4%

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Special considers for peripheral PN formulations: Ca2+ concentration must not exceed

A

5 mEq/L or less

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Special considers for peripheral PN formulations: K+ concentration must not exceed

A

40-60 mEq/L or less

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Special considers for peripheral PN formulations: Osmolarity must not exceed

A

900 mOsm/L or less

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Estimating the Osmolarity of PN: AA

A

10 mOsm/g

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Estimating the Osmolarity of PN: Dextrose

A

5 mOsm/g

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

Estimating the Osmolarity of PN: Lipid emulsion 10-20%

A

1.3-1.5 mOsm/g

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

Estimating the Osmolarity of PN: Sodium chloride/acetate

A

2 mOsm/mEq

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

Estimating the Osmolarity of PN: Potassium chloride/acetate

A

2 mOsm/mEq

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

Estimating the Osmolarity of PN: Calcium gluconate

A

0.68 mOsm/mL

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

Estimating the Osmolarity of PN: Magnesium sulfate

A

4.06 mOsm/mL

22
Q

What is the preferred type of venous access for PN?

A

Central

23
Q

Define central access

A
  1. Intravenous catheter (peripherally inserted central catheter, Hickman, Port-A-Cath)
  2. Where tip is in the superior vena cava or adjacent to the right atrium
24
Q

What type of central catheter should be avoided for PN and why?

A
  1. Femoral catheter

2. High risk of venous thrombosis and catheter-related infection

25
Q

Over what duration is PN typically infused for hospitalized patients?

A

Continuous infusion over 24 hours

26
Q

Over what duration is PN typically infused for ambulatory patients?

A

Cyclic continuous infusion over 12 hours

27
Q

Infusions are generally tolerated by patients if they are removed from the _____ and allowed to come to _______ before infusion

A
  1. refrigerator

2. room temperature

28
Q

What is a 2-in-1 PN?

A

PN in which all nutrients are mixed in the same IV bag, except for lipids, which are administered by a separate infusion

29
Q

What is a 3-in-1 PN?

A

Also called a total nutrient admixture, refers to PN in which all nutrients are mixed in the same IV bag.

30
Q

When lipids are infused separately, no faster than __ g/kg/hour in adults, using a ___ micron filter

A
  1. 0.1 g/kg/hour in adults

2. Using a 1.2-micron filter

31
Q

Rapid administration of lipids is associated with what 3 “temperature” related side effects?

A
  1. fever
  2. sweating
  3. flushing
32
Q

Rapid infusion of lipids is associated with what two types of “pain”

A
  1. Headache

2. Back or chest pain

33
Q

Rapid infusion of lipids is associated with what two “respiratory” symptoms?

A
  1. dyspnea

2. cyanosis

34
Q

Rapid infusion of lipids is associated with what laboratory derangement?

A

Hypertriglyceridemia

35
Q

Rapid infusion of lipids is associated with what GI-like side effect?

A

Nausea

36
Q

Lipid infusion time should be less than ___ hours because of the potential for _____ after this time

A
  1. Less than 12 hours

2. Potential for microbial growth after this time

37
Q

Why do 3-in-1 admixtures have less risk of microbial growth of lipids?

A
  1. Dextrose and AAs

2. Reduce pH and increase osmolarity

38
Q

How often should administration tubing for the dextrose/AA admixture of 2-in-1 tubing and the total nutrient admixture of 3-in-1 tubing be change?

A
  1. Administration tubing for a 2-in-1 should be changed every 24 hours
  2. Administration tubing for a 3-in-1 should be changed every 24 hours
39
Q

When should lipid tubing be changed?

A

Lipid tubing should be discarded after use (no longer than 12 hours)

40
Q

The stability of a 3-in-1 depends on the ___, which is determined primarily by the final ___ concentration. It should be maintained at least __%

A
  1. pH
  2. AA
  3. At least 4%
41
Q

Do not add concentrated ___ directly to a _____ emulsion when mixing a total nutrient admixture

A

Dextrose

42
Q

Avoid excessive amounts of these two elements when compounding 3-in-1 PN:

A
  1. Ca2+

2. Magnesium

43
Q

Total nutrient admixtures should have a final concentration of AA __%; monohydrated dextrose ____%; injectable lipid emulsion greater than __%

A
  1. AA: at least 4%
  2. Dextrose at least 10%
  3. Lipid at least 2%.
44
Q

List four premixed PN products available in the US

A
  1. Clinimix
  2. ProcalAmine
  3. Kabiven
  4. Perikabiven
45
Q

Describe Clinimix (hint: design, product variations, how to use, how to use lipids)

A
  1. Two-compartment bag containing AAs in one compartment and dextrose in the other
  2. Available with and without electrolytes
  3. Seal between the two-compartment bag must be broken to mix the AAs and dextrose
  4. Lipids can be added to the container after compartments are mixed or can be administered by Y-site
46
Q

Describe ProcalAmine (hint: contents, including kcal/g; limitation)

A
  1. Solution containing 3% AAs, glycerin (4.3 kcal/g), electrolytes in a single container
  2. Not sufficient for most patients because of insufficient protein and calories
47
Q

Describe Kabiven (hint: contents, design)

A
  1. Newer solution containing AAs, electrolytes, dextrose and a lipid emulsion
  2. Available in a 3-compartment bag for central line administration only
48
Q

Describe perikabiven

A
  1. Variation of kabiven

2. Formulated for peripheral administration, can also be administered centrally.

49
Q

What does the evidence say about the superiority of customized PN to standardized premixed PN?

A

Evidence is insufficient to show that customized PN is superior to standardized premixed products

50
Q

What type of patient would be a good candidate for premixed standardized PN? (hint: consider in ___, avoid in ____)

A
  1. Consider in stable patients who require PN

2. Avoid in patients with fluid restriction or high protein needs.

51
Q

Premixed products require fewer ______ and have a lower risk of _____ and ______ (three advantages)

A
  1. Fewer manipulations, therefore they have
  2. Lower risk of contamination
  3. Compounding errors.
52
Q

What three additives are sometimes added to premixed PN?

A
  1. Electrolytes
  2. vitamins
  3. Trace elements

BCPS Exam (34 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions