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CNSC Exam > Home Parenteral Nutrition > Flashcards

Home Parenteral Nutrition Flashcards

1
Q

Indications for home PN

A 
GI length/function
Intestinal failure (chron's , short bowel )
Short term loss of GI function (radiation enteritis from CA tx)
Temporary/permanent failure of EN feedings
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2
Q

Is a patient with ESRD an indicator for the need of home PN

A

no

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3
Q

in a patient with a small bowel resection, home PN will be covered if TPN is needed for longer than ___ days and if

A 
90 days
2 feet (60 cm)
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4
Q

in order to be covered for HPN, the diagnosis of _______ is critical to document

A

nonfunctional GI tract

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5
Q

In order to be considered for HPN coverage a patient must have been shown to trial and fail

A

enteral feeding (motility disturbance, short bowel >5 feet lost, mild malabsorption, regional enteritis, enter cutaneous fistula w/ inability to feed distally)

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6
Q

in order for Medicare to pay for home PN the MD must document

A

the need for PN based on the patient’s condition for 90 + days, anything less is NOT considered long and indefinite duration

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7
Q

for a home PN patient, there should be enough supplies for a ___,___, or ___ day supply

A

3,7,14 days

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8
Q

why can’t a 30 day supply of PN bags be provided to a home PN patient

A

not allowed by compounding guidelines

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9
Q

what is one of the main key concepts for discharge teaching for a home PN patient

A

learning the signs/symptoms of hypoglycemia/hyperglycemia

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10
Q

what factors contribute to quality of life in HPN patients

A
  • the severity of their underlying dz
  • frequency/magnitude and duration of sx
  • effect of sx on functional status
  • a person’s perception of health
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11
Q

in a home PN patient displaying signs of metabolic bone disease, the following adjustment would be the most appropriate

A

decrease the protein content, it will cause more calcium losses

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12
Q

in a home PN patient displaying signs of liver impairment, the most appropriate course of action would be to

A

decrease carbs and fat content

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13
Q

in addition to quality of life, cycling PN may provide __ in home PN patients

A

decreased risk of hepatic complications

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14
Q

____ can lead to metabolic bone disease, a possible complication of home PN

A

chronic metabolic acidosis

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15
Q

_____ increases the risk for hypercalciuria in home PN patients

A

excess dietary protein. Increased phosphate in the blood enhances calcium reabsorption by the renal tubule and won’t be urinated out. The urine will become concentrated with calcium

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16
Q

_____ing PN may increase renal losses s of calcium

A

cycling

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17
Q

a ____ to obtain a blood specimen during a lab draw can cause psuedohyperkalemia 2/2 hemoconstriction/hemostasis

A

tourniquet

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18
Q

as part of CMS documentation, documentation of inability to tolerating nutrition via the enteral route must include less than ____ feet of small bowel remaining beyond the ________, GI losses greater than____% of oral intake (2.5-3L/day), bowel rest for at least _____ days, calorie necessity of ____ to _____ kcal/kg/day, ____ to _____g/kg of protein a day, and lipids greater than _____ grams a month

A
  1. < 50 feet
  2. ligament of Treitz
  3. 50%
  4. 90 days
  5. 25-30 kcal/kg
  6. 0.8-1.5 g/kg/day
  7. > 1500 g /month
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19
Q

what materials/environmental necessities are REQUIRED for home TPN

A
  1. home or cell phone for medical emergencies
  2. back up BATTERY
  3. area for supplies storage
  4. electricity and running water
  5. refridgeration
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20
Q

is a back up generator required for home PN

A

no

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21
Q

who are considered high risk home PN patients

A

infants, patients on dialysis, diabetics, IV drug abuse, fluid/electrolyte or acid base disorders, refeed risk

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22
Q

high risk HPN patients require more

A

monitoring/clinical assessment

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23
Q

what does Medicare/Medicaid require in regards to length of time for insurance coverage

A

90 days, 3 months

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24
Q

Following initial certification of parenteral nutrition by Medicare, after what length of time is recertification required?

A

6 months(180 days)

25
Q

Enteral tube feeding must be trialed and attempted or shown to fail or explain why it isn’t an option prior to starting

A

PN

26
Q

under medicare guidelines, enteral infusion pumps are covered only with documentation of

A
  • not tolerative gravity feeding
  • gravity feeding contraindicated: reflux, aspiration, dumping syndrome, glycemic control, circulatory overload, slow infusion rate, or jejunal feedings
27
Q

serum conjugated bilirubin level is elevated in an adult patient with short bowel syndrome. The pt has been getting a 12 hour cycle of 3 in 1 TPN solution. The clinicians initial plan may include

A

evaluating for possible overfeeding of dextrose and or IVFE

28
Q

a condition of impaired secretion of bile or frank biliary obstruction in children/ LTPN adult patients is known as

A

Parenteral Nutrition Associated Cholestasis (PNAC)

29
Q

symptoms of PNAC include

A

elevated alk phos
elevated GGT
elevated conjugated/direct bilirubin with or without jaundice
increase manganese/copper (potentially)

30
Q

what is the proposed main cause of parenteral nutrition associated cholestasis

A

overfeeding of dextrose or IVFE

31
Q

there is no commercially available form of ______ and no proven benefits of helping with PNAC

A

choline

32
Q

only add carnitine to PN where there is __________ and it is not shown to help with ____________

A

a true deficiency detected

PNAC

33
Q

which trace element is most likely to occur in LTPN patients after 3-6 months of therapy

A

Iron Deficiency

34
Q

Fe deficiency is common in LTPN patients becuase

A

iron is not a component of PN to avoid potential microbial growth and damaging oxidative reactions

35
Q

IV iron should only be considered when

A

there is an identified iron deficiency and oral iron cannot be used

36
Q

what are the symptoms of iron deficiency

A

fatigue, headache, pallor, impaired behavior, unable to maintain body temperature

37
Q

iron is not compatible in which type of PN solution

A

TNA 3 in 1 TPN 2/2 the IVFE

38
Q

IV / parenteral iron can be added to this type of PN _______ but only when __________ ________ is given as a test dose for tolerance and to rule out a(n) _________

A

2: in 1 PN, iron dextran, anaphylactic reaction

39
Q

when IV iron is added to 2 in 1 PN solutions, how often should serum iron and ferritin levels be monitored

A

every 1-3 months to prevent Fe overload

40
Q

Medicare approved indications for HPN includes which of the following: supplement to EN, ESRD, long term loss of GI function, or delayed gastric emptying

A

long term loss of GI function

41
Q

a patient’s condition is considered to be long and indefinite when the duration is documented as ____ days

A

90 days, 3 months

42
Q

what defines good quality of life in HPN patients

A

the patient enjoys life, is happy, satisfied with life.

43
Q

_________ depends on a patients physical health, psychological well being, social and cognitive function and outlook on their illness/treatment

A

Quality of Life

44
Q

long term PN patients may develop metabolic bone disease if they have

A 
pre existing disease
malabsorption
metabolic acidosis
steroid treatment
calcium, phos, mag imbalances
vitamin D deficiency
45
Q

all patients on PN for greater than 1 year should be recommended for ______ to screen for metabolic bone disease

A

DEXA

46
Q

what is a key concept that should be included in post discharge teaching regimen for a HPN patient

A

signs and symptoms of complications and who to notify

47
Q

patients who maintain stability in their personal lives (employment, family support, financial support) adjust better to

A

life with HPN

48
Q

cosmetic look of a VAD is a concern for many HPN patients, true or false

A

true

49
Q

adjusting to HPN is easier for patients who

A

structure HPN around their specific lifestyles

50
Q

patients with _____ or ____ are at a higher risk for developing aluminum toxicity in long term PN

A

iron deficiency anemia (transferrin binds to aluminum to eliminate)

Renal disease: aluminum is excreted by the kidneys

51
Q

a majority of aluminum is bound to ______

A

transferrin

52
Q

clinical manifestations of aluminum toxicity are

A 
neruologic
hepatic
hematologic skeletal
non-specific
non sensitive
53
Q

many components of PN have an affinity for ___ which makes LTPN patients at high risk for toxicity

A

aluminum

54
Q

70% ethanol locks removes the _____ from the inside of VAD’s in which microorganisms are harbored.

A

biofilm

55
Q

70% ethanol locks are _____ with heparin

A

incompatible

56
Q

Ethanol locks should not be used on a venous access device made out of this material as it can degrade it

A

polyurethane

57
Q

True or false; 70% ethanol lock solutions have been known to provide microbial resistance

A

FALSE

58
Q

the ______ provides education, self help, research, an annual summer conference and online education materials

A

Oley Foundation

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