Home Parenteral Nutrition Flashcards
Indications for home PN
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
Is a patient with ESRD an indicator for the need of home PN
no
in a patient with a small bowel resection, home PN will be covered if TPN is needed for longer than ___ days and if
90 days 2 feet (60 cm)
in order to be covered for HPN, the diagnosis of _______ is critical to document
nonfunctional GI tract
In order to be considered for HPN coverage a patient must have been shown to trial and fail
enteral feeding (motility disturbance, short bowel >5 feet lost, mild malabsorption, regional enteritis, enter cutaneous fistula w/ inability to feed distally)
in order for Medicare to pay for home PN the MD must document
the need for PN based on the patient’s condition for 90 + days, anything less is NOT considered long and indefinite duration
for a home PN patient, there should be enough supplies for a ___,___, or ___ day supply
3,7,14 days
why can’t a 30 day supply of PN bags be provided to a home PN patient
not allowed by compounding guidelines
what is one of the main key concepts for discharge teaching for a home PN patient
learning the signs/symptoms of hypoglycemia/hyperglycemia
what factors contribute to quality of life in HPN patients
- the severity of their underlying dz
- frequency/magnitude and duration of sx
- effect of sx on functional status
- a person’s perception of health
in a home PN patient displaying signs of metabolic bone disease, the following adjustment would be the most appropriate
decrease the protein content, it will cause more calcium losses
in a home PN patient displaying signs of liver impairment, the most appropriate course of action would be to
decrease carbs and fat content
in addition to quality of life, cycling PN may provide __ in home PN patients
decreased risk of hepatic complications
____ can lead to metabolic bone disease, a possible complication of home PN
chronic metabolic acidosis
_____ increases the risk for hypercalciuria in home PN patients
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
_____ing PN may increase renal losses s of calcium
cycling
a ____ to obtain a blood specimen during a lab draw can cause psuedohyperkalemia 2/2 hemoconstriction/hemostasis
tourniquet
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
- < 50 feet
- ligament of Treitz
- 50%
- 90 days
- 25-30 kcal/kg
- 0.8-1.5 g/kg/day
- > 1500 g /month
what materials/environmental necessities are REQUIRED for home TPN
- home or cell phone for medical emergencies
- back up BATTERY
- area for supplies storage
- electricity and running water
- refridgeration
is a back up generator required for home PN
no
who are considered high risk home PN patients
infants, patients on dialysis, diabetics, IV drug abuse, fluid/electrolyte or acid base disorders, refeed risk
high risk HPN patients require more
monitoring/clinical assessment
what does Medicare/Medicaid require in regards to length of time for insurance coverage
90 days, 3 months
Following initial certification of parenteral nutrition by Medicare, after what length of time is recertification required?
6 months(180 days)
