Lecture 2 - Parenteral Nutrition Flashcards
What do IV fluids contain?
Water, glucose, major electrolytes and potassium and sodium
What does enteral nutrition contain?
Balance of carbohydrates, proteins, fats, vitamin electrolytes and trace elements
What are the risks of increasing the volume of fluid to reach adequate calories?
Fluid overload - risk of low sodium in the blood
Increasing glucose concentration could damage blood vessels
Name the reasons for enteric nutrition
Neurological disorders (e.g. stroke)
Tumours
Trauma
Functional Gastrointestinal Tract
Patients who are unable to take anything orally
Anoxic encephalopathy
Oropharyngeal-Esophagael Disease
Name the 4 routes enteral nutrition can be taken
Nasogastric
Nasojejunal
Gastrostomy
Jejunostomy
What are the specific indications for PN when patient?
Unable to eat or absorb through the GI tract e.g. massive bowel resection
When EN feeing cannot be established e.g. major surgery, IBD, Crohn’s Disease and ulcerative colitis
Patients with disorders that necessitate complete bowel rest
Pre-term infants, congenital GI abnormalities
Define parenteral nutrition
Provides sufficient supplementation in patient groups such as cancer patients, critically ill, elderly patients and pre-term infants
What must PN provide?
Proteins, carbohydrates, lipids, vitamins, electrolytes, water and trace elements in variable populations to meet demand
Name the two types of PN
TPN (Total Parenteral Nutrition)
PPN (Partial Parenteral Nutrition)
What monitoring is required?
Body weight
FBC
Liver Function Tests
Glucose intake/ output
Electrolytes
BUN
What is considered when preparing a PN regimen?
The fluid volume of regimen
Energy requirement
Nitrogen requirement, proportion of fats, carbohydrates
Type of IV access - peripheral or central
whether or not the standard regimen is suitable as a basis of therapy
electrolyte and trace element requirements
When should fluid requirements be increased in?
Fever
Diarrhoea and vomiting
NG suction
unusual fluid loss from burns, wounds, stomas
Fistulas
When should fluid requiements be reduced In?
Renal failure
Congestive Heart Failure
Cirrhotic Disease
Pulmonary Disease
Name the possible reactions which could occur
Creaming and coalescence of a fat emulsion
Sugars and AAs might react to form yellow or brown substances
occurrence of precipitates of electrolytes
Non-preferred changes in pH
Define multiple chamber bag
Plastic bag divided into 3 compartments by a breakable seal, prevents reactions between the compartments
Less personalised lasts longer (6-18months) once opened use within 20 hours
Can add individual elements e.g. vitamins
