Lecture 6 Flashcards
T or F: prescribing PN independently is an entry-level competency
False
PN used for people with:
non functional GI tract, unable meet nutr rqts with PO/EN, inadequate PO/EN for prolonged period
symptoms of non functional GI:
significant malabsorption, bowel obstruction, prolonged ileus, GI ischemia, intractable vomiting, GI fistula, GI bleed
contraindications for PN:
functioning GI, anticipated duration only <7days, prognosis in which goals of care don’t warrant aggressive nutr support
2 routes of PN infusion?
peripheral (terminate in small diameter vein), central (terminate in large diameter vein)
most common PN in Sask?
PICC
factors influencing choice of PN:
anticipated duration, osmolarity of solution, energy requirements, fluid tolerance, central line contraindicated
indicators for PPN:
short term period of PN (up to 14 days), pt reasonably nourished, have peripheral vein access, catheritization of central vein is contraindicated
PPN contraindications:
large cal/nutr/electrolyte needs (max solution osmolarity is 900 mOsm/L), fluid restriction, need for prolonged PN, renal/liver compromise, severe metabolic stress, poor peripheral vein access
complications of PPN:
phlebitis (inflammation of a vein), thrombosis, pain, infection
advantages of PPN:
relatively easy venous access, decreased complications/infections risk (BUT have to change IV site often to maintain vein patency)
indications for CPN:
PN >14 days, can accommodate hyperosmolar solution, easier to maintain
why can CPN handle hypertonic solution?
high blood flow and volume of blood present rapidly dilutes hypertonic solution so doesn’t damage BV
form of protein in PN:
crystalline a a (3.5-20% protein)
a a products typically assumed to be __% Nitrogen
16
nitrogen balance = _________
(protein intake g/d / 6.25) - (UUN g/d + 4 g/d)
dextrose monohydrate has ___ kcal/g
3.4
available concentrations of dextrose:
2.5-70%
max concentration dextrose for PPN is:
10%
why not >10% dextrose in PPN?
thrombophlebitis
max oxidative rate for CHO is ___, minimum required for pro sparing is ____
4-5 mg/kg/min; 1 mg/kg/min
why max oxidative rate for CHO?
excess cause hyperglycemia, hepatic abnormalities, excess CO2 production/ventilatory drive, overfeeding
dual role of lipid:
source of non protein energy, source of EFA
PN lipid emulsions available in these 3 concentrations:
10%, 20%, 30%
1st gen lipid emulsions:
intralipid, high in n-6 fa
2nd gen lipid emulsions:
balanced blends of n-3, n-6, n-9; anti-inflammatory, improved outcomes for septic pt and reduced PN associated liver disease
minimum amount of fat to prevent EFA deficiency is:
8-10% energy, which is 500mL (100g/week) intralipid weekly
when would you need to restrict amount of fat?
hypertriglyceridemia
typical adult dosing for lipid:
25-30% energy, max 1-1.5 g /kg/day, infusion rate not to exceed 0.11 g /kg/h
is 3-in-1 or 2-in-1 more flexible?
2-in-1
most common PN deficiencies:
linoleic acid, zinc, copper, selenium, fat/water soluble vits, chromium
how to prevent and treat liver steatosis?
decrease CHO intake, avoid hyperalimentation, use cyclical PN
how to prevent and treat PNALD?
stim intestine, prevent bacterial overgrowth, taurine, ursodeoxycholic acid, cholecystokinin, vit E
2 emphasized acute deficiencies:
hypoglycemia, hypophosphatemia
liver steatosis is associated with:
^ plasma aminotransferases and liver enlargement (overfeeding, esp gluc)
cholestatic liver disease is more common in:
kids and neonates
most severe PN complications:
cholestatic liver disease, metabolic bone disease
