Lecture 6

Question 1

T or F: prescribing PN independently is an entry-level competency

Answer 1

False

Question 2

PN used for people with:

Answer 2

non functional GI tract, unable meet nutr rqts with PO/EN, inadequate PO/EN for prolonged period

Question 3

symptoms of non functional GI:

Answer 3

significant malabsorption, bowel obstruction, prolonged ileus, GI ischemia, intractable vomiting, GI fistula, GI bleed

Question 4

contraindications for PN:

Answer 4

functioning GI, anticipated duration only <7days, prognosis in which goals of care don’t warrant aggressive nutr support

Question 5

2 routes of PN infusion?

Answer 5

peripheral (terminate in small diameter vein), central (terminate in large diameter vein)

Question 6

most common PN in Sask?

Answer 6

PICC

Question 7

factors influencing choice of PN:

Answer 7

anticipated duration, osmolarity of solution, energy requirements, fluid tolerance, central line contraindicated

Question 8

indicators for PPN:

Answer 8

short term period of PN (up to 14 days), pt reasonably nourished, have peripheral vein access, catheritization of central vein is contraindicated

Question 9

PPN contraindications:

Answer 9

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

Question 10

complications of PPN:

Answer 10

phlebitis (inflammation of a vein), thrombosis, pain, infection

Question 11

advantages of PPN:

Answer 11

relatively easy venous access, decreased complications/infections risk (BUT have to change IV site often to maintain vein patency)

Question 12

indications for CPN:

Answer 12

PN >14 days, can accommodate hyperosmolar solution, easier to maintain

Question 13

why can CPN handle hypertonic solution?

Answer 13

high blood flow and volume of blood present rapidly dilutes hypertonic solution so doesn’t damage BV

Question 14

form of protein in PN:

Answer 14

crystalline a a (3.5-20% protein)

Question 15

a a products typically assumed to be __% Nitrogen

Answer 15

16

Question 16

nitrogen balance = _________

Answer 16

(protein intake g/d / 6.25) - (UUN g/d + 4 g/d)

Question 17

dextrose monohydrate has ___ kcal/g

Answer 17

3.4

Question 18

available concentrations of dextrose:

Answer 18

2.5-70%

Question 19

max concentration dextrose for PPN is:

Answer 19

10%

Question 20

why not >10% dextrose in PPN?

Answer 20

thrombophlebitis

Question 21

max oxidative rate for CHO is ___, minimum required for pro sparing is ____

Answer 21

4-5 mg/kg/min; 1 mg/kg/min

Question 22

why max oxidative rate for CHO?

Answer 22

excess cause hyperglycemia, hepatic abnormalities, excess CO2 production/ventilatory drive, overfeeding

Question 23

dual role of lipid:

Answer 23

source of non protein energy, source of EFA

Question 24

PN lipid emulsions available in these 3 concentrations:

Answer 24

10%, 20%, 30%

Question 25

1st gen lipid emulsions:

Answer 25

intralipid, high in n-6 fa

Question 26

2nd gen lipid emulsions:

Answer 26

balanced blends of n-3, n-6, n-9; anti-inflammatory, improved outcomes for septic pt and reduced PN associated liver disease

Question 27

minimum amount of fat to prevent EFA deficiency is:

Answer 27

8-10% energy, which is 500mL (100g/week) intralipid weekly

Question 28

when would you need to restrict amount of fat?

Answer 28

hypertriglyceridemia

Question 29

typical adult dosing for lipid:

Answer 29

25-30% energy, max 1-1.5 g /kg/day, infusion rate not to exceed 0.11 g /kg/h

Question 30

is 3-in-1 or 2-in-1 more flexible?

Answer 30

2-in-1

Question 31

most common PN deficiencies:

Answer 31

linoleic acid, zinc, copper, selenium, fat/water soluble vits, chromium

Question 32

how to prevent and treat liver steatosis?

Answer 32

decrease CHO intake, avoid hyperalimentation, use cyclical PN

Question 33

how to prevent and treat PNALD?

Answer 33

stim intestine, prevent bacterial overgrowth, taurine, ursodeoxycholic acid, cholecystokinin, vit E

Question 34

2 emphasized acute deficiencies:

Answer 34

hypoglycemia, hypophosphatemia

Question 35

liver steatosis is associated with:

Answer 35

^ plasma aminotransferases and liver enlargement (overfeeding, esp gluc)

Question 36

cholestatic liver disease is more common in:

Answer 36

kids and neonates

Question 37

most severe PN complications:

Answer 37

cholestatic liver disease, metabolic bone disease