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CDM 2 Exam 3 > Lecture 6 - Parenteral Nutrition > Flashcards

Lecture 6 - Parenteral Nutrition Flashcards

1
Q

PN Indications for use

A
  1. pts whose nutritional needs cant be met with enteral feedings w/I 7 days
  2. Pts w/ severe malnutrition or catabolism where GI tract no useable
  3. GI tract not functional
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2
Q

PN CI

A
  1. pts w/ functional or usable GI tract capable of absorption
  2. Less than 5 days of treatment
  3. prognosis doest warrant aggressive nutrition or when not wanted by pt/faily

** If the gut works, use it **

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3
Q

When can PN be life saving?

A
  1. functional short gut
  2. prematurity
  3. inflammatory lesions
  4. ileus
  5. anatomic short gut
  6. severe anorexia/hypermetabolsim
  7. cancer
  8. burns
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4
Q

PN access

A

Central = catheter tip into SVC/RA junction

PICC = use perisperhal veins insert tip into SVC/RA junction

Peripheral = catheter not in heart, Max PN 900mOsm/l

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5
Q

Peripheral PN info

A
  1. limited to max osmolality of 900mOsm/L

2. Ideal pts = adequate veins, short duration, not critically ill, not fluid restricted

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6
Q

Macronutrients of PN

A

Dextrose
Protein (amino acid)
Fat

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7
Q

Micronutrients of PN

A

Electrolytes
Minerals
Vitamins
Trace elements

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8
Q

Protein req

A

healthy adult = 0.8g/kg/day

critical ill = 1.2-2.5g/kg/day
moderate = 1-1.5g/kg/day
severe stress = 1.5-2g/kg/day

restrict protein - hepatic encephalopathy, renal failure when dialysis CI

4kcal/g amino acids

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9
Q

Protein calories

A

15-20% calories should be protein

health adult = 300 nonprotein calories to utilize 1g N2
critical ill = 100-150NPC 1g N2

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10
Q

Dextrose Info

A
  1. cheap, stable,easily stored
  2. 3.4kcal/g
  3. fuel sources for CNS,RBC, renal medulla
  4. 10% ok for PIV
  5. Osm > 900 req CVL
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11
Q

What happens if give over max dextrose?

A

fatty liver
insulin resistance
hyperglycemia

dont exceed 4-7mg/kd/min, 5.8-10g/kg/day

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12
Q

IV Fat emulsion info

A
  1. 2nd source of NPC
  2. 9kcal/g
  3. use hormone + prostaglandin synthesis, cell membrane structure
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13
Q

Electrolyte Req

A 
sodium
potassium
chloride
acetate
magnesium
calcium gluconate
phosphorus
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14
Q

PN with zero chloride is….

A

rare…question it

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15
Q

Typical Trace elements

A 
Zinc
Copper
Chronium
Manganese
Selenium
iron
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16
Q

Multivitamin info

A

** Should always be included in PN, if not IV for available atleast give thiamine***

17
Q

Admin of TPN

A

24hr = hospitalized pts

Cyclic = popular w/ home patients, must be tapered on/off

Lipids = separate infusion, 12hr hang time…TNA = 24hrs hang time

18
Q

Refeeding syndrome

A
  1. occurs in malnourished pts receiving aggressive PN
    consequences: hypo- kalemia/phosphatemia, cardiac arrythmias, respiratory failure
    management: close monitoring of dextrose, K, Mg, Phos
19
Q

infectious complications of PN risk factors

A
  1. critical illness
  2. foreign body in bloodstream
  3. mucosal atrophy
  4. multiple antibiotics
20
Q

Metabolic complications of PN

A 
Azotemia
electrolyte imbalance
glucose intolerance
cholestasis
metabolic bone disease
urolithiasis
coagulopathy, thrombocytopenia
21
Q

Mechanical complications of PN

A
  1. CVL related…malposition, blockage, embolization

2. infusion related = superficial or deep extravasation

22
Q

PN associated Cholestasis

A 
amino acid imbalances
ratio of carb:fat
nutrient deficiencies
phytosterols
inflammaton
lack of enteral feeding
23
Q

Preventing PNAC

A

Cycling PN
Trophic Enteral feedings
Protection of PN from light

24
Q

PNAC treatment options

A

Limit IV fat < 1g/kg/day average
Limit carb calories
Reduce copper and manganese in PN
Eliminate hepatotoxic meds

Absolute: 100% enteral feedings and no PN *****

25
Q

Aluminum toxicity

A
  1. associated with impaired bone mineralization, renal insufficiency and neurotoxicity
  2. FDa mandate limit al intake in PN < 5 mCg/kg/day
  3. neonates greatest risk
  4. avoid product with aluminum contamination
26
Q

Max tolerance lvl for fat

A

2.5g/kg and 60% of energy

27
Q

Min amount and Max infusion rate carbs/day

A

min= 100g

max rate = 5mg/kg/min

28
Q

General compounding guidelines

A

Phosphorus first, calcium last

Assess visually

Most conc first, least conc last

29
Q

Factors affecting Ca/Phos solubility

A
  1. Ca/Phos salt conc
  2. pH of final solution
  3. Type/quantity of AA used
  4. Temp
  5. Time
  6. Mg content
  7. order of mixing
30
Q

Calcium-Phosphorus Solubility FDA Safety Alert

A

3-1 1. Solubility of calcium should be calc from the volume of solution at the time the calcium is added, not final volume

  1. Some brands of amino acids contain phosphorus and must be considered when calc the final phosphorus conc
  2. Phosphate added prior to calcium
31
Q

TNA

A

3 in 1 solution

simplified Admin
improves pt tolerance
allows lipid infusion over 24hrs = less side effects
dont use pediatrics

CDM 2 Exam 3 (13 decks)

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