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Nursing Semester 2 > Monica - Week 8 - Exam 3 > Flashcards

Monica - Week 8 - Exam 3 Flashcards

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1
Q

what are three reasons we give parenteral nutrition in acute care setting?

A
  • administration of nutrients other than GI tract
  • not able to tolerate enteral feedings
  • delivers complete nutritional support
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2
Q

what are 4 considerations when it comes to parenteral nutrition?

A
  • critical illness after 7 days of hospitalization and enteral not feasible
  • protein-calorie malnutrition
  • major GI surgery and not able to feed (GI resection)
  • unable to meet energy requirements after 7 - 10 days by enteral route alone (helps supplement PO nutrient)
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3
Q

what are 8 other indications of parenteral nutrition?

A
  • chronic severe diarrhea and vomiting
  • complicated surgery or trauma
  • intractable diarrhea (loss of F+E)
  • GI tract abnormalities
  • severe malabsorption
  • GI obstruction
  • severe anorexia nervosa
  • short bowel syndrome (missing/removed; most nutrients absorbed here)
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4
Q

what is the osmolarity of PPN?

A

osmolarity NTE 900 mOsm/L

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5
Q

what is one indication for PPN?

A

supplement inadequate oral intake

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6
Q

how long can someone be on PPN?

A

temporarily; nutritional support for < 2 weeks

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7
Q

when is PPN administered?

A

administered around the clock or in cycles

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8
Q

how many calories does PPN offer?

A

provides < 2000kcal/day

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9
Q

what is the volume (size) of a PPN bag?

A

2000 - 3000 mL

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10
Q

what is the osmolarity of TPN?

A

ranges from 1500 - 2800 mOsm/L

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11
Q

what is one indication for TPN?

A

to correct nutritional deficits

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12
Q

who is a candidate for TPN?

A

a patient that has high protein/calorie requirements

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13
Q

how long can some be on TPN?

A

> 2 weeks

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14
Q

how many calories does TPN offer?

A

> 2000 kcal/day

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15
Q

how much dextrose might TPN contain?

A

may contain up to 50% dextrose

**may think about adding insulin??

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16
Q

what is the volume (size) of a TPN bag?

A

1 - 2 L bags; infusion volumes < PPN d/t higher tonicity

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17
Q

there is a risk for _______ when using both TPN and PPN.

A

phlebitis; 3-4 days –> start new IV to ensure patency and decrease risk of phlebitis

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18
Q

how is TPN given??

A

ONLY THROUGH A CENTRAL LINE; WE CAN’T GIVE THIS YET

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19
Q

what are 5 assessments/lab tests we need to be aware of when giving PN?

A
  • height/weight, ideal body weight, % of weight loss
  • electrolytes (Na+, K+, Mag+, glucose, Ca2+)
  • protein level (6 - 8g/dL; protein deficit?)
  • kidney function (BUN, Cr, GFR)
  • liver enzymes
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20
Q

why are we assessing function of the kidneys and liver?

A

to see if liver and kidneys can handle the PN (metabolism and excretion); can’t give too much protein if kidney/liver problems

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21
Q

what is the normal range for pre-albumin?

A

17 - 40mg/dL

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22
Q

what does pre-albumin tell us?

A
  • protein synthesis (mainly made by liver)

- assess malnutrition risk (can tell us RIGHT NOW if there is malnutrition)

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23
Q

what is the half life of pre-albumin?

A

2 days - that’s why it’s a good indicator of current state of malnutrition

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24
Q

T/F pre-albumin is more sensitive to changes in protein status

A

TRUE - d/t half life of 2 days

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25
Q

what is a lab test that monitors the efficacy of PN??

A

pre albumin

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26
Q

what pre-albumin level indicates severe nutritional deficiency?

A

< 10mg/dL

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27
Q

what pre-albumin level indicates severe protein depletion?

A

< 5mg/dL - other systems could be in danger - breakdown of muscle

28
Q

what is the normal range for albumin?

A

3.5 - 5.0

29
Q

what does albumin tell us?

A

it assesses nutritional status

30
Q

what is the half-life of albumin?

A

20 - 24 days

31
Q

what is the function of albumin?

A

maintains colloidal osmotic pressure –> prevents 3rd spacing

32
Q

what do low levels of albumin indicate?

A

severe malnutrition, liver, and kidney disease

33
Q

what do high levels of albumin indicate?

A

dehydration, severe vomiting or diarrhea

losing more fluid volume, so albumin is more concentrated

34
Q

what are the 4 macronutrients in PN?

A
  • water
  • dextrose (CHO)
  • lipids (fat)
  • amino acids (protein)
35
Q

what are the 3 micronutrients in PN?

A
  • electrolytes
  • vitamins
  • trace elements
36
Q

when are electrolyte levels drawn? why?

A
  • all electrolytes are drawn daily
  • assessed by pharmacy to adjust therapy
  • assess for abnormal levels
37
Q

what is the primary source of calories?

A

dextrose (carbohydrate souce) - 70 - 85%

38
Q

when is dextrose increased?

A

gradually increased based on patients tolerance

39
Q

what interventions should RN implement in relation to dextrose?

A
  • evaluate glucose tolerance

- glucoscan orders

40
Q

what are glucoscan orders for PN?

A

q6hrs initially and then qPM for qDay

**diabetics: increased frequency throughout therapy - already have insulin resistance issue

41
Q

what are 3 reasons amino acids are added?

A
  • synthesize proteins
  • conserve lean body mass - promotes body mass
  • promote wound healing - slows blood sugar rise
42
Q

one gram of amino acid = _____ gram of protein

A

ONE

43
Q

what is the percent of total calories for amino acid?

A

15 - 20%

44
Q

T/F renal or hepatic disease may decrease protein need

A

TRUE

45
Q

what are lipids?

A
  • essential fatty acids

- dense source of calories

46
Q

why are lipids added?

A
  • help w cellular development

- formation of healthy cell membranes

47
Q

what percentage of calories is lipids?

A

30% of calories

48
Q

what is the primary source of lipids?

A

soybean oil; also safflower oil

49
Q

T/F lipids is hung in conjunction with TPN with it’s own line and pump.

A

TRUE

50
Q

why are electrolytes added? how are they calculated?

A

acid based balance; adjusted based on lab results

51
Q

the liver converts ______ in the electrolyte solution into _______ via the _________.

A

acetate salts; bicarbonate; liver

***important to have a functioning liver

52
Q

which vitamins are added?

A

both fat- and water-soluble vitamins

53
Q

why are trace minerals added?

A

assist in transport of substances

54
Q

what specific minerals can be added?

A

chromium, copper, manganese, zinc

55
Q

what is special about iron?

A

iron not compatible; if needed. infuse separately on own pump and line

56
Q

what are the four risks/complications?

A
  • hyperglycemia
  • rebound hypoglycemia
  • refeeding syndrome
  • fluid overload
57
Q

what is hyperglycemia? how is it managed?

A
  • impaired glucose tolerance
  • insulin added or use sliding scale (educate pt)
  • ↑ monitoring frequency
58
Q

what should glucose levels be at initiation?

A

< 200 mg/dL

59
Q

what is glucose target range?

A

110 - 150 mg/dL during therapy

60
Q

how does rebound hypoglycemia occur? how can we prevent it?

A
  • ↑ insulin secretion during therapy (hyperinsulinemia)
  • PN withdrawn too rapidly
  • wean PN off gradually
  • reduce rate by 1/2 for 1 hr before d/c
61
Q

what should you do if PN bag empties before next bag is ready?

A

hang D10W or D20W (based on dextrose concentration that the patient is receiving.

62
Q

what should we assess for fluid overload?

A
  • elevated BP, bounding pulses, distended neck veins, rales

- assess I + O and daily weights

63
Q

what is refeeding syndrome?

A

overzealous caloric replacement

64
Q

how does refeeding syndrome occur

A

insulin release triggers cellular uptake of K+, phosphate, Mg++

65
Q

what is the hallmark sxs of refeeding syndrome?

A

profound hyposphatemia

66
Q

what are the sxs of hyposphatemia?

A

cardiac dysrhythmias, respiratory arrest, and neurological distrubances

Nursing Semester 2 (21 decks)

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