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Ther III test 2 > nutrition 2 TPN > Flashcards

nutrition 2 TPN Flashcards

1
Q

when is parenteral nutrition usually initiated

A

7-14 days after supoptimal PO nutrition

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2
Q

What are the types of micronutrients in TPNs

A
  1. electrolytes
  2. vitamins and minerals
  3. additives`
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3
Q

what are the 3 macronutrients in TPNs

A
  1. energy
  2. nitrogen
  3. fluid
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4
Q

what are the two main sources of energy in TPNs

A
  1. dextrose (carbohydrates)

2. fat

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5
Q

what is the approximate breakdown of caloric components in TPNs

A
  1. dextrose (50-60%)
  2. lipid (20-30%)
  3. protein
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6
Q

how many calories is in 1 g of protein

A

4 calories

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7
Q

how grams of protein make up 1 gram of nitrogen

A

6.25

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8
Q

how many calories are in one gram of dextrose

A

3.4 calories

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9
Q

what is the most common stock solution of dextrose for compounding solutions

A

70%

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10
Q

what is the core component in fat emulstions that gives a caloric contribution

A

egg phospholipids and glycerol components

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11
Q

what are some contraindications for IVFE

A
  1. egg allergy
  2. liver failure
  3. acute pancreatitis due to hyperlipidemia
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12
Q

what is the most important noncaompatible electrolyte to remember that is not compatible in TPNs

A

bicarbonate

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13
Q

what can be used instead of bicartbonate in TPNs

A

acetate

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14
Q

what are some of the typical compatible additional TPN additives

A
  1. regular insulin
  2. h2 blockers (famotidine, ranitidine)
  3. metoclopramide
  4. albumin
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15
Q

how are daily caloric needs calculated when determining nutritional needs

A
  1. calculate BEE
  2. calculate protein requirements
  3. calculate fluid requirements
  4. assess electrolyte needs
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16
Q

what % dextrose is considered hypertonic and must go through a central line

A

greater than 10% dextrose

17
Q

how should discontinuation of TPN infusions be done

A

gradual taper over 24 hours; never stop without a taper for central TPNs

18
Q

when can a TPN be discontinued without tapering

A

peripheral access TPN

19
Q

what are intermittent (“cyclic”) TPNs

A

chronic TPN used in home for patients

20
Q

what is one caution when using intermittent (“cyclic”) TPNs

A

increased fluid tolerance over a shorter period time and is difficult in the presence of diabetes or other glucose intolerant states

21
Q

what are 4 types of complications of parenteral nutrition

A
  1. mechanical/ technical
  2. infectious
  3. metabolic
  4. long term
22
Q

what are the different types of mechanical/ technical complications that can occur with TPNs

A 
1. infusion pump malfunction
2, hematoma
3. air embolus
4. pneumothorax
5. thrombosis
23
Q

what are 5 metabolic/ nutritional complications with TPNs

A
  1. parenteral nutrition associated liver disease (PNALD)
  2. hypertriglyceridemia
  3. hyperglycemia
  4. refeeding syndrome
  5. electrolyte/ acid-base disorders
24
Q

what are the risk factorls for PNALD

A
  1. preexisting liver disease
  2. sepsis
  3. prolonged TPN therapy
  4. nutrient deficiencies
  5. excessive calorie administration
25
Q

what are the risk factors of hypertriglyceridemia in TPNs

A
  1. pre-xisting liver or pancreatic dysfunction
  2. sepsis
  3. multiple organ failure
  4. IVFE infusion rate
26
Q

what are 4 risk factors for hyperglycemia with TPNs

A
  1. history of DM
  2. metabolic stress
  3. glucocorticoid use
  4. excessive carbohydrate intake
27
Q

how should hyperglycemia in TPNs be manageed

A

adding regular insulin to PN

2. start with 100-200 g dextrose on day 1 and advance when BG is controlled

28
Q

what characterizes refeeding syndrome

A
  1. severe electrolyte depletion
  2. fluid retention
  3. micronutrient deficiency
  4. hyperglycemia
29
Q

how is refeeding syndrome prevented

A

25-50% of non protein requirements initially and advance over 3-4 days to the desired goal

30
Q

what are two long term complications with TPNs

A
  1. essential fatty acid deficiency

2. metabolic bone disease

Ther III test 2 (15 decks)

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