nutrition 2 TPN Flashcards
when is parenteral nutrition usually initiated
7-14 days after supoptimal PO nutrition
What are the types of micronutrients in TPNs
- electrolytes
- vitamins and minerals
- additives`
what are the 3 macronutrients in TPNs
- energy
- nitrogen
- fluid
what are the two main sources of energy in TPNs
- dextrose (carbohydrates)
2. fat
what is the approximate breakdown of caloric components in TPNs
- dextrose (50-60%)
- lipid (20-30%)
- protein
how many calories is in 1 g of protein
4 calories
how grams of protein make up 1 gram of nitrogen
6.25
how many calories are in one gram of dextrose
3.4 calories
what is the most common stock solution of dextrose for compounding solutions
70%
what is the core component in fat emulstions that gives a caloric contribution
egg phospholipids and glycerol components
what are some contraindications for IVFE
- egg allergy
- liver failure
- acute pancreatitis due to hyperlipidemia
what is the most important noncaompatible electrolyte to remember that is not compatible in TPNs
bicarbonate
what can be used instead of bicartbonate in TPNs
acetate
what are some of the typical compatible additional TPN additives
- regular insulin
- h2 blockers (famotidine, ranitidine)
- metoclopramide
- albumin
how are daily caloric needs calculated when determining nutritional needs
- calculate BEE
- calculate protein requirements
- calculate fluid requirements
- assess electrolyte needs
what % dextrose is considered hypertonic and must go through a central line
greater than 10% dextrose
how should discontinuation of TPN infusions be done
gradual taper over 24 hours; never stop without a taper for central TPNs
when can a TPN be discontinued without tapering
peripheral access TPN
what are intermittent (“cyclic”) TPNs
chronic TPN used in home for patients
what is one caution when using intermittent (“cyclic”) TPNs
increased fluid tolerance over a shorter period time and is difficult in the presence of diabetes or other glucose intolerant states
what are 4 types of complications of parenteral nutrition
- mechanical/ technical
- infectious
- metabolic
- long term
what are the different types of mechanical/ technical complications that can occur with TPNs
1. infusion pump malfunction 2, hematoma 3. air embolus 4. pneumothorax 5. thrombosis
what are 5 metabolic/ nutritional complications with TPNs
- parenteral nutrition associated liver disease (PNALD)
- hypertriglyceridemia
- hyperglycemia
- refeeding syndrome
- electrolyte/ acid-base disorders
what are the risk factorls for PNALD
- preexisting liver disease
- sepsis
- prolonged TPN therapy
- nutrient deficiencies
- excessive calorie administration
