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Clinical > oral and parenteral nutrition > Flashcards

oral and parenteral nutrition Flashcards

1
Q

define malnutrition

A

deficiency or excess of energy and nutrients

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2
Q

define cachexia

A

gerneral weight loss and wasting occurring in the course of a chronic or emotional disease

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3
Q

define nutrition support

A

provision of enteral or parenteral nutrients to treat or prevent nutrition

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4
Q

define enteral nutrition

A

feeding tube placed in Gi tract to deliver liquid formulas containing all essential nutrients

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5
Q

define parenteral nutrition

A

infusion of complete nutrient solutions into the bloodstream

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6
Q

prevalence of malnutrition *

A

malnutrition at admission is prevalent and associated with prolonged length of stay
complex disease and age related social factors are contributors

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7
Q

complications of malnutrition *

A 
impaired immune response 
reduce muscle strength and fatigue
reduced respiratory muscle function 
impaired thermoregulation
impaired wound healing and delayed recovery 
depression 
increased risk of admin to hospital and LOS 
poor libido, fertility
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8
Q

nutritionally high risk patients

A 
diagnosis of malnutrition 
significant weight loss
conditions requiring increase calories
BMI less than 18.5/23
intak eless than 50% of estimated energy needed for >3 days
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9
Q

diet suggestions for malnourished

A 
promote intake of nutrient dense food 
liberalize diet 
preferred foods
high energy protein shakes or drinks between meals 
snacks between meals
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10
Q

3 types of tube feedings

A

continuous
cyclic - over fixed period over night usually
bolus - 4-6 timesa day to mimic normal eating patterns

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11
Q

when do you use enteral nutrition *

A

oral intake inadequate or not recommended for long period of time
malnourished - after 2-5 days
prolonged inadequate intake - 7-10 days

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12
Q

why is enteral preferred over parenteral when the Gi tract is functioning *

A 
more convenient 
lower cost
decreased infectious complications 
may enhance immune function, maintain gut flora
decrease metabolic complications
allow access for meds
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13
Q

complications of enteral

A

NV
aspiration
refeeding
metabolic complications

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14
Q

contraindications of enteral

A

perforation of GI
mechanical or non-mechanical bowel obstruction
inability to access GI tract
GI ischemia

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15
Q

polymeric formualtion

A

intact milk or soy proetin based

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16
Q

elemental formulation

A

free amino acids or short chain peptides

17
Q

incorrect med admin results in

A

clogged feeding tubes
decreased drug effectiveness
increase adverse effects
drug formula incompatibilities

18
Q

how can you administer meds *

A

liquid dosage form when possible
dilute hypertonic meds wiht 10-30ml
crush tablets to powder and mix with 30ml water
administer each drug separately
flush tube with 15ml warm water before, 5ml between each drug, 15ml after last med given

19
Q

indications of parenteral

A

where Gi tract not functional or cant be accessed
patient who cant be adequately nourished by oral diets or enteral
inadequate oral intake for 7-14 days

20
Q

4 conditions that indication parenteral

A

Gi ischemia
small bowel/intestinal obstruction
GI fistula
short bowel syndrome

21
Q

components of total peripheral nutrition

A 
dextrose
amino acids
lipids
electrolytes
trace elements
multivitamins
22
Q

energy requirements

A

25-30 kcal/kg

23
Q

fluid requirements

A

30ml/kg

24
Q

what are the electrolytes

A 
Na
K
Cl
Ca
phosphate
Mg
25
Q

what must you keep separate in TPN

A

phosphate and calcium

26
Q

how does osmolarity determine route of admin

A

under 900 mOsm/L for peripheral

27
Q

2 in 1 parenteral nutrition

A

mixture of dextrose and amino acids with lipids infused separately

28
Q

medications that can be added to TPN

A

special insulin
ranitidine
zinc
iron

29
Q

complications of TPN

A 
infections
blood clots 
foreign body in vascular 
hyperglycemia 
refeeding
increased triglycerides
hepatotoxicity 
fluid overload
metabolic acidosis/alkalosis
osteomalacia
30
Q

what is cycling TPN

A

admin of full PN over the shortest tolerable time

31
Q

role of pharmacist

A

asses patients nutritional status, comorbid disease states, medications
work with team to determine if TPN appropriate
review clinical parameters and make recommendations
work with team to manage complications

32
Q

what is refeeding

A

intracellular shift of serum phosphorus as metabolism starts
stimulates insulin and internal transport of K and Mg
increased sodium and fluids

Clinical (16 decks)

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