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FN 125 LE3 > PARENTERAL > Flashcards

PARENTERAL Flashcards

1
Q

method of providing macronutrients & micronutrients to those who are unable to assimilate nutrients via the GIT

A

Parenteral Nutrition

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2
Q

What are the INDICATIONS of PN

A

-Non-Functioning GIT
-Bowel Rest
-Severe Malnutrition
-Patient unable to eat orally ≥5 days
-Anticipated return to enteral nutrition is <7-10 days for Adults, 3-5 days for Infants/Children

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3
Q

CONTRAINDICATIONS of PN

A

-Functioning GIT
-Duration of anticipated treatment is <5 days provided patient is not severely malnourished
-Inability to obtain venous access
-Any prognosis which not warrant an aggressive form of nutrition support

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4
Q

3 ways of estimating TER in Parenteral Nutrition

A
  1. Calorie/Weight Method
  2. Harris-Benedict Equation for Basal Energy Expenditure
  3. Indirect Calorimetry & Oxygen Consumption Measurements
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5
Q

Provide the GOALS and corresponding kcal/kg BW/day of Calorie/Weight Method

A

-Resting Metabolic Expenditure = 25
-Maintenance = 30
-Anabolism = 35

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6
Q

What is the Harris-Benedict Equations for Basal Energy Expenditure in MALES?

A

TER = 66.47 + 13.75W (kg) + 5H (cm) - 6.75A (yrs)

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7
Q

What is the Harris-Benedict Equations for Basal Energy Expenditure in FEMALES?

A

TER = 655.1 + 9.56W (kg) + 1.85H (cm) - 4.67A (yrs)

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8
Q

Provide the GOALS and corresponding FACTOR of Harris-Benedict Equations for BEE

A

-Maintenance = BEE x 1.2
-Anabolism = BEE x 1.5

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9
Q

In Estimation of Fluid Requirements:

What are the approximate body fluid and fluid volumes by GIT secretion?

A

-Saliva = 1500 mL
-Gastric = 2500 mL
-Bile = 500 mL
-Pancreatic Juice = 700 mL
-Small Intestines = 3000 mL

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10
Q

Estimation of Fluid Requirements by Sex

A

-Ave. Males = 125 mL/hr (3L/day)
-Ave. Females = 100 mL/hr (2.4L/day)

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11
Q

Minimum acceptable Urine Output (UO)

A

900 mL/day

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12
Q

Estimation of Fluid Requirements by Method 1 (Adults & Older Adults)

Provide each category and corresponding volume

A

-Young, vigorous, previously healthy adult = 40 mL/kg
-Other adults = 35 mL/kg
-Older adults (elderly) = 25 mL/kg

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13
Q

Estimation of Fluid Requirements by Method 2 (Based on Body Weight)

Provide each weight and corresponding volume

A

-1st 10 kg = 100 mL/kg/day
-2nd 10 kg = 50 mL/kg/day
-each addition kg for:
»> ≤50 y/o = 20 mL/kg/day
»> >50 y/o = 15 mL/kg/day

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14
Q

Estimation of Fluid Requirements by Method 3 (Based on Goal)

Provide each goal and corresponding volume

A

-Maintenance = 60 mL/kg/day
-Replacement = 70 mL/kg/day

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15
Q

Guiding Principles in CARB REQUIREMENTS

  1. for a 70 kg man:
A

1 mg/kg/min HCHO or 100 g/day

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16
Q

Guiding Principles in CARB REQUIREMENTS

  1. Maximum CHO
A

5 mg/kg/min

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17
Q

Guiding Principles in CARB REQUIREMENTS

  1. Dextrose =
A

3.4 kcal/g

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18
Q

Guiding Principles in CARB REQUIREMENTS

  1. Final Dextrose conc should not exceed _____% (Peripheral) or ____%(Central)
A

-5% (Peripheral)
-35% (Central)

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19
Q

Guiding Principles in CARB REQUIREMENTS

  1. Glucose Infusion Rate should not exceed _____
A

5-7 mg/kg/min

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20
Q

PROTEIN REQUIREMENTS per condition

A

-Maintenance = 0.8-10 g/kg/day
-Minor Stress/Surgery = 1.25 g/kg/day
-Moderate Stress/Surgery = 1.50 g/kg/day
-Severe Stress/Trauma/Burns/Sepsis = 2.0-2.5 g/kg/day

21
Q

Guiding Principles in PROTEIN REQUIREMENTS:

  1. ___% of CHON/Amino Acids = Nitrogen (Protein Intake: ___ X amount of Nitrogen in g)
A

-16%
-6.25

22
Q

Guiding Principles in PROTEIN REQUIREMENTS:

  1. CHON should provide ____ of TER
A

15%

23
Q

Guiding Principles in PROTEIN REQUIREMENTS:

  1. In adults, PN should be able to provide _______ CHON/kg BW/day
A

1-2 g

24
Q

Guiding Principles in PROTEIN REQUIREMENTS:

True or False

  1. Excess CHON intake leads to CHON accumulation in the body
A

FALSE!

Excess CHON intake DOES NOT lead to CHON accumulation in the body

25
Q

Guiding Principles in PROTEIN REQUIREMENTS:

  1. For normal individuals: _______ is needed for the optimal utilization of 1 g of N atom
A

300 non-CHON kcal

26
Q

Guiding Principles in PROTEIN REQUIREMENTS:

  1. In critical illness: _______ is needed for the optimal utilization of 1 g of N atom
A

100-150 non-CHON kcal

27
Q

Guiding Principles in PROTEIN REQUIREMENTS:

  1. Amino Acid PN solution should provide
A

4 kcal/g

28
Q

Guiding Principles in PROTEIN REQUIREMENTS:

  1. Final amino acid concentration in PN solution should not exceed:
A

-4.25% for 3-in-1 solutions
-7.5% for non 3-in-1 solutions

29
Q

Guiding Principles in PROTEIN REQUIREMENTS:

  1. Adjustments for ______ should be applied
A

organ failure

30
Q

Guiding Principles in PROTEIN REQUIREMENTS:

Provide each condition and corresponding value for organ failure adjustments

(No. 9)

A

-On chronic hemodialysis = 1-1.29 g/kg/day
-On chronic ambulatory peritoneal = 1.2-1.5 g/kg/day
-Creatinine Clearance <30 mL/min = 0.5-1.0 g/kg/day

31
Q

Guiding Principles in PROTEIN REQUIREMENTS:

  1. Calorie:Nitrogen ratio Goals
A

-promote optimal utilization of N
-decrease gluconeogenesis with possible associated pre-renal azotemia

32
Q

What is azotemia?

A

accumulation of nitrogenous products

33
Q

Guiding Principles in PROTEIN REQUIREMENTS:

Provide each clinical status and corresponding calorie:nitrogen ratio

(No. 10)

A

-Mild-moderate stress = 133:1 (as NPC)
-Severe Stress (ex. Sepsis/Trauma) = 100:1
-Renal Patients = 250:450

34
Q

Guiding Principles in FAT REQUIREMENTS:

  1. For prevention of Essential Fatty Acid Deficiency (EFAD):

-____% of TER should come from Linoleic Acid (_____ mg/kg/day): ___ or ___ oil

-EFAD occurs if fat is not added to the ______ after ___ days

-____ mL fat emulsion every ____ days is sufficient

-Do not exceed _____ g/kg/day

-infuse over ____ hrs

A

-2-4% of TER should come from Linoleic Acid (25-100 mg/kg/day): Soy or Safflower oil

-EFAD occurs if fat is not added to the PN solution after 5 days

-500 mL fat emulsion every 5 days is sufficient

-Do not exceed >2.5 g/kg/day

-infuse over 12 hrs

35
Q

Guiding Principles in FAT REQUIREMENTS:

  1. Fat should not exceed ____ of TER
A

> 60%

36
Q

Guiding Principles in FAT REQUIREMENTS:

  1. In sepsis: fat should not exceed ____ of TER
A

> 20%

37
Q

Guiding Principles in FAT REQUIREMENTS:

  1. 10% fat emulsion =
A

1.1 kcal/mL

38
Q

Guiding Principles in FAT REQUIREMENTS:

  1. 20% fat emulsion =
A

2.0 kcal/mL

39
Q

Guiding Principles in MICRONUTRIENT REQUIREMENTS:

  1. Vitamins are mixed with ____ just prior to _____
A

vitamins are mixed with PN SOLUTION just prior to INFUSION

40
Q

Guiding Principles in MICRONUTRIENT REQUIREMENTS:

  1. Vitamin K is added: _____mg/week (not done if patient is on ______ therapy)
A

-2-4 mg/week
-coumarin/warfarin therapy

41
Q

Guiding Principles in MICRONUTRIENT REQUIREMENTS:

  1. Extracellular electrolytes: Non-stressed, average individual

(Provide electrolyte and corresponding value)

A

-Sodium = 50 mEq/L
-Chloride = 50 mEq/L
-Acetate = 50 mEq/L

42
Q

Guiding Principles in MICRONUTRIENT REQUIREMENTS:

  1. Intracellular electrolytes: for every ____ NPC
A

750-1000

43
Q

Guiding Principles in MICRONUTRIENT REQUIREMENTS:

Provide each intracellular electrolytes and corresponding value.

(No. 3)

A

-Potassium = 40 mEq/L
-Phosphate = 5 mEq/L
-Magnesium = 8 mEq/L
-Calcium = 10 mEq/L
-Zinc = 5 mEq/L

44
Q

Amino acid content of each commercially available solutions:

  1. Nutriflex Peripheral
  2. Nutriflex Basal
  3. Nutriflex Plus
  4. Nutriflex Special
A
  1. Nutriflex Peripheral (40/80)
  2. Nutriflex Basal (32/125)
  3. Nutriflex Plus (48/150)
  4. Nutriflex Special (70/240)
45
Q

This is available in a 3-chamber bag system.

A

Kabiven Peripheral

46
Q

Each bag of Kabiven Peripheral contains:

A

-glucose (largest chamber)
-amino acids & electrolytes
-fat emulsion (white solution)

47
Q

True or False

Electrolytes in Kabiven Peripheral can be mixed with glucose

A

True

48
Q

True or False

Electrolytes in Kabiven Peripheral can be mixed with fat

A

False

FN 125 LE3 (5 decks)

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