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ClinMed II Exam #4 GI > Parenteral/Enteral Nutrition > Flashcards

Parenteral/Enteral Nutrition Flashcards

1
Q

What are the responsibilities of the provider with nutritional support for patients?

A

Ordering dietary needs for, and supporting patients

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2
Q

What are some considerations for ordering oral nutritional support for patients?

A

Need to order a specific type, feeding tube may be needed

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3
Q

What are some considerations for ordering IV nutritional support for patients?

A

Need to order pharmacy consult and include diagnosis/total volume
Will also need to order IV access

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4
Q

Dietary support for nutritional needs?

A

Consult on oral nutrition types, evaluations on nutritional needs of ANY patient

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5
Q

Pharmacy support for nutritional needs?

A

Order & monitor parental nutrition w/ consult of dietary

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6
Q

Nursing support for nutritional needs?

A

Patient history, tube & IV access

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7
Q

SNS stands for what?

A

Nutritional support (aka specialized nutritional supplementation)
*enteral or parenteral

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8
Q

EN stands for what?

A

Enteral nutrition
(food supplementation using the gut)

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9
Q

PN stands for what?

A

Parenteral nutrition (aka total parenteral nutrition)
*food supplementation using IV access

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10
Q

Indications for SNS?

A

Non-functional GI tract, Critically ill patients, Eating disorders

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11
Q

Causes of a non-functional GI tract?

A

Bowel obstruction or resection, Intractable vomiting/severe diarrhea, Malabsorption, Bowel rest needed for >7 days, Enterocutaneous fistula

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12
Q

Intractable vomiting/severe diarrhea causing non-functional GI tract might be present in which conditions?

A

Pregnancy hyperemesis gravidarum (pregnancy N/V), Cancer patients

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13
Q

Bowel rest needed for >7 days causing non-functional GI tract might be present in which conditions?

A

Pancreatitis

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14
Q

What would classify as critically ill patients requiring extra nutritional support?

A

Burn or multi-system organ failure, COVID

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15
Q

Pediatric indications for SNS?

A

Non-functional GI tract, Critical illness, Inability to tolerate or deliver adequate nutrition

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16
Q

Pediatric causes of non-functional GI tract?

A

Bowel obstruction, Prolonged ileus, Peritonitis, Intractable vomiting/severe diarrhea, Enterocutaneous fistula, Short bowel syndrome

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17
Q

Pediatric causes of critical illness requiring extra nutritional support?

A

Hemodynamically instability, Severe metabolic state

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18
Q

Nutritional supplemental decision tree?

A

Disease state of nutritional deficiency –>Is pt alreadynnutritional deficient? –> Would SNS improve outcome/quality of life –> Is GI tract working? (yes = EN, no= possible TPN) –> How long will patient need SNS? (will determine tx for functional bowel SNS)

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19
Q

If patient has functional GI tract and needs SNS for <4 days, which support is recommended?

A

Fluid/electrolyte support

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20
Q

If patient has functional GI tract and needs SNS for >4 days, which support is recommended?

A

TPN

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21
Q

If patient has dysfunctional GI tract, which SNS is recommended?

A

EN

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22
Q

Pros of enteral nutrition?

A

Lets gut keep working, cost efficient

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23
Q

Cons of enteral nutrition?

A

Diarrhea, aspiration, requires GI function

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24
Q

Pros of parenteral nutrition?

A

Does not require GI function

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25
Cons of parenteral nutrition?
Requires IV access, increases the risk of: infection, thrombosis, hyperglycemia, metabolic abnormalities, fluid overload
26
1 kg is equal to how many pounds?
2.2 lbs
27
What is the ideal body weight (IBW) for men?
50kg + (2.3 kg x inches over 5 ft)
28
What is the ideal body weight (IBW) for women?
45.5kg + (2.3 kg x inches over 5 ft)
29
What is the formula for adjusted body weight?
IBW + 0.4 (actual weight - IBW)
30
When to use actual body weight for supplemental nutrition orders?
If actual is lower than IBW
31
When to use adjusted body weight for supplemental nutrition orders?
If patient's BMI is > or = 25
32
Daily fluid requirements for Neonates?
Day 1: 60 mL/kg/day Day 2: 80 mL/kg/day Day 3: 100 mL/kg/day Thereafter: 100-150 mL/kg/day
33
Daily fluid requirements for infants that are 3.5-10kg?
100 mL/kg/day
34
Daily fluid requirements for children that are 11-20kg?
1000 mL + 50 mL/kg/day (over 10 kg)
35
Daily fluid requirements for children that are >20kg?
1500 mL + (20mL) (W in kg-20kg)
36
How to calculate basal energy expenditure (BEE) for men?
66.67 + 13.75 * (W) + (5.0 * H) - (6.76 * A) A = age W = weight in kg H = height
37
How to calculate basal energy expenditure (BEE) for women?
665.1 + 9.56 * (W) + (1.86 * H) - (4.68 * A) A = age W = weight in kg H = height
38
Total daily energy formula?
(BEE) x (activity factor) x (stress factor)
39
Activity factor for patients confined to bed?
1.2
40
Activity factor for patients out of bed?
1.3
41
Stress factor for surgery?
1.2
42
Stress factor for infection?
1.4
43
Stress factor for trauma?
1.5
44
Stress factor for burns?
1.7
45
Normal protein intake for normal adult?
0.8-1g/kg/day
46
Normal protein intake for hospitalized adult?
1.2-2g/kg/day
47
How many kcal per gram?
4 kcal
48
Lipid intake requirements?
15-30% of total non-protein caloric requirement (kcal)
49
Non-protein calories formula?
Total calories - Protein caloric requirements
50
Carbohydrate percentage of typical intake?
70-85% of total non-protein calories (typical patient is 70%)
51
Maximum infusion rate for carbohydrates?
5 mg/kg/min
52
Lipids are needed to provide what?
Needed to provide essential fatty acids
53
Do not exceed what amount when administering lipids?
2.5 g/kg/day
54
What are supplemental nutritional lipids made from?
Soybean +/- olive oil
55
Cautions when administering lipids?
Allergies: egg, soy, & peanut w/ some formulations
56
What are the two formulations of supplemental lipids?
10%: 1.1 kcal/mL 20%: 2 kcal/mL
57
Caution with sodium electrolyte administration?
Heart failure
58
Caution with potassium electrolyte administration?
Renal failure
59
Caution with chloride electrolyte administration?
Alkalosis
60
Caution with acetate electrolyte administration?
Acidosis
61
Caution with calcium electrolyte administration?
Depends on albumin levels
62
Caution with magnesium electrolyte administration?
Renal failure, Diuretics
63
Caution with phosphorus electrolyte administration?
Malnutrition, High GI loss
64
What are standard set common additives for all TPN?
Multivitamins
65
Trace element common additives for TPN?
Zinc, Copper, Manganese, Chromium, Selenium
66
Other common additives for TPN?
Thiamine, Folic acid
67
Less common adult additives for TPN?
Insulin (regular only), Heparin, Iron dextran, Famotidine/Ranitidine
68
Which less common additive is used in dialysis?
Carnitine
69
Which less common additive is a must for pediatrics?
Cysteine
70
Why don't adults absolutely need cysteine as an additive to TPN?
Adults can make cysteine from methionine
71
Types of supplements?
2 in 1 3 in 1
72
Most common type of IV access in the hospital?
Peripheral line
73
Peripheral lines are inserted into which kind of vein?
Small vein
74
What is common with peripheral lines with high osmolality IV fluids such as TPN?
Vein irritation
75
Max osmolality for TPN with peripheral lines?
900-1000 mOsm/L
76
Central lines are inserted into which kind of vein?
Large vein
77
Which type of central lines are surgically implanted?
Central venous catheter (CVC)
78
Which type of central lines are inserted at bedside with sterile field setup?
PICC lines (Peripheral inserted central catheter)
79
Max osmolality for central lines?
No max osmolality due to fast dilution
80
Complications of TPN?
Hyperglycemia, Re-feeding syndrome, Hypoglycemia, Essential fatty acid deficiency (EFAD), Hypertriglyceridemia, Azotemia, Hepatobiliary issues
81
What is needed in Hyperglycemia with TPN?
Sliding scale of regular insulin q6hrs
82
What is needed in re-feeding syndrome with TPN?
Higher levels of phosphate and thiamine needed, extra monitoring of electrolytes, titrate TPN slowly
83
What is causes hypoglycemia with TPN?
Abrupt discontinuation
84
What is needed in essential fatty acid deficiency with TPN?
Essential linolenic and alpha linolenic at least BID
85
What causes hypertriglyceridemia with TPN?
Too much dextrose (overfeed)
86
What causes Azotemia with TPN?
Excessive protein (higher risk with liver/renal failure)
87
What causes Azotemia with TPN?
Excessive protein (higher risk with liver/renal failure)
88
Hepatobiliary issues with TPN?
Steatosis, Cholestasis, Gallbladder slude/stones (lack of GI stimulation)
89
What to add for Gallbladder issues with TPN?
Small amount of clear fluids orally
90
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ClinMed II Exam #4 GI (7 decks)

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