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Therapeutics IV > Parenteral Nutrition > Flashcards

Parenteral Nutrition Flashcards

1
Q

Male IBW Calculation

A

IBW = 50 + 2.3 (in > 60)

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2
Q

Female IBW Calculation

A

IBW = 45.5 + 2.3 (in > 60)

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3
Q

NBW Calculation

A

NBW = IBW + 0.25(wt - IBW)

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4
Q

When do you use NBW?

A

if actual weight is > 130% of IBW

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5
Q

What classifies someone as under body weight (UBW)?

A

actual weight 20% below IBW

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6
Q

When does involuntary weight loss become concerning?

A

Weight loss > 10% within 6 months

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7
Q

After how many days of NPO does a person become at risk for malnutrition?

A

7 days

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8
Q

What types of patients are hypermetabolic at baseline?

A

trauma and burn patients

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9
Q

What medication leads to increased metabolic needs?

A

high dose steroids

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10
Q

Why does chronic alcohol/substance abuse put you at risk for malnutrition? (2)

A

decreases functional protein levels; intake of empty calories

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11
Q

All hospitalization patients should have their nutrition risk assessed within __ hours of admission.

A

48

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12
Q

What 3 aspects of a patient history are important for assessing nutrition risk?

A

dietary; medical; medication

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13
Q

Normal Transthyrenin (prealbumin) level

A

15-40 mg/dL

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14
Q

Why is it important to get baseline a baseline prealbumin value?

A

prealbumin is a negative acute phase reactant and can be lowered during inflammatory response

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15
Q

Which type of malnutrition is characterized by wasting of skeletal muscle and SQ fat as well as cachectic appearance?

A

protein-calorie malnutrition

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16
Q

What is another name for protein-calorie malnutrition?

A

marasmus

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17
Q

What type of malnutrition is characterized by adequate caloric intake?

A

protein malnutrition

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18
Q

What is another name for protein malnutrition?

A

kwashiorkor

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19
Q

Which type of nutrition is associated with trauma and burn patients?

A

protein malnutrition (kwashiorkor)

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20
Q

Which type of malnutrition is associated with muscle wasting?

A

protein-calorie malnutrition (marasmus)

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21
Q

List common symptoms of marasmus. (3)

A

hair loss; edema; skin folds

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22
Q

List common symptoms of kwashiorkor. (3)

A

failure to gain weight; large belly; change in skin pigment

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23
Q

Why must you provide carbs before protein in a patient with protein malnutrition?

A

if you just give protein, the body will use up all the protein for energy and stores will never be repleted

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24
Q

Increased protein catabolism leads to ______ UUN.

A

Increased

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25
Q

How is UUN measured?

A

24 hr urine collection

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26
Q

UUN represents ___% of total nitrogen excretion.

A

85-90

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27
Q

Goal nitrogen balance

A

+3 to +5 grams

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28
Q

Nitrogen balance calculation

A

(N in) - (N out)

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29
Q

(N in) equation

A

N in = [24-hr protein intake (g)] / 6.25

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30
Q

(N out) equation

A

N out = [24-hr UUN (g)] + 4

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31
Q

How often should you check a nitrogen balance?

A

once a week

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32
Q

Caloric requirement for all patients

A

25-30 kcal/kg/day

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33
Q

What is the goal RQ?

A

0.85-0.95

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34
Q

A high RQ is associated with _____.

A

overfeeding

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35
Q

A low RQ is associated with _____.

A

underfeeding

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36
Q

Underfeeding leads to depletion of ____ stores.

A

protein

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37
Q

Protein requirement for mild/moderate stress (floor patients)

A

1-1.5 gm/kg/day

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38
Q

Protein requirement for moderate/severe stress (ICU, trauma, burn)

A

1.5-2 gm/kg/day

39
Q

What is the standard distribution of non-protein calories?

A

70% dextrose / 30% fat

40
Q

How would you change the NPC distribution if a patient had high blood sugar?

A

decrease dextrose, increase fat

41
Q

How would you change the NPC distribution if a patient had high triglycerides?

A

increase dextrose, decrease fat

42
Q

When might 100/0 NPC be used?

A

sepsis; bloodstream infections

43
Q

List the indications for parenteral nutrition. (6)

A
  1. anticipated NPO > 7 days
  2. inability to absorb nutrients via the gut
  3. enterocutaneous fistulas
  4. inflammatory bowel disease
  5. hyperemesis gravidum (pregnant patients)
  6. bone marrow transplant
44
Q

What are some problems that lead to the inability to absorb nutrients through the gut? (4)

A
  1. bowel or colonic ileus
  2. small bowel resection
  3. malapsorptive states
  4. vomitting/diarrhea
45
Q

Why might bone marrow transplant patients require PN?

A

mucositis caused by treatments may cause pain that prevents the patient from eating

46
Q

What are the 3 sites available for central venous catheter insertion?

A
  1. subclavian
  2. internal jugular
  3. femoral
47
Q

Short term CVCs are _______.

A

percutaneously inserted

48
Q

Long term CVCs include: (3)

A
  1. PICC
  2. tunneled
  3. implanted port
49
Q

What type of catheter is most commonly used?

A

triple lumen

50
Q

TEE calculation

A

TEE = REE x 1.2

51
Q

1 gram protein = ___ kcal

A

4 kcal

52
Q

1 gram dextrose = ___ kcal

A

3.4 kcal

53
Q

What is the maximum carbohydrate utilization?

A

4-5 mg/kg/min

54
Q

1 gram lipid = ___ kcal

A

10 kcal

55
Q

What are anthroprometrics?

A

measures of the body’s muscle protein

56
Q

What are the 4 ways you can measure a person’s muscle protein?

A

weight; triceps skin fold; arm muscle circumference; physical appearance

57
Q

What is the goal final dextrose concentration for a TPN?

A

10%

58
Q

What are the ingredients in Intralipid? (4)

A

Soybean oil; glycerin; egg yolk phospholipid; water

59
Q

What type of essential fatty acid is available in Intralipid? (Hint: comes from soybean oil)

A

omega-6-fatty acid

60
Q

Which two parts of Intralipid might people be allergic to?

A

glycerin & egg yolk

61
Q

What are the ingredients of SMOFlipid?

A

soybean oil; medium-chain TG; olive oil; fish oil

62
Q

What type of EFA is in fish oil?

A

omega-3-fatty acid

63
Q

Which EFA is better?

A

omega-3-fatty acid

64
Q

What part of SMOFlipid might people be allergic to?

A

fish oil

65
Q

What are the benefits of SMOFlipid over Intralipid? (2)

A

improved liver function; lower increase in TG

66
Q

General lipid dosing in adult patients

A

1-1.5 g/kg/day

67
Q

Max lipid dose for adults

A

2.5 g/kg/day

68
Q

What sedative medication contains lipids?

A

propofol

69
Q

How much lipid is in propofol?

A

1.1 kcal/mL

70
Q

Which two types of fat emulsions are isotonic?

A

10% and 20%

71
Q

What does a total nutrient admixture consist of?

A

dextrose, AA, and lipids all in one bag

72
Q

What does a convential administration TPN consist of?

A

dextrose and AA in one bag with lipids given intermittently as IVPB

73
Q

What is not included in a premix solution TPN?

A

lipids

74
Q

Are electrolytes included in a premixed solution TPN?

A

they can be made with or without electrolytes

75
Q

Patients with a CrCl of ___ should not receive electrolytes in their TPN.

A

< 50

76
Q

You should start a TPN at __% of the goal rate and reach the final rate in ___ hours.

A

25%; 24 hours

77
Q

How often should you check BG after initiating the first TPN bag?

A

every 4-6 hours

78
Q

What do you do if after checking the patient’s BG it is > 200 mg/dL?

A

continue TPN at the same rate and re-check in 4-6 hours

79
Q

When would you initiate insulin in a TPN patient?

A

after 2 consecutive BG checks > 200 mg/dL

80
Q

How do you stop a TPN?

A

decrease rate by 1/2 every 2 hours

81
Q

How much vitamin product goes in a TPN?

A

10 ml/day

82
Q

How often should you monitor a patient’s prealbumin?

A

twice a week

83
Q

How often should you monitor RQ and UUN?

A

once a week

84
Q

What labs should you get at baseline for a patient being started on a TPN? (7)

A

CMP; Mg; Phos; Ca; prealbumin; hepatic function; PT/INR

85
Q

What electrolyte is most at risk for depletion in refeeding syndrome?

A

phos

86
Q

What are 3 consequences of refeeding syndrome? (Hint: all hypo-)

A

hypophosphatemia; mypomagnesemia; hypokalemia

87
Q

What is the first thing you should do to prevent refeeding syndrome in at-risk patients?

A

replete electrolytes before initiating feeds

88
Q

To prevent refeeding syndrome you should limit dextrose to _____ on the first day of feeds.

A

100-150 g/day

89
Q

To prevent refeeding syndrome you should limit fluids to _____ on the first day of feeds.

A

800 ml/day

90
Q

To prevent refeeding syndrome you should provide __% of total caloric needs on the first day of feeds.

A

50%

91
Q

Essential fatty acids make up __% of daily calories.

A

4-10%

92
Q

What is the mechanism behind EFA deficiency?

A

inhibits lipolysis and fatty acid mobilization

93
Q

When does EFA onset usually occur?

A

10-14 days after starting fat-free regimen

94
Q

What are the two options for prevention of EFA deficiency?

A
  1. 500 ml of 10% fat emulsion twice weekly

2. 250 ml of 20% fat emulsion twice weekly

Therapeutics IV (21 decks)

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