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Parenteral therapy 2 > Parenteral Nutrition > Flashcards

Parenteral Nutrition Flashcards

1
Q

Nutritionally at risk

A

1 month >5% UBW loss
6 month >10% UBW or >20% IBW loss

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2
Q

% IBW

A

Weight/IBW x 100
% of ideal body weight

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3
Q

% UBW

A

% usual body wight
Current weight/usual weight x 100

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4
Q

% of recent weight

A

Usual weight -current weight/usual weight x100

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5
Q

When should actual weight be used?

A

If the patient is underweight or normal weight
For severely underweight use actual weight initially and then increase requirements to an upper limit if 35 kcal/kg/day

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6
Q

When should adjusted body weight be used?

A

In overweight patients so as not to overestimate nutritional requirements

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7
Q

Adjusted weight

A

(Adj-IBW/2)+IBW

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8
Q

Parenteral nutrition

A

Administered outside the digestive tract intravenously

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9
Q

Enteral nutrition

A

Oral or tube feedings into the digestive tract

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10
Q

When to use parenteral nutrition

A

If the GI tract is not working

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11
Q

If the GI tract is not used

A

It can atrophy
Gut bacteria can translocate to the circulatory system when GI tract atrophies

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12
Q

Nutrition types

A

Enteral
Peripheral parenteral nutrition
Total parenteral nutrition

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13
Q

Peripheral parenteral nutrition (PPN)

A

AKA peripheral venous nutrition

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14
Q

PPN advantages

A

Avoid central catheter-related complications
Avoid hyperosmolar complications

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15
Q

PPN Disadvantages

A

Thrombophlebitis
Frequent vein rotation
Caloric intake is limited
Fluid restriction is NOT possible

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16
Q

Why it’s caloric intake limited in PPN

A

Because the hypertonic solutions would cause an intolerable rush of fluid into the small veins via osmotic shift leading to thrombosis

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17
Q

PPN infusion

A

Catheter in upper arm
Up to 1800-2500 kcal and 90g protein supported
Only supported for a short period at high levels

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18
Q

TPN

A

AKA central parenteral nutrition
Hyperal

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19
Q

TPN advantages

A

Long term catheter maintenance
Maximum caloric intake
Fluid restriction is possible

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20
Q

TPN disadvantages

A

Mechanical complications of catheter placement
Potential hyperosmolar complications
Infectious complications

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21
Q

Parenteral nutrition composition

A

Dextrose—3.4 kcal/gm
Protein—4 kcal/gm
Fat—10 kcal/gm
Electrolytes
Trace elements
Vitamins
Water—35 mL/kg/day
Other ingredients

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22
Q

Composition of 10% amino acid products

A

Nitrogen content
Essential AA
BCAA
AAA
Actual content amounts vary depending on the specific product

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23
Q

What does aminosyn II have more of than Travasol

24
Q

Classification of fatty acids

A

Carbon chain length
Number of double bonds

25
Carbon chain length
SCFA: 2-4 C MCT: 6-12 C LCT: 14-24 C
26
Number of double bonds
Saturated: 0 Monounsaturated: 1 Polyunsaturated: 2+
27
US Commercially available IV lipid products
Linoleic acid (Omega-6)—49-65.8% Linolenic acid (Omega-3)—4.2-9%
28
How are lipids administered?
Via Y tube of piggybacked Does not have to be mixed with amino acids and dextrose
29
Electrolyte requirements
Na: 1-2 mEq/kg K: 1-2 mEq/kg Phos: 20-40 mmol/day Ca (gluconate): 10-15 mEq/day Mg(SO4): 8-20 mEq/day
30
Vitamins
Administered daily, now contain vitamin K Multiple entity product
31
Trace elements
Zn, Cr, Se, Cu, Mn Single or multiple entity products
32
For osteomyelitis or diarrhea losses
Increased Zn
33
For severe hepatic cholestasis
Decrease Cu and Mn intake
34
Other components of PN
Albumin Heparin Insulin
35
Vein protectors
Hydrocortisone 15 mg Heparin 1500 units Nitroglycerin patch 0.1 mg/hr
36
H2 antagonists and PN
Given in patients with GI stress ulcer for prophylaxis Famotidine common, stable 72 hours Ranitidine may also be added, stable 24 hours
37
Fluid status monitoring
Signs and symptoms of fluid overload/dehydration Measuring daily weight Measuring daily input/output
38
When should PN be used
patients who cannot/will not eat for >7 days Can be used for up to 1 week Central PN is necessary when GI tract is not accessible/functional for > 2 weeks
39
Optimal provision of nutrition
max glucose: 5 mg/kg/min Infuse 30% or less of total daily calories as fat to avoid immune dysfunction Protein delivery in stressed patients with normal function is 1.5-2 g/kg/day
40
Mifflin-St Jeor Equation
Men: BMR=10W + 6.25H - 5A+5 Women: BMR=10W + 6.25H - 5A - 161
41
Revised Harris-Benedict Equation
For men: BMR=13.397W + 4.799H + 5.677A + 88.362 For men: BMR = 9.247W + 3.098H + 4.330A + 447.593
42
Katch McArdie Formula
BMR = 370 + 21.6 (1-F)W F= body fat percentage
43
Micronutrients
Na/K: 1-2 mEq/kg Phosphate: 20-40 mmol/day Magnesium: 8-24 mEq/day Calcium: 10-15 mEq/day Chloride 60-100 mEq/day Acetate: 60-100 mEq/day
44
What should not be made for TPN
Kevorkian because it's deadly
45
Osmolarity compatibility
osmotic pressure is proportional to the total number of particles in solution nonelectrolyte: 1 mmol = 1 mOsmol electrolyte: 1 mmol NaCl = 2 mOsmol assuming complete dissosciation
46
Osmolarity of separate ions
mOsmol/L = W substance (g/L)/MW(g) x 1000
47
Osmolarity of whole electrolyte
mOsmol/L = W substance (g/L)/MW(g) x number of species x 1000
48
Osmolality
mmol/kg of solvent
49
PN solution osmolarity
<600-900 mOsm/L
50
Hazardous preciptiation
Phosphates + calcium ions in solution form a less soluble compound leading to precipitation
51
Factors of ensuring the solubility of Ca and P in PN formulations (additives)
Lower final pH to get the more soluble compound --higher dextrose --add cysteine HCl --lower final concentration of lipids Increase the amino acid concentration Rate of growth in admixtures may be variable Keep concentrations below the solubility curve
52
Factors of ensuring the solubility of Ca and P in PN formulations (technique)
Agitate after each ingredient Added Phos early and CaGluc nearly last using a 0.2 micron filter Never use CaCl2
53
Factors favoring Ca / P solubility
Ca<10 mEq/L and PO4 <30 mMol/L decreased T
54
IV lipid emulsion stability
Contain chylomicron-like oil droplets of neutral TGs with a surrounding layer of phospholipids Droplet size ~0.5 microns and negative surface size Charge prevents aggregation and maintains emulsion stability
55
Broken/cracked emulsion
Cracked TNA occurs when oil globules on the surface coalesce or fuse to form larger oil droplets Appears as an amber oil layer or streaks Irreversible

Parenteral therapy 2 (6 decks)

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