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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

A

BCAA

24
Q

Classification of fatty acids

A

Carbon chain length
Number of double bonds

25
Q

Carbon chain length

A

SCFA: 2-4 C
MCT: 6-12 C
LCT: 14-24 C

26
Q

Number of double bonds

A

Saturated: 0
Monounsaturated: 1
Polyunsaturated: 2+

27
Q

US Commercially available IV lipid products

A

Linoleic acid (Omega-6)—49-65.8%
Linolenic acid (Omega-3)—4.2-9%

28
Q

How are lipids administered?

A

Via Y tube of piggybacked
Does not have to be mixed with amino acids and dextrose

29
Q

Electrolyte requirements

A

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
Q

Vitamins

A

Administered daily, now contain vitamin K
Multiple entity product

31
Q

Trace elements

A

Zn, Cr, Se, Cu, Mn
Single or multiple entity products

32
Q

For osteomyelitis or diarrhea losses

A

Increased Zn

33
Q

For severe hepatic cholestasis

A

Decrease Cu and Mn intake

34
Q

Other components of PN

A

Albumin
Heparin
Insulin

35
Q

Vein protectors

A

Hydrocortisone 15 mg
Heparin 1500 units
Nitroglycerin patch 0.1 mg/hr

36
Q

H2 antagonists and PN

A

Given in patients with GI stress ulcer for prophylaxis
Famotidine common, stable 72 hours
Ranitidine may also be added, stable 24 hours

37
Q

Fluid status monitoring

A

Signs and symptoms of fluid overload/dehydration
Measuring daily weight
Measuring daily input/output

38
Q

When should PN be used

A

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
Q

Optimal provision of nutrition

A

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
Q

Mifflin-St Jeor Equation

A

Men: BMR=10W + 6.25H - 5A+5
Women: BMR=10W + 6.25H - 5A - 161

41
Q

Revised Harris-Benedict Equation

A

For men: BMR=13.397W + 4.799H + 5.677A + 88.362
For men: BMR = 9.247W + 3.098H + 4.330A + 447.593

42
Q

Katch McArdie Formula

A

BMR = 370 + 21.6 (1-F)W
F= body fat percentage

43
Q

Micronutrients

A

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
Q

What should not be made for TPN

A

Kevorkian because it’s deadly

45
Q

Osmolarity compatibility

A

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
Q

Osmolarity of separate ions

A

mOsmol/L = W substance (g/L)/MW(g) x 1000

47
Q

Osmolarity of whole electrolyte

A

mOsmol/L = W substance (g/L)/MW(g) x number of species x 1000

48
Q

Osmolality

A

mmol/kg of solvent

49
Q

PN solution osmolarity

A

<600-900 mOsm/L

50
Q

Hazardous preciptiation

A

Phosphates + calcium ions in solution form a less soluble compound leading to precipitation

51
Q

Factors of ensuring the solubility of Ca and P in PN formulations (additives)

A

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
Q

Factors of ensuring the solubility of Ca and P in PN formulations (technique)

A

Agitate after each ingredient
Added Phos early and CaGluc nearly last
using a 0.2 micron filter
Never use CaCl2

53
Q

Factors favoring Ca / P solubility

A

Ca<10 mEq/L and PO4 <30 mMol/L
decreased T

54
Q

IV lipid emulsion stability

A

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
Q

Broken/cracked emulsion

A

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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