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Therapeutics 4 > Parenteral Nutrition > Flashcards

Parenteral Nutrition Flashcards

1
Q

PN

When would nutritional body weight (NBW) be used for parenteral nutrition calculations?

A

if ABW is > 130% of IBW

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2
Q

PN

What is the equation for nutritional body weight (NBW)?

A

NBW= IBW + 0.25(ABW-IBW)

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3
Q

PN

What are the risk factors for malnutrition?

A
  • under body weight (UBW)= 20% below IBW
  • involuntary weight loss= > 10% within 6 months
  • NPO > 10 days (clinically= inadequate intake > 7 days)
  • increased metabolic needs (trauma and burns, high dose steroids)
  • alcohol/substance abuse
  • protracted nutrient losses (chronic disease states)
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4
Q

PN

What screening tools can be used to assess nutritional needs?

A
  • NUTRIC
  • Nutritional Risk Score (NRS-2002)

and many others…

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5
Q

PN

What NUTRIC score determines a patient is high risk for malnutrition?

A

6-10

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6
Q

PN

How can visceral proteins be used to determine a patients nutritional status?

A

albumin and transferrin may be used but have long half lives, so monitoring transthryetin (prealbumin) may be a better indicator

although none may be accurate for the ICU setting

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7
Q

PN

What is the normal lab value for C-Reactive protein?

A

< 1 mg/dL

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8
Q

PN

How can C-Reactive protein be used to determine nutritional status?

A

prealbumin decreases as CPR normal = malnutrition

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9
Q

PN

Define: Marasmus malnutrition

A

protein-calorie nutrition due to decrease in total intake and/or utilization of food= patients have evident muscle wasting, peeling and alternatively pigmented skin, hair loss, edema, swelling

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10
Q

PN

Define: Kwashiorkor malnutrition

A

protein malnutrition due to inadequate protein intake, but calorie intake is adequate (typically seen in trauma and burn patients)- muscle wasting is not evident, large belly, diarrhea, failure to gain weight, fatigue, hair changes

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11
Q

PN

What is the treatment for Marasmus malnutrition?

A

well balanced substrate, while considering the addition of vitamin B

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12
Q

PN

What is the treatment for Kwashiorkor malnutrition?

A

carbohydrates followed by high protein

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13
Q

PN

How is excretion of nitrogen measured?

A

urinary urea nitrogen (UUN)

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14
Q

PN

What is the goal nitrogen balance (Nin-Nout)?

A

+3 - +5

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15
Q

PN

What is the formula for nitrogen balance?

A

Nin - Nout
Nin= 24h protein intake (g)/ 6.25
Nout= 24h UUN (g) + factor of 4

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16
Q

PN

What is the recommended calorie intake for non-stressed/non-depleted patients?

A

20-25 kcal/kg/day

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17
Q

PN

What is the recommended calorie intake for trauma/stress/surgery patients?

A

25-30 kcal/kg/day

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18
Q

PN

What is the recommended calorie intake for patients with BMI 30-50?

A

11-14 kcal/kg/day (use actual body weight)

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19
Q

PN

What is the recommended calorie intake for patients with BMI > 50?

A

22-25 kcal/kg/day (use ideal body weight)

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20
Q

PN

What does the TEE tell you about the patients nutrition?

A

required kcal/day

TEE= REE x 1.2

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21
Q

PN

What is the goal respiratory quotient (RQ)?

22
Q

PN

What respiratory quotient (RQ) indicates overfeeding?

23
Q

PN

What respiratory quotient (RQ) indicates underfeeding?

24
Q

PN

What is the recommended maintenance proteins for patients?

A

0.8-1 g/kg/day

25
Q

PN

What is the recommended proteins for mild-moderate stress patients?

A

1-1.5 g/kg/day

26
Q

PN

What is the recommended proteins for moderate-severe stress patients?

these patients would be found in the ICU, trauma/surgery/burn patients

A

1.5-2 g/kg/day

27
Q

PN

What is the recommended proteins for patients with BMI > 30?

A

2 g/kg/day (use ideal body weight)

28
Q

PN

What is the recommended proteins for patients with BMI 40+?

A

2.5 g/kg/day (use ideal body weight)

29
Q

PN

What patients may be protein intolerance?

A

patients with renal and hepatic diseases

30
Q

PN

What is distribution of non-protein calories (NPC)?

A

standard distribution (70/30)= 70-85% dextrose, 15-30% fat

31
Q

PN

What is parenteral nutrition (PN)?

A

supplying nutrients via IV

32
Q

PN

What are the indications for parenteral nutrition (PN)?

A
  • anticipated prolonged NPO (> 7 days)
  • inability to absorb nutrients through the gut (small bowel or colonic ileus, extensive bowel resection, malabsorption stress, intractable vomiting/diarrhea)
  • enterocutaneous fistulas
  • inflammatory bowel disease
  • hypperemesis gravidum
  • bone marrow transplantation
33
Q

PN

What must be taken into account for peripheral parenteral nutrition?

A
  • dextrose concentration due to hypertonicity (not well tolerated in peripheral vein)- ristrict dextrose concentration to 5-10%/ or < 900 mOsm/L
  • large volume required so not a good choice for HF or AKI/CKD patients
  • limited calories
  • only short term access is tolerated (7-10 days)

always double check to confirm the route was intentional

34
Q

PN

What must be taken into account for centeral parenteral nutrition?

A
  • hypertonic solutions may be delievered and more calories
  • risk of infection (appropiate line care is critcial)
  • line must be implanted with risk of pneumothroax, air embolus, thrombus
35
Q

PN

How many kcal are in one gram of protein?

36
Q

PN

How many kcal are in 1 gram dextrose?

37
Q

PN

What is the maximum carbohydrate utilization?

A

4-5 mg/kg/min

38
Q

PN

How many kcal are in 1 gram lipids?

39
Q

PN

What does Intralipid 10% consist of?

A
  • soybean oil
  • glycerin (check allergies)
  • egg yolk (check allergies)
  • water for injection
40
Q

PN

What does SMOFlipid consist of?

A
  • soybean oil
  • medium chain triglycerides
  • olive oil
  • fish oil (check allergies)
41
Q

PN

What is the benefit of using SMOFlipid over other lipid products?

A
  • improved liver function (over pure soybean oil products)
  • lower increase in TG levels from baseline (compared to pure soybean oil products)
  • less pro-inflammatory
  • less negative impact on liver function
  • reduced risk of infection
  • decreased length of hospital stay
42
Q

PN

What is the maximum intake of lipids?

A

60% of total intake lipids- generally 1-1.5 g/kg/day of lipids, max of 2.5 g/kg/day if patient is tolerating

43
Q

PN

What sedative drug includes lipids and needs to be considered for parenteral nutrition?

A

propofol is a 10% lipid solution= 1.1 kcal/mL

44
Q

PN

What trace elements must be included in parenteral nutrition to avoid complications?

A
  • zinc
  • copper
  • chromium
  • selenium
  • manganese
  • iron
45
Q

PN

What complications can arise from parenteral nutrition?

A
  • mechanical (clotting of line, displacement)
  • infections (sepsis)
  • metabolic (electrolyte imbalances, fluid imbalances, hyper- and hypo-glycemia, liver function abnormalities)
46
Q

PN

What are the monitoring parameters for parenteral nutrition?

A
  • BASELINE= CMP, Mg, Phos, Ca, hepatic function, prealbumin, PT/INR
  • vital signs (daily)
  • I/O (daily)
  • electrolytes (daily)
  • weight (2x/week, but daily in ICU)
  • CBC (2x/week, but daily in ICU)
  • magnesium, phosphorus, calcium (2x/week, but daily in ICU)
  • prealbumin (2x/week, but daily in ICU)
  • ONCE WEEKLY= albumin, transferrin, nitrogen balance, liver function, triglycerides, PT/INR, RESPIRATORY QUOTIENT (RQ)/indirect calorimetry
47
Q

PN

What is refeeding syndrome?

A

potentially life threatening condition that occurs within the first few days of feeding a starved patient due to fluid, micronutrient, electrolye, and vitamin imbalances

48
Q

PN

What are the clinical findings of refeeding syndrome?

A
  • hypophosphatemia, hypomagnesemia, hypokalemia
  • respiratory distress
  • paresthesias
  • tetany
  • cardiac arrhythmias
  • hemolytic anemia
49
Q

PN

What are the risk factors for refeeding syndrome?

A
  • rapid feeding, excessive dextrose infusion
  • low BMI (< 16-18)
  • excessive weight loss
  • insufficient calorie intake
  • low levels of K, Phos, or Mg prior to feeding
  • loss of subcut fat or muscle mass
  • high risk comorbidities: alcoholism, anorexia, Marasmus malnutrition
50
Q

PN

How can refeeding syndrome be prevented?

A
  • replete electrolytes before initiating feeds
  • upon initiation limit carbohydrates to 100-150g, limit fluids to 800 mL/day, provide adequate electrolytes, provide 50% of caloric needs
  • give thiamine 100mg daily for 5-7 days
51
Q

PN

What is the essential fatty acid (EFA) requirements?

A

4-10% of daily calories

Therapeutics 4 (7 decks)

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