Parenteral Nutrition Flashcards
Who needs parenteral nutrition?
Patients with…
- intestinal obstructions
- intestinal paralysis
- short-bowl syndrome
- vomiting or diarrhea
- severe electrolyte, mineral and glucose imbalance
- severe pancreatitis
- bone marrow transplants
- severe malnutrition
define parenteral nutrition
-intravenous feeding
define intravenous
-through a vein
what two groups of veins are used for intravenous?
-peripheral veins and central veins
what is PPN : Peripheral Parenteral Nutrition?
-peripheral veins (arms and legs)
When is PPN given to a patient?
- short term nutrition support (7-10 days)
- those who do not have high nutrient needs
What is TPN : Total Parenteral Nutrition?
-central veins (near the heart)
When is TPN given to a patient?
- can support up to a 2500 cal /day diet
- longer term needs
- greater volume needs
Why is there no limit on nutrient concentration with TPN?
because the veins are larger so it can support larger nutrient formulas
In what form does the protein contained in IV feeding solutions appear? Why?
- amino acids
- because proteins in the blood can trigger an immune response
In what form does the carbohydrate contained in IV feeding solutions appear? Why?
- dextrose monohydrate
- sugar that is chemically altered to be more soluble than glucose
How are fats presented in IV feeding solutions?
-lipid emulsions : fatty acids in 10, 20, and 30% solutions
what other nutrients besides amino acids, carbohydrates, and lipids are in IV feeding solutions?
- fluids and electrolytes
- vitamins and trace minerals (Zn,Cu, Cr, Se, Mn)
What is the typical make up (%) of an IV feeding solution?
- 2.5% amino acid
- 6.25% dextrose
- 10-20% fat
What is in a Simple IV Solution?
water, dextrose, and electrolytes
what is NS?
- Normal Saline
- 0.9% NaCl
- Isotonic : same concentration as RBC
define D#W.
-% dextrose in water
explain what D5 or D5W tells you.
5% dextrose in water
explain what D5/NS tells you.
5% dextrose in Normal Saline
What is Phlebitis?
-inflammation of the vein
What causes Phlebitis?
-overly concentrated nutrient solution
What are the S/S of phlebitis?
- redness, swelling and tenderness at the infusion site
- if not treated can lead to large open wound and necrosis
What is Respiratory Acidosis?
- low blood pH
- caused by improper lung function
- could also be caused by glucose oxidation
Describe Cyclic Infusion.
- periodic administration of IV feeding
- usually 10-16 hours
- allows the patients to carry on with normal day
- usually done at home at night
- insulin rise and fall normally
Discuss the Cruzan Case
- occured in the 80s
- families do not have the right to remove a feeding tube unless there is a convincing evidence from the patient
What came out of this case?
- health care proxy
- medical directive
Durable Power of Attorney
- health care proxy
- another person to make decisions for someone
Living Will
- medical directive
- whether or not a person wishes to have heroic life saving measures, specifies desired and non desired medical procedures
What was another case that dealt with an ethical dilemma and legal decisions?
- Terri Shavio
- parents v. husband
- feeding tube removed 3 times, reinserted twice
- Terri’s Law : said governor has a say in cases like this, determined to be unconstitutional
