Parenteral Nutrition

Question 1

Who needs parenteral nutrition?

Answer 1

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

Question 2

define parenteral nutrition

Answer 2

-intravenous feeding

Question 3

define intravenous

Answer 3

-through a vein

Question 4

what two groups of veins are used for intravenous?

Answer 4

-peripheral veins and central veins

Question 5

what is PPN : Peripheral Parenteral Nutrition?

Answer 5

-peripheral veins (arms and legs)

Question 6

When is PPN given to a patient?

Answer 6

• short term nutrition support (7-10 days)

- those who do not have high nutrient needs

Question 7

What is TPN : Total Parenteral Nutrition?

Answer 7

-central veins (near the heart)

Question 8

When is TPN given to a patient?

Answer 8

• can support up to a 2500 cal /day diet
• longer term needs
• greater volume needs

Question 9

Why is there no limit on nutrient concentration with TPN?

Answer 9

because the veins are larger so it can support larger nutrient formulas

Question 10

In what form does the protein contained in IV feeding solutions appear? Why?

Answer 10

• amino acids

- because proteins in the blood can trigger an immune response

Question 11

In what form does the carbohydrate contained in IV feeding solutions appear? Why?

Answer 11

• dextrose monohydrate

- sugar that is chemically altered to be more soluble than glucose

Question 12

How are fats presented in IV feeding solutions?

Answer 12

-lipid emulsions : fatty acids in 10, 20, and 30% solutions

Question 13

what other nutrients besides amino acids, carbohydrates, and lipids are in IV feeding solutions?

Answer 13

• fluids and electrolytes

- vitamins and trace minerals (Zn,Cu, Cr, Se, Mn)

Question 14

What is the typical make up (%) of an IV feeding solution?

Answer 14

• 2.5% amino acid
• 6.25% dextrose
• 10-20% fat

Question 15

What is in a Simple IV Solution?

Answer 15

water, dextrose, and electrolytes

Question 16

what is NS?

Answer 16

• Normal Saline
• 0.9% NaCl
• Isotonic : same concentration as RBC

Question 17

define D#W.

Answer 17

-% dextrose in water

Question 18

explain what D5 or D5W tells you.

Answer 18

5% dextrose in water

Question 19

explain what D5/NS tells you.

Answer 19

5% dextrose in Normal Saline

Question 20

What is Phlebitis?

Answer 20

-inflammation of the vein

Question 21

What causes Phlebitis?

Answer 21

-overly concentrated nutrient solution

Question 22

What are the S/S of phlebitis?

Answer 22

• redness, swelling and tenderness at the infusion site

- if not treated can lead to large open wound and necrosis

Question 23

What is Respiratory Acidosis?

Answer 23

• low blood pH
• caused by improper lung function
• could also be caused by glucose oxidation

Question 24

Describe Cyclic Infusion.

Answer 24

• 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

Question 25

Discuss the Cruzan Case

Answer 25

• 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

Question 26

Durable Power of Attorney

Answer 26

• health care proxy

- another person to make decisions for someone

Question 27

Living Will

Answer 27

• medical directive
• whether or not a person wishes to have heroic life saving measures, specifies desired and non desired medical procedures

Question 28

What was another case that dealt with an ethical dilemma and legal decisions?

Answer 28

• 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