Parenteral Nutrition Flashcards by Unknown Unknown

Osmolarity of PN.
Dextrose
Amino Acids
Electrolytes provide…

Dextrose =50 Osm/gram
Amino Acids=100 m0sm/gram
Electrolytes=1 mOsm/mEq or 2 x na and 2 x k + 25

How well did you know this?

Not at all

Perfectly

Morbidity

Refers to having a disease or a symptom of disease, or to the amount of disease within a population. Morbidity also refers to medical problems caused by a treatment.

How well did you know this?

Not at all

Perfectly

Mortality

Susceptible to death or rate that a population or group is susceptible

How well did you know this?

Not at all

Perfectly

Smallest filter size for 3 in 1 PN is

1.2 microns

How well did you know this?

Not at all

Perfectly

2 in 1 PN filter size is

0.22 microns

This is considered a sterilizing filter

How well did you know this?

Not at all

Perfectly

Increased amino acid concentration will do what to increase phosphorus/ calcium chances of precipitation?

Higher concentration of amino acids the less chance of precipitation

How well did you know this?

Not at all

Perfectly

Lipids should not be infused as a 2-1 or 3-1 faster than what rate per kg per hour?

0.11 grams/kg/hour

How well did you know this?

Not at all

Perfectly

Dexapanthenol in PN

Dexpanthenol is a synthetic derivative of pantothenic acid, a B complex vitamin that is widely distributed in plants and animals. Dexpanthenol is used parenterally as a gastrointestinal stimulant to treat and prevent ileus after GI surgery and in other conditions with impaired GI activity. Dexpanthenol was approved by the FDA in 1948.

Mechanism of Action: Dexpanthenol is a precursor needed for acetylcholine synthesis, which in turn causes parasympathetic activity to maintain normal GI activity. The exact mechanism is not known.

How well did you know this?

Not at all

Perfectly

Iron dextran can be added to 2-1 or 3-1 PN?

Only 2-1 as as lipids are disrupted by iron in a 3-1 solution.

How well did you know this?

Not at all

Perfectly

Corrected calcium equation

0.8 (4 - alb level) then add serum calcium for corrected level.

4 is normal albumin.

How well did you know this?

Not at all

Perfectly

What 2 components are in adult PN multivitamins that could cause a toxic side effect on a neonate?

Propylene glycol

Polysorbate

How well did you know this?

Not at all

Perfectly

The two main EFA are:

two primary EFAs are known as
linoleic acid (omega-6) and ( olive oil)
alpha-linolenic acid (omega-3) ( soy and canola oil)

How well did you know this?

Not at all

Perfectly

Carnitine is needed for

Transport and metabolism of long chain fatty acids.

Not in parenteral nutrition formulations

Deficiency has been shown to correlate with steatosis.

How well did you know this?

Not at all

Perfectly

The single most critical factor affecting the pH of a PN formulation is

pH of the amino acid solution

How well did you know this?

Not at all

Perfectly

3-1 is discouraged in neonate and peds due to

Lipids not stable at lower pH and the lower pH helps the addition of more calcium and phosphorus and their solubility.

How well did you know this?

Not at all

Perfectly

Labeling of PN components lists the max amount of Alumimum that can accumulate over time . The max amount is?

25 mcg per liter. The amount accumulate over time from the container.

How well did you know this?

Not at all

Perfectly

Specific AA, calcium salts and phosphate salts will accumulate less aluminum if stored in

Plastic not glass.

How well did you know this?

Not at all

Perfectly

Aluminum is cleared from the body by

Kidneys

How well did you know this?

Not at all

Perfectly

Aluminum is deposited

Brain
Lungs
Bones
Liver

How well did you know this?

Not at all

Perfectly

Amount of aluminum allowed per kg per day

4 to 5 mcg

How well did you know this?

Not at all

Perfectly

The SVC is formed by the joining of what two veins?

The left and right brachiocephalic veins.

How well did you know this?

Not at all

Perfectly

approximately how’s long is the SVC?

7 cm

How well did you know this?

Not at all

Perfectly

Leading complication of peripheral PN is?

Peripheral venous thrombophlebitis

How well did you know this?

Not at all

Perfectly

Symptoms of infusion phlebitis are?

Pain
erythema
tenderness
palpable cord

How well did you know this?

Not at all

Perfectly

Insulin added to PN

0.05 to 0.1 units of insulin per gram of dextrose or 0.15 to 0.2 units per gram of dextrose

Chrominium deficiency can cause

Hyperglycemia

Trace element components in PN

``` Zinc Copper Manganese Chromium Selenium Aluminum ```

Decrease what trace elements in PN patients with Hepatobiliary disease?

Copper and manganese

Carnitine plays a role in fat metabolism in adults or neonates receiving PN?

Neonates

What causes excess urinary calcium loses in patients receiving PN?

High protein intake in PN such as 2 grams/kg Chronic metabolic acidosis Cyclic PN infusion

Low calcium is common in

Magnesium deficiency.

Copper deficiency can cause what

Osteoporosis

Glutamine in PN has the issue of

Physical stability after compounding It is conditionally essential in critical illness Primary fuel for small bowel

DRI for water soluble vitamins given orally compared to DRI parenterally given water soluble vitamins

Water soluble vitamin dosage is greater in PN due to increased metabolic stress. Less for fat soluble vitamins in PN compared to oral as PN fat soluble vitamins have no GI loss

With lipids monitor what regularly as the fat contains inconsistent sources of what vitamin?

Vitamin K so monitor pro thrombin time

Rapid infusion of sodium or potassium phosphate can cause

Tetany due to phos decreasing the calcium

PN products that contribute to aluminum accumulation...

Heparin Calcium and phos salts Albumin

In PN if potassium is low assess what mineral?

Magnesium and replace b4 the potassium

Metabolic bone disease can be caused by

Aluminum toxicity

Long term PN pt with involuntary movements, tumor and rigidity could have or Parkinson's like movements

Manganese toxicity Can happen with cholestasis Manganese under goes biliary excretion

Fibrin that builds up on the wall of blood vessels and may adhere to the catheter is creating a

Mural thrombus

Fibrin that builds up due to the presence of the venous catheter

Fibrin shealth around the outside of the catheter

Fibrin that builds up at the end of the catheter is called

Fibrin tail

Fibrin or blood products that build up inside the catheter lumen casing a partial or total inclusion is called

Intraluminal thrombus

To clear a PN inclusion with 0.1 hydrochloride acid means it is an occlusion due to

Calcium phosphate

What do use use to clear a lipid PN occlusion?

70% ethanol.

What do you use to clear a medication occlusion in PN?

Sodium bicarbonate 1 mEq/mL

To clear an intraluminal clot in a PN line use

Alteplase 2 mg/2mL ( thrombolytic agent)

Treatment of mural thrombus

Catheter removal or thrombolytic therapy

Causes of metabolic alkalosis in PN patients

Elevated serum bicarbonate due to excess acetate as it is metabolized to bicarbonate NG suctioning Volume depletion Diuretic use

Causes of metabolic acidosis in PN

Excess chloride Diarrhea Acute renal failure

Carbohydrate content of PN should not exceed

7 gram/kg/day in adults 4 mg/kg/min

Lipid infusion max rate

1 to 2.5 gram/kg/day or 30% or less of total calories 0.11/kg/hour

Max amounts for amino acids in PN

2.0 grams/kg/day to 2.5 grams/kg/day

For blood gases what is normal pH?

7.35 to 7.45

For blood gases what is normal carbon dioxide? PaCO2?

35 to 45 mm Hg

For blood gases what is normal bicarbonate?

22 to 26 mEq/L.

In hepatobiliary disease remove what from the PN?

Manganese or it will accumulate in the brain

What is malassezia furfur?

Yeast infection of skin and related structures that can cause catheter related blood stream infections in premature infants receiving PN with lipids. The lipids provide growth factor for the yeast. Treat with amphotercin B, remove line, stop lipids.

Manganese can be a contaminant in

Commercial trace element preps

How to test for chromium deficiency?

Treat with chromium and see if hyperglycemia resolves

What is the most common trace element deficiency in long term PN?

Zinc

Excreted via biliary tract?

Copper and manganese

PN recertification is required every

6 months

Increased urine calcium in PN can be caused by

Increased AA | Cycled PN

Digoxin toxicity can occur in PN pt with what?

Hypercalcemia Hypokalemia Hypomagnesemia

IV fat emulsion is mainly

Linoleic (soybean oil or soy/safflower oil) and 3 to 4 % linolenic

Choline is NOT added to PN because

Endogenous synthesis from methionine in the aa solution.

Short bowel is defined as

200 cm or less of jejunum/ileum.