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Nutrition Support > Parenteral Nutrition > Flashcards

Parenteral Nutrition Flashcards

1
Q

Osmolarity of PN.
Dextrose
Amino Acids
Electrolytes provide…

A

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

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2
Q

Morbidity

A

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.

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3
Q

Mortality

A

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

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4
Q

Smallest filter size for 3 in 1 PN is

A

1.2 microns

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5
Q

2 in 1 PN filter size is

A

0.22 microns

This is considered a sterilizing filter

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6
Q

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

A

Higher concentration of amino acids the less chance of precipitation

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7
Q

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

A

0.11 grams/kg/hour

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8
Q

Dexapanthenol in PN

A

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.

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9
Q

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

A

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

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10
Q

Corrected calcium equation

A

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

4 is normal albumin.

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11
Q

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

A

Propylene glycol

Polysorbate

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12
Q

The two main EFA are:

A

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

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13
Q

Carnitine is needed for

A

Transport and metabolism of long chain fatty acids.

Not in parenteral nutrition formulations

Deficiency has been shown to correlate with steatosis.

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14
Q

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

A

pH of the amino acid solution

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15
Q

3-1 is discouraged in neonate and peds due to

A

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

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16
Q

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

A

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

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17
Q

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

A

Plastic not glass.

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18
Q

Aluminum is cleared from the body by

A

Kidneys

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19
Q

Aluminum is deposited

A

Brain
Lungs
Bones
Liver

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20
Q

Amount of aluminum allowed per kg per day

A

4 to 5 mcg

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21
Q

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

A

The left and right brachiocephalic veins.

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22
Q

approximately how’s long is the SVC?

A

7 cm

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23
Q

Leading complication of peripheral PN is?

A

Peripheral venous thrombophlebitis

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24
Q

Symptoms of infusion phlebitis are?

A

Pain
erythema
tenderness
palpable cord

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25
Q

Insulin added to PN

A

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

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26
Q

Chrominium deficiency can cause

A

Hyperglycemia

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27
Q

Trace element components in PN

A 
Zinc
Copper 
Manganese 
Chromium
Selenium 
Aluminum
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28
Q

Decrease what trace elements in PN patients with Hepatobiliary disease?

A

Copper and manganese

29
Q

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

A

Neonates

30
Q

What causes excess urinary calcium loses in patients receiving PN?

A

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

31
Q

Low calcium is common in

A

Magnesium deficiency.

32
Q

Copper deficiency can cause what

A

Osteoporosis

33
Q

Glutamine in PN has the issue of

A

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

34
Q

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

A

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

35
Q

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

A

Vitamin K so monitor pro thrombin time

36
Q

Rapid infusion of sodium or potassium phosphate can cause

A

Tetany due to phos decreasing the calcium

37
Q

PN products that contribute to aluminum accumulation…

A

Heparin
Calcium and phos salts
Albumin

38
Q

In PN if potassium is low assess what mineral?

A

Magnesium and replace b4 the potassium

39
Q

Metabolic bone disease can be caused by

A

Aluminum toxicity

40
Q

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

A

Manganese toxicity

Can happen with cholestasis

Manganese under goes biliary excretion

41
Q

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

A

Mural thrombus

42
Q

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

A

Fibrin shealth around the outside of the catheter

43
Q

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

A

Fibrin tail

44
Q

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

A

Intraluminal thrombus

45
Q

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

A

Calcium phosphate

46
Q

What do use use to clear a lipid PN occlusion?

A

70% ethanol.

47
Q

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

A

Sodium bicarbonate 1 mEq/mL

48
Q

To clear an intraluminal clot in a PN line use

A

Alteplase 2 mg/2mL ( thrombolytic agent)

49
Q

Treatment of mural thrombus

A

Catheter removal or thrombolytic therapy

50
Q

Causes of metabolic alkalosis in PN patients

A

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

51
Q

Causes of metabolic acidosis in PN

A

Excess chloride
Diarrhea
Acute renal failure

52
Q

Carbohydrate content of PN should not exceed

A

7 gram/kg/day in adults

4 mg/kg/min

53
Q

Lipid infusion max rate

A

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

0.11/kg/hour

56
Q

Max amounts for amino acids in PN

A

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

57
Q

For blood gases what is normal pH?

A

7.35 to 7.45

58
Q

For blood gases what is normal carbon dioxide? PaCO2?

A

35 to 45 mm Hg

59
Q

For blood gases what is normal bicarbonate?

A

22 to 26 mEq/L.

60
Q

In hepatobiliary disease remove what from the PN?

A

Manganese or it will accumulate in the brain

61
Q

What is malassezia furfur?

A

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.

62
Q

Manganese can be a contaminant in

A

Commercial trace element preps

63
Q

How to test for chromium deficiency?

A

Treat with chromium and see if hyperglycemia resolves

64
Q

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

A

Zinc

65
Q

Excreted via biliary tract?

A

Copper and manganese

66
Q

PN recertification is required every

A

6 months

67
Q

Increased urine calcium in PN can be caused by

A

Increased AA

Cycled PN

68
Q

Digoxin toxicity can occur in PN pt with what?

A

Hypercalcemia
Hypokalemia
Hypomagnesemia

69
Q

IV fat emulsion is mainly

A

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

70
Q

Choline is NOT added to PN because

A

Endogenous synthesis from methionine in the aa solution.

71
Q

Short bowel is defined as

A

200 cm or less of jejunum/ileum.

Nutrition Support (7 decks)

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