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1051 PBL > Parenteral Nutrition > Flashcards

Parenteral Nutrition Flashcards

1
Q

what is pn?

A

method of nutrition support designed to entirely bypass the digestive tract by providing a sterile, nutrient dense soln which is infused by IV

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2
Q

is TPN of PN the preferred terminology?

A

PN

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3
Q

is PN the first line of defence in nutrition intervention?

A

no

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4
Q

what is the over-arcing goal of PN?

A

correct patients caloric and nitrogen imbalances, fluid or electrolyte abnormalities and any known vitamin / mineral issues w/o worsening metabolic conditions

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5
Q

what are four more specific goals of PN?

A
  1. improve wound healing
  2. fewer complications and quicker convalescence
  3. improved response to drug therapy
  4. avoid surgey
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6
Q

give 5 conditions where PN could be needed

A
  1. GI obstructions
  2. severe malabsorption
  3. active bowel disorders
  4. excessive nutritional needs
  5. GI tract unsafe for use
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7
Q

who does NOT need PN?

A

those with

  1. functioning GI tract
  2. treatment plans less than 5 days
  3. inability to gain venous access
  4. poor prognosis that does not warrant aggressive nutritional support
  5. risks seen as higher than benefits
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8
Q

who needs PN?

A

those who

  1. cant meet daily needs with GI tract
  2. have documented inadequate intake
  3. have unpredictable return of GI funvction
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9
Q

what is the tonicity of PN solutions?

A

hypertonic

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10
Q

what are the 2 main methods of infusion?

A
  1. central venous catheter

2. peripheral venous catheter

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11
Q

what change to the osmolarity must be made for peripheral venous catherters?

A

reduced osmolarity

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12
Q

where is insertion of the central venous catheter?

A

usually into subclavian / jugular veins and tunneled to superior and infeerior vena cava

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13
Q

which of the methods of administration requires surgical insertion?

A

central

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14
Q

PICC is able to give concentrated formulas to meet patients nutritional needs without requiring a large ___

A

blood volume

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15
Q

PICC is necessary for patients with ___ requirement sthat expected to get therapy in what time frame?

A

large ; greater than 7 days

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16
Q

what are 3 issues that can arise due to bypassing the GI tract?

A
  1. bypass of portal circulation, so nutrients do not undergo natural hepatic metabolism / storage
  2. lack of stimulation of bile acid and ither pancreatic secetions may lead to build up in bile duct, pacreas or liver
  3. diminshed peristalsic stimulation may result in bacterial growth
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17
Q

what macronutrients are in PN?

A

carbs, protein, fat , water

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18
Q

what micronutrients are in PN?

A

electrolytes, vitamins, trace elements

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19
Q

what is the only type of insulin that can be infused with PN ?

A

regualr human insulin

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20
Q

what is the recommended limit (ASPEN) of PICC administration?

A

900 mOsm/l

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21
Q

dextrose ___% is considered the max tolerable medicatl conciderations

A

10

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22
Q

in PICC, risk of infection (compared to central) has ____ risk of infection

A

reduced

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23
Q

PPN is NOT an appropriate option for pts with

A

crically ill, those with renal, hepatic, cardiac msucles

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24
Q

there are variour methods of estimating energy requirements which take into account ____, ___, ___, ___-, ____ and ____ factors

A

age, height, weight, sex, activity level and stress

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25
Q

what is the standard calorie range for PN??

A

28-30 kcal/kg/day

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26
Q

what is the max calorie intake for PN?

A

40 kcal/kg/day

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27
Q

the main sources of energy in PN should be ____ and ___

A

carbohydrate and fat

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28
Q

lipid emulsions provide a ___ source of calories while helping decrease ____

A

concentrated; osmotic load

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29
Q

what is the usual adult dose of lipids in pN?

A

1-1.5g/kg/day

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30
Q

in PN, fat usually makes up what % of the daily calories?

A

20-30%, max 60%

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31
Q

a 20% lipid mix provides how many kcal/ml?

A

2

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32
Q

protein is required for ___ and ____

A

tissue growth and repair

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33
Q

protein in PN is provided as a mix of ___ and ___

A

essential and non-essential amino acids

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34
Q

a _____ (+/-) nitrogen balance is desired

A

+

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35
Q

when giving protein, enough nitrogen is needed for what?

A

the minimize the breakdown of proteins for use as an energy source

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36
Q

what is the normal maintenance dose of PN proetin for an adult?

A

0.8-1 g/kg

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37
Q

what is the protein dose for a patient under mild to moderate stress?

A

1.5 g/kg

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38
Q

what s=is the protein dose for a patient under severe stress?

A

2 g/kg

39
Q

on average, there are ___kcal per 1g of protein

A

4

40
Q

___ is the primary energy source in pN

A

dextrose

41
Q

dextrose provides ____kcal/g

A

3.4

42
Q

dextrose should provide _____% of total calories

A

30-60

43
Q

what is the max dextrose rate for an adult?

A

7.2g/kg/day

44
Q

when the max dextrose rate is exceeded, ____ will occur, which requires energy and generates excess __

A

fat synthesis; co2

45
Q

what is the neonatal rate for protein? does it have to be gradually increased

A

15-20mg/kg/min ; yes

46
Q

in neonates, the max dextrose rate ____ with increasing age

A

decreases

47
Q

____ is essential for the transport of dextrose into cells

A

insulin

48
Q

the total volume of fluid administered is based on the ___ of administration

A

rate

49
Q

fluid requirements are increased when ____ losses are high

A

extra-renal (sweating, diarrhea, emesis)

50
Q

fluid requirements are ___ with renal impairment

A

decreased

51
Q

administration of fats prevents ____ deficiency

A

essential fatty acid

52
Q

what are the essential fatty acids given?

A

linoleic acid and alpha-linoleic acid

53
Q

intralipid contains mostly what fatty acid?

A

omega 6

54
Q

clinoleic contains mostly what fattty acid?

A

omega 9

55
Q

clioleic is less pro ____

A

inflammatory

56
Q

SMOFlipid is pro ____ and provides what type of fatty acid?

A

antiinflammatory; omega 3

57
Q

t/f omega 3 fatty acid may provide liver protection

A

true

58
Q

what are potential allergens found in all fat mixes?

A

eggs yolk phospholipd emulsifiers and fish

59
Q

can someone with a shellfish allergy recieve a fatty acid pn?

A

yes, as long as not allergic to regular fish

60
Q

what are the positive electrolytes in PN?

A

NA, K, CA, Mg

61
Q

what are the negative electrolytes in PN?

A

phosphate, cl, acetate

62
Q

electrolyte requirements very with ___ and ___

A

age and medical condition

63
Q

amino acid solutions cotain ___ and or ___ as the anions associated with the various amino acids

A

cl; acetate

64
Q

additional cl and or acetate will be added to the solution depending on the ___ chosen for the addition of NA and K

A

salt

65
Q

acetate is the precursor for ___ and can be used to adjust ___ balance

A

bicarbonate; acid-base

66
Q

minerals are required in very small amounts for a variety of ___ and ___ functions

A

biochemical and physiological

67
Q

minerals are usually part of enzymes involved in ___

A

metabolic pathways

68
Q

what mineral may be required in greater amounts for intestinal losses?

A

zinc

69
Q

why is iron not typically included in the pn?

A

body has stores that take a long time to deplete

70
Q

t/f iron can be given directly in pn or seperately

A

true

71
Q

what patient may need iron in their pn?

A

one who is long term

72
Q

vitamins are needed for normal ___ and ___

A

metabolism and cellular function

73
Q

t/f the daily allowances for parenteral vitamins is the same as the oral allowances

A

false

74
Q

why is vitamin K not usually part of the adult pn?

A

to avoid interaction with warfarin

75
Q

standard dosage of vitamin K may be added to pn how often for adults?

A

once weekly or every 2 weeks

76
Q

what is a fixed combination solution?

A

commercially available fixed combination of amino acids and dextrose with or without lipids or electrolytes

77
Q

what are 3 in 1 or TNA solutions?

A

all 3 macronutrients in one bag

78
Q

what are 2 in 1 solutions?

A

dextrose and aa in one bag, lipids piggy back or at Y site

79
Q

what are some advantages of 3 in 1?

A

cost, convenience, balanced delivery, less contamination potential

80
Q

what are some disadvantages of 3 in 1?

A

solution instability, cant use o.22u filter, may be hard to see precipiates, increased bacterial growth, increased catherter occlusion

81
Q

the PN product provided to the patient must be ___, ____, and ____

A

sterile, pyrogen free, in the exact quantities ordered by the clinician

82
Q

t/f all components of the PN must be stable over the entire stoarge and admin period

A

true

83
Q

t/f calculation and measurement of volumes must be completely accurate in every solution

A

true

84
Q

t/f pn contain the largest # of combined chemical of any IV mix

A

true

85
Q

where are pn solutions stored once they are made?

A

refrigerator

86
Q

t/f only well-established compatibilities should be included in PN

A

true

87
Q

give 3 reasons why sterility of PN solutions is vital

A
  1. nutritional components are a ready substrate for bacterial growth
  2. administered by the IV route
  3. administered to vulnerable patients
88
Q

list some ways sterility is maintained with PN

A

clean air room, laminar flow hood with HEPA, sterile ingredients, sterile procedures and trained staff

89
Q

automated compounding machines are available to help with the ___ of many individual components

A

measurement

90
Q

calcium and phosphate are only compatible in a well defined range of __ and __

A

pH and concentration

91
Q

is calcium and phosphate are mixed outside of their solubility curves, what will happen

A

a micro-precipitate will form

92
Q

the calcium phosphate precipitate can cause

A

death

93
Q

how can the precipitate of calcium phosphte be avoided?

A
  1. only prepare in the pH and concentration rnage for the specific aa used
  2. use calcium gluconate rather than calcium cl
  3. add phosphate forst and ca last
  4. use in-line micron filter (only in 2 in 1)
  5. visual inspection

1051 PBL (10 decks)

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