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Nutritional > Parenteral Nutrition: Initiation and Management > Flashcards

Parenteral Nutrition: Initiation and Management Flashcards

1
Q

What are the 7 indications for PN?

A
  1. Patients severely malnourished (unable to take oral products for > 7 days OR enteral products)
  2. Severe pancreatitis
  3. Small or large bowel obstruction
  4. Pregnant (severe N/V)
  5. Head injury patients who have no enteral access or GI dysfunction
  6. Severe inflammatory bowel disease exacerbated by oral or enteral nutrition
  7. Extensive bowel surgery causing malabsoprtion
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2
Q

Give two examples of severe inflammatory bowel disease?

A
  • Chron’s disease

- Ulcerative colitis

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3
Q

Give an example of an extensive bowel surgery?

A

Short bowel syndrome

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4
Q

How is IBW for females calculated?

A

IBW = 45.5 + 2.3 (height (in) - 60)

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5
Q

How is IBW for males calculated?

A

IBW = 50 + 2.3 (height (in) -60)

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6
Q

(T/F) - Obesity is considered 130% above IBW

A

TRUE

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7
Q

(T/F) - Severely malnourished is considered less than 80%

A

FALSE - less than 70%

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8
Q

(T/F) - In PN, you will use Adj. BW when a patient is obese to solve calculations

A

FALSE - IBW will be used even if the patient is obese

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9
Q

(T/F) - In PN, you will use Act. BW when a patient is malnourished to solve calculations

A

TRUE

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10
Q

How is Adj. BW calculated?

A

Adj. BW = IBW + 0.25(Act. BW - IBW)

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11
Q

How is the body mass index (BMI) calculated?

A

BMI = weight (kg) / height (m^2)

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12
Q

What is the range of an overweight BMI - also known as Grade I obesity?

A

25 - 29.9 kg/m^2

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13
Q

(T/F) - The normal weight BMI is 20 - 24.9 kg/m^2

A

TRUE

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14
Q

What is the range for a Grade II obese BMI?

A

30 - 40 kg/m^2

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15
Q

(T/F) - The Grade III obese scale is > 40 kg/m^2

A

TRUE

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16
Q

For obese patients, what is their goal for kcal/kg?

A

22 kcal/kg of their IBW

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17
Q

For obese patients, what is their protein gm/kg goal?

A

2 gm/kg of their IBW

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18
Q

What are the fluid requirements for adults with normal renal function?

A

2500 - 3500 mL/day

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19
Q

What are the fluid requirements for adults with insufficient renal function?

A

500 - 1500 mL/day

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20
Q

What type of insulin can be added to PN bags to control glucose levels?

A

Regular insulin

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21
Q

What is the initial dose of insulin?

A

0.1 units/gm of dextrose

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22
Q

(T/F) - Insulin is usually added to PN bags to prevent hyperglycemia and reduce cost for patient

A

FALSE - it’s not added usually because of the risk of hypoglycemia and a high cost

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23
Q

How much should IV fat consist of in total calories?

A

1 - 4%

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24
Q

Why is IVFE (IV fat emulsion) given to nearly all patient?

A

To prevent essential fatty acid deficiency

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25
Q

What are the two main essential fatty acids? Are they produced within the body or need to be given from the environment?

A
  • Linolenic acid and Alpha-linolenic acid

- They are given from the environment (food)

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26
Q

How should IVFE preparations be given? What filter size should be used?

A
  • In-line IV filter

- A 1.2 micrometer filter size

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27
Q

(T/F) - Lipids cannot be given as a separate peripheral IV infusion (piggyback)

A

FALSE - Lipids can be given as a piggyback and MUST not exceed 12 hours

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28
Q

Are there any contraindications for IVFE?

A

Yes, egg allergy patients - IVFE are stabalized with egg phospholipids

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29
Q

What is propofol?

A

A sedative agent that is manufactured as a 10% lipid emulsion

30
Q

(T/F) - Propofol does not require to measure the kcal if administered in a patient who is malnourished

A

FALSE - it needs to be taken into account since it contains lipids in its formulation

31
Q

At what concentration does dextrose have to be in order for total nutrition admixtures (TNAs) to be stable?

A

> 10% of the final concentration

32
Q

At what concentration does amino acids have to be in order for TNAs to be stable?

A

> 4% of the final concentration

33
Q

At what concentration do lipids have to be in order for TNAs to be stable?

A

> 2% of the final concentration

34
Q

(T/F) - Sodium can be given in a PN when it’s clinically needed (use clinical judgement)

A

TRUE

35
Q

In which patients should sodium be avoided in? (3 types)

A
  • Iatrogenic fluid overload
  • End-stage liver disease
  • Congestive heart failure
36
Q

In which patients should sodium be given to? (4 types)

A
  • High ileostomy output
  • High pancreatic fitula output
  • Large nasogastric fluid output
  • Large small bowel losses
37
Q

Sodium content in PN should not exceed how much?

A

154 mEq/L

38
Q

(T/F) - Potassium cannot be given in a PN, even if a patient needs it

A

FALSE - It can be given in a PN but clinicians need to use their clinical judgement

39
Q

(T/F) - Potassium is generally influenced by acid-base status

A

TRUE

40
Q

What happens to potassium serum levels when a patient is metabolic acidic? Does it increase or decrease?

A

Increase (hyperkalemia)

41
Q

What happens to potassium serum levels when a patient is metabolic alkalotic? Does it increase or decrease?

A

Decrease (hypokalemia)

42
Q

What is the recommended parenteral daily intake of calcium?

A

10 mEq OR 200 mg/day

43
Q

In which patients should low amounts of calcium be given? (3 types)

A
  • Hyperparathyroidism
  • Hypophosphatemia
  • Metastatic cancer
44
Q

How do you calculate corrected Ca 2+?

A

Corrected Ca 2+ = measured calcium + 0.8(4 - albumin)

45
Q

What is the recommended parenteral daily intake of magnesium?

A

10 mEq OR 120 mg/day

46
Q

The amount of calcium and magnesium should not exceed what number in a 3-in-1 formulation?

A

20 mEq/L

47
Q

Which disease states require a larger dose of magnesium? (2 types)

A
  • Short bowel syndrome

- Alcoholism

48
Q

What is the recommended parenteral daily intake of phosphorus?

A

30 mmol OR 100 mg/day

49
Q

(T/F) - Omission of PN can induce life-threatening hypophosphatemia within a week in normal renal function patients

A

TRUE

50
Q

What disease states are associated with hypophosphatemia? (4 types)

A
  • Alcohol abuse
  • Thermal injury
  • Refeeding syndrome
  • Trauma
51
Q

If a patient has metabolic acidosis, which salts would you use?

A

Acetate salts

52
Q

If a patient has metabolic alkalosis, which salts would you use?

A

Chloride salts

53
Q

(T/F) - ONLY sodium bicarbonate should not be used in PN formulas

A

FALSE - sodium bicarbonate AND calcium chloride should not be used in PN formulas

54
Q

There are 5 trace elements that can be added once a day – what are the names?

A
  • Zinc
  • Chromium
  • Selenium
  • Manganese
  • Copper
55
Q

What should be done with the trace elements in patients with small/large bowel fluid loses?

A

Provide a zinc supplement of 5-10 mg/day (if needed) with the Trace element cocktail

56
Q

What should be withheld in patients with hepatic cholestasis? Why?

A
  • Copper and Manganese

- Excreted through bile

57
Q

(T/F) - Not every PN should contain MVI

A

FALSE - every PN should contain MVI

58
Q

How many products are available in the US that contain MVI? What are the names?

A
  • 2 products

- MVI-Adult and Infuvite Adult

59
Q

Should iron be added to the TNA formulation? Why or why not?

A

No, it’s not generally stable in TNAs

60
Q

What is preferable, PNs given in central lines or peripheral lines?

A

In central lines, unless the formulated product is needed to be given peripherally

61
Q

Name 4 types of central lines

A
  • PICC
  • Hickman
  • Port-A-Cath
  • Lines in which the tip of the catheter is positioned in the superior vena cava
62
Q

How can you minimize vein damage from administering hypertonic solutions?

A

By administering PN through a large diameter central vein

63
Q

Why is administering PN through a large-diameter central vein going to help minimize vein damage? (2 reasons)

A

Because of rapid blood flow and PN will be diluted quickly

64
Q

If PN is given peripherally, would the solution be hypertonic or less hypertonic?

A

Less hypertonic

65
Q

What must the osmolality be for PPN (peripheral parenteral nutrition)?

A

700 - 900 mOsmol/L

66
Q

Is PPN given for short-term or long-term?

A

Short-term

67
Q

What are some limitations of PPN? (2 limitations)

A
  • Limits concentrations of nutrients (osmolality)

- Fluid overload is possible

68
Q

In which patients is PPN not recommended to? (3 types)

A
  • Long-term PN
  • Fluid restriction
  • Severe under nutrition
69
Q

What should be checked in a patient before discontinuing PN?

A

Make sure patient is consuming 50% or more of an oral diet that contains at least 60 gm of protetin/day

70
Q

(T/F) - Abruptly discontinuing PN is recommended in several patients

A

FALSE - It is not recommended in any patient because it could cause a rebound hypoglycemia

71
Q

How will a patient be discontinued PN if they’re not receiving continuous enteral feedings? (2 steps)

A
  • Decrease 50% of PN rate q 2 hours

- If PN is < 25 mL/hr, discontinue PN

Nutritional (5 decks)

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