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Advanced Medical Nutrition Therapy II > Parenteral Nutrition (part 1) > Flashcards

Parenteral Nutrition (part 1) Flashcards

1
Q

____ ____ is the delivery of nutrients directly into the bloodstream intravenously

A

Parenteral nutrition

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2
Q

Parenteral nutrition is a means of providing adequate nutrition for those who not have sufficient ____ function to restore or maintain optimal nutrition status

A

GI

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3
Q

Indications for the use of parenteral nutrition:

A

-A non-functioning GI tract
-Bowel rest
-Bowel obstruction
-Bowel perforation
-High output small bowel fistula
-Enteral access is not feasible or failed trials of enteral nutrition (post-pyloric)

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4
Q

What could lead to a non-functioning GI tract?

A

-Prolonged small bowel ileus
-Severe malabsorption
-Intractable vomiting or diarrhea
-Severe short bowel syndrome
-Small bowel ischemia
-Severe IBD

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5
Q

What would be indications of bowel rest?

A

-Severe exacerbation of IBD
-Radiation enteritis

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6
Q

What are some contraindications to parenteral nutrition?

A

-Functioning GIT
-Treatment < 7 days
-Inability to obtain venous access
-Prognosis that does not warrant aggressive nutrition support

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7
Q

Parenteral nutrition may be used if the GIT cannot be used for over ____ days

A

7

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8
Q

Carbohydrates are in the form of ___ ___ in parenteral nutrition

A

Dextrose Monohydrate

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9
Q

Dextrose monohydrate provides ____ kcal/g

A

3.4

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10
Q

Commercially available parenteral nutrition formulas can range from ___-___% carbohydrate

A

5-70%

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11
Q

The minimum dextrose dose should be ____ mg/kg/min

A

1

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12
Q

Inadequate carbohydrate administration causes ____ to be utilized as an energy source

A

Protein

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13
Q

In stable patients, the dose of dextrose should be ___-____ mg/kg/min

A

4-5

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14
Q

We should use the low end of the dextrose range (4 mg/kg/min) for patients with…

A

-Diabetes mellitus
-Hyperglycemia

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15
Q

Critically I’ll patients should get under ____ mg/kg/min of dextrose

A

4

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16
Q

Excessive carbohydrate administration can lead to…

A

-Hyperglycemia
-Increased CO2 production
-Fatty liver

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17
Q

How to calculate the maximum carbohydrate dose:

A

-Decide which standard to use (4 or 5 mg/kg/min)
-(4 or 5 mg) x (weight in kg) x (1440)
-Divide value by 1000 (to convert mg to g)

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18
Q

What is the protein source that is added to parenteral nutrition?

A

Crystalline amino acids

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19
Q

Parenteral nutrition contains all ___ ___ ___ and some NEAA

A

Essential amino acids

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20
Q

The concentration of protein in parenteral nutrition ranges from ____-___%

A

3-20

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21
Q

The protein in parenteral nutrition provides ____ kcal/g

A

4

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22
Q

Currently, ____ is not included in crystalline amino acids solutions because it is unstable

A

Glutamine

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23
Q

Lipids in parenteral nutrition are in the form of ____ ____ ___

A

Lipid injectable emulsions

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24
Q

The source of fat is…

A

Long-chain fatty acid emulsion

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25
The long-chain fatty acid emulsions in parenteral nutrition come from...
-Soybean oil -Also contain egg yolk phospholipid and glycerol
26
Lipid injectable emulsions are ____-dense and ____
Calorie; isotonic
27
There is also a mixed oil lipid injectable emulsion called ____
Smoflipid
28
Smoflipid is made up of...
-30% soybean oil -30% MCT -25% olive oil -15% fish oil
29
Another alternative lipid injectable emulsion is Omegaven, which is rich in ___-___ fatty acids
Omega 3
30
Omegaven is believed to have ____-____ effects
Anti-inflammatory
31
Omegavan is FDA-approved for use in pediatric patients with parenteral nutrition-associated _____
Cholestasis
32
A 10% lipid emulsion provides ____ kcal/mL or ____ kcal/g
1.1; 11
33
A 20% lipid emulsion provides ____ kcal/mL or ____ kcal/g
2.0; 10
34
A 30% lipid emulsion is only available for ____ ____ _____
Total nutrient admixture
35
A 30% lipid emulsion provides ____ kcal/mL or ____ kcal/g
3.0; 10
36
What are the minimum requirements for lipids in a parenteral nutrition formula?
-2-4% of total kcal needs from linoleic acid -10% of total kcal needs provided as lipid in parenteral nutrition should prevent essential fatty acid deficiency
37
What is the optimal fat intake for someone on parenteral nutrition?
-20-30% of kcal from fat OR -1 g/kg/day for stable patients and <1 g/kg/day for critically ill patients
38
Optimal fat intake reduces the complications of solely dextrose-based parenteral nutrition, such as...
-Hyperglycemia -Respiratory compromise
39
Lipid injectable emulsions should be provided with a slow, continuous infusion rate over ____ or more hours per day
10
40
Fat overload can lead to _____
Hypertriglyceridemia
41
Hypertriglyceridemia can lead to...
-Impaired immune response -Hepatic steatosis -Acute pancreatitis -Impaired vascular integrity
42
Hypertriglyceridemia can impair immune response by...
-Causing hepatic reticuloendothelial system dysfunction -Linoleic acid inhibits cell-mediated immune response
43
Contraindications of lipids:
-Egg allergy -Severe hyperlipidemia -Use with caution in those with severe sepsis and multiple organ dysfunction syndrome
44
Lipid clearance is monitored by serum _____
Triglycerides
45
We should check baseline triglycerides prior to the initiation of ___ ____ ___, and then check again after IV lipid is initiated
Lipid injectable emulsions
46
We should hold IV lipids if serum triglyceride level is ____ or more mg/dL
400
47
If serum triglycerides continue to be 400 or more mg/dL, limit lipid injectable emulsions to ____ amount to prevent essential fatty acid deficiency
Minimal
48
____ is a cofactor necessary for the transport of long-chain fatty acids for beta-oxidation
Carnitine
49
Carnitine is not present in ___ ___
Parenteral nutrition
50
What populations are at risk of carnitine deficiency while on parenteral nutrition?
-Premature infants -Dialysis patients
51
A deficiency of carnitine can lead to...
-Hypertriglyceridemia -Fatty liver -Hypoglycemia -Muscle weakness -Cardiomyopathy
52
An IV form of L-carnitine is available to treat _____
Deficiency
53
Vitamins are provided together in a ____ ml dose of "standard vitamins"
10
54
Vitamin requirements differ from the ____
DRI's
55
Parenteral requirements for many vitamins are ____ for many of the vitamins due to decreased stability in parenteral nutrition
Higher
56
Commercially prepared parenteral nutrition has ___ mL/day of trace elements
1
57
Parenteral requirements for most trace elements are ____ than enteral requirements because there is 100% absorption when given IV
Lower
58
What is the recommended dose of zinc in parenteral nutrition?
3-5 mg/day
59
An additional ___ mg/day of zinc should be given to hypermetabolic patients
2
60
Patients with EC fistulae, diarrhea, and intestinal drainage may require up to ___-___ mg of zinc per liter of lost fluid
12-17
61
What is the recommended dose of copper in parenteral nutrition?
0.3-0.5 mg/day
62
What is the recommended dose of manganese in parenteral nutrition?
55 mcg/day
63
What is the recommended dose of chromium in parenteral nutrition?
10-15 mcg/day
64
What is the recommended dose of selenium in parenteral nutrition?
60-100 mcg/day
65
What minerals are not routinely included in standard trace element preparation?
-Iron -Iodine -Molybdenum
66
With cholestatic liver disease, what minerals should be omitted from parenteral nutrition?
-Copper -Manganese
67
What are the available forms of sodium in parenteral nutrition?
-Phosphate -Chloride -Acetate
68
What are the available forms of potassium in parenteral nutrition?
-Phosphate -Chloride -Acetate
69
What form of calcium is given in parenteral nutrition?
Gluconate
70
What form of magnesium is given in parenteral nutrition?
Sulfate
71
We may need to increase electrolytes if someone has...
-Abnormal losses (urinary, GI, or dermal) -Refeeding syndrome
72
We may need to decrease electrolytes if someone has...
-Renal failure -Congestive heart failure
73
Individual electrolytes can be adjusted to correct ____
Abnormalities
74
Acid-base balance is usually maintained by using equal amounts of ____ and ____ (1:1 ratio)
Chloride and acetate
75
If someone is having metabolic acidosis, provide more ____
Acetate
76
If someone is having metabolic alkalosis, provide more _____
Chloride
77
Parenteral nutrition product ____ are a major problem in the United States
Shortages
78
Shortages are due to...
-Manufacturing issues -Company closures -Drug recalls -Companies can't keep up with demand
79
Shortages affect both ____ and ____
Macronutrients and micronutrients
80
The result of product shortages is serious adverse patient outcomes, leading to...
-Use of suboptimal alternatives -Errors -Inadequate nutrition -Deficiencies
81
Strategies to manage parenteral nutrition shortages:
-Assess each patient for need for parenteral nutrition -Use oral or enteral nutrition when possible -Assess at an individual level the need for specific nutrients -Prioritize patients -Rationing: providing 50% dose of MVI or MVI 3x/week; ILE 1x/week

Advanced Medical Nutrition Therapy II (19 decks)

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