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Advanced MNT 2 > Parenteral Nutrition Part 1 > Flashcards

Parenteral Nutrition Part 1 Flashcards

1
Q

the delivery of nutrients directly into the bloodstream intravenously

A

Parenteral Nutrition

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2
Q

PN is indicated in conditions that preclude the use of the GIT for more than ____ days

these include ?

A

7-10

a non-functioning GI tract
bowel rest
bowel issues
EN not available

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3
Q

condition that cause non-functioning GI tract

A

prolonged small bowel ileus
severe malabsorption
intractable vomiting or diarrhea
severe short bowel syndrome
small bowel ischemia
severe GIB

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4
Q

needing PN for bowel rest from _________ or ___________

A

severe exacerbation of IBD
radiation enteritis

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5
Q

bowel indications for PN

A

bowel obstruction
bowel perforation
high output small bowel fistula

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6
Q

PN needed if EN _____ is not feasible or failed trials of EN (________)

A

access
post-pyloric

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7
Q

Contraindications to PN

A

Functioning GIT

Treatment < 7 days

Inability to obtain venous access

Prognosis that does not warrant aggressive nutrition support

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8
Q

carbohydrate in PN is in form of _______
provides ____ kcal/g
commercially available in concentrations (______)

A

dextrose monohydrate
3.4
5-70%

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9
Q

DEXTROSE
______ mg/kg/min for stable patients
_____ for patients with DM or hyperglycemia
_____ mg/kg/min for critically ill patients

A

4-5
low end (4)
<4

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10
Q

Excessive dextrose/carb administration can results in _________, ________, and ______.

A

hyperglycemia
increased CO2 production
fatty liver

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11
Q

calculation for maximum CHO dose

A

4 or 5 mg X wt in kg X 1440 (min in day)

divide by 1000 to convert to g

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12
Q

You have a 60 kg patient who has Type 1 DM. What is the max amount of CHO the patient should be given in a day?

A

345.6

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13
Q

Source of Protein in PN is ___________
Contain all ____ and some ____
Concentrations: ______%
Provides ___ kcal/g

A

crystalline amino acids
EAA
NEAA
3% - 20%
4.0

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14
Q

Currently ________ is not included in crystalline AA solutions because it is ____

A

glutamine
unstable

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15
Q

Lipids in PN are called _________

A

Lipid injectable emulsions (ILEs)

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16
Q

Source of ILEs: _________
usually ________ and also may contain ______ and ________

A

Long-chain fatty acid emulsions
Soybean oil

egg yolk phospholipid & glycerol

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17
Q

ILEs are _____ dense and _______

A

Calorie
Isotonic

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18
Q

Alternative Lipid Injectable Emulsions Available in the U.S. is a __________ called ________.

A

mixed oil lipid injectable emulsion
smoflipid

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19
Q

smoflipid consists of

A

30% soybean oil
30% MCT oil
25% olive oil
15% fish oil

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20
Q

There is a mixed oil PN formula for pediatric patients with _______

this formula is called ______

A

PN associated cholestasis
omegaven

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21
Q

Omegaven is rich in _______ and believed to have _________ effects

A

omega-3 FA
anti-inflammatory effects

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22
Q

most commonly used percent of lipid emulsion

A

20%

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23
Q

10% Lipid emulsion:
_____ kcal/mL or ____ kcal/g

A

1.1
11

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24
Q

20% Lipid emulsion:
____ kcal/mL or ___ kcal/g

A

2.0
10

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25
Q

30% Lipid emulsion [only available for ______]: ____ kcal/mL or ___ kcal/g

A

Total Nutrient Admixture (TNA)
3.0
10

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26
Q

minimum requirements

_____% of total kcal needs from _____ acid

____% of total kcal needs provided as lipid in PN should prevent EFAD

A

2-4
linoleic

10

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27
Q

OPTIMAL FAT INTAKE

______% of kcal from fat; or
____ g/kg/d for stable patients and ___ g/kg/d for critically ill patients

Reduces the complications of solely dextrose-based PN=>hyperglycemia, respiratory compromise

Provide _____, ____ infusion (>___ hrs/d)

A

20-30
1
<1

slow, continuous
10

28
Q

CONSEQUENCES OF FAT OVERLOAD

A

Hypertriglyceridemia

29
Q

hypertriglyceridemia from fat overload can cause ________, ________, ________, and ______

A

Impaired immune response
Hepatic steatosis
Acute Pancreatitis
Impaired vascular integrity

30
Q

impaired immune system from fat overload can cause __________________

impaired immune system function comes from_______, which inhibits _______ immune response

A

hepatic reticuloendothelial system (RES) dysfunction

linoleic acid
cell-mediated

31
Q

CONTRAINDICATIONS OF LIPIDS
- ________
- ________

use with caution in _______ and ______

A

Egg allergy
severe hyperlipidemia

severe sepsis
multiple organ dysfunction syndrome (MODS)

32
Q

Lipid clearance is monitored by ______
check levels _____________

A

serum TG
prior to initiation and after

33
Q

Hold ILE if serum TG level is >____ mg/dL

If serum TG continues to be >_____ mg/dL=> ______________________

A

400

400
limit ILE to minimum amount to prevent EFAD

34
Q

Cofactor necessary for the transport of LCFA for beta-oxidation is _______

A

carnitine

35
Q

is carnitine in PN formulas?

A

no

36
Q

At risk for deficiency of carnitine=>
_______ and _______

A

premature infants
dialysis patients

37
Q

Deficiency of carnitine can result in…
_______
______
______
______

A

hypertriglyceridemia
fatty liver
muscle weakness
cardiomyopathy

38
Q

How to treat carnitine deficiency

A

An IV form of L-carnitine

39
Q

Vitamins provided together in a ____ dose of “standard vitamins”

Requirements ____ from DRI’s
Parenteral requirements for many vitamins are ______ for many of the vitamins due to __________ in PN

A

10 ml
differ
higher
decreased stability

40
Q

ASPEN Recommendations for PN vitamins

A

dont think I need to know this

Thiamin: 6 mg
Riboflavin: 3.6 mg
Niacin: 40 mg
Folic acid: 600 mcg
Pantothenic acid: 15 mg
Pyridoxine: 6 mg
Vitamin B12: 5 mcg
Biotin: 60 mcg
Ascorbic acid: 200 mg
Vitamin A: 990 mcg
Vitamin D: 5 mcg
Vitamin E: 10 mg
Vitamin K: 150 mcg

41
Q

Trace elements

Commercial preparation: _____ ml/day
Parenteral requirements for most trace elements are ______ than the DRIs because there is _________ when given IV

A

1
lower
100% absorption

42
Q

ASPEN Recommendations for PN Trace Elements

A

Zinc
Copper
Manganese
Chromium
Selenium

43
Q

Zinc: ___ mg/d

Additional __ mg/d for _____ patients

Patients with EC fistulae, diarrhea, & intestinal drainage may require up to _____ of lost fluid

A

3-5

2
hypermetabolic

12–17 mg/L

44
Q

Copper: _____ mg/d

A

0.3-0.5

45
Q

Manganese: ___ mcg/d

A

55

46
Q

Chromium: ____ mcg/d

A

10-15

47
Q

Selenium: _____ mcg/d

A

60-100

48
Q

Not routinely included in standard trace element preparations=> _____, ____, and ____

Cholestatic liver disease=> ___ and ___ should be omitted from PN

A

Iron
Iodine
Molybdenum

Cu & Mn

49
Q

Daily Electrolyte Guidelines for PN include which ones

A

sodium
potassium
magnesium
calcium
phosphorous
chloride
acetate

50
Q

Sodium: _____ mEq/kg

A

1-2

51
Q

Potassium: ____ mEq/kg

A

1-2

52
Q

Magnesium ____ mEq

A

8-20

53
Q

Calcium ____ mEq

A

10-15

54
Q

Phosphorus ____ mmol

A

20-40

55
Q

Chloride: _____

A

as needed to maintain acid-base balance

56
Q

Acetate: ______

A

as needed to maintain acid-base balance

57
Q

Available forms of Sodium:

A

phosphate
chloride
acetate

58
Q

Available forms of Potassium:

A

phosphate
chloride
acetate

59
Q

Available forms of Calcium:

A

gluconate

60
Q

Available forms of Magnesium:

A

sulfate

61
Q

ELECTROLYTE ADJUSTMENTS

May need to increase if abnormal ______(urinary, GI or dermal) or ______

May need to decrease if=> _____ or _____

Individual electrolytes can be adjusted to correct imbalances

A

losses
refeeding syndrome

renal failure
CHF

62
Q

ACID-BASE BALANCE
Usually maintained by using ______ & ______ (___ ratio)

Metabolic acidosis=> provide more _____
Metabolic alkalosis=>provide more _____

A

chloride
acetate
1:1

acetate
chloride

63
Q

Major problem in the U.S. is PN shortages

Shortages due to=> manufacturing issues, company ________, drug recalls, companies can’t keep up with _____

Affecting both macro- and micronutrients
Resulting in=> serious adverse patient outcomes
- Use of suboptimal alternatives, errors, inadequate nutrition & deficiencies

A

closures
demand

64
Q

Strategies for Managing PN Shortages
1. Assess each patient for need for PN
2. Use _____________ when possible
3. Assess at individual level the need for _________
4. Prioritize patients
5. Rationing

A

oral or enteral nutrients
specific nutrients

65
Q

Rationing examples

providing ____% dose of MVI
MVI ____/week; ILE ___/week

If MVI not available, administer individual parenteral _____, _____, _____, and _____ daily.

A

50
3x
1x

thiamin
ascorbic acid
pyridoxine
folic acid

66
Q
A

Advanced MNT 2 (17 decks)

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