Parenteral Nutrition Part 1 Flashcards by Sydney Perry

the delivery of nutrients directly into the bloodstream intravenously

Parenteral Nutrition

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

these include ?

7-10

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

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condition that cause non-functioning GI tract

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

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needing PN for bowel rest from _________ or ___________

severe exacerbation of IBD
radiation enteritis

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bowel indications for PN

bowel obstruction
bowel perforation
high output small bowel fistula

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

access
post-pyloric

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Contraindications to PN

Functioning GIT

Treatment < 7 days

Inability to obtain venous access

Prognosis that does not warrant aggressive nutrition support

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

dextrose monohydrate
3.4
5-70%

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

4-5
low end (4)
<4

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

hyperglycemia
increased CO2 production
fatty liver

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calculation for maximum CHO dose

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

divide by 1000 to convert to g

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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?

345.6

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

crystalline amino acids
EAA
NEAA
3% - 20%
4.0

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

glutamine
unstable

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Lipids in PN are called _________

Lipid injectable emulsions (ILEs)

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

Long-chain fatty acid emulsions
Soybean oil

egg yolk phospholipid & glycerol

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ILEs are _____ dense and _______

Calorie
Isotonic

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

mixed oil lipid injectable emulsion
smoflipid

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smoflipid consists of

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

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

this formula is called ______

PN associated cholestasis
omegaven

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Omegaven is rich in _______ and believed to have _________ effects

omega-3 FA
anti-inflammatory effects

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most commonly used percent of lipid emulsion

20%

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

1.1
11

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

2.0
10

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

Total Nutrient Admixture (TNA) 3.0 10

minimum requirements _____% of total kcal needs from _____ acid ____% of total kcal needs provided as lipid in PN should prevent EFAD

2-4 linoleic 10

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)

20-30 1 <1 slow, continuous 10

CONSEQUENCES OF FAT OVERLOAD

Hypertriglyceridemia

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

Impaired immune response Hepatic steatosis Acute Pancreatitis Impaired vascular integrity

impaired immune system from fat overload can cause __________________ impaired immune system function comes from_______, which inhibits _______ immune response

hepatic reticuloendothelial system (RES) dysfunction linoleic acid cell-mediated

CONTRAINDICATIONS OF LIPIDS - ________ - ________ use with caution in _______ and ______

Egg allergy severe hyperlipidemia severe sepsis multiple organ dysfunction syndrome (MODS)

Lipid clearance is monitored by ______ check levels _____________

serum TG prior to initiation and after

Hold ILE if serum TG level is >____ mg/dL If serum TG continues to be >_____ mg/dL=> ______________________

400 400 limit ILE to minimum amount to prevent EFAD

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

carnitine

is carnitine in PN formulas?

At risk for deficiency of carnitine=> _______ and _______

premature infants dialysis patients

Deficiency of carnitine can result in... _______ ______ ______ ______

hypertriglyceridemia fatty liver muscle weakness cardiomyopathy

How to treat carnitine deficiency

An IV form of L-carnitine

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

10 ml differ higher decreased stability

ASPEN Recommendations for PN vitamins

*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

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

1 lower 100% absorption

ASPEN Recommendations for PN Trace Elements

Zinc Copper Manganese Chromium Selenium

Zinc: ___ mg/d Additional __ mg/d for _____ patients Patients with EC fistulae, diarrhea, & intestinal drainage may require up to _____ of lost fluid

3-5 2 hypermetabolic 12–17 mg/L

Copper: _____ mg/d

0.3-0.5

Manganese: ___ mcg/d

Chromium: ____ mcg/d

10-15

Selenium: _____ mcg/d

60-100

Not routinely included in standard trace element preparations=> _____, ____, and ____ Cholestatic liver disease=> ___ and ___ should be omitted from PN

Iron Iodine Molybdenum Cu & Mn

Daily Electrolyte Guidelines for PN include which ones

sodium potassium magnesium calcium phosphorous chloride acetate

Sodium: _____ mEq/kg

1-2

Potassium: ____ mEq/kg

1-2

Magnesium ____ mEq

8-20

Calcium ____ mEq

10-15

Phosphorus ____ mmol

20-40

Chloride: _____

as needed to maintain acid-base balance

Acetate: ______

as needed to maintain acid-base balance

Available forms of Sodium:

phosphate chloride acetate

Available forms of Potassium:

phosphate chloride acetate

Available forms of Calcium:

gluconate

Available forms of Magnesium:

sulfate

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

losses refeeding syndrome renal failure CHF

ACID-BASE BALANCE Usually maintained by using ______ & ______ (___ ratio) Metabolic acidosis=> provide more _____ Metabolic alkalosis=>provide more _____

chloride acetate 1:1 acetate chloride

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

closures demand

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

oral or enteral nutrients specific nutrients

Rationing examples providing ____% dose of MVI MVI ____/week; ILE ___/week If MVI not available, administer individual parenteral _____, _____, _____, and _____ daily.

50 3x 1x thiamin ascorbic acid pyridoxine folic acid