Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Advanced Medical Nutrition Therapy II > Parenteral Nutrition (part 3) > Flashcards

Parenteral Nutrition (part 3) Flashcards

You may prefer our related Brainscape-certified flashcards:
USMLE® Step 1 flashcards
1
Q

Hyperglycemia is a common metabolic complication with parental nutrition, this could mean that someone’s random blood glucose is over ____ mg/dL

A

180

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Hyperglycemia can be caused by…

A

-Metabolic stress
-Medication
-Diabetes
-Excess carbohydrate administration
-Overfeeding

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Complications of hyperglycemia:

A

-Dehydration
-Increased CO2 production
-Hepatic steatosis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Target blood glucose range is between ____-____ mg/dL

A

140-180

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

How can we prevent hyperglycemia?

A

-Administer dextrose in amounts less than or equal to 4-5 mg/kg/min
-Mixed substrate solution
-Avoid overfeeding
-At risk patients, limit dextrose to 100-150 g/day on day 1
-Capillary glucose monitoring every 6-8 hours

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Treatment for hyperglycemia:

A

-Reduce dextrose content in PN to less than or equal to 4 mg/kg/min
-Insulin therapy: addition of regular insulin to PN

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

How should insulin be dosed for someone on PN?

A

-0.1 unit of regular insulin for every gram of dextrose provided OR
-2/3 the previous day’s sliding scale insulin requirement

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

____ ____ is metabolic alterations that occur within the first few days after refeeding a starved patient

A

Refeeding Syndrome

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Refeeding Syndrome occurs due to a rapid shift of _____ from the bloodstream to cells due to insulin

A

Electrolytes

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

This shift of electrolytes leads to…

A

-Hypophosphatemia
-Hypokalemia
-Hypomagnesemia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

____ deficiency may manifest as a result of refeeding syndrome

A

Thiamin

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Refeeding syndrome can cause…

A

-Respiratory failure
-Paresthesias
-Muscle weakness
-Cardiac arrhythmias
-Hemolysis
-Death

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Individuals at risk for refeeding syndrome are those with:

A

-Anorexia nervosa
-Alcohol and substance use disorders
-Cancer
-Mental health disorders
-Malabsorption
-Starvation
-Critical illness
-AIDS

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Individuals at significant risk of refeeding syndrome have any 1 of the following:

A

-BMI <16
-Weight loss of 7.5% in 3 months or >10% in 6 months
-Caloric intake: none or negligible for >7 days or <50% of EER for >5 days during acute illness/injury or <50% of EER for >1 month
-Low levels of K+, phos, or magnesium before feeding
-Evidence of severe subcutaneous fat loss
-Evidence of severe muscle loss

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Individuals at moderate risk of refeeding syndrome have 2 of the following:

A

-BMI: 16-18.5
-Weight loss 5% in 1 month
-Caloric intake: none or negligible for 5-6 days or <75% of EER for >7 days during acute illness/injury or <75% of EER for >1 month
-Low levels of K+, phos, or magnesium before feeding
-Evidence of moderate subcutaneous fat loss
-Evidence of moderate or mild muscle loss

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Prevention and treatment of refeeding syndrome:

A

-Identify patients at risk
-Replete low serum electrolyte levels
-Include adequate amounts of potassium, magnesium, phosphorus, and vitamins in initial PN solutions
-Supplement with 100 mg thiamin before initiating feeding; continue with 100 mg/d for 5-7 days or longer in patients with severe starvation, alcohol use disorder, or if signs of thiamin deficiency

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

To prevent refeeding syndrome, we should initiate PN kcal at ___-___ kcal/kg for the 1st 24 hours

A

10-20

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

To prevent refeeding syndrome, we should also limit initial carbohydrates to ___-___ g/d on day 1

A

100-150

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

To prevent refeeding syndrome, we should provide ___-___ g/kg of protein

A

1.2-1.5

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

To prevent refeeding syndrome, we should increase PN gradually, advancing by ___% of goal every 1-2 days to reach goal in 3-5 days

A

33%

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

In those at risk for refeeding, we should monitor serum ____ and ___ ___ as PN is advanced

A

Electrolytes and fluid status

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

Overfeeding results in…

A

-Hyperglycemia
-Hypercapnia
-Lipogenesis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

Overfeeding is particularly common for ____ ____ patients

A

Critically ill

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

We need to consider other sources of ____, such as from tube feedings, propofol, dextrose from IVF, PD, and CRRT

A

Calories

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

Hypertriglyceridemia is caused by…

A

-Excessive administration of lipid injectable emulsions (total amount or rapid rate)
-Hyperlipidemia
-Dextrose overfeeding
-Medications
-Carnitine deficiency

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

Treatment for hypertriglyceridemia:

A

-Increase infusion time: 10 or more hours/day
-Deceased lipid administration: provide <30% of kcal from fat or less than or equal to 1 g/kg/d
-If chronic, EFAD replacement only

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

Essential fatty acid deficiency is caused by…

A

-Inadequate fat administration

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

Essential fatty acid deficiency can be prevented by…

A

-Providing a minimum of 2-4% of energy as linoleic acid or 10% of energy from lipid
-Minimum: 250 ml of 20% lipid 2x/week or 500 ml of 20% lipid once per week

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q

Prerenal azotemia is caused by…

A

-Excessive protein administration
-Dehydration

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
30
Q

Treatment for prerenal azotemia:

A

-Decrease protein content of parenteral nutrition solution as appropriate
-Increase fluid intake
-Monitor BUN

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
31
Q

Metabolic ____ disease is a long-term complication of parenteral nutrition

A

Bone

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
32
Q

Metabolic bone disease causes…

A

-Bone pain
-Pathological fractures

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
33
Q

Metabolic bone disease has a multifactorial etiology that includes…

A

-Limited Ca intake
-Hypercalciuria
-Metabolic acidosis
-Aluminum toxicity
-Corticosteroids
-Prolonged immobilization

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
34
Q

Recommendations for the prevention of metabolic bone disease:

A

-Provide adequate calcium (10-15 mEq/d)
-Provide adequate phosphorus (20-40 mmol/d)
-Provide adequate magnesium
-Avoid metabolic acidosis
-Avoid high protein loads
-Prescribe weight-bearing exercise

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
35
Q

Possible etiology of GIT atrophy and bacterial translocation with parenteral nutrition:

A

-Lack of intestinal stimulation by enteral nutrients

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
36
Q

Symptoms of GIT atrophy and bacterial translocation:

A

-Enteric bacteremia
-Sepsis

37
Q

Prevention of GIT atrophy and bacterial translocation:

A

-Early use of GIT

38
Q

Treatment of GIT atrophy and bacterial translocation:

A

-Transition to enteral/oral feedings as tolerated

39
Q

Possible etiology of parenteral nutrition-associated liver disease:

A

-Overfeeding
-Dextrose-based parenteral nutrition with minimal lipid injectable emulsion
-Excessive lipid injectable emulsions
-Essential fatty acid deficiency

40
Q

Symptoms of parenteral nutrition-associated liver disease:

A

-Elevation of liver function tests

41
Q

Prevention and management of parenteral nutrition-associated liver disease:

A

-Cyclic parenteral nutrition
-Avoid overfeeding
-Avoid dextrose infusion >5 mg/kg/min
-Use mixed substrate solution
-Decrease mixed substrate solution
-Decrease injectable lipid emulsions to <1 g/kg/d
-Rule out other causes

42
Q

Possibly etiology of catheter-related infections:

A

-Inappropriate technique in line placement
-Poor catheter care
-Contaminated solution

43
Q

Symptoms of a catheter-related infection:

A

-Elevated white blood cells
-Fever
-Red, hardened area around the catheter site

44
Q

Prevention of catheter-related infections:

A

-Development of strict protocols for line placement and catheter care

45
Q

Treatment of catheter-related infections:

A

-IV antibiotics
-Remove catheter and place at another site (last resort)

46
Q

Possible etiology of a pneumothorax:

A

-Catheter placement by inexperienced personnel

47
Q

Symptoms of pneumothorax:

A

-Dyspnea
-Tachycardia

48
Q

Prevention of pneumothorax:

A

-Catheter placement by experienced personnel

49
Q

Treatment of pneumothorax:

A

-A large pneumothorax may require chest tube placement

50
Q

Possibly etiology of phlebitis:

A

-Peripheral administration of hypertonic solution (>900 mOsm/L)
-Line infiltration

51
Q

Symptoms of phlebitis:

A

-Redness, swelling, and pain at peripheral site

52
Q

Prevention of phlebitis:

A

-Minimize osmolarity of solution
-Use of a mixed substrate solution

53
Q

Treatment of phlebitis:

A

-Change peripheral line site
-Consider TPN

54
Q

Possible etiology of catheter occlusion:

A

-Venous thrombosis
-Fibrin sheath
-Solution precipitates

55
Q

Symptoms of catheter occlusion:

A

-Inability to infuse fluid
-Swelling or pain in the arm or neck

56
Q

Prevention of catheter occlusion:

A

-Routine catheter flushing
-Prophylactic anticoagulation therapy
-Monitor solution for precipitation
-Calculate the Ca-Phos precipitation check

57
Q

Treatment of catheter occlusion:

A

-Anticoagulation therapy with urokinase or streptokinase

58
Q

Calcium and phosphorus precipitation causes the formation of an insoluble ____-____ salt

A

Calcium-phosphorus

59
Q

Calcium and phosphorus precipitation can result in…

A

-Catheter occlusion
-Respiratory distress

60
Q

Risk factors for calcium and phosphorus precipitation:

A

-Excessive calcium and/or phosphorus in parenteral nutrition
-Increased temperature
-Increased pH
-Order of mixing

61
Q

How to prevent calcium and phosphorus precipitation:

A

-Avoid excessive calcium and phosphorus in parenteral nutrition
-Provide additional phosphorus or calcium via separate IV line

62
Q

Formula for determining if the amount of phosphorus and calcium is appropriate:

A

[2 x Phos] + Ca must be less than or equal to 45 per liter of parenteral nutrition

63
Q

A parenteral nutrition prescription begins with nutrition assessment, which includes…

A

-Current clinical condition, GI status, past medical history
-Assess for need/validate rationale for parenteral nutrition
-Determination of nutrition diagnoses/problems, nutritional status, and goals

64
Q

What else should be done before a parenteral nutrition prescription is made?

A

-Calculation of energy, protein, max carbohydrate utilization, fluid, electrolyte, and micronutrient needs
-Selection of route: TPN vs PPN
-Institutional factors (compounding method, product availability)

65
Q

Energy needs for someone on parenteral nutrition:

A

20-30 kcal/kg

66
Q

Energy needs for an obese patient on parenteral nutrition:

A

22-25 kcal/kg IBW

67
Q

Protein needs for a stable patient on parenteral nutrition:

A

0.8-1.5 g/kg

68
Q

Protein needs for critically ill patients on parenteral nutrition:

A

1.2-2.5 g/kg

69
Q

Protein needs for patients with obesity on parenteral nutrition:

A

2.0-2.5 g/kg IBW

70
Q

For day 1 of parenteral nutrition, volume should be based on…

A

-Estimated fluid needs
-Patient tolerance

71
Q

For day 1 of parenteral nutrition, we should begin with ____-____ grams of carbohydrates

A

150-200

72
Q

For those with diabetes, hyperglycemia, or refeeding syndrome risk, we should begin day 1 of parenteral nutrition with ____-____ grams of carbohydrates

A

100-150

73
Q

On day 1 of parenteral nutrition, the ____ amount of protein can usually be given

A

Goal

74
Q

We can provide lipid injectable emulsions on day one if _____ clearance is adequate (<400 mg/dL)

A

Triglyceride

75
Q

On day 1, we can provide standard ____ and recommend adjustments as needed

A

Electrolytes

76
Q

We can also provide standard ____ and ___ ___ on day 1 of parenteral nutrition, and consider the need to additions or restrictions

A

Vitamins and trace elements

77
Q

If tolerating, we can increase everything to goal by day ____ of parenteral nutrition

A

2

78
Q

If someone is tolerating their parenteral nutrition, that would mean that…

A

-Fluid status is acceptable
-Glucose is less than or equal to 180 mg/dL
-Triglycerides <400 mg/dL
-Electrolytes: adjust as needed based on serum levels

79
Q

With cyclic parenteral nutrition, begin with a 24-hour continuous infusion and then decrease the hours provided daily while increasing ___ ___ until goal hours are achieved

A

Infusion rate

80
Q

The process of switching from continuous to cyclic parenteral nutrition is achieved over ___-___ days

A

3-4

81
Q

Stable patients can tolerate ____-___ hour/day cycle

A

8-12

82
Q

There will be fluctuations in ____ when beginning and ending cyclic parenteral nutrition

A

Glucose

83
Q

Cyclic parenteral nutrition can cause _____ hypoglycemia

A

Rebound

84
Q

In order to decrease the risk of rebound hypoglycemia, we should taper the rate to _____ the goal infusion rate for the first and last hour

A

Half

85
Q

When should we be monitoring glucose in someone one cyclic parenteral nutrition (before tolerance is established)?

A

-2 hours after initiation
-Mid-cycle
-2 hours after cycle is complete

86
Q

We should not abruptly stop total parenteral nutrition because it can lead to ____ ____

A

Rebound hypoglycemia

87
Q

How should we taper TPN in order to discontinue use?

A

-Reduce infusion rate by 50% for the 1st hour and 50% in the 2nd hour before discontinuation

88
Q

If a TPN taper can not be done, we can also hang an IV solution of ____

A

D10

89
Q

When we do discontinue PN, we should closely monitor ____ ____

A

Serum glucose

Advanced Medical Nutrition Therapy II (19 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions