Parenterals 3

Question 1

What are the 2 specialized large volume parenterals?

Answer 1

peritoneal dialysis solutions and parenteral nutrition solution

Question 2

Explain peritoneal dialysis?

Answer 2

• a large bore catheter placed into the abdominal cavity
• placement is through a tunnel and the catheter usually has 2 dacron cuffs to seal the tunnel from microorganisms and leaks

Question 3

What are the 5 stages of dialysis?

Answer 3

• hookup
• infusion
• diffusion (fresh)
• diffusion (waste)
• drainage

Question 4

What is CAPD?

Answer 4

continuous ambulatory peritoneal dialysis

Question 5

How does continuous ambulatory peritoneal dialysis work?

Answer 5

• uses soft catheters with 1 mm perforations and slots to allow fluid replacement and removal
• • catheter placement is a surgical procedure with some risk of complications:
• • bladder perforations, hemorrhage, hydrothorax, peritonitis, tunnel infection or bowel perforation

Question 6

How many litres of fluid are ran throughout the abdominal cavity in the process of dialysis?

Answer 6

2 liters

Question 7

What is the process of continuous ambulatory peritoneal dialysis?

Answer 7

• two litres of fluid are run throughout the abdominal cavity
• catheter is sceptically capped and fluid remains in place for 4-6 hours
• waste materials and water from the blood establish an equilibrium with the fluid
• fluid is then drained out via the catheter into an empty bag
• the usual daily fluid is 8 L

Question 8

What do dialysis solutions usually contain?

Answer 8

• sodium, magnesium, calcium and lactate (about the same concentrations found in blood)

Question 9

What concentration determines the amount of water that will be removed from the patient?

Answer 9

dextrose content

Question 10

What controls the exchange of fluid and waste in dialysis?

Answer 10

peritoneal membrane

Question 11

Peritoneal dialysis is not effective in removing what mineral?What is used for this?

Answer 11

• phosphate

- antacid tablets are generally used as they are phosphate binders (aluminum hydroxide is usually used)

Question 12

What is the most common complication of peritoneal dialysis?

Answer 12

infection - need to have a good aseptic technique when handling solutions and proper care of catheter exit sites are essential in avoiding infections

Question 13

What is parenteral nutrition?

Answer 13

the intravenous administration of water, nitrogen, calories, electrolytes, vitamins and trace metals in amounts appropriate to achieve an anabolic state in patients who cannot eat or cannot eat enough to maintain life

Question 14

Who are candidates for parenteral nutrition?

Answer 14

• those who are severely malnourished and those who have a dysfunctional GI tract for more than 5-7 days
• patients with post-surgery complications, sever trauma, severe burns, IBS, chemotherapy and short gut syndrome . Preterm infants also get this

Question 15

What are the energy requirements for adults?

Answer 15

30-50 kcal/kg/day

Question 16

How is total daily requirement calculated?

Answer 16

resting energy expenditure (REE) x activity x injury factors

Question 17

What equation is resting energy expenditure calculated from?

Answer 17

Harris-Benedict equation

Question 18

What else can energy requirements be determined from?

Answer 18

oxygen consumption and CO2 production

Question 19

What are the calorie sources that are used in parenteral nutrition?

Answer 19

• carbohydrate

- fat

Question 20

Carbohydrate calories in excess can cause damage to what vital organ and high production of what?

Answer 20

can damage the liver and cause high production of CO2

Question 21

If more than ___ of dextrose is given, hyperglycemia will result with high volume diuresis

Answer 21

5 mg/kg/minute

Question 22

What are the fluid requirements of neonates?

Answer 22

100-150 mL/kg/day

Question 23

Peritoneal nutrient mixture tends to be quite hypertonic and may contain as much as 25% ___ and 5% ___ so administration through a suitable large vein is required

Answer 23

dextrose

amino acids

Question 24

What is nitrogen provided as in a peritoneal nutrient mixture?

Answer 24

provided as a picture of amino acids

(requirements vary with patients but usually ran from 0.16-0.32 g/kg/day

Question 25

Nitrogen output can be estimated from what?

Answer 25

Urinary urea nitrogen - accounts for 85% of total nitrogen output – we want a slight positive balance in most cases

Question 26

Why should we expect a temporary drop in serum levels when anabolic state is reached?

Answer 26

• since K and P are intracellular electrolytes

Question 27

What vitamin is controversial in being needed via parenteral nutrition?

Answer 27

vitamin D

Question 28

What minerals are added to the parenteral nutrition bag?

Answer 28

zinc, copper, manganese, chromium

Question 29

What are the complications of the dialysate and parenteral nutrition?

Answer 29

• several related to the catheter (thrombosis, occlusion, phlebitis)
• infection at access site (catheter removal and antibiotic therapy may be required)
• metabolic complications may occur (electrolyte imbalances, fluid imbalance, acidosis, alkalosis, hypo and hyperglycaemia, liver abnormalities