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PT: Nutrition Exam 2 > Pediatric Nutrition Support > Flashcards

Pediatric Nutrition Support Flashcards

1
Q

Premature

A

<37 weeks gestation

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2
Q

When do you start PN for premature infant?

A

Started on day of birth

  • <1800 g or 33 weeks or less
  • used as supplement to enteral feedings during transition to complete enteral feedings
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3
Q

Types of parenteral nutrition

A
  • starter or vanilla
  • custom
  • protein solution
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4
Q

Starter or vanilla TPN

A
  • used in premature infants until custom TPN can be made
  • dextrose and protein only
  • may add calcium
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5
Q

Custom TPN

A
  • customized concentrations of dextrose, protein, electrolytes
  • contains vitamins and minerals
  • intralipids started at this time
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6
Q

protein solution (PN)

A
  • contain protein only

- used to keep lines open

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7
Q

When are fluids initiated in a premature infant?

A

1st day of life

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8
Q

What line does the starter TPN go into in pediatric?

A

UVC (umbilical venous catheter)

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9
Q

What line dose the protein solution go into in pediatric?

A

UAC (umbilical arterial catcher)

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10
Q

Fluid needs for preemie on day 1 of life

A

80 mL/kg/day

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11
Q

Fluid needs on 2nd day of life

A

100 mL/kg/day

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12
Q

Fluid needs on 3rd day of life

A

120 mL/kg/day

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13
Q

Fluid needs on 4th day of life

A

140 mL/kg/day

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14
Q

Fluid needs on 5th day of life

A

140 - 160 mL/kg/day

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15
Q

What are parenteral fluids used for in pediatrics?

A
  • maintain hydration
  • help stabilize electrolytes
  • maintain appropriate glucose level
  • aid in A/B balance
  • provide adequate nutrition for proper growth and development
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16
Q

What component of PN is carbohydrates?

A

Dextrose

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17
Q

What is the CHO rate in PN?

A

Initiate @ 4-6 mg/kg/min and increase by 2-3 mg/kg/min daily
GOAL: 8-12 mg/kg/min
(Needed to maintain cals.)

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18
Q

What are the parenteral calorie requirements for a neonate?

A

90-110 kcal/kg/day

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19
Q

What is the goal protein level for a neonate?

A

4 gm/kg/day

  • Blend of AAs (trophamine)
  • Add L-cysteine for neonates
  • Always start at goal
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20
Q

What is the goal lipid level for a neonate?

A

Initiate @ 1-2 gm/kg/day toward goal of ~3 gm/kg/day

  • No less than 0.5 g/kg/day to prevent EFA deficiency
  • Add L-carnitine
  • Monitor TG level if hyperglycemic
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21
Q

What are PN additives?

A
  1. Daily vitamin/minetals
  2. Adjust Na, K, Mg prn
  3. Acetate/Chloride for Acid:Base
    * 4. Goal to Max. Ca and P content for bone mineralization*
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22
Q

What is the most optimal source of of nutrition in a premature infant?

A

ENTERAL

-initiate as soon as stable @ 30 mL/kg/day and increase as tolerated

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23
Q

What are the goals of pediatric nutrition support?

A
  1. Provide appropriate nutrition for growth
  2. Preserve existing tissue stores
  3. Provide catch-up growth for malnourished patients and rehab of nutritionally depleted patients
  4. Preserve oral motor skills
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24
Q

What are the steps taken before PN in pediatrics?

A
  1. Oral intake
  2. Supplements (formulas0
  3. Modulars (add CHO, proteins, fats)
  4. Tube feedings
  5. PN
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25
Q

What are indications for TF in pediatrics?

A
  1. Neure/NM disorders with impaired swallowing/oral motor skills
  2. Congenital anomalies
  3. Increased metabolic needs
  4. Altered absorption/metabolism
  5. Growth failure
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26
Q

Why is EN better than PN?

A
  1. More physiologic
  2. Maintains GI integrity
  3. Decreased potential for bacterial translocation
  4. Decreased hepatobilliary complications
  5. Less expensive
  6. Fewer technical/infectious complications
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27
Q

What are contraindications of TF?

A
  1. Severe shock state
  2. Severe peritonitis
  3. Non-functional gut-ischemia, anatomic disruption, post-surg ileus
  4. High output fistula
  5. Diarrhea exacerbated by EN
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28
Q

What are the different enteral access devices?

A
  1. OG
  2. NG (most common <3 mo)
  3. NJ
  4. Gastrostomy/PEG (>3 mo)
  5. GJ
  6. Surgical jejunostomy/PEJ
29
Q

What are the different formulas available for selection?

A
  1. Polymeric–Pediasure
  2. Semi-elemental–Peptamen Jr
  3. Elemental–Elecare Jr
  4. Blenderized TF
  5. Specialized metabolic formulas (PKU, etc.)
30
Q

What are complications associated with TF?

A
  1. Mechanical: placement, clogging, leakage
  2. GI: N/V/D, distention, aspiration, emptying, constipation
  3. Impaired oral/motor skills
  4. Psychosocial
31
Q

When do you start PN in child?

A
  1. Preterm infant: DOL 1
  2. Term infant: 1-3 days
  3. Children/Ado: 4-5 days
  4. Mal.Nut. Child: 2-3 days
32
Q

What is TPN?

A
  1. Long term nutrition support via central line to provide 100% of nut needs
  2. Central venous catheter must be placed with distal tip in the superior vena cava
33
Q

What are the components of TPN compared to a normal diet?

A 
Protein: Crystalline AA
CHO: Dextrose
Fat: Lipid emulsion 
Vitamins: MV infusion
Minerals: E'lytes &amp; Trace
34
Q

What is PPN?

A
  1. Dextrose, AA, lipids, vitamins, m/e’lytes
  2. Osm = 900 mOsm/L
  3. Maximum dextrose concentration: 12.5% = thrombophlebitis
  4. Difficult to meet all needs
35
Q

What indicates the need for PPN?

A
  1. Patient expected to be NPO for 5-7 days
  2. Transitioning to oral diet or tube feeding
  3. Oral intake not meeting needs
36
Q

Indications for TPN?

A

Severe mal. nut., severe malabs./intestinal failure, IBS, fistula, obstruction, ileum, GI bleeding, intolerant to EN feedings, motility disorders
-Expected to need for at least SEVEN days

37
Q

What are contraindications for PN?

A
  1. Functioning GI tract
  2. Unstable fluid and e’lyte status
  3. Poor patient prognosis
  4. Nutrition objectives cannot be met
38
Q

What are complications related to PN?

A
  1. Catheter related sepsis
  2. Hyperglycemia & compromised immune function
  3. Bacterial translocation
  4. IFLAD
  5. Impaired oral-motor skills
  6. Psychosocial
39
Q

What are fluid requirements?

A

Includes from all IV lines
1-10 kg = 100 mL/kg
> 10 = 1000 mL + 50 mL/kg
> 20 = 1500 mL + 20 mL/kg

40
Q

When do you need to increase fluids?

A

fever, GI losses, insensible losses (burns, increased RR)

41
Q

When do you need to decrease fluids?

A

cardiac disease, head trauma, renal insufficiency

42
Q

When do you need to increase requirements for a neonate?

A

fever, catch-up growth, trauma, recent surgery, burns, hypotonia
-Actual numbers in notes-

43
Q

When do you need to decrease requirements for a neonate?

A

immobility, mechanical ventilation, medical sedation/paralysis
-Actual numbers in notes-

44
Q

What are the carbohydrate requirements of a TPN in pediatrics?

A

Infants: begin with 50-75 gm/day and increase by 50 gm/day

Children/Ado: begin with 100 gm/day and increase by 50-100 gm/day

45
Q

What are consequences of overfeeding?

A
  1. Increased CO2 production
  2. Hyperglycemia
  3. Liver steatosis
46
Q

What are the protein requirements of pediatric TPN?

A 
Infants = 2-3 g/kg/day
Children = 1-2 g/kg/day
Ado = 0.8-1.5 g/kg/day
47
Q

What do you need to raise the protein requirement to in patients who are in sepsis, premature, burns?

A

3.5 g/kg/day

48
Q

What do you need to decrease protein requirements to in patients with renal/liver failure?

A

0.5 g/kg/day, but most give essential AAs to prevent breakdown of lean body mass

49
Q

What are different Amino Acid formulations?

A
  1. Travasol (>2, w/o liver disease
  2. Trophamine/Premasol (infants, similar to BM, lower pH for higher Ca and P)
  3. Novamine/Clinisol (fluid constriction)
50
Q

What is SMOF?

A

soybean oil, MCT oil, olive oil, fish oil (few inflammatory FA)

51
Q

What can you do to prevent EFA deficiency?

A

Minimum lipids of 0.5 g/kg/day in infants & 1.5 g/kg twice a week for children/ado

52
Q

What electrolyte modifications need to be made in patients with UPPER GI LOSSES?

A
  1. Sodium
  2. Chloride
  3. Potassium
  4. Fluid
  5. Magnesium
53
Q

What electrolyte modifications need to be made in patients with LOWER GI LOSSES?

A
  1. Acetate/bicarbonate
  2. Sodium
  3. Fluid
  4. Chloride
54
Q

What electrolytes needs to be modified in renal dysfunction?

A

Increased: acetate/bicarbonate
Decreased: K, P, Mg, Na

55
Q

What is the maximum sum of Ca and P to have in a TPN with out precipitation?

A

40 mEq/L

-Bolus Ca may be required

56
Q

What trace elements are added to TPN?

A
  1. Zinc
  2. Chromium
  3. Copper
  4. Maganese
  5. Selenium
  6. Iron
57
Q

What is the importance of zinc?

A
  1. deficiency may cause alopecia, dermatitis, immune deficiencies
  2. increased needs with growth, GI losses, wound healing
58
Q

What is the importance of chromium?

A

plays role in glucose and lipid metabolism

59
Q

What is the importance of copper?

A

deficiency results in anemia, skin, and hair depigmentation

60
Q

What is the importance of manganese?

A
  1. Toxicity- accretion in basal ganglia

2. Long-term PN–remove if conjugates bili >2.0

61
Q

What is the importance of selenium?

A

deficiency can be fatal, symptoms can include depigmentation of hair, skin, and nails, and cardiomyopathy

62
Q

What is the importance of iron?

A
  • Deficiency is common in long term PN patients w/o transfusions
  • Venofer (monthly infusion)
63
Q

What issues does the pharmacy need to be aware of in patients on TPN?

A
  1. Multiple drug therapy (line access, compatibility)
  2. Calcium and Phosphorous solubility
  3. Electrolyte and mineral content
  4. IV antibiotics/fluids
64
Q

What interactions do loop diuretics have with nutrients?

A

hyponatremia, hypokalemia, hypocalcemia, metabolic alkalosis

65
Q

What interactions do H2-antagonists have with nutrients?

A

hyponatremia

66
Q

What interactions do corticosteroids have with nutrients?

A

hypokalemia, hypocalcemia, hypophosphatemia, metabolic alkalosis

67
Q

What interactions does ampB have with nutrients?

A

hypokalemia, hypomagnesemia, metabolic acidosis

68
Q

What interactions do aminoglycosides have with nutrients?

A

metabolic acidosis

PT: Nutrition Exam 2 (10 decks)

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