PN Flashcards

Question

Inc Alk Phos

Answer 1

seen with bone disease

Answer 2

GB sludge/stones, seen often in peds with jaundice

Answer 3

Multifactorial, disease, excess Gluc, 24hr infusion, lack of enteral stimulation, bacterial overgrowth in sm bowel, infection/sepsis, sterols in IV fat (toxicity)

Answer 4

Max 400, dec IVFE 400-500, hold IVFE over 500-immunosuppresants, poor glucose control

Answer 5

Fat free 2-4 weeks, altered PLT, hair loss, poor wound, dry scalp/skin.

Answer 6

2-4% total kcals as IVFE, 1-2% linoleic acid

Answer 7

CPN over 1 year, 40-100% CPN pts with malabsorption, chr liver, immobile, steroids, loop diuretics, heparin

Answer 8

inc Ca/PO4, urine net loss Ca/Mg, Vit D (def/toxicity)

Answer 9

High PRO (2g/kg/d), High Na, chr metab acidosis, excess fluid, Hyperglycemia, Alum contaminates, steroids, loop diuretics, cyclic PN infusion

Answer 10

5mcg/kg/d, AA replaced with crystalline from protein hydolysates

Answer 11

Maillard reaction (browning), Photodegradation by light (B vits), hydrolysis (Vit C)

Answer 12

physically alters end product

Answer 13

pH < 5.3 or > 10 of AA, use Ca Gluconate or Ca, gluceptate, lack mixing, storage conditions, add Phos than other additives before Ca

Answer 14

unfavorable for IVFE

Answer 15

store in plastic, excretes kidney but binds to transferrin, not more 25,mcg/L, toxicity with renal dz, Fe def, high intake in PN, AA,Ca, Phos have affinity for bind with aluminum

Answer 16

fat particles aggregate to form larger droplets but redisperse with agitation.

Answer 17

Large fat droplets rise to surface= cream layer but REVERSE with agitation.

Answer 18

fat droplets aggregate into larger but irreversible, can't use PN

Answer 19

total separation oil/water phases- unusable PN

Answer 20

clarity of form, ingred listed same order as bag label, avoid decimals/percents, all components amt/day, contact # for provider, location of CL, ht/wt/dosing wt, dz, PN indication, hangtime guidelines, infusion rate

Answer 21

amt daily or kg/day (peds), dose wt, route admin, admin date/time, exp date, overfill is stated, PO4 in mmol and mEq salts, rate cc/hr or cycle, who prepared and reviewed sol'n, additives for pt to add in HCPN

Answer 22

late 1960s Dudrick

Answer 23

5-10% Dext, 3% AA, high total volume, mild-mod malnourished, short duration up to 2 weeks

Answer 24

good PIVs, tolerate volume, @ least 5 days, no more than 2 weeks, NOT SEVERLY Malnourished

Answer 25

Severely Malnourished, sever metabolic stress, lg nutrient/lytes needs, fluid restriction, over 2 weeks, renal/liver compormise

Answer 26

In mod/severe malnutrition pts

Answer 27

crohns flare, GI fistulae, extrese SBS, critical care pts NPO for long time, nectrotizing pancreatitis, failed EN, pulm aspiration

Answer 28

over 10% involuntary wt loss x 2-3 months, lower 75% DBW/UBW, prealb less 10, transferrin less 100, inadequate po greater than 7 days

Answer 29

well nourised pt, inadequate EN, less 7 dyas, DNR

Answer 30

Crohns flare with fistula

Answer 31

bowel rest not needed for crohns, mild, acute, chronic or relapsing pancreatitis less 7 days, could harm mild pancreatitis, EN favored for severe acute pancreatitis

Answer 32

Malnutr inc OR complications, benefit fro mod malnourished for OR or upper GI Cancers. Benefit for severely malnourished. Less than 7 days=inapp.

Answer 33

PN with chemo/rad increases infections, unclear with BMT, associated with net harm

Answer 34

Malnutrition

Answer 35

K less 60meq/L, heparin, piggyback IVFE, osmolarity less/equal 900 mosm/L

Answer 36

High oleic/palmitoleic acids & Low linoleic/arachidonic acids, Mead acid is present (by product of oleic)

Answer 37

10% IVFat (contains inc concentrations of phospholipids)

Answer 38

1g fat/kg/day

Answer 39

2-4% t. cals

Answer 40

8-10% t cals

Answer 41

inability to aspirate blood

Answer 42

resistance to infusion/aspiration- may have neck distension, edema, tinglin or pain over ipsilateral arm/neck, tight feeling in throat--may result permanent vascular obstruction