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Nutrition Support Certification Exam 2013 > PN > Flashcards

PN Flashcards

1
Q

Indications for PN

A

diffuse peritonitis, obstruction (unable to bypass), intractable N/V, inadeq intestinal absorption, GI ischemia, ileus, unable to place TF, nutrient req more than able to be met via GI tract

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2
Q

Duration of PN

A

over 7 days

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3
Q

CHO Source: Glycerin ? cals/gram

A

4.3= sugar alcohol

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4
Q

PRO Source: Renal uses

A

Essential AA, dillute

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5
Q

Hepatic AA

A

Branched chain AA with dec AAA

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6
Q

Stress AA

A

Branch chain AA with normal AAA

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7
Q

FAT Source: If egg allergy

A

test dose 1cc/min x 30 mins

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8
Q

FAT component in US

A

soybean

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9
Q

How much Vit C in standard MVI for PN

A

200 mg

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10
Q

How much thiamin/folic acid in standard MVI

A

6 mg/600 mcg

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11
Q

Extra zinc (4-30 mg/d) for what reasons?

A

diarrhea, ulcer, wounds, aid GI Fx, drugs Ampho B, cisplatin, diuretics

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12
Q

Iron Dextrose in what kind PN

A

2:1 only

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13
Q

Sodium Ferric gluconate

A

not compatible

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14
Q

Iron Sucrose

A

neonatal AA 2:1

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15
Q

Dec L-carnitine in what GI d/o

A

fat malabsorption

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16
Q

2:1 PN uses what filter

A

.2 micron (better)

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17
Q

3:1 PN uses what filter

A

1.2 micron (larger particles get thru)

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18
Q

PPN Facts

A

3-7 days, good veins (PIVs), osmolarity 600-900, phlebitis risk, large total volume, not good with renal failure, CHF

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19
Q

High osmolarity components

A

AA 10 mosm/gram, Dextrose 5 mosm/gram, Ca Gluc 1.4/meq, K/Na 2/meq

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20
Q

Dextrose rule

A

3-5g/kg/min or 7g/kg/day Safe Practice Guidelines

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21
Q

Fat rule

A

2.5g/kg/day (adult)

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22
Q

Cath occlusion-thrombic

A

instill anti-thrombotic agent, drug/lipid precipitation

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23
Q

Cath occlusion- non-thrombic

A

drug related (identify drug), HCl-Acid or Na Bicarb-base

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24
Q

Inc LFTs r/t PN Tx

A

transaminases (Inc LFTs)-suspect PN if occur after PN 2 weeks, normalizes with d/c PN

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25
Q

Inc Alk Phos

A

seen with bone disease

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26
Q

Inc Bilirubin

A

GB sludge/stones, seen often in peds with jaundice

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27
Q

Hepatobiliary Complications caused by what

A

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

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28
Q

What level of Inc TG in PN Tx do you adjust therapy

A

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

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29
Q

Essential Fatty Acid Deficiency s/s

A

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

30
Q

Supplement Ess FAcid Def

A

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

31
Q

Metabolic Bone disease from CPN

A

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

32
Q

Metabolic Bone Dz- what labs show this

A

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

33
Q

Conditions that increase urine Ca+ excretion

A

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

34
Q

Safe Aluminum amounts in LT PN pts

A

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

35
Q

Low Ca associated with low

A

Magnesium

36
Q

Bone disease reported in infants with what lacking from PN formulation

A

Copper

37
Q

Example Stability in PN

A

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

38
Q

Incompatiibility in PN

A

physically alters end product

39
Q

Ca/Phos stability

A

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

40
Q

L-cysteine in peds PN AA to lower pH

A

unfavorable for IVFE

41
Q

Aluminum

A

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

42
Q

Aggregation (flocculation)

A

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

43
Q

Creaming

A

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

44
Q

Coalescence

A

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

45
Q

Oiling out

A

total separation oil/water phases- unusable PN

46
Q

2004 Safe Practice Guidelines for Ordering PN: Mandatory

A

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

47
Q

PN label: Mandatory

A

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

48
Q

Who developed PN/when

A

late 1960s Dudrick

49
Q

3:1 sol’n when developed

A

1980

50
Q

PPN Facts

A

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

51
Q

Indications for PPN

A

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

52
Q

Contraindications PPN

A

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

53
Q

Pre-op PN

A

In mod/severe malnutrition pts

54
Q

PN beneficial for

A

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

55
Q

Severe Malnutrition Defined as

A

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

56
Q

Contraindicated PN

A

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

57
Q

GI indications for PN

A

Crohns flare with fistula

58
Q

PN not beneficial in GI

A

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

59
Q

PN in Periop Malnutrition

A

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

60
Q

PN in critical illness

A

EN is #1

61
Q

PN in Cancer

A

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

62
Q

Comorbidity that influences pt’s response to therapy/outcome

A

Malnutrition

63
Q

Decrease phlebitis in PN

A

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

64
Q

Essential Fatty acid deficiency test

A

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

65
Q

Increases circulating plasma TG

A

10% IVFat (contains inc concentrations of phospholipids)

66
Q

FAT Daily

A

1g fat/kg/day

67
Q

Prevent EFAD

A

2-4% t. cals

68
Q

Correct EFAD

A

8-10% t cals

69
Q

Fibrin Sleeve

A

inability to aspirate blood

70
Q

Vessel thrombosis

A

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

Nutrition Support Certification Exam 2013 (11 decks)

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