PN Pt 2 Flashcards
What are the calories in the following: Carbs Protein Fat (Intralipid 20% or 30%) Fat (Liposyn 10%) Alcohol
Carbs 3.4 kcal/g Protein 4 kcal/g Fat (Intralipid 20% or 30%) 10 kcal/g Fat (Liposyn 10%) 1.1 per mL kcal/g Alcohol 7 kcal/g
What is the IBW for males
50 + (2.3 * inches over 5’)
multiply by 1.25 to see if you need to use ABW
What is the IBW for females
45.5 + (2.3 * inches over 5’)
multiply by 1.25 to see if you need to use ABW
What is Adjusted BW
When do you use it
IBW + 0.25 * (ABW - IBW)
Use it when actual weight is over 25% of IBW
What is the weight based estimation of energy calories
20-35 kcal/mL
What are the usual protein requirements?
0.8-1 g/kg/d
What are the protein requirements in renal failure
0.6-0.8 g/kg/d
What are the protein requirements in HD
1.1-1.4 g/kg/d
What are the protein requirements in liver failure
0.5-1 g/kg/d
What are the protein requirements in the critically ill
1.2-1.5 g/kg/d
What are the protein requirements in burn victims
1.5-2 g/kg/d
What are the protein requirements for someone undergoing continuous renal replacement therapy (CRRT)?
1.7-2 g/kg/d
What are fluid requirements for newborn to young adult
100 ml/kg for 1st 10 kg
50 ml/kg for next 10 kg
20 ml/kg for every kg over 20 kg
What are the fluid requirements for 25-55 yrs
35 ml/kg
What are the fluid requirements for 56-65 yrs
30 ml/kg
What are the fluid requirements for over 65 yrs
25 ml/kg
How do you convert lb to kg
divide by 2.2
2.2 lb is 1 kg
What are the calculation steps
- Calculate calorie needs (BEE or 20-25 kcal/kg)
- Determine protein needs
- Calculate non-protein calories
- Calculate dextrose
- Calculate lipids
- Determine fluid volume
How do you calculate caloric needs of a pt?
BEE or assume 20-25 kcal/kg
How do you determine protein needs?
Determine protein requirement based on the table (or given) then multiply by the weight
ie a 70kg critically ill pt needs 1.2 g/kg
1.2 times 70 is 84 g
How do you calculate protein calories needed?
Multiply protein in g needed by how many kcals are in a gram of protein
(it’s 4 kcal/g)
How do you calculate non-protein calories?
Subtract protein calories from total calories
How do you intervene with a pt who has hypertriglyceridemia? What levels would they have?
Adult over 400, infants/pediatrics 150-200
Intervene by reducing rate or dose, withholding IVFE, and using low dose heparin (in neonates)
How should PN be administered in pts with hyperglycemia?
Initiate 100-200g of dextrose with 0.05 to 0.1 units of insulin per gram of dextrose for mild hyperglycemia (130-150)
for 151-200:
Increase insulin dose to 0.15-0.2 units/g of dextrose
Monitor BG every 4-6 hours
When would you see the effects of essential fatty acid deficiency? How would you confirm it?
Within 1-4 weeks of PN in adults, 48 hours in newborns
Confirm bc triene: tetraene ratio is greater than 0.4
How does AA and dextrose conc affect stability?
As conc decreases, TNA becomes less stable
What is the right order of mixing
Combine AA with dextrose and sterile water
Add electrolytes, vitamins, and trace elements
Visually inspect the solution
What precipitation do you have to worry about in TPN?
Calcium and phosphate
Never add ____ to lipids. Only ______.
Iron; iron dextran
