PN Pt 2

Question 1

What are the calories in the following:
Carbs
Protein
Fat (Intralipid 20% or 30%)
Fat (Liposyn 10%)
Alcohol

Answer 1

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

Question 2

What is the IBW for males

Answer 2

50 + (2.3 * inches over 5’)

multiply by 1.25 to see if you need to use ABW

Question 3

What is the IBW for females

Answer 3

45.5 + (2.3 * inches over 5’)

multiply by 1.25 to see if you need to use ABW

Question 4

What is Adjusted BW

When do you use it

Answer 4

IBW + 0.25 * (ABW - IBW)

Use it when actual weight is over 25% of IBW

Question 5

What is the weight based estimation of energy calories

Answer 5

20-35 kcal/mL

Question 6

What are the usual protein requirements?

Answer 6

0.8-1 g/kg/d

Question 7

What are the protein requirements in renal failure

Answer 7

0.6-0.8 g/kg/d

Question 8

What are the protein requirements in HD

Answer 8

1.1-1.4 g/kg/d

Question 9

What are the protein requirements in liver failure

Answer 9

0.5-1 g/kg/d

Question 10

What are the protein requirements in the critically ill

Answer 10

1.2-1.5 g/kg/d

Question 11

What are the protein requirements in burn victims

Answer 11

1.5-2 g/kg/d

Question 12

What are the protein requirements for someone undergoing continuous renal replacement therapy (CRRT)?

Answer 12

1.7-2 g/kg/d

Question 13

What are fluid requirements for newborn to young adult

Answer 13

100 ml/kg for 1st 10 kg
50 ml/kg for next 10 kg
20 ml/kg for every kg over 20 kg

Question 14

What are the fluid requirements for 25-55 yrs

Answer 14

35 ml/kg

Question 15

What are the fluid requirements for 56-65 yrs

Answer 15

30 ml/kg

Question 16

What are the fluid requirements for over 65 yrs

Answer 16

25 ml/kg

Question 17

How do you convert lb to kg

Answer 17

divide by 2.2

2.2 lb is 1 kg

Question 18

What are the calculation steps

Answer 18

1. Calculate calorie needs (BEE or 20-25 kcal/kg)
2. Determine protein needs
3. Calculate non-protein calories
4. Calculate dextrose
5. Calculate lipids
6. Determine fluid volume

Question 19

How do you calculate caloric needs of a pt?

Answer 19

BEE or assume 20-25 kcal/kg

Question 20

How do you determine protein needs?

Answer 20

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

Question 21

How do you calculate protein calories needed?

Answer 21

Multiply protein in g needed by how many kcals are in a gram of protein

(it’s 4 kcal/g)

Question 22

How do you calculate non-protein calories?

Answer 22

Subtract protein calories from total calories

Question 23

How do you intervene with a pt who has hypertriglyceridemia? What levels would they have?

Answer 23

Adult over 400, infants/pediatrics 150-200

Intervene by reducing rate or dose, withholding IVFE, and using low dose heparin (in neonates)

Question 24

How should PN be administered in pts with hyperglycemia?

Answer 24

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

Question 25

When would you see the effects of essential fatty acid deficiency? How would you confirm it?

Answer 25

Within 1-4 weeks of PN in adults, 48 hours in newborns

Confirm bc triene: tetraene ratio is greater than 0.4

Question 26

How does AA and dextrose conc affect stability?

Answer 26

As conc decreases, TNA becomes less stable

Question 27

What is the right order of mixing

Answer 27

Combine AA with dextrose and sterile water
Add electrolytes, vitamins, and trace elements
Visually inspect the solution

Question 28

What precipitation do you have to worry about in TPN?

Answer 28

Calcium and phosphate

Question 29

Never add ____ to lipids. Only ______.

Answer 29

Iron; iron dextran