Principles of Delivering Nutritional Support Flashcards
What is the maximum osmolarity tolerated by peripheral vein when using Peripheral parenteral nutrition?
900mOsm/L
What are the advantages of using Peripheral parenteral nutrition?
- In patient with mild - mod malnutrition it is used to provide partial or total nutrition support when they are unable to ingest adequate calories via gut or when the central PN is not feasible.
- Infectious complications of peripheral catheters are less
- Can be D/C without tapering dextrose.
True or False? Peripheral Parenteral Nutrition is Hypoosmolar.
FALSE!! It is Hyperosmolar ( 600-900 mOsm/L)
- Increase in osmolarity increases the risk of Thrombophlebitis, Extravasation & occlusion .
Complications as per TPN
Where is Total Parenteral Nutrition normally given?
Hospitals, Home, Nursing homes
What is the Dextrose final concentration in Total Parenteral Nutrition ?
15-25%
How is Parenteral nutrition (PN) normally distributed?
Intravenously
In what conditions is the use of Parenteral nutrition (PN) indicated?
Paralytic Ileus
Mesenteric Ischaemia
Small Bowel Obstruction
GI fistula
Crohn’s disease
Severe pancreatitis
Short Bowel syndrome
Necrotizing Enterocolitis ( NEC)
What are contraindications to Parenteral Nutrition?
Hyperosmolality
Severe HYPERglycemia
Severe electrolyte disturbances
Volume Overload
Inadequate IV access
Inadequate attempts to feed enterally
How is peripheral parenteral nutrition administered?
By peripheral veins in the hand forearm or lower leg
What is the typical duration for the use of Peripheral parenteral nutrition (PPN)?
Up to 2 weeks
True or False? Repletion of nutrients stores is a goal of administering Peripheral Parenteral nutrition ( PPN)?
FALSE!! It is NOT a goal to replenish Nutrition stores
How is Total Parenteral Nutrition ( Central Parenteral Nutrition ) normally administered?
A central venous catheter (CVC) allows for the infusion of nutrients at higher concentrations & lower fluid volumes than by peripheral veins.
What Is the duration for Total Parental Nutrition (TPN)?
Usually More than 1 week
Given an example of a vein used to administer Hyperosmolar solutions in Total Parenteral Nutrition ?
Superior Vena Cava (SVC) - normally large diameter veins
What is the concentration of the Hyperosmolar solution that is normally used in TPN?
1300-1800mOsm/L
What is the concentration of Dextrose normally given in Peripheral Parenteral nutrition?
Dextrose final concentration 5-10 %
What is the Amino acid (aa) concentration used in Peripheral Parenteral Nutrition?
4.5%
True or False? Enteral Nutrition is the preferred route of feeding over PN.
TRUE!!
What are the benefits of using Enteral Nutrition?
- It maintains functional integrity of the gut ( tight junctions , blood flows, trophic endogenous agents)
- It maintains structural integrity ( villous height , gut associated lymphoid tissue)
When is early enteral feeding normally done?
24-48 hours
What are the different feeding routes for Enteral nutrition?
- Orogastric/NGT
- Nasojejunal
- Gastronomy / PEG
- Jejunostomy
What are the different delivery methods for Enteral nutrition ?
- Bolus feeds
- Continuous drip feeds
What are the different tube related complications of Enteral nutrition?
- Trauma to surrounding tissues
- Blockage
- Displacement
- Dislodgement
What are the different formula related complications of Enteral nutrition?
- Feed tolerance- diarrhoea GIT discomfort , nausea, vomitting, constipation .
- Aspiration
- Metabolic complications
When should Early Parenteral Nutrition(PN) be initiated?
If the patient is INADEQUATELY NOURISHED and if patient is not a candidate for EN AND expect npc for more than 7-10 days .
What is the duration period for Total Parenteral nutrition?
Weeks to years
What are the complications of Total parenteral nutrition?
- Catheter - related malposition , blockage leakage, arterial/vein/nerve damage , localized infection at exit or entry site , pneumothorax air embolism.
- Fluid & electrolyte & metabolic - pulmonary edema, electrolyte imbalances, hypo/hyperglycemia, metabolic/respiratory acidosis/alkalosis, refeeding syndrome.
- Liver & gallbladder- abnormalities in LFT’s (transient) ,
cholestasis,cholelithiasis,acute cholecystitis, hepatic steatosis. - Long- term complications- metabolic bone disease, renal disease mineral/vitamin deficiencies .
How is the Resting Metabolic rate measured?
Indirect calorimetry
How is the Resting Metabolic Rate (RMR) or REE calculated?
Using Weir’s equation - Measures the Oxygen consumed and the Carbon dioxide produced.
What is the equation used to calculate the Respiratory Quotient( RQ)?
RQ= Ratio of VCO2 PRODUCED / VO2 CONSUMED
What is the ideal Respiratory quotient (RQ)?
0.85-0.95 ( protein sparing & mixed utilisation of carbohydrates and fats)
True or False? Ventilated patients have a higher energy requirement.
FALSE!! They have a lower energy requirement.
What are the possible causes for a RQ to be Greater than 1?
- XS Carbohydrates/calories ….lipogenesis
- The machine is not working
- Other causes
What is the hallmark biochemical feature of Refeeding syndrome?
Hypophosphatemia
True or False? In refeeding syndrome - the starvation period there is an Increase in Insulin levels and a Decrease in Glucagon levels.
FALSE!! There is a DECREASE in Insulin levels and a INCREASE in Glucagon levels.
What are the distinct area that changes during Refeeding syndrome?
- Decrease in Electrolytes —-> Systemic pathologies
- Fluid balance ( Refeeding Oedema)
- Micronutrient status ( Vitamin B1)
