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Human Nutrition > Principles of Delivering Nutritional Support > Flashcards

Principles of Delivering Nutritional Support Flashcards

1
Q

What is the maximum osmolarity tolerated by peripheral vein when using Peripheral parenteral nutrition?

A

900mOsm/L

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2
Q

What are the advantages of using Peripheral parenteral nutrition?

A
  • 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.
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3
Q

True or False? Peripheral Parenteral Nutrition is Hypoosmolar.

A

FALSE!! It is Hyperosmolar ( 600-900 mOsm/L)
- Increase in osmolarity increases the risk of Thrombophlebitis, Extravasation & occlusion .

Complications as per TPN

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4
Q

Where is Total Parenteral Nutrition normally given?

A

Hospitals, Home, Nursing homes

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5
Q

What is the Dextrose final concentration in Total Parenteral Nutrition ?

A

15-25%

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6
Q

How is Parenteral nutrition (PN) normally distributed?

A

Intravenously

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7
Q

In what conditions is the use of Parenteral nutrition (PN) indicated?

A

Paralytic Ileus
Mesenteric Ischaemia
Small Bowel Obstruction
GI fistula
Crohn’s disease
Severe pancreatitis
Short Bowel syndrome
Necrotizing Enterocolitis ( NEC)

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8
Q

What are contraindications to Parenteral Nutrition?

A

Hyperosmolality
Severe HYPERglycemia
Severe electrolyte disturbances
Volume Overload
Inadequate IV access
Inadequate attempts to feed enterally

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9
Q

How is peripheral parenteral nutrition administered?

A

By peripheral veins in the hand forearm or lower leg

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10
Q

What is the typical duration for the use of Peripheral parenteral nutrition (PPN)?

A

Up to 2 weeks

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11
Q

True or False? Repletion of nutrients stores is a goal of administering Peripheral Parenteral nutrition ( PPN)?

A

FALSE!! It is NOT a goal to replenish Nutrition stores

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12
Q

How is Total Parenteral Nutrition ( Central Parenteral Nutrition ) normally administered?

A

A central venous catheter (CVC) allows for the infusion of nutrients at higher concentrations & lower fluid volumes than by peripheral veins.

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13
Q

What Is the duration for Total Parental Nutrition (TPN)?

A

Usually More than 1 week

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14
Q

Given an example of a vein used to administer Hyperosmolar solutions in Total Parenteral Nutrition ?

A

Superior Vena Cava (SVC) - normally large diameter veins

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15
Q

What is the concentration of the Hyperosmolar solution that is normally used in TPN?

A

1300-1800mOsm/L

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16
Q

What is the concentration of Dextrose normally given in Peripheral Parenteral nutrition?

A

Dextrose final concentration 5-10 %

17
Q

What is the Amino acid (aa) concentration used in Peripheral Parenteral Nutrition?

A

4.5%

18
Q

True or False? Enteral Nutrition is the preferred route of feeding over PN.

A

TRUE!!

19
Q

What are the benefits of using Enteral Nutrition?

A
  • It maintains functional integrity of the gut ( tight junctions , blood flows, trophic endogenous agents)
  • It maintains structural integrity ( villous height , gut associated lymphoid tissue)
20
Q

When is early enteral feeding normally done?

A

24-48 hours

21
Q

What are the different feeding routes for Enteral nutrition?

A
  1. Orogastric/NGT
  2. Nasojejunal
  3. Gastronomy / PEG
  4. Jejunostomy
22
Q

What are the different delivery methods for Enteral nutrition ?

A
  1. Bolus feeds
  2. Continuous drip feeds
23
Q

What are the different tube related complications of Enteral nutrition?

A
  1. Trauma to surrounding tissues
  2. Blockage
  3. Displacement
  4. Dislodgement
24
Q

What are the different formula related complications of Enteral nutrition?

A
  1. Feed tolerance- diarrhoea GIT discomfort , nausea, vomitting, constipation .
  2. Aspiration
  3. Metabolic complications
25
Q

When should Early Parenteral Nutrition(PN) be initiated?

A

If the patient is INADEQUATELY NOURISHED and if patient is not a candidate for EN AND expect npc for more than 7-10 days .

26
Q

What is the duration period for Total Parenteral nutrition?

A

Weeks to years

27
Q

What are the complications of Total parenteral nutrition?

A
  1. Catheter - related malposition , blockage leakage, arterial/vein/nerve damage , localized infection at exit or entry site , pneumothorax air embolism.
  2. Fluid & electrolyte & metabolic - pulmonary edema, electrolyte imbalances, hypo/hyperglycemia, metabolic/respiratory acidosis/alkalosis, refeeding syndrome.
  3. Liver & gallbladder- abnormalities in LFT’s (transient) ,
    cholestasis,cholelithiasis,acute cholecystitis, hepatic steatosis.
  4. Long- term complications- metabolic bone disease, renal disease mineral/vitamin deficiencies .
28
Q

How is the Resting Metabolic rate measured?

A

Indirect calorimetry

29
Q

How is the Resting Metabolic Rate (RMR) or REE calculated?

A

Using Weir’s equation - Measures the Oxygen consumed and the Carbon dioxide produced.

30
Q

What is the equation used to calculate the Respiratory Quotient( RQ)?

A

RQ= Ratio of VCO2 PRODUCED / VO2 CONSUMED

31
Q

What is the ideal Respiratory quotient (RQ)?

A

0.85-0.95 ( protein sparing & mixed utilisation of carbohydrates and fats)

32
Q

True or False? Ventilated patients have a higher energy requirement.

A

FALSE!! They have a lower energy requirement.

33
Q

What are the possible causes for a RQ to be Greater than 1?

A
  • XS Carbohydrates/calories ….lipogenesis
  • The machine is not working
  • Other causes
34
Q

What is the hallmark biochemical feature of Refeeding syndrome?

A

Hypophosphatemia

35
Q

True or False? In refeeding syndrome - the starvation period there is an Increase in Insulin levels and a Decrease in Glucagon levels.

A

FALSE!! There is a DECREASE in Insulin levels and a INCREASE in Glucagon levels.

36
Q

What are the distinct area that changes during Refeeding syndrome?

A
  1. Decrease in Electrolytes —-> Systemic pathologies
  2. Fluid balance ( Refeeding Oedema)
  3. Micronutrient status ( Vitamin B1)
37
Q
A

Human Nutrition (13 decks)

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