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Nutrition Therapeutics > TPN > Flashcards

TPN Flashcards

1
Q

indications for TPN

A

GI tract dysfunction (short bowel, severe vomiting, diarrhea)
adjunctive tx for cancer (malnourished and not EN candidates)
pancreatitis (if EN exacerbates sx or disease)
critically ill (EN not available, intolerable) withold for up to 7 days
perioperative (pre-existing MN)
hyperemesis
eating disorders

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2
Q

is central or peripheral PN more common

A

central

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3
Q

central PN
dextrose =
amino acids (AA) =
electrolytes =

A

provides “complete” PN
5mOsm/g
10mOsm/g
1-2mOsm/mEq

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4
Q

peripheral PN is for patients who _______

A

do not have significant MN
have good peripheral vascular access
can tolerate large fluid volumes (2.5-3L/day)
need 5-14 days of PN support

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5
Q

3 IV access points for PN

A

subclavian
peripherally inserted central catheter
tunneled catheter

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6
Q

PN complications

A 
costly, labor intensive, monitoring
pneumothorax (partially collapsed lung), thrombisis, thrombophlebitis
line sepsis
inc bacterial translocation
electrolyte abnormalities
hyper/o glycemia
hyperTG
fluid overload
osteoporosis/malacia
hepatobiliary
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7
Q

refeeding syndrome
definition
treatment
caveat

A

rapid, severe depletion of K, Mg and phos in starved patients
limited electrolyte stores –> intracellular electrolyte shift
death can result
tx: supplementation of lytes PLUS thiamine 50-100mg/day

the more nutritionally depleted the SLOWER nutritional support should be initiated

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8
Q

in refeeding syndrome, which things make a patient more nutritionally depleted and therefore require slower nutritional support

A

chronic diseases (cancer, COPD, cirrhosis)
malabsorption
anorexia nervosa
previously morbidly obese and has lost weight
EtOH abuse
severely ill w/out nutritional support in last 7 days

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9
Q

PN components protein:
kcal/g ratio
_____g = 1 g nitrogen
commercially available concentrations

A

4kcal/1g protein
6.25g protein = 1g nitrogen

3-20%

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10
Q 
Carbohydrates (CHO)
kcal/g?
commercially available concentrations
pH range
glycerol specifics
A

3.4kcal/1g CHO
2.5-70% (>10% require central admin bc they are hyperosmolar)
pH 3.5-6.5
glycerol provides 4.3kcal/g, available as 3% w AAs

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11
Q

Lipids (IVFE)

definition

A

oil suspension in an aqueous medium that has properties similar to chylomicrons
source of vitamin K (may interfere with warfarin)

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12
Q

Lipids
kgal/g?
allergy CI?
contains ______?

A

9kcal/g
cannot be used in soybean allergy
contains omega-6 PUFAs which promote production of pro-inflam cytokines

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13
Q

lipids monitoring and AE

A

infusion reactions (SOB, angina, palpitations, chills, rash, HA, N, fever) all rate related
hypertriglyceridemia >400 (inc risk w sepsis, pancreatitis, multi-organ failure, neonates)
hepatotoxicity

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14
Q

steps to initiating PN

A
  1. est vascular access (typically central)
  2. calc micronutrient req
  3. provide 25-30% on first day (CHO 150-200g initially)
  4. eval electrolyte needs and refeeding risk
  5. eval trace element and vitamin needs
  6. insulin?
  7. review compatibility
  8. ASPEN Guidance
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15
Q

“standard formula”

A

protein is 1-2g/kg/d
cant change AA, dextrose or lipids
rate is protein-based

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16
Q

individualized formula

A 
use is standard is off by a lot
lipid contribution is up to 30%
protein 1-2g/kg/day
dextrose = total - [protein-lipids] kcal
est volume (2 in 1 vs 3 in 1)
17
Q

what is 2 in 1

A

carbs and protein

use in ICU first week then add 100g lipids/week thereafter

18
Q

whats 3 in 1

A

carbs
proteins
lipids

19
Q

sodium daily requirement

A

1-2mEq/kg

20
Q

potassium daily requirement

A

1-2mEq/kg

21
Q

chloride daily requirement

A

as needed to balance acid base status

22
Q

acetate daily requirement

A

prn to balance acid/base

23
Q

Calcium daily requirement

A

10-15 mEq

24
Q

Mg daily requirement

A

8-20 mEq

25
Q

Phosphate

A

20-40

26
Q

trace elements and their excretion

A

high-output ostomies or diarrhea –> add’nal Zinc
manganese and copper –> biliary tract
chromium, molybdenum, selenium–> renal

27
Q

add phosphate to TPN ______

A

first!

28
Q

everything but _____ must be mixed before admin

A

procalamine

29
Q

vitamins are added when in regards to admin

A

immediately prior to admin

30
Q

`Factors that affect calcium phosphate compatibility

A

AAs inc pH which dec solubility

dextrose concentration dec pH which inc solubility

31
Q

if neonates have a fever what can happen with TPN admin

A

inc temp dec flow in IV line which can cause precipitation

32
Q

monitoring of patients

A 
fluids, weights qd
glucose q1-6h
elec daily-TIW
LFT, visceral proteins, CBC, PT/PTT 1-2x/week
protein turnover weekly
triglycerides weekly

Nutrition Therapeutics (4 decks)

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