TPN

Question 1

parenteral nutrition

Answer 1

nutrients administered intravenously and can be given in conjunction with enteral feeding to meet body requirements

Question 2

most common
- dextrose

Answer 2

carbs

Question 3

dextrose

Answer 3

part of carbs
- easily metabolized, stimulates insulin secretion, helps to create proteins

Question 4

fat emulsion; fatty acids; soy bean and egg yolk; isotonic
- concentrated source of calories
- available in 10, 20, 30 %
- is a good medium for bacterial growth which can cause infection

Answer 4

lipids

Question 5

proteins
- concentrations range from 5-15 %
- meds can be added but only by pharmacy

Answer 5

amino acids

Question 6

1. meet caloric needs until patient can be transitioned to enteral nutrition (maintain body ability to fight infection)
2. transition to enteral to prevent cell shrinkage
3. preventing complications like septicemia

Answer 6

goal of PN

Question 7

1. patients unable to digest or absorb enteral nutrition (non functional GI and extended bowel rest)
2. highly stressed psychological states (sepsis, head injury, burns)
3. perioperative TPN (bowel rest)

Answer 7

indications for PN

Question 8

Marasmus

Answer 8

starvation

Question 9

kwashiorkor

Answer 9

extended bowel but still starvation

Question 10

effects of malnutrition

Answer 10

decreased wound healing, muscle mass
increased risk of fall, infection

Question 11

BMI less than 18.5

Answer 11

underweight

Question 12

BMI 18.5-24.9

Answer 12

desirable

Question 13

BMI 25-29

Answer 13

overweight

Question 14

Albumin

Answer 14

protein synthesized by liver; prevents fluid from leaking into interstitial spaces
- found in plasma

Question 15

Transferrin

Answer 15

transports iron in plasma and synthesized in liver

Question 16

prealbumin

Answer 16

required for thyroxine transport

Question 17

nitrogen balance

Answer 17

indicator of gain or loss of protein

Question 18

hair assessment findings

Answer 18

dull, thin, dry

Question 19

nail assesment findings

Answer 19

thin and concave

Question 20

heart assessment findings

Answer 20

tachycardic, enlarged

Question 21

abdomen assessment findings

Answer 21

hepatomegaly

Question 22

muscle and extremity findings

Answer 22

muscle wasting, edema, pain

Question 23

surgery, paralytic ileus, obstruction, head trauma, chemo/radiation therapy

Answer 23

non functional GI tract indications

Question 24

IBD, enterocutaneous fistula, pancreatitis

Answer 24

extended bowel rest indications

Question 25

zinc

Answer 25

important for wound healing

Question 26

copper

Answer 26

works with iron to form RBC

Question 27

chromium

Answer 27

potentiates insulin reactions

Question 28

PPN

Answer 28

see more in bowel rest pre surgery - short term - peripheral - less than 10% dextrose

Question 29

TPN

Answer 29

through central line - can be greater than 10% dextrose

Question 30

40cc-60cc

Answer 30

amino acid dextrose infusion pump rate

Question 31

10cc-20cc

Answer 31

lipid emulsion infusion pump rate

Question 32

pneumothorax

Answer 32

mechanical complication due to catheter insertion

Question 33

S&S of pneumothorax

Answer 33

sudden sharp chest pain, SOB, coughing

Question 34

causes of air embolus

Answer 34

mechanical complication - catheter insertion - cap/tubing change - sudden dislodgement

Question 35

S&S of air embolus

Answer 35

tachypnea, wheezing, hypotension, cyanosis, ST depression

Question 36

hyperglycemia

Answer 36

metabolic complication relating to solution used

Question 37

hypercapnia

Answer 37

metabolic complication; buildup of CO2 in bloodstream - due to excessive rates of carbohydrate infusion

Question 38

S&S of hypercapnia

Answer 38

- will present with increased CO2 (above 45) - SOB - anxiety

Question 39

- typically supplied as 20% - stored at room temp - stable for 12 hours once primed - indicator on back must be yellow, no other colour

Answer 39

lipid solution

Question 40

mix of protein and carbs - individualized - take out of fridge 30 min before - good for 24 hours once spiked - use in order # - give through central line

Answer 40

Travasol

Question 41

lipid filter

Answer 41

1.22 micron filter

Question 42

amino acid filter

Answer 42

0.22 micron filter

Question 43

Olimel (3 in 1) infusion time, fatty acid base, and filter

Answer 43

infusion time max 24hr from priming - fatty acid olive oil based instead of soy - high protein and less glucose - requires 1.22 micron filter

Question 44

cyclin PN

Answer 44

administering PN over reduced time frame for patients on long term PN - over 8 to 16 hours instead of continuous 24 hours

Question 45

renal failure formula

Answer 45

composed mainly of amino acids

Question 46

In TPN hypomagnesemia is caused by...

Answer 46

caused by refeeding syndrome

Question 47

S&S of hyperglycemia

Answer 47

fruity breath, anxiety, confusion, thirsty, tired, lethargy

Question 48

S&S of hyperkalemia

Answer 48

cardiac arrest, muscular weakness, diarrhea, tall T wave - give insulin

Question 49

S&S of hypocalcemia

Answer 49

irritability, confusion, muscle cramps, seizures

Question 50

S&S of hypokalemia

Answer 50

constipation, hypotension, bradycardia

Question 51

S&S of hypomagnesemia

Answer 51

muscular hyperexcitability, tremors, tachycardia, V-fib

Question 52

S&S of hypophosphatemia

Answer 52

decreased RBC, insulin resistance

Question 53

S&S of refeeding syndrome

Answer 53

dyspnea, tachycardia,

Question 54

solution to use if patient is disconnected from PN/TPN

Answer 54

D10 W