TPN Flashcards
parenteral nutrition
nutrients administered intravenously and can be given in conjunction with enteral feeding to meet body requirements
most common
- dextrose
carbs
dextrose
part of carbs
- easily metabolized, stimulates insulin secretion, helps to create proteins
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
lipids
proteins
- concentrations range from 5-15 %
- meds can be added but only by pharmacy
amino acids
- meet caloric needs until patient can be transitioned to enteral nutrition (maintain body ability to fight infection)
- transition to enteral to prevent cell shrinkage
- preventing complications like septicemia
goal of PN
- patients unable to digest or absorb enteral nutrition (non functional GI and extended bowel rest)
- highly stressed psychological states (sepsis, head injury, burns)
- perioperative TPN (bowel rest)
indications for PN
Marasmus
starvation
kwashiorkor
extended bowel but still starvation
effects of malnutrition
decreased wound healing, muscle mass
increased risk of fall, infection
BMI less than 18.5
underweight
BMI 18.5-24.9
desirable
BMI 25-29
overweight
Albumin
protein synthesized by liver; prevents fluid from leaking into interstitial spaces
- found in plasma
Transferrin
transports iron in plasma and synthesized in liver
prealbumin
required for thyroxine transport
nitrogen balance
indicator of gain or loss of protein
hair assessment findings
dull, thin, dry
nail assesment findings
thin and concave
heart assessment findings
tachycardic, enlarged
abdomen assessment findings
hepatomegaly
muscle and extremity findings
muscle wasting, edema, pain
surgery, paralytic ileus, obstruction, head trauma, chemo/radiation therapy
non functional GI tract indications
IBD, enterocutaneous fistula, pancreatitis
extended bowel rest indications
zinc
important for wound healing
copper
works with iron to form RBC
chromium
potentiates insulin reactions
PPN
see more in bowel rest pre surgery
- short term
- peripheral
- less than 10% dextrose
TPN
through central line
- can be greater than 10% dextrose
40cc-60cc
amino acid dextrose infusion pump rate
10cc-20cc
lipid emulsion infusion pump rate
pneumothorax
mechanical complication due to catheter insertion
S&S of pneumothorax
sudden sharp chest pain, SOB, coughing
causes of air embolus
mechanical complication
- catheter insertion
- cap/tubing change
- sudden dislodgement
S&S of air embolus
tachypnea, wheezing, hypotension, cyanosis, ST depression
hyperglycemia
metabolic complication relating to solution used
hypercapnia
metabolic complication; buildup of CO2 in bloodstream
- due to excessive rates of carbohydrate infusion
S&S of hypercapnia
- will present with increased CO2 (above 45)
- SOB
- anxiety
- typically supplied as 20%
- stored at room temp
- stable for 12 hours once primed
- indicator on back must be yellow, no other colour
lipid solution
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
Travasol
lipid filter
1.22 micron filter
amino acid filter
0.22 micron filter
Olimel (3 in 1) infusion time, fatty acid base, and filter
infusion time max 24hr from priming
- fatty acid olive oil based instead of soy
- high protein and less glucose
- requires 1.22 micron filter
cyclin PN
administering PN over reduced time frame for patients on long term PN
- over 8 to 16 hours instead of continuous 24 hours
renal failure formula
composed mainly of amino acids
In TPN hypomagnesemia is caused by…
caused by refeeding syndrome
S&S of hyperglycemia
fruity breath, anxiety, confusion, thirsty, tired, lethargy
S&S of hyperkalemia
cardiac arrest, muscular weakness, diarrhea, tall T wave
- give insulin
S&S of hypocalcemia
irritability, confusion, muscle cramps, seizures
S&S of hypokalemia
constipation, hypotension, bradycardia
S&S of hypomagnesemia
muscular hyperexcitability, tremors, tachycardia, V-fib
S&S of hypophosphatemia
decreased RBC, insulin resistance
S&S of refeeding syndrome
dyspnea, tachycardia,
solution to use if patient is disconnected from PN/TPN
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