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Exam 1 Year 3 > TPN > Flashcards

TPN Flashcards

1
Q

What deficiencies can cause abnormal nutrient intake causing malnutrition?

A

Nutrient intake, Digestion, Absorption, Metabolism, Excretion/Nutrition losses

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2
Q

Rapidly developing malnutrition triggered by acute stress and injury, which is short lived, and resolves as patient condition improves is known as?

A

Acute Malnutrition

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3
Q

Happens because of another disease such as cancer, IBD, organ failure, and requires long term monitoring and therapy is known as?

A

Chronic malnutrition

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4
Q

What is the consequence of untreated malnutrition?

A

-Impaired immunity
-Decreased wound healing
-Increased complications
-Poor response to medical or surgical therapy
-Reduced growth or development of infant or child
-Death

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5
Q

You have a patient who has inadequate or unsafe oral intake, and a functional accessible GIT, what type of feeding would you recommend for this person?

A

Enteral tube feeding

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6
Q

You have a patient with inadequate or unsafe oral or enteral intake and a non-functional or perforated GIT. What type of feeding would you recommend for this person?

A

Parenteral nutrition

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7
Q

What does parenteral nutrition include?

A

Water, Amino acids, Glucose, Lipids, Vitamins, Trace elements, Electrolytes

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8
Q

Why might someone use parental nutrition short term?

A

-Post surgery if the patient is on gut rest (NBM) - for more than 7 days
-Obstruction in the gut
-Severe shock or gut infection
-Malnourished or unable to eat

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9
Q

Why might someone use parental nutrition long term?

A

-Non-functioning gut
-Not enough gut to function due to surgery
*Some patients still eat small amounts, this may or may not be permanent

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10
Q

If in oral diet someone has water/volume what do they have in the PN source?

A

Water/volume

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11
Q

If in someone’s oral diet they have protein what would this replace this with in PN?

A

L-amino acids mixture

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12
Q

If someone’s oral diet they have carbohydrates, what is the equivalent to this in PN?

A

Glucose

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13
Q

If someone’s oral diet they have Fat with essential fatty acids, what is the equivalent to this in PN?

A

Lipid emulsion with essential fatty acids

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14
Q

If in someone’s oral diet they have Vitamins what is the equivalent to this is PN?

A

Vitamins

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15
Q

If in someone’s oral diet they have Minerals, what is the equivalent to this in PN?

A

Trace elements

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16
Q

If in someone’s oral diet they have Electrolytes what is the equivalent to this in PN?

A

Electrolytes

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17
Q

What is the equation to work out how much water a patient would require?

A

Maintenance fluid = 1500ml + (20ml x each kg of weight >20kg)

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18
Q

What factors mean that less fluid would be given?

A

-Fluid overload
-High humidity
-Blood transfusion
-Drugs
-Cardiac failure
-Renal failure

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19
Q

What factors mean that more water should be given?

A

-Dehydration
-Fever
-Acute anabolic state
-High temp
-Low humidity
-GI losses
-Burns/wounds
-Blood loss

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20
Q

What is the equation for nitrogen?

A

0.2g nitrogen/kg/day

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21
Q

What is given for amino acids?

A

Nitrogen

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22
Q

Amino acid solutions are hypertonic to blood, what does this mean?

A

They should not be administered alone in peripheral circulation as they can cause damage to blood vessels.

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23
Q

What is the equation for how much Energy is required for a person?

A

25-35 non-protein kcal/kg/day

24
Q

Where is energy for PN sourced from?

A

Lipid and Glucose (dual energy source)

25
Q

Why do we need a dual energy source?

A

Metabolic issues can arise, as they can exceed metabolic capacity.

26
Q

How many ‘g’ of anhydrous glucose provides 4kcal?

A

1

27
Q

Why shouldn’t glucose be used alone as an energy source?

A

-Hyperglycaemia
-Fatty infiltration of the liver (excess glucose is converted to fatty acids)
-Excessive CO2 production
-Excessive consumption of oxygen
-Essential fatty acid deficiency
-Metabolic issues

28
Q

How much lipid should a patient receive?

A

Patients typically receive 2.5g lipid/kg/day

29
Q

What are some examples of lipid emulsions containing essential fatty acids?

A

Linoleic acid 52% / 8%

30
Q

What examples of lipid emulsions contain other fatty acids?

A

*Oleic acid 22%
*Palmitic acid 13%
*Stearic acid 4%
*Other fatty acids 1%

31
Q

What are the two groups of micronutrients?

A

Trace elements and Vitamins

31
Q

What is the advantage of Lipid Emulsions?

A

*Large amount of energy in small amount of fluid
*Allows peripheral administration
-Isotonic
-Veno-protective effect
*Contains some fat soluble vitamins (E and K)
*Prevents/reverses essential fatty acid deficiency

31
Q

What are micronutrients key role?

A

Intermediary metabolism as both co-factors and co-enzymes, affect enzyme activity and total metabolism

31
Q

What affects micronutrient requirements?

A

*Baseline nutritional state on starting PN
*Increased loss
- small bowl fistulae/aspirate (Zinc rich)
- Biliary fluid loss (Copper rich)
- Burn fluid loss (Zinc, Copper, Selenium rich)

31
Q

What clearance is reduced when someone is in liver failure?

A

Copper and Manganese

32
Q

What clearance is reduced when someone is in renal failure?

A

Aluminium, chromium, zinc and nickel clearance

33
Q

What are the commercially available products which are added into TPN?

A

Additrace and Decan

34
Q

What are the 10 known trace elements?

A

1) Iron
2) Copper
3) Zinc
4) Fluorine
5) Manganese
6) Iodine
7) Cobalt
8) Selenium
9) Molybdenum
10) Chromium

35
Q

What are fat-soluble vitamins stored in the body?

A

A - retinol
D - Ergocalciferol
E - tocopherol
K1

36
Q

What are the water-soluble renally cleared vitamins?

A

B1 - Thiamine
B2 - Riboflavin
B6 - Pyridoxine
B12
C - Ascorbic acid
Folic acid
Panthothenic acid
Biotin
Niacin

36
Q

What commercial preparation is availble for fat-soluble vitamins?

A

Vitilipid N Adult

36
Q

What is in a TPN bag?

A

Amino acids (nitrogen/proteins), Glucose & Lipids (Energy and fluid), Trace elements, Vitamins, Electrolytes

36
Q

What commercial preparation is available for water-soluble vitamins?

A

Solivito-N

36
Q

What electrolytes are added according to the patients daily blood tests?

A

Sodium, Potassium, Calcium, Magnesium, Phosphate, Chloride, Acetate

37
Q

What is the first line administration route for TPN?

A

Peripheral Administration when for short term.
Central Administration for longer term feeding.

38
Q

How many hours before giving TPN should it be taken out of the fridge?

A

3 hours

39
Q

How can physical stability be affected with TPN?

A

-Precipitation:
*Can cause fatal emboli - cannot be seen if nutrients contains a lipid.
-Lipid destabilisation
*Lipid globules may come together and coalesce, cause respiratory and circulatory blockages
-All PN fluids are passed through a filter when infused into a patient

40
Q

How can Chemical stability be affected in TPN?

A

Vitamins undergo chemical degradation, they are sensitive to light exposure.
-Vitamin C is the least stable and used as a marker for vitamin degradation

41
Q

How can Microbial stability be affected in TPN?

A

*High nutritious medium - growth
*Manipulations are performed using validated aseptic techniques
*Staff are trained in aseptic technique when connecting/disconnecting infusions

42
Q

What do we monitor in a patient with TPN?

A

DAILY BLOODS
-LFT, Electrolyte, Blood glucose, Haematology, CRP, Calcium, Albumin
ALSO
Clinical symptoms, temperature, blood pressure, fluid balance, weight, nitrogen balance, lipid tolerance, acid-base profile

43
Q

What are the complications when having TPN?

A

-Line blockages
-Line sepsis
-Thrombophlebitis
-Refeeding syndrome

44
Q

What causes line blockages in TPN lines?

A

-Fibrin sheath forms around the line or a thrombosis blocks the tip
-Internal blockage of lipid, blood clot or salt and drug precipitates
-Line Kinking
-Blockage of a protective line filter

45
Q

What is Refeeding syndrome?

A

*Metabolic complication when the infused nutrition exceeds the tolerance of a previously malnourished patient

46
Q

What should be added to a TPN back if the patient is at risk of refeeding syndrome?

A

Thiamine

47
Q

How many hours should the first bag of TPN be given over?

A

48 hours

48
Q

What happens in the body in refeeding syndrome?

A

Fat stores are getting used up when starting TPN, the food changes the metabolising carbohydrate and instead of fat, there is a sudden increase of insulin, this decreases K and Mg causing fluid retention.

Exam 1 Year 3 (40 decks)

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