TPN

Question 1

define malnutrition

Answer 1

deficiency/excess/imbalance of energy/proteins/other nutrients causing adverse effects on the body

Question 2

what can malnutrition cause

Answer 2

impaired immunity decreased wound healing increased complications poor response to therapy (3x more likely to have complications) reduced growth/development death

Question 3

what is acute malnutrition

Answer 3

develops rapidly in the presence of acute stress/injury

Question 4

what is chronic malnutrition

Answer 4

develops in a number of disease states but requires long term monitoring and therapy

Question 5

if a patient has Inadequate or unsafe oral intake but a Functional, accessible GI tract which feeding method would you use

Answer 5

enteral feeding tube

Question 6

if a patient has Inadequate or unsafe oral intake but a non-functional, accessible GI tract which feeding method would you use

Answer 6

parenteral nutrition (IV)

Question 7

what is parenteral nutrition

Answer 7

IV administration of nutritionally balanced, physiochemical, stable and sterile combination of water and nutrients

Question 8

what makes up parenteral nutrition

Answer 8

wateramino acids glucose lipids vitamins trace elements electrolytes

Question 9

maintenenace water requirements in PN

Answer 9

1500ml + 20ml/kg >20kg

Question 10

causes of dehydration/increased fluid requirements with PN

Answer 10

fever, GI loss, blood loss and burns

Question 11

causes of fluid overload/decreased fluid requirements with PN

Answer 11

blood transfusion, drugs, renal/cardiac failure

Question 12

how much of your bw is made up of water

Answer 12

60%

Question 13

nitrogen requirements in PN

Answer 13

0.2g/kg/day

Question 14

when would more amino acids be required in PN

Answer 14

diseased/clinically stressed states

Question 15

what are the amino acid requirements

Answer 15

20 in total, 8 cannot be synthesised and 5 conditionally essential

Question 16

warning with TV amino acid administration

Answer 16

hypertonic - should not be administered alone

Question 17

what affects energy requirements

Answer 17

age, activity, disease severity

Question 18

what are the energy requirements

Answer 18

25-35 non-protein kcal/kg/day

Question 19

why should glucose not be given alone

Answer 19

hyperglycaemia fatty infiltration of liver excessive co2 production and o2 consumption essential fatty acid deficiency

Question 20

energy content of glucose

Answer 20

1g anhydrous glucose = 4kcal

Question 21

energy content of lipids

Answer 21

10kcal/g of oil

Question 22

lipid requirements

Answer 22

2.5g/kg/day

Question 23

which acids contain essential fatty acids

Answer 23

linolenic and linoleic acids

Question 24

what are the fat soluble vitamins

Answer 24

A, D, E, K1

Question 25

what are water soluble vitamins

Answer 25

B1, B2, B6, B12, C, folic acid

Question 26

why are vitamins important

Answer 26

play a key role in intermediary metabolism as co-factors and co-enzymes

Question 27

in which diseases would you need altered vitamin requirements

Answer 27

□ Small bowel fistulae - decreased zinc □ Biliary fluid loss - decreased copper □ Burns - decreased zinc, copper and selenium □ Liver failure - copper and manganese clearance reduced □ Renal failure - aluminium, chromium, zinc and nickel clearance reduced

Question 28

what are the 10 known trace elements required in PN

Answer 28

iron copperzinc fluorine manganese iodine cobalt selenium molybdenum chromium

Question 29

which electrolytes are required in PN

Answer 29

sodiumpotassium calcium magnesium phosphate chloride acetate

Question 30

what are the two reasons a patient may need TPN

Answer 30

• short term inpatient (NMB/obstruction or malnourished) - long term/home (non-functioning gut)

Question 31

what are the two methods for TPN administration

Answer 31

peripheral administration (PICC) - 1st line central line

Question 32

indications for a PICC line

Answer 32

short term supplemental feeding high sepsis risk no immediate central line access

Question 33

feed requirements via PICC line

Answer 33

good line care and low tonicity feeds (<800mOsmol/L)

Question 34

C/I for PICC lines

Answer 34

inaccessible peripheral veins high PN osmolality (high calorie/nitrogen content)

Question 35

how do central lines work

Answer 35

put into subclavian vein or jugular vein - must be confirmed via x ray

Question 36

indications for central lines

Answer 36

longer term feeding inaccessible peripheral feeding higher tonicity formulations (>2000mOsmol/L)

Question 37

what are some pharmaceutical issues with TPN

Answer 37

physical stability, chemical stability and microbial stability

Question 38

issues with physical stability with TPN bags

Answer 38

precipitation not seen in bags containing lipids - can cause embolism lipid destabilisation - coalescence occluding microvasculature - all PN fluids passed through filter before infusion

Question 39

issues with chemical stability with TPN bags

Answer 39

vitamins undergo chemical degradation - all bags must be protected from light

Question 40

issues with microbial stability with TPN bags

Answer 40

lots of nutrients - good for bacterial growth - use aseptic techniques

Question 41

monitoring requirements with TPN

Answer 41

• ongoing requirements - complications - clinical symptoms: temp, bp, fluid, weight - lfts/electrolytes/bm/crp- calcium and albumin

Question 42

complications with TPN

Answer 42

• line blockages (tip, blood/drug clot, line kinking) - line sepsis - thrombophlebitis - refeeding syndrome

Question 43

what is refeeding syndrome

Answer 43

when infused nutrition exceeds tolerance of previously malnourished patient - can cause sudden insulin production

Question 44

how to avoid refeeding syndrome

Answer 44

start feeding slowly - over 48 hours add thiamine if at risk