TPN

Question 1

when would you decide to use tpn

Answer 1

1. cant feed via mouth or etn
2. cant digest or absorb via git

Question 2

issues that may cause no git function for tpn

Answer 2

• Git related complications
• intractile vomiting
• severe diarrhea
• abdominal trauma
• enterocutaneous fistula
• vascular event with decreased perfusion to gut

Question 3

contraindications of tPN

Answer 3

1. git working
2. short term non feeding
3. ethical issues

Question 4

RD role for TPN

Answer 4

making the prescription

Question 5

delivery routes for TPN

Answer 5

peripheral vs central

Question 6

types of central routes

Answer 6

1. subclavian
2. PICC
3. tunnel catheters and implants

Question 7

long term vs short term central routes

Answer 7

long = implants and tunnel catheters
short = picc and subclavian < 7 months

Question 8

important notes for peripheral

Answer 8

very short time, < 7 days
need to make sure solution osmolarity is low bc veins cant have high osmolarity or pressure
= more fat instead of dextrose in sol

Question 9

when might you opt for peripheral route for TPN

Answer 9

mildly MN pt who cant eat orally, doesnt qualify for ENT and has no access to central

Question 10

what would happen if you dont use a low osmolarity solution for peripheral TPN

Answer 10

risk for phlebitis

Question 11

PICC vs peripheral?

Answer 11

PICC leads to right superior vena cava and peripheral stays in veins

Question 12

TPN Feeding solution types

Answer 12

1. compounded
2. 3 in 1
3. 2 in1

Question 13

explain diff betwen 3-1 vs 2-1 feeding solution

Answer 13

3-1= lipid/cho/pro in diff compartments
easier to use
common
opaque

2/1 = cho and AA in 1 bag, lipids in other
more flexibility in specializaing, clear

Question 14

nutritional order for TPN

Answer 14

1. dextrose
2. AA
3. lipids
4. vitamins minerals
5. fluids
6. electrolytes

Question 15

source of cho in tpn

Answer 15

dextrose
- monohydrate glucose w h20
primary source of energy

Question 16

how much energy does dextrose provide

Answer 16

3.4 kcal/g

Question 17

source of protein in TPN

Answer 17

form of AA
meant for N balance = lower skm breakdown

Question 18

energy in protein from TPN

Answer 18

3.8 kcal/g

Question 19

Lipids in TPN solutions

Answer 19

• emulsion of LCT with phospholipid or fat oils
• energy source and essential FA
• 10 kcal/g
• want 10% of energy needs to come from total fat

Question 20

why do we control min max infusion rates

Answer 20

body can tolerate and metabolize only a certain amount of solutio via veins

things need to be able to dissolve

Question 21

vit and minerals in TPN

Answer 21

standard multivitamin usually used unless pt has a condition where the kidney and liver cant produce or process mv

Question 22

electrolytes in tpn

Answer 22

need to monitor daily
imbalance = death

Question 23

fluids in tpn

Answer 23

based on pt needs calculation
add sterile h20 to adjust needs
monitor ins and outs

factor in 250ml from electrolyte and mv
need to be realistic, compromise based on how much solution can be tolerated

Question 24

when would fluid needs increase

Answer 24

gi
wound
resp issues

Question 25

when would fluid needs decrease

Answer 25

cardiac liver renal issues

Question 26

when monitorinf ins and outs of fluids, what are u looking at

Answer 26

ins - meds - tpn outs - bm - urine

Question 27

osmolarity vs osmolality

Answer 27

#particles / 1L of solution (vol) vs #particles / 1 kg of solution (wt)

Question 28

overfeeding syndrome

Answer 28

your gut is responsible for releasing nutrients that able to metabolize - TPN = gut bypass, no hunger cues, fullness = not regulation of nutrient release = nutr in blood but body not able to metabolize - causes lots of issues on body function

Question 29

biomarkers of overfeeding syndrome

Answer 29

1. co2 2. bilirubin 3. ast/asl 4. bun 5. albumin

Question 30

too much CHO

Answer 30

- pressure on lungs to brethr harder for metabolism - c02 build up - hyper glycemia - more ASL/AST/bilirubin bc liver dysfunction working too hard to metabolize cho

Question 31

too much fat

Answer 31

- liver dysfunction= fatty liver = lots of bilirubin/ast/asl - lots of TG

Question 32

too much AA

Answer 32

kidney dysfuncton too much BUN/albumin

Question 33

weight for volume amounts in 3in1 tpn macros

Answer 33

50% dextrose 10% aa 20% fat per 100ml

Question 34

indication of refeeding syndrome

Answer 34

low blood phosphorous levels monitor K and mg too

Question 35

TPN prescription

Question 36

TPN maintainence protocol

Answer 36

day 1 always continious admin - calculate goal formula and rate - administer 50% of goal rate ; lower if RF risk day 2 - advance to target over 72-96hrs - decrease infusion rate from 24 to 12-14hr/day - intense monitoring

Question 37

# what what to monitor for TPN maintence

Answer 37

- fluid status - electrolytes - glucose - tag looking out for RF and OF

Question 38

short term TPN complications

Answer 38

1. pneumothorax 2. hemothorax 3. hyperglycemia 4. catheter related infections 5. RF syndrome 6. elec fluid imbalance 7. azotema

Question 39

long term tpn complications

Answer 39

1. gallstones 2. osteoporosis 3. sepsis

Question 40

azotema

Answer 40

high blood nitrgen levels

Question 41

why can gallstones be a complication

Answer 41

gallbladder collects bile and squeezes into GIT = no git function = no squeezing = combined into stones