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NUTR 4040 > TPN > Flashcards

TPN Flashcards

1
Q

when would you decide to use tpn

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

issues that may cause no git function for tpn

A
  • Git related complications
  • intractile vomiting
  • severe diarrhea
  • abdominal trauma
  • enterocutaneous fistula
  • vascular event with decreased perfusion to gut
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3
Q

contraindications of tPN

A
  1. git working
  2. short term non feeding
  3. ethical issues
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4
Q

RD role for TPN

A

making the prescription

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5
Q

delivery routes for TPN

A

peripheral vs central

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6
Q

types of central routes

A
  1. subclavian
  2. PICC
  3. tunnel catheters and implants
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7
Q

long term vs short term central routes

A

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

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8
Q

important notes for peripheral

A

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

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9
Q

when might you opt for peripheral route for TPN

A

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

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10
Q

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

A

risk for phlebitis

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11
Q

PICC vs peripheral?

A

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

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12
Q

TPN Feeding solution types

A
  1. compounded
  2. 3 in 1
  3. 2 in1
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13
Q

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

A

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

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14
Q

nutritional order for TPN

A
  1. dextrose
  2. AA
  3. lipids
  4. vitamins minerals
  5. fluids
  6. electrolytes
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15
Q

source of cho in tpn

A

dextrose
- monohydrate glucose w h20
primary source of energy

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16
Q

how much energy does dextrose provide

A

3.4 kcal/g

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17
Q

source of protein in TPN

A

form of AA
meant for N balance = lower skm breakdown

18
Q

energy in protein from TPN

A

3.8 kcal/g

19
Q

Lipids in TPN solutions

A
  • 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
20
Q

why do we control min max infusion rates

A

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

things need to be able to dissolve

21
Q

vit and minerals in TPN

A

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

22
Q

electrolytes in tpn

A

need to monitor daily
imbalance = death

23
Q

fluids in tpn

A

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

24
Q

when would fluid needs increase

A

gi
wound
resp issues

25
Q

when would fluid needs decrease

A

cardiac
liver
renal issues

26
Q

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

A

ins
- meds
- tpn

outs
- bm
- urine

27
Q

osmolarity vs osmolality

A

particles / 1L of solution (vol)

vs
#particles / 1 kg of solution (wt)

28
Q

overfeeding syndrome

A

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

29
Q

biomarkers of overfeeding syndrome

A
  1. co2
  2. bilirubin
  3. ast/asl
  4. bun
  5. albumin
30
Q

too much CHO

A
  • 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
31
Q

too much fat

A
  • liver dysfunction= fatty liver = lots of bilirubin/ast/asl
  • lots of TG
32
Q

too much AA

A

kidney dysfuncton
too much BUN/albumin

33
Q

weight for volume amounts in 3in1 tpn macros

A

50% dextrose
10% aa
20% fat

per 100ml

34
Q

indication of refeeding syndrome

A

low blood phosphorous levels
monitor K and mg too

35
Q

TPN prescription

A
36
Q

TPN maintainence protocol

A

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

37
Q

what

what to monitor for TPN maintence

A
  • fluid status
  • electrolytes
  • glucose
  • tag

looking out for RF and OF

38
Q

short term TPN complications

A
  1. pneumothorax
  2. hemothorax
  3. hyperglycemia
  4. catheter related infections
  5. RF syndrome
  6. elec fluid imbalance
  7. azotema
39
Q

long term tpn complications

A
  1. gallstones
  2. osteoporosis
  3. sepsis
40
Q

azotema

A

high blood nitrgen levels

41
Q

why can gallstones be a complication

A

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

NUTR 4040 (4 decks)

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