TPN 2 concepts

Question 1

what are the 2 routes of specialized nutrition support

Answer 1

enteral and parenteral

Question 2

2 advantages of enteral nutrition over parenteral

Answer 2

lower risk of infection
shorter hospital stay

Question 3

enteral nutrition support can be through a feeding tube or….

Answer 3

orally to supplement patient’s diet — like ensure or boost

Question 4

parenteral nutrition can start to be considered over enteral after 7-14 days of…..

Answer 4

suboptimal nutrition intake

or obviously if the pt as vomiting or diarrhea, bowel obstruction, pancreatitis, etc

Question 5

macronutrients vs micronutrients

Answer 5

macro - water, protein, dextrose, fat (CARBS, FATS, PROTEINS)

micro - vitamins, electrolytes, trace elements

Question 6

PRIMARY SOURCE OF PROTEIN

Answer 6

amino acid

Question 7

*amino acids provide how many kcal

Answer 7

4kcal per gram

Question 8

**what is the primary source of carbohydrates

Answer 8

dextrose

Question 9

**how many kcal does dextrose provide

Answer 9

if enteral - 4kcal/gram

if parenteral - 3.4kcal/gram

Question 10

*2 grams of dextrose is given orally

how many calories are provided

Answer 10

8

Question 11

PURE fat provides how many calories

Answer 11

9kcal/gram

Question 12

***as mentioned, PURE fat provides 9kcal/gram

however, IVFE are available in 10%, 20%, and 30%

name the kcal they each provide per mL*****

Answer 12

10% - 1.1kcal/mL

20% - 2kcal/mL

30% - 3kcal/mL

Question 13

**differentiate between how 10%, 20%, and 30% IV fat emulsions can be administered

Answer 13

10 and 20% - can be given IV

30% emulsion — CANNOT BE DIRECTLY ADMINISTERED VIA IV!!!! only as part of a total nutrient admixture (TNA)

Question 14

which salt of calcium is preferred to administer and why

Answer 14

calcium gluconate

prevent incompatibilities

Question 15

name and differentiate the 2 different types of parenteral nutrition

Answer 15

2-in-1
3-in-1

2-in-1:
all nutrients are mixed together in same IV bag – EXCEPT for lipids. lipids may be given SEPARATELY

3-in-1:
all nutrients mixed together in same IV bag to form a LIPID EMULSION

Question 16

differentiate between the filter size needed for 2-in-1 vs 3-in-1 parenteral nutrition**

Answer 16

2-in-1 — need 0.2 micron filter

3-in-1 — need 1.2 micron filter bc lipids are larger

Question 17

differentiate between peripheral vs central parenteral nutrition in terms of where they are administered

Answer 17

peipheral - in arm or hand

central – vein – superior vena cava (catheter)

Question 18

true or false

peripheral parenteral nutrition is the preferred choice for patients who require parenteral nutrition for more than 7-14 days either hospitalized or at home

Answer 18

FALSE - central

Question 19

disadvantages of central parenteral nutrition

Answer 19

risks with catheter insertion – and infection risk

Question 20

something more concentrated with calories would use central or peripheral

Answer 20

central

diluted – peripheral

Question 21

what is a potential drawback of parenteral nutrition

Answer 21

stability

Question 22

****GOAL pH and why

Answer 22

WANT LOW PH — HIGH ACIDITY

this is bc the reaction will shift to the left and more MONOBASIC calcium phosphate will form – and this salt is more soluble with calcium

want MONOBASIC – H2PO4 - NOT H2PO4 2-

there is 60x greater solubility for monobasic calcium phosphate over dibasic

Question 23

*****the _____ the concentration of dextrose, the lower the pH

Answer 23

HIGHER

therefore, we want high concentration of dextrose to attain high acidity

Question 24

***true or false

it is desirable to obtain an acidic product. therefore, we do not want to add cysteine HCl

Answer 24

FALSE

we want to add cysteine

it is an antioxidant that will LOWER THE pH

Question 25

***in order to obtain a LOW pH, what has to be done to the lipids

Answer 25

LOWER THE FINAL CONC OF LIPIDS

Question 26

*****the ______ the final amino acid concentration, the less likely CaHPO4 is to precipitate (dibasic)

Answer 26

HIGHER

want high conc amino acids

Question 27

which form of calcium should never be used in IV therapy that contains phosphate

Answer 27

calcium chloride – will dissociate and react with dibasic phosphate – WANT TO LIMIT THIS!!!!

always use CALCIUM GLUCONATE bc it dissociates much less

Question 28

the addition of _____ should NOT be in close sequence with ____

they should be added far apart from each other

Answer 28

calcium and phosphate

phosphate should be added EARLY and calcium gluconate should be added LAST — to the MOST DILUTE phosphate conc as possible

Question 29

***true or false

to limit calcium and phosphate incompatibilities there should be low amino acid concentration and high dextrose concentration

Answer 29

FALSE

WANT HIGH OF BOTH

Question 30

true or false

cracking is irreversible

Answer 30

true