TPN

Question 1

What is TPN (total parenteral nutrition)

Answer 1

A specialized form of nutritional support delivered via IV to those with GI dysfx

Question 2

When is PPN (peripheral parenteral nutrition) used?

Answer 2

Used for mild-mod malnutrition for weeks as long as the final formula has a final dextrose conc of of 5%-10% and amino acid content of 3%

Question 3

PN (parenteral nutrition) at home requires a _____ ______

Answer 3

central catheter

Question 4

For a pt on PN, you must have a baseline assessment of:

Answer 4

• Lytes
• Serum proteins
  CBC
• Triglyceride levels
• Liver fx tests

Question 5

What are the components of PN?

Answer 5

• Amino acids, glucose, and lipids as energy sources
• Addition of lytes, minerals, trace elements, vitamins,
  and water

Question 6

What makes a PN solution 3:1 (also known as 3-in-1 or total nutrition admixture (TNA))

Answer 6

The addition of fat (lipid) emulsion

Question 7

T or F:

Enteral nutrition is preferred over PN

Answer 7

T

Question 8

When should PN be initiated?

Answer 8

Only if the duration is expected to be greater than or equal to 7 days

Question 9

When is PN d/c?

Answer 9

When 60% or more of nutritional needs are being met by PO or enteral route

Question 10

What is the most frequent complication of PN? How can you avoid this?

Answer 10

Catheter-related bloodstream infct (CRBSI)
- Avoid blood draws
- Avoid interruption
of infusions
- Monitor temp regularly to check for infct

Question 11

Why should Central PN (CPN) using concentrated dextrose solutions should not be infused into PIVs or midline catheters?

Answer 11

Because of the inc risk for phlebitis

Question 12

Why is PPN only used short term or for those with low caloric needs?

Answer 12

because it is difficult to meet nutrient requirements with PPN due to the limitation of dextrose peripherally and the inability to meet caloric goals without large volumes

Question 13

Why is PE a risk when using PN? How is this risk decreased?

Answer 13

Particulate matter from the solutions, or large lipid droplets can cause PE, there is a filter in the TPN tubing to decrease the risk of PE

Question 14

What is refeeding syndrome?

Answer 14

In extremely malnourished pts put on PN, some ‘lytes (such as K, Mg, P) may shift intracellularly with the glucose provided in the PN. This can result in low serum levels with risk for arrhythmias and muscle weakness

Question 15

How can we prevent refeeding syndrome?

Answer 15

Adequate lyte repletion should take place before the initiation of PN

Question 16

There is an inc risk of _____ _____and _____ _______ when initiating feeding in malnourished pts at greater risk of refeeding syndrome

Answer 16

• Pulmonary edema

- Heart failure

Question 17

Indications of and risks for protein/calorie malnutrition:

Answer 17

• Weight loss from baseline or ideal
• Muscle atrophy or weakness
• Edema
• Lethargy
• Failure to wean from ventilatory support
• Chronic illness
• Nothing by mouth for 7 days

Question 18

What is the ideal weight gain for pts on PN?

Answer 18

1-3lbs per week

Question 19

What should you inspect 2:1 TPN for? what should you inspect 3:1 TPN for?

Answer 19

• 2:1 for particulate matter

- 3:1 for separation of fats

Question 20

How often should the tubing for TPN be changed?

Answer 20

Every 24 hours

Question 21

What is the max hangtime for PN containing dextrose and amino acids alone of with fat emulsion added as a 3:1 formulation? For fat emulsion alone?

Answer 21

Hang time not to exceed 24 hours, not over 12 hours for fat emulsion alone

Question 22

How often should you measure weights for a pt on TPN?

Answer 22

At least 3x per week