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Nurse 202 > TPN week 7 > Flashcards

TPN week 7 Flashcards

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1
Q

What is TPN?

A

Nutritional intake that bypasses the GI tract

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2
Q

Why would someone need TPN?

A

When they have the inability to absorb nutrients through their GI tracts for more than 10 days

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3
Q

What are 3 main criteria for TPN?

A
  • Presence of a debilitationg illness lasting more than 2 weeks
  • Loss of 10% or more of pre-illness weight in a short time
  • Serum albumin levels less than 3.5g/dL
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4
Q

What are some illnesses that may cause the patient to require TPN?

A
  • Burns
  • Crohn’s/UC
  • Gastroparesis
  • Trauma
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5
Q

What are the two main types of Parenteral nutrition?

A
  • Total

- Peripheral

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6
Q

What is Total (central) Parenteral Nutrition?

A
  • Used for long term therapy
  • Nutrient dense fluids (hypertonic)
  • Greater than or equal to 10% glucose
  • Administered via a central line
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7
Q

What is Peripheral Parenteral Nutrition?

A
  • Used for short term therapy (2 weeks)
  • Nutrient Adequate = isotonic
  • Less than 10% glucose
  • Can be given via peripheral line
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8
Q

What types of shifts occur with hypertonic fluids?

A

-Causes fluid shifts from inside cells/veins to moce out into intravascular/extracellular space

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9
Q

What types of shifts occur with Hypotonic fluids?

A

Causes fluids to shift from intravascular/extracellular spaces to the tissues and cells

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10
Q

What types of shifts occur with isotonic fluids?

A

No shifts in fluids

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11
Q

What percentage of glucose is conisdered isotonic?

A

4.5% so D5W is considered isotonic

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12
Q

What baselines are needed prior to the start of TNP therapy?

A
  • Weight
  • Cardiac panel
  • Renal function panel
  • Nutritional allergies
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13
Q

What is the number one determinant of PN therapy?

A

Protein!

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14
Q

What is the main protein in human blood?

What % does it make up?

A

Albumin

60%

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15
Q

What are the main functions of albumin?

A
  • It is the main contributor to oncotic pressure
  • It is the main transporter for many nutrients, hormones, and drugs
  • Needed in the repain and maintenance of tissues
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16
Q

Where is albumin produced and what is its half-life?

A

Liver

20days

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17
Q

How much protein is usually in PN fluids?

A

5-15%

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18
Q

What is the protein % in PN fluid for a patient at risk for FVE?

A

15% or greater

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19
Q

What are the 4 main effects of Hypoalbuminemia?

A
  • Reduced onconic pressure
  • leads to intravascular leakage
  • Causes Generalized edema
  • Decreases blood pressure
  • Malnutrition from reduced transport
  • Muscle wasting
  • Renal dysfunction from overload of protein in urine
  • Dehydration
20
Q

What effects of hypoalbuminemia can be masked by edema?

A
  • Muscle wasting

- Dehydration

21
Q

What is the primary CHO energy source in PN fluids?

A

Glucose!

22
Q

What percentage of Glucose is in PN fluids?

A

60-70%

23
Q

What patients need a decreased glucose in their PN fluid?

A

Ventilator patients (why?)

24
Q

IF a PN fluid is hypertonic, it needs to be administered via?

A

A central line

25
Q

in Peripheral PN, what is the percentage of glucose?

A

Less than or equal to 10% if the solution

26
Q

Lipids in PN fluid make up ___ % of calories

A

30

27
Q

Lipids are administered ____ from the primary TPN

A

Separately

28
Q

What are some components of Lip PN fluids?

A
  • Soybean/safflower oil
  • Glycerol
  • Egg phospholipids
29
Q

what % of Lipid PN fluids need to be essential fatty acids?

A

4%

30
Q

What are some major considerations when administering PN?

A
  • ALWAYS USE A PUMP
  • ALWAYS USE A MICRON FILTER!
  • Change tubing q24hr
  • Use a designated port
  • Check bag
  • Check patient
31
Q

What size filter is used for PN fluids?

A
  • Just PN is a .2 micron

- If with lipids or a 3-1 use a 1.2 micron filter

32
Q

Do lipids always need to have a filter?

A

No, they can be hung below the PN fluid fliter if piggybacked

33
Q

What are the main considerations when D/C PN therapy?

A
  • DO IT S L O W L Y!!!!!

- Give isotonic dextrose solutions for 1-2 hours after stopping PN

34
Q

A patient receiving PN therapy is often on Total ____ orders as well

A

Fluid intake

35
Q

Why are patients placed on total fluid intake orders when they are receiving PN therapy

A

-to minimize risk for FVO

36
Q

What do total fluid intake orders include?

A
  • Medications
  • Intravenous fluids
  • TPN
  • Lipids
  • etc
37
Q

How are Total fluid intake orders described?

A

ml/hr

38
Q

How long should TPN and lipids be out of refrigeration prior to administration?

A

1hr

39
Q

How should TPN fluid appear?

A

Clear not cloudy

40
Q

How should PN lipids appear?

A

White with no cracking or creaming

41
Q

TPN should be administered via a _____

A

IV PUMP over a 24/hr rate

42
Q

What size filter is used for TPN?

A

0.2 micron

43
Q

If using a filter with lipids what size should be used?

A

1.2 micron

44
Q

What size syringe should be used when flushing a central line? Why?

A

10ml or greater

-Smaller ones exert too much pressure and may break line

45
Q

Why are push pause techniques used for central line flushing?

A

They create turbulence for more effective clearance

Nurse 202 (2 decks)

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