Tube Feedings and TPN

Question 1

State the results of too much nutrition

Answer 1

– increased CO2 –  Increased Triglycerides –  Fluid/Edema –  Weight gain –  High blood sugars –  Refeeding syndrome

Question 2

State the results of too little nutrition

Answer 2

–  Poor wound healing –  Muscle loss –  Weight loss –  Infection risk –  Malnutrition

Question 3

Calculate the caloric requirements for an adult using kcals/kg

Answer 3

Range: •  20-25 kcals/kg •  25-25 kcals/kg •  25-30 kcals/kg •  30-35 kcals/kg Don’t exceed 40

Question 4

Calculate the protein needs for a normal and critically ill adult.

Answer 4

•  RDA for healthy adult = .8 g/kg/d 90 kg patient X .8 = 72 g/d •  Critically ill= 1.5 to 2.0 g/kg/d 90 kg patient X 1.5 = 135 g/d

Question 5

State the calorie to nitrogen ratio in a healthy adult

Answer 5

200:1 (12.5% of kcals as protein)

Question 6

Calculate the fluid requirements for an average adult.

Answer 6

30-35 mL/kg

Question 7

Given the caloric need for a person, calculate the calories from carbohydrates fats, and proteins.

Answer 7

look up

Question 8

Given a hospitalized person, indicate whether enteral nutrition is indicated or contraindicated

Answer 8

indicated: for pts w/ functioning GI but unable to meet nutrient needs w/ oral intake contraindication: for obstructions, ileus,

Question 9

List the potential placement and complications associated with enteral nutrition

Answer 9

Placements: orogastric, nasogastric, post pyloric, ligament of Treitz, “ostomy”, PEG (percutaneous endoscopic gastrostomy) Complications: aspiration, dehydration, constipation, diarrhea, tubes clogging, dislodging, disconnected

Question 10

Describe the three types of feeding regimens

Answer 10

Bolus: 2 cans 4 X day; via syringe Continuous: 75 mLs/hr x 24 hrs; via pump Nocturnal: 135 mL/hr X 12 hrs; 7PM - 7AM

Question 11

List the probable causes and treatment of diarrhea in patients on enteral feedings

Answer 11

Causes: secretory vs. osmotic; motility issues; multiple antibiotics on board - c. diff; hyperosmolality Tx: check for c. diff and medications; trial of formula w/ fiber; antidiarrheal agents; Lactinex 1 tab QID or other probiotic; Monitor K+ and fluid balance; GI consult

Question 12

List the indications for parenteral therapy

Answer 12

Pts who can’t eat, won’t eat, shouldn’t eat, can’t eat enough.

Question 13

3 in 1 parenteral therapy

Answer 13

*dextrose, protein and lipids in bag *less to hang *easier for nursing *requires compounding *more expensive *can tweak all day long

Question 14

2 in 1 parenteral therapy

Answer 14

*Dextrose and protein in one bag *Lipids hung separately *more work for nursing *stock solutions *cheaper *harder to tweak

Question 15

List the ingredients of parenteral therapy

Answer 15

Dextrose; protein; lipids; multivitamins; trace elements; meds; electrolytes - Ca, phosphorus

Question 16

List the percent of calories of dextrose, protein, and lipids in a bag of parenteral fluid

Answer 16

Dextrose: 45-55% of total cals Protein: 15-20% of total cals Lipids: 25-35% of cals

Question 17

Explain the role of dextrose in parenteral therapy.

Answer 17

Provides carbs; concentrations vary - if BGs are high will want lower concentration.

Question 18

List the complications of parenteral therapy

Answer 18

Infections; fatty liver; fluid overload; hyperglycemia; hyperlipidemia; phlebitis/thrombosis; catheter dislodgement

Question 19

Explain refeeding syndrome

Answer 19

Metabolic and physiologic shifts of fluid, electrolytes, and minerals that occur as a result of aggressive nutrition support. * increased carbs –> increased insulin secretion –> increased intracellular shifts of lytes –> decreased serum levels of Phosphorus, Mg and K

Question 20

State the results of too much nutrition

Answer 20

– increased CO2 –  Increased Triglycerides –  Fluid/Edema –  Weight gain –  High blood sugars –  Refeeding syndrome

Question 21

State the results of too little nutrition

Answer 21

–  Poor wound healing –  Muscle loss –  Weight loss –  Infection risk –  Malnutrition

Question 22

Calculate the caloric requirements for an adult using kcals/kg

Answer 22

Range: •  20-25 kcals/kg •  25-25 kcals/kg •  25-30 kcals/kg •  30-35 kcals/kg Don’t exceed 40

Question 23

Calculate the protein needs for a normal and critically ill adult.

Answer 23

•  RDA for healthy adult = .8 g/kg/d 90 kg patient X .8 = 72 g/d •  Critically ill= 1.5 to 2.0 g/kg/d 90 kg patient X 1.5 = 135 g/d

Question 24

State the calorie to nitrogen ratio in a healthy adult

Answer 24

200:1 (12.5% of kcals as protein)

Question 25

Calculate the fluid requirements for an average adult.

Answer 25

30-35 mL/kg

Question 26

Given the caloric need for a person, calculate the calories from carbohydrates fats, and proteins.

Answer 26

look up

Question 27

Given a hospitalized person, indicate whether enteral nutrition is indicated or contraindicated

Answer 27

indicated: for pts w/ functioning GI but unable to meet nutrient needs w/ oral intake contraindication: for obstructions, ileus,

Question 28

List the potential placement and complications associated with enteral nutrition

Answer 28

Placements: orogastric, nasogastric, post pyloric, ligament of Treitz, “ostomy”, PEG (percutaneous endoscopic gastrostomy) Complications: aspiration, dehydration, constipation, diarrhea, tubes clogging, dislodging, disconnected

Question 29

Describe the three types of feeding regimens

Answer 29

Bolus: 2 cans 4 X day; via syringe Continuous: 75 mLs/hr x 24 hrs; via pump Nocturnal: 135 mL/hr X 12 hrs; 7PM - 7AM

Question 30

List the probable causes and treatment of diarrhea in patients on enteral feedings

Answer 30

Causes: secretory vs. osmotic; motility issues; multiple antibiotics on board - c. diff; hyperosmolality Tx: check for c. diff and medications; trial of formula w/ fiber; antidiarrheal agents; Lactinex 1 tab QID or other probiotic; Monitor K+ and fluid balance; GI consult

Question 31

List the indications for parenteral therapy

Answer 31

Pts who can’t eat, won’t eat, shouldn’t eat, can’t eat enough.

Question 32

3 in 1 parenteral therapy

Answer 32

*dextrose, protein and lipids in bag *less to hang *easier for nursing *requires compounding *more expensive *can tweak all day long

Question 33

2 in 1 parenteral therapy

Answer 33

*Dextrose and protein in one bag *Lipids hung separately *more work for nursing *stock solutions *cheaper *harder to tweak

Question 34

List the ingredients of parenteral therapy

Answer 34

Dextrose; protein; lipids; multivitamins; trace elements; meds; electrolytes - Ca, phosphorus

Question 35

List the percent of calories of dextrose, protein, and lipids in a bag of parenteral fluid

Answer 35

Dextrose: 45-55% of total cals Protein: 15-20% of total cals Lipids: 25-35% of cals

Question 36

Explain the role of dextrose in parenteral therapy.

Answer 36

Provides carbs; concentrations vary - if BGs are high will want lower concentration.

Question 37

List the complications of parenteral therapy

Answer 37

Infections; fatty liver; fluid overload; hyperglycemia; hyperlipidemia; phlebitis/thrombosis; catheter dislodgement

Question 38

Explain refeeding syndrome

Answer 38

Metabolic and physiologic shifts of fluid, electrolytes, and minerals that occur as a result of aggressive nutrition support. * increased carbs –> increased insulin secretion –> increased intracellular shifts of lytes –> decreased serum levels of Phosphorus, Mg and K