MNT Exam 1-Parenteral nutrition
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MNT Exam 1-Parenteral nutrition
What is the general definition for parenteral nutrition and the two types?
PN refers to the provision of nutrients by any route that does not involves the intestine tract.
1.Total parenteral nutrition (more common)
2. Periperal/partial parenteral nutrition
Delivering nurition thru vein, pass the GI
Fluid is broken down when go thru vein
What are some things to know about the hanging bags of solution?
once spiked they can hang for 48 hrs
the yellow bag contains vitamins, mineral, and lipid and is given its color because if B vitamin (plus may be added seperatly)
The white bag is typically CHO, protein, and lipid
Both connect at base forming a "Y" shape
What are indications for PN?
a not working GI
npo (nothing by mouth) for more than 7 days
Fistula in GI
short bowel syndrme
Needed GI res-massive bowel ressection
what are contraindications for PN?
tx anticipated for more than 5 days
a working GI
no venous access
terminal condition-put someone at higher risk
risks are higher than benefits
What is the definition for tpn?
central access for catheter tip placement in large, high blood flow vein ( superior vena cava, jugular or femoral)
what are two common ways to deliver access thru ppn and tpn?
*threated into superior vena cava (in arm)
*one at bedside by RN's-surgery??
*in subclavian vein
*can be used for many things
*thick and dense
IJ(interal jugular) vein
*easiest, go straight to heart
*high risk because of infection
what are some important things about ppn?
It is not commonly used
its peripheral access
it avoids risk of central route
has lower osmolality(because of sm vein)
short term(no more than 5 days)
can increase fluid (because low conc.= high fluid)
what are the indications for ppn?
for short term nutrition (5 days-so vein wont burst)
to avoid risk linked to central route placement
FOR SUPPLEMENTAL NUTRITION
intermediate way to wean from tpn (dont switch right away)
what are the macronutrients for pn?
dextrose (cho's), amino acids (protein), fat/essential f.a's (lipids)
What are some important things to know about dextrose?
= 3.4 kcals/kg
con. of 5-70%, 5-20% in soltn.
limit venous access because hypertonicity
limit to 5mg/kg/min (limit per body per minute, to control blood sugar, keeps vein healthy)
max 10% for ppn
What are some important things to know about a.a's?
crystalline a.a's ( so small)
provides all Eaa's and 10-12 non-Eaa's
max at 4% for ppn
usually 10-20% kcal
What are some important things to know about fatty acids?
in 10% or 20% conc.
100 ml (kids), 250 ml, or 500 ml
provide 20-30% kcal
max at 60% of 2 mg/kg/min
use egg phospholipid (if allergic to egg then dont use!)
stablized by glycerol
What patients may benefit from higher fat?
those who need less fluid (heart failure, not raise bp)
glucose intolerance( low CHO, so increase fat)
respiratory compromise( CHO make breath out CO2)
hat are the contraindications for using lipid emulsions?
acute pancreatitis with hypertrygliceridemia
high amount lipid-contain medicine
bad egg allergy
what are some important things about electrolytes?
they vary in need by patient
they increase amount from GI, skin, and urine loss
they correct severe imbalances
what are some important things about vitamins?
10-12 ml MVI added daily
larger doses to correct deficinecies
vitamin K not incuded in addition
what are some important things about trace elements?
withhold cu and mg because liver failure
xtra zn for GI loss
fe not really added because burns
what is the mixture of totoal nutrient admixture solutions (3 in 1)?
dextrose, fats, a.a's, vitamins, trace elements, electrolytes
what are pro/con of total nutrient admixture?
: convinience, ensure mixed fuel
: not stable, limited info, $$$, higher contamination, not felxible
What do you consider when doing a nutrition Rx?
distribute remaining kcal between pro and fat
electrolyte, vitamins/min needed
when calcualting fluid needs what is something important to take into consideration?
that it should be 30 ml/kg??
what do you moniter with regards to a nutrition Rx?
check lytes, BUN, ca/mg/po4 until stable
check TG and liver function tests every 7-10 days
signs of GI function
what is the tpn advancing guidelines?
start at 30 cc/hr
advance 20-25 cc/hr q every 12 hrs
(q 12-24 hr in icu)
what are the advancement guidelines for ppn?
start at half the goal rate
advance to goal after 12 hrs
max dextrose at 10% and AA at 4%
what are complications associated with pn?
mechanical issues (power die)
gut bacterial translocator
what is the etiology of hyperglycemia?
high steriod doses
overfeed total kcal
insulin in tpn bag
what is rebound hyperglicemia?
can happen with abrupt stopping of tpn, need to ween off tpn
what are important things about refeeding syndrome?
can occur thru pn, enteral, etc
labs show low PO4, MG, CA, K, high BG
due to cell uptake of increased CHO
people can die from low PO4+ MG= cardio death
what patients are at risk for re-feeding syndrome?
unfed 7-10 days
how do you prevent refeeding syndrome?
be aware of signs within 24 hrs
recognition of patients with risk
do lab tests
what are the infectious and mechanical complications?
vein/ line occulusion
what are hepatic complications?
what are some important things about fatty liver?
happen within 2-3 weeks of TPN- with overfeeding
labs show increase LFTS
return to normal after stop tpn, or modify delivery
what are the etiologies/implications of fatty liver?
: kcal, glucose (more than 5mg/kg/min), fat
EFA and carnitine deficient
what are some important things about cholestasis?
stones cause blockage in liver
increase billi, and alk phos in labs
how would you prevent/manage hepatic condidtions?
limit CHO (5 mg/kg/min)
used mixed fuel source
find other causes
cycle tpn and lipids
why would you use cyclic/intermittent pn?
lessens load on organs
allow adminster blood products
what are benefits of enteral nutrition?
avoid complications with pn