TPN/PPN

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Author:
jjennings1
ID:
201173
Filename:
TPN/PPN
Updated:
2013-02-17 14:17:25
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TPN PPN
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Description:
TPN/PPN
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  1. Highly stressed physiological states such as _____ benefit from PN.
    • sepsis
    • head injury
    • burns
  2. Never use an _____ IV site to give PN.
    • existing 
    • Always use a new site to decrease the risk of infection
  3. 2L of PPN delivers up to _________kcal/day.
    • 2000
    • 10% dextrose with 10% amino acids (supplimented by 500 mL of fat emulsion piggy-backed BELOW the filter)
  4. Why is PPN difficult to maintain?
    Because of frequent episodes of phlebitis and infiltration.
  5. How are lipids stored?
    • At room temperature
    • It should look like milk
    • No separation or oily substances
  6. Where are Lipids attached to the IV line?
    • Below the filter if it is smaller than 1.2 micron size
    • Fat particles are large and would break down passing through a filter smaller than 1.2 micron
  7. PPN is given through ______.
    A PICC line or IV
  8. _____ contains a mixture of carbohydrates (10-70% dextrose), amino acids (protein/nitrogen), fats, electrolytes, vitamins & trace minerals (zinc, copper, maganese, and chromium)
    TPN
  9. What three meds can pharmacy add to TPN?
    • H2 blockers
    • Heparin
    • insulin
  10. Goals of PN
    • Ideal weight gain-1 to 3lbs a week
    • Serum glucose levels - maintained between 80-110 mg/dL or <150
  11. When can clients PN be reduced by 1/2?
    Once they are meeting 1/3 - 1/2 of their kcal needs per day via enteral route
  12. When is PN discontinued?
    When the patient is meeting 75% of their kcal needs via enteral route.
  13. How often do you monitor the flow rate of PN?
    Q1hour
  14. How often do you monitor glucose for pts recieving PN?
    Q6hours
  15. Change TPN tubing q _____.
    24hours
  16. Do not allow lipids to hang for more than ____.
    12 hours
  17. Why are TPN pts at risk for Vitamin K deficiency?
    • Vitamin K is synthesized in the GI tract.
    • Must supplement TPN pts
  18. If TPN runs dry what do you do?
    Hang at least 10% dextrose until more TPN is available.  Prevents hypoglycemia.
  19. Lipids are a/an ______ solution.
    isotonic solution
  20. _____ do NOT have to be filtered?
    Lipids, they have no sediment
  21. How do you start and run TPN?
    • Start slow then increase
    • TPN is a hypertonic solution
  22. How are lipids ran?
    They start at 21mL/hr and run at 12 mL/hr
  23. PN with greater than 10% dextrose requires a _____.
    CVC
  24. Suspect _______ if client develops fever, chills, and glucose intolerance.
    catheter sepsis
  25. What is refeeding syndrome?
    • When concentrated glucose is given and is accompanied by increases in endogenous insulin production (K, mag, phosphorus) move intracellularly).  
    • In malnourished pts this results in low serum extracellular levels of electrolytes and edema causes cardiac dysrhythmias, CHF, resp distress, convulsions, coma, or death.

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