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Highly stressed physiological states such as _____ benefit from PN.
Never use an _____ IV site to give PN.
- Always use a new site to decrease the risk of infection
2L of PPN delivers up to _________kcal/day.
- 10% dextrose with 10% amino acids (supplimented by 500 mL of fat emulsion piggy-backed BELOW the filter)
Why is PPN difficult to maintain?
Because of frequent episodes of phlebitis and infiltration.
How are lipids stored?
- At room temperature
- It should look like milk
- No separation or oily substances
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
PPN is given through ______.
A PICC line or IV
_____ contains a mixture of carbohydrates (10-70% dextrose), amino acids (protein/nitrogen), fats, electrolytes, vitamins & trace minerals (zinc, copper, maganese, and chromium)
What three meds can pharmacy add to TPN?
- H2 blockers
Goals of PN
- Ideal weight gain-1 to 3lbs a week
- Serum glucose levels - maintained between 80-110 mg/dL or <150
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
When is PN discontinued?
When the patient is meeting 75% of their kcal needs via enteral route.
How often do you monitor the flow rate of PN?
How often do you monitor glucose for pts recieving PN?
Change TPN tubing q _____.
Do not allow lipids to hang for more than ____.
Why are TPN pts at risk for Vitamin K deficiency?
- Vitamin K is synthesized in the GI tract.
- Must supplement TPN pts
If TPN runs dry what do you do?
Hang at least 10% dextrose until more TPN is available. Prevents hypoglycemia.
Lipids are a/an ______ solution.
_____ do NOT have to be filtered?
Lipids, they have no sediment
How do you start and run TPN?
- Start slow then increase
- TPN is a hypertonic solution
How are lipids ran?
They start at 21mL/hr and run at 12 mL/hr
PN with greater than 10% dextrose requires a _____.
Suspect _______ if client develops fever, chills, and glucose intolerance.
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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