Parenteral Nutrition

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Author:
giddyupp
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47477
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Parenteral Nutrition
Updated:
2011-01-13 12:21:13
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Parenteral Nutrition PHPR522
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Parenteral Nutrition
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  1. Above what level of triglycerides should TPN not include lipids?
    400
  2. What drug can cause hyperlipidemia in TPN?
    propofol
  3. What should be done to TPN if BUN is high (>50 mg/dL)?
    • start proteins very low
    • keep vitamin C low
  4. Which salt should be used in TPN if the pt is acidotic?
    acetate salts
  5. Which salt should be used in TPN if the pt is alkaline?
    chloride salts
  6. What characterizes refeeding syndrome?
    • hypophosphatemia
    • hypokalemia
    • hypomagnesemia
  7. What are some symptoms of refeeding syndrome?
    • weakness
    • convulsions
    • resp. failure
    • cardiac decompensation
  8. What causes refeeding syndrome?
    the sudden shift from fat to carbohydrate metabolism upon feeding a starving pt, which requires more ATP
  9. How should you try to avoid causing refeeding syndrome in pt at risk?
    start TPN at 1/2 to 1/3 of calculated daily calories and move up slowly
  10. How do you treat refeeding syndrome once it starts?
    • stop TPN
    • initiate 10% dextrose
    • replace electrolytes
    • supportive care (oxygen for resp. distress, diuresis for edema)
  11. How should TPN be monitored?
    • basic metabolic panel
    • Ca, Mg, PO4
    • CBC w/differential
    • serum albumin, prealbumin, AST/ALT, PT/INR
    • TGs
    • 24h urinary urea nitrogen (if necessary)
    • ability to use GI tract
    • functional status
  12. Which parameters should be monitored weekly in the initial period of TPN?
    • TG
    • CBC
    • prealbumin
    • PT/PTT, AST, ALT
  13. What should be monitored daily when the patient is stable on TPN?
    • glucose
    • I/O
    • fluid status
  14. What should be monitored weekly for long-term TPN?
    fluid status
  15. What should be monitored quarterly for long-term TPN?
    • PT/PTT, AST, ALT
    • trace elements
  16. What is the half-life of albumin?
    20 days
  17. What is the half-life of prealbumin?
    2-3 days
  18. What is the normal range of albumin?
    3.5 - 5.0 g/dL
  19. What is the normal range for prealbumin?
    20-40 mg/dL
  20. How many lipid-based calories does propofol provide?
    1.1 kcal/ml of infusion
  21. What nutrition weight should be used for underweight patients?
    ideal body weight
  22. What nutrition weight should be used for obese patients?
    adjusted body weight = IBW + 1/4(ABW - IBW)
  23. How do you determine calorie needs for TPN?
    Basic Energy Expenditure (BEE) x stress factor
  24. What are the stress factors for calorie need?
    • confined to bed = 1.2
    • out of bed = 1.3
    • surgery = 1.2
    • severe infection = 1.4
    • trauma = 1.5
    • burn = 1.7
  25. How do you determine fluid goal for TPN?
    1500 mL for the first 20 kg of wt, then add 20 mL/kg for each add'l kg
  26. How do you determine the protein goal for TPN?
    • range = 0.6 g/kg/d - 2.0 g/kg/d
    • usually = 1.2 - 2.0 g/kg/d
  27. How do you determine the lipid goal for TPN?
    no more than 1/3 of the total non-protein calories
  28. How do you determine the dextrose goal for TPN?
    about 2/3 of the total non-protein calories
  29. What should the glucose infusion rate be limited to for TPN?
    < 5 mg/kg/min or 7 g/kg/d on a 24h TPN
  30. How much sodium should be in a TPN?
    1-2 mEq/kg (80-150 mEq)
  31. How much potassium should be in a TPN?
    1-2 mEq/kg (40-100 mEq)
  32. How much magnesium should be in a TPN?
    6-12 mEq
  33. How much calcium should be in a TPN?
    4-10 mEq
  34. How much phosphate should be in a TPN?
    15-45 mmol
  35. What is the usual salt used in TPN?
    chloride salt
  36. What is the conversion for sodium to phosphate?
    4.0 mEq Na for every 3 mmol PO4
  37. What is the conversion for potassium to phosphate?
    4.4 mEq K for every 3 mmol PO4
  38. What is the dose for multivitamins in adults on TPN?
    10 mL daily
  39. How much trace elements should be used in a TPN?
    1-2 mL/d (each mL contains 5 mg Zn, 1 mg Cu, 0.5 mg Mn, 10 Mcg Cr)
  40. What infections are common complications of TPN tx?
    • coagulase-negative staph
    • staph areus
    • strep pyogenes
    • fungal infection (most common)
    • candida
  41. What should dextrose infusion rate be limited to in order to avoid causing hyperglycemia?
    5 mg/kg/min
  42. What causes hypercapnia?
    excessive carbon dioxide production d/t excessive calories and dextrose

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