ASPEN ch 14--PN overview Flashcards
(34 cards)
why crystalline a.a. better?
better utilized and lack preformed ammonia
3-in-1 also called ____ admixture
total nutrient
PN is hypertonic to body fluids and can result in _______ if admin inappropriately
venous thrombosis, suppurative thrombophlebitis, extravasation
osmolarity of PN formula primarily depend on these components:
dextrose (5mOsm/g), a.a. (10mOsm/g), electrolytes (1mOsm/g)
max osmolarity of PPN:
900mOsm
CPN often referred to as:
total parenteral nutr
why can handle greater osmolarity in CPN?
rate of blood flow in large vessels rapidly dilutes hypertonic formulation to that of body fluids, minimize risk of complications
PPN used up to ____ days
14
why PPN undesirable for pt on fluid restriction?
large fluid vols needed because can’t concentrate solution too much
why limit PPN?
tolerance limit, few suitable veins
for PPN must meet these 2 criteria:
good peripheral venous access and able tolerate large volumes of fluid
__ may be used to ^ energy density of PPN without increasing osmolarity, can improve vein tolerance of PPN:
ILE
use of ___ catheters recommended in pt needing PPN>6 days
midline (lower probability dislodge)
contraindications to PPN:
significant malnutrition, severe stress, large nutr/electrolyte needs, fluid restriction, prolonged PN need, renal/liver probs
____ concept is relevant to critically ill pt who don’t tolerate nutr (esp PN) well
permissive underfeeding
why permissive underfeed?
intended minimize complications of PN delivery by providing only 80% of est. energy requirements until condition improves
___ feeding used in both EN and PN for obese to meet pro rqts but provide less nrg than estimated rqt
hypocaloric
why use hypocaloric feed?
minimize metabolic complications of PB while improve N balance
___ PN is approach designed to minimize energy deficit accumulated during period of no nutrition/undernutrition
supplemental
indications for PN:
unable meet nutr rqts with EN, PPN up to 2 wks when pt can’t ingest/absorb PO or EN or when CPN not feasible, CPN necessary when >2wks and peripheral access limited/nutr needs large/fluid restrict
use CPN when:
pt failed EN trial, EN contraindicated cuz of underlying condition, duration of starvation unknown and can’t tolerate EN/PO, clinical conditions
PN should only be initiated if pt is ____ stable and can tolerate doses
hemodynamically
when PN needed in pancreatitis, recommended that PN energy admin not exceed _____kcal/kg/d and glucose controlled
25-35
why glutamine recommended in PN for pancreatitis?
minimize effect of being NPO on GI integrity
