PARENTERAL Flashcards by Janielle Advincula

Q

method of providing macronutrients & micronutrients to those who are unable to assimilate nutrients via the GIT

A

Parenteral Nutrition

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Q

What are the INDICATIONS of PN

A

-Non-Functioning GIT
-Bowel Rest
-Severe Malnutrition
-Patient unable to eat orally ≥5 days
-Anticipated return to enteral nutrition is <7-10 days for Adults, 3-5 days for Infants/Children

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Q

CONTRAINDICATIONS of PN

A

-Functioning GIT
-Duration of anticipated treatment is <5 days provided patient is not severely malnourished
-Inability to obtain venous access
-Any prognosis which not warrant an aggressive form of nutrition support

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Q

3 ways of estimating TER in Parenteral Nutrition

A

Calorie/Weight Method
Harris-Benedict Equation for Basal Energy Expenditure
Indirect Calorimetry & Oxygen Consumption Measurements

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Q

Provide the GOALS and corresponding kcal/kg BW/day of Calorie/Weight Method

A

-Resting Metabolic Expenditure = 25
-Maintenance = 30
-Anabolism = 35

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Q

What is the Harris-Benedict Equations for Basal Energy Expenditure in MALES?

A

TER = 66.47 + 13.75W (kg) + 5H (cm) - 6.75A (yrs)

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Q

What is the Harris-Benedict Equations for Basal Energy Expenditure in FEMALES?

A

TER = 655.1 + 9.56W (kg) + 1.85H (cm) - 4.67A (yrs)

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Q

Provide the GOALS and corresponding FACTOR of Harris-Benedict Equations for BEE

A

-Maintenance = BEE x 1.2
-Anabolism = BEE x 1.5

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Q

In Estimation of Fluid Requirements:

What are the approximate body fluid and fluid volumes by GIT secretion?

A

-Saliva = 1500 mL
-Gastric = 2500 mL
-Bile = 500 mL
-Pancreatic Juice = 700 mL
-Small Intestines = 3000 mL

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Q

Estimation of Fluid Requirements by Sex

A

-Ave. Males = 125 mL/hr (3L/day)
-Ave. Females = 100 mL/hr (2.4L/day)

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Q

Minimum acceptable Urine Output (UO)

A

900 mL/day

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Q

Estimation of Fluid Requirements by Method 1 (Adults & Older Adults)

Provide each category and corresponding volume

A

-Young, vigorous, previously healthy adult = 40 mL/kg
-Other adults = 35 mL/kg
-Older adults (elderly) = 25 mL/kg

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Q

Estimation of Fluid Requirements by Method 2 (Based on Body Weight)

Provide each weight and corresponding volume

A

-1st 10 kg = 100 mL/kg/day
-2nd 10 kg = 50 mL/kg/day
-each addition kg for:
»> ≤50 y/o = 20 mL/kg/day
»> >50 y/o = 15 mL/kg/day

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Q

Estimation of Fluid Requirements by Method 3 (Based on Goal)

Provide each goal and corresponding volume

A

-Maintenance = 60 mL/kg/day
-Replacement = 70 mL/kg/day

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Q

Guiding Principles in CARB REQUIREMENTS

for a 70 kg man:

A

1 mg/kg/min HCHO or 100 g/day

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Q

Guiding Principles in CARB REQUIREMENTS

Maximum CHO

A

5 mg/kg/min

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Q

Guiding Principles in CARB REQUIREMENTS

Dextrose =

A

3.4 kcal/g

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Q

Guiding Principles in CARB REQUIREMENTS

Final Dextrose conc should not exceed _____% (Peripheral) or ____%(Central)

A

-5% (Peripheral)
-35% (Central)

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Q

Guiding Principles in CARB REQUIREMENTS

Glucose Infusion Rate should not exceed _____

A

5-7 mg/kg/min

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Q

PROTEIN REQUIREMENTS per condition

Study These Flashcards

A

-Maintenance = 0.8-10 g/kg/day
-Minor Stress/Surgery = 1.25 g/kg/day
-Moderate Stress/Surgery = 1.50 g/kg/day
-Severe Stress/Trauma/Burns/Sepsis = 2.0-2.5 g/kg/day

Q

Guiding Principles in PROTEIN REQUIREMENTS:

___% of CHON/Amino Acids = Nitrogen (Protein Intake: ___ X amount of Nitrogen in g)

Study These Flashcards

A

-16%
-6.25

Q

Guiding Principles in PROTEIN REQUIREMENTS:

CHON should provide ____ of TER

Study These Flashcards

A

15%

Q

Guiding Principles in PROTEIN REQUIREMENTS:

In adults, PN should be able to provide _______ CHON/kg BW/day

Study These Flashcards

A

1-2 g

Q

Guiding Principles in PROTEIN REQUIREMENTS:

True or False

Excess CHON intake leads to CHON accumulation in the body

Study These Flashcards

A

FALSE!

Excess CHON intake DOES NOT lead to CHON accumulation in the body

Guiding Principles in PROTEIN REQUIREMENTS: 5. For normal individuals: _______ is needed for the optimal utilization of 1 g of N atom

300 non-CHON kcal

Guiding Principles in PROTEIN REQUIREMENTS: 6. In critical illness: _______ is needed for the optimal utilization of 1 g of N atom

100-150 non-CHON kcal

Guiding Principles in PROTEIN REQUIREMENTS: 7. Amino Acid PN solution should provide

4 kcal/g

Guiding Principles in PROTEIN REQUIREMENTS: 8. Final amino acid concentration in PN solution should not exceed:

-4.25% for 3-in-1 solutions -7.5% for non 3-in-1 solutions

Guiding Principles in PROTEIN REQUIREMENTS: 9. Adjustments for ______ should be applied

organ failure

Guiding Principles in PROTEIN REQUIREMENTS: Provide each condition and corresponding value for organ failure adjustments (No. 9)

-On chronic hemodialysis = 1-1.29 g/kg/day -On chronic ambulatory peritoneal = 1.2-1.5 g/kg/day -Creatinine Clearance <30 mL/min = 0.5-1.0 g/kg/day

Guiding Principles in PROTEIN REQUIREMENTS: 10. Calorie:Nitrogen ratio Goals

-promote optimal utilization of N -decrease gluconeogenesis with possible associated pre-renal azotemia

What is azotemia?

accumulation of nitrogenous products

Guiding Principles in PROTEIN REQUIREMENTS: Provide each clinical status and corresponding calorie:nitrogen ratio (No. 10)

-Mild-moderate stress = 133:1 (as NPC) -Severe Stress (ex. Sepsis/Trauma) = 100:1 -Renal Patients = 250:450

Guiding Principles in FAT REQUIREMENTS: 1. For prevention of Essential Fatty Acid Deficiency (EFAD): -____% of TER should come from Linoleic Acid (_____ mg/kg/day): ___ or ___ oil -EFAD occurs if fat is not added to the ______ after ___ days -____ mL fat emulsion every ____ days is sufficient -Do not exceed _____ g/kg/day -infuse over ____ hrs

-2-4% of TER should come from Linoleic Acid (25-100 mg/kg/day): Soy or Safflower oil -EFAD occurs if fat is not added to the PN solution after 5 days -500 mL fat emulsion every 5 days is sufficient -Do not exceed >2.5 g/kg/day -infuse over 12 hrs

Guiding Principles in FAT REQUIREMENTS: 2. Fat should not exceed ____ of TER

> 60%

Guiding Principles in FAT REQUIREMENTS: 3. In sepsis: fat should not exceed ____ of TER

>20%

Guiding Principles in FAT REQUIREMENTS: 4. 10% fat emulsion =

1.1 kcal/mL

Guiding Principles in FAT REQUIREMENTS: 5. 20% fat emulsion =

2.0 kcal/mL

Guiding Principles in MICRONUTRIENT REQUIREMENTS: 1. Vitamins are mixed with ____ just prior to _____

vitamins are mixed with PN SOLUTION just prior to INFUSION

Guiding Principles in MICRONUTRIENT REQUIREMENTS: 2. Vitamin K is added: _____mg/week (not done if patient is on ______ therapy)

-2-4 mg/week -coumarin/warfarin therapy

Guiding Principles in MICRONUTRIENT REQUIREMENTS: 3. Extracellular electrolytes: Non-stressed, average individual (Provide electrolyte and corresponding value)

-Sodium = 50 mEq/L -Chloride = 50 mEq/L -Acetate = 50 mEq/L

Guiding Principles in MICRONUTRIENT REQUIREMENTS: 4. Intracellular electrolytes: for every ____ NPC

750-1000

Guiding Principles in MICRONUTRIENT REQUIREMENTS: Provide each intracellular electrolytes and corresponding value. (No. 3)

-Potassium = 40 mEq/L -Phosphate = 5 mEq/L -Magnesium = 8 mEq/L -Calcium = 10 mEq/L -Zinc = 5 mEq/L

Amino acid content of each commercially available solutions: 1. Nutriflex Peripheral 2. Nutriflex Basal 3. Nutriflex Plus 4. Nutriflex Special

1. Nutriflex Peripheral (40/80) 2. Nutriflex Basal (32/125) 3. Nutriflex Plus (48/150) 4. Nutriflex Special (70/240)

This is available in a 3-chamber bag system.

Kabiven Peripheral

Each bag of Kabiven Peripheral contains:

-glucose (largest chamber) -amino acids & electrolytes -fat emulsion (white solution)

True or False Electrolytes in Kabiven Peripheral can be mixed with glucose

True

True or False Electrolytes in Kabiven Peripheral can be mixed with fat

False