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ClinMed II Exam #4 GI > Parenteral/Enteral Nutrition > Flashcards

Parenteral/Enteral Nutrition Flashcards

1
Q

What are the responsibilities of the provider with nutritional support for patients?

A

Ordering dietary needs for, and supporting patients

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2
Q

What are some considerations for ordering oral nutritional support for patients?

A

Need to order a specific type, feeding tube may be needed

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3
Q

What are some considerations for ordering IV nutritional support for patients?

A

Need to order pharmacy consult and include diagnosis/total volume
Will also need to order IV access

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4
Q

Dietary support for nutritional needs?

A

Consult on oral nutrition types, evaluations on nutritional needs of ANY patient

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5
Q

Pharmacy support for nutritional needs?

A

Order & monitor parental nutrition w/ consult of dietary

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6
Q

Nursing support for nutritional needs?

A

Patient history, tube & IV access

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7
Q

SNS stands for what?

A

Nutritional support (aka specialized nutritional supplementation)
*enteral or parenteral

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8
Q

EN stands for what?

A

Enteral nutrition
(food supplementation using the gut)

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9
Q

PN stands for what?

A

Parenteral nutrition (aka total parenteral nutrition)
*food supplementation using IV access

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10
Q

Indications for SNS?

A

Non-functional GI tract, Critically ill patients, Eating disorders

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11
Q

Causes of a non-functional GI tract?

A

Bowel obstruction or resection, Intractable vomiting/severe diarrhea, Malabsorption, Bowel rest needed for >7 days, Enterocutaneous fistula

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12
Q

Intractable vomiting/severe diarrhea causing non-functional GI tract might be present in which conditions?

A

Pregnancy hyperemesis gravidarum (pregnancy N/V), Cancer patients

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13
Q

Bowel rest needed for >7 days causing non-functional GI tract might be present in which conditions?

A

Pancreatitis

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14
Q

What would classify as critically ill patients requiring extra nutritional support?

A

Burn or multi-system organ failure, COVID

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15
Q

Pediatric indications for SNS?

A

Non-functional GI tract, Critical illness, Inability to tolerate or deliver adequate nutrition

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16
Q

Pediatric causes of non-functional GI tract?

A

Bowel obstruction, Prolonged ileus, Peritonitis, Intractable vomiting/severe diarrhea, Enterocutaneous fistula, Short bowel syndrome

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17
Q

Pediatric causes of critical illness requiring extra nutritional support?

A

Hemodynamically instability, Severe metabolic state

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18
Q

Nutritional supplemental decision tree?

A

Disease state of nutritional deficiency –>Is pt alreadynnutritional deficient? –> Would SNS improve outcome/quality of life –> Is GI tract working? (yes = EN, no= possible TPN) –> How long will patient need SNS? (will determine tx for functional bowel SNS)

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19
Q

If patient has functional GI tract and needs SNS for <4 days, which support is recommended?

A

Fluid/electrolyte support

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20
Q

If patient has functional GI tract and needs SNS for >4 days, which support is recommended?

A

TPN

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21
Q

If patient has dysfunctional GI tract, which SNS is recommended?

A

EN

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22
Q

Pros of enteral nutrition?

A

Lets gut keep working, cost efficient

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23
Q

Cons of enteral nutrition?

A

Diarrhea, aspiration, requires GI function

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24
Q

Pros of parenteral nutrition?

A

Does not require GI function

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25
Q

Cons of parenteral nutrition?

A

Requires IV access, increases the risk of: infection, thrombosis, hyperglycemia, metabolic abnormalities, fluid overload

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26
Q

1 kg is equal to how many pounds?

A

2.2 lbs

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27
Q

What is the ideal body weight (IBW) for men?

A

50kg + (2.3 kg x inches over 5 ft)

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28
Q

What is the ideal body weight (IBW) for women?

A

45.5kg + (2.3 kg x inches over 5 ft)

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29
Q

What is the formula for adjusted body weight?

A

IBW + 0.4 (actual weight - IBW)

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30
Q

When to use actual body weight for supplemental nutrition orders?

A

If actual is lower than IBW

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31
Q

When to use adjusted body weight for supplemental nutrition orders?

A

If patient’s BMI is > or = 25

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32
Q

Daily fluid requirements for Neonates?

A

Day 1: 60 mL/kg/day
Day 2: 80 mL/kg/day
Day 3: 100 mL/kg/day
Thereafter: 100-150 mL/kg/day

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33
Q

Daily fluid requirements for infants that are 3.5-10kg?

A

100 mL/kg/day

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34
Q

Daily fluid requirements for children that are 11-20kg?

A

1000 mL + 50 mL/kg/day (over 10 kg)

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35
Q

Daily fluid requirements for children that are >20kg?

A

1500 mL + (20mL) (W in kg-20kg)

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36
Q

How to calculate basal energy expenditure (BEE) for men?

A

66.67 + 13.75 * (W) + (5.0 * H) - (6.76 * A)
A = age
W = weight in kg
H = height

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37
Q

How to calculate basal energy expenditure (BEE) for women?

A

665.1 + 9.56 * (W) + (1.86 * H) - (4.68 * A)
A = age
W = weight in kg
H = height

38
Q

Total daily energy formula?

A

(BEE) x (activity factor) x (stress factor)

39
Q

Activity factor for patients confined to bed?

A

1.2

40
Q

Activity factor for patients out of bed?

A

1.3

41
Q

Stress factor for surgery?

A

1.2

42
Q

Stress factor for infection?

A

1.4

43
Q

Stress factor for trauma?

A

1.5

44
Q

Stress factor for burns?

A

1.7

45
Q

Normal protein intake for normal adult?

A

0.8-1g/kg/day

46
Q

Normal protein intake for hospitalized adult?

A

1.2-2g/kg/day

47
Q

How many kcal per gram?

A

4 kcal

48
Q

Lipid intake requirements?

A

15-30% of total non-protein caloric requirement (kcal)

49
Q

Non-protein calories formula?

A

Total calories - Protein caloric requirements

50
Q

Carbohydrate percentage of typical intake?

A

70-85% of total non-protein calories
(typical patient is 70%)

51
Q

Maximum infusion rate for carbohydrates?

A

5 mg/kg/min

52
Q

Lipids are needed to provide what?

A

Needed to provide essential fatty acids

53
Q

Do not exceed what amount when administering lipids?

A

2.5 g/kg/day

54
Q

What are supplemental nutritional lipids made from?

A

Soybean +/- olive oil

55
Q

Cautions when administering lipids?

A

Allergies: egg, soy, & peanut w/ some formulations

56
Q

What are the two formulations of supplemental lipids?

A

10%: 1.1 kcal/mL
20%: 2 kcal/mL

57
Q

Caution with sodium electrolyte administration?

A

Heart failure

58
Q

Caution with potassium electrolyte administration?

A

Renal failure

59
Q

Caution with chloride electrolyte administration?

A

Alkalosis

60
Q

Caution with acetate electrolyte administration?

A

Acidosis

61
Q

Caution with calcium electrolyte administration?

A

Depends on albumin levels

62
Q

Caution with magnesium electrolyte administration?

A

Renal failure, Diuretics

63
Q

Caution with phosphorus electrolyte administration?

A

Malnutrition, High GI loss

64
Q

What are standard set common additives for all TPN?

A

Multivitamins

65
Q

Trace element common additives for TPN?

A

Zinc, Copper, Manganese, Chromium, Selenium

66
Q

Other common additives for TPN?

A

Thiamine, Folic acid

67
Q

Less common adult additives for TPN?

A

Insulin (regular only), Heparin, Iron dextran, Famotidine/Ranitidine

68
Q

Which less common additive is used in dialysis?

A

Carnitine

69
Q

Which less common additive is a must for pediatrics?

A

Cysteine

70
Q

Why don’t adults absolutely need cysteine as an additive to TPN?

A

Adults can make cysteine from methionine

71
Q

Types of supplements?

A

2 in 1
3 in 1

72
Q

Most common type of IV access in the hospital?

A

Peripheral line

73
Q

Peripheral lines are inserted into which kind of vein?

A

Small vein

74
Q

What is common with peripheral lines with high osmolality IV fluids such as TPN?

A

Vein irritation

75
Q

Max osmolality for TPN with peripheral lines?

A

900-1000 mOsm/L

76
Q

Central lines are inserted into which kind of vein?

A

Large vein

77
Q

Which type of central lines are surgically implanted?

A

Central venous catheter (CVC)

78
Q

Which type of central lines are inserted at bedside with sterile field setup?

A

PICC lines (Peripheral inserted central catheter)

79
Q

Max osmolality for central lines?

A

No max osmolality due to fast dilution

80
Q

Complications of TPN?

A

Hyperglycemia, Re-feeding syndrome, Hypoglycemia, Essential fatty acid deficiency (EFAD), Hypertriglyceridemia, Azotemia, Hepatobiliary issues

81
Q

What is needed in Hyperglycemia with TPN?

A

Sliding scale of regular insulin q6hrs

82
Q

What is needed in re-feeding syndrome with TPN?

A

Higher levels of phosphate and thiamine needed, extra monitoring of electrolytes, titrate TPN slowly

83
Q

What is causes hypoglycemia with TPN?

A

Abrupt discontinuation

84
Q

What is needed in essential fatty acid deficiency with TPN?

A

Essential linolenic and alpha linolenic at least BID

85
Q

What causes hypertriglyceridemia with TPN?

A

Too much dextrose (overfeed)

86
Q

What causes Azotemia with TPN?

A

Excessive protein (higher risk with liver/renal failure)

87
Q

What causes Azotemia with TPN?

A

Excessive protein (higher risk with liver/renal failure)

88
Q

Hepatobiliary issues with TPN?

A

Steatosis, Cholestasis, Gallbladder slude/stones (lack of GI stimulation)

89
Q

What to add for Gallbladder issues with TPN?

A

Small amount of clear fluids orally

90
Q

Slide 29/39

A

ClinMed II Exam #4 GI (7 decks)

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