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Therapeutics IV > Parenteral Nutrition > Flashcards

Parenteral Nutrition Flashcards

(94 cards)

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1
Q

Male IBW Calculation

A

IBW = 50 + 2.3 (in > 60)

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2
Q

Female IBW Calculation

A

IBW = 45.5 + 2.3 (in > 60)

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3
Q

NBW Calculation

A

NBW = IBW + 0.25(wt - IBW)

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4
Q

When do you use NBW?

A

if actual weight is > 130% of IBW

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5
Q

What classifies someone as under body weight (UBW)?

A

actual weight 20% below IBW

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6
Q

When does involuntary weight loss become concerning?

A

Weight loss > 10% within 6 months

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7
Q

After how many days of NPO does a person become at risk for malnutrition?

A

7 days

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8
Q

What types of patients are hypermetabolic at baseline?

A

trauma and burn patients

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9
Q

What medication leads to increased metabolic needs?

A

high dose steroids

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10
Q

Why does chronic alcohol/substance abuse put you at risk for malnutrition? (2)

A

decreases functional protein levels; intake of empty calories

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11
Q

All hospitalization patients should have their nutrition risk assessed within __ hours of admission.

A

48

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12
Q

What 3 aspects of a patient history are important for assessing nutrition risk?

A

dietary; medical; medication

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13
Q

Normal Transthyrenin (prealbumin) level

A

15-40 mg/dL

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14
Q

Why is it important to get baseline a baseline prealbumin value?

A

prealbumin is a negative acute phase reactant and can be lowered during inflammatory response

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15
Q

Which type of malnutrition is characterized by wasting of skeletal muscle and SQ fat as well as cachectic appearance?

A

protein-calorie malnutrition

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16
Q

What is another name for protein-calorie malnutrition?

A

marasmus

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17
Q

What type of malnutrition is characterized by adequate caloric intake?

A

protein malnutrition

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18
Q

What is another name for protein malnutrition?

A

kwashiorkor

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19
Q

Which type of nutrition is associated with trauma and burn patients?

A

protein malnutrition (kwashiorkor)

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20
Q

Which type of malnutrition is associated with muscle wasting?

A

protein-calorie malnutrition (marasmus)

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21
Q

List common symptoms of marasmus. (3)

A

hair loss; edema; skin folds

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22
Q

List common symptoms of kwashiorkor. (3)

A

failure to gain weight; large belly; change in skin pigment

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23
Q

Why must you provide carbs before protein in a patient with protein malnutrition?

A

if you just give protein, the body will use up all the protein for energy and stores will never be repleted

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24
Q

Increased protein catabolism leads to ______ UUN.

A

Increased

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25
How is UUN measured?
24 hr urine collection
26
UUN represents ___% of total nitrogen excretion.
85-90
27
Goal nitrogen balance
+3 to +5 grams
28
Nitrogen balance calculation
(N in) - (N out)
29
(N in) equation
N in = [24-hr protein intake (g)] / 6.25
30
(N out) equation
N out = [24-hr UUN (g)] + 4
31
How often should you check a nitrogen balance?
once a week
32
Caloric requirement for all patients
25-30 kcal/kg/day
33
What is the goal RQ?
0.85-0.95
34
A high RQ is associated with _____.
overfeeding
35
A low RQ is associated with _____.
underfeeding
36
Underfeeding leads to depletion of ____ stores.
protein
37
Protein requirement for mild/moderate stress (floor patients)
1-1.5 gm/kg/day
38
Protein requirement for moderate/severe stress (ICU, trauma, burn)
1.5-2 gm/kg/day
39
What is the standard distribution of non-protein calories?
70% dextrose / 30% fat
40
How would you change the NPC distribution if a patient had high blood sugar?
decrease dextrose, increase fat
41
How would you change the NPC distribution if a patient had high triglycerides?
increase dextrose, decrease fat
42
When might 100/0 NPC be used?
sepsis; bloodstream infections
43
List the indications for parenteral nutrition. (6)
1. anticipated NPO > 7 days 2. inability to absorb nutrients via the gut 3. enterocutaneous fistulas 4. inflammatory bowel disease 5. hyperemesis gravidum (pregnant patients) 6. bone marrow transplant
44
What are some problems that lead to the inability to absorb nutrients through the gut? (4)
1. bowel or colonic ileus 2. small bowel resection 3. malapsorptive states 4. vomitting/diarrhea
45
Why might bone marrow transplant patients require PN?
mucositis caused by treatments may cause pain that prevents the patient from eating
46
What are the 3 sites available for central venous catheter insertion?
1. subclavian 2. internal jugular 3. femoral
47
Short term CVCs are _______.
percutaneously inserted
48
Long term CVCs include: (3)
1. PICC 2. tunneled 3. implanted port
49
What type of catheter is most commonly used?
triple lumen
50
TEE calculation
TEE = REE x 1.2
51
1 gram protein = ___ kcal
4 kcal
52
1 gram dextrose = ___ kcal
3.4 kcal
53
What is the maximum carbohydrate utilization?
4-5 mg/kg/min
54
1 gram lipid = ___ kcal
10 kcal
55
What are anthroprometrics?
measures of the body's muscle protein
56
What are the 4 ways you can measure a person's muscle protein?
weight; triceps skin fold; arm muscle circumference; physical appearance
57
What is the goal final dextrose concentration for a TPN?
10%
58
What are the ingredients in Intralipid? (4)
Soybean oil; glycerin; egg yolk phospholipid; water
59
What type of essential fatty acid is available in Intralipid? (Hint: comes from soybean oil)
omega-6-fatty acid
60
Which two parts of Intralipid might people be allergic to?
glycerin & egg yolk
61
What are the ingredients of SMOFlipid?
soybean oil; medium-chain TG; olive oil; fish oil
62
What type of EFA is in fish oil?
omega-3-fatty acid
63
Which EFA is better?
omega-3-fatty acid
64
What part of SMOFlipid might people be allergic to?
fish oil
65
What are the benefits of SMOFlipid over Intralipid? (2)
improved liver function; lower increase in TG
66
General lipid dosing in adult patients
1-1.5 g/kg/day
67
Max lipid dose for adults
2.5 g/kg/day
68
What sedative medication contains lipids?
propofol
69
How much lipid is in propofol?
1.1 kcal/mL
70
Which two types of fat emulsions are isotonic?
10% and 20%
71
What does a total nutrient admixture consist of?
dextrose, AA, and lipids all in one bag
72
What does a convential administration TPN consist of?
dextrose and AA in one bag with lipids given intermittently as IVPB
73
What is not included in a premix solution TPN?
lipids
74
Are electrolytes included in a premixed solution TPN?
they can be made with or without electrolytes
75
Patients with a CrCl of ___ should not receive electrolytes in their TPN.
< 50
76
You should start a TPN at __% of the goal rate and reach the final rate in ___ hours.
25%; 24 hours
77
How often should you check BG after initiating the first TPN bag?
every 4-6 hours
78
What do you do if after checking the patient's BG it is > 200 mg/dL?
continue TPN at the same rate and re-check in 4-6 hours
79
When would you initiate insulin in a TPN patient?
after 2 consecutive BG checks > 200 mg/dL
80
How do you stop a TPN?
decrease rate by 1/2 every 2 hours
81
How much vitamin product goes in a TPN?
10 ml/day
82
How often should you monitor a patient's prealbumin?
twice a week
83
How often should you monitor RQ and UUN?
once a week
84
What labs should you get at baseline for a patient being started on a TPN? (7)
CMP; Mg; Phos; Ca; prealbumin; hepatic function; PT/INR
85
What electrolyte is most at risk for depletion in refeeding syndrome?
phos
86
What are 3 consequences of refeeding syndrome? (Hint: all hypo-)
hypophosphatemia; mypomagnesemia; hypokalemia
87
What is the first thing you should do to prevent refeeding syndrome in at-risk patients?
replete electrolytes before initiating feeds
88
To prevent refeeding syndrome you should limit dextrose to _____ on the first day of feeds.
100-150 g/day
89
To prevent refeeding syndrome you should limit fluids to _____ on the first day of feeds.
800 ml/day
90
To prevent refeeding syndrome you should provide __% of total caloric needs on the first day of feeds.
50%
91
Essential fatty acids make up __% of daily calories.
4-10%
92
What is the mechanism behind EFA deficiency?
inhibits lipolysis and fatty acid mobilization
93
When does EFA onset usually occur?
10-14 days after starting fat-free regimen
94
What are the two options for prevention of EFA deficiency?
1. 500 ml of 10% fat emulsion twice weekly | 2. 250 ml of 20% fat emulsion twice weekly

Therapeutics IV (21 decks)

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