Parenteral nutrition

Question 1

what is the composition of IV fluids ?

Answer 1

water
electrolytes
glucose
Na+ and K+

Question 2

when are IV fluids used?

Answer 2

when oral routes are not suitable for the patient.

Used to maintain hydration, organ function and metabolic activities

Question 3

what are some of the negatives of IV fluids?

Answer 3

it cannot provide all the daily calorie intake and increasing fluids in the body can cause low sodium (hypotranemia)

Question 4

how can you reach adequate calories with IV fluids ?

Answer 4

by infusing hypertonic glucose solution but it can cause damage to the blood vessel used

Question 5

what is enteral nutrition?

Answer 5

it is a tube that goes through the nose and down the osophagus and is good at delivering carbohydrates, proteins, fats , vitamins, electrolytes and trace elements. As iv cannot deliver these.

Question 6

why are nasogastric tubes better than nasoentric tubes?

Answer 6

they both offer feeding but nasogastric also can quantify gastric residuals AND are less likely to become clogged BUT are less comfortable for the patient.

Question 7

what are some of the reasons for enteral feeding tubes?

Answer 7

• trauma
• stroke ( nurological disorders)
• oesophageal reflux disease
• Gi tract disruption
• anorexogenic encalpahy

Question 8

who is enteral nutrition best for?

Answer 8

best for patients who have a healthy gut but cannot gain sufficient nutrition by mouth

Question 9

what are the enteral nutrition routes ?

Answer 9

nasogastric , nasaljuogenal or gastronomy or jejustomy tubes.

Question 10

what are the advantages of enteral nutrition?

Answer 10

• maintains a healthy gut function until normal feeding has resumed
• cheaper
• less risk of error

Question 11

what are the disadvantages of enteral nutrition?

Answer 11

• has a high risk of infection if the tube is in place for long periods of time

Question 12

when is parenteral feeding best and for which types of patients ?

Answer 12

best for a patient who needs long term supplement nutrition (more than 7 days)
best for patients who are unable to meet there daily nutritional requirement such as critically ill patients , preterm infants , patients with server gut dysfunction and patients who cannot tolerate enteral nutrition

Question 13

what is the aim for parenteral nutrition?

Answer 13

to be able to provide sufficient nutrition to certain patient groups with carbs (plc and dextrose) lipids amino acids , electrolytes, vitamins, water , trace elements and even drugs

Question 14

where is partial parental nutrition administered?

Answer 14

it is IV into the vein in the arm and bypassed the normal GI tract processes

Question 15

where is total parenteral nutrition administered?

Answer 15

it is IV and into a vein near the heart and a mechanical pump delivers the nutrition

Question 16

what are the monitoring parameters for parenteral nutrition?

Answer 16

• body weight
• complete blood count
• blood urea nitrogen
• glucose ; input and output monitoring for hyperglycaemia
• liver function tests

Question 17

what is the best choice of nutrition for the critically ill?

Answer 17

enteral nutrition

Question 18

what are the considerations when making a parenteral nutrition regime?

Answer 18

• fluid intake
• energy requirement
• nitrogen requirement ( proportion of fast , proteins and carbs
• type of IV available- central or peripheral
• heather or not a standard regime is suitable for therapy
• electrolyte and trace elements requirements

Question 19

what are the considerations for fluid volume ?

Answer 19

• fluid assessment status has to be done before and after TPN
• no other fluid intake (2-3L)
• fluid intake must increase with burns , vomiting , diahorrea , fever, stoma, pulmonary disease, renal function decline and CHF .

Question 20

what are the considerations In energy requirements ?

Answer 20

• calculated by age, sex and weight , height ad clinical condition
• better to under feed rather than over feed to avoid metabolic complications and organ damage

Question 21

why is dextrose included in parenteral nutrition?

Answer 21

it is used as an energy supply instead of plc as plc can damage the BV.
use with lipids to reduce the incidence of hypoglycaemia., fatty liver and acidosis

Question 22

why are lipid used in parenteral nutrition?

Answer 22

• a better energy source
• acts as a carreir for fat soluble vitamins (D and E)
• reduces the excessive need for glc
• provides essential fatty acids
• caution with neonates

Question 23

why must lipids be handled with care in parenteral nutrition?

Answer 23

• take car in 3 in 1 emulsions ( dextrose , amino acids and fatty emulsions) as the STABILITY of IV fatty emulsions decreased and can cause cracking

Question 24

why is nitrogen added to parenteral nutrition?

Answer 24

• protein source and under metabolic stress acts as an energy source
• can also be a buffer
• acts as calories so the amino acids aren’t used for energy

Question 25

what is the aim for adding nitrogen into parenteral nutrition?

Answer 25

to achieve a positive balance to provide all the essential amino acids for tissue building and metabolic functions

Question 26

who does nitrogen benefit the most in parenteral nutrition ?

Answer 26

patients with sever metabolic dysfunction and insufficient reabsorption
and preterm neonates