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Therapeutics 4 > Parenteral Nutrition > Flashcards

Parenteral Nutrition Flashcards

(51 cards)

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1
Q

PN

When would nutritional body weight (NBW) be used for parenteral nutrition calculations?

A

if ABW is > 130% of IBW

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2
Q

PN

What is the equation for nutritional body weight (NBW)?

A

NBW= IBW + 0.25(ABW-IBW)

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3
Q

PN

What are the risk factors for malnutrition?

A
  • under body weight (UBW)= 20% below IBW
  • involuntary weight loss= > 10% within 6 months
  • NPO > 10 days (clinically= inadequate intake > 7 days)
  • increased metabolic needs (trauma and burns, high dose steroids)
  • alcohol/substance abuse
  • protracted nutrient losses (chronic disease states)
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4
Q

PN

What screening tools can be used to assess nutritional needs?

A
  • NUTRIC
  • Nutritional Risk Score (NRS-2002)

and many others…

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5
Q

PN

What NUTRIC score determines a patient is high risk for malnutrition?

A

6-10

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6
Q

PN

How can visceral proteins be used to determine a patients nutritional status?

A

albumin and transferrin may be used but have long half lives, so monitoring transthryetin (prealbumin) may be a better indicator

although none may be accurate for the ICU setting

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7
Q

PN

What is the normal lab value for C-Reactive protein?

A

< 1 mg/dL

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8
Q

PN

How can C-Reactive protein be used to determine nutritional status?

A

prealbumin decreases as CPR normal = malnutrition

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9
Q

PN

Define: Marasmus malnutrition

A

protein-calorie nutrition due to decrease in total intake and/or utilization of food= patients have evident muscle wasting, peeling and alternatively pigmented skin, hair loss, edema, swelling

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10
Q

PN

Define: Kwashiorkor malnutrition

A

protein malnutrition due to inadequate protein intake, but calorie intake is adequate (typically seen in trauma and burn patients)- muscle wasting is not evident, large belly, diarrhea, failure to gain weight, fatigue, hair changes

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11
Q

PN

What is the treatment for Marasmus malnutrition?

A

well balanced substrate, while considering the addition of vitamin B

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12
Q

PN

What is the treatment for Kwashiorkor malnutrition?

A

carbohydrates followed by high protein

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13
Q

PN

How is excretion of nitrogen measured?

A

urinary urea nitrogen (UUN)

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14
Q

PN

What is the goal nitrogen balance (Nin-Nout)?

A

+3 - +5

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15
Q

PN

What is the formula for nitrogen balance?

A

Nin - Nout
Nin= 24h protein intake (g)/ 6.25
Nout= 24h UUN (g) + factor of 4

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16
Q

PN

What is the recommended calorie intake for non-stressed/non-depleted patients?

A

20-25 kcal/kg/day

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17
Q

PN

What is the recommended calorie intake for trauma/stress/surgery patients?

A

25-30 kcal/kg/day

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18
Q

PN

What is the recommended calorie intake for patients with BMI 30-50?

A

11-14 kcal/kg/day (use actual body weight)

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19
Q

PN

What is the recommended calorie intake for patients with BMI > 50?

A

22-25 kcal/kg/day (use ideal body weight)

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20
Q

PN

What does the TEE tell you about the patients nutrition?

A

required kcal/day

TEE= REE x 1.2

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21
Q

PN

What is the goal respiratory quotient (RQ)?

22
Q

PN

What respiratory quotient (RQ) indicates overfeeding?

23
Q

PN

What respiratory quotient (RQ) indicates underfeeding?

24
Q

PN

What is the recommended maintenance proteins for patients?

Study These Flashcards
A

0.8-1 g/kg/day

25
# PN What is the recommended proteins for mild-moderate stress patients?
1-1.5 g/kg/day
26
# PN What is the recommended proteins for moderate-severe stress patients? | these patients would be found in the ICU, trauma/surgery/burn patients
1.5-2 g/kg/day
27
# PN What is the recommended proteins for patients with BMI > 30?
2 g/kg/day (use ideal body weight)
28
# PN What is the recommended proteins for patients with BMI 40+?
2.5 g/kg/day (use ideal body weight)
29
# PN What patients may be protein intolerance?
patients with renal and hepatic diseases
30
# PN What is distribution of non-protein calories (NPC)?
standard distribution (70/30)= 70-85% dextrose, 15-30% fat
31
# PN What is parenteral nutrition (PN)?
supplying nutrients via IV
32
# PN What are the indications for parenteral nutrition (PN)?
- anticipated prolonged NPO (> 7 days) - inability to absorb nutrients through the gut (small bowel or colonic ileus, extensive bowel resection, malabsorption stress, intractable vomiting/diarrhea) - enterocutaneous fistulas - inflammatory bowel disease - hypperemesis gravidum - bone marrow transplantation
33
# PN What must be taken into account for peripheral parenteral nutrition?
- dextrose concentration due to hypertonicity (not well tolerated in peripheral vein)- ristrict dextrose concentration to 5-10%/ or < 900 mOsm/L - large volume required so not a good choice for HF or AKI/CKD patients - limited calories - only short term access is tolerated (7-10 days) | always double check to confirm the route was intentional
34
# PN What must be taken into account for centeral parenteral nutrition?
- hypertonic solutions may be delievered and more calories - risk of infection (appropiate line care is critcial) - line must be implanted with risk of pneumothroax, air embolus, thrombus
35
# PN How many kcal are in one gram of protein?
4 kcal
36
# PN How many kcal are in 1 gram dextrose?
3.4 kcal
37
# PN What is the maximum carbohydrate utilization?
4-5 mg/kg/min
38
# PN How many kcal are in 1 gram lipids?
~10 kcal
39
# PN What does Intralipid 10% consist of?
- soybean oil - glycerin (check allergies) - egg yolk (check allergies) - water for injection
40
# PN What does SMOFlipid consist of?
- soybean oil - medium chain triglycerides - olive oil - fish oil (check allergies)
41
# PN What is the benefit of using SMOFlipid over other lipid products?
- improved liver function (over pure soybean oil products) - lower increase in TG levels from baseline (compared to pure soybean oil products) - less pro-inflammatory - less negative impact on liver function - reduced risk of infection - decreased length of hospital stay
42
# PN What is the maximum intake of lipids?
60% of total intake lipids- generally 1-1.5 g/kg/day of lipids, max of 2.5 g/kg/day if patient is tolerating
43
# PN What sedative drug includes lipids and needs to be considered for parenteral nutrition?
propofol is a 10% lipid solution= 1.1 kcal/mL
44
# PN What trace elements must be included in parenteral nutrition to avoid complications?
- zinc - copper - chromium - selenium - manganese - iron
45
# PN What complications can arise from parenteral nutrition?
- mechanical (clotting of line, displacement) - infections (sepsis) - metabolic (electrolyte imbalances, fluid imbalances, hyper- and hypo-glycemia, liver function abnormalities)
46
# PN What are the monitoring parameters for parenteral nutrition?
- BASELINE= CMP, Mg, Phos, Ca, hepatic function, prealbumin, PT/INR - vital signs (daily) - I/O (daily) - electrolytes (daily) - weight (2x/week, but daily in ICU) - CBC (2x/week, but daily in ICU) - magnesium, phosphorus, calcium (2x/week, but daily in ICU) - prealbumin (2x/week, but daily in ICU) - ONCE WEEKLY= albumin, transferrin, nitrogen balance, liver function, triglycerides, PT/INR, RESPIRATORY QUOTIENT (RQ)/indirect calorimetry
47
# PN What is refeeding syndrome?
potentially life threatening condition that occurs within the first few days of feeding a starved patient due to fluid, micronutrient, electrolye, and vitamin imbalances
48
# PN What are the clinical findings of refeeding syndrome?
- hypophosphatemia, hypomagnesemia, hypokalemia - respiratory distress - paresthesias - tetany - cardiac arrhythmias - hemolytic anemia
49
# PN What are the risk factors for refeeding syndrome?
- rapid feeding, excessive dextrose infusion - low BMI (< 16-18) - excessive weight loss - insufficient calorie intake - low levels of K, Phos, or Mg prior to feeding - loss of subcut fat or muscle mass - high risk comorbidities: alcoholism, anorexia, Marasmus malnutrition
50
# PN How can refeeding syndrome be prevented?
- replete electrolytes before initiating feeds - upon initiation limit carbohydrates to 100-150g, limit fluids to 800 mL/day, provide adequate electrolytes, provide 50% of caloric needs - give thiamine 100mg daily for 5-7 days
51
# PN What is the essential fatty acid (EFA) requirements?
4-10% of daily calories

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