Parenteral nutrition

Question 1

What characteristics do patients needing partenteral nutrition present with? 6

Answer 1

Small bowel obstruction
Peritonitis
Intractable vomiting
Severe acute pancreatitis
Short bowel syndrome
Prolonged ileus

Question 2

Contraindications for parenteral nutrition support?

Answer 2

Catheter-related complications
Coagulopathies
Local and systemic complications to central line placement and use

Question 3

Contraindications associated with disease stage for parenteral nutrition support?

Answer 3

Poor prognosis or terminal illness with no other therapy

Question 4

Clients whose GI tracts will return to normal after ______ shouldn’t use TPN?

Answer 4

7-10 days

Question 5

How is TPN always administered?

Answer 5

Through central line

Question 6

When is TPN used?

Answer 6

When nutritional requirements are high and needed for an extended period of time (different from PPN)

Question 7

When is peripheral parenteral nutrition used?

Answer 7

For clients who do not need to gain weight and who have some oral intake

Question 8

When is PPN typically used?

Answer 8

For lipids when they are not included in the primary nutrient solution because they are considered isotonic.

Question 9

Which solution type is used for TPN?

Answer 9

Always hypertonic
Customized to patient

Question 10

What dextrose solution is used for TPN?

Answer 10

50%-70% dextrose

Question 11

How often should TPN solution be changed?

Answer 11

Every 24 hours

Question 12

How often should TPN tubing be changed?

Answer 12

Every 24 hours

Question 13

How often should TPN lipids be changed?

Answer 13

Every 24 hours

Question 14

What could the high dextrose contents in TPN solution cause?

Answer 14

Hyperglycemia, increased risk for infections, hepatic steatosis.

Question 15

What is the purpose of lipids in TPN solution?

Answer 15

Lipids can help support patient’s need for supplemental kilocalories to prevent essential fatty acid deficiencies and control hyperglycemia during periods of stress.

Question 16

What should be assessed in patients being administered lipids during TPN?

Answer 16

• Liver function tests (hepatic steatosis)
• Triglycerides (>400 mg/dL) must hold

Question 17

S/sx associated with hyperglycemia?

Answer 17

Thirst, headache, lethargy, increased urination

Question 18

S/sx associated with hypoglycemia?

Answer 18

Diaphoresis, shakiness, confusion, LOC.

Question 19

S/sx of fluid overload related to parenteral nutrition?

Answer 19

Refeeding syndrome in malnutriton
Excess free water or dluted (hypotonic) formula

Question 20

What should be done if refeeding syndrome is observed?

Answer 20

Restrict fluids if necessary and use either a specialized formula or diluted enteral formula first

Question 21

What should be done if excess free water if observed?

Answer 21

Monitor levels orf serum proteins and electrolytes. Use more concentrated formula with FVE without risk of refeeding syndrom.

Question 22

A TPN patient with electrolyte imbalance should be given…?

Answer 22

Maintain steady rate of infusion and monitor I/O

Question 23

S/sx associated with hypercapnia?

Answer 23

Increased O2 consumption, CO2 respiratory quotient, and minute ventilation.

Question 24

How should hypercapnia be addressed?

Answer 24

Provide 30%-60% of energy requirements per HCP order due to higher risk for ventilator patients.

Question 25

How should hypoglycemia be addressed?

Answer 25

Taper PTN rate down to within 10% infusion rate 1-2 hours prior to cessation. Test BG and administer IV bolus of 50% dextrose of glucagon per order or protocol if necessary.

Question 26

How should hyperglycemia be addressed?

Answer 26

Monitor BG every 6 hours. Initiate TPN slowly and taper up to maximal unfusion rate to prevent hyperglycemia. Additional insulin may be required during therapy if patient has DM or problem persists.

Question 27

HHNKC or HHNS shows s/sx of?

Answer 27

Confusion, axotemia, headache, dehydration, hypernatremia, metabolic acidosis, convulsions, coma

Question 28

How should HHNKC or HHNS be addressed?

Answer 28

Monitor glucose and BUN, glucose in urine, fluid lossess, administer insulin and replace fluids. Provide 30% of daily energy needs as fat. Patients taking steroids are more at risk and older adilts diagnosed with DM or renal or pancreatic impairments... and those with increased metabolism who are septic.

Question 29

What is the difference between central line and peripheral line infusion in parenteral nutrition?

Answer 29

Central line can handle high osmolarity solutions and hypertonic solutions and lipid administrations are given separately. Peripheral line infusions are given over shorter periods of time and only suitable for lower osmolarity use due to vein irritation.

Question 30

Why are lipids often given through peripheral line?

Answer 30

They are considered isotonic... and the lipid molecules are to large to pass through a filter which is how TPN should be adminstered.