Rd

Question 1

Facility codes

Answer 1

A= WRC B= Plains C = RGH D = PH

Question 2

Typical TF flushes

Answer 2

60-120-150

Question 3

LTC tube patency

Answer 3

25-30 ml QID

Question 4

Normal body temp

Answer 4

37 C

Question 5

Normal BMI young and older

Answer 5

19-25 or 23-30

Question 6

Kcal needs LtC

Answer 6

60+ = 25-30
<60 = 30-35

Question 7

Protein typical LTC wounds wasted
Acute care

Answer 7

1-1.2; 1.2; 1.5
1.2-1.5

Question 8

Fluid needs LTC; acute

Answer 8

LTC: 1 ml/kg or 30-40 ml/kg
Acute: >65 = 25 ml/kg
55-65 = 30
25-55= 35
15-30=40

Question 9

Refeeding kcal/kg
Refeeding TPN g dextrose
Reefeeding max GIR

Answer 9

10-20 kcal/kg
Or 15 kcal/ kg
<150-200 g dextrose
GIR < 2

Question 10

Labs TPN,

Answer 10

TPN= 3 consecutive days then q Mon, Thurs. fine to keep same schedule after changing ppn to TPN.

Question 11

Vit K day for TPN

Answer 11

Monday

Question 12

How long peripheral vs central line TPN

Answer 12

Central if > 1-2 weeks

Question 13

How long peripheral vs central line TPN

Answer 13

Central if > 1-2 weeks

Question 14

Peripheral TPN time, dex %, max osmolarity, electrolyte maxes, protein %; meets needs, typical fluid volume?

Answer 14

< 2 weeks
< 7-10% dex
900 osmol/L
KCl < 40 mmol/litre
10 meq Mg max
10 Ca max
< 4% protein
No. Often reefeeding amount continues unless fluid can be increased
30-40 ml/kg

Question 15

How much of fluid needs met w TPN

Answer 15

75-80%

Question 16

Lipid products

Answer 16

Use SMOF unless fish allergy then intralipid

Question 17

Maximum TPN compound Regina

Answer 17

9% aa and 25% dextrose

Question 18

Less than what volume TPN unlikely to compound

Answer 18

< 1 litre

Question 19

Cycling TPN

Answer 19

Change rate gradually
See new TPN, note rate change with new bag. Check BG one hour after stopping Tpn x 2-3 days
24-20 hours if decreased fluid tolerance of oral intake, increase GIR .5 likely ok. Too much change if high Refeeding risk or not eating po.

Question 20

Hemolyzed sample

Answer 20

Falsely elevated K

Question 21

TPN K

Answer 21

1 meq/kg unless
High none
Ppn max 40/L

Question 22

Sodium TPN

Answer 22

1/kg
Refeeding use 20-40
77 meq/L = NS
2-3 numbers up or down not sig. enough to adjust TPN
Never above 2 even if sodium low (likely other factor ie: high ostomy output, vomiting, meds, diarrhea)
If seems expect to be on low end or slightly low. Don’t adjust TPN.
Don’t increase Na if Refeeding risk even if low.

Question 23

Refeeding electrolytes

Answer 23

Need higher K, Mg, phos. Lower Na.

Question 24

Electrolytes TPN

Answer 24

1-2 meq
1-2 meq
15-20
15-20
10-15

Question 25

When to not add trace minerals

Answer 25

If ALP and bilirubin BOTH elevated: do not add TE. Flip to back. Add Zn and Cr. No Cu or Mang.

Question 26

Thiamine to TPN

Answer 26

100 daily x 5 days if Refeeding risk

Question 27

Folic acid TPN

Answer 27

Add except with lower GI CA Janelle Or only if ETOH or inflammatory bowel disease (Michelle)

Question 28

Vitamin k tPN

Answer 28

Always add unless taking Warfarin

Question 29

Selenium TPN

Answer 29

Always add

Question 30

When to minimize chloride

Answer 30

If elevated (Janelle) If >~120 (Michelle)

Question 31

TPN label

Answer 31

New TPN Nov 3 Vit K today and every Monday Thiamine 100 meq (03 Nov-07Nov) SMoF 168 ml/24 hours

Question 32

If —————— low then 0 in TPN

Answer 32

K, phos (not hemolyzed)

Question 33

When to worry re: TG on TPN

Answer 33

When 4-5

Question 34

Stopping TPN/PPN

Answer 34

TPN run 1/2 rate 1-2 hours PPN can just stop

Question 35

SHA TPN protein product

Answer 35

Travasol