TPN

Question 1

Advantages of Nutrition Support Therapy
1. Reduce ___
2. Diminish ___
3. Decr length of___
4. Incr pt’s ___
5. Decr ___

Answer 1

disease severity
complications
hospital stay
QOL
Costs of medical care

Question 2

Indications for Nutr support therapy

Severe chronic ____
___ cant be fed by mouth
Preexisting ___
Anticipated or actual ___
Significant ____

Answer 2

intestinal failure
neonates
nutritional deprivation
inadequate PO intake (>7 days)
Multiorgan system disease

Question 3

If the gut works, use it –> EN
-Maintains __, fewer ___, Lower __ and ___

Parenteral feeding
-useful if ____ not feasible, __, or not __
PN has less risk of ?

Answer 3

gut integrity, infections, costs , shorter hospital stays

enteral access, inadequate, toelrated

gastric retention, emesis, aspiration

Question 4

Indications for PN
-Prevent ae’s of ___ in pt’s unable to consume adequate nutrients by the ____ or ____
-____ pt’s have prolonged hospitalizations and at higher risk of developing complications

Specific Indication :
S,R,D,P,P,M

Answer 4

malnutrition , oral, enteral

Malnourished

Short bowel, radiation enteritis, distal high output fistulas, persistent ileus, pseudo obstruction, mechanical obstruction

Question 5

IV access for PN Therapy
-What kind of IV?
How long can u use?
___ or (TPN) -PICC stands for?

Answer 5

Peripheral IV (PPN)
Limited use for less than 7 days

Central Line , Peripherally inserted central catheter

Question 6

Max Dextrose Concentrations

1. For peripheral line PPN?
2. central line TPN?

Answer 6

1. Dextrose 10%
2. Dextrose 25%

Question 7

Osmolarity Limits

Peripheral line vs Central ?

Answer 7

900 mOsm/L
1500 mOsm/L

Question 8

Estimated Energy Requirement Examples

1. healthy, maintenance ?
2. Malnourished or stressed?
3. Severe stress?

Answer 8

1. 20-25 kcal/kg/day
2. 25-30 kcal/kg/day
3. 30-35 kcal/kg/day

Question 9

Protein requirements :
-based on ?
Estimated protein needs ? Maintenance, mild catabolism, mod catab, severe

What about pt’s with renal and hepatic dysfunction ?

Answer 9

body weight, degree of stress and disease state

0.8-1.2 g/kg/day
1.2-1.5 g/kg/day
1.5-2.0 g/kg/day
2.0-2.5 g/kg/day

0.6-0.8 g/kg/day

Question 10

PROTEIN in PN
-Supplied as an Amino acid mixture
-protein provides ???
Noted as “AA” –> AA 10% = 10g/100mL
Max AA% in PN?

Answer 10

4kcal/g

8%

Question 11

WHat’s the most common carb for IV use?
It provides how many kcal /g
Carbs to meet what percent of non protein calories?

Answer 11

Dextrose

3.4 kcal/g

70-85%

Question 12

FAT
-How many kcal /g
IV formulas supplied as 10% lipids and 20% lipids –> How many kcal/mL in each?

Fat to provide what percent of nonprotein calories?

When are lipids held?

Answer 12

9kcal/g

10% = 1.1 kcal/mL
20% = 2kcal/mL

15-30%

If pt is on propofol or if TG >/= 400 mg/dL

Question 13

Daily Fluid Req’s
How much?
Range?

Can also estimate using?

Answer 13

1500 mL for first 20 kg of patients weight.
20 mL/kg for every excess kg over 20

20-40 mL/kg/day

1mL/kcal

Question 14

Nutritional Requirements Ranges :

TOTAL calories
Protein
Carbs
Fats
Fluids

Answer 14

20-35 kcal/kg/d

0.8-2.5 g/kg/d

70-85% non protein calories

15-30% non protein calories

20-40 mL/kg/d

Question 15

IBW equation for males and females?

Adjusted BW ?

If their BMI is <30 use ?
If >30 use?

When actual BW is less than IBW –> use?

Answer 15

Males: 50 kg + 2.3 kg for each inch over 5 feet
Females: 45.5 kg + 2.3 kg for each inch over 5 feet

• Adjusted body weight: IBW + 0.4 (ABW - IBW

Actual body weight
adjusted bdoy weight

Actual body weight

Question 16

Monitoring pt’s on PN

-Body __
Intake such as ?
Output such as
Blood __ and ___
Hepatic Panel and ___
Signs and sx’s of line infection

Answer 16

weight
PO, IVF, IV medications, PN
Drainage, fistula, diarrhea
glucose, metabolic panel
Triglycerides