TPN week 7 Flashcards
(45 cards)
What is TPN?
Nutritional intake that bypasses the GI tract
Why would someone need TPN?
When they have the inability to absorb nutrients through their GI tracts for more than 10 days
What are 3 main criteria for TPN?
- Presence of a debilitationg illness lasting more than 2 weeks
- Loss of 10% or more of pre-illness weight in a short time
- Serum albumin levels less than 3.5g/dL
What are some illnesses that may cause the patient to require TPN?
- Burns
- Crohn’s/UC
- Gastroparesis
- Trauma
What are the two main types of Parenteral nutrition?
- Total
- Peripheral
What is Total (central) Parenteral Nutrition?
- Used for long term therapy
- Nutrient dense fluids (hypertonic)
- Greater than or equal to 10% glucose
- Administered via a central line
What is Peripheral Parenteral Nutrition?
- Used for short term therapy (2 weeks)
- Nutrient Adequate = isotonic
- Less than 10% glucose
- Can be given via peripheral line
What types of shifts occur with hypertonic fluids?
-Causes fluid shifts from inside cells/veins to moce out into intravascular/extracellular space
What types of shifts occur with Hypotonic fluids?
Causes fluids to shift from intravascular/extracellular spaces to the tissues and cells
What types of shifts occur with isotonic fluids?
No shifts in fluids
What percentage of glucose is conisdered isotonic?
4.5% so D5W is considered isotonic
What baselines are needed prior to the start of TNP therapy?
- Weight
- Cardiac panel
- Renal function panel
- Nutritional allergies
What is the number one determinant of PN therapy?
Protein!
What is the main protein in human blood?
What % does it make up?
Albumin
60%
What are the main functions of albumin?
- It is the main contributor to oncotic pressure
- It is the main transporter for many nutrients, hormones, and drugs
- Needed in the repain and maintenance of tissues
Where is albumin produced and what is its half-life?
Liver
20days
How much protein is usually in PN fluids?
5-15%
What is the protein % in PN fluid for a patient at risk for FVE?
15% or greater
What are the 4 main effects of Hypoalbuminemia?
- Reduced onconic pressure
- leads to intravascular leakage
- Causes Generalized edema
- Decreases blood pressure
- Malnutrition from reduced transport
- Muscle wasting
- Renal dysfunction from overload of protein in urine
- Dehydration
What effects of hypoalbuminemia can be masked by edema?
- Muscle wasting
- Dehydration
What is the primary CHO energy source in PN fluids?
Glucose!
What percentage of Glucose is in PN fluids?
60-70%
What patients need a decreased glucose in their PN fluid?
Ventilator patients (why?)
IF a PN fluid is hypertonic, it needs to be administered via?
A central line
