Week 4 - TPN Flashcards
describe TPN
- more invasive
- higher infection risk
- higher risk of metabolic complications
- increased cost
- continuous infusion
does TPN require functioning GI tract?
no
does TPN preserve GI function?
no
describe enteral feeding
- lower risk of infection/ metabolic complications
- less expensive
what does enteral feeding help maintain?
gut integrity and prevent translocation of bacteria
does enteral feeding require a functioning GI tract?
yes
what does enteral feeding reduce?
risk for refeeding syndrome
how is TPN given?
bloodstream through PICC/ VAD
what are some indications of TPN use?
- paralyzed/ nonfunctional GO tract
- conditions where GI tract requires rest
- NPO X +7 days
- chronic/ extreme malnutrition
- chronic diarrhea/ vomiting
- requiring surgery or chemo
when someone is taking TPN their GO tract can’t be used for what?
- ingestion
- digestion
- absorption of essential nutrients
what are common conditions that lead someone to using TPN?
- chronic/ severe diarrhea and vomiting
- complicated surgery/ trauam
- GI obstruction
- GI tract fistulas
- anorexia
- severe malabsorption
- short bowel snydrome
what are the major components of TPN?
- carbohydrates (dextrose)
- protein (amino acids)
- fat (lipids)
- electrolytes
- vitamins
- minerals
who decides the combination of components for a patient’s TPN order? What does it depend on?
- physician in consult with a dietitian
- depends on pts metabolic needs, clinical hx and blood work
what does PN stand for?
portion of the nutritional needs or component
what are complications of TPN?
- hyperglycaemia
- dehydration
- electrolyte imbalance
- thrombosis
- infection
- liver failure
- micronutrient deficiencies
- hypersensitivity
what type of infection is common with TPN?
catheter related bloodstream infection
what are signs someone is hypersensitive regarding TPN
- fever
- N&V
- hives
- back pain
- headaches
- dyspnea
- chest pain
what signs and symptoms might indicate a hypersensitivity to the fat emulsion?
- dyspnea
- back and chest pain
- diaphoresis
- N&V
- headache
- hyper coagulability or thrombocytopenia
when does refeeding syndrome occur?
when a client who is severely malnourished suddenly receives nourishment again particularly carbs
what does refeeding syndrome start with?
low levels of:
- potassium
- magnesium
- phosphorus
what is re-feeding syndrome characterized by?
- fluid retention
- electrolyte imbalances
- hyperglycemia
what are some conditions that predispose patients to re-feeding syndrome?
- longstanding malnutrition
- chronic alcoholism
- vomiting and diarrhea
- chemotherapy
- major surgery
re-feeding syndrome can occur any time a malnourished patient is what?
started on aggressive nutritional support
what is a hallmark for re-feeding syndrome?
hypophosphatemia
