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Flashcards in Total Parenteral Nutrition Deck (41)
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1

How many calories per day does a patient require?

A patient requires 2000 calories per day. Critically ill patients may require 3000-5000 calories per day or more.

2

What can delay of nutrition for 5 days for a client with trauma or neuro damage lead to?

Poor wound healing

Increased risk of infection

May become malnourished if NPO for extended periods of time.

3

Are D5W, NS, and LR nutritional supports?

D5W, NS, and LR are not nutritional support. They provide fluids and some electrolytes.

4

What are four modalities for delivery of intravenous nutritional support?

Peripheral Parenteral Nutrition (PPN)
Peripheral Nutrition (PN)
Total Nutrition Admixture (TNA)
Cyclic Therapy

5

What is the cost of parenteral nutrition compared to enteral nutrition?

More costly (3x more) than enteral

6

What are some negative aspects of parenteral nutrition?

More costly (3x more) than enteral
Higher infection rate
Does not promote GI integrity, liver function or body weight gain.

7

What is a positive effect of parenteral nutrition?

Can enhance wound healing and prevent cellular catabolism (destructive phase of metabolism)

8

What are some indications for parenteral nutrition?

GI tract is incapacitated or needs complete rest.
Intestinal obstruction.
Uncontrolled vomiting.
High risk for aspiration.
Supplement to inadequate oral intake.
Severe burns with negative nitrogen balance.
Debilitating diseases.
Metastatic cancer.
AIDS
10% weight loss from pre-illness weight
Inability to take oral foods or fluids within 7 days after surgery
Hypercatabolic situations
Major infections with fever
Burns
Short gut syndrome
Enterocutaneous Fistulas
Renal failure
Hepatic failure
Serum albumin <35 (normal 35-50)

9

What is an important question when considering the indications of parenteral nutrition?

What's the goal of treatment and how should this influence the type of interventions offered?

10

What is Parenteral Nutrition?

AKA Hyperalimentation
Infusion of hyperosmolar glucose, amino acids, vitamins, electrolytes, minerals and trace elements.
May contain 20%-60% glucose and 3.5%-10% protein (in form of amino acids)
Can meet client's total nutritional needs (thus the name).

11

What are some advantages of parenteral nutrition?

Dextrose solution administered as calorie source

-Beneficial for long term use (greater than 3 weeks)
-Useful for patients with large caloric and nutrient needs
-Provides calories, restores nitrogen balance, and replaces essential vitamins, electrolytes, and minerals
-Promotes tissue synthesis, wound healing and normal metabolic function
-allows bowels rest and healing
-improves tolerance to surgery
-is nutritionally complete

12

What are some disadvantages of parenteral nutrition?

Minor surgical procedure for insertion of tunneled cath or implanted port (central line).
May cause metabolic complications (glucose intolerance, electrolyte imbalance, EFAD).
Fat emulsions may not be utilized effectively in some severely stressed patients (esp. burn patients)
Risk of pneumothorax or hemothorax with central line insertion procedure,

13

What are the components of parenteral nutrition (PN)?

Carbohydrates (CHO)
Fats (Lipids)
Proteins (Amino acids)
Electrolytes
Vitamins
Trace elements

14

What are some additives in parenteral nutrition?

Insulin
Heparin
Histamine 2 (H2) inhibitors
Minerals

15

What kind of insulin may be included in parenteral nutrition?

Regular insulin only

16

What is the most common complication of TPN therapy?

Hyperglycemia is most common complication of TPN therapy (due to high concentration of glucose).

17

What dose of heparin is given in TPN, and why?

1000 to 3000 U/L sometimes added to decrease potential formation of a fibrin sleeve which can lead to venous thrombosis.

18

What are some types of histamine 2 (H2) inhibitors given in TPN?

Cimetidine
Pepcid
Reglan
Zantac

19

What is the reason for giving histamine 2 (H2) inhibitors in TPN?

To prevent stress ulcers

20

What are some catheter related risks associated with parenteral nutrition?

Pneumothorax
Air embolism
Vein thrombosis
Catheter malposition
Cardiac dysrhythmias
Nerve injury

21

What are some metabolic complications associated with parenteral nutrition?

Rebound hypoglycemia
Hyperglycemia
EFAD
Hyperammonemia
Electrolyte imbalances

22

What kind of infectious and septic complications are associated with parenteral nutrition?

Catheter related sepsis

23

What are some nutrition alterations associated with parenteral nutrition?

Refeeding syndrome
Altered mineral balance
Altered vitamin balance

24

What are four types of risks and complications associated with parenteral nutrition?

Catheter related
Metabolic (avoidable or controllable)
Infectious and septic
Nutrition alterations

25

Are peripheral parenteral nutrition solutions hypotonic, hypertonic, or isotonic? Why?

PPN solutions must be isotonic to prevent damage to veins.

26

What do isotonic parenteral nutrition solutions contain?

Isotonic parenteral nutrition solutions usually contain 5-10% dextrose and 3-5% amino acids plus electrolytes, vitamins and mineral and fat as needed.

27

What is peripheral parenteral nutrition used for?

PPN is used for short term nutrition support in non-hypermetabolic conditions.

28

What are some advantages of peripheral parenteral nutrition (PPN)?

No need for central line
Less hypertonic solution
Reduced chance of metabolic complications
Increases calorie source along with fat emulsion

29

What are some disadvantages of peripheral parenteral nutrition (PPN)?

Can't be used in nutritionally depleted patients
Can't be used in volume reduced patients
Does not usually increase a patient's weight
May cause phlebitis

30

What are some important nursing assessments of patients on parenteral nutrition?

Verify correct placement of central line
Monitor vital signs
Monitor blood glucose
Weigh daily
Accurate I & O
Monitor for infection
Physician order
Assess solution
Tubing and solution changes