Term
| What is a total nutrient admixture? |
|
Definition
|
|
Term
| What components of TPN have the greatest influence on osmolality? |
|
Definition
| Dextrose, amino acids, electrolytes |
|
|
Term
| What is the dextrose content of PPN? |
|
Definition
|
|
Term
| What is the AA content of PPN? |
|
Definition
|
|
Term
| What are contraindications to PPN? |
|
Definition
- Significant malnutrition (mild to moderate is OK)
- Severe metabolic stress
- Large nutrient or electrolyte needs
- Fluid restriction
- Need for PN >2 weeks
- Renal or liver compromise
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|
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Term
| What are the inclusion criteria for PPN? |
|
Definition
- Must have good peripheral venous access
- Must be able to tolerate large volumes of fluid
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|
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Term
| How often should IV sites be rotated when using PPN? |
|
Definition
| At least every 48 to 72 hours |
|
|
Term
| What are the requirements for hypocaloric PN? |
|
Definition
- BMI >30
- Weight loss must be allowable
|
|
|
Term
| When is supplemental PN appropriate? |
|
Definition
| When EN is insufficient to fully meet calorie needs |
|
|
Term
| Which groups have shown benefits with PN use? |
|
Definition
- Perioperative support of patients with moderate-to-severe malnutrition
- Acute exacerbations of Crohn's disease
- GI fistula
- Extreme SBS
- Critical care patients who will be NPO for prolonged periods of time
- Severe acute necrotizing pancreatitis
|
|
|
Term
| What are the indications for CPN? |
|
Definition
- Patient has failed EN trial with appropriate tube placement
- EN is contraindicated or the intestinal tract has severely diminished function due to underlying disease or treatment
|
|
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Term
| Which conditions are specific contraindications to EN (and therefore indications for PN) |
|
Definition
- Paralytic ileus
- Mesenteric ischemia
- SBO
- GI fistula except when enteral access can be placed posterior to the fistula or volume of output is <200 mL/day
|
|
|
Term
| What are the types of clinical conditions where nutrition support is poorly tolerated and should be witheld until condition improves? |
|
Definition
- Specific lab results (see other cards)
- Encephalopathy and hyperosmolality
- Severe fluid and electrolyte disturbances
|
|
|
Term
| What is the suggested glycemic limit for PN? |
|
Definition
|
|
Term
| What is the suggested BUN limit for initiating PN? |
|
Definition
|
|
Term
| What is the suggested osmolality limit for initiating PN? |
|
Definition
|
|
Term
| What is the suggested serum sodium upper limit for initiating PN? |
|
Definition
|
|
Term
| What is the suggested serum potassium lower limit for initiating PN? |
|
Definition
|
|
Term
| What is the suggested upper chloride limit for initiation of PN? |
|
Definition
|
|
Term
| What is the suggested lower chloride limit for initiation of PN? |
|
Definition
|
|
Term
| What is the suggested lower phosphate limit for initiation of PN? |
|
Definition
|
|
Term
| What conditions affect chloride? |
|
Definition
- Metabolic acidosis (elevated)
- Metabolic alkalosis (decreased)
|
|
|
Term
| What are the guidelines for PN in peri-operative states? |
|
Definition
| PN is reserved for surgical patients with severe malnutrition at baseline, in whom the risk of surgery would outweigh any benefit due to a high risk of postoperative complications |
|
|
Term
| What is the length of time for which perioperative PN patients receive maximal benefit? |
|
Definition
| Maximal benefit is derived for surgical patients who receive PN for >7-10 days |
|
|
Term
| Is PN indicated during hemodynamic instability? |
|
Definition
|
|
Term
| What are the suggested monitoring parameters for parenteral nutrition? |
|
Definition
- CBC with differential
- INR, PT, PTT
- Mg/Phos
- Serum TG
- Transferrin or prealbumin
- Serum glucose
- ALT, AST, ALP, total bilirubin
- Weight
- I and O
|
|
|
Term
| When is it appropriate to advance PN? |
|
Definition
- Stable blood pressure, pulse, respiration rates
- Normal serum phos, potassium, glucose concentrations (100-200 mg/dL)
|
|
|
Term
| What are the recommended frequencies for monitoring PN after initiation? |
|
Definition
- Fluid, electrolyte, renal status: daily
- Blood glucose: daily
- Triglycerides and LFTs: periodically
- Serum visceral proteins: weekly
|
|
|
Term
| What should be done to prevent rebound hypoglycemia when stopping TPN? |
|
Definition
| PN should be tapered over 1-2 hours |
|
|
Term
| What should be done to prevent rebound hypoglycemia if stopping TPN emergently? |
|
Definition
| If stopping TPN emergently, D10 should be infused at either the same rate as TPN or 50 mL/hr or more |
|
|
Term
| When is it appropriate to rapidly discontinue TPN? |
|
Definition
| When patient is tolerating tube feeding in amounts adequate to maintain BG levels |
|
|
Term
| What is the osmolarity range for PPN? |
|
Definition
|
|
Term
| What is the osmolality range for TPN? |
|
Definition
|
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