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NSC 325 last exam PN questions with actual answers.
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NSC 325 last exam PN questions withactual answers.
parenteral nutrition ANS - delivery of nutrient intravenously via bloodstream
-central parenteral nutrition: often called total PN; delivered into central vein
-peripheral PN: delivered into a smaller or peripheral vein
common indications for PN ANS - -patient has failed EN w/ appropriate tube placement
(severe acute pancreatitis)
-severe short bowel syndrome
-mesenteric ischemia
-paralytic ileus
-small bowel obstruction
-GI fistula
-malnourish or @ high risk ICU patient when EN not feasible or adequate
-consider supplemental PN after 7-10 days when EN not feasible or inadequate
-do not start for 7-10 days in healthy patients
Contraindications for PN (releases to not administer) ANS - -functional & accessible GI tract
-patient is taking oral diet
-prognosis doesnt warrant aggressive nutrition support (terminally ill)
-risk exceeds benefit
-patient expected to meed needs w/in 14 days
Catheter lumens ANS - single, double or multilumen
-need sterile lumen for PN to decrease infections
Peripheral PN ANS - 1) need more fluid to infuse so the vein "will tolerate"
,2) also usually reduce on the dextose, AA & additives leading to inadequate nutrition support
3)large nutrition or electrolyte needs (potassium is a strong vascular irritant)
4) contraindications
-fluid restriction
-need for prolonged PN >2wks
-renal or liver compromise
Parenteral Nutrition formulations ANS - -components are in elemental or "pre digested" form
1) solution contains:
-proteins as amino acids
-energy sources: CHO as dextrose, fat as lipid emulsion
-electrolytes, vit, minerals
-other: meds
PN solutions ANS - 1) Total nutrient admixture (TNA) or 3 in 1
-dextrose, amino acid, lipids, additives are mixed together in 1 container
-lipid is provided as part of the PN mixture on a daily basis & becomes an important energy substrate
2) 2 in1 solution: dextrose, amino acids, additives
-typically compounded in 1 L bags
-lipid is delivered as piggyback daily or intermittently as a source of EFA
TNA or 3 in 1 advantages ANS - -decreased nursing time
-decreased risk of tough contamination
-decreased pharmacy prep time
-cost savings
-easier administration in home PN
-better fat utilization in slow, continuous infusion of fat
-physiological balance of macronutrients
, Disadvantages of TNA or 3 in 1 ANS - -diminished stability & compatibility
-IVFE (IV fat emulsions) limits the amount of nutrients that can be compounded
-limited visual inspection of TNA; decreases ability to detect precipitates
Administration of PN ANS - 1) continuous
-24 hrs/day
-promote best tolerance
2) cyclic infusion
-8-16 hrs/day
-usually at night
-ideal for long term/home TPN
-pump ALWAYS used
Macronutrients: carbs ANS - energy source as monohydrous dextrose
1) properties
-nitrogen sparing
-energy source
-3.4 kcal/g
-hypersmolar
2) recommended intake
-2-5 mg/kg/min
-50-60% of total kcal
3) potentially adverse effects
-increased minute ventilation, CO2 production, RQ, O2 consumption
-lipogenesis & liver probs
-hyperglycemia
Macronutrients: amino acids ANS - 1) source: crystalline amino acids: standard or specialty
2) properties
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