WorksheetsParenteral Nutrition - Higgins - Nutrition Exam 1
Total questions: 45
Worksheet time: 30mins
Select all of the following indications for parental nutrition
A person who's able to take medications PO
A person with motility disorders
A person with a mechanical bowel obstruction
A person with impaired absorption. or loss of nutrients via GIA tract
Patients with an inability to achieve or mantain enteral access
Which of the following patients would peripheral parenteral nutrition be reccomended
JT who needs parenteral nutrition indefinitely
MK who needs a large amount of nutrients for parenteral nutrition
DT who needs parental nutrition and is expected to recover in 10 days
BG who needs a large amount of nutrients over the next 4 weeks
Match the following descriptions to their proper types of peripheral parenteral nutritions
Shortest term. Uses a vein in arm. Highest infection risk
Peripherally inserted central catheter
Usually used in cancer population. Port hidden under the skin. Lowest infection risk
Port-a-cath (port)
Surgically inserted. Lines hang out of chest.
Central venous catheter
Which of the following is the best description on how peripheral parenteral nutrition (PPN) is different from central parenteral nutrition (CPN)
Lower concentrations of AA, dextrose, and micronutrients compared to CPN
Higher concentrations of AA, dextrose, and micronutrients compared to CPN
PPN is the preferred route due to allowing higher osmolality and wider pH variation
PPN is best for long term use
Between peripheral parenteral nutrition and central parenteral nutrition, which is preferred
Centeral
Parenteral
Which of the following is an advantage when using the peripheral parenteral nutrition (PPN)
Allows for higher osmolarity
Allows for wider variation in pH
Best for long term and large nutrients needed
Lower risk of infectious, metabolic, and technical complications
Which of the following are the advantage when using the central parenteral nutrition (PPN). Select all that apply
Allows for higher osmolarity
Allows for wider variation in pH
Best for long term and large nutrients needed
Lower risk of infectious, metabolic, and technical complications
Which of the following is a disadvantage when using the peripheral parental nutrition (PPN)
Higher risk of phlebitis and vein damage
Cather insertion, routine catheter use, and care of access site required
Access is associated with a greater potential for infeciton
Which of the following are disadvantage when using the central parental nutrition (SATA
Higher risk of phlebitis and vein damage
Cather insertion, routine catheter use, and care of access site required
Access is associated with a greater potential for infeciton
Central parenteral nutrition is best for patients who are expected to need nutrition over 14 days or patients who will need nutrition indefinitely
True
False
When would you initiate parenteral nutrition in an adult who was previously well nourished
Initiate after 7 days of oral or EN intake less than 50% of estimated requirements
Initiate after 3-5 days of oral or EN intake less than 50% of estimated requirements
Initiate PN as soon as feasible for those whom oral or EN is not possible or sufficient
Delay parenteral nutrition until until improvement in clinical condition
When would you initiate parenteral nutrition in an adult who is nutritionally at-risk
Initiate after 7 days of oral or EN intake less than 50% of estimated requirements
Initiate after 3-5 days of oral or EN intake less than 50% of estimated requirements
Initiate PN as soon as feasible for those whom oral or EN is not possible or sufficient
Delay parenteral nutrition until until improvement in clinical condition
When would you initiate parenteral nutrition in an adult who is moderately or severely malnourished
Initiate after 7 days of oral or EN intake less than 50% of estimated requirements
Initiate after 3-5 days of oral or EN intake less than 50% of estimated requirements
Initiate PN as soon as feasible for those whom oral or EN is not possible or sufficient
Delay parenteral nutrition until until improvement in clinical condition
If you have an ICU patient who is metabolically unstable when should you initiate parenteral nutrition
Initiate after 7 days of oral or EN intake less than 50% of estimated requirements
Initiate after 3-5 days of oral or EN intake less than 50% of estimated requirements
Initiate PN as soon as feasible for those whom oral or EN is not possible or sufficient
Delay parenteral nutrition until until improvement in clinical condition
Which of the following are macronutrients in PN (SATA)
Protein
Fat
Carbohydrates
Fluid
Vitamins
Which of the following are micronutrients in PN (SATA)
Fluids
Fat
Trace elements
Electrolytes
Vitamins
Match the caloric content with their descriptions
1.1 kcal/mL
10% IVFE
2 kcal/mL
20% IVFE
3 kcal/mL
30% IVFE
In critically ill patients, when should fat be held or added to their PN solution
Consider holding fat for first week then adding fat 1-2 days per week
Consider holding fat indefinitely for patients critically ill
Consider holding fat for initial weeks then adding fat 3 weeks later
Consider holding fat for a month then add into second month
All of the following are times you should take extra caution when creating PN using lipid emulsions EXCEPT
Severe egg allergy
Soybean allergy
Fish oil allergy
Milk allergy
How often do you need to give fat in order to avoid fatty acid deficiency
at least daily
at least monthly
at least weekly
At least annually
Excessive amounts of dextrose in PN can lead to
Hypoglycemia
Hyperglycemia
Kidney disfunction
Hypotension
Match the following initiation doses for adolescents/adults with the macronutrient
1 g/kg/day
Lipids
1-3 g/kg/day
Amino acids
3-5 mg/kg/min
Dextrose
Match the following goal doses for adolescents/adults with the macronutrient
1-2 g/kg/day
Lipids
0.8-2 g/kg/day
Amino acids
4-7 mg/kg/min
Dextrose
What is the advancement dose of lipids in adolescents/adults
0.5-1 g/kg/day
1-2 g/kg/day
0.8-2 g/kg/day
1-2 mg/kg/min
What is the advancement dose of AA in adolescents/adults
0.5-1 g/kg/day
1-2 g/kg/day
0.8-2 g/kg/day
1-2 mg/kg/min
What is the advancement dose of dextrose in adolescents/adults
4-7 mg/kg/min
1-2 g/kg/day
0.8-2 g/kg/day
1-2 mg/kg/min
What is the maximum safe osmolarity of PN admixtures for peripheral administration
500 mOSM/L
900 mOSM/L
700 mOSM/L
1200 mOSM/L
When calculating the total daily fluid requirement for a patient, what needs to be taken into consideration
Fluid restricted patients
Adjust for current fluid running IV medications
Continuous infusion medications
Any other fluids patient has
All of these need to be considered
In PN, what amount of sodium do we usually try not to exceed
154 mEq/L
200 mEq/L
90 mEq/L
200 mEq/L
We usually choose sodium and potassium chloride for TPN except for acidotic patients
True
False
Acidotic patient lab values will show which of the following when given sodium chloride
Low chloride and low bicarb (or high total CO2)
high chloride and low bicarb (or low total CO2)
High chloride and high bicarb (or high total CO2)
low chloride and low bicarb (or low total CO2)
What are other sources of sodium or potassium to be aware of
IV antibiotics
IV bolus
IV fluids
All of these should be accounted for
Phosphorous often needs to be reduced in renal disease
True
False
In PN, what type of precipitation needs to be monitored
Sodium phosphorous
Calcium phosphorus
Potassium phosphorus
Calcium is added to TPN as
Calcium phosphate
Calcium gluconate
Calcium bicarbonate
Calcium hydroxide
When albumin in a patient is high we need to calculate a corrected calcium
True
False
Calculate the corrected calcium for a patient with the following laboratory parameters. They have a serum calcium of 7.5mg/dL, albumin of 2.0 g/dL and the normal albumin of 4g/dL
.
Corrected calcium = serum calcium + 0.8[(normal albumin - serum albumin)]
4.8 mg/dL
9.1 mg/dL
5.9 mg/dL
8.4 mg/dL
Match the following goals serum levels with there proper labs
135-145 MEQ/L
Sodium
3.5-5 MEQ/L
Potassium
2.5 to 4.5 MMOL/dL
Phosphorus
8.5-10.2 mg/dL
Calcium
1.8-3 mg/dL
Magnesium
When discontinuing TPN, stop it immediately and transition to EN
True
False
Iron is routinely given in a PN
True
False
Which of the following is in trace elements PN (SATA)
Chromium
Copper
Manganese
Zinc
Iron
Each day you should assess serum concentration of electrolytes and adjust as needed
True
False
Which of the following is NOT a fat soluble vitamin
A
D
K
E
C
Which of the following TPN labs should be run weekly (SATA)
Proteins
Triglyceride levels
Hepatic function (ALP, AST, ALT, TBILI)
Renal function (BUN, SCR)
Blood glucose
Which of the following TPN labs should be run daily (SATA)
Fluid balance
Triglyceride levels
Vital signs
Weight
Basic metabolic pannel
