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WorksheetsPT EXAM 2: TPN
Total questions: 35
Worksheet time: 21mins
When is EN used?
When patient is unable to ingest foods PO
When the GI is working
When critically ill patient require nutrition support
For fluid resuscitation
When is Parenteral nutrition used?
When patient has severe pancreatitis
When patient has bowel obstruction
When patient has severe IBD
When the patient has severe intractable vomiting or diarrhea
What are some contraindications of EN?
GI tract malfunction
Pregnancy
Children under 12 y/o
upset stomach
Which are delivery routes of EN?
Jejunostomy tube
Nasogastric
Nasojejunal
Nasoileum
What are the 2 ways to give EN?
Intermittent feeding via pump
Intermittent feeding via gravity drip
Continuous infusion via drip
Continuous infusion via pump
What are the benefits of starting EN early in the ICU?
Reduce hospital stay
Improved wound healing
Preserve intestinal mucosal integrity
Lower chance of infection
Improves nitrogen balance
Dosing Enteral Feeding: BMI <30 Protein requirements?
1.2-2 g/kg ABW
1.2-2 g/kg IBW
2 g/kg ABW
2-2.5g/kg IBW
Dosing Enteral Feeding: BMI 30-40 Protein requirements?
1.2-1.5 g/kg IBW
1.5 g/kg IBW
2 g/kg IBW
2.5 g/kg IBW
Dosing Enteral Feeding: BMI ≥40 Protein requirements?
1.2 g/kg IBW
2-2.5 g/kg IBW
2-2.5 g/kg ABW
1.5 g/kg ABW
Dosing Enteral Feeding: BMI 30-50 Calorie requirement?
22-25kcal/kg IBW
11-14 kcal/kg IBW
22-25 kcal/kg ABW
11-14 kcal/kg ABW
Dosing Enteral Feeding: BMI 50 Calorie requirement?
11-14 kcal/kg IBW
22-25 kcal/kg IBW
22-25 kcal/kg ABW
11-14 kcal/kg ABW
Patients receiving hemodialysis or continuous renal replacement therapy should receive
decreased protein up to max of 2 g/kg/day
increased protein up to max of 2.5 g/kg/day
decreased protein up to max of 1.5 g/kg/day
increased protein up to max of 5 g/kg/day
What preparation is the preferred route in patients with acute or chronic liver disease?
Decreased EN
Diluted EN
Standard EN
Increased EN
Fluid restricted energy dense formulation should be considered for patients with what disease?
Renal failure
Cardiovascular disease
Pulmonary disease
Hepatic failure
What are some tips for successful initiation & progression of EN feeding?
Aseptic technique
Elevate head of bed at 30-45 degrees
Confirm tube placement
Prokinetic meds initiated when clinically feasible if patient at high risk of aspiration
How should you initiate Continuous EN feedings?
via pump full strength at a low rate (10-30 cc/hr)
via pump low strength at a high rate (10-30 cc/hr)
via drip full strength at a low rate (10-30 cc/hr)
via drip low strength at a low rate (10-30 cc/hr)
How often should you increase Continuous EN feeding and by how much?
0-10 cc every 4 hours based on tolerance up to the goal rate
10-20 cc every 36 hours based on tolerance up to the goal rate
0-10 cc every 24 hours based on tolerance up to the goal rate
10-20 cc every 4-24 hours based on tolerance up to the goal rate
How to initiate Intermittent EN feeds?
1/2 can formula over 30+ minutes TID/QID
Increase feeds by 1/2 can per feeding BID
Increase feeds by 1/2 can per feeding daily
1/2 can formula over 60+ minutes BID
How to flush tube?
Before/ After all feedings & medications
Only after feedings and meds
30-60 cc TID for latency
40-60 cc TID for latency
TPN macronutrients
Carbs
Dextrose
Lipids
Amino Acids
What is in a 2-in-1 PN admixture?
Dextrose, Amino Acids, & Lipids
Amino Acids & Lipids
Dextrose & Lipids
Dextrose & Amino Acids
Which are apart of the initial TPN Plan?
Provide at least 2 g/kg/day of dextrose
Provide no more than 15 kcal/kg/kg total for the first 24-48hrs until serum electrolytes & glucose are stabilized
Provide at least 1g/kg/day of protein
evaluate serum triglycerides before initiating IV fat emulsion
TPN Caloric Requirements: BMI < 30
10-15 kcal/kg/day IBW
20-30 kcal/kg/day ABW
20-30 kcal/kg/day IBW
10-15 kcal/kg/day ABW
TPN Caloric Requirements: BMI 30-50
22-25 kcal/kg IBW
11-14 kcal/kg ABW
11-14 kcal/kg IBW
22-25 kcal/kg ABW
TPN Caloric Requirements: BMI >50
22-25 kcal/kg ABW
11-14 kcal/kg ABW
22-25 kcal/kg IBW
11-14 kcal/kg IBW
TPN Protein Goal: BMI 30-40
2 g/kg IBW
2 g/kg ABW
2.5 g/kg ABW
2.5 g/kg IBW
TPN Protein Goal: BMI ≥40
1.5-2 g/kg ABW
2-2.5 g/kg IBW
1.5-2 g/kg IBW
2-2.5 g/kg ABW
What is TPN fluid requirements?
45-50 mL/kg/day
30-35 mL/kg/day
20-25 mL/kg/day
40-45 mL/kg/day
When should TPN fluid be used?
For fluid replacement
For resuscitation
For maintenance
For fun
0.8-1 g/kg/day is the TPN protein requirement for which patient?
Kidney failure with dialysis
Patients with early kidney dysfunction
Kidney failure without dialysis
Patients with kidney stones
1.2-1.5 g/kg/day is the TPN Protein requirements for which patient?
Patients with Kidney stones
Kidney failure with dialysis
Kidney failure without dialysis
Patients with family history of kidney failure
What should you observe to determine patients micronutrients?
labs
electrolytes
disease state
renal function
How to prevent overfeeding?
Initiate 1 g/kg/day slowly & gradually titrate to goal
Dextrose should be ≤ 4 mg/kg/min
Initiate 2 g/kg/day slowly & gradually titrate to goal
Dextrose should be ≤ 6 g/kg/day
What is Refeeding syndrome?
Characterized by hypomagnesemia
Can cause cardiac & respiratory dysfunction
Happens in chronically malnourished patients
Characterized by hypophosphatemia
Characterized by hypokalemia
How to prevent Refeeding Syndrome?
Provide no more than 15 total kcal/kg/day for the first 24-48 hrs
Titrate up and down prn
Advance over several days to desired goal
Provide no more than 10 total kcal/kg/day for the first 24-48 hrs
