ASPEN SELF STUDY SET 2 question and answers 2023

ASPEN SELF STUDY SET 2 question and answers 2023Would PN be routinely needed for Crohn's disease? No What is the preferred route of administration for nutrition intervention in patients with acute pancreatitis? Enteral Nutrition When would PN therapy be used for hyperemesis gravidarum? When it is severe and refractory to EN What is the general indication for PN? PN is indicated for a non-functioning or inaccessible gastrointestinal tract When is parenteral nutrition (PN) indicated in severe burn patients? 1. total body surface area burn exceeds 20% 2. as soon as possible after admission due to extremely high caloric needs 3. Enteral nutrition is contraindicated or unlikely to meet nutritional needs 4. Within 7-10 days after hospital admission 3. Enteral nutrition is contraindicated or unlikely to meet nutritional needs Why is the use of PN in patients with burns reserved for patients who are unable to be fed enterally? Several studies have found that the use of PN in patients with burns has been associated with increased mortality The routine use of perioperative parenteral nutrition (PN) is indicated for patients with a non-functioning GI tract who are 1. normally nourished 2. mildly to moderately malnourished 3. mildly malnourished with secondary co-morbidities 4. severely malnourished 4. severely malnourished Why would perioperative PN be indicated for patients with a nonfunctioning GIT who are severely malnourished? Many studies have identified the severely malnourished patient as benefiting from preoperative nutrition support with PN. Results from multiple preoperative PN studies of surgical patients have shown no overall reduction in perioperative mortality. However, significant reductions in perioperative complications are achieved in the severely malnourished patient receiving more than 7 days of preoperative PN Which of the following is an indication for PN support in an adult cancer patient? 1. Abdominal tumor resulting in an unresolved small bowel obstruction for greater than seven days 2. Metastatic cancer, receiving palliative care 3. Receiving concurrent chemotherapy and radiation therapy 4. Mild malnutrition, scheduled for tumor resection surgery in 3 days 1. Abdominal tumor resulting in an unresolved small bowel obstruction for greater than seven days When would mildly malnourished patients require PN? Mildly malnourished patients do not require PN unless oral intake is anticipated to be inadequate for more than one week Is PN used in palliative nutrition support? Rarely indicated When would PN be indicated in cancer treatment? The palliative use of nutrition support in terminally ill cancer patients is rarely indicated. Most side effects of chemotherapy and radiation can be managed without the use of PN. Adult cancer patients scheduled for surgery who are severely malnourished may benefit from PN if the therapy can continue for 7-10 days preoperatively When should PN be used in Crohn's disease? 1. As a primary therapy to rest the bowel 2. Only after failure to tolerate EN 3. To prevent associated malnutrition 4. Preoperatively regardless of nutrition status 2. Only after failure to tolerate EN What does the evidence show about enteral vs. parenteral nutrition in Crohn's disease? Studies comparing PN to EN in patients with Crohn's disease found no advantage of parenteral over enteral nutrition. Remission rates were similar and there was no evidence that bowel rest with PN had any advantage. Therefore, EN should be used in patients with Crohn's disease requiring nutrition support therapy. PN should be reserved for Crohn's patients who do not tolerate EN. Peri-operative specialized nutrition support is indicted in patients with inflammatory bowel disease who are severely malnourished and in whom surgery may be safely postponed Current recommendations regarding the safe administration of intravenous fat emulsions (IVFE) include 1. IVFE hang time up to 24 hours when included as part of a total nutrient admixture TNA 2. IVFE hang time up to 24 hours when administered as an infusion separate from PN 3. Use of a 0.22 micron filter when administering a TNA to remove microorganisms from a contaminated PN 4. Use of a 1.2 micron filter when administering a TNA to remove microorganisms from a contaminated PN 1. IVFE hang time up to 24 hours when included as part of a total nutrient admixture TNA Describe the length of stability of TNA. TNA are more likely to be stable for 30 hours at room temperature (25 degrees Celsius) or for 9 days refrigerated (5 degrees Celsius) followed by 24 hours at room temperature 2 risks that can result in degradation of some components of TNA? 1. Prolonged storage 2. Light exposure What pH are IVFEs most stable at? What can cause instability with this pH? IVFEs are most stable at their manufactured pH (6-9) , the addition of acidic dextrose can contribute to TNA instability How do electrolytes impact the stability of IVFE? Electrolytes, especially positively charged cations calcium and magnesium neutralize the negative charge on the surface of the lipid particle How are commercially available IVFE in the US stabilized? With egg yolk phosphatides providing a mechanical and electrical barrier to particle coalescence. How do amino acids impact the stability of TNAs? Amino acids offer a protective effect by enhancing the admixtures buffering effects Which of the following is the most appropriate distal catheter tip placement of a peripherally inserted central catheter (PICC)? 1. Cephalic vein 2. Superior vena cava 3. Internal jugular vein 4. Supraclavicular vein 2. Superior vena cava Define PICC. Peripherally Inserted Central Catheter (PICC) - a catheter inserted via peripheral vein whose distal tip lies in the vena cava. The cephalic or basilic vein is often used as the insertion site for PICCs. Central or peripheral access is not defined by the initial point of entry into the vascular system but rather by the position of the distal catheter tip. Define central line. Central lines are defined as catheters with the distal tip in either the superior or inferior vena cava. Therefore, by definition, a PICC is used as central venous access Which of the following is a disadvantage of a peripherally-inserted central catheter (PICC)? 1. High rate of catheter malposition 2. High risk of pneumothorax 3. Requires repeated skin puncture 4. Only available with single lumen 1. High rate of catheter malposition 3 disadvantages of a PICC line? 1. High rate of malposition 2. Limited arm mobility 3. Limited ability to perform daily self care due to the availability of only one hand