CDRE Prep – TPN Exam Questions With 100% Correct Answers

CDRE Prep – TPN Exam Questions With 100% Correct Answers The patient's attending physician or designate (i.e. may be the physician's resident) authorizes the TPN order on the Adult TPN sheet. - answerWhat member of the health care team in Capital Health authorizes the TPN order form? RD, pharmacist, IV team nurse, Medical director - answerWho is a part of the Nutrition support team establishes whether or not TPN is indicated in conjunction with the medical team - writes TPN order - assess weight, in'/out's, glucose, electrolytes and other laboratory data - rewrites TPN orders biweekly and p.r.n.(as needed). - monitors changes in patient status, transition to enteral feeds - answerDietitians role with TPN -makes up TPN solution -assesses TPN formula and stability -crosschecks order with dietitian who writes the order -monitors protocols for heparin, H2 receptor antagonists, insulin. - answerPharmacists role with TPN arranges for CVL (central venous line) insertion and responsible for PICC (peripherally inserted central catheter) - daily assessment of temperature, WBC, infection status - answerNursing role with TPN reason for admission history of presenting illness past medical history reason for parenteral nutrition, length of parenteral therapy height, weight, % IBW lab values, including chemstrips if applicable intake and output record ("ins & outs" including sources of ins and outs) current nutritional value of parenteral solution medical plans, changes to parenteral solution current x-rays, ultra sounds, CT reports that affect nutritional support current medical/surgical status - answerWhat should be included regarding TPN in medical rounds provision of nutrients that bypass the intestinal tract can be utilized for a brief period of time or for years. may act as the sole source of nutrition (Total parenteral nutrition: TPN) or as a supplement to enteral feeding or oral feeding - answerdefine TPN a) Total nutrition into central vein (TPN) or via PICC - peripherally inserted central catheter b) Total nutrition into peripheral vein (PPN) - answer2 types of TPN delivery gastrointestinal tract is impossible or inadvisable. A rule of thumb: if the gut works, use it. - answerParenteral nutrition is a complex and expensive procedure. There are also several potential risks and complications. Therefore, parenteral nutrition should only be initiated if use of the a) unavailability / non-functioning GI tract b) to minimize GI function c) severe malnutrition d) patients undergoing chemotherapy, radiation, bone marrow transplant accompanied by an inability to maintain adequate oral intake. e) hypercatabolic patients unable to meet requirements orally/enterally f) any patient who cannot be fed for more than 7-10 days - answerwhat are the 6 indications for TPN short bowel (> 70% of small bowel removed/non-functional) - impaired absorption with GI disease - intractable vomiting - bowel obstruction - prolonged ileus - radiation enteritis - answerWhen would you use TPN for unavailability / non-functioning GI tract - acute pancreatitis - intractable diarrhea - inflammatory bowel disease - answerWhen would you use TPN to minimize GI function - albumin < 30 mg/dl, weight loss > 10% over 6 months, > 5% over 1 month, body weight < 85 % IBW, TLC < 1000 - answerWhen would you use TPN for a) functional and usable GI tract capable of absorbing adequate nutrients to meet requirements b) previously well nourished adult with minimal stress/trauma/immediate postoperative period where the GI tract will recover within 7-10 days c) sole dependence on TPN is anticipated to be < 5 days d) patients whose prognosis does not warrant aggressive nutritional support e) when the risks of TPN are judged to exceed the potential benefits. - answerwhat are 5 contraindications for TPN No organ failure requiring fluid restriction. - sensitivity of veins to hypertonic solutions limits the caloric density of fluids - access is difficult to maintain (hard on veins >7 days) - need a high volume of solution in attempt to meet nutritional requirements - often impossible to meet all nutritional requirements with PPN - answerwhat are the indications for PPN (peripheral parenteral