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PHPR 2813 Study Guide - Catheter, Thrombophlebitis, Osmotic Concentration

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vmturner96
7 Mar 2022
School
Lipscomb University
Department
PHPR - Pharmacy Practice
Course
PHPR 2813
Professor

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Document Summary

Indications for pn: ensure indication is appropriate, ensure access is in place and documented, estimate total caloric needs, determine protein needs, determine lipid and carbohydrate amounts, micronutrients, determine total volume and initial rate, develop titration and monitoring plan. Logistics for pn: gi is unable to absorb nutrients, cancer patients, severe pancreatitis who is not candidate for en, critical care patient, perioperative for malnurourished, eating disorders. Long term access: non-tunneled catheter is most common catheter tip terminates in vena cave or right atrium, utilized for vasopressors andothers, peripherally inserted central catheter (picc) is commonly inserted for nutrition. Protein: provides 4 kcal/gram, should be 15-20% of total kcal, concentration grams/total volume. Lipids: provides 10 kcal/gram, typically, 30% of total kcal, able to be mixed w/ tpn or separate, holding lipids, 1 week for icu patients, fungal infections, propofol use, day of surgery, high tgs >400. Daily dosing: total calories x 0. 3 = calories from lipids, convert to grams of lipid, 10 kcal/gram.

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"Micronutrient deficiencies can lead to many severe diseases such as anemia, pellagra, osteomalacia or impaired cognitive development. There are more than 2 billion people worldwide affected by micronutrient malnutrition. In Vietnam, regardless of economic growth improvements in recent years, micronutrient deficiencies still remain the major public health problem. Especially, the issue is even more detrimental in ethnic minorities due to their poverty, backward eating habit and insufficient nutritional knowledge.

From April 2011, an idiopathic disease called inflammatory palmoplantar hyperkeratosis (IPPH) syndrome has caused 20 deaths among 300 hospitalized patients in Ba To, a rural district of Quang Ngai province in central Vietnam. Ba To is a remote mountainous district highly populated by ethnic minorities whose main occupations are farming. Most of households had been continuously consuming moldy rice stored in poor conditions from previous harvests. Of the cases known to have died, 62.8% of patients were admitted with malnutrition and wasting syndrome. We hypothesized that micronutrient deficiencies are the risk factors of high incidence of IPPH syndrome in ethnic minorities. Therefore, we aim to study the micronutrient status and the adequacy of micronutrient intake in ethnic minorities. This study also investigates the association of socioeconomic status, lifestyle factors and living environment of ethnic minorities with their micronutrient malnutrition. Subsequently, a research-based community intervention will be conducted to prevent and control outbreak of IPPH syndrome in Ba To district."

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