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Unformatted text preview: SCANNED TO PHARMACY
Nursing will hang a 24-hour bag daily at 2200 (SMCS) 2300 (SRMC). Changes received after 1130 (SRMC) 1230 (SMCS)
will be initiated the next day. If the order is received after 1130 (SRMC) 1230 (SMCS), it will take effect the following day.
1. Specify Route of Administration: Central OR Peripheral NEONATAL
Note: Maximum dextrose concentration in Peripheral PN = 12.5%, and Central PN = 25%
& INFANT 2. Today's Weight _________ Kg
NUTRITION 3. Final Dextrose Concentration = __________% Note: Dextrose Not to exceed 12-13 mg/kg/min or 18 gm/kg/day
(UP TO 7.5Kg) 4. Infant Amino Acid _________________ gm/kg/day Note: Usually initiated at 2-3 gm/kg/day and advanced by 0.5 gm/kg/day, as tolerated, up to goal of 4 gm/kg/day in
Preterm neonates and 3 gm/kg/day in Term neonates. 5. PN Infusion Rate = _____________ mL/hr for______________ hrs = ______________ mL Total
Prepare 24 hour infusion volume of _____________mL. Infusion rate to follow weaning orders.
Rate not to exceed _____________mL/hour.
Note: Pharmacy will prepare a 24-hour supply, plus 100mL overfill, based on infusion rate ordered. Neonatal & Infant 6. Fat Emulsion 20% _____________ mL/hr for_____________ hrs = _____________ mL Total
Note: 20% lipid supplies 2 kcal/mL. Up to 40% of daily calories may be administered as lipid. Initiate at 2.5 - 5 mL/kg/day.
Advance by 2.5 mL/kg/day, as tolerated, up to a maximum of 15 mL/kg/day (3gm/kg/day). Maximum rate is 1.25 mL/kg/hr. 7. Additives:
CI: Acetate Ratio
Ped. Trace Metals
Note: Usual Range
_________ mEq/kg/day 2-4 mEq/kg/day
_________ mEq/kg/day 2-4 mEq/kg/day
_________ mEq/kg/day Preterm goal is 3 mEq/kg/day -Term goal is 0.5-2mEq/kg/day
_________ mEq/kg/day 0.25-0.5 mEq/kg/day
_________ mM/kg/day Goal is 0.5-1 mM/kg/day. 2:1 Ca: Phos ratio
_________ Approximate 1:1
1 mL/kg/day up to 5 mL. See note below.
0.2 mL/kg/day up to 3 mL. See note below.
_________ mcg/kg/day 2 mcg/kg/day
0.5 units/mL, only if needed
0.2 mg/kg/day See note**
_________ ___/day 5 mL of Pediatric MVI contains: Vitamin A - 2300units, Vitamin B1 - 1.2mg, Vitamin B6 - 1mg, Vitamin B12 - 1mcg,
Vitamin C - 80mg, Vitamin D - 400units, Vitamin E - 7units, Vitamin K - 200mcg, Biotin - 20mcg,
Dexpanthenol - 5mg, Folic Acid - 140mcg, Niacinamide - 17mg, Riboflavin - 1.4mg.
Each 0.2 mL of Ped. Trace Metals contains: ZN 200 mcg, CU 20 mcg, Mn 5 mcg, Cr 0.2 mcg
*Carnitine: 8mg / kg for infants <1250 gm begin on day of life 14; > = 1250 gm begin on day of life 30
**Iron Dextran: begin on day of life 14 or as soon as epoetin alfa begins Time __________ Date ______________ _____________________________________________ M.D. Caloric Profile:
Dextrose: ( ___ %) x ( ____ mL infused) x (0.034kcal/mg) =
20% Lipid: ( ___ mL infused) x (2kcal/mL) = _____ Kcal Dextrose ____% total kcal Not to exceed 60% (dex)
_____ Kcal Lipid ____% total kcal Not to exceed 40% (lipid)
_____ Kcal NonProtein Calories
Protein: ( _____ gm infused) x (4kcal/gm) =
_____ Kcal Protein ____% total kcal not to exceed 12% (protein)
( _______ Kcal Dextrose) + ( _______ Kcal Lipid) + ( _______ Kcal Protein) divided by _______Kg = _______ Total Kcal/Kg Authorization for therapeutic substitution is given unless checked here ZZ09414 (8/10/09) Patient Identification SAFH SDH SMCS SRMC Daily Neonatal/Infant
Parenteral Nutrition Order
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This note was uploaded on 12/26/2009 for the course PHYS 341 taught by Professor Mavromatis during the Spring '09 term at American University of Beirut.
- Spring '09