01118_tpnadult07 - SCANNED TO PHARMACY Date:...

Info iconThis preview shows page 1. Sign up to view the full content.

View Full Document Right Arrow Icon
This is the end of the preview. Sign up to access the rest of the document.

Unformatted text preview: SCANNED TO PHARMACY Date: _________________ Time: _________________ Nursing will hang a 24-hour bag daily at 2100. Changes received after 1230 will be initiated the next day. CENTRAL Check desired box. LIPIDS 1. 10% or 2. 250mL or 20%; 500mL Tailored Formula ☞ Infusion Rate mL/hour Volume/day Dextrose Calories/day Amino Acids in gm/day Na (mEq/day) K (mEq/day) Ca (mEq/day) Magnesium (mEq/day) PO4 (mM/day) CI:Acetate Ratio MVI-12 (mL/day) Trace Metals (mL/day) Heparin (units/day) Insulin (units/day) Other ____________________ Dextrose kcal/Kg/day gm Protein/day Fluid RENAL PERIPHERAL (Dex 25%/AA 4.25%) Standard Formula (Dex 35%/Std AA 3.5%) (Dex 10%/AA 3.0%) 42 1 ltr 850 42.5 120 62 9 10 15 1:1 10 1 ____ ____ ____ __________ __________ __________ 63 1.5 ltr 1275 64 120 62 9 10 15 1:1 10 1 ____ ____ ____ kcal gm mL/day Per Day LIPIDS 1. 10% or 2. 250mL or 20%; 500mL Na __________ K __________ Ca __________ Magnesium __________ PO4 __________ CI:Acetate Ratio __________ MVI-12 __________ Trace Metals __________ Heparin __________ Insulin ____________________ Other _____________________ 83 2 ltr 1700 85 120 62 9 10 15 1:1 10 1 ____ ____ ____ or or or 42 1 ltr 1190 35 41 ____ 9 ____ ____ 1:1 10 0.5 ____ ____ ____ 83 2 ltr 680 60 120 62 9 10 10 1:1 10 1 ____ ____ ____ ________ ________ ________ % Dextrose % Amino Acids mL/hour Per Liter mEq/day mEq/day mEq/day mEq/day mM/day mL/day mL/day units/day units/day ___ /day ________ ________ ________ ________ ________ ________ ________ ________ ________ ________ ________ mEq/ltr mEq/ltr mEq/ltr mEq/ltr mM/ltr mL/day mL/day units/ltr units/ltr ___ / ___ STANDARD NURSING ORDER Standard, unless otherwise indicated. 4. Comprehensive Metabolic Panel, PO4 Triglyceride and Magnesium 1. Daily Wt. on first three days of TPN, then Q 2. I & O Q shift. Mon. & Thurs. 3. Infuse D10 at same rate 5. Fingerstick bloodsugars Q 4 hours when TPN not available. 6. Other Labs: ________________ _________________________ MD Signature __________________________________________ Physician # ______________________________________ Authorization for therapeutic substitution is given unless checked here Patient Identification Sutter Medical Center, Sacramento A Sutter Health Affiliate TPN Orders, Adult 01118 (10/19/09) Page 1 of 2 ORDERS To calculate Daily Requirements, follow Steps A-D. A dietary assessment will be performed automatically per JCAHO requirement for high risk nutritional patients. These are educational guidelines only, and are not meant to be restrictive. A. B. C. Use enteral feeding instead of TPN if at all possible if the bowel is functional. Calculate the weight that will be used for all other calculations. Use the ideal body weight (IBW) for height, except in severely malnourished subjects, in whom over-feeding may cause sudden death up to two weeks from TPN initiation. For these patients, use the actual, no-edematous weight for calculations initially, and gradually increase over two weeks to the amount necessary for anabolism for their IBW. In muscular, non-obese patients, use the pre-morbid weight. Approximate IBW = Males: IBW (in Kg.) = (110 lbs+6 lbs per in. over 5 ft. tall)/2.2 Females: IBW (in Kg.) = (100 lbs+5 lbs per in. over 5 ft. tall)/2.2 Calculate energy and protein needs for patient with normal hepatic and renal function. Recommended amounts apply to either standard or tailored formulae. Provided by Central Standard TPN Recommendedc (70% CHO kcal, 30% lipid kcal) Non-Protein kcal/Kg/day Protein gm/Kg/day Standard TPNc ml/Kg/day 10% Lipidd,e ml/Kg/day Maintenance 30 15-80 0.8-1.1 25 9 Infection/ Surgery/Stress/ Fever 35 11-71 1.1-1.3 29 10.5 Head Trauma/ Burns abcde- % CHOa,b kcal/day 40-50 See a 1.5-2.0 Must use tailored formula 25kcal/Kg/day from CHO is maximum amount that is oxidizable. Any more induces fat synthesis and much higher risk of fatty liver. Minimum provides amount necessary for neural and hematopoietic tissue. Maximum=maximum amount oxidizable. (see a). Start with 1/2 calculated requirement to assess tolerance of volume and need for insulin, and minimize sudden intracellular shifts of K, Mg and PO4, Within a safe range, round off to standard quantities of lipids to reduce waste. 10% lipid provides 1.1 kcal/ml; 20% lipid provides 2 kcal/ml. Peripheral Parenteral Nutrition: 27-40mL/Kg/day provides 0.8-1.2g protein/Kg/day and 3.4kcal from CHO/mL. Give balance of calories as lipid. D. Minerals and Electrolytes Electrolyte/ Mineral Recommended Initial Range Sodium 2-3mEq/IBW Kg/day Potassium 1-1.5mEq/IBW Kg/day Comments Start with 2mEq/Kg if severely malnourished, then decrease after levels stabilize. Increase ratio if alkalotic. Decrease ratio if acidotic. Suggested ratios: Max Ac, 1:3, 1:2, 1:1, 2:1, 3:1, Max C1. For tCO2 out of range by 1-3mM/ltr, increase or decrease ratio by 1. For tCO2 out of range by over 4mM/ltr, increase or decrease ratio by 2. CI:Acetate ratio 1:1 Calcium 5-15mEq/day May need 2-3 times normal amount in malabsorption syndrome. Maximum limited by phosphate conc. Magnesium 8-16mEq/day Start at high end if severely malnourished or stressed, and decrease after levels stabilize. May need 2-3x normal amount in malabsorption syndrome. Phosphate 5-30mMol/day Start at high end if severely malnourished or stressed, and decrease when levels stabilize. 01118 (10/19/09) Page 2 of 2 ORDERS ...
View Full Document

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.

Ask a homework question - tutors are online