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01118_tpnadult07 - SCANNED TO PHARMACY Date Time Nursing...

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TPN Orders, Adult Sutter Medical Center, Sacramento A Sutter Health Affiliate Patient Identification 01118 (10/19/09) Page 1 of 2 ORDERS Authorization for therapeutic substitution is given unless checked here Nursing will hang a 24-hour bag daily at 2100 . Changes received after 1230 will be initiated the next day. Standard Formula LIPIDS Tailored Formula Check desired box. CENTRAL (Dex 25%/AA 4.25%) RENAL (Dex 35%/Std AA 3.5%) PERIPHERAL (Dex 10%/AA 3.0%) 1. 10% or 20%; 2. 250mL or 500mL LIPIDS 1. 10% or 20%; 2. 250mL or 500mL STANDARD NURSING ORDER Standard, unless otherwise indicated. 1. Daily Wt. 2. I & O Q shift. 3. Infuse D10 at same rate when TPN not available. MD Signature __________________________________________ Physician # ______________________________________ Infusion Rate mL/hour 42 63 83 42 83 Volume/day 1 ltr 1.5 ltr 2 ltr 1 ltr 2 ltr Dextrose Calories/day 850 1275 1700 1190 680 Amino Acids in gm/day 42.5 64 85 35 60 Na (mEq/day) 120 120 120 41 120 K (mEq/day) 62 62 62 ____ 62 Ca (mEq/day) 9 9 9 9 9 Magnesium (mEq/day) 10 10 10 ____ 10 PO 4 (mM/day) 15 15 15 ____ 10 CI:Acetate Ratio 1:1 1:1 1:1 1:1 1:1 MVI-12 (mL/day) 10 10 10 10 10 Trace Metals (mL/day) 1 1 1 0.5 1 Heparin (units/day) ____ ____ ____ ____ ____ Insulin (units/day) ____ ____ ____ ____ ____ Other ____________________ ____ ____ ____ ____ ____ Dextrose kcal/Kg/day __________ kcal gm Protein/day __________ gm Fluid __________ mL/day Per Day Na __________ mEq/day K __________ mEq/day Ca __________ mEq/day Magnesium __________
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