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PATIENT CARE PROCESS

Patient Care Process for Providing Parenteral Nutrition

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Collect

  • Patient characteristics (e.g., age, race, sex)

  • Patient history (past medical, surgical, family, social—alcohol use)

  • Nutrition history (dietary history, weight history)

  • Current medications (including nutritional supplements)

  • Age appropriate objective data (see Figure 142-3)

    • Height/length, weight, BMI, head circumference

    • Fluid balance (intake and output)

    • Labs (e.g., serum electrolytes, Scr, BUN, glucose, albumin)

    • Vital signs (e.g., temperature, pulse rate, respiration rate, blood pressure)

Assess

  • Current nutrition status and time period of insufficient nutrient intake

  • Clinical conditions preventing adequate oral nutrient intake

  • Clinical conditions preventing use of enteral tube feeding to determine if an indication for parenteral nutrition (PN) therapy exists (see Tables 142-1 and 142-2)

  • Vascular access

  • Current degree of metabolic instability (e.g., hemodynamics, organ function, fluid/electrolyte status)

  • Appropriate route of PN (central or peripheral)

Plan*

Implement*

  • Provide education regarding all elements of treatment plan to patient/caregivers and other members of the healthcare team

  • Use a standardized PN order form for ordering PN prescription to minimize risk of errors

  • Verify the order to ensure that it is clear, complete, and correctly transcribed

  • Confirm stability of formulation and compatibility of ordered nutrients and any non-nutrient medications

  • Determine if PN solution will be provided as compounded sterile preparation according to United States Pharmacopoeia Chapter 797 standards or provided as a standardized, commercially available parenteral nutrition product

  • Determine appropriate plan for patient-specific monitoring based on the patient's clinical condition to anticipate, prevent or treat mechanical/technical, metabolic/nutritional, or infectious complications (Figure 142-3)

Follow-up: Monitor and Evaluate

  • Evaluate patient for mechanical, metabolic, and infectious complications (Figure 142-3)

  • Re-evaluate clinical conditions preventing adequate oral intake or precluding use of enteral tube feeding to anticipate either transition off of PN support or need for continuing PN therapy (Figure 142-3)

*Collaborate with patient, caregivers, and other health professionals

KEY CONCEPTS

KEY CONCEPTS

  • image Development and implementation of an appropriate, individualized nutrition care plan requires definition of nutrition goals, determination of nutrition requirements and appropriate route of nutrient delivery, and design of a monitoring plan to evaluate suitability of the nutrition regimen as a patient’s clinical condition changes.

  • image The appropriate route of nutrition support depends on the functional condition of the patient’s gastrointestinal (GI) tract, risk of aspiration, expected duration of nutrition therapy, and clinical condition.

  • image Suitable candidates for parenteral nutrition (PN) therapy can be identified on the basis of their age, nutrition status, expected duration of GI dysfunction, and potential risks of PN therapy.

  • image PN formulations include injectable amino acids, dextrose, fat, water, electrolytes, vitamins, trace elements, and other additives.

  • image PN solutions may be appropriately formulated for administration by peripheral or central venous access.

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