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PATIENT CARE PROCESS

Patient Care Process for Providing Parenteral Nutrition

Image not available.

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 not available. 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 not available. 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 not available. 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 not available. PN formulations include injectable amino acids, dextrose, fat, water, electrolytes, vitamins, trace elements, and other additives.

  • Image not available. PN solutions may be appropriately formulated for administration by peripheral or central venous access.

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