TPN Writing Flashcards
Before calculating and writing a TPN order, one should first _____
Verify indication for TPN
- confirm central venous access line for TPN
Determining BMIW for TPN
<30 use ABW
>30 use IBW
Fluid needs range
30-40 mL/kg/day
Disease states that can affect fluid
Heart failure
Renal failure
Usual protein needs TPN
1.0 - 1.5 g/kg/day
Dialysis protein needs TPN
1.2 - 2.0 g/kg/day
CCRT protein needs TPN
1.7 - 2.5 g/kg/day
Usual lipid needs for TPN
0.5 - 1 g/kg/day (max 2.0)
25-35% of total calories
250mL of 20% lipid is ____ g/day
50g/day
Dextrose monohydrate kcal/g
3.4 kcal/g
Usual range dextrose of TPN
- 3.0 - 5.0 g/kg/day
When would you consider less dextrose?
Refeeding risk
Poorly controlled hyperglycemia
Usual Na in TPN
1-2 mEq/kg/day
Usual K in TPN
1-2 mEq/kg/day
Usual P for TPN
20-40 mmol/day
Usual adult MVI TPN
5-10 mL/day
Usual adult TE in TPN
1-2 mL/day
Other agents you could add to TPN
- antacid (famotidine, ranitidine)
- insulin
T/F every floor pharmacist is required to evaluate every TPN Rx for potential errors or clarify questions and initial the form
True
PN evaluation
- serum (CMP)
- physical exam
- status of underlying disease
- changes in meds
- all of these with initial PN order in mind
If you need to change fluids, you should do what?
New PN order
If changing a PN order how much should you change?
> 20% increase or decrease
No change: <10%
