Pre Lecture PN Calculations & Complications – 20 points
Ted is a 48 y.o. male admitted to the surgical floor for an exacerbation of Crohn’s disease (severe inflammation of the small bowel usually but can affect the GI tract anywhere). He is currently NPO and will be starting PN before being discharged in a few days. He will be on PN for 6-8 weeks due to the presence of a high output fistula. A PN consult has been ordered and he will begin PN today which is hospital day #4. An implantable device has been placed for vascular access. MIV @ 130 mL/hr with ½ normal saline & 20 mEq KCl/d. He has been NPO since admit.
Ht: 5’ 10” Current Wt: 170 lbs. UBW: 175 lbs. (3 weeks ago)
Meds: antibiotics
| HOD | 1 | 2 | 3 | 4 |
| Weight: | 77 kg | 74 kg | 75 | 76 |
| Labs: | ||||
| Sodium | 138 | 140 | 142 | 143 |
| Potassium | 4.0 | 4.1 | 4.0 | 3.5 |
| Chloride | 107 | 108 | 108 | 110 |
| HCO2 | 26 | 25 | 24 | 22 |
| Glucose | 91 | 120 | 125 | 122 |
| BUN | 10 | 9 | 9.5 | 8 |
| Creatinine | 0.8 | 0.8 | 0.7 | 0.8 |
| Prealbumin (16-40) | 10 | 8 | ||
| Albumin | 2.8 | 2.7 | ||
| Phosphorus (2.5-4.5) | 2.2 | |||
| Magnesium (1.5-2.5) | 1.3 | |||
| Triglycerides | 155 | |||
| Total Bilirubin (0.1-1.0) | 0.1 | 0.2 | ||
| AST (7-55) | 33 | 37 | ||
| ALT (8-48) | 40 | 42 | ||
| WBC | 11 | 11.5 | 11.5 | 13 |
| Hemoglobin | 12.5 | 12.5 | 12 | 11.9 |
| Temperature (centigrade) | 38.6 | 38 | 39 | 39 |
| Input/Output:
Urine Stools Fistula
|
3500 mL
2000 mL None ~500mL |
3500 mL
2500 mL None ~550 mL |
3560 mL
2620 mL smear 550 mL |
3500 mL
2500 mL Smear 525 mL |
Create a Nutrition Prescription (3 points):
Calories:
Protein:
Fluid:
Calculate the following (6 points):
Dextrose needed in grams:
Amino acids needed in grams:
Lipids needed in grams:
List the most common complications associated with PN (at least 5) 5 points:
Complete the following PN order for PN day 1 based on Ted’s laboratory data for hospital day #4 highlighted in yellow exhibited above; show your work for how you calculated his goal rate (6 points):
| TNA Day # | Weight used for calculations: _____ kg | ||||||||||||
| All additives are based on AMOUNT PER DAY: | |||||||||||||
| Dextrose | grams | o TNA Sliding Scale Regular Insulin – check box | |||||||||||
| Amino acids | grams | (FSBS (Finger-stick blood sugar) every 6 hours) | |||||||||||
| Lipids | grams | ||||||||||||
| Sodium Chloride | 100 | mEq | FSBS | Regular Insulin subQ | |||||||||
| Sodium Acetate | 60 | mEq | Less than 70mg/dL | Call physician | |||||||||
| Sodium Phosphate | 0 | mEq | 140 – 179 mg/dL | 3 units | |||||||||
| Potassium Chloride | 60 | mEq | 180 – 199 mg/dL | 4 units | |||||||||
| Potassium Phosphate | 20 | mEq | 200 – 249 mg/dL | 6 units | |||||||||
| Potassium Acetate | 0 | mEq | 250 – 299 mg/dL | 9 units | |||||||||
| Magnesium Sulfate | 10 | mEq | 300 – 349 mg/dL | 12 units | |||||||||
| Calcium Gluconate | 10 | mEq | 350 – 399 mg/dL | 15 units | |||||||||
| MVI (Adult) | 10 | mL | More than 400mg/dL | Call physician | |||||||||
| Trace Elements | 1 | mL | |||||||||||
| Regular insulin | units | _______ IV insulin drip @ _____ | |||||||||||
| Famotidine | mg | ||||||||||||
| Thiamine | mg | ||||||||||||
| Folic Acid | mg | ||||||||||||
| Zinc sulfate | mg | ||||||||||||
| Vitamin C | mg | ||||||||||||
| ____ Start TNA at _____mL per hour for ___ hours and decrease MIV to _____ mL/hr;
After 8 hours if FSBS < 200 mg/dL, increase TNA to: _____ mL per hour and decrease MIV rate to: _____ mL/hr Then after 8 hours if FSBS < 200 mg/dL, increase TNA to goal rate of _____ mL/hr and decrease MIV rate to ____ mL/h |
|||||||||||||
|
Total TNA/ MIV:__________ mL/hr |
|||||||||||||
| Date for lab draw: ________ | |||||||||||||
| ____TPN-A labs (CBC with Diff, BMP, Pre-albumin, Mag, Phos, Calcium, Trig, PT/INR) | |||||||||||||
| ____TPN-B labs (BMP, Mag, Phos, Calcium, Albumin) | |||||||||||||
| ____Daily weight | _____Daily intake and output | Other: ___________________ | |||||||||||
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