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Total Parenteral Nutrition (TPN) Order Form Prescriber Signature Date Please Print Name Page 1 of 1 Form # 306 N:\Forms\300 - PHARMACY\F306 - TPN Physician Order Form.docx Orders are initiated unless crossed out by provider. Check box to initiate order. Please complete this form and fax to (360)933-1197 Diagnoses: ICD -10:
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EXAMPLE TPN CALCULATION: Calculate a TPN solution for a 6 mo, 5 kg infant, w/ diarrhea, feeding intolerance, & moderately underweight; TPN to provide all maintenance fluid & Nutrition Support. First determine Fluid needs. At maintenance, this is 500 cc/24 hours; Next determine goal energy needs. Upper end of the range for age is 90 kcal/kg.
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quickly with TPN initiation. Managing refeeding syndrome: 1) Correct low serum levels pre-TPN. 2) Limit initial energy intake to < 20 kcal/kg. ↑to 25 kcal/kg 4) Once serum levels normal↑to goal kcal. (Note: achieve goal kcal by day 5 TPN) Renal Failure: 1) Caution advised when adding K, Mg, and/or PO. to the TPN solution. Provide . repletion Dynamic Nutrition Support Dietitian | Dietitians On Demand Registered dietitians can write tube feeding and TPN orders with or without the CNSC credential, and even having it doesn't guarantee order writing privileges. But what the credential can always bring to the dietitian holding it is a higher level of expertise. "I do feel like I have an extra boost," Sara said. PDF Hospital: Parenteral Nutrition Consultation and Monitoring ... When signing TPN and lab orders, pharmacists will enter the name of the physician who placed the original consult order in the Ordering Provider field and "Protocol/ No Co-Sign/ Follow Up" in the Authorizing Provider field.