Learning Objectives – Total Parenteral Nutrition

I will be heading to St. Paul’s Hospital for a week of TPN! From our recent ADS on TPN, I’m expecting that this will be a very valuable, rewarding and challenging rotation. The following are my learning objectives:

  1. Competently evaluate the nutritional status of a patient. Determine the appropriate form of nutrition and set monitoring parameters to help determine when it is:
    (1) no longer necessary, or
    (2) appropriate to taper off TPN and transition to PO intake
    (3) appropriate to taper off TPN and transition to EN
  2. Describe the available formulations and their differences/similarities.
  3. Competently and safely order electrolyte replacements for patients on TPN, and create an appropriate monitoring plan for them
  4. Describe how to approach TPN in patients with metabolic disorders (e.g. metabolic alkalosis, metabolic acidosis)
  5. Describe the different delivery methods and determine which is most appropriate in a given patient
  6. Describe commonly used equations and calculators and understand when and how to use them
  7. Describe the role of pharmacists in managing TPN

The following are the rotation manual’s learning objectives:

  1. Evaluate the nutritional status of a given patient.
  2. Determine the most appropriate form of the nutrition support required, if any.
  3. Estimate protein and caloric requirements of a patient based on the disease state.
  4. Design a suitable parenteral nutrition formulation for a given patient, allowing for compounding limitations of the pharmacy department, and medical conditions of the patient.
  5. Monitor nutrition support for potential metabolic, infectious, or technical complications, and recommend appropriate TPN formula adjustments to better meet nutritional needs or to prevent adverse effects.
  6. Identify altered nutrient requirements due to concomitant medications or drug-nutrient interactions.
  7. Demonstrate competence in discussing the pathophysiology, clinical features, and management of the following disease states/processes:
    1. Protein-energy malnutrition
    2. Refeeding syndrome
    3. Overfeeding from parenteral nutrition
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