(Also refer to the general goals and objectives for PhPr 803)
The goals for this rotation are to provide the student with a general understanding of issues related to specialized nutrition support and to allow the student the opportunity to develop skills in patient assessment, patient monitoring, parenteral nutrition formulation, and formula adjustment. The student should also increase their proficiency in communication techniques so as to facilitate interaction with other health care professionals and patients.
At the beginning of this rotation, the preceptor and student will review the goals and objectives. The rotation will be tailored to the student's strengths and weaknesses, especially as related to basic topics such as fluid and electrolyte balance, interpretation of blood gas values and laboratory tests, and effects of medications on fluid balance, electrolytes, and laboratory tests.
At the completion of this rotation, the student should be able to:
- Evaluate the appropriateness of parenteral nutrition as the route for nutritional intervention.
- Recognize the purposes and goals of parenteral nutrition therapy.
- Estimate caloric and protein requirements for a patient and formulate a parenteral nutrition plan to meet these requirements.
- Recognize when three-in-one formulations are most appropriate to use.
- Discuss options for controlling hyperglycemia in patients receiving parenteral nutrition.
- Recognize the types of specialized amino acid formulas available for use in parenteral and enteral nutrition formulations and when these formulas might be recommended.
- Discuss normal fluid and electrolyte balance.
- Recognize the effects of medications on fluid and electrolyte balance.
- Recommend adjustments in electrolyte provision and the most appropriate route for adjustments (change TPN versus change maintenance IV versus IV or PO supplemental dose).
- Discuss monitoring parameters for patients receiving parenteral nutrition including which parameters to use, how often they are checked, and interpretation of test results.
- Understand basic interpretation of blood gas values, especially as related to components of the parenteral nutrition formulation and appropriate changes in the parenteral nutrition formulation.
- Recognize differences between adult and pediatric parenteral nutrition guidelines and requirements.
- Recognize the general categories of enteral formulas.
- Discuss issues related to medications and tube feeding.
- Write chart notes using SOAP format.
- Gather necessary patient data from appropriate sources (R.N., patient, chart, physicians, etc.).
- Effectively present recommendations for changes in the parenteral nutrition therapy of a patient, both oral presentation and written in the plan portion of the SOAP note.
- Give an in-service presentation, including development of written materials, for nurses. This topic may be a medication or disease state. The preceptor and student will determine the topic.
The responsibilities of the student during this rotation will include, but are not limited to, the following:
- Attendance of daily nutritional support rounds.
- Attendance at Monday clinical pharmacy conference and Thursday pediatric home parenteral nutrition meeting.
- Initiating interactions with other health care professionals as appropriate.
- Chart review, collection of data, recommendations (oral and written) for assigned parenteral nutrition patients.
- Daily progress notes on assigned parenteral nutrition patients.
- Coordination of total pharmaceutical care with pharmacists or medical teams following the patient.
- Discuss patients and selected nutrition-related topics with the preceptor. Topics will be selected to meet the goals and objectives for the individual student.
- Provide information related to the patient's overall therapy as appropriate, but specifically as therapy relates to nutrition support.
- Provide an in-service presentation on a topic selected by the student and preceptor.