Nutrition Support Rotation
Goals
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.
Objectives
At the completion of this rotation, the student should be able to:
1. Evaluate the appropriateness of parenteral nutrition as the route for nutritional
intervention.
2. Recognize the purposes and goals of parenteral nutrition therapy.
3. Estimate caloric and protein requirements for a patient and formulate a parenteral
nutrition plan to meet these requirements.
4. Recognize when three-in-one formulations are most appropriate to use.
5. Discuss options for controlling hyperglycemia in patients receiving parenteral
nutrition.
6. Recognize the types of specialized amino acid formulas available for use in parenteral
and enteral nutrition formulations and when these formulas might be
recommended.
7. Discuss normal fluid and electrolyte balance.
8. Recognize the effects of medications on fluid and electrolyte balance.
9. Recommend adjustments in electrolyte provision and the most appropriate route for
adjustments (change TPN versus change maintenance IV versus IV or PO
supplemental dose).
10.
Discuss monitoring parameters for patients receiving parenteral nutrition
including which parameters to use, how often they are checked, and
interpretation of test results.
11.
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.
12.
Recognize differences between adult and pediatric parenteral nutrition
guidelines and requirements.
13.
Recognize the general categories of enteral formulas.
14.
Discuss issues related to medications and tube feeding.
15.
Write chart notes using SOAP format.
16.
17.
18.
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.
Responsibilities
The responsibilities of the student during this rotation will include, but are not limited
to, the following:
1. Attendance of daily nutritional support rounds.
2. Attendance at Monday clinical pharmacy conference and Thursday pediatric home
parenteral nutrition meeting.
3. Initiating interactions with other health care professionals as appropriate.
4. Chart review, collection of data, recommendations (oral and written) for assigned
parenteral nutrition patients.
5. Daily progress notes on assigned parenteral nutrition patients.
6. Coordination of total pharmaceutical care with pharmacists or medical teams
following the patient.
7. Discuss patients and selected nutrition-related topics with the preceptor. Topics will
be selected to meet the goals and objectives for the individual student.
8. Provide information related to the patient's overall therapy as appropriate, but
specifically as therapy relates to nutrition support.
9. Provide an in-service presentation on a topic selected by the student and preceptor.