CHAPTER 6


evaluation for HPN. Following are examples of the roles and responsi- bilities for each team member, though specific responsibilities will vary based on the facility’s needs.


Physician determines that the patient’s diagnosis warrants PN in the home setting. The managing physician also directs the patient’s nutrition care.2


Nurse practitioners and physician assistants are also able to pre- scribe PN and oversee the patient’s nutrition care plan.1


Registered dietitian nutritionist (RDN) completes initial and periodic nutrition assessments to determine protein, calorie, fluid, electrolyte, and micronutrient requirements and monitors response to therapy. Pro- vides recommendations for the PN administration schedule. Completes appropriate diet education. Plays a vital role in the patient’s transition to oral or enteral nutrition therapy (eg, recommending enteral nutrition for- mula and prescription) when appropriate. Collaborates with the patient or caregiver along with other health care providers (eg, surgical team, home care provider) involved in the patient’s care to ensure a safe and efficient discharge.3


Registered nurse


ƒ Inpatient registered nurse (RN) reviews central vascular access device (CVAD) options with the patient and recommends the most appropriate option based on length of therapy and the patient’s ability to care for the CVAD. The RN assesses the need and administration schedule of any other IV therapies that require coordination with the PN infusion, such as IV antibiotics or pain medications. The RN initiates the teaching process for all proce- dures related to HPN, including caring for the CVAD, metabolic complications, catheter-related complications, and safe hookup and disconnect from the infusion pump.4


ƒ Outpatient/home health RN continues teaching for all procedures related to HPN. Completes CVAD care and laboratory orders.4


Registered pharmacist monitors drug therapy for dosing and drug- nutrient interactions. The registered pharmacist serves as a resource for PN-related issues involving compounding, compatibility, and stability.5


Social worker assesses the patient or caregiver to ensure that they have the cognitive and physical abilities to manage HPN or to determine whether placement in an alternate site is necessary. The social worker performs a psychosocial assessment and determines whether the patient


88


Page 1  |  Page 2  |  Page 3  |  Page 4  |  Page 5  |  Page 6  |  Page 7  |  Page 8  |  Page 9  |  Page 10  |  Page 11  |  Page 12  |  Page 13  |  Page 14  |  Page 15  |  Page 16  |  Page 17  |  Page 18  |  Page 19  |  Page 20  |  Page 21  |  Page 22  |  Page 23  |  Page 24  |  Page 25  |  Page 26  |  Page 27  |  Page 28  |  Page 29  |  Page 30  |  Page 31  |  Page 32  |  Page 33  |  Page 34  |  Page 35  |  Page 36  |  Page 37  |  Page 38  |  Page 39  |  Page 40  |  Page 41  |  Page 42  |  Page 43  |  Page 44  |  Page 45  |  Page 46  |  Page 47  |  Page 48  |  Page 49  |  Page 50  |  Page 51  |  Page 52  |  Page 53  |  Page 54  |  Page 55  |  Page 56  |  Page 57  |  Page 58  |  Page 59  |  Page 60  |  Page 61  |  Page 62  |  Page 63  |  Page 64  |  Page 65  |  Page 66  |  Page 67  |  Page 68  |  Page 69  |  Page 70  |  Page 71  |  Page 72  |  Page 73  |  Page 74  |  Page 75  |  Page 76  |  Page 77  |  Page 78  |  Page 79  |  Page 80  |  Page 81  |  Page 82  |  Page 83  |  Page 84  |  Page 85  |  Page 86  |  Page 87  |  Page 88  |  Page 89  |  Page 90  |  Page 91  |  Page 92  |  Page 93  |  Page 94  |  Page 95  |  Page 96  |  Page 97  |  Page 98  |  Page 99  |  Page 100  |  Page 101  |  Page 102  |  Page 103  |  Page 104  |  Page 105  |  Page 106  |  Page 107  |  Page 108  |  Page 109  |  Page 110  |  Page 111  |  Page 112  |  Page 113  |  Page 114  |  Page 115  |  Page 116  |  Page 117  |  Page 118  |  Page 119  |  Page 120  |  Page 121  |  Page 122  |  Page 123  |  Page 124  |  Page 125  |  Page 126  |  Page 127  |  Page 128  |  Page 129  |  Page 130  |  Page 131  |  Page 132  |  Page 133  |  Page 134  |  Page 135  |  Page 136  |  Page 137  |  Page 138  |  Page 139  |  Page 140  |  Page 141  |  Page 142  |  Page 143  |  Page 144  |  Page 145  |  Page 146  |  Page 147  |  Page 148  |  Page 149