Nutrition Support Progress Note (Parenteral Nutrition/TPN)

Date/Time: [date and time]

Author/Credentials: [name, credentials]

Patient Location: [unit/room]

PN Day #: [number] (Start Date: [date])

Route: [Central PN / Peripheral PN] (If unknown, state "Information not available" as this is safety-critical.)

Indication: [brief statement of why PN is required and why EN/oral is not feasible]

Interval Summary

[Single-line status: PN running/held status; key constraints; highest-priority issues] (Use semicolons to separate; prioritize active safety concerns such as electrolyte instability, refeeding vigilance, hyperglycemia, hypertriglyceridemia.)

Current Nutrition Delivery

Dosing Weight: [actual / ideal / adjusted] [weight in kg] (If not actual weight, state rationale.)

Energy Target: [kcal/day] | Protein Target: [g/day]

TPN: [volume, rate, infusion hours, total kcal, protein g] (Document what is actually infusing. If held, state explicitly.)

Lipids: [product, dose, schedule, kcal if separate infusion; or "included in TPN" or "held — reason"]

Other Sources: [EN, oral intake, propofol kcal, dextrose-containing fluids as applicable]

Totals: [total kcal/day], [protein g/day], [fluid mL/day] — [X]% energy goal, [X]% protein goal (If delivery data unavailable, state explicitly and note calculations based on ordered regimen.)

PN Prescription

Current Regimen: (List in consistent order for safety.)

• Volume: [mL/day]
• Amino acids: [g/day]
• Dextrose: [g/day] (GIR: [mg/kg/min])
• Lipids: [product, g/day, schedule]
• Electrolytes: [Na, K, Mg, Ca, Phos with mEq or mmol units]
• Additives: [MVI, trace elements, thiamine if indicated, insulin units if in bag]

Recommended Changes: [If no changes: "Continue current PN formulation unchanged." If changes: list each change with explicit quantity and rationale, then provide complete revised formula below to prevent partial-update errors.] (Avoid vague instructions like "adjust per labs" without explicit thresholds.)

Labs & Clinical Status

Electrolytes: [K, Phos, Mg, Na, Ca — today's values with prior comparison and brief interpretation; highlight abnormals and trends]

Glucose: [recent BG range]; [insulin exposure: IV / SQ / in-bag / none]; [stability: controlled / variable / uncontrolled] (Safety-critical; if unknown, state "Glycemic data not available.")

Other Pertinent Labs: [TG if on lipids, LFTs if indicated, renal function as relevant — values with interpretation]

Fluid Status: [I/O balance, edema/ascites, hemodynamics, fluid restriction if any]

Refeeding Risk: [low / at-risk / high-risk] (On initiation: document baseline electrolytes, thiamine/MVI plan, advancement strategy. On stable ongoing notes: state status and whether mitigation required.)

Plan

PN Changes: [list each change with numeric detail and rationale, or state "No changes"]

Glycemic Plan: [insulin regimen with targets and titration parameters]

Monitoring: [electrolyte frequency, BG monitoring cadence, TG/LFT schedule if applicable]

Contingencies: [explicit thresholds and responses, e.g., "If K <3.0, add X mEq to bag and bolus Y"; "Hold lipids if TG >400"]

Transition Plan: [plan to advance EN/oral and wean PN; cycling schedule if relevant] (Include when applicable.)

Communication: [team contacted, agreements reached, pending order entry]