Write a set of orders to begin total parenteral nutrition for a patient such as the one presented. Discuss the use of fat emulsions in parenteral nutrition for this patient and other surgical patients. For each of the following cases, suggest a plan for evaluation and management. Increasing somnolence has developed over the past forty eight hours ending with a grand mal seizure with no localizing neurologic signs. He is presently being maintained on IV fluids but there is a concern for nutritional support.
Plans are for a six week course of radiation therapy.
He is presently unable to take anything by mouth. Attempts to wean him from the ventilator have been complicated by over-production of CO2. He has been nutritionally supported with TPN for the last four weeks with fat emulsions once weekly.