NS490 Unit 6 Parenteral Plan for a Fistula Example

Course	NS490 Medical Nutrition Therapy II
Unit	Unit 6
Paper type	Parenteral nutrition plan
Length	About 880 words, 6 pages double-spaced
Format	APA 7 student paper
School	Purdue University Global
Program	BS in Nutrition Science
Updated	October 2026

Free sample paper for NS490 Unit 6

One Macronutrient at a Time, and When to Stop: A Unit 6 Parenteral Nutrition Plan for a High-Output Enterocutaneous Fistula

[Student Name]

Purdue University Global

NS490: Medical Nutrition Therapy II

Unit 6 Parenteral Nutrition Plan

[Instructor Name]

[Date]

The patient and all values are composite; the parenteral nutrition safety recommendations, the fistula guideline and the refeeding consensus cited are real; the regimen is a course example, not an order.

What this part is doingPromising stopping criteria alongside the regimen in the lead tells the grader the plan treats safety as part of the design.

Indication

Rosa, 56, developed an enterocutaneous fistula from the small bowel ten days after surgery for a perforated diverticulum. The fistula drains about 1,100 mL a day, which classifies it as high output. Her surgeons have made her nothing by mouth to reduce output and allow possible spontaneous closure. Parenteral nutrition is indicated when the gut cannot be used or cannot meet needs for an extended period, and recommendations on parenteral safety describe high-output fistula as one such situation (Worthington et al., 2017). A central line is in place.

Why Not Feed the Gut

Enteral nutrition is usually preferred when the gut works, and some fistulas allow feeding below the opening or through a tube placed beyond it. For Rosa, the fistula arises from the mid small bowel, its output rises when she eats, and the surgeons want the bowel at rest while they wait to see whether it closes on its own. Feeding by mouth or tube now would likely raise output, worsen fluid and electrolyte losses and damage the skin around the opening. The plan therefore uses parenteral nutrition as a bridge, with the expectation that enteral feeding will return as output falls.

Goals of the Plan

The goals are to stop further weight loss, provide enough protein to replace effluent losses and support healing, avoid complications of parenteral nutrition, and prepare for a return to the gut. Weight regain is not the aim in the first weeks; preventing further loss is.

Assessment Summary

Height 165 cm. Weight 68 kg, without significant edema. Usual weight 74 kg, a loss of about 8 percent over a month. Intake minimal for ten days. Serum potassium, magnesium and phosphate low-normal. Glucose 110 to 140 mg/dL. No history of diabetes.

Step 1: Energy

25 to 30 kcal per kilogram: 25 times 68 equals 1,700, and 30 times 68 equals 2,040. Goal 1,900 kcal per day.

Step 2: Protein

High-output fistulas lose protein in the effluent, and the fistula guideline suggests higher protein, about 1.5 to 2.5 g per kilogram for high-output fistulas (Kumpf et al., 2017). Using 1.5 g per kilogram: 1.5 times 68 equals 102 g. Goal 105 g amino acids, providing 105 times 4, or 420 kcal.

Step 3: Lipid

Lipid injectable emulsion, 20 percent, 250 mL per day, providing 50 g of fat, which is 0.74 g per kilogram, below the commonly cited limit of 1 g per kilogram per day. At 2.0 kcal per mL, it supplies 500 kcal.

Step 4: Dextrose

Remaining energy: 1,900 minus 420 minus 500 equals 980 kcal. At 3.4 kcal per gram, 980 divided by 3.4 equals 288 g dextrose.

Glucose infusion rate check: 288,000 mg divided by 68 kg divided by 1,440 minutes equals 2.9 mg per kilogram per minute, below the usual upper limit of about 4 to 5.

Building the regimen one macronutrient at a time lets every limit be checked on its own line, the lipid dose, the glucose infusion rate and the protein target, before the totals are added.

What this part is doingThe highlighted sentence explains the method behind the stepwise build, which is what a PN plan is graded on.

Step 5: Starting Safely

Rosa has had ten days of little intake and has lost weight, which places her at risk of refeeding syndrome. Following the refeeding consensus, dextrose will start at about 150 g on day 1 and advance toward goal over three to five days, with phosphate, potassium and magnesium checked before starting and daily during advancement, and thiamine given before dextrose (da Silva et al., 2020).

Step 6: Fluid and Electrolytes

Maintenance fluid in the parenteral solution is about 2,000 mL. Fistula losses are replaced separately by the medical team, milliliter for milliliter, with a solution matched to small-bowel fluid, so that changes in output do not require changing the nutrition bag. Electrolytes in the bag are adjusted daily to labs.

Step 7: Micronutrients

Standard multivitamin and trace element additions daily. Zinc is often added beyond the standard amount in high-output fistulas because of losses in the effluent.

Monitoring

1. Glucose every 6 hours during advancement, then daily.

2. Electrolytes, phosphate and magnesium daily for the first week.

3. Triglycerides at baseline and weekly.

4. Liver tests weekly.

5. Weight three times a week.

6. Fistula output daily.

7. Line site daily for signs of infection.

When to Reduce, Hold or Stop

1. Reduce dextrose if glucose stays above 180 mg/dL on two checks despite insulin.

2. Hold advancement if phosphate falls below 2.0 mg/dL, potassium below 3.5 mEq/L or magnesium below 1.6 mg/dL, and replace before continuing.

3. Reduce or hold lipid if triglycerides exceed 400 mg/dL.

4. Stop the infusion and notify the team immediately for fever with suspected line infection, according to facility protocol.

5. Reassess the plan if liver tests rise steadily.

6. Begin weaning when output falls and the surgeons allow enteral feeding, reducing parenteral volume as enteral intake meets more of her needs.

What this part is doingA final page of explicit thresholds turns the plan into something a team could follow safely day by day.

References

da Silva, J. S. V., Seres, D. S., Sabino, K., Adams, S. C., Berdahl, G. J., Citty, S. W., Cober, M. P., Evans, D. C., Greaves, J. R., Gura, K. M., Michalski, A., Plogsted, S., Sacks, G. S., Tucker, A. M., Worthington, P., Walker, R. N., & Ayers, P. (2020). ASPEN consensus recommendations for refeeding syndrome. Nutrition in Clinical Practice, 35(2), 178-195. https://doi.org/10.1002/ncp.10474

Kumpf, V. J., de Aguilar-Nascimento, J. E., Diaz-Pizarro Graf, J. I., Hall, A. M., McKeever, L., Steiger, E., Winkler, M. F., & Compher, C. W. (2017). ASPEN-FELANPE clinical guidelines: Nutrition support of adult patients with enterocutaneous fistula. Journal of Parenteral and Enteral Nutrition, 41(1), 104-112. https://doi.org/10.1177/0148607116680792

Worthington, P., Balint, J., Bechtold, M., Bingham, A., Chan, L., Durfee, S., Jevenn, A. K., Malone, A., Mascarenhas, M., Robinson, D. T., & Holcombe, B. (2017). When is parenteral nutrition appropriate? Journal of Parenteral and Enteral Nutrition, 41(3), 324-377. https://doi.org/10.1177/0148607117695251

Reading the NS 490 Unit 6 instructions

In the sixth NS490 unit, students receive a patient who needs parenteral nutrition and write the regimen. The prompt asks for the indication, goals, each macronutrient, fluid and electrolytes, micronutrients and monitoring. Start by justifying why the gut cannot be used, citing appropriateness guidance. Set energy and protein from a stated weight. Calculate lipid and dextrose separately, using the correct energy values for each. Check the lipid dose and the glucose infusion rate against accepted limits. Address refeeding risk if the patient is malnourished, with a slower start. Fistula or other losses need their own fluid and electrolyte plan. Include vitamins, trace elements and any added items. Monitoring should name labs and frequency. A good plan also says when the infusion would be reduced or stopped. Expect three to five pages with APA 7 references.

Inside the NS490 Unit 6 example

The plan opens with the indication and a short section on why feeding the gut would worsen fistula output. Goals and an assessment summary come next. Step 1 sets energy and Step 2 sets protein, each from her weight. Step 3 doses a 20 percent lipid emulsion at 250 mL a day, giving 0.74 g per kilogram and 500 kcal. Step 4 subtracts protein and lipid energy from the total and converts the remainder into grams of dextrose at 3.4 kcal per gram. The highlighted sentence explains why building the regimen one line at a time lets each limit be checked. Step 5 starts at a reduced rate for refeeding risk. Step 6 replaces fistula losses, and Step 7 adds micronutrients. Monitoring and a final section on when to reduce, hold or stop close the plan.

Reading the NS490 Unit 6 grading rubric

Parenteral plans are assessed on safety and accuracy above all. The indication must be clear and supported, because parenteral nutrition carries risks the gut route does not. Each macronutrient needs its own calculation with the right energy value. Checking the lipid dose and glucose infusion rate against limits earns points that many plans miss. Refeeding precautions are expected for a malnourished patient. Fluid and electrolyte planning for ongoing losses shows clinical awareness. Micronutrients cannot be left out. The rubric also wants a monitoring schedule that names each lab and how often it is drawn. A section on stopping or weaning shows the plan is temporary by design. Clear layout and APA 7 references finish the grade, with the parenteral appropriateness guidance a strong source to cite.

NS490 Unit 6 help: mistakes that cost points

The most frequent parenteral error is using 4 kcal per gram for dextrose, which overstates the energy delivered. Some writers never check the glucose infusion rate, so a plan can deliver more glucose than the body handles safely. Lipid doses above common limits slip through when totals are calculated first. Refeeding risk is often mentioned but not built into the starting rate. Fistula losses are left out of the fluid plan. Micronutrients appear as a single line with no detail. Few plans say when to stop. If your case is ready but the order of calculations keeps tangling, a member of our team can write the parenteral plan around your patient's numbers.

Get an NS490 Unit 6 example written to your instructions

Short bowel, obstruction or severe pancreatitis may take the fistula's place in an NS490 Unit 6 case, and some sections provide a PN order template. Include the case, any template supplied, and the rubric. The bag gets built line by line, refeeding shapes day one, and stop criteria carry thresholds. Your first custom sample is free and comes back in 24-48h. The paper above is an original model document written by our desk, not a submitted student paper and not an official Purdue University Global document.

More NS490 papers and BS in Nutrition Science samples

NS490 Unit 6 questions, answered

Which energy value should be used for dextrose in PN?

In parenteral solutions dextrose is hydrated, so the standard value is 3.4 kcal per gram rather than the 4 kcal per gram used for dietary carbohydrate. Using 4 overstates the energy delivered, and markers often check this first. Amino acids are counted at 4 kcal per gram, and lipid emulsions by the manufacturer's value per milliliter.

Should protein energy be counted in the total?

Most current practice counts it, and the example does, so the total reflects everything infused. Some older texts calculate non-protein calories separately and set goals on that basis. Follow the convention your course text uses and state it in the plan, because the two methods give different totals from the same bag.

Does the plan need to mention the type of lipid emulsion?

It helps. Emulsions differ in their oil sources, and the choice can matter for patients on long-term PN or with liver concerns. Naming the type your case or formulary supplies, with one sentence explaining its fit for the patient, shows the lipid was chosen rather than defaulted. Dosing limits should still be cited.

Where can I find a free NS490 Unit 6 sample paper?

The complete NS490 Unit 6 parenteral nutrition plan on this page builds a regimen for a woman with a high-output fistula, step by step from energy and protein to lipid, dextrose, electrolytes and stopping rules.

How is dextrose calculated in the NS490 Unit 6 sample?

Protein and lipid energy are subtracted from the total goal, and the remaining 980 kcal is divided by 3.4 kcal per gram, the value for hydrated dextrose, giving 288 g a day.