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1 Chapter 12 Nutritional Care Orders. Slide 2 Copyright © 2009, 2004 by Saunders, an imprint of Elsevier Inc. All rights reserved. ObjectivesObjectives.

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Presentation on theme: "1 Chapter 12 Nutritional Care Orders. Slide 2 Copyright © 2009, 2004 by Saunders, an imprint of Elsevier Inc. All rights reserved. ObjectivesObjectives."— Presentation transcript:

1 1 Chapter 12 Nutritional Care Orders

2 Slide 2 Copyright © 2009, 2004 by Saunders, an imprint of Elsevier Inc. All rights reserved. ObjectivesObjectives Interpret the dietary orders included in this chapter.Interpret the dietary orders included in this chapter. Explain the importance of communicating patient food allergies to the nutritional care department.Explain the importance of communicating patient food allergies to the nutritional care department. List the diets that provide change in the consistency of food.List the diets that provide change in the consistency of food. Identify two diets that may be requested by patients.Identify two diets that may be requested by patients. Interpret the dietary orders included in this chapter.Interpret the dietary orders included in this chapter. Explain the importance of communicating patient food allergies to the nutritional care department.Explain the importance of communicating patient food allergies to the nutritional care department. List the diets that provide change in the consistency of food.List the diets that provide change in the consistency of food. Identify two diets that may be requested by patients.Identify two diets that may be requested by patients.

3 Slide 3 Copyright © 2009, 2004 by Saunders, an imprint of Elsevier Inc. All rights reserved. Objectives, continued Identify five therapeutic diets.Identify five therapeutic diets. List four diets that may be selected for the patient who is on a diet as tolerated.List four diets that may be selected for the patient who is on a diet as tolerated. List three types of formula or preparations used for tube feeding.List three types of formula or preparations used for tube feeding. Identify five therapeutic diets.Identify five therapeutic diets. List four diets that may be selected for the patient who is on a diet as tolerated.List four diets that may be selected for the patient who is on a diet as tolerated. List three types of formula or preparations used for tube feeding.List three types of formula or preparations used for tube feeding.

4 Slide 4 Copyright © 2009, 2004 by Saunders, an imprint of Elsevier Inc. All rights reserved. Objectives, continued List three methods of administering tube feedings.List three methods of administering tube feedings. List three items a health unit coordinator may have to order when transcribing an order for tube feeding.List three items a health unit coordinator may have to order when transcribing an order for tube feeding. List three methods of administering tube feedings.List three methods of administering tube feedings. List three items a health unit coordinator may have to order when transcribing an order for tube feeding.List three items a health unit coordinator may have to order when transcribing an order for tube feeding.

5 Slide 5 Copyright © 2009, 2004 by Saunders, an imprint of Elsevier Inc. All rights reserved. Lesson 12.1

6 Slide 6 Copyright © 2009, 2004 by Saunders, an imprint of Elsevier Inc. All rights reserved. Communication with the Nutritional Care Department The HUC communicates an order for a new diet or a change/modification by computer to the nutritional care department.The HUC communicates an order for a new diet or a change/modification by computer to the nutritional care department. If the computer is shut down, the HUC orders the diet from the nutritional care department by telephone or written requisition and later enters the diet order into the computer to maintain a record.If the computer is shut down, the HUC orders the diet from the nutritional care department by telephone or written requisition and later enters the diet order into the computer to maintain a record. The patients food allergies and intolerances must be communicated to the nutritional care department (noted on the order).The patients food allergies and intolerances must be communicated to the nutritional care department (noted on the order). The HUC communicates an order for a new diet or a change/modification by computer to the nutritional care department.The HUC communicates an order for a new diet or a change/modification by computer to the nutritional care department. If the computer is shut down, the HUC orders the diet from the nutritional care department by telephone or written requisition and later enters the diet order into the computer to maintain a record.If the computer is shut down, the HUC orders the diet from the nutritional care department by telephone or written requisition and later enters the diet order into the computer to maintain a record. The patients food allergies and intolerances must be communicated to the nutritional care department (noted on the order).The patients food allergies and intolerances must be communicated to the nutritional care department (noted on the order).

7 Slide 7 Copyright © 2009, 2004 by Saunders, an imprint of Elsevier Inc. All rights reserved. A Nutritional Care Department Requisition

8 Slide 8 Copyright © 2009, 2004 by Saunders, an imprint of Elsevier Inc. All rights reserved. Communication with the Nutritional Care Department With EMR and CPOE, the HUC may have to order equipment from CSDWith EMR and CPOE, the HUC may have to order equipment from CSD The HUC may communicate with the nutritional care department when ordering a diet for a patient who had been NPO for a procedure or testThe HUC may communicate with the nutritional care department when ordering a diet for a patient who had been NPO for a procedure or test With EMR and CPOE, the HUC may have to order equipment from CSDWith EMR and CPOE, the HUC may have to order equipment from CSD The HUC may communicate with the nutritional care department when ordering a diet for a patient who had been NPO for a procedure or testThe HUC may communicate with the nutritional care department when ordering a diet for a patient who had been NPO for a procedure or test

9 Slide 9 Copyright © 2009, 2004 by Saunders, an imprint of Elsevier Inc. All rights reserved. Standard or Regular Diets Regular: example: steak, baked potatoRegular: example: steak, baked potato Soft: example: broiled chicken, mashed potatoesSoft: example: broiled chicken, mashed potatoes Mechanical soft: example: ground meats, vegetables chopped or dicedMechanical soft: example: ground meats, vegetables chopped or diced Pureed: food is blended in blenderPureed: food is blended in blender Full liquid: example: creamed soups, puddingsFull liquid: example: creamed soups, puddings Clear liquid: example: broth, jello, teaClear liquid: example: broth, jello, tea Regular: example: steak, baked potatoRegular: example: steak, baked potato Soft: example: broiled chicken, mashed potatoesSoft: example: broiled chicken, mashed potatoes Mechanical soft: example: ground meats, vegetables chopped or dicedMechanical soft: example: ground meats, vegetables chopped or diced Pureed: food is blended in blenderPureed: food is blended in blender Full liquid: example: creamed soups, puddingsFull liquid: example: creamed soups, puddings Clear liquid: example: broth, jello, teaClear liquid: example: broth, jello, tea

10 Slide 10 Copyright © 2009, 2004 by Saunders, an imprint of Elsevier Inc. All rights reserved. Diet as Tolerated When a doctor orders DAT, the HUC would need to ask the nurse caring for the patient, as personnel preparing the tray have no idea what that patient could tolerateWhen a doctor orders DAT, the HUC would need to ask the nurse caring for the patient, as personnel preparing the tray have no idea what that patient could tolerate Choices would be consistency (liquid to solid) dietsChoices would be consistency (liquid to solid) diets Nurse could not modify or restrict nutrients or caloriesNurse could not modify or restrict nutrients or calories An initial consistency is often specifiedAn initial consistency is often specified When a doctor orders DAT, the HUC would need to ask the nurse caring for the patient, as personnel preparing the tray have no idea what that patient could tolerateWhen a doctor orders DAT, the HUC would need to ask the nurse caring for the patient, as personnel preparing the tray have no idea what that patient could tolerate Choices would be consistency (liquid to solid) dietsChoices would be consistency (liquid to solid) diets Nurse could not modify or restrict nutrients or caloriesNurse could not modify or restrict nutrients or calories An initial consistency is often specifiedAn initial consistency is often specified

11 Slide 11 Copyright © 2009, 2004 by Saunders, an imprint of Elsevier Inc. All rights reserved. Diet as Tolerated (DAT) Diet Choices RegularRegular SoftSoft Mechanical softMechanical soft BlandBland Full liquidFull liquid Clear liquidClear liquid RegularRegular SoftSoft Mechanical softMechanical soft BlandBland Full liquidFull liquid Clear liquidClear liquid

12 Slide 12 Copyright © 2009, 2004 by Saunders, an imprint of Elsevier Inc. All rights reserved. Patient Requested Diets OvolactovegetarianOvolactovegetarian LactovegetarianLactovegetarian VeganVegan FlexitarianFlexitarian Kosher, and other religious dietary restrictionsKosher, and other religious dietary restrictions OvolactovegetarianOvolactovegetarian LactovegetarianLactovegetarian VeganVegan FlexitarianFlexitarian Kosher, and other religious dietary restrictionsKosher, and other religious dietary restrictions

13 Slide 13 Copyright © 2009, 2004 by Saunders, an imprint of Elsevier Inc. All rights reserved. Therapeutic or Special Diet Orders Need to be ordered specifically by doctorNeed to be ordered specifically by doctor ExamplesExamples Low cholesterolLow cholesterol Modified fatModified fat High carbohydrateHigh carbohydrate Sodium restrictedSodium restricted High fiberHigh fiber Low residueLow residue Potassium restrictedPotassium restricted Need to be ordered specifically by doctorNeed to be ordered specifically by doctor ExamplesExamples Low cholesterolLow cholesterol Modified fatModified fat High carbohydrateHigh carbohydrate Sodium restrictedSodium restricted High fiberHigh fiber Low residueLow residue Potassium restrictedPotassium restricted

14 Slide 14 Copyright © 2009, 2004 by Saunders, an imprint of Elsevier Inc. All rights reserved. Therapeutic or Special Diet Orders Need to be ordered specifically by doctorNeed to be ordered specifically by doctor ExamplesExamples 1200 cal ADA1200 cal ADA Renal dietRenal diet Cardiac prudent dietCardiac prudent diet Dysphagia diet (levels I, II, III, IV)Dysphagia diet (levels I, II, III, IV) BRAT dietBRAT diet Need to be ordered specifically by doctorNeed to be ordered specifically by doctor ExamplesExamples 1200 cal ADA1200 cal ADA Renal dietRenal diet Cardiac prudent dietCardiac prudent diet Dysphagia diet (levels I, II, III, IV)Dysphagia diet (levels I, II, III, IV) BRAT dietBRAT diet

15 Slide 15 Copyright © 2009, 2004 by Saunders, an imprint of Elsevier Inc. All rights reserved. Tube Feeding Orders Tube feeding order may require the HUC Tube feeding order may require the HUC to order: to order: The formulaThe formula An enteral feeding set with or without pumpAn enteral feeding set with or without pump Chest x-ray to check tube placement (would need to be a specific doctors order)Chest x-ray to check tube placement (would need to be a specific doctors order) Tube feeding order may require the HUC Tube feeding order may require the HUC to order: to order: The formulaThe formula An enteral feeding set with or without pumpAn enteral feeding set with or without pump Chest x-ray to check tube placement (would need to be a specific doctors order)Chest x-ray to check tube placement (would need to be a specific doctors order)

16 Slide 16 Copyright © 2009, 2004 by Saunders, an imprint of Elsevier Inc. All rights reserved. A Nasogastric Feeding Tube Courtesy of Baxter Travenol laboratories, Inc.

17 Slide 17 Copyright © 2009, 2004 by Saunders, an imprint of Elsevier Inc. All rights reserved. A Gastrostomy Feeding

18 Slide 18 Copyright © 2009, 2004 by Saunders, an imprint of Elsevier Inc. All rights reserved. Administration of Tube Feedings Bolus: infusion of a small amount of formula over a short timeBolus: infusion of a small amount of formula over a short time Gravity: formula runs in by gravity by attaching a bag to the nasogastric tubeGravity: formula runs in by gravity by attaching a bag to the nasogastric tube Infusion pump: drip is controlled by the feeding pumpInfusion pump: drip is controlled by the feeding pump Bolus: infusion of a small amount of formula over a short timeBolus: infusion of a small amount of formula over a short time Gravity: formula runs in by gravity by attaching a bag to the nasogastric tubeGravity: formula runs in by gravity by attaching a bag to the nasogastric tube Infusion pump: drip is controlled by the feeding pumpInfusion pump: drip is controlled by the feeding pump

19 Slide 19 Copyright © 2009, 2004 by Saunders, an imprint of Elsevier Inc. All rights reserved. Administration of a Bolus through a Syringe From Potter PA, Perry AG: Fundamentals of Nursing, 6th ed, St. Louis, Mosby, 2005.

20 Slide 20 Copyright © 2009, 2004 by Saunders, an imprint of Elsevier Inc. All rights reserved. An Enteral Feeding Pump with Tubing for Continuous Feeding From Potter PA, Perry AG: Fundamentals of Nursing, 6th ed, St. Louis, Mosby, 2005.

21 Slide 21 Copyright © 2009, 2004 by Saunders, an imprint of Elsevier Inc. All rights reserved. Other Nutritional Care Orders The HUC would send any diet-related orders to nutritional careThe HUC would send any diet-related orders to nutritional care ExamplesExamples All food allergiesAll food allergies Limit or force fluidsLimit or force fluids Calorie countCalorie count Dietary consultDietary consult NPONPO Sips and chipsSips and chips The HUC would send any diet-related orders to nutritional careThe HUC would send any diet-related orders to nutritional care ExamplesExamples All food allergiesAll food allergies Limit or force fluidsLimit or force fluids Calorie countCalorie count Dietary consultDietary consult NPONPO Sips and chipsSips and chips From Potter PA, Perry AG: Fundamentals of Nursing, 6th ed, St. Louis, Mosby, 2005.


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