Chapter 12

1. Chapter 12 Nutritional Care Orders

2. Objectives • Interpret the dietary orders included in this chapter. • Explain the importance of communicating patient food allergies to the nutritional care department. • List the diets that provide change in the consistency of food. • Identify two diets that may be requested by patients.

3. Objectives, continued • Identify five therapeutic diets. • 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.

4. Objectives, continued • 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.

5. Lesson 12.1

6. 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. • 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 patient’s food allergies and intolerances must be communicated to the nutritional care department (noted on the order).

7. A Nutritional Care Department Requisition

8. Communication with the Nutritional Care Department • With 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 test

9. Standard or Regular Diets • Regular: example: steak, baked potato • Soft: example: broiled chicken, mashed potatoes • Mechanical soft: example: ground meats, vegetables chopped or diced • Pureed: food is blended in blender • Full liquid: example: creamed soups, puddings • Clear liquid: example: broth, jello, tea

10. 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 tolerate • Choices would be consistency (liquid to solid) diets • Nurse could not modify or restrict nutrients or calories • An initial consistency is often specified

11. Diet as Tolerated (DAT) Diet Choices • Regular • Soft • Mechanical soft • Bland • Full liquid • Clear liquid

12. Patient Requested Diets • Ovolactovegetarian • Lactovegetarian • Vegan • Flexitarian • Kosher, and other religious dietary restrictions

13. Therapeutic or Special Diet Orders • Need to be ordered specifically by doctor • Examples • Low cholesterol • Modified fat • High carbohydrate • Sodium restricted • High fiber • Low residue • Potassium restricted

14. Therapeutic or Special Diet Orders • Need to be ordered specifically by doctor • Examples • 1200 cal ADA • Renal diet • Cardiac prudent diet • Dysphagia diet (levels I, II, III, IV) • BRAT diet

15. Tube Feeding Orders Tube feeding order may require the HUC to order: • The formula • An enteral feeding set with or without pump • Chest x-ray to check tube placement (would need to be a specific doctor’s order)

16. A Nasogastric Feeding Tube Courtesy of Baxter Travenol laboratories, Inc.

17. A Gastrostomy Feeding

18. Administration of Tube Feedings • Bolus: infusion of a small amount of formula over a short time • Gravity: formula runs in by gravity by attaching a bag to the nasogastric tube • Infusion pump: drip is controlled by the feeding pump

19. Administration of a Bolus through a Syringe From Potter PA, Perry AG: Fundamentals of Nursing, 6th ed, St. Louis, Mosby, 2005.

20. An Enteral Feeding Pump with Tubing for Continuous Feeding From Potter PA, Perry AG: Fundamentals of Nursing, 6th ed, St. Louis, Mosby, 2005.

21. Other Nutritional Care Orders • The HUC would send any diet-related orders tonutritional care • Examples • All food allergies • Limit or force fluids • Calorie count • Dietary consult • NPO • Sips and chips From Potter PA, Perry AG: Fundamentals of Nursing, 6th ed, St. Louis, Mosby, 2005.