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UWHC,UWMF,

Clinical Hub,UW Health Clinical Tool Search,UW Health Clinical Tool Search,Delegation/Practice Protocols,Inpatient Delegation Protocols,Related

Tube Feeding - Adult - Supplemental

Tube Feeding - Adult - Supplemental - Clinical Hub, UW Health Clinical Tool Search, UW Health Clinical Tool Search, Delegation/Practice Protocols, Inpatient Delegation Protocols, Related


IP - Tube Feeding - Adult - Supplemental [1406]
Patient Care Orders
Patient Monitoring - General [19287]

Glucose, POC [IPGLUCOSE] AS NEEDED FOR SIGNS AND SYMPTOMS OF
HYPOGLYCEMIA, Starting today For 1 Occurrences,
Routine
If Conditional, What Condition?:
Patient Monitoring - Continuous Tube Feeding [19292]

Glucose, POC [IPGLUCOSE] EVERY 6 HRS IF NPO/ CONT. TUBE FEEDING/ OR
TPN, Starting today For 48 Hours, Routine
If Conditional, What Condition?:
Patient Monitoring - Tube Feeding Bolus [19293]

Glucose, POC [IPGLUCOSE] SEE COMMENTS, Starting today For 48 Hours,
Routine
If Conditional, What Condition?:
30 Minutes before tube feeding bolus
Patient Monitoring - Gastric Feeding [19294]

For Gastric Feedings [NURMON0060] SEE COMMENTS, Starting today, -Measure and
document residual every 4 hours for 48 hours
-Hold tube feeding for 1 hour if residual is greater
than 250 milliliters
-Recheck residual after 1 hour and restart tube
feeding at previous rate if residual is less than 250
milliliters
-Restart tube feeding at previous rate if residual is
less than 250 milliliters
-Notify Physician if tube feeding residual is still
greater than 250 milliliter."

Patient Monitoring - Small Bowel Feeding [19295]

For Small Bowel Feeding [NURMON0060] SEE COMMENTS, Starting today with First
Occurrence Include Now, - Monitor GI tolerance
closely
- Hold tube feeding if there are sudden changes in
abdominal exam, GI function, or hemodynamic status
Contingency Parameters [19296]

Notify Provider [NURCOM0001] Provider to Notify: Provider
If systolic blood pressure > (mmHg):
If systolic blood pressure < (mmHg):
If diastolic blood pressure > (mmHg):
If diastolic blood pressure < (mmHg):
If temperature > (C):
If temperature < (C):
If heart rate > (bpm):
If heart rate < (bpm):
If respiratory rate >:
If respiratory rate <:
If blood glucose > (mg/dL): 150 during the first 48
hours of tube feeding administration
If blood glucose < (mg/dL):
If pain score >:
Pulse Oximetry < (%):
If urine output < (mL):
Other:
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Copyright © 2013 University of Wisconsin Hospital and Clinics Authority


Nutrition
Diet [19301]

Tube Feeding With Tray [NUT0001] EFFECTIVE NOW, Starting today, Routine
General Diet:
Diabetic Diet:
NPO (If patient receiving tube feeding see question
25):
Liquids & Modified Consistency (If Dysphagia
Protocol see questions 21-24):
Fiber:
Renal & Dialysis Multi-Nutrient Restriction:
Lactose Restricted:
Protein:
Fat:
Sodium:
Potassium:
Phosphorus:
Other Minerals:
Calories:
Fluid Restriction: Total mLs/24 hours (IV & PO):
Research:
Metabolic:
Other Modifiers:
Infant Nutrition (Select product and calories per
ounce):
Infant Formula (Calories per Ounce):
Dysphagia Protocol:
Dysphagia Protocol-Modified Consistency (Also
select Dysphagia Protocol Liquid Consistency and
Dysphagia Protocol-Supervision):
Dysphagia Protocol-Liquid Consistency:
Dysphagia Protocol-Supervision:
Tube Feeding (Use Tube Feeding Order Set to
indicate order detail): TUBE FEEDING WITH TRAY;
Tube Feeding Management:
Room Service Class:

Tube Feeding No Tray [NUT0001] EFFECTIVE NOW, Starting today, Routine
General Diet:
Diabetic Diet:
NPO (If patient receiving tube feeding see question
25):
Liquids & Modified Consistency (If Dysphagia
Protocol see questions 21-24):
Fiber:
Renal & Dialysis Multi-Nutrient Restriction:
Lactose Restricted:
Protein:
Fat:
Sodium:
Potassium:
Phosphorus:
Other Minerals:
Calories:
Fluid Restriction: Total mLs/24 hours (IV & PO):
Research:
Metabolic:
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Copyright © 2013 University of Wisconsin Hospital and Clinics Authority


Other Modifiers:
Infant Nutrition (Select product and calories per
ounce):
Infant Formula (Calories per Ounce):
Dysphagia Protocol:
Dysphagia Protocol-Modified Consistency (Also
select Dysphagia Protocol Liquid Consistency and
Dysphagia Protocol-Supervision):
Dysphagia Protocol-Liquid Consistency:
Dysphagia Protocol-Supervision:
Tube Feeding (Use Tube Feeding Order Set to
indicate order detail): TUBE FEEDING NO TRAY;
Tube Feeding Management:
Room Service Class: RS3-ROOM SERVICE NON-
SELECT

Tube Feeding With TNA [NUT0001] EFFECTIVE NOW, Starting today, Routine
General Diet:
Diabetic Diet:
NPO (If patient receiving tube feeding see question
25):
Liquids & Modified Consistency (If Dysphagia
Protocol see questions 21-24):
Fiber:
Renal & Dialysis Multi-Nutrient Restriction:
Lactose Restricted:
Protein:
Fat:
Sodium:
Potassium:
Phosphorus:
Other Minerals:
Calories:
Fluid Restriction: Total mLs/24 hours (IV & PO):
Research:
Metabolic:
Other Modifiers:
Infant Nutrition (Select product and calories per
ounce):
Infant Formula (Calories per Ounce):
Dysphagia Protocol:
Dysphagia Protocol-Modified Consistency (Also
select Dysphagia Protocol Liquid Consistency and
Dysphagia Protocol-Supervision):
Dysphagia Protocol-Liquid Consistency:
Dysphagia Protocol-Supervision:
Tube Feeding (Use Tube Feeding Order Set to
indicate order detail): TUBE FEEDING WITH TNA;
Tube Feeding Management:
Room Service Class:

Tube Feeding Strict NPO [NUT0001] EFFECTIVE NOW, Starting today, Routine
General Diet:
Diabetic Diet:
NPO (If patient receiving tube feeding see question
25):
Liquids & Modified Consistency (If Dysphagia
Protocol see questions 21-24):
Fiber:
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Copyright © 2013 University of Wisconsin Hospital and Clinics Authority


Renal & Dialysis Multi-Nutrient Restriction:
Lactose Restricted:
Protein:
Fat:
Sodium:
Potassium:
Phosphorus:
Other Minerals:
Calories:
Fluid Restriction: Total mLs/24 hours (IV & PO):
Research:
Metabolic:
Other Modifiers:
Infant Nutrition (Select product and calories per
ounce):
Infant Formula (Calories per Ounce):
Dysphagia Protocol:
Dysphagia Protocol-Modified Consistency (Also
select Dysphagia Protocol Liquid Consistency and
Dysphagia Protocol-Supervision):
Dysphagia Protocol-Liquid Consistency:
Dysphagia Protocol-Supervision:
Tube Feeding (Use Tube Feeding Order Set to
indicate order detail): TUBE FEEDING STRICT NPO
Tube Feeding Management:
Room Service Class:

Tube Feeding NPO Except Medications
[NUT0001]
EFFECTIVE NOW, Starting today, Routine
General Diet:
Diabetic Diet:
NPO (If patient receiving tube feeding see question
25):
Liquids & Modified Consistency (If Dysphagia
Protocol see questions 21-24):
Fiber:
Renal & Dialysis Multi-Nutrient Restriction:
Lactose Restricted:
Protein:
Fat:
Sodium:
Potassium:
Phosphorus:
Other Minerals:
Calories:
Fluid Restriction: Total mLs/24 hours (IV & PO):
Research:
Metabolic:
Other Modifiers:
Infant Nutrition (Select product and calories per
ounce):
Infant Formula (Calories per Ounce):
Dysphagia Protocol:
Dysphagia Protocol-Modified Consistency (Also
select Dysphagia Protocol Liquid Consistency and
Dysphagia Protocol-Supervision):
Dysphagia Protocol-Liquid Consistency:
Dysphagia Protocol-Supervision:
Tube Feeding (Use Tube Feeding Order Set to
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Copyright © 2013 University of Wisconsin Hospital and Clinics Authority


indicate order detail): TUBE FEEDING NPO EXCEPT
MEDICATIONS
Tube Feeding Management:
Room Service Class:

Tube Feeding NPO With Ice Chips [NUT0001] EFFECTIVE NOW, Starting today, Routine
General Diet:
Diabetic Diet:
NPO (If patient receiving tube feeding see question
25):
Liquids & Modified Consistency (If Dysphagia
Protocol see questions 21-24):
Fiber:
Renal & Dialysis Multi-Nutrient Restriction:
Lactose Restricted:
Protein:
Fat:
Sodium:
Potassium:
Phosphorus:
Other Minerals:
Calories:
Fluid Restriction: Total mLs/24 hours (IV & PO):
Research:
Metabolic:
Other Modifiers:
Infant Nutrition (Select product and calories per
ounce):
Infant Formula (Calories per Ounce):
Dysphagia Protocol:
Dysphagia Protocol-Modified Consistency (Also
select Dysphagia Protocol Liquid Consistency and
Dysphagia Protocol-Supervision):
Dysphagia Protocol-Liquid Consistency:
Dysphagia Protocol-Supervision:
Tube Feeding (Use Tube Feeding Order Set to
indicate order detail): TUBE FEEDING NPO WITH
ICE CHIPS
Tube Feeding Management:
Room Service Class:

Tube Feeding NPO With Sips of Water
[NUT0001]
EFFECTIVE NOW, Starting today, Routine
General Diet:
Diabetic Diet:
NPO (If patient receiving tube feeding see question
25):
Liquids & Modified Consistency (If Dysphagia
Protocol see questions 21-24):
Fiber:
Renal & Dialysis Multi-Nutrient Restriction:
Lactose Restricted:
Protein:
Fat:
Sodium:
Potassium:
Phosphorus:
Other Minerals:
Calories:
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Copyright © 2013 University of Wisconsin Hospital and Clinics Authority


Fluid Restriction: Total mLs/24 hours (IV & PO):
Research:
Metabolic:
Other Modifiers:
Infant Nutrition (Select product and calories per
ounce):
Infant Formula (Calories per Ounce):
Dysphagia Protocol:
Dysphagia Protocol-Modified Consistency (Also
select Dysphagia Protocol Liquid Consistency and
Dysphagia Protocol-Supervision):
Dysphagia Protocol-Liquid Consistency:
Dysphagia Protocol-Supervision:
Tube Feeding (Use Tube Feeding Order Set to
indicate order detail): TUBE FEEDING NPO WITH
SIPS OF WATER
Tube Feeding Management:
Room Service Class:
Tube, Nasojejunal, J-tube (DOBHOFF or JEJUNOSTOMY) [19297]

Tube Feeding, Continuous [NUT0002] EFFECTIVE NOW, Starting today, Routine
Products (Adult / Adolescent / Pediatric):
Products (Infant):
Continuous Start Rate: *** mL/hr
Advance Rate by: *** mL/hr
Advance Rate Frequency: ***
Continuous Goal Rate: *** mL/hr
Flush With: ***
Flush Volume: *** mL
Flush Frequency: ***

Tube Feeding, Cyclic [NUT0003] EFFECTIVE NOW, Starting today, Routine
Products (Adult / Adolescent / Pediatric):
Products (Infant):
Rate: *** mL/hr
Start Time: ***
End Time: ***
Flush With: ***
Flush Volume: *** mL
Flush Frequency: ***
Tube, Nasogastric, Gastrostomy, Percutaneous Endoscopic Gastrostomy, (PEG-Tube) [19298]

Tube Feeding, Continuous [NUT0002] EFFECTIVE NOW, Starting today, Routine
Products (Adult / Adolescent / Pediatric):
Products (Infant):
Continuous Start Rate: *** mL/hr
Advance Rate by: *** mL/hr
Advance Rate Frequency: ***
Continuous Goal Rate: *** mL/hr
Flush With: ***
Flush Volume: *** mL
Flush Frequency: ***

Tube Feeding, Cyclic [NUT0003] EFFECTIVE NOW, Starting today, Routine
Products (Adult / Adolescent / Pediatric):
Products (Infant):
Rate: *** mL/hr
Start Time: ***
End Time: ***
Flush With: ***
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Copyright © 2013 University of Wisconsin Hospital and Clinics Authority


Flush Volume: *** mL
Flush Frequency: ***

Tube Feeding, Bolus [NUT0004] EFFECTIVE NOW, Starting today, Routine
Products (Adult / Adolescent / Pediatric):
Products (Infant):
Bolus Volume: *** mL/hr
Number of Cans to Bolus: ***
Bolus Frequency: ***
Flush With: ***
Flush Volume: *** mL
Flush Frequency: ***
Laboratory
Labs [19299]

ELECTROLYTES [LYTE] NEXT DRAW, Starting today For 1 Occurrences,
Routine
If add on test, what should lab do if unable to add test
to previous specimen?:
If Conditional, What Condition?:

ELECTROLYTES [LYTE] EVERY MONDAY AND THURSDAY, Starting today
with First Occurrence As Scheduled For 4 Days,
Routine
If add on test, what should lab do if unable to add test
to previous specimen?:
If Conditional, What Condition?:
Consults
Consults [19302]

Consult Nutrition (Inpatient) [CON0043] ONCE, Starting today For 1 Occurrences, Routine
Reason for Consult:
Delegate to Initiate and Manage Tube Feeding:
Delegate to Initiate Feeding Tube Placement Order
Set:
Delegate to Manage Diet Order/Supplement Order:
Delegate to Dysphagia Diet Order Progression:
Initiation of tube feeding

Consult Surgical Nutrition Support (Inpatient)
[CON0106]
ONCE, Starting today
Intent: Consult and Recommend (Write Orders)
Reason for Consult:
Initiation of tube feeding.

Consult Diabetes Management (Inpatient)
[CON0022]
ONCE, Starting today
Intent:
Concern or Specific Question or Task to be
Addressed (Symptom, Sign, or Diagnosis): Initiation
of tube feeding for patients being followed by diabetes
management
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Copyright © 2013 University of Wisconsin Hospital and Clinics Authority