APPENDIX 8: Guidance for patients that require Specific Nutritional Requirements
Guidance for Patients that require Specific Nutritional Requirements
Implement and document appropriate interventions within the Ongoing Nursing Record of Care or
Continuation sheets. Re-assess nutritional risk each shift or if condition changes.
FLUID BALANCE
Unable to maintain adequate fluid intake:
If over 60 years of age
– 30 mls/kg x body weight
If 18-60 years of age
– 35 mls/kg x body weight
RECOMMENDATIONS
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Calculate fluid requirements per 24 hours
Consider prescribed fluids
Commence fluid balance chart
Give regular mouth care
Refer to Medical Management of
Dysphagia in FFNC policy
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Encourage small meals little and often
Encourage whole milk
Commence on 3 day food chart
Record portion size
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Follow Oral Care Standard Operating
Procedure in FFNC policy
For Urgent dental problems refer to
Urgent Dental Care Pathway in FFNC
policy
POOR APPETITE
Poor appetite or patient/carer concerned
with oral intake
MOUTH CARE
Problems with mouth/dentures e.g. dry
mouth, oral thrush, taste changes
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SWALLOWING DIFFICULTIES
Problems swallowing
Textured Modified Diet Thickened Fluids
B (thin puree)
Stage 1 (Syrup)
C (thick puree)
Stage 2 (Custard)
D (pre-mashed)
Stage 3 (Paste)
E (fork mashable)
 Refer to Medical Management of
Dysphagia in FFNC Policy
 Refer to Speech and Language
Therapy (if appropriate)
 Refer to dietitian (if appropriate)
 Commence on 3 day food chart
 Commence on fluid balance chart
 Coloured tray requested
 Give regular mouth care
EQUIPMENT
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Requires specific equipment to help with
eating and drinking
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Occupational Therapy referral ( if
appropriate)
Patients own equipment brought in
Offer support to eat and drink
Offer assistance to cut up food
Copyright © 2012. Nursing & Midwifery Directorate, NHS Tayside. This publication can be used or reproduced including photocopying, for noncommercial purposes. We request that the source and Copyright owners be acknowledged and that the material is not substantially altered in any
way. Applications for use outwith these terms should be forwarded in writing to the Nursing and Midwifery Directorate, Level 9, Ninewells, Dundee..
COGNITIVE FUNCTION
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Request coloured meal tray (if
applicable)
Offer picture menu
Check if patient has 'This is Me'
document, if no, refer to 'This is Me'
guidelines for hospital staff
Give assistance to eat and drink
Consider carer involvement
Commence 3 day food chart
Commence fluid balance chart
Consider or offer finger food if
appropriate
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Cognitive Impairment/Dementia
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ELIMINATION
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Diarrhoea/Constipation
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Consider laxatives/anti diarrhoeal
medication
Encourage oral fluids
Consider prescribed fluids
Complete fluid balance chart
Consider dietary modification
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Consider anti-emetic
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Encourage regular oral fluids/ light diet
Prescribed Fluids
Commence 3 day food chart
Give regular mouth care
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Provide encouragement with meals
/drinks
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Consider appropriateness of mealtime
environment
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Protected mealtimes
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Consider carer involvement at
mealtimes
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Assist with menu choices
Offer picture menu
Consider carer involvement
NAUSEA & VOMITING
Nausea/Vomiting
PSYCHOLOGICAL FACTORS
Psychological aspects of nutrition e.g.
anxiety, depression
NUTRITIONAL SUPPORT
Unable to make food choices
independently
Receiving artificial nutritional support or
oral nutritional supplements at home/care
home
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Refer to dietitian
Document route/type of
feed/volume/rate/frequency within the
ongoing nursing record of care
Copyright © 2012. Nursing & Midwifery Directorate, NHS Tayside. This publication can be used or reproduced including photocopying, for noncommercial purposes. We request that the source and Copyright owners be acknowledged and that the material is not substantially altered in any
way. Applications for use outwith these terms should be forwarded in writing to the Nursing and Midwifery Directorate, Level 9, Ninewells, Dundee..