Private Duty Nursing Flow Chart - Idaho

This "Private Duty Nursing Flow Chart" is a part of the paperwork released by the Idaho Department of Health and Welfare specifically for Idaho residents.

The latest fillable version of the document was released on December 14, 2009 and can be downloaded through the link below or found through the department's forms library.

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PRIVATE DUTY NURSING FLOW CHART
Airway
Mode of
Suctioning
Types of Seizures
Feeding Routes
Ventilation
NT Nasal Tube
CPAP Continuous
NP Nasal Pharyngeal
Partial (focal, local)
NJ Nasal-Jejunum
Pressure
OT Oral Tube
OP Oral Pharyngeal
A
Simple partial
NG Nasal-Gastric
BiPAP Patient
H Hood
O Oral
B
Complex partial
PO By Mouth
Assisted
P
Nasal Prongs
T
Tracheal
JT Jejunostomy Tube
Generalized
O
Other
NP Nasal Pharyngeal
GT Gastrostomy Tube
C Absence
NC Nasal Cannula
OG Oral Gastric
D Myoclonic
T
Trach
E
Tonic clonic
F
Atonic
G Other
Status Epilepticus
PRIVATE DUTY NURSING FLOW CHART
CODES
Airway
Mode of
Suctioning
Types of Seizures
Feeding Routes
Ventilation
NT Nasal Tube
CPAP Continuous
NP Nasal Pharyngeal
Partial (focal, local)
NJ Nasal-Jejunum
Pressure
OT Oral Tube
OP Oral Pharyngeal
A
Simple partial
NG Nasal-Gastric
BiPAP Patient
H Hood
O Oral
B
Complex partial
PO By Mouth
Assisted
P
Nasal Prongs
T
Tracheal
JT Jejunostomy Tube
Generalized
O
Other
NP Nasal Pharyngeal
GT Gastrostomy Tube
C Absence
NC Nasal Cannula
OG Oral Gastric
D Myoclonic
T
Trach
E
Tonic clonic
F
Atonic
G Other
Status Epilepticus
PRIVATE DUTY NURSING FLOW CHART
CODES
Airway
Mode of
Suctioning
Types of Seizures
Feeding Routes
Ventilation
NT Nasal Tube
CPAP Continuous
NP Nasal Pharyngeal
Partial (focal, local)
NJ Nasal-Jejunum
Pressure
OT Oral Tube
OP Oral Pharyngeal
A
Simple partial
NG Nasal-Gastric
BiPAP Patient
H Hood
O Oral
B
Complex partial
PO By Mouth
Assisted
P
Nasal Prongs
T
Tracheal
JT Jejunostomy Tube
Generalized
O
Other
NP Nasal Pharyngeal
GT Gastrostomy Tube
C Absence
NC Nasal Cannula
OG Oral Gastric
D Myoclonic
T
Trach
E
Tonic clonic
F
Atonic
G Other
Status Epilepticus
Private Duty Nursing Flow Chart V1.0
12/14/09, sc
PRIVATE DUTY NURSING FLOW CHART
Airway
Mode of
Suctioning
Types of Seizures
Feeding Routes
Ventilation
NT Nasal Tube
CPAP Continuous
NP Nasal Pharyngeal
Partial (focal, local)
NJ Nasal-Jejunum
Pressure
OT Oral Tube
OP Oral Pharyngeal
A
Simple partial
NG Nasal-Gastric
BiPAP Patient
H Hood
O Oral
B
Complex partial
PO By Mouth
Assisted
P
Nasal Prongs
T
Tracheal
JT Jejunostomy Tube
Generalized
O
Other
NP Nasal Pharyngeal
GT Gastrostomy Tube
C Absence
NC Nasal Cannula
OG Oral Gastric
D Myoclonic
T
Trach
E
Tonic clonic
F
Atonic
G Other
Status Epilepticus
PRIVATE DUTY NURSING FLOW CHART
CODES
Airway
Mode of
Suctioning
Types of Seizures
Feeding Routes
Ventilation
NT Nasal Tube
CPAP Continuous
NP Nasal Pharyngeal
Partial (focal, local)
NJ Nasal-Jejunum
Pressure
OT Oral Tube
OP Oral Pharyngeal
A
Simple partial
NG Nasal-Gastric
BiPAP Patient
H Hood
O Oral
B
Complex partial
PO By Mouth
Assisted
P
Nasal Prongs
T
Tracheal
JT Jejunostomy Tube
Generalized
O
Other
NP Nasal Pharyngeal
GT Gastrostomy Tube
C Absence
NC Nasal Cannula
OG Oral Gastric
D Myoclonic
T
Trach
E
Tonic clonic
F
Atonic
G Other
Status Epilepticus
PRIVATE DUTY NURSING FLOW CHART
CODES
Airway
Mode of
Suctioning
Types of Seizures
Feeding Routes
Ventilation
NT Nasal Tube
CPAP Continuous
NP Nasal Pharyngeal
Partial (focal, local)
NJ Nasal-Jejunum
Pressure
OT Oral Tube
OP Oral Pharyngeal
A
Simple partial
NG Nasal-Gastric
BiPAP Patient
H Hood
O Oral
B
Complex partial
PO By Mouth
Assisted
P
Nasal Prongs
T
Tracheal
JT Jejunostomy Tube
Generalized
O
Other
NP Nasal Pharyngeal
GT Gastrostomy Tube
C Absence
NC Nasal Cannula
OG Oral Gastric
D Myoclonic
T
Trach
E
Tonic clonic
F
Atonic
G Other
Status Epilepticus
Private Duty Nursing Flow Chart V1.0
12/14/09, sc
PRIVATE DUTY NURSING FLOW CHART
Date
Page 1 of 2
Participant’s Name:
Medicaid Identification Number:
Diagnosis:
Physician’s
Name:
Code Status:
Seizure
VENTILATION
Activity
S
Temp
A
R
X
O
T
A
Time
0001
0100
0200
0300
0400
0500
0600
0700
0800
0900
1000
1100
1200
1300
1400
1500
1600
1700
1800
1900
2000
2100
2200
2300
NURSE(s)
PARENT(s)/GUARDIAN(s)
INITIALS:
INITIALS:
Time In:
Time Out:
Total Hours Provided:
Total Hours Provided:
Time In:
Time Out:
Total Hours Provided:
Total Hours Provided:
Private Duty Nursing Flow Chart V1.0
12/14/09, sc
PRIVATE DUTY NURSING FLOW CHART
Time In:
Time Out:
Total Hours Provided:
Total Hours Provided:
Date
Page 2 of 2
Participant’s Name:
Medicaid Identification Number:
Private Duty Nursing Flow Chart V1.0
12/14/09, sc
PRIVATE DUTY NURSING FLOW CHART
Date
Page 3 of 2
Participant’s Name:
Medicaid Identification Number:
INTAKE
OUTPUT
NARRATIVE
FEEDING
Time:
Formula:
Route:
0001
0100
0200
0300
0400
0500
0600
0700
0800
0900
1000
1100
1200
1300
1400
1500
1600
1700
1800
1900
2000
2100
2200
2300
NURSE(s) SIGNATURE
INITIALS:
DATE:
PARENT(s) SIGNATURE:
INITIALS:
PARENT(s) REVIEWED:
DATE:
Private Duty Nursing Flow Chart V1.0
12/14/09, sc

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