Quiz 1 Flashcards
Who is the administrative dietitian?
the director of the dietary department
what duties are included in the administrative dietitian ?
- overseeing operation of department
- purchasing food
- handling admin duties
what does the therapeutic dietitian do? (3)
- prepares menus for patients
- visits patients if requested
- provides teaching of special diets to pts and family
When is the cut off time for lunch trays?
1000
when is the cut off time for breakfast trays?
0600
when is the cut off time for dinner trays?
1500
when are evening snacks delivered?
2000
if an order is changed BEFORE a mean time cut off we do not have to call down to FNS? T/F
true
if a diet order has been changed and its after the meal cut off time we need to call FNS?
yes
what are the functions of the FNS department? (3)
- planning diets for pts and employees
- preparing and serving food
- preparing diet as per BC diet manual
who are the 5 staff members of the kitchen?
- dietitian
- food service supervisor
- food service worker
- cooks
- dishwasher
what are the hours of of FNS?
0600 - 1900
what are the 4 methods of feeding a patient?
- ingestion - by mouth
- NG tube
- Gastrotomy tube feeding
- TPN
what is a NG tube (nasogastric tube insertion)
soft rubber/plastic tube that extends from nose to stomach
why is an NG tube used?
to withdraw contents of the stomach for analysis / inserted for tube feeding
who performs a NG tube insertion?
- doctor
2. nurse
the doctor orders the patients diet to coincide with their condition? T/F
true
what are the 2 main categories for diet orders?
- standrad diet/ DAT
2. therapeutic diets
what is a therapeutic diet?
a diet with modifications or restrictions
a nurse/doctor will tell you which texture diet to order? T/F
true
the texture of food may be increased as the patient is able to tolerate more food?
true
what are examples of diet textures? (4)
- Normal
- digestive light
- clear fluids
- full fluids
what is a normal texture diet?
regular texture
what is a digestive light texture diet?
easily digested foods - small portions
what is a clear fluids texture diet?
only liquids (coffee, tea, juices, broths)
what is a full fluids texture diet?
liquified food at room temp - easily digested
list 5 therapeutic diets
- calorie count
- diabetic calorie count
- gluten free
- bland diet
- digestive soft
- tube feeding
- heart healthy
- pediatric diet
what is a calorie count diet?
for patients who can only have a few calories
what is a diabetic calorie count diet?
for diabetic patients
what is a gluten free diet?
for celiac disease
what is a bland diet?
eliminates spicy food
what is a digestive soft diet?
restricted to fiber - post op patients
what is a heart healthy diet?
cardiac history / low sodium
what is a paediatric diet?
for patients 0-6 years
you must always order and diet texture and type? T/F
true
name the 5 miscellaneous diets orders
- hold trays/NPO
- fluid restriction
- push or force fluids
- calorie count
- natural laxatives
what is a bag lunch for?
patients leaving the hospital for apt. etc
what are the NUAs responsibilities for diet orders?
- enter into comp
- kardex under diet
- symbolize EC and K
what are the NUA duties for “hold trays”
- enter into comp
2. kardex
when a patient is put on a fluid restriction diet, what should we add to the nursing chart?
fluid balance record
what does FNS stand for?
food and nutrition services
what is TPN used for?
pts who can’t or should not get their nutrition through eating
what does NG stand for?
nasogastric
when phoning FNS you must have what information? (3)
- pts name
- room number
- which ward
all wards stock what types of nourishments? (5)
- jam
- cream
- sugar
- juice
- crackers
who is responsible for stocking the ward with nourishments ?
kitchen staff
the NUA is in charge of making all diet changes? T/F
true
what are 5 common categories found on admit orders?
- diet
- activity
- diagnosis
- vital signs
- medications
what are the 10 unit clerk responsibilities for surgical admission
- greet patient
- follow regular admit routine
- if pt. already admitted check if they have had all pre-op tests
- put chart together
- put pre-op check list onto chart for nurse
- leave MAR in front of chart & have labels
- have old chart
- OR will call for patient when ready
- OR will call porter to get patient
- double check chart to make sure its ready
the patients activity order is ordered by who?
doctor
what does BRP stand for?
bed rest w/ bathroom privileges
name the 8 types of activity orders
- CBR
- BW w/ commode
- BR w. BRP
- Dangle
- Up in chair
- Walk w/ resistance
- ambulate
- AAT
define dangle
pt sits at edge of bed and dangles over the side
define AAT
patient has no restrictions
define BR with commode
patient may use the commode at the bed side
what are the 4 advancing stages of ambulation?
- dangle
- up in chair
- walk with assistance
- AAT
where do you record the activity orders?
under mobility on kardex
NUAs duties for Activity orders?
- enter into comp (enter physio referral if specified)
- kardex
- symbolize
define walk w resistance
physio/nurse will assist the patient with walking
define up in chair
pt sits beside their bed for a certain amount of time
define BR w BRP
bed rest with bathroom privileges
define CBR
patient remains in bed at all times
why does a doctor order vital signs?
to help diagnose patients disease and determine progress
what do vital signs consist of?
- temperature
- pulse
- respiration rate
- blood pressure
what is the normal range of human body temperature?
97F to 99F
where can the pulse be taken from?
- radial artery
- carotoid artery
- femoral artery
- perdal artery
- apex
define apex
taken over the heart with a stethoscope
how is respiration rate taken?
watching patients chest rise and fall or listening by stethoscope
define systole
top number and it records the heart at work or contracting
define diastole
bottom number and it records the heart at rest
name examples of how vital signs may be ordered
- VSR
- VS TID
- Check BP q15 min x 2h
- Temp qH, notify MD if T>38.5C
NUA duties for Vital Signs
- Kardex in Vital signs section
- Symbolize
- if order changes, erase off kardex and replace with new order
what does an adults heart rate/pulse range from?
70 - 82 BPM
what does a childs heart rate/pulse range from?
80 - 150 BPM
what does a adults respiration rate range from?
15-20 RPM
what does a childs respiration rate range from?
12 - 60 RPM
what is the usual blood pressure of an adult?
120/80
what is a child’s blood pressure?
8o + 2x = systolic and 6o - 8o is the diastolic
define systole
top number, records the heart at work or contracting
define diastole
bottom number, records the heart at rest
NVS are commonly ordered as?
NVS q2h, q4h, etc
NUA duties with NVS orders
- kardex
- symbolize
- if changed/cancelled we erase off kardex and update newest order
what are common pre-op orders?
- diet
- meds
- lab orders
- IV therapy
- skin prep
- bowel prep
- urinary cath
a consent form must be what?(4)
- witnessed
- signed
- dated
- time
unit clerks are allowed to witness consent forms. T/F
false
if patient is unable to sign consent, who can sign?
- parents
- siblings
- son, daughter
what happens in an emergency situation with consent forms
doctor will sign “need for emergency surgery or procedures” form
who orders pre-op meds?
anesthetist
when does the anesthetist see the patient, and what for?
before surgery to determine type of anesthetic needed
the anesthetist will routinely order the following types of drugs: (3)
- anti-anxiety
- antic nausea
- antibiotics
does the NUA mar pre-op orders?
yes, and any specifics
what type of test is done prior to surgery? (blood replacement)
type and crossmatch test
why is a type and crossmatch test preformed before surgery?
incase there is blood loss during surgery
why is skin prep done before surgery?
prevent contamination
who performs skin prep?
nurse
if a doctor write an order for skin prep what does the NUA do?
kardex and symbolize
why is bowel prep ordered?
prevent contamination and prevent blocking the surgeons view of the abdominal organs
if a doctor orders bowel prep what does he NUA do?
MAR the order and symbolize
what is a catheter ?
tube inserted into a body cavity/vessel
what do catheters allow?
drainage of fluids
what are 3 common catheter orders?
- foley cath to straight drainage
- CBI until clear
- foley prn
if the doctor orders a catheter the NUA does what?
kardex and symbolize
what is an OR slate?
schedule of all the surgeries being done the next day
what does the NUA do with OR slate?
highlight the patients scheduled for surgery on their unit
Additional NUA duties for Pre-op patients
- have chart prepared and pre-op orders are complete
- on day of surgery check chart for completion
- morning of surgery check any new reports have been filed
- OR will call when sending for pt. inform RN asap
after surgery where is the pt transferred?
to PAR (post anesthetic recovery room)
how long will the pt spend in PAR?
approx. 1-3 hours
in PAR the pt is assigned to a nurse, what will that nurse do after seeing the pt.
call the unit and ask when the best time to send them is
NUAs duties for post-op orders
- return old chart and thinned
- file forms and papers from PAR
- record date, time, surgery on kardex (if not already done)
- process post-op orders (if not already done)
what are examples of some forms we may find once pt is back from PAR? (6)
- consent
- OR checklist
- OR record
- PAR record
- Record of surgical anesthesia
- surgical procedures performed
All pre-op orders that were written prior to surgery are automatically discontinued and replaced by post-op orders. T/F?
true
what is PCA (patient controlled analgesia)
drug delivery system that gives a preset dose of analgesia when the patient pushes the button. (pain relief system where a pts. pushes a button)
what are the 2 types of PCA?
- intravenous PCA
2. Epidural PCA
what is intravenous PCA?
small tube in your arm - pain meds are delivered to your body via your veins
what us epidural PCA
small tube in your back - pain meds are delivered near the nerves in your back
there are 2 functions of the PCA pump to ensure you don’t over medicate yourself. what are they?
- safety timer called a lockout
2. limit to how much pain meds you cab receive in 48 hours
what are PCA pumps used for?
when a pt can’t take meds orally
the anesthetist will write an order when to stop PCA? T/F
true
what is the NUA duties when the anesthetist write a order to stop PCA?
- enter into comp
2. MAR
who orders “monitor I&O” ?
doctor
what does “monitor I&O” mean?
the pts fluid intake and output are to be estimated and recorded throughout the nurses shift
dressing are used to?
protect surgical incisions/wounds
dressings are applied by?
- doctor
2. nurse and examined by the nurse regularly
for an ostomy nurse to see a patient the doctor must do what?
write an order - and the NUA enters it into medi-tech
what are examples of wound/skin treatment orders (3)
- remove staples
- change dressing
- saline soaked dressings to leg ulcer q6h while awake
a telephone consent can be accepted in an emergency situation if what? (2)
- heard by 2 people
2. both people sign consent
Mr. Green is on the OR slate for surgery today, what are our duties?
- file any diagnostic reports
- get old/thinned chart
- have chart and MAR ready
- double check chart
- OR porter will come get pt
when the OR calls to tell us they are calling for a patient, what do we need to do?
- inform nurse
2. have chart and MAR ready
when the OR slate prints, what do we do with it?
highlight pts on our unit
how do we indicate in medi-tech that a pt wants extra gravy with their meals?
under clinical data in diet info
it is 1600 and Mr. green’s surgery has been cancelled, the nurse asks us to ensure he gets a dinner tray, what do we do?
call FNS and ask them to bring us a tray
list the activity orders from most confined to least restrained
- CBR
- BR w commode
- BR w BRP
- Dangle
- Up in chair
- Walk w assistance
- Ambulate
- AAT
dr. asks you to print off the pts last urinalysis, how do you do this? (3)
- click lab
- click which report
how do you print a census report from Medi-Tech? (5)
- click reports
- inpatient
- nursing unit bed roster
- select location
define afebrile
no fever
define febrile
fever
