Review Questions Flashcards
List 9 categories of admission orders with an example
- Admitting diagnosis - ex. MI
- Diet - ex. DAT
- Activity - ex. AAT
- Diagnostic test / procedures - ex. CBC
- Nursing observation - ex. RVS tid
- Medications - ex. Advil 2 tabs po q4hr prn
- Treatment order - ex. change dressing bid
- Patient code status - ex. DNR
- Miscellaneous - ex. request old records
What is an Admission Order?
Written directives by the doctor for the care and treatment of the patient upon entry into the hospital
List 10 steps in progressive ambulation
- CBR
- BR c̅ BRP
- dangle
- up in chair c̅ assist
- BRP when A&O
- up as tol
- up ad lib
- up in hall
- OOB
- Amb.
- walk c̅ assistance
- AAT
- may shower
dangle
The patient may sit and dangle his/her feet over the edge of the bed
BRP when A&O
The patient may use the bathroom as desired when alert and oriented
up ad lib
The patient has no restrictions on activity
amb.
Patient may be up and move around as desired
What are the 5 roles of Nutrition Services?
- To meet the dietary preferences and needs of the patient.
- Preparing and serving food for patients.
- To maintain patient’s health.
- To be part of the treatment plan.
- Providing dietary information to patients.
List 12 common dietary orders
- Regular
- GI soft
- Mechanical soft
- Puree
- No thin fluids / thick fluids only
- Diabetic
- Renal diet
- Neutropenic
- Lactose controlled
- NPO
- Clear fluids
- Full fluids
- Cardiac diet
- Controlled sodium
- Controlled calorie
- Tube feed
- Dysphagia
regular diet
For patients with no dietary restrictions
GI soft
For patients with nausea and distention
mechanical soft
For patients who have trouble chewing or swallowing
puree
For patients with problems chewing or swallowing
no thin fluids / thick fluids only
to prevent choking
diabetic diet
For patients with diabetes mellitus. Carbohydrates, calories, protein and fat are regulated.
renal diet
For patients with kidney disease
neutropenic diet
For patients on chemotherapy or with immune deficiency diseases
lactose controlled diet
Patients unable to digest products containing milk
NPO
For patients pre and post surgery or scheduled for procedures or tests
clear fluids
For patients post-op, acute illness, infection, nausea, and vomiting
full fluids
Advance from clear fluids.
Includes: custard, egg nod, strained soups and fruits, etc.
cardiac diet
Low sodium, no sugar, low cholesterol
controlled sodium diet
For patients with heart disease, high blood pressure, kidney disease. Or may be using certain drugs
controlled calorie diet
The number of calories is usually reduced and monitored
tube feed
Nutrition for tube fed patients. i.e. Isosource
dysphagia diet
For patients with difficulty swallowing. Thickened fluids
What is a Calorie Count Sheet and how is it used?
A 24-hour calorie count record on which the RN records each item a patient has eaten on the sheet.
What does push or force fluids mean? When is it used?
When patients are dehydrated and require additional fluids.
What is Ward Stock? What are some of the nourishments the NUC would order as ward stock?
Ward stock is the food supplies kept on the unit and in the fridge. They are ordered by the NUC.
i.e. juice, bread, ice cream, milk, sugar, cheese and crackers, popsicles, peanut butter, jam, etc.
List 3 methods of feeding
- ingestion (po)
- enteral feeding - NG tube, gastrostomy tube
- parenteral nutrition - TPN
Who might be given a snack between meals?
Patients on special diets
Who receives a snack regularly before bedtime delivered to the unit by dietary services?
Diabetic patients
When would you hold a tray?
Patients waiting for fasting bloodwork or tests
When would you order an early or late tray?
Patients going to or returning from OR, tests, or treatments
What do we order for a patient when they are hungry, but it is too late to receive a regular meal?
A brown bag meal
When do we order a diet with fluid restrictions?
For patients retaining fluids in tissues (edema)
When do we order “fruitlax”?
For patients who require more natural fiber in their diet
Give the meaning for the following symbols:
RMO
APPT
DEPT AWARE
Requisition Made Out
Appointment
Department Aware
What is the primary function of the Lab Department?
To perform tests on body fluids (blood, urine, stool, sputum, etc) to aid in the diagnosis of a patient
Who is charge in the Lab?
Pathologist
Name 6 titles of staff who work in the Lab
- Pathologist
- Hematologist
- Microbiologist
- Lab Technician
- Lab Assistants (Phlebotomists)
- Lab clerks
Pathologist
In charge of Lab. Analyzes tissues and cells for evidence of disease
Hematologist
Medical specialist who deals with blood disorders
Microbiologist
Medical specialist who deals with infectious diseases
Lab technician
Draws blood and performs tests
Lab assistants (Phlebotomists)
Draws blood and performs routine procedures
Lab clerks
Maintain records and reports
List the 8 steps for processing Lab orders.
- Scan the order and previous order
- Fax/tube order to Pharm prn (if there are meds)
- Enter the lab order onto the Kardex
- Complete the req from the PO (check and double check)
- Symbolize each lab order on the PO with K, I/C, and RMO
- Sign off
- Add blank addressographed forms prn
- Flag chart for the RN
Why must Lab requisitions always be completed thoroughly and accurately?
Because they are often the only form of communication used to request a test and they are part of the identification process that ensures the correct test is performed on the correct patient.
Name 4 sources of specimens sent to the Lab.
- blood
- stool
- urine
- CSF
- bone marrow
- sputum
- vag. nose, throat, etc swabs
CBC
A complete blood count.
Includes: Hgb, Hct, WBC, RBC
Diff
Reports the various types of WBC’s found in the blood specimen
ESR
Erythrocyte sedimentation rate. Determines the rate at which RBC’s settle out of the liquid portion of the blood. Used to determine the progress of inflammatory disease.
Hct
hematocrit
A measurement of the volume percentage of red blood cells in whole blood
Hgb
The oxygen-carrying pigment of blood that gives it its colour. May aid in diagnosing anemia or need for additional blood
Platelets
The count of cells that are essential for the coagulation process to take place.
RBC
The measurement of red blood cells
Retics
The count of reticulocytes (immature red blood cells) which determines bone marrow activity. Used in the diagnosis of anemia
WBC
The count of the number of white blood cells that are present in the blood to fight disease-causing organisms. Used in the diagnosis of infection.
A “CBC” is ordered STAT. List all the steps in chronological order to process the order.
- Call accessioning - Symbolize “Dept Aware” on the PO
- Prepare requisition - addressograph, room and bed number, date, write STAT in red for time, diagnosis, check tests name under S requisition
- Complete daily bloodwork card if ordered daily
- Symbolize “RMO” on the PO
- Sent the req to the lab or put in appropriate place for lab work
- Sign off the orders
- Flag the chart
- Add blank addressographed pages prn
How do chemistry tests determine that something in the body is not normal?
When a disease process occurs, the chemicals within the body fluids vary from the normal. Any variance permits a diagnosis or evaluation of the patient’s health status.
What is the purpose of the chemistry test Alk. Phos.?
To evaluation bone and liver disease
What is the purpose of the chemistry test AST (SGOT)?
Used when an MI is suspected. This enzyme is released when there is damage from the attack in process.
What is the purpose of the chemistry test CPK (CK)?
Used when an MI is suspected. This enzyme is released when there is damage from the attack in process.
What is the purpose of the chemistry test LD(H)?
Used when an MI is suspected. This enzyme is released when there is damage from the attack in process.
What is the purpose of the chemistry test ALT?
Enzyme released into the circulation from destroyed liver cells
What is the purpose of the chemistry test bilirubin?
Measures liver erythropoietic (protein produced by kidneys and liver) function and helps differentiate types of jaundice.
What is the purpose of the chemistry test BS?
Determines the amount of sugar in the blood.
What is the purpose of the chemistry test BUN?
Used in diagnosing diseases that affect kidney function
What is the purpose of the chemistry test cholesterol?
Increased level may indicate cardiovascular disease and risk of hardening of the arteries.
What is the purpose of the chemistry test triglycerides?
Increased level may indicate cardiovascular disease and risk of hardening of the arteries.
What is the purpose of the chemistry test HDL?
Increased level may indicate cardiovascular disease and risk of hardening of the arteries.
What is the purpose of the chemistry test cortisol (serum/urine)?
Test done to make sure that the gland that produces cortisol is functioning properly.
What is the purpose of the chemistry test creatinine (serum)?
Test done to study kidney function.
What is the purpose of the chemistry test creatinine clearance (urine)?
Test done to study kidney function.
What is the purpose of the chemistry test C-Reactive Protein?
A rise in CRP indicates high inflammation and/or tissue damage
What is the purpose of the chemistry test cryoglobulins?
Determines if there are abnormal proteins in the body.
What is the purpose of the chemistry test gastrin?
Test evaluations the nutritional status of the patient.
What is the purpose of the chemistry test GGT?
Helps determine if the liver is damaged.
What is the purpose of the chemistry test GTT?
To determine abnormalities in the glucose metabolism.
What is the purpose of the chemistry test HbA1c?
This test is a reflection of the blood glucose on the red blood cells during the past 3 months.
What is the purpose of the chemistry test IgG, IgA, IgM, IgE?
These tests show how well the body is able to fight infections and take care of itself by making antibodies.
What is the purpose of the chemistry test isoenzymes?
This test determines the source responsible for the elevation of enzymes.
What is the purpose of the chemistry test lytes?
Consists of 4 tests:
- sodium
- chloride
- potassium
- bicarbonate
What is the purpose of the chemistry test osmolality (serum/urine)?
Helps evaluation how well the kidneys are working to keep a good water balance in the body.
What is the purpose of the chemistry test protein electrophoresis?
A procedure performed to determine protein levels.
What is the purpose of the chemistry test TIBC?
Used to diagnose anemia, some infections, and cirrhosis of the liver.
What is the purpose of the chemistry test troponin?
Test is performed to diagnose acute MI from a few hours onset to as long as 5 days.
What is the purpose of the chemistry test uric acid?
Used principally to diagnose gout.
What 3 chemical tests make up a LIPID PROFILE?
- cholesterol
- triglycerides
- HDL
What 5 chemical tests make up a LIVER FUNCTION TEST?
- Alk. Phos.
- ALT
- AST
- Bili T&D
- GGT
Name the CARDIAC ENZYMES
- AST (SGOT)
- CPK (CK)
- LD(H)
- ALT
Who do you call to advise of a STAT lab order?
Accessioning
“Lytes” are ordered. List all the steps in chronological order to process the order.
- Kardex the order
- Addressograph the requisition
- Check the name of the req
- Record the date and diagnosis on the req. Check if it’s fasting, STAT, pre-op or other
- Place STAT on the req prn
- Call Accessioning if it is STAT or after scheduled pick times
- Complete diet section of the Kardex if it is fasting bloodwork
- Complete a daily bloodwork card prn
- Symbolize the Physician’s order
- Flag the chart
- Add blank addressographed PO’s prn
- Send req to Accessioning or place it in the appropriate place
When is the sample of fasting bloodwork collected by the Lab?
Why?
The next day because the patient has to be NPO for a required length of time.
For a hospital that draws blood routinely starting at 0700, when would a patient be NPO for 8 hour fast?
10 hour fast?
12 hour fast?
How would you record it on the Kardex in the Nutrition Section?
In the Lab Section?
8 hour fast
Nutrition Section: NPO 2300 (FBW)
Lab Section: test name for date
10 hour fast
Nutrition Section: NPO 2100 (FBW)
Lab Section: test name for date
12 hour fast
Nutrition Section: NPO 1900 (FBW)
Lab Section: test name for date
List the tests which require an 8 hour fast
- cryoglobulins
- (FBS) glucose fasting
- fasting phosphate
- viscosity
List the tests which require a 10 hour fast
- gastrin
- glucose tolerance test (GTT)
List the tests which require a 12 hour fast
- cholesterol
- HDL cholesterol
- tryglycerides
- LDL
Define sulfonamide antibiotic
Used to treat chronic and acute UTI (urinary tract infection)
Define analgesic
A drug that selectively suppresses pain without producing sedation
Define antipyretic
A drug that reduces fever
Define narcotic analgesic
A drug that inhibits severe pain - can produce tolerance and dependency
Define narcotic antagonist
A drug that reverses life-threatening respiratory depression due to incorrect or excessive narcotic dosage