Nutritional Care Orders



Nutritional Care Orders



Chapter Objectives


On completion of this chapter, you will be able to:


1. Define the terms listed in the vocabulary list.


2. Write the meaning of the abbreviations in the abbreviations list.


3. Explain the importance of communicating diet changes and patient food allergies to the nutritional care department.


4. Discuss the methods that may be used by the health unit coordinator (HUC) to order a late tray for a patient.


5. Discuss two eating disorders and other factors that a doctor would need to consider when ordering a hospitalized patient’s diet.


6. List three groups of diets that may be ordered for the hospitalized patient.


7. List five consistency changes that can be made to a standard diet, and explain what is included in each.


8. List four diet options that may be selected for the patient who has started on clear liquids and has an order for diet as tolerated, and explain how the selection would be made.


9. Identify two diets that may be requested by patients.


10. Identify at least five therapeutic diets that the patient’s doctor may order.


11. Discuss the reasons a patient would require a tube feeding, and list three methods of administering tube feedings.


12. List three items a HUC may need to order when transcribing an order for tube feeding.


13. Explain the purpose of the doctors’ orders force fluids, limit fluids, and calorie count, and discuss the importance of sending all doctors’ orders regarding a patient’s diet or modifications to a patient’s diet to the nutritional care department.


14. Discuss the importance of sending total parenteral nutrition (TPN) orders to the pharmacy in a timely manner.



Vocabulary



Anorexia Nervosa


Condition characterized by intense fear of gaining weight or becoming fat, although underweight.


Body Mass Index


Body weight in kilograms divided by height in square meters; this is the usual measurement to define overweight and obesity.


Bolus


Rounded mass of food formed in the mouth and ready to be swallowed; also defined as a concentrated dose of medication or fluid, frequently given intravenously (discussed in Chapter 13).


Bulimia Nervosa


Recurrent episodes of binge eating (rapid consumption of a large amount of food in a discrete period of time) and self-induced vomiting, often along with use of laxatives or diuretics.


Calorie


A measurement of energy generated in the body by the heat produced after food is eaten.


Dehydration


Excessive loss of body water. Causes may include diseases of the gastrointestinal tract that cause vomiting or diarrhea, heat exposure, prolonged vigorous exercise (e.g., in a marathon), kidney disease, and medications (diuretics).


Diet Manual


Hospitals are required to have available in the dietary office and on all nursing units an up-to-date diet manual that has been jointly approved by the medical and nutritional care staffs. May also be called the diet formulary (may be available on computer).


Diet Order


A doctor’s order that states the type and quantity of food and liquids the patient may receive.


Dietary Reference Intake (DRI)


The framework of nutrient standards now in place in the United States; this provides reference values for use in planning and evaluating diets for healthy people.


Dietary Supplements


A product (other than tobacco) taken by mouth that contains a “dietary ingredient” intended to supplement the diet; dietary supplements come in many forms, including extracts, concentrates, tablets, capsules, gel caps, liquids, and powders.


Duodenostomy


Surgical formation of a permanent opening into the duodenum. May be performed for the purpose of introducing a tube for postpyloric feeding.


Dysphagia


Difficulty eating and swallowing.


Enteral Feeding Set


Equipment needed to infuse tube feeding; includes plastic bag for feeding solution and may be ordered with or without pump.


Enteral Nutrition


The provision of liquid formulas into the gastrointestinal tract by tube or by mouth.


Feeding Tube


A small flexible plastic tube that is usually placed in the patient’s nose and that goes down to the stomach or small intestine to provide and/or increase nutritional intake.


Food Allergy


A negative physical reaction to a particular food that involves the immune system (people with food allergies must avoid offending foods).


Food Intolerance


Nonallergic food hypersensitivity—a more common problem than food allergies, involving digestion (people with food intolerance can eat some of the offending foods without developing symptoms).


Gastritis


Inflammation of the stomach.


Gastroenteritis


Inflammation of the stomach and intestines.


Gastrostomy


A surgical procedure for inserting a tube through the abdominal wall and into the stomach. The tube may be used for feeding or drainage.


Gavage


Feeding by means of a tube inserted into the stomach, duodenum, or jejunum through the nose or an opening in the abdominal wall; also called tube feeding.


Hydration


Adequate water in the intracellular and extracellular compartments of the body.


Ingest


To take in food by mouth.


Ingestion


The act of taking in food by mouth.


Intravenous Hyperalimentation


The administration of nutrients by intravenous feeding, especially to individuals unable to take in food through the alimentary tract.


Jejunostomy


A creation of an artificial opening into the jejunum that may be used for enteral feeding when it is necessary to bypass the upper gastrointestinal tract.


Kangaroo Pump


A brand name of a feeding pump used to administer tube feeding.


Kosher


Adhering to the dietary laws of Judaism; the conventional meaning in Hebrew is “acceptable” or “approved.”


Morbid Obesity


An excess of body fat that threatens necessary body functions such as respiration.


Nutrients


Substances derived from food that are used by body cells, for example, carbohydrates, fats, proteins, vitamins, minerals, and water.


Obese


Having an excess amount of body fat, usually defined by body mass index.


Obesity


Condition characterized by an excess amount of body fat, usually defined by body mass index.


Parenteral Nutrition


A mode of feeding that does not use the gastrointestinal tract, instead providing nutrition by intravenous delivery of nutrient solutions.


Partial Parenteral Nutrition (PPN)


A solution containing some essential nutrients injected into a vein to supplement other means of nutrition, usually a partially normal diet of food.


Percutaneous Endoscopic Gastrostomy


Insertion of a tube through the abdominal wall into the stomach under endoscopic guidance.


Recommended Dietary Allowance (RDA)


The average daily intake of a nutrient that meets the requirements of nearly all (97% to 98%) healthy people of a given age and sex. Also commonly known as recommended daily allowance.


Registered Dietitian


One who has completed an educational program, served an internship, and passed an examination sponsored by the American Dietetic Association.


Regular Diet


A diet that consists of all foods and is designed to provide good nutrition.


Rehydration


Restoration of normal water balance in a patient through the administration of fluids orally or intravenously.


Therapeutic Diet


A diet with modifications or restrictions (also called a special diet) that must be ordered by the doctor.


Total Parenteral Nutrition (TPN)


The provision of all necessary nutrients via veins (discussed in detail in Chapter 13).


Tube Feeding


Administration of liquids into the stomach, duodenum, or jejunum through a tube.





image EXERCISE 1


Write the abbreviation for each term listed.





image EXERCISE 2


Write the meaning of each abbreviation listed.




Communication with the Nutritional Care Department


When the electronic medical record (EMR) with computer physician order entry (CPOE) is implemented, the physician orders are entered directly into the patient’s electronic record, and the dietary order is automatically sent to the nutritional care department. The health unit coordinator (HUC) may have tasks to perform, such as ordering equipment from the central service department (CSD). A computer icon may indicate a HUC task, may indicate important information such as “nothing by mouth” (NPO), or may indicate a nurse request. There will still be late patient trays to order after completion of tests or procedures for which it was necessary for the patient to be NPO or after a patient has undergone minor surgery.


The procedure for ordering a new diet or a change or modification to an existing diet when paper charts are used requires the HUC to communicate the order by computer to the nutritional care department. The HUC chooses the correct patient from the unit census screen on the computer, selects the nutritional care department from the department ordering screen, then checks the box to order the specific diet from the options on the dietary screen, along with other items that apply (e.g., dietitian consultation). The HUC must communicate with the nutritional care department (by computer or telephone) when ordering a diet for a patient who has completed a procedure or test that requires him or her to be NPO. The patient’s food allergies and intolerances must be communicated to the nutritional care department (usually on admission). Some food allergies or intolerances cause minor discomforts such as hives or an upset stomach. True food allergies such as allergies to tree nuts, fish, shellfish, and peanuts can produce life-threatening changes in circulation and bronchioles called anaphylactic shock. The notation NKFA indicates that the patient has no known food allergies.


A “write-in” option is provided for additional comments. The diet order would be sent to the nutritional care department by pressing “enter” on the computer keyboard.


If the computer system is unavailable, the diet is ordered from the nutritional care department via a written downtime requisition. The diet order is later entered into the computer to maintain a record (Fig. 12-1).


image
Figure 12-1 A nutritional care department requisition.

Most health care facilities provide each patient with the next day’s menu of items that are allowed for the particular diet the doctor has ordered for the patient. The patient checks what foods he or she would like from the menu. The menu is then sent to the nutritional care department. Many facilities have initiated a system to better serve patients and save the cost of printing menus. This requires the diet aide or technician to interview each patient on admission to obtain and record food preferences and allergies. The diet aide may use a laptop computer to record the information. With the increase in computerization, many patients are encouraged to submit their preferences online. The doctor, nurse, diet aide, or diet technician may ask the registered dietitian to consult with the patient.



image HIGH PRIORITY


The health unit coordinator must communicate with the nutritional care department (by e-mail or telephone) when requesting a diet tray for a patient who has completed a procedure or test that requires him or her to be NPO.


Note: Some hospital nutritional care departments require that all diet orders be submitted in writing via computer.


All dietary information, including orders for NPO, tube feedings, allergies, limit fluids, force fluids, and calorie count, must be sent to the nutritional care department, so necessary adjustments will be made when the patient’s trays are prepared. The dietitian also maintains a record (usually on computer) on each patient, which is updated with each order received.



image HIGH PRIORITY


A patients’ food allergy and/or food intolerance must be communicated to the nutritional care department (usually on admission). Some food allergies and intolerances cause minor discomforts such as hives or an upset stomach. True food allergies such as allergies to tree nuts, fish, shellfish, and peanuts can produce life-threatening changes in circulation and bronchioles called anaphylactic shock. “NKFA” indicates that the patient has no known food allergies.

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Apr 8, 2017 | Posted by in MEDICAL ASSISSTANT | Comments Off on Nutritional Care Orders

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