Treatment Orders



Treatment Orders



Chapter Objectives


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


1. Define the terms in the vocabulary list.


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


3. Discuss three methods that may be used to treat cardiovascular conditions, and identify three areas within the hospital where cardiovascular surgical and treatment procedures may be performed.


4. Identify the three commonly used procedures performed to repair obstructed coronary blood vessels.


5. Identify the name and location of a vein and an artery that may be used for grafts during a coronary artery bypass graft.


6. Discuss the reasoning for cardiovascular treatment procedures being performed in conjunction with diagnostic procedures, and list five treatment procedures performed in interventional radiology.


7. State the purpose of the cardiopulmonary (respiratory care) department pertaining to patient treatment orders, and list at least five cardiopulmonary (respiratory care) treatments.


8. Explain the importance of the health unit coordinator (HUC) including the entire doctor’s order when communicating a cardiopulmonary (respiratory care) order (electronically, by requisition, or by telephone), and list the information that would be needed when sending an order for oxygen.


9. List four types of aerosol delivery devices, and identify at least two types of aerosolized drugs.


10. Explain the procedure and equipment needed to obtain an induced sputum specimen.


11. Discuss the purpose of incentive spirometry, chest percussion therapy, and noninvasive positive pressure ventilation, and explain the use of a mechanical ventilator.


12. State the purpose of the wound care department, and explain the purpose of hyperbaric oxygen therapy.


13. Identify the two basic types of traction and the traction setup used by patients to assist them to move in bed.


14. Identify three divisions that make up the physical medicine department.


15. Describe the purpose of the physical therapy (PT) division of physical medicine, and list four methods that would be used by PT personnel.


16. Describe the purpose of the occupational therapy (OT) division of the physical medicine department, and list three doctor’s orders that would be sent to the OT department.


17. Explain the purpose of speech therapy, and describe the patients who would benefit from speech therapy.


18. Explain the need for dialysis, identify two types of dialysis, and discuss the process of each type.


19. Identify three areas in the hospital that may provide radiation treatments, and explain the HUC’s role regarding doctors’ orders for radiation.



Vocabulary



Active Exercise


Exercise performed by the patient without assistance as instructed by the physical therapist.


Activities of Daily Living


Tasks that enable individuals to meet basic needs (eating, bathing, and so forth).


Aerobic Exercise


Exercise that causes the heart and lungs to work harder to benefit the cardiovascular and circulatory system.


Aerosol


Liquid suspension of particles in a gas stream for inhalation purposes.


Anaerobic Exercise


Exercise that involves strengthening muscles by forcing them to work very hard for a brief time.


Angioplasty


A medical procedure in which a balloon is used to open narrowed or blocked blood vessels of the heart (coronary arteries).


Auscultation


The act of listening for sounds within the body to evaluate the condition of the heart, blood vessels, lungs, pleura, intestines, or other organs or to detect fetal heart sounds.


Cardiac Pacemaker


An electronic device, temporary or permanent, that regulates the pace of the heart when the heart is incapable of doing it.


Certified Respiratory Therapist (CRT)


Title granted after completion of an approved respiratory therapy program; graduates may become credentialed by taking an entry level examination to become CRTs.


Constraint-Induced (movement) Therapy (CI therapy)


A therapy to treat a dysfunctional upper extremity that involves constraining the functional arm in a sling to improve the movement and use of the affected arm.


Crackles (rales)


A common, abnormal respiratory sound that consists of discontinuous bubbling noises caused by fluid in the small airways or atelectasis and heard on auscultation of the chest during inspiration.


Débridement


The process of removing dirt, foreign objects, damaged tissue, and cellular debris from a wound or a burn to prevent infection and to promote healing.


Defibrillation


Application of an electric shock to the myocardium through the chest wall to restore normal cardiac rhythm. External defibrillators deliver the shock through the chest wall, whereas internal cardioverter-defibrillators (ICDs) deliver the shock via implanted electrodes within the heart.


Dialysis


A mechanical process to remove from the blood toxic wastes that would normally be filtered out by the kidneys.


Dyspnea


Difficult or labored breathing.


Endotracheal Tube


A tube inserted through the mouth that supplies air to the lungs and assists breathing. The endotracheal tube is connected to a ventilator.


Extubation


Removal of a previously inserted tube (such as an endotracheal tube).


Hemodialysis (extracorporeal dialysis)


The removal of waste products from the blood through use of a machine through which the blood flows.


Hydrotherapy


The use of water—including continuous tub baths, wet sheet packs, or shower sprays—to soothe pains and treat various conditions and diseases.


Hyperbaric Oxygen Therapy


A treatment that involves breathing 100% oxygen while in an enclosed system pressurized to greater than one atmosphere (sea level).


Hypertonic


A concentrated salt solution (>0.9%).


Hypotonic


A dilute salt solution (<0.9%).


Induced Sputum Specimen


A sputum specimen obtained by performing a respiratory treatment to loosen lung secretions.


Intervention


Synonymous with treatment.


Intubation


Insertion and placement of a tube within the trachea to maintain an open airway.


Isometric


Of equal dimensions. Holding ends of contracting muscle fixed so that contraction produces increased tension at a constant overall length.


Nebulizer


A gas-driven device that produces an aerosol.


Passive Exercise


Exercise in which the patient is submissive and the physical therapist moves the patient’s limbs.


Peritoneal Dialysis


Process involving introduction of a fluid (dialyzing fluid) into the abdominal cavity; the fluid absorbs the wastes from the blood through the lining of the abdominal cavity or through the peritoneum; afterward, the dialysate is emptied from the abdominal cavity.


Positive Pressure


Pressure greater than atmospheric pressure.


Range of Motion


The range in which a joint can move.


Resistive Exercise


Exercise that uses opposition. A T band or water may be used to provide resistance for patient exercises.


Splint


An orthopedic device for immobilization, restraint, or support of any part of the body; may be rigid (metal, plaster, or wood) or flexible (felt or leather).


Spica Cast


A cast that begins at the chest and includes one or both lower limbs.


Stent


A tiny metal or plastic tube that is placed into an artery, blood vessel, or other duct to hold the structure open.


Stridor


A high-pitched harsh sound heard during inspiration that is caused by obstruction of the upper airway; it is a sign of respiratory distress and therefore requires immediate attention.


Tank Room


A room where hydrotherapy is performed.


Traction


A mechanical pull to part of the body to maintain alignment and facilitate healing; traction may be static (continuous) or intermittent.


Ultrasound Therapy


A deep heating modality using high-energy sound waves that is most effective for heating tissues or deep joints and is performed by a physical therapist.


Unit Dose


Any premixed or prespecified dose; often administered with a small-volume nebulizer or intermittent positive pressure breathing treatments.


Ventilator


A machine that is used to give the patient breaths through the ET or tracheostomy tube.


Wheezes


Sounds that are heard continuously during inspiration or expiration or both and are caused by air moving through airways narrowed by constriction or swelling of airways or partial airway obstruction.



ABBREVIATIONS
















































































































































































































































































































Abbreviation Meaning Example of Usage on a Doctor’s Order Sheet
AA active assisted AA exercises B/L LE
ADLS activities of daily living OT for ADLs
ADS adult distress syndrome The patient’s dx is ADS
AKA above-the-knee amputation AKA protocol
BiPAP bilevel positive airway pressure  
BiW twice a week PT 2 × a wk
BKA below-the-knee amputation consent for BKA
BLE both or bilateral lower extremities HBOT BLE
BUE both or bilateral upper extremities strengthening exercises BUE
CABG coronary artery bypass graft consent for CABG
CBNT continuous bronchodilator nebulizer therapy  
CP cold pack CP L arm
CPAP continuous positive airway pressure CPAP 5 cm H2O
CPM continuous passive motion CPM
CPR cardiopulmonary resuscitation CPR training for parents before child’s discharge
CPT chest percussion therapy DC CPT
DPI dry powder inhaler instruct patient on use of DPI
EPC electronic pain control EPC
ES electrical stimulation ES
ET endotracheal tube CXR for ET tube placement
FWW front-wheel walker provide FWW
HA heated aerosol HA T-piece @ 60%
HBOT hyperbaric O2 therapy HBOT qd 3 × wk for 8 wk
HD hemodialysis HD BiW × 3 h
HP hot packs HP to neck
ICD implantable cardioverter-defibrillator Have consent signed for ICD
IPPB intermittent positive pressure breathing IPPB q4h 0.5 mL Ventolin in 2 mL NS
IS incentive spirometry IS tid
ISOM isometric ISOM UE bid
lb or # pounds bucks traction 5# weight
LE lower extremities ROM LE qd
LLE left lower extremity passive exercises LLE
LLL left lower lobe CPT—LLL only
L/min liters per minute ↑ O2 to 4 L/min
LUE left upper extremities ROM LUE
LUL left upper lobe CPT to LUL
MDI metered-dose inhaler MDI puffs qid
NC or NP nasal cannula or nasal prongs 02 40% by NC
NWB non–weight bearing Crutch-walking NWB
O2 oxygen O2 6 L/min by mask
O2 SAT oxygen Saturation Place on oximetry to monitor O2 SAT
ORIF open reduction, internal fixation ORIF lt femur
OT occupational therapy or occupational therapist OT for ADLs
PD peritoneal dialysis Tenckhoff cath for PD
PDPV postural drainage, percussion, and vibration PDPV to LUL
PEP positive expiratory pressure IS PEP
PROM passive range of motion PROM LUE bid
PT physical therapy or physical therapist To PT for crutch walking
PTA physical therapy assistant PTA to assist patient in amb
PTCA percutaneous transluminal coronary angioplasty Have consent signed for PTCA
RLE right lower extremities ISOM to RLE
RLL right lower lobe CPT RLL
RML right middle lobe CPT RML
ROM range of motion ROM to upper extremities tid
RT respiratory therapy or respiratory therapist RT to obtain induced sputum specimen
RUE right upper extremity Hot pk to RUE
RUL right upper lobe CPT to RUL
SaO2
 arterial oxygen saturation (on pulse
oximetry, not ABGs)		 ABG now—notify resident of SaO2
SpO2 oxygen saturation via pulse oximetry SpO2 notify resident if O2 SAT below 90%
SIDS sudden infant death syndrome The baby died of SIDS
STM soft tissue massage STM lt shoulder 20 min bid
SVN small volume nebulizer Δ SVN to bid
TENS transcutaneous electrical nerve stimulation Postop TENS
THR or THA total hip replacement or arthroplasty follow THR protocol
TKR or TKA total knee replacement or arthroplasty TKA protocol
TT tilt table PT for TT
TTOT transtracheal oxygen therapy Start TTOT today
Tx traction Buck’s Tx
UD unit dose UD Ventolin now
USN ultrasonic nebulizer USN 15 min tid
WBAT weight bearing as tolerated amb, WBAT rt leg
WP whirlpool WP to L leg bid
> greater than Call hospitalist if pH >7.4
< less than Call Dr. Jones if O2 Sats <70%



image EXERCISE 1


Write the abbreviation for each term listed.



1. left upper lobe


2. occupational therapy or occupational therapist


3. physical therapy or physical therapist


4. liters per minute


5. oxygen


6. intermittent positive pressure breathing


7. right upper lobe


8. range of motion


9. right lower lobe


10. activities of daily living


11. coronary artery bypass graft


12. right middle lobe


13. ultrasonic nebulizer


14. small-volume nebulizer


15. left lower lobe


16. pounds


17. non–weight bearing


18. whirlpool


19. hot packs


20. transcutaneous electrical nerve stimulation


21. electronic pain control


22. electrical stimulation


23. continuous passive motion


24. incentive spirometry


25. metered-dose inhaler


26. chest percussion therapy


27. active assisted


28. twice a week


29. above-the-knee amputation


30. soft tissue massage


31. lower extremities


32. hemodialysis


33. total hip replacement or arthroplasty


34. open reduction, internal fixation


35. traction


36. tilt table


37. isometric


38. below-the-knee amputation


39. endotracheal tube


40. heated aerosol


41. positive expiratory pressure


42. postural drainage, percussion, and vibration


43. oxygen saturation


44. unit dose


45. greater than


46. total knee replacement or arthroplasty /


47. less than


48. cold packs


49. cardiopulmonary resuscitation


50. hyperbaric oxygen therapy


51. transtracheal oxygen therapy


52. continuous positive airway pressure


53. both upper extremities


54. both lower extremities


55. right upper extremity


56. left upper extremity


57. right lower extremity


58. left lower extremity


59. physical therapist assistant


60. respiratory therapist


61. passive range of motion


62. weight bearing as tolerated


63. front-wheel walker


64. peritoneal dialysis


65. implantable cardioverter-defibrillator


66. adult distress syndrome


67. dry powder inhaler


68. sudden infant death syndrome


69. nasal cannula or nasal prongs


70. arterial oxygen concentration


71. continuous bronchodilator nebulizer therapy


72. percutaneous transluminal coronary angioplasty


73. bilevel positive airway pressure


74. oxygen concentration via pulse oximetry



image EXERCISE 2


Write the meaning of each abbreviation listed.




image HIGH PRIORITY


When the electronic medical record (EMR) with computer physician order entry (CPOE) is implemented, the physicians’ orders are entered directly into the patient’s electronic record, and the treatment order is automatically sent to the appropriate department. The health unit coordinator (HUC) may have tasks to perform, such as coordinating and scheduling procedures, ordering special diets and cathartics for preparation, and so forth. An icon may indicate a HUC task, or it may signify a nurse request. When paper charts are used, the doctors’ orders are communicated by the ordering step of transcription via computer or by completion of a downtime requisition form.



image HIGH PRIORITY


Downtime requisitions are included in this chapter for learning purposes. The Evolve website associated with the Health Unit Coordinator Skills Manual includes a simulated hospital computer program that may be used as well.



Cardiovascular


Cardiovascular conditions may be treated with medication and/or surgery, and/or placement of various therapeutic cardiac instruments. Some of the surgical procedures required and the placement of these therapeutic instruments are discussed in this chapter. An emergency procedure to correct life-threatening fibrillations of the heart is discussed in the High Priority box.



image HIGH PRIORITY




Invasive Cardiovascular Therapies


Many cardiovascular therapies are invasive and are performed by an interventional cardiologist and/or an interventional radiologist. These procedures may be done in the cardiovascular laboratory (CV lab or cardiac cath lab), a special x-ray division of the radiology department, or the surgery department.



Insertion of a Cardiac Pacemaker


A cardiac pacemaker is an electric apparatus that is used in most cases to increase the heart rate in severe bradycardia by electrically stimulating the heart muscle. A pacemaker may be permanent or temporary, may emit the stimulus at a constant and fixed rate, or may fire only on demand. Permanent pacemakers are implanted under a chest muscle during surgery. With temporary pacemakers, wires from outside the body lead into the heart (Fig. 17-1).


image
Figure 17-1 Pacemaker. (From Thibodeau GA, Patton KT: Anatomy and physiology, ed 6, St Louis, 2007, Mosby.)

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

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