| A | B |
|---|
| Basal metabolic rate (BMR) | The amount of energy the body expends in a given period to maintain basic functions. |
| Genetics and nutritional needs | Genetics influence body structure, thyroid function, and basal metabolic rate. |
| Age and nutritional needs | Metabolic rate usually slows with age, so fewer calories may be required. |
| Gender and nutritional needs | Men tend to need more calories than women on average because they are often larger and have more muscle mass. |
| Pregnancy and nutritional needs | Pregnancy increases energy needs; adequate calories and protein are important to support pregnancy and, after delivery, breastfeeding. |
| Activity and nutritional needs | Increased activity uses more calories and raises metabolic rate; inactivity generally lowers calorie needs. |
| Illness and nutritional needs | Illness can increase calorie and protein needs, especially when fever, trauma, surgery, or healing is involved. |
| Why hospitalized patients may need extra protein | Extra protein may be required to promote tissue repair and recovery. |
| Dietitian | Health professional who oversees nutritious diets specifically ordered for patients. |
| Clinical secretary and nutritional services | The clinical secretary communicates diet orders and changes so patients receive the correct diet. |
| Diet change near mealtime | The clinical secretary may need to call nutritional services to ensure the change is processed for the next meal. |
| Diet order for a new admission | Check that a diet has been ordered and that nutritional services knows the patient is on the unit and needs a meal. |
| Discharged patient meals | Cancel meals when a patient is discharged, following facility procedure. |
| Incorrect or missing meal tray | Contact nutritional services to correct errors or omissions. |
| Clinical secretary and feeding a patient | If a patient asks to be fed, get the nurse because the nurse is more aware of the patient’s feeding needs and restrictions. |
| Regular diet (DAT - Diet as tolerated) | A diet with no restrictions; adjusted according to what the patient can tolerate. |
| Therapeutic diet | A diet ordered as part of treatment for a disease or clinical condition. |
| NPO | Nothing by mouth. |
| Clear fluid diet (CF) | A low-residue liquid diet that may include clear soup or juice, ginger ale, coffee, tea, and plain Jell-O. |
| Full fluid diet (FF) | Includes clear fluids plus foods such as strained soups, milk, yogurt, ice cream, eggnog, and custard. |
| No Added Salt diet (NAS) | often ordered for patients with fluid retention or congestive heart failure. |
| Cardiac diet | Generally restricts fat and cholesterol and may also restrict sodium and calories. |
| CDA diet | A diabetic diet with a prescribed calorie level and controlled proportions of carbohydrates, fats, and proteins. |
| Diabetic diet and snacks | Patients with diabetes, especially those using insulin, may receive scheduled snacks during the day. |
| Gluten-free diet | A lifelong diet for people with celiac disease that avoids gluten-containing grains. |
| Celiac disease | A condition involving damage to the small intestine in response to gluten; a gluten-free diet is required. |
| High-fibre diet | Used to stimulate peristalsis and bowel movements, often for constipation or sluggish bowels. |
| High-protein diet | May be ordered for weight gain or tissue repair, such as after major surgery. |
| High-calorie diet | May be ordered for patients with excessive weight loss or difficulty maintaining a healthy weight. |
| Low-residue or surgical soft diet | Decreases fibre and cellulose to reduce bowel motility, often after gastrointestinal surgery or with certain bowel conditions. |
| Bland diet | Contains easily digested foods and avoids fried or highly spiced foods; may be used for chronic gastritis, peptic ulcers, dyspepsia, or hiatus hernia. |
| Mechanical soft diet | Foods are soft in texture and may be chopped, ground, or puréed to reduce chewing. |
| Puréed diet | Food is ground to a smooth texture; often ordered for patients who cannot chew or who have dysphagia. |
| Dysphagia | Difficulty swallowing; a puréed diet may be ordered. |
| Minced diet | Food is ground finely, but not as finely as a puréed diet; used when a patient can swallow some texture but not larger pieces. |
| Progressive diet | A sequence of diets advanced in stages as tolerated, often after major surgery or gastrointestinal illness. |
| Typical progressive diet sequence | NPO, ice chips or sips, clear fluids, full fluids, soft diet, then DAT or regular diet. |
| Progressive diet advancement | The nurse assesses the patient and determines when the diet can advance; the clinical secretary updates the diet status accordingly. |
| Transitional diet | A temporary limited diet used as an alternative to a progressive diet before or after surgery. |
| Diet protocol before anesthesia | A patient is usually NPO for a period before a procedure requiring anesthesia, according to the order and facility protocol. |
| Gastroscopy and diet | A patient is typically kept NPO before gastroscopy; the diet order should be reflected on the eKardex and meals cancelled or delayed as required. |
| Tests that may require fasting | Some blood tests, such as fasting blood sugar or cholesterol/triglyceride testing, may require the patient to be NPO. |
| Postoperative diet | Diet is often reintroduced gradually depending on the surgery, the patient’s response to anesthesia, bowel sounds, and tolerance. |
| Bowel sounds | Sounds that may help guide when a postoperative diet can be advanced. |
| Enteral feed | Nutrition delivered by a tube directly into the gastrointestinal system. |
| Purpose of tube feeding | To provide nutrition when a patient cannot safely eat or swallow normally or cannot obtain adequate nutrition orally. |
| Nasogastric tube (N/G tube) | A tube inserted through the nose into the stomach; also called a Levine tube. |
| Gastrostomy tube (G-tube) | A tube inserted through the abdominal wall into the stomach. |
| Jejunostomy tube (J-tube) | A tube inserted through the abdominal wall into the jejunum or small bowel. |
| PEG tube | Percutaneous endoscopic gastrostomy tube inserted through the skin and abdominal wall into the stomach using an endoscope. |
| Bard button | A skin-level device surgically placed into the stomach through the abdominal wall to facilitate gastric feeding. |
| French (Fr.) size | A measurement of the bore or diameter of a feeding tube. |
| Small-bore feeding tube | Approximately 6 to 8 Fr. |
| Large-bore feeding tube | Approximately 10 to 14 Fr. |
| Tube insertion on the eKardex | Insertion of a feeding tube is entered as an intervention and becomes active once completed. |
| Continuous enteral feed | Feeding solution is delivered slowly and continuously, often using an electronic feeding pump. |
| Trickle feed | A very slow continuous gastric feed used to gradually reintroduce nutrition. |
| Periodic enteral feed | A prescribed volume of feeding solution is given at scheduled intervals throughout the day. |
| Enteral feeding pump | A pump used to control tube feeding volume and rate; it is different from an IV infusion pump. |
| Enteral feeding formulas | May be specially prepared or commercial products such as Osmolite, Jevity, Ensure, Compleat, Enrich, Travasorb, or Ensure Plus. |
| Enteral diet order documentation | Without CPOE, enter the feed type, route or delivery method, and rate if ordered on the eKardex. |
| Storage of enteral feeds | Feeds delivered to the unit should be stored appropriately, usually in the refrigerator, rather than left at the nursing station. |
| TPN | Total parenteral nutrition; a complete form of nutrition containing protein, carbohydrate, fat, vitamins, and minerals. |
| TPN route | Usually delivered through a central line or PICC line because these are suitable for long-term feeding. |
| TPN indications | Severe malnutrition, major trauma or surgery, prolonged coma, severe bowel inflammation |
| TPN baseline blood work | Blood work is ordered when TPN begins to establish baseline values and help monitor nutritional status and needs. |
| Blood tests commonly associated with TPN | May include glucose, BUN, creatinine, electrolytes, calcium, albumin, INR, triglycerides, PTT, bilirubin, AST, and phosphorus. |
| Clinical secretary and TPN blood work | Ensure ordered blood work reaches the lab and that results are returned according to the workflow. |
| TPN on the eKardex | TPN may appear under nutrition, parenteral therapy, or both. |
