Sheena gets a referral to see Mrs. Wayne

The last email Sheena reads is a referral by one of the radiation oncologists to see Mrs. Wayne. This patient has been admitted for radiation therapy for an oral tumour. Although most patients receive this treatment on an outpatient basis, Mrs. Wayne is 79 years old and somewhat frail. Her oncologist felt it would be best to admit her while on radiation to provide additional supports.

After reviewing her chart (3.01i) and speaking with Mrs. Wayne, Sheena collects the following information. Mrs. Wayne has just started her radiation treatment and is not yet experiencing many of the associated side effects. However, the inflammation caused by the oral tumour is making it difficult for Mrs. Wayne to wear her dentures and therefore she cannot chew harder textures (3.01f, 3.01cc).

Sheena also notes that Mrs. Wayne has lost approximately 8% of her body weight over the past few months (3.01r). Mrs. Wayne has had vision loss in both of her eyes. This makes it difficult for her to see her food, cut it up, or open packages easily (3.01z). Lastly, Mrs. Wayne’s nurse says the she has quite a few food likes and dislikes (3.01n) and that Ms. Wayne would like to review her food preferences with someone.

Sheena reviews some of the foods that Mrs. Wayne was eating at home and thinks that ‘minced’ may be the most appropriate texture to offer at the hospital. She describes these nutritional problems to Mrs. Wayne and discusses the types of foods that would come on a minced meal tray, along with snacks and supplements that would help to meet her energy and protein needs (3.01hh, 3.02f). Mrs. Wayne agrees to Sheena’s recommendations.

Sheena documents her assessment and nutrition care plan for Mrs. Wayne

Sheena goes back to the nursing station on the hospital floor to document her interaction with Mrs. Wayne, her assessment, and nutrition care plan (1.10g, 2.01d). She enters the diet order to change Mrs. Wayne’s diet to a minced texture diet (3.03b). Sheena also adds a few extra snacks for her throughout the day, and a liquid nutritional meal supplement to improve her overall energy and protein intake (3.02h, 3.02j). As mentioned before, she is able to implement this order under the authority of the medical directive established at her hospital.

Sheena also thinks it would be a good idea to have the diet technician see Mrs. Wayne to review some of her food preferences, and adds a suggestion in the chart for this referral. This referral to the diet technician may help to further maximize Mrs. Wayne’s food intake (3.03e).

She then adds a suggestion in the physicians orders section for the nurses to weigh Mrs. Wayne weekly and to request that they help with opening packages around mealtime (3.02x, 3.03b). Sheena will follow up with a phone call to the diet technician to provide more information about the referral (3.02t).

Sheena made sure to obtain Mrs. Wayne’s approval on the complete nutrition care plan she developed before she implemented the plan (1.02l).

Continue Reading