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CDM Study Set QUESTIONS AND SOLUTIONS RANKED A+
define tube feeding and when it is used - process of giving a person nutrients through a tube into their digestive tract, used when a client is unable to eat or is not eating enough to meet their nutrient needs, paralyzing injury, or coma usually temporary, most commonly through nose and into stomach describe a self-audit and when one is used - a procedure in which a check-list or other form is used to review a currently used process or program can be used at any time, should be used routinely purpose is to identify problems in currently used procedures describe a taste panel and when one should be used - a group of people who taste food and rate them on a given scale used to taste new recipes before they are officially added to the menu the taste panel gives an idea of the acceptance of the new item rating scale goes from extremely poor to extremely good describe an effective quality control process (9) - must be proactive, do not wait for a complaint
- establish objectives for department
- determine steps needed to achieve objective
- develop procedures
- establish standards
- teach employees standards
- implement procedures
- develop monitoring program
- evaluate outcome
- if needed, rewrite procedure describe and F-tag and its purpose - numbers used by the Centers for Medicare and Medicaid services f-tags for every aspect of care in the facility, making sure clients with these tags are being held to specific standards describe batch cooking and when you would use it - preparing foods in small amounts continuously (baked chicken, stir fry, hot sandwiches) allows food to remain at the correct temperature after preparation describe communication techniques that should be used with any client - 1. good verbal techniques: open and honest, treat with respect, involve them in goal setting
- listening: although you are the educator, you must listen tot he client, maintain eye contact, ask follow up questions
- promote effective communication: know how your client communicates and struggles or concerns, use language they understand, not medical terms
describe the factors that should be taken into consideration when planning a menu - adhere to personal taste, and try to honor those preferences adhere to chewing or swallowing difficulties food should be aesthetically pleasing goal is to have client consistently finish meals describe the importance of charting nutritional information in the medical record - helps to remember details of the client's nutritional status, but also provides all other health care professionals to the client's nutritional status nutritional information that is noted in medical records may change the type of treatment that other providers are prescribing charting it may also bring attention to other problems that other providers may have missed refer to your previous note to track trends and see progress (ex: if they eat less it may be why they seem weak during physical therapy describe the one-pot cooking method for modifying standard menus - for patients who must have a low-sodium diet, though others have no restrictions, everyone will get a low sodium diet to reduce number of meals that must be prepared could lead to issues though, restricting those who do not need it
describe the point-of-sales record - computer-based cash register to keep track of what items are sold and when keeps inventory to see when out of items describe the process of using a census to create a forecast - when looking at the census, split clients according to diet order gives an estimate of how much of each product in each diet order will be used describe the six types of selective menus - 1. preselect: a preplanned menu that the client receives to make their selections
- table-side select: a preplanned menu that is posted in the dining room and clients make selections at the time of the meal
- spoken: an employee from the food service department tells the client what the options are, if the client is unsatisfied then other options may be presented
- restaurant variations: a menu presented ahead of the meal to show daily specials as well as standard items
- cafeteria: similar to the restaurant variation but not presented ahead of time
- buffet: menu planned for clients to serve themselves describe the steps in monitoring food waste - 1. implement a waste log
- have employees record the amount of food wasted at each meal
- find out why certain items werent eaten
discuss how to conduct a plate waste study - take a large sample of trays from a single meal, analyze the different waste and the different reasons for it (too much served, didnt like, difficulty eating, not hungry) talk to clients about why they didnt eat it on a plate waste form, include each item of the meal and mark how much was eaten use this menu when testing new items discuss the information that is found on a diet order - written or printed diet order goes from physician to kitchen lists client's name, room number, and date of order any restrictions will be listed on diet order diet order will also include texture, allergies, and intolerances discuss the purpose of an electronic health record (EHR) and what can be found (6) - document any interaction with the client and any treatment that the client receives, available for other healthcare professionals involved in treatment to communicate with each other, document client's condition and progress past medical history, demographics, progress notes from other healthcare professionals, prescribed treatments, medications, and relevant images discuss time and temperature controls - must be monitored continuously time and temperature determine quality and safety of food
discuss what to look for in a client to decide of supplemental feeding is necessary - usually considered nutritionally at risk, could be for multiple different reasons low intake at meals, difficulty chewing, or swallowing, unintentional weight loss, or increased nutritional needs Dx - diagnosis eastern orthodox christian dietary patterns - limits on meat and fish during fasting times explain how a client's medical or personal condition would impact the menu offered to them - any condition will be noted in nutrition plan medical conditions, allergies, intolerances, pregnancy, and eating disorder would all impact nutritional plan explain how a nutrition plan for a client would impact the meals they are served - considered part of treatment, nutrition plan should always be reviewed when planning a menu for a client there is usually a recommended amount of calories and proteins which should be adhered to the plan is also to limit the amounts and types of food a client can have this part of the nutrition plan is very important and can have a detrimental impact on clients health if not followed explain how the food habits of a client would impact the menu you offer them - if the goal is to have them finish their food, their food habits need to be in consideration
total cost divided by number of servings explain how to do carbohydrate counting and when you would use it - used for clients with diabetes due to carbs sugar content when broken down, diabetics need to watch their intake to prevent spikes in blood sugar. need a chart of how many carbs are in different food groups, a physician will have a daily carb limit for the client and spread those carbs throughout the day so the client's blood sugar can remain steady carb limit is dependent on weight, type of diabetes, medications, and amount of insulin they are prescribed explain how to recognize the appropriateness of a diet order - double check the clients diagnosis and medical history must know what diagnosis means and what sorts of foods must be monitored always double check with physician explain how to summarize and explain data from survery - open-ended: read each answer individually and analyze what they say and look for any problems which havent been mentioned before closed questions: tally up number of responses and make notes of trends
explain how to tell if a nutrition care plan is effective - check hydration status, monitor nutrition status and weight loss blood sugar daily if diabetic explain how you would honor client rights while still getting the information you need to do your job - listening to client can go a long way to gain the client's trust adhere to food requests when you can observe the client eat a meal, but not to make them uncomfortable explain importance of verifying nutrition information that you record or view in the medical record - what you record is a justification of for their medical treatment, therefore information must be accurate. using subjective and objective information will ensure the accuracy of what is recorded if you suspect they are losing weight, weight them before documenting anything if you think food intake might be low, find in the record where it has been observed verify information by speaking with other members of the healthcare team keep detailed record explain the consequences of not adhering to a physician's diet order - could potentially make the disease worse, could effect blood sugar, organ failure, or choking
ensure evaluations are taken upon admission **best way to ensure at-risk clients are identified in a timely manner explain the importance of having a production schedule - preparing meals takes a lot of planning and preparation, and having a schedule to list what needs to be down, when, and by who, makes the process a lot easier any advanced preparation should be listed on production schedule explain the importance of keeping client information confidential - can be shared with healthcare worker if it is their job, but you need permission otherwise. if it is heard and does not concern you as a healthcare worker, do not repeat. explain the importance of knowing the nutrient content of foods before making food substitutions - foods are vastly different in nutrient makeup. make sure the foods you re substituting are equal in the nutrient being substituted explain the importance of monitoring the delivery of supplements - very important to receive as prescribed specific to time or number of times per day directions should be listed in medical chart explain the importance of portion control when using a standardized rcipe - a standardized recipe produces a specific number of servings, and if portions are too large the yield of the recipe will be off, effecting the predicted cost
nutrient information will change as well effected the portion is changed explain the process of completing a Minimum Data Set (MDS) - used by healthcare team to assess client, different sections are filled out by different members of healthcare team CDM - section K Oral/Nutritional Status
- filled out with information you gather from interviewing client, reading medical chart, discussion with other members of healthcare team, Section K:
- swallowing ability (observable or need speech path referral)
- height and weight (cdm or registered nurse)
- weight loss (gathered by client or in medical record
- nutritional approaches (any nutritional interventions)
- feeding tubes (record how much formula the client needs through artificial means) explain the process of monitoring diet accuracy - when kitchen receives a diet order, it should be placed separately from other diets (by charts/color-coding) diet orders should be checked every day for any changes made, when being prepared and when leaving the kitchen explain the purpose of a Hazard Analysis Critical Control Point plan - prevents a product from becoming contaminated during the preparation stages and to prevent causing illness these steps are critical to the safety of the food, known as critical control points (ex: cooking temp)
give examples of quality improvement monitoring that you could do with snacks and supplements - make sure snack or supplement follows diet order make sure snack is prepared in kitchen with the correct nutrients make sure snack is delivered at the appropriate time communicate with patients to make sure they like the snack hinduism dietary patterns - does not consume beef, also limits other meat and animal products identify contacts who will give you the best idea of a client's nutritional status - most of the information should come from the client themselves if possible anyone who lives in the house, client's caregiver, any other member of the healthcare team, medical records communication with entire team is key to understanding their nutritional status identify critical issues that would make a client be considered a risk (7) - has concerns that could cause nutritional concerns, risks such as low food intake, not being able to hold down food, having gastrointestinal disease that impacts nutrient absorption, having a disability making it hard to cook/chew/swallow, malnutrition, evidence of an eating disorder, recent weight loss of
10% body weight over 6 months identify sensitive ways you would ask about a client's food customs - never make any assumptions, let them share all info with you. tell client you are more than happy to accommodate any food customs and preferences based on their religion
never ask why they dont eat a certain food liquid diets are used for what - gastrointestinal problems list common differences in islamic dietary law - halal must be prepared and slaughtered a certain way list main sources of carbs - simple: table sugar, corn syrup, brown sugar, and molasses complex: starches and fibers found in bread, cereal, legume, pasta, veggie, fruits list questions you should ask a client to best evaluate their nutritional status - food allergies, food likes and dislikes, typical eating habits, who does the grocery shopping, who does the cooking, how many meals and snacks are eaten in a day, any recent weight changes, supplement intake, energy levels food diaries are very helpful (weeks worth is ideal, but 24 hour recall is fine) also available by caregiver list relevant nutrition-related information that should be documented ina client's medical record - anthropometric measurements (measurements of the clients body - height, weight, and wrist circumference) these numbers will be used for calculations for the medical record relevant lab tests: (see note card) medical and social factors that have an impact on nutrition, a diet history, medication list, and estimated nutrient needs
monounsaturated fats: peanuts, olive oil, almonds, avocado, seeds polyunsaturated fats: margarine, corn oil, sunflower oil, walnuts, sunflower seeds list the main sources of protein - complete: found in meat, poultry, fish, dairy, and eggs incomplete: plant products such as grains, legumes, seeds, nuts list the people involved in implementing the nutrition care plan - dietary staff makes sure plan is approved before each meal CDM supervises day to day implementation of the nutrition care plan by managing dietary staff RD implements the nutrition care plan by reading clients chart and talking to client to ensure certain foods are being eaten an progress toward nutrition goal is being made nursing staff implements nutrition care plan by charting client's adherence and tolerance to the plan and note any issues physician follows up with patients regarding all goals set in the care plan list the steps that you would take if a client requests a food substitution that you do not have available at the facility - first step is to talk to the RD of physician if needed if it is decided that it cannot be provided, speak to the client and tell them everything was done but it is not possible to provide the substitution provide them w other substitutions that might meet their satisfaction list the team members involved in evaluating care plans
(RD, CDM, nurses, occupational therapist, social worker, speech path) - RD continually evaluates nutrition care plan to adjust as needed as progress is made CDM talks to client and nursing staff to see how client is tolerating plan nurses present meals, monitor eating and weight occupational therapist helps w devices needed to aid clients social worker evaluates care plans when client is discharged speech pathologist involved in care plan in event of chewing or swallowing issues list ways to gauge client acceptance of new recipes - talking with client, surveys, observe plate waste list what documentation should be reviewed for nutrition care follow-up - review anything nutritionally relevant start with previous nutrition progress, read subjective information and ask follow up questions based from those (if they said they felt nauseous after meals, ask if they still do) review previous lab work for any nutrition related tests medications can change so be sure to look at recent medications taken review any other healthcare worker's previous notes
