Nutrition

TPN is prescribed for a client with Crohn's disease. What indicates to the nurse that the TPN has been effective?

The client has met nutritional needs. The goal of TPN is to meet the client's nutritional needs. TPN is a hypertonic solution containing carbohydrates, amino acids, electrolytes, trace elements, and vitamins.

A client has impaired skin integrity related to compromised circulation. What should the nurse include in the teaching plan regarding nutritional considerations?

adequate intake of vitamins A and C, protein, and zinc For clients with a risk for impaired skin integrity related to compromised circulation, good nutrition in the form of adequate intake of vitamins A and C, protein, and zinc is recommended.

The nurse is providing nutrition counseling for an obese adolescent. What is the most effective way for the nurse to obtain a nutrition history from this client?

Ask her what she ate yesterday if it was a typical day. A 24-hour recall history is the best method to obtain a dietary history from an adolescent. Open-ended questions tend not to provide sufficient details for a nutrition history. Asking what the client plans to eat in the future gives the client an opportunity to report the "right" answer. The nurse obtains the information directly from the client; asking the mother has the potential to undermine trust.

The nurse is developing a teaching plan for the client with hepatitis A. What should the nurse tell the client to do?

Increase carbohydrates and protein in the diet. A low-fat, high-protein, high-carbohydrate diet is encouraged for a client with hepatitis to promote liver rejuvenation. Nutrition intake is important because clients may be anorexic and experience weight loss. Activity should be modified and adequate rest obtained to promote recovery. Social isolation should be avoided, and education on preventing transmission should be provided; the client does not need to sleep in a separate room.

Which adverse effect occurs when there is too rapid an infusion of TPN solution?

Circulatory Overload Too rapid infusion of a TPN solution can lead to circulatory overload. The client should be assessed carefully for indications of excessive fluid volume. A negative nitrogen balance occurs in nutritionally depleted individuals, not when TPN fluids are administered in excess. When TPN is administered too rapidly, the client is at risk for receiving an excess of dextrose and electrolytes. Therefore, the client is at risk for hyperglycemia and hyperkalemia.

A client with cancer of the stomach had a total gastrectomy 2 days earlier. Which indicates the client is ready to try a liquid diet?

The client has frequent bowel sounds. The client can begin eating with a liquid diet when bowel sounds return, usually in 2 to 3 days. The client may be hungry but cannot have oral fluids or foods until intestinal motility has been established. The client may continue to have postoperative pain for several days; because receiving a liquid diet does not depend on the client being pain free, the nurse can continue to offer pain medication. The client does not have to experience a bowel movement to receive fluids and food.

A client is admitted with multiple pressure ulcers. When developing the client's diet plan, the nurse should include

ground beef patties Meat is an excellent source of complete protein, which this client needs to repair the tissue breakdown caused by pressure ulcers. Oranges and broccoli supply vitamin C but not protein. Ice cream supplies only some incomplete protein, making it less helpful in tissue repair.

A client has been on long-term prednisone therapy. What should the nurse instruct the client to include in the diet? Select all that apply.

Protein, Potassium, Calcium, Vitamin D Adverse effects of prednisone are weight gain, retention of sodium and fluids with hypertension and cushingoid features, a low serum albumin level, suppressed inflammatory processes with masked symptoms, and osteoporosis. A diet high in protein, potassium, calcium, and vitamin D is recommended. Carbohydrates would elevate glucose and further compromise a client's immune status. Saturated does not counteract the adverse effects of steroids such as prednisone.

A nurse is administering total parenteral nutrition (TPN) to a client hospitalized with severe anorexia nervosa. Which laboratory finding would alert the nurse to a potential problem?

decreased magnesium levels A decreased magnesium level indicates continued malnutrition problems; the prescribing physician or an advanced practice nurse would have to adjust the chemical composition of the TPN. Elevated glucose levels are expected in a client receiving TPN because of the high concentration of glucose being administered. A client with anorexia nervosa is at risk for a decreased, not elevated, phosphate level. A decreased CD4 cell count is a laboratory value associated with a diagnosis of human immunodeficiency virus or acquired immunodeficiency syndrome, not with a diagnosis of anorexia nervosa.

Which foods should the nurse teach the client not to consume when taking phenelzine?

Chocolate, Smoked meat, yogurt When taking phenelzine, the client should not consume foods and beverages containing tyramine or tryptophan, or drugs containing pressor agents. Tyramine-containing foods/fluids include aged cheeses, tofu, beer, and smoked meats. Tryptophan-containing foods include chocolate, cottage cheese, milk, and yogurt. Strawberries and pasta are safe for this client to consume.

A client with alcohol dependency is prescribed a B-complex vitamin. The client states, "Why do I need a vitamin? My appetite is just fine." Which of the following responses by the nurse is most appropriate?

"The vitamin is a nutritional supplement important to your health." Stating that the vitamin is a nutritional supplement important to the client's health is the best response. The client is nutritionally depleted, and the B-complex vitamins produce a calming effect on the irritated central nervous system and prevent anemia, peripheral neuropathy, and Wernicke's encephalopathy.

A parent of a 7-year-old child with Hirschsprung's Disease and chronic constipation asks about increasing dietary fiber in the child's diet. Which food could the nurse recommend?

Popcorn Popcorn is high in fiber. Foods high in fiber help the bowels move. Constipation may be managed initially with increased fiber and fluids. White bread, fruit juice and pancakes are foods that are not high in fiber.

Which client should the nurse expect to manage a percutaneous feeding tube as part of daily care?

90-year-old client with dysphagia following a stroke. A percutaneous feeding tube is usually placed when there is difficulty with swallowing because of neurologic or anatomic disorders and can help prevent aspiration. It is a tube into the stomach or intestine and used to give medications and long-term enteral nutrition, such as for the 90-year-old client with dysphagia (difficulty swallowing) from a stroke. The client with bilateral upper extremity amputations may require assistance feeding oneself, but nothing in this scenario indicates the client would need a percutaneous feeding tube. The client with paraplegia would not have feeding difficulty or dysphagia, as the lower extremities would be affected in this case. The child with an autism spectrum disorder would not need a feeding tube for behavioral disturbances.

Caregivers of an infant with a feeding button style gastrostomy tube mention to the nurse there is leaking present. What action should the nurse take?

Assess if the leakage is coming from valve failure or from the peristomal area. The nurse should assess the source of the leakage because intervention will vary depending on the cause. Leakage should not be treated as normal until interventions have failed to remedy the source of the leaking. Therefore, simply applying barrier cream or gauze does not properly address the problem. How the caregivers attach the tubing could be explored after the nurse assesses the infant's gastrostomy site but the technique would not explain leakage that occurs between feedings.

A client with bipolar disorder, manic phase, shows little interest in eating. What should the nurse do to help the client meet recommended daily allowances of nutrients?

Give the client half a meat and cheese sandwich to carry with them. The best nursing intervention is giving the client finger foods high in protein and calories that he can eat while he paces or walks. Informing the client that snacks are available if he eats properly at mealtime is inappropriate because the client is too busy and distracted to sit and eat an entire meal. Telling the client to sit alone at mealtime to decrease distractions will not help him, because the client is in a manic state, is easily distracted, and needs to move. Teaching the client about proper nutrition ignores his need for adequate intake. The client would be unable to focus on the nurse's teaching.

An older adult has vertigo accompanied with tinnitus as the result of Ménière's disease. The nurse should instruct the client to restrict which dietary element?

Sodium Ménière's disease is commonly seen in older women; the disorder is caused by pressure within the labyrinth of the inner ear as a result of excess endolymph resulting in swelling in the cochlea. Therefore, the nurse should instruct the client about dietary restrictions of sodium to reduce fluid retention. Pharmacologic treatment includes antivertiginous drugs and diuretics. If the client is prescribed a diuretic, the fluid and electrolytes are monitored. The amount of protein does not have a direct influence in this disease process.

A nurse is caring for a client with bulimia nervosa. Strict management of the client's dietary intake is necessary. Which intervention is the most important?

Serve the client's menu choices in a supervised area and observe the client 1 hour after each meal. Why? Allowing the client to select food from the menu will help the client feel some sense of control.

The parent asks the nurse about a 9-year-old child's apparent need for between-meal snacks, especially after school. What information should the nurse include in the teaching plan?

The child should help with preparing the snacks. Snacks are necessary for school-age children because of their high energy level. School-age children are in a stage of cognitive development in which they can learn to categorize or classify and can also learn cause and effect. By preparing their own snacks, children can learn the basics of nutrition (such as what carbohydrates are and what happens when they are eaten). The mother and child should make the decision about appropriate foods together. School-age children learn to make decisions based on information, not instinct. Some knowledge of nutrition is needed to make appropriate choices.

The nurse observes that the client's total parenteral nutrition (TPN) solution is infusing too slowly. The nurse calculates that the client has received 300 mL less than was prescribed for the day. The nurse should:

assess the infusion system, note the client's condition, and notify the health care provider. The nurse's most appropriate action is to assess the infusion system to determine the cause of the inaccurate flow rate and to note the client's response to the decreased infusion, especially signs of hypoglycemia. The health care provider should be notified of the infusion discrepancy.

The nurse is planning care for a client who has been experiencing a manic episode for 6 days and is unable to sit still long enough to eat meals. Which choice will best meet the client's nutritional needs at this time?

a peanut butter sandwich Giving the client finger foods that have protein, carbohydrates, and calories supplies energy and allows the client to eat while on the move. A salad or soup is very difficult for the client to eat while moving and may not supply the nutrients needed. Favorite foods from home may or may not be appropriate to eat while walking.

In evaluating a client's response to nutrition therapy which laboratory test would be of highest priority to examine?

albumin level Protein and vitamin C help build and repair injured tissue. Albumin is a major plasma protein; therefore, a client's albumin level helps gauge their nutritional status. Potassium levels indicate fluid and electrolyte status. Lymphocyte count and differential count help assess for infection.

The nurse teaches a client who has recently been diagnosed with hypertension about following a low-calorie, low-fat, low-sodium diet. Which menu selection would best meet the client's needs?

baked chicken, an apple, and a slice of white bread Processed and cured meat products, such as cold cuts, ham, and hot dogs, are all high in both fat and sodium and should be avoided on a low-calorie, low-fat, low-salt diet. Dietary restrictions of all types are complex and difficult to implement with clients who are basically asymptomatic.

The client attends two sessions with the dietitian to learn about diet modifications to minimize gastroesophageal reflux. The teaching would be considered successful if the client decreases the intake of which foods?

fats Fats are associated with decreased esophageal sphincter tone, which increases reflux. Obesity contributes to the development of hiatal hernia, and a low-fat diet might also aid in weight loss. Carbohydrates and foods high in sodium or calcium do not affect gastroesophageal reflux.

A client is recovering from a gastric resection for peptic ulcer disease. Which outcome indicates that the goal of adequate nutritional intake is being achieved 3 weeks following surgery? The client:

increases food intake and tolerance gradually. Weight gain will be slow and gradual because less food can be eaten at one time due to the decreased stomach size. More food and fluid will be tolerated as edema at the suture line decreases and healing progresses. The remaining stomach may stretch over time to accommodate more food.

A nurse is discussing nutrition and weight control with clients during a class about diabetes. Which statement best reflects the purpose of nutritional management of diabetes?

to maintain blood glucose levels close to the normal range to reduce risk for long-term complications Maintaining normal blood glucose is the most important factor in preventing long-term complications associated with diabetes. Therefore, the most important purpose of nutritional management is maintaining blood glucose as close to normal as possible to prevent long-term complications. Following nutritional recommendations will meet energy needs, may contribute to weight control, and keep cholesterol levels within acceptable ranges, but the most important reason for nutritional management is to maintain blood sugars in the normal range.

Pancreatic enzyme replacements are prescribed for the client with chronic pancreatitis. When should the nurse instruct the client to take them to obtain the most therapeutic effect?

with each meal and snack In chronic pancreatitis, destruction of pancreatic tissue requires pancreatic enzyme replacement. Pancreatic enzymes are prescribed to facilitate the digestion of proteins and fats and should be taken in conjunction with every meal and snack. Specified hours or limited times for administration are ineffective because the enzymes must be taken in conjunction with food ingestion.

A primiparous client is on a regular diet 24 hours postpartum. The client's mother asks the nurse if she can bring her daughter some "special foods from home." The nurse responds, based on the understanding about which principle?

The mother can bring the daughter any foods that she desires. On most postpartum units, clients on regular diets are allowed to eat whatever kinds of food they desire. Generally, foods from home are not discouraged. The nurse does not need to obtain the HCP's permission. Although it is preferred, the foods do not necessarily have to be high in iron. In some cultures, there is a belief in the "hot-cold" theory of disease; certain foods (hot) are preferred during the postpartum period, and other foods (cold) are avoided. Therefore, the nurse should allow the mother to bring her daughter "special foods from home." Doing so demonstrates cultural sensitivity and aids in developing a trusting relationship.

After teaching the client about bottle-feeding, which client statement indicates the need for additional teaching?

"Whole milk is an acceptable alternative to formula once the baby is 4 months old." Neither unmodified cow's milk nor whole milk is an acceptable alternative for newborn nutrition. The American Academy of Pediatrics and Canadian Pediatric Society recommend that infants be given breast milk or formula until 1 year of age. However, the American Academy of Pediatrics Committee on Nutrition has decreed that cow's milk could be substituted in the second 6 months of life, but only if the amount of milk calories does not exceed 65% of total calories and iron is replaced through solid foods. The protein content in cow's milk is too high, is poorly digested, and may cause gastrointestinal tract bleeding. Bottle-fed infants may gain as much as 1 oz (30 g)/day up to age 6 months. Iron-fortified formulas are recommended. Bottle-fed neonates may regain their birth weight by 10 to 14 days of age.