Nutrition practice B

Manifestations: diabetic ketoacidosis

↑ Urination Fruity breath Kussmaul respirations Excessive thirst Orthostatic hypotension

Reducing the risk of infection: Dietary teachings (Immuno compromised/receiving Chemotherapy)

↓ risk from food borne pathogens: Thaw food in fridge Use leftovers within 24 hours Use home canned goods within 1 year of canning & Cook for 10 minutes prior to eating Keep hot foods at > 140°F

Diet Teaching: post-op colostomy placement

Increase intake of foods containing pectin -Eat foods that thicken the consistency of feces (e.g. pectin) Drink 8-10 C fluid/daily Resume regular diet by 6 weeks

Nurse Action: reduce aspiration risk during intermittent Enteral feedings

**Semi Fowler's position 30 min + after feeding Flush tubing with at least 40-50 mL water following each feeding to maintain to patency Room temp formula = ↓ abdominal cramps Check NG-tube placement 1x/day

What lab finding indicates that TPN therapy was effective?

Pre-albumin 30 mg/dL

Manifestations: Hypoglycemia

Tremors Diaphoresis Confusion Irritability Heart palpitations Sweating

Breast milk as nutritionally complete for an infant up to

6 months -Iron fortified infant formula is an acceptable substitute for, or supplement to breast-feeding -breast milk and formula provide adequate water-to-calorie ratio to meet needs of newborns and infants -cows milk 1yr+

Appropriate snack foods for a two-year-old toddler

1 cup of yogurt - The consistency poses no choking hazard, has 8 g of high-quality protein -toddlers require 13 to 16 g of protein/day to meet the demands for muscle growth -until a toddler reaches 4-years-old they are at an extremely high risk for choking

High-fiber diet is recommended for diverticular disease

1/2 C bran cereal = 10 g/serving 1 med. Apple (w/skin) = 4 g 1/2 C oatmeal = 4 g 1 med. Banana = 3 g

What food item contains a high amount of folate?

3.5 oz chicken liver = 770 mcg

Increase zinc intake: chronic skin ulcers of lower extremities

4 oz ground beef = 5.49 mg HIGH 1 C Apple slices = 0.04 mg

What ↑ risk for dysrhythmias for a client with end-stage kidney diseases (ESKD)

A diet rich in potassium -Urine output declines, hyperkalemia develops which can cause cardiac dysrhythmias -A client with ESKD should NOT consume a protein rich diet (uremia occurs from the buildup of waste products from the breakdown of proteins)

5% weight loss in 30 days: indication of malnutrition

Ankle edema -Lower extremity edema indicative of Protein deficiency (malnutrition) Dry skin Paresthesia & weak hand grasp Dry conjunctiva

Three loose stools in 4 hrs: Continuous tube feedings via a gastrostomy

Anticipate a prescription to Decrease rate of the feeding -Prokinetic Medication = manage delayed gastric emptying, not diarrhea

Care plan: anorexia nervosa

Assign privileges based on direct weight gain -Involve Client in development of plan, gives them control in achieving desired privileges Remain with client during meals & 1 hr + after Daily weight

Avoid taking iron with ____

Calcium -can interfere with ______ absorption if taken together with meals

What mineral supplements can cause constipation

Calcium - decreased peristalsis Magnesium - excessive supplementation (diarrhea & cramping) Potassium - excessive supplementation (vomiting)

Diet modifications for cardiovascular disease: Traditional Mexican food

Canola oil - instead of lard to fry with Fat-free or low-fat cows milk - instead of whole or soy(not part of traditional diet) ↑ raw & cooked vegetables Limit lean meat, poultry, & fish to 2.5-3oz/meal

Which food can cause a potential medication interaction with captopril

Cantaloupe = 473 mg/ cup -ACE inhibitors retain potassium and can lead to hyperkalemia -Client should avoid cantaloupe and other foods high in potassium while taking ACE inhibitor

Cirrhosis & Ascites

Cirrhosis ↓ normal flow of blood through the liver = increasing pressure in the vein that brings blood to the liver from the intestines & spleen. Swelling in the legs & abdomen. The increased pressure in the portal vein can cause fluid to accumulate in the legs (edema) & abdomen (ascites).

Care plan: A client receiving radiation to the neck has developed stomatitis

Encourage client to consume frozen food such as bananas, ice cream or Popsicles -numbs mouth & alleviates pain Maintain good oral hygiene by: -soft bristle toothbrush -frequently rinse mouth using 0.9% sodium chloride & water or baking soda & water mix High-calorie, high-protein drinks -Promotes healing & replaces traditional meals Use straw -Minimize contact of liquids was sores in mouth

Dietary Teaching: COPD

Eat a soft diet & avoid foods that are difficult to chew - ↓ SOB while eating sauces & gravy should be added to prevent dry mouth Drink high-protein, high-calorie formula is between meals Eat 6 small meals/day -usually ______do not have the energy to eat large meals

Client Teaching: Nausea during pregnancy

Eat dry cereal before getting out of bed -carbs (dry cereal) absorbed quickly & readily raise blood sugar levels = ↓ Nausea Drinking liquids with meals leads to abdominal distention = exacerbate Nausea High-fat foods Delay gastric emptying time = ↑ nausea Avoid caffeine drinks such as coffee & tea; contributes to heartburn

A flu vaccine: what could place client at risk for a food allergy reaction

Eggs Hypersensitivity to eggs

NG-tube feedings: 1st action if feeding has stopped in fusing

Flush with 30 to 50 mL warm water to reestablish flow

Client client experiencing an acute exacerbation of Crohn's disease Should___

Follow a high-protein diet -to prevent Malnutrition and attain the required calories to promote healing Reduce fat intake during episode -fatty foods ↑ diarrhea & steathorrhea

Dietary interventions: stomatitis with prescribed external radiation for laryngeal cancer

Food Room temp or Colder -less irritating to the mucosa drink high-calorie, high-protein drinks as meal substitutes (minimal irritation) Avoid spices & salty foods (irritating) Avoid citrus and acidic foods

Dysphasia diet: A prescription/mechanical soft diet includes

Foods with altar texture, Softened with liquids, & Second for consistency Fruits & vegetables that are easy to chew Mashed potatoes

A client with chronic bronchitis requires _____ formula (enteral feeding)

High Calorie -pulmonary disease requires a high calorie formula & protein to maintain energy demands

Dietary recommendations: older clients

Increase daily protein intake ↑ strength & enhance immune function & wound healing Healthy older client - 1-1.5 g/kg/day acute or chronic issues 1.2-1.5 g/kg/day Take Calcium supplements → maintain healthy bones & aid in preventing osteoporosis -take with meals to ↑ Absorption Daily Vit D supplements → promote Calcium Absorption -older adults ↓ ability to synthesize from sun 1,000-2,000 IU/day

Ferrous Sulfate can be taken with___

Juice between meals (if gastric upset occurs) -beverages containing vitamin C enhance absorption (eg. tomato juice, orange juice) -caffeine ↓ absorption

Niacin aids in_____

Lowering LDL and triglycerides

Nutritional changes to consider for age related macular degeneration

Lutein - a carotenoid found in vitamin A slows the progression of a AMD Found in: kale, spinach, collards & mustard greens

Nursing Actions: client with advanced Parkinson's disease and dysphasia

Offer high-calorie diet -muscle rigidity ↑ metabolic rate = ↑ caloric need limit distractions so client can concentrate -reduce risk of aspiration Do NOT offer liquids to clear clients mouth of food solids ↑ risk of aspiration Position client in high-Fowlers -Prevent aspiration

Levodopa/Carbidopa (Parkinson's) Consume with____

One slice wheat toast -lower source of protein Protein ↓ Drugs Absorption

Client Teaching: Pregnant with a BMI of 22

Plan to gain 25-35 lb Increase daily intake by 400 cal

Cancer/chemotherapy: Aid with treatment related changes and taste

Plastic utensils -minimize metallic taste Increase fluid intake to improve taste Serve foods cold or room temp to improve taste Try tart foods & seasonings to improve taste

What is a low-residue diet/what is it used for?

Preparation for bowel surgery Limits the amount of stool traveling through the intestinal track Avoid: whole grains Fruits with seeds High fiber foods Fatty meats Poached eggs & bananas are acceptable low residue menu choices

Dietary discharge teaching: New ileostomy

Prepare meals on a schedule -promotes regular bowel elimination patterns ↑ Pasta & Other foods that can help thicken stool ↑ dietary salt to replenish fluid loss B12 necessary to prevent anemia related malabsorption

Early-stage renal disease: Advised to reduce____in diet (due to impaired kidney function)

Protein intake

Manifestations of phosphorus toxicity

Reflect those of hypocalcemia: Numbness & tingling - around the mouth & Extremities Tetany Deficiencies - rarely occur (extensive amount in food supply)

Diarrhea: Intermittent intro feedings

Small, frequent volumes; Room temperature -large volumes or rapid feeding of formula can cause diarrhea -Large volume of low-calorie formula at one time can cause diarrhea -Discard cans of formula within 24 hours

Which of the following indicates fluid overload? Albumin - 5.5 g/dL Urine specific gravity - 1.035 Hct - 55% Sodium level - 135 mEq/L

Sodium -indicates hyponatremia or water deficit equals decrease of sodium concentration caused by excess water S & S: confusion, HA, nausea, fatigue -albumin 3.5 - 5 g/dL > indicates dehydration -specific gravity 1.005 - 1.030; > Indicates concentrated urine from fluid volume deficit -Hct 37% - 47% women; 42% - 52% men > indicates Chemo concentration from fluid volume deficit

Dietary deficiency of which mineral causes confusion, nausea, & abdominal cramping dizziness, HA Manifestations of Sodium toxicity: Confusion, thirst, & weakness

Sodium Sodium deficit

Nutritional recommendations during pregnancy

Take 30 mg of iron supplementation daily -reduce risk for iron deficiency anemia -reduce fat intake during entire pregnancy Max weight gain (underweight) -40 lbs

Client Teaching: Managing IBS

Take peppermint oil during exacerbation of manifestations (peppermint relaxes smooth muscle of G.I. tract & ↓ manifestations of ___)

A client with celiac disease can consume____ because this starch does not contain gluten

Tapioca

Lipid panel report: Expected reference ranges

Total cholesterol level: < 200 mg/dL HDL: > 45 mg/dL - Male > 55 mg/dL - female Triglycerides: 35-135 mg/dL - female 40-160 mg/dL - Male LDL: < 130 mg/dL

Dietary instruction: cirrhosis & ascites

To decrease fluid retention: Limit daily sodium intake to 2000 mg(1-2g) Limit fluid intake to 1.5L/day To prevent Malnutrition: Consume 0.8-1.2g/kg of protein daily Consume foods with vitamin K: Clients with_____ have a ↓ production of prothrombin = ↑ risk for bleeding

Normal lab results/Low range may indicate

WBC: 5,000-10,000/mm3 (elevated = infection & dietary deficiencies in iron or B12) sodium: 136-145 mEq/L (Low = malnutrition) Pre-albumin: 15-36 mg/dL (8 mg = severe Malnutrition) Thyroxine (T4): 4-12 mcg/dL (Low = hypothyroidism or protein Malnutrition)