Chapter 11: Nutritional Components of Care

Full liquid diet indications

May be used as a transition diet after clear liquids after surgery or for clients who have difficulty chewing, swallowing, or tolerating solid foods

ovo-vegetarian

The only animal foods that the ovo-vegetarian consumes are eggs, which are an excellent source of complete proteins. Considerations - 1. Vegan and vegetarian diets are not usually prescribed but are a diet choice made by a client. 2. Ensure that the client eats a sufficient amount of varied foods to meet nutrient and energy needs. 3. Clients need to be educated about consuming complementary proteins over the course of each day to ensure that all EAAs are provided. 4. Potential deficiencies in vegetarian diets include energy, protein, vitamin B12, zinc, iron, calcium, omega-3 fatty acids, and vitamin D (if limited exposure to sunlight). 5. To enhance the absorption of iron, vegetarians would consume a good source of iron and vitamin C with each meal. 6. Foods eaten may include tofu, tempeh, soy milk and soy products, meat analogs, legumes, nuts and seeds, sprouts, and a variety of fruits and vegetables. 7. Soy protein is considered equivalent in quality to animal protein.

Vegan diet

Vegans follow a strict vegetarian diet and consume no animal foods. 2. Eat only foods of plant origin (e.g., whole or enriched grains, legumes, nuts, seeds, fruits, vegetables). 3. The use of soybeans, soy milk, soybean curd (tofu), and processed soy protein products enhance the nutritional value of the diet.

High calcium diet considerations

a. Primary dietary sources of calcium are dairy products (see Box 11.2 for food items high in calcium). b. Clients with lactose intolerance need to incorporate nondairy sources of calcium into their diet regularly.

When reinforcing dietary instructions to a client with irritable bowel syndrome whose primary symptom is alternating constipation and diarrhea, the nurse would tell the client that which foods are best to include in the diet for this disorder? Select all that apply. 1. Beans 2. Apples 3. Cabbage 4. Brussels sprouts 5. Whole-grain bread

2, 5 Rationale: A high-fiber, high-residue diet is used for constipation; irritable bowel syndrome, when the primary symptom is alternating constipation and diarrhea; and asymptomatic diverticular disease. High-fiber foods include fruits and vegetables and whole-grain products. Gas-forming foods such as beans, cabbage, and Brussels sprouts need to be limited. Test-Taking Strategy: Note the strategic word, best, and focus on the data in the question. Note that the client has irritable bowel syndrome whose primary symptom is alternating constipation and diarrhea. Think about the food items that would increase irritability in the bowel to direct you to the correct option.

Examples of Food Sources of Minerals

Minerals Calcium Cheese Collard greens Milk and soy milk Rhubarb Sardines Tofu Yogurt Chloride Salt Iron Breads and cereals Dark green vegetables Dried fruits Egg yolk Legumes Liver Meats Magnesium Avocados Canned white tuna Cauliflower Cooked rolled oats Green, leafy vegetables Milk Peanut butter Peas Pork, beef, chicken Potatoes Raisins Yogurt Phosphorus Fish Nuts Organ meats Pork, beef, chicken Whole-grain breads and cereals Potassium Avocado Bananas Cantaloupe Carrots Fish Mushrooms Oranges Pork, beef, veal Potatoes Raisins Spinach Strawberries Tomatoes Sodium Bacon Butter Canned food Cheese Cottage cheese Cured pork Hot dogs Ketchup Lunch meat Milk Mustard Processed food Snack food Soy sauce Table salt White and whole-wheat bread Zinc Eggs Green, leafy vegetables Meats Protein-rich foods

High iron diet

Used for anemia Considerations - a. The high-iron diet replaces an iron deficit caused by inadequate intake or loss. b. The diet includes organ meats; meat; egg yolks; whole-wheat products; dark green, leafy vegetables; dried fruit; and legumes. c. Inform the client that concurrent intake of vitamin C with iron foods enhances the absorption of iron.

Low purine diet

Used for gout, kidney stones, and elevated uric acid levels Considerations - precursor of uric acid, which forms stones and crystals. b. Foods to restrict include anchovies, herring, mackerel, sardines, scallops, organ meats, gravies, meat extracts, wild game, goose, and sweetbreads.

sodium restricted diet

Used for hypertension, heart failure, kidney disease, cardiac disease, and liver disease

Protein restricted diet

Used for renal disease and end-stage liver disease

Full liquid diet considerations

a. A full liquid diet is nutritionally deficient in energy (calories) and many nutrients. b. The diet includes both clear and opaque liquid foods and those that are liquid at body temperature. c. Foods include all clear liquids and items such as plain ice cream, sherbet, breakfast drinks, milk, pudding and custard, soups that are strained, refined cooked cereals, fruit juices, and strained vegetable juices. d. Use of a complete nutritional liquid supplement is often necessary to meet nutrient needs for clients on a full liquid diet for more than 3 days.

Considerations for soft diet

a. Clients with mouth sores would be served foods at cooler temperatures. b. Clients who have difficulty chewing and swallowing because the reduced flow of saliva can increase salivary flow by sucking on sour candy. c. Encourage the client to eat a variety of foods. d. Provide plenty of fluids with meals to ease chewing and swallowing of foods. e. Drinking fluids through a straw may be easier than drinking from a cup or glass; a straw may not be allowed for a client with dysphagia (because of the risk of aspiration). f. All foods and seasonings are permitted; however, liquid, chopped, or puréed foods or regular foods with a soft consistency are tolerated best. g. Foods that contain nuts or seeds, which can easily become trapped in the mouth and cause discomfort, would be avoided. h. Raw fruits and vegetables, fried foods, and whole grains would be avoided

Considerations for renal diet

a. Controlled amounts of protein, sodium, phosphorus, calcium, potassium, and fluids may be prescribed; may also require modifications of the amounts of fiber, cholesterol, and fat based on individual requirements; clients receiving peritoneal dialysis usually have diets prescribed that are less restrictive with fluid and protein intake than those receiving hemodialysis. b. Most clients who are receiving dialysis need to restrict fluids

Cardiac diet

a. Indicated for atherosclerosis, diabetes mellitus, hyperlipidemia, hypertension, myocardial infarction, nephrotic syndrome, and renal failure b. Reduces the risk of heart disease c. Dietary Approaches to Stop Hypertension (DASH) diet: recommended to prevent and control hypertension, hypercholesterolemia, and obesity d. The DASH diet includes fruits, vegetables, whole grains, and low-fat dairy foods; meat, fish, poultry, nuts, and beans; and is limited in sugar-sweetened foods and beverages, red meat, and added fats.

Considerations for low sodium diet

a. Individualized; can include 4 g of sodium daily (no-added-salt diet), 2 to 3 g of sodium daily (moderate restriction), 1 g of sodium daily (strict restriction), or 500 mg of sodium daily (severe restriction and seldom prescribed) b. Encourage the intake of fresh rather than processed foods, which contain higher amounts of sodium. c. Canned, frozen, instant, smoked, pickled, and boxed items usually contain higher amounts of sodium. Lunch meats, soy sauce, salad dressings, fast foods, soups, and snacks such as potato chips and pretzels also contain large amounts of sodium. d. Certain medications contain significant amounts of sodium. e. Salt substitutes may be used to improve palatability. Most salt substitutes contain large amounts of potassium and would not be used by clients with renal disease.

Protein restricted diet considerations

a. Provide enough protein to maintain nutritional status but not an amount that will allow for the buildup of waste products from protein metabolism (40-60 g of protein daily). b. The less protein allowed, the more important it becomes that all protein in the diet be of high biological value (contain all EAAs in recommended proportions). c. An adequate total energy intake from foods is critical for clients on protein-restricted diets. (Protein will be used for energy rather than for protein synthesis.) d. Special low-protein products, such as pastas, bread, cookies, wafers, and gelatin made with wheat starch, can improve energy intake and add variety to the diet. e. Carbohydrates in powdered or liquid form can also provide additional energy. f. Vegetables and fruits contain some protein. For very low-protein diets, these foods must be calculated into the diet. g. Foods from the milk, meat, bread, and starch groups are limited.

Considerations for high fiber diet

a. Provides 25 g to 35 g of dietary fiber daily b. Adds volume and weight to the stool and speeds the movement of undigested materials through the intestine c. Consists of fruits, vegetables, and whole-grain products d. Increase fiber gradually and provide adequate fluids to reduce possible undesirable side effects such as abdominal cramps, bloating, diarrhea, and dehydration. e. Gas-forming foods would be limited

Clear liquid diet indications

a. Provides fluids and electrolytes to prevent dehydration b. Used as initial feeding after complete bowel rest c. Used initially to feed a malnourished person or a person who has not had any oral intake for some time d. Used for bowel preparation for surgery or diagnostic tests, as well as postoperatively and in clients with fever, vomiting, or diarrhea e. Used in gastroenteritis

Indications for mechanical soft diet

a. Provides foods that have been mechanically altered in texture to require minimal chewing b. Used for clients who have difficulty chewing but who can tolerate more variety in texture than a liquid diet offers c. Used for clients who have dental problems, surgery of the head or neck, or dysphagia (requires swallowing evaluation and may require thickened liquids if the client has swallowing difficulties)

Considerations for low fat diet

a. Restricts the total amount of fat, including saturated fats, trans fats, polyunsaturated fats, and monounsaturated fats b. Clients with malabsorption may also have difficulty tolerating fiber and lactose. c. Vitamin and mineral deficiencies may occur in clients with diarrhea or steatorrhea. d. A fecal-fat test may be prescribed and indicates fat malabsorption with the excretion of more than 6 g to 8 g of fat (or more than 10% of the fat consumed) per day during the 3 days of specimen collection.

Low fiber/low residue diet

a. Supplies foods that are least likely to form an obstruction when the intestinal tract is narrowed by inflammation or scarring or when GI motility is slowed b. Used for inflammatory bowel disease, partial obstructions of the intestinal tract, gastroenteritis, diarrhea, or other GI disorders

Considerations for carb consistent diet

a. The Exchange System for Meal Planning, developed by the Academy of Nutrition and Dietetics and the American Diabetes Association, is a food guide that may be recommended. b. The Exchange System groups foods according to the amounts of carbohydrates, fats, and proteins that they contain; major food groups include the carbohydrate, the meat and meat substitute, and the fat groups. c. A carbohydrate consistent diet focuses on maintaining a consistent amount of carbohydrate intake each day and with each meal; also known as "carb counting"

Indications for soft diet

a. Used for clients with difficulty chewing or swallowing b. Used for clients with ulcerations of the mouth or gums, broken jaws, or dysphagia, and for those who have experienced oral surgery, plastic surgery of the head or neck, or stroke

Fat restricted diet

a. Used to reduce symptoms of abdominal pain, steatorrhea, flatulence, and diarrhea associated with a high intake of dietary fat, and to decrease nutrient losses caused by the ingestion of dietary fat in individuals with malabsorption disorders b. Used for clients with malabsorption disorders, pancreatitis, gallbladder disease, and gastroesophageal reflux

gas forming foods

▪ Apples ▪ Artichokes ▪ Barley ▪ Beans ▪ Bran ▪ Broccoli ▪ Brussels sprouts ▪ Cabbage ▪ Celery ▪ Figs ▪ Melons ▪ Milk ▪ Molasses ▪ Nuts ▪ Onions ▪ Radishes ▪ Soybeans ▪ Wheat ▪ Yeast

Nursing considerations for a mechanical soft diet

a. Degree of texture modification depends on individual need, including puréed, mashed, ground, or chopped. b. Foods to be avoided in mechanically altered diets include nuts; dried fruit; raw fruits and vegetables; fried foods; chocolate candy; tough, smoked, or salted meats; and foods with coarse textures.

Considerations for high calorie high protein diet

a. Encourage nutrient-dense, high-calorie, high-protein foods such as whole milk and milk products, peanut butter, nuts, seeds, beef, chicken, fish, pork, and eggs. b. Encourage snacks between meals, such as milkshakes, instant breakfasts, and nutritional supplements.

The nurse reinforces instructions to a client to increase the amount of riboflavin in the diet. The nurse would tell the client to select which food item that is high in riboflavin? 1. Milk 2. Tomatoes 3. Citrus fruits 4. Green, leafy vegetables

1 Rationale: Food sources of riboflavin include milk, lean meats, fish, and grains. Tomatoes and citrus fruits are high in vitamin C. Green leafy vegetables are high in folic acid. Test-Taking Strategy: Focus on the subject, food sources high in riboflavin. Knowledge regarding food items that are high in riboflavin is required to answer this question. Remember that milk is a food source of riboflavin, so this will help you eliminate the remaining options.

A hospitalized client is a lacto-vegetarian. Which food item would the nurse remove from the meal tray? 1. Eggs 2. Milk 3. Cheese 4. Broccoli

1 Rationale: Lacto-vegetarians eat milk, cheese, and dairy foods, but avoid meat, fish, poultry, and eggs. Test-Taking Strategy: Focus on the subject, lacto-vegetarian. With that in mind, immediately eliminate broccoli. From the remaining options, note that milk and cheese are dairy products, making them comparable or alike, so they can be eliminated. Eggs are the food items that are not consumed by lacto-vegetarians; however, they are eaten by lacto-ovo vegetarians.

A low-sodium diet has been prescribed for a client with hypertension. Which food selected from the menu by the client indicates an understanding of this diet? 1. Baked turkey 2. Tomato soup 3. Boiled shrimp 4. Chicken gumbo

1 Rationale: Regular soup (1 cup) contains 900 mg of sodium. Fresh shellfish (1 oz) contains 50 mg of sodium. Poultry (1 oz) contains 25 mg of sodium. Test-Taking Strategy: Eliminate tomato soup and chicken gumbo first, because they are comparable or alike. Also, recall that canned foods are high in sodium. From the remaining options, select baked turkey, remembering that shellfish is also high in sodium, even if it is boiled.

Each kilogram (2.2 lb) of weight gained or lost is equal to

1 liter of fluid retained or lost

Parental Nutrition indications

1. Clients with a severely dysfunctional or nonfunctional GI tracts who are unable to process nutrients may benefit from PN. 2. Clients who can take some oral nutrition (but not enough to meet their nutrient requirements) may benefit from PN. 3. Clients with multiple GI surgeries, GI trauma, severe intolerance to enteral feedings, intestinal obstructions, or those who need to rest the bowel for healing may benefit from PN. 4. Clients with severe nutritionally deficient conditions, such as AIDS, cancer, burn injuries, or malnutrition, or clients receiving chemotherapy, may benefit from PN.

lacto-ovo-vegetarian

1. Lacto-ovo-vegetarians follow a food pattern that allows for the consumption of dairy products and eggs. 2. Consumption of adequate plant and animal food sources that excludes meat, poultry, pork, and fish poses no nutritional risks.

lacto-vegetarian diet

1. Lacto-vegetarians eat milk, cheese, and dairy foods but avoid meat, fish, poultry, and eggs. 2. A diet of whole or enriched grains, legumes, nuts, seeds, fruits, and vegetables in sufficient quantities to meet energy needs provides a balanced diet.

What can cause hypoglycemia in PN patients?

Abrupt discontinuation of PN

TPN

Administered through a central vein; the use of a PICC is acceptable

client with heart disease is instructed regarding a low-fat diet. The nurse determines that the client understands the diet if the client states it is acceptable to eat which food item? 1. Steak 2. Apples 3. Cheese 4. Pizza without pepperoni

2 Rationale: Fruits contain minimal amounts of fat so apples are acceptable to eat. Steak, cheese, and pizza are high in fat. Even though pepperoni is removed from the pizza, the cheese and ingredients in the crust make pizza high in fat.

A clear liquid diet has been prescribed for a client with gastroenteritis. Which item is appropriate to offer to the client? 1. Soft custard 2. Orange juice 3. Clam chowder 4. Fat-free beef broth

4 Rationale: A clear liquid diet consists of foods that are relatively transparent. Soft custard and orange juice would be included in a full liquid diet because they are opaque, not clear. Clam chowder is opaque and also includes pieces of clams, thus eliminating it from a full liquid diet. Test-Taking Strategy: Focus on the subject, clear liquid diet. Remember that a clear liquid diet consists of foods that are relatively transparent. This will direct you to fat-free beef broth, because this is the only food item that is transparent. 7. 2 Rationale: Fruits contain minimal amounts of fat so apples are acceptable to eat. Steak, cheese, and pizza are high in fat. Even though pepperoni is removed from the pizza, the cheese and ingredients in the crust make pizza high in fat. Test-Taking Strategy: Focus on the subject, the food item low in fat that is acceptable to eat. First note that cheese and pizza are comparable or alike in that pizza has cheese on it, so they can be eliminated. From the remaining options, recall that apples contain minimal fat as compared with steak, which is high in fat.

1. A client is having problems with blood clotting. Which food item would the nurse encourage the client to eat? 1. Legumes 2. Citrus fruits 3. Vegetable oils 4. Green, leafy vegetables

4 Rationale: Green, leafy vegetables are high in vitamin K, which acts as a catalyst for facilitating blood-clotting factors. Legumes are high in folic acid and thiamine. Citrus fruits are high in vitamin C, which helps with wound healing. Vegetable oil is high in vitamin E, which acts as an antioxidant. Test-Taking Strategy: First, focus on the subject, problems with blood clotting, and recall that vitamin K is involved in the clotting process. Next, determine the food sources that are high in vitamin K.

Examples of Food Sources of Vitamins Water Soluble

Folic acid: green, leafy vegetables; liver, beef, and fish; legumes ▪ Niacin: meats, poultry, fish, beans, peanuts, grains ▪ Vitamin B1 (thiamine): pork, nuts, whole-grain cereals, legumes ▪ Vitamin B2 (riboflavin): milk, lean meats, fish, grains ▪ Vitamin B6 (pyridoxine): yeast, corn, meat, poultry, fish ▪ Vitamin B12 (cobalamin): meat, liver ▪ Vitamin C (ascorbic acid): citrus fruits, tomatoes, broccoli, cabbage Fat Soluble ▪ Vitamin A: liver, egg yolk, whole milk, green or orange vegetables, fruits ▪ Vitamin D: fortified milk, fish oils, cereals ▪ Vitamin E: vegetable oils; green, leafy vegetables; cereals; apricots; apples; peaches ▪ Vitamin K: green, leafy vegetables; cauliflower; cabbage

Potassium modified diet considerations

Foods that are low in potassium include applesauce, green beans, cabbage, lettuce, peppers, grapes, blueberries, cooked summer squash, cooked turnip greens, fresh pineapple, and raspberries.

Cardiac diet considerations

Restricts total amounts of fat, including saturated, trans, polyunsaturated, and monounsaturated; cholesterol; and sodium

High calorie high protein diet

Severe stress, burns, cancer, human immunodeficiency virus (HIV) infection, acquired immunodeficiency syndrome (AIDS), chronic obstructive pulmonary disease, respiratory failure, or any other type of debilitating disease

What can hypertonic solutions do to the veins?

cause sclerosis, phlebitis, or swelling. Monitor closely for these complications

PPN

peripheral parenteral nutrition usually administered through a large distal vein in the arm with a standard peripheral (intravenous [IV]) catheter or midline or through a peripherally inserted central catheter (PICC). b. If a PICC cannot be established, the subclavian vein or internal or external jugular veins can be used for PPN.

Fats

provide a concentrated source and a stored form of energy and 9 cal/g. 2. Fats protect internal organs and maintain body temperature. 3. Fats enhance the absorption of fat-soluble vitamins. 4. Inadequate intake of essential fatty acids leads to clinical manifestations of sensitivity to cold, skin lesions, increased risk of infection, and amenorrhea in women. 5. Diets high in fat can lead to obesity and increase the risk of cardiovascular disease and some cancers.

Home care instruction for PN

▪ Reinforce to the client and caregiver how to administer and maintain parenteral nutrition fluids. ▪ Reinforce to the client and the caregiver how to change a sterile dressing. ▪ Obtain a daily weight at the same time of day in the same clothes. ▪ Stress that weight gain of more than 3 lb/week may indicate excessive fluid intake and needs to be reported. ▪ Monitor the blood glucose level, and report abnormalities immediately. ▪ Check for signs and symptoms of infection, thrombosis, air embolism, and catheter displacement. ▪ Teach the client and caregiver about the signs and symptoms of side or adverse effects such as infection, thrombosis, air embolism, and catheter displacement. ▪ Teach the client and caregiver the actions to take if a complication arises and about the importance of reporting complications to the primary health care provider. ▪ For symptoms of thrombosis, the client must report edema of the arm or at the catheter insertion site, neck pain, and jugular vein distention. ▪ The leakage of fluid from the insertion site or pain or discomfort as the fluids are infused may indicate the displacement of the catheter. This must be reported immediately. ▪ Reinforce to the client and caregiver the importance of follow-up care. ▪ Teach the client to keep electronic infusion devices fully charged in case of electrical power failure.

Renal diet

Used for the client with acute kidney injury and chronic kidney disease, and those requiring hemodialysis or peritoneal dialysis

What can be added to PN?

Vitamins, minerals, electrolytes, water amounts, insulin, and heparin

The nurse is providing dietary instructions to a client with gout. The nurse needs to tell the client that which food item will exacerbate the condition? 1. Scallops 2. Chocolate 3. Cornbread 4. Macaroni products

1 Rationale: Scallops would be omitted from the diet of a client who has gout because of the high purine content; this food item would exacerbate the condition. The food items identified in the remaining options have negligible purine content and may be consumed by the client with gout. Test-Taking Strategy: Focus on the subject, the food item that will exacerbate the condition. Note the client's diagnosis of gout, and think about the pathophysiology associated with this condition. Recalling the food items that are high in purine will direct you to the correct option.

Nutritional guidelines

1. Avoid eating oversized portions of foods. 2. Fill half of the plate with fruits and vegetables. 3. Vary the type of vegetables and fruits eaten. 4. Select at least half of the grains as whole grains. 5. Ensure that foods from the dairy group are high in calcium. 6. Drink milk that is fat-free or low fat (1%). 7. Eat protein foods that are lean. 8. Select fresh foods over frozen or canned foods. 9. Drink water rather than liquids that contain sugar

Carbohydrates

1. Carbohydrates are the preferred source of energy and provide 4 cal/g. 2. Carbohydrates promote normal fat metabolism, spare protein, and enhance lower gastrointestinal (GI) function. 3. Major food sources of carbohydrates include milk, grains, fruits, and vegetables. 4. Inadequate carbohydrate intake affects metabolism.

Carb consistent diet

Diabetes mellitus, hypoglycemia, hyperglycemia, and obesity

A client has been placed on fluid restriction because of an acute kidney injury. The client complains of thirst and asks what can be done to relieve this discomfort. What measures can the nurse tell the client to take to relieve thirst while adhering to the fluid restriction?

The client with acute kidney injury may be placed on fluid restriction because of decreased renal function and glomerular filtration rate, resulting in fluid volume excess. To allow the kidneys to rest, decreased fluid consumption may be indicated. When a client is placed on this restriction, increased thirst may be a problem. The nurse would instruct the client in measures to relieve thirst in order to promote adherence to the fluid restriction. These measures include chewing gum or sucking hard candy, freezing fluids so they take longer to consume, adding lemon juice to water to make it more refreshing, and gargling with refrigerated mouthwash.

Considerations for low fiber diet

a. Foods that are low in residue include white bread, refined cooked cereals, cooked potatoes without skins, white rice, and refined pasta. b. Foods to limit or avoid are raw fruits (except bananas), vegetables, nuts and seeds, plant fiber, and whole grains. c. Dairy products would be limited to 2 servings a day.

Refeeding syndrome

(a rapid drop in potassium, magnesium, and phosphate serum levels); monitor for shallow respirations, confusion, weakness, bleeding tendencies, and seizures

The nurse has completed diet teaching for a client who has been prescribed a low-sodium diet to treat hypertension. The nurse determines that there is a need for further teaching when the client makes which statement? 1. "This diet will help lower my blood pressure." 2. "Fresh foods such as fruits and vegetables are high in sodium." 3. "This diet is not a replacement for my antihypertensive medications." 4. "The reason I need to lower my salt intake is to reduce fluid retention."

2 Rationale: A low-sodium diet is used as an adjunct to antihypertensive medications for the treatment of hypertension. Sodium retains fluid, which leads to hypertension, secondary to increased fluid volume. Fresh foods such as fruits and vegetables are low in sodium. Test-Taking Strategy: Note the strategic words, need for further teaching. These words indicate a negative event query and ask you to select an option that is an incorrect statement. Remember that fresh foods are low in sodium, so they would be incorporated in the diet. Eliminate the remaining options because these are accurate statements related to the management of hypertension.

A client with a burn injury is transferred to the nursing unit, and a regular diet has been prescribed. The nurse encourages the client to eat which dietary items to promote wound healing? 1. Veal, potatoes, gelatin, and orange juice 2. Chicken breast, broccoli, strawberries, and milk 3. Peanut butter and jelly sandwich, cantaloupe, and tea 4. Spaghetti with tomato sauce, garlic bread, and ginger ale

2 Rationale: Protein and vitamin C are necessary for wound healing. Poultry and milk are good sources of protein. Broccoli and strawberries are good sources of vitamin C. Peanut butter is a source of niacin. Gelatin and jelly have no nutrient value. Spaghetti is a complex carbohydrate. Test-Taking Strategy: Focus on the subject, promoting wound healing, and recall that protein and vitamin C are necessary for wound healing. Eliminate options containing gelatin and jelly first, because they have no nutrient value related to healing. From the remaining options, select chicken breast, broccoli, strawberries, and milk over the remaining option because of the greater nutrient value of the foods.

Proteins

Amino acids, which make up proteins, are critical to all aspects of the growth and development of body tissues and provide 4 cal/g. 2. Proteins build and repair body tissues, regulate fluid balance, maintain acid-base balance, produce antibodies, provide energy, and produce enzymes and hormones. 3. Essential amino acids (EAAs) are required in the diet because the body cannot manufacture them. 4. Complete proteins contain all EAAs; incomplete proteins lack some of the essential fatty acids. 5. Inadequate protein intake can cause protein energy malnutrition and severe wasting of fat and muscle tissue.

High calcium diet

Calcium is needed during bone growth and in adulthood to prevent osteoporosis and facilitate vascular contraction and vasodilation, muscle contraction, and nerve transmission

Adverse reactions to lipids

Chest and back pain ▪ Chills ▪ Cyanosis ▪ Diaphoresis ▪ Dyspnea ▪ Fever ▪ Flushing; rash ▪ Headache ▪ Nausea and vomiting ▪ Pressure over the eyes ▪ Thrombophlebitis ▪ Vertigo

Measures to relieve thirst

Chew gum or suck hard candy. Freeze fluids so that they take longer to consume. Add lemon juice to water to make it more refreshing. Gargle with refrigerated mouthwash.

enteral nutrition

Description: Provides liquefied foods to the GI tract via a tube Considerations - Clients with lactose intolerance (diarrhea, bloating, cramping) need to be placed on lactose-free formulas. Indications - 1. When the GI tract is functional but oral intake is not meeting estimated nutrient needs 2. Used for clients with swallowing problems, burns, major trauma, liver or other organ failure, or severe malnutrition

Minerals and electrolytes

Minerals are components of hormones, cells, tissues, and bones. 2. Minerals act as catalysts for chemical reactions and enhancers of cell function. 3. Almost all foods contain some form of minerals. 4. A deficiency of minerals can develop in chronically ill or hospitalized clients. 5. Electrolytes play a major role in osmolality and body water regulation, acid-base balance, en zyme reactions, and neuromuscular activity

High fiber/high residue diet

Used for clients with constipation; irritable bowel syndrome, when the primary symptom is alternating constipation and diarrhea; and asymptomatic diverticular disease

Nursing considerations for a clear liquid diet

considerations a. Clear liquid diet is deficient in energy (calories) and many nutrients b. The body digests and absorbs clear liquids easily c. Contributes to little or no residue in the GI tract d. Can be unappetizing and boring e. As a transition diet, clear liquids are intended for short-term use only. f. Clear liquids and foods that are relatively transparent to light and are liquid at body temperature are considered "clear liquids," such as water, bouillon, clear broth, carbonated beverages, gelatin, hard candy, lemonade, ice pops, and regular or decaffeinated coffee or tea. g. By limiting caffeine intake, an upset stomach and sleeplessness may be prevented. h. Client may have salt or sugar. i. Dairy products and fruit juices with pulp are not clear liquids.

Parental nutrition

termed hyperalimentation or total parenteral nutrition [TPN]) supplies nutrients via the veins. 2. PN consists of both partial parenteral nutrition (PPN) and TPN. The indication of the type used depends on the client's nutritional needs. 3. Supplies carbohydrates in the form of dextrose; fats in a special emulsified form; proteins in the form of amino acids; vitamins; minerals; electrolytes; and water. 4. Prevents subcutaneous fat and muscle protein from being catabolized by the body for energy. 5. PN solutions are hypertonic because of their higher concentration of glucose and the addition of amino acids.

Sodium-Free Spices and Flavorings

▪ Allspice ▪ Almond extract ▪ Bay leaves ▪ Caraway seeds ▪ Cinnamon ▪ Curry powder ▪ Garlic powder or garlic ▪ Ginger ▪ Lemon extract ▪ Maple extract ▪ Marjoram ▪ Mustard powder ▪ Nutmeg

BMI calculation

dividing the client's weight in kilograms by height in meters squared

Vitamins

facilitate metabolism of proteins, fats, and carbohydrates, and act as catalysts for metabolic functions. 2. Vitamins promote life and growth processes, and maintain and regulate body functions. 3. Fat-soluble vitamins A, D, E, and K can be stored in the body, so an excess can cause toxicity. 4. The B vitamins and vitamin C are water soluble, are not stored in the body, and can be excreted in the urine.

Potassium modified diet

indicated for hyperkalemia, which may be the result of impaired renal function, hypoaldosteronism, Addison's disease, angiotensin-converting enzyme inhibitor medications, immunosuppressive medications, potassium-retaining diuretics, and chronic hyperkalemia. indicated for hypokalemia, which may be the result of renal tubular acidosis, GI losses (diarrhea, vomiting), intracellular shifts, potassium-wasting diuretics, antibiotics, mineralocorticoid or glucocorticoid excess resulting from primary or secondary aldosteronism, Cushing's syndrome, or exogenous corticosteroid use.