Nutrition, Elimination, and Enteral Feeds
The nursing student analyzes drug information on a chart after being taught about uterine stimulant medications. Which statement by the nursing student would indicate an understanding of the teaching?
The elimination half-life and peak plasma concentration of uterine stimulants are proportional. The statement made by the student that the elimination half-life and peak plasma concentration of uterine stimulants are proportional indicates an understanding of the teaching. Elimination half-life of a drug is the plasma concentration remaining when 50 percent of the drug plasma concentration has been eliminated. The nursing student would notice from the chart that the elimination half-life of the intravenous (IV) medication (Oxytocin) is 3 to 5 minutes versus the oral medication (Methylergonovine) which is 2 hours. Oxytocin shows an immediate and not a delayed onset of action because it is given IV. Methylergonovine does not show an immediate peak plasma concentration because oral medications require time for absorption. The elimination half-life of uterine stimulants is dependent and not independent of the peak plasma concentration because, by definition, a half-life is one half of the peak plasma concentration.
A client is being prepared for surgery to have placement of a percutaneous endoscopic gastrostomy (PEG) tube. The client asks why the PEG tube is preferred over the existing nasogastric tube that is being used for feedings. What explanation does the nurse give for why a PEG tube is preferred for administering a tube feeding?
There is less change of aspiration. When tube feedings are given via a PEG tube, they bypass the upper gastrointestinal tract (oropharynx, esophagus, cardiac sphincter of the stomach), which reduces the risk of tracheal aspiration. A gastrostomy tube may be attached to a pump for continuous feedings. Clients can be taught to feed themselves with either method. The amount of the feeding is not affected.
A client is recently diagnosed with an oral cancerous lesion. Which question should the nurse ask when assessing the client's need for instruction in relation to this condition?
"Have you noticed any change in your appetite?" Problems involving the oral cavity often result in nutritional problems and weight loss needing nursing intervention. The question, "Have you noticed any change in your appetite?" will elicit more information. The nurse needs to determine a client's past and current appetite and nutritional status. Difficulty sleeping is not usually a characteristic symptom of cancer of the oral cavity although it may occur after the diagnosis due to anxiety. Gum infections are not typically an early problem after an oral cancer diagnosis. Although a dentist may be the first to identify oral cancer, medical treatment is needed.
A nurse is instructing about nutrition with a client who has inflammatory bowel disease of the ascending colon. Which suggestion by the nurse is most appropriate?
Consume scrambled eggs and applesauce Low-residue foods produce less fecal waste (eggs and applesauce), decreasing bowel contents and irritation; protein promotes healing, and calories provide energy. Barbecued foods are spicy; foods high in fat can increase peristalsis. Fruit and aged, sharp cheese can be irritating to the bowel. Chunky peanut butter and whole wheat bread are high-residue (high fiber) foods.
A client is diagnosed with gastroenteritis. What does the nurse determine is the basic intention underlying the unique dietary management for this client?
Eliminate chemical, mechanical, and thermal irritation. Irritation of the mucosa may cause increased bleeding or perforation and therefore should be avoided. All clients' diets should be nutritionally balanced; this is not specific to this client's problem. Bulk and roughage may irritate the mucosa and should be decreased. Psychological support is not the primary goal; efforts should be made to include foods that are psychologically beneficial but eliminate foods that are irritating to the mucosa.
A client with chronic obstructive pulmonary disease (COPD) states, "I have had steady weight loss, and I am often too tired to eat." Which nursing diagnosis would be most appropriate for this client?
Imbalanced nutrition: less than body requirements, related to fatigue The response portion of the nursing diagnosis is Imbalanced nutrition: less than body requirements, and the etiology is fatigue associated with the disease process of COPD. Interventions should be planned to deal with the breathing problem and the fatigue associated with it while implementing actions to combat the weight loss. Weight loss related to COPD is not a NANDA-approved nursing diagnosis. Fatigue associated with the COPD disease process is the cause of the weight loss, not COPD in itself. Altered breathing pattern is also a problem, but does not specifically relate to the weight loss problem.
A nurse is caring for a client who is receiving total parenteral nutrition (TPN). The nurse would monitor the client for which complications?
Infection Hyperglycemia Hyperglycemia related to the high concentration of dextrose in TPN is a common complication of this therapy and must be monitored for by the nurse. Another common complication is related to the central venous access that is needed for infusion of TPN. Catheter-related infection is frequently seen and must be monitored for by the nurse. Hepatitis is usually not associated with total parenteral nutrition. Anorexia often is present before the medical decision is made to begin total parenteral nutrition. Dysrhythmias are not related to total parenteral nutrition, but may be a sign of hyperkalemia or hypokalemia.
An adolescent with a BMI of 30 reports fatigue, frequent urination, and a tingling sensation on the feet. The adolescent is then diagnosed with type 2 diabetes mellitus. Which nursing interventions would be appropriate?
Physical activities Dietary counseling Behavior modification An adolescent with type 2 diabetes mellitus should engage in regular physical activity to reduce his or her weight and glucose levels. Dietary counseling helps to improve nutritional intake and decrease saturated fats and sugars. Behavior modification weight programs help adolescents identify and eliminate inappropriate eating behavior habits. Bariatric surgery is recommended for clients with morbid obesity (characterized by a BMI greater than 40). Dietary restriction should not be recommended because this action may cause a lot of nutrients.
Which pharmacokinetic condition of a drug may result in a high intensity and long duration of response?
When absorption is rapid but elimination is delayed Pharmacokinetic factors determine the concentration of a drug at its sites of action. When the drug's absorption is rapid and elimination is delayed, the concentration of the drug at the site of action is high. This action increases the intensity and duration of the drug response. When both the absorption and elimination rates are rapid, the concentration of drug at the site of action is lesser. This in turn decreases the duration of the drug response. In contrast, when both the absorption and elimination of the drug are delayed, the intensity of the drug's effect is also decreased. When absorption is delayed but elimination is rapid, the duration and intensity of the drug are decreased because the concentration of the drug at the site of action is low. Quality of drug response is determined by the concentration at the site of action.
During a discussion regarding nutrition, the nurse explains to a pregnant client that she will need additional calcium during pregnancy and that the ideal source is milk. The client states, "I never drink milk or eat milk products. They turn my stomach." What is the nurse's best reply?
"Your practitioner can prescribe calcium supplements." Calcium is essential to a pregnant woman's diet for the development of the fetal skeleton; it must be supplemented if the client dislikes or is allergic to milk and milk products. A nutritionally sound diet without dairy products does not meet the needs of the pregnant woman or her fetus. Dental care and oral hygiene will be more beneficial for maintaining healthy teeth than adding more calcium to the diet will. If milk makes the client ill, the statement "Drinking milk is so important for your baby to develop strong bones" is ineffective advice, and the dietary regimen probably will not be followed.
