Chapt. 45 Nutrition

Dysphagia Stages

, Thickened Liquids, Pureed As for clear and full liquid, with addition of scrambled eggs; pureed meats, vegetables, and fruits; mashed potatoes and gravy

The nurse is teaching a program on health nutrition at the senior community center. Which points should be included in the program for older adults? (select all that apply) 1. Avoid grapefruit and grapefruit juice, which impair drug absorption 2. Increase the amount of carbohydrates for energy 3. Take a multivitamin that includes vitamin D for bone health 4. Cheese and eggs are good sources of protein 5. Limit fluids to decrease edema

1. Avoid grapefruit and grapefruit juice, which impair drug absorption 3. Take a multivitamin that includes vitamin D for bone health 4. Cheese and eggs are good sources of protein

the nurse teaches a patient who has had surgery to increase which nutrient to help with tissue repair? 1. Fat 2. Protein 3. Vitamin 4. Carbohydrate

2. Protein

Low Sodium

4-g (no added salt), 2-g, 1-g, or 500-mg sodium diets; vary from no-added-salt to severe sodium restriction (500-mg sodium diet), which requires selective food purchases

a nurse is discussing health problems associated with nutrient deficiencies with a group of adolescents. the nurse should include that which of the following conditions is associated with a deficiency of vitamin C? A. dysrhythmias B. scurvy C. pernicious anemia D. megaloblastic anemia

B. scurvy

gluten Free

Eliminates wheat, oats, rye, barley and their derivatives

Regular

No restrictions unless specified

North American Summit on Aspiration in the Critically Ill Patient recommends the following:

(1) stop feedings immediately if aspiration occurs (2) withhold feedings and reassess patient tolerance to feedings if GRV is over 500 mL (3) routinely evaluate the patient for aspiration; (4) use nursing measures to reduce the risk of aspiration if GRV is between 250 and 500 mL

cancer

. Patients with cancer often experience anorexia, nausea, vomiting, and taste distortions. The goal of nutrition therapy is to meet the increased metabolic needs of a patient. Malnutrition in cancer is associated with increased morbidity and mortality. Enhanced nutritional status often improves a patient's quality of life. Radiation therapy destroys rapidly dividing malignant cells; however, normal rapidly dividing cells such as the epithelial lining of the GI tract are often affected. Radiation therapy causes anorexia, stomatitis, severe diarrhea, strictures of the intestine, and pain. Radiation treatment of the head and neck region causes taste and smell disturbances, decreased salivation, and dysphagia. Nutrition management of a patient with cancer focuses on maximizing intake of nutrients and fluids

Which action is initially taken by the nurse to verify correct position of a newly placed small-bore feeding tube? 1. Placing an order for x-ray film examination to check position 2. Confirming the distal mark on the feeding tube after taping 3. Testing the pH of the gastric contents and observing the color 4. Auscultating over the gastric area as air is injected into the tube

1. Placing an order for x-ray film examination to check position

The nurse is caring for a patient experiencing dysphagia. Which interventions help decrease the risk of aspiration during feeding? (select all that apply) 1. Sit the patient upright in a chair 2. Give liquids at the end of the meal 3. Place food in the strong side of the mouth 4. Provide thin foods to make it easier to swallow 5. Feed the patient slowly, allowing time to chew and swallow 6. Encourage patient to lie down to rest for 30 minutes after eating

1. Sit the patient upright in a chair 3. Place food in the strong side of the mouth 5. Feed the patient slowly, allowing time to chew and swallow

Continuous

1. Start formula at full strength for isotonic formulas (300 to 400 mOsm) or at ordered concentration. 2. Begin infusion rate at designated rate typically at 10 to 40 mL/hr (Stewart, 2014). 3. Advance rate slowly (e.g., 10 to 20 mL/hr every 8 to 12 hours) to target rate if tolerated (tolerance indicated by absence of nausea and diarrhea and low gastric residuals)

Intermittent

1. Start formula at full strength for isotonic formulas (300 to 400 mOsm) or at ordered concentration. 2. Infuse bolus of formula over at least 20 to 30 minutes via syringe or feeding container. 3. Begin feedings with a volume of 2.5-5 mL/kg 5 to 8 times per day. Increase by 60-120 mL per feeding every 8-12 hours to achieve needed volume and calories in four to six feedings (Stewart, 2014).

The patient receiving total parenteral nutrition (TPN) asks the nurse which his blood glucose is being checked since he does not have diabetes. What is the best response by the nurse? 1. TPN can cause hyperglycemia, and it is important to keep your blood glucose level in an acceptable range 2. The high concentration of dextrose in the TPN can give you diabetes; thus you need to be monitored closely 3. Monitoring your blood glucose level helps to determine the dose of insulin that you need to absorb the TPN 4. Checking your blood glucose level regularly helps to determine if the TPN is effective as a nutrition intervent

1. TPN can cause hyperglycemia, and it is important to keep your blood glucose level in an acceptable range

Nutrient metabolism consists of 3 main processes

1.) catabolism of glycogen, CO2, & H2o (glycogenolysis) 2.) anabolism of glucose into glycogen for storage (glycogenesis) 3.) catabolism of amino acids & glycerol into glucose for energy (gluconeogenesis)

The home care nurse is seeing the following patients. Which patient is at greatest risk for experiencing inadequate nutrition? 1. A 55-year-old obese man recently diagnosed with diabetes mellitus 2. A recently widowed 76-year-old woman recovering from a mild stroke 3. A 22-year-old mother with a 3-year-old toddler who had tonsillectomy 4. a 46-year-old man recovering at home following a coronary artery bypass surgery

2. A recently widowed 76-year-old woman recovering from a mild stroke

The nurse sees the nursing assistive personnel (NAP) perform the following for a patient receiving continuous enteral feedings. What intervention does the nurse need to address immediately with the NAP? The NAP: 1. Fastens the tube to the gown with tape 2. Places the patient supine while giving a bath 3. Performs oral care for the patient 4. Elevates the head of the bed 45 degree

2. Places the patient supine while giving a bath

the catheter of the patient receiving parenteral nutrition (PN) becomes occluded. Place the steps for caring for the occluded catheter in the order in which the nurse would perform them. 1. Attempt to aspirate the clot 2. Temporarily stop the infusion 3. Flush the line with saline or heparin 4. Use a thrombolytic agent if ordered or per protocol

2. Temporarily stop the infusion 3. Flush the line with saline or heparin 1. Attempt to aspirate the clot 4. Use a thrombolytic agent if ordered or per protocol

which statement made by an adult patient demostrates understanding of healthy nutrition teaching? 1. I need to stop eating red meat. 2. I will increase the servings of fruit juice to four a day. 3. I will make sure that I eat a balanced nutrition and exercise regularly 4. I will not eat so many dark green vegetables and eat more yellow vegetables

3. I will make sure that I eat a balanced nutrition and exercise regularly

diarrhea and cramping every time he has ice cream. He attributes this to the cool nature of the food. However, the nurse begins to suspect that the symptoms are associated with: 1. Food allergy 2. Irritable bowel 3. Lactose intolerance 4. Increase peristalsis

3. Lactose intolerance

Nurse Ryan is assessing for correct placement of a nasogastric tube. The nurse aspirates the stomach contents and check the contents for pH. The nurse verifies correct tube placement if which pH value is noted?

3.5 (usually between 1.5 to 3.5)

Low Cholesterol

300 mg/day cholesterol, in keeping with American Heart Association guidelines for serum lipid reduction

the nurse is assessing a patient receiving enteral feeding via a small-bore nasogastric tube. Which assessment findings need further intervention? 1. Gastric pH of 4.0 during placement check 2. Weight gain of 1 pound over the course of a week 3. Active bowel sounds in the four abdominal quadrants 4. Gastric residual aspirate of 350 mL for the second consecutive time

4. Gastric residual aspirate of 350 mL for the second consecutive time

The nurse suspects that the patient receiving parenteral nutrition (PN) through a central venous catheter (CVC) has an air embolus. What action does the nurse need to take first? 1. Raise head of bed to 90 degrees 2. Turn patient to left lateral decubitus position 3. Notify health care provider immediately 4. Have patient perform the Valsalva maneuver

4. Have patient perform the Valsalva maneuver

Based on knowledge of peptic ulcer disease (PUD), the nurse anticipates the presence of which bacteria when reviewing the laboratory data for a patient suspected of having PUD? 1. Micrococcus 2. Staphylococcus 3. Corynebacterium 4. Helicobacter pylori

4. Helicobacter pylori

which statement made by a patient of a 2-month-old infant requires further education? 1. I'll continue using formula for the baby until he is at least a year old 2. I'll make sure that I purchase iron-fortified formula 3. I'll start feeding the baby cereal at 4 months 4. I'm going to have to alternate formula with whole milk starting next month

4. I'm going to have to alternate formula with whole milk starting next month

The nurse is checking feeding tube placement. Place the steps in the proper sequence. 1. Draw 5 to 10 mL gastric aspirate into syringe 2. Flush tube with 30 mL air 3. Mix aspirate in syringe and place in medicine cup 4. Observe color for gastric aspirate 5. Perform hand hygiene and put on clean gloves 6. Dip pH strip into gastric aspirate 7. Compare strip with color chart from manufacturer

5. Perform hand hygiene and put on clean gloves 2. Flush tube with 30 mL air 1. Draw 5 to 10 mL gastric aspirate into syringe 4. Observe color for gastric aspirate 3. Mix aspirate in syringe and place in medicine cup 6. Dip pH strip into gastric aspirate 7. Compare strip with color chart from manufacturer

The nurse is performing blood glucose monitoring for a patient receiving parenteral nutrition. Place the steps of the procedure in the correct sequence. 1. Clean puncture site with antiseptic solution 2. Identify patient using two identifiers 3. Check code on test strip vial 4. Wick blood drop into test strip 5. Gently squeeze fingertip until drop of blood appears 6. Assess area of skin to be used as puncture site 7. Read results and document in medical record

6. Assess area of skin to be used as puncture site 2. Identify patient using two identifiers 3. Check code on test strip vial 1. Clean puncture site with antiseptic solution 5. Gently squeeze fingertip until drop of blood appears 4. Wick blood drop into test strip 7. Read results and document in medical record

A nurse is planning care for a client who is receiving enteral nutrition through continuous infusion. Which of the following interventions should be selected in the plan of care? (select all that apply) A. Administer with an infusion pump B. Measure residual every eight hours C. Flush the feeding tube every four hours D. Re-instill the residual feeding into the stomach E. Reassess tolerance if the residual volume is greater than the prescribed amount

A. Administer with an infusion pump. C. Flush the feeding tube every four hours D. Re-instill the residual feeding into stomach E. Reassess tolerance if the residual volume is greater than the prescribed amount

A charge nurse is providing information about fat emulsion added to total parenteral nutrition to a group of nurses. Which of the following statements by the charge nurse are appropriate? (select all that apply) A. Concentration of lipid emulsion can be up to 30% B. Adding lipid emulsion gives the solution a milky appearance C. Check for allergies to soybean oil D. Lipid emulsion prevents essential fatty acid deficiency E. Lipids provide calories by increasing the osmolality of the PN solut

A. Concentration of lipid Emulsion can be up to 30% B. Adding a lipid emulsion give the solution a milky appearance C. Check for allergies to soy bean oil D. Lipid emulsion prevents essential fatty acid deficiency

A nurse is planning care for a patient who has a new prescription for peripheral parenteral nutrition. Which of the following actions should the nurse include in the plan of care? (Select all that apply) A. Examine trends in weight loss B. Review pre-albumin finding C. Administer an IV solution of 20% dextrose D. Add a micron filter to IV tubing E. Use an IV infusion pump

A. Examine trends in weight loss B. Review pre-albumin finding D. Add a micron filter to IV tubing E. Use an IV infusion pump

A nurse is administering Bolis enteral feedings to a client who has malnutrition. Which of the following are appropriate nursing interventions? (Select all that apply) A. Verify the presence of bowel sounds B. Flush the feeding tube with warm water C. Elevate the head of the bed 20° D. Administer the feeding at room temperature E. Inspect the tube insertion site

A. Verify the presence of bowel sounds B. Flush the feeding tube with warm water D. Administer the feeding at room temperature E. Inspect the tube insertion site

a nurse is conducting a nutritional class on minerals and electrolytes. the nurse should include that 1/2 cup of which of the following foods is the best source of magnesium? A. whole almonds B. chopped tomatoes C. raw spinach D. low-fat vanilla yogurt

A. whole almonds

High Fiber

Addition of fresh uncooked fruits, steamed vegetables, bran, oatmeal, and dried fruits

Soft/Low Residue

Addition of low-fiber, easily digested foods such as pastas, casseroles, moist tender meats, and canned cooked fruits and vegetables; desserts, cakes, and cookies without nut

Mechanical Soft

As for clear and full liquid and pureed, with addition of all cream soups, ground or finely diced meats, flaked fish, cottage cheese, cheese, rice, potatoes, pancakes, light breads, cooked vegetables, cooked or canned fruits, bananas, soups, peanut butter, eggs (not fried)

Full Liquid

As for clear liquid, with addition of smooth-textured dairy products (e.g., ice cream), strained or blended cream soups, custards, refined cooked cereals, vegetable juice, pureed vegetables, all fruit juices, sherbets, puddings, frozen yogurt

aspiration

Aspiration of enteral formula into the lungs irritates the bronchial mucosa, resulting in decreased blood supply to affected pulmonary tissue . This leads to necrotizing infection, pneumonia, and potential abscess formation. The high glucose content of a feeding serves as a bacterial medium for growth, promoting infection. Acute respiratory distress syndrome (ARDS) is also an outcome frequently associated with pulmonary aspiration.

a nurse is educating a client who is taking iron supplements about which aid in iron absorption. which of the following foods is the best choice for the client to make? A. 1 baked potato B. 1/2 cup of orange juice C. 1/2 cup of low-fat milk D. 2 cups boiled green beans

B. 1/2 cup of orange juice

A nurse is preparing to administer intermittent enteral feeding to a client who has neuromuscular disorder. Which of the following are appropriate nursing interventions? (Select all that apply) A. Fill the feeding bag with 24 hours worth of formula B. Discard feeding equipment after 24 hours C. Leave unused portions of formula at the bedside D. Label the unused portion of the formula E. Elevate the head of the clients bed for 15 minutes after administration

B. Discard feeding equipment after 24 hours D. Label the unused portion of the formula

a nurse is teaching a client who is starting continuous feedings about the various types of enteral nutrition formulas. which of the following should the nurse include in the teaching? A. formula rich in fiber is recommended when starting EN B. standard formula contains whole protein C. hydrolyzed formula is recommended for a full-functioning GI tract D. the high-calorie formula has increased water conten

B. standard formula contains whole protein

Clear Liquid

Clear fat-free broth, bouillon, coffee, tea, carbonated beverages, clear fruit juices, gelatin, fruit ices, popsicles

Medical Nutrition therapy- peptic ulcer disease

Control peptic ulcers with regular meals and medications such as histamine receptor antagonists that block secretion of HCl or proton pump inhibitors. Marshall and Warren first identified Helicobacter pylori in 1984. H. pylori, a bacterium that causes up to 85% of peptic ulcers, is confirmed by laboratory tests or a biopsy during endoscopy. Antibiotics treat and control the bacterial infection. Stress and overproduction of gastric HCl also irritate a preexisting ulcer. Encourage patients to avoid foods that increase stomach acidity and pain such as caffeine, decaffeinated coffee, frequent milk intake, citric acid juices, and certain seasonings (hot chili peppers, chili powder, black pepper). Discourage smoking, alcohol, aspirin, and nonsteroidal antiinflammatory drugs (NSAIDs). Teach patients to eat a well-balanced, healthy diet; avoid eating large meals; and eat three regular meals (or several small meals) without snacks, especially at bedtime.

a nurse is discussing food that are high in vitamin D with a client who is unable to be out in the sunlight. which of the following should be included in the teaching? A. 1 cup steamed long-grain brown rice B. 6 medium raw strawberries C. 1/2 cup boiled brussel sprouts D. 2 large, poached eggs

D. 2 large, poached eggs

a nurse is caring for a client who is prescribed warfarin. the nurse should teach the client that which of the following vitamins can interfere with this medication? A. Vitamin A B. Vitamin D C. Vitamin E D. Vitamin K

D. Vitamin K

Nurse Oliver checks for residual before administering a bolus tube feeding to a client with a nasogastric tube and obtains a residual amount of 150 mL. What is appropriate action for the nurse to take?

Hold the feeding

types of enteral nutrition

Nasogastric, jejunal, or gastric tubes Surgical or endoscopic placement Nasointestinal Gastrostomy Jejunostomy PEG (percutaneous endoscopic gastrostomy) PEJ (percutaneous endoscopic jejunostomy)

Diabetic

Nutrition recommendations by the American Diabetes Association: focus on total energy, nutrient and food distribution; include a balanced intake of carbohydrates, fats, and proteins; varied caloric recommendations to accommodate patient's metabolic demands

A nurse is inserting a nasogastrictube in an adult male client. During the procedure, the client begins to cough and has difficulty breathing. the appropriate nursing action?

Pull back on the tube and wait until the respiratory distress subsides

Cardiovascular diseases

The goal of the American Heart Association (AHA) dietary guidelines is to reduce risk factors for the development of hypertension and coronary artery disease. Diet therapy for reducing the risk of cardiovascular disease includes balancing calorie intake with exercise to maintain a healthy body weight; eating a diet high in fruits, vegetables, and whole-grain high-fiber foods; eating fish at least 2 times per week; and limiting food and beverages that are high in added sugar and salt. The AHA guidelines also recommend limiting saturated fat to less than 7%, trans-fat to less than 1%, and cholesterol to less than 300 mg/day. To accomplish this goal, patients choose lean meats and vegetables, use fat-free dairy products, and limit intake of fats and sodiu

Inflammatory bowel disease includes Crohn's disease and idiopathic ulcerative colitis.

Treatment of acute inflammatory bowel disease includes elemental diets (formula with the nutrients in their simplest form ready for absorption) or PN when symptoms such as diarrhea and weight loss are prevalent. In the chronic stage of the disease, a regular highly-nourishing diet is appropriate. V itamins and iron supplements are often required to correct or prevent anemia. Patients manage irritable bowel syndrome by increasing fiber, reducing fat, avoiding large meals, and avoiding lactose or sorbitol-containing foods for susceptible individuals.

type 1 diabetes

Type 1 diabetes mellitus (DM) requires both insulin and dietary restrictions for optimal control, with treatment beginning at diagnosis

modular formulas (3.8 to 4 kcal/mL),

are single macronutrient (e.g., protein, glucose, polymers, or lipids) preparations and are not nutritionally complete. You can add this type of formula to other foods to meet your patient's individual nutritional needs

70 y/o pt admitted to hospital post stroke. client suffers right side hemiplegia and dysphagi. complication of dysphagia that nurse might observe?

aspiration pneumonia

you receive an order to begin enteral tube feedings. the first step is to: A. place patient in prone position B. irrigate tube with normal saline C. check if tube is properly placed D. introduce small amount of fluid into tube before feeding

c

Diverticulitis

condition that results from an inflammation of diverticula, which are abnormal but common pouch-like herniations that occur in the bowel lining. Nutritional treatment for diverticulitis includes a moderate- or low-residue diet until the infection subsides. Afterward, prescribing a high-fiber diet for chronic diverticula problems ensues.

elemental formulas (1 to 3 kcal/mL)

contain predigested nutrients that are easier for a partially dysfunctional GI tract to absorb

A male client who is recovering from surgery has been advanced from a clear liquid diet to a full liquid diet. The client is looking forward to the diet change because he has been "bored" with the clear liquid diet. The nurse would offer which full liquid item to the client?

custard

specialty formulas (1 to 2 kcal/mL)

designed to meet specific nutritional needs in certain illness (e.g., liver failure, pulmonary disease, or HIV infection).

Aspiration (inhaling food or drink) is a common problem for people with _______________.

dysphagia

HIV/AIDS

experience body wasting and severe weight loss related to anorexia, stomatitis, oral thrush infection, nausea, or recurrent vomiting, all resulting in inadequate intake. Factors associated with weight loss and malnutrition includes severe diarrhea, GI malabsorption, and altered metabolism of nutrients. Systemic infection results in hypermetabolism from cytokine elevation. The medications that treat HIV infection often cause side effects that alter the patient's nutritional status. Restorative care of malnutrition resulting from AIDS focuses on maximizing kilocalories and nutrients. Diagnose and address each cause of nutritional depletion in the care plan. The progression of individually tailored nutrition support begins with administering oral, to enteral, and finally to parenteral. Good hand hygiene and food safety are essential because of a patient's reduced resistance to infection. For example, minimization of exposure to Cryptosporidium in drinking water, lakes, or swimming pools is important. Small, frequent, nutrient-dense meals that limit fatty and overly sweet foods are easier to tolerate. Patients benefit from eating cold foods and drier or saltier foods with fluid in between.

enteral access tubes

inability of patients to ingest food but still able to digest and absorb nutrients supports the use of enteral tube feeding. Feeding tubes are inserted through the nose (nasogastric or nasointestinal), surgically (gastrostomy or jejunostomy), or endoscopically (percutaneous endoscopic gastrostomy or jejunostomy [PEG or PEJ]). If EN therapy is for less than 4 weeks, total, nasogastric, or nasojejunal feeding tubes may be used. Surgical or endoscopically placed tubes are preferred for long-term feeding (more than 6 weeks) to reduce the discomfort of a nasal tube and provide a more secure, reliable access

celiac disease (malabsorption syndrome)

includes a gluten-free diet. Gluten is present in wheat, rye, barley, and oats. Short-bowel syndrome results from extensive resection of bowel, after which patients suffer from malabsorption caused by lack of intestinal surface area. These patients require lifetime feeding with either elemental enteral formulas or PN.

. Polymeric (1 to 2 kcal/mL)

includes milk-based blenderized foods prepared by hospital dietary staff or in a patient's home For this type of formula to be effective, a patient's GI tract needs to be able to absorb whole nutrients

Parenteral nutrition (PN)

is a form of specialized nutrition support provided intravenously. A basic PN formula is a combination of crystalline amino acids, hypertonic dextrose, electrolytes, vitamins, and trace elements. Total PN (TPN), administered through a central line, is a 2-in-1 formula in which administration of fat emulsions occurs separately from the protein and dextrose solution. Patients who are unable to digest or absorb EN benefit from PN. Patients in highly stressed physiological states such as sepsis, head injury, or burns are candidates for PN therapy.

enteral nutrition

provides nutrients into the GI tract. It is the preferred method of meeting nutritional needs if a patient is unable to swallow or take in nutrients orally yet has a functioning GI tract.

A patient with dysphagia are often given liquids that have been __________ so they move more slowly and stay together.

thickened

type 2 diabetes

type 2 DM initially with exercise and diet therapy. If these measures prove ineffective, it is common to add oral medications. Insulin injections often follow if type 2 DM worsens or fails to respond to these initial interventions. Maintaining a prescribed carbohydrate intake is the key in diabetes management.