Chapter 45 Nutrition NURS 305

Disaccharides

- 2 monosaccharides and water

proteins

- 4 kcal/g - growth, maintenance, repair of body tissue - collagen, immune cells, DNA, RNA, hormones, enzymes - blood clotting & fluid regulation - transport nutrients and drugs in blood

Carbohydrates

- CHO - main source of energy in diet - each gram makes 4 Kcal/g - fuel for brain, skeletal muscles, erythrocyte production, leukocyte production, cell function of renal medulla - plant foods, not lactose

monosaccharides

- Do not break down

Food security

- all members of household have access to sufficient, safe, nutritious food - Consistent resources

resting energy expidenture

- amount of energy needed over 24 hours for body to maintain activities at rest

saccharides

- carbohydrate units

fatty acids

- chains of carbon and hydrogen w/ an acid group on one end of chain and methyl group on the other - saturated (each carbon has 2 hydrogen atoms( - unsaturated (unequal # of hydrogen atoms are attached and carbons attach making a double bond

triglycerides

- circulate in the blood and composed of 3 fatty acids to glycerol

Incomplete

- does not contain indispensable - cereals, legumes (beans, peas), vegetables

nutrients

- elements necessary for normal body function - carbs, proteins, vitamins, minerals, fat, water

Basal Metabolic Rate

- energy needed at rest to maintain breathing, circulation, HR, Temperature) for a specific time. - age, body mass, gender, fever

Nitrogen Balance

- intake and output of nitrogen are equal - I > O = body in positive nitrogen balance; required for growth, normal pregnancy, maintenance of lean muscle mass and vital organs, wound healing

Lipids

- most calorie dense nutrient - 9 kcal/g

fiber

- polysaccharide; structural part of plants - fiber does not contribute to our diet - indigestible - soluble fibers dissolve in water including barley, oats, cereal grains, cornmeal

nutrient density

- proportion of essential nutrients to the number of Kcal

Amino acid

- simplest form of protein - CHON - body does not synthesize indispensable amino acids (histidine, lysine, phenylalanine) - body synthesizes dispensable amino acids (alanine, asparagine, glutamic acid)

The nurse is inserting a central catheter into a patient to provide parenteral nutrition (PN). The nurse places the patient in a left lateral decubitus position, and instructs the patient to hold her breath and bear down during catheter insertion. What is the most probable reason the nurse put the patient in that position and asked her to hold her breath and bear down?

An air embolism can occur when inserting a catheter for parenteral nutrition (PN). It can be prevented by placing the patient in a left lateral decubitus position, because the chances of air embolism are minimal due to the anatomic position of the heart. Holding the breath and bearing down is called the Valsalva maneuver. Performing the Valsalva maneuver helps to increase the venous pressure and prevent air from entering the bloodstream. The patient's position does not promote the patient's comfort nor does it promote lung expansion. It also does not help to prevent pulmonary aspiration; pulmonary aspiration is a complication of enteral nutrition and is not related to PN. p. 1080

Which action is initially taken by the nurse to verify the correct position of a recently placed small-bore feeding tube?

At present, the most reliable method for verification of placement of small-bore feeding tubes after initial placement is x-ray film examination. The measurement of the pH of gastric secretions withdrawn from the feeding tube helps to determine the location of the tube before use, but after the initial placement verification by x-ray should be done. Auscultation has repeatedly been shown to be ineffective in detecting tubes accidentally placed in the lung. Further, it is not effective in distinguishing between gastric and intestinal placement for feeding tubes. p. 1075

Which food items contain gluten and should be avoided in patients with celiac disease?

Celiac disease is characterized by malabsorption of gluten. Therefore, the patient should avoid food items containing gluten. Wheat, rye, barley, and oats are rich in gluten and should be avoided. Rice is wheat- and gluten-free and can be included in the diet. p. 1081

A dietitian advised the mother of a school-age child to include complete proteins in the child's diet to promote growth. Which food items should the nurse instruct the mother to include in the diet?

Complete proteins, also called high-quality proteins, are those proteins that contain all essential amino acids in adequate amounts to promote growth. Fish, cheese, and soybeans are examples of complete proteins. These food items contain balanced amounts of all amino acids required for growth and development. Beans and cereals are incomplete proteins and are deficient in one or more essential amino acids. p. 1055

The nurse is assessing a patient receiving enteral feedings via a small-bore nasogastric tube. Which assessment findings need further intervention?

Delayed gastric emptying is a concern if 250 mL or more remains in the patient's stomach on each of two consecutive assessments. The North American Summit on Aspiration in the Critically Ill Patient made the following recommendations regarding gastric residual volumes (GRVs): (1) stop feedings immediately if aspiration occurs; (2) withhold feedings and reassess patient tolerance to feedings if GRV is over 500 mL for two successive measurements; and (3) routinely evaluate the patient for aspiration and use nursing measures to reduce the risk of aspiration if GRV is between 250 and 500 mL. p. 1076

A patient on enteral feeding complains of diarrhea. What could be the possible causes of this health condition?

Diarrhea in patients on enteral feeding may be due to hyperosmolar formula, bacterial contamination, or antibiotic therapy. Hyperosmolar formula may not be tolerated and absorbed, causing diarrhea. Bacterial contamination of enteral formula may cause infection of the gastrointestinal tract, leading to diarrhea. Diarrhea can also be a side effect of antibiotic therapy. Displacement of the tube and delayed gastric emptying do not cause diarrhea. p. 1079

Which patients are at high risk of dysphagia?

Dysphagia refers to abnormal swallowing, which can lead to aspiration. Coughing during eating indicates that food has entered the respiratory tract. Abnormal lip movements can indicate an abnormal swallowing reflex. A change in voice tone after swallowing is caused by the food entering the respiratory tract. Speaking consistently and having coordinated speech indicate a normal swallowing reflex. p. 1067

Upon assessing a patient, the nurse suspects anorexia nervosa. What behavioral finding may have led the nurse to this suspicion?

Fear of becoming fat despite being significantly underweight is indicative of anorexia nervosa. A patient with anorexia nervosa refuses to eat in order to stay at or below a minimal normal weight for his or her age and height. Frequent self-induced vomiting, recurrent episodes of binge eating, and frequent use of laxatives or diuretics are more characteristic of bulimia nervosa than of anorexia nervosa. p. 1060

The nurse is caring for a patient diagnosed with hemorrhoids. While taking the patient's clinical history and vitals, the nurse finds that the patient has chronic constipation. What should the nurse teach the patient about the diet?

Low fluid intake, low fiber, and physical inactivity can lead to constipation, which may cause hemorrhoids in the long term. Fibers relieve constipation by adding bulk to the stool and helping in bowel elimination. Fluids soften the stool and help in easy passage. Fruits and vegetables are good sources of fibers and should be included in the diet. Fibers do not add calories to the body, because these are not digested by the body. p. 1069

What is the minimum recommended daily intake of macrominerals in the body?

Macrominerals help balance the body's pH. The recommended daily intake of macrominerals is 100 mg. p. 1055

A postoperative patient refuses to eat and complains of a loss of appetite. What intervention should the nurse perform to improve the patient's appetite?

Offering smaller, more frequent meals often helps to improve the appetite in the postoperative patient. In addition, it also helps to meet the nutritional needs. Eating is a social activity. The patient may eat more if he or she eats with family members or friends. A low-fiber diet does not help in promoting appetite. Skipping breakfast does not improve appetite; it may deprive the patient of required nutrition. p. 1074

The home care nurse is seeing the following patients. Which patient is at greatest risk for experiencing inadequate nutrition?

Older adults who are home-bound and have chronic illness have additional nutritional risks. Frequently members of this group live alone with few or no social or financial resources to assist in obtaining or preparing nutritionally sound meals. This contributes to a risk for food insecurity caused by low income and poverty. In addition, the mild stroke might cause dysphagia.

By which process do particles move outward from an area of greater concentration to one of lesser concentration without the help of a special carrier?

Passive diffusion is the process in which particles move outward from an area of greater concentration to one of lesser concentration without a carrier. In the process of osmosis, water moves through a semipermeable membrane to equalize the concentration pressures on both sides of the membrane. Pinocytosis is the process of an absorbing cell engulfing large molecules of nutrients when the molecules attach to the absorbing cell membranes. Active transport is the energy-dependent movement of particles from a region of greater concentration to a region of lesser concentration with the help of a special carrier. p. 1057

Which enteral formula type consists of milk-based, blended foods and can be prepared by hospital dietary staff or in a patient's home?

Polymeric formula consists of milk-based, blended foods and can be prepared by hospital dietary staff or in a patient's home. These formulas are appropriate for patients who have functional gastrointestinal tracts. Modular formulas consist of single macronutrient preparations. These formulas are incomplete and do not meet nutritional requirements. Elemental formulas contain predigested nutrients that make digestion easier for the patient with a partially dysfunctional gastrointestinal (GI) tract. Specialty formulas consist of specific nutrients to meet specific nutritional needs. p. 1075

The nurse works at a weight loss clinic. A teenage girl approaches the nurse for advice on weight loss. Which instructions should the nurse give to the teenager to help reduce her weight?

Regular exercise, physical activities, and sports are all essential for burning calories and reducing weight. Junk foods are excessively fatty, so these should be avoided. Carbohydrate content should be increased in the diet when exercising because carbohydrates are a major source of energy. p. 1060

Which vitamin does not have antioxidant properties?

Researchers believe oxidative damage may contribute to a person's risk for cancer. Vitamin D does not have antioxidant properties, but vitamins A, C, and E do. p. 1055

A postoperative patient is advised to take clear fluids. What types of fluids should the nurse provide to the patient?

Some patients who are chronically ill or who have undergone surgery may need to resume their diet gradually. They are usually started on clear fluids and then progressed to other diets. Clear fluids include tea, coffee, and carbonated beverages. These fluids are easy to digest and do not leave any residue after digestion. Vegetables and blended cream soups are full liquids and are usually given once the patient is able to tolerate clear fluids. p. 1074

The nurse is teaching an infant's mother about the developmental needs of infants. What statement made by the mother indicates a need for further teaching?

Soy protein-based formulas are safe and good for infants, especially those who are allergic to cow's milk. The remaining statements indicate understanding. Honey should be avoided during the first year of an infant's life because it is a potential source of botulism toxin. Cow's milk should be avoided during the first year of an infant's life because it increases the risk of milk-product allergies and is a poor source of iron and vitamins C and E. Cow's milk is also too concentrated for an infant's kidneys to process. Corn syrup products should be avoided during the first year of an infant's life because, like honey, they are a potential source of botulism toxin. Test-Taking Tip: The most reliable way to ensure that you select the correct response to a multiple-choice question is to recall it. Depend on your learning and memory to furnish the answer to the question. To do this, read the stem, and then stop! Do not look at the response options yet. Try to recall what you know and, based on this, what you would give as the answer. After you have taken a few seconds to do this, then look at all of the choices and select the one that most nearly matches the answer you recalled. It is important that you consider all the choices and not just choose the first option that seems to fit the answer you recall. If you do not consider all the choices, you are not maximizing your chances of correctly answering the question. p. 1059

The nurse is learning about the Mini Nutritional Assessment (MNA®). What is the highest score in the test?

The Mini Nutritional Assessment (MNA ®) can be used for screening the nutritional status of older adults. The maximum score is 14. If the score is from 12 to 14 points, it is considered a normal nutritional status. If the score is between 8 and 11 points, the patient is at risk of malnutrition. A total score of less than 7 points indicates malnutrition. p. 1065

The patient receiving total parenteral nutrition (TPN) asks the nurse why his blood glucose is being checked, because he does not have diabetes. What is the best response by the nurse?

The TPN formula is a combination of crystalline amino acids, hypertonic dextrose, electrolytes, vitamins, and trace elements. Administration of concentrated glucose is accompanied by increases in endogenous insulin production, which causes cations (potassium, magnesium, and phosphorus) to move intracellularly. Blood glucose levels should be monitored every 6 hours to assess for hyperglycemia. Maintaining blood glucose within acceptable limits helps prevent complications from the TPN. p. 1078

The U.S. Food and Drug Administration (FDA) created daily values for food labels. These daily values are based on percentages of a diet consisting of how many kilocalories per day?

The daily values for food labels are based on percentages of a diet consisting of 2000 kcal/day. The average population needs more than 1000 and 1500 kcal per day and less than 2500 kcal per day. p. 1058

In renal failure, protein intake should be approximately 1 g to 1.4 g per kilogram of body weight. What is the best source of this protein?

The use of high-biological value or high-quality proteins is recommended in renal failure. A high-quality protein contains all essential amino acids in sufficient quantity. These proteins help growth, development, and maintaining nitrogen balance. Fish is a source of high-quality protein and contains all essential amino acids. Cereals and legumes such as peas and beans are incomplete proteins and lack one or more of the nine essential amino acids. p. 1055

The nurse is assessing the nutritional status of a 3-month-old baby. The mother informs the nurse that she feeds the baby with cow's milk mixed with one spoon of honey. What should the nurse advise this mother to do?

There is no perfect alternative to human breast milk. It is the best food for infants. Infant formulas contain the approximate nutrient composition of human milk. Honey should not be given to an infant, because it may be a source of botulinum toxin. The infant should not be given cow's milk, because it is deficient in iron and vitamin C and may increase the risk of anemia in the infant. In addition, the cow's milk is too concentrated for the infant's kidneys to handle. Infants fed cow's milk have an increased risk of developing kidney problems. Corn syrup is also a source of botulinum toxin and should be avoided. p. 1059

The nurse is preparing a diet plan for a patient diagnosed with gluten intolerance. What food item can be included in the diet plan?

White rice does not contain gluten and can be added to the diet plan. Gluten is present in wheat, rye, barley, and oats, so they should be avoided in patients with celiac disease or patients with gluten intolerance. Gluten can result in malabsorption and nutritional deficiencies in the patient. p.1081 and box 45-10

Complete proteins

both indispensable and dispensable - Fish, chickens, soybeans, cheese, turkey

Simple Carbohydrates

classification for both monosaccharides and disaccharides - found in sugars

Which term describes the suggested intake for individuals based on experimentally determined estimates of nutrient intakes?

Adequate intake is the suggested intake for individuals based on experimentally determined estimates of nutrient intakes. The tolerable upper intake level is the highest level of nutrient intake that likely poses no risk of adverse health events. The estimated average requirement is the recommended amount of a nutrient that appears sufficient to maintain a specific body function for 50 percent of the population on the basis of age and gender. The recommended dietary allowance is the average needs of 98 percent of the population but not the exact needs of an individual. p. 1058

The nurse has inserted a nasogastric tube into a patient. However, when the first feeding is administered, the patient has pulmonary aspiration. Which action would have prevented this complication?

Following insertion of a tube for enteral feeding, the placement of the tube should be verified through an x-ray. This verification helps prevent complications such as pulmonary aspiration. Starting the enteral feeding at a slow rate helps to advance the feeding based on the patient's tolerance. Administering a milk-based formula does not help to prevent aspiration. Auscultating the bowel sounds helps to determine if the gastrointestinal tract is functioning; it does not help to ascertain the placement of the tube. p. 1075

During which phase of the nursing process does the nurse consult other health care professionals to adopt the best nursing intervention for a patient diagnosed with nutritional disturbances?

For a patient diagnosed with nutritional disturbances, the nurse consults other health care professionals to adopt the best intervention during the planning phase of the nursing process. During the evaluation phase, the nurse reassess signs and symptoms in the patient associated with altered nutrition. In the assessment phase, the nurse identifies signs and symptoms. The nurse provides different interventions to the patient during the implementation phase; these include dietary guidelines, exercise therapy, or others, depending upon the patient's nursing diagnosis. p. 1070

A patient of normal weight asks the nurse for dietary guidelines for maintaining her weight. What does the nurse teach the patient?

The nurse should teach the patient to consume fats containing unsaturated fatty acids such as polyunsaturated or monounsaturated fatty acids. The patient should eat lean meats in moderate, not high, amounts. The patient should consume, not avoid, foods that are rich in potassium. The patient's total fat intake should be between 20 and 35 percent of total calories. p. 1058

The nurse is helping a patient with vision impairment to feed himself. What nursing actions would help the patient maintain independence during feeding?

The patient with vision impairment should be assisted with feedings. The patient should be told where the beverage is in relation to the plate so that he or she can drink it without assistance. Identifying where the food is on the plate using a clockwise pattern helps the patient locate the food and eat without assistance. The patient may be able to eat the food without assistance if the plate is always set in the same pattern. Using large, adaptive utensils helps the patient use them effectively. The patient should not be left alone to eat if he or she is visually impaired. p. 1074

What does the nurse do when evaluating a patient who has been treated for malnutrition?

When evaluating a patient treated for malnutrition, the nurse determines the patient's satisfaction with the nutritional therapy and reassesses signs and symptoms associated with the altered nutrition plan. During the assessment phase of the nursing process, the nurse will have determined the patient's nutritional energy needs and will have gathered data from the patient regarding nutritional practices. During the planning phase, the nurse will have selected nursing interventions consistent with the therapeutic diet. p. 1082