PrepU hapter 15: Hospital Nutrition: Defining Nutrition Risk and Feeding Clients

The nurse is assigned to a psychiatric ward to help with nutrition assessments. Which psychological factor(s) may affect nutritional intake? Select all that apply.

- Depression - Anxiety - Eating disorders - Psychosis

The nurse is precepting a nursing student and teaching strategies to promote optimal intake. Which strategy(s) will the nurse include in the teaching? Select all that apply.

- Avoid disconnecting enteral or parenteral nutrition for client repositioning - Question diet orders that appear inappropriate - Gently motivate the client to eat - Get the client out of bed to eat, if possible

The nurse is caring for an older-aged client with ill-fitting dentures and adhering to a mechanically altered diet. Which food(s) is the client able to eat? Select all that apply.

- Cottage cheese - Biscuits and gravy - Mashed potatoes Cottage cheese, biscuits and gravy, and mashed potatoes are all part of a mechanically altered diet. A mechanically altered diet is a regular diet modified in texture only and excludes most raw fruits and vegetables and foods containing seeds, nuts, and dried fruit.

The nurse suspects a patient has malnutrition. According to ASPEN, which criteria is associated with a diagnosis of malnutrition? Select all that apply.

- Diminished functional status as measured by handgrip strength - Localized fluid accumulation that may mask weight loss - Unintentional weight loss - Loss of muscle mass - Loss of subcutaneous fat

The nurse is taking care of a client that requires oral nutrition supplements (ONS). Which action(s) can the nurse take to help promote compliance with ONS? Select all that apply.

- Explain the benefits - Obtain taste preference - Closely monitor acceptance

The nurse is teaching a client about the restaurant-style service the hospital offers. The nurse knows the restaurant-style service has which advantage(s) when compared to traditional-style service? Select all that apply.

- Greater client control - Improved calorie intake - Improved client satisfaction

The nurse is performing an admission assessment on a client. Which physical finding(s) may indicate risk for malnutrition? Select all that apply.

- Loss of subcutaneous fat -Brittle hair - Loss of muscle mass

The nurse is caring for a client that is post-gastrointestinal surgery. Which action(s) will the nurse take while monitoring the client's nutrition? Select all that apply.

- Observe intake of food and supplements whenever possible - Assess tolerance - Order supplements if intake is low - Monitor weight - Rescreen client

The nurse is preparing to perform a screening for malnutrition. While there are many screening tools available the nurse knows which factor(s) makes a screening tool useful? Select all that apply.

- Quick - Simple - Valid - Reliable - Done regularly

The nurse is taking care of a client that weighs 65.2 kilograms. When calculating estimated caloric needs, the nurse knows the client's estimated calories will be between which values?

1,630 g and 1,956 g -A simple method of estimating calorie needs is to multiply a person's weight in kilograms by a factor appropriate for the medical condition. A range frequently used is 25 to 30 cal/kg/day.

At a 6-month follow-up visit, the nurse congratulates a client on having lost weight. The client is surprised and relates that she has not been trying to lose weight; she just does not feel like eating. This change will be significant if the percent weight change is greater than:

10 percent. -Unintentional percent weight change of greater than 10 pounds in six months is significant and should be investigated further as it can be a sign of a disease process and may result in nutritional deficiencies or malnutrition.

The nurse is teaching the client about protein intake post surgery. The client weighs 80 kilograms. The nurse will recommend a diet with which amount of protein daily?

120g to 160g -Postsurgical clients may need 1.5 to 2.0 g/kg/day. Protein is more of a priority for postsurgical clients than total calorie intake.

The client has come to the office for follow-up after a viral infection. The nurse notes that the client has lost weight and now weighs 130 pounds. One month ago, the client weighed 150 pounds. What is the percent weight change in this client? Round the answer to the nearest percent.

13 -To calculate the percent weight change, subtract the current weight from the normal weight, divide by the normal weight, and multiply by 100, so (150 - 130)/150 x 100 = 20/150 x 100 = 13 percent.

The nurse is performing an assessment on a client of older age with chronic obstructive pulmonary disorder (COPD). The client's weight has decreased, unintentionally, from 240 pounds to 204 pounds over the past year. Which is the correct percentage of weight lost?

15% -Percentage of weight loss is a calculation where the amount of weight lost is divided by usual body weight and multiplied by 100: (amount of weight loss/usual body weight) x 100 = percentage of weight loss 240 - 204 = 36 (36/240) x 100 = 15%

Healthy weight is

18.5 to 24.9;

The nurse is admitting a client diagnosed with congestive heart failure (CHF). The nutritional screening assessment for this client will be completed within which time period after admission?

24 hours -The Joint Commission specifies that nutrition screening must be conducted within 24 hours of admission to a hospital or other health care facility.

overweight is

25 to 29.9;

above 40 is obesity class

3

The nurse is caring for a client experiencing acute constipation. The client is ordered a high-fiber diet. Which number is within the goal range for fiber in grams?

30 -A high fiber diet is a general diet with low-fiber foods replaced by foods high in fiber with a goal of 25-35 g or more per day.

obesity class 1 is

30 to 34.9;

obesity class 2 is

35 to 39.9;

Which of the following does not describe a good candidate for nasogastric feedings?

A client with cognitive deficits -A confused or combative client could remove a nasogastric (NG) tube. Clients with intact swallow ability and low risk for aspiration are appropriate candidates for NG tube therapy. NG tube therapy is used on a short-term basis, usually less than 4 weeks. A client that needs therapy for 3 weeks would be a good candidate for an NG tube.

The nurse is caring for a client with bloodwork indicating hypokalemia. Which type of diet will the nurse identify as appropriate for this client?

A potassium modified diet -Hypokalemia is low potassium. The patient will require a potassium modified diet high in potassium to bring the serum level of this electrolyte back up again. A low-sodium diet may be prescribed for clients with hypertension, congestive heart failure, acute and chronic renal disease, or liver disease. A gluten free diet is appropriate for clients with celiac disease or other gluten sensitivities. A renal diet is appropriate for clients with chronic kidney disease.

The nurse is caring for an adult client that requires parenteral nutrition for a small bowel obstruction. The client is to begin taking nutrition orally. Which diet should the nurse anticipate as a transitional diet?

Clear liquid -A clear liquid diet is a short-term, highly restrictive diet composed only of fluids or foods that are transparent and liquid at body temperature and used as a transitional feeding method after parenteral nutrition. A pureed diet is composed of foods that are blended, whipped, or mashed to a pudding-like consistency and are used for wired jaws. A mechanically altered diet is a regular diet modified in texture only and excludes most raw fruits and vegetables and foods containing seeds, nuts, and dried fruit. A mechanically altered diet is used for clients who have limited chewing ability. A soft diet is a regular diet that features soft-textured foods that are easy to chew and swallow. Hard, sticky, dry, or crunchy foods are excluded.

The nurse's client is returning to the floor after having a cholecystectomy. Which diet order would the nurse question?

Clear liquid -It is now known that early resumption of oral feeding after major surgery, including gastrointestinal (GI) surgery, is associated with a decrease in postoperative complications, length of stay, and mortality (Warren et al., 2011). It is recommended that clear liquid diets not be routinely used postoperatively because they do not provide adequate nutrition or protein (Wischmeyer et al., 2018). The current recommendation is that a high-protein diet of food and/or high-protein oral nutrition supplements (ONS) be initiated on the day of surgery in most cases (Wischmeyer et al., 2018).

The nurse is considering a variety of oral nutritional supplements for a hospitalized client. The nurse identifies Ensure Original Pudding as an example of which type of oral nutritional supplement?

Commercially prepared supplemental food

The nurse is obtaining a nursing history. Which word should the nurse avoid when asking about nutritional intake?

Diet

The nurse is taking care of an adult client with pneumonia. The client has a regular diet ordered and was recently intubated due to low oxygen saturation. Which person should the nurse contact about the client's nutrition?

Dietitian

The nurse is taking care of a postsurgical client experiencing decreased appetite. The client is consistently consuming less than 50% of their protein and calorie goals. When the nurse is talking to the health care provider, which order can the nurse expect?

Enteral nutrition support

The nurse is caring for a client who is receiving oral nutritional supplements. What intervention can aid in the client's compliance with taking the supplements?

Explain why supplements are being used.

The nurse is caring for an adult client with congestive heart failure. Which food would not be recommended for this client?

Fried rice -Fried rice is high in sodium and a client with congestive heart failure may be prescribed a sodium-restricted diet. All other foods are not contraindicated on a sodium-restricted diet.

The nurse is participating in a committee examining the use of nutritional screenings within the facility. The nurse is aware that the Joint Commission has indicated that all nutritional screenings must be conducted by which professional?

Individualized to the facility -The Joint Commission, a nonprofit organization that sets healthcare standards and accredits healthcare facilities that meet those standards, specifies that nutrition screening must be conducted within 24 hours after admission to a hospital or other healthcare facility. The standard applies 24 hours a day, 7 days a week; therefore, staff nurses are usually responsible for completing the screen as part of the admission process. Each facility, however, is able to determine the criteria it uses for screening, who completes nutrition screening, and when rescreening is required.

Malnutrition literally means "bad nutrition." In practice, malnutrition usually refers to:

Insufficient nutrient intake

The spouse of a client being prepared for surgery asks whether the client will be placed on a clear liquid diet following surgery. What fact about the clear liquid diet will the nurse include in the response?

It provides less nutrition and is not recommended.

The nurse is conducting an assessment on a malnourished client with a closed head injury. Which assessment will the nurse anticipate in addition to loss of body mass?

Marked inflammatory response -Acute injury-related malnutrition may occur in clients due to a marked inflammatory response. Starvation-related malnutrition occurs when food is not available due to environmental or social circumstances. In this case, inflammation is absent. Chronic disease-related malnutrition has a mild to moderate degree of inflammation that impedes appetite, intake, or nutrient utilization.

The nurse is caring for an adult client that post-knee replacement surgery. The client has had a 4% loss of body weight 1 month after surgery. The nurse knows this indicates which level of malnutrition?

Moderate malnutrition -With acute disease or injury, moderate malnutrition is greater than 2% and up to 5% weight loss in a month. Severe malnutrition is greater than 5% weight loss.

The nurse recognizes that malnutrition is a serious health concern for all individuals. The nurse is aware that which of the following tools is used to diagnosis malnutrition?

No single method is recognized.

Which method will the nurse recognize as the most effective way to monitor a client's appetite in a medical hospital unit?

Observing intake whenever possible

The nurse is assessing an adult client with a BMI of 27. Which category does the client fall into?

Overweight -Overweight is defined as a body mass index (BMI) of 25-29.9. Underweight is a BMI less than 18.5. Healthy weight a BMI of 18.5-24.9. Obesity is a BMI greater than or equal to 30.

The nurse is caring for an adult client who had been in a motor vehicle accident and subsequently had their jaw wired shut. Which diet should the nurse anticipate the health care provider will order?

Pureed diet

A nurse is caring for a client requesting a cheeseburger and fries. Which diet would the client need to be on for them to receive this?

Regular diet -With a regular diet, no foods are excluded and portion sizes are not limited. Heart healthy diet limits saturated fats, trans fats, and sodium. A consistent carbohydrate diet has a consistent total daily carbohydrate content with an emphasis on heart healthy food choices. Fat restricted diet limits total fat and limitations vary from less than 25-50 g/day.

The nurse is caring for a client on a potassium-restricted diet. Which food item will the nurse question for this client?

Romaine salad -Romaine is a leafy green vegetable and contains high amounts of potassium.

The nurse is caring for a client who may be malnourished. After the laboratory results return, the nurse knows which laboratory value shows malnutrition?

There are no biochemical indicators used to diagnose malnutrition

The client states that they weigh 215 pounds. In which situation would the nurse accept a stated weight?

There are no other options to obtain weight available -A client's stated height and weight should be used only when there are no other options.

The nurse is assessing a new client to the clinic. During the initial assessment the nurse determines this client has a BMI of 18. Which category is this client in?

Underweight

A client is in the hospital after surgery to remove a neck tumor. He does not have any teeth. Which diet is indicated?

a mechanically altered diet -Mechanically altered diets are indicated for patients who have limited chewing ability, such as patients who are edentulous (without teeth), have ill-fitting dentures, or have undergone surgery to the head, neck, or mouth.

A patient flipped over the handle bars of his bike and broke his jaw, which is now wired shut. Which of the following diets is indicated?

a pureed diet -Pureed diets are used after oral or facial surgery, for wired jaws, and for chewing and swallowing problems.

The nurse has ordered a high-protein, soft diet for a patient who is malnourished and has had gastrointestinal surgery. The nurse has order which type oral diet for this patient?

combination -Often, combination diets are ordered, such as a ground low-sodium diet or a high-protein, soft diet.

A nurse is trying to promote adequate intake with a hospitalized client who is prescribed a diet as tolerated after abdominal surgery. Which approach should the nurse use?

have alternative foods on 'standby'

The nurse correctly explains to the family of a hospitalized client that a clear liquid diet is an example of which type of oral diet?

modified consistency

Which type of menu allows patients more control over their diet?

restaurant-style

The nurse who is taking a quick look at a few patient variables to detect risk for nutritional problems is doing which of the following?

screening -Nutrition screening is a quick look at a few variables to judge a client's relative risk for nutritional problems.

Individuals with a BMI below 18.5 are at risk for developing health problems and are considered to be

underweight.

The nurse conducting an assessment of an acutely ill client notes several characteristics of malnutrition. Which of the following is are general characteristics for the diagnosis of adult malnutrition?

unintentional weight loss