Fundamentals Nutrition modifications

liver diet

low protein low sodium fluid restriction

food allowed with Gluten

meats, eggs, dairy products, fruits. Vegetables, gluten free wheat, flour, cornmeal, puffed rice

low purine diet

purine is a precursor for uric acid, indicated in: gout, kidney stones, elevated uric acid levels. (anchovies, scallops, glandular, meats, gravies, meat extracts, sweet breads)

A nurse in a provider's office is reviewing the medical records of a group of clients. The nurse should identify that which of the following clients are at risk of iron deficiency?

A client who is a vegetarian, a client who is pregnant, and a toddler who is overweight. A client who is a vegetarian might require additional iron because of the limited availability of iron in vegetable sources. During pregnancy, maternal blood volume increases, and the fetus requires iron. Therefore, the RDA of iron for clients who are pregnant is increased to 27mg/day. Toddlers who are overweight might get most of the calories from milk and from foods that are not considered healthy, which places toddlers at risk of iron-deficiency anemia. Iron requirements are increased for woman who have excessive blood loss due to menstruation. Generally, postmenopausal women do not require additional iron. Most adult males consume adequate iron in their diet and do not require additional iron.

A home health nurse is contributing to the plan of care for a client who is receiving chemotherapy and has neutropenia. Which of the following foods should the nurse include in the client's plan of care?

Backed chicken. Well-cooked meats, including backed chicken, do not pose a threat to clients who have neutropenia and may be included in the cliet's dietary plan. For optimal safety, poultry should be cooked until its internal temperature is 74 degrees C (165 degrees F) Soft-foiled eggs can be a source of infection. Clients who have neutropenia should avoid eating them. For optimal safety, eggs should be cooked until the yolk and white are solid (example: hard-boiled eggs). Soft cheeses such as brie, which are made with unpasteurized milk, can contain bacteria and should be avoided by clients who have neutropenia. Hard or processed cheeses or those clearly labeled as being made with pasteurized milk are an alternative to brie for a client who has neutropenia. Cold deli meats and lunchmeats can contain listeria monocytogenes. These bacteria remain viable at refrigerated and room temperatures and can make clients who are immunocompromised severely ill. As an alternative, the nurse should recommend heating all deli meats or lunchmeats.

fluid modified diet

Conditions in which body retains fluid. Heart failure. Renal patients: Fluids restricted to 500-750 mL/day + an amount equal to daily urine output during end-stage renal disease, CHF, MI. Approx 3-3 cups plus amount of urine output. Liver disease, hyponatremia. Giving ice chips to reduce consumption of water

A nurse is planning care for a client who is postoperative following a gastrectomy. Which of the following strategies should the nurse suggest to help prevent dumping syndrome?

Eliminate simple sugars and sugar alcohols from the client's diet. Sugar, honey, and sugar alcohols such as sorbitol and xylitol increase hypertonicity and propel food through the intestines faster than food without sweeteners. The client should drink beverages between meals only, about 1 hour after eating solid foods. Mixing food and fluids propels the mixture through the gastrointestinal tract faster than solid food alone. The client should have several smaller meals that include only 1 or 2 foods throughout the day. The client should ingest protein at every meal because it helps slow gastric emptying.

Cardiac diet

indications; atherosclerosis, DM, HTN, MI, Nephrotic syndrome, renal failure, hyperlipidemia

A nurse is reinforcing teaching about calcium intake with a client who is breastfeeding. Which of the following amounts of calcium is the daily recommended amount for a woman who is breastfeeding?

1,000 mg. The nurse should instruct the client that 1,000 mg of calcium is recommended for woman ages 19 and older, as well as those who are lactating. This amount of calcium is sufficient to meet the needs of a client and the infant because additional calcium is absorbed from the intestines. Although the calcium requirement for a client who is breastfeeding does not increase, 800 mg of calcium is less than daily recommended intake of 1,000mg. The nurse should explore additional sources of calcium with the client if she does not drink milk products. Although the calcium requirement for a client who is breastfeeding does not increase, 400mg of calcium is less than the daily recommended intake of 1,000 mg. The nurse should identify that 2,000 mg of calcium is above the recommended daily intake of 1,000 mg. A calcium intake this high can result in the development of kidney stones and decrease the absorption of other nutrients such as iron and zinc.

A nurse is reviewing laboratory reports for a client who is receiving enteral feedings. Which of the following values indicates a complication of the enteral feeding that the nurse should report to the provider?

BUN 25mg/dL. A BUN level of 25mg/dL is above the expected reference range of 10 to 20 mg/dL and is an indication of dehydration, a complication of enteral feedings. The nurse should report this laboratory value to the provider. A sodium level of 143 mEq/L is within the expected reference range of 136 to 145 mEq/L and does not indicate a complication of the enteral feeding. A potassium level of 4.2 mEq/L is within the expected reference range of 3.5 to 5.0 mEq/L and does not indicate a complication of the enteral feeding. A glucose level of 185mg/dL is within the expected reference range of less than 200mg/dL for casual blood glucose and does not indicate a complication of the enteral feeding.

A nurse is caring for a client who has diverticulitis and a new prescription for a low fiber diet. Which of the following food items should the nurse remove from the client's meal tray?

Coleslaw. Coleslaw contains raw cabbage, which is high in fiber. Clients who are following a low-fiber diet should avoid most raw vegetables. Canned fruit is an appropriate low-fiber food for this client. Fresh fruit contains more fiber. White bread is an appropriate low-fiber food for this client. Whole-grain bread contains more fiber. Broiled hamburger is an appropriate low-fiber food for this client. Fish and poultry are also low in fiber.

A nurse is caring for a client during her first prenatal visit and notes that she is lactose intolerant. Which of the following foods should the nurse recommend as a calcium source for this client?

Collard greens. Collard greens are a good source of lactose-free calcium. One cup of collard greens provides approximately the same amount of calcium as the equivalent volume of 240 mL (8 oz) of milk. They also contain folic acid, which is a nutrient that women should consume during pregnancy to prevent birth defects. Cottage cheese is a good source of calcium, but it contains lactose, which the client cannot tolerate. Orange juice is high in vitamin C. But, unless the orange juice is calcium-fortified, it is not a rich source of calcium. Broccoli is high in folic acid but is not a rich source of calcium.

A nurse is reviewing the laboratory findings of a client who has protein-calorie malnutrition. Which of the following findings should the nurse expect?

Decreased albumin. A decreased albumin level can be an indication of long-term protein depletion. Other potential conditions that result in decreased albumin levels include burns, wound drainage, and impaired hepatic function. Protein-calorie malnutrition can negatively y impact the production of RBCs, resulting in a decrease in hemoglobin. Nutritional deficiencies such as protein-calorie malnutrition can result in low lymphocyte levels, which increases the client's risk of infection. Cortisol is a glucocorticoid that plays a role in the metabolism of proteins, fats, and carbohydrates. Low levels are associated with Addison's disease. However, cortisol does not indicate protein-calorie malnutrition.

A nurse is collecting data from a client. Which of the following findings should the nurse identify as an indication of protein-calorie malnourishment?

Dry, brittle hair, edema, poor wound healing. Dry, brittle hair that falls out easily suggests inadequate protein intake and malnutrition. Edema can occur when albumin levels are lower than the expected reference range; this finding indicates the client might be experiencing protein-calorie malnutrition. Poor wound healing suggests the client might be experiencing protein-calorie malnutrition. Adequate wound healing depends on the ingestion of sufficient protein, calories, water, vitamins (especially C and A), iron, and zinc. exophthalmos is a manifestation of hyperthyroidism. A red facial rash, often termed a butterfly rash because of its shape across the nose and on the cheeks, is a manifestation of systemic lupus erythematosus.

A nurse is reinforcing postoperative teaching with a client who had a partial gastrectomy about the management of dumping syndrome. Which of the following instructions should the nurse include?

Eat protein with each meal. The client should eat meals that are high in protein and fat with low to moderate carbohydrate content. Protein should be included in every meal because it delays digestion, which helps reduce the manifestations of dumping syndrome. The nurse should reinforce the need to avoid fluids at mealtime to decrease gastric stimulation. The nurse should reinforce the need to lie down when the client is experiencing early manifestations of dumping syndrome such as tachycardia, syncope, or sweating to slow the progress of food through the gastrointestinal tract. The nurse should reinforce the need to avoid simple carbohydrates such as honey, sugar, and syrup because they aggravate the stomach and worsen manifestations of dumbing syndrome.

A nurse is reviewing a client's 24 hour dietary recall. The client reports eating a slice of toasted white bread with butter, a banana, a glass of milk, and a cup of coffee for breakfast; grilled chicken, a backed potato, and a glass of milk for lunch; and apple and cheddar cheese for a snack; and 2 servings of chicken, 2 cups of steamed broccoli, and a glass of milk for dinner. The nurse should identify that this client's diet is deficient in which of the following food groups?

Grains. The nurse should identify that the client only consumed 1 serving of grains on the day of th e24 hour dietary recall. The recommendation is 3 or more ounce-equivalents of whole-grain products per day according to the United States Department of Agriculture (USDA) dietary guidelines. Additionally, the choice of white bread is low in fiber, chich can lead to constipation and an incrased risk of deveoping hyperlipidemia. The USDA guidelines recommend that at least half of the grains consumed be whole-grain. The client consumed 3 servings of dairy throughout the day, which is the recommended daily amount according to the USDA dietary guidelines. The client consumed at least 2 1/2 cups of vegetables, which is the recommended daily amount according to the USDA dietary guidelines. The client consumed 2 servings of fruit, which is the recommended daily amount according to the USDA dietary guidelines.

A nurse is reinforcing dietary teaching with a client who has heart failure and is on a 2g sodium diet. Which of the following statements by the client indicates an understanding of the teaching?

I can have yogurt as a dessert. Salt should be eliminated from the client's diet. Spices or vinegar can be used to season the client's food. Baking soda is high in sodium and should be eliminated from the client's diet. Canned vegetables are high in sodium and should be eliminated from the client's diet. Frozen or fresh vegetables, which are low in sodium, should be incorporated into the client's diet.

A nurse is reinforcing teaching with a client who has a prescription for a low-sodium diet to manage hypertension. Which of the following client statements indicates the teaching has been understood?

I can snack on fresh fruit. The nurse should identify that fresh fruits contain little to no sodium and are a good snack for a client who has hypertension. Lunch meats are usually high in sodium and should be avoided. The nurse should recommend that the client choose lower-sodium options, such as fresh fish or poultry. Cottage cheese contains 390mg per 113 g of sodium. the nurse should recommend low-fat yogurt as a low-sodium snack. Canned soups contain high amounts of sodium. The nurse should instruct the client to avoid convenience and fast foods such as canned or dry-packaged soups.

A nurse is reinforcing nutritional teaching with a client who is pregnant. Which of the following nutrients should the nurse instruct the client to increase in her daily diet?

Iron. Iron supplements are recommended during pregnancy to promote adequate transfer of iron to the fetus and to support the expansion of the maternal RBC mass. Calcium is essential for fetal bone and tooth development. However, the recommended daily calcium intake for women childbearing age is sufficient for a client who is pregnant. Vitamin E is essential for protection against oxidative stress, so it is important for women who are pregnant to have an adequate supply of this nutrient. However, the recommended daily vitamin E intake for women of childbearing age is sufficient for a client who is pregnant. Vitamin K can help prevent a rare bleeding disorder in newborns. However, the recommended daily vitamin K intake for women of childbearing ag is sufficient for a client who is pregnant.

When a pt is suffering from anorexia.

It is important to maintain a positive attitude and provide encouragement when serving meals. Make meals as attractive as possible, and serve beverages, especially liquid nutritional supplements, in glasses, not cans. Make sure to serve meals promptly and at the correct temperature. Refrigerate snacks and supplements if necessary.

A good calorie should intake?

It should provide no fewer than 1200 kcal/day. When the diet provides less than 1500 kcal/day, a multivitamin and mineral supplement is recommended. Aerobic (oxygen-using) exercises such as brisk walking, jogging, cycling, cross-country skiing, and cross-training appear to be the most helpful in decreasing body fat. Resistance training like weightlifting, calisthenics, is also beneficial to maintain lean body mass and bone density. BMR decreases when muscle mass is lost; therefore resistance training tends to help prevent a reduction of BMR.

A nurse is contributing to the plan of care for a client who is receiving chemotherapy and has a protein deficiency. Which of the following interventions should the nurse include in the plan of care?

Mix powder skim milk into milk Add a slice of cheese to hot vegetables Mix yogurt into fresh fruit. Diary products are good sources of protein. Mixing powdered skim milk into milk, adding cheese to vegetables, and mixing yogurt into fresh fruit can provide the client with additional protein. Clients who are immunocompromised should avoid foods that contain raw egg because they are potential source of infection. Adding honey to hot tea can increase the client's caloric intake, but it will not increase his protein intake. Honey is NOT a good source of protein.

A nurse is reinforcing teaching with a female client who has a new prescription for pravastatin to treat hyperlipidemia. Which of the following pieces of information should the nurse include in the teaching?

Pravastatin can be taken with grapefruit juice. Pravastatin, unlike other statins, such as lovastatin, simvastatin, and atorvastatin, is not affected by CYP3A4 inhibitors. It is safe for the client to consume grapefruit juice if desired. Pravastatin can cause fetal abnormalities if taken during pregnancy. The nurse should instruct the client to notify her provider if pregnancy is planned or if she becomes pregnant. Taking pravastatin in the evening is recommended as the synthesis of cholesterol increases during the night, thereby increasing the efficacy of the medication. The nurse should instruct the client to take the medication at bedtime. Clients who are taking statin medications such as pravastatin should have laboratory testing to evaluate liver function prior to starting the medication, as well as cholesterol and triglyceride testing performed periodically during treatment. Pravastatin does not affect the WBC count.

A nurse is caring for an older client with dementia who gets up frequently to pace during meals and eats sparingly. Which of the following actions should the nurse take?

Provide finger foods for the client. Finger foods will provide nutrition and accommodate the client's behavior. Offering food at fewer times each day will likely decrease the client's intake and is inappropriate. Instead, the nurse should provide snacks between meals and in the evenings if the client is at risk of undernutrition. The administration of a benzodiazepine medication before meals is a form of restraint and should be used only for the safety of the client or others. In addition, the medication can make the client drowsy. The use of physical restraints should be reserved only for the safety of the client or others. In addition, restraining the client will likely promote agitation.

A nurse is caring for a client who is receiving intermittent enteral feedings through an NG tube. The specific gravity of the client's urine is 1.035. Which of the following actions should the nurse take?

Provide more water with feedings. The elevation in the client's specific gravity indicates dehydration. The nurse should provide more fluids by adding free water to feedings or instilling water between feedings. Another strategy is to request a formula that contains less protein. Slowing the delivery rate is an intervention for diarrhea. Instilling a lower-fat formula is an intervention for abdominal distention and bloating. instilling a lactose-free formula is an intervention for nausea and vomiting.

A nurse is caring for a client who has peripheral edema. The nurse should identify that which of the following nutrients regulates extracellular fluid volume?

Sodium. The nurse should identify that sodium regulates extracellular fluid balance as well as nerve impulse transmission, acid-base balance, and various other cellular activities. The nurse should identify that calcium supports bone and tooth formation and facilitates nerve impulse transmission. However, it does not affect extracellular fluid volume. The nurse should identify that potassium affects the storage of glycogen, nerve impulse transmission, cardiac conduction, and smooth muscle contraction. However, it does not affect extracellular fluid volume. The nurse should identify that magnesium affects enzyme and neurochemical activities and the excitability of cardiac and skeletal muscles. However, it does not affect extracellular fluid volume.

A nurse is reinforcing dietary reaching with a client who has AIDS. Which of the following instructions should the nurse include in the teaching?

Use a separate cutting board for cutting poultry. The nurse should instruct the client to use a separate cutting board to cut raw poultry. Raw poultry can contain bacteria such as salmonella, which can contaminate other foods or work surfaces. Using a separate cutting board prevents cross-contamination of work surface areas when preparing foods. Leftover food should be discarded after 24 hours to prevent the growth of bacteria that can cause a foodborne illness. The nurse should instruct the client to thaw frozen foods in the refrigerator to prevent the growth of bacteria that can cause a foodborne illness. The nurse should instruct the client to store cold foods at 4.4 decrees C (40 degrees F) or less. This prevents the growth of bacteria that can cause foodborne illness.

A nurse is caring for a client who is receiving radiation therapy for mouth cancer and reports a dry mouth. Which of the following dietary recommendations should the nurse provide?

Use gravies or sauces to soften food. The nurse should instruct the client to use gravies or sauces to soften foods and make them easier to eat. The nurse should instruct the client to avoid eating dry, coarse foods such as Grahm crackers. This type of food can make the client's mouth drier and more unpleasant. The nurse should instruct the client to consume foods containing citrus, which stimulates saliva. The nurse should instruct the client to rinse the mouth with an alcohol-free mouthwash before eating. Alcohol-based mouthwash can make the client's mouth drier.

A nurse is reinforcing dietary teaching with a client who has AIDS and stomatitis of the mouth. Which of the following instructions should the nurse include in the teaching?

You can suck on popsicles to numb your mouth. The nurse should instruct the client to suck on popsicles or ice chips to numb the mouth. The nurse should instruct the client to avoid spices, acidic foods, and salt, which can irritate and burn the client's mouth. The nurse should instruct the client that using a straw can decrease the discomfort when drinking liquids. The nurse should instruct the client to consume foods that are cold or at room temperature. Hot foods can be irritating or possibly burn the client's mouth.

mechanical soft diet

are ordered for patients who have difficulty chewing or swallowing. All meats are ground, and fruits and vegetables are cooked and pureed.

BMI

18.5-24.9 is considered within the normal range. If the BMI falls between 25 and 29.9, the person is consider overweight; and people with BMIs of 30 or greater are considred obese.

A nurse is calculating the protein needs of a young adult client who weighs 132 lb. The RDA for protein for an adult who has no health medical condition is 0.8g/kg. How many grams of protein per day should the nurse recommend for this client?

48 132/2.2=60kg 60kg x 0.8g = 48g

high fiber continue

6 - 8 small frequent meals or snacks are recommended. Helps regulate blood glucose in Diabetes mellitus, helps control cholesterol in clients with heart disease. (now providers are encouraging bigger meals once per morning and once per night but its not frequently used)

Low fat diets

All fats limited, regardless of saturation. Used for diseases that involve malabsorption of fat. A low-fat diet has a limited amounts of total fat, saturated fat, and trans fatty acids. Treatment for Atherosclerosis, heart disease, and hyperlipidemia.

Dumping syndrome

Diet therapy is aimed at slowing gastric emptying and distributing the amount of gastric contents in the bowel over time. This involves giving small, frequent meals that are higher in protein and fat and lower in carbohydrates.

A nurse is reinforcing dietary teaching with a client who has a history of kidney stones. Which of the following instructions should the nurse include in the teaching?

Drink 3.8 L (4 quarts) of water throughout the day. The nurse should instruct the client to drink 3.8 L of water per day to keep urine diluted and decrease the chance of kidney stone formation. The nurse should instruct the client to avoid large amounts of vitamin C, which can increase the chance of kidney stone formation. The nurse should instruct the client to avoid high-oxalate foods such as almonds or other types of nuts because they increase the risk of kidney stone formation. The nurse should instruct the client to limit sodium intake 2g per day. A high sodium diet increases the risk of kidney stone formation.

Kilocalorie modifications

Specific amount of energy each day to carry out its tasks.

high quality protein

are complete proteins found in eggs, meat, poultry, fish, and milk products.

Protein restricted diets

chronic renal failure and cirrhosis of the liver. In renal failure, the kidneys are unable to excrete protein waste products and it builds up in the blood stream leading to azotemia. It could delay the need for dialysis.

pureed diet

foods have been blenderized to liquid form; consistency based on client's needs, nectar or honey thick, can be long term

incomplete proteins

found in plant products such as dried beans and whole grains, contribute to azotemia and must be limited.

non-soluble fiber

not broken down in the intestine and moves through the GI tract solid; improves constipation and gut motility

NPO

nothing by mouth

Etiology of obesity

-Multifactorial -Heredity- overweight parents... overweight children -Social and individual psychology -Metabolism -Eating and Physical Activity -Environment Obesity is caused by the chronic energy imbalance that results when more energy is consumed than expended. It is a complex disease, and much remains to be learned regarding its cause.

A nurse is reviewing the laboratory results of a client who has end-stage renal disease and reports fatigue. The client's hemoglobin is 8g/dL. The nurse should expect a prescription for which of the following medications?

Erythropoietin. Erythropoietin stimulates the production of RBCs and is used to treat anemia associated with chronic renal failure. Erythromycin is used to tread infections. There is no indication that the client is experiencing an infection. Filgrastim is used to stimulate the production of neutrophils. There is no indication that the client is experiencing neutropenia. Calcitriol is used to prevent hypocalcemia in clients who have chronic kidney disease. There is no indication that the client is experiencing hypocalcemia.

A nurse is contributing to the planning of an in-service session about nutrition. Which of the following nutrient functions should the nurse include in the teaching?

Fats provide energy. Fat serves as a stored energy source for the body, providing 9 cal/g of energy. Proteins play a role in tissue repair. Protein is primarily responsible for regulating fluid balance. The presence of protein prevents intestinal edema. The appropriate amount of albumin in blood keeps intestinal edema from occurring.

A nurse is reinforcing dietary teaching about a low-cholesterol diet with a client who has heart disease. Which of the following client statements indicates the teaching was effective?

I should remove the skin from poultry before eating it. The client should remove the skin from poultry before eating because the skin contains the greatest amount of fat. The nurse should instruct the client to eat seafood at least twice per week because it is high in omega-3 fatty acids. The nurse should instruct the client to use liquid oils such as canola oil instead of margarine, which is a solid fat. The nurse should instruct this client to use nonfat or low-fat milk instead of whole milk on oatmeal or cereal.

A nurse is caring for an infant who has gastroenteritis and is dehydrated. Which of the following characteristics places the infant at a higher risk for electrolyte imbalances compared to an adult client?

Longer intestinal tract. Compared to adults or older children, infants have a longer intestinal tract. This results in greater fluid losses, especially through diarrhea. Compared with adults or older children, infants have a larger body surface area. This results in greater fluid losses through insensible means. Compared to adults or older children, infants have an increased rate of metabolism. This results in more metabolic waste, which must be excreted by the kidneys.

A nurse is contributing to the plan of care for a client with AIDS who has developed stomatitis. Which of the following interventions should the nurse recommend for the plan of care?

Aoid daily salty foods. Stomatitis is an inflammation of the mucosa of the mouths, usually with ulcerations. Food that are spicy, acidic, or salty should be avoided to prevent further irritation and damage to the oral mucosa. Chlorhexidine is an antiseptic that could cause further irritation to the oral mucosa. Instead, the nurse should provide the client with 0.95 sodium chloride solution or baking soda to mix with water and use as a rinse aid. The nurse should plan to provide moist foods and liquids with meals to decrease the client's discomfort during mealtimes and to promote nutritional intake. The client's oral care should be provided with a soft-bristled toothbrush to avoid further irritation and damage to the oral mucosa.

Carbohydrate-modified diets

are used most often in the treatment od diabetes mellitus.

goods high in pottassium

avocados, bananas, carrots, fish, mushrooms, tomatoes, oranges, spinach, strawberries, potatoes

low residue; low fiber

low residue diet is similar to the soft diet (itis problems)

Sodium restricted diets

no added salt diet is the least restrictive allowing 2000 to 3000 mg/day of sodium or as little as 500mg/day.

spirinolactone

potassium sparing diuretic

body composition

ratio of body fat to lean body tissue

soft diet

similar to a regular diet, but foods must require little chewing and be easy to digest. Generally low in fiber, low residue diet is similar to the soft diet; includes restrictions on milk. A mechanical soft diet eliminates foods that are difficult to chew or swallow

basal metabolic rate (BMR)

the rate at which the body burns energy when the organism is resting.

full liquids diet

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

A nurse is presenting an in-service session about nutrition. Which of the following simple sugars should the nurse identify as the carbohydrate found in milk?

Lactose. The nurse should identify that lactose is a form of sugar that is found in milk. Sucrose is table sugar. It is also found in fruits and vegetables. Maltose is found in germinating cereals such as barley. Fructose is found in honey and fruit.

A nurse is assisting with the planning of an in-service session about nutrition. How many of the amino acids must be obtained from dietary intake?

9. Proteins are made up of chains of amino acids, which are composed of carbon, hydrogen, oxygen, and nitrogen. Nine amino acids are considered essential for the human body and must be obtained from the diet. These include histidine, isoleucine, leucine, lysine, methionine, phenylalanine, threonine, tryptophan, and valine. Of the 20 amino acids identified, the body is able to manufacture 11 of them. These are defined as nonessential amino acids.

Exchange Lists for Meal Planning

A grouping of foods, in specific portions, according to their carbohydrate, protein, and fat composition to ensure that each food in the group contributes a similar amount of calories per serving.

Marasmus

A wasting away of body tissues in the infant's first year, caused by severe protein-calorie deficiency.

A nurse is collecting data from a school-aged child who has celiac disease. Which of the following findings should the nurse expect?

Steatorrhea. Foul, fatty, frothy stools known as steatorrhea are a manifestation of celiac disease, which is a malabsorption syndrome. Children who have cystic fibrosis have an elevated sweat chloride level. Children who have cardiovascular disorders develop clubbing of the fingers and toes due to chronic hypoxemia of the tissues. Jaundice results form liver dysfunction, not celiac disease.

A nurse is caring for a client who is recovering at home after receiving inpatient treatment for burn injuries. To increase the protein density of the client's meals, which of the following recommendations should the nurse share with the client's caregiver?

Add chopped, hard-cooked eggs to soups and casseroles. Eggs are a good source of protein. Adding them to combination foods and coating meats with raw eggs before breading and cooking increases the protein density of those foods. To increase protein density, the caregiver should use plain yogurt instead of sour cream in recipes. Adding honey to cereal increases the caloric density, not the protein density. Mayonnaise contains more protein than most salad dressings.

A nurse is reinforcing dietary teaching with a client who has diabetes mellitus. Which of the following actions should the nurse take first?

Ask the client to identify the types of foods she prefers. The nurse should apply the nursing process priority-setting framework when planning client care and prioritizing nursing actions. Each step of the nursing process builds on the previous step, beginning with an assessment or data collection. Before the nurse can formulate a plan of action, implement a nursing intervention, or notify the provider of a change in the client's status, the nurse must first collect adequate idata from the client. Assessing or collecting additional data will provide the nurse with the knowledge to make an appropriate decision. Therefore, the nurse should first ask the client about individual food preferences to provide an opportunity for the nurse to include these food preferences to provide an opportunity for the nurse to include these foods in her diet. Involving the client in the planning will help promote adherence to the dietary plan. The nurse should work with a registered dietitian to provide the client with appropriate materials to use during reinforcement of dietary teaching. Sample menus can be helpful providing the client with ideas for new foods or exchanges; however, there is another action that the nurse should take first. The nurse should identify the recommended blood glucose range that the client should maintain through diet, medication, and lifestyle changes; however, there is another action that the nurse should take first. The nurse should identify the log-term complications so the client understands the importance of adherence to the dietary plan; however, there is another action that the nurse should take first.

A nurse is updating the plan of care for a client who has celiac disease. Which of the following dietary selections should the nurse recommend for the client?

Baked chicken and rice. The nurse should recommend backed chicken and rice as a dietary selection for a client who has celiac disease. Clients who have celiac disease should avoid foods containing gluten. A client who has celiac disease should avoid eating whole-wheat tortillas because whole-wheat tortillas is a source of gluten. A client who has celiac disease should avoid eating pasta because pasta is a source of gluten.

A nurse is caring for a group of clients on a medical-surgical unit. Which of the following disorders should the nurse identify as increasing the metabolic needs of the client?

COPD Cancer Parkinson's disease Major burns Clients who have COPD develop hypermetabolism as a result of the increased amount of energy used to breathe. Cancer can cause a number of metabolic changes, including hypermetabolism as a result of the tumor growth. Clients who have Parkinson's disease develop hypermetabolism because they burn calories due to muscular rigidity. Finally, clients who have major burns develop severe metabolic stress, which includes hypermetabolism and hyper catabolism. Insufficient thyroid hormone results in decreased metabolism.

A nurse is reinforcing teaching about a low-cholesterol diet with a client who had a myocardial infraction. Which of the following meal selections by the client indicates an understanding of the teaching?

Chicken breast and corn on the cob. The nurse should identify that chicken breast is low in cholesterol and all vegetables, including corn, are cholesterol-free; therefore, this food selection by the client ndicates an understanding of the teaching. The nurse should inform the client that shrimp are high in cholesterol and should be eaten in moderation; therefore, this food selection does not indicate an understanding of a low cholesterol diet. The nurse should inform the client that eggs and cheese are high in cholesterol. The nurse should inform the client that liver and other organ meats are high in cholesterol.

A nurse is reinforcing teaching with assistive personnel (AP) about dietary restrictions for a client who is taking phenelzine to treat depression. The AP's selection of which of the following foods for the client's lunch indicates an understanding of the instructions?

Chicken salad. Phenelzine is a MAOI. Clients taking MAOIs must avoid foods that contain tyramine due to a dangerous food-drug interaction. Foods high in tyramine include those that are processed and aged such as lunchmeats and cheeses. This menu selection does not contain foods high in tyramine; therefore, it is the best choice.

A nurse is caring for a client from the Middle East who has celiac disease. Which of the following actions should the nurse take regarding the client's diet?

Determine the client's dietary preferences. While generalizations are often made regarding traditional eating practices of clients based on their cultural background, individual food choices can deviate from these generalizations. The nurse should assess the client's dietary habits before planning for dietary needs. While several clients who have celiac disease are unable to consume grains such as wheat, rye, and barley, it is not culturally sensitive to request the preparation of certain foods without consulting the client. While several religions have dietary restrictions, it is not culturally sensitive prepare food without discussing the client's dietary preferences. Clients who have celiac disease are unable to process certain grains, including wheat, rye, and barley. If consumed, these grains can result in manifestations such as diarrhea, abdominal pain, and weigh loss.

A nurse is caring for a client with a BMI of 29 who expresses a desire to lose weight. Which of the following actions should the nurse take first?

Determine the client's intention to change current eating habits. When using the nursing process, the nurse should first assess the client's readiness to commit to a change in behaviors. Effectivge weight management requires establishing and following healthy eating habits. The nurse should refer the client to a nutritionist for an evaluation of dietary needs and planning of diet to promote weigh loss. However, this is not the first action the nurse should take. The nurse should discuss various eating startegies such as portion control and reduction or elimination of sugar-sweetened beverages as a means of reducing weight. Although the nurse should recommend increasing physical activity to promote overall health and weigh loss, this is not the first action the nurse should take.

High-kilocalorie and high-protein diets

During times of physiologic stress, the body's energy and protein needs are increased, such as after surgery, during sepsis, or in the presence of bone fractures, burns, or pressure injuries-the body's energy and protein needs are increased. Medical trauma has the potential to increase the BMR greatly. Diet should provide increased amounts of kilocalories and protein in small volumes. The diet should still provide a balance of foods from all of the food groups Nutritional support in the form of tube feedings or IV feedings may be considered.

A nurse is caring for a client who has osteoporosis and a new prescription for calcium supplements. Which of the following foods should the nurse recommend to promote calcium absorption?

Fortified milk. Fortified milk provides 2.45 mcg of vitamin D, which promotes calcium absorption from the gastrointestinal tract. Adults up to age 70 need 600 international units of vitamin D per day and 800 international units thereafter. Therefore, fortified milk is a good source of vitamin D.

A nurse is contributing to the plan of care for a client who adheres to kosher dietary laws. Which of the following food selections should the nurse recommend?

Grilled Salmon. The nurse should recommend grilled salmon to a client who observes Kosher dietary laws. Grilled salmon is a fish with fins and scales, which can be consumed according to Kosher practices. Seafood with shells such as lobster or crab is prohibited. Pork is prohibited by Kosher dietary laws. A cheeseburger contains both meat and diary products, which are not to be eaten at the same time according to Kosher dietary laws.

A nurse is reinforcing teaching with a client who has COPD about maintaining proper nutrition. Which of the following statements by the client indicates an understanding of the teaching?

I will eat more cold foods at meals rather than hot foods. The client should prepare more cold foods to eat because they provide a decreased feeling of fullness compared to hot foods. The nurse should explain to the client that drinking fluids with meals will contribute to early satiety. The client should consume as much food as possible prior to feeling full or tired. The nurse should encourage the client to add items such as butter, sauces, and gravies to foods to increase the client's caloric intake. The nurse should recommend the client to eat convenience foods, easy-to-prepare meals, and ready-prepared meals because they take less energy to assemble

A nurse is assisting with the planning of an in-service session for a group of nurses regarding the role of enzymes in digestion. Which of the following enzymes has a role in the digestion of protein?

Pepsin. Pepsin is an enzyme secreted by the gastric mucosa that breaks down protein into polypeptides. Other enzymes such as trypsin and aminopeptidase further break down the polypeptides into amino acids, which can be used by the body. Amylase is an enzyme secreted by the pancreas and intestine that break down starches into glucose. Lipase is an enzyme secreted by the pancreas that breaks down triglycerides into monoglycerides. Steapsin is an enzyme secreted by the gastric mucosa that breaks down triglycerides into monoglycerides.

A nurse is caring for an adolescent following a lumbar puncture. Which of the following actions should the nurse take?

Place the adolescent in a supine position. The nurse should place the adolescent in a supine position for 30 minutes to 1 hour following a lumbar puncture to decrease the risk of a post-Dural puncture headache. The nurse should encourage the adolescent to consume fluids following a lumbar puncture to promote replacement of cerebrospinal fluid. The nurse should assist the provider in applying an adhesive bandage to the puncture site following the procedure. The nurse should avoid the application of heat because it promotes blood flow to the site which increases the client's risk for bleeding. The nurse should apply EMLA cream to the puncture site at least 1 hour prior to the lumbar puncture to decrease the adolescent's pain during the puncture.

A nurse is contributing to the planning of an in-service session about nutrition. Which of the following pieces of information should the nurse recommend for the teaching?

Protein serves as an energy source when other sources are inadequate. Protein is used as an energy source for the body when carbohydrates and fat stores are unavailable or depleted. Protein breaks down into amino acids. Protein breaks down into ammonia. Glucose does not produce any products of metabolism. Carbohydrates provide 4 cal/g of energy. Fat provides 9 cal/g of energy.

A nurse in a pediatric clinic is talking with the parent of a toddler who states that her child will not sit at the table and eat with the family. She asks the nurse for recommendations for finger foods for her child. Chich of the following foods should the nurse suggest?

Slices of ripe banana. Toddlers should have about 8oz (1cup) of fruit per day. Bananas are nutritious and, as long as they are soft, do not present a choking hazard for young children. Popcorn, chunks of cheese, and raisins present a choking hazard for young children. Hot dogs, sausages, and tough meat present a choking hazard for young children. Raw carrots, nuts, and seeds present a choking hazard for young children.

The nurse is caring for a client who has xerostomia with a lack of saliva. The nurse should identify that which of the following nutrients will be affected by the lack of salivary amylase?

Starch. Salivary amylase begins the process of digestion in the mouth with the initial break of down starches. The majority of starch breakdown occurs in the small intestine with pancreatic amylase. Lipase breaks down fats. Pepsin breaks down proteins. Fiber is not digestible, but fermentation occurs in the large intestine by intestinal microbes, which results in the release of methane, hydrogen, water, and fatty acids.

A nurse is reinforcing teaching with a group of clients about nutrition. Which of the following definitions of the recommended dietary allowance (RDA) should the nurse include in the teaching?

The RDA defines the level of nutrient intake that meets the needs of healthy people in various groups. The RDA represents daily requirements considered adequate for healthy people. RDA's are based on estimated amounts for each nutrient, including additional amounts for individuals such as women or infants. Dietary reference intakes (DRI) include 4 nutrition-based standards that are used to plan dietary intake and evaluate a client's nutritional status. These dietary standards include RDAs, estimated average requirements (EARs) adequate intake (AI), and tolerable upper intake levels (ULs) Tolerable upper intake levels (ULs) are the level of nutrients that should not be exceeded to prevent adverse effects. Acceptable macronutrients distribution ranges (AMDRs) are the daily percentage of energy intake values for fat, carbohydrates, and proteins.

Thermogenesis

When energy intake equals energy output, the body is in zero energy balance, or equilibrium. During zero energy balance, weight remains constant. If energy intake exceeds energy output, the energy balance becomes positive. Positive energy balance results in weigh gain. Conversely, if energy intake is less than energy output, the energy balance becomes negative, leading to weight loss.

A nurse is reinforcing teaching with a client who is at 10 weeks of gestation and reports frequent nausea and vomiting. Which of the following statements should the nurse make?

You should eat dry foods that are high in carbohydrates when you wake up. The nurse should instruct the client to eat food high in carbohydrates such as dry toast or crackers upon waking or when nausea occurs. The nurse should instruct the client to eat foods served at cool temperatures to decrease nausea and vomiting. The nurse should instruct the client to avoid brushing her teeth immediately after eating to decrease the likelihood of vomiting. The nurse should instruct the client to eat salty and tart foods during periods of nausea.

carbohydrate counting

a method to track carbohydrates consumed so that those with diabetes can appropriately balance physical activity and medication to manage blood glucose levels.

what is a serving size

a standard amount of food

Saturated fat recommendation

be limited to less than 5 to 6% of calories.

cirrhosis

builds up ammonia in the bloodstream and could lead to hepatic coma, brain damage, and death. In the presence of cirrhosis, protein intake initially should be at or above the DRI to facilitate healing and tissue regeneration.

mechanical soft diet

clear and full liquids + diced or ground foods

Liquid diets

clear liquid diet to full liquid diet.

fluid restricted intake

considerations: Foods that melt at room temperature, soups, etc

clear liquids diet

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

Symptoms of hypoglycemia

headache, disorientation, weakness, perspiration, shallow breathing, nervousness, visual disturbances, and vertigo, and sometimes the individual may become unconscious.

Low residue diet

includes restrictions on milk and ilk products, because they leave more residue in the colon. If milk is omitted, the patient needs to get adequate calcium from other sources.

Obesity

increases the risk for many diseases and health conditions, including hypertension, coronary heart disease, stroke, type 2 diabetes, dyslipidemias, osteoarthritis, gallbladder disease, some cancers, and sleep apnea. In addition to physical health risks, people who are obese often suffer from social prejudice and psychological issues related to their disease. Obesit dramatically affects quality of life and reduces average life expectancy. It is defined as an excess of adipose tissue or body fat above the level considered healthy.

insulin

is a hormone that is needed to convert sugar, starches, and other food into the energy needed for daily life.

high-fiber diet

is a variation of the regular diet and sometimes is used therapeutically. High-fiber diets often are used in the treatment of constipation. With adequate fluids, fiber has the capacity to reduce constipation in young patients, as well as in older adults, which helps reduce or eliminate the need for laxatives. It is recommended for patients with diverticulosis and often helps lessen the severity of symptoms and inflammation (diverticulitis) Whole grains are good.

Full liquid diet

is used as a transition diet after a clear liquid diet. it is ore nutritionally complete than a clear liquid diet but still is lacking in some nutrients, such as iron, zinc, and fiber. Liquid diet supplement, or vitamins may be added to increase the nutritive value of the diet. Full liquid diets include ice cream, cram soups, pudding, milk, and juices containing pulp. All clear liquids, custards, fruit and vegetable juices, ice cream, sherbet, milk, milk shakes, puddings, strained cereals, strained soups, supplemental formulas.

A nurse is reinforcing teaching with a client who is beginning a vegan diet and is concerned about maintaining adequate protein intake. Which of the following food servings should the nurse recommend as having the highest amount of protein?

2 tbsp of peanut butter. The nurse should determine that peanut butter is the best food source to recommend because it contains 7.11 g of protein per 2 tablespoons. The nurse should recommend a different food because there is another choice that contains more protein. Tomato soup contains 1.08 g of protein per 1/2 cup. Raw broccoli contains 3.6 g of protein per1/2 cup Penne pasta contains 5.81 g of protein per cup.

A nurse is reinforcing teaching with a young adult client who has a history of calcium oxalate renal calculi. Which of the following instructions should the nurse include in the teaching?

Consume 1,000 milligrams of calcium daily. Clients who are prone to the development of calcium oxalate stones should consume the recommended daily allowance (RDA) of calcium for their age. The RDA for calcium for adults 19-50 years old is 1,000 mg daily. Calcium should be obtained from dietary sources rather than supplements that can promote the development of renal calculi. Clients who are prone to renal calculi should limit beverage with high sugar contents such as fruit punch or juice because these beverages can promote the development of renal calculi. Clients who are prone to the development of calcium oxalate stones should avoid taking nutritional supplements such as vitamin C. Taking 1g of vitamin C daily can result in toxicity and promote the development of renal calculi. Clients who are prone to renal calculi should exclude bran from their diet because brain is high in oxalates, which can precipitate the formation of renal calculi.

gluten free diet

Eliminates wheat, oats, rye, barley and their derivatives

High-kilocalorie and high-protein diets

For people with increased energy and protein needs during physiological stress Provides increased kilocalories and protein in small volume

A nurse is reinforcing teaching with a client who has diabetes mellitus about food choices. Which of the following client statements indicates the teaching has been understood?

I should replace white bread with whole-grain bread. Clients who have diabetes mellitus have the same fiber requirement as the general population. Fiber content can be increased by substituting white bread, which is made with refined grains, with whole-grain bread, which retains the outer layer of the grain that is higher in fiber. Sweet desserts are not prohibited from clients who have diabetes mellitus. Instead, they should be consumed in moderation and substituted for other carbohydrates in the client's meal plan. Sucralose is a non-nutritive sweetener that has been approved by the food and drug administration for this use. It is considered safe for clients who have diabetes mellitus. Although clients who have diabetes mellitus can consume alcohol in moderation, the nurse should instruct the client to consume alcohol with food to avoid hypoglycemia.

A nurse is assisting with planning care for a client who has anorexia and nausea due to cancer treatment. Which of the following interventions should the nurse suggest?

Limit drinking liquids when eating food. Drinking beverages with food leads to early satiety and bloating, which results in the client consuming fewer calories. The nurse should make sure the client receives cold or room temp foods. To increase the nutritional value of the food and the client's caloric intake, the nurse should make sure that the client receives high-protein, high-calorie, nutrient-dense foods. The client should also eat nutrient-dense foods first during meals. To reduce nausea, the client should sit upright for 1 hour after meals. The client should also rest before meals to conserve energy for eating and digesting the food.

A nurse is reinforcing teaching about dietary therapy with a client who has dumping syndrome following gastric bypass surgery 4 days ago. Which of the following pieces of information should the nurse include in the teaching?

Maintain a supine position after meals. The nurse should instruct the client to lie supine after eating to help slow the rapid emptying of food into the small intestine. A client who has dumping syndrome should decrease the amount of food eaten at a time, eat small meals more frequently, and eliminate fluids at mealtime. Fluid shifts occur in the upper gastrointestinal tract when food contents and simple sugars exit the stomach too rapidly, attracting fluid into the upper intestine. This makes blood volume decrease, causing the client to experience nausea and vomiting, sweating, syncope, palpitations, increased heart rate, and hypotension. The nurse should instruct the client to avoid drinking liquids during meals and to wait 30 to 60 minutes after eating solid foods to drink liquids. Drinking liquids with meals increases the motility of the gastrointestinal tract. The nurse should instruct the client to avoid eating foods that contain simple sugars. Simple sugars increase the hypertonicity of the gastrointestinal tract, which increases the movement of the food bolus.

A nurse is caring for a client who is receiving radiation therapy for breast cancer and reports a metallic taste in the mouth. Which of the following dietary recommendations should the nurse relay?

Offer Mints The nurse should encourage the client to suck on mints. Mints can overcome the metallic taste the client is experiencing as a result of the radiation therapy. The nurse should encourage the client to eat with plastic utensils to prevent an increase in the metallic taste. The nurse should encourage the client to add coffee to sweet beverages or milk to cut the sweet taste for a clint who reports a metallic taste in the mouth. The nurse should encourage the client to consume foods that contain citrus or that have a tart flavor. This overcomes the metallic taste.

A nurse is caring for a client who has a deficiency in vitamin D. Which of the following foods should the nurse recommend the client include in his diet?

Whole milk. The fat-soluble vitamins, A,D,E, and K require fatty substances or tissues to be dissolved as well as the presence of bile in the small intestine for absorption. Whole milk contains vitamins A and K and is often fortified with vitamin D. The water-soluble vitamins B complex and C readly dissolve in water and are absorbed into the bloodstream from the small intestine. Chicken contains many of the B complex vitamins, including B2, B3, B6, B12 and pantothenic acid. Oranges are a good source of vitamin C. Dried peas are a good source of many of the B complex vitamins, including B1, folate, and pantothenic acid.

dumping syndrome

increase fat and protein, small frequent meals, lie down after meal to decrease peristalsis. Wait 30 mins after meals to have a drink.

Kwashiorkor

A disease of chronic malnutrition during childhood, in which a protein deficiency makes the child more vulnerable to other diseases, such as measles, diarrhea, and influenza.

A nurse is reinforcing teaching with a client who has lactose intolerance about dietary modification. Which of the following food items should the nurse recommend?

Almond milk. The nurse should recommend lactose-free foods such as almond milk, soy cheese, soy yogurt, and lactose-free milk. Foods that might contain lactose include bread and breakfast cereals, lunchmeats, margarine, salad dressings, instant mashed potatoes, and instant soups.

carbohidrates

Are molecules made of carbon hydrogen and oxygen atoms nad are ussually the bodys major source of energy. It also causes increased CO2 and hypermetabolism because of constant out of breath and use the respiratory muscles to breathe. O2 of 90-92 and are very skinny and frail. They have them on low sodium diet because of fluid retention

sodium restricted diet

indications; HTN, heart failure, renal disease, cardiac disease, cirrhosis of the liver. Restrictions range from 'no added salt' to as little as 500 mg sodium per day. (Normal is 1200)

Other diet modifications

NPO, ice-chips only, fluid restriction, extra fluid

lactose intolerance

impaired ability to digest lactose due to reduced amounts of the enzyme lactase

types of protein

complete (animal). Eggs, meat, poultry, fish, milk Incomplete (plants). Dried beans, whole grains

diets modified for allergens

depending on the number of allergens and how widespread they are in the diet, vitamin and mineral supplements may be necessary to ensure a nutritionally adequate intake. Soy, eggs, milk, fish, wheat, tree nuts, peanuts, shellfish

bland diet

diet containing only mild-flavored foods with soft textures Peptic ulcers GI reflux (GERD) Gastritis

soluble fiber

fiber that dissolves in water or is broken down by bacteria in the large intestine

A nurse is reinforcing teaching about dietary modifications for a client with newly diagnosed with cirrhosis. Which of the following of foods should the nurse recommend?

grilled chicken A client who has cirrhosis requires to compensate for the weight loss as a result of the disease. Increasing protein intake from animal or plant sources will also provide more energy. A client who has cirrhosis should avoid foods that are high in sodium, especially if ascites is present; therefore, the nurse should recommend another food choice so no potato soup or baked ham A client who has cirrhosis should avoid foods that are high in fat, especially if the client is experiencing steatorrhea; therefore the nurse should recommend another food choice.

carbohydrate modified.

hypoglycemia

A nurse is reinforcing discharge teaching with a client who has a transient ischemic attack (TIA). Which of the following instructions should the nurse include?

reduce dietary sodium. A temporary disturbance of the blood supply to the brain leads to TIAs, which are brief alterations in neurological function. The most common causes are atherosclerotic plaque in the carotid arteries and hypertension; therefore, the client should limit sodium intake to help control hypertension and prevent future TIAs. Dietary management of hypertension, which is a major cause of TIAs, includes an increased intake of dietary potassium and fiber. Dietary management of hypertension includes limiting alcohol intake to no more than 2 servings for men or 1 serving for women per day.

high fiber; high residue

regular diet with double the fiber, replace foods with no fiber with fiber. used for treatment of some GI disorders. 6-8 small meals or snacks recommended because it decreases workload on the GI tract, (doubles the intake of fiber for constipation)

COPD diet

soft, high-calorie, low-carbohydrate, high-fat, small frequent feedings. High protein and high fiber needed.

diet modification (textures)

thin puree, thick puree, pre-mashed, fork mashable, mechanical soft

fat restricted diet

used on patients to reduce abdominal pain, steatorrhea, flatulence. Also malabsorption disorders; pancreatitis, gallbladder disease, GI reflux

measure BMI

-measure height in meters(1m=3.3ft) -measue weight in kilograms(1kg=2.2lbs) Calucute: BMI=weight in kg/height in meters^2

A nurse is reinforcing teaching with the parent of a school-aged child who has celiac disease. Which of the following foods selected by the parent indicates an understanding of the teaching?

A corn tortilla with black beans. Children who have celiac disease are placed on a gluten-free diet. Gluten is found in wheat, rye, and barley. Selecting products made from corn, and beans indicates and understanding of the teaching. Pizza often contains gluten. Prepared soups often contain gluten. Hot dogs and hot dog buns often contain gluten.

metabolic syndrome

A syndrome marked by the presence of usually three or more of a group of factors (as high blood pressure, abdominal obesity, high triglyceride levels, low HDL levels, and high fasting levels of blood sugar) that are linked to increased risk of cardiovascular disease and Type 2 diabetes.

A nurse is assisting a client who has dysphagia with eating meals. Which of the following actions should the nurse take?

Ak the client to think of a food that produces salivation. To prevent dryness in the mouth during meals, which can be a risk factor for choking, the nurse should ask the client to think of food that promotes salivation such as lemon slices or dill pickles. thick liquids are easier for clients who have dysphagia to manage when swallowing. Clients who have dysphagia should only drink fluids after clearing the mouth of food. They should use coughing and dry swallowing to remove food particles from their mouth. Clients who have dysphagia should rest before meals to avoid fatigue when focusing on swallowing safely.

A nurse is reinforcing dietary teaching with a client who has chronic renal failure. Which of the following food choices by the client indicates the teaching has been understood?

Grilled fish. Protein such as fresh fish or poultry can minimize the risk of chronic renal failure worsening. Foods that are high in sodium such as canned soup, pastrami, and many kinds of peanut butter should be avoided by clients who have chronic renal failure.

DASH diet

Dietary Approaches to Stop Hypertension

A nurse is reinforcing teaching with a client who has gout and urolithiasis. The client asks how to prevent future uric stones. Which of the following suggestions should the nurse provide?

Take allopurinol as prescribed, exercise several times a week, limit intake of foods high in purine. The nurse should inform the client that allopurinol is an antigout medication that reduces levels of uric acid, which helps prevent uric acid stone formation. Immobility is a risk factor for urinary stasis and stone formation; therefore, the client should maintain a healthy lifestyle, including regular exercise, to help prevent stone formation. Purine increases the risk of uric acid stone formation. The nurse should identify that organ meats, poultry, fish, red wine, and gravies are high in purine. Adequate fluid intake of 2 to 3 L per day reduces the risk of stone formation. Citrus juices alkalinize the urine, which helps prevent uric acid stone formation.

A nurse is caring for a client who has scurvy. Which of the following vitamin deficiencies should the nurse identify as the cause of this disease?

Vitamin C. Vitamin C deficiency produces signs and symptoms of scurvy, such as delayed would healing and capillary fragility. A deficiency in vitamin A produces manifestations of night blindness and immunodeficiency. It is not associated with scurvy. A deficiency in vitamin B3 produces manifestations of pellagra, which include a scaly rash on sun-exposed skin, confusion, paranoia, and diarrhea. A deficiency in vitamin D produces manifestations of rickets and osteomalacia, which include bowed legs, fractures, and malformed teeth.

potassium modified diet

indicated; Hyperkalemia, hypokalemia, diuretics. Increased intake may help with blood pressure control. Encourage fruit, vegetables, and low fat diary products

vegetarian diets

potential deficiencies: energy, protein, vitamin B12, zinc, iron, calcium, omega-3 fatty acids, vitamin D

medical nutrition therapy and therapeutic diets

-Medical nutrition therapy is the use of specific nutritional variations to build good health -A diet used as a medical treatment is called a therapeutic diet -Modifying a diet usually means adding or taking away specific nutrients or calories in a diet or a change in the consistency of a diet -Consistency, texture, and frequency modifications *Therapeutic diets that include changes in thickness, consistency, texture or are modified *Examples: puréed, soft, full, or thickened diets

A nurse is reinforcing teaching with a group of clients about the functions of the liver and gallbladder. Which of the following should the nurse include in the teaching a s the purpose of bile?

Digests fats. Bile is a product of the liver and aids in the digestion of fats. Chyme is a semi-solid mixture of food and gastric secretions that is formed in the stomach. Gastrin is a hormone produced by the stomach mucosa that stimulates the release of gastric secretions during the process of digestion. Glycogen is stored in the liver and is released in the form of glucose to meet the body's energy needs.

A nurse is contributing to the pan of care for a client who has dumping syndrome. Which of the following instructions should the nurse include?

Eat a source of protein with each meal. The nurse should recommend eating a source of protein with each meal because protein delays gastric emptying. The nurse should not recommend consuming beverages between meals, which delays gastric emptying. The nurse should recommend consuming small, frequent meals each day to delay gastric emptying and aid digestion. The nurse should recommend including low-fiber foods in the client's diet to delay gastric emptying.

A nurse is reinforcing teaching with a client who has constipation. Which of the following instructions should the nurse include in the teaching?

Eat yogurt with live cultures. Yogurt that contains live bacterial cultures provides dietary probiotics that can help maintain and promote bowel function. Bismuth subsalicylate is an antidiarrheal agent and will increase constipation. increasing fiber gradually can present constipation. A low-fiber diet is recommended for clients who have diarrhea. The regular use of stimulant laxatives can result in decreased defecation reflexes, causing a reliance on stimulant laxatives to have a bowel movement. This might eventually cause electrolyte imbalances and colitis.

A nurse is reinforcing teaching with a group of parents of toddlers about measures to reduce the risk of choking. Which of the following foods should the nurse increases the risk of choking in toddlers?

Hot dogs, grapes, bagels, marshmallows. Foods that are tubular or circular in shape such as hot dogs and grapes increase the risk of choking because they can completely block the throat when swallowed whole due to their shape and solidity. Foods that are hard to chew such as bagels and marshmallows can block the airway if swallowed before they are adequately chewed. All foods and fluids can potentially cause choking. However, graham crackers become soft quickly when mixed with saliva. Their consistency when wet is more like cooked cereal or soft cookies soaked in milk. Therefore, graham crackers do not pose an increased choking hazard for toddlers.

A nurse is reinforcing teaching about nutrition with an older adult client. The client asks, "do I need the same amount of nutrients that I did when i was younger?" Which of the following responses should the nurse provide?

Older adults require increased amounts of calcium, as ell as vitamin D, B12 and A.

A nurse is reinforcing teaching with a client regarding nutrition. Which of the following statements should the nurse include about nutrients?

Protein builds and repairs body tissue. Protein is responsible for building and repairing body tissues such as muscles, tendons, and collagen. The skin, hair, and nails are also made up of protein structures. A diet that is low in protein can impair would healing. Proteins transport nutrients such as fats and fat-soluble vitamins throughout the body. Protein, in the form of hemoglobin, transports oxygen; in the form of albumin, it transports many medications. Ketosis develops when the body relies only on fats to provide for energy needs. Carbohydrates prevent ketosis by allowing the body to use fat as an energy source without the production of ketones. Fats help regulate body temperature by providing a protective layer when the environment temperature drops.

A nurse is reinforcing teaching with the parent of a child who has celiac disease. Which of the following foods should the nurse instruct the parent to omit from the child's diet?

Wheat bread. Clients who have celiac disease should eliminate as much gluten as possible from their diets. Wheat, rye, and barley contain gluten and should be eliminated from the diet of a child who has celiac disease. Cornflakes do not contain gluten and do not have to be omitted from the diet of a child who has celiac disease. Milk is gluten-free and does not have to be eliminated from the diet of a child who has celiac disease. Canned fruits are gluten-free and do not have to be eliminated from the diet of a child who has celiac disease.

A nurse in a provider's office is reinforcing teaching with a client about foods that are high in fiber. Which of the following food choices made by the client indicate an understanding of the teaching?

black beans, whole-grain bread. Dried peas and beans, including black beans, are high in fiber and are a good choice for this client. Whole grains consist of the entire kernel of grain and are high in fiber. Canned fruits, including peaches, are low in fiber and are recommended for clients on a low fiber diet. Fresh fruits contain more fiber. White rice is low in fiber and is recommended for clients on a low-fiber diet. Brown rice is higher in fiber. Canned juices, with the exception of prune juice, are recommended for clients on a low-fiber diet. Therefore, tomato juice is not a good choice for the client.

protein restricted diet

indications; Renal disease, cirrhosis of the liver, hepatic coma. Reduces nitrogen metabolites and ammonia. Foods from milk, meat, bread and starch exchanges are limited

foods to avoid in soft mechanical diet

nuts, dried-raw fruits, chocolate candy; fried foods; tough, smoked, or salted meats; vegetables; and foods with course textures.

A client at 12 weeks of gestation reports practicing Hinduism. The provider states that the client needs more protein in her diet and suggests eating more meat. After provider leaves the examination room, the client tells the nurse that eating animal products will cause her to miscarry. Which of the following responses should the nurse make?

"Let's discuss other foods that are high in protein that you could substitute for meat" Many cultures have beliefs about food that the nurse should respect. Discussing nonanimal protein sources can help the client identify foods that do not conflict with her religious and cultural beliefs.

A nurse is collecting data regarding a client's nutritional status during a community health screening. The nurse determines the client is consuming 500 calories per day more than his energy level requires. When will the client have gained 4.5 kg (10lb)?

10 weeks. Because 1lb of body fat is equivalent to 3,500 calories, 500 calories each day for 7 days would mean 3,500 calories total and a 1 lb gain per week. So, at the rate of 1 lb per week, the client would gain 10 lb in 10 weeks. At the rate of 1 lb per week, the client would gain 40 to 50 lb in 10 months. at the rate of 1 lb per week, the client would gain 20 to 25 lb in 5 months. At the rate of 1 lb per week, the client would gain 5 lb in 5 weeks.

A nurse is caring for a client who has protein malnutrition. Which of the following foods should the nurse identify as a source of complete protein?

Eggs. Complete proteins contain all of the essential amino acids to support growth and hemostasis. Examples of complete proteins include eggs, meat, poultry, seafood, milk, yogurt, cheese, soybeans, and soybean products. Cereal is an incomplete protein is missing 1 or more of the essential amino acids necessary to support growth and maintain homeostasis. Cereal is an example of an incomplete protein. However, it can be combined with skim milk to make a complete protein. Peanut butter is an example of an incomplete protein. However, it can be combined with whole wheat bread to make a complete protein. Pasta is an example of an incomplete protein. However, it can be combined with cheese to make a complete protein.

A nurse is reinforcing teaching with a client who has type 2 diabetes mellitus. The client states, "I eat pasta every day. I can't imagine giving it up". Which of the following responses should the nurse make?

You don't have to give up pasta; just adjust the amount you eat. The American Diabetes Association recommends individualizing carbohydrate restriction for each client A careful evaluation of usual dietary practices and modifications is an important part of helping clients manage this disorder. The nurse is capable of using resources as necessary and counseling clients about appropriate dietary choices without consulting the provider. The client is expressing dismay about giving up pasta. Often, there is no substitute for a food client really enjoys. While a reduced sodium intake is recommended for most clients, especially those who have hypertension, this is not a solution for this client's concern about pasta and does not relate to glycemic control, which is the critical issue for this client.

foods low in potassium

applesauce, green beans, cabbage, lettuce, pepers, grapes, blueberries, cooked turnip greens, fresh pineapple, summer squash

toximia

toxins in the blood

soft/low residue diet (similar to soft diet)

- foods that are low in fiber and easy to digest; - dairy products and eggs, such as custard and yogurt. It is an intermediate step when a patient is progressing from a liquid to a regular diet. Soft diets and low-residue diets also are used for many people with conditions affecting the GI tract, such as acute diverticulitis, inflammatory bowel disease, gastritis, and esophageal varices, and during periods of indigestion or diarrhea. A soft diet is generally low in fiber an dis similar to regular diet. It includes foods from all food groups, including meat, fish, poultry, eggs, milk, grains, fruits, and vegetables, but foods with strong spices are avoided.

A nurse in a provider's office is collecting data form a client. The nurse determines the client's body mass index (BMI) is 21.2. This finding is classified as which of the following?

Healthy weight. Body mass index is a measure of an individual's weight relative to height. A BMI from 18.5 to 24.9 is in the healthy range. Therefore, this client's weight is considered healthy. A BMI below 18.5 is considered underweight and a health risk. A BMI in the range of 25 to 29.9 is in the overweight range. A BMI greater than or equal to 30 is in the obese range.

A nurse is reviewing the dietary choices of a client who has a chronic pancreatitis. Which of the following food items should the nurse suggest removing from the client's dietary choices for the following day.

Ice cream. Clients who have chronic pancreatitis should limit their fat intake to no more than 30 to 40% of their total calories. Ice cream is high in fat, with 48 g of fat in a 1 cup serving of vanilla ice cream. The client should choose healthier fat-containing options to support a balanced diet such as avocados and nuts. Foods high in fiber can reduce lipase activity, making a low-fiber diet helpful for clients who have chronic pancreatitis. White rice is low in fiber, with only 1 g of fiber in a f1 cup serving. Clients who have chronic pancreatitis need an adequate amount of protein, about 1.5 g/kg/day. Fish is a good source of protein, with 26 g of protein in a 170 g portion of cod. Foods high in fiber can reduce lipase activity, making a low-fiber diet helpful for clients who have chronic pancreatitis. Canned peaches are low in fiber, with only 3 g of fiber in a 1 cup serving.

A nurse is reinforcing teaching about nutritious diets to a group of adult women. Which of the following statements should the nurse include in the teaching?

Include 2.5 cups of vegetables in your daily diet. Nutritious diets contain a variety of foods to ensure the required daily allowance of nutrients is ingested. The nurse should instruct the women to include 2.5 cups of vegetables and 2 cups of fruit into their daily diets. Fruits and vegetables should be a variety of colors to provide an assortment of nutrients. The nurse should instruct these women to consume sodium in moderation. The American Heart Association recommends consuming less than .6 g of sodium daily, while the adequate intake (AI) is 1.5g. Excessive intake of sodium can lead to hypertension. Although certain alcoholic beverages such as red wine contain phytochemicals that can reduce the risk of cardiovascular disease and have anti-inflammatory properties, excessive intake can lead to a deficiency in other nutrients. The recommended amount of alcohol for women is 1 drink per day, which is equivalent to 350 mL (12oz) of beer, 148 mL (5oz) of wine, or 44 mL (1.5 oz) of hard alcohol that is greater than 80 proof. Water is an important component of a nutritious diet because it is necessary for the digestion, absorption, and transport of nutrients. The nurse should instruct these women to drink between 2 and 3 L of water daily to maintain homeostasis based on client comorbidities, the climate and the client's activity level.

A nurse is assisting with the planning of an in-service training session regarding nutrition. Which of the following minerals should the nurse include as a factor in oxygen transportation?

Iron. Iron transports oxygen via hemoglobin and myoglobin. It is also a component of enzyme systems. Zinc plays a role in tissue growth and wound healing and supports immune function, but it does not affect oxygen transport. Phosphorus plays a role in bone and teeth formation and energy metabolism. Magnesium affects enzyme and neurochemical activities and the excitability of cardiac and skeletal muscles.

fat controlled diet

Is used to treat symptoms of diarrhea, steatorrhea, and flatulence or to treat diseases of the hepatobiliary tract, pancreas, intestinal mucous, and the lymphatic system, as well as malabsorption syndromes. restrict fat to as little as 25g/day and meats no more that 5 oz a day. It is important to encourage adequate consumption of grains, cereals, fruits and vegetables. Vitamin and mineral supplementation also may be necessary.

A nurse is assisting with the planning of an in-service training session about various dietary practices. Which of the following pieces of information should the nurse recommend including in the teaching?

Kosher diets involve restrictions regarding how food must be prepared. Kosher diets are guided by a set of laws regarding the processing, preparation, and eating of food. The nurse should identify that ovo-vegetarian diets are primarily vegetable-based and exclude meats and dairy except for eggs. The nurse should identify that macrobiotic diets are primarily plant-based but do not include fish and seafood. The nurse should identify that flexitarian diets are primarily plant based with the occasional consumption of meat, fish, and dairy products.

A nurse is reinforcing teaching with a client regarding protein intake. Which of the following foods should the nurse include as an example of an incomplete protein?

Lentils. Incomplete proteins are missing 1 or more of the essential amino acids necessary for the synthesis of protein in the body. Examples of incomplete proteins include, lentils, vegetables, grains, nuts, and seeds. Complete proteins such as eggs, soybeans, and yogurt contain all of the essential amino acids necessary for the synthesis of protein in the body.

A nurse in an urgent care center is collecting data from an infant who has laryngotracheobronchitis. Which of the following findings should the nurse report to the provider as an indication of impeding airway obstruction?

Nasal flaring. Acute laryngotracheobronchitis (croup) causes dyspnea and swelling of the upper airway. Indications of impending airway instruction include tachycardia, tachypnea, increasing restlessness, flaring nares, and intercostal retractions. Tachycardia, not bradycardia, is an indication of impeding airway obstruction. Tachypnea, not bradypnea, is an indication of impeding airway obstruction. A barking cough is a classic manifestation of acute laryngotracheobronchitis; however, it is not an indication of impending airway obstruction.

diabetes lifestyle modifications

The need to monitor more closely and control carbohydrate intake. The patient with diabetes must coordinate the timing of meals and snacks and administration of insulin or oral diabetic medication with exercise. Consistent meal timing, approximately every 4 to 5 hors, and consistent carbohydrate content are important to stress during patient teaching. Advise inclusion in the diet of foods containing carbohydrates fromwhole grains, fruits, vegetables, and low-fat milk. People with diabetes also should limit the amoaunt of fat in their diet to control blood lipid levels. monitor carbohydrate and fat content.

A nurse is reinforcing teaching with a client who has COPD about dietary choices. Which of the following client selections indicates an understanding of the teaching?

The nurse should instruct the client that food high in carbohydrates such as spaghetti or a baked potato increases the amount of carbon dioxide in the body due to the breakdown of carbohydrates and makes respiration more difficult for a client who has COPD. While a lettuce salad provides fiber, it does not provide protein and can contribute to early satiety. The orange slices provide calories but also increase the amount of carbon dioxide in the body due to breakdown of carbohydrates.

A nurse is caring for a client who has a new diagnosis of pernicious anemia. The nurse should expect the client's provider to prescribe which of the following medications for this client?

Vitamin B12. The nurse should expect the client's provider to prescribe vitamin B12 to a client who has pernicious anemia. The nurse should expect a prescription for ferrous sulfate for a client who has iron-deficiency anemia. The nurse should expect a prescription for epoetin alfa for a client who has anemia secondary to chemotherapy. The nurse should expect a prescription for folic acid for a client who has anemia due to a folic acid deficiency.

clear liquid diet

a diet that consists of foods that are liquid at room temperature and leave little residue in the intestine. Ex: Water, Sprite, Ginger Ale, all beverages without any residue, broth, Jell-O. It is used before diagnostic tests, particularly tests on the GI tract, and before surgery. It is frequently used postoperatively until peristalsis returns and sometimes is used during episodes of vomiting and diarrhea. Clear liquid diet is low in kilocalories, proteins, and most nutrients. It is used temporarily, ideally for 2 to 3 days or less. Pt's are usually given small meals more frequently, usually every 2 to 3 hours. Food does not need to be colorless. Liquids are just free of pulp or pieces of fruit. It can be semisolid like popsicles. If it has pulp or pieces of fruit it is considered full liquid diet. Bouillon, fat-free broth, gelatin, ginger ale, lemon-lime soda, popsicles, tea, coffee, white grape, apple, cranberry juice.

tips to relieve thirst

avoid salt, gum/hard candy, freeze juice in ic traiy, gargle with refrigerated mouthwash, stay cool on hot days, giving ice chips, see patient teaching on page 565

lactose intolerance

lack of enzyme lactase. The GI tract is unable to break down lactose, the milk sugar. It is increased in African Americans, Hispanics, Asian Americans, and Native Americans. Lactose intolerance is not the same condition as an allergy to cow's milk. Symptoms usually occur 30 mins to 2 hours after ingestion of milk products and include nausea, cramps, a bloated feeling, flatulence and diarrhea. Diet for lactose intolerance excludes milk and milk products, such as ice cream, puddings, cheese, and powdered milk. Affected patients often need to avoid foods with milk added, such as biscuit or muffin mixes, some soups, and other prepared foods. In addition many processed foods such as waffles, pancakes, and processed meats-contain lactose.

dietary cholesterol

less than 200mg/day.

trans fatty acids

should be kept to a minimum. Evidence suggests that the use of monounsaturated fats in place of carbohydrates often helps lower blood triglyceride levels and improves glycemic control as well. Two or more servings of fish per week (except commercially fried filets) are recommended.

end stage renal disease and other kidney disease

sometimes is necessary to restrict potassium intake as little as 2000 mg/day. During renal failure, potassium is retained, which leads to a buildup of potassium in the blood stream.

Body composition

the ratio of body fat to lean body tissue, including muscle, bone, water, and connective tissue such as ligaments, cartilage, and tendons. The percentages of weight that comprise body fat versus lean tissue. as well as BMI. The location and amount of body fat in combination with BMI are sometimes better predictors of health risk than is BMI alone. Excess body fat in the upper body and the abdominal area in particular (central adiposity) increases the risk of cardiovascular disease and diabetes, whereas excess weight in the hips and the lower body poses a lesser risk.

cirrhosis foods to avoid

high sodium, high fats