unit 4 exam

A client with diabetes asks how exercise will affect insulin and dietary needs. What information does the nurse share about insulin and exercise? A."Exercise increases the need for carbohydrates and decreases the need for insulin." B."Exercise increases the need for insulin and increases the need for carbohydrates." C."Regular physical activity decreases the need for insulin and decreases the need for carbohydrates." D."Intensive physical activity decreases the need for carbohydrates but does not affect the need for insulin.

"Exercise increases the need for carbohydrates and decreases the need for insulin Exercise increases the uptake of glucose by active muscle cells without the need for insulin; carbohydrates are needed to supply energy for the increased metabolic rate associated with exercise. The need for insulin is decreased.

Signs and symptoms of Hypoglycemia

(BG is less than 70) (BG less than 50 is severe) -reduced cognition -tremors -diaphoresis -weakness -hunger -headache -irritability -seizure

Signs and symptoms of hyperglycemia

(BG more than 140) (BG more than 180 is severe) -polyuria -polydipsia -dehydration -fatigue -fruity odor to breath -kussumal breathing -weightloss -hunger -poor wound healing

Individual risk factors

-Genetic Risk factors (family history of type 2 diabetes, obesity) -lifestyle ( poor diet high in fatty acids w. low fiber intake, high intake of calories, lack of physical attack) -chronic conditions(diabetes, metabolic syndrome, paternal nuritrion, malabsorption, traumatic injury, cancer and surgery) -medications (insulin, corticosteriods, estrogen, ACE inhibitors and many antibiotics)

Secondary Prevention

-Hemoglobin A1c, cholesterol, and microalbuminuria - Blood pressure - Dental, foot, and eye examinations

Normal physiological process

-Oral intaking - Digestion - Absorption - Elimination - Cellular metabolism

Primary prevention for elimination

-based on persons normal bowel movements -intake of healthy diet -adequate fluids -emptying the bladder the first urge -maintaining normal BMI -no smoking -limit intake of caffeine -adhering to regular elimination habits -consistent exercise program

Lab tests

-blood glucose and hemoglobin -lipid profile -electrolytes -hemoglobin and hematocrit

individual risk factors

-genetics -Lifestyle and patterns of eating -personal food choices -underlying medical conditions (impaired oral intake, impaired digestion and absorption, increased metabolic demand, altered organ function)

Examination findings: Inspection

-inspect for contour, distention -inspect genitalia, for redness, lesions, discharge -inspecting stool/urine -urine should be clear and yellow with mild odor -stool should be brown and formed

Examination findings: Auscultation

-limited to abdomen -listen to all 4 bowel sounds

Primary prevention

-maintain optimal body weight -exercise -diet

Examination findings

-measure height and weight -physical appearance -level of orientation -asses skin integrity and turgor(smooth and elastic no cracks) -hair should be shiny -nail beds should be pink, smooth and firm -teeth should be cavity free -oral tissue should be moist, pink, and firm -sclera should be white

Examination findings: Palpation

-should be soft and nontender over entire abdomen and urinary bladder -distention is abnormal -rectal palpation is done to asses the rectal sphincter and examine for masses,lesions,impacted stool

Types of urinary incontinence

-stress(leakage of small amounts from physical movement) -urge(leakage of large amounts of urine at unexpected times, including sleep) -overactive(frequency and urgency w/ or w/o urge incontinence) -functional(untimely urination b/c of physical disability/ cognitive problems) -mixed(usually occurrence of stress and urge incontinence together) -transient( leakage that occurs temporarily b/c of an infection, new meds, colds w/ coughing)

Secondary prevention for elimination

-testing for occult blood -colonoscopy

Laboratory tests

-urinalysis -renal function tests -culture -occult blood test

Normal blood glucose level in a nonfasting state?

100-140 mg/dl

Until what age in years does a child need to drink whole milk for adequate neurologic development?

2 Toddlers need to drink whole milk until the age of 2 years to ensure adequate intake of the fatty acids necessary for brain and neurologic development.

Normal blood glucose levels?

70-99 mg/dL

What is underweight?

<18.5 BMI

What is Dumping Syndrome?

A condition associated with malnutrition commonly found after any form of gastric surgery but especially with bariatric surgery that bypasses the pyloric sphincter.

A client is recovering from full-thickness burns, and the nurse provides counseling on how to best meet nutritional needs. Which client food selections indicate to the nurse that the client understands the teaching? A.Cheeseburger and a milkshake B.Beef barley soup and orange juice C.Bacon and tomato sandwich and tea D.Chicken salad sandwich and soft drink

A.Cheeseburger and a milkshake Of the selections offered, a cheeseburger and a milkshake have the highest calories and protein, which are needed for the increased basal metabolic rate associated with burns and for tissue repair. Although orange juice provides vitamin C, beef barley soup does not provide adequate protein or calories. A bacon and tomato sandwich and tea do not provide an adequate amount of calories and protein; nor do a chicken salad sandwich and a soft drink.

A client presents to the emergency department with weakness and dizziness. The blood pressure is 90/60 mm Hg, pulse is 92 and weak, and body weight reflects a 3-pound (1.4 kilogram) loss in two days. The weather has been hot. Which condition should the nurse conclude is the priority for this client? A.Deficient fluid volume B.Impaired skin integrity C.Inadequate nutritional intake D.Decreased participation in activities

A.Deficient fluid volume The low blood pressure indicates hypovolemia, the increased pulse is an attempt to maintain adequate oxygenation of tissues, and the rapid weight loss reflects loss of body fluid. Although impaired skin integrity is a concern with dehydration, it is not the priority. The rapid weight loss reflects a loss of fluid, not a loss of body tissue. Although the client may need assistance with activities, an inadequate intake of fluid has caused the client's dehydration, which is a serious medical problem that needs to be treated immediately.

Which formula is most preferable for a child who has lactose intolerance? A.Soy-based formula B.Whey hydrolysate formula C.Cow's milk-based formula D.Amino acid-based formula

A.Soy-based formula Soy-based formula is a commercially available formula that has a high amount of protein but does not contain lactose. Amino acid-based formula is preferable for a child who has food allergies. However, it is not the most preferable formula for the child with lactose intolerance. Whey hydrolysate formula and cow's milk-based formula contain high amounts of lactose.

. The nurse provides a list of appropriate food choices to a client with newly diagnosed diabetes. The client reviews the list and says, "I do not like and refuse to eat asparagus, broccoli, and mushrooms." In response, the nurse teaches the client about the food exchange list. The nurse evaluates that teaching was effective when the client states, "Instead of asparagus, broccoli, and mushrooms, I will eat which foods? A.String beans, beets, or carrots." B.Corn, lima beans, or dried peas." C.Baked beans, potatoes, or parsnips." D.Corn muffins, corn chips, or pretzels.

A.String beans, beets, or carrots." String beans, beets, and carrots are in the vegetable exchange, as are asparagus, broccoli, and mushrooms. Corn, lima beans, dried peas, baked beans, potatoes, or parsnips are starchy vegetables and are listed as bread exchanges. Corn muffins, corn chips, or pretzels are from the bread exchange list.

The nurse is caring for a client with a diagnosis of diabetic ketoacidosis. Which arterial blood gas results are associated with this diagnosis? A.pH: 7.28; PCO 2: 28; HCO 3: 18 B.pH: 7.30; PCO 2: 54; HCO 3: 28 C.pH: 7.50; PCO 2: 49; HCO 3: 32 D.pH: 7.52; PCO 2: 26; HCO 3: 20

A.pH: 7.28; PCO 2: 28; HCO 3: 18 A low pH and bicarbonate reflect metabolic acidosis; a low PCO 2 indicates compensatory hyperventilation. A low pH and elevated PCO 2 reflect hypoventilation and respiratory acidosis. An elevated pH and bicarbonate reflect metabolic alkalosis; an elevated PCO 2 indicates compensatory hypoventilation. An elevated pH and low PCO 2 reflect hyperventilation and respiratory alkalosis.

Which hormonal deficiency causes diabetes insipidus in a client? A.Prolactin B.Thyrotropin C.Luteinizing hormone (LH) D.Antidiuretic hormone (ADH)

ADH deficiency causes diabetes insipidus. Decreased levels of prolactin may cause decreased amounts of milk secretion after birth. Decreased levels of thyrotropin cause hypothyroidism, weight gain, and lethargy. LH deficiency causes menstrual abnormalities, decreased libido, and breast atrophy.

What is short acting "R" or regular insulin?

Administered to cover meal intake.

What is the portion of a nutritional assessment must the registered nurse complete?

Analyzing the data.

A client who had a cesarean birth is unable to void 3 hours after the removal of an indwelling catheter. How would the nurse evaluate the client for bladder distension? A.By catheterizing the client for residual urine B.By palpating the client's suprapubic area gently C.By asking the client whether she still feels the urge to urinate D. By determining whether the client is experiencing suprapubic pain

B.By palpating the client's suprapubic area gently Palpation will indicate whether bladder distention is present. The increased intra-abdominal space available after birth can result in bladder distention without discomfort. Assessment should be done before interventions. Trauma to the area makes surrounding organs atonic; the client may have a full bladder and not feel the urge to void.

A nurse assesses a client's intravenous site. What clinical finding, unique to infiltration, leads the nurse to conclude that the intravenous (IV) site has infiltrated, rather than become inflamed? A.Pain B.Coolness C.Localized swelling D.Cessation in flow of solution

B.Coolness When an IV infiltrates, the IV solution entering the interstitial space is at room temperature (approximately 75° F [23.9° C]), whereas body temperature is approximately 98.6° F (37° C); therefore, the client's skin will feel cool to the touch at the site of an IV infiltration. The site of an inflammation will feel warm to the touch because of vasodilation and hyperemia. Pain may occur with both an inflammation and an infiltration. The pain of an inflammation is related to the pressure of edema on nerve endings. The pain of an infiltration is related to the IV solution in the interstitial compartment pressing on nerve endings. An increase in interstitial fluid occurs with both an inflammation and an infiltration. With an inflammation there is increased vascular permeability at the site; fluid, proteins, and leukocytes then move from the intravascular compartment into the interstitial compartment. With an infiltration the IV solution enters the interstitial compartment rather than the intravascular compartment. A cessation in flow of solution occurs with both an inflammation and an infiltration. An inflammation in the vein at the insertion site may close the lumen of the vessel, interfering with the flow of solution. An infiltration will cause excess fluid in the interstitial compartment to the extent that it will not accommodate more solution, interfering with the flow of the solution.

A newborn weighing 9 lb 14 oz (4479 g) is delivered by cesarean due to cephalopelvic disproportion. The Apgar scores are 7 at 1 minute and 9 at 5 minutes. Which nursing action should be taken after the initial physical assessment? A.Administer oxygen by hood B.Determine the blood glucose level C.Pass a gavage tube for a formula feeding D.Transfer the newborn to the neonatal intensive care unit

B.Determine the blood glucose level The simple measure of determining the infant's blood glucose level will reveal hypoglycemia in this large-for-gestational-age infant. There are no data that indicate a need for oxygen. Formula will not be given at this time, and there are no data that indicate a need for gavage feeding. The situation does not indicate the need for transfer of the newborn to the neonatal intensive care unit. The Apgar scores demonstrate that this infant is adapting to extrauterine life.

After surgery for creation of an ileostomy, a client is to be discharged. Before discharge, what is the primary nursing intervention? A.Emphasizing that it is essential that the client can care for the ileostomy without assistance B.Evaluating the client's ability to care for the ileostomy C.Ensuring that the client understands the dietary limitations that must be followed D.Ensuring that the client is competent at changing the dry sterile dressing on the incision

B.Evaluating the client's ability to care for the ileostomy The client's feelings, knowledge, and skills concerning the ileostomy must be assessed before discharge. People should not be pressured into performing self-care before they are physically and emotionally ready. The diet is not limited; however, the client should be encouraged to eat a high-protein diet or a regular diet with supplemental protein. A high-fluid intake should be maintained. Often the client no longer needs a dressing on the incision at the time of discharge; a collection pouch is used over the stoma.

A 5-month-old infant who weighs 12 lb 4 oz (5.6 kg) is receiving 8 oz (240 mL) of full-strength formula every 4 hours between 8:00 AM and midnight. In light of the recommended caloric intake of 108 kcal/kg/day, what does the nurse conclude about the amount of formula ingested? A.Meets recommended requirements B.Exceeds recommended requirements C.Falls below the amount recommended D.Not enough data to determine the correct amount

B.Exceeds recommended requirements The current caloric intake for a 24-hour period is 8 oz (240 mL) five times each day for a total of 40 oz (1200 mL). Infant formula contains 20 kcal/oz (20 kcal/30 mL). The infant is consuming 800 kcal/day. The infant weighs 5.6 kg. The recommended daily intake is 108 kcal/kg, or 605 kcal for this infant. Therefore the infant is receiving 195 kcal/day over the recommended caloric intake for body weight.

A nurse provides nutrition instruction to the parents of a school-aged child with celiac disease, including foods that their child may safely eat. What foods selected by the parents indicate that the teaching has been successful? A.Apple crisp and milk B.Hamburger patty and fries C.Spaghetti and meatballs D.Chicken tenders and sauce

B.Hamburger patty and fries Celiac disease impairs the body's ability to handle gluten. Hamburgers, potatoes, and fat for cooking do not contain gluten. The "crisp" in apple crisp is made with flour. Spaghetti is made of flour, and meatballs may have added bread crumbs. Chicken tenders are dipped in flour or crumbs, both of which contain gluten.

A nurse is providing dietary instructions to a client who is being treated with continuous ambulatory peritoneal dialysis (CAPD) for chronic glomerulonephritis. Which should the nurse include when discussing what the client needs? A.Low-calorie foods B.High-quality protein C.Increased fluid intake D.Foods rich in potassium

B.High-quality protein Proteins eaten should be high quality to replace those lost during dialysis. Adequate calories are required to maintain weight. Usually there is a restriction of fluids when the client is on dialysis; restriction with CAPD is not as severe as with hemodialysis. Although there is no restriction of potassium on peritoneal dialysis, the client does not need a diet high in potassium.

A school-aged child with type 1 diabetes is admitted to the pediatric unit in ketoacidosis. What sign of ketoacidosis does the nurse expect to identify when assessing the child? A.Sweating B.Hyperpnea C.Bradycardia D.Hypertension

B.Hyperpnea Deep, rapid breathing (hyperpnea) is an attempt by the respiratory system to eliminate excess carbon dioxide; it is a compensatory mechanism associated with metabolic acidosis. Sweating is a physiological response to hypoglycemia. Tachycardia, not bradycardia, results from the hypovolemia caused by the polyuria associated with ketoacidosis. Hypotension, not hypertension, may result from the decreased vascular volume caused by the polyuria associated with ketoacidosis.

Which statement regarding calcitonin is correct? A.It is secreted by follicular cells. B.Its actions are opposite to that of parathyroid hormone. C.It decreases phosphorous levels by increasing bone resorption. D.It works along with thyroid hormone to maintain normal calcium levels in blood.

B.Its actions are opposite to that of parathyroid hormone. Calcitonin reduces serum calcium levels, whereas parathyroid hormone increases serum calcium levels. Therefore, the actions of calcitonin are opposite to that of parathyroid hormone. Calcitonin is secreted by parafollicular cells of the thyroid gland. Calcitonin decreases calcium and phosphorus levels by decreasing bone resorption. Calcitonin works along with parathyroid hormone to maintain calcium levels in blood.

When obtaining a health history from a client recently diagnosed with type 1 diabetes, the nurse expects the client to report what clinical manifestations? A.Irritability, polydipsia, and polyuria B.Polyuria, polydipsia, and polyphagia C.Nocturia, weight loss, and polydipsia D.Polyphagia, polyuria, and diaphoresis

B.Polyuria, polydipsia, and polyphagia Excessive thirst (polydipsia), excessive hunger (polyphagia), and frequent urination (polyuria) are caused by the body's inability to metabolize glucose adequately. Although polydipsia and polyuria occur with type 1 diabetes, lethargy occurs because of a lack of metabolized glucose for energy. Although polydipsia and weight loss occur with type 1 diabetes, frequent urination occurs throughout a 24-hour period because glucose in the urine pulls fluid with it. Although polyphagia and polyuria occur with type 1 diabetes, diaphoresis occurs with severe hypoglycemia, not hyperglycemia.

What should nursing care for a child admitted with acute glomerulonephritis be directed toward? A.Enforcing bed rest B.Promoting diuresis C.Encouraging fluids D.Removing dietary salt

B.Promoting diuresis With the reduction of edema the child's health improves, the appetite increases, and the blood pressure normalizes. Ambulation does not have an adverse effect on this disorder; most children voluntarily restrict their activities and remain in bed during the acute phase. Fluids are not encouraged because the kidneys are inflamed and cannot tolerate large amounts of fluid. Sodium intake is decreased, not eliminated; sodium restriction is not tolerated well by children and may further decrease their appetite.

What is the action of vasopressin? A.Promotes sodium reabsorption B.Reabsorbs water into the capillaries C.Promotes tubular secretion of sodium D.Stimulates bone marrow to make red blood cells

B.Reabsorbs water into the capillaries Vasopressin is also known as an antidiuretic hormone (ADH). It helps in the reabsorption of water into the capillaries. Aldosterone promotes sodium reabsorption. Natriuretic hormones promote tubular secretion of sodium. Erythropoietin stimulates bone marrow to make red blood cells (RBCs).

A client, visiting the health center, reports feeling nervous, irritable, and extremely tired. The client says to the nurse, "Although I eat a lot of food, I have frequent bouts of diarrhea and am losing weight." The nurse observes a fine hand tremor, an exaggerated reaction to external stimuli, and a wide-eyed expression. What laboratory tests may be prescribed to determine the cause of these signs and symptoms? A.Partial thromboplastin time (PTT) and prothrombin time (PT) B.T 3, T 4, and thyroid-stimulating hormone (TSH) C.Venereal disease research laboratory (VDRL) test and complete blood count (CBC) D.Adrenocorticotropic hormone (ACTH), antidiuretic hormone (ADH), and corticotropin-releasing factor (CRF)

B.T 3, T 4, and thyroid-stimulating hormone (TSH) T 3, T 4, and TSH provide a measure of thyroid hormone production; an increase is associated with the client's signs and symptoms. PT and PTT assess blood coagulation. The VDRL test is for syphilis; the CBC assesses the hematopoietic system. ACTH stimulates the synthesis and secretion of adrenal cortical hormones. ADH increases water reabsorption by the kidney. CRF triggers the release of ACTH.

What is the consequence of Vitamin C deficiency?

Bleeding tendency/scurvy

Laboratory tests

Blood glucose testing Antibody testing Lipid analysis renal function tests

The registered nurse is preparing to assess a client's renal system. Which statement by the nurse indicates effective technique? A."I must first palpate the client if a tumor is suspected." B."I must first listen for normal pulse at the client's wrist region." C."I must first auscultate the client and then proceed to percussion and palpation." D."I must first examine tender abdominal areas and then proceed to nontender areas

C."I must first auscultate the client and then proceed to percussion and palpation." Palpation and percussion can cause an increase in normal bowel sounds and hide abdominal vascular sounds. Therefore it is wise to perform auscultation prior to percussion and palpation during clinical assessment of the renal system. Palpation should be avoided if a client is suspected of having a tumor because it could harm the client. It is more important as part of clinical assessment of the renal system to listen for bruit by auscultating over the renal artery. Bruit indicates renal artery stenosis. The nontender areas should be examined prior to tender areas to avoid confusion regarding radiating pain from the tender area being percussed.

The health care provider prescribes an oral hypoglycemic for the patient with type 2 diabetes. What will the nurse need to consider when developing the teaching plan? A.Oral hypoglycemics work by decreasing absorption of carbohydrates. B.Oral hypoglycemics work by stimulating the pancreas to produce insulin. C.Clients taking oral hypoglycemics may subconsciously relax dietary rules to gain a sense of control. D.Clients with type 2 diabetes do not need to be concerned about serious adverse effects from oral hypoglycemics.

C.Clients taking oral hypoglycemics may subconsciously relax dietary rules to gain a sense of control. Taking a tablet may give the client a false sense that the disease is under control, and this can lead to dietary indiscretions. Some oral hypoglycemics work by stimulating the pancreas to produce insulin, others work by decreasing carbohydrate absorption, and others work in a variety of other ways; therefore teaching should be specific to the drug prescribed. Oral hypoglycemic drugs can have serious adverse effects.

A nurse is caring for a postoperative client who has a nasogastric (NG) tube set to low intermittent suction. The nurse recalls that the primary reason that an intravenous infusion of 5% dextrose with 0.45% sodium chloride and 20 mEq of potassium has been prescribed is to prevent which complication? A.Constipation B.Dehydration C.Electrolyte imbalance D.Nausea and vomiting

C.Electrolyte imbalance When clients do not receive nutrients or fluids by mouth and have loss of electrolytes through the removal of gastric secretions via an NG tube, then electrolyte imbalance is a primary concern. Constipation is usually not a concern in this type of situation. Although dehydration is a possible effect of an NG tube removing gastric secretions and fluid, electrolyte balance is still the priority. An NG tube set to low intermittent suction usually relieves nausea and vomiting.

A client progresses to a regular diet after a gastrectomy for gastric cancer. After eating lunch the client becomes diaphoretic and has palpitations. What probable cause of this response does the nurse recognize? A.Intolerance to fatty foods B.Dehiscence of the surgical incision C.Extracellular fluid shift into the bowel D.Diminished peristalsis in the small intestine

C.Extracellular fluid shift into the bowel Hypertonic food increases osmotic pressure and pulls fluid from the intravascular compartment into the intestine (dumping syndrome). Increased carbohydrates, not fats, are responsible for the increased osmotic pressure often associated with the dumping syndrome. Dehiscence of the surgical incision is separation of the wound edges, usually accompanied by a gush of pink-tinged fluid; it is unrelated to dumping syndrome. Although peristalsis may be decreased because of surgery, it does not account for the adaptations.

During a parenting class a nurse is discussing infant/toddler nutrition and ways to reduce the risk of food allergies. What food item should the nurse recommend that the parents avoid until their children are 3 years old? A.Cow's milk B.Soy products C.Peanut butter D.Chocolate candy

C.Peanut butter Peanut allergies tend to be very severe. To reduce the risk of peanut allergies, parents should delay their introduction into the diet until the gastrointestinal tract has matured. Cow's milk is introduced after 1 year. Although often considered hypoallergenic, soy products can cause food allergies. However, because of the infrequency of soy in the American diet, its entry is not delayed after the first year. Chocolate may be introduced after the first year of life.

A nurse is caring for a client with severe burns. The nurse determines that this client is at risk for hypovolemic shock. Which physiologic finding supports the nurse's conclusion? A.Decreased rate of glomerular filtration B.Excessive blood loss through the burned tissues C.Plasma proteins moving out of the intravascular compartment D.Sodium retention occurring as a result of the aldosterone mechanism

C.Plasma proteins moving out of the intravascular compartment The shift of plasma proteins into the burned area increases the shift of fluid from the intravascular to the interstitial compartment; the result is decreased blood volume and hypovolemic shock. Decreased glomerular filtration may occur because of hypovolemia; it does not cause hypovolemia. Extracellular fluid, not blood, is lost through burned tissue. Sodium is not retained; it passes to interstitial spaces and surrounding tissue.

Clear Liquid diet

Can be ordered before designated procedures or after surgeries • Liquids at room Temp • Little or no residue • When other forms of food are not tolerated • Inadequate calories and nutrients • Generally for 3-5 days • Suitable for Diabetic clients • Choices include: Coffee/tea, juices, sodas, gelatin (not red), deserts, popsicles, fat free broths

A nurse administers a parenteral preparation of potassium slowly and cautiously to avoid which complication? Acidosis Cardiac arrest Psychoticlike reactions Edema of the extremities

Cardiac arrest Too rapid administration can cause hyperkalemia, which contributes to a long refractory period in the cardiac cycle, resulting in cardiac dysrhythmias and arrest. Although acidosis can cause hyperkalemia, hyperkalemia will not lead to acidosis. Psychoticlike reactions do not occur with hyperkalemia. Hyperkalemia usually causes nausea, vomiting, and diarrhea, which may result in dehydration; in this instance, fluid will shift from interstitial spaces to the intravascular compartment. With edema, the fluid shift occurs in the opposite direction.

What is HNKS? (hyperosmolar nonketotic syndrome)

Condition that is now rare because of routine screening of glucose levels and home blood glucose monitoring.

A nurse is educating the mother of a one-year-old baby about an adequate child's diet plan. Which statement made by the mother indicates the need for further education? A."I should limit the intake of milk to two to three cups per day." B."I should serve finger foods in small and reasonable amounts." C."I can start supplementing milk with solid food items such as vegetables and fruits." D."I should give low-fat or skimmed milk to the child until he or she is two years old."

D."I should give low-fat or skimmed milk to the child until he or she is two years old." Children under two years of age should not be given low-fat or skimmed milk because fat is important for physical and intellectual growth. Milk intake should be limited to two to three cups per day because the consumption of more than a quart of milk per day will decrease a child's appetite for essential solid foods and result in inadequate iron intake. Serving finger foods to toddlers allows them to eat by themselves and to satisfy their need for independence and control. Small, reasonable servings allow toddlers to eat all of their meals. By the age of six months, the mother should start supplementing milk with solid food items, ensuring a balanced diet for an adequate growth of the child.

During the initial prenatal visit of a woman at 23 weeks' gestation, the nurse discovers that she has a history of pica. What is the most appropriate nursing action? A.Seeking a psychology referral B.Explaining the danger this poses to the fetus C.Obtaining a prescription for an iron supplement D.Determining whether the diet is nutritionally adequate

D.Determining whether the diet is nutritionally adequate The primary concern for a pregnant women who practices pica is that her diet is nutritionally inadequate. Nutritional guidance may be necessary, depending on the findings of this assessment. Pica does not indicate a psychologic/emotional disturbance; frequently it is influenced by the client's culture. If a substance is not toxic to the mother, it is generally not fetotoxic. Iron is routinely prescribed during pregnancy; this does not specifically address the practice of pica.

A client with diabetes who is receiving long-term corticosteroid therapy is admitted to the hospital with leg ulcers. What increased risk does the nurse consider when assessing this client? A.Weight loss B.Hypoglycemia C.Decreased blood pressure D.Inadequate wound healing

D.Inadequate wound healing Because the antiinflammatory response is depressed as a result of increased cortisol levels, the wounds of clients receiving long-term corticosteroid therapy tend to heal slowly. A common finding associated with long-term corticosteroid use is weight gain, caused not only by fluid retention but also by alterations in fat, carbohydrate, and protein metabolism. Persistent hyperglycemia (steroid diabetes) occurs because of altered glucose metabolism. Hypertension, not hypotension, occurs as a result of sodium and fluid retention.

A client with type 1 diabetes is admitted to the hospital for major surgery. Before surgery, the client's insulin requirements are elevated but well controlled. What insulin requirements will the nurse anticipate for this client postoperatively? A.Decrease B.Fluctuate C.Increase sharply D.Remain elevated

D.Remain elevated Emotional and physical stress may cause insulin requirements to remain elevated in the postoperative period. Insulin requirements will remain elevated rather than decrease. Fluctuating insulin requirements usually are associated with noncompliance, not surgery. A sharp increase in the client's insulin requirements may indicate sepsis, but this is not expected.

A 4-year-old child with nephrotic syndrome is admitted to the pediatric unit. What clinical finding does the nurse expect when assessing this child? A.Severe lethargy B.Dark, frothy urine C.Chronic hypertension D.Flushed, ruddy complexion

Dark, frothy urine is characteristic of a child with nephrotic syndrome; large amounts of protein in the urine cause it to take this appearance. The child may be somewhat, not severely, lethargic. Blood pressure is normal or decreased; hypertension is associated with glomerulonephritis. Children with nephrotic syndrome usually have a pale complexion and are not flushed and ruddy in appearance.

SIgns of protein deficiency

Deficiency is weight loss, muscle wasting, alopecia, peripheral edema.

Renal diet

Diet is as important as medications • Body is unable to eliminate waste products from the breakdown of foods, which builds up and causes illness • Dialysis will remove wastes but build up will reoccur • Control of diet includes limitation of sodium, potassium, protein, phosphorous and fluids Limit Milk and dairy products to ½ cup per day (protein, phosphorous, sodium) • Limit meat to 6-8oz per day (protein, potassium, phosphorous, possible some sodium) • NO salt substitute • Allowed 3-5 (1/2 cup servings) of low potassium/low phosphorus vegetables and fruits

What is insulin resistance?

Difficulty moving glucose into the cells.

What are consequences of hyperglycemia?

Diminished circulation, loss of sensation, dehydration, poor skin integrity/pressure ulcers, constipation, increased risk of clot formation

A client has a low hemoglobin level that is attributed to nutritional deficiency, and the nurse provides dietary teaching. Which food choices by the client indicate that the nurse's instructions are effective? Select all that apply. Eggs Squash Carrots Spinach Apricots

Eggs and spinach are high in iron. Although squash and apricots contain some iron, they are not the best source. Carrots are high in vitamin A.

jobs of fatty acids

Essential to membrane structure and function , vision, and nervous system function. Deficiency is weight loss, dermatitis, impaired neurologic function.

What is the basic element of a nutrition history?

Essential to potentially identify risk factors associated with poor nutrition.

What is hyperglycemia?

Excess counter regulatory hormones

Definition of elimination

Excretion of waste products

What is glucagon?

First to be produced in response to cellular deficiency of glucose

Low Residue/Low Fiber Diet

Generally short term use ( 2weeks) • Low fiber foods ( 20g per day): • Fruits, vegetables, seeds, legumes, nuts, and whole grains • Non-irritating to the GI tract • Ordered or recommended for digestive disorders such as diarrhea, abdominal cramping, diverticulitis, partial bowel resection, pelvic/abdominal radiation, after GI surgery • Long-term use leads to constipation

What are risk factors for impaired glucose utilization?

Genetic Predisposition, Environmental factors, metabolic syndrome

What suggestion should the nurse provide to the mother whose child has had constipation for three days? Select all that apply. Give laxatives to the child. Reduce the child's fluid intake. Include dairy products in the child's diet daily. Increase the child's physical activity. Include food with a high fiber content in the child's diet.

Give laxatives to the child. Increase the child's physical activity. Include food with a high fiber content in the child's diet. Constipation is infrequent and difficult passage of stools, and it can be managed by following certain measures. Laxatives may help with the easy passage of stools to relieve constipation. Bowel movements can also be promoted by increasing physical activity and adding fiber to the diet to add bulk to the stool to relieve constipation. Low fluid intake and consumption of dairy products can increase the risk for constipation.

A parent expresses concern that the adolescent child is not ingesting enough calcium because of an allergy to milk. What alternative foods or liquids should the nurse suggest? Select all that apply. Cottage cheese Green leafy vegetables Black or baked beans Yogurt Oranges Salmon and sardines

Green leafy vegetables Black or baked beans Oranges Salmon and sardines Green leafy vegetables, black and baked beans, oranges, and salmon and sardines are all good sources of calcium even though they do not contain milk or milk products. Cottage cheese and yogurt both contain milk and therefore must be eliminated.

Which hormone may be excreted in urine during pregnancy? A.Estrogen B.Oxytocin C.Progestin D.Human chorionic gonadotropin

Human chorionic gonadotropin hormone may be isolated from the urine during pregnancy. Estrogen, oxytocin, and progestin may induce ovulation but cannot be isolated from urine.

Plasma Ca+2 imbalances

Hypocalcemia: increased neuromuscular excitability, positive signs for Trousseau;s signs, muscle cramps, twitching, hyperactive reflexes, carpal, pedal spasms, tetany, seizures, cardiac dysrhythmias, Hypercalcemia: Decreased neuromuscular excitability, anorexia, nausea, constipation, muscle weakness, dimished reflexes,

Plasma K+ imbalance

Hypokalemia: flaccid muscle weakness, abdominal distention, constipation, hypotension, polyuria, cardiac dysrhthmias <3.5 mEq/L Hyperkalemia: flaccid muscle weakness, dysrhythmias, cardiac arrest if severe >5.0 mEq/L

Plasma Mg+2 imbalances

Hypomagnesemia: increased neuromuscular excitability, positive chvosteks and trousseasus signs, insomnia, hyperactive, reflexes, muscle cramps and twitching <1.5mEq/L Hypermagnesium: decreased neuromuscular excitabilty, flushing, diaphoresis, diminshed relfexes , hypotension, decreased LOC, muscle weakness, respiratory depression, bradycardia >2.5mEq/L

A nurse is caring for a client with endocrine problems. Which lab finding will alert the nurse that aldosterone will be released? A.Hypokalemia B.Hypoglycemia C.Hyponatremia D.Hypochloremia

Hyponatremia IT stimulates the secretion of aldosterone. Hypoglycemia inhibits the secretion of insulin. Hyperkalemia, not hypokalemia, stimulates the secretion of aldosterone. Hypochloremia is associated with increased levels of antidiuretic hormone.

Carbohydrate Controlled

Important for clients with impaired glucose regulation • Carbohydrates cause a rise in blood glucose • Necessary to balance carbs throughout the day with medications and/or insulin within the daily diet • Read food labels: 5% carbs is low and 20% carbs is high (for a 1800 calorie diet) • Meats and fats have no carbohydrates • Suggested food portions: 1oz of grain, ½ cup fruits, 1cup milk equals 15gms of carbs ½ cup of starchy vegetables (peas, corn, dried beans, or ½ of a potato equals 15gms of carbs The KEY is moderation and control using portion sizes

What is hypoglycemia?

Inadequate counter regulatory hormones

Who receives Tube feedings?

Indicated for an individual who is unable to swallow or eat but has a functional GI tract

What is A1c?

Is advised to be higher for persons with reduced symptoms of hypoglycemia and provides an average blood glucose reading over 3 months.

A common digestive problem that includes symptoms of abdominal bloating and diarrhea

Lactose intolerance

What are vitamins?

Needed because they participate as enzymes in metabolic processes

what is the importance of protein?

Needed for growth and maintenance of tissue and those in the blood are responsible for holding fluid in the blood vessels.

What is the consequence of Vitamin A deficiency?

Night blindness

What is euglycemia?

Normal blood glucose levels range between70 & 140mg/dl at all times

Scope of Fluid and Electrolytes

Optimal balance vs. imbalance imbalances can be too little, too much, or misplaced

The scope of Nutrition

Optimal or suboptimal Optimal is all nutrients are available in balanced amounts for cellular metabolism and physiological function suboptimal is a malnourished state that reflects insufficent or excessive quantity or quality of macro/micro nutrients

NPO (Nothing by Mouth)

Ordered before a surgical procedure and designated testing or to rest the bowel (if illness indicates) • Only temporary • No nutritional value • Nutrition can be sustained through IV fluids • Specified orders can include: with medications, sips of H2O, Ice chips

Mechanical soft diet

Ordered for clients who have difficulty chewing or swallowing • Do not use for clients with dysphagia or require blenderized/pureed foods • Suitable for clients with head/neck/oral surgery, poor dentation, esophageal strictures • Food texture is modified by chopping, grinding or blending Mechanical soft foods require minimal chewing and are moist • Sauces, juices, gravies for moisture and to facilitate chewing and swallowing are included • NO crisp raw fruits, vegetables or nuts

What is the consequence of Vitamin B12 deficiency?

Pernicious anemia.

What are signs and symptoms of hyperglycemia?

Polyphagia, Polydipsia, Polyuria

A nurse is caring for a client who is receiving total parenteral nutrition. Which responses indicate that the client is experiencing hyperglycemia? Select all that apply. Polyuria Polydipsia Paralytic ileus Respiratory rate of 16 breaths/min Serum glucose of 105 mg/dL (5.8 mmol/L)

Polyuria Polydipsia Respiratory rate of 16 breaths/min Glucose that is being filtered in the kidney acts as an osmotic diuretic; glycosuria promotes polyuria. Polydipsia (excessive thirst) and fluid intake are the responses to excess fluid loss related to osmotic diuresis. With hyperglycemia, there may be hyperventilation in an attempt to blow off carbon dioxide if ketones are produced; 16 breaths/min per minute is characteristic of hyperventilation. Paralytic ileus is not associated with hyperglycemia. Serum glucose of 105 mg/dL (5.8 mmol/L), by most standards, is within the expected range of 60 to 110 mg/dL (3.3 to 6.1 mmol/L).

What is the 1800 rule?

Predicts the drop in BG level for each unit of extra insulin beyond the bolus insulin needed to cover meal carbohydrate

Full Liquids diet

Progressive from clear liquids to solids • In conditions of difficulty chewing, swallowing or digesting solid foods • Sore throat/mouth • Can include liquefied foods at room temp and strained cereals (some milk based) • Small amount of calories and nutrients • General time frame can be 2-3 weeks with addition of ensure Milk/milk drinks • Creamed soups with strained meats • Strained cooker cereals • Vegetables and fruit juices • Pureed vegetables in soups( not canned) • Spreads • Flavored gelatin, plain puddings, ice cream, sherbet, yogurt without fruit, popsicles, sodas • Soups

Clinical manifestations and examination findings

Related to impaired glucose regulation of hyperglycemia or hypoglycemia Neuropathy -height/weight -determine BMI -acanthosis nigricans (velvety darkening of skin( ^red flag for diabetes -examine for poor perfusion and chronic wounds -asses visual acuity

What is a Renal diet?

Restrictions of phosphorous, sodium and potassium.

What are symptoms of uncontrolled diabetes?

Result in increased incidence of depression due to altered cellular metabolism and increased cortisol production related to hypoglycemia.

What are consequences of hypoglycemia?

Seizures, unconsciousness, cell damage/ death.

Patient education

Self-Management • Monitoring and managing blood sugar • Nutrition therapy • Glucose control • Pharmacologic agents

What are the indicators of nutritional risk in pregnancy in a client who is of normal weight? Select all that apply. Smoker Twin gestation Hemoglobin of 12 g/dL (120 mmol/L) Term delivery 2 years ago Caffeine intake of 180 mg/day Fasting blood sugar of 80 mg/dL (4.4 mmol/L)

Smoker Twin gestation Smokers generally have a nutrient-poor diet and are at risk for continuing the same diet through pregnancy. Multifetal pregnancies require nutrition above the normal requirements for pregnancy. A hemoglobin reading of 12 g/dL (120 mmol/L) and fasting blood sugar of 80 mg/dL (4.4 mmol/L) are normal values. Caffeine intake of 180 mg/day is less than the daily recommended intake.

Low Fat Diet

Sources of low fat can be found from animals or vegetables either liquid or solid • Provides energy, aids in absorption of fat-soluble vitamins (A, D, E, K) • The digested breakdown is fatty acids • Digestion may be disrupted in some disorders causing diarrhea, cramping, abdominal pain, gas General guidelines • Choose leaner cuts of meat • Avoid processed luncheon meats • Choose low fat dairy • Focus on fresh vegetable, fruits, cooked dried beans, whole grains cereals • Use low fat cooking methods such as baking, broiling, grilling, roasting, microwaving • Read Food labels: Keep total fat to 20-30% of total calories (for 2,ooo calorie daily diet, fat= 36-44 grams a day)

What is glycogen?

Storage form of glucose

glycogen

Storage form of glucose

What is gluconeogenesis?

The process in which nitrogen is cleaved from protein sources (dietary or lean muscle tissue) resulting in the creation of glucose.

What is the concept "Glucose Regulation"?

The process of maintaining optimal blood glucose level

what is glucose regulation?

The process of maintaining optimal blood glucose levels

Thick liquid diet

Thick liquids (delayed swallow response, risk for aspiration) • All Liquids at body temperature such as beverages, soup, frozen desserts and water can be thickened • Mayonnaise and thick cream can be used to moisten foods (usually pureed) • Use puddings and custards instead of ice cream, sherbet, sorbet, fruit ice • Drop of lemon/lime juice can be thirst quenching than sweet or milky beverages

Examination findings for disrupted fluid balance (for osmolality imbalances)

Too dilute (hyponatremia): impaired cerebral function, nausea, seizures Too concentrated: impaired cerebral function. thirst, seizures if severe

All women of childbearing age are advised to include at least 400 mcg of folic acid in the daily diet to decrease the risk of neural tube defects in pregnancy. What should the nurse recommend to meet the recommendation? Select all that apply. 1 Vitamin A 2 Vitamin B 6 3 Vitamin B 9 4 Vitamin B 12 5 Legumes, dark-green leafy vegetables, and citrus fruit 6 Eggs, meat, and poultr

Vitamin B 9 Legumes, dark-green leafy vegetables, and citrus fruit Vitamin B 9 is folic acid, and legumes, dark-green leafy vegetables, and citrus fruits are natural sources of folic acid. Most women receive adequate vitamin A in their diets, and too much may cause birth defects. Vitamin B 6 aids in metabolism conversion and the formation of red blood cells. Vitamin B 12 is associated with nerve cells and red blood cells. Eggs, meat, and poultry are sources of vitamin B 12.

A client begins therapy with a new medication. One month later the client notices blood in the urine. Which drug does the nurse anticipate as the cause? Warfarin Nifedipine Nitrofurantoin Phenazopyridine

Warfarin is an anticoagulant medication and could result in blood in urine, a condition known as hematuria. Nifedipine is a calcium channel blocker that could affect the ability of the urinary bladder or sphincter to contract and relax normally. Nitrofurantoin is used to treat urinary tract infections but can cause alteration in urine color to a dark yellowish-brown. Phenazopyridine, a bladder analgesic used to treat pain associated with urinary tract conditions, changes the color of urine to orange or red.

signs of fatty acid deficiency?

Weight loss, dermatitis, impaired neurologic function.

Signs for protein deficiency?

Weight loss, muscle wasting, alopecia, peripheral edema.

Organ damage will affect the metabolism of nutrients. Lost through the urine & can cause hypoalbuminemia that can lead to impaired skin integrity, impaired wound healing, suppressed immunity, sarcopenia and generalized edema (anasarca)

What is Protein?

Body Mass Index (BMI)

a measure of body weight relative to height

Hypoglycemia

abnormally low level of sugar in the blood

anuria

absence of urine

Risk factors for altered bowel elimination

advanced age, excessive use of medications, laxatives, cognitive impairment, consumption of a lot of caffeine, limited access to toilet b/c of immobility, lack of fluids/fiber/ exercise, diuretics, narcotics,antidepressants, anxiolytics, pregnancy

Risk factors for altered Urinary Elimination

altered mobility, neurologic impairment, cognitive impairment, immunologic impairment of infections, trauma to brain or spinal cord

Micturition

another term for urination

Populations at risk?

anyone can be affected: Pregnant women(hormonal changes) infants older adults(b/c increase in visceral fat and reduction in muscle mass) Racial/ethnic groups(american indians/alaska natives )

Assessment: History

ask about urinary/bowel elimination -frequency -appearance -any discomfort or difficulty associated with urinating/pooping -any recent changes in diet -recent changes in health status -new medications -is it voluntary or involuntary?

Populations at risk

beginning of life and at the later stages, ethinicty/race the poor and undeserved- those of low socioeconomic status are at risk for malnutrition b/c of food insecurity and food availability

Continence

control of urination and fecal elimination

Important initial step in assessing nutritional status

determining BMI

Defecation

elimination of feces

Hyperglycemia

excessive sugar in the blood

Normal physiological process of elimination

formation of urine excretion of urine the kidneys, ureters, bladder and urethra must all function normally for urination to occur

polyuria

frequent urination

A form of autonomic neuropathy that causes reduced ability of stomach to transfer food into the small intestine because of reduced peristalsis?

gastroparesis

Primary prevention

healthy eating and physical activity - Healthy diet -Current Dietary Guidelines for Americans MyPlate Physical activity, Physical exercise for 30 minutes most days of the week

Cellular metabolism

hormonal and enzymatic processes that occur within cell structures that allow proteins, carbs,fats to be used.

Incontinence

inability to control bladder and/or bowels

Assessment: History

includes nutritional intake, diet restrictions, changes in appetite and intake, changes in weight, medical history, current medical medications, current medications, and treatments, allergies, family/social history

Age related differences

infant &children: newborns depend on a strong suck swallow reflex for adequate nutritional intake Pregnancy and lactation:pregnancy is very important stage of long term effects on the infant, infants are at risk b/c of impaired oral intake and older adults: reduced ability to ingest, absorb, metabolize

Populations at risk

infants and children: higher % of body fat higher fluid exchange ratio, they have immature kidneys that have little reserve capacity -infants can not communicate thirst except by crying olderadults: thirst sensation is blunted the osmolality of their body fluids can rise higher before they become thirsty , decreased renal reserve.

Secondary prevention

infants: glucose levels, genetically linked metabolic disorders Adults: lipids and BMI

Oral intake

ingesting of necessary foods to meet macro/micro nutrient and fluid needs. Adequate oral intake of nutrients and water involves access to food sources, informed food choices and efficient chewing

Intracellular

inside the cell

Hormones: (e.g., glucagon, epinephrine, cortisol)

insulin (e.g., insulin resistance, hyperinsulinemia),

Normal physiological processes

intake and absorption, distribution, and output -intake and absorption match the output of fluid and electrolytes -volume, osmolaity and electrolytes concentration of liquids in the various body fluid compartments and within normal range -Most fluid and electrolyte intake is oral, triggered by osmolality of fluids, volume, hormones, and dietary habits. -Distribution of fluid and electrolytes occurs in the cells or out of the cells. -Fluid and electrolyte output is via urine, feces, skin, and respiration.

Insulin

is the only hormone produced that lowers high BG levels after carb intake

Definition of Nutrition

is the science of optimal cellular metabolism and its impact on health and disease

Elimanation

large food particles and eliminated through the colon

Secondary prevention for fluid and electrolytes

measurements of serum Na, K, Ca

Absorption

microscopic villi absorb nutrients into capillaries which are transported by the vascular system. -duodenum is the primary site for absorbing trace minerals -jejunum is the primary site for absorbing water soluble vitamins -ileum is the site of fat/ fat soluble absorption

Electrolytes

minerals that carry electrical charges that help maintain the body's fluid balance

frequency

multiple episodes of urinating and little urine produced in a short period of time

Anions

negatively charged ions

euglycemia

normal level of sugar in the blood

What is the scope of glucose regulation?

normal/optimal to impaired regulation

Extracellular

outside the cell

dysuria

painful urination

Age related differences for infants, toddlers and children

patterns of elimination change in the first few years, they lack control over the sphincters and muscles that control urination/bowel elimination toilet training helps contain control of bowl movements

Assessment: History

personal medical record, current medications, social history, family history and a review of systems. (Vascular disease, Diet, Weight changes, Pregnancy induced diabetes)

Interstitial

pertaining to spaces between cells in a tissue or organ

Cations

positively charged ions

Age related differences for Pregnant women

presence of fetus affects bowel and bladder function, increased pressure is placed on bladder and frequent urination is required b/c larger blood volume while pregnant -can also cause constipation b/c the fetus can affect intestinal peristalsis and the use of iron

Normal elimination for bowels

presence of stools/feces passage of stool form of stool color of stool frequency of stool passage retention of stool -urge to defecate, possible cramping or fullness in rectum

Normal bladder elimination

presence of urine passage of urine retention of urine color of urine frequency of urination amount of urine -urge to urinate, feeling full, possible contraction of bladder

Digestion

process of mechanical and chemical breakdown of food matter and forms of macronutrients - mechanical breakdown (chewing) -chemical breakdown begins in the mouth

Gluconeogenesis

process of producing glucose from non carbohydrate sources (proteins, fats)

Assessment: History

recent vomitting or diahrrea, frequency, quanity

Osmolality

refers to the concentration of dissolved particles of chemicals and minerals

Age related differences for Older adults

renal blood flow reduces, kidneys lose up to 50% of functioning nephrons, including changes in the size of kidney -muscles around urethra become weak which increases incontinence

individual risk factors

serious injury, significant health conditions. so many things can disrupt fluid and electrolyte imbalance

Primary prevention for fluid and electrolytes

teaching people to replace body fluid from vomiting or diarrhea. -teaching people who take potassium wasting diuretics how to increase their dietary K+ intake

Glycogenolysis

the breakdown of glycogen to glucose

Definition of Fluid and Electrolytes

the process of regulating the extracellular fluid volume, body fluid osmolality, and plasma concentrations of electrolytes

Increased risk of impaired glucose metabolism?

the very young and the very old

counterregulatory hormones

these are hormones that oppose the action of other hormones, these are required to raise BG if levels begin to decrease or in anticipation of increased needs. (e.g., glucagon, epinephrine, cortisol)

Examination findings for disrupted fluid balance (for extracelluar volume imbalance)

too little volume: sudden weight loss, skin tenting, dry mucous membranes, rapid thready pulse, lightheadedness, flat neck veins, shock too much volume: weight gain, dependent edema, vascular overload, bounding pulse, distended neck vein, dysnpea

Retention

unintentional retention of your stool

hesitancy

urge to pee exists but person has difficulty starting urine stream

Voiding

urinating

common risk factors for imbalance include:

vomiting, diarrhea, malabsorption, fever, inadequate fluid intake

The scope of Elimination

waste formation to waste excretion

Buffers

weak acids or bases that can react with strong acids or bases to prevent sharp, sudden changes in pH

Reduced sodium

• 2,000mg (2 gm) daily • Do not add salt to food while cooking • Regular breads, milk, soft margarine allowed • Season with herbs and spices • Do not exceed ½ tsp of salt per day in cooking • Choose no added salt canned vegetables • Choose low sodium cheeses, prepackaged food should contain less than 500mg of salt Avoid salt cured, smoked, in brine, pickled meats or fish • Avoid salted nuts, chips, pretzels • Avoid salted meat sauces • Avoid pickles, canned vegetables and soups • Remove the salt shaker from areas that food is consumed or cooked Recommended toward controlling blood pressure

Low Tyramine

• Clients who take MAO inhibitors should avoid foods containing Tyramine Leads to severe headache and HTN crisis • Tyramine can be found in foods such as aged cheeses, foods that contain yeast • Dx for MAO inhibitors include: • Psyche • Seizures • Food selections to avoid: • Breads such as rye, rolls and wheat • Skim milk, milkshakes, juices • Peanut Butter, dried beans and eggs • Apples, grapes, carrots, broccoli, celery

General Guidelines: for a low residue/low fiber diet

• NO raw fruits or vegetables • Fruits and vegies should be cooked or canned • NO whole grains or bran containing products • Avoid all types of seeds, nuts, highly seasoned, deep fat fried foods • Avoid large meals • Broil, bake, grill or roast. Avoid frying

Phosphorus food

• Phosphorus is found in all protein containing foods • Meats • Milk • Dried Beans • Cheese • Bran, Whole wheat Limit ( other than meat and milk) to ½ cup serving of one other food selection to the top

Bland diet

• Reduce gastric distress • Non-stimulating, non- irritating • Mildly seasoned foods • Individualized for acceptance • Includes: all foods from different food groups, NO tough, course, highly seasoned, high fat, strongly flavored products

Fluid Restriction

• Suggested for CHF, Renal Failure disease processes • Fluid builds up when kidneys are unable to make urine for elimination of waste products • Overloading causes swelling, HTN, Heart Failure (nursing concern for Hyponatremia) Anything liquid at room temperature: (8ozs=240mL=1cup) • Water • Tea/coffee • Ice cream • Sherbet • Popsicles • Soup • Milk • Juice • Gelatin • All beverages

Potassium Foods

• Very High: salt, salt substitute, milk, potatoes, bananas, tomatoes, cantaloupe, oranges, avocados, dried beans, spinach, pumpkin, squash • Low: Applesauce, blueberries, cranberry, grape juice, peach nectar, canned pears, green beans, raw cabbage, peeled cucumber, green peppers, rice, noodles