Nutrition
A nurse is caring for a client who reports having daily constipation. Which of the following information should the nurse provide to the client regarding fiber intake?
- Increase daily fiber intake to alleviate issues - Eating more whole grains can promote regular bowel movements - Consume 25-38g of fiber a day (low end female, high end male) - Brown rice is good
A nurse is caring for a client who is prescribed a low glycemic index diet. The client states "I don't understand what this means". What responses should the nurse make?
- THe glycemic index of food relates to its ability to increase the blood glucose level (stabilized energy bc it doesnt spike the blood glucose level) - Eat foods such as whole grains, fruits, and veggies (they all have low glycemic index) - Limit or avoid potatoes due to high glycemic index - Foods with high glycemic index will cause your blood glucose to increase rapidly (white bread)
A nurse is caring for a client who has renal disease and must limit potassium intake. Which of the following foods should the nurse instruct the client to avoid because they are high in potassium?
- bananas - dried beans - spinach - tomatoes *Eating foods high in potassium can lead to heart dysrythmias and increase the risk of myocardial infarction for clients who have renal disease
What foods will help fix low iron?
- red meats - spinach - whole meal pasta / bread - nuts / dried fruits
A nurse is caring for a client whose provider prescribed a heart-healthy diet. Which of the following info should the nurse include for the client regarding heart-healthy diets?
- you should limit saturated fats in your diet (this can decr cholesterol lvls and reduce risk of heart disease) - Eat foods with whole grains (fiber and nutrients that regulate heart health and BP) - Eat larger portions of fruits and veggies (nutrient rich) - Limit high calorie food intake will promote adherence to new diet (these are typically not nutrient rich foods) - Lean meats and skim milk promote good heart health as opposed to other higher fat options - restricting sodium can decrease high BP and risk for heart disease
A nurse is assessing a client who is experiencing digestive issues. Which of the following findings should the nurse expect?
-nausea - abdominal pain - diarrhea - reports of bloating **Excessive salivation is NOT A FINDING you should expect with someone who is experiencing digestive issues
on an MNA what are the indications?
0-7 = malnurished 8-11 = risk for malnutrition 12-15 = normal nutritional status
Renal disease is characterized by BUN / Creatinine below what level?
35
How many glasses of water should someone drink per day to avoid constipation?
6-8 glasses
Undernourished patients should do what with a nurse?
A food diary for the past 24 hours, a nutritionist will add it up and advise a diet
A nurse is caring for a client who states " I feel like I don't have to eat a varied diet when I take my multivitamin". Which of the following responses should the nurse make?
A multivitamin should not be used in place of a nutritious diet. The diet should be varied and nutritious even while taking a multi vitamin
A nurse is caring for a client who states "I only eat a diet high in protein and carbs". Which of the following responses should the nurse make?
A nutritious diet should include carbs proteins and healthy fats. Dairy grains fruits veggies and proteins
What is siliac disease?
A patient cannot consume glutton, therefore no wheat - cookies, pasta, burgers etc. PATIENT CAN HAVE OATS
What precaution are people with NG tubes always on?
Aspiration, they must always be fed at 90 degrees and they must never be flat because of the aspiration risk
What is BMR
Basal metabolic rate the minimum amount of calories needed for us to function
What kind of patients should be on strict input and output monitoring?
CHF patients
What supplement is best for osteoporosis
Calcium, monitor for constipation
What are some signs of hypoglycemia?
Clammy sweaty diapheresis coma and seizure
What must we watch for when giving a patient ferasulfate?
Constipation, and black stool. Fix the constipation with a high fiber diet
A nurse is preparing to assist with feeding a client who is at risk for aspiration. Which of the following actions should the nurse take?
Cut the clients food into small bites in order to prevent aspiration client should be positioned at 90 degrees avoid distractions like TV the client should be provided with sips of their drink between bites after they have completely swallowed their food
What scan looks for osteoporosis?
Dexascan
A nurse is caring for a client who states " I have been getting a lot of cavities lately, but I don't know what is causing them" What response should the nurse make?
Drinking sugary beverages can make you prone to cavities - foods high in vitamin C can help with gum irritation (side note) so foods like leafy green vegies and tomatoes can help with the gums
What is the most common supplement given for low iron?
Ferasulfate
What level do we monitor for iron deficiency?
Feritin Level
If the pharmacy is out of TPN feeding, what should the nurse do?
Find something that is 10% dextrose to give to the patient
Kidney failure and dialysis indicates a patient must be on what type of restriction?
Fluid restriction, they should also avoid salt, potassium (kidneys filter it)
What type of restrictions should CHF patients have?
Fluid restrictions bc retention Avoid salt Adhere to certain meds
If patient can tolerate the clear diet they can advance to a full liquid diet. what does that contain?
It contains clear and full liquid milk products (ice cream, pudding, yogurt)
Why must we be careful of ginkgo biloba?
It is a memory enhancing drug which thins the blood
A nurse is caring for a client who is receiving tube feedings via PEG. What action should the nurse implement in order to help prevent the client from aspiration.
Keep the client's head elevated to at least 30 degrees for a minimum of 1hr after a feeding - the tube should already also be verified via xray prior to feeding - the nurse should be checking the client's tube feeding tolerance every 4 hr - the pH should be checked ever 4 hr to confirm tube placement
What foods are high in potassium?
Leafy green veggies Escorol kale potatoes oranges kale
When experiencing dysphagia what type of food should you avoid?
Liquids - they are the hardest to swallow. start with applesauce
A nurse is preparing to measure a nasogastric tube for insertion. The nurse recalls that the client's xyphoid process should be used as the last place of measurement. What landmarks should the nurse measure before the xyphoid process?
Measure from the tip of the nose to the earlobe. then from the earlobe to the xyphoid process.
What diet is best for memory
Mediterranian diet consistng of fish, fruits, veggies, olives, and nuts
What kind of diet for stroke patients?
NPO - dont eat orally unless SPEECH THERAPIST verifies
Can TPN and antibiotics be given in the same line together?
No they cannot
Where is the highest amount of malnutrition seen?
Nursing homes
Who tells the nurse what kind of diet the patient should be on?
Nutritionist or doctor
What macronutrient best aids in the wound healing process?
Protein (chicken, beans)
A nurse is caring for a nondiabetic client who has a new prescription for a fasting blood glucose check. The nurse checks the client's blood glucose and it is 67 mg/dL. Which of the following actions should the nurse take next?
Provide the client with a 15-g carb snack. According to EBP this will help bring up their blood glucose level to expected reference range. Less than 70mg/dL is hypoglycemic.
What foods are high in calcium
SARDINES cheese milk (dairy) Spinach
What should diabetic patients avoid?
Sugars and carbs
How do you test an NG tube if there is no litmus paper?
Take air in syringe and push it in tube, place stethoscope on stomach and it should gurgle
A nurse is assessing a clients hair and notes that it is brittle. Which of the following should the nurse determine about the client's nutritional intake?
The client has insufficient protein in their diet. Protien helps promote healthy hair and prevents brittle hair and hair loss.
A nurse is caring for a client who routinely eats a regular diet and is scheduled to have surgery with sedation in the morning. The nurse receives a new NPO diet prescription for the client. Which of the following should the nurse identify as the rationale for the provider's prescription?
The client is at risk for aspiration due to the upcoming surgery with sedation. NPO is typically prescribed to decrease the risk of aspriation.
A nurse is reviewing a clients medical records and notes that their BMI is 25.5. How should the nurse interpret this finding?
The client is overweight. 25-29.9 is overweight. The normal range is 18.5-24.9.
Why can total parental nutrition not be stopped abruptly?
The patient may experience rebound hypoglycemia which is a sudden drop in sugar
A patient post surgery is typically on what kind of diet?
They are on a clear liquid diet - coffee without milk, tea, without milk, orange juice, jello etc
What should iron supplements be taken with to enhance its absorption?
They should be taken with vitamin C
Should a patient on total parental nutrition with high sugar be monitored?
They should have blood glucose monitored often because they can become hypoglycemic
What should nurses teach patients about eating?
They should teach patients how to read labels
A nurse is caring for a client who has a new prescription for parenteral nutrition. The client states "I am scared that I will be on this therapy for the rest of my life". Which of the following responses should the nurse make?
This type of nutrition can be lifelong, but it can also be temporary depending on how your nutritional needs change - this response gives the client objective information without the false reassurance
What is measured in output?
Urine, shit, chest tube drains, Blood lost during surgery patient vomit
What supplement is good to take with calcium?
Vitamin D helps absoprtion
A nurse is caring for a client who has a high phosphorus level. Which of the following instructions regarding food should the nurse provide?
You should eat white bread - whole grain foods are high in phosphorus limit milk intake limit brocolli intake limit oatmeal, granola, bran, and wheat cereals
A nurse is caring for a client who has a new prescription for a clear liquid diet. The client asks the nurse " How long will I have to be on this type of diet" how should the nurse respond?
You should not be on this diet for more than a few days - clear liquid diet should be limited to a few days because this type of diet has an inadequate nutritional value
IV intake with nutrition must be documented by whom?
a nurse
What can change someones dietary habits?
age ability to chew meds can change the way someone tastes culture
What blood level indicates poor nutrition?
albumin potassium sodium and magnesium must be checked as well
Document the total input and output, what are we looking for here?
balance
what kind of feeding is intermittent?
bolus
How many calories are in carbs, proteins, and fats?
carb - 4 cal fat - 9 cal protein -4 cal REMEMBER 4-9-4
Carribean patients like ginger, this cannot be taken with what medicine?
coumadin - avoid vitamin K foods
A stroke patient may experience which side effect that affects feeding?
dysphagia (difficulty swallowing) pocketing food
ALS/ Parkinsons patients are at risk for what food issue?
dysphagia (difficulty swallowing) use red dye to see if food goes down
Before feeding a patient with an NG tube, you should check
for residual (make sure they tolerated previous feeding) and always check placement of NG tube
What is enteral feeding
it is feeding directly to the stomach
Sterile water is used for NG tube care/ irrigation. What must we do when we open sterile water
it is good for 24 hrs, initial it and write the time as well as the day opened
where must total parental feeding be given?
it must be given on a central line because it is very concentrated with dextrose (sugar)
What temperature should the food be when feeding enterally?
it should be room temp.. never cold
Jewish diet
kosher, no mixing meat and milk, no pork, no shellfish
A nurse is discussing macronutrients with a client. Which of the following statements should the nurse make?
macronutrients are essential and consist of Carbs, proteins, and fats. These provide the body with energy and are the building blocks of the diet.
What is proper PPE for NG tube
mask, face shield, gloves
if feeding milk based for for enteral patient, what are the rules?
milk should be opened for only 24 hours, otherwise throw it away if it is milk based product, never fill up the full 1 L bag because it can spoil
What do we need when administer oral meds thru an NG tube
need pill crusher, cup, tubing syringe, litmus paper (test for pH)
Muslim dietary restrictions?
no pork or gelatin or alc
What is parenteral nutrition?
nutrition feeding through an IV
What is a heart healthy diet?
omega 3s (salmon), grains, buckwheat, brown rice
What should be used to give meds to patient with NG tube?
only sterile water that is labeled or freshly opened
What is the concern with mental status and nutrition
over or under eating dementia, psychological like depression
Spirinolactone retains
potassium - so CHF patient needs to refrain from potassium
Feurosemide removes
potassium, so patient needs more potassium
If you test the pH of NG tube an it is 7, what does that indicate
the NG tube is in the lungs, you must report to the doctor and get an xray
Who are at high risk for malnutrition?
the elderly because they cannot chew foods, the cost is high, medical conditions restrict diet, and immobility doesnt help either
What happens if a patient cannot get food down for 2 months?
the tube must be removed and they must use a PEG PEG= the surgical thingy that sticks out of the stomach for feeding
Why would one get parenteral nutriton?
they cannot digest, maybe stomach cancer etc. or healing from gastro surgery. it can get partial or total feeding
Where is partial parental nutrition (PPN) given?
through peripheral IV
A nurse is helping a client calculate how many net carbs they consumed in their last meal. The client's food had a total of 72g of carbs and 9g of fiber. How many net carbs did the client consume?
total carbs - (Fiber + Sugar Alc if applicable) = net carbs. So 72 carbs - 9 fiber = 63 net carbs
If the NG tube is clogged, how can you clean it out?
with coke/ pepsi/ cranberry juice
In order to see if patient is tolerating food with NG tube, the nurse should..
withdraw stomach contents with a syringe.. pull until there is no fluid left. anything of 300mL might cause the patient to vomit. All food pulled out should be pushed back in because it has nutritional value
How do we confirm placement of an NG tube?
xray which shows the tip is in the stomach and is okay to use
Can PCAs document fluid intake?
yes, but not through an IV
Is changing the central line sterile?
yes, it requires sterile dressings
