Topic 5: Digestion and Nutrition PREPU

An older adult client states it is uncomfortable to take a walk around noon in the summer, noting it was easier to do so when younger. What should the nurse explain to this client?

"Because of more body fat with aging, heat dissipates slower making it more uncomfortable to walk during the highest heat of the day." Explanation: The proportionate increase in body fat in older bodies causes heat to dissipate less effectively, making older persons more susceptible to heat stroke if they exercise in hot temperatures. This is the best explanation for the client noticing an intolerance to activity at noon. There is a reason for the client's intolerance. This intolerance is not an indication that the body needs more activity or that the client needs a complete cardiovascular examination.

An older adult reports that the dentures are rubbing against the gums and causing discomfort. The client is not wearing the dentures at all now and states it will be too expensive to buy another set. What is the nurse's best response?

"Sometimes dentures can be lined to ensure a proper fit." Explanation: Poorly fitting dentures need not always be replaced; sometimes they can be lined to ensure a proper fit. Eating soft foods is important, but this response does not address the financial concern of replacing the dentures and is not the best solution for the long term due to possible nutrient deficiencies of a soft food and liquid diet. Wearing ill-fitting dentures is an aspiration risk. The client should clean the dentures, but this does not help the fit.

The nurse notes that an older adult client is scheduled for extracorporeal shock wave lithotripsy. Which direction will the nurse provide the client for preparation?

Do not drink any carbonated beverages in the 12 hours prior. Explanation: Cholelithiasis is the formation or presence of gallstones in the gallbladder. Treatment measures include extracorporeal shock wave lithotripsy. The client should be advised to avoid carbonated drinks and foods that produce gas, such as beans and broccoli. The procedure is outpatient, but the client should not be allowed to drive home after sedation.

A frail older adult client who has slowly been losing weight states, "I just feel so full so full, I cannot eat any more." Which initial recommendation will the nurse make?

Eat five small meals during the day. Explanation: Slight slowing of gastric emptying in older adults after ingestion of large meals leads to early sensations of fullness. The nurse will recommend the client eat 5 small meals throughout the day. Restriction of fluid or increase in exercise will not resolve this issue. Making an appointment with the health care provider is not an initial intervention the nurse would recommend the client use to improve the problem.

During a physical examination the nurse notes flaccid skin around the entrance to an older adult client's anus. What should the nurse suspect is occurring with this client?

Hemorrhoids Explanation: Flaccid skin around the entrance to the anus are hemorrhoids. This tissue is not a rectal tumor. A rectal fissure is not visible when inspecting the anus. The flaccid tissue is not caused by an infection.

An older adult client reports new-onset diarrhea. The client's vital signs are stable. Which action will the nurse implement?

Review the client's medication list. Explanation: The nurse will review the client's medication list. A number of medications can cause diarrhea in the older adult client (e.g., cimetidine, laxatives, antibiotics, cardiovascular drugs, and cholinesterase inhibitors). Additionally, Clostridium difficile and its related diarrhea are related to antibiotic usage. Acute pancreatitis may result in abdominal pain, fever, bloating, and diarrhea. There are no indications of the additional symptoms in the scenario. Determining the last bowel movement assesses the frequency of the stools but does not help determine the underlying cause of the diarrhea. There is no indication in the scenario that suggests the nurse should review meal preparation techniques with the client. Improper meal preparation can increase risks for developing diarrhea secondary to infection. Serving undercooked eggs, for instance could result in diarrhea and fever, secondary to salmonella. The client is afebrile.

A client's family brings an older adult family member to the emergency department, stating, "My parent is not eating well." The nurse should assess for which sign of malnutrition?

Serum albumin level 2.7 g/dL (27 g/L) Explanation: Some of the clinical signs of malnutrition include: weight 10% below or 20% above the ideal range; serum albumin level lower than 3.5 g/dL (35 g/L); hemoglobin level below 12 g/dL (120 g/L); hematocrit value below 35% (0.35).

An older adult client has a history of a deep vein thrombosis. The client should be taught to avoid excessive intake of which vitamin or nutrient?

Vitamin K Explanation: High doses of vitamin K can result in the formation of blood clots. Excess vitamin D can result in calcium deposits in the kidneys and arteries. Calcium in excess can lead to kidney stones. Excess potassium can lead to cardiac abnormalities.

A nurse at a rehabilitation unit assesses an older adult woman with a body mass index (BMI) of 30 and a history of heart failure, whose oral intake is declining. Which is a risk factor for this older adult's decline in appetite?

fatigue Explanation: A client with heart failure may be experiencing fatigue that leads to a lack of food intake. The gender of the client is not relevant in this scenario. Exercise increases appetite. Obesity is unrelated.

The nurse assesses an older adults client's nutritional status. Which anthropometric measurement should the nurse use to help determine if the client is experiencing protein-calorie malnutrition?

midarm circumference Explanation: The midarm circumference is used to assess for protein-calorie malnutrition. A circumference below 60% is an indicator for this health problem. Height, weight, and triceps skinfold are not used to assess for protein-calorie malnutrition.