Exam 5 – Nutrition – Flashcards

C (I will make sure that I eat a balanced diet and exercise regularly.) (Obesity is an epidemic in the United States. Proposed contributing factors are sedentary lifestyle and poor meal choices. Healthy eating and participation in exercise or other activities of healthy living promote good health.)

B (Protein) (Proteins provide a source of energy ''4 kcal/g'', and they are essential for synthesis ''building'' of body tissue in growth, maintenance, and repair. Collagen, hormones, enzymes, immune cells, deoxyribonucleic acid ''DNA'', and ribonucleic acid ''RNA'' are all made of protein.)

A, C, E (Patients with dysphagia are at risk for aspiration and need more assistance with feeding and swallowing. Feed the patient with dysphagia slowly, providing smaller-size bites, and allow the patient to chew thoroughly and swallow the bite before taking another. Position the patient in an upright, seated position in a chair or raise the head of the bed to 90 degrees. If the patient has unilateral weakness, teach him or her and caregiver to place food in the stronger side of the mouth. Additional interventions include providing a 30-minute rest period before eating. Have the patient slightly flex the head to a chin-down position to help prevent aspiration. Determine the viscosity of foods that the patient tolerates best through the use of trials of different consistencies of foods and fluids. Thicker fluids are generally easier to swallow. More frequent chewing and swallowing assessments throughout the meal are necessary. Allow the patient time to empty the mouth after each spoonful, matching the speed of feeding to the patient's readiness. If the patient begins to cough or choke, remove the food immediately.)

B (Turn patient to left lateral decubitus position) (An air embolus possibly occurs during insertion of the catheter or when changing the tubing or cap. Have the patient assume a left lateral decubitus position first. Then have the patient perform a Valsalva maneuver -holding the breath and "bearing down"-. The increased venous pressure created by the maneuver prevents air from entering the bloodstream during catheter insertion. Maintaining integrity of the closed intravenous system also helps prevent air embolus.)

A (At present the most reliable method for verification of placement of small-bore feeding tubes is x-ray film examination. The measurement of the pH of gastric secretions withdrawn from the feeding tube helps to determine the location of the tube. Auscultation has repeatedly been shown to be ineffective in detecting tubes accidentally placed in the lung. Further, it is not effective in distinguishing between gastric and intestinal placement for feeding tubes.)

D (Helicobacter pylori) (Marshall and Warren first identified Helicobacter pylori in 1984. It is a bacteria that causes up to 85% of peptic ulcers and is confirmed by laboratory tests. It is treated with antibiotics that control the bacterial infection.)

D (Gastric residual aspirate of 350 mL for the second consecutive time) (Delayed gastric emptying is a concern if 250 mL or more remains in the patient's stomach on each of two consecutive assessments. The North American Summit on Aspiration in the Critically Ill Patient made the following recommendations regarding gastric residual volumes ''GRVs'': 1. stop feedings immediately if aspiration occurs; 2. withhold feedings and reassess patient tolerance to feedings if GRV is over 500 mL for two successive measurements; and 3. routinely evaluate the patient for aspiration and use nursing measures to reduce the risk of aspiration if GRV is between 250 and 500 mL.)

B (A recently widowed 76-year-old woman recovering from a mild stroke) (Older adults who are homebound and have a chronic illness have additional nutritional risks. Frequently this group lives alone with few or no social or financial resources to assist in obtaining or preparing nutritionally sound meals. This contributes to a risk for food insecurity caused by low income and poverty. In addition, the mild stroke might cause dysphagia.)

D (I'm going to alternate formula with whole milk starting next month.) (Infants should not have regular cow's milk during the first year of life. It causes gastrointestinal bleeding, is too concentrated for the infant's kidneys to manage, increases the risk of milk product allergies, and is a poor source of iron and vitamins C and E. Breast milk or formula provides sufficient nutrition for the first 4 to 6 months of life. The development of fine-motor skills of the hand and fingers parallels the infant's interest in food and self-feeding. Iron-fortified cereals are typically the first semisolid food to be introduced. For infants 4 to 11 months, cereals are the most important nonmilk source of protein.)

A, C, D (Caution older adults to avoid grapefruit and grapefruit juice because these impair absorption of many drugs. Thirst sensation diminishes, leading to inadequate fluid intake or dehydration; thus older adults should be encouraged to ingest adequate fluids. Some older adults avoid meats because of cost or because they are difficult to chew. Cream soups and meat-based vegetable soups are nutrient-dense sources of protein. Cheese, eggs, and peanut butter are also useful high-protein alternatives. Milk continues to be an important food for older women and men who need adequate calcium to protect against osteoporosis ''a decrease of bone mass density''. Screening and treatment are necessary for both older men and women. Vitamin D supplements are important for improving strength and balance, strengthening bone health, and preventing bone fractures.)

B (Places the patient supine while giving a bath.) (Patients receiving enteral feedings should have the head of the bed elevated a minimum of 30 degrees, preferably 45 degrees, unless medically contraindicated. Laying the patient supine increases the risk of aspiration of the feeding and should be avoided. This needs to be addressed to maintain patient safety.)

A (The TPN formula is a combination of crystalline amino acids, hypertonic dextrose, electrolytes, vitamins, and trace elements. Administration of concentrated glucose is accompanied by increases in endogenous insulin production, which causes cations -potassium, magnesium, and phosphorus- to move intracellularly. Blood glucose levels should be monitored every 6 hours to assess for hyperglycemia. Maintaining blood glucose within acceptable limits helps prevent complications from the TPN.)

B (Instruct the client to tuck her chin when swallowing.) (Tucking the chin when swallowing allows food to pass down the esophagus more easily. Thin liquids and using a straw both increase the client's risk for aspiration. Sitting for an hour after meals helps prevent gastroesophageal reflux and possible aspiration of the contents after a meal.)

D (Carbohydrates) (Most of the body's energy comes from carbohydrates. Fat provides energy but should be less than 30% of total caloric intake. Protein is responsible for growth and repair of body tissues. Vitamins do not provide energy.)

D (Vitamins) (School-age children must have their dietary intake supervised to ensure adequate intake of protein and vitamins C and A. They tend to eat too many foods high in carbohydrates, fats, and salt.)

C (Dairy Products) (A soft/low-residue diet consists of foods that are low in fiber and easy to digest. Dairy products are low in fiber and easy to digest. Whole grains, fruits, vegetables, nuts, and legumes all are high in fiber.)

A (Polymeric) (Polymeric formulas are nutritionally complete. Modular formulas provide a single macronutrient. Elemental formulas are composed of predigested nutrients, and specialty formulas are designed to meet specific nutritional needs and are not nutritionally complete.)

A (nasogastric tube.) (Nasogastric tubes are used short-term and can be inserted through the nose. Insertion of a gastrostomy or jejunostomy tube is done by a surgical procedure, and a percutaneous endoscopic gastrostomy ''PEG'' tube is inserted endoscopically. Surgical and endoscopic insertion presents an increased risk for injury and infection; therefore, they are only indicated for long-term use.)

C (clear the tubing to prevent clogging.) (Flushing the tube after the feeding has been given helps maintain patency by clearing any excess formula from the tube. If the client requires additional fluids, the small amount used for flushing will not be adequate. If formula is to be diluted, it should be done before instilling the feeding. Flushing the tube does not maintain placement of the tube.)

B (that the tube is correctly placed.) (The greatest risk to the client receiving enteral feedings is injury from aspiration. Therefore, the priority nursing assessment before initiating an enteral feeding is to determine proper place of the tube. Assessing the client's level of consciousness, the presence of any complications of tube feeding ''diarrhea'', and the freshness of the formula are important but are not the highest priority for this client.)

B (Stop the feeding.) (The greatest risk to the client is aspiration pneumonia. Therefore, the first action the nurse should take is to stop the feeding so that no more formula can travel to the lungs. Auscultating for breath sounds, obtaining a chest x-ray, and providing oxygen are all important actions, but none of them is the highest priority.)

A (tape from the client's nose to the nasogastric tube.) (Tape from the client's nose to the nasogastric tube secures the placement. Safety pins pose a risk for piercing the tubing. The tubing is too bulky to create a loop. Applying tape to the connection of the nasogastric tube and suction tubing does not secure the tube.)

Carbohydrates (CHO)

Protein

Positive Nitrogen Balance

Negative Nitrogen Balance

Metabolism

Catabolism

Anabolism

A, D, E, K

A, E, K

C, B

Underweight

Normal

Overweight

Obese

BMR (Basal Metabolic Rate)

Resting Metabolic Rate

Minerals