Lab 5-Malnutrition and Life Cycle Nutrition
Readings: Dudek, Nutrition Essentials For Nursing Practice, Seventh Edition (chapters 1,14)
Please do the case study in Dudek, page 14
Malnutrition–over-nutrition- example-obesity
Over-nutrition is consuming one or more nutrients in amounts more than are required-results in being overweight or obese or facingtoxicity
See pages 377-380 of Dudek and complete points raised in the overview and specifics below.
Overview
1)develop specifics* for pre-onset management (prevention)of obesity in a 20 year old male or female- your choice- please see specifics below*
2)diagnosis and management for pre-onset management is an assessment of the potential for obesity to arise and how to prevent obesity
3)develop specifics* for post-onset obesity managementin a 20 year old male or female- your choice–please see specifics below*
4)diagnosis and management for post-onset management is an assessment of the potential for obesity to decrease at least somewhat and how to implement a plan to decrease that obesity at least somewhat
5)you must do pre- and post-onset for obesity
*Specifics for nutritional care management plan-detail what you will do for each of the following
1)assessment – ABCD (Anthropometric, Biochemical, Clinical And Dietary data) plus medical –psychosocial history
2)nursing diagnosis
3)planning-patient outcomes
4)monitoring and evaluation
5)conclusions-key points from specifics 1-4 immediately above-be sure to show how these key points integrate with one another
Complete case study in Dudek, page 385
Please see and note the video- video mentions nurses using the 5As tool.
Please also see powerpoint
Malnutrition-undernutrition-examples-Anorexia nervosa and bulimia nervosa
Undernutrition is not consuming enough of one or more nutrients and/or having an ingestion, digestion, absorption, transport, metabolism and or excretion issue that results in not getting one or more nutrients to where (W) they are needed, when (W) they are needed, in the form (F) they are needed and in the quantity (Q)they are needed
Life Cycle-Nutrition-NCLEX QUESTIONS
Page 585-Q 86- During a client’s first visit to a pre-natal, a nurse discusses a pregnancy diet. The client states that her mother told her she should restrict her salt intake. What is the nurse’s best response?
a) “your mother is correct. You should use less salt to prevent swelling”
b)” because you need salt to maintain body water balance, it is not restricted. Just eat a well-balanced diet”
c) “salt is an essential nutrient that is naturally reduced by the body’s estrogen. There is no reason to restrict salt in your diet”
d) “We no longer recommend that salt be as restricted as much as in the past. However, you shouldn’t add salt to your food”
a) “your mother is correct. You should use less salt to prevent swelling”-this could be detrimental to the client’s health
b) “because you need salt to maintain body water balance, it is not restricted. Just eat a well-balanced diet”- sodium is needed to maintain body water balance; sodium requirements increase slightly during pregnancy to accommodate the increased blood volume. A healthy pregnant woman should not limit her sodium intake
c) “salt is an essential nutrient that is naturally reduced by the body’s estrogen. There is no reason to restrict salt in your diet”-this statement is not correct
d) “We no longer recommend that salt be as restricted as much as in the past. However, you shouldn’t add salt to your food”-sodium intake should be as for the general population unless medically indicated otherwise
Page 585-Q 91- A pregnant women tells a nurse in a pre-natal clinic that she knows that folic acid is very important during pregnancy and she is taking a prescribed supplement. She also asks the nurse what foods contain folic acid (folate) so she can add them to her diet in its natural form. Which foods should the nurse recommend? Select all that apply.
a) beef and fish
b) milk and cheese
c) chicken and turkey
d) black and pinto beans
e) enriched bread and pasta
a) beef and fish-do not contain adequate amounts of folate
b) milk and cheese-do not contain adequate amounts of folate
c) chicken and turkey-do not contain adequate amounts of folate
d) black and pinto beans –rich in folate
e) enriched bread and pasta-rich in folate
Page 585-Q 95-A client at 10 weeks gestation calls the clinic and tells a nurse that she has morning sickness and cannot control it. What should the nurse suggest to promote relief?
a) eat dry crackers before rising
b) increase fat intake before bedtime
c) drink high carbohydrate fluids with meals
d) have two small meals a day with a snack at noon
a) eat dry crackers before rising-simple remedy that works
b) increase fat intake before bedtime-does not relieve nausea
c) drink high carbohydrate fluids with meals—this is not helpful;separating fluids from solids at mealtime is more advisable
d) have two small meals a day with a snack at noon-two small meals a day with a snack at noon does not meet the nutritional needs of a pregnant women nor will it relieve nausea. Some women find that eating five or six small meals daily instead of three large ones is helpful.
Page 585-Q 96- What should a nurse suggest to a pregnant client that might help overcome first trimester morning sickness?
a) eat protein before bedtime
b) take an antacid before breakfast
c) drink water until the nausea subsides
d) request a prescription for an anti-emetic
a) eat protein before bedtime-nausea and vomiting in early pregnancy can be relieved with a small snack of protein before bedtime to slow digestion
b) take an antacid before breakfast-an antacid may affect electrolyte balance; also this will not help morning sickness
c) drink water until the nausea subsides-this is contraindicated because both mother and foetus need nourishment
d) request a prescription for an anti-emetic-medications in the first trimester are contraindicated because this is the period of organogenesis, and congenital abnormalities could result
Page 585-Q 97- What should a nurse include in nutritional planning for a newly pregnant woman of average height weighing 145 pounds?
Note possible answers to question may read calories- this actually means kcal
a) a decrease of 100 kcal/day-
b) a decrease of 200 kcal/day-
c) an increase of 300 kcal/day-
d) an increase of 500 kcal/day
a) a decrease of 100 kcal/day-this will not meet the metabolic demands of pregnancy and may harm the foetus
b) a decrease of 200 kcal/day- this will not meet the metabolic demands of pregnancy and may harm the foetus
c) an increase of 300 kcal/day-this will meet the increased metabolic demands of pregnancy
d) an increase of 500 kcal/day-this is the recommendation for breast feeding mothers
Page 585-Q 102- What is the best advice a nurse can give to a pregnant women in her first trimester?
a) cut down on drugs, alcohol and cigarettes
b) avoid drugs, and refrain from smoking and ingesting alcohol
c) avoid smoking, limit alcohol consumption and do not take aspirin
d) take only prescription drugs, especially in the second and third trimesters
a) cut down on drugs, alcohol and cigarettes-this is insufficient, all are teratogens and must be eliminated
b) avoid drugs, and refrain from smoking and ingesting alcohol-first trimester is when all major embryonic organs are forming; drugs, alcohol and tobacco may cause major defects
c) avoid smoking, limit alcohol consumption and do not take aspirin-any amount of alcohol is considered harmful, baby aspirin may be prescribed to some women who are considered at risk for pregnancy induced hypertension but not during the first trimester
d) take only prescription drugs, especially in the second and third trimesters-medications, unless absolutely necessary, should be avoided throughout pregnancy, but the first trimester is most significant.
Page 587-Q 105-A client who is 28 weeks into her second pregnancy is experiencing increasing edema in the lower extremities. The nurse advises rest with legs elevated and provides dietary instructions. What else should the nurse suggest?
a) a preferred diet will include favourite foods
b) a nutritionist should be involved in planning a diet
c) the foods selected do not need to have a low salt content
d) the client should be referred to the health care provider at the prenatal clinic
a) a preferred diet will include favourite foods-not all preferences can be included;the diet should contain normal sodium, high protein and sufficient calories
b) a nutritionist should be involved in planning a diet-immediate planning based on the nurse’s knowledge of dietary needs is sufficient
c) the foods selected do not need to have a low salt content-dependent oedema is common during the last trimester; there is no need to lower the salt content of the client’s diet. Teaching should be based on optimum nutrition as well as caloric content of the diet
d) the client should be referred to the health care provider at the prenatal clinic –unless the nurse thought there was a need for medical intervention, the nurse may discuss care related to human responses
Page 587-Q 106-What recommendation should a nurse give to clients who have fluid retention during pregnancy?
a) decrease fluid intake
b) maintain low-sodium diet
c) elevate the lower extremities
d) ask the healthcare provider for a diuretic
a) decrease fluid intake-fluid intake should be encouraged because adequate hydration maintains fluid and electrolyte balance
b) maintain low-sodium diet-sodium intake should not be restricted because it is needed to balance the increased fluid volume during pregnancy
c) elevate the lower extremities-elevation of the lower extremities several times daily is recommended to decrease the dependent oedema
d) ask the healthcare provider for a diuretic-diuretics can be harmful and are not used during a healthy pregnancy
Page 587-Q 113 During the post-partum period, a client tells a nurse she is having leg cramps. Which foods should the nurse encourage the clients to eat?
a) liver and raisins
b) cheese and broccoli
c) eggs and lean meats
d) whole grain breads and cereals
a) liver and raisins- although these foods are recommended to maintain quality nutritional intake, they are inadequate sources of calcium
b) cheese and broccoli-the leg cramps may be related to low calcium intake; cheese and broccoli both have high calcium intake
c) eggs and lean meats-although these foods are recommended to maintain quality nutritional intake, they are inadequate sources of calcium
d) whole grain breads and cereals-although these foods are recommended to maintain quality nutritional intake, they are inadequate sources of calcium
Page 599-Q 272- At the beginning of the first formula feeding a newborn begins to cough and choke, and the lips become cyanotic. What is the immediate nursing action?
a) stimulate crying
b) suction and then oxygenate
c) substitute the formula with sterile water
d) stop the feeding momentarily and then restart
a) stimulate crying-crying made add to the distress
b) suction and then oxygenate-cyanosis, choking and coughing are signs of aspiration and hypoxia. Suctioning and oxygenation are needed
c) substitute the formula with sterile water-the water may be aspirated and intensify the problem
d) stop the feeding momentarily and then restart-this is unsafe;the newborn is showing signs of a blocked airway
Page 600-Q 279-A nurse teaches a group of post-partum clients that all their newborns that all their newborns will be screened for phenylketonuria (PKU) to:
a) assess protein metabolism
b) reveal potential retardation
c) detect chromosomal damage
d) identify thyroid insufficiency
a) assess protein metabolism-PKU, is a rare inherited disorder that causes an amino acid called phenylalanine to build up in your body. PKU is caused by a defect in the gene that helps create the enzyme needed to break down phenylalanine.
b) reveal potential retardation- PKU can cause retardation but the PKU test does not identify retardation
c) detect chromosomal damage- PKU is due to a gene defect which is not due to chromosomal damage
d) identify thyroid insufficiency-this is done at the same time as PKU testing, but thyroid deficiency is related to a hormone deficiency, not to PKU
Page 600-Q 280-When assessing a 9 pound neonate, 2 hours after birth, nurse identifies jitteriness, apneic episodes, tachycardia and temperature instability. What complication do these findings indicate to the nurse?
a) hyponatremia
b) hypoglycaemia
c) cardiac defect
d) immature CNS
a) hyponatremia-not a sign of this problem
b) hypoglycaemia-hypoglycaemia causes CNS and sympathetic nervous system responses
c) cardiac defect-not a sign of this problem
d) immature CNS-not a sign of this problem
Page 600-Q 285-A client asks the nurse what advantage breastfeeding has over formula feeding. What group of substances in human milk are of special importance to the newborn and cannot be reproduced in a bottle formula?
a) amino acids
b) gamma globulins
c) essential electrolytes
d) complex carbohydrates
a) amino acids-these are present in commercial formulas
b) gamma globulins-the antibodies in human milk provide the infant with immunity against all or most of the pathogens that the mother has encountered
c) essential electrolytes-these are present in commercial formulas
d) complex carbohydrates-complex carbohydrates are not required by the infant
Page 600-Q 292-A nurse is teaching a group of new mothers about breast-feeding. Which factor that influences the availability of milk in the lactating women should the nurse include in the teaching?
a) age of the woman at the time of birth
b) distribution of erectile tissue in the nipples
c) amount of milk products consumed during pregnancy
d) viewpoint of the woman’s family toward pregnancy
a) age of the woman at the time of birth-this has no influence on lactation
b) distribution of erectile tissue in the nipples-this has no influence on lactation
c) amountof milk products consumed during pregnancy-milk or milk product intake during pregnancy promotes relaxation and the let-down reflex
d) viewpoint of the woman’s family toward pregnancy-if a women perceives a negative viewpoint about breastfeeding from significant others, she may be tense and the let-down reflex may not occur; a positive attitude from significant others toward breastfeeding promotes relaxation and the let down reflex
Page 600-Q 293-While teaching a prenatal class about infant feeding, the nurse is asked a question about the relationship between the size of breasts and breast feeding. How should the nurse respond?
a) breast size is not related to milk production
b) movtivated women tend to breastfeed successfully
c) you seem to some concerns about breastfeeding
d) glandular tissue in the breast determines the amount of milk produced
a) breast size is not related to milk production-the question should be answered directly in class. However the mother’s statement indicates some concerns about breast feeding
b) motivated women tend to breastfeed successfully-this is false reassurance; successful breastfeeding requires mastery and some women have difficulty
c) you seem to some concerns about breastfeeding-although the nurse perceives the clients conerns, the response is inappropriate in class with others present
d) glandular tissue in the breast determines the amount of milk produced-the infant’s suckling and emptying of breasts will determine the amount of milk produced.
Page 600-Q 294- A women learning about infant feedings asks a nurse how anyone who is breastfeeding gets anything done with a baby on demand feedings? Which is the best response by the nurse?
a) most mothers find that feeding the baby whenever the baby cries works out fine
b) perhaps a schedule might be better because the baby is already accustomed to the hospital routine
c) babies on demand feedings eventually set a schedule, so there should be time for you to do other things
d) most breastfeeding mothers find that their babies do better on demand because the amount of milk ingested may vary at each feeding
a) most mothers find that feeding the baby whenever the baby cries works out fine-some of the episodes of crying do not indicate that the infant is hungry; the mother will learn the difference
b) perhaps a schedule might be better because the baby is already accustomed to the hospital routine-it is best to allow the infant to set the schedule
c) babies on demand feedings eventually set a schedule, so there should be time for you to do other things-most averaged sized infants regulate themselves to an approximate 3 to 4 hour schedule. However, variations do exist.
d) most breastfeeding mothers find that their babies do better on demand because the amount of milk ingested may vary at each feeding-although this is true, this does not answer the mother’s question concerning when she will have free time