21.2.10: Chapter 10
Unfolding Case Study
1.
c.
The Mini Nutritional Assessment is a nutritional screening tool for older clients.
2.
a.
The client will need education regarding foods rich in iron to consume at home.
3.
b.
Using Maslow’s hierarchy of needs framework, understanding the physical environment should be the first consideration. It is essential to understand if the client will be cooking or eating prepared meals before considering other options.
4.
d.
Eating smaller portions more frequently is a strategy that can overcome decreased food intake that occurs due to getting full quickly. Although hypertension and diabetes are not risk factors for worsening anemia, decreased taste is a physiological consequence of the change in density of taste buds that occurs with aging.
5.
a.
A holistic approach to client teaching includes spiritual influences, emotional influences, physical influences, and social determinants of health.
6.
b.
The client’s cognitive functioning will determine if a caregiver needs to be present for the educational session.
7.
c.
Ms. Foster is choosing food options and making plans for meals. She will be in the action stage of change once she begins modifying her diet.
8.
a.
The nurse should recognize that change is a cyclic process and that successes and failures are expected.
Review Questions
1.
a.
Vitamin K is a fat-soluble vitamin necessary for the synthesis and activation of coagulation factors II (prothrombin), VII, IX, and X.
2.
c.
Folate deficiency in pregnancy can lead to macrocytic anemia in mothers and neural tube defects in fetuses.
3.
b.
Long-term alcohol use can cause the malabsorption of Vitamin B
12
.
4.
c.
These are all possible signs of scurvy, or vitamin C deficiency.
5.
c.
Iron is better absorbed when taken with vitamin C, found in orange juice, and on an empty stomach.
6.
a.
An older adult with anemia is likely to experience hypotension and/or lightheadedness, which is a significant risk for falls.
7.
a.
Animal meat, fish, eggs, and dairy are sources of vitamin B
12
.
8.
a.
Health literacy is the only modifiable psychosocial factor listed.
9.
a.
Providing written material before determining the client’s preferred learning style, without assessing their preference and without giving time to ask questions, is not consistent with holistic nursing care.
10.
a.
The nurse should consider that a change in behavior typically takes 6 months to achieve.
Unfolding Case Study
1.
a.
The recommended dose is 3–6 mg/kg/day for 2–3 months; 3 mg/kg/dose twice daily is equal to 6 mg/kg/day. Dividing the total daily dose will decrease gastrointestinal side effects.
2.
a.
Having the client identify their food likes and dislikes is a collaborative strategy the nurse can use to develop a diet plan. Adolescents are more likely to adhere to diet modifications if they are partners in developing their nutritional plan.
3.
d.
Taking iron with orange juice will increase gastrointestinal absorption. Taking iron with milk, tea, or coffee can decrease its absorption. Antacids should be taken 2 hours before or 4 hours after taking iron for better absorption because iron is better absorbed in an acidic environment. Missed doses of iron should not be made up.
4.
c.
Feeling weak and dizzy may be a sign of low hemoglobin or worsening anemia. This can occur if oral iron is not absorbed sufficiently by the body.
Review Questions
1.
b.
Common nutritional deficiencies affecting all ages include iron; vitamins B
12
, D, and K; and folate.
2.
a.
The groups most frequently affected by anemia are pregnant individuals, infants and toddlers, female adolescents, and older adults.
3.
b.
Infants and children have increased nutrient demands due to rapid physical and cognitive growth, resulting in rapid cell turnover.
4.
b.
Decreased sun exposure is one of several risk factors for vitamin D deficiency.
5.
b.
Zinc deficiency occurs in 31% of children between ages 1 and 3 years and can cause decreased immunity and increased infections. Foods rich in zinc include eggs and dairy products, which the child is not consuming.
6.
c.
Clients with sickle cell disease are at high risk for vitamin D deficiency, which can increase their risk of disease-related effects.
7.
c.
Older adults who consume excessive amounts of alcohol, live alone, smoke, or are obese are at risk for folate deficiency.
8.
b.
Sickle cell disease is the most common inherited blood disorder in the United States. Clients with this disease are prone to micronutrient and macronutrient deficiencies.
9.
d.
Iron-fortified foods such as breakfast cereals should be limited because this client is at risk for iron overload after the transfusion.
10.
c.
The Mediterranean diet includes various foods and spices with anti-inflammatory and antioxidant properties.