21.2.11: Chapter 11
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.
c.
The client’s blood pressure meets the criteria for hypertension, which is a systolic blood pressure greater than or equal to 129 mm Hg and/or a diastolic blood pressure greater than or equal to 80 mm Hg. Peripheral vascular disease causes blood return issues, while peripheral arterial disease will cause ischemia and blood flow restrictions. This client has symptoms of erectile dysfunction which can be directly related to the decreased blood flow caused by hypertension.
2.
a.
An electrocardiogram evaluates the electrical function of the heart and can provide initial indication of heart disease or heart damage.
3.
c.
Increasing fiber intake has several health benefits. It lowers cholesterol and blood pressure and decreases the risk of heart disease.
4.
d.
A cheeseburger contains red meat and cheese, both of which contain saturated fats that contribute to heart disease.
5.
a.
It appears that the changes are effective, as the client’s blood pressure is coming down. The goal of the diet is to reduce blood pressure and, secondarily, cholesterol levels. Cholesterol can be affected by much more than just diet, and it may take more than 3 months for levels to decrease.
6.
a.
The client’s BMI was never an issue, so they do not have to lose a lot of weight. However, the client needed to lessen their waist size and is currently on track with that goal.
Review Questions
1.
a.
The DASH diet has beneficial effects for clients with heart disease, including decreasing sodium intake to control hypertension.
2.
d.
Hypertension is defined as a systolic blood pressure greater than 129 mm Hg and/or a diastolic blood pressure greater than 80 mm Hg.
3.
c.
A heart-healthy diet, such as the DASH diet, promotes increasing intake of fruits, including pineapple.
4.
a.
The client’s body mass index (BMI) has decreased from 30 kg/m
2
, in the obese range, to 29 kg/m
2
, in the overweight range.
5.
c.
The HDL level of 48 mg/dL falls within the normal range of greater than 40 mg/dL.
6.
a.
Coffee should be avoided because caffeine can trigger or aggravate atrial fibrillation.
7.
c.
Torsades de pointes is primarily caused by an extremely low magnesium level, so the priority of care with this client is to monitor their serum magnesium level.
8.
d.
A high serum potassium level may cause peaked tall or high T-wave ECG.
9.
b.
Oatmeal is not only low in cholesterol but is high in fiber, which helps to lower LDL.
10.
a.
Whole milk is high in fat and cholesterol. The DASH diet promotes fat-free or low-fat dairy products.