21.2.13: Chapter 13
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.
b.
The pulmonary or respiratory system comprises the upper airways, the lower airways, lungs, and alveolar sacs. The primary function of the pulmonary system is to ensure adequate oxygenation throughout the body.
2.
c.
Aspirin and other nonsteroidal anti-inflammatory medications (NSAIDs) can induce bronchospasm in clients who are sensitive and have had reactions to these medications in the past.
3.
b.
Processed meats and aged cheeses are high in histamines and can cause increased mucus production, which can worsen asthma symptoms.
4.
a.
Protein drinks provide high protein amounts in low-volume portions to provide the nutritional components necessary for muscle synthesis and improved muscle strength.
5.
a.
Eating protein, found in foods like cheese and nuts, at least twice daily will help with strong respiratory muscles.
6.
c.
Obesity alters the mechanics of the pulmonary system leading to dyspnea, wheezing, airway hyperresponsiveness, and increased work of breathing.
Review Questions
1.
c.
Fatigue is a common symptom of COPD that can make it difficult for the client to prepare and eat nutritious foods.
2.
c.
Albumin is the primary protein of the body. Decreased levels may indicate chronic disease, malabsorption, malnutrition with low protein, or dilution by IV fluids. Follow-on diagnostics would be pre-albumin and blood urea nitrogen.
3.
b.
The process of gas exchange is when oxygen and carbon dioxide are exchanged in the alveoli of the lungs.
4.
a.
Calcium and vitamin D intake reduce the risk of osteoporosis and kyphoscoliosis that decrease the size and diameter of the rib cage and reduce lung capacity.
5.
c.
The client should eat high-protein, calorie-dense meals to maintain nutritional status and prevent weight loss that results from increased work of breathing.
6.
a.
A primary goal of nutrition therapy for pulmonary wellness is to maintain adequate respiratory function to decrease or prevent malnutrition and obesity. Healthy body weight will help preserve muscle strength and help maintain the integrity of the immune system.
7.
d.
The client should eat smaller, more frequent meals. Larger meals should be consumed earlier in the day when the client is less tired.
8.
c.
Crackles indicate crepitus, or air trapped in and under the skin.
9.
d.
While all of these findings can indicate the client is knowledgeable of and is following the prescribed nutritional plan, actually maintaining the recommended weight is an objective measure that indicates adherence.
10.
d.
ACE inhibitors are known to induce nighttime coughing.