21.2.16: Chapter 16
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.
130 kcal/kg/day is the highest daily recommended amount for a preterm infant. 130 × 1 kg = 130 calories daily
2.
d.
Carbohydrate is the preferred energy source for the body.
3.
a.
Protein and calories will be the biggest concerns at this age because she will need them to develop and grow appropriately; however, she cannot take in so much that her kidneys will be overloaded and her glucose out of range.
4.
d.
To prevent additional issues like UTIs, kidney stones, and hypertension, which can impact already-poor kidney health, the client should eat a low-sodium, heart-healthy, high-fiber diet, and Ramen noodles are extremely high in sodium.
5.
b.
Education on preventing STIs should start at age 10 to help ensure renal health. UTIs resulting from STIs can spread silently and asymptomatically, depending on the cause, which could lead to pyelonephritis and damage Kayla’s already weakened kidneys.
6.
a.
The requirement is 2,000 calories daily for an adolescent female.
7.
d.
Fetal intrauterine growth restriction (IUGR) is a risk for a client with these health conditions.
8.
b.
The client’s original CKD stage was stage 3, which is associated with the GFR range of 30 to 59 mL/min/1.73 m
2
. During pregnancy, the range is expected to increase, so a lower range would be something to address immediately. At 15 mL/min/1.73 m
2
, the client would require dialysis as an immediate intervention.
Review Questions
1.
a.
The GFR increases in early pregnancy, causing a hyperfiltrative state, so a decreased GFR would be considered abnormal.
2.
c.
The pregnant client should avoid or limit caffeine intake to promote fetal health.
3.
d.
Protein is extremely important in growth and development and in repair of muscles and injury, but it is still restricted in the diet of clients with CKD.
4.
d.
Females are at risk for anemia. The recommended daily iron intake for female adolescents aged 14 to 18 years, including those with CKD, is 15 mg.
5.
a.
Coffee, tea, colas, energy drinks, and brown chocolate all contain caffeine, which contains an acid that acts as a bladder irritant and can aggravate OAB symptoms.
6.
b.
The client with calcium stones should avoid foods high in oxalate, such as rhubarb, beets, and potatoes.
7.
c.
Protein intake, particularly from red meat or canned sources, can increase the risk of kidney stone development.
8.
a.
Increased intake of vegetables, especially cruciferous vegetables, decreases the risk of developing renal cancer.
9.
c.
The client with stage 4 CKD should restrict intake of potassium as well as that of magnesium, phosphorus, and sodium.
10.
a.
The Mediterranean diet, which includes an emphasis on fresh fruits, can decrease lower urinary tract symptoms.