21.2.17: Chapter 17
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.
Vitamin A deficiency is not associated with any of the client’s symptoms and could be ruled out based on the assessment data. Based on the findings, the health care provider orders laboratory tests to determine the client’s potassium, magnesium, and vitamin B
12
levels.
2.
a.
The health care provider would be expected to check the client’s iron level. Iron deficiency can cause tongue redness and inflammation and pallor. The provider decides to order a complete metabolic panel and vitamin B
12
, iron, and magnesium levels.
3.
d.
Protein deficiency can cause weight loss, poor appetite, pallor, hair loss, and dry, brittle nails.
4.
b.
Quinoa is a seed grouped with whole grain that is high in protein and is a good protein option in a vegetarian diet.
5.
d.
With Crohn’s disease, and when a client has many bowel movements daily, absorption becomes a problem. In particular, iron, calcium, and vitamin D are not absorbed properly in this disease process.
6.
c.
The nurse should expect supplementation to be ordered. Enteral supplementation will likely be used, but if that is not sufficient, parenteral supplementation may be considered.
Review Questions
1.
b.
Digestion includes mastication, which requires the teeth to be in working condition.
2.
c.
Palpating the abdomen can reveal any pain, guarding, or tenderness present in the gastrointestinal organs.
3.
b.
Angular cheilitis, or fissures and crusts in the corners of the lips, can indicate vitamin B
1
(thiamine), vitamin B
12
, or iron deficiency.
4.
c.
Tofu is a plant-based protein that can be an option in a vegetarian diet.
5.
a.
Edamame is a plant-based source of both protein and iron.
6.
b.
Eating yogurt and other probiotic foods supports the gut’s normal microbial growth.
7.
d.
Oranges have vitamin C and help create an acidic environment that increases iron absorption.
8.
b.
Vitamin C assists with iron absorption and should be included in the nutritional plan.
9.
b.
Ecchymosis, or bruising, is consistent with vitamin K deficiency because vitamin K is needed for adequate blood clotting.
10.
a.
For vegan clients, protein options such as quinoa, tofu, and edamame are appropriate suggestions.