21.2.19: Chapter 19
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.
Often, a client with age-related degenerative disorders such as osteoarthritis will have limited ROM and increased pain upon ROM of the joints. This simple screening provides valuable information for the diagnosis of osteoarthritis as well as the treatment parameters for the client.
2.
a.
The provider would start with an x-ray of both knees to evaluate for any soft tissue changes and signs of arthritis.
3.
a.
Leafy green vegetables have anti-inflammatory properties. Because the client has osteoarthritis with edema in both knees, these nutrients should be included in the diet.
4.
b.
Nuts and seeds have anti-inflammatory properties that can be beneficial for clients with arthritis.
Review Questions
1.
a.
Adequate vitamin D intake is necessary for strong bones and the prevention and treatment of osteoporosis.
2.
d.
Good skin turgor indicates a normal moisture level in the skin. Tenting, when the skin remains stretched out like a tent when pinched, is a sign of decreased moisture in the skin.
3.
a.
Protein aids in the repair of muscles and tissue.
4.
d.
Bromelain is a group of enzymes found in pineapples and is believed to reduce swelling and pain.
5.
c.
The pressure ulcer changed from a stage 2 ulcer to a stage 1 ulcer, which indicates improvement. Stage 1 pressure injuries are reddened, but not open.
6.
b.
Foods rich in calcium and vitamin D, such as dairy products, are important for bone health and the treatment of osteoporosis.
7.
b.
Bread and pasta contain gluten and would not be included in a gluten-free diet.
8.
c.
Clubbing of nails, when nails look wider or swollen, is often seen with chronic obstructive pulmonary disease (COPD).
9.
b.
The client understands hydration, like drinking water throughout the day, promotes skin integrity and wound healing.
10.
d.
Biotin is found in foods such as liver and cooked egg yolks, and it is important in the promotion of hair and nail health.