ATI Nutrition Exam 2023 Study Set

What are some nursing interventions when a patient experiences nausea?

-Avoid foods that delay gastric emptying: high fat and high protein foods.

-Avoid irritating foods: such as spicy foods, caffeine

-Eat simple carbs: toast, crackers, oatmeal, etc

-Avoid drinking liquids with meals (exacerbates nausea)

-Elevate HOB

Hyperglycemia S/S

Polydipsia, polyuria, polyphagia, nausea, vomiting, blurred vision, poor wound healing

When a patient has an infection or disease process, how should the nurse manage nutritional needs?

Increase caloric intake due to increased metabolic rate

What are some interventions for a patient with COPD?

COPD patients do not have the energy reserve to consume large meals.

-6 small meals per day

-HIGH PROTEIN , HIGH FAT, ND HIGH CALORIE foods

-Consume high calorie foods first!!

-Encourage nutritional supplements between meals

-Add gravies and sauces to prevent dry mouth and increase caloric intake

-Consume foods that are easy to chew (decreases energy expenditure)

What is the Smogyi effect?

Morning Hyperglycemia in response to overnight hypoglycemia. Monitor blood glucose over night.

What is the dawn phenomenon?

Natural increase in early morning blood glucose and insulin requirements due to overnight release of growth hormone. Treated by increasing the amount of insulin provided overnight.

hypoglycemia nursing interventions

10-15 g of carbs;

Parenteral glucose or glucagon (1 mg subq or IM) (+ carbs);

50% D5W via IV push

-15 g readily absorbable carbs

-4 oz soda

-1 tbsp honey or 4 tsp sugar

-two to three glucose tablets

-6-10 hard candies

General nutritional guidelines for a client with diabetes:

Carbs: 130 g/day RDA from grains, fruits, legumes, milk. No simple carbs and compose 45-65% AMDR (acceptable macronutrient distribution range).

Fats: sat fat less than 7% of total calories, trans fatty acid less than 1% of total daily caloric intake, limit fried foods.

Cholesterol: 200-300 mg/day

Fiber: 14 g per 1000 calories from beans, oats, veggies, whole grains

Protein: 15-20% AMDR total caloric intake from meats, eggs, fish, nuts, beans, & soy products

Sodium: 2300 mg per day limit

NO TOBACCO, LIMIT ALCOHOL

Hyperlipidemia? NO ALCOHOL

Artificial sweeteners okay, except preggo! sucrose (table sugar) can be included in diabetic diet as long as adequate insulin is available

1 serving of Carbs is:

15 grams

-1 slice of bread

-1/2 cup of pasta

-1/2 canned fruit in juice (not syrup)

-1/4 cup dried fruit

-3 cups vegetables (raw)

-4-6 snack crackers

Celiac Disease interventions

1. Maintain a gluten-free diet, substituting corn, rice, and millet as grain sources.

2. Instruct the parents and child about lifelong elimination of gluten sources such as wheat, rye, oats, and barley.

3. Administer mineral and vitamin supplements, including iron, folic acid, and fat-soluble vitamins A, D, E, and K.

TEACHINGS

4. Teach the child and parents about a gluten-free diet and about reading food labels carefully for hidden sources of gluten

5. Instruct the parents in measures to prevent celiac crisis.

6. Inform the parents about the Celiac Sprue Association.

Refeeding syndrome

metabolic alterations that may occur during nutritional repletion of starved patients

-Combination of hypokalemia, hypomagnesemia, hypophospatemia, decreased thiamine, and fluid volume overload.

Foods high in potassium

avocados, broccoili, dairy products, dried fruit, cantaloupe, bananas, potatoes, raisins, spinach, carrots

MAOI foods to avoid

foods that contain tyramine:

aged cheeses-cheddar, blue cheese, Swiss, Parmesan

yogurt

banana, avocado

processed meats-salami, pepperoni, summer sausage

caffeinated beverages

chocolate

pickled foods

wine

Soy products- miso, tempeh, soy sauce

high levels of caffeine

causes hyperintensive crisis

Foods that exacerbate Gout

Purine rich foods:

-Beans

-Red meat

-Shellfish

-Organ meats

-Peas

-Lentils

-honey

When can a patient with a colostomy resume a regular diet?

6 weeks post op

Dietary considerations for colostomies

-Consume low fiber foods (no psyllium)

-Increase foods containing pectin

-Drink 8-10 glasses of water per day

-Consume yogurt, buttermilk, cranberry juice, or parsley to reduce odor

-Avoid foods like fish, eggs, asparagus, onions, beans, cabbage, garlic, broccoli, Brussels sprouts

Stomatitis nursing interventions

Avoid sodium, laurel sulfate; rinse mouth every 2 hr; avoid commercial washes; swish and swallow (tetracycline, minocycline); mystatin); have pt avoid hard/spicy/acidic foods; increase protein, provide comfort foods (bananas, ice cream, cottage cheese). Increase intake fluid intake to help peristalsis. Relieve mouth pain by consuming frozen foods. Oral hygiene with soft bristles, sodium chloride rinse or baking soda. Encourage intake of high calorie high protein shakes.

Breast milk storage guidelines

- Room temperature for 4 hours

- Store in plastic d/t WBC's adhere to glass

uRefrigerator for 5-8 days

- Freezer with a separate door from refrigerator for 6 months (not in door)

- Deep freezer for up to 12 months

- Educate mom to thaw milk in refrigerator starting 24 hrs. before needed or run under warm H2O. Milk must be used within 24 hrs.

- Do not use microwave.

- Do not refreeze milk

Formula storage guidelines

Discard after 2 hours

Stored in refrigerator for up to 24 hr

Enteral nutrition

-check placement

- assess bowel sounds

-flush with 30 ml of water before and after feedings and meds

-flush q 4 hr during continuous feeding

-verify placement with x-ray

-Elevate HOB atleast 30 degrees

-Check gastric residual q 4 hr to prevent aspiration

-change bag and tubing q 24 hr

-open system hang time is 4 hr

Foods high in calcium

yogurt, sardines, cheese, spinach, collard greens, tofu, rhubarb, milk

Enteral nutrition and diarrhea

Slow the rate

Enteral nutrition and bloating (abdominal dissension)

Low fat formula

Enteral nutrition and N&V

Lactose free formula

Malnutrition Universal Screening Tool (MUST)

BMI, unintentional weight loss, effect of acute disease on intake for more than 5 days

Common MAOI drugs

Phenelzine, Isocarboxazid, Selegiline, Tranylcypromine

antiparkinsonian agents (levodopa/carbidopa)

Interacts with high protein foods

What are some sources of omega- 3 fatty acids? Who needs them?

Vegetarians, CAD patients:

-walnuts, flaxseed, soy beans, canola oil, fish

What does thiamine deficiency cause?

Beriberi: headache, fatigue, weight loss

What are some sources of thiamine?

Meats, gains, peas, legumes

What does Riboflavin (VIT B2) deficiency cause?

Kylosis- skin eruptions, cracked lips, glossitis

Vit B3 deficiency (niacin)

Pellagra: 3 D's: dermatitis, dementia, diarrhea

Vit B6 (pyridoxine) deficiency

Marcocytic anemia: poor growth and CNS disturbances

Vit B9: folate: deficiency causes what conditions (3)

Megaloblastic anemia

Glossitis

Neural tube defects (spina bifida)

Vit B12 deficiency causes

pernicious anemia, glossitis, parasthesias, poor muscle coordination

What are some sources of Biotin?

egg yolks, liver, dairy products, soybeans, nuts, cereals, dark green leafy vegetables

What are some source of B6 (pyridoxine):

Meats, grains, legumes

What is the RDI for Vit D?

20 mcg/day

What are some sources of Vit D?

Sunlight, fish oils, fatty fish, eggs, dairy

Iodine deficiency

goiter

The RDA for iodine _____.

150 micrograms

Iron nutritional guidance

Take supplements with Vit C and avoid calcium

May cause tooth discoloration

Increase fluids and fiber

Who needs increased iron?

Infants, menstruating women, overweight toddlers

What is the Recommended Dietary Allowance (RDA)?

Intake that meets nutrient needs of 97-98% of healthy individuals in an age/sex group

What is the Dietary Reference Intake (DRI)?

4 nutrition based standards and scales used to plan dietary intake and evaluate nutritional status

What is the acceptable macronutrient distribution range?

Daily percentage of energy intake values for carbs, fat, & protein.

What is the AMDR for protein?

10-35% of total calories

What is the AMDR for fat?

20-35% of total calories

What is the AMDR for carbs?

45-65% of total calories

What is the upper tolerable intake level?

Levels of nutrients that should not be exceeded to prevent adverse effects

What is the AI of sodium for adults?

1.5 g per day

What is the AI of carbohydrates?

130 g per day

What is the AI for potassium?

4700 mg per day

What vitamins minerals are associated with nervous system functioning?

Calcium, Sodium, B Vitamins (Thiamine and Folate)

What are the required components of food labels?

Total carbs, total fat, calories, total fiber, % daily values

Food Storage Guidelines:

fresh meat

maintain fridge temp at 40 degrees F

FOOD STORAGE GUIDELINES - eggs

4-5 weeks

FOOD STORAGE GUIDELINES: Bacon

7 days

Food storage guidelines: Fatty fish

1-2 days

Food storage guidelines: Summer sausage

3 months unopened- 3 weeks opened

Food Storage guidelines: shellfish

1-2 days

Food Storage Guidelines: canned food

3-4 days after opening

How many calories is equivalent to 1lb of body fat?

3500 calories

kidney stones nursing interventions

-Instruct pt to limit beverages high in sugar

-Avoid nutritional vitamins and supplements (VIT C will contribute to stone formation

-Avoid bran and almonds (have high oxalates)

-Avoid high sodium foods

-Consume calcium rich foods

Saturated fat guidelines and added sugar

Less than 10% daily calories

Exercise guidelines

Adults should engage in 150 minutes per week of moderate-intensity exercise per week, or 75 minutes per week of vigorous-intensity aerobic exercise, or a combination

2 days per week of strength training

How many calories would someone need to reduce to loose 1 lb per week?

500 cal

Weight loss

-set realistic goals

-keep food diary

-Get support

-Meal plan

-Address unhealthy habits

-Monitor weight regularly

-Daily physical activity

Alcohol intake for women

1 drink/day

Alcohol intake for men

2 drinks per day

How much folic acid during pregnancy?

600 mcg

How much protein in pregnancy?

71 g

How much iron in pregnancy?

27 mg

How much calcium and vitamin D during pregnancy?

1.000 IU and 600 IU

Caffiene intake during pregnancy?

Less than 200 mg per day

Extra calories during pregnancy First trimester?

None

Extra calories second trimester of pregnancy??

340 cal

Extra calories third trimester?

452 calories

How many extra calories for breastfeeding?

Additional 450-500 calories per day for a minimum of 1800 cal per day

PKU

phenylketonuria- strict low phenylalanine diet (protein)

hyperemesis gravidarum nutritional interventions

Instruct pt to consume small but frequent meals

Instruct pt to drink liquids between meals

Eat room temp or chilled foods

Readily digestible carbs such as toast

Avoid high fat foods

Avoid strong smells

Infant nutrition

breast milk first 6 months, solids 4 to 6 months and first solid is usually iron fortified rice cereal (may mix with juice), no juice or water is needed for first year, foods introduced one at a time over 4-7 day period to monitor for allergies

Infant weight

Doubles weight by 6 months; triples weight by 1 year

Should be back up to birth weight by 1 week

Should be around 20 lb by 1 year

Should be around 27 inches long

sodium UL for adults

2300 mg/day

Breastfeeding calorie AI

1800 cal per day

What meds interact with dairy products?

Iron and tetracycline antibiotics

Warfarin pts need to

Maintain consistent VIT K intake

What is the Daily meat AI?

5 oz

Lowering solid fat intake

-The nurse should instruct the client to select ground beef that is at least 90% lean.

-The nurse should instruct the client to select cheeses that contain no more than 3 g of fat per serving.

-The nurse should instruct the client to choose margarine that contains no more than 2 g of saturated fat per tablespoon.

Dumping syndrome diet

Sm. frequent meals, low fiber, high fat and protein

Avoid liquids @ meal time

-Avoid foods with more than 2g fiber

Lay down of left side after meals to slow gastric emptying

Dehydration and intermittent Enteral Feedings

Give a continuous infusion to prevent excess carbohydrate load with each feeding

What beverage is contraindicated with atorvastatin?

Grape Fruit Juice

TPN adverse effects:

-wheezing and crackles (fluid volume overload)

-nausea

-vomiting

-rash

-weight gain of 1 kg/day

Lipid emulsion for TPN

Contraindicated in an egg or soy allergy

Foods that are good for gout

Citrus juices (VIT C)- akalinize urine and reduces stone formation

-avocado

-coffee

Common names of MAOI drugs

Phenelzine, Isocarboxazid, Selegiline, Tanlcypromine

Foods high in zinc

Pinto beans, legumes, nuts, shellfish, oysters, ground beef, fortified cereals

Who is at risk for dysphasia?

PT's with musculoskeletal disorders such as Parkinson's disease, (esophageal webs), glossitis, chronic iron deficiency anemia, cancer, AIDs, Scleroderma

dysphasia diet: what are the different levels and foods included in each?

1. pureed- foods that require no chewing- pudding like texture- (puréed fruits, vegetables, meats, soups, scrambled eggs, custard, apple sauce)

2. mechanical altered- soft texture, ground meats served with gravy, chicken and tuna salad, moist pancakes with syrup, poached eggs, soft canned or cooked fruit/veggies)

3. advanced- Near normal texture- moist meats, casseroles, breads that are not crusty, moist potatoes, soups, rice, and stuffing. NO HARD OR STICKY FOODS

Dysphagia nursing care

- Modifying the texture of foods and the consistency of liquids

-Do not offer liquids to clear the client’s mouth

-Always elevate the HOB to high fowler’s

- Dry mouth can contribute to dysphagia

- Clients are at increased risk aspiration so place the client in an upright or high- Fowlers position to facilitate swallowing

- Provide oral care prior to eating to enhance the clients sense for taste

- Pills should be taken with at least 8 oz of fluid (can be thickened) to prevent medication from remaining in the esophagus

- Avoid thin liquids and sticky foods