NUR 3302 Exam 3 Review: Chronic Disease, Clinical Nutrition, and Food Safety

Flashcards covering chronic diseases, clinical medical nutrition therapies, enteral and parenteral feeding, and food safety standards for NUR 3302 Exam 3.

How many clinical criteria must be present to establish a diagnosis of metabolic syndrome?

At least $3$ out of the $5$ defined criteria.

What are the five diagnostic criteria and cutoff values for metabolic syndrome?

Waist circumference greater than $40\,\text{in}$ in men or $35\,\text{in}$ in women; triglycerides $\ge 150\,\text{mg/dL}$; HDL less than $40\,\text{mg/dL}$ in men or $50\,\text{mg/dL}$ in women; blood pressure $\ge 130/85\,\text{mm Hg}$; and fasting glucose $\ge 100\,\text{mg/dL}$.

Is LDL cholesterol included as one of the criteria for diagnosing metabolic syndrome?

No, LDL cholesterol is not one of the five diagnostic criteria.

What blood pressure readings define Stage 1 hypertension versus Stage 2 hypertension?

Stage 1 is systolic $130\text{ to }139\,\text{mm Hg}$ or diastolic $80\text{ to }89\,\text{mm Hg}$. Stage 2 is systolic $\ge 140\,\text{mm Hg}$ or diastolic $\ge 90\,\text{mm Hg}$.

What are the initial and target daily sodium limits under the DASH eating plan?

Start at $2,300\,\text{mg}$ per day and move down toward $1,500\,\text{mg}$ per day.

Which minerals and nutrients make the DASH eating plan effective in lowering blood pressure?

It is rich in potassium, calcium, magnesium, and fiber.

What weight gain thresholds indicate fluid retention in a heart failure client and require notifying the healthcare provider?

A weight gain of $2\text{ to }3\,\text{lb}$ in $1\,\text{day}$ or $5\,\text{lb}$ in $1\,\text{week}$.

What daily sodium and fluid intake limits are typically recommended for advanced heart failure?

Sodium is limited to $2,000\,\text{mg}$ per day, and fluid is restricted to $1.5\text{ to }2\,\text{L}$ per day.

What is cardiac cachexia, and what dietary intervention should the nurse plan for it?

It is severe muscle wasting masked by fluid retention and edema where the client feels full quickly; it is managed by providing small, frequent meals.

What are the dietary saturated fat guidelines for general cardiovascular health versus clients with elevated LDL cholesterol?

Saturated fat should be under $10\%$ of total daily calories generally, and reduced to $5\text{ to }6\%$ of calories if LDL is elevated.

How often should fatty fish such as salmon be consumed for heart health and lipid management?

Twice a week.

Which dietary modifications are recommended to lower elevated triglyceride levels?

Eliminate sugary drinks, reduce refined carbohydrates, avoid alcohol, and consume omega-3 fatty acids from fish.

What hemoglobin A1C level diagnoses diabetes mellitus, and what is the general target goal for glycemic control?

An A1C of $\ge 6.5\%$ diagnoses diabetes, and the goal for management is below $7\%$.

What blood glucose level defines hypoglycemia, and what is the Rule of 15 treatment protocol?

A level below $70\,\text{mg/dL}$; administer $15\,\text{g}$ of fast-acting carbohydrate and recheck blood glucose in $15\,\text{min}$.

How should an unconscious hypoglycemic client or a client unable to swallow be treated?

Administer glucagon.

How many grams of carbohydrate represent one carbohydrate choice?

$15\,\text{g}$ of carbohydrate.

If a client takes $1\,\text{unit}$ of rapid-acting insulin per $15\,\text{g}$ of carbohydrate and consumes $2\,\text{slices}$ of bread ($30\,\text{g}$), $1\,\text{small apple}$ ($15\,\text{g}$), and $1/3\,\text{cup}$ cooked rice ($15\,\text{g}$), how many units of insulin are needed?

$4\,\text{units}$ (total carbs = $60\,\text{g}$; $60\,\text{g} \div 15\,\text{g/unit} = 4\,\text{units}$).

Why must an individual taking insulin consume food when drinking alcohol?

Alcohol blocks hepatic gluconeogenesis and glycogenolysis, preventing the liver from releasing glucose and leading to delayed hypoglycemia hours later.

What timing and dietary guidelines reduce chemotherapy-induced nausea during meal consumption?

Administer antiemetics $30\text{ to }60\,\text{min}$ before meals, serve cold foods or dry crackers to minimize odors, and avoid hot, high-fat, or greasy items.

What rates of unintentional weight loss in a cancer client are classified as clinically significant?

A weight loss of $5\%$ in $1\,\text{month}$ or $10\%$ in $6\,\text{months}$.

What bone mineral density T-score diagnostic criterion defines osteoporosis?

A T-score of $-2.5$ or lower.

What is the maximum amount of elemental calcium that should be taken in a single dose?

$500\text{ to }600\,\text{mg}$ per dose.

How do the administration requirements differ between calcium carbonate and calcium citrate supplements?

Calcium carbonate requires gastric acid for absorption and must be taken with meals; calcium citrate absorbs without acid and can be taken without food.

What clinical criteria must be met before advancing a postoperative client's diet from clear liquids?

Presence of active bowel sounds, passage of flatus, and absence of nausea, vomiting, or abdominal distension.

What are key clinical red flags for dysphagia during feeding?

Coughing during or after swallowing, a wet or gurgly vocal quality, and food pocketing in the buccal cavity.

What immediate actions should the nurse take if a dysphagic client coughs or develops a wet, gurgly voice while eating?

Stop the meal immediately, maintain the client upright at $90^∘$, and request a swallow reevaluation from the speech-language pathologist (SLP).

Which grains must be permanently eliminated from the diet in a client with celiac disease?

Wheat, barley, and rye.

How does the nutritional management of diverticulosis differ from an acute diverticulitis flare?

Diverticulosis requires a high-fiber diet of $25\text{ to }35\,\text{g/day}$ (nuts and seeds do not need to be avoided). An acute diverticulitis flare requires clear liquids progressing gradually to low fiber.

What dietary regimen and medication schedule are indicated for chronic pancreatitis?

A low-fat diet accompanied by pancreatic enzyme replacement therapy taken with every meal and snack.

What are the primary dietary recommendations for preventing recurrent calcium oxalate kidney stones?

Consume $2.5\text{ to }3\,\text{L}$ of fluid daily, maintain normal dietary calcium intake, and limit high-oxalate foods like spinach, rhubarb, and nuts.

How do protein intake recommendations change between pre-dialysis chronic kidney disease and maintenance hemodialysis?

Protein is restricted prior to dialysis to reduce nitrogenous waste accumulation, but must be increased once maintenance hemodialysis begins.

When is a nasogastric (NG) tube preferred versus a percutaneous endoscopic gastrostomy (PEG) or jejunostomy (J-tube)?

NG tubes are used short term ($< 4\,\text{weeks}$); PEG tubes are indicated for long-term feeding when gut motility is intact; J-tubes are reserved for long-term feeding with high aspiration risk or severe gastric reflux.

What methods are used to verify enteral tube placement initially and bedside prior to feedings?

An initial radiographic X-ray confirms placement; ongoing bedside verification relies on checking external tube length markings and testing gastric aspirate pH ($\le 5$). Auscultating air is unreliable.

What head-of-bed elevation angle must be maintained during and following enteral tube feedings?

$30\text{ to }45^∘$.

What is the proper technique for administering multiple medications via an enteral tube?

Administer each crushed medication separately, never mix medications directly into formula, and flush with $15\,\text{mL}$ of water between medications.

What is the maximum hang time for an open-system enteral feeding formula bag?

$8\,\text{hours}$ or less.

What dextrose concentration limit and duration distinguish Peripheral Parenteral Nutrition (PPN) from Total Parenteral Nutrition (TPN)?

PPN delivers $\le 10\%$ dextrose via a peripheral vein for short-term support up to $2\,\text{weeks}$, whereas TPN requires central venous access for higher osmolarity/dextrose and longer durations.

What monitoring protocols are required for a client receiving Total Parenteral Nutrition (TPN)?

Check capillary blood glucose every $4\text{ to }6\,\text{hours}$, obtain daily body weights, use a dedicated single central line lumen, change TPN solution tubing every $24\,\text{hours}$, and change lipid tubing every $12\,\text{hours}$.

What nursing action must be taken immediately if an active TPN bag runs out before the replacement arrives from pharmacy?

Hang an IV infusion of $10\%$ dextrose in water at the same rate to prevent rebound hypoglycemia.

What is the hallmark laboratory finding of refeeding syndrome during rapid nutritional repletion?

Hypophosphatemia (low serum phosphorus).

Why is honey contraindicated in infants under 12 months of age?

It contains Clostridium botulinum spores that can germinate in immature infant intestines, causing infant botulism characterized by poor feeding, constipation, weak cry, flaccidity, and respiratory arrest.

What temperature range constitutes the food safety 'danger zone' for bacterial proliferation?

$40^∘\text{F to }140^∘\text{F}$.

Within what timeframe must perishable cooked food be chilled to prevent foodborne illness?

Within $2\,\text{hours}$, or within $1\,\text{hour}$ if the ambient room temperature exceeds $90^∘\text{F}$.

What are the safe methods for thawing frozen poultry, and which common method is unsafe?

Safe methods are thawing in the refrigerator, under cold running water, or in a microwave immediately prior to cooking; thawing on the kitchen counter is unsafe.

What are the safe minimum internal cooking temperatures for poultry/leftovers, ground meats, and whole meat/fish?

$165^∘\text{F}$ for all poultry and reheated leftovers; $160^∘\text{F}$ for ground meats and egg dishes; $145^∘\text{F}$ for whole cuts of meat and fish.

What is the maximum duration that prepared leftovers can safely be stored in the refrigerator?

$3\text{ to }4\,\text{days}$.

What is the primary intervention of choice during severe acute anaphylaxis caused by a food allergen?

Intramuscular epinephrine administration first.

How is 'low food security' distinguished from 'very low food security'?

Low food security involves reduced diet quality and variety while overall intake is maintained; very low food security involves disrupted eating patterns and reduced overall food intake.

In global malnutrition assessment, what distinguishes stunting from wasting?

Stunting is low height-for-age resulting from chronic undernutrition; wasting is low weight-for-height resulting from acute, severe nutritional deficit.

What overarching rule guides dietary planning for clients with diverse religious or cultural backgrounds?

'Ask, don't assume'—assess individual food practices directly, as adherence and customs vary from person to person.