6.Sample answers:
a.Eat a variety of high-fiber foods daily.
b.Drink six to eight glasses of water daily.
c. Substitute high-fiber foods for lower-fiber foods.
d.Add bran to diet slowly to decrease likelihood
of flatus and distention.
- a.Anorexia nervosa: Characterized by denial of
appetite and bizarre eating patterns; may result
in extremely dangerous amount of weight loss;
can be fatal. Typical individual is adolescent girl
from middle or upper socioeconomic class;
competitive; obsessive; distorted body image.
b.Bulimia: Characterized by episodes of gorging
followed by purging. Typical individual is
college student who fears gaining weight but is
overwhelmed by periods of intense hunger. - a.Sex: Men have higher caloric and protein
requirements than women because of their
larger muscle mass.
b.State of health: The alteration in nutrient
requirements that results from illness and
trauma varies with the intensity and duration
of stress.
c. Alcohol abuse: Alcohol can alter the body’s use
of nutrients and thereby its nutrient
requirements by numerous mechanisms.
d.Medications: Nutrient absorption may be
altered by drugs that change the pH of the
gastrointestinal tract, increase gastrointestinal
motility, damage the intestinal mucosa, or bind
with nutrients, rendering them unavailable to
the body.
e.Megadoses of nutrient supplements: An excess
of one nutrient can lead to a deficiency of
another.
f. Religion: Nurses need to be aware of dietary
restrictions associated with religions that might
affect a patient’s nutritional requirements.
g.Economics: A person’s food budget affects
dietary choices and patterns. - a.Food diaries: The patient records all food and
beverages consumed in a specified time period
(3 to 7 days).
b.Diet history: 24-hour recall, food frequency
record, plus interview designed to determine
past and present food intake and habits
10.Sample answer:
The nurse should explain the diet order to the
patient, screen patients at home who are at nutri-
tional risk, observe intake and appetite, evaluate
patient’s tolerance for specific types of foods,
assist the patient with eating, address potential
for harmful drug–nutrient interactions, and teach
nutrition.
11.Sample answers:
a.Provide simple verbal instructions; include
family members when appropriate.
b.Advise the patient to eliminate any foods that
are not tolerated.
c. Offer support and encouragement. - a.Clear liquid diet: Only foods that are clear liq-
uids at room temperature, such as gelatins, fat-
free bouillon, ice pops, clear juices, and so on;
inadequate in calories, proteins, and most
nutrients
b.Full liquid diet: All liquids that can be poured at
room temperature, such as clear liquids plus
milk, plain frozen desserts, pasteurized eggs,
cereal gruels; high-calorie, high-protein supple-
ments are recommended if used for more than
3 days
c. Soft diet: Regular diets that have been modified
to eliminate foods that are hard to digest and
chew, including those that are high in fiber and
fat, adequate in calories and nutrients, and can
be used long term - a.Nasogastric feeding tube: Inserted through nose
and into stomach. Advantage: Allows stomach
to be used as natural reservoir, regulating
amount of food that enters intestine. Disadvan-
tage: Introduces risk for aspiration of tube feed-
ing solution into lungs.
b.Nasointestinal feeding tube: Passed through the
nose into the upper portion of the small intes-
tine. Advantage: Minimal risk for aspiration.
Disadvantage: Dumping syndrome may
develop. - a.Patient’s progress toward meeting nutritional
goals
b.Patient’s tolerance of and adherence to the diet
when appropriate
c. Patient’s level of understanding of the diet and
need for further diet instruction
d.Findings should be communicated to other
healthcare team members.
e.Plan should be revised or terminated as needed.
APPLYING YOUR KNOWLEDGE
REFLECTIVE PRACTICE USING CRITICAL
THINKING SKILLS
Sample Answers
1.What patient teaching might the nurse provide to
help Mr. Johnston meet his nutritional and exercise
needs?
The nurse should assess Mr. Johnston’s eating habits
by conducting a diet history. A diet plan could then
be devised that would contain foods low in fat and
cholesterol, enabling him to lose 1 to 2
pounds/week. The nurse should also set up an exer-
cise program for Mr. Johnston that he could adapt
to his busy lifestyle. For the greatest chance of suc-
cess, the nurse should tailor diet instructions indi-
vidually to Mr. Johnston’s lifestyle, culture,
intellectual ability, and level of motivation.
2.What would be a successful outcome for this patient?
By the end of the visit, Mr. Johnston lists
recommended allowances of grains, vegetables,
fruits, milk, and meat and beans as seen in the
MyPyramid Food Guide
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