Nutrition For Nursing
Nutrition For Nursing
Contributors
Honey C. Holman, MSN, RN
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User’s Guide
Welcome to the Assessment Technologies Institute® NCLEX® CONNECTIONS
Nutrition for Nursing Review Module Edition 7.0. The
To prepare for the NCLEX, it is important to understand
mission of ATI’s Content Mastery Series® Review Modules
how the content in this Review Module is connected to
is to provide user-friendly compendiums of nursing
the NCLEX test plan. You can find information on the
knowledge that will:
detailed test plan at the National Council of State Boards
● Help you locate important information quickly.
of Nursing’s website, www.ncsbn.org. When reviewing
● Assist in your learning efforts.
Nursing concepts chapters begin with an overview ● Health Promotion and Maintenance
describing the central concept and its relevance to nursing. ● Psychosocial Integrity
Subordinate themes are covered in outline form to ● Physiological Integrity
demonstrate relationships and present the information in ◯ Basic Care and Comfort
nutritional intake.
AND APPLICATION EXERCISES
Each chapter includes opportunities for you to test your
knowledge and to practice applying that knowledge. Active
Learning Scenario exercises pose a nursing scenario
and then direct you to use an ATI Active Learning
Template (included at the back of this book) to record
the important knowledge a nurse should apply to the
scenario. An example is then provided to which you can
compare your completed Active Learning Template. The
Application Exercises include NCLEX-style questions, such
as multiple-choice and multiple-select items, providing
you with opportunities to practice answering the kinds of
questions you might expect to see on ATI assessments or
the NCLEX. After the Application Exercises, an answer key
is provided, along with rationales.
FEEDBACK
ATI welcomes feedback regarding this Review Module.
Please provide comments to [email protected].
Table of Contents
NCLEX® Connections 1
Proteins 4
Lipids 4
Vitamins 5
Water 9
Phytonutrients 9
Obesity 16
Infancy 39
Childhood 41
Adolescence 43
NCLEX® Connections 49
NCLEX® Connections 65
Diagnostic Procedure A3
Medication A7
Nursing Skill A9
NCLEX® Connections
When reviewing the following chapters, keep in mind the
relevant topics and tasks of the NCLEX outline, in particular:
Physiological Adaptation
FLUID AND ELECTROLYTE IMBALANCES: Manage the
care of the client with a fluid and electrolyte imbalance.
CHAPTER 1
UNIT 1 PRINCIPLES OF NUTRITION
Carbohydrates and fiber
CHAPTER 1 Sources of Nutrition All carbohydrates are organic compounds composed of
carbon, hydrogen, and oxygen (CHO). The main function of
carbohydrates is to provide energy for the body.
Nutrients absorbed in the diet determine, to a ● The average minimum amount (DRI) of carbohydrates
needed to fuel the brain is 130 g/day for adults and
large degree, the health of the body. Deficiencies children. Median carbohydrate intake is 305 g/day for
or excesses can contribute to a poor state of males aged 20 years and older, and 228 g/day for adults,
children, and females in the same age range. The AMDR
health. Essential nutrients are those that the body for carbohydrates is 45% to 65% of calories.
cannot manufacture, and the absence of essential ● Carbohydrates provide energy for cellular work, and
help to regulate protein and fat metabolism. Adequate
nutrients can cause deficiency diseases. amounts of protein in the diet creates a protein-sparing
effect, which results in protein being spared from
Components of nutritive sources are energy use to perform its other essential functions.
carbohydrates and fiber, protein, lipids (fats), Brain and nervous system tissue require carbohydrates
for maximum effective functioning.
vitamins, minerals and electrolytes, and water.
Carbohydrates, fats, and proteins are all TYPES OF CARBOHYDRATES (1.1)
energy-yielding nutrients. A healthy eating pattern Carbohydrates are classified according to the number of
saccharide units making up their structure.
includes foods that provide all essential nutrients,
Monosaccharides: simple carbohydrates (glucose, fructose,
and allows a broad assortment of food sources.
and galactose)
Disaccharides: simple carbohydrates (sucrose, lactose,
DIETARY REFERENCE INTAKES and maltose)
Polysaccharides: complex carbohydrates (starch, fiber,
Dietary Reference Intakes (DRIs) are developed by the
and glycogen)
Institute of Medicine’s Standing Committee on the
Scientific Evaluation of Dietary Reference Intakes.
● DRIs are useful in understanding the food intake
CONSIDERATIONS
patterns of large groups, planning nutrition program ● The liver converts fructose and galactose into glucose,
standards (Supplemental Nutrition Assistance program which is then released in the bloodstream. This elevates
[SNAP]), and helping individuals. blood glucose levels, which causes the release of insulin
● DRIs are comprised of the following reference values. from the pancreas. With insulin production, glucose is
◯ Recommended Dietary Allowances (RDAs): The moved out of the bloodstream into cells in order to meet
amount of a particular nutrient that most healthy energy needs.
people in a similar life-stage and sex will need to ● The body digests 95% of starch within 1 to 4 hr after
decrease the risk of chronic disease. ingestion. Digestion occurs mainly in the small
◯ Estimated Average Requirement (EAR): The amount intestine using pancreatic amylase to reduce complex
of a nutrient required to meet basic requirements for carbohydrates into disaccharides.
half of the people in a particular population. This ● Glycogen is the stored carbohydrate energy source found
reference is often used by researchers and policy in the liver and muscles. It is a vital source of backup
makers, and is used to help determine RDAs. energy, but is only available in limited supply.
◯ Adequate Intake (AI): The amount of a nutrient that ● To maintain glucose levels between meals, glucose is
most people in a group or population consume. This is released through the breakdown of liver glycogen.
helpful when there is not enough data to establish an ● Digestible carbohydrates provide 4 cal/g of energy and
RDA for a nutrient. make blood glucose levels more stable.
◯ Tolerable Upper Intake Level (UL): The
Lipids
of intestinal cancers. It has also been shown to help
keep blood glucose levels stable by slowing the rate of
glucose absorption. ● The chemical group of fats is called lipids, and they are
● Total fiber AI is 25 g/day for females and 38 g/day
available from many sources.
for males. ◯ Dark meat
● The fermentation and metabolization of fiber in the colon ◯ Poultry skin
provides 1.5 to 2.5 cal/g of energy, depending on the type. ◯ Dairy foods
combinations for specific use by the body. ◯ Structural material for cell walls
◯ Tissue-building and maintenance olives, canola oil, avocado, peanuts, and other nuts.
◯ Balance of nitrogen and water ◯ Sources of polyunsaturated fatty acids include corn,
are needed for energy to be metabolized. Pyridoxine/Vitamin B6 is needed for cellular function and
synthesis of hemoglobin, neurotransmitters, and niacin.
● Deficiency causes macrocytic anemia and
CNS disturbances.
● High intake of supplements can cause sensory neuropathy.
● Widespread food sources include meats, grains,
and legumes.
Vitamin C Antioxidant, tissue building, Citrus fruits and Scurvy, decreased iron
(ascorbic acid) iron absorption juices, vegetables absorption, bleeding gums
Muscle energy, energy Beriberi, headache,
Meats, grains, legumes
Thiamin (B1) metabolism weight loss, fatigue
Assists with releasing Milk, meats, dark Skin eruptions, cracked lips,
Riboflavin (B2) energy from cells leafy vegetables red swollen tongue
Metabolism of fat, glucose,
and alcohol; synthesis of Pellagra, skin lesions, GI and
Liver, nuts, legumes
fatty acids, cholesterol, CNS findings, dementia
Niacin (B3) and steroid hormones
Carbohydrate, fat, and Meats, whole grain cereals, Rare
Pantothenic acid protein metabolism dried peas and beans. Generalized body system failure
Cellular function, heme and Meats, grains, Macrocytic anemia, CNS
Pyridoxine (B6) neurotransmitter synthesis and legumes disturbances, poor growth
Synthesis of amino acids
Liver, green leafy Megaloblastic anemia,
and hemoglobin, formation
vegetables, legumes CNS disturbance
Folate of fetal neural tube
Pernicious anemia, GI findings,
Folate activation, red Meats, clams, oysters,
poor muscle coordination,
blood cell maturation eggs, dairy products
Cobalamin (B12) paresthesia of the hands and feet
Fatty acid synthesis, amino acid Eggs, milk, dark Rare; scaly rash, hair loss,
Biotin metabolism, glucose formation green vegetables depression, fatigue
D. Turkey is an animal product, which provides heme iron. sufficient amounts of all nine essential amino acids.
Incomplete proteins, generally from plant sources, can
◯
B. Strawberries do not contain vitamin D. incomplete proteins eaten alone, but together are equivalent
C. Brussels sprouts do not contain vitamin D. to a complete protein. It is not necessary to consume
D. CORRECT: Include eggs as a food that is high in vitamin D. complementary proteins at the same time to form a complete
protein; instead, consuming a variety of complementary
NCLEX® Connection: Basic Care and Comfort,
proteins over the course of the day is sufficient.
Nutrition and Oral Hydration ●
Main factors influencing the body’s requirement for protein
Tissue growth needs
◯
3. A. Fats should be 20% to 35% of daily calorie intake. Quality of the dietary protein
◯
CHAPTER 2
UNIT 1 PRINCIPLES OF NUTRITION METABOLIC RATE
CHAPTER 2 Ingestion, Digestion, Metabolic rate refers to the speed at which food energy
Absorption, and
is burned.
● Basal metabolic rate (BMR), also called basal energy
measure of BMR.
that occur on a cellular level to maintain ● Acute stress causes an increase in metabolism, blood
catabolism (the breaking down of substances protein deficiency as stress hormones break down
protein at a very rapid rate.
with the resultant release of energy) and ◯ Protein deficiency increases the risk of complications
anabolism (the use of energy to build or from severe trauma or critical illness (skin
breakdown, delayed wound healing, infections, organ
repair substances). failure, ulcers, impaired medication tolerance).
◯ Protein requirements can be increased to more than
Energy nutrients are metabolized to provide 2 g/kg of body weight, or up to 25% of total calories,
carbon dioxide, water, and adenosine depending on the client’s age and prior
nutritional status.
triphosphate (ATP). Excess energy nutrients are ● Any catabolic illness (surgery, extensive burns)
stored; glucose is converted to glycogen and increases the body’s requirement for calories to meet
the demands of an increased BMR.
stored in the liver and muscle tissue; surplus ● Disease and sepsis also increase metabolic demands and
glucose is converted to fat; glycerol and fatty can lead to starvation/death.
DECREASE BMR
● Short, overweight body build
● Starvation/malnutrition
● Age-related loss of lean body masses
Nitrogen balance refers to the difference between the daily STRATEGIES TO INCREASE PROTEIN, CALORIC CONTENT
intake and excretion of nitrogen. It is also an indicator ● Add skim milk powder to milk (double-strength milk).
of tissue integrity. A healthy adult experiencing a stable ● Use whole milk instead of water in recipes.
weight is in nitrogen equilibrium, also known as neutral ● Add cheese, peanut butter, chopped hard-boiled eggs, or
nitrogen balance. yogurt to foods.
● Dip meats in eggs or milk and coat with bread crumbs
Positive nitrogen balance indicates that the intake of
before cooking.
nitrogen exceeds excretion. Specifically, the body builds ● Nuts and dried beans are significant sources of protein.
more tissue than it breaks down. This normally occurs
These are good alternatives for a dairy allergy or lactose
during periods of growth: infancy, childhood, adolescence,
intolerance.
pregnancy, and lactation.
1. A nurse is discussing how the body processes food A nurse is conducting a nutritional program for a group
with a client during a routine provider’s visit. Which of of newly licensed nurses regarding how the body
the following statements should the nurse include? uses food for energy. Use the ATI Active Learning
Template: Basic Concept to complete this item.
A. Glycerol can be broken down into
glucose for use by the body. RELATED CONTENT: Describe the steps of
B. The liver converts unused glucose into glycogen. ingestion, digestion, and absorption.
C. Excess fatty acids are stored in the muscle tissue. UNDERLYING PRINCIPLES: Explain the two
D. The body uses glycogen for fat processes that occur during metabolism.
before using available ATP.
CHAPTER 3
UNIT 1 PRINCIPLES OF NUTRITION DIET HISTORY
CHAPTER 3 Nutrition Assessment/ A diet history is an assessment of usual foods, fluids, and
Data Collection
supplements. The diet history is part of the nutrition
screening performed using various settings to determine
malnutrition issues. Components of the diet history
include the following.
Time, type, and amount of food eaten for breakfast,
Nurses play a key role in assessing the
●
or school)
teaching community groups regarding nutrition. ● Type of preferred or prescribed diet (ovo-lacto
vegetarian, 2 g sodium/low-fat diet)
A collaborative, interprofessional approach ● Foods avoided due to allergy or preference
Frequency and dose/amount of medications or
provides the best outcomes for the client.
●
nutritional balance.
to ensure accurate weight readings. ● Total average output: 1,750 to 3,000 mL/day
● Daily fluctuations generally are indicative of water
Protein levels are usually measured by albumin levels,
weight changes.
although total protein is sometimes used.
● Percentage weight change calculation (weight change ● Many non-nutritional factors (injury, kidney disease),
over a specified time):
interfere with this measure for protein malnutrition.
(usual weight - present weight) Expected reference range for albumin: 3.5 to 5 g/dL
% weight change = × 100 ●
usual weight
Prealbumin (thyroxine-binding protein) is a sensitive
● Ideal body weight based on the Hamwi method using measure used to assess critically ill clients who are at risk
height/weight calculation. for malnutrition. This test reflects acute changes rather
◯ MALES: 48 kg (106 lb) for the first 152 cm (5 ft) than gradual changes. However, it is more expensive and
of height, and 2.7 kg (6 lb) for each additional often unavailable. This is not part of routine assessment.
2.5 cm (1 in). ● Prealbumin levels can decrease with an inflammatory
◯ FEMALES: 45 kg (100 lb) for the first 152 cm (5 ft) process resulting in an inaccurate measurement.
of height, and 2.3 kg (5 lb) for each additional ● Prealbumin levels are used to measure effectiveness of
2.5 cm (1 in). total parenteral nutrition.
● During illness, weight loss is monitored to prevent or ● Expected reference range is 15 to 36 mg/dL. (Less than
detect malnutrition. 10.7 mg/dL indicates severe nutritional deficiency.)
◯ With starvation or chronic disease, weight loss
severe malnutrition: greater than 2%/week, greater ◯ Record nitrogen excretion in urine over 24 hr
● Measure on a vertical, flat surface. Ask the client to ◯ 24 hr protein intake ÷ 6.25 = nitrogen intake (g)
remove shoes and head coverings and stand straight ◯ 24 hr urinary urea nitrogen + 4 g = total nitrogen output
Obesity
excess body fat.
● Healthy weight is indicated by a BMI of 18.5 to 24.9.
● Underweight is indicated by a BMI less than 18.5.
Approximately 36.5% of American adults have obesity, and
● Overweight is defined as an increased body weight in
an estimated 68.5% have obesity or are overweight.
relation to height. It is indicated by a BMI of 25 to 29.9, ● Obesity is a chronic condition caused by calorie intake
and are about 20% above desirable levels.
in excess of energy expenditure. It can be affected by
● Obesity is indicated by a BMI greater than or equal to 30.
numerous factors (culture, metabolism, environment,
BMI = weight (kg) ÷ height (m2) socioeconomics, individual behaviors).
● Obesity might be linked to protective measures
within the body to prevent weight loss during calorie
restriction, which cause it to secrete hormones that
stimulate the appetite to maintain a specific weight. As
weight increases, the body accepts a higher weight as
the expected weight and seeks to maintain it.
ASSESSMENT Phentermine-topiramate
Suppresses the appetite and induces a feeling of satiety.
RISK FACTORS ADVERSE EFFECTS: Dry mouth, constipation, nausea,
● Genetic predisposition change in taste, dizziness, insomnia, numbness and
● Hormones (leptin, ghrelin) tingling of extremities
● Behavioral factors (sedentary lifestyle, diet choices)
CONTRAINDICATIONS: Hyperthyroidism, glaucoma,
taking an MAO inhibitor
EXPECTED FINDINGS
Clients report of depression, low self-esteem, avoidance of INTERPROFESSIONAL CARE
health-related appointments, and no desire to exercise as
The care team can include a health care provider, nursing
a result of feeling stigmatized by their excessive weight
team, dietitian, social worker, surgeon, and mental health
Body mass index therapist or counselor.
● Overweight: 25 to 29.9
Obesity: 30 or greater
NURSING CARE
●
COMPLICATIONS
PATIENT-CENTERED CARE ● Obesity increases the risk for dyslipidemia, diabetes
mellitus type 2, vascular disease, gallbladder disease,
hypertension, osteoarthritis, respiratory problems,
MEDICATIONS some cancers, and sleep apnea.
● Clients who do not lose weight during weight loss ● Obesity also increases the risk for perioperative
programs can benefit from pharmacological therapy. complications and complications during pregnancy,
● Anorectic medications suppress appetite and reduce food labor, and delivery.
intake. When combined with an exercise program, they
can result in weight loss. Reduced life expectancy
For class I obesity, life expectancy is reduced by 2
Orlistat
●
to 4 years.
Prevents digestion of fats ● For BMI 40 to 50, life expectancy is reduced by 8
to 10 years.
ADVERSE EFFECTS: Oily discharge; reduced food and
vitamin absorption; decreased bile flow; loose, oily stools;
Other complications
abdominal cramps; fecal incontinence
Nonalcoholic fatty liver disease, polycystic ovary
Lorcaserin syndrome, gastroesophageal reflux disease
surgery or use of medications and supplements. a diuretic and low-sodium diet. Diuretics can cause
● Genetic predisposition (lactose intolerance, osteoporosis) sodium and potassium imbalances. A low-sodium diet
● Age can be unappetizing and cause the client to eat less.
● Osteoporosis has many modifiable risk factors. A client
PSYCHOLOGICAL FACTORS
who takes action to prevent osteoporosis (increasing
● Mental illness (clinical depression)
intake of vitamin D and calcium, engaging in weight-
● Excessive stress
bearing exercise, reducing use of tobacco and alcohol
● Negative self-concept
products) will positively affect their nutritional status.
● Use of comfort foods ● Poor self-concept can cause a client to avoid eating or
SOCIOECONOMIC FACTORS to overeat.
● Poverty
NURSING ACTIONS
● Alcohol and other substance use disorders ● In addition to determining the client’s nutrient and
● Fad or “special” diets
calorie intake, assess other factors that might alter
● Food preferences: cultural, ethnic, or religious
nutrient intake.
● Consult with the provider to see if the client’s medical
Active Learning Scenario treatment plan needs to be altered to improve nutrition,
such as administering a different medication to prevent
A community health nurse is conducting a dietary the adverse effect of anorexia, or adding a medication to
assessment for a client. Use the ATI Active Learning treat nausea or improve appetite.
Template: Basic Concept to complete this item. ● Plan the client’s schedule of activities to prevent
interruptions during mealtime, and to avoid fatigue,
UNDERLYING PRINCIPLES: Describe four
nausea, or pain before meals.
components of a diet history.
Application Exercises
1. A nurse in a nutrition clinic is calculating body mass 3. A nurse is performing a nutrition assessment on a
index (BMI) for several clients. The nurse should identify client. Which of the following clinical findings are
which of the following client BMIs as overweight? suggestive of malnutrition? (Select all that apply.)
A. 24 A. Poor wound healing
B. 30 B. Dry hair
C. 27 C. Blood pressure 130/80 mm Hg
D. 32 D. Weak hand grips
E. Impaired coordination
2. A nurse on an orthopedic unit is reviewing data for
a client who sustained trauma in a motor-vehicle 4. A nurse is teaching a group of female clients
crash. Which of the following values indicates about risk factors for developing osteoporosis.
the client is in a catabolic state (using protein Which of the following risk factors should the
faster than protein is being synthesized)? nurse include? (Select all that apply.)
A. Blood albumin 3.5 g/dL A. Inactivity
B. Negative nitrogen balance B. Family history
C. BMI of 18.5 C. Obesity
D. Blood prealbumin 15 mg/dL D. Hyperlipidemia
E. Cigarette smoking
CHAPTER 4
UNIT 1 PRINCIPLES OF NUTRITION ◯ Consume a minimum of five servings per day of
Healthy Eating mineral content of these foods can also decrease the
risk of DNA damage.
◯ Choose monounsaturated and polyunsaturated fats
from fish, lean meats, nuts, and vegetable oils. Fat
Nutrition is vital to maintaining optimal health. intake can average 30% of total caloric intake with
a goal of less than 7% from saturated fats. While
Healthy food choices and controlling weight progressing toward the 7% goal, individuals should
are important steps in promoting health and try to consume less than 10% of intake from saturated
fats, and progress to 7% or less over time.
reducing risk factors for disease. ◯ Limit sugar and starchy foods to decrease the risk of
dental caries.
Nurses should encourage favorable nutritional ◯ Consume less than 2,300 mg/day (about 1 tsp) of
choices and can serve as informational resources salt by limiting most canned and processed foods.
Prepare foods without adding salt. Middle-aged
for clients regarding guidelines for healthy eating. and older adults benefit even more from a diet with
1,500 mg/day or less of sodium.
Established guidelines for healthy eating that ◯ Drink alcohol in moderation: up to one drink per day
clients and nurses can refer to include the Dietary for females and two per day for males. Some medical
conditions, medication therapies, and physical
Guidelines for Americans and MyPlate, along with a activities preclude the use of alcohol.
number of condition- or system-specific guidelines. ◯ Eating at least 12 oz seafood from a variety of sources
DIETARY GUIDELINES FOR AMERICANS healthy ingredients (frozen vegetables, canned legumes)
● The U.S. Department of Agriculture (USDA) and the to increase the volume of food and add nutrition.
U.S. Department of Health and Human Services (HHS) ◯ Decrease the amount of salt or seasonings containing
evidence-based advice concerning food intake and of meals (packaged salad kits, pre-cut fruit,
physical activity for Americans older than 2 years of age, whole-grain bread).
including those at risk for chronic disease. The updates ● When eating out, these strategies can help meet
can be found on the USDA and health.gov websites. nutritional guidelines.
● The Dietary Guidelines for Americans advocates healthy ◯ Eat a high-fiber snack 1 hour before leaving to eat.
food selections: a variety of fiber-rich fruits and It is easier to make healthier food choices when not
vegetables, whole grains, low-fat or fat-free milk and really hungry.
milk products, lean meats, poultry, fish, legumes, eggs, ◯ If one meal out is going to be high-calorie, make the
and nuts. Recommendations include nutrient-dense other meals of the day lower in calories and high in
foods and beverages. nutrients and fiber to provide balance.
◯ Balance energy intake with energy expenditure by ◯ Watch for components that add fat content to the meal
selecting a wide variety of foods, and limiting saturated (fatty meats, nuts, creams, gravies and sauces with
and trans saturated fat, sugars, sodium, and alcohol. whole milk, fatty salad dressings). Asking for these
◯ Establish exercise routines to promote cardiovascular items on the side can reduce the amount consumed.
health, muscle strength and endurance, and ◯ Pick restaurants that offer healthy options.
psychological well-being.
MYPLATE
The USDA sponsors a website that promotes healthy 4.1 MyPlate
food choices balanced with physical activity
(www.choosemyplate.gov). MyPlate is based on the current
USDA dietary guidelines, and is a tool to help individuals
identify daily amounts of foods based on criteria (age, sex,
activity level). The food groups represented are grains,
vegetables, fruit, dairy, oils, and protein foods.
Grains
Whole grains should equal half of the grains eaten.
Children Females Males One slice bread = 1 oz
2 to 3 years: 3 oz 9 to 13 years: 5 oz 9 to 13 years: 3 oz 1 cup flake cereal = 1 oz
4 to 8 years: 5 oz 14 to 50 years: 6 oz 14 to 18 years: 4 oz ½ cup cooked pasta = 1 oz
51 years and older: 5 oz 19 to 30 years: 8 oz 1 6-inch flour tortilla = 1 oz
31 to 50 years: 7 oz
51 years and older: 6 oz
Vegetables
Vegetables include raw, cooked, frozen, canned, dried, or 100% juice. Broccoli, carrots, pumpkin,
tomato juice, peas, corn,
potatoes, onions, mushrooms
Children Females Males
2 to 3 years: 1 cup 9 to 13 years: 2 cups 9 to 13 years: 2.5 cups
4 to 8 years: 1.5 cups 14 to 50 years: 2.5 cups 14 to 50 years: 3 cups
51 years and older: 2 cups 51 years and older: 2.5 cups
Fruits
Fruits include fresh, frozen, canned, dried, or 100% juice.
Children Females Males One small banana = ½ cup serving
2 to 3 years: 1 cup 9 to 18 years: 1.5 cups 9 to 13 years: 1.5 cups One small orange = ½ cup serving
4 to 8 years: 1 to 1.5 cups 19 to 30 years: 2 cups 14 years and older: 2 cups ¼ cup dried apricots = ½ cup serving
31 years and older: 1.5 cups
Dairy
Dairy selections should include reduced-fat or fat-free options. Higher-fat options are Milk, yogurt, cheese, pudding,
counted as part of daily calories from solid fats and added sugars (i.e., empty calories). ice cream, soy milk
Children Females and Males ¼ cup evaporated milk = 1 cup serving
2 to 3 years: 2 cups 9 years and older: 3 cups ½ cup shredded cheese = 1 cup serving
4 to 8 years: 2.5 cups 1.5 oz hard cheese = 1 cup serving
½ cup ricotta cheese = 1 cup serving
2 cups cottage cheese = 1 cup serving
1.5 cups ice cream = 1 cup serving
Proteins
Protein requirements can increase with physical activity. Selection should Meats (beef, pork), poultry, eggs,
include lean or low-fat proteins. Higher fat options are counted as part of kidney beans, soy beans, seafood,
daily calories from solid fats and added sugars (i.e., empty calories). nuts and seeds, peanut butter
Children Females Males One small chicken breast = 3 oz
2 to 3 years: 2 oz 9 to 18 years: 5 oz 9 to 13 years: 5 oz 1 can drained tuna = 3 to 4 oz
4 to 8 years: 4 oz 19 to 30 years: 5.5 oz 14 to 30 years: 6.5 oz One egg = 1 oz
31 years and older: 5 oz 31 to 50 years: 6 oz ¼ cup cooked beans = 1 oz
51 years and older: 5.5 oz ½ oz seeds or nuts = 1 oz
Oils
Children Females Males Vegetable oils (canola, corn,
2 to 3 years: 3 tsp 9 to 18 years: 5 tsp 9 to 13 years: 5 tsp olive, peanut, safflower, soybean,
sunflower), mayonnaise, some salad
4 to 8 years: 4 tsp 19 to 30 years: 6 tsp 14 to 18 year: 6 tsp dressings, avocado, nuts and seeds
31 years and older: 5 tsp 19 to 30 years: 7 tsp Avocados and olives are also part
31 years and older: 6 tsp of the vegetable food group.
Nuts and seeds are also part
of the protein food group.
Application Exercises
1. A nurse is providing teaching to a client who follows 3. A nurse is discussing essential nutrients for
vegan dietary practices. The nurse should instruct the normal functioning of the nervous system with a
client that there is a risk of having a deficit in which client. Which of the following should the nurse
of the following nutrients? (Select all that apply.) include in the teaching? (Select all that apply.)
A. Vitamin D A. Calcium
B. Fiber B. Thiamin
C. Calcium C. Vitamin B6
D. Vitamin B12 D. Sodium
E. Whole grains E. Phosphorus
2. A nurse is conducting a nutrition class at a local 4. A school nurse is teaching a group of students how to
community center. Which of the following information read food labels. Which of the following is a required
should the nurse include in the teaching? component of food labels that the nurse should
A. Progress toward limiting saturated include in the teaching? (Select all that apply.)
fat to 7% of total daily intake. A. Total carbohydrates
B. Good bowel function requires B. Total fat
35 g/day of fiber for females. C. Calories
C. Limit cholesterol consumption to 400 mg/day. D. Magnesium
D. Normal functioning cardiac systems E. Dietary fiber
depends on B-complex vitamins.
Food Safety vegetables at 40° F (4° C). All pre-cut and pre-peeled fruits
CHAPTER 5 and vegetables should also be refrigerated.
● Proper handling
● Proper preparation Foodborne illnesses occur due to improper storage of food
products, as well as unsafe handling and preparation. In
order to decrease the incidence of foodborne illnesses,
FOOD STORAGE GUIDELINES primary education should be conducted by nurses. Proper
Fresh meat: Maintain refrigerator temperature at 40° F handing and preparation is simple and includes
(4° C) or colder. performing frequent hand hygiene. It is important to
● Bacon: 7 days refrigerate food products when necessary, and to avoid
● Sausage (pork/chicken/beef/turkey): 1 to 2 days cross-contamination when preparing food. Food should be
● Summer sausage: 3 months (unopened); 3 weeks (opened) heated to recommended temperatures to kill unwanted
● Steaks, chops, roasts (beef, veal, lamb, or pork): 3 to 5 days bacteria. Following these basic principles can prevent the
● Chicken or turkey (whole/parts): 1 to 2 days occurrence of foodborne illnesses.
● Fish: Maintain refrigerator temperature at 40° F (4° C) ● Foodborne illnesses pose the greatest risk to children,
or colder. older adults, immunocompromised clients, and
◯ Lean or fatty: 1 to 2 days pregnant clients.
◯ Smoked: 14 days ● Viruses cause the majority of foodborne illnesses, but
◯ Fresh shellfish: 1 to 2 days bacteria are responsible for the majority of deaths
◯ Canned: 3 to 4 days (after opening); 5 years (pantry) caused by foodborne illness.
● Foods most commonly associated with foodborne illness
Eggs: Store in the refrigerator for 4 to 5 weeks in shell,
are the following.
and 1 week if hard-boiled. ◯ Raw or undercooked foods of animal origin
animal feces
◯ Raw sprouts
FOOD-MEDICATION INTERACTIONS
Foods and medications can interact in the body in
ways that alter the intended action of medications.
The composition and timing of food intake should be
considered in relation to medication use.
1. A nurse is teaching about food safety and A nurse is providing teaching to a client about
foodborne illness to a group of adults at a food safety. What should the nurse include in the
local community center. Which of the following teaching? Use the ATI Active Learning Template:
information should the nurse include? Basic Concept to complete this item.
A. ”Unpasteurized fruit juice is a common UNDERLYING PRINCIPLES
cause of foodborne illness.”
●
Describe four food storage guidelines.
B. ”Store hard-boiled eggs in the
refrigerator for up to 2 weeks.”
●
Describe three foodborne illnesses
and how they are acquired.
C. ”The recommended cooking temperature
for ground beef is 145° F.”
D. ”The onset of norovirus is 5 to 7 days
after exposure to the bacteria.”
C. Include in the teaching that the recommended cooking Summer sausage: 3 months (unopened); 3 weeks (opened)
■
temperature for ground beef is 160° F (71° C). Steaks, chops, roasts (beef, veal, lamb, or pork): 3 to 5 days
■
D. Include in the teaching that the onset of norovirus Chicken or turkey (whole/parts): 1 to 2 days
■
2. A. CORRECT: Infants who react to soy typically outgrow Canned: 3 to 4 days (after opening); 5 years (pantry)
■
the sensitivity by the age of 4 years. Eggs: Store in the refrigerator for 5 weeks
◯
B. Include in the teaching that wheat is a common food in shell, and 1 week if hard-boiled.
allergy, but do not include that sensitivities during Fruits and vegetables: Refrigerate perishable fruits and
◯
infancy are typically outgrown later in life. vegetables at 40° F (4° C). All pre-cut and pre-peeled
C. CORRECT: Infants who react to cow’s milk typically fruits and vegetables should also be refrigerated.
outgrow the sensitivity by the age of 4 years. Do not leave perishables at room temperature for more than
◯
D. Include in the teaching that eggs are a common food 2 hr (1 hr if the temperature is 90° F [32° C] or above).
allergy, but do not include that sensitivities during Canned goods: Check for rusting, crushing, and denting.
◯
infancy are typically outgrown later in life. Observe for stickiness on the outside of can, which may indicate
E. Include in the teaching that fish is a common food leakage. Do not use any canned foods that are damaged.
allergy, but do not include that sensitivities during ●
Foodborne illnesses
infancy are typically outgrown later in life.
Salmonella: Occurs due to eating undercooked or raw meat,
◯
NCLEX® Connection: Health Promotion and Maintenance, poultry, eggs, fish, fruit, and dairy products. Common
Aging Process manifestations include headache, fever, abdominal cramping,
diarrhea, nausea, and vomiting. This condition can be fatal.
Escherichia coli 0157:H7: Raw or undercooked meat,
◯
3. A. Grapefruit juice interferes with the metabolism of especially ground beef, can cause this foodborne pathogen.
many medications, but will not cause a hypertensive Findings include severe abdominal pain and diarrhea.
crisis in the client who is taking phenelzine.
Listeria monocytogenes: Soft cheese, raw milk products,
◯
Because tyramine is metabolized by MAO, clients fruits and vegetables, salads prepared by someone who is infected,
who are taking MAOIs (phenelzine) and consume oysters, and contaminated water. Norovirus is very contagious,
tyramine can experience a hypertensive crisis. and has an onset of 24 to 48 hr. Manifestations include projectile
vomiting, fever, myalgia, watery diarrhea, and headache.
NCLEX® Connection: Basic Care and Comfort,
Nutrition and Oral Hydration NCLEX® Connection: Health Promotion and Maintenance, Health
Promotion/Disease Prevention
Cultural, Ethnic, and categories regarding the role they have in the diet.
CHAPTER 6 Core foods make up the majority of dietary intake (the
Religious Influences
◯
Chinese
American
Largest Asian American subgroup
● Many foods from various cultures are components of
American cuisine. TRADITIONAL FOODS: Wheat (northern), rice (southern),
● Foods are often prepared quickly or are expected to noodles, fruits, land and sea vegetables, nuts/seeds, soy
be made fast. Foods prepared at home often include foods (tofu), nut/seed oils, fish, shellfish, poultry, eggs,
premade ingredients or packaged kits to reduce sweets, rarely red meats, seafoods, tea, beer
mealtime preparation. ● Tofu, soups made from bone, and fish containing small
bones provide most of calcium intake.
Application Exercises
1. A nurse is assisting a client with selecting food 3. A nurse educator is teaching a class on culture
choices on a menu. Which of the following actions and food to a group of newly hired nurses.
by the nurse demonstrates ethnocentrism? Which of the following statements by a nurse
A. Asking the client about some favorite food choices indicates an understanding of the teaching?
B. Notifying the dietitian to complete the menu A. “Most clients who practice Roman Catholicism
do not drink caffeinated beverages.”
C. Recommending one’s own favorite foods
B. “Most clients who practice orthodox Judaism
D. Asking the client’s family to fill out the menu do not eat meat with dairy products.”
C. “Most clients who are Mormon eat
2. A nurse is caring for a client who has hypertension. only the protein of animals that are
Which of the dietary patterns is sometimes followed by slaughtered under strict guidelines.”
Asian clients and places clients at risk for this condition? D. “Most clients who practice Hinduism
A. Incorporation of plant-based foods in the diet do not eat dairy products.”
B. Consumption of raw fruits
C. Preparation of foods using sodium 4. A nurse is reviewing the effect of culture on nutrition
D. Focus on shellfish in the diet during a staff in-service. Which of the following groups
prescribes eating specific foods to balance forces
in the body during illness? (Select all that apply.)
A. Asian culture
B. African culture
C. Roman Catholicism
D. Hispanic/Latinx culture
E. Buddhism
C. CORRECT: Recommending one’s own favorite foods is an Tropical fruits and vegetables
◯
example of ethnocentrism, which is the belief that one’s own Protein: nuts, legumes, eggs, cheese, seafood, poultry
◯
is not an example of an ethnocentric approach. Replacement of corn by wheat in tortillas and breads
◯
NCLEX® Connection: Psychosocial Integrity, Decreased bean use and change in rice
◯
CHAPTER 7
UNIT 1 PRINCIPLES OF NUTRITION DIETARY GUIDELINES
CHAPTER 7 Nutrition Across ● Achieving an appropriate amount of weight gain during
the Lifespan
pregnancy prepares a client for the energy demands of
labor and lactation, and contributes to the delivery of a
newborn of normal birth weight.
● The recommended weight gain during pregnancy varies
for each client depending on their body mass index
Nutritional needs change as clients pass (BMI) and weight prior to pregnancy. (7.1)
through the stages of the lifespan, reflecting ● Lactating clients require an increase in daily caloric
intake. If the client is breastfeeding during the
physiological changes. postpartum period, an additional daily intake of
330 calories is recommended during the first 6 months,
Nurses must address nutritional needs across the and an additional daily intake of 400 calories is
lifespan and have a thorough understanding of recommended during the second 6 months.
Pregnancy and lactation ◯ Carbohydrates should comprise 50% of the total daily
calorie intake. Ensuring adequate carbohydrate intake
● Prepregnancy nutrition is highly significant and plays an allows for protein to be spared and available for the
important role, because early fetal development occurs synthesis of fetal tissue.
before a client might realize they are pregnant. A client ● The need for most vitamins and minerals increases
should be well-nourished and within the normal weight during pregnancy and lactation. Vitamins are
range prior to conception. Low levels of folate prior to essential for blood formation, absorption of iron,
conception increases the likelihood of neural tube defects. and development of fetal tissue. TABLE 7.2 lists the
● Good nutrition during pregnancy is essential for the comparative DRIs of major vitamins for clients age 19 to
health of the unborn child. 30 during nonpregnancy, pregnancy, and lactation.
● Maternal nutritional demands are increased for the
development of the placenta, enlargement of the uterus,
formation of amniotic fluid, increase in blood volume, 7.1 Recommended weight
and preparation of the breasts for lactation.
gain during pregnancy
● A daily increase of 340 calories is recommended during
the second trimester of pregnancy, and an increase of FIRST TRIMESTER: Recommended weight gain is 1.1 to 4.4 lb.
452 calories is recommended during the third trimester
SECOND AND THIRD TRIMESTERS:
of pregnancy. Recommended weight gain is 2 to 4 lb/month.
● The nutritional requirements of clients who are ●
Normal weight client (BMI 18.5-24.9):
pregnant or lactating involves more than increased 1 lb/week for a total of 25 to 35 lb.
caloric intake. Specific dietary requirements for major ●
Underweight client (BMI < 18.5): just more
than 1 lb/week for a total of 28 to 40 lb.
nutrients and micronutrients should be met. ●
Overweight client (BMI 25-29.9):
0.66 lb/week for a total of 15 to 25 lb.
●
Obese client (BMI > 30): 0.5 lb/week
for a total of 11 to 20 lb.
● Growth rate during infancy is more rapid than any other source other than the infant’s parent should be
period of the life cycle. It is important to understand made in consultation with the provider, because the
normal growth patterns to determine the adequacy of nutritional needs of each infant depend on many
an infant’s nutritional intake. factors, including the infant’s age and health.
● Birth weight doubles by 4 to 6 months and triples by ◯ The FDA recommends that if an infant is to be fed
1 year of age. The need for calories and nutrients is high human milk from a source other than the infant’s
to support the rapid rate of growth. parent, use only milk from a source that has screened
● Appropriate weight gain averages 0.15 to 0.21 kg (5 to its donors and take other precautions to ensure the
7 oz) per week during the first 5 to 6 months. safety of the milk.
● An infant grows approximately 2.5 cm (1 in) per month ● The AAP recommends that for the first 6 months,
in height during the first 6 months, and approximately infants should receive no water or formula except in
1.25 cm (0.5 in) per month during the second 6 months. cases of medical indication or informed parental choice.
● Head circumference increases rapidly during the first In the hospital, no water or formula should be given to a
6 months at a rate of 1.5 cm (0.6 in) per month. The breastfed infant unless prescribed by a provider.
rate slows to 0.5 cm/month for months 6 to 12. By
1 year, head size should have increased by 33%. This is Nutritional advantages of breast milk
reflective of the growth of the nervous system. ● Carbohydrates, proteins, and fats in breast milk are
● Breast milk, infant formula, or a combination of
predigested for ready absorption.
the two is the sole source of nutrition for the first ● Breast milk is high in omega-3 fatty acids.
6 months of life. ● Breast milk is low in sodium.
● Semisolid foods should not be introduced before ● Iron, zinc, and magnesium found in breast milk are
6 months of age to coincide with the development of the
highly absorbable.
gastrointestinal system, head control, ability to sit, and ● Calcium absorption is enhanced, as the
the back-and-forth motion of the tongue.
calcium-to-phosphorous ratio is 2:1.
● Gestational iron stores begin to deplete around
4 months of age, so iron supplementation is
Breastfeeding teaching points
recommended after this time for infants who are
exclusively fed breast milk. Once solid foods are ● The newborn is offered the breast immediately after
introduced, iron-fortified cereal is a good source of iron. birth and frequently thereafter. There should be eight to
● Cow’s milk should not be introduced into the diet until 12 feedings in a 24-hr period.
after 1 year of age because protein and mineral content ● Instruct the client to demand-feed the infant and to
stress the immature kidney. A young infant cannot fully assess for hunger cues. These include rooting, suckling
digest the protein and fat contained in cow’s milk. on hands and fingers, and rapid eye movement. Crying
is a late indicator of hunger.
● The newborn should nurse up to 15 min per breast.
MEETING NUTRITIONAL NEEDS Findings that indicate the newborn has completed the
feeding include the slowing of newborn suckling, a
Additional information about feeding is available in
softened breast, or sleeping. Eventually, the infant will
MATERNAL NEWBORN CHAPTER 25: NEWBORN NUTRITION and
empty a breast within 5 to 10 min, but might need to
NURSING CARE OF CHILDREN CHAPTER 3 : HEALTH PROMOTION
continue to suck to meet comfort needs.
OF INFANTS (2 DAYS TO 1 YEAR).
● Do not offer the newborn any supplements unless
indicated by the provider.
BREASTFEEDING ● Frequent feedings (every 2 hr can be indicated) and
manual expression of milk to initiate flow can be needed.
● The American Academy of Pediatrics (AAP), World ● Awaken the infant to feed every 3 hr during the day and
Health Organization (WHO), Department of Health
every 4 hr at night.
and Human Services (HHS), and American College ● Encourage clients to express breast milk for
of Obstetricians and Gynecologists recommend that
supplementation if extra fluids or calories are required.
infants receive breast milk for the first 6 to 12 months ● Expressed milk can be refrigerated in sterile bottles or
of age (exclusive breast feeding) followed by
storage bags and labeled with the date and time the milk
breastfeeding with the introduction of complementary
was expressed. It can be maintained in the refrigerator
foods until at least 12 months of age, then continuation
for 24 hr or frozen in sterile containers for 3 months.
of breastfeeding for as long as the parent and infant ● Thaw milk in the refrigerator. It can be stored for 24 hr
desire. Even a short period of breastfeeding has
after thawing. Defrosting or heating in a microwave oven
physiological benefits.
is not recommended because high heat destroys some of
milk’s antibodies, and can burn the infant’s oral mucosa.
● Do not refreeze thawed milk. ● Open jars of infant food can be stored in the refrigerator
● Unused breast milk must be discarded. for up to 24 hr.
● Limit alcohol and caffeine while breastfeeding. ● By 9 months of age, the infant should be able to eat
● Begin manual expression of the breast or use an electric table foods that are cooked, chopped, and unseasoned.
breast pump if the infant is unable to breastfeed due to ● Do not feed the infant honey due to the risk of botulism.
prematurity or respiratory distress. ● Appropriate finger foods include ripe bananas, toast
strips, graham crackers, cheese cubes, noodles, and
peeled chunks of apples, pears, or peaches.
FORMULA FEEDING
Can be used in place of breastfeeding, as an occasional
supplement to breastfeeding, or when exclusively NUTRITION-RELATED PROBLEMS
breastfed infants are weaned before 12 months of age.
● Commercial infant formulas provide an alternative to Colic
breast milk. They are modified from cow’s milk to provide
Colic is characterized by persistent crying lasting 3 hr or
comparable nutrients. However, breast milk is superior to
longer per day.
any formula and even more crucial for a premature infant. ● The cause of colic is unknown, but usually occurs in the
● If formula-fed, an iron-fortified formula is recommended
late afternoon, more than 3 days per week for more than
for at least the first 12 months of life or until the infant
3 weeks. The crying is accompanied by a tense abdomen
consumes adequate solid food.
and legs drawn up to the belly.
● Fluoride supplements can be required if an adequate level ● If breastfeeding, eliminate cruciferous vegetables
is not supplied by the water supply.
(cauliflower, broccoli, and Brussels sprouts), cow’s milk,
● Precisely follow the manufacturer’s mixing directions.
onion, and chocolate, and limit caffeine and nicotine.
● Bottles of mixed formula or open cans of liquid formula ● Burp the infant in an upright position.
require refrigeration. Do not use if the formula has been
left at room temperature for 2 hr or longer. Do not reuse
Lactose intolerance
partially emptied bottles of formula.
● Formula can be fed chilled, warmed, or at room Lactose intolerance is the inability to digest significant
temperature. Always give formula at approximately the amounts of lactose (the predominant sugar of milk) and is
same temperature. due to inadequate lactase (the enzyme that digests lactose
● The infant should not drink more than 32 oz formula into glucose and galactose).
per 24 hr period unless directed by a provider. ● Lactose intolerance has an increased prevalence in
individuals of Asian, Native American, African, Latino,
and Mediterranean descent.
BOTTLE FEEDING ● Findings include abdominal distention, flatus, and
● Hold the infant during feedings with the head slightly occasional diarrhea.
elevated to facilitate passage of formula or breast milk ● Soy-based or casein hydrolysate formulas can be
into the stomach. Tilt the bottle to maintain liquid in prescribed as alternative formulas for infants who are
the nipple and prevent the swallowing of air. lactose intolerant.
● Do not prop the bottle or put an infant to bed with a
bottle. This practice promotes tooth decay. Failure to thrive
Failure to thrive is defined as inadequate gains in
INTRODUCING SOLID FOOD weight and height in comparison to established growth
and development norms (weight-for-length less than
● Indicators for readiness include voluntary control of the
5th percentile or weight for age below the 3rd percentile).
head and trunk, hunger less than 4 hr after vigorous ● Assess for findings of congenital defects,
Diarrhea
Childhood
Diarrhea is characterized by the passage of more than ● Growth rate slows following infancy.
three loose, watery stools over a 24-hr period. ● ChooseMyPlate.gov is a food guidance system that offers
● Overfeeding and food intolerances are common causes
an Internet-based tool to provide clients with
of osmotic diarrhea.
individualized recommendations for adequate nutrition.
● Infectious diarrhea in the infant is commonly caused
Children require the same food groups as adults, but in
by rotavirus.
smaller serving sizes.
● Mild diarrhea can require no specific interventions. ● Energy needs and appetite vary with the child’s activity
Check with the provider for any diet modifications.
level and growth rate.
● Treatment for moderate diarrhea should begin at ● Generally, nutrient needs increase with age.
home with oral rehydration solutions. After each loose ● Attitudes toward food and general food habits are
stool, an 8 oz solution should be given. Sports drinks
established by 5 years of age.
are contraindicated. ● Increasing the variety and texture of foods helps the
● Educate parents about the findings of dehydration:
child develop good eating habits.
listlessness, sunken eyes, sunken fontanels, decreased ● Foods like hot dogs, popcorn, peanuts, grapes, raw
tears, dry mucous membranes, and decreased
carrots, celery, peanut butter, tough meat, and candy
urine output.
can cause choking or aspiration.
● Breastfed infants should continue nursing. ● Inclusion in family mealtime is important for
● Formula-fed infants usually do not require diluted
social development.
formulas or special formulas. ● Group eating becomes a significant means of
● Contact the provider if findings of dehydration are
socialization for school-age children.
present, or if vomiting, bloody stools, high fever, change
in mental status, or refusal to take liquids occurs.
Constipation
TODDLERS: 1 TO 3 YEARS OLD
Constipation is the inability or difficulty to evacuate
the bowels.
NUTRITION GUIDELINES
● Constipation is not a common problem for ● Toddlers generally grow 2 to 3 inches in height and gain
breastfed infants. approximately 5 to 6 lb/year.
● Constipation can be caused by formula that is ● Limit 100% juice to 4 to 6 oz a day.
too concentrated. ● The 1- to 2-year-old child requires whole cow’s milk to
● Stress the importance of accurate dilution of formula. provide adequate fat for the still-growing brain.
● Advise adherence to the recommended amount of ● Food serving size is 1 tbsp for each year of age.
formula intake for age. ● Exposure to a new food might be needed 15 to 20 times
before the child develops an acceptance of it.
● If there is a negative family history for allergies, cow’s
NURSING ASSESSMENT/DATA milk, chocolate, citrus fruits, egg white, seafood,
COLLECTION AND INTERVENTIONS and nut butters can be gradually introduced while
monitoring the child for reactions.
● Nursing assessments should include an assessment ● Toddlers prefer finger foods because of their increasing
of knowledge base of the client regarding nutritional
autonomy. They prefer plain foods to mixtures, but
guidelines for infants, normal infant growth patterns,
usually like macaroni and cheese, spaghetti, and pizza.
breastfeeding, formula feeding, and the progression for ● Regular meal times and nutritious snacks best meet
the introduction of solid foods.
nutrient needs.
● Additionally, nurses should provide education and ● Snacks or desserts that are high in sugar, fat, or sodium
references for the client regarding each of the
should be avoided.
assessments listed above. ● Children are at an increased risk for choking until
4 years of age.
● Avoid foods that are potential choking hazards. Always
provide adult supervision during snack and mealtimes.
During food preparation, cut small, bite-sized pieces
that are easy to swallow to prevent choking. Do not
allow the child to engage in drinking or eating during
play activities or while lying down.
Vitamin D
NUTRITION GUIDELINES
● School-age children generally grow 2 to 3 inches in
● Vitamin D is essential for bone development.
height and gain approximately 5 to 6 lb/year.
● Recommended vitamin D intake is the same (5 mcg/day) ● Following MyPlate recommendations, the diet should
from birth through age 50. Children require more vitamin
provide variety, balance, and moderation.
D because their bones are growing. ● Young athletes need to meet energy, protein, and
● Milk (cow, soy) and fatty fish are good sources of
fluid needs.
vitamin D. ● Educate children to make healthy food selections.
● Sunlight exposure leads to vitamin D synthesis. ● Children enjoy learning how to safely prepare
Children who spend large amounts of time inside
nutritious snacks.
(watching TV, playing video games) are at an increased ● Children need to learn to eat snacks only when hungry,
risk for vitamin D deficiency.
not when bored or inactive.
● Vitamin D assists in the absorption of calcium into
the bones.
NUTRITIONAL CONCERNS/RISKS
Not eating breakfast occurs in about 10% of children.
PRESCHOOLERS: 3 TO 6 YEARS ● Optimum performance in school is dependent on a
nutritious breakfast.
NUTRITION GUIDELINES ● Children who regularly eat breakfast tend to have an
age-appropriate BMI.
● Preschoolers generally grow 2 to 3 inches in height and
gain approximately 5 to 6 lb/year. Overweight/obesity affects at least 20% of children.
● Preschoolers need to consume 13 to 19 g/day of ● Greater psychosocial implications exist for children
complete protein. than adults.
● If the preschooler consumes foods from all five food ● Overweight children tend to be obese adults.
groups and height and weight are within expected ● Prevention is essential. Encourage healthy eating habits,
reference ranges, supplemental vitamins/minerals decrease fats and sugars (empty-calorie foods), and
might not be needed. increase the level of physical activity.
● Preschoolers tend to dislike strong-tasting vegetables ● A weight-loss program directed by a provider is indicated
(cabbage, onions), but like many raw vegetables that are for children who are overweight, or obese if they have
eaten as finger foods. comorbidity. Otherwise, efforts are directed at maintaining
● Food jags (ritualistic preference for one food) are weight so the BMI will normalize as height increases.
common and usually short-lived. ● Praise the child’s abilities and skills.
● MyPlate guidelines are appropriate, requiring the lowest ● Never use food as a reward or punishment.
number of servings per food group.
● Food patterns and preferences are first learned from
the family, and peers begin influencing preferences and NURSING ASSESSMENT/DATA
habits at around 5 years of age. COLLECTION AND INTERVENTIONS
Nursing assessments should include the parent’s knowledge
NUTRITIONAL CONCERNS/RISKS base of the child’s nutritional requirements, and nutritional
Concerns include overfeeding; intake of high-calorie, concerns with regard to age. Nurses should provide education
high-fat, high-sodium snacks, soft drinks, and juices; and for the parent and child about nutritional recommendations.
inadequate intake of fruits and vegetables.
● Be alert to the appropriate serving size of foods (1 tbsp
per year of age).
● Avoid high-fat and high-sugar snacks.
Adolescence Dieting
● The stigma of obesity and social pressure to be thin can
● The rate of growth during adolescence is second only to lead to unhealthy eating practices and poor body image,
the rate in infancy. Nutritional needs for energy, protein, especially in females.
calcium, iron, and zinc increase at the onset of puberty ● Males are more susceptible to using supplements and
and the growth spurt. high-protein drinks in order to build muscle mass and
● The female adolescent growth spurt usually begins at 10 improve athletic performance. Some athletes restrict
or 11 years of age, peaks at 12 years, and is completed by calories to maintain or achieve a lower weight.
17 years. Female energy requirements are less than that ● Eating disorders can follow self-imposed crash diets for
of males, as they experience less growth of muscle and weight loss.
bone tissue and more fat deposition.
Eating disorders (anorexia nervosa, bulimia nervosa,
● The male adolescent growth spurt begins at 12 or 13 years
binge eating disorder) commonly begin during
of age, peaks at 14 years, and is completed by 21 years.
adolescence. These disorders are discussed further
● Eating habits of adolescents are often inadequate in
in the MENTAL HEALTH REVIEW MODULE, CHAPTER 19:
meeting recommended nutritional intake goals.
EATING DISORDERS.
Adolescent pregnancy
NUTRITIONAL CONSIDERATIONS ● The physiologic demands of a growing fetus
compromise the adolescent’s needs for their own
● Energy requirements average 2,000 cal/day for a
unfinished growth and development.
12- to 18-year-old female and 2,200 to 2,800 cal/day for ● Inconsistent eating and poor food choices place the
a 12- to 18-year-old male.
adolescent at risk for anemia, pregnancy-induced
● The USDA reports that the average U.S. adolescent
hypertension, gestational diabetes, premature labor,
consumes a diet deficient in folate, vitamins A and E,
miscarriage, and delivery of a newborn of low birth weight.
iron, zinc, magnesium, calcium, and fiber. This trend is
more pronounced in females than males.
Diets of adolescents generally exceed recommendations
NURSING ASSESSMENT/DATA
●
Eating and snacking patterns promote essential ◯ Weight patterns, current weight, and body mass
convenience stores, and fast food restaurants. These ◯ Use of over-the-counter medications
foods are typically high in fat, sugar, and sodium. ◯ Use of substances (marijuana, alcohol, tobacco)
● Carbonated beverages can replace milk and fruit juices ◯ Level of daily physical activity
in the diet with resulting deficiencies in vitamin C, ● Assess for findings of an eating disorder. This
riboflavin, phosphorous, and calcium.
can include an evaluation of the adolescent’s
Increased need for iron laboratory values.
● Females 14 to 18 years of age require 15 mg/day of iron ● Nursing assessments should include strategies that
to support expansion of blood volume and blood loss promote health for the adolescent.
during menstruation. ◯ Educate the adolescent on using MyPlate to meet
● Males 14 to 18 years of age require 11 mg/day of iron to energy and nutrient needs with three regular meals
support expansion of muscle mass and blood volume. and snacks.
◯ Stress the importance of meeting calcium needs by
Grains 8 oz 7 oz 6 oz 6 oz 6 oz 5 oz
food difficult.
● Medications can cause electrolyte losses.
● Loss of smell and vision interfere with the interest in
eating food.
● Older adults can have difficulty chewing, in which case
mincing or chopping food is helpful. They can have
difficulty swallowing food, and thickened liquids can
decrease the risk for aspiration.
● Social isolation, loss of a partner, and mental
deterioration can cause poor nutrition in adult and older
adult clients. Encourage socialization and refer to a
senior center or program.
● A fixed income can make it difficult for older adults to
purchase needed foods. Refer to food programs, senior
centers, and food banks. Meals on Wheels programs are
available for housebound older adults.
NCLEX® Connections
When reviewing the following chapters, keep in mind the
relevant topics and tasks of the NCLEX outline, in particular:
CHAPTER 8 Modified Diets ● Consists of foods that are liquid at room temperature
including plain ice cream and strained cereals. Some
facilities include pureed vegetables.
Offers more variety and nutritional support than a clear
Therapeutic nutrition is the role of food and
●
1. A nurse is caring for a client following an A nurse is planning care for a newly admitted client
appendectomy who has a postoperative who has a prescription for a regular diet. Use the ATI
prescription that reads “discontinue NPO Active Learning Template: Basic Concept to complete
status; advance diet as tolerated.” Which of the this item to include the following sections:
following are appropriate for the nurse to offer
UNDERLYING PRINCIPLES: Identify the
the client initially? (Select all that apply.)
indication for a regular diet.
A. Applesauce
NURSING INTERVENTIONS
B. Chicken broth
●
Identify at least two assessments that are
C. Sherbet
appropriate to determine the need for dietary
D. Wheat toast modifications to the regular diet.
E. Cranberry juice ●
Identify at least two nursing actions that are appropriate
to monitor the client’s response to diet therapy.
2. A nurse is caring for a client who is to receive a Level
2 dysphagia diet due to a recent stroke. Which of the
following dietary selections is most appropriate?
A. Turkey sandwich
B. Poached eggs
C. Peanut butter crackers
D. Granola
gag reflex. Gavage feeding is implemented to placed with the aid of an endoscope.
conserve energy when an infant is attempting ● An alternative to the PEG tube is a skin-level gastrostomy
to the client’s stomach or to hold or reduce feedings. ◯ Liquid medications should be used when possible.
◯ The volume that indicates a need for intervention
■ For an infant or child, the volume of water to flush
● A registered dietitian will work with the provider to client is eating up to six small meals daily.
evaluate nutritional and energy needs. ◯ When oral intake equals 500 to 750 cal/day, the
● Verify gastrointestinal function. Dysfunction of the GI continuous tube feeding is administered only during
tract can indicate a need for alternate forms of nutrition. the night.
1. A nurse is discussing the use of a low-profile A nurse is providing information to a client on complications
gastrostomy device with the guardian of a child that can occur when administering an enteral nutrition.
who is receiving an enteral feeding. Which of the What information should the nurse include in the teaching?
following is an appropriate statement by the nurse? Use the ATI Active Learning Template: Basic Concept
to complete this item to include the following.
A. “The device is usually comfortable for children.”
B. “Checking residual is much easier with this device.” RELATED CONTENT: Identify three complications. List
C. “This access requires less maintenance two nursing interventions for each complication.
than a traditional nasal tube.”
D. “Mobility of the child is limited with this device.”
CHAPTER 10
UNIT 2 CLINICAL NUTRITION Lipids (fats) are available in concentrations of 10%, 20%,
catheter tip.
because it has a low dextrose content. It is ● Glutamine, antioxidants, prebiotics, or probiotics might
be prescribed based on individual client needs.
indicated for clients who require short-term
nutritional support with fewer calories per day. ! Administering any IV medication through
a PN IV line or port is contraindicated.
The solution must be isotonic and contain no
more than 10% dextrose and 5% amino acids. INDICATIONS
EVIDENCE SUPPORTING EFFECTIVENESS ● Monitor for “cracking” of TPN solution. This occurs if
the calcium or phosphorous content is high or if
● Daily weight: Maintenance of baseline or gain of up
poor-salt albumin is added. A “cracked” TPN solution
to 1 kg/day
has an oily appearance or a layer of fat on top of the
● Increases in prealbumin level (expected reference range
solution and should not be used.
of 15 to 36 mg/dL) ● Verify the prescription of the PN solution with a second
● Blood urea nitrogen level within the expected reference
nurse prior to administration.
range (10 to 20 mg/dL) ● If the PN solution is prepared and stored in the
refrigerator, allow it to come to room temperature for
1 hr prior to administering it.
CONSIDERATIONS ● Maintain strict aseptic techniques to reduce the risk of
infection. The high dextrose content of PN contributes
PREPARATION OF THE CLIENT to bacterial growth.
● Use sterile technique when changing central line dressing
● Prior to initiating PN, review the client’s weight, BMI,
and tubing. Change the bag and IV tubing for the dextrose
nutritional status, diagnosis, and current laboratory
solution every 24 hr unless facility policy differs. With
data. This can include CBC, blood chemistry profile,
intermittent IV lipid infusions, ensure the solution does
PT/aPTT, iron, total iron-binding capacity, lipid profile,
not hang more than 12 hr to prevent microbial growth.
liver function tests, electrolyte panel, BUN, prealbumin ● Ensure lipid infusion is stopped 12 hr prior to obtaining a
and albumin level, creatinine, blood glucose, and
blood specimen for triglycerides to ensure accurate results.
platelet count.
● Assess the client’s educational needs.
● Use an electronic infusion device to prevent the NURSING ACTIONS
accidental overload of a solution. ● Ask the provider about giving some enteral substance
● A micron filter on the IV tubing is required when
during long-term PN administration, such as diluted juice,
administering PN solution. This filter is not added to
to prevent atrophy of the gastrointestinal tract.
the IV tubing when administering a lipid emulsion. ● PN should be discontinued as soon as possible to avoid
● Evaluate for allergies to soybeans, safflower, or eggs if
potential complications, but not until the client’s enteral
lipids are prescribed.
or oral intake can provide 60% or more of estimated
caloric requirements.
ONGOING CARE ! Discontinuation should be done gradually
Nursing care is focused on preventing complications to avoid rebound hypoglycemia.
through consistent monitoring. Specific monitoring ● During transition, the client will need enteral or oral
guidelines vary among health care facilities.
nutrition. Oral nutrition usually begins with clear
● Parameters can include I&O, daily weights, vital signs,
liquids that are low in fat or substances that might
pertinent laboratory values (e.g., electrolytes), and
irritate the client’s gastrointestinal tract. The client
evaluation of the client’s underlying condition. This
might not have an appetite for 1 to 2 weeks, so PN
data is used to determine the client’s response to
infusion will need to continue until the client can take
therapy, whether the formulation of the solution is
in adequate calories through other means.
correct, and to prevent nutrient deficiencies or toxicities. ● Educate the client and family regarding home PN,
● Monitor blood and urine glucose as prescribed and per
including aseptic preparation and administration
facility guidelines. Sliding scale insulin can treat or
techniques, blood glucose monitoring, and criteria to
prevent hyperglycemia, or regular insulin can be added
evaluate for complications.
to the PN solution.
● Monitor flow rate carefully.
◯ Administering the solution too slowly will fail to meet COMPLICATIONS
the client’s nutritional needs.
Infection and sepsis are evidenced by a fever or elevated
◯ Administering the infusion too rapidly can cause
NCLEX® Connections
When reviewing the following chapters, keep in mind the
relevant topics and tasks of the NCLEX outline, in particular:
Physiological Adaptation
ALTERATIONS IN BODY SYSTEMS: Implement interventions
to address side/adverse effects of radiation therapy.
Adequate Nutrition
required for a specific diet can be a barrier to maintaining
a proper diet.
● Nutritious foods (fresh fruit, vegetables) tend to be more
expensive than canned and boxed foods.
Canned, boxed, and processed foods (lunch meats and
Many individuals have difficulty consuming a
●
dental attention, and can facilitate the referral process. eat or choose a small selection of food that might not
● Provide children with information about healthy snacks provide adequate nutrition.
that are low in sugar.
NURSING CARE
● Advise children and adults to limit consumption of ● If the client lives independently, encourage shopping with
processed carbohydrates, which can stick to teeth and
a friend or family member and following a shopping list.
increase the risk for dental caries. ● Monitor for vitamin and mineral deficits, and evaluate
● Encourage children and adults to use a fluoridated tooth
the need for nutritional supplements.
paste and have fluoride applied to their teeth. ● Contact social services regarding the availability of food
● Perform a basic dental screening for clients admitted to
or meal delivery to the client’s home.
acute or long-term care facilities to identify issues that ● If the client lives in a care facility, provide a menu with
can affect the ability to properly eat.
minimal but nutritious options.
● Consult a dietitian or nutritionist to assist with meal ● Serve meals at the same time and in the same location
and diet planning, as well as for recommendations on
surrounded by the same people. Keep environmental
nutritional supplements.
distractions to a minimum.
● Provide snacks in between meals if mealtime intake
is inadequate.
● Cut food into small pieces if the client has difficulty
chewing food. Remind the client to chew and then
swallow. Lightly stroking the chin and throat can help
promote swallowing.
eat foods that are served cool, as they are typically less
about nutrition
aromatic and are less likely to precipitate nausea.
● Suggest consuming foods that are spicy or tangy to Clients can be subject to overnutrition, undernutrition, and
compensate for the decreased sense of taste. the ingestion of an inadequate intake of essential nutrients.
● Recommend sucking on hard candies, mints, or chewing ● Clients might not have basic knowledge about nutrition.
gum to counteract an unusual taste in the mouth. ● Information about nutrition can be confusing
● Instruct the client to avoid ingestion of empty or misleading.
calories. If an increase in calories and fluid is desired, ● Clients can be drawn to fad diets (which are generally
milkshakes, juice, and supplements are good options. unhealthy) because quick results are promised.
● Clients can be misled by false advertising.
Impairment in swallowing
NURSING CARE
Clients who have neurologic disorders (Parkinson’s ● Encourage clients to use dietary guidelines available from
disease, cerebral palsy, stroke) or had a surgical procedure government and health associations (MyPlate
done on their mouth, throat, epiglottis, or larynx can have [www.choosemyplate.gov], American Heart Association,
difficulty managing food and swallowing without choking. Office of Disease Prevention and Health Promotion Dietary
● Clients who have a neurologic disorder affecting the Guidelines [https://health.gov/dietaryguidelines]).
muscles in the mouth and throat are at risk for aspiration ● Assist clients in locating community resources that
due to delayed swallowing and/or inadequate mastication. provide education on nutrition.
● Clients who have a history of oral cancer might have had ● Assess dietary intake.
part of their lip, tongue, and/or soft palate removed. This ● Instruct clients on how to read nutrition fact labels.
significantly affects the ability to masticate and coordinate ● Encourage the client to keep a journal of dietary intake.
the development of a bolus of food prior to swallowing. ● Provide clients with information on foods that are
● The larynx and epiglottis prevent food from entering healthy and portion sizes.
the trachea. Clients who have had partial or total ● Warn clients that advertisements can be fraudulent.
removal of these can easily aspirate food and fluids,
Medical conditions
unless special precautions are taken.
NURSING CARE ● Clients who have medical conditions (cancer, COPD,
● Continually monitor clients who are at risk for burns, severe trauma, or HIV/AIDS) are at increased risk
aspiration during meals, and have suction equipment for malnutrition due to anorexia, nausea, or stomatitis
immediately available. related to treatments, increased metabolic demands, or
● Consult a dietitian regarding an appropriate diet for the the inability to consume a diet.
client. The National Dysphagia diet includes three levels ● Clients who are undergoing diagnostic testing that
of solid textures. require NPO status are potentially at risk.
◯ Level 1: Pureed ● Clients who have comorbidities resulting in
◯ Level 2: Mechanically altered polypharmacy are at risk for malnutrition and
◯ Level 3: Advanced medication nutrient interactions.
Application Exercises
1. A nurse is caring for several clients in an extended 4. A nurse is caring for a client who is transitioning
care facility. Which of the following clients is the to an oral diet following a partial laryngectomy.
highest priority to observe during meals? Which of the following actions should the nurse
A. A client who has decreased vision take to reduce the client’s risk for aspiration?
B. A client who has Parkinson’s disease A. Request to have the client’s oral
medications provided in liquid form.
C. A client who has poor dentition
B. Instruct the client to follow each bite
D. A client who has anorexia of food with a drink of water.
C. Encourage the client to tuck the
2. A nurse is planning care for a client who is receiving chin when swallowing.
treatment for malnutrition. The client is scheduled D. Consult the dietitian about providing
for discharge to their home where they live alone. the client with a thin liquid diet.
Which of the following actions should the nurse
include in the plan of care? (Select all that apply.)
A. Consult social services to arrange 5. A nurse is planning care for a client who has mechanical
home meal delivery. fixation of the jaw following a motorcycle crash.
Which of the following actions should the nurse
B. Encourage the client to purchase include in the plan of care? (Select all that apply.)
nonperishable boxed meals.
A. Thicken liquids to honey consistency.
C. Advise the client to purchase frozen
fruits and vegetables. B. Educate the client about the use
of a nasogastric tube.
D. Recommend drinking a supplement
between meals. C. Assist the client to use a straw to drink liquids.
E. Educate the client on how to read nutrition labels. D. Ensure that the client receives ground meats.
E. Encourage intake of fluids between meals.
CHAPTER 12 Cardiovascular The presence of three of the five following risk factors.
and Hematologic
● Abdominal obesity
disease process. Understanding the role of ◯ Diastolic greater than or equal to 85 mm/Hg
primary and secondary prevention is essential to ● Fasting blood glucose greater than or equal to 100 mg/dL
or taking medication to control blood glucose levels
successful treatment.
adolescence, infection
MANIFESTATIONS
Coronary heart disease ● Fatigue
Hypercholesterolemia leads to atherosclerosis, a process ● Lethargy
of damage and cholesterol deposits on the blood vessels ● Pallor of nail beds
of the heart. Atherosclerosis is the cause of many ● Intolerance to cold
cardiovascular disease complications (myocardial ● Headache
infarction, kidney failure, ischemic strokes). ● Tachycardia
High-density lipoprotein (HDL) cholesterol is “good”
! Children who have low iron intake can
●
NEUROLOGIC FINDINGS
● Decreased concentration
● Paresthesia (numbness) of hands and feet
● Decreased proprioception (sense of body position)
● Poor muscle coordination
● Increasing irritability
● Delirium
medications (anticonvulsants and oral contraceptives) ● Encourage the client to consume a high-fiber diet.
MANIFESTATIONS ◯ Soluble fiber lowers LDL.
● Consuming a diet that is limited in trans fats, saturated complementary to personal food preferences and
fats, and cholesterol can reduce the risk of developing lifestyle. A food diary can be helpful.
CHD. The Therapeutic Lifestyle Change (TLC) diet is ◯ Instruct the client that occasional deviations from the
Saturated fat should be limited to less than 7% of daily than 2,300 mg is recommended, and should gradually
caloric intake. be decreased to 1,500 mg for maximum benefit).
● To lower cholesterol and saturated fats, instruct the ◯ Foods high in sodium include canned soups and
◯ Broil, bake, grill, or steam foods. Avoid frying foods. (apricots, bananas, tomatoes, potatoes).
◯ Use low-fat or nonfat milk, cheese, and yogurt. ● Limit alcohol intake.
◯ Use spices in place of butter or salt to season foods. ● Encourage the client to read labels and educate the
◯ Use liquid oils (olive or canola) in place of oils that are client about appropriate food choices.
high in saturated fat (lard, butter). ● Other lifestyle changes include exercising, weight loss,
and smoking cessation.
THERAPEUTIC NUTRITION
to breastfeeding)
● Reduce sodium intake to less than 3,000 mg per day for ◯ Infant cereal (usually the first food introduced
1. A nurse is teaching a client about dietary A nurse is providing teaching to a client who has hypertension.
recommendations to lower high blood What should the nurse include in the teaching? Use
pressure. Which of the following statements the ATI Active Learning Template: System Disorder to
by the client indicates understanding? complete this item to include the following sections.
◯ Laboratory values
modifications in relationship to the disease fecal output and slow transit time of food through the
process. Understanding the role of primary digestive tract.
◯ Low-fiber diets are used short-term for clients who
◯ Stimulate peristalsis.
indicates bile).
abdominal pain or cramping, abdominal distention, ● Once manifestations subside, begin with clear
pale, sticky bowel movements
liquids followed by full liquids, and advance the diet
◯ Changes in weight, eating patterns, or bowel habits
as tolerated.
● Determine whether the client uses the following. ● Easy-to-digest, low-fat carbohydrate foods (crackers,
◯ Tobacco
usually well-tolerated.
◯ Caffeine
◯ Over-the-counter medications to treat GI NURSING ACTIONS
conditions (many can have GI complications or be ● Promote good oral hygiene with tooth brushing, mouth
contraindicated with GI conditions) swabs, mouthwash, and ice chips.
◯ Nutritional supplements ● Elevate the head of the bed.
◯ Herbal supplements for GI conditions or other ● Serve foods at room temperature or chilled.
problems (some clients do not consider them to
CLIENT EDUCATION
be medications, so they do not mention them to ● Avoid hot and spicy foods.
the provider) ● Avoid liquids with meals, as they promote a feeling
of fullness.
● Avoid high-fat foods if they contribute to nausea
because they are difficult to digest.
1. A nurse is teaching a client who is recovering A nurse is providing instructions to the guardian of a
from pancreatitis about following a low-fat child who has lactose intolerance. What should the nurse
diet. Which of the following foods should the include in the teaching? Use the ATI Active Learning
nurse recommend? (Select all that apply.) Template: System Disorder to complete this item.
Diarrhea
◯
●
Foods to limit or avoid include milk, soft cheese,
2. A. Peanut butter is high in fat. ice cream, cream soups, puddings.
B. Unpeeled fruit is a better source of fiber.
C. Egg yolk is high in fat. NCLEX® Connection: Physiological Adaptation,
D. CORRECT: Brown rice is a good source Illness Management
of fiber and is low in fat.
NCLEX® Connection: Basic Care and Comfort, Elimination
CHAPTER 14
UNIT 3 ALTERATIONS IN NUTRITION End-stage kidney disease (ESKD) manifestations include
dietary needs with the client and recommend Nephrotic syndrome’s most pronounced manifestations
are edema and high proteinuria. Other manifestations
modifications related to the disease process.
include hypoalbuminemia, hyperlipidemia, and blood
Understanding the role of primary and secondary hypercoagulation.
prevention is essential to successful treatment. Kidney stones are characterized by sudden, intense pain
that is typically located in the flank and is unrelieved by
The kidneys have two primary functions: position changes as the stone moves out of the kidney
pelvis and down the ureter. Diaphoresis, nausea, and
maintaining blood volume and excreting waste
vomiting are common, and there can be blood in the urine.
products. Other functions include the regulation The majority of kidney stones are made of calcium oxalate.
kidney disease. Monitoring protein intake is critical. Weight is an indicator of fluid status, which is a
primary concern.
Short-term kidney disease requires nutritional ◯ Monitor fluid intake, and encourage compliance with
fluid restrictions.
support for healing rather than dietary ◯ Nurses should monitor urine output. Placement of an
restrictions. Dietary recommendations are indwelling urinary catheter might be necessary for
accurate measurement.
dependent upon the stage of kidney disease. ◯ Monitor for manifestations of constipation. Fluid
Chronic kidney disease is distinguished by an the intake of protein, which results in decreased
increase in blood creatinine. Manifestations phosphorus levels.
include fatigue, back pain, and appetite changes. ● Restricting phosphorus intake slows the progression of
It is a progressive disorder, characterized by five stages. kidney disease. High levels of phosphorus contribute to
● Stage 1: at risk for CKD calcium and phosphorus deposits in the kidneys.
● Stage 2: mild CKD ● Protein restriction is essential for clients who have
● Stage 3: moderate CKD stage 1 to 4 CKD.
● Stage 4: severe CKD ◯ Slows the progression of kidney disease.
● Stage 5: CKD requiring dialysis or transplant for ◯ Too little protein results in the breakdown of body
● The recommended daily protein intake is 0.8 to and magnesium, leading to hyperphosphatemia,
1.0 g/kg/day of ideal body weight. hypocalcemia, and hypermagnesemia.
◯ Protein restrictions are decreased as the disease ◯ Calcium supplements will likely be required because
progresses to ESKD, and to decrease the workload on foods high in phosphorus (which are restricted) are
the kidneys. also high in calcium.
◯ High biologic value proteins are recommended for
clients who have CKD to prevent catabolism of muscle Acute kidney injury
tissue. These proteins include eggs, meats, poultry,
AKI is an abrupt, rapid decline in kidney function caused by
game, fish, soy, and dairy products.
trauma, sepsis, poor perfusion, or medications, and usually
● Limit meat intake to 5 to 6 oz/day for most males and
is reversible. AKI can cause hyponatremia, hyperkalemia,
4 oz/day for most females.
hypocalcemia, and hyperphosphatemia. Fluid overload
● Limit dairy products to ½ cup per day.
leading to pulmonary edema is a complication of AKI.
● Limit high-phosphorus foods (peanut butter, dried
peas and beans, bran, cola, chocolate, beer, some whole THERAPEUTIC NUTRITION
grains) to one serving or less per day. ● Diet therapy for AKI is dependent upon the phase of AKI
● Caution clients to use vitamin and mineral supplements and its underlying cause. Protein, calories, fluids, potassium,
only when recommended by a provider. Avoid high and sodium need to be individualized according to the three
protein sports drinks, energy drinks, or meal phases of AKI (oliguric, diuretic, recovery) and whether the
supplements. Avoid herbal supplements that can affect client is receiving dialysis.
bleeding time and blood pressure. ● Recommendation is to consume 20 to 30 cal/kg/day of
body weight in clients who are in any stage of AKI to
End-stage kidney disease maintain energy and demands of stress.
● Simple carbohydrates, fats, oils, and low-protein starches
ESKD, or Stage 5 CKD, occurs when the GFR is less than
are included in the diet. Provide nonprotein calories in
15 mL/min and the blood creatinine level steadily rises,
an adequate amount to maintain the client’s weight.
and indicates complete kidney failure. ● Protein intake can increase to 1 to 1.5 g/kg if the client
THERAPEUTIC NUTRITION is receiving dialysis, compared to 0.6 g/kg (40 g/day) for
● The goal of nutritional therapy is to maintain appropriate nondialysis clients.
fluid status, blood pressure, and blood chemistries. ● Potassium and sodium are dependent on urine output,
◯ A low-protein, low-phosphorus, low-potassium, blood values, and if the client is receiving dialysis.
low-sodium (2 to 3 g/day), fluid-restricted diet ◯ Potassium is restricted to 60 to 70 mEq/day when
is recommended. on dialysis.
◯ Consume adequate calories (35 kcal/kg of body ◯ Sodium is restricted to 1 to 2 g/day if not receiving
weight) to maintain body protein stores. dialysis, and 2 to 4 g/day if receiving dialysis, which
● Monitor potassium level and replace as needed. Sodium also depends on the phase.
and fluid allowances are determined by blood pressure, ◯ Calcium requirements are less than 2,000 mg daily if
weight, blood electrolyte findings, and urine output. receiving hemodialysis or peritoneal dialysis.
● Achieving a well-balanced diet based on the above ● Fluids are restricted to the client’s daily urine output
guidelines is difficult. The National Renal Diet provides plus 500 mL during the oliguric phase. Fluid needs are
clients with a list of food choices. increased during the diuretic phase.
● Protein needs increase from 0.6 to 1.0 g/kg before
dialysis to 1.2 to 1.5 g/kg, depending on the type of Nephrotic syndrome
dialysis, once dialysis has begun as protein and amino ● Nephrotic syndrome results in the increased excretion of
acids are lost in the dialysate.
proteins into the urine, resulting in hypoalbuminemia,
◯ Fifty percent of protein intake should come from
CHAPTER 15
UNIT 3 ALTERATIONS IN NUTRITION ASSESSMENT/DATA COLLECTION
CHAPTER 15 Diabetes Mellitus Hypoglycemia is a blood glucose level less than 70 mg/dL.
It results from taking too much insulin, inadequate food
intake, delayed or skipped meals, extra physical activity,
or consumption of alcohol without food.
Glucose is the body’s primary source of ● Manifestations include mild shakiness, mental
energy, and insulin is needed to assist the confusion, sweating, palpitations, headache, lack of
coordination, blurred vision, seizures, and coma.
body in the breakdown of glucose to a form
Hyperglycemia is a blood glucose level above the
that is used for energy. Diabetes mellitus
expected reference range. It results from an imbalance
inhibits the body’s production and/or use of with food, medication, and activity, combined with an
inadequate amount of insulin production or cells that are
insulin. This results in elevated blood glucose
insulin-resistant.
levels. Complications of diabetes mellitus are ● Infection, other illness, and stress can cause an increase
in blood glucose.
characterized as macrovascular (cardiovascular ● Primary manifestations include polydipsia (excessive
and cerebrovascular disease) or microvascular thirst), polyuria (excessive urination), and polyphagia
(excess hunger and eating). As hyperglycemia
(kidney, nerve, and vision problems). For clients progresses, ketones (which can be detected in the urine
who are pregnant, blood glucose control and other manifestations (hyperventilation [Kussmaul
respirations], dehydration, fruity odor to the breath,
prevents maternal and fetal complications. headache, inability to concentrate, decreased levels of
consciousness, seizures leading to coma) develop.
The nurse assists the client in identifying lifestyle ● The Somogyi phenomenon is morning hyperglycemia
changes necessary to manage diabetes mellitus, in response to overnight hypoglycemia. Providing a
bedtime snack and appropriate insulin dose prevents
including diet and activity level. this phenomenon.
● The dawn phenomenon is an elevation of blood glucose
TYPES OF DIABETES MELLITUS around 0500 to 0600. It results from an overnight release
of growth hormone and is treated by increasing the
Prediabetes amount of insulin provided during the overnight hours.
● Clients who have glucose levels that are elevated above Metabolic syndrome is a cluster of factors that increase
the expected range but below the diagnostic criteria for the risk for diabetes mellitus and cardiovascular
diabetes mellitus are said to have prediabetes. complications. Factors include elevated glucose levels,
● Clients who have prediabetes are encouraged to adopt central obesity, hyperlipidemia, hypertension, and low
lifestyle modifications to prevent the development of levels of HDL cholesterol. The presence of at least 3 factors
diabetes mellitus. indicates metabolic syndrome.
viral infection.
Damage to or destruction of beta cells of the pancreas
Hypoglycemia
●
or more servings per week are recommended. Carbohydrate counting focuses on counting total grams
■ Consuming foods enriched with plant sterols or of carbohydrates in each food item. Many clients find it
stanols can reduce LDL cholesterol. easier than exchange lists because of the simplicity and
◯ Fiber flexibility. It does not require the client to learn how much
■ Promote fiber intake (beans, vegetables, oats, whole a portion size is.
grains) to improve carbohydrate metabolism and ● One serving equals 15 g of carbohydrates. Clients are
lower cholesterol. free to choose what carbohydrates to consume, but are
■ Recommendation for fiber intake includes at least encouraged to choose a variety of types and include
14 g per 1,000 calories. consistent amounts of protein and fats in the diet.
◯ Protein: Protein from meats, eggs, fish, nuts, beans, ◯ Foods that contain 15 g of carbohydrates
and soy products should comprise 15% to 20% of total ■ 1 slice of sandwich bread
caloric intake. Reduce protein intake if needed in ■ 1/2 cup cooked pasta
clients who have diabetes and kidney failure. ■ 1/2 cup canned fruit in juice (not syrup)
● Encourage clients to eliminate all tobacco use due to the ■ 3 cups raw vegetables
● Moderate alcohol intake can lower the risk for ■ 4 to 6 snack crackers
cardiovascular disease. Clients should limit daily alcohol ■ 1/2 cup regular ice cream
intake to one alcoholic beverage for females or two ● With basic carbohydrate counting, a client consumes a
for males. specific amount or servings of carbohydrates at each
◯ To avoid hypoglycemia, the client should consume meal and snack.
alcohol with a meal or immediately after a meal. ● With advanced carbohydrate counting, clients calculate
◯ Alcoholic beverages should not replace food intake. mealtime insulin based on the amount of carbohydrates
● Vitamin and mineral requirements are unchanged consumed. Clients must be able to perform basic math
for clients who have diabetes. Supplements are skills and be willing to check their glucose before each
recommended for identified deficiencies. meal to provide a corrective insulin dose, if the glucose
level is too high.
● Clients can exchange carbohydrate selections as long as
the grams of carbohydrates are the same per serving.
Food selections can vary in amount of additional
calories from fat and protein each food can contain.
CHAPTER 16
UNIT 3 ALTERATIONS IN NUTRITION ASSESSMENT/DATA COLLECTION
CHAPTER 16 Cancer and ● Current illness and presence of other medical diagnoses
Immunosuppression
● Nutritional habits, food preferences, and restrictions
● Food allergies
RISK FACTORS
Nurses should be knowledgeable of Immunosuppression disorders
nutritional needs for clients who have cancer ● Unprotected sex (HIV)
and immunosuppression disorders. Cancer ● Use of contaminated needles (injection substance
use [HIV])
and cancer treatments can affect chewing, ● Use of medications that have immunosuppressive
swallowing, satiety, digestion, taste, appetite, effects (cytotoxic medications, corticosteroids, disease
modifying immunosuppressive medications)
nutrient absorption, use of glucose, and stool ● History of radiation treatment
formation (dependent on type). ● Congenital immune deficiencies
● Sedentary lifestyle
disorders (HIV/AIDS). Nutritional deficits are ● Consumption of processed meats, red meats,
refined grains
a major cause of morbidity and mortality for ● Excessive alcohol intake
these clients. Adverse effects of treatments ● Family history
History of cigarette smoking
compromise the nutritional status of affected
●
effects of treatment.
maintain weight, promote healing, reduce CLIENT EDUCATION
adverse effects, decrease morbidity and ● Potential food sources of bacteria include raw fruits and
vegetables, and undercooked meat, poultry, or eggs.
mortality, and enhance quality of life and overall Wash fruits and vegetables. Cook foods thoroughly.
effectiveness of treatment therapies. Nutritional Refrigerate perishable foods as soon as possible.
Make food choices based on nutrition recommendations.
plans are individualized for client needs.
●
Cancer HIV/AIDS
Excess body fat stimulates the production of estrogen and The body’s response to the inflammatory and immune
progesterone, which can intensify the growth of various processes associated with HIV increases nutrient
cell types and can contribute to breast, gallbladder, colon, requirements. Malnutrition is common and is one cause of
prostate, uterine, and kidney cancers. death in clients who have AIDS.
● HIV infection, secondary infection, malignancies, and
NURSING ACTIONS: Use semisolid, thickened foods for
medication therapies can cause manifestations and
clients who have dysphagia, and instruct them to sit
adverse effects that impair intake and alter metabolism.
upright and tilt their head forward when swallowing. ● Decreased nutrient intake occurs due to physical
CLIENT EDUCATION manifestations (anorexia, nausea, vomiting, diarrhea).
● Eat more on days when feeling better (on “good” days). Psychological manifestations can include depression
● Consume nutritional supplements that are high in and dementia.
protein and/or calories as between-meal snacks. When ● Nutritional findings include rapid weight loss,
necessary, use as a meal replacement. gastrointestinal problems, inadequate intake,
● Increase protein and caloric content of foods. increased nutrient needs, food aversions, fad diets,
◯ Substitute whole milk for water in recipes. and supplements.
◯ Add milk, cheese, yogurt, or ice cream to dishes. ● Poor nutritional status leads to wasting and fever,
◯ Use peanut butter as a spread for fruits. further increasing susceptibility to secondary infections.
◯ Use yogurt as a topping for fruit. ● HIV-associated wasting is characterized by unintended
◯ Dip meats in eggs, milk, and bread crumbs weight loss of 10% and at least one concurrent
before cooking. problem (diarrhea, chronic weakness, or fever) for at
● Preventative nutrition least 30 days.
◯ Consume adequate dietary fiber (25 to 38 g/day ● Diarrhea and malabsorption are prominent concerns in
depending on sex and age) to lessen the risk of clients who have AIDS.
colon cancer.
◯ Eliminate tobacco and exposure to loose asbestos to
Therapeutic nutrition
● Creating an individualized plan for the client who has
reduce the risk of lung cancer.
HIV/AIDS is based on reducing unintentional weight loss
◯ Eat at least 2.5 cups of a variety of fruits and
and wasting.
vegetables daily (linked to lowered incidence of many ◯ Increased caloric needs ranges from 37 to 55 cal/kg.
types of cancer and obesity, which affects the risk for ◯ A high-protein diet is recommended with amounts
cancer development).
varying from 1.2 to 2.0 g/kg/day.
■ Foods high in vitamin A (dark green, red, and
◯ Intake of a multivitamin that meets 100% of the
orange vegetables)
recommended daily servings is sufficient, unless a
■ Foods high in vitamin C (citrus fruits)
types of cancers).
● Therapeutic nutrition
◯ Cancer can cause anorexia, increased metabolism, and
negative nitrogen balance.
◯ Systemic effects result in poor food intake, increased
1. A nurse is teaching a client who has cancer A nurse in an oncology clinic is reviewing dietary
about ways to increase protein and calories in management with a group of clients who have cancer
foods. Which of the following actions should and are undergoing treatment. What instructions should
the nurse include? (Select all that apply.) the nurse include in this discussion? Use the ATI Active
Learning Template: System Disorder to complete this item.
A. Use peanut butter as a spread on crackers.
B. Add water in place of milk in soups. CLIENT EDUCATION
C. Top fruit with yogurt. ●
Describe three effects of cancer on nutrition.
D. Dip chicken in eggs before cooking. ●
Describe three nutritional needs.
E. Sprinkle cheese on a baked potato. ●
Describe three activities that promote improved nutrition.
References
Berman, A., Snyder, S., & Frandsen, G. (2016). Kozier & Erb’s fundamentals of nursing:
Concepts, process, and practice (10th ed.). Upper Saddle River, NJ: Prentice-Hall.
Grodner, M., Escott-Stump, S., & Dorner, S. (2016). Nutritional foundations and
clinical applications of nutrition: A nursing approach (6th ed.). St. Louis, MO: Mosby
Potter, P. A., Perry, A. G., Stockert, P., & Hall, A. (2017). Fundamentals
of nursing (9th ed.). St. Louis, MO: Elsevier.
Touhy, T. A., & Jett, K. F. (2016). Ebersole & Hess’ toward healthy aging:
Human needs and nursing response (9th ed.). St. Louis, MO: Elsevier.
United States Department of Agriculture (USDA). (2013). Sausages and food
safety. Retrieved from https://www.fsis.usda.gov/wps/wcm/connect/fsis-
content/internet/main/topics/food-safety-education/get-answers/food-
safety-fact-sheets/meat-preparation/sausages-and-food-safety/ct_index
Description of Procedure
Indications CONSIDERATIONS
Interpretation of Findings
Client Education
Health Promotion
PURPOSE OF MEDICATION
Contraindications/Precautions
Nursing Interventions
Interactions
Client Education
Description of Skill
Indications CONSIDERATIONS
Outcomes/Evaluation
Client Education
ASSESSMENT SAFETY
CONSIDERATIONS
Risk Factors Expected Findings
Description of Procedure
Indications CONSIDERATIONS
Outcomes/Evaluation
Client Education
Defining Characteristics