Nutrition and Health Quiz

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Questions and Answers

What does Basal Metabolic Rate (BMR) measure?

The amount of energy used for physical activity

The energy expended during digestion

The energy used during sleep

The energy required for involuntary bodily functions (correct)

Which of the following factors is likely to increase Basal Metabolic Rate (BMR)?

Prolonged fasting

Cold temperatures

Extreme environmental temperatures (correct)

Aging

How is Body Mass Index (BMI) calculated?

Weight in kilograms divided by height in meters squared (correct)

Weight in pounds divided by height in inches

Weight in grams divided by height in centimeters

Height in meters divided by weight in kilograms

In which part of the digestive system does absorption primarily occur?

Small intestine Signup and view all the answers

What process transforms chyme into feces in the gastrointestinal system?

Peristalsis Signup and view all the answers

What is a common nutritional requirement for infants during their early development?

High protein and vitamin needs Signup and view all the answers

Which factor significantly affects nutrition in older adults?

Reduced sensory perception Signup and view all the answers

What impact does socioeconomic stability have on food choices?

It may limit food access. Signup and view all the answers

Which of the following is essential in the nutritional assessment process?

Assessing dietary intake with various methods Signup and view all the answers

How does the nutritional need of pregnant women differ from that of young adults?

Pregnant women require increased nutrients and calories. Signup and view all the answers

What is a key consideration when assisting visually impaired patients with eating?

Explain the placement of food using a clock reference Signup and view all the answers

What is a potential consequence of dysphagia in nutritional health?

Aspiration pneumonia Signup and view all the answers

Which diet allows for clear liquids only?

Clear liquid diet Signup and view all the answers

What effect does alcohol use disorder have on nutrition?

It can interact with vitamins and medications. Signup and view all the answers

What type of diet is designed for patients who need food that is easily chewed and digested?

Soft diet Signup and view all the answers

Which of the following is NOT a factor that influences food choices?

Environmental temperature Signup and view all the answers

Which of the following describes a pureed diet?

Is a blenderized liquid diet Signup and view all the answers

What is a critical indicator for advancing a patient's diet?

Patient's swallowing capability and comfort Signup and view all the answers

What is the purpose of enteral nutrition (EN)?

To administer nutrients into the GI tract Signup and view all the answers

Which diet is specifically indicated for individuals with diabetes?

Consistent carbohydrate diet Signup and view all the answers

What type of monitoring is essential to prevent aspiration during feeding?

Monitoring the patient's chewing and swallowing Signup and view all the answers

What is a warning sign for dysphagia?

Coughing or choking during eating Signup and view all the answers

What should be avoided to minimize the risk of aspiration during feeding?

Rushed or forced feeding Signup and view all the answers

Which laboratory value indicates normal albumin levels?

4.0 g/dL Signup and view all the answers

Which of the following is NOT a recommended precaution for patients with dysphagia?

Providing a cluttered dining environment Signup and view all the answers

What should nurses do to stimulate appetite in patients?

Provide small, frequent meals Signup and view all the answers

What precaution may be necessary after a meal for patients with dysphagia?

Sitting upright for 30-60 minutes Signup and view all the answers

Which nursing diagnosis relates to potential complications from impaired swallowing?

Risk for aspiration Signup and view all the answers

What is the normal range for creatinine levels in the body?

0.6-1.2 mg/dL Signup and view all the answers

Which of the following is an effective way to ensure oral hygiene before meals?

Regular inspection of oral cavity Signup and view all the answers

What is a common occurrence after a stroke that can complicate swallowing?

Change in voice after eating Signup and view all the answers

Which condition indicates tolerance of enteral feeding?

Absence of fullness and distension Signup and view all the answers

What is a reliable method to confirm the placement of a feeding tube?

Measuring tube length and tube markings Signup and view all the answers

What action should be avoided if gastric residual volume (GRV) is less than 500 mL?

Automatic cessation of enteral feeding Signup and view all the answers

Which feeding method is preferred for enteral nutrition administration?

Intermittent feeding Signup and view all the answers

What is the recommended angle for elevating the head of the bed during enteral feeding?

30 degrees Signup and view all the answers

What is the recommended gastric pH for confirming the proper placement of a feeding tube?

pH =< 5.5 Signup and view all the answers

When administering enteral feeding, what is crucial to check before starting?

Expiration dates of the formula Signup and view all the answers

What happens when you administer enteral feeding too quickly to a patient?

May cause dumping syndrome Signup and view all the answers

What is the maximum time a closed system can be used before needing to change the tubing and container?

48 hours Signup and view all the answers

Which of the following practices should be avoided during enteral feeding administration?

Administering medications Signup and view all the answers

What should be done if a tube becomes clogged during enteral feeding?

Irrigate the tube with water Signup and view all the answers

What is a key precaution to prevent aspiration during enteral feedings?

Keep the head of bed elevated at least 30 degrees Signup and view all the answers

For which patients is Total Parenteral Nutrition (TPN) typically indicated?

Patients with nonfunctioning GI tracts Signup and view all the answers

What is a possible complication of enteral feeding related to tube management?

Nasal erosion Signup and view all the answers

What is the optimal feeding rate increase for tolerance during enteral feeding?

10-25 mL/hr Signup and view all the answers

What is the purpose of Peripheral Parenteral Nutrition (PPN)?

To manage moderate nutritional deficiencies short term Signup and view all the answers

Study Notes

Nutrition Overview

Fundamentals of Nursing, Taylor 10th ed., Chapter 37
Authors: Wei Liu PhD, MANP, RN, CNE; Fran Gallina MSN, RN; Susan Zori, DNP, RN, NEA-BC

Basal Metabolic Rate (BMR)

The amount of energy needed for involuntary bodily functions
Factors increasing BMR: growth, infection, fever, emotional tension, elevated thyroid hormone/epinephrine, and extreme environmental temperatures
Factors decreasing BMR: aging, sleep, cold temperatures, decreased thyroid hormone, and prolonged fasting

Body Mass Index (BMI)

Ratio of weight (kg) to height (m) squared
Used to assess risk of diseases (heart disease, type II diabetes, hypertension, certain cancers)
BMI classifications:
- Underweight: <18.5
- Normal: 18.5-24.9
- Overweight: 25.0-29.9
- Obesity Class 1: 30.0-34.9
- Obesity Class 2: 35.0-39.9
- Extreme Obesity: 40.0+
Waist circumference is an indicator of abdominal fat and risk for diseases
- Men > 40 inches
- Women > 35 inches

GI System: Digestion, Absorption, Metabolism & Elimination

Digestion begins in the mouth and ends in the small and large intestines
Absorption primarily occurs in the intestines
Metabolism involves anabolic and catabolic reactions, storing nutrients
Elimination: chyme is processed into feces

Factors Influencing Nutrition (Developmental)

Infants: high protein, vitamin, mineral, and energy needs; breastfeeding, formula or solid foods
Toddlers & Preschoolers: slower growth rate, picky eaters
School-aged Children: need for foods with high nutritional value
Adolescents: increased energy needs
Young & Middle Adults: reduced nutrient demands
Pregnant & Lactating Women: increased nutrient and caloric needs
Older Adults: decreased energy need

Factors Influencing Nutrition (Other Considerations)

Sex assigned at birth/gender
State of health
Alcohol use disorder
Medication (including megadoses of vitamins/supplements that may interact with other medications or herbs, vitamins, and minerals)
Socio-cultural/psychological factors: socioeconomic resources and stability; religion; culture; meaning of food; health literacy; language barriers; caregiver support; social isolation; knowledge of cooking/food preparation to obtain and cook foods

Nursing Process: Assessment

Mini Nutritional Assessment (MNA) tool for screening
Screening questions
Anthropometric measurements (height, weight, changes, BMI, waist circumference, signs of altered nutrition)
Nutritional habits
General condition
Self-evaluation of dietary intake
- 24-hour recall method
- Food diaries/calorie counts
- Food frequency record
- Diet history
Dietary and health history (health status, age, cultural background, religious food patterns, socioeconomic status, personal food preferences, psychological factors, use of alcohol/drugs/supplements, and general nutrition knowledge)
Physical examination addressing dysphagia
- Complications of dysphagia (e.g., aspiration pneumonia, dehydration, weight loss; altered nutrition)
Laboratory and biochemical data:
- Albumin (normal 3.5-5.5 g/dL), pre-albumin (19-38 mg/dL)
- Transferrin (250-425 mg/dL), Hgb (12-18 g/dl), Hct (46-52%)
- BUN (6-20 mg/dL), Creatinine (0.6-1.2 mg/dL)
- 24-hour urine -Warning signs of dysphagia (coughing/choking during eating, change in voice after eating, slow/imprecise/uncoordinated speech, abnormal gag, delayed swallowing, incomplete oral clearance, pharyngeal pooling, "silent aspiration," which occurs without a cough)

Feeding Patients with Dysphagia/Aspiration Precautions

Provide 30 minutes of rest prior to meals
Sit upright; slightly flex head
Monitor/check gag reflex; oral hygiene
Avoid rushed/forced feeding
Reduce distractions or eliminate them wherever possible
Alternating liquids and solids
Place food on unaffected side of the mouth
Obtain speech therapy and nutrition consult; consider additional patient needs, such as dentures, hearing aids, etc.
Avoid sedatives or hypnotics that might impair cough or swallowing
Observe for coughing, gagging, or abnormal digestive processes
Inspect oral cavity
If necessary, position the patient upright for 30-60 minutes after meals.

Nursing Diagnoses

Risk for aspiration
Readiness for enhanced nutrition
Imbalanced nutrition: more than body requirements
Diarrhea
Feeding self-care deficit
Imbalanced nutrition: less than body requirements
Deficient knowledge
Impaired swallowing
Risk for imbalanced nutrition: more than body requirements

Implementation (Stimulating Appetite)

Small, frequent meals
Solicit food preferences and cultural/religious considerations (holidays)
Provide a pleasant environment
Make food attractive
Schedule procedures and medications when they won't interfere with eating
Administer anti-nausea meds/anti-emetics and pain meds
Offer food alternatives
Good oral hygiene (including well-fitting dentures)
Organize and arrange food on meal trays to minimize clutter and allow easier access per patient limitations
Meal time rituals
Order a late tray if the patient misses a meal; heat up food where possible
Do not disturb mealtime; do not interrupt

Assisting with Eating

Offer toileting before beginning
Involve the person and maximize independence
Provide appropriate drinks
Sit at eye level, making eye contact
Engage in conversation; provide a napkin; consider dentures/hearing aids as well as assisting with opening containers, cutting meats
Monitor patient for aspiration, or other swallowing difficulties
Explain placement of food like a clock for visually impaired patients
Use special plate guards and utensils as needed

Therapeutic Diets

Nothing by Mouth (NPO)
Clear liquid diet
Full liquid diet
Soft diet
Pureed diet
Mechanically altered diet
Diet as tolerated
Low residue diet
High residue diet
Sodium restricted
Fat restricted
Renal diet
Consistent Carbohydrate Diet (Diabetic)

Enteral Tube Feeding

Provides nutrients directly into the GI tract; an alternative to oral feeding
Indications: Head, neck, upper GI cancers; critical illness/trauma; neurological/muscular disorders; GI disorders; Respiratory failure/prolonged intubation; Inadequete oral intake, such as anorexia, impaired chewing/swallowing, or lack of gag reflex
Contraindications: Peritonitis, bowel obstruction, intractable vomiting, or paralytic ileus
Enteral access tubes: Short-term (NG, nasointestinal), long-term (gastrostomy - G-tube, jejunostomy - J-tube, PEG or PEJ)

Complications of Enteral Tubing

Aspiration
Clogged tube; irrigate
Nasal erosion
Diarrhea
Nausea, vomiting, distention
Unplanned extubation
Stoma site infection
Check placement; avoid oversedation

Parenteral Nutrition (PN)

Infuses nutrient rich hypertonic solution intravenously through a central line (central venous catheter or port)
Used for patients with non-functioning or malnourished GI tracts or high physiological stress
Indications: Sepsis; head injury, burns
Types: TPN (central line) - expensive, high potential for complications; PPN (peripheral vein) - less concentrated, used for shorter term
Complications: Air embolism; pneumothorax; catheter occlusions; central line-associated bloodstream infection(CLABSI); hyperglycemia/hypoglycemia, fluid overload, electrolyte imbalances, hyperlipidemia, Refeeding syndrome

Administering TPN, Guidelines for Nursing Care

Use the same lumen of catheter
Use pumps; use in-line filter on tubing
Label tubing; Double check order for all ingredients
Use strict aseptic technique when adding fluids
Change tubing & bag daily
Refrigerate solution unless immediately using
Do not add lipids if oil droplets are present
Never add meds to parenteral nutrition solution
Monitor (input, output, vital signs, labs)
Monitor IV site
Gradually reduce TPN rate
Wean off using 10% dextrose

Complications of TPN

Air embolism
Pneumothorax
Catheter occlusions
Central line-associated bloodstream infection (CLABSI)
Hyperglycemia
Hypoglycemia
Fluid overload
Electrolyte and acid-base imbalances
Hyperlipidemia
Refeeding syndrome

Evidence-Based Practice (PN)

Early nutritional assessment
Maintain blood glucose
Use central venous catheter

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Description

Test your knowledge on key concepts related to nutrition and health. This quiz covers topics including Basal Metabolic Rate (BMR), Body Mass Index (BMI), and dietary needs across different life stages. Dive into the essentials of nutrition in relation to various health conditions and lifestyle factors.