RN Nutrition Online Practice 2019 B

RN Nutrition Online Practice 2019 B a. Nutrition and Oral Hydration a. Fluid Imbalances: Identifying Manifestations of Fluid Overload i. Overhydration 1. Too much fluid in the body from excessive intake or ineffective removal from the body 2. Fluid overload is an excess of fluid or water, such as with water intoxication. This includes hemodilution, which makes the amount of blood components (blood cells, electrolytes) seem lower. 3. Hypervolemia, or fluid volume excess, involves an excess of water and electrolytes, so that the two are still in the right proportions. For example, excessive sodium intake causes the body to retain water, so that there is too much of both. 4. Clients who have fluid overload are at risk for developing pulmonary edema or congestive heart failure. 5. In older adult clients, the risk of fluid imbalance is greater due to changes in the body with age (such as reduced kidney function). ii. HEALTH PROMOTION AND DISEASE PREVENTION 1. When clients have known heart disease and impairment of kidney function, it important to instruct the client regarding the following. 2. Consume a diet low in sodium. Consult with the provider regarding diet restrictions. 3. Restrict fluid intake. Consult with provider regarding prescribed restrictions. iii. RISK FACTORS 1. Causes of hypervolemia 2. Compromised regulatory systems (heart failure, kidney disease, cirrhosis) 3. Overdose of fluids (oral, enteral, IV) 4. Fluid shifts that occur following burns 5. Prolonged use of corticosteroids 6. Severe stress 7. Hyperaldosteronism iv. Causes of overhydration 1. Water replacement without electrolyte replacement, excessive water intake (forced or psychogenic polydipsia) 2. Syndrome of inappropriate antidiuretic hormone (SIADH) 3. Excessive administration of IV D5W; use of hypotonic solutions for irrigations v. EXPECTED FINDINGS 1. Fluid volume overload a. VITAL SIGNS: Tachycardia, bounding pulse, hypertension, tachypnea, increased central venous pressure b. NEUROMUSCULAR: Weakness, visual changes, paresthesias, altered level of consciousness, seizures (if severe, sudden hyponatremia/water excess) c. GASTROINTESTINAL: Ascites, increased motility, liver enlargement d. RESPIRATORY: Crackles, cough, dyspnea e. OTHER SIGNS: Peripheral edema due to an excess of fluids within the body and lungs, resulting in weight gain, distended neck veins, and increased urine output, skin cool to touch with pallor 2. LABORATORY TES TS a. Decreased Hct and Hgb b. Decreased blood osmolarity with water/fluid excess c. Decreased urine sodium and specific gravity d. Decreased BUN due to plasma dilution 3. DIAGNOSTIC PROCEDURES a. Chest x-ray: Reveals possible pulmonary congestion vi. NURSING CARE 1. Monitor I&O. 2. Monitor daily weight. A weight gain or loss of 1 kg (2.2 lb) in 24 hr is equivalent to 1 L of fluid. 3. Assess breath sounds. 4. Monitor peripheral edema. 5. Maintain sodium-restricted diet as prescribed (indicated for isotonic/fluid volume excess). 6. Maintain fluid restrictions if prescribed. 7. Encourage rest. 8. Monitor clients receiving diuretics. 9. Encourage the client to discuss use of over-the-counter medications with the provider, as some of these contain sodium. 10. Position the client in the semi-Fowler’s or Fowler’s position, and reposition to prevent tissue breakdown in edematous skin. 11. Use a pressure-reducing mattress, and assess bony prominence on a regular basis. 12. Monitor blood sodium and potassium levels. vii. INTERPROFESSIONAL CARE 1. Respiratory services can be consulted for oxygen management. 2. Pulmonology can be consulted if fluid moves into lungs. viii. CLIENT EDUCATION 1. Weigh daily. Notify the provider if there is a 1- to 2-lb gain in 24 hr, or a 3-lb gain in 1 week. 2. If excessive sodium intake is the cause of fluid volume excess, consume a low-sodium diet, read food labels to check sodium content, and keep a record of daily sodium intake. 3. Adhere to fluid restriction. Consult with the provider regarding prescribed restrictions, and divide the 24-hr fluid allotment to allow for fluid intake throughout the day. ix. COMPLICATIONS 1. Pulmonary edema a. Pulmonary edema can be caused by severe fluid overload. b. Manifestations include anxiety, tachycardia, increased vein distention, premature ventricular contractions, dyspnea at rest, change in level of consciousness, restlessness, lethargy, ascending crackles (fluid level within lungs), and cough productive of frothy pink-tinged sputum. 2. NURSING ACTIONS a. Position the client in high-Fowler’s to maximize ventilation. b. Administer oxygen, positive airway pressure, and/or possible intubation and mechanical ventilation. c. Administer morphine, nitrates, and diuretic as prescribed if blood pressure is adequate. b. Food Safety: Caring for a Client Who Is Taking Levodopa-Carbidopa i. Dopaminergics 1. When given orally, medications such as levodopa are converted to dopamine in the brain, increasing dopamine levels in the basal ganglia. 2. Dopaminergics may be combined with carbidopa to decrease peripheral metabolism of levodopa, requiring a smaller dose to make the same amount available to the brain. Adverse effects are subsequently less. 3. Due to medication tolerance and metabolism, the dosage, form of medication, and administration times must be adjusted to avoid periods of poor mobility. ii. NURSING ACTIONS : 1. Monitor for the “wearing-off” phenomenon and dyskinesias (problems with movement), which can indicate the need to adjust the dosage or time of administration or the need for a medication holiday. c. Gastrointestinal Disorders: Dietary Teaching About Celiac Disease i. CLIENT EDUCATION 1. Eat foods that are gluten-free (milk, cheese, rice, corn, eggs, potatoes, fruits, vegetables, fresh meats and fish, dried beans). 2. Read labels on processed products. Gravy mixes, sauces, cold cuts, soups, and many other products have gluten as an ingredient. 3. Read labels and research nonfood products (lipstick, communion wafers, vitamin supplements), which also can have gluten as an ingredient. b. Laboratory Values a. Cardiovascular and Hematologic Disorders: Interpreting Cholesterol Levels b. High-density lipoprotein (HDL) cholesterol is “good” cholesterol because it removes cholesterol from the body tissue and takes it to the liver. Levels greater than or equal to 60 mg/dL for males and 70 mg/dL or greater for females provide some protection against heart disease. c. Low-density lipoprotein (LDL) cholesterol is “bad” cholesterol because it transports cholesterol out of the liver and into the circulatory system, where it can form plaques on the coronary artery walls. The optimal range for LDL is less than 130 mg/dL. a. Optimal total cholesterol level is less than 200 mg/dL. c. Illness Management - (1) a. Noninflammatory Bowel Disorders: Teaching About Managing Irritable Bowel Syndrome i. IBS is a disorder of the gastrointestinal system that causes changes in bowel function (chronic diarrhea, constipation, bloating, and/or abdominal pain). ii. The etiology of IBS is uncertain, but it is thought that environmental, immunological, genetic, hormonal, and stress influence the development and course of the disease. Food intolerances worsen the manifestations. iii. Environmental factors: Dairy products, caffeinated beverages, infectious agents iv. Immunological factors: Cytokine genes (pro-inflammatory interleukins), tumor necrosis factor (TNF) alpha v. Stress-related factors: Anxiety, depression vi. IBS is diagnosed primarily based on the presence of manifestations. Criteria can include recurrent abdominal pain for 3 days during a month in the past 3 months, and two or more of the following. vii. Improvement when the client moves their bowels viii. Onset when there is a change in frequency of stools ix. Onset when there is a change in appearance of stools x. HEALTH PROMOTION AND DISEASE PREVENTION 1. Avoid foods that trigger exacerbation (dairy, wheat, corn, fried foods, alcohol, spicy foods, aspartame). 2. Avoid alcoholic and caffeinated beverages, and other fluids containing fructose and sorbitol. 3. Consume 2 to 3 L fluid per day from food and fluid sources. 4. Increase fiber intake (approximately 30 to 40 g/day). xi. CLIENT EDUCATION 1. Manifestations should resolve within 1 to 4 weeks. Discontinue medication after 4 weeks if manifestations persist. 2. Avoid concurrent use of psychoactive drugs and antihistamines. 3. Report constipation, fever, increasing abdominal pain, fatigue, dark urine, bloody diarrhea, or rectal bleeding immediately because alosetron can cause ischemic colitis. Discontinue medication if these manifestations occur.