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Ati rn nutrition 2023
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Medical/Surgical History: Tonsillectomy age 5, Gravida 0
Family History: Parent hypertension, prostate hypertrophy (father); diabetes, cataract, hyperthyroid (mother)
Tobacco/Substance Use: Occasional vape, denies use of other illicit substances or alcohol
Medications: None
Today:
28-year-old female client is here for annual visit. Reports they recently started a new job and have experienced increased fatigue.
1 year ago:
Weight 95.3 kg (210 lb) Height 160 cm (63 in)
BMI 37.2
Temperature 36.4° C (97.5° F)
Heart rate 82/min
Respiratory rate 20/min
Blood pressure 126/74 mm Hg
SaO2 95% on room air
Today:
Weight 99.3 kg (219 lb)
Height 160 cm (63 in)
BMI 38.8
Temperature 37.2° C (99° F)
Heart rate 92/min
Respiratory rate 22/min
Blood pressure 136/85 mm Hg
SaO, 95% on room air
Today:
WBC count 6,500/mm3 (5,000 to 10,000/mm3)
RBC count 5.2 x 105/μL (4.2 to 5.4 x 10/μL)
Hemoglobin 10.1 g/dL (12 to 16 g/dL)
Hematocrit 36% (37% to 47%)
Platelets 155,000/mm3 (150,000 to 400,000/mm3)
Thyroid stimulating hormone 3 mU/L (0.3 to 5 mU/L)
Blood glucose 110 mg/dL (less than 200 mg/dL)
A nurse in a provider's office is caring for a client.
The client is at greatest risk for developing
Explanation
- Anemia: The client's hemoglobin level is 10.1 g/dL, which is below the normal reference range of 12 to 16 g/dL for females. This, along with the hematocrit being slightly low at 36%, indicates anemia, which can contribute to symptoms like fatigue.
- Hypertension: The client's blood pressure is 136/85 mm Hg, which falls into the elevated to stage 1 hypertension range. Combined with a BMI of 38.8, which classifies the client as obese, she is at increased risk of developing hypertension over time.
- Hyperthyroidism is unlikely given her normal TSH level and the symptom of fatigue, which is more consistent with hypothyroidism or anemia.
- Malnutrition is not indicated, as the client is overweight and has no signs of nutrient deficiencies aside from anemia.
- Leukemia is unlikely given her normal WBC and platelet counts, and there are no associated symptoms like bruising, frequent infections, or severe fatigue beyond what's explained by anemia.
1 week ago:
The client is admitted to the oncology unit to initiate radiation and chemotherapy for endometrial cancer. Consent for treatment signed.
Today, 1200:
The client reports a decrease of appetite and that everything has an odd aftertaste. The client reports nausea and has vomited once today. The client has had two bowel movements and steatorrhea is noted. The client reports abdominal pain as 6 on a scale of 0 to 10.
Today, 1200:
Temperature 37.2° C (99° F)
Heart rate 75/min
Respiratory rate, 18/min
Blood pressure 110/78 mm Hg
Oxygen saturation 97% on room air
Past 8 hr:
Intake 400 mL
Urine output 340 mL
A nurse on an oncology unit is caring for a client.
Complete the following sentence by using the lists of options.
The nurse should recognize the client is most likely experiencing
Explanation
- Malabsorption syndrome: While steatorrhea indicates fat malabsorption, this diagnosis is too general. The client’s symptoms are more likely linked to recent pelvic radiation, making a treatment-induced etiology more probable. There is no evidence of chronic GI disease or a primary malabsorption disorder that predates cancer treatment.
- Tumor lysis syndrome: Typically presents with hyperuricemia, hyperkalemia, and acute kidney injury due to rapid tumor breakdown, not GI symptoms. The client’s vital signs and urine output are stable, with no lab evidence of metabolic abnormalities or renal failure.
- Radiation enteritis: Caused by radiation damage to the small bowel, common in pelvic cancer treatments like for endometrial cancer. Symptoms such as nausea, steatorrhea, abdominal pain, and anorexia strongly support this diagnosis, especially within a week of initiating radiation.
- Steatorrhea : Fatty stools indicate impaired fat absorption due to inflammation of the intestinal lining, consistent with radiation-induced enteritis. This is a key symptom supporting a diagnosis related to intestinal damage from radiation.
- Metallic taste: Common with chemotherapy but non-specific; it does not indicate the underlying cause of malabsorption or abdominal discomfort. While notable, it’s not as critical as steatorrhea for identifying radiation enteritis.
- Constipation: The client reports two bowel movements today, so constipation is not present and contradicts the clinical picture. Steatorrhea, rather than absence of bowel movements, suggests increased motility or malabsorption.
4 months old:
Infant in office for routine physical examination. Infant is exclusively breastfed and feeding well. Parent states that they will be moving to a rural area in a few weeks. Infant is happy and active. Respirations clear bilaterally, heart rate and rhythm regular.
5 years old:
Preschooler unable to bear weight on legs when walking. Preschooler in office for physical examination. Family recently returned to the area after living in a rural area for the past 5 years. The parent states the preschooler is a very picky eater. The preschooler refuses all dairy products and only agrees to eat chicken nuggets. The preschooler is alert and active. Respirations clear bilaterally. Heart rate and rhythm regular. Abdomen soft, nontender. Legs are bowed bilaterally.
5 years old:
Vitamin D 5 ng/mL (25 to 80 ng/mL)
A nurse in a clinic is caring for a client.
Click to highlight the findings that require follow-up by the nurse. To deselect a finding, click on the finding again.
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Nurses' Notes
5 years old:
Preschooler unable to bear weight on legs when walking. Preschooler in office for physical examination. Family recently returned to the area after living in a rural area for the past 5 years. The parent states the preschooler is a very picky eater. The preschooler refuses all dairy products and only agrees to eat chicken nuggets. The preschooler is alert and active. Respirations clear bilaterally. Heart rate and rhythm regular. Abdomen soft, nontender. Legs are bowed bilaterally.
Laboratory Results
5 years old:
Vitamin D 5 ng/mL (25 to 80 ng/mL)
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Explanation
- Preschooler unable to bear weight on legs when walking: This is a concerning physical limitation in a child of this age and suggests a possible musculoskeletal or nutritional disorder. In vitamin D deficiency, it may indicate bone pain or weakness due to poor mineralization, requiring prompt evaluation and intervention.
- Preschooler refuses all dairy products: Dairy products are a primary source of dietary calcium and often fortified with vitamin D, both essential for healthy bone development. A prolonged lack of dairy in a young child's diet can lead to nutritional deficiencies, particularly if the overall diet is limited or unbalanced.
- Legs are bowed bilaterally: Bowed legs in a preschool-aged child are a classic sign of rickets, a condition resulting from vitamin D deficiency. This skeletal deformity reflects impaired bone development and mineralization and warrants immediate medical follow-up to prevent further complications.
- Vitamin D 5 ng/mL (25 to 80 ng/mL): This level is critically low and indicates a severe vitamin D deficiency. Such a deficiency impairs calcium absorption, leading to weakened bones and increasing the risk for rickets, fractures, and long-term skeletal issues if not corrected.
2 days ago:
Client returned from operating room following a colon resection. Client has a colostomy. Stoma is red and moist. Skin around stoma intact. Bowel sounds hypoactive. Education provided on care of the stoma.
Today:
Client is ready for discharge. Stoma is red and moist, skin is intact around stoma with no breakdown noted, colostomy bag is in place with small amount of soft, formed stool. Bowel sounds normoactive in all 4 quadrants. Education provided on nutrition for colostomies.
Today:
Temperature 37° C (98.6° F)
Heart rate 72/min
Respiratory rate 14/min
Blood pressure 124/84 mm Hg SpO2 99% on room air
A nurse on a medical-surgical unit is caring for a client.
Select the 5 client statements that indicate an understanding of the discharge teaching on nutrition.
Two weeks ago:
Client presents to office with missed menses and states they had a positive home pregnancy test a week ago. Provider assessment performed and labs obtained.
0930:
Client called office with reports of nausea and vomiting. Client states, "I feel nauseous most of the day and don't think I am eating enough to support my baby."
Two weeks ago:
Serum human chorionic gonadotropin positive
A nurse is caring for a client at a provider's office.
Select 4 statements the nurse should plan to include when providing teaching to the client.
A nurse is planning care for a client who had a stroke and is having difficulty eating. Which of the following interventions should the nurse include in the plan?
A nurse is caring for a client who is receiving chemotherapy treatments. The client states, "I feel so nauseated after my treatments." Which of the following instructions should the nurse provide the client? (Select all that apply.)
A nurse is teaching a client who has dysphagia. Which of the following instructions should the nurse include
A nurse is teaching a client who reports wanting to lose weight about behavioral modifications. Which of the following statements should the nurse include in the teaching?
A nurse is providing teaching to a client who recently had a hemoglobin A1c level obtained. Which of the following statements should the nurse include in the teaching?
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