Concept of Nutrition

Activity
1. Re – read the concept of nutrition found in your Fundamentals in Nursing book.
2. Analyze the case study and do the following:
a. Answer the given question and provide a rationale
b. Create Nursing care plan appropriate to the client given
c. Produce Client health teaching plan.

Case study

Carlyn Lim is an 84 year old woman who was admitted with a diagnosis of Cerebro Vascular
Accident. she is 70 inches tall and weighs 153 lbs with a usual weight of 180 lbs. Her family
reports that she has a long history of alcoholism. After the first 36 hours of admission, her
voluntary intake is reported to be very poor. She is unable to communicate with caregivers and
family and has marked difficulty swallowing. Her latest order is Isocal HCN is ordered at 65
ml/hr.because of the abdominal distension and excess residuals,

She has the following lab reports:

Pertinent admission labs
Value Normal

5 to 25
BUN 42 mg/dl
mg/dl
0.5 to 1.5
Creatinine 1.9 mg/dl
mg/dl
135 to 145
Sodium 151 mEq/dl
mEq/dl
3.5 to 5.0
Potassium 5.1 mEq/dl
mEq/dl
3.5 to 5.0
Albumin 3.1 g/dl
g/dl

Questions

What are her initial estimated calorie, protein, and fluid requirements?

What metabolic problem is she at risk of developing?

What mechanical problem is she at risk of experiencing?

Does the latest order meet all of the patient's nutrition needs?

What is a better option at this point?

What is a long term solution?

Quiz
1. Which of the following accurately describes the greatest risk related to having a feeding tube?
A) Electrolyte imbalance
B) Fluid volume overload
C) Infection
D) Aspiration

2. A patient had an NG feeding tube inserted 1 week ago. You notice that the patient's nasal mucosa is
inflamed, and the patient complains of pain at the site of insertion. The other naris appears patent with intact
skin. What is the best action to take at this time?
A) Call the health care provider; get an order to remove the feeding tube and insert a new feeding tube in the
opposite naris.
B) Remove the feeding tube and reinsert it in the opposite naris.
C) Apply triple antibiotic ointment at the site of insertion and leave the tube in place.
D) Medicate the patient for pain and stop using the feeding tube.

3. The patient's wife is watching as the nurse prepares to insert a small bore feeding tube. She asks the nurse,
"What is the purpose of the guide wire?" The nurse correctly responds:
A) "Because placement must be verified by a chest x-ray, the guide wire is used to determine correct
placement when it shows up on radiography."
B) "To keep the patient from pulling the tube out as readily."
C) "To serve as a guide to determine when the correct length of tubing has been inserted."
D) "Because feeding tubes are flexible, a guide wire or stylet is used to provide rigidity that facilitates
positioning."

4. A client who is receiving total enteral nutrition (TEN) exhibits acute confusion and shallow breathing and
says, "I feel weak." As the client begins to have a generalized seizure, how does the nurse interpret this client's
signs and symptoms?
A. The enteral tube is misplaced or dislodged.
B. Abdominal distention is present.
C. A fluid and electrolyte imbalance is present.
D. This is refeeding syndrome.

5. A stroke client who was initially on NGT feeding was able to tolerate soft diet so the physician
ordered for the removal of it. The nurse would instruct the client to do which of the following before he
removes the tube?
A. Inhale and exhale simultaneously.
B. Take a long breath and hold it.
C. Do a Valsalva maneuver.
D. Blow the nose.

6. Before feeding a client via NGT, the nurse checks for residual and obtains a residual amount of
90ml. What is the appropriate action for the nurse to take?
A. Discard the residual amount.
B. Hold the due feeding.
C. Skip the feeding and administer the next feeding due in 4 hours.
D. Reinstill the amount and continue with administering the feeding.
7. Continuous type of feedings is administered over a __ hour period.?  
A. 4.
B. 12.
C. 24.
D. 36.

8. The registered nurse is preparing to insert a nasogastric tube in an adult client. To determine the accurate
measurement of the length of the tube to be inserted, the nurse should take which action?
1. Mark the tube at 10 inches
2. Mark the tube at 32 inches
3. Place the tube at the tip of the nose and measure by extending the tube to the earlobe and then down to the
xiphoid process.
4. Place the tube at the tip of the nose and measure by extending the tube to the earlobe and then down to the
top of the sternum

9. Which patient would benefit from a Nasogastric Tube?

A. A patient with Congestive Heart Failure
B. A patient with a Platelet count of 50
C. A patient who had a left leg amputation
D. A stroke victim who failed their swallow evaluation

10. A male client who is recovering from surgery has been advanced from a clear liquid diet to a full liquid diet. The client is looking
forward to the diet change because he has been “bored” with the clear liquid diet. The nurse would offer which full liquid item to the client?
A. Tea
B. Gelatin
C. ice cream
D. Popsicle

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