Nursing Chapter 47 Homework Activities Have The Students Perform Nutritional

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Identify essential nutrients and their dietary sources.

Concepts for Lecture

1. The body’s most basic nutrient need is water. The energy-providing

nutrients are carbohydrates, fats, and proteins. Micronutrients (vita–

mins and minerals) are required in small amounts to metabolize the

energy-providing nutrients.

Starches are insoluble, non–sweet forms of carbohydrates that

exist naturally in plants such as grains, legumes, and potatoes. Cere-

als, breads, flour, and puddings are processed from starches.

Fiber is derived from plants and is found in the outer layer of

Fats are lipids that are solid at room temperature and oils are li-

pids that are liquid at room temperature. Fatty acids are the basic

structural units of most lipids. Fatty acids are either saturated (for

example, butyric acid found in butter) or unsaturated.

Unsaturated fatty acids may be monounsaturated or polyunsatu-

rated (for example, linoleic acid found in vegetable oil). Lipids are

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NUTRITION

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UGGESTIONS FOR

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• Have the students select a meal from the institu-

tion’s cafeteria and identify the essential nutri-

ents in the meal.

•

Have the students keep a food diary and use a

computer program to identify the essential

nutrients in their diet.

346 CHAPTER 47 / Nutrition

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Describe normal digestion, absorption, and metabolism of carbohydrates,

proteins, and lipids.

Concepts for Lecture

1. Major enzymes of carbohydrate digestion include ptyalin (salivary

amylase), pancreatic amylase, and the disaccharidases: maltase,

sucrase, and lactase. The desired end products are monosaccharides.

2. Digestion of protein foods begins in the mouth, where the enzyme

pepsin breaks protein down into smaller units. However, most pro-

tein is digested in the small intestine. The pancreas secretes the pro-

3.

Lipid digestion begins in the stomach, but lipids are mainly digested in

the small intestine, primarily by bile, pancreatic lipase, and enteric li-

pase. End products of lipid digestion are glycerol, fatty acids, and cho-

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Identify factors influencing nutrition.

Concepts for Lecture

1. Habits about eating are influenced by developmental considerations,

•

Have the students obtain menus from various

ethnic restaurants and compare and contrast

the essential nutrients found in various foods

offered.

• Have the students compare the cost of fresh

fruits and vegetables to the cost of canned or

frozen fruits and vegetables. Have the students

read the food labels on the canned and frozen

vegetables for additives.

teoporosis, and hypertension, for example.

Because of body composition differences and the effects of

reproductive function, men and women require different amounts of

Because of lifestyle, individuals may select convenience foods.

There are also individual differences in cooking skills, concerns

about health, and necessity to work certain shifts that can influence

nutrition. The amount of muscular activity performed daily will also

influence the type and amount of nutrients required.

health benefits of moderate alcohol consumption.

Advertising attempts to persuade individuals to purchase certain

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Identify nutritional variations throughout the life cycle.

Concepts for Lecture

1. The neonate’s fluid and nutritional needs are met by breast milk or

formula. The fluid needs of infants are proportionately greater than

those of adults because of higher metabolic rate, immature kidneys,

and greater water losses through the skin and the lungs. The addition

clients as identified in the textbook (e.g., eth-

nicity, lifestyle, health, alcohol consumption).

Discuss findings.

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• Divide the students into groups. Assign an

age group to each group. Ask the students to

develop a pamphlet addressing nutritional

requirements, nutritional issues (e.g., food

jags), and suggestions for addressing these for

the assigned age group.

2. Toddlers can eat most foods and adjust to three meals each day. By

the age of 3 when most of the deciduous teeth have emerged, the

toddler is able to bite and chew adult table food. The toddler is less

3. Preschoolers eat adult foods, are very active, and often require

snacks between meals. Cheese, fruits, yogurt, raw vegetables, and

4. The school-age child requires a balanced diet including 2,400

Kcal/day. School–age children eat three meals a day and one or two

5. During adolescence, the need for nutrients and calories increases,

particularly during the growth spurt. In particular, the need for pro-

tein, calcium, vitamin D, iron, and the B vitamins increases. An ade-

6. The nutritional habits established during young adulthood often lay

the foundation for the patterns maintained throughout an individual’s

life. Young adult females need to maintain adequate iron intake, in-

gesting 18 mg of iron daily. Calcium is needed in young adulthood

7.

Older adults require the same basic nutrition as the younger adult. How-

ever, fewer calories are needed by older adults because of the lower met-

abolic rate and the decrease in physical activity. Some older adults may

need more carbohydrates for fiber and bulk, but most nutrient require-

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Evaluate a diet using a food guide pyramid.

Concepts for Lecture

1. The Food Guide Pyramid is a graphic aid that was developed by the

U.S. Department of Agriculture (USDA) as a guide in making daily

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Discuss essential components and purposes of nutritional assessment and

nutritional screening.

Concepts for Lecture

1.

A nutritional screen is an assessment performed to identify clients at risk

for malnutrition or those who are malnourished. Clients who are found to

be at moderate or high risk are followed up with a comprehensive as-

2.

Nurses carry out nutritional screens through routine nursing histories and

physical examinations. Custom-designed screening tools for specific

populations and specific disorders are available and can be incorporated

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UGGESTIONS FOR

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• Have the students use the

www.mypyramid.gov

site to develop a meal

plan for themselves and track their intake for 1

week. Discuss results.

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UGGESTIONS FOR

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•

Have the students select a partner and perform a

24-hour food recall.

• Have the students practice performing a phys-

ical examination (skin, hair, nails, eyes, and

mucosa) on a partner to assess for signs asso-

ciated with malnutrition.

• Invite a dietitian from the agency to discuss

the components of an in-depth nutritional

assessment.

350 CHAPTER 47 / Nutrition

The physical examination focuses on rapidly proliferating tis-

sues such as skin, hair, nails, eyes, and mucosa, but also includes a

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Identify risk factors for and clinical signs of malnutrition.

Concepts for Lecture

1. Box 47–5 presents a summary of risk factors for nutritional prob-

lems. These include factors identified in the diet history (chewing

2.

Clinical signs of malnutrition are listed in Clinical Manifestations: Mal-

nutrition. These include changes in appearance and vitality; over– or un-

derweight; dry, flaky, pale, or pigmented skin; presence of petechiae or

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Describe nursing interventions to promote optimal nutrition.

Concepts for Lecture

1. Nursing interventions to promote optimal nutrition for hospitalized

clients are often provided in collaboration with the primary care pro-

vider who writes the diet orders and the dietician who informs cli-

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UGGESTIONS FOR

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• Discuss the most common risk factors for

malnutrition in the local community.

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UGGESTIONS FOR

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• Have the students plan a presentation for the

educational institution on optimal nutrition.

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2. In the community setting, the nurse’s role is largely educational. In

the home setting, nurses initiate nutritional screens, refer clients at

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Discuss nursing interventions to treat clients with nutritional problems.

Concepts for Lecture

1. Nursing interventions include assisting clients with special diets,

stimulating the appetite, assisting clients with meals, referring clients

to special community nutritional services, and providing enteral and

parenteral nutrition.

Assisting clients and support individuals with special diets is a

Guidelines for providing meals to clients are summarized in Box

47–10. When feeding a client, ask in which order the client would

like to eat the food. Allow ample time for the client to chew and

swallow the food. Provide fluids as requested. If the client is unable

to communicate, offer fluids after every three or four mouthfuls of

solid food. Make the time pleasant, choosing topics of conversation

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Arrange for several students to observe the prep-

352 CHAPTER 47 / Nutrition

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Verbalize the steps used in:

a. Inserting a nasogastric tube.

Concepts for Lecture

1. Skill 47–1: Inserting a Nasogastric Tube, lists the steps in this pro-

cedure. Essential steps include: assess the nares to determine ob-

structions to airflow; select the nostril with greatest airflow; prepare

the tube by ensuring that the stylus or guidewire is secured; deter-

the client to hyperextend his or her head and insert along the floor of

the nasal passage through the nasopharynx; withdraw if resistance is

met; once the tube is in the oropharynx, ask the client to tilt the head

2. Skill 47–2: Removing a Nasogastric Tube lists the steps in this pro-

cedure. Essential steps include: detach the tube from suction, the cli-

3.

Skill 47-3: Administering a Tube Feeding lists the steps in this proce-

dure. Essential steps include: correctly position the client prior to feed-

ing; assess tube placement; assess residual feeding volume and hold if

greater than 100 mL or greater than 1/2 volume of last feeding according

to agency policy; re-instill residual according to agency policy; check re-

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• Demonstrate the use of the feeding pumps

used in the institution.

• Whenever possible, assign students to insert

nasogastric tubes, provide care for clients who

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UGGESTIONS FOR

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• Have the students practice performing inser-

tion of nasogastric tubes and administering

feedings on manikins.

CHAPTER 47 / Nutrition 353

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Recognize when it is appropriate to delegate aspects of feeding clients to

unlicensed assistive personnel.

Concepts for Lecture

1. Insertion of a nasogastric tube is an invasive procedure requiring

application of knowledge (e.g., anatomy and physiology, risk fac-

nasogastric tube.

2. Due to the need for assessment of client status, the skill of removing

a nasogastric tube is not delegated to UAP.

3.

Administering a tube feeding requires application of knowledge and

problem solving and it is not usually delegated to UAP. Some agencies,

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Plan, implement, and evaluate nursing care associated with nursing diagnoses