NU 311 Skills Exam 4 Questions With Complete Solutions
Risk Factors for Nutritional Problems
•Clear- or full-liquid diets for more than 3 days without
nutrient supplementation or inappropriate or insufficient
nutrient supplementation
•Intravenous feeding (dextrose or saline) or NPO for more
than 3 days without supplementation
•Low intakes of prescribed diet or tube feedings
•Weight 20% above or 10% below desirable body weight
(accounting for edema)
•Pregnancy weight gain deviating from normal patterns
•Diagnoses that increase nutritional needs or decrease
nutrient intake (or both): cancer, malabsorption, diarrhea,
hyperthyroidism, excessive inflammation, postoperative
status, hemorrhage, infected or draining wounds, burns,
infection, major trauma
•Chronic use of drugs, especially alcohol, that affect
nutritional intake
•Alterations in chewing, swallowing, appetite, taste, and
smell
•Body temperature consistently above 37° C (98.6° F) for
more than 2 days
,•Hematocrit: <43% in men, <37% in women; hemoglobin
<14 g/dL in men, <12 g/dL in women
Absolute decrease in lymphocyte count (<1500 cells/mm3)
•Elevated (>250 mg/dL) or decreased (<130 mg/dL) total
plasma cholesterol
Serum albumin <3 g/dL in patients without renal or liver
disease, generalized dermatitis, overhydration.
· Remaining NPO (nothing by mouth)
Clear-liquid
Foods that are clear and liquid at room or body temperature
(e.g., water, apple or cranberry juice, gelatin, Popsicles), that
leave little residue, and are easily absorbed; commonly ordered
for short-term use (24 to 48 hours) after surgery, before
diagnostic tests, and after episodes of diarrhea and vomiting
Full-liquid
Includes foods on clear-liquid diet plus addition of smooth-
textured dairy products (e.g., milk and ice cream), strained soups
and custard, refined cooked cereals, vegetable juice, and pureed
vegetables; commonly ordered before or after surgery for
patients who are acutely ill from infection or for patients who
cannot chew or tolerate solid foods; must verify that patients are
able to tolerate lactose before providing dairy products
Pureed
Includes foods on clear- and full-liquid diet plus easily
swallowed foods that do not require chewing (e.g., scrambled
,eggs, pureed meats, vegetables, fruits, mashed potatoes).
Ordered for patients with head and neck abnormalities or who
have had oral surgery. Can be modified for low sodium, fat, or
calorie count
Mechanical or dental-soft
Consists of all previous diets plus addition of lightly seasoned
ground or finely diced meats, flaked fish, cottage cheese, cheese,
rice, potatoes, pancakes, light breads, cooked vegetables, cooked
or canned fruit, bananas, and peanut butter; avoid tough meats,
nuts, bacon, and fruits with tough skins or membranes; ordered
for patients who have chewing problems or mild GI problems;
used as a transition diet from liquids to regular
Soft/low-residue
Addition of low-fiber, easily digested foods such as pastas,
casseroles, moist tender meats, and canned cooked fruits and
vegetables; includes foods that are easy to chew and simply
cooked; does not permit fatty, rich, and fried foods; sometimes
referred to as low fiber
High-fiber
Addition of fresh uncooked fruits, steamed vegetables, bran,
oatmeal, and dried fruits; includes sufficient amounts of
indigestible carbohydrates to relieve constipation, increase GI
motility, and increase stool weight
Restricted fluids
Required in severe heart failure or kidney failure
, Sodium-restricted
Low levels of sodium: may include a 4-g (no added salt), 2-g
(moderate), 1-g (strict), or 500-mg (very strict) diet; may be
ordered for patients with heart failure, renal failure, cirrhosis, or
hypertension
Fat-modified
Low total and saturated fat and low cholesterol intake limited to
less than 300 mg daily, and fat intake 30% to 35%; eliminates or
reduces fatty foods for hypercholesterolemia, malabsorption
disorders, and diarrhea
Diabetic
Essential treatment for patients with diabetes mellitus; provide
patient with a diet recommended by the American Diabetes
Association, which allows for patients to select set amount of
food from basic food groups.
Causes of Dysphagia
-Neurogenic
• Stroke
• Cerebral palsy
• Guillain-Barré syndrome
• Multiple sclerosis
• Amyotrophic lateral sclerosis (Lou Gehrig's disease)
• Diabetic neuropathy
• Parkinson's disease
-Myogenic
• Myasthenia gravis
Risk Factors for Nutritional Problems
•Clear- or full-liquid diets for more than 3 days without
nutrient supplementation or inappropriate or insufficient
nutrient supplementation
•Intravenous feeding (dextrose or saline) or NPO for more
than 3 days without supplementation
•Low intakes of prescribed diet or tube feedings
•Weight 20% above or 10% below desirable body weight
(accounting for edema)
•Pregnancy weight gain deviating from normal patterns
•Diagnoses that increase nutritional needs or decrease
nutrient intake (or both): cancer, malabsorption, diarrhea,
hyperthyroidism, excessive inflammation, postoperative
status, hemorrhage, infected or draining wounds, burns,
infection, major trauma
•Chronic use of drugs, especially alcohol, that affect
nutritional intake
•Alterations in chewing, swallowing, appetite, taste, and
smell
•Body temperature consistently above 37° C (98.6° F) for
more than 2 days
,•Hematocrit: <43% in men, <37% in women; hemoglobin
<14 g/dL in men, <12 g/dL in women
Absolute decrease in lymphocyte count (<1500 cells/mm3)
•Elevated (>250 mg/dL) or decreased (<130 mg/dL) total
plasma cholesterol
Serum albumin <3 g/dL in patients without renal or liver
disease, generalized dermatitis, overhydration.
· Remaining NPO (nothing by mouth)
Clear-liquid
Foods that are clear and liquid at room or body temperature
(e.g., water, apple or cranberry juice, gelatin, Popsicles), that
leave little residue, and are easily absorbed; commonly ordered
for short-term use (24 to 48 hours) after surgery, before
diagnostic tests, and after episodes of diarrhea and vomiting
Full-liquid
Includes foods on clear-liquid diet plus addition of smooth-
textured dairy products (e.g., milk and ice cream), strained soups
and custard, refined cooked cereals, vegetable juice, and pureed
vegetables; commonly ordered before or after surgery for
patients who are acutely ill from infection or for patients who
cannot chew or tolerate solid foods; must verify that patients are
able to tolerate lactose before providing dairy products
Pureed
Includes foods on clear- and full-liquid diet plus easily
swallowed foods that do not require chewing (e.g., scrambled
,eggs, pureed meats, vegetables, fruits, mashed potatoes).
Ordered for patients with head and neck abnormalities or who
have had oral surgery. Can be modified for low sodium, fat, or
calorie count
Mechanical or dental-soft
Consists of all previous diets plus addition of lightly seasoned
ground or finely diced meats, flaked fish, cottage cheese, cheese,
rice, potatoes, pancakes, light breads, cooked vegetables, cooked
or canned fruit, bananas, and peanut butter; avoid tough meats,
nuts, bacon, and fruits with tough skins or membranes; ordered
for patients who have chewing problems or mild GI problems;
used as a transition diet from liquids to regular
Soft/low-residue
Addition of low-fiber, easily digested foods such as pastas,
casseroles, moist tender meats, and canned cooked fruits and
vegetables; includes foods that are easy to chew and simply
cooked; does not permit fatty, rich, and fried foods; sometimes
referred to as low fiber
High-fiber
Addition of fresh uncooked fruits, steamed vegetables, bran,
oatmeal, and dried fruits; includes sufficient amounts of
indigestible carbohydrates to relieve constipation, increase GI
motility, and increase stool weight
Restricted fluids
Required in severe heart failure or kidney failure
, Sodium-restricted
Low levels of sodium: may include a 4-g (no added salt), 2-g
(moderate), 1-g (strict), or 500-mg (very strict) diet; may be
ordered for patients with heart failure, renal failure, cirrhosis, or
hypertension
Fat-modified
Low total and saturated fat and low cholesterol intake limited to
less than 300 mg daily, and fat intake 30% to 35%; eliminates or
reduces fatty foods for hypercholesterolemia, malabsorption
disorders, and diarrhea
Diabetic
Essential treatment for patients with diabetes mellitus; provide
patient with a diet recommended by the American Diabetes
Association, which allows for patients to select set amount of
food from basic food groups.
Causes of Dysphagia
-Neurogenic
• Stroke
• Cerebral palsy
• Guillain-Barré syndrome
• Multiple sclerosis
• Amyotrophic lateral sclerosis (Lou Gehrig's disease)
• Diabetic neuropathy
• Parkinson's disease
-Myogenic
• Myasthenia gravis
