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PN to meet nutrition needs
When the fistula output is high and distal, discontinuation of oral intake is recommended
because oral intake stimulates further loss of fluids, electrolytes and protein via the fistula. -
ANS ✔A client with a history of ovarian cancer is being treated with radiation. The client is
admitted to the hospital with a high-output distal gastrointestinal fistula and has lost 15 kg in
the last 4 months.
What nutrition intervention should the dietitian recommend?
In refeeding syndrome, a rapid increase in insulin stimulates movement of extracellular
potassium and phosphate into the cells causing a rapid fall in blood concentrations of these
ions. - ANS ✔The client is at risk for refeeding syndrome. Which electrolyte abnormalities
should the dietitian monitor?
dehydration
High-output fistula is defined by fluid loss over 500 mL/day. A high-output fistula increases the
possibility of fluid and electrolyte imbalance and puts the client at high risk of dehydration. -
ANS ✔The dietitian notices that the client's serum sodium is above the normal range. What is
the mostlikely cause?
Overhydration
Diuretic use
Inadequate sodium intake
Dehydration
CF
,Oral feeding should be initiated as soon as the gastrointestinal tract is functional. Dilute liquids
are taken first and then, as the bowel adapts, the patient begins the slow return to a regular
diet. - ANS ✔The fistula has healed, and the physician asks the dietitian to reassess the client.
What should the dietitian recommend?
Initiate nutrition support
Initiate a regular meal plan
Initiate clear fluids
Initiate a low-fibre meal plan
3 day food record
A 3-day food record would provide the best picture of usual intake as it allows the dietitian to
average intake over a 3-day period.
observation : This will provide information only for the observed meals, not total food intake.
A 24-hr recall provides no information about day-to-day variation of food intake.
Information from nursing can be subject to interpretation depending on the person.
Also, often the rotation of nursing staff can change every 8-12 hours and from day to day so
observations may not be consistent. - ANS ✔The client is now on a regular meal plan and the
dietitian wants to determine if nutrition needs are being met. What method would the dietitian
use to get an estimate of the client's usual intake?
Obtain a 3-day food intake record
Observe the client at mealtime
Complete a 24-hr food recall
Request nursing for comments on the client's intake
, Rapid and significant weight gain is most likely due to a shift in fluid balance. This is supported
by the low albumin level, which can result in edema, confirmed by theclient's ascites. - ANS ✔A
patient is admitted to hospital for shortness of breath, nausea, vomiting and ascites. The patient
reports a recent rapid weight gain of 7 kg (height: 160 cm, current weight: 67 kg). Upon
admission, lab data reveal a low serum albumin and normal liver function tests. The patient's
diet provides about 6,800 kJ (1,600 kcal) and 60 g protein. Which conclusion should the dietitian
make based on this information?
Weight gain is a positive indicator of improved nutrition status
Recent weight gain reflects an increased oral intake
Serum albumin is low due to the intake of a low-protein diet
Recent weight gain is related to low serum albumin
assess vernal and nonverbal cues
Drawing client out puts them at ease and establishes rapport. Non-verbal communication is a
reliable indicator of client apprehension - ANS ✔A client is referred to the dietitian for an initial
visit about their lactose intolerance. The referral form indicates that the client is apprehensive
and reluctant to discuss their symptoms. Which action would be most effective when
counselling the client?
Ask the client questions to assess verbal and non-verbal responses
Ask the client to record and email their symptoms before their next appointment
Provide the client with a list of lactose-free products
Outline the dietary changes the client will have to make
pre and post questionnaire: This approach assesses whether the behavioral change goals of the
program have been achieved.