Study Guide Proctored ATI
• Age-related macular degeneration (AMD) (eyes) - o Inc lutein (carotenoid found in vit
A) foods - kale, spinach, collards, mustard greens
o Inc antioxidants, vit E & B12
• Anorexia nervosa - o Weight pt DAILY @ the same time
o Stay w/ pt during and 1hr after meal (pv vomit)
o RN sched meals
o Privileges based on direct wt gain
• Atorvastatin - o Lipitor (tx high cholesterol)
o Okay to take w/ OJ, coffee, milk
o Contraindicated w/ grapefruit juice (cx inc serum lvl)
• Braden scale - o Very poor (1) very poor nutrition
o Probably inadequate (2) ½ meals & sometimes sup
o Adequate (3) >1/2 & refuses sometimes
o Excellent (4) eats q meal & between meals
• Breast feeding - o No water f/ baby ONLY milk
o No sup formula d/t nipple confusion
o Feed on demand x8-12/day
o x5min feed on each breast 1st day after birth
o breast milk is all that is needed f/ 1st 6mo (nutritionally complete)
o no cow's milk until 1yr
o cottage cheese is a complete protein, eat when lactating
o incomplete proteins - legumes, peanut butter, & whole grain cereal
o storage - discard after feeding (cannot refreeze/use), store f/ 6-12mo, do not thaw in
microwave
• Bronchitis - o Enteral feeding - high protein, fat, & calorie; low carbs (breakdown prod
CO2)
• Calcium - o Almonds highest
o Yogurt 315mg
o Cheese 214mg
o Egg 25mg
o Spinach 122mg
• Cancer - o Sensitivity to odor ∴ dec aromatic foods to dec NV
o Avoid hot foods d/t odor
o Sm, freq meals q2hr
o Inc citrus food, pickles, & mouth wash to prod more saliva to dec metallic taste
o Inc cal & protein but not TOO high cal (cx cancer)
o Eat 2.5 cups fruit to maintain wt
o Exercise >150min/wk
o Limit alcohol male (2) & female (1)/day
o Use plastic utensils (dec metallic taste)
o Inc fluid & tart f/ taste
o Prevention - 4-5 servings (2.5 cups) fruits & veggies/day; limit alcohol; inc whole grain
not refined; limit processed meats d/t inc sodium lvl; inc lean cuts w/out skin
• Captopril - o Limit potassium rich foods (cantaloupe)
• Carbohydrate - o Starchy vs non-starchy veggies
o 3-5 carbs/meal (45g)
o portion size effects carbs
o carb not r/t calorie amt
• Cardiovascular - o Inc K to dec risk HTN
o Inc fiber to dec cholesterol
o Dec trans FA
o x2> fatty fish/wk to dec HTN
o Limit alcohol & sodium
• Celiac - o No gluten (wheat, barely, rye)
• Child - o Dec choke ∴ peanut butter & celery, whole grapes, pretzels
o <2y/o whole milk
o >2y/o low fat milk
• Cirrhosis + ascites - o Limit sodium intake 2000mg / 2g
o Limit fluids to 1.5L
o 0.8-1.2g/kg protein pv malnutrition
o consume vit K d/t dec prothrombin prod by liver ∴ @ risk clots
• Cleft lip - o Feed upright
o Nipple to side of mouth to pv enter nasal passage
• Colostomy - o cx loose stool ∴ thicken w/ pectin
o return regular diet 6 wk post op
o fiber w/ cx obstruction
• Constipation - o Inc Ca dec peristalsis
• COPD - o 6 sm meals/day
o drinks w/ inc protein/cal between meal
o add gravy/sauce to pv dry mouth
o soft diet will dec SOB w/ chew
• Crohn's Disease - o Dec fiber, lactose, fructose
o Eat eggs (easily digest & high protein)
• DASH diet - o Dec Na to 135-145mEq/L
o Glucose 70-110mg/dL
o Total cholesterol <200mg/dL
• Dehydration - o Cont infusion enteral feeding to pv high carb load w/ each IM feed
• Diabetes mellitus - o Goal HgbA1c <7% - shows avg glucse lvl over past few mo ∴
>7% = not follow diet & avg high sugar lvl
• Dumping syndrome - o Drink liquid to slow movement
o Complex carbs better than simple
o Not associate w/ fat or protein content of food
o Lie down after eat to slow food movement via GI
o Dec fiber to slow gastric emptying
• Dysphagia - o Palpate throat during swallow
o High fowler 90 degrees
o Assess food pockets
o Allow rest b4 meal
o Do not hyper extend neck
o Neck to chest to pv aspiration
o S/s - painful swallow, change in voice
o @ risk if drool
o do not drink via straw
o place food on unaffected side of mouth
o limit disruptions during eating
o take sm bites
o mechanical soft diet - fruits & veggies easy to chew, thickener f/ liquids, altered
texture (mashed potatoes)
• Electrolyte imbalance - o Dec sodium - confusion, headache, N, dizzy, abd cramp
o Inc sodium - confusion, thirst, weakness
o Inc phos = dec Ca - numb/tingle, tetany
o Dec K - irregular HR, muscle weak, leg cramp, anorexia
o Inc K - VD, dysrhythmias, muscle weak
o Dec Cl - lack of emotion, anorexia, muscle cramp
o Inc Cl - V
• End-stage kidney disease (ESKD) - o Limit potassium intake d/t dec kidney excretion
of K
• Enteral (w/in GI) tube feed - o Place in fowlers position
o Verify tube placement
o Check residual
o Flush w/ 30mL water
o Admin @ room temp; cold induce cramp/D
o Admin @ full strength
o Bolus IM feeding over 15-30min
o IM feeding over 30-60min
o Promote tolerance - inc vol each feeding f/ 1st 4-6hr
o Discard open cans in 24hr
o Feed in sm, freq
o Switch to high cal to pv D
o Dec abd distention risk to pv aspiration - ambulate, turn pt on R side (inc GI
movement), avoid inc rat, switch to low fat formula (NOT high fat)
o If tube clogs switch to less cal dense formula
o Tube feeding stops - flush 30-50mL warm water to re-establish flow
o Pv aspration w/ monitor gastric residuals q4hr, HOB 30-45 degrees, check tube
placement w/ xray once @ beginning
o Maintain patency by flushing 30-50mL water b4 & after Rx
o Dec D - low fat formula, cont feed, warm b4 admin, dec rate to inc abs
• Failure to thrive (toddler) - o Dec distraction during feeding
o Cont feed regardless of behavior
o Limit fruit juice 4oz/day
o Schedule meals @ same time each day
o Maintain unhurried meal time 20-30min inc positive eat habit
• Fasting RN ?s - o Exempt f/ fast during illness
o Fasting mean no liquids
o Fasting certain hours of day
o Fasting only apply to certain type(s) food
• Female dec risk HTN - o Low fat milk
o 4-5 servings unsalted nuts
o <=1 alcohol/day
• Ferrous sulfate (iron) - o Take between meals w/ JUICE
o Dec abs w/ eggs, milk, caffeine
o Do not take w/ Ca sup d/t dec abs Fe
o Inc abs w/ vit C (tomato / orange juice)
• Fiber - o Bran cereal 8.8g
o Apple w/ skin 3.3g
o Banana 3g
o Oatmeal 2g
o Replace meat entreee w/ main dish peas/beans
o Add 2tbs or ¼ cup brain
o Leave skin on when eating fruit
o Inc fluid intake w/ inc fiber intake
• Fluid Overload - o Dilutional hyponatremia <135mEq/dL
o Decreased Hct male 42-52% & female 37-47%
o Decreased urine specific gravity 1.005-1.030
o Decreased albumin 3.5-5g/dL
• Folate - o Liver 770 mcg
o Chickpeas 141mcg
o Orange 47mcg
o White bread 47mcg
• Gastric bypass - o 3 meals & 2 snacks/day - limit portion
o begin each meal w/ protein 60-120g/day
o eat slowly & stop when feel full
• Gero - o Req less cal d/t dec metabolism
o Req inc protein d/t inc strength, immune func, heal
o Protein intake 20-25% of cal intake
o Ca sup w/ meal (inc abs) to maintain healthy bones
o Vit D sup d/t dec ability to activate it ∴ @ risk dec Ca level
• Glycemic index - o Potato - 90
o Corn - 60
o Macaroni - 45
o Peanuts - 14
• Gout - o Dec purine foods (organ meats & seafood)
• HIV - o Infc s/t HIV tx w/ inc nutrition d/t inc metabolic rate
• Hyperglycemia - o Abd cramps, NV, acetone breath, rapid shallow RR (kussmaul),
polydipsia, vomiting, ketonuria
• Hyperkalemia - o Cx V
• Hyperlipidemia - o <3g fat f/ cheese
o limit egg+yolk to 2-3/wk
o 90% lean beef
o limit meat to 5oz/day
• Hypermagnesium - o Cx D & cramp
• Hypoglycemia - o s/s diaphoresis, irritability, tremors, tachycardia, hunger
• Ileostomy - o Inc Na to inc fluid retention to combat fluid loss
o Inc pasta/thickening agents
o Prep meals on schedule to promote reg BM
o B12 necessary to pv anemia
• Infec (dec risk w/ chemo) - o Thaw food in fridge, not room temp
o Discard leftover after 3-4days
o Eat canned goods w/in 1 yr
o Cook canned good f/ 10min b4 eat
o Heat food >140 degrees
• Inflammatory bowel disease - o Hydrolyzed formula - protein in simplest form for
simple digestion
o NOT polymeric, milk-based, modular formula
• Irritable Bowel Syndrome - o Dec High fructose
o Inc probiotics
o Peppermint oil f/ exacerbations
o Glucose is better than fructose (honey)
• Kosher - o No pork/shell fish
o No combine meat + milk
o Can eat meat & milk separate of each other
• Lactose intolerance - o Flatulence, bloating, cramping
• Lipid panel - o Niacin dec LDL & triglycerides
o Total cholesterol <200mg/dL
o HDL male >45mg/dL & female >55mg/dL
o LDL <100mg/dL
o Triglycerides <150mg/dL
• Low residue - o No whole gains, fatty meats, high fiber, fruits w/ seeds
o Eggs & banana are low residue menu options
• Malnutrition - o Dec albumin (3.5-5g/dL) = dec protein & dec wound heal
o 1.5K cal f/ proper wound heal
o s/s dry skin, ankle edema (low protein), dec reflex, weak grip, dry eyes
• MAOI Rx - o Tyramine cx HTN crisis (inc BP, headache, sweating)
o Cheese has tyramine
• Mucositis (cancer tx breaks down GI lining) - o Inc fluid intake f/ hydration & peristalsis
• Nifedipine - o Ca channel blocker
o No grapefruit juice d/t inc Rx lvl & inc risk AE
• Nutrient dense - o Pasta w/ red is better than white
o No sweet yogurt
o Canned pinto better than refried
o Canadian bacon is better than sausage f/ protein
• Obese - o 1st tx is 24 diet recall
• Osteomalacia - o 20mcg vit D sup daily
o inc antioxidant foods (vit C, E, & beta-carotene) dec free radicals
o 15mg vit E f/ antioxidant
• Pancreatitis - o Dec Ca
o Inc bilirubin
o Inc glucose (d/t dec insulin prod by pancreas)
o Inc Alk Phos
• Parkinson's Disease - o Inc metabolic rate (muscle spasms) ∴ inc cal need
o Drooling inc risk dysphagia/aspiration
o Levodopa-carbidopa abs dec w/ protein intake ∴ consume w/ low protein (wheat
bread)
o High protein - yogurt, cheese, peanut butter crackers
• Preggo - o Vegetarian diet okay
o Inc protein
o Inc iron (30mg sup)
o Dec fat/sat fat
o Norm wt gain 25-35lb w/ norm BMI
o 11-20lb wt gaim w/ abnorm BMI
o dec morning sickness - drink/eat separate to dec abd distention, eat carbs to rais
sugar quickly & dec N (eat cereal b4 get out of bed), dec fat (inc fat cx delay gastric
empty & inc N), no caffeine (l/t heartburn)
o Dec constipation - drink 240mL water/day, inc fiber, exercise regularly
o Dec NV - eat sm amt food freq
• Ramadan - o Only eat during nighttime hours (after sunset) & before dawn
o Caffeine prohibited @ any time
o Drinks consumed after meals (not with)
• Solid food w/ 4mo - o 1-2tsp @ each feeding
o majority of cal f/ milk
o fruit juice starts @ 6mo (limit to 4oz/120mL)
o start new food q 4-7days - monitory f/ allergy
• Somogyi phenomenon - o Fasting hyperglycemia that occur in morn d/t hypoglycemia
@ night
o Monitor by check glucose during night
• Stomatitis - o Food @ room temp to dec irritation
o Avoid acidity, citrus, spicy, salty
o Drink high cal/protein meal substitutes
• Stress management - o exercise
• Total parenteral nutrition (banana bag) - o PO must be 60% total cal b4 TPN can be
D/C
o Must maintain consistent rate
o Infuse dextrose 10/20 until next bag arrive d/t high sugar concentration - avoid
hypoglycemia
o Do not abruptly stop d/t metabolic comp
o TPN effective w/ prealbumin 19-38mg/dL
o Lipid emulsions made of egg phospholipid ∴ monitor egg allergy
• Vegetarian - o Low fat cheese f/ protein sup
o Low vit b12 d/t lack of animal meat ∴ may req sup
o Dec fat rather than cal
o Nutrient dense food to avoid protein breakdown f/ energy
o x2 servings nuts/flaxseed per day f/ omega 3 FA
• Vision - o Vit A
• Warfarin - o Limit foods rich in vit K (green leafy veggies)
• Wt management - o Do not taste food during prep
o Portion b4 excluding food
o 3-5 meal/day ∴ do not skip
o make a list b4 grocery shop
o limit sodium to 1500mg/day
o lose wt @ ½ to 1lb/week
o egg yoly x3/week or <
o restric meat to 5oz/day (deck of cards)
o cheese <3g fat/serving
o butter <2g saturated fat/tbs
• Zinc diet - o BEEF, pinto beans