NUR 12 (Nutrition) Quiz 4 Study Guide Spring 2022
Chapter 21: Diet & Cancer
1. Dietary considerations
 For all: provide oral hygiene, before and after meals.
a. Mouth ulcers
Nutrient intake in clients with mouth ulcerations may be enhanced by using straws to
bypass the sores; by serving cool, smooth, bland nutrient-dense foods; and by
avoiding acidic, salty, and spicy foods.

For mouth ulcerations, try the following strategies:
o
o
o
o
o
o
o
o
Serve soft, mild foods.
Top foods with sauces, gravies, and dressings, which may make
foods easier to eat.
Serve cream soups and milk, which provide much nutrition for the
volume ingested.
Serve cold foods, which have a somewhat numbing effect and
may be better tolerated than hot food.
Include liquids with meals to help wash down the food.
Introduce drinking straws, which may detour liquids around mouth
ulcerations.
Avoid these irritants (a highly recommended strategy): hot items,
salty or spicy foods, acidic juices, and alcohol (even in
mouthwash).
If necessary, seek an anesthetic mouthwash, which can be
prescribed. If the mouth is anesthetized, clients should be
instructed to chew slowly and carefully to avoid biting their lips,
tongue, or cheeks.
b. Low WBC
Protective isolation is common for clients with altered immune responses. Dietary
strategies to protect the immunosuppressed client are directed at strict
adherence to food safety and sanitation procedures. Some providers may wish to
limit the client’s access to unpasteurized, uncooked, and unwashed foods.

Institute protective isolation to minimize exposure to microorganisms.

Observe strict procedures for food safety and sanitation (see Chapter 13).
c. Reducing the risk of cancer
The best dietary advice to prevent cancer: avoid obesity, stay physically
active, consume a healthy plant-based diet with limited red and processed
meats, and drink minimal amounts of alcohol if at all.

The American Institute of Cancer Research developed the New American
Plate®.

The image is a tool, not a specialized diet, for Americans to use in order
to evaluate what they are eating to reduce cancer risk by addressing the
following components:

Eat plant-based meals that are ⅔ or greater of vegetables, fruits,
whole grains, or beans and ⅓ or less of animal proteins.

Control portion sizes.

Maintain a healthy BMI by using the above guidelines
Recommendations to Decrease Cancer Risk
For Community Action
 Increase access to healthful foods in schools, worksites, and communities.


Decrease access to and marketing of foods and drinks of low nutritional value,
particularly to youth.
Provide safe, enjoyable, and accessible environments for physical activity in schools and
workplaces, and for transportation and recreation in communities.
For Individual Choices
 Maintain a healthy weight throughout life. Be as lean as possible without being
underweight.
o Avoid excess weight gain at all ages. For the overweight person, even a small
amount of weight loss has health benefits.
o Limit intake of high-calorie foods and drinks.

Adopt a physically active lifestyle. Some activity above one’s usual level can produce
health benefits.
o Adults: 150 minutes of moderate-intensity or 75 minutes of vigorous-intensity
activity per week, preferably distributed throughout the week.
o Children and teens: 1 hour of moderate or vigorous physical activity daily with
vigorous activity 3 days per week.
o Limit sedentary behavior: sitting, lying down, screen-based entertainment.

Consume a healthy diet, emphasizing plant food sources.
o Choose amounts to maintain a healthy weight.
o Limit intake of processed meat and red meat.
o Consume at least 2½ cups of vegetables and fruits daily.
o Select whole grains in preference to refined grain products.

If alcohol is chosen, limit consumption to one standard drink per day for women and two
for men.
Chapter 22: Nutrition in Critical Care
1. Enteral feeding via gastrostomy tube
 Until peristalsis returns, the client’s stomach should not be the site of choice for a
tube feeding.

Most institutions have a policy of measuring gastric residual volume (GRV) in
clients with gastric tube feedings.

To measure stomach contents that have not been absorbed, the nurse will
periodically suction the stomach’s gastric contents using a large bore syringe.

Do not administer Enteral feeding if gastric residual volume is at 250 ml or
greater.

If the critically ill client is adequately fluid resuscitated, then enteral nutrition
should be started within 24 to 48 hours after surgery or admission to the critical
care unit.

Enteral nutrition is associated with a reduction in infectious complications and
may reduce length of stay as opposed to parenteral nutrition.

Although early enteral feeding offers many advantages, in many cases it is not
medically feasible.

A functioning GI tract is a prerequisite to enteral feeding.

These conditions preclude the use of enteral feedings:
o Low mesenteric blood (ischemic bowel)
o Severe hypotension
o Perforate bowel
o Peritonitis
o Chemotherapy- or radiation-induced mucositis
o Multisystem organ failure
2. Kilocalorie demand
 For patients who have surgery, burns, Trauma, & infection and fever.

The number of required kilocalories is typically calculated by either kcal/kg or one
of several different predictive formulas.

A surgical client with complications may require a large increase in kilocalories.

Major burns are the most extreme state of stress a client can sustain and
produce a hypermetabolic state that raises kilocaloric needs higher than those of
most other stresses.

The body needs extra kilocalories and fluids during fever because it takes more
energy to support the higher metabolic rate.

Victims of traumas may become hypermetabolic, depending on the severity of
the injury, and vitamin and mineral supplements may be necessary.
3. Acute respiratory distress
 (ARDS) is often caused by conditions such as pneumonia and is characterized
by a rapid onset of dyspnea and severe deficits in gas exchange.

O2 saturation reflects the percentage of hemoglobin saturated with oxygen and is
an indicator of inadequate oxygen delivery to tissues.

Normal oxygen (O2) saturation in adults is usually 95% to 100% in adults and
95% in the elderly.

Critical O2 saturation is equal or less than 90%.
4. Terms
a. Peristalsis
 Peristalsis, the wavelike motion that propels food through the GI tract,
ceases in some burn clients.

Until peristalsis returns, the client’s stomach should not be the site of
choice for a tube feeding.
b. Hypermetabolism
 An abnormal increase in the rate at which fuel or kilocalories are burned
is called hypermetabolism.

Characteristics of this condition are:
 Increased metabolic rate
 Negative nitrogen balance
 Hyperglycemia
 Increased oxygen consumption
Cancer, major surgery, burns, infections, and trauma are the physical
stressors that have the greatest impact on metabolism.
c. Wound infection
 Malnutrition decreases resistance to infection, and infection aggravates
malnutrition by depleting body nutrient stores.

Fever characteristically accompanies infection but can also result from a
variety of causes.

The body needs extra kilocalories and fluids during fever because it takes
more energy to support the higher metabolic rate.

Infection may result in:
o Decreased food intake and absorption of nutrients
o Altered metabolism
o Increased excretion of nutrients

Extra protein is also needed to produce antibodies and white blood cells
to fight the infection.
d. Sepsis
 Burn clients are particularly susceptible to sepsis, the state in which
disease-producing organisms are present in the blood.

Sepsis is a medical emergency that causes an overwhelming,
uncontrolled, systemic inflammatory response leading to tissue and organ
failure and death.

Major sepsis further increases a client’s metabolic rate.

Clients with indwelling catheters and central venous access devices are
at risk for sepsis.

Sepsis, of course, is not limited to burn clients; clients with surgical
trauma or infections such as pneumonia or urinary tract infections may
also suffer from sepsis.
e. Uncomplicated starvation
 Uncomplicated starvation means that the client is experiencing food
deprivation without an underlying disease state.
f.

During uncomplicated starvation, clients expend (use up) about 70% of
the kilocalories they normally need to maintain body weight.

Because of the biochemical adaptation to starvation, these clients require
fewer kilocalories than is normal for their height and weight.
Wasting syndrome
 Wasting syndrome is characterized primarily by involuntary weight loss,
consisting of both lean and fat body mass.

Wasting may be caused by undernutrition or nutrient malabsorption.

Weight loss and tissue compartment loss

When kilocaloric intake is decreased, the body begins to break down
muscle stores, including those of the respiratory muscles.

A loss in the lean mass of any muscle affects the muscle’s function.

The lung’s structure itself is thus affected as a result of catabolism, often
referred to as pulmonary cachexia.

Malnutrition may also result in decreased lung tissue cell replacement or
growth.

Clients on ventilators do not have to use their respiratory muscles to
breathe.

To some extent, all the respiratory muscles atrophy, or waste away, due
to inactivity while a client is artificially breathing.
g. Multisystem Organ Failure
 Sepsis is a medical emergency that causes an overwhelming,
uncontrolled, systemic inflammatory response leading to tissue and organ
failure and death.
h. Refeeding syndrome

Refeeding syndrome is a detrimental state that results when a previously
severely malnourished person is reintroduced to food and nutrients
improperly.

The term refeeding syndrome has been used to describe a series of
metabolic and physiological reactions that occur in some malnourished
clients when nutritional rehabilitation is begun.

Improper refeeding of a chronically malnourished client can result in
congestive heart failure (CHF) and respiratory failure.

Clients at risk include those with:
o Alcoholism
o Chronic weight loss
o Hyperglycemia, or insulin-dependent diabetes mellitus
o Included also are clients on:
o Chronic antacid or
o Diuretic therapy

Elderly persons living alone who choose not to eat or are unable to eat
because of progressive infirmity are likely candidates.

Any incompetent mentally or physically challenged adult or abused child
who has not been eating, either by choice or because of neglect, is also
at risk of experiencing refeeding syndrome.

The net effect of these metabolic changes is an increased workload for
the cardiopulmonary system.

Refeeding may increase the work of the cardiopulmonary system beyond
its diminished capacity (due to the loss of lean body mass) and cause
CHF and respiratory failure.

Health-care workers need to be aware of the dangers of refeeding a
severely malnourished or starved client.
Chapter 23: Diet in HIV and AIDS
1. Nutritional assessment (HIV)
 Screening HIV-infected clients for nutritional problems is a crucial component of
quality client care.

Early indicators of decreased nutritional status include decreases in usual body
weight, low weight for height, a low albumin level, and a body mass index (BMI)
less than 20.

The following should be included in the assessment process:
o A baseline measure of percent body fat and lean body mass to monitor
disease progression
o
Recent food intake
o
Comorbidities and opportunistic infection
o
Oral or gastrointestinal symptoms
o
Barriers the client may have to safe nutritious food
o
Lack of food and poor food choices, which are linked to transmission of
HIV infection and a poor response to treatment
2. Thrush
 Thrush: a thick whitish coating on the tongue or in the throat that may be
accompanied by sore throat.

Thrush is a fungal infection that can cause oral ulcers, frequent fevers, and
gastrointestinal inflammation.

Basic teaching for mouth care by the health educator should include the following
information:
 Use a prescribed antifungal medication as directed.

Use a cotton swab instead of a toothbrush if brushing is painful or causes
bleeding. Commercial mouthwash may cause discomfort or pain.

Avoid hot foods.

Try soft foods, such as scrambled eggs, cottage cheese, mashed
potatoes, mashed winter squash, puddings, custards, milk, juices (not
citrus), and canned fruits such as peaches, pears, apricots, and bananas.

Cut meat into small pieces or grind or blend it.

Supplement the diet with a complete oral nutritional supplement.

Use a straw.

Application of anesthesia gel before eating.

Tilt the head forward or backward to ease swallowing.

Avoid any food that causes discomfort. Fried, spicy, sour, salty, and sticky
foods may not be tolerated, such as chips, nuts, seeds, raw vegetables,
peanut butter, pickles, citrus fruits and juices, and tomatoes.
3. Nutritional status and medications
 Nutritional management is both a preventive and a therapeutic treatment in HIV
infection.

A malnourished client has a limited ability to fight infection.

A well-nourished individual infected with the HIV virus is better able to resist
opportunistic infections and tolerate the side effects of treatment.

Good nutritional status may influence response to medications by:
o Decreasing the incidence of adverse drug reactions
o Providing nutrients for reactions evoked by medications
o Supporting organ functions

Worldwide, few people who have advanced disease are receiving antiretroviral
treatment.

Micronutrient supplements have been proposed as a low-cost intervention that
may slow the progression of HIV disease.

3 classes of antiretroviral medications used during the initial treatment of an HIVpositive client include (lifelong medication therapy)
o
Nucleoside reverse transcriptase inhibitor (NRTIs)
 Tenofovir



Emtricitabine
Zidovudine
Lamivudine
o
Nonnucleoside reverse transcriptase inhibitors (NNRTIs)
 Efavirenz
 Nevirapine
o
Integrase inhibitors (IIs)
 Dolutegravir
4. Healthy food choices
 A low-fat diet may be necessary to control steatorrhea.

Several additional meal-planning tips are suggested to promote the client’s wellbeing and to control malabsorption:
o Fluids should be encouraged to maintain hydration when large fluid
volume is lost in stools.
o
o
Yogurt and other foods that contain the Lactobacillus acidophilus culture
may be helpful if bacteria overgrowth is a problem secondary to long-term
anti-infective use.
Small, frequent meals make the best use of a limited absorptive capacity
of the gut.
o
A multivitamin supplement is indicated to increase the amount of vitamin
available for absorption. Clients should always consult with their healthcare providers before beginning supplements.
o
Oral liquid nutritional supplements may be helpful.
o
Aggressive nutritional support such as enteral and parenteral nutrition, if
appropriate, should be considered.
o
Pancreatic enzymes (Pancrecarb) may be prescribed as indicated.
o
Sorbitol, which is used as a sweetening agent in both sugar-free candies
and some medications, has been shown to cause diarrhea and should be
avoided.
o
Caffeine should be avoided because it stimulates peristalsis.
o
Fiber-containing supplements may be useful.
5. Terms
a. Wasting
 AIDS wasting syndrome is characterized primarily by involuntary weight loss,
consisting of both lean and fat body mass.

Analysis of body composition, measurement of soft tissue volumes (muscle,
fat, and organ), and diagnostic imaging of adipose tissue distribution make it
possible to define wasting syndrome in terms of total weight loss and tissue
compartment loss.

Wasting may be caused by undernutrition or nutrient malabsorption.
b. Lipodystrophy

Lipodystrophy, an adverse effect of ART, is a syndrome causing peripheral
fat wasting and fat accumulation centrally.
c. Ketosis
 Accumulation of ketone bodies: acetone, beta-hydroxybutyric acid, and
acetoacetic acid.

Ketosis results from the incomplete metabolism of fatty acids, generally from
carbohydrate deficiency, and occurs commonly in starvation.

The body uses ketone bodies for energy during prolonged starvation to meet
the central nervous system’s need for glucose.

The use of ketones reduces, but does not eliminate, the need for glucose.
d. Hyperemesis
 Repeated and severe bouts of vomitting

Characterized by severe nausea, vomiting, weight loss, and electrolyte
disturbance.
Chapter 24: Nutritional Care of the Terminally ILL
1. Nurses actions & responsibilities during final days of life
 Health-care professionals need to address clients’ values, goals of care, and
preferences with regard to treatment to truly become advocates.
 Pain & symptom control
 Spiritual and psychological support
 Improving quality of life
2. Nutritional needs
3. Ethical disagreements
 Many of the legal and ethical issues concerning health-care delivery and healthcare provider–client relations involve the provision of nutrition and hydration.

In the past, before the development of tube feedings and intravenous feedings,
the inability to eat and drink by mouth meant death from progressive body
wasting.

Now a decision needs to be made whether to feed a client.

A client may experience a more comfortable death if he or she is slightly
dehydrated.

On the other hand, efforts to hydrate some clients (not those actively dying) may
offer a benefit.

This is controversial. Sometimes a client, significant other, or physician thinks
that artificial hydration may promote client comfort and prolong life in a given
situation.

Perhaps a client’s vital signs had been fluctuating and are now stable.

Ethicists use rational processes for determining the most morally desirable
course of action in the face of conflicting value choices.

The process of choosing an ethical course of action involves:
o Medical goals and proportionality
o Client preferences
o
o
Quality of life
Contextual features
4. Dyspnea (Difficulty breathing)
 Encourage intake of coffee, tea, and chocolate. These foods are bronchodilators
that increase blood pressure, dilate pulmonary vessels, increase glomerular
filtration rate, and thus break up and expel pulmonary secretions and fluids.

Encourage use of a soft diet. Liquids are usually better tolerated than solids. Cold
foods are often better accepted than hot foods.

Recommend small, frequent feedings.

Encourage ice chips, frozen fruit juices, and popsicles; these are often well
accepted.

Consider the use of a complete high-fat, low-carbohydrate nutritional
supplement. This decreases carbon dioxide retention and assists in breathing.