Chapter 4 - Nutrition and Diet Therapy for Nurses

Tucker and Dauffenbach Chapter 4 Learning Outcome 1 To classify the three types of lipids in the body and relate their functions. The nurse is explaining about fats to a community group. A member of the audience says, “I have always been told fats are bad and I should eliminate them from my diet; is that right?” The nurse should explain that fats: Need to be severely restricted for good health. Are the worst of the major nutrients. Lead to cardiovascular disease. Are part of a healthy diet. Answer: 4 Rationale: The nurse should explain that fats are necessary to good health and should be part of every good diet. Fats should make up about 30% of an adult diet, preferably unsaturated fats. Unless there is a medical reason, fats should not be severely restricted. There is no hierarchy of nutrients; all are necessary for good health. Fats do not lead inevitably to cardiovascular disease when consumed in recommended amounts. Nursing Process: Implementation Client Need: Health Promotion and Maintenance Cognitive Level: Application The nurse is explaining to a client about foods that are low in cholesterol and foods that are cholesterol-free. Which of the following would the nurse explain is cholesterol-free? Skinless chicken Eggs Peanut butter All-beef hot dogs Answer: 3 Rationale: Cholesterol-free foods are easy to identify. Foods that have cholesterol come from animal sources; cholesterol-free foods do not. Peanut butter is made of creamed peanuts; it does not have butter but is of the consistency of butter, hence the name. Chicken, eggs, and hot dogs come from animal sources. Nursing Process: Implementation Client Need: Health Promotion and Maintenance Cognitive Level: Application The nurse reviews the medical record of a middle-age client and finds that the client had the gallbladder removed 3 years ago. What teaching can the nurse expect to reinforce for this client? Weight management continues to be a priority to prevent stones from forming in the liver A lower-fat diet is easier to digest since bile salts are no longer stored in the gallbladder Adequate cholesterol intake is needed since there is no gallbladder to help digest it Carbohydrates are now easier to digest so continue to make them a dietary priority Answer: 2 Rationale: The gallbladder releases bile into the small intestine to help with fat digestion. Most people who have had the gallbladder removed find that smaller amounts of fat are easier to digest than large, high-fat meals. Weight management is not related to having a gallbladder and its role in fat digestion. The liver manufactures adequate cholesterol without any additional dietary intake. Carbohydrate digestion is not related to the gallbladder. Nursing Process: Planning Client Need: Health Promotion and Maintenance Cognitive Level: Application Learning Outcome 2 To differentiate between the classifications of fatty acids. A client asks the nurse why there are different fats listed on the Nutrition Facts label. The nurse responds: “You need to know the correct portion of each fat to consume each day.” “Each fat has a different role.” “It is important to eat some of each fat every day so you don’t get deficiencies. This helps in diet planning.” “It helps you plan a diet that included the healthiest fats.” Answer: 4 Rationale: The Nutrition Facts label included information about saturated, monounsaturated, and trans fats. It is important to plan a diet that limits intake of saturated and trans fats and one that includes monounsaturated fats. The label does not inform the consumer about the portion of fats that should be consumed daily. Each fat has a different role, but that information is not on the label. It is not necessary to consume some of each kind of fat on a daily basis; it is important to limit saturated and trans fats. Nursing Process: Implementation Client Need: Health Promotion and Maintenance Cognitive Level: Application A client asks the nurse why omega-3 and omega-6 fats are promoted so much. The nurse responds that they: (Select all that apply.) “Can be found only in fish.” “Are believed to have a role in preventing cardiovascular disease.” “Are polyunsaturated fats.” “Are a type of fat that is solid at room temperature.” “Closely resemble trans fats.” Answer: 2, “Are believed to have a role in preventing cardiovascular disease”; 3, “Are polyunsaturated fats.” Rationale: Omega-3 and omega-6 fatty acids are found in canola oil, soybean oil, or can be purchased in capsule form. Research has shown that omega-3 and omega-6 fatty acids have a role in preventing cardiovascular disease and reducing risk; therefore, increased intake of foods rich in these fatty acids is recommended. Omega-3 and omega-6 fatty acids are polyunsaturated fats, which are preferred over saturated and trans fats. Saturated fats, like butter, are solid or firm at room temperature. Trans fats behave like saturated fats and should be avoided in the diet. Omega-3 and omega-6 fatty acids are polyunsaturated fats. Nursing Process: Implementation Client Need: Health Promotion and Maintenance Cognitive Level: Application While explaining the different types of fats to a client, the nurse emphasizes that intake of hydrogenated fat should be limited because it: Contributes to weight gain. Has no nutritional value. Is detrimental to blood clotting. Has been associated with plaque buildup in arteries. Answer: 4 Rationale: Hydrogenation is the process by which unsaturated fats are made more saturated. This makes a “better” fat into a “bad” fat. Fats only contribute to weight gain insofar as they are consumed in excess and energy expenditure is less than caloric intake. All fats have nutritional value, although hydrogenated and saturated fats are less so than polyunsaturated. Fats do not affect blood clotting. Nursing Process: Implementation Client Need: Health Promotion and Maintenance Cognitive Level: Application Learning Outcome 3 To categorize dietary sources of fat, including saturated and unsaturated fatty acids. The nurse is teaching a class that included information about the role of fats in a healthy diet. Some of the things the nurse would explain about fats are: (Select all that apply.) They add flavor to foods. Most people should consume as little as possible. They allow the body to absorb some vitamins. The best source is meat. They spoil within 2 days at room temperature. Answer: 1, They add flavor to foods; 3, They allow the body to absorb some vitamins Rationale: Fats add flavor and texture to foods, thereby making them more palatable to most people. People do not need to consume as little fat as possible; they need to consume the ideal fats, like monounsaturated fats, in the right proportion in the diet. Fats are necessary to promote the absorption of fat-soluble vitamins; A, D, E, and K. Fats come from many sources including plant oils, nuts, wheat germ, among others. Vegetarians can consume adequate fats without eating meat. Most fats, especially poly- and monounsaturated fats, are stable at room temperature. Nursing Process: Implementation Client Need: Health Promotion and Maintenance Cognitive Level: Application A client asks the nurse how to avoid trans fats. The nurse replies that most trans fats can be avoided by limiting intake of: Eggs. Donuts. Baked fish. Barbequed pork. Answer: 2 Rationale: Trans fats are created when polyunsaturated fats are hydrogenated; therefore they are present when hydrogenated fats are used in the cooking process. Donuts are fried, often in partially hydrogenated fats, so they should be avoided. Eggs, fish, and pork are not significant sources of trans fats. Nursing Process: Implementation Client Need: Health Promotion and Maintenance Cognitive Level: Application A client asks the nurse if it is possible for a vegetarian to consume too much fat. The nurse replies: “Yes, because they often use too much oil or fat while cooking or sautéing vegetables.” “No, because they use complementary proteins which are low in fat.” “Yes, because they may consume non-meat or dairy foods that are high in fat.” “No, because they tend to consume only plant-based, healthy fats.” Answer: 3 Rationale: Anyone, vegetarians included, can consume excess fat by eating products that contain fats. Processed foods, fried foods, and bakery products often contain large amounts of fat; when they are consumed in excess, an individual eats too much fat. The sautéing of vegetables requires minimal fat. Vegetarians may use complementary proteins, but that meal planning leads to minimal consumption of fat. Plant-based fats, as found in nuts, are healthier, but a vegetarian may consume too many processed foods and therefore too many fats. Nursing Process: Implementation Client Need: Health Promotion and Maintenance Cognitive Level: Application Learning Outcome 4 To summarize the current recommendations for dietary fat and health. The nurse has been working with a client about the necessity of limiting intake of saturated fats. Which diet selection by the client indicates that the client has understood the teaching? Peanut butter and jelly sandwich Bacon, lettuce, and tomato sandwich Macaroni and cheese Beef taco with refried beans Answer: 1 Rationale: A peanut butter and jelly sandwich has some fat from the peanuts, but it is not saturated fat so it is a good choice for this client. Bacon has saturated fat (solid at room temperature) as does the cheese. Beef has saturated fat and refried beans are made with lard, another saturated fat. Nursing Process: Evaluation Client Need: Health Promotion and Maintenance Cognitive Level: Analysis The nurse is assisting a client with planning to meet nutrient needs for a 2000 calorie diet. How many grams of saturated fat should the nurse recommend to the client? About 35 grams 25–35 grams 20–25 grams Less than 20 grams Answer: 3 Rationale: According to the American Heart Association, intake of saturated fats should be limited to less than 10% of total caloric intake. The calculation for this client is: 10% x total calories / 9 cal/gm (0.10 x 2000/9 = 22.2). Nursing Process: Planning Client Need: Health Promotion and Maintenance Cognitive Level: Application The American Heart Association recommends increased consumption of omega-3 fatty acids to reduce risk of cardiac disease. What foods could the nurse recommend to a client who wants to increase consumption of foods higher in omega-3 and omega-6 fatty acids? Two servings per day of organically grown whole wheat One serving per week of free-range grown chicken that is served skinless One serving per week of shellfish, like shrimp or oysters Two servings per week of deep water fish, like salmon or tuna Answer: 4 Rationale: Omega-3 and omega-6 fatty acids are found in highest concentrations in deep, cold water fish like fresh tuna or salmon. Shellfish are found in shallow, warmer waters so do not have high concentration of omega-3 or omega-6 fatty acids. In addition, many people are allergic to shellfish. Plant-based foods and chicken, regardless of how grown or raised, are not good sources of omega-3 and omega-6 fatty acids. Nursing Process: Planning Client Need: Health Promotion and Maintenance Cognitive Level: Application Learning Outcome 5 To compare the lifespan specific recommendations for dietary fat intake. Parents are concerned about their child becoming obese so want to limit the fat intake of their 2-year-old by switching to skim milk and fat-free foods. What advice should the nurse give to these parents? “Preventing obesity is a good goal; limiting fat is the first step.” “This is a reasonable goal only if you think obesity is a problem in your family.” “Toddlers need fats to grow so this is not a time to severely limit fat.” “As long as your toddler gets about 25% of calories from fats, this is reasonable.” Answer: 3 Rationale: Toddlers need about 30% to 40% of their daily calories from fat to promote growth and development. The fats should come from healthy sources like monounsaturated oils, fish, or reduced fat milk. Trans and saturated fats should be avoided. Obesity can be avoided by providing time for regular activity and modeling healthy eating. Nursing Process: Implementation Client Need: Health Promotion and Maintenance Cognitive Level: Application A middle-age adult consumes about 1800 calories per day. The nurse counseling the client recommends about how many calories per day could come from fats? 200 calories 350 calories 600 calories 800 calories Answer: 3 Rationale: Adults should get about 20% to 35% of their daily calories from fats. The client who consumes about 1800 calories per day needs approximately 360 to 630 calories per day from fat. The calculation is as follows: (1800 calories x 0.20 = 360 calories to 1800 x 0.35 = 630). Nursing Process: Planning Client Need: Health Promotion and Maintenance Cognitive Level: Application What dietary recommendations should the nurse make to an older adult male regarding intake of linoleic acid? It is so widely available in foods that it is not a concern for healthy adults A minimum of 10 grams a day is required for good health It should be no more than 5% to 8% of daily caloric intake About 17 grams per day will be sufficient Answer: 4 Rationale: The current recommendation for adult males is 17 grams of linoleic acid and 1.6 grams of linolenic acid per day, or a combination of the two equaling about 10% of calories per day. These are fatty acids that are present in foods that contain fats. Nursing Process: Planning Client Need: Health Promotion and Maintenance Cognitive Level: Application Learning Outcome 6 To develop strategies for nursing interventions that target dietary fat intake. The nurse is working with a client who has problems with fat malabsorption. The nurse should assess the client for signs of: Edema. Vitamin A deficiency. Dehydration. Brittle nails. Answer: 1 Rationale: Clients who have fat malabsorption may have signs of fat-soluble vitamin deficiencies. Vitamins A, D, E, and K are fat-soluble vitamins. Edema is associated with protein deficiency. Dehydration occurs with fluid deficiency. Brittle nails may occur for many reasons, such as fungal diseases, not associated with fat intake. Nursing Process: Assessment Client Need: Physiologic Integrity Cognitive Level: Application A client explains that meat is still an important component of the family meals and they can’t figure out how to reduce the fat if they like meat so much. Which of the following suggestions should the nurse make? (Select all that apply.) Broil meat Remove skin from poultry Eat smaller portions Avoid gravies Reduce total calories per day Answer: 1, Broil meat; 2, Remove skin from poultry; 3, Eat smaller portions; 4, Avoid gravies Rationale: Meat can be part of a healthy diet. Broiling meat, rather than frying, can reduce the amount of fat. Skin contains a lot of the fat so the skin should be removed from poultry. Other meats should have the fat trimmed before preparation. A serving that is about the size of a deck of cards or the palm of the hand, 3–4 ounces, is considered a serving of meat. Many people eat more than that as a portion size. Gravies are made from meat drippings which contain fat. They should be avoided unless they can be made without meat drippings. Calorie reduction does not address fat intake, only total energy intake. People who like meat do not necessarily need to reduce caloric intake. Nursing Process: Planning Client Need: Health Promotion and Maintenance Cognitive Level: Application A client who is concerned about fat intake asks the nurse, “What is the best nutritional action to take to reduce the risk of cardiovascular disease?” The nurse responds: “Eliminate saturated fat.” “Increase intake foods with omega-3 and omega-6 fatty acids.” “Keep fat calories at less than 10% of your daily calories.” “Use fat substitutes whenever possible.” Answer: 2 Rationale: Omega-3 and omega-6 fatty acids, found primarily in cold water fish, have been shown to reduce the risk of cardiovascular disease and sudden cardiac death. They can also be taken in the form of supplements. Saturated fats should be no more than 10% of daily calories, but a healthy diet should include 20% to 35% of calories from fat. Fat substitutes may be a good idea, but they are not the best way to reduce cardiovascular risk. Nursing Process: Implementation Client Need: Health Promotion and Maintenance Cognitive Level: Application 1 ©2011 by Education, Inc. Tucker/Dauffenbach, Test Item File for Nutrition and Diet Therapy for Nurses