Answer Key to Chapter 14 Learning Activities

Scenario 1

1.  It would be important to assess Mr. Jones’s swallowing, bowel sounds, ability to pass flatus, abdominal distention, and any complaints of nausea.
2. When transitioning the client from NPO status, the client would be started on clear liquids to ensure dietary tolerance, followed by full liquids, prior to progression toward solid foods.

Scenario 2

1. Mrs. Casey’s BMI is 15, placing her in the “Underweight” category because it is below 18.5.
2. Mrs. Casey’s hemoglobin (hgb), white blood cells (WBC) and albumin levels are all low, which may be caused by poor intake of protein. Magnesium levels may be low due to poor nutritional intake or can also be caused by excessive alcohol intake.
3. The nurse should perform a general survey on Mrs. Casey, paying close attention to her energy level and mobility deficits as a result of the stroke. The nurse should ask Mrs. Casey about her typical 24-hour food intake, swallowing abilities, appetite, food allergies, and food shopping and preparation activities.
4. Imbalanced Nutrition: Less than Body Requirements related to insufficient dietary intake as evidenced by BMI 15 and albumin level 10 g/mL.
5. Mrs. Casey’s BMI will increase to at least 16 in the next month with a continued upward trend.
6. The nurse will contact the provider and request a referral for a dietician. The nurse will contact the facility’s social worker regarding promoting nutritional intake with Meals on Wheels and other in-home services. The nurse will monitor food/fluid ingested daily and caloric intake in collaboration with the dietician and encourage nutritional supplements as prescribed. The nurse will encourage the client to select or order preferred foods for mealtimes. The nurse will ensure that oral care is performed before meals and that foods are presented in an attractive, pleasing manner. The client will be placed in a seated position before eating, the meal tray set up, and assistance provided according to the client’s needs.
7. The nurse will evaluate the effectiveness of interventions by monitoring the client’s weekly weights and assessing if her BMI is trending upward according to the previously established SMART goal.

Answers to interactive elements are given within the interactive element.