INSTRUCTIONS:
Read the question. Consider your response. Click
on the button to compare answers.
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1. During Karen's pregnancy for Kirk, what factors
contributed to his undernutrition? |
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2. Besides the assessment data, other
important information during prenatal and early postnatal history can
influence nutritional status. What are some of the factors? Using Kirk's
nutritional history, find three such factors affecting his current nutritional
status? |
|
3. In evaluating the adequacy of the
diet, the objective is to obtain a 24-hr diet that represents what a person
usually eats. Nutrient adequacy can be evaluated by using a computerized
nutrient analysis program. A quick method is by comparing a food recall
with the Food Guide Pyramid. On a piece of paper summarize Kirk's 24-hour
food recall from the Day 2 record, under Nutrition in the Client Records.
Are your answers similar to those in the second column of the Table below? |
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4. Besides
diet, one can use anthropometric measurements such as weight and height
to assess rate of growth. Kirk's weight gain is plotted on the graph below.
How does Kirk's weight data compare to growth generally expected among
children ages 2-8 yrs? |
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5. Identify reasons that may explain why Kirk's
weight and height is below normal range? |
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6. Review of blood and urine nutrient-related
findings are important in confirming or disproving the existence of nutritional
deficiencies determined questionable by dietary study. Hemoglobin level
is a common screening tool for nutritional anemia. Nutrient levels, for
instance, of calcium or albumin,reflect dietary intake. Using Kirk's laboratory
report, find one finding that may suggest a possible nutrient deficiency.
Consult your nutrition text for additional biochemical nutrition profile
that may be used to screen for nutritional deficiencies. |
|
7. What are some of the clinical signs
that could be related to Kirk's current nutritional deficiencies? Using
Kirk's nutritional history, find two clinical signs. |
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8. Based
on the assessment data, describe whether or not you feel Kirk is at nutritional-risk.
Provide support for your decision. |
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9. Assuming that the data so far has
led one to conclude that part of Kirk's problems are of nutritional origin,
one needs to develop a nutritional care plan for the client. The first
part of this process involves identifying the goals of the care plan.
What do you feel is an appropriate goal for Kirk and give your rationale?
A goal must be measurable, requiring a time frame for achievement. |
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10. Given the goals determined in #9, recommend
ways to improve Kirk's nutritional status. |
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11. Finally, integrate the nutritional
assessment findings and care plan by stating the nutrition-related diagnosis.
(according to the nursing process) |
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Unit Background
Client Overview
Client Records Quiz
Glossary Suggested
Readings
.
1. During Karen's pregnancy for Kirk, what
factors contributed to his undernutrition? You may consult the
glossary for a list of general causes of undernutrition.
Karen smoked and drank beer during pregnancy.
Her diet was nutritionally inadequate. Her weight gain was only
15 lbs.
2. Besides the assessment data, other important
information during prenatal and early postnatal history can influence
nutritional status. What are some of the factors ? Using Kirk's
nutritional history, find three such factors affecting his current
nutritional status? (See Glossary forCauses of Undernutrition).
Birth weight and height
Type and kind of feeding
Number of Illnesses and hospitalization
3. In evaluating the adequacy of the diet,
the objective is to obtain a 24-hr diet that represents what
a person usually eats. Nutrient adequacy can be evaluated by
using a computerized nutrient analysis program. A quick method
is by comparing a food recall with the Food Guide Pyramid (check
Glossary). On a piece of paper summarize Kirk's 24-hour food
recall from the Day 2 record, under Nutrition in the Client Records.
Are your answers similar to those in the second column of the
Table below?
Evaluation of Food Record
Food Groups
|
Actual Intake
|
Serving Size
|
Total Recommended Servings
|
| Milk and milk products |
2 |
1c |
2 or more |
| Meat, fish, poultry, eggs |
1/4 |
2 oz |
2 or more |
| Vegetable group |
2 |
1/4-1/2 c |
3 or more |
| Fruit group |
1+ |
1 whole |
2 or more |
| Grain group |
2 |
1 sl/1 c |
6 or more |
| Other:sugar |
7 |
1 t |
As desired to maintain
optimal body weight |
| Other: fat |
4 |
1 t |
As desired to maintain
optimal body weight |
The recommended number of servings for
each food group in the Food Guide Pyramid is given in the table.
The recommendation varies according to age and sex. The amount
per serving is also less for children like Kirk . Except for
milk, Kirk's food intake is inadequate. Although Kirk's excess
intake of sugar and fat provide necessary calories, they provide
no other nutrients.
4. Besides diet, one can use anthropometric
measurements such as weight and height to assess rate of growth.
Kirk's weight gain is plotted on the graph below. How does Kirk's
weight data compare to growth generally expected among children
ages 2-8 yrs?
The graph shows where Kirk's weight data
falls in comparison to other children. It shows that Kirk is
underweight because his calorie intake was inadequate. This in
part has affected his growth. Kirk's parents were both tall,
but his height was below normal range. At seven, his size corresponded
to that of an average 5-year old.
5. Identify reasons that may explain why Kirk's
weight and height is below normal range?
Malnutrition, both prenatal and early postnatal,
maybe a major factor in his growth retardation. Possible brain
injury during birth, his numerous illnesses and hospitalizations,
and environmental and emotional deprivation before age three
may also have affected his growth. Present chewing difficulties
resulted in deficiencies in calories, iron,magnesium, pyridoxine
and zinc.
6. Review of blood and urine nutrient-related
findings are important in confirming or disproving the existence
of nutritional deficiencies determined questionable by dietary
study. Hemoglobin level is a common screening tool for nutritional
anemia. Nutrient levels, for instance, of calcium oralbumin,
reflect dietary intake. Using Kirk's laboratory report, cite
one finding that may suggest a possible nutrient deficiency.
Consult your nutrition text for additional biochemical nutrition
profile that may be used to screen for nutritional deficiencies.
Kirk could be at risk for iron deficiency.
Dietary sources of iron such as meat, eggs and grains, are inadequate
in Kirk's diet resulting in iron intake below what is recommended.
Deficient iron intake, however, was not confirmed by hemoglobin
finding which was at the low normal level. However, he was anemic
when he was one year old.
7. What are some of the clinical signs that
could be related to Kirk's current nutritional deficiencies?
Using Kirk's nutritional history, find two clinical signs.
Kirk was observed to be lethargic during
the interview. His face was slightly pale. Lethargy and pallor
are clinical signs of possible iron deficiency anemia.
Kirk's oral hygiene was poor and two carious
teeth were identified. It is possible that his low intake of
meat was influenced by these oral problems. Meat is a good source
of iron which might explain his low intake of the nutrient.
8. Based on the assessment data, describe
whether or not you feel Kirk is at nutritional-risk. Provide
support for your decision.
Yes, Kirk is at nutritional risk. Kirk
is showing growth retardation attributable to:
- a. gestational and early postnatal undernutrition
- b. early postnatal emotional deprivation
- c. undernutrition due in large part to
chewing difficulties. His diet is deficient in meat, vegetables,
grains, and fortified milk, reflecting inadequacies in calories,
vitamin D, iron, magnesium, pyridoxine and zinc.
9. Assuming that the data so far has led one
to conclude that part of Kirk's problems are of nutritional origin,
one needs to develop a nutritional care plan for the client.
The first part of this process involves identifying the goals
of the care plan. What do you feel is an appropriate goal for
Kirk and give your rationale. A goal must be measurable, requiring
a time frame for achievement.
Facilitate catch-up growth by improving
nutritional status within a year.
a. Complete dental work in three months.
b. Improve dietary intake by 6 months.
10. Given the goals determined in #9, recommend
ways to improve Kirk's nutritional status.
Recommendations:
- a. Refer Kirk to a local dentist.
- b. Give one-a-day vitamins and minerals
for 6 months.
- c. Improve diet by giving high nutrient
density-low volume foods that are easy to chew, such as milkshake,
custard, spaghetti with ground meat, etc. Buy only milk that
is fortified with vitamin D.
- d. Avoid 'clean plate' practice. Do not
use food as reward or punishment.
- e. Plan fun activities with food, such
as gardening, cooking and reading stories pertaining to food.
- f. Monitor intake frequently.
11. Finally, integrate the nutritional assessment
findings and care plan by stating the nutrition-related diagnosis.
(according to the nursing process)
Parenting: alteration in potential for
inadequate calories and nutrients related to emotional deprivation.
Nutrition: alteration in potential for
less than body requirements for calories, vitamin D, iron, magnesium,
and zinc, related to inadequate dietary intake of calorie-rich
foods, enriched cereals and fortified milk.
Resources: inadequate, related to limited
knowledge of community resources.
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Unit Background
Client Overview
Client Records Quiz
Glossary Suggested
Readings
