c. Serum transferrin is a protein that is synthesized by the liver and
used for iron transport and decreases when there is protein deficiency. An
increase in the protein would indicate a more positive nitrogen balance
with amino acids available for synthesis. Decreased lymphocytes and
serum prealbumin are indicators of protein depletion and increased serum
potassium shows continuing failure of the sodium-potassium pump.

. a. Standard nasogastric (NG) tubes are only used for enteral nutrition
(EN) for short-term feeding problems because prolonged therapy can
result in irritation and erosion of the mucosa of the upper GI tract. Gastric
reflux and the potential for aspiration can occur with both NG and
gastrostomy feeding tubes. Both tubes deprive the patient of the
sensations associated with eating and can become displaced.

c. The sodium-potassium pump uses 20% to 50% of all calories
ingested. When energy sources are decreased, the pump fails to function,
sodium and water are left in the cell, and potassium remains in
extracellular fluids. Hyperkalemia, as well as hyponatremia, can occur.

b. Although calorie intake should be decreased in the older adult
because of decreased activity, lean muscle mass and basal metabolic rate,
the need for specific nutrients, such as proteins and vitamins, does not
change

a. Remaining solution should be discarded. Bacterial growth occurs at
room temperature in nutritional solutions. Therefore solutions must not be
infused for longer than 24 hours. Speeding up the solution may cause
hyperglycemia and should not be done. The HCP does not need to be
notified as the rate is determined to meet the patient’s nutritional needs.

c. In malabsorption syndromes, foods that are ingested into the
intestinal tract cannot be digested or absorbed and tube feedings infused
into the intestinal tract would not be absorbed. All of the other conditions
can be treated with enteral or parenteral nutrition, depending on the
patient’s needs

. a. The breakfast with the eggs provides 24 g of complete protein,
compared with 14 g for the protein-fortified cream of wheat and
milkshake breakfast. Whole milk instead of skim milk helps meet the
calorie requirements. The toast has 10 g of protein and the pancakes have
about 6 g. Bacon is considered a fat rather than a meat serving.

a, b, c, e, f. In malnutrition, metabolic processes are slowed, leading to
increased sensitivity to cold, decreased heart rate (HR) and cardiac output
(CO), and decreased neurologic function. Because the immune system is
weakened, susceptibility to respiratory infections is increased. Because of
slowed GI motility and absorption, the abdomen becomes distended and
protruding and bowel sounds are decreased. Skin is rough, dry, and scaly
and bone structures protrude because of muscle loss. Neurologic effects
of malnutrition include decreased reflexes, lack of attention, irritability,
syncope, and peripheral neuropathy

d. Anthropometric measurements, including mid-upper arm
circumference and triceps skinfold measurements, are good indicators of
lean body mass and skeletal protein reserves and are valuable in
evaluating persons who may have been or are being treated for acute
protein malnutrition. The other measurements do not specifically address
muscle mass.

a. With surgery a patient will recover more rapidly with a balanced
nutritional status before the surgery and increased protein is needed for
healing after the surgery. Following a vegan diet does not put the patient
at risk of low protein intake. A fever will increase protein-calorie needs.
Following religious and cultural beliefs would not be expected to affect
an increased need for protein

d. The potential life-threatening cardiac complications related to the hypokalemia are the most important immediate considerations in the patient’s care. The other nursing diagnoses are important for the patient’s care but do not pose the immediate risk that the hypokalemia does.

a. Socioeconomic conditions frequently have the greatest effect on the
nutritional status of the healthy older adult. Limited income and social
isolation can result in the “tea and toast” meals of the older adult. The
other options do not interfere with nutritional status.

d. In the United States, where protein intake is high and of good
quality, chronic disease–related or secondary protein-calorie malnutrition
most commonly results from problems of the GI system. In developing
countries, adequate food sources may not exist, the inhabitants may not be
well educated about nutritional needs, and economic conditions can
prevent purchase of balanced diets.

b. Patients who have surgery on the gastrointestinal (GI) tract may be at
risk for vitamin deficiencies because of inability to absorb or metabolize
them. The strict vegan diet most often lacks cobalamin (vitamin B12
) and
iron. Vitamin deficiencies in adults also have neurologic manifestations.
Although the high intake of fat is a major nutritional problem in the
United States, vitamin deficiencies are rare in developed countries except
in people with eating disorders or chronic alcohol abuse.

d. Malnutrition that results from a decreased intake of food is most
common in individuals with severe anorexia where there is a decreased
desire to eat. Infections create a hypermetabolic state that increases
nutritional demand, malabsorption causes less availability of nutrients that
are ingested, and draining decubitus ulcers (although treated) are
examples of disorders that cause both loss of protein and hypermetabolic
states.