A nurse is planning to administer total parenteral nutrition (TPN) to a client who is malnourished. Which of the following actions should the nurse plan to take? (Select all that apply.)

• Malabsorption syndrome: While steatorrhea indicates fat malabsorption, this diagnosis is too general. The client’s symptoms are more likely linked to recent pelvic radiation, making a treatment-induced etiology more probable. There is no evidence of chronic GI disease or a primary malabsorption disorder that predates cancer treatment.
• Tumor lysis syndrome: Typically presents with hyperuricemia, hyperkalemia, and acute kidney injury due to rapid tumor breakdown, not GI symptoms. The client’s vital signs and urine output are stable, with no lab evidence of metabolic abnormalities or renal failure.
• Radiation enteritis: Caused by radiation damage to the small bowel, common in pelvic cancer treatments like for endometrial cancer. Symptoms such as nausea, steatorrhea, abdominal pain, and anorexia strongly support this diagnosis, especially within a week of initiating radiation.

• Steatorrhea : Fatty stools indicate impaired fat absorption due to inflammation of the intestinal lining, consistent with radiation-induced enteritis. This is a key symptom supporting a diagnosis related to intestinal damage from radiation.
• Metallic taste: Common with chemotherapy but non-specific; it does not indicate the underlying cause of malabsorption or abdominal discomfort. While notable, it’s not as critical as steatorrhea for identifying radiation enteritis.
• Constipation: The client reports two bowel movements today, so constipation is not present and contradicts the clinical picture. Steatorrhea, rather than absence of bowel movements, suggests increased motility or malabsorption.

A. "I will eat something when I feel hungry." Responding to true physical hunger is a principle of mindful eating, which supports weight loss by preventing overeating due to emotional or external cues. Recognizing and honoring hunger promotes better portion control and sustainable eating habits.
B. "I will peel apples before I eat them." Apple peels contain fiber, which increases satiety and supports digestive health. Removing the peel reduces fiber content, which may make the snack less filling and hinder weight management efforts.
C. "I will eliminate carbohydrates from my diet." Eliminating carbohydrates completely is not recommended for healthy weight loss. Balanced diets that include whole grains, fruits, and vegetables support long-term weight management and provide essential nutrients.
D. "I will use corn oil when frying foods." Frying foods, regardless of the type of oil, increases calorie density and may not support weight loss. Healthier cooking methods like baking, steaming, or grilling are preferred for reducing fat intake and promoting weight control.