Chelsea Green is a 16-year-old white young woman brought to the health clinic today by her mother, Lisa Green.
Chelsea is a sophomore high school student who appears extremely underweight.
Lisa has been concerned for a while and decided that she needs to be seen by a health care professional.
Chelsea is not pleased to be at the appointment but agreed to come.
Rachael is a 30-year-old student nurse assigned to Sylvia, who is the nurse practitioner at the clinic.
They go in to see Chelsea.
Mrs.
Green tells them that Chelsea has been eating only small amounts and then works out 3 to 4 hours each day.
Chelsea tells them that she does not want to get fat like her mother.
On assessment, Chelsea's body mass index is 17. Lisa Green asks Rachael if she can recommend a healthy diet for her as well.
She tells Rachael that she has gained 20 lb in the past few years and is overweight as Chelsea pointed out.
To what resource sponsored by the USDA could Rachael refer Mrs.
Green?

Choice A rationale

The side-lying position with the head of bed at 30 degrees does not optimally align the nasal passages with the esophagus, increasing the risk of the NGT entering the trachea. Proper alignment facilitates easier and safer insertion into the stomach.

Choice B rationale

The tripod position is typically used for patients experiencing respiratory distress to maximize lung expansion. It does not provide the necessary head and neck alignment for safe nasogastric tube insertion.

Choice C rationale

Sitting the patient in an upright position, ideally between 45 to 90 degrees, uses gravity to aid the passage of the NGT down the esophagus. This position also allows the patient to cough effectively if the tube inadvertently enters the trachea.

Choice D rationale

Hyperextending the patient's head during NGT insertion can close off the esophagus and open the trachea, significantly increasing the risk of misplacement of the tube into the respiratory tract. The neck should be flexed forward with the chin to the chest during insertion.

Choice A rationale

Normoactive bowel sounds are the typical, intermittent gurgling sounds heard during a bowel assessment, indicating normal peristalsis and intestinal activity. The absence of any sounds for 30 seconds suggests a significant reduction or cessation of this activity, which is not consistent with normoactive findings.

Choice B rationale

Hypoactive bowel sounds are characterized by infrequent and faint gurgling sounds, indicating a decrease in intestinal motility. While a pause of 30 seconds without any sounds might precede hypoactive sounds, the complete absence of sounds for this duration is more indicative of a further reduction in bowel activity than simply hypoactivity.

Choice C rationale

Absent bowel sounds are documented when no bowel sounds are heard after listening in each of the four abdominal quadrants for a specified period, typically ranging from 2 to 5 minutes per quadrant. A 30-second period without any sounds in one area is a significant finding that should be documented as absent in that specific quadrant, warranting further assessment.

Choice D rationale

Hyperactive bowel sounds are loud, high-pitched, and frequent gurgling sounds, often described as "borborygmi" or stomach rumbling. These sounds indicate increased intestinal motility, which is the opposite of the finding of no bowel sounds for 30 seconds.