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

While documenting medications is important for the physician's review, this is not the primary nutritional assessment reason for asking about medications. The focus here is on how medications interact with nutritional status.

Choice B rationale

Assessing for allergic reactions to medications is crucial for patient safety, but it is a separate aspect of medication history and not directly related to the metabolism of nutrients during a nutritional assessment.

Choice C rationale

Certain medications can significantly interfere with the absorption, metabolism, and excretion of various nutrients. For example, some drugs can increase nutrient excretion, decrease appetite, or alter the body's ability to utilize vitamins and minerals, directly impacting nutritional status.

Choice D rationale

While some medications can affect memory and thus the accuracy of a 24-hour food recall, the more direct and critical reason for asking about medications during a nutritional assessment is to identify potential drug-nutrient interactions that affect metabolism.

Choice A rationale

NPO (nothing by mouth) until dysphagia subsides might be a temporary measure immediately following a stroke to prevent aspiration. However, prolonged NPO status can lead to malnutrition and dehydration. The plan of care should aim for the safest and most effective route for nutritional support as soon as feasible, considering the patient's swallowing ability.

Choice B rationale

Initiation of total parenteral nutrition (TPN) is a method of providing nutrition intravenously, bypassing the gastrointestinal tract. TPN is typically reserved for patients with a non-functional or severely impaired digestive system. For a patient with dysphagia after a stroke, if the gastrointestinal tract is functional, enteral feeding (via a feeding tube) is often preferred over TPN due to its physiological benefits and lower risk of complications.

Choice C rationale

A mechanical soft diet consists of foods that are easy to chew and swallow. The texture of the food is altered (e.g., pureed, mashed, ground) to reduce the effort required for mastication and swallowing, thereby decreasing the risk of aspiration in patients with dysphagia. This type of diet is a common nutritional therapy for individuals with mild to moderate swallowing difficulties following a stroke.

Choice D rationale

Supplements via NG tube (nasogastric tube) involve delivering liquid nutritional formulas directly into the stomach through a tube inserted into the nose and down the esophagus. While an NG tube can provide necessary nutrition for patients with dysphagia, a gastrostomy tube (G-tube or PEG tube), placed directly into the stomach through the abdominal wall, is often preferred for long-term enteral feeding as it is generally more comfortable and less likely to cause irritation than an NG tube.