Nurses' Notes

A 28-year-old female who has started weightlifting. g nutritional counselling due to unwanted weight loss. 8, and she is hoping to build muscle mass and see weight gain. The client denies drinking, smoking, or drug es an oral contraceptive and uses melatonin for sleep.

Review H and P and nurse's notes.

Click to highlight the foods that are both nutrient and energy dense. 24-hour diet history:

0630

1 whole-wheat tortilla, 4 oz chicken breast, 4 of an avocados, 1/4 cup of salsa

1030

1 cup coffee, 2 tbsp half and half, 1 small apple, 1 tbsp almond butter

1200

1 cup spinach, 4 oz ground turkey with taco seasoning. 1/4 cup cheddar cheese, 2 bananas

1500

6 cashews

1900

1 cup regular soda, 6 oz white fish, 1/2 white potato, 2 tbsp butter, 1⁄2 cup green beans

2200

Choice A

Protein is not essential. While protein can influence blood sugar levels to some extent, its effect is much smaller compared to carbohydrates. Protein is not typically counted as a primary factor in insulin dosing.

Choice B

Carbohydrates are essential. For a client with type 1 diabetes mellitus who uses both short-acting (mealtime) and long-acting (basal) insulin, counting carbohydrates is essential for meal planning and insulin dosing. Carbohydrates have the most direct and significant impact on blood sugar levels. When carbohydrates are consumed, they are broken down into glucose, which enters the bloodstream and can lead to increased blood sugar levels

Choice C

Dairy is not essential. Dairy products can contain carbohydrates (such as lactose), but the carbohydrate content varies and is not as significant as in foods like grains, fruits, and starchy vegetables.

Choice D

Fats are not essential. Fats have minimal direct impact on blood sugar levels. However, they can affect the overall rate of digestion and absorption of carbohydrates, potentially influencing the timing of insulin administration. But carbohydrate counting remains the primary focus for insulin adjustment.

Choice A

Serum HDL (high-density lipoprotein) of 35 mg/dL (0.91 mmol/L). Among the options provided, a serum HDL level of 35 mg/dL (0.91 mmol/L) is the assessment data that indicates the need for referral to a nutritionist. HDL is often referred to as "good" cholesterol because it helps remove excess cholesterol from the bloodstream, reducing the risk of cardiovascular disease. In this case, the HDL level of 35 mg/dL is below the recommended reference range for females (greater than 55 mg/dL or greater than 0.91 mmol/L), which could suggest a potential need for dietary and lifestyle interventions to improve cardiovascular health.

Choice B

Serum HbA1c (glycosylated haemoglobin) of 4.8% (0.05) is incorrect. This HbA1c level is within the normal reference range (4% to 5.9%) and indicates good blood sugar control.

Choice C

BMI (body mass index) of 22 kg/m² is incorrect. A BMI of 22 is within the normal weight range and might not necessarily indicate the need for a nutritionist referral.

Choice D

Total serum calcium of 10 mg/dL (2.5 mmol/L) is incorrect. This calcium level is within the normal reference range and might not require a nutritionist referral, unless there are other specific concerns related to calcium intake.