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

Planning low carbohydrate and high protein meals is not recommended. While meal planning is important for weight loss, focusing solely on low carbohydrate and high protein meals may not be the most balanced or sustainable approach. It's essential to consider a variety of nutrients and food groups in the diet.

Choice B

Engaging in strenuous activity for an hour daily is not recommended. Jumping into strenuous activity for an hour daily might not be realistic or safe for everyone, especially for someone who is just starting their weight loss journey. A more gradual increase in physical activity is often recommended.

Choice C

Participating in a group exercise class 3 times a week is not recommended. Group exercise classes can be beneficial, but they may not address the whole spectrum of weight loss factors. Additionally, starting with three times a week might be challenging for someone new to exercise.

Choice D

Keep a record of food and drinks consumed daily is recommended. When helping a client with a BMI of 30 (which falls within the obese range) start a weight loss plan, keeping a record of food and drinks consumed daily can be an effective initial approach. This approach is often referred to as "food journaling" or "food tracking." It involves writing down everything the client eats and drinks throughout the day. This practice can help raise awareness of eating habits, identify patterns, and uncover areas where changes can be made to reduce calorie intake.

Choice A

Cutting the spaghetti and meatballs into small pieces is inappropriate. This choice is not directly related to the risk of infection. It might be helpful for a client who has difficulty swallowing or chewing, but it doesn't address the compromised immune system and infection risk.

Choice B

Exchanging pasteurized whole milk with skim milk is inappropriate. The type of milk doesn't have a direct impact on infection risk. Both pasteurized whole milk and skim milk are considered safe for consumption. This choice doesn't address the specific concern of infection in a client with a low ANC.

Choice C

Substituting fried potatoes with a garden salad is inappropriate. While choosing healthier food options can be beneficial for overall health, the choice between fried potatoes and a garden salad doesn't necessarily impact the infection risk for a client with a low ANC. This choice also doesn't address the specific concern of infection in this context.

Choice D

Remove the fresh grapes from the meal tray is appropriate. The reason for this choice is that a client with an absolute neutrophil count (ANC) of 400 has a significantly compromised immune system, and they are at a high risk of infection due to their low neutrophil count. Neutrophils are a type of white blood cell that plays a crucial role in fighting off infections. A normal ANC falls within the range of 2500 to 8000 mm3 or cells/uL.

Fresh grapes, being a raw and uncooked food item, may carry a higher risk of containing bacteria or pathogens that could pose a threat to a client with such a low ANC. The nurse needs to ensure that the client's exposure to potential sources of infection is minimized.