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Chapter 19: Applying Clinical Judgment to Promote Nutrition for Musculoskeletal and Integumentary Wellness

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Chapter 19: Applying Clinical Judgment to Promote Nutrition for Musculoskeletal and Integumentary Wellness

14 problems · 0 figures

Case Study 19.1.1 §19.1 source ↗

Table 19.3 in the book ↗
Vital Signs
Temperature: 98.4°F
Blood pressure: 142/88 mm Hg
Heart rate: 82 beats/min
Respiratory rate: 20 breaths/min

Read the following clinical scenario and then answer the questions that follow. This case study will evolve throughout the chapter.

Anne Wilson, a 70-year-old Black woman is referred by the primary care provider to a rheumatologist for complaints of pain and swelling in bilateral knees. Anne states that the ibuprofen that was earlier prescribed is no longer treating the pain. The nurse at the rheumatologist’s office notices that Anne appears anxious with a facial grimace. Anne states that she is having 8 out of 10 pain in both knees and that she only got a few hours of sleep last night due to the pain. Anne reports that she exercises daily by walking, but she admits that her nutritional plan (meal plan) could improve.

The provider enters the examination room to see Anne. On assessment, both knees are swollen with no redness or discoloration noted. The client denies injury to the knees or legs and has no history of falls. The client is taking short, tentative steps on observance of ambulation. The client admits that legs are stiff. No pain in both feet is reported. Anne said her primary doctor thinks she has arthritis and needs to see a rheumatologist. Client vitals are listed in the following table.

Based on these findings and client history, what screening tests should the nurse perform?
  1. a.
    Morse fall risk assessment
  2. b.
    NIS
  3. c.
    Passive and active ROM
  4. d.
    Braden scale

Answer

C. Passive and active ROM
Often, a client with age-related degenerative disorders such as osteoarthritis will have limited ROM and increased pain upon ROM of the joints. This simple screening provides valuable information for the diagnosis of osteoarthritis as well as the treatment parameters for the client.

Case Study 19.1.2 §19.1 source ↗

Table 19.3 in the book ↗
Vital Signs
Temperature: 98.4°F
Blood pressure: 142/88 mm Hg
Heart rate: 82 beats/min
Respiratory rate: 20 breaths/min

Read the following clinical scenario and then answer the questions that follow. This case study will evolve throughout the chapter.

Anne Wilson, a 70-year-old Black woman is referred by the primary care provider to a rheumatologist for complaints of pain and swelling in bilateral knees. Anne states that the ibuprofen that was earlier prescribed is no longer treating the pain. The nurse at the rheumatologist’s office notices that Anne appears anxious with a facial grimace. Anne states that she is having 8 out of 10 pain in both knees and that she only got a few hours of sleep last night due to the pain. Anne reports that she exercises daily by walking, but she admits that her nutritional plan (meal plan) could improve.

The provider enters the examination room to see Anne. On assessment, both knees are swollen with no redness or discoloration noted. The client denies injury to the knees or legs and has no history of falls. The client is taking short, tentative steps on observance of ambulation. The client admits that legs are stiff. No pain in both feet is reported. Anne said her primary doctor thinks she has arthritis and needs to see a rheumatologist. Client vitals are listed in the following table.

What diagnostic testing would the nurse expect the rheumatology provider to order?
  1. a.
    X-ray of both knees
  2. b.
    Vitamin D level
  3. c.
    Tissue biopsy
  4. d.
    Serum electrolyte panel

Answer

A. X-ray of both knees
The provider would start with an x-ray of both knees to evaluate for any soft tissue changes and signs of arthritis.

Case Study 19.3.3 §19.3 source ↗

Read the following clinical scenario and then answer the questions that follow. This case study is a follow-up to Case Study Part A.

The nurse prepares to instruct the client on nutritional strategies to manage her arthritis. Client teaching for Anne includes the reinforcement teaching of a nutritional plan that has anti-inflammatory properties for her osteoarthritis with edema in the knees. Along with nutritional education, the nurse instructs the client to stay as active as possible, doing stretching exercises daily as prescribed by the physical therapist to maintain or gain ROM in lower extremities. The nurse instructs Anne to pay close attention to the skin surrounding her knees, observing for warmth or redness. Anne is encouraged to report these integumentary symptoms if they occur because they could indicate septic arthritis of the knees.

From what is known about nutrition and the impact that it has on the musculoskeletal system, which of the following foods would you expect the nurse to include in dietary teaching for the client?
  1. a.
    Leafy green vegetables
  2. b.
    Dairy products
  3. c.
    Red meat
  4. d.
    Protein shakes

Answer

A. Leafy green vegetables
Leafy green vegetables have anti-inflammatory properties. Because the client has osteoarthritis with edema in both knees, these nutrients should be included in the diet.

Case Study 19.3.4 §19.3 source ↗

Read the following clinical scenario and then answer the questions that follow. This case study is a follow-up to Case Study Part A.

The nurse prepares to instruct the client on nutritional strategies to manage her arthritis. Client teaching for Anne includes the reinforcement teaching of a nutritional plan that has anti-inflammatory properties for her osteoarthritis with edema in the knees. Along with nutritional education, the nurse instructs the client to stay as active as possible, doing stretching exercises daily as prescribed by the physical therapist to maintain or gain ROM in lower extremities. The nurse instructs Anne to pay close attention to the skin surrounding her knees, observing for warmth or redness. Anne is encouraged to report these integumentary symptoms if they occur because they could indicate septic arthritis of the knees.

After the nurse finishes the instructions, which of the following statements by the client indicates additional education is needed?
  1. a.
    “I will try to incorporate more berries into my diet.”
  2. b.
    “I will stop eating nuts.”
  3. c.
    “I will try to eat more salmon and tuna.”
  4. d.
    “I will eat fewer carbohydrates.”

Answer

B. “I will stop eating nuts.”
Nuts and seeds have anti-inflammatory properties that can be beneficial for clients with arthritis.

19-1 §19.RQ source ↗

The nurse is educating a client on ways to promote bone health after the client suffered a stress fracture. Foods containing which of the following vitamins are the priority for this client?
  1. a.
    Vitamin D
  2. b.
    Vitamin B12
  3. c.
    Vitamin C
  4. d.
    Vitamin E

Answer

A. Vitamin D
Adequate vitamin D intake is necessary for strong bones and the prevention and treatment of osteoporosis.

19-2 §19.RQ source ↗

During an assessment, the nurse notes the client has tenting. What does this indicate?
  1. a.
    Poor muscle tone
  2. b.
    Poor circulation
  3. c.
    Poor skin integrity
  4. d.
    Poor hydration

Answer

D. Poor hydration
Good skin turgor indicates a normal moisture level in the skin. Tenting, when the skin remains stretched out like a tent when pinched, is a sign of decreased moisture in the skin.

19-3 §19.RQ source ↗

The nurse is educating the client with a torn bicep muscle on the effects of nutrition on musculoskeletal health. What recommendation do you expect the nurse to make?
  1. a.
    Increase protein intake
  2. b.
    Increase vitamin D intake
  3. c.
    Include foods high in biotin
  4. d.
    Include foods high in iron

Answer

A. Increase protein intake
Protein aids in the repair of muscles and tissue.

19-4 §19.RQ source ↗

Which client would most likely benefit from consuming bromelain?
  1. a.
    A 40-year-old marathon runner with sore muscles in legs
  2. b.
    A 78-year-old client with a stage 3 pressure ulcer
  3. c.
    An 83-year-old client with osteoporosis
  4. d.
    A 65-year-old client with edema in their right knee due to osteoarthritis

Answer

D. A 65-year-old client with edema in their right knee due to osteoarthritis
Bromelain is a group of enzymes found in pineapples and is believed to reduce swelling and pain.

19-5 §19.RQ source ↗

A client with a stage 2 pressure injury was prescribed protein shakes twice daily. Upon return to the office for a recheck, the pressure ulcer changed to stage 1. Which of the following findings supports the conclusion the client has improved?
  1. a.
    A blister has now formed at the site of the pressure injury.
  2. b.
    The site of the pressure injury shows some healthy adipose tissue.
  3. c.
    The site of the pressure injury is red but intact.
  4. d.
    The pressure injury diameter is smaller but deeper.

Answer

C. The site of the pressure injury is red but intact.
The pressure ulcer changed from a stage 2 ulcer to a stage 1 ulcer, which indicates improvement. Stage 1 pressure injuries are reddened, but not open.

19-6 §19.RQ source ↗

The client has returned to the clinic for a follow-up appointment after being diagnosed with osteoporosis. Which of the following statements by the client indicates they have followed the recommended diet to manage their condition?
  1. a.
    “I have been eating more fruit than I used to.”
  2. b.
    “I try to eat several servings of dairy products each day.”
  3. c.
    “I don’t like to eat fish.”
  4. d.
    “I have switched from eating French fries to baked potatoes.”

Answer

B. “I try to eat several servings of dairy products each day.”
Foods rich in calcium and vitamin D, such as dairy products, are important for bone health and the treatment of osteoporosis.

19-7 §19.RQ source ↗

The nurse is caring for a client who is prescribed a gluten-free diet to manage their dermatitis herpetiformis. Which foods require modification when conforming to a gluten-free diet?
  1. a.
    Fresh fruit and vegetables
  2. b.
    Bread and pasta
  3. c.
    Brown and wild rice
  4. d.
    Fish and poultry

Answer

B. Bread and pasta
Bread and pasta contain gluten and would not be included in a gluten-free diet.

19-8 §19.RQ source ↗

During an admission assessment, the nurse is assessing the client’s fingernails. Which of the following findings would be concerning?
  1. a.
    Capillary refill < 2 seconds
  2. b.
    Smooth nails
  3. c.
    Clubbing of nails
  4. d.
    Translucent color with pinkish tone

Answer

C. Clubbing of nails
Clubbing of nails, when nails look wider or swollen, is often seen with chronic obstructive pulmonary disease (COPD).

19-9 §19.RQ source ↗

The nurse is providing nutritional instruction to a client with a surgical wound that is slow to heal. Which of the following statements by the client indicates the client understands the recommended diet strategies?
  1. a.
    “I will eat smaller, more frequent meals.”
  2. b.
    “I will drink water throughout the day.”
  3. c.
    “I will limit my intake of dairy products.”
  4. d.
    “I will eat several servings of fruits and vegetables each day.”

Answer

B. “I will drink water throughout the day.”
The client understands hydration, like drinking water throughout the day, promotes skin integrity and wound healing.

19-10 §19.RQ source ↗

The nurse is working with a client who is experiencing alopecia. Which of the following nutrients, found in liver and egg yolks, could the nurse recommend?
  1. a.
    Folate
  2. b.
    Zinc
  3. c.
    Selenium
  4. d.
    Biotin

Answer

D. Biotin
Biotin is found in foods such as liver and cooked egg yolks, and it is important in the promotion of hair and nail health.

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Problems and answers are adapted from Nutrition for Nurses by Emerald Charity Bilbrew, Jody Vogelzang and Kelli Whittington, OpenStax, and are used under the CC BY-NC-SA 4.0 licence. Access for free at https://openstax.org/books/nutrition/pages/1-introduction. Illustrations: Copyright Rice University, OpenStax, under CC BY-NC-SA 4.0 license. This adaptation is released under the same licence, is non-commercial, and is neither affiliated with nor endorsed by OpenStax or Rice University.