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Chapter 5: Applying Clinical Judgment to Promote Nutrition for Neurological Wellness

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Chapter 5: Applying Clinical Judgment to Promote Nutrition for Neurological Wellness

18 problems · 0 figures

Case Study 5.1.1 §5.1 source ↗

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

The nurse completes a nutritional assessment of Jamal Powell. The client’s past medical history is positive for hypertension, high cholesterol, and obesity.

The nurse is evaluating Jamal’s nutritional intake and symptoms. Which aspect of the client’s dietary intake could be associated with these cognitive changes?
  1. a.
    Increased vegetable intake
  2. b.
    Increased whole grain intake
  3. c.
    Increased dairy product intake
  4. d.
    Increased intake of processed foods
Table 5.3 in the book ↗
Vital Signs Laboratory Values
Temperature: 98.5°F (36.94°C) Jamal had blood work drawn the week prior to this visit:

• Total cholesterol: 240 mg/dL

• Low-density lipoprotein (LDL): 160 mg/dL

• High-density lipoprotein (HDL): 30 mg/dL

• Triglycerides: 250 mg/dL
Blood pressure: 148/90 mm Hg
Heart rate: 97 beats/min
Respiratory rate: 14 breaths/min
Oxygen saturation: 97% on room air
Height: 5'9"
Weight: 230 lb (104.33 kg)
BMI: 34 (Class 1 obesity)

Answer

D. Increased intake of processed foods
Diets high in processed foods, red meats, and refined sugars have all been shown to lead to cognitive decline.

Case Study 5.1.2 §5.1 source ↗

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

The nurse completes a nutritional assessment of Jamal Powell. The client’s past medical history is positive for hypertension, high cholesterol, and obesity.

When assessing the nutritional impact on cognitive function, what should the nurse anticipate the health care provider to prescribe to evaluate the client further?
  1. a.
    Spiral computed tomography
  2. b.
    Positron emission tomography
  3. c.
    Computed tomography of the head with contrast
  4. d.
    Cerebral angiography
Table 5.3 in the book ↗
Vital Signs Laboratory Values
Temperature: 98.5°F (36.94°C) Jamal had blood work drawn the week prior to this visit:

• Total cholesterol: 240 mg/dL

• Low-density lipoprotein (LDL): 160 mg/dL

• High-density lipoprotein (HDL): 30 mg/dL

• Triglycerides: 250 mg/dL
Blood pressure: 148/90 mm Hg
Heart rate: 97 beats/min
Respiratory rate: 14 breaths/min
Oxygen saturation: 97% on room air
Height: 5'9"
Weight: 230 lb (104.33 kg)
BMI: 34 (Class 1 obesity)

Answer

B. Positron emission tomography
Cerebral blood flow should be evaluated with a PET scan to determine whether poor blood flow could be contributing to changes in cognitive status.

Case Study 5.3.3 §5.3 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.

Jamal Powell has a normal PET scan result and is advised to follow up with the clinic regularly. The client is referred to a dietician but misses 6 separate appointments over 2 years.

Jamal is visiting the clinic today for a routine follow-up 2 years after the initial clinic visit. During this time, Jamal’s memory has progressively worsened. Jamal believes these deficits have not been obvious to friends.

The client describes a recent problem of forgetting where they put things and confusing things in their memory. However, the client’s relationship to time, as well as their skills in math and literacy, have not changed. Jamal is independent with regard to basic activities of daily living, but complex tasks are becoming more challenging.

The client states that they have started to feel less confident about driving over the past few months. Jamal appears to be irritable and becomes distressed when discussing the symptoms and recent events they have been dealing with. The client discusses their fears and frustrations surrounding these changes and feels they are becoming depressed about the situation.

The nurse discusses Jamal’s diet and activity and plans to work with the client to improve their nutritional state. Jamal’s diet is high in saturated fats and low in fresh vegetables and fruits. The client’s spouse mentions that they read that polyphenols are good for brain health and asks which foods would be best to include in their diets.

Jamal also asks why everyone keeps saying that sugar in the diet is bad, stating that they have enjoyed sweets their whole life. This is apparent with the recent HbA1c test result, which is 6.3%. (The expected range for nondiabetic clients, such as Jamal, is less than 5.7%.)

The nurse explains that the combination of Jamal’s high BMI of 40, HbA1c of 6.3%, total cholesterol level of 250 mg/dL, and diagnosis of chronic hypertension (today’s blood pressure was 156/98 mm Hg) classifies them as having a condition called metabolic syndrome. The nurse sets up another appointment with the dietitian to help Jamal correct the nutritional issues identified. Because the dietitian’s earliest appointment is 2 months away, the nurse teaches Jamal and their spouse about some basic nutritional changes they can make before the next appointment.

How much omega-3 fatty acid content should the nurse instruct Jamal to include in his diet each day?
  1. a.
    1.1–1.6 g
  2. b.
    3.5–6.6 g
  3. c.
    0.1–0.16 g
  4. d.
    11–16 g

Answer

A. 1.1–1.6 g
Consuming 1.1–1.6 g of omega-3 fatty acids daily has been shown to optimize brain function in clients over 51 years of age.

Case Study 5.3.4 §5.3 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.

Jamal Powell has a normal PET scan result and is advised to follow up with the clinic regularly. The client is referred to a dietician but misses 6 separate appointments over 2 years.

Jamal is visiting the clinic today for a routine follow-up 2 years after the initial clinic visit. During this time, Jamal’s memory has progressively worsened. Jamal believes these deficits have not been obvious to friends.

The client describes a recent problem of forgetting where they put things and confusing things in their memory. However, the client’s relationship to time, as well as their skills in math and literacy, have not changed. Jamal is independent with regard to basic activities of daily living, but complex tasks are becoming more challenging.

The client states that they have started to feel less confident about driving over the past few months. Jamal appears to be irritable and becomes distressed when discussing the symptoms and recent events they have been dealing with. The client discusses their fears and frustrations surrounding these changes and feels they are becoming depressed about the situation.

The nurse discusses Jamal’s diet and activity and plans to work with the client to improve their nutritional state. Jamal’s diet is high in saturated fats and low in fresh vegetables and fruits. The client’s spouse mentions that they read that polyphenols are good for brain health and asks which foods would be best to include in their diets.

Jamal also asks why everyone keeps saying that sugar in the diet is bad, stating that they have enjoyed sweets their whole life. This is apparent with the recent HbA1c test result, which is 6.3%. (The expected range for nondiabetic clients, such as Jamal, is less than 5.7%.)

The nurse explains that the combination of Jamal’s high BMI of 40, HbA1c of 6.3%, total cholesterol level of 250 mg/dL, and diagnosis of chronic hypertension (today’s blood pressure was 156/98 mm Hg) classifies them as having a condition called metabolic syndrome. The nurse sets up another appointment with the dietitian to help Jamal correct the nutritional issues identified. Because the dietitian’s earliest appointment is 2 months away, the nurse teaches Jamal and their spouse about some basic nutritional changes they can make before the next appointment.

The nurse is teaching Jamal and their spouse how to choose foods high in omega-3 fatty acids. Which food choices would indicate understanding by the client?
  1. a.
    Dairy and eggs
  2. b.
    Fatty fish and oils
  3. c.
    Colorful fruits and vegetables
  4. d.
    Peanut butter and almond butter

Answer

C. Colorful fruits and vegetables
Omega-3 fatty acids are found largely in colorful fruits and vegetables, as well as in fortified cereals and beverages. Fruits, such as grapes, apples, pears, cherries, and berries; dark chocolate; legumes; red wine; tea; and coffee are also good sources.

Case Study 5.4.5 §5.4 source ↗

Table 5.4 in the book ↗
Vital Signs Laboratory Values
Temperature: 98.6°F (37.0°C) Jamal had blood work drawn the previous week:

• Total cholesterol: 254 mg/dL

• LDL cholesterol: 170 mg/dL

• HDL cholesterol: 30 mg/dL

• Triglycerides: 270 mg/dL
Blood pressure: 187/86 mm Hg
Heart rate: 99 beats/min
Respiratory rate: 14 breaths/min
Oxygen saturation: 97% on room air

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

Jamal and their spouse attended the appointment with the dietitian. Jamal is now back in the clinic 6 months after the last visit. The nurse is evaluating the client’s adherence to the new nutritional plan (meal plan) that was formulated with Jamal, their spouse, and the dietitian 3 months previously. The client has gained 10 lb (4.54 kg) over this time.

Jamal’s spouse assisted the client in completing a 3-day diet history, which revealed an absence of fruits and vegetables, a high intake of foods containing processed sugar, and a minimal amount of fiber. Even though the client did not have an issue in any other prior visits, Jamal had become more depressed and started to drink alcohol. The client’s alcohol intake for the 3-day diet history was approximately a 6-pack of beer daily and a couple of bottles of wine over the 3 days.

As a follow-up study, the health care provider ordered an amyloid PET scan. The results revealed tau proteins consistent with early Alzheimer’s disease.

To optimize all aspects of possible treatments for this diagnosis, the health care provider recommends a Mediterranean diet and a weight loss regimen and prescribes donepezil 5 mg once by mouth daily at bedtime. The nurse provides Jamal and their spouse educational materials about the medication, the Mediterranean diet, and MyPlate recommendations. The nurse also advises the client to engage in a moderate exercise routine by walking for 30 minutes at least 3 times a week.

Based on the assessment findings, which of the following clinical findings indicates compliance with the prescribed nutritional plan?
  1. a.
    Alcohol intake of 3 glasses wine per day
  2. b.
    Total cholesterol level remains 240
  3. c.
    Dietitian appointment scheduled
  4. d.
    Body mass index > 35

Answer

C. Dietitian appointment scheduled
The client’s going to their dietitian appointment shows adherence to the prescribed plan. Signs of nonadherence include alcohol use; increased BMI; increased total cholesterol; increased blood pressure; low intake of fruits, vegetables, and fiber; and high intake of processed sugars.

Case Study 5.4.6 §5.4 source ↗

Table 5.4 in the book ↗
Vital Signs Laboratory Values
Temperature: 98.6°F (37.0°C) Jamal had blood work drawn the previous week:

• Total cholesterol: 254 mg/dL

• LDL cholesterol: 170 mg/dL

• HDL cholesterol: 30 mg/dL

• Triglycerides: 270 mg/dL
Blood pressure: 187/86 mm Hg
Heart rate: 99 beats/min
Respiratory rate: 14 breaths/min
Oxygen saturation: 97% on room air

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

Jamal and their spouse attended the appointment with the dietitian. Jamal is now back in the clinic 6 months after the last visit. The nurse is evaluating the client’s adherence to the new nutritional plan (meal plan) that was formulated with Jamal, their spouse, and the dietitian 3 months previously. The client has gained 10 lb (4.54 kg) over this time.

Jamal’s spouse assisted the client in completing a 3-day diet history, which revealed an absence of fruits and vegetables, a high intake of foods containing processed sugar, and a minimal amount of fiber. Even though the client did not have an issue in any other prior visits, Jamal had become more depressed and started to drink alcohol. The client’s alcohol intake for the 3-day diet history was approximately a 6-pack of beer daily and a couple of bottles of wine over the 3 days.

As a follow-up study, the health care provider ordered an amyloid PET scan. The results revealed tau proteins consistent with early Alzheimer’s disease.

To optimize all aspects of possible treatments for this diagnosis, the health care provider recommends a Mediterranean diet and a weight loss regimen and prescribes donepezil 5 mg once by mouth daily at bedtime. The nurse provides Jamal and their spouse educational materials about the medication, the Mediterranean diet, and MyPlate recommendations. The nurse also advises the client to engage in a moderate exercise routine by walking for 30 minutes at least 3 times a week.

The client’s spouse asks the nurse to explain a little more about tau proteins and why they are an issue. What should the nurse say?
  1. a.
    ”Jamal has too many tau proteins in his brain.”
  2. b.
    “Tau proteins are genetic mutations that are causing dysfunction.”
  3. c.
    “The tau proteins are tangled and accumulate in the brain, causing dysfunction.”
  4. d.
    “There is no relationship between the tau proteins and Jamal’s symptoms.”

Answer

C. “The tau proteins are tangled and accumulate in the brain, causing dysfunction.”
Tau proteins can become tangled and accumulate in the brain and cause dysfunction.

Case Study 5.4.7 §5.4 source ↗

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

Jamal returns for a follow-up appointment 2 months later so the nutritional plan can be evaluated and changed if necessary. The check-in revealed a weight loss of 4 lb over the previous 2 months. Jamal states that they like and are following the currently prescribed diet because it is easier than eating separate meals. However, Jamal and their spouse still have some questions regarding food preparation and meal planning. Jamal has been very adherent but is having a hard time giving up fried foods.

Jamal’s spouse reveals that the expense of groceries has risen recently, and they were trying to adjust their monthly budget to accommodate this change. The client states that they have even decreased their alcohol intake to 1 glass of red wine a day, not only for health reasons but also due to increases in grocery prices.

The nurse discusses the situation more with the client and their spouse to get all the data in order to best help them. The nurse discovers that the client retired and is living on retirement income and Social Security. The client’s spouse has not worked in 10 years and receives disability and Social Security checks each month as income.

The client has stopped driving because they felt it was unsafe, and the couple continues to live at home. Jamal’s neurologist has ordered additional diagnostic exams to further evaluate the Alzheimer’s diagnosis, as well as cognitive tests to evaluate the client’s safety.

When evaluating ways to help improve Jamal’s nutritional intake based on the information obtained, what is the best suggestion to cost-effectively improve the nutritional plan?
  1. a.
    Buy more fresh fruits and vegetables.
  2. b.
    Use an air fryer to cook foods without breading.
  3. c.
    Eat more microwaved meals to make meal preparation easier.
  4. d.
    Increase the number of daily servings of fruit juice.

Answer

B. Use an air fryer to cook foods without breading.
Because of rising food costs, it may be helpful to use an air fryer to avoid deep-frying foods while maintaining the client’s current food preferences, such as fried foods, and increasing adherence to the meal plan.

Case Study 5.4.8 §5.4 source ↗

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

Jamal returns for a follow-up appointment 2 months later so the nutritional plan can be evaluated and changed if necessary. The check-in revealed a weight loss of 4 lb over the previous 2 months. Jamal states that they like and are following the currently prescribed diet because it is easier than eating separate meals. However, Jamal and their spouse still have some questions regarding food preparation and meal planning. Jamal has been very adherent but is having a hard time giving up fried foods.

Jamal’s spouse reveals that the expense of groceries has risen recently, and they were trying to adjust their monthly budget to accommodate this change. The client states that they have even decreased their alcohol intake to 1 glass of red wine a day, not only for health reasons but also due to increases in grocery prices.

The nurse discusses the situation more with the client and their spouse to get all the data in order to best help them. The nurse discovers that the client retired and is living on retirement income and Social Security. The client’s spouse has not worked in 10 years and receives disability and Social Security checks each month as income.

The client has stopped driving because they felt it was unsafe, and the couple continues to live at home. Jamal’s neurologist has ordered additional diagnostic exams to further evaluate the Alzheimer’s diagnosis, as well as cognitive tests to evaluate the client’s safety.

The nurse educates Jamal about abstaining from alcohol and suggests a few other nutritional modifications. Based on the client’s case, what studies or tests should the nurse expect the health care provider to prescribe to investigate other potential changes needed in treatment?
  1. a.
    Magnetic resonance imaging of the head
  2. b.
    PET scan
  3. c.
    Computed tomography scan of the head with contrast
  4. d.
    Cerebral angiogram

Answer

B. PET scan
Cerebral blood flow should be evaluated with a PET scan to determine whether poor blood flow could be contributing to Jamal’s changes in cognitive status.

5-1 §5.RQ source ↗

The nurse is caring for a client who had a stroke 2 days ago and is experiencing continued dysphagia. Which of the following nutritional therapies will likely be prescribed?
  1. a.
    Nothing by mouth until the dysphagia subsides
  2. b.
    Supplements given via a nasogastric tube
  3. c.
    Initiation of total parenteral nutrition
  4. d.
    Initiation of a soft diet

Answer

B. Supplements given via a nasogastric tube
Supplements given via nasogastric tube can provide enteral nutrition for clients with dysphagia who are at risk for aspiration.

5-2 §5.RQ source ↗

A client admitted with traumatic brain injury develops syndrome of inappropriate antidiuretic hormone (SIADH). The nurse should prioritize which intervention to improve the client’s nutritional status?
  1. a.
    Infuse intravenous fluids rapidly.
  2. b.
    Perform a dysphagia screen.
  3. c.
    Restrict fluids.
  4. d.
    Check the client’s blood glucose level.

Answer

C. Restrict fluids.
The client is hyponatremic due to the head injury and is conserving fluids. In addition to fluid restriction, medications may be administered to correct SIADH.

5-3 §5.RQ source ↗

The nurse is caring for a client who is in the early stage of Alzheimer’s disease. The client and family inquire about meal choices. Which food choice would be most appropriate for the nurse to discuss with the client?
  1. a.
    Colored berries
  2. b.
    Fried fish
  3. c.
    Margarine
  4. d.
    Zero-calorie sweeteners

Answer

A. Colored berries
The progression of Alzheimer’s disease may be slowed by the consistent intake of polyphenols, and colored berries are a rich source of polyphenols.

5-4 §5.RQ source ↗

A client with multiple sclerosis asks the nurse about the best foods to fight fatigue and enhance nerve cell conduction. Which food choices would be appropriate for this client?
  1. a.
    Nuts, seeds, and salmon
  2. b.
    Cheese, milk, and margarine
  3. c.
    Lean red meats, potatoes, and white bread
  4. d.
    Eggs, lamb, and zero-calorie beverages

Answer

A. Nuts, seeds, and salmon
All other choices may result in inflammation and can cause further damage to the myelin sheath of nerve cells.

5-5 §5.RQ source ↗

A child is diagnosed with epilepsy and is being seen for intractable seizures. Which diet(s) would the interprofessional team potentially recommend?
  1. a.
    Mediterranean diet
  2. b.
    Ketogenic diet
  3. c.
    DASH diet
  4. d.
    Vegan diet

Answer

B. Ketogenic diet
The ketogenic diet is low in carbohydrates, and a low-carbohydrate diet has been shown to reduce the incidence of seizures.

5-6 §5.RQ source ↗

A 67-year-old woman presents to the urgent care center with a headache and dizziness following a 5-mile running event for charity. Which of the following findings would be most concerning?
  1. a.
    Seizure history
  2. b.
    Limited fluid intake
  3. c.
    History of kidney stones
  4. d.
    Recent vaccination for influenza

Answer

B. Limited fluid intake
Dehydration is common among older adults because of a diminished sense of thirst; vigorous exercise can cause rapid dehydration, and hydration is the priority to assess.

5-7 §5.RQ source ↗

A client asks the nurse about taking supplements for improving memory. Which would be the nurse’s best response?
  1. a.
    “You should start taking fish oil immediately to improve blood flow to your brain.”
  2. b.
    “You should start taking a potassium supplement because this will help with nerve conduction.”
  3. c.
    “You should start taking zinc because this will help regenerate myelin to help your nervous system.”
  4. d.
    “You should review the content of your current diet with the nutritionist.”

Answer

D. “You should review the content of your current diet with the nutritionist.”
Although supplements may be beneficial in some cases, most nutrients are best absorbed when they are consumed as regular food. Even though many Americans do not eat a healthy diet, it is best to evaluate current dietary patterns and offer changes before recommending dietary supplements.

5-8 §5.RQ source ↗

A client with Parkinson’s disease asks the nurse about possible benefits of intermittent fasting. Which reply would be appropriate?
  1. a.
    “There is no clear evidence of a benefit of intermittent fasting with your condition.”
  2. b.
    “Although evidence supports a benefit in people with epilepsy, there is no clear evidence of a benefit with Parkinson disorder.”
  3. c.
    “Yes, there is. Let’s talk with your health care provider to see if this is right for you.”
  4. d.
    “You will need to discuss this issue with your health care provider.”

Answer

C. “Yes, there is. Let’s talk with your health care provider to see if this is right for you.”
Evidence supports a cognitive benefit of intermittent fasting in Parkinson’s disease as well as epilepsy, stroke, and Alzheimer’s disease.

5-9 §5.RQ source ↗

What is the recommendation for daily omega-3 fatty acid intake for a 52-year-old adult?
  1. a.
    0.5–1 mg
  2. b.
    1.1–1.6 mcg
  3. c.
    1.1–1.6 g
  4. d.
    The daily recommendation is not yet established.

Answer

C. 1.1–1.6 g
The National Institutes of Health recommends 1.1–1.6 g of omega-3 fatty acids daily for a 52-year-old adult.

5-10 §5.RQ source ↗

Nutrition can impact the development of neurofibrillary tangles that are found in individuals with Alzheimer’s disease. Which of the following provides structural strength to microtubules in the neuron?
  1. a.
    Beta-amyloid
  2. b.
    Amyloid precursor protein
  3. c.
    Tau protein
  4. d.
    Microglia

Answer

C. Tau protein
Tau proteins provide structural support to the microtubules in the neuron but can become tangled due to phosphorylation.

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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.