Answer to Question 1
Patient is meeting <60 of nutritional needs by mouth
Continued weight loss/malnutrition due to chronic illness (>18 within 6 months and muscle/fat wasting)
Functional status/DOSS continues to decline
Risk of aspiration due to swallowing difficulty/GERD prohibits feeding into the stomach, alternative routes will be needed
Answer to Question 2
Assess readiness/motivation for change
Educate the importance of sodium and fluid restriction and their implications on the clinical manifestations and exacerbations of her cachexic state (increased work of breathing due to pulmonary congestion, anorexia, etc.)
Educate Mrs. Maney on nutrient density steps to add both kcal and protein to her diet. Suggest that Mrs, Maney have assistance with meal preparation and grocery shopping. Attempt to get at least 1/3 of her kcal at the meal where she is hungriest. Could also suggest spreading meals over 5-6 small feedings rather than only three. Discuss the use of high calore and high protein supplements. Every bite of food should provide both kcal and protein discourage consumption of empty calorie foods.
Educate Mrs. Maney on fluids:
- See question 5 . for examples
- How to optimize/reduce intake (e.g. avoid salty foods, drink only when thirsty, etc.)
Educate on low-sodium and avoidance of high-sodium options:
- Low sodium: fresh or frozen vegetables, fruits, unprocessed meats, noodles, rice, English muffins, etc.
- High-sodium: processed foods, salty snack foods, soups, sauces, fast foods, pickles, etc.
Pacific Silver Fir cone debris from feeding Douglas Squirrels, North Cascades National Park
Red squirrel at a feeding tray in the Lake District, England.
Oxytocin and breast-feeding
Selected Drugs Associated with Serious Adverse Effects During Breast-Feeding