What criteria would you use to determine whether Mrs. McCormick ...

[Alainaaa8]

What criteria would you use to determine whether Mrs. McCormick requires enteral feeding?
 
  What will be an ideal response?

Question 2

Outline steps you would take to assist Mrs. Maney as she prepares for discharge. Include the specific nutrition education that you would include.
 
  What will be an ideal response?

[vickybb89]

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.

[Alainaaa8]

Gracias!

[coreycathey]

Excellent