Order chronic obstructive pulmonary disease

Order chronic obstructive pulmonary disease
iatrician that he had found it hard to cook
and to maintain a healthy diet. He said he
felt tired all the time and also quite irritable. On examination, he had red spots
on his shins. His hair appeared to fracture easily, coil like a corkscrew or bend
in several places, leading to a ‘swan-neck
deformity’. What is a reasonable first step
in management?
10
Nutrition
LEARNING OBJECTIVE:
To know how to assess the nutritional status of older people across various care
settings and in conjunction with other relevant health professionals to be able to
devise an appropriate nutritional support strategy for patients.
Nutrition 127
A. blood test for vitamin C
B. niacin replacement
C. riboflavin replacement
D. thiamine replacement
E. vitamin C supplementation
Question 203
A 92-year-old complains of marked
lethargy, has unintentionally lost 20% of
her body weight in the past four months
and has had very little nutritional intake
for 15 days. She has a history of alcohol
misuse and has been self-administering
antacids to help with symptoms of heart
burn. Admission bloods show electrolyte and fluid imbalance, and ketones are
found in her urine. How should recommencement of nutrition be implemented?
A. correction of electrolyte and fluid
imbalances before feeding is not necessary
B. oral thiamine 100 mg once a day
C. starting nutrition support at a maximum of 10 kcal/kg/day, increasing
levels slowly to meet or exceed full
needs by day 4–7
D. starting nutrition support at a maximum of 20 kcal/kg/day, increasing
levels slowly to meet or exceed full
needs by day 4–7
E. starting nutrition support at a maximum of 30 kcal/kg/day, increasing
levels slowly to meet or exceed full
needs by day 4–7
Question 204
You are asked by nursing staff to review
the position of a nasogastric (NG) feeding
tube so that feeding of a 68-year-old man,
who has suffered a haemorrhagic stroke,
can commence. He has a past medical history of chronic obstructive pulmonary disease and takes a number of medications to
control his symptoms. The NG tube was
flushed with water before insertion, and
the X-ray shows a hyperexpanded chest
and the tube line deviating out to the left
from around mid-thorax distally (level of
T5). The pH of aspirated fluid is measured
at 4.9. Which of the following is the most
appropriate intervention?
A. begin feeding and watch for any
symptoms of coughing
B. leave the tube overnight, flush the
tube with water and recheck the position the following day
C. remove the nasogastric tube
D. repeat the chest X-ray to recheck the
position
E. repeat the pH testing
Question 205
A 72-year-old man with a history of
alcohol abuse is brought to the emergency department by the police, who
found him lying down by the side of the
street. On examination, he is somnolent
and confused. He has a horizontal gaze
palsy with impaired vestibulo-ocular
reflexes and severe truncal ataxia in the
presence of normal motor strength and
muscle stretch reflexes. MRI brain was
normal. What is the appropriate immediate management?
A. carbohydrate only
B. multivitamin only
C. thiamine: 100–200 mg orally once
daily; 100 mg intramuscularly once
daily
D. thiamine: 250–500 mg intravenously
every eight hours, magnesium sulphate: 2–4 g/day intravenously and
multivitamin supplements
E. thiamine: 250–500 mg intravenously
every eight hours, and multivitamin
supplements

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