MrAvery's Swallowing Ability and Oral Intake Are Improving $\bullet$ End-Stage Adenocarcinoma of the Gastroestophageal Juncture

question 74

Multiple Choice

Mr.Avery's swallowing ability and oral intake are improving.He is now consuming about ²/₃ of his estimated nutrient needs from oral intake.It would be appropriate at this time to:

• A)discontinue the tube feeding.
• B)increase the rate of the tube feeding.
• C)decrease the rate of the parenteral feeding.
• D)discontinue the parenteral feeding.
• Use the following case study to answer questions 63-68.
• Mr)Stanley Edward, a 58-year-old African American male, was admitted to the emergency room of the medical center upon being found unconscious in his car in a parking lot and resuscitated.His history was obtained by contacting his daughter.The patient presents with:
• \(\bullet\)end-stage adenocarcinoma of the gastroestophageal juncture.
• \(\bullet\)chronic malnutrition and significant weight loss × 1 year.Low BMI, loss of muscle, loss of subcutaneous fat, bitemporal wasting.
• \(\bullet\)acute pancreatitis with intractable vomiting.
• Medical Hx: Hypertension; S/P stroke @ age 56; cataract surgery.Meds: antilipemic medication, antihypertensive medication.
• Hx: Lifelong chain smoker (2 packs per day); alcohol abuse since his late 20s.
• Ht: 5'8".Admission Wt: 107 lbs.Usual Wt, 1 year ago: 170 lbs.
• Social Hx: Lives alone; cooks and shops for himself despite illness.
• Dietary Hx: Previously followed a low-cholesterol, low-sodium, high-potassium diet.
• Mr)Edward is not being actively treated for cancer at his request.Plan is to keep Mr.Edward NPO and place a peripheral line for hydration and nutrition support.

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