Question

In: Nursing

Describe what you would do for Mr. Miller, a 75-year-old male with a recent unintentional weight...

Describe what you would do for Mr. Miller, a 75-year-old male with a recent unintentional weight loss of 15 pounds in the last month. Include in your discussion: subjective history, objective history, differential diagnosis, diagnostics, and treatment plan; prioritize your diagnosis and your differential diagnosis.

Expert Solution

Unintentional weight loss or involuntary decline in total body weight over time .It commonly occurs to elderly who retires at home due to a multitude of factors such as psychoogical,social along with age-related changes.weight loss of atleast 5%

Subjective history-Fever,fatigue,dysphagia,oral problems,dyspnea,indigestion,abdominal pain and change in the colour of the stool

Objective historyverbal reports from the patient regarding weight loss,evidence of change in clothing size and information of weight loss by a relative..

lDifferential diagnosis-The most commmon are Malignancy,gastrointestinal conditions,psychiatric causes.Other etiologies that need to be considered are cachexia syndromes associated with organ failure ie heart failure and renal failure,endocrinopathies,serious infection,medication sideeffects and substance abuse.

Diagnostics-Complete blood count,basic metabolic panel,liver function tests,thyroid function tests,C-reactive proteinl levels,ESR,Glucose measurement,lactate dehydrogenase measurement and urine analysis.Chest tradiography and faecal occult blood testing,abdominal USS.

Treatment plan

Assess the dietary intake or screen for malnutrition

Inadequate Dietary intake

Assess the patient for physiological and psychosocial factors and investigate physiological and psychosocial causes

Increase oral intake,community support services,nutritional supplements,high energy snacks,physical activity and decrease dietary restrictions.

Reassess weight in 3 months.if gaining weight continue to monitor weight.

Adequate dietary intake by

Assess underlying disease,history taking,physical examination and lab tests.

Determine whether cause is organic,psychological or non medical.

Treat underlying cause,correct vitamins and mineral deficiencies .Consider non pharmacologic interventions to optimize absorption and metabolism.

if there is No weight gain,reassess cause,reasses energy intake and consider drug therapy.

Nightingale answered 2 years ago

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