NR 228 Discussion 5 Latest 2023 / 2024
You are asked to see Mr. Basset, who is 80 years old, currently living alone, and has recently lost his wife. His children do not live nearby, but Mr. Basset sees them on holidays. Mr. Basset was recently diagnosed with lung cancer and has had an unexplained weight loss of 20 pounds in 3 months. He is getting chemotherapy as well as taking oral medication for hypertension and arthritis, and is showing signs of dehydration.
Mr. Basset reports that his wife did most of the cooking and he has limited cooking skills. He usually has cereal with milk and coffee for breakfast and soup for a second meal later in the day. He eats crackers throughout the day if he is hungry, but admits that he doesn’t have much of an appetite. In addition, Mr. Basset has ill-fitting dentures and claims that food just does not taste the same. He is also on a limited budget.
- What physiological factors might contribute to Mr. Basset’s weight loss?
• Elevated concentrations of tumor necrosis factor a • Decrease of lean body mass that occurs naturally with age • Lack of intake, due to Ms. Basset no longer being there to cook • He fills up on foods that are not nutritious or caloric enough to maintain weight
- What psychosocial factors might contribute to Mr. Basset’s weight loss?
• Depression • Ill-fitting dentures make eating unenjoyable 1 / 2
• Limited budget to buy food
- Give one likely explanation why Mr. Basset’s dentures do not fit.
• They may be new and he has not adjusted • Improper denture care may have caused the dentures to lose shape • Aging and weight fluctuations can change the fit of the dentures. Mr. Basset’s mouth may have changed.
- What nursing actions need to be included in the plan of care to improve Mr. Basset’s nutritional
- / 2
status?Treatment depends on the underlying cause, so Mr. Basset needs to be thoroughly assessed to find the cause of his weight loss. He should begin taking nutritional supplements while he is undergoing other treatments for this issue.Dietary changes that incorporate his taste preferences, flavor enhancers that help food taste better, softer foods that may be more comfortable to chew, or enlisting the help of someone to assist him in eating or to provide him company while he eats are some possible non-pharmacological interventions that may result in higher food consumption.If these methods prove ineffective, there are medications that will increase appetite. Megastrol, mirtazapine, cyproheptadine, and dronabinol, and human growth hormone have all proven helpful in increasing appetite. If Mr. Barrow is in a state that allows the use of medical marijuana, that is also an option. Studies have shown that the use of medical marijuana can not only increase appetite, but may shrink cancer cells and limit the inflammation associated with arthritis. However, it should be made clear to Mr. Barrows that these are limited studies and this research, while exciting, has not been widely accepted by the medical community. It should also be pointed out that all medications, even so-called