Case Study Mr. B Background: Mr. B. was admitted to a skilled… Case Study Mr. BBackground: Mr. B. was admitted to a skilled nursing facility to improve his nutritional status post acute hospitalization for a GI bleed, aspiration pneumonia, and acute renal failure. He was admitted to the hospital after being found down by the Meals on Wheels delivery volunteer. He lives alone with no family in the area. He has loose fitting dentures that he wears. No nausea or vomiting but recurrent diarrhea. His preferred meal is fried pork chops and potatoes with whisky to drink. A speech pathologist evaluation identified that Mr. B has moderate pharyngeal dysphagia. His admitting diet to the SNF is a pureed diet with nectar thick liquids. Mr. B disliked these food textures and has been unable to eat or drink enough to maintain nutrition status. Tube feedings had been recommended, yet placement of an NG tube was unsuccessful and Mr. B continued to pull the tube out. With much team discussion Mr. B agreed to have a PEG placed. Yet at the appointment he changed his mind and was readmitted to the hospital. An ethics consult was held. It was agreed that he understood the risks of aspiration with eating. Medical History:ETOH abuseMalnutritionHypomagnesaemiaBarrett’s esophagusColon polypsCVA with lasting left hemiplegia and wrist contracturesOsteoporosisCOPDQuestions:As his nurse and advocate, consider the burdens vs. benefits of the following treatment choices. 1. Gastric tube placement and feeding to treat the malnutrition and decrease aspiration risk. 2. Allowing Mr. B to eat what he wants; optimize his nutrition with oral intake and team interventions focusing on his quality of life. Health Science Science NursingNURS 428
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