Question 1

The use of feeding gastrostomy tubes at the end of life in Alzheimer's disease patients has been associated with:&#10;A) Prolongation of life&#10;B) Aspirational pneumonia&#10;C) Increase in decubitus ulcer rate&#10;D) Reversal of any clinical signs of failure to thrive

Accepted Answer

Feeding gastrostomy tubes at the end of life in Alzheimer's disease patients has been associated with an increased risk of aspirational pneumonia due to the inability to protect their airway. Other side effects may include an increase in decubitus ulcer rate, complications with tube placement, and discomfort for the patient. There is no evidence to suggest that the use of feeding gastrostomy tubes can prolong life or reverse any clinical signs of failure to thrive in end-stage Alzheimer's disease patients.

Question 2

A key issue that needs to be addressed to families and patients with Alzheimer's disease about the use of feeding tubes is that a feeding tube:&#10;A) Decreases the risk of aspirational pneumonia&#10;B) Does not improve nutritional status or quality of life&#10;C) Is a simple bedside procedure to place the tube and has minimal complications&#10;D) Is an irreversible process once the patient is started on feedings

Accepted Answer

Studies have shown that the use of feeding tubes in patients with Alzheimer's disease does not improve their nutritional status or quality of life. In fact, it may increase the risk of complications such as infections and pressure ulcers. Therefore, families and patients should be informed of this fact before deciding on the use of a feeding tube.

Question 3

Patients at risk of Refeeding Syndrome include those with:&#10;A) No food intake for more than 10 days&#10;B) Chronic malnutrition&#10;C) Dysphagia&#10;D) All of the above

Accepted Answer

Refeeding syndrome is characterized by severe electrolyte shifts (mainly hypophosphatemia), fluid overload, and organ dysfunction, which can occur in patients who are malnourished and/or have had little or no oral intake for more than 10 days (Choice A) or those with chronic malnutrition (Choice B). Dysphagia (Choice C) alone is not a risk factor for refeeding syndrome, but patients with dysphagia may have underlying malnutrition or inadequate nutrient intake, which can increase the risk of refeeding syndrome. Therefore, all of the above choices are risk factors for refeeding syndrome.

Question 4

Which of the following nutritional indicators is not an indication of poor nutritional status in an older person?&#10;A) Albumin of <3.5 g/dl&#10;B) Body mass index of 24&#10;C) Total cholesterol <150 mg/dl&#10;D) Loss of 5-10% body weight in 180 days

Accepted Answer

A Body mass index (BMI) of 24 is within the healthy range, so it is not an indication of poor nutritional status. A low albumin level (< 3.5 g/dl) and low cholesterol level (< 150 mg/dL) indicate poor nutritional status. Loss of 5-10% of body weight in 180 days could also be an indication of poor nutritional status, especially if there is no apparent reason for the weight loss.

Question 5

An 87-year-old female previously independent comes to the ER with 2 days of difficulty swallowing,productive cough,and dyspnea.History includes hypertension and atrial fibrillation.She has a low-grade fever and increased blood pressure.Physical examination and chest radiography are consistent with consolidation in left lower lobe.On bedside testing,she immediately sputters and coughs after drinking a small amount of water from a cup.There are no other neurological signs.Labs: Mild dehydration and WBC increased.MRI reveals a new small brain-stem infarction and mild generalized cerebral atrophy.Treatment for aspiration pneumonia is instituted.Five days later a speech therapy consult was ordered to evaluate swallowing.No improvement has been noted and formal evaluation shows aspiration with most consistencies of food and liquid.Which of the following is the best recommendation?

A) Careful oral feeding
B) Hospice
C) Gastrostomy feeding
D) Nasogastric feeding

Accepted Answer

Given the patient's continued aspiration with most consistencies of food and liquid, the best recommendation would be gastrostomy feeding, which ensures that the patient receives adequate nutrition without the risk of further aspiration. This would be a more long-term solution compared to nasogastric feeding, which can be uncomfortable and has a higher risk of dislodgement, and hospice, which is not appropriate at this time given that the patient is still receiving treatment for her pneumonia. Careful oral feeding would not be recommended due to the risk of further aspiration.

Question 6

Which of the following is a major indicator of protein-energy malnutrition?&#10;A) Total cholesterol less than 200 mg/dl with LDL <100&#10;B) Intentional weight loss of 25 pounds in 2 years&#10;C) Mid-arm circumference less than 16 inches&#10;D) Unintentional low body weight less than 10% of average for height and age

Accepted Answer

Unintentional low body weight less than 10% of average for height and age is a major indicator of protein-energy malnutrition. Total cholesterol levels, intentional weight loss, and mid-arm circumference are not specific indicators of protein-energy malnutrition.

Question 7

Which lab test is most indicative that a patient has refeeding syndrome?&#10;A) A serum albumin level of 3.0 g/dL&#10;B) Hemoglobin of 10.0 g/dL&#10;C) Prealbumin level of 17 mg/dL&#10;D) Serum phosphate level of less than 0.6 mmol/L

Accepted Answer

Refeeding syndrome is characterized by the rapid shift of electrolytes and fluids that occurs when a malnourished patient begins receiving nutrition. The most indicative lab test for refeeding syndrome is a serum phosphate level of less than 0.6 mmol/L. Other potential findings include hypokalemia, hypomagnesemia, and hypocalcemia. While a low albumin level (A) or prealbumin level (C) may be seen in malnourished patients, they are not specific to refeeding syndrome. Hemoglobin (B) may be low in anemia, but it is not directly related to refeeding syndrome.

Question 8

Which of the following is not considered a benefit of high protein supplements added to diets of hospitalized older adults?&#10;A) Improved grip strength&#10;B) Increased weight&#10;C) Overall increased intake of food&#10;D) Reduced readmissions to the hospital

Accepted Answer

High protein supplements are primarily aimed at improving muscle mass and strength, increasing weight, and potentially reducing hospital readmissions, but they do not necessarily lead to an overall increased intake of food.

Question 9

What is the name of the federal program that allots a month supply of food stamps to eligible participants?&#10;A) Meals on Wheels&#10;B) Food Assistance&#10;C) Second Harvest&#10;D) Supplemental Nutrition Assistance Program (SNAP)

Accepted Answer

The Supplemental Nutrition Assistance Program (SNAP), formerly known as the Food Stamp Program, is a federal program that provides assistance to eligible low-income individuals and families to purchase food. It allots a month supply of food stamps to those who qualify.

Question 10

Feedings via PEG tube can safely begin hours after PEG tube placement,barring any contraindications.&#10;A) 2 hours&#10;B) 6 hours&#10;C) 24 hours&#10;D) 48 hours

Accepted Answer

Feedings via PEG tube can safely begin 2 hours after PEG tube placement, barring any contraindications.

Deck 17: Nutritional Support in the Older Adult