nb - miss_ismail_79

[ArchivalUser]

1.9 12 days after sustaining a cerebral infarction, a 72-y6ar-old man has fever and cough Initial symptoms included inability to movo his right arm and log, swallow, spoak, or respond to questions Ho has boon receiving a diet of pureed foods since he recovered his ability to swallow 3 days ago He is wearing false teeth His temperature now is 38 8°C (101 8°F), blood pressure is 135/85 mm Hg, pulse is 94/min, and respirations are 28/min Examination shows moderate weakness of the facial muscles and right extremities Gag reflex is absent Breath sounds are decreased, and there is dullness to percussion over the right lung base posteriorly An x-ray film of the chest shows an infiltrate in the posterior basal segment of the right lung Which of the following is most likely to prevent recurrence of this patient's lung condition?
A) Removal of false teeth
B) Suppression of gastric acid production
C) Chronic antibiotic prophylaxis
D) Administration of metoclopramide to increase gastrointestinal motility
E) Insertion of a feeding jejunostomy tube

[ArchivalUser]

B) Suppression of gastric acid production

[ArchivalUser]

B. seems he got aspiration pneumonia.

[ArchivalUser]

B. aspiration pneumonia

[ArchivalUser]

why not removve false teeth ,,aaaaaa

[ArchivalUser]

came across this question in kaplan in a different setting (e.g Eldery Pt will go onto surgery has Hx of Ulcers and decr gag) what the best thing to do before him going to surgery. ans supression of gastric contents

[ArchivalUser]

Answer is E. Feeding tube.
Giving a PPI is not going to prevent this man's aspiration pneumonia. It may reduce gastric acid production and probably prevent ulcer, but stuff is going to go down the lungs nonetheless.
Taking out his false teeth may be done, but does not address the problem, which is reduced gag due to the stroke.

Either you put in a nasogastric tube, or a jejunostomy tube.

[ArchivalUser]

Aspiration pneumonia is a potentially preventable illness requiring attention to the small details of patient care. Elevation of the head of the bed to use gravity to prevent reflux and aspiration of gastric contents is important . High-risk patients should be fed in the sitting position and not placed supine until 1 to 2 hours after meals. Dental prophylaxis and good oral hygiene also are important. Nonrestorable teeth are a nidus for pathogenic bacilli and should be extracted.

Feeding tubes should be managed properly. The position of oral feeding tubes should be monitored because they can easily become displaced over time. The position of small-bore nasogastric tubes should be confirmed by radiography after reinsertion or repositioning. The residual volume of tube feedings in the stomach should be monitored, and tube feedings should be held if the residual volume exceeds 50 mL. There is no evidence that prophylactic antibiotic therapy after a recognized episode of aspiration prevents the subsequent development of bacterial pneumonia; rather, it may select for resistant organisms.

http://www.postgradmed.com/issues/2003/0...ohnson.htm

Thus we can infer that positioning and proper care of orodental hygiene can prevent aspiration and so will removal of oral foreign bodies like dentures and false teeth.

suppresing acid can lower damage because contents will be less acidic but there is no role in prevention of aspiration perse ( moreover suppresion of acid predisposes to bacterial growth in stomach which will then be aspirated ) Tubes are causes rather than solution to prevent aspiration and additional care is required like sitting before and after feeding, repeated confirmation of tube positioning and looking for excessive residual volumes.

hence removal of dentures is appropriate answer.