11-30-2015, 06:24 AM
A 98-year-old female resident of an assisted-living facility is brought to the office by her daughter because of a 6-month history of weight loss. The patient says, "I've felt okay but have had to buy a whole new wardrobe because all of my old clothes are too big now." She has not had abdominal pain, nausea, vomiting, constipation, or diarrhea. Her appetite is unchanged and she has no problems with her diet. She eats all her meals in her own room. Medical history is significant for osteoarthritis. Medications include acetaminophen as needed for pain. BMI is 22 kg/m2. She has lost 11 kg (25 lb) since her last office visit 6 months ago. Vital signs are temperature 36.6°C (97.8°F), pulse 78/min, respirations 16/min, and blood pressure 126/88 mm Hg. Physical examination discloses interosseous wasting bilaterally, but muscle tone and strength are normal. The remainder of the physical examination discloses no abnormalities. The patient's total daily caloric intake is recorded and shows that she eats 60% of her meals and consumes 1000 calories daily. Which of the following is the most appropriate next step?
A) Begin enteral feedings via nasogastric tube B) Prescribe megestrol therapy C) Recommend eating meals in the facility dining hall D) No intervention is indicated
A) Begin enteral feedings via nasogastric tube B) Prescribe megestrol therapy C) Recommend eating meals in the facility dining hall D) No intervention is indicated