Nutritional status in the elderly

Nutritional status in the elderly

A 74-year-old man was admitted to a nursing home for the first time following hospitalization for an exacerbation from heart failure, which is being controlled with Lasix 120 mg a day at this time. While the patient was in the hospital, he fell on the way to the bathroom and sustained a fractured hip, which required an ORIF. He had spinal anesthesia for the fractured hip.

He lives alone at home and has three grown children who live in the same town. He would like to return home. He has been widowed for 9 months. He had been married for 50 years and worked outside the home as a banker. His wife prepared all his meals for him.

During hospitalization, his dietary intake was 10 to 20% of the food provided. He did not receive any food from family or friends to offset his hospital meals. Since admission to the nursing home two days ago, he has eaten only 10% of his diet, which was a low-NA diet, mechanical soft (due to improperly fitting dentures). He was a 20-year smoker, one pack a day. He reports minimum alcohol intake.

He states that since his wife died, he has been leading a sedentary lifestyle, not going out very often. He reports no “real exercise” activities.

The Medications Discharge from Hospital:

Digoxin 0.125 mg oral every morning
Lasix 40 mg tid
Nu-Iron 150 mg oral daily
Hydrocodone and acetaminophen tablets, 5 mg/500 mg for pain
Answer these questions:

What additional subjective information will you be asking for?
What objective findings will you be looking for?
What laboratory tests do you think you want to order and why?
What factors are affecting this patient’s current nutritional and hydration status?
What recommendations would you make to alter his nutritional status?