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By X. Ateras. Drew University. 2017.

Parenteral nutrition is the preferred mode of nutrition in cancer patients because of its lower incidence of infections Key Concept/Objective: To understand that enteral nutrition is less likely to cause infection than parenteral nutrition Comparisons of enteral nutrition with parenteral nutrition have consistently shown fewer infectious complications with enteral nutrition discount 250 mg famciclovir mastercard. Elderly patients should receive supple- mental feeding or enteral nutrition if they are incapable of eating adequately. A trial in 501 hospitalized elderly patients randomized to oral supplements or a ward diet showed that, irrespective of their initial nutritional status, the patients receiving oral supplements had lower mortality, better mobility, and a shorter hospital stay. The difference between ward diet and supplementation was even more pronounced in a secondary analysis of patients with weight loss. A 32-year-old man with AIDS who is experiencing chronic diarrhea, anorexia, and wasting is referred for evaluation for nutritional support. Results of physical examination are as follows: temperature, 97. The patient appears chronically ill; there is bitemporal wasting, and his hair is easily pluckable. The patient says he has friends with AIDS who are receiving “I. Which of the following statements regarding home total parenteral nutrition (TPN) is true? Evidence demonstrates improved survival and quality of life in patients with metastatic cancer who are receiving home TPN B. Evidence demonstrates improved survival and quality of life in patients with AIDS who are receiving home TPN C. Evidence demonstrates improved survival and quality of life in patients with short bowel from Crohn disease who are receiving home TPN D. No evidence supports the use of home TPN in any patient population Key Concept/Objective: To understand which patients clearly benefit from home TPN Patients with intestinal failure from a short bowel, chronic bowel obstruction, radiation enteritis, or untreatable malabsorption can be nourished by TPN at home. Long-term suc- cess has been achieved with a tunneled silicone rubber catheter or an implanted reservoir. The catheter is then disconnected and a heparin lock applied, leaving the patient free to attend to daily activities. Survival of patients with short bowel resulting from the treatment of Crohn disease or pseudo-obstruction is excel- lent.

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Thyroid-stimulating hormone test results and serum chemistries are normal proven 250mg famciclovir. The differential reveals several granulocytes with 5 nuclear segments. What should be the next step in the treatment of this patient? Determine the vitamin B12 serum level Key Concept/Objective: To understand that neuropsychiatric symptoms may occur in patients with vitamin B12 deficiency before many of the typical hematologic changes of vitamin B12 defi- ciency occur Memory impairment in the absence of hematologic changes can be a presenting symptom of vitamin B12 deficiency. Studies have shown that in 20% to 30% of patients who are defi- cient in vitamin B12, anemia and macrocytosis are absent. A diagnosis of vitamin B12 defi- ciency should be entertained in patients with neurologic disturbances in the absence of anemia and macrocytosis. The indications for vitamin B12 deficiency have broadened to include nonspecific forms of cerebral dysfunction. The finding of hypersegmented neu- trophils remains a sensitive indicator of vitamin B12 deficiency. A 27-year-old African-American man presents to the hospital with increased fatigue, which he has been experiencing for the past several months. He has been treated for sickle cell anemia in the past and has received many blood transfusions. He has been hospitalized multiple times in the past for apparent crises. He currently has no fever, and his general ROS is negative. On physical examination, his vital signs are normal.

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