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Scott Summers is 63 years old, his usual weight is 14 stone and height is 5’ 10’’. He lives with his wife Sandy and they have one son who lives locally and one daughter who lives 2.5 hours away. A few months ago he was admitted to hospital with confusion as a neighbour found him wandering in the street during the day. During this admission he was diagnosed with early-onset dementia and was discharged home with support from his family. His wife Sandy is 52 years old and continues to work full time in an office job, so whilst she is able to get him ready in the morning and spend time with him in the evening, she is unable to watch him during the day. Recently she has been struggling to cope and is finding it more difficult to get him to eat and drink. Before she leaves for work she prepares sandwiches and makes him a jug of squash for during the day, however when she comes home these are usually untouched. Scott often gets distracted when eating breakfast and his evening meal so has not been having very much of these either. His son also works full time in construction so is only able to see him in the evenings and his daughter visits around once per month with his 2 grandchildren.

 

He has been re-admitted to hospital this week with delirium secondary to a urinary tract infection and poor intake of fluids which require antibiotics and intravenous fluids to treat. His weight on admission is 68kg and he has a MUST score of 3. The nursing staff on the ward have raised concerns of minimal intake of food and drink. Scott complains of being hungry and thirsty, but he gets agitated when ward staff keep prompting him to eat and drink. He has had a mental capacity assessment and is deemed not to have capacity at current to make his own decisions. Medical staff are worried he will rapidly decline unless his nutritional intake improves and have attempted to insert a nasogastric tube (NGT) in Scott’s best interest. However, he has already pulled out 2 NGTs related to agitation. When you speak to the medical team on the ward, they are discussing whether it would be appropriate or not to insert another NGT with the addition of a bridle. 

 

The following biochemical results were obtained on admission (reference ranges in brackets):

 

Sodium 

147mmol/L 

(135-145mmol/L)

Urea 

7.1mmol/L 

(3.0-6.5mmol/L)

Creatinine 

130µmol/L 

(60-125µmol/L)

Potassium 

3.4mmol/L 

  (3.5-5.0mmol/L) 

Phosphate
0.7mmol/L
(0.8-1.5 mmol/L)
Magnesium
0.5mmol/L
(0.7-1.05 mmol/L)

C-reactive protein  127 mg/L 

(<10 mg/l) 

White Blood Count   9.0 x 109/L 

(4.0-11×109/L)