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d The muscles provide a structural framework, moving by contracting or extending, crossing at least one joint and attached to the articulating bones.

2 What are the most common effects of inactivity?

a Pulmonary embolism, urinary tract infection and fear of people.

b Deep arterial thrombosis, respiratory infection, fear of movement, loss of consciousness, deconditioning of cardiovascular system leading to an increased risk of angina.

c Loss of weight, frustration and deep vein thrombosis.

d Social isolation, loss of independence, exacerbation of symptoms, rapid loss of strength in leg muscles, deconditioning of cardiovascular system leading to increased risk of chest infection, and pulmonary embolism.

3 What do you need to consider when helping a patient with shortness of breath sit out in a chair?

a They shouldn’t sit out in a chair; lying flat is the only position for someone with shortness of breath so that there are no negative effects of gravity putting pressure on the lungs.

b Sitting in a reclining position with the legs elevated to reduce the use of postural muscle oxygen requirements, increasing lung volumes and optimizing perfusion for the best V/Q ratio. The patient should also be kept in an environment that is quiet so they don’t expend any unnecessary energy.

c The patient needs to be able to sit in a forward leaning position supported by pillows. They may also need access to a nebulizer and humidified oxygen so they must be in a position where this is accessible without being a risk to others.

d There are two possible positions, either sitting upright or side lying. Which is used is determined by the age of the patient. It is also important to remember that they will always need a nebulizer and oxygen and the air temperature must be below 20° C.

4 Your patient has bronchitis and has difficulty in clearing his chest. What position would help to maximize the drainage of secretions?

a Lying flat on his back while using a nebulizer.

b Sitting up leaning on pillows and inhaling humidified oxygen.

c Lying on his side with the area to be drained uppermost after the patient has had humidified air.

d Standing up in fresh air taking deep breaths.

5 Mrs Jones has had a cerebral vascular accident, so her left leg is increased in tone, very stiff and difficult to position comfortably when she is in bed. What would you do?

a Give Mrs Jones analgesia and suggest she sleeps in the chair.

b Try to diminish increased tone by avoiding extra stimulation by ensuring her foot doesn’t come into contact with the end of the bed; supporting, with a pillow, her left leg in side lying and keeping the knee flexed.

c Give Mrs Jones diazepam and tilt the bed.

d Suggest a warm bath before she lies on the bed. Then use pillows to support the stiff limb.

These multiple choice questions are also available for you to complete online. Visit www.royalmarsdenmanual.com and select the Student Edition tab.

Answers to the multiple choice questions can be found in Appendix 3.

Chapter 8

Nutrition, Fluid Balance and Blood Transfusion

Overview

Good nutrition, the supply of optimal nutrients and fluid to meet requirements, is an essential component of health, with poor nutrition contributing to ill health and prolonged recovery from illness or disease. It is therefore crucial that the nutritional status of all patients is assessed and considered during the whole of the patient’s care. This chapter addresses how fluid and nutrition can influence body composition, how to identify patients who are malnourished or at risk of malnutrition and, most importantly, how the patient’s nutritional needs can be met.

The provision of food and fluids to patients is an integral part of basic care. In normal circumstances adequate nutritional intake enables the body to maintain homoeostasis of body composition and function but in disease states this balance can be altered. The majority of patients will achieve adequate nutrition through the oral route of diet and fluids but, for some,