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1、www.kaobo100.com中国考博辅导首选学校华东理工大学考博英语辅导：考博英语阅读文章NameBrandMedicallyNecessary:DoNotSubstituteCharlesMason,MD;AmyGivler,MDMonroe,LaIfirstlearnedthatMrBwasmypatientwhentheradiologistcalledmeearlyonemorning."Wecan'tdothebariumswallow,"hesaid,"becauseMrBkeepssp
2、ittingitoutonthetable.""Okay,"Ireplied."Sendhimbacktohisroom."Iamanattendingphysicianinateachinghospital.Latethenightbefore,MrBhadbeensentfromthelocalveteranshometoouremergencydepartment,andtheresidentonmyteamhadadmittedhim.OutsideMrB'sroom,Ilookedoverhi
3、srecords.Threedaysearlierhehadstoppedtakinganythingbymouth,includingliquidsandhismedicationforhypertension,depression,andagitation.Lastnighttheveteranshomestaffhadn'tbeenabletoarousehimandhadsenthimtoourED.Theysuspectedthathehadhadastroke.IwalkedintoMrB'
4、sroomandintroducedmyself.Hewassittingupinbedandalert—afterhisnightofintravenousfluids.Hecouldspeakbuthewasconfused.Hislegswereweak,whichhadkepthimbedriddenformonths,butotherwisehisexaminationwasunremarkable.Iofferedhimaglassofwaterwithastraw.Hesuckedamou
5、thfulbutInoticedhedidn'tswallowit."Swallowthatdown,MrB,"Isaid.Heswallowed,thensuckedanothermouthful."Swallowagain,MrB."Heswallowed.IcalledMrB'sphysicianattheveteranshome.MrBhadlivedthereforayear,havingarrivedafteralongstintattheveteranshospital.Beforetha
6、thehadbeenhomeless.Therehadneverbeenanycontactwithfamily.MrBhadalonghistoryofalcoholanddrugabuseandhadbeendiagnosedwithdementia.www.kaobo100.com中国考博辅导首选学校Thetroublestartedintheearlyafternoon.AnutritionistpagedmewhileIwasseeingmyclinicpatients."DrMason,th
7、enutritionalsupportteamjustmetanddiscussedMrB,yourpatientwiththestroke,andwehaveseveralconcerns.Hehasn'teatenfor4daysnow,andwewantyoutoaddresshisnutritionalneeds.Wewanttoknowhowyouaregoingtoevaluatehisdysphagiaandfeelyoushouldplaceafeedingtubeorstarthype
8、ralimentationuntilhisproblemimprovesoryoudecidetoplaceaPEGtube.""Thankyou,"Ireplied."ButIdon'tthinkhe'shadastrokeandIdon'tthinkhehasdysphagia.Ithinkhe'sjustreachedapointinhisdementiawherehecan'tremembertoswallow.Hisalbumin
