Comprehensive Case Study: Cancer Patient and Malnutrition
Comprehensive Case Study: Cancer Patient and Malnutrition I N T ER N: J AN N A N EI TZ EL P R E C E P T O R : L O R I H O U G H TA L I N G FA C I L I T Y: A L B A N Y M E M O R I A L H O S P I TA L R O T AT I O N : C L I N I C A L Identification Information Age: 67 Sex: Female Date of admission: 9/17/13 Admit HT and WT: 56, 125# Weight classification: BMI 20.2within normal limits Chief Complaint Admitting diagnosis: Patient admitted with
nausea vomiting, UTI Patient admitted 1 month prior Back pain History of Present Illness History of colon and bladder cancer Metastatic colon cancer with chemo Cancer: group of diseases characterized by uncontrolled growth and spread of abnormal cells
Tumor growth and immune-mediated tumor destruction Endogenous and exogenous risk factors exist for cancer development Cancer is a genetic disease caused by chronic inflammation which elicits a chronic inflammatory response, eventually compromising the function ad structure of cells, creating uncontrolled proliferation (programmed cell death) Endogenous factors: can initiate or promote development of cancer; free radicals, hormones, growth factors, specific genes (oncogenes) Exogenous factors: lifestyle, environmental/occupational exposures, infectious organisms Suspect poor nutrition prior to admit based on dietary recall The National Cancer Institute and the American Cancer Society estimate that 1/3 of cancer deaths relate to poor dietary choices, physical inactivity, or obesity
Tobacco use accounts for additional 1/3 annual deaths from cancer Past Medical History Colon cancer Bladder cancer Pyelonephritis Uropsepsis Cecal mass CKD III ARF Symptomatic anemia Medications, Eating Habits, Weight Hx Medications
Lopressor Xanex Mylanta Dilaudid Fentanyl patch Cefepine Megace Colace Ativan Eating habits: Healthy diet at home, unable to tolerate >1000cal/day, stated; restricts Na, K, and phosphorus intake/renal diet Loss of appetite
WT Hx UBW 142# 120-125# @ admit 112# most recent per bed scale Laboratory Data Current (12/5/13): Low GFR
Low Na Low Cl Low Ca High WBC Low RBC Low HGB Low HCT Assessment Estimating needs: 1600-1800kcal, 60-70g protein, 1.8L fluid per day PES statement: Suboptimal intake, unintentional WT loss, malnutrition in the context of chronic disease Interventions:
Monitored intake at meals & reinforced importance of adequate intake Provided magic cu/ ensure supplementation with meals TPN recfollowed nutrition support team Monitored WT and serial labs Plan of Care Exhausted all efforts to meet patients nutritional needs PO TPN discontinued due to patient request Follow case manager plan for patient to transfer to nursing home Hospice to consult Resources Evidence Analysis Library and eatright.org Copeiand,
Edward M., Daly, John M., and Dudrick, Stanley J. Nutrition as an Adjunct to Cancer Treatment in the Adult. Cancer Research. 1977;37:2451-2456. Tsai, Susan. Importance of Lean Body Mass in the Oncologic Patient. Nutrition in Clinical Practice. 2012;27(5): 593-598. Vargas, Ashley J., Thompson, Patricia A. Diet and Nutrient Factors in Colorectal Risk. Nutrition in Clinical Practice. 2012;27(5): 613- 623. Ross PJ, Norton A, Priest K, Waters JS, Eisen T, Smith IE, O'Brien MER. Do patients with weight loss have a worse outcome when undergoing chemotherapy for lung cancers? British Journal of Cancer. 2004; 90: 1,905-1,911. Capuano G, Grosso A, Gentile PC, Battista M, Bianciardi F, Di Palma A, Pavese I, Satta F, Tosti M, Palladino A, Coiro G, Di Palma M. Influence of weight loss on outcomes in patients with head and neck cancer undergoing concomitant chemoradiotherapy. Head Neck. 2008 Apr; 30(4): 503-508.
Eriksson KM, Cederholm T, Palmblad JE. Nutrition and acute leukemia in adults: Relation between nutritional status and infectious complications during remission induction. Cancer. 1998; 82: 1,071-1,077. Prado CM, Baracos VE, McCargar JL, Mourtzakis M, Mulder KE, Reiman T, Butter CA, Scarfe AG, Sawyer MB. Body composition as an independent determinant of 5-fluorouracil-based chemotherapy toxicity. Clin Cancer Res. 2007 Jun 1; 13(11): 3,264-3,268. Prado CM, Baracos VE, McCargar LJ, Reiman T, Mourtzakis M, Tonkin K, Mackey JR, Koski S, Pituskin E, Sawyer MB. Sarcopenia as a determinant of chemotherapy toxicity and time to tumor progression in metastatic breast cancer patients receiving capecitabine treatment. Clin Cancer Res. 2009 Apr 15; 15(8) :2,920-2,926. Gottschlich, Michele M. The A.S.P.E.N. Nutrition Support Core Curriculum: A Case-Based Approachthe Adult Patient. Pg 651-671
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