Case Study 11 Topic: Nutrition Support John is a 6 feet 1 inches, 58 year old Bl
ID: 124655 • Letter: C
Question
Case Study 11
Topic: Nutrition Support
John is a 6 feet 1 inches, 58 year old Black male who recently retired from bus driving for 40 years. John’s wife reported that John started complaining of chest pain 4 months ago, but recently believes the pain is getting worst. She reported that John’s appetite has been reduced and that he is currently below his normal weight of 180 lbs.
During their visit to the doctor, they discovered that his weight is currently at 160 lbs. Blood work and an Upper GI series test was done. The UGI revealed a tumor in his stomach and he was immediately admitted into the hospital for removal and biopsy of the tumor. It was found to be cancerous and with metastases. John continues to be hospitalized while chemotherapy and radiation therapy begun. His doctor ordered a dietitian consult and asked for john to be fed. John in the meanwhile was given D5NS at 50 cc/hr, until nutritional support administration started.
Objective Data
Gender: Male
Age: 55 y
Height: 6"1"
Weight: 160 lb
UBW: 180 lb
LABS Actual Normal
Hct 30% 33 - 44%
Hgb 11 g/dL 11.5 - 15.5 g/dL
Glucose 91 mg/dL 70 - 110 mg/dL
BUN 11 mg/dL 8 - 18 mg/dL
Alb 2.7 g/dL 4.0 - 6.0 g/dL
Na 130 mEq/L 135 - 145 mEq/L
K 3.6 mEq/ L 3.7 - 5.2 mEq/L
1. Between enteral nutrition and TPN which is more preferable, and why?
2.Calculate John’s IBW, percent IBW, and percent UBW.
3.Calculate John’s kcal and protein needs.
4.Is there any nutrition concern with John’s lab results? If so what lab results show concern and what does it or they reflect nutritionally
5.Should john be given TPN would you recommend iron be added? And if so, why or why not?
6.Due to John surgery, which Vitamin would be of concern if added to the TPN solution and why?
7. Calculate a TPN formula for John.
8.Based on a specialized formula of 1.1 kcal/mL/ 72 g PRO per mL and 730 mL free water per mL. Calculate John’s enteral formula at a rate of 65 cc/h to be administered over 24 h.
9.How much free water does the formula provide? How much free water would needed additionally
10. Based on your calculated nutrient needs for John, would his needs be met with the nutrition support calculated in question 12? If not what would you recommended?
11. What are some potential complications of TPN?
12. Explain Refeeding Syndrome. How can you prevent this from happening to John?
13. John has recuperated from her surgery and chemotherapy well. After one month on nutritional support, the doctor asked the RD to make a TF recommendation. Describe how you would recommend making the transition from TPN to TF.
Explanation / Answer
1, Enteral nutrition refers to any method of feeding that uses the gastrointestinal tract to deliver part or all of a persons caloric requirement. Total parenteral nutrition is the way of supplying all the nutritional needs by bypassing the digestive system and dripping the nutritive solution directly into a vein. Enteral nutrition is of prefable because it can include a normal oral diet the use of liquid supplements or part of or all the daily requirements through this. And also the patency of the GI tract will be maintained. It is of like a normal process, all the gastic issues will not be arised by this enteral nutrition
2, Johns IBW,
Based on Robinsons formula,
The formula for IBW(men)= (Male) 52kg+1.9kg per inch over 5ft
=169.1lbs
Percent IBW= Actual weight/Ideal body weight= 160/169=0.946
Percent UBW= Current body weight/UBW X 100= 160/180 X 100= 88.8
3, KCal of Johns is 2500 kcal . Protein needs are 0.8gms per kg body weight. so, 0.8x72= 57.6g proteins required
4, The lab results shows nutrition concern, there is less albumin, sodium, potassium and Hb. So, there is need for protein rich diet and nutritious meal to improve iron, and potssium and sodium supplementation.
5, If the John is given TPN, then iron can be added because there is deficiency of iron, to correct imbalance you can add.
6,Multivitamins can be addede because all the nutrients are required as he posted for surgery. Mulitivitamin especially of Bcomplex will be added to TPN.
7,TPN formula=
In TPN carbs are given as dextrose monohydrate which yields 3.4kcal and proteins ideally 0.8gms but it can be incresed for john due to less albumin. Increased to 2.5 to 3g.
11, Complications related to central venous access, catheter related sepsis, hyperglycemia, hypoglycemia, volume overload, metabolic bone disease
12, Refeeding syndrome is a syndrome consisting of metabolic disturbance that occurs as a result of reinstitution of nutrients to the patients who are starved, severly malnourished, or metabolically stressed due to severe illness. This can be prevented to john by maintaining proper nutrition from time to time and monitoring.
Note: Because of time constrain, not able to answer all. There are many number of questions