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NUTR-UE 1185.002
Clinical Nutrition Assessment and Intervention
Fall 2017
Estimate the patient’s energy needs, indicate the method you used to do so, and briefly explain your choice.
56 yr old male
5’8” (using 1” = 2.54cm) à 68” x 2.54 = 173 cm= 1.73 m
ABW 165 lbs (using 1 lb = .454 kg) à165 x .454 = 75 kg
UBW 185 lbs (4 months ago) à 185 x .454 = 84 kg
% weight lost= 20/185 à 10.8% weight loss over 4 months = SEVERE weight loss
Current BMI: kg/m2 à 75/1.732 = 25 just at the edge of overweight status.
At this point we just want to keep his weight and nutrition stable, and not gain or lose weight. We don’t
want to overfeed the patient, as he is at risk for refeeding syndrome dysphasia and cancer cachexia, and
we also don’t want him to lose weight, but rather keep him stable. A high protein, high calorie diet, as
tolerated, is recommended for patients who are being treated with chemotherapy and radiation prior to
surgery.
We cannot use the Penn State equation because we don’t have the data for it, and don’t have IC. Using
the data at hand, the Mifflin St. Jeor Equation is the closest we can get to BMR and will adjust it slightly
with the modest sedentary activity level and coefficients. I will compare this calorie estimate with the rule
of thumb method.
As the patient is a drinker with 30 years of smoking, and is currently feeling weak, I would place his PA
level at sedentary, giving a PA coefficient of 1; As the patient is on the edge between normal and
overweight, but recently lost quite a bit of weight and has had trouble eating, I would use the equation
for TEE for Overweight or Obese Men over 19 years old with BMI ≥ 25 kg/m2.
TEE = 1086 – 10.1 x 56 yrs + 1 x (13.7 x 75kg + 416 x 1.73m) = 2267 cal/day; I will round to an estimated
2200 cal/day.
And, just to check, this is in line with the the rule of thumb method of 25-30 cal/ kg per day for critically ill
patients: 25 cal x 75 = 1875 cal/ day, and 30 cal x 75 = 2250 cal/ day; we get a range of 1875-2250 cal/day.
Estimate the patient’s protein and fluid needs and document what you are basing this on.
Estimated Protein needs: should be higher because he is sick; Daily Protein Requirements for People with
Cancer: 1- 1.5 PRO g/kg a day à estimated 75-112 g PRO /day per 75 kg weight.
A. Using the NYP formulary (found in the EN/PN Lectures Resources folder), which formula is most appropriate for
this patient? Why? (10 points)
Calculate the volume of feeding you would need to provide for your client’s energy and protein needs. Calculate an
appropriate flush (volume/frequency) to meet total fluid needs.
Will provide: 2160 cal/day = 1440 x 1.5 (all in range of est. cal, fluid & PRO needs)
2294 ml/day fluids = (200cc x 6) + 1094 ml
97g PRO/day = 1440 ml x .0675 PRO g /ml
Choose the method of feeding [bolus/gravity drip/intermittent/continuous] for your patient while in the hospital
and explain why you made this choice.
Write out the tube feeding regimen listing total mL of formula, total kilocalories, protein, free fluids, % RDI of
vitamins and minerals you are providing and total volume of regimen.
Nutrition Assessment:
History:
56 yr old male, appears weak and uncomfortable; suffering from Esophageal cancer, malnutrition, and
recent rapid weight loss; will have surgery, chemotherapy and radiation; Pt was a pack a day smoker for
30 years and 3-4 martinis on weekends; has a history of GERD, Barrett’s esophagus. Pt is also currently
suffering from coughing (2 months), sore throat, and difficulty swallowing with both solids and liquids;
Dysphagia and odynophagia; Nausea and early satiety also limits his food intake.
Anthropometric Measurements:
5’8” (using 1” = 2.54cm) à 68” x 2.54 = 173 cm= 1.73 m
ABW 165 lbs (using 1 lb = .454 kg) à165 x .454 = 75 kg
UBW 185 lbs (4 months ago) à 185 x .454 = 84 kg
% weight lost= 20/185 à 10.8% weight loss over 4 months = SEVERE weight loss
Current BMI: kg/m2 à 75/1.732 = 25 just at the edge of overweight status.
Nutrition Diagnosis:
Chronic disease or condition related malnutrition, related to adenocarcinoma of the distal esophagus and
gastroesophageal, as evidenced by recent weight loss.
Nutrition Intervention:
Nutrition Prescription:
1. J-tube placement for Enteral Nutrition feeding
2. Using a 24-hour continuous feeding:
Recommend: Vital 1.5 cal. via J-tube @ 60 cc/hr GOAL x 24hrs.
Initiate at 25 cc/hr, and advance by 10-20 cc/hr q8-12hrs, as tolerated, until goal rate is reached. Flush
with 200cc H20 q6hrs. Provides a 24hr. total of: 1440mL formula, 2160 cal, 97g PRO, 2294 ml H2O, 144%
RDI of vitamins and minerals.
3. Maintain aspiration precautions and adjust for residuals >500cc.
4. Keep head of bed elevated 30 - 45 degrees.