Advanced Medical Nutrition Therapy

Case Studies 1

Question 1

RK is a 25 years old man, who was involved in MVA. He had multiple fractures, contusions, and severe head injury. He was unconscious most of the time and being fed via nasogastric tube feeding.

RK’s lab results were normal upon admission with exception of Hb (8.1 g/dL) and Hematocrit (31%). His height is 179 cm and weight is 80 kg, and he loss about 5 kg within 3 weeks of ICU stay.

Currently he was on Ensure plus 50cc/Hr and physician is planning to insert PEG tube.

Discuss the dietary care plan for RK’s current condition and after PEG tube was inserted.

Question 2

AH is a 82 years old man. He had been diagnosed with cancer last year and had finished all the

radiation therapy all together 15 treatments. But recently patient had admitted back to hospital

due to pyloric cancer and underwent operation of the stomach. Currently he is on TPN, and the

physician already done gastrojejunostomy for long term plan.

He is on Nutriflex (peripheral) after operation (75 ml/hr). After 2 days, he started with mix

feeding TPN and EN, before changing to EN solely on the next day.

Discuss the dietary care plan for AH in current condition and after changing to EN solely.

Anthropometry Data: Weight = 42 kg; Height = 165

Biochemical Data: RBG: 6.2 mmol/L Hb: 10.1 g/dL

Urea: 5.9 mmol/L Potassium: 4.5 mmol/L

Sodium: 134 mmol/L Creatinine: 94 mmol/L

Total Protein: 59 g/L Albumin: 29 g/dL

Question 3

Mr TEC, 62 years old Chinese man was admitted to oncology ward due to metastatic adenocarcinoma neck cancer. He was on radiotherapy. Initially, patient was able to eat orally. However, recently he experienced poor oral intake due to dysphagia. Therefore, he was referred to dietitian for nutritional support. Patient’s height is 172 cm and his weight before admission was 68 kg, but since admission, he had lost 5 kg due to poor appetite and poor oral intake. Plan for this patient’s EN regime.

Biochemical data:

Sodium 125 mmol/LPotassium 3.6 mmol/LUrea 2.7 mmol/L Creatinine 77 mmol/LAlbumin 28 g/LTotal protein 62 g/LBilirubin total 11 μmol/LALT 20 U/LALP 74 U/L

Question 4

A 16 years old, Indian boy alleged with MVA. He was admitted to hospital with acute subdural hematoma. Decompressive craniectomy has been done and patient was referred to dietitian for enteral Ryle’s tube feeding regime.

Height: 163 cm

Weight: 51 kg Sodium 137 mmol/l

Potassium 3.9 mmol/l

Urea 5.0 mmol/l

Creatinine 44 mmol/L

Albumin 39 g/L

Total protein 70 g/L

Question 5

Mr RK age 49,Indian male, was admitted to ICU ward due to burn with hot oil and scalded wound over left side of face and trunk (face involving nose and mouth). He then was diagnosed with 17% mixed thickness burn (43% superficial burn). Pt was put on RT. Plan for this pt’s EN regime.

Height: 163 cm Weight: 80 kg Sodium 135 mmol/l

Potassium 3.2 mmol/l

Urea 3.3 mmol/l

Creatinine) 42 mmol/L

Albumin 22 g/L

Total protein 44 g/L

WBC 8.4

Platelet 179

Question 6

Mr S is a 59 years old man. He was diagnosed with stage 1 Chronic Obstructive Pulmonary Disease (emphysema) 5 years ago. Previous medical history showed that he suffered bronchitis and upper respiratory infections especially during cold weather. He was a smoker for 46 years and quit smoking about 1 year ago. Current diagnosis is acute exacerbation of COPD 2º to bacterial pneumonia. He was unable to do anything by himself, even taking a bath or getting dressed makes him short of breath.

He responded well to treatment for the emphysema, however COPD has progressed. He was discharged home O2 therapy and bronchodilators, and referred to an outpatient pulmonary rehabilitation program.

He was referred to dietitian for diet consultation, as patient has poor appetite, and experienced weight loss, 6 month ago he was 68 kg and now is 59kg and his height is 167 cm. He avoids milk as he believed that milk will increase the mucus production. Plan a dietary care plan for Mr S.

Biochemical Data: WBC: 15 x 103 mm3 (4.3 - 10 x 103 mm3) Hb: 11.5 g/dl

Total Protein: 59 g/L Albumin: 22 g/dL

Usual Intake: AM: Coffee, juice or fruit, dry cereal with small amounts of milk

Lunch: Meat, vegetables; rice, potato or bread. Pt eat small amounts

Dinner: Soup, scrambled eggs, or sandwich.

Drink Pepsi throughout the day (around 1000 ml/d)

24 hr recall: 1 cup coffee with nondairy creamer, few sips of orange juice, ½ cup oatmeal with 1 tsp sugar, ¾ cup chicken noodle soup, 2 cream crackers, 900 ml of Pepsi.