Nutrition Care

Conference
Esha Fletcher
UConn Health Center
Spring 2015

Patient
Name: BW
Age: 68

BMI: 25.5(overweight)

Sex: Male

Height: 511 or 71 inches

Race: Caucasian

Weight: 182# or 82.7kg

Admission Date: 4/8/15 IBW: 172 +/- 10%

Date Seen: 4/9/15
I&Os: 4/8: 170

IBW%: 105%

4/9: -220

Admitting Diagnosis
J-tube (Jejunostomy) placement
Feeding tube inserted through abdominal wall directly
into the jejunum, bypassing the stomach
Treatment
Diagnostic Laparoscopy & Feeding Jejunostomy

History
Past Medical History
Anterior ST-elevation, MI, Esophageal Cancer, asthma
Social History
Lives with wife, stopped smoking 4 years ago
Nutrition History
Patient on TPN at home
TPN order: 2475mL of 348g Dextrose, 134g AA, 20% lipid
75g/day

Esophageal Cancer
When cancerous cells or a
tumor develops in the
esophagus
Much more common in men
than women
Usually linked to tobacco
or alcohol use

Nutritional Requirements
Mifflin St Jeor
Male: (9.99 x 82.7kg) + (6.25 x 180cm) (4.92 x 68) + 5
=1,621 x 1.3
= 2,107
Kcal/kg
=2,067
Range of 2,000-2,200

Nutritional Requirements
Protein= 1.3-1.5
1.5g x 82.7kg = 124g PRO

Fluid
1cc/kcal= 2,107

Diet Order
Current Diet Order
Clear Liquid Diet
Easily digested and leaves no undigested residue in the
intestinal tract
Used before tests, procedures or surgeries that require no
food in the stomach or intestines
Ex: water, broth, plain gelatin, sports drinks, honey,
carbonated drinks

Labs
Lab Name

Current
Lab

Normal
Range

Notes

BUN

24

(8-24)

WNL

Creatinine

0.7

(0.6-1.2)

WNL

Glucose

117 H

75-100

illness, infection, surgery, alcohol

abuse

Chloride

105

(98-107)

WNL

Sodium

134 L

(137-144)

Dehydration

Potassium

4.0

(3.5-5.1)

WNL

CO2

21

(21-32)

WNL

Albumin

3.2 L

(3.8-5.3)

Poor nutritional state, cancer

Lymphocyte
s

5.9 L

(20-50)

Due to hx of cancer

Hgb

10.2 L

(13-18)

Bleeding from digestive tract, poor

nutrition, anemia. Recent surgery

Hct

29.8 L

(40-52)

Anemia, blood loss

Significant Medications
Medication Name Dosage

Notes

Heparin

5000 units Anticoagulant. Side effects: N/V, abdominal

Lipitor

80mg

Antihyperlipidemic. Caution w/
grapefruit/related citrus

Oxycodone HCL

5mg

Do not administer via any feeding tube-may

clog tube. Caution w/ grapefruit/related citrus

pain, GI bleeding, constipation.

Plavix Clopidogrel 75mg

Prevention of repeat MI. Side effects:

dyspepsia, N/V, abdominal pain, GI bleeding

Protonix
Pantoprazole

40mg

Anitgerd. Can decrease iron and B12

absoprtion.Side effects: decreased gastric acid
secretion, nausea, increased gastric pH
abdominal pain, diarrhea

Senna

8.6mg

Laxative. Do not use for >1 week. Electrolyte

imbalance w/ excessive use

Nutrition Diagnosis
Diagnosis: Inadequate oral intake related to altered GI
function as evidenced by poor appetite and reliance on
TPN

Intervention
Food and/or Nutrient Delivery
Recommend TF: Peptamen AF @ 125mL x 14hrs
Start at 20-30mL for 4 hrs, advance to 20mL/hr every
4hrs if tolerated
Coordination of Nutrition Care
Check with nurses to see if patient is tolerating the tube
feed

Monitoring & Evaluation

Food/Nutrition Related Outcomes
Check for tolerance of tube feed and dehydration
Anthropometric Measurements
Monitor weight
Biochemical Data
Monitor electrolytes, BUN, creatinine, albumin, residuals
Goal
Patient will tolerate tube feed by follow-up

References
https://www.nutritioncaremanual.org/topic.cfm?ncm_category_id=1&
lv1=22938&lv2=255467&ncm_toc_id=255467&ncm_heading=Nutrition%
20Care
http://cancer.dukemedicine.org/cancer/health_library/care_guides/tr
eatment_instructions/
jejunostomy
http://www.mayoclinic.org/healthy-lifestyle/nutrition-and-healthy-eati
ng/in-depth/clear-liquid-diet/art20048505
http://www.cancer.org/cancer/esophaguscancer/

Questions?