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St.

Maisey Hospital
Nutrition Department

Lillie
70 years old
11/10/2018

Nutrition Assessment:
This is a 30 minute face to face Medical Nutrition Therapy visit. Patient is a 70 year old female
referred for dietary counseling by her doctor.

Diagnosis and medical history:


Diagnosed with breast cancer at 53 years old
Remained in remission until one year ago
Cancer has returned and metastasized in her bones
Esophageal dysmotility
Was on an experimental oncology until 6 months ago
Started chemotherapy
Vomiting, nausea and dysphagia whenever consuming either food or beverages
History of constipation
Isn’t typically hungry
Feels weak and disoriented, constant fatigue, stays in bed most of the day
Has cancer cachexia

Weight History:
Height: 5’1’’; Current weight: 146lbs; current BMI is 27.6 (Overweight)
Usual body weight 173lbs; % usual body weight: 84.4%
Ideal body weight: 105lbs; % ideal body weight: 139%
Adjusted Body weight: 115.3lbs; % ABW: 126.6%
Has lost 27lbs in the last 1 month

Food and Nutrition Related History


Standard diet over the years
Was eating for Breast Cancer health
Daily intake is 8oz of apple juice and ½ cup of apple sauce
100-200 calories a day

Nutrition Impact Symptoms:


Looks pale and fatigued
Severe fat and muscle wasting
Clothes are too big
Looks frail

Activities and Function:


Sedentary lifestyle
Currently spending most of her day in bed
Use to do walking, gardening, and household chores

Social history:
Use to be an active member of her community
Has a son and a friend caring for her
Nurses she used to work with are also willing to help out

Labs and tests:


Lab tests are not in the medical record yet

Current Meds:
Ibranz (chemotherapy agent)
Constipation medications
Heartburn medications
Pain medications
Cancer medications

Nutrition Diagnosis:
Poor nutrition quality of life (NB-2.5) related to inability to chew and swallow foods, constant
fatigue, and calorie consumption of 100-200 a day as evidenced by muscle and fat deficit,
weight loss, and being bed ridden.

Nutrition Intervention:
Nutrition Prescription
1. Recommended energy needs for a malnourished cancer hypermetabolism patient-
35kcals/kg
• 66kg * 35= 2,310kcals
2. High protein diet suggested for malnourished cancer patients- 1.2-1.5g/kg
• 66kg * 1.2-1.5= 99-132g of protein/d
3. 66* 20-40= 1,320-2,640mL/kg
4. From formula:
 1500mL
 6 cartons
 2250kcals
 102g of protein
 Flushes (water)- 720 mL (60 before and after each feeding)
 Total fluids: 2,888mL
5. Start at 50% of needs first day, 75% the second, and 100% every day on
 Day one:
o Fluid: 750 ml, 3 cartons, 95mL from formula, 720mL from flushing
o Energy: 1125 kcal
o Protein: 51 g
 Day two:
o Fluid: 1,125mL, 4.5 cartons,143mL from formula
o Energy: 1,678kcals
o Protein: 76.5g

Implementation of Intervention
6 feedings a day of event distribution of the formula (1 carton)
Have son or friend help administer the fluids

Education Materials Provided


1. Handout describing enteral feeding
2. Handout explain what refeeding syndrome is
Referrals and RD Follow Up Plan for Monitoring and Evaluation
Patient will return in three weeks for evaluation of progress towards treatment goals. Provided
patient with contact information and encouraged Lillie to call with any additional questions.
Patient was agreeable with this plan.

Have a motivation change towards completing feedings and understanding of how enteral
feeding works
Maintain Weight
Have more energy to be able to get out of bed
Get small household chores done
Be able to see friends or family for one hour without getting too fatigued

Medical Nutrition Therapy provided using the 2018 evidence based practice guidelines from the
American Academy of Nutrition and Dietetics.

Tessa Vojtik

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