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Comprehensive Case Study:
Cancer Patient and Malnutrition
Identification Information
 Age: 67
 Sex: Female
 Date of admission: 9/17/13
 Admit HT and WT: 5’6”, 125#
 Weight classification: BMI 20.2—within normal
Chief Complaint
 Admitting diagnosis:
 Patient admitted with
 vomiting,
Patient admitted 1 month prior
Back pain
History of Present Illness
 History of colon and bladder cancer
 Metastatic colon cancer with chemo
 Cancer: group of diseases characterized by uncontrolled growth and spread of
abnormal cells
Tumor growth and immune-mediated tumor destruction
Endogenous and exogenous risk factors exist for cancer development
Cancer is a genetic disease caused by chronic inflammation which elicits a
chronic inflammatory response, eventually compromising the function ad
structure of cells, creating uncontrolled proliferation (programmed cell death)
Endogenous factors: can initiate or promote development of cancer; free radicals,
hormones, growth factors, specific genes (oncogenes)
Exogenous factors: lifestyle, environmental/occupational exposures, infectious
 Suspect poor nutrition prior to admit based on dietary recall
The National Cancer Institute and the American Cancer Society estimate that 1/3 of
cancer deaths relate to poor dietary choices, physical inactivity, or obesity
Tobacco use accounts for additional 1/3 annual deaths from cancer
Past Medical History
 Colon cancer
 Bladder cancer
 Pyelonephritis
 Uropsepsis
 Cecal mass
 Symptomatic anemia
Medications, Eating Habits, Weight Hx
 Medications
 Xanex
 Mylanta
 Dilaudid
 Fentanyl patch
 Cefepine
 Megace
 Colace
 Ativan
 Eating habits:
“Healthy” diet at home,
unable to tolerate
>1000cal/day, stated;
restricts Na, K, and
phosphorus intake/renal
 Loss of appetite
 WT Hx
UBW 142#
 120-125# @ admit
 112# most recent per bed
Laboratory Data
 Current (12/5/13):
 Low Na
 Low Cl
 Low Ca
 High WBC
 Low RBC
 Low HGB
 Low HCT
 Estimating needs:
 1600-1800kcal, 60-70g protein, 1.8L fluid per day
 PES statement:
 Suboptimal intake, unintentional WT loss, malnutrition in the
context of chronic disease
 Interventions:
 Monitored intake at meals & reinforced importance of
adequate intake
 Provided magic cu/ ensure supplementation with meals
 TPN rec—followed nutrition support team
 Monitored WT and serial labs
Plan of Care
 Exhausted all efforts to meet patient’s nutritional
needs PO
 TPN discontinued due to patient request
 Follow case manager plan for patient to transfer to
nursing home
 Hospice to consult
Evidence Analysis Library and
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Gottschlich, Michele M. The A.S.P.E.N. Nutrition Support Core Curriculum: A Case-Based Approach—the Adult Patient. Pg 651671