Topic: Nutrition Support

 John is a 6 feet 1 inches, 58 year old Black male who recently retired from bus driving for 40 years. John's wife reported that John started complaining of chest pain 4 months ago, but recently believes the pain is getting worst. She reported that John's appetite has been reduced and that he is currently below his normal weight of 180 lbs.

During their visit to the doctor, they discovered that his weight is currently at 160 lbs. Blood work and an Upper GI series test was done. The UGI revealed a tumor in his stomach and he was immediately admitted into the hospital for removal and biopsy of the tumor. It was found to be cancerous and with metastases. John continues to be hospitalized while chemotherapy and radiation therapy begun. His doctor ordered a dietitian consult and asked for john to be fed. John in the meanwhile was given D5NS at 50 cc/hr, until nutritional support administration started.

Objective Data

 Gender: Male

Age: 55 y

Height: 6"1"

Weight: 160 lb

UBW: 180 lb

LABS Actual                                        Normal

Hct 30%                                              33 - 44%

Hgb 11 g/dL                                       11.5 - 15.5 g/dL

Glucose 91 mg/dL                                 70 - 110 mg/dL

BUN 11 mg/dL                                       8 - 18 mg/dL

Alb 2.7 g/dL                                           4.0 - 6.0 g/dL

Na 130 mEq/L                                         135 - 145 mEq/L

K 3.6 mEq/                                               L 3.7 - 5.2 mEq/L

1.    Is john a good candidate for TPN or enteral feeding? And if so why or why not?

2.    List other indications for use of the nutrition support that you selected.

3.    What is the difference between PPN and CPN? Explain the conditions under which each is given.

4.    What is the difference between a PEG and nasogastric tube. Explain under what conditions would either be considered appropriate to meet nutritional needs.

5.    Between enteral nutrition and TPN which is more preferable, and why? 

6.    Calculate John's IBW, percent IBW, and percent UBW.

7.    Calculate John's kcal and protein needs.

8.    Is there any nutrition concern with John's lab results? If so what lab results show concern and what does it or they reflect nutritionally

9.    Should john be given TPN would you recommend iron be added? And if so, why or why not?

10. Due to John surgery, which Vitamin would be of concern if added to the TPN solution and why?

11.  Calculate a TPN formula for John.  

12. Based on a specialized formula of 1.1 kcal/mL/ 72 g PRO per mL and 730 mL free water per mL. Calculate John's enteral formula at a rate of 65 cc/h to be administered over 24 h.

13. How much free water does the formula provide? How much free water would needed additionally

14.  Based on your calculated nutrient needs for John, would his needs be met with the nutrition support calculated in question 12? If not what would you recommended?

15. What are some potential complications of TPN?

16. Explain Refeeding Syndrome. How can you prevent this from happening to John?

17. John has recuperated from her surgery and chemotherapy well. After one month on nutritional support, the doctor asked the RD to make a TF recommendation. Describe how you would recommend making the transition from TPN to TF.