S:

Denise Mitchell is an adult female, she is 21 years old. Ms.Mitchell’s

mouth hurts so badly that she can hardly talk. She has had only
puree’d fruit’ vegetable juices, and a little water over the last 3 days.
Patient’s aunt and uncle introduced them to a special “anticancer” diet
that will help her cure her disease. Ms.Mitchell’s was told to only eat
natural foods without any meet or dairy products. She was also started
5000 mg of vaitmin C,20,000 ug RE of vitamin A,and 1000 mg of
vitamin E. the patient is also taking a mixture of echinacea , ginger,
and ginseng. The patient tells you privately that she doesn’t know
what to believe about “this diet stuff” but doesn’t want to make any
one mad. She also states that the vegetable juices and fruits make her
mouth burn worse.”I'd really like some sherbet, but they said I couldn’t
have any”

Ms.Mitchell’s recently diagnosed with stage 2 diffuse large B-cell

lymphoma with mediastinal disease and positive lymph nodes. She is
day 20 s/p her first chemotherapy cycle of cyclophosphamide
,doxorubicin,vincristine, and prednisone (CHOP). She had tonsillectomy
at age 5. She uses prescribed tylox for pain, which she started taking
yesterday. She is nonsmoker.

O:
Chemistry

Admit 1 Admit 2 Day 1 Admit 2 Day 2

Albumin 3.3 3.5 3
Total 5.4
5.5 6.0
protein
Creatinine 0.6 1.1 0.4
CHOL 141 _ 120

Hematology:

Admit 1 Admit 2 Day 2

HGB 11 9
HCT 31 29
MCV 70 65
MCH 28 22
MCHC 27 21
A:

• Temperature is high 39.5c because of infection, dehydration. RR

which is 22bpm is high, due to the increased pressure on her
chest. She’s under weight. Her BMI is 17.4

• From her 24-hr recalls, her dietary intake is very low which mean
that the patient is malnourished. She uses vitamins supplements
of mega dose which can lead to toxicity.

• Her (Total protein, Albumin ,Creatinine, CHOL) low in the second

day because lack adequate protein and energy intake, thus her
body can’t repair and rebuild tissues as fast as they depilated.
Albumin is an indicator of poor protein intake. Total protein is low
also due to poor supply of protein required for the serum protein
synthesis. Creatinine is at low level due to low protein intake.
WBC ,RBC ,HGB ,HTC ,MCV ,MCH , MCHC level is very low
because of the chemotherapy coarse that actually can damage
all body cells. Venues infusion was introduced to the patient and
that help the Osmolality to return to the normal level in the
second day.

P:

• Develop the nutrition plan designed to prevent malnutrition

• Increase Fluid intake to prevent dehydration (should be about 8

cups/day)

• Avoid high doses vitamins and herbal supplement.

• Avoid milk products, sauce, fried foods, citrus juices, row foods,
spicy foods.

• Liquid and soft diet should be given.

• A high-calorie, high protein diet. (Protein intake should be as 1-

1.2 g/kg )