Nutrition Care

Presentation
Chloe Seddon
April 27th, 2017
Patient Introduction
GK: 59 year old male

60 182.9cm

157 lbs/71.4kg on admit 3/15/2017

BMI: 21.6 kg/m2

Acute kidney injury; acute encephalopathy

Suspected prostate cancer

No previous medical history

Unemployed, never married

Medical Diagnosis
Acute kidney injury

Kidneys suddenly unable to filter waste

Dangerous levels of waste may accumulate

Typically occurs secondary to other medical problems
Develops rapidly
GKs AKI is most likely due to lying on the floor and developing
rhabdomyolysis or an obstruction and blockage to the ureter from the
cancer (metastatic to liver and bones)
Physical Assessment
Acute encephalopathy confines him to bed

Unable to self feed or void

Nephrostomy tube

Not able to effectively communicate

Extremely confused

Appears extremely malnourished

Previous weight 180lbs within the last year

Muscles wasting: temples, clavicles, interosseous

Possibly cachexia due to prostate cancer

Medication
Drug/Generic Name Purpose Side Effect Nutritional Concerns

Bicalutamide Treats prostate cancer Hot flashes. Absorption is not affected by food.

Enoxaparin Blood thinner. Swelling of the legs. Avoid ginger, ginko and ginseng.

First-Omeprazole Treats GERD. Stomach pain. Avoid cranberry.

Dilaudid Treats pain. Constipation. None.

DuoNeb Nebulizer. Headaches. None.

Imodium Treats diarrhea. Fatigue. Avoid alcohol

Lopressor Treats hypertension. Constipation. None.

Kayciel Treats hypokalemia. Diarrhea. None.

Lab Data
Name of Lab Test Normal Range Patients Value Date Interpretation

Na 135-145 mmol/L 150 mmol/L 4/6/17 High due to AKF

K 3.3 mmol/L 3.5-5.0 mmol/L 4/6/17 Low due to AKF

Cl 96-106 mmol/L 114 mmol/L 4/6/17 High due to AKF

BUN 7-20 mg/dL 54 mg/dL 4/6/17 High due to AKF

Creatinine 0.6-1.2 mg/dL 1.7 mg/dL 4/6/17 High due to AKF

Calcium 8.5-10.2 mg/dL 7.6 4/6/17 Low

GFR 90-120 mL/min/m2 41 mL/min/m2 4/6/17 Low due to AKF

RBC 4.0-5.4 M/uL 2.41 M/uL 4/6/17 Low

HGB 12.1-15.7 g/dL 7.3 g/dL 4/6/17 Low

HCT 36-46% 23.8% 4/6/17 Low-possible anemia due to AKF

Nutrient Needs
kcal: Mifflin St Jeor X 1.2 injury factor = 1,880 kcal

25 kcal/kg = 1785kcal

Protein gm/kg = 87g protein

Protein: 20% = 94g

Carbohydrate: 55% = 258g CHO

Fat: 25% = 52g fat

Fluid = 30mL/kg = 2,142mL

Current Diet
NPO
Due to inability to self feed

aspiration due to dysphagia

Nasogastric tube feed

Nepro with carb steady

Rate: 45 mL per hour = 1080 mL total

250 cc free water q4h = 1500mL per day

High calorie and high protein

PES Statement

Malnutrition related to prostate cancer as evidenced by

unplanned weight loss of 11.7% from baseline weight as
well as clavicle and interosseus muscle wasting.
Intervention

Continue to be evaluated by SLP

Status of prostate cancer needs to be evaluated

Malnutrition should be addressed as he seems to becoming more cachectic the

longer he stays in acute care

Switch to bolus feeding to improve quality of life if he goes home or to a long-term

care facility

Metastatic prostate cancer survival rate: 3% for five years

Monitoring and Evaluation
Monitor malnutrition and nutrient needs
as he continues to be on tube feed

Intake may need to be increased and

possibly switched to a new tube feed
Novasource or Fibersource as his kidney
function returns

Labs should be monitored to ensure they

are normalizing
BUN, creatinine, sodium, potassium, GFR
References
"CORFLO CORSCOPE Endoscopically Placed Feeding Tubes." CORPAK MedSystems. 10 Apr. 2017.

Medically Reviewed by Steven Kim, MD on November 4, 2015 Written by Bree Normandin and Winnie
Yu. "Acute Kidney Failure." Healthline. 04 Nov. 2015. Web.

"Prostate Cancer Center: Treatments, Symptoms, Detection, Stages, Diagnosis, and Tests." WebMD.
WebMD,.

"Therapeutic Nutrition for People on Dialysis - Nepro with Carb Steady." Nepro. 10 Apr. 2017
 Thank
you!
Questions
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