Reference no: EM133446107
Mrs. P.S. is a 70-year-old woman who has been diagnosed as having cancer of the cervix. She is currently living in a nursing home. Her only son and his wife live nearby. Mrs. P.S. is receiving only social security and is on a limited budget. Her diet prior to admission has been a regular diet. She is 5 feet, 3 inches tall and weighs 102 pounds. She has lost 10 pounds within the past three months. She complains of anorexia and has refused to eat on several occasions. She appears anemic, and the nursing home reports that she is weak and apathetic. Mrs. P.S. was ordered to receive a course of radiation and chemotherapy as an outpatient. Her appetite worsened and malabsorption became evident.
Pertinent laboratory data include:
Test Patient's Values Normal Values
Hemoglobin 8.4 12.0-16.0 gm/100 ml
Hematocrit 26.7 36.0-47.0 ml/100ml
RBC Count 2.74 4.0-56 millions/mm3
Serum Iron 28 56-183 micrograms/100 ml
Total Iron-Binding Capacity 250 277-379 micrograms/100 ml
Serum Folate 1 6.0 nanograms/ml
Mean Corpuscular Volume 100 80-94 cubic microns
Total Protein 5.8 6.0-8.0 grams/100 ml
Albumin 1.8 4.3-5.6 grams/100 ml
Globulin 2.0 1.3-2.7 grams/100 ml
1. What is the patient's ideal body weight?
2. What would be her normal (non-disease state) caloric needs?
3. What are her caloric needs secondary to her disease state?
4. Mrs. P.S. has decreased total protein, albumin, and total iron binding capacity secondary to malabsorption, weight loss, and poor kilocalorie and protein intake. What nutrition related signs can result from depressed serum and tissue protein levels?
5. What dietary protein level would you recommend for Mrs. P.S., knowing she is protein and calorically malnourished?
6. What are the characteristics of cancer cachexia?
7. If the patient is receiving radiation therapy generalized to the gastrointestinal tract, what diet modifications may be appropriate and why?
8. Anorexia, nausea and vomiting, stomatitis, mucositis, malabsorption, and diarrhea are common nutrition-related side effects of chemotherapy. How do you explain Mrs. P.S.'s anorexia?
9. What suggestions can you offer which will attempt to maximize the chances that Mrs. P.S. will receive adequate nutrition while undergoing radiation and chemotherapy?
10. Once the patient has completed radiation and chemotherapy, what means can be employed to maintain or improve nutritional status?
11. The patient reported to you that she is taking ginger, Echinacea and green tea on her own. Why is she taking each product? What advice would you give her regarding the use of each of these herbal products?