Patient: RK

Nutrition Therapy: Follow-up

Assessment: Patient was previously seen (one week ago) following a referral from his
oncologist due to planned radiation therapy to treat recently diagnosed squamous cell
carcinoma of the oral cavity. At this point, patient had experienced severe weight loss of
27 pounds (16%) in 6 weeks, and reported having a poor appetite secondary to worsening
dysphagia. Presently, patient reports that dysphagia has improved, but that his oral intake
has worsened due to presentation of odynophagia, mucositis, and xerostomia. Since
previous appointment, patient has undergone two radiation treatments, and reports taking
Oxycodone, ibuprofen, and Pilocarpine. Additionally, patient reported taking St. Johns
Wort, OTC cough syrup, and Imodium in the initial appointment.
Diet: Self-restricted
Dietary Intake:
c. flavored gelatin
6 oz. applesauce
o TOTAL ENERGY INTAKE: 200 kcal/day

Height: 511 (1.80 m)

Weight: 144 lbs (65.5 kg)
Weight at last appt: 148 lbs (67.3 kg)
BMI: 20.2 (normal)
UBW: 175 lbs (79.5 kg)
IBW: 172 lbs (78.2 kg)
%IBW: 84%
% wt change: 3% (severe; >2% in 1 wk)
Estimated Energy Needs:
Kcal: 2400-2700 kcal/day (using MSJ with IF 1.15-1.3 as aiming for weight maintenance ,
AF 1.3 as pt is ambulatory, and averaging these calculations using CBW and IBW as
desiring to stabilize weight and potentially induce weight gain while ensuring tolerance)
Pro: 80-100 g (1.2-1.5 g/kg BW due to pt undergoing treatment, averaging IBW and CBW
from above reasoning)
Carb: 270-390 g (45-65% of 2400 kcal/day)
Fat: 53-93 g (20-35% of 2400 kcal/day)
Fluid: 2000-2300 ml/day (30-35 ml/kg CBW)
Labs reviewed:
Alb: 3.1 g/dL (Lowreference value 3.5-5.0 g/dL)
Nutrition Diagnosis (PES):
Inadequate oral intake related to complications including odynophagia, mucosistis, and
xerostomia secondary to cancer of the oral cavity and radiation therapy as evidenced by
reported dietary intake of 200 kcal per day with notably insufficient protein, vitamin,
mineral, and supplement intake, and severe weight loss of 3% in one week (severe weight
loss defined as >2% in one week).

EN:
Goal Rate: 320 mL/bolus at 5 bolus feedings per day
Nutrition prescription: Begin Osmolite 1.5 at 160 mL per bolus; if gastric residuals <250
mL and no nausea, vomiting, or distention are presenting, then increase by 20 mL per
bolus feeding until goal rate is met. Flush with 217 mL water after each bolus.
Total volume: 1600 mL/day
Energy: 2400 kcal
Protein: 100 g
Fat: 79 g
CHO: 326 g
Free water: 1219
Water with flushes: 2304 mL
Nutrition Intervention:
1. FOOD AND/OR NUTRIENT DELIVERY: (1)Enteral Nutrition; Inserted J-tube for enteral
feeding. (2) Meals and Snacks; Implemented increased protein diet via nutrition
support to address increased protein needs due to cancer diagnosis and treatment.
(3) Meals and Snacks; Implemented increased/consistent energy diet via nutrition
support to maintain weight status and prevent further weight loss.
2. NUTRITION EDUCATION: (1) Content; Discussed nutritional needs as they relate to
maintaining current weight and increasing protein intake as required due to patient
receiving cancer treatment. (2) Content; Discussed need for enteral nutrition, how
EN works, and desired outcomes following implementation of EN. (3) Application;
Worked on developing skills related to administering bolus feedings.
Goal: Meet goal feeding rate within 8 bolus feedings and maintain current weight by next
appointment in one week.

Monitor/Evaluate:
1. Enteral Nutrition Intake: Enteral nutrition formula/solution (amount prescribed and
amount administered), volume and frequency of feeding tube flush, gastric
residuals, signs of nausea/vomiting/abdominal distension
2. Nutrition Related Physical Findings: Gastric residuals, signs of
nausea/vomiting/abdominal distension
3. Anthropometrics: Weight, weight change
4. Biochemical: Pre-albumin, vitamin profile, mineral profile, electrolyte profile (to
ensure that nutrition support is adequately addressing needs)
5. Knowledge/Beliefs/Attitudes: Level of knowledge/skill related to administering bolus
feedings