UConn Health

Nutrition Care Plan

Presentation
PATIENT: ER
BY: SCARLETT BALL
 INTRODUCTION TO E.R.
• 67 yr. old Male
• Admitted 3/22/23
• Hispanic/Latino
• Divorced
• Lives in an apartment alone
• Smokes 1/2 pack for the past 40 years
• Quit heroin in 2015
• Occasionally smokes marijuana
 ADMISSION DIAGNOSIS/
COURSE OF HOSPITALIZATION

ADMISSION- 3/22/23
• Recently diagnosed with Lower Left
Squamous Carcinoma Lung Cancer
• Surgery: Lower left lobectomy
• Given Tylenol and Oxycodone as needed
for pain
 MEDICAL HISTORY
• Hepatic Cirrhosis: chronic liver
damage
• Chronic Pancreatitis
• Chronic Kidney Disease (CKD)
• Hypothyroid
• Nephrolithiasis: Kidney stones
• Gastroesophageal Reflex
Disease (GERD)
 ANTHROPROMETRICS
• 6’2” (74 inches)
• Admit Weight: 147 lbs (66.7kg)
• BMI: 18.9
• IBW: 184 lbs (77.6 kg)
• UBW: 164 lbs (Back in 2018)
Patient Weight History
7/16/18 - 164 LBS
5/13/21 - 152 LBS -3.7%
11/3/22 - 149 LBS -7.3.%
12/19/22 - 143 LBS -12.8%
3/23/23 = 148 LBS -9.8%
 LABORATORY DATA
Patients
Name of Lab Normal Range Date/s
Value/s
• BUN and Creatinine levels are
BUN 8-24 mg/dL 30 3/23 high since E.R. suffers from CKD.
• GFR is low since he suffers from
Creatinine 0.60-1.20 mg/dL 1.90 3/23 CKD.
Hematocrit/ 40-52%/ 13.0- • Hematocrit, hemoglobin, RBC,
34.4/ 10.2 3/23
Hemoglobin 18g/dL and MCHC are low since he just
underwent lower left lobe
eGFR >60 mL/min 38 3/23
surgery for lung cancer.
RBC 4.40-5.90 uL 4.14 3/23 • POCT glucose level was high
MCHC 32-36 g/dL 29.7 3/23 because of stress or due to the
decadron
POCT Glucose 70-100 mg/dL >180 3/22
 KEY MEDICATIONS
DRUG NAME CATEGORY how it works, why /when use

Gabapectin anti-epileptic/ used to treat nerve pain and used to treat seizures
anticonvulsant

Heparin (porcine) anti-coagulant an anticoagulant (blood thinner) that prevents the

formation of blood clots.

Levothyroxine Levothyroxine is a thyroid medicine that replaces a

(Euthyrox) thyroid hormone normally produced by your thyroid gland to
regulate the body's energy and metabolism.

Pantoprazole Proton pump inhibitor a proton pump inhibitor that decreases the amount of
acid produced in the stomach.

Decadron steroid that prevents the release of substances in the body that
cause inflammation and pain
 NUTRITIONAL REQUIREMENTS
• Calories: 1,913 (Mifflin)= Maintenance
⚬ SF= 1.3 (major surgery)
⚬ 30-35 kcal/kg = 2,000 - 2,335 kcal
• Protein g/kg:= 1.0-1.5g *66.7 kg= 60- 100 g
• Fluid: 1mL/ kcal= 2,200 mL
 DIET ORDER

Current: Consistent Carbohydrate (Diabetic) diet of 250 grams a

day/regular texture, thin liquids.
Assessment of the appropriateness of the current diet order:
• Inappropriate
• Only one POCT finger stick > 180.
• No other history of Diabetes
⚬ Important to note: on Decadron -> steroid -> increase blood glucose
⚬ No other history of Diabetes

My recommendation:
High protein, High-Calorie Diet
 ASSESSMENT OF INTAKE

• Prior to lung cancer ate 2 Meals A Day.

• Decreased appetite and weight loss since cancer dx.
• He ate about 75% of the trays in the Hospital.
• For breakfast, he likes to eat an omelet and coffee.
• For dinner, he likes to eat steak, rice, and beans.
• He used to take many supplements, but his kidney doctor told him to
stop when he was trying to figure out his kidney stone issue.
• He is knowledgeable about his diet and prefers to cook with olive oil, a
little salt, and does not eat junk food.
 NUTRITION-FOCUSED PHYSICAL FINDINGS
• During the visit, he was alert and sitting in
his chair watching tv and on his phone.
• Missing teeth-> wasn't wearing dentures
⚬ Inhibited him from eating hard string
beans at lunch
• His lips, tongue, and gums looked normal.
• He had a little bit of muscle wasting
throughout the whole body.
• He told me that he hopes for his appetite
to get better
 DIAGNOSIS

Inadequate oral intake related to lung

cancer diagnosis as evidenced by losing
weight without trying and decreased
appetite.
 INTERVENTION

HIGH-CALORIE, HIGH-PROTEIN DIET

• Increase calories to 2,220 kcal and 100g of protein
⚬ 1.5g/kg protein requirement = 100 g Protein
• Increase calorie intake by 300 kcal a day which should help them gain over ½ a
pound per week to return to normal weight-> 168 back in 2018
• I gave him Nutrition Education on a High Protein, High-Calorie diet, which he said
he would read> Importance for healing and recovery.
• Defer him to PT to gain back muscle mass and strength.
• Refer E.R. to a smoking cessation program to deter him from smoking again.
MEAL
PLAN
 MONITOR/ EVALUATION
• Consume at least 75% of high protein, high-calorie
• Increase in weight after 1-month assessment (1-2 pounds gained)
• If the tolerating amount of food at 1- month follow-up increase to
(+500 kcal) a day, to gain 1-pound a week
• Monitor muscle mass at the 1-month assessment
• Monitor Creatinine at one-month follow-up -> since he has CKD
• Monitor POCT glucose to make sure he does not have diabetes at a
one-month follow-up since we took him off the diabetic diet
• He will be able to name three lean proteins
 WHAT I WOULD DO DIFFERENTLY THE
NEXT TIME

• While interviewing him, he told me he is aware of his

cholesterol as it has been high-> I would have told him not to
worry about his cholesterol but to worry more about eating
enough to support his energy needs as he has cancer.
• Provide Oral Nutrition Supplement -> in between meals or
replace for a meal if he is not hungry
 REFERENCES
• Academy of Nutrition and Dietetics. Nutrition Care Manual. Nutrition During And After
Cancer Treatment
https://www.nutritioncaremanual.org/client_ed.cfm?ncm_client_ed_id=81. Accessed
March 26, 2023.
• Academy of Nutrition and Dietetics. Nutrition Care Manual. High-Calorie, High-Protein
Nutrition Therapy
https://www.nutritioncaremanual.org/client_ed.cfm?ncm_client_ed_id=509. Accessed
March 26, 2023.
• Academy of Nutrition and Dietetics. Nutrition Terminology Reference Manual (eNCPT):
Dietetics Language for Nutrition Care. http://www.ncpro.org. Accessed February 13, 202].
• Decadron uses Side Effects & Warnings. Drugs.com.
https://www.drugs.com/mtm/decadron.html
• St Vincent's Heart Health. (n.d.). After Lung Surgery. St Vincent's Lung Health. Retrieved
March 26, 2023, from https://www.svhlunghealth.com.au/rehabilitation/after-lung-
surgery#:~:text=Exercising%20will%20help%20to%20speed,gradually%20increase%20le
ngth%20and%20intensity.
ANY QUESTIONS?