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Case3

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  • -Family history is unknown-People exposed to ionizing radiation have increased risk of brain tumors-We do not know his employment history but people working in certain industries have increased risk; including: agriculture, electrical, health care, and oil refineries-Age: the majority of brain tumors occur in people 45 and older-brain tumors more common in white people than other races
  • -Occur in hospitals or other health care settings, such as nursing homes and dialysis centers-It is known health care-associated MRSA or HA-MRSA
  • -Acute kidney failure is common in people that are already hospitalized, particularly those in intensive care
  • Cannot tell whether blood potassium is high because it is removed during the dialysisThere is no indication of urine output amount
  • Transcript

    • 1. Case 3
      60 year old male
      Caucasian
      Presents with:
      Low grade fever (99.8)
      Mild low back pain
      Extremity weakness
      Has been on steroids & antibiotics
      Not a surgical candidate
      Has borderline lung function
    • 2.
    • 3.
    • 4. Atherosclerosis
      Less
      No constriction
      More permeable
    • 5.
    • 6. HTN
      Atherosclerosis
      MI
      Stroke
    • 7. MRSA
      Metastases
    • 8. MRSA: Methicillin-resistant Staphylococcus aureus
    • 9.
    • 10. Pulmonaryedema
    • 11.
    • 12.
    • 13. Corticosteroids
      Include prednisone & cortisone
      Anti-inflammatory medication
      Used to treat diseases such as asthma, eczema, allergies, arthritis, colitis, and kidney disease, IBD, lupus, and MS
      Intended use for 1 to 2 weeks
    • 14. Long-term Use of Corticosteroids
      Cataracts
      Inc. blood sugar
      Inc. risk of infections
      Calcium loss from bones
      Suppressed adrenal gland hormone production
      Easy bruising & slower wound healing
      Weight gain
      Stomach ulcers
      • Not recommended with active infection
    • Temador
      Anti-cancer chemotherapy drug 
      For treatment of anaplasticastrocytoma and glioblastomamultiforme (GBM) brain tumors
      Low blood counts may occur:
      White & red blood cells and platelets may temporarily decrease
      This may increase risk for infection, anemia, and bleeding
    • 15. Delayed Effects of Temodar
      Swelling/edema
      Central neurotoxicity
      Diarrhea
      Weakness
      Skin rash
      Itching
    • 16. Diet Prescription
      It is recommended that you supply 45-55 kcal per kg BW to avoid catabolism
      45*97 kg= 4,300 kcals
      Patient is obese so with this consideration
      Mifflin St. Jeor equation= 1,800 kcals
      Recommended that patient receive ~ 3000 kcals per day
    • 17. Diet Prescription
      Protein is a main focus: 0.55 g/kg
      0.55 (97kg)= 53 grams per day
      Fluid needs based on urine output
      Want to watch BUN, creatinine, and electrolyte levels