The document provides an overview of pancreatic cancer including:
- It predominantly affects those over age 45 and is more common in men and African Americans.
- Symptoms are often vague and non-specific, leading to late stage diagnosis in over 50% of cases.
- Treatment options include surgery, chemotherapy, and radiation, though pancreatic cancer has a very low 5-year survival rate.
- Nutrition therapy aims to manage symptoms, support nutritional status, and address deficiencies from the cancer and its treatment.
This document provides background information on ovarian cancer, including its pathophysiology, etiology, epidemiology, clinical presentation, diagnosis, and screening. It states that ovarian cancer typically spreads within the peritoneal cavity. Several risk factors are identified, including genetic and reproductive factors. Epithelial ovarian cancer represents the most common histology and has a poor prognosis when diagnosed at advanced stages, due to nonspecific symptoms. No approved screening methods exist for ovarian cancer detection.
The document discusses cancer cachexia and wasting syndrome. It begins by quoting Hippocrates' description of wasting syndrome. It then provides context that the paintings described were done between 1912-1915 by Ferdinand Hodler of his wife Valentine Gode-Darel, who died of gynecological cancer. The rest of the document covers topics like the definition and pathophysiology of cancer cachexia, diagnostic criteria, stages of cachexia, assessment tools, and management of cancer anorexia-cachexia syndrome.
This document discusses nutrition in cancer patients. It notes that malnutrition is common in cancer patients, affecting 15-40% of patients and up to 80% of those with advanced malignancy. Cancer and its treatments can cause weight loss, reduced food intake, nausea, and other issues leading to malnutrition. Malnutrition is associated with decreased survival, increased treatment toxicity, and reduced quality of life. Nutritional screening and assessment tools can identify patients at risk. Nutrition support options include oral diet, oral supplements, enteral feeding via tube, and parenteral nutrition for those unable to meet nutritional needs enterally. The goals of nutrition therapy are to maintain nutritional status, quality of life, treatment efficacy and reduce complications.
This document provides an overview of gastrointestinal (GI) cancers, including esophageal cancer, gastric cancer, pancreatic cancer, and colorectal cancer. It discusses the anatomy and types of GI cancers, along with risk factors, symptoms, diagnostic tests, and treatment options for each cancer type. Nursing care focuses on managing nutrition, symptoms, surgical recovery, and providing education and psychosocial support. GI cancers remain a significant health issue globally due to their prevalence and impacts.
Liver cancer is cancer that affects the liver through tumors or cancer cells. The liver performs important functions like breaking down nutrients, producing substances for blood clotting, and filtering out toxic waste. Risk factors for liver cancer include hepatitis, cirrhosis, age, gender, and environmental factors like smoking. Symptoms can include weight loss, appetite loss, nausea, vomiting, and jaundice. Tests used to detect liver cancer are AFP tests, ultrasounds, biopsies, CT scans, and MRIs. Treatment options include surgery, liver transplant, radiation, chemotherapy, and tumor ablation.
Polycystic Ovarian Syndrome - Obstetrics/Gynecology Case Presentationcandicelainereyes
DL, a 25-year-old woman, presents with irregular periods, weight gain, acne, and excess hair growth. Her lab tests confirm she has polycystic ovarian syndrome (PCOS) based on irregular periods, signs of excess androgens, and polycystic ovaries. She is started on oral contraceptives to regulate her cycle and reduce symptoms. Now that her symptoms have improved with treatment, she inquires about fertility options as she plans to get pregnant within a year. Treatment options discussed include ovulation induction medications and surgery. Her risks in pregnancy include miscarriage, gestational diabetes, and preterm delivery due to her PCOS diagnosis.
This document discusses cirrhosis and its complications over two parts. Part I covers what cirrhosis is, its etiologies, clinical presentations, physical exam findings, laboratory tests, liver biopsy, and prognosis for different etiologies. Part II covers complications of cirrhosis including portal hypertension, variceal bleeding, hepatic encephalopathy, spontaneous bacterial peritonitis, hepatorenal syndrome, hepatopulmonary syndrome, and hepatocellular carcinoma screening and treatment. Liver transplantation is also discussed as a treatment option.
This document provides background information on ovarian cancer, including its pathophysiology, etiology, epidemiology, clinical presentation, diagnosis, and screening. It states that ovarian cancer typically spreads within the peritoneal cavity. Several risk factors are identified, including genetic and reproductive factors. Epithelial ovarian cancer represents the most common histology and has a poor prognosis when diagnosed at advanced stages, due to nonspecific symptoms. No approved screening methods exist for ovarian cancer detection.
The document discusses cancer cachexia and wasting syndrome. It begins by quoting Hippocrates' description of wasting syndrome. It then provides context that the paintings described were done between 1912-1915 by Ferdinand Hodler of his wife Valentine Gode-Darel, who died of gynecological cancer. The rest of the document covers topics like the definition and pathophysiology of cancer cachexia, diagnostic criteria, stages of cachexia, assessment tools, and management of cancer anorexia-cachexia syndrome.
This document discusses nutrition in cancer patients. It notes that malnutrition is common in cancer patients, affecting 15-40% of patients and up to 80% of those with advanced malignancy. Cancer and its treatments can cause weight loss, reduced food intake, nausea, and other issues leading to malnutrition. Malnutrition is associated with decreased survival, increased treatment toxicity, and reduced quality of life. Nutritional screening and assessment tools can identify patients at risk. Nutrition support options include oral diet, oral supplements, enteral feeding via tube, and parenteral nutrition for those unable to meet nutritional needs enterally. The goals of nutrition therapy are to maintain nutritional status, quality of life, treatment efficacy and reduce complications.
This document provides an overview of gastrointestinal (GI) cancers, including esophageal cancer, gastric cancer, pancreatic cancer, and colorectal cancer. It discusses the anatomy and types of GI cancers, along with risk factors, symptoms, diagnostic tests, and treatment options for each cancer type. Nursing care focuses on managing nutrition, symptoms, surgical recovery, and providing education and psychosocial support. GI cancers remain a significant health issue globally due to their prevalence and impacts.
Liver cancer is cancer that affects the liver through tumors or cancer cells. The liver performs important functions like breaking down nutrients, producing substances for blood clotting, and filtering out toxic waste. Risk factors for liver cancer include hepatitis, cirrhosis, age, gender, and environmental factors like smoking. Symptoms can include weight loss, appetite loss, nausea, vomiting, and jaundice. Tests used to detect liver cancer are AFP tests, ultrasounds, biopsies, CT scans, and MRIs. Treatment options include surgery, liver transplant, radiation, chemotherapy, and tumor ablation.
Polycystic Ovarian Syndrome - Obstetrics/Gynecology Case Presentationcandicelainereyes
DL, a 25-year-old woman, presents with irregular periods, weight gain, acne, and excess hair growth. Her lab tests confirm she has polycystic ovarian syndrome (PCOS) based on irregular periods, signs of excess androgens, and polycystic ovaries. She is started on oral contraceptives to regulate her cycle and reduce symptoms. Now that her symptoms have improved with treatment, she inquires about fertility options as she plans to get pregnant within a year. Treatment options discussed include ovulation induction medications and surgery. Her risks in pregnancy include miscarriage, gestational diabetes, and preterm delivery due to her PCOS diagnosis.
This document discusses cirrhosis and its complications over two parts. Part I covers what cirrhosis is, its etiologies, clinical presentations, physical exam findings, laboratory tests, liver biopsy, and prognosis for different etiologies. Part II covers complications of cirrhosis including portal hypertension, variceal bleeding, hepatic encephalopathy, spontaneous bacterial peritonitis, hepatorenal syndrome, hepatopulmonary syndrome, and hepatocellular carcinoma screening and treatment. Liver transplantation is also discussed as a treatment option.
Colon cancer develops in the large intestine and rectal cancer in the lower part of the colon. Risk factors include older age, family history, inflammatory bowel diseases, diet high in fat and low in fiber, smoking, obesity, and lack of exercise. Symptoms include changes in bowel habits, rectal bleeding, abdominal discomfort, weight loss, and fatigue. Diagnosis involves colonoscopy and biopsy. Treatment depends on cancer stage and may include surgery, chemotherapy, radiation therapy, and targeted drug therapy. Lifestyle changes such as screening, healthy diet, exercise, and limiting alcohol and smoking can help prevent colon cancer.
This document provides an overview of liver cancer, including its causes, symptoms, diagnosis, and treatment options. It explains that liver cancer occurs when liver cells grow abnormally and form tumors. Common symptoms include abdominal pain and swelling. Diagnosis involves physical exams, blood tests, CT scans, MRIs, and ultrasounds. Treatment may include surgery to remove part or all of the liver, ablation to destroy tumor cells, embolization to cut off their blood supply, targeted drug therapy, or radiation therapy. The risk of recurrence remains high even after treatment.
Colorectal cancer is one of the most common and fatal cancers globally. Risk factors include age, family history, diet, obesity, and lack of physical activity. Screening tests like colonoscopy can detect and remove precancerous polyps, helping to prevent colorectal cancer by interrupting its typical development through the adenoma-carcinoma sequence. Modifying lifestyle factors and participating in screening are important for colorectal cancer prevention and early detection.
This document discusses alcoholic liver disease (ALD), including its causes, risk factors, symptoms, diagnosis, and treatment options. It notes that ALD encompasses conditions like fatty liver, alcoholic hepatitis, and cirrhosis that result from excessive alcohol consumption over time. Heavy drinking, especially in men who consume 60-80 grams per day for over 20 years or women who drink over 20 grams per day, significantly increases risk. Symptoms may not appear initially but can include abdominal pain, nausea, fatigue, and jaundice as the disease progresses. Treatment focuses on abstinence from alcohol as well as nutrition supplementation and medications to manage complications like ascites and hepatic encephalopathy.
Colon cancer can develop due to chromosomal instability or microsatellite instability. Presentation may be asymptomatic, or include changes in bowel habits, blood in stool, weight loss, or abdominal masses. Diagnosis involves tests such as colonoscopy, biopsy, and imaging. Treatment depends on stage and includes surgery to remove the cancerous section of colon as well as nearby lymph nodes, with the possibility of additional chemotherapy or radiation. Recurrence is common within the first few years and is monitored through cancer antigen testing, imaging and colonoscopy surveillance.
The document provides an overview of cancer biology, including key terminology, epidemiology, etiology, prevention, screening, diagnosis, staging, treatment, and biomarkers. It defines various types of cancers and neoplasms, describes the cellular and genetic events leading to cancer development, and outlines the general principles and goals of cancer treatment, which may include surgery, chemotherapy, radiation therapy, and palliative care.
This document provides an overview of ovarian cancer, including:
1. The different types of ovarian tumors that can develop from the epithelial, germ, and stromal cells in the ovaries.
2. The symptoms of ovarian cancer, which can include pelvic pain, back pain, indigestion, and frequent urination.
3. Causes of ovarian cancer such as family history, age, number of ovulations, and genetic syndromes.
4. Stages of ovarian cancer from Stage 1 through Stage 4.
A 75-year-old male presented with constipation and abdominal bloating. Diagnostic workup revealed colonic adenocarcinoma. He underwent sigmoidectomy and Hartmann's procedure. Pathology confirmed well-differentiated colonic adenocarcinoma. Risk factors for the patient included age, smoking history, and family history of colon cancer. Treatment guidelines include surgical resection and chemotherapy depending on stage.
This document summarizes findings from the Continuous Update Project (CUP) on diet, weight, physical activity and cancer risk. The CUP analyzes global research on cancer prevention and survival. The summary identifies several factors that increase cancer risk, such as being overweight, eating processed meat, drinking alcohol, and smoking. It also identifies factors that decrease cancer risk, such as eating vegetables, fruits, whole grains, and engaging in physical activity. The CUP findings are used to update the World Cancer Research Fund's Cancer Prevention Recommendations.
Breast cancer is the second leading cause of death and second most common cancer in women. It occurs when abnormal cells in the breast grow in an uncontrolled way and form tumors. The breasts contain lobes and lobules which produce milk, connected by ducts. The two main types are ductal carcinoma, originating in the ducts, and lobular carcinoma, originating in the lobules. Risk factors include gender, age, family history, obesity, lack of exercise, alcohol consumption, and hormone therapy. Screening methods include breast self-exams, clinical exams by a doctor, and mammography. Treatment options depend on cancer stage and may involve surgery, radiation, chemotherapy, and hormone therapy. With early detection and treatment, the
Cervical cancer develops in the cervix, the lower part of the uterus. It begins as pre-cancerous changes to cervical cells and can progress to cancer. About 10,520 new cases are diagnosed in the US each year, with risks highest for those who are sexually active at a young age or have HPV. Screening via Pap tests can detect cell abnormalities early when treatment is most effective. Treatment options depend on cancer stage and may include surgery, radiation, chemotherapy, or vaccines.
I and 4 other classmates researched Colorectal Cancer, commonly called Colon Cancer, and presented before our class about what we learned. Our presentation covered the pathophysiology, epidemiology, risk factors, screenings, signs and symptoms, assessments and diagnostic tests, diagnostic criteria, treatments, and article on evidence based practices.
Ovarian cancer forms from abnormal cell growth in one or both ovaries. Most cases are epithelial cell tumors. Symptoms include abdominal bloating and pain. Risk factors include age, family history, and never being pregnant. It is often diagnosed late since symptoms are vague, but earlier detection improves prognosis. Treatment typically involves surgery to remove the ovaries and chemotherapy. Nursing care focuses on managing pain, preventing infections and blood clots, and providing education and support.
Ethics presentation given at Providence Health Care on 2/19/16 as a part of a day-long nursing oncology conference. Discusses the fundamental clinical ethics consultation approach and discusses in narrative the relevant ethics cases that are common to oncology practice
This document summarizes guidelines for managing varices and variceal hemorrhage in patients with cirrhosis. It discusses risk factors for variceal bleeding, methods for risk stratification, and recommendations for primary prevention of bleeding in patients with and without varices. Key points include using nonselective beta-blockers or endoscopic variceal ligation for primary prevention in patients with medium or large varices, monitoring patients without varices for development of varices, and using the hepatic venous pressure gradient to further stratify risk and guide treatment decisions.
The colon is a muscular tube that extends from the small bowel to the anus. Colon cancer develops from benign polyps that mutate into cancerous tumors. Symptoms include changes in bowel habits, rectal bleeding, and abdominal discomfort. Treatment options include surgery to remove part or all of the colon, chemotherapy, and radiation. Those at higher risk include those over 60, with a family history or certain genetic conditions, who eat a diet high in processed meats. Regular screening colonoscopies after age 50 can help detect colon cancer early.
Breast cancer screening, prevention and genetic counsellingDrAyush Garg
Mrs. X is a 46-year-old woman concerned about breast cancer risk due to a friend's recent diagnosis. She has no family history of breast cancer herself. The document discusses guidelines for breast cancer screening, genetic screening, and prevention. For Mrs. X, the assistant recommends annual mammography and clinical breast examination in line with screening guidelines for average-risk women over age 40. The benefits of screening increase with age, so annual screening is advised to detect any potential issues earlier.
This document provides an overview of gastrointestinal cancers, including gastric adenocarcinoma, colorectal cancer, and small bowel tumors. Key points discussed include risk factors, signs and symptoms, diagnostic testing, staging classifications, treatment options, and screening recommendations for colorectal cancer. Inheritable syndromes associated with colorectal cancer such as familial adenomatous polyposis and Lynch syndrome are also reviewed.
This case study describes a 37-year-old female patient who presented with a breast mass. Diagnostic tests performed included a mammogram, biopsy, and right modified radical mastectomy which revealed invasive ductal carcinoma. The management plan for this patient includes neoadjuvant chemotherapy, followed by surgical therapy such as modified radical mastectomy and adjuvant radiation therapy. Adjuvant chemotherapy or hormone therapy may also be recommended depending on risk factors. Regular follow-up exams are important to monitor for potential recurrence.
A 57-year-old male with Stage III colon cancer who underwent an 18-inch colon resection two months ago is experiencing decreased appetite and nausea from chemotherapy treatments every other week. A nutrition assessment found the patient to be overweight and have low calcium levels. The registered dietitian developed a medical nutrition therapy plan to meet the patient's increased calorie, protein, fluid, and supplement needs through a high-calorie diet and Ensure Clear drinks on chemotherapy weeks in order to prevent malnutrition and support recovery from cancer treatment. Progress will be monitored every 3 months.
Colon cancer develops in the large intestine and rectal cancer in the lower part of the colon. Risk factors include older age, family history, inflammatory bowel diseases, diet high in fat and low in fiber, smoking, obesity, and lack of exercise. Symptoms include changes in bowel habits, rectal bleeding, abdominal discomfort, weight loss, and fatigue. Diagnosis involves colonoscopy and biopsy. Treatment depends on cancer stage and may include surgery, chemotherapy, radiation therapy, and targeted drug therapy. Lifestyle changes such as screening, healthy diet, exercise, and limiting alcohol and smoking can help prevent colon cancer.
This document provides an overview of liver cancer, including its causes, symptoms, diagnosis, and treatment options. It explains that liver cancer occurs when liver cells grow abnormally and form tumors. Common symptoms include abdominal pain and swelling. Diagnosis involves physical exams, blood tests, CT scans, MRIs, and ultrasounds. Treatment may include surgery to remove part or all of the liver, ablation to destroy tumor cells, embolization to cut off their blood supply, targeted drug therapy, or radiation therapy. The risk of recurrence remains high even after treatment.
Colorectal cancer is one of the most common and fatal cancers globally. Risk factors include age, family history, diet, obesity, and lack of physical activity. Screening tests like colonoscopy can detect and remove precancerous polyps, helping to prevent colorectal cancer by interrupting its typical development through the adenoma-carcinoma sequence. Modifying lifestyle factors and participating in screening are important for colorectal cancer prevention and early detection.
This document discusses alcoholic liver disease (ALD), including its causes, risk factors, symptoms, diagnosis, and treatment options. It notes that ALD encompasses conditions like fatty liver, alcoholic hepatitis, and cirrhosis that result from excessive alcohol consumption over time. Heavy drinking, especially in men who consume 60-80 grams per day for over 20 years or women who drink over 20 grams per day, significantly increases risk. Symptoms may not appear initially but can include abdominal pain, nausea, fatigue, and jaundice as the disease progresses. Treatment focuses on abstinence from alcohol as well as nutrition supplementation and medications to manage complications like ascites and hepatic encephalopathy.
Colon cancer can develop due to chromosomal instability or microsatellite instability. Presentation may be asymptomatic, or include changes in bowel habits, blood in stool, weight loss, or abdominal masses. Diagnosis involves tests such as colonoscopy, biopsy, and imaging. Treatment depends on stage and includes surgery to remove the cancerous section of colon as well as nearby lymph nodes, with the possibility of additional chemotherapy or radiation. Recurrence is common within the first few years and is monitored through cancer antigen testing, imaging and colonoscopy surveillance.
The document provides an overview of cancer biology, including key terminology, epidemiology, etiology, prevention, screening, diagnosis, staging, treatment, and biomarkers. It defines various types of cancers and neoplasms, describes the cellular and genetic events leading to cancer development, and outlines the general principles and goals of cancer treatment, which may include surgery, chemotherapy, radiation therapy, and palliative care.
This document provides an overview of ovarian cancer, including:
1. The different types of ovarian tumors that can develop from the epithelial, germ, and stromal cells in the ovaries.
2. The symptoms of ovarian cancer, which can include pelvic pain, back pain, indigestion, and frequent urination.
3. Causes of ovarian cancer such as family history, age, number of ovulations, and genetic syndromes.
4. Stages of ovarian cancer from Stage 1 through Stage 4.
A 75-year-old male presented with constipation and abdominal bloating. Diagnostic workup revealed colonic adenocarcinoma. He underwent sigmoidectomy and Hartmann's procedure. Pathology confirmed well-differentiated colonic adenocarcinoma. Risk factors for the patient included age, smoking history, and family history of colon cancer. Treatment guidelines include surgical resection and chemotherapy depending on stage.
This document summarizes findings from the Continuous Update Project (CUP) on diet, weight, physical activity and cancer risk. The CUP analyzes global research on cancer prevention and survival. The summary identifies several factors that increase cancer risk, such as being overweight, eating processed meat, drinking alcohol, and smoking. It also identifies factors that decrease cancer risk, such as eating vegetables, fruits, whole grains, and engaging in physical activity. The CUP findings are used to update the World Cancer Research Fund's Cancer Prevention Recommendations.
Breast cancer is the second leading cause of death and second most common cancer in women. It occurs when abnormal cells in the breast grow in an uncontrolled way and form tumors. The breasts contain lobes and lobules which produce milk, connected by ducts. The two main types are ductal carcinoma, originating in the ducts, and lobular carcinoma, originating in the lobules. Risk factors include gender, age, family history, obesity, lack of exercise, alcohol consumption, and hormone therapy. Screening methods include breast self-exams, clinical exams by a doctor, and mammography. Treatment options depend on cancer stage and may involve surgery, radiation, chemotherapy, and hormone therapy. With early detection and treatment, the
Cervical cancer develops in the cervix, the lower part of the uterus. It begins as pre-cancerous changes to cervical cells and can progress to cancer. About 10,520 new cases are diagnosed in the US each year, with risks highest for those who are sexually active at a young age or have HPV. Screening via Pap tests can detect cell abnormalities early when treatment is most effective. Treatment options depend on cancer stage and may include surgery, radiation, chemotherapy, or vaccines.
I and 4 other classmates researched Colorectal Cancer, commonly called Colon Cancer, and presented before our class about what we learned. Our presentation covered the pathophysiology, epidemiology, risk factors, screenings, signs and symptoms, assessments and diagnostic tests, diagnostic criteria, treatments, and article on evidence based practices.
Ovarian cancer forms from abnormal cell growth in one or both ovaries. Most cases are epithelial cell tumors. Symptoms include abdominal bloating and pain. Risk factors include age, family history, and never being pregnant. It is often diagnosed late since symptoms are vague, but earlier detection improves prognosis. Treatment typically involves surgery to remove the ovaries and chemotherapy. Nursing care focuses on managing pain, preventing infections and blood clots, and providing education and support.
Ethics presentation given at Providence Health Care on 2/19/16 as a part of a day-long nursing oncology conference. Discusses the fundamental clinical ethics consultation approach and discusses in narrative the relevant ethics cases that are common to oncology practice
This document summarizes guidelines for managing varices and variceal hemorrhage in patients with cirrhosis. It discusses risk factors for variceal bleeding, methods for risk stratification, and recommendations for primary prevention of bleeding in patients with and without varices. Key points include using nonselective beta-blockers or endoscopic variceal ligation for primary prevention in patients with medium or large varices, monitoring patients without varices for development of varices, and using the hepatic venous pressure gradient to further stratify risk and guide treatment decisions.
The colon is a muscular tube that extends from the small bowel to the anus. Colon cancer develops from benign polyps that mutate into cancerous tumors. Symptoms include changes in bowel habits, rectal bleeding, and abdominal discomfort. Treatment options include surgery to remove part or all of the colon, chemotherapy, and radiation. Those at higher risk include those over 60, with a family history or certain genetic conditions, who eat a diet high in processed meats. Regular screening colonoscopies after age 50 can help detect colon cancer early.
Breast cancer screening, prevention and genetic counsellingDrAyush Garg
Mrs. X is a 46-year-old woman concerned about breast cancer risk due to a friend's recent diagnosis. She has no family history of breast cancer herself. The document discusses guidelines for breast cancer screening, genetic screening, and prevention. For Mrs. X, the assistant recommends annual mammography and clinical breast examination in line with screening guidelines for average-risk women over age 40. The benefits of screening increase with age, so annual screening is advised to detect any potential issues earlier.
This document provides an overview of gastrointestinal cancers, including gastric adenocarcinoma, colorectal cancer, and small bowel tumors. Key points discussed include risk factors, signs and symptoms, diagnostic testing, staging classifications, treatment options, and screening recommendations for colorectal cancer. Inheritable syndromes associated with colorectal cancer such as familial adenomatous polyposis and Lynch syndrome are also reviewed.
This case study describes a 37-year-old female patient who presented with a breast mass. Diagnostic tests performed included a mammogram, biopsy, and right modified radical mastectomy which revealed invasive ductal carcinoma. The management plan for this patient includes neoadjuvant chemotherapy, followed by surgical therapy such as modified radical mastectomy and adjuvant radiation therapy. Adjuvant chemotherapy or hormone therapy may also be recommended depending on risk factors. Regular follow-up exams are important to monitor for potential recurrence.
A 57-year-old male with Stage III colon cancer who underwent an 18-inch colon resection two months ago is experiencing decreased appetite and nausea from chemotherapy treatments every other week. A nutrition assessment found the patient to be overweight and have low calcium levels. The registered dietitian developed a medical nutrition therapy plan to meet the patient's increased calorie, protein, fluid, and supplement needs through a high-calorie diet and Ensure Clear drinks on chemotherapy weeks in order to prevent malnutrition and support recovery from cancer treatment. Progress will be monitored every 3 months.
Nephrotic syndrome is a kidney disorder characterized by protein in the urine, low protein levels in the blood, high cholesterol, and swelling. It is caused by increased permeability of the kidney's filtering membrane, allowing protein but not blood cells to pass into the urine. Nephrotic syndrome has many potential causes including primary kidney diseases or systemic diseases affecting other organs like diabetes or lupus. Complications can include blood clots, infections, anemia, heart disease, high blood pressure, and fluid buildup due to low protein levels in the blood.
A 70-year-old man presented with vague abdominal pain following treatment for stage III colon cancer. Imaging showed no evidence of recurrence but his CEA level was rising. Review of his initial PET scan in light of a subsequent scan found a lesion that was initially missed due to its location near the bowel.
This document provides an overview of Abby's case study of being diagnosed with ovarian cancer at the young age of 20. It discusses her initial symptoms, tests performed that found a mass on her ovary, and her discussions with Dr. Allen about the diagnosis and treatment options. Specifically, it notes that her CA-125 levels were high, indicating cancer rather than a cyst. The document then explores topics like the genetics of ovarian cancer, how cancer primarily affects older individuals, cell cycle regulation and checkpoints, and Abby's treatment process including surgery, radiation, and chemotherapy. Overall, it presents Abby's story as a case study to educate about ovarian cancer causes, diagnosis, and standard treatment approaches.
1 scoop myotein in 2 times feeding per day
Calories = 6(42kcal) x 6 + 2(30.1) = 1566.2 kcal/day
Protein = 6(1.7g) x 6 + 2(5g) = 72.4 g/day
Total CHO = 6(5.1g) x 6 = 183.6g/day
Total Fat = 6(1.6g) x 6 = 57.6g/day
3. Flush with 30ml of water
Gradually increase feeding amount based on tolerance.
Monitoring and Evaluation
1. Daily monitoring of:
- Intake and output
Alzheimer's is a gradual mental decline that destroys cognitive abilities over time. It progresses from mild forgetfulness to severe memory loss and inability to perform basic tasks. While the exact cause is unknown, risk factors include age, family history, head injuries, and medical conditions. Symptoms start with memory loss and confusion and worsen to include changes in personality and behavior. Home remedies like consuming carrots, fish, and vitamins E and B may help curb Alzheimer's progression, though it currently has no cure.
Parkinson's disease is a chronic, degenerative illness caused by the loss of dopamine-producing cells in the brain. Its main symptoms include tremors, slow movement, and muscle stiffness. While its exact causes are unknown, it mainly affects those over 65. Treatment focuses on dopamine replacement via L-Dopa medication.
Alzheimer's disease was first identified in 1901 and slowly destroys memory and cognitive skills by forming plaques and tangles that damage neurons. It progresses from mild memory loss to severe impairment, eventually preventing communication. While its causes are unknown, genetic and lifestyle factors may play a role. Current treatments focus on managing symptoms rather than finding a cure.
Case of a rare inflammatory hepatic hilar mass mimicking cholangiocarcinomaDebdeep Banerjee
This case report describes a rare case of an inflammatory hepatic hilar mass that mimicked cholangiocarcinoma in a 66-year-old man. Imaging and biopsy were initially suggestive of cholangiocarcinoma but surgical exploration revealed the mass to be caused by diffuse fibrotic and inflammatory reactions. A definitive diagnosis of benign inflammatory mass, rather than cholangiocarcinoma, was made based on histopathological examination showing only chronic inflammation. The patient recovered well with conservative management, highlighting the challenges of distinguishing between benign and malignant hilar masses preoperatively.
The document describes a case study of a man who was diagnosed with blood cancer through medical astrology. The astrologer was asked to examine the man's horoscope and predicted he would be hospitalized for a stomach or lung issue related to blood. He was later found to have acute blood cancer. The astrologer analyzed the man's chart and found indications of stomach cancer such as the 8th lord Jupiter in the 5th house signifying the stomach and liver. The man passed away from blood cancer in April 2003 as predicted during the periods of unfavorable planetary combinations. The case study demonstrates how medical astrology can be used to predict health conditions like cancer well in advance through astrological chart
Metastatic hepatocellular carcinoma case post liver transplantationNabil El-Hady
The document discusses the epidemiology, etiology, diagnosis, and treatment of hepatocellular carcinoma (HCC). It notes that HCC is the 5th most common cancer worldwide and the 3rd leading cause of cancer death. Risk factors include hepatitis B, hepatitis C, cirrhosis, alcohol, tobacco, and aflatoxins. Diagnosis involves tumor marker AFP and imaging exams. Treatment options mentioned are surgical resection, liver transplantation, transarterial chemoembolization, radiofrequency ablation, and targeted drug therapy like sorafenib.
Surgical Treatment of Pancreatic Cancer - Dimitris P. KorkolisDimitris P. Korkolis
This document discusses pancreatic cancer and surgical treatment options. It begins with an overview of stage-specific survival rates, with the highest being 24.1 months for stage I or II cancers that are resected. It then discusses criteria for determining if a tumor is resectable, borderline resectable, or locally advanced. For borderline resectable tumors, it presents a classification system and data showing improved outcomes for patients who undergo neoadjuvant therapy and resection compared to unresected patients. The document also reviews surgical techniques for venous resection if needed during pancreatectomy and presents survival data supporting this approach.
Staging and Surgical Management of Pancreatiic Canceru.surgery
This document discusses staging and surgical management of pancreatic cancer. It covers staging techniques like CT, endoscopic ultrasound, laparoscopy and biomarkers. CT is good for predicting resectability but not lymph node status. Endoscopic ultrasound is useful for diagnosis and staging. Laparoscopy can detect small volume disease and changes management in 10-15% of cases. Extended resections, portal vein resection and pylorus-preserving pancreaticoduodenectomy are discussed. Reconstruction techniques after resection include pancreaticojejunostomy. Drains and stents may not provide benefits while octreotide could help for high-risk anastomoses. Outcome depends on tumour type and quality of life is improved at high-volume
This document summarizes a human clinical trial that evaluated the safety and efficacy of using ultrasound and microbubbles to enhance gemcitabine treatment of inoperable pancreatic cancer. 10 patients received the standard gemcitabine chemotherapy protocol along with ultrasound-mediated microbubble delivery directly to their pancreatic tumors. Results showed no additional toxicity compared to gemcitabine alone. 5 patients experienced partial tumor shrinkage and 1 patient's tumor reduced enough to allow for potentially curative surgery. Patients also experienced less abdominal pain and weight loss. Overall survival was nearly twice as high compared to historical controls treated with gemcitabine only, suggesting ultrasound-mediated microbubble delivery improved gemcitabine treatment outcomes for inoperable pancreatic cancer.
Lewis Washkansky was the recipient of the first successful human heart transplant in 1967 in South Africa. While he survived over two weeks, he ultimately succumbed to pneumonia. Now approximately 2,000 heart transplants are performed annually in the US, allowing patients to live longer, healthier lives. The most common causes of death after transplant are graft failure early on, opportunistic infections between 6 months to a year post-transplant, and acute rejection within the first three years. Cardiac allograft vasculopathy (CAV), where the transplanted coronary arteries develop atherosclerosis, increases risk of death beyond the first year. Screening for CAV involves annual coronary angiography. Treatment focuses on controlling hypertension and
A 23-year-old male presented with lower back pain, fatigue, cough, and fever for three months. Physical examination revealed tenderness in the lower back and ribs as well as an enlarged lymph node. Imaging showed bony lesions in the ribs and spine consistent with a diagnosis of multifocal skeletal tuberculosis, also known as Potts disease. The patient was started on antitubercular medications while further tests were conducted to confirm the diagnosis.
The document provides information on Taenia species tapeworm infections, including T. solium, T. saginata, and T. asiatica. It discusses the life cycles, clinical presentation, diagnosis, and treatment of taeniasis. It also covers cysticercosis and neurocysticercosis caused by the larval form of T. solium in human tissue, which can present with seizures or neurological symptoms. Diagnosis of taeniasis is usually from detecting eggs or proglottids in stool, while cysticercosis requires monitoring and glucocorticoids due to potential inflammatory response from praziquantel treatment.
This document presents the case of a 14-year-old female patient admitted with recurrent acute pancreatitis. Her episodes are associated with hypertriglyceridemia. Her brother also had a history of similar symptoms. Laboratory tests revealed elevated triglyceride levels in the patient and her family members. She was diagnosed with familial hypertriglyceridemia-induced recurrent acute pancreatitis. Treatment involved managing triglyceride levels and supportive care for the acute attack.
Current pancreatic cancer research 10 May 16Derek Louden
Pancreatic cancer research is exploring new treatment options through a pipeline of clinical studies and drug developments. These include siG12D-LODER which releases siRNA to knock down YAP1 and significantly improve survival times, miR-375 which targets the 3'UTR of YAP1 mRNA to decrease its levels and inhibit cancer cell proliferation, and a peptide mimicking VGLL4 to compete with YAP for TEAD4 binding and prevent metastasis. Other approaches discussed are PEGPH20 to ablate stromal HA and improve drug delivery, QD232 targeting multiple oncogenic pathways, and combinations of drugs such as Cilengitide and Verapamil with Gemcitabine.
Sarah, a 45-year-old woman, presents with a tender lump in her left breast. An x-ray confirms a small lump, and a biopsy determines it is malignant stage III breast cancer without hormone receptors. Treatment options for Sarah's aggressive cancer include chemotherapy to target cancer cells, radiation therapy using high-energy sources to kill cells, and potentially a mastectomy given the stage and size of the tumor. MicroRNAs that inhibit protein production and contribute to breast cancer development and treatment may also impact Sarah's case.
liver cancer and it's pharmacology and medical management.pptxzeexhi1122
This document discusses liver cancer including its definition, clinical manifestations, causes, risk factors, diagnosis, and treatment options. Liver cancer begins in the liver cells and is one of the most common cancers worldwide. Its symptoms can include weight loss, jaundice, fatigue, nausea, back pain, itching, fever, abdominal pain, loss of appetite, and enlarged liver. Risk factors include cirrhosis, alcohol use, hepatitis, obesity, and certain genetic conditions. Treatment may involve surgery, chemotherapy, radiation, or a combination depending on the cancer stage and patient's health. Nursing care focuses on pain management, wound care, monitoring for complications, preventing infections, and providing education and nutritional support.
Inpatient case study on the Multifactorial Conditions of Failure to Thrive in adulthood. Outlines the literature review, hospital course, and nutrition care plan, including the nutritional assessments and educations conducted. This case study was presented at Johns Hopkins Bavyiew Medical Center.
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Chronic kidney disease (CKD), a major global public health problem, has been recognized as one of the eleven important causes of death (WHO, 2009). This review explores wide range of barriers related to patients and health systems involved in controlling the prevalence of CKD at the primary health care level.
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Chronic liver disease in children22.pptxAmmaraHameed6
This document discusses chronic liver disease and portal hypertension in children. It defines chronic liver disease as ongoing liver injury for at least 6 months that can progress to cirrhosis and liver failure. Cirrhosis is the end result of liver cell damage and destruction. The etiology of chronic liver disease in children varies according to age and includes infectious, metabolic, autoimmune, anatomical, and toxic/drug-induced causes. Some common chronic liver diseases in children discussed in detail include biliary atresia, alpha-1 antitrypsin deficiency, cystic fibrosis, and Wilson's disease.
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This document summarizes chronic liver disease and cirrhosis. It defines chronic liver disease as ongoing chronic liver damage that can progress to cirrhosis. Cirrhosis is characterized by diffuse hepatic cell injury, inflammation, fibrosis and nodular regeneration, resulting in the loss of normal liver architecture. Chronic liver disease can be compensated or decompensated. Compensated disease is asymptomatic while decompensated disease presents with jaundice, bleeding, ascites or hepatic encephalopathy. The causes, clinical features, investigations, grading scales like Child-Pugh, and management of chronic liver disease and cirrhosis are described.
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A presentation from a tutorial about an interesting case that came to the Pediatric Department of Sebha Medical Center and was imaged by the Radiology Department.
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Nonalcoholic fatty liver disease (NAFLD) is defined as hepatic steatosis without significant alcohol consumption or other known liver diseases. It includes nonalcoholic fatty liver (NAFL) characterized by hepatic fat accumulation without inflammation or fibrosis, and nonalcoholic steatohepatitis (NASH) characterized by fat accumulation with inflammation and hepatocyte injury. NAFLD is strongly associated with obesity and metabolic syndrome. Lifestyle interventions including weight loss and exercise are recommended first-line treatment, while pioglitazone and vitamin E may improve liver histology in non-diabetic adults with NASH. Liver biopsy is needed to distinguish NASH from NAFL and assess fibrosis to guide management.
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This document summarizes a seminar presentation on gallbladder disorders given by a group of nursing students. It includes an overview of the anatomy and physiology of the gallbladder, risk factors for gallbladder disease, types of gallbladder disorders like cholelithiasis, and clinical manifestations. It also discusses diagnostic evaluations like ultrasound and treatments like cholecystectomy. The nursing management of a patient with acute calculus cholecystitis is presented as a case study.
Similar to Case Study_Pancreatic Cancer patient with TPN (20)
3. Objective
Overview the medical and
nutritional therapy related
to diagnosis and
complications of
metastatic pancreatic
cancer
4. Patient Profile (S.L.)
71 year old
Male
Caucasian
College graduate
Admitted to St John’s March 15th with complaints of
generalized weakness, chill and fever
Active diagnosis: generalized weakness, neutropenia,
leukopenia, acute renal failure and Pancreatic
Cancer (PC)
Recently diagnosed with stage 4 metastatic
Pancreatic cancer in October 2011.
5. Disease Background
Cancer – 2nd leading cause of mortality in the US
Unspecific and universal
Affects people of any age, gender, ethnicity and
socioeconomic and cultural status
Cancer is a cluster of more than a 100 conditions that lead
to development of uninhibited growth and multiplication of
abnormal cells
Prevalence of Pancreatic cancer
6. Epidemiology
Elderly, 45 years or older
Men and African Americans
5-year survival rate is 6% in Caucasians, 4% in Africans Americans
No improvement over the past 30 years, 1.5% increase in cases every year
7. Cancer of the Pancreas
Exocrine
responsible for making pancreatic juice, enzymes
responsible for digestion of fats, protein and
carbohydrates
transported via a pancreatic duct which leads into a
common duct and empties into the duodenum
during digestion.
Endocrine
AKA islets of Langerhans
responsible for releasing hormones such as insulin
and glucagon for maintenance of blood sugars
Most of the cancers of the pancreas are of
the exocrine cells and ducts
95% are pancreatic ductal adenocarcinoma
5% are of the endocrine, have different
symptom, diagnosis, treatment and more
favorable prognosis
8. Pathology
Initiation Promotion Progression
Pancreatic
cancer (PC)
develops in a
multistep
process:
• Initiation
• Promotion
• Progression –
angiogenesis &
metastasis
Is a familial cancer
Prevalent in families
Inherited or acquired
DNA mutations
9. Etiology
No known causes of pancreatic cancer have yet been established
Pancreatic cancer more prevalent in developed countries rather than
developing countries
Risk associated with
Cigarette smoking
Obesity
Diabetes type 2
Chronic pancreatitis
(inflammation of the pancreas)
Liver cirrhosis
Other infections (e.g. H. Pylori)
Environmental toxins
12 - Bracci PM. Obesity and pancreatic cancer: overview of epidemiologic evidence and biologic mechanisms.Molecular carcinogenesis. Jan 2012;51(1):53-63.
http://www.heattreat.ca/aging.php
10. Cigarette Smoking
well-established environmental risk factor worldwide
Risk increases two-fold
However recent decline in tobacco consumption
has not decreased the incidence of pancreatic cancer
Alcohol - linked to pancreatitis and liver cirrhosis
Sedentary Lifestyle
Physical Inactivity increases risk of PC in both men and women
Women with a high waist-to-hip ratio have 70 percent higher risk
Positive correlation between high BMI, total caloric intake, sugary
drinks and dietary fat intake
Red meat, Pork, and Processed Meats such as sausage and bacon
6- Pancreatic Cancer: What Are the Risk Factors for Cancer of the Pancreas? American Cancer Society (ACS). http://www.cancer.org/acs/groups/cid/documents/webcontent/003131-pdf.pdf.
14 - Lowenfels AB, Maisonneuve P. Epidemiology and risk factors for pancreatic cancer. Best practice & research. Clinical gastroenterology. Apr 2006;20(2):197-209.
11. Metabolic Syndrome
Elevated serum glucose, glucose intolerance,
high insulin concentrations, presence of insulin
resistance, and high insulin receptor expression
Leptin and ghrelin, hormones which are commonly elevated
during obesity are also associated
Obesity and diabetes are part of metabolic syndrome, which
can cause inflammation, a key regulator of carcinogenesis
Obese individuals tend to have high levels of angiogenetic
factors which help to promote metastasis of tumor cells
12. Symptoms
Not specific to PC, symptoms are very mild and non-
specific, and appears when the tumor grows big enough to
cause discomfort and pain
Jaundice (tumor blocks the bile duct)
Dark urine (bilirubin)
Light color stool (bilirubin in plasma)
Loss of appetite or food intolerance
Epigastric or back pain
Constipation
Weakness
Nausea, Vomiting
Anorexia and unexplained weight loss
The symptoms are individually treated, or misdiagnosed.
Pancreatic cancer usually goes undetected
13. Diagnosis
More than 50% of cases are metastasized and only 10% are localized by
the time of diagnosis
Lack of screening methods
Poor early diagnosis by conventional endoscopy and physical exams
because of location of pancreas
Current diagnosis for symptomatic patients are
Elevated serum bilirubin, alkaline phosphate, and brown or dark urine
those with jaundice, or metastasis to liver
Unusually bulky stools, greasy or tend to float
lack of pancreatic enzymes and malabsorption
Serum tumor marker antigen CA 19-9 and CEA
Released by exocrine pancreatic cells, not sensitive for small tumors
Enlarged gallbladder or swelling of metastasized areas (lymph nodes)
Deep vein thrombosis (DVTs)
Metastasized PC to liver – enlarged liver; to Lungs – cough and difficulty breathing
Diagnostic tests are Endoscopic ultrasound and Biopsy
14. Medical Treatment
Presently, surgical resection is the only curative procedure,
however it is not always indicated when tumors have
metastasized.
3 types of treatments for exocrine PC:
Surgical Resection
Pancreaticoduodenectomy (Whipple procedure)
Distal pancreatectomy
Total pancreatectomy
Palliative Surgeries
Radiation therapy
External beam radiation therapy
Chemotherapy
Gemcitabine, fluorouracil monotherapy or
5-fluorouracil (5-FU), leucovorin
Combinations, e.g. FOLFOX consists of 5-FU, leucovorin,
and oxaliplatin
better outcome, severe side effects
nausea, vomiting, loss of appetite, hair loss, mouth sores, diarrhea,
fatigue and shortness of breath and low blood count
15. Nutrition Intervention
Nutrition cannot cure or reverse PC
Nutrition can impact quality of life, help relieve symptoms
and manage adverse effects of therapy
Typical nutrition interventions are:
Pancreatic enzyme replacements
Enteral or parenteral nutrition support
Prevent or correct nutritional deficiencies
Minimize weight loss
Encourage high-energy foods and supplements
Improve nutritional status
Individualized therapies for patient’s specific symptoms, complains and
preferences including
taste aversions, dysphagia, decreased saliva, GI intolerances, and early
satiety
16. Prevention
There are no established guidelines to prevent PC
Studies suggest negative correlation with:
Diets high in fruits and vegetables
High vitamins A, E and D
have shown to decrease oxidative stress and oxidation of fatty
acids, ultimately preventing carcinogenesis
Eating high levels of the healthy fats, omega-3 and omega-6
Exercise and high levels of physical activity
Cigarette smoking cessation
18. Present Illness
S.L 71 Y.O. male with stage 4 metastatic PC, to liver and
lungs. Was in between chemotherapy cycles of FOLFOX (5-
FU, leucovorin and oxaliplatin)
Found to have hypotension, hypokalemia, dehydration and
suspicion for sepsis and was admitted March 15th
Leukopenia, febrile neutropenia, acute renal failure
Prior to admission S.L. was experiencing
Significant diarrhea, painless with about 4 to 6 bouts daily
Mucositis, oral pain, difficulty in chewing, some odynophagia and
dysphagia,
Cough
Some epigastric pain and discomfort
19. Previous History
Previous Medical Hx:
Enlarged prostate
Previous multiple UTIs
Urinary retention and self-
catheterization
Type 2 Diabetes
Coronary artery disease
Diffuse large B-cell lymphoma,
stage 4 (2004)
Cirrhosis
High cholesterol
High blood pressure
Kidney stones
Anemia
Macular degeneration (right
eye)
Previous Surgical Hx:
o cardiac catheterization with
stent placement
o Mediport insertion
o lymph node and bone
marrow aspiration biopsy
Social history:
o Smoker (quit > 1yr)
o Alcohol abuse (abstinence for
1 yr)
o Denied illicit drug use
20. Diagnostic Tests
Chest X-Ray:
showed no acute pulmonary disease or interval change
Abdomen X-Ray (r/o ileus)
nonspecific bowel gas patterns, no evidence of obstruction or free air
with possible left renal calculus
Braden score of 19
suggesting moderate risk for pressure ulcers
Speech therapy for swallow evaluation
mild deficits with suspected pharyngeal dysphagia
Rec.: Regular texture diet and thin liquids as tolerated
Ultrasound of retroperitoneal cavity
bilateral renal cysts and urinary bladder wall thickening.
Stool culture to r/o C. diff
Septic work up, and infectious disease consult
21. Medical Treatment
Antibiotics – Vancomycin, Flagyl, Cefazolin, Cefepime, Rocephin, Maxipime
Sepsis, infection
IV fluids – 0.9% Normal Saline
Dehydration from diarrhea
Transfusional support (packed RBCs, Platelets) - Neupogen
Neutropenia, and leukopenia
Medications – Protonix, Lomotil, Zofran, Flomax
Diarrhea, epigastric pain, nausea, enlarge prostate
Mineral Supplements
Calcium gluconate, K-Dur, KCl
Foley Catheter placement
Urinary retention
Placed on one person assist
Weakness
Magic Mouthwash, oral care
Mouth sores
22. Day 1 (March 15th)
Dropped blood pressure and was transferred to step-down
Found to have positive cultures/sepsis, low WBC count
Day 2 (March 16th)
Transferred to ICU
Continued profound diarrhea, flexiseal placed
Day 4 (March 18th)
Diminished lung sounds, severe watery diarrhea
Severe mouth pain, refused meals and PO medication, PICC line
placement
Stage I pressure ulcer
Day 5 (March 19th)
Signs of jaundice, nausea, no oral intake
SLP unable to evaluate due to severe pain
TPN feedings initiated
24. Nutrition Assessment
Anthropometric
Ht: 6 feet
Wt: 174 lb (79 kg)
UBW: 237 lbs (107 kg; had BMI 32)
BMI: 24
IBW: 178 lbs (81 kg)
% IBW: 98%
% UBW: 74%
Wt change: 26% involuntary weight loss
Estimated Nutrition Needs:
Calories: 1975 – 2370 kcal (25-30 kcal/kg)
Protein: 79 – 95g (1.0 – 1.2 g/kg for high BUN and Cr labs)
Fluids: 1975 – 2370 ml (25-30 ml/kg)
25. Biochemical Data
Pertinent labs
Normal ranges
(Day 1)
March 15th
(Day 6)
March 21st
(Day 10)
March 25th
Nutrition implications
Glucose (mg/dl) 70 - 200 163 332 187 Elevated with diabetes, hyperglycemia
BUN (mg/dl) 8 – 23 94 81 93
Elevated with renal failure, shock, dehydration,
infection, diabetes
Creatinine (mg/dl) 0.4 – 1.2 2.29 2.47 2.61
Elevated with acute and chronic renal disease, muscle
damage, starvation, diabetic acidosis
Sodium (mEq/L) 136 - 144 142 143 147 Elevated with dehydration
Potassium (mEq/L) 3.5 – 5.0 3.8 3.8 3.8
Elevated with renal failure.Decreases with IV fluids,
diarrhea, vomiting, chronic stress or fever, renal disease
Chloride (mmol/L) 98 - 107 109 119 115 Elevated with dehydration, renal insufficiency, diarrhea
Bicarbonate
(mmol/L)
22 – 29 21 16 24
Decreases with metabolic acidosis, renal failure,
diarrhea, starvation
Calcium (mg/dl) 8.4– 10.2 *7.6 *6.8 *6.1
Decreases with hypoalbuminemia, diarrhea,
hyperphosphatemia, starvation
Phosphorous
(mg/dl)
2.3 – 5.0 - 2.9 -
Decreases with low vitamin D, alcoholism, diabetes,
hyperinsulinism, hyperthyroidism
Magnesium
(mEq/L)
1.3 – 2.1 2.3 1.9 -
Elevated with renal failure, diabetic acidosis,
dehydration, use of anacid
Albumin (g/dl) 3.5 – 5.0 - 1.6 1.5
Decreases with edema, hepatic disease, diarrhea, ESRD,
cancer, overhydration, low protein diet
WBC (x103/ul) 3.2– 10.6 0.5 1.5 33.3 Decreased with infection, chemotherapy and radiation
Neutrophils 44 - 76% 3% 27% 50%
26. Nutrition-Focused Physical Findings
Throat & mouth pain, fatigue, weakness - poor oral intake
Nausea
Severe Diarrhea
+ Flexiseal: 1L dark liquid stool
Skin: Stage 1 bilateral buttocks
Edema: 1+ generalized
No sign/symptoms of hyper/hypoglycemia
Lethargic, decreased alertness, and ADLs
Client History
No known food allergies and intolerances
Prior Diabetic instructions, unable to determine compliance (no Hgb
A1C labs)
Alcohol and smoking history
27. Nutrition Diagnosis
Problem:
Suboptimal protein-energy intake
Etiology (related to)
poor appetite
medical condition
nausea
Pain
Taste changes
Sign/Symptom (as evidenced by)
consumption of less than 50% of meals
involuntary weight loss of 26%
delayed wound healing with stage 1 pressure ulcers.
28. Nutrition Intervention
The initial treatment plan was to provide adequate oral intake by:
1) Liberalize diet to 2000 kcal Diabetic, to improve oral intake and provide
more meal choices
2) Glucerna shakes to provide 220 calories and 9.9g protein each, three times
daily
3) Encourage oral intake and Recommend appetite stimulant
4) Consider palliative care consult
5) Increase assistance with meal choices
6) Discussed nutritional management with health care team to consider adding
multivitamin and mineral supplements
When it was clear that his oral intake would not increase, and he was degraded
by Swallow evaluation to Dysphagia II diet
Initiate TPN at rate of 75 ml/h with 20% Dextrose (1100ml), 15% Amino
Acids (700ml) with 20% Lipids (500ml) 3 times weekly (M-W-F)
Provides 1597 kcals, 105 g protein.
Also recommend adding the TPN bag with 80 mEq KAcetate & 100 mEq NaCl
When oral intake improve, decrease TPN to half, and provide diet education when
medically stable
29. Teaching Plan
Evaluation of Education
S.L. provided feedback and verbalized understanding.
Barriers to learning
Acuity of illness and emotional state
Teaching needs
Needs further teaching and reinforcement, showed interest & receptiveness to education
Key Pt/Topics Objective Method Activity Aids
1) High Calorie
and Protein
Eat small, more
frequent meals
Explanation One-on-One
discussion
Printed
Materials
Eat energy dense
foods
Examples and
Handout
One-on-One
discussion
Printed
Materials
2)Neutropenic Use low microbial
foods
Examples and
Handout
One-on-One
discussion
Printed
Materials
Properly wash Explanation One-on-One
discussion
Printed
Materials
3) Managing
diarrhea, taste
aversions,
mouth sores
Give survival tips
to improve oral
food/bev intake
Explanation
and examples
One-on-One
discussion
Printed
Materials
30. Monitoring and Evaluate
Monitor
Diet order
Monitor and documentation of oral intake
Tolerance to oral diet
Intake and acceptance of supplements
Parenteral nutrition order, intake and tolerance
Flexiseal outputs
Blood glucose levels and adjusting insulin as needed
GI profile
Nutrition quality of life
Nutrition-focused physical findings
Protein profile: serum albumin and prealbumin levels
Renal panel profile
Evaluated initial interventions and made new recs to
Consider change appetite stimulant to Marinol due to compromised renal functions triggered by
megace
Protein levels improved, prealbumin levels of increased from 5 to 12 mg/dl.
Oral intake began to improve slightly, and he started consuming the glucerna shakes
regularly, and TPN was discontinued
31. Conclusion
S.L. was discharged to ECF for further rehabilitation and PT and OT
Most of S.L’s symptoms where a result of the adverse side effects of
aggressive chemotherapy
S.L. was immunocompromised and became a host to many pathogens
Nutrition and Parenteral nutrition helped improved his nutrition
status, improved is protein levels
Pancreatic cancer has poor prognosis and many complications but
nutrition intervention was needed too improve his quality of life and
manage compromised symptoms
32. References
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