Question

Lisa is a 31-year-old Caucasian female of Northern European descent. She is 5 feet 3 inches tall, has an average frame size, and weighs 162 pounds with a BMI of 28.7 (overweight). She lives with her husband and two children, and works as a surgical technician at a local community hospital.

Lisa was diagnosed with Hodgkin’s lymphoma six months ago after experiencing chest pain over a few days. Lisa is currently on a weekly chemotherapy (doxorubicin, bleomycin, vinblastine, and dacarbazine) regimen, which is administered in an outpatient center. Lisa is also taking epoetin (Epogen) with each treatment to maintain a hematocrit above 36%, and filgrastim (Neupogen) for five days after each treatment to stimulate the production of neutrophils.

Lisa reports to the nurse that the only nutritional counseling she has received since diagnosis is to avoid greasy and spicy foods for four to five days post-treatment. She did receive a booklet on what to eat if she has a decrease in appetite, which she reports she has not read.

Since starting chemotherapy, Lisa has gained seven pounds and reports that she actually has more of an appetite than before she started treatment, but prefers more “junk food.” Lisa attributes this to dexamethasone, a steroid she receives with each treatment. She did ask her physician to decrease the dose in order to decrease her appetite. However, when the medication was decreased, she reported feeling “terrible” and chose to return to the higher dose.

Lisa has had occasional problems with mouth sores, a common problem of chemotherapy patients, but states that she is currently able to drink orange juice without much irritation.

Lisa also reports that she experiences significant lethargy and nausea for about four days post-treatment. She has been prescribed Compazine for the nausea, but states she often avoids taking it because it makes her feel “jittery.” Instead she finds eating bland foods like corn flakes, grilled cheese, or chicken with rice helps the nausea. Lisa found the advice not to eat greasy, spicy foods for 4-5 days post-treatment to be helpful. She stated that sausage and pizza made her stomach hurt. This was followed by the statement, “I think eating is the key to getting through chemo.”

8.Develop a nursing care plan for the nutritional management of this patient .

9. What four (4) specific dietary interventions would you suggest to maximize her
nutritional intake? Be sure to consider micronutrients as well as caloric and protein
intake.

10. What would you want to reevaluate in three to four weeks at a follow-up appointment?

Answer 1

8. Nursing care plan for nutritional management :-

Asessment - Poor nutrition status and it worsens with chemotherapy .

Diagnosis - Deficient knowledge regarding the diet to be taken during cancer treatment .

Planning - To provide diet counseling to the patient

Interventions :

- Assess the nutritional knowledge patient has

- Advice the patient to eat fruits and vegetables of thick outer covering or skin

- Advice the patient to put the fruits and vegetables in warm water for half to one hour before using it

- Advice the patient to eat and cook food in hygienic condition

- Advice to eat home made food only

- Avoid fast food or junk food which are spicy ,oily etc

- Avoid foods that are wrapped in cartan .

- Encourage patient to express her concerns

- Help her to arrange a meeting with the dietician

- Follow up the patient

Evaluation - reassess the patient after few days for nutritional assessment and modify the interventions according to the results .

9. Specific dietary interventions to maximize her nutrition all intake are :-

- encourage her to take small frequent diet rich in carbohydrates ,protein ,and fat

- make favorite food at home even if it is oily and spicy but maintain hygiene , it will provide her a sense of taste because of chemotherapy side effects

- Increase fluids and liquid diet to avoid irritation

- include fruits and vegetables in the diet to provide micronutrients , but clean it thoroughly with warm water Provide nuts like cashew , almond etc in few amounts to provide strength and immunity

10. I will reevaluate the following parameters in the following three to four weeks :-

- weight

- height

- CBC levels

- LFT and RFT levels

- BMI