Question

Malnutrition Patient Summary: Ali is a 68 yo. male admitted to acute care for possible dehydration, weight loss, generalized weakness, and malnutrition. History: pt Dx with squamous cell carcinoma of tongue five yrs ago. pt previously treated with radiation therapy-no treatment x 3 yrs. pt. states that he has lost over 27 kg (60 lb) in past 1-2 yr. He lost some weight when Dx with cancer 5 yrs. ago but steady at approximately 100 kg (220 lb) even after completing radiation therapy 1-2 years ago, when he began losing weight. He states that he gets full easily and never feels hungry. Medical hx: HTN; hyperlipidemia; weight loss; primary tongue squamous cell carcinoma five yrs ago; PVD Surgical history: s/p partial glossectomy five yrs ago Medication: at home Lipitor 80 mg daily, Monopril 10 mg daily Tobacco use: 1 ppd for 60+ yrs Alcohol use: No Family history: Mother died of pneumonia; father died of lung cancer. Marital status: Married lives with wife (Number of children: 2-alive, ages 42, 45) Education: 9 yrs., Occupation: Electrician for 26 years, retired 122/77 101 bpm 36°c 190.5 cm 70.9 kg 100 kg Admitting Hx/Physical: Chief complaint: "I just feel weak all over and don't have the energy to do anything." General appearance: Cachectic, appears older than 68 years of age PE: Vital signs: Heart: Regular rate and rhythm HEENT: Head: Noted temporal wasting BP: Eyes: PERRLA Pulse: Ears: Clear Temp: Nose: Dry mucous membranes with petechiae Ht.: Throat: Dry mucous membranes without exudates CWT: or lesions UWT: Neurologic: Alert and oriented; strength reduced Extremities: Decreased muscle tone with normal ROM; loss of lean mass noted quadriceps and gastrocnemius; 1+ pedal edema Skin: Warm and dry with ecchymoses, Skin color pale. Skin turgor (tenting) Chest/lungs: Respirations are shallow clear to auscultation and percussion Peripheral vascular: Diminished pulses bilaterally Abdomen: Hypoactive bowel sounds X4; nontender, nondistended. Palpation of abdomen (soft), 85 Ky Bu

Answer 1

1.The malnutrition of the patient is associated with chronic disease condition of primary tongue squamous cell carcinoma.

The signs and symptoms that support the malnutrition according to the ASPEN guidelines are

• Weight loss (27 kg in about 1 to 2 years)
• Cachechetic ,the patient has muscle loss
• Presence of edema
• Lack of energy

2.The signs and symptoms associated with dehydration are

• Dry mucus membrane
• Decreased muscle tone
• Warm ,dry ,pale,tenting skin
• Increased sodium, BUN and creatinine due to altered renal function due to dehydration
• Decreased oral intake
• Low levels of protein,albumin

3.The low levels of albumin and prealbumin is one of the typical marker to associate malnutrition .The typical laboratory vale which may be needed to determine inflammation is the level of CRP,ESR and procalcitonin.

4.The ensure plus supplement is indicated when a patient has severe weight loss ,low protein and low energy levels .Administration of this will help the patient to come out of malnutrition and lead to healthy weight gain .

The additional option to increase calorie and protein are

• Increased and frequent oral intake
• Protein and energy drink between meals