Question

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

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: Heart:                    Regular rate and rhythm HEENT:                Head: Noted temporal wasting                               Eyes: PERRLA                               Ears: Clear                               Nose: Dry mucous membranes with petechiae                               Throat: Dry mucous membranes without exudates                                               or lesions 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),

Vital signs: BP:                  122/77 Pulse:               101 bpm Temp:              36 OC Ht.:                  190.5 cm CWT:              70.9 kg UWT:              100 kg

Laboratory Results:                                           Dietary intake:

Chemistry
Glucose (mg/dL)	141 H
Sodium (mEq/L)	150 H
BUN (mg/dL)	36 H
Creatinine serum (mg/dL)	1.4 H
Protein (g/dL)	5.8 L
Albumin (g/dL)	1.8 L
Prealbumin (mg/dL)	9 L
Hematology
WBC (3 103/mm3)	12.6 H
RBC (3 106/mm3)	2.4 L
Hemoglobin (Hgb, g/dL)	8.1 L
Hematocrit (Hct, %)	24.1 L
MCV	106 H
MCH	33.6 H
Transferrin (mg/dL)	382 H
Ferritin (ng/mL)	17 L

Meal type: Mechanical soft diet

Intake % of meals: 5%; sips of liquids

Fluid requirement: 2000–2500 mL

Usual intake (for past several months):

Breakfast:        egg, coffee, few bites of toast

Snack: ½ can Ensure plus
Lunch:             soup or ½ sandwich, milk

Dinner:            balls few bites of soft meat,

                    potatoes or rice. Tries to drink

                    the other ½ can of Ensure plus.

Estimated intake: 820 kcal, 45 g protein

Questions:

1. What is the Ensure plus supplement that was ordered? Determine additional options for Mr. Ali that would be appropriate for a high-calorie, high-protein beverage supplement.

Answer 1

The mechanical soft diet is made for patients who are unable to consume hard food. it is made by various processes such as blending, grinding, mashing or chopping mechanisms to allow the patient to swallow a portion of food easily.

Ensure plus is a oral supplement, ready to use-drink, used in a patient with a disease that may cause malnutrition.  

The bottle of 8 fluid ounce contains about 360KCal, 50gms protein, 13gms of protein, and 11gms fat.

An additional option for Mr. A is Boost plus that contains 360Kcal, 45gms protein, 14gms of protein, and 14gms fat in each 8 fluid ounce bottle.