Question

Carmine is a 34-year-old mother of three young children. She was admitted to the hospital with multiple enterocutaneous fistulas 3 weeks ago, at which time she weighed 52 kg (116 bs). She is 165 cm (5 ft 5 in) tall. Carmine has a history of recurrent cervical cancer for which she had a hysterectomy four months before admission. During chemotherapy that followed, she had regular bouts with nausea and anorexia. Surgery was performed again Her fistulas continued to drain for 2 weeks postoperatively, during which she tolerated clear liquids only. An intravenous drip of 10% glucose and 45% normal saline was ordered to supplement fluids and kcal. This week she developed peritonitis and has had a fever with a maximum temperature of 39° C (102° F) over the past 24 hours. Her weight has dropped to 41 kg (90 lbs); drainage from the fistulas has become odorous. The patient was placed in isolation today and was advised by her physician that he intended to start her on total parenteral nutrition (TPN) and conduct some more tests to determine her progress. . Questions for Analysis 1. What types of nutrition assessment procedures would be used by the TPN team for planning Carmine's nutrition therapy? Explain the purpose of each. 2. Calculate Carmine's energy and protein needs, and account for increased needs 3. Why did Carmine develop nausea and anorexia during chemotherapy? What are the implications of this for recovery? 4. Outline a plan for evaluating and controlling nausea and vomiting in patients undergoing chemotherapy

Answer 1

Q. No. 1. Answer :

Nutritional assessment procedures like ABCD Methods those are,

1. A - Anthropomorphic measurements like, height and weight of the client,

* And after that to check BMI ,

* at present weight is 41kgs, and height is 165cm.

* so BMI is 15. 07 kg per meter square.

* so extremely underweight we can notice.

* so according to this TPN team can plan the high caloric diet to improve weight.

2. Biochemical or laboratory examination :

Electrolytes like calcium, potassium, chloride, sodium ect.

Hemoglobin estimation, and complete blood picture to know the WBC count and platelets ect.

3. C - clinical data :

She is on chemotherapy and having bouts of nausea and vomiting, having peritonitis and fever 102 degree foreign heat.

4. D - Dietary history :

She is on total parentral nutrition. Based on dietary history we can plan the needed nutrients to the client.

Q. No. 2. Answer :

At least 2000 to 2400 Calories per day should be needed,

Q. No. 3. Answer :

Chemotherapy medications circulates into the blood and those are creat upset in the stomach and causes nausea and vomiting ect.

Implications for recovery :

* Avoid caffeine and smoking,

* eat ice cream during chemotherapy,

* administered anti emitic medications.

Q. No. 4. Answer :

* educate to avoid food while chemotherapy time.

* educate to eat lite meal before chemotherapy.

* educate to avoid caffeine and smoking ect.

* educate to take dry fruits and to avoid nausea and vomiting.

* administer anti emitics ect.