Question

Catherine is a 35 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 (116lbs). She is 165 cm (5ft 5in) tall. Catherine has a history of recurrent cervical cancer for which she had a hysterectomy 4 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 (90lbs); 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 Catherine's nutrition therapy? Explain the purpose of each.

2.    Calculate Catherine's energy and protein needs, and account for increased needs.

3.    Why did Catherine develop nausea and anorexia during chemotherapy? What are the implications of this for recovery? Outline a plan for evaluating and controlling nausea and vomiting in patients undergoing chemotherapy.

4.    What personal concerns would you expect Catherine to have? What resources would you use to help her obtain the personal and physical support she probably needs?

Answer 1

What types of nutrition assessment procedures would be used by the TPN team for planning Catherine's nutrition therapy? Explain the purpose of each.

Answer:-

The sort of sustenance evaluation method that would be utilized by the TPN group for arranging Catherine's nourishment treatment; individual dietary appraisal as dependent on proof based practice. it will create a personalized nutritional requirement after the initial assessment for the baseline data after this optimal nutritional assessment.

Calculate Catherine's energy and protein needs, and account for increased needs.

Answer:-

Add up to vitality require = BMR X action factor

Here BMR for ladies = 655 + (9.6 X weight in kg) + (1.8 x tallness in cm) – (4.7 x age in yrs)

BMR = 655 + (9.6 x 41) + (1.8 x 165) — (4.7 x 35) = 655 + 393.6 + 297 — 164.5 = 1181.1calories/day

Action factor for inactive way of life with no activity is 1.2

So add up to vitality require = 1.2 x 1181.1 = 1417.32

So Catherine requires 1417.32 calories every day

Protein need =

The lower limit for protein requirement = 0.8 x 41 = 32.8gm/day

The upper limit for protein requirement = 1.8 x 41 = 73.8gm/day

So we can say the protein requirement for Catherine ranges between 32.8 - 73.8gm/day.

The vitality necessity has expanded for Catherine since her body is recouping from an infected conditions which requires for calorie and protein

Why did Catherine develop nausea and anorexia during chemotherapy? What are the implications of this for recovery? Outline a plan for evaluating and controlling nausea and vomiting in patients undergoing chemotherapy.

Answer:-

The advancement of sickness and anorexia amid chemotherapy are expected :

The chemotherapeutic medications trigger certain regions of mind.

It additionally can invigorate a few territories of the throat , stomach, small digestive tract, and vast intestine.The chemotherapeutic specialists are detected in the gastric or intestinal mucosa and cause incitement of vagal afferents that cooperate with the hindbrain of the focal sensory system , bringing about efferent vagal activity that prompts an emetic reaction

Chemo treatment expands dimensions of TNF and interleukin-1, bringing about anorexia and weight reduction

The advancement of sickness and anorexia amid chemotherapy are expected :

The chemotherapeutic medications trigger certain regions of mind.

It additionally can invigorate a few territories of the throat , stomach, small digestive tract, and vast intestine.The chemotherapeutic specialists are detected in the gastric or intestinal mucosa and cause incitement of vagal afferents that cooperate with the hindbrain of the focal sensory system , bringing about efferent vagal activity that prompts an emetic reaction

Chemo treatment expands dimensions of TNF and interleukin-1, bringing about anorexia and weight reduction

Chemotherapy induced nausea and vomiting can be classified as acute (occurring within 24 hours of therapy), delayed (persisting for 6–7 days after therapy), or anticipatory (occurring prior to chemotherapy administration). The occurance of vomiting is influenced by the emetogenic potential of the administered chemotherapy, patient variables.The emetogenic potential of the drugs depends on the chosen cytotoxic agent, the dose given, and the administration schedule.

Assess and contol queasiness and spewing in patients with chemotherapy

1. Check for the level of lack of hydration

Give little measure of liquids for the duration of the day like water and squeeze.

if there should arise an occurrence of sevee spewing substitution of liquids by means of IV.

Try not to drink liquids while having suppers.

2. Check the amount of food intake

• Eat small and frequent meals
• Eat before getting too hungry.
• Eat dry foods such as dry cereal, toast immediately getting up from the bed.
• Avoid heavy and high fat meals before chemotherapy.
• Avoid caffeine and smoking.
• Suck on hard candy, or ice during chemotherapy.
• 3. Assess the tidiness of the environment:

• Maintain a strategic distance from awful scents in the suroundings.

  Rest by sitting up or leaning back with your head lifted atleast two hours in the wake of eating

4. Check for the ways of Distraction during chemotheapy:

• Relax and the keep the mind free during chemotherapy.
• Listen to music, watch a funny film,get company of a good friend during chemotherapy.

4.    What personal concerns would you expect Catherine to have? What resources would you use to help her obtain the personal and physical support she probably needs?

Answer:-

A portion of the individual concerns which Catherine could hope to have are

To inspire all fundamental treatment to leave the afflictions

the youngsters will be a primary worry for Catherine on the off chance that she is sick for a drawn out timeframe

for doing and aiding her day by day exercises

The most effective method to meet the expense of medicinal costs

Some of the resources which she can use to obtain the personal and physical support which she needs are

Counselling to support her emotionally to avoid mental stress

She can be connected with the support groups

undergoing the necessary procedures to close her fistula

meeting the metabolic needs and nutritional needs with the support of the healthcare team

Contamination control rehearses pursued by social insurance group to maintain a strategic distance from disease

utilizing the solace gadgets to have an useful situation.

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