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Esha Fletcher
UConn Health Center
Spring 2015
Patient
Name: BW
Age: 68
BMI: 25.5(overweight)
Sex: Male
Race: Caucasian
IBW%: 105%
4/9: -220
Admitting Diagnosis
J-tube (Jejunostomy) placement
Feeding tube inserted through abdominal wall directly
into the jejunum, bypassing the stomach
Treatment
Diagnostic Laparoscopy & Feeding Jejunostomy
History
Past Medical History
Anterior ST-elevation, MI, Esophageal Cancer, asthma
Social History
Lives with wife, stopped smoking 4 years ago
Nutrition History
Patient on TPN at home
TPN order: 2475mL of 348g Dextrose, 134g AA, 20% lipid
75g/day
Esophageal Cancer
When cancerous cells or a
tumor develops in the
esophagus
Much more common in men
than women
Usually linked to tobacco
or alcohol use
Nutritional Requirements
Mifflin St Jeor
Male: (9.99 x 82.7kg) + (6.25 x 180cm) (4.92 x 68) + 5
=1,621 x 1.3
= 2,107
Kcal/kg
=2,067
Range of 2,000-2,200
Nutritional Requirements
Protein= 1.3-1.5
1.5g x 82.7kg = 124g PRO
Fluid
1cc/kcal= 2,107
Diet Order
Current Diet Order
Clear Liquid Diet
Easily digested and leaves no undigested residue in the
intestinal tract
Used before tests, procedures or surgeries that require no
food in the stomach or intestines
Ex: water, broth, plain gelatin, sports drinks, honey,
carbonated drinks
Labs
Lab Name
Current
Lab
Normal
Range
Notes
BUN
24
(8-24)
WNL
Creatinine
0.7
(0.6-1.2)
WNL
Glucose
117 H
75-100
Chloride
105
(98-107)
WNL
Sodium
134 L
(137-144)
Dehydration
Potassium
4.0
(3.5-5.1)
WNL
CO2
21
(21-32)
WNL
Albumin
3.2 L
(3.8-5.3)
Lymphocyte
s
5.9 L
(20-50)
Due to hx of cancer
Hgb
10.2 L
(13-18)
Hct
29.8 L
(40-52)
Significant Medications
Medication Name Dosage
Notes
Heparin
Lipitor
80mg
Antihyperlipidemic. Caution w/
grapefruit/related citrus
Oxycodone HCL
5mg
Protonix
Pantoprazole
40mg
Senna
8.6mg
Nutrition Diagnosis
Diagnosis: Inadequate oral intake related to altered GI
function as evidenced by poor appetite and reliance on
TPN
Intervention
Food and/or Nutrient Delivery
Recommend TF: Peptamen AF @ 125mL x 14hrs
Start at 20-30mL for 4 hrs, advance to 20mL/hr every
4hrs if tolerated
Coordination of Nutrition Care
Check with nurses to see if patient is tolerating the tube
feed
References
https://www.nutritioncaremanual.org/topic.cfm?ncm_category_id=1&
lv1=22938&lv2=255467&ncm_toc_id=255467&ncm_heading=Nutrition%
20Care
http://cancer.dukemedicine.org/cancer/health_library/care_guides/tr
eatment_instructions/
jejunostomy
http://www.mayoclinic.org/healthy-lifestyle/nutrition-and-healthy-eati
ng/in-depth/clear-liquid-diet/art20048505
http://www.cancer.org/cancer/esophaguscancer/
Questions?