Kendra Knudsen

NDFS 356
CANCER ASSIGNMENT
30 POINTS

J.T. is a 32 y.o.m. with bone cancer of the right leg. He is currently receiving both chemotherapy
and radiation therapy. He has a 2 cm x 2 cm stage III pressure sore on his coccyx from being in
bed. His albumin is 2.1 g/dL, prealbumin is 8.2 mg/dL, Hct 33%. He is 5'11", he weighed 180#
before the cancer. He has lost 35# over the past 3 months, secondary to nausea, vomiting, no
appetite, and lately, mucositis. He is on 25 mg of prednisone a day. He just received a
prescription for megase to hopefully stimulate his appetite, and he is on compazine prn for the
nausea. He states he is very tired and has no strength.

Please write a 1 day diet plan which will meet his calorie and protein requirements. The texture
needs to be very soft since his mouth is so raw. Be careful of strong flavors and odors--they make
him very nauseated and he wont eat anything the rest of the day. He states his appetite is best in
the morning and then gradually goes down hill.

1. Complete a nutritional assessment, including the A, B, C, and D of nutrition assessment.

Show your work in your calculations. Write a PES statement (10 points)
A: CBW: 145#, UBW: 180#, BMI: 20, IWR: 155-189#, IWR%: 94%, Wt loss -19.4% per 3
months.
B: Albumin: 2.1 g/dL (LOW), prealbumin: 8.2 mg/dL (LOW), Hct 33% (LOW, possible
anemia). Medications: prednisone, megase, and compazine.
C: Symptoms: nausea, vomiting, no appetite, mucositis, raw mouth, tired, no strength, weight
loss, Stage III pressure sore on coccyx.
D: Risk factors for malnutrition: immobility, loss of appetite, medications, weight loss. Kcal
needs: 1977-2307cal (factor: 30-35), Protein needs: 80-100 (factor: 1.2-1.5gm/kg), Fl needs:
1977-2307ml 30-35 ml/kg of body weight.

PES: Weight loss related to loss of appetite, increased needs, and side effects of treatments as
evidenced by calculated energy needs of 1977-2307cal daily and calculated protein needs of
80-100 grams daily.

2. Please write the assessment and plan in the form of an ADIME note.
Assessment: CBW: 145#, UBW: 180#, BMI: 20, IWR: 155-189#, IWR%: 94%, Wt loss
-19.4% per 3 months. Albumin: 2.1 g/dL (LOW), prealbumin: 8.2 mg/dL (LOW), Hct
33% (LOW, possible anemia). Medications: prednisone, megase, and compazine.
Symptoms: nausea, vomiting, no appetite, mucositis, raw mouth, tired, no strength, weight
loss, Stage III pressure sore on coccyx.
Nutrition Diagnosis: Risk factors for malnutrition: immobility, loss of appetite,
medications, weight loss. Kcal needs: 1977-2307cal (factor: 30-35), Protein needs: 80-100
(factor: 1.2-1.5gm/kg), Fl needs: 1977-2307ml 30-35 ml/kg of body weight. Not meeting
needs with intake.
Interventions: Goals: increase calorie and protein intake. Plan: High caloric and protein
diet. Counseling: ways to overcome nausea and increase calorie intake.
 Monitoring and Evaluation: Track daily calorie, protein, and fluid intake. Review lab levels
(especially albumin, prealbumin, hemocrit). Reevaluate for possible supplement and tube
feed interventions.

3. Write a one day diet plan which meets his calorie and protein requirements. (5 points)
4. Using either a spreadsheet (Excel) or a table in word processing please create a chart listing
each food item in the one day diet plan with the grams of protein and total calories next to
each food item. Make totals of protein and calories at the bottom of each column. (5 points)
Meal Food Quantity Calories Protein (gm)
Breakfast Buttermilk Pancakes, fortified 2 medium 183 6
Syrup 2 TBSP 115 0
Scrambled Eggs 2 medium 231 18
Chopped ham 2 slices 156 16
Orange Juice 1 cup 122 2
Snack Yogurt, strawberry, fat free 1 cup 162 7
Lunch Bread, whole wheat, toasted 2 slices 141 7
American cheese 2 slices 101 7
Cream of tomato soup 1 cup 144 6
Snack Banana 1 medium 105 0
Peanut Butter, creamy 1 TBSP 97 4
Dinner Chicken breast, chopped 1 medium 138 26
Broccoli cooked (with salt and 1 cup 89 4
butter
Mashed potatoes 1 cup 212 4
Gravy 1 cup 123 9
Soft white roll 1 medium 100 4
Snack Chocolate ice cream 1 scoop 143 3
Total: 2345 123

5. Write down two or three specific MNT goals that you as an RD have for J.T. (5 points)
1. Increase low blood proteins by increasing protein in diet.
2. Decrease weight loss and maintain or gain weight by increasing PO intake of calories.
3. Keep well dehydrated.

6. Write a summary of two or three things (pointers) you would tell him in a diet instruction. (5
points)
Ways to overcome nausea: eat small, more frequent meals, avoid high-fat and greasy
foods, ask for whatever sounds good to you to eat
Ways to increase calorie intake: find any foods that are enjoyable and eat them; think of
calories like medicine and eat even when you dont feel like it; if you dont feel like eating,
we can give you a drink with calories in it.