SILLIMAN UNIVERSITY

Building Competence, Character & Faith

A Case Study on:

Incarcerated Hernia; Prostate Cancer Stage IV; Hypertension

In partial fulfilment for the requirements of the course

ND 100: Hospital Dietetics Practicum

For the degree

BACHELOR OF SCIENCE IN NUTRITION AND DIETETICS

Submitted by:

John Michael A. Macabenta

Intern

Submitted to:

Chong Hua Hospital Capitol

Food and Nutrition Services
 Table of Contents

I. General Information of Patient ............................................................................................................. 3

II. Medical History ................................................................................................................................ 3
A. Incarcerated Hernia ............................................................................................................................. 4
B. Prostate Cancer .................................................................................................................................... 6
C. Hypertension ....................................................................................................................................... 8
Pathophysiology Explanation ................................................................................................................ 13
III. Socio Economic History ................................................................................................................. 14
IV. Assessment of Nutritional Status .................................................................................................... 14
a. Anthropometry Assessment ............................................................................................................... 14
b. Biochemical Assessment.................................................................................................................... 15
c. Clinical Assessment ........................................................................................................................ 16
d. Dietary Assessment ............................................................................................................................ 17
Table 1. Relevant Drug and Nutrient Interaction/Food and Drug Interaction ................................... 18
SGA Grade ......................................................................................................................................... 19
VI. Nutrition Care Plan ......................................................................................................................... 21
Table 2. Identification of nutrition and other related problems ......................................................... 21
Table 4. Recommendations ................................................................................................................ 23
Dietary Calculations ........................................................................................................................... 28
Monitoring and Evaluation ................................................................................................................ 31
VII. Glossary of Medical terms and abbreviations used ........................................................................ 32
VIII. References ......................................................................................................................................... 33
IX. How did your case study relates to your chosen field of endeavour .............................................. 35

2
 I. General Information of Patient

Name of Patient: MTY Date of Birth: 4/16/1955

Attending Physician: Dr. Stella Marie C. Yap Date of Admission: 9/8/2019

Age: 64 yrs old Sex: Male

II. Medical History

Chief Complaint: Urinary Retention Past

Illness and Surgery:

1. Chong Hua Hospital 6/2018

o Left Prostatic Cancer Stage IV (Bone, Soft Tissue Masses) Progressive Disease

o Hypertension

o Status Post (Doretaxel) Pledinon Chemotherapy (6/8/18)

o Status Post Zoledronic Acid Infusion (6//8/18)

2. Status Post Doretaxel, Zoledronic Acid Infusion (9/6/19)

3. Status Post Prostatectomy (2011)

Physical State of Health

2 days Prior to Admission noted onset of during urine output associated with loose
stools. Also noted protusion of Left inguinal area with occasional pain. Condition
tolerated. Resistance of symptom with decreasing urine output prompted admission.

Family History

• Breast Cancer (Maternal)

• Hypertension (Paternal)

3
A. Incarcerated Hernia

Definition and Classification

An incarcerated hernia is a part of the intestine or abdominal tissue that becomes

trapped in the sac of a hernia the bulge of soft tissue that pushes through a weak spot in the
abdominal wall. Incarceration occurs when part of the fat or intestine from inside the
abdomen gets stuck in the groin or scrotum and cannot go back into the abdomen. (Yang &
Liu, 2014)

Etiology

Acquired precipitating factors are abdominal surgery or abdominal injuries that

cause abdominal wall weakness and infection, or reduced synthesis of collagen fibers and
consequently weak wall strength due to old ages, poor nutrition and smoking (Yang & Liu,
2014)

Incidence

Adult males over age 40 are much more likely to develop direct inguinal hernias
than females. About 25% of males, and only about 2% of females, will develop an inguinal
hernia in their lifetime. A family history of having an inguinal hernia, smoking, and men
who have had previous abdominal surgery are at greater risk for developing an inguinal
hernia.

4
General Pathophysiology (Inguinal Hernia)

5
 Clinical Manifestations

Symptoms of an inguinal hernia include:

• A small bulge in one or both sides of the groin that may increase in size and disappear when
lying down; in males, it can present as a swollen or enlarged scrotum
• Discomfort or sharp pain-especially when straining, lifting, or exercising-that improves
when resting
• A feeling of weakness or pressure in the groin
• A burning, gurgling, or aching feeling at the bulge
(Hyperarts, "Inguinal Hernia")
Prognosis

Patients who have had inguinal hernia repair generally do very well. Following
surgery, Patients are advised to maintain a healthy weight and avoid heavy lifting or
straining during bowel movements. These steps can help to prevent inguinal hernia from
returning. ("Inguinal Hernia Outlook / Prognosis," 2018)

B. Prostate Cancer

Definition and Classification

Cancer starts when cells in the body begin to grow out of control. Cells in nearly any
part of the body can become cancer cells, and can then spread to other areas of the body.
Prostate cancer begins when cells in the prostate gland start to grow out of control. The
prostate is a gland found only in males. It makes some of the fluid that is part of semen.

Etiology

It's not known exactly what causes prostate cancer, although a number of things can increase
the risk of developing the condition.

These include:

• age – the risk rises as you get older, and most cases are diagnosed in men over 50
years of age

6
 • family history – having a brother or father who developed prostate cancer before
age 60 seems to increase your risk of developing it; research also shows that having
a close female relative who developed breast cancer may also increase the risk of
developing prostate cancer

• obesity – recent research suggests there may be a link between obesity and prostate
cancer, and a balanced diet and regular exercise may lower the risk of developing
prostate cancer

• diet – research is ongoing into the links between diet and prostate cancer, and there
is some evidence that a diet high in calcium is linked to an increased risk of
developing prostate cancer ("Prostate cancer", 2019)

Tobacco smoking is a major risk factor of pancreatic cancer. However, the

mechanisms through which it causes the disease remains unknown. Accumulating evidence
indicates that carcinogenic compounds in cigarette smoke stimulate pancreatic cancer
progression through induction of inflammation and fibrosis which act in concert with
genetic factors leading to the inhibition of cell death and stimulation of proliferation
resulting in the promotion of the Prostate Cancer. (Pandol, Apte, Wilson, Gukovskaya, &
Edderkaoui, 2012)

Incidence

According to the Department of Health (DOH), cancer is the third leading cause of
deaths in the Philippines and 19.3 percent of every 100,000 Filipino men are affected by
prostate cancer. (Junio, 2018)

Prostate cancer is the most common cancer among men, except for skin cancer. This
year, an estimated 174,650 men in the United States will be diagnosed with prostate cancer.
Approximately 60% of cases are diagnosed in men over 65. The average age of diagnosis
is 66; the disease rarely occurs before age 40. A man’s individual survival depends on the
type of prostate cancer and the stage of the disease. ("Prostate Cancer - Statistics," 2019)

7
 Clinical Manifestations

Prostate cancer may cause no signs or symptoms in its early stages. Prostate cancer
that's more advanced may cause signs and symptoms such as Trouble urinating, Decreased
force in the stream of urine, Blood in semen, Discomfort in the pelvic area, Bone pain and
erectile dysfunction ("Prostate cancer", 2019)

Prognosis

Prostate cancers detected at the distant stage have an average five-year survival rate
of 28 percent, which is much lower than local and regional cancers of the prostate. This
average survival rate represents stage IV prostate cancers that have metastasized (spread)
beyond nearby areas to lymph nodes, organs or bones in other parts of the body ("Prostate
Cancer Prognosis")

In retrospective study at Johns Hopkins Medical Centre in Baltimore, a greater

connection between cigarette smoking and risk of prostate cancer recurrence was identified
in men who had been treated with radical prostatectomy (Joshu, et al., 2011)

C. Hypertension

Definition and Classification

Hypertension is defined as abnormal elevation of the systolic arterial blood pressure

(BP). A systolic blood pressure of 140 mm Hg or more or a diastolic blood pressure of 90
mm HG or more (Bullock, 1996). 90% of patients with hypertension has no specific cause
for the elevated blood can be found. The type of hypertension these patients have is
Essential or Primary hypertension.

Etiology

The Pathogenesis of essential hypertension remains unknown; many contributing

factors are identified, including genetics determinants, occupation, lifestyle and diet. Due
to unknown causes and mechanism of this type of hypertension the disease can be treated

8
successfully with modern drugs and appropriate change in lifestyle and eating habits.
(Damjanov, 2017)

Of over the 4,000 toxic substances identified in cigarette smoking, there is evidence
that mainly two, specifically nicotine and carbon monoxide, exert toxic effects on the heart
and blood vessels. Both these compounds show their harmful properties by different
mechanisms. Nicotine produces more marked effects on heart rate, blood pressure via
catecholamine release, and sympathetic stimulation. The carbon monoxide present in the
smoke reduces the amount of available oxygen for the heart and other organs. This reduces
the stamina of an individual to perform various physical activities and it causes smokers to
have shortness of breath (Aurelio, 2015).

As you age, so do the blood vessels. They become less flexible, making it harder for
blood to move through them easily. Fatty deposits called plaques also collect along the
artery walls and slow the blood flow from the heart. These things, along with poor nutrition
and exercise habits, can increase the risk of heart disease. Add other risk factors such as
high blood pressure, smoking, and diabetes and it's likely that you will have a greater risk
for a heart attack. Gender may also affect the risk. (Resnick & Permanente, 2014).

Incidence

Hypertension is considered as the biggest single risk factor for deaths worldwide.
According to the World Health Organization (WHO), hypertension causes 7 million deaths
every year while 1.5 billion people suffer due to its complications. A study conducted by
Philippine Society of Hypertension (PSH) found out that the prevalence of hypertension in
the country is increasing. In 2003, data showed that 16 percent or approximately 7 million
Filipino adults 20 years and above has hypertension. The incidence increased to 10 million
or 21 percent of Filipino adults 20 years and above in 2008. (Agron, n.d.)

9
 General Pathophysiology

Mahan, L. K., & Escott-Stump, S. (2008). Krause’s food & nutrition therapy. St. Louis, MO:
Saunders/Elsevier.

10
Clinical Manifestations

Most people with Hypertension usually don’t have signs or symptoms, even if the blood
pressure readings reach dangerously high levels. Few people with hypertension may have
headaches, shortness of breath, but these signs and symptoms are not specific and don’t
usually occur until high blood pressure has reached a severe or life-threatening stage. (Mayo
Clinic, 2018)

Prognosis
There is no cure for hypertension. However, it can be well controlled with the proper
treatment. Therapy with a combination of lifestyle changes and antihypertensive medicines
usually can keep blood pressure at levels that will not cause damage to the heart or other
organs. The key to avoiding serious complications of hypertension is to detect and treat it
before damage occurs. Because antihypertensive medicines control blood pressure, but do
not cure it, patients must continue taking the medications to maintain reduced blood
pressure levels and avoid complications ("Hypertension - Prognosis

11
Specific Pathophysiology
Pathophysiology Explanation

The patient had a Prostatectomy in 2011 and was also diagnosed last June 2018 with Left
Prostatic Cancer Stage IV (Bone, and Soft tissue masses) as a Progressive Disease, Hypertension
and had gone through Chemotherapy. In tracing the Pathophysiology one of the Precipitating
Factors of the Patient is Cigarette Smoking that is verbalized by the patient that he has just stopped
2 years ago (2017) which has been evident to contribute in the disease of Hypertension. The patient
is 64 years old and as you age, so do the blood vessels they become less flexible, making it harder
for blood to flow through the blood vessels (Resnick & Permanente, 2014), with a family history
of Hypertension which also contributes as a predisposing factor. A BMI of 25.38 kg/m 2 which is
classified as Overweight contributes as a risk factor for Hypertension, According to the National
Heart, Lung and Blood Institute they say that the higher the BMI, the higher the risk for certain
diseases such as heart disease, high blood pressure, type 2 diabetes, gallstones, breathing problems,
and certain cancers ("Assessing The Weight and Health Risk")

Due to the Patients cigarette smoking there has been a study at Johns Hopkins Medical Centre in
Baltimore, a greater connection between cigarette smoking and risk of prostate cancer recurrence
was identified in men who had been treated with radical prostatectomy (Joshu, et al., 2011) which
would be one of the main factors why the patient had been diagnosed with a progressive prostate
cancer in 2018 which has metastasised to his liver and bones through Extravasation, which cells
can gain access to the circulatory system or lymphatic system which would then tend to travel
through neighbouring organs via Extravasation then going to the Liver and Bone hence Metastasis
(Rodwell, Bender, Botham, Kennelly, & Weil, 2018).

The patient went through Prostatectomy last 2011 which is a surgical procedure for the
partial or complete removal of the prostate. It may be performed to treat prostate cancer. A
common surgical approach to prostatectomy includes making a surgical incision and removing the
prostate gland or part of it. This may be accomplished with either of two methods, the retro pubic
or suprapubic incision of the lower abdomen, or a perineum incision through the skin between the
scrotum and the rectum ("Radical Prostatectomy"). One of the factors that can cause Incarcerated
Hernia is an Acquired precipitating factors which can be an abdominal surgery or abdominal
injuries that cause abdominal wall weakness and infection, or reduced synthesis of collagen fibres
and consequently weak wall strength due to old ages, poor nutrition and smoking (Yang & Liu,
2014). In the event of a sudden increase in intra-abdominal pressure, hernia contents are squeezed
through a narrow hernia sac neck into the sac. The subsequent recoil of sac neck entraps the hernia
contents, preventing them from returning into the abdomen, and incarcerated hernia occurs. Signs
and Symptoms that have been a chief complaint by the Patient is the Urinary Retention which can
be cause by the bulge in the groin, between the abdomen and thigh.

III. Socio Economic History

Patient MTY is a Filipino, Resident of Cebu City, Married, and a Roman Catholic. He lives
with his Family and He is now retired and has an educational attainment at College level. The
vices of the Patient is that he has just stopped smoking 2 years ago (2017).

IV. Assessment of Nutritional Status

a. Anthropometry Assessment

Actual Height 1.67 meters

Actual Weight 70.80 kg

Body Mass Index 25.38 kg/m2

Classification: Overweight

Ideal Body Weight 60 kg

14
 b. Biochemical Assessment
Patients
Normal Variance
Laboratory Indication Rationale
Values (High/Low)
Values
Helps transport Due to the patients
electrical signals to Urinary Retention
cells in the body. It is which lead to
Electrolyte Imbalance
3.5-5 critical to the proper
Potassium 3.2 mmo/L Low
mmo/L functioning of nerve
and muscles cells,
particularly heart
muscle cells.
Often a problem in Tramadol HCL
older adults. Potential increases serotonin
complications such as levels stimulating the
rapid brain swelling, release of ADH.
Sodium 134-148
123.0 mmol/L Low which can result in a Vasopressin causes
(serum) mmo/L
coma and death. fluid retention resulting
in expansion of extra
cellular volume and
lowered sodium levels.
High levels indicate The Prostate Cancer has
damage to liver cells metastasised to the liver
and higher risk to and caused liver damage
SGPT ALT 171 U/L 5.0-50 High
infections which lead to an
increase of Alanine
Aminotransferase.

15
 c. Clinical Assessment
Body Parts/System Clinical Sign Possible Nutritional
Deficiency
Hair Normal None

Face Normal None

Eyes Normal None

Lips Normal None

Tongue Normal None

Teeth Normal None

Gums Normal None

Thyroid Glands Normal None

Skin Normal None

Nails Normal None

Subcutaneous None None

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 d. Dietary Assessment

Usual Food Intake Recall

Time Food Item Amount CHON (g) Calorie (kcal)

Breakfast
3 scoops/ ½ cup/1
Sustagen/ Rice /Fish /Mixed 14.97 245.92
mbs/ ½ cup
Vegetable
Snack
Sustagen 3 scoops 3.978 88.92
No
specific Lunch 1 cup/ 1 mbs/ ½ cup 13 302
Time Rice/ Fish/ Mixed Vegetable
Snack
Sustagen 3 scoops 3.978 88.92

Dinner
1 cup/ 1 mbs/ ½ cup 13 302
Rice/ Fish/ Mixed Vegetable
Appetite: Good Total
48.926 g 1027.76 kcal
Oral Function: Normal
Swallowing Difficulties: None % Adequacy
46.15% 47.80%

Inadequate Inadequate

17
 Table 1. Relevant Drug and Nutrient Interaction/Food and Drug Interaction
Name of Drug Indication
Treatment of signs and
Tamsulosin symptoms of Benign
prostatic Hyperplasia
Indicated for the treatment
Telmisartan of hypertension, to lower
blood pressure.
Indicated for Allergic
conditions, Acute Asthma,
Prednisone
Rheumatoid Arthritis
the management of
neuropathic pain associated
with diabetic peripheral
Pregabalin neuropathy, postherpetic
neuralgia, and as adjunctive
therapy for adult patients
with partial onset seizures
the management of moderate
to severe pain in adult and has
Tramadol HCL the same analgesic which
stimulates the same receptor
as morphine
Treatment of active duodenal
ulcer in adults and
Eradication of Helicobacter
Omeprazole pylori to reduce the risk of None
duodenal ulcer recurrence in
adults
Possible Interaction Management Strategy
Should be taken with food.
Food reduces rate and
Take 30 min following the
extent of absorption.
same meal daily.
May slightly decrease
May be taken with or without
bioavailability with
food.
food.
Should be taken with food
Licorice may inhibit
the metabolism of and avoid consumption of
prednisone. Licorice
Alcohol increases Avoid alcohol (may increase
CNS effects CNS effects).
Oral administration of
tramadol
hydrochloride with
Can be administered without
food does not
regard to food.
significantly affect its
rate or extent of
absorption
Avoid alcohol. Take 30-60
minutes before meals.
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 SGA Grade

Criteria Norma/Mild Moderate Severe

None <10% of usual wt >10% of usual wt
Weight Loss

Food Intake (last No change Suboptimal Starvation

1-2 months)

Gastrointestinal Nausea, vomiting Anorexia, diarrhea, severe

symptoms >2 None
weeks

No change Dysfunction <3 wks Bedridden >2 wks

Functional
Suboptimal work
Capacity Bedridden <2 weeks
Disease and
relation to No or low stress Moderate Stress Severe stress
nutritional
requirements

Physical 0 subcutaneous fat and/or +1 to +2 subcutaneous +3 subcutaneous fat

Examination muscle loss fat and/or muscle loss and/or muscle loss

None
Edema/Ascites None +1 or +2

A 0 B 1 C 2
SGA Grade C

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 V. Nutrition Diagnosis (PES Statements)

P: Inadequate Calorie and Protein Intake

E: Consumption of less than the recommended

S/S: Patient’s Usual Food intake with an Inadequacy of 47.80% Calorie intake and 46.15%
Protein intake

P: Altered nutrition-related laboratory values

E: Disease Condition

S/S: Patient laboratory values of Low Potassium 3.8 mmol/L, Low Sodium (serum) 123.0
mmol/L and High SGPT-ALT 171 U/L

*the PES statements mentioned above are that of the first Nutritional Assessment to the patient
and these are the problems that are identified.

P: Increased Caloric and Protein needs

E: Disease Condition: Prostate Cancer Stage IV metastasised to liver and bone with possible
cancer cachexia

S/S: Nutritional Assessment

20
 VI. Nutrition Care Plan
Table 2. Identification of nutrition and other related problems
Parameters Nutrition related Problems
Anthropometry Possible Cancer cachexia
Biochemical Low Potassium 3.8 mmol/L
Low Sodium (serum) 123.0
mmol/L
High SGPT-ALT 171 U/L
Dietary Inadequate Calorie and Protein
Intake with an Inadequacy of
61.09% Calorie intake and
73.89% Protein intake
Other Related Problems
Cancer cachexia, involuntary
weight loss, tissue wasting,
inability to perform daily
activities and metabolic
alterations. Weight loss in cancer
patients is life threatening
Hypokalemia would result to
improper functioning of nerve
and muscle cells.
Hyponatremia, it would result to
headache, seizures and severe
hyponatremia can cause coma
High levels indicate damage to
liver cells and higher risk to
infections
Adult Malnutrition and due to
Hyper catabolic state would
result to Cachexia
21
Table 3. Analysis of Diet Prescription (analyse doctor’s prescription)
Nutrient Amount % Distribution Remarks Rationale
Types of Diet: None None Agreeable, for patient In preparation for Surgery.
that would be having an Surgery patients must not
elective surgery anything past midnight the
NPO
night before a scheduled
surgery.

Others: None None Agreeable, Diet • Aims to provide oral

Additional prescribe by the feedings that will promote
physician as a
prescription return to a normal intake
Postsurgery diet but it
doesn’t have the of food.
which are not
specifications such as
mentioned : • Post-surgical patients
Calorie, Macronutrients
and Micronutrients ready to have some whole
needed by the patient. foods but are not yet ready
Soft Diet
for the regular diet.

22
Table 4. Recommendations

Management Short Term Rationale Long Term Rationale

Parameter Recommendation Recommendation

Anthropometry Increase Caloric • Maintain strength Maintain Total Caloric • Maintain strength
and Protein and energy Aid Goal and and energy Aid
needs • recovery and Total Protein • recovery and
healing ; maximize Goal and monitor healing ; maximize
quality of life To weight of patient quality of life
• promote protein for possible • Preserve lean body
synthesis, support involuntary mass
immune function weight loss or to
and limit muscle check for muscle
catabolism function
Biochemical May provide To correct Monitor patients To make sure that
Low Potassium patient with >2g Potassium deficit laboratory values the patients
3.8 mmol/L K by consuming that may result to once a week and if laboratory values are
at least one improper signs of Low normal and that if
potassium may
banana per meal functioning of nerve there is change it can
still continue to
or Potassium and muscle cells. be corrected with a
provide at least
rich foods such prescribe diet
one Banana per
as Green Leafy or Potassium
Vegetables rich foods such
as Green leafy
vegetables.
Low May include no To correct Sodium Monitor patient’s It is to make sure
Sodium(Serum) salt restriction to (Serum) deficit and laboratory values that the patient’s
123.0 mmol/L the diet to decrease laboratory values
once a week and
specification. complication that if values are still are normal and that
may result to low may provide if there is change it
headache, seizures with a <4g of salt can be correct with
and severe restriction to diet a prescribe diet To
control sodium
hyponatremia can specification.
intake because the
cause coma patient is
hypertensive
High SGPT-ALT May provide The diet has to be May instruct • The diet had to be
171 U/L patient moderate moderate in fat in patient on Good low in fat in order to
fat diet to the order to prevent Fats and Bad prevent deposition in
the liver which
current doctor deposition in the Fats, Cholesterol
would relieve stress
prescription with liver which would and provide from the organ The
at least 30% Fat relieve stress from hand-outs for • patient’s prostate
of the Total the organ. further adherence cancer has metastasis
Caloric Goal at home the liver
and have damaged it.

24
Dietary • Total Caloric • To correct Calorie • Maintain Patient • For patient to
Inadequate Goal of 2150 and Protein Total Caloric achieve TCR of
Calorie and kcal/day and Inadequacy Goal of 2150 2150 kcal and TPR
Protein Total Protein • To promote protein kcal/day and of 106g/day To
Intake Requirement of synthesis, support 106g/day Protein • promote protein
with an 106g/day Limit immune function and , 60% Complex synthesis, support
Inadequacy • intake of limit muscle Carbohydrates, immune function
of 47.80% simple sugars catabolism no simple sugar, and limit muscle
Calorie <10% of Total Omega-3 fatty acids low fat diet in 3 catabolism To
•
intake and Caloric goal and act as anti meals and 2 achieve the
•
46.15% consume 60% of inflammatory agents snacks May optimum total
Protein intake total caloric goal • provide patient to caloric goal
reverses protein of HBV
complex CHO Omega-3 fatty acids
immunosuppression preferably white •
such as Rice, act as anti
• Supportan is a
Bread and Root inflammatory agents
disease-specific for

25
• crops to 7-8 • cancer and indicated meat such as • reverses
servings per day for catabolic state chicken and fish immunosuppression
May provide with special features from 6 servings Supportan is a
patient to of EPA,MCT’s and per day Provide disease-specific for
consume CHON Prebiotic fibre oral nutrition cancer and indicated
of HBV Supportan has 27% supplementation for catabolic state
preferably white energy protein to that is a disease with special features
meat such as • compensate for an specific for • of EPA,MCT’s and
chicken and fish increased protein cancer to achieve Prebiotic fiber
• from 5-6 servings turnover and optimum caloric Supportan has 27%
per day counteract loss of goal with a energy protein to
Consumption of muscles mass High serving of 2 compensate for an
foods that are in fat fat and low in bottles per day increased protein
rich in omega-3 carbohydrates taken as snacks turnover and
fatty acids such adapted to the counteract loss of
•
as salmon, tuna • specific metabolic muscles mass High
• and mackerel changes in cancer in fat fat and low in
Provide oral patients carbohydrates
nutrition High in EPA from adapted to the
supplementation fish oil to counteract specific metabolic
that is a disease weight and muscle changes in cancer
specific for loss and support patients
cancer to achieve immune function • High in EPA from
optimum caloric fish oil to counteract
goal with a weight and muscle
serving of 2
bottles per day loss and support
• taken as snacks immune function
Prior to
discharge, advise
Dietary
Instruction on
2150 kcal/day,

26
 Complex
Carbohydrates,
no simple sugar,
low fat diet in 3
meals and 2
snacks

*The recommendations above is that of the 1st nutritional assessment and seen Nutrition Problems and that these are only
recommendations and it is still the attending physician’s decision on following these recommendations.

*During the Reassessment the patient has achieved at least 75% of his Total Caloric goal because as verbalized by the patient is
that he can consume the Diet given by the Hospital that is a Soft diet and has an average 1800 kcal for male. With the
Reassessment is that the seen problems for the Biochemical and Dietary parameter is achieved for its short term goals and for
the long term problem is the possible cancer cachexia due to the patient’s disease condition.

27
Dietary Calculations

i. Total Energy Requirement (Harris-Benedict Energy Expenditure)

= 66.5 + (13.8 x 70.80 kg) + (5.0 x 167 cm) – (6.8 x 64 yrs. old)
= 1443.34 kcal x 1.0 PA bed rest
= 1443.34 kcal x 1.5 stress factor (cancer with chemotherapy)
TER = 2,150 kcal ii.
Percentage Distribution

CHON = 70.80 kg (AW) x 1.5 = 106g/ day

NPC = 106 x 4 = 424kcal
NPC = 2150 kcal – 400 kcal
= 1726 kcal
CHO = 1726 kcal x .70 = 1035.6/4 = 258.9 or 260 g/day
Fat = 1726 kcal x .30 = 690.4/ 9 = 77g/day

iii. Diet Prescription

Diet Rx: 2150 kcal; 260g/day CHO; 106g CHON; 77g Fat iv.
Food Exchange List

Energy
Food Group # of Exchanges CHO (g) CHON (g) FAT (g)
(kcal)

Veg 2 6 2 32

Fruit 2 20 80

Rice 8 184 16 800

Meat (LF) 3 24 3 123

Meat (MF) 3 24 18 258

Fat 6 30 270

Supportan 2 bottles 46.4 40 26.8 600

Total 256.4 106 77.8 2,163 kcal

 *during the reassessment is that the patient can consume the average 1800 kcal for male given by
the Hospital and it given that the food that the patient will consume can reach the 75% adequacy
that is and with Oral Nutrition supplementation it can reach the Total Caloric and Protein Goal of
the patient
v. Meal Distribution
Food List # of Breakfast Snack Lunch Snack Dinner
Exchange

Veg 2 1 1

Fruit 2 1 1

Rice 8 2 1 2 1 2

Meat (LF) 3 1 2

Meat (MF) 3 2 1

Fat 6 2 2 2

Supportan 2 bottles 1 1

29
 vi. One Day Sample Menu
Meal Food Item # of Menu Household Measure
Exchange
Fruit 1 Banana, Latundan 1 pc
Rice 2 Rice, cooked 1 cup, packed
Breakfast
Meat (MF) 2 Chicken Leg / Egg 1 matchbox Size / 1 pc
Fat 2 Canola Oil 2 teaspoon
Rice 1 Skyflakes 4 pcs
AM Snack
ONS 1 Supportan 1 bottle/ 200ml
Sauteed Kalabasa and
Veg 1 ½ cup, cooked
Malunggay
Fruit 1 Banana, Latundan 1 pc
Rice 2 Rice, cooked 1 cup
Lunch
Meat (LF) 1
Fish Tinola 2 matchbox size
Meat (MF) 1
Fat 2 Canola Oil (For Veg) 2 teaspoon
Rice 1 Boiled Kamote ½ of 11 cm long
PM Snack
ONS 1 Supportan 1 bottle/ 200ml
Sauteed Kangkong and
Veg 1 ½ cup, cooked
Baguio Beans
Rice 2 Rice, cooked 1 cup, packed
Dinner
Meat 2 Grilled Salmon 2 matchbox size
Fat 2 Canola Oil (for Veg) 2 teaspoon

*The sample meal for one day is similar to the patient’s usual food intake to prevent sudden change
of diet and provided with oral nutrition supplement to be able to achieve total protein and caloric
goal

30
Monitoring and Evaluation
Weekly Monitor the patient's tolerance to each specific type of food and
change the diet accordingly

Monitor patient's complete blood count and clinical chemistry

through biochemical tests to see if there are deficiencies or
improvement to existing deficiencies and also improvement in
nutrition-related lab results specifically of SGPT –ALT, sodium,
and potassium.

Monitor daily fluid intake

Monitor medicine intake and if there are side effects, especially

regarding drug-nutrient interactions

Monthly Observe the food changes: amount, kind, type and variation and
prevent further eating habits that would decrease the beneficial
progress of the patient

Check laboratory results to determine if there is progress or

changes of the results and to see if there is an improvement to
nutrition-related laboratory values

Monitor if patient’s body weight

Check if to see complications that arose from diseases have been

relieved through medical nutrition therapy

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VII. Glossary of Medical terms and abbreviations used

CA – Cancer
HTN – Hypertension
CHON – Protein
CHO – Carbohydrates
ONS – Oral Nutrition Support
LF – Low Fat
MF- Medium Fat
NPC – Non-Protein Calories
TER - Total Energy Requirement
HBV – High Biological Value
MCT – Medium Chain Triglycerides

32
 VIII. References

Agron, E. (n.d.). Prevalence of hypertension among Filipinos increasing - PSH. Retrieved from
http://www.pchrd.dost.gov.ph/index.php/news/2806-prevalence-of-hypertension-
amongfilipinos-increasing-psh

Alanine Aminotransferase (also known as ALT or SGPT). (n.d.). Retrieved from

http://sphweb.bumc.bu.edu/otlt/MPH-Modules/PH/Sparta/Liver_Function_Tests.pdf

Assessing Your Weight and Health Risk. (n.d.). Retrieved from

https://www.nhlbi.nih.gov/health/educational/lose_wt/risk.htm

Aurelio, L. (2015, March 20). Smoking and Hypertension. Retrieved from

https://medcraveonline.com/JCCR/JCCR-02-00057.pdf

Basic Information About Prostate Cancer | CDC. (n.d.). Retrieved from

https://www.cdc.gov/cancer/prostate/basic_info/index.htm

Escott-Stump, S. (2015). Nutrition and diagnosis-related care. Philadelphia: Wolters Kluwer.

Herniacauses, symptoms, complications, surgery Southern Cross NZ. (2017, June). Retrieved
from https://www.southerncross.co.nz/group/medical-library/hernia-causes-
symptomscomplications-surgery

Hyperarts, R. M.-. (n.d.). Inguinal Hernia. Retrieved from

https://general.surgery.ucsf.edu/conditions--procedures/inguinal-hernia.aspx

Hypertension - Prognosis. (n.d.). Retrieved from

https://science.jrank.org/pages/3488/Hypertension-Prognosis.html

Inguinal Hernia Outlook / Prognosis. (2018, September 17). Retrieved from

https://my.clevelandclinic.org/health/diseases/16266-inguinal-hernia/outlook--prognosis

Inguinal Hernia. (2018, September 27). Retrieved from

https://my.clevelandclinic.org/health/diseases/16266-inguinal-hernia

Joshu, C. E., Mondul, A. M., Meinhold, C. L., Humphreys, E. B., Han, M., Walsh, P. C., & Platz,
E. A. (2011, May 18). Cigarette smoking and prostate cancer recurrence after
prostatectomy. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3096800

Junio, L. (2018, June 5). Group launches free prostate cancer consultation on June 16. Retrieved
from https://www.pna.gov.ph/articles/1037538

Mahan, L. K., & Escott-Stump, S. (2008). Krauses food & nutrition therapy. St. Louis, MO:
Saunders/Elsevier.

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Pandol, S. J., Apte, M. V., Wilson, J. S., Gukovskaya, A. S., & Edderkaoui, M. (2012). The burning
question: why is smoking a risk factor for pancreatic cancer? Retrieved from
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3956306

Potassium. (n.d.). Retrieved from https://labtestsonline.org/tests/potassium

Prostate Cancer - Statistics. (2019, June 6). Retrieved from

https://www.cancer.net/cancertypes/prostate-cancer/statistic
Prostate Cancer Prognosis. (n.d.). Retrieved from
https://www.hopkinsmedicine.org/health/conditions-and-diseases/prostatecancer/prostate-
cancer-prognosis

Prostate cancer. (2019, April 17). Retrieved from

https://www.mayoclinic.org/diseasesconditions/prostate-cancer/symptoms-causes/syc-
20353087

Radical Prostatectomy. (n.d.). Retrieved from

https://www.hopkinsmedicine.org/health/treatmenttests-and-therapies/radical-
prostatectomy

Resnick, A., MD, & Permanente, K. (2014, March 01). Kaiser Permanente Washington. How Age
and Gender Affect Your Heart. Retrieved from
https://wa.kaiserpermanente.org/healthAndWellness?item=/common/healthAndWellness/
conditions/heartDisease/ageAndGender.html

Rodwell, V. W., Bender, D. A., Botham, K. M., Kennelly, P. J., & Weil, P. A. (2018). Harpers
illustrated biochemistry. New York: McGraw-Hill Education.

Serum Sodium. (n.d.). Retrieved from https://www.ucsfhealth.org/tests/003481.html

What Is Prostate Cancer? (n.d.). Retrieved from

https://www.cancer.org/cancer/prostatecancer/about/what-is-prostate-cancer.html

Yang, X.-F., & Liu, J.-L. (2014, November). Acute incarcerated external abdominal hernia.
Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4245506/

34
 IX. How did your case study relates to your chosen field of endeavour

My case study that is all about Incarcerated Hernia; Prostate Cancer Stage IV; Hypertension
relates to my chosen field of endeavour because one must know how the disease progresses
through Theoretical explanations of the disease condition, its Etiology, Signs and Symptoms,
Incidence, and Prognosis that way one can really make a good Pathophysiology basing on the case
of the patient you cannot just skip the steps of Nutrition Care Plan that with your ADIME.

Assessment which is a crucial part where one must correlate your ABCD’s to your PESSR which
would lead to your Nutrition Diagnosis and it would let you analyse on what you can recommend
as a RND and also a part of the Multidisciplinary Team. Nutrition of one is really important
because it would matter if your given calories would be less or too much because that is what you
get in this kind of field the passion and challenge of how one can really give the Nutrition Care
Plan for one’s patient.

This has been really a great experience for me encountering new methods and techniques and
trying to cope up with the trends and formulas that would by then be really helpful in achieving
the optimum nutrition of a patient because when I become a RND it would really in my hands on
how I would take care of patient through Food and not just by food but also through other ways
such as Dietary Instruction, it would mean that how a RND can manage and give the proper Long
term recommendations for the patient to have healthy life.

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