Practice 7 ( Esophageal Cancer Treated with Surgery and Radiation)

Student's Names:
Meznah Almaghlouth 381230061
Nouf Almousa 381230078
Reem Alhadi 381230038
Latifah Alsahaley 371230061
Case Questions:

I. Understanding the Disease and Pathophysiology

1. Mr. Seyer has been diagnosed with adenocarcinoma of the esophagus. What does the
term adenocarcinoma mean?

Adenocarcinoma is a malignant mass formed from the glandular cells in mucus-secreting glands
in the epithelial tissue begin in glands but can spread to other types of tissue and areas of the
body. The disease may develop in many different places in the body, but it is most prevalent in
the following cancer types:lung, prostate, pancreatic, esophageal, and colorectal.

II. Understanding the Nutrition Therapy

2. Many cancer patients experience changes in nutritional status. Briefly describe the
potential effect of cancer on nutritional status.
The type of cancer and treatment used can largely affect the nutritional status of a patient.
Certain cancers that are more closely related to nutrition and food intake, such as cancer of the
head and neck, or esophageal cancer, can make it difficult for patients to desire to eat. One
treatment that can affect one’s nutritional status is chemotherapy. This fluid infusion can
significantly increase nausea and other GI problems, which lead to lack of appetite. The
symptoms associated with cancer can make eating very difficult, and most patients lose weight.

3. Both surgery and radiation affect nutritional status. Describe the potential nutritional and
metabolic effects of these treatments.
Common effects of radiation will include fatigue, mucositis, dysphasia, or severe esophagitis.
Dehydration is also a main concern, and should be observed by receiving intravenous fluids and
electrolyte correction. Oral intake of food may become extremely difficult and a feeding tube
may be needed. Esophageal cancer patients that receive surgery will often need a jejunal
feeding tube placement.With cancer, removal of any tumor can cause cancer cells to leak
causing more issues.

III. Nutrition Assessment

A. Evaluation of Weight/Body Composition

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4. Calculate and evaluate Mr. Seyer’s percent UBW and BMI
BMI=89/(190/100)^2=24 normal healthy weight
UBW=ABW/UBWx100
89/103.5=86% he had severe weight loss

5. Summarize your findings regarding his weight status. Classify the severity of his weight
loss. What factors may have contributed to his weight loss?
Mr. seyer’s BMI is normal but he had severe weight loss. His percent UBW weight was 86%. The
factors that affected his weight loss are dysphagia and heartburn due to adenocarcinoma of his
esophagus which lead to difficulty in swallowing foods, especially textured foods.

6. What other assessment measures would you recommend be conducted to complete his
nutrition assessment?
Percentage of weight change, check GI functioning, biochemical data, chech macronutrient
especially energy and protein and micronutrient levels.

B. Calculation of Nutrient Requirements

7. Estimate Mr. Seyer’s energy and protein requirements based on his current weight.
Identify the factors you used in determining which equations to use for these calculations.

Energy Requirements:
REE (Mifflin-St. Joer)
Men: Energy expenditure = 5 + 10 (89 kg) + 6.25 (190.5 cm) – 5 (58 yrs.) = 1795.6 kcal

REE X PA = TER
1795.6 X 1.3 (PA)= 2334 kcal/day

Protein Requirements:
1.5 = Hypermetabolism, 2.5 = Extreme Wasting
1.5*89kg= 133.5g
2.5*89kg= 222.5g

8. Estimate Mr. Seyer’s fluid requirements based on his current weight.

Fluid needs= 30-35 mL/kg

89 kg x 30 mL=2,670 mL
89 kg x 35 mL=3,115 mL

C. Intake Domain

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9. What factors can you identify from Mr. Seyer’s history and physical that may indicate any
problems with eating an oral diet prior to admission?

Physical: patient’s physical findings state that the pt has dry mucous membranes in this throat
which could make it tough for the patient to swallow. Also, the patient shows signs of epigastric
tenderness on palpation.
History: patient has heartburn for a 1 year, difficulty and pain when swallowing (especially
textured foods), loss of appetite, early satiety. Dysphagia for 3-4 months and odynophagia for
5-6 months.
These factors indicate that he has difficulty in swallowing and has problems with eating oral
diet.

10. Mr. Seyer is currently receiving enteral nutrition therapy. He is prescribed Isosource 1.5 at
75 mL/hr.
a. Calculate the amount of energy and protein that will be provided at this rate. 1735 ml

Energy:
75ml x 24h = 1800 ml
1800 ml x 1.5 kcal = 2700 kcal\day
Protein:
Isosource 1.5 protein is 18%
2700 kcal * 18% = 486 kcal, 486\4 = 121.5 g of protein\day

b. Next, by assessing the information on the patient care summary sheet, determine the
actual amount of enteral nutrition that he received on September 11.

1735 ml through enteral feeding formula, 2602 kcal and 117g of protein

c. Compare this to his estimated nutrient requirements. Identify any nutrition problems.

The patient's needs were 2700 kcal and 121g of protein and according to his 24-hour recall,
he is suffering from nutrition problems due to not receiving adequate amounts of daily kcal
and protein needs.

11. From the information gathered within the intake domain, list possible nutrition problems
using the diagnostic term.

1. Inadequate energy intake NI-1.4

2. Inadequate enteral intake infusion NI-2.3
3. Inadequate protein intake NI-52.1

D. Clinical Domain

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 12. After reviewing the patient’s admission history and physical, are there any clinical signs of
malnutrition?

He has complained of dysphasia and odynophagia, having pain swallowing. He also experiences
heartburn and has experienced food being caught in his throat. His chemistry data shows low
albumin, prealbumin, and total protein levels. These low values show clearly that he is not
receiving enough protein in his diet.

13. Review the patient’s chemistries upon admission. Identify any that are abnormal. Using
the following table, describe their clinical significance for this patient.

Chemistry/ Date Normal Mr. Seyer’s Reason for Abnormality Nutritional Implications
Value Value
Total Protein 6-8 5.7 Low Inadequate intake of protein Increase the intake of protein
(g/dL)
Albumin (g/dL) 3.5-5 3.1 Low Inadequate intake of protein Increase the intake of protein
& dehydration & rehydration
Prealbumin 16-35 15 Low Inadequate intake of protein Increase the intake of protein
(mg/dL)
CPK (U/L) 55-170 172 High Dystrophy of muscles Increase the intake of protein
& physical activity.
RBC 4.5-6.2 4.2 Low Side effect of cancer & Increase the intake of iron,
(x10^6/mm^3) malabsorption B9, and B12. If there is a
problem in eating on an oral
diet, then supplements may
be needed.
HGB (g/dL) 14-17 13.5 Low Decreased production & Increase the intake of iron,
blood loss, damage to RBC B9, and B12. If there is a
due to cancer problem in eating on an oral
diet, then supplements may
be needed.
HCT % 40-54 38 Low Decreased RBC Increase the intake of iron,
B9, and B12. If there is a
problem in eating on an oral
diet, then supplements may
be needed.
ESR (mm/hr) 0-15 17 High Infection & inflammation When adenocarcinoma is
treated, then it will be
reduced
MCH (pg) 26-32 32.4 Decreased RBC Increase the intake of iron,
Slightly B9, and B12. If there is a
High problem in eating on an oral
diet, then supplements may
be needed.

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14. From the information gathered within the clinical domain, list possible nutrition problems
using the diagnostic term.

1. Swallowing difficulty NC-1.1

2. Altered GI function NC-1.4
3. Impaired nutrient utilization NC-2.1
4. Involuntary weight loss NC-3.2

E. Behavioral–Environmental Domain

15. Mr. Seyer has been diagnosed with a life-threatening illness. What is the definition of a
terminal illness?

Terminal illness or end-stage disease is a disease that cannot be cured or adequately treated
and is reasonably expected to result in death of the patient. This term is more commonly used
for progressive diseases such as cancer or advanced heart disease than for trauma

IV. Nutrition Diagnosis

16. Select two high-priority nutrition problems and complete the PES statement.

PES1: Involuntary weight loss related to inadequate energy intake as evidenced by decreased
appetite and pain upon swallowing.

PES2: Inadequate enteral intake infusion related to increased needs of calories as evidenced by
involuntary weight loss, muscle wasting, dry mucous membranes, low protein levels (5.7g/dL),
low albumin levels (3.1g/dL), and low prealbumin levels (15 mg/dL).

V. Nutrition Intervention

17. For each of the PES statements that you have written, establish an ideal goal (based on
the signs and symptoms) and an appropriate intervention (based on the etiology) at this
point of Mr. Seyer’s hospital course.
PES1:
Goal: Increase the patient's appetite and decrease his pain in swallowing by providing appetite
stimulants and enteral tube feeding.
Intervention: Provide nutrient dense food and fluids through enteral tube feeding to supply
adequate amounts of energy to the patient and to increase his weight in a healthy way.

PES2:
Goal: Provide adequate enteral tube feeding that meets his calories and protein needs.
Intervention: Increase the rate of the formula so that it coordinates with the patient's needs.

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VI. Nutrition Monitoring and Evaluation

18. List the factors that you should monitor for Mr. Seyer while he is receiving enteral
nutrition therapy. For example, you might indicate that you should “monitor weight
weekly.”
- Monitor weight weekly to avoid muscle wasting and loss of weight.
- Monitor total protein, albumin, prealbumin, RBC, HGB, HCT, and MCT and make sure
that they are within the normal range.
- Monitor if the patient is receiving an adequate amount of the prescribed formula.