Megan Blackburn

Esophageal Cancer Case Study

CSU ID: 830130344

Due: 11/20/2015

I have not given or received any unauthorized assistance on this assignment:

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Case report:

Answer the following questions.

1. What does the term adenocarcinoma mean?a. Adenocarcinoma forms in the mucus-secreting glands throughout the body, and is

most prevenlent in lung cancer, prostate cancer, pancreatic cancer, esophageal cancer, and colorectal cancer. This patient seems to have esophageal cancer which is a malignant tumor that is formed from the glandular structures in the epithelial tissue.

2. What are the two most common risk factors for esophageal cancer? Does the patient have these risk factors?

a. The two most common risk factors are GERD, when contents/acid from the stomach back up into the esophagus, and smoking.

b. Mostly, this patient has a huge risk factor when it comes to smoking. Smoking 20 cigarettes a day will highly increase your risk for getting esophageal cancer. This patient is also experiencing heartburn, which is a symptom of GERD. I would say this patient has both risk factors.

3. The patient’s stage was TII. What is the meaning of the terms T1, N1, M0?a. T1 indicates that the cancer is growing into the tissue under the epithelium.

Tissues could include the lamina propria, muscularis muscosa, or submucosa.b. N1 indicates that the cancer has spread to 1 or 2 lymph nearby lymph nodes.c. M0 indicated that the cancer has not spread to distant organs or lymph nodes.

4. Why is cancer therapy multi-modality? a. Mutli-modality is a treatment approach to types of cancers that involves two or

more treatment types. Multi-modality treatment has been shown to be more effective and increases survival more so than only one therapy. It also decreases side effects, decreases tumor resistance, and attaches at different stage of cell division.

5. Evaluate the patient’s usual body weight and current body weight and risk factors for malnutrition.

a. Usual Body Weight: 220#b. Current Body Weight: 190#c. This patient has lost 30# in the last 3-4 months, mostly due to the fact that he has

been unable to eat due to reoccurring heartburn and difficulty swallowing (especially anything with course or crunchy texture). He claims his appetite has been poor due to regurgitation of some foods and again, pain upon swallowing. This could allow him to lose a significant amount of weight in a very short period of time.

6. Assess the patients Kcal and protein needs for TPN. You do not need to calculate a TPN but suggest a protein sources and % Kcal from protein, fat and glucose.

a. Kcal: 1.3-1.5 BEE (30-35 kcal/kg for malnourished)i. 32kcal*86.4 kg= 2,764.8 kcal/day

b. Protein: 1.5-2.0 g protein/kg for depletedi. 1.7 g * 86.4 kg= 146.8 g/day

ii. Source: free amino acids

c. % Kcal from:i. Protein: Free amino acids: 1 gm = 4 kcal

1. 10%ii. Fat:

1. 20% = 2.0 kcal/mliii. Glucose: Dextose monohydrate: 1 gm = 3.4 kcal

1. 70%7. Describe how you will transition the patient from TPN to tube feeding. Suggest a

product that you will use for tube feeding that will meet the need of this patient a) in the post-operative period and 2) long term.

a. The way I would transition the patient from TPN to tube feeding is that once they reach their goal rate of TPN, I would start introducing tube feeding at a very low rate (~15-20% of their needs). Once the patient is able to tolerate the tube feeding, slowly start introducing 10 ml/day until tube feeding reaches 50% of their needs. Once 50% of needs are met for tube feeding, you can reduce TPN to 50% of their needs.

i. Post-operative period: The product that I would use for post-operative tube feeding would be the Pivot (1.5 kcal/ml).

ii. Long Term: The product I would use for long term would be the Jevity (1 kcal/ml).

8. Describe the volume and method of administration of the TF you selected for a) post-operative recovery in the hospital and b) TF you selected for home (long term).

a. The product that I would use for post-operative tube feeding would be a continuous Pivot formula (1.5 kcal/ml)

1. 2,764 (kcal needs) * 1,000/1,526kcal=1,811ml2. 1,811ml/1.5kcal/=1,207ml/24hr=50 ml/hr

b. Long Term: I would use intermittent (bolus) Jevity (1 kcal/ml).i. 2,764 (kcal needs) * 1000ml/1,050kcal=2,632ml

ii. 2,632/24hr=110 ml/hr 9. Compare fluid requirements to the amount of fluid provided in each tube feeding. How

will you make up the difference?a. Pivot: 2,764 (kcal needs) * 1,000/1,526kcal=1,811ml

i. 1,811ml/1.5kcal/=1,207ml/24hr=50 ml/hrii. 1,811ml/1000=1.8 L * 759 ml/H2O=1,375 ml/free H2O.

iii. Needs 1ml H2O/2,764kcal.iv. 2,764-1,375=1,366 ml/H2O needs

b. Jevity : 2,764 (kcal needs) * 1000ml/1,050kcal=2,632mli. 2,632/24hr=110 ml/hr

ii. 2,620ml/1000=2.6 L * 831 ml/H2O=2,160 ml/free H2O. iii. Needs 1ml H2O/2,764 kcal.iv. 2,764-2,160=604 ml/H2O needs.

c. How I would make up the difference:i. For Pivot (post-op), I would do water flushes (which keep the tubes

functioning). To meet the difference of 1,366 ml, I would see how much ml I would need to flush per hour. That equals 57 ml/H2O/hr.

1. 1,366ml/24hr=57ml/hr

ii. For the Jevity post op, I would make up the difference by having the patient drink 10 ml of H2O every hour for six hours.

10. Write a PES statement for the patients discharge plan including goals and follow –up (list at least four factors you should monitor?

a. PES statement : i. Swallowing difficulty r/t diagnosis of Stage II adenocarcinoma of the

esophagus AEB heartburn and regurgitation of some foods.b. Goals :

i. Encourage that patient maintain proper nutrient levels by continuing on tube feeding until patient can return to normal foods.

ii. Encourage that patient consumes and adequate amount of H2Oiii. Encourage patient to stop smoking entirely to avoid further progression of

cancer and further damage to esophagus. c. Follow-up :

i. Monitor that patient is complying with tube feedingii. Monitor that patient’s kcal/H2O needs are being met

iii. Ensure that patient has stopped smoking entirelyiv. Monitor lab values that were low (albumin, prealbumin, protein levels,

and transferrin)(when admitted) and make sure that they have increased to normal levels.

11. The patient will receive outpatient radiation therapy following D/C. List additional nutritional complications that may occur.

a. Many cancer patients (40-80%) experience Cancer Cachexia, which is anorexia and weight loss. They experience early satiety, fatigue, food aversions, and altered metabolism (lipid, protein and CHO). Patients also can experience nausea, vomiting, diarrhea, constipation, dysphagia, and pain. This could cause patients to have a loss of appetite or a decreased desire to eat, which could cause malnutrition and weight loss.