Determine Mr. Mahon's energy and protein requirements. Explain the rationale for the method you ...

Answer to #1

Provide 30-35 kcal/kg of IBW. Used his IBW for this calculation because he is obese and it is recommended to base calories on IBW for obese individuals. This caloric value is still enough to account for the hyper-metabolic state caused by pancreatitis (it is known that caloric needs increase by about 20).
EER: 2345-2736 kcal/d 30-35 kcal/kg IBW/per ASPEN guidelines
EPR: 94-117 g pro/d (1.2-1.5 g/kg IBW)

Answer to #2

Surgical resection: Removal of part of an organ or a structure in an attempt to remove the malignancy from the body.
Radiation therapy:
 Therapeutic radiation is the use of electromagnetic energy, which can destroy rapidly proliferating cells.
 It alters DNA enough to brake the cell cycle.
 It reduces tumor size and is often used in conjunction with other therapies.
Chemotherapy:
 Interrupts cell DNA, RNA, or protein synthesis of the cell cycle.
 Different types of drugs interrupt cell proliferation at different stages.
 It is common therapy to use a combination of drugs, which will enhance the effectiveness of treatment and minimize overall toxicity.
Immunotherapy:
 Also called biological therapy and biotherapy
 Medications that will stimulate your immune system and medications that contain components of the immune system such as interleukin or interferon

Answer to #3

 Has not eaten over past 3 days (d/t pain)
 Alcohol intake
 Frequent consumption of fast food
 50 wt. gain x 5 years
 Attempting to stop antidepressant meds (may affect appetite or may use food as a replacement)
Mr. Mahon's initial nursing assessment shows signs of dehydration (cloudy, amber urine; tenting of skin; poor skin integritydry, tears; dry mucous membranes), which will affect calculations for fluid requirements. Mr. Mahon has a fever and his skin is clammy and diaphoretic. Presence of fever may increase energy needs.

Answer to #4

 The stage number I-V refers to how extensive the disease is.
- Higher numbers indicate more extensive disease, greater tumor size, and/or spread of the cancer to nearby lymph nodes and/or organs.
- In stage IV, the cancer has spread to distant tissues and organs.
 The Tumor Node Metastases (TNM) Staging System uses T, N, and M to further categorize the tumor.
- The T category describes the original tumor:
 TX means the tumor can't be measured or found.
 T0 means there is no evidence of a primary tumor.
 Tis means the tumor has not started growing into surrounding tissues.
 The numbers T1-T4 describe size and/or level of invasion into nearby structures.
- The N category describes whether or not the cancer has reached nearby lymph nodes:
 NX means nearby lymph nodes can't be measured or found.
 N0 means nearby lymph nodes do not contain cancer.
 N1-N3 describe size, location, and/or the number of lymph nodes involved.
- The M category tells whether there are distant metastases:
 MX means metastasis can't be measured or found.
 M0 means there are no known distant metastases.
 M1 means distant metastases are present.
- In stage T2 N2b, it means that cancerous cells have invaded into nearby tissues and are found in 7 or more nearby lymph nodes.

Answer to #5

Ht: 71 Wt: 245 BMI: 34 (obese)
UBW: 195 (based off pt. reports of 50 wt. gain over 5 years)
UBW: 126 IBW: 172 +/-10 IBW: 142

Answer to #6

 HPV stands for human papillomavirus and is the most common sexually transmitted infection. The different strains of HPV is related to various health problems including cancer and genital warts.
 An HPV positive tumor implies a better prognosis

Answer to #7

The most current evidence regarding EN and immune-modulating formulas in patients with pancreatitis suggests that these formulas should not be used in this situation. However, this decision will vary amongst different institutions and should ultimately be decided on an individual basis. A small-peptide-based, medium-chain triglyceride formula would be appropriate for Mr. Mahon.

Answer to #8

 Risk factors:
- Tobacco use
- Alcohol abuse (especially smoking and alcohol abuse in combination)
- Diet low in fruits and vegetables
- African American
- Environmental exposures (wood/nickel dust inhalation, sun, asbestos)
- Radiation to the head and neck
- Human papillomavirus
- GERD (chronic)

 Mr. Seyer's risk factors:
- Smoker
- HPV positive
- Reports daily consumption of alcohol
- Family history of cancer (Mother - liver cancer)
- Possible occupational hazards - contractor (wood dust inhalation, asbestos)

Answer to #9

The initiation of the enteral feeding is appropriate if the patient is hemodynamically stable (Mean arterial pressure >90 mm Hg). The patient's clinical status and diagnosis of severe acute pancreatitis absolutely indicate the initiation of nutrition support. According to current ASPEN guidelines, in severe forms of pancreatitis, it is recommended that enteral nutrition is initiated within the first 24-48 hours of admission. EN will prevent bacterial translocation and the risk of sepsis. Nutritional support is also important due to the increased energy and protein needs associated with this condition. Providing adequate kcal, protein, and nutrients will help to minimize losses and optimize recovery. EN is recommended rather than PN for several reasons. Early initiation of EN has been shown to reduce the rate of mortality and infection, and to decrease the likelihood of future surgeries. In addition, EN will help to stimulate the gut, maintaining the villi and overall gut integrity. PN is only reserved for EN failure or when nutritional needs are higher than what can be met via EN and oral intake.

Thank you for taking the time to explain this, just got my quiz back: Perfect