Question

Lisa is a 31-year-old Caucasian female of Northern European descent. She is 5 feet 3 inches tall, has an average frame size, and weighs 162 pounds with a BMI of 28.7 (overweight). She lives with her husband and two children, and works as a surgical technician at a local community hospital.

Lisa was diagnosed with Hodgkin’s lymphoma six months ago after experiencing chest pain over a few days. Lisa is currently on a weekly chemotherapy (doxorubicin, bleomycin, vinblastine, and dacarbazine) regimen, which is administered in an outpatient center. Lisa is also taking epoetin (Epogen) with each treatment to maintain a hematocrit above 36%, and filgrastim (Neupogen) for five days after each treatment to stimulate the production of neutrophils.

Lisa reports to the nurse that the only nutritional counseling she has received since diagnosis is to avoid greasy and spicy foods for four to five days post-treatment. She did receive a booklet on what to eat if she has a decrease in appetite, which she reports she has not read.

Since starting chemotherapy, Lisa has gained seven pounds and reports that she actually has more of an appetite than before she started treatment, but prefers more “junk food.” Lisa attributes this to dexamethasone, a steroid she receives with each treatment. She did ask her physician to decrease the dose in order to decrease her appetite. However, when the medication was decreased, she reported feeling “terrible” and chose to return to the higher dose.

Lisa has had occasional problems with mouth sores, a common problem of chemotherapy patients, but states that she is currently able to drink orange juice without much irritation.

Lisa also reports that she experiences significant lethargy and nausea for about four days post-treatment. She has been prescribed Compazine for the nausea, but states she often avoids taking it because it makes her feel “jittery.” Instead she finds eating bland foods like corn flakes, grilled cheese, or chicken with rice helps the nausea. Lisa found the advice not to eat greasy, spicy foods for 4-5 days post-treatment to be helpful. She stated that sausage and pizza made her stomach hurt. This was followed by the statement, “I think eating is the key to getting through chemo.”

5. What other nutritional data available from this medical record can be used in your nutrition
assessment? [4 marks]
6. What other questions might you ask to further assess here appetite? What are possible
causes of her poor food intake?

Answer 1

5. To asses the nutritional status one should perform anthropometric measurement, biochemical assessment, clinical assessment and dietary data.

Here the given data are about the anthropometric measurement (Height, weight and BMI and recent weight gain of 7 pounds).she prefers junk foods. But advised to avoid greasy and spicy foods. Have mouth sores and the prescribed medications she is taken. There are data given in question.

These are the other nutritional data can be done to assess nutrition:

Not mentioned about any information about the biochemical data. So can go ahead with biochemical assessment.

Clinical assessment should perform in systematic way to find fluid retention, puffiness, edema in extremities and grade of pitting edema.

Dietary data get a 24 hour recall about her diet can be ask including water intake. Get a list of likes and dislikes of food.

This three helps to find the fat amount, cholesterol, HDL, LDL, VLDL, triglycerides etc. Find further objective data and dietary habits.

6. To assess about appetite, ask about the hunger frequency, level of satiety. Can ask after how many hours of food intake you feel hungry.

To assess satiety how many bread will you eat if you are in hungry and also not in hungry.

To assess the food carving how many bread will you eat as plain bread and also with spicy and cheesy chicken.

Hungry, satiety and food carving should be assess to know about appetite. So these are the possible questions can ask.

Causes for poor food intake:

Actually she prefers junk foods this is the prime reason for not eating healthy.

Other reason is to eat along with the complaints she has mentioned.