NUTRITION SUPPORT:

ENTERAL NUTRITION
ALLANA BOONE
P R E C E P T O R: F RA N KO Z LO W S K I M S , R D , L D

OSTEORADIONECROSIS (ORN)
Necrosis of the bone leading to exposure of the
bone through soft-tissue
Therapeutic radiation of head and neck cancer
can lead to ORN of the jaw, particularly the
mandible

Prevention of ORN
Pretreatment dental exam
Good oral hygiene
Frequent follow-up
Teeth extractions
Daily fluoride treatments terminal
Good nutrition

Mandibulectomy

PATIENT INFORMATION

R.F. Well-developed 61 YO WM
Attending: Jonathon Baskin
W5A
Occupation: Unemployed
PMH: oropharyngeal cancer T1N1, ORN of the
mandible, carpal tunnel, OA of knee,
osteoporosis, GERD, alcoholic cirrhosis
Chart reviewed: s/p l mandibulectomy
Reason for consult: POD# 8 requiring nutrition
assessment and TF recs via PEG

MEDICATIONS

Aspirin
Chlorhexidine
Milk of Magnesia
Mupirocin
Ondansetron
Oxycodone (Liq)
Sulfamethox/Trimeth

B Complex
Vitamin C
Vitamin E
Vitamin D
Fish oil

ANTHROPOMETRICS

Height: 6
Weight: 132.9#
UBW: 140#
TBW: 178#
% UBW: 95%
% TBW: 75%
Weight Loss: 13#, 8.9% x 1 mo (sig, undesired)
BMI: 18.1

LAB VALUES

Albumin 2.8 L
CRP: 42.10 H
Creat 0.4 L possible lean body mass loss
Na 135 L
HGB 11 L
HCT 34 L
MCV WNL @ 86.7
Fe and TIBC% L @ 33 and 10, respectively

FOOD/NUTRITION RELATED HX
Last seen in WP Outpatient Clinic 3/4/15
TF recommendations at home:
Jevity 1.5 cal @ 6-8 servings per day.
8am, 4pm: 2 cans
12pm, 8 pm: 1-2 cans
Providing 1440-1920ml/day -- 2160-2880 kcal, 91.9-122.5 g
protein, 31.7-42g fiber, 1094-1459ml water and >>100% RDI
for vit/min.
Flushes of 180-240 ml H20 w/ each feeding adjust per
hydration needs**
HOB >45 degrees during feedings and 1 hour after

COMPARATIVE STANDARDS
Energy Requirements: 2114 kcall/d
Based on 35 kcal/kg bw and ABW

Protein Requirements: 78.5 g/d

Based on ABW and protein level of 1.3

Fluid Requirements: 2114 ml/d

Based on 1 ml/kcal

Current Diet: NPO

Current TF Rx: Jevity 1.2, FS, 240 ml (1 can) 3x/d providing
864 kcal, 48 g PRO; >100 of RDIs

NUTRITION DIAGNOSIS
Energy Balance
Inadequate Energy Intake
Related to: increased needs d/t POD#8 s/p
surgery
As evidenced by: documented sig wt loss,
need for re-eval of TF regimen

NUTRITION INTERVENTIONS
Meals:
Suggest Cl Liq Diet as appropriate
Possible advancement Full Liq > Dysph Puree
Enteral Nutrition:
Jevity 1.2, FS, 2 cans TID w/ 2 cans HS (8 cans total)
Providing: 2304kcal, 107g pro, 1550ml H2O, > 100%
RDIs
TF regimen will be assessed if diet is adv
Water Flushes: 200 ml/feeding adj per hydration status
HOB elevated 45 degrees during and 1 hr after feedings

NUTRITION INTERVENTIONS
Coordination of Nutrition Care:
Please consider drawing pre-albumin and CRP s/p
3 days to better assess protein status
Consider Rx iron suppl as appropriate
Nutrition Education:
Importance of adequate PO intake

NUTRITIONAL GOALS
1.) Tolerance of TF
2.) Prealbumin >/=15 OR up-trending pre-albumin
w/ down-trending CRP
3.) Weight maintenance
Range: 130-140#)

4.) Healthy weight gain

0.5-1# per week towards UBW of 140#

5.) Iron 50-150 ug/dL

UPDATE
Veteran has been discharged home
Independent with all care PEG, wound, trach
Wife trained and educated in his care as well.

REFERENCES
http://
www.ncbi.nlm.nih.gov/pmc/articles/PMC3757894/
http://
emedicine.medscape.com/article/851539-treatme
nt
http
://www.headandneckcancerguide.org/adults/cancer
-diagnosis-treatments/surgery-and-rehabilitatio
n/cancer-removal-surgeries/mandibulectomy/

THANK YOU!

Any Questions?