A Case Study: Astrocytoma
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Transcript of A Case Study: Astrocytoma
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ASTROCYTOMA
Victoria Parry, Dietetic InternJune 9, 2010
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Astrocytoma
Astrocytomas normally develop in the cerebrum but can originate in other parts of the brain and spinal cord.
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Star-shaped glial cells located in the brain and spinal cord (CNS)
Function: Regulate external chemical environment of neurons; blood flow in brain
Astrocytes
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Stages of Astrocytoma
Stage 1: Pilocytic Astrocytoma
Stage 2: Diffuse Astrocytoma
Stage 3: Anaplastic Astrocytoma
Stage 4: Glioblastoma Multiforme (GBM) Gliosarcoma Giant Cell Glioblastoma
(1)
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Examples of Astrocytomas
Low-grade Astrocytoma Giant Cell Astrocytoma
(2)
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Cause of Astrocytoma
Currently unknown Cell phones Prophylactic Radiation
for Acute Lymphatic Leukemia
Genetics Family history of
astrocytoma Molecular Mutation
(3)
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Prevalence
Male predominance 1.18:1 Low-grade 1.87:1 Anaplastic (Grade
III)
Affects all ages 10% less than 20 years 60% 20-45 years 30% 45 years or older
Gender Age
Mortality and MorbidityRace
Affects all races Grade 1: 10 years Grade 2: More than 5 years Grade 3: 2-5 years Grade 4: Less than 1 year
(3)
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Symptoms
Altered development or growth (in children)
Double Vision Drowsiness Eyesight Problems Headache Lethargy Mental Status Change Obtuseness Personality Changes Seizures Vomiting
(1,4)
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Diagnosis and Treatment
Testing: Neurological Exam
Vision Hearing Balance Coordination
Computed Tomography Scan (CT)
Magnetic Resonance Imaging (MRI)
Angiogram Biopsy
Treatment Options:
Surgery Resection of
tumor Radiation Chemotherapy
Temozolomide
(1, 2, 3, 5)
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Case Study Patient Information• Admit Diagnosis: Aspiration Pneumonia,
Dehydration, Sepsis • Sex: Female• Age: 36 Years Old• Weight: 157#• Height: 5’0”• BMI: 31• Ideal Body Weight: 90-110#• Percent Ideal Body Weight: 157%• Adjusted Body Weight: 114#• Home Diet Regimen: G-Tube with Jevity Bolus 5
Cans Daily
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Past Medical History
Astrocytoma 1987: Cerebral Astrocytoma
Surgery 1992: Repeat Brain Surgery
Pituitary Insufficiency Post radiation treatment
Seizure Disorder Post brain surgery
Hypothyroidism Pneumonia Gastrostomy Tube Placement
2006
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Social History
Resides with mother and other family
Bed bound last 3-4 years
Home Health Care Aide Three times daily
Nonverbal
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Relevant Medications
Os-Cal: Calcium supplement. Also used as antacid, phosphate binder, antidiarrheal
Prilosec: Proton Pump Inhibitor. Used to decrease gastric acid secretion and increase gastric pH
Lactinex: Lactobacillus probiotic. Used to aid with GI regulation and antidiarrheal
Zofran: Antiemetic. Used to decrease vomiting
Flagyl: Antibiotic used to treat C. diff. Can cause nausea, diarrhea, anorexia, taste changes
(6)
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Laboratory Values
Date Hgb12-18
Hct37-47
MCV82-101
Na+135-155
K+3.5-5.5
Gluc.70-120
BUN8-26
Creat..6-1.3
Ca+8.7-10.2
4/18 16.4 49.2 81.8 141 4.4 86 12 0.9 9.1
4/19 14.2 42.1 80.7 135 3.4 97 10 0.9 8.5
4/20 12.3 35.9 80.9 140 3.8 84 5 0.6 8.2
4/21 N/A N/A N/A 145 2.9 73 1 0.6 8.0
4/22 11.4 33.0 79.5 N/A N/A N/A N/A N/A N/A
4/23 N/A N/A N/A 145 2.9 90 2 0.6 8.0
4/24 12.6 37.0 79.8 141 3.4 102 6 0.6 7.7
4/25 12.3 37.0 81.6 143 3.4 86 8 0.5 7.9
4/26 12.6 37.9 82.3 N/A N/A N/A N/A N/A N/A
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Laboratory ValuesDate Alb
3.4-5.0Alk Phos50-136
SGOT7-47
PO42.5-4.9
RBC4.2-5.4
WBC4-10.5
Cl-96-107
4/18 N/A N/A N/A N/A 6.01 16.2 100
4/19 2.4 339 43 3.2 5.21 18.4 102
4/20 N/A N/A N/A N/A 4.44 12.4 107
4/21 N/A N/A N/A N/A N/A N/A 108
4/22 2.2 232 63 N/A 4.16 7.7 N/A
4/23 2.5 257 58 N/A N/A N/A 107
4/24 2.3 189 32 N/A 4.63 16.7 106
4/25 2.2 187 18 N/A 4.53 14.7 109
4/26 N/A N/A N/A N/A 4.60 13.4 N/A
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Dietary Trigger
Dietary Consult for Tube Feeding Recommendation
Moderately Depleted Albumin Level of 2.4 and Pre-albumin Level of 11.6
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PES Statements
(NC-1.1) Swallowing difficulty related to dysphagia and past medical history as evidenced by patient needing Gastrostomy Tube for main nutrition and hydration support.
(NI-5.1) Increased protein needs related to increased demand for protein as evidenced by moderately depleted albumin level of 2.4 and pre-albumin level of 11.6. (7)
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Interventions
Await restart of tube feedings
Recommend necessary adjustments to tube feeding rate and fluids
Monitor tolerance of tube feeding
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Energy, Protein, and Fluid Needs*
Estimated Energy Needs: 1266 (BEE) x 1.2 x 1.1= 1,671 kcals
Estimated Protein Needs: 1.2-1.3g/kg= 62-68g
Estimated Fluid Needs: 35mL/kg= 1,820mL
*All needs based on Adjusted Body Weight of 114#
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Tube Feeding Recommendations
Jevity 1.5 at 30cc/hr
Provides: 1,080 kcals 46g protein 16g fiber 547cc free water
IV Fluid 100cc/hr
Jevity 1.5 at 50cc/hr Provides:
1,800 kcals 77g protein 26g fiber 912cc free water 100% RDI’s vitamins and
minerals IV Fluid KVO Water Flushes 200cc QID
Initial MD Order RD Recommended Order*
*RD recommendation based on Adjusted Body Weight of 114#
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Tests and Procedures
Chest X-Ray
Kidney, Ureters, Bladder X-ray (KUB)
Abdominal Ultrasound
Conversion G-Tube to G-J Tube
Abdominal CT Scan with Contrast
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Diet Orders
Tube Feeding via G-Tube Jevity 1.5 at 30cc/hr Held due to projectile vomit
Gatorade via G-Tube 30cc/hr Held for testing
Tube Feeding via G-J Tube Jevity 1.5 at 40cc/hr
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Discharge Notes
April 26, 2010
Approximate 15# Weight Gain Positive Fluid Balance
Discharge to home Continue with Home Health Care
Medical follow ups in two-three weeks
Resume Jevity bolus of 5 cans daily
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Questions?
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Works Cited
1. Astrocytoma. Astrocytoma. 2007. Available at: http://www.astrocytoma.org/. Accessed June 1, 2010.
2. Glioma. Mayo Clinic. April 2010. Available at: http://www.mayoclinic.org/glioma/. Accessed June 1, 2010.
3. Kennedy B, Bruce JN. Astrocytoma. eMedicine Oncology. January 23, 2009. Available at: http://emedicine.medscape.com/article/283453-overview. Accessed June 2, 2010.
4. Brain tumor-primary-adults. Medline Plus Medical Encyclopedia. May 7, 2010. Available at: http://www.nlm.nih.gov/medlineplus/ency/article/007222.htm. Accessed June 5, 2010
5. Adult brain tumor treatment. National Cancer Institute. October 13, 2009. Available at: http://www.cancer.gov/cancertopics/pdq/treatment/adultbrain/HealthProfessional/page7. Accessed June 4, 2010.
6. Pronsky ZM. Food Medication Interactions. 15th Ed. Birchrunville, PA: Food-Medication Interactions; 2008.
7. American Dietetic Association. International Dietetics & Nutrition Terminology Reference Manual. 2nd Ed. Chicago, IL: American Dietetic Association; 2009.