This case depicted the essential of nutrition management for pre- and post- operation management of a surgery, which is one of the main roles as a dietitian. That is, to ensure the optimized nutrition plan is given to patient whenever he or she is hospitalized.
Client History
Name: Mr. Q
Age/Sex/Gender: 62/Male/Chinese
Occupation: Pensioner
Reason for referral: Nutrition optimization pre- and post-surgery
Med. Diagnosis: 1) post chemotherapy of esophageal carcinoma
2) thickened medial limb of left adrenal gland
Medical History
•he was referred from HKL for further management (29/10/16-28/11/16)
•transferred out on 28/11/16 to HKL for chemotherapy
Family/Social History
•no family history of chronic disease
•was a chronic alcohol consumer and heavy smoke (for >20years about 1 pack/day)
Anthropometry Measurements
Weight: 51.8kg (taken from ward chart)
Height: 1.69m (taken from ward chart)
BMI: 18kg/m2 (underweight)
IBW: 52.8kg @ BMI 22.5kg/m2
Food- and Nutrition-related History
Dietary Assessment in Ward
•Currently on ONS diet with regime:
8 scoops Nutren Optimum + 250cc H2O, 3Hly, 5x/day
E= 1440kcal (91% TEE); P=96g (15.36gN); V: 1250ml/day
•Tolerating well with ONS
Nutrition Diagnosis
Increased nutrient needs (energy and protein) related to increased demand for nutrient (pt has esophageal carcinoma) as evidenced by clinical Assessment (SGA score: 7, indicating muscle wasting).
Objective of Management & Nutrient Prescription:
Goals
Short term
1) To promote nutrient optimization preoperation
2) To promote weight gain (5% in 2 weeks)
Long term
1) To prevent muscle wasting, malnutrition and weight loss
2) To promote speedy recovery rate and reduce hospital’s length of stay
Nutrient Prescription:
 Energy= 1850kcal/day @ 35kcal/kg
 Protein= 74g/day @ 1.4g/kg
 Fluid= 1590-1855ml/day (30-35ml/kg)
Outcome & Follow-Up
• four follow-ups were made from 1/3/17 to 13/3/17 to monitor pt’s condition and nutrition status
• patient had operation on 9/3/17
• patient had excellent nutrition status prior to surgery
• post-surgery:
 pt was admitted to ICU (9/3/17)
 had SOB and breathing difficulty and unable to sleep (13/3/17)
 pronounced dead at 15/3/17 (CoD: severe HAI)
Discussion
• the nutrition management for surgery of this hospital (Hosp. Sg. Buloh) follows the ERAS protocol (2016)
Learning Points:
• Clinicians interventions and managements of various disciplines are important in ensuring good nutrient optimization, speedy recovery rate and reducing LoS
