Crohn’s Disease TC
Crohn’s Disease
TCis district manager for a national flooring company. She travelsweekly for her job. She is 38 years old.She was admitted to thehospital for weakness, severe abd pain and distention. She is 5’7″and weighs 100 lb on admission. She reports a weight loss of about35 lb since her most recent small bowel resection for Crohn’sdisease, about 6 months ago. She reports that she can only tolerate2-3 bites of food at a time, but tries to eat as often as possiblewhich is 3-4 times daily. She is tired and lethargic and isconsidering taking a medical leave of absence from work because sheis having a hard time keeping up with her travel schedule. TheGastrointestinal doctor diagnoses the patient with Short GutSyndrome: she has 3 feet of small intestine left after her mostrecent bowel resection. On further evaluation, she is noted to havea SBO on admission. Because of her medical history, conservativemanagement of the SBO is discussed and a NG tube to suction fordecompression is placed. She is started on corticosteroids, normalsaline (IVF) at 75ml/hr (x24hr), ciprofloxacin and azathioprine.The medical team has consulted the RDN (you) for a recommendationfor long term TPN. The patient is scheduled to have a central lineplaced.
Her current labs are as follows:
Glucose: 110 mg/dl
Albumin: 2.5 mg/dl
Hemoglobin: 9 mg/dl
Hematocrit: 32%
PAB: 10 mg/dl
1. Calculate the following and interpretthe results
IBW %IBW %UBW BMI
2. Calculate TC’s kcal, protein and fluidneeds. (Use Mifflin St Joer or Harris Benedict Equation). Be sureto use an appropriate SF/AF. Justify your answers.
3. Based on her history and laboratoryvalues, what do you conclude regarding her nutritionalstatus/risk?
4. Describe the action and potential sideeffects of each of the following: corticosteroids, IVF,ciprofloxacin and azathioprine.
5. Would performing a NPFE be helpful?Why or why not?
6. She may experience nausea/vomiting,weight loss, malabsorption, anemia, and bone disease. Why mighteach of these occur?
7. Are there any other vitamin or mineralissues that the RDN should consider? Why?
8. Why is the medical team recommendingTPN and not TF? Do you agree with this course of action? Why or whynot?
9. Do you anticipate that TC will ever beable to meet her needs by oral intake alone? Why or why not?
10. Assume she gets 25 % of her calorie and protein needs metfrom food eaten during the day. Recommend nutrition support to meetthe remainder of her protein, calorie and fluid needs. Show yourwork. (write the actual TPN prescription)
11. Write sample menu for her providing 25% of her estimatedkcal, protein and fluid needs
12. Write PES statement appropriate for TC.
Answer:
Ans -1}
• IBW – Male IBW = 50 kg + 2.3 kgfor each inch over 5 feet. Females: IBW = 45.5 kg+ 2.3 kg for each inch over 5 feet. The IBW andABW are used to calculate medication dosages whenthe patient is obese.
• % IBW – (Actual body weight/Ideal body weight) × 100 = %IBW
Eg. :- woman who is 5’2″ and wt. 125 pound ( 125/110)× 100= 113%IBW .
• % UBW – percent UBW = current body weight/UBW x 100.
• BMI = kg/m2 where kg is aperson’s weight in kilograms and m2 is their height in metressquared. A BMI of 25.0 or more is overweight,while the healthy range is 18.5 to 24.9.
Ans -2} TC’s kcal and fluid needs are :-
The formula is Energy (inKcal) = 4x (Proteins andcarbohydrates mass in grams) + 9 x mass of fat in grams.
Maintenance Fluid Calculation forChildren
- For infants 3.5 to 10 kg the daily fluidrequirement is 100 mL/kg.
- For children 11-20 kg the daily fluidrequirement is 1000 mL + 50 mL/kg for every kg over10.
- For children > 20 kg the daily fluidrequirement is 1500 mL + 20 mL/kg for every kg over 20, upto a maximum of 2400 mL daily.
Ans-3} conclusion :- Many symptoms can signal problems with theGI tract, including: abdominal pain, blood in the stool, bloating,constipation, diarrhea, heartburn, incontinence, nausea andvomiting and difficulty swallowing, according to the NIH. Among themost widely known diseases of the digestive systemis colon cancer.
Ans-4} Action and potential side effects are –
# corticosteroid :- Corticosteroids are a class of steroidhormones that are produced in the adrenal cortex of vertebrates, aswell as the synthetic analogues of these hormones.
Side effects –
- osteoporosis (fragile bones),
- hypertension (high blood pressure)
- diabetes
- weight gain
- increased vulnerability to infection
- cataracts and glaucoma (eye disorders)
- thinning of the skin
- bruising easily
# IVF :- IVF works by using a combination ofmedicines and surgical procedures to help sperm fertilize an egg,and help the fertilized egg implant in your uterus. First, you takemedication that makes several of your eggs mature and ready forfertilization.
Side effects –
allergic reactions
vaginal bleeding
blood in urine, bloating
breast tenderness
bruising from shots
cramping,
headaches
infection
pelvic pain
constipation or mood swings.
# Ciprofloxacin :- Ciprofloxacin acts on bacterial topoisomeraseII (DNA gyrase) and topoisomerase IV.Ciprofloxacinis a broad-spectrum antibiotic of the fluoroquinolone class. It isactive against some Gram-positive and many Gram-negativebacteria.
Side effects –
- nausea.
- vomiting.
- stomach pain.
- heartburn.
- diarrhea.
- vaginal itching and/or discharge.
- pale skin.
- unusual tiredness.
# Azathioprine :- It is used in rheumatoid arthritis,granulomatosis with polyangiitis, Crohn’s disease, ulcerativecolitis, systemic lupus erythematosus, and in kidney transplants toprevent rejection.
Side effects –
- diarrhea.
- rash.
- fever.
- tiredness.
- muscle aches.
- liver damage.
- dizziness.
- low blood pressure.
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