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A Case Study: Astrocytoma
- 1. ASTROCYTOMA June 9, 2010 Victoria Parry, Dietetic Intern
- 2. Astrocytoma Astrocytoma s normally develop in the cerebrum butcan originate in other parts of the brain and spinal cord.
- 3. Astrocytes Star-shaped glial cellslocated in the brain and spinal cord (CNS) Function: Regulate external chemical environment of neurons; blood flow in brain
- 4. 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)
- 5. Examples of Astrocytomas Low-gradeAstrocytoma Giant Cell Astrocytoma (2)
- 6. Cause of Astrocytoma Currently unknown Cell phones Prophylactic Radiation for Acute Lymphatic Leukemia Genetics Family history of astrocytoma Molecular Mutation (3)
- 7. Prevalence Gender Age Male predominance Affects all ages 10% less than 20 years 1.18:1 Low-grade 60% 20-45 years 1.87:1 Anaplastic (Grade 30% 45 years or older III) Race Mortality and Morbidity 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)
- 8. Symptoms Altered development or growth (in children) Double Vision Drowsiness Eyesight Problems Headache Lethargy Mental Status Change Obtuseness Personality Changes Seizures Vomiting (1,4
- 9. Diagnosis and Treatment Testing: Treatment Options: Neurological Exam Surgery Vision Resection of tumor Hearing Balance Radiation Coordination Chemotherapy Computed Tomography Temozolomide Scan (CT) Magnetic Resonance Imaging (MRI) Angiogram Biopsy (1, 2, 3, 5)
- 10. Case Study PatientInformation • 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
- 11. 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
- 12. Social History Resides with mother and other family Bed bound last 3-4 years Home Health Care Aide Three times daily Nonverbal
- 13. 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. (6) Can cause nausea, diarrhea, anorexia,
- 14. Laboratory Values Date Hgb Hct MCV Na+ K+ Gluc. BUN Creat. Ca+ 12-18 37-47 82-101 135-155 3.5-5.5 70-120 8-26 .6-1.3 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
- 15. Laboratory Values Date Alb Alk Phos SGOT PO4 RBC WBC Cl- 3.4-5.0 50-136 7-47 2.5-4.9 4.2-5.4 4-10.5 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
- 16. Dietary Trigger Dietary Consult for Tube Feeding Recommendation Moderately Depleted Albumin Level of 2.4 and Pre-albumin Level of 11.6
- 17. 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)
- 18. Interventions Await restart of tube feedings Recommend necessary adjustments to tube feeding rate and fluids Monitor tolerance of tube feeding
- 19. Energy, Protein, andFluid 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#
- 20. Tube Feeding Recommendations Initial MDOrder RD Recommended Order* Jevity 1.5 at 30cc/hr Jevity 1.5 at 50cc/hr Provides: Provides: 1,800 kcals 1,080 kcals 77g protein 26g fiber 46g protein 912cc free water 16g fiber 100% RDI’s vitamins and minerals 547cc free water IV Fluid KVO IV Fluid 100cc/hr Water Flushes 200cc QID *RD recommendation based on Adjusted Body Weight of 114#
- 21. 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
- 22. Diet Orders Tube Feeding via G-Tube Jevity1.5 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
- 23. 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
- 24.
- 25. 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.
Editor's Notes
- #3 Glioma Tumor
- #4 http://missinglink.ucsf.edu/lm/ids_104_cns_injury/Response%20_to_Injury/Astrocytes.htmAstrocytes (Astroglia)Most abundant glial cellOther Glial Cells: Oligodendrocytes, Schwann CellsThe most abundant type of macroglial cell, astrocytes (also called astroglia) have numerous projections that anchor neurons to their blood supply. They regulate the external chemical environment of neurons by removing excess ions, notably potassium, and recycling neurotransmitters released during synaptic transmission. The current theory suggests that astrocytes may be the predominant "building blocks" of the blood-brain barrier. Astrocytes may regulate vasoconstriction and vasodilation by producing substances such as arachidonic acid, whose metabolites are vasoactive.
- #5 Astrocytoma.org
- #6 Brainstemglioma (low-grade) normally in childrenMayoclinic.org
- #8 5.4 cases per 100,000 populationNo difference US vs internationalhttp://emedicine.medscape.com/article/283453-overview
- #9 http://www.astrocytoma.org/http://www.nlm.nih.gov/medlineplus/ency/article/007222.htm
- #10 Chemotherapy: anaplasticastrocytomahttp://www.mayoclinic.org/glioma/treatment.htmlhttp://emedicine.medscape.com/article/283453-treatmenthttp://www.cancer.gov/cancertopics/pdq/treatment/adultbrain/HealthProfessional/page7
- #12 Previous admissions: 2006: Aspiration Pneumonia, Fever, Weakness 2007: AMS 2009: Pneumonia
- #15 Received K Bolus
- #21 Increase from 45cc/hr to increase protein intake1620kcal, 69g protein, 24g fiber, 820 mL fluid
- #22 http://www.mountnittany.org/assets/images/krames/115616.jpg
- #23 Tolerated feedings well. Very little residuals of 10-40cc