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M.L. 68 y/o Male Primary Diagnosis: Adenocarcinoma (Abnormal Labs …
M.L.
68 y/o
Male
Primary Diagnosis:
Adenocarcinoma
Medications
Atorvastatin 40 mg per J tube q night
Heparin 5,000 units subcut injection q 12 hours
Metoprolol Tartrate 25 mg per J tube BID
Lansoprazole 30 mg per J tube daily (before breakfast)
Pantoprazole 40 mg IV push BID
Senna 17.6 mg per J tube BID
Dextrose 5% & Sodium Chloride %0.45 w/ KCl 20 mEq/L 100 mL/hr IV continuous
PRN Medications
Acetaminophen suspension 1,000 mg per J tube PRN q 6 hrs
Nystatin 500,000 units oral PRN BID
Senna 8.6 mg per J tube PRN BID
Oxycodone 5-15 mg per J tube PRN q 4 hrs
Methocarbamol 1,000 mg per J tube PRN q 6 hrs
Abnormal Labs
Low Hct (27) and Hgb (8.2) related to blood loss during surgery and malnutrition
High MCV and RDW indicates anemia due to nutritional deficiencies
Low MCHC related to nutritional deficiencies of iron and diagnosis of cancer
Elevated K+ levels related malnutrition, dehydration and CKD
Low Ca++, Mg and phosphate related to malnutrition
Slightly elevated blood glucose (106) related to prediabetes diagnosis
Diagnostic Tests
Esophagram w/ air & barium contrast (2/17/2020); stent patency
XR Chest (2/17/2020); esophageal stent placement
Fluoroscopy C arm (2/17/2020); esophageal stent placement
Asses for signs and symptoms of anemia ; fatigue weakness, pallor, headache
Continue to monitor electrolyte levels for nutritional deficiencies
Consult with dietitian
Encourage tube feedings and eating
Psycho/social
Lives in Spokane, WA with his girlfriend
Divorced with 6 kids
Retired
Pathophysiology
Adenocarcinoma is a type of cancer that starts in mucus-producing glandular cells of your body. Your glands make fluids that your body needs to stay moist and work well. You get adenocarcinoma when cells in the glands that line your organs grow out of control. They may spread to other places and harm healthy tissue. Adenocarcinoma usually starts in mucus glands that line the lower part of your esophagus. Treatment usually consists of chemotherapy, radiation, specific therapy and surgery.
Secondary Diagnosis
Severe Protein Calorie Malnutrition related to chronic illness
Refusal of J tube feedings
NPO diet for several days
22% unintentional weight loss past 6 months
Ht: 5 ft 10 in
Wt: 150 lb
Chronic Illness
Medical History
Acid reflux
Anemia
Depression
Anxiety
Arthritis
hiatal hernia
coronary artery disease
hyperlipidemia
acute renal failure
Chronic kidney disease (stage 3)
paroxysmal atrial fibrillation
esophageal dysphagia
Prediabetes
Embolisms/occlusions of extremity veins
cardiomyopathy
chemotherapy and radiation (October to December 2019)
Surgical History
Abdominal Aortic Aneurysm (9/27/18)
Aortic Valve Replacement (3/5/18)
Coronary Artery Bypass Graft (6/2014)
Coronary Angioplasty w/stent (2007)
GI endoscopy (9/17/19 & 9/26/19)
Family History
Paternal; heart disease
Treatment
Patient went in for a esophagectomy (2/14/2020), which was aborted due to peritoneal metastasis. Esophageal Stent was placed (2/17/2020)
Patient was on a clear liquids (2/18/2020) and then was advanced to dental soft, fiber restricted (2/19/2020)- patient has refused tube feeding
Receive PO medications through J tube
Risk for thrombosis formation r/t surgery
Prophylaxis heparin adminstration
Promote mobility
Risk for falls r/t surgery and anticoagulation therapy
supervision when active
Nutritional Deficiencies r/t diet and refusal of tube feedings AEB low electrolyte levels
consult dietician
Consult Chaplain for emotional support of prognosis