Instruction:

Please discuss the problems and factors of the issues in this case. Please discuss how you thought about the case as well as your conclusions. The problems are related to the nutritional-metabolic pattern.

65-year-old man treated with a lobectomy for lung cancer on February 8. His situation on February 13 is given below.

Activity level

Although the patient can walk around the ward freely, he is usually found in a supine position on the bed when nurses visit his room. He said “There is nowhere I want to go to”.

Eating

A meal of gruel (1600 kcal) was served for lunch on February 10. From February 10 to 13, he consumed half of every meal. The daily energy requirement for this patient is 1600 kcal calculated by age, physique, and activity level. After breakfast on February 13 he said “I might not be hungry because I do not walk”.

Cleanliness

Showering is not allowed yet. Bed-bath is conducted with some assistance. When a nurse hands him a towel, he can maintain a sitting position and independently wipes his body. Wiping his back and lower extremities requires assistance.

Excretion

He can walk to the restroom and self-excrete.

After surgery, there was a little stool on only the 10^th.

He said he has no desire to defecate but voiced that “My stomach feels heavy”.

Blood test

WBC

RBC

Hb

TP

ALB

CRP

Admission day

5500/μl

4.7 million/μl

14.0 g/dl

6.7 g/dl

3.5 g/dl

0.203 mg/dl

February 12

8080 μ/l

4.5 million/μl

11.2 g/dl

5.8 g/dl

2.5 g/dl

1.543 mg/dl

Baseline

3600 - 9300/μl

4.3 - 5.54 million/μl

13.8 - 16.9 g/dl

6.6 - 8.1 g/dl

4.1 - 4.9 g/dl

Under 0.6 mg/dl