Denielle Saitta

NCP
Cancer and Diabetes
I.

Introduction: Patient Profile

Mr. S is a 65 year old, African-American male recently diagnosed with multiple myeloma
and type 2 diabetes.
II.

Disease Process
Multiple myeloma is a cancer made by malignant plasma cells. Normal plasma cells are
located in bone marrow and are a main part of the immune system. While the immune system is
made up of numerous types of cells that together work to bout infections and other diseases
lymphocytes (lymph cells) are the main cell type in the immune system. There are two types of
lymphocytes which are T and B cells. When B cells respond to an infection, they change into
plasma cells. Plasma cells create the antibodies that support the body and attack germs. When
plasma cells become cancerous, they can form a tumor called a plasmacytoma. If an individual
has more than one plasmacytoma, they have multiple myeloma.
Multiple myeloma is characterized by several features such as low blood count, bone and
calcium problems, infections kidney problems, monoclonal gammopathy, light chain
amyloidosis, Monoclonal gammopathy of undetermined significance, or Solitary plasmacytomas.
Chemotherapy is the usage of drugs to destroy or regulate cancer cells and can be taken
by mouth or given in a vein or a muscle. Chemo enters the bloodstream and is able to reach all
areas of the body, making it useful for cancers that often spread throughout the body, like
multiple myeloma.
Chemotherapy kills cancer cells but also can damage normal cells. These drugs are
administered cautiously to avoid or lessen the side effects. Side effects depend on the type and
dose of chemotherapy given and the length of time taken. Common side effects of chemotherapy
include hair loss, mouth sores, loss of appetite, nausea and vomiting, and low blood counts.
Often treatment leads to low blood counts, which can cause an increased risk of serious
infection, easy bruising or bleeding, tiredness or short of breath.
Good nutrition is particularly imperative if you have cancer because the illness and
treatments can change the way you eat. Cancer and the treatments can also upset the way your
body reacts to certain foods and uses nutrients.
The nutrient needs of patients with cancer vary by each person. Healthy eating while
going through treatment might help with a number of things such as keeping strength and energy,
maintaining weight and body stores of nutrition, tolerate treatment-related side effects better,
lower the risk of infection, and heal/ recovery. Eating well means eating a variety of foods to get
the nutrients your body needs to fight cancer. These nutrients include protein, carbohydrates, fat,
water, vitamins, and minerals.

During treatment a persons diet may change to help build strength and withstand the
effects of the cancer and treatment. This may mean consuming foods that are not normally
recommended when you are in good health.
For example, a high-fat, high-calorie diet to keep weight up, or cold foods like ice cream
or milk shakes due to sores in a persons mouth and throat making it hard to eat. The type of
cancer, treatment, and side effects must be considered when trying to figure out the best
nutritional needs for an individuals body. Some of the more common side effects that can affect
eating are loss of appetite, sore mouth or throat, dry mouth, dental problems, changes in taste or
smell, nausea, vomiting, diarrhea, constipation, tiredness, or depression.
III.

Patient history: Medical conditions consist of bipolar disorder, secondary diabetes,

multiple myeloma, malignant hypertension, unspecified constipation, unilateral inguinal
hernia, nontoxic multinodular goiter, unspecified deficiency anemia, mixed
hyperlipidemia, neuroleptic induced Parkinsonism, Tardive dyskinesia. Mr. S is
considered to be at high risk for the development of metabolic syndrome secondary to his
diagnosed hypertension, diabetes and hyperlipidemia, and at high risk for complications
associated with his diabetes due to precious elevations in blood sugars.

IV.
Course of hospital treatment Chemotherapy for multiple myeloma. Mr. S is receiving
several cycles of IV Velcade and Dexamethasone chemotherapy. Also Revlimid po at higher
doses daily for 21 days and then 7 days off.
V.
Nutrition Care
a. Nutrition Assessment
Weight
o 191 lb = 86.82 kg
Height
o 5 7 = 67 in = 1.7018 m
BMI
o ((86.8181)/((1.7018)) / 1.7018 = 29.9 kg/m2
o Obese
Ideal Body Weight
o 106 + 6(7) = 148 lb
o 191/148 = 129%

Labs
o Albumin: 3.7 (Normal 3.0 5.0)
o Calcium: 8.9 (Normal 8.5
10.5)
o Alkaline Phosphate: 66 (Normal
38 126)
o Potassium: 4.0 (Normal 3.5
5.1)
o Creatinine: 0.83 (Normal 0.50
1.25)

o Total Protein: 6.7 (Normal 6.0

8.4)
o Glucose: 145 (Normal 74
106)
o Sodium: 142 (Normal 137
145)
o BUN: 23.0 (Normal 9.0 21.0)
o Cholesterol: 133 (Normal 112
199)

o Triglyceride: 65 (Normal 36
150)
o HDL: 46 (Normal 60 96)
o LDL: 74 (Normal 60 100)
o Cholesterol HDLC Ratio: 2.89
(Normal 0.00 4.96)
Medications
o Ativan (Lorazepam)
o Catapress (Clonidine)
o Cogentin (Benztropine
Mesylate) Take with
food
o Colace (Docusate
Sodium)
o Glucophage (Metformin
Hydrochloride), 2x a day
& varying doses Do
not drink alcohol
o Glucotrol XL (Glipizide)
Do not drink alcohol
o Lamictal (Lamotrigine)
Do not drink alcohol
o Lopressor (Metoprolol
Tartrate) No licorice
o Milk of magnesia
o Motrin (Ibuprofen), as
needed for pain

o WBC: 4.3 (Normal 4.5 11.0)

o RBC: 4.0 (Normal 3.8 5.8)
o HGB: 12.5 (Normal 12.6
17.4)
o HCT: 38.8 (Normal 37.0 51.0)

o Multivitamin w/ Iron
o Revlimid 10 MG PO
QHS, treatment for
multiple myeloma to
help immune response
o Norvasc (Amlodipine
Besylate)
o Pepto Bismol (Bismuth
Subsalicylate), as needed
for nausea
o Prinicil (Lisinopril) No
licorice
o Tylenol
(Acetaminophen), as
needed for pain/fever
o Vitamin D3
(Cholecalciferol)
o Zypreza (Olanzapine)
Increase appetite

Nutrition Needs
o Kcal: 2604 3038 kcal (30 35 kcal/kg)
o Protein: 86.8 g protein (greater than or equal to 1 g/kg)
o Fluid: 2604 cc
Diet order
o Diabetic diet, 2200 calorie diet, normal texture and consistency. Glucerna
1.5 cal as needed with meals and snacks. Sugar free powerade. Gatorade
for hydration.
Other: Experienced a 25#/11% weight loss during last month during
hospitalization. Has experienced some nausea and vomiting. Blood glucose levels
sometimes high, on SSI and BS checks. HgB low but improved. Has been
gradually advanced from liquid diet to regular texture. FS prepared to modify diet
per his needs and requests.
b. Diagnosis (PES) Statement
Potential risk for nutritional deficit related to cancer diagnosis and treatments as
evidenced by medical record.
Potential risk for complications of hyperglycemia related to diabetes DX as
evidenced by elevated fasting blood glucose lab values (145).
c. Intervention Plan & Implementation
Nutrition related to health/disease: Nutrition education on type 2 diabetic diet,
high carbohydrate foods and low sugars, snack ideas. Provide information on
healthy food options for cancer treatment and immune system, high iron and
calcium food items.
d. Monitoring/Evaluation
Will monitor weight, patient reported intakes, lab values, maintain nutritional
status until end of treatment.
e. Documentation
Completed