Muhammad AN1 , Haishah H1, Raihana MS1
Universiti Kebangsaan Malaysia
A 67 years old, married Malay female was on POD17 post TAHBSO with resection of vaginal mass and Hartman procedure of supravaginal GIST complicated with perforated lower rectum. She had wound breakdown on POD14 post operation during follow up in day care. Then, she had an exploratory laparotomy for wound breakdown closure and was referred to dietitian on POD2 for high protein diet. Patient had underlying of DM and hypertension, CKD stage 3 and history of left parotid tumour. Patient has a family history of DM (mother) and no history of malignancy in family.
Upon reviewed by dietitian, patient had moderate weight loss of 5.5% in 6 months with BMI 35.4 kgm-2. Patient had poor appetite due to vomiting post operation. SGA was graded as B. Stoma output was normal. Patient started on nourishing fluid with intake only constituted around 37% of requirement and 47% of protein requirement (0.37g/kg BW), indicated as inadequate energy and protein intake since post operation.
Inadequate protein-energy intake related to lack of interest of food due to low appetite and vomiting as evidenced by patient only achieved 37% of requirement, 47% of protein requirement.
Nutrition intervention targeted at least 75% of energy requirement, protein at 0.80-1.0 g/kg due to CKD stage 3 and post operation. Oral nutrition supplement was prescribed to increase protein-energy intake (at least 50% of requirement). Nutrition counselling focusing on tips to increase protein-energy intake, tackle the barriers such as vomiting, LOA in elderly and highlight the importance of protein intake in the wound healing towards patient.
Monitoring & Evaluation
Patient hardly achieved the energy and protein recommendation due to vomiting. Personalized meal plan has been developed as guidelines for patient at home upon discharge.