Week 3: I-Human (Redo)
Primary Diagnosis: Esophageal Neoplasm
Status/Condition: Critical
Code Status: Full Resuscitation Code Status
Allergies: Seasonal Allergies but no known food or drug allergies
Admit to Unit: Admit to the ICU for diagnosis/management of esophageal neoplasm, and
monitor/protect airway.
Activity Level: Will maintain on bedrest to rule out whether patient’s fatigue is related to
primary diagnosis.
Diet: NPO for barium swallow study and EGD with biopsy (Merck Manual, 2019). After
procedure will refer to speech therapy’s recommendations for dietary needs. If patient tolerates
will maintain on clear liquid diet. Dependent on the plan of care that the patient wishes to
proceed with can determine what diet status they have after a confirmed diagnosis of esophageal
cancer. If patient is undergoing chemotherapy, radiation, and order surgery the best choice of
nutrition during this time may be PEG tube feeding or TPN IV gtt (Mayo Clinic, 2018).
IVF: During NPO status for procedures (before confirmation of diagnosis) it is important to start
D5W@75cc/hr to keep patient’s blood sugars in a normal range until further nutritional decisions
can be made.
Critical Drips: If TPN is ordered for patient’s management of nutritional status.
-TPN@75cc/hr and Lipids@10cc/hr (Nutrition consult will appropriately dose according to
patient’s weight and caloric needs)
Respiratory: Apply supplemental oxygen via nasal cannula to support patient’s oxygen
requirements. Start at 2 L O2 NC and titrate up as necessary to keep O2 saturation >95%.
Perform pulmonary toilet needs such as cough, deep breathing, suctioning, and frequent oral
care. Be sure to frequently monitory patient’s respiratory status and ability to maintain airway
due to primary diagnosis.
Medications:
(include ALL, tx of primary condition, underlying conditions, pain, comfort needs etc. dose and
route)
-Continue patient’s home medications if able to tolerate PO medications
-Rantidine 150 mg PO BID PRN heartburn
-Tums (Calcium Bicarbonate) 500 mg PO TID PRN heartburn
-Aspirin 81 mg PO QD **Due to (+)occult stool, need to hold medication**
-Tamulosin 4 mg PO Q HS for BPH
-Zofran 4mg/2mL IVP Q4H PRN for nausea/vomiting (especially if patient pursues
chemotherapy, or radiation treatments)
Primary Diagnosis: Esophageal Neoplasm
Status/Condition: Critical
Code Status: Full Resuscitation Code Status
Allergies: Seasonal Allergies but no known food or drug allergies
Admit to Unit: Admit to the ICU for diagnosis/management of esophageal neoplasm, and
monitor/protect airway.
Activity Level: Will maintain on bedrest to rule out whether patient’s fatigue is related to
primary diagnosis.
Diet: NPO for barium swallow study and EGD with biopsy (Merck Manual, 2019). After
procedure will refer to speech therapy’s recommendations for dietary needs. If patient tolerates
will maintain on clear liquid diet. Dependent on the plan of care that the patient wishes to
proceed with can determine what diet status they have after a confirmed diagnosis of esophageal
cancer. If patient is undergoing chemotherapy, radiation, and order surgery the best choice of
nutrition during this time may be PEG tube feeding or TPN IV gtt (Mayo Clinic, 2018).
IVF: During NPO status for procedures (before confirmation of diagnosis) it is important to start
D5W@75cc/hr to keep patient’s blood sugars in a normal range until further nutritional decisions
can be made.
Critical Drips: If TPN is ordered for patient’s management of nutritional status.
-TPN@75cc/hr and Lipids@10cc/hr (Nutrition consult will appropriately dose according to
patient’s weight and caloric needs)
Respiratory: Apply supplemental oxygen via nasal cannula to support patient’s oxygen
requirements. Start at 2 L O2 NC and titrate up as necessary to keep O2 saturation >95%.
Perform pulmonary toilet needs such as cough, deep breathing, suctioning, and frequent oral
care. Be sure to frequently monitory patient’s respiratory status and ability to maintain airway
due to primary diagnosis.
Medications:
(include ALL, tx of primary condition, underlying conditions, pain, comfort needs etc. dose and
route)
-Continue patient’s home medications if able to tolerate PO medications
-Rantidine 150 mg PO BID PRN heartburn
-Tums (Calcium Bicarbonate) 500 mg PO TID PRN heartburn
-Aspirin 81 mg PO QD **Due to (+)occult stool, need to hold medication**
-Tamulosin 4 mg PO Q HS for BPH
-Zofran 4mg/2mL IVP Q4H PRN for nausea/vomiting (especially if patient pursues
chemotherapy, or radiation treatments)
