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CSO Exam 2018 > Chapter 12: Symptom Management of Cancer Therapies > Flashcards

Chapter 12: Symptom Management of Cancer Therapies Flashcards

1
Q

Common Nutrition Impact Symptoms of people going through cancer treatment?

A

anorexia, poor appetite, early satiety, constipation, diarrhea, malabsorption, dysphagia, mucositis, esophagitis, oral candidiasis, xerostomia, thick saliva, taste and smell changes, or fatigue.

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2
Q

What is Anorexia?

A

the loss of appetite or desire to eat

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3
Q

What are potential nutritional outcomes of anorexia?

A

weight loss, nutrient insufficiencies & deficiencies, dehydration

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4
Q

Nutrition Interventions for anorexia.

A

small, frequent meals of calorie-dense foods and fluids, eat in pleasant surroundings, avoiding stress or conflict at meals, eat by the clock rather than waiting for appetite or hunger cues, view eating as part of treatment, use medical nutritional beverages when eating is too hard, use easy to prepare foods, engage in light activity to stimulate appetite.

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5
Q

Other considerations for anorexia?

A

Look for other conditions that may depress appetite (constipation or depression), and look for medications that may depress appetite (meds that manage constipation, nausea, or pain)

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6
Q

Nutrition interventions for Early Satiety?

A

choose calorie dense foods or medical nutritional beverages, maximize intake when most hungry, eat small frequent meals/snacks, eat by the clock, eat by the clock rather than hunger cues, consume liquids between meals instead of with meals.

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7
Q

Other considerations for early satiety?

A

Evaluate for conditions that may slow gastric emptying (GERD, diabetes, gastroparesis, obstruction), evaluate for use of medications that may slow gastric emptying (opioids, H2 receptor antagonists, proton pump inhibitors, sucralfate, interferon, levadopa)

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8
Q

What is Constipation?

A

The decrease in frequency of bowel movements and or hard to pass stools that may be due to dehydration, medication or mechanical changes from anticancer therapy.

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9
Q

Potential nutrition outcomes of constipation?

A

infrequent or hard to pass stools, pain, early satiety, nausea, vomiting

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10
Q

Nutrition diagnosis of constipation?

A

altered GI function related to inadequate food, fluid and/or fiber intake or medications.

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11
Q

Nutrition interventions for constipation?

A

Education pt on importance of adequate hydration, fiber intake, and total food intake on bowel regularity.
Aim for 64 oz fluid per day and a slow increase to 25-35 grams of fiber per day as tolerated.
Encouraged use of hot beverages, hot cereal or high fiber food to stimulate bowel movements.
Incorporate probiotics and/or other supplements that help regular bowel movements. Engage in light activity to stimulate bowel regularity. Discuss meds that may effect bowel movements, schedule adequate bathroom time.

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12
Q

What is Diarrhea?

A

An increase of three or more stools per day as compared to usual or an increase in liquidity of bowel movements possibly caused by diet, emotional stress, inflammation or irritation of the mucosa of the intestines, medications or cancer treatment or lactose intolerance.

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13
Q

Nutrition diagnosis for Diarrhea?

A

Altered GI function related to inability to digest/absorb certain foods, anticancer treatment, and or medications.

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14
Q

Potential nutrition outcomes of Diarrhea?

A

Frequent stools, dehydration, electrolyte imbalances, weight loss, fatigue, nutrient insufficiencies and deficiencies, malnutrition.

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15
Q

Nutrition interventions of Diarrhea?

A

Identify problem foods or eating habits via food/symptom log, encourage low fat, low fiber, and or low lactose diet, avoid gas producing foods, caffeine and alcohol. Consider the use of bulking agents (soluble fiber) to control diarrhea. Avoid sugar alcohols.

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16
Q

What is Dysphagia?

A

Pain or difficulty swallowing that leads to decrease intake.

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17
Q

Possible causes of Dysphagia?

A

extrinsic compression of the esophagus, mechanical obstruction, neurological dysfunction, oral or esophageal candidasis, or sever mucositis, or esophageal radiation

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18
Q

Nutrition diagnosis of Dysphagia?

A

Inadequate oral intake related to swallowing difficulty

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19
Q

Potential nutrition outcomes of Dysphagia?

A

Dehydration, coughing, choking, feeling of “food getting stuck”, pain while swallowing, weight loss, nutrient insufficiencies and deficiencies, dehydration, malnutrition.

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20
Q

Nutrition interventions of Dysphagia?

A

Use of good posture when eating to prevent aspiration, avoid distractions and limit talking while eating, encouraged double swallows to assure food clears, encourage verbalization after drinks to assure liquids have cleared, choose moist foods of a similar texture, consider using thickeners in liquids to slow flow and allow safe swallow, avoid straws, alter food texture as needed for safe swallow.

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21
Q

What is oral candidiasis?

A

May be an opportunistic infection seen as red or white patches in the mouth due to treatment or a depressed immune status, causing taste alterations, sore mouth, and coated tongue.

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22
Q

Nutrition Diagnosis of candidiasis?

A

Inadequate food and beverage intake related to infection, taste alterations, and a sore mouth.

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23
Q

Potential Outcomes of Candidiasis?

A

sore mouth and throat, decrease in food intake, weight loss, malnutrition

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24
Q

Nutrition interventions for Candidiasis?

A

practice good oral hygiene, choose soft textured, low acid foods, avoid sugar and yeast-derived foods

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25
Q

What is Fatigue?

A

Lack of energy, tiredness, and mental fuzziness

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26
Q

Possible causes of Fatigue?

A

anemia, inadequate energy and/or protein intake, weight loss, pain, medications, acticancer treatment, dehydration, and/or sleep disturbances.

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27
Q

Nutrition diagnosis of Fatigue?

A

inadequate food and beverage intake or involuntary weight loss related to inadequate energy or protein intake, fatigue, pain or medications.

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28
Q

Potential outcomes of Fatigue?

A

poor oral intake, weight loss, weight gain, depression

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29
Q

Nutrition interventions for Fatigue?

A

Review food/fluid intake for adequacy, monitor weight and adjust calories as needed, encourage easy to prepare foods, advise use of non-perishable snacks (trail mix), consume soft, easy-to-chew foods, small frequent meals, eat well when appetite is best (morning), encouraged light ADL

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30
Q

Other considerations for Fatigue?

A

evaluate for anemia as a cause of lack of energy. Pt may need mvi

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31
Q

What is Malabsorption?

A

decreases in the ability to digest and absorb nutrients.

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32
Q

Possible causes of Malabsorption?

A

chemotherapy, surgery, medications, medical conditions, or infections

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33
Q

Possible symptoms of Malabsorption?

A

gas, bloating, gastrointestinal pain and/or diarrhea

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34
Q

Nutrition diagnosis of Malabsorption?

A

altered GI function related to disease process, infection, surgery, medications, chemotherapy, or radiation

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35
Q

Potential nutrition outcomes of Malabsorption?

A

abnormal digestive enzyme studies, cachexia, steatorrhea, weight loss, dehydration, fatigue, nutrient insufficiencies and deficiencies, malnutrition

36
Q

Nutrition interventions for bloating and gas?

A

avoid cruciferous vegetables and limit swallowed air by avoiding use of straws, carbonated beverages and chewing gum and by eating slowly with mouth closed

37
Q

Nutrition intervention for bloating, cramping, and gas from milk products?

A

eat low lactose diet and use lactase treated dairy products or lactase pills or drops

38
Q

Nutrition intervention for gas from beans and legumes

A

avoid these foods and use Beno drops

39
Q

Nutrition intervention for chronic diarrhea?

A

try a low insoluble fiber, low fat, low lactose diet

40
Q

Nutrition intervention for bulky, foul smelling stools?

A

eat a low fat diet and use pancreatic enzymes

41
Q

Nutrition intervention for fatty stools

A

try a low fat diet and use pancreatic enzymes

42
Q

What is Mucositis/Esophagitis

A

The inflammation of the mouth or espophagus, usually described as a painful, irritated throat or the feeling of a lump in the throat.

43
Q

What are some symptoms of Mucositis/Esophagitis?

A

indigestion, esophageal reflux, belching, feeling of fullness, and early satiety

44
Q

Nutrition diagnosis of Mucositis/Esophagitis?

A

Inadequate energy intake related to disease process or treatment that produces pain when swallowing

45
Q

Potential Outcomes of Mucositis/Esophagitis?

A

weight loss, nutrient insufficiencies and deficiencies, malnutrition

46
Q

Nutrition intervention for Mucositis/Esophagitis?

A

lower acidity foods, low spice foods, soft texture foods with added moisture (gravy, etc), creamy soups, mashed potatoes, etc, cool/room temp foods, smoothies with low acid fruits and tofu, avoid alcohol and tobacco

47
Q

What are some causes of Nausea/Vomiting?

A

chemotherapy, radiation, immunotherapy, pain, dysguesia (change in sense of taste), fatigue, mucous drainage, flu, constipation, psychological factors and or medications such as antibiotics and narcotics

48
Q

Nutrition diagnosis for Nausea/Vomiting?

A

Inadequate oral food/beverage intake and altered GI function related to disease process or treatment

49
Q

Potential outcomes of Nausea/Vomiting?

A

dehydration, electrolyte imbalances, weight loss, nutrient insufficiencies and deficiencies

50
Q

Nutrition interventions of Nausea/Vomiting?

A

5-6 small meals/day, limit exposure to food smells, cool, light foods, avoid high fat foods, consume liquids between meals, avoid strong smelling soaps, perfumes, etc, rest with head elevated for 30 min after eating, if taking pain meds, take with crackers or light food.

51
Q

Other considerations for Nausea/Vomiting?

A

consider use of complementary therapies such as ginger tea, ginger ale, acupressure bracelet, relaxation techniques

52
Q

Symptoms of changes to taste and smell?

A

Caused by radiation and chemotherapy, characterized by having little or no sense of taste and smell or heightened sense of metallic, bitter, salty or sweet taste (normal taste may take up to a year to return)

53
Q

Nutrition diagnosis of taste and smell?

A

Inadequate food and beverage intake related to taste and smell changes

54
Q

Potential outcomes of taste and smell?

A

decreased intake, nutrient insufficiencies and deficiencies, weight loss

55
Q

Nutrition interventions when foods have no taste?

A

choose fruit marinades for meats, use lemon, herbs an spices, pickles or hot sauce to flavor foods

56
Q

Nutrition interventions when food has an “off” taste?

A

fruity or salty flavors are often well accepted and taste correctly. Suggest sugar-free lemon drops, gum, or mints

57
Q

Nutrition interventions for bitter or metallic taste?

A

use spices or seasonings like onion, garlic or chili powder, suck on lemon drops or mints, use plastic utensils, flavor water with lemon or other fruit flavors

58
Q

Nutrition interventions when meat tastes “bitter” or strange?

A

add fruit-based marinades, or sweet and sour sauce to meats, chose alternative protein sources like eggs, beans, tofu or dairy

59
Q

Nutrition interventions when smells are bothersome?

A

avoid cooking ares during meal prep, eat foods that aren’t cooked such as smoothies, cold sandwiches, crackers, cheese, yogurt, and fruit, use a cup with a lid and straw to mask food oders, avoid microwave as it can spread food odors

60
Q

What is Xerostomia?

A

the abnormal dryness of the mouth that causes difficulty eating and talking, taste alterations, and or thick saliva and ropy saliva

61
Q

Nutrition diagnosis for Xerostomia?

A

inadequate food and beverage intake related to difficulty eating

62
Q

Potential outcomes of Xerostomia?

A

decreased oral intake, nutrient insufficiencies and deficiencies, weight loss

63
Q

Nutrition interventions of Xerostomia?

A

small frequent meals, alternate bites and sips at meals, add broth, gravy and sauces to meals and dunk dry foods in liquids, sip fluids throughout the day (aim for 8-10 cups/day), chew on carrots/celery, swish and spit using club soda or carbonated water, use a humidifier at home to moisten the air, good oral hygiene, suck on hard candies, avoid alcohol

64
Q

Pharmacologic interventions for anorexia and early satiety.

A 
Periactin
Decadron
Solu-medrol
Provera
Megase
Reglan
65
Q

Pharmacologic intervention for constipation (Bulking agents).

A

Bran, flaxseed or wheat germ
Citrucel (methycellulose)
Konsyl

66
Q

Pharmacologic intervention for constipation (stool softener/surfactant).

A

Colase (docusate)

Mineral oil

67
Q

Pharmacologic intervention for constipation (osmotic laxative).

A

MiraLAX (polyethylene glycol)
Lactulose
MOM

68
Q

Pharmacologic intervention for constipation (stimulant laxative).

A

Carter’s pills (bisacodyl)

Senocot (senna)

69
Q

Pharmacologic intervention for constipation (herbals).

A

Probiotics
Slippery elm
Aloe juice

70
Q

Pharmacologic intervention for diarrhea (opoid receptor agonist).

A

Imodium AD
Lomotil
Sandostatin
Timcture of opium

71
Q

Pharmacologic intervention for diarrhea (anti-inflammatory, anti-diarrheal).

A

Pepto-Bismol

Kaopectate

72
Q

Pharmacologic intervention for diarrhea (bile acid sequestrant).

A

Questran (cholestyramine)

73
Q

Pharmacologic intervention for diarrhea (anticholinergic).

A

Benadryl (diphenhydramine)

74
Q

Pharmacologic intervention for diarrhea (herbal).

A

Probiotics

75
Q

Pharmacologic intervention for dysphasia (topical spray).

A

Xylocaine (lidocaine spray)

76
Q

Pharmacologic intervention for dysphagia (thickeners).

A

Thick It
Thicken up
Thicken Right
Thick and Easy

77
Q

Pharmacologic intervention for oral candidasis.

A

Polyenes such as nystatin
Azoles such as Diflucan
Chlorhexidine

78
Q

Pharmacologic intervention for fatigue.

A

Blood transfusions

Erythropoietin given as Epogen, Procrit

79
Q

Pharmacologic intervention for malabsorption to reduce gas.

A

Gas-X

Probiotics

80
Q

Pharmacologic intervention for lactose malabsorption.

A

Lactaid

Probiotics

81
Q

Pharmacologic intervention for malabsorption of beans and vegetable starches.

A

Beano

Probiotics

82
Q

Pharmacologic intervention for fat malabsorption.

A

Pancreatic enzymes

83
Q

Pharmacologic intervention for mucositis/esophagitis.

A

Anticeptic gels containing lidocaine
Gargle made of salt and baking soda
Glutamine rinces 5 g 3x/day

84
Q

Pharmacologic intervention for acute nausea and vomiting.

A

Zofran (ondansetron)
Anzemet (dolasetron)
Kytril (granisetron)
Aloxi (palonosetron)

85
Q

Pharmacologic intervention for delayed nausea and vomiting.

A 
Dopamine antagonis: compazine, phenergan
Reglan
Marinol (dronabinol) of Cesamet (nabilone)
Ativan or valium
Decadron or Prednisone
86
Q

Pharmacologic intervention for change in taste and smell.

A

zinc supplements (50 mg of elemental zinc)

87
Q

Pharmacologic intervention for xerostomia thick saliva.

A 
accupuncture
Biotene (gel, liquid, spray)
BioXtra (gel, tablets, spray)
Caphosol
Glandosane
Salivart
Xero-Lube
MouthKote

CSO Exam 2018 (32 decks)

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