Chapter 14: Nutrition Management of the Surgical Oncology Patient

Question 1

Surgeries to which locations have the greatest rick for derangements in nutritional status?

Answer 1

Head and neck, GI tract, and abdominal casculature

Question 2

T/F: Pre-operative screening should include subjective and objective data.

Answer 2

True

Question 3

Decreased albumin is associated with ….

Answer 3

increased surgical morbidity and mortality, sepsis, and healing complications.

Question 4

T/F: Enteral tube feeding provided for 10 days prior to surgery can reduce morbidity and mortality in malnourished surgical patients by preserving bowel mucosa and modulating the immune response.

Answer 4

True

Question 5

The risks of enteral nutrition outweigh the benefits in the cases of….

Answer 5

ascites, peritoneal carcinomatosis or inoperable bowel obstruction.

Question 6

T/F: Early post-operative enteral feeding in patients with moderate or severe pre-operative malnutrition can improve surgical outcomes.

Answer 6

True

Question 7

T/F: Following major abdominal surgery, the small bowel regains function almost immediately.

Answer 7

True

Question 8

After intestinal resection, the GI tract may take ___ to ___ to regain function.

Answer 8

weeks to months

Question 9

After intestinal resection, patients resume oral intake with ___ days postoperatively.

Answer 9

6-9 days

Question 10

Nutrition support is indicated only in individuals anticipated to require support for more than___ days, unless the patient is malnourished.

Answer 10

7-10 days

Question 11

Nutrition support should continue until oral intake is tolerated and consistently meets ___ to ___ of their nutrition and ____ mL fluid for 3 consecutive days.

Answer 11

2/3 to 3/4, 1000 mL

Question 12

When intake reaches ___% of needs, nutrition support should be progressively weaned as oral intake increases.

Answer 12

50%

Question 13

Surgery to the GI tract can be associated with altered transit time. What are the symptoms of altered transit time?

Answer 13

Transit time may be too fast, too slow, or even occur in the wrong direction. Dumping syndrome, heartburn, feelings of fullness, pain, meteorism, abdominal distention, dysphagia, constipation or diarrhea

Question 14

What kind of tube is ofen placed at the time of esophageal surgery?

Answer 14

Jejunostomy

Question 15

Remival of the lower esophageal sphincter (LES), often causes ___

Answer 15

Acid reflux into the esophagus

Question 16

What is achlorhydria?

Answer 16

The decrease or cessation of the production pf stomach acid.

Question 17

Achlorhydria can lead to ___?

Answer 17

Bacterial and fungal overgrowth which can cause pain when eating and lead to suboptimal intake.

Question 18

Loss of stomach acid and IF may lead to…?

Answer 18

B12 malabsorption which can cause megaloblastic anemia and dementia.

Question 19

Delayed stomach emptying is associated with….?

Answer 19

Early satiety, heartburn, dysphagia, aspiration and pneumonia

Question 20

What is short bowel syndrome?

Answer 20

Having less than 30% of normal intestinal length (75 cm in kids, 200 cm in adults).

Question 21

Individuals with an ileostomy are at increased risk for ___?

Answer 21

Dehydration and electrolyte abnormalities.

Question 22

How much fluid are ileostomy patients instructed to take?

Answer 22

1 L more than their ostomy output.

Question 23

Nutrition intervention for Dumping Syndrome?

Answer 23

Small frequent meals, separation of solids and fluids at meals, reduction of simple carbohydrates and comcentrated fat, increase in soluble fiber.

Question 24

Nutrition intervention for reflux esophagitis?

Answer 24

Small frequent meals, low fat, avoid alcohol, comsume smaller volumes per meal/snack, use antacids

Question 25

Manifestations of reflux esophagitis?

Answer 25

Regurgitation of food and digestive juices causing heartburn, nausea, vomiting.

Question 26

Diet guidelines after intestinal surgery.

Answer 26

• small freqent meals
• chew foods well
• choose high protein foods at each meal/snack
• avoid high fiber foods (limit fiber to 20 g or less per day)

Question 27

Peritoneal cancer patients usually present with..

Answer 27

General GI symptoms such as abdominal bloating and cramping, nausea, diarrhea, constipation and anorexia which usually result in weight loss.

Question 28

After peritoneal surgery, PN is often needed initially because of what the develops after surgery?

Answer 28

ileus. Once the ileus resolves and GI function returns to normal, PN can be transitioned too EN.