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CSO Exam 2018 > Chapter 4: Nutritional Needs of the Adult Oncology Patient > Flashcards

Chapter 4: Nutritional Needs of the Adult Oncology Patient Flashcards

1
Q

What is “disease-related malnutrition”?

A

when the severity of persistence of inflammation results in a decrease in lean body mass, causing functional impairment.

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2
Q

In chronic disease-related malnutrition, successful nutrition intervention must address ____ and ____.

A

the underlying health condition and its nutritional needs.

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3
Q

Why do individuals with cancer have an increased requirements for macro- and micro nutrients?

A

Due to periods of under nutrition (before and after diagnosis) and because of the metabolic effects from the cancer and its treatment.

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4
Q

Which cancers have the highest energy expenditures?

A

Esophageal, gastric, pancreatic and non-small cell lunch cancers.

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5
Q

Which cancer showed no change in energy expenditure?

A

Colorectal cancer

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6
Q

Longer-term consequences of under-feeding?

A

Loss of lean body mass, immunosuppression, poor wound healing and risk of hospital acquired infections.

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7
Q

Longer-term consequences of over-feeding?

A

Respiratory failure d/t increased CO2 production, hyperglycemia, azotemia (high levels of nitrogen-containing compounds), hypertriglyceridemia, electrolyte imbalances, immunosuppression, alterations in hydration status and hepatic statosis.

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8
Q

The DRI for protein for healthy adults?

A

0.8 g/kg/day

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9
Q

Recommended protein range for catabolic individuals?

A

1.2-2.0 g/kg/day

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10
Q

Protein for metabolically stressed individuals?

A

1.5 g/kg/day

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11
Q

The RDA for carbohydrate?

A

130 g/day

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12
Q

How can a person meet their essential fatty acid needs and with which fats?

A

Linoleic acid: 2-4% of total calories

Alpha linolenic acid: 0.25-0.5% of total calories

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13
Q

A.S.P.E.N. guidelines for carbs and fat for those receiving nutritional support?

A

Carbohydrate: <7 g/kg/day
Fat: <2.5 g/kg/day

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14
Q

Factors impacting hydration status in the elderly?

A

Impaired thirst mechanism, access issues and decreased mobility.

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15
Q

In the palliative care setting, how many mL of fluid/day is acceptable?

A

1000 mL

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16
Q

List three methods for fluid requirements?

A

A.S.P.E.N.: 20-40 mL/kg/day or 1-1.5 mL/kcal energy expenditure
RDA: 1 mL/kcal energy consumed
Body Surface Area (BSA): 1500 mL/M2 or BSA x 1500 mL

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17
Q

Micronutrient goal?

A

100% of the RDAs

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18
Q

Which minerals decrease during the inflammatory process?

A

selenium, copper, iron and zinc

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19
Q

Which vitamins are usually not effected by inflammation?

A

B1, B2, B12 and folate

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20
Q

what is sarcopenia?

A

the degenerative loss of skeletal muscle mass

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21
Q

What are 3 ways to estimated energy needs?

A

Direct calorimetry, Indirect calorimetry, Predictive equations.

22
Q

What is the gold standard of measuring energy needs?

A

Indirect caloimetry

23
Q

Direct calorimetry

A

Used infrequently, and mostly a research method which measures heat from macronutrient consumption released from the subject.

24
Q

Indirect calorimetry (IC)

A

Uses oxygen consumption and carbon dioxide production but the equipment is not always available

25
Q

Predictive equations

A

developed for select patient populations and used to assess energy needs

26
Q

BEE

A

Basal Energy Expenditure: minimum amount of energy expended to be compatible with life.

27
Q

BMR

A

Basal Metabolic Rate: measurement of the baseline energy expended; measured early in the morning before activity and 10-12 h after ingestion of food, beverage or nicotine. Is measured in a temperate environment

28
Q

RMR

A

Resting Metabolic Rate: energy expended at rest; measured after fasting for at least 5 hours, generally 10-20% higher than BMR

29
Q

REE

A

Resting Energy Expenditure: energy needs to maintain normal body functions; measured after 30 min of recombinant rest

30
Q

EEE

A

Estimated Energy Expenditure: energy needed per day to maintain normal body functions

31
Q

EER

A

Estimated Energy Requirements: average predicted nutrition intake for maintenance of energy balance and good health based on age, gender, weight, height, and activity level

32
Q

PAL

A

Physical Activity Level: 4 levels: sedentary, low active, active, and very active

33
Q

RQ

A

Respiratory Quotient: calculation derived from IC using carbon dioxide expended and oxygen consumed

34
Q

What does an RQ below 0.7 indicate?

A

hypoventilation or prolonged fasting

35
Q

What does an RQ over 1.0 indicate?

A

hyperventilation, overfeeding or inaccurate gas collection.

36
Q

Mifflin-St Jeor Equation is best for?

A

(using actual wt) Best at predicting RMR in non-obese and obese populations age 20-82 years

37
Q

Harris-Benedict Equation?

A

Estimated energy needs in healthy adults. Not to be used in acutely or critically ill pts.

38
Q

Best equations to use to assess energy needs for acutely ill populations?

A

Mifflin-St Jeor and Ireton-Jones Equations

39
Q

Best equations to use to assess energy needs for critically ill populations?

A

Penn State Equation and the Swinamer equation and the Ireton-Jones equation

40
Q

Which equation is best to estimate the needs of the mechanically ventilated critically ill pt?

A

Swinamer Equation

41
Q

Which equation is best to estimate the needs of the ventilator-dependent critically ill pt?

A

Ireton-Jones Equation

42
Q

Best equations to assess energy needs of obese?

A

11-14 kcal/kg of actual wt in hypometabolic disease (without renal or hepatic dysfunction)
11-18 kcal/kg of actual body wt (without renal or hepatic dysfunction)
22 kcal/kg IBW (without renal or hepatic dysfunction)

43
Q

Energy needs for cancer (for weight gain)

A

30-35 kcal/kg

44
Q

Energy needs for cancer (inactive, non-stressed)

A

25-30 kcal/kg

45
Q

Energy needs for cancer, hypermetabolic, stressed

A

35 kcal/kg

46
Q

Energy needs for sepsis

A

25-30 kcal/kg

47
Q

Energy needs for Hematopoietic cell transplant

A

30-35 kcal/kg

48
Q

What is best to use: actual wt, adjusted wt or IBW?

A

Actual wt

49
Q

What is one sign that a pt is suffering from re-feeding syndrome?

A

3 days after the start of re-feeding, they may get hypophosphatemia.

50
Q

Energy needs for re-feeding?

A

20 kcal/kg or no more than 1000 kcal per day and advance as tolerated while monitoring electrolytes.
(or start with 25% of estimated needs and increase over 3-5 days).

CSO Exam 2018 (32 decks)

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