Chapter 12: Symptom Management of Cancer Therapies Flashcards
What are the different nutritional side effects from cancer therapies?
Anorexia/poor appetite/early satiety Constipation Diarrhea Dysphagia Oral Candidiasis Fatigue Malabsorption Mucositis/Esophagitis N/V Taste and Smell Changes Xerostomia/Thick Saliva
What are the Nutritional interventions for Anorexia?
Small/Frequent meals of calorie dense foods/fluids
Eat in pleasant surroundings, avoid stress of conflict at meals
Eat by a clock rather than waiting for appetite/hunger cues
View eating as part of treatment
Consume supplements when eating is too tiring
Engage in light physical activity to stimulate appetite
Use easy to prepare and serve foods to preserve energy
What are the Nutritional interventions for Early Satiety?
Choose calorie dense foods/fluids
maximize intake when most hungry
Small/Frequent meals
Eat by a clock rather than waiting for appetite/hunger cues
Engage in light physical activity to help move food through GI tract
Consume liquids between meals, rather than with meals
What are the Pharmacologic Interventions for Anorexia?
Antihistimines - Periactin
Corticosteroids - Decadron, solu-medrol
Progestational agents - Provera, Megace
Prokinetic agents - Reglan
Antidepressant - Remeron
What are the Nutritional interventions for Constipation?
Importance of adequate hydration, fiber intake and total food intake on bowel regularity
Aim for 64 ounces of fluid/day, increase to 25-35 g fiber/day
Encourage hot beverages/cereal/high fiber foods to simulate movements
Incorporate probiotics and/or other supplements that help facilitate bowel movements
Engage in light activity and/or stretching to improve regularity
Discuss medications that affect bowel function and encourage appropriate use of stool softeners
Schedule adequate bathroom time to facilitate bowel movements
What are the Pharmacologic Interventions for Constipation?
Bulking agents - Bran/Flaxseed/wheat germ; Citrucel, Konsyl
Stool surfactants - colace, mineral oil
Osmotic laxatives - MiraLAX, Lactulose, MoM
Stimulant laxatives - Carter’s Pills, Senocot
Herbals - probiotics, slippery elm, aloe juice
What are the Nutritional interventions for Diarrhea?
Identify problem foods/eating habits via a detailed diet and symptom history
As indicated, encourage low fat, low fiber and/or low lactose diet, avoiding gas producing foods, caffeine, and alcohol
small/frequent meals
consider bulking agents, pectin, or soluble fiber foods to control diarrhea
avoid sorbitol or other sugar-alcohol containing products
What are the Pharmacologic Interventions for Diarrhea?
Opioid receptor agonist - imodium AD, lomotil, sandostatin, camphorated tincture of opium
Anti-infammatory, anti-diarrheal - pepto-bismol, kaopectate
bile acid sequestrant - questran
anticholinergics - benadryl
probiotics
What are the Nutritional interventions for Dysphagia?
Good posture when eating to help prevent aspiration
avoid distractions and limit talking while eating
encourage double swallows to assure that food clears
encourage verbalization after drinks to assure liquids have cleared
choose moist foods of a similar texture to help form a cohesive bolus in the mouth
consider using thickeners in liquids to slow flow and allow safe swallow
alter textures as needed for safe swallow
What are the Pharmacologic Interventions for Dysphagia?
Topical anesthetics - xylocaine, sprays, lozenges
Thickeners - thicken right, up, thick and easy, thick it
What are the Nutritional interventions for oral candidiasis?
practice good oral hygiene
choose soft textured, low acid foods
avoid sugar and yeast-derived foods
What are the Pharmacologic Interventions for oral candidiasis?
pharmacologic/non-food interventions - polyenes like nystatin, diflucan, chlorhexidine
probiotics
What are the Nutritional interventions for Fatigue?
review food and fluid intake for adequacy and advise on dietary modifications and need for supplements to promote an adequate energy and nutrient intake
monitor weight and modify intake plan as needed to stabilize weight or promote weight gain
encourage use of easy to prepare meals/snacks/prepare foods/energy dense foods
advise patient to keep non-perishable snacks at bedside
consume soft/easy to chew foods
eat well when appetite best
encourage energy saving, limiting duties/chores as much as possible
encourage ADL’s and light activity
Consider physical therapy consult for stregthening
What are the Pharmacologic Interventions for Fatigue?
blood transfusions
Epogen, Procrit
What are the Nutritional interventions for Malabsorption?
Bloating/gas - avoid cruciferous vegges, limit swallowed air by avoiding straws/carbonated beverages, and chewing gum and by eating slowly and mouth closed
Bloating/cramping/gas from milk products - eat a low lactose diet and use lactase treated dairy products or lactase pills or drops
Gas - avoid beans/legumes, use beano drops
Chronic diarrhea - low insoluble fiber, low fat, low lactose diet
Bulky/foul smelling stools - eat a low fat diet and use pancreatic enzymes
Fatty stools - eat a low fat diet and use pancreatic enzymes
What are the Pharmacologic Interventions for Malabsorption?
Gas - Gas-x, probiotics
Lactose intolerance - lactaid, probiotics
Gas - beano, probiotics
Diarrhea - probiotics
Fat malabsorption - Pancreatic Enzymes with each meal/snack that contains fat
What are the Nutritional interventions for Mucositis/Esophagitis?
Choose foods lower in acidity and avoid tomato products, citrus juices, and pickled foods
Choose foods that are less spicy, avoid chili, chili powder, curry, cloves, black pepper and hot sauces
Choose foods softer in textures with added moistness/sauce/gravy
Choose cream soups, mashed potatoes, yogurt, eggs, tofu, and pudding
Serve foods at cool/room temperatures
Prepare smoothies with low acid fruits like melons/bananas/peaches and add yogurt/milk/silken tofu
Avoid alcohol
Mucositis:
good oral care
sip one Tbsp honey dissolved in one cup of warm water
keep dentures clean and limit their use if they increase irritation
avoid carbonated beverages
consume ice chips/frozen ice pop during the administration of 5-FU
Esophagitis:
avoid smoking/chewing tobacco/alcohol
What are the Pharmacologic Interventions for Mucositis/Esophagitis?
Anesthetic gels-containing lidocaine
gargle salt/baking soda/water mix
rinse/swish/spit magic mouth wash
glutamine rinses 5 g three times/day
What are the Nutritional interventions for N/V?
small/frequent meals
limit exposure to food smells by avoiding food prep areas
consider eating cool/light foods with little odor
avoid greasy/high fat foods
consume liquids between meals, rather than with
avoid/limit strong smelling lotions, soaps, perfumes, and air fresheners
rest with head elevated for 30 minutes after eating
Take nausea meds as prescribed
Take pain meds with crackers/light food
What are the Pharmacologic Interventions for N/V?
Acute N/V - Zofran, Anzemet, Kytril, Aloxi
Delayed N/V - antagonists (compazine, phenergan), benzamides (reglan), cannabinoids (Marinol, Cesamet), benzodiazapines (ativan, valium), or corticosteroids (Decadron, prednisone)
What are the Nutritional interventions for Taste and Smell Changes?
Little/No taste - fruit marinades, lemon, herbs/spices, pickles, hot sauce
“off” taste - fruity/salty often accepted better/taste right, suggest sugar free lemon drops, gum, or mints to improve mouth taste
bitter/metallic taste - spice/seasonings like onion/garlic/chili powder
too salty/bitter/acid taste - foods that are naturally sweet, low sodium foods
meat taste bitter/strange - fruit marinade, sweat/sour sauce, alternate protein sources
smells - avoid cooking prep, non cooked foods (smoothies), avoid microwaves, cup with lid/straw
What are the Pharmacologic Interventions for Taste and Smell Changes?
Zinc - limit to no more than 60 days duration
salt/baking soda/water rinse
What are the Nutritional interventions for Thick Saliva?
small/frequent meals
alternate bites/sips at meals
add broth/gravies/sauces to meals and dunk dry foods in liquids
sip liquids throughout the day; 8-10 cups
chew on carrots/celery
swish/spit using club soda/carbonated water
use humidifier at home
good oral hygiene
suck on hard candy/frozen grapes/melon balls
avoid alcohol
What are the Pharmacologic Interventions for Thick Saliva?
acupunture biotene BioXtra Caphosol Glandosane Salivart xero-lube mouthKote
