Chapter 12: Symptom Management of Cancer Therapies Flashcards

1
Q

What are the different nutritional side effects from cancer therapies?

A
Anorexia/poor appetite/early satiety
Constipation
Diarrhea
Dysphagia
Oral Candidiasis
Fatigue
Malabsorption
Mucositis/Esophagitis
N/V
Taste and Smell Changes
Xerostomia/Thick Saliva
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2
Q

What are the Nutritional interventions for Anorexia?

A

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

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3
Q

What are the Nutritional interventions for Early Satiety?

A

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

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4
Q

What are the Pharmacologic Interventions for Anorexia?

A

Antihistimines - Periactin

Corticosteroids - Decadron, solu-medrol

Progestational agents - Provera, Megace

Prokinetic agents - Reglan

Antidepressant - Remeron

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5
Q

What are the Nutritional interventions for Constipation?

A

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

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6
Q

What are the Pharmacologic Interventions for Constipation?

A

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

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7
Q

What are the Nutritional interventions for Diarrhea?

A

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

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8
Q

What are the Pharmacologic Interventions for Diarrhea?

A

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

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9
Q

What are the Nutritional interventions for Dysphagia?

A

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

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10
Q

What are the Pharmacologic Interventions for Dysphagia?

A

Topical anesthetics - xylocaine, sprays, lozenges

Thickeners - thicken right, up, thick and easy, thick it

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11
Q

What are the Nutritional interventions for oral candidiasis?

A

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

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12
Q

What are the Pharmacologic Interventions for oral candidiasis?

A

pharmacologic/non-food interventions - polyenes like nystatin, diflucan, chlorhexidine

probiotics

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13
Q

What are the Nutritional interventions for Fatigue?

A

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

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14
Q

What are the Pharmacologic Interventions for Fatigue?

A

blood transfusions

Epogen, Procrit

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15
Q

What are the Nutritional interventions for Malabsorption?

A

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

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16
Q

What are the Pharmacologic Interventions for Malabsorption?

A

Gas - Gas-x, probiotics

Lactose intolerance - lactaid, probiotics

Gas - beano, probiotics

Diarrhea - probiotics

Fat malabsorption - Pancreatic Enzymes with each meal/snack that contains fat

17
Q

What are the Nutritional interventions for Mucositis/Esophagitis?

A

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

18
Q

What are the Pharmacologic Interventions for Mucositis/Esophagitis?

A

Anesthetic gels-containing lidocaine

gargle salt/baking soda/water mix

rinse/swish/spit magic mouth wash

glutamine rinses 5 g three times/day

19
Q

What are the Nutritional interventions for N/V?

A

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

20
Q

What are the Pharmacologic Interventions for N/V?

A

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)

21
Q

What are the Nutritional interventions for Taste and Smell Changes?

A

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

22
Q

What are the Pharmacologic Interventions for Taste and Smell Changes?

A

Zinc - limit to no more than 60 days duration

salt/baking soda/water rinse

23
Q

What are the Nutritional interventions for Thick Saliva?

A

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

24
Q

What are the Pharmacologic Interventions for Thick Saliva?

A
acupunture
biotene
BioXtra
Caphosol
Glandosane
Salivart
xero-lube
mouthKote