Chapter 4: Nutritional Needs of the Adult Oncology Patient Flashcards
What is the gold standard for predicting energy requirements?
Indirect Calorimetry
What patients are at risk of refeeding syndrome?
Several conditions are risk factors for refeeding – anorexia, alcoholism, prolonged starvation, morbid obesity with substantial weight loss, and chronic diseases like cancer and cirrhosis
Which predictive equation is best at predicting RMR in non-obese and obese populations?
Mifflin-St Joer
True or False: Using body weight alone, the estimated calorie needs per kg for a cancer patient needing weight gain is 30-35 kcal/kg
True
Name the different general medical conditions that can affect vitamin and mineral levels
Alcoholic liver Renal Failure GI fistulas and diarrhea Loss of Bile Pancreatitis Chylous leaks and fistulas Gastrectomy or terminal ileum resection Bariatric surgery (Roux-en-Y and banding) Critical Illness
Micronutrient deficiencies in an already ill person can affect various biochemical processes and enzyme functions. This can lead to:
Muscle Weakness
Poor wound healing
altered immunity
What is a long term consequence of both over and under feeding in the oncology population?
immunosuppression
What energy level would an RD consider initiating nutrition support for individuals at risk of refeeding syndrome and then monitor electrolyte levels for the ability to advance to better meet needs?
20 kcal/kg or 1000 kcal/day
According to the AND pocket guide for nutrition assessment, what are the protein requirements for metabolically stressed individuals?
1.5 g/kg of body weight per day
What energy needs (kcal/kg) would you recommend, based on ASPEN guidelines, for a 62 yr old female, 65”, 108# with pancreatic CA and anticipating surgery
30-35 kcal/kg of body weight
You are assessing a lung CA patient, initiating chemotherapy. No WT loss, is 15# overweight, and appears healthy/content. What range would you use for his protein needs?
How would you quickly assess his energy needs?
1-1.5 g/kg of body weight
25-30 kcal/kg of body weight
What is not an appropriate method for estimating fluid needs?
1.5 x reported urine volume
Appropriate methods:
ASPEN - 20-40 ml/kg or 1-1.5 ml/kcal energy expended
RDA - 1 ml/kcal consumed
BSA - 1500 ml/m2 or BSA x 1500 ml
80 yr old male s/p neck dissection with slight Wt loss post-op. Starting chemo-radiation for H&N CA. 69”, 172#. What would you use for his needs (energy and protein)?
30-35 kcal/kg and 1-1.5 gm/kg
Patients with GI cancers that develop fistulas and/or diarrhea are at risk of having low levels of what micronutrients?
Zinc and Selenium
What type of cancer has shown not to have a significant different in energy expenditure from control patients?
Colorectal
What type of cancer has shown to have significant higher energy expenditures from control patients?
Esophageal
Gastric
Pancreatic
NSCLC
For a patient at risk for refeeding syndrome, what should calorie repletion start at?
15 kcal/kg
What labs should be monitored if you are worried about a patient at risk of refeeding sydrome?
K
Mg
Phos
Gluc
What serum vitamin and mineral levels are effected by the inflammatory process?
Decrease: vitamins A, C, and E. Selenium, copper, iron, and zinc levels.
Lower levels of iron help protect against bacterial infections, therefore lower levels of trace minerals may occasionally be beneficial.
Typically not affected: thiamin, riboflavin, vitamin B-12, folate
What are the acceptable macronutrient distribution ranges for adults?
fat 20-35% of calories
carbohydrates 45-65% of calories
protein 10-35% of calories
Thirst is the main determinant but not always a reliable gauge for fluid needs. The formula for calculating fluid needs using BSA is:
1500ml/m2
Gastrectomy or terminal ileum resection can cause a decrease in which 2 nutrients?
Iron and B12
Critical illness can cause a decrease in which vitamin, despite supplementation?
Vitamin C
