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Clinical Nutrition 2 > Final Details Part II > Flashcards

Final Details Part II Flashcards

1
Q

(T/F) APNED is more restrictive in their soft diet compared to IDDSI’s soft and bite sized

A

F
IDDSI is more restrictive, only allows crumply foods.
APNED soft allows mixed textures, crumbly foods, crusts and juicy foods

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2
Q

(T/F) APNED has more liberal tender diet compared to IDDSI regular

A

F

More restrictive in APNED
IDDSI considers regular foods in transitional foods, and allows for all foods except for sauce foods

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3
Q

(T/F) Mixed textures are allowed in IDDSI mixed and moist

A

F

Allowed in APNED
Mixed Textures in IDDSI are only allowed in Pureed an liquidized

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4
Q

Trigeminal nerve?

A

Mastication

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5
Q

Facial nerve?

A

All muscles of facial expression and corneal reflex

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6
Q

Glossopharyngeal nerve? (SG)

A

Swallow and gag reflex

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7
Q

vagus nerve?

A

-Cough and Gi activity

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8
Q

Spinal accessory nerve?

A

Innervation of velum, which will constrict they pharync

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9
Q

Hypoglossal nerve?

A

tongue control

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10
Q

Submandibular/Submental nodes? (LAF-BG)

A

Lip, Anterior of Tongue, Floor or mouth, Buccal Mucosa, Gingiva

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11
Q

Upper Jugular nodes? (OLP)

A
  • Oropharynx
  • Larynx
  • Pharynx
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12
Q

Middle jugular nodes? (LOON-H)

A

Larynx, oral cavity, oral pharynx, nasopharynx, hypopharynx

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13
Q

Inferior jugular nodes? (HES)

A
  • Hypopharynx
  • Esophagus
  • Subglottic larynx
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14
Q

What 3 things is dysphagia induced in by H and N cancer?

A

1) Disruption of normal anatomy
2) Nerve involvement
3) Nerve pain

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15
Q

General dysphagia intervention pre-op H and N cancer?

A

1) Swallow evaluation, MBS, FEES if necessary

2) Dietary recommendations; HEHP, supplements, increase moisture of foods, chew well, avoid chewy/adhesive foods, SFQM

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16
Q

Compensatory techniques to suggest if dysphagia pre-op is more severe in H and N Cancer?

A
  • Further modification of diet texture and consistency
  • Placement of food into the oral cavity
  • Use of shortened straws, adapted cutlery
  • Effortful swallow, subglottic swallow
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17
Q

When may a tracheostomy be performed?

A

Both pre and post op

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18
Q

Reasons for prophylactic trach insertion (pre-op)?

A

1) Obstruction in airway (edema, swelling, cancer0
2) Removal of excess secretions
3) Paralysis of vocal cords in closed position

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19
Q

Why does a trach affect swallowing? (SAME-SAD-C)

A
  • Increased saliva and secretions
  • Increased risk of aspiration
  • Mobility of tongue reduced
  • Elevation of anterior tongue reduced
  • Subglottic air pressure decreases
  • Abductor and adductors of laryngeal muscle decreases
  • Desensitization of oropharynx and larynx due to diverted air flow
  • Cough mechanism altered
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20
Q

How can we improve swallowing and speech if trach? (DOD-C)

A
  • Digital occlusion
  • One-way speaking valve
  • Decannulation
  • Capping or plugging valve
  • -> Will allow for the restoration of subglottic and transglottic airflow
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21
Q

What is the impact of laryngectomy on swallowing?

A

Respiration and deglutition are completely separated, resulting in a combination of decreased muscle contractions and air pressure will significantly alter the pharyngeal phase of swallowing. This causes the tongue to compensate and results in a more effortful swallow

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22
Q

Post-op in H and N cancer, what is the best practice?

A

EN right after surgery unless PENTTS surgery

–> often inserted at time of surgery

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23
Q

What are the 6 surgeries (PENTTS) that do NOT result in EN insertion at time of surgery?

A
  • Parotid gland surgery
  • Ear/sinus surgery
  • Neck dissection
  • TORS
  • Thyroidectomy
  • Small lip or oral cavity

–>Consider ERAS protocol

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24
Q

Why is EN best practice s/p H and N Sx? (3)

A

1) Bypass expected swelling and edema
2) Protect a surgical anastomosis
3) Brachytherapy (results in edema of tongue and issues with swallowing)

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25
Q

Discuss the protocol to transition from EN to PO feeds after Sx, when is the transition realistic?

A
  • Swallow rehabilitation with small sips of water and puree foods
  • No transition for 7-10 days in major OR, >14 days if previous XRT and not until brachytherapy tx is complete
26
Q

When we are ready to transition for EN to PO fees, what are the steps? What should be considered? (FEAT)

A

1) Conduct a formal swallow assessment
2) Consider fistula present, edema reduced, adequate wound healthy and of flap, trach removal or closure
3) Decide whether to progress to PO, or keep on EN

27
Q

What are the issues with flaps? (3)

A
  • Non sensate
  • Bulky
  • Cannot perform peristalsis
28
Q

We decide to progress our patient from EN to PO foods after the swallow assessment. Which foods should we initially introduce?

A
  • Avoid adhesive, grainy, spicy or foods with mixed consistencies
  • Favour cohesive and non adhesive foods
29
Q

What does the severity of radiation therapy depend on?

A

-Volume, Site, Number of Tx, Concurrent therapy, Dosage

30
Q

When should we expect side effects of radiation therapy?

A
  • 2-4 weeks after start of Tx
  • 2-4 weeks after end of Tx
  • May require up to 4-8 weeks after end of Tx
31
Q

Nutritional intervention at start of radiation Tx? SAFFO

A
  • Swallow assessment
  • Avoid alcohol, caffeine, spicy moods, extreme temps
  • Fluids
  • Food safety
  • Oral care
32
Q

Nutritional intervention during radiation Tx? MICE

A
  • Monitor weekly
  • Initiate ONS
  • Counsel on specific symptoms
  • EN if required
33
Q

When may EN be required during radiation Tx? When may it be initiated prior to starting the RTX?

A

When odynophagia or mucositis becomes severe, prophylactic PEG inserted
-If previous H and N cancer, previous mucositis and odynophagia or deemed high risk for M and O, prophylactic PEG may be inserted prior to TX

34
Q

Post RTX nutritional intervention?

A

NPO–> Oral: Start with pureed foods, thickened liquids, may need ONS

35
Q

Long term impacts of RTX? (PDP-XST)

A
  • Poor oral health
  • Dentition issues
  • Permanent taste alterations
  • Xerostemia
  • Soft tissue necrosis
  • Thyroid problems
36
Q

What are the consequences of fibrosis observed in XRT? (PS-MATE)

A
  • Peristalsis decreased
  • Stenosis
  • Motion of neck decreased
  • Ability to stimulate UES decreases
  • Trichmus
  • Epiglottic dysfunction
37
Q

Classical presentation of celiac disease? (CAD-BG)

A
  • Cramping
  • Abdominal Pain
  • Diarrhea
  • Bloating
  • Gas
38
Q

What are the MOST common symptoms of celiac disease?

A

-Diarrhea, abdominal pain and weight-loss

39
Q

Atypical presentation of celiac disease? (SMH-BMP)

A
  • Skin rash
  • Mouth ulcer
  • Higher risk of lymphoma and osteoporosis
  • Bone and joint pain
  • Muscle weakness and fatigue
  • Peripheral neuropathy and seziures
40
Q

Atypical presentation prevalence

A

1:250

41
Q

Classical presentation prevalence

A

1:4500

42
Q

Percent of celiacs asymptomatic?

A

85%

43
Q

Uncommon symptoms of celiac disease? (OAC-NIN)

A
  • Osteoporosis
  • Abnormal liver function
  • Constipation
  • Neurological issues
  • IDA
  • Nausea
44
Q

Prevalence of celiac disease is ___ incidence __

A

1% and 0.9%

45
Q

Risk factors for celiac disease? (3DAT)

A
  • Dermatitis hepatoformis
  • 1st Degree relative
  • Downsyndrome
  • Autoimmune thyroid disease
  • T1DM
  • -> 1-3% with osteoporosis have CD
  • -> 9-14% with IDA have CD
46
Q

3 steps in diagnosis CD? What is the Gluten challenge?

A

1) Physical exam and AB test
2) Duodenal biopsy, may need gluten challenge
3) Adherence to GFD and follow up for symptoms
- –> Gluten challenge; 2 serving gluten/day for 8 weeks to induce damage to GIT, where as little as 3 g of gluten over 14-28 days has been shown to induce damage

47
Q

Upon duodenal biopsy, how should we expect the duodenum to appear if CD? (SIP)

A
  • Subtle increasing of crypt length
  • Increased epithelial lymphocytes
  • Partial or total villous atrophy
48
Q

Upon adhering to a GFD, when should ABs return to normal? When should outwards symptoms resolve?

A
  • 3-12 months
  • 2-3 weeks
  • -> However, GIT damage or nutritional deficiencies may require more time
49
Q

What has a near 100% PPV?

A

IgA endomysial in high risk population

80% for IgA tTG

50
Q

(T/F) Specificity is greater in IgA endomysial

A

Yes, near 100%

However has less sensitivity compared to tTG

51
Q

5 key nutritional intervention/teaching points in celiac disease?

A
  • Defining celiac disease
  • Defining gluten free diet
  • Assess issue such as decreased fibre, weight gain, and common nutrient deficiencies
  • Malabsorption and maldigestion
52
Q

What 3 things are key for successful tx of CD?

A

1) Patient motivation
2) Physician tx of co-morbidities
3) Formal consultation with RD

53
Q

Common co-morbidities of celiac disease? (C-DOT)

A
  • Cancers
  • Deficiencies in folic acid, ADEK, B12, iron, calcium, vitamin D
  • Osteoporosis
  • Thyroid auto-immune disease
54
Q

What does CELIAC stand for?

A
  • Consultation with Skilled RD
  • Education of GFD
  • Lifelong adherence to GFD
  • Identification and treatment of nutrient deficiencies
  • Access to advocacy group
  • Continuous, life-long follow-up
55
Q

Gluten free foods? (CARB/QT/TMS)

A
  • Corn
  • Amaranth
  • Rice
  • Buckwheat
  • Quinoa
  • Teff
  • Tapioca
  • Millet
  • Sorghum
56
Q

(T/F) Millet is GF

A

T

57
Q

(T/F) Teff is NOT GF

A

F

58
Q

(T/F) Triticale is GF

A

F

59
Q

What are the 10 Steps to Dysphagia?

A

R3P/MWI/RRR

60
Q

Cisplatin nutritional impact?

A
  • Ensure adequate fluid, may need Mg and K supplementation

- Anorexia, altered taste, stomatitis, diarrhea, bone marrow suppression, may increase BUN and Creat, renal toxicity

61
Q

5-FU nutritional impact?

A

-Sour taste, esophagitis, enteritis, Gi bleeding and ulceration, bone marrow suppression, weakness, fatigue

Clinical Nutrition 2 (21 decks)

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