MNT and side effect management Flashcards
dry mouth MNT
- small freq meals
- alternate bites and sips
- add broths, gravies, sauces
- sip liquids throughout day - 8-10 cups
- chew on carrots/celery
- swish and spit with club soda/carbonated water
- use humidifier
- good oral hygiene
- suck on hard candy, frozen grapes or melon balls
- avoid alcohol and alcohol containing rinses
pharm: acupuncture, biotene, caphosol, glandosane, salivart, xero-lube, mouthkote
prevention pharm: ethyol, salagen
mucositis/esophagitis MNT
- choose foods low in acidity and spice
- choose soft foods with added moistness, sauce, gravy
- choose cream soups, mashed potatoes, yogurt, eggs, tofu, pudding
- serve cool or at room temperature
- prepare smoothies with low acid fruits
- avoid alcohol + alcohol containing rinses
mucositis: oral care, honey in warm water, avoid carbonated beverages, ice chips during 5FU and adriamycin infusion
esophagitis: avoid smoking, chewing tobacco and alcohol
pharm: lidocaine gels, sore throat gargles with baking soda/salt, magic mouthwash, glutamine rinses (5 gm 3x/day)
constipation MNT
- encourage hydration, fiber, total food intake
- aim for 64oz water, 25-35gm fiber
- hot beverage, hot cereal or high fiber food
- probiotics
- light physical activity and/or stretches
- look @ meds and encourage stool softeners prn
- schedule adequate bathroom time
pharm: bran/flaxseed/wheat germ, citrucel, konsyl, colace, mineral oil, miralax, lactulose, milk of mg, bisacodyl, senna
herbal: probiotics, slippery elm, aloe juice
constipation MNT
- encourage hydration, fiber, total food intake
- aim for 64oz water, 25-35gm fiber
- hot beverage, hot cereal or high fiber food
- probiotics
- light physical activity and/or stretches
- look @ meds and encourage stool softeners prn
- schedule adequate bathroom time
pharm: bran/flaxseed/wheat germ, citrucel, konsyl, colace, mineral oil, miralax, lactulose, milk of mg, bisacodyl, senna
herbal: probiotics, slippery elm, aloe juice
diarrhea MNT
- identify problem foods via food journal
- low fat, low fiber, and/or low lactose
- avoid gas producing foods, caffeine, alcohol
- small freq meals
- bulking agents: pectin, soluble fiber foods (applesauce, banana, oatmeal, potatoes, rice)
- avoid sorbitol or other sugar alcohols
- consider multivitamin
pharm: imodium, lomotil, octreotide, tincture of opium, peptobismol, kaopectate, benadryl, probiotics, cholestytamine (bile acid binder for bild acid diarrhea)
dysphagia MNT
- good posture
- avoid distractions/talking with meals
- double swallows to clear food
- verbalization after liquids to assure clearance
- moist foods of similar texture
- thickeners in liquids
- avoid straws
- consult SLP
pharm: lidocaine spray for pain, thickeners for liquids
oral candidiasis MNT
- good oral hygiene
- choose soft textured, low acid food
- avoid sugar/yeast products
- hold yogurt in mouth 5 min daily
pharm: nystatin, fluconazole, chlorhexidine, probiotics
oral candidiasis MNT
- good oral hygiene
- choose soft textured, low acid food
- avoid sugar/yeast products
- hold yogurt in mouth 5 min daily
pharm: nystatin, fluconazole, chlorhexidine, probiotics
fatigue MNT
- review for adequate food intake to maintain wt
- encourage easy to prepare meals and snacks
- keep snacks at bedside
- consume soft easy to chew foods
- eat well when appetite best
- limit duties/chores when possible; do ADLs and light activity as able
- consider PT consult
consider multivitamin
pharm: blood transfusions, erythropoietin (RBCs)
malabsorption MNT
- avoid cruciferous, straws, gum for gas
- avoid lactose or take lactase for lactose intolerance
- avoid beans/legumes or use beano
- low insoluble fiber, low fat, low lactose for chroic diarrhea
- enzymes for bulky foul smelling stools
- low fat diet and enzymes for fatty stools
pharm: gas-x, probiotics, lactaid, beano, saccharomyces boulardii and lactobacillus GG (caution for bacteremia if immunocompromised), pancreatic enzymes (30-40,000 units/meal or 500mg/kg/meal)
nausea/vomiting MNT
- 5-6 small meals
- limit exposure to food smells
- cool, light foods
- avoid greasy, high fat foods
- liquids between meals
- rest with head elevated for 30min after meals
- take nausea meds as prescribed
- take pain meds with crackers or light food
- consider ginger, acupressure bracelets, acupuncture, massage, nerve stimulation, distraction strategy, relaxation techniques, self-hypnosis
pharm: zofran or other -setron meds; compazine, dronabinol, ativan, dexamethasone, emend, reglan
taste/smell change MNT
- check mouth for thrush
- oral care before/after meals
- fruit marinades for meat, lemon, herb/spices, pickles for no taste
- fruity and salty flavors for “off” taste
- sugar free lemon drops, gum or mints
- onion/garlic/chili, eat with bamboo/plastic silverware, flavor water with lemon or fruit for metallic taste
- low sodium products for salty taste
- fruit marinade or choose other proteins when meat tastes off
- avoid cooking areas, eat cold foods and avoid microwave when smells are bothersome
pharm: zinc - 50mg elemental zinc **no more than 60 days to prevent copper deficiency
baking soda/salt rinses
dumping syndrome MNT
- small freq meals
- separate liquids from solids
- reduction in simple carb/fat intake
- increase soluble fiber intake
reflux esophagitis MNT
- small freq meals
- diet modification (lower fat, avoid alcohol)
- antacids or sucralfate
delayed gastric empytying MNT
- small freq meals
- diet modification (chew well, avoid fried/greasy foods, moderate fiber intake)
- prokinetic agents
