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MNT Test > MNT II Test 1 > Flashcards

MNT II Test 1 Flashcards

1
Q

Types of originating tissue

A

Sarcoma: connective tissue

 Carcinoma: epithelial tissue

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2
Q

Causes of cancer

A 
excess energy
viruses
malignant neplasm
radiation
limited antioxidants and other nonnurtrients
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3
Q

Medical and Nutritional Mgmt.

A

Medical - surgery, radiation, chemotherapy, immunotherapy, marrow transplantiation

nutritional - prevent or correct nutritional deficiencies,minimize weight loss, oral feelind , enteral tube feeding, parenteral feeding

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4
Q

Acute vs. palliative vs. hospice care

A

Acute care: Focus on active
treatment/intervention to cure, alter or prevent
disease &/or to prolong life
 Palliative Care: Focus on relief of suffering &
improving the quality of life.
 Hospice Care: Focus on relief of suffering &
improving the quality of life

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5
Q

Role of the RD with palliative care

A

Palliative care may be offered at any time during
illness whereas hospice is usually limited to the
final 6 month of life
 Wt. loss: repletion of nutrition stores and
regaining lost wt. may not be reasonable goals
 Pressure ulcers: encourage adequate kcal/pro.
 Dehydration: hydrate when death is not
imminent

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6
Q

Side effects of chemotherapy

A 
Taste abnormalities that leads to anorexia & 
constipation 
 Mucositis, cheilosis, stomatitis & esophagitis 
 N/V/D 
 Anemias 
 Depressed immune system 
 Myelosuppression 
 Xerostomia 
 Neutropenia
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7
Q

Radiation therapy and the side effects

A

cns - acute - fatigue, loss of appetite, elevated blood glucose, - late - headache/lethargy

Head/neck- tongue, larynx, pharynx, tonsils, salivary glands- sore mouth and throat, xerostomia, mocositis, dysphagia, odynophagia
alteration in taste and smell - late effects - mucosal atrophy

thorax - esophagus, lung, breast, acute effects- dysphagia, odynophagia, heartburn fatiuge, loss of appetite , late effects - Esophageal stenosis 
& necrosis 
Cardiac: angina 
Pulmonary: dry cough 
pneumonitis
Abdomen & 
pelvis 
Acute
N/V, gastritis 
Fatigue, loss of appetite 
Changes in bowel 
function 
Late
Diarrhea, 
malabsorption, 
maldisgestion
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8
Q

Concepts of immunotherapy

A 
Immunotherapy 
 —Flu-like symptoms, decreased food intake, fatigue, 
chills, and fever
Bone marrow transplant (hematopoietic 
stem cell transplantation(HSCT) 
 —Nausea, vomiting, diarrhea, mucositis, 
xerostomia, dysgeusia 
 Severe oral muscositis 
 Graft versus host disease (GVHD) 
 Veno-occlusive disease (VOD)
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9
Q

Bone marrow transplant (implications/complications)

A 
Bone marrow transplant (hematopoietic 
stem cell transplantation(HSCT) 
 —Nausea, vomiting, diarrhea, mucositis, 
xerostomia, dysgeusia 
 Severe oral muscositis 
 Graft versus host disease (GVHD) 
 Veno-occlusive disease (VOD)
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10
Q

Medical and Nutrition management of marrow transplantation

A

medical
pretransplantation postransplantation
antiemetics antibiotics/blood products

nutritional
pretransplantation
bland liquids and soft solids
salivary stimunlants and substitutes
sauces and gravies with food

postransplantation
nutritional support
enteral or tpn
meet increased energy and protien needs

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11
Q

Neutropenia (neutrophil counts & neutropenic diet)

A

Neutropenia: a reduction in WBC count
(neutrophils) that can be caused by
chemotherapy or radiation therapy.
 Can result in increased susceptibility to
potentially life-threatening infections.
 Neutropenic precautions
 Instituted when absolute neutrophil count drops
<1500/mm3

 Food safety is important. See pg. 745 Escott-Stump for
tip
Immune system compromise
 Avoid all fresh foods (raw meat, moldy foods,
unpasteurized beverages)
 See Table 13-10 (Nutrition & Diagnosis)
 Neutropenic Diet Guidelines

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12
Q

Surgery sites and related effects

A 
Site                Effect 
Head/Neck Chewing/swallowing 
Gastrectomies Total: Malabsorption & fat 
intolerance 
Partial: if is in the lower remnant 
part of the stomach: Dumping 
Syndrome 
Pancreas 
70% resection: Insulin and CHO 
controlled diet 
90% resection: Insulin, CHO 
controlled diet and pancreatic 
enzymes replacement

Partial & total Intestinal Tract
Resections Large losses of fluid and
electrolytes

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13
Q

Cancer cachexia – characteristics & etiology

A 
Cachexia 
 Kakos: bad 
 Hexis: condition 
 Inadequate energy intake 
 Increased energy expenditure 
 Metabolic changes induced by the tumor itself.

It is a syndrome characterized by severe weight loss,
muscle wasting, anemia and anorexia.

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14
Q

Factors that affect appetite

A 
intermidiary metabolites
nutritional abnomalities
neurologic influences
psychological influences
endocrine abnormalites
secondary infections 
malignant lesions
medication
cytokines
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15
Q

Medications that may be useful for cachexia and weight loss

A

 Appetite stimulants
 Metabolic agents and cytokine blockers
 Prokinetic drugs
 Anabolic agents

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16
Q

Purpose of MNT

A

To prevent or correct nutritional deficiencies,
 Minimize wt. loss
 Treat the side effects

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17
Q

Treatments for Nausea, vomiting and diarrhea

A

Seratonin antagonists (Zofran)
 Corticosteriods (Decadron, Prednisone)
 Non-medication: acupressure, massage, hypnosis
& diet modification, ginger
 Frequent small meals, timing of meals

18
Q

Treatments of symptoms (dysgeusia, xerostomia, esophagitis, stomatitis, mucositis, constipation, early satiety)

A 
 Dysgeusia 
 Increase flavoring and seasonings 
 Xerostomia 
 Artificial saliva 
 Suck in hard candy and/or ice
 Soft/Bland diet 
 Cold foods, no rough and salty foods
19
Q

Nutritional recommendations (be able to calculate needs) Protein & calories

A

Protein: (g/kg)
 0.8-1.0 for normal maintenance
 1-1.2 for non stressed patient
 1.2-1.6 for hyper-catabolic patient
 1.5-2.5 for severely stressed patient
 1.5-2.0 for hematopoietic stem cell transplant patient
Caloric Needs
 Harris Benedict plus injury factor between 1.1-1.6
depends the severity
 Other such are Mifflin-St Jeor or Ireton-Jones
formula can be used.
 Per Krause: pg. 842
 25-30 kcal/kg – normometabolic
 30 – 35 kcal/kg – hypermetabolic, stressed, BMT
 30 – 40 kcal/kg/day – nutritional repletion, wt gain

20
Q

AICR recommendations

A

Be as lean as possible without becoming underweight.
Be physically active for at least 30 minutes every day.
Avoid sugary drinks. Limit consumption of energy-dense foods.
Eat more of a variety of vegetables, fruits, whole grains and legumes such as beans.
Limit consumption of red meats (such as beef, pork and lamb) and avoid processed meats.
If consumed at all, limit alcoholic drinks to 2 for men and 1 for women a day.
Limit consumption of salty foods and foods processed with salt (sodium).
Don’t use supplements to protect against cancer.
* It is best for mothers to breastfeed exclusively for up to 6 months and then add other liquids and foods.
* After treatment, cancer survivors should follow the recommendations for cancer prevention.

21
Q

Inhibitors & enhancers of carcinogens

A 
Inhibitors of carcinogens 
 Antioxidants 
 Vitamin C, E, selenium, & carotenoids 
 Phytochemicals 
 Anthrocyanins, & lycopene 
 Enhancers of carcinogens 
 Fat in red meat 
 Grilling of meat at high temperatures
22
Q

Nutritional Factors for cancer prevention

A

Fat
 High consumption of red meats & high fat dairy products
 Protein
 Avoid foods high in fat (esp. those above)
 Plant based proteins = protection
 Soy & phytoestrogens
 Protective prior to adulthood for women
 Should be limited though for women with breast cancer

23
Q

Who is at higher risk of contracting the HIV virus

A 
~1 in 4 new infections is among 13 – 24 
year olds 
 Stable increase at about 50,000 new 
/year in US 
 African Americans increasing 
disproportionately(44% of new cases in 
2010)
24
Q

Cells that are affected by HIV

A

HIV invades the genetic core of the CD4

cells, (T-helper lymphocyte cells)

25
Q

Transmission of HIV (how it is NOT transmitted too)

A 
Virus also resides in semen, vaginal 
secretions, lymph system, and CNS 
Transmitted via blood, semen, 
preseminal fluid, vaginal fluid, breast 
milk, other body fluids

NOT transmitted via saliva, tears, and
urine or through casual contact

Transmission also via sharing 
contaminated needles, by injecting 
contaminated blood products, from 
mother to baby before or during birth, 
or via breast milk

Universal precautions

26
Q

People at risk for HIV

A 
 Persons with male-to-male sexual 
contact 
 Heterosexuals with more than one sex 
partner 
 Intravenous drug users 
 Now low risk for hemophiliacs and other 
blood transfusion recipients 
 Mother-to-child infection declining 
 Homeless and mentally ill
27
Q

Stages of HIV infection & symptoms present in each stage

A

 Acute HIV infection
• 2 to 4 weeks after infection, flu-like symptoms, lasts a few
days to 4 weeks, seroconversion

 Asymptomatic chronic HIV infection
• Lasts a few months to 10 years, few symptoms,
subclinical changes

 Symptomatic HIV infection
• Fever, sweats, skin problems, fatigue, decline in nutrient
status or body composition

 AIDS or advanced HIV
• Dx when a person has a T-cell < 200 cells/mm3 or
develop an opportunistic infection or a tumor

28
Q

goals for medical managements

A

 The goals of medical management of HIV are
to:
• Reduce HIV-related morbidity and mortality
• Improve the quality of life
• Restore and preserve immunologic function
• Maximize suppression of viral replication
• Optimize and extend the usefulness of currently
available therapies
• Minimize drug toxicity and manage side effects

29
Q

ART and how they work

A

Combination of at least two fully active
antiretroviral agents known to kill virus or
suppress replication
• Drug therapy decisions based on:
– Viral load levels (HIV-RNA)
– Current and lowest CD4 cell counts
– Current and past clinical conditions and symptoms
– Life stage
• Need at least 95% adherence to medication
schedules for efficacy

30
Q

Opportunistic infections and the related complications associated with them

A

OIs with bacteria, fungi, protozoa, or viruses cause
diarrhea, malabsorption, fever, and weight loss
• Cancers: Kaposi’s sarcoma, non-Hodgkin
lymphomas, and cervical cancer
• Neuromuscular diseases
• HIV-liver disease
• Tuberculosis and lung diseases
• HIV-associated nephropathy
• Gastrointestinal and pancreatic issues

31
Q

Kaposi’s Sarcoma & Candidiasis- know terms

A

Cancer develops on cells that line lymph or
blood vessels
• Affects the skin, mucous membranes and
lymph nodes
• KS in the esophagus causes pain, difficulty
swallowing and chewing. In the GI tract can
cause diarrhea and obstruction.
Trush
Common in persons with AIDS

32
Q

Lipodystrophy & Metabolic abnormalities – changes that occur & disorders

A

 Abnormalities in fat metabolism
 Body shape change
 Glucose dysregulation and dyslipidemia
 Bone disorders
 Mitochondrial toxicity and lactatemia
 Morphological changes: lipoatrophy; loss of
subcutaneous adipose tissue; thinning of
arms, legs, buttocks, and face

33
Q

MNT goals

A

Maintain and expand nutrition
knowledge and sense of empowerment
• Maintain or restore healthy body weight
and normal morphology
• Preserve or restore optimal somatic and
visceral protein status
• Prevent nutrient deficiencies or excesses
known to compromise immune function
Nutrition Interventions – calculating energy and protein needs, fat recommendations, fluid & electrolyte needs, Vitamin & mineral supplementation

34
Q

Nutrition Interventions – calculating energy and protein needs, fat recommendations, fluid & electrolyte needs, Vitamin & mineral supplementation

A

Energy and protein
• Energy requirements increase 13% and
protein increases 10% for every degree C of
fever
• Use Mifflin-St. Jeor equation plus 500 calories
to replenish when HIV wasting is present or
40-50 kcal/kg
• Protein 1.0 to 1.4 k/kg for maintenance; 1.5 to
2.0 g/kg for repletion

 Fat
• Individual tolerance; MCT
• Omega-3 fatty acids may improve immune
function
Fluids and electrolytes
– 30 to 35 ml/kg
– Extra fluid and electrolytes for diarrhea,
vomiting, night sweats, and prolonged fever
• Vitamins and minerals supplement
providing 100% RDA
• Special concerns in pediatric patients

35
Q

Pediatric calorie and protein needs

A 
Low heights and weights 
• <50th
 percentile 
• Do not catch up 
Monitor growth and development, 
immune function, quality of life, CD4 
percentage (not number) 
Assess every 1 to 6 months 
Multidisciplinary team 
 find that out
36
Q

Diet therapy recommendations

A 
High calorie/high protein diet 
Nutrient dense snacks 
Small frequent feedings 
When diarrhea present; avoid high fat 
foods and high fiber diet. Check if 
person is lactose intolerant 
Drug-nutrient interactions
37
Q

Complications that can impact nutrition

A

Diarrhea and malabsorption
• CD4 count <200 to 250 cells/mm3
 Disorders of the oral cavity and esophagus
• Neoplastic, bacterial, viral, or fungal; dysgeusia
 Neurologic disorders
 Alterations in metabolism and body shape
• Wasting, lipodystrophy, obesity; stigma

38
Q

CD4 counts and symptoms

A

St. John’s wort decreases plasma levels of
indinavir; may cause drug resistance and
treatment failure

 Garlic supplements reduce blood levels of
saquinavir

 Milk thistle (silymarin) could lessen
metabolism of medications and increase
toxicity

 High use of CAM; may not reported

39
Q

CD4 counts and symptoms

A

Diarrhea and malabsorption
• CD4 count <200 to 250 cells/mm3
 Disorders of the oral cavity and esophagus
• Neoplastic, bacterial, viral, or fungal; dysgeusia
 Neurologic disorders
 Alterations in metabolism and body shape
• Wasting, lipodystrophy, obesity; stigm

40
Q

terms

A 
AIDS 
AIDS enteropathy 
Candidiasis 
HIV encephalopathy 
HIV wasting syndrome 
Kaposis’s sarcoma 
Opportunistic infection 
ART & HAART 
Retrovirus 
Constitutional Disease
41
Q

terms 2

A 
 Dysgeusia 
 Ageusia 
 Hypogeusia 
 Candidiasis 
 Metastasis 
 Cheilosis 
 Cytokines 
 Cachexia 
 thrombocytopenia 
 Stomatitis 
 Neutropenia 
 Mucositis 
 Glossitis 
 Emesis 
 Palliative care 
 Xerostomia 
 Myelosuppresion 
 Oncology

MNT Test (13 decks)

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