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Clinical Nutrition 1 > Required Readings - Final > Flashcards

Required Readings - Final Flashcards

1
Q

What contributes to systemic glucotoxicity?

A

Increased hepatic glucose output, which leads to further complications of chronic disease

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2
Q

What contributes to fatty liver disease?

A

Increased glucose and fatty acid uptake (increased conversion to TGs and VLDLs)

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3
Q

What does increased pancreatic islet mass followed by exhaustion lead to?

A

Pre-diabetes, followed by overt diabetes

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4
Q

In metabolic syndrome, what are some examples abnormal GI activity?

A
  • Increased dietary fat and sugar absorption

- Increased gut motility

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5
Q

What contributes to increase fat storage and fat tissue hypertrophy in visceral adipose tissues?

A
  • Decreased glucose uptake
  • Increased lipid uptake
  • Increased lipolysis
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6
Q

What does increased fat storage and fat tissue hypertrophy in adipose tissue lead to?

A

Systemic low-grade inflammation

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7
Q

What leads to systemic lipotoxicity, and will lead to complications of chronic diabetes?

A

Increased lipolysis in visceral adipose tissues

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8
Q

How is satiety altered in metabolic syndrome?

A

-Abnormal hedonic and homeostatic response

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9
Q

What contributes to abnormal satiety?

A

CCk, Ghrelin, PPY, increase in ECs

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10
Q

What contributes to abnormal nutrient sensing?

A
  • Increased insulin

- Increased dietary nutrients, CCK

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11
Q

(T/F) Both insulin and glucagon increase in MetS

A

T
Insulin (resistance)
Glucagon increases because cells “starved”

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12
Q

What does incretin control?

A

GLP-1 and GIP

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13
Q

What are the actions of incretin? (4)

A
  • Stimulate insulin release-Inhibits glucagon release
  • Increases insulin sensitivity
  • Effects on gut-motility
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14
Q

In MetS, incretin increases/decreases?

A

Decreases

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15
Q

Which gut hormone increases?

A

EC

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16
Q

Which gut hormone decreases?

A

GLP-1 (under the influence of incretin)

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17
Q

Which adipose tissue hormone increases?

A

Leptin, but with resistance

Adiponectin

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18
Q

What are the effects of increased leptin resistance?

A

-Decreased satiety and decreased energy expenditure.

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19
Q

What are the effects of decreased adiponectin?

A
  • Increased gluconeogenesis
  • Decreased glucose uptake
  • Decreased insulin sensitivity
  • Increased body-weight
  • Decreased endothelial function
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20
Q

What are the abnormal muscle functions in MetS?

A

Decreased glucose uptake while fatty-acid uptake increases

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21
Q

Risk factors that should be assessed for T2DM annually?(CP-FHH)

A
  • CVD risk factor
  • Presence of end-organ damage associated with diabetes
  • Family history
  • History of GDM/pre-diabetes
  • High risk populations
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22
Q

No risk factors present in <40 y/o pt or low-moderate risk?

A

No screening, continue to assess risk factors

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23
Q

No risk factors, but >40 y/o or high risk?

A

Screen every 3 years

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24
Q

Presence of risk factors OR very high risk?

A

Screen every 6-12 months?

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25
Q

High risk?

A

33% of developing T2DM within 10 years

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26
Q

Very high risk?

A

50% of developing T2DM within 10 years

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27
Q

How to screen?

A

FPG or AIC

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28
Q

FBG 6.1-6.9?

A

IFG

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29
Q

FBP >/= 7.0?

A

Diabetes

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30
Q

A1C 6.0-6.4 %

A

Prediabetes

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31
Q

A1C >/= 6.5%?

A

Diabetes

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32
Q

Meds for patient with CVD and diabetes?

A

Statin + ACEi/ARB + ASA

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33
Q

Patient with CVD and diabetes started on meds, but NOT at glycemic targets?

A

Add Liraglutide, Emaglifloinor Canafliglozin (ONLY for T2DM)

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34
Q

Patient has NO CVD, but has microvascular disease. What meds?

A

Statin + ACEi/ARB

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35
Q

Patient has NO CVD or microvascular disease BUT >55 with additional CV risk factors. What meds?

A

Statin + ACEi/ARV

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36
Q

When is ONLY a statin prescribed in T2DM for cardiovascular protection?

A
  • Age >/= 40
  • Age>/= 30 and diabetes >15 years
  • Warranted for statin therapy based on Canadian CVD Lipid guidelines
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37
Q

____ should be used as a secondary prevention in cardiovascular disease prevention in diabetics.

A

ASA

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38
Q

How can we keep patients safe when they are at risk of HypoG? (RAPR)

A
  • Recognize
  • Act/Treat
  • Prevent
  • Reduce Driving Risk
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39
Q

How can we reduce driving risk?

A

Educate patients to drive safely with diabetes by:

  • Prepare w/ fast acting sugar nearby
  • Be ware of BG every 4 hours during long drives
  • Stop driving and treat symptoms
  • After treating, wait until BG > 5 mmol/L to start driving again
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40
Q

Brain function may not be fully restored until ___ after hypoG is resolved

A

40 mins

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41
Q

How can we keep patients safe when they are at risk of dehydration (V/D)?

A
  • Rehydrate appropriately, avoid caffeine (Water, broth, diet drinks, sugar free beverages Ok)
  • Hold SADMANS and restart when able to drink/eat normally
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42
Q

What are SADMANS meds that should be stopped then resumed when pt can eat/drink normally?

A
  • Sulfonylureas/Secretagogues
  • ACEi
  • Diuretics
  • Metformin
  • ARB
  • NSAIDs
  • SGLT2 inhibitors
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43
Q

Discuss consideration for women with T1DM and T2DM who wish to conceive

A
  • A1C <7% –> Aim for <6.5%
  • Stop certain meds
  • Start folic acid supplementation
  • Screen for complications
  • Aim for healthy BMI
  • Ensure vaccinations have occured
  • Refer to diabetes clinic
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44
Q

Which meds should be stopped prior to conception?

A
  • Non-insulin antiHG meds EXCEPT for metformin/glyburide
  • Sating
  • ACEi/ARB
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45
Q

What may be used until the detection of pregnancy if nephropathy exists?

A

ACEi or ARB

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46
Q

What meds may need to be begun prior to conception?

A
  • Insulin if target A1C not achieved on metformin/glyburide

- Other antiHTN agents safe for pregnancy if HTN control needed

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47
Q

3 quick questions to help patients to meet their goals?

A

1) Ask them to rate the IMPORTANCE of their goals (high, medium low)
2) Ask them to rate the CONFIDENCE of achieving their goals
3) Ask to set a SMART goal before next meeting

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48
Q

What are some suggestions of goals?

A

-Eat healthy
-Check feet
-Manage stress
-Be more active
(Practical/simple recommendations)

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49
Q

Goal of CANRISK?

A

To determine risk of having pre-diabetes or T2DM (NOT Type 1)

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50
Q

CANRISK age?

A

For adults aged 40-74 years

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51
Q

Key CANRISK questions? (WAGE-H-BPFDE)

A 
Waist C
Age
Gender
Ethnicity
HTN
BMI
PA
Family history 
Diet (Fruits &amp; Veg)
Education
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52
Q

CANRISK<21?

A

Low risk

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53
Q

CANRISK 21-32?

A

Mod risk

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54
Q

CANRISK >33 ?

A

High risk

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55
Q

How does MetS contribute a financial and social burden?

A

MetS is a leading cause of blindness, amputation and kidney failure

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56
Q

Main underlying cause of MetS?

A

Insulin resistance an central obesity

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57
Q

How does the IDF based the definition of MetS?

A

The need for early diagnosis and treatment

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58
Q

Official IDF definition of MetS?

A

Central obesity (WC) plus and two out of four factors

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59
Q

What are the 2/4 factors that must be present for Mets?

A

-Raised TGs
-Reduced HDL
-High BP
-High FBG
OR treatment of any of these abnormalities (i.e. even if they are on medications and normal levels, still considered MetS)

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60
Q

Important to consider about central obesity?

A

WC must be ethnicity specific

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61
Q

HIGHEST WC for MetS?

A

USA (102 cm Men and 88 Women)

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62
Q

LOWEST WC for Met S?

A

South asians, chinese and japanese (90 cm Men and 80 cm women)

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63
Q

Examples of additional metabolic measurements for research in MetS?

A
  • abnormal BF distribution
  • Pro-inflammatory state
  • Prothrombotic state
  • Hormonal factors
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64
Q

Primary intervention of MetS from IDF?

A
  • Moderate kcal restriction to achieve 5-10% weight-loss in 1st year
  • Moderate increase in PA
  • Changes in dietary consumption
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65
Q

Secondary intervention of MetS from IDF?

A

Drug therapy (when lifestyle not enough and who are at high risk for CVD)

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66
Q

What is the pathogenesis of MetS?

A

Primary underlying cause is insulin resistance and central obesity

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67
Q

Is MetS a valid indicator of CVD?

A

Not an absolute risk factor, but those with MetS increase risk of major CVD events x2.

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68
Q

People with diabetes and Mets S have a much _____ than those with T2DM alone

A

Higher CVD risk

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69
Q

Is the risk of CVD greater in MetS than the sum of its parts?

A

Studies are contradictory

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70
Q

How were the WC for men and women in the US determined?

A

ATP III (Adult Treatment Panel)

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71
Q

(T/F) As a general rule, alcohol should be avoided in diabetes

A

False

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72
Q

What is important prior to drinking alcohol?

A

That patients diabetes in under control, knowledgeable of preventing low blood sugar ad free from health problems that could where alcohol may aggravate diseases.

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73
Q

Mod alcohol women?

A

<2 SD/day and <10/week

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74
Q

Mod alcohol men?

A

<3 SD/day and <15/week

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75
Q

SD beer?

A

341ml/12 oz

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76
Q

SD spirits?

A

43ml/1.5oz

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77
Q

SD wine?

A

142 ml/5 oz

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78
Q

(T/F) in CHO counting,CHO’s MUST be counted for within the alcoholic drinks, and insulin should be adjusted

A

False

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79
Q

What may delay hypoG?

A

When alcohol is consumed with, or 2-3 hours after an evening meal

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80
Q

In delayed hypoG, when does it arise?

A

Next morning, or 24 hours after consumptions

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81
Q

(T/F) Only T1DM must be cautious of alcohol, as they must CHO count

A

False, T2DM who are using insulin or insulin secretagogues

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82
Q

Risks of alcohol?

A
  • Increase Bp and TGs
  • Damage to liver/nerves
  • Inflammation of pancreas
  • Dehydrate body –> very dangerous if high blood sugar
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83
Q

Recommendations before drinking alcohol?

A

1) Always have treatment for low BG with you
2) Have someone know your signs and symptoms of hyperG
3) Wear diabetes ID

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84
Q

What is the danger of glucagon when alcohol is in the body?

A

Glucagon will NOT work. Ambulances should be called if a diabetic passes out.

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85
Q

Practical recommendation while drinking alcohol?

A

Eat CHO rich foods
Drink slowly
Avoid coolers, dilute alcoholic drinks with sugar-free beverages

86
Q

Practical recommendation after drinking alcohol?

A
  • Tell responsible person that you have been drinking and have them look for low blood sugar symptoms
  • Set alarm for early morning/middle of night to monitor blood glucose
  • Do not miss medications
87
Q

(T/F) Diabetics have the same alcohol intake recommendations as healthy individuals

A

True

88
Q

Delayed low blood sugar can occur anytime up to ___ after consuming alcohol

A

24 hours

89
Q

When are diabetics at risk for dehydration?

A
  • Vomiting
  • Diarrhea
  • Fever
  • Excessive exposure to heat/humidity without drinking enough
90
Q

Practical recommendations to drink more fluids in deydration or illness?

A
  • Consider electrolyte replacement solutions, clear soups, broth, water, diet soda, watered down apple juice
  • Limit caffeine
91
Q

Practical recommendations to avoid risk of hypoG in dehydration or illness??

A

If usual foods cannot be eaten, try having 1 cup milk, 1/2 cup applesauce, 1/2 cup ice-cream

  • each contain 15 g CHO
  • Avoid dairy option of vomiting/diarrhea
92
Q

Other recommendations in dehydration or illness?

A

-Check blood glucose more frequently if on insulin

93
Q

When should certain diabetes meds be temporarily stopped?

A

If eating less than normal and symptoms>24 hours

94
Q

What medications should be stopped if eating less than 24 hours and dehydrates or at the risk of dehydration?

A
  • BP/Heart Meds (ACE and ARBs)
  • All water pills
  • Metformin, SGLT2 inhibitors
  • Anti-inflammatory drugs, including ibuprofen
95
Q

Examples of symptoms of hypoglycemia (from least –>most severe?)?

A

-Sweating, hunger, disturbed sleep, vision changes

96
Q

Practical recommendations of fast acting sugar (15-15 rule?

A
  • 15 g of glucose tablets
  • 1 TBSP honey
  • 2/3 juice
  • 6 LifeSavers
97
Q

After 15mins, blood glucose > 4 and meal within the hour?

A

Good to go

98
Q

After 15 mins, blood glucose > 4 but meal is longer than 1 hour away?

A

Eat one starch (i.e 7 crackers) and one protein (i.e. 2 TBSP PB)

99
Q

After 15 mins, glucose <4?

A

Consume 15 g fast-acting glucose

100
Q

value of one starch CHO exchange?

A

15 g

101
Q

value of one milk/alternatives CHO exchange?

A

12-15

102
Q

value of fat and protein CHO exchange?

A

0

103
Q

How many CHOs needed per meal?

A

45-75 g

104
Q

How many CHOs per snack, if needed?

A

15-30 g

105
Q

Visual representation of 5 g of sugar?

A

1 sugar cube

106
Q

Practical recommendations to control blood sugar and weight?

A

-30 mins of moderate PA most days of the week
-Eat 3 balanced meals each day
Eat meals and snacks at regular hours
-Opt for high fibre foods
-Limit intake of high trans/sat fats, high salt, season with herbs

107
Q

Spacing of meals for diabetics?

A

4-6 hour interval

108
Q

Spacing of snack for diabetics?

A

2-3 hours after meals

109
Q

Practical recommendations for diabetics when eating out?

A
  • Mostly cook from home
  • Choose ones similar to the balanced plate method
  • measure blood sugar more often when eating out
110
Q

How to calculate meal pattern targets?

A

Start with CHO, then protein, then fat

111
Q

Divide total allowance of CHO g by ____ to determine number of starches

A

15

112
Q

Subtotal protein g and subtract from total, then divide remaining by ____ to determine number of meat and alternative

A

-8

113
Q

Subtotal fat g and subtract from total, then divide remaining by ____ to determine number of fats available

A

-5

114
Q

What increases the risk of breast cancer?

A
  • First period before 12
  • Not having children, or having first child after age 30
  • Late age at menopause
  • FMhx of breast cancer
115
Q

Dietary factors increasing risk of breast cancer?

A
  • Increase body weight

- Alcohol (even low amounts)

116
Q

(T/F) Lowering fat intake has an effect of breast cancer risk

A

False

117
Q

Bottom line recommendations on breast cancer

A
  • Regular, intentional PA
  • Reduce weight gain, limit kcals
  • -Avoid/limit alcohol intake
118
Q

Bottom line recommendations on colorectal cancer

A
  • Increase intensity and amount of PA
  • Limit red and processed meats
  • Meet calcium and Vit D DRIs
  • Eat more F&V
  • Avoid obesity, avoid excess alcohol
119
Q

Why does obesity increase risk of endometrial cancer?

A

Increase in estrogen levels

120
Q

Bottom line recommendations on endometrial cancer?

A

Stay at a healthy weight, regular PA

121
Q

Best known modifiable risk factors of kidney cancer?

A
  • Obesity

- Tobacco smoking

122
Q

(T/F) There is clear evidence regarding diet an kidney cancer

A

False, main recommendations are to stay at healthy weight and avoid tobacco

123
Q

Diet and lung cancer?

A

-High fruit/veg may reduce lung cancer BUT high doses of vitamin A or b-carotene INCREASE lung cancer amongst smokers

124
Q

Bottomline recommendations on lung cancer

A
  • Avoid tobacco use, second hand smoke

- Avoid radon exposure

125
Q

___ raised the risk of cancer in the lower esophagus and at the junction between the stomach and esophagus due to ____

A

Obesity

Increased acid reflux

126
Q

What kind of beverage may increase risk of mouth and esophagus cancers?

A

Hot beverages due to damage from heat

127
Q

Bottomline recommendations on lung cancer

A
  • Avoid all forms of tobacco
  • Restrict alcohol intake
  • Avoid obesity
  • Eat at least 2 1/2 cups of veg/day
128
Q

There are no clearly proven nutritional risk factors for _____

A

Ovarian cancer

No strong recommendations can be made

129
Q

What increases the risk of pancreatic cancer?q

A

-Tobacco, T2DM, pre-diabetes

130
Q

Bottomline recommendations on pancreatic cancer

A
  • Stay at healthy weight

- PA

131
Q

Bottomline recommendations on prostate cancer

A
  • Eat a wide range of V&F each day
  • PA
  • Healthy weight
  • -> Sensible to limit calcium supplement and calcium in diet, but no official recommendations
132
Q

Why has cancer in the cardia (first part of the stomach) risen in the past years?

A

Increased gastric reflux, which is linked to obesity

133
Q

Bottomline recommendations on stomach cancer

A
  • Eat at least 2 1/2 servings of V/F/day
  • Reduce intake of meat, salt and foods preserved with salt
  • PA
  • Healthy weight
134
Q

ACS guidelines for weight and PA?

A
  • Be as lean and possible throughout life without being underweight
  • Avoid excess weight gain at all ages
  • If obese or overweight, lose a small amount of weight to begin with
  • Get regular PA, limit high kcal foods and drinks
135
Q

Which cancers are clearly linked to body weight? (PECK-BE)

A
  • Pancreas
  • Endometrium
  • Colon
  • Kidney
  • Breast
  • Esophagus
136
Q

Adults should get ____ mins off moderate intensity or __ minutes of vigorous intensity PA each week, spread out throughout the week

A

150

75

137
Q

Differentiate between usual and intentional activities

A
  • Usual are those done within usual routine

- Intentional are those that are planned, and are done at leisure or adding more purposeful activity

138
Q

Light intensity activity examples

A

-housework, shopping, gardening

139
Q

Moderate intensity activities?

A

Equal effort to a brisk walk

140
Q

Vigorous intensity?

A

Larger muscle groups, resulting is a faster heart rate, deeper and faster breathing and sweating

141
Q

1 minute of vigorous activity can take the place of ___ of moderate activity

A

2 mins

142
Q

Can garlic lower cancer risk?

A

Maybe, however allium compound supplements have little evidence

143
Q

Do GMOs cause cancer?

A

No evidence indicating that they increase or decrease cancer - however no proof of safety as long-term impacts are unknown

144
Q

Do organic foods lower cancer risk?

A

No evidence that organic foods are more effective in educing cancer risk or providing other health benefits than similar foods produced by conventional methods

145
Q

Do pesticides and herbicides cause cancer?

A

No evidence that the residues in low doses cause cancer, however fruits and vegetables should be thoroughly washed

146
Q

Do selenium supplements lower cancer risk? Are supplements recommended?

A

Maybe in animal studies, but no supplements recommended

147
Q

Does sugar case cancer?

A

Higher sugar may cause weight-gain, leading to cancer

148
Q

Will eating F and V lower cancer risk?

A

Yes

149
Q

Bottom line recommendations from ACS?

A
  • Achieve and maintain a HBW throughout life
  • Be physically active
  • Eat a healthy diet,, with an emphasis on plant foods
  • If you drink alcohol limit intake
150
Q

Alcohol for cancer prevention?

A

<1 drink/day females<2 drinks/day males

151
Q

What is used in nutritional assessment in cancer?

A

PG-SGA

152
Q

Common nutritional diagnosis with cancer?

A
  • Involuntary weight loss
  • Increased energy an protein needs
  • Inadequate oral intake
  • Malnutrition
  • Altered GI function
  • Impaired ability to prepare meals
153
Q

What is the most common cause of nausea and vomiting in cancer patients?

A

Chemotherapy-induced vomiting (CINV)

154
Q

Which cancer treatments are emetogenic?

A
  • Cisplatin
  • Methotrexate
  • Doxorubicin
  • Cyclophosphamide
  • Pain medications, such as morphine and fentanyl
155
Q

When should antiemetics be taken?

A

30-45 minutes prior to a meal, even if they do not feel nauseated

156
Q

(T/F) Nausea is only induced by eating in cancer patients

A

False, could also be cooking odours

157
Q

Recommended nutrition therapy for emesis?

A

Eat small, low fat meal the morning of the first treatment and avoid friend, greasy foods, favourite foods several days after the treatment.

158
Q

When may a clear liquid diet be prescribed? What else should be recommended?

A
  • First 24 hr after therapy

- Electrolyte fortified beverages and non-acidic fruit drinks

159
Q

Why should patients with emesis avoid favourite foods?

A

If it is vomited up, they are less likely to consume later

160
Q

What else should be avoided in emesis?

A

Creamy nutritional drinks (ONS) as if they are vomited on, less likely to consume and they will be important later in nutritional therapy

161
Q

What is the primary cause of early satiety?

A

Delayed gastric emptying

162
Q

Nutrition therapy for pt with early satiety?

A

Eat small, frequent nutrient dense meals and caloric beverages

163
Q

When should beverages be consumed for pt w/ early satiety?

A

BETWEEN meals, not w/ meals to avoid adding to satiety

164
Q

What should be avoided in early satiety?

A

Consumption of raw veg, high fiber foods.

165
Q

What is the action of prokinetics?

A

Will increase gastric emptying

166
Q

Potential side effects of prokinetics?

A

Diarrhea

167
Q

What is mucositis?

A

Irritation of the lining of the epithelial cells of the mucosal membranes within any point of the GI tract , causing pain

168
Q

What is mucositis associated with?

A

Main source of cancer treatment-related pain, and afflicts 40-70% of patients receiving chemo or radiotherapy -

169
Q

When does mucositis occur?

A

5-7 days after chemotherapy initiated, and may continue until the patient recovers from immunosuppresion

170
Q

Main nutritional related concerns with mucositis?

A

SEVERE pain and burning when chewing/swallowing which could inhibit intake of any foods or fluids

171
Q

What can mucositis lead to?

A

Dehydration, acute weight-loss

172
Q

What does the NCI recommend to supplement with to prevent pain cause by mucositis?

A

Zinc

173
Q

Mucositis may leave pt more prone to mouth sores - practical recommendations?

A
  • Eat foods cold/room temp
  • Choose soft foods/blended
  • Drink plenty of liquids
  • Suck on ice-chips, popsicles
174
Q

Bottom line nutritional therapy for mucositis?

A
  • Eat only soft, non-fibrous, non-acidic foods.
  • Avoid hot foods
  • Liquids to prevent dehydration
  • Non-acidic juices (nectars)
  • High kcal/supplements (ONS - granted not vomiting)
175
Q

What agent is likely to cause diarhea?

A

Antineoplastic agents

176
Q

Bottom line nutritional therapy of diarrhea?

A
  • Drink small amounts of fluids throughout the day, avoid fruit juice (fructose)
  • Clear liquid nutritional beverages
  • Increase soluble fiber BUT caution if low appetite
177
Q

Effects of dysgeusia?

A

Alterations in taste which can have a profound effect on patients ability to ingest an adequate amount of nutrition.

178
Q

What are key suspects of dysgeusia?

A

-Chemotherapeutic agents, such as cisplatin and radiation to head and neck area

179
Q

What is aguesia?

A

no taste sensations

180
Q

What does dysgeusia include?

A
  • Heightening of certain foods (especially sweets)
  • Aversions to foods liked in the past
  • Metallic taste
181
Q

Utensil/containers recommendations for patients with dygeusia?

A
  • Use plastic utensils

- Consume nutritional supplement in a glass (to avoid metal container)

182
Q

Food often not tolerated in dysgeusia?

A

Meats (metallic) but concern for not enough protein

183
Q

(T/F) We should recommend meat to pt with dysgeusia to avoid malnutriton

A

F - should recommend vegetarian sources

184
Q

Recommendation fo patients with ageusia?

A

Use lots of spices, and highly flavoured foods

185
Q

Issue with heightened sweet taste? Recommendation?

A

ONS are often too sweet could use non-sweet glucose supplement such as Polycose

186
Q

What is dysphonia?

A

Difficulty speaking

187
Q

What is dysomia?

A

Difficulty smelling

188
Q

Xerostomia recommendations?

A
  • Artificial saliva (less recommended)

- Sugar free gum or candies to increase saliva flow (more recommended)

189
Q

Prevalence of anorexia amongst cancer patients?

A

50%

190
Q

Nutritional therapy for anorexia?

A
  • Small, frequent meals
  • Maximize food intake when appetite is normal
  • Limit fluids w/ meals
  • Eat favourite food and in pleasant, relaxing environments
  • Eat in well ventilated room
  • ONS that is appealing
191
Q

Recommendations to increase appetite in anorexia?

A
  • Wine before meals (check w/ physician)

- Mild exercise (check w/ physician)

192
Q

Pharm to increase appetite in anorexia?

A

Megestrol acetate and cotriciosteroids

-Caution with corticosteroid side effects

193
Q

(T/F) EN and PN should be used ROUTINELY adjunct to radiation/chemo

A

False

194
Q

When should EN PN be used?

A

When pt is malnourished or anticipated to have low ingestion of food/fluids for long periods of time

195
Q

(T/F) Antioxidant supplementation should not be taken with radiation therapy

A

True, as they may reduce the efficacy of treatment

196
Q

When is nutrition support before surgery beneficial?

A

In moderately or severely malnourished patients if administered 7-14 days PO

197
Q

What is prophylactic?

A

Anticipatory nutrition therapy

198
Q

When may prophylactic nutritional therapy be used?

A
  • 5% weight loss in 1 mo or 10% in 6 mo
  • Ongoing dehydration or interruptions with feeding
  • Severe aspiration
  • High risk of long-term swallowing disorder after therapy
199
Q

_____ enteral formulas may be beneficial in cancer patients undergoing major cancer operations

A

Immune-enhancing

200
Q

When are alterations in swallowing seen?

A

Can occur long-after treatment, and especially in radiation

-requires life-time monitoring

201
Q

Pharmacological doses of ___ may benefit pat undergoing hematopoietic cell transplantation

A

parenteral glutamine

202
Q

cancer kcal requirements obese?

A

21-25 kcal/kg

203
Q

cancer kcal requirements non-ambulatory or sedentary adults?

A

25-30 kcal/kg

204
Q

Cancer kcal requirements for hypermetabolic pt that need to gain weight?

A

30-35 kcal/kg

205
Q

Cancer kcal requirements for hypermetabolic pt w/ malabsorption?

A

35 kcal/kg +

206
Q

When are protein needs elevated in cancer?

A
  • Severe diarrhea

- Malabsortption

207
Q

Normal cancer protein needs

A

0.8-1.0 g/kg/day

208
Q

Non-stressed cancer pt protein needs?

A

1.0-1.5 g/kg/day

209
Q

Fluid req cancer?

A

Calculate w/ same formula, but need to monitor for dehydration

210
Q

Multivitamin supplementation cancer?

A

<150% of DRI may be beneficial for patient under going chemo/radiotherapy

211
Q

What should be monitored in cancer?

A
  • Weight
  • Caloric and protein intakes
  • Aspects of the PG-SFA
  • Tolerance to diet

Clinical Nutrition 1 (30 decks)

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