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37 Cards in this Set

  • Front
  • Back
Functions of nutrients
*Serve as source of energy
*Support the growth and maintenance of tissue
*Aid in the regulation of basic body processes
Nutrition and Cancer
*Diet and the development of cancer
-diet is likely to influence the pre-malignant phase of cancer, but not frank tumor growth
*Diet during treatment of cancer
-Altered nutrition r/t anorexia, nausea & vomiting, diarrhea, stomatitis/mucositis, esophagitis, dysphagia and changes in taste, aeb....
International Dietary Guidelines to Prevent Cancer
*Diet should be based on plant products
*Diet should parallel the food pyramid
*Food should be cooked at low temperatures
*Alcohol should be limited to two drinks per day
Dietary Carcinogens
*Cancer Promoters (favor the development of cancer)
-Linoleic Acid (fatty acid)
-ETOH
*Cancer Antipromoters (opposes the development of cancer)
-Dietary Fiber
-Plant Food
-Antioxidants
-Cruciferous Vegetables
-Vegetarian Diets
Cancer Promoters
*Linoleic Acid
-An essential fatty acid found in corn oil
-Enhance the development of breast, colon, pancreas and prostate cancer in animals
Cancer Promoters
*ETOH
-Increases the risk of cancers of the mouth, pharynx, larynx, esophagus, colorectal, liver and breast
Cancer Antipromoters
*Dietary Fiber
-Promotes the excretion and speeds up intestinal transit time so that carcinogens are eliminated more rapidly
-Reduces the risk of colon cancer
Cancer Antipromoters
*Plant Food
-People who eat yellow and green fruits and vegetables have fewer cancers
Cancer Antipromoters
*Antioxidants
-Found in fruits and vegetables
-Protects the body against damage to tissues
-Vitamin C & E, selenium and carotenoids
Cancer Antipromoters
*Cruciferous Vegetables
-Cabbage, Broccoli, Brussel sprouts and cauliflower
-Reduces the risk of cancers of the GI and Respiratory Tracts
Cancer Antipromoters
*Vegetarian Diets
-Limits the consumption of animal fats to varying degrees
-Low in saturated fat and high in fiber
-Risk of inadequate protein intake
Nutrition for the Cancer Patient
*Goal
-Maintain the client's strength to endure the treatment of cancer
Adequate Nutrition Necessary
*To improve ability to tolerate demands of disease and therapies
*Prior nutritional status influences ability to tolerate therapy
*Decrease complications of therapy
*Improved quality of life and sense of well being
Nutritional Needs Will Change
*During treatment--needs increase
*During Recovery
*Advance Disease--Needs increase
Cancer Therapies
*Chemotherapy
-Stomatitis and mouth ulcers make eating painful
-Altered taste perception; strong aversion to foods, tastes, odors
-Abdominal pain related to ulcers
Cancer Therapies
*Radiation
-Head and neck radiation may cause altered taste perceptions, "mouth blindness"
-Altered taste perception; strong aversion to foods
-Thick saliva resulting in dysphasia
Radiation Effects on the Oral Cavity
*Radiation to the head and neck can harm normal cells resulting in problems with your teeth, gums, mucous, and jaw bone
*Side effects can make it difficult to eat, talk and swallow
Radiation Effects on the Oral Cavity
*Side effects
-Dry mouth
-Cavities
-Loss of taste
-Sore mouth and gums
-Infections
-Jaw stiffness
-Jaw bone changes
*Need to think about pain meds*
Chemotherapy Effects on the Oral Cavity
*Chemotherapy
-Neurotoxicity: persistent, deep pain which mimics a toothache
-Bleeding: from neutropena or thrombocytopenia (platelets <50 spontaneous bleeding of gums)
Chemotherapy Effects on the Oral Cavity
*Teach patient
-Go to dentist before starting treatment
-Saliva substitutes
-Nutrition is important to healing
-Stay away from hot, spicy foods
*Treatment for mucocitis
-gel clear-coats inside of mouth also vitamin E oil coats mouth
Metabolic Alterations of the Cancer Client
*Altered Energy Metabolism
*Protein Metabolism
*Carbohydrate Metabolism
*Lipid Metabolism
Cachexia
*A state of malnutrition and wasting
-Resulting from a combination of anorexia and accelerated metabolism
-Leads to muscle wasting and general poor health
-Major cause of morbidity & mortality
Common Nutritional Problems
*Early satiety and anorexia
*Taste alterations
*Local effects on the mouth
*Nausea, vomiting & diarrhea
*Altered immune response
Common Nutritional Problems
*Abnormal blood glucose regulation
*Protein-calorie malnutrition
*Inability to take/digest food
Teach patient to eat 6 small meals a day
Common Nutritional Problems
*Satiety
-The feeling of being full after eating; the sensation of satisfaction
-Physical pressure from the tumor (obstructions) or fluid accumulation (ascites) may give the feeling of fullness
*Anorexia
-Loss of appetite
-Control of the disease process improves appetite
Common Nutritional Problems
*Taste Alterations
-Decrease threshold for bitterness
-Decrease sensation of sweet, sour or salt (crave salt)
*Local Effects in the Mouth
-Mucositis/Stomatitis, Esophagitis, Dysphagia
*Nausea, Vomiting and Diarrhea
-Radiation enteritis
*Altered Immune System
-Suppression of the immune system increases the risk of infection from fresh fruits, vegetables and yogurt
(neutropenic diet - no fresh fruit, or salad)
Nutritional Support
*Helps client enjoy a better quality of life
*Stabilizes or reverses weight loss if cachexia is diagnosed early
*May improve resistance to infections and response to therapies
*Aids in healing
Nursing Process: Nursing Diagnosis
*Alteration in nutrition, less than body requirements r/t anorexia, nausea, vomiting, diarrhea, stomatitis/mucositis, esophagitis, dysphagia, changes in taste
Altered Nutrition: Anorexia
*Assessment Data:
-Assess contributing factors:
*inactivity
*medications
*inability to ingest/digest food
-Weight loss
-Fatigue
*Nursing Considerations:
-Teaching
-Assess the loss of appetite
-Always teach client the importance of nutrition and maintaining weight
Expected Outcomes
*Patient and family will understand the need to maintain adequate nutrition
-Will identify ways to maintain adequate nutrition
*Client will maintain or return to ideal body weight
Alteration in Nutrition: Nausea & Vomiting
*Assessment Data:
-Occurrence and pattern
-General appearance
-Skin turgor
-Diet history
-Medication
-Ascultate bowel sounds
-Evaluate labs
*Nursing Considerations:
-Dietary modifications
-Teaching
Altered Nutrition: Esophagitis and Dysphagia
*Assessment Data:
-Difficulty swallowing
-Pain c/o "lump in throat"
*Occurs with chest radiation
*Begins around 2-3 weeks after the start of treatment
*Nursing Considerations:
-Diet
-Pain management (Take 1 hour before meals)
-Teaching
Altered Elimination: Diarrhea
Assessment Data:
-Determine frequency and character of stools
-Stools loose, watery with cramping
-Determine usual bowel pattern
-Assess hydration
-Assess labs
*Nursing Considerations:
-Diet modifications
-Minimize diarrhea
-Skin care
-Medications
-Teaching
Altered Mucous Membranes: Stomatitis/Mucositis
*Assessment Data:
-Tenderness
-Mild-moderate erythema
-Whitish pseudomembrane on mucosa
-Edema of mucosa
-Bleeding with severe stomatitis, neutropenia
-Assess ability to swallow
-Assess for superinfection
*Nursing Considerations:
-Mouth care
-Pain management
-Diet
-Treat infections
General Dietary Strategies
*Use nutritional supplements: Carnation Instant Breakfast, Ensure or Sustacal
*Eat what you like when you feel like it
*Small frequent meals of soft, creamy foods
*Add calories when possible
*Thick liquids are easier than thin
*Lubricate foods with butter or gravies
*Keep food cool or at room temperature
*Offer favorite foods
*Avoid fried, spicy, crunchy, low nutrient foods
*Lemon juice, onion, mint and basil can improve the metallic taste of meats
Pharmacological Interventions
*Lack of appetite (Megace, antidepressants)
*Dry mouth
*Stomatitis
*Emesis (Antiemetics)
*Pain
*Diarrhea
*Constipation