Section 6: Supportive Care

Front 1

What are the goals of nutritional support for heme/onc patients?

Back 1

- Preserving nutritional status
- Reversing nutritional deficiencies
- Preserving lean body mass
- Minimizing nutrion-related side effects
- Maximizing the patient's quality of life

Front 2

Nutritional status should be assessed to identify patients at nutritional risk. T/F

Back 2

True - Nutritional assessment

Front 3

What aspects of taking a nutritional history should be included?

Back 3

- Recent changes in diet
- Past and current appetite levels
- Food allergies or intolerances
- Typical food preparations
- Use of vitamins, herbs or other supplements
- Recent weight changes
- Bowel history
- Past and current GI symptoms
- Food diary 3-7 days more accurate

Front 4

What are subtle characteristics of a patient's nutritional status on physical exam?

Back 4

- Edema
- Dehydration
- Poor fat or muscle mass

Micronutrient deficiencies can cause subtle changes in the appearance of a patient's skin, eyes, lip, tongue, nails and hair

Front 5

What are examples of anthropometric measurements?

Back 5

Weight and length/height
Head circumference
Midarm circumference and skin-fold triceps.

Front 6

What laboratory values are important in assessing a patient's nutritional status?

Back 6

Serum protein markers- albumin and prealbumin can be used to evaluate a patient's nutritional status

Also important to evaluate triglyceride and cholesterol levels as part of a complete nutritional assessment. Other important labs include Chem 10 and liver panel.

Front 7

Marcus a 10yo with h/o ALL, who is 30 days out from MUD BMT comes to his first clinic visit after being discharged from the hospital. He reports anorexia and early satiety. What are appriopriate nursing interventions to help with these GI symptoms?

Back 7

- Offer small, frequent meals and have snacks readily available.
- Drink minimally during meals
- Offer high-calorie oral supplements
- Provide a comfortable, relaxing environment while eating.
- Appetite stimulant may be indicated.

Front 8

What are appriopriate nursing interventions with a patient who reports n/v?

Back 8

- Provide small, frequent meals
- Offer bland and cold foods
- Avoid foods that are fatty, fried, greasy, very sweet, spicy or have strong odors
- Do not force the patient to eat
- Rest after meals
- Encourage use of relaxation or distraction

Front 9

Hot food typically make nausea worse. T/F

Back 9

True

Front 10

Molly a 8 yo with h/o AML, who has just completed consolidation therapy. She reports dysgeusia. What are appriopriate nursing interventions to help with this symptom?

Back 10

- Tart foods (e.g. organges or lemonade) may taste better
- Marinate meat in fruit juice, salad dressing or sweet and sour sauce
- Offer chicken, turkey, eggs, dairy, or fish for protein if beef tastes strange.
- Use herbs or seasonings to add flavor
- Offer fluids with meals

Front 11

What are appropriate nursing interventions with a patient who has mucositis?

Back 11

- Offer soft foods
- Avoid food and drinks that can irritate the mouth (citrus fruits, tomato products, spicy, salfty, hot, rough or dry foods)
- Mix food with butter, gravy or sauce to soften and make swallowing easier
- Perform mouth care frequently

Front 12

What are appropriate nursing interventions with a patient who has xerostomia?

Back 12

- Drink fluids frequently
- Sweet and tart foods can help saliva production
- Suck on hard candy or popsicles or chew gum
- Add sauce, gravy or salad dressing to food

Front 13

What are appropriate nursing interventions with a patient who has diarrhea?

Back 13

- Offer small, frequent meals
- Avoid milk and milk products if lactose worsens the diarrhea
- Avoid excessive juice consumption and greasy, fatty, fried, high-fiber foods
-Drink large amounts of fluids to replenish fluid losses
- Provide rectal skin care as indicated
- Provide antidiarrhea medication if indicated

Front 14

What are appropriate nursing interventions with a patient who has constipation?

Back 14

- Offer a high-fiber diet and drink large amounts of fluid; offer prune juice
- Encourage physical activity
- Consider laxative or stool softener

Front 15

Enteral nutrition is the preferred method of nutritional support. T/F

Back 15

True- It preserves GI integrity and prevents bacterial translocation of the gut; patient's GI tract be intact to absorb nutrients.

Front 16

Gastrostomy or jejunostomy tubes are reommended for nutritional support greater than 4 weeks. T/F

Back 16

True- Nasogastric are placed for short-term use, while nasoduodenal and nasojejunal are for long-term use. Gastrostomy and jejunostomy are for longer than 4 weeks.

Front 17

Parental nutrition can be used to meet 100% of the patient's nutritional needs without exacerbating GI symptoms and distress. T/F

Back 17

True

Front 18

Parental nutritional can cause early satiety and decreased oral intake in patients. T/F

Back 18

True

Front 19

What patients are identified at being at nutritional risk?

Back 19

- Weight loss of 5% of pre-illness body weight
- Weight-for-length of body mass index < 10th percentile for age
- Voluntary food intake of < 70% of estimate requirements for 5 or more days
- Anticipated gut dysfunction for more than 5 days

Front 20

When treating a malnourished patient, it is important to condiser refeeding syndrome. What are the characteristics of refeeding syndrome?

Back 20

Refeeding syndrome creates acute and often significant, electrolyte changes when enteral or parental nutritional support is initiated in malnourished patients.
Results in an increase in insulin secretion, which stimulates cellular uptake of phosphate, leading to profound hypophosphatemia that is often accompanied by hypokalemia and hypomagnesemia.
-Occurs within 4 days of initiation of feeds and can result in multiple complications including muscle weakness, immune dysfunction, cardiac failure, respiratory distress and death

-To reduce risk of this syndrome, feedings should be introduced at a reduced caloric rate and advanced slowly. In addition, serum electrolytes should be measured before starting feeds and repeated at least for 4 days after feeding is started.