the primary goal of nutrition care for clients who have cancer is: This is a topic that many people are looking for. star-trek-voyager.net is a channel providing useful information about learning, life, digital marketing and online courses …. it will help you have an overview and solid multi-faceted knowledge . Today, star-trek-voyager.net would like to introduce to you MNT Cancer Part 3. Following along are instructions in the video below:
Is a condition where both the disease and the treatment can have major nutrition implications. Implications. For example.
Cancer itself could lead to cancer cachexia. Which would be malnutrition status through chemotherapy could give the patient a lot of gi symptoms as side effects. And this could affect their dietary intake.
Therefore overwhelmingly when we deal with cancer patients as dietitians malnutrition is the theme. We need to keep in mind the goals of nutrition care for cancer patients include prevention and reversal of nutritional deficiencies. Preserving lean body.
Mass and this is consistent with fighting and correcting malnutrition for patients undergoing treatment. We want to minimize nutrition related. Side effects and also maximize quality of life.
No matter. What stage. The patients is at mel nutrition and weight loss.
In cancer patients are associated with increased mortality. This is not news to us because other conditions the loss of signet of a significant significant amount of body weight and lean mass is also associated with death. So the primary goal as we mentioned is to prevent malnutrition.
We need to understand that the nature of the disease promotes the bodied to go through the wasting process. Therefore reversing malnutrition can be very challenging since cancer is a chronic illness depending on how long the patient has had the diagnosis. And if they have received multiple treatments.
Malnutrition can be very severe. And more prevalent basically. The longer.
The cancer history. Including the longer. The treatment history.
Then the more likely we would be seeing patients with malnutrition depending on the type of cancer. So which organ or tissue the disease affects.
The patient may have different risks for malnutrition for example a few cancers listed here so lung patriotic gi. Head and neck ovarian cancers these patients are at very high risks for malnutrition. And this is because you know for example.
If its pancreatic cancer. Then these patients wont have normal digestive enzymes from the pancreas. Not to mention the wasting nature of cancer itself.
Therefore. The digestion and absorption process will be severely compromised. Then the result is malnutrition and cancer.
So this is a vicious cycle that can push people towards a negative outcome when we conduct nutrition assessments for cancer patients. An additional you know we rechecked the usual things that you know should be pretty routine by now and specifically we have different tools to assess the general condition of the patient for example. We have the patient generated subjective global assessment or the pg sga and also must the malnutrition.
Universal screening tool. These are already validated tools. And if you recall what you learned in nutrition assessment.
These tools are very easy to apply. Its not a tedious process that exhausts both the professionals and the patients so these are tools that are validated and easy to use in terms of nutrition diagnosis. It will widely vary depend on depending on the type of cancer and how severe.
The disease and also the treatment modality for example someone who is actively receiving chemotherapy treatment for these patients almost everyone in these cases has altered gi function and are usually having nausea and vomiting or if they are doing radiation treatment. They may have dysphasia or a lot of pain when they swallow because the radiation. Hurts the mucosa of the gi tract or if its a breast cancer patient then because the breast tissue is relatively comparatively further away from other internal organs.
The radiation itself may not have a lot of gi fx. However it may have certain respiratory effects. Because the breast tissue being above the lung tissue.
So all of this could change the diagnosis depending again on the severity of the cancer. The type of cancer and treatment modality. So it must be looked at on a case by case basis.
So here are some side effects associated with cancer and its treatment. And we did see a similar list when we talked about chemotherapy.
Although other therapies could lead to these side effects depending on the case for example for radiation therapy. If its the gi tract. Then maybe like esophageal cancer.
Then we would see a lot of these gi related side effects. Because of this it would be very uncomfortable for the patient to eat anything therefore. One strategy is to increase the density of whatever theyre eating to make every bite count so for instance.
We could make a very nutrient dense smoothie as shown in the figure here to maximize nutrient delivery. If the patient can tolerate oral intake and different companies also make some high energy high protein beverages for people who have these conditions that are able to drink obviously. So for example ab makes ensure or theres boost by nestle.
So this here is a good summary to have and those companies also have free apps or online product information that we can refer to as well so here. We have nutrition therapy for anorexia so were putting this in cancer treatment. But there are other types.
But for other types of anorexia these strategies can also be very useful so remember in this case for anorexia meaning loss of appetite. So this is not the same as the eating disorder anorexia nervosa where someone is refusing to eat to lose weight so again were referring to strategies for dealing with loss of appetite and if we look at this table. We want to eat smaller more frequent meals and thats understandable because when a patient does not have a good appetite.
They probably wont be able to eat a large meal. Which you know can take a long time to finish also limiting fluid so this would help avoid the feeling of fullness and that you might remember we had a similar strategy when talking about post bariatric patients. They are advised not to drink fluid with solid food and we want to separate those so eating food and drinking fluid by at least 30 minutes or so.
Because this way they can maximize the intake of the solid food. Which has more nutrients. So this is a similar strategy here if they dont have a good appetite.
We want to use that limited appetite to allow them to intake. Solid food and then of course. Drink water separately and also another thing to kind of emphasize is a glass of wine before a meal may help stimulate the appetite and this is not only for cancer patients.
There are studies that indicate for example say in nursing home. Residents. Seniors with a glass of wine may also have increased appetite.
So this could be something that is useful and if we think about it drinking wine could also be a social event. So this may help cancer patients to deal with stress or improve their mood.
And that itself could have a positive impact on their appetite. However. We do need to check with the doctor first there may be contraindications for alcohol depending on the patients medications and treatment and also of course.
We are talking about you know having one glass of wine to moderate drinking because we do know that excessive alcohol consumption can increase cancer risk. Another thing is to you know keeping favorite foods. Available at all times.
Especially for patients who have had cancer over a long period of time or her or who currently are receiving treatment their appetite may come and go quickly. So we really want to honor their food preferences. Because decreased intake is a prevalent problem so if they have their favorite foods.
Handy. Then when they feel like its they can have a few bites and enjoy the food that they love this in itself could boost their mood. And of course is also bringing in more nutrients.
More energy to help combat malnutrition or risk of so. This list of strategies is very useful for any reason. When a patient is suffering from loss of appetite for patients who are receiving chemo and radiation therapy.
Due to side effects experienced. During these therapies. Sometimes patients cannot really have an adequate intake.
So both of and flu both of food and fluid through. Piatt the pio route in this case we need to us. Usif specializing nutrition.
Support is indicated. So we do have some standards here. So.
The patient has to be malnourished and and we anticipate that the patient wont be able to ingest or absorb adequate nutrition for a prolonged period of time. So you know the malnutrition is pretty common in cancer patients and then we also need to look at if we suspect that they will not be able to have adequate intake. So this means that even if they can intake a certain amount of oral intake their body cannot get enough its not adequate through the oral route obviously knowing that we need to start thinking about whether.
En rpn is appropriate sometimes it may be beneficial to provide certain nutrition interventions prior to a patient surgery because we know patients surgery itself is a controlled trauma and that would increase the patients need for energy and protein. But if they are already malnourished their post op complications will be more likely to happen.
What we want to do is something to prepare the bodies. The patients body to better deal with the incoming trauma caused by the surgery so after the surgery. Unless.
The gut is not working. We prefer to use ntral nutrition. The benefits should be clear by now it helps stimulate the intestine helps reduce potential complications and it can also prevent the translocation of colon bacteria into other parts of the body so aspen has issued some guidelines for intervention for patients who receive bone marrow transplants nutrition support aspen guidelines is appropriate for patients who are malnourished and how also have this anticipated and quit po2 and take period.
We should be consulting patients on foods. That may pose infection. Risk.
And let them know about safe food handling. And this is because at this time until the transplant. Becomes successful patients host immunity is compromised.
Therefore any raw food and things like that could potentially bring infection in healthy individuals. It may not be an issue. But for these people who are already immunocompromised.
It may become a major challenge and also if they have the grass graft versus host disease. Then this can also be accompanied by poor oral intake and also malabsorption is possible so aspen guidelines has clear indications for nutrition support for patients receiving this transplantation therapy. So how do we determine the nutritional requirements.
We could use the mifflin st. George n. Remember this has different formulas for men and women or we could follow this strategy.
That is maybe a little bit more practical so depending on the status of the patients. We have a quick energy allowance reference and this is something we can look at quickly to give us some guidance so depending on if theyre obese sedentary slightly hep or metabolic. Having malabsorption those types of things when it comes to monitoring and evaluation.
We definitely need to closely monitor weight status and intake level. Because the main nutrition theme here is malnutrition and we need to fight it then we have to check weight loss see if they are regaining weights and also if the calorie intake and protein intake whether its through pio or through en or pn support we need to check if it is meeting the patients needs also how well the patients are tolerating the intervention and any changes in the symptoms. Also if we did initially use the pgs ga.
Then not something we could repeat. And see if theres any change in total score or even if there is suggestion for any new problems. .
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