miscellaneous

Question 1

HSCT acute complications

Answer 1

• GI toxicities from chemo
• acute GVHD
• renal impairment
• SOS
• infection

Question 2

long term complications of HSCT

Answer 2

• chronic GVHD (80-100days post transplant)
• osteoporosis (Ca/vitD, weight bearing exercise, biphosphanate therapy)
• growth and development issues (peds)
• endocrine complications - metabolic syndrome, hyperlipidemia **esp peds have high risk of DM, HTN, obesity
• iron overload - due to large # of transfusions; avoid iron containing supplements

Question 3

hemochromatosis

Answer 3

iron overload
common in hepatocellular cancer and certain treatments (ie. gemcitabine)
- avoid high iron foods such as shellfish
- avoid iron supplementation + vitamin c
- avoid alcohol (stresses liver)
- increase fruit/veg and whole grain/legume intake
*non-heme does not contribute to iron overload

Question 4

PERT

Answer 4

most likely for pancreatic/bile duct cancer

• steatorrhea symptoms - light, floating, fatty stools, excessive gas
• unexplained weight loss
• common after whipple surgery

starting dose: 10,000-40,000 units/meal (half for snacks)
- titrate dose based on symptoms

upper level: don’t exceed 10,000 units/kg/day

Question 5

fat limit per day for malabsorptive symptoms

Answer 5

75gm/day

Question 6

gastric outlet obstruction

Answer 6

symptoms: n/v/abd distention/pain

treatment:

• surgical (gastric bypass where jejunum is connected to stomach to bypass duodenum)
• stent (metallic stent placed in duodenum to hold open obstructed area)
• if above no possible: drainage g-tube + j-tube for feeding

Question 7

diet for duodenal stent

Answer 7

not well established

• establish tolerance to liquids first few days
• soft, low fiber diet
• advise to chew well and drink plenty of liquids

Question 8

trismus

Answer 8

limited ability to open jaw

long term side effect of HN radiation

Question 9

trismus

Answer 9

limited ability to open jaw

long term side effect of HN radiation

Question 10

measuring outcomes of nutrition care/programs

• clinical
• practice
• program

Answer 10

clinical: focus on end result of medical intervention
practice: look at best practice and meeting established guidelines
program: measure success of a program via patient satisfaction surveys (press ganey, gallup, etc)

results used to support nutrition program, increase staffing, improve services/overall nutr care

Question 11

Higher energy expenditure with these cancers

Answer 11

Esophageal
Gastric
Pancreatic
NSCLC

(PEGN)

Question 12

Energy needs predictive equations for healthy individuals

Answer 12

Mifflin StJeor
Harris Benedict
DRI

Question 13

Energy needs predictive equations acutely ill

Answer 13

Mifflin StJeor

Ireton Jones

Question 14

Energy needs predictive equations critically ill

Answer 14

Penn State
Swinamer
Ireton Jones (ventilator)

Question 15

Energy needs predictive equations obese population

Answer 15

*indirect calorimetry

If not available:
Ireton Jones or hypocaloric:
11-14 kcal/kg of actual BW (hypo metabolic)
14-18 kcal/kg of actual BW
22 kcal/kg of IBW (both acutely and critically ill)

Question 16

Calorie needs/:

Cancer, inactive and nonstressed 
Sepsis
Cancer, weight gain and depletion
HSCT
Cancer, hyper metabolic and stressed

Answer 16

Cancer, inactive and non-stressed 25-30 
Sepsis 25-30
Cancer, weight gain and repletion 30-35
HSCT 30-35
Cancer, hyper metabolic and stressed 35