NS335-Unit 6

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Unit 6: Cancer and HIV

Dr. Jeanette Andrade PhD, RDN, LDN

NS335

Reminders

Unit 6 discussion board due Tuesday

Unit 6 assignment due Tuesday

Unit 6 Assignment

1. In which stage of HIV infection would you categorize Mr. W?

2. Name and describe the major clinical complications in the final stage of AIDS and explain how these complications profoundly compromise a patient’s nutritional status.

3. What should be the goal of nutritional therapy based on assessment data and the patient’s history?

4. Utilize your critical thinking skills to determine the most appropriate route of feeding to administer nutrition support. Defend your choice with evidence from the patient description and the knowledge you have gained regarding alternative feeding routes.

Unit 6 Assignment

5. Working with patients who have HIV can include a number of sensitive issues, including patient confidentiality, integrity and ethical issues, and social responsibility. Explain how you would deal with these issues as you attend to Mr. W.

6. List several nutritional supplements that might be used to alleviate some of Mr. W’s symptoms and increase his caloric intake when he is able to tolerate a diet again.

7. Write a Nutrition Care Plan/Chart note on the HIV patient that addresses the patient’s current clinical situation. Write this note as though you were a nutrition professional caring for this patient in a hospital setting. Please refer to Table 11-3 and 11-4 in your textbook for information on the ADIME chart note process.

Unit 6 Assignment

Answer questions numbers 1–5 in a 2–3 page paper using APA format and citation guidelines. Include a title page, introduction, body, conclusion, and reference page. Include number 6, the Nutrition Care Plan/ Chart note, as an appendix.

References: Include a minimum of 4 quality references

Last week

What was your muddiest point from last week?

What was your clearest point from last week?

Any questions from last week’s material?

Cancer

Abnormal cell division and reproduction that can spread throughout the body

Three stages

Initiation

Promotion

Tumor progression, including metastasis

Response to treatment is complete, partial, stable, or progressive

Cancer

What are risk factors for cancers? Both dietary and lifestyle

How can nutrition contribute/ reduce risk for cancer?

Color Code System of Vegetables and Fruits

Color	Phytochemical	Vegetables and Fruits
Red	Lycopene	Tomatoes and tomato products, pink grapefruit, watermelon
Red and purple	Anthocyanins, polyphenols	Berries, grapes, red wine, prunes
Orange	α-, β-carotene	Carrots, mangoes, pumpkin
Orange and yellow	β-cryptoxanthin, flavonoids	Cantaloupe, peaches, oranges, papaya, nectarines
Yellow and green	Lutein, zeaxanthin	Spinach, avocado, honeydew, collard and turnip greens
Green	Sulforaphanes, indoles	Cabbage, broccoli, Brussels sprouts, cauliflower
White and green	Allyl sulphides	Leeks, onion, garlic, chives

Data from Heber D: Vegetables, fruits and phytoestrogens in the prevention of diseases, F Postgrad Med 50:145, 2004.

Factors That Affect Appetite

Cancer Cachexia

Progressive weight loss

Anorexia

Generalized wasting and weakness

Immunosuppression

Altered BMR

Abnormalities in fluid and energy metabolism

Mediated via cytokines, including tumor necrosis factor (TNF-a and TNF-b), interleukin-1, interleukin-6, and interferon-a

Estimating Energy Needs of People with Cancer

Fluid and Micronutrient Requirements

Fluid

Body surface area: 1500 mL/m2 or BSA × 1500 mL

Daily requirements method: 1 mL fluid per 1 kcal of estimated needs

Holliday-Seger method: >20 kg of body weight = 1500 mL + 20 mL/kg for each kg >20 kg

Age-based method: <55 years of age, 30 to 40 mL/kg; 55 to 65 years of age, 30 mL/kg; >65 years of age, 25 mL/kg

Micronutrients

High-dose supplements common

Preexisting deficiencies

Recommend supplement with 100% DRI

Protein Requirements

Must consider degree of malnutrition, extent of disease, degree of stress, ability to metabolize and use protein

1.5 to 2 g/kg/day is the estimated need

Generally calculated based on actual weight

Focal Points

Nutrition plays an important role throughout the continuum of cancer care from helping to reduce cancer risk to caring for patients undergoing cancer treatment to promoting healthy lifestyles for cancer survivors.

Patients have different needs and challenges with regard to their nutrition management, and providing individualized nutritional guidance is an essential component of their care.

Prompt and appropriate nutrition management may help to improve patients’ tolerance of treatment, minimize nutrition impact symptoms, and maximize quality of life.

Cancer patients should be encouraged to actively participate in their care and to communicate with their health care providers.

Integrative oncology is becoming part of traditional cancer centers.

HIV Life Cycle

Stages of HIV Infection

Acute HIV infection

2 to 4 weeks after infection, flu-like symptoms, lasts a few days to 4 weeks, seroconversion

Asymptomatic chronic HIV infection

Lasts a few months to 10 years, few symptoms, subclinical changes

Symptomatic HIV infection

Fever, sweats, skin problems, fatigue, decline in nutrient status or body composition

AIDS or advanced HIV

One or more well-defined, life-threatening clinical condition

Nutrition Interventions

Energy and protein

Establish if the individual needs to gain, lose, or maintain weight

Altered metabolism, nutrient deficiencies, severity of disease, comorbidities, and OIs should be taken into account

No evidence exists for increased protein intake over and above that necessary to accompany the required increase in energy

Fat

Individual tolerance; MCT

Omega-3 fatty acids may low triglycerides

Nutrition Interventions (cont’d)

Fluids and electrolytes

30 to 35 mL/kg

Extra fluid and electrolytes for diarrhea, vomiting, night sweats, and prolonged fever

Vitamins and minerals

Special concerns in pediatric patients

Specific CAM Therapies

St. John’s wort decreases plasma levels of indinavir; may cause drug resistance and treatment failure

Garlic supplements reduce blood levels of saquinavir

Milk thistle (silymarin) could lessen metabolism of medications and increase toxicity

High use of CAM; may not report

Focal Points

HIV disease involves multiple systems and has complex psychological, social, and economic ramifications.

Until recently, research, medical care, and education about HIV have been less than ideal throughout the world.

Nutrition intervention has a role in improving the quality of life of those living with HIV infection and may even prolong life.

Multiple factors must be considered to find the best ways to provide appropriate HIV medical nutrition therapy.

Advocacy for improving inequities will undoubtedly improve outcomes for people with HIV in the United States and in the rest of the world.