Dietary Counseling Nutrition Intervention
12.3.2 Appetite Stimulants
Appetite stimulants may augment dietary intake although consistent evidence is lacking regarding effi cacy and the side effect profi le must be consid- ered Ladas et al. 2005 . Both Orme et al. 2003 and Cuvelier et al. 2013 reported signifi cant weight gain with megestrol acetate although with common severe adrenal suppression. A study of 66 evaluated pediatric oncology patients showed modest but signifi cant weight gain with cypro- heptadine hydrochloride with the main reported side effect being drowsiness Couluris et al. 2008 . Additional agents utilized include canna- binoids such as dronabinol as well as mirtazapine, a noradrenergic and serotonergic antidepressant. Systematic studies on the benefi t of these agents and their comparative side effects are lacking.12.3.3 Enteral Tube Feeding
Enteral tube feeding TF should be initiated when oral intake is inadequate to support growth or nutri- tional repletion in the child with cancer. Patients eligible for TF must have an intact GI tract. Enteral feeding has numerous advantages over total paren- teral nutrition TPN including maintenance of GI mucosal function, cost- effi ciency, and avoidance of TPN complications including bacterial infec- tion, thrombosis, hepatic toxicity, cholestasis, and metabolic derangements den Broeder et al. 1998 ; Nevin-Folino and Miller 1999 . TF also offers the benefi t of medication administration without oral ingestion. Despite these benefi ts, hesitation remains in the provision of TF in the medical com- munity Ladas et al. 2006 . TF is often presented as a punishment for not eating. Concerns arise from patients especially adolescents and families due to the perceived inconvenience, discomfort and poor body image associated with the placement of a nasogastric tube. To optimize acceptance, TF should be proposed as a positive intervention mea- sure that is part of a comprehensive supportive care plan to aid in overall patient well-being. Multiple studies in pediatric oncology patients have demonstrated that TF is successful in main- taining adequate nutritional status and reversing malnutrition Aquino et al. 1995 ; Mathew et al. 1996 ; den Broeder et al. 1998 ; Deswarte-Wallace et al. 2001 ; Bakish et al. 2003 ; Ladas et al. 2005 . Moreover, TF appears feasible and safe in patients with mucositis, severe neutropenia and thrombocy- topenia. DeSwarte-Wallace et al. 2001 evaluated the use of TF in a pediatric oncology population during and after intensive oncologic treatment and demonstrated that most children tolerate TF with- out signifi cant vomiting or diarrhea. The investiga- tors concluded that TF is a safe and cost-effective intervention in pediatric patients receiving dose- intensive chemotherapy. Pietsch et al. 1999 eval- uated TF in children receiving intensive chemotherapy n = 14 or HSCT n = 3 and found TF was well tolerated with minimal complications, including risk of emesis and tube dislodgment, at a substantial cost saving compared to TPN. Finally, 32 children with solid tumors were administered TF during the most intensive phase of therapy; TF was well tolerated and improved weight among the patients Den et al. 2000 . An association between TF and reduction in non- leukopenic infection was also observed p = .009 Den et al. 2000 . Taken together these small studies lend support to the benefi ts of TF on nutritional status and possibly therapy-related toxicities. Depending on the tolerability of TF and amount of oral intake, TF can commence as bolus feeds, nocturnal continuous feeds, nocturnal con- tinuous feeds with bolus feeds during the day or as continuous drip-feeds. The clinical aim of TF is to supply the required nutrient intake of both macro- and micronutrients as described in the Dietary Reference Intakes DRIs Otten et al. 2006 . The DRIs are designed to guide health professionals in determining the dietary needs of each individual patient; recommendations by age and gender are available at the United States Department of Agriculture website http:fnic. nal.usda.govdietary-guidancedietary-reference- intakesdri-tables . Table 12.5 Food safety practices a Food shopping 1. Check expiration dates on food and do not buy or use if the food is out of date. 2. Do not purchase ready-to-eat food from bulk food bins i.e., breads, nuts, dried fruit, candies. 3. Avoid all food in cans that are swollen, dented or damaged. 4. Avoid produce that is bruised or damaged. 5. Bag fresh fruits and vegetables separately from meat, poultry and seafood products. Food storage 1. Store perishable fresh fruits and vegetables i.e. cucumbers, tomatoes in a clean refrigerator at a temperature of 40 °F or below. 2. Refrigerate all produce that is purchased pre-cut or peeled. 3. Beef should be refrigerated at 40 °F and used within two days. Beef can be frozen at 0 °F and used within 6 months of the purchase date. Food preparation 1. Wash hands with water and soap for 20 s before and after any food preparation. 2. Wash fruits or vegetables under running water even if you are going to peel them. Do not use soap, bleach or commercial produce washes to clean fruit. 3. Dry produce with a clean cloth towel or paper towel. This will reduce the spread of bacteria. Do not wash meat, poultry or eggs. 4. Defrost all meats in the refrigerator. Do not defrost at room temperature. 5. Food-preparation surfaces must be cleaned fi rst. Wash surfaces thoroughly with soap and water and thoroughly dry. As an extra precaution, you can use a solution of one tablespoon unscented, liquid chlorine bleach in one gallon of water to sanitize washed surfaces and utensils. 6. Wash cutting boards, dishes, utensils and counter tops with hot, soapy water after preparing each food item and before you go on to the next item. Cooking 1. Cook foods immediately after thawing. 2. All raw foods such as meats, poultry and entrees should be cooked until they are well-done. Beef should be cooked to 160 °F, depending on the cut. Chicken should be cooked to an internal temperature of 165 °F. Cold foods should be stored 40 °F, hot foods kept 140 °F. A home thermometer may help. Storage of cooked foods 1. Store leftovers within 2 h. By dividing leftovers into several clean, shallow containers, you’ll allow them to chill faster. Discard leftovers that were kept at room temperature for greater than 2 h. 2. Perishable foods fruits, vegetables, meat, dairy should be put into the fridge or freezer within 2 h. In the summer months, cut this time down to 1 h. 3. Do not use leftovers prior to reheating to 165 °F before serving. Baby foodinfant formula 1. Never put baby food in the refrigerator if the baby doesn’t fi nish it. Do not feed your baby directly from the jar of baby food. Instead, put a small serving of food on a clean dish and refrigerate the remaining food in the jar. If the baby needs more food, use a clean spoon to serve another portion. Throw away any food in the dish that’s not eaten. If you do feed a baby from a jar, always discard any remaining food. 2. Prepare safe water for preparing formula. Bring tap water to a roiling boil and boil it for 1 min. If you use bottled water, follow this same process. Cool the water to body temperature before mixing formula. 3. Sterilize bottles and nipples before fi rst use. After that, wash them by hand or in a dishwasher. 4. Formula can become contaminated during preparation, and bacteria can multiply quickly if formula is improperly stored. Prepare formula in smaller quantities on an as-needed basis to greatly reduce the possibility of contamination. Always follow the label instructions for mixing formula. Additional information may be found at www.foodsafety.gov. a Select recommendations from the United States Federal Drug Adminis tration’s Clean, Separate, Cook and Chill. 12 NutritionParts
» Supportive Care in Pediatric Oncology irantextbook.ir 93df
» Introduction Supportive Care in Pediatric Oncology irantextbook.ir 93df
» History and Physical Supportive Care in Pediatric Oncology irantextbook.ir 93df
» Defi ning the Risk for Serious
» Initial Laboratory Evaluation Diagnostic Evaluation
» Chest Radiography CXR A supine CXR may identify pleural effusions,
» Computed Tomography CT Radiographic Imaging
» Magnetic Resonance Imaging MRI
» Positron Emission Tomography PET
» Aspergillus Galactomannan GMN Biomarkers for Invasive
» 1,3-β- Biomarkers for Invasive
» Polymerase Chain Reaction PCR
» Viral Studies Diagnostic Evaluation
» Invasive Procedures: Diagnostic Evaluation
» Adult FN Guidelines Empiric Management
» Monotherapy Versus Combination Therapy
» Which Monotherapy to Choose A Cochrane review of antipseudomonal beta-
» Alterations in Initial Empiric FN Antibiotic Management
» Outpatient Management of FN Although there remains a lack of one uniform
» Choice of Empiric Antifungal Therapy
» Duration of Antimicrobial Empiric Management
» Endovascular Sources Empiric Management
» Adjunctive Treatment Empiric Management
» Emergence of Resistant Empiric Management
» Red Blood Cell Administration
» Granulocyte Transfusion Supportive Care in Pediatric Oncology irantextbook.ir 93df
» Hemolytic Transfusion Risks of Blood Product
» Infection and Sepsis Risks of Blood Product
» Allergic Reactions Risks of Blood Product
» Febrile Nonhemolytic Risks of Blood Product
» Transfusion-Related Acute Risks of Blood Product
» Transfusion-Associated Risks of Blood Product
» Iron Overload Risks of Blood Product
» Laboratory Risk Factors Supportive Care in Pediatric Oncology irantextbook.ir 93df
» General Management Supportive Care in Pediatric Oncology irantextbook.ir 93df
» Alkalinization Urinary alkalinization has been a long-standing
» Allopurinol Allopurinol inhibits xanthine oxidase, an enzyme
» Rasburicase Rasburicase, recombinant urate oxidase, converts
» Renal Interventions Supportive Care in Pediatric Oncology irantextbook.ir 93df
» Pathophysiology Superior Vena Cava
» History and Physical Exam SVCSSMS should be suspected in a patient
» Imaging Studies The diagnosis of SVCSSMS is often made on
» Other Studies Tissue is required to make a defi nitive diagnosis
» Treatment Superior Vena Cava
» History and Physical Exam Small pericardial effusions are frequently asymp-
» Imaging and Other Studies The presence of a pericardial effusion can be
» History and Physical Exam Many patients with small pleural effusions are
» Imaging Studies When a pleural effusion is suspected, a chest
» History and Physical Exam Patients with pheochromocytoma typically have
» Laboratory Studies The diagnosis of pheochromocytoma is best made
» Imaging Studies Clinical Presentation
» Pulmonary Leukostasis Supportive Care in Pediatric Oncology irantextbook.ir 93df
» Presentation Spinal Cord Compression
» Differential Diagnosis Spinal Cord Compression
» Imaging MRI of the spine can help narrow the differential
» Surgery Surgery in spinal cord compression can be uti-
» Radiation Therapy The advantages of external beam radiation ther-
» Outcomes Spinal Cord Compression
» Presentation Altered Mental Status
» Initial Management Altered Mental Status
» Metabolic The metabolic causes of AMS or seizure in pedi-
» Chemotherapy-Associated Neurotoxicity Differential Diagnosis
» Posterior Reversible Encephalopathy Syndrome
» Outcomes Altered Mental Status
» Initial Management Increased Intracranial
» Soft Tissue A large meta-analysis of published data suggests
» Cerebrospinal Fluid Hydrocephalus is an excess of CSF within the
» Hemorrhage and Thrombosis Differential Diagnosis
» Idiopathic Intracranial Hypertension Differential Diagnosis
» Presentation of Stroke Cerebrovascular Disease
» Differential Diagnosis Cerebrovascular Disease
» Etiology of Stroke in Pediatric
» Ischemic Stroke After an ischemic stroke is diagnosed, the patient
» Hemorrhagic Stroke Hematomas can expand over several hours from
» Acute Lymphoblastic Supportive Care in Pediatric Oncology irantextbook.ir 93df
» Acute Myelogenous Leukemia Supportive Care in Pediatric Oncology irantextbook.ir 93df
» Acute Promyelocytic Leukemia Supportive Care in Pediatric Oncology irantextbook.ir 93df
» Chronic Myelogenous Supportive Care in Pediatric Oncology irantextbook.ir 93df
» Management of Tumor Supportive Care in Pediatric Oncology irantextbook.ir 93df
» Leukapheresis Supportive Care in Pediatric Oncology irantextbook.ir 93df
» Hyperhydration Other Treatment Modalities
» Hydroxyurea Other Treatment Modalities
» Cranial Irradiation Other Treatment Modalities
» Pseudohyperkalemia Hyperleukocytosis has been noted to cause pseudo-
» Pseudohypoxemia Due to the rapid consumption of oxygen by leu-
» Pseudohypoglycemia Consumption of glucose by excess leukocytes
» Pseudothrombocytosis Leukemic blast lysis can lead to cell fragmenta-
» Transfusion Practice with Other Supportive Care
» Anesthetic Procedures Other Supportive Care
» Neutropenic Enterocolitis Gastrointestinal Infection
» Perirectal Abscess Gastrointestinal Infection
» Gastrointestinal Supportive Care in Pediatric Oncology irantextbook.ir 93df
» Pancreatitis Supportive Care in Pediatric Oncology irantextbook.ir 93df
» Bowel Obstruction Supportive Care in Pediatric Oncology irantextbook.ir 93df
» Abdominal Compartment Supportive Care in Pediatric Oncology irantextbook.ir 93df
» ALL Risk Factors Supportive Care in Pediatric Oncology irantextbook.ir 93df
» Other Malignancies Supportive Care in Pediatric Oncology irantextbook.ir 93df
» Central Venous Catheters Supportive Care in Pediatric Oncology irantextbook.ir 93df
» Diagnosis Supportive Care in Pediatric Oncology irantextbook.ir 93df
» Nociceptive Pain Types of Pain
» Neuropathic Pain Types of Pain
» World Health Organization Pharmacologic Treatment
» Intermittent Opioid Use Pharmacologic Treatment
» Long-Acting Opioids Pharmacologic Treatment
» Breakthrough Dosing Pharmacologic Treatment
» Opioid Rotation Pharmacologic Treatment
» Patient-Controlled Analgesia Pharmacologic Treatment
» Constipation Side Effects of Opioids
» Nausea and Vomiting Nausea and vomiting are rare opioid side effects
» Pruritus Pruritus is a common side effect of opioid use
» Sedation Side Effects of Opioids
» Confusion and Agitation Renal and hepatic function should be checked
» Respiratory Depression When dosed appropriately, opioids rarely result
» Myoclonus Patients receiving very high doses of opioids for
» Urinary Retention Urinary retention can be caused by any opioid but
» Calcium Channel Blockers Neuropathic Pain
» Serotonin and Norepinephrine Neuropathic Pain
» Tricyclic Antidepressants Neuropathic Pain
» Interventional Techniques Supportive Care in Pediatric Oncology irantextbook.ir 93df
» Vincristine-Related Peripheral Oncology-Specifi c Pain
» Osteonecrosis Oncology-Specifi c Pain
» Post-lumbar Puncture Oncology-Specifi c Pain
» Mucositis Pain Oncology-Specifi c Pain
» Pathophysiology of Emesis Chemotherapy-Induced
» Principles of Emesis Control in the Cancer Patient
» Emetogenicity of Chemotherapy Chemotherapy-Induced
» Dopamine Receptor Antagonists Classes of Antiemetics
» Corticosteroids Classes of Antiemetics
» Cannabinoids The plant Cannabis contains more than 60 differ-
» Other Antiemetic Agents Antihistamines
» Alternative Therapies Ginger Classes of Antiemetics
» Management of CINV Management of CINV Table
» Special Considerations Anticipatory Nausea and Vomiting
» Radiation-Induced Nausea Supportive Care in Pediatric Oncology irantextbook.ir 93df
» Initiation The initiation stage occurs immediately following
» Primary Damage Response Pathophysiology of Oral Mucositis
» Signal Amplifi cation Pathophysiology of Oral Mucositis
» Ulceration Ulceration is the phase with the most clinical sig-
» Healing Pathophysiology of Oral Mucositis
» Clinical Course of Oral Mucositis
» Assessment Supportive Care in Pediatric Oncology irantextbook.ir 93df
» Palifermin Prevention and Treatment
» Low-Level Laser Therapy Prevention and Treatment
» Glutamine Prevention and Treatment
» Cryotherapy Prevention and Treatment
» Oral Care Supportive Care in Pediatric Oncology irantextbook.ir 93df
» Oral Infections Supportive Care in Pediatric Oncology irantextbook.ir 93df
» Nutrition Assessment Supportive Care in Pediatric Oncology irantextbook.ir 93df
» Dietary Counseling Nutrition Intervention
» Appetite Stimulants Nutrition Intervention
» Enteral Tube Feeding Nutrition Intervention
» Parenteral Nutrition Nutrition Intervention
» Nutrition and Survivorship Supportive Care in Pediatric Oncology irantextbook.ir 93df
» Management of Neutropenia Hematologic Toxicity
» Management of Thrombocytopenia Hematologic Toxicity
» Management of Anemia Hematologic Toxicity
» Somnolence Syndrome Central Nervous System
» Lhermitte’s Sign Central Nervous System
» Skin Complications Supportive Care in Pediatric Oncology irantextbook.ir 93df
» Oral Mucositis Head and Neck
» Ear Complications Head and Neck
» Laryngeal Complications Head and Neck
» Dysphagia and Esophagitis Gastrointestinal
» Nausea, Vomiting and Anorexia
» Pneumonitis Major Organ Infl ammation
» Pericarditis Major Organ Infl ammation
» Hepatitis Major Organ Infl ammation
» Nephropathy Major Organ Infl ammation
» Cystitis Major Organ Infl ammation
» Risk Stratifi cation Prevention of Bacterial
» Adult Data Antimicrobial Approaches
» Pediatric Data Data regarding the utility of bacterial prophylaxis
» Risks of Prophylaxis Prevention of Bacterial
» Guidelines and Current Usage of Antibacterial Prophylaxis
» Protocols for Line Placement and Care
» Antibiotic and Ethanol Locks
» Chlorhexidine Cleansing Chlorhexidine gluconate CHG is a bactericidal
» Future Directions Prevention of Bacterial
» Risk Stratifi cation Prevention of Fungal
» Approaches to Antifungal Prophylaxis
» Guideline Recommendations for Antifungal Prophylaxis
» Limitations of Current Options for Antifungal Prophylaxis
» Risks of Prophylaxis Prevention of Fungal
» Biomarkers Prevention of Fungal
» Future Directions Prevention of Fungal
» Risk Stratifi cation Prevention of Pneumocystis
» Approaches to PCP Prophylaxis
» Summary of the Recommendations
» Future Directions Prevention of Pneumocystis
» Postexposure Chemoprophylaxis Prevention of Viral Infections
» Suppressive Therapy Prevention of Viral Infections
» Future Directions Prevention of Viral Infections
» Hand Hygiene Infection Control Practices
» Mandatory Vaccination Infection Control Practices
» Hospital Isolation Practices Infection Control Practices
» Visitor Screening Policies Infection Control Practices
» Work Restriction Infection Control Practices
» Cytomegalovirus CMV Status of Transfused Blood
» Treatment of Myelosuppression with
» Prevention of Febrile Neutropenia, Delay
» Treatment of Febrile Neutropenia
» Treatment of Myelosuppression Clinical Usage of Myeloid Growth Factors
» Comparison of Granulocyte Colony-Stimulating Factor
» Optimal Dosing Adult guidelines recommend dosing of 5 mcgkg
» Route of Administration Optimal Administration of Colony-Stimulating Factors
» Optimal Timing Optimal Administration of Colony-Stimulating Factors
» Erythropoietin Supportive Care in Pediatric Oncology irantextbook.ir 93df
» Interleukin-11 Platelet Growth Factors
» Thrombopoietin Receptor Agonists Platelet Growth Factors
» Immune Status Prior Supportive Care in Pediatric Oncology irantextbook.ir 93df
» Immune Status During Supportive Care in Pediatric Oncology irantextbook.ir 93df
» Immune Recovery After Supportive Care in Pediatric Oncology irantextbook.ir 93df
» Immunization Practice Prior Supportive Care in Pediatric Oncology irantextbook.ir 93df
» Diphtheria, Tetanus, and Acellular Pertussis
» Pneumococcal Conjugate Vaccine Recommendations
» Hemophilus Infl uenzae Type b
» Inactivated Infl uenza Vaccine Although in a Cochrane review Goossen et al.
» 2009 H1N1 Pandemic Vaccine Seven studies have reported on effi cacy of the
» Live Attenuated Infl uenza Vaccine
» Meningococcal Conjugate Vaccine Recommendations
» Varicella Zoster Virus Recommendations
» Recommendations Supportive Care in Pediatric Oncology irantextbook.ir 93df
» Treatment of Hypogammaglobulinemia Supportive Care in Pediatric Oncology irantextbook.ir 93df
» Vaccination of Household Contacts
» Peripherally Inserted Central Catheter
» External Tunneled Central Venous Catheter
» Implanted Port Types of Central Venous
» Catheter Insertion Supportive Care in Pediatric Oncology irantextbook.ir 93df
» Exit Site Infection Infection
» Prevention of Infection Infection
» Drug Precipitate or Lipid Residue Occlusion Thrombotic Occlusion
» Evaluation of Catheter- Related Thrombosis
» Treatment of Catheter- Related Thrombosis
» Special Considerations During Anticoagulation Therapy
» Contraindications of Anticoagulant Therapy
» Skin Antisepsis Catheter Maintenance
» Central Venous Catheter Dressings
» Hub Care Catheter Maintenance
» Central Venous Catheter Flushing and Locking
» Chlorhexidine Bathing Chlorhexidine has been shown to be effective in
» Antiseptic Needleless Connectors and Antiseptic
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