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Advanced Medical Nutrition Therapy > MNT for Stem Cell Transplant > Flashcards

MNT for Stem Cell Transplant Flashcards

1
Q

Blood stem cells are produced in the __ ___ and can become any kind of cell that the body needs

A

Bone marrow

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2
Q

Stem cells are constantly ___ and ___ into different types of blood cells, replacing older and worn-out blood cells in the body

A

Diving and maturing

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3
Q

Stem cells produce billions of new ___ ___ every day

A

Blood cells

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4
Q

If the stem cells cannot make enough new blood cells, many serious __ ___ can occur

A

Health problems

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5
Q

Stem cells are immature blood cells that can be removed from the blood or bone marrow of a patient or donor and the ___ and stored

A

Frozen

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6
Q

If someone is getting a stem cell transplant, high doses of ____ and/or radiation therapy are needed to kill existing bone marrow that is producing the cancerous cells before the transplant

A

Chemotherapy

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7
Q

The infused stem cells replace the blood-forming cells that were destroyed by the ___ ____ by growing into and restoring the body’s blood cells

A

Cancer treatment

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8
Q

Currently, 85% of transplants performed at UPMC Cancer Center use stem cells from ___ ___

A

Peripheral blood

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9
Q

Stem cell transplant shave the potential to cure a variety of __ and ___ diseases that may be incurable with conventional therapy

A

Benign and hematologic

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10
Q

What are some examples of common diseases treated with stem cell transplants?

A

-Acute Myelogenous Leukemia (AML)
-Chronic Myelogenous Leukemia (CML)
-Hodkin’s Lymphoma
-Non-Hodgkins Lymphoma
-Myelodysplastic Syndrome (MDS)
-Multiple Myeloma (MM)
-Aplastic anemia

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11
Q

Stem cell transplant allows for high doses of ___ or ___ therapy to be used for disease treatment

A

Chemotherapy or raditation

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12
Q

Bone marrow becomes depressed due to the higher doses of chemotherapy and/or radiation used and the transplanted stem cells will eventually restore normal __ __ production

A

Blood cell

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13
Q

An ____ stem cell transplant means that stem cells are harvested from the patient prior to other cancer treatments, purged or abnormal cells, and transplanted into the patient

A

Autologous

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14
Q

Autologous stem cell transplants are commonly used for…

A

-Lymphomas
-Lyelomas
-Testicular cancer
-Less commonly used for leukemia

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15
Q

Autologous stem cell transplants are the predominant type of transplant used in ___ ___

A

Older adults

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16
Q

____ stem cell transplants are when a physician collects and transplants stem cells from a donor who matches the recipients’ cells

A

Allogenic

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17
Q

What are the two types of allogenic stem cell transplants?

A

-Sibling (SIB)
-Matched unrelated donor (MUD)

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18
Q

A ____ stem cell transplant is from an identical twin

A

Syngenic

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19
Q

We can also perform ___ ___ blood transplants where stem cells are harvested from the umbilical cord blood and transplanted

A

Umbilical cord

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20
Q

Recent studies have shown that umbilical cord transplants are just as effective as transplants from ___ ___

A

Unrelated donors

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21
Q

A ____ transplantation is when a half-matched bone marrow transplant that has been successful in “curing” patients of some cancers and blood disorders

A

Haploidentical

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22
Q

With haploidentical transplantation, a physician administers just enough chemotherapy to suppress the immune system, which keeps the patient from ___ the donated marrow without harming their organs

A

Rejecting

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23
Q

Haploidentical transplantation has ____ side effects and also expands the potential donor pool, making more patients eligible for the transplant

A

Milder

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24
Q

A stem cell transplant consists of what three major parts?

A

-Conditioning phase
-Infusion of stem cell transplant
-Engraftment

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25
Q

The conditioning phase is designed to destroy ____ ___ that are resistant to conventional doses of chemo without causing fatal organ toxicity

A

Tumor cells

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26
Q

The choice of ___ ___ varies based on patient and disease characteristics as well as donor availability

A

Conditioning regimen

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27
Q

After conditioning is complete, the patient receives their ____

A

Transplant

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28
Q

____ refers to the types of chemotherapy given and is dependent on the protocol and the disease

A

Conditioning

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29
Q

Common chemotherapeutic agents:

A

-Vincristine
-Cisplatin
-Busulfan
-Carboplatin
-Melphalan
-Etoposide
-Topotecan
-Cyclophosphamide

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30
Q

Step 1 of apheresis is ____, and is when whole blood is collected though a tube from a vein in one arm

A

Collection

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31
Q

Step 2 of apheresis is called ____ and is when the blood is filtered through an apheresis machine, which separates the stem cells from the blood

A

Separation

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32
Q

Step 3 of apheresis is ___ ___ ___ and is when stem cells are collected for storage

A

Stem cell storage

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33
Q

Step 4 of apheresis is ___, when the rest of the blood is returned through a tube to a vein in the other arm

A

Return

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34
Q

When stem cells are transplanted, cells are infused through a patients’ __ __ over several hours

A

Central line

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35
Q

While transplantation is happening, patients are closely monitored for…

A

-Fever
-Chills
-Hives
-Low blood pressure
-Shortness of breath

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36
Q

____ is when the donated stem cells take hold and begin producing normal blood cells

A

Engraftment

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37
Q

Defined at UPMC Shadyside, white blood cells are considered engrafted when absolute neutrophil count is above ___ for 2 consecutive days or ___ cells on one day

A

500; 1,000

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38
Q

Platelet engraftment is defined as an unsupported count greater than ____

A

20,000

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39
Q

The average time to engraftment with an autologous stem cell transplant is…

A

day 15-25

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40
Q

The average time to engraftment with an allogeneic stem cell transplant is…

A

Day 13-24

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41
Q

Advantages of an autologous stem cell transplant:

A

-No HLA matching requirement
-No GVHD
-No need for immune suppression

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42
Q

Disadvantages of autologous stem cell transplant:

A

-Possibility of stem cell damage from prior therapy leading to delay in engraftment
-Possibility of contamination with tumor

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43
Q

With autologous stem cell transplant, there is a ___ risk of complications but ____ risk of relapse

A

Lower; higher

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44
Q

Advantages of allogenic stem cell transplant:

A

-Stem cells have not been exposed to chemotherapy
-Stem cell product is free of tumor

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45
Q

Disadvantages of allogenic stem cell transplant:

A

-Donor availability uncertain
-GVHD
-Higher risk of complications

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46
Q

With allogenic stem cell transplant, there is a ____ risk of complications but a ___ risk of relapse

A

Higher; lower

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47
Q

The outcome of stem cell transplant depends on many patient factors like…

A

-Age
-Disease factors (diagnosis, disease state, prior therapy)
-Donor factors (human leukocyte antigen, gender match)
-Transplantation (conditioning regimen, stem cell source, GVHD prophylaxis, engraftment)

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48
Q

A nutrition history includes…

A

-Disease state
-Previous treatment history
-Relevant other PMHx
-Problems impacting appetite
-GI symptoms
-Mucositis, stomatitisis, xerostomia
-Taste alterations

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49
Q

After transplantation, patients should receive a ___ ____ diet comprised of food that contains low numbers of potentially harmful microbes

A

Low microbial

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50
Q

Tips for a low microbial diet:

A

– Fresh fruits & vegetables are washed well under clean running water
– Avoid raw or rare-cooked meat, fish, & eggs. All meat should be cooked to a “well-done” stage
– Avoid raw honey
– Avoid foods that are visibly rotten and/or have mold
– Do not keep leftovers for >3 days
– Do not share food and drinks with other people
– Make sure all dairy products are pasteurized
– Keep hot foods hot and cold foods cold
– Use proper hand hygiene before handling food and during food preparation

51
Q

Anthropometric data should include…

A

-UBW/pre-illness weight
-IBW
-Adjusted weight for IBW > 120%
-Weight loss history (intentional vs unintentional; significant vs not significant)

52
Q

The prognosis of ____ patients is less favorable

A

Underweight

53
Q

Biochemical data should include…

A

-Serum protein (Albumin; and prealbumin->desired)
-Basic metabolic panel (glucose, K, BUN, Cr, Mg, PO4, Calcium)
-Liver function tests
-Absolute neutrophil count
-Platelets, WBC

54
Q

If someone has a low absolute neutrophil count (<500), recommend the ____ diet (it has not been proven, but UPMC Shadyside follows the CDC guidelines)

A

Neutropenic diet

55
Q

Formula for calculating absolute neutrophil count:

A

WBC x (% Neutrophils + % Bands)
(or you could look at the ABS neutrophils if available)

56
Q

Immediately post transplant, energy needs are between ___-___ kcal/kg/actual weight but usually go between 30-35 kcal/kg

A

25-35

57
Q

You should use ___ ___ ___ if patient is obese/overweight

A

Adjusted body weight

58
Q

In acute GVHD/sepsis, recommend ___-___ kcal/kg of actual body weight

A

30-50

59
Q

After stem cell transplant, recommend ___-___ g of protein ber kg of body weight

A

1.3-1.5

60
Q

If someone has metabolic stress, is on corticosteroid treatment, or has GVHD, increase protein recommendations to ___-___ g/kg

A

1.5-2

61
Q

Protein needs are adjusted for renal failure and/or hepatic encephalopathy, may need to decreased to ___ grams/kg

A

0.8

62
Q

Nausea/vomiting is common with stem cell transplants; what can we recommend to help?

A

-Cold, bland food
-Small, frequent meals
-Open dishes on the other side of the room
-Eat when not nauseated or after antiemetic given

63
Q

Anorexia is also common with stem cell transplant; what can we recommend to help?

A

-Small frequent meals
-Even if not hungry at all, encourage patient to eat at least a little (sometimes it is okay if they can’t eat much for a couple days)

64
Q

What should we recommend to patients with diarrhea?

A

-Encourage adequate hydration
-May need soft GI diet/low fiber diet

65
Q

____ is caused by injury to the mouth tissue from conditioning regimens and/or radiation

A

Mucositis

66
Q

Severe mucositis can lead to…

A

-Sever pain
-Hemorrhage
-Infection
-Upper airway edema
-Airway compromise

67
Q

Supportive care for mucositis:

A

-Opioids
-Good oral hygiene
-Avoidance of spicy, acidic, hard and hot food and beverages
-Use of saline rinses

68
Q

Preventative care for mucositis includes ___ and ___ ___

A

Cryotherapy and lase therapy

69
Q

Mucositis is one of the main reasons why ___ ___ is not frequently used; feeding tube can irritate the mucous membranes, making it difficult to place a tube (TPN may be required)

A

Enteral nutrition

70
Q

__ ___ ___ ___ is a noninvasive, simple, and atraumatic therapeutic management corresponding to a local application of a high-density monochromatic narrow-band light source

A

Low Level Laser Therapy (LLLT)

71
Q

LLLT is becoming more common in the clinical setting as a treatment option for preventing and treating oral mucositis as it can…

A

-Promote pain relief
-Reduces oral mucositis incidence and its severity

72
Q

What can be done to help those with xerostomia (dry mouth)?

A

-Mouthwashes without alcohol
-Sugarless gum or hard candies
-Mouth moisturizer, artificial saliva
-Moist foods with extra sauce

73
Q

Taste changes are a common side effect of chemotherapy; they can be either ___ or ____

A

-Hypogeusia (reduced ability to taste)
-Dysgeusia (distortion of the sense of taste)

74
Q

Tips for patients with taste changes:

A

-Use plastic utensils, plastic plate, seasonings, salt, sugar, lemon drops before meals, saline or baking soda mouth rinse

75
Q

Patients receive ____ transfusions to counteract low counts

A

Platelet

76
Q

One of the reasons why enteral nutrition is not frequently used is because placing a tube may cause ___ with bleeding

A

Irritation

77
Q

Low platelet count is a major factor that holds patients in the hospital for ___ days

A

Extended

78
Q

__ __ ___ ___ is one of the major complications that can occur after an allogenic stem cell transplant in which the newly transplanted material attacks the transplant recipient’s body

A

Graft versus host disease

79
Q

The onset of acute GVHD is when neutrophil count is less than or equal to ___ after transplant

A

100

80
Q

What organs are most affected by CVHD?

A

-Skin
-Liver
-Gut

81
Q

Classical symptoms of GVHD include…

A

-Maculopapular rash
-Anorexia
-Profuse diarrhea
-Abdominal cramps
-Ileus or hepatitis

82
Q

A ___ can be done to confirm the diagnosis of GVHD

A

Biopsy

83
Q

There is a specialized diet for GVHD that has __ distinctive stages

A

5

84
Q

Chronic GVHD has features resembling autoimmune and other immunologic disorders such as…

A

-Scleroderma
-Sjogren syndrome
-Wasting syndrome

85
Q

Symptoms of GVHD usually present within ___ ___ after allogenic stem cell transplant and are often preceded by a history of acute GVHD

A

3 years

86
Q

Manifestations of chronic GVHD may be restricted to a single organ or tissue or may be ____

A

Widespread

87
Q

Reported incidence rates of chronic GVHD after allogenic stem cell transplant range from __-___%

A

6-80%

88
Q

The diagnosis of GVHD requires…

A

-Distinction from acute GVHD
-Presence of at least one diagnostic clinical sign of chronic GVHD or presence of at least one distinctive manifestation confirmed by pertinent biopsy or other relevant tests
-Exclusions of other possible diagnoses

89
Q

There is no standard regimen for the prevention of GVHD, and different combinations of ____ are given at different institutions

A

Medications

90
Q

Some common medications that are given to prevent GVHD include…

A

-Methotrexate
-Cyclosporine
-Tacrolimus
-Mycophenolate mofetil
-Sirolimus
-Corticosteroids
-Antithymocyte globulin (ATG)
-Alemtuzumab
-Cyclophosphamide

91
Q

It is important to alter ___ when making the diagnosis of GVHD of the gut, once diagnosis is confirmed

A

Diet

92
Q

The phase of the diet refers to the patients’ ____ and guides the RD as to which stage diet should be followed

A

Symptoms

93
Q

Progression of diet occurs as symptoms improve and can ___ from patient to patient

A

Vary

94
Q

In phase I of GVHD, someone might have what symptoms?

A

-Cramping
-Voluminous diarrhea (>1L)
-Nausea
-Emesis

95
Q

What is the diet for phase I of GVHD?

A

-NPO for bowel rest
-TPN with increased calorie and protein needs (35 kcal/kg and 1.8 g of protein/kg)

96
Q

Symptoms of phase II of GVHD:

A

-Diarrhea volume decreasing
-Forming of stool
-Significantly less to no cramping
-No emesis

97
Q

What is the diet plan for phase II GVHD?

A

-Continue TPN is started
-Start clear, isotonic, low residue, lactose free beverages

98
Q

Symptoms of phase III GVHD:

A

-Stool is formed (pudding-like)
-No emesis
-Decreasing diarrhea frequency and volume
-Tolerating phase II diet without complications

99
Q

What is the diet plan for phase III of GVHD?

A

-Wean TPN as oral intake increases
-Progress to solid foods
-Limit fat intake (20gm/day), lactose-free, low insoluble fiber, free of gastric irritants, high soluble fiber

100
Q

Symptoms of phase VI GVHD:

A

-Formed stool
-Minimal cramping
-Tolerating >50% of nutritional needs orally

101
Q

What is the diet plan for phase IV GVHD?

A

-Wean TPN as oral intake increases
-Continue to expand diet adding more starches, protein, and fatty foods; continue lactose free

102
Q

Symptoms of stage V GVHD:

A

-No GI cramping
-Normal stool
-Normal transit time

103
Q

What is the diet plan for stage V GVHD:

A

-Discontinue TPN
-Advance diet to regular by adding one new food per day and assess tolerance

104
Q

The patient’s nutritional status, ability to eat, and degree of oral and GI toxicity determine if ___ ___ ___ is indicated

A

Total parenteral nutrition

105
Q

For patients with a ___ degree of GI toxicity including GVHD of the gut, TPN may be initiated; for patients with less toxic conditioning regimens, the period of inadequate oral intake may extend longer before TPN is considered

A

High

106
Q

At Shadyside, the ___ ___ ___ team will determine if patients are deemed appropriate for TPN

A

Nutrition Support Service

107
Q

After transplant, someone is discharged after…

A

-Engraftment
-There is no indication of infection
-Tolerance of medications
-Able to eat and drink to get sufficient fluids and nourishment
-No severe treatment complications
-The patient is medically stable and physically able to function outside the hospital

108
Q

There is a ____ recovery period after autologous stem cell transplant than after allogenic stem cell transplantation

A

Shorter

109
Q

It often take the immune system ___-___ months to recovery from an autologous transplant

A

3-12

110
Q

It often takes at least ___-___ months to recover nearly normal blood cell levels and immune cell function after an allogenic transplant

A

6-12

111
Q

Immune recovery can take longer if the patient has ____ and required additional GVHD therapy

A

GVHD

112
Q

In early recovery, someone should follow and well-balanced diet for ___ and ___, as well as maintain good blood glucose control and good electrolyte levels

A

Repair and recovery

113
Q

Tips for dining out after stem cell transplant:

A

-Eat early to avoid crowds
-Ask that food may be made fresh
-Avoid raw fruits and vegetables when dining out
-Do not eat salsa or other fresh condiments that are not refrigerated
-Ask for single-serve condiment packages
-Avoid salad bars, buffets, etc.
-Check the overall condition of the restaurant

114
Q

What are some long-term complications of stem cell transplant?

A

-Organ complications
-Endocrine risk
-Risk for bone loss and subsequent osteoporosis
-Infertility
-Chronic GVHD
-Mental health
-Relapse
-Secondary cancer

115
Q

If a non-mainstream approach is used together with complementary medicine, it is considered ____

A

Complimentary

116
Q

If a non-mainstream approach is used in place of conventional medicine, it is considered ____

A

Alternative

117
Q

What are three categories of alternative and complementary medicine?

A

-Natural products (herbs, vitamins, minerals, probiotics)
-Mind and body practices (acupuncture, massage, meditation, yoga, etc)
-Other complementary health approaches (traditional healer, Chinese medicine, etc)

118
Q

A substantial amount of scientific evidence suggest that some complementary health approaches may help to manage some ____ of cancer and side effects of treatment

A

Symptoms

119
Q

There is no convincing evidence that any complementary health approach is effective in ____ cancer or causing it to go into remission

A

Curing

120
Q

A 2012 study indicated that taking a ____/____ ___ may slightly reduce the risk of cancer in older men

A

Multivitamin/mineral supplement

121
Q

____ conventional cancer treatment can decrease the chances of remission or cure

A

Delaying

122
Q

Some ___ health approaches may interfere with cancer treatments or be unsafe for cancer patients

A

Complementary

123
Q

What are some common complementary approaches to cancer?

A

-Acupuncture
-Ginger
-Massage therapy
-Mindfulness stress reduction
-Yoga
-Hypnosis
-Herbal supplements

Advanced Medical Nutrition Therapy (14 decks)

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