Introduction
Chemotherapy and radiotherapy have various side effects on the body including the GIT. This article will focus on the effects on the GIT that may contribute to weight loss and interventions to minimize the effects. It will also demonstrate calculations on weight loss and classify the patient’s nutritional status in the case study.
Effects that Contribute to Weight Loss
Dysgeusia is due to the effects of the drugs and the radiation on the taste cell receptors and this causes alterations in taste. The cell receptors may be decreased, receptor surface is changed and neural coding is interfered with. Dysgeusia decreased food intake because the patient could not derive enjoyment from eating (Wasserman, 2010). Radiotherapy and chemotherapy causes reactions on mucous membranes and these lead to alterations in digestion causing diarrhea or constipation like in this case; loss of appetite follows.
Radiotherapy causes dryness of the mouth especially when applied on the head and neck region. This makes eating and swallowing difficult and that is why the patient has difficulty in swallowing, and hence chokes on water. The patient complained of pain on swallowing since the chemotherapy and radiotherapy had not been stopped, worsening the previous effects. Since the patient had had pain on swallowing and choking on water for a long time, he later developed dehydration. Loss of appetite could have also been caused by radiation nausea. It usually occurs several hours after treatment and decreased fluid intake worsens it (Anon, n.d.).
Interventions to these effects
Dysgeusia can be managed by changing food preparation and serving. This includes consuming cold foods and avoiding hot ones, avoiding use of silver metal products, adding more seasonings and additives to food, choosing proteins like chicken and beef that have low flavor, adding sugar, avoiding bitter foods, marinating of meat, bland foods, drinking more water and eating small meals more frequently. Studies have been conducted for pharmacological management of the dysgeusia. Zinc sulfate and the amino acid glutamate have been extensively studied and they may be available soon (Wasserman, 2010).
Constipation can be avoided by eating more fiber, avoiding irritation by making the foods soft and avoiding trauma. Analgesic agents, steroids and antibiotics may be given. These factors also reduce reaction of the mucous membranes and thus they help to reduce choking on water. Dehydration can be avoided by encouraging the patient to drink more water and giving intravenous fluids if necessary. Decreased appetite due to nausea can be managed by serving the patient with salty foods and ice cold drinks, avoiding foods that are greasy, with a strong smell or very sweet. Eating small and frequent meals also help decrease the problem. Anti-nausea medications can be given where the above interventions do not work (Davis, 2009).
The percent of usual body weight (%UBW) is the most appropriate. It is more effective in this case because the patient is overweight and the ideal body weight may not be sensitive to significant loss of weight (DeBruyne et al., 2008).
At the beginning:
- %UBW= (current weight) / (usual body weight) * 100
- %UBW= 171.5lbs / 183lbs * 100
- = 93.7 %
- At the end of 8 week therapy:
- %UBW= (current weight) / (usual body weight) * 100
- %UBW= 164lbs / 183lbs * 100
- = 89.6 %
The nutritional status is important to determine the priorities of assessment and nutritional interventions that are supposed to be taken. This patient’s nutritional status can be classified as level 3, which is moderately compromised nutritional status.
References
Anon. (n.d.). Radiation side effects. 2011. Web.
Davis, S. (2009). Side Effects of Radiotherapy. Web.
DeBruyne et al. (2008). Nutrition and Diet Therapy: Principles and Practice. New York, NY: Cengage Learning Publications.
Wasserman, A. (2010). Management of Chemotherapy-Induced Dysgeusia. Web.