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NUTRITION DURING HEAD AND NECK RADIATION

NUTRITION DURING HEAD AND NECK RADIATION

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NUTRITION DURING HEAD AND NECK RADIATION

  1. 1. NUTRITION DURING HEAD & NECK RADIATION ICRO,VISAKHAPATNAM 17TH AUAGUST 2019 DR KANHU CHARAN PATRO 1
  2. 2. 2
  3. 3. 3
  4. 4. NUTRITION NUTRITION NUTRITION VERY IMPORTANT DURING RADIATION 4
  5. 5. BEFORE RADIATION ASSESSMENT DURING RADIATION MANAGEMENT POST RADIATION SURVILLENCE ALL ARE IMPORTANT GUIDENCE 5
  6. 6. 6
  7. 7. MCOSITIS,DYSPHAGIA AND ASPIRATION XEROSTOMIA,DYSGUESIA IN ADDITION CHEMO VOMITING AND NAUSEATING SENSATION ADDING FACTORS DUE TO TUMORIZATION CTREAT PROBLEM FOR NUTRITION THESE ALL HAPPENS DURING RADIATION 7
  8. 8. 8
  9. 9. CAUSES OF MALNUTRITION • Radiation therapy – Oral Mucositis, – Stomatitis, – Xerostomia, – Dysphagia, – Dysgeusia. • Chemotherapy - enhances the side effects of radiation therapy, and also cause s nausea, vomiting and decreased desire to eat 9
  10. 10. 10
  11. 11. CONCURRENT CHEMO 11
  12. 12. 12
  13. 13. ASK THE PATIENT TO DRINK WATER COUGHING IS A SIGN TO SUFFER [5] COUGHING IS A SIGN OF ASPIRATION NEEDS THE FEEDING TUBE INSERTION [6] 13
  14. 14. Assessment 14
  15. 15. 15
  16. 16. 16
  17. 17. EVERYDAY WEIGHT MEASUREMENT IT IS THE ONE STEP NUTRITION MANAGEMENT 17
  18. 18. 18
  19. 19. TRY TO MAINTAIN A DIET CHART IT SHOULD BE IN YOUR RADIATION CART 19
  20. 20. 20
  21. 21. PATIENTS NEED HIGH PROTEIN DIET NO NEED TO RESTRICT FAT & CARBOHYDRATE 21
  22. 22. 22
  23. 23. EGG, NUTS, PANEER, CHICKEN AND MUTTON THESE ARE THE HIGH PROTEIN NUTRITION 23
  24. 24. HIGH PROTEIN DIET 24
  25. 25. THE ROLE OF GLUTAMINE IS NOT FOR SURE SOME STUDIES SHOWED MUCOSITIS CURE [11] 25
  26. 26. 26
  27. 27. MULTIVITAMIN AND MINERALS NOT RECOMMENDED MORE THAN ALLOWANCES 27
  28. 28. 28
  29. 29. 29
  30. 30. WHEN MUCOSITIS HINDERS THE FLOW TO DRINK BEST USE A STRAW 30
  31. 31. 31
  32. 32. PROTEIN NEED IS ONE GM PER KG PER DAY ENERGY IS 30 CALORIE PER KG PER DAY 32
  33. 33. 33
  34. 34. THERE ARE VARIOUS ASSESSMENT TOOLS ANY ONE IS OK FOR TO KEEP YOU COOL 34
  35. 35. 35
  36. 36. TRY TO AVOID PARENTRAL NUTRITION NOTHING CAN REPLACE ENTERAL NUTRITION 36
  37. 37. 37
  38. 38. ANOTHER FACTOR IS ORAL CANDIDACIES NEEDS ANTIFUNGAL TO ERADICATE THIS CRISIS 38
  39. 39. 39
  40. 40. 40
  41. 41. PERIODIC GARGLING IS REQUIRED FOR HYGIENE TRY MAGIC MOUTH WASH AND BENZYDAMINE 41
  42. 42. 42
  43. 43. SODA SALT GARGLE DISSOLVES THE STICKY SUBSTANCE TOPICAL ANESTHETICS HAS ITS OWN IMPORTANCE 43
  44. 44. 44
  45. 45. 45 HYPONATREMIA IS SECONDARY TO POOR NUTRITION ALTERED SENSORIUM LEADS TO ASPIRATION
  46. 46. 46
  47. 47. 47
  48. 48. 48
  49. 49. 49
  50. 50. 50
  51. 51. OAR AND TARGET HINDERS NUTRITION EXTRA CARE IMPROVES NUTRITION 51
  52. 52. MEDIAL BORDER AT MEDIAL OF CAROTID NODAL CONTOURING ARTICLES ARE THE GUIDE 52
  53. 53. 53
  54. 54. UPPER BORDER AT C1 TRANSVERSE IN L2 NODE UNLESS YOU ARE TREATING RP NODE 54
  55. 55. 55
  56. 56. WHEN ADDRESSING RETROPHARYNGEAL NODE DO NOT INCLUDE MEDIAL RETROPHARYNGEAL NODE 56
  57. 57. 57
  58. 58. 58
  59. 59. BOT, SUPRAGLOTTIS AND CONSTRICTORS THEY ARE SWALLOWING ELEVATORS 59
  60. 60. v 60
  61. 61. OC ,VC AND PC PLEASE COUNT ON CC 61
  62. 62. 62
  63. 63. 63
  64. 64. IF YOU WANT TO IMPROVE NUTRITON TRY TO IMPROVE PLAN OPTIMIZATION 64
  65. 65. TRY TO COLLAPSE THE BRIDGE OVER VC & PC IMPORTANT DURING NON LARYNGOPHARYNX 65
  66. 66. GREEN-95% DISTRIBUTION 66
  67. 67. GREEN-95%,BLUE -70% DISTRIBUTION 67
  68. 68. STILL THERE IS A VALUE OF MIDLINE BLOCK IN 2D PLANNING TRY TO USE THAT BLOCK 68
  69. 69. 69
  70. 70. POSTCRICOID STENOSIS 70
  71. 71. PLANNING FOR NON ORAL CAVITY AVOID LOW DOSE SPILLAGE OVER ORAL CAVITY 71
  72. 72. PAROTID IS NOT THE ONLY MOIST TARGET OTHER MOIST STRICTURES ARE NOT TO FORGET 72
  73. 73. 73
  74. 74. 74
  75. 75. 75
  76. 76. 899 76
  77. 77. PREVENT LOW DOSE FALL OVER ORAL CAVITY 77
  78. 78. 78
  79. 79. WE SHOULD NOT BE HAPPY WITH IMRT HOPE WE WILL PRACTICE “DO IMRT” 79
  80. 80. DARS STUDY-ONGOING 80
  81. 81. DO-IMRT-[Dysphagia Optimized IMRT] 81 ST.IMRT VS DO-IMRT
  82. 82. 82
  83. 83. 83
  84. 84. 84
  85. 85. 85
  86. 86. TAKE CARE OF THE NUTRITION DURING RADIATION WEIGHT LOSS NEEDS ADAPTIVE RADIATION 86
  87. 87. LOOSE ORFIT 87
  88. 88. SWALLOWING EXERCISES DURING AND AFTER RADIATION YOU TUBE DEMO GIVES BETTER VISUALIZATION MENDELSHON, MASAKO AND SHAKER MANEUVERS THESE EXERCISES INCREASE NUTRITION TURNOVERS 88 https://www.youtube.com/watch?v=H4S1Afq4fps
  89. 89. 89
  90. 90. 90
  91. 91. 91 MENDELSOHN MANEUVER
  92. 92. 92 SHAKER MANEUVER
  93. 93. IMPORTANT POST RT SURVILLENCE CORRECT THE FLUID AND ELECTROLYTE IMBALANCE 93
  94. 94. XEROSTOMIA AND POST CRICOID STENOSIS THESE ARE THE IMPORTANT LATE CRISIS 94
  95. 95. POSTCRICOID STENOSIS 95
  96. 96. 96
  97. 97. 97
  98. 98. ARTIFICAL SALIVA, PILOCARPINE AND STIMULATION SOME PATIENTS NEED ENDODAILATATION 98
  99. 99. 99
  100. 100. 100
  101. 101. 101
  102. 102. 102
  103. 103. 103 European Society for Clinical Nutrition and Metabolism (ESPEN)
  104. 104. 104
  105. 105. 105
  106. 106. 106
  107. 107. SUMMARY • Counseling – Assessment • TOOLS – Management – Rehabilitation • METICULOUS TARGET DELINEATION • METICULOUS PLANNING 107
  108. 108. • AROI • ICRO • ORGANIZERS • PATIENT AUDIENCE 108

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NUTRITION DURING HEAD AND NECK RADIATION

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