Unit 6: Cancer and HIV Dr. Jeanette Andrade PhD, RDN, LDN NS335 Elsevier items and derived items © 2012, 2008, 2007 by Saunders, an imprint of Elsevier Inc. 1 Reminders Unit 6 discussion board due Tuesday Unit 6 assignment due Tuesday Elsevier items and derived items © 2012, 2008, 2007 by Saunders, an imprint of Elsevier Inc. 2 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. Elsevier items and derived items © 2012, 2008, 2007 by Saunders, an imprint of Elsevier Inc. 3 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. Elsevier items and derived items © 2012, 2008, 2007 by Saunders, an imprint of Elsevier Inc. 4 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 Elsevier items and derived items © 2012, 2008, 2007 by Saunders, an imprint of Elsevier Inc. 5 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 7 Elsevier items and derived items © 2012, 2008, 2007 by Saunders, an imprint of Elsevier Inc. 7 Cancer What are risk factors for cancers? Both dietary and lifestyle How can nutrition contribute/ reduce risk for cancer? Elsevier items and derived items © 2012, 2008, 2007 by Saunders, an imprint of Elsevi ...

1. Unit 6: Cancer and HIV
Dr. Jeanette Andrade PhD, RDN, LDN
NS335
Elsevier items and derived items © 2012, 2008, 2007 by
Saunders, an imprint of Elsevier Inc.
1
Reminders
Unit 6 discussion board due Tuesday
Unit 6 assignment due Tuesday
Elsevier items and derived items © 2012, 2008, 2007 by
Saunders, an imprint of Elsevier Inc.
2
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

2. feeding routes.
Elsevier items and derived items © 2012, 2008, 2007 by
Saunders, an imprint of Elsevier Inc.
3
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.
Elsevier items and derived items © 2012, 2008, 2007 by
Saunders, an imprint of Elsevier Inc.
4
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
Elsevier items and derived items © 2012, 2008, 2007 by
Saunders, an imprint of Elsevier Inc.
5

3. 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
7
Elsevier items and derived items © 2012, 2008, 2007 by
Saunders, an imprint of Elsevier Inc.
7
Cancer
What are risk factors for cancers? Both dietary and lifestyle
How can nutrition contribute/ reduce risk for cancer?
Elsevier items and derived items © 2012, 2008, 2007 by
Saunders, an imprint of Elsevier Inc.
8

4. Color Code System of Vegetables and Fruits
ColorPhytochemicalVegetables and
FruitsRedLycopeneTomatoes and tomato products, pink
grapefruit, watermelonRed and purpleAnthocyanins,
polyphenolsBerries, grapes, red wine, prunesOrangeα-, β-
caroteneCarrots, mangoes, pumpkinOrange and yellowβ-
cryptoxanthin, flavonoidsCantaloupe, peaches, oranges, papaya,
nectarinesYellow and greenLutein, zeaxanthinSpinach, avocado,
honeydew, collard and turnip greensGreenSulforaphanes,
indolesCabbage, broccoli, Brussels sprouts, cauliflowerWhite
and greenAllyl sulphidesLeeks, onion, garlic, chives
Data from Heber D: Vegetables, fruits and phytoestrogens in the
prevention of diseases, F Postgrad Med 50:145, 2004.
9
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Saunders, an imprint of Elsevier Inc.
9
Factors That Affect Appetite
10
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Saunders, an imprint of Elsevier Inc.
10
Cancer Cachexia
Progressive weight loss
Anorexia
Generalized wasting and weakness
Immunosuppression

5. 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
11
Elsevier items and derived items © 2012, 2008, 2007 by
Saunders, an imprint of Elsevier Inc.
11
Estimating Energy Needs of People with Cancer
12
Elsevier items and derived items © 2012, 2008, 2007 by
Saunders, an imprint of Elsevier Inc.
12
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
13

6. Elsevier items and derived items © 2012, 2008, 2007 by
Saunders, an imprint of Elsevier Inc.
13
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
14
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Saunders, an imprint of Elsevier Inc.
14
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.
15

7. Elsevier items and derived items © 2012, 2008, 2007 by
Saunders, an imprint of Elsevier Inc.
15
HIV Life Cycle
16
Elsevier items and derived items © 2012, 2008, 2007 by
Saunders, an imprint of Elsevier Inc.
16
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
17
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Saunders, an imprint of Elsevier Inc.
17

8. 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
18
Elsevier items and derived items © 2012, 2008, 2007 by
Saunders, an imprint of Elsevier Inc.
18
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
19
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Saunders, an imprint of Elsevier Inc.
19
Specific CAM Therapies

9. 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
20
Elsevier items and derived items © 2012, 2008, 2007 by
Saunders, an imprint of Elsevier Inc.
20
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.
21
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Saunders, an imprint of Elsevier Inc.
21

10. NS335 | Nutrition for Special Populations
Assignment Introduction
Script | Unit 6
The Unit 6 Assignment focuses on a severely ill patient
suffering from HIV. Advances in
medical treatment for HIV have shown massive improvements
over the past 20 years.
Although many nutrition professionals may never come across a
patient with HIV or
AIDS, many of the symptoms of HIV or AIDS patients are
similar to those suffered from
other critical diseases. Examples would include cancer, GI
disorders, serious infections,
and many more.
For this Assignment, it is advised that you conduct your
research and write your essay
prior to drafting up your nutrition care plan for the patient.
The nutrition care plan is an important part of the Assignment
and is worth 20 points.
Please refer to Chapter 11 and tables 11-3 and 11-4 for more
guidance.
The “A” or Assessment part of the note should include
information relating to the
nutrition and medical background of the patient. This may
include things like: age,
height, weight, medical diagnosis, medical history which may
include other diagnoses,
labs, medicines, any gastrointestinal issues, and the current diet

11. order and intake
amount.
For the “D” or Diagnosis part of the note, be sure to focus on
the most important or
MAIN issue that the patient is facing when you are writing your
chart note. Once you
identify the main problem of the patient, then you can choose a
matching nutrition
diagnosis term from Table 11-4 in your text.
PES is the structure for the Nutrition Diagnosis sentence. The
“p” stands for problem.
For this piece, choose an appropriate phrase from Table 11-4 in
your text.
Then, the “E” stands for etiology. This is the reason for or
source of the nutrition
problem. This is usually the medical diagnosis of the patient or
something that is
causing the nutrition problem.
Lastly, the S represents Signs and Symptoms. This is the
“evidence” or “proof” that the
nutrition diagnosis is true and accurate. These are usually things
like weight status, lab
data, and subjective information including meal consumption
and family reports.
1
NS335 | Nutrition for Special Populations

12. “I” is for the Intervention part of the note. This is where you
design a plan to address the
nutrition diagnosis/problem. Basically, this is what should be
done to address the
nutrition problem. Topics to include may be: diet education,
estimated calorie and
protein needs, change in diet order, and recommendations for
nutrition support like
enteral, parenteral, or oral supplements.
“M/E” is for the Monitoring and Evaluation part of the note.
This is where you include
information regarding your plans for follow up and evaluating
the progress of your
patient towards the goals.
Upon completion of this Assignment you will have a better
understanding of how
medical complications can profoundly influence the nutritional
status of a patient. Please
refer to the Assignment directions for details on the format of
the Assignment.
2
Kaplan University School of Health Sciences
NS335 Unit 6 Assignment

13. Unit 6 Assignment
Unit outcomes addressed in this Assignment:
• Describe common nutritional side effects from cancer and
HIV.
• Name nutritional goals for cancer and HIV treatment.
Course outcomes addressed in this Assignment:
NS335-2: Explain the use of parenteral and enteral nutrition in
special populations.
Professional Competency Outcome(s) addressed in this
Assignment:
PC 2.3: Identify opportunities within my profession to
demonstrate integrity through relevant
codes of conduct and social responsibility.
Instructions:
Review the following case study patient details
Mr. W is a 25-year-old male who was in a drug rehabilitation
program last year. He has been
admitted to the hospital with a history of weight loss, weakness,
and intractable diarrhea. His
height is 70 inches and his weight has dropped from 180 lbs. to
110 lbs. He is also suffering
from fever and night sweats. Physical examination reveals
swollen lymph glands, tongue lesions

14. of herpes simplex and ulcers in the perianal region. Further
tests indicated depressed T-cell
levels and the presence of Pneumocystis carinii. He was tested
for HIV infection and the blood
test for HIV infection antibodies was positive.
While in the hospital he developed several other symptoms:
anorexia, fever, fatigue, nausea,
vomiting, watery diarrhea, and fecal incontinence. His
temperature was 103°F (39.8°C) and was
treated with antibiotics to which he did not respond. The
amount of diarrhea increased
markedly, necessitating intravenous hydration. He developed
esophageal candiasis and a
duodenal infection.
The patient did not tolerate a soft diet or nutritional
supplements, continued to lose weight, and
had severe anorexia, abdominal cramping, and bloating.
Nutritional assessment was deficient in
all aspects, showing a decreased BMI, decreased muscle mass,
and depleted total protein and
serum albumin.
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?

15. Kaplan University School of Health Sciences
NS335 Unit 6 Assignment
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.
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. W rite 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.
Requirements

16. Paper format: 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. Be aware that the title
page, reference page, and appendix/chart note DO NOT count
towards the 2–3 page minimum.
Please organize your paper in the following paragraph format.
Please see KUs Writing Center
for more information regarding essay and paragraph format.
Section 1: Introductory paragraph (incorporate your answer to
question 1)
Section 2: Body paragraph(s) (incorporate your answer to
question 2)
Section 3: Body paragraph(s) (incorporate your answer to
question 3)
Section 4: Body paragraph(s) (incorporate your answer to
questions 4-5)
Section 5: Concluding paragraph (incorporate your answer to
question 6)
Appendix: Nutrition Care Plan/Chart note (question 7)
References: Include a minimum of 4 quality references. Your
textbook may count towards this
requirement. You can use reputable websites or other textbooks/
scientific or medical journal

17. articles. Please use APA style citations within the paper itself
and also on the reference page.
See Writing Center Resources found in Doc Sharing and the
Kaplan University Writing Center
for complete details and examples regarding APA style
references.
Submitting your work:
javascript:ulinkPopup('https://kucampus.kaplan.edu/MyStudies/
AcademicSupportCenter/WritingCenter/WritingReferenceLibrar
y/TheWritingProcess/HowToWriteAstrongParagraph.aspx','https
://kucampus.kaplan.edu/MyStudies/AcademicSupportCenter/Wri
tingCenter/WritingRe
Kaplan University School of Health Sciences
NS335 Unit 6 Assignment
Submit your Assignment to the appropriate Dropbox. For
instructions on submitting your work,
view the Dropbox Guide located under Academic Tools at the
top of your unit page.
Please be sure to download the file “Writing Center Resources”
from Doc Sharing to assist you
with meeting APA expectations for written Assignments.
To view your graded work, come back to the Dropbox or go to
the Gradebook after your
instructor has evaluated it. Make sure that you save a copy of
your submitted work.

18. Unit 6 Assignment Grading Rubric = 200 points
Assignment Requirements
Points
possible
Points earned
by student
Adequately identifies the stage of the patient’s HIV infection
(question 1)
0-20
Describes the complications of HIV and how they impact the
nutritional status (question 2)
0-20
Develops a realistic nutrition goal for the patient (question 3)
0-20
Chooses the most appropriate nutrition support route and
supports their choice with relevant information (question 4)
0-25
Explains how to deal with patient confidentiality, integrity and
ethical issues, and social responsibility as relates to Mr. W.

19. 0-20
Identifies nutritional supplements once the patient can tolerate
an oral diet (question 6)
0-20
Designs an accurate Nutrition Care Plan Chart note using the
ADIME style.
0-60
Effectively supports ideas and answers with specific
references.
0-15
Total (Sum of points earned) 200
The Proposal is written in the most current version of APA
format with no grammatical, spelling, copyright, plagiarism or
proof reading errors.
Points deducted for spelling, grammar, and/or APA errors.
Adjusted total points earned
Kaplan University School of Health Sciences

20. NS335 Unit 6 Assignment
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