Question

1. Briefly describe the hydration and nutrition requirements of an adult patient during palliative care and at end-of-life. Discuss ways a nurse could address the hydration and nutrition requirements of the patient when providing palliative care or end of life care.

2.Discuss common non-pharmaceutical and complementary care in pain management for a patient receiving palliative care or end of life care using examples.

Answer 1

Nutrition and Hydration: People approaching the end of life often lose their appetite and most ultimately stop eating and drinking,

- the anorexia-cachexia syndrome frequently occurs in patients with advanced cancer and cachexia is a common and poor prognostic sign in patients with Heart failure,

- ill people often have no hunger with total caloric deprivation and the associated ketonemia produces a sense of well being, analgesia and mild euphoria,

- Although it is unclear to what extent withholding hydration at the end of life creates an uncomfortable sensation of thirst, any such sensation is usually relieved by simply moistening the dry mouth,

- Ice chips, hard candy, swabs, popsicles or minted mouth wash may be effective,

- although this normal process of diminishing oral intake and accompanying weight loss is very common,

- In response , patients and families often ask about supplemental enteral or parenteral nutrition.

As a Nurse, we can reduse the distress and explain about the importance of end of life, try to listen their words to reduse their stress,

- give tube feedings are often considered patients with advanced dementia who aspirate,

- prevent aspiration by suction of material which may cause increase risk of choking, aspiration and dyspneoa, ascities, edema and effusions may be worsened,

- Nasogastric and gastrotomy tube feeding and parenteral nutrition impose risks of infection, epistaxis, pneumothorax, electrolyte imbalance and aspiration as well as the need to physically restrain the delirious patient to prevent dislodgement of catheters and tubes.

Non Pharmaceutical and Complementary care in Pain Management:

Non pharmacological therapies are valuable in treating pain,

- Hot or Cold packs , massage and physical therapy can be helpful for musculoskeletal pain,

- similarly biofeedback, acupuncture, chiropractic, meditation, music therapy, cognitive behavioural therapy, guided imaginary, cognitive distraction and framing may be help in treating pain,

- because mood and psychological issues play an important role in the patient's perception of and response to pain, psychotherapy, support groups can also help for in the management of pain,

- major depression which may be instigated by chronic pain or may alter the response to pain, should be treated aggressively,

- complementary care given by acetaminophen and NSAIDS, aspirin,

- for moderate to severe pain opioids often are necessary.