Chapter 26: Palliative/Hospice Flashcards
With hospice, ________ services are offered to families before and for up to 1 year after a patient’s death
bereavement
Lifespan estimate for hospice to be covered by medicare/medicaid
6 months or less
Referral to palliative care is recommended within _______ weeks of an advanced cancer diagnosis
8
T/F: Many MNT interventions designed to manage digestive and oral symptoms in order to improve the enjoyment/tolerance of food are palliative in nature
True
3 goals of RD in palliation
- Symptom management
- Educate patient/family on nutrition recommendations
- Assist with decisions regarding use of artificial nutrition/hydration
_______% of advanced cancer patients in hospice care have taste/smell abnormalities, impacting food enjoyment & QOL
93%
Top 5 nutrition impact symptoms in advance cancer (palliative setting)
- Xerostomia
- Loss of appetite
- Wt loss
- Early satiety
- Constipation
(Diarrhea, nausea, dysphagia less common but prevalent)
Besides specific GI/oral issues, ____ & _____ can significantly impact eating as a result
Pain, fatigue
Comment on appetite stimulants with EOL
Only increase burden in taking meds, appetite loss is a normal condition at EOL
Ensure _________ for dry mouth, dysguesia, mouth sores w/ hospice
Good oral hygiene
Are swallowing evals recommended w/ QOL
Yes, although it may seem aggressive it may be useful to establish strategies for safe swallowing
When oral antiemetics are difficult PO to take at EOL, _______ administration should be considered
Topical
Monitoring wt may be stressful at the end of life, consider more indirect measures like ___________
Arm circumference
_______ is the standard of screening for oncology patients
PG-SGA
D/t close correlation, besides traditional nutrition screening tools, ______ & _____ assessments performed in hospice settings may be useful tools to identify those who would benefit from nutrition intervention
QOL & functional `
What are the 3 principles of comfort feeding?
- Offer appropriate & favorite foods
- Assist without force
- Recognize signs of satiety or refusal
What are some more MNT-based interventions that may help QOL?
Low salt for fluid retention, wound healing, DM management
With palliative care, artificial nutrition is commonly used when bowel obstruction prevents an oral diet, most commonly in patients with _____ cancer
Ovarian
Use of artificial hydration when patients are getting palliative care, both while receiving treatment versus comfort care
Hydration is crucial while still getting treatment and artificial hydration is often used
when not under treatment, if a pt is dehydrated focus on palliating the symptoms. Comfort.
ASPEN’s stand on EN/PN during EOL
Rarely indicated
Other countries may recommend offering PN if Karnofsky score is > ____ or if ECOG is </=
50
2
