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Life Cycle Nutrition > Nutritional Issues in End of Life > Flashcards

Nutritional Issues in End of Life Flashcards

1
Q

refers to tube feeding and/or intravenous fluids as a medical therapy

A

artificial nutrition and hydration (ANH)

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2
Q

condition expected to lead to death

A

terminal

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3
Q

the process of terminating life-sustaining treatments

A

withdrawal of care

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4
Q

describes patients or family’s wishes regarding resuscitation

A

code status

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5
Q

all efforts to resuscitate patient should be made, including CPR and mechanical ventilation

A

full code

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6
Q

customizable, may desire CPR, but no mechanical ventilation or vise versa

A

limited code

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7
Q

allows death to occur without intercession

A

DNR/DNI

do not resuscitate/do not intibate

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8
Q

appoints individuals to make health-related decisions hen an individual is incapacitated

A

health care proxy
- health care power of attorny

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9
Q

defines patients wishes for medical treatment in case of coma, terminal illness, or persistent vegetative state

A

living will

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10
Q

ne document defining wishes regarding specific treatments and medical care

A

physicians orders for life sustaining treatment (POLST)

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11
Q

Any nutrition and/or hydration support of an invasive nature requiring placement of a tube into the alimentary tract or parenterally via intravenous or subcutaneous means

A

artificial nutrition and hydration (ANH)

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12
Q

Is withholding or withdrawing ANH the same as denying food and drink?

A

no

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13
Q

can patients refuse hydration

A

yes

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14
Q

provides physical symptom management, emotional support, and spiritual comfort when no curative therapy is available or after making the decision to no longer continue curative or life-prolonging therapies

A

palliative care

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15
Q

integrates palliative care into focus on relieving the substantial symptom burden patients face at the end of life, as well as advanced care planning needs, existential concerns, and family and social stressors

A

hospice care

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16
Q

palliative care is_______ management and designed to improve quality of life
- utilized for serious and chronic diseases
- can be used concurrently with curative treatment

some examples?

A

symptom

anxiety, depression, loss of appetite, pain, nausea, diarrhea, shortness of breath, difficulty sleeping

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17
Q

Central ethical question: is it painful not to have access to food & water when dying?
* Hospice professionals have long observed that terminally ill patients experience ______ hunger & thirst and stop eating and drinking
* The analgesic theory proposes that starvation increases production of ______ which may have an ______ effect

A

no

decreased

ketones

anesthetic (calming)

18
Q

Artificial hydration can cause discomfort from increased _______ and _________ from fluid retention
* Thought that most discomfort is due to ______=> alleviate with ice chips, sips of favorite beverages, and good mouth care

A

urine output
respiratory distress

dry mouth

19
Q

ANH in ______ includes Alzheimers, Parkinson’s, alcohol-related, and other etiologies.

  • progressive cognitive and physical decline
  • dysphagia and inability to self-feed are normal sequelae
  • discuss nutrition implications early in disease development

hand feeding?

A

advanced dementia
hand feeding can help these patients

20
Q

Placement of _______ is typically the method of choice for long-term tube feeding
* No proven long-term benefits for individuals with advanced dementia
* Does not reduce _______
* Increases morbidity & mortality
* Often result in=> increased discomfort, use of physical or chemical restraints, increased risk of pressure ulcers, and compromised human dignity

A

PEG tubes

aspiration

21
Q

Why are PEG tubes often placed?
* Lack of knowledge of risks vs. benefits
* Belief by health care professionals that they will reduce morbidity & mortality
* Demands of ____________
* Fear of __________

A

family members

lawsuits

22
Q

Oral feeding should be advocated whenever possible
* Patient’s ____________ of food should be primary consideration. Family & staff should be encouraged to assist in feeding the patient
* Diet restrictions should be individualized or liberalized
* Suboptimal oral feedings may be more appropriate than tube or parenteral feedings

A

emotional enjoyment

23
Q

absence of responsiveness & awareness due to overwhelming dysfunction of the cerebral hemispheres, with sufficient sparing of the brain stem to preserve autonomic & motor reflexes

A

vegetative state

24
Q

vegetative state caused by _________

Patients may have reflexes, including eye movements, yawning, and involuntary movements, but show no awareness of __________

A

brain injuries

self or environment

25
Q

Patients who remains in a vegetative state for > 1 month=> __________

A

Persistent Vegetative State (PVS)

26
Q

If remain unconscious for > 3 months (if non-trauma cause ) or
> 1 year if trauma is the cause are deemed in a __________

A

permanent vegetative state

27
Q

If remain unconscious for > ____ months (if non-trauma cause ) or > ___ year if trauma is the cause are deemed in a permanent vegetative state

A

3
1

28
Q

One of the most difficult decisions facing health care providers & families is whether to place or remove a PEG tube in a PVS patient
* Current findings/conclusions
* Consciousness appears to be a prerequisite for suffering
* Neuroscience supports that PVS patients _________

A

do not suffer

29
Q

Terri Schiavo Case
* Patient in PVS for ___ years
* No advanced directive was left, principle of substituted judgment was applied

A

15

30
Q

Many believe it is more acceptable to _____ a treatment than to _____ it
* No ethical or legal distinction between them
* However, the decision to _____ ANH can be more psychologically distressing to family and practitioners
* A decisionally capable person may refuse any form of life-saving treatments

A

withhold
withdraw

withdraw

31
Q

Be a patient advocate - RDN may be able to best express the needs and wants of the patient and family since the RDN is the main conversation partner for issues related to nutrition

  • Provide ____ that reduce the side effects of medicine and treatment
  • Encourage families to suggest the patients favorite meals, when appropriate, and participate in ____ feeding
A

meals

hand

32
Q

for pediatric patients, ____ generally responsible for decision-making
- withdrawal/withholding of ANH to infants is particularly difficult because they lack autonomy to ______ in any way

___ exist to prevent abuse-related withdrawal/withholding of ANH

A

parents
feed themselves
laws

33
Q

Collaborate with health care team to make ___________ recommendations
* Facilitate policy-making and become involved in the institution’s ethics committee
* Enhance health literacy about ANH – benefits & burdens
* Consider ________ diversity concerning life-sustaining treatments

A

nutrition & hydration
cultural and religious

34
Q

the rules and standards governing the conduct or members of a profession

A

ethics

35
Q
  • the study of the controversial ethical issues emerging from new situations and possibilities brought about by advances in medical technology
  • encompasses theoretical, clinical, regulatory and policy/cultural domains
  • what can be done (the technology) vs. what should be done (ethics) vs. what must be done (law)
A

bioethics

36
Q

A patient with intact decisional capacity may refuse ANH even if medically recommended.

A

autonomy

37
Q

A nutrition support professional may recommend a temporary PEG tube for patients undergoing chemotherapy and radiation of gastric cancer.

A

beneficience

38
Q

A nutrition support professional may recommend against ANH in a patient if it decreases quality of life and outcomes.

A

Non-maleficence

39
Q

Lack of access to appropriate hospice and palliative care may lead to overuse of ANH in disadvantaged cohorts.

A

justice

40
Q

Communication & Compassion
* Some families will request that “everything be done”
* Effective ___________ can help prevent ethical dilemmas
* Explain risks and burdens of ANH
* Clinicians are not obligated to provide futile treatment
* Judgment of what is “futile” considers goals of care, proposed treatment, the outcome

A

communication

Life Cycle Nutrition (21 decks)

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