2. NUTRITION IN PALLIATIVE CARE
Introduction
Nutrition is an essential component of palliative care, which aims to provide
comfort and relief to patients with serious illnesses. Patients in palliative care may
experience a range of symptoms that can affect their ability to eat, such as pain,
nausea, vomiting, and fatigue. Proper nutrition can help improve quality of life and
alleviate some of these symptoms.
The goal of nutrition in palliative care is to ensure that the patient is getting the
appropriate nutrients to meet their needs, while also considering their individual
preferences, values, and goals. The focus should be on promoting comfort and
pleasure in eating rather than strict dietary restrictions or goals
Presented by : N Cdt Saloni Singh
3. PRINCIPLES OF NUTRITION IN
PALLIATIVE CARE
Assessment: A thorough nutritional assessment is essential to identify the patient's
nutritional needs, preferences, and any barriers to eating.
Individualized plan: A tailored plan should be developed based on the patient's
nutritional needs, preferences, and goals, as well as any medical conditions.
Symptom management: Nutrition interventions should be targeted towards managing
symptoms such as pain, nausea, and constipation. For example, the use of soft, easily
digestible foods, small and frequent meals, and antiemetics may help alleviate nausea.
Emotional support: Eating can be a source of comfort and pleasure, so it is important to
provide emotional support to patients who may be experiencing anxiety or depression
related to eating.
Communication: Communication with the patient and their family is key to ensuring
that their nutritional needs and preferences are met, and any concerns or changes in
their appetite or weight are addressed.
Nutrition should be supportive and should aim to optimize the management of nutrition
related symptoms, thus improving the sense of well being felt by the patient
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4. NUTRITION ASSESSMENT
The first step in managing the nutritional needs of
a palliative care patient is to conduct a
comprehensive nutritional assessment.
The assessment includes evaluating the patient's
nutritional status, identifying any underlying
medical conditions that may affect their nutritional
needs, and assessing any symptoms that may
impact their ability to eat.
The nutritional assessment should be conducted by
a registered dietitian or other qualified healthcare
professional with expertise in nutrition.
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5. The nutritional assessment should include the following
components:
Medical History: The patient's medical history should be reviewed to identify any
underlying medical conditions that may affect their nutritional needs. This may include
conditions such as cancer, heart disease, diabetes, or gastrointestinal disorders.
Anthropometric Measurements: Anthropometric measurements, such as height, weight,
and body mass index (BMI), can provide information on the patient's body composition
and nutritional status.
Dietary Intake: The patient's dietary intake should be evaluated to assess their nutrient
intake and identify any deficiencies or excesses. This can be done through a food diary,
food frequency questionnaire, or other dietary assessment tools.
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6. Symptoms: The patient's symptoms should be evaluated to
identify any issues that may impact their ability to eat or
their nutritional status. This may include symptoms such
as nausea, vomiting, pain, or fatigue.
Laboratory Tests: Laboratory tests, such as blood tests or
urine tests, can provide information on the patient’s
nutritional status, including levels of nutrients such as
protein, iron, and vitamins.
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7. TAILORED NUTRITION PLAN
Once the nutritional assessment has been completed, a tailored nutrition plan should be
developed for each patient. The nutrition plan should be based on the patient's individual
needs and goals, taking into account their medical condition, symptoms, and personal
preferences. The nutrition plan may include modifications to the patient's diet, such as
adding high-protein or high-calorie foods, or the use of nutritional supplements.
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8. STRATEGIES TO HELP DEVELOP
TAILORED NUTRITION PLAN FOR PC PTS
Caloric and Protein Requirements: Caloric and protein requirements should
be calculated based on the patient's age, gender, weight, and activity
level, as well as their medical condition and symptoms.
Meal Planning: Meal planning should be tailored to the patient's individual
needs and preferences and should include a variety of foods from all food
groups.
Nutritional Supplements: Nutritional supplements may be recommended
to meet the patient's nutrient needs. This may include supplements such
as protein powder, meal replacement shakes, or liquid supplements.
Texture Modification: Texture modification may be necessary to
accommodate any swallowing difficulties or other issues that may impact
the patient's ability to eat
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9. COMPONENTS OF NUTRITION IN
PALLIATIVE CARE
i. Energy Requirements: Palliative care patients often have
decreased energy requirements due to changes in body
composition, metabolism, and decreased physical activity.
ii. Protein Requirements: Palliative care patients may have
increased protein requirements due to changes in body
composition, metabolism, and wound healing.
iii. Micronutrient Requirements: Palliative care patients may
have increased micronutrient requirements due to changes
in metabolism, increased oxidative stress, and altered
immune function.
iv. Hydration Requirements: Palliative care patients may have
increased hydration requirements due to decreased fluid
intake, increased fluid losses, and changes in fluid balance.
10. NUTRIENTS REQUIRED FOR SPECIFIC
PEOPLE IN PALLIATIVE CARE
i. Elderly: May require higher amounts of vitamins B12 and D for bone health.
ii. Cancer Patients: Increased protein, iron, vitamin B6, and folic acid
requirements.
iii. Patients with Chronic Illnesses: Increased protein, vitamin B12, calcium,
and iron requirements.
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11. NUTRITION THERAPY FOR CANCER
PATIENTS
The guidelines comprises of;
Eat a variety of foods with an emphasis on plant sources
Plenty of fruits and vegetables
Plenty of whole grains and legumes(high fiber diet)
Limit consumption of red meats, especially processed and fatty meat.
Eat a low fat diet o Maintain a healthy weight (What is the normal BMI?).
Maintaining physical activity (what is the importance of being physically active?)
Excessive consumption of alcohol is to be discouraged o Limit consumption of salted
foods and use of table salt
A void use of tobacco in any form
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12. NUTRITION FOR THE DIABETIC
PATIENTS AND ITS RATIONALE
Diabetic patients need to pay close attention to their nutrition because their bodies
have difficulty regulating blood sugar levels. The rationale for this is that the food they
consume directly affects their blood glucose levels.
Hence, managing their diet is a critical component of their diabetes management.
Here are some key nutrition guidelines for diabetic patients and the rationale behind
them:
Limit sugar intake: Diabetic patients must limit their sugar intake because sugar raises
blood glucose levels. Eating too much sugar can lead to high blood sugar levels, which
can cause complications such as neuropathy, blindness, and kidney disease.
Choose complex carbohydrates: Complex carbohydrates, such as whole-grain bread,
brown rice, and whole-wheat pasta, are better for diabetic patients than simple
carbohydrates like white bread, rice, and pasta. Complex carbohydrates are digested
more slowly and cause a more gradual rise in blood glucose levels.
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13. CONT’D
Control portion size: Diabetic patients need to control their portion size because
consuming too much food can cause a rapid rise in blood sugar levels. They should
use measuring cups or a food scale to ensure they are eating the right amount of
food.
Choose lean protein sources: Diabetic patients should choose lean protein sources
such as skinless chicken, fish, and legumes. These are lower in fat and calories than
red meat and can help prevent complications associated with high cholesterol
levels.
Eat plenty of fruits and vegetables: Fruits and vegetables are essential for diabetic
patients because they are rich in nutrients, fiber, and antioxidants. They also have a
lower glycemic index than other carbohydrates, which means they cause a slower
rise in blood sugar levels.
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14. NUTRITION ON PEOPLE LIVING
WITH HIV/AIDS (PLWHA)
HIV patients
This patients needs a variety of nutrients since they are susceptible to many
infection. They need foods high reach in Vitamins such a green vegetables fruits.
They should avoid foods rich in saturated fats, sugars and salts
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15. IMPORTANCE OF NUTRITION TO
PATIENT ON PALLIATIVE CARE
i. Improves Quality of Life: Proper nutrition helps to improve the overall health
and wellbeing of the person
ii. Supports Healing: Adequate nutrition helps to support healing and reduce the risk
of infections.
iii. Maintains Body Weight: Nutrition helps to maintain body weight and reduce the
risk of cachexia.
iv. Supports Immune System: Proper nutrition helps to support the immune system
and prevent infections.
v. Reduces Fatigue: Adequate nutrition helps to reduce fatigue and increase energy
levels.
vi. Improves Mood: Nutrition can help to improve mood and reduce symptoms of
depression and anxiety.
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16. LIMITATIONS OF NUTRITION OF
PALLIATIVE CARE PATIENTS
i. Appetite Loss: Palliative care patients often experience a decrease in appetite,
which can limit the amount of food they are able to consume.
ii. Nausea and Vomiting: Nausea and vomiting can make it difficult for the person
to eat and absorb nutrients.
iii. Malnutrition: Palliative care patients are at risk of malnutrition, which can lead
to weight loss, weakness and fatigue.
iv. Difficulty Eating: Many palliative care patients have difficulty eating due to
pain, nausea, and other symptoms
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17. EFFECTS OF NUTRITION TO
PALLIATIVE CARE PATIENTS
i. Improved Physical Function: Proper nutrition can help to improve physical function
and reduce fatigue.
ii. Improved Mood: Nutrition can help to improve mood and reduce symptoms of
depression and anxiety.
iii. Reduced Risk of Infections: Adequate nutrition can help to reduce the risk of
infections.
iv. Maintained Body Weight: Proper nutrition helps to maintain body weight and
reduce the risk of cachexia.
v. Improved Quality of Life: Adequate nutrition can improve the overall health and
wellbeing of the person.
vi. Improved Immune Function: Good nutrition supports immune function, which is
important for preventing infections and promoting wound healing
Presented by : N Cdt Saloni Singh
18. FACTORS AFFECTING NUTRITION
TO PALLIATIVE CARE PATIENTS
i. Appetite changes: Many palliative care patients experience changes in their
appetite, which can lead to decreased food intake and weight loss.
ii. Nausea and vomiting: These symptoms can make it difficult for patients to eat and
keep food down.
iii. Pain: Pain can make it difficult for patients to eat, as well as affect their overall
well-being and mood.
iv. Fatigue: Fatigue can also make it difficult for patients to eat and prepare meals.
v. Changes in taste and smell: Changes in taste and smell can make food
unappetizing, leading to decreased food intake
vi. Medications: Certain medications can cause side effects such as dry mouth,
constipation, and decreased appetite, which can impact nutrition.
Presented by : N Cdt Saloni Singh
19. CONT’D
vii. Psychological factors: Depression, anxiety, and stress can all affect a patient's
appetite and ability to eat.
viii. Physical limitations: Physical limitations such as difficulty swallowing,
difficulty sitting up, and difficulty reaching for food can all impact nutrition.
It is important for palliative care teams to be aware of these factors and work
with patients to address them in order to maintain good nutrition and overall
well-being
Presented by : N Cdt Saloni Singh
20. FEEDING A PATIENT UNDER
PALLIATIVE CARE
Palliative care is a form of medical care that focuses on
improving the quality of life of patients with life-limiting
illnesses such as cancer, heart disease, and neurological
conditions. One of the key aspects of palliative care is
managing the patient's symptoms, including pain,
nausea, and appetite loss. In this context, feeding the
patient is an important part of palliative care as it can
help improve the patient's quality of life.
Presented by : N Cdt Saloni Singh
21. TYPES OF FEEDING
There are several types of feeding that may be considered for patients
under palliative care. These include:
Oral feeding: This involves giving the patient food and fluids orally. If
the patient has difficulty swallowing, modifications may be made to the
food consistency or the patient may be taught specific swallowing
techniques to make it easier.
Enteral feeding: This involves providing nutrition through a tube that is
inserted through the nose, mouth, or stomach. This is often used when
the patient is unable to eat or drink orally due to medical conditions
such as stroke or cancer.
Parenteral feeding: This involves providing nutrition through a vein,
usually through an IV line. This is typically used when the patient is
unable to receive nutrition through the digestive system.
22. CONSIDERATIONS FOR FEEDING
i. Patient preferences: The patient's preferences regarding the type of
feeding should be taken into account as much as possible.
ii. Medical condition: The patient's medical condition will also influence
the type of feeding that is most appropriate. For example, a patient
with a bowel obstruction may not be able to receive enteral feeding.
iii. Goals of care: The patient's goals of care should also be taken into
account when deciding on the type of feeding. If the patient is
nearing the end of life and the goal is to provide comfort care, enteral
or parenteral feeding may not be necessary.
iv. Potential benefits and risks: The potential benefits and risks of each
feeding method should also be considered. For example, enteral
feeding may increase the risk of aspiration pneumonia, while
parenteral feeding may increase the risk of infections.
23. CONCLUSION
Nutrition plays a vital role in the overall well-being of individuals in palliative
care. It is essential for maintaining good health, managing symptoms and side
effects, and promoting mental and emotional well-being. However, there may
be limitations to nutrition for individuals in palliative care, such as loss of
appetite, difficulty swallowing, or limited mobility. It is important for
healthcare providers to assess the nutritional needs of individuals in palliative
care and support them in making choices that meet those needs
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24. REFERENCES
1. "Oxford Textbook of Palliative Medicine" by Derek Doyle, Neil MacDonald,
and Christina Faull.
2. "Palliative Care: A Guide for Nurses and Other Health Care Professionals" by
J. Mark Callister.
3. "Palliative Care Nursing: Quality Care to the End of Life" by Marianne
LaMontagne and Constance Dahlin
Presented by : N Cdt Saloni Singh
