Case 16 addresses the Nutrition Care Process during palliative and hospice care. The four phases of Lillie's care reflect the first four of the five phases of palliative care described in Table 2 of the Perspective. As you work through the information below, consider the dietitian's focus during Phase 4 of Lillie's progress. What are the key issues for consideration in terms of nutrition care? What questions will the patient and her caregiver be asking? How does the dietitian's advice change at this stage of Lillie's life?
After several weeks of gathering information, Lillie makes the difficult decision to formally enter hospice care. She decides she would prefer to continue at home for the final weeks of her life. Lillie's carer, Evelyn submits a request for a hospital bed to be delivered to Lillie's home and Lillie is allocated the additional support of hospice care workers to assist with personal care, feeding and household maintenance.
Evelyn has been very uncomfortable with the increased responsibility of Lillie's care. Lillie has no appetite, no interest in eating and reports constant nausea. She experiences swallowing difficulties and her physician reports advanced cachexia. She is in a weakened state, bedbound and very sleepy through the course of each day. Evelyn has been concerned about Lillie being alone during the night. She gathers support from Lillie's friends, who take turns spending the night sleeping on the couch in the living room to keep her company and to provide care, e.g. assistance with toileting. Lillie continues to communicate appropriately with her loved ones on occasion.
During this phase of her care, Lillie accepted treatment for the cancer ceased. She requested her PEG feeding regimen be halted. Her carers complied and assisted in the provision of an enteral feed only when she requested one.
Once her son had made arrangements to join his mother for a visit, Lillie requested an enteral feed on the morning he was due to arrive, believing this would give her strength for his visit. By the late afternoon, she experienced explosive diarrhoea and the feed was suspended.
The dietitian is required to conduct a home health visit the following day and report to the Palliative Team with an assessment of Lillie's nutrition status.
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