NUR 420 NUTRITION IN PALLIATIVE CARE Bsc Nursing

1. Nutrition in Palliative
Care
Palliative & Geriontology

2. Members
Name Reg No
i. Akal Lobenyo Morris 21-2668
ii. Kennedy Mukwami 21-2317
iii. Collins Obayo 21-2443
iv. Asnath Makori 21-2853
v. Isaac Kipkemoi 21-2309
vi. Rachel Muthoni 21-2761
vii. Ojala Shadrack 21-2239
viii. Joseph Ng’ang’a 21-2266
ix. Natali Wambui 21-1594
x. Morema Sharon 21-2285

3. 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

4. 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

5. 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.

6. 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.

7. • 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.

8. 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.

9. 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

10. 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.

11. 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.

12. 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

13. 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.

14. 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.

15. 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

16. 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.

17. 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

18. 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

19. 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.

20. 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

21. 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.

22. 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.

23. 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.

24. 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

25. 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

26. THANK YOU FOR YOUR ATTENTION😉😉
QUESTIONS😁
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Prepared By: Akal