Hospice Education Network
                                                          Nutrition at End-of-Life, by C. Andrew Martin, MS, RN, CHPN
                                 NUTRITION AT END-OF-LIFE
                                       C. Andrew Martin, MS RN CHPN
                                          Hospice Education Network
                                              camartin@hospiceonline.com
                                                 HANDOUTS
                            • Pause the presentation
                            • Click on the link for the PowerPoint handouts 
                               and any supplemental materials
                            • Download the handouts (PDF files)
                            • Print the handouts
                                                                                            2
                                                OBJECTIVES
                            • The learner will:
                                – Identify nutritional care givers as both family and 
                                  professionals, located in various care settings
                                – List some components of a nutritional assessment
                                – List nutritional support activities
                                – Identify cultural, personal and ethical issues 
                                  concerning nutrition at end-of-life
                                                                                            3
                                                                             Hospice Education Network (c) 2008
                                                                                      www.hospiceonline.com
                                                                              Hospice Education Network
                                                      Nutrition at End-of-Life, by C. Andrew Martin, MS, RN, CHPN
                                            DEFINITIONS
                          • Nutrition: the act of nourishing or of being 
                             nourished 
                          • Hydration: the act of giving liquids to the body
                              – They are basic care giving activities
                              – They are opportunities for social interaction between 
                                patient and care giver, whether family or professional 
                                                                                      4
                                          “FOOD IS LOVE”
                          • Life cycle events
                              –Birthdays
                              – Weddings
                              – Anniversaries
                              – Funerals
                          • Caring activities
                              – Newborns
                              –Illness
                              –Dying
                                                                                      5
                                   NUTRITIONAL SUPPORT AT 
                                              END-OF-LIFE
                          • Nutrition may be beneficial early in the disease 
                             process
                              – Six month prognosis
                          • Educate care givers in understanding nutritional 
                             needs and limitations in terminal situations
                          • Develop an individualized approach to each 
                             patient
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                                                                       Hospice Education Network (c) 2008
                                                                                www.hospiceonline.com
                                                                                        Hospice Education Network
                                                              Nutrition at End-of-Life, by C. Andrew Martin, MS, RN, CHPN
                                            CARING PARTNERS
                              • Hospice
                                  –Family
                                  – Inpatient facility staff
                                      • Collaboration
                                      • Conflict resolution
                                                                                                  7
                              HOSPICE IN THE INPATIENT FACILITY
                              • Documentation must meet the regulations for 
                                 both agencies
                              • Documentation must indicate coordination of the 
                                 plan of care
                              • Goals of both agencies must agree
                              • Hospice manages the plan of care
                                                                                                  8
                                               CARE PLANNING
                              • Normal for a hospice patient to have:
                                  – Decreased appetite
                                  – Decreased fluid intake
                              • Nutrition is part of the care plan
                                  – Trajectory of the disease
                                  – Patient/family wishes
                                                                                                  9
                                                                                 Hospice Education Network (c) 2008
                                                                                           www.hospiceonline.com
                                                                                  Hospice Education Network
                                                         Nutrition at End-of-Life, by C. Andrew Martin, MS, RN, CHPN
                                 CARE GIVING ASSESSMENT
                            • Care giving settings may be:
                                –Home
                                – Inpatient Facility
                            • Care givers may be:
                                – Family, friends, or healthcare professionals
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                                 NUTRITIONAL ASSESSMENT
                            • Diet history
                            • Eating habits
                            • Food preferences
                            • Food aversions
                            • Weight loss history
                                – Certification and re-certification periods
                            • Physical exam
                                –oral
                                                                                          11
                           PHARMACOLOGICAL ASSESSMENT
                            •Steroids
                                – Increase appetite
                            • Megastrol acetate
                                – Increase appetite
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                                                                           Hospice Education Network (c) 2008
                                                                                    www.hospiceonline.com