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Kaitlyn Kavan

Illinois State University


OSF – St. Joseph Hospital
Date D. S. Height Admit Wt Nutrition-Related Trigger
9/16 64 YOM 5’ 10” 170# 14.4 oz Risk Screen indicating weight loss

Past Medical History

 Diffuse large B-cell lymphoma  Pachymeningitis


 Muscular weakness; limited mobility
 Pancytopenia
 Recent fall  Nursing home
 Chronic obstructive pulmonary
disease  Chronic usage of systemic steroids
 Dyspnea  Type II Diabetes Mellitus
 Pressure ulcer – Stage II  III
 Severe systemic inflammatory
response syndrome
 E. coli
 Non-Hodgkin Lymphoma
 Lymphocytes
 White blood cell
 Protect body against bacteria and viruses

 The cancer grows quickly, requires:


 Chemotherapy
 R-CHOP

 Signs and symptoms  Risk Factors


 Weight loss  60+
 Fatigue  Male
 Shortness of breath  White
 Decreased appetite
 Weakened immune system
Date D. S. Height Admit Wt Nutrition-Related Trigger
9/16 64 YOM 5’ 10” 170# 14.4 oz Risk Screen indicating weight loss

Past Medical History

 Diffuse large B-cell lymphoma  Pachymeningitis


 Muscular weakness; limited mobility
 Pancytopenia
 Recent fall  Nursing home
 Chronic obstructive pulmonary
disease  Chronic usage of systemic steroids
 Dyspnea  Type II Diabetes Mellitus
 Pressure ulcer – Stage II  III
 Severe systemic inflammatory
response syndrome
 E. coli
Date D. S. Height Admit Wt Nutrition-Related Trigger
9/16 64 YOM 5’ 10” 170# 14.4 oz Risk Screen indicating weight loss

Past Medical History

 Diffuse large B-cell lymphoma  Pachymeningitis


 Muscular weakness; limited mobility
 Pancytopenia
 Recent fall  Nursing home
 Chronic obstructive pulmonary
disease  Chronic usage of systemic steroids
 Dyspnea  Type II Diabetes Mellitus
 Pressure ulcer – Stage II  III
 Severe systemic inflammatory
response syndrome
 E. coli
Date D. S. Height Admit Wt Nutrition-Related Trigger
9/16 64 YOM 5’ 10” 170# 14.4 oz Risk Screen indicating weight loss

Past Medical History

 Diffuse large B-cell lymphoma  Pachymeningitis


 Muscular weakness; limited mobility
 Pancytopenia
 Recent fall  Nursing home
 Chronic obstructive pulmonary
disease  Chronic usage of systemic steroids
 Dyspnea  Type II Diabetes Mellitus
 Pressure ulcer – Stage II  III
 Severe systemic inflammatory
response syndrome
 E. coli
Date D. S. Height Admit Wt Nutrition-Related Trigger
9/16 64 YOM 5’ 10” 170# 14.4 oz Risk Screen indicating weight loss

Past Medical History

 Diffuse large B-cell lymphoma  Pachymeningitis


 Muscular weakness; limited mobility
 Pancytopenia
 Recent fall  Nursing home
 Chronic obstructive pulmonary
disease  Chronic usage of systemic steroids
 Dyspnea  Type II Diabetes Mellitus
 Pressure ulcer – Stage II  III
 Severe systemic inflammatory
response syndrome
 E. coli
Date D. S. Height Admit Wt Nutrition-Related Trigger
9/16 64 YOM 5’ 10” 170# 14.4 oz Risk Screen indicating weight loss

Past Medical History

 Diffuse large B-cell lymphoma  Pachymeningitis


 Muscular weakness; limited mobility
 Pancytopenia
 Recent fall  Nursing home
 Chronic obstructive pulmonary
disease  Chronic usage of systemic steroids
 Dyspnea  Type II Diabetes Mellitus
 Pressure ulcer – Stage II  III
 Severe systemic inflammatory
response syndrome
 E. coli
Date Reason for Note / Assessments, Interventions, and Recommendations

9/16 Initial assessment / Follow up to define malnutrition; offer supplements; change MCC diet to HCC; consider general diet

9/19 Follow up; interview; Nutrition-Focused Physical Assessment; hypoglycemic event /


Severe malnutrition diagnosis; send supplements TID; multivitamin; encourage BM; consider appetite stimulant; ↓ Lantus
9/22 Follow up / Provide cafeteria menu; emphasize importance of adequate intakes; goal of intake >75% of larger food order

9/26 Follow up / Recommend diet advancement to general; increase supplement consumption- order in place when no longer NPO

9/28 Follow up / Provide cafeteria menu; share concern for pt’s safety with family and staff; TF discussion (PEG)  palliative care

10/2 Follow up; hypoglycemic event / Continued poor intakes; calorie count; nutrition support (NG or PEG) warranted at <50%
estimated nutrition needs; 60 g CHO per meal; HS snack; continuous dextrose source; ↓ Lantus; encourage ↑ intakes
10/4* Follow up; calorie count interpretation / Discussed dinner mishap with RN; pre-ordered dinner trays; Send two supplements TID

10/6* Follow up; calorie count interpretation / CC extension; talked with palliative care and speech therapy; monitor weight; TF recs

10/9* Follow up; calorie count interpretation; hypoglycemic event / “Recommend continuous TF,” nocturnal if diet advances;↓ Lantus

10/12* Follow up / Respiratory MD note = ”nutrition is of concern;” recalculated needs utilizing refeeding syndrome precautions

10/13* Addendum / Care team aware of patient’s nutrition deficits; ICU daily rounding meeting: respiratory MD shared his concerns
Date Reason for Note / Assessments, Interventions, and Recommendations

9/16 Initial assessment / Follow up to define malnutrition; offer supplements; change MCC diet to HCC; consider general diet

9/19 Follow up; interview; Nutrition-Focused Physical Assessment; hypoglycemic event /


Severe malnutrition diagnosis; send supplements TID; multivitamin; encourage BM; consider appetite stimulant; ↓ Lantus
9/22 Follow up / Provide cafeteria menu; emphasize importance of adequate intakes; goal of intake >75% of larger food order

9/26 Follow up / Recommend diet advancement to general; increase supplement consumption- order in place when no longer NPO

9/28 Follow up / Provide cafeteria menu; share concern for pt’s safety with family and staff; TF discussion (PEG)  palliative care

10/2 Follow up; hypoglycemic event / Continued poor intakes; calorie count; nutrition support (NG or PEG) warranted at <50%
estimated nutrition needs; 60 g CHO per meal; HS snack; continuous dextrose source; ↓ Lantus; encourage ↑ intakes
10/4* Follow up; calorie count interpretation / Discussed dinner mishap with RN; pre-ordered dinner trays; Send two supplements TID

10/6* Follow up; calorie count interpretation / CC extension; talked with palliative care and speech therapy; monitor weight; TF recs

10/9* Follow up; calorie count interpretation; hypoglycemic event / “Recommend continuous TF,” nocturnal if diet advances;↓ Lantus

10/12* Follow up / Respiratory MD note = ”nutrition is of concern;” recalculated needs utilizing refeeding syndrome precautions

10/13* Addendum / Care team aware of patient’s nutrition deficits; ICU daily rounding meeting: respiratory MD shared his concerns
Severe Malnutrition
in the context of chronic illness
ASPEN Diagnostic Patient’s Signs and  BMI: 24.5 kg/m2
Characteristics Symptoms
 EMR wt hx:
Energy Intake ~50% of meals  198# (5/2017)
 195# (11/2016)
Interpretation of 26# weight loss
Weight Loss 13% x 4 months  UBW: 195# 87% UBW
Muscle Loss Temple region:
 Wound: Stage II Pressure Ulcer
scooped, depressed
Clavicle bone visible
Fluid Accumulation 2+ BIL edema:
generalized, periorbital
 Patient’s Estimated Nutrition Needs
3+ BIL edema: 2350-2750 kcal/day (30-35 kcal/kg CBW 78 kg)
dependent, R arm
78-94 g PRO/day (1.0-1.2 g/kg CBW)
Reduced Grip 7.5 kg - weak
Strength ~ 2350 mL fluids/day (1.0 mL/kcal)
Date Reason for Note / Assessments, Interventions, and Recommendations

9/16 Initial assessment / Follow up to define malnutrition; offer supplements; change MCC diet to HCC; consider general diet

9/19 Follow up; interview; Nutrition-Focused Physical Assessment; hypoglycemic event /


Severe malnutrition diagnosis; send supplements TID; multivitamin; encourage BM; consider appetite stimulant; ↓ Lantus
9/22 Follow up / Provide cafeteria menu; emphasize importance of adequate intakes; goal of intake >75% of larger food order

9/26 Follow up / Recommend diet advancement to general; increase supplement consumption- order in place when no longer NPO

9/28 Follow up / Provide cafeteria menu; share concern for pt’s safety with family and staff; TF discussion (PEG)  palliative care

10/2 Follow up; hypoglycemic event / Continued poor intakes; calorie count; nutrition support (NG or PEG) warranted at <50%
estimated nutrition needs; 60 g CHO per meal; HS snack; continuous dextrose source; ↓ Lantus; encourage ↑ intakes
10/4* Follow up; calorie count interpretation / Discussed dinner mishap with RN; pre-ordered dinner trays; Send two supplements TID

10/6* Follow up; calorie count interpretation / CC extension; talked with palliative care and speech therapy; monitor weight; TF recs

10/9* Follow up; calorie count interpretation; hypoglycemic event / “Recommend continuous TF,” nocturnal if diet advances;↓ Lantus

10/12* Follow up / Respiratory MD note = ”nutrition is of concern;” recalculated needs utilizing refeeding syndrome precautions

10/13* Addendum / Care team aware of patient’s nutrition deficits; ICU daily rounding meeting: respiratory MD shared his concerns
Date Reason for Note / Assessments, Interventions, and Recommendations

9/16 Initial assessment / Follow up to define malnutrition; offer supplements; change MCC diet to HCC; consider general diet

9/19 Follow up; interview; Nutrition-Focused Physical Assessment; hypoglycemic event /


Severe malnutrition diagnosis; send supplements TID; multivitamin; encourage BM; consider appetite stimulant; ↓ Lantus

9/22 Follow up / Provide cafeteria menu; emphasize importance of adequate intakes; goal of intake >75% of larger food order

9/26 Follow up / Recommend diet advancement to general; increase supplement consumption- order in place when no longer NPO

9/28 Follow up / Provide cafeteria menu; share concern for pt’s safety with family and staff; TF discussion (PEG)  palliative care

10/2 Follow up; hypoglycemic event / Continued poor intakes; calorie count; nutrition support (NG or PEG) warranted at <50%
estimated nutrition needs; 60 g CHO per meal; HS snack; continuous dextrose source; ↓ Lantus; encourage ↑ intakes
10/4* Follow up; calorie count interpretation / Discussed dinner mishap with RN; pre-ordered dinner trays; Send two supplements TID

10/6* Follow up; calorie count interpretation / CC extension; talked with palliative care and speech therapy; monitor weight; TF recs

10/9* Follow up; calorie count interpretation; hypoglycemic event / “Recommend continuous TF,” nocturnal if diet advances;↓ Lantus

10/12* Follow up / Respiratory MD note = ”nutrition is of concern;” recalculated needs utilizing refeeding syndrome precautions

10/13* Addendum / Care team aware of patient’s nutrition deficits; ICU daily rounding meeting: respiratory MD shared his concerns
Date Reason for Note / Assessments, Interventions, and Recommendations

9/16 Initial assessment / Follow up to define malnutrition; offer supplements; change MCC diet to HCC; consider general diet

9/19 Follow up; interview; Nutrition-Focused Physical Assessment; hypoglycemic event /


Severe malnutrition diagnosis; send supplements TID; multivitamin; encourage BM; consider appetite stimulant; ↓ Lantus
9/22 Follow up / Provide cafeteria menu; emphasize importance of adequate intakes; goal of intake >75% of larger food order

9/26 Follow up / Recommend diet advancement to general; increase supplement consumption- order in place when no longer NPO

9/28 Follow up / Provide cafeteria menu; share concern for pt’s safety with family and staff; TF discussion (PEG)  palliative care

10/2 Follow up; hypoglycemic event / Continued poor intakes; calorie count; nutrition support (NG or PEG) warranted at <50%
estimated nutrition needs; 60 g CHO per meal; HS snack; continuous dextrose source; ↓ Lantus; encourage ↑ intakes
10/4* Follow up; calorie count interpretation / Discussed dinner mishap with RN; pre-ordered dinner trays; Send two supplements TID

10/6* Follow up; calorie count interpretation / CC extension; talked with palliative care and speech therapy; monitor weight; TF recs

10/9* Follow up; calorie count interpretation; hypoglycemic event / “Recommend continuous TF,” nocturnal if diet advances;↓ Lantus

10/12* Follow up / Respiratory MD note = ”nutrition is of concern;” recalculated needs utilizing refeeding syndrome precautions

10/13* Addendum / Care team aware of patient’s nutrition deficits; ICU daily rounding meeting: respiratory MD shared his concerns
Date Reason for Note / Assessments, Interventions, and Recommendations

9/16 Initial assessment / Follow up to define malnutrition; offer supplements; change MCC diet to HCC; consider general diet

9/19 Follow up; interview; Nutrition-Focused Physical Assessment; hypoglycemic event /


Severe malnutrition diagnosis; send supplements TID; multivitamin; encourage BM; consider appetite stimulant; ↓ Lantus
9/22 Follow up / Provide cafeteria menu; emphasize importance of adequate intakes; goal of intake >75% of larger food order

9/26 Follow up / Recommend diet advancement to general; increase supplement consumption- order in place when no longer NPO

9/28 Follow up / Provide cafeteria menu; share concern for pt’s safety with family and staff; TF discussion (PEG)  palliative care

10/2 Follow up; hypoglycemic event / Continued poor intakes; calorie count; nutrition support (NG or PEG) warranted at <50%
estimated nutrition needs; 60 g CHO per meal; HS snack; continuous dextrose source; ↓ Lantus; encourage ↑ intakes
10/4* Follow up; calorie count interpretation / Discussed dinner mishap with RN; pre-ordered dinner trays; Send two supplements TID

10/6* Follow up; calorie count interpretation / CC extension; talked with palliative care and speech therapy; monitor weight; TF recs

10/9* Follow up; calorie count interpretation; hypoglycemic event / “Recommend continuous TF,” nocturnal if diet advances;↓ Lantus

10/12* Follow up / Respiratory MD note = ”nutrition is of concern;” recalculated needs utilizing refeeding syndrome precautions

10/13* Addendum / Care team aware of patient’s nutrition deficits; ICU daily rounding meeting: respiratory MD shared his concerns
Date Reason for Note / Assessments, Interventions, and Recommendations

9/16 Initial assessment / Follow up to define malnutrition; offer supplements; change MCC diet to HCC; consider general diet

9/19 Follow up; interview; Nutrition-Focused Physical Assessment; hypoglycemic event /


Severe malnutrition diagnosis; send supplements TID; multivitamin; encourage BM; consider appetite stimulant; ↓ Lantus
9/22 Follow up / Provide cafeteria menu; emphasize importance of adequate intakes; goal of intake >75% of larger food order

9/26 Follow up / Recommend diet advancement to general; increase supplement consumption- order in place when no longer NPO

9/28 Follow up / Provide cafeteria menu; share concern for pt’s safety with family and staff; TF discussion (PEG)  palliative care

10/2 Follow up; hypoglycemic event / Continued poor intakes; calorie count; nutrition support (NG or PEG) warranted at <50%
estimated nutrition needs; 60 g CHO per meal; HS snack; continuous dextrose source; ↓ Lantus; encourage ↑ intakes
10/4* Follow up; calorie count interpretation / Discussed dinner mishap with RN; pre-ordered dinner trays; Send two supplements TID

10/6* Follow up; calorie count interpretation / CC extension; talked with palliative care and speech therapy; monitor weight; TF recs

10/9* Follow up; calorie count interpretation; hypoglycemic event / “Recommend continuous TF,” nocturnal if diet advances;↓ Lantus

10/12* Follow up / Respiratory MD note = ”nutrition is of concern;” recalculated needs utilizing refeeding syndrome precautions

10/13* Addendum / Care team aware of patient’s nutrition deficits; ICU daily rounding meeting: respiratory MD shared his concerns
Date Reason for Note / Assessments, Interventions, and Recommendations

9/16 Initial assessment / Follow up to define malnutrition; offer supplements; change MCC diet to HCC; consider general diet

9/19 Follow up; interview; Nutrition-Focused Physical Assessment; hypoglycemic event /


Severe malnutrition diagnosis; send supplements TID; multivitamin; encourage BM; consider appetite stimulant; ↓ Lantus
9/22 Follow up / Provide cafeteria menu; emphasize importance of adequate intakes; goal of intake >75% of larger food order

9/26 Follow up / Recommend diet advancement to general; increase supplement consumption- order in place when no longer NPO

9/28 Follow up / Provide cafeteria menu; share concern for pt’s safety with family and staff; TF discussion (PEG)  palliative care

10/2 Follow up; hypoglycemic event / Continued poor intakes; calorie count; nutrition support (NG or PEG) warranted at <50%
estimated nutrition needs; 60 g CHO per meal; HS snack; continuous dextrose source; ↓ Lantus; encourage ↑ intakes

10/4* Follow up; calorie count interpretation / Discussed dinner mishap with RN; pre-ordered dinner trays; Send two supplements TID

10/6* Follow up; calorie count interpretation / CC extension; talked with palliative care and speech therapy; monitor weight; TF recs

10/9* Follow up; calorie count interpretation; hypoglycemic event / “Recommend continuous TF,” nocturnal if diet advances;↓ Lantus

10/12* Follow up / Respiratory MD note = ”nutrition is of concern;” recalculated needs utilizing refeeding syndrome precautions

10/13* Addendum / Care team aware of patient’s nutrition deficits; ICU daily rounding meeting: respiratory MD shared his concerns
Date Reason for Note / Assessments, Interventions, and Recommendations

9/16 Initial assessment / Follow up to define malnutrition; offer supplements; change MCC diet to HCC; consider general diet

9/19 Follow up; interview; Nutrition-Focused Physical Assessment; hypoglycemic event /


Severe malnutrition diagnosis; send supplements TID; multivitamin; encourage BM; consider appetite stimulant; ↓ Lantus
9/22 Follow up / Provide cafeteria menu; emphasize importance of adequate intakes; goal of intake >75% of larger food order

9/26 Follow up / Recommend diet advancement to general; increase supplement consumption- order in place when no longer NPO

9/28 Follow up / Provide cafeteria menu; share concern for pt’s safety with family and staff; TF discussion (PEG)  palliative care

10/2 Follow up; hypoglycemic event / Continued poor intakes; calorie count; nutrition support (NG or PEG) warranted at <50%
estimated nutrition needs; 60 g CHO per meal; HS snack; continuous dextrose source; ↓ Lantus; encourage ↑ intakes
10/4* Follow up; calorie count interpretation / Discussed dinner mishap with RN; pre-ordered dinner trays; Send two supplements TID

10/6* Follow up; calorie count interpretation / CC extension; talked with palliative care and speech therapy; monitor weight; TF recs

10/9* Follow up; calorie count interpretation; hypoglycemic event / “Recommend continuous TF,” nocturnal if diet advances;↓ Lantus

10/12* Follow up / Respiratory MD note = ”nutrition is of concern;” recalculated needs utilizing refeeding syndrome precautions

10/13* Addendum / Care team aware of patient’s nutrition deficits; ICU daily rounding meeting: respiratory MD shared his concerns
Date Reason for Note / Assessments, Interventions, and Recommendations

9/16 Initial assessment / Follow up to define malnutrition; offer supplements; change MCC diet to HCC; consider general diet

9/19 Follow up; interview; Nutrition-Focused Physical Assessment; hypoglycemic event /


Severe malnutrition diagnosis; send supplements TID; multivitamin; encourage BM; consider appetite stimulant; ↓ Lantus
9/22 Follow up / Provide cafeteria menu; emphasize importance of adequate intakes; goal of intake >75% of larger food order

9/26 Follow up / Recommend diet advancement to general; increase supplement consumption- order in place when no longer NPO

9/28 Follow up / Provide cafeteria menu; share concern for pt’s safety with family and staff; TF discussion (PEG)  palliative care

10/2 Follow up; hypoglycemic event / Continued poor intakes; calorie count; nutrition support (NG or PEG) warranted at <50%
estimated nutrition needs; 60 g CHO per meal; HS snack; continuous dextrose source; ↓ Lantus; encourage ↑ intakes
10/4* Follow up; calorie count interpretation / Discussed dinner mishap with RN; pre-ordered dinner trays; Send two supplements TID

10/6* Follow up; calorie count interpretation / CC extension; talked with palliative care and speech therapy; monitor weight; TF recs

10/9* Follow up; calorie count interpretation; hypoglycemic event / “Recommend continuous TF,” nocturnal if diet advances;↓ Lantus

10/12* Follow up / Respiratory MD note = ”nutrition is of concern;” recalculated needs utilizing refeeding syndrome precautions

10/13* Addendum / Care team aware of patient’s nutrition deficits; ICU daily rounding meeting: respiratory MD shared his concerns
Date Reason for Note / Assessments, Interventions, and Recommendations

9/16 Initial assessment / Follow up to define malnutrition; offer supplements; change MCC diet to HCC; consider general diet

9/19 Follow up; interview; Nutrition-Focused Physical Assessment; hypoglycemic event /


Severe malnutrition diagnosis; send supplements TID; multivitamin; encourage BM; consider appetite stimulant; ↓ Lantus
9/22 Follow up / Provide cafeteria menu; emphasize importance of adequate intakes; goal of intake >75% of larger food order

9/26 Follow up / Recommend diet advancement to general; increase supplement consumption- order in place when no longer NPO

9/28 Follow up / Provide cafeteria menu; share concern for pt’s safety with family and staff; TF discussion (PEG)  palliative care

10/2 Follow up; hypoglycemic event / Continued poor intakes; calorie count; nutrition support (NG or PEG) warranted at <50%
estimated nutrition needs; 60 g CHO per meal; HS snack; continuous dextrose source; ↓ Lantus; encourage ↑ intakes
10/4* Follow up; calorie count interpretation / Discussed dinner mishap with RN; pre-ordered dinner trays; Send two supplements TID

10/6* Follow up; calorie count interpretation / CC extension; talked with palliative care and speech therapy; monitor weight; TF recs

10/9* Follow up; calorie count interpretation; hypoglycemic event / “Recommend continuous TF,” nocturnal if diet advances;↓ Lantus

10/12* Follow up / Respiratory MD note = ”nutrition is of concern;” recalculated needs utilizing refeeding syndrome precautions

10/13* Addendum / Care team aware of patient’s nutrition deficits; ICU daily rounding meeting: respiratory MD shared his concerns
 Electrolyte fluctuation related to glucose influx
 Low potassium, phosphorus, magnesium
 Increased sodium and water retention

 Can occur in enterally fed patients, but not as common

 Typically occurs in acutely ill, malnourished population

 Cancer is a risk factor

 Future research: Refeeding syndrome occurrence in patients with diabetes?


Date Reason for Note / Assessments, Interventions, and Recommendations

9/16 Initial assessment / Follow up to define malnutrition; offer supplements; change MCC diet to HCC; consider general diet

9/19 Follow up; interview; Nutrition-Focused Physical Assessment; hypoglycemic event /


Severe malnutrition diagnosis; send supplements TID; multivitamin; encourage BM; consider appetite stimulant; ↓ Lantus
9/22 Follow up / Provide cafeteria menu; emphasize importance of adequate intakes; goal of intake >75% of larger food order

9/26 Follow up / Recommend diet advancement to general; increase supplement consumption- order in place when no longer NPO

9/28 Follow up / Provide cafeteria menu; share concern for pt’s safety with family and staff; TF discussion (PEG)  palliative care

10/2 Follow up; hypoglycemic event / Continued poor intakes; calorie count; nutrition support (NG or PEG) warranted at <50%
estimated nutrition needs; 60 g CHO per meal; HS snack; continuous dextrose source; ↓ Lantus; encourage ↑ intakes
10/4* Follow up; calorie count interpretation / Discussed dinner mishap with RN; pre-ordered dinner trays; Send two supplements TID

10/6* Follow up; calorie count interpretation / CC extension; talked with palliative care and speech therapy; monitor weight; TF recs

10/9* Follow up; calorie count interpretation; hypoglycemic event / “Recommend continuous TF,” nocturnal if diet advances;↓ Lantus

10/12* Follow up / Respiratory MD note = ”nutrition is of concern;” recalculated needs utilizing refeeding syndrome precautions

10/13* Addendum / Care team aware of patient’s nutrition deficits; ICU daily rounding meeting: respiratory MD shared his concerns
 Pulmonology
 ICU

 Respiratory

 Oncology

 Nursing

 Speech Therapy

 Palliative Care
 Palliate = to make less severe or pleasant without removing the cause

 Specially trained team focused on providing relief from:


 Symptoms
 Pain
 Stress

 Goal of comfort and best quality of life – for patients and families

 Help identify and respect goals related to patients’ care

 Provide answers, assistance, and emotional support

 Essential component to cancer care


 Palliative care team trained to delicately present nutrition support options
 The individual’s expressed desire for extent of medical care is primary guide for
determining the level of nutrition intervention.
 The decision to forgo nutrition should not be taken lightly, as such a decision may
result in nutrient deficits that are difficult or impossible to reverse.
 The expected benefits of nutrition support must be weighed against the potential
burdens by the health care team and discussed with the patient. The focus of care
should include the patient’s physical and psychological comfort. Look at the
specific facts concerning the patient’s medical and mental status:
 Will nutrition support improve the patient’s quality of life during the final stages?
 Will nutrition support improve the patient’s emotional comfort?
 Will nutrition support be a burden?
 In some cases, suboptimal oral feedings may be more appropriate than burdensome TF/PN.
 What would you do differently?
 Perfect world: Initiate tube feeding
 Note wounds more closely
 Seek a “big picture” perspective

 What challenges did you face?


 Unsure whether my place to speak with patient’s wife regarding nutrition support
 Dynamic between palliative care and wife
 Disciplines not on same page

 What did you learn and will apply in the future?


 Gained interdisciplinary experience
 Greater appreciation of the complexity
 Do what you can, no matter how small
Bachmann, P., Marti-Massoud, C., Blanc-Vincent, M. P., Desport, J. C., Colomb, V., Dieu, L., … Senesse, P.
(2003). Summary version of the standards, options, and recommendations for palliative or
terminal nutrition in adults with progressive cancer. British Journal of Cancer, 89, S107-110.

Bosman, T., Simonin, C., Launay, D., Caron, S., Destee, A., & Defebvre, L. (2008). Idiopathic hypertrophic
cranial pachymeningitis treated by oral methotrexate: a case report and review of literature.
Rheumatology International, 28(7), 713-718.
Diffuse large B-cell lymphoma. (n.d.). Retrieved from https://www.cancer.org/cancer/non-hodgkin-
lymphoma/treating/b-cell-lymphoma.html
Mahan, L. K., Escott-Stump, S., & Raymond, J. L. (2012). Krause’s food and the nutrition care process. (13th
ed.). St. Louis, MO: Elsevier Saunders
Marinella, M. A. (2008). Refeeding syndrome in cancer patients. International Journal of Clinical Practice, 62,
460-465.
Pachymeningitis. (n.d.). Retrieved from https://www.patientslikeme.com/conditions/1866-
pachymeningitis
Wang, A. S., Armstrong, E. J., & Armstrong, A. W. (2013). Corticosteroids and wound healing: Clinical
considerations in the perioperative world. American Journal of Surgery, 206(3), 410-417.
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