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You matter because you are you. You matter to last moment of
your life, and we will do all we can, not only to help you die
peacefully but to live until you die
Dame Cicely Saunders
Background
anticancer, qOL
IV : peripheral, central
SC : hypodermoclysis
Enteral
NGT
Gastrostomy
Rectal: Proctoclysis
Current Conditions
Literature review:
Most terminally ill cancer patients decrease or cessation
of oral intake
Risk of dehydration:
a. Decreased /cessation of oral intake:
b. Increased water losses
Is IV REDEHYDRATION NECESSARY?
Hunger, thirst, dry mouth could be eleviated with small amount
Evidence base in PC
NGT and PEG do not produce prolongation of life & tumor
response
N/GTs can cause abdominal distention & cramps, vomiting,
diarrhea, dyspnea and aspiration pneumonia.
IV: Hospitalization, Regular monitoring, Cost
Waller A et al, 1994: 1-2 l/day: more abnormal sodium, urea,
osmolarity
Fainsenger R et al, 94: hydration related to a better symptom
control
Bruera E et al, 2000: hydration results in decreased myoclonus
and sedation, but not hallucination
Edmenton PC Canada routine use of hydration to reduce
confussion and delirium, and accumulation of opioid metabolites
which induce myoclonus and confussion.
Dietary requirement
The simpler the advice the better
Explain to the family:
Do not force the patient to eat: discourage he must eat
or he will die
Balance diet is unnecessary, ristriction?
FOOD IS LOVE AND FEEDING HIM IS MY JOB
Eat small frequent meals, smaller plate, well served
What the patient want,
When the patient want,
Where the patient feel comfortable: dining room, dress
well
Anorexia
Activity, exercise
Food serving: tasty, visually appealing,
Dysphagia
Avoid large meals, carbonated drink, alcohol
Small meals, soft moist food, blendered food
Maximize calories: cream soup,
Dry mouth: drug evaluataion, ice chips, chewing gums,
artificial saliva
Liquid may more difficult to swallow
Small amount of food place towards the back of the mouth
small routine...close
lips...chew...pause...purposeful swallow..pause
TAKE TIME
After meals: drink small amount of water: rinse the
mouth and clear throat
SIT: remain sitting half an hour
Stomatitis
Avoid spicy, acid, sharp food and carbonated
drinks
Drink through a straw
HEART BURN
Wear loss garment
Elevate bed 10 cm
Abnormal taste
Tart food: pickles, vinegar, lemon juice
Add or reduce sugar
White meat, eggs, diary product
Bitter taste: more seasoning, room
Constipation
Bowel obstruction
Indication of TPN
Chronically obstructed patients
Life expectancy of over two months with malnutrition
Indications of SC infusion
Mild/moderate dehydration
Impaired IV access
Community care
Contraindication
Severe dehydration
Poor tissue perfussion
Infection /broken skin
Increased risk of pulmunary cangestion/oedema
Clotting disorder
Preexisting oedema
IV line +
do not over hydrate (balance?)
regular evaluation
If IV canule fails, consider not to replace
IV line - COMFORT
Sips
Ice chips
Regular mouth care
Artificial saliva
SC HYDRATION