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Part II Nutrition Assessment, Consequences, and Implications BOX 19.5 Dietary Therapy for Treating Common Symptoms in Palliative Care

Belching ●

Allow the client to make the final choice of foods to eat and avoid, but consider testing the client’s tolerance to gas-producing foods such as the following: beer, carbonated beverages, alcohol, dairy products if lactose intolerant, nuts, beans, onions, peas, corn, cucumbers, radishes, cabbage, broccoli, brussels sprouts, spinach, cauliflower, high-fat foods, yeast, and mushrooms.

● Encourage the client to eat solids at mealtimes and drink liquids between meals instead of with solid foods. ●

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Advise the client to avoid eating quickly and reclining immediately after eating; encourage the client to relax before, during, and after meals.

Advise the client to avoid overeating, sucking through straws, and chewing gum, and encourage the client to keep the mouth closed when chewing and swallowing.

Constipation ●

Encourage the client to eat foods high in fiber (bran; whole grains; fruits, especially pineapple, prunes, and raisins; vegetables; nuts; and legumes) if adequate fluid intake can be maintained. Avoid high-fiber foods if dehydration, severe constipation, or obstruction is anticipated.

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Increase fluid intake as tolerated; encourage fruit juices, prune juice, cider, and hot beverages. If liked by the client, the following recipe is effective and may reduce laxative use: 1 to 2 oz with the evening meal of a mixture of 2 c applesauce, 2 c unprocessed bran, and 1 c 100% prune juice).

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Discontinue calcium and iron supplementation if used; limit cheese, rich desserts, and other foods if constipating.

Diarrhea ●

Let the client make the final choice of foods to eat or to avoid, but suggest omission of the following foods if they cause diarrhea: milk, ice cream, whole-grain breads and cereals, nuts, beans, peas, greens, fruits with seeds and skins, fresh pineapple, raisins, cider, prune juice, raw vegetables, gas-forming vegetables, alcohol, caffeine-containing beverages, and foods containing sugar alcohols.

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Encourage the client to eat bananas, applesauce, peeled apple, tapioca, rice, peanut butter, refined grains, crackers, pasta, Cream of Wheat (B&G Foods, Inc), oatmeal, and cooked vegetables.

● Encourage the client to avoid liquids with a meal and instead to drink liquids an hour after a meal. ● Encourage the client to relax before, during, and after a meal.

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Enteral and/or parenteral nutrition support in the AIDS client may be appropriate if the client has a lengthy life expectancy and the cause of the diarrhea is known and treatable; if tube feedings or oral diet is appropriate, they should be high in energy and protein and low in fiber, lactose, and fat.

● If dehydration is a problem, encourage high-potassium foods.

Hypercalcemia ●

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Allow the hypercalcemic client to eat foods high in calcium, such as dairy products if desired, but encourage the client to avoid calcium and vitamin D supplementation; restriction of high-calcium foods is rarely helpful.

Encourage the client to drink lots of fluids, particularly carbonated beverages containing phosphoric acid if the client enjoys them.

Mental Disorders ●

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Encourage the client to avoid alcohol and caffeine-containing foods, such as coffee, tea, and chocolate, if they contribute to anxiety, sleep deprivation, or depression.

If the client is drowsy or apathetic, suggest that the family may need to assist the client with meal intake. Encourage them to prepare the client’s favorite foods, usually in soft form to be served with a spoon or bite- sized so the client may self-feed. Help the family protect the client and others from the client by shutting off or removing knobs from stoves, removing matches, and locking doors to cabinets or closets that contain poisons, alcohol, or medications. Put away electrical appliances, such as mixers, food processors, can openers, and waffle irons; unplug microwave ovens.

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If the client is agitated or confused, caution the family about the dangers of hand-feeding the client. Suggest assisting with a spoon and not allowing the client to handle feeding utensils, plates, glass, and so on. Encourage the family to tell the client what time of day it is, what meal is served, and what foods are served. Remind the client that the foods served are favorites. Make mealtimes enjoyable by reminiscing about pleasant events in the client’s life. Consider the pros and cons of waking the client if asleep at mealtimes.