Chapter 19 Palliative Care: End of Life

BOX 19.5 cont. Dietary Therapy for Treating Common Symptoms in Palliative Care ●

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If the client is stuporous or comatose, counsel the family that semistarvation and dehydration are not painful to the client. Explore with them the possible pros (such as increased length of life) and possible cons (such as aspiration and need for suctioning) of hand-feeding and enteral and parenteral nutrition support if they request information.

Mouth Problems ●

If the client says that foods taste bitter, encourage poultry, fish, dairy products, eggs, milk, and cheese; bitter-tasting foods usually include red meat, sour juices, coffee, tea, tomatoes, and chocolate. Suggest cooking foods in glass or porcelain instead of in metal containers, and avoid serving foods on metal or with metallic utensils. Encourage sweet fruit drinks, carbonated beverages, flavored ice chips, and seasonings, herbs, and spices to enhance flavors. Hard candy, like peppermint or lemon, can help with bad tastes in the mouth.

● ● ● ● If the client says that foods taste “old,” try adding sugar; sour and salty tastes often taste “old.”

If the client says that foods taste too sweet, suggest drinking sour juices; cooking with lemon juice, vinegar, spices, herbs, and mint; and adding pickles to appropriate foods.

If the client says that foods have no taste, suggest marinating appropriate foods, serving highly seasoned foods, adding sugar, and eating foods at room temperature.

If the client has difficulty swallowing, suggest small, frequent meals of soft foods (pureed if needed), and advise against foods that might irritate the mouth and esophagus, such as acidic juices or fruits, spicy foods, very hot or cold foods, alcohol, and carbonated beverages. Avoid rough and dry foods. Consider referring to a speech language pathologist.

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If the client has mouth sores, suggest blenderized and cold foods. Gravies, cream soups, eggnog, milkshakes, cream pies, cheesecake, mousses, macaroni and cheese, souffles, and casseroles are well liked. Suggest that the client avoid alcohol, acidic fruit juices, and vegetable juices; spicy, rough, hot, and highly salted foods and carbonated beverages may need to be avoided. Antifungal preparations, if necessary, are available.

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If the client has a dry mouth, suggest frequent sips of water, defatted bouillon, juice, ice chips, flavored ice chips, ice cream, fruitades, or slushy frozen baby foods mixed with fruit juice. Sucking on hard sweets and chewing on sugar-free gum may stimulate saliva. Dry alcoholic beverages may also stimulate saliva produc- tion. Solid foods should be moist, pureed as needed, with sauces and gravies, and not too tart or too hot or cold if mouth sores are present. Synthetic salivary substitutes (some prefer citrus added while some prefer refrigerated) are often helpful. Caffeine drinks may need to be limited.

Nausea and Vomiting ●

● Encourage the client to avoid eating if nauseated or if nausea is anticipated.

Suggest small meals of cool, nonodorous foods, such as dry biscuits, cream crackers, soft toast, dry cereals, lean and white meats, milk, yogurt, pudding, and cheese. Suggest brewed cinnamon tea. Many clients find it helpful to avoid fatty, greasy, or fried foods; avoid mixing hot and cold foods at the same meal; avoid high-bulk meals; and avoid nausea-precipitating foods, such as overly sweet foods, alcohol, spicy foods, and tobacco with meals.

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Encourage the client to eat slowly and to avoid overeating. Relaxing before and after meals and avoiding physical activity and lying flat for two hours after eating may also help.

● Suggest that the client not prepare his or her own food.

Obstruction (Gastrointestinal) ●

If oral intake is not contraindicated, encourage the client to eat small meals that are low in fiber, low in residue, and blenderized or strained. Many clients will prefer to eat their favorite foods, enjoy large meals, and then vomit frequently. A gastric tube, open to straight or intermittent drain, may alleviate the need for regular vomiting.

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When the client constantly feels full, encourage small, frequent meals, and avoid nausea-producing foods, odorous foods, gas-producing foods, and high-fat or fried foods. Limit fluid with meals, taking fluids an hour before and after meals.

Note: Not all of the identified treatments may be appropriate for all diseases or conditions. Source: Adapted with permission from Gallagher-Allred CR. Nutritional Care of the Terminally Ill. Rockville, MD: Aspen Publishers; 1989:156-195, with permission of Aspen Publishers.