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Part II Nutrition Assessment, Consequences, and Implications

BOX 19.7 Supportive Nutrition Care Program Goal

Allow family and caregivers to provide comfort to failing clients by providing emotional and social benefits of continued oral intake of foods and beverages of choice given ad lib, as tolerated.

Clients

Allow individuals with significant weight loss and persistent inadequate intake of fluids and nutrition, whose poor oral intake and weight loss represent the inevitable progression of the client’s condition, to make their own choices.

Characteristics ●

Base diet choice on client and family goals.

● Offer food and fluids at usual times and in the usual location, or at any time in any location. ● Monitor hunger and thirst. ● Provide mouth care. ● Stop obtaining weights.

● Offer family food and beverages.

Documentation ●

Multidisciplinary evaluation and team recommendation/decision ● Lack of standard curative intervention efficacy ● Discussion of options and family choice

●

Certain outcomes may be inevitable due to decline in client’s condition (eg, infection, pressure ulcer, dehydration, decline in independence)

● Elements of comfort care, including symptom control, emotional support, spiritual support ●

●

“Do not do” list (eg, do not resuscitate, hospitalize, give medications unrelated to symptoms, obtain labs, perform vital signs, treat infection)

“Will do” list (eg, will provide comfort, compassion, respect, and dignity; will be vigilant, treat fever, provide skin care, provide nutrition and hydration whenever possible; will control manageable symptoms with aids such as lip lubricants and ice chips to make mouth feel comfortable; will address shortness of breath and nausea with medications)

Role of the RDN ●

Listen carefully to the client and family. ● Clarify options.

● Provide pros and cons of a supportive nutrition care program versus curative nutrition support. ● Support the client-family choice.

● Encourage deliberative palliative care team decisions that are consistent with client and family wishes. ● Develop and ensure delivery of plan of care, as determined by client and caregivers. ● Record client outcomes.

● Periodically reevaluate client and family wishes, goals of therapy, actions, and outcomes.

Source: Adapted with permission from Smucker W. Palliative care in a nursing home: policies, procedures, and outcomes. Presented at the American Medical Directors Association 24th Annual Symposium, March 16, 2001, Atlanta Marriott Marquis Hotel, Atlanta, GA.