Deck 24: Nutritional Care of the Terminally

Question 1

The intervention appropriate for a terminally ill client with dyspnea who requests dietary treatment is:

A) Encourage a high-fiber diet
B) Consider a high-fat, low-carbohydrate complete nutritional supplement
C) Recommend fresh fruits, whole grains, and vegetables
D) Encourage avoidance of caffeine

Answer 1

In a client with terminal illness, difficulty of breathing is a usual problem. Recommending intake of fatty foods and low-carbohydrate foods are considered. This kind of diet will facilitate the person's breathing by decreasing retention of carbon dioxide in the body.
Hence, the correct answer is b.
Encouraging a high-fiber diet to a dying client with dyspnea will promote good elimination of bowel but will not ease his/her difficulty in breathing.
Thus, option 'a' is incorrect.
Recommending fresh fruits, whole grains, and vegetables will prevent constipation; however, it is an inappropriate recommendation.
Therefore, answer 'c' is wrong.
Although, encouraging a caffeine-free diet will help decrease palpitations, still it is not the most needed dietary treatment by a patient with breathing difficulties.
So, choice 'd' is incorrect.

Question 2

Discuss the ethical and legal considerations for feeding a terminally ill client.

Answer 2

The ethical and legal considerations for feeding a terminally-ill client:
Feeding of terminally-ill clients involves acting legally in the persons' best interest. An example of a disheartening responsibility is when families or health professionals are faced with hard choices. Nutritional supplement via an intravenous catheter or tube feeding is a lifesaving treatment for clients who are unable eat orally. There are suitable guidelines for clinicians in introducing feedings through tubes. The question lies on whether to put severely-ill clients in a feeding tube. It is one of the hardest concerns in the management of clients with incurable illness.

Question 3

Mr. O is actively dying. 1.Mr. O's wife is concerned because her husband adamantly refuses all food and fluids. The nurse should:

A) Call the doctor and request an order for a tube feeding
B) Call the doctor and request an order for an intravenous feeding
C) Instruct the caregiver to be more creative in the type of food and fluids she gives the client
D) Counsel the caregiver that oral intake often ceases near the end of life

Answer 3

A nurse should counsel the client's significant other that the client's eating and drinking reduces critically when end-of-life is near.
Thus, option d is the correct answer.
It is unlikely to force foods or fluids on the client who is actively dying.
Thus, option 'a' is incorrect.
Intravenous feeding isn't a necessity for patients who are approaching end-of-life.
Thus, option 'b' is incorrect.
Appetite is lost during end-of-life stages. Creative cooking will not be beneficial.
Thus, option 'c' is incorrect.

Question 4

A diet prescription consistent with palliative care goals is:

A) Forty grams of protein for liver failure
B) Low-cholesterol, low-saturated-fat diet for hyperlipidemia
C) Gluten-free diet for diarrhea and celiac disease
D) High-calorie, high-protein diet for anorexia in an actively dying client

Question 5

The client's swallowing disorders are becoming more severe. 1.Ms. Z is capable of eating only very small bites of food very slowly. The client's daughter is her caregiver, and she states, "It has been taking me 2 hours to feed my mother each meal. If I go any faster, she chokes. My husband is becoming very resentful and has asked me to make a decision. He says I can't continue to spend all day with my mother and ignore him." What would you say to this caregiver?

Question 6

Differentiate between palliative and curative nutritional care.

Question 7

Mrs. P has terminal brain cancer and insulin dependent diabetes mellitus; her life expectancy is a few days. She and her caregiver have been selfmonitoring her blood glucose levels. The caregiver is quite concerned because 1.Mrs. P's blood glucose levels are running between 400 and 500 mg/dL. Historically, the client claims to have followed her 1200-kcalorie diet faithfully. Recently, her appetite is markedly reduced, and her blood glucose levels are elevated. The physician has been contacted and refuses to increase the client's insulin further but recommends to 1.Mrs. P's caregiver to stop monitoring the client's blood glucose levels. The nurse should:

A) Encourage the caregiver to offer 1.Mrs. P frequent sips of clear liquid fruit juices (about 30 grams of carbohydrate every 3 hours)
B) Encourage the caregiver to continue to offer the client the 1200-kcalorie diet to avoid a hypoglycemic episode
C) Recommend the caregiver look for a new doctor because obviously the doctor does not know how to treat clients with insulindependent diabetes
D) Contact the hospice medical director and ask for an order to increase the client's insulin

Question 8

An appropriate nutritional screening question for a client with a terminal illness is:

A) "How many times a day do you eat?"
B) "How much weight have you lost in the past month?"
C) "Do you look forward to meals?"
D) "Do you include a green or yellow vegetable in your diet each day?"

Question 9

The caregiver believes the client is still mentally alert and oriented, although the client cannot communicate. The client has progressed to the point where she has lost all motor function. She cannot talk or walk and has lost the use of her hands. The client's physician now believes 1.Ms. Z has an ileus (paralysis of the bowel). Why does this mean the client cannot be fed orally? What are the treatment options? Who needs to be informed of the treatment options?

Question 10

State appropriate nutritional screening questions for the terminally ill client.

Question 11

Mr. J has a partial bowel obstruction and shows signs of dehydration. He has an order for Metamucil® as needed (prn). The nurse should immediately recommend:

A) Eating high-fiber foods such as bran, whole grains, fruits, and vegetables
B) Discontinuing the use of Metamucil®
C) Increasing the dose of Metamucil®
D) Eating cheese, cakes, pies, cookies, and doughnuts

Question 12

The most important ethical principle to consider when a decision must be made about whether or not to feed a client is:

A) The client's right to self-determination
B) The principle of proportionality
C) The client's medical goals
D) The client's quality of life

Question 13

List at least two appropriate dietary management techniques for symptom control for each of the following: anemia, anorexia, bowel obstruction, cachexia, constipation, cough, dehydration, diarrhea, dysgeusia, esophageal reflux, fever, fluid accumulation, hiccups, incontinence, jaundice and hepatic encephalopathy, migraine headache, nausea and vomiting, pruritus, stomatitis, weakness, wounds and pressure sores, and xerostomia.

Question 14

Which recommendation would be appropriate for a client with end-stage congestive heart failure who requests dietary advice?

A) Recommend a low-potassium diet
B) Recommend a 1000 mL fluid restriction
C) Monitor the client's fluid intake and output
D) Recommend a 1- or 1.5-gram sodium diet

Question 15

State appropriate assessment questions for a terminally ill client.