Case Study Of Palliative Care

Palliative care is about maintaining and improving quality of life for patients with terminal illness. Optimal nutrition is one essential component to maintaining quality of life, especially in early stages of illness. Malnourishment has been found to be the cause of death for many cancer patients (Prevost & Grach, 2012). In addition, according to research by Dahele and Fearon (as cited in Prevost & Grach, 2012), lower quality of life scores have been reported in extremely ill and malnourished patients.

Mrs. Francis is a 78-year old female with stage IIIB large cell, undifferentiated lung cancer. This paper presents the case of “Mrs. Francis” and focuses on nutrition symptom management. Mrs. Francis’s daughter, Linda, is concerned about her

Prevost and Grach (2012) recommended combining several validated nutritional assessments to gain the best understanding of the patient’s current nutritional state and the patient’s probable course of nutritional health. The Malnutrition Universal Screening Tool (MUST) (Holmes, 2010) and the Subjective Global Assessment (SGA) (Prevost & Grach, 2012) are two assessment tools used to determine those adults at risk for malnutrition. The Edmonton Symptom Assessment System (ESAS) is a recommended assessment tool specific to palliative care patients (Prevost & Grach, 2012). This tool assesses several symptoms at once, but all the symptoms assessed can potentially be affected by or contribute to the patient’s nutritional status (Prevost & Grach, 2012). The nutrition screening tools consider factors such as the patient’s current weight, body mass index, and lab values. Albumin, pre-albumin, and C-reactive protein values have been shown to be sensitive indicators for malnutrition and are incorporated into some screening tools (Prevost & Grach,

The patient may no longer be able to orally take in food, and the artificial means of feeding may worsen the patient’s quality of life. The concept of food cessation is often difficult for the patient’s friends and family to understand and accept, especially because food is essential to life, and eating is a sociocultural experience. Family must be reminded that to feed the patient may do more harm than good. However, until the time that oral intake stops, nurses must be providing other ways to increase the patient’s nutrient intake. The performance of symptom assessments and the development of plans of care should begin at the time of diagnosis and continue throughout the remainder of the patient’s life. These assessments and plans of care are both critical to preventing the onset of early malnutrition and to maintaining the patient’s quality of