3633 Module 7 Assignment

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NUTRITION and HYDRATION

CURE / CARE

BASIC CARE:

• NUTRITION • HYDRATION • SHELTER • HUMAN INTERACTION

SWALLOW TEST (THICKENED FLUIDS)

MEDICALLY ASSISTED N/H

ENTERAL NUTRITION (EN) (GI TRACT)

NUTRITION / HYDRATION (N/H)

PARENTERAL NUTRITION (PN) (LINE; PORT)

ENTERAL NUTRITION (TUBE FEEDING):

• NASO-GASTRIC TUBE (NG TUBE) • NASO-JEJUNAL TUBE (NJ TUBE) • PERCUTANEOUS ENDOSCOPIC GASTROSTOMY (PEG)

EXAMPLES OF

ENTERAL ACCESS

NPO = NOTHING PER ORAL (6-12 HRS)

PURPOSE:

• PREVENT ASPIRATION PNEUMONIA

• UNDERGO GENERAL ANESTHESIA

• WEAK SWALLOWING REFLEX

• GASTRO-INTESTINAL BLEEDING OR BLOCKAGE

PARENTERAL NUTRITION (INTRAVENOUS = IV):

• PARTIAL PARENTERAL NUTRITION (PPN) • TOTAL PARENTERAL NUTRITION (TPN)

VASCULAR ACCESS TO

PARENTERAL NUTRITION

(VENOUS CIRCULATION)

TPN solutions :

• Concentrated • can cause thrombosis of peripheral veins • central venous catheter usually required

TPN not used routinely in patients with an intact GI tract

disadvantages:

• It causes more complications • It does not preserve GI tract structure and function as well (PERISTALSIS) • It is more expensive

Indications

TPN may be the only feasible option for patients who do not have a functioning GI tract or who have disorders requiring complete bowel rest.

NUTRITION / HYDRATION

IN PRINCIPLE, ORDINARY CARE

MEDICALLY ASSISTED N/H

ENTERAL NUTRITION (EN) (GI TRACT)

NUTRITION / HYDRATION (N/H)

PARENTERAL NUTRITION (PN) (LINE; PORT)

PEG

ERD 56. A person has a moral obligation to use ordinary or proportionate means of preserving his or her life. Proportionate means are those that, in the judgment of the patient, offer a reasonable hope of benefit and do not entail an excessive burden or impose excessive expense on the family or the community.

ERD 57. A person may forgo extraordinary or disproportionate means of preserving life. Disproportionate means are those that, in the patient's judgment, do not offer a reasonable hope of benefit or entail an excessive burden, or impose excessive expense on the family or the community.

ERD 58. There should be a presumption in favor of providing nutrition and hydration to all patients, including patients who require medically assisted nutrition and hydration, as long as this is of sufficient benefit to outweigh the burdens involved to the patient.

N/H, IN PRINCIPLE, ARE ORDINARY MEANS OF LIFE SUPPORT

2 EXCEPTIONS:

• WHEN N/H CAN NO LONGER BE ABSORBED OR ASSIMILATED

• WHEN, IN THE ESTIMATION OF THE DYING PATIENT,

N/H BECOMES AN EXCESSIVE BURDEN

CASE STUDY: TERRY (SCHINDLER) SCHIAVO

(1963 – 2005; AGED 41)

TERRI SCHIAVO TIMELINE

“QUALITY OF LIFE” (SUBJECTIVE)

VS

“SANCTITY OF LIFE” (OBJECTIVE)

SACRED QUALITY OF HUMAN LIFE