Download ppt - Pediatric Palliative Care C C E E N N L L E E Anorexia and Cachexia Anorexia – loss of appetite, usually with decreased intake Cachexia – lack of nutrition

Pediatric Palliative CareCCEENNLLEE

Anorexia and Cachexia Anorexia – loss of appetite, usually with

decreased intake Cachexia – lack of nutrition and wasting Offer favorite foods but educate families

about disease process Forcing intake orally or artificially may

cause additional suffering


Causes of Anorexia and Cachexia

Pre-maturity

Disease related

Psychological

Treatment related


Assessment of Anorexia and Cachexia

Physical findings

Impact on function and QOL

Calorie counts/daily weights

Laboratory tests


Treatment of Anorexia and Cachexia

Dietary consult/intervention Medications Parenteral/enteral nutrition Education (as artificial nutrition

at EOL may increase suffering)


Time with Grandfather


Constipation

Infrequent passage of stool Frequent symptom in palliative

care Prevention is key Discussion may be difficult with

child/adolescent


Causes of Constipation

Disease related (e.g. obstruction, hypercalcemia, neurolgic, inactivity)

Treatment related (e.g. opioids, other meds)


Assessment of Constipation

Bowel history

Abdominal assessment

Rectal assessment

Medication review


Treatment of Constipation

Medications Dietary/fluids

Popsicles Clear sodas Jello

Other approaches


Assessment of Nausea and Vomiting

Clinical/physical exam

History

Lab values

BARF scale

Minimize suffering


Causes of Nausea and Vomiting

Overview/ definition Gastrointestinal

causes Metabolic causes CNS causes


Pharmacologic Treatment of Nausea and Vomiting

Anticholinergics

Antihistamines

Steroids

Prokinetic agents

Other Hellsten & Medellin, 2010; Karwacki, 2006; Santucci & Mack, 2007


Non-Drug Treatment of Nausea and Vomiting

Distraction

Dietary

Small/slow feeding

Invasive therapies


Oh, My Child