Often, whether due to the disease process, medications, treatments or the change in physical activity, a patient’s appetite may change. A patient may lose his or her appetite or the taste of foods may “change.” Problems with swallowing or nausea may arise and make eating difficult. Constipation and or diarrhea may also play a role in a patient’s loss of appetite. These symptoms are not uncommon in hospice patients, but there are some things which can be done to help. Please inform your hospice nurse if you have any of these problems so he or she can recommend treatment.
It is not at all uncommon for a patient’s need and desire for food to change. Never try to “force” a patient to eat. Instead, you may try to encourage a patient to eat smaller portions of food more often. Let the patient choose what he or she would like and when. Nutritional value can be increased in foods by adding prepared breakfast drinks or commercial supplements (such as Ensure) to a patient’s diet.
As with food, a patient’s need and desire for fluids will also change. This is a natural part of the body’s
process toward the end of life. Again, the patient’s needs and desires are the most important consideration.
It is still important to keep the patient’s mouth moist to keep him or her comfortable. You may try small sips
of fluids: water, soups, juices or other liquids. Sucking on ice chips, popsicles, or a moist washcloth will
sometimes help. Keep the patient’s lips moist with lip balm or Vaseline.
Occasionally, patients will have difficulty swallowing. Please notify your hospice nurse if this happens so he or she can make recommendations for the patient’s safety. Sitting as upright as possible usually makes swallowing easier. Sometimes, slightly thicker liquids such as milkshakes are easier to swallow. Most foods can be pureed. DO NOT crush medications before checking with your hospice nurse. Some medications must be taken whole to be effective. Many medications may be prescribed in liquid or suppository form for patients who have difficulty swallowing. The hospice nurse can consult with your doctor to make any necessary changes in your medications.
Should a patient experience constipation or diarrhea, your hospice nurse can make recommendations to eliminate or control.
Changes in nutrition, lessening of activity and fatigue which result in spending more time sitting or lying can cause discomfort with joints and muscles and skin problems. Patients are encouraged to continue with as much activity as they can tolerate. A patient should NOT feel pressured to do more than they are able. Sometimes just moving around, stretching, and changing positions will make one more comfortable. The hospice nurse and doctor can decide if physical therapy would be helpful to you.
For patients who have very limited ability to move or those who are bedfast, proper skin care is essential. Regular hygiene such as bathing and shampooing is important. Use of skin lotions and or balms may help dry or itching skin. Pressure points, the areas that have prolonged pressure when patients are unable to move such as shoulder blades, buttocks, heels, elbows and lower back, need to be checked regularly for irritation or redness. Keeping skin clean and dry will help avoid irritation. Repositioning the patient every few hours as tolerated will also help to relieve pressure points. Keep your hospice nurse notified of any changes in a patient’s skin so he or she can make recommendations for providing treatment and relief.