pediatric palliative care c c e e n n l l e e anorexia and cachexia anorexia – loss of appetite,...
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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
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Pediatric Palliative CareCCEENNLLEE
Causes of Anorexia and Cachexia
Pre-maturity
Disease related
Psychological
Treatment related
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Pediatric Palliative CareCCEENNLLEE
Assessment of Anorexia and Cachexia
Physical findings
Impact on function and QOL
Calorie counts/daily weights
Laboratory tests
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Pediatric Palliative CareCCEENNLLEE
Treatment of Anorexia and Cachexia
Dietary consult/intervention Medications Parenteral/enteral nutrition Education (as artificial nutrition
at EOL may increase suffering)
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Pediatric Palliative CareCCEENNLLEE
Time with Grandfather
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Pediatric Palliative CareCCEENNLLEE
Constipation
Infrequent passage of stool Frequent symptom in palliative
care Prevention is key Discussion may be difficult with
child/adolescent
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Pediatric Palliative CareCCEENNLLEE
Causes of Constipation
Disease related (e.g. obstruction, hypercalcemia, neurolgic, inactivity)
Treatment related (e.g. opioids, other meds)
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Pediatric Palliative CareCCEENNLLEE
Assessment of Constipation
Bowel history
Abdominal assessment
Rectal assessment
Medication review
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Pediatric Palliative CareCCEENNLLEE
Treatment of Constipation
Medications Dietary/fluids
Popsicles Clear sodas Jello
Other approaches
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Pediatric Palliative CareCCEENNLLEE
Assessment of Nausea and Vomiting
Clinical/physical exam
History
Lab values
BARF scale
Minimize suffering
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Pediatric Palliative CareCCEENNLLEE
Causes of Nausea and Vomiting
Overview/ definition Gastrointestinal
causes Metabolic causes CNS causes
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Pediatric Palliative CareCCEENNLLEE
Pharmacologic Treatment of Nausea and Vomiting
Anticholinergics
Antihistamines
Steroids
Prokinetic agents
Other Hellsten & Medellin, 2010; Karwacki, 2006; Santucci & Mack, 2007
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Pediatric Palliative CareCCEENNLLEE
Non-Drug Treatment of Nausea and Vomiting
Distraction
Dietary
Small/slow feeding
Invasive therapies
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Pediatric Palliative CareCCEENNLLEE
Oh, My Child