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Palliative care - fluid, food, and digestion

Constipation - palliative care; End of life - digestion; Hospice - digestion

Palliative care is a holistic approach to care that focuses on treating pain and symptoms and improving quality of life in people with serious illnesses.

When Your Body Has Problems Handling Fluids and Food

It is normal for a person who has a very serious illness or who is dying not to feel like eating. Body systems that manage fluids and food may change at this time. They can slow and fail. Also, medicine that treats pain can cause dry, hard stools that are difficult to pass.

You may experience any of the following:

  • Loss of appetite
  • Trouble chewing, caused by mouth or tooth pain, mouth sores, or a stiff or painful jaw
  • Constipation, which is fewer bowel movements than usual or hard stools
  • Nausea or vomiting

What You Can Do to Feel Better

Fluids:

  • Sip water at least every 2 hours while awake.
  • Fluids can be given by mouth, through a feeding tube, an IV (a tube that goes into a vein), or through a needle that goes under the skin (subcutaneous).
  • Keep your mouth moist with ice chips, a sponge, or oral swabs made for this purpose.
  • Talk to someone on your health care team about what happens if there is too much or too little fluid in the body. Decide together whether you need more fluids than you are taking in.

Food:

  • Cut food into small pieces and chew slowly.
  • Blend or mash foods so they don't need to be chewed much.
  • Eat food that is soft and smooth, like soup, yogurt, applesauce, or pudding.
  • Drink shakes or smoothies.
  • If you have nausea, try dry, salty foods and clear liquids.

Digestion:

  • Write down the times when you have bowel movements.
  • Sip water or juice at least every 2 hours while awake.
  • Eat fruit, especially prunes.
  • If possible, walk more.
  • When you try to have a bowel movement, sit on a toilet, commode, or bedpan.
  • Talk to someone on your health care team about stool softeners or laxatives.

When to Call the Doctor

Call a member of your health care team if you have nausea, constipation, or pain that cannot be managed.

References

Baracos VE. What therapeutic strategies are effective in improving anorexia and weight loss in nonmalignant disease? In: Goldstein NE, Morrison RS, eds. Evidence-Based Practice of Palliative Medicine. Philadelphia, PA: Elsevier; 2013:chap 29.

Levine SK, Shega JW. How should medications be initiated and titrated to prevent and treat nausea and vomiting in clinical situations unrelated to chemotherapy? In: Goldstein NE, Morrison RS, eds. Evidence-Based Practice of Palliative Medicine. Philadelphia, PA: Elsevier; 2013:chap 26.

Levine SK, Shega JW. What interventions are effective for relieving acute bowel obstruction in cancer and other conditions? In: Goldstein NE, Morrison RS, eds. Evidence-Based Practice of Palliative Medicine. Philadelphia, PA: Elsevier; 2013:chap 27.

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          Review Date: 2/2/2016

          Reviewed By: Laura J. Martin, MD, MPH, ABIM Board Certified in Internal Medicine and Hospice and Palliative Medicine, Atlanta, GA. Also reviewed by David Zieve, MD, MHA, Isla Ogilvie, PhD, and the A.D.A.M. Editorial team.

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