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To take just this course, test, and evaluation and get your certificate online, the cost is only $ 30.00!
| Hours |
Price |
p/Hour |
Discount |
| 10 |
$ 142 |
$ 14.20 |
5% off! |
| 15 |
$ 203 |
$ 13.53 |
10% off! |
| 20 |
$ 257 |
$ 12.85 |
14% off! |
| 25 |
$ 302 |
$ 12.08 |
19% off! |
| 30 |
$ 339 |
$ 11.30 |
25% off! |
| 35 |
$ 367 |
$ 10.49 |
30% off! |
| 40 |
$ 386 |
$ 9.65 |
36% off! |
| 45 |
$ 405 |
$ 9.00 |
40% off! |
Hours purchased are good for an unlimited time, but only within the discipline they were purchased in.
(If located in Ohio state taxes will be applied before purchase)
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No Commercial Support or Sponsorship is accepted by CEU4U, Inc.
Products, drugs, and/or therapies discussed within this educational offering do NOT imply endorsement by CEU4U, Inc. or American Nurses Credentialing Center.
No off label use of product(s) are discussed in this educational offering.
The author(s) and planning committee of this content declare that they have no real or perceived conflict of interest related to this presentation.
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Course Sample:
NYSNA is accredited as a provider of continuing nursing education by the American Nurses Credentialing Center's (ANCC) Commission on Accreditation.
All ANCC accredited organizations' contact hours are recognized by all other ANCC accredited organizations. Most states with mandatory continuing education requirements recognize the ANCC accreditation/approval system. Questions about the acceptance of ANCC contact hours to meet mandatory regulations should be directed to the Professional licensing board within that state.
Introduction
If you were to look back at your basic nursing education experience, chances are that you had few or no classes or clinical experiences in caring for the dying patient and their family. Yet, hardly a week goes by where you don't deal with issues related to death and dying on some level. Most nurses learned these skills from other nurses and from clinical experience itself. I have heard nurses say that they feel powerless to help people whom are at the end of their life.
This educational series will address issues of ethics, law, and practice related to care of the dying person and their family. This is the fourth module in the series and will explore the issues of food and fluids when providing competent nursing care at the end of life. Specific symptom management techniques, ethical issues, nurse-assisted death, and family issues will be covered in subsequent modules.
Food and Fluids at the End of Life
Historically, malnutrition and dehydration typically accompanied deaths from prolonged illness because sick and dying people could not consume adequate amounts of food or fluid. In the past, little could be done to prevent these conditions until the development of IV fluids, tube feedings, and TPN (total parenteral nutrition). Now, malnutrition and dehydration can be corrected in nearly every patient who would otherwise have died from the effects of these conditions (Andrews & Levine, 1989, p. 31). Nutritional support improves survival after acute renal failure, improves post-operative outcomes, protects from cancer therapy toxicity, and improves survival of cancer patients. There is no proof of benefit to the terminally ill patient.
About the Author
Marianne LaPorte Matzo Ph.D, RN, GNP, CS
Dr. Matzo is a Professor of Nursing at New Hampshire Community Technical College in Manchester, NH and a Soros Scholar for the Project on Death in America. She was awarded a Doctorate in Gerontology from the University of Massachusetts-Boston and a Masters degree in Nursing from the Gerontological Nurse Practitioner Program at the University of Massachusetts-Lowell. The former Gerontology Project Director in the Department of Nursing at Saint Anselm college, Manchester, NH, she was also employed for eight years in the Massachusetts State Department of Mental Health. Her work for the Project on Death in America has included undergraduate curriculum development on the care of the dying patient and their family, work as a Hospice nurse, continuing education programs related to death, dying and bereavement, as well as co-authoring the first Palliative Care Nursing Textbook. Her research has included nurse's practices of assisted suicide and is currently working on a quantitative study of health care provider' responses to the death of their patients. Dr. Matzo has presented educational programs both regionally and nationally on many topics related to Care of the Dying Person, Gerontological Nursing, and Curriculum Development. Her work has been published in Nurse Practitioner, Nurse Educator, Geriatric Nursing, Nursing Homes, Geriatric Psychiatry, The Journal of Gerontological Nursing and Gerontology and Geriatrics Education and the Geriatric Clinics of North America.
Definitions
Anorexia and cachexia are two conditions commonly found in advanced disease. Anorexia is defined as a loss of desire to eat or a loss of appetite associated with a decrease in food intake (Grant, 1986). Cachexia is a general lack of nutrition and wasting occurring in the course of a chronic disease. Weight loss is present in both conditions, but cachexia is also a result of metabolic abnormalities. Cachexia increases distress, impacts negatively on self-concept and body image, is associated with decreased survival, and serves as a constant reminder of the disease process and impending death.
Decreased appetite can occur very early in some diseases. In some institutions the leading referral to palliative care consulting teams is related to the issues regarding nutrition. The etiology of cachexia is rarely reversible in advanced disease. Unfortunately, aggressive nutritional treatment does not improve survival or quality of life and may actually create more discomfort for the patient. Artificial nutrition is a medical procedure requiring serious consideration as it can incur significant morbidity and financial cost.
There are multiple causes of anorexia/cachexia in terminally ill patients including:
Disease related causes such as:
- Oral or systemic infection, such as candidiasis, may cause discomfort when eating.
- Pain associated with eating can occur in certain disease states, such as pancreatitis.
- Treatment, medications, or disease progression can cause chronic nausea and vomiting.
- Medications, decreased fluid intake, and inactivity may cause constipation.
- Metabolic alterations may be due in a large part to systemic inflammatory response and the stimulation of cytokine production (Bistrian, 1999).
- Delayed gastric emptying and ulcers may decrease a person's desire to consume food.
- Diarrhea causes increased weakness and food intake may worsen the symptom.
- Malabsorption may be a result of medications or disease process.
- Bowel obstruction can be a result of tumor present in the bowel.
- Raised intracranial pressure can be a frequent cause of chronic nausea in terminal illness (Bruera & Fainsingard, 1993).
- People who are depressed exhibit many somatic symptoms, which includes anorexia (Roth & Breitbart, 1996).
Treatment related causes such as:
- Taste changes are often a result of treatments such as chemotherapy.
- Radiation therapy effects, including bowel strictures and fistulas, can be problematic for patients long after radiation has been completed.
Malnutrition is exhibited by:
- Loss of more than 5 pounds in a month or 10% weight loss in 6 months.
- Negative nitrogen balance
- Weakness
- Skeletal muscle wasting
Complications of malnutrition include:
- anemia
- edema
- poor wound healing
- increased infection rate
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