- palliative care client with end stage liver cancer, independent up until a month ago, now bed bound and coughing on fluids.
- Presented with reduced breath support, muscle weakness (globalised) affecting the cranial nerves, behaviours – very fast drinking, large sips – not responding to prompts to slow down. Having oral intake in a semi-lying down position due to preference + drinking from a beaker and tipping head back.
- Recommended syrup thick fluids from a cup, upright for oral intake, pillows behind head to prevent tilting head back.
- On review a week later – put on custard thick fluids due to signs of aspiration on syrup – syrup thick when drinking from a spoon.
- Patient had slured speech + reduced breath support – able to understand 1-2 stage commands and follow instructions.
What did this session make you feel?
- I felt that I was calm and able to improve the patient’s quality of life by reducing his distressing coughing on fluids. In retrospect I felt that I did not take enough professional responsibility for ensuring that the patient was able to make a decision in regard to his feeding if he deteriorated.
What would you want to change, and why?
- I would discuss oral feeding with the patient in my first session i.e. assess their capacity to understand information about feeding tubes and make a decision about artificial feeding if they deteriorated and were unable to eat orally.
- I would ask about medications – i.e. whether they could swallow their pain medication and contact their GP to discuss this and a decision on feeding.
- I would give the patient's family information on what foods are the least effortful to eat and how to downgrade the patient If they are having increasing difficulties with eating. I would plan for deterioration.
What do you need to learn or find out before
the next event?
- Cancer and dysphagia - further information.
- Read up on the procedures for recording end of life decisions and capacity assessments.
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