Source 5 Things Practitioners Need to Know About Malnutrition
Table of Contents
Introduction
Having a loved one diagnosed with terminal Protein-Calorie Malnutrition (PCM) can be overwhelming and emotionally challenging. As an experienced hospice nurse with extensive experience, I’m here to help you understand what to expect during this challenging journey. This article aims to provide compassionate and informative guidance to families caring for a terminally ill individual with Protein-Calorie Malnutrition from the onset of the disease until the end of life.
What is Protein-Calorie Malnutrition?
Source 5 Things Practitioners Need to Know About Malnutrition
Protein-calorie malnutrition (PCM) is when the body does not receive enough protein and calories to maintain proper health and functioning. It is common among terminally ill patients due to numerous factors, such as reduced appetite, difficulty eating, and a weakened immune system. As the body loses its ability to absorb nutrients, the patient becomes more vulnerable to infections and other complications.
Protein-calorie malnutrition (PCM) can be an admitted terminal diagnosis for hospice, and, like many disease processes, it can stand by itself or be a part of a mixture of diseases as to why a loved one becomes extremely sick.
Recognizing the Symptoms
As the disease progresses, your loved one may experience various symptoms. Being aware of these changes will help you provide the best possible care and comfort:
Weight Loss: You may notice your loved one losing weight without trying. They may look thinner and weaker than before. Their clothes may become loose, and their bones may stick out. This is because their body uses its fat and muscle for energy.
Fatigue and Weakness: You may notice that your loved one is more tired and less active than before. They may have trouble doing things that they used to enjoy, such as playing, working, or studying. They may also have difficulty walking, standing, or lifting things. This is because their body does not have enough energy to function properly.
Changes in Appetite: You may notice your loved one eating less than before. They may not feel hungry, or they may feel full after eating a small amount. They may also have trouble swallowing, chewing, or tasting food. They may lose interest in food or have cravings for certain foods. This is because their body is not getting enough nutrients from their food.
Muscle Wasting: You may notice your loved one’s muscles getting smaller and weaker. They may have trouble moving their arms, legs, or other parts of their body. They may also have pain or cramps in their muscles. Their body is breaking down its muscle tissue for energy and protein.
Edema: You may notice your loved one’s legs, ankles, or feet are swollen and puffy. They may also have swelling in their face, hands, or abdomen. This is because their body is holding on to too much fluid. This can happen when their body does not have enough protein to keep the fluid in the blood vessels.
Mood Changes: You may notice your loved one is more irritable, sad, or depressed. They may have trouble sleeping, concentrating, or remembering things. They may also lose interest in things that they used to like or have mood swings. This is because their body is affected by the lack of nutrients and hormones that regulate their emotions.
Increased Susceptibility to Infections: You may notice that your loved one gets sick more often than before. They may have fever, cough, diarrhea, or other signs of infection. They may also take longer to heal from wounds, cuts, or bruises. This is because their immune system, which fights off germs, is weakened by the lack of protein and calories.
Caring for Your Loved One: Practical Tips
During this challenging time, your support and care can significantly improve your loved one’s quality of life. Here are some practical tips to provide the best possible care:
Nutrition and Hydration: Food and water are essential for your loved one’s health. They must eat and drink enough to get the needed protein and calories. You can help them by offering them small meals and snacks with a lot of nutrients, such as eggs, cheese, yogurt, nuts, peanut butter, or smoothies. You can also make the food softer or pureed if they have trouble swallowing or chewing. You can help them drink more water by giving them small sips throughout the day. You can also offer them other fluids they like, such as juice, milk, tea, or soup. Avoid giving them alcohol, caffeine, or sugary drinks, as they can make them dehydrated or lose their appetite. Please remember there’s a difference between encouraging someone to eat and drink and forcing them to eat and drink. Always respect any statement or body language indicating the patient is not hungry.
Comfort and Dignity: Your loved one may feel pain, discomfort, or distress because of their condition. You can help them by ensuring they are comfortable and can access pain medicine as needed. You can also help them by keeping them clean and dry, changing their clothes and bedding regularly, and helping them with their hygiene, such as brushing their teeth, washing their face, or combing their hair. You can also respect their dignity and preferences by asking them what they want or need and letting them make their own choices as much as possible. For example, you can ask them what they want to wear, what they want to eat, or how they want to spend their time.
Emotional Support: Your loved one may feel sad, scared, angry, or lonely because of their condition. You can help them by being there for them emotionally. You can offer them a listening ear and let them express their feelings without judging them. You can also provide them with reassurance and comfort by telling them that you love them, are proud of them, and are here for them. You can also hug them, hold their hand, or touch them gently. You can also help them cope by encouraging them to do things that make them happy, such as reading, watching TV, playing games, or talking to friends or family.
Assist with Mobility: Your loved one may have trouble moving around because of weakness or fatigue. You can help them by assisting them with their mobility, whether transferring from a bed to a chair, using a walker or wheelchair, or taking short walks if possible. You can also help them by ensuring their environment is safe and accessible, such as removing clutter, rugs, or cords that may cause them to trip or fall. You can also help them by providing devices or equipment to make their movement more accessible, such as a cane, a lift, or a rail.
Create a Calm Environment: Your loved one may feel more relaxed and peaceful if their environment is calm and comforting. You can help them by adjusting the lighting, temperature, and noise level to their liking. You can also help them by playing soothing music, reading, or praying with them if they wish. You can also help them by displaying meaningful or sentimental items like photos, cards, or gifts. You can also help them by keeping their room clean and organized and making sure they have everything they need within reach, such as a phone, a remote, or a glass of water.
Coordinate with the Hospice Team: Your loved one may benefit from the care and support of the hospice team, which includes the hospice nurse and other professionals, such as a doctor, a social worker, a chaplain, or a volunteer. You can help them by working closely with the hospice team and communicating with them regularly. You can also help them by following their instructions and recommendations and asking them questions or concerns. You can also help them by informing them about changes in your loved one’s condition, symptoms, or needs. You can also help them by accepting their help and support and caring for yourself.
Understanding End-of-Life Signs
As Protein-Calorie Malnutrition reaches its final stages, your loved one may exhibit certain end-of-life signs. These signs indicate that the body is gradually shutting down. Some common signs include:
Reduced Responsiveness: As your loved one approaches death, they may become less aware of their surroundings and less interested in talking or interacting with others. They may also sleep more, and it will be harder to wake up. This is because their brain is getting less blood and oxygen, and their body is shutting down. You can still talk to them, hold their hand, or play their favorite music, as they may still hear you and feel your presence.
Changes in Breathing: You may notice that your loved one’s breathing changes as they approach death. They may breathe faster or slower, deeper or shallower, or have pauses between breaths. They may also make noises when they breathe, such as gurgling, rattling, or wheezing. This is called the “death rattle,” when saliva or mucus builds up in the throat or chest. This is not painful or distressing for them, but it may be upsetting for you to hear. You can help them by raising their head, turning them on their side, or gently wiping their mouth with a moist cloth. You can also ask the hospice team for medications or devices that can make their breathing easier.
Cooling of Extremities: You may notice that your loved one’s hands and feet feel cold, even if the rest of their body is warm. Their skin may also look pale, bluish, or mottled (with purple or red patches). This is because their heart pumps less blood to their limbs and more to their vital organs, such as the brain, heart, and lungs. This is a normal part of the dying process, and it does not mean they are cold or uncomfortable. You can keep them warm with blankets, socks, or gloves, but do not use electric blankets or heating pads, as they may burn their skin.
Decreased Urine Output: You may notice that your loved one urinates less often or not at all as they near death. Their urine may also be darker or more concentrated. This is because their kidneys are also not working, and their body is trying to conserve water and energy. This is not harmful or painful for them but may increase the risk of infection or bladder problems. You can help them by keeping them clean and dry, regularly changing their diapers or pads, and applying cream or powder to prevent rashes or sores. You can also ask the hospice team for catheters or other devices that can drain their urine.
Changes in Skin Color: You may notice that your loved one’s skin color changes as they approach death. Their skin may look pale, gray, yellow, or ashen, depending on their ethnicity, health condition, and medication use. Their blood pressure drops, and blood flow decreases, causing less oxygen and nutrients to reach their skin. This is not a sign of pain or suffering, but it may indicate that death is near. You can still touch, massage, or apply lotion to their skin, as they may enjoy your touch and care.
Embracing the End-of-Life Journey
When someone you love is dying of Protein-Calorie Malnutrition, it can be extremely hard and sad. You may feel many emotions, such as anger, fear, guilt, or grief. You may also have questions about why, what will happen next, or how you can help. These are normal feelings and thoughts, and you are not alone.
One of the best things you can do for your loved one is to be there for them and support them. This means you show them you care and are with them until the end. You can do this by:
Surrounding them with love and compassion: You can show your love and compassion by spending time with them, talking to them, listening to them, or just being silent. You can also hug them, hold their hand, or touch them gently. You can also tell them you love, are proud of, and are thankful for them. You can also share memories, stories, or jokes that make them happy or laugh.
Honoring their wishes: You can honor their wishes by respecting their choices and decisions about their care and their death. You can also help them fulfill their goals or dreams, such as seeing a particular place, person, or thing or doing something they enjoy. You can also help them say goodbye to their friends and family or make peace with anyone they have problems with. You can also help them with spiritual or religious needs, such as praying, meditating, or reading sacred texts.
Ensuring a peaceful and meaningful transition: You can ensure a peaceful and meaningful transition by ensuring they are comfortable and pain-free. Adjusting the lighting, temperature, and noise can also make their environment calm and soothing. You can also play their favorite music, read, or sing to them if they wish. You can also display items that are important or sentimental to them, such as photos, cards, or gifts. You can also help them create a legacy, such as writing a letter, making a video, or donating to a cause.
By doing these things, you can help your loved one have a good death, which means that they die with dignity, comfort, and peace. You can also help yourself and your family cope with the loss and heal from the grief. Remember that you are not alone and can get help and support from the hospice team, other professionals, or support groups.
Conclusion
Protein-calorie malnutrition is a severe condition that affects many terminally ill patients. It can cause various physical and emotional symptoms that can reduce the quality of life of your loved one. As a family caregiver, you can provide the best possible care and comfort by being aware of these symptoms and following some practical tips. These include ensuring adequate nutrition and hydration, managing pain and discomfort, providing emotional support, and seeking professional help. Remember that you are not alone in this journey. Many resources and services are available to help you and your loved one cope with this challenging condition. By working with your loved one, your healthcare team, and other supportive people, you can make the most of the time you have left with your loved one.
