1 Nutrition and Hydration / Persistent Vegetative State (PVS)
Cure / care: compare and contrast. Cure refers to the restoration of one’s health after treatment. It is the permanent recovery from a disease or condition. On the other hand, care refers to the holistic process of delivering treatment with compassion, being mindful and looking after a patient. Cure leads quantifiable improvement on patient’s health while care improves the quality of treatment received.
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2 Basic care: Nutrition, hydration, shelter, human interaction. o
Are we morally obliged to this? Why? Example Every individual has the right to basic care. Therefore, we are morally obliged to provide basic care needs to everyone equally. Nutrition and hydration may be compromised in patients in vegetative states, requiring them to use artificial nutrition and hydration methods. The moral obligation to providing basic care is debatable based on religious and philosophical ways of thinking. In such cases, assisted nutrition and hydration can be justifiably withdrawn according to the patient wishes, if the care is futile and if the patient cannot assimilate what is provided.
Swallow test, describe; when is it indicated? A swallow test is used to assess for dysphagia. It is done by asking the patient to swallow substances of different consistencies as they assess how you chew, swallow and breathe. Barium can be ingested for fluoroscopic examination of the upper gastrointestinal track using x-rays. It is indicated in cases of dysphagia or increased risk of aspiration.
When is medically assisted N/H indicated? Assisted nutrition and hydration are indicated in cases where a patient has eating and swallowing problems due to an underlying medical condition. It is also used in patients whose nutritional needs cannot be met by the amount of food they can eat (Loofs & Haubrick, 2020). o
Briefly describe Enteral Nutrition (EN), including: Enteral nutrition involves the delivery of nutrients past the esophagus by use of feeding tubes or their oral intake in patients with functional gut but their nutrient
3 and energy needs cannot be met through normal food intake (Loofs & Haubrick, 2020).
NJ tube – NJ tube is inserted through the nose and passes through the stomach into the jejunum on the upper part of the small intestine. It can be used to deliver fluid, nutrients and / or medications.
NG tube – this is a tube inserted through the nose into the stomach or first portions of the small intestines, used to deliver fluid, nutrients and / or medications.
PEG – PEG tube is inserted through the skin and directly into the stomach to deliver fluid, nutrients and / or medications.
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Briefly describe Parenteral Nutrition (PN), including: Parenteral nutrition involves the intravenous administration of nutrients, completely bypassing the use of the gastrointestinal tract.
a. Total parenteral nutrition – in total parenteral nutrition, all the dietary needs of the patient are met by intravenous administration of nutrients.
b. Partial parenteral nutrition – partial parenteral nutrition uses intravenous administration of nutrients to supplement oral intake.
Bioethical analysis of N/H; state the basic principle and briefly describe the two exceptions. Bioethicists justify the use of assisted nutrition and hydration (ANH) based on the four basic principles of ethics. Its use must be of benefit to the patient, respect the patient’s wishes and decision regarding its use, have minimal risk on the patient and should be equally indicated for patients under similar circumstances without discrimination
4 (Marcolini, Putnam & Aydin, 2018). The issues arising with the withdrawal or withholding of ANH is assessed based on the benefits and burdens arising from its use and executed with the consent of the patient or their legal.
5 References Loofs, T. S., & Haubrick, K. (2020). End-of-Life Nutrition Considerations: Attitudes, Beliefs, and Outcomes. American Journal of Hospice and Palliative Medicine®, 1049909120960124. doi:10.1177/1049909120960124 Marcolini, E. G., Putnam, A. T., & Aydin, A. (2018). History and Perspectives on Nutrition and Hydration at the End of Life. The Yale journal of biology and medicine, 91(2), 173–176.