22. Anorexia and Cachexia
Anorexia – loss of appetite, usually with decreased intake
Cachexia – lack of nutrition and wasting
Offer favorite foods but educate families about disease process
Forcing intake orally or artificially may cause additional suffering

23. Causes of Anorexia and Cachexia
Pre-maturity
Disease related
Psychological
Treatment related

24. Assessment of Anorexia and Cachexia
Physical findings
Impact on function and QOL
Calorie counts/daily weights
Laboratory tests

25. Treatment of Anorexia and Cachexia
Dietary consult/intervention
Medications
Parenteral/enteral nutrition
Education (as artificial nutrition at EOL may increase suffering)

26. Time with Grandfather

27. Constipation Infrequent passage of stool
Frequent symptom in palliative care
Prevention is key
Discussion may be difficult with child/adolescent

28. Causes of Constipation
Disease related (e.g. obstruction, hypercalcemia, neurolgic, inactivity)
Treatment related (e.g. opioids, other meds)

29. Assessment of Constipation
Bowel history
Abdominal assessment
Rectal assessment
Medication review

30. Treatment of Constipation
Medications
Dietary/fluids
Popsicles
Clear sodas
Jello
Other approaches

31. Assessment of Nausea and Vomiting
Clinical/physical exam
History
Lab values
BARF scale
Minimize suffering

32. Causes of Nausea and Vomiting
Overview/ definition
Gastrointestinal causes
Metabolic causes
CNS causes

33. Pharmacologic Treatment of Nausea and Vomiting
Anticholinergics
Antihistamines
Steroids
Prokinetic agents
Other
Hellsten & Medellin, 2010; Karwacki, 2006; Santucci & Mack, 2007

34. Non-Drug Treatment of Nausea and Vomiting
Distraction
Dietary
Small/slow feeding
Invasive therapies

35. Oh, My Child