Nutrition & Hydration/Persistent Vegetative State (PVS)

 

After studying the course materials located on

Module 7: Lecture Materials & Resources

page, answer the following:

1. Cure / care: compare and contrast.
2. Basic care: Nutrition, hydration, shelter, human interaction.

   Are we morally obliged to this? Why? Example

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3. Swallow test, describe; when is it indicated?
4. When is medically assisted N/H indicated?

   Briefly describe Enteral Nutrition (EN), including:

   NJ tube
   NG tube
   PEG

   Briefly describe Parenteral Nutrition (PN), including:

   a. Total parenteral nutrition
   b. Partial parenteral nutrition

5. Bioethical analysis of N/H; state the basic principle and briefly describe the two exceptions.
6. Case Study: Terry Schiavo (EXCEL FILE on Module 7: Lecture Materials & Resources page). Provide a bioethical analysis of her case; should we continue with the PEG or not? Why yes or why not?
7. Read and summarize ERD paragraphs #:  32, 33, 34, 56, 57, 58.

Submission Instructions:

• The paper is to be clear and concise and students will lose points for improper grammar, punctuation, and misspelling.
• The paper is to be no shorter than 1 page in length and no more than 2 pages in length. The student will automatically lose points if these limits are not followed.
• If references are used, please cite properly according to the current APA style (use of lecture materials encouraged). Refer to your syllabus for further detail or contact your instructor.

NUTRITION and HYDRATION

CURE / CARE

BASIC CARE:

• NUTRITION
• HYDRATION
• SHELTER
• HUMAN INTERACTION

SWALLOW TEST (THICKENED FLUIDS)

MEDICALLY ASSISTED N/H

ENTERAL NUTRITION (EN) (GI TRACT)

NUTRITION / HYDRATION (N/H)

PARENTERAL NUTRITION (PN) (LINE; PORT)

ENTERAL NUTRITION (TUBE FEEDING):

• NASO-GASTRIC TUBE (NG TUBE)
• NASO-JEJUNAL TUBE (NJ TUBE)
• PERCUTANEOUS ENDOSCOPIC GASTROSTOMY (

PEG

)

EXAMPLES
OF

ENTERAL
ACCESS

NPO = NOTHING PER ORAL (6-12 HRS)

PURPOSE:

• PREVENT ASPIRATION PNEUMONIA

• UNDERGO GENERAL ANESTHESIA

• WEAK SWALLOWING REFLEX

• GASTRO-INTESTINAL BLEEDING OR BLOCKAGE

PARENTERAL NUTRITION (INTRAVENOUS = IV):

• PARTIAL PARENTERAL NUTRITION (PPN)
• TOTAL PARENTERAL NUTRITION (TPN)

VASCULAR ACCESS
TO

PARENTERAL
NUTRITION

(VENOUS CIRCULATION)

TPN solutions :

• Concentrated
• can cause thrombosis of peripheral veins
• central venous catheter usually required

TPN not used routinely in patients with an intact GI tract

disadvantages:

• It causes more complications
• It does not preserve GI tract structure and function as well (PERISTALSIS)
• It is more expensive

Indications

TPN may be the only feasible option for patients who do not have a
functioning GI tract or who have disorders requiring complete bowel rest.

NUTRITION / HYDRATION

IN PRINCIPLE, ORDINARY CARE

MEDICALLY ASSISTED N/H

ENTERAL NUTRITION (EN) (GI TRACT)

NUTRITION / HYDRATION (N/H)

PARENTERAL NUTRITION (PN) (LINE; PORT)

PEG

ERD 56. A person has a moral
obligation to use ordinary or
proportionate means of preserving
his or her life. Proportionate means
are those that, in the judgment of
the patient, offer a reasonable
hope of benefit and do not entail
an excessive burden or impose
excessive expense on the family or
the community.

ERD 57. A person may forgo
extraordinary or disproportionate
means of preserving life.
Disproportionate means are those
that, in the patient’s judgment, do
not offer a reasonable hope of
benefit or entail an excessive
burden, or impose excessive
expense on the family or the
community.

ERD 58. There should be a
presumption in favor of providing
nutrition and hydration to all
patients, including patients who
require medically assisted nutrition
and hydration, as long as this is of
sufficient benefit to outweigh the
burdens involved to the patient.

N/H, IN PRINCIPLE, ARE ORDINARY MEANS OF LIFE SUPPORT

2 EXCEPTIONS:

• WHEN N/H CAN NO LONGER BE ABSORBED OR ASSIMILATED

• WHEN, IN THE ESTIMATION OF THE DYING PATIENT,

N/H BECOMES AN EXCESSIVE BURDEN

CASE STUDY: TERRY (SCHINDLER) SCHIAVO

(1963 – 2005; AGED 41)

TERRI SCHIAVO TIMELINE

“QUALITY OF LIFE” (SUBJECTIVE)

VS

“SANCTITY OF LIFE” (OBJECTIVE)

SACRED QUALITY OF HUMAN LIFE

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