Lambeth and Southwark Action on Malnutrition Project Resource pack

Transcription

1 Lambeth and Southwark Action on Malnutrition Project Resource pack This pack was designed by the Lambeth and Southwark Action on Malnutrition Project (LAMP) Community Nutrition and Dietetics Service. The leaflets in this pack provide advice and information for anyone who is struggling to eat and drink enough, or who is at risk of malnutrition. We would advise that the individual is supported to carry out the strategies and ideas outlined in this pack for one month. Following this, if the individual continues to struggle to meet their nutritional needs, they should be referred to the LAMP Community Nutrition and Dietetics Service. When completing a referral to the dietitians, please outline what strategies have been trialled and what difficulties the individual continues to have. You can refer to the LAMP Community Nutrition and Dietetics Service by calling the Malnutrition Advice Line on or by completing our referral form, which is available on request or via the Guys and St Thomas website. This resource pack uses information originally produced by South Essex Partnership University NHS Foundation Trust, adapted with their kind permission.

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3 100-calorie boosters The following examples are approximately 100 calories each. These boosters can be added to any appropriate meal to fortify it, or eaten as a snack to promote weight gain. Savoury options a small handful of grated cheese 1 tablespoon of mayonnaise 1 tablespoon of peanut butter 1 tablespoon of oil 2 cubes (around 14g) of butter 2 tablespoons of pesto 2 tablespoons of salad cream 2 tablespoons of hummus 2 heaped tablespoons of dried milk powder Sweet options 1 heaped tablespoon of sugar 1 small pot of full fat yoghurt 1.5 tablespoons of double cream 2 tablespoons of chocolate sauce 2 tablespoons of golden syrup 2 tablespoons of lemon curd 2 tablespoons of condensed milk 2 tablespoons of honey 2 scoops of ice cream Snacks and drinks a small handful of nuts a small handful of dried fruit 1 banana 1 shortbread finger 1 bag of crisps 1 slice of malt loaf 2 Jaffa Cakes 3 cream crackers 3 cubes of milk chocolate 5 jelly babies 150ml of full-fat milk 200ml of orange juice 250ml of regular cola Tip: Choose at least five booster examples to have each day to achieve the 500 extra calories required to help you gain weight

4 Contact us If you have any questions or concerns about these information sheets, please contact the Lambeth and Southwark Action on Malnutrition Project on (Monday to Friday, 9am to 5pm). For more information leaflets on conditions, procedures, treatments and services offered at our hospitals, please visit Pharmacy Medicines Helpline If you have any questions or concerns about your medicines, please speak to the staff caring for you or call our helpline. t: am to 5pm, Monday to Friday Patient Advice and Liaison Service (PALS) To make comments or raise concerns about the Trust s services, please contact PALS. Ask a member of staff to direct you to the PALS office or: t: at St Thomas t: at Guy s e: pals@gstt.nhs.uk Language Support Services If you need an interpreter or information about your care in a different language or format, please get in touch using the following contact details. t: fax: NHS 111 Offers medical help and advice from fully trained advisers supported by experienced nurses and paramedics. Available over the phone 24 hours a day. t: 111 NHS Choices Provides online information and guidance on all aspects of health and healthcare, to help you make choices about your health. w: Become a member of your local hospitals, and help shape our future Membership is free and it is completely up to you how much you get involved. To become a member of our Foundation Trust, you need to be 18 years of age or over, live in Lambeth, Southwark, Lewisham, Wandsworth or Westminster or have been a patient at either hospital in the last five years. To join: t: e: members@gstt.nhs.uk w: This leaflet uses information originally produced by South Essex Partnership University NHS Foundation Trust, adapted with their kind permission. Leaflet number: 4053/VER1 Date published: April 2015 Review date: April Guy s and St Thomas NHS Foundation Trust

5 Constipation Keeping hydrated and eating more fibre will help your bowels to function regularly. Make simple changes to your diet and lifestyle to improve or avoid constipation. Most cases of constipation resolve quickly. However, if you have persistent constipation you should visit your GP. Consider what may have triggered constipation. Not enough fibre in your diet, side-effects of medication and dehydration are common causes. Aim to drink at least litres (6-8 glasses) of fluid throughout the day to help keep your stools soft and easier to pass. Gradually increase your fibre intake to avoid stomach cramps, bloating and trapped wind. Choose wholegrain or granary bread, pasta and rice in place of white options. Opt for high-fibre cereals such as Weetabix, porridge or bran. Eat fruits and vegetables to increase your fibre intake. Sweetcorn, beans, lentils, prunes, dates or figs are particularly high in fibre. Choose high-fibre snacks such as dried fruit, nuts, seeds or oatcakes. See the Making every mouthful count resource for more information if you have lost weight or have a small appetite. Keep as mobile as possible because physical activity can help ease constipation. Never ignore the urge to go! Ensure you have enough time and privacy to pass stools comfortably. Laxatives may be advised by your pharmacist or GP. Dietary and lifestyle changes may take up to four weeks to take effect. Visit your GP for more support. Tip: See Keeping hydrated and Hydration boosters resources for more advice on how to improve your hydration status.

6 Contact us If you have any questions or concerns about these information sheets, please contact the Lambeth and Southwark Action on Malnutrition Project on (Monday to Friday, 9am to 5pm). For more information leaflets on conditions, procedures, treatments and services offered at our hospitals, please visit Pharmacy Medicines Helpline If you have any questions or concerns about your medicines, please speak to the staff caring for you or call our helpline. t: am to 5pm, Monday to Friday Patient Advice and Liaison Service (PALS) To make comments or raise concerns about the Trust s services, please contact PALS. Ask a member of staff to direct you to the PALS office or: t: at St Thomas t: at Guy s e: pals@gstt.nhs.uk Language Support Services If you need an interpreter or information about your care in a different language or format, please get in touch using the following contact details. t: fax: NHS 111 Offers medical help and advice from fully trained advisers supported by experienced nurses and paramedics. Available over the phone 24 hours a day. t: 111 NHS Choices Provides online information and guidance on all aspects of health and healthcare, to help you make choices about your health. w: Become a member of your local hospitals, and help shape our future Membership is free and it is completely up to you how much you get involved. To become a member of our Foundation Trust, you need to be 18 years of age or over, live in Lambeth, Southwark, Lewisham, Wandsworth or Westminster or have been a patient at either hospital in the last five years. To join: t: e: members@gstt.nhs.uk w: This leaflet uses information originally produced by South Essex Partnership University NHS Foundation Trust, adapted with their kind permission. Leaflet number: 4054/VER1 Date published: April 2015 Review date: April Guy s and St Thomas NHS Foundation Trust

7 Dairy-free super shakes Dairy-free super shakes all have approximately 500 calories in one 250ml serving, with no dairy ingredients. In addition to balanced meals, these may be useful for those who dislike milk, have dairy intolerance or require extra calories to gain weight. Virgin Piña Colada approx 520kcal Simply combine: 100ml tinned coconut milk 100ml pineapple juice 2.5 tablespoons apricot jam 2.5 tablespoons icing sugar 1 tablespoon golden syrup Serve with ice for authentic Caribbean flavours. Eton mess approx 520kcal Blend together: 2 meringue nests (approx 30g) 150ml soya milk 2.5 tablespoons strawberry milkshake powder 2.5 tablespoons strawberry jam 1.5 tablespoons icing sugar A taste of British summertime. Lemon and lime sublime approx 500kcal Whisk together: 100ml lemonade 100ml lime cordial 2.5 tablespoons lemon curd 2.5 tablespoons icing sugar 1 tablespoon golden syrup Pour through a strainer to serve. Tip: These recipes can be adapted or diluted to suit your flavour preferences.

8 Contact us If you have any questions or concerns about these information sheets, please contact the Lambeth and Southwark Action on Malnutrition Project on (Monday to Friday, 9am to 5pm). For more information leaflets on conditions, procedures, treatments and services offered at our hospitals, please visit Pharmacy Medicines Helpline If you have any questions or concerns about your medicines, please speak to the staff caring for you or call our helpline. t: am to 5pm, Monday to Friday Patient Advice and Liaison Service (PALS) To make comments or raise concerns about the Trust s services, please contact PALS. Ask a member of staff to direct you to the PALS office or: t: at St Thomas t: at Guy s e: pals@gstt.nhs.uk Language Support Services If you need an interpreter or information about your care in a different language or format, please get in touch using the following contact details. t: fax: NHS 111 Offers medical help and advice from fully trained advisers supported by experienced nurses and paramedics. Available over the phone 24 hours a day. t: 111 NHS Choices Provides online information and guidance on all aspects of health and healthcare, to help you make choices about your health. w: Become a member of your local hospitals, and help shape our future Membership is free and it is completely up to you how much you get involved. To become a member of our Foundation Trust, you need to be 18 years of age or over, live in Lambeth, Southwark, Lewisham, Wandsworth or Westminster or have been a patient at either hospital in the last five years. To join: t: e: members@gstt.nhs.uk w: This leaflet uses information originally produced by South Essex Partnership University NHS Foundation Trust, adapted with their kind permission. Leaflet number: 4055/VER1 Date published: April 2015 Review date: April Guy s and St Thomas NHS Foundation Trust

9 Diarrhoea Any illness can cause a lack of appetite, but try to make every mouthful count and choose nourishing foods and fluids to replenish your body when you have diarrhoea. Most cases of diarrhoea clear up within a few days. However, if you have persistent diarrhoea it is advisable to visit your GP. Consider what may have triggered diarrhoea. Infection, side effects of medication, too much alcohol and anxiety are common causes. It is important to try and replace the fluid you are losing. Aim to drink at least litres (6-8 glasses) of fluid per day. Taking small frequent sips of a drink may be more manageable than drinking a whole glass at once. Eat as soon as you can. Choose plain light meals avoiding fatty or spicy foods. Try eating little and often as smaller portions are often easier to manage. Take time to chew your food well and relax after meals. Choose fluid-rich foods such as soup, vegetables and potato, as water in food also contributes towards our fluid intake (see Hydration boosters resource for examples). Avoid foods high in fibre such as beans, bran cereal and nuts as these may worsen your diarrhoea. Cook fruits and vegetables rather than eating them raw as they will be easier to digest. Choose white bread, pasta and rice in place of wholegrain options. Probiotic products such as Yakult, Actimel or Activia may help shorten your bout of diarrhoea. Return to your normal diet once symptoms improve and reintroduce high-fibre foods gradually.

10 Contact us If you have any questions or concerns about these information sheets, please contact the Lambeth and Southwark Action on Malnutrition Project on (Monday to Friday, 9am to 5pm). For more information leaflets on conditions, procedures, treatments and services offered at our hospitals, please visit Pharmacy Medicines Helpline If you have any questions or concerns about your medicines, please speak to the staff caring for you or call our helpline. t: am to 5pm, Monday to Friday Patient Advice and Liaison Service (PALS) To make comments or raise concerns about the Trust s services, please contact PALS. Ask a member of staff to direct you to the PALS office or: t: at St Thomas t: at Guy s e: pals@gstt.nhs.uk Language Support Services If you need an interpreter or information about your care in a different language or format, please get in touch using the following contact details. t: fax: NHS 111 Offers medical help and advice from fully trained advisers supported by experienced nurses and paramedics. Available over the phone 24 hours a day. t: 111 NHS Choices Provides online information and guidance on all aspects of health and healthcare, to help you make choices about your health. w: Become a member of your local hospitals, and help shape our future Membership is free and it is completely up to you how much you get involved. To become a member of our Foundation Trust, you need to be 18 years of age or over, live in Lambeth, Southwark, Lewisham, Wandsworth or Westminster or have been a patient at either hospital in the last five years. To join: t: e: members@gstt.nhs.uk w: This leaflet uses information originally produced by South Essex Partnership University NHS Foundation Trust, adapted with their kind permission. Leaflet number: 4056/VER1 Date published: April 2015 Review date: April Guy s and St Thomas NHS Foundation Trust

11 Eat well to heal well Your food and fluid requirements will increase if you have a pressure ulcer or open wound. To encourage your skin to heal and to prevent further ulcer development, make every mouthful count and try to have a variety of nourishing foods and fluids. Nutrient-rich foods Vitamin C, zinc and protein are essential nutrients required to promote wound healing. Try to include some of the nutrient rich food examples below in your diet: Vitamin C Zinc Protein fruit juice meat meat oranges shellfish fish strawberries milk milk broccoli cheese eggs red and green peppers bread nuts and seeds potatoes baked beans pulses and lentils Choose full-fat and full-sugar* products rather than diet, low fat or healthy eating varieties, as these provide more calories. Have high-calorie snacks in between meals such as a yoghurt, peanuts or cheese and crackers (see 100-calorie boosters resource for more examples). Aim to drink at least litres of fluid per day to keep hydrated and improve healing (see keeping hydrated resource for more information). Drink nourishing fluids* such as fruit juice, smoothies, fortified milk or milkshakes (see Super shakes resource for recipe examples). Fortify your milk to add extra protein. Add 2-4 heaped tablespoons of dried milk powder to a pint of milk, mix well and then use like regular milk. *If you have diabetes, continue to choose sugar free drinks although you can have a moderate amount of sugar containing foods as part of a fortified diet. Speak to your GP, nurse or diabetes team for more information. Tip: Taking an over-the-counter multivitamin or mineral may be helpful if you find it difficult to have a varied diet

12 Contact us If you have any questions or concerns about these information sheets, please contact the Lambeth and Southwark Action on Malnutrition Project on (Monday to Friday, 9am to 5pm). For more information leaflets on conditions, procedures, treatments and services offered at our hospitals, please visit Pharmacy Medicines Helpline If you have any questions or concerns about your medicines, please speak to the staff caring for you or call our helpline. t: am to 5pm, Monday to Friday Patient Advice and Liaison Service (PALS) To make comments or raise concerns about the Trust s services, please contact PALS. Ask a member of staff to direct you to the PALS office or: t: at St Thomas t: at Guy s e: pals@gstt.nhs.uk Language Support Services If you need an interpreter or information about your care in a different language or format, please get in touch using the following contact details. t: fax: NHS 111 Offers medical help and advice from fully trained advisers supported by experienced nurses and paramedics. Available over the phone 24 hours a day. t: 111 NHS Choices Provides online information and guidance on all aspects of health and healthcare, to help you make choices about your health. w: Become a member of your local hospitals, and help shape our future Membership is free and it is completely up to you how much you get involved. To become a member of our Foundation Trust, you need to be 18 years of age or over, live in Lambeth, Southwark, Lewisham, Wandsworth or Westminster or have been a patient at either hospital in the last five years. To join: t: e: members@gstt.nhs.uk w: This leaflet uses information originally produced by South Essex Partnership University NHS Foundation Trust, adapted with their kind permission. Leaflet number: 4057/VER1 Date published: April 2015 Review date: April Guy s and St Thomas NHS Foundation Trust

13 Finger foods Finger foods can be enjoyed by everyone and are a great way to increase your independence at mealtimes. Think about size and shape. Foods too small will be hard to pick up but foods too big will be difficult to handle. Check the temperature. Make sure food is cool enough to hold and eat. Use moist fillings in bread to help hold sandwiches together. Try using butter, soft cheese or mayonnaise alongside other ingredients. Keep the skin on fruit to make them less slippery and easier to hold. A sprinkle of lemon juice will stop fruit turning brown as quickly. Try using a carrying bag or waist pouch so you can carry around your food and eat when you want to. Example finger foods toast cherry tomatoes cheese cubes sandwiches hardboiled egg slices celery sticks cereal bars chips / potato wedges cucumber chicken drumsticks pizza slices carrot batons sausages small potatoes banana meat balls cakes apple slices fish fingers biscuits grapes Tip: Try using handled mugs, plastic tumblers or a bottle to encourage your fluid intake as these may be lighter and easier for you to hold

14 Contact us If you have any questions or concerns about these information sheets, please contact the Lambeth and Southwark Action on Malnutrition Project on (Monday to Friday, 9am to 5pm). For more information leaflets on conditions, procedures, treatments and services offered at our hospitals, please visit Pharmacy Medicines Helpline If you have any questions or concerns about your medicines, please speak to the staff caring for you or call our helpline. t: am to 5pm, Monday to Friday Patient Advice and Liaison Service (PALS) To make comments or raise concerns about the Trust s services, please contact PALS. Ask a member of staff to direct you to the PALS office or: t: at St Thomas t: at Guy s e: pals@gstt.nhs.uk Language Support Services If you need an interpreter or information about your care in a different language or format, please get in touch using the following contact details. t: fax: NHS 111 Offers medical help and advice from fully trained advisers supported by experienced nurses and paramedics. Available over the phone 24 hours a day. t: 111 NHS Choices Provides online information and guidance on all aspects of health and healthcare, to help you make choices about your health. w: Become a member of your local hospitals, and help shape our future Membership is free and it is completely up to you how much you get involved. To become a member of our Foundation Trust, you need to be 18 years of age or over, live in Lambeth, Southwark, Lewisham, Wandsworth or Westminster or have been a patient at either hospital in the last five years. To join: t: e: members@gstt.nhs.uk w: This leaflet uses information originally produced by South Essex Partnership University NHS Foundation Trust, adapted with their kind permission. Leaflet number: 4058/VER1 Date published: April 2015 Review date: April Guy s and St Thomas NHS Foundation Trust

15 Fortified puree diet Pureed foods should be smooth, require no chewing and hold their shape; they should not be runny. A food processor and sieve will help you to prepare pureed foods. A puree diet should only be given after advice from a healthcare professional. Prescription thickeners may also be recommended to make your meals and drinks safe to swallow. Choose full-fat products rather than diet, low fat or healthy eating varieties as these provide more calories. Puree foods separately to maintain colour and taste. Add butter, cream cheese, mayonnaise or oil into savoury options such as mashed potato, eggs or vegetables. Add sugar, honey, cream, or dried milk powder into sweet options such as porridge, rice pudding or custard. Make meals in bulk and freeze individual portions to reduce preparation time. Food moulds, piping bags or a scoop will help to improve presentation. Use high-calorie liquids such as fortified milk, cream or rich gravy to thin food and boost calorie content. Try natural thickeners such as cornflour, wheatflour or instant potato to stiffen food and boost calorie content. Example fortified puree meal plan Breakfast: Pureed porridge with fortified milk and honey, and a glass of thickened orange juice. Mid-morning: A cup of thickened tea or coffee with fortified milk and pureed banana. Lunch: A rich pureed shepherd s pie with creamy mashed potato and pureed carrots, followed by pureed treacle sponge and custard made with fortified milk. Mid-afternoon: Pureed skinless sausages with sour cream dip and a nourishing fruit smoothie or milkshake. Dinner: Fortified pureed omelette followed by a thick and creamy yoghurt. Before bed: Chocolate mousse made with fortified milk, cream and sugar. Note: Ice cream and jelly are not suitable desserts for a puree diet as they melt into a thin liquid in your mouth.

16 Contact us If you have any questions or concerns about these information sheets, please contact the Lambeth and Southwark Action on Malnutrition Project on (Monday to Friday, 9am to 5pm). For more information leaflets on conditions, procedures, treatments and services offered at our hospitals, please visit Pharmacy Medicines Helpline If you have any questions or concerns about your medicines, please speak to the staff caring for you or call our helpline. t: am to 5pm, Monday to Friday Patient Advice and Liaison Service (PALS) To make comments or raise concerns about the Trust s services, please contact PALS. Ask a member of staff to direct you to the PALS office or: t: at St Thomas t: at Guy s e: pals@gstt.nhs.uk Language Support Services If you need an interpreter or information about your care in a different language or format, please get in touch using the following contact details. t: fax: NHS 111 Offers medical help and advice from fully trained advisers supported by experienced nurses and paramedics. Available over the phone 24 hours a day. t: 111 NHS Choices Provides online information and guidance on all aspects of health and healthcare, to help you make choices about your health. w: Become a member of your local hospitals, and help shape our future Membership is free and it is completely up to you how much you get involved. To become a member of our Foundation Trust, you need to be 18 years of age or over, live in Lambeth, Southwark, Lewisham, Wandsworth or Westminster or have been a patient at either hospital in the last five years. To join: t: e: members@gstt.nhs.uk w: This leaflet uses information originally produced by South Essex Partnership University NHS Foundation Trust, adapted with their kind permission.. Leaflet number: 4059/VER1 Date published: April 2015 Review date: April Guy s and St Thomas NHS Foundation Trust

17 Fortified soft diet Soft foods should be smooth, moist and chewed easily with no tough skins or shells. They can be broken into small lumps by your tongue, not your teeth, and are easily mashed with a fork, needing less chewing. You should only have a soft diet if this is your preference or if this has been advised by a healthcare professional. Cook foods for longer to make them a softer texture. Choose full-fat products rather than diet, low fat or healthy eating varieties as these provide more calories. Add butter, cheese, mayonnaise or oil into savoury options such as mashed potato, eggs or vegetables. Add sugar, honey, cream, or dried milk powder into sweet options such as porridge, rice pudding or custard. Allow time for cereals to soften and milk to be absorbed, or try serving with hot milk. Serve meals with extra sauce or accompaniments. Try a rich gravy, cheese or white sauce with your main meal and custard, cream or ice cream with your dessert. Try naturally soft foods such as casseroles, minced meat/vegetarian alternative or moist sponge cakes. Avoid dry and crumbly foods such as crisps, crackers and pastry. Example fortified soft meal plan Breakfast: Soaked Weetabix or porridge with fortified milk and honey, and a glass of orange juice. Mid-morning: A cup of tea or coffee with fortified milk and a banana or Jaffa Cakes. Lunch: A rich shepherd s pie with creamy mashed potato and soft boiled carrots, followed by treacle sponge and custard made with fortified milk. Mid-afternoon: Skinless sausages with sour cream dip and a nourishing fruit smoothie or milkshake. Dinner: Omelette made with fortified milk followed by a creamy fruit yoghurt dessert. Before bed: Hot chocolate made with fortified milk, cream and sugar. Tip: Ask your GP to refer you to a speech and language therapist (SLT) for more individualised advice.

18 Contact us If you have any questions or concerns about these information sheets, please contact the Lambeth and Southwark Action on Malnutrition Project on (Monday to Friday, 9am to 5pm). For more information leaflets on conditions, procedures, treatments and services offered at our hospitals, please visit Pharmacy Medicines Helpline If you have any questions or concerns about your medicines, please speak to the staff caring for you or call our helpline. t: am to 5pm, Monday to Friday Patient Advice and Liaison Service (PALS) To make comments or raise concerns about the Trust s services, please contact PALS. Ask a member of staff to direct you to the PALS office or: t: at St Thomas t: at Guy s e: pals@gstt.nhs.uk Language Support Services If you need an interpreter or information about your care in a different language or format, please get in touch using the following contact details. t: fax: NHS 111 Offers medical help and advice from fully trained advisers supported by experienced nurses and paramedics. Available over the phone 24 hours a day. t: 111 NHS Choices Provides online information and guidance on all aspects of health and healthcare, to help you make choices about your health. w: Become a member of your local hospitals, and help shape our future Membership is free and it is completely up to you how much you get involved. To become a member of our Foundation Trust, you need to be 18 years of age or over, live in Lambeth, Southwark, Lewisham, Wandsworth or Westminster or have been a patient at either hospital in the last five years. To join: t: e: members@gstt.nhs.uk w: This leaflet uses information originally produced by South Essex Partnership University NHS Foundation Trust, adapted with their kind permission. Leaflet number: 4060/VER1 Date published: April 2015 Review date: April Guy s and St Thomas NHS Foundation Trust

19 Hydration boosters You should aim to have at least litres (around 6-8 glasses) of fluid per day to stay hydrated. If you find it difficult to increase the amount you drink, try opting for foods high in moisture to maintain a good hydration status. Did you know? Around 20% of our daily fluid intake comes from our food. Sweet options 2 tablespoons of cream = 30ml Fromage frais (60g) = 50ml 2 pineapple rings = 70ml Ice lolly (70g) = 70ml Stewed apple (85g) = 75ml 2 scoops of ice cream = 75ml Small bowl of porridge (110g) = 80ml Custard (120g) = 90ml Yoghurt (125g) = 95ml Tinned fruit cocktail (115g) = 100ml Jelly (120g) = 100ml Instant whip (120g) = 120ml Serve cereal with milk = 125ml 1 slice of melon = 140ml Rice pudding (200g) = 160ml Savoury Options Houmous dip (50g) = 30ml 1 boiled egg = 40ml Serving of gravy = 50ml 1 chicken drumstick (90g) = 55ml 2 celery sticks = 55ml 2 tablespoons of cottage cheese = 60ml 2 tablespoons of mashed potato = 70ml 3 tablespoons of mushy peas = 70ml Cauliflower cheese (90g) = 70ml 4 florets of broccoli = 75ml 1 tomato (85g) = 80ml Scrambled eggs with milk (120g) = 80ml 3 tablespoons of baked beans = 90ml Side salad (100g) = 95ml Small tin of soup (300g) = 265ml Tip: Choosing fluid rich meals or serving foods with a sauce can help improve your fluid intake. See keeping hydrated resource for more hydration advice

20 Contact us If you have any questions or concerns about these information sheets, please contact the Lambeth and Southwark Action on Malnutrition Project on (Monday to Friday, 9am to 5pm). For more information leaflets on conditions, procedures, treatments and services offered at our hospitals, please visit Pharmacy Medicines Helpline If you have any questions or concerns about your medicines, please speak to the staff caring for you or call our helpline. t: am to 5pm, Monday to Friday Patient Advice and Liaison Service (PALS) To make comments or raise concerns about the Trust s services, please contact PALS. Ask a member of staff to direct you to the PALS office or: t: at St Thomas t: at Guy s e: pals@gstt.nhs.uk Language Support Services If you need an interpreter or information about your care in a different language or format, please get in touch using the following contact details. t: fax: NHS 111 Offers medical help and advice from fully trained advisers supported by experienced nurses and paramedics. Available over the phone 24 hours a day. t: 111 NHS Choices Provides online information and guidance on all aspects of health and healthcare, to help you make choices about your health. w: Become a member of your local hospitals, and help shape our future Membership is free and it is completely up to you how much you get involved. To become a member of our Foundation Trust, you need to be 18 years of age or over, live in Lambeth, Southwark, Lewisham, Wandsworth or Westminster or have been a patient at either hospital in the last five years. To join: t: e: members@gstt.nhs.uk w: This leaflet uses information originally produced by South Essex Partnership University NHS Foundation Trust, adapted with their kind permission. Leaflet number: 4061/VER1 Date published: April 2015 Review date: April Guy s and St Thomas NHS Foundation Trust

21 Increasing your calorie intake You may require more calories in your diet to help promote weight gain. Here are some easy ways to add calories throughout the day and make every mouthful count. Standard option Porridge with whole milk 380kcal / 15g protein Two scrambled eggs with whole milk 210Kcal / 16g protein Vegetable soup served with bread 190kcal / 9g protein Shepherd s pie 420kcal / 23g protein Madeira cake served with custard 270kcal / 6g protein Cup of tea 15kcal / 1g protein For extra calories add: 1 heaped tablespoon of dried milk powder 1.5 tablespoons of double cream a small handful of dried fruit to 630kcal / 21g protein 2 cubes of butter (15g) 1 heaped tablespoon of dried milk powder 2 tablespoons of cream cheese to 440kcal / 23g protein 1.5 tablespoons of double cream 1 heaped tablespoon of dried milk powder thick spread of butter on bread to 400kcal / 14g protein 2 cubes of butter (15g) 1.5 tablespoons of double cream 1 tablespoon of dried milk powder to 690kcal / 28g protein 1.5 tablespoons of double cream 1 heaped tablespoon of dried milk powder added to whole milk and custard to 410kcal / 9g protein 1 teaspoon of sugar 1 teaspoon of dried milk powder 1 shortbread biscuit to 155kcal / 3g protein Tip: Butter, cheese, double cream and dried milk powder are great for adding extra calories to almost any meal. See Making every mouthful count resource for more information about fortifying your diet.

22 Contact us If you have any questions or concerns about these information sheets, please contact the Lambeth and Southwark Action on Malnutrition Project on (Monday to Friday, 9am to 5pm). For more information leaflets on conditions, procedures, treatments and services offered at our hospitals, please visit Pharmacy Medicines Helpline If you have any questions or concerns about your medicines, please speak to the staff caring for you or call our helpline. t: am to 5pm, Monday to Friday Patient Advice and Liaison Service (PALS) To make comments or raise concerns about the Trust s services, please contact PALS. Ask a member of staff to direct you to the PALS office or: t: at St Thomas t: at Guy s e: pals@gstt.nhs.uk Language Support Services If you need an interpreter or information about your care in a different language or format, please get in touch using the following contact details. t: fax: NHS 111 Offers medical help and advice from fully trained advisers supported by experienced nurses and paramedics. Available over the phone 24 hours a day. t: 111 NHS Choices Provides online information and guidance on all aspects of health and healthcare, to help you make choices about your health. w: Become a member of your local hospitals, and help shape our future Membership is free and it is completely up to you how much you get involved. To become a member of our Foundation Trust, you need to be 18 years of age or over, live in Lambeth, Southwark, Lewisham, Wandsworth or Westminster or have been a patient at either hospital in the last five years. To join: t: e: members@gstt.nhs.uk w: This leaflet uses information originally produced by South Essex Partnership University NHS Foundation Trust, adapted with their kind permission. Leaflet number: 4062/VER1 Date published: April 2015 Review date: April Guy s and St Thomas NHS Foundation Trust

23 Keeping healthy on a high-calorie diet A fortified diet is higher in calories and is usually recommended on a short-term basis. You can still maintain a healthy balance while trying to gain or maintain your weight. The healthy heart tips ( ) indicate healthier choices you can make if you are concerned or have been advised to fortify your diet in the longer term. Carbohydrate Main source of energy and fibre. Examples: Bread, cereals, rice, potatoes, pasta, oats, grains etc. Choose wholegrain options, such as porridge, muesli or wholemeal bread to help keep your digestive system and heart healthy. Add margarine, cheese, mayonnaise or oil into savoury options such as mashed potato, lasagne or sandwiches. Add sugar, honey, cream or dried milk powder into sweet options such as semolina, rice pudding or cereal. Protein Supports growth and our body structure. Examples: Meat, fish, poultry, vegetarian alternatives, lentils, pulses, beans, eggs, nuts etc. Help to reduce cholesterol by choosing lentils, beans and pulses. Try high protein toppings on your toast such as sardines, scrambled egg or peanut butter. Add extra pieces of meat into soups, casseroles, stews or pies. Fruit and vegetables: Provide vitamins, minerals and fibre. Examples: Banana, berries, apple, carrot, peas, sweetcorn etc. Choose a rainbow of colours to get a range of antioxidants to help keep your arteries clear. Make nourishing smoothies or milkshakes using fresh, tinned or frozen fruits. Serve vegetables with a sauce or accompaniment such as a rich gravy, cheese sauce or honey.

24 Dairy: Supplies calcium needed to strengthen our bones. Examples: Milk, dried milk powder, yoghurt and cheese etc. Use dried milk powder to boost protein and calcium without any additional fat. Choose full-fat varieties as these are higher in calories. Fortify your milk by adding 2-4 tablespoons of dried milk powder to a pint of milk, mix well and then use like regular milk. Fats and sugars: Promote weight gain and provide insulation. Examples: Margarine, oil, pastries, cakes, biscuits and sweets etc. Oils found in fish are good for the heart. Try eating oily fish like salmon, herrings, sardines or trout once a week. Use vegetable/olive oil and spreads in place of animal fats, like butter or lard, to lower your saturated fat intake. Clean your teeth regularly using fluoride toothpaste to protect against tooth decay. Example of a balanced fortified meal plan Breakfast: Weetabix or porridge with fortified milk and honey, served with mixed berries or dried fruit and a glass of orange juice. Mid-morning: A cup of tea or coffee with fortified milk and a shortbread finger or a banana. Lunch: Shepherd s pie made with a rich gravy and creamy mashed potato, followed by apple crumble and custard made with fortified milk. Mid-afternoon: A nourishing fruit smoothie or milkshake and a slice of fruit malt loaf with margarine or a handful of nuts. Dinner: Scrambled eggs made with margarine and fortified milk or tinned sardines on toast with spread followed by a creamy fruit yoghurt dessert. Before bed: Hot chocolate or Horlicks made with fortified milk and sugar.

25 Contact us If you have any questions or concerns about these information sheets, please contact the Lambeth and Southwark Action on Malnutrition Project on (Monday to Friday, 9am to 5pm). For more information leaflets on conditions, procedures, treatments and services offered at our hospitals, please visit Pharmacy Medicines Helpline If you have any questions or concerns about your medicines, please speak to the staff caring for you or call our helpline. t: am to 5pm, Monday to Friday Patient Advice and Liaison Service (PALS) To make comments or raise concerns about the Trust s services, please contact PALS. Ask a member of staff to direct you to the PALS office or: t: at St Thomas t: at Guy s e: pals@gstt.nhs.uk Language Support Services If you need an interpreter or information about your care in a different language or format, please get in touch using the following contact details. t: fax: NHS 111 Offers medical help and advice from fully trained advisers supported by experienced nurses and paramedics. Available over the phone 24 hours a day. t: 111 NHS Choices Provides online information and guidance on all aspects of health and healthcare, to help you make choices about your health. w: Become a member of your local hospitals, and help shape our future Membership is free and it is completely up to you how much you get involved. To become a member of our Foundation Trust, you need to be 18 years of age or over, live in Lambeth, Southwark, Lewisham, Wandsworth or Westminster or have been a patient at either hospital in the last five years. To join: t: e: members@gstt.nhs.uk w: This leaflet uses information originally produced by South Essex Partnership University NHS Foundation Trust, adapted with their kind permission. Leaflet number: 4063/VER1 Date published: April 2015 Review date: April Guy s and St Thomas NHS Foundation Trust

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27 Keeping hydrated You should aim to have litres (around 6-8 glasses) of fluid per day to stay hydrated. Keeping hydrated can prevent or aid the treatment of constipation, low blood pressure, urinary tract infections (UTIs), pressure ulcers and falls. All fluids count, except for alcohol! Choose a drink that you are most likely to enjoy and finish. Do not wait until you feel thirsty to have a drink; thirst is a late response to dehydration. Use the pee chart (right) to score your hydration status as the colour of your urine can indicate dehydration risk. Serve drinks at their optimum temperature and replenish any drink that has been left to stand. Choose nourishing fruit or milk-based drinks if you are not eating well or need to gain weight (see the Super shakes resource for recipe examples). Opt for water, skimmed milk or sugar-free drinks if you have diabetes or are trying to lose weight. Replace fluid that is lost through sweat, open wounds, diarrhoea or vomit to prevent dehydration. You will sweat more in warm conditions and when you are more active. Limiting your fluid intake can make incontinence worse because it reduces your bladder s capacity. Increase your fluid intake earlier in the day if you worry about urinating at night. Fit your fluid intake around your daily routine and take a bottle with you on the go. Spout cups, handled mugs or plastic tumblers may be lighter and easier to handle. Healthy pee is you must hydrate! Tip: use a measuring jug to gauge the volume of your cups / glasses at home and complete the Self-reported fluid intake resource to record your daily fluid intake.

28 Contact us If you have any questions or concerns about these information sheets, please contact the Lambeth and Southwark Action on Malnutrition Project on (Monday to Friday, 9am to 5pm). For more information leaflets on conditions, procedures, treatments and services offered at our hospitals, please visit Pharmacy Medicines Helpline If you have any questions or concerns about your medicines, please speak to the staff caring for you or call our helpline. t: am to 5pm, Monday to Friday Patient Advice and Liaison Service (PALS) To make comments or raise concerns about the Trust s services, please contact PALS. Ask a member of staff to direct you to the PALS office or: t: at St Thomas t: at Guy s e: pals@gstt.nhs.uk Language Support Services If you need an interpreter or information about your care in a different language or format, please get in touch using the following contact details. t: fax: NHS 111 Offers medical help and advice from fully trained advisers supported by experienced nurses and paramedics. Available over the phone 24 hours a day. t: 111 NHS Choices Provides online information and guidance on all aspects of health and healthcare, to help you make choices about your health. w: Become a member of your local hospitals, and help shape our future Membership is free and it is completely up to you how much you get involved. To become a member of our Foundation Trust, you need to be 18 years of age or over, live in Lambeth, Southwark, Lewisham, Wandsworth or Westminster or have been a patient at either hospital in the last five years. To join: t: e: members@gstt.nhs.uk w: This leaflet uses information originally produced by South Essex Partnership University NHS Foundation Trust, adapted with their kind permission. Leaflet number: 4064/VER1 Date published: April 2015 Review date: April Guy s and St Thomas NHS Foundation Trust

29 Making every mouthful count Boost the nutritional content of your food without increasing the quantity or size of your meals. By fortifying your diet you can help prevent weight loss and encourage weight gain. Once your treatment goal has been met you can return to your normal diet. Did you know? An extra 500 calories per day can help you gain up to 0.5kg or 1lb a week Choose full-fat and full-sugar* products rather than diet, low fat or healthy eating varieties as these provide more calories. Try eating little and often as smaller portions and snacks are easier to manage. Add butter, cream, cheese, mayonnaise or oil into savoury options such as mashed potato, soups or scrambled eggs. Add sugar, honey, jam, cream or dried milk powder into sweet options such as porridge, rice pudding or custard. Serve meals with a sauce or accompaniment. Try a rich gravy, cheese or white sauce with your main meal and custard, cream or ice cream with your dessert. Drink nourishing fluids* such as fruit juice, smoothies, fortified milk or milkshakes (see the Nourishing drinks and Super shakes resources for recipe examples). Have high-calorie snacks in between meals such as peanuts, dried fruit or biscuits (see the 100-calorie boosters resource for more examples). *If you have diabetes, continue to choose-sugar free drinks although you can have a moderate amount of sugar containing foods as part of a fortified diet. Speak to your GP, nurse or diabetes team for more information. Fortify your milk: add 2-4 heaped tablespoons of dried milk powder to a pint of milk, and stir until dissolved. Once made keep refrigerated and use like regular milk on your cereal, in tea or coffee or as a drink on its own.

30 Contact us If you have any questions or concerns about these information sheets, please contact the Lambeth and Southwark Action on Malnutrition Project on (Monday to Friday, 9am to 5pm). For more information leaflets on conditions, procedures, treatments and services offered at our hospitals, please visit Pharmacy Medicines Helpline If you have any questions or concerns about your medicines, please speak to the staff caring for you or call our helpline. t: am to 5pm, Monday to Friday Patient Advice and Liaison Service (PALS) To make comments or raise concerns about the Trust s services, please contact PALS. Ask a member of staff to direct you to the PALS office or: t: at St Thomas t: at Guy s e: pals@gstt.nhs.uk Language Support Services If you need an interpreter or information about your care in a different language or format, please get in touch using the following contact details. t: fax: NHS 111 Offers medical help and advice from fully trained advisers supported by experienced nurses and paramedics. Available over the phone 24 hours a day. t: 111 NHS Choices Provides online information and guidance on all aspects of health and healthcare, to help you make choices about your health. w: Become a member of your local hospitals, and help shape our future Membership is free and it is completely up to you how much you get involved. To become a member of our Foundation Trust, you need to be 18 years of age or over, live in Lambeth, Southwark, Lewisham, Wandsworth or Westminster or have been a patient at either hospital in the last five years. To join: t: e: members@gstt.nhs.uk w: This leaflet uses information originally produced by South Essex Partnership University NHS Foundation Trust, adapted with their kind permission. Leaflet number: 4065/VER1 Date published: April 2015 Review date: April Guy s and St Thomas NHS Foundation Trust

31 Making mealtimes manageable Our eating habits change as we go through life. We may start to like different foods, enjoy unusual combinations or lose interest in eating. Small fluctuations in weight are perfectly normal, but to avoid noticeable weight change look at the following suggestions to help improve your intake. Keep snacks nearby and store foods that are easy to prepare so you can make the most of times when you feel hungry. Try eating little and often as smaller portions and snacks are easier to manage. Adapted cutlery and crockery may be easier to use, or prepare meals that you can eat with your hands (see the Finger foods resource). Make meals look colourful so they are more appealing and appetising. Give yourself time to eat in a calm, peaceful and well-lit environment. Eating with others can also make mealtimes more pleasurable. Remove any distractions and keep your table free of clutter so that you can concentrate on your food. Turn off the television at mealtimes as it can be distracting. Background music may be more relaxing. Season food generously to add flavour. Use pepper, lemon juice, herbs or spices rather than salt. Try adding sugar to savoury foods like baked beans, scrambled egg or gravy to increase taste. Cook sweeter vegetables such as carrots, parsnips or swede and serve chutneys and pickles with main dishes to add sweetness. Keep meals warm on an insulated plate or put aside food in the oven or microwave and serve later. Tip: Contact your local occupational therapy department or disability resource centre for more information about available equipment to help you eat and drink more independently.

32 Contact us If you have any questions or concerns about these information sheets, please contact the Lambeth and Southwark Action on Malnutrition Project on (Monday to Friday, 9am to 5pm). For more information leaflets on conditions, procedures, treatments and services offered at our hospitals, please visit Pharmacy Medicines Helpline If you have any questions or concerns about your medicines, please speak to the staff caring for you or call our helpline. t: am to 5pm, Monday to Friday Patient Advice and Liaison Service (PALS) To make comments or raise concerns about the Trust s services, please contact PALS. Ask a member of staff to direct you to the PALS office or: t: at St Thomas t: at Guy s e: pals@gstt.nhs.uk Language Support Services If you need an interpreter or information about your care in a different language or format, please get in touch using the following contact details. t: fax: NHS 111 Offers medical help and advice from fully trained advisers supported by experienced nurses and paramedics. Available over the phone 24 hours a day. t: 111 NHS Choices Provides online information and guidance on all aspects of health and healthcare, to help you make choices about your health. w: Become a member of your local hospitals, and help shape our future Membership is free and it is completely up to you how much you get involved. To become a member of our Foundation Trust, you need to be 18 years of age or over, live in Lambeth, Southwark, Lewisham, Wandsworth or Westminster or have been a patient at either hospital in the last five years. To join: t: e: members@gstt.nhs.uk w: This leaflet uses information originally produced by South Essex Partnership University NHS Foundation Trust, adapted with their kind permission. Leaflet number: 4066/VER1 Date published: April 2015 Review date: April Guy s and St Thomas NHS Foundation Trust

33 Mouth problems Your mouth can become sore if you have dentures that don t fit properly, mouth ulcers, infection or a dry mouth as a side-effect of medication. Mouth problems can make eating and drinking unpleasant, but it is important that you continue to eat and drink as well as you can. Choose soft foods as these require less chewing (see the Fortified soft diet resource for examples). Serve meals with a sauce such as gravy, cream or custard to keep food moist. Try soaking dry foods to make them easier to eat; for example cereal with warm milk, dipping bread into soup or dunking biscuits into your cup of tea. Allow foods and drinks to cool down and take small mouthfuls at a time. Use a straw in your drinks throughout the day. Stimulate saliva flow by sucking ice cubes, boiled sweets or chewing gum. Choose cool, smooth foods to refresh and soothe your mouth such as yoghurts, ice cream or mousses. Avoid salty, spicy or sharp foods, which may sting your mouth. Refrain from drinking alcohol or smoking as these irritate your mouth and throat. Apply lip balm to relieve chapped dry lips. Dental care It is important to maintain your oral hygiene and visit your dentist regularly, as having a sore or dry mouth can make you more prone to tooth decay. Leave dentures to soak in a denture-cleaning solution overnight and brush to remove all debris. Help prevent chafing and remove your dentures when you can. Your dentures may not fit properly if you have lost weight. Visit your dentist to get them refitted. Tip: Speak with your dentist, GP or pharmacist for more specialised advice

34 Contact us If you have any questions or concerns about these information sheets, please contact the Lambeth and Southwark Action on Malnutrition Project on (Monday to Friday, 9am to 5pm). For more information leaflets on conditions, procedures, treatments and services offered at our hospitals, please visit Pharmacy Medicines Helpline If you have any questions or concerns about your medicines, please speak to the staff caring for you or call our helpline. t: am to 5pm, Monday to Friday Patient Advice and Liaison Service (PALS) To make comments or raise concerns about the Trust s services, please contact PALS. Ask a member of staff to direct you to the PALS office or: t: at St Thomas t: at Guy s e: pals@gstt.nhs.uk Language Support Services If you need an interpreter or information about your care in a different language or format, please get in touch using the following contact details. t: fax: NHS 111 Offers medical help and advice from fully trained advisers supported by experienced nurses and paramedics. Available over the phone 24 hours a day. t: 111 NHS Choices Provides online information and guidance on all aspects of health and healthcare, to help you make choices about your health. w: Become a member of your local hospitals, and help shape our future Membership is free and it is completely up to you how much you get involved. To become a member of our Foundation Trust, you need to be 18 years of age or over, live in Lambeth, Southwark, Lewisham, Wandsworth or Westminster or have been a patient at either hospital in the last five years. To join: t: e: members@gstt.nhs.uk w: This leaflet uses information originally produced by South Essex Partnership University NHS Foundation Trust, adapted with their kind permission. Leaflet number: 4067/VER1 Date published: April 2015 Review date: April Guy s and St Thomas NHS Foundation Trust

35 Nourishing drinks You may find it easier to boost your nutritional intake by having nourishing drinks throughout the day, rather than eating more at mealtimes. Try some of our suggestions below, or see the Super shakes resource for more recipe ideas. If you have diabetes, speak to your GP, nurse or diabetes team before starting nourishing drinks. Tip: aim to drink two nourishing drinks per day to help prevent weight loss and encourage weight gain Have nourishing drinks in between your meals, not in place of them. Choose full-fat and full-sugar products rather than diet, sugar free or skimmed varieties as these provide more calories. Use milk, dairy-free milk alternative or fruit juice as base ingredients in your drinks, rather than water. Make fortified milk to boost protein and calorie content. Add 2-4 tablespoons of dried milk powder to a pint of milk, stir until dissolved and use like regular milk. Marvel, Nido or supermarkets own brands are available. Try fruit smoothies to help improve your vitamin and mineral intake. Relax with a warm milky drink such as Horlicks, Ovaltine or cocoa before bed. Simple milkshake: 200ml fortified milk, 1 scoop of ice cream or 1 small yoghurt, fresh fruit or flavoured milkshake powder = approximately 300kcal and 10g protein Fruit smoothie: 150ml orange juice, 1 banana, 2 teaspoons of honey, 4 tablespoons of tinned peaches (in syrup) = approximately 265kcal and 2g protein Iced coffee: 200ml fortified milk, 2 teaspoons of instant coffee, 2 tablespoons of sugar = approximately 330kcal and 11g protein Chocolate dream: 200ml fortified milk (warm), 1 tablespoon of drinking chocolate, sugar to taste = approximately 230kcal and 17g protein

36 Contact us If you have any questions or concerns about these information sheets, please contact the Lambeth and Southwark Action on Malnutrition Project on (Monday to Friday, 9am to 5pm). For more information leaflets on conditions, procedures, treatments and services offered at our hospitals, please visit Pharmacy Medicines Helpline If you have any questions or concerns about your medicines, please speak to the staff caring for you or call our helpline. t: am to 5pm, Monday to Friday Patient Advice and Liaison Service (PALS) To make comments or raise concerns about the Trust s services, please contact PALS. Ask a member of staff to direct you to the PALS office or: t: at St Thomas t: at Guy s e: pals@gstt.nhs.uk Language Support Services If you need an interpreter or information about your care in a different language or format, please get in touch using the following contact details. t: fax: NHS 111 Offers medical help and advice from fully trained advisers supported by experienced nurses and paramedics. Available over the phone 24 hours a day. t: 111 NHS Choices Provides online information and guidance on all aspects of health and healthcare, to help you make choices about your health. w: Become a member of your local hospitals, and help shape our future Membership is free and it is completely up to you how much you get involved. To become a member of our Foundation Trust, you need to be 18 years of age or over, live in Lambeth, Southwark, Lewisham, Wandsworth or Westminster or have been a patient at either hospital in the last five years. To join: t: e: members@gstt.nhs.uk w: This leaflet uses information originally produced by South Essex Partnership University NHS Foundation Trust, adapted with their kind permission. Leaflet number: 4068/VER1 Date published: April 2015 Review date: April Guy s and St Thomas NHS Foundation Trust

37 Providing assistance at mealtimes Help others to maintain their dignity and independence at mealtimes and make their eating experience more positive. Use picture menus to help someone decide what meal they would like. Allow more time for slower eaters. Serve their meals first, or have more than one sitting at each mealtime. Try eating with others to make mealtimes more sociable and lead by example. Setting the table, wiping down surfaces or calling others to the dining room are tasks that can help include everybody during the meal preparation. Cut up food into smaller pieces before taking the meal to the table. Adapted cutlery and crockery may be easier to use. Load food on to a fork or spoon and place it in the hand of the person you are helping. Guide cutlery to their mouth or verbally prompt them to place food in their mouth. Prepare meals that you can eat with your hands (see the Finger foods resource for more information). Sit down and maintain eye contact when assisting with feeding. Serve one course at a time so other foods do not spoil, and keep meals warm on an insulated plate. Use a wipe-clean tablecloth and protect clothing using napkins on the lap or tucked into the collar. Miss out troublesome mealtimes and make the most of the time when someone will eat well.

38 Contact us If you have any questions or concerns about these information sheets, please contact the Lambeth and Southwark Action on Malnutrition Project on (Monday to Friday, 9am to 5pm). For more information leaflets on conditions, procedures, treatments and services offered at our hospitals, please visit Pharmacy Medicines Helpline If you have any questions or concerns about your medicines, please speak to the staff caring for you or call our helpline. t: am to 5pm, Monday to Friday Patient Advice and Liaison Service (PALS) To make comments or raise concerns about the Trust s services, please contact PALS. Ask a member of staff to direct you to the PALS office or: t: at St Thomas t: at Guy s e: pals@gstt.nhs.uk Language Support Services If you need an interpreter or information about your care in a different language or format, please get in touch using the following contact details. t: fax: NHS 111 Offers medical help and advice from fully trained advisers supported by experienced nurses and paramedics. Available over the phone 24 hours a day. t: 111 NHS Choices Provides online information and guidance on all aspects of health and healthcare, to help you make choices about your health. w: Become a member of your local hospitals, and help shape our future Membership is free and it is completely up to you how much you get involved. To become a member of our Foundation Trust, you need to be 18 years of age or over, live in Lambeth, Southwark, Lewisham, Wandsworth or Westminster or have been a patient at either hospital in the last five years. To join: t: e: members@gstt.nhs.uk w: This leaflet uses information originally produced by South Essex Partnership University NHS Foundation Trust, adapted with their kind permission. Leaflet number: 4069/VER1 Date published: April 2015 Review date: April Guy s and St Thomas NHS Foundation Trust

39 Self-reported fluid intake over 24 hours To remain healthy and avoid dehydration and its unwanted complications, you should aim to have litres (around 6-8 glasses) of fluid per day. To help you keep track, use this chart to record all drinks and fluid-rich foods that you have within 24 hours (excluding alcohol). Tick the box that represents the cup or glass, and make a note if you don t manage the full drink. Add all items together to give your overall estimated daily fluid intake. Tip: Use a measuring jug to find out the volume of your cups and glasses at home as some hold more fluid than you think.

40 Contact us If you have any questions or concerns about these information sheets, please contact the Lambeth and Southwark Action on Malnutrition Project on (Monday to Friday, 9am to 5pm). For more information leaflets on conditions, procedures, treatments and services offered at our hospitals, please visit Pharmacy Medicines Helpline If you have any questions or concerns about your medicines, please speak to the staff caring for you or call our helpline. t: am to 5pm, Monday to Friday Patient Advice and Liaison Service (PALS) To make comments or raise concerns about the Trust s services, please contact PALS. Ask a member of staff to direct you to the PALS office or: t: at St Thomas t: at Guy s e: pals@gstt.nhs.uk Language Support Services If you need an interpreter or information about your care in a different language or format, please get in touch using the following contact details. t: fax: NHS 111 Offers medical help and advice from fully trained advisers supported by experienced nurses and paramedics. Available over the phone 24 hours a day. t: 111 NHS Choices Provides online information and guidance on all aspects of health and healthcare, to help you make choices about your health. w: Become a member of your local hospitals, and help shape our future Membership is free and it is completely up to you how much you get involved. To become a member of our Foundation Trust, you need to be 18 years of age or over, live in Lambeth, Southwark, Lewisham, Wandsworth or Westminster or have been a patient at either hospital in the last five years. To join: t: e: members@gstt.nhs.uk w: This leaflet uses information originally produced by South Essex Partnership University NHS Foundation Trust, adapted with their kind permission. Leaflet number: 4070/VER1 Date published: April 2015 Review date: April Guy s and St Thomas NHS Foundation Trust

41 Super shakes These super shakes all have approximately 500 calories in one 250ml serving. In addition to balanced meals these may be useful for those who require extra calories to gain weight. Berry delight Simply combine: 2 x 50g pots fromage frais yogurt 100ml cranberry juice 5 tablespoons double cream 1 tablespoon strawberry milkshake powder No blender required. Approximately 550kcal and 13g protein Nice n nutty Whisk together: 200ml whole milk 2 tablespoons double cream 2 tablespoons condensed milk 2 tablespoons hazelnut chocolate spread 1 tablespoon dried milk powder Not suitable for those with a nut allergy. Approximately 580kcal and 15g protein Bourbon cream dream Crush and mix: 4 bourbon cream biscuits into fine crumbs 200ml whole milk 2 tablespoons condensed milk 1 tablespoon dried milk powder Try replacing the bourbon cream biscuits with custard creams or gingernuts. Approximately 560kcal and 17g protein