Nutrition and hydration at the end of life. Hannah McLoughlin Palliative Medicine St5 Sheffield Teaching Hospitals 23rd May 2018
|
|
- Annabelle Bishop
- 5 years ago
- Views:
Transcription
1 Nutrition and hydration at the end of life Hannah McLoughlin Palliative Medicine St5 Sheffield Teaching Hospitals 23rd May 2018
2 Caveat I am not an expert! Some of this is personal opinion as this is not a black and white subject, and we have little evidence If in doubt- phone a friend Second opinion in your department Palliative medicine Gastroenterology Dietetics
3 Outline Cultural significance Refusal of care at end of life Medically assisted hydration and nutrition Case studies
4 Aims and Objectives By the end of this session learners will be able to: Explain why food and drink is important in a healthcare setting. Describe the different types of medically assisted nutrition and hydration. Start to consider the evidence when making decisions about hydration and nutrition.
5 Why is food and drink important in hospital? In small groups 5 minutes
6 Why is food and drink important? Basic human need and right Used to express ourselves Social activity Cultural significance Social expression of love and comfort Karin Nordstro m Christian Coff Ha kan Jo nsson Lennart Nordenfelt Ulf Go rman Food and health: individual, cultural, or scientific matters? 15 th March Genes Nutrition.
7 Why do patients and families place high importance on food? Control The only thing they can offer We should not take this away, offer families to come in and help in meal times Sign of health How will they get better if they are not E+D? Worrying reports from LCP review
8 Basic Care The fundamentals of care include, but are not limited to, nutrition, hydration, bladder and bowel care, physical handling and making sure that those receiving care are kept in clean and hygienic conditions making sure you provide help to those who are not able to feed themselves or drink fluid unaided. NMC guidance 2015
9 Advanced refusal of basic care The BMA uses the term basic care to cover the sorts of care primarily intended to keep patients comfortable rather than specifically to extend their lives. It includes offering them food, liquids. While they are competent, individuals may prefer to tolerate some pain or discomfort in order to remain alert but they cannot decide in advance to refuse pain relief and basic care when their competence is lost. Advance decisions and proxy decision-making in medical treatment and research. Guidance from the BMA s Medical Ethics Department. June 2007
10 Types of patients that we see Patients that can eat normally Patients that can t eat
11 Patients who are able to eat Normal for appetite to decrease in illness Smaller portions Little and often Naughty foods and things they actually like Support the patient and family if they choose not to eat Would still want to keep fluid up Squashes Hot or cold, Ice Ice pops/ice cream
12 Things that can help appetite Positioning Sat up, if possible out at a table Normalising meals, drinks Sit together, use cutlery and crockery Dentition Where are their dentures and do they fit? Don t force the issue Light exercise- make them hungry Medications Steroids (in the short term), antidepressants, hormones Alcohol
13 Medical support Assess the patient and take a proper history N+V Constipation Early satiety or fullness Mouth care and dental state Review medications Metformin, antibiotics, oral iron/magnesium,. Investigations Renal function, LFTs, Magnesium, Calcium, TFT s
14 What if the patient can t eat? Unconscious Unsafe swallow Mechanical Loss of capacity NBM Overwhelming N+V, breathlessness, fatigue, delirium
15 Clinically assisted hydration and nutrition CAH CAN
16 Clinically assisted hydration and nutrition CAH Enteral NG, NJ, RIG, PEG, PEJ fluids Rectal fluids Parenteral SC or IV fluids CAN PEG, PEJ, NG, NJ, RIG, feeds TPN (ie via IV route)
17 How do we decide when to start or stop these??? Can be very very very tricky. Ideally have spoken to the patient before and made a plan as part of their advance care planning.
18 Mick 68 years old H+N tumour PEG tube in situ and has been fed through this for 5 years Normally does his feed at home himself, 2 bags over 8 hours (or so) Meant to be NBM but E+D what he likes Always bothered by a dry mouth Admitted to the hospice for pain control? EOLC as has been clearly deteriorating at home
19 What would you do with his PEG feed? Would you let him E+D still?
20 Mick Mick deteriorates further, is very frail and can no longer manage his own PEG feed so the nurses take over Still bothered by a dry mouth Also starts to get some diarrhoea Later on that week becomes unconscious
21 What would you do with his PEG feed? How would you manage his mouth?
22 Mick Mick is now unconscious and clearly in last days of life Has started to develop respiratory secretions Has marked sacral oedema
23 What would you do with his PEG feed?
24 Where I find CAN difficult Massive stroke with a short life expectancy Bowel obstruction in well people Short gut syndrome Dementia Get a second opinion Have an exit strategy
25 Ellen 94 years old Dementia, HTN, Diverticular disease, CRF, touch of CML Lives in a NH, hoisted, non verbal, normally E+D with assistance Admitted unwell from her NH Has 5 children, one daughter who accompanies her, when doing your assessment reels off what she has eaten for the past 2 weeks in minute detail
26 Ellen Dehydrated, Na 156 (high) and septic Given IV fluid and full active treatment 48 hours later no improvement and looks to be dying and looses IV access Walk in and find her daughter stuffing a Malteaser in her mouth
27 How do you explain to relatives Take it slowly Make sure they understand the situation I.e. the person is dying I often explain in terms of a bad flu Comfort feeding? Capacity or best interest decision Still need to be awake enough to manage it Buttons Reassure that she will be assessed every day for dehydration and hunger
28 Decide to start SC fluid MDT decision The doctors often have no idea what a patient is taking in- you guys do! Decision is made each day- cannot be made in advance as the situation changes Needs to have a clear idea of what you are trying to achieve and when you would stop This has to be explained to family!
29 How to give SC fluid In Sheffield we only give SC normal saline Dextrose is irritant to the skin in large volumes Given via a butterfly needle to a large bit of skinthigh, tummy, chest wall Run via gravity- NOT THROUGH A PUMP Max is really 2 litres in 24 hours
30 Ellen Written up for 1 litre over 24 hours. The next day she has Respiratory secretions Ascites Large bruise Peripheral oedema
31 What would you do with her SC fluids?
32 Risks of SC fluid Fluid overload Respiratory secretions (maybe) Oedema Ascites Pleural effusion Bleeding Ideally have an idea of platelets and clotting function before hand, in practice try it and see Patient distress Fluid pooling
33 Evidence behind CAH at EOL Cochrane review 2014 Only 6 studies Basically not very good evidence either way Not harmful but also not really beneficial No evidence it prolongs life May cause harm SE Good, P. Richard, R. Syrmis, W. Jenkins-Marsh, S. Stephens, J. Medically assisted hydration for adult palliative care patients. 23 rd April Cochrane library
34 A cluster randomised feasibility trial of clinically assisted hydration in cancer patients in the last days of life. Davies et al. Palliative Medicine Vol 32(4) Withdrawal due to localised oedema and respiratory secretions. May delay the onset of hyperactive delirium May not affect the frequency of respiratory secretions (around 50% in both groups) May prolong the length of life
35 CAH, CAN at the end of life Not black and white Rarely appropriate to start CAN at end of life May be appropriate in last few months/weeks CAH at end of life is a risk vs benefit Reassess every 24 hours Have a clear aim Individual to each patient National guidance to assess hydration and nutrition DAILY so please document it!!!!!
Hydration at the End of Life:
Hydration at the End of Life: A systematic literature review and audit of current practice November 12 th 2015 Dr Alison Coackley- Consultant in Palliative Medicine, Clatterbridge Cancer Centre Dr Catherine
More informationNUTRITION AT END-OF-LIFE HANDOUTS OBJECTIVES. Hospice Education Network. Nutrition at End-of-Life, by C. Andrew Martin, MS, RN, CHPN
NUTRITION AT END-OF-LIFE C. Andrew Martin, MS RN CHPN Hospice Education Network camartin@hospiceonline.com HANDOUTS Pause the presentation Click on the link for the PowerPoint handouts and any supplemental
More informationArtificial Nutrition and Hydration at End of Life (EOL)
Artificial Nutrition and Hydration at End of Life (EOL) Sonali M Wilborn, MD, MBA National Medical Director Seasons Healthcare Management Seasons Hospice & Palliative Care 1 Objectives Define Artificial
More informationPreparing for Approaching Death
Preparing for Approaching Death Old Colony Hospice created this guide for our hospice family and caregivers by revising and adapting the following journal article: Hospice Techniques: Preparing for the
More informationCONTROLLED DOCUMENT. Guidelines for the use of subcutaneous hydration in palliative care (hypodermoclysis) Controlled Document Number: CG259
Guidelines for the use of subcutaneous hydration in palliative care (hypodermoclysis) CONTROLLED DOCUMENT CATEGORY: CLASSIFICATION: Controlled Document Number: Version Number: 1 Controlled Document Sponsor:
More informationCare in the Last Days of Life
Care in the Last Days of Life Introduction This guideline is an aid to clinical decision making and good practice in person-centred care for patients who are deteriorating and at risk of dying. The patient
More informationIntravenous anti-cancer treatment
Intravenous anti-cancer treatment Information for patients Chemotherapy Name Hospital No Your consultant is Anti-cancer treatment is the term used to describe medicines used to treat cancer including chemotherapy.
More informationArtificial Hydration and Nutrition at the end of life Providing effective mouth care. Dr Sarah Human & Catherine Hughes RN
Artificial Hydration and Nutrition at the end of life Providing effective mouth care Dr Sarah Human & Catherine Hughes RN Dying is not only a physical event it is the conclusion of a life defined in its
More informationEnd of Life Care in Dementia. Dr Rosie Lockwood Consultant Geriatrician Sheffield Teaching Hospitals
End of Life Care in Dementia Dr Rosie Lockwood Consultant Geriatrician Sheffield Teaching Hospitals Rosie.Lockwood@sth.nhs.uk Agenda Some facts and figures What are the challenges? What is good care? How
More informationENTERAL FEEDING ISSUES IN THE COMMUNITY. Gary Simpson Home Enteral Feed Specialist Dietitian
ENTERAL FEEDING ISSUES IN THE COMMUNITY Gary Simpson Home Enteral Feed Specialist Dietitian HEF DIETETIC SERVICE Service started in 2002 (HAZ funded now substantive) 2 wte. Band 7 Dietitian 1 wte. Band
More informationNivolumab. Other Names: Opdivo. About this Drug. Possible Side Effects (More Common) Warnings and Precautions
Nivolumab Other Names: Opdivo About this Drug Nivolumab is used to treat cancer. It is given in the vein (IV). Possible Side Effects (More Common) Bone marrow depression. This is a decrease in the number
More informationWhat to expect in the last few days of life
What to expect in the last few days of life Contents Introduction... 3 What are the signs that someone is close to death?... 4 How long does death take?... 7 What can I do to help?... 7 Can friends and
More informationPalliative Care Victoria The Process of Dying Page 1. The Process of Dying. What to expect and how to help
Palliative Care Victoria The Process of Dying Page 1 The Process of Dying What to expect and how to help Palliative Care Victoria The Process of Dying Page 2 About dying Dying is a natural part of life.
More informationwrha.mb.ca a conversation about tube feeding a guide for clients, families and friends healthcare professional guide Healthcare Professional Guide
a conversation about tube feeding a guide for clients, families and friends healthcare professional guide Health Care Professional Guide Pamphlet Information Healthcare Professional Guide If you are reading
More informationEating and drinking in dementia
Eating and drinking in dementia Patient infomation Nutrition and dietetics Clinical and diagnostic services centre This leaflet offers practical advice on how you can help someone with early stage dementia
More informationOesophageal and gastric stents Patient Information leaflet
Oesophageal and gastric stents Patient Information leaflet Why have you been given this leaflet? This leaflet has been written to help you understand why it has been recommended that you have a stent.
More informationTraztuzumab (Herceptin)
Traztuzumab (Herceptin) Information for patients Chemotherapy Name Hospital No Your consultant is Important Advice Always carry your chemotherapy alert card. It is important that you know what to do if
More informationWhat to expect in the last few days of life
What to expect in the last few days of life Contents Introduction... 3 What are the signs that someone is close to death?... 4 How long does death take?... 6 What can I do to help?... 7 Can friends and
More informationRecovering at home. How will I feel when I get home? How should I look after my wound?
How will I feel when I get home? Following your operation it is normal to have feelings of stress, anxiety or depression. Being affected emotionally is normal. It may help to talk about how you feel with
More informationGASTRECTOMY. Date of Surgery. Please bring this booklet the day of your surgery. QHC#34
GASTRECTOMY Date of Surgery Please bring this booklet the day of your surgery. QHC#34 What is a Gastrectomy? A Gastrectomy is the surgical removal of all or part of the stomach. The stomach is the digestion
More informationEnd of Life Care in Dementia. Sue Atkins Dignity in Care/Dementia/Learning Disabilities Clinical Nurse Specialist
End of Life Care in Dementia Sue Atkins Dignity in Care/Dementia/Learning Disabilities Clinical Nurse Specialist Objectives Understanding the decline in people with dementia To recognise when patients
More informationThis talk will cover
, pain and fatigue: complications of myeloma and side-effects of treatment Caroline Overvoorde Myeloma/Lymphoma Clinical Nurse Specialist, Leeds Teaching Hospitals NHS Trust This talk will cover Pain Take
More informationIn-Patient Radioactive Iodine ( 131 I) Treatment
In-Patient Radioactive Iodine ( 131 I) Treatment Information for patients and families Princess Margaret Read this booklet to learn: what radioactive iodine treatment is what to expect instructions to
More informationDelirium A guide for caregivers
Delirium A guide for caregivers Disclaimer This is general information developed by The Ottawa Hospital. It is not intended to replace the advice of a qualified health-care provider. Please consult your
More informationAfter Dental Extractions or Wisdom Teeth Removal
Patient & Family Guide After Dental Extractions or Wisdom Teeth Removal 2017 Aussi disponible en français : Après l extraction des dents ou l enlèvement des dents de sagesse (FF85-1786) www.nshealth.ca
More informationOral anti-cancer treatment
Oral anti-cancer treatment Information for patients Chemotherapy Name Hospital No Your consultant is Anti-cancer treatment is the term used to describe medicines used to treat cancer, including chemotherapy.
More informationSubtotal and Total Gastrectomy
DR ADEEB MAJID MBBS, MS, FRACS, ANZHPBA FELLOWSHIP GENERAL, HEPATOBILIARY AND PANCREATIC SURGEON CALVARY MATER HOSPITAL NEWCASTLE Information for patients and carers Subtotal and Total Gastrectomy Introduction
More informationChapter 19. Nutrition and Fluids. All items and derived items 2015, 2011 by Mosby, Inc., an imprint of Elsevier Inc. All rights reserved.
Chapter 19 Nutrition and Fluids Nutrition Nutrition--processes involved in the ingestion, digestion, absorption & use of foods & fluids by the body. The person s diet affects physical & mental wellbeing
More informationMethotrexate for inflammatory bowel disease: what you need to know
Methotrexate for inflammatory bowel disease: what you need to know This leaflet aims to answer your questions about taking methotrexate for inflammatory bowel disease (IBD). If you have any questions or
More informationDeciding About Tube Feeding
Deciding About Tube Feeding A guide for you, as a patient, or your Substitute Decision-Maker(s) Providing Patient and Family Centred Care www.stjoes.ca Here are some questions you may want answered before
More informationEND-OF-LIFE DECISIONS HONORING THE WISHES OF A PERSON WITH ALZHEIMER S DISEASE
END-OF-LIFE DECISIONS HONORING THE WISHES OF A PERSON WITH ALZHEIMER S DISEASE PREPARING FOR THE END OF LIFE When a person with late-stage Alzheimer s a degenerative brain disease nears the end of life
More informationMY surgery: There are two common types of surgery for colon cancer. The one you receive depends on the stage and location of your tumour.
MY surgery: - There are two common types of surgery for colon cancer. The one you receive depends on the stage and location of your tumour. In addition to explaining both options, this section gives you
More informationUnderstanding late stage dementia Understanding dementia
Understanding late stage dementia About this factsheet This factsheet is for relatives of people diagnosed with dementia. It provides information about what to expect as dementia progresses to late stage.
More informationMouth care for people with dementia. Mouth care for people with dementia. Staying well with dementia
Mouth care for people with dementia Mouth care for people with dementia Staying well with dementia 2 Dementia UK Mouth care for people with dementia Maintaining good oral health is essential to your overall
More informationGuidelines: EOLC Symptom Control for Patients with Normal Renal Function (in Wandsworth)
Guidelines: EOLC Symptom Control for Patients with Normal Renal Function (in Wandsworth) Policy Number : DC020 Issue Date: October 2014 Review date: October 2016 Policy Owner: Head Community Services Monitor:
More informationROLE OF A DIETITIAN & KEEPING HYDRATED. Emily Capener Haematology Dietitian UHW
ROLE OF A DIETITIAN & KEEPING HYDRATED Emily Capener Haematology Dietitian UHW We will cover: PART 1 What is a dietitian Where do dietitans work About an acute dietitians role - Screening - Food charts
More informationDelirium Information for relatives, carers and patients
Delirium Information for relatives, carers and patients Contents Part A Introduction What is delirium? Quotes from relatives or carers showing what might happen to a patient suffering from delirium How
More informationFacet Joint Medial Branch Blocks
Information sheet for adult patients undergoing: Facet Joint Medial Branch Blocks for the Treatment of Pain What is the aim of this information sheet? The aim of this information sheet is to provide you
More informationHaematology. The other 2 drugs, folinic acid and GCSF, help to reduce the side effects of the treatment.
Haematology CODOX-M Chemotherapy This information is about CODOX-M chemotherapy, which is a treatment for Burkitts Lymphoma. Lymphoma is a cancer of the lymphatic system - a network of glands in the body
More informationFor the Patient: Fludarabine injection Other names: FLUDARA
For the Patient: Fludarabine injection Other names: FLUDARA Fludarabine (floo-dare-a-been) is a drug that is used to treat many types of cancer. It is a clear liquid that is injected into a vein. Tell
More informationTrastuzumab (Herceptin )
Trastuzumab (Herceptin ) About This Drug Trastuzumab is used to treat cancer. It is given in the vein (IV) Possible Side Effects Bone marrow depression. This is a decrease in the number of white blood
More informationCapecitabine. Other Names: Xeloda. About This Drug. Possible Side Effects. Warnings and Precautions
Capecitabine Other Names: Xeloda About This Drug Capecitabine is used to treat cancer. It is given orally (by mouth). Possible Side Effects Tired and weakness Loose bowel movements (diarrhea) Nausea and
More informationGemcitabine (Gemzar )
1 Gemcitabine (Gemzar ) This fact sheet is for anyone diagnosed with pancreatic cancer who would like to find out more about gemcitabine chemotherapy to treat pancreatic cancer. It provides information
More informationChapter 20. Assisting With Nutrition and Fluids
Chapter 20 Assisting With Nutrition and Fluids Food and water: Are physical needs Basics of Nutrition Are necessary for life A poor diet and poor eating habits: Increase the risk for diseases and infection
More informationThe Palliative Care Journey. By Sandra O Sullivan Clinical Nurse Manager 1 St Luke's home
The Palliative Care Journey By Sandra O Sullivan Clinical Nurse Manager 1 St Luke's home Aims 1. To provide an overview of what palliative care involves. 2. Identify, at what stage should Dementia be acknowledged
More informationPhysical/Emotional Symptoms and Appropriate Comfort Measures
Physical/Emotional Symptoms and Appropriate Comfort Measures A. Diminishing Appetite Page 2 B. Decreased Socialization Page 2 C. Sleeping Page 2 E. Changes in Pain Level Page 3 D. Incontinence Page 3 F.
More informationPrecious Moments. Giving comfort and support when someone you love is dying.
Precious Moments Giving comfort and support when someone you love is dying www.stjoes.ca When someone you love is dying When someone you love is dying, you may want to know how you can provide comfort
More informationHaving a pancreas transplant alone (PTA)
Having a pancreas transplant alone (PTA) This leaflet explains more about having a pancreas transplant alone (PTA), including the benefits, risks, alternatives, and what you can expect at the time of the
More informationDental care and dementia
PBO 930022142 NPO 049-191 Dental care and dementia Good oral health is important for a person s sense of well-being and quality of life. Poor oral health can lead to pain and tooth loss, affecting self-esteem
More informationPreparing for the Death of a Loved One. Information for Patients & Visitors
Preparing for the Death of a Loved One Information for Patients & Visitors This booklet is provided to help you know what to expect when your loved one is dying. It may help you to respond in ways that
More informationBackground and Context
Background and Context People affected by cancer need information that is timely and relevant to enable them to make decisions. It can be difficult for patients and others affected by cancer to identify
More informationAcute kidney injury. Information for patients Sheffield Teaching Hospitals
Acute kidney injury Information for patients Sheffield Teaching Hospitals page 2 of 12 Acute kidney injury You have been given this leaflet because you have had an episode of acute kidney injury (AKI).
More informationThere are several reasons why a person with dementia may have a poor appetite and seem uninterested in eating.
PBO 930022142 NPO 049-191 EATING If you are caring for someone with dementia you will want to ensure that they enjoy their food and that they eat a healthy, balanced diet. But for some people, as dementia
More informationMethotrexate. About This Drug. Possible Side Effects. Warnings and Precautions
Methotrexate About This Drug Methotrexate is used to treat cancer. This drug is given in the vein (IV). Possible Side Effects Soreness of the mouth and throat. You may have red areas, white patches, or
More informationE09 PEG. Expires end of March 2018 VITALITY.CO.UK
VITALITY.CO.UK E09 PEG Expires end of March 2018 You can get more information and share your experiences at www.aboutmyhealth.org Tell us how useful you found this document at www.patientfeedback.org eidohealthcare.com
More informationPreventing delirium while in hospital Tips for family, whānau, and friends who are supporting an older person
Preventing delirium while in hospital Tips for family, whānau, and friends who are supporting an older person This brochure shares some simple ways you can help our care staff to prevent delirium, recognize
More informationAssessing Nutritional Risk. Presented by Heather Smart
Assessing Nutritional Risk Presented by Heather Smart Aims Why we assess nutritional risk. The symptoms of malnutrition Barriers to improved nutrition How we assess nutritional risk. How to use nutritional
More informationNausea and Vomiting. Principles and Practice in End of Life Care November 2018
Nausea and Vomiting Principles and Practice in End of Life Care November 2018 Overview Aims and Objectives Why is managing nausea and vomiting important? Definitions Causes Interventions pharmacological
More informationPlasma exchange. Information for patients Sheffield Kidney Institute (Renal Unit)
Plasma exchange Information for patients Sheffield Kidney Institute (Renal Unit) Plasma exchange This leaflet explains about plasma exchange; the benefits, risks, alternatives and what you can expect when
More informationHow is primary breast cancer treated? This booklet is for anyone who has primary breast cancer and wants to know more about how it is treated.
How is primary breast cancer treated? This booklet is for anyone who has primary breast cancer and wants to know more about how it is treated. How is primary breast cancer treated? Part 1 the treatment
More informationDignity and Nutrition for Older People
South Gloucestershire Community Health Services Dignity and Nutrition for Older People Lorraine Norris Nutrition and Dietetic Professional Lead South Gloucestershire Community Health November 9th 2011
More informationDocetaxel (Taxotere )
Page 1 of 5 Docetaxel (Taxotere ) About This Drug Docetaxel is used to treat cancer. It is given in the vein (IV). Possible Side Effects Bone marrow depression. This is a decrease in the number of white
More informationinformation The Enhanced Recovery Programme for Total Hip Replacement (1 of 6) What will happen before I come into hospital?
information If you need this information in another language or medium (audio, large print, etc) please contact the Customer Care Team on 0800 374 208 email: customercare@ salisbury.nhs.uk. You are entitled
More informationEndoscopy Unit Pyloric and Duodenal Stent insertion
Endoscopy Unit Pyloric and Duodenal Stent insertion Information for patients Your doctor has recommended that you have a Pyloric or Duodenal Stent Insertion. This leaflet will explain the procedure and
More informationChronic Obstructive Pulmonary Disease. Information about medication and an Action Plan to use if your condition gets worse due to an infection
Chronic Obstructive Pulmonary Disease Information about medication and an Action Plan to use if your condition gets worse due to an infection Information about your medication Your usual treatment Inhalers
More informationWHEN IT S A MATTER OF LIFE AND DEATH THE QUESTIONS YOU SHOULD ASK EDUCATION FUND
WHEN IT S A MATTER OF LIFE AND DEATH THE QUESTIONS YOU SHOULD ASK EDUCATION FUND WHAT QUESTIONS SHOULD YOU ASK YOUR DOCTOR IN LIFE-OR-DEATH SITUATIONS? Your mother has a stroke and is rushed to the hospital.
More informationCapecitabine (Xeloda )
1 Capecitabine (Xeloda ) This fact sheet is for anyone diagnosed with pancreatic cancer who would like to find out more about capecitabine chemotherapy to treat pancreatic cancer. It provides information
More informationEnhanced Recovery Programme
Enhanced Recovery Programme Enhanced Recovery Programme This leaflet should increase your understanding of the programme and how you can play an active part in your recovery. If there is anything you are
More informationHaving a radiologically inserted gastrostomy. An information guide
TO PROVIDE THE VERY BEST CARE FOR EACH PATIENT ON EVERY OCCASION Having a radiologically inserted gastrostomy An information guide Having a radiologically inserted gastrostomy Introduction This leaflet
More informationFor the Patient: ULUAVPMTN
ABOUT THIS MEDICATION For the Patient: ULUAVPMTN Other Names: Maintenance Therapy of Advanced n-small Cell Lung Cancer (NSCLC) with Pemetrexed U = Undesignated (requires special approval) LU = LUng AV
More informationFacet joint injections
Information sheet for adult patients undergoing: Facet joint injections for the Treatment of Pain What is the aim of this information sheet? The aim of this information sheet is to provide you with information
More informationFacet Joint Rhizolysis/Radio Frequency Lesioning (Denervation)
Information sheet for adult patients undergoing: Facet Joint Rhizolysis/Radio Frequency Lesioning (Denervation) for the Treatment of Pain What is the aim of this information sheet? The aim of this information
More informationMedication is just part of the management of these illnesses. Other therapies are also helpful; you may wish to discuss these with your prescriber.
Know Your Medicines Duloxetine The purpose of this leaflet is to give you some general information on duloxetine, and is intended as a guide only. This should be read in conjunction with the official patient
More informationSpinal Anaesthesia and Analgesia. Patient information Leaflet
Spinal Anaesthesia and Analgesia Patient information Leaflet February 2018 Introduction For many operations, patients receive a general anaesthetic and remain asleep during the operation. A spinal anaesthetic
More informationDorsal root ganglion block / Transforaminal epidural / Nerve root block
Information sheet for adult patients undergoing: Dorsal root ganglion block / Transforaminal epidural / Nerve root block What is the aim of this information sheet? for the Treatment of Pain The aim of
More informationPalliative Care Impact Survey
September 2018 Contents Introduction...3 Headlines...3 Approach...4 Findings...4 Which guideline are used...4 How and where the guidelines are used...6 Alternative sources of information...7 Use of the
More informationPeripheral Nerve Injections: General Information
Information sheet for adult patients undergoing: Peripheral Nerve Injections: General Information for the Treatment of Pain What is the aim of this information sheet? The aim of this information sheet
More informationSTAY NOURISHED. Be happy and healthy as you age
STAY NOURISHED Be happy and healthy as you age As we age physical changes to our bodies occur which can affect the way we think and feel about food. These changes can prevent us from having access to a
More informationEATING WELL AND CANCER
EATING WELL AND CANCER 2 Why is it important for people with cancer to eat well? If the person you care for has cancer, it is more important than ever that they eat well. Unfortunately, it is often at
More informationFacet Joint Medial Branch Blocks
Information sheet for adult patients undergoing: Facet Joint Medial Branch Blocks for the Treatment of Pain What is the aim of this information sheet? The aim of this information sheet is to provide you
More informationSwallowing, nutrition and PEG feeding: deciding, doing and managing
Swallowing, nutrition and PEG feeding: deciding, doing and managing Swallowing in MND Dysphagia disruption in the swallowing process In MND can be variable depending on type Bulbar MND - faster progression
More informationSEPSIS INFORMATION BOOKLET. A life-threatening condition triggered by infection
SEPSIS INFORMATION BOOKLET SEPSIS is A life-threatening condition triggered by infection It affects the function of the organs and is most effectively treated if recognised early If you have infection
More informationRenal Palliative Care Last Days of Life
Renal Palliative Care Last Days of Life Introduction This guideline is an aid to clinical decision-making and good practice for patients with stage 4-5 chronic kidney disease (egfr
More informationChronic Obstructive Pulmonary Disease (COPD)
James Paget University Hospitals NHS Foundation Trust Great Yarmouth and Waveney Clinical Commissioning Group HealthEast Chronic Obstructive Pulmonary Disease (COPD) Information and Advice for Patients
More informationUnderstanding THE SYMPTOMS YOU SEE
Understanding THE SYMPTOMS YOU SEE Z Human existence is rich with experiences that weave a completed quilt called life. As the quilt nears completion, there is no set calendar as to its final, beautiful
More informationType 2 Diabetes. Care for your body today for a healthier tomorrow
Type 2 Diabetes Care for your body today for a healthier tomorrow Understanding diabetes You may already know that having diabetes means you have too much sugar in your blood. Why do you have high blood
More informationGastrostomy Tube Feeding
Gastrostomy Tube Feeding A gastrostomy tube (g-tube) is a tube that enters through your abdomen and rests in your stomach. This tube is used for tube feeding formula, water, and medicine (instead of taking
More informationLumbar sympathetic block (lumbar sympathectomy) with local anaesthetic
Information sheet for adult patients undergoing: Lumbar sympathetic block (lumbar sympathectomy) with local anaesthetic for the Treatment of Pain What is the aim of this information sheet? The aim of this
More informationCARING FOR SICK PEOPLE AT HOME
PANDEMIC INFLUENZA CARING FOR SICK PEOPLE AT HOME What is pandemic flu? Pandemic flu means that a new strain of influenza has spread all over the world and is affecting a large number of people. During
More informationDelirium. Script. So what are the signs and symptoms you are likely to see in this syndrome?
Delirium Script Note: Script may vary slightly from the audio. Slide 2 Index Definition About delirium Signs and symptoms of delirium Why delirium occurs Risk Factors and causes of delirium Conditions
More informationMouth care for people with dementia. Delirium (Confusion) Understanding changes in behaviour in dementia
Mouth care for people with dementia Delirium (Confusion) Understanding changes in behaviour in dementia 2 Dementia UK Delirium (confusion) A sudden change in a person s mental state is known as delirium.
More informationMyeloma Haematology and Transplant Unit MPT
MPT Myeloma Haematology and Transplant Unit MPT This leaflet is offered as a guide to you and your family. The possible benefits of treatment vary; for some people chemotherapy may reduce the risk of the
More informationPATIENT AGREEMENT TO SYSTEMIC ANTI- CANCER THERAPY:
PATIENT AGREEMENT TO SYSTEMIC ANTI- CANCER THERAPY: Ponatinib PATIENT DETAILS PATIENT S SURNAME/FAMILY NAME: PATIENT S FIRST NAME(S): DATE OF BIRTH: NHS NUMBER: (or other identifier) HOSPITAL NAME/STAMP:
More informationPeripheral Nerve Injections: Intercostal nerve block
Information sheet for adult patients undergoing: Peripheral Nerve Injections: Intercostal nerve block for the Treatment of Pain What is the aim of this information sheet? The aim of this information sheet
More informationCancer associated thrombosis palliative care and the end of life. Tracy Anderson May 2017
Cancer associated thrombosis palliative care and the end of life Tracy Anderson May 2017 Treatment at the end of life Can be challenging to know what treatments are appropriate Benefit vs burden Patients
More informationSpinal anaesthetic. Brought to you in association with EIDO Healthcare and endorsed by the Royal College of Surgeons England.
Spinal anaesthetic Brought to you in association with EIDO Healthcare and endorsed by the Royal College of Surgeons England. Discovery has made every effort to ensure that we obtained the information in
More informationABOUT THIS MEDICATION
For the Patient: UHNOTVAN Other Names: Therapy for Medullary Thyroid Cancer using Vandetanib HN = Head and Neck (tumour group) OT = Other (includes Thyroid) VAN = VANdetanib ABOUT THIS MEDICATION What
More informationWhat to expect in the last days and hours of life in the Intensive Care Unit (ICU)
What to expect in the last days and hours of life in the Intensive Care Unit (ICU) Information for patients and caregivers Please visit the UHN Patient Education website for more health information: www.uhnpatienteducation.ca
More informationQuick Death, Slow Death, Hopefully No Death
Quick Death, Slow Death, Hopefully No Death Collaborative presentation on learning from choking and nutrition incidents in RWT. Introduction of IDDSI for food and fluids Why there is an NPSA Alert Safe
More informationPalliative Care: What is it?
Palliative Care: What is it? CSIM Annual Meeting 2014 Calgary Dr. Amanda Brisebois MSc MD FRCPC General Internal Medicine and Palliative Care What has surprised me is how little palliative care has to
More information