By Marie Fallon, Geoffrey Hanks
This fresh version of ABC of Palliative Care pulls jointly the main updated details in this advanced, multidisciplinary sector in a pragmatic, basic demeanour. absolutely up-to-date, it offers with the very important social and mental points for palliative care of individuals with incurable ailments together with caliber of lifestyles, verbal exchange and bereavement issues.
This authoritative, functional name may be valuable to the expanding numbers of medical professionals, senior and professional nurses, and all these healthiness execs who take care of melanoma sufferers in the clinic, at domestic or in a hospice.
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Qxd 28/6/06 11:28 AM Page 23 Anorexia, cachexia, nutrition, and fatigue and metabolic change, once the overall management of the cachectic patient has been optimised, therapeutic strategies should try to address both these issues. Intake of food can be improved by providing small and frequent meals that are dense in energy and easy to eat (for example, dairy products, ice cream). Patients should eat in pleasant surroundings, and attention should be given to the presentation of food. If, however, patients are unable to finish meals, relatives should be counselled to avoid conflict over the issue.
Osmotic laxatives—Lactulose is popular but can cause bloating and flatulence and is too sweet for some patients. Saline laxatives, such as magnesium sulphate or hydroxide, have a mixed osmotic and stimulant mode of action and at higher doses can be strongly purgative. Magnesium hydroxide in combination with the lubricant softener liquid paraffin (now rarely used on its own) is a cheaper alternative to lactulose. Macrogols (polyethylene glycols) are administered with fluid, and they do not therefore draw further fluid from the body into the bowel.
If a cord lesion is present what is the level? Choices of rectal laxative ● ● ● ● Bisacodyl suppository—Evacuates stools from rectum or stoma; for colonic inertia Glycerine suppository—Softens stools in rectum or stoma Phosphate enema—Evacuates stools from lower bowel Arachis oil enema—Softens hard impacted stools Stimulant laxatives These drugs stimulate the myenteric plexus to induce peristalsis and reduce net absorption of water and electrolytes in the colon. The latency of action is 6–12 hours.
ABC of Palliative Care by Marie Fallon, Geoffrey Hanks