British journal of nursing (Mark Allen Publishing)
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Perioperative hypothermia is associated with poor outcomes for patients, yet it is preventable in most cases (National Institute for Health and Clinical Excellence (NICE), 2011a). NICE guideline 65 (2008) provides clear recommendations for avoiding perioperative hypothermia in surgical patients at each stage of their surgical journey, preoperatively, intraoperatively and postoperatively. ⋯ The Enhanced Recovery after Surgery programme (ERAS) considers patient warming to maintain perioperative normothermia to be a key component in accelerating patient recovery. This article looks at how the NICE guidelines on inadvertent perioperative hypothermia and the ERAS programme complement each other to successfully and significantly improve patient recovery.
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Noisy breathing or death rattle is a common clinical sign in the final days of life. When it occurs, the level of consciousness is usually low and it is generally assumed that patients are not distressed by it. Despite the assumption that patients are not distressed, death rattle is usually actively treated in palliative care settings through a combination of pharmacological and non-pharmacological measures. ⋯ Moreover, anti-cholinergic drugs can result in unpleasant side-effects such as urinary retention and dry mouth for patients who are probably unable to report symptoms. Recent research calls for prescribers to consider carefully why they are treating death rattle. Moreover, families need to be reassured and have it explained to them that it is unlikely that the patient is distressed and why this is the case.
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Consent protects the right of patients to decide what happens to them. Before any medical intervention, adults must give valid consent, which must be voluntary, informed and given free of undue influence. When consent is being obtained, patients must be informed about the intervention, why it is being done and its risks; information they are given must be recorded. ⋯ While different types of consent are valid, some are evidence of stronger proof in court that valid consent has been given. Competent adults have the right to refuse treatment, regardless of the reasons they give for refusal and even if the refusal will result in death; clinicians must respect their decision. In some circumstances-such as when an unconscious person is admitted as an emergency-healthcare professionals can make decisions on behalf of patients, and must do so in patients' best interests.
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For people with chronic obstructive pulmonary disease (COPD), hospital admission can be associated with a poor prognosis. Consequently, the end-stage of the illness needs to be recognized for timely palliative care to be initiated. ⋯ The Lincolnshire Respiratory Network has developed criteria to help recognize the end stage of COPD, which correlate well with recommendations from the Consultation on a Strategy for Services for COPD in England (Department of Health, 2010). However, there needs to be appropriate training to assist practitioners in their confidence to refer patients with end-stage COPD to palliative care providers.