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El. knyga: Kidney Disease: From Advanced Disease to Bereavement 2nd Revised edition [Oxford Medicine Online E-books]

(Clinical Senior Lecturer and Consultant in Palliative Care, Cicely Saunders Institute, Ki), , (Consultant Nephrologist, Honorary Professor of Renal Medicine, Imperial College Kidney and Transplant Centre, Hammersmith Hospital, London, UK)
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Kidney Disease: From Advanced Disease to Bereavement 2nd Revised editionDidesnis paveikslėlis
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Partnerių interneto svetainė: http://oxfordmedicine.com/view/10.1093/med/9780199695690.001.0001/med-9780199695690
Kidney Disease: From advanced disease to bereavement provides guidance to renal and palliative care professionals dealing with patients with advanced kidney disease, who are approaching end of life. The book describes the tools used to achieve a good death including advance care planning, symptom control law and ethics, recognizing dying, withdrawal of treatment, and a holistic approach to patient care. By using case histories, the book highlights how to facilitate good communication between patients, families and their renal and palliative teams. There are also chapters on support for carers and bereavement.

Revised and updated, this new edition is written in a bullet point style to provide an indispensable guide to the day-to-day management of patient care. This pocketbook will be an essential guide for nephrologists, renal nurses, nephrologist trainees, and doctors and nurses working in palliative care.
Contributor xix
Symbols and abbreviations xxi
1 End-stage kidney disease
1(14)
Chronic kidney disease
2(2)
Causes of kidney failure
4(4)
New patients on dialysis
8(2)
Patients on renal replacement therapy
10(2)
Choice of modality of renal replacement therapy
12(3)
2 Comorbidity
15(24)
Introduction
16(2)
Diabetes
18(4)
Cardiovascular disease
22(2)
Ischaemic heart disease
24(2)
Peripheral vascular disease
26(2)
Amputation
28(2)
Cerebrovascular disease
30(2)
Malignancy
32(2)
Infection
34(2)
Old age and frailty
36(3)
3 Complications of end-stage kidney disease
39(26)
Introduction
40(2)
Uraemia
42(2)
Electrolyte disorders
44(2)
Anaemia
46(2)
Fluid overload
48(2)
Calcium/phosphate disorders
50(2)
Poor nutrition
52(2)
Neuropathy
54(2)
Complications of haemodialysis
56(2)
Complications of peritoneal dialysis
58(2)
Complications of transplantation
60(5)
4 Causes of death in end-stage kidney disease
65(12)
Mortality
66(2)
Causes of death
68(2)
Cardiac arrest
70(2)
Stopping dialysis
72(2)
Conservative care
74(2)
Predicting the end of life
76(1)
5 Health-related quality of life in end-stage kidney disease
77(14)
Introduction
78(2)
Measures of HRQOL
80(2)
HRQOL of dialysis patients
82(4)
Factors affecting quality of life
86(2)
Quality of life at the end of life
88(2)
Conclusions
90(1)
6 Symptom assessment and trajectories
91(12)
Introduction
92(2)
Symptom prevalence
94(2)
Symptom assessment
96(2)
Symptom trajectories
98(4)
Further reading
102(1)
7 The management of pain
103(34)
Introduction
104(2)
Causes of pain
106(2)
Types of pain
108(2)
Assessment of pain
110(2)
What hinders pain management?
112(2)
Principles of management: the WHO analgesic ladder
114(2)
WHO analgesic ladder: steps 1 and 2
116(2)
WHO step 3: opioids for moderate-severe pain + non-opioid ± adjuvant
118(6)
Summary: WHO analgesic ladder
124(2)
Managing opioid side-effects
126(2)
Adjuvant analgesia
128(2)
Episodic, movement-related, or incident pain
130(2)
Chronic pain clinic referral and anaesthetic procedures
132(2)
Referral to the palliative care team
134(2)
Further reading
136(1)
8 Non-pain symptoms in end-stage kidney disease
137(34)
Introduction
138(2)
Pruritus and dry skin
140(4)
Fatigue, daytime somnolence, and weakness
144(2)
Anorexia and weight loss
146(2)
Dry mouth and thirst
148(2)
Nausea
150(4)
Constipation
154(2)
Insomnia
156(2)
Restless legs syndrome (RLS)
158(2)
Symptoms from long-term complications of treatment of ESKD
160(2)
Symptoms related to comorbid conditions
162(2)
Dialysis-related symptoms
164(2)
Other symptoms
166(2)
Summary
168(2)
Further reading
170(1)
9 How to deliver the best supportive and palliative care
171(14)
Introduction and definitions
172(4)
Advance care planning
176(2)
Cause for concern registers
178(2)
Preferred priorities of care
180(2)
Referral and joint working
182(3)
10 Recognizing dying
185(14)
Introduction
186(2)
Recognition of the need for supportive and palliative care
188(2)
Gold Standards Framework
190(2)
Recognition of the terminal phase
192(2)
Listening to the patient and their families/carers
194(2)
The nephrologist's perspective
196(3)
11 Communicating with patients and families
199(26)
Choosing conservative (non-dialytic) care
200(4)
Introducing palliative and hospice care
204(2)
Helping with decision-making
206(2)
Withdrawal from dialysis
208(4)
Raising awareness and improving communication skills
212(2)
Sharing bad news
214(2)
Responses to difficult questions
216(2)
Communicating with family members
218(2)
Communicating on issues around sexuality and intimacy
220(2)
Communicating within teams and information sharing
222(3)
12 Ethical and legal considerations
225(28)
Principles of ethical decisions
226(6)
A process of ethical decision-making
232(2)
Choosing conservative management of ESKD
234(4)
Renal replacement therapy and the elderly
238(2)
Truth telling and collusion
240(2)
Legal considerations: consent and capacity
242(4)
Lasting power of attorney and court-appointed deputies
246(2)
Advance decisions to refuse treatment
248(2)
Multicultural issues
250(3)
13 Management of the last few days
253(44)
Introduction
254(2)
Key issues to consider before cessation of dialysis
256(4)
Where death is expected
260(2)
Quality in end of life care
262(2)
Domains of care
264(2)
Symptoms at end of life
266(2)
Symptom management: pain
268(4)
Management: dyspnoea and retained secretions
272(2)
Management: agitation, delirium, and neurological problems
274(2)
Management: nausea and vomiting
276(2)
Symptom management: syringe drivers and anticipatory prescribing
278(2)
End of life symptom control guidelines
280(4)
Dialysis at end of life
284(2)
Preferred place of care
286(2)
The nursing perspective of end of life care in the renal setting
288(4)
Summary: main principles of end of life care
292(2)
Integrated care pathway for end of life care
294(3)
14 Spiritual and religious care
297(18)
Introduction
298(4)
Assessing spiritual and religious needs
302(4)
Cultural issues and spiritual support
306(2)
Religious practices of different faiths in relation to end of life care
308(7)
15 Caring for the carers
315(10)
Introduction
316(2)
Support for carers
318(2)
Caring for the professional
320(2)
Caring for the bereaved
322(3)
16 Drug doses in advanced chronic kidney disease by Wendy Lawson
325(22)
Drug handling in advanced chronic kidney disease
326(2)
Dosages of commonly used drugs in advanced chronic kidney disease: introduction
328(2)
Drug dosages in CKD5: analgesics
330(2)
Drug dosages in CKD5: antimicrobials
332(2)
Drug dosages in CKD5: antidepressants/anti-emetics/antihistamines
334(2)
Drug dosages in CKD5: antipsychotic and antisecretory drugs
336(2)
Drug dosages in CKD5: anxiolytics/hypnotics
338(2)
Some drugs not requiring dosage alteration in CKD5 with or without haemodialysis
340(2)
Some drugs to avoid in CKD5 with or without haemodialysis
342(2)
Notes on analgesics
344(2)
Further reading
346(1)
17 Audit and research in renal end of life care
347(12)
Why audit and research are important
348(2)
Linking audit and research to existing expertise
350(2)
Data sources
352(4)
Challenges in end of life research
356(2)
Further reading
358(1)
Appendix: Resources
359(8)
Patients and carers
360(4)
Professionals
364(3)
Index 367
Edwina Brown is a clinical nephrologist with a special interest in patient outcomes, particularly the elderly, on dialysis. Over the last decade she has developed an increasing interest in the support and management of renal patients at their end of life. She was an editor of Supportive Care for the Renal Patient, first published by Oxford University Press in 2004 and with a second edition in 2010, has published and lectured extensively on the topic and runs an annual course on Supportive Care for the Renal Patient. She is currently a member of the UK End of Life Care for Advanced Kidney Care Disease Project Board.

Fliss qualified in medicine in the UK in 1986. She initially trained in General Practice, and worked as a General Practitioner from 1992 - 2000, then undertook specialist training in palliative medicine between 2000 and 2004. She went on to undertake a PhD at King's College London, on 'Improving the quality of care of patients with Stage 5 Chronic Kidney Disease managed without dialysis' in the Department of Palliative Care, Policy & Rehabilitation at King's College London. She has now gained a HEFCE Clinical Senior Lecturership - one of the first nationally in Palliative Care. She is based at King's College London and King's College Hospital. She has published on the palliative and end of life care needs of renal patients, including on symptoms, withdrawal from dialysis, survival, and use of opioids. Fliss has a keen interest in longitudinal study, including methodological development, and symptom and functional trajectories in the last year of life (including for renal patients).
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