In the Midst of Life (55 page)

Advance decisions to refuse treatment

• Useful in finding out more information about recording your own, or your patients’, wishes.
  http://www.adrtnhs.co.uk/
  

The Mental Capacity Act

• Direct.gov
  is a useful website for lots of different things, the mental Capacity Act being one of them:
  http://www.direct.gov.uk/en/DisahledPeople/HealthAndSupport/YourRightsInHealth/DG_10016888
  
• The Department of Justice now governs this, but information can be found from the Department of Constitutional affairs, an archive website. This link will take you to the list of booklets available for professionals and the public:
  http://www.dca.gov.uk/legal-policy/mental-capacity/publications.htm#booklets
  

Enteral/artificial
feeding

• Information about patient selection, and complications:
  http://www.patient.co.uk/doctor/Enteral-Feeding.htm
  
• For people with cancer, this site gives information on what enteral feeding is all about:
  http://www.cancerhelp.org.uk/coping-with-cancer/coping-physically/diet/managing/drip-or-tube-feeding
  

Do Not Attempt Resuscitation

• The Resuscitation Council (UK) guidance, which has been written with the British Medical Association and the Royal College of Nursing:
  http://www.resus.org.uk/pages/dnarrstd.htm
  

For anyone living with, or caring for someone with, a long-term illness, or terminal illness

• Financial support if caring for someone with a terminal illness, available at
  Direct.gov
  :
  http://www.direct.gov.uk/en/CaringForSomeone/
  CaringAndSupportServices/DG_10035718
  
• If I should Die: a very informative website covering lots of different subjects, such as funeral plans, benefits and how to comfort those who are grieving:
  http://www.ifishoulddie.co.uk/terminal-life-threatening-illness-c40.html
  
• A website for family carers which offers help and advice for anyone caring for someone with a long-term or terminal illness:
  http://www.carers.org/
  

by Madeline Bass, RGN, BSC (Hons)

Abdominal
exploration:
a surgical investigation through an incision, or through key-hole surgery using cameras.

Abdominal sounds:
the normal sounds produced by movement of the bowel and gut.

Acetylcholine:
a neuro-transmitter. This is a substance which the body produces at the end of each nerve cell which then stimulates the next nerve cell to continue the message.

Acidosis:
increased acid levels in the blood which is caused by partial or complete renal failure.

Acute intestinal obstruction:
This is when the gut suddenly blocks either internally, such as from a tumour or the gut twisting, or externally such as from a tumour pressing on to the gut.

Adrenaline:
a substance produced by the body in times of threat or stress. One of its actions is to speed up the heart rate. If the heart stops unexpectedly, adrenaline is one of the drugs used to try and stimulate it to begin working again.

Advance Directive: now called Advance Decision:
These are now legally recognised documents, with specific wording, which refuses treatment in specific circumstances, witnessed. They have to be written whilst the person still has mental capacity and can only come into effect when the person loses that capacity. They must be signed and witnessed to become legal. If overruled by a healthcare professional they could face charges of neglect or assault.

Amyotrophic Lateral Sclerosis (AMS):
a form of Motor Neurone Disease (MND): MND affects the nerves which control functions of the body, and is always fatal.

Analgesic:
a medication or drug which reduces the feeling of pain.

Aneurysm:
a blood-filled swelling of the wall of an artery.

Angina pectoris:
lack of oxygen to the heart muscles, which causes pain in the chest and breathlessness.

Anodyne:
an analgesic which works by lessening the sensitivity of the nerves or brain.

Anorexia:
not to be confused with anorexia nervosa, this refers to lack of appetite.

Anti-coagulants:
a wide-ranging group of drugs to dissolve and prevent blood clots forming inside the blood vessels.

Anti-emetics:
drugs which suppress nausea and vomiting.

Aperients:
oral drugs used to stimulate the bowels.

Arteries:
blood vessels which carry oxygenated blood.

Arterioles:
the smallest arteries in the body.

Ascites:
build-up of fluid in the abdominal cavity.

Asphyxia:
suffocation, dying through lack of oxygen.

Aspirating needle:
a needle used to remove fluid from a part of the body.

Aspiration:
being wrongly taken into the lungs, e.g. food entering the lungs. Aspiration will lead to pneumonia if not prevented and treated.

Atheroma of the arterial circulation:
swelling of the walls of the arteries, caused by debris such as fats, cholesterol, calcium and connective tissue.

Atrial response:
action of the atria, the two smaller chambers of the heart. The right atrium pushes blood into the right ventricle, where blood is then pushed to the lungs to collect oxygen. From there it returns to the left atrium which pumps it into the left ventricle. From there it is pushed via the aorta around the body.

Auscultations:
examination by listening.

Bedsores:
also called pressures sores: these occur when the body does not move around enough, e.g. due to accident, illness, disability or injury. This causes the person to be less mobile. If pressure is applied to an area of the body for too long the circulation is compromised and the skin starts to break down, causing a sore.

Bladder irrigation:
certain conditions can cause a blockage of
the urethra, e.g. in prostatectomy, bleeding is prevented from blocking the urethra by passing a large catheter, which has two drainage lines, into the bladder: one allows sterile saline to be flushed into the bladder, and the other allows the saline and bladder contents to drain out.

Blood count:
a general term referring to the counts of different elements of the blood, such as red blood cells, urea or potassium.
BMA:
British Medical Association.

Brompton cocktail:
a concoction of many different types of drugs often given to terminally ill patients to alleviate pain.

Bronchitis:
inflammation of the bronchi, the smallest breathing passages in the lungs.

Cannula:
a very thin tube, thinner than a catheter, which can be inserted into the body, e.g. into a vein.

Carcinogenic:
something which causes cancer, e.g. tar in cigarettes is a known carcinogenic.

Cardiac stimulants:
drugs which stimulate the heart to work correctly.

Cardiologist:
a medical specialist in conditions and problems with the heart.

Cardio-pulmonary:
pertaining to the heart and lungs.

Cardiovascular:
pertaining to the heart and circulation system.

Carotid beat:
the pulse felt from the carotid artery, in the neck.

Catheterise:
to place a catheter, which is a small tube, into the body, e.g. a bladder catheter to help drain urine, a kidney catheter to help drain urine directly from the kidneys.

Central line:
a small tube inserted into the one of the large veins leading to the heart. Drugs can be administered into this, and blood samples taken from it.

Cerebral arteries:
the arteries in the brain.

Chemotherapy:
strong poisons used to destroy fast-dividing cells. Since cancer cells normally grow much more quickly than normal cells, chemotherapy may effectively kill them. However some chemotherapy cannot discern between the cancer’s fast-dividing cells and normal fast-dividing cells, e.g. gut cells, hair cells. This is
why some chemotherapy causes nausea, mouth ulcers, diarrhoea and hair loss. These drugs are dose-limiting: i.e. a person can only have so much of a certain drug at a time.

Cholera:
gastroenteritis caused by bacteria. It results in severe diarrhoea. The disease can progress very quickly resulting in shock within twelve hours from severe dehydration. It is extremely contagious.

Clot-buster:
a drug to dissolve any clots which have formed in the blood vessels.

Colitis:
inflammation of the colon, the large bowel.

Colostomy:
when the bowel is surgically attached to the skin so that faeces are excreted into a bag which can then be emptied.

Congestive heart failure:
heart failure is when the heart, which is a large muscle, begins to enlarge and get weaker through age or disease. This means it has to work harder to maintain normal heart function. The disease can be controlled at times by certain drugs.

Coronary arteries:
the arteries of the heart. There are four arteries which supply the heart muscle with oxygen.
Coronary failure:
another term for heart failure.
CPR: short for cardio-pulmonary resuscitation:
the full term for resuscitation.

Craniotomy:
removal of part of the skull bone during a surgical procedure to the brain.

Cross-matching:
this is a process which is carried out to make sure the person is given the right type of blood during a blood transfusion.

Cyanosis:
lack of oxygen in the body’s tissues leading to a blue colour in extremities.

Defensive medicine:
medicine and treatment carried out to prevent complaints and safeguard against malpractice.

Defibrillator:
a machine which delivers electric shocks to the heart, to try and reverse fibrillation of the heart muscle.

Dementia:
a disease which causes the brain to begin to degenerate. There are over two hundred different types of dementia, the most common being Alzheimer’s. The disease is not curable.

Dialyse:
pertaining
to kidney dialysis, a process where the blood is mechanically filtered because the kidneys are unable to perform this function.

Diuretics:
drugs which increase the drainage of urine out of the kidneys, often used to reduce blood volume, e.g. in high blood pressure and heart failure.

Draining filaments:
a drain where the end is frayed out into filaments: used to drain wounds or wound cavities.

Duodenal ulcer:
an area of the duodenum, which becomes very sore and excoriated. This can cause pain, indigestion and nausea.

Duodenum:
first part of the small bowel leading away from the stomach.

Electrolyte balance:
electrolytes are substances produced by the body which maintain healthy functioning. Certain electrolytes include potassium and sodium. If the levels become abnormal such as in kidney dysfunction many of the body’s otherwise normal functions may go wrong.

Embolism / embolus / emboli:
an object migrating from one part of the body to another which occludes a blood vessel, e.g. blood clot.

Encapsulated:
a growth confined to a specific, localised area.

Endogenous clinical depression:
depression that people are born with. It is thought it may be genetic.

Endomorphs:
endorphins, the body’s natural morphine-like substances which give the ‘feel good’ factor.

Endotracheal tube:
a tube placed into the lungs via the mouth and throat. It may be used during surgery to help a person breathe. It is usually temporary.

Epiglottis:
a cartilaginous flap of skin which lies between the trachea and the gullet. When swallowing food, saliva or fluid, the epiglottis closes over the trachea to prevent food going in to the lungs.

Erythrocyte sedimentation rates:
the rate at which red blood cells precipitate within an hour. ESR is a general test indicating the presence of inflammation within the
body.