Renal Care Plans

PKB has created a number of care plans for Renal teams to use with their patients at different stages of their kidney disease. Below are a list of the care plans with the key objectives and outcomes.

Renal Care Plan Workflow Diagram

Showing how care plans are added to patients PKB record and used by patients and team.

Renal Care plan Templates

MyCondition Care Plan

My Kidney Results and Measurements Tracker Care Plan

Managing My Chronic Kidney Disease Care Plan

Managing My Symptoms with Advanced Kidney Disease Care Plan

Enhanced Recovery After Surgery Care Plan

MyCondition Care Plan

Key Objectives

Provide kidney patients with a digital treatment plan, with their diagnoses, medications via HL7.

Outcome measures

Equip patients with the information they need digitally rather than relying on a face to face appointments and pharmacy prescriptions for a list of current medications.

Current Baselines

All activity is face to face, patients are travelling large distances, and their follow-ups aren’t being efficient.

Example HTML code for MyCondition Care Plan Template

Coming soon

My Kidney Results and Measurements Tracker Care Plan

Key Objectives

Provide kidney patients with a digital treatment plan to track and monitor their kidney blood results.

Outcome measures

Equip patients with the information they need digitally rather than relying on a face to face appointments or phone calls to find out their kidney blood results.

Current Baselines

Patients have to call the nurses to find out their blood test results, making it time-consuming for both patient and team.

Examples HTML for My Kidney Results and Measurements Tracker care plan

coming soon

Managing My Chronic Kidney Disease Care Plan

Key Objectives

Provide kidney patients with a digital care plan to support the management of their chronic kidney disease.

Outcome measures

Equip patients with the information they need digitally rather than relying on a face to face appointments or phone calls to give patients information on their kidney disease.

Current Baselines

All activity is face to face or over the phone. Patients are always retaining verbal information.

Example HTML code for Managing My Chronic Kidney Disease Care Plan

a {word-wrap: break-word;}

.form-group {width: 100%; !important}

ul {list-style:inherit; margin-left: 15px;}

.cp_label {font-size: 18px;font-weight: 900;}

.cp_whiteBox {background-color:#ffffff; padding:15px; margin-bottom:10px; margin-top:10px; -moz-border-radius: 10px; -webkit-border-radius: 10px; -khtml-border-radius: 10px; border-radius: 10px;}

</style>

<p> This plan is designed for patients with Chronic Kidney Disease (CKD) stage I to III. In cases of more advanced CKD patients should refer to Advanced Kidney Care (AKC) plan.</p>

<ul>

<li style="list-style:inherit; margin-left: 15px; margin-top: 5px"><a href="#about_disease">Understanding Chronic Kidney Disease (CKD)</a></li>

<ul>

<li style="list-style:circle; margin-left: 15px; margin-top: 5px"><a href="#kidneys">Kidneys</a></li>

<li style="list-style:circle; margin-left: 15px; margin-top: 5px"><a href="#more_CKD">More about CKD</a></li>

<li style="list-style:circle; margin-left: 15px; margin-top: 5px"><a href="#how_diagnosed">How is CKD diagnosed</a></li>

<li style="list-style:circle; margin-left: 15px; margin-top: 5px"><a href="#cause_CKD">What causes CKD</a></li>

</ul>

<li style="list-style:inherit; margin-left: 15px; margin-top: 5px"><a href="#living_disease">Living with Chronic Kidney Disease</a></li>

<ul>

<li style="list-style:circle; margin-left: 15px; margin-top: 5px"><a href="#exercise">Exercise</a></li>

<li style="list-style:circle; margin-left: 15px; margin-top: 5px"><a href="#smoking">Smoking</a></li>

<li style="list-style:circle; margin-left: 15px; margin-top: 5px"><a href="#weight">Weight (BMI)</a></li>

<li style="list-style:circle; margin-left: 15px; margin-top: 5px"><a href="#family">Family</a></li>

<li style="list-style:circle; margin-left: 15px; margin-top: 5px"><a href="#medication">Medication</a></li>

</ul>

<li style="list-style:inherit; margin-left: 15px; margin-top: 5px"><a href="#doctor_monitoring">How will my doctor or nurse monitor my CKD</a></li>

<ul>

<li style="list-style:circle; margin-left: 15px; margin-top: 5px"><a href="#k_function">Monitoring kidney function</a></li>

<li style="list-style:circle; margin-left: 15px; margin-top: 5px"><a href="#p_leak">Monitoring urine protein leak</a></li>

</ul>

<li style="list-style:inherit; margin-left: 15px; margin-top: 5px"><a href="#treatment">Treatment of CKD</a></li>

<ul>

<li style="list-style:circle; margin-left: 15px; margin-top: 5px"><a href="#b_pressure">Blood pressure</a></li>

<li style="list-style:circle; margin-left: 15px; margin-top: 5px"><a href="#diabetes">Diabetes</a></li>

<li style="list-style:circle; margin-left: 15px; margin-top: 5px"><a href="#ADPKD">Autosomal Dominant Polycystic Kidney Disease (ADPKD)</a></li>

</ul>

<li style="list-style:inherit; margin-left: 15px; margin-top: 5px"><a href="#my_involvement">How to be more involved in my care</a></li>

</ul>

</div>

<h2 style="color:#ffffff;">Understanding Chronic Kidney Disease (CKD)</h2>

</div>

<p>Chronic Kidney Disease (CKD) is a condition that affects the function of the kidneys. It tends to progress (get worse) over years and at some stage specialised care may be needed.</p>

<H2>Meet Glenn</H2>

</div>

<h2 style="color:#000000;">Kidneys</h2>

</div>

<ul>

<li style="list-style:inherit; margin-left: 15px; margin-top: 15px">Most people are born with 2 kidneys. They sit in the back under the lower ribs.</li>

<li style="list-style:inherit; margin-left: 15px; margin-top: 15px">They are shaped like kidney beans and each one is about the size of your clenched fist.</li>

<li style="list-style:inherit; margin-left: 15px; margin-top: 15px">The kidneys filter the blood and produce urine. Check the image below to understand the different kidney functions.</li>

</ul>

</div>

<h3 style="color:#000000;">What are the functions of the kidney?</h3>

</div>

<h2 style="color:#000000;">More about CKD</h2>

</div>

<ul>

<li style="list-style:inherit; margin-left: 15px; margin-top: 15px"> Chronic Kidney Disease happens when the kidneys do not work as well as they should.</li>

<li style="list-style:inherit; margin-left: 15px; margin-top: 15px"> It affects 10% of the population.</li>

<li style="list-style:inherit; margin-left: 15px; margin-top: 15px"> It can get worse with time (months or years).</li>

<li style="list-style:inherit; margin-left: 15px; margin-top: 15px"> Most people feel well and have no symptoms. Symptoms only start to show when the kidney function is very poor.</li>

<li style="list-style:inherit; margin-left: 15px; margin-top: 15px"> Adequate treatment can:</li>

<ul>

<li style="list-style:inherit; margin-left: 15px; margin-top: 15px"> Prevent or delay the progression of the disease </li>

<li style="list-style:inherit; margin-left: 15px; margin-top: 15px"> Prevent or delay the development of complications of CKD </li>

<li style="list-style:inherit; margin-left: 15px; margin-top: 15px"> Reduce the cardiovascular risk that comes with having CKD </li>

</ul>

<li style="list-style:inherit; margin-left: 15px; margin-top: 15px"> Have a look at the image to understand the different stages of CKD.</li>

</ul>

<br />

</div>

<h2 style="color:#000000;">How is CKD diagnosed</h2>

</div>

<ul>

<li style="list-style:inherit; margin-left: 15px; margin-top: 15px"> Early detection of CKD is not always easy because in most cases it does not cause symptoms so you do not present to the doctor!</li>

<li style="list-style:inherit; margin-left: 15px; margin-top: 15px"> A simple urine sample and blood test can check the kidney function.</li>

<li style="list-style:inherit; margin-left: 15px; margin-top: 15px"> The blood test will test the eGFR (estimated Glomerular Filtration Rate) also known as kidney percentage or kidney number. The higher the number, the better your kidney function. </li>

</ul>

<ul>

<li style="list-style:inherit; margin-left: 15px; margin-top: 15px"> A urine sample is also required to test for protein or blood in the urine. These things can indicate a kidney problem.</li>

<li style="list-style:inherit; margin-left: 15px; margin-top: 15px"> A doctor will ask you some questions to understand your medical history, current treatments and family history of kidney disease.</li>

<li style="list-style:inherit; margin-left: 15px; margin-top: 15px"> In some cases a GP may need to seek help from a kidney specialist (nephrologist), and sometimes a kidney biopsy is needed to make a diagnosis. A kidney biopsy is where a small piece of kidney is removed for testing under a microscope. Click here to find out more. Insert link to leaflet</li>

</ul>

</div>

<h2 style="color:#000000;">What causes CKD</h2>

</div>

<ul>

<li style="list-style:inherit; margin-left: 15px; margin-top: 15px"> Chronic kidney disease is caused by other diseases that over time put a strain on your kidneys, and cause them to lose function.</li>

<li style="list-style:inherit; margin-left: 15px; margin-top: 15px"> More than 70% cases of CKD are caused by diabetes and hypertension </li>

<li style="list-style:inherit; margin-left: 15px; margin-top: 15px"> Overtime, recurrent urine infections or kidney stones can also damage the kidneys and cause CKD.</li>

<li style="list-style:inherit; margin-left: 15px; margin-top: 15px"> Some immune disorders such a Lupus or vasculitis damage the little filters in a part of the kidney called the "glomerulus". As a result, these immune disorders can cause CKD too.</li>

<li style="list-style:inherit; margin-left: 15px; margin-top: 15px"> Polycystic Kidney Disease is an inherited condition that is responsible for a small number of CKD cases. It leads to the development of cysts (fluid sacks) that grow inside the kidney.</li>

<li style="list-style:inherit; margin-left: 15px; margin-top: 15px; font-weight: bold;"> Do you understand what caused your CKD? If you are not sure, ask your doctor or nurse next time to speak to them.</li>

</ul>

</div>

<h2 style="color:#ffffff;">Living with Chronic Kidney Disease (CKD)</h2>

</div>

</div>

<H2> Drinking</H2>

<ul>

<li style="list-style:inherit; margin-left: 15px; margin-top: 15px"> Good hydration is very important and we should all aim to drink 2 litres (4 pints) per day.</li>

<li style="list-style:inherit; margin-left: 15px; margin-top: 15px"> Most fluid intake should be water </li>

<li style="list-style:inherit; margin-left: 15px; margin-top: 15px"> Reduce alcohol drinking to <a href="https://www.nhs.uk/live-well/alcohol-support/calculating-alcohol-units/" target="_blank">safe recommendations</a></li>

<li style="list-style:inherit; margin-left: 15px; margin-top: 15px"> If you are experiencing fluid retention (e.g. ankle swelling) you may be advised to drink less.</li>

</ul>

<H2> Eating</H2>

<ul>

<li style="list-style:inherit; margin-left: 15px; margin-top: 15px"> Eating a <a href="https://www.nhs.uk/live-well/eat-well/" target="_blank">healthy diet rich in</a> fruit and vegetables and low in processed foods helps general health.</li>

<li style="list-style:inherit; margin-left: 15px; margin-top: 15px"> Reducing the salt in your diet helps to reduce blood pressure. <a href="https://www.nhs.uk/live-well/eat-well/tips-for-a-lower-salt-diet/" target="_blank"> Click here </a></li>

<li style="list-style:inherit; margin-left: 15px; margin-top: 15px"> Reducing sugary drinks and foods helps to prevent and control diabetes as well as looking after you teeth!</li>

<li style="list-style:inherit; margin-left: 15px; margin-top: 15px"> Depending on your blood results, you may be advised to avoid certain foods which contain potassium or phosphate. If this applies to you, your doctor or nurse will tell you.</li>

</ul>

</div>

<h2 style="color:#000000;">Exercise</h2>

</div>

<ul>

<li style="list-style:inherit; margin-left: 15px; margin-top: 15px"> Regular exercise helps to improve your general health, including your kidney health.</li>

<li style="list-style:inherit; margin-left: 15px; margin-top: 15px"> It boosts energy levels, helps sleeping and helps to reduce the risk of cardiovascular problems (e.g. heart disease).</li>

<li style="list-style:inherit; margin-left: 15px; margin-top: 15px"> Having CKD does not affect your ability to exercise.</li>

</ul>

</div>

</div>

<ul>

<li style="list-style:inherit; margin-left: 15px; margin-top: 15px"> Start slowly and build up gradually! You can find more information and videos <a href="https://www.kidneycareuk.org/about-kidney-health/living-kidney-disease/exercise/" target="_blank">here.</a></li>

</ul>

</div>

<h2 style="color:#000000;">Smoking</h2>

</div>

<ul>

<li style="list-style:inherit; margin-left: 15px; margin-top: 15px"> Smoking ruins your health, and damages your kidneys. Stop now! Find out more <a href="https://www.nhs.uk/better-health/quit-smoking/find-your-local-stop-smoking-service/#bt4Q3X2d7CKUh5Ml.97" target="_blank">here.</a></li>

<li style="list-style:inherit; margin-left: 15px; margin-top: 15px"> Call the free Smoke-free National Helpline on 0300 123 1044.</li>

</ul>

</div>

<h2 style="color:#000000;">Weight (BMI)</h2>

</div>

<ul>

<li style="list-style:inherit; margin-left: 15px; margin-top: 15px"> BMI stands for body mass index and measures if a person's weight is healthy for their height.</li>

<li style="list-style:inherit; margin-left: 15px; margin-top: 15px"> Keeping a healthy BMI helps your general health including your kidney health.</li>

<li style="list-style:inherit; margin-left: 15px; margin-top: 15px"> Obesity can speed up the progression of CKD. Losing weight (when overweight or obese) could improve your kidney function, blood pressure and diabetic control.</li>

<li style="list-style:inherit; margin-left: 15px; margin-top: 15px"> Find out your BMI and get NHS advice on your result<a href="https://www.nhs.uk/live-well/healthy-weight/bmi-calculator/" target="_blank"> here</a>.</li>

</ul>

</div>

<h2 style="color:#000000;">Family</h2>

</div>

<ul>

<li style="list-style:inherit; margin-left: 15px; margin-top: 15px"> CKD can affect sex drive in men and women. Fertility is maintained in early to moderate CKD but can decrease with severe CKD.</li>

<li style="list-style:inherit; margin-left: 15px; margin-top: 15px"> It is possible to have a safe pregnancy with CKD, but there may be an increased risk of complications during and post pregnancy.</li>

<li style="list-style:inherit; margin-left: 15px; margin-top: 15px"> Most kidney diseases are not transmitted to children, but some can be inherited, so it is important to know what caused your CKD in the first place, especially if there are a few cases in your family.</li>

<li style="list-style:inherit; margin-left: 15px; margin-top: 15px"> If you are planning a pregnancy or are worried about your children having CKD, discuss it with your doctor.</li>

<li style="list-style:inherit; margin-left: 15px; margin-top: 15px"><a href="https://www.kidney.org.uk/sexual-relationship-in-kidney-failure-having-children" target="_blank">Click here to find out more</a>.</li>

</ul>

</div>

<h2 style="color:#000000;">Medication</h2>

</div>

<ul>

<li style="list-style:inherit; margin-left: 15px; margin-top: 15px"> It is very important to carry a list of your medications with you <b>at all times</b> e.g. in your wallet or on your phone.</li>

<li style="list-style:inherit; margin-left: 15px; margin-top: 15px; font-weight: bold;"> Non-Steroidal Anti-inflammatory painkiller drugs (NSAIDS) such as ibuprofen and diclofenac can damage the kidneys and should be avoided (including gels and creams).</li>

<li style="list-style:inherit; margin-left: 15px; margin-top: 15px"> If you are finding a medication difficult to take or struggling with side effects, it is very important that you talk to your doctor because there may be an alternative.</li>

<li style="list-style:inherit; margin-left: 15px; margin-top: 15px"> If you are unwell, you should adjust your medication according to the sick day guidance.</li>

<li style="list-style:inherit; margin-left: 15px; margin-top: 15px; font-weight: bold;"> Remembering to take medication can be difficult, especially if you have a busy life, but it is really important that you understand it and take it correctly (medication name, dose, time and what it is for).</li>

<li style="list-style:inherit; margin-left: 15px; margin-top: 15px"> If you take more than one regular, prescribed medication you could save money by applying for a pre-paid prescription. To find out more on how to apply and how much money you would be saving <a href="https://www.nhsbsa.nhs.uk/help-nhs-prescription-costs/prescription-prepayment-certificates-ppcs" target="_blank">click here</a>.</li>

</ul>

</div>

<h2 style="color:#ffffff;"> How will my doctor or nurse monitor my CKD</h2>

</div>

<h2 style="color:#000000;">Monitoring kidney function</h2>

</div>

<ul>

<li style="list-style:inherit; margin-left: 15px; margin-top: 15px">Your kidney function will be measured by a blood test that tells us how much creatinine (waste) there is in your blood. A number called the estimated Glomerular Filtration Rate (eGFR) is calculated, which will tell you the level of kidney function.</li>

</ul>

<ul>

<li style="list-style:inherit; margin-left: 15px; margin-top: 15px"> It is very common to see the function going up and down time, so the most important way is to look at the overall trend over time to determine how quickly your kidney function is worsening.</li>

<li style="list-style:inherit; margin-left: 15px; margin-top: 15px"> It is normal to lose some kidney function with age and usually that alone does not cause concern. </li>

</ul>

</div>

<h2 style="color:#000000;">Monitoring urine protein leak</h2>

</div>

<ul>

<li style="list-style:inherit; margin-left: 15px; margin-top: 15px"> Often a urine sample is also requested to measure the level of protein leak in the urine, it can be called ACR (albumin creatinine ratio) or PCR (protein creatinine ratio).</li>

<li style="list-style:inherit; margin-left: 15px; margin-top: 15px"> If a urine sample shows protein (albumin) in the urine, it suggests kidney disease (even if the kidney function or eGFR are not affected).</li>

</ul>

</div>

<h2 style="color:#ffffff;"> Treatment of CKD</h2>

</div>

<p> Good self-management (life-style) and treatment of CKD aim to slow down the progression of kidney disease by years and months and ultimately try to prevent the stage of kidney failure.</p>

<p>Usually CKD is not symptomatic up to stage 4, however you should be aware of the common symptoms related to kidney disease. If you experience any of these you should talk to your doctor to see what treatment options there are to help you feel better.</p>

<ul>

<li style="list-style:inherit; margin-left: 15px; margin-top: 15px"> Swollen ankles</li>

<li style="list-style:inherit; margin-left: 15px; margin-top: 15px"> Lack of appetite</li>

<li style="list-style:inherit; margin-left: 15px; margin-top: 15px"> Nausea and vomiting</li>

<li style="list-style:inherit; margin-left: 15px; margin-top: 15px"> Dizziness</li>

<li style="list-style:inherit; margin-left: 15px; margin-top: 15px"> Itching</li>

<li style="list-style:inherit; margin-left: 15px; margin-top: 15px"> Shortness of breath</li>

<li style="list-style:inherit; margin-left: 15px; margin-top: 15px"> Insomnia</li>

<li style="list-style:inherit; margin-left: 15px; margin-top: 15px"> Cramps</li>

</ul>

</div>

<h2 style="color:#000000;">Blood pressure</h2>

</div>

<ul>

<li style="list-style:inherit; margin-left: 15px; margin-top: 15px"> High blood pressure is also called HYPERTENSION, <b>and is a major cause of kidney disease.</b> It can also lead to other cardiovascular diseases such as heart attack and stroke.</li>

<li style="list-style:inherit; margin-left: 15px; margin-top: 15px"> Often medication is needed to help control your blood pressure.</li>

<li style="list-style:inherit; margin-left: 15px; margin-top: 15px"> Ask your doctor what your blood pressure target is and register it here. <b>Your recommended blood pressure is: <input type="text" name="BP" id="BP" class="form-control"></input></b></li>

<li style="list-style:inherit; margin-left: 15px; margin-top: 15px"> We would recommend you record your blood pressure at home regularly. Click <a href="/test/myMeasurements.action" target="_blank">here</a> to record your blood pressure reading.</li>

<li style="list-style:inherit; margin-left: 15px; margin-top: 15px"> If you have financial hardship and need help to purchase a BP monitor you can apply to the <a href="https://www.westlondonkpa.org/about-us" target="_blank">West London Kidney Patients' Association</a></li>

<li style="list-style:inherit; margin-left: 15px; margin-top: 15px"> Watch this video about checking your blood pressure at home:</li>

</ul>

</div>

<h2 style="color:#000000;"> Diabetes</h2>

</div>

<ul>

<li style="list-style:inherit; margin-left: 15px; margin-top: 15px">Diabetes is a chronic disease that affects the pancreas and results in poor control of blood sugar levels. Over the years, diabetes damages small blood vessels in the whole body, including the kidneys and the filtering membrane of the kidney resulting in kidney disease. <a href="https://www.diabetes.org.uk/guide-to-diabetes/complications/kidneys_nephropathy" target="_blank">Click here to find out more</a></li>

<li style="list-style:inherit; margin-left: 15px; margin-top: 15px"> Diabetes treatments include diet and lifestyle changes, tablets and insulin </li>

<li style="list-style:inherit; margin-left: 15px; margin-top: 15px"> Good diabetic control is important to slow down the progression of the kidney disease.</li>

<li style="list-style:inherit; margin-left: 15px; margin-top: 15px"><u>How can patients gain control?</u></li>

<ul>

<li style="list-style:inherit; margin-left: 15px; margin-top: 15px"> Knowing what Hba1c blood test is and target </li>

<li style="list-style:inherit; margin-left: 15px; margin-top: 15px"> Understanding blood sugar readings</li>

<li style="list-style:inherit; margin-left: 15px; margin-top: 15px"> Knowing anti-diabetic medication (Metformin, canagflifozin, insulin) - when to take and when to miss </li>

</ul>

<li style="list-style:inherit; margin-left: 15px; margin-top: 15px"> Diagnosing diabetes early is very important to prevent long term complications (such as kidney failure) - You can screen yourself and your family <a href=" https://riskscore.diabetes.org.uk/start" target="_blank">here.</a></li>

</ul>

</div>

<h2 style="color:#000000;"> Autosomal Dominant Polycystic Kidney Disease (ADPKD)</h2>

</div>

<ul>

<li style="list-style:inherit; margin-left: 15px; margin-top: 15px"> ADPKD is an inherited disorder that leads to the growth of many cysts in the kidneys </li>

<li style="list-style:inherit; margin-left: 15px; margin-top: 15px"> Cysts are sacs filled with fluid that over time grow in number and size taking over the healthy kidney tissue and leading to kidney disease </li>

<li style="list-style:inherit; margin-left: 15px; margin-top: 15px"> It is a genetic condition, meaning that can be transmitted to children, and as a result there are often many cases in a family </li>

<li style="list-style:inherit; margin-left: 15px; margin-top: 15px"> To find out more about PKD <a href="https://pkdcharity.org.uk/" target="_blank"> click here.</a></li>

</ul>

</div>

<h2 style="color:#ffffff;"> How to be more involved in my care</h2>

</div>

<ul>

<li style="list-style:inherit; margin-left: 15px; margin-top: 15px"><u>Plan your appointment</u></li>

<li style="list-style:inherit; margin-left: 15px; margin-top: 15px"> Write down any questions you want to ask </li>

<li style="list-style:inherit; margin-left: 15px; margin-top: 15px"> Bring your medication list with you </li>

<li style="list-style:inherit; margin-left: 15px; margin-top: 15px"> Bring your home blood pressure readings </li>

<li style="list-style:inherit; margin-left: 15px; margin-top: 15px"> Sometimes, in chronic kidney disease, the treatment option may affect your family dynamics. Family members are welcome to take part in your care if you wish.</li>

</ul>

<li style="list-style:inherit; margin-left: 15px; margin-top: 15px"> Understand your kidney care (STEM of kidney health)</li>

<li style="list-style:inherit; margin-left: 15px; margin-top: 15px"> Would you like to attend a "know your kidneys" virtual education session? Ask your kidney doctor or nurse to invite you!</li>

<li style="list-style:inherit; margin-left: 15px; margin-top: 15px"> Register as a member with the <a href="https://www.westlondonkpa.org/about-us" target="_blank">West London Kidney Patients' Association</a>.</li>

<li style="list-style:inherit; margin-left: 15px; margin-top: 15px"> Find out more about chronic kidney disease:</li>

<ul>

<li style="list-style:inherit; margin-left: 15px; margin-top: 15px"><a href="https://www.nhs.uk/conditions/kidney-disease/" target="_blank">Chronic kidney disease</a></li>

<li style="list-style:inherit; margin-left: 15px; margin-top: 15px"><a href="https://www.kidney.org.uk" target="_blank">National Kidney Federation</a></li>

<li style="list-style:inherit; margin-left: 15px; margin-top: 15px"><a href="https://www.kidneycareuk.org/" target="_blank">Kidney Care UK</a></li>

<li style="list-style:inherit; margin-left: 15px; margin-top: 15px"><a href="https://www.diabetes.org.uk/" target="_blank">Diabetes UK</a></li>

<li style="list-style:inherit; margin-left: 15px; margin-top: 15px"><a href="http://www.bloodpressureuk.org/" target="_blank">Blood Pressure UK</a></li>

</ul>

<li style="list-style:inherit; margin-left: 15px; margin-top: 15px"> To access more patient leaflets and information explore the library section by clicking on the button: <a href="/library/manageLibrary.action" target="_blank" class="btn arrow btn-primary" title="Back to Top" alt="Click here to go to the library">Library Section</a></li>

</ul>

</div>

</div>

Managing My Symptoms with Advanced Kidney Disease Care Plan

Key Objectives

Provide kidney patients with a digital care plan to support the management of their chronic kidney disease.

Outcome measures

Equip patients with the information they need digitally rather than relying on a face to face appointments or phone calls to give patients information on their kidney disease.

Current Baselines

All activity is face to face or over the phone. Patients are always retaining verbal information.

Example HTML code for Managing my symptoms with Advanced Kidney Disease Care Plan

a {word-wrap: break-word;}

.form-group {width: 100%; !important}

.cp_label {font-size: 18px;font-weight: 900;}

.cp_whiteBox {background-color:#ffffff; padding:15px; margin-bottom:10px; margin-top:10px; -moz-border-radius: 10px; -webkit-border-radius: 10px; -khtml-border-radius: 10px; border-radius: 10px;}

</style>

<h2 style="color:#ffffff;">How to monitor and manage my kidney disease</h2>

</div>

<p>The Advanced kidney clinic care looks after people with stage 4 or 5 kidney disease. As a patient diagnosed with advanced kidney disease you will be reviewed and monitored by the Kidney consultant and a nurse specialist until you have a transplant or start dialysis in this clinic. If you choose not to have either of these treatments you will remain under their care as long as you are fit enough to attend.</p>

<p>The aims of your management is to continue the correct medical management for your condition, assist with your symptoms and support you in your decision making with regards to your treatment options.</p>

<p>You may also benefit from some other treatments that have been proven to benefit people with advanced kidney disease and your specialist will consider these when it is appropriate.</p>

<p>This plan is divided into the following sections:</p>

<ul>

<li style="list-style: inherit; margin-left: 15px;"><a href="#about_team">About my clinical team</a></li>

<li style="list-style: inherit; margin-left: 15px;"><a href="#recommend">Recommendations to patients</a></li>

<li style="list-style: inherit; margin-left: 15px;"><a href="#what_measure">List of measurements that you and your Dr or nurse will monitor</a></li>

<li style="list-style: inherit; margin-left: 15px;"><a href="#what_symptom">List of possible symptoms that you and your Dr and nurse will monitor</a></li>

<li style="list-style: inherit; margin-left: 15px;"><a href="#trafficlight">Traffic light symptoms guide</a></li>

</ul>

</div>

<h2 style="color:#ffffff;">About my clinical team</h2>

</div>

<label class="cp_label" for="cp_consultant">My consultant is:</label>

<b>

</b>

</div>

<label class="cp_label" for="cp_specialistNurseName">My specialist nurse is:</label>

<b>

</b>

</div>

<label class="cp_label" for="cp_specialistNurseContactDetails">Contact details for my specialist nurse:</label>

<b>

</b>

</div>

<h2 style="color:#ffffff;"> Recommendations to patients</h2>

</div>

<ul>

<li style="list-style:inherit; margin-left: 15px;">Take your medications as prescribed. If you think any of your tablets are disagreeing with you please inform your GP. Your GP will seek additional advice from your specialist team if necessary.</li>

<li style="list-style:inherit; margin-left: 15px;"><a href="https://www.nhs.uk/better-health/quit-smoking/" target="_blank" >Don't smoke.</a></li>

<li style="list-style:inherit; margin-left: 15px;">Keep alcohol intake to below the recommended <a href="https://www.drinkaware.co.uk/facts/alcoholic-drinks-and-units/how-much-alcohol-is-too-much" target="_blank" >government guidelines</a></li>

<li style="list-style:inherit; margin-left: 15px;">Try to be as active and exercise as is safely possible. </li>

<li style="list-style:inherit; margin-left: 15px;">Eat a healthy diet. If you have been advised of restrictions by your specialist team a renal dietician is available to offer advice. Ask your nurse specialist for a referral.</li>

</ul>

<p>This care plan is to help you and your family self-manage your kidney disease. You can use this plan as your online resource folder and to track symptoms. You can access additional information such as videos, information from kidney charities from resources available in the <a href="/library/manageLibrary.action" target="_blank" class="btn arrow btn-primary" title="Library section" alt="Click here to return to the Table of Contents">Library section</a></p>

<p>The Advanced kidney care clinic looks after you when you get to stage 4 or 5. Ask your team what stage you are at and what your GFR or level of kidney function is at.</p>

</div>

<h2 style="color:#ffffff;"> List of measurements that you and your Dr or Nurse will monitor </h2>

</div>

<h3>Blood pressure</h3>

<p>You will be advised what range of Blood pressure (BP) is best for you. You are encouraged to purchase a BP machine so that you can monitor your BP at home. We recommend looking at the pages which explain blood pressure and reading the <a href="https://s3.eu-central-1.amazonaws.com/pkb-uploads-nocrypto-eu-test/71515d22f07f4760b89380f0799c3e6f_A%20guide%20to%20understanding%20your%20blood%20pressure%20and%20how%20to%20take%20your%20own%20measurements%20at%20home.pdf" target="_blank" >leaflet on taking your Blood pressure</a> which also gives advice on buying one.</p>

<p>If you have financial hardship and need help to purchase a BP monitor you can apply to the <a href="https://www.westlondonkpa.org/about-us" target="_blank" >West London Kidney Patients' Association</a>. In addition read <a href="https://s3.eu-central-1.amazonaws.com/pkb-uploads-nocrypto-eu-test/beadcf2e605e4bb9a1aae3e71c1d2bb9_Applying%20for%20a%20grant.pdf" target="_blank" >this leaflet</a> from Kidney Care UK for information on types of grants and how to apply.</p>

<label for="cp_BPrecommend"><b style="font-size:20px"> Your recommended BP range is </b></label>

</b>

<h3>Kidney Function</h3>

<p>Your kidney function will be measured by a blood test that tells us how much Creatinine (waste) there is in your blood. A number called the Estimated Glomerular Filtration rate (e GFR) is calculated which will tell you the level of kidney function. The picture below explains the stages. You can learn more about kidney function by attending our 'Know your kidneys' seminar, speak to your nurse specialist if you are interested:</p>

<h3>Anaemia</h3>

<p>Your haemoglobin will be monitored. This tells you if you are anaemic. Treatments for anaemia include iron tablets or infusion and/or a hormone injection called Erythropoietin (EPO).</p>

<p><a href="https://www.kidneycareuk.org/about-kidney-health/conditions/anaemia/" target="_blank" >https://www.kidneycareuk.org/about-kidney-health/conditions/anaemia/</a></p>

<h3>Bone health</h3>

<p>The kidneys play a role in keeping your bones healthy. A blood test to monitor the Calcium, Phosphate and Parathyroid hormone level will tell us how your bone health is. You can read more about bone health in kidney Disease here:</p>

<p><a href="https://www.kidneycareuk.org/about-kidney-health/conditions/chronic-kidney-disease-mineral-bone-disease-ckd-mbd/" target="_blank" >https://www.kidneycareuk.org/about-kidney-health/conditions/chronic-kidney-disease-mineral-bone-disease-ckd-mbd/</a></p>

<h3>Fluid balance</h3>

<p>The kidneys play a role in keeping the fluid in your body balanced. You will have a physical assessment by the nurse specialist or Doctor to assess your fluid balance. Weight and blood pressure also tells us if your fluid is balanced . It is useful to keep an eye on your weight in Kilograms (KG). Sometimes you may be asked to monitor it regularly. </p>

<p>In general 1.0KG weight = 1.0 litre of fluid.</p>

<p>It is recommended that you drink 2.0 litres of fluid per day unless you are taking diuretics (water pills) or have been advised by your Doctor or nurse to reduce your daily intake. </p>

<p>More information can be found about fluid balance <a href="https://s3.eu-central-1.amazonaws.com/pkb-uploads-nocrypto-eu-test/5551eb3197fc4dabaad84a48a21bc2dc_Managing%20your%20fluid%20-%20patient%20information.pdf" target="_blank" >here</a></p>

<p>The signs to look out for dehydration or too much fluid in your body are listed in the <a href="#trafficlight">traffic light symptoms guide below.</a></p>

</div>

<h2 style="color:#ffffff;"> List of Possible Symptoms that you and your Dr or Nurse will monitor </h2>

</div>

<p>People with Kidney disease rarely suffer any particular symptoms until their kidney function has fallen to stage 4 or 5. Symptoms vary from person to person, no two people would experience the same symptoms. Here is a list of some of the common ones that you may experience. The <a href="#trafficlight">traffic light symptoms guide</a> will help you to manage your symptoms and know what to do if they change or get worse. Note that some symptoms can be caused by more than one problem for example breathlessness could be related to fluid level or anaemia. For this reason the symptoms are grouped to help you. </p>

<ul>

<li style="list-style:inherit; margin-left: 15px;">Lack of appetite</li>

<li style="list-style:inherit; margin-left: 15px;">Weight loss</li>

<li style="list-style:inherit; margin-left: 15px;">Vomiting</li>

<li style="list-style:inherit; margin-left: 15px;">Bad taste in mouth</li>

<li style="list-style:inherit; margin-left: 15px;">Halitosis (bad breath)</li>

<li style="list-style:inherit; margin-left: 15px;">Tiredness</li>

<li style="list-style:inherit; margin-left: 15px;">Lethargy</li>

<li style="list-style:inherit; margin-left: 15px;">Dizziness</li>

<li style="list-style:inherit; margin-left: 15px;">Itching</li>

<li style="list-style:inherit; margin-left: 15px;">Loss of libido</li>

<li style="list-style:inherit; margin-left: 15px;">Shortness of breath</li>

<li style="list-style:inherit; margin-left: 15px;">Swollen ankle</li>

<li style="list-style:inherit; margin-left: 15px;">Insomnia</li>

<li style="list-style:inherit; margin-left: 15px;">Cramps</li>

</ul>

<p>If you experience any of the symptoms listed above, please use this plan to record this information. To do this, select the <b>Edit plan</b> button at the top of the page, select the <i>List of Possible Symptoms that you and your Dr or Nurse will monitor</i> hyperlink, record your symptoms in the relevant sections of the plan and select <b>Save</b> to save the information you have added.</p>

<H3>Additional symptoms I have experienced (not listed above)</H3>

<p>

<p style="color:black; padding:15px; margin-bottom:10px; margin-top:10px; -moz-border-radius: 10px; -webkit-border-radius: 10px; -khtml-border-radius: 10px; border-radius: 10px; border: 2px solid red;"><b>Please note</b> that your doctor or nurse will not be routinely checking this information. So it is important that you contact them directly about anything concerning you.</p>

</div>

</div>

Enhanced Recovery After Surgery Care Plan

Key Objectives

Provide a tool for the remote management of kidney transplant patients

Outcome measures

Equip patients with the tools they need to support self-management post-operatively, as well as providing the tools they need to interact digitally rather than relying on a face to face consultations.

Current Baselines

All activity is face to face, patients are travelling large distances, and their follow-ups aren’t being efficiently, or effectively managed.

Workflow:

The whole workflow is from pre op> transplant> post-op but the care plan is introduced in the transplant phase.

Patient pathway

Patients register with their PKB record before surgery or on the ward post-operatively when the Enhance Recovery care plan is added to the patient's PKB record on day one by the nurse caring for the patient.

The care plan is completed by the nurse each day while the patient is in the hospital, which is normally for six days post-operatively, before being discharged home where they will complete the care plan themself. The care plan is then reviewed daily by the team over the phone with the patient.

Enhance Recovery After Surgery Care Plan Template

Days 1-2 and days 8-10

Example HTML code for Renal Enhance recovery after surgery Care Plan

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.form-group {width: 100%; !important}

.cp_label {font-size: 18px;font-weight: 900;}

.cp_whiteBox {background-color:#ffffff; padding:15px; margin-bottom:10px; margin-top:10px; -moz-border-radius: 10px; -webkit-border-radius: 10px; -khtml-border-radius: 10px; border-radius: 10px;}

.cp_frame {height: 80px; position: relative;}

.cp_imgCentre {width: 60px; position: absolute; top: 50%; left: 50%; transform: translate(-50%, -50%);}

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<p>Quick links: <a href="#cp_day1anchor">Day 1</a> / <a href="#cp_day2anchor">Day 2</a> / <a href="#cp_day3anchor">Day 3</a> / <a href="#cp_day4anchor">Day 4</a> /

<a href="#cp_day5anchor">Day 5</a> / <a href="#cp_day6anchor">Day 6</a> / <a href="#cp_day7anchor">Day 7</a> / <a href="#cp_day8anchor">Day 8</a> /

<h2>Introduction to our enhanced recovery programme</h2>

<p>Enhanced recovery after surgery (ERAS) helps patients to recover more quickly from their transplant. Reaching certain targets can reduce the likelihood of complications and can help improve the experience of patients as they recover.</p>

<p>We hope this journal will help you to understand what to expect and feel more involved in what happens during your transplant inpatient journey. The journal is yours to keep and complete to help you record your progress. Relatives, friends and members of the transplant team can help you to fill it in if you find this difficult. By completing this journal as you go along, it will help us to support you and ensure your recovery is as efficient as possible.</p>

<p><b>All elements of the programme may not be suitable for everyone. Do not worry if you don't meet all of your targets. Every patient is different and everyone will achieve targets at their own pace. The transplant team will make any changes where needed to make sure that you receive high quality care specific to your needs.</b></p>

<h2>On admission for your transplant</h2>

<ul>

<li style="list-style:inherit; margin-left: 15px;">The nurses will ask you some questions to help plan for your needs when you go home.</li>

<li style="list-style:inherit; margin-left: 15px;">If you have a relative or friend who can be a support person during your recovery, please arrange for them to be available in the afternoon on days 3 and 4 following your transplant. This is an important part of your recovery where the nurses will provide you with education on how to look after your transplant as well as the details of your medications.</li>

<li style="list-style:inherit; margin-left: 15px;">Please record the details of your support person below.</li>

</ul>

<label class="cp_label" for="cp_namedSupportPerson">Named support person:</label>

</div>

</div>

<label class="cp_label" for="cp_supportRelationship">Relationship:</label>

</div>

</div>

<label class="cp_label" for="cp_admissionDate">Date of admission:</label>

</div>

</div>

<label class="cp_label" for="cp_transplantDate">Date of transplant:</label>

</div>

</div>

<label class="cp_label" for="cp_estDischargeDate">Estimated Date of discharge:</label>

</div>

</div>

</div>

<h3>After surgery</h3>

</div>

</div>

</div>

</div>

<h3 class="hidden-lg hidden-md hidden-sm">After surgery</h3>

<p>Eat & drink as soon as you feel able. You have a drip to keep you hydrated.</p>

</div>

<p>Your drip stops today. Try to drink to your fluid target.</p>

</div>

<p>Try to drink to your fluid target. The nurses will help you to record your fluid intake.</p>

</div>

</div>

<h3 class="hidden-lg hidden-md hidden-sm">After surgery</h3>

<p>The nurses will help you to sit out in your chair.</p>

</div>

<p>Try to sit in your chair for every meal. Aim for two walks.</p>

</div>

<p>Try to sit in your chair for every meal. Aim for four walks.</p>

</div>

</div>

<h3 class="hidden-lg hidden-md hidden-sm">After surgery</h3>

<p>Your weight will not routinely be measured today.</p>

</div>

<p>The nurses will help to weigh you before breakfast.</p>

</div>

<p>The nurses will help you to weigh yourself. Please record it in your journal.</p>

</div>

</div>

<h3 class="hidden-lg hidden-md hidden-sm">After surgery</h3>

<p>Use your PCA button as much as you need. Your pain catheter will keep you comfortable.</p>

</div>

<p>Your PCA stops today. Your pain catheter is still there and you will be given pain relief.</p>

</div>

<p>Your pain catheter may be removed. The nurses will help you to take pain relief.</p>

</div>

<h3 class="hidden-lg hidden-md hidden-sm">no title</h3>

</div>

<p>The nurses will monitor your drain output.</p>

</div>

<p>The nurses will help you to record the drain output in your journal.</p>

</div>

<p>Record the drain output in your journal. If the volume is low, it may be removed.</p>

</div>

</div>

<h3 class="hidden-lg hidden-md hidden-sm">After surgery</h3>

<p>The nurses will monitor your urine output.</p>

</div>

<p>The nurses will help you to record your urine output.</p>

</div>

<p>The nurses will help you to record your urine output.</p>

</div>

</div>

<h3 class="hidden-lg hidden-md hidden-sm">After surgery</h3>

<p>The nurses will give you all the medicine you need.</p>

</div>

<p>You will be given your medicine card today.</p>

</div>

<p>The nurses will help you to start taking your own medicines using your card.</p>

</div>

</div>

<h3 class="hidden-lg hidden-md hidden-sm">After surgery</h3>

<p>Let the nurses know if anything has changed with your needs on discharge.</p>

</div>

<p>Let the nurses know if anything has changed with your needs on discharge.</p>

</div>

<p>Let the nurses know if anything has changed with your needs on discharge.</p>

</div>

</div>

</div>

</div>

</div>

</div>

<p>Try to drink to your fluid target and record your fluid intake. The nurses will help you.</p>

</div>

<p>Try to drink to your fluid target. Please record your fluid intake.</p>

</div>

<p>Try to drink to your fluid target. Please record your fluid intake.</p>

</div>

</div>

<p>Try to sit in your chair for every meal. Aim for four walks.</p>

</div>

<p>Try to sit in your chair for every meal. Aim for four walks.</p>

</div>

<p>Try to sit in your chair for every meal. Aim for four walks.</p>

</div>

</div>

<p>Please weigh yourself and record it in your journal.</p>

</div>

<p>Please weigh yourself and record it in your journal.</p>

</div>

<p>Please weigh yourself and record it in your journal.</p>

</div>

</div>

<p>Continue to take pain relief as needed to keep you comfortable and mobile.</p>

</div>

<p>Continue to take pain relief as needed to keep you comfortable and mobile.</p>

</div>

<p>Continue to take pain relief as needed to keep you comfortable and mobile.</p>

</div>

</div>

<p>If you still have a drain, record the output in your journal. It may be removed today.</p>

</div>

<p>If you still have a drain, record the output in your journal. It may be removed today.</p>

</div>

<p>You may go home with the drain. The nurses will show you how to look after it.</p>

</div>

</div>

<p>Your catheter may be removed today. The nurses will help to record your output.</p>

</div>

<p>Please continue to record your urine output.</p>

</div>

<p>Please continue to record your urine output.</p>

</div>

</div>

<p>Use your card to identify your medicines. The nurses will check them.</p>

</div>

<p>Use your card to identify your medicines. The nurses will check them.</p>

</div>

<p>Use your card to identify your medicines. The nurses will check them.</p>

</div>

</div>

<p>The nurses will teach you and your support person about caring for your transplant.</p>

</div>

<p>You will have a second education session today. We are preparing for you going home. Let us know if you don't feel ready.</p>

</div>

<p>You may be discharged home today if you are ready.</p>

</div>

<h2>After Surgery</h2>

</div>

<h3>Drinking</h3>

<p>You can start to eat and drink as you feel able. If you are struggling, let the nurses know.</p>

</div>

</div>

<h3>Mobility</h3>

<p>The nurses will help you to sit out in your chair if possible. Tomorrow, the physiotherapist will provide you with breathing exercises and a mobility programme to help you recover.</p>

</div>

</div>

<h3>Weight</h3>

<p>The nurses will help you to weigh yourself before breakfast. Please record your weight below.</p>

</div>

</div>

<h3>Pain management</h3>

<p>Your PCA and pain catheter will help to keep you comfortable. Talk to the nurses if you have pain.</p>

</div>

</div>

<h3>Drain</h3>

<p>The nurses will monitor and record your drain output.</p>

</div>

</div>

<h3>Catheter</h3>

<p>The nurses will monitor and record your urine output.</p>

</div>

</div>

<h3>Medicines</h3>

<p>The nurses will give you all your medications.</p>

</div>

</div>

<h3>Care planning</h3>

<p>Let the nurses know if anything has changed with your home circumstances or other needs for when you go home. Do you have someone to take you home and bring you to clinic appointments?</p>

</div>

<h2 id="cp_day1anchor">Day 1 after surgery</h2>

</div>

<h3>Drinking</h3>

<p>If the team is happy with your fluids, your drip will stop today. You will be asked to drink and the team will give you a target to aim for. If you are struggling, let the nurses know. Record your fluid target and how much you drink below.</p>

</div>

</div>

<h3>Mobility</h3>

<p>The physiotherapist will show you some breathing exercises and give you a mobility programme (A, B or C). This will include two walks today. Try to follow this as much as possible. Aim to sit in your chair for every meal. Record your progress below.</p>

</div>

</div>

<h3>Weight</h3>

<p>The nurses will help you to weigh yourself before breakfast. Please record your weight below.</p>

</div>

</div>

<h3>Pain management</h3>

<p>Your pain catheter may be removed today. The nurses will help you to take your oral painkillers. Heat packs are also available to help. Talk to the nurses if you have pain.</p>

</div>

</div>

<h3>Drain</h3>

<p>The nurses will help you to monitor your drain output. Please record this below. Your drain may be removed today if the volume is less than 100ml.</p>

</div>

</div>

<h3>Catheter</h3>

<p>The nurses will help you to monitor your urine output. Please record this below.</p>

</div>

</div>

<h3>Medicines</h3>

<p>We will explain your medications to you today. We will help you to use your card to identify your medications.</p>

</div>

</div>

<p>Let the nurses know if anything has changed with your home circumstances or other needs for when you go home. Do you have someone to take you home and bring you to clinic appointments?</p>

</div>

<h2>Progress day 1</h2>

<p><b><u>Before the morning ward round</u></b></p>

<p>Please record yesterday's fluid measurements up to this morning</p>

<label class="cp_label" for="cp_qtyDrink">How much did you drink?</label>

</div>

<input type="text" name="cp_qtyDrink" id="cp_qtyDrink" class="form-control"></input> ml

</div>

<label class="cp_label" for="cp_qtyUrine">How much urine did you pass?</label>

</div>

<input type="text" name="cp_qtyUrine" id="cp_qtyUrine" class="form-control"></input> ml

</div>

<label class="cp_label" for="cp_qtyDrain">What was the drain output?</label>

</div>

<input type="text" name="cp_qtyDrain" id="cp_qtyDrain" class="form-control"></input> ml

</div>

<p>Please record your weight this morning <a href="#bottom">here</a></p>

</div>

<p><b><u>During the morning ward round</u></b></p>

<label class="cp_label" for="cp_day1FluidTarget">Today's fluid target is:</label>

</div>

<input type="text" name="cp_day1FluidTarget" id="cp_day1FluidTarget" class="form-control"></input> ml

</div>

<p><b><u>Physiotherapy assessment</u></b></p>

<label class="cp_label" for="cp_day1MobilityProgramme">Your mobility programme is: (please select)</label>

</div>

<div>

</div>

</div>

</div>

<p><b><u>After the evening ward round</u></b></p>

<label class="cp_label" for="cp_Day1targetComplete">Please tick the targets as you manage them</label>

</div>

<input class="form-check-input form-control" type="checkbox" name="cp_Day1targetCompletea" id="cp_Day1targetCompletea" value="I reached my fluid target?"> I reached my fluid target?</input>

</div>

<input class="form-check-input form-control" type="checkbox" name="cp_Day1targetCompleteb" id="cp_Day1targetCompleteb" value="I managed to weigh myself?"> I managed to weigh myself?</input>

</div>

<input class="form-check-input form-control" type="checkbox" name="cp_Day1targetCompletec" id="cp_Day1targetCompletec" value="I recorded my measurements?"> I recorded my measurements?</input>

</div>

<label class="cp_label" for="cp_day1WalksManaged">How many walks did you manage?</label>

</div>

</div>

<label class="cp_label" for="cp_day1TimesSat">How many times did you manage to sit in your chair?</label>

</div>

</div>

<p>If you had difficulty reaching your daily targets, don't worry. Tell us what you are finding difficult (e.g. pain, sickness, too tired).</p>

<label class="cp_label" for="cp_day1Questions">If you have questions for the transplant team, you might find it useful to write them here:</label>

</div>

<h2 id="cp_day2anchor">Day 2 after surgery</h2>

</div>

<h3>Drinking</h3>

<p>Try to drink to your fluid target. The nurses will help you to record your fluid target and fluid intake below.</p>

</div>

</div>

<h3>Mobility</h3>

<p>Aim to sit in your chair for every meal. Try to follow your mobility programme, which will include four walks today. Ask the nurses to help you with this. Please record your progress below.</p>

</div>

</div>

<h3>Weight</h3>

<p>The nurses will help you to weigh yourself before breakfast. Please record your weight below.</p>

</div>

</div>

<h3>Pain management</h3>

<p>Your pain catheter may be removed today. The nurses will help you to take your oral painkillers. Heat packs are also available to help. Talk to the nurses if you have pain.</p>

</div>

</div>

<h3>Drain</h3>

<p>The nurses will help you to monitor your drain output. Please record this below. Your drain may be removed today if the volume is less than 100ml.</p>

</div>

</div>

<h3>Catheter</h3>

<p>The nurses will help you to monitor your urine output. Please record this below.</p>

</div>

</div>

<h3>Medicines</h3>

<p>We will explain your medications to you today. We will help you to use your card to identify your medications.</p>

</div>

</div>

<p>Let the nurses know if anything has changed with your home circumstances or other needs for when you go home. Do you have someone to take you home and bring you to clinic appointments?</p>

</div>

<h2>Progress day 2</h2>

<p><b><u>Before the morning ward round</u></b></p>

<p>Please record yesterday's fluid measurements up to this morning</p>

<label class="cp_label" for="cp_qtyDrink_day2">How much did you drink?</label>

</div>

<input type="text" name="cp_qtyDrink_day2" id="cp_qtyDrink_day2" class="form-control"></input> ml

</div>

<label class="cp_label" for="cp_qtyUrine_day2">How much urine did you pass?</label>

</div>

<input type="text" name="cp_qtyUrine_day2" id="cp_qtyUrine_day2" class="form-control"></input> ml

</div>

<label class="cp_label" for="cp_qtyDrain_day2">What was the drain output?</label>

</div>

<input type="text" name="cp_qtyDrain_day2" id="cp_qtyDrain_day2" class="form-control"></input> ml

</div>

<p>Please record your weight this morning <a href="#bottom">here</a></p>

</div>

<p><b><u>During the morning ward round</u></b></p>

<label class="cp_label" for="cp_FluidTarget_day2">Today's fluid target is:</label>

</div>

<input type="text" name="cp_FluidTarget_day2" id="cp_FluidTarget_day2" class="form-control"></input> ml

</div>

<p><b><u>Physiotherapy assessment</u></b></p>

<label class="cp_label" for="cp_MobilityProgramme_day2">Your mobility programme is: (please select)</label>

</div>

<div>

</div>

</div>

</div>

<p><b><u>After the evening ward round</u></b></p>

<label class="cp_label" for="cp_targetComplete_day2">Please tick the targets as you manage them</label>

</div>

<input class="form-check-input form-control" type="checkbox" name="cp_targetComplete_day2a" id="cp_targetComplete_day2a" value="I reached my fluid target?"> I reached my fluid target?</input>

</div>

<input class="form-check-input form-control" type="checkbox" name="cp_targetComplete_day2b" id="cp_targetComplete_day2b" value="I managed to weigh myself?"> I managed to weigh myself?</input>

</div>

<input class="form-check-input form-control" type="checkbox" name="cp_targetComplete_day2c" id="cp_targetComplete_day2c" value="I recorded my measurements?"> I recorded my measurements?</input>

</div>

<label class="cp_label" for="cp_WalksManaged_day2">How many walks did you manage?</label>

</div>

</div>

<label class="cp_label" for="cp_TimesSat_day2">How many times did you manage to sit in your chair?</label>

</div>

</div>

<p>If you had difficulty reaching your daily targets, don't worry. Tell us what you are finding difficult (e.g. pain, sickness, too tired).</p>

<label class="cp_label" for="cp_day2Questions">If you have questions for the transplant team, you might find it useful to write them here:</label>

</div>

<h2 id="day3anchor">Day 3 after surgery</h2>

</div>

<h3>Drinking</h3>

<p>Try to drink to your fluid target. If you are struggling, let the nurses know. Please record your fluid target and fluid intake below.</p>

</div>

</div>

<h3>Mobility</h3>

<p>Aim to sit in your chair for every meal. Try to follow your mobility programme which will include four walks today. Ask the nurses for assistance with this and record your progress below.</p>

</div>

</div>

<h3>Weight</h3>

<p>Please weigh yourself before breakfast and record your weight below.</p>

</div>

</div>

<h3>Pain management</h3>

<p>Continue to take oral painkillers as you need them. The nurses will help and will record what you are taking. Heat packs are available. Talk to the nurses if you have pain.</p>

</div>

</div>

<h3>Drain</h3>

<p>If you still have a drain and the volume is less than 100ml in the last 24 hours, it may be removed today. If you still need it, the nurses will help you to monitor your drain output.</p>

</div>

</div>

<h3>Catheter</h3>

<p>Your urinary catheter may be removed today. Please record your urine output below. If your catheter needs to stay longer, we will reassess this each day and give you an expected date for removal. The nurses will change your urine bag to a leg bag to make it easier for you to move around.</p>

</div>

</div>

<h3>Medicines</h3>

<p>Please use your card to identify your medicines. The nurses will check they are correct before you take them.</p>

</div>

</div>

<p>If possible, your support person should attend the ward today or be available for video/phone call around 3pm. The nurses will provide you both with important education about your transplant and plans for going home.</p>

</div>

<h2>Progress day 3</h2>

<p><b><u>Before the morning ward round</u></b></p>

<p>Please record yesterday's fluid measurements up to this morning</p>

<label class="cp_label" for="cp_qtyDrink_day3">How much did you drink?</label>

</div>

<input type="text" name="cp_qtyDrink_day3" id="cp_qtyDrink_day3" class="form-control"></input> ml

</div>

<label class="cp_label" for="cp_qtyUrine_day3">How much urine did you pass?</label>

</div>

<input type="text" name="cp_qtyUrine_day3" id="cp_qtyUrine_day3" class="form-control"></input> ml

</div>

<label class="cp_label" for="cp_qtyDrain_day3">What was the drain output?</label>

</div>

<input type="text" name="cp_qtyDrain_day3" id="cp_qtyDrain_day3" class="form-control"></input> ml

</div>

<p>Please record your weight this morning <a href="#bottom">here</a></p>

</div>

<p><b><u>During the morning ward round</u></b></p>

<label class="cp_label" for="cp_FluidTarget_day3">Today's fluid target is:</label>

</div>

<input type="text" name="cp_FluidTarget_day3" id="cp_FluidTarget_day3" class="form-control"></input> ml

</div>

<p><b><u>Physiotherapy assessment</u></b></p>

<label class="cp_label" for="cp_MobilityProgramme_day3">Your mobility programme is: (please select)</label>

</div>

<div>

</div>

</div>

</div>

<p><b><u>After the evening ward round</u></b></p>

<label class="cp_label" for="cp_targetComplete_day3">Please tick the targets as you manage them</label>

</div>

<input class="form-check-input form-control" type="checkbox" name="cp_targetComplete_day3a" id="cp_targetComplete_day3a" value="I reached my fluid target?"> I reached my fluid target?</input>

</div>

<input class="form-check-input form-control" type="checkbox" name="cp_targetComplete_day3b" id="cp_targetComplete_day3b" value="I managed to weigh myself?"> I managed to weigh myself?</input>

</div>

<input class="form-check-input form-control" type="checkbox" name="cp_targetComplete_day3c" id="cp_targetComplete_day3c" value="I recorded my measurements?"> I recorded my measurements?</input>

</div>

<label class="cp_label" for="cp_WalksManaged_day3">How many walks did you manage?</label>

</div>

</div>

<label class="cp_label" for="cp_TimesSat_day3">How many times did you manage to sit in your chair?</label>

</div>

</div>

<p>If you had difficulty reaching your daily targets, don't worry. Tell us what you are finding difficult (e.g. pain, sickness, too tired).</p>

<label class="cp_label" for="cp_day3Questions">If you have questions for the transplant team, you might find it useful to write them here:</label>

</div>

<h2 id="cp_day4anchor">Day 4 after surgery</h2>

</div>

<h3>Drinking</h3>

<p>Try to drink to your fluid target. If you are struggling, let the nurses know. Please record your fluid target and fluid intake below.</p>

</div>

</div>

<h3>Mobility</h3>

<p>Aim to sit in your chair for every meal. Try to follow your mobility programme which will include four walks today. Ask the nurses for assistance with this and record your progress below.</p>

</div>

</div>

<h3>Weight</h3>

<p>Please weigh yourself before breakfast and record your weight below.</p>

</div>

</div>

<h3>Pain management</h3>

<p>Continue to take oral painkillers as you need them (the nurses will need to record what you are taking). Heat packs are available to help. Talk to the nurses if you have pain.</p>

</div>

</div>

<h3>Drain</h3>

<p>The nurses will help you to monitor your drain output. Please record this below. Your drain may be removed today if the volume is less than 100ml.</p>

</div>

</div>

<h3>Catheter</h3>

<p>Please record your urine output below. Ask the nurses if you need help with this. If you still have a catheter, we will continue to assess how long you need it for.</p>

</div>

</div>

<h3>Medicines</h3>

<p>Please use your card to identify your medicines. The nurses will check they are correct before you take them.</p>

</div>

</div>

<p>The nurses will go over any education needed in preparation for going home and order your medications. We are preparing for your possible discharge home tomorrow. It is very important to tell us about any worries or any help you need at home as soon as possible.</p>

</div>

<h2>Progress day 4</h2>

<p><b><u>Before the morning ward round</u></b></p>

<p>Please record yesterday's fluid measurements up to this morning</p>

<label class="cp_label" for="cp_qtyDrink_day4">How much did you drink?</label>

</div>

<input type="text" name="cp_qtyDrink_day4" id="cp_qtyDrink_day4" class="form-control"></input> ml

</div>

<label class="cp_label" for="cp_qtyUrine_day4">How much urine did you pass?</label>

</div>

<input type="text" name="cp_qtyUrine_day4" id="cp_qtyUrine_day4" class="form-control"></input> ml

</div>

<label class="cp_label" for="cp_qtyDrain_day4">What was the drain output?</label>

</div>

<input type="text" name="cp_qtyDrain_day4" id="cp_qtyDrain_day4" class="form-control"></input> ml

</div>

<p>Please record your weight this morning <a href="#bottom">here</a></p>

</div>

<p><b><u>During the morning ward round</u></b></p>

<label class="cp_label" for="cp_FluidTarget_day4">Today's fluid target is:</label>

</div>

<input type="text" name="cp_FluidTarget_day4" id="cp_FluidTarget_day4" class="form-control"></input> ml

</div>

<p><b><u>Physiotherapy assessment</u></b></p>

<label class="cp_label" for="cp_MobilityProgramme_day4">Your mobility programme is: (please select)</label>

</div>

<div>

</div>

</div>

</div>

<p><b><u>After the evening ward round</u></b></p>

<label class="cp_label" for="cp_targetComplete_day4">Please tick the targets as you manage them</label>

</div>

<input class="form-check-input form-control" type="checkbox" name="cp_targetComplete_day4a" id="cp_targetComplete_day4a" value="I reached my fluid target?"> I reached my fluid target?</input>

</div>

<input class="form-check-input form-control" type="checkbox" name="cp_targetComplete_day4b" id="cp_targetComplete_day4b" value="I managed to weigh myself?"> I managed to weigh myself?</input>

</div>

<input class="form-check-input form-control" type="checkbox" name="cp_targetComplete_day4c" id="cp_targetComplete_day4c" value="I recorded my measurements?"> I recorded my measurements?</input>

</div>

<label class="cp_label" for="cp_WalksManaged_day4">How many walks did you manage?</label>

</div>

</div>

<label class="cp_label" for="cp_TimesSat_day4">How many times did you manage to sit in your chair?</label>

</div>

</div>

<p>If you had difficulty reaching your daily targets, don't worry. Tell us what you are finding difficult (e.g. pain, sickness, too tired).</p>

<label class="cp_label" for="cp_day4Questions">If you have questions for the transplant team, you might find it useful to write them here:</label>

</div>

<h2 id="cp_day5anchor">Day 5 after surgery</h2>

</div>

<h3>Drinking</h3>

<p>Try to drink to your fluid target. If you are struggling, let the nurses know. Please record your fluid target and fluid intake below.</p>

</div>

</div>

<h3>Mobility</h3>

<p>Aim to sit in your chair for every meal. Try to follow your mobility programme which will include four walks today. Ask the nurses for assistance with this and record your progress below.</p>

</div>

</div>

<h3>Weight</h3>

<p>Please weigh yourself before breakfast and record your weight below.</p>

</div>

</div>

<h3>Pain management</h3>

<p>Continue to take oral painkillers as you need them (the nurses will need to record what you are taking). Heat packs are available to help. Talk to the nurses if you have pain.</p>

</div>

</div>

<h3>Drain</h3>

<p>If the drain volume remains high you may need to go home with it. Please continue to measure and record the output. The nurses will show you how to care for it yourself.</p>

</div>

</div>

<h3>Catheter</h3>

<p>Please record your urine output below. If you need to go home with your catheter, the nurses will show you how to care for it yourself.</p>

</div>

</div>

<h3>Medicines</h3>

<p>Please use your card to identify your medicines. The nurses will check they are correct before you take them.</p>

</div>

</div>

<p>The nurses will go over any education needed in preparation for going home. Please check your medicine card is up to date. The team are preparing for your possible discharge home today. If you or your family are worried about going home, let us know.</p>

</div>

<h2>Progress day 5</h2>

<p><b><u>Before the morning ward round</u></b></p>

<p>Please record yesterday's fluid measurements up to this morning</p>

<label class="cp_label" for="cp_qtyDrink_day5">How much did you drink?</label>

</div>

<input type="text" name="cp_qtyDrink_day5" id="cp_qtyDrink_day5" class="form-control"></input> ml

</div>

<label class="cp_label" for="cp_qtyUrine_day5">How much urine did you pass?</label>

</div>

<input type="text" name="cp_qtyUrine_day5" id="cp_qtyUrine_day5" class="form-control"></input> ml

</div>

<label class="cp_label" for="cp_qtyDrain_day5">What was the drain output?</label>

</div>

<input type="text" name="cp_qtyDrain_day5" id="cp_qtyDrain_day5" class="form-control"></input> ml

</div>

<p>Please record your weight this morning <a href="#bottom">here</a></p>

</div>

<p><b><u>During the morning ward round</u></b></p>

<label class="cp_label" for="cp_FluidTarget_day5">Today's fluid target is:</label>

</div>

<input type="text" name="cp_FluidTarget_day5" id="cp_FluidTarget_day5" class="form-control"></input> ml

</div>

<p><b><u>Physiotherapy assessment</u></b></p>

<label class="cp_label" for="cp_MobilityProgramme_day5">Your mobility programme is: (please select)</label>

</div>

<div>

</div>

</div>

</div>

<p><b><u>Before you go home?</u></b></p>

<input class="form-check-input form-control" type="checkbox" name="cp_targetComplete_day5a" id="cp_targetComplete_day5a" value="I have everything you need at home?"> I have everything you need at home?</input>

</div>

<input class="form-check-input form-control" type="checkbox" name="cp_targetComplete_day5b" id="cp_targetComplete_day5b" value="Transport has been arranged to take you home?"> Transport has been arranged to take you home?</input>

</div>

<input class="form-check-input form-control" type="checkbox" name="cp_targetComplete_day5c" id="cp_targetComplete_day5c" value="My medicine card is up to date?"> My medicine card is up to date?</input>

</div>

<input class="form-check-input form-control" type="checkbox" name="cp_targetComplete_day5d" id="cp_targetComplete_day5d" value="I have arranged my transport to & from clinic?"> I have arranged my transport to & from clinic?</input>

</div>

<input class="form-check-input form-control" type="checkbox" name="cp_targetComplete_day5e" id="cp_targetComplete_day5e" value="I have a tunnelled dialysis line or PD catheter, and a removal date been arranged for me?"> I have a tunnelled dialysis line or PD catheter, and a removal date been arranged for me?</input>

</div>

<p>Your next follow up appointment is on <input type="date" name="cp_followupDate" id="cp_followupDate" class="form-control" placeholder="dd/mm/yyyy"></input> with <input type="text" name="cp_followupUnit" id="cp_followupUnit" class="form-control"></input> at <input type="text" name="cp_followUpUnit" id="cp_followUpUnit" class="form-control" placeholder="hh:mm" maxlength="5"></input></p>

<p>We will call you tomorrow at <input type="text" name="cp_followUpTime" id="cp_followUpTime" class="form-control" placeholder="hh:mm" maxlength="5"></input> to see how you are.</p>

<label class="cp_label" for="cp_day5Questions">Notes</label>

</div>

<p>When you get home, if you are worried about anything please call us on <a href="tel:+441912137538">0191 2137538</a></p>

</div>

<h2 id="day6anchor">Progress day 6</h2>

<p><b><u>Before the morning ward round</u></b></p>

<p>Please record yesterday's fluid measurements up to this morning</p>

<label class="cp_label" for="cp_qtyDrink_day6">How much did you drink?</label>

</div>

<input type="text" name="cp_qtyDrink_day6" id="cp_qtyDrink_day6" class="form-control"></input> ml

</div>

<label class="cp_label" for="cp_qtyUrine_day6">How much urine did you pass?</label>

</div>

<input type="text" name="cp_qtyUrine_day6" id="cp_qtyUrine_day6" class="form-control"></input> ml

</div>

<label class="cp_label" for="cp_qtyDrain_day6">What was the drain output?</label>

</div>

<input type="text" name="cp_qtyDrain_day6" id="cp_qtyDrain_day6" class="form-control"></input> ml

</div>

<p>Please record your weight this morning <a href="#bottom">here</a></p>

</div>

<p><b><u>During the morning ward round</u></b></p>

<label class="cp_label" for="cp_FluidTarget_day6">Today's fluid target is:</label>

</div>

<input type="text" name="cp_FluidTarget_day6" id="cp_FluidTarget_day6" class="form-control"></input> ml

</div>

<label class="cp_label" for="cp_notes_day6">Notes</label>

</div>

<h2 id="cp_day7anchor">Progress day 7</h2>

<p><b><u>Before the morning ward round</u></b></p>

<p>Please record yesterday's fluid measurements up to this morning</p>

<label class="cp_label" for="cp_qtyDrink_day7">How much did you drink?</label>

</div>

<input type="text" name="cp_qtyDrink_day7" id="cp_qtyDrink_day7" class="form-control"></input> ml

</div>

<label class="cp_label" for="cp_qtyUrine_day7">How much urine did you pass?</label>

</div>

<input type="text" name="cp_qtyUrine_day7" id="cp_qtyUrine_day7" class="form-control"></input> ml

</div>

<label class="cp_label" for="cp_qtyDrain_day7">What was the drain output?</label>

</div>

<input type="text" name="cp_qtyDrain_day7" id="cp_qtyDrain_day7" class="form-control"></input> ml

</div>

<p>Please record your weight this morning <a href="#bottom">here</a></p>

</div>

<p><b><u>During the morning ward round</u></b></p>

<label class="cp_label" for="cp_FluidTarget_day7">Today's fluid target is:</label>

</div>

<input type="text" name="cp_FluidTarget_day7" id="cp_FluidTarget_day7" class="form-control"></input> ml

</div>

<label class="cp_label" for="cp_notes_day7">Notes</label>

</div>

<h2 id="cp_day8anchor">Progress day 8</h2>

<p><b><u>Before the morning ward round</u></b></p>

<p>Please record yesterday's fluid measurements up to this morning</p>

<label class="cp_label" for="cp_qtyDrink_day8">How much did you drink?</label>

</div>

<input type="text" name="cp_qtyDrink_day8" id="cp_qtyDrink_day8" class="form-control"></input> ml

</div>

<label class="cp_label" for="cp_qtyUrine_day8">How much urine did you pass?</label>

</div>

<input type="text" name="cp_qtyUrine_day8" id="cp_qtyUrine_day8" class="form-control"></input> ml

</div>

<label class="cp_label" for="cp_qtyDrain_day8">What was the drain output?</label>

</div>

<input type="text" name="cp_qtyDrain_day8" id="cp_qtyDrain_day8" class="form-control"></input> ml

</div>

<p>Please record your weight this morning <a href="#bottom">here</a></p>

</div>

<p><b><u>During the morning ward round</u></b></p>

<label class="cp_label" for="cp_FluidTarget_day8">Today's fluid target is:</label>

</div>

<input type="text" name="cp_FluidTarget_day8" id="cp_FluidTarget_day8" class="form-control"></input> ml

</div>

<label class="cp_label" for="cp_notes_day8">Notes</label>

</div>

<h2 id="cp_day9anchor">Progress day 9</h2>

<p><b><u>Before the morning ward round</u></b></p>

<p>Please record yesterday's fluid measurements up to this morning</p>

<label class="cp_label" for="cp_qtyDrink_day9">How much did you drink?</label>

</div>

<input type="text" name="cp_qtyDrink_day9" id="cp_qtyDrink_day9" class="form-control"></input> ml

</div>

<label class="cp_label" for="cp_qtyUrine_day9">How much urine did you pass?</label>

</div>

<input type="text" name="cp_qtyUrine_day9" id="cp_qtyUrine_day9" class="form-control"></input> ml

</div>

<label class="cp_label" for="cp_qtyDrain_day9">What was the drain output?</label>

</div>

<input type="text" name="cp_qtyDrain_day9" id="cp_qtyDrain_day9" class="form-control"></input> ml

</div>

<p>Please record your weight this morning <a href="#bottom">here</a></p>

</div>

<p><b><u>During the morning ward round</u></b></p>

<label class="cp_label" for="cp_FluidTarget_day9">Today's fluid target is:</label>

</div>

<input type="text" name="cp_FluidTarget_day9" id="cp_FluidTarget_day9" class="form-control"></input> ml

</div>

<label class="cp_label" for="cp_notes_day9">Notes</label>

</div>

<h2 id="cp_day10anchor">Progress day 10</h2>

<p><b><u>Before the morning ward round</u></b></p>

<p>Please record yesterday's fluid measurements up to this morning</p>

<label class="cp_label" for="cp_qtyDrink_day10">How much did you drink?</label>

</div>

<input type="text" name="cp_qtyDrink_day10" id="cp_qtyDrink_day10" class="form-control"></input> ml

</div>

<label class="cp_label" for="cp_qtyUrine_day10">How much urine did you pass?</label>

</div>

<input type="text" name="cp_qtyUrine_day10" id="cp_qtyUrine_day10" class="form-control"></input> ml

</div>

<label class="cp_label" for="cp_qtyDrain_day10">What was the drain output?</label>

</div>

<input type="text" name="cp_qtyDrain_day10" id="cp_qtyDrain_day10" class="form-control"></input> ml

</div>

<p>Please record your weight this morning <a href="#bottom">here</a></p>

</div>

<p><b><u>During the morning ward round</u></b></p>

<label class="cp_label" for="cp_FluidTarget_day10">Today's fluid target is:</label>

</div>

<input type="text" name="cp_FluidTarget_day10" id="cp_FluidTarget_day10" class="form-control"></input> ml

</div>

<label class="cp_label" for="cp_notes_day10">Notes</label>

</div>

<h2>Explanation of terms</h2>

<h3>Drain</h3>

<p>A tube coming from the transplant wound to remove blood and fluid that collects from the operation. It is connected to a bag that can be emptied so that the fluid volumes can be measured.</p>

<h3>Education session</h3>

<p>This is delivered by the nurses to give you information and help you better understand how to care for your new kidney. This will include signs and symptoms of potential complications as well as things you should try to avoid. They can put you in touch with other professionals if you need help with finances, work or have other concerns.</p>

<h3>ERAS = Enhanced recovery after surgery</h3>

<p>The name of the programme we are following to better support you as you recover from your operation.</p>

<h3>Fluid target</h3>

<p>On the morning ward round each day, we will suggest a certain amount of fluid that we would like you to aim to drink over the course of the day. It is important to try to work towards this but don't worry if you don't reach the target. Talk to the transplant team if you are finding it difficult and they will help.</p>

<h3>Medication card</h3>

<p>You will be provided with a card that has a list of your medications. This includes the name of the medication, the dose you take, when to take it and what the medication is for. The nurses will guide you in how to use this card to identify your medications.</p>

<h3>Pain Catheter</h3>

<p>This is a tiny tube inserted during the operation and sits around the muscle layer surrounding your new kidney. It provides a continuous supply of local anaesthetic to numb the area. The anaesthetic is stored in a ball that is attached to you. It usually lasts between 48-72 hours then it can be removed. You may also hear people referring to this as a 'pain buster' or 'OnQ catheter'.</p>

<h3>PCA = Patient controlled analgesia</h3>

<p>This is a machine that provides you with a painkiller called Fentanyl. This attaches to a cannula and enters the body through your veins. A dose is given each time you press the button. There is a safety mechanism which means you will only receive a dose once every 5 mins regardless of how often you press it. This usually stops 24 hours after surgery.</p>

<h3>Physiotherapy mobility programme</h3>

<p>A programme designed to help restore, maintain and make the most of a patient's mobility, function and well-being.</p>

<p>After your transplant, the physiotherapists will assess you and provide you with a mobility programme (A, B or C) prescribing a distance for you to try to walk each day. This is an important part of your recovery. They will take into account your level of fitness before transplant as well as your ability after the operation to make sure that the programme is right for you.</p>

<h2>Fluid Volumes</h2>

<ul>

<li style="list-style:inherit; margin-left: 15px;">Large glass (blue) 240ml</li>

<li style="list-style:inherit; margin-left: 15px;">Small glass 170ml</li>

<li style="list-style:inherit; margin-left: 15px;">Water Jug 1litre</li>

</ul>

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<label class="cp_label" for="cp_additionalNotes">Additional Notes</label>

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