Download Physical health handbook - South West London and St George`s

Physical health handbook
Patient information
Contents
Foreword 2
Do you have a choice? 4-5
What checks do I need for my medicines?
6-7
If you take antipsychotic medication completing
this form before your health check may be useful
8-9
Taking control of side effects
10 - 12
Managing long term health conditions
(diabetes, obesity, CHD, COPD)
13 -18
Smoking Cessation (Stopping Smoking)
19 - 21
Exercise therapy
22 - 23
Healthy Eating24
Useful resources26
Foreword
At South West London and St George’s Mental Health NHS
Trust, we are committed to providing the best care and
support for you not only for your mental health but your
physical wellbeing too. People with mental health problems
and learning disabilities are at increased risk of developing
physical illness, especially heart disease and diabetes. This
is due to a combination of factors including the effects of
medication, smoking and lack of exercise.
Physical health problems can often affect your mental health
so that is why we want to ensure we offer you the right
support and help in order for a speedy recovery. This booklet
will provide you with information on the types of checks we
carry out and on common physical health conditions which
may have an impact on you and your recovery.
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Physical health handbook
About us
We are committed to the provision of consistent, personalised, high
quality services, a journey of continuous quality improvement.
We also have an on-going commitment to being a learning
organisation. Our approach focuses on three components of
quality: safety, effectiveness and patient experience to assure our
stakeholders on the quality of our services.
Why are physical health checks needed?
We aim to provide excellent care that not only looks after your
mental health and wellbeing but will support you with any
physical health care needs. The national mental health strategy
‘No health without Mental Health’ (2011) outlined good physical
health as one of six key objectives to improve outcomes for people
with mental health problems. Whether on the ward or in the
community, the team need to get a good idea of how healthy you
are when you first come into hospital and may need to monitor
your physical health throughout your stay. This is important, as
sometimes physical health conditions may be causing or contributing
to your mental health symptoms. Therefore assessing your physical
health is just as important as assessing your mental health.
Why do we do this?
• It helps us to identify and treat any early signs of physical health
problems you may have
• It helps us to prevent or treat any physical health problems associated with medicines you take for your mental health condition. Please ask your nurse for a copy of the physical health checks for those taking medicines for your mental health
• We may need to continue with any care and treatment you may
have been getting from your family doctor or another hospital
service before you came into hospital
• We can help by putting you in touch with a GP if you do not already have one
www.swlstg-tr.nhs.uk3
Do you have a choice?
Staff will offer physical health tests and checks and you can
choose whether or not to have them. However, we feel that
it may be in your best interest to have the test done so we
may offer them to you again, even if you have previously
refused.
If we see your health getting worse and you refuse any of the
tests we offer you, we’ll talk to you to make sure you understand
the consequences of refusing. A ‘best interest meeting’ may
be set up with you, your care team, your family or someone
else you’d like with you to discuss how best to care for you.
When do these physical health checks happen?
Everyone admitted to an inpatient ward should have a
comprehensive physical health care assessment within 48
hours of admission. Also, we will offer daily physical checks
which will include, taking your blood pressure, temperature
and pulse along with regular weight checks.
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Physical health handbook
What physical health checks are included?
Physical health care assessment include the following:
• Questions about any pre-existing medical conditions you may have
• Questions about lifestyle e.g. smoking/ diet / nutrition /
exercise / alcohol / drugs/ sleep
• Asking about allergies
• Asking about side effects of medication
• Measuring your pulse, blood pressure, breathing and temperature
• Measuring weight and height
• Testing urine
• Routine blood tests
www.swlstg-tr.nhs.uk5
What checks do
I need for my medicines?
If you are prescribed medication to treat your mental illness
we will need to complete various physical tests including
an ECG (electro-cardiogram records the electrical activity
of the heart and detect abnormal heart rhythms), blood
pressure, pulse, height and weight measurements.
We also carry out blood tests that include checks for diabetes,
cholesterol and other conditions that may impact on your
wellbeing. The blood test will also measure levels of certain
medications you may be taking.
Some tests are repeated after three months, six months or
annually depending on the type of medication to monitor
the impact of the treatment on your physical health.
If there are any negative impacts or side effects, your
doctor will review and change the medication if necessary.
Information on different medications
Printed information on the different medications is
available, including the types of physical checks you
should expect.
You can request this information from your named nurse,
psychiatrist or ward pharmacist who can also advise you on
the types and frequency of any physical examinations.
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Physical health handbook
When you are in the community
An annual physical health check is available to people with
a diagnosed mental illness, not only for people who are
taking psychiatric medication. You should be sent a reminder
about a physical health check if you are on the GP practice’s
register for people with a mental health diagnosis.
The check-up will be similar to the one you had when you were
admitted to hospital and should include taking your blood
pressure, blood tests to check for cholesterol levels; checking
weight and blood sugar levels, and a discussion about lifestyle e.g.
exercise, healthy eating and smoking. If any problems are found,
the GP should refer you for specialist assessment and support.
The GP, practice nurse or community mental health team (CMHT)
should share the test results with other people involved in your
care for example your GP, care coordinator and/or psychiatrist. You
should also get a copy of the results.
www.swlstg-tr.nhs.uk7
If you take antipsychotic medication
completing this form before your
health check may be useful
Glasgow Antipsychotic Side effect Scale (GASS-C)
This questionnaire is used to see if you have any side effects
of newer antipsychotic medicines. Put a tick in the box that
describes if you get the side effects and a tick if that side effect
distresses you. Health professionals can help with the results
and management of side effects.
Over the past week:
Never Once
A few
times
Everyday
Distressing?
1. I felt sleepy during the day
2. I felt drugged or like a zombie
3. I felt dizzy when I stood up
and / or have fainted
4. I have felt my heart beating
irregularly or unusually fast
5. My muscles have been tense
or jerky
6. My hands or arms have been
shaky
7. My legs have felt restless and
/ or I couldn’t sit still
8. I have been drooling
9. My movements or walking have
been slower than usual
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Physical health handbook
Over the past week:
Never Once
A few
times
Everyday
Distressing?
10. I have had, or people have
noticed, uncontrollable
movements of my face or body
11. My vision has been blurry
12. My mouth has been dry
13. I have had difficulty passing
urine
14. I have felt like I am going to
be sick or have vomited
15. I have wet the bed
16. I have been very thirsty and /
or passing urine frequently
17. The areas around my nipples
has been sore or swollen
18. I have noticed fluid coming
from my nipples
19. I have had problems
enjoying sex
20. Men: I have had problems
getting an erection
21. I have been constipated or
had difficulty passing stools
Over the past three months:
Yes
No
22. I have been constipated or had difficulty passing stools
23. Women: I have noticed a change in my periods
24. I have been gaining weight
www.swlstg-tr.nhs.uk9
Taking control of side effects
These are a few suggestions you may want to
think about for dealing with unwanted side effects
Nausea/sickness
• Take medication with food, unless told otherwise.
• Eat smaller, more frequent meals. Sip water.
• Talk to your prescriber about changing the dose or medicine.
Movement problems such as shakiness or stiffness
• These types of side effects are best treated by reducing
the dose or switching to a different medication.
• You can have an additional type of medication to treat
any shakiness or stiffness but this is not recommended in
the long term.
• No one should have to tolerate this type of side effect
as there are plenty of other choices of medicines
available that cause little or no movement problems.
Dry mouth, constipation
• A high fibre diet that includes plenty of fruit and
vegetables is helpful. Water rather than fizzy drinks and
sugar free gum for a dry mouth might help.
• It is important to look after your oral hygiene. It is
helpful to brush your teeth twice a day and have regular
dental check ups as a dry mouth can lead to tooth pain
and tooth loss.
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Physical health handbook
Weight gain
• It is helpful for you and your care team to take a
proactive approach to prevent weight gain.
• You should weigh yourself regularly and measure your
waist size.
• Take into account your appetite may be much stronger
and you might crave foods that relieve hunger quickly
such as chocolate, sweets, cakes, fizzy drinks and fast
food.
• Try and plan ahead, learn how to read food labels and
how to make healthy snacks and meals.
• Speak to your team about getting support to increase
your activity.
• If you are unhappy with the effects of your medicine
on your weight, speak to your prescriber and ask for an
alternative medicine.
Low blood pressure
(dizziness, feeling faint and light headed)
• Have your blood pressure taken regularly. Make sure
you are not dehydrated, avoid alcohol, heavy meals,
long periods of lying down, long periods of standing still
and very hot baths or showers.
• If it persists, discuss the possibility of switching to a
drug that does not cause low blood pressure with your
prescriber.
www.swlstg-tr.nhs.uk11
Raised blood sugar, diabetes
• Just like with weight gain, a proactive approach is
needed to prevent changes in blood sugar and the onset
of diabetes.
• The level of sugar in your blood should be tested before
a medicine is prescribed, then every three months and
every six months, when stable.
• A healthy lifestyle - a good diet, keeping active and not
smoking all help to maintain stable blood sugar levels.
• Report symptoms such as frequently passing water,
increased thirst and abdominal pain to your
care coordinator.
Sexual side effects
• Report any changes in your interest, performance and
satisfaction with sex, as well as swollen, leaking breasts
(men and women) and erratic periods (women).
• Discuss with your prescriber either reducing the
dose or switching to a drug that does not cause these
side effects.
• Make sure you follow health promotion advice e.g.
breast self-examination and contraceptive advice.
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Physical health handbook
Managing long term health conditions
Diabetes
What is diabetes?
Diabetes is a condition where there is too much glucose (sugar) in
the blood stream. This happens either because the body does not
produce enough insulin or stops responding to it. For those who
have diabetes, it is a condition for life. However, it can be well
managed to avoid complications developing.
It is important for someone with diabetes to monitor their blood
glucose levels regularly to ensure they have good control.
Being on medication for your mental health may affect your
diabetes control, so close monitoring is very important.
Do you have diabetes?
If you have diabetes there is a wide range of help and support
available:
• If you are an inpatient staff can help you monitor your blood for glucose and understand your medication
• The dietician can help you with healthy eating and
weight management
• Exercise therapy, gym sessions and occupational therapy are available to you
In the community your GP and practice nurse will offer
monitoring and support.
www.swlstg-tr.nhs.uk13
Obesity
What is obesity?
Obesity or being very overweight is a condition described by
an abnormal or excessive amount of body fat that presents a
risk to your health.
One of the ways to check for obesity is to calculate something
called the Body Mass Index (BMI) by measuring your height
and weight.
Another useful method is to measure around your waist.
People with large waists (94cm or more in men and 80cm or
more in women) are more likely to develop obesity-related
health problems.
Medications and obesity
Many medications prescribed for psychiatric conditions, like
antidepressants and antipsychotics, can also cause weight
gain as a side effect. Your doctor will discuss this with you,
before starting treatment and will suggest methods how to
address this.
Management of obesity
• The ward staff can help you with developing a plan to manage weight gain and can referral to a dietitian for more specialist advice.
• The ward menu has healthy choices marked with a red healthy heart.
• We recommend that you take part in regular activities. These
may be arranged on the ward or a gym referral can be made.
• We recommend that you avoid snacks, takeaway meals and sugary drinks.
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Physical health handbook
Hypertension (High blood pressure)
What is hypertension?
Hypertension is abnormally high blood pressure.
What causes hypertension?
In the majority of cases, no clear cause is found for raised blood
pressure. In some cases, it may be due to a underlying illness, for
example, a kidney disease or a thyroid problem and this would need
to be ruled out. You have a higher risk of developing high blood
pressure if you lead an unhealthy or stressful lifestyle or there is a
family history of high blood pressure, heart disease or stroke.
What are the complications of hypertension?
The main problem with hypertension is that there are almost no
symptoms until serious problems develop. You can have raised
blood pressure for a long time without noticing, until you develop
complications. High blood pressure increases the risk of heart
attacks and stroke. That is why it is important to check your blood
pressure regularly if you are at risk.
Next steps
If you are admitted to the ward, the nurses will check your
blood pressure and the doctor will perform a physical health
examination. Your team will discuss any concerns with you and
can advise and support you should you need further tests or
treatment. They will also liaise with your GP as they will take
over your monitoring once you leave the ward.
www.swlstg-tr.nhs.uk15
COPD
What is COPD?
COPD stands for Chronic Obstructive Pulmonary Disease. It is
also known as chronic bronchitis and emphysema.
Typical symptoms of COPD are:
• Increasing shortness of breath when physically active
• A persistent cough with phlegm
• Frequent chest infections.
What causes COPD?
The main cause of COPD is smoking. The more you smoke and
the longer you have been smoking, the more likely you are
to develop COPD. Smoking irritates and inflames the lungs,
which causes scarring of the lung tissue. Over many years, the
inflammation leads to permanent changes in the lungs.
Prevention of COPD
The best way to prevent developing COPD is to stop smoking.
Next steps
If you are admitted to the ward, the nurses will check your
blood pressure and the doctor will perform a physical health
examination. Your ward team will discuss any concerns with
you and can advise and support you should you need further
tests or treatment. They will also liaise with your GP as they
will take over your monitoring once you leave the ward.
If you wish to stop smoking, your team will be able to support
you and refer you to a smoking cessation advisor.
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Physical health handbook
Cardiovascular disease (CVD)
What is CVD?
CVD is a narrowing of your heart arteries due to fatty deposits in
the artery walls. It is more common in smokers and in people with
high blood pressure, diabetes or high cholesterol.
How common is it?
CVD is the most common cause of death in the UK. One in five
men and one in seven women die from CVD. There are over 2.5
million people in the UK living with cardiovascular disease.
Symptoms of
cardiovascular disease
These develop slowly over many
years. Breathlessness when
exercising may be your only
symptom. You may not know
anything is wrong until you
develop chest pains (angina) or
have a heart attack.
What increases your of cardiovascular disease?
A risk factor is something that increases your likelihood of getting
a disease. There are several risk factors for CVD, including:
• Smoking
• High blood pressure
• High blood cholesterol
• Being physically inactive
• Being overweight or obese
• Diabetes
www.swlstg-tr.nhs.uk17
• Family history of heart disease.
• Ethnic background - for Bangladeshis, Indians and
Pakistanis, and people with an African Caribbean background, cardiovascular risk can be higher than for the rest of the UK population
• Gender - men are more likely to develop CVD at an earlier age than women
• Age - the older you are, the more likely you are to develop CVD
How you deal with stress, the amount of
alcohol you drink, as well as the type of
job you do may also influence your risk of
developing CVD.
The more risk factors you have, the higher your
riskof developing CVD. Even though you can’t
change all your risk factors, there is plenty you
can do to reduce your risk and help to protect
your heart.
On admission to the ward a number of tests will
be carried out. This includes having your pulse
and blood pressure taken as well as having a
Electro Cardiogram (ECG). The doctor will also
ask about your family history, any heart disease
and life style questions.
(British Heart Foundation 2015)
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Physical health handbook
Smoking Cessation (Stopping smoking)
Smoking and medicines
Smoking interacts with some psychiatric medications (e.g. Clozapine,
Olanzapine) making it less effective, resulting in increased dosages
and more side effects associated with these drugs.
Please note that if you stop or reduce smoking, your mental health
medication may need to be reduced or adjusted.
If you have questions about your medicines ask your Mental Health
Team or contact Medicines Information on: 020 3513 6829
Smokers are four times more likely to quit successfully
with NHS Stop Smoking support.
Benefits of quitting / stopping smoking can:
• Improve mood
• Decrease anxiety and depression
• Increase energy levels
• Reduce chances of heart disease, lung cancer and stroke
• Save you a fortune (At today’s rates, a 20-a-day smoker can save over £3,000 a year).
Why do we advise the use of nicotine replacement products?
Scientific studies have shown that the use of Nicotine Replacement
Therapy (NRT) products such as patches or inhalator:
• Are safe to use because they don’t contain the toxic chemicals found
in cigarettes such as tar, carbon monoxide and other poisons
• Increase the chance of quitting smoking by 50-70%
• Reduce nicotine cravings
• Reduce withdrawal symptoms such as irritability and anxiety, hunger
and difficulty concentrating.
www.swlstg-tr.nhs.uk19
Thinking about quitting or managing your
smoking? Get support today
Ask a member of staff to refer you to your local specialist
adviser for support to stop smoking and they can arrange an
appointment for you.
Please do not hesitate to contact us if you require further
information about our Smokefree policies and/or smoking
cessation services.
Specialist mental health stop smoking service
079 3616 7350 (Wandsworth Smoking Cessation Team)
075 9044 5168 (Merton and Sutton Smoking Cessation Team)
“Kick it” Stop Smoking Service
020 3434 2500 (Kingston & Richmond Kick it service)
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Physical health handbook
10 ways to stay smoke free
2
Get rid of any
cigarettes,
tobacco, lighters
and ashtrays
3
Stay away from
second hand
smoke
4
Keep reminding
yourself why
you want to stop
smoking
5
Say to yourself
“A cigarette won’t
solve anything”
6
Relax, breathe,
stretch
7
Stay positive
8
Drink a glass of
water, fruit juice
or herbal tea
9
Take some
stop smoking
medication
10
Speak to your local
Stop Smoking
Specialist
1
Say no to cigarettes
www.swlstg-tr.nhs.uk21
Exercise Therapy The benefits of physical activity
Physical activity can:
• Help you lose weight, especially fat
• Lower heart rate and blood pressure so your heart doesn’t have to work so hard
• Reduce risk of heart disease
• Help circulation
• Reduced risk of falls and injuries from falls in older people.
Physical activity can:
• Improve feeling of well being
• Help you release stress and feel more relaxed
• Help improve mood due to release of endorphins
• Increase energy levels
• Help sleep patterns
• Decrease anxiety and depression.
Exercise can help in the treatment and prevention of
many illnesses including:
• Type II diabetes
• Osteoporosis.
It also helps reduce the likelihood of contracting some cancers
and can improve the immune system.
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Physical health handbook
Exercise can help boost self confidence
Exercise doesn’t have to mean leggings, lycra, gyms or aerobics.
There are many other ways to increase your activity levels.
• Walking is free. Take the dog to make it more interesting or take part in an organised walking group
• Park at the far end of the car park
• Get off the bus one stop earlier and walk
• Use stairs instead of escalators or lifts
• Exercise with others to make it more fun and sociable
• Take part in more structured exercise with the Exercise Therapy Team.
Why exercise?
• For enjoyment
• For social reasons
• For the psychological benefits
• Physical health benefits
People take up exercise for many reasons, but tend to only
continue exercising if they enjoy it.
Exercising with others can help you to meet new people and
make it more fun.
www.swlstg-tr.nhs.uk23
Healthy eating
Tips to make sure you eat a balanced diet
• Avoid foods that have a lot of calories like burgers, fried foods and takeaways
• Choose low-fat dairy options (e.g. skimmed milk, reduced-
fat cheese, low-fat yoghurts)
• Try not to skip breakfast. This should stop you needing to snack before lunch
• Watch the amount of food you eat. Weighing out portion sizes so you know how many calories you have eaten
may help
• Remember that sugary drinks and alcohol contain calories it’s not just food
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Physical health handbook
www.swlstg-tr.nhs.uk25
Useful Resources
There are lots of local and national resources where you can find additional
information to support your wellbeing. Local mental health teams can provide
information about in your specific areas.
NHS Choices - www.nhs.uk
British Heart Foundation - www.bhf.org.uk
Greater London House, 180 Hampstead Road, London NW1 7AW
0300 333 1333
Diabetes UK - www.diabetes.org.uk
10 Parkway, London NW1
0345 123 2399
British Lung Foundation - www.blf.org.uk
73-75 Goswell Road, London, EC1V 7ER
0300 003 0555
Cancer Research UK - www.cancerresearchuk.org
0207 242 0200
Smokefree England - www.smokefree.nhs.uk
NHS Stop smoking helpline
0800 022 4332
Drink Aware UK - www.drinkaware.co.uk
0300 123 1110
Rethink Mental - www.rethink.org
Head Office,15th Floor 89 Albert Embankment, London, SE1 7TP
0300 500 0927
Mental Health Foundation - www.mentalhealth.org.uk
Colechurch House, 1 London Bridge Walk, London SE1 2SX
020 7803 1100
MIND - www.mind.org.uk
15-19 Broadway, Stratford, London E15 4BQ
0208 519 2122
Samaritans - www.samaritans.org
0845 790 9090
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Physical health handbook
About this Handbook
Physical Health Handbook – was written by specialists, and reviewed
by healthcare professionals and patients.
Contacting the Trust
Trust Headquarters, Springfield University Hospital
Building 15, 2nd Floor, South West London and St George’s
Mental Health NHS Trust, Springfield University Hospital,
61 Glenburnie Road, London SW17 7DJ
020 3513 5000
In an emergency (for existing patients of the Trust)
• Mental Health Support Line: 0800 028 8000
(5pm to 9am Monday to Friday, 24 hours Saturday and Sunday).
Patient Advice and Liaison Service (PALS)
You can call our dedicated Patient Experience team and talk to
someone about the service you, or the person you care for, has received.
020 3513 6150 (Monday to Friday 9am to 5pm)
Disclaimer
We make every effort to ensure that the information we provide is accurate and up to date
but it should not be relied upon as a substitute for specialist professional advice tailored to
your situation. So far as is permitted by law, South West London and St George’s Mental Health
NHS Trust does not accept liability in relation to the use of any information contained in this
publication, or third-party information or websites included or referred to in it.
Sources
For a full list of the sources we used:
020 3513 6006
[email protected]
www.swlstg-tr.nhs.uk27
We are the leading provider of mental health services
across south west London and a beacon of excellence for
national mental health specialist services.
Help us make our services even better
The views of patients, their carers, friends and families are at the heart of improving
the way we deliver our services. We are committed to delivering high quality care.
Your feedback will help us understand what we do well and what we can do better.
If you would like to give us feedback please contact:
• Patient Advice and Liaison Service (PALS): 020 3513 6150
• Feedback online at: https://feedback.swlstg-tr.nhs.uk
• Patient Opinion: www.patientopinion.org.uk
Become a member:
To find out about becoming a member
E-mail: [email protected]
Physical health
handbook
Our values
If you require this document in an alternative format
please call: 020 3513 6006
South West London and St George’s Mental Health NHS Trust
Springfield University Hospital, 61 Glenburnie Road, London SW17 7DJ
Telephone: 020 3513 5000
Website: www.swlstg-tr.nhs.uk
Copyright © 2016 South West London and St George’s Mental Health NHS Trust
Published and distributed by: Communications Department
Published: March 2016 Review date: March 2018
Ref: PHH0815
All information correct at time of printing