my health passport after liver transplantflipbooks.leedsth.nhs.uk/ln004191p/ln004191.pdf · bowel...
TRANSCRIPT
nThe Leeds
Teaching HospitalsNHS Trust
My health passport after liver transplant
Information for patients
2
This Passport is for you to record essential information about your care. Information logged in this book can be from all care settings you attend. Please take this passport to all appointments and show it to the health care staff. This is your passport, and please keep this passport safe.
Name: ........................................................................................
Date of Birth: ....... / ....... / ..............
Important contact details
Post-transplant Clinical Nurse Specialists
Telephone: (0113) 206 8184 (answer phone available 24 hours for non-emergency issues) 8.00 am - 6.00 pm Tuesday and Wednesday, 8.00 am - 2.30 pm Thursday and 8.00 am - 5.30 pm Friday Mobile: 07775 115752Email: [email protected]
Liver Unit (J83) Telephone: (0113) 206 9183 Please contact in emergency after 5.30 pm
Pharmacy Telephone: (0113) 206 6826 (9.00 am - 5.00 pm)Email: [email protected]
If any guidance or support is needed by GP’s or any other medical teams, please ask them to contact the on-call Hepatology registrar via St James’s switch board: (0113) 243 3144.
3
Patient information
NHS number
Patient contact telephone numbers
Email address
Home address
GP contact details (address / telephone number)
Next of kin
Relation to next of kin
Next of kin details
4
Ad
mis
sio
ns
to o
ther
car
e se
ttin
gs
If y
ou
are
ad
mit
ted
to
an
y o
ther
hea
lth
car
e se
ttin
g f
or
any
illn
ess
or
med
ical
in
terv
enti
on
, ple
ase
list
bel
ow
.
Dat
e o
f A
dm
issi
on
Rea
son
fo
r ad
mis
sio
nH
osp
ital
/
Loca
tio
nD
ura
tio
n o
f ad
mis
sio
n
5
Following your liver transplant, you are at greater risk of developing cardiovascular disease (i.e. stroke, heart attack), weight gain, high blood pressure diabetes and skin cancer.You can use this passport to document information from all of the care settings that you attend such as your GP, your local hospitals (clinics), and the Leeds Liver Unit to help manage your long-term health to reduce these risk factors.
You can fill in your allergies here:
Allergies: ...................................................................................
....................................................................................................
....................................................................................................
Common medications you should avoid following your liver transplant
Macrolide antibiotics e.g. • Clarithromycin
• Erythromycin
Other medication to avoid • Simvastatin (if on ciclosporin) • Non-steroidal anti-inflammatories of all forms
(gel, tablets, creams)
• Live vaccines
If you are worried about any new medication you are starting, please don’t hesitate to contact the Post Liver Transplant Clinical Nurse Specialist on: (0113) 206 8184 / mobile: 07775 115752.
6
Blood testsFollowing your liver transplant, you will be on lifelong immunosuppression and will require full blood count, liver function and kidney function tests to be taken every 3 - 4 monthly, either at your GP or at your local hospital.
You may also require additional tests and you and you GP will be informed of by the liver team if this is necessary.
Please do not take your Adoport / Advagraf / Ciclosporin /Sirolimus, prior to a blood test if this drug level is being taken.
These results can be emailed to us here at Leeds via: [email protected], either by you or your GP practice.
Blood pressure limitsFollowing a liver transplant, approximately 65% - 70% of recipients develop high blood pressure.
If your blood pressure is identified as being elevated on several visits to the liver unit, it may be suggested a 24 hour ambulatory blood pressure monitoring be performed by your GP and if required, anti-hypertensive medication should be started as per the advised protocols and NICE guidelines.
• Your blood pressure reading should be 135 / 85.
• If your blood pressure is outside this parameter consistently, then it may be that your GP arranges a 24 hour ambulatory BP monitoring and medication prescribed as needed.
7
Q risk 2 scoreThe Q risk 2 score is a tool used by the hospital and your GP practice to calculate your risk of cardiovascular disease (CVD).
Your Q risk 2 score will be assessed by the Post-transplant Clinical Nurse Specialist at your 3 months+ clinic visit and at your annual review. This will be documented in your clinic letter from the Specialist Nurse.
• If your Q risk 2 score is between 10 - 20%, you should attend your GP practice to discuss lifestyle and dietary changes, along with POSSIBILITY of starting Statin therapy.
• If your Q risk 2 score is >20%, you should attend your GP practice to discuss lifestyle and dietary changes, alongside discussion about the starting of statin therapy as per the guidelines sent to your GP by Leeds Liver Unit.
Q-Risk 2 score
Statin started Statin name / Dose
Statin reviewed by GP
3 months+: % Y N Date: Y N Date:
Annual: % Y N Date: Y N Date:
Annual: % Y N Date: Y N Date:
Annual: % Y N Date: Y N Date:
Annual: % Y N Date: Y N Date:
Annual: % Y N Date: Y N Date:
8
Weight / BMIFollowing liver transplant, you are predisposed to put on weight, particularly in the first 2 years. Your BMI will be calculated by the Post Liver Transplant Clinical Nurse Specialist at your 3 months+ review and on an annual review at the Leeds Liver Unit.
• If your BMI is calculated to be >25 during your Nurse-led review, it will be discussed with you, along with suggestions and strategies around changes to your lifestyle / diet. It may also be suggested that the GP refer you to a local weight loss / exercise programme to support you with this to help ensure that your weight / BMI remain in the healthy range.
• The Post Liver Transplant Clinical Nurse Specialist will also give you leaflets to help with weight loss / management.
• You should talk to your GP about what weight management facilities are available in your area.
9
ExerciseExercise is important to ensure that you stay healthy following your liver transplant. It is advised that adults should do two types of physical activity per week which include a combination of aerobic and strength exercises. The amount of exercise you should perform on a weekly basis depends on your age. You should aim to reduce the amount of time that you are sitting still and move more, aiming for a target of 10,000 steps per day.
Types of exercise:
• As described on https://www.nhs.uk/live-well/exercise//
For further information about exercise ideas / programmes:
• https://www.nhs.uk/live-well/exercise//
• https://www.nhs.uk/live-well/excecise/walking-for-health/
• https://www.nhs.uk/oneyou/be-healthier/move-more/
• https://www.nhs.uk/oneyou
• Couch to 5K running plan for beginners.
• Strength and flex podcast.
• 10 minute workout series.
• NHS weight loss plan
10
Plea
se li
st o
ther
med
ical
tea
ms
/ hea
lth
care
pro
fess
ion
als
you
see
in o
ther
set
tin
gs
and
if
yo
u w
ou
ld li
ke le
tter
s co
pie
d t
o t
hem
, fo
llow
ing
yo
ur
clin
ic a
pp
oin
tmen
t h
ere
at
Leed
s Li
ver
Un
it.
Do
cto
rsH
ealt
hca
re
Sett
ing
Rea
son
fo
r at
ten
dan
ceLe
tter
s to
be
cop
ied
to
o
ther
tea
ms.
Ple
ase
tick
Y
N
Y
N
Y
N
Y
N
Y
N
Y
N
Y
N
Y
N
Y
N
Y
N
Y
N
Y
N
Y
N
11
Pati
ent
on
-go
ing
car
e ch
eckl
ist
On
e ye
ar p
ost
-tra
nsp
lan
t D
EXA
sc
an
Co
mp
lete
No
t co
mp
lete
Res
ult
s g
iven
/ se
nt
to L
eed
s
Ann
ual r
evie
w b
y Po
st L
iver
Tra
nspl
ant
Clin
ical
Nur
se S
peci
alis
t
Thes
e re
view
s w
ill t
ake
pla
ce
lon
g-t
erm
.
1 ye
ar
2
year
s
3
year
s
5 ye
ars
10
yea
rs
AA
A
scre
enin
g
Off
ered
to
al
l men
ove
r 65
yea
rs a
s pr
e-na
tion
al
scre
enin
g.
An
nu
al D
erm
ato
log
y re
view
It is
ad
vise
d t
hat
po
st-t
ran
spla
nt
pat
ien
ts r
ecei
ve a
to
tal
cuta
neo
us
revi
ew a
nn
ual
du
e to
th
e in
crea
sed
ris
k o
f sk
in c
ance
r.
This
rev
iew
can
be
com
ple
ted
b
y yo
ur
GP
or
a d
erm
ato
log
ist
loca
lly.
Bo
wel
scr
een
ing
• O
ffer
ed a
t 55
yea
rs o
ld -
invi
ted
fo
r o
ne-
off
bo
wel
sco
pe
scre
enin
g t
est
• 60
- 7
4 ye
ars
old
(au
tom
atic
invi
te)
for
ho
me
scre
enin
g f
aeca
l occ
ult
blo
od
te
stin
g k
it.
• O
ffer
ed, e
very
2 y
ears
.•
If o
ver
75 y
ears
+, c
an r
equ
est
furt
her
2
year
ly h
om
e ki
t sc
reen
ing
to
co
nti
nu
e.
(Tel
: 080
0 70
7 60
6)
3 m
on
ths+
Rev
iew
by
Post
Li
ver
Tran
spla
nt
Clin
ical
Nu
rse
Spec
ialis
t
Co
mp
lete
No
t co
mp
lete
An
nu
al c
olo
no
sco
py
PSC
pati
ents
wit
h IB
D y
earl
y co
lono
scop
y sc
reen
ing
prog
ram
me?
Yes
No
12
Med
icin
eD
ose
08.0
010
.00
14.0
018
.00
22.0
0W
hy
am I
taki
ng
th
is m
edic
atio
n?
Ad
dit
ion
al
Info
rmat
ion
13
Med
icin
eD
ose
08.0
010
.00
14.0
018
.00
22.0
0W
hy
am I
taki
ng
th
is m
edic
atio
n?
Ad
dit
ion
al
Info
rmat
ion
14
Med
icin
eD
ose
08.0
010
.00
14.0
018
.00
22.0
0W
hy
am I
taki
ng
th
is m
edic
atio
n?
Ad
dit
ion
al
Info
rmat
ion
15
Med
icin
eD
ose
08.0
010
.00
14.0
018
.00
22.0
0W
hy
am I
taki
ng
th
is m
edic
atio
n?
Ad
dit
ion
al
Info
rmat
ion
16
Live
r fu
nct
ion
tes
t (L
FT)
Dat
eD
ate
Dat
eD
ate
Dat
eD
ate
Dat
eD
ate
Dat
eD
ate
ALT
ALP
Bili
rub
in
Ren
al f
un
ctio
n (
U+
E)D
ate
Dat
eD
ate
Dat
eD
ate
Dat
eD
ate
Dat
eD
ate
Dat
e
Ure
a
Cre
atin
ine
eGFR
Full
Blo
od
Co
un
t (F
BC
)D
ate
Dat
eD
ate
Dat
eD
ate
Dat
eD
ate
Dat
eD
ate
Dat
e
Hb
WC
C
Neu
tro
ph
ils
Dat
eD
ate
Dat
eD
ate
Dat
eD
ate
Dat
eD
ate
Dat
eD
ate
Wei
gh
t
BM
I
Blo
od
Pre
ssu
re (
BP)
Q-R
isk
2 Sc
ore
17
Live
r fu
nct
ion
tes
t (L
FT)
Dat
eD
ate
Dat
eD
ate
Dat
eD
ate
Dat
eD
ate
Dat
eD
ate
ALT
ALP
Bili
rub
in
Ren
al f
un
ctio
n (
U+
E)D
ate
Dat
eD
ate
Dat
eD
ate
Dat
eD
ate
Dat
eD
ate
Dat
e
Ure
a
Cre
atin
ine
eGFR
Full
Blo
od
Co
un
t (F
BC
)D
ate
Dat
eD
ate
Dat
eD
ate
Dat
eD
ate
Dat
eD
ate
Dat
e
Hb
WC
C
Neu
tro
ph
ils
Dat
eD
ate
Dat
eD
ate
Dat
eD
ate
Dat
eD
ate
Dat
eD
ate
Wei
gh
t
BM
I
Blo
od
Pre
ssu
re (
BP)
Q-R
isk
2 Sc
ore
18
Live
r fu
nct
ion
tes
t (L
FT)
Dat
eD
ate
Dat
eD
ate
Dat
eD
ate
Dat
eD
ate
Dat
eD
ate
ALT
ALP
Bili
rub
in
Ren
al f
un
ctio
n (
U+
E)D
ate
Dat
eD
ate
Dat
eD
ate
Dat
eD
ate
Dat
eD
ate
Dat
e
Ure
a
Cre
atin
ine
eGFR
Full
Blo
od
Co
un
t (F
BC
)D
ate
Dat
eD
ate
Dat
eD
ate
Dat
eD
ate
Dat
eD
ate
Dat
e
Hb
WC
C
Neu
tro
ph
ils
Dat
eD
ate
Dat
eD
ate
Dat
eD
ate
Dat
eD
ate
Dat
eD
ate
Wei
gh
t
BM
I
Blo
od
Pre
ssu
re (
BP)
Q-R
isk
2 Sc
ore
19
Live
r fu
nct
ion
tes
t (L
FT)
Dat
eD
ate
Dat
eD
ate
Dat
eD
ate
Dat
eD
ate
Dat
eD
ate
ALT
ALP
Bili
rub
in
Ren
al f
un
ctio
n (
U+
E)D
ate
Dat
eD
ate
Dat
eD
ate
Dat
eD
ate
Dat
eD
ate
Dat
e
Ure
a
Cre
atin
ine
eGFR
Full
Blo
od
Co
un
t (F
BC
)D
ate
Dat
eD
ate
Dat
eD
ate
Dat
eD
ate
Dat
eD
ate
Dat
e
Hb
WC
C
Neu
tro
ph
ils
Dat
eD
ate
Dat
eD
ate
Dat
eD
ate
Dat
eD
ate
Dat
eD
ate
Wei
gh
t
BM
I
Blo
od
Pre
ssu
re (
BP)
Q-R
isk
2 Sc
ore
20
Live
r fu
nct
ion
tes
t (L
FT)
Dat
eD
ate
Dat
eD
ate
Dat
eD
ate
Dat
eD
ate
Dat
eD
ate
ALT
ALP
Bili
rub
in
Ren
al f
un
ctio
n (
U+
E)D
ate
Dat
eD
ate
Dat
eD
ate
Dat
eD
ate
Dat
eD
ate
Dat
e
Ure
a
Cre
atin
ine
eGFR
Full
Blo
od
Co
un
t (F
BC
)D
ate
Dat
eD
ate
Dat
eD
ate
Dat
eD
ate
Dat
eD
ate
Dat
e
Hb
WC
C
Neu
tro
ph
ils
Dat
eD
ate
Dat
eD
ate
Dat
eD
ate
Dat
eD
ate
Dat
eD
ate
Wei
gh
t
BM
I
Blo
od
Pre
ssu
re (
BP)
Q-R
isk
2 Sc
ore
21
Live
r fu
nct
ion
tes
t (L
FT)
Dat
eD
ate
Dat
eD
ate
Dat
eD
ate
Dat
eD
ate
Dat
eD
ate
ALT
ALP
Bili
rub
in
Ren
al f
un
ctio
n (
U+
E)D
ate
Dat
eD
ate
Dat
eD
ate
Dat
eD
ate
Dat
eD
ate
Dat
e
Ure
a
Cre
atin
ine
eGFR
Full
Blo
od
Co
un
t (F
BC
)D
ate
Dat
eD
ate
Dat
eD
ate
Dat
eD
ate
Dat
eD
ate
Dat
e
Hb
WC
C
Neu
tro
ph
ils
Dat
eD
ate
Dat
eD
ate
Dat
eD
ate
Dat
eD
ate
Dat
eD
ate
Wei
gh
t
BM
I
Blo
od
Pre
ssu
re (
BP)
Q-R
isk
2 Sc
ore
22
Live
r fu
nct
ion
tes
t (L
FT)
Dat
eD
ate
Dat
eD
ate
Dat
eD
ate
Dat
eD
ate
Dat
eD
ate
ALT
ALP
Bili
rub
in
Ren
al f
un
ctio
n (
U+
E)D
ate
Dat
eD
ate
Dat
eD
ate
Dat
eD
ate
Dat
eD
ate
Dat
e
Ure
a
Cre
atin
ine
eGFR
Full
Blo
od
Co
un
t (F
BC
)D
ate
Dat
eD
ate
Dat
eD
ate
Dat
eD
ate
Dat
eD
ate
Dat
e
Hb
WC
C
Neu
tro
ph
ils
Dat
eD
ate
Dat
eD
ate
Dat
eD
ate
Dat
eD
ate
Dat
eD
ate
Wei
gh
t
BM
I
Blo
od
Pre
ssu
re (
BP)
Q-R
isk
2 Sc
ore
23
Notes
.........................................................................................................
.........................................................................................................
.........................................................................................................
.........................................................................................................
.........................................................................................................
.........................................................................................................
.........................................................................................................
.........................................................................................................
.........................................................................................................
.........................................................................................................
.........................................................................................................
.........................................................................................................
.........................................................................................................
.........................................................................................................
.........................................................................................................
.........................................................................................................
.........................................................................................................
.........................................................................................................
.........................................................................................................
.........................................................................................................
.........................................................................................................
.........................................................................................................
.........................................................................................................
.........................................................................................................
LN004191Publication date
03/2019
Review date03/2021
© The Leeds Teaching Hospitals NHS Trust • 1st edition (Ver 2.0)Developed by: Kirsty Miles - Hepatology Specialist Nurse
Produced by: Medical Illustration Services MID code: 20190913_001/MH