Symptom Care Flow Sheet Aide-mémoire Name : NHS Number: Date/time: Appearance: Same Better Worse Well Unwell Ill Distress: Nil Mild Moderate Severe Pain: Controlled Some Breakthrough Uncontrolled Sleep Pattern: Normal Changed Communication: Normal Fluctuating Deteriorating Conscious Level: Normal Reduced Convulsions: N/A Controlled Uncontrolled Breathing: Normal Abnormal Colour: Normal Pale Mottled Cyanosed Flushed Cough: Nil Occasional Frequent Unable to cough Secretions: Normal Productive Feeding: Nil Orally Oral Tube Fed Appetite: Normal Increased Decreased Vomiting: Nil Nausea Occasional Frequent Moist Dry Sore Mouth: Nil Occasional Frequent Distention Abdominal Pain: <1 2 3 4 >5 Bowels: Continent Incontinent Dysuria Retention Catheter Urinary Output: Good Volume < than usual >than usual Normal Reduced Spasm Posture/Movement: Reduced Normal Hypersensitive Sensation: Dry Normal Sore Itchy Oedema Skin: Intact / Broken Risk Assessment Yes/No
Symptom Care Flow Sheet Aide-mémoire Name : NHS Number: Date/time: Appearance: Distress: Pain: Sleep Pattern: Communication: Conscious Level: Convulsions: Breathing: Colour: Cough: Secretions: Feeding: Appetite: Vomiting: Mouth: Abdominal Pain: Bowels: Urinary Output: Posture/Movement: Sensation: Skin: Same Better Worse Well Unwell Ill Nil Mild Moderate Severe Controlled Some Breakthrough Uncontrolled Normal Changed Normal Fluctuating Deteriorating Normal Reduced N/A Controlled Uncontrolled Normal Abnormal Normal Pale Mottled Cyanosed Flushed Nil Occasional Frequent Unable to cough Normal Productive Nil Orally Oral Tube Fed Normal Increased Decreased Nil Nausea Occasional Frequent Moist Dry Sore Nil Occasional Frequent Distention <1 2 3 4 >5 Continent Incontinent Dysuria Retention Catheter Good Volume < than usual >than usual Normal Reduced Spasm Reduced Normal Hypersensitive Dry Normal Sore Itchy Oedema Intact / Broken Risk Assessment Yes/No
ExRes-West-Midlands-Toolkit-Section-3-Approaching-Symptom-Management-in-Palliative-Care.docx