Transudative chylothorax and frailty: a diagnostic and therapeutic challenge.

Transudative chylothoraces are a rare entity and their management in the presence of multiorgan dysfunction and frailty is complex. A woman in her 90s was investigated during acute hospital admission and found unexpectedly to have a transudative chylothorax secondary to cryptogenic cirrhosis. Not all chylothoraces have the classically described milky appearances and a high index of suspicion is vital in determining appropriate investigation and management. Our patient required repeated thoracocentesis and subsequently chose to be discharged from hospital with comfort care. Management of non-malignant pleural effusions can be challenging. Case reports surrounding the management of transudative chylothoraces in particular are scarce. Establishing patient priorities and openly explaining the uncertainty regarding prognosis and potential therapeutic options is paramount in this complex and changing field.

Constipation: causes and cures.

Constipation is a common but poorly understood problem. Within the UK it is estimated that three million GP consultations relate to constipation every year. It is a problem that could affect any person at any time, yet it is often preventable. There is no accepted definition for constipation, however, and it is open to individual interpretation. Some may describe constipation as passing hard stools, others may describe it as infrequent defaecation. Constipation can affect a person's physical, psychological and social wellbeing. Nurses are in a key position to help with this problem, although a multidisciplinary approach is needed if treatment is to be successful.