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- Herausgeber: John Wiley & Sons
- Kategorie: Fachliteratur
- Serie: Student Survival Skills
- Sprache: Englisch
Acute Care for Nurses A practical handbook to boost your confidence with assessment techniques and key clinical skills when administering effective acute care This helpful revision tool was developed to assist healthcare workers in the field of acute care, at a time when healthcare professionals have been under more pressure than ever before. In Acute Care for Nurses, readers will find: * A revision of medicines management formulas, plus advanced formulas seen in a clinical setting, with chapters on sepsis and conflict resolution * Assessment techniques and the individual components of the ABCDE assessment, covering vital signs, clinical observation at superficial and more in-depth levels, and clinical actions * Higher skills, such as caring for the ventilated patient and fluid resuscitation in adults and children, and subcutaneous fluid hydration * Critical care simulation and need-to-know medical abbreviations, plus three helpful appendices containing tool kits and charts Acute Care for Nurses is a must-have resource for nursing students, including nursing associates, registered nurses and midwives, assistant practitioners and senior healthcare assistants, return to practice nurses, overseas nurses and anyone else requiring acute clinical skills and assessment techniques.
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Seitenzahl: 318
Veröffentlichungsjahr: 2023
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Table of Contents
Cover
Series Page
Title Page
Copyright Page
Preface
Introduction
Acknowledgements
Part 1: NURSING IN THE ACUTE CARE SETTING
Chapter 1: DIAGNOSTIC TESTS AND ADVANCED FORMULAE
MEAN ARTERIAL PRESSURE
HEALTHCARE CALCULATIONS
CALCULATING INFANT FEEDING REGIMENS
WORKING OUT INFANT GROWTH EXPECTATIONS
BODY SURFACE AREA ESTIMATIONS
BODY MASS INDEX
MAKING ORGAN AND SYSTEMS CALCULATIONS
MEASURING CARDIAC OUTPUT
ASSESSING LUNG FUNCTION
RENAL CLEARANCE
WORKING OUT THE ENERGY REQUIREMENTS OF THE BODY
TEST YOUR KNOWLEDGE
WEB RESOURCES
Chapter 2: RECOGNISING SEPSIS
SEPSIS FACTS AND FIGURES
WHAT HAPPENS TO THE BODY DURING SEPSIS?
RECOGNISING SEPSIS
RISK FACTORS TO SEPSIS
OBSERVATION CHARTS
SEPSIS SIX
FULL BLOOD COUNT NORMAL VALUES
WHITE BLOOD CELL COUNT
LACTATE
SEPSIS TREATMENT PATHWAY
PRESCRIBED ANTIBIOTICS
TEST YOUR KNOWLEDGE
WEB RESOURCES
Chapter 3: CONFLICT RESOLUTION
WHAT IS CONFLICT?
WHAT CAUSES AGGRESSION WITHIN THE HEALTHCARE ENVIRONMENT?
HOW DO WE COMMUNICATE?
HOW DOES COMMUNICATION BREAK DOWN?
MINIMISING THE RISK OF COMMUNICATION BREAKDOWN
TWO COMMUNICATION MODELS
RECOGNISE HOW YOUR BEHAVIOUR AFFECTS OTHERS
PATTERNS OF BEHAVIOUR
STAGES TO CONFLICT
WHAT ARE THE WARNING AND DANGER SIGNS TO CONFLICT?
BODY LANGUAGE TO AVOID CONFLICT
PERSONAL SPACE
FIGHT OR FLIGHT
DEALING WITH UNPREDICTABLE BEHAVIOUR
USE OF DISTANCE FOR DEALING WITH CONFLICT
THE LONE WORKER AND RISK ASSESSMENT
DE‐ESCALATION – THE BASICS
LEGAL ASPECTS – USE OF FORCE
WHAT TO DO AFTER AN INCIDENT
TEST YOUR KNOWLEDGE
WEB RESOURCES
Chapter 4: PATIENT ASSESSMENT
NATIONAL EARLY WARNING SCORE‐2 AND ABCDE ASSESSMENTS
CRITICAL CARE – cABCDE ASSESSMENT
PALPATION
PERCUSSION
AUSCULTATION
ASSESSMENT INVESTIGATIONS
PATIENT DOCUMENTATION AND COMMUNICATION
TEST YOUR KNOWLEDGE
WEB RESOURCES
Chapter 5: SITUATION, BACKGROUND, ASSESSMENT, AND RESPONSE (SBAR)
WHAT DOES SBAR MEAN?
HOW NOT TO DO IT
BEFORE CALLING THE CLINICIAN
MAKING THE CALL
THE INFORMATION WE NEED TO COMMUNICATE EFFECTIVELY
TEST YOUR KNOWLEDGE
WEB RESOURCES
REFERENCE
Part 2: RECOGNISING AND RESPONDING TO MEDICAL EMERGENCIES
Chapter 6: AIRWAY
ASSESSING THE AIRWAY
COMPLETE OR PARTIAL AIRWAY OBSTRUCTION
OTHER INDICATORS OF AIRWAYS AT RISK
CAUSES OF AIRWAY OBSTRUCTION
HOW TO MANUALLY OPEN THE AIRWAY
ADJUNCTS TO AIRWAY MANAGEMENT
SUCTIONING TO CLEAR THE AIRWAY
MANAGING THE DETERIORATING PATIENT
KNOW WHEN AND HOW TO ESCALATE
TEST YOUR KNOWLEDGE
WEB RESOURCES
Chapter 7: BREATHING
BREATHLESS ASSESSMENT
BREATHLESS ESCALATION
TREATMENT FOR BREATHLESSNESS
THE SIX P'S OF DYSPNOEA
RECOGNISE THAT THERE IS A PROBLEM
SIGNS OF RESPIRATORY DETERIORATION
MANAGING THE DETERIORATING PATIENT
BREATHING TREATMENT
KNOW WHEN AND HOW TO ESCALATE
RESPIRATORY FAILURE
COMMUNITY SETTINGS: CURB‐65
TEST YOUR KNOWLEDGE
WEB RESOURCES
Chapter 8: CIRCULATION
THE HEART
CIRCULATORY ASSESSMENT
CAPILLARY REFILL TIME
THE PULSE, ALSO KNOWN AS HEART RATE
COMMON PALPABLE SITES
BLOOD PRESSURE
BLOOD SAMPLING
CANNULATION
PAIN ASSESSMENT
BLOOD LOSS
TEST YOUR KNOWLEDGE
WEB RESOURCES
Chapter 9: DISABILITY
CONSCIOUSNESS
NEUROLOGICAL ASSESSMENT
IMPAIRMENT OF THE NEUROLOGICAL SYSTEM
RECOGNISE THAT THERE IS A PROBLEM
MANAGE THE DETERIORATING PATIENT AND ESCALATE
CONDUCTING THE GCS ASSESSMENT
EYE OPENING
VERBAL RESPONSE
MOTOR RESPONSES
PUPILLARY RESPONSE
LIMB MOVEMENT
PAEDIATRICS
TREATMENT FOR IMPAIRED CONSCIOUS STATE
A SELECTION OF POSSIBLE PHARMACEUTICAL INTERVENTIONS
DIURESIS
DRUGS
TEST YOUR KNOWLEDGE
WEB RESOURCES
Chapter 10: EXPOSURE
THERMOREGULATION
NORMAL BODY TEMPERATURE
PYREXIA – FEVER
HYPOTHERMIA
HYPERTHERMIA
SHOCK
THE IMPORTANCE OF ‘EXPOSURE’
OBSERVATIONS
TEST YOUR KNOWLEDGE
WEB RESOURCES
Part 3: ACUTE CARE SKILLS
Chapter 11: EMERGENCY FLUID MANAGEMENT
TOTAL BODY WATER VOLUME
STAYING HYDRATED
ELECTROLYTE IMBALANCES
DESCRIBING THE FLUID COMPARTMENTS
TRANSPORTING THE FLUIDS
KNOWING THE TYPES OF IV FLUIDS
HYPERVOLAEMIA VERSUS HYPOVOLAEMIA
TREATING HYPOVOLAEMIC SHOCK
TEST YOUR KNOWLEDGE
WEB RESOURCES
Chapter 12: TREATING PAEDIATRIC DEHYDRATION
PAEDIATRIC DEHYDRATION
ASSESSMENT
REHYDRATION
DEFICIT CORRECTION
HYPERNATRAEMIC DEHYDRATION
RECURRING DEHYDRATION
NIL BY MOUTH
TEST YOUR KNOWLEDGE
WEB RESOURCES
Chapter 13: HYPODERMOCLYSIS
WHAT IS HYPODERMOCLYSIS?
DEHYDRATION
TRAINING TO ADMINISTER SUBCUTANEOUS INFUSIONS
INDICATIONS FOR ADMINISTERING SUBCUTANEOUS INFUSIONS
BENEFITS OF SUBCUTANEOUS FLUID ADMINISTRATION
ADMINISTERING SUBCUTANEOUS INFUSIONS IN CHILDREN
MEDICATIONS
CONTRAINDICATIONS FOR SUBCUTANEOUS INFUSIONS
FLUIDS USED IN SUBCUTANEOUS INFUSIONS
CHOICE OF SITES FOR SUBCUTANEOUS INFUSIONS
PATIENT MONITORING
CALCULATING RATE OF ADMINISTERING SUBCUTANEOUS INFUSIONS
SETTING UP SUBCUTANEOUS INFUSIONS
REMOVING INFUSIONS
TEST YOUR KNOWLEDGE
WEB RESOURCES
Chapter 14: CENTRAL LINES
TYPES OF CENTRAL LINE
INSERTING CENTRAL LINES
WHY USE CENTRAL VENOUS ACCESS DEVICES
HOW LONG CAN A CENTRAL LINE BE LEFT IN SITU?
WITHDRAWING BLOOD FROM A CENTRAL LINE
CARING FOR A CENTRAL LINE
TEST YOUR KNOWLEDGE
WEB RESOURCES
Chapter 15: INVASIVE AND NON‐INVASIVE VENTILATION
INVASIVE MECHANICAL VENTILATION
NORMAL ARTERIAL BLOOD GAS VALUES
CORONAVIRUS
MECHANICS OF BREATHING AND LUNG VOLUMES
NON‐INVASIVE VENTILATION
CONTINUOUS POSITIVE AIRWAY PRESSURE
INDICATIONS FOR CPAP IN ADULTS
INDICATIONS FOR CPAP IN NEONATES
COMPLICATIONS OF CPAP IN ADULTS
COMPLICATIONS OF CPAP IN NEONATES
NURSING CARE OF PATIENTS RECEIVING CPAP
THE CPAP MACHINE
BILEVEL POSITIVE AIRWAY PRESSURE
WITHDRAWING FROM MECHANICAL VENTILATION
TEST YOUR KNOWLEDGE
WEB RESOURCES
Part 4: CRITICAL CARE SIMULATION
Chapter 16: CRITICAL CARE SIMULATION
INVESTIGATION AND TREATMENT
ABCDE ASSESSMENT SKILLS
WEB RESOURCES
Chapter 17: MEDICAL ABBREVIATIONS
GENERAL ABBREVIATIONS USED IN HEALTH CARE
ABBREVIATIONS RELATED TO MEDICAL TESTS ANDPROCEDURES
ABBREVIATIONS USED FOR BODY PARTS
ABBREVIATIONS RELATED TO DISEASE
TEST YOUR KNOWLEDGE
Chapter 18: ANSWERS TO ACTIVITIES, QUESTIONS, AND TEST YOUR KNOWLEDGE
CHAPTER 1
CHAPTER 2
CHAPTER 3
CHAPTER 4
CHAPTER 5
CHAPTER 6
CHAPTER 7
CHAPTER 8
CHAPTER 9
CHAPTER 10
CHAPTER 11
CHAPTER 12
CHAPTER 13
CHAPTER 14
CHAPTER 15
CHAPTER 16
CHAPTER 17
Appendix 1: NATIONAL EARLY WARNING SCORE 2 OBSERVATION CHART
Appendix 2: SEPSIS TOOL CHART
Appendix 3: FLUID PRESCRIPTION CHART
Index
End User License Agreement
List of Tables
Chapter 1
Table 1.1 Useful approximate values.
Table 1.2 World Health Organisation weight classifications.
Chapter 2
Table 2.1 How to spot sepsis in adults.
Table 2.2 How to spot sepsis in children.
Table 2.3 The sepsis six recommendations breakdown.
Table 2.4 Full blood count normal values.
Table 2.5 Haemoglobin normal values.
Table 2.6 Protocol for first‐dose antibiotics in sepsis.
Chapter 3
Table 3.1 Examples of conflict within health care.
Table 3.2 Warning and danger signs.
Table 3.3 The dos and don'ts of avoiding conflict.
Chapter 4
Table 4.1 Nursing process.
Table 4.2 Example of using the ABCDE assessment tool.
Table 4.3 How the Look, Listen, Feel, and Smell observations can be applied ...
Table 4.4 Modified Early Obstetric Warning Score (MEOWS) parameters.
Table 4.5 Paediatric early warning score observations.
Table 4.6 Palpating the radial pulse.
Table 4.7 Percussion sounds.
Table 4.8 Assessment investigations.
Table 4.9 Selection of blood tests.
Chapter 5
Table 5.1 The SBAR communication tool.
Table 5.2 National early warning score 2 clinical risk and response.
Table 5.3 Clinical response (nursing actions) broken down into more detail....
Chapter 7
Table 7.1 Abnormal lung sounds detected by auscultation.
Chapter 8
Table 8.1 Physiological changes with increasing blood loss.
Chapter 9
Table 9.1 Cranial nerves.
Table 9.2 Causes of impaired conscious levels in patients.
Table 9.3 Modification of Glasgow Coma Scale for children younger than two y...
Table 9.4 Modification of Glasgow Coma Scale for children older than two yea...
Table 9.5 Typical fluid balance for a healthy adult.
Chapter 10
Table 10.1 Circadian rhythm of healthy male temperature.
Table 10.2 Definition of temperature readings.
Table 10.3 Shock signs and symptoms.
Chapter 11
Table 11.1 Tests performed to evaluate fluid status.
Table 11.2 Common IV fluids.
Chapter 12
Table 12.1 Guidelines for assessing dehydration and hypovolaemic shock in pa...
Chapter 13
Table 13.1 Symptoms of mild, moderate, and severe dehydration.
Table 13.2 Medications administered via subcutaneous infusion.
Chapter 14
Table 14.1 General time limits for central lines.
Chapter 15
Table 15.1 Greek alphabet.
Table 15.2 Complications of continuous positive airway pressure.
Table 15.3 Nursing care of patients receiving continuous positive airway pr...
Table 15.4 Advantages and disadvantages of bilevel positive airway pressure...
Table 15.5 Advantages and disadvantages of bilevel positive airway pressure...
Table 15.6 Nursing care of patients receiving bilevel positive airway press...
List of Illustrations
Chapter 1
Figure 1.1 Aneroid sphygmomanometer.
Figure 1.2 Nomogram for infants.
Chapter 2
Figure 2.1 Infection criteria.
Chapter 3
Figure 3.1 The behaviour cycle.
Figure 3.2 Personal boundaries according to relationship.
Chapter 4
Figure 4.1 Look, listen, feel and smell.
Figure 4.2 MEOWS escalation pathway.
Figure 4.3 Paediatric early warning score escalation pathway.
Figure 4.4 The bell and diaphragm of a stethoscope.
Chapter 5
Figure 5.1 Electrocardiogram showing fast atrial fibrillation.
Chapter 6
Figure 6.1 Head tilt/chin lift technique.
Figure 6.2 Oropharyngeal airway adjuncts.
Chapter 7
Figure 7.1 Titrating oxygen.
Chapter 8
Figure 8.1 Blood flow through the body.
Figure 8.2 Capillary refill test.
Chapter 9
Figure 9.1 Adult Glasgow Coma Scale.
Chapter 11
Figure 11.1 Capillary refill time and passive leg‐raising tests.
Chapter 12
Figure 12.1 Managing dehydration in paediatrics. IV, intravenous; NG, nasoga...
Figure 12.2 Managing hypovolaemic shock in paediatrics. FBC, full blood coun...
Chapter 13
Figure 13.1 Picture of skin turgor test.
Chapter 14
Figure 14.1 Selection of central lines. CVAD, central venous access device; ...
Figure 14.2 Central line placement.
Chapter 15
Figure 15.1 Ventilator.
Guide
Cover Page
Series Page
Title Page
Copyright Page
Preface
Introduction
Acknowledgements
Table of Contents
Begin Reading
Appendix 1 NATIONAL EARLY WARNING SCORE 2 OBSERVATION CHART
Appendix 2 SEPSIS TOOL CHART
Appendix 3 FLUID PRESCRIPTION CHART
Index
Wiley End User License Agreement
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Student Survival Skills Series
Survive your nursing course with these essential guides for all student nurses:
Medicine Management Skills for Nurses, 2nd EditionClaire Boyd9781119807926
Clinical Skills for Nurses, 2nd EditionClaire Boyd9781119871545
Study Skills for NursesClaire Boyd9781118657430
Care Skills for NursesClaire Boyd9781118657386
Communication Skills for NursesClaire Boyd and Janet Dare9781118767528
Calculation Skills for Nurses, 2nd EditionClaire Boyd9781119808121
Wellbeing Strategies for NursesClaire Boyd9781119893554
Reflective Practice for NursesClaire Boyd9781119882480
ACUTE CARE FOR NURSES
Claire Boyd
RGN, Cert Ed
Practice Development Trainer
Bristol, UK
This edition first published 2023© 2023 John Wiley & Sons Ltd
All rights reserved. No part of this publication may be reproduced, stored in a retrieval system, or transmitted, in any form or by any means, electronic, mechanical, photocopying, recording or otherwise, except as permitted by law. Advice on how to obtain permission to reuse material from this title is available at http://www.wiley.com/go/permissions.
The right of Claire Boyd to be identified as the author of this work has been asserted in accordance with law.
Registered OfficesJohn Wiley & Sons, Inc., 111 River Street, Hoboken, NJ 07030, USAJohn Wiley & Sons Ltd, The Atrium, Southern Gate, Chichester, West Sussex, PO19 8SQ, UK
For details of our global editorial offices, customer services, and more information about Wiley products visit us at www.wiley.com.
Wiley also publishes its books in a variety of electronic formats and by print‐on‐demand. Some content that appears in standard print versions of this book may not be available in other formats.Trademarks: Wiley and the Wiley logo are trademarks or registered trademarks of John Wiley & Sons, Inc. and/or its affiliates in the United States and other countries and may not be used without written permission. All other trademarks are the property of their respective owners. John Wiley & Sons, Inc. is not associated with any product or vendor mentioned in this book.
Limit of Liability/Disclaimer of WarrantyThe contents of this work are intended to further general scientific research, understanding, and discussion only and are not intended and should not be relied upon as recommending or promoting scientific method, diagnosis, or treatment by physicians for any particular patient. In view of ongoing research, equipment modifications, changes in governmental regulations, and the constant flow of information relating to the use of medicines, equipment, and devices, the reader is urged to review and evaluate the information provided in the package insert or instructions for each medicine, equipment, or device for, among other things, any changes in the instructions or indication of usage and for added warnings and precautions. While the publisher and authors have used their best efforts in preparing this work, they make no representations or warranties with respect to the accuracy or completeness of the contents of this work and specifically disclaim all warranties, including without limitation any implied warranties of merchantability or fitness for a particular purpose. No warranty may be created or extended by sales representatives, written sales materials or promotional statements for this work. The fact that an organization, website, or product is referred to in this work as a citation and/or potential source of further information does not mean that the publisher and authors endorse the information or services the organization, website, or product may provide or recommendations it may make. This work is sold with the understanding that the publisher is not engaged in rendering professional services. The advice and strategies contained herein may not be suitable for your situation. You should consult with a specialist where appropriate. Further, readers should be aware that websites listed in this work may have changed or disappeared between when this work was written and when it is read. Neither the publisher nor authors shall be liable for any loss of profit or any other commercial damages, including but not limited to special, incidental, consequential, or other damages.
Library of Congress Cataloging‐in‐Publication Data applied forISBN: 9781119882459 (paperback)
Cover Design: WileyCover Images: © chuwy/Getty Images; © rambo182/Getty Images
Preface
This book has been developed to assist the healthcare worker in the field of acute care.
It is designed as a resource for nursing students, including nursing associates, Registered Nurses, and midwives requiring a bit of revision, assistant practitioners and senior health care assistants, perhaps working toward their vocational skills certification (qualification and credit framework level two), return to practice nurses, overseas nurses, and basically anyone requiring these more acute clinical skills and rapid assessment of the acutely ill patient. This knowledge has never been so important, especially during times of pandemic and winter pressures.
Introduction
Hello, my name is Claire, and those of you who have read the other books in this series will know that I have been in health care for more than 40 years, beginning my nursing career as a Nursing Auxiliary (Healthcare Assistant). After completing my training to become a Registered General Nurse and later obtaining a Certificate in Education to become a Teacher/Lecturer in health care, I began teaching medics, nurses, students, among others, in clinical skills.
As with other books in the series, this book has been divided into four sections. Part 1 begins by looking at some medication management formulas as revision before going on to look at some more advanced formulas you may see in the clinical setting. As these books are what you want, it was requested, by readers just like you, that sepsis and conflict resolution chapters were added.
Sepsis was included because of the fact that healthcare systems worldwide, including our beloved NHS (National Health System), have pledged to reduce the number of infections and deaths by early recognition and treatment.
Conflict resolution was added because of the assaults on healthcare staff. We’ve all seen angry patients and their families upset that visitors have been banned because of the coronavirus disease 2019 pandemic; others were furious that they were asked to wear masks in the hospital setting or because of cancelled clinics as a result of staff needed to cover for their sick colleagues in the ward areas. In truth, assaults by those we are trying to care for is nothing new.
Part 2 looks at assessment techniques and the individual components of the ABCDE assessment, moving on from the vital signs clinical observation at a superficial level and looking at the individual components more in depth, as well as the clinical actions performed by the more experienced nurse.
Part 3 focuses on some of the higher skills, such as caring for the ventilated patient, fluid resuscitation in adults and children, and subcutaneous fluid hydration in those unable to tolerate the intravenous route. Without adequate hydration, patients will die very quickly.
Throughout the book we will look at real‐life scenarios, with questions at the end of chapters to consolidate our understanding.
You will find a soupçon (that’s a posh word for ‘sprinkling’) of humour, as goodness knows nursing is a stressful profession at the best of times, never mind adding pandemics and winter pressures to the mix!
A man speaks frantically on the phone:
Midwife:
Father:
Everything has been designed as a quick overview read, cutting out the waffle (and perhaps ‘the nice to know’) and relaying only the important, vital information. See the information box below as an example as to what I mean:
VITAL VERSUS NICE TO KNOW
HOW TO SWITCH ON A LIGHT SWITCH
VITAL:
Go to light switch.
Using index finger of dominant hand, press down switch to turn on.
NICE TO KNOW:
You did not need to know how electricity is generated, how it is supplied to dwelling, how the fuse box is wired, how the light switch is wired, etc., as asked only to switch on the light switch!
Thank you to the students, and others, for writing and verbalising what you wanted covered in this book, thereby getting it right for you, the healthcare professional.
Acknowledgements
As always my thanks go to the many healthcare nurses and students I have had the pleasure of working with in the acute care setting (Southmead Hospital) and the community setting (South Gloucestershire care homes, Brain Injury Rehabilitation Centre, etc.). We have had so many laughs along the way, in often difficult times.
Acknowledgements also go to North Bristol NHS Trust and to all my friends and colleagues in the Staff Development Department.
Thank you to Tom Marriott, Ann Hunt, Selvakumar Gunakundru, and Sheila Higgins, copy editor, and all those at Wiley‐Blackwell, and to Magenta Styles, who first approached me to begin this series of books.
This book is dedicated to my family – husband Rob, children Simon and Louise, my lovely son‐in‐law David, and my two little treasures, Owen and Rhys, who kept us all laughing in our COVID bubble!
