Nursing Practice E-Book

• Herausgeber: John Wiley & Sons
• Kategorie: Fachliteratur
• Sprache: Englisch

Seitenzahl: 3465

Veröffentlichungsjahr: 2017

Beschreibung

The second edition of the successful and definitive nursing textbook, Nursing Practice is designed to support the student throughout the entire nursing degree. Structured around the latest Nursing and Midwifery Council Code of Conduct, it explores a range of clinical and professional issues that the student will need to know, in one complete and accessible volume.

Thoroughly updated and with full-colour, high quality illustrations throughout, this new edition features an additional chapter on the principles of supporting families and carers in practice, advice on revalidation, as well as a number of learning features and activities to help consolidate learning.

Nursing Practice provides invaluable information to enable not just student nurses, but also those who are qualified and members of the extended nursing family, to develop a deeper understanding of their patients’ needs and to ensure that they are practicing safely and effectively.

Leseprobe

This edition first published 2018 © 2018 by John Wiley & Sons, Ltd.

Edition History

1st edition © 2014, Wiley-Blackwell.

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The right of Ian Peate and Karen Wild to be identified as the authors of the editorial material in this work has been asserted in accordance with law.

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The 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

Names: Peate, Ian, editor. | Wild, Karen, 1959- editor.

Title: Nursing practice : knowledge and care / [edited] by Ian Peate, Karen Wild.

Other titles: Nursing practice (Peate)

Description: Second edition. | Hoboken, NJ : Wiley, 2018. | Includes bibliographical references and index. |

Identifiers: LCCN 2017027179 (print) | LCCN 2017029403 (ebook) | ISBN

9781119237488 (pdf) | ISBN 9781119237495 (epub) | ISBN 9781119237471 (pbk.)

Subjects: | MESH: Nursing Care–methods | Nursing Process

Classification: LCC RT41 (ebook) | LCC RT41 (print) | NLM WY 100.1 | DDC 610.73–dc23

LC record available at https://lccn.loc.gov/2017027179

Cover image: © sturti/Gettyimages

Cover design by Wiley

CONTENTS

Preface

Acknowledgements

About the Editors

Contributors

How to Use Your Textbook

About the Companion Website

Unit 1: Contextualising the Art and Science of Nursing

1: Nursing: Past, Present and Future

Introduction

A Glance at the History of Nursing

The Beginnings of the NHS and Nursing

Early Nursing Research

Modernising Nursing Careers

Current Nurse Education

The Francis Report

The Quality Assurance Framework for Nursing and Midwifery

The NHS and Healthcare Reform

Conclusion

Glossary

References

2: The Professional Nurse and Contemporary Healthcare

Introduction

Teaching and Learning in Practice

Theoretical Frameworks for Teaching and Learning

The Adult Learner

Revalidation and Continuing Professional Development

Leadership Styles and Theories

Evidence-based Practice

Change Management

Clinical Governance

Interprofessional Working

Working in Collaboration with Patients

Conclusion

Glossary

References

3: Health Promotion

Introduction

Health Promotion

Interpersonal Skills for Nursing and Health Promotion

Motivational Interviewing and Brief Interventions

Models of Health Promotion

Frameworks for Supporting Health

The Contemporary Focus of Health Promotion

Travel Health

Conclusion

Glossary

References

4: Public Health

Introduction

Setting the Scene for Public Health in the UK

Public Health England

Health Inequalities

Epidemiology and Public Health

Health Protection

Primary Care Nursing

District Nursing

Community Matrons

Health Visitor and School Health Advisor

Conclusion

Glossary

References

Unit 2: The Elements of Care

5: Ethics, the Law and the Nurse

Introduction

Approaches to Ethics

Ethical Principles

Legal and Ethical Dilemmas in Nursing

Legal Perspectives

Accountability

Conclusion

Glossary

References

6: The Nursing Process

Introduction

Defining Nursing

Organisational Models of Care

The Nursing Process

A Systematic Approach

Patient Goals

Nursing Goals: A Lost Art?

Writing the Care Plan

How Does ‘Intentional Rounding’ Fit In?

Compassion

Conclusion

Glossary

References

7: Models of Nursing

Introduction

Nursing Theory

History and Principles

A Framework for Children's Nursing

The Tidal Model in Mental Health Nursing

The Art and Science of Nursing

Patient-centred Care and Safety

Conclusion

Glossary

References

Unit 3: The Principles of Care

8: The Principles of Safeguarding and Dignity

Introduction

What Is Safeguarding?

Principles of Safeguarding

What Is Abuse or Harm?

Safeguarding Is Everybody's Business

Policy Framework for Safeguarding Adults

Responding to Disclosures

Key Stages of the Adult Safeguarding Process

Preventing the Abuse of Adults at Risk

What Is Dignity?

What Is Respect?

Thinking About and Understanding Dignity

Types of Dignity

Essence of Care 2010

Influencing Dignity in Care Practice

Conclusion

Glossary

References

9: The Principles of Older People's Care

Introduction

Attitudes and Stereotyping

Effective Communication

Patient-centred Care

The Older Person's Nutritional Needs

Pressure Ulcer Prevention

Falls Prevention

After a Fall

Discharge Planning

Glossary

References

10: The Principles of Caring for People with Learning Disabilities and/or Autism

Introduction

Definitions of Learning Disabilities

Autistic Spectrum Conditions Defined

Prevalence and Causes of Learning Disabilities

Classification of Learning Disability

Inequalities in Health Care

Attitudes Towards People with Learning Disabilities

Supporting Access to Services

Communication

Legal Aspects

Safeguarding

Conclusion

Glossary

References

11: Principles of Caring for Children and Families

Introduction

The Key Stages in Relation to the Development of Infants, Children and Young People

A Range of Communication Strategies

Some Common Physical and Mental Health Problems

Basic/Fundamental Care Needs

The Importance of Acting to Protect Infants, Children and Young People

Identifying Signs of Deterioration in General Health

Best Practice Relating to End of Life Care

Glossary

References

12: The Principles of Caring for People with Mental Health Problems

Introduction

Policy Context

What Is Mental Disorder?

Settings for Mental Health Care

Recovery

Holism

Caring for Carers

Comprehensive Assessment in Mental Health

The Physical Health of People with Mental Health Problems

Risk Assessment and Management

Legal Context

Therapeutic Nursing Care

Conclusion

Glossary

References

13: The Principles of Maternity Care

Introduction

The Role of the Midwife in Maternity Care

Overview of the Physiology of Pregnancy

Overview of Antenatal Care

Overview of Intranatal Care

Midwifery Care in Normal Labour

Unexpected and Rapid Deliveries

Initial Care of the Mother and Baby after Birth

Overview of Postnatal Care: Mother

Health and Advice in the Postnatal Period

Care of the Neonate after Birth

Infant Feeding

Conclusion

Glossary

References

14: The Principles of Surgical Care

Introduction

The Classification of Surgery and Risk

The Phases of Surgery

Complications of Surgery

Further Care of the Surgical Patient

Discharge

Day-case Surgery

Conclusion

Glossary

References

15: The Principles of Cancer Care

Introduction

Pathophysiology

Signs and Symptoms

Investigations and Diagnosis

Treatment of Cancer

Other Problems Resulting from All Cancer Therapies

Survivorship

End of Life Care

Conclusion

Glossary

References

16: The Principles of Infection Control

Introduction

Development of Infection Control Practices

Preventing the Spread of Infection

Common Healthcare-associated Infections

Antimicrobial Resistance

Care and Treatment for People with Infectious Diseases

Diagnostic Tests and Treatment

Technology and Infection Control

Conclusion

Glossary

References

17: The Principles of Nutrition

Introduction

The Nutrients

A Healthy Diet

Physiology of the Alimentary System

Undernourishment and Malnutrition

Nutritional Support

Obesity

Diabetes and Nutrition

Nutrition and Mental Illness

Hydration

Nutrition and Wound Healing

Nutrition for the Person Who Is Dying

Hospital Nutrition Services

Conclusion

Glossary

References

18: The Principles of Skin Integrity

Introduction

Anatomy and Physiology of the Skin

Function of the Skin

Wound Healing (Figure 18.6)

Psycho-Socioeconomic Aspects of Wound Care

The Quality Agenda and Wound Management

Wound Care and Management

Nursing Management

Multiple Pathology and Wound Care

Conclusion

Glossary

References

19: The Principles of Medicine Administration and Pharmacology

Introduction

Pharmacology

Person Group Directions

Changing Demography of the UK

Generic and Brand Names

Legislation and Policies Governing Drug Administration

Cold Chain

Preparation of Drugs

Medical Abbreviations

Compliance, Concordance and Adherence

Some Common Drugs Used in Practice and Their Action

Drug Calculations

Conclusion

Glossary

References

20: Care at the End of Life

Introduction

Where Do Our Ideas about Death and Dying Come From?

The Death of Personhood

Care at the End of Life

Advance Care Planning

Care in the Last few Days of Life

Communication

Breaking Bad News

Culture and Ethnicity

Grief, Loss and Bereavement

Who Cares for the Carers?

Conclusion

Glossary

References

21: The Principles of Supporting Families and Carers in Practice

Introduction

Carers

Families

Opportunities for Family and Carer Involvement

Adaptability and Coping

The Impact of Caregiving

Interventions to Support Families and Carers

Conclusion

Glossary

References

Unit 4: The Scientific Nature of Disease

22: The Cell

Introduction

The Chemical Level

The Genetic Level

The Cellular Level

The Tissue Level

Conclusion

Glossary

References

23: Immunity, Inflammation and Infection

Introduction

Inflammation

An Introduction to the Classification of Microbes/Microorganisms

The Lymphatic System and Immunity

The Cells of Immunity

Chemical Proteins Involved in Immunity

Immunity in Action

Disorders of the Immune System

Immunodeficiency

Conclusion

Glossary

References

24: Pain Management

Introduction

The Physiology of Pain

The Classification of Pain

Pain Theory

Pain Assessment

Pain Management

Nursing Management of Acute Pain

Nursing Management of Chronic Pain

Conclusion

Glossary

References

25: Fluid and Electrolyte Imbalance, and Shock

Introduction

Fluid Balance

Electrolyte Imbalance

Shock

Conclusion

Glossary

References

Unit 5: The Art and Science of Nursing Care

26: The Person with a Cardiovascular Disorder

Introduction

Anatomy and Physiology of the Heart

Anatomy and Physiology of the Blood Vessels

Assessing the Cardiovascular System

Disorders of the Cardiovascular System

Conclusion

Glossary

References

27: The Person with a Haematological Disorder

Introduction

Composition of Blood

Red Blood Cells

Conditions Associated with the Red Cells

White Blood Cells and Lymphoid Tissue Disorders

The Lymphatic System

Conditions Associated with the White Blood Cells

Platelet and Haemostasis Disorders

Conclusion

Glossary

References

28: The Person with a Respiratory Disorder

Introduction

Anatomy and Physiology

Respiratory Disease

Respiratory Failure

Respiratory Tract Infection

Obstructive Lung Disorders

Restrictive Lung Disorders

Lung Cancer

Pleural Disorders

Interstitial Lung Disease (Diffuse Parenchymal Lung Disease)

Conclusion

Glossary

References

29: The Person with a Gastrointestinal Disorder

Introduction

Anatomy and Physiology

Peptic Ulcer

Carcinoma of the Stomach

Hepatitis

Inflammatory Bowel Disease

Stomas

Gallbladder Disorders

Conclusion

Glossary

References

30: The Person with a Urinary Disorder

Introduction

Anatomy and Physiology

Urinary Tract Infection

Renal Calculi

Bladder Cancer

Renal Tumour

Renal Failure

Acute Kidney Injury

Chronic Kidney Disease

Conclusion

Glossary

References

31: The Woman with a Reproductive Disorder

Introduction

Anatomy and Physiology

Assessing the System

Abnormal Menstrual Bleeding

The Menopause

Disorders of the Female Reproductive System

Gynaecological Oncology

Female Genital Mutilation

Breast Disease

Breast Surgery

Conclusion

Glossary

References

32: The Man with a Reproductive Disorder

Introduction

Anatomy and Physiology

Assessing the System

Testicular Disorders

Prostate Disease

Erectile Dysfunction

Circumcision

Conclusion

Glossary

References

33: The Person with a Sexually Transmitted Infection

Introduction

Assessing the System

Features of STIs

Preventing STIs

Partner notification

Genital Warts

Gonorrhoea

Syphilis

Conclusion

Glossary

References

34: The Person with an Endocrine Disorder

Introduction

Anatomy and Physiology of the Endocrine System

Anatomy and Physiology of the Individual Endocrine Glands

Assessing the Endocrine System

Hypopituitarism (Pituitary Insufficiency)

Disorders of the Thyroid Gland

Disorders of the Parathyroid Glands

Disorders of the Adrenal Glands

Diabetes Mellitus

Conclusion

Glossary

References

35: The Person with a Neurological Disorder

Introduction

Anatomy and Physiology

Nursing Assessment of the Neurological System

The Unconscious Patient

The Patient with Raised Intracranial Pressure

Traumatic Brain Injury (Head Injury)

Stroke

Neurological Oncology

Infections of the CNS

Epilepsy

Headaches

Multiple Sclerosis

Parkinson's Disease

Alzheimer's Disease and Related Disorders

Peripheral Neuropathy

Conclusion

Glossary

References

36: The Person with an Ear or Eye Disorder

Introduction

Anatomy and Physiology of the Ear

Assessing the Person with an Ear Problem

Common Conditions of the Ear

Anatomy and Physiology of the Eye

Assessing Vision

Common Conditions of the Eye

Cataract Surgery

Conclusion

Glossary

References

37: The Person with a Musculoskeletal Disorder

Introduction

Anatomy and Physiology

Musculoskeletal Conditions

Assessing the Musculoskeletal System

Arthritis

Fractured Neck of Femur

Caring for People with Plaster Casts

Conclusion

Glossary

References

38: The Person with a Skin Disorder

Introduction

Anatomy and Physiology

Assessment

Skin Infections: Viral, Bacterial and Fungal

Infestations

Acne

Rosacea

Psoriasis

Eczema

Skin Tumours

Vascular Disorders (Including Naevi)

Disorders of the Hair and Nails

Connective Tissue Disorders

Conclusion

Glossary

References

Appendix A Reference Values in Venous Serum (Adults)

Appendix B List of Units

Index

EULA

List of Tables

Chapter 1

Table 1.1

Table 1.2

Table 1.3

Table 1.4

Chapter 2

Table 2.1

Table 2.2

Table 2.3

Table 2.4

Table 2.5

Chapter 3

Table 3.1

Table 3.2

Table 3.3

Table 3.4

Chapter 4

Table 4.1

Table 4.2

Chapter 8

Table 8.1

Table 8.2

Table 8.3

Chapter 11

Table 11.1

Table 11.2

Table 11.3

Chapter 13

Table 13.1

Table 13.2

Table 13.3

Table 13.4

Chapter 16

Table 16.1

Chapter 18

Table 18.1

Table 18.2

Table 18.3

Table 18.4

Table 18.5

Table 18.6

Table 18.7

Chapter 19

Table 19.1

Table 19.2

Table 19.3

Table 19.4

Table 19.5

Table 19.6

Chapter 21

Table 21.1

Table 21.2

Table 21.3

Chapter 22

Table 22.1

Chapter 24

Table 24.1

Table 24.2

Table 24.3

Table 24.4

Table 24.5

Table 24.6

Chapter 25

Table 25.1

Table 25.2

Table 25.3

Table 25.4

Chapter 26

Table 26.1

Table 26.2

Chapter 27

Table 27.1

Table 27.2

Table 27.3

Table 27.4

Table 27.5

Table 27.6

Table 27.7

Table 27.8

Table 27.9

Table 27.10

Table 27.11

Chapter 28

Table 28.1

Table 28.2

Table 28.3

Table 28.4

Table 28.5

Table 28.6

Table 28.7

Table 28.8

Table 28.9

Chapter 30

Table 30.1

Table 30.2

Table 30.3

Chapter 31

Table 31.1

Table 31.2

Table 31.3

Table 31.4

Table 31.5

Chapter 32

Table 32.1

Table 32.2

Table 32.3

Table 32.4

Table 32.5

Chapter 33

Table 33.1

Table 33.2

Table 33.3

Table 33.4

Table 33.5

Table 33.6

Chapter 34

Table 34.1

Table 34.2

Table 34.3

Table 34.4

Chapter 35

Table 35.1

Table 35.2

Table 35.3

Table 35.4

Table 35.5

Table 35.6

Table 35.7

Table 35.8

Table 35.9

Table 35.10

Table 35.11

Table 35.12

Table 35.13

Table 35.14

Table 35.15

Table 35.16

Table 35.17

Table 35.18

Table 35.19

Table 35.20

Table 35.21

Chapter 36

Table 36.1

Table 36.2

Table 36.3

Table 36.4

Chapter 37

Table 37.1

Table 37.2

Table 37.3

Table 37.4

Table 37.5

Table 37.6

Table 37.7

Chapter 38

Table 38.1

Table 38.2

Table 38.3

Table 38.4

Table 38.5

Table 38.6

Table 38.7

Table 38.8

Table 38.9

Table 38.10

Table 38.11

Table 38.12

Table 38.13

List of Illustrations

Chapter 1

Figure 1.1

Early engraving depicting the support of a woman in labour.

Figure 1.2

Florence Nightingale.

Figure 1.3

Lighting the lamps in 1913.

Figure 1.4

Mary Seacole.

Figure 1.5

Some significant dates in the history of the NHS.

Figure 1.6

An overview of the health and care system from April 2013.

Figure 1.7

Leading Change, Adding Value.

Chapter 2

Figure 2.1

Methods of assessment in clinical practice.

Figure 2.2

Kolb's experiential learning cycle.

Figure 2.3

Experiential readiness to learn.

Figure 2.4

Gibbs reflective cycle.

Figure 2.5

The five domains of the Clinical Leadership Competency Framework (CLCF).

Figure 2.6

Sources of evidence.

Figure 2.7

The six-stage framework for service improvement.

Chapter 3

Figure 3.1

Historical journey of health promotion.

Figure 3.2

Determinants that influence health.

Figure 3.3

Health may be viewed in relation to balance of the ‘humours’ as in Yin and Yang.

Figure 3.4

Tannahill's model of health promotion. Source: cited in Downie et al. 1996.

Figure 3.5

Prochaska and DiClemente's transtheoretical (stages of change) approach.

Figure 3.6

The Health Belief Model.

Chapter 4

Figure 4.1

Some important public health interventions of the 19th century.

Figure 4.2

Examples of agencies and services to support contemporary public health activities.

Figure 4.3

Three levels of nursing and midwifery practice: improving and protecting the public's health.

Figure 4.4

Public Health England: improving the public's health and well-being.

Figure 4.5

Determinants of health.

Figure 4.6

Questions that guide epidemiology.

Figure 4.7

Basic principles of community nursing.

Figure 4.8

The many roles of the District Nurse.

Figure 4.9

Examples of clinical skills undertaken by district nurses.

Figure 4.10

The various roles of the Health Visitor.

Chapter 5

Figure 5.1

Ethical principles.

Figure 5.2

UK legislation related to confidentiality.

Figure 5.3

Hierarchy of the court system in the UK.

Figure 5.4

The legal system is divided into civil and criminal law.

Figure 5.5

Stages in raising and escalating concerns.

Chapter 6

Figure 6.1

Patient allocation.

Figure 6.2

Task allocation.

Figure 6.3

Team nursing.

Figure 6.4

Primary nursing.

Figure 6.5

Primary nursing and the Nursing Process.

Figure 6.6

The four phases of the Nursing Process.

Figure 6.7

The four phases plus the nursing diagnosis.

Figure 6.8

The pivotal role of the nurse when communicating with the interprofessional team.

Chapter 7

Figure 7.1

The 12 activities of living.

Figure 7.2

A report comparing the quality and cost-effectiveness of healthcare systems in seven major countries. Note that 1 is top rank, 7 is lowest.

Chapter 8

Figure 8.1

Safeguarding continuum.

Figure 8.2

Categories of abuse.

Figure 8.3

Multidimensional approach to preventing abuse or neglect.

Figure 8.4

Universal Declaration of Human Rights 1948.

Figure 8.5

Maslow's hierarchy of needs (Maslow 1954).

Figure 8.6

Combined Framework of Human Rights and Needs.

Figure 8.7

Dignity Challenges Framework.

Chapter 9

Figure 9.1

Some members of the multidisciplinary team.

Chapter 10

Figure 10.1

Examples of Makaton signs (Bailey 2012).

Chapter 11

Figure 11.1

Major developmental milestones.

Figure 11.2

Hormones produced in adolescence.

Figure 11.3

Illustration of the passage of a message.

Figure 11.4

Illustration of potential barriers to sending and receiving messages.

Figure 11.5

The importance of facial expressions within the process of communication.

Figure 11.6

Maslow's hierarchy of need.

Figure 11.7

An infant receiving headbox oxygen.

Figure 11.8

Maryam's fundamental care needs.

Figure 11.9

Emily's fundamental care needs.

Figure 11.10

Josh's fundamental care needs.

Figure 11.11

Assessment of an acutely ill child.

Chapter 12

Figure 12.1

Factors affecting the development of mental disorders.

Chapter 13

Figure 13.1

Terminology used during abdominal palpation. In this case, the presentation is cephalic. The position is left occiptio anterior (the fetal occiput is anterior and is on the left of the maternal pelvis). The lie is longitudinal. The attitude is one of flexion and the head is not engaged.

Figure 13.2

Fetal growth from week 4 to week 36.

Figure 13.3

Antenatal and neonatal screening test schedule. This information was originally developed by the UK National Screening Committee/NHS Screening Programmes.

Figure 13.4

The cervix is effaced and dilated.

Figure 13.5

Expulsion of the fetal head during the second stage of labour.

Figure 13.6

The placenta after delivery of the baby and prior to separation from the wall of the uterus.

Figure 13.7

The fetal surface of the placenta.

Figure 13.8

Stool colour chart. Approximate colour guide for the first few days of a baby's life. This should be used as a guide only.

Chapter 14

Figure 14.1

Leg exercises after surgery.

Figure 14.2

Serum levels of analgesia using PCA and intramuscular regimens.

Figure 14.3

Subcutaneous continuous suture showing one of the retaining beads.

Figure 14.4

Intermittent skin sutures.

Chapter 15

Figure 15.1

The cell cycle.

Figure 15.2

Cell division: mitosis.

Chapter 16

Figure 16.1

Infection control: a historical timeline.

Figure 16.2

Correct hand-washing technique.

Figure 16.3

Five moments for hand hygiene.

Figure 16.4

Protecting yourself using personal protective equipment (PPE).

Figure 16.5

Trends in rates of

Clostridium difficile

. Prevention measures dramatically reduced rates but now appear to be plateauing. FY, Financial year, April to March.

Figure 16.6

Seasonal variation of norovirus infections in England and Wales, 2014–2016.

Figure 16.7

Measles outbreak: reported cases in South Wales, 2012–2013.

Chapter 17

Figure 17.1

Proportions of nutrients for a healthy lifestyle.

Figure 17.2

Organs of the digestive system.

Figure 17.3

Relationship of the peritoneal folds to one another and to the organs of the digestive system.

Chapter 18

Figure 18.1

Structure of the fingernail.

Figure 18.2

Cross-section of the skin.

Figure 18.3

Layers of the epidermis.

Figure 18.4

Epidermal ridges and sweat pores.

Figure 18.5

Structure of the hair.

Figure 18.6

Healing of epidermal and deep wounds.

Figure 18.7

Suitable dressings for different wound types.

Figure 18.8

Using larvae to clean a peri-wound area.

Figure 18.9

Evisceration of a wound can be frightening for the patient.

Figure 18.10

Venous leg ulcer.

Figure 18.11

Arterial leg ulcer.

Figure 18.12

Stage II pressure ulcer.

Figure 18.13

Lund and Browder tool.

Figure 18.14

The diabetic foot.

Figure 18.15

Malignant and fungating wound.

Figure 18.16

Skin tear.

Chapter 19

Figure 19.1

Portal circulation.

Figure 19.2

First pass metabolism.

Figure 19.3

Active transport system.

Figure 19.4

Passive transport system.

Figure 19.5

Facilitated diffusion.

Figure 19.6

Cell membrane.

Figure 19.7

Anatomy of a cell.

Figure 19.8

Sublingual route.

Figure 19.9

Buccal route.

Figure 19.10

Rectal anatomy.

Figure 19.11

Location of the gluteus medius muscle.

Figure 19.12

Location of the deltoid muscle.

Figure 19.13

Location of the rectus femoris and vastus lateralis muscles of the thigh.

Figure 19.14

Subcutaneous injection sites.

Figure 19.15

Analgesic steps.

Chapter 20

Figure 20.1

End of Life Care Pathway.

Figure 20.2

Gold Standards Framework Programme (2011) Prognostic Indicator Guidance.

Figure 20.3

Relationship between advance care planning, best interest decision-making, Advance Decision to Refuse Treatment (ADRT) and Lasting Power of Attorney.

Figure 20.4

Stroebe and Schut's dual process model.

Chapter 21

Figure 21.1

Triangle of Care.

Chapter 22

Figure 22.1

Four-cell stage of the first cell divisions of a fertilised egg. These first cell divisions set the stage for all subsequent development, structure and function.

Figure 22.2

Individual sodium and chlorine atoms combine to make an NaCl molecule.

Figure 22.3

The alternating deoxyribose (sugar) molecule and phosphate group with the nucleotides (bases) attached in a small portion of the DNA molecule.

Figure 22.4

(a) A nucleotide consists of a base, 5-carbon sugar and a phosphate group. (b) A and T pair with two hydrogen bonds, while C and G pair with three hydrogen bonds.

Figure 22.5

DNA base-pairing: paired bases face towards the centre of the double helix. The structure is stabilised by the hydrogen bonds between base pairs.

Figure 22.6

Stages of the cell cycle.

Figure 22.7

Stages of mitosis.

Figure 22.8

Stages of meiosis.

Figure 22.9

Meiosis: reproductive cell division.

Figure 22.10

Mixing and matching: note chromosomes 13 and 22.

Figure 22.11

The process of making a new strand involves the pairing of the bases, although these are slightly different in RNA.

Figure 22.12

The three stages of transcription.

Figure 22.13

Structure of the cell and its organelles.

Figure 22.14

Membrane structure.

Figure 22.15

Stress response can lead to protein misfolding and on to disease.

Chapter 23

Figure 23.1

Inflammation, highlighting the key cells and chemical mediators involved in the process of inflammation. The immune response has three distinct interlinked phases: innate (green box), cell-mediated (orange box) and antibody-mediated (red box).

Figure 23.2

Simple preventative measures.

Figure 23.3

Components of the lymphatic system.

Figure 23.4

Origin, development and structure of formed elements. Some of the generations of some cell lines have been omitted.

Figure 23.5

Structure of a lymph node. Arrows indicate direction of lymph flow through a lymph node.

Figure 23.6

The middle J chain of IgM immunoglobulin regulates its five-pronged wheel structure. All immunoglobulins have heavy and light chains (coloured green and blue, respectively) with a hinge or central region.

Figure 23.7

Antigens and antibodies involved in the ABO blood groups.

Figure 23.8

Immunoglobulins: blue light chain represents open forceps, green heavy chain represents the forceps fixed end and the hinge region enables the forceps to open and close.

Figure 23.9

Phagocytosis.

Figure 23.10

The structures and features of the innate immune system.

Figure 23.11

Skin wound healing.

Figure 23.12

Cell-mediated immunity.

Figure 23.13

Binding of the helper T-cell receptor (TCR) with major histocompatability complex (MHC)/human leukocyte antigen (HLA) receptor and microbial DNA.

Figure 23.14

Activation and clonal selection of B cells. Plasma cells are actually much larger than B cells.

Chapter 24

Figure 24.1

Pain pathway of transmission and interpretation.

Figure 24.2

The ascending pain pathway.

Figure 24.3

Structure of a typical neurone.

Figure 24.4

Cross-section of the spinal cord. Note that both sides are identical.

Figure 24.5

The spinothalamic tract.

Figure 24.6

The limbic system.

Figure 24.7

The reflex arc.

Figure 24.8

The gate control theory of pain.

Figure 24.9

The gate control theory and influence of T and SG cell activity.

Figure 24.10

The four dimensions of the pain experience.

Figure 24.11

The verbal rating scale.

Figure 24.12

The verbal analogue scale

Figure 24.13

The visual analogue scale.

Figure 24.14

The McGill Pain Questionnaire.

Figure 24.15

The action of cyclooxygenase-2 (COX-2) in enhancing prostaglandin action.

Figure 24.16

The WHO analgesic ladder (World Health Organization 1986).

Figure 24.17

Transcutaneous electrical nerve stimulation (TENS) machine.

Figure 24.18

Examples of referred pain and the origin of the tissue damage.

Chapter 25

Figure 25.1

Fluid compartments of the body.

Figure 25.2

Osmosis.

Figure 25.3

Simple diffusion.

Figure 25.4

Facilitated diffusion.

Figure 25.5

Electrolytes of intracellular and extracellular compartments.

Figure 25.6

The pH scale.

Figure 25.7

Bicarbonate–carbonic acid buffer reversible reaction.

Figure 25.8

ECG showing the effects of (a) normokalaemia and (b) hypokalaemia.

Figure 25.9

ECG pattern of hyperkalaemia, showing prolonged QRS and tall T wave.

Chapter 26

Figure 26.1

Location of the heart.

Figure 26.2

Heart wall.

Figure 26.3

The chambers of the heart.

Figure 26.4

A simplified diagram of the flow of blood through the heart.

Figure 26.5

(a) Anatomical view of blood flow through the heart. (b) Simplified diagrammatic view of blood flow through the heart and the systemic and pulmonary circulations.

Figure 26.6

Conduction system of the heart (the white dashed line shows the passage of the electrical impulses through the heart muscle).

Figure 26.7

The cardiac cycle.

Figure 26.8

The cardiac cycle and the ECG.

Figure 26.9

The coronary arteries.

Figure 26.10

The pressure differences through the blood vessels.

Figure 26.11

The comparative structure of blood vessels.

Figure 26.12

The relationship between systolic, diastolic and pulse pressures.

Figure 26.13

The negative feedback control of blood pressure through the baroreceptors.

Figure 26.14

Pulse sites on the body.

Figure 26.15

Assessing the radial pulse.

Figure 26.17

Palpating the posterior tibial pulse.

Figure 26.18

Palpating the popliteal pulse.

Figure 26.19

Atherosclerosis.

Figure 26.20

Ruptured atherosclerotic plaque.

Figure 26.21

Typical areas where pain associated with myocardial infarction may be reported.

Figure 26.22

Coronary stent insertion.

Figure 26.23

Signs and symptoms of heart failure.

Figure 26.24

Abdominal aortic aneurysm.

Chapter 27

Figure 27.1

The constituents of blood.

Figure 27.2

Haematopoiesis.

Figure 27.3

The difference between normal red blood cells and sickled red blood cells, and the effects at the smaller blood vessels.

Figure 27.4

The location of lymphoid tissue.

Figure 27.5

Blood clotting pathways.

Figure 27.6

Haemophilia inheritance.

Chapter 28

Figure 28.1

Upper and lower respiratory tract.

Figure 28.2

Structure of the upper airways.

Figure 28.3

Anatomy of the lower respiratory tract.

Figure 28.4

Structure of the larynx.

Figure 28.5

Surface anatomy of the lungs.

Figure 28.6

Anatomy of a lobule of the lungs.

Figure 28.7

Muscles of inhalation and exhalation.

Figure 28.8

Events of inhalation and exhalation.

Figure 28.9

Diagrammatic description of the major lung volumes and capacities. Values are for males, with values for females in parentheses.

Figure 28.10

The respiratory centres of the brain.

Figure 28.11

External respiration: exchange of oxygen and carbon dioxide within the lungs.

Figure 28.12

The oxyhaemoglobin dissociation curve: (a) at normal body temperature, arterial carbon dioxide levels and normal arterial blood pH; (b) with high or low arterial blood pH; (c) with high or low arterial carbon dioxide levels.

Figure 28.13

Internal respiration: exchange of oxygen and carbon dioxide in systemic capillaries.

Figure 28.14

Airway pathophysiology: normal compared with asthmatic.

Chapter 29

Figure 29.1

Organs of the gastrointestinal tract.

Figure 29.2

The four layers of the gastrointestinal tract.

Figure 29.3

Structures of the mouth.

Figure 29.4

Milk teeth.

Figure 29.5

Permanent teeth.

Figure 29.6

Nasopharynx and laryngopharynx.

Figure 29.7

Oesophagus.

Figure 29.8

Histology of the oesophagus.

Figure 29.9

Anatomy of the stomach.

Figure 29.10

Layers of the stomach.

Figure 29.11

Small intestine.

Figure 29.12

Large intestine.

Figure 29.13

Hepatobiliary system.

Figure 29.14

Common sites for peptic ulcer.

Figure 29.15

(a) Tumour affecting the layers of the stomach. (b) Tumour has spread into neighbouring lymph nodes. (c) Tumour has spread to the liver.

Figure 29.16

Ileostomy on the right side of the abdomen.

Figure 29.17

Types of colostomy.

Figure 29.18

Carcinoma of the gallbladder. The tumour has spread into the hepatic ducts and is partially blocking the right hepatic duct and the liver. Note some gallstones in the gallbladder.

Chapter 30

Figure 30.1

Organs of the urinary system in a female.

Figure 30.2

Location of the kidneys: back view.

Figure 30.3

Internal structures of the kidney.

Figure 30.4

Blood flow through the kidney.

Figure 30.5

The nephron.

Figure 30.6

Glomerular filtration.

Figure 30.7

Urinary bladder in the female.

Figure 30.8

The male urethra in relation to other pelvic organs.

Figure 30.9

The female urethra in relation to other pelvic organs.

Figure 30.10

Stages of bladder cancer.

Figure 30.11

Formation of an ileal conduit. A section of the terminal ileum is used to form a stoma, where both ureters are implanted and for the urine to flow into. The stoma protrudes from the skin to minimise skin irritation from the urine.

Chapter 31

Figure 31.1

The external female genitalia.

Figure 31.2

The internal organs of the female reproductive system.

Figure 31.3

The ovaries.

Figure 31.4

Secretion and physiological effects of oestrogen, progesterone, relaxin and inhibin in the female reproductive cycle. Dashed red lines indicate negative feedback inhibition.

Figure 31.5

The female reproductive cycle.

Figure 31.6

The breast: (a) sagittal and (b) anterior views.

Figure 31.7

Breast self-examination.

Figure 31.8

The muscles of the female pelvic floor.

Figure 31.9

Types of prolapse.

Figure 31.10

Taking a sample of cells.

Figure 31.11

Colposcope.

Figure 31.12

The transformation zone.

Figure 31.13

Cone biopsy.

Figure 31.14

Loop diathermy.

Figure 31.15

Hysteroscope.

Figure 31.16

Endometrial ablation. A heated wire loop or a rollerball (a ball on the end of a handle) is used to cut or burn away the lining of the uterus with the aid of a hysteroscope.

Figure 31.17

Needle aspiration.

Figure 31.18

Lymph nodes and drainage: the breast.

Chapter 32

Figure 32.1

Male organs of reproduction and surrounding structures.

Figure 32.2

The anatomy of a testis.

Figure 32.3

Transverse section of a portion of seminiferous tubule. (n) and

(2n)

refer to haploid and diploid numbers of chromosomes.

Figure 32.4

Events in spermatogenesis.

Figure 32.5

Parts of a sperm cell.

Figure 32.6

Hormonal control of spermatogenesis.

Figure 32.7

Internal structure of the penis. The inset in (b) shows details of the skin and fasciae.

Figure 32.8

Model of vascular events controlling erection.

Figure 32.9

Neural pathways involved in penile erection. ACh, acetylcholine; MPOA, medial preoptic area; NO, nitric oxide; VIP, vasoactive intestinal peptide.

Figure 32.10

Pelvic and para-aortic lymph nodes.

Figure 32.11

Trans-rectal ultrasound-guided biopsy of the prostate.

Figure 32.12

Trans-perineal template biopsy of the prostate.

Figure 32.13

Prostate cryotherapy.

Figure 32.14

The male sexual response.

Chapter 34

Figure 34.1

The location of the endocrine glands and the organs that secrete hormones.

Figure 34.2

Transportation of hormones in the blood.

Figure 34.3

Target cell and non-target cell.

Figure 34.4

Negative feedback loop.

Figure 34.5

Example of a negative feedback system.

Figure 34.6

The hypothalamus and the posterior pituitary gland.

Figure 34.7

The hypothalamus and the anterior pituitary gland.

Figure 34.8

The thyroid gland.

Figure 34.9

The negative feedback control of thyroid hormone release.

Figure 34.10

The parathyroid glands.

Figure 34.11

The effects of parathyroid hormone, calcitonin and calcitriol in the regulation of blood calcium levels. Purple arrows, calcitonin; blue arrows, parathyroid hormone; red arrows, calcitriol.

Figure 34.12

The adrenal glands.

Figure 34.13

Cross-section of an adrenal gland and its subdivisions.

Figure 34.14

The renin–angiotensin–aldosterone system.

Figure 34.15

The negative feedback control of cortisol production and secretion.

Figure 34.16

The pancreas.

Figure 34.17

The negative feedback control of the production of insulin (red arrows) and glucagon (blue arrows).

Chapter 35

Figure 35.1

The main parts of the nervous system.

Figure 35.2

Structure of a typical motor neurone and Schwann cell.

Figure 35.3

Myelinated and unmyelinated axons.

Figure 35.4

How the different types of neurones interact.

Figure 35.5

Neuroglia of (a) the central and (b) the peripheral nervous system.

Figure 35.6

The brain.

Figure 35.7

Structure of the left cerebral hemisphere.

Figure 35.8

External anatomy of the spinal cord. See Figure 35.13 for the spinal nerves.

Figure 35.9

The protective coverings of the brain.

Figure 35.10

The formation and circulation and absorption of the CSF.

Figure 35.11

Inferior view of base of brain showing cerebral arterial circle.

Figure 35.12

Sagittal view of extension of the dura mater.

Figure 35.13

Spinal nerves and plexuses.

Figure 35.14

Organisation of the nervous system. Grey boxes represent sensory components of the peripheral nervous system (PNS). Yellow boxes represent motor components of the PNS. Red boxes represent effectors (muscles and glands).

Figure 35.15

Somatic sensory map in the cerebral cortex.

Figure 35.16

Origins of the cranial nerves.

Figure 35.17

The reticular activating system (RAS).

Chapter 36

Figure 36.1

The ear.

Figure 36.2

The auricle.

Figure 36.3

The external auditory meatus.

Figure 36.4

The ossicles.

Figure 36.5

The structures of the inner ear.

Figure 36.6

The mechanism of hearing.

Figure 36.7

The otoscope.

Figure 36.8

A tuning fork.

Figure 36.9

Cross-section of the eye.

Figure 36.10

The orbit.

Figure 36.11

The eyelids.

Figure 36.12

The lacrimal apparatus.

Figure 36.13

The iris and chambers of the eye.

Figure 36.14

The ciliary body.

Figure 36.15

The layers of the retina.

Figure 36.16

The optic nerve.

Figure 36.17

The visual pathway.

Figure 36.18

Inspection of the eyes.

Figure 36.19

The Snellen chart.

Figure 36.20

Cardiff cards.

Figure 36.21

Phacoemulsification.

Chapter 37

Figure 37.1

The divisions of the skeletal system.

Figure 37.2

Osteons in compact bone and trabeculae in spongy bone.

Figure 37.3

Bone shapes (not to scale).

Figure 37.4

Parts of a long bone.

Figure 37.5

Diagrammatic representation of the bone remodelling process.

Figure 37.6

The six types of synovial joint.

Figure 37.7

The gross and microscopic anatomy of skeletal muscles.

Figure 37.8

Smooth muscle.

Figure 37.9

Cardiac muscle.

Figure 37.10

Categories of fracture.

Figure 37.11

Blood supply of a mature long bone.

Figure 37.12

Osteoarthritis.

Figure 37.13

Types of fracture: (a) intracapsular; (b) extracapsular.

Figure 37.14

Types of fixation and implantation for hip fracture.

Chapter 38

Figure 38.1

Vitiligo.

Figure 38.2

Types of wart.

Figure 38.3

Tinea pedis.

Figure 38.4

Atopic dermatitis; seborrhoeic dermatitis; contact dermatitis; psoriasis; Henoch–Schönlein purpura; acne; urticaria; Kawasaki disease.

Figure 38.5

Rosacea.

Figure 38.6

Psoriasis.

Figure 38.7

Eczema.

Figure 38.8

Haemangiomas and naevi.

Figure 38.9

Nail disorders: (a) pitting of nail, (b) nail psoriasis, (c) nail eczema, (d) lichen planus and (e) dystrophy due to lupus.

Figure 38.10

Tinea capitis.

Figure 38.11

Lupus erythematosus.

Guide

Cover

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Preface

The contents of this edition have been updated and we have retained all the features that you have told us have been helpful to you as you learn the art and science of nursing. We have added an additional chapter, ‘The Principles of Supporting Families and Carers in Practice’, as we felt that families and carers require support and assistance as they provide care to others. The book will be an invaluable resource as you begin and continue on your journey to becoming a registered nurse. The text will also be invaluable for those who educate nurses, mentors and preceptors, those who are returning to practice, those already registered, for other members of the extended nursing family, the nursing associate and those who have chosen nursing in the UK who are coming from other parts of the world. There are many challenges facing all these people who must keep abreast of new developments in knowledge and technologies, in the important activity of promoting health and well-being and with the provision of health and social care that has an evidence base, and all of this against a backdrop of ongoing social and economic austerity.

Much has changed in the field of health and social care since the first edition of this popular text was published. The ways in which health and social care are delivered will continue to change as nurses and those who provide care in order to meet the needs of others adapt in their approach when striving to deliver safe and effective care.

The changes bring with them a range of opportunities and challenges for nurses and other health and social care professionals. The needs of people in relation to their health and well-being demand that nurses are knowledgeable and up to date with contemporary practice and this is absolutely right – the public need to know that the people who are providing care are fit for purpose and fit for practice. This is a tall order given that the transformations occurring within the ever-widening sphere of health and social care (wherever this may be) and the amount of knowledge the nurse needs to possess in order to be able to say confidently and competently that they are up to date are changing on a daily basis.

The content of this book is derived from a variety of sources, for example the Standards for Pre-registration Nursing Education (Nursing and Midwifery Council 2010), the proposed standards issued by the NMC in 2017 and the Principles of Nursing Practice (Royal College of Nursing 2012) as well drawing on the revised The Code. Professional Standards of Practice and Behaviour for Nurses and Midwives (Nursing and Midwifery Council 2015). There are a number of themes and trends that are driving strategic direction and change within and without the nursing profession and these too have had an impact on the chapters within the book:

The UK population continues to grow

Infant mortality is at its lowest rate ever

Premature mortality is still poor compared with some other European countries

There are different health outcomes between socioeconomic groups

Black and ethnic minority groups experience worse health outcomes than white communities

The population is ageing

There will be more people living with long-term conditions and dementia

Lifestyle choice continues to hinder good health, i.e. obesity, heavy drinking and sexually transmitted infections are not improving

Expectations of health and social services amongst the public are rising

Users and carers are a more focused part of health and social care delivery systems

Patient-centred healthcare and self-management has led to a growth in service user involvement

Movement of care into the community is a growing policy theme

There is a continued increasing emphasis on patient safety and the prevention of adverse incidents

Experiences of poor health and social care feature in public discourse

The majority of nurses work in the NHS, with a growing number working in voluntary and independent healthcare settings

Nurses continue to take on and develop more advanced roles

There is, and will continue to be, an increase in the use of assistant practitioners and healthcare assistants across the health and social care sectors The introduction of the Nursing Associate.

Nursing Practice: Knowledge and Care provides you with much information to enable you to develop a deeper understanding of issues that impact on the health and well-being of the people nurses serve. The book has been written by a number of expert practitioners and academics who are passionate about the art and science of nursing, dedicated to the health and well-being of the public and committed to nurse education and the notion of lifelong learning.

The book is presented to you in five units:

Unit 1: Contextualising the Art and Science of Nursing

Unit 2: The Elements of Care

Unit 3: The Principles of Care

Unit 4: The Scientific Nature of Disease

Unit 5: The Art and Science of Nursing Care

It is intended that the book be used as a reference at home or in the classroom. The art and science of nursing has been intertwined in the chapters and each unit is interrelated. The focus will be on the adult field of nursing; however, where appropriate, each chapter provides examples of how content can be applied to the other fields of nursing.

The first four chapters are ‘scene-setting’ chapters and we would suggest you read these first. The remaining chapters have been arranged in such a way that they can be read at random, for example if you are caring for people with cardiovascular conditions, it would be useful to delve into the chapter that addresses issues concerning cardiovascular disorders and then go on to other chapters such as the discussion of diabetes mellitus in the endocrinology chapter as related to cardiovascular disease. We are aware, however, that we all have our own learning styles and you will use whatever approach appeals to you.

In general we have used a systems approach; we understand that people are not systems, but we have chosen this approach in order to make learning and application easier. There are 38 chapters. Each chapter is preceded by learning outcomes related where appropriate to the Standards for Pre-registration Nursing Education (Nursing and Midwifery Council 2010) and the proposed standards issued by the NMC in 2017.

There are a number of learning features and activities within each chapter and these are discussed in the ‘How to Use Your Textbook’ pages that follow the Contributors section.