Vital Signs for Nurses E-Book

Joyce Smith

• Herausgeber: John Wiley & Sons
• Kategorie: Fachliteratur
• Sprache: Englisch
• Veröffentlichungsjahr: 2011

Seitenzahl: 375

Beschreibung

Accurate clinical observations are the key to good patient care and fundamental to nursing practice. Vital Signs for Nurses will support anyone in care delivery to enhance their skills, reflect upon their own practice and assist in their continuing professional development. This practical introductory text explores how to make assessments of heart rate, blood pressure, temperature, pain and nutrition. It also looks at issues of infection control, record-keeping and legal and ethical considerations. With case studies and examples throughout, this text will be invaluable to all healthcare assistants, student nurses, Trainee Assistant Practitioners and students on foundation degrees.

Leseprobe

Table of Contents

Title Page

Copyright

Preface

Acknowledgements

Introduction

References

Chapter 1: Legal and Ethical Principles

Introduction

The Legal System in England and Wales

Ethical Principles

Professional Regulation

Consent

Dignity and Respect

Conclusion

References

Further Reading

Chapter 2: Infection Prevention

Introduction

What Are Micro-Organisms?

How Are Micro-Organisms Spread?

The Chain of Infection

The Four Areas of Standard Principles (SP) for Preventing HCAIs

Conclusion

References

Useful Websites

Appendix

Chapter 3: The Respiratory System

Introduction

The Organs Involved in Respiration

What Is the Role of the Lungs?

Performing a Respiratory Assessment

Conclusion

References

Chapter 4: The Cardiovascular System

Introduction

The Cardiovascular System (CVS)

CVS Monitoring

Conclusion

References

Chapter 5: Temperature

Introduction

The Role of Thermoregulation Within the Body

Normal Body Temperature

What Factors Influence Body Temperature?

Defining Fever (PYREXIA)

A Low Body Temperature – Hypothermia

A High Body Temperature – Hyperthermia

Temperature Assessment Using Look, Listen and Feel

Temperature Management

Conclusion

References

Chapter 6: Urine Output

Introduction

The Anatomy and Physiology of the Kidneys

The Role and Function of the Kidneys Within the Body

Factors That Influence Urine Output

Normal Range for Maintaining Hydration and Urine Output

What Is a Normal Sample of Urine?

How to Measure Urine Output

Performing Urinalysis Using Reagent Strips

Urine Output: Applying the Look, Listen and Feel Approach

Conclusion

References

Chapter 7: Pain: The Fifth Vital Sign

Introduction

The Anatomy and Physiology of Pain Transmission

Definitions of Pain

Pain Assessment Strategies

The Physiological Consequences of Acute Pain

World Health Organisation (WHO) Pain Ladder

Pharmacological Pain Management Strategies

Epidural Analgesia

Look, Listen and Feel

Conclusion

References

Chapter 8: Early Warning Scoring Tools

Introduction

The Principles of the Early Warning Scoring Systems

How to Complete an Early Warning Scoring Chart

The Concept of Outreach and Medical Emergency Teams

Look, Listen and Feel When Using the EWS

Conclusion

References

Chapter 9: Communication

Introduction

Ways in Which Patients and Staff Communicate with Each Other

Using the Look, Listen and Feel Approach in Communication

The Importance of Timely Communication in Relation to Deteriorating Clinical Observations

Reporting Findings

The Need for Team Work to Promote Best Care for the Patient

Conclusion

References

Chapter 10: Nutrition

Introduction

The Role of the Gastrointestinal (GI) Tract in the Body

Food Groups

What Is Metabolism?

Definition of Malnutrition

The Effects of Poor Nutrition on Health and the Recovery of Patients

Oral Nutrition

Enteral Route

The Role of the Nurse in Monitoring and Reporting the Nutritional Intake of Patients

Conclusion

References

Further Reading

Chapter 11: Blood Glucose Monitoring

Introduction

Anatomy and Physiology

What Is Blood Glucose?

What Is the Stress Response?

Why Do We Need to Monitor Our Blood Glucose?

Diabetes

Blood Sampling

The Diabetes National Service Framework

Conclusion

References

Chapter 12: Record Keeping

Introduction

Government Initiatives

Legal and Professional Accountability

Recording Vital Signs

Conclusion

References

Chapter 13: Continuing Professional Development

Introduction

Example of PDP Process

Portfolio

Conclusion

References

Chapter 14: Reflective Practice

Introduction

What IS Reflection?

Different Models for Reflection

Conclusion

References

Chapter 15: Conclusion and Multiple Choice Questions

Multiple Choice Questions (MCQ)

References

Glossary of Terms

Answers to Practice Points and Multiple Choice Questions

Chapter 1

Chapter 2

Chapter 3

Chapter 4

Chapter 5

Chapter 6

Chapter 7

Chapter 8

Chapter 9

Chapter 11

Chapter 12

Chapter 14

Chapter 15

Index

This edition first published 2011 by Blackwell Publishing Ltd

©2011 by Joyce Smith and Rachel Roberts

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Library of Congress Cataloging-in-Publication Data

Vital signs for nurses : an introduction to clinical observations / Joyce Smith, Lecturer in Adult Nursing, School of Nursing and Midwifery, University of Salford, UK, Rachel Roberts, Matron, Calderdale and Huddersfield NHS Trust, UK.

p. ; cm.

Includes bibliographical references and index.

ISBN 978-1-4051-9038-1 (paperback : alk. paper)

1. Vital signs—Measurement. 2. Physical diagnosis. 3. Nursing. I. Roberts, Rachel, 1970- author, II. Title.

[DNLM: 1. Physical Examination—nursing. 2. Vital Signs. WY 100.4]

RT48.S 636 2011

616.07′54—dc22

2010049555

A catalogue record for this book is available from the British Library.

This book is published in the following electronic formats: ePDF [9781444341867], ePub [9781444341874], MobiPocket [9781444341881]

Preface

This book will provide a comprehensive resource for a cadet, student nurse or a registered nurse working within any adult healthcare environment. It is a valuable resource for registered nurses, allied health professionals or healthcare students undertaking or working towards a BTEC qualification, foundation degree or relevant in-house courses linked to vital signs monitoring.

Vital signs monitoring and the reporting of any clinical changes are fundamental in the delivery of quality patient care. Chapter 1 relates to legal and ethical principles and Chapter 2 reiterates the importance of infection prevention. Both chapters are integral to every aspect of healthcare delivery including vital signs monitoring. The remaining chapters focus on different aspects of physiological monitoring and a brief overview of the related anatomy and physiology. The concluding chapters discuss record keeping, reflective practice and continuing professional development. We hope this book will help healthcare professionals involved in monitoring a patient's vital signs link theory to practice, promote reflection upon their own practice and assist in their continuing professional development.

The aim of the book is to develop the underpinning knowledge and skills in both theory and practice for the adult patient found in hospital, private sector or community settings. This will enable staff to demonstrate their knowledge and skills when performing vital signs monitoring. In a changing National Health Service (NHS) climate, performing and monitoring vital signs, including good standards of record keeping, has never been more important.

Acknowledgements

We would like to acknowledge the Pennine Acute NHS Trust for allowing us to reproduce several charts and clinical procedures. Special thanks to the following people who kindly agreed to proofread chapters within the book:

Sylvia Maxfield, Infection Control Nurse, Pennine Acute Trust

Dr Tracy Birdsey, Lecturer in Diabetes and Physiology Open University

Lis Bourne, Lecturer in Health Care Ethics and Law, University of Salford

We would like to dedicate this book to our families for their support and patience as well as for accepting limited time together when the book took priority over many evenings and weekends. Special thanks therefore to Patrick, Eleanor, Irene, Marion, Robert, Emma, Helen, Ian, Matthew, Abbi and Eleanor.

Introduction

The focus on performing, recording and documenting vital signs has never been more important. For over a decade it has been recognised as problematic within clinical practice (McQuillan et al., 1998; Kenward et al., 2001; Goldhill et al., 1999; Goldhill, 2005). Research has highlighted that a patient's physiological deterioration has not been acted upon in a timely manner despite vital signs monitoring being an essential part of nursing care. In response to the concerns highlighted within publications by the National Confidential Enquiry into Patient Outcome and Death (NCEPOD) (NCEPOD, 2005) and the National Patient Safety Agency (NPSA) (NPSA, 2007a, 2007b), the National Institute for Health and Clinical Excellence (NICE) (NICE, 2007) has developed clinical guideline 50 Acutely Ill Patients in Hospital and Response to Acute Illness in Adults in Hospital.

In support of NICE clinical guideline 50, the Department of Health (DH) has reinforced the principles and standards set within the guidelines that NHS trusts must implement. One of the key recommendations states that anyone performing and monitoring the patients' vital signs be trained and assessed as competent (DH, 2007, 2009) as part of maintaining patient safety (NPSA, 2007a, 2007b).

This book is designed to be read as a whole or allow the reader to dip in and out of relevant areas of interest. The importance of each element of the patients' vital signs will be explored in more detail within each dedicated chapter. Within each chapter, learning objectives will be outlined to assist the readers in achieving their learning outcomes. The chapters will incorporate written and visual information for the readers to enhance their reflection during their learning experience. Case studies, activities or points for reflection have been included to relate the theory within each chapter to the reader's area of practice. Optional case studies and activity boxes are highlighted throughout the book as ‘Practice points’. Taking the time to complete the practice point will encourage you to reflect on your practice as well as to evaluate your current knowledge.

It is hoped that this book will empower the readers to gain more confidence in their knowledge and skills in recognising and responding to the patient's vital signs. References and website addresses will be incorporated at the end of each chapter. At the back of the book is a glossary of terms that may be useful to the reader in explaining the bold and italic terminology used within the text. Answers to the practice points can be found at the conclusion of the book.

References

Department of Health (2007). Acutely Ill Patients in Hospital: Recognition of and Response to Acute Illness in Adults in Hospital. NICE clinical guideline 50. London, NICE.

Department of Health (2009). Competencies for Recognising and Responding to Acutely Ill Patients in Hospital. http://www.dh.gov.uk/publications.

Goldhill DR, White SA, and Sumner A (1999). Physiological values and procedures in the 24 h before ICU admission from the ward. Anaesthesia54, 529–534.

Goldhill DR (2005). Preventing surgical deaths: critical care and intensive care outreach services in the postoperative period. British Journal of Anaesthesia95(1), 88–94.

Kenward G, Castle N, and Hodgetts T (2001). Time to put the R back in TPR. Nursing Times97(40), 32–33.

McQuillan P, Pilkington A, Allan A, et al. (1998). Confidential inquiry into quality of care before admission to intensive care. British Medical Journal316, 1853–1858.

National Confidential Enquiry into Patient Outcome and Death (NCEPOD) (2005). An Acute Problem?www.ncepod.org.uk

National Institute for Health and Clinical Excellence (NICE) (2007). Acutely Ill Patients in Hospital: Recognition of and Response to Acute Illness in Adults in Hospital. London, NICE.

National Patient Safety Agency (2007a). Recognising and Responding Appropriately to Early Signs of Deterioration in Hospitalised Patients. London, NPSA, Available at: http//tinyurl.com/yk8qbx5 [Accessed 26th March 2010].

National Patient Safety Agency (2007b). Safer Care for the Acutely Ill Patient: Learning from Serious Incidents. London, NPSA, Available at: http://www.nrls.npsa.nhs.uk/resources/?entryid45=59828 [Accessed 26th March 2010].

Chapter 1

Legal and Ethical Principles

Introduction

Legal and ethical issues/dilemmas are abundant in healthcare practice and it is therefore important that nurses understand the law, ethical theory and professional guidance in order to be able to account for their practice. The law and ethical principles underpin all aspects of health care; therefore, as a member of the healthcare team, one needs to have an awareness of the legal and ethical issues that impact on healthcare professionals when undertaking and recording patients' vital signs. The legal, professional and ethical principles discussed throughout this chapter relate to adult patients only. All healthcare professionals taking responsibility for treating a patient thereby owe that patient a duty of care (Fullbrook, 2007a; NMC, 2008). The concept of ‘duty of care’ was introduced in Donoghue v Stevenson (1932) AC562 and Lord Atkin introduced the ‘neighbour principle’.

You must take reasonable care to avoid acts or omissions that you can reasonably foresee would be likely to injure your neighbour. Who then in law is my neighbour? The answer seems to be persons who are so closely and directly affected by my act that I ought reasonably to have them in contemplation as being so affected when I am directing my mind to the acts or omissions which are called in question

(Dimond, 2008, p. 40)

Learning Outcomes

By the end of this chapter, you will be able to discuss the following:

The legal system in England and WalesEthical principlesProfessional regulationConsentDignity and respect