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Fundamentals of Critical Care
A Textbook for Nursing and Healthcare Students
In Fundamentals of Critical Care, a team of clinicians and health educators deliver an accessible, timely, and evidence-based introduction to the role of nurses and healthcare practitioners in critical care. The book explores fundamental concepts in critical care and their implications for practice. Each chapter outlines essential knowledge necessary to understand key concepts and includes high quality, full-colour artwork to enhance learning and recall.
Readers are also provided with clinical scenarios, practice questions, and red and orange flags to indicate physiological and psychological alerts respectively. Covering a range of common and specialised disease processes and treatments requiring critical care, the book provides:
* A thorough introduction to the critical care unit, including philosophies of care, ways of working, humanisation, and outreach
* Comprehensive exploration of organisational influences, including political, local, national, and international influences
* Practical discussion of legal, ethical, and professional issues, as well as evidence-based approaches to critical care
* In-depth examination of nursing care assessment tools, nursing communication, cognition, pharmacology, and more
Perfect for nursing students and trainee nursing associates, Fundamentals of Critical Care: A Textbook for Nursing and Healthcare Students will also earn a place in the libraries of healthcare students in physiotherapy, paramedicine, medicine, and those returning to practice.
All content reviewed by students for students.
If you would like to be one of our student reviewers, go to [...] to find out more.
To receive automatic updates on Wiley books and journals, join our email list. Sign up today at [...]
A Textbook for Nursing and Healthcare Students
In Fundamentals of Critical Care, a team of clinicians and health educators deliver an accessible, timely, and evidence-based introduction to the role of nurses and healthcare practitioners in critical care. The book explores fundamental concepts in critical care and their implications for practice. Each chapter outlines essential knowledge necessary to understand key concepts and includes high quality, full-colour artwork to enhance learning and recall.
Readers are also provided with clinical scenarios, practice questions, and red and orange flags to indicate physiological and psychological alerts respectively. Covering a range of common and specialised disease processes and treatments requiring critical care, the book provides:
* A thorough introduction to the critical care unit, including philosophies of care, ways of working, humanisation, and outreach
* Comprehensive exploration of organisational influences, including political, local, national, and international influences
* Practical discussion of legal, ethical, and professional issues, as well as evidence-based approaches to critical care
* In-depth examination of nursing care assessment tools, nursing communication, cognition, pharmacology, and more
Perfect for nursing students and trainee nursing associates, Fundamentals of Critical Care: A Textbook for Nursing and Healthcare Students will also earn a place in the libraries of healthcare students in physiotherapy, paramedicine, medicine, and those returning to practice.
All content reviewed by students for students.
If you would like to be one of our student reviewers, go to [...] to find out more.
To receive automatic updates on Wiley books and journals, join our email list. Sign up today at [...]
Fundamentals of Critical Care
A Textbook for Nursing and Healthcare Students
In Fundamentals of Critical Care, a team of clinicians and health educators deliver an accessible, timely, and evidence-based introduction to the role of nurses and healthcare practitioners in critical care. The book explores fundamental concepts in critical care and their implications for practice. Each chapter outlines essential knowledge necessary to understand key concepts and includes high quality, full-colour artwork to enhance learning and recall.
Readers are also provided with clinical scenarios, practice questions, and red and orange flags to indicate physiological and psychological alerts respectively. Covering a range of common and specialised disease processes and treatments requiring critical care, the book provides:
* A thorough introduction to the critical care unit, including philosophies of care, ways of working, humanisation, and outreach
* Comprehensive exploration of organisational influences, including political, local, national, and international influences
* Practical discussion of legal, ethical, and professional issues, as well as evidence-based approaches to critical care
* In-depth examination of nursing care assessment tools, nursing communication, cognition, pharmacology, and more
Perfect for nursing students and trainee nursing associates, Fundamentals of Critical Care: A Textbook for Nursing and Healthcare Students will also earn a place in the libraries of healthcare students in physiotherapy, paramedicine, medicine, and those returning to practice.
All content reviewed by students for students.
If you would like to be one of our student reviewers, go to [...] to find out more.
To receive automatic updates on Wiley books and journals, join our email list. Sign up today at [...]
A Textbook for Nursing and Healthcare Students
In Fundamentals of Critical Care, a team of clinicians and health educators deliver an accessible, timely, and evidence-based introduction to the role of nurses and healthcare practitioners in critical care. The book explores fundamental concepts in critical care and their implications for practice. Each chapter outlines essential knowledge necessary to understand key concepts and includes high quality, full-colour artwork to enhance learning and recall.
Readers are also provided with clinical scenarios, practice questions, and red and orange flags to indicate physiological and psychological alerts respectively. Covering a range of common and specialised disease processes and treatments requiring critical care, the book provides:
* A thorough introduction to the critical care unit, including philosophies of care, ways of working, humanisation, and outreach
* Comprehensive exploration of organisational influences, including political, local, national, and international influences
* Practical discussion of legal, ethical, and professional issues, as well as evidence-based approaches to critical care
* In-depth examination of nursing care assessment tools, nursing communication, cognition, pharmacology, and more
Perfect for nursing students and trainee nursing associates, Fundamentals of Critical Care: A Textbook for Nursing and Healthcare Students will also earn a place in the libraries of healthcare students in physiotherapy, paramedicine, medicine, and those returning to practice.
All content reviewed by students for students.
If you would like to be one of our student reviewers, go to [...] to find out more.
To receive automatic updates on Wiley books and journals, join our email list. Sign up today at [...]
Über den Autor
Ian Peate OBE FRCN is Senior Lecturer, Roehampton University; Visiting Professor of Nursing, St George's University of London and Kingston University London; Visiting Professor, Northumbria University; Visiting Senior Clinical Fellow, University of Hertfordshire, and Editor-in-Chief of the British Journal of Nursing.
Barry Hill is the Director of Education (Employability) for Nursing, Midwifery and Health at Northumbria University. His academic practice includes teaching and learning as well as research which impacts on undergraduate, postgraduate and CPD programmes. He specialises in clinical education relating to acute and critical care, and advanced level practice.
Inhaltsverzeichnis
Contributors xix
Preface xxv
Acknowledgements xxvii
How to use your textbook xxix
About the companion website xxxi
Chapter 1 The critical care unit 1
Vikki Park
Introduction 2
Levels of care 2
The critical care environment 2
Critical care patients 3
Level 1 care 4
Level 2 care 4
Level 3 care 4
Critical care competence 5
The interprofessional team 6
Communication 7
Ways of working 7
Understanding philosophies of care 8
Humanising critical care 8
Surviving critical care 9
Death in critical care 9
Resilience 9
Nursing considerations and recommendations for practice 11
Future challenges 11
Conclusion 11
References 12
Chapter 2 Organisational influences 14
Vikki Park
Introduction 15
The four UK nations 15
Legislation 15
Professional Statutory Regulatory Bodies (PSRBs) 15
Shared decision making 16
Capacity for shared decision making 16
Confidentiality 17
Decisions relating to end-of-life care 17
Risk management 18
International influences 18
National influences 18
UK government organisations 18
Networks 19
National guidelines 20
Quality assurance 20
Local policies 21
Nursing considerations and recommendations for practice 21
Conclusion 21
References 22
Chapter 3 Legal and ethical issues 24
Leonie Armstrong, Tracey Carrott, and Jacqueline Newby
Introduction 25
Confidentiality 25
End-of-life care and best interest decisions 26
Ethical themes 27
Mental Capacity Act 27
Organ donation 29
Consent (authorisation in Scotland) for organ donation 30
First person consent 31
First person opt-in 31
First person opt-out 31
Appointed/nominated representative (not Scotland) 31
Deemed consent 31
The ethics of deemed consent 32
Consent from a person in the highest-ranking relationship 32
Cadaveric organ donation 33
The organ donation process 33
Post organ retrieval 34
Organ allocation 34
Conclusion 35
References 35
Chapter 4 Professional issues in critical care 37
Aurora Medonica
Introduction 38
Opportunities for learning 38
NMC Code in critical care units: journey to independent, safe practice 38
The core principles 39
UK National Competency Framework: critical care 41
Development of critical thinking in healthcare 42
The prioritising process 42
Support systems: the student 44
Conclusion 44
References 45
Chapter 5 Using an evidence-based approach 46
Sadie Diamond-Fox and Alexandra Gatehouse Introduction 47
What is evidence-based practice (EBP)? 47
Step 1: formulating a clinical question - the PICO method 48
Step 2: locating the evidence/research: performing a systematic literature review 48
Step 3: critical appraisal and the hierarchy of evidence 49
Step 4: extracting the most relevant and useful results 51
Step 5: implementing research into practice 52
Quality healthcare in critical care 53
Clinical audit and quality improvement 53
Research and development in critical care 55
Conclusion 56
References 56
Chapter 6 Nursing care 58
Sarah Crowe and Fiona McLeod
Introduction 59
Standards of care 59
Physical care 63
Mobility 66
Critical care bundles 67
Conclusion 67
References 68
Chapter 7 Skin integrity 70
Victoria Clemett
Introduction 71
Anatomy and physiology of the skin 71
Impact of ageing on skin and tissue integrity 71
Pressure ulcers 71
Nursing assessment 75
Prevention of pressure ulcers 76
Management of pressure ulcers 79
Wound healing 79
Patient factors that affect wound healing 79
Nursing assessment 79
Recognising wound infection 81
Management of non-healing wounds 83
Conclusion 83
References 84
Chapter 8 Shock 86
Barry Hill
Introduction 87
Shock 87
Hypovolaemic shock 87
Blood analysis 88
Multiple organ dysfunction syndrome 89
Staging of hypovolaemic shock 89
Principles of managing hypovolaemic shock 90
Fluid resuscitation 91
Training and education for Registered Nurses 91
Cardiogenic shock 91
Obstructive shock 93
Altered pathophysiology 93
Tension pneumothorax 94
Cardiac tamponade 94
Pulmonary embolism (PE) 94
Distributive shock 95
Conclusion 96
References 97
Chapter 9 Communication 98
Paul Jebb
Introduction 99
Communicating effectively with patients 100
Communicating during a pandemic 100
Communication with families 102
Conclusion 103
References 103
Chapter 10 Electronic health records 105
Timothy Kuhn
Introduction 106
Digitisation within healthcare 106
Understand your responsibilities and the law in relation to record keeping 107
Intensive Care Society Guidelines 107
Understanding the different types of EHRs in critical care and how they are used 108
Understanding what patient data is available within the critical care unit and how this is recorded in an electronic health record 109
Understanding how EHRs are used in critical care audit and research 110
Understanding the benefits and barriers to EHRs 112
Conclusion 113
References 113
Chapter 11 Pharmacology 115
Sadie Diamond-Fox and Alexandra Gatehouse
Introduction 116
Principles of pharmacology and pharmacotherapy 116
The processes of drug therapy 116
Medication safety in critical care 119
Drugs and dialysis 120
Core drugs utilised within critical care 120
Respiratory drugs 120
Cardiovascular drugs 122
Haematological drugs 126
Renal drugs 126
Fluids and electrolytes 127
Gastrointestinal drugs 128
Insulin 129
H2-histamine antagonists and proton pump inhibitors (PPIs) 129
Anti-emetics 129
Laxatives and anti-diarrhoeal drugs 130
Neurological drugs 130
Analgesics 130
Opioids 130
Non-opioid analgesics 130
Epidural and regional anaesthesia 130
Sedatives and anxiolytics 131
Muscle relaxants 131
Anticonvulsants 132
Antideliriogenics 132
Immunomodulatory drugs 132
Antibacterial agents 132
Antifungals 133
Antiviral drugs 134
Corticosteroids 134
Immunoglobulins 134
Toxicology 134
Conclusion 135
References 135
Chapter 12 Anaesthesia and sedation 138
Lorraine Mutrie and Iain Carstairs
Introduction 139
Indications for sedation and anaesthesia 139
Anaesthetic and sedative medications 142
Sedative drugs 142
Neuromuscular blocking agents and reversal agents 143
Sedation management 145
Conclusion 147
References 148
Chapter 13 Medicines management and drug calculations 150
Jan Guerin
Introduction 151
Purpose of pharmacological interventions in the critically ill adult patient 152
Legal and professional issues 152
Collaborative multidisciplinary team working 154
Medication errors 154
Overview of routes and methods of administering medications in CCU 155
Rights of medication administration 158
Managing and reporting a medication error 159
Anaphylaxis 160
Pathophysiology and clinical manifestations of DIA 160
Management for DIA 160
Medication calculation formulae 160
Displacement 165
Conclusion 165
References 166
Chapter 14 Neurological critical care 167
Samantha O'Driscoll
Introduction 168
Neurological anatomy and physiology 168
Central nervous system 169
Neurological assessment 174
Signs and symptoms of increasing ICP 179
Primary and secondary brain injury 180
Management of raised ICP 180
Nursing care 181
Transfer 182
Conclusion 184
References 184
Chapter 15 Cognition 186
Barry Hill and Sadie Diamond-Fox
Introduction 187
Cognitive impairment 187
Causes of cognitive impairment 187
Signs of cognitive impairment 188
Delirium 188
Risk factors 190
Management of delirium 191
Sleep 193
Assessment of sleep in ICU 193
Conclusion 195
References 195
Chapter 16 Respiratory care: intubation and mechanical ventilation 197
Barry Hill and Lorraine Mutrie
Introduction 198
Respiratory failure 198
Hypoventilation 198
Ventilation/perfusion (V/Q) mismatch 199
Work of breathing 199
Arterial blood gases (ABGs) 200
Non-invasive
ventilation (NIV) 201
Continuous positive airway pressure (CPAP) 204
High flow nasal oxygen 204
Intubation 204
Mechanical ventilation 206
Artificial ventilation 207
Minute ventilation (Vm) 207
Fraction of inspired oxygen 207
Positive end-expiratory
pressure (PEEP) 207
Volume control 207
Pressure control 207
Inspiratory:Expiratory (I:E) ratio 208
Inverse ratio 208
Synchronisation 208
Humidification 208
Benefits of mechanical ventilation 208
Risks of mechanical ventilation 208
Ventilator care bundles 209
Prone positioning 209
Prone positioning in COVID-19 209
Weaning from mechanical ventilation 210
Conclusion 210
References 211
Chapter 17 Lung function in critical care 213
Rana Din and Joyce Smith
Introduction 214
Anatomy and physiology 214
Composition of air 215
Alveolar gas 215
Expired air 216
Lung volumes 216
Pulmonary ventilation 216
External respiration 217
Ventilation/Perfusion 217
Transport of gases 217
Internal respiration 218
Assessment of lung function 220
Normal breath sounds (vesicular) 221
Absent Sounds 221
Wheeze 222
Crackles 222
The work of breathing 222
Compliance 222
Resistance 222
Emphysema 222
Asthma 223
Obstructive sleep apnoea 224
Prone positioning 224
Conclusion 225
References 226
Chapter 18 Cardiac physiology 227
Paul Sinnott
Introduction 228
Functions of the cardiovascular system 228
Anatomy of the heart and great vessels 228
Pericardium 229
Layers of the heart 229
Chambers of the heart 230
Valves of the heart 230
Coronary circulation 232
Cardiac conduction system 235
The cardiac cycle 236
Cardiac output and blood pressure 237
Regulation of heart rate 238
Stroke volume 239
The regulation of blood pressure 240
The microcirculation 242
Capillary exchange 243
Effects of ventilation on the cardiovascular system 245
Conclusion 245
References 246
Chapter 19 Cardiovascular critical care 247
Alice Shaw and Paul Sinnott
Introduction 248
Cardiovascular assessment 248
Heart rate and rhythm 248
Atrial ectopic beats 249
Ventricular ectopic beats 253
Blood pressure 254
Invasive blood pressure monitoring 255
Central venous catheters (CVCs) and central venous pressure (CVP) 256
Markers of organ and tissue perfusion 258
Neurological status 258
Urine output 258
Blood...
Preface xxv
Acknowledgements xxvii
How to use your textbook xxix
About the companion website xxxi
Chapter 1 The critical care unit 1
Vikki Park
Introduction 2
Levels of care 2
The critical care environment 2
Critical care patients 3
Level 1 care 4
Level 2 care 4
Level 3 care 4
Critical care competence 5
The interprofessional team 6
Communication 7
Ways of working 7
Understanding philosophies of care 8
Humanising critical care 8
Surviving critical care 9
Death in critical care 9
Resilience 9
Nursing considerations and recommendations for practice 11
Future challenges 11
Conclusion 11
References 12
Chapter 2 Organisational influences 14
Vikki Park
Introduction 15
The four UK nations 15
Legislation 15
Professional Statutory Regulatory Bodies (PSRBs) 15
Shared decision making 16
Capacity for shared decision making 16
Confidentiality 17
Decisions relating to end-of-life care 17
Risk management 18
International influences 18
National influences 18
UK government organisations 18
Networks 19
National guidelines 20
Quality assurance 20
Local policies 21
Nursing considerations and recommendations for practice 21
Conclusion 21
References 22
Chapter 3 Legal and ethical issues 24
Leonie Armstrong, Tracey Carrott, and Jacqueline Newby
Introduction 25
Confidentiality 25
End-of-life care and best interest decisions 26
Ethical themes 27
Mental Capacity Act 27
Organ donation 29
Consent (authorisation in Scotland) for organ donation 30
First person consent 31
First person opt-in 31
First person opt-out 31
Appointed/nominated representative (not Scotland) 31
Deemed consent 31
The ethics of deemed consent 32
Consent from a person in the highest-ranking relationship 32
Cadaveric organ donation 33
The organ donation process 33
Post organ retrieval 34
Organ allocation 34
Conclusion 35
References 35
Chapter 4 Professional issues in critical care 37
Aurora Medonica
Introduction 38
Opportunities for learning 38
NMC Code in critical care units: journey to independent, safe practice 38
The core principles 39
UK National Competency Framework: critical care 41
Development of critical thinking in healthcare 42
The prioritising process 42
Support systems: the student 44
Conclusion 44
References 45
Chapter 5 Using an evidence-based approach 46
Sadie Diamond-Fox and Alexandra Gatehouse Introduction 47
What is evidence-based practice (EBP)? 47
Step 1: formulating a clinical question - the PICO method 48
Step 2: locating the evidence/research: performing a systematic literature review 48
Step 3: critical appraisal and the hierarchy of evidence 49
Step 4: extracting the most relevant and useful results 51
Step 5: implementing research into practice 52
Quality healthcare in critical care 53
Clinical audit and quality improvement 53
Research and development in critical care 55
Conclusion 56
References 56
Chapter 6 Nursing care 58
Sarah Crowe and Fiona McLeod
Introduction 59
Standards of care 59
Physical care 63
Mobility 66
Critical care bundles 67
Conclusion 67
References 68
Chapter 7 Skin integrity 70
Victoria Clemett
Introduction 71
Anatomy and physiology of the skin 71
Impact of ageing on skin and tissue integrity 71
Pressure ulcers 71
Nursing assessment 75
Prevention of pressure ulcers 76
Management of pressure ulcers 79
Wound healing 79
Patient factors that affect wound healing 79
Nursing assessment 79
Recognising wound infection 81
Management of non-healing wounds 83
Conclusion 83
References 84
Chapter 8 Shock 86
Barry Hill
Introduction 87
Shock 87
Hypovolaemic shock 87
Blood analysis 88
Multiple organ dysfunction syndrome 89
Staging of hypovolaemic shock 89
Principles of managing hypovolaemic shock 90
Fluid resuscitation 91
Training and education for Registered Nurses 91
Cardiogenic shock 91
Obstructive shock 93
Altered pathophysiology 93
Tension pneumothorax 94
Cardiac tamponade 94
Pulmonary embolism (PE) 94
Distributive shock 95
Conclusion 96
References 97
Chapter 9 Communication 98
Paul Jebb
Introduction 99
Communicating effectively with patients 100
Communicating during a pandemic 100
Communication with families 102
Conclusion 103
References 103
Chapter 10 Electronic health records 105
Timothy Kuhn
Introduction 106
Digitisation within healthcare 106
Understand your responsibilities and the law in relation to record keeping 107
Intensive Care Society Guidelines 107
Understanding the different types of EHRs in critical care and how they are used 108
Understanding what patient data is available within the critical care unit and how this is recorded in an electronic health record 109
Understanding how EHRs are used in critical care audit and research 110
Understanding the benefits and barriers to EHRs 112
Conclusion 113
References 113
Chapter 11 Pharmacology 115
Sadie Diamond-Fox and Alexandra Gatehouse
Introduction 116
Principles of pharmacology and pharmacotherapy 116
The processes of drug therapy 116
Medication safety in critical care 119
Drugs and dialysis 120
Core drugs utilised within critical care 120
Respiratory drugs 120
Cardiovascular drugs 122
Haematological drugs 126
Renal drugs 126
Fluids and electrolytes 127
Gastrointestinal drugs 128
Insulin 129
H2-histamine antagonists and proton pump inhibitors (PPIs) 129
Anti-emetics 129
Laxatives and anti-diarrhoeal drugs 130
Neurological drugs 130
Analgesics 130
Opioids 130
Non-opioid analgesics 130
Epidural and regional anaesthesia 130
Sedatives and anxiolytics 131
Muscle relaxants 131
Anticonvulsants 132
Antideliriogenics 132
Immunomodulatory drugs 132
Antibacterial agents 132
Antifungals 133
Antiviral drugs 134
Corticosteroids 134
Immunoglobulins 134
Toxicology 134
Conclusion 135
References 135
Chapter 12 Anaesthesia and sedation 138
Lorraine Mutrie and Iain Carstairs
Introduction 139
Indications for sedation and anaesthesia 139
Anaesthetic and sedative medications 142
Sedative drugs 142
Neuromuscular blocking agents and reversal agents 143
Sedation management 145
Conclusion 147
References 148
Chapter 13 Medicines management and drug calculations 150
Jan Guerin
Introduction 151
Purpose of pharmacological interventions in the critically ill adult patient 152
Legal and professional issues 152
Collaborative multidisciplinary team working 154
Medication errors 154
Overview of routes and methods of administering medications in CCU 155
Rights of medication administration 158
Managing and reporting a medication error 159
Anaphylaxis 160
Pathophysiology and clinical manifestations of DIA 160
Management for DIA 160
Medication calculation formulae 160
Displacement 165
Conclusion 165
References 166
Chapter 14 Neurological critical care 167
Samantha O'Driscoll
Introduction 168
Neurological anatomy and physiology 168
Central nervous system 169
Neurological assessment 174
Signs and symptoms of increasing ICP 179
Primary and secondary brain injury 180
Management of raised ICP 180
Nursing care 181
Transfer 182
Conclusion 184
References 184
Chapter 15 Cognition 186
Barry Hill and Sadie Diamond-Fox
Introduction 187
Cognitive impairment 187
Causes of cognitive impairment 187
Signs of cognitive impairment 188
Delirium 188
Risk factors 190
Management of delirium 191
Sleep 193
Assessment of sleep in ICU 193
Conclusion 195
References 195
Chapter 16 Respiratory care: intubation and mechanical ventilation 197
Barry Hill and Lorraine Mutrie
Introduction 198
Respiratory failure 198
Hypoventilation 198
Ventilation/perfusion (V/Q) mismatch 199
Work of breathing 199
Arterial blood gases (ABGs) 200
Non-invasive
ventilation (NIV) 201
Continuous positive airway pressure (CPAP) 204
High flow nasal oxygen 204
Intubation 204
Mechanical ventilation 206
Artificial ventilation 207
Minute ventilation (Vm) 207
Fraction of inspired oxygen 207
Positive end-expiratory
pressure (PEEP) 207
Volume control 207
Pressure control 207
Inspiratory:Expiratory (I:E) ratio 208
Inverse ratio 208
Synchronisation 208
Humidification 208
Benefits of mechanical ventilation 208
Risks of mechanical ventilation 208
Ventilator care bundles 209
Prone positioning 209
Prone positioning in COVID-19 209
Weaning from mechanical ventilation 210
Conclusion 210
References 211
Chapter 17 Lung function in critical care 213
Rana Din and Joyce Smith
Introduction 214
Anatomy and physiology 214
Composition of air 215
Alveolar gas 215
Expired air 216
Lung volumes 216
Pulmonary ventilation 216
External respiration 217
Ventilation/Perfusion 217
Transport of gases 217
Internal respiration 218
Assessment of lung function 220
Normal breath sounds (vesicular) 221
Absent Sounds 221
Wheeze 222
Crackles 222
The work of breathing 222
Compliance 222
Resistance 222
Emphysema 222
Asthma 223
Obstructive sleep apnoea 224
Prone positioning 224
Conclusion 225
References 226
Chapter 18 Cardiac physiology 227
Paul Sinnott
Introduction 228
Functions of the cardiovascular system 228
Anatomy of the heart and great vessels 228
Pericardium 229
Layers of the heart 229
Chambers of the heart 230
Valves of the heart 230
Coronary circulation 232
Cardiac conduction system 235
The cardiac cycle 236
Cardiac output and blood pressure 237
Regulation of heart rate 238
Stroke volume 239
The regulation of blood pressure 240
The microcirculation 242
Capillary exchange 243
Effects of ventilation on the cardiovascular system 245
Conclusion 245
References 246
Chapter 19 Cardiovascular critical care 247
Alice Shaw and Paul Sinnott
Introduction 248
Cardiovascular assessment 248
Heart rate and rhythm 248
Atrial ectopic beats 249
Ventricular ectopic beats 253
Blood pressure 254
Invasive blood pressure monitoring 255
Central venous catheters (CVCs) and central venous pressure (CVP) 256
Markers of organ and tissue perfusion 258
Neurological status 258
Urine output 258
Blood...
Details
| Erscheinungsjahr: | 2022 |
|---|---|
| Fachbereich: | Allgemeine Lexika |
| Genre: | Medizin |
| Rubrik: | Wissenschaften |
| Medium: | Taschenbuch |
| Seiten: | 544 |
| Inhalt: | 544 S. |
| ISBN-13: | 9781119783251 |
| ISBN-10: | 1119783259 |
| Sprache: | Englisch |
| Einband: | Kartoniert / Broschiert |
| Autor: | Peate, I |
| Redaktion: |
Hill, Barry
Peate, Ian |
| Herausgeber: | Ian Peate/Barry Hill |
| Hersteller: | John Wiley and Sons Ltd |
| Maße: | 216 x 275 x 31 mm |
| Von/Mit: | Barry Hill (u. a.) |
| Erscheinungsdatum: | 29.09.2022 |
| Gewicht: | 1,496 kg |
Über den Autor
Ian Peate OBE FRCN is Senior Lecturer, Roehampton University; Visiting Professor of Nursing, St George's University of London and Kingston University London; Visiting Professor, Northumbria University; Visiting Senior Clinical Fellow, University of Hertfordshire, and Editor-in-Chief of the British Journal of Nursing.
Barry Hill is the Director of Education (Employability) for Nursing, Midwifery and Health at Northumbria University. His academic practice includes teaching and learning as well as research which impacts on undergraduate, postgraduate and CPD programmes. He specialises in clinical education relating to acute and critical care, and advanced level practice.
Inhaltsverzeichnis
Contributors xix
Preface xxv
Acknowledgements xxvii
How to use your textbook xxix
About the companion website xxxi
Chapter 1 The critical care unit 1
Vikki Park
Introduction 2
Levels of care 2
The critical care environment 2
Critical care patients 3
Level 1 care 4
Level 2 care 4
Level 3 care 4
Critical care competence 5
The interprofessional team 6
Communication 7
Ways of working 7
Understanding philosophies of care 8
Humanising critical care 8
Surviving critical care 9
Death in critical care 9
Resilience 9
Nursing considerations and recommendations for practice 11
Future challenges 11
Conclusion 11
References 12
Chapter 2 Organisational influences 14
Vikki Park
Introduction 15
The four UK nations 15
Legislation 15
Professional Statutory Regulatory Bodies (PSRBs) 15
Shared decision making 16
Capacity for shared decision making 16
Confidentiality 17
Decisions relating to end-of-life care 17
Risk management 18
International influences 18
National influences 18
UK government organisations 18
Networks 19
National guidelines 20
Quality assurance 20
Local policies 21
Nursing considerations and recommendations for practice 21
Conclusion 21
References 22
Chapter 3 Legal and ethical issues 24
Leonie Armstrong, Tracey Carrott, and Jacqueline Newby
Introduction 25
Confidentiality 25
End-of-life care and best interest decisions 26
Ethical themes 27
Mental Capacity Act 27
Organ donation 29
Consent (authorisation in Scotland) for organ donation 30
First person consent 31
First person opt-in 31
First person opt-out 31
Appointed/nominated representative (not Scotland) 31
Deemed consent 31
The ethics of deemed consent 32
Consent from a person in the highest-ranking relationship 32
Cadaveric organ donation 33
The organ donation process 33
Post organ retrieval 34
Organ allocation 34
Conclusion 35
References 35
Chapter 4 Professional issues in critical care 37
Aurora Medonica
Introduction 38
Opportunities for learning 38
NMC Code in critical care units: journey to independent, safe practice 38
The core principles 39
UK National Competency Framework: critical care 41
Development of critical thinking in healthcare 42
The prioritising process 42
Support systems: the student 44
Conclusion 44
References 45
Chapter 5 Using an evidence-based approach 46
Sadie Diamond-Fox and Alexandra Gatehouse Introduction 47
What is evidence-based practice (EBP)? 47
Step 1: formulating a clinical question - the PICO method 48
Step 2: locating the evidence/research: performing a systematic literature review 48
Step 3: critical appraisal and the hierarchy of evidence 49
Step 4: extracting the most relevant and useful results 51
Step 5: implementing research into practice 52
Quality healthcare in critical care 53
Clinical audit and quality improvement 53
Research and development in critical care 55
Conclusion 56
References 56
Chapter 6 Nursing care 58
Sarah Crowe and Fiona McLeod
Introduction 59
Standards of care 59
Physical care 63
Mobility 66
Critical care bundles 67
Conclusion 67
References 68
Chapter 7 Skin integrity 70
Victoria Clemett
Introduction 71
Anatomy and physiology of the skin 71
Impact of ageing on skin and tissue integrity 71
Pressure ulcers 71
Nursing assessment 75
Prevention of pressure ulcers 76
Management of pressure ulcers 79
Wound healing 79
Patient factors that affect wound healing 79
Nursing assessment 79
Recognising wound infection 81
Management of non-healing wounds 83
Conclusion 83
References 84
Chapter 8 Shock 86
Barry Hill
Introduction 87
Shock 87
Hypovolaemic shock 87
Blood analysis 88
Multiple organ dysfunction syndrome 89
Staging of hypovolaemic shock 89
Principles of managing hypovolaemic shock 90
Fluid resuscitation 91
Training and education for Registered Nurses 91
Cardiogenic shock 91
Obstructive shock 93
Altered pathophysiology 93
Tension pneumothorax 94
Cardiac tamponade 94
Pulmonary embolism (PE) 94
Distributive shock 95
Conclusion 96
References 97
Chapter 9 Communication 98
Paul Jebb
Introduction 99
Communicating effectively with patients 100
Communicating during a pandemic 100
Communication with families 102
Conclusion 103
References 103
Chapter 10 Electronic health records 105
Timothy Kuhn
Introduction 106
Digitisation within healthcare 106
Understand your responsibilities and the law in relation to record keeping 107
Intensive Care Society Guidelines 107
Understanding the different types of EHRs in critical care and how they are used 108
Understanding what patient data is available within the critical care unit and how this is recorded in an electronic health record 109
Understanding how EHRs are used in critical care audit and research 110
Understanding the benefits and barriers to EHRs 112
Conclusion 113
References 113
Chapter 11 Pharmacology 115
Sadie Diamond-Fox and Alexandra Gatehouse
Introduction 116
Principles of pharmacology and pharmacotherapy 116
The processes of drug therapy 116
Medication safety in critical care 119
Drugs and dialysis 120
Core drugs utilised within critical care 120
Respiratory drugs 120
Cardiovascular drugs 122
Haematological drugs 126
Renal drugs 126
Fluids and electrolytes 127
Gastrointestinal drugs 128
Insulin 129
H2-histamine antagonists and proton pump inhibitors (PPIs) 129
Anti-emetics 129
Laxatives and anti-diarrhoeal drugs 130
Neurological drugs 130
Analgesics 130
Opioids 130
Non-opioid analgesics 130
Epidural and regional anaesthesia 130
Sedatives and anxiolytics 131
Muscle relaxants 131
Anticonvulsants 132
Antideliriogenics 132
Immunomodulatory drugs 132
Antibacterial agents 132
Antifungals 133
Antiviral drugs 134
Corticosteroids 134
Immunoglobulins 134
Toxicology 134
Conclusion 135
References 135
Chapter 12 Anaesthesia and sedation 138
Lorraine Mutrie and Iain Carstairs
Introduction 139
Indications for sedation and anaesthesia 139
Anaesthetic and sedative medications 142
Sedative drugs 142
Neuromuscular blocking agents and reversal agents 143
Sedation management 145
Conclusion 147
References 148
Chapter 13 Medicines management and drug calculations 150
Jan Guerin
Introduction 151
Purpose of pharmacological interventions in the critically ill adult patient 152
Legal and professional issues 152
Collaborative multidisciplinary team working 154
Medication errors 154
Overview of routes and methods of administering medications in CCU 155
Rights of medication administration 158
Managing and reporting a medication error 159
Anaphylaxis 160
Pathophysiology and clinical manifestations of DIA 160
Management for DIA 160
Medication calculation formulae 160
Displacement 165
Conclusion 165
References 166
Chapter 14 Neurological critical care 167
Samantha O'Driscoll
Introduction 168
Neurological anatomy and physiology 168
Central nervous system 169
Neurological assessment 174
Signs and symptoms of increasing ICP 179
Primary and secondary brain injury 180
Management of raised ICP 180
Nursing care 181
Transfer 182
Conclusion 184
References 184
Chapter 15 Cognition 186
Barry Hill and Sadie Diamond-Fox
Introduction 187
Cognitive impairment 187
Causes of cognitive impairment 187
Signs of cognitive impairment 188
Delirium 188
Risk factors 190
Management of delirium 191
Sleep 193
Assessment of sleep in ICU 193
Conclusion 195
References 195
Chapter 16 Respiratory care: intubation and mechanical ventilation 197
Barry Hill and Lorraine Mutrie
Introduction 198
Respiratory failure 198
Hypoventilation 198
Ventilation/perfusion (V/Q) mismatch 199
Work of breathing 199
Arterial blood gases (ABGs) 200
Non-invasive
ventilation (NIV) 201
Continuous positive airway pressure (CPAP) 204
High flow nasal oxygen 204
Intubation 204
Mechanical ventilation 206
Artificial ventilation 207
Minute ventilation (Vm) 207
Fraction of inspired oxygen 207
Positive end-expiratory
pressure (PEEP) 207
Volume control 207
Pressure control 207
Inspiratory:Expiratory (I:E) ratio 208
Inverse ratio 208
Synchronisation 208
Humidification 208
Benefits of mechanical ventilation 208
Risks of mechanical ventilation 208
Ventilator care bundles 209
Prone positioning 209
Prone positioning in COVID-19 209
Weaning from mechanical ventilation 210
Conclusion 210
References 211
Chapter 17 Lung function in critical care 213
Rana Din and Joyce Smith
Introduction 214
Anatomy and physiology 214
Composition of air 215
Alveolar gas 215
Expired air 216
Lung volumes 216
Pulmonary ventilation 216
External respiration 217
Ventilation/Perfusion 217
Transport of gases 217
Internal respiration 218
Assessment of lung function 220
Normal breath sounds (vesicular) 221
Absent Sounds 221
Wheeze 222
Crackles 222
The work of breathing 222
Compliance 222
Resistance 222
Emphysema 222
Asthma 223
Obstructive sleep apnoea 224
Prone positioning 224
Conclusion 225
References 226
Chapter 18 Cardiac physiology 227
Paul Sinnott
Introduction 228
Functions of the cardiovascular system 228
Anatomy of the heart and great vessels 228
Pericardium 229
Layers of the heart 229
Chambers of the heart 230
Valves of the heart 230
Coronary circulation 232
Cardiac conduction system 235
The cardiac cycle 236
Cardiac output and blood pressure 237
Regulation of heart rate 238
Stroke volume 239
The regulation of blood pressure 240
The microcirculation 242
Capillary exchange 243
Effects of ventilation on the cardiovascular system 245
Conclusion 245
References 246
Chapter 19 Cardiovascular critical care 247
Alice Shaw and Paul Sinnott
Introduction 248
Cardiovascular assessment 248
Heart rate and rhythm 248
Atrial ectopic beats 249
Ventricular ectopic beats 253
Blood pressure 254
Invasive blood pressure monitoring 255
Central venous catheters (CVCs) and central venous pressure (CVP) 256
Markers of organ and tissue perfusion 258
Neurological status 258
Urine output 258
Blood...
Preface xxv
Acknowledgements xxvii
How to use your textbook xxix
About the companion website xxxi
Chapter 1 The critical care unit 1
Vikki Park
Introduction 2
Levels of care 2
The critical care environment 2
Critical care patients 3
Level 1 care 4
Level 2 care 4
Level 3 care 4
Critical care competence 5
The interprofessional team 6
Communication 7
Ways of working 7
Understanding philosophies of care 8
Humanising critical care 8
Surviving critical care 9
Death in critical care 9
Resilience 9
Nursing considerations and recommendations for practice 11
Future challenges 11
Conclusion 11
References 12
Chapter 2 Organisational influences 14
Vikki Park
Introduction 15
The four UK nations 15
Legislation 15
Professional Statutory Regulatory Bodies (PSRBs) 15
Shared decision making 16
Capacity for shared decision making 16
Confidentiality 17
Decisions relating to end-of-life care 17
Risk management 18
International influences 18
National influences 18
UK government organisations 18
Networks 19
National guidelines 20
Quality assurance 20
Local policies 21
Nursing considerations and recommendations for practice 21
Conclusion 21
References 22
Chapter 3 Legal and ethical issues 24
Leonie Armstrong, Tracey Carrott, and Jacqueline Newby
Introduction 25
Confidentiality 25
End-of-life care and best interest decisions 26
Ethical themes 27
Mental Capacity Act 27
Organ donation 29
Consent (authorisation in Scotland) for organ donation 30
First person consent 31
First person opt-in 31
First person opt-out 31
Appointed/nominated representative (not Scotland) 31
Deemed consent 31
The ethics of deemed consent 32
Consent from a person in the highest-ranking relationship 32
Cadaveric organ donation 33
The organ donation process 33
Post organ retrieval 34
Organ allocation 34
Conclusion 35
References 35
Chapter 4 Professional issues in critical care 37
Aurora Medonica
Introduction 38
Opportunities for learning 38
NMC Code in critical care units: journey to independent, safe practice 38
The core principles 39
UK National Competency Framework: critical care 41
Development of critical thinking in healthcare 42
The prioritising process 42
Support systems: the student 44
Conclusion 44
References 45
Chapter 5 Using an evidence-based approach 46
Sadie Diamond-Fox and Alexandra Gatehouse Introduction 47
What is evidence-based practice (EBP)? 47
Step 1: formulating a clinical question - the PICO method 48
Step 2: locating the evidence/research: performing a systematic literature review 48
Step 3: critical appraisal and the hierarchy of evidence 49
Step 4: extracting the most relevant and useful results 51
Step 5: implementing research into practice 52
Quality healthcare in critical care 53
Clinical audit and quality improvement 53
Research and development in critical care 55
Conclusion 56
References 56
Chapter 6 Nursing care 58
Sarah Crowe and Fiona McLeod
Introduction 59
Standards of care 59
Physical care 63
Mobility 66
Critical care bundles 67
Conclusion 67
References 68
Chapter 7 Skin integrity 70
Victoria Clemett
Introduction 71
Anatomy and physiology of the skin 71
Impact of ageing on skin and tissue integrity 71
Pressure ulcers 71
Nursing assessment 75
Prevention of pressure ulcers 76
Management of pressure ulcers 79
Wound healing 79
Patient factors that affect wound healing 79
Nursing assessment 79
Recognising wound infection 81
Management of non-healing wounds 83
Conclusion 83
References 84
Chapter 8 Shock 86
Barry Hill
Introduction 87
Shock 87
Hypovolaemic shock 87
Blood analysis 88
Multiple organ dysfunction syndrome 89
Staging of hypovolaemic shock 89
Principles of managing hypovolaemic shock 90
Fluid resuscitation 91
Training and education for Registered Nurses 91
Cardiogenic shock 91
Obstructive shock 93
Altered pathophysiology 93
Tension pneumothorax 94
Cardiac tamponade 94
Pulmonary embolism (PE) 94
Distributive shock 95
Conclusion 96
References 97
Chapter 9 Communication 98
Paul Jebb
Introduction 99
Communicating effectively with patients 100
Communicating during a pandemic 100
Communication with families 102
Conclusion 103
References 103
Chapter 10 Electronic health records 105
Timothy Kuhn
Introduction 106
Digitisation within healthcare 106
Understand your responsibilities and the law in relation to record keeping 107
Intensive Care Society Guidelines 107
Understanding the different types of EHRs in critical care and how they are used 108
Understanding what patient data is available within the critical care unit and how this is recorded in an electronic health record 109
Understanding how EHRs are used in critical care audit and research 110
Understanding the benefits and barriers to EHRs 112
Conclusion 113
References 113
Chapter 11 Pharmacology 115
Sadie Diamond-Fox and Alexandra Gatehouse
Introduction 116
Principles of pharmacology and pharmacotherapy 116
The processes of drug therapy 116
Medication safety in critical care 119
Drugs and dialysis 120
Core drugs utilised within critical care 120
Respiratory drugs 120
Cardiovascular drugs 122
Haematological drugs 126
Renal drugs 126
Fluids and electrolytes 127
Gastrointestinal drugs 128
Insulin 129
H2-histamine antagonists and proton pump inhibitors (PPIs) 129
Anti-emetics 129
Laxatives and anti-diarrhoeal drugs 130
Neurological drugs 130
Analgesics 130
Opioids 130
Non-opioid analgesics 130
Epidural and regional anaesthesia 130
Sedatives and anxiolytics 131
Muscle relaxants 131
Anticonvulsants 132
Antideliriogenics 132
Immunomodulatory drugs 132
Antibacterial agents 132
Antifungals 133
Antiviral drugs 134
Corticosteroids 134
Immunoglobulins 134
Toxicology 134
Conclusion 135
References 135
Chapter 12 Anaesthesia and sedation 138
Lorraine Mutrie and Iain Carstairs
Introduction 139
Indications for sedation and anaesthesia 139
Anaesthetic and sedative medications 142
Sedative drugs 142
Neuromuscular blocking agents and reversal agents 143
Sedation management 145
Conclusion 147
References 148
Chapter 13 Medicines management and drug calculations 150
Jan Guerin
Introduction 151
Purpose of pharmacological interventions in the critically ill adult patient 152
Legal and professional issues 152
Collaborative multidisciplinary team working 154
Medication errors 154
Overview of routes and methods of administering medications in CCU 155
Rights of medication administration 158
Managing and reporting a medication error 159
Anaphylaxis 160
Pathophysiology and clinical manifestations of DIA 160
Management for DIA 160
Medication calculation formulae 160
Displacement 165
Conclusion 165
References 166
Chapter 14 Neurological critical care 167
Samantha O'Driscoll
Introduction 168
Neurological anatomy and physiology 168
Central nervous system 169
Neurological assessment 174
Signs and symptoms of increasing ICP 179
Primary and secondary brain injury 180
Management of raised ICP 180
Nursing care 181
Transfer 182
Conclusion 184
References 184
Chapter 15 Cognition 186
Barry Hill and Sadie Diamond-Fox
Introduction 187
Cognitive impairment 187
Causes of cognitive impairment 187
Signs of cognitive impairment 188
Delirium 188
Risk factors 190
Management of delirium 191
Sleep 193
Assessment of sleep in ICU 193
Conclusion 195
References 195
Chapter 16 Respiratory care: intubation and mechanical ventilation 197
Barry Hill and Lorraine Mutrie
Introduction 198
Respiratory failure 198
Hypoventilation 198
Ventilation/perfusion (V/Q) mismatch 199
Work of breathing 199
Arterial blood gases (ABGs) 200
Non-invasive
ventilation (NIV) 201
Continuous positive airway pressure (CPAP) 204
High flow nasal oxygen 204
Intubation 204
Mechanical ventilation 206
Artificial ventilation 207
Minute ventilation (Vm) 207
Fraction of inspired oxygen 207
Positive end-expiratory
pressure (PEEP) 207
Volume control 207
Pressure control 207
Inspiratory:Expiratory (I:E) ratio 208
Inverse ratio 208
Synchronisation 208
Humidification 208
Benefits of mechanical ventilation 208
Risks of mechanical ventilation 208
Ventilator care bundles 209
Prone positioning 209
Prone positioning in COVID-19 209
Weaning from mechanical ventilation 210
Conclusion 210
References 211
Chapter 17 Lung function in critical care 213
Rana Din and Joyce Smith
Introduction 214
Anatomy and physiology 214
Composition of air 215
Alveolar gas 215
Expired air 216
Lung volumes 216
Pulmonary ventilation 216
External respiration 217
Ventilation/Perfusion 217
Transport of gases 217
Internal respiration 218
Assessment of lung function 220
Normal breath sounds (vesicular) 221
Absent Sounds 221
Wheeze 222
Crackles 222
The work of breathing 222
Compliance 222
Resistance 222
Emphysema 222
Asthma 223
Obstructive sleep apnoea 224
Prone positioning 224
Conclusion 225
References 226
Chapter 18 Cardiac physiology 227
Paul Sinnott
Introduction 228
Functions of the cardiovascular system 228
Anatomy of the heart and great vessels 228
Pericardium 229
Layers of the heart 229
Chambers of the heart 230
Valves of the heart 230
Coronary circulation 232
Cardiac conduction system 235
The cardiac cycle 236
Cardiac output and blood pressure 237
Regulation of heart rate 238
Stroke volume 239
The regulation of blood pressure 240
The microcirculation 242
Capillary exchange 243
Effects of ventilation on the cardiovascular system 245
Conclusion 245
References 246
Chapter 19 Cardiovascular critical care 247
Alice Shaw and Paul Sinnott
Introduction 248
Cardiovascular assessment 248
Heart rate and rhythm 248
Atrial ectopic beats 249
Ventricular ectopic beats 253
Blood pressure 254
Invasive blood pressure monitoring 255
Central venous catheters (CVCs) and central venous pressure (CVP) 256
Markers of organ and tissue perfusion 258
Neurological status 258
Urine output 258
Blood...
Details
| Erscheinungsjahr: | 2022 |
|---|---|
| Fachbereich: | Allgemeine Lexika |
| Genre: | Medizin |
| Rubrik: | Wissenschaften |
| Medium: | Taschenbuch |
| Seiten: | 544 |
| Inhalt: | 544 S. |
| ISBN-13: | 9781119783251 |
| ISBN-10: | 1119783259 |
| Sprache: | Englisch |
| Einband: | Kartoniert / Broschiert |
| Autor: | Peate, I |
| Redaktion: |
Hill, Barry
Peate, Ian |
| Herausgeber: | Ian Peate/Barry Hill |
| Hersteller: | John Wiley and Sons Ltd |
| Maße: | 216 x 275 x 31 mm |
| Von/Mit: | Barry Hill (u. a.) |
| Erscheinungsdatum: | 29.09.2022 |
| Gewicht: | 1,496 kg |
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