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.

Contributors xix Preface xxv Acknowledgements xxvii How to use your textbook xxix About the companion website xxxi Chapter 1 The critical care unit 1Vikki 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 14Vikki 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 24Leonie 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 37Aurora 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 46Sadie 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 58Sarah 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 70Victoria 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 86Barry 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 98Paul 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 105Timothy 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 115Sadie 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 138Lorraine 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 150Jan 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 167Samantha 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 186Barry 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 197Barry 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 213Rana 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 227Paul 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 247Alice 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 results 259 Advanced haemodynamic monitoring 260 Cardiac pacing 262 Nursing considerations and recommendations for practice 263 Conclusion 263 References 263 Chapter 20 Fluids and electrolytes in critically ill patients 265Barry Hill Introduction 266 The role of the critical care nurse 266 Intravenous fluids 266 Crystalloids versus colloids...