Care of the Acutely Ill Adult: An essential guide for nurses

575 Pages·2010·3.29 MB·English

by  Fiona Creed

Care of the acutely ill adult – an
essential guide for nurses
This page intentionally left blank
Care of the acutely ill
adult – an essential
guide for nurses
Edited by
Fiona Creed
Senior Lecturer,
School of Nursing and Midwifery,
University of Brighton, UK
and
Christine Spiers
Principal Lecturer,
School of Nursing and Midwifery,
University of Brighton, UK
1
1
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Care of the acutely ill adult : an essential guide for nurses / edited by Fiona Creed and Christine Spiers.
p. ; cm.
Includes bibliographical references and index.
ISBN 978-0-19-956438-5
1. Intensive care nursing. I. Creed, Fiona. II. Spiers, Christine.
[DNLM: 1. Acute Disease—nursing. 2. Adult. 3. Critical Illness. 4. Nursing Assessment—methods. WY 154
C2708 2010]
RT120.I5C366 2010
610.73'6—dc22 2009053050
Typeset in Minion by Glyph International, Bangalore, India
Printed in Great Britain on acid-free paper by Ashford Colour Press, Gosport, Hampshire
ISBN 978–0–19–956438–5
10 9 8 7 6 5 4 3 2 1
Oxford University Press makes no representation, express or implied, that the drug dosages in this book
are correct. Readers must therefore always check the product information and clinical procedures with the
most up-to-date published product information and data sheets provided by the manufacturers and the most
recent codes of conduct and safety regulations. The authors and the publishers do not accept responsibility
or legal liability for any errors in the text or for the misuse or misapplication of material in this work. Except
where otherwise stated, drug dosages and recommendations are for the non-pregnant adult who is not
breastfeeding.
Foreword
The recognition of deterioration in the acutely ill patient and timely referral for treatment has
been, and remains, a ‘hot topic’ for acute care services and the educators of the nurses who work
there. Recent advances aim to prevent rather than manage deterioration to forestall the escalation
of patients’ conditions into critical status. The purpose of recent guidance (see Chapter 1) is to
enable the recognition and referral sooner for effective and timely care. This text serves to empow-
er nurses, through the acquisition of core knowledge and competencies, to make a significant
contribution to these outcomes.
S ince the work of McQuillan e t al. (1998), who contributed the term ‘suboptimal care’ to the
lexicon of healthcare workers, a series of interventions have been put in place to improve the
recognition of deterioration in the acutely ill patient. Interventions include the introduction of
emergency care teams and critical care outreach services (see Chapter 12), who respond to calls
from acute care nurses for assistance, and the introduction of early warning scores (see Chapter
11) to enable ward teams to identify signs of deterioration sooner and make referrals to these
teams. Despite these initiatives, further work remains to be done to support acute care staff in
the recognition of clinical signs of cascade sooner and make appropriate and timely referrals to
specialist teams to instigate advanced treatment. This text serves to provide detailed information
on how to assess various body systems, recognize the significance of those assessment findings,
and plan to implement thoughtful, timely, and compassionate care (Chapters 2–10).
The term ‘failure-to-rescue’ is an indicator to measure or track error at an individual or organi-
zational level (Talsma et al. 2008). Critical incident analyses examine documentation alongside
an audit of the clinical events that lead to the outcome, normally sadly related to a patient’s unex-
pected death. The importance of accurate documentation and how this might be improved is
emphasized (see Chapter 16). Although such approaches seek to learn from mistakes and redress
omissions in the organization or delivery of care, one fact remains: the capacity to recognize and
respond to acute deterioration, formulate salient decisions and take appropriate action resides
in the knowledge and clinical wisdom of the practitioner. We may create systems to facilitate
better communication between clinical teams, tools to prompt a reaction, or data to inform the
effectiveness of emergency care pathways, but without the relevant ‘know how’ exercised by the
carer at the patient’s bedside the problem will remain.
This book is an invaluable text to enable nurses to aquire knowledge and assessment skills but
it can also serve as an invaluable reference book to those who wish to refresh their thinking about
what to look for, and how to respond, to the early signs of physiological change. However, there
can be no substitute for the rehearsal of those skills to ensure theory can be applied to practice.
The learning outcomes and clear identification of competences gives the reader the material to
take with them into supervised practise or, better still, a simulation environment where they can
truly test out their applied knowledge without risk to the patient. Furthermore, the structure of
the chapters will be invaluable to those who support or supervise clinicians to think about what
to consider when assessing competencies in their colleagues.
I am particularly proud that the authors of this text are educators and clinicians, all in the
front line of delivering services and training to those who work in the acute care setting, yet linked
to the University of Brighton. I have had the privilege of working with the authors as a fellow
clinician, teacher and researcher. Beyond the personal, this book is evidence of strong collegiate
vi FOREWORD
relationships and partnerships working between the clinical environment and the higher edu-
cation sector. This group of authors come together as a ‘community of practice’ dedicated to
addressing ‘failure to rescue’. This demonstrates the importance of working together to achieve
the same outcome: creating a safer environment for our patients. The book celebrates the exper-
tise of both the academic and the clinician in achieving the same goal. All the authors are aware
of the issues and complexities of recognizing deterioration and have disassembled the vast array
of theory into easily accessible yet challenging learning chapters that can then be applied to prac-
tice and close the theory–practice gap. Thus, as the authors have worked together to inform the
generation of the book, invaluable learning has taken place for all those who have been involved
and myths have been dispelled about the relative value of knowledge from the ‘ivory tower’ of
academia or clinical know how. In this book we see fusion, and this can only serve to inform
the application of knowledge and improve the care we provide to all our patients in acute care
services.
I n summary, I believe this is an outstanding book that will be a constant source of reference for
educators and clinicians. I am honoured to have been asked to review this manuscript and write
this foreword. I commend it to you.
Professor Julie Scholes
Centre for Nursing and Midwifery Research University of Brighton
Co-editor: Nursing in Critical Car .
References
Talsma, A., Bahl, V., and Campbell, D.A. (2008) Exploratory analyses of the ‘failure to rescue’ measure:
evaluation through medical record review. J . Nurs. Care Qual. 23 (3), 202–10.
Acknowledgement
‘This book is dedicated to our ever-patient families and the immense support they offered us
throughout the preparation of this book. We are also indebted to all our contributors who gave
their time and expertise so willingly’.
The editors wish to thank Clare Gochmanski for taking the photographs included in Chapter 13.
Fiona Creed and Christine Spiers
Permissions
Critical Care Outreach Team: Eastbourne District Hospital for allowing us to use their track-and-trigger
scoring chart.
Keith Young, Department of Health for permission to quote the new competence framework (2009)
Competencies for recognising and responding to acutely ill adults in hospital . Department of Health,
HMSO, London.
Iain Moir at NICE for permission to quote from the NICE (2007) Guidelines Acutely ill patients in hospital:
recognition of and response to acute illness of adults in hospital . HMSO, London.
Resuscitation Council for permission to use
Resuscitation Council (UK) (2006) I mmediate Life Support , 2nd edn. Resuscitation Council (UK), London.
Resuscitation Council (UK) (2006) A dvanced Life Support , 5th edn. Resuscitation Council (UK), London.
Resuscitation Council (UK) (2008) Anaphylaxis Algorithm.
Contents
Glossary of terms and abbreviations xi
Contributors xv
1 Introduction to acute care 1
Fiona Creed
2 Respiratory assessment and care 15
Annie Chellel
3 Cardiovascular assessment and care 59
Christine Spiers
4 Neurological care 106
Fiona Creed
5 Renal assessment and support 143
Cristina Osorio
6 Gastrointestinal tract 165
Kathy Martyn
7 Fluid assessment and associated treatment 205
Heather Baid
8 Assessment and care of the septic patient 241
Kevin Barrett
9 Psycho-social assessment, care, and support 274
Heather Baid
10 Blood investigations in acute care 306
Gary Creed
11 Assessment tools and track-and-trigger systems 338
Fiona Creed, Jackie Dawson, and Kaye Looker
12 The role of outreach 362
Fiona Creed , with contributions from Ruth Creasy, Corinne Elliott, Sylvia Hedges, and
Joanna Thorpe
13 Acute emergency situations 385
Lorna East
14 Transfer of acutely ill patients 426
Denise Hinge
15 Caring for the patient post intensive care 448
Fiona Creed
16 Documentation in acute care 479
Christine Spiers