Initial Management of Acute Medical Patients

321 Pages·2012·3.47 MB·English

initial management of
ai
n
acute medical patients ci
t
ui
a
tl

a guide for nurses and healthcare practitioners em
a
mn
a
Second Edition
eg
e
dm
Initial Management of Acute Medical Patients is a clinically focused, practical and ie
cn
contemporary guide for assessing and managing patients with acute medical conditions. at

Suitable for all nurses and healthcare practitioners working in medical assessment units, lo
medical wards and emergency departments, it presents a structured approach based on f
common presenting features and focuses on the fi rst 24 hours of the patient’s hospital p
stay. The book draws on a wide range of supporting evidence and also provides the reader a
t
with sources for further reading.
i
e
key features
n
• Written predominantly by nurses for nurses, this text is also suitable for a range of t
s
healthcare professionals, including paramedics and nurse practitioners, and anybody
working in an acute care environment including primary care assessment units, clinical
decision units and intermediate care.
S Edited by Ian Wood and Michelle Garner
• Designed as a quick reference text for use in clinical practice. e
c
o
• Extensively referenced throughout, thus increasing its appeal to practitioners at all stages n
d
of their careers and to those who are undertaking further study.
E
d
• Devotes two entire chapters to assessing and meeting the acute care needs of vulnerable it
adults (i.e. older adults, those with mental health needs and those with learning io
n initial management of
disabilities), and discussing best practice in dealing with sudden death.
• Each chapter offers clear, concise and down-to-earth information based on a common
W acute medical
presenting symptom and provides practical advice, supported by best evidence and the
o
most up-to-date clinical guidelines.
o
d
• Fully updated and extensively expanded to include recent guidelines and procedures.
patients
a
n
about the editors
d

Ian Wood is a Lecturer in the School of Nursing & Midwifery, Keele University. His clinical G
background is in emergency nursing and, in this context, he has worked in emergency a
r
departments in Manchester, Leicester and Stoke on Trent. n a guide for nurses and
e
Michelle Garner is a Senior Lecturer and pathway lead for acute and critical care within r
healthcare practitioners
the Faculty of Health & Wellbeing, University of Cumbria. Her clinical background is in
cardiology and she has worked in cardiac units in Stoke on Trent, Macclesfi eld and London.
Second Edition
Cover design: Meaden Creative
Cover image: © Stephan Morrosch – Fotolia.com
ISBN 978-1-4443-3716-7
9 781444 337167
wood_9781444337167_pb.indd 1 08/12/2011 16:48
Initial Management of
Acute Medical Patients
A Guide for Nurses and
Healthcare Practitioners
Second Edition
Edited by
Ian Wood
MA, RN, DipN (Lond)
Lecturer
School of Nursing & Midwifery
Keele University
Keele
UK
Michelle Garner
MPhil, BSc (Hons), RN, DipN (Lond)
Senior Lecturer
Faculty of Health & Wellbeing
University of Cumbria
Carlisle
UK
A John Wiley & Sons, Ltd., Publication
ffffiirrsstt..iinndddd ii 11//1100//22001122 33::1100::5555 PPMM
This edition first published 2012
© 2003 by Whurr Publishers
© 2012 by John Wiley & Sons, Ltd
Wiley‐Blackwell is an imprint of John Wiley & Sons, formed by the merger
of Wiley’s global Scientific, Technical and Medical business with Blackwell Publishing.
Registered Office
John Wiley & Sons, Ltd, The Atrium, Southern Gate, Chichester, West Sussex, PO19 8SQ, UK
Editorial Offices
9600 Garsington Road, Oxford, OX4 2DQ, UK
The Atrium, Southern Gate, Chichester, West Sussex, PO19 8SQ, UK
2121 State Avenue, Ames, Iowa 50014‐8300, USA
For details of our global editorial offices, for customer services and for information about
how to apply for permission to reuse the copyright material in this book please see our website
at  www.wiley.com/wiley‐blackwell.
The right of the author to be identified as the author of this work has been asserted in accordance
with the UK Copyright, Designs and Patents Act 1988.
All rights reserved. No part of this publication may be reproduced, stored in a retrieval system,
or transmitted, in any form or by any means, electronic, mechanical, photocopying, recording or
otherwise, except as permitted by the UK Copyright, Designs and Patents Act 1988, without the
prior permission of the publisher.
Designations used by companies to distinguish their products are often claimed as trademarks.
All brand names and product names used in this book are trade names, service marks, trademarks
or registered trademarks of their respective owners. The publisher is not associated with any product
or vendor mentioned in this book. This publication is designed to provide accurate and authoritative
information in regard to the subject matter covered. It is sold on the understanding that the publisher
is not engaged in rendering professional services. If professional advice or other expert assistance is
required, the services of a competent professional should be sought.
Library of Congress Cataloging‐in‐Publication Data
Initial management of acute medical patients : a guide for nurses and healthcare practitioners / edited
by Ian Wood, Michelle Garner. – 2nd ed.
p. ; cm.
Rev. ed. of: Medical assessment units / edited by Ian Wood and Michelle Rhodes. London : Whurr, 2003.
Includes bibliographical references and index.
ISBN 978-1-4443-3716-7 (pbk. : alk. paper)
I. Wood, Ian, 1962– II. Garner, Michelle. III. Medical assessment units. [DNLM:
1. Critical Care–methods. 2. Emergency Nursing–methods. 3. Acute Disease–nursing.
4. Nursing Assessment–methods. 5. Triage–methods. WY 154]
616.02′8–dc23
2011037445
A catalogue record for this book is available from the British Library.
Wiley also publishes its books in a variety of electronic formats. Some content that appears in print
may not be available in electronic books.
Set in 10/12.5 pt Sabon by SPi Publisher Services, Pondicherry, India
1 2012
ffffiirrsstt..iinndddd iiii 11//1100//22001122 33::1100::5566 PPMM
Contents
List of Contributors i v
Preface v i
Acknowledgements v ii
Introduction viii
Normal Clinical Values i x
1 Initial Assessment of the Acute Medical Patient 1
Judith Morgan and Ian Wood
2 Vulnerable Adults 2 3
Louise Nelson, Scott Inglis, Fiona Howell, Michael Gibbs
and Judi Thorley
3 Sudden Death 5 6
Sue Read and Jane Jervis
4 Cardiac Arrest 80
Carole Donaldson
5 Shock 108
Judith Morgan and Ian Wood
6 Altered Consciousness 133
Ian Wood and Carole Donaldson
7 Shortness of Breath 170
Michelle Garner, Susan Hope and Ian Wood
8 Chest Pain 2 21
Michelle Garner
9 Abdominal Pain and Upper Gastrointestinal Bleeding 262
Toni Jordan, Ruth Harris and Terry Wardle
10 Extremity Pain and Swelling 288
Ian Wood
Index 300
ffttoocc..iinndddd iiiiii 11//1100//22001122 33::1122::1166 PPMM
List of Contributors
Carole Donaldson
Staff Development Educator, Postgraduate Critical Care Nursing Program,
Sir Charles Gairdner Hospital, Perth, Western Australia
Michelle Garner
Senior Lecturer, Faculty of Health & Wellbeing, University of Cumbria, Carlisle
Michael Gibbs
Lecturer, School of Nursing & Midwifery, Keele University, Keele
Ruth Harris
Consultant Gastroenterologist, Department of Gastroenterology, Countess of
Chester NHS Foundation Trust, Chester
Susan Hope
Respiratory Nurse Specialist, Department of Respiratory Medicine, University
Hospital of North Staffordshire NHS Trust, Stoke on Trent
Fiona Howell
Matron, Elderly Care Unit, University Hospital of North Staffordshire NHS
Trust, Stoke on Trent
Scott Inglis
Senior Lecturer, Faculty of Health & Wellbeing, University of Cumbria, Carlisle
Jane Jervis
Medical Advanced Nurse Practitioner, University Hospital of North Staffordshire
NHS Trust, Stoke on Trent and Institute for Life Course Studies, Keele University,
Keele
Toni Jordan
Consultant Physician, University Hospital of North Staffordshire NHS Trust,
Stoke on Trent
Judith Morgan
Consultant Nurse in Emergency Care, Local Accident Centre, Neath Port Talbot
Hospital, Port Talbot
Louise Nelson
Principal Lecturer, Faculty of Health & Wellbeing, University of Cumbria, Carlisle
ffbbeettww..iinndddd iivv 11//1100//22001122 33::1100::2266 PPMM
List of Contributors v
Sue Read
Reader in Learning Disability Nursing, School of Nursing & Midwifery, Keele
University, Keele
Judi Thorley
Regional Lead, Learning Disability Health and Adult Safeguarding, NHS East
Midlands
Terry Wardle
Consultant Gastroenterologist and General Physician, Countess of Chester NHS
Foundation Trust, Chester
Ian Wood
Lecturer, School of Nursing & Midwifery, Keele University, Keele

ffbbeettww..iinndddd vv 11//1100//22001122 33::1100::2266 PPMM
Preface
Increasing demands on acute hospital resources, together with a reduction in the
number of acute beds available, have placed greater emphasis on the need for rapid
and effective assessment of patients in order to determine their need for hospital
admission. The increased acuity of patients who are treated in hospital also means
that they are at greater risk of deterioration than was previously the case. From a
different perspective, it is equally important that those cared for in primary and
intermediate care settings are assessed and managed in order to prevent their
admission to acute hospital beds. In this context, it is vital that nurses and other
healthcare practitioners caring for these patients are aware of how to assess and
manage acutely ill patients.
This book provides an up‐to‐date guide for the initial assessment and manage-
ment of patients with acute medical conditions. It presents a structured approach
based on common presenting features and focuses on the first 24 hours of the
patient’s hospital stay. The book draws on a wide range of supporting evidence and
also provides the reader with sources for further reading.
In writing this book, the authors have been able to draw on their experience as
educators in the fields of acute and critical care and their clinical experiences as a
charge nurse in emergency department nursing and a sister in acute cardiology,
respectively.
Ian Wood
Michelle Garner
ffpprreeff..iinndddd vvii 11//1100//22001122 33::1111::4499 PPMM
Acknowledgements
The Editors would like to thank the following people for their valuable contributions
to the writing of this book:
● The contributors for their hard work in writing and revising their respective
chapters
● Magenta Styles and her colleagues at Wiley‐Blackwell for their support
● Our families (Sam, Steph and Alex [IW], and Andy and Matthew [MG]) for their
support and patience
ffllaasstt..iinndddd vviiii 11//1100//22001122 33::1111::2233 PPMM
Introduction
Initial Management of Acute Medical Patients: A Guide for Nurses and Healthcare
Practitioners builds on the success of the first edition in meeting the need for a
nursing text which relates to the assessment and management of acutely ill medical
patients. This second edition has been extensively updated and expanded to include
greater focus on the recognition and management of those patients whose condition
deteriorates while they are in hospital. The book focuses on the assessment and
management of acutely ill medical patients during the first 24 hours of their care
but will also appeal to primary and intermediate care professionals whose aim may
be to prevent patients’ admission to hospital.
Written predominantly by nurses for nurses, the book has been designed as a
quick reference text for use in clinical practice. To act as a source of further reading,
the book is extensively referenced throughout, thus increasing its appeal to nurses
at all stages of their careers and to those who are undertaking further study.
Each chapter offers clear, concise and down‐to‐earth information based on a
common presenting symptom and provides practical advice, supported by best
evidence and the most up‐to‐date clinical guidelines. The reader is led, step by step,
through the initial assessment and management of the patient. Text boxes identify
the most common conditions associated with each presenting symptom. A detailed
explanation of the causes, pathophysiology, presenting features, investigations and
initial management is given for each condition. Text boxes also identify the less
common conditions associated with each presenting symptom. The book does not
provide information relating to the continuing management of the patient, nor to
the less common conditions associated with each presenting symptom. However,
sources of further reading are identified.
Notably, the book contains chapters relating to the principles of initial assessment,
management of cardiac arrest, sudden death and vulnerable groups. The latter two
chapters are deliberately placed early in the book in recognition of their importance
in the provision and organisation of care for older people, those with mental health
needs and those with learning disabilities.
Normal physiological values are detailed within the preliminary pages. Specific
aims and a reference list are contained within each chapter. Text boxes are used to
highlight key points from the text and the book is cross‐referenced throughout.
ffllaasstt..iinndddd vviiiiii 11//1100//22001122 33::1111::2233 PPMM
Normal Clinical Values
1. Haematology
Haemoglobin
Male 14.0–17.7 g /dL
Female 12.0–16.0 g /dL
White cell count 4–11 × 10 9 /litre
Basophils <0.01–0.1 × 109 /litre
Eosinophils 0 .04–0.4 × 109 /litre
Lymphocytes 1 .5–4.0 × 109 /litre
Monocytes 0.2–0.8 × 109 /litre
Neutrophils 2.0–7.5 × 109 /litre
Platelet count 150–400 × 109 /litre
Mean corpuscular haemoglobin (MCH) 27–35 pg
MCH concentration (MCHC) 32–35 g/dL
Mean corpuscular volume (MCV) 80–96 fL
Packed cell volume (PCV)
Male 0.42–0.53 litres/litre
Female 0.36–0.45 litres/litre
Erythrocyte sedimentation rate (ESR) <20 mm in 1 hour
Coagulation studies
Activated partial thromboplastin time (aPTT) 25–35s
Usually recorded in relation to
the laboratory control or reference level
Partial thromboplastin time (PTTK) 24–31s
Prothrombin time 12–16s
International normalised ratio (INR) 1
Activated clotting time (ACT) 70–120s
ffllaasstt..iinndddd iixx 11//1100//22001122 33::1111::2233 PPMM