Medical Assessment Units The Initial Management of Acute Medical Patients Edited by IANWOOD MA, RN, DipN (Lond) Lecturer, Department of Nursing & Midwifery Keele University, Keele MICHELLE RHODES BSc(Hons), RN, DipN (Lond) Senior Lecturer, Department of Nursing Studies St Martin’s College, Carlisle W WHURR PUBLISHERS LONDON AND PHILADELPHIA Medical Assessment Units The Initial Management of Acute Medical Patients Medical Assessment Units The Initial Management of Acute Medical Patients Edited by IANWOOD MA, RN, DipN (Lond) Lecturer, Department of Nursing & Midwifery Keele University, Keele MICHELLE RHODES BSc(Hons), RN, DipN (Lond) Senior Lecturer, Department of Nursing Studies St Martin’s College, Carlisle W WHURR PUBLISHERS LONDON AND PHILADELPHIA © 2003 Whurr Publishers First published 2003 by Whurr Publishers Ltd 19b Compton Terrace, London N1 2UN, England and 325 Chestnut Street, Philadelphia PA 19106, USA Reprinted 2003 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 or otherwise, without the prior permission of Whurr Publishers Limited. This publication is sold subject to the conditions that it shall not, by way of trade or otherwise, be lent, resold, hired out, or otherwise circulated without the publisher’s prior consent in any form of binding or cover other than that in which it is published and without a similiar condition including this condition being imposed upon any subsequent purchaser. British Library Cataloguing in Publication Data A catalogue record for this book is available from the British Library. ISBN: 1 86156 325 6 Typeset by HWA Text and Data Management, Tunbridge Wells Printed and bound in the UK by Athenaeum Press Limited Gateshead, Tyne & Wear Contents List of contributors vii Acknowledgements ix List of normal clinical values ix Preface xi Introduction xiii Chapter 1 1 Service organisation in Medical Assessment Units Ian Wood Chapter 2 14 Initial assessment of the acute medical patient Michelle Davies, Judith Morgan and Ian Wood Chapter 3 35 Vulnerable groups Linda Miller, Michael Gibbs, Judi Thorley and Elizabeth Whelan Chapter 4 72 Sudden death Sue Read and Jane Jervis Chapter 5 94 Cardiac arrest Carole Donaldson, Ian Wood and Michelle Rhodes v vi Medical Assessment Units Chapter 6 125 Shock Judith Morgan Chapter 7 150 Altered consciousness Brendan Davies, Michelle Davies, Lorraine Taylor and Ian Wood Chapter 8 188 Shortness of breath Susan Hope, Jacqueline Mitchell, Michelle Rhodes, Helen Whitehouse and Ian Wood Chapter 9 232 Chest pain Michelle Rhodes Chapter 10 271 Abdominal pain and upper gastrointestinal bleeding Ruth Harris and Terry Wardle Chapter 11 299 Extremity pain and swelling Ian Wood Index 311 Contributors Brendan Davies Consultant Neurologist, Department of Neurology, North Staffordshire Hospital NHS Trust Michelle Davies Senior Staff Nurse, MAU, North Staffordshire Hospital NHS Trust CaroleDonaldson NightNursePractitioner,MedicalDivision,NorthStaffordshire Hospital NHS Trust Michael Gibbs Lecturer in Nursing, Department of Nursing & Midwifery, Keele University Ruth Harris Consultant Physician & Gastroenterologist, Countess of Chester NHS Trust SusanHopeRespiratoryNurseSpecialist,DepartmentofRespiratoryMedicine,North Staffordshire Hospital NHS Trust Jane JervisStaff Nurse, MAU, North Staffordshire Hospital NHS Trust Linda Miller Lecturer in Nursing, Department of Nursing & Midwifery, Keele University JacquelineMitchellAssociateLecturer,DepartmentofNursing&Midwifery,Keele University and Sister, Intensive Care Unit, Mid Cheshire NHS Trust Judith MorganConsultant Nurse, A&E Department, Oldchurch Hospital Sue ReadLecturer, Department of Nursing & Midwifery, Keele University Michelle Rhodes Senior Lecturer, Department of Nursing Studies, St Martin’s College Lorraine TaylorStaff Nurse, MAU, North Staffordshire Hospital NHS Trust Judi ThorleyTeam Manager, Combined Healthcare NHS Trust, Stoke on Trent Terry WardleConsultant Physician, Countess of Chester NHS Trust Elizabeth Whelan Assistant Director of Nursing, Emergency Department, Mater Misercordiae Hospital, Dublin Helen Whitehouse Respiratory Research Nurse, Department of Respiratory Medicine, University Hospital Birmingham Ian Wood Lecturer, Department of Nursing & Midwifery, Keele University vii 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 • Stephen Boyce, ICU, Mid Cheshire NHS Trust, for his work on acute respiratory failure • JaniceBailey,KathleenBentley,SuePassandBarbaraRickardfromthe MAU, North Staffordshire Hospital NHS Trust for their contributions tothechapteroninitialassessmentofacutemedicalpatients(Chapter2) • Alison Clarke, Jane Jervis, Michelle Davies, Marsha Holding and Sue Lapper for their ideas and comments when the book was originally conceived • Debbie Danitsch and Sara Morris for their constructive comments • Helena Priest and Bernard Beech for their review of the mental health section in Chapter 3 • Sam,Stephanie&Alexander(IW)andAndy(MR)fortheirsupportand patience viii