Full the full range of M&K Publishing books please visit our website: www.mkupdate.co.uk Ward-based Critical Care A Guide for Health Professionals Edited by Ann M. Price RGN BSc (Hons) ENB 100 PGCE MSc MA Senior Lecturer, Canterbury Christ Church University, Canterbury, Kent, UK Sally A. Smith DN, MSc, DipHE, ENB 100, ENB 998, ENB 934 Chief Nurse & Director of Quality, East Kent Hospitals University NHS Foundation Trust. Alistair Challiner MBA FFICM FRCA FIMC EDIC Consultant Intensivist and Anaesthetist, Maidstone Hospital, Maidstone and Tunbridge Wells NHS Trust, Kent. Ward-based Critical Care: a guide for health professionals 2nd edition Edited by: Ann M Price Sally A Smith Alistair Challiner ISBN: 9781905539-92-5 First published 2010. This revised edition 2016 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, without either the prior permission of the publishers or a licence permitting restricted copying in the United Kingdom issued by the Copyright Licensing Agency, 90 Tottenham Court Road, London, W1T 4LP. Permissions may be sought directly from M&K Publishing, phone: 01768 773030, fax: 01768 781099 or email: [email protected] Any person who does any unauthorised act in relation to this publication may be liable to criminal prosecution and civil claims for damages. British Library Cataloguing in Publication Data A catalogue record for this book is available from the British Library Notice Clinical practice and medical knowledge constantly evolve. Standard safety precautions must be followed, but, as knowledge is broadened by research, changes in practice, treatment and drug therapy may become necessary or appropriate. Readers must check the most current product information provided by the manufacturer of each drug to be administered and verify the dosages and correct administration, as well as contraindications. It is the responsibility of the practitioner, utilising the experience and knowledge of the patient, to determine dosages and the best treatment for each individual patient. Any brands mentioned in this book are as examples only and are not endorsed by the publisher. Neither the publisher nor the authors assume any liability for any injury and/or damage to persons or property arising from this publication. Disclaimer M&K Publishing cannot accept responsibility for the contents of any linked website or online resource. The existence of a link does not imply any endorsement or recommendation of the organisation or the information or views which may be expressed in any linked website or online resource. We cannot guarantee that these links will operate consistently and we have no control over the availability of linked pages. To contact M&K Publishing write to: M&K Update Ltd • The Old Bakery • St. John’s Street Keswick • Cumbria CA12 5AS Tel: 01768 773030 • Fax: 01768 781099 [email protected] www.mkupdate.co.uk Designed and typeset by Mary Blood Printed in Scotland by Bell & Bain, Glasgow. Contents About the contributors Preface to the second edition Acknowledgements Introduction 1 Critical care outreach Deborah Higgs 2 Assessing and monitoring the acutely ill ward patient Alistair Challiner and Sally A. Smith 3 Examination of the sick ward patient Alistair Challiner 4 Respiratory physiotherapy and rehabilitation Sarah Elliot 5 Patient safety Jorge da Fonseca and Alistair Challiner Airway 6 Assessing and managing the airway Alistair Challiner and Sally A. Smith 7 Temporary tracheostomies Philip Woodrow 8 Suctioning a tracheostomy tube Sally A. Smith 9 Changing a tracheostomy tube Sally A. Smith Breathing 10 Obtaining and interpreting arterial blood gases Ann M. Price and Sally A. Smith 11 Oxygen therapy Debbie King 12 Pleural chest drains Philip Woodrow 13 Pulmonary oedema in acute heart failure Julie Macinnes and Simon Merritt 14 Chronic obstructive pulmonary disease Ann M. Price and Simon Merritt 15 Asthma Ann M. Price and Simon Merritt 16 Non-invasive ventilation in type 2 respiratory failure Jayne Fraser 17 Pulmonary embolism Gaurav Agarwal 18 Pneumonia Gaurav Agarwal 19 Neurological disease affecting breathing Alistair Challiner Cardiovascular 20 Assessing and managing the cardiovascular system Ann M. Price 21 Sepsis Ann M. Price and Sally A. Smith 22 Hypovolaemic shock Tim Collins 23 Cardiogenic shock Russell Canavan 24 Anaphylactic shock Ann M. Price 25 Management of the critically ill patient with malignancy Angus Turner 26 Tachyarrhythmias in the acutely ill Kuno Budack 27 Cardiac chest pain Kuno Budack 28 Acute abdomen Russell Canavan and Ann M. Price 29 Oesophageal varices Russell Canavan and Ann M. Price 30 Electrolytes Philip Woodrow 31 Renal failure Russell Canavan and Michelle Webb 32 Emergency and massive blood transfusion Alistair Challiner 33 Pregnancy related conditions Diane Blake and Jo Cotton Disability 34 Assessing and managing aspects of consciousness and disability Ann M. Price 35 Neurological compromise secondary to electrolyte imbalance Amanda Sudan and Sally A. Smith 36 Diabetic ketoacidosis Ann M. Price and Russell Canavan 37 Neurogenic shock Ann M. Price 38 Severe acute pain Jane Donn 39 Nutrition in the acutely unwell patient Wendy-Ling Relph 40 Placement of a nasogastric tube Ian Setchfield Exposure 41 Exposure, examination and evaluation Karen E. Lumsden 42 Compartment syndrome Ann M. Price 43 Organ and tissue donation Tim Collins 44 Patient transport Alistair Challiner Psychosocial aspects of acute illness 45 The post-ICU patient Catherine Plowright 46 The ethics of acute care Victor Nebbiolo and Sally A. Smith 47 Communication Julie Cook 48 Family care Catherine Plowright 49 Caring for the suddenly bereaved in the acute care setting Catherine Plowright and Sally A. Smith Index About the contributors Dr Gaurav Agarwal MBBS, MRCP (UK); Consultant Physician in Acute and General Medicine at Tunbridge Wells Hospital, Maidstone and Tunbridge Wells NHS Trust Diane Blake RGN, Dip HE, RM, BSc(Hons), MSc, PGCELT; Supervisor of Midwives, Senior Midwifery Lecturer, Canterbury Christ Church University, Kent Dr Kuno Budack FRCP; Associate Specialist in Cardiology, Tunbridge Wells Hospital, Maidstone and Tunbridge Wells NHS Trust Dr Russell E. M. Canavan Consultant Gastroenterologist and Associate Medical Director, Bronglais Hospital, Aberystwyth, Wales Dr Alistair Challiner MBA, PgDip (Systems Prac), EDIC, FFICM, FRCA, FIMCRCSEd; Consultant in Intensive Care Medicine and Anaesthesia. Maidstone and Tunbridge Wells NHS Trust. Dr Tim Collins EdD, MSc, PGCLT(HE), BSc(Hons) ENB100, RN; Consultant Nurse, Acute Care, East Kent Hospitals University NHS Foundation Trust Julie Cook Acute Pain Nurse Specialist, Kent and Sussex Hospital, Maidstone and Tunbridge Wells NHS Trust, Kent, UK J0 Cotton RGN, RM, MTD, MA (Education); formerly Senior Lecturer, Canterbury Christ Church University, Kent Jane Donn RGN, DipN, ENB N53, BSc(Hons), Nurse Independent Prescriber (NIP), MSc; Clinical Nurse Specialist Acute Pain, Maidstone and Tunbridge Wells NHS Trust Sarah Elliot MA, PGCert, PGCert, BSc(Hons), MCSP; Physiotherapy Practitioner in Critical Care, Medway Maritime Hospital, Medway NHS Foundation Trust Dr Jorge da Fonseca BA, MBChB, DA(UK), FRCA, FFICM, PgCert (Medical Education), MSc (Patient Safety); Consultant Intensivist and Anaesthetist, Maidstone and Tunbridge Wells NHS Trust Jayne Fraser Senior Outreach Sister, Maidstone and Tunbridge Wells NHS Trust Deborah Higgs Consultant Nurse in Critical Care, East Kent Hospitals University NHS Foundation Trust Debbie King RGN, DipN, BSc, MA, PGCLT; Senior Lecturer, Canterbury Christ Church University, Kent Karen E. Lumsden PGCert (Critical Care), BSc (Hons), PGCLT, RN; Senior Lecturer, Canterbury Christ Church University, Kent Dr Julie Macinnes PhD, MSc, BSc (Hons), PGCE, Dip (HE), RN, RNT; Senior Lecturer Cardiac Care, Canterbury Christ Church University, Kent Dr Simon Merritt Consultant Sleep and Respiratory Medicine, Conquest Hospital, Hastings Victor Nebbiolo Resuscitation Consultant, Victor Nebbiolo Ltd, East Sussex Catherine Plowright RN, BSc Nursing, MSc Nursing, MA in Applied Professional Research, Diploma in Management Studies, ENB 100; Consultant Nurse Critical Care, Medway NHS Foundation Trust, Medway Maritime Hospital, Gillingham, Kent Ann M. Price RGN, BSc(Hons), ENB 100, PGCE, MSc, MA; Senior Lecturer, Canterbury Christ Church University, Kent Wendy-Ling Relph RGN, MSc in Care Policy and Management, ENB 100; Matron for Nutrition and Quality Improvement, East Kent Hospitals University NHS Foundation Trust Ian Setchfield MSc, BSc (Open), RN, Critical Care Matron, East Kent Hospitals University NHS Foundation Trust Dr Sally A. Smith DN, MSc, DipHE, ENB 100, ENB 998, ENB 934; Chief Nurse & Director of Quality, East Kent Hospitals University NHS Foundation Trust. Amanda Sudan RGN, BSc(Hons), MBPsS; Staff Nurse, Immunisation Service, Kent Community NHS Foundation Trust Dr Angus Turner Consultant in Anaesthesia and Intensive Care, Maidstone and Tunbridge Wells NHS Trust, Kent Dr Michelle C. Webb MB, BChir, MD, FRCP; Consultant Nephrologist, East Kent Hospitals University NHS Foundation Trust Philip Woodrow MA, RGN, DipN, Grad Cert Ed, ENB 100; Practice Development Nurse, Critical Care, East Kent Hospitals University NHS Trust