Critical Care Manual of Clinical Procedures and Competencies (Jul 22, 2013)_(1405122528)_(Wiley-Blackwell)

This Manual Is Aimed At All Healthcare Practitioners, From Novice To Expert, Who Care For The Critically Ill Patient, Recognising That Different Disciplines Contribute To The Provision Of Effective Care And That Essential Knowledge And Skills Are Shared By All Practitioners. It Provides Evidence-based Guidelines On Core Critical Care Procedures And Includes A Comprehensive Competency Framework And Specific Competencies To Enable Practitioners To Assess Their Abilities And Expertise. Each Chapter Provides A Comprehensive Overview, Beginning With Basic Principles And Progressing To More Complex Cover; Title Page; Copyright Page; Contents; List Of Contributors; Foreword; Foreword; Preface; List Of Abbreviations; Chapter 1: Scope And Delivery Of Evidence-based Care; Importance Of Critical Care; Background And Classification Of Critically Ill Patients; National Guidance; Evidence-based Practice; Definitions; Debates On The Nature Of 'evidence'; Supporting Evidence-based Practice; Integrated Governance; Using This Book; References; Chapter 2: Competency-based Practice; Introduction; Defining Competence; Competence Acquisition; Defining The Specialty; Competency-based Curriculum Competency And The Relationship With Integrated Governanceassessing Competence: When And How; Objective Structured Clinical Evaluation (osce) And Simulation; Linking The Technical With Humanistic Care; References And Further Reading; Chapter 3: Recognizing And Managing The Critically Ill And 'at Risk' Patient On A Ward; Definition; Aims And Indications; Background; Rapid Response Systems; Assessing And Managing The Deteriorating Patient; Abcde Assessment Process; Summary; References And Further Reading; Chapter 4: Admitting A Critically Ill Patient; Definition; Aims And Indications Backgroundcalling For Appropriate Assistance; Admission Of A Patient To A Level 2 Or 3 Care Facility; Recording Status On Admission; Establishing A Rapport With The Patient; Establishing A Rapport With Family And Carers; References And Further Reading; Chapter 5: Assessment, Monitoring And Interventions For The Respiratory System; Clinical Assessment; Chest Auscultation; Definition; Indications For Chest Auscultation; Background; Chest Auscultation In Critical Care; Arterial Blood Gas Sampling; Definition; Indications For Arterial Blood Gas Sampling; Background Arterial Blood Sampling In Critical Carepulse Oximetry; Definition; Indications For Pulse Oximetry Monitoring; Background; Pulse Oximetry In Critical Care; Airway Management And Care With Adjunct Airways; Definition; Aims And Indications; Background; Airway Management In Critical Care; Monitoring Airway Adjuncts; Partial Pressure Of End Tidal Carbon Dioxide (etco2) Monitoring; Definition; Indications For End Tidal Co2 Monitoring; Background; Etco2 Monitoring In Critical Care; Measuring Endotracheal/tracheostomy Tube Cuff Pressure; Definition Indications For Measuring Endotracheal/tracheostomy Tube Cuff Pressurebackground; Endotracheal/tracheostomy Tubes In Critical Care; Interventions For The Respiratory System; Ventilatory Support; Indications For Ventilatory Support; Background; Non-invasive Ventilation; Definition Of Non-invasive Ventilatory (niv) Support; Niv In Critical Care - An Overview; Invasive Ventilation; Definition Of Invasive Ventilator Support; Background; Invasive Ventilation In Critical Care; Invasive Ventilation Modes; Weaning From Mechanical Ventilation; Definition; Aim; Background Reduction Of Mechanical Support Edited By Jane Mallett, John W. Albarran, Annette Richardson. Description Based Upon Print Version Of Record. Includes Bibliographical References And Index. English Cover Title page Copyright page Contents List of contributors Foreword Foreword Preface List of abbreviations Chapter 1: Scope and delivery of evidence-based care Importance of critical care Background and classification of critically ill patients National guidance Evidence-based practice Definitions Debates on the nature of ‘evidence’ Supporting evidence-based practice Integrated governance Using this book References Chapter 2: Competency-based practice Introduction Defining competence Competence acquisition Defining the specialty Competency-based curriculum Competency and the relationship with integrated governance Assessing competence: when and how Objective Structured Clinical Evaluation (OSCE) and simulation Linking the technical with humanistic care References and further reading Chapter 3: Recognizing and managing the critically ill and ‘at risk’ patient on a ward Definition Aims and indications Background Rapid response systems Assessing and managing the deteriorating patient ABCDE assessment process Summary References and further reading Chapter 4: Admitting a critically ill patient Definition Aims and indications Background Calling for appropriate assistance Admission of a patient to a level 2 or 3 care facility Recording status on admission Establishing a rapport with the patient Establishing a rapport with family and carers References and further reading Chapter 5: Assessment, monitoring and interventions for the respiratory system Clinical Assessment Chest auscultation Definition Indications for chest auscultation Background Chest auscultation in critical care Arterial blood gas sampling Definition Indications for arterial blood gas sampling Background Arterial blood sampling in critical care Pulse oximetry Definition Indications for pulse oximetry monitoring Background Pulse oximetry in critical care Airway management and care with adjunct airways Definition Aims and indications Background Airway management in critical care Monitoring Airway Adjuncts Partial pressure of end tidal carbon dioxide (ETCO2) monitoring Definition Indications for end tidal CO2 monitoring Background ETCO2 monitoring in critical care Measuring endotracheal/tracheostomy tube cuff pressure Definition Indications for measuring endotracheal/tracheostomy tube cuff pressure Background Endotracheal/tracheostomy tubes in critical care Interventions For The Respiratory System Ventilatory support Indications for ventilatory support Background Non-invasive ventilation Definition of non-invasive ventilatory (NIV) support NIV in critical care – an overview Invasive ventilation Definition of invasive ventilator support Background Invasive ventilation in critical care Invasive ventilation modes Weaning from mechanical ventilation Definition Aim Background Reduction of mechanical support Extubation/decannulation Other respiratory interventions Intermittent positive pressure breathing (IPPB, e.g. Bird, Bennett PR2) Definition Indications for intermittent positive pressure breathing Contraindications Complications Background Intermittent positive pressure breathing in critical care Suctioning via a tracheal tube (endotracheal or tracheostomy) Definition Aim and indications Background Suctioning through endotracheal and tracheal tubes Humidification Definition Aims and indications Background Humidifiers Manual hyperinflation and hyperoxygenation Definition Aims and indications Background Manual hyperinflation and hyperoxygenation in critical care Prone ventilation Definition Aims and indications Background Risks of prone ventilation Chest drains Definition Aims and indications Background Pneumothorax Pleural fluid Chest drain insertion Management of chest drains Chest drain removal Flexible fibreoptic bronchoscopy Definition Indications for flexible bronchoscopy Contraindications and complications Background Bronchoscopy in critical care Competency and troubleshooting Summary References and further reading Chapter 6: Monitoring of the cardiovascular system: insertion and assessment Introduction Electrocardiogram monitoring Definition Aims and indications Background The 12-lead ECG Continuous cardiac monitoring Applying ECG monitoring Assessing an ECG Arterial blood pressure monitoring Non-invasive arterial blood pressure monitoring Definition Aims and indications Background Invasive arterial blood pressure monitoring Definition Aims and indications Background Evidence and current debates Insertion of and monitoring using an invasive blood pressure monitoring system Central venous pressure monitoring Definition Aims and indications Background CVP trace Efficacy of CVP monitoring Insertion of and monitoring using a CVP monitoring system Safety and risk issues Advanced haemodynamic monitoring Introduction Definition Aims and indications Background Haemodynamic monitoring The measurement of cardiac output Pulmonary thermodilution method Transpulmonary dilution method Summary References Chapter 7: Titration of inotropes and vasopressors Definition Aims and indications Background Choice of inotrope or vasopressor Components of titration of inotropic drug therapies Administration of inotropic drugs via syringe pumps Titration of inotropic drugs to meet patient requirements Changeover of inotrope and vasopressor infusions Troubleshooting References and further reading Chapter 8: Assessment and support of hydration and nutrition status and care Definition Aims and indications Background The effect of critical illness on hydration and nutrition Optimizing hydration and nutrition Therapy to maintain hydration and nutrition status Maintaining fluid balance in the critically ill Maintaining nutrition Therapy Enhanced recovery programmes Feeding critically ill patients Glycaemic control Insulin titration Problems with providing hydration and nutrition Overfeeding Refeeding syndrome Enteral feeding access in an intubated patient Advantages of fine-bore and wide-bore enteral tubes Risks and complications of nasogastric tube insertion Parenteral nutrition Complications Ethical considerations References and further reading Chapter 9: Continuous renal replacement therapies: assessment, monitoring and care Definition Aims and indications Anatomy and physiology of the kidney Acute kidney injury Indications for CCRT in acute kidney injury Aims of CRRT How CRRT works Principles of renal replacement therapy Continuous versus intermittent renal replacement therapy Types of CRRT CRRT priming and treatment choices Maintaining the CRRT circuit Assessment and monitoring of the patient on CRRT Cardiovascular status and fluid management Intravenous access and infection control Maintaining patency of intravenous access Monitoring electrolytes and metabolic status Hypothermia Nutritional support Respiratory management Neurological care Monitoring and problem solving on the CRRT circuit References Chapter 10: Assessment and monitoring of analgesia, sedation, delirium and neuromuscular blockade levels and care Pain Definitions Aims and indications Background Anatomy and physiology Assessment of pain Management of pain Sedation Definition Aims of sedation Background Sedation hold Withdrawal of sedation Rescue sedation Assessment of sedation Monitoring of sedated patients Delirium Definition Aims in treating patients with, or at risk of developing, delirium Background Drugs and delirium Assessment and monitoring of delirium Neuromuscular blockade Definition Aims and indications Anatomy and physiology Neuromuscular blockade Assessment of neuromuscular blockade Treatment Drugs for sedation, analgesia and neuromuscular blockade Sedation Analgesia Opioids Neuromuscular blockade Rescue sedation References and further reading Chapter 11: Assessment and monitoring of neurological status Definition Aims and indications Background anatomy and physiology of the central nervous system Assessment of neurological status Clinical methods Invasive monitoring ICP monitoring devices Aspects of care impacting on intracranial pressure Advanced neuromonitoring References Chapter 12: Assessment and care of tissue viability, and mouth and eye hygiene needs Tissue viability Definition Indications Anatomy and physiology Functions of the skin Challenges to health of skin Pressure ulcers Definition Indications Background Pressure ulcer grading Extrinsic factors Assessment Skin inspection Prevention Healing pressure ulcers Dressings Reporting pressure ulcers Conclusion Useful websites Mouth care Definition Aims and indications Background Anatomy and physiology Oral pathophysiology Problems in critical illness Assessment and care of oral cavity Dentures Eye care Definition Aims and indications Background Anatomy and physiology Problems Assessment and care References and further reading Chapter 13: Assessment of sleep and sleep promotion Definition Indications Background The stages of sleep Why is sleep important? Assessment of sleep Physiological sleep assessment methods Non-physiological sleep assessment methods Non-physiological sleep assessment tools Factors that disrupt and promote sleep References and further reading Chapter 14: Physical mobility and exercise interventions for critically ill patients Definitions Aims and indications Background anatomy and physiology Evidence and current debates Review of components of physical mobility and exercise Assessment of readiness to mobilize Interventions During the acute phases of illness Rehabilitation for patients unable to sit on the edge of the bed (i.e. ‘bed bound’) Rehabilitation for patients deemed ready to sit on the edge of the bed Post-critical care rehabilitation Measurement of manual handling risk References and further reading Chapter 15: Transfer of the critically ill patient Definitions Aims Indications Background Physiological effects of transfer Cardiovascular system Effect of movement/gravitational forces Respiratory system The effects of altitude: potential for hypoxia The effects of altitude: expansion of air spaces Physiological stress response Temperature control Evidence and current debates Quality of patient transfers Organization Role of critical care networks Specialist transfer teams Timing of transfers Components of the transfer process The decision to transfer Communication Assessment and stabilization prior to transfer Selection of transport mode Preparation for transfer Safe transfer Handover Competency statements Guidelines for transfer Equipment References and further reading Chapter 16: Rehabilitation from critical illness Definition Aims and indications for rehabilitation Background Rehabilitation and critical care Effect of critical illness on patients’ families Review of components of rehabilitation from critical care Muscle loss and weakness Cognitive deficits Rehabilitation Rehabilitation interventions Diaries Counselling Summary References Chapter 17: Withdrawal of treatment and end of life care for the critically ill patient Definition Aims and indications Background Pre-EOLC considerations: at the beginning Prognosis Post prognosis: EOLC in critical care environments Tools that facilitate best care at EOL Guidance for EOLC Assessment of need for ‘Do Not Attempt Cardiopulmonary Resuscitation’ orders Process for obtaining a DNACPR order Assessment of need for discussion of withdrawal of treatment Avoiding prolongation of dying and decisions about transfer Care around withdrawal: care in the last days and hours Diagnosing dying Consultation and communication of decision to withdraw treatment with patient, next of kin and significant others Patients Families/Next of kin/Significant others Nurses and allied health professionals Communication and breaking bad news: supporting the family Cultural issues Review of practical components of withdrawal of treatment and end of life care When to withdraw How and when to withdraw treatment Extubation Care of the dying patient during extubation Further EOLC considerations in the last days and hours Sudden or unexpected dying Brainstem function measurement and death Brainstem death After-death care Communicating procedures around death Preparing the body of the patient who has died Considerations before showing families the deceased patient (either before or after last offices) Families’ time with patient in unit after the patient’s death Bereavement care Competencies Conclusion References and further reading Chapter 18: Cardiopulmonary resuscitation Definition Aims and indications Background Anatomy and physiology Incidence and causes of cardiac arrest Evidence for guidelines In-hospital resuscitation Location Skills of the staff who respond to the cardiac arrest Number of responders Equipment and medicines available Resuscitation team Initial management of the ‘collapsed’ patient Personal safety Recognizing cardiac arrest and calling for help Starting CPR High-quality chest compressions Airway and ventilation Defibrillation Drugs and vascular access Identifying reversible causes Post-cardiac arrest care Diagnosing death References Index This manual is aimed at all healthcare practitioners, from novice to expert, who care for the critically ill patient, recognising that different disciplines contribute to the provision of effective care and that essential knowledge and skills are shared by all practitioners. It provides evidence-based guidelines on core critical care procedures and includes a comprehensive competency framework and specific competencies to enable practitioners to assess their abilities and expertise. Each chapter provides a comprehensive overview, beginning with basic principles and progressing to more complex ideas, to support practitioners to develop their knowledge, skills and competencies in critical care. Chapter 1 Scope and delivery of evidence-based care John W. Albarran and Annette Richardson Chapter 2 Competency-based practice Julie Scholes, Jo Richmond and Jane Mallett Chapter 3 Recognizing and managing the critically ill and at risk' patient on a ward Mandy Odell Chapter 4 Admitting a critically ill patient Vanessa Gibson and Karen Hill Chapter 5 Assessment, monitoring and interventions for the respiratory system Maureen Coombs, Judy Dyos, David Waters and Ian Nesbitt Chapter 6 Monitoring of the cardiovascular system: insertion and assessment Alan T. Platt, Sarah Conolly and Jonathan Round Chapter 7 Titration of inotropes and vasopressors Kirsty Rutledge Chapter 8 Assessment and support of hydration and nutrition status and care Kirsty Rutledge and Ian Nesbitt Chapter 9 Continuous renal replacement therapies: assessment, monitoring and care Annette Richardson and Jayne Whatmore Chapter 10 Assessment and monitoring of analgesia, sedation, delirium and neuromuscular blockade levels and care Phil Laws and Nicola Rudall Chapter 11 Assessment and monitoring of neurological status Margaret A. Douglas and Sarah E.C. Platt Chapter 12 Assessment and care of tissue viability, and mouth and eye hygiene needs Philip Woodrow, Judy Elliott and Pauline Beldon Chapter 13 Assessment of sleep and sleep promotion Annette Richardson, Micheala Allsop and Elaine Coghill Chapter 14 Physical mobility and exercise interventions for critically ill patients D.J. McWilliams and Amanda Thomas Chapter 15 Transfer of the critically ill patient Andrew Baker and Simon M. Whiteley Chapter 16 Rehabilitation from critical illness Catherine I. Plowright and Christina Jones Chapter 17 Withdrawal of treatment and end of life care for the critically ill patient Natalie A. Pattison Chapter 18 Cardiopulmonary resuscitation Jackie S. Younker and Jasmeet Soar