Fundamentals of Critical Care : A Textbook for Nursing and Healthcare Students, 1e

Fundamentals of Critical Care A Textbook for Nursing and Healthcare Students In Fundamentals of Critical Care , a team of clinicians and health educators deliver an accessible, timely, and evidence-based introduction to the role of nurses and healthcare practitioners in critical care. The book explores fundamental concepts in critical care and their implications for practice. Each chapter outlines essential knowledge necessary to understand key concepts and includes high quality, full-colour artwork to enhance learning and recall. Readers are also provided with clinical scenarios, practice questions, and red and orange flags to indicate physiological and psychological alerts respectively. Covering a range of common and specialised disease processes and treatments requiring critical care, the book provides: A thorough introduction to the critical care unit, including philosophies of care, ways of working, humanisation, and outreach Comprehensive exploration of organisational influences, including political, local, national, and international influences Practical discussion of legal, ethical, and professional issues, as well as evidence-based approaches to critical care In-depth examination of nursing care assessment tools, nursing communication, cognition, pharmacology, and more Perfect for nursing students and trainee nursing associates, Fundamentals of Critical Care: A Textbook for Nursing and Healthcare Students will also earn a place in the libraries of healthcare students in physiotherapy, paramedicine, medicine, and those returning to practice. All content reviewed by students for students. 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Sign up today at www.wiley.com/email Cover Title Page Copyright Page Contents Contributors Preface Acknowledgements How to use your textbook About the companion website Chapter 1 The critical care unit Introduction Levels of care The critical care environment Critical care patients Level 1 care Level 2 care Level 3 care Critical care competence The interprofessional team Communication Ways of working Understanding philosophies of care Humanising critical care Surviving critical care Death in critical care Resilience Personal resilience Team resilience Organisational resilience Nursing considerations and recommendations for practice Future challenges Conclusion References Chapter 2 Organisational influences Introduction The four UK nations England Scotland Wales Northern Ireland Legislation Professional Statutory Regulatory Bodies (PSRBs) Shared decision making Capacity for shared decision making Confidentiality Decisions relating to end-of-life care Risk management International influences National influences UK government organisations Networks National guidelines Quality assurance Local policies Nursing considerations and recommendations for practice Conclusion References Chapter 3 Legal and ethical issues Introduction Confidentiality End-of-life care and best interest decisions Ethical themes Mental Capacity Act Euthanasia Abandonment Organ donation Ethical and legal issues related to organ donation in the UK The donation process Consent (authorisation in Scotland) for organ donation First person consent First person opt-in First person opt-out Appointed/nominated representative (not Scotland) Deemed consent The ethics of deemed consent Consent from a person in the highest-ranking relationship Cadaveric organ donation The organ donation process Post organ retrieval Organ allocation Conclusion References Chapter 4 Professional issues in critical care Introduction Opportunities for learning NMC Code in critical care units: journey to independent, safe practice The core principles Prioritise people Practise effectively Preserve safety Promote professionalism and trust UK National Competency Framework: critical care Step 1 Step 2 Step 3 Development of critical thinking in healthcare The prioritising process Time Resource Constraints Multidisciplinary interactions Support systems: the student Red Flag Conclusion References Chapter 5 Using an evidence-based approach Introduction What is evidence-based practice (EBP)? Step 1: formulating a clinical question – the PICO method Step 2: locating the evidence/research: performing a systematic literature review Step 3: critical appraisal and the hierarchy of evidence Step 4: extracting the most relevant and useful results Step 5: implementing research into practice Quality healthcare in critical care Clinical audit and quality improvement Research and development in critical care Conclusion References Chapter 6 Nursing care Introduction Standards of care Preadmission Admission Comprehensive assessments Focused assessments Safety assessments Handover Alarm settings Physical care Patient hygiene Skin care Eye care Oral care Perineum and elimination care Urinary incontinence Bowel care Mobility Critical care bundles Conclusion References Chapter 7 Skin integrity Introduction Anatomy and physiology of the skin Impact of ageing on skin and tissue integrity Pressure ulcers Nursing assessment Prevention of pressure ulcers Management of pressure ulcers Wound healing Inflammation phase Proliferation phase Patient factors that affect wound healing Nursing assessment Recognising wound infection Management of non-healing wounds Conclusion References Chapter 8 Shock Introduction Shock Hypovolaemic shock Pathophysiology and symptoms Risk factors Aetiology Gastrointestinal losses Renal losses Skin losses Third-space sequestration Blood analysis Multiple organ dysfunction syndrome Staging of hypovolaemic shock Stage 1 Stage 2 Stage 3 Stage 4 Principles of managing hypovolaemic shock Fluid resuscitation Training and education for Registered Nurses Cardiogenic shock Pathophysiology Symptoms Management Obstructive shock Altered pathophysiology Tension pneumothorax Signs and symptoms Cardiac tamponade Signs and symptoms Pulmonary embolism (PE) Signs and symptoms Distributive shock Septic shock Lactate Anaphylactic shock Neurogenic shock Conclusion References Chapter 9 Communication Introduction Communicating effectively with patients Communicating during a pandemic Communication with families Nurses as information and communication facilitators Nurses as family support providers Nurses’ non-specific behaviours Improving nurses’ communication skills Conclusion References Chapter 10 Electronic health records Introduction Digitisation within healthcare Electronic health records (EHRs) The NHS Long Term Plan and technology Data security Barriers to further development of EHRs Errors and personal responsibility Understanding your responsibilities and the law in relation to record keeping Professional responsibility for record keeping Intensive Care Society Guidelines Data protection Data security Understanding the different types of EHRs in critical care and how they are used Imaging systems Test and result systems Clinical documentation Understanding what patient data is available within the critical care unit and how this is recorded in an electronic health record Understanding how EHRs are used in critical care audit and research EHR use in research and audit EHR use in monitoring performance Understanding the benefits and barriers to EHRs Benefits of EHRs Barriers to implementation Buy-in from clinicians Conclusion References Chapter 11 Pharmacology Introduction Principles of pharmacology and pharmacotherapy The processes of drug therapy Medication safety in critical care Drugs and dialysis Core drugs utilised within critical care Respiratory drugs Oxygen Bronchodilators Mucolytics Respiratory stimulants Cardiovascular drugs Inotropes/Inoconstrictors and vasoconstrictors Inodilators Anti-arrhythmics and anti-anginal Anti-hypertensives Haematological drugs Anticoagulants Renal drugs Fluids and electrolytes Fluids Electrolytes Gastrointestinal drugs Insulin H2-histamine antagonists and proton pump inhibitors (PPIs) Anti-emetics Laxatives and anti-diarrhoeal drugs Neurological drugs Analgesics Opioids Non-opioid analgesics Epidural and regional anaesthesia Sedatives and anxiolytics Muscle relaxants Anticonvulsants Antideliriogenics Immunomodulatory drugs Antibacterial agents Antifungals Antiviral drugs Corticosteroids Immunoglobulins Toxicology Conclusion References Chapter 12 Anaesthesia and sedation Introduction Indications for sedation and anaesthesia Anaesthetic and sedative medications Sedative drugs Propofol Midazolam Thiopentone Ketamine Etomidate Opioids Dexmedetomidine Neuromuscular blocking agents and reversal agents Suxamethonium Rocuronium Atracurium Sugammadex Neostigmine Sedation management Targeted sedation Sedation interruption Protocolised sedation Analgesia first Conclusion Red Flag Learning event: reflection References Chapter 13 Medicines management and drug calculations Introduction Purpose of pharmacological interventions in the critically ill adult patient Legal and professional issues Collaborative multidisciplinary team working Medication errors Overview of routes and methods of administering medications in CCU Oral Topical Sublingual Rectal Aerosolisation (nebulisation) Subcutaneous Intramuscular Enteral Intravenous Rights of medication administration Managing and reporting a medication error Anaphylaxis Pathophysiology and clinical manifestations of DIA Management for DIA Medication calculation formulae Displacement Conclusion References Chapter 14 Neurological critical care Introduction Neurological anatomy and physiology Functions of the nervous system The central and peripheral nervous systems Central nervous system Structure and function of the brain Meninges Cerebrospinal fluid (CSF) Cerebral blood flow Monro–Kellie hypothesis Regulation of CPP and ICP Herniation of the brain Neurological assessment Glasgow Coma Scale Limb movement Pupillary assessment Signs and symptoms of increasing ICP Primary and secondary brain injury Management of raised ICP Goal-directed therapy Fluid balance Haemodynamic therapy Oncotic therapy Nursing care Transfer Conclusion References Chapter 15 Cognition Introduction Cognitive impairment Causes of cognitive impairment Signs of cognitive impairment Delirium Risk factors Management of delirium Sleep Assessment of sleep in ICU Conclusion References Chapter 16 Respiratory care: intubation and mechanical ventilation Introduction Respiratory failure Hypoventilation Ventilation/perfusion (V/Q) mismatch Shunt Dead space Work of breathing Arterial blood gases (ABGs) Non-invasive ventilation (NIV) Continuous positive airway pressure (CPAP) High flow nasal oxygen Intubation Mechanical ventilation Artificial ventilation Minute ventilation (Vm) Fraction of inspired oxygen Positive end-expiratory pressure (PEEP) Volume control Pressure control Inspiratory:Expiratory (I:E) ratio Inverse ratio Synchronisation Humidification Benefits of mechanical ventilation Risks of mechanical ventilation Ventilator care bundles Prone positioning Prone positioning in COVID-19 Weaning from mechanical ventilation Conclusion References Chapter 17 Lung function in critical care Introduction Anatomy and physiology Composition of air Alveolar gas Expired air Lung volumes Pulmonary ventilation External respiration Ventilation/Perfusion Transport of gases Internal respiration Assessment of lung function Normal breath sounds (vesicular) Absent Sounds Wheeze Crackles The work of breathing Compliance Resistance Emphysema Asthma Obstructive sleep apnoea Prone positioning Conclusion References Chapter 18 Cardiac physiology Introduction Functions of the cardiovascular system Anatomy of the heart and great vessels Pericardium Layers of the heart Chambers of the heart Valves of the heart Coronary circulation Cardiac conduction system The cardiac cycle Cardiac output and blood pressure Regulation of heart rate Stroke volume Preload Contractility Afterload The regulation of blood pressure The microcirculation Capillary exchange Effects of ventilation on the cardiovascular system Conclusion References Chapter 19 Cardiovascular critical care Introduction Cardiovascular assessment Heart rate and rhythm Atrial ectopic beats Ventricular ectopic beats Blood pressure Invasive blood pressure monitoring Central venous catheters (CVCs) and central venous pressure (CVP) Markers of organ and tissue perfusion Lactate Mixed venous oxygen saturation (SvO2) and central venous oxygen saturation (ScVO2) Neurological status Urine output Blood results Advanced haemodynamic monitoring Cardiac pacing Nursing considerations and recommendations for practice Conclusion References Chapter 20 Fluids and electrolytes incritically ill patients Introduction The role of the critical care nurse Intravenous fluids Crystalloids versus colloids critical care Fluid management Third spacing Assessment and monitoring Training and education Electrolyte replacement therapy Oral preparations Oral potassium Management of hyperkalaemia Oral sodium and water Oral rehydration therapy (ORT) Oral bicarbonate Parenteral preparations for fluid and electrolyte imbalance Electrolytes and water Intravenous sodium Intravenous glucose Intravenous potassium Bicarbonate and lactate Plasma and plasma substitutes Plasma substitutes Fluid overload The four Ds of fluid management Drug Dosing Duration De-escalation Hyponatraemia Hypernatraemia Hypokalaemia Hyperkalaemia Hypophosphataemia Hypocalcaemia Hypomagnesaemia Conclusion References Chapter 21 Critical care emergencies Introduction A – Airway B – Breathing C – Circulation/Cardiovascular D – Disability E – Everything else (exposure, endocrine, electrolytes and environmental) Care of the patient post return of spontaneous circulation (ROSC) Critical care emergencies and human factors Debriefing Do-not-attempt-cardiopulmonary-resuscitation (DNACPR) and Recommended Summary Plan for Emergency Care and Treatment (ReSPECT) Conclusion References Chapter 22 Gastrointestinal critical care Introduction Anatomy and physiology Anatomy and physiology of the GI system Anatomy and physiology of the hepatic system GI monitoring and investigation in the critically ill Blood tests Imaging and endoscopy X-ray Ultrasound (USS) Computer tomography (CT) Endoscopy Bowel charts and abnormal GI motility Constipation Diarrhoea Faecal management systems The acute abdomen in critical care Perforation Gastrointestinal haemorrhage Ischaemic colitis Acute pancreatitis Bowel obstruction Peritonitis Bacterial translocation – ‘leaky gut’ Biliary sepsis Acute liver failure Common surgical procedures cared for in critical care Post-operative monitoring Abdominal surgical drains Anaesthetics Post-operative complications Ileus Anastomotic leak Wound dehiscence Red Flag GI pharmacology Conclusion References Chapter 23 Nutrition in critical care Introduction Pathophysiology Fight or flight Resistance Exhaustion Nutritional screening and assessment Indirect calorimetry (IC) Routes of administration Enteral nutrition Parenteral nutrition Nursing considerations and recommendations for practice Care of people with feeding tubes Glycaemic control Refeeding syndrome Discontinuing feed Nutritional guidance Conclusion References Chapter 24 Renal critical care Introduction Anatomy and physiology of the renal tract Vascular supply Renin-angiotensin-aldosterone system (RASS) The nephrons Control of plasma osmolality Electrolyte balance Acid-base balance Renal failure Acute kidney injury Definition Classification of AKI Pathophysiology Organ cross-talk Risk factors for AKI Clinical features and examination Investigations Specific disorders associated with AKI Glomerular disease Acute glomerulonephritis Hepatorenal syndrome (HRS) Rhabdomyolysis Drug-induced renal damage Management of AKI Life-threatening emergencies Clinical features and examination Management Chronic kidney disease Management Diabetic nephropathy Continuous renal replacement therapy (CRRT) Dosing of CRRT Anticoagulation Drug dosing and RRT Kidney transplantation – critical care considerations Conclusion References Chapter 25 Endocrine critical care Introduction Thyroid and parathyroid glands Thyroid gland Disorders of the thyroid gland Hypothyroidism (myxoedema) Hyperthyroidism (thyrotoxicosis) Thyroid crisis Parathyroid glands Disorders of the parathyroid glands Hypercalcaemia Hypocalcaemia Pituitary gland Disorders of the pituitary gland Syndrome of inappropriate antidiuretic hormone secretion Diabetes insipidus Pathophysiology Pancreas Hyperglycaemia in the critically ill Diabetic emergencies Diabetic ketoacidosis Management Hyperosmolar, hyperglycaemic states (HHS) Hypoglycaemia Pathophysiology Adrenals Disorders of the adrenal glands Conclusion References Chapter 26 Haematological and immunological critical care Introduction Normal physiology Blood components Plasma Red blood cells White blood cells Platelets Haematopoiesis Disorders of erythrocytes B12 vitamin deficiency Sickle cell anaemia Genetic haemochromatosis Haemostasis Lymphoma Hodgkin lymphoma Non-Hodgkin lymphoma Disseminated intravascular coagulation Pathophysiology of DIC Signs and symptoms of DIC Diagnosis of DIC Care and treatment of DIC Thrombocytopenia Neutropenia and sepsis Neutropenia Sepsis Vasculitis Blood transfusions in adults Blood sample collections Blood groups Compatibility Indications for blood transfusions Red blood cells Platelets Fresh frozen plasma (FFP) Cryoprecipitate Granulocytes Procedural safety Pre-procedure and sampling Administration of the blood product Post-procedural care Traceability Patient information Alternatives to blood transfusions Summary of SaBTO recommendations on consent Conclusion References Chapter 27 Musculoskeletal considerations in critical care Introduction Trauma Mechanism of injury Musculoskeletal injury Pelvic injury Chest trauma Management of traumatic injury External fixation Surgical fixation Conservative management Intensive care unit-acquired weakness Pathophysiology Muscle protein homeostasis Skeletal muscle inflammation and structural disorganisation Bioenergetic disturbance Disuse atrophy Axonal degeneration Clinical presentation Diagnosis and assessment of ICUAW Assessment of musculoskeletal impairment or injury Joint range of motion Muscle power Pain Neurovascular assessment Management of musculoskeletal injury and impairment Joint positioning and passive movements Early mobilisation Physiological assessment for mobilisation Disability Measuring mobility and function Conclusion References Chapter 28 Burn care within a criticalcare setting Introduction Classification of burn wound depths Erythema Superficial dermal (or superficial partial thickness) Deep dermal (or deep partial thickness) Full thickness Pathological considerations Burn size estimation An ABCDE approach to burn care Airway Breathing Cardiovascular Disability (neurological assessment) Exposure (and everything else) Psychological support Acknowledgement References Chapter 29 Maternal critical care Introduction Epidemiology Adapted physiology Cardiovascular system Respiratory system Renal system Liver and gastro-intestinal system Immune system The placenta Recognising clinical deterioration Assessment of fetal wellbeing Nursing considerations and recommendations for practice Supporting breastfeeding Supporting the maternal-infant bond Psycho-social considerations Conclusion References Chapter 30 Critical care transfers Inter-hospital and intra-hospital patient transfers Transfer of the critically ill adult Critical care bed and repatriation The risks of critical care transfer Preparation for transfer ABCDE process during critical care transfer Airway Breathing Circulation Disability Exposure Conclusion References Chapter 31 Rehabilitation after critical illness Introduction The impact of critical illness – what do we mean by morbidity? Physical Psychological Cognitive Describing physical functioning and morbidity The World Health Organization (WHO) International Classification of Functioning, Disability and Health (ICF) Biopsychosocial description of functioning Models of post-critical care morbidity Assessment Goals Key timepoints in RaCI Treatment Early mobilisation Psychological interventions Cognitive interventions National guidelines and standards Conclusion Disclaimer References Chapter 32 Dying and death Introduction End-of-life care Palliative care Dying Recognising Dying Advance care planning Involve and support Nursing the dying patient The critical care environment Symptom management End-of-life care discharges from a critical care setting Care after death Conclusion References Index EULA "The education of student nurses in critical care is becoming an increasing challenge at this time of financial pressures in the National Health Service. The shortage of critical care nurses has encouraged many Intensive Care Units (ICUs) to employ newly qualified staff, highlighting the importance of preregistration education in ensuring that these staff are equipped with the skills to care for acutely ill patients. Significant numbers of critically ill patients are being managed outside specialist critical care facilities. It is therefore essential to ensure that graduating nurses are equipped with the knowledge and skills needed to assess and manage critically ill patients, regardless of their location within the health care setting. Despite this, concerns have been raised that nurses lacked the skills and knowledge to recognize and manage these situations. It was subsequently recommended that student nurses should develop skills to identify and manage acutely ill patients. Despite this, concern still remains over the ability to recognize and manage deteriorating patients in both students (Cooper et al., 2010) and registered nurses (Cooper et al., 2011). Nursing education providers need to anticipate, plan and respond to these changing needs and expectations"-- Provided by publisher