Rapid Adult Nursing (eBook)

Andrée Le May (Autor)

eBook Download: EPUB

2016
John Wiley & Sons (Verlag)
978-1-119-11713-1 (ISBN)

Infos

Rapid Adult Nursing is an essential read for all adult nursing students, as well as a refresher for qualified adult nurses, and a 'dip into text' for other healthcare professionals.  Designed for quick reference, it maps on to the essential clinical skills and knowledge required for pre-registration adult nurses, and captures the essentials of adult nursing care in an easy to read, and highly accessible format.

Covering all the key topics in adult nursing, this concise and easy-to-read title is the perfect quick-reference book for student adult nurses.

Andrée le May is Emeritus Professor of Nursing at the University of Southampton, UK.

Inhalt

Introduction viii

Acknowledgements ix

Part 1: Fundamentals of Nursing Care

Adult nursing 3

Assessment and monitoring 4

Audit 5

Communication 6

Continuing professional development 7

Dignity 8

Discharge planning 9

Documentation 10

Eating and drinking 11

Evaluation 12

Evidence-based practice 13

Fundamentals of nursing care 14

Health education and promotion 15

Infection prevention and control 16

Leadership 17

Management 18

Medicines management 19

Moving and positioning 20

Practice development 21

Quality improvement 22

Research 23

Risk assessment and management 24

Teamwork 25

Wound management 26

Part 2: Conditions

Acute coronary syndromes 29

Acute renal failure 31

Anaemias 32

Aneurysms 33

Angina 34

Appendicitis 35

Arrhythmias 36

Asthma 37

Breast lumps 38

Breathlessness 39

Cancer 40

Cardiovascular disorders 41

Cataracts 42

Cholecystitis 43

Chronic obstructive pulmonary disease 44

Chronic renal failure 45

Cirrhosis 46

Coagulation disorders 47

Constipation 48

Coronary heart disease 49

Crohn's disease 50

Dementias 51

Diabetes mellitus 52

Diarrhoea 53

Diverticular disease 54

Eczema 55

Encephalitis 56

Endocrine disorders 57

End-of-life care 58

Epilepsy 59

Fractures 60

Gallstone disease 61

Gastritis 62

Gastroenteritis 63

Gastro-oesophageal reflux disease 64

Glaucoma 65

Glomerulonephritis 66

Gout 67

Haemorrhoids 68

Hearing loss 69

Heart failure 70

Hepatitis 71

HIV 72

Hypertension 73

Hysterectomy 74

Immunodeficiency 75

Incontinence 76

Jaundice 77

Leukaemias 78

Life support: advanced adult 79

Life support: basic adult 80

Lymphomas 81

Macular degeneration 82

Meningitis 83

Multiple sclerosis 84

Myopathies 85

Nausea and vomiting 86

Neutropenia 87

Osteoarthritis 88

Osteomyelitis 89

Osteoporosis 90

Pain and discomfort 91

Pancreatitis 92

Parkinson's disease 93

Peptic ulceration 94

Peripheral vascular disease 95

Platelet disorders 96

Pneumonia 97

Post-operative care 98

Pre- and intra-operative care 99

Prostate gland disorders 100

Psoriasis 101

Raised intracranial pressure 102

Respiratory failure 103

Rheumatoid arthritis 104

Sepsis 105

Shock 106

Spinal cord compression 107

Tension pneumothorax 108

Tinnitus 109

Tuberculosis 110

Ulcerative colitis 111

Urethritis 112

Urinary calculi 113

Urinary retention 114

Urinary tract infections 115

Vaginal discharge 116

Valve disease 117

Vascular disorders of the brain 118

Venous thromboembolism 119

References and Websites 120

Index 121

Textauszug

A

Acute coronary syndromes

Definition

Unstable angina (UA) and heart attacks (myocardial infarctions, MI) are referred to as acute coronary syndromes (ACS) and are medical emergencies.

Their common pathology is sudden total/near total blockage of a coronary vessel, usually due to atherosclerotic plaque rupture leading to an intracoronary thrombus. The blockage may be episodic or transient (UA) or complete, resulting in reduced blood flow or complete blockage and the death of some of the myocardium (MI). Presentation and treatment depend on where the blockage is and whether it is complete or partial. MI are managed according to their type – ST elevation myocardial infarctions (STEMI) or non‐ST segment elevation myocardial infarctions (NSTEMI). STEMI shows sustained elevation of the ST segments of the ECG, indicating a large area of myocardium death. Troponins are elevated (troponins are proteins found in heart muscle and damage causes specific troponins to leak out into the bloodstream). NSTEMI causes less myocardial damage so may not cause ST elevation, but elevated troponins are present. There may be other ECG changes, such as ST depression or T‐wave inversion.

UA manifests as ACS symptoms, but there is no ST elevation/raised troponins. UA results in ischaemia, but no destruction of myocardium.

Diagnosis and investigations

Diagnosis is made by examination, history taking, 12‐lead ECGs to identify STEMI/NSTEMI/UA, and blood tests to assess myocardial damage (e.g. troponins T and I).

Common signs and symptoms

Pain usually at rest; unrelieved by nitrovasodilators; continuous and lasts longer than 15 minutes; described as crushing, tight or constricting; may radiate to arms and neck (may be described in the stomach area); sometimes no pain at all. Fear. Pallor and/or sweaty or clammy skin; cyanosis. Sometimes shortness of breath; nausea and vomiting; altered level of consciousness. Change in heart rate (usually tachycardia), rhythm and blood pressure (BP).

Treatment

In the acute phase management focuses on symptom control (pain relief usually with diamorphine, antiemetics to reduce nausea and oxygen if hypoxic), improving blood flow to the heart and reducing demand for oxygen by rest and drug therapy.

STEMI treatment focuses on reperfusion/revascularisation, either pharmacological (thrombolysis) or by percutaneous coronary intervention (PCI) – balloon catheter passed into coronary artery, balloon inflated to open narrowed vessel, stent inserted.

NSTEMI and UA are treated pharmacologically, for instance by antiplatelet therapy (e.g. aspirin), antithrombin therapy (e.g. low molecular weight heparin). Beta‐blockers and nitrates are used if needed.

Both conditions can progress to STEMI.

Following the acute phase attention focuses on education, rehabilitation, secondary prevention (e.g. long‐term aspirin, statin use) and cardiac interventions (e.g. revascularisation).

Nursing care

Providing highly skilled nursing care for people with MI is critical to their recovery. Many different nurses may be involved in a person’s care pathway, depending on where the patient presents with symptoms. Immediate care will focus on assessing pain levels, nausea and anxiety, giving medications/oxygen as prescribed, and monitoring and reporting the person’s condition (e.g. alterations in heart rate, fall in blood pressure, decreasing blood oxygen saturation, restlessness, breathlessness, falling pulse pressure). Reassuring communication with an explanation of interventions, equipment and plans will reduce anxiety. As recovery progresses, discuss with the patient suitable activity levels and monitor the effects of resumption of activity. Nurses may also be responsible for ongoing monitoring and health education and promotion once the patient is discharged from hospital.

Acute renal failure

Definition

Acute renal failure is a syndrome characterised by rapid decline (days to weeks) in glomerular filtration rate (GFR). This results in an accumulation of nitrogenous waste and problems regulating extracellular volume and electrolytes. Urine output may be reduced (oliguria) or non‐existent (anuria).

The kidneys comprise three parts: the renal cortex, the renal medulla and the renal pelvis. Kidneys primarily separate waste and excess water from blood and convert this filtrate into urine (filtration, selective reabsorption and secretion). Filtration occurs in the glomeruli (glomerular filtration). The glomeruli filter around 7 L of fluid/hour producing 50–100 ml of urine. Substances needed to maintain acid base and fluid balance are reabsorbed from the filtrate by osmosis, diffusion and active transportation. Ions, creatinine, urea and some hormones are secreted. Urine is stored in the bladder until it leaves the body via the urethra. Antidiuretic hormone (ADH) regulates the amount of urine passed.

The kidneys also have an endocrine function synthesising hormones. Renin and angiotensin regulate sodium and fluid retention and the expansion and contraction of blood vessels, and have a role in BP control. Renin controls the glomerular blood flow and filtration rate.

Acute renal failure results from a variety of causes (pre‐renal, renal and post‐renal). Pre‐renal causes largely relate to hypo‐perfusion of the kidneys. This mainly stems from other system failures, for instance cardiovascular. Renal causes result from diseases affecting the kidney. Post‐renal causes are associated with urinary tract obstructions. Disruption to the functioning of the kidneys will affect many bodily functions and systems.

Diagnosis and investigations

Patients with acute renal failure may present with a range of signs and symptoms, including oliguria/anuria, nausea/vomiting, malaise, hypertension, peripheral oedema, breathlessness (pulmonary oedema/metabolic acidosis), pericarditis, encephalopathy and hyperkalaemia. Investigations will include urinalysis, kidney function and blood tests.

Treatment

Treatment focuses on ensuring adequate oxygenation and circulation, and management of the presenting symptoms and the underlying causes. Dialysis (renal replacement therapy) may be required. Acute renal failure may be reversible.

Nursing care

Restoring and maintaining homeostasis are central aspects of care. This will involve careful monitoring of fluid balance and skilled observation of the patient’s condition for deterioration (or improvement). Focus on:

• Urinalysis (look for protein, blood, cells and casts).
• Fluid balance: intake and output measurement (over‐ or under‐hydration).
• Oxygen saturation and respiratory rate.
• Oxygen administration, recording and monitoring.
• Alterations in heart rate, rhythm and blood pressure.
• ECG: cardiac arrhythmias due to hyperkalaemia.
• Alteration in level of consciousness.
• Nutritional status/hydration (enteral/parenteral feeding may be needed).
• Signs of oedema in peripheral tissues due to fluid and electrolyte disruption.
• Compromised skin (oedema, waterlogged tissues at risk of infection).
• Signs of infection (redness around IVI sites, pyrexia).

Acute renal failure can be very frightening, so accurate, explanatory and empathic communication is essential.

Anaemias

Definition

WHO (http://www.who.int/nutrition/publications/micronutrients/global_prevalence_anaemia_2011/en/) defined anaemia as less than 12 g/dL Hb for non‐pregnant women, less than 11 g/dL Hb for pregnant women and less than 13 g/dL Hb for men. Haemoglobin (Hb) levels normally vary between individuals. Women tend to have lower levels than men. There are various types of anaemia (e.g. iron‐deficiency anaemia, thalassaemia, aplastic anaemia, pernicious anaemia and haemolytic anaemia).

Anaemia occurs because there are insufficient/poorly functioning red blood cells (RBC) or there is a reduction in haemoglobin in each RBC. Reduced haemoglobin means that RBC carry less oxygen. Anaemias are usually classified according to RBC size – microcytic/hypochromic (small red blood cells with less haemoglobin than normal); normochromic/normocytic (normal haemoglobin, normal‐sized red blood cells); or macrocytic (red blood cells are larger than normal).

Anaemias are caused by different illnesses/deficiencies. Iron deficiency is the most common cause of anaemia in the world. Iron‐deficiency anaemia may occur because of blood loss (e.g. through menstruation, gastro‐intestinal [GI] bleeding), an iron‐deficient diet, pregnancy, poor absorption of iron (e.g. coeliac disease) or hookworm infection. In pernicious anaemia vitamin B12 cannot be absorbed. Antibodies are formed against intrinsic factor (IF) or against the cells in the stomach that make IF, which stops IF from attaching to vitamin B12 and prevents its absorption. Thalassaemia is a genetic condition that affects the alpha or beta chains of haemoglobin. Consequently there is insufficient normal haemoglobin and the red blood cells break down easily. Thalassaemia is part of the group of haemolytic...

Produkt-Details

• Erscheint lt. Verlag: 12.10.2016
• Reihe/Serie: Rapid
• Reihe/Serie: Rapid
• Reihe/Serie: Rapid
• Sprache: englisch
• Themenwelt: Medizin / Pharmazie ► Pflege
• Schlagworte: Care • Communication • Compassion • disorders • documentation • Einführungen in die Krankenpflege • Einführungen in die Krankenpflege • General Clinical Nursing • Introductions to Nursing • Klinische Krankenpflege • Krankenpflege • leadership</p> • <p>adult • Management • nursing • Risk • sympton
• ISBN-10: 1-119-11713-5 / 1119117135
• ISBN-13: 978-1-119-11713-1 / 9781119117131