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

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