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Tabbner’s Nursing Care: Theory and Practice 6e by Koutoukidis, Stainton and Hughson

Tabbner’s Nursing Care: Theory and Practice 6e by Koutoukidis, Stainton and Hughson



Now in its sixth edition, Tabbner’s Nursing Care: Theory and Practice continues to meet the needs of Diploma of Nursing students. ...

Now in its sixth edition, Tabbner’s Nursing Care: Theory and Practice continues to meet the needs of Diploma of Nursing students.
Featuring a fresh approach and significantly revised content, this new edition of the popular nursing textbook reflects the current issues and scope of practice for all enrolled nurses, including recent regulations changes under National Registration.
Procedural Guidelines are highlighted throughout this sixth edition of Tabbner’s Nursing Care: Theory and Practice. The text incorporates a ‘lifespan approach’ and features four new chapters highlighting contemporary nursing issues – Leadership and Management; Older Adulthood; Acute Care and Rural and Remote Care.

The Australian and New Zealand team of editors and contributors have ensured a holistic, person-centred approach to client care, allowing students to appreciate the skill and scope required to be a competent enrolled nurse. They have also strengthened the text’s critical thinking and problem solving elements for students, with review questions, clinical interest boxes and case studies for reflection and deeper learning.



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    Tabbner’s Nursing Care: Theory and Practice 6e by Koutoukidis, Stainton and Hughson Tabbner’s Nursing Care: Theory and Practice 6e by Koutoukidis, Stainton and Hughson Document Transcript

    • Tabbner’sNursing Care Theory and Practice 6TH EDITION Gabrielle Koutoukidis Kate Stainton Jodie Hughson sample proofs © Elsevier Australia
    • Tabbner’sNursing Care Theory and Practice 6TH EDITION Gabrielle Koutoukidis Dip App Sci (Nurs), BNurs (Mid), Adv Dip Nurs (Ed), MPH, Dip Business, Voc Grad Cert Business (Transformational Management), MRCNAHead of Strategic & Business Development, Faculty of Health Science & Community Studies, Holmesglen Institute, Melbourne, Victoria Kate Stainton Dip App Sci (Nurs), BN (Mid), Grad Dip Nurs (Education), MA Hlth Sc (Nurs)Clinical Nurse Specialist, Newcastle Private Hospital, Newcastle, New South Wales Jodie Hughson MPH, Grad Cert Health Promotion, RN Community Services Manager, Metro South, Anglicare Southern Queensland, Queensland sample proofs © Elsevier Australia
    • Sydney, Edinburgh, London, New York, St Louis, TorontoChurchill Livingstoneis an imprint of ElsevierElsevier Australia. ACN 001 002 357(a division of Reed International Books Australia Pty Ltd)Tower 1, 475 Victoria Avenue, Chatswood, NSW 2067This edition © 2013 Elsevier Australia5th edition 2009. 4th edition 2005. 3rd edition 1997. 2nd edition 1991. 1st edition 1981.This publication is copyright. Except as expressly provided in the Copyright Act 1968and the Copyright Amendment (Digital Agenda) Act 2000, no part of this publicationmay be reproduced, stored in any retrieval system or transmitted by any means (includingelectronic, mechanical, microcopying, photocopying, recording or otherwise) without priorwritten permission from the publisher.Every attempt has been made to trace and acknowledge copyright, but in some cases thismay not have been possible. The publisher apologises for any accidental infringementand would welcome any information to redress the situation.This publication has been carefully reviewed and checked to ensure that the content is asaccurate and current as possible at time of publication. We would recommend, however, thatthe reader verify any procedures, treatments, drug dosages or legal content described in thisbook. Neither the author, the contributors, nor the publisher assume any liability for injuryand/or damage to persons or property arising from any error in or omission from this publication.National Library of Australia Cataloguing-in-Publication Data______________________________________________________________________________Koutoukidis, Gabrielle.Tabbner’s nursing care : theory and practice / Gabrielle Koutoukidis ; Kate Stainton ; Jodie Hughson.6th ed.9780729541145 (pbk.) Includes index. Nursing – Textbooks.Stainton, Kate.Hughson, Jodie.610.73______________________________________________________________________________Publisher: Libby HoustonDevelopmental Editors: Elizabeth Coady and Jane CoulcherProject Coordinator: Natalie HamadEdited by Sybil KestevenProofread by Tim LearnerPicture research by Karen ForsytheIllustrators: Trina McDonald and Rod McLeanCover and internal design by George CreativeIndex by Robert SwansonTypeset by Midland Typesetters, AustraliaPrinted in China by China Translation and Printing Services sample proofs © Elsevier Australia
    • vContentsContributors xi Chapter 5 Health promotion, educationReviewers xiii and wellness Marguerite Hoiby and Kate Stainton 77Foreword xv Concepts of health and wellness 78Publisher’s dedication xvi Models of health and wellness 79Preface xvii Variables influencing health beliefs and practices 80Acknowledgments xviii Impact of acute and chronic illness on client and family 84Text features xx Health promotion 85Unit 1 The evolution of the nursing Prerequisites for health 86profession Goals and targets for Australia’s and New Zealand’s health in the 21st century 88Chapter 1 Nursing: Historical, present and The role of the nurse in health promotion 89future perspectives Jodie Hughson 3 The nursing process in health promotion and healthWhat is nursing? 4 education 92Nursing—the profession 13 Chapter 6 Communication Jodie Hughson 97Influences on nursing 19 Components of the communication process 98Chapter 2 Legal and ethical aspects of Levels of communication 98nursing care Kalpana Raghunathan 22 Elements of the communication process 99Introduction 23 Factors that influence the communication process 100Legal aspects of nursing practice 23 Forms of communication 103Areas of legal liability in nursing 26 Assertiveness to enhance communication 106Legal issues in the nursing specialties 32 Therapeutic communication 107Ethical aspects of nursing 34 Skills to facilitate therapeutic communication 107Chapter 3 Nursing research Leah East 41 Communicating with children, adolescents andNursing research 42 older adults 111Evidence-based practice 42 Communicating with clients’ relatives, friends andResearch methods 44 significant others 112The research process 45 Barriers that interfere with therapeuticProposal writing for research approval 51 communication 113How is research utilised in practice? 55 Culturally safe communication 114The enrolled nurse and nursing research 56 Clients with special requirements 115 Complications in nurse–client relationships 120Unit 2 The contemporary healthcare Communication within the healthcare team 122environment Chapter 7 Leadership and managementChapter 4 Systems of healthcare delivery Gabrielle Koutoukidis 127Goetz Ottman 61 The nurse as a leader and manager 128Introduction 62 Models of nursing care delivery 128Components of a healthcare system 62 Leadership styles 129 sample proofs © Elsevier Australia
    • vi ContentsContemporary leadership theories 131 Child health services 194Management 132 Needs of infants and children 196The nurse as a delegator 134 Chapter 11 Growth and development:Preparing nurse leaders for the future 135 Late childhood through to adolescence Margaret Webb 199Unit 3 Health beliefs, cultural Preadolescence 200diversity and safety Growth and development of the preadolescent 200Chapter 8 Cultural diversity in Australia Adolescence 201and New Zealand Robyn Williams 141 Growth and development of the adolescent 201Introduction 142 Issues in adolescence 208What is culture? 142 Cultural diversity 210Culture and wellbeing 146 Health risks 211Effective communication 149 Health promotion 213Culture, the individual and their profession 150 Nursing implications 213Cultural diversity and clients’ experiences of the Chapter 12 Growth and development system 152 from the younger adult through to theCulture in practice 154 older adult Christine Baker 217Chapter 9 Indigenous health Robyn Williams 159 Emerging adulthood 218Overview 161 Growth and development in early adulthood 218Indigenous health before colonisation 162 Health risks/problems 220Indigenous health after colonisation 163 Growth and development in middle-aged adults 223Social determinants of Indigenous health 164 Health risks/problems 225Indigenous health and the living environment 164 Cultural diversity 226Major government responses to Indigenous health Health promotion 227 challenges 165 Implementing the nursing process 227Indigenous health, capacity and resilience 168 Chapter 13 Older adulthood Carol Barbeler 230 Ageism 231Unit 4 Nursing care throughout the Growth and development 232life span Health risks/problems 236 Cultural aspects of ageing 240Chapter 10 Theories of growth and Health assessment and promotion 241development: Conception through to latechildhood Andree Gamble 173 Care settings 241Conception 174 Nursing care of the ageing person 244Development of the placenta, membranes, liquor Implementing the nursing process 244 and cord 174Intrauterine development and growth 176 Unit 5 Critical thinking and reflectiveTransition to extrauterine life 177 practiceTheories of development 178 Chapter 14 Critical thinking, problem-Growth and development 180 based learning and reflective practiceGrowth and development of the infant 182 Valerie Zielinski 251Health risks/problems 185 Introduction 252Growth and development of the child 185 Critical thinking 252Health risks/problems 190 Problem-based learning 253Factors influencing growth and development 191 Reflective practice 254Cultural diversity 193 Chapter 15 Components of the nursingHealth promotion 193 process Gillianne Meek 259Paediatric nursing care 194 An overview of the nursing process 260 sample proofs © Elsevier Australia
    • Contents viiChapter 16 Documentation and reporting Chapter 21 Hygiene and comfort Carmel Duff 393skills Cindy Stainton 270 Factors affecting personal hygiene 394Purpose of documentation 271 Skin and skin care 394Legal and ethical considerations 272 Bathing and showering 396Documentation guidelines and principles 272 Hair care 403Reporting 279 Eye, ear and nasal care 405 Mouth care 407Unit 6 Health assessment Nail care 409 Hygiene summary 410Chapter 17 General health assessment Promoting comfort 410Shyamala Munusamy 287 Bed making 413Guidelines for conducting a general health Comfortable positioning 419 assessment 288Assessment techniques 295 Chapter 22 Medications Adriana Tiziani 425Routine shift assessment 297 Pharmacology 426Diagnostic investigations 298 Pharmacokinetics 429Recording and reporting 298 Pharmacodynamics 432Teaching considerations 298 Nursing care and administration of medications 433Clinical handover 298 Systems of measurement 441Advance health directives 299 Administering medications 445 Monitoring the effects of medications 461Chapter 18 Vital signs Amy Dearsley 301 Safe handling of hazardous substances 461Guidelines for taking vital signs 302 Safe storage, administration and disposal ofBody temperature 302 medications 465Steps in obtaining an accurate measurement of Medications and the older adult 465 body temperature 306 Continuation of medication after discharge 465Pulse 311Respiration 315 Unit 8 Health promotion andPulse oximetry—measuring oxygen saturation 319 psychosocial and physiologicalBlood pressure 320 nursing careChapter 19 Admission, transfer and Chapter 23 Oxygenation Kylie Porritt 473discharge processes Louise Alexander 332 Structure of the respiratory system 474Types of admission 333 Scientific principles of ventilation and respiration 478Reactions to admission 333 Structure of the cardiovascular system 481The admission process 337 Circulation of blood 489Admitting the client to the mental health unit 340 Structure of the lymphatic system 490Admitting a child to a healthcare facility 340 Factors affecting the respiratory system 492Admitting an adolescent to a healthcare facility 343 Pathophysiology related to the respiratory system 494Discharge planning 343 Specific disorders of the respiratory system 495 Factors affecting the cardiovascular system 497 Pathophysiology related to the circulatory system 499Unit 7 Basic healthcare needs Specific disorders of the circulatory system 501Chapter 20 Infection prevention and control Diagnostic tests 504Teresa Lewis 359 Cardiovascular diagnostic tests 505Healthcare-associated infection is preventable 360 Nursing a client with a respiratory and/or cardiacNature of infection 360 system disorder 509Microorganisms 361 The client with an artificial airway 518Infection prevention and control in practice 368 Nursing a client with an artificial airway 519 sample proofs © Elsevier Australia
    • viii ContentsThe client with thoracic drainage tubes 521 Pathophysiological effects and major manifestationsNursing a client with a chest drain 523 of skin disorders 607Nursing practice and oxygen administration 524 Specific disorders of the skin 609 Care of the individual with a skin disorder 612Chapter 24 Meeting fluid and electrolyte Pressure injuries 613needs Katie Piper 533 Leg ulcers 623Homeostasis 534 Burn injuries 626Fluid balance 538 Surgical wounds 634Electrolyte imbalances 541Nursing assessment of client with fluid and/or Chapter 28 Nutrition Lucinda Brown 643 electrolyte needs 542 Nutrition overview 644Intravenous therapy 546 Nutrition assessment 645Understanding acid–base balance 551 Nutrients 650 Diets to meet client needs 651Chapter 25 Rest and sleep Carol Barbeler 555 Nursing practice and nutritional needs 655Physiology of sleep 556 Common disorders associated with nutrition 659Sleep disorders 559 Chapter 29 Urinary elimination Susan Brown 670Factors leading to sleep disturbances 561 The urinary system 671Assessing sleep patterns 561 Alterations in urinary system functioning 673Sleep-promotion measures 563 Manifestations of urinary system disorders 673Chapter 26 Movement and exercise Changes to voiding patterns 674Susan Lanyon 568 Specific disorders of the urinary system 680The physiology of movement 569 Incontinence 682Body mechanics 570 Catheters 685Disease processes that influence body mechanics 570 Specialist urology nursing activities 689Development of movement and exercise through Chapter 30 Bowel elimination Susan Brown 696 the life span 572 The digestive system 697Overweight and obesity in Australia and Disorders of the digestive system 707 New Zealand 574 Chapter 31 Pain managementThe benefits of physical activity 574 Yangama Jokwiro 718Principles of muscle movement in exercise 576 Fundamentals of pain 719Assessment of movement, mobility and the Pain management across the life span 720 musculoskeletal system 578 Nursing interventions for a client experiencing pain 727Diagnosis of a musculoskeletal disorder 581Nursing care of the individual with a Chapter 32 Sensory abilities musculoskeletal disorder 581 Suzanne McArthur 736Treatment of bone injuries and musculoskeletal Classification of sense organs 737 disorders 582 The eye 739General treatment of musculoskeletal disorders 583 The ear 741Ambulation after prolonged immobilisation 585 Disorders of the eye 744Walking aids 586 Specific disorders of the eye 748Complications associated with reduced mobility 588 Disorders of the ear 755 Chapter 33 Neurological healthChapter 27 Skin integrity and wound care Fiona Skene and Gabrielle Koutoukidis 762Greer Hosking 594 The function and structure of the neurologicalThe integumentary system 595 system 763Wound healing 597 Pathophysiological influences and effects ofTypes of wounds 598 disorders of the nervous system 768Wound management 599 Assessing neurological status 771 sample proofs © Elsevier Australia
    • Contents ixDiagnostic tests 774 Philosophy of rehabilitation 918Specific disorders of the nervous system 777 Adjustment to disability 919Care of the client with a nervous system disorder 786 The rehabilitation team 920Care of the unconscious client 790 The process of rehabilitation 924Chapter 34 Endocrine health John Elias 802 Planning and implementation 926Structure and function of the endocrine system 803 Culturally relevant care 928Endocrine disorders 808 Chapter 39 Behavioural and social aspectsCare of the client with an endocrine disorder 821 of disability Trevor Skerry 931Chapter 35 Reproductive health Definitions of disability 932Christine Baker 831 Conceptual models of disability 933The male reproductive system 832 Classifications of disability 933Disorders of the male reproductive system 833 Historical background 934Nursing interventions in male reproductive health 839 The philosophy of inclusion and normalisation 935The female reproductive system 839 Responses to disability 938Disorders of the female reproductive system 840 Person-centred planning 939Assessment and diagnostic tests 847 Family caregiving—impact and support 942Women’s health promotion 849 Health promotion: disability prevention 944Contraception 850 Chapter 40 Acute care Michelle Hall 948Disorders of reproduction 853 Scope of practice 949Sexual abuse 854 Where is acute care delivered? 949Survivors of torture and trauma 854 Impact of acute illness 950Child sexual abuse 855 Acute disorders 951Sexually transmitted infections 855 Clinical pathways 959 Chapter 41 Perioperative nursingUnit 9 Healthcare in specialised Karen Stilo 963practice areas Perioperative care 964Chapter 36 Palliative care Jacqui Allen 863 Surgery 964Death and dying 864 Preoperative care 967Palliative care 865 Intraoperative phase 974Person- and family-centred palliative care 866 Postoperative care 979Multidisciplinary palliative care 866 Chapter 42 Emergency careSymptom management 867 Jennifer Jennings 991Loss and grief 871 Introduction 992Care of the dying 871 Recognising and responding to an emergency 993Care of the bereaved 873 Changes in vital signs 994Support for the nurse 874 Basic life support 996Chapter 37 Mental health Finbar Hopkins 876 Applying the principles of emergency care 996Concepts of mental health and mental illness 877 Defibrillation with the automated externalThe provision of care 886 defibrillator 999Historical perspectives and mental healthcare 890 Post-resuscitation care 1000Care of clients with specific emotional or In hospital code documentation 1001 behavioural challenges 893 Staff debriefing 1002Legal and ethical aspects of mental health nursing 910 Managing specific emergency situations 1002Ethical issues and dilemmas 911 Cardiac emergencies 1003Chapter 38 Rehabilitation nursing Chapter 43 Maternal and newborn careKate Stainton 916 Kate Stainton 1008Aims and characteristics of rehabilitation 917 Pregnancy 1009 sample proofs © Elsevier Australia
    • x ContentsPrenatal care and preparation 1012 Remote and rural Australia 1041Labour 1013 Health and illness patterns in rural and remotePostnatal care 1017 Australia 1042 Remote area and rural nursing 1044Chapter 44 Community-based careAnne Moates 1030 Effective healthcare service delivery in remote settings 1044Community healthcare 1031 Stress related to working in a remote health context 1047Community health nurse role 1033 Access to health services in rural and remote areas 1050Models of care in community health 1034Issues for community health nurses in home care 1035 Credits 1054The nursing process and community nursing 1036 Index 1061Chapter 45 Rural and remote careRobyn Williams and Gabrielle Koutoukidis 1040Introduction 1041 sample proofs © Elsevier Australia
    • xiContributorsThe publisher and editors would like to thank all past and Andree Gamble RN, BN, Postgrad Dip Adv Clin Nurspresent contributors and reviewers. (Child Health), Postgrad Cert Prof Educ & Training, Grad Cert Clin Simulation, M Nurs Sci, Cert IV TAA, Dip BusLouise Alexander BNur, Postgrad Cert (Psych Nurs), Lecturer, Bachelor of Nursing, Holmesglen, Melbourne,PGC (Education), MEd (PET) Victoria, AustraliaLecturer, Bachelor of Nursing (Mental Health),Holmesglen Institute, Victoria, Australia Michelle Hall BN, Grad Cert (Health Prof Ed), Cert IV (TAE)Jacqui Allen RN, BA (Hons), MPsych Teacher, Nursing, Health Science and BiotechnologyLecturer in Nursing, Deakin University, Victoria, Australia Department, Holmesglen, Melbourne, VictoriaChristine Baker MNsg, Grad Dip Ad & Voc Ed, Marguerite Hoiby RSCN, RN, Cert Spinal Injuries &BHlthSc, Dip VET, Cert IV TAE, Cert Sexual Health, Rehab Nursing, Cert Op Room Nursing, Grad Dip EducMRNCA Admin, Grad Dip BusSenior Educator, Nursing Programs, Swinburne University, Quality & Risk Manager, Linacre Private Hospital,Victoria, Australia Victoria, Australia Lead Auditor Quality Management Systems (ISO) &Carol Barbeler RN, BNur (Post-reg), M Appl Gerontol, Reproductive Technology Accreditation CommitteeDip Training & Assessment (RTAC)Educator, Nursing and Aged Care, GippsTAFE, Victoria, British Standards International Aged Care AssessorAustralia Aged Care Accreditation Standards & Accreditation Australian Sessional Trainer, Skills Training Australia, Knox,Lucinda Brown RN, MPH, Grad Dip Health Sci Victoria, AustraliaLecturer, Deakin University, School of Nursing andMidwifery, Victoria, Australia Finbar Hopkins RN, RMN, RM, BA Sciences (Nurs), Grad Dip (Women’s Health), MASue Brown BHlthSc, MHlthSc, GCert (TT) (Vic), DN Lecturer in Nursing, University of Melbourne, Victoria,(La Trobe), RN AustraliaNurse Consultant: Life in Place Greer Hosking RN, ONC, BEd, Cert IV Training andAmy Dearsley RN/RM AssessmentEducational specialist, Laerdal Australia Jodie Hughson MPH, Grad Cert Health Promotion, RNCarmel Duff RN, Grad Dip Adv Nurs (Education) Community Services Manager, Metro South, AnglicareLecturer in Nursing, Deakin University, Melbourne, Southern Queensland, AustraliaVictoria, Australia Jennifer Jennings RN, BN, Grad Dip (Adv ClinLeah East BN, RN (Hons), PhD Practice), GCHPE, Grad Cert Health Prof Educ, GCCS,School of Nursing and Midwifery, University of Western Grad Cert Clinical SimulationSydney, New South Wales, Australia Yangama Jokwiro BSc (NS), MSc (Physiology)John P Elias BSc (Hons), PhD Bioscience Lecturer, Holmesglen Institute, Melbourne,Human Bioscience Lecturer, Holmesglen Bachelor of Victoria, AustraliaNursing, Melbourne, Victoria, Australia sample proofs © Elsevier Australia
    • xii ContributorsGabrielle Koutoukidis Dip App Sci (Nurs), BNurs (Mid), Curriculum Development, Careers Australia, Victoria,Adv Dip Nurs (Ed), MPH, Dip Business, Voc Grad Cert AustraliaBus (Transformational Management), MRCNAHead of Strategic & Business Development, Faculty of Fiona Skene RN, M Multimedia, MEd, affiliate ofHealth Science & Community Studies, Holmesglen ANNA (Australasian Neuroscience Nurses’ Association)Institute, Melbourne, Victoria, Australia Trevor Skerry MEd, Grad Dip Adult Ed, Grad DipSusan Lanyon RN, CCRN, Grad Dip Midwifery, BT/BA Health Counselling, B Special Ed, Dip TeachingTeacher of Nursing, Holmesglen Institute, Melbourne, Lecturer, School of Health Sciences, RMIT University,Victoria, Australia Victoria, Australia Board Member, Australian Society of IntellectualTeresa Lewis RN, Cert Intensive Care Nurs (Post-reg), Disabilities (ASID)Cert Infect Control Nurs (Post-reg)Infection Prevention and Control Manager, Newcastle Cindy Stainton RN, Crit Care Cert, Postgrad Dip HealthPrivate Hospital, New South Wales, Australia Service Management, MRCNAMember Australasian College of Infection Prevention & Nurse Director, Western Australia Country Health Service,Control (ACIPC) [previously Australian Infection Control Great Southern, Western Australia, AustraliaAssociation (AICA)] Kate Stainton Dip AppSc (Nurs), BN (Mid), Grad DipSuzanne McArthur RN, BEd (La Trobe), Postgrad Dip Nurs (Education), MA Hlth Sc (Nurs)Crit Care Nurs (Austin), Cert IV TAA Clinical Nurse Specialist, Newcastle Private Hospital,Nursing Course Coordinator; Diploma of Nursing, Newcastle, New South Wales, AustraliaAdvance TAFE, Bairnsdale, Victoria, AustraliaMember, Australian Wound Management Association Karen Stilo RN, BN, Grad Cert Perioperative Nursing,Member, Moderation Delivery Committee Certificate Dip TAAIV/Diploma in Nursing, Victoria, Australia Teacher in Diploma of Nursing, Holmesglen Institute, Melbourne, Victoria, AustraliaGillianne Meek RN, BSc (Hons), MNTeam Leader, Waiariki Institute of Technology, Rotorua, Adriana Tiziani BSc, DipEd, MEdSt, RNNew Zealand Course Director, Postgraduate Studies in Wound Care, Monash University, Parkville, VictoriaAnne Moates RN, Midwife, MCHN, M Pub Health, Nursing Teacher, Health Science and BiotechnologyMEd, B AppSci (Nurs), Grad Dip Adv Nurs (Child, Department, Holmesglen Institute, Melbourne, Victoria,Family and Community Nursing), Grad Dip Adv Nurs Australia(Neonatal Intensive Care Nursing), Grad Cert Nurs (Educ)Senior Educator, Health and Nursing, Chisholm Institute, Margaret Webb BNurs, RM, MEd (AWE), Grad DipVictoria, Australia (FTE), AdvDip (Business) Project Manager, Department of Education and Training,Shyamala Munusamy BHSc (Nursing), Adv Dip Nurs Queensland(Neuroscience), Dip Nurs (Singapore), Cert IV TAA Executive Director, MW Projects Queensland, AustraliaGoetz Ottman PhD Robyn Williams BA, RN, Grad Dip Ed, MPETLead Researcher, Uniting Care Community Options/ Course Coordinator, Bachelor Health Science, School ofDeakin University Research Partnership, Victoria, Australia Health, Charles Darwin University, Northern Territory, AustraliaKatie Piper RN, MN, BNLecturer, Holmesglen Institute, Melbourne, Victoria, Valerie Zielinski RN, RM, PhD, BEd, MEd Admin,Australia FRCNA Clinical Coordinator and Teacher (Nursing), FACTSKylie Porritt RN, MNSc, PhD (Future Aged Care Learning Solutions), Geelong, Victoria,Research Fellow, The Joanna Briggs Institute, University of AustraliaAdelaide, South Australia, AustraliaKalpana Raghunathan RN, MHuman Resource Mgt,MDevelopment Studies, BSociology, BN, Dip BusMgt,Dip Community Development sample proofs © Elsevier Australia
    • xiiiReviewersTerri-Jayne Bissell RN, IPN, MN (Adv Clin Ed), BHSc, Ellie Kirov BSc (BiolSc) (Hons), PhDCert (Crit Care), Cert (High Dependency), Cert IV (TAA) Lecturer, School of Natural Sciences, Edith CowanSchool of Nursing, Queensland University of Technology, University, Perth, Western AustraliaBrisbane, Queensland, Australia Lecturer, Health Studies, Perth Institute of Business and Technology, Perth, Western AustraliaDianne Cheeseman Grad Dip Educ (N), BNur, RN,RCHN, Dip BTTM, MRCNA Anoni Morse BA, RN, Paed Cert, AMH CertTeacher, Nursing/Aged Care/Health Studies, Metropolitan Teacher, Health Services North West, TasmanianSouth Institute of TAFE, Brisbane, Queensland, Australia Polytechnic, Tasmania, AustraliaAli Drummond BNSc Teresa Sargent BN, RNIndigenous Nurse Advisor, Nursing and Midwifery Office, Registered Nurse, Wesley Private Hospital, Brisbane,Queensland Health, Queensland, Australia Queensland, AustraliaJeff Harding BAppSc Advanced Nursing (Nurs Ed), Cert Clarissa Spencer RNIV TAA Teacher, Western Institute of TAFE, New South Wales,RNRPL Coordinator AustraliaTeacher, Department of Health Services, Swinburne TAFE,Melbourne, Victoria, Australia Kay Syminton-Foley DipComN, ADN, BN, Postgrad Dip HSc, RNJanet Kerswell Unnasch RN, Grad Dip MH, Cert IV Senior Academic Staff Member, Waikato Institute ofTAA Technology, Hamilton, New ZealandGuest Nursing Lecturer for Institute of Continuing andTESOL Education, The University of Queensland Mandy Williams RN (UK & NZ), MHSc Health Prof Ed(ICTE-UQ) Blended Learning Coordinator, Waiariki Institute of Technology, Rotorua, New Zealand sample proofs © Elsevier Australia
    • xvForewordOver the years the role and function of the enrolled nurse Over the years previous editions of Tabbner’s Nursinghas expanded to become the nurse professional you see Care have been used in many countries to educate thetoday, employed in all healthcare settings across Australia enrolled nurse (however titled). I foresee future generationsand New Zealand. Very different indeed from 1979 when of nurses gaining from this edition a wealth of theNurse ‘Ray’ Tabbner was compelled to sit down to write knowledge, skills and techniques so essential to being athe first Tabbner—Nursing Care: Theory and Practice— professional healthcare provider.replacing the original Handbook for Nursing Aides. As people avail themselves of the content in Tabbner’s The enrolled nurse of the twenty-first century, like Nursing Care sixth edition it will become apparent howtheir registered nurse colleague, is a very different creature much critical thinking has gone into the development offrom their colleague of those bygone days. The differences this edition. All who use this book can only be enlightened.are immense. To start with, today’s enrolled nurse has a It has been developed in a clear and concise manner tosignificantly expanded educational preparation. Over the make it extremely user friendly and easy to assist withyears even the title has evolved from that of ‘nursing aide’ to study. The authors and editors must be thanked for theirtoday’s ‘enrolled nurse’. ‘Enrolled nurse’ is a title protected efforts in doing this. This text will energise and educate theby legislation, as are ‘registered nurse’, ‘midwife’ and ‘nurse enrolled nurse of the future.practitioner’. This legislation is monitored and supported Someone who must be thanked and recognised is Nurseby the Nursing and Midwifery Board of Australia to protect Ray Tabbner. All those years ago she had the courage andthose needing healthcare and health education. foresight to establish the educational journey that enrolled With the course now being delivered at diploma level nursing has since taken, culminating now in this sixthit is necessary to have comprehensive depth to the content edition. It is wonderful to see that her work continues to beand I believe the sixth edition of Tabbner’s Nursing Care recognised in the title of this publication and I thank theis an all-encompassing teaching tool. I see it being used authors, Gabrielle Koutoukidis, Kate Stainton and Jodieboth in the classroom and the workplace for many years to Hughson, for this body of work.come. The content is inclusive of all facets of the life span The sixth edition of Tabbner’s Nursing Care is testimonyin a health and health promotion context in metropolitan, to the journey of the enrolled nurse, past, present andrural and remote settings. The text has been concisely and future.clearly set out to guide the undergraduate nurse and theireducators as they traverse the enrolled nurse course. Maryanne Craker From that solid underpinning the knowledge gained will Presidentsupport those articulating to advanced diploma level, thus National Enrolled Nurse Association of Australiaexpanding the career pathways within enrolled nursing. sample proofs © Elsevier Australia
    • xviPublisher’s dedicationAlice Ray Tabbner In 1975 she was appointed Principal Teacher at25 December 1919–13 December 1994 the Melbourne Nursing Aides School (later renamedRay (as she preferred to be known) Tabbner was born in Melbourne School for Enrolled Nurses), a position sheBirmingham, England. After working in the St John occupied until 1978 when she retired to write. OriginallyAmbulance in World War II where she said she ‘became entitled The Handbook for Nursing Aides, it was laterengrossed in nursing’, she completed her training as a nurse renamed Nursing Care: Theory & Practice, and since thein the 1940s. She moved to Australia in 1948 and worked in publication of the first edition in 1981, it has becomea number of Sydney hospitals before settling in Melbourne. known and loved by generations of nursing students as Ray established a career in nursing education in 1953 simply Tabbner’s.taking on the role of Tutor at the recently established An article published in 1973 in the Melbourne SunMelbourne School of Nursing. In 1954 she successfully described her as being ‘as flighty as your average banker.completed her Sister Tutors Diploma through the College Her dark hair has streaks of steel grey and the creases inof Nursing Australia and remained a Tutor at the school her dazzlingly white nurse’s uniform would slice bread’.until 1961 when she was awarded the Inaugural Nurse However, students from the 1950s to the 1970s rememberScholarship in Geriatrics from Mount Royal Hospital. In her with great fondness and warmth. Ray Tabbner was saidconsequence of receiving this award, Ray was appointed to be very approachable and a welcome relief from manyto the position of Deputy Matron of Geriatric Nursing ‘military style’ nurse educators. She taught everythingat Mount Royal. She later established the Nursing Aides from Anatomy & Physiology to Bandaging and Nursingcourse at the Fairfield Hospital in Melbourne under Care and made a great impression on her students. As onethe leadership of Vivian Bulwinkel, and in 1973 was student from 1955 put it, ‘Everything Miss Tabbner said,appointed Deputy Director Nursing (Education), one of I learned’.three executive positions at the Royal Melbourne Hospital. The Tabbner name has become synonymous with An innovative educator and mentor, Ray Tabbner was Enrolled Nurse/Registered Nurse Division 2 education notone of the first nurses to call for the establishment of ‘Nurse only throughout Australia — the influence of her nameBanks’ in Australia to ensure flexibility in the nursing extends via this publication to New Zealand, the Unitedworkforce for those nurses wishing to pursue family or Kingdom, the Middle East, Africa and the West Indies.other interests while pursuing their chosen profession. She This sixth edition of Tabbner’s Nursing Care is dedicatedwas also a great advocate of ongoing training to ensure to her memory and her contribution to nurse education.nurses could maintain flexibility in their lives and return tonursing with confidence. sample proofs © Elsevier Australia
    • xviiPrefaceThe sixth edition of Tabbner’s Nursing Care is a Sixth edition of Tabbner’s Nursing Caresignificant revision which reflects the scope of practice As a new editorial team, we have ensured a holistic, person-in contemporary enrolled nursing practice while still centred approach to client care throughout the textbook,retaining the strengths of previous editions that have allowing students to appreciate the skill and scope requiredmade it an essential resource for enrolled nursing students to be a competent enrolled nurse. All chapters have beenand their facilitators. completely revised with a focus on critical thinking andThe role of the enrolled nurse problem solving and national registration requirementsThe enrolled nurse is an essential member of the healthcare have been addressed where appropriate.team, providing client-centred nursing care which includes Four new chapters have been included to highlight arecognising what is normal and abnormal in assessing, range of contemporary nursing issues:intervening and evaluating individual health and functional • Leadership and managementstatus. Enrolled nurses’ responsibilities also include • Older adulthoodproviding support and comfort, assisting with activities of • Acute caredaily living to enable clients to achieve their optimal level • Rural and remote care.of independence, and providing for the emotional needs The new full colour internal design enhances photosof clients. Where state and territory law and organisational and illustrations to provide clear and meaningful visualpolicies allow, enrolled nurses may administer prescribed aids to learning.medicines or maintain intravenous fluids, in accordance The sixth edition has been carefully developed to alignwith their educational preparation. with the Diploma of Nursing in the HLT07 National Enrolled nurses are required to be information- Health Training Package for the enrolled nursing student.technology literate, with specific skills in the application of It provides a contemporary approach to nursing practicehealthcare technology. Enrolled nurses demonstrate critical and is an invaluable teaching resource. The text providesand reflective thinking skills in contributing to decision the theoretical knowledge on the care that clients maymaking, which include reporting changes in health require in a range of healthcare settings and offers specialand functional status and individual client responses to features to enhance student learning of the material.healthcare interventions. Enrolled nurses work as part This edition is a culmination of the efforts of manyof the healthcare team to advocate for and facilitate the nursing academics and professionals who are passionateinvolvement of clients, their families and significant others about the education of enrolled nurses and the importantin planning and evaluating care and progress towards health role they play in healthcare settings. We are grateful for theiroutcomes. The role also requires them to act as preceptors enthusiasm and support throughout the writing process.for students and other healthcare workers. As the new editing team of Tabbner’s Nursing Care 6E Career opportunities for enrolled nurses are expanding we would like to acknowledge Rita Funnell and Karenand include: acute care; perioperative, emergency, intensive Lawrence, the editors of the fourth and fifth editions ofand coronary care; aged care; rehabilitation; community Tabbner’s, for their invaluable work and major contributionand mental health nursing, and general practice settings. to the education of enrolled nurses. In addition we wouldIn addition, enrolled nurses work in specialty areas such like to thank the team at Elsevier for their hard work andas nursing education, diabetes education, continence perseverance in ensuring the publication of this edition.management, dementia management, lactation consul- Gabby Koutoukidistancy, workplace safety and wound care. There are also Kate Staintonincreasing opportunities for enrolled nurses to move into Jodie Hughsonmanagement positions. sample proofs © Elsevier Australia
    • xviiiAcknowledgmentsI was delighted to be invited as an editor again for Tabbner’s This edition has been an epic adventure which has6E and to have the opportunity to do this alongside two consumed many hours of my spare time! I thank myvery good friends of mine – Kate and Jodie – whom I husband Stuart for listening, advising and his patience. Ithank so much for coming on this journey with me. thank my children for their interest and understanding.This sixth edition is the culmination of work by many I  also thank the Elsevier team for all the hard work inwriters and nursing educators and I would like to thank getting this edition to publication.all contributors—especially to both nursing teams at Nursing is an art: and if it is to be made an art, it requiresHolmesglen for jumping at the chance to write chapters— an exclusive devotion as hard a preparation as any painter’ssometimes with very short timelines! or sculptor’s work; for what is the having to do with dead canvas or dead marble, compared with having to do withI would also like to acknowledge all the nursing students the living body, the temple of God’s spirit? It is one of theand teams I have worked with over the years who have Fine Arts: I had almost said, the finest of Fine Arts.inspired in me a passion for teaching and ensuring best Florence Nightingalenursing practice. I hope this edition of Tabbner’s prepares future nurses well! Gabby Koutoukidis Jodie HughsonTo my husband, Anthony, and children Ben, Alex andMaddy, thank you so much for your understanding andsupport. Now you can have the study back, Anthony,and the kids can stop wondering if they are going to get fed! To my co-editors, authors and the team at Elsevierthank you for all your knowledge and hard work. Kate Stainton sample proofs © Elsevier Australia
    • xixStandard steps for all nursingprocedures/interventionsThese are the essential steps that must be done consistently During the procedurewith each client contact in order to deliver responsible and Step 5safe nursing care. • Perform hand hygieneBefore the procedure • Put on gloves following standard precautions asStep 1 appropriate• Mentally review the steps of the procedure beforehand • Place on eyewear, mask and gown as appropriate• Discuss the procedure with your instructor/supervisor/ • Ensure client safety and comfort throughout team leader, if required procedure• Confirm correct facility protocols/safe operating procedures Step 6 • Promote client independence and involvement ifStep 2 possible• Check the order in the chart, client’s nursing/medical • Assess client tolerance to the procedure history After the procedure• Review handover report to assess specific instruction Step 7 or need of client • Dispose of used supplies and sharps appropriately.• Gather equipment/supplies. If using a procedure Remove eyewear and other protective equipment and trolley, ensure it is cleaned discard or store appropriately• Perform hand hygiene • Remove gloves (if worn) and perform hand hygiene • Clean used equipment and store appropriatelyStep 3• Introduce yourself to the client and/or family Step 8• Gain client consent to perform the procedure • Make the client comfortable and inform them of how• Check the client’s identification, using two identifiers. the procedure went, or of any results/values When verifying identity, get client to verbalise name • Restore the bed height, tidy the bed and surrounding and check against identification band as well as area. Place call bell and personal items within reach relevant documentation • Perform hand hygiene• Explain the procedure to the client in terms they can understand Step 9• Assess client to determine whether intervention is still • Record and document assessment findings, details of appropriate the procedure performed and the client’s response• Identify teaching needed and describe what the client • Report abnormalities as required can expect • Reassess client to ensure there are no adverse effects/ events from the procedure.Step 4• Provide privacy (References: deWit S (2009) Fundamental Concepts and Skills for• Keep yourself safe, e.g. raise the bed to appropriate Nursing, 3rd edn. Philadelphia: WB Saunders, reproduced with working height permission; and Perry AG, Potter PA and Elkin MK (2012) Nursing Interventions & Clinical Skills, 5th edn. St Louis: Mosby Elsevier.)• Provide adequate lighting for the procedure• Arrange supplies and equipment sample proofs © Elsevier Australia
    • xxText features CHAPTER 26 Learning Outcomes assist students to focus on key information in each chapter Movement and exercise Susan Lanyon Key Terms are listed at the beginning of each chapter and defined within the text Chapter Focus introduces the key concepts in each Learning Outcomes Lear Learning O Learning Outcomes • Assess clients for impaired mobility and activity intolerance • Assist in plann and implementing nursing care planning chapter At the completion of this chapter and with some further reading, students should be able to: plans for clien with a musculoskeletal disorder clients • Define the key terms fi Define • According to specified role and function, perform the A According • Describe and implement the principles of good posture and body mechanics osture n he • Describe the role of the musculoskeletal system in the nursing activi ng activities described in this chapter safely and accura ac ities chapte accurately in the clinical environment Lived Experiences are taken from actual clinical Key Terms situations to help students understand a particular health l i f regulation of movement • Describe how joints are involved in movement Key Terms • State differences between isotonic, isometric and isokinetic exercise • Describe and define range of movement (ROM) active and passive exercise rthrography arthrography muscle atrophy weight obesi overweight and obesity experience from the point of view of clients, their families • Identify and demonstrate joint movements involved in ROM exercises ved benign tumours body mechanics contractures and ankylosis orthostatic or postural hypotension osteoclasts and osteoblasts or nurses and other health professionals. • Define obesity and describe how variables such as s family values and diet influence adult obesity crutch-walking gait osteogenic sarcoma • Describe how older adults may benefit from exercise dangling osteomyelitis • Identify and describe the complications associated with deep vein thrombosis osteoporosis immobility and implement appropriate preventive (DVT) plantar flexion (footdrop) measures haematopoiesis PRICE: prevention, rest, • State the influences and effects associated with health and wellbeing ice, compression and disorders of the musculoskeletal system hypostatic pneumonia elevation Clinical • Identify the major musculoskeletal system disorders isotonic/isometric/ pursed-lip breathing exercise | Chapter 26 569 Mov Movement and CLINICAL INTEREST BOX 26.2 that impact movement and exercise • Describe the major manifestations of musculoskeletal isokinetic exercise metastatic bone tumours range of movement (ROM) Interest system disorders CHAPTER FOC CHAPTER CHAPT R FOCUS HAPTER APTER APTE CHAPTER FOCUS • Briefly describe the specific disorders of the Self-care behaviours and exercise boxes offer musculoskeletal system outlined inexercise are essential components for restoring, maintaining and enhancing physical and psycho- Movement and this chapter e social health. As be used to assess e • Define the diagnostic tests that maysociety becomes increasingly sedentary in both work and home environments, government and musculoskeletal function agencies are researching and evaluating the effects of inactivity on health, disease processes, ageing and health effects ff health morbidity. Research suggests that despite the rising trend in health conditions related to obesity and immobility, y R rela information on • Make the most of opportunities for exercise—use the commencement of an exercise program can retard and even reverse the pro osteoporosis, heart disease, diabetes mellitus and the effects of ageing. ff effects progression of conditions such as The human body is ideally suited to movement. Regular exercise promotes health, feelings of wellbeing and stairs, park a kilometre away from work or walk to work developmental prevents illness throughout the life span. Exercise is made possible by the muscular, skeletal and nervous systems. These interconnected systems work together to make movement possible and for most human movement they must once or twice a week, walk faster and use lunchtimes considerations, for exercise function effectively for optimal physical performance. Disease processes that disable one or more of these systems may inhibit or restrict mobility. To ensure mobility and exercise are maximised and maintained, allied health teams cultural aspects should devise care plans to meet individual needs and abilities based on the specific strengths and disabilities of each • Choose an enjoyable physical activity client in their care. Healthcare workers are in a unique position to educate and support clients to make lifestyle changes for of care, current improvement in health and prevention of disease. Effective and timely health promotion can significantly • Plan 3–4 exercise activities per week contribute to long-term client health and potentially reduce disease progression and hospital re-admission. For those with recurring mobility issues, nurses and allied health professionals can support the transition to mobility • Before starting exercise sessions, ensure medical research and aids and promote independence and quality of life on discharge to home or an assisted facility. Nurses who promote and encourage mobility and movement play a significant role in the client’s healthcare experience. This important contribution can have a lasting impact on the client’s recovery and rehabilitation and benefit society with its positive clearance if in a high-risk group client teaching outcomes. • Alternate different types of exercise to keep interest up; for example, Pilates followed by weight-training sessions then walking or bike riding LIVED EXPERIENCE LIVED LIVED XPERIENCE LIVED EXPERIENCE LIVED EXPE IVE • Invite a friend to walk or join a health club or gym I found as I was getting older that I wasn’t as flexible as I used to be. My joints were se flexible seizing up and I decided to take positive f function. allow action to prevent loss of function. Keeping active with swimming and cycling allows me to keep moving without putting • Build up exercise sessions to avoid over-exertion pressure on painful joints. I haven’t felt this good in years. Felicity, 65 years Clinical Scenario Box 27.1 Nursing care plan 26.2 A client with a musculoskeletal disorder Mr Darcy, an 88-year-old man, was discharged from hospital following admission for a urinary tract infection. Nursing action Rationale As he has no family, Mr Darcy was taken home by hospital Preparation of environment Promote an area conducive to rest including pillows for elevation and bed cradle for air transport and was escorted into his home where he lives circulation around injured limb or newly applied cast alone, and placed in a lounge chair. Two days later, a nurse from hospital in the home did a follow-up visit on Mr Darcy. Specific equipment acquisition Ensure availability of equipment that is requested to enhance joint mobility and repair, On arrival the nurse found Mr Darcy still sitting in the e.g. CPM machine, traction equipment, plaster, mobility assistance aids lounge chair; he had not moved from the chair since his arrival at home, 2 days prior. He had been incontinent of Prevention of potential Air or padded mattress to protect pressure areas both urine and faeces. Mr Darcy made minimal eye contact problems related to immobility Bedsides to enhance client protection from falls and was not able to give coherent answers to questions. Antiembolic stockings to reduce risk of DVT While assisting Mr Darcy, the nurse noted a large lesion Plan of breathing exercises to reduce stasis of secretions on his sacrum. Mr Darcy was transferred to an acute care Client comfort Analgesia for client comfort facility where surgical debridement took place, identifying a stage IV pressure injury on his sacrum. Placement of articles within easy reach to prevent straining Call bell within reach to reduce anxiety and feelings of isolation • What would be the recommendation for care for Mr Darcy? Hot/cold packs to reduce pain and inflammation • What other allied health professionals would you Nutrition Plan diet for optimal healing including proteins, carbohydrates, vitamins, minerals and include in your care of Mr Darcy? ensuring adequate hydration and caloric needs • What specialised wound dressing regimen will Mr Darcy Allied health referral Specialist advice for mobility aids, ROM exercises and assistance for posturing and require and what are the expected outcomes? mobilisation to promote independence and rehabilitation • Before Mr Darcy is discharged, what additional (Crisp & Taylor 2009; Farrell & Dempsey 2011; Gulanick & Myers 2010) assessments will he require? Will you recommend that he is discharged back to his own home? Nursing care plans provide comprehensive examples of a step-by-step guide toClinical Scenarios provide context for patient care within a specific scenariopractice and include questions for studentreflection sample proofs © Elsevier Australia
    • xxi Procedural Guidelines use a Procedural Guideline 27.2: Shortening a drain tube step-by-step format emphasising Review and carry out the standard steps for all nursing procedures/interventions the use of the nursing process and include rationales for each Action Rationale step Follow the steps described in the guideline for dressing a The stab wound is cleansed to remove exudate, thus wound, up to and including cleaning the wound preventing contamination Using the stitch cutter, remove any suture securing the tube in Enables the tube to be rotated, if necessary, and shortened the wound If the tube is round, gently rotate it Rotation of the tube frees any adherent granulation tissue Withdraw the tube the prescribed length, e.g. 1.25 cm Tube must only be shortened the prescribed length, to allow the wound to heal from within Secure tube with sterile safety pin below level of planned cut Prevents tube from slipping into the wound Cut off excess tube Prevents it pressing on the wound Place and secure a clean dressing or pouch over the tube Protects the skin from irritation from wound drainage A gauze dressing is generally placed between the pin and the Protects the skin from irritation skin, and another dressing or pouch placed over the tube Remove and discard gloves and towels Prevents cross-infection Assist the client to reassume a comfortable position Promotes comfort Remove and attend to the equipment appropriately. Perform Prevents cross-infection hand hygiene Report and document the procedure Appropriate care can be planned and implemented References and Recommended Reading encourage further reading Summary Summary Summary within each chapter topic Palliative care is a speciality area of nursing. Nurses are palliative care team aims to meet physical, psychological valuable members of the multidisciplinary palliative care and spiritual needs that arise for clients at the end of theirThe Summary highlights team and provide care to individuals with a life-limiting illness and their families. Palliative care takes place in many life and to support the client’s family. Quality palliative care and symptom management has the person and their familythe key points in the chapter different settings, and many people prefer to die at home. In palliative care contexts, dying is a natural process and at the centre of care. Nurses are an important part of the multidisciplinary team supporting a ‘good death’ for clients people who are dying should be empowered to live life in the home and inpatient settings.content y p as fully as possible within the limits of their illness. TheReview Questions assist Review Questions Re Review Questions References References References and Recom eferences er nc Recommended Reading References and Recom di Berger AM, Shuster JL, Von Roenn JH (2006) Principles and Practice of Palliative Care and Supportive Oncology. Maher D & Hemming L (2005) Understanding p Hemmin family: holistic a of Community N assessment in palliative care Nursing 10:318–22 McLean Heitkamper M, Ross Staats C, Harringt Heitkampestudents with comprehension 1 List three (3) major functions of a multidisciplinary palliative care tea team. Lippincott Williams & Wilkins, Hagerstown MD Birks M & Chapman Y (2009) Complementary therapies in (2008) Palliative care. In: Brown D & Edward 2 Describe how you could provide a warm, caring environment for a d Berger AM Shuster JL Von Roe dying resident in an aged-care facility.nursing practice. In: Crisp J & Taylor C (eds) Potter & T Lewis’s Medical–Surgical Nursing, 2nd edn. Medical–and review of the chapter 3 List five (5) physical symptoms associated with incurable illness. F pp 700–817 Nursing, Perry’s Fundamentals of Nursing, 3rd edn. Elsevier, Sydney, Sydney, pp 153–67 Mooney D (2009) U 153– In: Crisp J & T Understanding loss, death an Tay Taylor C (eds) Potter & Perry’s Fcontent 4 What nursing actions could help an emaciated client whose pain is controlled but who cannot get physicallyJr E (2007) Supporting the Child and the Family in in bed? Brown comfortable Paediatric Palliative Care. Jessica Kingsley Publishers, London of Nursing, 3rd edn. Elsevier, Sydney, pp 498 New Zealand Ministry of Health (2001) The New 5 Describe five (5) ways you can promote a sense of wellbeing in the partner of a client who is dying in Chaplin J & Mitchell D (2005) Spiritual issues. In: Lugton J & the acute-care hospital Palliative Care Strategy. Online. Available: ww setting. nz/moh.nsf/pagesmh/2951 McIntyre M (eds) Palliative Care: The Nursing Role, 2nd edn. O’Connor M (2008) Palliative care in the commu Elsevier, Edinburgh, pp 169–99Critical Thinking Exercises Cheraghi M, Payne S, Salsali M (2005) Spiritual aspects of end-of-life care for Muslim patients: experiences from Iran, D & van Loon A (eds) Community Nursing in Blackwell Publishing, Oxford Old JL & Swagerty D (2007) A Practical Guide tostimulate the student to think International Journal of Palliative Nursing 11:468–74 Lippincott, Williams & Wilkins, Hagerstown,critically and problem solve Critical Thinking Exercise Cri Cr Critical Thinking Exercises Cicero JK (2007) Waking Up Alone: Grief and Healing. Author House, Bloomington IN D’Avanzo C (2007) Mosby’s Pocket Guide to Cultural Health Smith M (2002) Spiritual issues. In: Lugton J & K Palliative Care: the nursing role. Churchill Liv Stein-Parbury J (2009) Patient and Person: interp Assessment, 4th edn. Mosby Elsevier, St Louis nursing, 4th edn. Elsevier, Sydney 1 In what ways does the culture in busy acute care hospitals impact on the experience of clients who are dying? How does it deWit S (2009) Fundamental Concepts and Skills for Nursing, 1 In what ways does the culture in busy acute care 3rd edn. WB Saunders, St Louis impact on their family members? How might nurses improve the circumstances for t client who is dying and their family in the Tiziani A (2010) Havard’s Nursing Guide to Drug Elsevier, Sydney this setting? Egan G (2010) Exercises in Helping Skills: A manual to Varcarolis E & Halter M (2010) Foundations of P accompany the skilled helper. A problem-management and Mental Health Nursing: a clinical approach. W 2 The specialist has just told you that you have a brain tumour that is inoperable and n curable. Reflect on your own values, not opportunity-development approach to helping, 9th edn. attitudes and beliefs and consider what changes would happen in your life as a result of this prognosis. What would you need Learning, Belmont CA Philadelphia Brooks/Cole Cengage Victorian Department of Human Services (2011) to help you cope? If you were living in a rural area 2 hours drive from the nearest city, could you easily access health G, Botti M (2008) Pain management. In: Brown Ersek M, Irving services to Palliative Care Program. Online. Available: w meet your needs? & Edwards H (eds) Lewis’s Medical–Surgical Nursing, gov.au/palliativecare/index.htm 3 2nd edn. Elsevier, Sydney, pp 121–52 Joe, 72, has lung cancer. He has been admitted to the hospice today. He has been a frequent visitor to the hospice day centre Woodruff R (2004) Palliative Medicine, 4th edn. Foyle L & Hostad J (2007) Innovations in Cancer and Palliative University Press, Melbourne over the last few months, and several staff members have noted his positive attitude and how well he seems to have been Care Education. Radcliffe Publishing, Abingdon, Oxford World Health Organization (2008) Cancer Pain R coping physically and emotionally. Joe’s condition has deteriorated now and he is not expected to live for more than a few more Kübler-Ross E (1969) On Death and Dying: What the dying have days. He is alert but extremely agitated at the moment. Margaret, his wife, can’t understand this anxiety because he has been Palliative Care. Report of a WHO Expert Com to teach doctors, nurses, clergy, and their own families. Technical Report Series No 804. WHO, Gene so calm throughout his illness. She and his three daughters are finding his agitation very distressing. Consider factors that may Scribner, New York A Available: http://whqlibdoc.who.int/trs/WHO_ http://whqlibdoc.who.int/trs/WHO O_ be related to Joe’s anxiety. How would you explore his agitation with him? Which other health professionals may need to be M (2002) Transcultural Nursing Leininger M & McFarland consulted? Concepts, Theories, Research and Practice, 3rd edn. McGraw-Hill, New York Online Resources Online Re ource Online Resources nlin Resources 4 Tracey, 22 years old, has just died from leukaemia. You have been nursing Tracey for the past 2 weeks in the hospice and you Litwak K (2009) Somatosensory function, pain, and headache. developed a caring relationship with her over this period. On hearing that Tracey has died, you experience aMattson Porth C & Matfin G (eds) Pathophysiology, Reflect on your feelings. How might this experience influence your ability to nurse? In: sense of loss. 8th edn. Lippincott, Williams & Wilkins, Philadelphia, che. Online Resources National Association for Loss and Grief (Austral www.nalag.org.au/ National Association for Loss and Grief (NZ): ww l w pp 1225–60 Palliative Care Australia: www.palliativecare.org. www.palliativecare.org. National Association for Lo Online Resources provide useful web links related to the chapter content sample proofs © Elsevier Australia
    • 948CHAPTER 40Acute careMichelle Hall Learning Outcomes CHAPTER FOCUSAfter the completion of this chapter, and with furtherreading, students should be able to: aged care setting. With increasing scope of practice, nurses and the impact this has on clinical practice of clients with acute health problems the enrolled nurse; these are explored in this chapter. health problems all nurses and as the scope of practice expands for  enrolled nurses it is of utmost importance that these crucial tools for practice. Key Termscellulitis scope of practice sepsis sample proofs © Elsevier Australia
    • Acute care | Chapter 40 949 LIVED EXPERIENCE Clarissa Kovacevic, RNSCOPE OF PRACTICE WHERE IS ACUTE CARE DELIVERED? Hospital careto an ageing population, increase in chronic diseases andscope of practiceincrease in scope of practice has been met with resistanceof practice is not supported within the profession itself sample proofs © Elsevier Australia
    • 950 Unit 9 | Healthcare in specialised practice areas Table 40.1 | ICUs can be classified as: General ICU Those that care for both medical and surgical clients Combined ICU Combined ICUs where an ICU is combined with an HDU and/or coronary care unit Paediatric ICU Specialises in care of paediatrics Neonatal ICU Specialises in care of neonates Speciality ICU Examples are cardiothoracic, neurological or oncology Martin et al 2010some time in a hospital on a general ward. Although of Australia, and client fees, donations, sponsorship,paediatrics. When a client is admitted to acute care, the aim Box 40.1 Cultural awareness When caring for clients from a Chinese background it is IMPACT OF ACUTE ILLNESS important to have an understanding of Chinese culture The client and beliefs. Many Chinese believe in the Yin (female, negative energy, cold) and Yang (male, positive energy, hot). If an imbalance occurs between the Yin and the Yang, illness results. Foods, illness and treatments are classified as hot or cold. Clients and their families will try to restore the balance of Yin and Yang so you may find clients with heat or cool packs, depending on how the illness has been classified. Likewise, the family may bring in food that they think will help to restore this balance.Home care stress that an acute illness causes. When diagnosed withinpatient of the hospital and remains under the care of thebeen shown to result in better outcomes, such as reduced sample proofs © Elsevier Australia
    • Acute care | Chapter 40 951 Clinical Scenario Box 40.1 Rebecca’s acute care experience About 2 years ago Rebecca started experiencing intense headaches which culminated one day in her passing out at work. She worked as a nurse and her nurse unit manager put her in a wheelchair and took her around to the emergency department of the hospital that she worked in. This was the beginning of 2 months of being Clinical Scenario Box 40.2 admitted and discharged from hospital five times. She had all the tests done, MRI, CT, blood test and even a lumbar puncture and no doctor could tell Rebecca why Rebecca’s acute care experience: her head felt like it was going to explode. When admitted to the wards, she felt that once the nurses realised that the family’s perspective they were caring for a fellow nurse, they treated her When Rebecca started experiencing headaches I differently to other clients. Treatments didn’t get explained thought nothing of it; she has suffered from migraines as it was assumed that she understood what was since a young age. Then suddenly they escalated happening. No one explained to her the reasoning behind and she had to be admitted to hospital multiple times. all the tests she was having. For Rebecca, one of the I cannot explain the sense of helplessness I felt as her scariest experiences was when she had a drug reaction; mother. I felt I should have been able to make it all she thought she was going to die. better. It was very frustrating that the doctors could not On her last admission one of the nurses looking after her give us any answers; they didn’t listen to her when she suggested she see an osteopath and get her back and said it wasn’t a migraine. One of the worst moments neck looked at. Rebecca took her advice and achieved for me was receiving a phone call from my sister who some relief. Two years on and what started as an acute was visiting Rebecca when she had the drug reaction. episode has turned into a chronic pain issue. Rebecca My sister thought Rebecca was going to die. Another has had to change jobs and work part-time as the chronic moment that stands out for me was being ordered from pain causes her constant exhaustion. This has had a her room as nurses rushed in. No one told me what was major impact on her life and she has had to modify her going on. I found out later she had been given too much lifestyle to manage the pain she experiences every day. morphine and had a dangerously low respiratory rate. Two years on and I am proud of how Rebecca deals with the pain; most people have no idea that she has pain every day. It is lucky that I am a casual worker soThe family I can take time off when Rebecca needs to be taken to hospital; I don’t know what would happen if I had to work full-time. Lisa, mother of Rebecca ACUTE DISORDERS Cellulitis Cellulitisstress it is important to communicate expected healthcare Clinical manifestations sample proofs © Elsevier Australia
    • 952 Unit 9 | Healthcare in specialised practice areasPathophysiology Deep vein thrombosis Deep vein thrombosis Clinical manifestations manifestations can be similar to other diseases such asMedical managementWhen the infection is mild, the client can be treated with PathophysiologyNursing careWhen caring for the client with cellulitis the nurse should Diagnostic testsClient educationVenous thromboembolism Medical management CLINICAL INTEREST BOX 40.1 Risk factors in the development of cellulitis Nursing care Venous insufficiency or stasis Lymphoedema monitor the client for potential complications of treatment Surgery Diabetes mellitus Malnutrition Substance abuse Presence of another infection Compromised immune system Trauma Intravenous drug use Radical mastectomy with axillary dissection Client education (Farrell & Dempsey 2011) sample proofs © Elsevier Australia
    • Acute care | Chapter 40 953menstrual bleeding may be slightly increased: they should clinical manifestations indicate the possibility of PE (chestcontact their doctor if it increases significantly. Men pain, chest wall tenderness, palpitations, back and shouldershould shave with an electric razor to reduce the risk of pain, upper abdominal pain, syncope, haemoptysis,cuts and soft-bristle toothbrushes should be used. Contact dyspnoea and painful respirations) (Farley et al 2009), thensports should be avoided while taking anticoagulation a D-dimer test may be ordered; if this test is positive thendrugs (LeMone et al 2011). more investigations are required to confirm the diagnosis.Pulmonary embolism Table 40.2 outlines investigations for diagnosis of PE. In recent years the computed tomography pulmonaryPulmonary embolism (PE) is a major cause of mortality angiogram (CTPA) has replaced pulmonary angiogramsand morbidity (Otair et al 2009). For 25% of clients who in the diagnosis of PEs (Sheares 2011). This type of CTsuffer a PE the first clinical symptom is death (Farley et al evaluates slices as narrow as 1.0 mm (Farrell & Dempsey2009). The risk factors associated with the development 2011) allowing for accurate visualisation of a PE by enablingof a PE are very similar to those for a DVT (see Clinical visualisation of the pulmonary arteries (Sheares 2011).Interest Box 40.2). The main disadvantages of the CTPA are that the clientClinical manifestationsThe clinical manifestations of PE may include chest pain,chest wall tenderness, palpitations, back and shoulder Table 40.2 | Investigations for diagnosis ofpain,  upper abdominal pain, syncope, haemoptysis, pulmonary embolismdyspnoea and painful respirations (Farley et al 2009).PathophysiologyPE involves obstruction of a section of the pulmonaryartery tree by a thrombus or embolism (Sheares 2011). Thisthrombus or embolism forms in the venous system or rightside of the heart (Farrell & Dempsey 2011) and commonly (ECG) 1 –V4originates in the leg or pelvic vein (Sheares 2011). V1Diagnostic testsDiagnosis of PE can be difficult because of the non-specificsymptoms that are manifested (Otair et  al 2009). If the gases scan) CLINICAL INTEREST BOX 40.2 Risk factors associated with DVT Surgery Cancer Pregnancy (CTPA) Trauma Farrell & Dempsey 2011; Sheares 2011 sample proofs © Elsevier Australia
    • 954 Unit 9 | Healthcare in specialised practice areasmust be transferred to a diagnostic imaging department Table 40.3 | Emergency management ofwith contrast, which can cause allergic reactions and is pulmonary embolismcontraindicated in clients with renal impairment and those Nasal oxygen Relieves hypoxaemia and respiratory distressMedical management Insertion of Prepares for medication intravenous lines administration ECG Provides continuous monitoring for arrhythmias and right ventricular failure Medications May include digoxin glycosides, diuretics, enoxaparin, heparin and antiarrhythmic agents. Sedatives may be administered to relieve anxiety Blood tests Include serum electrolytes, full blood count, haematocrit and arterial blood gases Indwelling urinary Inserted to monitor fluid outputmolecular weight heparin or heparinoids such as enoxaparin. catheter Mechanical Used if the clinical assessment and ventilation investigations warrant it Farrell & Dempsey 2011 Clinical manifestationsNursing care Pathophysiology DiverticulitisClient education Diagnostic testsDiverticulitis Medical management sample proofs © Elsevier Australia
    • Acute care | Chapter 40 955 Acute renal failureNursing care Acute renal failurebe assessed at the same time, measuring girth, auscultatingClient educationGuillain-Barré syndromeGuillain-Barré syndrome Clinical manifestations Pathophysiology intrarenal failure and postrenal failure.and decreased sensation in their arms and legs, with or infections and toxins that result in inflammation or be as a result of renal calculi, strictures, thrombosis, sample proofs © Elsevier Australia
    • 956 Unit 9 | Healthcare in specialised practice areas Prerenal failure Hypovolaemia Hypotension (reduced intravascular volume) Cardiac insufficiency Volume Total loss redistribution GI loss (vomiting, diarrhoea, Reduced effective surgical fistulae) circulation volume (ascites, oedema, CCF) Haemorrhage Altered vascular (visible and occult) capacitance (sepsis, shunting, vasodilation) Renal loss (diuretics, polyurea) Skin loss (excessive sweating, burns) Figure 40.1 (Blakeley 2008) Intrarenal failure Interstitial infections Tubular Glomerulus infection Vascular Ischaemia Small vessels Toxic Large vessels Body toxins Foreign toxins Figure 40.2 (Blakeley 2008) sample proofs © Elsevier Australia
    • Acute care | Chapter 40 957 Postrenal failure Medical management The investigations required depend on the individual and the results of the health assessment (Murphy & Byrne 2010). Once a diagnosis is made the medical aim is to Obstruction restore chemical balance and prevent complications to allow the kidney to repair itself (Farrell & Dempsey 2011). If there is a known cause it is treated and eliminated. For some clients dialysis is required (see Ch 29). Internal pelvic/ureteral External ureteral Nursing care When caring for the client with ARF the nurse needs to closely monitor fluid balance. This can be done by commencing the client on a strict fluid balance and daily Stones Surrounding or weighing regimen, ensuring that the client is weighed at the infiltrating tumour/other obstruction same time on the same scales and in the same clothes every time. The nurse should also monitor the client for signs of oedema and any difficulty in breathing (Farrell & Dempsey Tumour 2011). Clients with ARF are at increased risk of infection and skin breakdown, therefore the nurse should ensure Figure 40.3 Causes of postrenal failure asepsis when caring for these clients and meticulous skin (Blakeley 2008) care to prevent skin breakdown (Farrell & Dempsey 2011). Client education The client with ARF needs education to identifyDiagnostic test complications of fluid volume excess such as increasedWhen a client is suspected of having ARF there are many weight or oedema. Educate to avoid nephrotoxic agentsinvestigations that may be ordered. These include: for at least 1 year post ARF. The client will need to avoid Urinalysis stress and infection (LeMone et al 2011). (See Table 40.4.) Blood test tests (including urea, creatinine and Sepsis electrolytes, full blood examination, coagulation status, virology for hepatitis B and C and HIV) Sepsis is an infection of the blood stream that spreads Renal ultrasounds quickly and can be difficult to diagnose (Dellacroce 2009). CT, MRI For a diagnosis of sepsis to be made the client must have Renal biopsy (Murphy & Byrne 2010). a known infection and systemic inflammatory reaction syndrome (SIRS) (see Clinical Interest Box 40.3). Table 40.4 | Differences between acute renal failure and chronic renal failure Acute renal failure Chronic renal failure Calcium sample proofs © Elsevier Australia
    • 958 Unit 9 | Healthcare in specialised practice areas Table 40.5 | Signs of organ failure CLINICAL INTEREST BOX 40.3 SIRS Body system Clinical manifestation Urinary The most common sites of infection that lead to sepsis One of the major complications of severe sepsis isare infections in the bloodstream, skin, respiratory tract, hypotension. When a client remains hypotensive in spitegastrointestinal tract and genitourinary tract (Schub & of adequate fluid resuscitation, the client has progressedSchub 2011). Gram-negative and gram-positive bacteria are into septic shock (Dellacroce 2009). Septic shock is athe usual causative agents; however, the infection can also life-threatening condition, with 1400 people worldwidebe due to fungi, viruses and protozoa (Farrell & Dempsey dying each day (Gerber 2010). After diagnosis of septic2011). shock, 30% of clients will die within the first month and 50% within 6 months (Gerber 2010). See ClinicalClinical manifestations Scenario Box 40.3.Clinical manifestations include fever, peripheral oedema,hypotension, tachycardia, tachypnoea and hot flushed skin Diagnostic test(LeMone et al 2011). As soon as sepsis is suspected blood cultures should be Risk factors for the development of sepsis include taken, ideally prior to the commencement of antibioticcauterisation, invasive devices, certain surgery, urinarytract infections, appendicitis, diverticulitis, Crohn’sdisease, cholecystitis, renal disease, prostatitis, meningitisand complicated obstetric delivery (Schub & Schub 2011). Clinical Scenario Box 40.3Older adults, children and immunosuppressed clients areat an increased risk of sepsis progressing to severe sepsisand septic shock (Schub & Schub 2011). Septic shockPathophysiologySepsis develops when the body is unable to contain alocalised infection, enabling the infective agent to enterthe blood stream (Dellacroce 2009). The associatedSIRS can impair the clotting cascade, causing systemicinflammation, vasodilation and capillary leakage whichcontributes to hypotension and can lead to organ failure(Whitehead 2010). Sepsis can develop into severe sepsis.Severe sepsis involves all the clinical features of sepsisbut has the added complication of organ dysfunction(Dellacroce 2009) (see Table 40.5). When a client isdiagnosed with severe sepsis there is a 30–35% chance ofdeath (Whitehead 2010). sample proofs © Elsevier Australia
    • Acute care | Chapter 40 959therapy. The cultures should be taken from all lumens of turn is developed into a pathway (Day 2009). The pathwaycentral and peripheral lines (Dellacroce 2009). enables less variation and more transparency in client care (Vanhaecht et al 2009).Medical management Clinical pathways are most advantageous when clientOxygen therapy should be commenced at high-doses to outcomes are predictable, thus ensuring that the clientstabilise oxygen saturations (Steen 2009). Fluid resus- receives relevant clinical interventions and assessmentscitation which includes both colloids (albumin and packed (Allen et  al 2009). While clinical pathways cannot bered blood cells) and crystalloids (normal saline and Ringer’s used for all clients, in 80% of cases a clinical pathway islactate) is commenced, with the aim of maintaining blood indicated (Duffy et al 2011). Pathways provide a daily carepressure greater than >100 systolic blood pressure (SBP) plan for the client, and include guidelines on assessment,(Dellacroce 2009). Urine output is monitored with a goal treatment, activities of daily living, nutrition, education,of >0.5 mL/kg/hr and it is recommended that a urinary referrals to be made and discharge planning (D’Entermontcatheter be inserted (Steen 2009). Broad-spectrum 2009).intravenous antibiotics are commenced until an infective The novice nurse can find pathways especially helpfulagent is identified; these should be commenced within by providing a guide as to what is expected of the client1 hour of the diagnosis (Steen 2009). The client’s serum on any given day (D’Entermont 2009). However, it is notlactate levels may need to be measured as increased levels just the novice nurse who benefits from clinical pathways;indicate progressing disease (Steen 2009). even the most experienced nurse will encounter clientNursing care conditions they are unfamiliar with and the pathway willThe best treatment for sepsis is prevention, which all nurses enable them to provide the most appropriate care for thesemust aim to achieve by being diligent with handwashing clients.and the use of aseptic technique and standard and Clinical pathways can form all or part of the client’sadditional precautions. medical records (Duffy et al 2011). At the end of a shift, providing there has been no variation from the pathway, the nurse responsible for the client’s care signs off thatCLINICAL PATHWAYS all expected outcomes and interventions have been met.A clinical pathway is best described as a multidisciplinary, When a variation from the plan has occurred the nurse islocally approved plan of care for a client based on guidelines expected to document this in the client’s progress notes.and, wherever possible, evidenced for a particular client Studies have shown that clinical pathways improvegroup (Duffy et al 2011). client outcomes, promote decision making and may lead The clinical pathway was introduced in the 1980s in to shorter hospital stays and reductions in readmissionthe USA to meet the needs of healthcare professionals and (Allen et  al 2009). Shorter hospital stays are achievedimprove quality of care for clients (Duffy et al 2011). The as clinical pathways act as an organisational devicemain aim is to encourage standardisation of care for all by encouraging proactive interventions and the useclients (Neuman et  al 2009) with similar requirements of relevant resources for the client (Allen et  al 2009).throughout a specific time frame by providing clinical However, not all clients are appropriate for clinicalstandards and expected outcomes (D’Entermont 2009; pathways. Clinical pathways are not effective whenNeuman et al 2009). care needs to be flexible, such as with the care of the The development of clinical pathways combines an client post cerebrovascular accident (Allen et  al 2009).evidence-based approach, with local policy and procedure Clinical pathways can never replace professional clinicaland current practice to develop a process map which in judgment (D’Entermont 2009). SummaryThis chapter has presented some common and not so to clinical pathways. There are many acute conditions thecommon conditions the enrolled nurse may encounter enrolled nurse will come across, in various settings, andwhen working in the acute, aged or community care this introduction, along with further reading, provides asectors. It has explored the area of acute care provided in general introduction to a broad range of conditions thatvenues other than hospitals and presented an introduction may be seen in acute settings. sample proofs © Elsevier Australia
    • 960 Unit 9 | Healthcare in specialised practice areasReview Questions 1 You suspect your client has cellulitis. What are the common sites the infection originates from? 2 Which two (2) conditions are included under the term venous thromboembolism? 3 Identify the major risk factors associated with the development of a DVT. 4 What does a positive D-dimer test indicate? 5 Outline the treatment of a client who has been diagnosed with a pulmonary embolism. 6 Describe diverticulitis. 7 List the clinical manifestations of diverticulitis. 8 What is a preceding factor for the development of Guillain-Barré syndrome? 9 Explain the pathophysiology of Guillain-Barré syndrome.10 Provide a cause of each stage of acute renal failure.11 What two (2) conditions must be present for a diagnosis of sepsis?12 What are the common sites where a sepsis infection originates?13 Define the term clinical pathway.14 What is the main aim of clinical pathways?15 For what clients are clinical pathways most appropriate?Critical Thinking Exercises1 You are looking after a client who has been admitted post a myocardial infarct. He is recovering post CABG surgery. Your client is the main income earner in his family and has three young children at home. a Identify physical issues for this client. b Identify psychological issues for this client. c List appropriate ongoing care including allied healthcare that this client will require.2 You receive handover from the morning nurse on one of your clients who is expected to be discharged this afternoon. Your client is a 39-year-old female admitted with a DVT who has responded well to treatment and will be transferred to the care of HITH. The nurse handing over to you reports that this morning the client complained of slight back and shoulder tip pain which was resolved with paracetamol. All paper work has been completed and the client is waiting for her discharge medications before she can leave. When you enter the client’s room, you find her pale and complaining of dyspnoea and chest pain. a What is your first action going to be? b What do you think has happened? c What sign did the morning nurse miss? d What diagnostic tests need to be done? sample proofs © Elsevier Australia
    • Acute care | Chapter 40 961References and Recommended Reading Haultain R, Weston K, Rolls S (2011) Realising enrolled nurses’ full potential, Kai Tiaki Nursing New Zealand 17(1):28–9Allen D, Gillen E, Rixson L (2009) Systematic review of the Hsu C, O’Connor M, Lee S (2009) Understanding of death effectiveness of integrated care pathways: what works, and dying for people of Chinese origin, Death Studies for whom, in which circumstances? Integrated Journal of 23(2):153–74 Evidence-based Healthcare 7:61–74 Kelly MA & McKinley S (2010) Patient’s recovery after criticalAnderson CM, Overend TJ, Godwin J et al (2009) Ambulation illness at early follow up, Journal of Clinical Nursing 19(5–6): after deep vein thrombosis: a systemic review, 691–700 Physiotherapy Canada 61(3):133–42 LeMone P Burke KM, Dwyer T et al (eds) (2011) Medical- ,Arnetz JE, Winblad U, Höglund AT et al (2010) Is patient Surgical Nursing. Critical Thinking in Client Care. Pearson, involvement during hospitalisation for acute myocardial Frenchs Forest, NSW infarction associated with post-discharge treatment Lipman M (2011) Diverticulitis reconsidered, Consumer Reports outcomes? An exploratory study, Health Expectations on Health 23:11 13(3):298–311 Lugg J (2010) Recognising and managing Guillain-BarréBacon S (2009) Understanding venous thromboembolism, syndrome, Emergency Nurse 18(3):27–30 Practice Nursing 20:334–41 Martin JM, Hart GK, Hick P (2010) A unique snapshot ofBlakeley S (ed) (2008) Renal Failure and Replacement intensive care resources in Australia and New Zealand, Therapies. Springer, London Anaesthesia & Intensive Care 38(1):149–58Carter K (2010) Identifying and managing deep vein Morrison R (2006) Venous thromboembolism: scope of the thrombosis, Primary Health Care 20(1):30–8 problem and the nurse’s role in risk assessment andCegarra-Navarro JG, Wensley AKP Sànchez-Polo MT (2011) , prevention, Journal of Vascular Nursing 24(3):82–90 Improving quality of service of home healthcare units Murphy F & Byrne G (2010) The role of the nurse in the with health information technologies, Health Information management of acute kidney injury, British Journal of Management Journal 40(2):30–8 Nursing 19(3):146–52Collins S (2009) Deep vein thrombosis—an overview, Practice Nankervis K, Kenny A, Bish M (2008) Enhancing scope of Nurse 37(9):23–5 practice for the second level nurse: A change processDay R (2009) Developing care pathways for hospice and to meet growing demand for rural health services, neurological care: Evaluating a pilot, British Journal of Contemporary Nurse 29(2):159–73 Neuroscience Nursing 5(2):79–84 Neuman MD, Archan S, Karlawish JH et al (2009) TheDavidson JE (2009) Family-centred Care. Meeting the needs relationship between short-term mortality and quality of of patients’ families and helping families adapt to critical care for hip fractures: A meta-analysis of clinical pathways illness, Critical Care Nursing 29(3):28–35 for hip fracture, Journal of the American Geriatrics SocietyDellacroce H (2009) Surviving sepsis: the role of the nurse, 57(11):2046–54 RN 72:16–21 O’Connor T (2010) Providing intensive care, Kai Tiaki NursingD’Entermont B (2009) Clinical pathways: the Ottawa hospital New Zealand 16(4):15–17 experience, Canadian Nurse 105:8–9 Own C, Hemmings L, Brown T (2009) Lost in translation.Department of Health, Victoria (2012) Hospital in the Home. Maximizing handover effectiveness between paramedics Online. Available: http://health.vic.gov.au/hith/ and receiving staff in the emergency department,Dougherty CM & Thompson EA (2009) Intimate partner Emergency Medicine Australasia 21:102–7 physical and mental health after sudden cardiac arrest and Otair H, Chaudhry M, Shaikh S et al (2009) Outcome of patients receipt of an implantable cardioverter defibrillator, Research with pulmonary embolism admitted to the intensive care in Nursing & Health 32:432–42 unit, Annals of Thoracic Medicine 4(1):13–16Duffy A, Payne S, Timmins F (2011) The Liverpool Care Pritchard J (2010) Guillain-Barré syndrome, Clinical Medicine Pathway: does it improve quality of dying? British Journal of 10(4):399–401 Nursing 20(15):942–6 Rogers J (2010) Risk assessment and treatment of venousEagar SC, Cowin LS, Gregory L et al (2010) Scope of practice thromboembolism, Emergency Nurse 18(8):24–6 conflict in nursing: A new war or just the same battle? Royal District Nursing Service (RDNS) (2011) Who We Are. Contemporary Nurse 36(1–2):86–95 Fact Sheet. Online. Available: www.rdns.com.au/media_Eron LJ (2009) Cellulitis and soft-tissue infections, American and_resources/media/Documents/2011%20Royal%20 College of Physicians ITC1:1–16 District%20Nursing%20Service%20Fact%20Sheet.pdfFarley A, McLafferty E, Hendry C (2009) Pulmonary embolism: Ruan X, Liu HN, Couch JP et al (2010) Recurrent cellulitis identification, clinical features and management, Nursing associated with long-term intrathecal opioid infusion Standard 23:49–50 therapy: A case report and review of the literature, PainFarrell M & Dempsey J (eds) (2011) Smeltzer & Bare’s Textbook Medicine 11(6):972–6 of Medical-Surgical Nursing, 2nd edn. Lippincott Williams & Schub E & Schub T (2011) Sepsis and Septic Shock. CINAHL Wilkins, Broadway, NSW Information SystemsGerber K (2010) Surviving sepsis: a trust wide approach. A Sheares K (2011) How do I manage a patient with suspected multi-disciplinary team approach to implementing evidence- acute pulmonary embolism? Clinical Medicine 11(2): based guidelines, Nursing in Critical Care 15(3):141–51 156–9Gould A, Ho KM, Dobb G (2010) Risk factors and outcomes Schub T, Caple C, Pravikott D (2011) Guillain-Barré Syndrome. of high-dependency patients requiring intensive care unit CINAHL Information Systems admission: a nested care-control study, Anaesthesia & Skott C & Lundgren SM (2009) Complexity and contradiction: Intensive Care 38(5):855–61 home care in a multicultural area, Nursing Inquiry 16(3):Harvard Women’s Health Watch (2011) Diverticular disease 223–31 prevention and treatment, Harvard Women’s Health Watch Steen C (2009) Developments in the management of patients 18:4–5 with sepsis, Nursing Standard 23(48):48–55 sample proofs © Elsevier Australia
    • 962 Unit 9 | Healthcare in specialised practice areasVandall-Walker V (2010) The work of family members: pushing episode of critical illness on subsequent hospitalisation: a our boundaries, Dynamics 21(2):39 linked data study, Journal of the Association of AnaesthetistsVanhaecht K, De Witte K, Panella M et al (2009) Do pathways of Great Britain and Ireland 65:172–7 lead to better organized care processes? Journal of Yaklin KM (2011) Acute kidney injury: an overview of Evaluation in Clinical Practice 15:782–8 pathophysiology and treatments, Nephrology NursingWarise L (2010) Update: Diuretic therapy in acute renal Journal 38(1):13–19 failure—a clinical case study, MEDSURG Nursing 19(3):149–52 Online ResourceWhitehead S (2010) Sepsis alert: recognition and treatment of a common killer, EMS magazine 39(6):29–37 Royal District Nursing Service: www.rdns.com.auWilliams TA, Knuiman MA, Finn JC et al (2010) Effects of an sample proofs © Elsevier Australia