Cardiovascular assessment and care

Cardiovascular disease remains a major cause of death in the United Kingdom. The early recognition of cardiovascular deterioration in the acutely ill patient is an essential skill for practitioners in acute care. This chapter offers an overview of the cardiovascular system and normal physiological and compensatory mechanisms which support cardiovascular function. Cardiac assessment is explored in some detail including symptom review, cardiac monitoring, and chest pain assessment. The complex subject of arrhythmia interpretation and management is reviewed in some depth. The chapter concludes with a focus on the management of acute coronary syndromes, heart failure, and cardiogenic shock. All three conditions are potentially life-threatening and rapid assessment and treatment is essential to prevent mortality; evidence-based management of these conditions is considered in detail within this chapter.

Assessment and care of the patient with sepsis

There has been considerable recent focus on sepsis in both the clinical arena and within the general public to raise awareness of the importance of early recognition of this potentially life-threatening condition. The early recognition of sepsis by ward nurses can both reduce progression of this lethal disease and improve survival for patients in hospital. This chapter focuses on definitions of sepsis and septic shock, physiological changes associated with inflammatory and cardiovascular responses to sepsis, and a clinical assessment framework to guide practice. There is also a discussion of the use of scoring systems and how to escalate support mechanisms for patients with sepsis and septic shock.

Acute kidney injury

Assessing and supporting kidney function is an integral aspect of acute care. AKI (acute kidney injury) may cause sudden, life-threatening biochemical disturbances and hence the early identification, escalation to treatment and management of AKI is an important focus in the management of acutely ill patients. This chapter reviews kidney anatomy and physiology followed by the nursing care involved in assessing and managing abnormal kidney function. The focus is on relevance and applicability to clinical practice and understanding of kidney function as protective measures and early detection of anomalies greatly reduces the risk of acute kidney injury. Common renal pathologies are explored and the role of renal replacement therapies is discussed.

Neurological care

This chapter explores neurological acute care and includes discussion of normal physiology and physiological changes following illness and injury. In order to understand how to assess and manage the patient with neurological conditions it is essential to have an understanding of the structure and function of the brain and how injury/illness can affect this. Additionally, the chapter explains the importance of accurate and timely neurological assessment and specific nursing care of patients with neurological injury. It emphasizes the need for prompt intervention and appropriate escalation if patients exhibit signs of deterioration. Common neurological conditions of stroke, head injury, and epilepsy are discussed.

Acute emergency situations

An essential part of nursing in an acute care area is to be fully prepared to deal promptly and effectively with any acute emergency situation. More acutely ill patients are being cared for within ward environments, which place an ever-increasing need for staff to be competent and confident in the care and management of those at risk of cardiac arrest. The importance of a multidisciplinary and coordinated response to acute emergencies is explored in this chapter which focuses on using evidence-based resuscitation procedures. Early identification of peri-arrest arrhythmias and the management of patient in cardiac arrest to maximize patient survival are the cornerstones of this chapter. There is also brief discussion of the utility of cardiac pacing and cardioversion and the management of the patient with anaphylaxis.

Acute care and failure to rescue

The last decade has seen significant changes in management and care of patients in the United Kingdom who are acutely ill. Increasing pressures on hospital beds has meant the patients are discharged earlier and sometimes admitted later to the hospital environment, resulting in an overall increased acuity in hospital wards. This chapter discusses the factors that have impacted upon the delivery of acute care in hospital environments. It looks at the concept of failure to rescue and the role of human factors in delivery of patient care. It explores the need for an increased focus on patient safety in acute care and considers tools that can facilitate the delivery of effective patient care.

Respiratory assessment and care

Respiratory conditions are a common complication for the acutely ill patient. Early recognition of the onset of a respiratory crisis is fundamental to prevent further deterioration of the acutely ill patient. This chapter provides a discussion of the respiratory system and the physiological mechanisms which control respiratory function with a useful overview of common respiratory symptoms. The principles of arterial blood gas analysis, respiratory support mechanisms, and tracheostomy care precedes a discussion of three commonly encountered respiratory disorders; asthma, COPD, and pneumonia, with focus upon nursing and medical support to support patients with these acute illnesses. A large proportion of emergency admissions to acute care wards are due to these diseases and thus a good understanding of the assessment and management of these conditions is essential.

The care of patients with gastrointestinal disease and nutritional support for the acutely ill patient

Acutely ill patients are often admitted to hospital with gastrointestinal conditions, in particular pelvic and abdominal pain. It is therefore essential that nurse has an understanding of the factors that impact on gut function. This chapter will therefore provide an overview of the gastrointestinal (GI) system and explore the normal anatomy and physiology of the GI tract and the accessory organs (liver, gall bladder, and pancreas). It explores the role of the nurse in caring for patients with nausea and vomiting, diabetes mellitus, and the importance of nutritional assessment and management during episodes of acute illness.

Pain assessment and management in acute care

This new chapter highlights the importance of recognizing, assessing, and managing patients in pain safely in the acute care setting, and particularly when they are acutely ill. It explains pain theories, the importance of assessment and management of pain and explores the use of pharmacological, non-pharmacological and invasive analgesic techniques during acute care: which include the use of patient controlled analgesia (PCA); and regional analgesia including spinals, epidurals and continuous perineural blockade (CPNB). The use of intravenous lidocaine and plasters are also discussed.

Planning for emergency care and treatment when recovery is uncertain

Managing patients with chronic and frailty conditions is complex and planning their goals of care and treatment may need adapting, particularly for an acute deterioration. Equally the family will need considerable support and robust communication strategies are imperative in these situations. This chapter highlights the importance of good leadership, decision-making, and care planning for patients within the context of the multidisciplinary team. This chapter explores the more complex process of advanced assessment, planning, and communication skills that may be required when caring for acutely ill adults. It discusses ethical dilemmas where treatment is withdrawn or withheld. The chapter explains the role of the acute care nurse as an essential member of the healthcare team and as an advocate for the patient and family.