Critically ill patients are defined as those patients who are at high risk of actual or potential life- threatening health problems. A critically ill patient is one who has an immediate requirement for any form of organ support (intubation, ventilation or inotropes), or is likely to suffer acute cardiac,
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respiratory or neurological deterioration requiring such support. The more critically ill the patient is, the more likely he or she is to be highly vulnerable, unstable and complex, thereby requiring intense and vigilant nursing care (American Association of Critical Care Nurses 2008).
Family-witnessed resuscitation is one way of supporting and helping families during a critical or life- threatening event. The family become part of the team by providing support to the patient, which can in turn relieve the sense of helplessness often felt by family members, and enhance communication (Kingsnorth-Hinrichs 2010).
Autopsy remains a very important tool to establish the cause of death in patients dying in ED. The concordance between the ante mortem presumed cause of death recorded in the patient’s notes and the real cause is often poor (Vanbrabant et al. 2004).
Conclusion
During a clinical placement nursing students will experience or witness the emergency care of patients with a wide variety of acute and possibly life-threatening trauma injuries, acute medical/surgical and behavioural conditions. They will gain an understanding of the role of the nurse in the emergency care team, and observe or participate in the skills of triage, rapid assessment, resuscitation, care of the dying/dead patient and support of family and friends.
Now visit the companion website and test yourself on this chapter:
www.wileyfundamentalseries.com/medicalnursing
Visit www.wileyfundamentalseries.com/medicalnursing and read Reflective Question 10.3 to think more about this topic.
References
American Association of Critical Care Nurses (2008) Scope and Standards for Acute and Critical Nursing Practice AACN Critical Care Publication, CA. Retrieved 4th June 2013 from http://www.aacn.org/wd/practice/docs/130300 -standards_for_acute_and_critical_care_nursing.pdf.
American College of Surgeons (2004) Advanced Trauma Life Support, 7th edn. Chicago: American College of Surgeons.
American Heart Association (2010) Guidelines for CPR & ECC. Dallas: American Heart Association.
Blank-Reid, C. & Reid, P.C. (2010) Family presence during resuscitation In: Kunz Howard, P. & Steinmann, R.A. (eds), Sheehy’s Emergency Nursing Principles and Practice, 6th edn. St Louis: Mosby.
Bullard, M.D., Unger, B., Spence, J., Grafstein, E. & the Canadian Triage and Acuity Scale National Working Group (2008) Revisions to the Canadian Emergency Department Triage. Canadian Journal of Emergency Medicine, 10(2):136–42.
College of Emergency Medicine, Emergency Nurse Consultant Association, Faculty of Emergency Nursing, Royal College of Nursing (2011) Triage Position Statement. Retrieved 4th June 2013 from www.collemergencymed.ac.uk/
code/document.asp?ID=5898.
Commonwealth Department of Health and Family Services (1997) The Australian National Triage Scale: A User Manual. Melbourne: Australian Government Publishing Service.
Dawood, M. & Holt, L. (2008) Skeletal injuries. In Dolan, B. & Holt, L. (eds), Accident and Emergency Nursing: Theory into Practice, 2nd edn (pp. 79–122). London: Elsevier.
East, J. (2010) Acute emergency situations. In: Creed, F. & Spiers, C. (eds), Care of the Acutely Ill Adult: An Essential Guide for Nurses (pp. 385–425). New York: Oxford University Press.
Joint Royal Colleges Ambulance Liaison Committee (2006) UK Ambulance Service Clinical Practice Guidelines.
Retrieved 9th July 2012 from http://www2.warwick.ac.uk/fac/med/research/hsri/emergencycare/
prehospitalcare/jrcalcstakeholderwebsite/guidelines.
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Jones, G. (2008) Nursing in emergency care. In: Dolan, B. & Holt, L. (eds), Accident and Emergency Nursing: Theory into Practice, 2nd edn (pp. 1–16). London: Elsevier.
Kingsnorth-Hinrichs, J. (2010) Family presence during resuscitation. In: Kunz Howard, P. & Steinmann R.A. (eds), Sheehy’s Emergency Nursing Principles and Practice, 6th edn (pp. 148–54). St Louis: Mosby.
Krug, E.G., Sharma, G.K. & Lozano, R. (2000) The global burden of injuries. American Journal of Public Health, 90:523–6.
Mackway-Jones, K., Marsden, J. & Windle, J. (2006) Emergency Triage: Manchester Triage Group, 2nd edn. Oxford:
Blackwell Publishing.
Mosby (2009) Mosby’s Medical Dictionary. St. Louis, Elsevier.
National Institute for Health and Clinical Excellence (2007) Head Injury: Assessment in the Emergency Department.
NICE Guideline No. 56. London: NICE.
Platt, R. (1962) Platt Report. British Medical Journal, 2(5263):1341–2.
Pre-Hospital Emergency Care Council (2008) A View of Pre-Hospital Emergency Care in Ireland. Naas: PHECC.
Resuscitation Council (UK) (2010) Resuscitation Guidelines. London: Resuscitation Council.
Sands, N. (2007) An ABC approach to assessing the risk of violence at triage. Australasian Emergency Nursing Journal, 10(3):107–9.
Small, V. (2008) Surgical emergencies. In: Dolan, B. & Holt, L. (eds), Accident and Emergency Nursing: Theory into Practice, 2nd edn. London: Elsevier.
Steinmann, R.A. (2010) Patient Assessment In: Kunz Howard, P. & Steinmann R.A. (eds), Sheehy’s Emergency Nursing Principles and Practice, 6th edn (pp. 73–82). St Louis: Mosby.
Vanbrabant, P., Dhondt, E. & Sabbe, M. (2004) What do we know about patients dying in the emergency depart- ment? Resuscitation, 60(2):163–70.
Wraa, C. (2010) Burns. In: Kunz Howard, P. & Steinmann R.A. (eds), Sheehy’s Emergency Nursing Principles and Practice, 6th edn (pp. 340–54). St Louis: Mosby.
Part 2
Adult Medical and Surgical Nursing
Chapter 11 Nursing care of conditions related to the skin 156 Chapter 12 Nursing care of conditions related to the respiratory system 176 Chapter 13 Nursing care of conditions related to the circulatory system 210 Chapter 14 Nursing care of conditions related to the digestive system 240 Chapter 15 Nursing care of conditions related to the urinary system 262 Chapter 16 Nursing care of conditions related to the endocrine system 298 Chapter 17 Nursing care of conditions related to the neurological system 326 Chapter 18 Nursing care of conditions related to the immune system 364 Chapter 19 Nursing care of conditions related to haematological disorders 386 Chapter 20 Nursing care of conditions related to the musculoskeletal system 422 Chapter 21 Nursing care of conditions related to the ear, nose, throat and eye 448 Chapter 22 Nursing care of conditions related to reproductive health 478
Nursing care of conditions related to the skin
Zena Moore 1 and Julie Jordan O’Brien 2
1Faculty of Nursing and Midwifery, Royal College of Surgeons in Ireland, Dublin, Ireland
2Beaumont Hospital, Dublin, Ireland
11
Contents
Introduction 157
The structure and function of the skin 157 Maintaining normal tissue integrity 158
Skin assessment 158
Treatments 160
Common skin diseases 161
Wound healing 165
Wound assessment 167
Wound management 168
Surgical wounds 169
Pressure ulcers 170
Conclusion 172
References 173
Having read this chapter, you will be able to:
•
Understand and describe the structure and function of the skin•
Understand and describe the pathophysiology of wound healing•
Understand the key components in the assessment of patients with altered tissue integrity•
Understand and describe the most commonly encountered dermatological disorders•
Describe the importance of wound assessment in determining nursing priorities for managing patients with wounds•
Understand the key factors in preventing and managing woundsLearning outcomes
Fundamentals of Medical-Surgical Nursing: A Systems Approach, First Edition. Edited by Anne-Marie Brady, Catherine McCabe, and Margaret McCann.
© 2014 John Wiley & Sons, Ltd. Published 2014 by John Wiley & Sons, Ltd.
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Introduction
This chapter provides an overview of the anatomy, physiology and related disorders of the skin. The nursing assessment, diagnosis and management of skin disorders are also outlined. Case scenarios relating to skin disorders are provided to enhance learning through reflection and discussion.