Pain management

121

122

important to assess the nature and cause of any pain, and a number of tools have been devised to establish severity of pain, including visual and verbal pain scales. As with any drugs that are adminis- tered to a patient, there are a number of issues to consider, including what analgesic drugs are avail- able, the pharmacology of these drugs, their indications and contraindications, and also their interactions.

Patients who have been administered opioids will need to be closely monitored for a longer period of time in recovery as opioids can have a number of adverse effects, including respiratory depression and nausea and vomiting.

Any drugs administered in the recovery area should be documented in the patient’s recovery care plan. Details required include the drug administered, the dose of the drug, the route by which it was delivered and the time at which it was delivered This record will then be signed by the person who administered the drug.

Specific criteria from PACU are often utilised in recovery and should be met prior to the patient returning to the ward.. These criteria are variable and are adapted for individual recovery areas, often depending on the types of patient and the surgical procedures undertaken. They offers guidance (Asso- ciation of Anaesthetists of Great Britain and Ireland, 2001) on the minimum safe requirements for vital signs, including:

•

conscious level;

•

oxygen saturation levels and respiratory rate;

•

blood pressure;

•

heart rate;

•

temperature;

•

pain and PONV scores;

•

urine output in catheterised patients.

To complete the patients’ journey through the theatre department, a comprehensive and succinct handover to the ward staff is necessary. This is carried out verbally as well as being documented in the patient’s notes. It will include all vital signs, any infusions (epidurals, intravenous lines, etc.) and infor- mation relating to the dressings, drains and irrigation systems used intraoperatively.

Conclusion

The role of the nurse working in the operating theatre is multifaceted, including patient assessment before, during and after surgery, advocacy, risk management and quality assurance. Providing an effi- cient and safe environment for patients and staff requires that members of the multidisciplinary team work and communicate collaboratively. It also requires the use of clearly defined and documented local, national and/or international policies by all those involved in providing this service.

Now visit the companion website and test yourself on this chapter:

www.wileyfundamentalseries.com/medicalnursing

123

References

Association of Anaesthetists of Great Britain and Ireland (2001) Immediate Post Anaesthetic Care. London: AAGBI.

Association of Anaesthetists of Great Britain and Ireland (2010) AAGBI Safety Guideline. Management of Severe Local Anaesthetic Toxicity. London: AAGBI.

Avard, B., McKay, H., Slater, N., Lamberth, P., Daveson, K. & Mitchell, I. (2011) Training Manual for the National Early Warning Score and associated Education Programme. Dublin: Health Service Executive.

Davey, A. & Ince, C.S. (2000) Fundamentals of Operating Theatre Practice. Cambridge: Cambridge University Press.

Gilmour, D. (2005) Infection control principles. Cited in: Woodhead, K. & Wicker, P. (eds) A Textbook of Perioperative Care (p. 89). Edinburgh: Elsevier Churchill Livingstone.

Gruendemann, B. & Mangum, S.S. (2001) Infection Prevention in Surgical Settings. St Louis: WB Saunders.

Gwinnutt, C. (2008) Clinical Anaesthesia, 3rd edn. Oxford: Wiley & Sons.

Health Service Executive (HSE) (2011) Training Manual for the National Early Warning Score and associated Educa- tion Programme. Retrieved 22nd May 2013 from http://www.hse.ie/eng/about/Who/clinical/natclinprog/

acutemedicineprogramme/earlywarningscore/compass.pdf.

National Institute for Health and Clinical Excellence (2010) CG92 Venous Thromboembolism – Reducing the Risk: Full Guideline. Clinical Guideline No. 92. Retrieved 20th May 2013 from http://guidance.nice.org.uk/CG92/Guidance/

pdf/English.

National Institute for Health and Clinical Excellence (2008) Perioperative Hypothermia (Inadvertent): Full Guideline.

Clinical Guideline No. 65. Retrieved 20th May 2013 from http://guidance.nice.org.uk/CG65/Guidance/pdf/

English.

National Patient Safety Agency (2005) Annual Report and Accounts. London: The Stationery Office.

Rees, J.E. (2003) Early Warning Scores. Update in Anaesthesia 17(10). Retrieved 6th November 2011 from http://

www.nda.ox.ac.

Rowley, S., Clare, S., Macqueen, S. & Molyneux, P. (2010) ANTTV2: an updated practice framework for aseptic tech- nique. British Journal of Nursing, 19(5):s5–10.

Smith, C.(2005) Care of the patient undergoing surgery. Cited in Woodhead, K. & Wicker, P. (eds), A Textbook of Perioperative Care (pp. 161–80). Edinburgh: Churchill Livingstone.

Subbe, C.P., Kruger, M., Rutherford, P. & Gemmel, L. (2001) Validation of Modified Early Warning Scores in Medical Admissions. Retrieved 6th November 2011 from http://www.qjmed.oxfordjournals.org.

Wicker, P. & Nightingale, A. (2010) Patient care during surgery. Cited in Wicker, P. & O’Neill, J. (eds), Care of the Perioperative Patient (pp. 339–78). Oxford: Wiley Blackwell.

Wicker, P. & O’Neill, J. (2010) Care of the Perioperative Patient, 2nd edn. Oxford: Wiley Blackwell.

World Health Organization (2009) Guidelines for Hand Hygiene in Health Care. Retrieved 20th May 2013from http://

whqlibdoc.who.int/publications/2009/9789241597906_eng.pdf.

World Health Organization (2008) WHO surgical safety checklist and implementation manual Retrieved 20th May 2013 from http://who.int/patientsafety/safesurgery/ss_checklist/en/.

Principles of

high-dependency nursing

Tina Day

Florence Nightingale School of Nursing and Midwifery, King’s College London, London, UK

9

Contents

Introduction 125

The high-dependency environment 125 Current policy in high-dependency care 125 Technological developments in

high-dependency care 126

The role of the nurse as a member of the

high-dependency team 126

Nursing assessment and monitoring of the

highly dependent patient 127

Respiratory assessment, monitoring and

intervention 128

Cardiovascular assessment, monitoring and

intervention 132

Neurological assessment, monitoring and

intervention 135

Conclusion 138

References 138

Having read this chapter, you will be able to:

•

Understand the role and function of high-dependency care in the UK

•

Recognise early signs of deterioration and identify appropriate nursing interventions

•

Demonstrate an understanding of how to assess a patient’s respiratory, cardiovascular and neurological status

•

Discuss interventions for a compromised respiratory, cardiovascular and neurological status

Learning 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.

125

Introduction

Critical care is essential and costs the National Health Service (NHS) over £700 million per year (Depart- ment of Health 2010). In August 2010, there were around 3463 adult critical care beds across the UK.

This included both intensive care and high-dependency beds (Department of Health 2010) and repre- sented a 56% increase in the number of open and staffed beds since data collection commenced in 2000. It is also well recognised that the cost of critical care has continued to increase. The cost of a patient occupying a high-dependency bed is six times that of a ward bed.