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Contents

Foreword xvii Acknowledgements xviii List of contributors xix Quick reference to the procedure guidelines xxiii How to use your manual xxv About the companion website xxviii 1 The context of nursing 1 Overview 2 Background 2 Context of nursing 2 Evidence-based practice 7 Structure of the manual 9 Structure of the chapters 9 Finally 9 References 10 Part One Managing the patient journey 13 2 Admissions and assessment 15 Overview 16 Inpatient assessment and the process of care 16 Observation 24 Physical assessment 25 References 44 3 Discharge care and planning 47 Overview 48 Discharge care and planning 48 Discharging patients from hospital: internal procedures 49 Interface between primary and secondary care: external processes 56 Informal carers 62 The role of voluntary services 65 References 66 4 Infection prevention and control 69 Overview 70 Infection prevention and control 70 Hand hygiene 80 Personal protective equipment (PPE) 92 Specific patient-related procedures 107 Isolation procedures 111 Environmental hygiene and the management of waste in the healthcare environment 118 Prevention and management of inoculation injury 125 References 126 Part Two Supporting patients with human functioning 131 5 Communication, psychological wellbeing and safeguarding 133 Overview 134 Communication 134 Providing information and making shared decisions 147 Communicating with specific populations 151 Psychological wellbeing 157 Safeguarding, mental capacity and the Mental Health Act 180 References 199 6 Elimination 205 Overview 206 Normal elimination 206 Altered urinary elimination 212 Altered faecal elimination 243 Stoma care 264 References 277 7 Moving and positioning 283 Overview 284 Moving and positioning: general principles 284 Moving and positioning an unconscious patient 297 Moving and positioning a patient with an artificial airway 299 Moving and positioning a patient with respiratory compromise 303 Moving and positioning a patient with neurological impairment 307 Moving and positioning a patient with actual or suspected spinal cord compression or spinal cord injury 320 Moving and positioning a patient with raised intracranial pressure 330 Moving and positioning a patient with an amputation 331 References 336 8 Nutrition and fluid balance 339 Overview 340 Fluid balance 340 Nutritional status 357 Provision of nutritional support: Oral 365 Nutritional management of patients with dysphagia 371 Enteral tube feeding 372 Parenteral nutrition 395 References 398 9 Patient comfort and supporting personal hygiene 403 Overview 404 Personal hygiene 404 Sleep promotion in a hospitalized patient 416 Patient environment 418 Eye care 423 Ear care 433 Mouth care 437 References 450 10 Pain assessment and management 457 Overview 458 Pain 458 Pain management 467 Regional analgesia: local anaesthetic nerve blocks and infusions 473 Epidural analgesia 475 Entonox administration 485 Non-pharmacological methods of managing pain 489 References 492 11 Symptom control and care towards the end of life 497 Overview 498 End-of-life care 498 Symptom control 516 Terminal sedation 527 Care after death (last offices) 528 References 535 12 Respiratory care, CPR and blood transfusion 539 Overview 540 Respiratory therapy 540 Oxygen therapy 543 High-flow oxygen via a nasal cannula 552 Humidification 555 Non-invasive ventilation 556 Chest drain management 564 Tracheostomy and laryngectomy care 581 Basic life support 612 Transfusion of blood and blood components 626 References 650 Part Three Supporting patients through the diagnostic process 657 13 Diagnostic tests 659 Overview 660 Diagnostic tests 660 Blood sampling 664 Venepuncture: obtaining blood samples from a peripheral vein 667 Blood cultures 677 Cerebrospinal fluid obtained by lumbar puncture 679 Specimen collection: swab sampling 683 Specimen collection: urine sampling 692 Specimen collection: faecal sampling 698 Specimen collection: respiratory tract secretion sampling 700 Specimen collection: pleural fluid 702 Endoscopic investigations 702 Liver biopsy 708 Radiological investigations: X-ray 710 Magnetic resonance imaging (MRI) 710 Computed tomography (CT) 712 References 714 14 Observations 719 Overview 720 Observations 720 Pulse (heart rate) 723 Electrocardiogram (ECG) 730 Blood pressure 738 Respiration and pulse oximetry 745 Peak flow 757 Temperature 762 Urinalysis 768 Blood glucose 773 Neurological observations 781 References 796 Part Four Supporting patients through treatment 801 15 Medicines optimization: ensuring quality and safety 803 Overview 804 Medicines management 804 Self-administration of medicines 817 Controlled drugs 817 Routes of administration 827 Parenteral administration (injections and infusions) 854 Peripheral cannulas 898 Infiltration and extravasation 915 References 927 16 Perioperative care 937 Overview 938 Pre-operative care 938 Intraoperative care 973 Post-operative care 999 References 1022 17 Wound management 1029 Overview 1030 Wounds 1030 Pressure ulcers 1043 Surgical wounds 1053 Negative pressure wound therapy 1055 References 1058 Part Five Looking after ourselves so we can support patients 1061 18 Self-care and wellbeing 1063 Overview 1064 Self-care and wellbeing 1064 Mindfulness 1072 Eating and drinking 1073 Physical wellbeing and musculoskeletal health 1077 References 1081 Appendix: Standards of Proficiency for Registered Nurses 1085 List of abbreviations 1089 Index 1093

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