Contributors xix

Preface xxv

Acknowledgements xxvii

How to use your textbook xxix

About the companion website xxxi

Chapter 1 The critical care unit 1
Vikki Park

Introduction 2

Levels of care 2

The critical care environment 2

Critical care patients 3

Level 1 care 4

Level 2 care 4

Level 3 care 4

Critical care competence 5

The interprofessional team 6

Communication 7

Ways of working 7

Understanding philosophies of care 8

Humanising critical care 8

Surviving critical care 9

Death in critical care 9

Resilience 9

Nursing considerations and recommendations for practice 11

Future challenges 11

Conclusion 11

References 12

Chapter 2 Organisational influences 14
Vikki Park

Introduction 15

The four UK nations 15

Legislation 15

Professional Statutory Regulatory Bodies (PSRBs) 15

Shared decision making 16

Capacity for shared decision making 16

Confidentiality 17

Decisions relating to end-of-life care 17

Risk management 18

International influences 18

National influences 18

UK government organisations 18

Networks 19

National guidelines 20

Quality assurance 20

Local policies 21

Nursing considerations and recommendations for practice 21

Conclusion 21

References 22

Chapter 3 Legal and ethical issues 24
Leonie Armstrong, Tracey Carrott, and Jacqueline Newby

Introduction 25

Confidentiality 25

End-of-life care and best interest decisions 26

Ethical themes 27

Mental Capacity Act 27

Organ donation 29

Consent (authorisation in Scotland) for organ donation 30

First person consent 31

First person opt-in 31

First person opt-out 31

Appointed/nominated representative (not Scotland) 31

Deemed consent 31

The ethics of deemed consent 32

Consent from a person in the highest-ranking relationship 32

Cadaveric organ donation 33

The organ donation process 33

Post organ retrieval 34

Organ allocation 34

Conclusion 35

References 35

Chapter 4 Professional issues in critical care 37
Aurora Medonica

Introduction 38

Opportunities for learning 38

NMC Code in critical care units: journey to independent, safe practice 38

The core principles 39

UK National Competency Framework: critical care 41

Development of critical thinking in healthcare 42

The prioritising process 42

Support systems: the student 44

Conclusion 44

References 45

Chapter 5 Using an evidence-based approach 46
Sadie Diamond-Fox and Alexandra Gatehouse Introduction 47

What is evidence-based practice (EBP)? 47

Step 1: formulating a clinical question - the PICO method 48

Step 2: locating the evidence/research: performing a systematic literature review 48

Step 3: critical appraisal and the hierarchy of evidence 49

Step 4: extracting the most relevant and useful results 51

Step 5: implementing research into practice 52

Quality healthcare in critical care 53

Clinical audit and quality improvement 53

Research and development in critical care 55

Conclusion 56

References 56

Chapter 6 Nursing care 58
Sarah Crowe and Fiona McLeod

Introduction 59

Standards of care 59

Physical care 63

Mobility 66

Critical care bundles 67

Conclusion 67

References 68

Chapter 7 Skin integrity 70
Victoria Clemett

Introduction 71

Anatomy and physiology of the skin 71

Impact of ageing on skin and tissue integrity 71

Pressure ulcers 71

Nursing assessment 75

Prevention of pressure ulcers 76

Management of pressure ulcers 79

Wound healing 79

Patient factors that affect wound healing 79

Nursing assessment 79

Recognising wound infection 81

Management of non-healing wounds 83

Conclusion 83

References 84

Chapter 8 Shock 86
Barry Hill

Introduction 87

Shock 87

Hypovolaemic shock 87

Blood analysis 88

Multiple organ dysfunction syndrome 89

Staging of hypovolaemic shock 89

Principles of managing hypovolaemic shock 90

Fluid resuscitation 91

Training and education for Registered Nurses 91

Cardiogenic shock 91

Obstructive shock 93

Altered pathophysiology 93

Tension pneumothorax 94

Cardiac tamponade 94

Pulmonary embolism (PE) 94

Distributive shock 95

Conclusion 96

References 97

Chapter 9 Communication 98
Paul Jebb

Introduction 99

Communicating effectively with patients 100

Communicating during a pandemic 100

Communication with families 102

Conclusion 103

References 103

Chapter 10 Electronic health records 105
Timothy Kuhn

Introduction 106

Digitisation within healthcare 106

Understand your responsibilities and the law in relation to record keeping 107

Intensive Care Society Guidelines 107

Understanding the different types of EHRs in critical care and how they are used 108

Understanding what patient data is available within the critical care unit and how this is recorded in an electronic health record 109

Understanding how EHRs are used in critical care audit and research 110

Understanding the benefits and barriers to EHRs 112

Conclusion 113

References 113

Chapter 11 Pharmacology 115
Sadie Diamond-Fox and Alexandra Gatehouse

Introduction 116

Principles of pharmacology and pharmacotherapy 116

The processes of drug therapy 116

Medication safety in critical care 119

Drugs and dialysis 120

Core drugs utilised within critical care 120

Respiratory drugs 120

Cardiovascular drugs 122

Haematological drugs 126

Renal drugs 126

Fluids and electrolytes 127

Gastrointestinal drugs 128

Insulin 129

H2-histamine antagonists and proton pump inhibitors (PPIs) 129

Anti-emetics 129

Laxatives and anti-diarrhoeal drugs 130

Neurological drugs 130

Analgesics 130

Opioids 130

Non-opioid analgesics 130

Epidural and regional anaesthesia 130

Sedatives and anxiolytics 131

Muscle relaxants 131

Anticonvulsants 132

Antideliriogenics 132

Immunomodulatory drugs 132

Antibacterial agents 132

Antifungals 133

Antiviral drugs 134

Corticosteroids 134

Immunoglobulins 134

Toxicology 134

Conclusion 135

References 135

Chapter 12 Anaesthesia and sedation 138
Lorraine Mutrie and Iain Carstairs

Introduction 139

Indications for sedation and anaesthesia 139

Anaesthetic and sedative medications 142

Sedative drugs 142

Neuromuscular blocking agents and reversal agents 143

Sedation management 145

Conclusion 147

References 148

Chapter 13 Medicines management and drug calculations 150
Jan Guerin

Introduction 151

Purpose of pharmacological interventions in the critically ill adult patient 152

Legal and professional issues 152

Collaborative multidisciplinary team working 154

Medication errors 154

Overview of routes and methods of administering medications in CCU 155

Rights of medication administration 158

Managing and reporting a medication error 159

Anaphylaxis 160

Pathophysiology and clinical manifestations of DIA 160

Management for DIA 160

Medication calculation formulae 160

Displacement 165

Conclusion 165

References 166

Chapter 14 Neurological critical care 167
Samantha O'Driscoll

Introduction 168

Neurological anatomy and physiology 168

Central nervous system 169

Neurological assessment 174

Signs and symptoms of increasing ICP 179

Primary and secondary brain injury 180

Management of raised ICP 180

Nursing care 181

Transfer 182

Conclusion 184

References 184

Chapter 15 Cognition 186
Barry Hill and Sadie Diamond-Fox

Introduction 187

Cognitive impairment 187

Causes of cognitive impairment 187

Signs of cognitive impairment 188

Delirium 188

Risk factors 190

Management of delirium 191

Sleep 193

Assessment of sleep in ICU 193

Conclusion 195

References 195

Chapter 16 Respiratory care: intubation and mechanical ventilation 197
Barry Hill and Lorraine Mutrie

Introduction 198

Respiratory failure 198

Hypoventilation 198

Ventilation/perfusion (V/Q) mismatch 199

Work of breathing 199

Arterial blood gases (ABGs) 200

Non-invasive

ventilation (NIV) 201

Continuous positive airway pressure (CPAP) 204

High flow nasal oxygen 204

Intubation 204

Mechanical ventilation 206

Artificial ventilation 207

Minute ventilation (Vm) 207

Fraction of inspired oxygen 207

Positive end-expiratory

pressure (PEEP) 207

Volume control 207

Pressure control 207

Inspiratory:Expiratory (I:E) ratio 208

Inverse ratio 208

Synchronisation 208

Humidification 208

Benefits of mechanical ventilation 208

Risks of mechanical ventilation 208

Ventilator care bundles 209

Prone positioning 209

Prone positioning in COVID-19 209

Weaning from mechanical ventilation 210

Conclusion 210

References...