Andy Parry

How to use a self-inflating bag and face mask.

Abstract Rationale and key points This article aims to help nurses to open and maintain an adults airway while providing breaths using a self-inflating bag and face mask. Maintaining a patients airway is vital in the management of acute, life-threatening illnesses and injuries. ▶ The nurse should address airway compromise immediately since it is a major factor in acute deterioration and may develop rapidly. ▶ The nurse should perform the head tilt and chin lift manoeuvre, or the jaw thrust manoeuvre for patients with suspected cervical spine injury, to maintain airway opening. Reflective activity Clinical skills articles can help update your practice and ensure it remains evidence based. Apply this article to your practice. Reflect on and write a short account of: 1. What you have gained from this article. 2. How this article will influence your practice. Subscribers can upload their reflective accounts at: rcni.com/portfolio .

Airway management in the hospital environment

In the hospital environment, patients can deteriorate rapidly and for many different reasons. Maintaining a patients breathing is the main priority in any emergency situation, although achieving airway control can be difficult. All health professionals need to be able to undertake airway management safely. The key is a thorough assessment to ensure first of all whether the airway is patent (open and clear) or not. This article will discuss airway management, both acute and chronic, as well as associated nursing care.

Managing chronic obstructive pulmonary disease in the community setting

Chronic obstructive pulmonary disease (COPD) is an umbrella term used to describe respiratory diseases characterised by airway obstruction. COPD is now an established and significant chronic disease, killing over 30 000 people in the UK every year. According to the World Health Organization, COPD will become the third biggest killer in the world by 2020. The financial and human cost of the disease is huge. To appreciate the pathophysiology of obstructive pulmonary diseases, it is first necessary to understand a number of important lung concepts. This article discusses the pathophysiology of COPD, highlighting the main mechanisms involved, provides an outline of the associated signs, symptoms and treatment of COPD and explore how health care professionals in the community/residential care settings can help manage and improve the quality of life for patients with COPD.

How to manage an arterial catheter.

 Any management of the arterial catheter should be explained to the patient to ensure they understand what is involved and to gain informed verbal consent for any action, where possible.  The arterial catheter should be inserted by an appropriately trained practitioner, usually an anaesthetist or a critical or emergency care doctor.  The practitioner inserting the arterial catheter requires the nurse’s assistance to hold the patient’s hand and forearm steady with the wrist slightly extended.  The nurse should ensure the necessary equipment is available, including: – An arterial catheter. – A catheter dressing. – A dressing pack. – 2% chlorhexidine in 70% alcohol. – Sterile gloves. – 2mL of 2% lidocaine. – 2mL syringe. – 27 gauge subcutaneous needle (smaller gauges may be used) – A transducer set. – A transducer plate or holder. – 500mL normal saline (0.9% sodium chloride), or heparinised saline depending on local protocols. – A pressure bag. – A pressure monitoring lead. – A multifunction monitor. – A spirit level. – Arterial catheter labels.

Importance of early mobilisation in critical care patients

of any critical care team is to minimise length of admission and expedite safe discharge from hospital. In reality, the journey for a critical care patient is fraught with risks involving both predictable and some unforeseen complications. From my experiences on critical care units, it quickly became apparent that maintaining a progressive path towards recovery was one of the greatest challenges in patient care. This could be attributed to the complex and systemic nature of critical illness, which will inevitably result in continual changes in the patient’s condition. These circumstances often leave the patient with life-changing chronic conditions, such as psychological issues or functional disabilities after weeks or months of immobility. Indeed, research strongly suggests that lean muscle mass is significantly diminished after only 10 days of bed rest, which, while it did not always affect functional ability, did have a detrimental effect on muscle power and stamina (Kortebein et al, 2008). Unsurprisingly, this effect was magnified in older patients, where muscle mass is lost at a greater rate than in their younger counterparts (English and Paddon-Jones, 2010). Every critical care nurse will be familiar with this process. It is always distressing to observe a patient overcome with exhaustion while attempting the most simple of movements, such as rolling in bed. However, we must not forget that we are only observing the early stages of their difficulties and for some the road to recovery may never be fully travelled. There is evidence to suggest that critical care patients remain unemployed 12 months after hospital discharge with a significant proportion still struggling to sustain employment after 5 years (Schweickert and Kress, 2011). The reason is that muscle-mass loss has left them with a chronic reduction in exercise tolerance, Importance of early mobilisation in critical care patients

How to perform chest compressions.

Abstract Rationale and key points This article outlines the correct and effective technique for performing chest compressions for adults in cardiac arrest. Correct performance of chest compressions relies on various factors that are within the control of the nurse. Therefore, it is essential that nurses have comprehensive knowledge of this vital skill. Techniques that deviate from evidence-based recommendations may lead to an ineffective resuscitation attempt and unfavourable outcomes for patients. ▶ Accurate hand placement on the patients chest is vital to ensure the heart is compressed effectively. ▶ Adhering to the recommended depth and rate of compression is fundamental to perfuse the myocardium. ▶ Interruptions to chest compressions should be kept to a minimum. Reflective activity Clinical skills articles can help update your practice and ensure it remains evidence based. Apply this article to your practice. Reflect on and write a short account of: 1. Your chest compression technique and consider if it follows the evidence base provided in this article. 2. How this article will change your practice. 3. The need to update your cardiopulmonary resuscitation skills. Subscribers can upload their reflective accounts at: rcni.com/portfolio .