Intrapleural chest drainage.

Abnormal fluid or air between the pleura results in respiratory distress and can cause death, if untreated. Intrapleural chest drains are used to remove abnormal accumulations of fluid or air. Caring for patients with intrapleural chest drains requires knowledge and skill to ensure patient safety. This article describes the pathophysiology, treatment and nursing care of patients who require intrapleural chest drains.

An introduction to electrocardiogram interpretation: part 1.

This article describes how to interpret the single-lead electrocardiogram (ECG). The author also describes cardiac electrophysiology and how this is represented by ECG graphs. Part 2 of this article, to be published in the next issue, will describe 12-lead ECGs and acute coronary syndromes.

Introduction to electrocardiogram interpretation: part 2.

Twelve-lead electrocardiograms (ECGs) record 12 different views of cardiac electrical activity, or leads. They therefore provide more information than bedside monitors, which usually record one or sometimes two leads. Many acutely ill patients have 12-lead ECGs recorded either on admission to hospital, before undergoing operations or when specific cardiac concerns have arisen. Traditionally, ECGs have aided clinical diagnoses and, by learning how to understand and interpret them, nurses will know when they need to summon expert help. This article describes what each of the 12 leads represents, outlines the main indications for recording 12-lead ECGs and identifies likely causes of error in interpreting them.

An introduction to electrocardiogram interpretation: part 2.

Twelve-lead electrocardiograms (ECGs) record 12 different views of cardiac electrical activity, thus providing more information than bedside monitors, which usually display one or sometimes two leads. Many acutely ill patients have 12-lead ECGs recorded on admission to hospital and at other times, such as pre-operatively or when there are specific cardiac concerns. ECGs have traditionally been an aid to medical diagnosis, but understanding and being able to interpret them enables nurses to summon help urgently if needed. This article describes what each of the 12 leads represents, outlines the main indications for recording 12-lead ECGs and identifies likely causes of error.

An introduction to electrocardiogram interpretation: Part 1.

This article describes how to interpret the single-lead electrocardiogram (ECG). The author also describes cardiac electrophysiology and how this is represented by ECG graphs. Part 2 of this article, to be published next week, will describe 12-lead ECGs and acute coronary syndromes.

Caring for patients receiving oxygen therapy.

Although respiratory disease can occur at any age, older people are more likely to suffer both acute and chronic respiratory disease. Without sufficient oxygen, cells fail and die, and extensive cell death causes body systems to fail. This article considers the principles of short-term oxygen therapy and offers guidance to nurses who may be required to administer such treatment in their work with older people.

Responsible and accountable.

Healthcare assistants are valuable members of the multi-disciplinary team, using many skills outlined in previous articles in this series. But anyone exceeding the limits of their skills can cause harm and may be called to account. This article explains how everyone is accountable.

Role of the lecturer practioner: 2.

The first part of this article examined the development of the role of the lecturer practitioner within nursing. This article discusses the qualifications needed for the role, the conflicts that may arise as a result of the dual nature of the role, and the career structure.

Arterial blood gas analysis.

With increasing use of arterial blood gas analysis in various ward and other hospital settings to aid medical diagnosis and management, nurses who can interpret results are often able to initiate earlier interventions and understand the reasons for medical interventions. This article enables nurses to interpret such results.

Anthrax: forms, symptoms and treatment.

BACKGROUND: This article examines the history of anthrax, the organism, the different forms of human anthrax, its symptoms and treatment. Set against fears of a bioterrorist attack, the article also examines the potential threat of anthrax as a weapon. CONCLUSION: Frontline staff such as nurses can contribute greatly to increasing survival by recognising symptoms, treating patients promptly and helping to allay public concern.

Using non-invasive ventilation in acute wards: Part 1.

Non-invasive ventilation (NIV) is increasingly being used in domestic and acute health settings. Part one of this article identifies the benefits of NIV and describes the use of continuous positive airway pressure (CPAP). Part two, published in next week's Nursing Standard, discusses bilevel NIV, which has fewer complications and so is largely replacing CPAP. Part two also examines how to monitor and assess patients receiving NIV.

Central venous catheters and central venous pressure.

Central venous catheters are increasingly being used in a variety of clinical areas outside critical care. Philip Woodrow examines the indications, measuring techniques and complications associated with central venous pressure monitoring.

Managing patients with a tracheostomy in acute care.

Most acute wards occasionally receive patients with tracheostomies, but relatively infrequent experience of caring for these patients means that nurses have limited opportunities to practise their knowledge and skills. This article examines the indications for using a tracheostomy and provides a problem-centred approach to patient care.

Using non-invasive ventilation in acute wards: Part 2.

The second part of this article on non-invasive ventilation (NIV) examines the use of bilevel non-invasive ventilation, discussing the differences between CPAP and bilevel NIV. It also focuses on how to assess and monitor patients receiving either CPAP or bilevel NIV, and patient outcomes.

The symptoms and management of respiratory failure.

Nurses are often in the best position to detect any breathing problems in patients. This paper describes the mechanisms of respiration, the reasons why respiratory difficulties can develop and explains how problems can be detected and alleviated. It includes a series of reflective exercises that aim to enhance nurses' understanding of this life-threatening condition.

A course in critical care for ward staff.

A government review has acknowledged that many critically ill patients are being cared for on acute wards. A lack of resources and intensive care beds, combined with low staffing levels, have led to increased demands being placed on wards that are already struggling to care for critically ill patients. Research shows that ward nurses are well placed to identify early indications of complications and initiate appropriate interventions, and that poor outcomes and some deaths are potentially avoidable. This article describes how one trust developed an in-house education programme to support nurses caring for acutely and critically ill patients on the wards.

Should older people be admitted to intensive care?

As you are reading Nursing Older People, your answer to the question 'Should older people be admitted to intensive care?' is probably yes, perhaps qualified by 'when appropriate'. But as well as appropriateness (individual best interests), the quality of services is also affected by attitudes within society and health care. So why is this important for you?

The evidence.

The issue of nailbrushes seems to be unidentified by infection control literature, including the Infection Control Nurses' Association hand hygiene guidelines. The infection risk is, however, that they will be used as communal items, like a bar of soap, so may transmit micro-organisms. Therefore, in acute care their use should be discouraged. If used, they should be single use, and then disposed of.