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.

End-of-life prognostic indicators in patients with COPD: Part 1.

In the UK, chronic respiratory diseases cause 13% of adult disability. The major chronic respiratory disease is chronic obstructive pulmonary disease (COPD), a condition involving chronic airway inflammation that causes airflow obstruction and destruction of lung tissue. This leads to a progressive loss of respiratory membrane, which accounts for the clinical manifestation of COPD, which is difficulty maintaining sufficient gas exchange to meet metabolic demands. The primary cause is smoking, with the vast majority of COPD patients having a past or present history of smoking. However exposure to industrial pollutants is also a contributing factor, as is a rare genetic predisposition to developing COPD.

End-of-life prognostic indicators in patients with COPD: part 2.

In the UK, chronic respiratory diseases cause 13% of adult disability. The major chronic respiratory disease is chronic obstructive pulmonary disease (COPD), a condition involving chronic airway inflammation that causes airflow obstruction and destruction of lung tissue. This leads to a progressive loss of respiratory membrane, which accounts for the clinical manifestation of COPD, which is difficulty maintaining sufficient gas exchange to meet metabolic demands. The primary cause is smoking, with the vast majority of COPD patients having a past or present history of smoking. However, exposure to industrial pollutants is also a contributing factor, as is a rare genetic predisposition to developing COPD.

Airway management in the hospital environment.

In the hospital environment, patients can deteriorate rapidly and for many different reasons. Maintaining a patient's 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.

Needlestick injuries and safety syringes: a review of the literature.

Needlestick injuries are a serious concern for nurses and other healthcare workers. One of the main clinical risks from needlestick injury is the possible infection by blood-borne diseases, such as hepatitis and HIV. A number of different measures have been introduced to minimise the risk and impact of needlestick injuries, including the use of fixed-needle safety syringes. However, some healthcare workers refuse to use such devices, for reasons that include the perceived need to change syringe needles between drawing up a medicine and its administration to a patient. This paper will explore the literature relating to needlestick injuries and the reasons commonly given for not using fixed-needle safety syringes.

Emergency airway management: common ventilation techniques.

Maintaining a patient's airway and facilitating breathing are the main priorities during any emergency situation in which breathing is compromised. The key to safe management of an airway is thorough assessment, primarily to ensure the airway is patent. In an emergency situation, a bag-valve-mask may be the most effective way to assist ventilation. If ventilation is required for prolonged periods in an emergency situation, then endotracheal intubation should be performed. This involves the placement of a cuffed, endotracheal tube in the trachea, through which ventilation is maintained. Each tracheal intubation event should be anticipated as a potentially difficult intubation. Longer term ventilatory support may be achieved by the use of mechanical ventilators, which are designed to assist the movement of gases (air) into and out of a patient's lungs, while minimising the work and effort of breathing. This article provides nurses with an overview of the techniques and equipment that is most often used within emergency and intensive care units to maintain the patency of a patient's airway and provide ventilatory support.

Utilising routine clinical laboratory data to support quality improvement in health care: Application of a national acute kidney injury alert system as a proof of concept.

BACKGROUND: Acute kidney injury (AKI) is a global health issue known to cause avoidable harm and death. Improvement in its prevention and management is therefore considered an important goal for the health-care sector. The work here aimed to develop a tool which could be used to robustly and reliably measure, monitor, and compare the effectiveness of health-care interventions related to AKI across the Welsh NHS, a mechanism which did not exist previously. METHODS: Using serum creatinine (SCr) as a biomarker for AKI and a validated national data-set collected from the all Wales Laboratory Information Management System, work involved applying Donabedian's framework to develop indicators with which to measure outcomes related to AKI, and exploring the potential of statistical process control (SPC) techniques for analysing data on these indicators. RESULTS: Rate of AKI incidence and 30-day AKI-associated mortality are proposed as valid, feasible indicators with which to measure the effectiveness of health-care interventions related to AKI. The control chart, funnel plot, and Pareto chart are proposed as appropriate, robust SPC techniques to analyse and visualise variation in AKI-related outcomes. CONCLUSIONS: This work demonstrates that routinely collected large SCr data offer a significant opportunity to monitor and therefore inform improvement in patient outcomes related to AKI. Moreover, while this work concerns utilisation of SCr data for improvement in AKI strategies, it is a proof of concept which could be replicated for other routinely collected clinical laboratory data, to improve the prevention and/or management of the conditions to which they relate.

The role of the nurse in mechanical ventilation.

Many patients admitted onto the intensive care unit (ICU) require airway maintenance and mechanical ventilator support (Cook et al, 2011). It is important that all qualified nurses working in critical care environments understand the indications for the use of mechanical ventilation, the modes of ventilation delivery, and the most common associated complications. Mechanical ventilators assist the movement of gases (air) into and out of a patient's lungs, while minimizing the effort of breathing (Scholz et al, 2011). Indicators for the use of mechanical ventilation include the maintenance of oxygenation, the management of type I reparatory failure, the removal of carbon dioxide, the management of type II respiratory failure, cardiorespiratory arrest and central nervous system depression (Oh et al, 2008).

IV therapy and infection control in patients in the community.

Universal precautions and general infection control measures need to be considered when undertaking any clinical procedure, but when administering intravenous (IV) therapy (medicines and/or maintenance fluids), specific measures need to be considered. This is especially important for vulnerable patients or if administering IV therapy in the home environment. There are many reasons why patients may need to receive IV therapy in the community, and these will all present nurses with specific problems. This article discusses some of the infection control procedures one must undertake when administering IV therapy to patients in the community.

Emergency and intensive care: assessing and managing the airway.

Airway assessment and management skills are vital in an emergency department (ED) as they are the most sensitive indicator of patient deterioration. Problems as common as head injury or alcohol intoxication are associated with an inadequate airway or diminished respiratory function and can cause a patient's condition to decline rapidly. Maintaining a patient's airway and facilitating breathing is the main priority in any emergency situation, although achieving airway control can be difficult. All health professionals need to be able to safely undertake airway management. The key is a thorough assessment to determine whether the airway is patent or not. This paper will discuss the importance and practicalities of airway management and assessment in the emergency and intensive care.

Phlebitis: treatment, care and prevention.

Peripheral venous catheter-associated phlebitis is caused by inflammation to the vein at a cannula access site. It can have a mechanical, chemical or infectious cause. Good practice when inserting a cannula, including appropriate choice of device and site, can help to prevent phlebitis. Good infection control techniques are also vital in preventing the condition. There are two phlebitis scoring systems, which should be used in routine practice to identify and treat early signs of the Peripheral venous cannulation

Infection control and intravenous therapy in patients in the community.

Recent efforts to reduce infections have been focused within the hospital setting. Early hospital discharge, shorter inpatient stays, day surgery and the movement of patients between acute and long-stay care facilities is likely to make community-acquired infection an increasing problem. There are, or course, universal precautions and general infection control issues to consider when undertaking any clinical procedure, both in hospital and the community, but when administering intravenous therapy (medicines and/or maintenance fluids) specific measures need to be considered. This is especially important if a patient is receiving intravenous therapy at home. There are many reasons why patients may need to receive intravenous therapy in the community and these will all present with specific problems. This paper will discuss some of the infection control procedures one must undertake when administering intravenous therapy to patients in the community.

Airway management for nurses:emergency assessment and care.

Within the hospital environment patients can deteriorate rapidly and for many different reasons. Maintaining a patient's breathing is the main priority in any emergency situation--although achieving airway control can be difficult. All health professionals need to be able to safely undertake airway management and the key to the management of an airway is through a thorough assessment, to firstly ensure whether the airway is patent or not. This article will discuss airway management--both acute and chronic--as well as associated nursing care.