Acute Medicine: A Handbook for Nurse Practitioners by Lisa Carroll

By Lisa Carroll

This booklet presents Nurse Practitioners operating within the box of Acute drugs with an up-to-the-minute, functional, and entire advisor to the administration of acute clinical sufferers. It serves as a textual content from which the busy hugely expert nurse can receive details on evaluate, analysis, and administration of acute health conditions. It identifies priorities for remedy and publications the reader throughout the administration of the sufferer. anyplace attainable the newest released directions were incorporated. the ultimate bankruptcy of the booklet considers the criminal, expert and moral concerns confronted by way of nurses operating at a sophisticated point. the problems of position improvement, the advance of protocols and prescribing are thought of.

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Example text

Count backwards from 20–1 A score of 7 or less is consistent with impaired brain function. Cranial Nerve Examination Observation r Ptosis (III). r Facial droop or asymmetry (VII). r Hoarse voice (X). r Articulation of words (V, VII, X, XII). r Abnormal eye position (III, IV, VI). r Abnormal or asymmetrical pupils (II, III). I Olfactory r Not normally tested. II Optic r Examine the optic fundi. r Test visual acuity. r Test pupillary reactions to light. r Test pupillary reactions to accommodation: ➢ hold your finger about 10 cm from the patient’s nose; ➢ ask them to alternate looking into the distance and at your finger; ➢ observe the pupillary response in each eye.

R Skin blisters – suggest barbiturates or tricyclics may have been ingested. r Hypothermia – can occur after barbiturate overdose or if patient has been exposed in an unconscious state. r Look for needle marks in the arms and pinpoint pupils – suggestive of opioid overdose. 42 ACUTE MEDICINE ASSESSMENT Follow an ABCDE approach to assessment and treatment. Airway r Ensure patent airway. r Nurse in recovery position if unconscious. r Utilise guedel airway or nasopharyngeal airway if necessary. r Consider intubation if unable to maintain airway.

Think of the underlying anatomy as you undertake an examination. Always begin with inspection, palpation and range of motion. Useful Hints r When taking a history for an acute problem always enquire about the mechanism of injury. r You can use SOCRATES. r When taking a history for a chronic problem always inquire about: ➢ past injuries ➢ past treatments ➢ effect on function ➢ current symptoms. r Signs of musculoskeletal disease are: ➢ pain ➢ redness (erythema) ➢ swelling ➢ increased warmth ➢ deformity ➢ loss of function.

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