Table of Contents
Website
Title page
Copyright page
Preface
References
Acknowledgements
About the Editors
Contributors
How to Use Your Textbook
Features Contained within your Textbook
The Anytime, Anywhere Textbook
About the Companion Website
Unit 1: Contextualising the Art and Science of Nursing
1: Nursing: Past, Present and Future
Introduction
A Glance at the History of Nursing
The Beginnings of the NHS and Nursing
Early Nursing Research
Modernising Nursing Careers
Current Nurse Education
The Francis Report
The New Framework for Nursing and Midwifery
Conclusion
References
Test Yourself
Answers
2: The Professional Nurse and Contemporary Health Care
Introduction
The Adult Learner
Conclusion
References
Test Yourself
Answers
3: Health Promotion
Introduction
Health Promotion
Interpersonal Skills for Nursing and Health Promotion
Motivational Interviewing and Brief Interventions
Models of Health Promotion
Frameworks for Supporting Health
The Contemporary Focus of Health Promotion
Travel Health
Conclusion
References
Test Yourself
Answers
4: Public Health
Introduction
Setting the Scene for Public Health in the UK
Public Health England
Health Inequalities
Epidemiology and Public Health
Health Protection
Primary Care Nursing
District Nursing
Community Matrons
Health Visitor and School Health Advisor
Conclusion
References
Test Yourself
Answers
Unit 2: The Elements of Care
5: Ethics, the Law and the Nurse
Introduction
Approaches to Ethics
Ethical Principles
Legal and Ethical Dilemmas in Nursing
Legal Perspectives
Accountability
Conclusion
References
Test Yourself
Answers
6: The Nursing Process
Introduction
Defining Nursing
Organisational Models of Care
The Nursing Process
A Systematic Approach
Patient Goals
How Does ‘Intentional Rounding’ Fit in?
Compassion
Conclusion
References
Test Yourself
Answers
7: Models of Nursing
Introduction
Nursing Theory
History and Principles
A Framework for Children's Nursing
The Tidal Model in Mental Health Nursing
Note
The Art and Science of Nursing
Patient-Centred Care and Safety
Conclusion
References
Test Yourself
Answers
Unit 3: The Principles of Care
8: The Principles of Safeguarding and Dignity
Introduction
What Is Safeguarding?
Principles of Safeguarding
What Is Meant by Deprivation of Liberty Safeguards?
What Is Abuse or Harm?
Safeguarding Is Everybody's Business
Policy Framework for Safeguarding Adults
Responding to Disclosures
Immediate Action
Key Stages of the Safeguarding Adult's Process
Preventing the Abuse of Adults at Risk
What Is Dignity?
What Is Respect?
Types of Dignity
Essence of Care 2010
Influencing Dignity in Care Practice
Conclusion
References
Further Reading
Test Yourself
Answers
9: The Principles of Older People's Care
Introduction
Attitudes and Stereotyping
Effective Communication
Patient-Centred Care
Pressure Ulcer Prevention
Falls Prevention
After a Fall
Discharge Planning
References
Test Yourself
Answers
10: The Principles of Caring for People with Learning Disabilities and Autism
Introduction
Definitions of Learning Disabilities
Autistic Spectrum Conditions Defined
Prevalence and Causes of Learning Disabilities
Classification of Learning Disability
Inequalities in Health Care
Attitudes Towards People with Learning Disabilities
Health Liaison
Health Action Plans
The Hospital Passport
Person-Centred Planning (PCP)
Mental Capacity Act 2005 (MCA)
Safeguarding
Conclusion
References
Test Yourself
Answers
11: The Principles of Caring for Children and Families
Introduction
The Key Stages in Relation to the Development of Infants, Children and Young People
A Range of Communication Strategies
Some Common Physical and Mental Health Problems
Basic/Fundamental Care Needs
The Importance of Acting to Protect Infants, Children and Young People
Professional Advice
Identifying the Signs of Deterioration in General Health
Best Practice Relating to End of Life Care
References
Test Yourself
Answers
12: The Principles of Caring for People with Mental Health Problems
Introduction
Policy Context
What Is Mental Disorder?
Settings for Mental Health Care
Recovery
Holism
Caring for Carers
Comprehensive Assessment in Mental Health
The Physical Health of People with Mental Health Problems
Risk Assessment and Management
Legal Context
Therapeutic Nursing Care
Conclusion
References
Test Yourself
Answers
13: The Principles of Maternity Care
Introduction
The Role of the Midwife in Maternity Care
Overview of the Physiology of Pregnancy
Overview of Antenatal Care
Overview of Intranatal Care
Midwifery Care in Normal Labour
Unexpected and Rapid Deliveries
Initial Care of the Mother and Baby after Birth
Overview of Postnatal Care – Mother
Health and Advice in the Postnatal Period
Care of the Neonate after Birth
Infant Feeding
Conclusion
References
Test Yourself
Answers
14: The Principles of Surgical Care
Introduction
The Classification of Surgery and Risk
The Phases of Surgery
Complications of Surgery
Further Care of the Surgical Patient
Discharge
Day-Case Surgery
Conclusion
References
Test Yourself
Answers
15: The Principles of Cancer Care
Introduction
Pathophysiology
Signs and Symptoms
Investigations and Diagnosis
Treatment of Cancer
Other Problems Resulting from All Cancer Therapies
Survivorship
End of Life Care
Conclusion
References
Test Yourself
Answers
16: The Principles of Infection Control
Introduction
Development of Infection Control Practices
Common Healthcare Associated Infections
Care and Treatment for People with Infectious Diseases
Diagnostic Tests and Treatment
Conclusion
References
Test Yourself
Answers
17: The Principles of Nutrition
Introduction
The Nutrients
A Healthy Diet
Physiology of the Alimentary System
Undernourishment and Malnutrition
Nutritional Support
Obesity
Diabetes and Nutrition
Nutrition and Mental Illness
Hydration
Nutrition and Wound Healing
Nutrition for the Person Who Is Dying
Hospital Nutrition Services
Conclusion
References
Test Yourself
Answers
18: The Principles of Skin Integrity
Introduction
Anatomy and Physiology of the Skin
Function of the Skin
Wound Healing
Psycho-Socioeconomic Aspects of Wound Care
Directors, Leads and General Managers
Medical Staff
Wound Care and Management
Nursing Management
Multiple Pathology and Wound Care
Conclusion
References
Test Yourself
Answers
19: The Principles of Medicine Administration and Pharmacology
Introduction
Pharmacology
Person Group Directions
Generic and Brand Names
Legislation and Policies Governing Drug Administration
Medical Abbreviations
Some Common Drugs Used in Practice and Their Action
Drug Calculations
Conclusion
References
Test Yourself
Answers
20: The Principles of Death, Dying and Bereavement
Introduction
Where Do Our Ideas about Death and Dying Come From?
The Death of Personhood
Care at the End of Life
Advance Care Planning
Care in the Last Few Days of Life
Communication
Breaking Bad News
Culture and Ethnicity
Mental Capacity
Grief, Loss and Bereavement
Who Cares for the Carers?
Conclusion
References
Test Yourself
Answers
Unit 4: The Scientific Nature of Disease
21: The Cell
Introduction
The Chemical Level
The Genetic Level
The Cellular Level
The Tissue Level
Conclusion
References
Test Yourself
Answers
22: Immunity, Inflammation and Infection
Introduction
Inflammation
An Introduction to the Classification of Microbes/Microorganisms
The Lymphatic System and Immunity
The Cells of Immunity
Chemical Proteins That Are Involved in Immunity
Immunity in Action
Disorders of the Immune System
Immunodeficiency
Conclusion
References
Further Reading
Test Yourself
Answers
23: Pain Management
Introduction
The Physiology of Pain
The Classification of Pain
The Pain Experience
Pain Theory
Pain Assessment
Pain Management
Nursing Management of Acute Pain
Nursing Management of Chronic Pain
Conclusion
References
Test Yourself
Answers
24: Fluid and Electrolyte Imbalance, and Shock
Introduction
Fluid Balance
Electrolyte Imbalance
Shock
Conclusion
References
Test Yourself
Answers
Unit 5: The Art and Science of Nursing Care
25: The Person with a Cardiovascular Disorder
Introduction
Anatomy and Physiology of the Heart
Disorders of the Cardiovascular System
Conclusion
References
Test Yourself
Answers
26: The Person with a Haematological Disorder
Introduction
Composition of Blood
Red Blood Cells
Conditions Associated with the Red Cells
White Blood Cells and Lymphoid Tissue Disorders
The Lymphatic System
Conditions Associated with the White Blood Cells
Conclusion
References
Test Yourself
Answers
27: The Person with a Respiratory Disorder
Introduction
Anatomy and Physiology
Respiratory Disease
Respiratory Tract Infection
Obstructive Lung Disorders
Restrictive Lung Disorders
Lung Cancer
Pleural Disorders
Interstitial Lung Disease (Diffuse Parenchymal Lung Disease)
Conclusion
References
Test Yourself
Answers
28: The Person with a Gastrointestinal Disorder
Introduction
Anatomy and Physiology
Peptic Ulcer
Carcinoma of the Stomach
Hepatitis
Inflammatory Bowel Disease
Stomas
Gallbladder Disorders
Conclusion
References
Test Yourself
Answers
29: The Person with a Urinary Disorder
Introduction
Anatomy and Physiology
Urinary Tract Infection
Urinary Calculi
Bladder Cancer
Renal Tumour
Renal Failure
Acute Kidney Injury
Chronic Kidney Disease (CKD)
Conclusion
References
Test Yourself
Answers
30: The Woman with a Reproductive Disorder
Introduction
Anatomy and Physiology
Assessing the System
Disorders of the Female Reproductive System
Gynaecological Oncology
Breast Disease
Breast Surgery
Conclusion
References
Test Yourself
Answers
31: The Man with a Reproductive Disorder
Introduction
Anatomy and Physiology
Assessing the System
Reproductive Health Conditions
Conclusion
References
Test Yourself
Answers
32: The Person with a Sexually Transmitted Infection
Introduction
Assessing the System
Genital Warts
Gonorrhoea
Syphilis
Conclusion
References
Test Yourself
Answers
33: The Person with an Endocrine Disorder
Introduction
Anatomy and Physiology of the Endocrine System
Disorders of the Endocrine System
Disorders of the Thyroid Gland
Disorders of the Parathyroid Glands
Disorders of the Adrenal Glands
Diabetes Mellitus
Conclusion
References
Test Yourself
Answers
34: The Person with a Neurological Disorder
Introduction
Anatomy and Physiology
Nursing Assessment of the Neurological System
Motor Function Assessments
The Patient with Raised Intracranial Pressure
Traumatic Brain Injury (Head Injury)
Stroke
Neurological Oncology
Infections of the CNS
Epilepsy
Headaches
Multiple Sclerosis
Parkinson's Disease
Alzheimer's Disease and Related Disorders
Peripheral Neuropathy
Conclusion
References
Test Yourself
Answers
35: The Person with an Ear or Eye Disorder
Introduction
Anatomy and Physiology of the Ear
Assessing the Person with an Ear Problem
Common Conditions of the Ear
Anatomy and Physiology of the Eye
Assessing Vision
Common Conditions of the Eye
Cataract Surgery
Conclusion
References
Test Yourself
Answers
36: The Person with a Musculoskeletal Disorder
Introduction
Anatomy and Physiology
Musculoskeletal Conditions
Arthritis
Fractured Neck of Femur
Conclusion
References
Test Yourself
Answers
37: The Person with a Skin Disorder
Introduction
Anatomy and Physiology
Skin Infections: Viral, Bacterial and Fungal
Viral Skin Infections
Bacterial Skin Infections
Fungal Skin Infections
Infestations
Acne
Rosacea
Psoriasis
Eczema
Skin Tumours
Vascular Disorders (Including Naevi)
Disorders of the Hair and Nails
Connective Tissue Disorders
Conclusion
References
Test Yourself
Answers
Appendix A: Reference Values in Venous Serum (Adults)
Appendix B: List of Units
Index
End User License Agreement
List of Tables
Table 1.1 Mapping the 6Cs against the basics of the RCN's
Principles of Nursing Practice
. (
Source
: Watterson 2013)
Table 1.2 Theoretical and conceptual philosophies of nursing.
Table 1.3 Comparison of Project 2000 curriculum to traditional nurse training.
Table 1.4 Outcomes applied by the CQC in relation to the quality and safety of care.
Table 2.1 Operant conditioning and conditioned response.
Table 2.2 The focus of the three main theorists in cognitive learning.
Table 2.3 The different approaches to learning, andragogy and pedagogy.
Table 2.4 The VARK domains.
Table 2.5 Leadership styles, characteristics and potential impact.
Table 3.1 Domains of Health (adapted from Naidoo & Wills 2009).
Table 3.2
Ottawa Charter for Health Promotion
– terminology.
Table 3.3 The reasons why health workers might resist flu vaccination.
Table 3.4 Information needed for a travel health risk assessment. Stringer
et al
. (2002)
Table 4.1 Standards of proficiency for entry to the NMC register for specialist community public health nurses. Reproduced with permission of the NMC.
Table 4.2 Psychosocial and neo-material causes of health inequalities.
Table 8.1 Principles of the Mental Capacity Act and Adults with Incapacity (Scotland) Act.
Table 8.2 The nature of abuse. (
Source
: SCIE 2011)
Table 8.3 Concepts and considerations towards application to practice. (
Source
: HASCAS 2010)
Table 11.1 Milestones in the pre-school child. (Sheridan 2008)
Table 11.2 Overview of childhood immunisations (UK 2013 immunisation schedule). Taken from http://www.patient.co.uk/health/immunisation-usual-uk-schedule
Table 11.3 Causative organisms of gastroenteritis.
Table 13.1 Methods of pain relief in labour.
Table 13.2 Apgar score.
Table 13.3 Signs and symptoms of potentially life-threatening conditions. (
Source
: NICE 2006)
Table 13.4 Common health problems in babies. (
Source
: NICE 2006)
Table 16.1 Preventing HIV transmission.
Table 18.1 The four main categories of wound.
Table 18.2 Classification of wound types.
Table 18.3 Description of types of surgical wound.
Table 18.4 Burn injuries.
Table 18.5 Classification of burns.
Table 18.6 Dressings.
Table 18.7 Classification of skin tears. (Carville
et al
. 2007)
Table 19.1 Drug–food interactions.
Table 19.2 A schedule table with examples of drugs within the schedules.
Table 19.3 Advantages and disadvantages of using the rectal route.
Table 19.4 Common medical abbreviations.
Table 19.5 Warfarin – Drug–drug interactions.
Table 19.6 CNS opioid receptors.
Table 21.1
Table 23.1 Size and velocity of first-order sensory fibres.
Table 23.2 Differences between acute and chronic pain. Adapted from Gould (2006).
Table 23.3 Common misconceptions about pain. Adapted from McGann (2007).
Table 23.4 Actions of opiate receptors.
Table 23.5 Main causes of chest pain. Adapted from MacLellan (2006)
Table 23.6 Types of cancer pain, their source, causes and descriptions. (Listed in order of prevalence. Most patients have a combination of somatic and visceral nociceptor pain.) Adapted from Kochhar (2002).
Table 24.1 Fluid intake and output. (Peate
et al
. 2012)
Table 24.2 Principal electrolytes and their functions. Adapted from Peate
et al
. (2012)
Table 24.3 Three major group of diuretics and their site of action.
Table 24.4 Summary of electrolytes – causes, signs and symptoms and nursing interventions. Adapted from Kozier
et al
. (2008)
Fundamentals of Nursing: Concepts, process and practice
. Pearson Education, Harlow.
Table 25.1 The coronary arteries, their major branches and the areas of the heart they supply.
Table 25.2 Blood pressure control by hormones.
Table 26.1 The formed elements of the blood, how they are identified, the serum value in health, lifespan and function.
Table 26.2 Foods that contain vitamins and minerals associated with anaemia.
Table 26.3 Normal red blood cell values from full blood count (FBC).
Table 26.4 Nursing care of anaemia.
Table 26.5 Summary of the types of leukaemia.
Table 26.6 Chemotherapy advice for patients.
Table 26.7 Bone marrow/stem cell transplant advice.
Table 26.8 Blood clotting factors and their functions.
Table 26.9 The blood test, normal range and explanation of what is being measured when assessing haemostasis.
Table 26.10 Visual signs associated with bleeding disorders.
Table 27.1 Summary of important gas laws. (Source: Davies & Moores 2003, reproduced with permission of Elsevier)
Table 27.2 Important lung volumes. (
Source
: Martini & Nath 2009)
Table 27.3 Definitions of important gas transport terminology.
Table 27.4 Table summarising the major types of hypoxia and their causes.
Table 27.5 Common positional dyspnoeas, their characteristics and causes.
Table 27.6 Abnormal respiratory patterns, their characteristics and their causes.
Table 27.7 Characteristics of sputum and possible diagnoses.
Table 27.8 Summary of corticosteroids used in the treatment of respiratory disease. (
Source
: Adapted from Barnes 2008 and the Joint Formulary Committee 2011)
Table 27.9 Summary of bronchodilator therapies given in asthma and chronic obstructive pulmonary disease. (
Source
: Adapted from Barnes 2008 and the Joint Formulary Committee 2011)
Table 29.1 The normal and abnormal findings in the urine.
Table 29.2 Staging of bladder tumour.
Table 29.3 Stages of CKD. (
Source
: Kathuria 2013)
Table 29.4 Pathophysiology of chronic kidney disease. (
Source
: Peate
et al
. 2012)
Table 30.1 Some changes associated with ageing and the reproductive system.
Table 30.2 Common menstrual terms and descriptions.
Table 30.3 Types of prolapse. (
Source
: Adapted from Norwitz & Schorge 2010; Thakar & Stanton 2002)
Table 30.4 Some surgical options for genitourinary prolapse. (
Source
: Adapted from Thakar & Stanton 2002; RCOG 2007; NICE 2007b)
Table 30.5 Staging, cancer of the cervix. (
Source
: Adapted from Norwitz & Schorge 2010)
Table 31.1 An overview of the examination process.
Table 31.2 Symptoms for prostate cancer. (
Source
: Adapted from LeMone
et al
. 2011; Weston
et al
. 2011)
Table 31.3 A summary of some potential surgical procedures that can be used to remove the enlarged prostate gland. (
Source
: Adapted from LeMone
et al
. 2011; Steggall 2011)
Table 31.4 Some potential organic causes of ED. (
Source
: Adapted from Dorey 2006; Paterson 2006)
Table 31.5 Psychogenic and organic causes of ED.
Table 32.1 Suggested sexual histories in various testing scenarios.
Table 32.2 Topical treatment and physical ablation methods used to treat warts. (
Source
: BASHH 2006b; American Cancer Society 2013)
Table 32.3 Overview of specimen collection. (
Source
: Adapted from Bignall & FitzGerald 2011)
Table 32.4 Classification of syphilis. (
Source
: Adapted from Kingston
et al
. 2008)
Table 32.5 A summary of the features of late syphilis. (
Source
: Adapted from Kingston
et al
. 2008)
Table 32.6 Recommended syphilis treatment regimens for adults (excluding pregnancy). (
Source
: Adapted from Kingston
et al
. 2008)
Table 33.1 The hormone cascade from the hypothalamus to the anterior pituitary gland and target organs. (
Source
: Peate and Nair 2011. Reproduced with permission of John Wiley & Sons Ltd.)
Table 33.2 Common clinical features and the potential endocrine causes.
Table 33.3 Signs and symptoms of hypopituitarism categorised by hormone deficiency.
Table 33.4 Potential biochemical tests and investigations for pituitary hormone insufficiency.
Table 34.1 Structure, location and functions of the different neurones.
Table 34.2 Types of neuroglia, their description, function and location in the NS.
Table 34.3 Main types of neurotransmitter, examples and main areas found in the CNS.
Table 34.4 General functions of the four main parts for the brain.
Table 34.5 Summary of the key-specific functions of each cerebral hemisphere.
Table 34.6 Limbic system major subcortical areas and their functions.
Table 34.7 A list of the different types of peripheral receptors, their location and function.
Table 34.8 Cranial nerves: type and function.
Table 34.9 Relationship of the component of consciousness and brain structures.
Table 34.10 Terms used to describe varying levels and disorders of consciousness. Monti
et al
. (2010).
Table 34.11 Common investigations and the key nursing considerations.
Table 34.12 Overview of classifying TBI by severity.
Table 34.13 Common physical, cognitive, emotional and behavioural problems associated with TBI.
Table 34.14 Treatment therapies and how these might be managed.
Table 34.15 Different behaviours and observations during non-epileptic seizures (NESs) and epilepsy.
Table 34.16 Signs and symptoms of primary headaches (tension-type headache, migraine and cluster headache). Adapted from NICE (2012b).
Table 34.17 Summary of treatment therapies for MS.
Table 34.18 Motor and non-motor signs and symptoms in PD.
Table 34.19 Pharmacological management of Parkinson's disease.
Table 34.20 Alzheimer's stages, signs, symptoms and medication. (NICE 2011)
Table 35.1 A summary of the structures and the functions of the ear. (
Source
: Adapted from Munir & Clarke 2013; Jenkins & Tortora 2013; Waugh & Grant 2010)
Table 35.2 Types of deafness. (
Source
: Adapted from Action on Hearing 2013)
Table 35.3 History and suggested examination in people with eye problems.
Table 35.4 Lid hygiene.
Table 36.1 The bones that make up the adult skeletal system.
Table 36.2 Bone formation throughout a person's life. (
Source
: Adapted from Tortora & Nielsen 2012)
Table 36.3 Muscle types.
Table 36.4 Grading of muscle strength. (Medical Research Council, MRC 1981)
Table 36.5 Types of surgical procedure. (
Source
: Adapted from NICE 2011a)
Table 36.6 Some complications associated with fractures. (
Source
: Adapted from Whitening 2008)
Table 36.7 Some types of cast.
Table 37.1 Questions to consider when questioning a patient about their skin disorder.
Table 37.2 Questions to ask about the character, distribution and shape of lesions.
Table 37.3 Primary lesions terminology.
Table 37.4 Secondary lesions terminology. (Adapted from Lawton 2002).
Table 37.5 Dermatological investigations.
Table 37.6 Common warts (see also Figure 37.2).
Table 37.7 Common types of bacterial skin infections.
Table 37.8 Signs and symptoms of dermatophytoses.
Table 37.9 Common signs and symptoms of acne.
Table 37.10 Different presentations of psoriasis.
Table 37.11 Types and clinical presentations of malignant melanomas.
Table 37.12 Common conditions and the effect on the nail bed.
Table 37.13 Common disorders of the scalp.
List of Illustrations
Figure 1.1 Early engraving depicting the support of a woman in labour. Reproduced with permission of Everett Collection Historical/Alamy.
Figure 1.2 Florence Nightingale. Reproduced with permission of Superstock/David Cole.
Figure 1.3 Lighting the lamps in 1913.
Figure 1.4 Mary Seacole. Reproduced with permission of Nils Jorgensen/Rex.
Figure 1.5 Copy of the state examination taken in 1963.
Figure 1.6 Some significant dates in the history of the NHS.
Figure 1.7 An overview of the health and care system from April 2013. Source: Department of Health, used under the Open Government Licence v2.0.
Figure 2.1 Methods of assessment in clinical practice.
Figure 2.2 Kolb's experiential learning cycle.
Source
: Kolb 1984.
Figure 2.3 Experiential readiness to learn.
Figure 2.4 Gibbs Reflective Cycle.
Figure 2.5 The five domains of the Clinical Leadership Competency Framework (CLCF). (The CLCF and associated graphics are ©NHS Leadership Academy, 2011. All rights reserved.)
Figure 2.6 Sources of evidence.
Figure 2.7 The six-stage framework for service improvement.
Source
: NHS Institute for Innovation and Improvement 2010.
Figure 3.1 Historical journey of health promotion.
Figure 3.2 Determinants that influence health.
Source
: Adapted from Dahlgren & Whitehead 1991.
Figure 3.3 Health may be viewed in relation to balance of the ‘humours’ as in Yin and Yang.
Figure 3.4 Tannahill's model of health promotion (cited in Downie
et al
. 1996).
Figure 3.5 Prochaska and DiClemente's transtheoretical (stages of change) approach.
Figure 3.6 The Health Belief Model.
Figure 4.1 Some important public health interventions of the 19th century.
Figure 4.2 Examples of agencies and services to support contemporary public health activities.
Figure 4.3 Three levels of nursing and midwifery practice: improving and protecting the public's health. (PHE 2013.)
Figure 4.4 Public Health England priorities for 2013/2014.
Figure 4.5 Determinants of health.
Source
: Dahlgren, G. & Whitehead, M. (1991)
Policies and Strategies to Promote Social Equity in Health
, Institute of Futures Studies, Stockholm.
Figure 4.6 The questions that drive epidemiology.
Source
: Mullhall 2001.
Figure 4.7 Basic principles of Community Nursing.
Figure 4.8 The many roles of the District Nurse.
Figure 4.9 Clinical skills undertaken by District Nurses.
Figure 4.10 The various roles of the Health Visitor.
Figure 5.1 Ethical principles.
Source
: Beauchamp and Childress 2008.
Figure 5.2 UK legislation related to confidentiality.
Figure 5.3 The Court system, England and Wales.
Figure 5.4 The legal system is divided into civil and criminal law.
Figure 5.5 Stages in raising and escalating concerns. (Reproduced with permission of the Royal College of Nursing and NMC: http://www.nmc-uk.org)
Figure 6.1 Patient allocation.
Figure 6.2 Task allocation.
Figure 6.3 Team nursing.
Figure 6.4 Primary nursing.
Figure 6.5 Primary nursing and the Nursing Process.
Figure 6.6 The four phases of the Nursing Process.
Figure 6.7 The four phases plus the nursing diagnosis.
Figure 6.8 The pivotal role of the nurse when communicating with the interprofessional team.
Figure 7.1 The 12 activities of living.
Figure 7.2 The quality and cost-effectiveness of healthcare systems. Note: 1 is top rank; 7 is lowest.
Source
: Davis, K., Schoen, K. & Stremikis, K. (2010) Reproduced with permission of The Commonwealth Fund.
Figure 8.1 Safeguarding continuum.
Source
: SCIE 2013c.
Figure 8.2 Types of abuse.
Source
: Department of Health and Home Office 2000.
Figure 8.3 Multidimensional approach to preventing abuse or neglect.
Source
: SCIE 2011.
Figure 8.4 Universal Declaration of Human Rights 1948.
Source
: HASCAS 2010.
Figure 8.5 Maslow's hierarchy of needs.
Source
: Maslow 1943.
Figure 8.6 Combined Framework of Human Rights and Needs.
Source
: HASCAS 2010.
Figure 8.7 Dignity Challenges Framework.
Source
: HASCAS 2010.
Figure 9.1 Some members of the multidisciplinary team.
Figure 10.1 Examples of Makaton signs.
Figure 11.1 Hormones produced in adolescence.
Figure 11.2 Communication from the sender to the receiver.
Figure 11.3 Maslow's hierarchy of need.
Figure 11.4 An infant receiving headbox oxygen.
Figure 11.5 Maryam's fundamental care needs.
Figure 11.6 Emily's fundamental care needs.
Figure 11.7 Josh's fundamental care needs.
Figure 11.8 A systematic approach to assessment.
Figure 12.1 Factors affecting the development of mental disorders.
Figure 13.1 Terminology used during abdominal palpation. In this case, the presentation is cephalic. The position is left occiptio anterior (the fetal occiput is anterior and is on the left of the maternal pelvis). The lie is longitudinal. The attitude is one of flexion and the head is not engaged.
Figure 13.2 Fetal growth from week 4 to week 36.
Figure 13.3 Antenatal and neonatal screening test schedule. This information was originally developed by the UK National Screening Committee/NHS Screening Programmes (www.screening.nhs.uk) and is used under the Open Government Licence v1.0.
Figure 13.4 The cervix is effaced and dilated.
Figure 13.5 Expulsion of the fetal head during the second stage of labour.
Figure 13.6 The placenta after delivery of the baby and prior to separation from the wall of the uterus.
Figure 13.7 The fetal surface of the placenta. Source: Jenkins & Tortora (2013) Reproduced with permission of John Wiley & Sons Singapore Pte. Ltd.
Figure 13.8 Stool colour chart. Approximate colour guide for the first few days of a baby's life. This should be used as a guide only.
Figure 14.1 Leg exercises post-surgery.
Figure 14.2 Serum levels of analgesia using PCA and intramuscular regimes. Source: Grass (2005). Reproduced with permission of LWW.
Figure 14.3 Subcutaneous continuous suture showing one of the retaining beads.
Figure 14.4 Intermittent skin sutures.
Figure 15.1 The cell cycle.
Figure 15.2 Cell division – mitosis.
Figure 16.1 Infection control – a historical timeline.
Figure 16.2 Correct hand washing technique. Reproduced with permission of WHO.
Figure 16.3 Five moments for hand hygiene (WHO 2009). Reproduced with permission of WHO.
Figure 16.4 Protecting yourself and using personal protective equipment (PPE).
Figure 16.5 Trends in rates of
Clostridium difficile
. Prevention and control measures appear to be working.
Figure 16.6 Laboratory reports of norovirus infections in England and Wales 2000–2012.
Source
: Norovirus Working Party 2012; Public Health England, used under the Open Government Licence v2.0.
Figure 16.7 Measles outbreak – reported cases in South Wales (21012/13).
Source
: Public Health Wales: http://www.wales.nhs.uk/sitesplus/888/page/66389#b.
Figure 17.1 Proportions of nutrients for a healthy lifestyle.
Figure 17.2 Organs of the digestive system.
Figure 17.3 Relationship of the peritoneal folds to one another and to the organs of the digestive system.
Figure 18.1 Structure of the fingernail.
Figure 18.2 Cross-section of the skin.
Figure 18.3 Layers of the epidermis.
Figure 18.4 Epidermal ridges and sweat pores. Source: Jenkins & Tortora (2013). Reproduced with permission of John Wiley & Sons Singapore Pte. Ltd.
Figure 18.5 Structure of the hair.
Figure 18.6 Healing of epidermal and deep wounds.
Figure 18.7 Suitable dressings for different wound types. Source: Buxton & Morris-Jones (2009). Reproduced with permission of John Wiley & Sons Ltd.
Figure 18.8 Using larvae to clean a peri-wound area. Source: Buxton & Morris-Jones (2009). Reproduced with permission of John Wiley & Sons Ltd.
Figure 18.9 Evisceration of a wound can be frightening for the patient.
Figure 18.10 Venous leg ulcer. Source: Buxton & Morris-Jones (2009). Reproduced with permission of John Wiley & Sons Ltd.
Figure 18.11 Arterial leg ulcer. Source: Buxton & Morris-Jones (2009). Reproduced with permission of John Wiley & Sons Ltd.
Figure 18.12 Stage II pressure ulcer. Source: Flanagan (2013). Reproduced with permission of John Wiley & Sons Ltd.
Figure 18.13 Lund and Browder tool.
Figure 18.14 The diabetic foot. Source: Buxton & Morris-Jones (2009). Reproduced with permission of John Wiley & Sons Ltd.
Figure 18.15 Malignant and fungating wound. Source: Buxton & Morris-Jones (2009). Reproduced with permission of John Wiley & Sons Ltd.
Figure 18.16 Skin tear. Source: Flanagan (2013). Reproduced with permission of John Wiley & Sons Ltd.
Figure 19.1 Portal circulation.
Figure 19.2 First pass metabolism.
Figure 19.3 Active transport system.
Figure 19.4 Passive transport system.
Figure 19.5 Facilitated diffusion.
Figure 19.6 Cell membrane.
Figure 19.7 Anatomy of a cell.
Figure 19.8 Sublingual route.
Figure 19.9 Buccal route.
Figure 19.10 Rectal anatomy.
Figure 19.11 Location of the gluteus medius muscle.
Figure 19.12 Location of the deltoid muscle.
Figure 19.13 Location of the rectus femoris and vastus lateralis muscles of the thigh.
Figure 19.14 Subcutaneous injection sites.
Figure 19.15 Analgesic steps.
Figure 20.1 End of Life Care Pathway.
Source
:
End of Life Care Strategy
2008; Department of Health, used under the Open Government Licence v2.0.
Figure 20.2 Gold Standards Framework Programme (2006). Prognostic Indicator Guidance (PIG). Reproduced with permission of The Gold Standards Framework Centre.
Figure 20.3 The relationship between Advance Care Planning, Best Interest decision-making, ADRT and Lasting Power of Attorney.
Figure 20.4 Kübler-Ross 5-stage model.
Figure 20.5 Grief and restorative-oriented states.
Source
: Stroebe and Schut 1999.
Figure 21.1 Four-cell stage of the first-cell divisions of a fertilised egg. These first-cell divisions set the stage for all subsequent development, structure and function.
Figure 21.2 Individual sodium and chlorine atoms combine to make an NaCl molecule.
Figure 21.3 Showing the alternating deoxyribose (sugar) molecule and phosphate group with the nucleotides (bases) attached in a small portion of the DNA molecule.
Figure 21.4 (a) A nucleotide consists of a base, 5-C sugar and a phosphate group. (b) A and T pair with 2 hydrogen bonds, while C and G pair with 3 bonds.
Figure 21.5 DNA base-pairing: paired bases face towards the centre of the double helix. The structure is stabilised by the hydrogen bonds between base-pairs.
Figure 21.6 Stages of the cell cycle.
Figure 21.7 Stages of mitosis.
Figure 21.8 Stages of meiosis.
Figure 21.9 Meiosis, reproductive cell division.
Figure 21.10 Mixing and matching: note chromosome 13 and 22.
Figure 21.11 The process of making a new strand involves the pairing of the bases, although these are slightly different in RNA.
Figure 21.12 The three stages of transcription.
Figure 21.13 Structure of the cell and its organelles.
Figure 21.14 Membrane structure.
Figure 21.15 Stress response can lead to protein misfolding and on to disease.
Figure 22.1 Inflammation, highlighting the key cells and chemical mediators involved in the process of inflammation. The immune response has three distinct interlinked phases: innate (green box), cell-mediated (red box) and antibody-mediated (purple box).
Figure 22.2 Simple preventative measures.
Figure 22.3 Components of the lymphatic system.
Figure 22.4 Origin, development and structure of formed elements. Some of the generations of some cell lines have been omitted.
Figure 22.5 Structure of a lymph node. Arrows indicate direction of lymph flow through a lymph node.
Figure 22.6 The middle J chain of IgM immunoglobulin regulates its five-pronged wheel structure. All immunoglobulins have heavy and light chains (coloured green and blue, respectively) with a hinge or central region.
Figure 22.7 Antigens and antibodies involved in the ABO blood groups.
Figure 22.8 Immunoglobulin(s) blue light chain represented by open forceps; green heavy chain represents the forceps fixed end and the hinge region enables the forceps to open and close.
Figure 22.9 Phagocytosis.
Figure 22.10 The structures and features of the innate immune system.
Figure 22.11 Skin wound healing.
Figure 22.12 Cell mediated immunity.
Figure 22.13 Showing the binding of the helper T-cell receptor with major histocompatability complex (MHC)/human leukocyte antigen receptor and the microbial DNA.
Figure 22.14 Activation and clonal selection of B cells. Plasma cells are actually much larger than B cells.
Figure 23.1 Pain pathway of transmission and interpretation.
Figure 23.2 The ascending pain pathway.
Figure 23.3 Structure of a typical neurone.
Figure 23.4 Cross-section of the spinal cord. Note that both sides are identical.
Figure 23.5 The spinothalamic tract.
Figure 23.6 The limbic system.
Figure 23.7 The reflex arc.
Figure 23.8 The Gate Control Theory of pain.
Figure 23.9 The Gate Control Theory and influence of T and SG cell activity.
Figure 23.10 The four dimensions of the pain experience.
Figure 23.11 The verbal rating scale.
Figure 23.12 The verbal analogue scale.
Figure 23.13 The visual analogue scale.
Figure 23.14 The McGill Pain Questionnaire. Source: Melzack & Torgerson (1971). Reproduced with permission of LWW.
Figure 23.15 The action of cyclooxygenase-2 (COX-2) enhancing prostaglandin action.
Figure 23.16 The World Health Organization analgesic ladder (WHO 1986).
Figure 23.17 Transcutaneous electrical nerve stimulation (TENS) machine. Source: Nair & Peate (2013). Reproduced with permission of John Wiley & Sons Ltd.
Figure 23.18 Examples of referred pain and the origin of the tissue damage.
Figure 24.1 Fluid compartments of the body.
Figure 24.2 Osmosis.
Figure 24.3 Simple diffusion.
Figure 24.4 Facilitated diffusion.
Figure 24.5 Electrolytes of intracellular and extracellular compartments.
Figure 24.6 The pH scale.
Figure 24.7 Bicarbonate–carbonic acid buffer reversible reaction.
Figure 24.8 ECG showing the effects of (a) normokalaemia and (b) hypokalaemia.
Figure 24.9 ECG pattern of hyperkalaemia, showing prolonged QRS and tall T wave.
Figure 25.1 Location of the heart.
Figure 25.2 Heart wall.
Figure 25.3 The chambers of the heart.
Figure 25.4 A simplified diagram of the flow of blood through the heart.
Figure 25.5 Anatomical view of the blood flow through the heart.
Figure 25.6 Conduction system of the heart (the white line shows the passage of the electrical impulses through the heart muscle).
Figure 25.7 The cardiac cycle.
Figure 25.8 The cardiac cycle and the ECG.
Figure 25.9 The coronary arteries.
Figure 25.10 The pressure differences through the blood vessels.
Figure 25.11 The comparative structure of blood vessels.
Figure 25.12 A diagram showing the relationship between systolic, diastolic and pulse pressures.
Figure 25.13 The negative feedback control of blood pressure through the baroreceptors.
Figure 25.14 Pulse sites on the body.
Figure 25.15 Assessing the radial pulse.
Figure 25.16 Palpating the dorsalis pedis pulse.
Figure 25.17 Palpating the posterior tibial pulse.
Figure 25.18 Palpating the popliteal pulse.
Figure 25.19 Atherosclerosis.
Figure 25.20 The ruptured atherosclerotic plaque.
Figure 25.21 Typical areas where pain associated with myocardial infarction may be reported.
Figure 25.22 Coronary stent insertion.
Figure 25.23 Signs and symptoms of heart failure.
Figure 25.24 Abdominal aortic aneurysm.
Figure 26.1 The constituents of blood.
Figure 26.2. Haematopoiesis.
Figure 26.3 The difference between normal red blood cells and sickled red blood cells, and the effects at the smaller blood vessels.
Figure 26.4 The location of lymphoid tissue.
Figure 26.5 Blood clotting pathways.
Figure 26.6 Haemophilia inheritance.
Figure 27.1 Upper and lower respiratory tract.
Figure 27.2 Structure of the upper airways.
Figure 27.3 Anatomy of the lower respiratory tract.
Figure 27.4 Structure of the larynx.
Figure 27.5 Surface anatomy of the lungs.
Figure 27.6 Anatomy of a lobule of the lungs.
Figure 27.7 Muscles of inhalation and exhalation.
Figure 27.8 Events of inhalation and exhalation.
Figure 27.9 Diagrammatic description of the major lung volumes and capacities.
Figure 27.10 The respiratory centres of the brain.
Figure 27.11 External respiration: the exchange of oxygen and carbon dioxide within the lungs.
Figure 27.12 The oxyhaemoglobin dissociation curve.
Figure 27.13 Internal respiration: the exchange of oxygen and carbon dioxide within the lungs.
Figure 27.14 Airway pathophysiology, normal compared with asthmatic.
Figure 28.1 Organs of the gastrointestinal tract.
Figure 28.2 The four layers of the gastrointestinal tract.
Figure 28.3 Structures of the mouth.
Figure 28.4 Milk teeth.
Figure 28.5 Permanent teeth.
Figure 28.6 Nasopharynx and laryngopharynx.
Figure 28.7 Oesophagus.
Figure 28.8 Histology of the oesophagus.
Figure 28.9 Anatomy of the stomach.
Figure 28.10 Layers of the stomach.
Figure 28.11 The small intestine.
Figure 28.12 Large intestine.
Figure 28.13 Hepatobiliary system.
Figure 28.14 Common sites for peptic ulcer.
Figure 28.15 (a) Tumour affecting the layer of the stomach. (b) Tumour has spread into neighbouring lymph nodes. (c) Tumour has spread to the liver.
Figure 28.16 Ileostomy on the right side of the abdomen.
Figure 28.17 Types of colostomy.
Figure 28.18 Carcinoma of the gallbladder. The tumour has spread into hepatic ducts and is partially blocking the right hepatic duct and the liver. Note some gallstones in the gallbladder.
Figure 29.1 Organs of the urinary system in a female.
Figure 29.2 Location of the kidneys – back view.
Figure 29.3 Internal structures of the kidney.
Figure 29.4 Blood flow through the kidney.
Figure 29.5 The nephron.
Figure 29.6 Glomerular filtration.
Figure 29.7 Urinary bladder in the female.
Figure 29.8 The male urethra in relation to other pelvic organs.
Figure 29.9 The female urethra in relation to other pelvic organs.
Figure 29.10 Stages of bladder cancer.
Figure 29.11 Formation of an ileal conduit. A section of the terminal ileum is used to form a stoma, where both ureters are implanted and for the urine to flow into. The stoma protrudes from the skin to minimise skin irritation from the urine.
Figure 30.1 The external female genitalia.
Figure 30.3 The ovaries. Source: Heffner & Schust (2014). Reproduced with permission of John Wiley & Sons Ltd.
Figure 30.2 The internal organs of the female reproductive system.
Figure 30.4 Secretion and physiological effects of oestrogen, progesterone, relaxin and inhibin in the female reproductive cycle. Dashed red lines indicate negative feedback inhibition.
Figure 30.5 The female reproductive cycle.
Figure 30.6 The breast: (a) sagittal and (b) anterior views.
Figure 30.7 Breast self-examination.
Figure 30.8 The muscles of the female pelvic floor.
Figure 30.9 Types of prolapse.
Figure 30.10 Taking a sample of cells.
Figure 30.11 Colposcope.
Figure 30.12 The transformation zone.
Figure 30.13 Cone biopsy.
Figure 30.14 Loop diathermy.
Figure 30.15 Hysteroscope.
Figure 30.16 Endometrial ablation. A heated wire loop or a rollerball (a ball on the end of a handle) is used to cut or burn away the lining of the uterus with the aid of a hysteroscope.
Figure 30.17 Needle aspiration.
Figure 30.18 Lymph nodes and drainage – the breast.
Figure 31.1 Male organs of reproduction and surrounding structures.
Figure 31.2 The anatomy of a testis.
Figure 31.3 Transverse section of a portion of seminiferous tubule. (n) and (2n) refer to haploid and diploid numbers and chromosomes.
Figure 31.4 Events in spermatogenesis.
Figure 31.5 Parts of a sperm cell.
Figure 31.6 Hormonal control of spermatogenesis.
Figure 31.7 Internal structure of the penis. The inset in (b) shows details of the skin and fasciae.
Figure 31.8 Model of vascular events controlling erection. Source: Heffner & Schust (2014). Reproduced with permission of John Wiley & Sons Ltd.
Figure 31.9 Neural pathways involved in penile erection. ACh – acetylcholine; MPOA – medial preoptic area; NO – nitric oxide; VIP – vasoactive intestinal peptide. Source: Heffner & Schust (2014). Reproduced with permission of John Wiley & Sons Ltd.
Figure 31.10 Pelvic and para-aortic lymph nodes.
Figure 31.11 Trans-rectal ultrasound-guided biopsy of the prostate.
Figure 31.12 Trans-perineal template biopsy of the prostate.
Figure 31.13 Prostate cryotherapy.
Figure 31.14 The male sexual response. Source: Heffner & Schust (2014). Reproduced with permission of John Wiley & Sons Ltd.
Figure 33.1 The location of the endocrine glands and the organs that secrete hormones.
Figure 33.2 Transportation of hormones in the blood.
Figure 33.3 Target cell and non-target cell.
Figure 33.4 Negative feedback loop.
Figure 33.5 Example of a negative feedback system.
Figure 33.6 The hypothalamus and the posterior pituitary gland.
Figure 33.7 The hypothalamus and the anterior pituitary gland.
Figure 33.8 The thyroid gland.
Figure 33.9 The negative feedback control of thyroid hormone release.
Figure 33.10 The parathyroid glands.
Figure 33.11 The effects of parathyroid hormone, calcitonin and calcitriol in the regulation of blood calcium levels. Purple arrows, calcitonin; blue arrows, parathyroid hormones; red arrows, calcitriol.
Figure 33.12 The adrenal glands.
Figure 33.13 Cross-section of an adrenal gland and its subdivisions.
Figure 33.14 The renin-angiotensin-aldosterone system.
Figure 33.15 The negative feedback control of cortisol production and secretion.
Figure 33.16 The pancreas.
Figure 33.17 The negative feedback control of insulin (red arrows) and glucagon (blue arrows) production.
Figure 34.1 The main parts of the nervous system.
Figure 34.2 Structure of a typical motor neurone and Schwann cell.
Figure 34.3 Myelinated and unmyelinated axons.
Figure 34.4 How the different types of neurones interact.
Figure 34.5 Neuroglia of (a) the central and (b) the peripheral nervous system.
Figure 34.6 The brain.
Figure 34.7 Structure of the left cerebral hemisphere.
Figure 34.8 External anatomy of the spinal cord. See Figure 34.13 for the spinal nerves.
Figure 34.9 The protective coverings of the brain.
Figure 34.10 The formation and circulation and absorption of the CSF.
Figure 34.11 Inferior view of base of brain showing cerebral arterial circle.
Figure 34.12 Sagittal view of extension of the dural mater.
Figure 34.13 Spinal nerves and plexuses.
Figure 34.14 Organisation of the nervous system. Grey boxes represent sensory components of the peripheral nervous system (PNS). Yellow boxes represent motor components of the PNS. Red boxes represent effectors (muscles and glands).
Figure 34.15 Somatic sensory map in the cerebral cortex.
Figure 34.16 Origins of the cranial nerves.
Figure 34.17 The reticular activating system (RAS).
Figure 35.1 The ear.
Figure 35.2 The auricle.
Figure 35.3 The external auditory meatus.
Figure 35.4 The ossicles.
Figure 35.5 The structures of the inner ear.
Figure 35.6 The mechanism of hearing. Source: Munir & Clarke (2013). Reproduced with permission of John Wiley & Sons Ltd.
Figure 35.7 The otoscope.
Figure 35.8 A tuning fork.
Figure 35.9 Cross-section of the eye.
Figure 35.10 The orbit.
Figure 35.11 The eyelids.
Figure 35.12 The lacrimal apparatus.
Figure 35.13 The iris and chambers of the eye.
Figure 35.14 The ciliary body.
Figure 35.15 The layers of the retina.
Figure 35.16 The optic nerve.
Figure 35.17 The visual pathway.
Figure 35.18 Inspection of the eyes.
Figure 35.19 The Snellen chart.
Figure 35.20 Cardiff cards.
Figure 35.21 Phacoemulsification.
Figure 36.1 The divisions of the skeletal system.
Figure 36.2 Osteons in compact bone and trabeculae in spongy bone.
Figure 36.3 Bone shapes (not to scale).
Figure 36.4 Parts of a long bone.
Figure 36.5 Diagrammatic representation of the bone remodelling process.
Figure 36.6 The six types of synovial joint.
Figure 36.7 The gross and microanatomy of skeletal muscles.
Figure 36.8 Smooth muscle.
Figure 36.9 Cardiac muscle.
Figure 36.10 Categories of fracture.
Figure 36.11 Blood supply of a mature long bone.
Figure 36.12 Osteoarthritis.
Figure 36.13 Types of fracture: (a) intracapsular; (b) extracapsular.
Figure 36.14 Types of fixation and implantation for hip fracture.
Figure 37.1 Vitiligo. Source: Buxton & Morris-Jones (2009). Reproduced with permission of John Wiley & Sons Ltd.
Table 37.6 Common warts (see also Figure 37.2).
Figure 37.2 Types of wart.
Table 37.8 Signs and symptoms of dermatophytoses.
Figure 37.3 Tinea pedis.
Source
: Buxton & Morris-Jones (2009). Reproduced with permission of John Wiley & Sons Ltd.
Figure 37.4 Acne.
Figure 37.5 Rosacea. Source: Buxton & Morris-Jones (2009). Reproduced with permission of John Wiley & Sons Ltd.
Figure 37.6 Psoriasis. Source: Buxton & Morris-Jones (2009). Reproduced with permission of John Wiley & Sons Ltd.
Figure 37.7 Eczema. Source: Buxton & Morris-Jones (2009). Reproduced with permission of John Wiley & Sons Ltd.
Figure 37.8 Haemangiomas and naevi. Source: Buxton & Morris-Jones (2009). Reproduced with permission of John Wiley & Sons Ltd.
Figure 37.9 Nail disorders: (a) pitting of nail, (b) nail psoriasis, (c) nail eczema, (d) lichen planus and (e) dystrophy due to lupus. Source: Buxton & Morris-Jones (2009). Reproduced with permission of John Wiley & Sons Ltd.
Figure 37.10 Tinea capitis. Source: Buxton & Morris-Jones (2009). Reproduced with permission of John Wiley & Sons Ltd.
Table 37.13 Common disorders of the scalp.
Figure 37.11 Lupus erythematosus. Source: Buxton & Morris-Jones (2009). Reproduced with permission of John Wiley & Sons Ltd.
Guide
Cover
Table of Contents
Start Reading
Preface
CHAPTER 1
Index