Oxford Handbook of Adult Nursing, Third Edition
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Third Edition
Questions & Answers from this book
Questions and answers are connected to the referenced book and its available source material.
Chapter 3: Safety in the clinical environment
Chapter 10: Clinical assessment
Chapter 12: Essential clinical skills
What is the recommended method to confirm the correct placement of a fine-bore nasogastric tube before administering fluids?
Aspirate a small amount of gastric contents and test its pH on a testing strip; a pH of 5.5 or lower indicates safe stomach placement. If the tube's position is still uncertain, confirm it by X-ray.
What are the known risk factors for developing a pressure ulcer?
The known risk factors for developing a pressure ulcer are significantly limited mobility, significant loss of sensation, significantly restricted movement, a previous or current pressure ulcer, nutritional deficiency, significant cognitive impairment, serious illness, neurological conditions, fragile or damaged skin, and old age. People with more than one of these risk factors are normally considered to be at high risk.
Chapter 14: Respiratory conditions
What are the nursing actions in acute respiratory care regarding oxygen therapy for a patient known to have COPD?
For a patient known to have COPD, oxygen therapy in acute respiratory care should be used only with medical advice. The nurse administers oxygen as required to maintain a comfortable respiratory rate and oxygen saturation above 95%, while monitoring for signs of CO2 retention such as flushing, a bounding pulse, drowsiness, confusion, and rising heart rate and blood pressure. Nebulized drugs should be driven with medical air until the risk of type II respiratory failure has been assessed by a clinician.
What are the differences between Type I and Type II respiratory failure in terms of ABG measurements and typical causes?
Type I respiratory failure shows a low arterial oxygen (PaO2 <8 kPa) and low oxygen saturation (SaO2 <92%), while Type II also has a low PaO2 but additionally a high arterial carbon dioxide (PaCO2 >6.5 kPa) with a normal or acidotic pH. Causes differ: Type I is linked to conditions such as severe asthma, pneumonia, pulmonary embolism, and ARDS, whereas Type II occurs with COPD exacerbations, neuromuscular disorders, or opiate/barbiturate overdose.
Chapter 15: Cardiovascular conditions
What are the key nursing considerations for a person admitted to hospital with heart failure?
Key nursing considerations include accurately measuring and recording vital signs, weight, oedema extent and skin condition, respiratory rate and ease, pulse oximetry, and fluid balance. Nurses also record ECG and continuous cardiac monitoring, secure IV access, obtain relevant blood samples, administer prescribed oxygen, diuretics, and symptom relief, and refer to the heart failure team for specialist drugs. Care follows organizational procedures and is determined by the MDT, with any changes in the person's condition reported promptly.
What are the ECG characteristics of Mobitz type I (Wenckebach) and Mobitz type II second-degree AV block?
In Mobitz type I (Wenckebach) second-degree AV block, the PR interval progressively lengthens with each successive P wave until one P wave is not followed by a QRS complex, and then the cycle repeats. In Mobitz type II, the PR interval remains constant in conducted beats, but some P waves are not followed by QRS complexes, and this may occur randomly without a consistent pattern.
Chapter 16: Neurological conditions
What is the time window for thrombolysis in ischaemic stroke, and when can it be extended?
Thrombolysis for ischaemic stroke is effective only within a 4.5-hour window from symptom onset. This window may be extended to 9 hours if CT perfusion or MRI shows evidence of salvageable brain tissue.
How does Parkinson's disease cause the typical symptoms of tremor, rigidity, and slowness of movement?
Parkinson's disease damages the substantia nigra of the brain, which reduces dopamine production. The lowered dopamine levels give rise to the typical symptoms of tremor, rigidity, and slowness of movement.
Chapter 18: Renal and urinary tract conditions
How is the treatment of chronic kidney disease (CKD) staged according to the Oxford Handbook of Adult Nursing?
CKD treatment is matched to five stages based on GFR: stage 1 is >90, stage 2 is 60-89, stage 3 is 30-59, stage 4 is 15-29, and stage 5 is under 15. Stages 1 and 2 are managed conservatively in primary care; stages 3 and 4 are managed by primary and renal specialist services with regular monitoring; stage 5 patients may be offered conservative management, renal replacement therapy, or transplantation.
What are the causes of acute kidney injury (AKI) categorized as pre-renal, renal, and post-renal?
Acute kidney injury (AKI) is caused by decreased blood flow to the kidneys (pre-renal), direct damage to kidney tissue and structures (renal), or obstruction of the urinary tract (post-renal).
Chapter 23: Pain
What does the PAINAD score measure and how is it scored?
The PAINAD (Pain Assessment in Advanced Dementia) scale measures pain in people with advanced dementia by scoring observable behaviours: breathing independent of vocalization, negative vocalization, facial expressions, body language, and consolability. Each of the five behaviours is rated 0, 1, or 2, giving a total score from 0 to 10. Scores of 1–3 indicate mild pain, 4–6 moderate pain, and 7–10 severe pain.
What is the WHO analgesic ladder and how is it used in pain management?
The WHO analgesic ladder is a stepwise framework originally designed for cancer pain but now often used to guide analgesia in general pain management. It has three steps: Step 1 uses non-opioids like paracetamol for mild to moderate pain, Step 2 adds weak opioids like codeine and tramadol, and Step 3 uses strong opioids like morphine, oxycodone, fentanyl, and diamorphine for severe pain. The ladder is used by starting at the step appropriate to the person's pain and moving in one direction, while considering adjuvant agents to maximize effect.
Chapter 26: Clinical emergencies
What is the difference between severe sepsis and septic shock according to the Oxford Handbook of Adult Nursing?
Severe sepsis is sepsis with evidence of organ dysfunction, hypotension, or hypoperfusion, which may be shown by reduced consciousness, hypoxia, oliguria, and a serum lactate above 2 mmol/L. Septic shock includes the same features as severe sepsis but additionally involves refractory hypotension, meaning hypotension continues despite adequate fluid resuscitation, and serum lactate is above 4 mmol/L.
What are the components of the 'Sepsis Six' care bundle?
The Sepsis Six care bundle comprises six components: taking blood cultures, usually two sets from different sites; giving antibiotics within one hour; providing high-flow oxygen; collecting serum lactate and full blood count samples; starting IV fluids; and accurately measuring fluid balance. These actions should begin if any red flag sepsis sign is present.
Chapter 27: Leadership and teamwork
Chapter 30: Collectivism, democratization, and involvement
What are the barriers to effective involvement in collaborative working?
The main barriers are co-option and incorporation threats, which dilute or mute patient and public voices by bringing them too close to the systems of power they want to influence. Friendly relationships with staff and managers can make people reluctant to challenge the status quo, so boundaries are needed. External pressures such as staffing levels, lack of continuity from agency staff, job insecurity, workload, and workplace environment can also constrain staff time and motivation. Without deliberate design and proper support, involvement can become tokenistic or co-opted.
What are the main barriers to meaningful public involvement in healthcare, and how do they dilute or mute patient and public voices?
The main barriers to meaningful public involvement are co-option and incorporation threats, where patient and public voices become diluted or muted by coming too close to the systems of power they aim to influence. This often happens through friendly relationships with staff and managers that make people feel uncomfortable challenging the status quo, and it can be worsened by resource pressures and tokenism when collaborative values are not embedded in organizational practice.
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