Royal Marsden Manual of Clinical Nursing Procedures, Student Edition

Sara Lister, Head of Pastoral Care and Psychological Support, The Royal Marsden NHS Foundation Trust.Justine Hofland, Formerly Divisional Clinical Nurse Director Cancer Services, The Royal Marsden NHS Foundation Trust.Hayley Grafton, Chief Nursing Information Officer, The Royal Marsden NHS Foundation Trust.Catherine Wilson, Formerly Head of School, The Royal Marsden School, The Royal Marsden NHS Foundation Trust.

• Foreword xviiAcknowledgements xviiiList of contributors xixQuick reference to the procedure guidelines xxiiiHow to use your manual xxvAbout the companion website xxviii1 The context of nursing 1Overview 2Background 2Context of nursing 2Evidence-based practice 7Structure of the manual 9Structure of the chapters 9Finally 9References 10Part One Managing the patient journey 132 Admissions and assessment 15Overview 16Inpatient assessment and the process of care 16Observation 24Physical assessment 25References 443 Discharge care and planning 47Overview 48Discharge care and planning 48Discharging patients from hospital: internal procedures 49Interface between primary and secondary care: external processes 56Informal carers 62The role of voluntary services 65References 664 Infection prevention and control 69Overview 70Infection prevention and control 70Hand hygiene 80Personal protective equipment (PPE) 92Specific patient-related procedures 107Isolation procedures 111Environmental hygiene and the management of waste in the healthcare environment 118Prevention and management of inoculation injury 125References 126Part Two Supporting patients with human functioning 1315 Communication, psychological wellbeing and safeguarding 133Overview 134Communication 134Providing information and making shared decisions 147Communicating with specific populations 151Psychological wellbeing 157Safeguarding, mental capacity and the Mental Health Act 180References 1996 Elimination 205Overview 206Normal elimination 206Altered urinary elimination 212Altered faecal elimination 243Stoma care 264References 2777 Moving and positioning 283Overview 284Moving and positioning: general principles 284Moving and positioning an unconscious patient 297Moving and positioning a patient with an artificial airway 299Moving and positioning a patient with respiratory compromise 303Moving and positioning a patient with neurological impairment 307Moving and positioning a patient with actual or suspected spinal cord compression or spinal cord injury 320Moving and positioning a patient with raised intracranial pressure 330Moving and positioning a patient with an amputation 331References 3368 Nutrition and fluid balance 339Overview 340Fluid balance 340Nutritional status 357Provision of nutritional support: Oral 365Nutritional management of patients with dysphagia 371Enteral tube feeding 372Parenteral nutrition 395References 3989 Patient comfort and supporting personal hygiene 403Overview 404Personal hygiene 404Sleep promotion in a hospitalized patient 416Patient environment 418Eye care 423Ear care 433Mouth care 437References 45010 Pain assessment and management 457Overview 458Pain 458Pain management 467Regional analgesia: local anaesthetic nerve blocks and infusions 473Epidural analgesia 475Entonox administration 485Non-pharmacological methods of managing pain 489References 49211 Symptom control and care towards the end of life 497Overview 498End-of-life care 498Symptom control 516Terminal sedation 527Care after death (last offices) 528References 53512 Respiratory care, CPR and blood transfusion 539Overview 540Respiratory therapy 540Oxygen therapy 543High-flow oxygen via a nasal cannula 552Humidification 555Non-invasive ventilation 556Chest drain management 564Tracheostomy and laryngectomy care 581Basic life support 612Transfusion of blood and blood components 626References 650Part Three Supporting patients through the diagnostic process 65713 Diagnostic tests 659Overview 660Diagnostic tests 660Blood sampling 664Venepuncture: obtaining blood samples from a peripheral vein 667Blood cultures 677Cerebrospinal fluid obtained by lumbar puncture 679Specimen collection: swab sampling 683Specimen collection: urine sampling 692Specimen collection: faecal sampling 698Specimen collection: respiratory tract secretion sampling 700Specimen collection: pleural fluid 702Endoscopic investigations 702Liver biopsy 708Radiological investigations: X-ray 710Magnetic resonance imaging (MRI) 710Computed tomography (CT) 712References 71414 Observations 719Overview 720Observations 720Pulse (heart rate) 723Electrocardiogram (ECG) 730Blood pressure 738Respiration and pulse oximetry 745Peak flow 757Temperature 762Urinalysis 768Blood glucose 773Neurological observations 781References 796Part Four Supporting patients through treatment 80115 Medicines optimization: ensuring quality and safety 803Overview 804Medicines management 804Self-administration of medicines 817Controlled drugs 817Routes of administration 827Parenteral administration (injections and infusions) 854Peripheral cannulas 898Infiltration and extravasation 915References 92716 Perioperative care 937Overview 938Pre-operative care 938Intraoperative care 973Post-operative care 999References 102217 Wound management 1029Overview 1030Wounds 1030Pressure ulcers 1043Surgical wounds 1053Negative pressure wound therapy 1055References 1058Part Five Looking after ourselves so we can support patients 106118 Self-care and wellbeing 1063Overview 1064Self-care and wellbeing 1064Mindfulness 1072Eating and drinking 1073Physical wellbeing and musculoskeletal health 1077References 1081Appendix: Standards of Proficiency for Registered Nurses 1085List of abbreviations 1089Index 1093

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