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How learning disability nurses can support self-management for people with asthma
Asthma is a long-term condition that requires patient education, support and close monitoring. It is important that individuals are empowered and educated about their asthma and supported to self-manage as appropriate. Self-management is a goal that is recommended as an established and effective approach. However, it can be challenging for many individuals, including those with learning disabilities. Learning disability nurses can support individuals diagnosed with asthma to self-manage the condition and should have the knowledge, skills and competence to do so.
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Nursing management of paediatric asthma in emergency departments
Childhood asthma is a complex disease which may be resistant to treatment and varies in its clinical presentation. The number of children admitted to emergency departments (EDs) with acute exacerbation of asthma is high and many are managed solely in the department. The correct assessment of the severity of an exacerbation can be achieved through competent history taking, examination and accurate recording of observations. Nurses working in EDs should be able to recognise the clinical signs and symptoms of acute asthma, assess severity and advise on appropriate management. Nurses should have some knowledge of first-line management and how and when to help deliver these therapies. They should also be able to guide patients in discharge and follow-up care, develop a rapport with families and educate them on topics such as trigger avoidance. The assessment and management of these patients as outlined in this article is based on the British Thoracic Society/Scottish Intercollegiate Network guidelines (BTS/SIGN) (2016).
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Symptom management at the end of life for people with intellectual disabilities
People with intellectual disabilities are living longer while experiencing significant health conditions often resulting in a prolonged period of dying. Symptom management may be complex at end of life and the unique needs of each individual necessitates a person-centred approach.This article discusses several symptoms at end of life including pain, anxiety, agitation, breathlessness and epilepsy, as well as their management strategies, focusing on the last days of life. Healthcare professionals may support people with intellectual disabilities at end of life in a variety of hospital or community settings. Therefore, they need to have the knowledge and skills to provide evidence-based care safely and effectively.Contemporary approaches to ensuring that people with an intellectual disability can self-determine the management of their symptoms and that their circle of support is involved in a meaningful way will be explored, including advanced care planning and shared decision-making. This article presents a biopsychological perspective to end of life care and symptom management, which speaks to a holistic and respectful approach.
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Nursing patients with acute aortic dissection in emergency departments
Acute aortic dissection is an emergency condition that is often missed during initial assessment. Delay in diagnosis increases mortality, but the presentation can mimic several more common conditions. Emergency practitioners must maintain a high index of suspicion in patients who present with chest or back pain and ensure timely diagnostic testing and interpretation of results if aortic dissection is suspected.
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Sepsis: an overview of the signs, symptoms, diagnosis, treatment and pathophysiology
Sepsis is a common phenomenon surrounded by uncertainty and misunderstanding. The urgency for treatment is complicated by the vagueness of signs and symptoms and lack of a conclusive diagnostic test. This article unpicks the signs and symptoms of sepsis with guidance for emergency department nurses who are responsible for assessing patients with potential sepsis. The article also relates monitoring, investigation and treatment expectations to the underlying pathophysiology and refers to the individual and global implications of the condition.
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Making reasonable adjustments to cancer services for people with learning disabilities
People with learning disabilities do not access or engage with proactive cancer screening in line with those without learning disabilities. As a result, they often experience delays in diagnosis and treatment for cancer, leading to suboptimal health outcomes and, in some cases, premature mortality. This article explores how the legal requirement for public bodies to make reasonable adjustments to ensure people with learning disabilities can use their services can have a positive effect on patient outcomes and experience. In cancer services this applies across the patient pathway, from access to screening, assessment, diagnosis, treatment and discharge. The authors use case studies to illustrate how reasonable adjustments can be made for individuals with learning disabilities in accessing cancer care. They also provide readers with the opportunity to reflect on their own practice and explain how to make small, achievable reasonable adjustments in their clinical areas.
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Best practice in the transition to adult services for young adults who had childhood cancer
This article discusses the importance of a successful transition from children’s to adult services for young adults who had childhood cancer. It considers the role of nurses in children’s and adult services in supporting young adults to adequately prepare for the transition to adult services. Historically, the responsibility has been with children’s services to prepare young adults to transition to adult services; however, a joint approach between children’s and adult service providers is now recommended. A well-organised, person-centred, transition plan commenced early can contribute to a young adult’s successful transition to adult services.
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Conducting holistic pain assessments in patients with cancer-related pain
The incidence of cancer is increasing and people diagnosed with cancer are living longer, with and beyond cancer, and experiencing acute and long-term effects of their disease and its treatment. One such effect is pain, which may occur at any stage, from diagnosis to survivorship or end of life. The exact incidence of cancer-related pain is challenging to determine but it is estimated to affect between 39% and 66% of patients, according to the stage of their disease trajectory. Cancer-related pain is complex, multifactorial and multidimensional, and nurses need to be equipped with the knowledge and skills to assess it in a holistic way. This article explores how nurses working in cancer settings can support people in their care by conducting holistic pain assessments.
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Prehabilitation in cancer care: preparing people for treatment physically and mentally
Prehabilitation is the process of enhancing an individual’s functional capacity by optimising their physical and mental health to prepare them for treatment. Prehabilitation is the first stage of the rehabilitation pathway and comprises pre-assessment, interventions and follow-up. It is designed to reduce the risk of the physical and psychological complications of cancer and its treatment, thereby improving patients’ ability to recover as well as their long-term outcomes.This article highlights the principles of prehabilitation in cancer care and its benefits for patients, and explores the role nurses can play in delivering prehabilitation assessments and interventions and in encouraging positive behaviour change in their patients.
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Adult primary brain tumours: presentation, diagnosis, treatment and complications
Primary malignant brain tumours are aggressive tumours with limited treatment options, and as such they remain the largest cause of cancer-related deaths in men aged under 45 years and women aged under 35 years. Benign brain tumours are frequently treated with the intention to cure them. Both malignant and benign brain tumours often cause long-term, debilitating neurological effects, and if they recur can be fatal.This article outlines the updated World Health Organization classification of adult primary brain tumours, as well as their treatment and predicted outcomes. It also identifies the role of cancer specialist nurses in supporting patients and their families.
