Understanding oral mucositis and the principles of effective mouth care.

Mucositis involves an inflammation of the oral or gastrointestinal mucosa and is a common complication of cancer treatment. Mucositis is usually associated with high-dose chemotherapy, radiotherapy and, more recently, molecular targeted therapy. Oral mucositis refers specifically to inflammation and ulceration that occurs in the mouth. If not treated promptly, it can potentially lead to life-threatening infection requiring hospitalisation and intravenous antibiotics. This article discusses the causes and nursing management of oral mucositis, with an emphasis on self-care and optimal oral hygiene, as well as pharmacological interventions.

How to take a patient's temperature.

RATIONALE AND KEY POINTS: Being able to accurately assess and record a patient's temperature is an essential nursing skill, and should be undertaken as part of a wider systematic assessment of the patient. Any concerns regarding individual recordings or trends should be escalated to other members of the healthcare team as appropriate. REFLECTIVE ACTIVITY: 'How to' articles can support you to update your practice and ensure it remains evidence-based. Apply this article to your practice. Reflect and write a short account of.

X-rays: what the nurse needs to know.

Rationale and key points X-ray imaging is a form of electromagnetic radiation that is able to pass through the human body producing an image of the internal structures. X-rays are one of the main investigations for confirming a suspected diagnosis. Developing an understanding of the underlying mechanism and the rationale for requesting an X-ray will increase nurses' understanding of the process and enable improved patient preparation through explanation and reassurance. This article provides an overview of the fundamental principles underlying the process of obtaining an X-ray. ¼ X-ray imaging is a common diagnostic tool that nurses will encounter on a regular basis. ¼ Several factors affect the production of a clear X-ray image, including patient movement. ¼ Radiation safety and avoidance of unnecessary exposure are paramount. ¼ Co-operation and communication by the multidisciplinary team are vital to ensure that X-ray imaging can be requested, performed, interpreted and acted on, and the findings communicated to the patient.

Sputum collection and analysis: what the nurse needs to know.

Rationale and key points Sputum is the term used to describe mucus that has been expectorated. It consists of secretions and other matter that has been coughed up from the lungs and large airways. This article informs nurses about how and why sputum collection and analysis are undertaken. ¼ Sputum is always considered abnormal, because healthy people swallow bronchial secretions. ¼ Sputum analysis is important, because it enables diagnosis of conditions such as pneumonia, tuberculosis, lung abscess and lung cancer. ¼ The nurse should record the colour, amount and consistency of the sputum collected. They should send the specimen to the laboratory for analysis without delay to ensure accurate results.

Pulse oximetry: what the nurse needs to know.

Rationale and key points Measurement of peripheral oxygen saturation (SpO2) is used to identify early hypoxia in patients and evaluate the effectiveness of oxygen therapy. Nurses should be aware of the procedure for using a pulse oximeter to measure SpO2 levels and the normal range for SpO2 readings. ¼ A pulse oximeter is used to measure SpO2 levels, and involves placing a probe on the patient's finger, toe or ear lobe. ¼ A SpO2 level of less than 90% is a clinical emergency. If the SpO2 level is below 94%, the nurse should assume the patient is hypoxic until proven otherwise, and therefore they may require supplemental oxygen administration. ¼ Nurses should be aware of the factors that might affect SpO2 readings, including anaemia, peripheral vasoconstriction, dark skin tone and skin discolouration.

Measuring peak expiratory flow rate: what the nurse needs to know.

Rationale and key points This article provides information on monitoring a patient's peak expiratory flow rate. It explains the rationale for measuring the peak expiratory flow rate, provides guidance for nurses to undertake this investigation and offers advice on how to instruct patients in the use of this technique. ¼ Measuring the peak expiratory flow rate is an inexpensive, straightforward and useful clinical investigation that enables fluctuations in the patient's respiratory effort to be monitored over time. ¼ The peak expiratory flow rate is used for the diagnosis, monitoring and assessment of the severity of respiratory compromise, particularly in patients with asthma. ¼ The nurse can enable significant improvements in patient care by providing patient education on the correct technique, and by accurate assessment and recording of the peak expiratory flow rate. ¼ The nurse should advise the patient on the action required if variation between readings occurs, where the patient is required to monitor their condition at home.

Nursing and Midwifery Council revalidation.

All UK nurses and midwives will be required to perform revalidation as part of their registration process, from April 2016. This entails a pre-determined number of practice hours and study time, reflection on practice, obtaining feedback on individual performance and confirmation of these achievements by a third party source. This article describes the actions nurses and midwives can take to fulfil their revalidation requirements. It also discusses how to prepare for the forthcoming changes and what the nurse and midwife need to consider to perform successful revalidation. By completing the time out activities included with this article, reflecting on your practice and submitting your work for continuing professional development credits, you will be working towards creating a revalidation portfolio, in accordance with Nursing and Midwifery Council guidelines.

Nursing care of patients with a temporary tracheostomy.

Safety considerations are important when caring for a patient with a temporary tracheostomy. Early detection and resolution of problems in tracheostomy management are important to prevent serious incidents arising. Nurses working outside critical care areas need to be competent and confident in the management or detection of potential problems with tracheostomies. This article summarises the essential care of a patient with a temporary tracheostomy with reference to best practice guidelines, emphasising the importance of prompt intervention and response, if a potential problem is identified.

Diagnosis and management of patients with pleural effusions.

Pleural effusions occur when fluid accumulates between the visceral and parietal pleura in the chest cavity, preventing the lung from expanding fully during inspiration. The reduction in lung volume, depression of the diaphragm and reduced chest wall compliance cause dyspnoea, and occasionally pain or cough. Pleural effusion is a complex problem caused by a variety of conditions requiring different treatment depending on the underlying diagnosis. This article discusses the causes and treatment of pleural effusions, referencing guidelines produced by the British Thoracic Society.

Management of patients with empyema.

Empyema is the term used to describe an accumulation of pus in a body cavity such as the pleural space as a result of bacterial infection. The condition is serious because it is difficult for the immune system to resolve infection in this area. Empyema can be avoided by the use of appropriate antibiotic therapy and good aseptic technique when dealing with any situation that breaches the chest wall. Treatment of this condition may be medical but if the condition does not resolve, surgical intervention is required. The nursing role involves providing support, education and long-term management for patients with empyema.

An introduction to thoracic surgery: assessment, diagnostics, treatment.

Thoracic surgery is an exciting and dynamic specialty. Many of the conditions treated can be regarded as life-limiting so practitioners require expert skills in communication as well as knowledge of the specific illnesses and complications that can arise. This article explains the types of surgery performed and discusses the factors that need to be taken into consideration before operating on malignant lung disease. The specific post-operative care required by patients following thoracic surgery is also discussed.

Changes in infection control practice to reduce MRSA infection.

An increase in the incidence of methicillin-resistant Staphylococcus aureus (MRSA) led to a review of infection control practice within the cardiothoracic directorate in a South London teaching hospital. Several changes in aspects of care were implemented including educational initiative, extension of the admission screening policy, a specific isolation nursing team and the development of a care pathway. This led to a considerable reduction in cross-infection rates. It was recognized that high-quality, high nurse-to-patient ratio and education on fundamental aspects of barrier nursing were necessary to maintain the low infection rates.