Pneumonia has a huge impact upon the healthcare system in the UK and is not only associated with higher rates of hospital admissions than any other respiratory disease, but also carries a high risk of mortality. This article offers an overview of community-acquired pneumonia in adult patients, including the pathophysiology, common aetiologies, at-risk groups and pharmacological management. There is also a brief discussion on differential diagnoses and potential strategies to support clinical decision-making in the community.
On primary infection, the varicella zoster virus is responsible for the development of chickenpox, after which the virus becomes dormant. Upon reactivation of the latent virus, shingles results. The incidence and severity of shingles increases with age, and is associated with significant morbidity and mortality. Early intervention with antiviral medications is crucial to help resolve the rash and reduce any potential complications induced by the virus.
Asthma is a common lung condition affecting many patients in the community. Nurses are pivotal in the diagnosis and management of people with both stable disease and during acute flare-ups. Asthma reviews offer opportunities to build therapeutic relationships and optimise treatment, helping patients to recognise and plan management of an asthma attack. On average, three people die of asthma every day in the UK - a stark statistic which should encourage nurses to be forever watchful of opportunities to regularly review the evidence base and produce patient-centred care. This article focuses on the management of chronic adult asthma, at diagnosis, management, and briefly touches on assessment of the acute exacerbation. They key differences between the asthma guidelines of the British Thoracic Society/Scottish Intercollegiate Guidelines Network (BTS/SIGN, 2016) and the National Institute for Health and Care Excellence (NICE, 2017) guidelines, which are currently in use in the UK, are presented for reader consideration.
Pilonidal sinuses are a common condition, and are often found in young males. Treatment is mainly by surgery and caring for these wounds is generally undertaken by primary care practitioners. Fistulas are also challenging wounds to care for. This article offers practical advice on the management of these, often problematic, wounds. Issues, such as cleansing, selecting appropriate wound care dressings, measuring and monitoring progression to healing will be discussed; together with advice on when to refer for specialist input.
The first part of this two-part series on breathlessness (JCN 28(5): 83–90) looked at the emotional and physical distress and social isolation caused by the condition for both patients and their families, as well as examining the assessment of the condition. Refractory breathlessness, i.e. that which persists even when measures to optimise the underlying condition have been implemented, is one of the most distressing symptoms experienced by patients with advanced life-limiting illnesses. This, the second part of the series, looks at how community nurses can successfully manage patients, including lifestyle changes, self-management, psychological therapy and pharmacology.
Increasing demographic changes in the type and age of patients as well as further government directives requiring more care at home, mean that there is a growing emphasis on primary care-led services. Large caseloads and patients with multiple and chronic health problems are stretching available community nursing resources. Against this background, continence promotion tends not to be a priority and at times it may seem easier and better to prescribe pads for patients with urinary incontinence. This article provides community nurses with guidance on the initial assessment and management options available for patients who present with urinary incontinence. Many patients will subsequently experience improvement in their symptoms (although not always complete resolution), with a corresponding improvement in overall quality of life.
This article provides an overview of lymphoedema and its management. It includes information on the definition of lymphoedema, anatomy (lymphatics), lymphoedema staging, complications and the psychosocial impact. This leads onto a discussion of the management methods that can be delivered by community staff and practice nurses who have received appropriate training. Involving patients and their family/carers in all aspects of the management plan can help them to cope with this lifelong condition and promote concordance with treatment.
Constipation is one of the most common gastrointestinal problems experienced by the general population, with an estimated UK prevalence of 52 per cent. Despite this, constipation is often both misdiagnosed and under-treated both in children and adults. This paper will look at the issues and suggest specific management strategies for addressing constipation in both the general adult population and these apparently vulnerable groups.
June Rogers MBE, RN, RSCN, BA(Hons), MSc, ENB 216, ENB N01, ENB 978. PromoCon Team Director, Disabled Living Manchester.
Article accepted for publication: January 2013
Hilary Holmes and Professor Steven Timmons discuss some research where the objective was to investigate how social care staff working within intermediate care perceived their role in medication management.
Hilary Holmes, RN, BSc
Community Matron, Nottinghamshire County Teaching PCT
Stephen Timmons, MA, MA, MSc, Ph.D.
Associate Professor, University of Nottingham School of Nursing
Article accepted for publication: February 2007
Gillian Pedley reviews the causes of pressure sores, assessment of risk and their prevention.
