Table of Contents
Cover
Series Page
Title Page
Copyright Page
Foreword
Acknowledgements
List of contributors
Quick reference to the procedure guidelines
How to use your manual
About the companion website
1 The context of nursing
Overview
Background
Context of nursing
Evidence‐based practice
Structure of the manual
Structure of the chapters
Finally
REFERENCES
Part One: Managing the patient journey
2 Admissions and assessment
Overview
Inpatient assessment and the process of care
Observation
Physical assessment
REFERENCES
3 Discharge care and planning
Overview
Discharge care and planning
Discharging patients from hospital: internal procedures
Interface between primary and secondary care: external processes
Informal carers
The role of voluntary services
REFERENCES
4 Infection prevention and control
Overview
Infection prevention and control
Hand hygiene
Personal protective equipment (PPE)
Specific patient‐related procedures
Isolation procedures
Environmental hygiene and the management of waste in the healthcare environment
Prevention and management of inoculation injury
REFERENCES
Part Two: Supporting patients with human functioning
5 Communication, psychological wellbeing and safeguarding
Overview
Communication
Providing information and making shared decisions
Communicating with specific populations
Psychological wellbeing
Safeguarding, mental capacity and the Mental Health Act
REFERENCES
6 Elimination
Overview
Normal elimination
Altered urinary elimination
Altered faecal elimination
Stoma care
REFERENCES
7 Moving and positioning
Overview
Moving and positioning: general principles
Moving and positioning an unconscious patient
Moving and positioning a patient with an artificial airway
Moving and positioning a patient with respiratory compromise
Moving and positioning a patient with neurological impairment
Moving and positioning a patient with actual or suspected spinal cord compression or spinal cord injury
Moving and positioning a patient with raised intracranial pressure
Moving and positioning a patient with an amputation
REFERENCES
8 Nutrition and fluid balance
Overview
Fluid balance
Nutritional status
Provision of nutritional support: Oral
Nutritional management of patients with dysphagia
Enteral tube feeding
Parenteral nutrition
REFERENCES
9 Patient comfort and supporting personal hygiene
Overview
Personal hygiene
Sleep promotion in a hospitalized patient
Patient environment
Eye care
Ear care
Mouth care
REFERENCES
10 Pain assessment and management
Overview
Pain
Pain management
Regional analgesia: local anaesthetic nerve blocks and infusions
Epidural analgesia
Entonox administration
Non‐pharmacological methods of managing pain
REFERENCES
11 Symptom control and care towards the end of life
Overview
End‐of‐life care
Symptom control
Terminal sedation
Care after death (last offices)
REFERENCES
12 Respiratory care, CPR and blood transfusion
Overview
Respiratory therapy
Oxygen therapy
High‐flow oxygen via a nasal cannula
Humidification
Non‐invasive ventilation
Chest drain management
Tracheostomy and laryngectomy care
Basic life support
Transfusion of blood and blood components
REFERENCES
Part Three: Supporting patients through the diagnostic process
13 Diagnostic tests
Overview
Diagnostic tests
Blood sampling
Venepuncture: obtaining blood samples from a peripheral vein
Blood cultures
Cerebrospinal fluid obtained by lumbar puncture
Specimen collection: swab sampling
Specimen collection: urine sampling
Specimen collection: faecal sampling
Specimen collection: respiratory tract secretion sampling
Specimen collection: pleural fluid
Endoscopic investigations
Liver biopsy
Radiological investigations: X‐ray
Magnetic resonance imaging (MRI)
Computed tomography (CT)
REFERENCES
14 Observations
Overview
Observations
Pulse (heart rate)
Electrocardiogram (ECG)
Blood pressure
Respiration and pulse oximetry
Peak flow
Temperature
Urinalysis
Blood glucose
Neurological observations
REFERENCES
Part Four: Supporting patients through treatment
15 Medicines optimization:
Overview
Self‐administration of medicines
Controlled drugs
Routes of administration
Parenteral administration (injections and infusions)
Peripheral cannulas
Infiltration and extravasation
REFERENCES
16 Perioperative care
Overview
Pre‐operative care
Intraoperative care
Post‐operative care
REFERENCES
17 Wound management
Overview
Wounds
Pressure ulcers
Surgical wounds
Negative pressure wound therapy
REFERENCES
Part Five: Looking after ourselves so we can support patients
18 Self‐care and wellbeing
Overview
Self‐care and wellbeing
Mindfulness
Eating and drinking
Physical wellbeing and musculoskeletal health
REFERENCES
Appendix: Standards of Proficiency for Registered Nurses
List of abbreviations
Index
End User License Agreement
List of Tables
Chapter 1
Table 1.1 The NHS Long Term Plan (NHS England 2019) and
The Royal Marsden Manu
...
Chapter 2
Table 2.1 Phases of the nursing process
Table 2.2 Principles of assessment
Table 2.3 Different sounds heard on percussion
Table 2.4 Examples of chest deformities
Table 2.5 Examples of adventitious sounds
Chapter 3
Table 3.1 Procedure for the assessment process for complex discharges
Table 3.2 Questions and things to look for when assessing a care or nursing h...
Chapter 4
Table 4.1 Links in the chain of infection
Table 4.2 Examples of how the human microbiome can be protective
Table 4.3 Medically significant bacteria
Table 4.4 Types of transmissible spongiform encephalopathies
Table 4.5 The Hygiene Code
Table 4.6 Legislation significant to healthcare infection control policy
Table 4.7 Examples of different levels of aseptic procedures
Table 4.8 Waste colour codes
Table 4.9 Waste containers
Chapter 5
Table 5.1 NHS
Knowledge and Skills Framework
: four levels of communication com...
Table 5.2 The most commonly prescribed antidepressants
Table 5.3 Safeguarding principles as outlined in the Care and Support Statuto...
Table 5.4 Choosing between the Mental Health Act (2007) and the Mental Capaci...
Chapter 6
Table 6.1 The HOUDINI protocol
Table 6.2 Types of catheter
Table 6.3 Complications of catheterization
Table 6.4 Long‐ and short‐term risk factors of urinary diversion
Table 6.5 Classification of laxatives
Table 6.6 A summary of products used for problems associated with stoma (the ...
Table 6.7 Decision tool to use when selecting an appropriate bag or pouch
Chapter 7
Table 7.1 Falls: risk factors
Table 7.2 Common postural problems seen in patients with neurological impairm...
Table 7.3 Shoulder subluxation supports
Table 7.4 Examples of commonly used resting splints
Table 7.5 Types of wheelchair
Table 7.6 Levels of spinal injury with resulting function loss.
Chapter 8
Table 8.1 Body fluid compartments
Table 8.2 Molecule transport modes
Table 8.3 Fluid intake and output
Table 8.4 Assessment of fluid status
Table 8.5 Kidney Disease: Improving Global Outcomes (KDIGO) staging classificati...
Table 8.6 Guidelines for estimation of a patient’s daily energy and protein requ...
Table 8.7 Waist circumference measurements
Table 8.8 Suggestions for modification of diet
Table 8.9 Oral nutritional supplements
Table 8.10 Difficulties that may be experienced by patients during eating and dr...
Table 8.11 Methods of administering enteral feeds
Table 8.12 Monitoring in parenteral nutrition support
Chapter 9
Table 9.1 Considerations for the care of the skin
Table 9.2 Risk factors and the level of risk for developing foot ulcers (NICE...
Table 9.3 Common bed positions
Table 9.4 Effects of ageing on the eye
Chapter 10
Table 10.1 Factors affecting pain sensitivity
Table 10.2 The use of adjuvant drugs (co‐analgesics)
Table 10.3 Recommended conversion rate guide from oral morphine to 72‐hour fe...
Table 10.4 Examples of regional analgesia blocks
Table 10.5 Epidural infusions of local anaesthetic agents and opioids: manage...
Table 10.6 Epidural: safety checklist
Chapter 11
Table 11.1 Recommendations for the pharmacological management of patients who are...
Table 11.2 Cultural and religious considerations in the care of dying patients an...
Table 11.3 Common medications used in the management of dyspnoea
Table 11.4 Common causes of nausea and vomiting in palliative care
Table 11.5 Receptor affinity sites of selected anti‐emetics
Chapter 12
Table 12.1 Common causes of respiratory failure
Table 12.2 Approximate oxygen concentrations related to flow rates of nasal cannu...
Table 12.3 Approximate oxygen concentrations related to flow rates of simple face...
Table 12.4 Total gas flow from Venturi masks at different oxygen flow rates
Table 12.5 Summary of oxygen devices
Table 12.6 Abbreviations for recording oxygen delivery on an observation chart...
Table 12.7 Causes of pneumothorax
Table 12.8 Chest drain observations
Table 12.9 Indications for a tracheostomy
Table 12.10 Indications for a laryngectomy
Table 12.11 Reversible causes of cardiac arrest
Table 12.12 Complications of cardiac arrest
Table 12.13 Red cell compatibility
Table 12.14 Blood, blood components and blood products used for transfusion
Table 12.15 Summary of training and competency assessment requirements in the UK ...
Table 12.16 Recognition of transfusion reactions
Chapter 13
Table 13.1 Types of organism
Table 13.2 Blood collection tubes and draw order
Table 13.3 Haematology
Table 13.4 Biochemistry
Table 13.5 Choice of intravenous device
Table 13.6 Common MRI scans
Table 13.7 Common CT scans
Chapter 14
Table 14.1 Normal resting pulse rates per minute at various ages
Table 14.2 Three‐ and five‐lead ECG positioning
Table 14.3 Respiratory volumes and capacities
Table 14.4 Non‐infectious causes of hyperthermia
Table 14.5 Grades of pyrexia
Table 14.6 Visual observations of urine and possible indications
Table 14.7 How drugs may influence the results of reagent stick testing
Table 14.8 Interpretation of the results (interpretation should always be mad...
Table 14.9 Normal target blood glucose ranges
Table 14.10 Possible causes of hyperglycaemia and hypoglycaemia
Table 14.11 Summary of cranial nerves
Table 14.12 Examination of pupils
Table 14.13 Abnormal respiratory patterns
Table 14.14 Scoring activities of the GCS; the scores are summed, with the hi...
Chapter 15
Table 15.1 Controlled drug (CD) prescribing by independent prescribers
Table 15.2 Royal Pharmaceutical Society’s Prescribing Competency Framework
Table 15.3 The rights associated with medicines administration
Table 15.4 Types of allergic reactions
Table 15.5 Types of pharmacokinetic interaction
Table 15.6 Types of pharmacodynamic interaction
Table 15.7 Legal requirements for the schedules of controlled drugs (CDs)
Table 15.8 Summary of legal requirements for handling of controlled drugs (CD...
Table 15.9 Advantages and disadvantages of the routes of administration
Table 15.10 Considerations for specific types of administration
Table 15.11 Example of gauge sizes and average flow rates, using water (note ...
Table 15.12 Examples of vesicant cytotoxic and non‐cytotoxic drugs in common ...
Table 15.13 Possible causes of extravasation
Table 15.14 Drug sequencing: rationales for administering vesicant drugs firs...
Table 15.15 Nursing assessment of extravasation
Table 15.16 Grading scale for monitoring extravasation
Table 15.17 Monitoring overinfusion and underinfusion
Chapter 16
Table 16.1 Modified American Society of Anesthesiologists physical status cla...
Table 16.2 Pre‐operative laboratory tests
Table 16.3 Forms of patient education
Table 16.4 Predisposing factors for aspiration under general anaesthesia
Table 16.5 Options for antiseptic skin preparation
Table 16.6 Hair removal prior to surgery
Table 16.7 Pre‐operative marking recommendation
Table 16.8 Allergic reactions
Table 16.9 Haematology values
Table 16.10 Post‐operative observations
Table 16.11 Open and closed drains
Chapter 17
Table 17.1 TIME principles for wound bed preparation
Table 17.2 Factors that may delay wound healing
Table 17.3 Common debridement methods.
Table 17.4 Dressing groups (refer to the manufacturers’ recommendations with ...
List of Illustrations
Chapter 1
Figure 1.1 Leading Change, Adding Value: A Framework for Nursing, Midwifery ...
Figure 1.2 The Human Factors Model.
Figure 1.3
Future Nurse: Standards of Proficiency for Registered Nurses
.
Figure 1.4 Summary of key changes to the standards for nurses.
Figure 1.5 Hierarchy of evidence pyramid for nursing.
Chapter 2
Figure 2.1 Phases of the nursing process.
Figure 2.2 Examples of 1 unit of alcohol.
Figure 2.3 Physical assessment framework.
Figure 2.4 Stethoscope.
Figure 2.5 Structures of the respiratory system.
Figure 2.6 Lung, fissures and lobes. RUL, right upper lobe; RML, right middl...
Figure 2.7 Structures of the chest and thorax.
Figure 2.8 The lymph nodes of the head and neck.
Figure 2.9 Position of hands to assess for chest expansion.
Figure 2.10 Locations for feeling fremitus: back.
Figure 2.11 Locations for feeling fremitus: front.
Figure 2.12 Ladder pattern for percussion and auscultation of the chest.
Figure 2.13 Structure of the heart.
Figure 2.14 Location of the internal jugular veins within the sternomastoid ...
Figure 2.15 Measuring a jugular venous pressure.
Figure 2.16 Auscultation points and location of the heart valves.
Figure 2.17 Organs of the gastrointestinal system.
Figure 2.18 The four quadrants of the abdomen. LLQ, left lower quadrant; LUQ...
Figure 2.19 Stethoscope positioning for auscultating bruits.
Figure 2.20 Percussion technique during abdominal examination.
Figure 2.21 Light palpation during abdominal examination.
Figure 2.22 Deep palpation during abdominal examination.
Chapter 3
Figure 3.1 A patient leaving hospital.
Figure 3.2 The SAFER Patient Flow Bundle.
Figure 3.3 Red and Green Bed Days.
Figure 3.4 An example of a tablet dispenser.
Figure 3.5 A sample medicines administration chart.
Figure 3.6 Example of a discharge checklist.
Figure 3.7 Example of a Social Services Assessment Notification form.
Figure 3.8 Example of a Social Services Discharge Notification form.
Figure 3.9 Checklist for patients being discharged home for urgent palliativ...
Chapter 4
Figure 4.1 The chain of infection: a useful tool for seeing how to prevent t...
Figure 4.2 (a) Gram‐positive and (b) gram‐negative bacterial cell walls. ...
Figure 4.3 Bacterial structures.
Figure 4.4 The viral life cycle. RNA, ribonucleic acid.
Figure 4.5 Results from the national Point Prevalence Survey in ESPAUR, 2016...
Figure 4.6
E. coli
bacteraemia rates in England, 2015/2016.
Figure 4.7 Taylor’s work in 1978 showed the areas most commonly missed follo...
Figure 4.8 ‘My 5 Moments for Hand Hygiene’.
Figure 4.9 Clinical handwash basin.
Figure 4.10 Correct position to wash hands.
Action Figure 8 (1) Rub hands palm to palm. (2) Rub the back of each hand wi...
Action Figure 2 Alcohol‐based handrub hand hygiene technique for visibly cle...
Action Figure 10 Surgical hand antisepsis.
Action Figure 6 Surgical hand preparation technique with an alcohol‐based ha...
Action Figure 2 Remove gloves from the box.
Action Figure 3 Holding the cuff of the glove, pull it into position.
Action Figure 7 Remove the first glove by firmly holding the outside of the ...
Action Figure 8 Remove the second glove by slipping the thumb of the unglove...
Action Figure 9 Dispose of used gloves in an appropriate clinical waste bag ...
Figure 4.11 A summary of donning and doffing standard personal protective eq...
Action Figure 2a Place the neck loop of the apron over your head.
Action Figure 2b Tie the ties together behind your back, positioning the apr...
Action Figure 4 Remove the apron by breaking the neck loop and ties.
Action Figure 3 Place the mask over your nose, mouth and chin.
Action Figure 5 Secure the mask at the back of your head with ties.
Action Figure 8a After use, remove the mask by untying or breaking the ties ...
Action Figure 8b Do not touch the front of the mask.
Action Figure 3 Application and removal of protective eye goggles.
Action Figure 3 Open the packet containing the gloves onto a clean surface a...
Action Figure 5a Hold the cuff of the first glove with the opposite hand and...
Action Figure 5b Keep hold of the folded edge and pull the glove onto your h...
Action Figure 5c Spread your fingers slightly to help them enter the fingers...
Action Figure 6a Slide the fingertips of your gloved hand beneath the folded...
Action Figure 6b Slide the fingertips of your ungloved hand into the opening...
Action Figure 7a Pull the glove onto your hand, again spreading your fingers...
Action Figure 7b When both gloves are on, adjust the fit.
Action Figure 3a Open the gown pack with clean hands onto a clean surface. D...
Action Figure 3b Open the inner layer of the pack.
Action Figure 4 Lift up the gown by its inner surface and hold it away from ...
Action Figure 5 Put one hand into the corresponding sleeve and use the other...
Action Figure 6 Put the other hand into the other sleeve. Again, your hand s...
Action Figure 7a The assistant opens a pair of sterile gloves and presents t...
Action Figure 7b Take the gloves, keeping your hands inside your sleeves.
Action Figure 8a Open the inner glove packet onto the sterile open gown pack...
Action Figure 8b Slide the thumb of one hand (still inside the sleeve) under...
Action Figure 8c Push your hand through the cuff and into the glove.
Action Figure 8d Pull the glove into position using the other hand (still in...
Action Figure 8e Repeat the process with the other glove.
Action Figure 8f Adjust the fit when both gloves are on.
Action Figure 12a At the end of the procedure, remove the gown and gloves as...
Action Figure 12b Turn the gown and gloves inside out.
Figure 4.12 Avoiding contamination by avoiding contact with the key elements...
Figure 4.13 A correctly fitted FFP3 mask may be required for aerosol‐generat...
Action Figure 6 Cleaning with a S‐shaped motion.
Chapter 5
Figure 5.1 Movement of the vocal cords.
Figure 5.2 Events in the stimulation of auditory receptors in the right ear....
Figure 5.3 Transactional model of communication.
Figure 5.4 Non‐verbal communication: SOLER.
Figure 5.5 The London Holistic Needs Assessment tool.
Figure 5.6 Example of an Option Grid™ tool to aid patient decision making. T...
Figure 5.7 Areas of the brain involved in the communication process.
Figure 5.8 Terminology in psychological wellbeing.
Figure 5.9 Example of a genogram. A genogram is a symbolic representation of...
Figure 5.10 Example of a circular interaction within a family.
Figure 5.11 Map of overlapping systems.
Figure 5.12 The body’s arousal system during the fight‐or‐flight response. ...
Figure 5.13 Example of an anxious spiral.
Figure 5.14 Cognitive–behavioural model of anxiety in the context of cancer....
Figure 5.15 Hand position for rebreathing technique.
Figure 5.16 Managing and assessing risk behaviours. A framework for explaini...
Figure 5.17 Example of an activity box.
Figure 5.18 Findings from the Safeguarding Adults Collection for 1 April 201...
Figure 5.19 Prevalence of child abuse and neglect.
Figure 5.20 Key lessons from safeguarding adults reviews.
Figure 5.21 Example of a safeguarding protocol.
Figure 5.22 Assessing capacity to make a decision.
Figure 5.23 Algorithm for assessing whether a Deprivation of Liberty Safegua...
Chapter 6
Figure 6.1 The male and female genitourinary tracts.
Figure 6.2 The gastrointestinal tract.
Figure 6.3 Bristol Stool Chart.
Figure 6.4 Slipper bedpans: (a) reusable, (b) disposable.
Figure 6.5 Commode.
Figure 6.6 Penile sheath: standard design.
Figure 6.7 Types of catheter.
Figure 6.8 Catheter tips.
Figure 6.9 Urinary catheter bag: large.
Figure 6.10 Urinary catheter leg bag.
Figure 6.11 Urinary catheter bag with urometer.
Figure 6.12 Bard StatLock™ Foley stabilization device.
Action Figure 3 Prepare the trolley, placing all required equipment on the b...
Action Figure 5 Assist the patient into the supine position with knees bent,...
Action Figure 16 Using gauze swabs, separate the labia minora, and with the ...
Action Figure 18 Apply anaesthetic lubrication to the meatus and then insert...
Action Figure 20 Advance the catheter until urine is draining and up to the ...
Action Figure 22 Inflate the balloon according to the manufacturer’s instruc...
Figure 6.13 Suprapubic catheter.
Figure 6.14 Closed urinary drainage system with provision for intermittent o...
Figure 6.15 Example bladder irrigation chart.
Note:
see the text for an e...
Figure 6.16 Nephrostomy bag.
Figure 6.17 Body‐worn nephrostomy drainage bag and belt system.
Figure 6.18 Ileal conduit.
Figure 6.19 A Mitrofanoff urinary diversion. (a) Front view. (b) Side view w...
Figure 6.20 A Mainz II urinary diversion.
Figure 6.21 (a) Female orthotopic neobladder. (b) Male orthotopic neobladder...
Figure 6.22 Flexi-Seal Faecal Management System.
Figure 6.23 Classification of constipation.
Figure 6.24 Correct positioning for opening your bowels.
Figure 6.25 Examples of enemas.
Figure 6.26 (a) Transverse (loop) colostomy, (b) ileostomy and (c) end colos...
Figure 6.27 End colostomy.
Figure 6.28 Loop colostomy with bridge
in situ
.
Figure 6.29 End ileostomy illustrating the ‘spout’.
Figure 6.30 A newly formed Carter double‐barrelled wet colostomy.
Figure 6.31 A patient wearing a specialist stoma product for the Carter stom...
Figure 6.32 Examples of stoma pouches. (a) Closed pouch. (b) Urostomy pouch....
Figure 6.33 Flow chart for choosing appliances: International Ostomy Forum G...
Figure 6.34 An example of a stoma discharge checklist.
Figure 6.35 Ostomy observational index.
Chapter 7
Figure 7.1 (a) Ankle in dorsiflexion (DF). (b) Ankle in plantarflexion (PF).
Figure 7.2 Sitting up in bed.
Action Figure 7 Side‐lying position.
Action Figure 5a Lying to sitting
Action Figure 5b Sitting on the edge of the bed (from side‐lying).
Action Figure 8 Preparing to stand from sitting.
Action Figure 9 Sitting to standing from a chair.
Figure 7.3 A tracheostomy tube
in situ
.
Figure 7.4 A patient with an artificial airway.
Action Figure 9 Foot resting in a splint.
Action Figure 9 Positioning an unconscious patient or a patient with a trach...
Figure 7.5 The effect of gravity on the distribution of ventilation and perf...
Figure 7.6 The effect of controlled mandatory ventilation on ventilation and...
Figure 7.7 The diaphragm as seen from the front. Note the openings in the ve...
Figure 7.8 Movement of the chest wall on inspiration. (a) The upper ribs mov...
Figure 7.9 Positions to reduce the work of breathing.
Figure 7.10 The bronchial tree.
Figure 7.11 The mucociliary escalator.
Figure 7.12 Divisions of the nervous system.
Figure 7.13 The lobes of the brain and their functions.
Figure 7.14 The spinal cord and spinal nerves.
Figure 7.15 Shoulder subluxation.
Figure 7.16 T‐roll.
Action Figure 5 Positioning a patient with tonal problems in bed: supine.
Action Figure 6 Positioning a patient with tonal problems in bed: side‐lying...
Action Figure 7 Positioning a patient with tonal problems in bed: sitting in...
Action Figure 5 Positioning a patient with tonal problems in a chair.
Figure 7.17 Spinal cord cross‐section.
Figure 7.18 Dermatomes and myotomes.
Action Figure 6 Neck stabilization throughout the application of the neck co...
Action Figure 7 Application of the collar around the patient’s neck while ma...
Action Figure 8 Securing the collar.
Action Figure 6 The practitioners position themselves as described in the st...
Action Figure 12 The roll is co‐ordinated by the lead practitioner, with the...
Action Figure 6 The practitioners position themselves as described in the st...
Action Figure 10 The roll is co‐ordinated by the lead practitioner, with the...
Figure 7.19 Causes of raised intracranial pressures. CSF, cerebrospinal flui...
Figure 7.20 Levels of amputation in the upper and lower limbs.
Figure 7.21 Wheelchair with amputee stump support.
Figure 7.22 The correct position for prone lying.
Chapter 8
Figure 8.1 Electrolyte composition of blood plasma, interstitial fluid and i...
Figure 8.2 Cellular membrane.
Figure 8.3 Active transport: sodium/potassium pump.
Figure 8.4 Thirst response.
Figure 8.5 Mechanisms and consequences of antidiuretic hormone (ADH) release...
Figure 8.6 The renin–angiotensin–aldosterone system.
Figure 8.7 Passive leg raise.
Figure 8.8 Algorithm for intravenous fluid therapy in adults.
Figure 8.9 Example of a fluid balance chart.
Figure 8.10 Foot and ankle oedema.
Figure 8.11 The pharyngeal stage of swallowing.
Figure 8.12 Conversion chart for estimating height from ulna length.
Action Figure 3 Weigh the patient.
Action Figure 10 Measure between the point of the elbow (olecranon process) ...
Action Figure 13 Measure the mid‐upper arm circumference (MUAC). (a) Identif...
Action Figure 14 Measure the circumference of the arm.
Action Figure 17 Measure the waist circumference.
Figure 8.13 The IDDSI framework.
Figure 8.14 The oral stage of swallowing.
Figure 8.15 Nasogastric tube
in situ
.
Figure 8.16 Nasojejunal tube
in situ
.
Figure 8.17 Gastrostomy tube
in situ
.
Figure 8.18 Radiologically inserted gastrostomy (RIG) with T‐fasteners in pl...
Figure 8.19 Low‐profile gastrostomy.
Figure 8.20 ENFit connector.
Action Figure 5 NEX measurement: from nose to ear lobe to the bottom of the
Figure 8.21 X‐radiograph of a correctly inserted nasogastric tube. ...
Figure 8.22 Test precision and test risk: the connection.
Figure 8.23 Four key checks to carry out when using the pH tests.
Chapter 9
Figure 9.1 Skin and subcutaneous layer.
Figure 9.2 Bed positions.
Action Figure 12 Bed making: mitring corners.
Figure 9.3 Horizontal cross‐section through the eyeball at the level of the ...
Figure 9.4 The anterior cavity in front of the lens is incompletely divided ...
Figure 9.5 Lacrimal apparatus.
Figure 9.6 Visual pathways and visual fields.
Figure 9.7 (a) The Morgan irrigation lens. (b) The Morgan lens in situ .
Action Figure 11 Irrigation of the eye from inner to outer canthus.
Action Figure 3 Removing hard contact lenses.
Action Figure 3 (a) Moving a soft lens down the interior part of the sclera....
Figure 9.8 Internal structure of the ear.
Figure 9.9 Structures of the mouth (the oral cavity).
Figure 9.10 Mouth Care Assessment Guide.
Figure 9.11 Mouth Care Pack.
Figure 9.12 Foam handle to assist with holding a toothbrush.
Figure 9.13 Examples of interdental cleaning products. (a) Disposable flosse...
Action Figure 4 Oral assessment using a torch, spatula and gauze.
Action Figure 8 Interdental cleaning using dental floss.
Chapter 10
Figure 10.1 Processing of sensory input and motor output by the spinal cord....
Figure 10.2 The pain pathway, showing key sites for particular analgesic int...
Figure 10.3 Distribution of referred pain.
Figure 10.4 Body diagram used for pain assessment.
Figure 10.5 Examples of universal pain assessment tools.
Figure 10.6 The WHO analgesic ladder.
Figure 10.7 Gross anatomy of the spinal cord. (a) Anterior view and transver...
Figure 10.8 Branches of a typical spinal nerve, shown in cross‐section throu...
Figure 10.9 Distribution of dermatomes.
Figure 10.10 Entonox cylinder and hose.
Figure 10.11 Patient using an Entonox demand valve.
Figure 10.12 TENS machine.
Chapter 11
Figure 11.1 Six ambitions of palliative and end‐of‐life care. ...
Figure 11.2 Palliative care discharge checklist.
Figure 11.3 Recommended summary plan for emergency care and treatment.
Figure 11.4 Royal Marsden NHS Foundation Trust principles of care for dying ...
Figure 11.5 Daily care plan review for patients at the end of life.
Figure 11.6 Example of a continuous syringe pump: the McKinley T34 Syringe P...
Figure 11.7 Example of a subcutaneous infusion chart.
Figure 11.8 The emetic pathway.
Figure 11.9 Peritoneum of female in lateral view.
Figure 11.10 Example of sterile equipment tray for abdominal paracentesis.
Chapter 12
Figure 12.1 The major respiratory organs in relation to surrounding structur...
Figure 12.2 Gas movement in the body is facilitated by partial pressure diff...
Figure 12.3 Oxyhaemoglobin dissociation curve. With a PaO2 of 8 kPa and more...
Figure 12.4 Nasal cannula.
Figure 12.5 Simple face‐mask.
Figure 12.6 Reservoir mask (non‐rebreathe mask).
Figure 12.7 Venturi attachments.
Figure 12.8 Tracheostomy mask.
Figure 12.9 Fowler position.
Figure 12.10 High‐flow oxygen via a nasal cannula.
Figure 12.11 Heat and moisture exchanger for a tracheostomy tube. (a) Swedis...
Figure 12.12 Heat and moisture exchanger for a laryngectomy.
Figure 12.13 Heat and moisture exchanger for a ventilation circuit.
Figure 12.14 Positive end‐expiratory pressure (PEEP) valves.
Figure 12.15 Non‐invasive ventilation (NIV) patient interfaces.
Figure 12.16 Non‐invasive ventilation (NIV) helmet.
Figure 12.17 Continuous positive airway pressure (CPAP) bellows.
Figure 12.18 Bacterial–viral filter.
Figure 12.19 Nasopharyngeal airway and safety pin.
Figure 12.20 A chest drain and underwater seal bottle are used to drain a le...
Figure 12.21 The relationship between the pleural membranes, chest wall and ...
Figure 12.22 Large‐bore chest drain.
Figure 12.23 (a) Pigtail drain with (b) magnification of the end.
Figure 12.24 Underwater chest drainage system.
Figure 12.25 Ambulatory chest drain bag with Heimlich valve.
Figure 12.26 Triangle of safety.
Figure 12.27 Alternative positions for chest drain insertion. (a) Supine on ...
Figure 12.28 Mattress suture.
Figure 12.29 Omental tag.
Figure 12.30 H‐shaped securing tape.
Figure 12.31 High‐volume, low‐pressure suction unit (thoracic suction adapto...
Figure 12.32 Chest drain on suction.
Figure 12.33 (a) Anatomy of the head and neck. (b) Tracheostomy. (c) Larynge...
Figure 12.34 (a) Emergency tracheostomy management algorithm. (b) Emergency ...
Figure 12.35 Bed signage. (a) Tracheostomy. (b) Laryngectomy.
Figure 12.36 Tracheal dilator.
Figure 12.37 Cuff pressure manometer.
Figure 12.38 Cuffed tracheostomy tube in situ .
Figure 12.39 Portex® Blue Line Ultra® tracheostomy tube shown with introduce...
Figure 12.40 Portex® Blue Line Ultra® Sucationaid tracheostomy tube....
Figure 12.41 Uncuffed tracheostomy tube in situ .
Figure 12.42 Portex® uncuffed fenestrated tracheostomy tubes with red inner ...
Figure 12.43 Fenestrated uncuffed tube in situ .
Figure 12.44 Portex® Uniperc® adjustable flange tracheostomy tube with Soft ...
Figure 12.45 (a) Jackson silver tube. (b) Negus silver tube.
Figure 12.46 Rusch speaking valve.
Figure 12.47 Passy Muir valve.
Figure 12.48 Tracheal suction using a fine‐bore suction catheter.
Figure 12.49 Oral suction using a Yankauer suction tip.
Figure 12.50 Components of a closed‐circuit catheter. The control valve lock...
Figure 12.51 Tracheostomy inner tube change.
Figure 12.52 Decannulation plug.
Figure 12.53 Larnyngectomy devices. (a) Laryngecomy tube. (b) Baseplate. (c)...
Figure 12.54 Red rubber tube, base plate with a heat and moisture exchanger,...
Figure 12.55 Cardiac arrest rhythms. (a) Asystole: non‐shockable. (b) Pulsel...
Figure 12.56 Assessing for signs of life.
Figure 12.57 Head tilt, chin lift.
Figure 12.58 Jaw thrust.
Figure 12.59 (a) Assisting the patient into the recovery position. (b) The p...
Figure 12.60 Feeling the carotid pulse.
Figure 12.61 Correct hand and arm position for chest compressions.
Figure 12.62 Pocket mask with oxygen port.
Figure 12.63 Mask with one‐way valve over patient’s nose and mouth and rescu...
Figure 12.64 Two people ventilating a patient with a bag valve mask.
Figure 12.65 Two people ventilating a patient using a Mapleson C system.
Figure 12.66 Standard position of self‐adhesive electrodes.
Figure 12.67 Anteroposterior position of self‐adhesive electrodes.
Figure 12.68 Biaxillary position of self‐adhesive electrodes.
Action Figure 4 Sizing an oropharyngeal airway.
Action Figure 5 Insertion of an oropharyngeal airway.
Action Figure 6 Correct placement of an oropharyngeal airway.
Figure 12.69 Vital steps involved in the transfusion of blood components. ...
Figure 12.70 Cumulative data for SHOT categories 1996 to 2017, n = 19,815. ...
Figure 12.71 Bedside checklist.
Figure 12.72 The pillars of patient blood management.
Figure 12.73 Transfusion‐associated circulatory overload (TACO) safety check...
Figure 12.74 A guide to the necessary elements of blood pack labelling.
Figure 12.75 Checking the compatibility label or tie‐on tag against the pati...
Chapter 13
Figure 13.1 Various blood bottles.
Figure 13.2 Various specimen pots.
Figure 13.3 Two different swabs.
Figure 13.4 Two different stool pots.
Figure 13.5 (a) Superficial veins of the forearm. (b) Superficial veins of t...
Figure 13.6 A vacuumed collection system: two blood culture bottles, a Vacut...
Action Figure 14 Palpating the vein.
Action Figure 20 Cleaning the skin.
Action Figure 22 Anchoring the skin.
Action Figure 27 Attaching the sample bottle to the holder.
Figure 13.7 Lateral view of the spinal column and vertebrae, showing the nee...
Figure 13.8 Lumbar puncture. Sagittal section through the lumbosacral spine....
Figure 13.9 Position for lumbar puncture: head is flexed onto chest and knee...
Action Figure 4 Area to be swabbed when sampling the outer ear.
Action Figure 6 Area to be swabbed when sampling the nose.
Action Figure 7 Area to be swabbed when sampling the throat.
Figure 13.10 Endoscopy.
Figure 13.11 Anatomy of the lower gastrointestinal tract. RUQ, right upper q...
Figure 13.12 Cystoscopy for a man.
Figure 13.13 Cystoscopy for a woman.
Figure 13.14 A flexible cystoscope.
Figure 13.15 A video stack.
Figure 13.16 Liver biopsy needles.
Chapter 14
Figure 14.1 National Early Warning Scoring System 2 (NEWS2).
Figure 14.2 Situation‐Background‐Assessment‐Recommendation (SBAR) tool....
Figure 14.3 Taking a radial pulse.
Figure 14.4 Pulse points.
Figure 14.5 Factors that increase cardiac output.
Figure 14.6 Conduction system of the heart. Auto‐rhythmic fibres in the SA n...
Figure 14.7 Dorsalis pedis pulse.
Figure 14.8 Posterior tibial pulse.
Figure 14.9 Popliteal pulse.
Action Figure 5 Taking a radial pulse.
Figure 14.10 A 12‐lead electrocardiogram (ECG).
Figure 14.11 Three‐lead electrocardiogram (ECG) electrode placement.
Figure 14.12 A normal electrocardiogram (ECG) (lead II). P wave, arterial de...
Figure 14.13 Einthoven triangle.
Figure 14.14 Position of chest electrodes for a 12‐lead electrocardiogram (E...
Figure 14.15 Mason–Likar 12‐lead electrocardiogram (ECG) system.
Figure 14.16 Electrocardiogram (ECG) calibration verification signal.
Figure 14.17 Right‐sided chest lead positioning for an electrocardiogram (EC...
Figure 14.18 (a) Normal electrocardiogram tracing. Abnormal electrocardiogra...
Figure 14.19 Factors that lead to an increase in blood pressure. Changes not...
Figure 14.20 Blood pressures in various parts of the cardiovascular system. ...
Figure 14.21 The renin–angiotensin–aldosterone system.
Figure 14.22 Arterial line and transducer set.
Figure 14.23 Korotkoff sounds.
Figure 14.24 Correct blood pressure reading technique.
Figure 14.25 Pressure changes in pulmonary ventilation.
Figure 14.26 Summary of events of inhalation and exhalation.
Figure 14.27 Negative feedback mechanisms by which changes in PaCO2 and bloo...
Figure 14.28 Factors that influence rate and depth of breathing.
Figure 14.29 Spirogram of lung volumes and capacities. The average values fo...
Figure 14.30 Changes to partial pressures of oxygen and carbon dioxide (in m...
Figure 14.31 Transport of oxygen (O2) and carbon dioxide (CO2) in the blood....
Action Figure 8 Position of an oxygen saturation probe.
Figure 14.32 Normal peak expiratory flow rate measurements.
Action Figure 10 Manual peak flow meter technique.
Figure 14.33 Mechanisms of body temperature regulation.
Figure 14.34 Tympanic membrane thermometer.
Figure 14.35 Summary of filtration, reabsorption and secretion in the nephro...
Figure 14.36 Reasons for predisposition to urinary tract infections (UTIs). ...
Figure 14.37 Significant bacteriuria. Specimens of urine are rarely sterile....
Figure 14.38 Negative feedback regulation of the secretion of glucagon and i...
Action Figure 5 Take a blood sample from the side of the finger using a lanc...
Action Figure 13 Insert the test strip into the blood glucose monitor and ap...
Action Figure 14 Read the result.
Figure 14.39 The brain.
Figure 14.40 The cerebrum.
Figure 14.41 External anatomy of the spinal cord and the spinal nerves (post...
Figure 14.42 Trapezium squeeze.
Figure 14.43 Pupil size guide.
Figure 14.44 Glasgow Coma Scale and neurological observations chart.
Figure 14.45 Normal and abnormal flexion and extension.
Chapter 15
Figure 15.1 A patient‐centred approach.
Figure 15.2 Self‐administration nursing assessment chart.
Figure 15.3 An example of recording the receipt from pharmacy and the supply...
Figure 15.4 An example of the incorrect recording of the receipt of a supply...
Figure 15.5 Examples of oral medication.
Figure 15.6 Medicine pot.
Figure 15.7 Tablet splitter.
Figure 15.8 Tablet crusher.
Figure 15.9 Dosette box.
Figure 15.10 Oral syringe (compliant with NHS Improvement guidance).
Figure 15.11 Transdermal patches.
Figure 15.12 Nebulizer.
Figure 15.13 Metered dose inhaler (MDI).
Figure 15.14 Accuhaler.
Figure 15.15 Turbohaler.
Figure 15.16 Spacer device.
Figure 15.17 How to instil eye drops.
Figure 15.18 How to instil eye ointment.
Figure 15.19 Effects of mydriatics.
Figure 15.20 Effect of miotics.
Action Figure 8 Holding the ear for ear drops.
Figure 15.21 Ampoules.
Figure 15.22 Vials.
Figure 15.23 Syringes: Luer‐Lok (far left and far right) and Luer‐Slip (midd...
Figure 15.24 Needles.
Figure 15.26 Lumbar puncture needles and intrathecal syringe.
Action Figure 5 Suggested method of vial reconstitution to avoid environment...
Action Figure 6 Method to minimize coring.
Action Figure 13 Intradermal bleb.
Figure 15.27 Sites recommended for subcutaneous injection.
Action Figure 10 A CME Medical (previously McKinley) T34 syringe pump.
Figure 15.28 Intramuscular injection sites.
Figure 15.29 (a) Superficial veins of the forearm. (b) Superficial veins of ...
Figure 15.30 The main veins used for central venous access device placement....
Figure 15.31 Fluid administration set.
Figure 15.32 Roller clamp.
Figure 15.33 Labelled administration set.
Figure 15.34 Blood administration set.
Figure 15.35 Extension set with needle‐free injection cap.
Figure 15.36 Volumetric pump.
Figure 15.37 Syringe pump.
Figure 15.38 Patient‐controlled analgesia (PCA) pump, generally used in acut...
Figure 15.39 Epidural pump.
Figure 15.40 Elastomeric device.
Figure 15.41 (a) Vein visualization device. (b) Vascular access ultrasound s...
Figure 15.42 Anchoring the vein with the thumb.
Figure 15.43 Ported cannula.
Figure 15.44 Safety non‐ported cannula.
Figure 15.45 Safety integrated closed system.
Figure 15.46 I‐DECIDED: IV Assessment and Decision Tool.
Figure 15.47 Visual Infusion Phlebitis (VIP) scale.
Figure 15.48 Cleaning the skin.
Action Figure 10 Palpating the vein.
Action Figure 14 Opening the equipment.
Action Figure 19 Checking the needle tip.
Action Figure 21 Inserting the cannula and waiting for first flashback. (a) ...
Action Figure 24 Second flashback. (a) Open cannula. (b) Integrated closed s...
Action Figure 27 Applying digital pressure and removing the stylet.
Action Figure 28 Disposing of the stylet into a sharps bin.
Action Figure 29 Flushing the cannula. (a) Open cannula. (b) Integrated clos...
Action Figure 30 Method of taping a peripheral cannula.
Action Figure 33 Semi‐permeable transparent IV film dressing.
Figure 15.49 Peripheral cannula secured with StatLock.
Figure 15.50 (a) Cannula in situ. (b) Cannula secured with a semipermeable t...
Figure 15.51 Documentation example from the Royal Marsden NHS Foundation Tru...
Figure 15.52 Venous Assessment Tool (VAT) score.
Figure 15.53 Extravasation.
Figure 15.54 Flowchart for the management of extravasation.
Figure 15.55 Vascular access device decision tool. CVA, cerebrovascular acci...
Chapter 16
Figure 16.1 Malignant hyperthermia crisis: AAGBI safety guideline.
Figure 16.2 Guide to preoperative medication.
Figure 16.3 An example of a 12‐lead electrocardiogram (ECG).
Figure 16.4 Cardiopulmonary exercise testing (CPET).
Figure 16.5 Pulmonary embolism.
Figure 16.6 Deep vein thrombosis.
Figure 16.7 Thrombus.
Figure 16.8 Antiembolic stockings. (a) Thigh length. (b) Knee length.
Figure 16.9 Example of a venous thromboembolism (VTE) risk assessment form.
Figure 16.10 Intermittent compression device and boots.
Figure 16.11 Example of a patient information sheet for deep vein thrombosis...
Action Figure 5 Measure (a) thigh circumference and (b) mid‐calf circumferen...
Action Figure 6 (a) Ensure the heel is centred in the heel pocket. (b) Pull ...
Figure 16.12 Example of skin marked for surgery.
Figure 16.13 Example of a pre‐operative and theatre checklist.
Figure 16.14 The World Health Organization’s Surgical Safety Checklist. ...
Figure 16.15 Anaesthetic machine.
Figure 16.16 Mallampati classification of the airway.
Figure 16.17 Surgical team.
Figure 16.18 Port placement for pneumoperitoneum in laparoscopic or robotic ...
Figure 16.19 Laparoscopic stack system.
Figure 16.20 Laparoscopic telescope.
Figure 16.21 Laparoscopic stapling and energy instruments.
Figure 16.22 Da Vinci surgical robotic operating theatre.
Figure 16.23 Specialist staff using Da Vinci robotic equipment.
Figure 16.24 Robotic surgical team.
Figure 16.25 Example of a complete endoscopy stack system.
Figure 16.26 Lithotomy position.
Figure 16.27 Armboard.
Figure 16.28 Lloyd‐Davies position.
Figure 16.29 Surgical scrub.
Figure 16.30 (a) Surgical scrubbing technique. (b) Surgical rubbing techniqu...
Figure 16.31 Lateral transfer, carried out in order from (a) to (f).
Figure 16.32 Thromboprophylaxis and pressure area prevention devices.
Figure 16.33 High vacuum suction unit.
Figure 16.34 Operating table.
Figure 16.35 Diathermy equipment.
Figure 16.36 Operating lights.
Action Figure 5 (a) Lateral position. (b) Prone position.
Action Figure 7 Warming blanket
Action Figure 8 Diathermy plate in position.
Action Figure 9 Surgical equipment in sterile field.
Action Figure 10 Surgical dressing
in situ
.
Figure 16.37 Recovery bay.
Figure 16.38 Potential post‐operative complications.
Figure 16.39 (a) Top to bottom: corrugated, Yates and Penrose drains. (b) Ro...
Action Figure 12 Use forceps to gently lift the knot of the suture.
Action Figure 15 Position of safety pin through open drain to prevent retrac...
Figure 16.40 Surgical wound dressings.
Chapter 17
Figure 17.1 Haemostasis in a wound.
Figure 17.2 The inflammatory phase of wound healing.
Figure 17.3 The proliferative phase of wound healing.
Figure 17.4 The maturation phase of wound healing.
Figure 17.5 Wound assessment chart.
Figure 17.6 Wound healing continuum.
Figure 17.7 Treatment aims and dressing selection guide.
Figure 17.8 The International National Pressure Ulcer Advisory Panel/Europea...
Figure 17.9 The Royal Marsden NHS Foundation Trust’s ASSKING bundle.
Figure 17.10 The Waterlow Pressure Ulcer Risk Assessment Tool.
Figure 17.11 Risk assessment flow diagram. PU, pressure ulcer.
Figure 17.12 Managing pressure ulcer risk factors.
Figure 17.13 Common locations of pressure ulcers.
Figure 17.14 Negative pressure wound therapy dressing and unit (example of s...
Figure 17.15 Single‐use negative pressure wound therapy dressing and unit (e...
Chapter 18
Figure 18.1 The ‘Wheel of Wellbeing’.
Figure 18.2 How much time do you spend thinking about the here and now?
Figure 18.4 How many cups should I drink on a 12 hour shift?
Figure 18.3 Am I hydrated?
Figure 18.5 Illustration of weight burden on the spine as the head tips forw...
Figure 18.6 Workstation adjustment and efficient working posture.
Guide
Series Page
Title Page
Copyright Page
Foreword
Acknowledgements
List of contributors
Quick reference to the procedure guidelines
The Royal Marsden Manual of Clinical Nursing Procedures
About the companion website
Table of Contents
Begin Reading
Appendix: Standards of Proficiency for Registered Nurses
List of abbreviations
Index
WILEY END USER LICENSE AGREEMENT
Pages
ii
iii
iv
xvii
xviii
xix
xx
xxi
xxii
xxiii
xxiv
xxv
xxvi
xxvii
xxviii
1
2
3
4
5
6
7
8
9
10
11
13
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
33
34
35
36
37
38
39
40
41
42
43
44
45
47
48
49
50
51
52
53
54
55
56
57
58
59
60
61
62
63
64
65
66
67
69
70
71
72
73
74
75
76
77
78
79
80
81
82
83
84
85
86
87
88
89
90
91
92
93
94
95
96
97
98
99
100
101
102
103
104
105
106
107
108
109
110
111
112
113
114
115
116
117
118
119
120
121
122
123
124
125
126
127
128
129
131
133
134
135
136
137
138
139
140
141
142
143
144
145
146
147
148
149
150
151
152
153
154
155
156
157
158
159
160
161
162
163
164
165
166
167
168
169
170
171
172
173
174
175
176
177
178
179
180
181
182
183
184
185
186
187
188
189
190
191
192
193
194
195
196
197
198
199
200
201
202
203
204
205
206
207
208
209
210
211
212
213
214
215
216
217
218
219
220
221
222
223
224
225
226
227
228
229
230
231
232
233
234
235
236
237
238
239
240
241
242
243
244
245
246
247
248
249
250
251
252
253
254
255
256
257
258
259
260
261
262
263
264
265
266
267
268
269
270
271
272
273
274
275
276
277
278
279
280
281
282
283
284
285
286
287
288
289
290
291
292
293
294
295
296
297
298
299
300
301
302
303
304
305
306
307
308
309
310
311
312
313
314
315
316
317
318
319
320
321
322
323
324
325
326
327
328
329
330
331
332
333
334
335
336
337
338
339
340
341
342
343
344
345
346
347
348
349
350
351
352
353
354
355
356
357
358
359
360
361
362
363
364
365
366
367
368
369
370
371
372
373
374
375
376
377
378
379
380
381
382
383
384
385
386
387
388
389
390
391
392
393
394
395
396
397
398
399
400
401
402
403
404
405
406
407
408
409
410
411
412
413
414
415
416
417
418
419
420
421
422
423
424
425
426
427
428
429
430
431
432
433
434
435
436
437
438
439
440
441
442
443
444
445
446
447
448
449
450
451
452
453
454
455
457
458
459
460
461
462
463
464
465
466
467
468
469
470
471
472
473
474
475
476
477
478
479
480
481
482
483
484
485
486
487
488
489
490
491
492
493
494
495
496
497
498
499
500
501
502
503
504
505
506
507
508
509
510
511
512
513
514
515
516
517
518
519
520
521
522
523
524
525
526
527
528
529
530
531
532
533
534
535
536
537
538
539
540
541
542
543
544
545
546
547
548
549
550
551
552
553
554
555
556
557
558
559
560
561
562
563
564
565
566
567
568
569
570
571
572
573
574
575
576
577
578
579
580
581
582
583
584
585
586
587
588
589
590
591
592
593
594
595
596
597
598
599
600
601
602
603
604
605
606
607
608
609
610
611
612
613
614
615
616
617
618
619
620
621
622
623
624
625
626
627
628
629
630
631
632
633
634
635
636
637
638
639
640
641
642
643
644
645
646
647
648
649
650
651
652
653
654
655
657
659
660
661
662
663
664
665
666
667
668
669
670
671
672
673
674
675
676
677
678
679
680
681
682
683
684
685
686
687
688
689
690
691
692
693
694
695
696
697
698
699
700
701
702
703
704
705
706
707
708
709
710
711
712
713
714
715
716
717
719
720
721
722
723
724
725
726
727
728
729
730
731
732
733
734
735
736
737
738
739
740
741
742
743
744
745
746
747
748
749
750
751
752
753
754
755
756
757
758
759
760
761
762
763
764
765
766
767
768
769
770
771
772
773
774
775
776
777
778
779
780
781
782
783
784
785
786
787
788
789
790
791
792
793
794
795
796
797
798
799
800
801
803
804
805
806
807
808
809
810
811
812
813
814
815
816
817
818
819
820
821
822
823
824
825
826
827
828
829
830
831
832
833
834
835
836
837
838
839
840
841
842
843
844
845
846
847
848
849
850
851
852
853
854
855
856
857
858
859
860
861
862
863
864
865
866
867
868
869
870
871
872
873
874
875
876
877
878
879
880
881
882
883
884
885
886
887
888
889
890
891
892
893
894
895
896
897
898
899
900
901
902
903
904
905
906
907
908
909
910
911
912
913
914
915
916
917
918
919
920
921
922
923
924
925
926
927
928
929
930
931
932
933
934
935
937
938
939
940
941
942
943
944
945
946
947
948
949
950
951
952
953
954
955
956
957
958
959
960
961
962
963
964
965
966
967
968
969
970
971
972
973
974
975
976
977
978
979
980
981
982
983
984
985
986
987
988
989
990
991
992
993
994
995
996
997
998
999
1000
1001
1002
1003
1004
1005
1006
1007
1008
1009
1010
1011
1012
1013
1014
1015
1016
1017
1018
1019
1020
1021
1022
1023
1024
1025
1026
1027
1029
1030
1031
1032
1033
1034
1035
1036
1037
1038
1039
1040
1041
1042
1043
1044
1045
1046
1047
1048
1049
1050
1051
1052
1053
1054
1055
1056
1057
1058
1059
1060
1061
1063
1064
1065
1066
1067
1068
1069
1070
1071
1072
1073
1074
1075
1076
1077
1078
1079
1080
1081
1082
1083
1085
1086
1087
1089
1090
1091
1092
1093
1094
1095
1096
1097
1098
1099
1100
1101
1102
1103
1104
1105
1106
1107
1108
1109
1110
1111
1112
1113
1114
1115
1116
1117
1118
1119
1120
1121
1122
1123
1124
1125
