BOOK
Priorities in Critical Care Nursing - E-Book
Linda D. Urden | Kathleen M. Stacy | Mary E. Lough
(2013)
Additional Information
Book Details
Abstract
Priorities in Critical Care Nursing, 6th Edition is the perfect companion to any critical care course with its succinct coverage of all core critical care nursing topics. Using the latest, most authoritative research, this evidence-based resource helps you identify priorities to accurately and effectively manage patient care. Updated content spans the areas of medication, patient safety, patient education, nursing diagnosis, and collaborative management to fully prepare you for success in all aspects of critical care nursing.
- Evidence-based approach offers the most accurate and timely patient care recommendations based on the latest and most authoritative research, meta-analyses, and systematic reviews available.
- Patient Safety Priorities boxes in each therapeutic management chapter highlight important patient safety considerations.
- UNIQUE! Nursing Diagnosis Priorities boxes list the most urgent potential nursing diagnoses, with a page reference to the corresponding Nursing Management Plan.
- Nursing Management Plans provide you with a complete care plan for every Priority Diagnosis that includes the diagnosis, definition, defining characteristics, outcome criteria, nursing interventions, and rationales.
- Evidence-Based Collaborative Practice boxes summarize evidence-based recommendations for a variety of therapies.
- Collaborative Management boxes guide you through the management of a wide variety of disorders.
- Patient Education boxes list the concepts that must be taught to the patient and the family before discharge from the ICU.
- Concept maps help you understand common critical health conditions, including acute coronary syndrome, acute renal failure, ischemic stroke, and shock.
- NEW! Case studies with critical thinking questions test your understanding of key concepts and their practical applications.
- NEW! Priority Medication boxes give you a foundation in the pharmacology used most in critical care.
- UPDATED! New information on the management of the alcoholic patient and disorders resulting from alcoholism is added to chapter nine.
Table of Contents
| Section Title | Page | Action | Price |
|---|---|---|---|
| Front cover | cover | ||
| Inside front cover | ifc1 | ||
| Half title page | i | ||
| Evolve page | ii | ||
| Priorities in Critical Care Nursing | iii | ||
| Copyright page | iv | ||
| CONTRIBUTORS | v | ||
| REVIEWERS | vi | ||
| Dedication | vii | ||
| Acknowledgments | viii | ||
| PREFACE | ix | ||
| Organization | ix | ||
| Evidence-Based Practice and Research | ix | ||
| Sixth Edition Continuing Features | ix | ||
| New to This Edition | ix | ||
| Teaching and Learning Package | ix | ||
| Table of Contents | x | ||
| Unit 1 Foundations in Critical Care Nursing | 1 | ||
| 1 Caring for the Critically Ill Patient | 1 | ||
| Objectives | 1 | ||
| Critical Care Nursing Roles | 1 | ||
| Critical Care Nursing Standards | 1 | ||
| Evidence-Based Nursing Practice | 2 | ||
| Holistic Care | 2 | ||
| Nursing’s Unique Role in Critical Care | 3 | ||
| Interdisciplinary Critical Care Management | 3 | ||
| Case Management | 3 | ||
| Outcomes Management | 4 | ||
| Care Management Tools | 4 | ||
| Algorithm | 4 | ||
| Practice Guideline | 4 | ||
| Protocol | 4 | ||
| Quality, Safety, and Regulatory Issues in Critical Care | 4 | ||
| Privacy and Confidentiality | 5 | ||
| Healthy Work Environment | 5 | ||
| References | 6 | ||
| 2 Ethical and Legal Issues | 8 | ||
| Objectives | 8 | ||
| Morals and Ethics | 8 | ||
| Moral Distress | 8 | ||
| Ethical Principles | 8 | ||
| Autonomy | 8 | ||
| Beneficence | 9 | ||
| Nonmaleficence | 9 | ||
| Veracity | 9 | ||
| Fidelity | 9 | ||
| Justice | 11 | ||
| Medical Futility | 11 | ||
| Ethical Foundation for Nursing Practice | 11 | ||
| Nursing Code of Ethics | 11 | ||
| What Is An Ethical Dilemma? | 11 | ||
| Steps in Ethical Decision Making | 12 | ||
| Step One | 12 | ||
| Step Two | 12 | ||
| Step Three | 12 | ||
| Step Four | 12 | ||
| Step Five | 12 | ||
| Step Six | 12 | ||
| Step Seven | 12 | ||
| Step Eight | 12 | ||
| Legal Relationships | 13 | ||
| Tort Liability | 13 | ||
| Administrative Law and Licensing Statutes | 14 | ||
| Negligence and Malpractice | 14 | ||
| Legal Doctrines and Theories of Liability | 15 | ||
| Nurse Practice Acts | 16 | ||
| Specific Patient Care Issues | 16 | ||
| Informed Consent and Authorization for Treatment | 16 | ||
| Right to Accept or Refuse Medical Treatment | 17 | ||
| Withholding and Withdrawing Treatment | 17 | ||
| Advance Directives | 17 | ||
| Orders Not To Resuscitate | 18 | ||
| References | 18 | ||
| 3 Patient and Family Education | 20 | ||
| Objectives | 20 | ||
| Adult Learning Principles | 20 | ||
| Teaching-Learning Process | 20 | ||
| Assessment | 20 | ||
| Development of Education Plan | 21 | ||
| Establish Education Phases and Priorities | 21 | ||
| Teaching Methods | 23 | ||
| Lecture. | 23 | ||
| Discussion. | 23 | ||
| Demonstration and Practice. | 23 | ||
| Other Methods of Instruction. | 23 | ||
| Written Materials. | 23 | ||
| Audiovisual Media. | 23 | ||
| Computer-Assisted Instruction. | 24 | ||
| Internet Websites. | 24 | ||
| Implementation of Education Plan | 24 | ||
| Learning Environment | 24 | ||
| Keys to Successful Patient Education | 24 | ||
| Get the Patient’s Attention. | 24 | ||
| Stick to the Basics. | 24 | ||
| Make the Most of Your Time. | 24 | ||
| Reinforce Learning. | 24 | ||
| Evaluation | 24 | ||
| What to Evaluate | 24 | ||
| How to Evaluate | 24 | ||
| Documentation | 25 | ||
| Special Considerations | 25 | ||
| The Older Adult | 25 | ||
| Cognitive Effects of Aging | 25 | ||
| Physical Effects of Aging | 25 | ||
| Psychological Effects of Aging | 25 | ||
| Sedated and Unconscious Patients | 25 | ||
| The Illiterate Patient | 25 | ||
| The Noncompliant Patient | 26 | ||
| Using an Interpreter | 26 | ||
| Informational Needs of Families in Critical Care | 26 | ||
| Preparation of Patient/Family for Transfer from Critical Care | 26 | ||
| References | 27 | ||
| Unit 2 Common Problems in Critical Care | 28 | ||
| 4 Psychosocial Alterations | 28 | ||
| Objectives | 28 | ||
| Effects of Stress on Mind-Body Interactions | 28 | ||
| Anxiety as a Response to Stress | 29 | ||
| Anxiety and Pain | 29 | ||
| Powerlessness | 30 | ||
| Hopelessness | 30 | ||
| Spiritual Distress | 30 | ||
| Major Depressive Episode | 31 | ||
| Suicide Attempt | 31 | ||
| Coping | 32 | ||
| Coping Mechanisms | 32 | ||
| Suppression | 32 | ||
| Denial | 32 | ||
| Trust | 32 | ||
| Hope | 32 | ||
| Spiritual Beliefs and Practices | 33 | ||
| Use of Family Support | 33 | ||
| Sharing Concerns | 33 | ||
| Coping Assessment | 33 | ||
| Enhancing the Coping Process | 33 | ||
| Supporting the Patient | 33 | ||
| Supporting Family Members | 33 | ||
| Supporting Spiritual Care | 34 | ||
| Supporting Complementary Therapies | 34 | ||
| References | 35 | ||
| 5 Sleep Alterations | 37 | ||
| Objectives | 37 | ||
| Normal Human Sleep | 37 | ||
| Sleep Physiology | 37 | ||
| Sleep Stages | 38 | ||
| Non-Rapid Eye Movement Sleep | 38 | ||
| Rapid Eye Movement Sleep | 38 | ||
| Sleep Cycles | 39 | ||
| Sleep Changes in Aging | 39 | ||
| Pharmacology and Sleep | 39 | ||
| Abnormal Sleep | 39 | ||
| Sleep Apnea Syndrome | 39 | ||
| Obstructive Sleep Apnea | 39 | ||
| Definition, Etiology, and Pathophysiology | 39 | ||
| Assessment and Diagnosis | 42 | ||
| Medical Management | 42 | ||
| Nursing Management | 43 | ||
| Central Sleep Apnea | 44 | ||
| Definition, Etiology, and Pathophysiology | 44 | ||
| Assessment and Diagnosis | 44 | ||
| Medical Management | 44 | ||
| Nursing Management | 44 | ||
| References | 44 | ||
| 6 Nutritional Alterations | 46 | ||
| Objectives | 46 | ||
| Implications of Undernutrition for the Sick or Stressed Patient | 46 | ||
| Assessing Nutritional Status | 46 | ||
| Biochemical Data | 46 | ||
| Clinical or Physical Manifestations | 47 | ||
| Diet and Health History | 48 | ||
| Evaluating Nutrition Assessment Findings | 48 | ||
| Determining Nutritional Needs | 48 | ||
| Nutrition and Cardiovascular Alterations | 49 | ||
| Nutrition Assessment in Cardiovascular Alterations | 49 | ||
| Nutrition Intervention in Cardiovascular Alterations | 49 | ||
| Myocardial Infarction | 49 | ||
| Hypertension | 49 | ||
| Heart Failure | 49 | ||
| Cardiac Cachexia | 49 | ||
| Nutrition and Pulmonary Alterations | 50 | ||
| Nutrition Assessment in Pulmonary Alterations | 50 | ||
| Nutrition Intervention in Pulmonary Alterations | 50 | ||
| Prevent or Correct Undernutrition/Underweight | 50 | ||
| Avoid Overfeeding | 50 | ||
| Prevent Fluid Volume Excess | 50 | ||
| Nutrition and Neurologic Alterations | 50 | ||
| Nutrition Assessment in Neurological Alterations | 51 | ||
| Nutrition Intervention in Neurological Alterations: Prevent or Correct Nutrition Deficits | 51 | ||
| Oral Feedings | 51 | ||
| Tube Feedings and Total Parenteral Nutrition | 51 | ||
| Nutrition and Renal Alterations | 51 | ||
| Nutrition Assessment in Renal Alterations | 51 | ||
| Nutrition Intervention in Renal Alterations | 51 | ||
| Protein | 51 | ||
| Fluids | 52 | ||
| Energy (Calories) | 52 | ||
| Nutrition and Gastrointestinal Alterations | 52 | ||
| Nutrition Assessment in Gastrointestinal Alterations | 52 | ||
| Nutrition Intervention in Gastrointestinal Alterations | 53 | ||
| Hepatic Failure | 53 | ||
| Monitoring Fluid and Electrolyte Status. | 53 | ||
| Provision of a Nutritious Diet and Evaluation of Response to Dietary Protein. | 53 | ||
| Pancreatitis | 54 | ||
| Prevention of Further Damage to the Pancreas and Preventing Nutritional Deficits. | 54 | ||
| Nutrition and Endocrine Alterations | 54 | ||
| Nutrition Assessment in Endocrine Alterations | 54 | ||
| Nutrition Intervention in Endocrine Alterations | 54 | ||
| Nutrition Support and Blood Glucose Control | 54 | ||
| Severe Vomiting or Diarrhea in the Patient with Type 1 Diabetes Mellitus. | 55 | ||
| Administering Nutrition Support | 55 | ||
| Enteral Nutrition | 55 | ||
| Oral Supplementation | 55 | ||
| Tube Feeding | 55 | ||
| Location and Type of Feeding Tube | 55 | ||
| Nursing Management | 55 | ||
| Tube Placement. | 55 | ||
| Formula Delivery. | 57 | ||
| Prevent or Correct Complications. | 57 | ||
| Total Parenteral Nutrition | 57 | ||
| Types of Parenteral Nutrition | 57 | ||
| Nursing Management of Potential Complications | 59 | ||
| Lipid Emulsion | 59 | ||
| Evaluating Response to Nutrition Support | 60 | ||
| References | 61 | ||
| 7 Gerontological Alterations | 63 | ||
| Objectives | 63 | ||
| Cardiovascular System | 63 | ||
| Age-Related Changes in Myocardial Structure and Function | 63 | ||
| Age-Associated Changes in Hemodynamics and the Electrocardiogram | 66 | ||
| Age-Related Changes in Baroreceptor Function | 67 | ||
| Left Ventricular Function | 67 | ||
| Peripheral Vascular System | 67 | ||
| Pulmonary System | 67 | ||
| Thoracic Wall and Respiratory Muscles | 67 | ||
| Alveolar Parenchyma | 68 | ||
| Pulmonary Gas Exchange | 69 | ||
| Lung Volumes and Capacities | 69 | ||
| Renal System | 69 | ||
| Fluid Filtration | 69 | ||
| Gastrointestinal System | 69 | ||
| Liver | 70 | ||
| Central Nervous System | 70 | ||
| Cognitive Functioning | 70 | ||
| Changes in Structure and Morphology | 70 | ||
| Cerebral Metabolism and Blood Flow | 70 | ||
| Immune System | 70 | ||
| Cell-Mediated and Humoral-Mediated Immunity | 71 | ||
| Integumentary and Musculoskeletal Systems | 71 | ||
| Changes in Pharmacokinetics and Pharmacodynamics | 72 | ||
| References | 73 | ||
| 8 Pain and Pain Management | 76 | ||
| Objectives | 76 | ||
| Importance of Pain Assessment | 76 | ||
| Definition and Description of Pain | 76 | ||
| Components of Pain | 77 | ||
| Types of Pain | 77 | ||
| Acute Pain | 77 | ||
| Chronic Pain | 77 | ||
| Nociceptive Pain | 77 | ||
| Neuropathic Pain | 77 | ||
| Pain in Critical Care | 77 | ||
| Physiology of Pain | 77 | ||
| Nociception | 77 | ||
| Transduction | 77 | ||
| Transmission | 77 | ||
| Perception | 78 | ||
| Modulation | 79 | ||
| Pain Assessment | 79 | ||
| Pain Assessment: The Subjective Component | 79 | ||
| P: Provocative and Palliative or Aggravating Factors | 80 | ||
| Q: Quality | 80 | ||
| R: Region or Location, Radiation | 80 | ||
| S: Severity and Other Symptoms | 80 | ||
| T: Timing | 80 | ||
| U: Understanding | 80 | ||
| Pain Assessment: The Observable or Objective Component | 80 | ||
| Behavioral Pain Scale | 81 | ||
| Critical-Care Pain Observation Tool | 81 | ||
| Physiological Indicators | 81 | ||
| Fifth Vital Sign | 83 | ||
| Patient Barriers to Pain Assessment and Management | 83 | ||
| Communication | 83 | ||
| Altered Level of Consciousness | 83 | ||
| Older Patients | 83 | ||
| Cultural Influences | 83 | ||
| Lack of Knowledge | 83 | ||
| Health Professional Barriers to Pain Assessment and Management | 84 | ||
| Addiction and Tolerance | 84 | ||
| Respiratory Depression | 84 | ||
| Pain Management | 84 | ||
| Pharmacological Control of Pain | 84 | ||
| Opioid Analgesics | 84 | ||
| Morphine. | 84 | ||
| Fentanyl. | 87 | ||
| Hydromorphone. | 88 | ||
| Meperidine. | 88 | ||
| Codeine. | 88 | ||
| Methadone. | 88 | ||
| More Potent Opioids: Remifentanil and Sufentanil. | 88 | ||
| Preventing and Treating Respiratory Depression | 88 | ||
| Monitoring. | 88 | ||
| Opioid Reversal. | 88 | ||
| Nonopioid Analgesics | 89 | ||
| Delivery Methods | 89 | ||
| Patient-Controlled Analgesia. | 89 | ||
| Intrathecal Analgesia. | 89 | ||
| Epidural Analgesia. | 89 | ||
| Equianalgesia | 89 | ||
| Nonpharmacological Methods of Pain Management | 91 | ||
| Cognitive Techniques | 91 | ||
| Relaxation. | 91 | ||
| Guided Imagery. | 91 | ||
| Music Therapy. | 91 | ||
| References | 92 | ||
| 9 Sedation and Delirium Management | 95 | ||
| Objectives | 95 | ||
| Sedation | 95 | ||
| Sedation Scales | 95 | ||
| Complications of Sedation | 95 | ||
| Pharmacological Management of Sedation | 98 | ||
| Benzodiazepines | 98 | ||
| Sedative-Hypnotic Agents | 98 | ||
| Central Alpha Agonists | 100 | ||
| Preventing Sedative Dependence and Withdrawal | 101 | ||
| Sedation Vacation. | 101 | ||
| Delirium | 101 | ||
| Pharmacological Management of Agitation and Delirium | 102 | ||
| Nonpharmacological Interventions to Prevent Delirium | 102 | ||
| Alcohol Withdrawal Syndrome and Delirium Tremens | 102 | ||
| Collaborative Management | 103 | ||
| References | 104 | ||
| 10 End-of-Life Care | 106 | ||
| Objectives | 106 | ||
| End-of-Life Experience in Critical Care | 106 | ||
| Planning for the End of Life | 107 | ||
| Advance Directives | 107 | ||
| Advance Care Planning | 107 | ||
| Ethical and Legal Issues in Advance Care Planning | 107 | ||
| Critical Care Issues in Advance Planning | 107 | ||
| Cardiopulmonary Resuscitation. | 107 | ||
| Misunderstandings Around Do-Not-Resuscitate Orders. | 107 | ||
| Prognostication and Uncertainty. | 108 | ||
| Decision Making and Communication | 108 | ||
| Critical Care Recommendations to Improve Family Interactions | 108 | ||
| Cultural and Religious Influences | 108 | ||
| Discussing Prognosis | 109 | ||
| Conflict and Staff Distress | 109 | ||
| Comfort Care and Symptom Management | 109 | ||
| Steps Toward Comfort Care | 109 | ||
| Palliative Care | 109 | ||
| Hospice | 109 | ||
| Pain Management | 110 | ||
| Non-Pain Symptom Management | 110 | ||
| Dyspnea | 110 | ||
| Nausea and Vomiting | 110 | ||
| Fever and Infection | 110 | ||
| Edema | 110 | ||
| Anxiety | 110 | ||
| Delirium | 110 | ||
| Metabolic Derangement | 110 | ||
| Skin Integrity | 110 | ||
| Anemia | 110 | ||
| Hemorrhage | 110 | ||
| Providing Comfort | 111 | ||
| Near-Death Awareness | 111 | ||
| Withdrawing Life Support | 111 | ||
| Family Meetings | 111 | ||
| Preparing to Withdraw Life Support | 111 | ||
| Opioids and Sedatives | 111 | ||
| Ventilator Withdrawal | 111 | ||
| Professional Issues Regarding End of Life in the Icu | 112 | ||
| Health Care Providers | 112 | ||
| Emotional Support for the Nurse | 112 | ||
| Organ Donation | 112 | ||
| Family Care | 112 | ||
| Delivering Bad News | 112 | ||
| Family Responses to Bad News | 113 | ||
| Policies Regarding Family Presence during Cardiopulmonary Resuscitation | 113 | ||
| Visiting Hours | 113 | ||
| Continuity of Nursing Care | 113 | ||
| After Death | 113 | ||
| Collaborative Care | 113 | ||
| References | 114 | ||
| Unit 3 Cardiovascular Alterations | 117 | ||
| 11 Cardiovascular Clinical Assessment and Diagnostic Procedures | 117 | ||
| Objectives | 117 | ||
| History | 117 | ||
| Physical Examination | 118 | ||
| Inspection | 118 | ||
| Assessing General Appearance | 118 | ||
| Examining the Extremities | 118 | ||
| Estimating Jugular Venous Distention | 118 | ||
| Observing the Apical Impulse | 119 | ||
| Palpation | 119 | ||
| Assessing Arterial Pulses | 119 | ||
| Evaluating Capillary Refill | 120 | ||
| Estimating Edema | 120 | ||
| Auscultation | 120 | ||
| Measuring Blood Pressure | 120 | ||
| Detecting Orthostatic Hypotension | 121 | ||
| Measuring Pulse Pressure | 123 | ||
| Detecting Pulsus Paradoxus | 124 | ||
| Assessing Normal Heart Sounds | 124 | ||
| First and Second Heart Sounds. | 124 | ||
| Pathological Splitting of S1 and S2. | 124 | ||
| Identifying Abnormal Heart Sounds, Murmurs, and Pericardial Rubs | 125 | ||
| Third and Fourth Heart Sounds. | 125 | ||
| Heart Murmurs. | 126 | ||
| Pericardial Friction Rub. | 126 | ||
| Bedside Hemodynamic Monitoring | 126 | ||
| Equipment | 126 | ||
| Heparin | 127 | ||
| Calibrating Hemodynamic Monitoring Equipment | 128 | ||
| Zeroing the Transducer. | 128 | ||
| Phlebostatic Axis. | 128 | ||
| Leveling the Transducer. | 128 | ||
| Recognizing Normal Hemodynamic Values | 128 | ||
| Accommodating Changes in Patient Position | 128 | ||
| Head-of-Bed Position. | 128 | ||
| Lateral Position. | 129 | ||
| Establishing Safe Monitor Alarm Limits | 129 | ||
| Solving Hemodynamic Equipment Problems | 129 | ||
| Intraarterial Blood Pressure Monitoring | 131 | ||
| Indications | 131 | ||
| Catheters | 131 | ||
| Insertion and Allen Test. | 131 | ||
| Nursing Management | 132 | ||
| Assessing Arterial Perfusion Pressures. | 132 | ||
| Interpreting Arterial Pressure Waveforms. | 132 | ||
| Troubleshooting Arterial Pressure Monitoring Problems. | 132 | ||
| Fast-Flush Square Waveform Test. | 132 | ||
| Central Venous Pressure Monitoring | 135 | ||
| Insertion | 135 | ||
| Internal Jugular Vein. | 135 | ||
| Subclavian Vein. | 135 | ||
| Femoral Vein. | 135 | ||
| Nursing Management | 136 | ||
| Preventing Central Venous Catheter-Associated Complications. | 136 | ||
| Air Embolus. | 136 | ||
| Thrombus Formation. | 136 | ||
| Infection. | 136 | ||
| Assessing Fluid Volume Status. | 137 | ||
| Low Central Venous Pressure. | 137 | ||
| High Central Venous Pressure. | 138 | ||
| Central Venous Pressure Limitations. | 138 | ||
| Accommodating Changes in Patient Position. | 138 | ||
| Interpreting the CVP Waveform. | 138 | ||
| Cannon Waves. | 138 | ||
| Specialized Central Venous Oximetry Catheters. | 138 | ||
| Pulmonary Artery Pressure Monitoring | 139 | ||
| Pulmonary Artery Catheter Educational Resources | 139 | ||
| Indications | 140 | ||
| Pulmonary Artery Catheters | 140 | ||
| Right Atrial Lumen. | 140 | ||
| Pulmonary Artery Lumen. | 140 | ||
| Balloon Lumen. | 140 | ||
| Thermistor Lumen. | 140 | ||
| Additional Features. | 140 | ||
| Insertion | 140 | ||
| Nursing Management | 140 | ||
| Accurately Interpreting Pulmonary Artery Waveforms. | 140 | ||
| Right Atrial Waveform. | 141 | ||
| Right Ventricular Waveform. | 142 | ||
| Pulmonary Artery Waveform. | 142 | ||
| Pulmonary Artery Occlusion Waveform (Wedge). | 142 | ||
| Accommodating Changes in Patient Position. | 143 | ||
| Recognizing the Effects of Respiratory Variation. | 143 | ||
| Positive End-Expiratory Pressure. | 143 | ||
| Preventing PA Catheter-Related Complications. | 143 | ||
| Removal of the Pulmonary Artery Catheter. | 144 | ||
| Monitoring Cardiac Output. | 144 | ||
| Thermodilution Cardiac Output Bolus Method. | 145 | ||
| Cardiac Output Curve Interpretation. | 145 | ||
| Injectate Temperature. | 145 | ||
| Patient Position and Cardiac Output. | 145 | ||
| Clinical Conditions That Alter Cardiac Output. | 145 | ||
| Continuous Cardiac Output Measurement Using the PA Catheter. | 145 | ||
| Noninvasive and Minimally Invasive Measurement of Cardiac Output. | 145 | ||
| Evaluating Hemodynamic Profiles. | 146 | ||
| Continuous Monitoring of Venous Oxygen Saturation | 148 | ||
| Indications | 148 | ||
| Catheters | 149 | ||
| Svo2 Catheter. | 149 | ||
| Scvo2 Catheter. | 149 | ||
| Svo2 or Scvo2 Catheter Calibration. | 149 | ||
| Nursing Management | 149 | ||
| Assessing the Accuracy of the Svo2 or Scvo2 Values. | 149 | ||
| Normal Svo2 Values. | 149 | ||
| Normal Scvo2 Values. | 149 | ||
| Assessment of Svo2 or Scvo2. | 149 | ||
| Incorporating Svo2 or Scvo2 Values into the Hemodynamic Assessment. | 149 | ||
| Therapeutic Goals for Svo2 or Scvo2. | 149 | ||
| Low Svo2 or Scvo2. | 149 | ||
| High Svo2 or Scvo2. | 150 | ||
| Electrocardiography | 150 | ||
| Nursing Management | 150 | ||
| Selecting ECG Leads | 150 | ||
| ECG Leads. | 150 | ||
| ECG Paper. | 150 | ||
| Interpreting the ECG | 151 | ||
| P Wave. | 151 | ||
| QRS Complex. | 151 | ||
| T Wave. | 151 | ||
| Intervals between Waveforms. | 151 | ||
| PR Interval. | 151 | ||
| ST Segment. | 151 | ||
| QT Interval. | 152 | ||
| Heart Rate Determination. | 152 | ||
| Rhythm Determination. | 154 | ||
| P-Wave Evaluation. | 154 | ||
| PR-Interval Evaluation. | 154 | ||
| QRS Complex Evaluation. | 155 | ||
| QT Evaluation. | 155 | ||
| Dysrhythmia Interpretation | 155 | ||
| Sinus Rhythms. | 155 | ||
| Normal Sinus Rhythm. | 156 | ||
| Sinus Bradycardia. | 156 | ||
| Sinus Tachycardia. | 156 | ||
| Sinus Dysrhythmia. | 156 | ||
| Atrial Dysrhythmias. | 156 | ||
| Premature Atrial Contractions. | 156 | ||
| Supraventricular Tachycardia. | 158 | ||
| Atrial Flutter. | 158 | ||
| Atrial Fibrillation. | 159 | ||
| Rhythm Control. | 160 | ||
| Rate Control. | 160 | ||
| Anticoagulation. | 161 | ||
| Catheter Ablation. | 161 | ||
| Junctional Dysrhythmias. | 161 | ||
| Premature Junctional Contraction. | 162 | ||
| Junctional Escape Rhythm. | 162 | ||
| Junctional Tachycardia and Accelerated Junctional Rhythm. | 162 | ||
| Ventricular Dysrhythmias. | 163 | ||
| Premature Ventricular Contractions. | 163 | ||
| Idioventricular Rhythms. | 163 | ||
| Ventricular Tachycardia. | 163 | ||
| Ventricular Fibrillation. | 166 | ||
| Atrioventricular Blocks. | 166 | ||
| First-Degree Atrioventricular Block. | 166 | ||
| Second-Degree Atrioventricular Block. | 167 | ||
| Third-Degree Atrioventricular Block. | 167 | ||
| Laboratory Assessment | 168 | ||
| Nursing Management | 168 | ||
| Interpreting Serum Electrolyte Levels | 168 | ||
| Potassium. | 168 | ||
| Hyperkalemia. | 168 | ||
| Hypokalemia. | 168 | ||
| Calcium. | 170 | ||
| Ionized Calcium. | 170 | ||
| Hypercalcemia. | 171 | ||
| Hypocalcemia. | 172 | ||
| Magnesium. | 172 | ||
| Hypermagnesemia. | 172 | ||
| Hypomagnesemia. | 172 | ||
| Monitoring Cardiac Biomarkers | 173 | ||
| Creatine Kinase-MB. | 173 | ||
| Troponin T and Troponin I. | 173 | ||
| Cardiac Biomarkers and Reperfusion. | 174 | ||
| Natriuretic Peptide Biomarkers in Heart Failure. | 174 | ||
| BNP Tests. | 174 | ||
| Trending Hematological Studies | 174 | ||
| Red Blood Cells. | 175 | ||
| Hemoglobin. | 175 | ||
| Hematocrit. | 175 | ||
| White Blood Cells. | 175 | ||
| Platelets. | 175 | ||
| Assessing Blood Coagulation Studies | 175 | ||
| Prothrombin Time. | 175 | ||
| International Normalized Ratio. | 175 | ||
| Activated Partial Thromboplastin Time. | 175 | ||
| Activated Coagulation Time. | 175 | ||
| Evaluating Serum Lipid Studies | 176 | ||
| Total Cholesterol. | 176 | ||
| Low-Density Lipoproteins. | 176 | ||
| Very-Low-Density Lipoproteins and Triglycerides. | 176 | ||
| High-Density Lipoproteins. | 176 | ||
| Diagnostic Procedures | 176 | ||
| References | 179 | ||
| 12 Cardiovascular Disorders | 184 | ||
| Objectives | 184 | ||
| Coronary Artery Disease | 184 | ||
| Description and Etiology | 184 | ||
| Risk Factors for Coronary Artery Disease | 184 | ||
| Age, Gender, and Race | 184 | ||
| Family History | 184 | ||
| Hyperlipidemia | 185 | ||
| Total Cholesterol. | 185 | ||
| High-Density Lipoprotein Cholesterol. | 185 | ||
| Low-Density Lipoprotein Cholesterol. | 185 | ||
| Very-Low-Density Lipoprotein Cholesterol. | 186 | ||
| Triglycerides. | 186 | ||
| Lipoprotein(a). | 186 | ||
| High-Fat Diet | 186 | ||
| Obesity | 186 | ||
| Physical Inactivity | 187 | ||
| Hypertension | 187 | ||
| Cigarette Smoking | 187 | ||
| Diabetes Mellitus | 188 | ||
| Chronic Kidney Disease | 188 | ||
| Metabolic Syndrome | 188 | ||
| Women and Heart Disease: Premenopause and Postmenopause | 188 | ||
| Vascular Inflammation | 189 | ||
| C-Reactive Protein | 189 | ||
| Multifactorial Risk and Risk Equivalents | 189 | ||
| Primary Versus Secondary Prevention of Coronary Artery Disease | 189 | ||
| Pathophysiology of Coronary Artery Disease | 189 | ||
| Development of Atherosclerosis | 189 | ||
| Atherosclerotic Plaque Rupture | 189 | ||
| Plaque Regression | 191 | ||
| Acute Coronary Syndromes | 191 | ||
| Angina | 191 | ||
| Women and Angina. | 191 | ||
| Stable Angina. | 192 | ||
| Unstable Angina. | 194 | ||
| Medical Management | 194 | ||
| Nursing Management | 194 | ||
| Recognizing Myocardial Ischemia | 194 | ||
| Relieving Chest Pain | 194 | ||
| Maintaining a Calm Environment | 195 | ||
| Providing Patient Education | 195 | ||
| Myocardial Infarction | 196 | ||
| Description and Etiology | 196 | ||
| Pathophysiology | 196 | ||
| Myocardial Ischemia | 196 | ||
| Myocardial Injury | 197 | ||
| Myocardial Infarction | 197 | ||
| 12-Lead Electrocardiographic Changes. | 197 | ||
| Myocardial Infarction Location | 197 | ||
| Anterior Wall Infarction. | 197 | ||
| Left Lateral Wall Infarction. | 198 | ||
| Inferior Wall Infarction. | 198 | ||
| Right Ventricular Infarction. | 198 | ||
| Posterior Wall Infarction. | 198 | ||
| Non-ST-Segment Elevation Myocardial Infarction | 198 | ||
| Cardiac Biomarkers During Myocardial Infarction | 198 | ||
| Complications of Acute Myocardial Infarction | 198 | ||
| Sinus Bradycardia and Sinus Tachycardia. | 200 | ||
| Sinus Tachycardia. | 200 | ||
| Atrial Dysrhythmias. | 200 | ||
| Ventricular Dysrhythmias. | 202 | ||
| Atrioventricular Heart Block During Myocardial Infarction. | 202 | ||
| Ventricular Aneurysm After Myocardial Infarction. | 202 | ||
| Ventricular Septal Rupture After Myocardial Infarction. | 202 | ||
| Papillary Muscle Rupture After Myocardial Infarction. | 203 | ||
| Cardiac Wall Rupture After Myocardial Infarction. | 203 | ||
| Pericarditis After Myocardial Infarction. | 203 | ||
| Heart Failure and Acute Myocardial Infarction. | 203 | ||
| Medical Management | 204 | ||
| Recanalization of the Coronary Artery | 204 | ||
| Anticoagulation | 204 | ||
| Dysrhythmia Prevention | 204 | ||
| Tight Glucose Control | 204 | ||
| Prevention of Ventricular Remodeling | 204 | ||
| Nursing Management | 204 | ||
| Balancing Myocardial Oxygen Supply and Demand | 205 | ||
| Preventing Complications | 205 | ||
| Providing Patient Education | 208 | ||
| Cardiac Arrest and Sudden Cardiac Death | 208 | ||
| Description | 208 | ||
| Etiology | 208 | ||
| Therapeutic Hypothermia | 209 | ||
| Heart Failure | 209 | ||
| Description and Etiology | 209 | ||
| Pathophysiology | 209 | ||
| Assessment and Diagnosis | 210 | ||
| Left Ventricular Failure | 210 | ||
| Right Ventricular Failure | 210 | ||
| Heart Failure with Systolic Dysfunction | 210 | ||
| Heart Failure with Diastolic Dysfunction | 210 | ||
| Systolic Versus Diastolic Dysfunction Heart Failure | 212 | ||
| Doppler Echocardiography | 212 | ||
| Acute Versus Chronic Heart Failure | 212 | ||
| Neurohormonal Compensatory Mechanisms in Heart Failure | 212 | ||
| Pulmonary Complications of Heart Failure | 214 | ||
| Shortness of Breath in Heart Failure | 214 | ||
| Pulmonary Edema in Heart Failure | 214 | ||
| Arterial Blood Gases in Pulmonary Edema. | 215 | ||
| Dysrhythmias and Heart Failure | 215 | ||
| Medical Management | 215 | ||
| Relief of Symptoms and Enhancement of Cardiac Performance | 215 | ||
| Correction of Precipitating Causes | 215 | ||
| Palliative Care for End-Stage Heart Failure | 215 | ||
| Nursing Management | 215 | ||
| Optimizing Cardiopulmonary Function | 216 | ||
| Promoting Comfort and Emotional Support | 216 | ||
| Monitoring the Effects of Pharmacological Therapy | 216 | ||
| Providing Adequate Nutritional Intake | 216 | ||
| Providing Patient Education | 216 | ||
| Cardiomyopathy | 217 | ||
| Description and Etiology | 217 | ||
| Hypertrophic Obstructive Cardiomyopathy | 217 | ||
| Dilated Cardiomyopathy | 218 | ||
| Ischemic Dilated Cardiomyopathy. | 218 | ||
| Familial Dilated Cardiomyopathy. | 218 | ||
| Other Causes of Dilated Cardiomyopathy. | 218 | ||
| Restrictive Cardiomyopathy | 218 | ||
| Nursing Management | 219 | ||
| Valvular Heart Disease | 219 | ||
| Description and Etiology | 219 | ||
| Pathophysiology | 219 | ||
| Mitral Valve Stenosis | 219 | ||
| Mitral Valve Regurgitation | 219 | ||
| Aortic Valve Stenosis | 219 | ||
| Aortic Valve Regurgitation | 221 | ||
| Tricuspid Valve Stenosis | 221 | ||
| Tricuspid Valve Regurgitation | 221 | ||
| Pulmonic Valve Disease | 222 | ||
| Mixed Valvular Lesions | 222 | ||
| Medical Management | 222 | ||
| Nursing Management | 222 | ||
| Maintaining Cardiac Output | 222 | ||
| Optimizing Fluid Balance | 222 | ||
| Providing Patient Education | 222 | ||
| References | 223 | ||
| 13 Cardiovascular Therapeutic Management | 227 | ||
| Objectives | 227 | ||
| Temporary Pacemakers | 227 | ||
| Indications | 227 | ||
| The Pacemaker System | 227 | ||
| Pacing Pulse Generator | 227 | ||
| Pacing Lead Systems | 227 | ||
| Pacing Routes | 228 | ||
| Transcutaneous Pacing | 228 | ||
| Epicardial Pacing | 228 | ||
| Transvenous Pacing | 229 | ||
| Codes and Modes | 229 | ||
| Three-Letter Pacemaker Code | 229 | ||
| Five-Letter Pacemaker Code | 229 | ||
| Synchronous Pacing Modes | 229 | ||
| DDD Pacing. | 229 | ||
| VVI Pacing. | 229 | ||
| Asynchronous Pacing Modes | 230 | ||
| Pacemaker Settings | 230 | ||
| Pacing Artifacts | 231 | ||
| Pacemaker Malfunctions | 231 | ||
| Pacing Abnormalities | 231 | ||
| Failure to Pace. | 231 | ||
| Failure to Capture. | 231 | ||
| Sensing Abnormalities | 232 | ||
| Undersensing. | 232 | ||
| Oversensing. | 232 | ||
| Medical Management | 233 | ||
| Nursing Management | 233 | ||
| Preventing Pacemaker Malfunction | 233 | ||
| Protecting against Microshock | 233 | ||
| Monitoring for Complications | 234 | ||
| Providing Patient Education | 234 | ||
| Permanent Pacemakers | 234 | ||
| Cardiac Resynchronization Therapy | 234 | ||
| Atrial Arrhythmia Suppression | 235 | ||
| Medical Management | 235 | ||
| Nursing Management | 235 | ||
| Implantable Cardioverter Defibrillators | 235 | ||
| The ICD System | 235 | ||
| ICD Insertion | 236 | ||
| Medical Management | 236 | ||
| ICD Programming | 237 | ||
| Nursing Management | 237 | ||
| Providing Patient Education | 237 | ||
| Fibrinolytic Therapy | 237 | ||
| Eligibility Criteria | 237 | ||
| Inclusion Criteria | 237 | ||
| Exclusion Criteria | 237 | ||
| Fibrinolytic Agents | 237 | ||
| Outcomes of Fibrinolytic Therapy | 238 | ||
| Evidence of Reperfusion | 240 | ||
| Nursing Management | 240 | ||
| Identifying Candidates for Reperfusion Therapy | 240 | ||
| Observing for Signs of Reperfusion | 240 | ||
| Monitoring for Signs of Bleeding | 240 | ||
| Providing Patient Education | 240 | ||
| Catheter Interventions for Coronary Artery Disease | 240 | ||
| Indications for Catheter-Based Interventions | 241 | ||
| Surgical Backup | 241 | ||
| Angioplasty | 241 | ||
| Atherectomy | 241 | ||
| Coronary Stents | 241 | ||
| Stent Thrombosis | 242 | ||
| Drug-Eluting Stents | 242 | ||
| PCI Complications | 242 | ||
| Acute Complications | 242 | ||
| Late Complications | 242 | ||
| Nursing Management | 243 | ||
| Monitoring for Recurrent Angina | 243 | ||
| Protecting Kidney Function | 244 | ||
| Monitoring the Femoral Access Site | 244 | ||
| Assessing for Bleeding. | 244 | ||
| Hemostatic Devices. | 245 | ||
| Monitoring Peripheral Pulses | 245 | ||
| Promoting Mobility | 245 | ||
| Providing Patient Education | 245 | ||
| Percutaneous Valve Repair | 246 | ||
| Cardiac Surgery | 246 | ||
| Coronary Artery Bypass Surgery | 246 | ||
| Saphenous Vein Graft | 247 | ||
| Internal Mammary Artery Graft | 247 | ||
| Right Gastroepiploic Artery Graft | 247 | ||
| Radial Artery Grafts | 247 | ||
| Valvular Surgery | 248 | ||
| Heart Transplant | 248 | ||
| Cardiopulmonary Bypass | 249 | ||
| Nursing Management | 249 | ||
| Optimizing Cardiac Output | 250 | ||
| Heart Rate. | 250 | ||
| Preload. | 250 | ||
| Afterload. | 250 | ||
| Contractility. | 250 | ||
| Temperature Regulation | 251 | ||
| Controlling Bleeding | 251 | ||
| Maintaining Chest Tube Patency | 251 | ||
| Recognizing Cardiac Tamponade | 251 | ||
| Promoting Early Extubation | 251 | ||
| Assessing for Neurological Complications | 252 | ||
| Preventing Infection | 252 | ||
| Preserving Kidney Function | 252 | ||
| Guidelines for Coronary Artery Bypass Grafting | 252 | ||
| Providing Patient Education | 254 | ||
| Minimally Invasive Cardiac Surgery | 254 | ||
| OPCAB and MIDCABG | 254 | ||
| Intraaortic Balloon Pump | 255 | ||
| Medical Management | 256 | ||
| Nursing Management | 256 | ||
| Preventing Dysrhythmias | 256 | ||
| Preventing Peripheral Ischemia | 256 | ||
| Monitoring for Balloon Complications | 256 | ||
| Monitoring Balloon-Catheter Position | 256 | ||
| Preventing Complications | 256 | ||
| Providing Psychological Support | 257 | ||
| Weaning from the IABP | 257 | ||
| Pharmacological Management | 257 | ||
| Antidysrhythmic Drugs | 257 | ||
| Class I Drugs | 257 | ||
| Class II Drugs | 257 | ||
| Class III Drugs | 258 | ||
| Class IV Drugs | 258 | ||
| Unclassified Antidysrhythmics | 258 | ||
| Side Effects | 258 | ||
| Treatment of Atrial Fibrillation | 259 | ||
| Inotropic Drugs | 259 | ||
| Cardiac Glycosides | 260 | ||
| Sympathomimetic Agents | 260 | ||
| Dopamine. | 260 | ||
| Dobutamine. | 262 | ||
| Epinephrine. | 262 | ||
| Norepinephrine. | 262 | ||
| Phosphodiesterase Inhibitors | 262 | ||
| Vasodilator Drugs | 262 | ||
| Direct Smooth Muscle Relaxants | 262 | ||
| Sodium Nitroprusside. | 262 | ||
| Nitroglycerin. | 262 | ||
| Calcium Channel Blockers | 262 | ||
| Angiotensin-Converting Enzyme Inhibitors | 264 | ||
| Atrial Natriuretic Peptide | 264 | ||
| Alpha-Adrenergic Blockers | 264 | ||
| Dopamine Receptor Agonists | 264 | ||
| Vasopressors | 264 | ||
| Vasopressin | 264 | ||
| Drug Treatment of Heart Failure | 265 | ||
| References | 267 | ||
| Unit 4 Pulmonary Alterations | 270 | ||
| 14 Pulmonary Clinical Assessment and Diagnostic Procedures | 270 | ||
| Objectives | 270 | ||
| History | 270 | ||
| Clinical Assessment | 271 | ||
| Inspection | 271 | ||
| Observation of the Tongue and Sublingual Area | 271 | ||
| Assessment of Chest-Wall Configuration | 271 | ||
| Evaluation of Respiratory Effort | 271 | ||
| Additional Assessment Areas | 271 | ||
| Palpation | 271 | ||
| Confirmation of Tracheal Position | 271 | ||
| Assessment of Respiratory Excursion | 271 | ||
| Evaluation of Tactile Fremitus | 272 | ||
| Percussion | 272 | ||
| Evaluation of Underlying Lung Structure | 272 | ||
| Assessment of Diaphragmatic Excursion | 272 | ||
| Auscultation | 272 | ||
| Evaluation of Normal Breath Sounds | 273 | ||
| Identification of Abnormal Breath Sounds | 273 | ||
| Assessment of Voice Sounds | 274 | ||
| Laboratory Studies | 274 | ||
| Arterial Blood Gases | 274 | ||
| Step 1: Look at the Pao2 level and answer the question, “Does the Pao2 level show hypoxemia?” | 274 | ||
| Step 2: Look at the pH level and answer the question, “Is the pH on the acid or alkaline side of 7.40?” | 275 | ||
| Step 3: Look at the Paco2 level and answer the question, “Does the Paco2 show respiratory acidosis, alkalosis, or normalcy?” | 275 | ||
| Step 4: Look at the Hco3− level and answer the question, “Does the Hco3− show metabolic acidosis, alkalosis, or normalcy?” | 275 | ||
| Step 5: Look back at the pH level and answer the question, “Does the pH show a compensated or an uncompensated condition?” | 275 | ||
| Oxygen Saturation | 275 | ||
| Oxygen Content | 276 | ||
| Classic Shunt Equation and Oxygen Tension Indices | 277 | ||
| Pao2/FIo2 Ratio | 277 | ||
| Pao2/PAo2 Ratio | 277 | ||
| Alveolar-Arterial Gradient | 277 | ||
| Dead Space/Tidal Volume Ratio | 277 | ||
| Sputum Studies | 277 | ||
| Diagnostic Procedures | 277 | ||
| Nursing Management | 277 | ||
| Bedside Monitoring | 278 | ||
| Pulse Oximetry | 278 | ||
| Physiological Limitations | 278 | ||
| Technical Limitations | 278 | ||
| Capnography | 280 | ||
| References | 281 | ||
| 15 Pulmonary Disorders | 283 | ||
| Objectives | 283 | ||
| Acute Respiratory Failure | 283 | ||
| Etiology | 283 | ||
| Pathophysiology | 283 | ||
| Alveolar Hypoventilation | 285 | ||
| Ventilation/Perfusion Mismatching | 285 | ||
| Intrapulmonary Shunting | 285 | ||
| Assessment and Diagnosis | 285 | ||
| Medical Management | 285 | ||
| Oxygenation | 285 | ||
| Ventilation | 286 | ||
| Pharmacology | 286 | ||
| Acidosis | 286 | ||
| Nutrition Support | 286 | ||
| Complications | 286 | ||
| Nursing Management | 287 | ||
| Optimizing Oxygenation and Ventilation | 287 | ||
| Positioning. | 287 | ||
| Preventing Desaturation. | 287 | ||
| Promoting Secretion Clearance. | 287 | ||
| Educating the Patient and Family | 288 | ||
| Acute Lung Injury | 289 | ||
| Etiology | 289 | ||
| Pathophysiology | 289 | ||
| Exudative Phase | 289 | ||
| Fibroproliferative Phase | 290 | ||
| Resolution Phase | 291 | ||
| Assessment and Diagnosis | 291 | ||
| Medical Management | 292 | ||
| Ventilation | 292 | ||
| Low Tidal Volume. | 292 | ||
| Permissive Hypercapnia. | 292 | ||
| Pressure Control Ventilation. | 292 | ||
| Inverse Ratio Ventilation. | 292 | ||
| High-Frequency Oscillatory Ventilation. | 292 | ||
| Oxygen Therapy | 292 | ||
| Positive End-Expiratory Pressure (PEEP). | 292 | ||
| Tissue Perfusion | 293 | ||
| Nursing Management | 293 | ||
| Optimizing Oxygenation and Ventilation | 293 | ||
| Prone Positioning. | 293 | ||
| Pneumonia | 294 | ||
| Etiology | 294 | ||
| Severe Community-Acquired Pneumonia | 294 | ||
| Hospital-Acquired Pneumonia | 294 | ||
| Pathophysiology | 294 | ||
| Assessment and Diagnosis | 295 | ||
| Medical Management | 296 | ||
| Antibiotic Therapy | 296 | ||
| Independent Lung Ventilation | 296 | ||
| Nursing Management | 296 | ||
| Optimizing Oxygenation and Ventilation | 296 | ||
| Preventing the Spread of Infection | 296 | ||
| Aspiration Pneumonitis | 297 | ||
| Etiology | 297 | ||
| Pathophysiology | 297 | ||
| Acid Liquid | 297 | ||
| Acid Food Particles | 297 | ||
| Nonacid Liquid | 297 | ||
| Nonacid Food Particles | 298 | ||
| Assessment and Diagnosis | 298 | ||
| Medical Management | 298 | ||
| Nursing Management | 299 | ||
| Optimizing Oxygenation and Ventilation | 299 | ||
| Preventing Aspiration | 299 | ||
| Pulmonary Embolism | 299 | ||
| Description | 299 | ||
| Etiology | 299 | ||
| Pathophysiology | 300 | ||
| Increased Dead Space | 300 | ||
| Bronchoconstriction | 301 | ||
| Compensatory Shunting | 301 | ||
| Hemodynamic Consequences | 301 | ||
| Assessment and Diagnosis | 301 | ||
| Medical Management | 302 | ||
| Prevention of Recurrence | 302 | ||
| Clot Dissolution | 302 | ||
| Reversal of Pulmonary Hypertension | 302 | ||
| Nursing Management | 303 | ||
| Optimizing Oxygenation and Ventilation | 303 | ||
| Monitoring for Bleeding | 303 | ||
| Educating the Patient and Family | 303 | ||
| Status Asthmaticus | 304 | ||
| Etiology | 304 | ||
| Pathophysiology | 304 | ||
| Pulmonary Effects | 304 | ||
| Cardiovascular Effects | 304 | ||
| Assessment and Diagnosis | 304 | ||
| Medical Management | 304 | ||
| Bronchodilators | 304 | ||
| Systemic Corticosteroids | 304 | ||
| Oxygen Therapy | 305 | ||
| Intubation and Mechanical Ventilation | 305 | ||
| Nursing Management | 305 | ||
| Optimizing Oxygenation and Ventilation | 305 | ||
| Educating the Patient and Family | 305 | ||
| Long-Term Mechanical Ventilator Dependence | 306 | ||
| Etiology and Pathophysiology | 306 | ||
| Medical and Nursing Management | 306 | ||
| Preweaning Stage | 307 | ||
| Weaning Preparedness. | 307 | ||
| Weaning Readiness. | 307 | ||
| Weaning Approach. | 307 | ||
| Weaning Method. | 308 | ||
| Weaning Process Stage | 308 | ||
| Weaning Initiation. | 308 | ||
| Weaning Progress. | 308 | ||
| Weaning Intolerance. | 308 | ||
| Facilitative Therapies. | 308 | ||
| Weaning Outcome Stage | 308 | ||
| Weaning Completed. | 308 | ||
| Incomplete Weaning. | 308 | ||
| References | 310 | ||
| 16 Pulmonary Therapeutic Management | 312 | ||
| Objectives | 312 | ||
| Oxygen Therapy | 312 | ||
| Principles of Therapy | 312 | ||
| Methods of Delivery | 312 | ||
| Low-Flow Systems | 312 | ||
| Reservoir Systems | 314 | ||
| High-Flow Systems | 314 | ||
| Complications of Oxygen Therapy | 314 | ||
| Oxygen Toxicity | 314 | ||
| Carbon Dioxide Retention | 314 | ||
| Absorption Atelectasis | 314 | ||
| Nursing Management | 314 | ||
| Artificial Airways | 315 | ||
| Pharyngeal Airways | 315 | ||
| Oropharyngeal Airway | 315 | ||
| Nasopharyngeal Airway | 315 | ||
| Endotracheal Tubes | 315 | ||
| Intubation | 315 | ||
| Unit 5 Neurological Alterations | 341 | ||
| 17 Neurological Clinical Assessment and Diagnostic Procedures | 341 | ||
| Objectives | 341 | ||
| Clinical Assessment | 341 | ||
| History | 341 | ||
| Physical Examination | 342 | ||
| Level of Consciousness | 342 | ||
| Evaluating Arousal | 342 | ||
| Appraising Awareness | 342 | ||
| Glasgow Coma Scale | 342 | ||
| Motor Function | 343 | ||
| Evaluating Muscle Size and Tone | 343 | ||
| Estimating Muscle Strength | 343 | ||
| Abnormal Motor Responses | 343 | ||
| Pupillary Function | 344 | ||
| Estimating Pupil Size and Shape | 344 | ||
| Evaluating Pupillary Reaction to Light | 344 | ||
| Assessing Eye Movement | 345 | ||
| Respiratory Function | 346 | ||
| Observing Respiratory Pattern | 347 | ||
| Evaluating Airway Status | 347 | ||
| Vital Signs | 347 | ||
| Evaluating Blood Pressure | 347 | ||
| Monitoring Heart Rate and Rhythm | 348 | ||
| Cushing’s Triad | 348 | ||
| Neurological Changes Associated With Intracranial Hypertension | 348 | ||
| Laboratory Studies: Lumbar Puncture | 348 | ||
| Diagnostic Procedures | 349 | ||
| Nursing Management | 349 | ||
| Bedside Monitoring | 353 | ||
| Intracranial Pressure Monitoring | 353 | ||
| Monitoring Sites | 353 | ||
| Intraventricular Space. | 353 | ||
| Subarachnoid Space. | 355 | ||
| Epidural Space. | 355 | ||
| Intraparenchymal Site. | 355 | ||
| Intracranial Pressure Waves | 355 | ||
| Normal Intracranial Pressure Waveform. | 356 | ||
| A Waves. | 356 | ||
| B Waves. | 356 | ||
| C Waves. | 356 | ||
| Cerebral Perfusion Pressure | 356 | ||
| Cerebral Oxygenation Monitoring | 356 | ||
| Cerebral Metabolism | 356 | ||
| Jugular Venous Oxygen Saturation | 357 | ||
| Brain Tissue Oxygen Pressure | 357 | ||
| References | 357 | ||
| 18 Neurological Disorders and Therapeutic Management | 359 | ||
| Objectives | 359 | ||
| Coma | 359 | ||
| Etiology | 359 | ||
| Pathophysiology | 359 | ||
| Assessment and Diagnosis | 360 | ||
| Medical Management | 361 | ||
| Nursing Management | 361 | ||
| Eye Care | 361 | ||
| Stroke | 362 | ||
| Ischemic Stroke | 362 | ||
| Etiology | 362 | ||
| Pathophysiology | 362 | ||
| Assessment and Diagnosis | 362 | ||
| Medical Management | 364 | ||
| Subarachnoid Hemorrhage | 366 | ||
| Etiology | 366 | ||
| Pathophysiology | 366 | ||
| Cerebral Aneurysm. | 366 | ||
| Arteriovenous Malformation. | 366 | ||
| Assessment and Diagnosis | 366 | ||
| Medical Management | 368 | ||
| Rebleeding. | 368 | ||
| Surgical Clipping of Aneurysms. | 368 | ||
| Surgical Excision of Arteriovenous Malformations. | 369 | ||
| Embolization. | 369 | ||
| Cerebral Vasospasm. | 369 | ||
| Hypertensive, Hypervolemic, Hemodilution Therapy. | 370 | ||
| Nimodipine. | 371 | ||
| Cerebral Angioplasty. | 371 | ||
| Hyponatremia. | 371 | ||
| Hydrocephalus. | 371 | ||
| Intracerebral Hemorrhage | 371 | ||
| Etiology | 371 | ||
| Pathophysiology | 371 | ||
| Assessment and Diagnosis | 371 | ||
| Medical Management | 371 | ||
| Nursing Management | 372 | ||
| Monitoring for Changes in Neurological and Hemodynamic Status | 373 | ||
| Maintaining Surveillance for Complications | 373 | ||
| Bleeding and Vasospasm. | 373 | ||
| Increased Intracranial Pressure. | 373 | ||
| Impaired Swallowing. | 373 | ||
| Educating the Patient and Family | 373 | ||
| Guillain-Barré Syndrome | 374 | ||
| Etiology | 374 | ||
| Pathophysiology | 374 | ||
| Assessment and Diagnosis | 374 | ||
| Medical Management | 375 | ||
| Nursing Management | 375 | ||
| Maintaining Surveillance for Complications | 375 | ||
| Initiating Rehabilitation | 375 | ||
| Facilitating Nutritional Support | 375 | ||
| Providing Comfort and Emotional Support | 376 | ||
| Educating the Patient and Family | 376 | ||
| Craniotomy | 376 | ||
| Preoperative Care | 376 | ||
| Surgical Considerations | 378 | ||
| Transcranial Approach | 378 | ||
| Transsphenoidal Approach | 378 | ||
| Postoperative Medical Management | 378 | ||
| Intracranial Hypertension | 379 | ||
| Surgical Hemorrhage | 379 | ||
| Fluid Imbalance | 379 | ||
| Cerebrospinal Fluid Leak | 380 | ||
| Deep Vein Thrombosis | 380 | ||
| Postoperative Nursing Management | 380 | ||
| Preserving Adequate Cerebral Perfusion | 380 | ||
| Positioning. | 380 | ||
| Fluid Management. | 381 | ||
| Vomiting and Fever. | 381 | ||
| Promoting Arterial Oxygenation | 381 | ||
| Providing Comfort and Emotional Support | 381 | ||
| Maintaining Surveillance for Complications | 381 | ||
| Infection. | 381 | ||
| Corneal Abrasions. | 381 | ||
| Injury. | 381 | ||
| Initiating Early Rehabilitation | 381 | ||
| Educating the Patient and Family | 381 | ||
| Intracranial Hypertension | 382 | ||
| Pathophysiology | 382 | ||
| Volume-Pressure Curve | 382 | ||
| Cerebral Blood Flow and Autoregulation | 382 | ||
| Assessment and Diagnosis | 383 | ||
| Medical and Nursing Management | 383 | ||
| Positioning and Other Nursing Activities | 383 | ||
| Hyperventilation | 385 | ||
| Temperature Control | 385 | ||
| Blood Pressure Control | 385 | ||
| Seizure Control | 385 | ||
| Cerebrospinal Fluid Drainage | 385 | ||
| Hyperosmolar Therapy | 385 | ||
| Control of Metabolic Demand | 386 | ||
| Barbiturate Therapy. | 387 | ||
| Herniation Syndromes | 387 | ||
| Supratentorial Herniation | 387 | ||
| Uncal Herniation. | 387 | ||
| Central Herniation. | 387 | ||
| Cingulate Herniation. | 387 | ||
| Transcalvarial Herniation. | 389 | ||
| Infratentorial Herniation | 389 | ||
| Upward Transtentorial Herniation. | 389 | ||
| Downward Cerebellar Herniation. | 389 | ||
| Pharmacological Agents | 389 | ||
| References | 389 | ||
| Unit 6 Renal Alterations | 392 | ||
| 19 Renal Clinical Assessment and Diagnostic Procedures | 392 | ||
| Objectives | 392 | ||
| Physical Examination | 392 | ||
| Inspection | 392 | ||
| Bleeding | 392 | ||
| Volume | 392 | ||
| Edema | 393 | ||
| Auscultation | 393 | ||
| Heart | 393 | ||
| Blood Pressure | 393 | ||
| Lungs | 393 | ||
| Percussion | 394 | ||
| Kidneys | 394 | ||
| Abdomen | 394 | ||
| Fluid Balance Assessment | 394 | ||
| Weight | 394 | ||
| Intake and Output | 394 | ||
| Hemodynamic Monitoring | 394 | ||
| Laboratory Assessment | 395 | ||
| Serum Components | 395 | ||
| Blood Urea Nitrogen | 395 | ||
| Creatinine | 396 | ||
| Creatinine Clearance | 396 | ||
| Osmolality | 396 | ||
| Anion Gap | 396 | ||
| Hemoglobin and Hematocrit | 397 | ||
| Urinalysis | 397 | ||
| Diagnostic Procedures | 398 | ||
| Imaging Studies | 398 | ||
| Kidney Biopsy | 398 | ||
| References | 398 | ||
| 20 Renal Disorders and Therapeutic Management | 400 | ||
| Objectives | 400 | ||
| Acute Kidney Injury | 400 | ||
| Critical Illness and Acute Kidney Injury | 400 | ||
| Definitions of Acute Kidney Injury and Acute Renal Failure | 401 | ||
| RIFLE Criteria | 401 | ||
| Acute Kidney Injury Network Criteria | 401 | ||
| Etiology of Acute Kidney Injury | 401 | ||
| Prerenal Acute Kidney Injury | 402 | ||
| Intrarenal Acute Kidney Injury | 402 | ||
| Postrenal Acute Kidney Injury | 402 | ||
| Azotemia | 403 | ||
| Phases of Acute Kidney Injury | 403 | ||
| Onset Phase | 403 | ||
| Oliguric or Anuric Phase | 403 | ||
| Diuretic Phase | 403 | ||
| Recovery Phase | 403 | ||
| Laboratory Assessment | 403 | ||
| Acidosis | 403 | ||
| Blood Urea Nitrogen | 404 | ||
| Serum Creatinine | 404 | ||
| Creatinine Clearance | 404 | ||
| Fractional Excretion of Sodium | 404 | ||
| At-Risk Disease States and Acute Kidney Injury | 404 | ||
| Underlying Chronic Kidney Disease | 406 | ||
| Older Age and Acute Kidney Injury | 406 | ||
| Heart Failure and Acute Kidney Injury | 407 | ||
| Respiratory Failure and Acute Kidney Injury | 407 | ||
| Sepsis and Acute Kidney Injury | 407 | ||
| Trauma and Acute Kidney Injury | 407 | ||
| Trauma Admissions | 407 | ||
| Rhabdomyolysis | 407 | ||
| Contrast-Induced Acute Kidney Injury | 407 | ||
| Limit Radiopaque Contrast | 408 | ||
| Promote Hydration and Avoid Dehydration | 408 | ||
| Medications | 408 | ||
| Hemodynamic Monitoring and Fluid Balance | 408 | ||
| Hemodynamic Monitoring | 408 | ||
| Daily Weight | 408 | ||
| Physical Assessment | 408 | ||
| Electrolyte Balance | 408 | ||
| Potassium | 408 | ||
| Sodium | 408 | ||
| Calcium and Phosphorus | 409 | ||
| Calcium Replacement | 409 | ||
| Dietary Phosphorus–Binding Drugs | 409 | ||
| Medical Management | 409 | ||
| Treatment Goals | 409 | ||
| Prevention | 409 | ||
| Fluid Resuscitation | 409 | ||
| Crystalloids and Colloids. | 409 | ||
| Crystalloids. | 410 | ||
| Colloids. | 410 | ||
| Fluid Restriction. | 411 | ||
| Fluid Removal. | 411 | ||
| Pharmacologic Management | 411 | ||
| Diuretics | 411 | ||
| Loop Diuretics. | 411 | ||
| Thiazide Diuretics. | 411 | ||
| Osmotic Diuretics. | 411 | ||
| Heart Failure. | 411 | ||
| Dopamine | 412 | ||
| Acetylcysteine | 412 | ||
| Fenoldopam | 412 | ||
| Dietary Phosphorus Binders | 412 | ||
| Nutrition | 413 | ||
| Nursing Management | 413 | ||
| Risk Factors for Acute Kidney Injury | 413 | ||
| Infectious Complications | 413 | ||
| Fluid Balance | 413 | ||
| Electrolyte Imbalance | 413 | ||
| Preventing Anemia | 413 | ||
| Patient Education | 414 | ||
| Renal Replacement Therapy: Dialysis | 414 | ||
| Hemodialysis | 414 | ||
| Hemodialyzer | 414 | ||
| Ultrafiltration | 414 | ||
| Anticoagulation | 414 | ||
| Vascular Access | 415 | ||
| Temporary Acute Access. | 415 | ||
| Permanent Vascular Access. | 415 | ||
| Arteriovenous Fistula. | 415 | ||
| Arteriovenous Grafts. | 417 | ||
| Tunneled Catheters. | 417 | ||
| Medical Management | 417 | ||
| Nursing Management | 417 | ||
| Continuous Renal Replacement Therapy | 418 | ||
| Terminology for Continuous Renal Replacement Therapy | 419 | ||
| Diffusion. | 419 | ||
| Convection. | 419 | ||
| Absorption. | 419 | ||
| Ultrafiltrate Volume. | 419 | ||
| Replacement Fluid. | 419 | ||
| Anticoagulation. | 419 | ||
| Methods of Continuous Renal Replacement | 419 | ||
| Slow Continuous Ultrafiltration. | 420 | ||
| Continuous Venovenous Hemofiltration. | 420 | ||
| Continuous Venovenous Hemodialysis. | 422 | ||
| Continuous Venovenous Hemodiafiltration. | 422 | ||
| Complications | 422 | ||
| Medical Management | 422 | ||
| Nursing Management | 422 | ||
| Kidney Transplantation | 422 | ||
| Living Donor Surgery | 422 | ||
| Deceased Donor Surgery | 423 | ||
| Recipient Surgery | 423 | ||
| Postoperative Medical Management and Nursing Care | 424 | ||
| Fluid Status | 424 | ||
| Electrolytes | 424 | ||
| Postoperative Complications | 424 | ||
| Immunosuppression | 425 | ||
| Infection Risk | 425 | ||
| Rejection | 425 | ||
| References | 426 | ||
| Unit 7 Gastrointestinal Alterations | 429 | ||
| 21 Gastrointestinal Clinical Assessment and Diagnostic Procedures | 429 | ||
| Objectives | 429 | ||
| Clinical Assessment | 429 | ||
| History | 429 | ||
| Physical Examination | 430 | ||
| Inspection | 430 | ||
| Observation of the Oral Cavity | 430 | ||
| Assessment of the Skin over the Abdomen | 430 | ||
| Evaluation of the Shape of the Abdomen | 431 | ||
| Auscultation | 431 | ||
| Evaluation of Bowel Sounds | 431 | ||
| Assessment of Bruits | 431 | ||
| Percussion | 431 | ||
| Assessment of Deep Organs | 431 | ||
| Palpation | 431 | ||
| Detection of Abdominal Pathological Conditions | 432 | ||
| Laboratory Studies | 432 | ||
| Diagnostic Procedures | 432 | ||
| Nursing Management | 432 | ||
| References | 437 | ||
| 22 Gastrointestinal Disorders and Therapeutic Management | 438 | ||
| Objectives | 438 | ||
| Acute Gastrointestinal Hemorrhage | 438 | ||
| Etiology | 438 | ||
| Peptic Ulcer Disease | 438 | ||
| Stress-Related Mucosal Disease | 439 | ||
| Esophagogastric Varices | 439 | ||
| Pathophysiology | 440 | ||
| Assessment and Diagnosis | 440 | ||
| Hematemesis | 440 | ||
| Hematochezia and Melena | 440 | ||
| Laboratory Studies | 440 | ||
| Diagnostic Procedures | 440 | ||
| Medical Management | 440 | ||
| Stabilization | 440 | ||
| Controlling the Bleeding | 440 | ||
| Peptic Ulcer Disease. | 440 | ||
| Unit 8 Endocrine Alterations | 471 | ||
| 23 Endocrine Clinical Assessment and Diagnostic Procedures | 471 | ||
| Objectives | 471 | ||
| History | 471 | ||
| Pancreas | 471 | ||
| Physical Assessment | 471 | ||
| Hyperglycemia | 471 | ||
| Hypoglycemia | 472 | ||
| Laboratory Studies | 472 | ||
| Blood Glucose | 473 | ||
| Urine Glucose | 474 | ||
| Glycated Hemoglobin | 474 | ||
| Blood Ketones | 474 | ||
| Urine Ketones | 474 | ||
| Pituitary Gland | 474 | ||
| Physical Assessment | 475 | ||
| Hydration Status | 475 | ||
| Vital Signs | 475 | ||
| Weight Changes and Intake and Output | 475 | ||
| Laboratory Assessment | 475 | ||
| Serum Antidiuretic Hormone | 475 | ||
| Urine and Serum Osmolality | 475 | ||
| Antidiuretic Hormone Test | 475 | ||
| Diagnostic Procedures | 476 | ||
| Radiographic Examination | 476 | ||
| Computed Tomography | 476 | ||
| Magnetic Resonance Imaging | 476 | ||
| References | 476 | ||
| 24 Endocrine Disorders and Therapeutic Management | 477 | ||
| Objectives | 477 | ||
| Neuroendocrinology of Stress and Critical Illness | 477 | ||
| Acute Neuroendocrine Response to Critical Illness | 477 | ||
| Hypothalamic-Pituitary-Adrenal Axis in Acute Stress | 477 | ||
| Liver and Pancreas in Acute Stress | 479 | ||
| Thyroid Gland in Acute Stress | 479 | ||
| Prolonged Neuroendocrine Response to Critical Illness | 479 | ||
| Hypothalamic-Pituitary-Adrenal Axis in Prolonged Stress | 479 | ||
| Liver-Pancreas in Prolonged Stress | 479 | ||
| Thyroid Gland in Prolonged Stress | 479 | ||
| Adrenal Dysfunction in Critical Illness | 479 | ||
| Assessment of Adrenal Function | 479 | ||
| Cosyntropin Stimulation Test | 479 | ||
| Corticosteroid Replacement | 480 | ||
| Hyperglycemia in Critical Illness | 480 | ||
| Clinical Practice Guidelines Related to Blood Glucose Management in Critically III Patients | 480 | ||
| Hyperglycemia and the Cardiovascular System | 480 | ||
| Hypoglycemia and Brain Injury | 481 | ||
| Insulin Management in the Critically Ill | 481 | ||
| Frequent Blood Glucose Monitoring | 481 | ||
| Continuous Insulin Infusion | 481 | ||
| Transition from Continuous to Intermittent Insulin Coverage | 482 | ||
| Intermittent Insulin Coverage | 483 | ||
| Hypoglycemia Management | 483 | ||
| Nursing Management | 483 | ||
| Monitoring Hyperglycemic Side Effects of Vasopressor Therapy | 483 | ||
| Monitoring Blood Glucose Levels, Insulin Therapy, Avoiding Hypoglycemia | 485 | ||
| Providing Nutrition | 485 | ||
| Providing Patient Education | 485 | ||
| Collaborative Management | 485 | ||
| Diabetes Mellitus | 485 | ||
| Morbidity and Mortality Associated with Diabetes Mellitus | 485 | ||
| Diagnosis of Diabetes | 485 | ||
| Glycated Hemoglobin | 486 | ||
| Types of Diabetes | 486 | ||
| Type 1 Diabetes | 486 | ||
| Management of Type 1 Diabetes. | 486 | ||
| Type 2 Diabetes | 486 | ||
| Cardiometabolic Syndrome. | 487 | ||
| Screening for Type 2 Diabetes. | 487 | ||
| Lifestyle Management for Type 2 Diabetes. | 487 | ||
| Pharmacological Management of Type 2 Diabetes. | 487 | ||
| Diabetic Ketoacidosis | 487 | ||
| Epidemiology and Etiology | 487 | ||
| Pathophysiology | 488 | ||
| Insulin Deficiency | 488 | ||
| Hyperglycemia | 488 | ||
| Fluid Volume Deficit | 489 | ||
| Ketoacidosis | 489 | ||
| Acid-Base Balance | 489 | ||
| Assessment and Diagnosis | 489 | ||
| Clinical Manifestations | 489 | ||
| Laboratory Studies | 490 | ||
| Medical Management | 490 | ||
| Reversing Dehydration | 490 | ||
| Replacing Insulin | 490 | ||
| Reversing Ketoacidosis | 490 | ||
| Replenishing Electrolytes | 490 | ||
| Nursing Management | 492 | ||
| Administering Fluids, Insulin, and Electrolytes | 492 | ||
| Monitoring Response to Therapy | 492 | ||
| Surveillance for Complications | 492 | ||
| Fluid Volume Overload. | 493 | ||
| Hypoglycemia. | 493 | ||
| Hypokalemia and Hyperkalemia. | 493 | ||
| Hyponatremia. | 493 | ||
| Risk for Cerebral Edema. | 493 | ||
| Skin Integrity. | 493 | ||
| Risk for Infection. | 494 | ||
| Providing Patient Education | 494 | ||
| Collaborative Management | 494 | ||
| Hyperglycemic Hyperosmolar State | 494 | ||
| Epidemiology and Etiology | 494 | ||
| Differences between Hyperglycemic Hyperosmolar State and Diabetic Ketoacidosis | 494 | ||
| Pathophysiology | 495 | ||
| Assessment and Diagnosis | 495 | ||
| Clinical Manifestations | 495 | ||
| Laboratory Studies | 495 | ||
| Medical Management | 495 | ||
| Rapid Rehydration | 495 | ||
| Insulin Administration | 496 | ||
| Insulin Resistance. | 496 | ||
| Electrolyte Replacement | 496 | ||
| Nursing Management | 496 | ||
| Administering Fluids, Insulin, and Electrolytes | 496 | ||
| Monitoring Response to Therapy | 497 | ||
| Surveillance for Complications | 497 | ||
| Providing Patient Education | 497 | ||
| Collaborative Management | 497 | ||
| Diabetes Insipidus | 497 | ||
| Etiology | 497 | ||
| Central Diabetes Insipidus | 497 | ||
| Nephrogenic Diabetes Insipidus | 498 | ||
| Psychogenic Diabetes Insipidus | 498 | ||
| Pathophysiology | 498 | ||
| Assessment and Diagnosis | 498 | ||
| Clinical Manifestations | 498 | ||
| Laboratory Studies | 498 | ||
| Serum Sodium. | 499 | ||
| Serum Osmolality Test. | 499 | ||
| Urine Osmolality. | 500 | ||
| Measurement of Antidiuretic Hormone. | 500 | ||
| Medical Management | 500 | ||
| Volume Restoration | 500 | ||
| Medications | 500 | ||
| Medications Used for Central Diabetes Insipidus. | 500 | ||
| Medications Used for Nephrogenic Diabetes Insipidus. | 500 | ||
| Nursing Management | 500 | ||
| Administrating Fluids and Medications | 500 | ||
| Evaluation of Response to Therapy | 500 | ||
| Surveillance for Complications | 501 | ||
| Patient Education | 502 | ||
| Collaborative Management | 502 | ||
| Syndrome of Inappropriate Secretion of Antidiuretic Hormone | 502 | ||
| Etiology | 502 | ||
| Pathophysiology | 502 | ||
| Assessment and Diagnosis | 502 | ||
| Clinical Manifestations | 502 | ||
| Laboratory Values | 502 | ||
| Medical Management | 503 | ||
| Fluid Restriction | 503 | ||
| Sodium Replacement | 503 | ||
| Medications | 504 | ||
| Medications that Increase Kidney Water Excretion. | 504 | ||
| Nursing Management | 504 | ||
| Restricting Fluids | 504 | ||
| Maintaining Surveillance for Complications | 505 | ||
| Patient Education | 505 | ||
| Collaborative Management | 505 | ||
| References | 506 | ||
| Unit 9 Multisystem Alterations | 508 | ||
| 25 Trauma | 508 | ||
| Objectives | 508 | ||
| Mechanisms of Injury | 509 | ||
| Blunt Trauma | 509 | ||
| Penetrating Trauma | 509 | ||
| Phases of Trauma Care | 509 | ||
| Prehospital Resuscitation | 509 | ||
| Emergency Department Resuscitation | 509 | ||
| Primary Survey | 509 | ||
| Resuscitation Phase | 510 | ||
| Secondary Survey | 512 | ||
| Definitive Care and Operative Phase | 512 | ||
| Critical Care Phase | 512 | ||
| Trauma Injuries | 513 | ||
| Traumatic Brain Injuries | 513 | ||
| Mechanism of Injury | 513 | ||
| Pathophysiology | 513 | ||
| Primary Injury. | 513 | ||
| Secondary Injury. | 514 | ||
| Classification | 514 | ||
| Skull Fracture. | 514 | ||
| Concussion. | 515 | ||
| Contusion. | 515 | ||
| Cerebral Hematomas. | 515 | ||
| Epidural Hematoma. | 515 | ||
| Subdural Hematoma. | 516 | ||
| Acute Subdural Hematoma. | 516 | ||
| Subacute Subdural Hematoma. | 516 | ||
| Chronic Subdural Hematoma. | 516 | ||
| Intracerebral Hematoma. | 516 | ||
| Missile Injuries. | 516 | ||
| Diffuse Axonal Injury. | 516 | ||
| Neurological Assessment of Traumatic Brain Injury | 517 | ||
| Degree of Injury | 517 | ||
| Mild Injury. | 517 | ||
| Moderate Injury. | 517 | ||
| Severe Injury. | 517 | ||
| Nursing Assessment of the Patient with Traumatic Brain Injury | 517 | ||
| Diagnostic Procedures | 518 | ||
| Medical Management | 518 | ||
| Surgical Management. | 518 | ||
| Nonsurgical Management. | 518 | ||
| Nursing Management | 518 | ||
| Spinal Cord Injuries | 519 | ||
| Mechanism of Injury | 519 | ||
| Hyperflexion. | 519 | ||
| Hyperextension. | 519 | ||
| Rotation. | 519 | ||
| Axial Loading. | 519 | ||
| Penetrating Injuries. | 519 | ||
| Pathophysiology | 519 | ||
| Functional Injury of the Spinal Cord | 520 | ||
| Complete Injury. | 520 | ||
| Tetraplegia. | 520 | ||
| Paraplegia. | 520 | ||
| Incomplete Injury. | 520 | ||
| Spinal Shock. | 521 | ||
| Neurogenic Shock. | 521 | ||
| Autonomic Dysreflexia. | 521 | ||
| Assessment | 521 | ||
| Airway. | 521 | ||
| Breathing. | 521 | ||
| Circulation. | 521 | ||
| Neurological Assessment for Spinal Cord Injury. | 522 | ||
| Diagnostic Procedures. | 522 | ||
| Screening for Spinal Cord Injury. | 522 | ||
| Medical Management | 522 | ||
| Pharmacological Management. | 522 | ||
| Surgical Management. | 522 | ||
| Nonsurgical Management. | 525 | ||
| Cervical Injury. | 525 | ||
| Thoracolumbar Injury. | 526 | ||
| Nursing Management | 526 | ||
| Thoracic Injuries | 526 | ||
| Mechanism of Injury | 526 | ||
| Blunt Thoracic Trauma. | 526 | ||
| Penetrating Thoracic Injuries. | 526 | ||
| Specific Thoracic Traumatic Injuries | 526 | ||
| Chest Wall Injuries. | 526 | ||
| Rib Fractures. | 526 | ||
| Flail Chest. | 527 | ||
| Diaphragmatic Injury. | 527 | ||
| Pulmonary Injuries | 528 | ||
| Pulmonary Contusion. | 528 | ||
| Tension Pneumothorax. | 528 | ||
| Open Pneumothorax. | 529 | ||
| Hemothorax. | 529 | ||
| Cardiac and Vascular Injuries | 529 | ||
| Penetrating Cardiac Injuries. | 529 | ||
| Cardiac Tamponade. | 529 | ||
| Blunt Cardiac Injuries. | 530 | ||
| Nursing Management | 530 | ||
| Abdominal Injuries | 530 | ||
| Mechanism of Injury | 531 | ||
| Blunt Trauma. | 531 | ||
| Penetrating Trauma. | 531 | ||
| Assessment | 531 | ||
| Physical Assessment. | 531 | ||
| Diagnostic Procedures. | 531 | ||
| Combined Abdominal Organ Injuries | 532 | ||
| Abdominal Compartment Syndrome. | 532 | ||
| Specific Organ Injuries | 533 | ||
| Liver Injuries. | 533 | ||
| Spleen Injuries. | 534 | ||
| Intestinal Injuries. | 534 | ||
| Genitourinary Injuries | 534 | ||
| Mechanism of Injury | 534 | ||
| Assessment | 534 | ||
| Specific Genitourinary Injuries | 534 | ||
| Kidney Trauma. | 534 | ||
| Bladder Trauma. | 535 | ||
| Nursing Management | 535 | ||
| Complications of Trauma | 535 | ||
| Hypermetabolism | 535 | ||
| Infection | 535 | ||
| Sepsis | 536 | ||
| Pulmonary Complications | 536 | ||
| Respiratory Failure | 536 | ||
| Fat Embolism Syndrome | 536 | ||
| Pain | 536 | ||
| Kidney Complications | 536 | ||
| Acute Kidney Injury | 536 | ||
| Myoglobinuria | 536 | ||
| Vascular Complications | 536 | ||
| Compartment Syndrome | 536 | ||
| Venous Thromboembolism | 537 | ||
| Missed Injury | 537 | ||
| Multiple Organ Dysfunction Syndrome | 537 | ||
| Special Considerations | 538 | ||
| Meeting the Needs of Family Members and Significant Others | 538 | ||
| Trauma in Older Adults | 538 | ||
| References | 539 | ||
| 26 Shock, Sepsis, and Multiple Organ Dysfunction Syndrome | 541 | ||
| Objectives | 541 | ||
| Shock Syndrome | 541 | ||
| Etiology | 541 | ||
| Pathophysiology | 541 | ||
| Assessment and Diagnosis | 542 | ||
| Medical Management | 544 | ||
| Nursing Management | 545 | ||
| Hypovolemic Shock | 545 | ||
| Etiology | 545 | ||
| Pathophysiology | 545 | ||
| Assessment and Diagnosis | 546 | ||
| Medical Management | 546 | ||
| Nursing Management | 547 | ||
| Cardiogenic Shock | 547 | ||
| Etiology | 547 | ||
| Pathophysiology | 547 | ||
| Assessment and Diagnosis | 548 | ||
| Medical Management | 549 | ||
| Nursing Management | 549 | ||
| Anaphylactic Shock | 550 | ||
| Etiology | 550 | ||
| Pathophysiology | 551 | ||
| Assessment and Diagnosis | 551 | ||
| Medical Management | 552 | ||
| Nursing Management | 554 | ||
| Neurogenic Shock | 554 | ||
| Etiology | 554 | ||
| Pathophysiology | 554 | ||
| Assessment and Diagnosis | 554 | ||
| Medical Management | 555 | ||
| Nursing Management | 555 | ||
| Severe Sepsis and Septic Shock | 555 | ||
| Etiology | 556 | ||
| Pathophysiology | 556 | ||
| Assessment and Diagnosis | 558 | ||
| Medical Management | 559 | ||
| Nursing Management | 561 | ||
| Multiple Organ Dysfunction Syndrome | 564 | ||
| Etiology | 564 | ||
| Pathophysiology | 566 | ||
| Assessment and Diagnosis | 567 | ||
| Gastrointestinal Dysfunction | 567 | ||
| Hepatobiliary Dysfunction | 567 | ||
| Pulmonary Dysfunction | 569 | ||
| Renal Dysfunction | 569 | ||
| Cardiovascular and Hematological System Dysfunction | 569 | ||
| Medical Management | 570 | ||
| Identification and Treatment of Infection | 570 | ||
| Maintenance of Tissue Oxygenation | 570 | ||
| Nutritional and Metabolic Support | 570 | ||
| Nursing Management | 571 | ||
| References | 572 | ||
| 27 Hematological Disorders and Oncological Emergencies | 576 | ||
| Objectives | 576 | ||
| Disseminated Intravascular Coagulation | 576 | ||
| Etiology | 576 | ||
| Pathophysiology | 576 | ||
| Assessment and Diagnosis | 577 | ||
| Clinical Manifestations | 578 | ||
| Laboratory Findings | 578 | ||
| Medical Management | 579 | ||
| Nursing Management | 579 | ||
| Supporting Patient’s Vital Functions | 579 | ||
| Initiating Bleeding Precautions | 579 | ||
| Providing Emotional Support | 580 | ||
| Heparin-Induced Thrombocytopenia | 580 | ||
| Etiology | 580 | ||
| Pathophysiology | 580 | ||
| Assessment and Diagnosis | 580 | ||
| Clinical Manifestations | 580 | ||
| Laboratory Findings | 581 | ||
| Medical Management | 581 | ||
| Nursing Management | 582 | ||
| Decreasing the Incidence of Heparin Exposure | 583 | ||
| Maintaining Surveillance for Complications | 583 | ||
| Initiating Patient Education | 583 | ||
| Tumor Lysis Syndrome | 584 | ||
| Etiology | 584 | ||
| Pathophysiology | 584 | ||
| Hyperuricemia | 584 | ||
| Hyperkalemia | 585 | ||
| Hyperphosphatemia and Hypocalcemia | 585 | ||
| Assessment and Diagnosis | 585 | ||
| Clinical Manifestations | 585 | ||
| Laboratory Findings | 586 | ||
| Other Diagnostic Tests | 586 | ||
| Medical Management | 586 | ||
| Nursing Management | 586 | ||
| Monitoring Fluid and Electrolytes | 586 | ||
| Maintaining Surveillance for Complications | 587 | ||
| Initiating Patient Education | 587 | ||
| References | 587 | ||
| Appendix A Nursing Management Plans of Care | A-1 | ||
| Appendix B Physiological Formulas for Critical Care | A-39 | ||
| Hemodynamic Formulas | A-39 | ||
| Mean Arterial Pressure (MAP) | A-39 | ||
| Cardiac Index (CI) | A-39 | ||
| Stroke Volume (SV) | A-39 | ||
| Stroke Volume Index (SVI) | A-39 | ||
| Systemic Vascular Resistance (SVR) | A-39 | ||
| Pulmonary Vascular Resistance (PVR) | A-39 | ||
| Left Ventricular Stroke Work Index (LVSWI) | A-39 | ||
| Right Ventricular Stroke Work Index (RVSWI) | A-39 | ||
| Corrected QT Interval (QTc) | A-39 | ||
| Body Mass Index (BMI) | A-40 | ||
| Body Surface Area (BSA) | A-40 | ||
| Pulmonary Formulas | A-40 | ||
| Shunt Equation (Qs/Qt) | A-40 | ||
| Pulmonary Capillary Oxygen Content (Cco2) | A-40 | ||
| Arterial Oxygen Content (Co2) | A-40 | ||
| Venous Oxygen Content (Cvo2) | A-40 | ||
| Alveolar Pressure of Oxygen (Pao2) | A-41 | ||
| Arterial/Inspired Oxygen Ratio | A-41 | ||
| Arterial/Alveolar Oxygen Ratio | A-41 | ||
| Alveolar-Arterial Gradient | A-41 | ||
| Dead Space Equation (Vd/Vt) | A-41 | ||
| Static Compliance (CST) | A-41 | ||
| Dynamic Compliance (CDY) | A-41 | ||
| Neurological Formulas | A-41 | ||
| Cerebral Perfusion Pressure (CPP) | A-41 | ||
| Arteriojugular Oxygen Difference (Ajdo2) | A-41 | ||
| Endocrine Formula | A-41 | ||
| Serum Osmolality | A-41 | ||
| Renal Formula | A-42 | ||
| Renal Clearance | A-42 | ||
| Nutritional Formulas* | A-42 | ||
| Estimate of Caloric Needs | A-42 | ||
| Estimate of Protein Needs | A-42 | ||
| Example of Calculation of Caloric and Protein Needs | A-42 | ||
| Index | I-1 | ||
| A | I-1 | ||
| B | I-4 | ||
| C | I-5 | ||
| D | I-9 | ||
| E | I-10 | ||
| F | I-12 | ||
| G | I-13 | ||
| H | I-13 | ||
| I | I-15 | ||
| J | I-17 | ||
| K | I-17 | ||
| L | I-17 | ||
| M | I-18 | ||
| N | I-19 | ||
| O | I-20 | ||
| P | I-21 | ||
| Q | I-24 | ||
| R | I-24 | ||
| S | I-25 | ||
| T | I-26 | ||
| U | I-28 | ||
| V | I-28 | ||
| W | I-29 | ||
| X | I-29 | ||
| Inside back cover | ibc1 |