Additional Information
Book Details
Abstract
Now completely up to date to meet the needs of today's pediatric nurses, Mary Fran Hazinski's Nursing Care of the Critically Ill Child, 3rd Edition, remains the foundational text of pediatric critical care nursing. Known for its outstanding organization and clear descriptions, this comprehensive reference details the unique care required for critically ill children with thorough discussions of physiology, pathophysiology, pharmacology, collaborative management, and nursing management. Ten new chapters, new advanced practice content, and new nurse contributors and reviewers ensure that this classic text continues to be the essential resource for the care of critically ill children.
- Details differences in caring for critically ill children as compared with caring for adults: how to modify assessment procedures, consider aspects of psychosocial development, and examine developmental aspects of various body systems.
- Provides comprehensive coverage of physiology, pathophysiology, pharmacology, and nursing management related to care of the critically ill child.
- Includes detailed Nursing Care Plans for select disorders.
- Contains helpful appendices such as pediatric drug dosages, central venous catheter care, and pediatric fluid requirements.
- Features Evolve online resources with additional content for further study of related topics, including tables for ease of recollection of material and additional references.
- Contains 10 all-new chapters, including Pharmacokinetics and Pharmacodynamics; Shock, Cardiac Arrest, and Resuscitation; Mechanical Support of Cardiopulmonary Function; Fluid, Electrolyte, and Endocrine Problems; Immunology and Infectious Disorders; Transplantation and Organ Donation; Toxicology/Poisonings; Fundamentals of Quality Improvement and Patient Safety; Clinical Informatics; and Ethical Issues in Pediatric Critical Care
- Features nurse contributors and reviewers for every chapter, making this edition a truly collaborative text.
- Provides information vital to the advanced practice nurse, such as assessment tools and severity of illness management.
- Includes numerous Pearls that highlight practical wisdom from experts in pediatric critical care nursing.
Table of Contents
| Section Title | Page | Action | Price |
|---|---|---|---|
| Front Cover | Cover | ||
| Nursing Care of the Critically Ill Child | iii | ||
| Copyright | iv | ||
| Dedication | v | ||
| Contributors | vi | ||
| Preface | xi | ||
| Contents | xv | ||
| Chapter 1: Children Are Different | 1 | ||
| Pearls | 1 | ||
| Introduction | 1 | ||
| Psychosocial development | 1 | ||
| General assessment | 1 | ||
| Initial Impression: \"Looks Good\" vs. \"Looks Bad | 1 | ||
| Evaluation of Vital Signs | 2 | ||
| Assessment Format | 3 | ||
| General characteristics | 4 | ||
| Thermoregulation | 4 | ||
| Fluid Requirements and Fluid Therapy | 4 | ||
| Electrolyte, Glucose, and Calcium Balance | 7 | ||
| Renal Function | 8 | ||
| Pediatric Pharmacokinetics | 9 | ||
| Nutrition and Gastrointestinal Function | 9 | ||
| Cardiovascular function | 9 | ||
| Cardiac Output | 9 | ||
| Heart Rate and Rhythm | 9 | ||
| Factors Influencing Stroke Volume | 10 | ||
| Response to Catecholamines | 10 | ||
| Signs of Shock | 10 | ||
| Circulating Blood Volume | 11 | ||
| Cardiac Arrest and Resuscitation | 11 | ||
| Respiratory function | 12 | ||
| Central Nervous System Control of Breathing | 12 | ||
| Airways | 13 | ||
| Chest Wall | 14 | ||
| Respiratory Muscles | 15 | ||
| Lung Tissue | 15 | ||
| Signs of Respiratory Distress | 15 | ||
| Neurologic function | 15 | ||
| Brain and Skull Growth | 15 | ||
| Neurologic Evaluation | 16 | ||
| Immune function and infection | 17 | ||
| Healthcare-Acquired (Nosocomial) Infections | 17 | ||
| Care of Vascular Monitoring Lines | 17 | ||
| Ventilator-Associated Pneumonia | 17 | ||
| Summary | 18 | ||
| References | 18 | ||
| Chapter 2: Psychosocial Aspects of Pediatric Critical Care | 19 | ||
| Pearls | 19 | ||
| Introduction | 19 | ||
| The critically ill infant | 20 | ||
| Developmental Tasks of the Infant | 20 | ||
| States of Consciousness in the Infant | 20 | ||
| Cognitive Development in the Infant | 21 | ||
| The Infant in the Critical Care Environment | 22 | ||
| Preparation of the Infant for Procedures and Surgery | 23 | ||
| The Infant and Play | 23 | ||
| The Infant and Death | 26 | ||
| The critically ill toddler | 26 | ||
| Emotional and Psychosocial Development of Toddlers | 26 | ||
| Cognitive Development of the Toddler | 26 | ||
| The Toddler in the Critical Care Environment | 27 | ||
| Preparation of the Toddler for Procedures and Surgery | 28 | ||
| The Toddler and Play | 28 | ||
| The Toddler and Death | 28 | ||
| The critically ill preschool child | 28 | ||
| Emotional and Psychosocial Development of the Preschooler | 28 | ||
| Cognitive Development of the Preschooler | 29 | ||
| The Preschooler in the Critical Care Environment | 29 | ||
| Preparation of the Preschooler for Procedures and Surgery | 30 | ||
| The Preschooler and Play | 31 | ||
| The Preschooler and Death | 31 | ||
| The critically ill school-aged child | 32 | ||
| Emotional and Psychosocial Development of the School-Aged Child | 32 | ||
| Cognitive Development in the School-Aged Child | 33 | ||
| The School-Aged Child in the Critical Care Environment | 33 | ||
| Preparation of the School-Aged Child for Procedures and Surgery | 33 | ||
| The School-Aged Child and Play | 34 | ||
| The School-Aged Child and Death | 34 | ||
| The critically ill adolescent | 35 | ||
| Emotional and Psychosocial Development of the Adolescent | 35 | ||
| Cognitive Development in the Adolescent | 35 | ||
| The Adolescent in the Critical Care Environment | 36 | ||
| Preparation of the Adolescent for Procedures and Surgery | 36 | ||
| The Adolescent and Play | 37 | ||
| The Adolescent and Death | 37 | ||
| Family members and the critical care unit | 37 | ||
| Parenting Children of Different Ages in the PCCU | 38 | ||
| Parental Stressors | 39 | ||
| Responses to Stress | 39 | ||
| Strategies to Support Families | 41 | ||
| Preparation for the Impact of the Critical Care Environment | 41 | ||
| Supporting Parental Coping | 42 | ||
| Siblings | 43 | ||
| Challenges of pediatric critical care nursing | 43 | ||
| Interpersonal Relationships | 44 | ||
| Nurse-Physician Relationships | 44 | ||
| Nurse-Management Relationships | 44 | ||
| Nurse-Nurse Relationships | 45 | ||
| Systems Issues | 45 | ||
| Patient Care Issues | 45 | ||
| Strategies for Coping | 46 | ||
| Rewards of pediatric critical care nursing | 46 | ||
| Conclusions | 47 | ||
| References | 47 | ||
| Chapter 3: Care of the Child with Life-Limiting Conditions and the Child's Family in the Pediatric Critical Care Unit | 51 | ||
| Pearls | 51 | ||
| Definition | 51 | ||
| Indications | 52 | ||
| Approaches to a family-centered model of care | 52 | ||
| The Child's Needs | 52 | ||
| Admission and Diagnosis | 52 | ||
| Physical Needs | 53 | ||
| Emotional Needs | 53 | ||
| Spiritual Needs | 54 | ||
| The Family's Needs | 54 | ||
| Family Challenges and Strengths | 54 | ||
| Communication and Planning | 54 | ||
| Emotional Needs | 55 | ||
| Special situations affecting timing of death | 55 | ||
| Withholding or Withdrawing Treatment | 55 | ||
| Organ Donation | 56 | ||
| Organ Donation after Brain Death | 56 | ||
| Organ Donation After Cardiac Death (DCD) | 57 | ||
| Interdisciplinary collaborative care | 57 | ||
| Support of the family at or near the time of death | 58 | ||
| Talking about Death | 58 | ||
| Support During Attempted Resuscitation | 59 | ||
| Expected Death | 60 | ||
| Informing Parents of a Child's Death | 61 | ||
| Support of the Parents at the Time of Child's Death | 61 | ||
| The Final Visit | 62 | ||
| Support for Siblings | 63 | ||
| Grief after death | 63 | ||
| Advanced practice concepts | 64 | ||
| Conclusions | 64 | ||
| References | 64 | ||
| Chapter 4: Pharmacokinetics and Pharmacodynamics | 67 | ||
| Pearls | 67 | ||
| Introduction | 67 | ||
| Principles of pharmacokinetics | 67 | ||
| Paths of Drugs in the Body | 67 | ||
| Drug Absorption | 67 | ||
| Drug Distribution | 67 | ||
| Drug Elimination | 68 | ||
| Mathematical modeling of drug paths | 68 | ||
| Michaelis-Menten Kinetics | 68 | ||
| First Order Kinetics | 68 | ||
| Volume of Distribution | 69 | ||
| Implications of Multicompartment Distribution | 69 | ||
| Drug Clearance | 69 | ||
| Frequently Used Terms | 70 | ||
| Half-Life | 70 | ||
| Steady State | 70 | ||
| Clinical Examples | 70 | ||
| Loading Doses | 70 | ||
| Bolus Plus Infusion Kinetics | 71 | ||
| Michaelis-Menten or Non-linear Kinetics and Dosing | 71 | ||
| Total versus free concentration | 71 | ||
| Additional factors affecting drug elimination | 72 | ||
| Maturation of Kinetic Processes | 72 | ||
| Clinical Factors Affecting Drug Metabolism | 72 | ||
| Pharmacogenetics | 72 | ||
| Drug Excretion | 73 | ||
| Practical clinical considerations | 73 | ||
| Dosing Changes | 73 | ||
| Bayes' Theorem | 73 | ||
| Drug Monitoring and Dosing | 73 | ||
| Start from the Expected | 73 | ||
| Wait Until Steady State | 73 | ||
| Make Conservative Changes in Dose | 74 | ||
| Monitor for Changes in Clinical Condition | 74 | ||
| Determine Whether Another Loading Dose is Indicated | 74 | ||
| Drug information in databases | 74 | ||
| Indications, Contraindications, and Mechanisms of Action | 74 | ||
| Pharmacokinetic Parameters | 74 | ||
| Dosing Information | 74 | ||
| Drug Interactions | 75 | ||
| Sampling for Monitoring Drug Concentrations | 75 | ||
| Pharmacodynamics | 75 | ||
| Summary | 76 | ||
| References | 76 | ||
| Chapter 5: Analgesia, Sedation, and Neuromuscular Blockade | 77 | ||
| Pearls | 77 | ||
| Introduction | 77 | ||
| Anatomy, physiology, and embryology of pain | 77 | ||
| Nociception | 78 | ||
| Hypersensitization and Preemptive Analgesia | 79 | ||
| Classification of Pain | 79 | ||
| Temporal Classification of Pain | 79 | ||
| Anatomic Classification of Pain | 79 | ||
| Pathophysiologic Classification of Pain | 80 | ||
| Neuropathic Pain | 80 | ||
| Patient assessment | 80 | ||
| Pediatric Pain Behavior | 81 | ||
| Assessment Tools | 81 | ||
| Subjective Patient Report | 81 | ||
| Objective Caregiver Evaluation | 82 | ||
| Management Planning | 82 | ||
| Nonpharmacologic interventions | 82 | ||
| Cognitive and Behavioral Modalities | 83 | ||
| Preparation for Procedures | 83 | ||
| Distraction | 83 | ||
| Relaxation and Guided Imagery | 83 | ||
| Music Therapy | 83 | ||
| Hypnosis | 83 | ||
| Biophysical Modalities | 84 | ||
| Cutaneous and Oral Stimulation | 84 | ||
| Cold and Heat Therapy | 84 | ||
| Transcutaneous Electrical Nerve Stimulation (TENS) | 84 | ||
| Acupuncture | 84 | ||
| Systemic analgesics | 84 | ||
| Nonopioid Analgesics | 86 | ||
| Acetaminophen | 86 | ||
| Nonsteroidal Antiinflammatory Drugs | 86 | ||
| Opioid Analgesics | 87 | ||
| Oral Opioids | 88 | ||
| Intravenous Opioids | 88 | ||
| Patient-Controlled Analgesia (PCA) | 89 | ||
| Local anesthetics | 89 | ||
| Infiltration | 90 | ||
| Topical Application | 90 | ||
| Regional Anesthetic Techniques | 90 | ||
| Peripheral Nerve Blocks | 90 | ||
| Plexus Blocks | 90 | ||
| Neuraxial Blocks | 91 | ||
| Systemic sedatives | 91 | ||
| Sedative-Hypnotic Agents | 91 | ||
| Chloral Hydrate | 92 | ||
| Barbiturates | 92 | ||
| Benzodiazepines | 93 | ||
| Ketamine | 93 | ||
| Propofol | 93 | ||
| Dexmedetomidine | 94 | ||
| Procedural Sedation | 94 | ||
| Neuromuscular blockade | 94 | ||
| Neuromuscular Blocking Agents | 95 | ||
| Depolarizing Agent: Succinylcholine | 95 | ||
| Nondepolarizing Agents | 96 | ||
| Reversal of Neuromuscular Blockade | 97 | ||
| Critical Illness Polyneuropathy and Myopathy | 97 | ||
| Neuromuscular Monitoring | 97 | ||
| Summary | 98 | ||
| References | 98 | ||
| Chapter 6: Shock, Cardiac Arrest, and Resuscitation | 101 | ||
| Shock | 101 | ||
| Shock pearls | 101 | ||
| Introduction | 101 | ||
| Cardiovascular physiology and shock pathophysiology | 101 | ||
| Cellular Basis of Shock | 101 | ||
| Determinants of Oxygen Delivery | 102 | ||
| Normal CO | 102 | ||
| Factors Influencing SV | 103 | ||
| Ventricular Preload | 103 | ||
| Ventricular Compliance | 104 | ||
| Ventricular Contractility | 105 | ||
| Afterload | 105 | ||
| Oxygen Delivery | 106 | ||
| Oxygen Content | 106 | ||
| Cardiac Output | 109 | ||
| Clinical Assessment of CO | 110 | ||
| Calculation and Estimation of CO | 111 | ||
| Relationship of Mixed Venous Oxygen Saturation to CO | 112 | ||
| Use of Central Venous Oxygen Saturation Monitoring | 112 | ||
| Near-Infrared Spectroscopy (NIRS) | 112 | ||
| Blood Pressure | 113 | ||
| Shock states | 113 | ||
| Hypovolemic Shock | 114 | ||
| Etiology | 114 | ||
| Pathophysiology | 114 | ||
| Clinical Signs and Symptoms | 114 | ||
| Management | 116 | ||
| Fluid Therapy: Diarrhea and Dehydration | 116 | ||
| Fluid Therapy in Traumatic or Hemorrhagic Shock | 117 | ||
| Crystalloid Versus Colloid | 118 | ||
| Distributive Shock: Definitions | 118 | ||
| Septic Shock | 119 | ||
| Etiology and Definitions | 119 | ||
| Pathophysiology | 119 | ||
| Clinical Signs and Symptoms | 122 | ||
| Management | 124 | ||
| Antibiotic Treatment | 124 | ||
| Airway and Ventilation | 124 | ||
| Volume Resuscitation | 124 | ||
| Inotropic Support | 125 | ||
| Vasopressors | 125 | ||
| Corticosteroid Therapy | 127 | ||
| Immunotherapy | 128 | ||
| Treatment of Coagulation Dysfunction | 128 | ||
| Extracorporeal Membrane Oxygenation (ECMO) | 129 | ||
| Cardiogenic Shock | 129 | ||
| Etiology and Definition | 129 | ||
| Pathophysiology | 129 | ||
| The Sympathetic Nervous System | 129 | ||
| Renin-Angiotensin-Aldosterone System | 129 | ||
| Nonosmotic Release of Arginine Vasopressin | 130 | ||
| Natriuretic Hormone System | 130 | ||
| Endothelial Hormones | 130 | ||
| Cytokines | 131 | ||
| Ventricular Dilation and Hypertrophy | 131 | ||
| Downward Spiral in Cardiogenic Shock | 131 | ||
| Diastolic Heart Failure | 131 | ||
| Right Ventricular Failure | 132 | ||
| Molecular Basis for Myocyte Dysfunction | 132 | ||
| Clinical Signs and Symptoms | 132 | ||
| CHF in First Weeks of Life | 133 | ||
| CHF Developing Later in Infancy | 134 | ||
| CHF Developing in Childhood and Adolescence | 134 | ||
| Management | 134 | ||
| Catecholamines | 135 | ||
| Dopamine | 135 | ||
| Dobutamine | 135 | ||
| Epinephrine | 136 | ||
| Norepinephrine | 136 | ||
| Isoproterenol | 136 | ||
| Phosphodiesterase Inhibitors | 136 | ||
| Levosimendan | 137 | ||
| Digoxin | 137 | ||
| Other Agents | 137 | ||
| Vasodilator Drugs | 137 | ||
| Nitroglycerin | 138 | ||
| Nitroprusside | 138 | ||
| Diuretics | 138 | ||
| Interventional Cardiology | 138 | ||
| Surgical Intervention | 139 | ||
| Etiology-Specific Treatment of Cardiogenic Shock | 139 | ||
| Obstructive Shock | 139 | ||
| Etiology, Pathophysiology, Clinical Signs and Management | 139 | ||
| Tension Pneumothorax | 139 | ||
| Cardiac Tamponade | 139 | ||
| Pulmonary Embolism | 139 | ||
| Cardiac arrest and resuscitation | 140 | ||
| Cardiac arrest pearls | 140 | ||
| Cardiac Arrest in Children | 140 | ||
| Out-of-hospital and In-hospital Arrest | 140 | ||
| Etiology | 140 | ||
| Pathophysiology | 140 | ||
| Clinical Signs and Symptoms of Prearrest and Arrest | 141 | ||
| Prearrest: Airway | 141 | ||
| Prearrest: Breathing | 141 | ||
| Prearrest: Circulation | 141 | ||
| Signs of Arrest | 142 | ||
| Management: Prearrest Support | 142 | ||
| Prearrest Support of Airway and Ventilation | 142 | ||
| Prearrest Support of Circulation | 142 | ||
| Management: Resuscitation | 142 | ||
| Cardiac Compressions | 142 | ||
| Blood Flow during CPR | 143 | ||
| Vascular Access | 143 | ||
| Fluid Therapy | 144 | ||
| Drug Therapy | 144 | ||
| Buffering Agents | 144 | ||
| Defibrillation and Cardioversion | 146 | ||
| Integration of CPR, Attempted Defibrillation, and Drugs | 146 | ||
| Support of the Parents | 147 | ||
| Extending or Discontinuing a Resuscitation Attempt | 147 | ||
| Resuscitation Training and Quality Improvement | 147 | ||
| The Postresuscitation Phase | 148 | ||
| References | 148 | ||
| Chapter 7: Mechanical Support of Cardiopulmonary Function... | 155 | ||
| Pearls | 155 | ||
| Introduction | 155 | ||
| Device Selection | 156 | ||
| Extracorporeal membrane oxygenation | 156 | ||
| ECMO Terminology | 156 | ||
| Venoarterial ECMO | 156 | ||
| Circuit | 156 | ||
| Venoarterial ECMO Flow and Function | 157 | ||
| Hemodynamic Changes During Venoarterial ECMO | 158 | ||
| Extremely High PaO2 or Fall in Native Cardiac Output | 158 | ||
| Falling PaO2 or Increase in Native Cardiac Output | 158 | ||
| ECMO Support with Single Ventricle Physiology | 158 | ||
| Venovenous ECMO | 158 | ||
| Circuit | 158 | ||
| Venovenous ECMO Flow and Function | 159 | ||
| Hemodynamic Changes during Venovenous ECMO | 159 | ||
| Advantages and Disadvantages of VA and VV ECMO | 159 | ||
| Indications and Contraindications of ECMO Support | 159 | ||
| Neonatal Respiratory Failure | 160 | ||
| Pediatric Respiratory Failure | 160 | ||
| Cardiac Failure | 160 | ||
| Weaning from ECMO | 160 | ||
| Complications of ECMO | 161 | ||
| ECMO Troubleshooting | 161 | ||
| ECMO Circuit Emergencies | 161 | ||
| Ventricular assist devices | 162 | ||
| Components and Function of VAD Support | 162 | ||
| Ventricular Assist Device Flow and Function | 163 | ||
| Types of Ventricular Assist Device Pumps | 164 | ||
| Continuous Flow Pumps | 164 | ||
| Centrifugal Pump | 164 | ||
| Axial Flow Pump | 164 | ||
| Pulsatile Pumps | 165 | ||
| Indications and Contraindications for Ventricular Assist Device Support | 165 | ||
| Weaning From VAD Support | 165 | ||
| Complications of Ventricular Assist Device Support | 166 | ||
| Troubleshooting Ventricular Assist Device Support | 166 | ||
| Intraaortic balloon pump | 166 | ||
| Components and Function | 166 | ||
| Indications and Contraindications | 167 | ||
| Technique of Balloon Placement | 167 | ||
| Timing of Inflation and Deflation | 167 | ||
| Weaning | 167 | ||
| Complications | 168 | ||
| Nursing Considerations | 168 | ||
| Nursing care of the pediatric patient requiring MCS | 168 | ||
| Preparation of the Child and Family | 168 | ||
| Pediatric Critical Care Unit (PCCU) Setup | 168 | ||
| Admission or Initiation of MCS and Staffing | 168 | ||
| Postoperative Care | 172 | ||
| Neurologic Assessment | 172 | ||
| Near-Infrared Spectroscopy (NIRS) | 172 | ||
| Sedation and Analgesia | 173 | ||
| Respiratory Assessment | 173 | ||
| Cardiac Assessment and Support | 173 | ||
| Inadequate Intravascular Volume | 173 | ||
| Inappropriate Vascular Resistance | 173 | ||
| Native Myocardial Dysfunction | 174 | ||
| Arrhythmias | 174 | ||
| Tamponade | 174 | ||
| Troubleshooting VAD Pump and Console | 174 | ||
| Hematologic Assessment | 174 | ||
| Anticoagulation | 175 | ||
| Consumptive Coagulopathy | 175 | ||
| Heparin-Induced Thrombocytopenia (HIT) | 175 | ||
| Fluid and Electrolyte Replacement and Balance | 175 | ||
| Renal and Hepatic Function | 176 | ||
| Nutrition | 176 | ||
| Infection | 176 | ||
| Skin Assessment | 176 | ||
| Activities of Daily Living and Rehabilitation | 177 | ||
| Psychological Support | 177 | ||
| Commonly used drugs | 177 | ||
| MCS for specific diseases | 177 | ||
| Diagnostic tests during MCS | 177 | ||
| Echocardiogram | 177 | ||
| Cardiac Catheterization | 177 | ||
| Chest Radiograph | 177 | ||
| Arterial and Venous Blood Gas Assessment | 177 | ||
| Cranial Ultrasound | 177 | ||
| References | 179 | ||
| Chapter 8: Cardiovascular Disorders | 181 | ||
| Introduction | 181 | ||
| Essential anatomy and physiology | 181 | ||
| Etiologies of chd: noninherited and genetic factors | 181 | ||
| Noninherited Risk Factors for CHD (Many Potentially Modifiable) | 182 | ||
| Maternal Disorders or Biologic Teratogens | 182 | ||
| Maternal Drug Exposure (Chemical Teratogens) | 182 | ||
| Environmental Exposures (Chemical, Biologic, and Physical Teratogens) and Influences | 183 | ||
| Genetic Factors Associated with CHD | 183 | ||
| Genetic Testing, Counseling, and Nursing Implications | 184 | ||
| Fetal development of the heart and great vessels | 190 | ||
| Formation of the Heart Tube: Day 22 | 190 | ||
| Formation of the Heart Loop: Day 22 to 28 | 191 | ||
| Formation of Cardiovascular Septation: Day 26 to 49 | 192 | ||
| Endocardial Cushion Development: Day 26 to 40 | 192 | ||
| Atrial Septation: Day 30 to 35 | 192 | ||
| Ventricular Septation: Day 25 to 49 | 194 | ||
| Septation of the Truncus Arteriosus: Day 26 to 42 | 194 | ||
| Formation of the Cardiac Valves: Day 34 to 42 | 194 | ||
| Classification of Complex Cardiac Malpositions and Malformations | 194 | ||
| Position of the Abdominal Viscera and Atria (S, I, or A) | 196 | ||
| Description of the Ventricular Loop (D or L) | 196 | ||
| Position of the Great Vessels (d- or l-Normal, or d- or l-Transposition) | 196 | ||
| Development of the Aortic Arch: Day 28 to 49 | 196 | ||
| Development of the Ventricular Myocardium, Conduction System, and Coronary Circulation | 196 | ||
| Fetal Circulation | 197 | ||
| Normal perinatal circulatory changes | 198 | ||
| Normal Postnatal Changes in Pulmonary Vascular Resistance | 198 | ||
| Closure of Fetal Shunts | 199 | ||
| Normal Postnatal Changes in Systemic Vascular Resistance | 200 | ||
| Gross anatomy and function | 200 | ||
| The Right Side of the Heart | 200 | ||
| The Left Side of the Heart | 201 | ||
| Normal cardiac function | 201 | ||
| The Cardiac Cycle | 201 | ||
| The Coronary Circulation | 203 | ||
| Cellular Physiology | 204 | ||
| Membrane and Action Potentials | 204 | ||
| Pacemaker Cells and Pacemaker Potentials | 206 | ||
| Potential Alterations in Membrane Potentials and Excitability | 206 | ||
| Refractory Periods | 206 | ||
| Myocardial Contraction | 206 | ||
| Factors influencing normal ventricular function | 207 | ||
| Ventricular Preload | 208 | ||
| The Frank-Starling Law of the Heart | 208 | ||
| Clinical Evaluation of Ventricular Preload | 209 | ||
| Factors Affecting Ventricular End-Diastolic Pressure (VEDP) | 209 | ||
| Ventricular Compliance | 209 | ||
| Maturational Changes in Response to Preload Manipulation | 210 | ||
| Contractility | 210 | ||
| Definition | 210 | ||
| Clinical Evaluation of Contractility | 210 | ||
| Maturational Changes in Cardiac Contractility | 211 | ||
| Afterload | 211 | ||
| Definition | 211 | ||
| Clinical Evaluation of Afterload | 211 | ||
| Maturational Changes in Response to Alterations in Ventricular Afterload | 212 | ||
| Oxygen transport, cardiac output, and oxygen consumption | 213 | ||
| Oxygen Transport | 213 | ||
| Oxygen Content | 213 | ||
| Factors Affecting Arterial Oxygen Content | 213 | ||
| Clinical Evaluation of Arterial Oxygen Content | 213 | ||
| Cardiac Output | 214 | ||
| Factors Affecting Cardiac Output | 214 | ||
| Clinical Evaluation of Cardiac Output | 214 | ||
| Doppler Echocardiography | 214 | ||
| Fick Cardiac Output Calculation | 215 | ||
| Mixed Venous Oxygen Saturation | 215 | ||
| Thermodilution Cardiac Output Calculation | 216 | ||
| Oxygen Consumption | 216 | ||
| Clinical Evaluation of Oxygen Consumption | 217 | ||
| Autonomic nervous system | 217 | ||
| Sympathetic Nervous System | 217 | ||
| Adrenergic Neurotransmitters | 217 | ||
| Adrenergic Receptors | 218 | ||
| Beta Receptors | 218 | ||
| Alpha Receptors | 218 | ||
| Dopaminergic Receptors | 218 | ||
| Modulation of Adrenergic Receptor Activation | 218 | ||
| Parasympathetic Nervous System | 219 | ||
| Parasympathetic Neurotransmitter | 219 | ||
| Cholinergic Receptors | 219 | ||
| Common clinical conditions | 219 | ||
| Congestive heart failure | 219 | ||
| Pearls | 219 | ||
| Etiology | 219 | ||
| Pathophysiology | 220 | ||
| Biochemical Alterations | 220 | ||
| Ventricular Dilation and Hypertrophy | 220 | ||
| Sympathetic Nervous System Compensation and Redistribution of Blood Volume | 220 | ||
| Renal and Humeral Factors Affecting Blood Volume and Distribution | 221 | ||
| Effects on Oxygen Delivery | 221 | ||
| Clinical Signs and Symptoms | 221 | ||
| Adrenergic Stimulation | 221 | ||
| Systemic Venous Congestion | 222 | ||
| Pulmonary Venous Congestion | 222 | ||
| Nonspecific Signs of Distress | 223 | ||
| Laboratory Evaluation | 223 | ||
| Management | 223 | ||
| Improvement in Cardiac Function: Digitalis Derivatives | 223 | ||
| Therapeutic Effects | 223 | ||
| Dose | 224 | ||
| Administration | 225 | ||
| Digoxin Levels | 225 | ||
| Digoxin Toxicity | 225 | ||
| Parent Instruction | 226 | ||
| Improvement in Cardiac Function: Additional Inotropic Agents | 226 | ||
| Vasodilator Therapy | 226 | ||
| Angiotensin Converting Enzyme (ACE) Inhibitors | 226 | ||
| Angiotensin Receptor Blockers | 227 | ||
| Reduction in Intravascular Volume: Diuretic Therapy | 227 | ||
| Furosemide (Lasix) | 228 | ||
| Bumetanide (Bumex) | 228 | ||
| Ethacrynic Acid (Edecrin) | 229 | ||
| Thiazides and Chlorothiazide | 229 | ||
| Metolazone (Zaroxolyn) | 229 | ||
| Aldosterone Inhibitors | 229 | ||
| Nesiritide (Natrecor) | 229 | ||
| Nursing Implications | 229 | ||
| Beta-Adrenergic Blockade | 229 | ||
| Metoprolol | 230 | ||
| Carvedilol | 230 | ||
| Fluid Therapy and Nutrition | 230 | ||
| Comfort Measures and Thermoregulation | 231 | ||
| Transfusion Therapy to Treat Severe Anemia | 231 | ||
| Evaluation of Therapy | 231 | ||
| Low cardiac output (shock) | 232 | ||
| Altered nutrition and potential gastrointestinal complications | 232 | ||
| Etiology, Pathophysiology and Identification of Growth Failure in Patients with Congenital Heart Disease | 232 | ||
| Management: Strategies to Optimize Nutrition and Growth | 234 | ||
| Gastroesophageal Reflux (GER) | 234 | ||
| Parenteral Nutrition | 234 | ||
| Enteral Feeding | 234 | ||
| Long-Term Supplementation | 236 | ||
| Management: Necrotizing Enterocolitis | 236 | ||
| Management: Mesenteric Arteritis | 236 | ||
| Management: Chylous Effusion | 237 | ||
| Management: Protein-Losing Enteropathy | 237 | ||
| Management: Vocal Cord Injury | 237 | ||
| Arrhythmias | 238 | ||
| Pearls | 238 | ||
| Normal Rhythm and Conduction | 238 | ||
| Etiology | 238 | ||
| Pathophysiology | 239 | ||
| Effects of Electrolyte Imbalances, Hypoxia and Acidosis | 239 | ||
| Effects of Cardiac Surgery | 241 | ||
| ST-Segment Deviation | 241 | ||
| Bradyarrhythmias | 241 | ||
| Tachyarrhythmias | 242 | ||
| Rhythm Identification and Clinical Signs and Symptoms | 242 | ||
| Rhythms Originating from the Sinus Node | 243 | ||
| Rhythms Originating in the Atria | 246 | ||
| Rhythms Originating at the AV Junction | 250 | ||
| Rhythms Originating in the Ventricles | 251 | ||
| AV Blocks | 253 | ||
| Nursing Assessment and Cardiac Monitoring | 254 | ||
| Acute Management of Arrhythmias | 255 | ||
| Bradycardia | 255 | ||
| Tachycardia | 255 | ||
| Antiarrhythmic Drug Therapy | 258 | ||
| Long-Term Arrhythmia Management | 258 | ||
| Device Therapy | 258 | ||
| Ablation Procedures | 261 | ||
| Hypoxemia caused by cyanotic congenital heart disease | 261 | ||
| Pearls | 261 | ||
| Etiology | 261 | ||
| Causes of Hypoxemia in Children | 261 | ||
| Pathophysiology | 262 | ||
| Systemic Consequences of Polycythemia | 262 | ||
| Increased Levels of 2,3 DPG | 263 | ||
| Hypercyanotic Spells | 263 | ||
| Clinical Signs and Symptoms | 263 | ||
| Management | 263 | ||
| Pulmonary hypertension | 265 | ||
| Pearls | 265 | ||
| Etiology | 265 | ||
| Pathophysiology | 265 | ||
| Diagnosis and Clinical Signs and Symptoms of Pulmonary Hypertension | 267 | ||
| Diagnosis | 267 | ||
| Clinical Signs | 268 | ||
| Management of Pulmonary Hypertension | 268 | ||
| Prevention | 268 | ||
| General Treatment Approaches | 269 | ||
| Postoperative Care | 269 | ||
| Drug Therapy | 271 | ||
| Inotropes and Vasodilators | 272 | ||
| Nitric Oxide | 272 | ||
| New and Evolving Therapies | 273 | ||
| Transition and Advanced Care | 273 | ||
| Congenital heart disease in adults | 273 | ||
| Pearls | 273 | ||
| Etiology/Epidemiology | 274 | ||
| Transitioning and Transfer | 274 | ||
| Residuae and Sequelae of Congenital Heart Disease | 275 | ||
| Arrhythmias | 276 | ||
| Cyanosis | 276 | ||
| Pulmonary Hypertension | 277 | ||
| Conduit Obstruction | 277 | ||
| Adult Cardiovascular Problems | 277 | ||
| Long-Term Outcomes of Specific Defects | 277 | ||
| Bicuspid Aortic Valve | 277 | ||
| Coarctation of the Aorta | 278 | ||
| Atrial Septal Defect | 278 | ||
| Tetralogy of Fallot | 278 | ||
| Transposition of the Great Arteries | 278 | ||
| Single Ventricle | 279 | ||
| Reproductive Health in Women with Congenital Heart Disease | 280 | ||
| Perioperative Care for the Patient with Adult CHD | 280 | ||
| Procedures | 280 | ||
| Postoperative Care | 280 | ||
| Transitioning to Adult Specialist Care | 281 | ||
| Resources for Healthcare Professionals and Families | 282 | ||
| Postoperative care and anticoagulation for the child with congenital heart disease | 282 | ||
| Admission to the critical care unit | 282 | ||
| Cardiovascular function | 282 | ||
| Cardiac Output | 282 | ||
| Hemodynamic Monitoring | 283 | ||
| Preload | 283 | ||
| Contractility | 284 | ||
| Afterload | 284 | ||
| Systemic Vascular Resistance | 284 | ||
| Pulmonary Vascular Resistance | 284 | ||
| Heart Rate and Arrhythmias | 285 | ||
| Low Cardiac Output Syndrome (LCOS) | 286 | ||
| Tamponade | 286 | ||
| Signs of Tamponade | 286 | ||
| Chapter 9: Pulmonary Disorders | 483 | ||
| Pearls | 483 | ||
| Essential anatomy and physiology | 483 | ||
| Embryology of the Lung | 483 | ||
| Anatomy of the Chest | 483 | ||
| The Upper Airway | 484 | ||
| Compliance and Resistance | 485 | ||
| Ventilation | 486 | ||
| Lung Volumes | 487 | ||
| Ventilation-Perfusion Relationships | 487 | ||
| Gas Transport | 488 | ||
| Oxygen Tension and Oxygen Content | 488 | ||
| The Oxyhemoglobin Dissociation Curve | 489 | ||
| Regulation of Carbon Dioxide Tension and Hydrogen Ion Concentration | 490 | ||
| Regulation of Respiration | 490 | ||
| Neural Control of Airway Caliber | 492 | ||
| Common clinical conditions | 492 | ||
| Upper Airway Obstruction | 492 | ||
| Etiology | 492 | ||
| Pathophysiology | 493 | ||
| Clinical Signs and Symptoms | 493 | ||
| Management | 493 | ||
| Lower Airway Obstruction | 495 | ||
| Chapter 10: Chest X-Ray Interpretation | 563 | ||
| Pearls | 563 | ||
| Introduction | 563 | ||
| Definitions | 563 | ||
| Interpretation of film technique | 565 | ||
| Patient Position and View | 565 | ||
| Film Technique | 566 | ||
| Interpretation of chest radiograph | 567 | ||
| Systematic Approach | 567 | ||
| Soft Tissues and Bony Thorax | 568 | ||
| Diaphragm and Abdomen | 569 | ||
| Pleura and Costophrenic Angles | 570 | ||
| Mediastinum and Trachea | 571 | ||
| Heart and Great Vessels | 573 | ||
| Lungs, Hili, and Pulmonary Vascularity | 575 | ||
| Common radiographic abnormalities | 577 | ||
| Identification of tubes, catheters, and wires | 579 | ||
| Common imaging studies obtained in critically ill children | 581 | ||
| Computed Tomography (CT) Scan | 581 | ||
| Magnetic Resonance Imaging (MRI) | 584 | ||
| Ultrasound | 584 | ||
| Fluoroscopy | 584 | ||
| Conclusions | 584 | ||
| Acknowledgments | 585 | ||
| References | 585 | ||
| Chapter 11: Neurologic Disorders | 587 | ||
| Pearls | 587 | ||
| Introduction | 587 | ||
| Essential anatomy and physiology | 587 | ||
| The Axial Skeleton | 587 | ||
| The Meninges | 588 | ||
| The Brain | 589 | ||
| The Cerebrum | 589 | ||
| The Cerebral Cortex | 589 | ||
| The Basal Ganglia | 590 | ||
| The Thalamus and Hypothalamus | 590 | ||
| The Brainstem | 591 | ||
| The Cerebellum | 591 | ||
| The Ventricles | 591 | ||
| The Cranial Nerves | 591 | ||
| The Spinal Cord | 591 | ||
| Central Nervous System Circulation and Perfusion | 593 | ||
| The Cerebral Circulation | 593 | ||
| Cerebral Blood Flow and Regulation | 596 | ||
| Cerebral Blood Flow | 596 | ||
| Cerebral Venous Return | 596 | ||
| Autoregulation | 596 | ||
| Alterations in Cerebral Blood Flow | 596 | ||
| Effects of Arterial Blood Gases on Cerebral Blood Flow | 596 | ||
| Oxygen Response | 596 | ||
| Carbon Dioxide Response | 596 | ||
| Cerebral Perfusion Pressure | 597 | ||
| Evaluation of Cerebral Blood Flow | 597 | ||
| Jugular Venous Oxygen Saturation | 597 | ||
| Doppler Flow Velocity | 598 | ||
| Partial Pressure of Oxygen in Brain Tissue | 598 | ||
| Noninvasive Near-Infrared Spectroscopy | 598 | ||
| The Blood-Brain Barrier | 598 | ||
| The Spinal Cord Circulation | 598 | ||
| Cerebrospinal Fluid and Its Circulation | 598 | ||
| Intracranial Pressure and Volume Relationships | 599 | ||
| Monroe-Kellie Hypothesis | 599 | ||
| The Brain | 602 | ||
| Cerebral Blood Volume | 602 | ||
| Cerebrospinal Fluid | 603 | ||
| Normal Intracranial Pressure | 603 | ||
| Common clinical conditions | 603 | ||
| Evaluation of Respiratory Pattern | 603 | ||
| Evaluation of Systemic Perfusion | 605 | ||
| The Cushing Reflex | 605 | ||
| Evaluation of Level of Consciousness | 605 | ||
| Evaluation of Pupil Response and Cranial Nerve Function | 605 | ||
| Glasgow Coma Scale Scoring of Neurologic Function | 606 | ||
| Additional Assessment of Motor Function and Reflexes | 609 | ||
| Increased Intracranial Pressure | 610 | ||
| Etiology | 610 | ||
| Increased Brain Volume | 610 | ||
| Increased Cerebral Blood Volume | 610 | ||
| Cerebral Spinal Fluid Accumulation | 610 | ||
| Mass Lesions | 610 | ||
| Pathophysiology | 610 | ||
| Intracranial Pressure and Volume | 610 | ||
| Intracranial Compliance | 611 | ||
| Complications of Increased Intracranial Pressure | 611 | ||
| Clinical Signs and Symptoms | 612 | ||
| Evaluation of Airway and Oxygenation | 612 | ||
| Evaluation of Systemic Perfusion | 612 | ||
| Level of Consciousness | 612 | ||
| Pupil Response and Cranial Nerve Function | 612 | ||
| Changes in Motor Function and Reflexes | 613 | ||
| Alterations in Respiratory Pattern | 613 | ||
| The Cushing Reflex | 613 | ||
| Papilledema | 613 | ||
| Scoring Neurologic Function | 613 | ||
| Other Signs of Increased Intracranial Pressure | 614 | ||
| Helpful Diagnostic Tests | 614 | ||
| Management | 614 | ||
| Assessment and Support of Airway and Ventilation | 614 | ||
| Assessment and Support of Systemic Perfusion | 616 | ||
| Intracranial Pressure Monitoring | 616 | ||
| Purposes | 616 | ||
| Zeroing and Calibration | 616 | ||
| Methods | 616 | ||
| Nursing Responsibilities | 617 | ||
| Dangerous Trends in the ICP | 618 | ||
| Documenting the ICP | 618 | ||
| Reduction in Cerebral Blood Volume | 620 | ||
| Maintenance and Manipulation of Serum Osmolality | 620 | ||
| Fluid administration | 620 | ||
| Estimation of Serum Osmolality | 620 | ||
| Administration of Hypertonic Saline | 620 | ||
| Mannitol | 621 | ||
| Other Osmotic Agents | 621 | ||
| Diuretic Therapy | 621 | ||
| Drainage of Cerebrospinal Fluid | 621 | ||
| General Supportive Care and Control of Oxygen Requirements and Nutrients | 622 | ||
| Barbiturate Therapy | 623 | ||
| Additional Controversial Therapies | 623 | ||
| Weaning from Support | 624 | ||
| Psychosocial Support | 624 | ||
| Coma | 624 | ||
| Etiology | 624 | ||
| Pathophysiology | 624 | ||
| Clinical Signs and Symptoms | 624 | ||
| Management | 626 | ||
| Support of Vital Functions | 627 | ||
| Maintenance of Adequate Nutrition | 627 | ||
| Prevention of the Complications of Immobility | 627 | ||
| Psychosocial Support | 628 | ||
| Status Epilepticus | 628 | ||
| Etiology | 628 | ||
| Pathophysiology | 629 | ||
| Clinical Signs and Symptoms | 629 | ||
| Management | 629 | ||
| Support of Vital Functions | 629 | ||
| Anticonvulsant Therapy | 630 | ||
| Barbiturate Coma | 631 | ||
| Non-pharmacologic Management of Seizures | 631 | ||
| Vagal Nerve Stimulators | 631 | ||
| Surgical Interventions | 632 | ||
| Endocrinopathies Associated with Neurologic Insults | 632 | ||
| Brain Death and Organ Donation | 632 | ||
| Etiology | 632 | ||
| Criteria for Pronouncement of Brain Death | 633 | ||
| Irreversible Condition | 633 | ||
| Physical Examination to Document the Absence of Brainstem Function | 633 | ||
| Confirmatory and Adjunct Tests | 635 | ||
| Observation Period | 635 | ||
| Infants 7 Days to 2 Months of Age | 635 | ||
| Infants 2 Months to 1 Year of Age | 635 | ||
| Beyond 1 Year of Age | 636 | ||
| Brain Death in the Neonate | 636 | ||
| Contact with the Local Organ Procurement Organization | 636 | ||
| Psychosocial Support of the Family | 637 | ||
| Support of the Cadaveric Donor | 637 | ||
| Care of the Donor after Cardiac Death | 638 | ||
| The Emotional Toll on the Nurse | 638 | ||
| Postoperative care of the pediatric neurosurgical patient | 638 | ||
| Preoperative Assessment | 638 | ||
| Preparation for Admission or Transfer to the Critical Care Unit | 640 | ||
| Postoperative Care | 640 | ||
| Initial Assessment | 640 | ||
| Maintenance of Cardiorespiratory Function | 641 | ||
| Neurologic Assessment | 642 | ||
| Highlights of the Neurologic Examination | 642 | ||
| Postoperative Complications | 643 | ||
| General Supportive Care | 643 | ||
| Fluids and Nutrition | 643 | ||
| Analgesia | 643 | ||
| Sedation | 644 | ||
| Prevention of Infection | 644 | ||
| Treatment of Fever | 644 | ||
| Prevention of the Complications of Immobility | 644 | ||
| Psychosocial Support | 644 | ||
| Specific diseases | 648 | ||
| Head Trauma | 648 | ||
| Etiology | 648 | ||
| Pathophysiology | 648 | ||
| Concussion | 648 | ||
| Contusion | 648 | ||
| Skull Fractures | 649 | ||
| Vascular Injuries and Hemorrhage | 649 | ||
| Diffuse Axonal Injury | 650 | ||
| Penetrating Injuries | 650 | ||
| Inflicted (Intentional/Non-accidental) Injuries and Shaken Baby Syndrome | 650 | ||
| Cerebral Edema | 650 | ||
| Clinical Signs and Symptoms | 650 | ||
| Cerebral Biomarkers | 651 | ||
| Concussion | 651 | ||
| Contusion | 651 | ||
| Skull Fractures | 652 | ||
| Vascular Injuries and Hemorrhage | 652 | ||
| Cerebral Edema | 653 | ||
| The \"Talk and Die\" Phenomenon | 653 | ||
| Management | 653 | ||
| Support of Cardiopulmonary Function | 653 | ||
| Assessment of Neurologic Function | 654 | ||
| Temperature Control | 655 | ||
| Supportive Care | 655 | ||
| Injury-Specific Management | 655 | ||
| Concussion | 655 | ||
| Contusion | 655 | ||
| Skull Fractures | 655 | ||
| Vascular Injuries | 656 | ||
| Cerebral Edema | 656 | ||
| Psychosocial Support | 656 | ||
| Spinal Cord Injury | 657 | ||
| Etiology | 657 | ||
| Pathophysiology | 657 | ||
| Clinical Signs and Symptoms | 657 | ||
| Physical Examination | 657 | ||
| Diagnostic Studies | 660 | ||
| Management | 660 | ||
| Intracranial Tumors | 660 | ||
| Etiology | 660 | ||
| Pathophysiology | 661 | ||
| Supratentorial Tumors | 661 | ||
| Infratentorial Tumors | 661 | ||
| Clinical Signs and Symptoms | 662 | ||
| Management | 662 | ||
| Meningitis | 663 | ||
| Etiology | 663 | ||
| Pathophysiology | 663 | ||
| Clinical Signs and Symptoms | 663 | ||
| Management | 664 | ||
| Bacterial Meningitis | 664 | ||
| Viral Meningitis | 666 | ||
| Fungal Meningitis | 666 | ||
| Supportive Care | 666 | ||
| Brain Abscess | 666 | ||
| Etiology | 666 | ||
| Pathophysiology | 666 | ||
| Clinical Signs and Symptoms | 666 | ||
| Chapter 12: Fluid, Electrolyte, and Endocrine Problems | 679 | ||
| Pearls | 679 | ||
| Introduction | 679 | ||
| Anatomy and physiology | 679 | ||
| Fluid Compartments | 679 | ||
| ICF Compartment | 679 | ||
| ECF Compartment | 679 | ||
| Fluid Shifts | 680 | ||
| Developmental Considerations | 680 | ||
| Fluid, Electrolyte, and Glucose Balance | 681 | ||
| Role of Osmolality | 681 | ||
| Renal Influences | 681 | ||
| Endocrine Influences | 681 | ||
| Antidiuretic Hormone (ADH, Vasopressin) | 682 | ||
| Aldosterone | 682 | ||
| Natriuretic Peptides | 682 | ||
| Serum Glucose in Critically Ill or Injured Children | 682 | ||
| Electrolyte homeostasis and common imbalances | 682 | ||
| Sodium Homeostasis | 682 | ||
| Sodium Imbalance: Hyponatremia | 682 | ||
| Etiology | 682 | ||
| Pathophysiology and Clinical Signs and Symptoms | 683 | ||
| Management | 683 | ||
| Sodium Imbalances: Hypernatremia | 683 | ||
| Etiology | 683 | ||
| Pathophysiology and Clinical Signs and Symptoms | 686 | ||
| Management | 686 | ||
| Potassium Homeostasis | 686 | ||
| Potassium Imbalances: Hypokalemia | 687 | ||
| Etiology | 687 | ||
| Pathophysiology and Clinical Signs and Symptoms | 687 | ||
| Management | 688 | ||
| Potassium Imbalances: Hyperkalemia | 688 | ||
| Etiology | 688 | ||
| Pathophysiology and Clinical Signs and Symptoms | 688 | ||
| Management | 689 | ||
| Calcium Homeostasis | 690 | ||
| Calcium Imbalances: Hypocalcemia | 690 | ||
| Chapter 13: Renal Disorders | 703 | ||
| Pearls | 703 | ||
| Introduction | 703 | ||
| Essential anatomy and physiology | 703 | ||
| Kidney Structure | 703 | ||
| Gross Anatomy | 703 | ||
| Renal Vasculature | 704 | ||
| Renal Tubules and Collecting Ducts | 704 | ||
| Ureters | 704 | ||
| The Bladder and Urethra | 705 | ||
| Urine Formation | 706 | ||
| Physiologic Processes | 706 | ||
| Glomerular Function | 707 | ||
| Filtration Physiology | 707 | ||
| Glomerular Filtration Rate (GFR) | 708 | ||
| Tubular Function | 709 | ||
| Reabsorption | 709 | ||
| Passive and Active Reabsorption | 709 | ||
| Transport Maximum and Thresholds | 709 | ||
| Secretion | 710 | ||
| Reabsorption and Secretion in the Proximal Tubule | 710 | ||
| Sodium | 710 | ||
| Bicarbonate and Hydrogen Ions | 710 | ||
| Potassium | 711 | ||
| Calcium | 711 | ||
| Urea | 712 | ||
| Drugs | 712 | ||
| The Loop of Henle | 712 | ||
| The Distal Tubule and Collecting Ducts | 713 | ||
| Renin, Aldosterone, and Antidiuretic Hormone | 713 | ||
| Regulation of Acid-Base Balance | 714 | ||
| Buffering Systems | 714 | ||
| The Bicarbonate-Carbonic Acid Buffering System | 714 | ||
| Additional Plasma Buffers | 714 | ||
| Renal Hydrogen Ion Excretion and Bicarbonate Reabsorption | 715 | ||
| Respiratory Buffering | 715 | ||
| Interpretation of Blood Gas Values | 715 | ||
| Evaluation of the pH and PaCO2 | 715 | ||
| The Base Deficit or Excess | 716 | ||
| The Serum Bicarbonate | 716 | ||
| Rules to Assess Effectiveness of Compensation | 716 | ||
| Acidosis | 716 | ||
| Respiratory Acidosis | 716 | ||
| Metabolic Acidosis | 716 | ||
| Alkalosis | 717 | ||
| Respiratory Alkalosis | 717 | ||
| Metabolic Alkalosis | 717 | ||
| Calcium Regulation | 717 | ||
| Renal Regulation of Calcium | 718 | ||
| Gastrointestinal Absorption of Calcium | 718 | ||
| Mobilization of Calcium from Bone | 718 | ||
| Prenatal and Postnatal Development of Renal Function | 718 | ||
| Factors Influencing Body Fluid Composition and Distribution | 718 | ||
| Serum Osmolality | 718 | ||
| Factors Influencing Water Movement Between Body Compartments | 719 | ||
| Changes in Body Fluid Composition and Distribution During Critical Illness | 719 | ||
| Potential Effects of Drugs and Solutions on Renal Function | 719 | ||
| Diuretics | 720 | ||
| Proximal Tubule Diuretics | 720 | ||
| Osmotic Agents | 720 | ||
| Carbonic Anhydrase Inhibitors | 720 | ||
| Metolazone | 720 | ||
| Distal Tubule Diuretics | 720 | ||
| Thiazide Diuretics | 720 | ||
| Potassium-Sparing Diuretics | 721 | ||
| Loop of Henle Diuretics | 721 | ||
| Common clinical conditions | 722 | ||
| Hyponatremia | 722 | ||
| Hypokalemia | 722 | ||
| Hyperkalemia | 722 | ||
| Etiology | 722 | ||
| Pathophysiology | 722 | ||
| Clinical Signs and Symptoms | 722 | ||
| Management | 722 | ||
| Acute Renal Failure and Acute Kidney Injury | 723 | ||
| Etiology | 724 | ||
| Prerenal Failure | 724 | ||
| Postrenal Failure | 724 | ||
| Intrinsic Renal Failure | 724 | ||
| Pathophysiology | 725 | ||
| Clinical Signs and Symptoms | 725 | ||
| Disorders of Fluid Balance | 725 | ||
| Disorders of Electrolyte and Acid-Base Balance | 726 | ||
| Hematologic Complications and Infections | 726 | ||
| Evaluation of Renal Function | 726 | ||
| Management | 727 | ||
| Fluid balance and Renal Perfusion | 727 | ||
| Assessment of Fluid Balance | 727 | ||
| Assessment of Systemic Perfusion | 727 | ||
| Cardiovascular Support | 728 | ||
| Fluid Therapy | 728 | ||
| Electrolyte and Acid-Base Balance | 728 | ||
| Potassium Balance | 728 | ||
| Phosphorus and Calcium Therapy | 729 | ||
| Metabolic Acidosis | 729 | ||
| Glucose | 730 | ||
| Hematologic Complications | 730 | ||
| Infection Control | 730 | ||
| Treatment of Hypertension | 730 | ||
| Nutrition | 731 | ||
| Adjustment of Medication Dosages | 731 | ||
| Psychosocial Aspects | 731 | ||
| Indications for Dialysis | 731 | ||
| Care of the child during dialysis, hemoperfusion, and hemofiltration | 731 | ||
| Dialysis in Children | 731 | ||
| Acute Peritoneal Dialysis | 734 | ||
| Bedside (Percutaneous) Placement of Peritoneal Catheter | 735 | ||
| Surgical Placement of Dialysis Catheter | 736 | ||
| Dialysate Solution | 736 | ||
| Dialysis Exchange | 736 | ||
| Calculation of Fluid Balance | 737 | ||
| Potential Complications | 741 | ||
| Peritonitis | 741 | ||
| Catheter Dysfunction and Obstruction | 741 | ||
| Pain | 741 | ||
| Miscellaneous Complications | 742 | ||
| Pulmonary Complications | 742 | ||
| Fluid or Electrolyte Imbalance | 742 | ||
| Catheter Removal | 742 | ||
| Extended Peritoneal Dialysis: Continuous Ambulatory Peritoneal Dialysis and Continuous Cycling Peritoneal Dialysis | 742 | ||
| Method | 742 | ||
| Continuous Ambulatory Peritoneal Dialysis | 742 | ||
| Continuous Cycling Peritoneal Dialysis | 743 | ||
| Complications | 743 | ||
| Hemodialysis | 743 | ||
| Method | 743 | ||
| Complications | 744 | ||
| Hypotension and Hypovolemia | 744 | ||
| Fluid Shifts and Dysequilibrium | 745 | ||
| Hypervolemia | 745 | ||
| Bleeding and Anemia | 745 | ||
| Infection and Febrile Reactions | 746 | ||
| Hemodialysis Access | 746 | ||
| Continued Problems of Uremia | 746 | ||
| Hemoperfusion | 746 | ||
| Definition | 746 | ||
| Method | 747 | ||
| Complications | 747 | ||
| Continuous Renal Replacement Therapy | 747 | ||
| Definition | 747 | ||
| Indications for Continuous Renal Replacement Therapy | 747 | ||
| Continuous Renal Replacement Therapy Modalities | 748 | ||
| Continuous Arteriovenous Hemofiltration | 748 | ||
| Definition | 748 | ||
| Contraindications | 748 | ||
| Method | 748 | ||
| Preparation for Continuous Arteriovenous Hemofiltration | 748 | ||
| Initiation of Continuous Arteriovenous Hemofiltration | 749 | ||
| Complications | 750 | ||
| Continuous Venovenous Hemofiltration Modalities | 750 | ||
| Pediatric Considerations | 750 | ||
| Contraindications and Indications | 751 | ||
| Method | 752 | ||
| Preparation for Venovenous Continuous Renal Replacement Therapy | 752 | ||
| Initiation of Venovenous Continuous Renal Replacement Therapy | 753 | ||
| Complications | 754 | ||
| Specific diseases | 754 | ||
| Nephrotic Syndrome | 754 | ||
| Etiology | 754 | ||
| Primary Nephrotic Syndrome | 755 | ||
| Secondary Nephrotic Syndrome | 755 | ||
| Congenital Nephrotic Syndrome | 755 | ||
| Pathophysiology | 755 | ||
| Common Elements | 756 | ||
| Clinical Signs and Symptoms | 757 | ||
| Management | 757 | ||
| Acute Glomerulonephritis | 759 | ||
| Etiology | 759 | ||
| Pathophysiology | 759 | ||
| Clinical Signs and Symptoms | 759 | ||
| Management | 759 | ||
| Systemic Lupus Erythematosus: Renal Involvement | 760 | ||
| Henoch-Schonlein Purpura | 760 | ||
| Hemolytic-Uremic Syndrome | 761 | ||
| Etiology | 761 | ||
| Pathophysiology | 761 | ||
| Clinical Signs and Symptoms | 761 | ||
| Management | 762 | ||
| Chronic Kidney Disease | 762 | ||
| Etiology | 762 | ||
| Pathophysiology | 762 | ||
| Uremia | 763 | ||
| Sodium and Water Balance | 763 | ||
| Potassium Balance | 763 | ||
| Acidosis | 763 | ||
| Calcium, Phosphate, and Bone | 763 | ||
| Anemia | 763 | ||
| Uremic Encephalopathy and Neuropathy | 763 | ||
| Clinical Signs and Symptoms | 764 | ||
| Management | 764 | ||
| Renal (Kidney) Transplantation | 765 | ||
| Indications | 765 | ||
| Preparation for Transplantation | 765 | ||
| Posttransplant Care | 767 | ||
| Fluid Therapy | 767 | ||
| Infection | 768 | ||
| Potential Causes of Renal Failure | 768 | ||
| Renal Vascular Complications | 768 | ||
| Rejection | 768 | ||
| Late Complications | 768 | ||
| Diagnostic studies | 769 | ||
| References | 770 | ||
| Chapter 14: Gastrointestinal and Nutritional Disorders | 773 | ||
| Pearls | 773 | ||
| Introduction | 773 | ||
| Essential anatomy and physiology | 773 | ||
| Mouth | 773 | ||
| Esophagus | 773 | ||
| Stomach | 773 | ||
| Gastric Emptying | 774 | ||
| Vascular Supply | 774 | ||
| Small Intestine | 774 | ||
| Duodenum | 775 | ||
| Jejunum | 775 | ||
| Ileum | 775 | ||
| Large Intestine | 775 | ||
| Liver | 776 | ||
| Gallbladder | 777 | ||
| Pancreas | 777 | ||
| Nutrition | 777 | ||
| Recommended Daily Nutritional Intake | 777 | ||
| Macronutrient Metabolism and Requirements | 777 | ||
| Carbohydrates | 777 | ||
| Fats | 778 | ||
| Protein | 778 | ||
| Enteral Nutrition | 778 | ||
| Parenteral Nutrition (PN) | 779 | ||
| Indications for Parenteral Nutrition | 779 | ||
| Parenteral Nutrition Solutions | 781 | ||
| Nursing Responsibilities | 781 | ||
| Common clinical conditions | 783 | ||
| Intestinal Failure | 783 | ||
| Etiology | 783 | ||
| Pathophysiology | 783 | ||
| Management | 783 | ||
| Gastrointestinal Bleeding | 786 | ||
| Etiology and Pathophysiology | 786 | ||
| Clinical Signs and Symptoms | 786 | ||
| Management | 787 | ||
| Hyperbilirubinemia | 788 | ||
| Etiology | 788 | ||
| Pathophysiology | 790 | ||
| Management | 792 | ||
| Portal Hypertension | 793 | ||
| Etiology | 793 | ||
| Pathophysiology | 793 | ||
| Clinical Signs and Symptoms | 793 | ||
| Management | 794 | ||
| Ascites | 795 | ||
| Etiology | 795 | ||
| Pathophysiology | 795 | ||
| Clinical Signs and Symptoms | 796 | ||
| Management | 797 | ||
| Bowel Obstruction | 797 | ||
| Etiology | 797 | ||
| Clinical Signs and Symptoms | 797 | ||
| Management | 798 | ||
| Care of the child after abdominal surgery | 798 | ||
| Fluid Balance | 798 | ||
| Postoperative Ileus | 798 | ||
| Infection | 799 | ||
| Management | 799 | ||
| Specific diseases | 800 | ||
| Congenital Gastrointestinal Abnormalities | 800 | ||
| Necrotizing Enterocolitis | 800 | ||
| Etiology | 800 | ||
| Pathophysiology | 803 | ||
| Clinical Signs and Symptoms | 804 | ||
| Management | 804 | ||
| Biliary Atresia | 805 | ||
| Chapter 15: Hematologic and Oncologic Emergencies Requiring Critical Care | 825 | ||
| Pearls | 825 | ||
| Essential anatomy and physiology | 825 | ||
| Blood Components | 825 | ||
| Clotting Cascade | 826 | ||
| The Spleen | 827 | ||
| Common clinical conditions | 827 | ||
| Acute Anemia | 827 | ||
| Etiology | 827 | ||
| Pathophysiology | 827 | ||
| Blood Loss | 827 | ||
| Decreased RBC Production | 828 | ||
| Increased RBC Destruction | 828 | ||
| Clinical Signs and Symptoms | 828 | ||
| Management | 828 | ||
| Thrombocytopenia | 829 | ||
| Etiology and Pathophysiology | 829 | ||
| Clinical Signs and Symptoms | 829 | ||
| Management | 830 | ||
| Disseminated Intravascular Coagulation | 830 | ||
| Etiology | 830 | ||
| Pathophysiology and Clinical Signs and Symptoms | 830 | ||
| Management | 831 | ||
| Hyperleukocytosis | 831 | ||
| Etiology | 831 | ||
| Chapter 16: Immunology and Infectious Disorders | 851 | ||
| Pearls | 851 | ||
| Anatomy and physiology: immunology | 851 | ||
| Immunology Overview | 851 | ||
| Developmental Considerations | 851 | ||
| Infectious Disease Overview | 851 | ||
| Colonization and Infection | 851 | ||
| Common clinical conditions | 852 | ||
| Immunodeficiency Versus Immunosuppression | 852 | ||
| Allergic Reactions and Anaphylaxis | 852 | ||
| Etiology | 852 | ||
| Pathophysiology | 852 | ||
| Clinical Signs and Symptoms | 852 | ||
| Management | 853 | ||
| Systemic Inflammatory Response Syndrome (SIRS) | 853 | ||
| Etiology | 853 | ||
| Pathophysiology | 853 | ||
| Clinical Signs and Symptoms | 855 | ||
| Chapter 17: Overview of Solid Organ Transplantation | 869 | ||
| History | 869 | ||
| History of Solid Organ Transplantation | 869 | ||
| Evolution of Immunosuppression | 869 | ||
| Pediatric heart transplantation | 869 | ||
| Overview | 869 | ||
| Immediate Postoperative Care | 871 | ||
| Pulmonary Hypertension and Right Ventricular Failure | 872 | ||
| Acute Allograft Dysfunction | 872 | ||
| Arrhythmias | 872 | ||
| Vasodilatory Hypotension | 872 | ||
| Renal Dysfunction and Hypertension | 872 | ||
| Posttransplant Immunosuppression | 873 | ||
| Rejection | 873 | ||
| Summary | 873 | ||
| Pediatric liver transplantation | 873 | ||
| Immediate Postoperative Care | 873 | ||
| Posttransplant Immunosuppression | 874 | ||
| Complications of Liver Transplantation | 874 | ||
| Hepatic Artery and Portal Vein Thrombosis | 874 | ||
| Biliary Complications | 875 | ||
| Infection | 875 | ||
| Nephrotoxicity | 875 | ||
| Central Nervous System Toxicity | 875 | ||
| Lymphoproliferative Disorders | 875 | ||
| Psychosocial Stress | 875 | ||
| Pediatric kidney transplantation | 875 | ||
| History | 875 | ||
| Immediate Postoperative Care | 876 | ||
| Posttransplant Immunosuppression | 876 | ||
| Complications of Kidney Transplantation | 877 | ||
| Surgical Complications | 877 | ||
| Lymphocele | 877 | ||
| Wound Infection | 877 | ||
| Thrombosis | 877 | ||
| Renal Artery Stenosis | 877 | ||
| Urologic Complications | 877 | ||
| Obstruction | 877 | ||
| Urine Leak | 877 | ||
| Summary | 878 | ||
| References | 878 | ||
| Chapter 18: Toxicology and Poisonings | 879 | ||
| Pearls | 879 | ||
| Scope of the problem | 879 | ||
| General approach to the poisoned patient | 880 | ||
| Gastrointestinal Decontamination | 881 | ||
| Activated Charcoal | 881 | ||
| Gastric Lavage | 881 | ||
| Antidotes | 881 | ||
| Management of specific poisonings | 882 | ||
| Cocaine | 882 | ||
| Epidemiology, Pathophysiology, and Clinical Manifestations | 882 | ||
| Management | 883 | ||
| General Care | 883 | ||
| Treatment of ACS | 884 | ||
| Treatment of Hyperthermia | 884 | ||
| Treatment of Seizures | 884 | ||
| Calcium Channel Blocker Toxicity | 884 | ||
| Epidemiology, Pathophysiology, and Clinical Manifestations | 884 | ||
| Management | 885 | ||
| General Care | 885 | ||
| Treatment of Cardiac Arrest | 886 | ||
| β-Adrenergic Blocker Toxicity | 886 | ||
| Epidemiology, Pathophysiology, and Clinical Manifestations | 886 | ||
| Management | 886 | ||
| General Care | 886 | ||
| Nonpharmacologic Therapies | 887 | ||
| Opioid Toxicity | 887 | ||
| Epidemiology, Pathophysiology, and Clinical Manifestations | 887 | ||
| Management | 888 | ||
| General Care | 888 | ||
| TCAs and Other Sodium Channel Blocking Agents | 889 | ||
| Epidemiology, Pathophysiology, and Clinical Manifestations | 889 | ||
| Management | 889 | ||
| General Care | 889 | ||
| Treatment of Hypotension | 890 | ||
| Treatment of Seizures | 890 | ||
| Advanced concepts | 890 | ||
| References | 891 | ||
| Chapter 19: Pediatric Trauma | 895 | ||
| Pearls | 895 | ||
| Introduction | 895 | ||
| Epidemiology and incidence of pediatric trauma | 895 | ||
| Frequency of Injuries | 895 | ||
| Intentional (Inflicted) Versus Unintentional Injuries | 895 | ||
| Role of Nurses and Healthcare Providers in Injury Prevention | 895 | ||
| Physiologic differences affecting manifestation and treatment of injuries | 895 | ||
| Airway and Ventilation | 895 | ||
| Larynx and Advanced Airways | 895 | ||
| Chest Wall | 896 | ||
| Respiratory Muscles | 896 | ||
| Cardiovascular Function and Circulating Blood Volume | 896 | ||
| Cardiac Output and Heart Rate | 896 | ||
| Circulating Blood Volume | 896 | ||
| Neurologic Function | 897 | ||
| Neurologic Assessment | 897 | ||
| Spinal Cord Injury | 897 | ||
| Thermoregulation | 897 | ||
| Fluid Administration | 897 | ||
| Rate | 897 | ||
| Vascular Access | 897 | ||
| Initial stabilization of the pediatric trauma patient | 898 | ||
| Field Triage and Scoring | 898 | ||
| Management of the pediatric trauma victim in the emergency department | 899 | ||
| Team Approach to Management | 899 | ||
| Emergency Department Stabilization and Transfer | 899 | ||
| Initial survey, resuscitation, and stabilization | 899 | ||
| Airway | 900 | ||
| Positioning, Jaw Thrust | 900 | ||
| Suctioning | 900 | ||
| Airway Obstruction | 900 | ||
| Spine Stabilization | 900 | ||
| Airway Management | 901 | ||
| Intubation | 901 | ||
| Cricothyrotomy and Tracheostomy | 902 | ||
| Ongoing Airway Assessment | 903 | ||
| Breathing | 903 | ||
| Oxygen Administration | 903 | ||
| Assessment of Ventilation and Oxygenation | 903 | ||
| Life-Threatening Thoracic Injuries | 903 | ||
| Pneumothorax | 903 | ||
| Tension Pneumothorax | 904 | ||
| Sucking Chest Wounds | 904 | ||
| Hemothorax | 905 | ||
| Cardiac Tamponade | 905 | ||
| Flail Chest | 905 | ||
| Diaphragm Rupture | 905 | ||
| Pulmonary Contusion | 905 | ||
| Circulation | 906 | ||
| Recognition of Hypovolemia | 906 | ||
| Control of External Bleeding | 907 | ||
| Vascular Access | 907 | ||
| Management of Shock | 908 | ||
| Treatment of Hypovolemia | 908 | ||
| Disability: Neurologic Function | 908 | ||
| Exposure | 909 | ||
| Secondary Survey: \"head-to-toe\" assessment | 909 | ||
| Head | 909 | ||
| Neck and Spine | 911 | ||
| Chest | 912 | ||
| Abdomen | 913 | ||
| Genitourinary Trauma | 915 | ||
| Extremities | 916 | ||
| Compartment Syndrome | 916 | ||
| Skin | 916 | ||
| History | 917 | ||
| Intentional injuries/inflicted trauma | 917 | ||
| Definition and Epidemiology | 917 | ||
| History of Injuries Suggesting Intentional Injuries (Inflicted Trauma) | 917 | ||
| Characteristics of Injuries Suggestive of Intentional Injury | 917 | ||
| Responsibilities of the Healthcare Team | 918 | ||
| Transition from the pediatric critical care unit after injuries | 918 | ||
| Long-term follow-up | 918 | ||
| References | 919 | ||
| Chapter 20: Care of the Child with Burns | 921 | ||
| Pearls | 921 | ||
| Introduction | 921 | ||
| Essential anatomy and physiology | 921 | ||
| Functions of the Skin | 921 | ||
| Severity and Classification of Injury | 922 | ||
| Depth of Burn | 922 | ||
| Extent of Injury | 923 | ||
| Factors Influencing Severity of Burn | 923 | ||
| Classification of Burns | 924 | ||
| Pathophysiology of a Burn | 924 | ||
| Local Circulatory Destruction | 924 | ||
| Capillary Permeability (Third-Spacing) Period | 924 | ||
| Capillary Healing Period: Fluid Remobilization (or Diuresis) | 926 | ||
| Cardiovascular Dysfunction | 926 | ||
| Pulmonary Injuries | 927 | ||
| Carbon Monoxide Poisoning | 927 | ||
| Gastrointestinal Dysfunction | 927 | ||
| Metabolic Changes | 927 | ||
| Compromise in Immune Function | 928 | ||
| Common clinical conditions | 928 | ||
| Inadequate Intravascular Volume and Cardiac Output: Third-Spacing Phase | 928 | ||
| Etiology and Pathophysiology | 928 | ||
| Clinical Signs and Symptoms | 928 | ||
| Management | 928 | ||
| Initiation of Therapy | 928 | ||
| Intravenous Access and Monitoring | 931 | ||
| Determination of Fluid Requirements | 932 | ||
| Selection of Fluid Content | 932 | ||
| Routine Care | 934 | ||
| Evaluation of Therapy | 935 | ||
| Hypervolemia: Fluid Mobilization Phase | 935 | ||
| Etiology and Pathophysiology | 935 | ||
| Clinical Signs and Symptoms | 935 | ||
| Management | 935 | ||
| Fluid and Electrolyte Therapy | 935 | ||
| Routine Care | 936 | ||
| Evaluation of Therapy | 936 | ||
| Respiratory Failure | 936 | ||
| Etiology | 936 | ||
| Pathophysiology | 936 | ||
| Clinical Signs and Symptoms | 937 | ||
| Airway Obstruction | 937 | ||
| Acute Respiratory Distress Syndrome | 937 | ||
| Carbon Monoxide Poisoning | 937 | ||
| Management | 938 | ||
| Airway Obstruction | 938 | ||
| Acute Respiratory Distress Syndrome | 938 | ||
| Carbon Monoxide Poisoning | 939 | ||
| Evaluation of Therapy | 939 | ||
| Pain | 939 | ||
| Etiology and Pathophysiology | 939 | ||
| Clinical Signs and Symptoms | 939 | ||
| Management | 939 | ||
| Potential Infection, Sepsis, and Septic Shock | 940 | ||
| Etiology | 940 | ||
| Pathophysiology | 940 | ||
| Normal Inflammatory Response | 940 | ||
| Effects of Thermal Injury | 940 | ||
| Clinical Signs and Symptoms | 941 | ||
| General Findings | 941 | ||
| Gram-Positive Infections and Sepsis | 941 | ||
| Gram-Negative Infections and Sepsis | 942 | ||
| Fungal Infections and Sepsis | 942 | ||
| Management | 942 | ||
| Prevention | 942 | ||
| Care of an Infected Wound | 942 | ||
| Treatment of Sepsis | 942 | ||
| Evaluation of Therapy | 942 | ||
| Nutritional Compromise | 943 | ||
| Etiology | 943 | ||
| Pathophysiology | 943 | ||
| Metabolic Rate and Oxygen Consumption | 943 | ||
| Glucose and Fat Metabolism | 943 | ||
| Negative Nitrogen Balance | 943 | ||
| Clinical Signs and Symptoms | 943 | ||
| Physical Assessment of Nutritional Status | 943 | ||
| Laboratory Evaluation of Nutritional Status | 944 | ||
| Protein Levels | 944 | ||
| Nitrogen Balance | 944 | ||
| Creatinine Height Index | 944 | ||
| Calorie Count | 944 | ||
| Determining Nutritional Requirements | 944 | ||
| Additional Nutritional Requirements | 945 | ||
| Indirect Calorimetry | 945 | ||
| Management | 945 | ||
| Oral Feeding | 945 | ||
| Tube or Enteral Feeding | 946 | ||
| Parenteral Feeding | 946 | ||
| Temperature Instability | 947 | ||
| Chapter 21: Bioinstrumentation... | 961 | ||
| Pearls | 961 | ||
| Overview of pediatric bioinstrumentation | 961 | ||
| Characteristics of Children that Affect Bioinstrumentation | 961 | ||
| Body Size | 961 | ||
| Cardiovascular Structure and Function | 961 | ||
| Pulmonary Anatomy and Physiology | 962 | ||
| Neurologic Development and Function | 962 | ||
| Metabolic Rate | 962 | ||
| Fluid Requirements | 962 | ||
| Immunologic Immaturity | 963 | ||
| General Problems During Monitoring | 963 | ||
| Instrument Theory and Safety | 963 | ||
| Definition of Terms | 963 | ||
| Current | 963 | ||
| Voltage | 963 | ||
| Resistance | 964 | ||
| Power | 964 | ||
| Application of Terms | 964 | ||
| Electrical Hazards in the Pediatric Critical Care Unit | 965 | ||
| The Electrically Sensitive Patient | 965 | ||
| Macroshock | 965 | ||
| Microshock | 965 | ||
| Current Leak | 965 | ||
| Grounding | 965 | ||
| Electrical Safety | 966 | ||
| Cardiovascular monitoring and support | 968 | ||
| Cardiovascular Monitoring | 968 | ||
| Electrocardiogram | 968 | ||
| Electrodes | 968 | ||
| ECG Electrode Placement | 968 | ||
| Telemetry | 969 | ||
| ECG Monitoring System Components | 970 | ||
| Filtering Units | 970 | ||
| Gain Units | 970 | ||
| Alarms | 970 | ||
| Display and Recording Units | 970 | ||
| Digital Meter | 971 | ||
| Trace Speed | 971 | ||
| Paper Recorders | 971 | ||
| Guidelines for Recording a Rhythm Strip | 971 | ||
| Troubleshooting Sources of Error | 972 | ||
| Mechanical Noise | 972 | ||
| Electrical Noise | 972 | ||
| Biologic Variations | 972 | ||
| Movement Artifact | 972 | ||
| Vascular Pressure Monitoring | 972 | ||
| Transducer Systems | 972 | ||
| Components of a Fluid-Filled Vascular Monitoring System | 973 | ||
| Monitor and Transducer | 973 | ||
| Continuous Infusion Systems | 973 | ||
| Pediatric Monitoring Systems | 973 | ||
| Intermittent Monitoring Systems | 973 | ||
| Zeroing and Calibration | 974 | ||
| Zeroing and Leveling of Transducer | 974 | ||
| Transducer Calibration | 975 | ||
| Monitor Calibration | 975 | ||
| Noninvasive Blood Pressure Monitoring | 975 | ||
| Arterial Pressure Monitoring | 976 | ||
| Indications | 976 | ||
| Risks | 976 | ||
| Common Insertion Sites | 976 | ||
| Continuous Infusion Systems | 976 | ||
| Pressure Bag | 976 | ||
| Infusion Pump | 976 | ||
| IV Tubing | 976 | ||
| Heparin | 976 | ||
| Papaverine | 977 | ||
| Blood Sampling | 977 | ||
| Two Stopcock Method | 977 | ||
| Closed Blood Draw Systems | 977 | ||
| Waveform Characteristics | 977 | ||
| Zeroing | 977 | ||
| Nursing Considerations | 979 | ||
| Central Venous Pressure (CVP) Monitoring | 981 | ||
| Indications | 981 | ||
| Insertion and Measurement | 981 | ||
| Blood Sampling | 982 | ||
| Pulmonary Artery Pressure Monitoring | 982 | ||
| Indications | 982 | ||
| Insertion | 982 | ||
| Maintenance | 982 | ||
| Measurements with PA Catheter | 984 | ||
| Right Atrial Pressure | 984 | ||
| Pulmonary Artery Pressure | 984 | ||
| Complications of PA Catheterization | 985 | ||
| Infections | 985 | ||
| Arrhythmias | 985 | ||
| Knotting of the Catheter | 985 | ||
| Pulmonary Infarction | 985 | ||
| Pulmonary Artery Rupture | 985 | ||
| Pulmonary Embolism | 986 | ||
| Intracardiac Catheters | 986 | ||
| Left Atrial Catheter | 986 | ||
| Right Atrial Catheter | 986 | ||
| Pulmonary Artery Catheter | 986 | ||
| Central Venous Catheter Care | 987 | ||
| Evaluation of Cardiac Output and Tissue Perfusion | 987 | ||
| Fick and Thermodilution Cardiac Output Calculation | 987 | ||
| Pulse Contour Cardiac Output Calculation | 987 | ||
| Ultrasound Dilution Cardiac Output Calculations | 988 | ||
| Noninvasive Calculation of Cardiac Output | 988 | ||
| Systemic Venous Oxygen Saturation (SCVO2) Monitoring | 989 | ||
| Continuous Central Venous Oximetry | 989 | ||
| Near-Infrared Spectroscopy (NIRS) | 989 | ||
| Temporary Pacemakers | 989 | ||
| Function and Nomenclature | 989 | ||
| Pacemaker Unit and Leads | 990 | ||
| Pacing Options | 990 | ||
| Single Chamber Temporary Pacing (VVI or AAI Modes) | 990 | ||
| Atrioventricular Sequential Pacing (DDD Mode) | 990 | ||
| Temporary Demand Pacemaker Controls and Indicators | 990 | ||
| Sensitivity Control and Threshold | 990 | ||
| Output Threshold and Control | 990 | ||
| Rate Control | 992 | ||
| Pulse Width | 992 | ||
| A-V Interval | 992 | ||
| Visual Indicators | 992 | ||
| Sense-Pace Indicator | 992 | ||
| Batteries | 992 | ||
| Ventricular Safety Pacing | 992 | ||
| Complications | 992 | ||
| Complications During Pacemaker Therapy | 992 | ||
| Arrhythmias | 992 | ||
| Electrical Hazards | 992 | ||
| Complications of Lead Insertion | 993 | ||
| Transvenous Lead Placement | 993 | ||
| Epicardial Lead Placement | 993 | ||
| Emergency Pacing | 993 | ||
| Emergency Invasive Pacing | 993 | ||
| Transcutaneous Cardiac Pacing | 994 | ||
| Defibrillation During Temporary Pacing | 994 | ||
| Nursing Considerations | 994 | ||
| ECG and Pulse Monitoring | 994 | ||
| Pacemaker Settings and Documentation | 994 | ||
| Defibrillation and Cardioversion | 994 | ||
| Defibrillation | 994 | ||
| Pads and Paddles | 997 | ||
| Factors Determining Effectiveness of Attempted Defibrillation | 997 | ||
| Electrodes | 997 | ||
| Conductive Gel | 997 | ||
| Chest (Transthoracic) Impedance | 997 | ||
| Integration of CPR with Shock Delivery and Optimal Defibrillation | 997 | ||
| Synchronized Cardioversion | 998 | ||
| Circulatory Assist Devices | 998 | ||
| Ventricular Assist Device (VAD) | 998 | ||
| Physiologic Effects of VAD Support | 999 | ||
| Clinical Applications | 999 | ||
| Potential Complications | 1000 | ||
| Nursing Considerations | 1000 | ||
| The Intraaortic Balloon Pump (IABP) | 1001 | ||
| Physiologic Effects of IABP Counterpulsation | 1001 | ||
| Pediatric Considerations | 1001 | ||
| Potential Complications | 1001 | ||
| Nursing Considerations | 1002 | ||
| Extracorporeal Membrane Oxygenation | 1002 | ||
| Physiologic Effects of ECMO Therapy | 1003 | ||
| Clinical Applications | 1003 | ||
| Nursing Considerations | 1004 | ||
| Complications | 1004 | ||
| Chest Tubes and Chest Tube Drainage Systems | 1004 | ||
| Principles of Chest Tube Drainage | 1005 | ||
| Chest Drainage Equipment and Nursing Management | 1005 | ||
| Placement of the Chest Tube | 1005 | ||
| Preparation and Use of the Chest Drainage System | 1005 | ||
| Chest Tube Removal | 1006 | ||
| Respiratory monitoring and support | 1007 | ||
| Respiratory Monitoring Devices | 1007 | ||
| Impedance Pneumography | 1007 | ||
| Spirometry | 1007 | ||
| Noninvasive Transcutaneous Blood Gas Monitoring | 1007 | ||
| Instrumentation | 1008 | ||
| Transcutaneous Oxygen Monitoring | 1008 | ||
| Transcutaneous Carbon Dioxide Monitoring | 1008 | ||
| Clinical Applications | 1008 | ||
| Nursing Considerations | 1008 | ||
| Noninvasive Blood Gas Monitoring: Pulse Oximetry | 1009 | ||
| Mode of Operation | 1009 | ||
| Troubleshooting During Pulse Oximetry | 1009 | ||
| Noninvasive Capnometry: End-Tidal Carbon Dioxide Monitoring (PETCO2) | 1009 | ||
| Instrumentation | 1009 | ||
| Clinical Applications of Capnography | 1010 | ||
| Relationship Between Arterial and End-Tidal CO2 Tension | 1010 | ||
| Analysis of Capnograph | 1010 | ||
| Evaluation of Changes in PETCO2. | 1010 | ||
| Nursing Considerations | 1011 | ||
| Invasive Arterial Oximetry | 1011 | ||
| Clinical Applications | 1011 | ||
| Invasive Mixed Venous Oxygen Saturation Monitoring | 1011 | ||
| Description | 1012 | ||
| Operation | 1012 | ||
| Clinical Applications | 1013 | ||
| Disadvantages | 1013 | ||
| Esophageal Pressure Monitoring | 1013 | ||
| Instrumentation | 1013 | ||
| Clinical Applications | 1014 | ||
| Nursing Considerations | 1014 | ||
| Oxygen Administration Systems | 1014 | ||
| Nursing Considerations | 1015 | ||
| Mechanical Ventilation | 1017 | ||
| Negative Pressure Ventilation | 1017 | ||
| Chapter 22: Fundamentals of Patient Safety and Quality Improvement | 1043 | ||
| Pearls | 1043 | ||
| Overview of patient safety and healthcare quality improvement | 1043 | ||
| Institute of Medicine Reports: The Case for Improving Healthcare Safety and Quality | 1043 | ||
| Human Error | 1045 | ||
| High Reliability Organizations | 1045 | ||
| Culture of Safety | 1046 | ||
| Crew Resource Management | 1046 | ||
| Healthcare improvement methodology | 1047 | ||
| Model for Improvement | 1047 | ||
| Performance Measurement | 1048 | ||
| Failure Mode and Effects Analysis | 1049 | ||
| Incident Reporting | 1049 | ||
| Root Cause Analysis | 1050 | ||
| Opportunities for improvement in pediatric critical care | 1051 | ||
| Environment of Care | 1051 | ||
| Failure to Rescue | 1051 | ||
| Role for Information Technology | 1051 | ||
| Common Pediatric Critical Care Unit Improvement Opportunities | 1053 | ||
| Pediatric Medication Errors and Adverse Drug Events | 1053 | ||
| Healthcare-Acquired Infections | 1054 | ||
| Preventing Central Line-Associated Blood Stream Infections | 1054 | ||
| Ventilator-Associated Pneumonia | 1054 | ||
| Conclusion | 1055 | ||
| References | 1056 | ||
| Chapter 23: Clinical Informatics | 1059 | ||
| Pearls | 1059 | ||
| Introduction | 1059 | ||
| Implemention of clinical information systems | 1060 | ||
| People, Process, and Technology | 1060 | ||
| Best Practices | 1061 | ||
| Executive Commitment | 1062 | ||
| Identified Project Leaders | 1062 | ||
| Road Map | 1062 | ||
| Process Redesign | 1062 | ||
| Communication Strategy | 1062 | ||
| Simulation and Pilot Testing | 1062 | ||
| Training and Support | 1062 | ||
| Feedback | 1062 | ||
| Clinical information systems | 1063 | ||
| Computerized Provider Order Entry | 1063 | ||
| Clinical Decision Support | 1063 | ||
| Order Sets | 1063 | ||
| Alerts and Cross-Checks | 1063 | ||
| Pediatric medication safety | 1065 | ||
| Pediatric Medication Dosing | 1065 | ||
| Pediatric Patient Specific Decision Support | 1066 | ||
| The Five Rights of Medication Administration | 1066 | ||
| Bar-Coded Medication Administration | 1066 | ||
| Electronic clinical documentation | 1069 | ||
| Summary | 1070 | ||
| References | 1070 | ||
| Internet Resources | 1070 | ||
| Chapter 24: Ethical Issues in Pediatric Critical Care | 1071 | ||
| Pearls | 1071 | ||
| Defining medical ethics | 1071 | ||
| Sources of Moral Guidance | 1071 | ||
| Clinical Ethics and the Law | 1072 | ||
| Clinical ethics as an aid to nursing care | 1072 | ||
| Creating an environment that supports ethical practice | 1072 | ||
| How are ethical issues in pediatrics different? | 1073 | ||
| Children Are Different | 1073 | ||
| The Family Is the Patient | 1074 | ||
| Medical decision making | 1075 | ||
| Consent or Permission from Parents or Guardians | 1075 | ||
| Assent and Self-determination | 1075 | ||
| Age of Consent: The Mature Minor in Law | 1077 | ||
| Advance Directives and Substituted Judgment | 1077 | ||
| Exceptions to parents as decision makers | 1077 | ||
| Informed Refusal of Care | 1078 | ||
| Child's Refusal of Care | 1078 | ||
| Baby Doe Rules | 1078 | ||
| Inappropriate Care Requests | 1079 | ||
| Ethics of communication | 1079 | ||
| Truth-Telling | 1079 | ||
| Confidentiality | 1080 | ||
| Breaking Bad News | 1081 | ||
| Withholding and withdrawing therapy | 1081 | ||
| The Do-Not-Attempt-Resuscitation (DNAR) Order | 1082 | ||
| Withdrawal of Medically Provided Nutrition and Hydration | 1083 | ||
| There is a cost of caring | 1084 | ||
| References | 1084 | ||
| Appendices | 1087 | ||
| Appendix A: Continuous Infusion Dose Charts (“Drip Charts”) | 1088 | ||
| Appendix B: Conversion Factors to Syste`me International (SI) Units | 1097 | ||
| Appendix C: Pediatric Weight Conversions | 1101 | ||
| Appendix D: Conversion of Fahrenheit Temperatures to Celsius | 1103 | ||
| Index | 1105 | ||
| Brief Table of Contents | 1142 |