Additional Information
Book Details
Abstract
Praised for its comprehensive coverage and clear organization, Critical Care Nursing: Diagnosis and Management, 7th Edition is the go-to critical care nursing text for both practicing nurses and nursing students preparing for clinicals. Nine sections highlight the alterations seen in critical care and make it easy to understand the unique challenges of critical care nursing. An abundance of learning tools such as Patient Safety Alerts, Evidence-Based Practice boxes, NIC interventions, case studies, Pharmacologic Management boxes, and more give you a better understanding of clinical practice and help you reference vital information quickly and easily.
- Consistent organization within each body-system unit allows you to use this book as a one-stop resource for your critical care nursing education, as well as a reference for the relevant assessment techniques, lab values, and patient management principles needed by practicing nurses.
- Evidence-Based Practice boxes reinforce practice guidelines for both collaborative and nursing care.
- Case studies in each chapter help you internalize and apply chapter content to clinical situations.
- Pharmacologic Management tables offer quick summaries of the drugs most often used in critical care.
- Patient Safety Alerts provide key information for special safety issues to keep safety in the forefront of your mind.
- Nursing Management Plans of Care appendix provides detailed, clinically-relevant care plans tied to 35 different NANDA nursing diagnoses.
- Highlighted QSEN content makes it easy to identify QSEN competencies as they relate to critical care nursing.
- Internet Resources box provides a list of key websites from leading organizations in critical care.
- Combined chapter on shock, sepsis and multiple organ dysfunction syndrome makes understanding similar physiologic processes easier.
- Chapter summaries provide quick study guides by organizing key information in the chapter.
- New! 6-second, standard ECG strips help you learn to identify wave forms and accurately reflect what you’ll use in practice.
- New equipment information and photos accurately depicts what you’ll encounter in a modern critical care unit.
Table of Contents
| Section Title | Page | Action | Price |
|---|---|---|---|
| Front Cover | cover | ||
| Inside Front Cover | ifc1 | ||
| Half title page | i | ||
| Evolve page | ii | ||
| Critical Care Nursing, 7/e | iii | ||
| Copyright Page | iv | ||
| Dedication | v | ||
| About the Authors | vii | ||
| Linda D. Urden, DNSc, RN, CNS, NE-BC, FAAN | vii | ||
| Kathleen M. Stacy, PhD, RN, CNS, CCRN, PCCN, CCNS | vii | ||
| Mary E. Lough, PhD, RN, CNS, CCRN, CNRN, CCNS | vii | ||
| Contributors | ix | ||
| Reviewers | xii | ||
| Preface | xiii | ||
| Organization | xiii | ||
| Nursing Diagnosis and Management | xiii | ||
| New to This Edition | xiv | ||
| Special Features | xiv | ||
| Evolve Resources for Critical Care Nursing | xiv | ||
| Student Resources | xiv | ||
| Instructor Resources | xiv | ||
| Acknowledgments | xvii | ||
| Table Of Contents | xix | ||
| Unit 1 Foundations of Critical Care Nursing | 1 | ||
| 1 Critical Care Nursing Practice | 1 | ||
| Overview | 1 | ||
| History of Critical Care | 1 | ||
| Critical Care Nursing | 1 | ||
| Contemporary Critical Care | 2 | ||
| Critical Care Nursing Roles | 2 | ||
| Expanded-Role Nursing Positions | 2 | ||
| Advanced Practice Nurses | 2 | ||
| Critical Care Professional Accountability | 3 | ||
| Critical Care Nursing Standards | 3 | ||
| Evidence-Based Nursing Practice | 3 | ||
| Holistic Critical Care Nursing | 4 | ||
| Caring | 4 | ||
| Individualized Care | 4 | ||
| Cultural Care | 4 | ||
| Complementary and Alternative Therapies | 7 | ||
| Spirituality and Prayer | 7 | ||
| Guided Imagery | 7 | ||
| Massage | 7 | ||
| Animal-Assisted Therapy | 7 | ||
| Nursing’s Unique Role in Health Care | 7 | ||
| Critical Care Nursing Practice | 7 | ||
| The Nursing Process | 8 | ||
| Nursing Diagnosis | 8 | ||
| Nursing Interventions | 8 | ||
| Outcomes Evaluation | 8 | ||
| Technology in Critical Care | 8 | ||
| Interprofessional Collaborative Practice | 9 | ||
| Interdisciplinary Care Management Models and Tools | 10 | ||
| Care Management | 10 | ||
| Case Management | 10 | ||
| Care Management Tools | 10 | ||
| Algorithm | 10 | ||
| Practice Guideline | 10 | ||
| Protocol | 11 | ||
| Order Set | 11 | ||
| Managing and Tracking Variances | 11 | ||
| Quality, Safety, and Regulatory Issues in Critical Care | 11 | ||
| Quality and Safety Issues | 11 | ||
| Quality and Safety Regulations | 12 | ||
| Quality and Safety Resources | 12 | ||
| Privacy and Confidentiality | 13 | ||
| Healthy Work Environment | 13 | ||
| Summary | 14 | ||
| References | 14 | ||
| 2 Ethical Issues | 17 | ||
| Differences between Morals and Ethics | 17 | ||
| Moral Distress | 17 | ||
| Moral Courage | 20 | ||
| Ethical Principles | 20 | ||
| Autonomy | 20 | ||
| Beneficence | 20 | ||
| Nonmaleficence | 21 | ||
| Veracity | 21 | ||
| Fidelity | 21 | ||
| Justice | 21 | ||
| Scarce Resources in Critical Care | 22 | ||
| Technologies and Treatments | 22 | ||
| Health Care Personnel | 23 | ||
| Withholding and Withdrawing Treatment | 23 | ||
| Medical Futility | 23 | ||
| Ethics as a Foundation for Nursing Practice | 23 | ||
| Nursing Code of Ethics | 24 | ||
| Ethical Decision Making in Critical Care | 24 | ||
| The Nurse’s Role | 24 | ||
| What Is an Ethical Dilemma? | 25 | ||
| Steps in Ethical Decision Making | 25 | ||
| Step One | 26 | ||
| Step Two | 26 | ||
| Step Three | 26 | ||
| Step Four | 26 | ||
| Step Five | 26 | ||
| Step Six | 27 | ||
| Step Seven | 27 | ||
| Step Eight | 27 | ||
| Strategies for Promotion of Ethical Decision Making | 27 | ||
| Institutional Ethics Committees | 27 | ||
| Inservice and Education Programs | 27 | ||
| Nursing Ethics Committees | 27 | ||
| Ethics Rounds and Conferences | 27 | ||
| Summary | 28 | ||
| References | 29 | ||
| 3 Legal Issues | 30 | ||
| Overview | 30 | ||
| Administrative Law: Professional Regulation | 30 | ||
| Functions of Boards of Nursing | 31 | ||
| Scope of Practice | 31 | ||
| Standards of Practice | 31 | ||
| Tort Law: Negligence and Professional Malpractice, Intentional Torts | 32 | ||
| Ordinary Negligence | 32 | ||
| Professional Malpractice | 32 | ||
| Duty | 36 | ||
| Breach | 36 | ||
| Harm Caused by the Breach | 37 | ||
| Damages | 37 | ||
| Professional Malpractice and the Nursing Process | 37 | ||
| Assessment Failure: Failure to Assess and Analyze the Level of Care Needed by the Patient. | 38 | ||
| Assessment Failure: Failure to Ascertain a Patient’s Wishes with Regard to Self-Determination. | 38 | ||
| Planning Failure: Failure to Appropriately Diagnose. | 38 | ||
| Implementation Failure: Failure to Timely Communicate Patient Findings. | 38 | ||
| Implementation Failure: Failure to Take Appropriate Action. | 39 | ||
| Implementation Failure: Failure to Document. | 39 | ||
| Implementation Failure: Failure to Preserve Patient Privacy. | 39 | ||
| Evaluation Failure: Failure to Act as a Patient Advocate. | 40 | ||
| Wrongful Death | 40 | ||
| Assault and Battery | 41 | ||
| Special Clinical Circumstances and Professional Malpractice | 41 | ||
| Respiratory Management | 41 | ||
| Blood Transfusions | 42 | ||
| Infection Control | 43 | ||
| Constitutional Law: Patient Decision Making | 43 | ||
| Patients Without Decision-Making Capacity | 44 | ||
| Never and Not Yet Competent Patients | 44 | ||
| Previously Competent Patients | 44 | ||
| Advance Directives | 44 | ||
| Futile Treatment and Orders Not to Resuscitate | 45 | ||
| Legal Issues Looking Forward | 45 | ||
| Summary | 46 | ||
| References | 47 | ||
| 4 Genetics and Genomics in Critical Care | 48 | ||
| Genetics and Genomics | 48 | ||
| Genetic and Genomic Structure and Function | 49 | ||
| Chromosomes | 49 | ||
| DNA and the Double Helix | 49 | ||
| DNA Base Pairs | 50 | ||
| DNA Replication | 50 | ||
| DNA Alphabet | 51 | ||
| Transcription | 51 | ||
| Translation | 52 | ||
| Genetic Variation, Mutation and Polymorphism | 53 | ||
| Variation | 53 | ||
| Mutation | 53 | ||
| Single-Nucleotide Polymorphisms | 53 | ||
| Alleles | 54 | ||
| Genetic Inheritance | 54 | ||
| Genetic Disorders | 54 | ||
| Chromosome Disorders | 55 | ||
| Single-Gene Disorders | 55 | ||
| Complex Gene and Multifactorial Disorders | 55 | ||
| Mitochondrial Disorders | 55 | ||
| Genotype and Phenotype | 56 | ||
| Genetic History and Family Pedigree | 56 | ||
| Homozygous versus Heterozygous | 56 | ||
| Modes of Inheritance | 56 | ||
| Autosomal Dominant Inheritance | 56 | ||
| Autosomal Recessive Inheritance | 56 | ||
| Sex-Linked Inheritance | 56 | ||
| Hemophilia A and Hemophilia B. | 56 | ||
| Complex Gene-Gene and Gene-Environment Disorders | 57 | ||
| Obesity and the FTO Gene | 58 | ||
| How Information about Genetics is Obtained | 58 | ||
| Genetic Epidemiology | 58 | ||
| Family-Based Genetic Studies | 58 | ||
| Twin Studies | 58 | ||
| Genetic Association Studies | 58 | ||
| Case-Control Studies | 59 | ||
| Candidate Gene Studies | 59 | ||
| Genome-Wide Association Studies | 59 | ||
| Genome Mapping Projects | 59 | ||
| The Human Genome Project | 59 | ||
| ENCODE Project | 59 | ||
| HapMap Project | 59 | ||
| 1000 Genomes Project | 59 | ||
| Personal Genome Project | 60 | ||
| The Human Microbiome Project | 60 | ||
| Genetic Diversity | 60 | ||
| Copy Number Variation | 60 | ||
| Individual Genome Sequences | 60 | ||
| Genetics in Critical Care | 60 | ||
| Cancer Genetics | 61 | ||
| Somatic Mutations | 61 | ||
| The Cancer Genome Atlas | 61 | ||
| Cardiovascular Genetics | 61 | ||
| Long QT Syndrome | 61 | ||
| Cardiomyopathy | 62 | ||
| Hypertrophic Cardiomyopathy. | 62 | ||
| Dilated Cardiomyopathy. | 62 | ||
| Restrictive Cardiomyopathy. | 62 | ||
| Pharmacogenetics | 62 | ||
| Cytochrome P450 Family and Medication Metabolism | 62 | ||
| Warfarin | 62 | ||
| Malignant Hyperthermia | 62 | ||
| Genetics, Genomics, and Nursing | 62 | ||
| Ethical and Legal Issues in Genetics and Genomics | 63 | ||
| Direct-to-Consumer Tests | 63 | ||
| The Genetic Information Nondiscrimination Act | 63 | ||
| Human Genetics Key Terms | 65 | ||
| Summary | 66 | ||
| References | 66 | ||
| 5 Patient and Family Education | 69 | ||
| Challenges of Patient and Family Education | 69 | ||
| Education | 70 | ||
| Definition | 70 | ||
| Benefits | 70 | ||
| The Education Process | 70 | ||
| Step 1: Assessment | 70 | ||
| Learner Identification | 71 | ||
| Family | 71 | ||
| Age-Specific Considerations | 71 | ||
| Adult Learners | 71 | ||
| Factors Affecting the Learning Process | 72 | ||
| Readiness, Willingness, Ability | 72 | ||
| Physiologic Factors | 72 | ||
| Health Literacy | 72 | ||
| Sociocultural Factors | 74 | ||
| Financial Factors | 74 | ||
| Psychologic Factors | 74 | ||
| Coping | 74 | ||
| Adaptation | 74 | ||
| Environmental Factors | 75 | ||
| Step 2: Education Plan Development | 75 | ||
| Determining What to Teach | 76 | ||
| Writing Goals or Outcomes | 76 | ||
| Developing Interventions | 76 | ||
| Standardized Education Plans | 78 | ||
| Step 3: Implementation | 78 | ||
| Setting up the Environment | 78 | ||
| Teaching Strategies | 79 | ||
| Discussion | 79 | ||
| Demonstration and Practice | 79 | ||
| Audiovisual Media | 79 | ||
| Written Materials | 80 | ||
| Computer-Assisted Instruction | 81 | ||
| Internet Sites | 81 | ||
| Communication | 81 | ||
| Special Considerations | 82 | ||
| The Older Adult | 82 | ||
| Cognitive Effects of Aging. | 82 | ||
| Physical Effects of Aging. | 82 | ||
| Psychologic Effects of Aging. | 82 | ||
| Sedated and Unconscious Patients | 82 | ||
| The Noncompliant Patient | 82 | ||
| Step 4: Evaluation | 83 | ||
| How to Evaluate | 83 | ||
| Step 5: Documentation | 83 | ||
| What Should Be Documented? | 83 | ||
| Factors that Affect the Teaching-Learning Process | 84 | ||
| Informational Needs of Families in Critical Care | 84 | ||
| Preparation of the Patient and Family for Transfer from Critical Care | 84 | ||
| Summary | 85 | ||
| References | 86 | ||
| 6 Psychosocial and Spiritual Alterations and Management | 88 | ||
| Stress and Psychoneuroimmunology | 88 | ||
| Stress Response | 89 | ||
| Psychoneuroimmunology | 89 | ||
| Post-Traumatic Stress Reactions | 90 | ||
| Anxiety | 91 | ||
| Anxiety and Pain | 91 | ||
| Alterations in Self-Concept | 91 | ||
| Body Image | 92 | ||
| Self-Esteem | 92 | ||
| Identity Disturbance | 92 | ||
| Risk for Compromised Human Dignity | 92 | ||
| Spiritual Challenges in Critical Care | 93 | ||
| Spiritual Distress | 93 | ||
| Hope and Hopelessness | 93 | ||
| Loss of Control and Powerlessness | 93 | ||
| Coping with Stress and Illness | 94 | ||
| Use of Psychologic Defense Mechanisms | 94 | ||
| Regression | 94 | ||
| Denial | 95 | ||
| Holistic Psychosocial-Spiritual Care | 95 | ||
| Communicate with Compassion and Care | 95 | ||
| Trust | 96 | ||
| Practice Dignity-Enhancing Care | 96 | ||
| Support Patient Coping | 97 | ||
| Helping Patients Maintain Control | 97 | ||
| Support Patient Preferred Complementary Therapies | 97 | ||
| Creating Healing Environments | 97 | ||
| Visiting Policies | 97 | ||
| Physical Environment | 97 | ||
| Provide Family-Centered Care | 97 | ||
| Engage Spiritual Resources | 98 | ||
| Patients with Mental Health Co-Morbidities | 99 | ||
| Alcohol Withdrawal in Critical Care Settings | 99 | ||
| Caring for Patients After Attempted Suicide | 99 | ||
| Nurse Self-Care | 99 | ||
| Summary | 100 | ||
| References | 101 | ||
| 7 Sleep Alterations and Management | 104 | ||
| Normal Human Sleep | 104 | ||
| Sleep Physiology | 104 | ||
| Sleep Stages | 105 | ||
| Non-Rapid Eye Movement Sleep | 105 | ||
| Rapid Eye Movement Sleep | 105 | ||
| Sleep Cycles | 105 | ||
| Chronobiology | 105 | ||
| Circadian System | 106 | ||
| Homeostatic Mechanism | 106 | ||
| Circadian and Homeostatic Interaction | 106 | ||
| Pharmacology | 106 | ||
| Sleep Pattern Disturbance | 107 | ||
| Description | 107 | ||
| Etiology and Pathophysiology | 107 | ||
| Assessment and Diagnosis | 108 | ||
| Medical Management | 108 | ||
| Nursing Management | 108 | ||
| Sleep Apnea Syndrome | 108 | ||
| Description | 108 | ||
| Obstructive Sleep Apnea | 109 | ||
| Etiology and Pathophysiology | 109 | ||
| Assessment and Diagnosis | 110 | ||
| Medical Management | 110 | ||
| Nursing Management | 111 | ||
| Central Sleep Apnea | 111 | ||
| Etiology and Pathophysiology | 111 | ||
| Assessment and Diagnosis | 112 | ||
| Medical Management | 112 | ||
| Nursing Management | 112 | ||
| Summary | 113 | ||
| Normal Human Sleep | 113 | ||
| Pharmacology | 113 | ||
| Sleep Pattern Disturbance | 113 | ||
| Sleep Apnea Syndrome | 113 | ||
| References | 113 | ||
| 8 Nutrition Alterations and Management | 115 | ||
| Nutrient Metabolism | 115 | ||
| Energy-Yielding Nutrients | 115 | ||
| Carbohydrates | 115 | ||
| Proteins | 116 | ||
| Lipids (Fats) | 116 | ||
| Assessing Nutritional Status | 117 | ||
| Anthropometric Measurements | 117 | ||
| Biochemical Data | 119 | ||
| Clinical or Physical Manifestations | 119 | ||
| Diet and Health History | 119 | ||
| Evaluating Nutrition Assessment Findings | 120 | ||
| Determining Nutritional Needs | 120 | ||
| Implications of Undernutrition for the Sick or Stressed Patient | 121 | ||
| Energy Deficiency | 121 | ||
| Protein-Calorie Malnutrition | 121 | ||
| Metabolic Response to Starvation and Stress | 121 | ||
| Nutrition Support | 122 | ||
| Nursing Management of Nutrition Support | 122 | ||
| Oral Supplementation | 122 | ||
| Enteral Nutrition | 122 | ||
| Enteral Feeding Access. | 124 | ||
| Location and Type of Feeding Tube. | 124 | ||
| Assessment and Prevention of Feeding Tube Complications. | 124 | ||
| Feeding Tube Occlusion. | 125 | ||
| Aspiration. | 125 | ||
| Gastrointestinal Complications. | 127 | ||
| Formula Delivery. | 127 | ||
| Adequacy of Enteral Nutrition. | 127 | ||
| Tubing and Catheter Misconnections. | 127 | ||
| Total Parenteral Nutrition | 128 | ||
| Types of Parenteral Nutrition. | 128 | ||
| Nursing Management of Potential Complications. | 128 | ||
| Lipid Emulsion. | 130 | ||
| Monitoring and Evaluation of Nutrition Support | 130 | ||
| Nutrition and Cardiovascular Alterations | 130 | ||
| Nutrition Assessment in Cardiovascular Alterations | 130 | ||
| Nutrition Intervention and Education in Cardiovascular Alterations | 130 | ||
| Myocardial Infarction | 130 | ||
| Short-Term Interventions. | 130 | ||
| Long-Term Changes | 131 | ||
| Heart Failure | 131 | ||
| Cardiac Cachexia | 131 | ||
| Nutrition and Pulmonary Alterations | 132 | ||
| Nutrition Assessment in Pulmonary Alterations | 132 | ||
| Nutrition Intervention and Education in Pulmonary Alterations | 132 | ||
| Prevent or Correct Undernutrition and Underweight | 132 | ||
| Avoid Overfeeding | 132 | ||
| Prevent Fluid Volume Excess | 132 | ||
| Nutrition and Neurologic Alterations | 133 | ||
| Nutrition Assessment in Neurologic Alterations | 133 | ||
| Nutrition Intervention and Education in Neurologic Alterations | 133 | ||
| Prevention or Correction of Nutritional Deficits | 133 | ||
| Oral Feedings. | 133 | ||
| Tube Feedings or Total Parenteral Nutrition. | 133 | ||
| Prevention of Overweight and Obesity. | 134 | ||
| Nutrition and Renal Alterations | 134 | ||
| Nutrition Assessment in Renal Alterations | 134 | ||
| Nutrition Intervention and Education in Renal Alterations | 134 | ||
| Protein | 134 | ||
| Fluid | 135 | ||
| Energy (Calories) | 135 | ||
| Other Nutrients | 135 | ||
| Nutrition and Gastrointestinal Alterations | 135 | ||
| Nutrition Assessment in Gastrointestinal Alterations | 135 | ||
| Nutrition Intervention and Education in Gastrointestinal Alterations | 136 | ||
| Hepatic Failure | 136 | ||
| Monitoring Fluid and Electrolyte Status. | 136 | ||
| Provision of a Nutritious Diet and Evaluation of Response to Dietary Protein. | 136 | ||
| Pancreatitis | 137 | ||
| Prevention of Further Damage to the Pancreas and Preventing Nutritional Deficits. | 137 | ||
| Nutrition and Endocrine Alterations | 137 | ||
| Nutrition Assessment in Endocrine Alterations | 137 | ||
| Nutrition Intervention in Endocrine Alterations | 137 | ||
| Nutrition Support and Blood Glucose Control | 137 | ||
| Severe Vomiting or Diarrhea in the Patient with Type 1 Diabetes Mellitus | 138 | ||
| Nutrition Education in Diabetes | 138 | ||
| Summary | 139 | ||
| Nutrient Metabolism | 139 | ||
| Assessing Nutritional Status | 139 | ||
| Implications of Undernutrition for the Sick or Stressed Patient | 139 | ||
| Nursing Management of Nutrition Support | 139 | ||
| Nutrition and Cardiovascular Alterations | 139 | ||
| Nutrition and Pulmonary Alterations | 139 | ||
| Nutrition and Neurologic Alterations | 139 | ||
| Nutrition and Renal Alterations | 139 | ||
| Nutrition and Gastrointestinal Alterations | 139 | ||
| Nutrition and Endocrine Alterations | 139 | ||
| References | 140 | ||
| 9 Pain and Pain Management | 143 | ||
| Importance of Pain Assessment | 143 | ||
| Definition and Description of Pain | 143 | ||
| Components of Pain | 144 | ||
| Types of Pain | 144 | ||
| Acute Pain | 144 | ||
| Chronic Pain | 144 | ||
| Nociceptive Pain | 144 | ||
| Neuropathic Pain | 144 | ||
| Physiology of Pain | 144 | ||
| Nociception | 144 | ||
| Transduction | 144 | ||
| Transmission | 144 | ||
| Perception | 145 | ||
| Modulation | 146 | ||
| Biologic Stress Response | 147 | ||
| Short-Term Direct Response | 148 | ||
| Midterm Indirect Response | 148 | ||
| Long-Term Indirect Response | 148 | ||
| Framework for Pain Assessment and Definition | 148 | ||
| Pain Assessment | 149 | ||
| Pain Assessment: The Subjective Component | 149 | ||
| P: Provocative and Palliative or Aggravating Factors | 149 | ||
| Q: Quality | 149 | ||
| R: Region or Location, Radiation | 150 | ||
| S: Severity and Other Symptoms | 150 | ||
| T: Timing | 150 | ||
| U: Understanding | 150 | ||
| Pain Assessment: The Observable or Objective Component | 150 | ||
| Behavioral Pain Scale | 151 | ||
| Critical-Care Pain Observation Tool | 151 | ||
| Use of Cut-Off Scores | 151 | ||
| Limitations Related to the Use of Behavioral Pain Scales | 151 | ||
| Physiologic Indicators | 151 | ||
| Cerebral Monitoring and Pain Assessment | 153 | ||
| Electroencephalogram | 153 | ||
| Bispectral Index | 153 | ||
| Pain as a Vital Sign | 154 | ||
| Patient Barriers to Pain Assessment and Management | 154 | ||
| Communication | 154 | ||
| Altered Level of Consciousness and Unconsciousness | 154 | ||
| Older Adult Patients | 154 | ||
| Neonates and Infants | 154 | ||
| Cultural Influences. | 154 | ||
| Lack of Knowledge | 155 | ||
| Health Professional Barriers to Pain Assessment and Management | 155 | ||
| Addiction and Tolerance | 155 | ||
| Respiratory Depression | 155 | ||
| Organizational Barriers to Pain Assessment and Management | 155 | ||
| Pain Management | 155 | ||
| Pharmacologic Control of Pain | 156 | ||
| Opioid Analgesics | 156 | ||
| Morphine. | 156 | ||
| Fentanyl. | 158 | ||
| Hydromorphone. | 159 | ||
| Meperidine. | 159 | ||
| Codeine. | 159 | ||
| Methadone. | 159 | ||
| More Potent Opioids: Remifentanil and Sufentanil. | 159 | ||
| Preventing and Treating Respiratory Depression | 159 | ||
| Monitoring. | 159 | ||
| Opioid Reversal. | 159 | ||
| New Sedative with Analgesic Properties: Dexmedetomidine | 160 | ||
| Nonopioid Analgesics | 160 | ||
| Acetaminophen. | 160 | ||
| Nonsteroidal Antiinflammatory Drugs. | 160 | ||
| Adjuvants. | 161 | ||
| Ketamine. | 161 | ||
| Lidocaine. | 161 | ||
| Delivery Methods | 161 | ||
| Patient-Controlled Analgesia | 161 | ||
| Intraspinal Pain Control | 161 | ||
| Intrathecal Analgesia | 162 | ||
| Epidural Analgesia | 162 | ||
| Equianalgesia | 163 | ||
| Nonpharmacologic Methods of Pain Management | 163 | ||
| Physical Techniques | 165 | ||
| Cold Application | 165 | ||
| Massage | 165 | ||
| Cognitive-Behavioral Techniques | 165 | ||
| Relaxation | 165 | ||
| Guided Imagery | 165 | ||
| Music Therapy | 166 | ||
| Summary | 166 | ||
| References | 166 | ||
| 10 Sedation, Agitation, Delirium: Assessment and Management | 170 | ||
| Sedation | 170 | ||
| Sedation and Agitation Assessment Scales | 170 | ||
| Pain Assessment Scales | 170 | ||
| Complications of Sedation | 170 | ||
| Pharmacologic Management of Sedation | 170 | ||
| Targeted Sedation | 172 | ||
| Neuromuscular Blockade | 172 | ||
| Peripheral Muscle Monitoring. | 172 | ||
| Brain Function Monitoring. | 172 | ||
| Benzodiazepines | 172 | ||
| Sedative-Hypnotic Agents | 174 | ||
| Central Alpha Agonists | 175 | ||
| Daily Sedation Interruption | 175 | ||
| Agitation | 175 | ||
| Delirium | 176 | ||
| Pharmacologic Management of Delirium | 176 | ||
| Nonpharmacologic Interventions to Prevent Delirium | 176 | ||
| Alcohol Withdrawal Syndrome and Delirium Tremens | 179 | ||
| Collaborative Management | 179 | ||
| Summary | 180 | ||
| References | 180 | ||
| 11 End-of-Life Issues | 182 | ||
| End-of-Life Experience in Critical Care | 183 | ||
| Advance Directives | 183 | ||
| Physician Orders for Life Sustaining Treatment | 184 | ||
| Advance Care Planning | 184 | ||
| Ethical and Legal Issues | 184 | ||
| Comfort Care | 185 | ||
| Cardiopulmonary Resuscitation | 185 | ||
| Impact of Do Not Resuscitate Orders | 185 | ||
| Prognostication and Prognostic Tools | 186 | ||
| Communication and Decision Making | 186 | ||
| Patient Communication | 187 | ||
| Family Communication | 187 | ||
| Cultural and Spiritual Influences on Communication | 187 | ||
| Hospice Information | 187 | ||
| Withdrawal or Withholding of Treatment | 188 | ||
| Proactive Approach | 188 | ||
| Disagreement and Distress for Caregivers | 188 | ||
| Barriers to Dying | 188 | ||
| Steps Toward Comfort Care | 188 | ||
| Palliative Care | 188 | ||
| Pain Management | 189 | ||
| Symptom Management | 189 | ||
| Dyspnea | 189 | ||
| Nausea and Vomiting | 189 | ||
| Fever and Infection | 189 | ||
| Edema | 189 | ||
| Anxiety | 189 | ||
| Delirium | 190 | ||
| Metabolic Derangement | 190 | ||
| Providing Comfort | 190 | ||
| Near-Death Awareness | 190 | ||
| Family Meetings | 190 | ||
| Withdrawal of Mechanical Ventilation | 190 | ||
| Opioids and Sedatives | 191 | ||
| Ventilator Settings | 191 | ||
| Professional Issues | 191 | ||
| Health Care Settings | 191 | ||
| Emotional Support for the Nurse | 191 | ||
| Organ Donation | 192 | ||
| Legal Issues | 192 | ||
| Brain Death | 192 | ||
| Family Care | 192 | ||
| Communication Needs | 192 | ||
| Waiting for Good News | 192 | ||
| Family Meetings | 193 | ||
| Family Presence During Cardiopulmonary Resuscitation | 193 | ||
| Visiting Hours | 193 | ||
| After Death | 194 | ||
| Collaborative Care | 194 | ||
| Summary | 195 | ||
| References | 195 | ||
| Unit 2 Cardiovascular Alterations | 200 | ||
| 12 Cardiovascular Anatomy and Physiology | 200 | ||
| Anatomy | 200 | ||
| Macroscopic Structure | 200 | ||
| Structures of the Heart | 200 | ||
| Size and Weight of the Heart | 200 | ||
| Layers of the Heart | 200 | ||
| Pericardium. | 200 | ||
| Epicardial Fat. | 201 | ||
| Epicardium. | 201 | ||
| Myocardium. | 201 | ||
| Endocardium. | 201 | ||
| Cardiac Chambers | 202 | ||
| Cardiac Valves | 202 | ||
| Atrioventricular Valves. | 202 | ||
| Semilunar Valves. | 203 | ||
| Conduction System | 203 | ||
| Sinoatrial Node. | 203 | ||
| Atrioventricular Node. | 203 | ||
| Bundle of His, Bundle Branches, and Purkinje Fibers. | 204 | ||
| Coronary Blood Supply | 204 | ||
| Coronary Veins. | 206 | ||
| Physiologic Cardiac Shunts. | 206 | ||
| Major Cardiac Vessels | 206 | ||
| Aorta | 206 | ||
| Pulmonary Artery | 206 | ||
| Pulmonary Veins | 206 | ||
| Systemic Circulation | 206 | ||
| Arterial System. | 206 | ||
| Blood Flow and Blood Pressure. | 207 | ||
| Microcirculation. | 208 | ||
| Venous System | 209 | ||
| Microscopic Structure | 210 | ||
| Cardiac Fibers | 210 | ||
| Cardiac Cells | 210 | ||
| Physiology | 213 | ||
| Electrical Activity | 213 | ||
| Transmembrane Potentials | 213 | ||
| Resting Membrane Potential | 213 | ||
| Phases of the Action Potential | 213 | ||
| Phase 0. | 213 | ||
| Phase 1 and Phase 2. | 213 | ||
| Phase 3. | 214 | ||
| Phase 4. | 214 | ||
| Fiber Conduction and Excitability. | 214 | ||
| Pacemaker Cell versus Non-pacemaker Cell Action Potentials. | 215 | ||
| Mechanical Activity | 215 | ||
| Excitation–Contraction Coupling | 215 | ||
| Cardiac Cycle | 215 | ||
| Atrial Systole | 215 | ||
| Isovolumic Contraction | 216 | ||
| Ventricular Systole | 216 | ||
| Isovolumic Relaxation | 217 | ||
| Ventricular Diastole | 217 | ||
| Interplay of the Heart and Vessels: Cardiac Output | 217 | ||
| Preload | 217 | ||
| Afterload | 218 | ||
| Contractility | 218 | ||
| Regulation of the Heartbeat | 218 | ||
| Nervous Control | 218 | ||
| Intrinsic Regulation | 219 | ||
| Baroreceptors. | 219 | ||
| Chemoreceptors. | 219 | ||
| Right Atrial Receptors. | 219 | ||
| Natriuretic Peptides. | 219 | ||
| Renin–Angiotensin–Aldosterone System. | 219 | ||
| Respiratory Influences. | 220 | ||
| Control of Peripheral Circulation | 220 | ||
| Intrinsic Control | 220 | ||
| Extrinsic Control | 220 | ||
| Summary | 221 | ||
| References | 221 | ||
| 13 Cardiovascular Clinical Assessment | 222 | ||
| History | 222 | ||
| Physical Examination | 224 | ||
| Inspection | 224 | ||
| Face | 224 | ||
| Thorax | 224 | ||
| Abdomen | 224 | ||
| Nail Beds and Cyanosis | 224 | ||
| Lower Extremities | 224 | ||
| Posture | 225 | ||
| Weight | 225 | ||
| Mentation | 225 | ||
| Jugular Veins | 225 | ||
| Abdominojugular Reflux | 225 | ||
| Thoracic Reference Points | 226 | ||
| Apical Impulse | 227 | ||
| Palpation | 227 | ||
| Arterial Pulses | 227 | ||
| Carotid Pulses | 227 | ||
| Brachial, Ulnar, and Radial Pulses | 227 | ||
| Femoral Pulses | 228 | ||
| Popliteal Pulses | 228 | ||
| Dorsalis Pedis and Posterior Tibial Pulses | 228 | ||
| Descending Aorta Pulse | 228 | ||
| Capillary Refill | 229 | ||
| Edema | 229 | ||
| Auscultation | 229 | ||
| Blood Pressure Measurement | 229 | ||
| Noninvasive Blood Pressure Monitoring. | 229 | ||
| Orthostatic Hypotension. | 229 | ||
| Blood Pressure Cuff Size. | 229 | ||
| Korotkoff Sounds. | 230 | ||
| Auscultatory Gap. | 230 | ||
| Automated Blood Pressure Devices. | 230 | ||
| Pulse Pressure. | 230 | ||
| Pulsus Paradoxus. | 230 | ||
| Pulsus Alternans. | 231 | ||
| Vascular Bruits. | 231 | ||
| Normal Heart Sounds | 231 | ||
| First and Second Heart Sounds. | 231 | ||
| Physiologic Splitting of S1 and S2. | 231 | ||
| Pathologic Splitting of S1 and S2. | 231 | ||
| Abnormal Heart Sounds | 231 | ||
| Third and Fourth Heart Sounds. | 231 | ||
| Heart Murmurs | 233 | ||
| Mitral Stenosis. | 234 | ||
| Mitral Regurgitation. | 234 | ||
| Aortic Stenosis. | 234 | ||
| Aortic Insufficiency. | 234 | ||
| Innocent Murmurs | 234 | ||
| Murmurs Associated with Myocardial Infarction | 234 | ||
| Papillary Muscle Rupture. | 235 | ||
| Ventricular Septal Rupture. | 235 | ||
| Cardiac Rubs | 235 | ||
| Pericardial Friction Rub. | 235 | ||
| Summary | 236 | ||
| References | 236 | ||
| 14 Cardiovascular Diagnostic Procedures | 237 | ||
| Cardiovascular Assessment and Monitoring | 237 | ||
| Bedside Hemodynamic Monitoring | 237 | ||
| Equipment | 237 | ||
| Heparin. | 237 | ||
| Calibration of Equipment. | 238 | ||
| Zeroing the Transducer. | 238 | ||
| Phlebostatic Axis. | 239 | ||
| Leveling the Transducer. | 239 | ||
| Patient Position | 240 | ||
| Head of Bed Backrest Position. | 240 | ||
| Lateral Position. | 240 | ||
| Intra-arterial Blood Pressure Monitoring | 240 | ||
| Indications | 240 | ||
| Catheters | 240 | ||
| Insertion and Allen Test. | 240 | ||
| Nursing Management | 240 | ||
| Infection. | 240 | ||
| Perfusion Pressure. | 242 | ||
| Pulse Pressure. | 242 | ||
| Cuff Blood Pressure. | 242 | ||
| Arterial Pressure Waveform Interpretation | 242 | ||
| Decreased Arterial Perfusion. | 242 | ||
| Pulse Deficit. | 243 | ||
| Pulsus Paradoxus. | 244 | ||
| Pulsus Alternans. | 244 | ||
| Damped Waveform. | 244 | ||
| Underdamped Waveform. | 246 | ||
| Fast-Flush Square Waveform Test. | 246 | ||
| Alarms. | 247 | ||
| Central Venous Pressure Monitoring | 247 | ||
| Indications | 247 | ||
| Central Venous Catheters | 248 | ||
| Insertion. | 248 | ||
| Internal Jugular Vein. | 248 | ||
| Subclavian Vein. | 248 | ||
| Femoral Vein. | 249 | ||
| Central Venous Catheter Complications | 249 | ||
| Air Embolus. | 249 | ||
| Thrombus Formation. | 249 | ||
| Infection. | 249 | ||
| Nursing Management | 250 | ||
| Central Venous Pressure—Volume Assessment. | 250 | ||
| Passive Leg Raise. | 250 | ||
| Water Versus Mercury Central Venous Pressure. | 250 | ||
| Removal. | 251 | ||
| Patient Position. | 251 | ||
| Central Venous Pressure Waveform Interpretation. | 251 | ||
| Cannon Waves. | 251 | ||
| Specialized Central Venous Catheters | 252 | ||
| Pulmonary Artery Pressure Monitoring | 252 | ||
| Indications | 253 | ||
| Cardiac Output Determinants | 253 | ||
| Oxygen Supply and Demand | 253 | ||
| Preload. | 253 | ||
| Measurement of Preload. | 255 | ||
| Frank-Starling Law of the Heart. | 255 | ||
| Ejection Fraction. | 256 | ||
| Cardiac Dysfunction. | 256 | ||
| Pulmonary Artery Diastolic Pressure and Pulmonary Artery Occlusion Pressure Relationship. | 256 | ||
| Pulmonary Hypertension. | 256 | ||
| Heart Failure. | 256 | ||
| Mitral Stenosis. | 256 | ||
| Mitral Regurgitation. | 257 | ||
| Afterload. | 258 | ||
| Systemic Vascular Resistance. | 258 | ||
| Systemic Vascular Resistance and Afterload Reduction. | 258 | ||
| Pulmonary Vascular Resistance. | 258 | ||
| Contractility. | 258 | ||
| Optimizing Contractility. | 258 | ||
| Pulmonary Artery Catheters | 258 | ||
| Right Atrial Lumen. | 259 | ||
| Pulmonary Artery Lumen. | 260 | ||
| Balloon Lumen. | 260 | ||
| Thermistor Lumen. | 260 | ||
| Additional Features. | 260 | ||
| Insertion | 260 | ||
| Pulmonary Artery Waveform Interpretation | 260 | ||
| Right Atrial Waveform. | 260 | ||
| Right Ventricular Waveform. | 261 | ||
| Pulmonary Artery Waveform. | 261 | ||
| Pulmonary Artery Occlusion Waveform (Wedge). | 261 | ||
| Medical Management | 261 | ||
| Nursing Management | 261 | ||
| Patient Position. | 261 | ||
| Respiratory Variation. | 261 | ||
| Positive End-Expiratory Pressure. | 261 | ||
| Avoiding Complications. | 262 | ||
| Pulmonary Artery Catheter Removal. | 263 | ||
| Cardiac Output Measurement | 263 | ||
| Thermodilution Cardiac Output Bolus Method. | 263 | ||
| Cardiac Output Curve. | 263 | ||
| Injectate Temperature. | 264 | ||
| Patient Position and Cardiac Output. | 264 | ||
| Clinical Conditions That Alter Cardiac Output. | 264 | ||
| Continuous Invasive Cardiac Output Measurement. | 264 | ||
| Calculated Hemodynamic Profiles. | 264 | ||
| Noninvasive and Minimally Invasive Measurement of Cardiac Output | 264 | ||
| Thoracic Electrical Bioimpedance. | 264 | ||
| Arterial Waveform - Pulse Contour Cardiac Output Methods. | 264 | ||
| Lithium Dilution Cardiac Output. | 264 | ||
| Pulse Index Contour Cardiac Output. | 265 | ||
| Pulse Contour Cardiac Output Method. | 266 | ||
| Esophageal Doppler Cardiac Output. | 266 | ||
| Partial Carbon Dioxide Rebreathing Cardiac Output. | 268 | ||
| Continuous Monitoring of Venous Oxygen Saturation | 268 | ||
| Indications | 268 | ||
| Catheters | 269 | ||
| Svo2 Catheter. | 269 | ||
| Scvo2 Catheter. | 269 | ||
| Svo2 or Scvo2 Calibration. | 269 | ||
| Nursing Management | 269 | ||
| Normal Svo2 Values. | 269 | ||
| Normal Scvo2 Values. | 269 | ||
| Svo2 or Scvo2 and Arterial Oxygen Saturation. | 270 | ||
| Svo2 or Scvo2 and Cardiac Output. | 270 | ||
| Svo2 or Scvo2 and Hemoglobin. | 271 | ||
| Svo2 or Scvo2 and Oxygen Consumption. | 271 | ||
| Normal Svo2 or Scvo2. | 273 | ||
| Low Svo2 or Scvo2. | 273 | ||
| High Svo2. | 274 | ||
| Electrocardiography | 274 | ||
| Basic Principles of Electrocardiography | 274 | ||
| Phase 0. | 274 | ||
| Phases 1 and 2. | 274 | ||
| Phase 3. | 275 | ||
| Phase 4. | 275 | ||
| Electrocardiographic Leads. | 275 | ||
| 12-Lead Electrocardiogram. | 275 | ||
| Standard Limb Leads. | 275 | ||
| Augmented Vector Leads. | 276 | ||
| Precordial Leads. | 277 | ||
| Right Ventricular Precordial Leads. | 277 | ||
| Posterior Wall Leads. | 277 | ||
| Baseline Distortion. | 277 | ||
| Electrocardiographic Analysis | 277 | ||
| Specialized Electrocardiographic Paper. | 277 | ||
| Calibration. | 277 | ||
| Waveforms. | 278 | ||
| P Wave. | 278 | ||
| QRS Complex. | 278 | ||
| T Wave. | 278 | ||
| Intervals Between Waveforms. | 278 | ||
| PR Interval. | 278 | ||
| QT Interval. | 279 | ||
| Ventricular Axis. | 281 | ||
| Calculating the Ventricular Axis. | 281 | ||
| Cardiac Monitor Lead Analysis | 281 | ||
| Lead II. | 282 | ||
| Lead V1. | 283 | ||
| MCL1. | 283 | ||
| Electrocardiographic Lead Selection for Optimal Bedside Monitoring | 284 | ||
| Continuous Dysrhythmia Monitoring. | 284 | ||
| Continuous ST Segment Monitoring. | 284 | ||
| Atrial Hypertrophy | 285 | ||
| Ventricular Hypertrophy | 285 | ||
| Ischemia and Infarction | 286 | ||
| Electrocardiographic Changes Indicating Ischemia and Infarction. | 286 | ||
| Non–Q-wave Infarction. | 287 | ||
| Infarct Location by 12-Lead Electrocardiogram. | 287 | ||
| lnfarct Electrocardiographic Progression. | 287 | ||
| Intraventricular Conduction Defects | 287 | ||
| Right and Left Bundle Branch Blocks. | 288 | ||
| Right Bundle Branch Block. | 288 | ||
| Left Bundle Branch Block. | 288 | ||
| Hemiblocks. | 289 | ||
| Bifascicular Block. | 289 | ||
| Dysrhythmia Interpretation | 289 | ||
| Heart Rate Determination. | 289 | ||
| Rhythm Determination. | 290 | ||
| P-Wave Evaluation. | 290 | ||
| PR-Interval Evaluation. | 290 | ||
| QRS Complex Evaluation. | 290 | ||
| QT Evaluation. | 291 | ||
| Sinus Rhythms | 291 | ||
| Normal Sinus Rhythm. | 291 | ||
| Sinus Bradycardia. | 291 | ||
| Sinus Tachycardia. | 291 | ||
| Sinus Dysrhythmia. | 292 | ||
| Atrial Dysrhythmias | 292 | ||
| Premature Atrial Contractions. | 292 | ||
| Supraventricular Tachycardia. | 293 | ||
| Supraventricular Tachycardia with Aberrant Conduction. | 294 | ||
| Paroxysmal Supraventricular Tachycardia. | 294 | ||
| Multifocal Atrial Tachycardia. | 295 | ||
| Atrial Flutter. | 295 | ||
| Pathogenesis of Atrial Flutter. | 295 | ||
| Atrial and Ventricular Rates in Atrial Flutter. | 296 | ||
| Atrial Flutter Management. | 296 | ||
| Atrial Fibrillation. | 296 | ||
| Pathogenesis of Atrial Fibrillation. | 297 | ||
| Types of Atrial Fibrillation. | 298 | ||
| Atrial Fibrillation Risk Factors. | 299 | ||
| Atrial Fibrillation Management. | 299 | ||
| Rhythm Control. | 299 | ||
| Rate Control. | 300 | ||
| Stroke Risk Assessment and Antithrombotic Therapy in Atrial Fibrillation | 300 | ||
| CHADS2. | 300 | ||
| CHA2DS2-VASc. | 300 | ||
| Nonpharmacologic Procedures to Treat Atrial Fibrillation. | 300 | ||
| Junctional Dysrhythmias | 301 | ||
| Premature Junctional Contraction. | 301 | ||
| Junctional Escape Rhythm. | 301 | ||
| Junctional Tachycardia and Accelerated Junctional Rhythm. | 302 | ||
| Ventricular Dysrhythmias | 302 | ||
| Premature Ventricular Contractions. | 302 | ||
| Compensatory Pause. | 302 | ||
| Describing Ventricular Ectopy. | 303 | ||
| Premature Ventricular Contraction Timing. | 303 | ||
| Causes of Premature Ventricular Contractions. | 303 | ||
| Premature Ventricular Contraction Management. | 304 | ||
| Idioventricular Rhythms. | 304 | ||
| Ventricular Tachycardia. | 305 | ||
| Ventricular Fibrillation. | 306 | ||
| Differential Diagnosis of a Wide QRS-Complex Tachycardia. | 306 | ||
| Significance of Ventricular Tachycardia and Supraventricular Tachycardia. | 306 | ||
| Clinical Differentiation of Ventricular Tachycardia from Supraventricular Tachycardia. | 307 | ||
| Nursing Management. | 308 | ||
| First-Degree Atrioventricular Block. | 309 | ||
| Second-Degree Atrioventricular Block. | 309 | ||
| Mobitz Type I. | 309 | ||
| Mobitz Type II. | 310 | ||
| 2 : 1 Conduction. | 310 | ||
| Third-Degree Atrioventricular Block. | 310 | ||
| Management of Atrioventricular Block. | 311 | ||
| Laboratory Assessment | 311 | ||
| Electrolytes | 311 | ||
| Potassium | 311 | ||
| Hyperkalemia. | 311 | ||
| Hypokalemia. | 312 | ||
| Calcium | 312 | ||
| Hypercalcemia. | 312 | ||
| Hypocalcemia. | 313 | ||
| Magnesium | 313 | ||
| Hypermagnesemia. | 313 | ||
| Hypomagnesemia. | 314 | ||
| Cardiac Biomarker Studies | 315 | ||
| Cardiac Biomarkers in Acute Coronary Syndrome | 315 | ||
| Creatine Kinase-MB. | 315 | ||
| Troponin T and Troponin I. | 315 | ||
| Cardiac Biomarkers and Reperfusion. | 316 | ||
| Natriuretic Peptide Biomarkers in Heart Failure | 316 | ||
| Hematologic Studies | 316 | ||
| Red Blood Cells | 316 | ||
| Hemoglobin | 317 | ||
| Hematocrit | 317 | ||
| White Blood Cells | 317 | ||
| Platelets | 317 | ||
| Blood Coagulation Studies | 317 | ||
| Prothrombin Time. | 317 | ||
| International Normalized Ratio. | 317 | ||
| Activated Partial Thromboplastin Time. | 317 | ||
| Anti-Factor Xa Test of Heparin Activity. | 317 | ||
| Activated Coagulation Time. | 317 | ||
| Serum Lipid Studies | 317 | ||
| Total Cholesterol | 318 | ||
| Low-Density Lipoproteins | 318 | ||
| Very-Low-Density Lipoproteins and Triglycerides | 318 | ||
| High-Density Lipoproteins | 318 | ||
| Triglycerides | 318 | ||
| Diagnostic Procedures | 318 | ||
| Cardiac Catheterization and Coronary Arteriography | 318 | ||
| Left-Heart Cardiac Catheterization | 318 | ||
| Right-Heart Cardiac Catheterization | 318 | ||
| Procedure | 318 | ||
| Prevention of Contrast-Induced Nephropathy. | 319 | ||
| Nursing Management | 319 | ||
| Femoral Artery Site Care. | 319 | ||
| Peripheral Pulses. | 319 | ||
| Rehydration. | 319 | ||
| Angina. | 319 | ||
| Dysrhythmias. | 319 | ||
| Patient Education | 319 | ||
| Electrophysiology Study | 320 | ||
| Indications | 320 | ||
| Atrial Measurements. | 320 | ||
| Ventricular Measurements. | 320 | ||
| Implantable Cardioverter Defibrillators. | 320 | ||
| Chest Radiography | 321 | ||
| Basic Principles and Technique | 321 | ||
| Tissue Densities. | 321 | ||
| Standard Views. | 321 | ||
| Portable Chest Radiography. | 321 | ||
| Nursing Interventions to Produce an Optimal Chest Radiograph. | 321 | ||
| Indications | 321 | ||
| Chest Radiograph Analysis: Lines and Tubes | 322 | ||
| Central Venous Catheter. | 322 | ||
| Pulmonary Artery Catheter. | 322 | ||
| Endotracheal Tube. | 322 | ||
| Enteric Tube. | 322 | ||
| Chest Tube. | 322 | ||
| Intra-aortic Balloon Catheter. | 322 | ||
| Pacemaker or Implantable Defibrillator. | 322 | ||
| Chest Radiograph Analysis: Cardiac and Pulmonary Factors | 322 | ||
| Cardiac Heart Size. | 322 | ||
| Pulmonary Edema. | 323 | ||
| Pneumonia. | 323 | ||
| Pneumothorax. | 323 | ||
| Digital Radiography | 323 | ||
| Ambulatory Electrocardiographic Tests | 323 | ||
| Continuous Electrocardiographic Recording Systems | 323 | ||
| Electrocardiographic Monitoring Leads. | 323 | ||
| Unit 3 Pulmonary Alterations | 467 | ||
| 17 Pulmonary Anatomy and Physiology | 467 | ||
| Thorax | 467 | ||
| Thoracic Cage | 467 | ||
| Lungs | 467 | ||
| Lobes and Segments | 467 | ||
| Mediastinum | 467 | ||
| Pleura | 469 | ||
| Intrapleural Pressure | 469 | ||
| Muscles of Ventilation | 470 | ||
| Inhalation | 470 | ||
| Exhalation | 471 | ||
| Accessory Muscles | 471 | ||
| Conducting Airways | 471 | ||
| Upper Airways | 471 | ||
| Epiglottis | 472 | ||
| Trachea | 472 | ||
| Bronchial Tree | 472 | ||
| Bronchi | 473 | ||
| Bronchioles | 473 | ||
| Defense System | 473 | ||
| Respiratory Airways | 474 | ||
| Respiratory Bronchioles | 474 | ||
| Alveoli | 474 | ||
| Type I Alveolar Epithelial Cells | 474 | ||
| Collateral Air Passages. | 474 | ||
| Type II Alveolar Epithelial Cells | 474 | ||
| Surfactant. | 474 | ||
| Defense System | 474 | ||
| Pulmonary Blood and Lymph Supply | 475 | ||
| Pulmonary Circulation | 475 | ||
| Pulmonary Artery Pressures | 475 | ||
| Alveolar-Capillary Membrane | 476 | ||
| Membrane Layers | 476 | ||
| Bronchial Circulation | 476 | ||
| Physiologic Shunting | 476 | ||
| Lymphatic Circulation | 477 | ||
| Ventilation | 477 | ||
| Work of Breathing | 477 | ||
| Pulmonary Volumes and Capacities | 477 | ||
| Physiologic Dead Space | 477 | ||
| Regulation of Ventilation | 478 | ||
| Controller | 478 | ||
| Brainstem. | 478 | ||
| Cerebral Cortex. | 479 | ||
| Effectors | 479 | ||
| Sensors | 479 | ||
| Central Chemoreceptors. | 480 | ||
| Peripheral Chemoreceptors. | 480 | ||
| Other Receptors. | 480 | ||
| Respiration | 480 | ||
| Diffusion | 480 | ||
| Ventilation/Perfusion Relationships | 481 | ||
| Distribution of Ventilation | 481 | ||
| Distribution of Perfusion | 482 | ||
| Ventilation/Perfusion Mismatch | 482 | ||
| Hypoxic Vasoconstriction | 483 | ||
| Gas Transport | 483 | ||
| Oxygen Content | 484 | ||
| Oxygen Content Formula | 484 | ||
| Oxyhemoglobin Dissociation Curve | 484 | ||
| Shifts in the Oxyhemoglobin Dissociation Curve. | 484 | ||
| Shift to the Right. | 484 | ||
| Shift to the Left. | 485 | ||
| Abnormalities of Hemoglobin | 485 | ||
| Carbon Dioxide Content | 486 | ||
| Summary | 486 | ||
| Anatomy | 486 | ||
| Physiology | 486 | ||
| References | 486 | ||
| 18 Pulmonary Clinical Assessment | 488 | ||
| History | 488 | ||
| Physical Examination | 488 | ||
| Inspection | 488 | ||
| Tongue and Sublingual Area | 490 | ||
| Chest Wall Configuration | 490 | ||
| Respiratory Effort | 490 | ||
| Additional Assessment Areas | 491 | ||
| Palpation | 491 | ||
| Position of the Trachea | 491 | ||
| Thoracic Expansion | 492 | ||
| Tactile Fremitus | 492 | ||
| Percussion | 492 | ||
| Underlying Lung Structure | 492 | ||
| Diaphragmatic Excursion | 493 | ||
| Auscultation | 493 | ||
| Normal Breath Sounds | 493 | ||
| Abnormal Breath Sounds | 493 | ||
| Voice Sounds | 495 | ||
| Assessment Findings of Common Disorders | 495 | ||
| Summary | 500 | ||
| History | 500 | ||
| Clinical Assessment | 500 | ||
| References | 501 | ||
| 19 Pulmonary Diagnostic Procedures | 502 | ||
| Laboratory Studies | 502 | ||
| Arterial Blood Gases | 502 | ||
| Steps for Interpretation of Blood Gas Levels | 502 | ||
| Step 1. | 502 | ||
| Step 2. | 502 | ||
| Step 3. | 503 | ||
| Step 4. | 503 | ||
| Step 5. | 503 | ||
| Oxygen Saturation | 503 | ||
| Oxygen Content | 504 | ||
| Base Excess and Base Deficit | 505 | ||
| Classic Shunt Equation and Oxygen Tension Indices | 505 | ||
| Pao2/FiO2 Ratio | 505 | ||
| Pao2/Pao2 Ratio | 505 | ||
| Alveolar-Arterial Gradient | 505 | ||
| Dead Space Equation | 506 | ||
| Sputum Studies | 506 | ||
| Diagnostic Procedures | 506 | ||
| Bronchoscopy | 506 | ||
| Thoracentesis | 507 | ||
| Bedside Pulmonary Function Tests | 508 | ||
| Ventilation/Perfusion Scanning | 508 | ||
| Chest Radiography | 509 | ||
| Bones | 509 | ||
| Mediastinum | 509 | ||
| Diaphragm | 509 | ||
| Pleural Space | 510 | ||
| Lung Tissue | 510 | ||
| Tubes, Wires, and Lines | 510 | ||
| Nursing Management | 510 | ||
| Bedside Monitoring | 511 | ||
| Capnography | 511 | ||
| Pulse Oximetry | 511 | ||
| Physiologic Limitations | 512 | ||
| Technical Limitations | 512 | ||
| Summary | 512 | ||
| Laboratory Studies | 512 | ||
| Diagnostic Procedures | 512 | ||
| Bedside Monitoring | 512 | ||
| References | 513 | ||
| 20 Pulmonary Disorders | 514 | ||
| Acute Lung Failure | 514 | ||
| Description | 514 | ||
| Etiology | 514 | ||
| Pathophysiology | 514 | ||
| Alveolar Hypoventilation | 514 | ||
| Ventilation/Perfusion Mismatching | 516 | ||
| Intrapulmonary Shunting | 516 | ||
| Assessment and Diagnosis | 516 | ||
| Medical Management | 516 | ||
| Oxygenation | 516 | ||
| Ventilation | 517 | ||
| Pharmacology | 517 | ||
| Acidosis | 517 | ||
| Nutrition Support | 518 | ||
| Complications | 518 | ||
| Nursing Management | 518 | ||
| Optimizing Oxygenation and Ventilation | 518 | ||
| Positioning. | 518 | ||
| Preventing Desaturation. | 518 | ||
| Promoting Secretion Clearance. | 518 | ||
| Educating the Patient and Family | 519 | ||
| Acute Respiratory Distress Syndrome | 519 | ||
| Description | 519 | ||
| Etiology | 519 | ||
| Pathophysiology | 519 | ||
| Exudative Phase | 521 | ||
| Fibroproliferative Phase | 522 | ||
| Resolution Phase | 522 | ||
| Assessment and Diagnosis | 522 | ||
| Medical Management | 523 | ||
| Ventilation | 523 | ||
| Low Tidal Volume. | 523 | ||
| Permissive Hypercapnia. | 523 | ||
| Pressure Control Ventilation. | 523 | ||
| Inverse Ratio Ventilation. | 523 | ||
| High-Frequency Oscillatory Ventilation. | 523 | ||
| Oxygen Therapy | 523 | ||
| Positive End-Expiratory Pressure. | 523 | ||
| Extracorporeal and Intracorporeal Gas Exchange. | 524 | ||
| Tissue Perfusion | 524 | ||
| Nursing Management | 524 | ||
| Optimizing Oxygenation and Ventilation | 524 | ||
| Prone Positioning. | 524 | ||
| Pneumonia | 524 | ||
| Description | 524 | ||
| Etiology | 525 | ||
| Severe Community-Acquired Pneumonia | 525 | ||
| Hospital-Acquired Pneumonia | 525 | ||
| Health Care-Associated Pneumonia | 525 | ||
| Pathophysiology | 525 | ||
| Assessment and Diagnosis | 527 | ||
| Medical Management | 527 | ||
| Antibiotic Therapy | 527 | ||
| Independent Lung Ventilation | 527 | ||
| Nursing Management | 527 | ||
| Optimizing Oxygenation and Ventilation | 527 | ||
| Preventing the Spread of Infection | 527 | ||
| Aspiration Pneumonitis | 528 | ||
| Description | 528 | ||
| Etiology | 528 | ||
| Pathophysiology | 528 | ||
| Acid Liquid | 528 | ||
| Acid Food Particles | 529 | ||
| Nonacid Liquid | 529 | ||
| Nonacid Food Particles | 529 | ||
| Assessment and Diagnosis | 529 | ||
| Medical Management | 529 | ||
| Nursing Management | 530 | ||
| Optimizing Oxygenation and Ventilation | 530 | ||
| Preventing Aspiration | 530 | ||
| Pulmonary Embolism | 530 | ||
| Description | 530 | ||
| Etiology | 531 | ||
| Pathophysiology | 531 | ||
| Increased Dead Space | 531 | ||
| Bronchoconstriction | 531 | ||
| Compensatory Shunting | 531 | ||
| Hemodynamic Consequences | 531 | ||
| Assessment and Diagnosis | 531 | ||
| Medical Management | 532 | ||
| Prevention of Recurrence | 533 | ||
| Clot Dissolution | 533 | ||
| Reversal of Pulmonary Hypertension | 533 | ||
| Nursing Management | 534 | ||
| Optimizing Oxygenation and Ventilation | 534 | ||
| Monitoring for Bleeding | 534 | ||
| Educating the Patient and Family | 534 | ||
| Status Asthmaticus | 535 | ||
| Description | 535 | ||
| Etiology | 535 | ||
| Pathophysiology | 535 | ||
| Pulmonary Effects | 535 | ||
| Cardiovascular Effects | 535 | ||
| Assessment and Diagnosis | 535 | ||
| Medical Management | 536 | ||
| Bronchodilators | 536 | ||
| Systemic Corticosteroids | 536 | ||
| Oxygen Therapy | 536 | ||
| Intubation and Mechanical Ventilation | 536 | ||
| Nursing Management | 536 | ||
| Optimizing Oxygenation and Ventilation | 536 | ||
| Educating the Patient and Family | 536 | ||
| Air Leak Disorders | 537 | ||
| Description | 537 | ||
| Etiology | 537 | ||
| Pathophysiology | 538 | ||
| Pneumothorax | 538 | ||
| Barotrauma | 538 | ||
| Assessment and Diagnosis | 538 | ||
| Medical Management | 538 | ||
| Tension Pneumothorax | 539 | ||
| Tension Pneumopericardium | 539 | ||
| Nursing Management | 539 | ||
| Optimizing Oxygenation and Ventilation | 539 | ||
| Maintaining the Chest Tube System | 539 | ||
| Long-Term Mechanical Ventilator Dependence | 540 | ||
| Description | 540 | ||
| Etiology and Pathophysiology | 540 | ||
| Medical and Nursing Management | 541 | ||
| Preweaning Stage | 541 | ||
| Weaning Preparedness. | 541 | ||
| Weaning Readiness. | 541 | ||
| Weaning Approach. | 541 | ||
| Weaning Method. | 544 | ||
| Weaning Process Stage | 544 | ||
| Weaning Initiation. | 544 | ||
| Weaning Progress. | 544 | ||
| Weaning Intolerance. | 544 | ||
| Facilitative Therapies. | 544 | ||
| Weaning Outcome Stage | 544 | ||
| Weaning Completed. | 544 | ||
| Incomplete Weaning. | 545 | ||
| Summary | 546 | ||
| Acute Lung Failure | 546 | ||
| Acute Respiratory Distress Syndrome | 546 | ||
| Pneumonia | 546 | ||
| Aspiration Pneumonitis | 546 | ||
| Pulmonary Embolism | 546 | ||
| Status Asthmaticus | 546 | ||
| Air Leak Disorders | 546 | ||
| Long-Term Mechanical Ventilation Dependence | 546 | ||
| References | 547 | ||
| 21 Pulmonary Therapeutic Management | 549 | ||
| Oxygen Therapy | 549 | ||
| Principles of Therapy | 549 | ||
| Methods of Delivery | 549 | ||
| Low-Flow Systems | 549 | ||
| Reservoir Systems | 549 | ||
| High-Flow Systems | 551 | ||
| Complications of Oxygen Therapy | 551 | ||
| Oxygen Toxicity | 551 | ||
| Carbon Dioxide Retention | 552 | ||
| Absorption Atelectasis | 552 | ||
| Nursing Management | 552 | ||
| Artificial Airways | 552 | ||
| Pharyngeal Airways | 552 | ||
| Oropharyngeal Airway | 552 | ||
| Nasopharyngeal Airway | 553 | ||
| Endotracheal Tubes | 553 | ||
| Rapid Sequence Intubation | 553 | ||
| Step 1—Preparation. | 553 | ||
| Step 2—Preoxygenation. | 554 | ||
| Step 3—Pretreatment. | 554 | ||
| Step 4—Paralysis with Induction. | 554 | ||
| Step 5—Protection and Positioning. | 554 | ||
| Step 6—Placement of the Endotracheal Tube. | 554 | ||
| Step 7—Post Intubation Management. | 554 | ||
| Complications | 554 | ||
| Tracheostomy Tubes | 555 | ||
| Tracheostomy Procedure | 555 | ||
| Complications | 555 | ||
| Nursing Management | 557 | ||
| Humidification | 559 | ||
| Cuff Management | 559 | ||
| Cuff Inflation Techniques. | 559 | ||
| Cuff Pressure Monitoring. | 560 | ||
| Foam Cuff Tracheostomy Tubes. | 560 | ||
| Subglottic Secretion Removal. | 560 | ||
| Suctioning | 560 | ||
| Complications. | 560 | ||
| Suctioning Protocol. | 561 | ||
| Closed Tracheal Suction System. | 561 | ||
| Communication | 561 | ||
| Passy-Muir Valve. | 562 | ||
| Oral Hygiene | 562 | ||
| Extubation and Decannulation | 563 | ||
| Invasive Mechanical Ventilation | 563 | ||
| Indications | 563 | ||
| Use of Mechanical Ventilators | 563 | ||
| Types of Ventilators | 563 | ||
| Ventilator Mechanics | 563 | ||
| Trigger. | 563 | ||
| Limit. | 563 | ||
| Cycle. | 563 | ||
| Baseline. | 564 | ||
| Modes of Ventilation | 564 | ||
| Ventilator Settings | 564 | ||
| Complications | 566 | ||
| Ventilator-Induced Lung Injury | 566 | ||
| Cardiovascular Compromise | 566 | ||
| Gastrointestinal Disturbances | 566 | ||
| Patient-Ventilator Dyssynchrony | 566 | ||
| Ventilator-Associated Pneumonia | 566 | ||
| Semirecumbency. | 566 | ||
| Sedation Vacation. | 567 | ||
| Other Measures to Reduce the Incidence of Ventilator-Associated Pneumonia. | 567 | ||
| Weaning | 568 | ||
| Readiness to Wean | 568 | ||
| Weaning Methods | 568 | ||
| T-Piece Trials. | 568 | ||
| Synchronized Intermittent Mandatory Ventilation Trials. | 568 | ||
| Pressure Support Ventilation Trials. | 568 | ||
| Nursing Management | 568 | ||
| Patient Assessment | 569 | ||
| Symptom Management | 569 | ||
| ABCDE Bundle | 571 | ||
| Ventilator Assessment | 571 | ||
| Patient Safety | 571 | ||
| Noninvasive Ventilation | 571 | ||
| Nursing Management | 572 | ||
| Positioning Therapy | 573 | ||
| Prone Positioning | 573 | ||
| Rotation Therapy | 575 | ||
| Thoracic Surgery | 575 | ||
| Preoperative Care | 575 | ||
| Surgical Considerations | 575 | ||
| Complications and Medical Management | 578 | ||
| Acute Lung Failure | 578 | ||
| Bronchopleural Fistula | 578 | ||
| Hemorrhage | 578 | ||
| Cardiovascular Disturbances | 578 | ||
| Postoperative Nursing Management | 578 | ||
| Optimizing Oxygenation and Ventilation | 578 | ||
| Preventing Atelectasis | 578 | ||
| Patient Positioning and Early Ambulation. | 578 | ||
| Deep Breathing and Incentive Spirometry. | 579 | ||
| Pain Management. | 579 | ||
| Maintaining the Chest Tube System | 579 | ||
| Assisting Patient to Return to Adequate Activity Level | 579 | ||
| Pharmacology | 579 | ||
| Bronchodilators and Adjuncts | 579 | ||
| Neuromuscular Blocking Agents | 579 | ||
| Peripheral Nerve Stimulator | 581 | ||
| Summary | 582 | ||
| Oxygen Therapy | 582 | ||
| Artificial Airways | 582 | ||
| Invasive Mechanical Ventilation | 583 | ||
| Noninvasive Mechanical Ventilation | 583 | ||
| Positioning Therapy | 583 | ||
| Thoracic Surgery | 583 | ||
| Pharmacology | 583 | ||
| References | 584 | ||
| Unit 4 Neurologic Alterations | 587 | ||
| 22 Neurologic Anatomy and Physiology | 587 | ||
| Divisions of the Nervous System | 587 | ||
| Anatomic Divisions | 587 | ||
| Physiologic Divisions | 587 | ||
| Microstructure of the Nervous System | 587 | ||
| Neuroglia | 588 | ||
| Neurons | 588 | ||
| Central Nervous System | 590 | ||
| Cranial Protective Mechanisms | 590 | ||
| Bony Structures | 590 | ||
| Meninges | 591 | ||
| Dura Mater. | 591 | ||
| Arachnoid Mater. | 591 | ||
| Pia Mater. | 593 | ||
| Ventricular System | 593 | ||
| Cerebrospinal Fluid | 593 | ||
| Blood–Brain Barrier | 593 | ||
| Cerebrum | 595 | ||
| Frontal Lobe | 595 | ||
| Parietal Lobe | 595 | ||
| Temporal Lobe | 597 | ||
| Occipital Lobe | 597 | ||
| Limbic Lobe | 597 | ||
| Internal Capsule | 598 | ||
| Basal Ganglia | 598 | ||
| Diencephalon | 598 | ||
| Thalamus | 598 | ||
| Hypothalamus | 598 | ||
| Cerebellum | 598 | ||
| Brainstem | 600 | ||
| Midbrain | 600 | ||
| Pons | 600 | ||
| Medulla Oblongata | 600 | ||
| Reticular Formation | 600 | ||
| Arterial Circulation | 600 | ||
| Anterior Circulation | 600 | ||
| Posterior Circulation | 609 | ||
| Circle of Willis | 609 | ||
| Venous Circulation | 610 | ||
| Spinal Cord | 610 | ||
| Spinal Protective Mechanisms | 610 | ||
| Bony Structures | 612 | ||
| Intervertebral Disk | 612 | ||
| Meninges | 612 | ||
| Spinal Nerves | 613 | ||
| Cross-Section of the Spinal Cord | 615 | ||
| Vascular Supply | 615 | ||
| Summary | 618 | ||
| Anatomy | 618 | ||
| Physiology | 618 | ||
| References | 618 | ||
| 23 Neurologic Clinical Assessment and Diagnostic Procedures | 620 | ||
| Clinical Assessment | 620 | ||
| History | 620 | ||
| Physical Examination | 620 | ||
| Level of Consciousness | 620 | ||
| Evaluation of Arousal | 621 | ||
| Appraisal of Awareness | 621 | ||
| Glasgow Coma Scale | 621 | ||
| Motor Function | 622 | ||
| Evaluation of Muscle Size and Tone | 622 | ||
| Estimation of Muscle Strength | 622 | ||
| Abnormal Motor Responses | 623 | ||
| Evaluation of Reflexes | 623 | ||
| Pupillary Function | 624 | ||
| Estimation of Pupil Size and Shape | 625 | ||
| Evaluation of Pupillary Reaction to Light | 625 | ||
| Assessment of Eye Movement | 626 | ||
| Respiratory Function | 626 | ||
| Observation of Respiratory Pattern | 626 | ||
| Evaluation of Airway Status | 627 | ||
| Vital Signs | 627 | ||
| Evaluation of Blood Pressure | 627 | ||
| Observation of Heart Rate and Rhythm | 628 | ||
| Cushing Reflex. | 628 | ||
| Rapid Neurologic Assessment | 628 | ||
| The Conscious Patient | 628 | ||
| The Unconscious Patient | 628 | ||
| Neurologic Changes Associated with Intracranial Hypertension | 628 | ||
| Diagnostic Procedures | 628 | ||
| Radiologic Procedures | 629 | ||
| Skull and Spine Films | 629 | ||
| Computed Tomography | 630 | ||
| Magnetic Resonance Imaging | 631 | ||
| Cerebral Angiography | 632 | ||
| Conventional Angiography. | 632 | ||
| Digital Subtraction Angiography. | 633 | ||
| Magnetic Resonance Angiography. | 633 | ||
| Computed Tomography Angiography. | 633 | ||
| Myelography | 633 | ||
| Cerebral Blood Flow and Metabolism Imaging | 634 | ||
| Perfusion Computed Tomography | 634 | ||
| Xenon Computed Tomography | 634 | ||
| Perfusion Magnetic Resonance Imaging | 634 | ||
| Carotid Ultrasonography | 634 | ||
| Emission Tomography Studies | 635 | ||
| Positive Emission Tomography. | 635 | ||
| Single-Photon Emission Computed Tomography. | 635 | ||
| Electrophysiology Studies | 635 | ||
| Electroencephalography | 635 | ||
| Evoked Potentials | 636 | ||
| Laboratory Studies | 636 | ||
| Cerebrospinal Fluid Analysis | 636 | ||
| Multimodal Bedside Monitoring | 636 | ||
| Intracranial Pressure Monitoring | 636 | ||
| Types of Catheters | 636 | ||
| Monitoring Sites | 637 | ||
| Intraventricular Space. | 638 | ||
| Subarachnoid Space. | 638 | ||
| Epidural Space. | 638 | ||
| Subdural Space. | 640 | ||
| Intraparenchymal Site. | 640 | ||
| Intracranial Pressure Waves | 640 | ||
| Normal Intracranial Pressure Waveform. | 640 | ||
| A-Waves. | 640 | ||
| B-Waves. | 640 | ||
| C-Waves. | 640 | ||
| Pupillometry | 641 | ||
| Cerebral Perfusion Pressure Monitoring | 641 | ||
| Cerebral Blood Flow Monitoring | 641 | ||
| Transcranial Doppler Studies | 641 | ||
| Transcranial Color-Coded Duplex Sonography. | 641 | ||
| Thermal Diffusion Flowmetry | 641 | ||
| Laser Doppler Flowmetry | 642 | ||
| Cerebral Oxygenation and Metabolic Monitoring | 642 | ||
| Jugular Venous Oxygen Saturation | 642 | ||
| Near Infrared Spectroscopy | 642 | ||
| Brain Tissue Oxygen Pressure | 642 | ||
| Cerebral Microdialysis | 642 | ||
| Continuous Electroencephalography Monitoring | 643 | ||
| Summary | 643 | ||
| Clinical Assessment | 643 | ||
| Diagnostic Procedures | 643 | ||
| Laboratory Studies | 643 | ||
| Multimodal Monitoring | 643 | ||
| References | 643 | ||
| 24 Neurologic Disorders and Therapeutic Management | 646 | ||
| Coma | 646 | ||
| Description | 646 | ||
| Etiology | 646 | ||
| Pathophysiology | 646 | ||
| Assessment and Diagnosis | 647 | ||
| Medical Management | 648 | ||
| Nursing Management | 648 | ||
| Eye Care | 648 | ||
| Stroke | 649 | ||
| Ischemic Stroke | 649 | ||
| Description | 649 | ||
| Etiology | 649 | ||
| Pathophysiology | 649 | ||
| Assessment and Diagnosis | 649 | ||
| Medical Management | 651 | ||
| Subarachnoid Hemorrhage | 652 | ||
| Description | 652 | ||
| Etiology | 653 | ||
| Pathophysiology | 654 | ||
| Cerebral Aneurysm. | 654 | ||
| Arteriovenous Malformation. | 654 | ||
| Assessment and Diagnosis | 654 | ||
| Medical Management | 655 | ||
| Rebleeding. | 655 | ||
| Surgical Clipping of Aneurysms. | 655 | ||
| Surgical Excision of Arteriovenous Malformations. | 656 | ||
| Embolization. | 656 | ||
| Cerebral Vasospasm. | 656 | ||
| Hypertensive, Hypervolemic, Hemodilution Therapy. | 656 | ||
| Nimodipine. | 657 | ||
| Cerebral Angioplasty. | 657 | ||
| Hyponatremia. | 658 | ||
| Hydrocephalus. | 658 | ||
| Intracerebral Hemorrhage | 658 | ||
| Description | 658 | ||
| Etiology | 658 | ||
| Pathophysiology | 658 | ||
| Assessment and Diagnosis | 658 | ||
| Medical Management | 658 | ||
| Nursing Management | 659 | ||
| Monitoring for Changes in Neurologic and Hemodynamic Status | 659 | ||
| Maintaining Surveillance for Complications | 659 | ||
| Bleeding and Vasospasm. | 659 | ||
| Increased Intracranial Pressure. | 660 | ||
| Damage to the Nondominant Hemisphere. | 660 | ||
| Agnosia. | 660 | ||
| Visual Field Defects. | 660 | ||
| Apraxia. | 660 | ||
| Damage to the Dominant Hemisphere. | 660 | ||
| Receptive Aphasia. | 661 | ||
| Expressive Aphasia. | 661 | ||
| Global Aphasia. | 661 | ||
| Impaired Swallowing. | 661 | ||
| Educating the Patient and Family | 661 | ||
| Guillain-BARRé Syndrome | 662 | ||
| Description | 662 | ||
| Etiology | 662 | ||
| Pathophysiology | 662 | ||
| Assessment and Diagnosis | 662 | ||
| Medical Management | 663 | ||
| Nursing Management | 663 | ||
| Maintaining Surveillance for Complications | 663 | ||
| Initiating Rehabilitation | 663 | ||
| Facilitating Nutritional Support | 663 | ||
| Providing Comfort and Emotional Support | 663 | ||
| Educating the Patient and Family | 664 | ||
| Craniotomy | 664 | ||
| Types of Surgery | 664 | ||
| Preoperative Care | 664 | ||
| Surgical Considerations | 665 | ||
| Transcranial Approach | 665 | ||
| Trans-sphenoidal Approach | 665 | ||
| Postoperative Medical Management | 666 | ||
| Intracranial Hypertension | 666 | ||
| Surgical Hemorrhage | 666 | ||
| Fluid Imbalance | 667 | ||
| Cerebrospinal Fluid Leak | 667 | ||
| Deep Vein Thrombosis | 667 | ||
| Postoperative Nursing Management | 667 | ||
| Preserving Adequate Cerebral Perfusion | 667 | ||
| Positioning. | 667 | ||
| Fluid Management. | 668 | ||
| Avoidance of Vomiting and Fever. | 668 | ||
| Promoting Arterial Oxygenation | 668 | ||
| Providing Comfort and Emotional Support | 668 | ||
| Maintaining Surveillance for Complications | 668 | ||
| Infection. | 668 | ||
| Corneal Abrasions. | 668 | ||
| Injury. | 668 | ||
| Initiating Early Rehabilitation | 668 | ||
| Educating the Patient and Family | 668 | ||
| Intracranial Hypertension | 668 | ||
| Pathophysiology | 668 | ||
| Volume-Pressure Curve | 669 | ||
| Cerebral Blood Flow and Autoregulation | 669 | ||
| Assessment and Diagnosis | 670 | ||
| Medical and Nursing Management | 670 | ||
| Positioning and Other Nursing Activities | 670 | ||
| Hyperventilation | 672 | ||
| Temperature Control | 672 | ||
| Blood Pressure Control | 672 | ||
| Seizure Control | 673 | ||
| Cerebrospinal Fluid Drainage | 673 | ||
| Hyperosmolar Therapy | 674 | ||
| Control of Metabolic Demand | 674 | ||
| Barbiturate Therapy. | 675 | ||
| Herniation Syndromes | 675 | ||
| Supratentorial Herniation | 675 | ||
| Uncal Herniation. | 675 | ||
| Central Herniation. | 675 | ||
| Cingulate Herniation. | 676 | ||
| Transcalvarial Herniation. | 676 | ||
| Infratentorial Herniation | 676 | ||
| Upward Transtentorial Herniation. | 676 | ||
| Downward Cerebellar Herniation. | 676 | ||
| Pharmacologic Agents | 676 | ||
| Summary | 678 | ||
| Coma | 678 | ||
| Stroke | 678 | ||
| Ischemic Stroke | 678 | ||
| Subarachnoid Hemorrhage | 678 | ||
| Intracerebral Hemorrhage | 678 | ||
| Guillain-Barré Syndrome | 678 | ||
| Craniotomy | 678 | ||
| Intracranial Hypertension | 678 | ||
| References | 678 | ||
| Unit V Kidney Alterations | 681 | ||
| 25 Kidney Anatomy and Physiology | 681 | ||
| Macroscopic Anatomy | 681 | ||
| Vascular Anatomy | 681 | ||
| Microscopic Structure and Function | 682 | ||
| Glomerulus | 683 | ||
| The Bowman Capsule | 683 | ||
| Proximal Tubule | 683 | ||
| Loop of Henle | 683 | ||
| Distal Tubule | 683 | ||
| Collecting Duct | 684 | ||
| Nervous System Innervation | 684 | ||
| Urine Formation | 684 | ||
| Glomerular Filtration | 684 | ||
| Tubular Resorption | 685 | ||
| Passive Transport | 685 | ||
| Active Transport | 685 | ||
| Tubular Secretion | 685 | ||
| Functions of the Kidneys | 685 | ||
| Elimination of Metabolic Wastes | 685 | ||
| Urea | 686 | ||
| Creatinine | 686 | ||
| Blood Pressure Regulation | 686 | ||
| Erythrocyte Production | 686 | ||
| Vitamin D Activation | 686 | ||
| Prostaglandin Synthesis | 687 | ||
| Acid–Base Balance | 687 | ||
| Fluid Balance | 687 | ||
| Fluid Compartments | 687 | ||
| Electrolytes | 688 | ||
| Fluid Physiology | 688 | ||
| Tonicity | 688 | ||
| Hydrostatic Pressure | 688 | ||
| Osmotic Pressure | 688 | ||
| Diffusion, Osmosis, and Active Transport | 688 | ||
| Movement of Water | 688 | ||
| Factors Controlling Fluid Balance | 689 | ||
| Antidiuretic Hormone and Aquaporins | 689 | ||
| Aldosterone | 689 | ||
| Atrial Natriuretic Peptide | 689 | ||
| Electrolyte Balance | 689 | ||
| Potassium | 689 | ||
| Sodium | 690 | ||
| Calcium | 690 | ||
| Phosphorus | 691 | ||
| Magnesium | 691 | ||
| Chloride | 691 | ||
| Bicarbonate | 691 | ||
| Effects of Aging | 692 | ||
| Summary | 692 | ||
| Anatomy | 692 | ||
| Physiology | 692 | ||
| References | 692 | ||
| 26 Kidney Clinical Assessment and Diagnostic Procedures | 694 | ||
| History | 694 | ||
| Physical Examination | 694 | ||
| Inspection | 695 | ||
| Bleeding | 695 | ||
| Volume | 695 | ||
| Edema | 696 | ||
| Auscultation | 696 | ||
| Heart | 696 | ||
| Blood Pressure | 697 | ||
| Lungs | 697 | ||
| Palpation | 697 | ||
| Percussion | 697 | ||
| Kidneys | 697 | ||
| Abdomen | 697 | ||
| Additional Assessments | 698 | ||
| Weight Monitoring | 698 | ||
| Intake and Output Monitoring | 698 | ||
| Hemodynamic Monitoring | 698 | ||
| Other Observations | 699 | ||
| Laboratory Assessment | 699 | ||
| Serum Components | 700 | ||
| Blood Urea Nitrogen | 700 | ||
| Creatinine | 700 | ||
| BUN to Creatinine Ratio. | 700 | ||
| Creatinine Clearance | 700 | ||
| Cystatin C | 701 | ||
| Osmolality | 701 | ||
| Anion Gap | 701 | ||
| Hemoglobin and Hematocrit | 701 | ||
| Albumin | 702 | ||
| Urinalysis | 702 | ||
| Urine Appearance | 702 | ||
| Urine pH | 702 | ||
| Urine Specific Gravity | 702 | ||
| Urine Osmolality | 702 | ||
| Urine Protein | 702 | ||
| Urine Glucose | 703 | ||
| Urine Ketones | 703 | ||
| Urine Electrolytes | 703 | ||
| Urine Sodium. | 704 | ||
| Urine Sediment | 704 | ||
| Hematuria | 704 | ||
| Urine Toxicology Screen | 704 | ||
| Imaging Studies | 704 | ||
| Kidney Biopsy | 704 | ||
| Summary | 705 | ||
| Clinical Assessment | 705 | ||
| Laboratory Studies | 705 | ||
| Diagnostic Procedures | 705 | ||
| References | 705 | ||
| 27 Kidney Disorders and Therapeutic Management | 707 | ||
| Acute Kidney Injury | 707 | ||
| Critical Illness and Acute Kidney Injury | 707 | ||
| Definitions of Acute Kidney Injury | 707 | ||
| RIFLE Criteria | 708 | ||
| Acute Kidney Injury Network Criteria | 708 | ||
| Types of Acute Kidney Injury | 709 | ||
| Prerenal Acute Kidney Injury | 709 | ||
| Intrarenal Acute Kidney Injury | 709 | ||
| Postrenal Acute Kidney Injury | 709 | ||
| Azotemia | 709 | ||
| Assessment and Diagnosis | 709 | ||
| Laboratory Assessment | 709 | ||
| Acidosis | 709 | ||
| Blood Urea Nitrogen | 710 | ||
| Serum Creatinine | 710 | ||
| Creatinine Clearance | 710 | ||
| Fractional Excretion of Sodium | 710 | ||
| At-Risk Disease States and Acute Kidney Injury | 710 | ||
| Underlying Chronic Kidney Disease | 710 | ||
| Older Age and Acute Kidney Injury | 711 | ||
| Heart Failure and Acute Kidney Injury | 713 | ||
| Respiratory Failure and Acute Kidney Injury | 713 | ||
| Sepsis and Acute Kidney Injury | 713 | ||
| Trauma and Acute Kidney Injury | 713 | ||
| Trauma Admissions | 713 | ||
| Rhabdomyolysis | 713 | ||
| Contrast-Induced Nephrotoxic Injury and Acute Kidney Injury | 714 | ||
| Radiopaque Contrast | 714 | ||
| Promote Hydration and Avoid Dehydration | 714 | ||
| Medications | 714 | ||
| Catheter-Associated Urinary Tract Infection | 714 | ||
| Hemodynamic Monitoring and Fluid Balance | 714 | ||
| Hemodynamic Monitoring | 714 | ||
| Daily Weight | 714 | ||
| Physical Assessment | 715 | ||
| Electrolyte Balance | 715 | ||
| Potassium | 715 | ||
| Sodium | 716 | ||
| Calcium and Phosphorus | 716 | ||
| Calcium Replacement | 716 | ||
| Dietary–Phosphorus-Binding Medications | 716 | ||
| Medical Management | 716 | ||
| Treatment Goals | 716 | ||
| Prevention | 716 | ||
| Fluid Resuscitation | 716 | ||
| Crystalloids and Colloids. | 717 | ||
| Crystalloids. | 717 | ||
| Colloids. | 717 | ||
| Fluid Restriction. | 718 | ||
| Fluid Removal. | 718 | ||
| Pharmacologic Management | 718 | ||
| Diuretics | 718 | ||
| Loop Diuretics. | 718 | ||
| Thiazide Diuretics. | 718 | ||
| Osmotic Diuretics. | 718 | ||
| Carbonic Anhydrase Inhibitor Diuretics. | 718 | ||
| Potassium Sparing Diuretics. | 719 | ||
| Vaptans. | 719 | ||
| Dopamine | 719 | ||
| Acetylcysteine | 720 | ||
| Dietary-Phosphorus Binders | 720 | ||
| Nutrition | 720 | ||
| Nursing Management | 720 | ||
| Risk Factors for Acute Kidney Injury | 720 | ||
| Infectious Complications | 721 | ||
| Fluid Balance | 721 | ||
| Electrolyte Imbalance | 721 | ||
| Preventing Anemia | 721 | ||
| Erythropoiesis-Stimulating Medications. | 721 | ||
| Patient Education | 721 | ||
| Renal Replacement Therapy: Dialysis | 722 | ||
| Hemodialysis | 722 | ||
| Hemodialyzer | 722 | ||
| Ultrafiltration | 722 | ||
| Anticoagulation | 723 | ||
| Vascular Access | 723 | ||
| Temporary Vascular Access. | 723 | ||
| Permanent Vascular Access. | 723 | ||
| Arteriovenous Fistula. | 723 | ||
| Arteriovenous Grafts. | 724 | ||
| Tunneled Catheters. | 724 | ||
| Medical Management | 724 | ||
| Nursing Management | 724 | ||
| Continuous Renal Replacement Therapy | 725 | ||
| Continuous Renal Replacement Therapy Terminology | 726 | ||
| Diffusion. | 726 | ||
| Convection. | 726 | ||
| Absorption. | 726 | ||
| Ultrafiltrate Volume. | 726 | ||
| Replacement Fluid. | 726 | ||
| Anticoagulation. | 727 | ||
| Modes of Continuous Renal Replacement | 727 | ||
| Slow Continuous Ultrafiltration. | 727 | ||
| Continuous Venovenous Hemofiltration. | 727 | ||
| Continuous Venovenous Hemodialysis | 727 | ||
| Continuous Venovenous Hemodiafiltration. | 727 | ||
| Complications | 728 | ||
| Medical Management | 729 | ||
| Nursing Management | 730 | ||
| Peritoneal Dialysis | 730 | ||
| Catheter Placement | 731 | ||
| Infection | 731 | ||
| Medical Management | 732 | ||
| Nursing Management | 732 | ||
| Summary | 734 | ||
| Acute Kidney Injury | 734 | ||
| Catheter-Associated Urinary Tract Infection | 734 | ||
| Diuretics and Renal Replacement Therapies | 734 | ||
| References | 734 | ||
| Unit VI Gastrointestinal Alterations | 737 | ||
| 28 Gastrointestinal Anatomy and Physiology | 737 | ||
| Mouth | 737 | ||
| Ingestion and Mastication | 737 | ||
| Salivation | 737 | ||
| Esophagus | 737 | ||
| Swallowing | 738 | ||
| Stomach | 738 | ||
| Gastric Secretion | 740 | ||
| Gastric Motility | 740 | ||
| Small Intestine | 740 | ||
| Intestinal Secretion | 741 | ||
| Intestinal Motility | 741 | ||
| Digestion and Absorption | 742 | ||
| Large Intestine | 742 | ||
| Colonic Motility | 743 | ||
| Resorption | 743 | ||
| Accessory Organs | 743 | ||
| Liver | 745 | ||
| Nutrient Metabolism | 745 | ||
| Hematologic Function | 747 | ||
| Detoxification and Storage | 747 | ||
| Unit VII Endocrine Alterations | 788 | ||
| 31 Endocrine Anatomy and Physiology | 788 | ||
| Pancreas | 788 | ||
| Anatomy | 788 | ||
| Pancreas Blood Supply | 788 | ||
| Exocrine Cells | 788 | ||
| Endocrine Cells | 788 | ||
| Physiology | 789 | ||
| Insulin | 790 | ||
| Blood Glucose | 790 | ||
| Carbohydrate Anabolism. | 791 | ||
| Fat Anabolism. | 791 | ||
| Protein Conservation. | 791 | ||
| Glucagon | 791 | ||
| Somatostatin | 791 | ||
| Pancreatic Polypeptide | 791 | ||
| Glucose Transporters | 791 | ||
| GLUT1 and GLUT3. | 792 | ||
| GLUT2. | 792 | ||
| GLUT4. | 792 | ||
| GLUT5. | 792 | ||
| Incretins | 792 | ||
| Glucose-Dependent Insulinotropic Polypeptide. | 792 | ||
| Glucagon-Like-Peptide 1. | 792 | ||
| Pituitary Gland and Hypothalamus | 793 | ||
| Anatomy | 793 | ||
| Anterior Pituitary | 793 | ||
| Posterior Pituitary | 794 | ||
| Physiology | 794 | ||
| Antidiuretic Hormone | 794 | ||
| Thyroid Gland | 795 | ||
| Anatomy | 795 | ||
| Physiology | 795 | ||
| Pituitary Gland and Thyroid-Stimulating Hormone | 795 | ||
| Iodine and Iodide | 795 | ||
| Thyroglobulin | 795 | ||
| Triiodothyronine and Thyroxine | 796 | ||
| Calcitonin | 796 | ||
| Hypothalamic–Pituitary–Thyroid Axis Feedback Loop | 796 | ||
| Adrenal Gland | 797 | ||
| Anatomy | 797 | ||
| Adrenal Cortex | 797 | ||
| Adrenal Medulla | 797 | ||
| Adrenal Blood Supply | 798 | ||
| Physiology | 798 | ||
| Hormones of the Adrenal Cortex | 798 | ||
| Hormones of the Adrenal Medulla | 798 | ||
| Hypothalamic–Pituitary–Adrenal Axis | 798 | ||
| Summary | 798 | ||
| Pancreas | 798 | ||
| Pituitary | 798 | ||
| Thyroid | 799 | ||
| Adrenal | 799 | ||
| References | 799 | ||
| 32 Endocrine Clinical Assessment and Diagnostic Procedures | 800 | ||
| History | 800 | ||
| Pancreas | 800 | ||
| Physical Assessment | 800 | ||
| Hyperglycemia | 800 | ||
| Laboratory Studies | 800 | ||
| Blood Glucose | 801 | ||
| Urine Glucose | 801 | ||
| Glycated Hemoglobin | 802 | ||
| Blood Ketones | 802 | ||
| Urine Ketones | 802 | ||
| Pituitary Gland | 802 | ||
| Physical Assessment | 802 | ||
| Hydration Status | 802 | ||
| Vital Signs | 803 | ||
| Weight Changes and Intake and Output | 803 | ||
| Laboratory Assessment | 803 | ||
| Serum Antidiuretic Hormone | 803 | ||
| Serum and Urine Osmolality | 803 | ||
| Antidiuretic Hormone Test | 803 | ||
| Diagnostic Procedures | 803 | ||
| Radiographic Examination | 803 | ||
| Computed Tomography | 803 | ||
| Magnetic Resonance Imaging | 804 | ||
| Thyroid Gland | 804 | ||
| Clinical Assessment | 804 | ||
| History | 804 | ||
| Physical Examination | 804 | ||
| Laboratory Studies | 804 | ||
| Thyroid Stimulating Hormone | 805 | ||
| Thyroid Tests in the Critically Ill | 805 | ||
| Medications and Thyroid Testing | 805 | ||
| Diagnostic Procedures | 805 | ||
| Adrenal Gland | 805 | ||
| Primary Adrenal Disorders | 805 | ||
| Clinical Assessment | 806 | ||
| History | 806 | ||
| Physical Examination | 806 | ||
| Adrenal Cortex | 806 | ||
| Primary Cushing Syndrome. | 806 | ||
| Secondary Cushing Syndrome. | 806 | ||
| Primary Aldosteronism | 806 | ||
| Addison Disease | 806 | ||
| Critical Illness-Related Corticosteroid Insufficiency | 807 | ||
| Adrenal Medulla | 807 | ||
| Pheochromocytoma. | 807 | ||
| Laboratory Studies | 807 | ||
| Adrenal Insufficiency and Critical Illness | 807 | ||
| Diagnostic Procedures | 807 | ||
| Summary | 808 | ||
| Pancreas | 808 | ||
| Pituitary | 808 | ||
| Thyroid | 808 | ||
| Adrenal | 808 | ||
| References | 808 | ||
| 33 Endocrine Disorders and Therapeutic Management | 809 | ||
| Neuroendocrinology of Stress and Critical Illness | 809 | ||
| Acute Neuroendocrine Response to Critical Illness | 809 | ||
| Hypothalamic-Pituitary-Adrenal Axis in Critical Illness | 809 | ||
| Serum Cortisol Level | 811 | ||
| Cosyntropin Stimulation Test | 811 | ||
| Corticosteroid Replacement | 811 | ||
| Liver and Pancreas in Critical Illness | 811 | ||
| Hyperglycemia in Critical Illness | 811 | ||
| Clinical Practice Guidelines Related to Blood Glucose Management in Critically Ill Patients | 811 | ||
| Insulin Management in the Critically Ill | 811 | ||
| Frequent Blood Glucose Monitoring | 812 | ||
| Continuous Insulin Infusion | 812 | ||
| Transition from Continuous to Intermittent Insulin Coverage | 812 | ||
| Corrective Insulin Coverage | 814 | ||
| Hypoglycemia Management | 814 | ||
| Nursing Management | 815 | ||
| Monitor Hyperglycemic Side Effects of Vasopressor Therapy | 815 | ||
| Administer Prescribed Corticosteroids | 815 | ||
| Monitor Blood Glucose, Insulin Effectiveness, Avoid Hypoglycemia | 815 | ||
| Provide Nutrition | 815 | ||
| Patient Education | 815 | ||
| Collaborative Management | 815 | ||
| Diabetes Mellitus | 815 | ||
| Diagnosis of Diabetes | 815 | ||
| Types of Diabetes | 816 | ||
| Glycated Hemoglobin | 816 | ||
| Type 1 Diabetes | 816 | ||
| Management of Type 1 Diabetes | 816 | ||
| Type 2 Diabetes | 816 | ||
| Lifestyle Management for Type 2 Diabetes | 817 | ||
| Pharmacologic Management of Type 2 Diabetes | 817 | ||
| Diabetic Ketoacidosis | 819 | ||
| Epidemiology and Etiology | 819 | ||
| Pathophysiology | 819 | ||
| Insulin Deficiency | 819 | ||
| Hyperglycemia | 820 | ||
| Fluid Volume Deficit | 820 | ||
| Ketoacidosis | 820 | ||
| Acid–Base Balance | 820 | ||
| Gluconeogenesis | 820 | ||
| Assessment and Diagnosis | 822 | ||
| Clinical Manifestations | 822 | ||
| Laboratory Studies | 822 | ||
| Medical Management | 822 | ||
| Reversing Dehydration | 822 | ||
| Replacing Insulin | 822 | ||
| Reversing Ketoacidosis | 822 | ||
| Replenishing Electrolytes | 823 | ||
| Nursing Management | 824 | ||
| Administering Fluids, Insulin, and Electrolytes | 824 | ||
| Monitoring Response to Therapy | 824 | ||
| Surveillance for Complications | 824 | ||
| Fluid Volume Overload. | 824 | ||
| Hypoglycemia. | 825 | ||
| Hypokalemia and Hyperkalemia. | 825 | ||
| Hyponatremia. | 826 | ||
| Risk for Cerebral Edema. | 826 | ||
| Risk for Infection. | 826 | ||
| Patient Education | 826 | ||
| Collaborative Management | 826 | ||
| Hyperglycemic Hyperosmolar State | 826 | ||
| Epidemiology and Etiology | 826 | ||
| Differences Between Hyperglycemic Hyperosmolar State and Diabetic Ketoacidosis | 827 | ||
| Pathophysiology | 827 | ||
| Assessment and Diagnosis | 829 | ||
| Clinical Manifestations | 829 | ||
| Laboratory Studies | 829 | ||
| Medical Management | 829 | ||
| Rapid Rehydration | 829 | ||
| Insulin Administration | 829 | ||
| Insulin Resistance. | 830 | ||
| Electrolyte Replacement | 830 | ||
| Nursing Management | 830 | ||
| Administering Fluids, Insulin, and Electrolytes | 830 | ||
| Monitoring Response to Therapy | 830 | ||
| Surveillance for Complications | 830 | ||
| Patient Education | 830 | ||
| Collaborative Management | 831 | ||
| Diabetes Insipidus | 831 | ||
| Etiology | 831 | ||
| Central Diabetes Insipidus | 832 | ||
| Nephrogenic Diabetes Insipidus | 832 | ||
| Primary Polydipsia | 832 | ||
| Pathophysiology | 832 | ||
| Assessment and Diagnosis | 832 | ||
| Clinical Manifestations | 832 | ||
| Laboratory Studies | 832 | ||
| Serum Sodium. | 834 | ||
| Serum Osmolality Test. | 834 | ||
| Urine Osmolality. | 834 | ||
| Measurement of Antidiuretic Hormone. | 834 | ||
| Medical Management | 834 | ||
| Volume Restoration | 834 | ||
| Medications | 834 | ||
| Medications Used for Central Diabetes Insipidus. | 834 | ||
| Medications Used for Nephrogenic Diabetes Insipidus. | 834 | ||
| Nursing Management | 834 | ||
| Administration of Fluids and Medications | 834 | ||
| Evaluation of Response to Therapy | 835 | ||
| Surveillance for Complications | 835 | ||
| Patient Education | 836 | ||
| Collaborative Management | 836 | ||
| Syndrome of Inappropriate Secretion of Antidiuretic Hormone | 836 | ||
| Etiology | 836 | ||
| Pathophysiology | 836 | ||
| Assessment and Diagnosis | 836 | ||
| Clinical Manifestations | 836 | ||
| Laboratory Values | 836 | ||
| Medical Management | 837 | ||
| Fluid Restriction | 837 | ||
| Sodium Replacement | 837 | ||
| Medications | 837 | ||
| Vasopressin Receptor Antagonists. | 839 | ||
| Nursing Management | 839 | ||
| Restriction of Fluids | 839 | ||
| Patient Education | 839 | ||
| Collaborative Management | 839 | ||
| Thyroid Storm | 839 | ||
| Description | 839 | ||
| Etiology | 840 | ||
| Pathophysiology | 840 | ||
| Assessment and Diagnosis | 840 | ||
| Medical Management | 840 | ||
| Prevent Cardiovascular Collapse | 840 | ||
| Reduce Hyperthermia | 841 | ||
| Reverse Dehydration | 841 | ||
| Pharmacologic Management | 841 | ||
| Medications That Block the Catecholamine Effect | 841 | ||
| Medications That Block Thyroid Synthesis | 841 | ||
| Medications That Block Release of Thyroid Hormone | 842 | ||
| Nursing Management | 842 | ||
| Medication Administration | 842 | ||
| Normalize Body Temperature | 842 | ||
| Rehydration and Correction of Metabolic Derangements | 843 | ||
| Patient Education | 843 | ||
| Collaborative Management | 843 | ||
| Myxedema Coma | 843 | ||
| Description | 843 | ||
| Etiology | 843 | ||
| Pathophysiology | 843 | ||
| Skin | 843 | ||
| Cardiopulmonary System | 844 | ||
| Pulmonary System | 844 | ||
| Kidneys and Fluid and Electrolyte Balance | 844 | ||
| Nutrition and Elimination | 844 | ||
| Thermoregulation | 844 | ||
| Anemia | 844 | ||
| Assessment and Diagnosis | 844 | ||
| Clinical Presentation | 845 | ||
| Laboratory Studies | 845 | ||
| Medical Management | 845 | ||
| Pharmacologic Management | 845 | ||
| Nursing Management | 845 | ||
| Pulmonary Care | 845 | ||
| Cardiac Concerns | 845 | ||
| Thermoregulation | 845 | ||
| Thyroid Replacement Therapy | 845 | ||
| Skin Care | 846 | ||
| Elimination | 846 | ||
| Patient Education | 846 | ||
| Collaborative Management | 846 | ||
| Summary | 847 | ||
| Stress of Critical Illness | 847 | ||
| Pancreas: DKA and HHS | 847 | ||
| Pituitary: DI and SIADH | 847 | ||
| Thyroid: Thyroid Storm and Myxedema Coma | 847 | ||
| References | 847 | ||
| Unit VIII Multisystem Alterations | 849 | ||
| 34 Trauma | 849 | ||
| Mechanisms of Injury | 849 | ||
| Blunt Trauma | 849 | ||
| Penetrating Trauma | 850 | ||
| Phases of Trauma Care | 850 | ||
| Prehospital Resuscitation | 851 | ||
| Emergency Department Resuscitation | 851 | ||
| Primary Survey | 851 | ||
| Airway. | 851 | ||
| Breathing. | 852 | ||
| Circulation. | 852 | ||
| Disability. | 852 | ||
| Exposure. | 853 | ||
| Resuscitation Phase | 853 | ||
| Damage Control Resuscitation. | 853 | ||
| Massive Transfusion Protocols. | 853 | ||
| Secondary Survey | 853 | ||
| Definitive Care and Operative Phase | 854 | ||
| Critical Care Phase | 854 | ||
| Specific Trauma Injuries | 855 | ||
| Traumatic Brain Injuries | 855 | ||
| Mechanism of Injury | 855 | ||
| Pathophysiology | 855 | ||
| Primary Injury. | 855 | ||
| Secondary Injury. | 855 | ||
| Tissue Ischemia. | 855 | ||
| Hypotension. | 855 | ||
| Hypercapnia. | 855 | ||
| Brain Edema. | 855 | ||
| Classification of Brain Injuries | 855 | ||
| Skull Fracture. | 855 | ||
| Concussion. | 856 | ||
| Contusion. | 856 | ||
| Cerebral Hematomas. | 856 | ||
| Epidural Hematoma. | 856 | ||
| Subdural Hematoma. | 857 | ||
| Acute Subdural Hematoma. | 857 | ||
| Subacute Subdural Hematoma. | 857 | ||
| Chronic Subdural Hematoma. | 857 | ||
| Intracerebral Hematoma. | 857 | ||
| Missile Injuries. | 857 | ||
| Diffuse Axonal Injury. | 858 | ||
| Neurologic Assessment of Traumatic Brain Injury | 858 | ||
| Degree of Injury | 858 | ||
| Mild Brain Injury. | 858 | ||
| Moderate Brain Injury. | 858 | ||
| Severe Brain Injury. | 858 | ||
| Nursing Assessment of the Patient with Traumatic Brain Injury. | 859 | ||
| Diagnostic Procedures. | 859 | ||
| Medical Management | 859 | ||
| Surgical Management. | 859 | ||
| Nonsurgical Management. | 859 | ||
| Nursing Management | 859 | ||
| Spinal Cord Injuries | 860 | ||
| Mechanism of Injury | 860 | ||
| Hyperflexion. | 860 | ||
| Hyperextension. | 860 | ||
| Rotation. | 860 | ||
| Axial Loading. | 860 | ||
| Penetrating Injuries. | 860 | ||
| Pathophysiology | 860 | ||
| Functional Injury of the Spinal Cord | 861 | ||
| Complete Injury. | 861 | ||
| Tetraplegia. | 861 | ||
| Paraplegia. | 862 | ||
| Incomplete Injury. | 862 | ||
| Brown-Séquard Syndrome. | 862 | ||
| Central Cord Syndrome. | 862 | ||
| Anterior Cord Syndrome. | 862 | ||
| Posterior Cord Syndrome. | 862 | ||
| Spinal Shock. | 862 | ||
| Neurogenic Shock. | 862 | ||
| Autonomic Dysreflexia. | 862 | ||
| Assessment | 862 | ||
| Airway. | 863 | ||
| Breathing. | 863 | ||
| Circulation. | 863 | ||
| Neurologic Assessment for Spinal Cord Injury. | 863 | ||
| Diagnostic Procedures. | 863 | ||
| Screening for Spinal Cord Injury. | 863 | ||
| Medical Management | 866 | ||
| Pharmacologic Management. | 866 | ||
| Surgical Management. | 866 | ||
| Laminectomy. | 866 | ||
| Spinal Fusion. | 866 | ||
| Rodding. | 866 | ||
| Nonsurgical Management. | 866 | ||
| Cervical Injury. | 866 | ||
| Thoracolumbar Injury. | 867 | ||
| Nursing Management | 867 | ||
| Cardiovascular Complications. | 867 | ||
| Pulmonary Complications. | 868 | ||
| Musculoskeletal Complications. | 868 | ||
| Integumentary Complications. | 868 | ||
| Elimination Complications. | 868 | ||
| Maximizing Psychosocial Adaptation. | 869 | ||
| Maxillofacial Injuries | 869 | ||
| Mechanism of Injury | 869 | ||
| Maxillofacial Skeletal Injuries. | 869 | ||
| Assessment and Diagnostic Procedures | 869 | ||
| Medical Management | 870 | ||
| Nursing Management | 870 | ||
| Thoracic Injuries | 870 | ||
| Mechanism of Injury | 870 | ||
| Blunt Thoracic Trauma. | 870 | ||
| Penetrating Thoracic Injuries. | 870 | ||
| Specific Thoracic Traumatic Injuries | 870 | ||
| Chest Wall Injuries | 870 | ||
| Rib Fractures. | 870 | ||
| Flail Chest. | 871 | ||
| Ruptured Diaphragm. | 871 | ||
| Pulmonary Injuries | 872 | ||
| Pulmonary Contusion. | 872 | ||
| Tension Pneumothorax. | 872 | ||
| Open Pneumothorax. | 872 | ||
| Hemothorax. | 873 | ||
| Cardiac and Vascular Injuries | 873 | ||
| Penetrating Cardiac Injuries. | 873 | ||
| Cardiac Tamponade. | 873 | ||
| Blunt Cardiac Injuries. | 874 | ||
| Blunt Cardiac Injury. | 874 | ||
| Aortic Injury. | 874 | ||
| Abdominal Injuries | 875 | ||
| Mechanism of Injury | 875 | ||
| Blunt Trauma. | 875 | ||
| Penetrating Trauma. | 875 | ||
| Assessment | 875 | ||
| Physical Assessment. | 875 | ||
| Diagnostic Procedures. | 875 | ||
| Diagnostic Peritoneal Lavage. | 875 | ||
| Bedside Ultrasound. | 876 | ||
| Combined Abdominal Organ Injuries | 876 | ||
| Abdominal Compartment Syndrome. | 877 | ||
| Specific Organ Injuries | 877 | ||
| Liver Injuries. | 877 | ||
| Spleen Injuries. | 878 | ||
| Hollow Viscus Injuries. | 878 | ||
| Genitourinary Injuries | 878 | ||
| Mechanism of Injury | 878 | ||
| Assessment | 878 | ||
| Specific Genitourinary Injuries | 878 | ||
| Kidney Trauma. | 878 | ||
| Bladder Trauma. | 879 | ||
| Nursing Management | 879 | ||
| Pelvic Fractures | 879 | ||
| Mechanism of Injury | 879 | ||
| Assessment | 879 | ||
| Classification of Pelvic Fractures | 879 | ||
| Lateral Compression Pelvic Injury. | 879 | ||
| Anteroposterior Compression Pelvic Injury. | 879 | ||
| Vertical Shear. | 880 | ||
| Open Fractures. | 880 | ||
| Medical Management | 880 | ||
| Nursing Management | 880 | ||
| Complications of Trauma | 880 | ||
| Hypermetabolism | 880 | ||
| Infection | 881 | ||
| Sepsis | 881 | ||
| Pulmonary Complications | 881 | ||
| Respiratory Failure | 881 | ||
| Fat Embolism Syndrome | 881 | ||
| Pain | 881 | ||
| Kidney Complications | 881 | ||
| Acute Kidney Injury | 881 | ||
| Rhabdomyolysis and Myoglobinuria | 882 | ||
| Vascular Complications | 882 | ||
| Compartment Syndrome | 882 | ||
| Venous Thromboembolism | 882 | ||
| Missed Injury | 882 | ||
| Multiple Organ Dysfunction Syndrome | 883 | ||
| Special Considerations | 883 | ||
| Meeting the Needs of Family Members and Significant Others | 883 | ||
| Trauma in the Older Patient | 883 | ||
| Summary | 885 | ||
| Phases of Trauma Care | 885 | ||
| Specific Trauma Injuries | 885 | ||
| References | 885 | ||
| 35 Shock, Sepsis, and Multiple Organ Dysfunction Syndrome | 887 | ||
| Shock Syndrome | 887 | ||
| Description | 887 | ||
| Etiology | 887 | ||
| Pathophysiology | 887 | ||
| Assessment and Diagnosis | 889 | ||
| Medical Management | 890 | ||
| Nursing Management | 891 | ||
| Hypovolemic Shock | 891 | ||
| Description | 891 | ||
| Etiology | 891 | ||
| Pathophysiology | 891 | ||
| Assessment and Diagnosis | 891 | ||
| Medical Management | 893 | ||
| Nursing Management | 893 | ||
| Cardiogenic Shock | 894 | ||
| Description | 894 | ||
| Etiology | 894 | ||
| Pathophysiology | 894 | ||
| Assessment and Diagnosis | 894 | ||
| Medical Management | 896 | ||
| Nursing Management | 896 | ||
| Anaphylactic Shock | 897 | ||
| Description | 897 | ||
| Etiology | 897 | ||
| Pathophysiology | 897 | ||
| Assessment and Diagnosis | 897 | ||
| Medical Management | 899 | ||
| Nursing Management | 900 | ||
| Neurogenic Shock | 900 | ||
| Description | 900 | ||
| Etiology | 902 | ||
| Pathophysiology | 902 | ||
| Assessment and Diagnosis | 902 | ||
| Medical Management | 902 | ||
| Nursing Management | 902 | ||
| Severe Sepsis and Septic Shock | 902 | ||
| Description | 902 | ||
| Etiology | 903 | ||
| Pathophysiology | 903 | ||
| Assessment and Diagnosis | 905 | ||
| Medical Management | 906 | ||
| Nursing Management | 908 | ||
| Multiple Organ Dysfunction Syndrome | 908 | ||
| Description | 908 | ||
| Etiology | 912 | ||
| Pathophysiology | 912 | ||
| Inflammatory Cells | 914 | ||
| Neutrophils. | 914 | ||
| Monocytes and Macrophages. | 914 | ||
| Mast Cells. | 914 | ||
| Lymphocytes. | 914 | ||
| Endothelial Cells. | 914 | ||
| Biochemical Mediators | 915 | ||
| Reactive Oxygen Species. | 915 | ||
| Tumor Necrosis Factor-alpha. | 915 | ||
| Interleukins. | 915 | ||
| Platelet-Activating Factor. | 915 | ||
| Arachidonic Acid Metabolites. | 915 | ||
| Proteases. | 915 | ||
| Assessment and Diagnosis | 916 | ||
| Gastrointestinal Dysfunction | 916 | ||
| Hepatobiliary Dysfunction | 917 | ||
| Pulmonary Dysfunction | 917 | ||
| Kidney Dysfunction | 918 | ||
| Cardiovascular and Hematologic System Dysfunction | 918 | ||
| Medical Management | 918 | ||
| Identification and Treatment of Infection | 918 | ||
| Maintenance of Tissue Oxygenation | 919 | ||
| Nutritional and Metabolic Support | 919 | ||
| Nursing Management | 919 | ||
| Summary | 921 | ||
| Shock | 921 | ||
| Hypovolemic Shock | 921 | ||
| Cardiogenic Shock | 921 | ||
| Anaphylactic Shock | 921 | ||
| Neurogenic Shock | 921 | ||
| Septic Shock | 921 | ||
| Systemic Inflammatory Response | 922 | ||
| Multiple Organ Dysfunction Syndrome | 922 | ||
| References | 922 | ||
| 36 Burns | 926 | ||
| Anatomy and Functions of the Skin | 926 | ||
| Pathophysiology and Etiology of Burn Injury | 927 | ||
| Zones of Injury | 927 | ||
| Classification of Burn Injury | 928 | ||
| Size of Injury | 928 | ||
| Depth of Burn Injury | 928 | ||
| Types of Injury | 931 | ||
| Thermal Burns | 931 | ||
| Electrical Burns | 931 | ||
| Chemical Burns | 931 | ||
| Radiation Burns | 931 | ||
| Location of Injury | 931 | ||
| Patient Age and History | 931 | ||
| Child Abuse | 931 | ||
| Initial Emergency Burn Management | 932 | ||
| Airway Management | 932 | ||
| Respiratory Management | 932 | ||
| Circulatory Management | 932 | ||
| Pathophysiology of Burn Shock | 933 | ||
| Kidney Management | 934 | ||
| Gastrointestinal System Management | 934 | ||
| Extremity Pulse Assessment | 934 | ||
| Laboratory Assessment | 934 | ||
| Wound Care | 934 | ||
| Burn Center Referral | 935 | ||
| Special Management Considerations | 935 | ||
| Inhalation Injury | 935 | ||
| Carbon Monoxide Poisoning | 935 | ||
| Upper Airway Injury | 935 | ||
| Lower Airway Injury | 936 | ||
| Nonthermal Burns | 936 | ||
| Chemical Burns | 936 | ||
| Electrical Burns | 936 | ||
| Burn Nursing Diagnoses and Management | 937 | ||
| Resuscitation Phase | 937 | ||
| Oxygenation Alterations | 937 | ||
| Impaired Gas Exchange. | 937 | ||
| Ineffective Airway Clearance. | 937 | ||
| Fluid Resuscitation | 938 | ||
| Deficient Fluid Volume. | 938 | ||
| Risk for Infection | 938 | ||
| Tissue Perfusion | 939 | ||
| Ineffective Kidney Tissue Perfusion | 939 | ||
| Ineffective Cerebral Tissue Perfusion | 939 | ||
| Ineffective Peripheral Tissue Perfusion | 939 | ||
| Ineffective Gastrointestinal Tissue Perfusion | 940 | ||
| Invasive Monitoring. | 940 | ||
| Hypothermia. | 940 | ||
| Laboratory Assessment. | 940 | ||
| Acute Care Phase | 940 | ||
| Inflammatory Phase | 941 | ||
| Proliferative Phase | 941 | ||
| Maturation Phase | 941 | ||
| Impaired Tissue Integrity | 941 | ||
| Factors Affecting Healing of the Burn Wound | 941 | ||
| Wound Cleansing | 941 | ||
| Wound Care | 941 | ||
| Topical Antibiotic Therapy | 942 | ||
| Wound Débridement | 943 | ||
| Mechanical Débridement. | 943 | ||
| Enzymatic Débridement. | 943 | ||
| Surgical Débridement. | 943 | ||
| Skin Substitutes | 943 | ||
| Definitive Burn Wound Closure | 943 | ||
| Autograft | 944 | ||
| Biosynthetic Skin Substitutes | 945 | ||
| Synthetic Skin | 945 | ||
| Imbalanced Nutrition: Less Than Body Requirements | 945 | ||
| Pain Management | 946 | ||
| Rehabilitation Phase | 946 | ||
| Impaired Physical Mobility | 947 | ||
| Scar Management | 947 | ||
| Itching | 948 | ||
| Multidisciplinary Care | 948 | ||
| Outpatient Burn Care | 948 | ||
| Support of the Burn Patient | 948 | ||
| Stressors of Burn Nursing | 949 | ||
| Summary | 949 | ||
| References | 950 | ||
| 37 Organ Donation and Transplantation | 951 | ||
| Organ Donation | 951 | ||
| Role of the Critical Care Nurse in Organ Donation | 951 | ||
| Organ Procurement Organization as Part of the Health Care Team | 952 | ||
| National Donation and Transplantation Laws | 953 | ||
| The Uniform Anatomical Gift Act | 953 | ||
| Uniform Determination of Death Act | 953 | ||
| National Organ Transplant Act (NOTA) (1984) | 953 | ||
| Omnibus Budget Reconciliation Act | 953 | ||
| Medical Examiner State Laws | 953 | ||
| Overview of the Donation Process | 953 | ||
| Types of Referrals | 954 | ||
| Donation After Brain Death | 954 | ||
| Donation After Cardiac Death | 954 | ||
| Donor Evaluation | 954 | ||
| Brain Death | 955 | ||
| Confirmatory Tests | 955 | ||
| Cerebral Motor Responses. | 955 | ||
| Brainstem Reflexes. | 955 | ||
| Pupillary Reflexes. | 955 | ||
| Oculocephalic Reflex. | 956 | ||
| Oculovestibular Reflex. | 956 | ||
| Corneal and Jaw Reflexes. | 956 | ||
| Gag and Cough Reflexes. | 956 | ||
| Apnea Testing. | 956 | ||
| Donation After Cardiac Death | 956 | ||
| Controlled Donation After Cardiac Death | 956 | ||
| Uncontrolled Donation After Cardiac Death | 956 | ||
| Authorization for Donation | 957 | ||
| Donor Management | 957 | ||
| Organ Allocation | 958 | ||
| Role of the Medical Examiner/Coroner in Organ and Tissue Donation | 958 | ||
| Organ Recovery | 958 | ||
| Tissue Donation | 958 | ||
| Organ Donation Summary | 959 | ||
| Immunology of Transplant Rejection | 959 | ||
| Immune Mechanism | 959 | ||
| Cells of the Immune System | 959 | ||
| Humoral Immunity | 959 | ||
| Cell-Mediated Immunity | 959 | ||
| Cytotoxic T Cells. | 959 | ||
| Helper T Cells. | 960 | ||
| Suppressor T Cells. | 960 | ||
| Other Immune System Defenses | 960 | ||
| Natural Killer Cells. | 960 | ||
| Phagocytes. | 960 | ||
| Complement. | 960 | ||
| Graft Rejection | 960 | ||
| Hyperacute Rejection | 961 | ||
| Acute Rejection | 961 | ||
| Chronic Rejection | 961 | ||
| Immunosuppressive Therapy | 961 | ||
| Corticosteroids | 961 | ||
| Cyclosporine | 963 | ||
| Tacrolimus | 964 | ||
| Azathioprine | 964 | ||
| Mycophenolate Mofetil | 964 | ||
| Sirolimus | 964 | ||
| Everolimus | 965 | ||
| Induction Therapy | 965 | ||
| Antilymphocyte Preparations | 965 | ||
| Antithymocyte Preparations | 965 | ||
| Interleukin-2 Receptor Antagonists | 965 | ||
| Alemtuzumab (Campath 1H) | 966 | ||
| Heart Transplantation | 966 | ||
| Indications and Selection | 966 | ||
| Heart Transplantation Surgical Procedure | 967 | ||
| Biatrial Technique | 967 | ||
| Bicaval Technique | 968 | ||
| Postoperative Medical and Nursing Management | 968 | ||
| Signs and Symptoms of Rejection | 968 | ||
| Rejection Surveillance | 969 | ||
| Infection Surveillance | 969 | ||
| Patient Education | 969 | ||
| Long-Term Considerations | 970 | ||
| Heart–Lung Transplantation | 971 | ||
| Indications and Selection | 971 | ||
| Heart–Lung Transplant Surgical Procedure | 971 | ||
| Postoperative Management | 972 | ||
| Ventilation | 972 | ||
| Fluids | 972 | ||
| Pleural Drainage | 973 | ||
| Ischemia-Reperfusion Injury | 973 | ||
| Rejection Surveillance | 973 | ||
| Infection | 974 | ||
| Immunosuppression | 974 | ||
| Patient Education | 974 | ||
| Long-Term Considerations | 974 | ||
| Bronchiolitis Obliterans Syndrome | 974 | ||
| Co-morbidities | 974 | ||
| Single-Lung and Double-Lung Transplantation | 975 | ||
| Single-Lung Transplantation Indications | 975 | ||
| Single-Lung Transplant Surgical Procedure | 975 | ||
| Double-Lung Transplantation Surgical Procedure | 975 | ||
| Lung Volume Reduction Surgery | 976 | ||
| Living Donor Lung Transplantation | 976 | ||
| Postoperative Management | 976 | ||
| Patient Education | 976 | ||
| Long-Term Considerations | 976 | ||
| Liver Transplantation | 976 | ||
| Indications and Selection | 976 | ||
| Recipient Evaluation | 977 | ||
| Model for End-Stage Liver Disease Formula. | 978 | ||
| Pediatric End-Stage Liver Disease Formula. | 978 | ||
| Pretransplantation Phase | 979 | ||
| Determining Donor Suitability | 979 | ||
| Living Donor Liver Transplantation | 980 | ||
| Living Liver Donor Complications. | 980 | ||
| Donor Advocate. | 980 | ||
| Liver Transplantation Surgical Procedure | 980 | ||
| Recipient Hepatectomy | 980 | ||
| Vascular Anastomoses with a Donor Liver | 980 | ||
| Biliary Anastomosis | 980 | ||
| Postoperative Medical and Nursing Management | 981 | ||
| Hemodynamics | 981 | ||
| Electrolytes | 982 | ||
| Pulmonary Management | 982 | ||
| Coagulopathy Risk | 982 | ||
| Neurologic Status | 982 | ||
| Pain Management | 982 | ||
| Glucose Control | 983 | ||
| Kidney Function | 983 | ||
| Infection Risk | 983 | ||
| Bile Drains | 983 | ||
| Nutrition | 983 | ||
| Liver Function Tests | 983 | ||
| Liver Graft Nonfunction | 983 | ||
| Rejection Surveillance | 983 | ||
| Transfer Out of Critical Care | 984 | ||
| Patient Education | 984 | ||
| Long-Term Follow-Up | 984 | ||
| The Future | 985 | ||
| Kidney Transplantation | 985 | ||
| Indications and Selection | 985 | ||
| Deceased Kidney Donation | 986 | ||
| Living Kidney Donation | 986 | ||
| Living Kidney Paired Donation. | 986 | ||
| Kidney Transplantation Surgical Procedure | 986 | ||
| Living Donor Kidney Transplantation | 986 | ||
| Deceased Donor Kidney Transplantation Surgery | 986 | ||
| Recipient Surgery | 987 | ||
| Postoperative Medical Management and Nursing Care | 987 | ||
| Fluid Status | 987 | ||
| Electrolytes | 988 | ||
| Postoperative Complications | 988 | ||
| Immunosuppression | 988 | ||
| Infection Risk | 988 | ||
| Kidney Graft Nonfunction | 988 | ||
| Preparation for Discharge Home | 988 | ||
| Long-Term Considerations | 988 | ||
| Pancreas Transplantation | 989 | ||
| Indications and Selection | 989 | ||
| Pancreas Transplantation Surgical Procedure | 989 | ||
| Arterial and Venous Revascularization | 989 | ||
| Exocrine Drainage | 990 | ||
| Enteric Exocrine Drainage. | 990 | ||
| Bladder Exocrine Drainage. | 990 | ||
| Postoperative Medical Management and Nursing Care | 990 | ||
| Long-Term Considerations | 991 | ||
| Islet Cell Transplantation | 991 | ||
| Summary | 991 | ||
| Organ Donation | 991 | ||
| Heart Transplantation | 992 | ||
| Lung Transplantation | 992 | ||
| Liver Transplantation | 992 | ||
| Kidney Transplantation | 992 | ||
| Pancreas Transplantation | 992 | ||
| References | 992 | ||
| 38 Hematologic Disorders and Oncologic Emergencies | 997 | ||
| Overview of Coagulation and Fibrinolysis | 997 | ||
| Coagulation Mechanism | 997 | ||
| Clot Formation | 997 | ||
| Regulatory Mechanisms | 997 | ||
| Fibrinolysis | 998 | ||
| Disseminated Intravascular Coagulation | 998 | ||
| Description | 998 | ||
| Etiology | 998 | ||
| Pathophysiology | 998 | ||
| Assessment and Diagnosis | 998 | ||
| Clinical Manifestations | 999 | ||
| Laboratory Findings | 1000 | ||
| Medical Management | 1001 | ||
| Nursing Management | 1002 | ||
| Supporting Patient’s Vital Functions | 1002 | ||
| Initiating Bleeding Precautions | 1002 | ||
| Providing Comfort and Emotional Support | 1003 | ||
| Thrombocytopenia | 1003 | ||
| Description | 1003 | ||
| Etiology | 1003 | ||
| Pathophysiology | 1003 | ||
| Assessment and Diagnosis | 1004 | ||
| Clinical Manifestations | 1004 | ||
| Laboratory Findings | 1004 | ||
| Medical Management | 1004 | ||
| Nursing Management | 1004 | ||
| Heparin-Induced Thrombocytopenia | 1005 | ||
| Description | 1005 | ||
| Etiology | 1005 | ||
| Pathophysiology | 1005 | ||
| Assessment and Diagnosis | 1006 | ||
| Clinical Manifestations | 1006 | ||
| Laboratory Findings | 1006 | ||
| Medical Management | 1006 | ||
| Direct Thrombin Inhibitors | 1006 | ||
| Nursing Management | 1006 | ||
| Decreasing the Incidence of Heparin Exposure | 1006 | ||
| Maintaining Surveillance for Complications | 1007 | ||
| Educating the Patient and Family | 1007 | ||
| Sickle Cell Anemia | 1007 | ||
| Description | 1007 | ||
| Etiology | 1008 | ||
| Pathophysiology | 1008 | ||
| Assessment and Diagnosis | 1008 | ||
| Clinical Manifestations | 1008 | ||
| Laboratory Studies | 1008 | ||
| Medical Management | 1008 | ||
| Prevent Infection | 1009 | ||
| Pain Management | 1009 | ||
| Transfusion Therapy | 1010 | ||
| Administration of Hydroxyurea | 1010 | ||
| Nursing Management | 1010 | ||
| Supporting Patient’s Vital Functions | 1010 | ||
| Maintaining Surveillance for Complications | 1010 | ||
| Educating the Patient and Family | 1010 | ||
| Tumor Lysis Syndrome | 1011 | ||
| Description | 1011 | ||
| Etiology | 1011 | ||
| Pathophysiology | 1011 | ||
| Hyperuricemia | 1012 | ||
| Hyperkalemia | 1012 | ||
| Hyperphosphatemia and Hypocalcemia | 1012 | ||
| Assessment and Diagnosis | 1012 | ||
| Clinical Manifestations | 1012 | ||
| Laboratory Findings | 1012 | ||
| Other Diagnostic Tests | 1013 | ||
| Medical Management | 1013 | ||
| Adequate Hydration | 1013 | ||
| Metabolic Imbalances | 1013 | ||
| Life-Threatening Complications | 1013 | ||
| Nursing Management | 1013 | ||
| Monitoring Fluid and Electrolytes | 1013 | ||
| Maintaining Surveillance for Complications | 1013 | ||
| Educating the Patient and Family | 1013 | ||
| Anemia of Critical Illness | 1014 | ||
| Etiology | 1014 | ||
| Blood Conservation Strategies | 1014 | ||
| Minimizing Blood Loss | 1014 | ||
| Managing Oxygen Delivery and Consumption | 1014 | ||
| Stimulating Production of Red Blood Cells | 1014 | ||
| Encouraging Safer Transfusions and Alternative Agents | 1014 | ||
| Summary | 1015 | ||
| Coagulation and Fibrinolysis | 1015 | ||
| Disseminated Intravascular Coagulation | 1015 | ||
| Idiopathic Thrombocytopenia Purpura | 1015 | ||
| Heparin-Induced Thrombocytopenia | 1015 | ||
| Sickle Cell Anemia | 1015 | ||
| Tumor Lysis Syndrome | 1015 | ||
| Hospital-Acquired Anemia | 1015 | ||
| References | 1016 | ||
| Unit IX Special Populations | 1017 | ||
| 39 The Obstetric Patient | 1017 | ||
| Risks to Fetal Development | 1018 | ||
| Perinatal Infection | 1018 | ||
| Group B Streptococcal Infection | 1018 | ||
| Cytomegalovirus Infection | 1018 | ||
| Toxoplasmosis | 1019 | ||
| Rubella | 1019 | ||
| Herpes Simplex Virus | 1019 | ||
| Prematurity | 1020 | ||
| Physiologic Alterations in Pregnancy | 1020 | ||
| Physiologic Changes during Labor and Delivery | 1021 | ||
| Cardiac Disorders in Pregnancy | 1022 | ||
| Congenital Cardiac Disorders | 1022 | ||
| Atrial Septal Defect | 1022 | ||
| Ventricular Septal Defect | 1022 | ||
| Patent Ductus Arteriosus | 1022 | ||
| Tetralogy of Fallot | 1023 | ||
| Coarctation of the Aorta | 1023 | ||
| Eisenmenger Syndrome | 1023 | ||
| Acquired Cardiac Disorders | 1023 | ||
| Mitral Stenosis | 1023 | ||
| Aortic Stenosis | 1023 | ||
| Marfan Syndrome | 1024 | ||
| Peripartum Cardiomyopathy | 1024 | ||
| Ischemic Cardiac Disease | 1024 | ||
| Acute Myocardial Infarction | 1024 | ||
| Prior Myocardial Infarction | 1024 | ||
| Cardiac Arrest in Pregnancy | 1024 | ||
| Basic Cardiac Life Support. | 1025 | ||
| Advanced Cardiac Life Support. | 1025 | ||
| Hypertensive Disease | 1025 | ||
| Classification of Hypertension | 1026 | ||
| Preeclampsia and Eclampsia | 1026 | ||
| Hemolysis, Elevated Liver Enzymes, and Low Platelet Syndrome | 1027 | ||
| Disseminated Intravascular Coagulation | 1027 | ||
| Abruptio Placentae | 1028 | ||
| Dead Fetus Syndrome | 1028 | ||
| Septic Abortion | 1028 | ||
| Shock | 1028 | ||
| Pulmonary Dysfunction | 1028 | ||
| Asthma | 1029 | ||
| Cystic Fibrosis | 1030 | ||
| Pneumonia | 1030 | ||
| Acute Respiratory Distress Syndrome | 1030 | ||
| Management of Respiratory Failure | 1030 | ||
| Pulmonary Embolism | 1031 | ||
| Amniotic Fluid Embolism | 1032 | ||
| Trauma | 1033 | ||
| Types of Injuries | 1033 | ||
| Cardiovascular Injuries | 1033 | ||
| Pulmonary Injuries | 1033 | ||
| Neurologic Injuries | 1035 | ||
| Abdominal and Pelvic Injuries | 1036 | ||
| Reproductive System Injuries | 1036 | ||
| Fetal Injuries | 1036 | ||
| Postpartum Hemorrhage | 1036 | ||
| Risk Factors and Causes | 1036 | ||
| Prevention | 1037 | ||
| Summary | 1037 | ||
| References | 1038 | ||
| 40 The Pediatric Patient | 1041 | ||
| Respiratory System | 1041 | ||
| Anatomy and Physiology | 1041 | ||
| Upper Airway | 1041 | ||
| Lower Airway | 1042 | ||
| Chest Mechanics | 1042 | ||
| Assessment and Oxygen Devices | 1042 | ||
| Airway Positioning | 1043 | ||
| Supplemental Oxygen Devices | 1044 | ||
| Endotracheal Intubation | 1045 | ||
| Procedure | 1045 | ||
| Securing Endotracheal and Nasotracheal Tubes | 1045 | ||
| Mechanical Ventilation | 1047 | ||
| Extubation Complications | 1047 | ||
| Tracheostomies | 1048 | ||
| Bronchiolitis | 1049 | ||
| Appendix A Nursing Management Plans of Care | 1119 | ||
| Appendix B Physiologic Formulas for Critical Care | 1163 | ||
| Hemodynamic Formulas | 1163 | ||
| Mean (Systemic) Arterial Pressure (MAP) | 1163 | ||
| Systemic Vascular Resistance (SVR) | 1163 | ||
| Systemic Vascular Resistance Index (SVRI) | 1163 | ||
| Pulmonary Vascular Resistance (PVR) | 1163 | ||
| Pulmonary Vascular Resistance Index (PVRI) | 1163 | ||
| Left Cardiac Work Index (LCWI) | 1163 | ||
| Left Ventricular Stroke Work Index (LVSWI) | 1163 | ||
| Right Cardiac Work Index (RCWI) | 1163 | ||
| Right Ventricular Stroke Work Index (RVSWI) | 1163 | ||
| Corrected QT Interval (QTc) | 1163 | ||
| Body Surface Area (BSA) | 1163 | ||
| Pulmonary Formulas | 1164 | ||
| Shunt Equation (Qs/Qt) | 1164 | ||
| Pulmonary Capillary Oxygen Content (Cco2) | 1164 | ||
| Arterial Oxygen Content (CO2) | 1164 | ||
| Venous Oxygen Content (Cvo2) | 1164 | ||
| Alveolar Pressure of Oxygen (Pao2) | 1164 | ||
| Arterial/Inspired Oxygen Ratio | 1165 | ||
| Arterial/Alveolar Oxygen Ratio | 1165 | ||
| Alveolar-Arterial Gradient | 1165 | ||
| Dead Space Equation (Vd/Vt) | 1165 | ||
| Static Compliance (CST) | 1165 | ||
| Dynamic Compliance (CDY) | 1165 | ||
| Neurologic Formulas | 1165 | ||
| Cerebral Perfusion Pressure (CPP) | 1165 | ||
| Arteriojugular Oxygen Difference (Ajdo2) | 1165 | ||
| Endocrine Formulas | 1165 | ||
| Serum Osmolality | 1165 | ||
| Fluid Volume Deficit in Liters | 1165 | ||
| Kidney Formulas | 1165 | ||
| Anion Gap | 1165 | ||
| Clearance | 1165 | ||
| Nutritional Formulas | 1166 | ||
| Resting Metabolic Rate (RMR) | 1166 | ||
| PSU 2003b (Penn State Equation) | 1166 | ||
| PSU 2010 (Modified Penn State Equation) | 1166 | ||
| Mifflin-St. Jeor Equation | 1166 | ||
| Caloric and Protein Needs4 | 1166 | ||
| Estimating Caloric Needs | 1166 | ||
| Estimating Protein Needs | 1166 | ||
| Example of a Calculation of Calorie and Protein Needs | 1166 | ||
| Energy Needs | 1166 | ||
| Protein Needs | 1166 | ||
| References | 1166 | ||
| Index | 1167 | ||
| A | 1167 | ||
| B | 1171 | ||
| C | 1173 | ||
| D | 1177 | ||
| E | 1179 | ||
| F | 1181 | ||
| G | 1182 | ||
| H | 1184 | ||
| I | 1186 | ||
| J | 1188 | ||
| K | 1188 | ||
| L | 1189 | ||
| M | 1190 | ||
| N | 1192 | ||
| O | 1193 | ||
| P | 1194 | ||
| Q | 1199 | ||
| R | 1200 | ||
| S | 1200 | ||
| T | 1203 | ||
| U | 1205 | ||
| V | 1206 | ||
| W | 1207 | ||
| X | 1207 | ||
| Z | 1207 | ||
| Inside Back Cover | ibc1 |