BOOK
AACN Advanced Critical Care Nursing - E-Book Version to be sold via e-commerce site
(2008)
Additional Information
Book Details
Abstract
From AACN experts comes a resource dedicated to helping you oversee or care for critical care patients in any practice setting. This comprehensive critical care nursing textbook addresses serious and potentially life-threatening patient conditions with a foundation rooted in the critical thinking process: the comprehension, analysis, synthesis, and application of knowledge.
- Endorsed by the American Association of Critical-Care Nurses (AACN), the largest specialty nursing organization in the United States, for the most authoritative coverage available.
- Thorough discussions of each body system emphasize advanced concepts, presenting physiology in an application format that examines the clinical implications of physiological science.
- Coverage of assessment focuses on interpreting abnormal findings and linking those findings to diagnosis and intervention.
- Appropriate interventions are discussed from an interdisciplinary, evidence-based perspective.
- Hundreds of new, full-color illustrations and design clarify important concepts and improve the book's usability.
- Complex, unfolding case studies are presented in all disease chapters, accompanied by review questions with a comprehensive answer key.
- Multidisciplinary Plans of Care provide at-a-glance information for common ICU conditions.
- Nutrition boxes appear in each relevant chapter, offering guidelines for patient needs with specific illnesses.
- Research-Based Practice Guidelines boxes and Promoting Evidence-Based Practice features appear throughout the text whenever applicable to present the latest research-supported nursing assessment and intervention practices.
- Drug boxes include common classifications of critical care drugs for specific disorders, including drug, actions, dosage, and special considerations.
- Applying the Technology features help you apply the latest technology to patient care.
- NIC Interventions boxes list NIC intervention labels appropriate for the conditions discussed in a chapter.
Table of Contents
| Section Title | Page | Action | Price |
|---|---|---|---|
| Front Cover | Cover | ||
| AACN Advanced Critical Care Nursing | iii | ||
| Copyright Page | iv | ||
| Dedication Page | v | ||
| Section Editors | ix | ||
| Contributors | x | ||
| Reviewers | xiii | ||
| Preface | xvii | ||
| Introduction | xvii | ||
| Organization | xvii | ||
| Special Features | xvii | ||
| Full-Color Illustrations | xviii | ||
| Evolve | xviii | ||
| Acknowledgments | xx | ||
| Contents | xxi | ||
| Unit 1: Practice in Today's Critical Care Environment | 1 | ||
| Chapter 1: The Critical Care Environment | 3 | ||
| Synergy Model Overview | 4 | ||
| Healthy Work Environment Standards | 4 | ||
| Skilled Communication | 5 | ||
| True Collaboration | 11 | ||
| Effective Decision Making | 12 | ||
| Appropriate Staffing | 14 | ||
| Meaningful Recognition | 16 | ||
| Authentic Leadership | 17 | ||
| Conclusions | 19 | ||
| References | 19 | ||
| Chapter 2: Alternative Settings for Critical Care | 22 | ||
| Moving Critical Care Beyond Traditional Critical Care | 22 | ||
| The Patient's Journey to Progressive Care | 23 | ||
| Progressive Care in the Hospital Setting | 24 | ||
| Out-of-Hospital Venues | 29 | ||
| Skilled Nursing Facilities/Long Term Care Facilities | 29 | ||
| Ambulatory Settings | 30 | ||
| Home Care | 30 | ||
| Conclusions | 31 | ||
| References | 32 | ||
| Chapter 3: Comorbid Conditions | 33 | ||
| Critical Care Predictive Scoring Systems | 33 | ||
| Scoring Systems Defined | 33 | ||
| Comorbidities Within the Scoring Systems | 33 | ||
| Additional Scoring Systems and Their Identified Comorbidities | 34 | ||
| Impact of Comorbidities on Length of Stay and Treatment | 34 | ||
| Comorbidities Used in Scoring Systems | 35 | ||
| Metastatic Cancer/Hematologic Malignancy | 35 | ||
| HIV, AIDS, and Immunosuppression | 36 | ||
| Hepatic Failure and Cirrhosis | 36 | ||
| Renal Insufficiency and End-Stage Renal Disease | 37 | ||
| Other Comorbidities as Predictors of Outcome | 37 | ||
| Respiratory Conditions | 37 | ||
| Cardiovascular Disease | 38 | ||
| Diabetes Mellitus | 39 | ||
| Age | 39 | ||
| Obesity | 40 | ||
| Social and Psychological Comorbidities | 40 | ||
| Care of Patients with Multiple Comorbidities | 40 | ||
| Conclusions | 40 | ||
| References | 41 | ||
| Chapter 4: Pain and Sedation | 44 | ||
| Patients at Risk | 44 | ||
| Acute Versus Chronic Pain | 46 | ||
| Peripheral Versus Central Pain | 47 | ||
| Pain Theory | 47 | ||
| Nociception and Inflammation | 47 | ||
| Response to Pain | 48 | ||
| Stress Response Theory | 49 | ||
| Guidelines Proposed by the Joint Commission on Accreditation of Healthcare Organizations | 50 | ||
| Measuring and Assessing Pain | 52 | ||
| Management of Pain and Discomfort | 58 | ||
| Nonpharmacologic Interventions | 58 | ||
| Pharmacologic Interventions | 63 | ||
| Recognizing and Managing Opioid Side Effects | 68 | ||
| Co-Analgesics | 70 | ||
| Assessment and Management of Sedation | 70 | ||
| Sedating Agents | 77 | ||
| Neuromuscular Blockade | 79 | ||
| Conclusions | 83 | ||
| References | 84 | ||
| Unit 2: Elements of Care | 89 | ||
| Chapter 5: Symptom Management | 91 | ||
| Patients at Risk | 91 | ||
| Nausea and Vomiting | 91 | ||
| Pathophysiology of Nausea and Vomiting | 93 | ||
| Causes Involving the Bowel | 93 | ||
| Causes Involving Toxins | 93 | ||
| Specific Causes | 93 | ||
| Assessment and Treatment | 95 | ||
| Diarrhea | 100 | ||
| Definition | 100 | ||
| Types of Diarrhea | 100 | ||
| Osmotic Diarrhea | 100 | ||
| Malabsorption Diarrhea | 100 | ||
| Secretory Diarrhea | 102 | ||
| Infectious Diarrhea | 102 | ||
| Exudative and Hypermotile Diarrhea | 102 | ||
| Diarrhea as a Side Effect of Medications | 103 | ||
| Diarrhea as the Result of Disease | 103 | ||
| Management | 103 | ||
| Dyspnea | 104 | ||
| Definition | 104 | ||
| Types of Dyspnea | 104 | ||
| Assessment and Management | 105 | ||
| Delirium | 106 | ||
| Definition | 106 | ||
| Types of Delirium | 106 | ||
| Assessment and Management | 107 | ||
| Multidisciplinary Plan of Care | 109 | ||
| Conclusions | 109 | ||
| References | 109 | ||
| Chapter 6: Nutrition | 111 | ||
| Normal and Altered Metabolism | 111 | ||
| Carbohydrate Metabolism | 111 | ||
| Protein Metabolism | 111 | ||
| Lipid Metabolism | 112 | ||
| The Metabolic Response | 112 | ||
| Nutrition Support | 114 | ||
| Total Parenteral Nutrition | 114 | ||
| Enteral Nutrition | 116 | ||
| Nutrition Assessment | 119 | ||
| Indirect Calorimetry | 120 | ||
| Predictive Equations | 120 | ||
| Obesity | 121 | ||
| Overfeeding | 122 | ||
| Protein Needs | 122 | ||
| Serum Proteins | 122 | ||
| Micronutrients | 124 | ||
| Antioxidants and Critical Illness | 124 | ||
| Wound Healing | 125 | ||
| Immunonutrition | 126 | ||
| Multidisciplinary Care | 127 | ||
| Conclusions | 127 | ||
| References | 127 | ||
| Chapter 7: Thermoregulation | 130 | ||
| Physiology of Thermoregulation | 130 | ||
| Fever | 131 | ||
| Definition | 131 | ||
| Patients at Risk | 132 | ||
| Pathophysiology | 132 | ||
| Fever Management | 134 | ||
| Hypothermia | 136 | ||
| Patients at Risk | 136 | ||
| Definition | 137 | ||
| Pathophysiology | 137 | ||
| Multidisciplinary Plan of Care | 137 | ||
| Hyperthermia | 140 | ||
| Patients at Risk | 140 | ||
| Definition | 141 | ||
| Pathophysiology | 141 | ||
| Multidisciplinary Plan of Care | 142 | ||
| Conclusions | 143 | ||
| References | 143 | ||
| Chapter 8: Families in Critical Care | 145 | ||
| Theoretical Foundations for Family-Centered Critical Care | 146 | ||
| Chaos/Complexity Theory | 146 | ||
| Theory of Human Relatedness | 146 | ||
| Family Systems Theory | 147 | ||
| Role Theories | 147 | ||
| Crisis Theory | 150 | ||
| Maslow's Theory of the Hierarchy of Needs | 150 | ||
| Evidence-Based Care for Families of the Critically Ill | 151 | ||
| Family Needs | 151 | ||
| Family Presence | 152 | ||
| Family-Centered Interventions and Outcomes | 152 | ||
| Implementing Family-Centered Critical Care | 153 | ||
| Unit and Organizational Assessment | 153 | ||
| Strategies and Tools for Implementing Family-Centered Care | 154 | ||
| Evaluation of Outcomes | 155 | ||
| Conclusions | 156 | ||
| References | 157 | ||
| Chapter 9: Improving Outcomes Through Prophylaxis | 158 | ||
| Rapid Response Teams | 158 | ||
| Venous Thromboembolism | 159 | ||
| Stress-Related Erosive Syndrome | 161 | ||
| Bloodstream Infection Related to Central Lines | 162 | ||
| Ventilator-Associated Pneumonia | 164 | ||
| Definition | 164 | ||
| Patient Outcomes of VAP | 165 | ||
| Ventilator Bundle of Care | 165 | ||
| Conclusions | 167 | ||
| References | 167 | ||
| Unit 3: Cardiac | 171 | ||
| Chapter 10: Advanced Dysrhythmias | 173 | ||
| The Cardiac Action Potential | 173 | ||
| Normal Cardiac Cell Function | 173 | ||
| Action Potential of Ventricular Muscle Cells | 173 | ||
| Action Potential of Pacemaker Cells | 174 | ||
| Ionic Channels and Pumps | 174 | ||
| Implications for Patient Care | 175 | ||
| Dysrhythmogenic Mechanisms | 176 | ||
| Alterations in Impulse Formation | 176 | ||
| Alterations in Impulse Conduction | 183 | ||
| Supraventricular Tachycardias | 184 | ||
| Wolff-Parkinson-White Syndrome | 184 | ||
| Atrioventricular Nodal Reentry Tachycardia | 185 | ||
| AV Reciprocating Tachycardia | 187 | ||
| Clinical Presentation of AVNRT and AVRT | 188 | ||
| Management of AVNRT and AVRT | 188 | ||
| Ventricular Tachycardias | 189 | ||
| Monomorphic Ventricular Tachycardia | 189 | ||
| Polymorphic Ventricular Tachycardia | 190 | ||
| Disorders of Repolarization | 192 | ||
| The QT Interval | 192 | ||
| Long QT Syndrome | 192 | ||
| Brugada Syndrome | 194 | ||
| Aberrancy Versus Ectopy | 195 | ||
| Mechanisms of Aberrancy | 195 | ||
| General Principles of Diagnosis | 195 | ||
| Digitalis Toxicity | 196 | ||
| Digitalis Dysrhythmias | 196 | ||
| Management of Digitalis Dysrhythmias | 199 | ||
| Atrial Fibrillation | 199 | ||
| Electrophysiologic Features | 199 | ||
| Management of Atrial Fibrillation | 200 | ||
| Heart Rate Variability | 202 | ||
| Measurement | 202 | ||
| Clinical Significance | 202 | ||
| Monitoring in Critical Care | 202 | ||
| Accurate Lead Placement | 202 | ||
| Choosing a Monitoring Lead | 202 | ||
| Conclusions | 203 | ||
| References | 203 | ||
| Chapter 11: Acute Coronary Syndromes | 207 | ||
| Pathophysiology | 207 | ||
| Patients At Risk | 209 | ||
| Classic (Stable) Angina | 210 | ||
| Physical Assessment | 210 | ||
| Laboratory Tests | 210 | ||
| Other Diagnostic Tests | 211 | ||
| Unstable Angina and Non-St Segment Elevation Myocardial Infarction | 212 | ||
| Multidisciplinary Plan of Care | 213 | ||
| Anti-Ischemic Nursing Interventions and Bedside Monitoring | 213 | ||
| Anti-Ischemic Medication Therapy | 216 | ||
| Antiplatelet and Anticoagulation Therapy | 219 | ||
| Preventive Nursing Interventions | 221 | ||
| Revascularization Therapy | 222 | ||
| Nursing Interventions for Patients Treated With Percutaneous Coronary Interventions | 223 | ||
| St Segment Elevation Myocardial Infarction | 226 | ||
| Physical and Laboratory Assessment | 226 | ||
| Other Diagnostic Tests | 226 | ||
| Reperfusion Therapy | 226 | ||
| Pharmacologic Reperfusion Therapy | 227 | ||
| Interventional Reperfusion Therapy | 229 | ||
| Complications of STEMI | 229 | ||
| Emergency Interventions | 231 | ||
| Prevention of Coronary Artery Disease | 233 | ||
| Lipid Management | 233 | ||
| Smoking Cessation | 233 | ||
| Blood Pressure Control | 234 | ||
| General Preventive Interventions | 234 | ||
| Conclusions | 234 | ||
| References | 234 | ||
| Chapter 12: Heart Failure | 237 | ||
| Prevention of Acute Decompensated Heart Failure | 237 | ||
| Definition | 237 | ||
| Pathophysiology of Heart Failure | 238 | ||
| Pathophysiology of Acute Decompensation in the Setting of Chronic Heart Failure | 245 | ||
| Stages and Types of Heart Failure | 245 | ||
| Patients at Risk | 247 | ||
| Assessment | 249 | ||
| Multidisciplinary Plan of Care | 252 | ||
| Pharmacologic Therapy: Acute Management | 254 | ||
| Diuretics | 257 | ||
| Vasodilators | 257 | ||
| Inotropic Agents | 258 | ||
| Other Vasoactive Agents | 259 | ||
| Device Therapy | 259 | ||
| Managing Comorbidities | 261 | ||
| Assessing Stability for Hospital Discharge | 262 | ||
| Pharmacologic Therapy: Chronic Management | 262 | ||
| Nonpharmacologic Therapy | 263 | ||
| Heart Failure Disease Management | 266 | ||
| Conclusions | 270 | ||
| References | 270 | ||
| Chapter 13: Heart Disease in Women | 276 | ||
| Primary Prevention | 276 | ||
| Assess Risk | 277 | ||
| Lower Risk With Lifestyle Changes | 279 | ||
| Other Risk-Reducing Interventions | 280 | ||
| Highest Risk Priority Interventions | 281 | ||
| Avoid Unhelpful Interventions | 281 | ||
| Depression | 282 | ||
| Applied Pathophysiology | 285 | ||
| Vessel Size | 285 | ||
| Plaque | 285 | ||
| Endothelial Integrity | 285 | ||
| Lipids, Apolipoproteins, and Lipoproteins | 286 | ||
| Hormones | 286 | ||
| Presentation | 286 | ||
| Angina With \"Normal\" Coronary Arteries | 287 | ||
| Assessment | 287 | ||
| Interventions | 289 | ||
| Medications | 290 | ||
| Hormone Replacement Therapy | 291 | ||
| Percutaneous Coronary Interventions | 291 | ||
| Coronary Artery Bypass Surgery | 292 | ||
| Conclusions | 292 | ||
| References | 292 | ||
| Chapter 14: Cardiac Surgery | 297 | ||
| Coronary Artery Bypass Grafting | 297 | ||
| Indications | 297 | ||
| Selection of Conduits | 297 | ||
| Surgical Procedure | 299 | ||
| Cardiopulmonary Bypass | 300 | ||
| Off-Pump\" Surgery | 301 | ||
| Transmyocardial Revascularization | 302 | ||
| Indications | 303 | ||
| Unit 4: Pulmonary | 445 | ||
| Chapter 19: Acute Respiratory Failure and Acute Lung Injury | 447 | ||
| Definition | 447 | ||
| Mechanism of Hypoxemic Acute Respiratory Failure | 447 | ||
| Ventilation/Perfusion Mismatching | 447 | ||
| Intrapulmonary Shunt | 447 | ||
| Alveolar Hypoventilation | 448 | ||
| Impaired Diffusion | 448 | ||
| Low Partial Pressure of Inspired Oxygen | 449 | ||
| Mechanisms of Hypercapnic Acute Respiratory Failure | 449 | ||
| Acute Lung Injury/Acute Respiratory Distress Syndrome | 453 | ||
| Epidemiology and Risk of Acute•Lung Injury/Acute Respiratory Distress Syndrome | 453 | ||
| Pathophysiology of Acute Lung Injury/Acute Respiratory Distress Syndrome | 454 | ||
| Physical Assessment Findings | 456 | ||
| Diagnostic Evaluations | 457 | ||
| Laboratory and Microbiology Studies | 458 | ||
| Multidisciplinary Plan of Care | 458 | ||
| Mechanical Ventilation | 458 | ||
| Positive End-Expiratory Pressure | 461 | ||
| Permissive Hypercapnia | 461 | ||
| Inverse Ratio Ventilation | 461 | ||
| Recruitment Maneuvers | 461 | ||
| High-Frequency Oscillatory Ventilation | 461 | ||
| Inhaled Nitric Oxide | 461 | ||
| Liquid Ventilation | 462 | ||
| Other Interventions | 462 | ||
| Noninvasive Positive Pressure Ventilation | 462 | ||
| Prone Positioning | 462 | ||
| Medication/Fluid Use in ALI/ARDS | 463 | ||
| Resolution of Acute Lung Injury and Acute Respiratory Distress Syndrome | 465 | ||
| Conclusions | 466 | ||
| References | 466 | ||
| Chapter 20: Mechanical Ventilation and \nWeaning | 469 | ||
| Volume Versus Pressure Modes | 469 | ||
| Characteristics of Volume Ventilation | 469 | ||
| Characteristics of Pressure Ventilation | 470 | ||
| Volume Versus Pressure Modes: the Science | 471 | ||
| Ventilating the Noncompliant Lung | 471 | ||
| Ventilating Patients With Severe Airflow Limitation | 472 | ||
| Permissive Hypercarbia | 473 | ||
| Ventilator Parameters | 473 | ||
| Invasive Modes of Ventilation | 473 | ||
| Volume Modes | 473 | ||
| Pressure Modes | 475 | ||
| Volume-Guaranteed Pressure Modes | 475 | ||
| High-Frequency Oscillation | 477 | ||
| Noninvasive Ventilator Modes | 477 | ||
| CPAP | 477 | ||
| BiPAP | 477 | ||
| Respiratory Waveform Monitoring | 478 | ||
| Pressure-Time and Flow-Time Waveforms | 478 | ||
| Pressure-Volume Loops | 480 | ||
| Flow-Volume Loops | 481 | ||
| Additional Uses of Respiratory Waveforms | 481 | ||
| Weaning from Mechanical Ventilation | 481 | ||
| Assessment | 483 | ||
| Respiratory Muscle Fatigue, Rest, Work, and Conditioning | 484 | ||
| Modes and Methods | 486 | ||
| Components of Weaning Protocols | 486 | ||
| Criteria for Entry (\"Wean Screen\") | 486 | ||
| Timing of Tracheostomy and Weaning Trials | 488 | ||
| Multidisciplinary Plan of Care | 488 | ||
| Conclusions | 489 | ||
| References | 489 | ||
| Chapter 21: Thoracic Surgery | 493 | ||
| Thoracic Surgeries | 493 | ||
| Pulmonary Resection | 493 | ||
| Indications | 493 | ||
| Diagnostic Evaluation | 494 | ||
| Preoperative Evaluation | 495 | ||
| Approaches and Procedures | 496 | ||
| Wedge Resection | 496 | ||
| Segmentectomy | 500 | ||
| Lobectomy | 500 | ||
| Pneumonectomy | 501 | ||
| Pleural Surgery | 503 | ||
| Problems of the Pleural Space | 504 | ||
| Pleural Space Procedures | 505 | ||
| Mediastinal Disease | 506 | ||
| Diaphragmatic Surgery | 506 | ||
| Diaphragmatic Abnormalities | 507 | ||
| Chest Wall Disorders | 507 | ||
| Complications of Thoracic Surgery | 507 | ||
| Intraoperative | 507 | ||
| Postoperative | 508 | ||
| Pulmonary Complications | 508 | ||
| Cardiac Complications | 511 | ||
| Neurologic Complications | 511 | ||
| Other Complications | 511 | ||
| Multidisciplinary Care | 512 | ||
| Principles of Care | 512 | ||
| Preoperative Preparation | 512 | ||
| Intraoperative Management | 513 | ||
| Chest Drainage Management | 513 | ||
| Pain Management | 514 | ||
| Nutrition | 514 | ||
| Mechanical Ventilation | 517 | ||
| Respiratory Care | 517 | ||
| Mobilization | 517 | ||
| Critical Pathway | 517 | ||
| Esophageal Surgeries | 519 | ||
| Esophageal Disease | 519 | ||
| Esophageal Cancer | 519 | ||
| Diagnosis | 520 | ||
| Esophageal Resection Procedures | 520 | ||
| Preoperative Evaluation | 520 | ||
| Preoperative Preparation | 522 | ||
| Postoperative Care | 522 | ||
| Complications Related to Esophageal Surgery | 523 | ||
| Other Esophageal Surgery | 524 | ||
| Conclusions | 524 | ||
| References | 524 | ||
| Unit 5: Nervous System | 527 | ||
| Chapter 22: Head Injury and Dysfunction | 529 | ||
| Applied Physiology | 529 | ||
| Cerebral Hemodynamics | 530 | ||
| Mechanism of Injury | 531 | ||
| Types of Traumatic Brain Injury | 533 | ||
| Focal Injuries | 533 | ||
| Skull Fractures | 533 | ||
| Contusions | 535 | ||
| Hematomas | 536 | ||
| Diffuse Injuries | 538 | ||
| Pathophysiology | 539 | ||
| Ischemia | 539 | ||
| Impaired Metabolism | 540 | ||
| Inflammatory Factors | 541 | ||
| Types of Cerebral Edema | 542 | ||
| Intracranial Pressure and Cerebral Perfusion | 544 | ||
| Herniation | 545 | ||
| Multidisciplinary Plan of Care for the Traumatic Brain Injury Patient | 546 | ||
| Prehospital Phase | 546 | ||
| Early Hospital Management | 546 | ||
| Continued Critical Care Management | 547 | ||
| Rehabilitation | 548 | ||
| Monitoring | 548 | ||
| Intracranial Pressure Monitoring | 548 | ||
| Neuroimaging | 549 | ||
| Cerebral Oxygen Monitoring | 552 | ||
| Microdialysis | 553 | ||
| Continuous Electroencephalography | 553 | ||
| Treatment of Traumatic Brain Injury | 555 | ||
| Management of Hypoxia and Hypotension | 555 | ||
| Management of Intracranial Pressure | 555 | ||
| First-Level Approaches for Intracranial Pressure Management | 556 | ||
| Second-Level Approaches for Intracranial Pressure Management | 559 | ||
| Strategies for Neuroprotection | 562 | ||
| Complications After Traumatic Brain Injury | 562 | ||
| Immunosuppression | 562 | ||
| Coagulopathy | 562 | ||
| Electrolyte Disturbances | 562 | ||
| Volume Depletion | 564 | ||
| Metabolic Response | 565 | ||
| Infectious Complications | 565 | ||
| Pulmonary Complications | 567 | ||
| Complications Related to Immobility | 567 | ||
| Seizures | 567 | ||
| Other Medications Used for Traumatic Brain Injury | 568 | ||
| Lidocaine | 568 | ||
| Furosemide | 568 | ||
| Steroids | 568 | ||
| Outcomes | 569 | ||
| Conclusions | 569 | ||
| References | 570 | ||
| Chapter 23: Cerebrovascular Disorders | 576 | ||
| Patients At Risk | 576 | ||
| Stroke Across the Life Continuum | 577 | ||
| Prevention | 578 | ||
| Definition | 578 | ||
| Pathophysiology | 580 | ||
| Ischemic Stroke | 580 | ||
| Subarachnoid Hemorrhage | 582 | ||
| Intracerebral Hemorrhage | 586 | ||
| Assessment | 589 | ||
| Laboratory Findings | 590 | ||
| Radiographic Findings | 593 | ||
| Management | 599 | ||
| Initial Management | 599 | ||
| Critical Care Management | 599 | ||
| Ischemic Stroke | 615 | ||
| Subarachnoid Hemorrhage | 619 | ||
| Intracerebral Hemorrhage | 626 | ||
| Evidence-Based Care | 627 | ||
| Ethical Considerations | 628 | ||
| Conclusions | 628 | ||
| References | 628 | ||
| Chapter 24: Spinal Cord Injury | 637 | ||
| Patients at Risk | 637 | ||
| Prevention | 637 | ||
| Definition | 637 | ||
| Applied Pathophysiology | 641 | ||
| Assessment | 650 | ||
| Management | 656 | ||
| Critical Care Management | 660 | ||
| Neurologic | 661 | ||
| Pulmonary | 666 | ||
| Cardiac | 668 | ||
| Gastrointestinal | 668 | ||
| Genitourinary | 670 | ||
| Endocrine | 671 | ||
| Musculoskeletal | 671 | ||
| Integumentary | 673 | ||
| Pain | 673 | ||
| Psychosocial | 673 | ||
| Evidence-Based Care | 675 | ||
| Research | 675 | ||
| Outcomes | 675 | ||
| Ethical Considerations | 677 | ||
| Conclusions | 677 | ||
| References | 678 | ||
| Chapter 25: Special Neurologic Patient Populations | 681 | ||
| Neurodiagnostic Testing | 681 | ||
| Computed Tomography Scan | 681 | ||
| Computed Tomography Angiography | 687 | ||
| Magnetic Resonance Scan | 688 | ||
| Cerebral Angiogram | 688 | ||
| Positron Emission Tomography Scan | 688 | ||
| Single Photon Emission Computed Tomography Scan | 688 | ||
| Electroencephalogram | 688 | ||
| Electromyography, Nerve Conduction Studies, and Neuromuscular Junction Studies | 689 | ||
| Evoked Potentials | 689 | ||
| Seizure Disorders | 689 | ||
| Status Epilepticus | 689 | ||
| Other Seizure-Related Admissions to Critical Care | 695 | ||
| Brain Tumors | 696 | ||
| Incidence and Classification | 697 | ||
| Clinical Presentation and Diagnosis | 697 | ||
| Management and Treatment | 700 | ||
| Infections of the Central Nervous System | 705 | ||
| Meningitis | 705 | ||
| Encephalitis | 708 | ||
| Brain Abscess | 708 | ||
| Neurocysticercosis | 710 | ||
| Creutzfeldt-Jakob Disease | 712 | ||
| Ventriculostomy-Related Infections | 714 | ||
| Neuromuscular Disorders | 715 | ||
| Myasthenia Gravis | 715 | ||
| Guillain-Barreacute Syndrome | 717 | ||
| Critical Illness Polyneuropathy/Myopathy | 720 | ||
| Therapeutic Hypothermia After Cardiac Arrest | 721 | ||
| Determination of Death by Neurologic Criteria | 722 | ||
| Multidisciplinary Plan of Care | 727 | ||
| Conclusions | 727 | ||
| References | 727 | ||
| Unit 6: Gastrointestinal | 735 | ||
| Chapter 26: Gastrointestinal Bleeding | 737 | ||
| Applied Physiology and Pathophysiology | 737 | ||
| Prevention | 741 | ||
| Assessment | 743 | ||
| Physical Assessment Findings | 743 | ||
| Laboratory Findings | 745 | ||
| Radiology Findings | 746 | ||
| Diagnostic Evaluations | 746 | ||
| Multidisciplinary Plan of Care | 747 | ||
| Conclusions | 751 | ||
| References | 751 | ||
| Chapter 27: Liver Dysfunction and Failure | 754 | ||
| Acute Liver Failure | 754 | ||
| Acute-On-Chronic Liver Dysfunction and Failure | 754 | ||
| Applied Physiology | 755 | ||
| Cirrhosis | 756 | ||
| Hepatic Encephalopathy | 759 | ||
| Multidisciplinary Plan of Care | 768 | ||
| Referral/Listing for Liver Transplantation | 769 | ||
| Liver Support Devices | 770 | ||
| Conclusions | 771 | ||
| References | 771 | ||
| Chapter 28: Pancreatitis | 774 | ||
| Definition | 774 | ||
| Patients at Risk | 774 | ||
| Applied Physiology | 776 | ||
| Assessment of Severity and Early Risk Stratification | 778 | ||
| Laboratory Findings | 779 | ||
| Radiology Findings | 780 | ||
| Complications of Acute Pancreatitis | 781 | ||
| Cardiopulmonary Complications | 781 | ||
| Pulmonary Complications | 782 | ||
| Renal Complications | 782 | ||
| Gastrointestinal Complications | 782 | ||
| Hematologic and Coagulation Derangements | 782 | ||
| Multiple Organ Dysfunction Syndrome | 782 | ||
| Local and Systemic Infectious Complications | 783 | ||
| Multidisciplinary Plan of Care | 783 | ||
| Conclusions | 790 | ||
| References | 790 | ||
| Chapter 29: The Gut in Critical Illness | 792 | ||
| Normal Gastrointestinal Physiology | 792 | ||
| Alterations to Normal Gastrointestinal Physiology in Critical Illness | 792 | ||
| Gastrointestinal Mucosal Hypoperfusion | 792 | ||
| Gastric Tonometry | 796 | ||
| Historical Development | 796 | ||
| Principles of Gastric Tonometry | 796 | ||
| Physiologic Underpinnings of Gastric Tonometry | 796 | ||
| Physiologic Influences on the Measurement of Carbon Dioxide Within the Tonometer Balloon | 797 | ||
| Clinical Evaluation of Tonometrically Derived Measurements | 797 | ||
| Technical Limitations of Gastric Tonometry | 800 | ||
| Procedural Errors | 800 | ||
| Semi-Continuous Measurement of Ptco2 | 800 | ||
| Stress-Related Mucosal Disease in Critically Ill Patients | 802 | ||
| Prevalence | 802 | ||
| Pathophysiology | 802 | ||
| Risk Factors | 803 | ||
| Stress-Related Mucosal Disease: Prophylaxis | 803 | ||
| Antacids | 805 | ||
| Histamine-2 Receptor Antagonists | 805 | ||
| Proton Pump Inhibitors | 805 | ||
| Sucralfate | 806 | ||
| Enteral Nutrition | 806 | ||
| Abdominal Compartment Syndrome | 806 | ||
| Etiology | 806 | ||
| Pathophysiology | 806 | ||
| Measurement of Intra-Abdominal Pressure | 807 | ||
| Management of Abdominal Compartment Syndrome | 810 | ||
| Multidisciplinary Plan of Care | 812 | ||
| References | 814 | ||
| Chapter 30: Liver, Kidney, and Pancreas Transplantation | 818 | ||
| Liver Recipient Before Transplant | 818 | ||
| Liver Transplantation | 819 | ||
| Types of Liver Donors | 819 | ||
| Preoperative Care | 820 | ||
| Postoperative Care | 820 | ||
| Primary Graft Nonfunction | 820 | ||
| Assessment of the Liver Transplant Patient | 827 | ||
| Liver and Kidney Transplantation | 828 | ||
| Multidisciplinary Plan of Care | 828 | ||
| Conclusions | 832 | ||
| Renal Transplantation | 832 | ||
| Patients at Risk | 832 | ||
| Postoperative Care | 832 | ||
| Kidney-Pancreas or Pancreas-Only Transplantation | 834 | ||
| Patients at Risk | 834 | ||
| Postoperative Complications | 835 | ||
| Assessment | 836 | ||
| Multidisciplinary Plan of Care | 836 | ||
| Hospitalizations for Nontransplant Concerns | 836 | ||
| Conclusions | 836 | ||
| References | 836 | ||
| Unit 7: Renal | 839 | ||
| Chapter 31: Electrolyte Emergencies | 841 | ||
| Applied Physiology | 841 | ||
| Multidisciplinary Plan of Care | 842 | ||
| Potassium | 842 | ||
| Applied Physiology | 842 | ||
| Hyperkalemia | 843 | ||
| Hypokalemia | 846 | ||
| Sodium | 849 | ||
| Applied Physiology and Pathophysiology | 849 | ||
| Hypernatremia | 850 | ||
| Hyponatremia | 851 | ||
| Calcium | 854 | ||
| Applied Physiology and Pathophysiology | 854 | ||
| Hypercalcemia | 856 | ||
| Hypocalcemia | 857 | ||
| Magnesium | 859 | ||
| Applied Physiology and Pathophysiology | 859 | ||
| Hypermagnesemia | 859 | ||
| Hypomagnesemia | 860 | ||
| Phosphorus | 861 | ||
| Applied Physiology and Pathophysiology | 861 | ||
| Hyperphosphatemia | 861 | ||
| Hypophosphatemia | 862 | ||
| Conclusions | 863 | ||
| References | 863 | ||
| Chapter 32: Complex Acid-Base Disorders and Associated Electrolyte Imbalances | 865 | ||
| Patients At Risk | 865 | ||
| Acid-Base Physiology | 865 | ||
| Definitions and Normal Values | 865 | ||
| Understanding Compensation | 866 | ||
| Application of Acid-Base Principles | 866 | ||
| The Anion Gap | 867 | ||
| Primary Acid-Base Disorders | 869 | ||
| Metabolic Acidosis | 869 | ||
| Causes of Metabolic Acidosis | 870 | ||
| Manifestations of Metabolic Acidosis | 871 | ||
| Electrolyte Imbalances Associated With Metabolic Acidosis | 872 | ||
| Treatment of Metabolic Acidosis | 872 | ||
| Metabolic Alkalosis | 876 | ||
| Causes of Metabolic Alkalosis | 876 | ||
| Manifestations of Metabolic Alkalosis | 877 | ||
| Electrolyte Imbalances Associated With Metabolic Alkalosis | 877 | ||
| Treatment of Metabolic Alkalosis | 879 | ||
| Respiratory Acidosis | 880 | ||
| Causes of Respiratory Acidosis | 880 | ||
| Manifestations of Respiratory Acidosis | 880 | ||
| Treatment of Respiratory Acidosis | 880 | ||
| Respiratory Alkalosis | 881 | ||
| Causes of Respiratory Alkalosis | 881 | ||
| Manifestations of Respiratory Alkalosis | 882 | ||
| Treatment of Respiratory Alkalosis | 882 | ||
| Mixed Acid-Base Disorders | 882 | ||
| Conclusions | 884 | ||
| References | 884 | ||
| Chapter 33: Acute Renal Failure | 886 | ||
| Prevention of Renal Failure | 886 | ||
| Definition | 887 | ||
| Applied Pathophysiology | 888 | ||
| Types of Renal Failure | 888 | ||
| Prerenal Renal Failure | 889 | ||
| Intrarenal Renal Failure | 891 | ||
| Postrenal Renal Failure | 892 | ||
| Assessment | 892 | ||
| Uremic Complications | 893 | ||
| Cardiovascular Manifestations | 893 | ||
| Respiratory Manifestations | 894 | ||
| Hematologic Manifestations | 894 | ||
| Gastrointestinal Manifestations | 894 | ||
| Neurologic Manifestations | 895 | ||
| Interventions | 895 | ||
| Fluid Balance | 895 | ||
| Alterations in Electrolyte Balance | 901 | ||
| Metabolic Acidosis | 901 | ||
| Renal Replacement | 901 | ||
| Peritoneal Dialysis | 901 | ||
| Hemodialysis | 902 | ||
| Continuous Renal Replacement Therapies | 903 | ||
| Nutrition in Acute Renal Failure with Renal Replacement Therapy | 909 | ||
| Multidisciplinary Plan of Care | 910 | ||
| Conclusions | 911 | ||
| References | 911 | ||
| Unit 8: Endocrine | 913 | ||
| Chapter 34: Glycemic Control | 915 | ||
| Patients At Risk | 916 | ||
| Definition | 916 | ||
| Classification of Diabetes Mellitus | 917 | ||
| Physiology of Glucose Metabolism | 917 | ||
| Functions of the Pancreatic Hormones | 919 | ||
| Pathophysiology of Diabetes Mellitus and Hyperglycemia | 920 | ||
| Acute Complications of Diabetes Mellitus | 921 | ||
| Diabetic Ketoacidosis | 921 | ||
| Causes or Precipitating Factors of Diabetic Ketoacidosis | 921 | ||
| Hyperosmolar Hyperglycemic Nonketotic Syndrome | 926 | ||
| Hypoglycemia | 932 | ||
| Hyperglycemia | 933 | ||
| References | 937 | ||
| Chapter 35: Pituitary, Thyroid, and Adrenal Disorders | 939 | ||
| Applied Pathophysiology | 939 | ||
| Disorders of Antidiuretic Hormone | 942 | ||
| Diabetes Insipidus | 942 | ||
| Syndrome of Inappropriate Antidiuretic Hormone | 946 | ||
| Thyroid Gland Disorders | 950 | ||
| Hyperthyroidism (Thyrotoxicosis/Thyroid Storm) | 950 | ||
| Hypothyroidism and Myxedema Coma | 956 | ||
| Adrenal Insuffiency in Critical Illness | 957 | ||
| Definition of Adrenal Insufficiency | 957 | ||
| References | 964 | ||
| Unit 9: Hematologic | 967 | ||
| Chapter 36: Blood Conservation and Blood Component Replacement | 969 | ||
| Controversies in Transfusion | 969 | ||
| Blood Conservation | 970 | ||
| Increasing Erythropoiesis | 971 | ||
| Minimizing Perioperative and Iatrogenic Blood Loss | 971 | ||
| Optimizing Hemostasis and Blood Transfusion Practices | 971 | ||
| Alternatives To Transfusion | 971 | ||
| Recombinant Human Erythropoietin | 971 | ||
| Vitamin K | 971 | ||
| Recombinant Activated Factor VIIa | 971 | ||
| Blood Component Review | 975 | ||
| Whole Blood | 976 | ||
| Red Blood Cells | 977 | ||
| Fresh Frozen Plasma | 977 | ||
| Thawed Plasma | 978 | ||
| Cryoprecipitate | 978 | ||
| Platelets | 978 | ||
| Apheresis Platelets | 979 | ||
| Pooled Platelets | 979 | ||
| Granulocytes | 979 | ||
| Blood Component Modification | 980 | ||
| Leukocyte Reduction | 980 | ||
| Plasma Volume Reduction | 981 | ||
| Cytomegalovirus-Negative Components | 981 | ||
| Gamma Irradiation | 981 | ||
| Artificial Red Blood Cell Substitutes (Modified Hgb Blood Substitutes, Perfluorochemicals) | 981 | ||
| Hemoglobin-Based Oxygen Carriers | 981 | ||
| Perfluorochemicals | 981 | ||
| Considerations in Blood Transfusion | 981 | ||
| ABO/Rh Compatibility | 981 | ||
| Rhesus (Rh) System | 982 | ||
| Autologous Transfusion | 982 | ||
| Preoperative Autologous Donation | 982 | ||
| Perioperative Blood Salvage | 982 | ||
| Acute Normovolemic Hemodilution | 982 | ||
| Postoperative Blood Collection | 983 | ||
| Directed Donor Transfusion | 983 | ||
| Massive Transfusions | 983 | ||
| Use of Blood Warmers | 983 | ||
| Adverse Effects Related To Transfusion of Blood Components | 984 | ||
| Transfusion-Related Acute Bacteremia/Bacterial Contamination | 985 | ||
| Transfusion-Associated Graft-Versus-Host Disease | 985 | ||
| Delayed Hemolytic Transfusion Reaction | 985 | ||
| Febrile Nonhemolytic Transfusion Reaction | 985 | ||
| Allergic Transfusion Reactions | 988 | ||
| Nonimmune-Related Hemolysis Transfusion Reaction | 988 | ||
| Acute Hemolytic Transfusion Reaction | 989 | ||
| Other Blood-Related Issues | 991 | ||
| Red Blood Cell Storage Lesion | 991 | ||
| 2,3-Diphosphoglyceric Acid and Adenosine Triphosphate | 991 | ||
| Red Blood Cell Deformability | 991 | ||
| Red Blood Cell Adhesion | 991 | ||
| Transfusion-Related Immune Modulation | 991 | ||
| Transfusion-Related Acute Lung Injury | 991 | ||
| Post-Transfusion Purpura | 992 | ||
| Disease Transmission | 993 | ||
| Conclusions | 993 | ||
| References | 993 | ||
| Chapter 37: Coagulopathies | 995 | ||
| Normal Hemostasis and the Pathways to a Clot | 995 | ||
| Disseminated Intravascular Coagulation | 998 | ||
| Pathophysiology of DIC | 998 | ||
| Clinical Manifestations of DIC | 1001 | ||
| Laboratory Features of DIC | 1001 | ||
| Management of DIC | 1002 | ||
| Postoperative Coagulopathy | 1004 | ||
| Bleeding Resulting from Anticoagulation | 1005 | ||
| Platelet Inhibitors | 1007 | ||
| Warfarin | 1008 | ||
| Heparin | 1008 | ||
| Direct Thrombin Inhibitors | 1009 | ||
| Inhibitors of Factor Xa | 1010 | ||
| Thrombolytic Agents | 1010 | ||
| Thrombocytopenia | 1010 | ||
| Heparin-Induced Thrombocytopenia | 1010 | ||
| Pathologic Fibrinolysis | 1011 | ||
| Vitamin K Deficiency | 1011 | ||
| Bleeding Associated With Liver Disease | 1011 | ||
| Bleeding Associated with Uremia | 1012 | ||
| Bleeding Associated with Head Injury | 1012 | ||
| Circulating Inhibitors of Coagulation | 1012 | ||
| Thrombotic Disorders | 1012 | ||
| Deep Venous Thrombosis | 1013 | ||
| Pulmonary Emboli | 1013 | ||
| Multidisciplinary Plan of Care | 1013 | ||
| Conclusions | 1017 | ||
| References | 1017 | ||
| Unit 10: Critical Care Immunology | 1019 | ||
| Chapter 38: Caring for the Immunocompromised Patient | 1021 | ||
| Definitions | 1021 | ||
| Patients at Risk | 1022 | ||
| Assessment | 1027 | ||
| Physical Findings | 1027 | ||
| Diagnostic Test Results | 1027 | ||
| Multidisciplinary Plan of Care | 1030 | ||
| Prevention of Infection | 1030 | ||
| Enhancement of Immune Function | 1036 | ||
| Treatment of Infection | 1038 | ||
| Conclusions | 1040 | ||
| References | 1040 | ||
| Chapter 39: Bone Marrow Transplantation | 1042 | ||
| Autologous Stem Cell Transplantation | 1042 | ||
| Allogeneic Stem Cell Transplantation | 1042 | ||
| Pretransplant Considerations | 1043 | ||
| Recipient Evaluation and Preparation | 1043 | ||
| Conditioning Regimen | 1045 | ||
| Donor Evaluation | 1046 | ||
| Stem Cell Harvesting, Mobilization, and Collection | 1047 | ||
| Transplantation and Engraftment | 1048 | ||
| Psychosocial Implications | 1049 | ||
| Complications of Transplant | 1053 | ||
| Graft-Versus-Host Disease | 1053 | ||
| Infection | 1056 | ||
| Anemia | 1058 | ||
| Thrombocytopenia | 1058 | ||
| Mucositis | 1058 | ||
| Nutritional Issues | 1059 | ||
| Veno-Occlusive Disease of the Liver | 1060 | ||
| Pulmonary Complications | 1060 | ||
| Relapse of Primary Disease | 1061 | ||
| Conclusions | 1061 | ||
| References | 1061 | ||
| Unit 11: Multisystem Disorders | 1065 | ||
| Chapter 40: Shock and End Points of Resuscitation | 1067 | ||
| Applied Physiology of Cellular Metabolism | 1067 | ||
| Oxygen Delivery, Consumption, and Extraction | 1067 | ||
| Oxygen Consumption | 1068 | ||
| Oxygen Delivery Dependence and Oxygen DEBT | 1068 | ||
| Classifications of Shock | 1070 | ||
| Hypovolemic Shock | 1070 | ||
| Obstructive Shock | 1070 | ||
| Cardiogenic Shock | 1071 | ||
| Vasogenic Shock | 1071 | ||
| Neurogenic Shock | 1071 | ||
| Septic Shock | 1071 | ||
| Anaphylactic Shock | 1072 | ||
| General Phases of Shock | 1072 | ||
| Compensatory Phase | 1073 | ||
| Decompensated Phase | 1073 | ||
| Irreversible Shock Phase | 1074 | ||
| Resuscitation Measures in Shock | 1074 | ||
| Initial Evaluation | 1074 | ||
| Fluid Resuscitation | 1075 | ||
| Colloid Solutions | 1076 | ||
| Nutritional Support in Shock | 1077 | ||
| End Points of Resuscitation | 1078 | ||
| Blood Pressure | 1079 | ||
| Urine Output | 1080 | ||
| Serum Lactate Levels | 1080 | ||
| Arterial Base Deficit | 1080 | ||
| Monitoring Technology | 1081 | ||
| Oxygen Monitoring | 1081 | ||
| Mixed Venous Oxygen Saturation | 1082 | ||
| Hemodynamic Indices | 1082 | ||
| Preload | 1083 | ||
| Right Ventricular End-Diastolic Volume Index | 1083 | ||
| Afterload | 1084 | ||
| Contractility | 1084 | ||
| End-Tidal Carbon Dioxide | 1085 | ||
| Regional Resuscitation End Points | 1086 | ||
| Intramucosal pH | 1086 | ||
| Sublingual Capnometry | 1087 | ||
| Near-Infrared Spectroscopy | 1088 | ||
| Multidisciplinary Plan of Care | 1088 | ||
| Complications of Shock | 1094 | ||
| Conclusions | 1095 | ||
| References | 1096 | ||
| Chapter 41: Optimizing Hemodynamics: Strategies for Fluid and Medication Titration in Shock | 1099 | ||
| Hypoperfusion States and Systemic Responses | 1099 | ||
| The Truth about Blood Pressure | 1100 | ||
| Identifying and Interpreting Hemodynamic Measures | 1103 | ||
| Arterial Blood Pressure | 1104 | ||
| Preload Measures | 1104 | ||
| Afterload Measures | 1105 | ||
| Contractility Measures | 1105 | ||
| Overall Cardiovascular Performance and Perfusion Indicators | 1107 | ||
| Putting It Together: Differentiating Shock States | 1109 | ||
| Shock-Specific Therapy | 1109 | ||
| Hypovolemic Shock | 1109 | ||
| Cardiogenic Shock | 1112 | ||
| Vasogenic Shock | 1113 | ||
| Titratable Medications Used in Managing Shock | 1115 | ||
| Inotropic Agents | 1122 | ||
| Vasopressor Agents | 1125 | ||
| Vasodilator Agents | 1126 | ||
| Nursing Care of the Shock Patient | 1128 | ||
| Conclusions | 1131 | ||
| References | 1131 | ||
| Chapter 42: Trauma | 1134 | ||
| Epidemiology | 1134 | ||
| Development of the Trauma System | 1134 | ||
| Mechanisms of Injury | 1134 | ||
| Laws of Motion and Energy (Kinematics) | 1135 | ||
| Blunt Trauma | 1137 | ||
| Motor Vehicle Crash | 1137 | ||
| Other Types of Collisions | 1137 | ||
| Falls | 1140 | ||
| Blast Injuries | 1140 | ||
| Penetrating Trauma | 1140 | ||
| Gunshot Wounds | 1140 | ||
| Stab Wounds and Impalements | 1142 | ||
| Applied Pathophysiology | 1142 | ||
| Physiologic Responses to Shock | 1142 | ||
| Shock | 1142 | ||
| Systemic Inflammatory Response During Traumatic Shock | 1143 | ||
| Hypermetabolic Response to Trauma | 1143 | ||
| Physiologic Sequelae During Trauma Resuscitation | 1144 | ||
| Abdominal Compartment Syndrome | 1148 | ||
| Rhabdomyolysis | 1148 | ||
| Pathophysiology of Specific Injuries | 1149 | ||
| Brain and Spinal Cord Injury | 1149 | ||
| Facial Trauma | 1149 | ||
| Chest Trauma | 1149 | ||
| Abdominal Trauma | 1151 | ||
| Musculoskeletal Injuries | 1152 | ||
| Assessment and Intervention | 1154 | ||
| Primary Survey | 1155 | ||
| Airway | 1155 | ||
| Breathing | 1155 | ||
| Circulation | 1155 | ||
| Disability | 1157 | ||
| Secondary Survey | 1157 | ||
| Assessment and Intervention of Specific Injuries | 1159 | ||
| Early Critical Care Resuscitation | 1159 | ||
| Continued Resuscitation | 1171 | ||
| Reversing the Lethal Triad of Hypothermia, Acidosis, and Coagulopathy | 1173 | ||
| Managing Abdominal Compartment Syndrome | 1176 | ||
| Identifying, Preventing, and Managing Rhabdomyolysis | 1176 | ||
| Providing Analgesia and Sedation | 1177 | ||
| Critical Care Management of Complications Following Trauma | 1177 | ||
| Acute Respiratory Distress Syndrome | 1177 | ||
| Providing Nutritional Support | 1179 | ||
| Assessing and Treating Infection | 1180 | ||
| Preventing Deep Venous Thrombosis | 1181 | ||
| Providing Psychosocial Support | 1183 | ||
| Conclusions | 1184 | ||
| References | 1184 | ||
| Chapter 43: Systemic Inflammatory Response Syndrome and Multiple Organ Dysfunction Syndrome | 1189 | ||
| Definitions and Patient Identification | 1189 | ||
| Epidemiology | 1190 | ||
| Pathophysiology of Multiple Organ Dysfunction Syndrome | 1190 | ||
| Inflammation | 1190 | ||
| Activation of Coagulation | 1191 | ||
| Impairment of Fibrinolysis | 1191 | ||
| Role of the Endothelium | 1193 | ||
| Mechanisms of Organ Dysfunction in MODS | 1193 | ||
| Cardiovascular System | 1193 | ||
| Respiratory System | 1194 | ||
| Gastrointestinal System | 1194 | ||
| Hepatic System | 1195 | ||
| Renal System | 1195 | ||
| Neurologic System | 1195 | ||
| Hematologic System | 1195 | ||
| Assessment of Multiple Organ Dysfunction Syndrome | 1196 | ||
| Interventions | 1198 | ||
| Initial Resuscitation | 1199 | ||
| Management of Infection | 1205 | ||
| Additional Hemodynamic Support | 1205 | ||
| Conclusions | 1210 | ||
| References | 1210 | ||
| Chapter 44: Burns | 1212 | ||
| Applied Physiology | 1214 | ||
| Initial Assessment | 1214 | ||
| Burn Stress Response | 1216 | ||
| Sympathetic Nervous System | 1216 | ||
| Use of Medications to Reduce Metabolic Demands | 1217 | ||
| Causative Agents | 1217 | ||
| Thermal Burns | 1217 | ||
| Electrical Burns | 1218 | ||
| Chemical Burns | 1218 | ||
| Inhalation Injury | 1219 | ||
| Zones of Burn Wounds | 1221 | ||
| Depth of Burns | 1222 | ||
| First-Degree Burns (Superficial) | 1223 | ||
| Second-Degree Burns (Partial Thickness) | 1224 | ||
| Third-Degree Burns (Full Thickness) | 1226 | ||
| Fourth-Degree Burns | 1226 | ||
| Severity of Burns | 1226 | ||
| Rule of Nines | 1227 | ||
| Rule of Palms | 1228 | ||
| Lund and Browder Chart | 1229 | ||
| Resuscitation | 1229 | ||
| Fluid Resuscitation in the First 24 Hours | 1229 | ||
| Pediatric Resuscitation | 1233 | ||
| Difficult Resuscitation | 1234 | ||
| Fluid Resuscitation in the Second 24 Hours (Hours 24 to 48) | 1234 | ||
| Fluid Resuscitation in the Third 24 Hours (Hours 48 to 72) | 1234 | ||
| Specific Burn Injury Interventions | 1235 | ||
| Electrical Injury | 1235 | ||
| Chemical Burns | 1236 | ||
| Circumferential Burns | 1238 | ||
| Compartment Syndrome | 1240 | ||
| Abdominal Compartment Syndrome | 1240 | ||
| Specific Anatomic Burns | 1242 | ||
| Extremity Burns | 1242 | ||
| Facial Burns | 1242 | ||
| Burns of the Eyes | 1242 | ||
| Burns of the Ears | 1242 | ||
| Burns of the Hands and Feet | 1243 | ||
| Burns of the Genitalia and Perineum | 1243 | ||
| Other Burn Center Patients | 1243 | ||
| Appropriate Diagnostic Evaluations | 1243 | ||
| Laboratory Testing | 1243 | ||
| Radiologic Testing | 1243 | ||
| Fiberoptic Bronchoscopy | 1243 | ||
| Other Diagnostic Interventions | 1243 | ||
| Patient Transport | 1244 | ||
| Monitoring | 1244 | ||
| Hemodynamic Monitoring | 1244 | ||
| Indwelling Urinary Catheter | 1245 | ||
| Mechanical Ventilation | 1245 | ||
| Carboxyhemoglobin | 1245 | ||
| Interventions for Inhalation Injury | 1245 | ||
| Intravenous Fluid | 1245 | ||
| Analgesia | 1246 | ||
| Nutritional Support | 1246 | ||
| Wound Care | 1247 | ||
| Topical Antimicrobial Therapy | 1249 | ||
| Primary Approaches to Wound Care | 1250 | ||
| Surgical Excision and Grafting | 1251 | ||
| Vacuum-Assisted Closure | 1252 | ||
| Identification of Targeted/Expected Outcomes | 1257 | ||
| Conclusions | 1258 | ||
| References | 1258 | ||
| Chapter 45: Mass-Casualty Competencies | 1261 | ||
| Mass-Casualty Preparation | 1265 | ||
| Triage and Decontamination | 1265 | ||
| Personal Protective Equipment | 1266 | ||
| Command and Control | 1266 | ||
| Critical Care Unit Planning and Management | 1267 | ||
| Chemical-Biological-Radiologic-Nuclear Review | 1269 | ||
| Chemical Attack | 1270 | ||
| Biological Attack | 1270 | ||
| Nuclear and Radiologic Attacks | 1279 | ||
| Educational Competencies for Registered Nurses Related to Mass-Casualty Incidents | 1280 | ||
| Conclusions | 1280 | ||
| References | 1284 | ||
| Unit 12: Special Patient Populations | 1287 | ||
| Chapter 46: Caring for the Patient in the Immediate Postoperative Period | 1289 | ||
| Patients at Risk for Postoperative Complications | 1289 | ||
| Overview of Anesthesia and the Anesthetic Agents | 1290 | ||
| General Anesthesia | 1290 | ||
| Intravenous Agents | 1291 | ||
| Neuromuscular Blocking Agents | 1293 | ||
| Regional Anesthesia | 1293 | ||
| Local Anesthetics | 1293 | ||
| Patient Transfer to Postanesthesia Care from the Operating Room | 1298 | ||
| Respiratory Complications | 1300 | ||
| Cardiovascular Complications | 1301 | ||
| Central Nervous System Complications | 1302 | ||
| Electrolytes | 1302 | ||
| Nutrition | 1303 | ||
| Thermoregulation | 1303 | ||
| Postanesthesia Shivering | 1304 | ||
| Acute Postoperative Pain and Comfort Management | 1305 | ||
| Postoperative Nausea and Vomiting | 1305 | ||
| Other Complications: Risks Associated With the Use of Herbal or Vitamin Supplements | 1305 | ||
| The Surgical Care Improvement Project | 1306 | ||
| Multidisciplinary Plan of Care | 1307 | ||
| Conclusions | 1310 | ||
| References | 1311 | ||
| Chapter 47: Caring for the Critically Ill Pregnant Patient | 1313 | ||
| Pregnancy and Critical Illness | 1313 | ||
| Normal Physiologic Changes in Pregnancy | 1315 | ||
| Reproductive System | 1315 | ||
| Cardiovascular System | 1315 | ||
| Pulmonary System | 1316 | ||
| Gastrointestinal System | 1317 | ||
| Renal System | 1317 | ||
| Monitoring of the Critically Ill Obstetric Patient | 1317 | ||
| Maternal Monitoring | 1317 | ||
| Fetal Monitoring | 1318 | ||
| Multidisciplinary Plan of Care | 1318 | ||
| Environment of Safety | 1319 | ||
| Psychosocial Care | 1322 | ||
| Maintenance of Cardiac Output | 1322 | ||
| Airway and Oxygenation Support | 1322 | ||
| Infection Control | 1323 | ||
| Pharmacologic Concerns | 1323 | ||
| Nutritional Considerations/Glycemic Control | 1326 | ||
| Prevention of Deep Venous Thrombosis | 1327 | ||
| Labor and Delivery Considerations | 1327 | ||
| Pain Management | 1329 | ||
| Postdelivery Care | 1329 | ||
| Prevention of Hemorrhage | 1329 | ||
| Support of Breast-Feeding | 1330 | ||
| Support of Maternal-Infant Bonding | 1330 | ||
| Cardiac Disease in Pregnancy | 1330 | ||
| General Considerations | 1330 | ||
| Pregnancy in Women With Preexisting Valvular Heart Disease | 1331 | ||
| Pregnancy in Women With Congenital Heart Disease | 1331 | ||
| Cardiac Disease Arising During Pregnancy | 1332 | ||
| Hypertensive Disease | 1333 | ||
| Pulmonary Dysfunction in Pregnancy | 1334 | ||
| Mechanical Ventilation | 1335 | ||
| Asthma | 1335 | ||
| Acute Respiratory Distress Syndrome | 1335 | ||
| Pulmonary Embolism | 1335 | ||
| Amniotic Fluid Embolism/Anaphylactoid Syndrome of Pregnancy | 1335 | ||
| Acute Fatty Liver of Pregnancy | 1336 | ||
| Trauma in Pregnancy | 1336 | ||
| General Pregnancy Considerations | 1336 | ||
| Cardiovascular Considerations | 1336 | ||
| Abdominal and Pelvic Considerations | 1337 | ||
| Reproductive System Considerations | 1337 | ||
| Neurologic System Considerations | 1337 | ||
| Multisystem Considerations | 1337 | ||
| Conclusions | 1338 | ||
| References | 1338 | ||
| Chapter 48: Caring for the Pediatric Patient in an Adult Critical Care Unit | 1340 | ||
| Levels of PICU Care | 1340 | ||
| Models of Co-Residence | 1340 | ||
| Service Line Model | 1340 | ||
| Geographic Model | 1340 | ||
| Regionalization of Care | 1340 | ||
| Pediatric Intensivist Coverage | 1341 | ||
| Tiered Care | 1341 | ||
| Localized Community Care | 1341 | ||
| Standardizing Care for Children | 1341 | ||
| Standardized Equipment | 1347 | ||
| Standardizing Emergency Equipment | 1349 | ||
| Standardizing Documentation Across the Institution | 1350 | ||
| Child and Family-Centered Care | 1350 | ||
| Decreasing Family Stressors | 1351 | ||
| Family Presence | 1353 | ||
| Siblings and Childhood Friends | 1353 | ||
| Quality Monitoring | 1353 | ||
| The Child's Response to Critical Care | 1354 | ||
| Considerations in Pediatric Care | 1355 | ||
| Pediatric Assessment | 1355 | ||
| Fluid Balance in Children | 1356 | ||
| Medication Administration in Children | 1357 | ||
| Pain in Children | 1358 | ||
| Neuromuscular Blockade | 1360 | ||
| Intentional Injuries in the Pediatric Patient | 1361 | ||
| Role of the Nurse | 1361 | ||
| Parental Permission and Child Assent | 1361 | ||
| Transitions for the Child and Family in Critical Care | 1364 | ||
| Out of the PICU | 1364 | ||
| Palliative Care | 1364 | ||
| Pediatric Resuscitation Priorities | 1364 | ||
| Competent Pediatric Intensive Care Nursing | 1364 | ||
| Initial Pediatric Orientation | 1367 | ||
| Ongoing Competencies | 1367 | ||
| Conclusions | 1369 | ||
| References | 1369 | ||
| Chapter 49: Caring for the Critically Ill Elderly Patient | 1372 | ||
| The Aging Population | 1372 | ||
| Demographics | 1372 | ||
| Factors that Influence Aging | 1372 | ||
| Age-Related Changes | 1372 | ||
| Social and Environmental Factors | 1373 | ||
| Cumulative Health History | 1373 | ||
| Comorbidities | 1373 | ||
| The Geriatric Critical Care Patient | 1373 | ||
| Demographics | 1373 | ||
| Traumatic Injury | 1374 | ||
| Minimizing Potential Critical Care Problems | 1375 | ||
| Cardiovascular System | 1375 | ||
| Age-Related Changes | 1375 | ||
| Common Problems and Management Strategies | 1377 | ||
| Respiratory System | 1378 | ||
| Age-Related Changes | 1378 | ||
| Common Problems and Management Strategies | 1379 | ||
| Neurologic System | 1381 | ||
| Age-Related Changes | 1381 | ||
| Common Problems and Management Strategies | 1382 | ||
| Musculoskeletal System | 1384 | ||
| Age-Related Changes | 1384 | ||
| Answers to Decision Point Questions | 1527 | ||
| Chapter 4, Pain and Sedation | 1527 | ||
| Chapter 5, Symptom Management | 1528 | ||
| Chapter 7, Thermoregulation | 1529 | ||
| Chapter 8, Families in Critical Care | 1529 | ||
| Chapter 11, Acute Coronary Syndromes | 1530 | ||
| Chapter 12, Heart Failure | 1530 | ||
| Chapter 14, Cardiac Surgery | 1531 | ||
| Chapter 15, Valvular Disease and Surgery | 1531 | ||
| Chapter 16, Vascular Emergencies | 1532 | ||
| Chapter 17, Cardiomyopathy | 1532 | ||
| Chapter 18, Heart and Lung Transplantation | 1532 | ||
| Chapter 19, Acute Respiratory Failure and Acute Lung Injury | 1533 | ||
| Chapter 20, Mechanical Ventilation and Weaning | 1534 | ||
| Chapter 21, Thoracic Surgery | 1534 | ||
| Chapter 22, Head Injury and Dysfunction | 1535 | ||
| Chapter 23, Cerebrovascular Disorders | 1536 | ||
| Chapter 24, Spinal Cord Injury | 1536 | ||
| Chapter 25, Special Neurologic Patient Populations | 1537 | ||
| Chapter 27, Liver Dysfunction and Failure | 1538 | ||
| Chapter 28, Pancreatitis | 1539 | ||
| Chapter 32, Complex Acid-Base Disorders and Associated Electrolyte Imbalances | 1539 | ||
| Chapter 33, Acute Renal Failure | 1542 | ||
| Chapter 34, Glycemic Control | 1543 | ||
| Chapter 35, Pituitary, Thyroid, and Adrenal Disorders | 1544 | ||
| Chapter 36, Blood Conservation and Blood Component Replacement | 1546 | ||
| Chapter 37, Coagulopathies | 1547 | ||
| Chapter 38, Caring for the Immunocompromised Patient | 1548 | ||
| Chapter 39: Bone Marrow Transplantation | 1550 | ||
| Chapter 40, Shock and End points of Resuscitation | 1551 | ||
| Chapter 41, Optimizing Hemodynamics: Strategies for Fluid and Medication Titration in Shock | 1553 | ||
| Chapter 42, Trauma | 1554 | ||
| Chapter 43, Systemic Inflammatory Response Syndrome and Multiple Organ Dysfunction Syndrome | 1555 | ||
| Chapter 44, Burns | 1556 | ||
| Chapter 45, Mass-Casualty Competencies | 1557 | ||
| Chapter 46, Caring for the Patient in the Immediate Postoperative Period | 1559 | ||
| Chapter 47, Caring for the Critically Ill Pregnant Patient | 1560 | ||
| Chapter 49, Caring for the Critically Ill Elderly Patient | 1561 | ||
| Chapter 50, Caring for the Critically Ill Patient with A Neuropsychiatric Disorder | 1561 | ||
| Chapter 51, Caring for the Bariatric Patient | 1562 | ||
| Chapter 53, Chemical Dependency | 1564 | ||
| Illustration Credits | 1567 | ||
| Chapter 4 | 1567 | ||
| Chapter 16 | 1567 | ||
| Chapter 17 | 1567 | ||
| Chapter 18 | 1567 | ||
| Chapter 19 | 1567 | ||
| Chapter 23 | 1567 | ||
| Chapter 24 | 1567 | ||
| Chapter 25 | 1567 | ||
| Chapter 26 | 1568 | ||
| Chapter 27 | 1568 | ||
| Chapter 28 | 1568 | ||
| Chapter 35 | 1568 | ||
| Chapter 41 | 1568 | ||
| Chapter 43 | 1568 | ||
| Chapter 44 | 1568 | ||
| Chapter 48 | 1568 | ||
| Index | 1569 |