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Book Details
Abstract
Get a firm understanding and mastery of the unique issues and procedures involved in critical care nursing with Critical Care Nursing: Diagnosis and Management, 8th Edition. Praised for its comprehensive coverage and clear organization, this market-leading text offers a great foundation in the realities and challenges of today’s critical care unit that’s perfect for both nursing students and practicing nurses alike. This new edition also features enhanced integration of QSEN and interprofessional collaborative practice, plus expanded coverage of leadership, post-ICU outcomes and highly contagious infections. Revamped case studies, Patient Teaching boxes, Evidence-Based Practice boxes, Patient Safety Alerts, and other learning tools further develop your critical thinking skills and prepare you for success in high-acuity, progressive, and critical care settings.
- UNIQUE! Nursing management plans of care feature approximately 35 NANDA-I nursing diagnoses to provide a detailed, ready-to-use, clinically current reference for safe, effective patient care.
- Consistent organization within each body-system unit provides a systematic framework for learning and for CCRN and PCCN certification preparation. It also serves as a great reference for clinical practice.
- Pharmacologic Management tables offer quick summaries of the drugs most often used in critical care.
Table of Contents
| Section Title | Page | Action | Price |
|---|---|---|---|
| Front Cover | Cover | ||
| CONTENTS | i | ||
| Critical Care Nursing: Diagnosis and Management | iii | ||
| Copyright | iv | ||
| Dedication | v | ||
| About the Authors | vi | ||
| Linda D. Urden, DNSc, RN, CNS, NE-BC, FAAN | vi | ||
| Kathleen M. Stacy, PhD, RN, CNS, CCRN, PCCN, CCNS | vi | ||
| Mary E. Lough, PhD, RN, CCRN, CNRN, CCNS, FCCM | vi | ||
| CONTRIBUTORS | vii | ||
| REVIEWERS | x | ||
| PREFACE | xi | ||
| ORGANIZATION | xi | ||
| NURSING DIAGNOSIS AND MANAGEMENT | xi | ||
| INCLUDED IN THIS EDITION | xi | ||
| Special Features | xii | ||
| EVOLVE RESOURCES FOR CRITICAL CARE NURSING | xii | ||
| Student Resources | xii | ||
| Instructor Resources | xii | ||
| ACKNOWLEDGMENTS | xiii | ||
| CONTENTS | xiv | ||
| I - 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 | 2 | ||
| EVIDENCE-BASED NURSING PRACTICE | 3 | ||
| HOLISTIC CRITICAL CARE NURSING | 3 | ||
| Caring | 3 | ||
| Individualized Care | 4 | ||
| Cultural Care | 4 | ||
| COMPLEMENTARY AND ALTERNATIVE THERAPIES | 4 | ||
| Guided Imagery | 4 | ||
| Massage | 4 | ||
| Animal-Assisted Therapy | 4 | ||
| TECHNOLOGY IN CRITICAL CARE | 5 | ||
| INTERPROFESSIONAL COLLABORATIVE PRACTICE | 5 | ||
| INTERDISCIPLINARY CARE MANAGEMENT MODELS AND TOOLS | 5 | ||
| Care Management | 6 | ||
| Case Management | 6 | ||
| Care Management Tools | 6 | ||
| Algorithm | 6 | ||
| Practice Guideline | 6 | ||
| Protocol | 6 | ||
| Order Set | 6 | ||
| Managing and Tracking Variances | 6 | ||
| QUALITY, SAFETY, AND REGULATORY ISSUES IN CRITICAL CARE | 6 | ||
| Quality and Safety Issues | 6 | ||
| Quality and Safety Regulations | 7 | ||
| Quality and Safety Resources | 7 | ||
| Privacy and Confidentiality | 8 | ||
| Communication Among Health Care Providers | 8 | ||
| HEALTHY WORK ENVIRONMENT | 8 | ||
| REFERENCES | 10 | ||
| 2 - Ethical Issues | 12 | ||
| DIFFERENCES BETWEEN MORALS AND ETHICS | 12 | ||
| Nurses, Moral Distress, and Moral Courage | 12 | ||
| Virtues | 15 | ||
| ETHICAL PRINCIPLES | 15 | ||
| Respect for Persons/Autonomy | 15 | ||
| Beneficence and Nonmaleficence | 18 | ||
| Justice | 18 | ||
| CONFLICTING PRINCIPLES, PATERNALISM, AND MEDICAL FUTILITY | 18 | ||
| PROFESSIONAL NURSING ETHICS AND THE NURSING CODE OF ETHICS | 19 | ||
| SITUATIONAL AND ORGANIZATIONAL ETHICAL DECISION MAKING IN CRITICAL CARE | 19 | ||
| Framework for Resolving Ethical Problems | 19 | ||
| SFNO MODEL FOR DELIBERATION OF ETHICAL PROBLEMS | 20 | ||
| STRATEGIES FOR PROMOTION OF ETHICAL DECISION MAKING | 22 | ||
| Institutional Ethicists, Ethics Committees, and Ethics Consultation Services | 22 | ||
| Ethics Rounds and Conferences | 22 | ||
| REFERENCES | 23 | ||
| 3 - Legal Issues | 24 | ||
| OVERVIEW | 24 | ||
| ADMINISTRATIVE LAW: PROFESSIONAL REGULATION | 24 | ||
| Functions of Boards of Nursing | 24 | ||
| Scope of Practice | 24 | ||
| Standards of Practice | 25 | ||
| TORT LAW: NEGLIGENCE AND PROFESSIONAL MALPRACTICE, INTENTIONAL TORTS | 27 | ||
| Ordinary Negligence | 27 | ||
| Professional Malpractice | 28 | ||
| Duty | 28 | ||
| Breach | 28 | ||
| Harm Caused by the Breach | 29 | ||
| Damages | 29 | ||
| Professional Malpractice and the Nursing Process | 29 | ||
| Wrongful Death | 32 | ||
| Assault and Battery | 32 | ||
| Special Clinical Circumstances and Professional Malpractice | 32 | ||
| Respiratory Management | 32 | ||
| Blood Transfusions and Infection Control | 33 | ||
| CONSTITUTIONAL LAW: PATIENT DECISION MAKING | 34 | ||
| Patients With Decision-Making Capacity | 34 | ||
| Patients Without Decision-Making Capacity | 34 | ||
| Never and Not Yet Competent Patients | 35 | ||
| Previously Competent Patients | 35 | ||
| Advance Directives | 35 | ||
| Futile (or Nonbeneficial) Treatment and Orders Not to Resuscitate | 36 | ||
| Brain Death | 36 | ||
| LEGAL ISSUES LOOKING FORWARD | 37 | ||
| SUMMARY | 37 | ||
| REFERENCES | 38 | ||
| 4 - Genetic Issues | 39 | ||
| GENETICS AND GENOMICS | 39 | ||
| GENETIC AND GENOMIC STRUCTURE AND FUNCTION | 39 | ||
| Chromosomes | 39 | ||
| DNA and the Double Helix | 40 | ||
| DNA Base Pairs | 40 | ||
| DNA Replication | 40 | ||
| DNA Alphabet | 41 | ||
| Transcription | 41 | ||
| Translation | 42 | ||
| Telomeres | 42 | ||
| Genetic Variation, Mutation, and Polymorphism | 42 | ||
| Variation | 42 | ||
| Mutation | 43 | ||
| Single Nucleotide Polymorphisms | 43 | ||
| Alleles | 45 | ||
| GENETIC INHERITANCE | 45 | ||
| Genetic Disorders | 45 | ||
| Chromosome Disorders | 45 | ||
| Single-Gene Disorders | 45 | ||
| Complex Gene and Multifactorial Disorders | 46 | ||
| Mitochondrial Disorders | 46 | ||
| Genotype and Phenotype | 46 | ||
| Genetic History and Family Pedigree | 46 | ||
| Homozygous Versus Heterozygous | 46 | ||
| Modes of Inheritance | 46 | ||
| Autosomal Dominant Inheritance | 46 | ||
| Autosomal Recessive Inheritance | 46 | ||
| Sex-Linked Inheritance | 46 | ||
| . Hemophilia is an example of a single-gene X-linked pattern. The F8 gene, which codes for the protein that makes coagulation fa... | 48 | ||
| Complex Gene-Gene and Gene-Environment Disorders | 48 | ||
| OBTAINING INFORMATION ABOUT GENETICS AND GENOMICS | 48 | ||
| Genetic Epidemiology and Phenotypes | 48 | ||
| Family-Based Genetic Studies | 48 | ||
| Twin Studies | 48 | ||
| Genetic Association Studies | 49 | ||
| Case-Control Studies | 49 | ||
| Candidate Gene Studies | 49 | ||
| Genome-Wide Association Studies | 49 | ||
| Genome Mapping Projects | 49 | ||
| Human Genome Project | 49 | ||
| ENCODE Project | 49 | ||
| HapMap Project | 49 | ||
| 1000 Genomes Project | 49 | ||
| Exome Sequencing Project | 49 | ||
| Human Proteome Project | 50 | ||
| Human Microbiome Project | 50 | ||
| Genetic Diversity | 50 | ||
| Copy Number Variation | 50 | ||
| Individual Genome Sequences | 50 | ||
| GENETICS IN CRITICAL CARE | 50 | ||
| Gene Editing—CRISPR-Cas9 Technology | 50 | ||
| Cancer Genetics | 51 | ||
| Somatic Mutations | 51 | ||
| The Cancer Genome Atlas | 51 | ||
| Cardiovascular Genetics | 51 | ||
| Long QT Syndrome | 51 | ||
| Cardiomyopathy | 51 | ||
| Pharmacogenetics | 52 | ||
| Cytochrome P450 Family and Medication Metabolism | 52 | ||
| Warfarin | 52 | ||
| Malignant Hyperthermia | 52 | ||
| GENETICS, GENOMICS, AND NURSING | 52 | ||
| Ethical and Legal Issues in Genetics and Genomics | 52 | ||
| Direct-to-Consumer Tests | 53 | ||
| Genetic Information Nondiscrimination Act | 53 | ||
| HUMAN GENETICS KEY TERMS | 53 | ||
| REFERENCES | 56 | ||
| 5 - Patient and Family Education | 58 | ||
| CHALLENGES OF PATIENT AND FAMILY EDUCATION | 58 | ||
| EDUCATION | 58 | ||
| Definition | 58 | ||
| Benefits | 58 | ||
| Education Process | 59 | ||
| STEP 1: ASSESSMENT | 59 | ||
| Learner Identification | 59 | ||
| Family | 59 | ||
| Age-Specific Considerations | 60 | ||
| Adult Learners | 60 | ||
| Factors Affecting the Learning Process | 60 | ||
| Readiness, Willingness, Ability | 60 | ||
| Physiologic Factors | 61 | ||
| Health Literacy | 61 | ||
| Sociocultural Factors | 61 | ||
| Financial Factors | 61 | ||
| Psychological factors | 62 | ||
| Coping | 63 | ||
| Adaptation | 63 | ||
| Environmental Factors | 63 | ||
| STEP 2: EDUCATION PLAN DEVELOPMENT | 64 | ||
| Determining What to Teach | 64 | ||
| Writing Goals or Outcomes | 66 | ||
| Developing Interventions | 66 | ||
| Standardized Education Plans | 66 | ||
| STEP 3: IMPLEMENTATION | 66 | ||
| Setting up the Environment | 66 | ||
| Teaching Strategies | 67 | ||
| Discussion | 67 | ||
| Demonstration and Practice | 67 | ||
| Use of Media | 67 | ||
| Computers and Patient Education | 69 | ||
| Communication | 69 | ||
| Special Considerations | 69 | ||
| Older Adults | 69 | ||
| Sedated and Unconscious Patients | 70 | ||
| Noncompliant Patients | 70 | ||
| STEP 4: EVALUATION | 70 | ||
| How to Evaluate | 70 | ||
| STEP 5: DOCUMENTATION | 71 | ||
| What Should Be Documented? | 71 | ||
| FACTORS THAT AFFECT THE TEACHING-LEARNING PROCESS | 71 | ||
| INFORMATIONAL NEEDS OF FAMILIES IN CRITICAL CARE | 71 | ||
| PREPARATION OF THE PATIENT AND FAMILY FOR TRANSFER FROM CRITICAL CARE | 72 | ||
| SUMMARY | 73 | ||
| REFERENCES | 73 | ||
| 6 - Psychosocial Alterations and Management | 75 | ||
| STRESS | 75 | ||
| Stress Response | 75 | ||
| POSTTRAUMATIC STRESS DISORDER | 76 | ||
| ANXIETY | 76 | ||
| Anxiety and Pain | 77 | ||
| ALTERATIONS IN SELF-CONCEPT | 77 | ||
| Body Image | 77 | ||
| Self-Esteem | 78 | ||
| Identity Disturbance | 78 | ||
| RISK FOR COMPROMISED HUMAN DIGNITY | 78 | ||
| SPIRITUAL CHALLENGES IN CRITICAL CARE | 78 | ||
| Spiritual Distress | 79 | ||
| Hope and Hopelessness | 79 | ||
| Loss of Control and Powerlessness | 79 | ||
| COPING WITH STRESS AND ILLNESS | 79 | ||
| Use of Psychological Defense Mechanisms | 80 | ||
| Regression | 80 | ||
| Denial | 80 | ||
| USEFUL PSYCHOSOCIAL SKILLS | 81 | ||
| Holistic Psychosocial-Spiritual Care | 81 | ||
| Communicate With Compassion and Care | 81 | ||
| Trust | 81 | ||
| Practice Dignity-Enhancing Care | 82 | ||
| Support Patient Coping | 82 | ||
| Helping Patients Maintain Control | 82 | ||
| Support Patient-Preferred Complementary Therapies | 82 | ||
| Creating Healing Environments | 83 | ||
| Provide Family-Centered Care | 83 | ||
| Engage Spiritual Resources | 83 | ||
| PATIENTS WITH PSYCHIATRIC DISORDERS | 83 | ||
| Alcohol Withdrawal in Critical Care Settings | 84 | ||
| Caring for Patients After Attempted Suicide | 84 | ||
| NURSE SELF-CARE | 84 | ||
| REFERENCES | 85 | ||
| 7 - Nutrition Alterations and Management | 88 | ||
| NUTRIENT METABOLISM | 88 | ||
| Energy-Yielding Nutrients | 88 | ||
| Carbohydrates | 88 | ||
| Proteins | 88 | ||
| Lipids (Fats) | 89 | ||
| ASSESSING NUTRITION STATUS | 89 | ||
| Anthropometric Measurements | 90 | ||
| Biochemical Data | 91 | ||
| Clinical or Physical Manifestations | 91 | ||
| Diet and Health History | 92 | ||
| Evaluating Nutrition Assessment Findings | 92 | ||
| Determining Nutrition Needs | 92 | ||
| IMPLICATIONS OF UNDERNUTRITION FOR SICK OR STRESSED PATIENTS | 93 | ||
| Energy Deficiency | 93 | ||
| Protein-Calorie Malnutrition | 93 | ||
| Metabolic Response to Starvation and Stress | 94 | ||
| Etiology-Based Approach in Defining Malnutrition | 94 | ||
| NUTRITION SUPPORT | 94 | ||
| Nursing Management of Nutrition Support | 94 | ||
| Oral Supplementation | 94 | ||
| Enteral Nutrition | 95 | ||
| Total Parenteral Nutrition | 100 | ||
| Monitoring and Evaluation of Nutrition Support | 102 | ||
| NUTRITION AND CARDIOVASCULAR ALTERATIONS | 102 | ||
| Nutrition Assessment in Cardiovascular Alterations | 102 | ||
| Myocardial Infarction | 103 | ||
| Long-Term Changes | 103 | ||
| Heart Failure | 103 | ||
| Cardiac Cachexia | 103 | ||
| NUTRITION AND PULMONARY ALTERATIONS | 104 | ||
| Nutrition Assessment in Pulmonary Alterations | 104 | ||
| Prevent or Correct Undernutrition and Underweight | 104 | ||
| Avoid Overfeeding | 104 | ||
| Prevent Fluid Volume Excess | 104 | ||
| NUTRITION AND NEUROLOGIC ALTERATIONS | 105 | ||
| Nutrition Assessment in Neurologic Alterations | 105 | ||
| Prevention or Correction of Nutrition Deficits | 105 | ||
| NUTRITION AND RENAL ALTERATIONS | 106 | ||
| Nutrition Assessment in Renal Alterations | 106 | ||
| Nutrition Intervention and Education in Renal Alterations | 106 | ||
| Protein | 106 | ||
| Fluid | 106 | ||
| Energy (Calories) | 107 | ||
| Other Nutrients | 107 | ||
| NUTRITION AND GASTROINTESTINAL ALTERATIONS | 107 | ||
| Nutrition Assessment in Gastrointestinal Alterations | 107 | ||
| Hepatic Failure | 107 | ||
| Pancreatitis | 108 | ||
| NUTRITION AND ENDOCRINE ALTERATIONS | 109 | ||
| Nutrition Assessment in Endocrine Alterations | 109 | ||
| Nutrition Intervention in Endocrine Alterations | 109 | ||
| Nutrition Support and Blood Glucose Control | 109 | ||
| Severe Vomiting or Diarrhea in Patients With Type 1 Diabetes Mellitus | 109 | ||
| Nutrition Education in Diabetes | 109 | ||
| REFERENCES | 111 | ||
| 8 - Pain and Pain Management | 114 | ||
| IMPORTANCE OF PAIN ASSESSMENT | 114 | ||
| DEFINITION AND DESCRIPTION OF PAIN | 114 | ||
| Components of Pain | 114 | ||
| Types of Pain | 114 | ||
| Acute Pain | 114 | ||
| Chronic Pain | 115 | ||
| Nociceptive Pain | 115 | ||
| Neuropathic Pain | 115 | ||
| Physiology of Pain | 115 | ||
| Nociception | 115 | ||
| Transduction | 115 | ||
| Transmission | 115 | ||
| Perception | 115 | ||
| Modulation | 115 | ||
| Summary | 117 | ||
| Biologic Stress Response | 117 | ||
| Short-Term Direct Response | 117 | ||
| Midterm Indirect Response | 118 | ||
| Long-Term Indirect Response | 118 | ||
| Summary | 118 | ||
| Framework for Pain Assessment and Definition | 118 | ||
| PAIN ASSESSMENT | 119 | ||
| Subjective Component of Pain Assessment | 119 | ||
| P: Provocative and Palliative or Aggravating Factors | 120 | ||
| Q: Quality | 120 | ||
| R: Region or Location, Radiation | 120 | ||
| S: Severity and Other Symptoms | 120 | ||
| T: Timing | 120 | ||
| U: Understanding | 120 | ||
| Observable or Objective Component of Pain Assessment | 121 | ||
| Behavioral Pain Scale | 121 | ||
| Critical-Care Pain Observation Tool | 121 | ||
| Use of Cut-Off Scores | 121 | ||
| Limitations Related to Use of Behavioral Pain Scales | 123 | ||
| Physiologic Indicators | 123 | ||
| Pain as a Vital Sign | 123 | ||
| Patient Barriers to Pain Assessment and Management | 123 | ||
| Communication | 123 | ||
| Altered Level of Consciousness and Unconsciousness | 123 | ||
| Older Adult Patients | 124 | ||
| Delirious Patients | 124 | ||
| Neonates and Infants | 124 | ||
| Lack of Knowledge | 124 | ||
| Health Professional Barriers to Pain Assessment and Management | 125 | ||
| Addiction and Tolerance | 125 | ||
| Respiratory Depression | 125 | ||
| Organizational Barriers to Pain Assessment and Management | 125 | ||
| PAIN MANAGEMENT | 125 | ||
| Pharmacologic Control of Pain | 125 | ||
| Opioid Analgesics | 127 | ||
| Preventing and Treating Respiratory Depression | 128 | ||
| New Sedative With Analgesic Properties: Dexmedetomidine | 129 | ||
| Nonopioid Analgesics | 129 | ||
| Delivery Methods | 130 | ||
| Patient-Controlled Analgesia | 130 | ||
| Intraspinal Pain Control | 130 | ||
| Intrathecal Analgesia | 131 | ||
| Epidural Analgesia | 131 | ||
| Equianalgesia | 131 | ||
| Nonpharmacologic Methods of Pain Management | 132 | ||
| Physical Techniques | 132 | ||
| Ice Therapy | 133 | ||
| Massage | 133 | ||
| Cognitive-Behavioral Techniques | 133 | ||
| Relaxation | 133 | ||
| Guided Imagery | 133 | ||
| Music Therapy | 133 | ||
| REFERENCES | 134 | ||
| 9 - Sedation, Agitation, Delirium Management | 137 | ||
| SEDATION | 137 | ||
| Sedation and Agitation Assessment Scales | 137 | ||
| Pain Assessment Scales | 137 | ||
| Levels of Sedation | 137 | ||
| Pharmacologic Management of Sedation | 137 | ||
| Benzodiazepines | 138 | ||
| Sedative-Hypnotic Agents | 140 | ||
| Central Alpha Agonists | 140 | ||
| Daily Sedation Interruption | 140 | ||
| AGITATION | 141 | ||
| DELIRIUM | 141 | ||
| Pharmacologic Management of Delirium | 141 | ||
| Interventions to Prevent Delirium | 144 | ||
| ALCOHOL WITHDRAWAL SYNDROME AND DELIRIUM TREMENS | 144 | ||
| COLLABORATIVE MANAGEMENT | 144 | ||
| REFERENCES | 145 | ||
| 10 - End-of-Life Care | 147 | ||
| END-OF-LIFE EXPERIENCE IN CRITICAL CARE | 148 | ||
| Advance Directives | 148 | ||
| Physician Orders for Life-Sustaining Treatment | 148 | ||
| Advance Care Planning | 148 | ||
| ETHICAL AND LEGAL ISSUES | 149 | ||
| COMFORT CARE | 149 | ||
| Cardiopulmonary Resuscitation | 149 | ||
| Impact of Do Not Resuscitate Orders | 150 | ||
| Prognostication and Prognostic Tools | 150 | ||
| DECISION MAKING | 151 | ||
| Communication and Decision Making | 151 | ||
| Patients | 151 | ||
| Families | 151 | ||
| Strategies to Support Decision Making | 151 | ||
| Daily Rounds | 151 | ||
| Family Meetings | 151 | ||
| Cultural and Spiritual Influences on Communication | 152 | ||
| Hospice Information | 152 | ||
| WITHDRAWAL OR WITHHOLDING OF TREATMENT | 152 | ||
| Proactive Approach | 152 | ||
| Futility/Nonbeneficial Care Discussions | 152 | ||
| Steps Toward Comfort Care | 153 | ||
| PALLIATIVE CARE | 153 | ||
| Symptom Management | 153 | ||
| Pain Management | 153 | ||
| Dyspnea | 153 | ||
| Nausea and Vomiting | 154 | ||
| Fever and Infection | 154 | ||
| Edema | 154 | ||
| Anxiety | 154 | ||
| Delirium | 154 | ||
| Metabolic Derangement | 154 | ||
| Near-Death Awareness | 154 | ||
| WITHDRAWAL OF MECHANICAL VENTILATION | 154 | ||
| Sedation During Withdrawal of Life Support | 155 | ||
| Ventilator Settings | 155 | ||
| PROFESSIONAL ISSUES | 155 | ||
| Health Care Settings | 155 | ||
| Emotional Support for the Nurse | 155 | ||
| ORGAN DONATION | 156 | ||
| Legal Issues | 156 | ||
| Brain Death | 156 | ||
| FAMILY CARE | 156 | ||
| Waiting for Good News | 156 | ||
| Families in Crisis | 157 | ||
| Family Presence During Cardiopulmonary Resuscitation | 157 | ||
| Visiting Hours | 157 | ||
| After Death | 157 | ||
| COLLABORATIVE CARE | 157 | ||
| REFERENCES | 158 | ||
| II - Cardiovascular Alterations | 161 | ||
| 11 - Cardiovascular Anatomy and Physiology | 161 | ||
| ANATOMY | 161 | ||
| Macroscopic Structure | 161 | ||
| Structures of the Heart | 161 | ||
| Size and Weight of the Heart | 161 | ||
| Layers of the Heart | 161 | ||
| Cardiac Chambers | 163 | ||
| Cardiac Valves | 163 | ||
| Conduction System | 164 | ||
| Coronary Blood Supply | 166 | ||
| Major Cardiac Vessels | 167 | ||
| Aorta | 167 | ||
| Pulmonary Artery | 167 | ||
| Pulmonary Veins | 169 | ||
| Systemic Circulation | 169 | ||
| Venous System | 170 | ||
| Microscopic Structure | 171 | ||
| Cardiac Fibers | 171 | ||
| Cardiac Cells | 172 | ||
| PHYSIOLOGY | 173 | ||
| Electrical Activity | 173 | ||
| Transmembrane Potentials | 173 | ||
| Resting Membrane Potential | 173 | ||
| Phases of the Action Potential | 174 | ||
| Mechanical Activity | 175 | ||
| Excitation-Contraction Coupling | 175 | ||
| Cardiac Cycle | 176 | ||
| Atrial Systole | 176 | ||
| Isovolumic Contraction | 176 | ||
| Ventricular Systole | 177 | ||
| Isovolumic Relaxation | 177 | ||
| Ventricular Diastole | 178 | ||
| Interplay of Heart and Vessels: Cardiac Output | 178 | ||
| Preload | 178 | ||
| Afterload | 179 | ||
| Contractility | 179 | ||
| Regulation of Heartbeat | 179 | ||
| Autonomic Nervous System Control | 179 | ||
| Intrinsic Regulation | 179 | ||
| Control of Peripheral Circulation | 181 | ||
| Intrinsic Control | 181 | ||
| Extrinsic Control | 182 | ||
| REFERENCES | 182 | ||
| 12 - Cardiovascular Clinical Assessment | 184 | ||
| HISTORY | 184 | ||
| PHYSICAL EXAMINATION | 184 | ||
| Inspection | 184 | ||
| Face | 184 | ||
| Thorax | 184 | ||
| Abdomen | 184 | ||
| Nail Beds and Cyanosis | 184 | ||
| Lower Extremities | 186 | ||
| Posture | 186 | ||
| Weight | 186 | ||
| Mentation | 186 | ||
| Jugular Veins | 186 | ||
| Abdominojugular Reflux | 187 | ||
| Thoracic Reference Points | 187 | ||
| Apical Impulse | 188 | ||
| Palpation | 188 | ||
| Arterial Pulses | 188 | ||
| Carotid Pulses | 190 | ||
| Brachial, Ulnar, and Radial Pulses | 190 | ||
| Femoral Pulses | 190 | ||
| Popliteal Pulses | 190 | ||
| Dorsalis Pedis and Posterior Tibial Pulses | 190 | ||
| Descending Aorta Pulse | 190 | ||
| Capillary Refill | 190 | ||
| Edema | 190 | ||
| Auscultation | 191 | ||
| Blood Pressure Measurement | 191 | ||
| Normal Heart Sounds | 193 | ||
| Abnormal Heart Sounds | 194 | ||
| Heart Murmurs | 194 | ||
| Innocent Murmurs | 196 | ||
| Murmurs Associated With Myocardial Infarction | 196 | ||
| Cardiac Rubs | 196 | ||
| REFERENCES | 198 | ||
| 13 - Cardiovascular Diagnostic Procedures | 199 | ||
| HEMODYNAMIC MONITORING | 199 | ||
| Hemodynamic Monitoring Equipment | 199 | ||
| Heparin | 199 | ||
| Calibration of Hemodynamic Monitoring Equipment | 199 | ||
| Zeroing the Transducer | 199 | ||
| ELECTROCARDIOGRAPHY | 235 | ||
| Basic Principles of Electrocardiography | 235 | ||
| Phase 0 | 235 | ||
| Phases 1 and 2 | 235 | ||
| Phase 3 | 235 | ||
| Phase 4 | 235 | ||
| Electrocardiogram Leads | 235 | ||
| Electrocardiogram Analysis | 238 | ||
| Specialized Electrocardiogram Paper | 238 | ||
| Calibration | 238 | ||
| Waveforms | 239 | ||
| Intervals Between Waveforms | 239 | ||
| Ventricular Axis | 241 | ||
| Cardiac Monitor Lead Analysis | 242 | ||
| Lead II | 242 | ||
| Lead V1 | 243 | ||
| Electrocardiogram Lead Selection for Optimal Bedside Monitoring | 243 | ||
| Continuous Dysrhythmia Monitoring | 243 | ||
| Continuous ST Segment Monitoring | 243 | ||
| Atrial Hypertrophy | 245 | ||
| Ventricular Hypertrophy | 245 | ||
| Ischemia and Infarction | 245 | ||
| Electrocardiogram Changes Indicating Ischemia and Infarction | 246 | ||
| Non–Q Wave Infarction | 246 | ||
| Infarct Location by 12-Lead Electrocardiogram | 246 | ||
| Infarct Progression on Electrocardiogram | 247 | ||
| Intraventricular Conduction Defects | 247 | ||
| Right and Left Bundle Branch Blocks | 247 | ||
| Hemiblocks | 248 | ||
| Bifascicular Block | 248 | ||
| Dysrhythmia Interpretation | 248 | ||
| Heart Rate Determination | 249 | ||
| Rhythm Determination | 249 | ||
| P Wave Evaluation | 249 | ||
| P–R Interval Evaluation | 249 | ||
| QRS Complex Evaluation | 249 | ||
| Q–T Interval Evaluation | 249 | ||
| Sinus Rhythms | 249 | ||
| Normal Sinus Rhythm | 250 | ||
| Sinus Bradycardia | 251 | ||
| Sinus Tachycardia | 251 | ||
| Sinus Dysrhythmia | 251 | ||
| Atrial Dysrhythmias | 251 | ||
| Premature Atrial Contractions | 252 | ||
| Supraventricular Tachycardia | 252 | ||
| Supraventricular Tachycardia With Aberrant Conduction | 253 | ||
| Paroxysmal Supraventricular Tachycardia | 253 | ||
| Focal Atrial Tachycardia | 254 | ||
| Multifocal Atrial Tachycardia | 254 | ||
| Atrial Flutter | 254 | ||
| Atrial Fibrillation | 255 | ||
| Stroke Risk Assessment and Antithrombotic Therapy in Atrial Fibrillation | 257 | ||
| CHADS2 | 257 | ||
| CHA2DS2-VASc | 257 | ||
| Surgical Procedures to Manage Atrial Fibrillation | 258 | ||
| Catheter Procedures to Manage Atrial Fibrillation | 259 | ||
| Junctional Dysrhythmias | 259 | ||
| Premature Junctional Contraction | 259 | ||
| Junctional Escape Rhythm | 259 | ||
| Junctional Tachycardia and Accelerated Junctional Rhythm | 259 | ||
| Ventricular Dysrhythmias | 259 | ||
| Premature Ventricular Contractions | 259 | ||
| Ventricular Fibrillation | 263 | ||
| Differential Diagnosis of Wide QRS Complex Tachycardia | 264 | ||
| First-Degree Atrioventricular Block | 266 | ||
| Second-Degree Atrioventricular Block | 266 | ||
| Third-Degree Atrioventricular Block | 268 | ||
| Management of Atrioventricular Block | 268 | ||
| LABORATORY TESTS | 268 | ||
| Electrolytes | 269 | ||
| Potassium | 269 | ||
| Calcium | 269 | ||
| Magnesium | 270 | ||
| Cardiac Biomarker Studies | 271 | ||
| Cardiac Biomarkers in Acute Coronary Syndrome | 271 | ||
| Natriuretic Peptide Biomarkers in Heart Failure | 272 | ||
| Hematologic Studies | 273 | ||
| Red Blood Cells | 273 | ||
| Hemoglobin | 273 | ||
| Hematocrit | 273 | ||
| White Blood Cells | 273 | ||
| Platelets | 273 | ||
| Blood Coagulation Studies | 274 | ||
| Serum Lipid Studies | 274 | ||
| Total Cholesterol | 274 | ||
| Low-Density Lipoproteins | 274 | ||
| Very-Low-Density Lipoproteins and Triglycerides | 274 | ||
| High-Density Lipoproteins | 274 | ||
| Triglycerides | 274 | ||
| DIAGNOSTIC PROCEDURES | 275 | ||
| Cardiac Catheterization and Coronary Arteriography | 275 | ||
| Left-Heart Cardiac Catheterization | 275 | ||
| Right-Heart Cardiac Catheterization | 275 | ||
| Procedure | 275 | ||
| Nursing Management | 275 | ||
| Patient Education | 276 | ||
| Electrophysiology Study | 276 | ||
| Indications | 276 | ||
| Chest Radiography | 277 | ||
| Basic Principles and Technique | 277 | ||
| Indications | 278 | ||
| Chest Radiograph Analysis: Lines and Tubes | 278 | ||
| Chest Radiograph Analysis: Cardiac and Pulmonary Factors | 278 | ||
| Digital Radiography | 279 | ||
| Ambulatory Electrocardiography | 279 | ||
| Continuous Electrocardiogram Recording Systems | 279 | ||
| Intermittent Electrocardiogram Recording Systems | 280 | ||
| Stress Tests: Exercise With Electrocardiogram Monitoring | 280 | ||
| Signal-Averaged Electrocardiogram | 281 | ||
| III - Pulmonary Alterations | 411 | ||
| 16 - Pulmonary Anatomy and Physiology | 411 | ||
| THORAX | 411 | ||
| Thoracic Cage | 411 | ||
| Lungs | 411 | ||
| Lobes and Segments | 411 | ||
| Mediastinum | 411 | ||
| Pleura | 411 | ||
| Intrapleural Pressure | 411 | ||
| Muscles of Ventilation | 413 | ||
| Inhalation | 413 | ||
| Exhalation | 414 | ||
| Accessory Muscles | 414 | ||
| CONDUCTING AIRWAYS | 414 | ||
| Upper Airways | 415 | ||
| Epiglottis | 415 | ||
| Trachea | 415 | ||
| Bronchial Tree | 415 | ||
| Bronchi | 416 | ||
| Bronchioles | 416 | ||
| Defense System | 416 | ||
| RESPIRATORY AIRWAYS | 417 | ||
| Respiratory Bronchioles | 417 | ||
| Alveoli | 417 | ||
| Type I Alveolar Epithelial Cells | 417 | ||
| Type II Alveolar Epithelial Cells | 418 | ||
| Defense System | 418 | ||
| PULMONARY BLOOD AND LYMPH SUPPLY | 418 | ||
| Pulmonary Circulation | 418 | ||
| Pulmonary Artery Pressures | 419 | ||
| Alveolar-Capillary Membrane | 419 | ||
| Membrane Layers | 420 | ||
| Bronchial Circulation | 420 | ||
| Physiologic Shunting | 420 | ||
| Lymphatic Circulation | 420 | ||
| VENTILATION | 420 | ||
| Work of Breathing | 420 | ||
| Pulmonary Volumes and Capacities | 421 | ||
| Physiologic Dead Space | 421 | ||
| Regulation of Ventilation | 422 | ||
| Controller | 422 | ||
| Effectors | 423 | ||
| Sensors | 423 | ||
| RESPIRATION | 425 | ||
| Diffusion | 425 | ||
| VENTILATION/PERFUSION RELATIONSHIPS | 425 | ||
| Distribution of Ventilation | 426 | ||
| Distribution of Perfusion | 426 | ||
| Ventilation/Perfusion Mismatch | 426 | ||
| Hypoxic Vasoconstriction | 427 | ||
| GAS TRANSPORT | 427 | ||
| Oxygen Content | 427 | ||
| Oxygen Content Formula | 428 | ||
| Oxyhemoglobin Dissociation Curve | 428 | ||
| Abnormalities of Hemoglobin | 429 | ||
| Carbon Dioxide Content | 429 | ||
| REFERENCES | 429 | ||
| 17 - Pulmonary Clinical Assessment | 431 | ||
| HISTORY | 431 | ||
| FOCUSED CLINICAL ASSESSMENT | 431 | ||
| Inspection | 431 | ||
| Tongue and Sublingual Area | 431 | ||
| Chest Wall Configuration | 431 | ||
| Respiratory Effort | 433 | ||
| Additional Assessment Areas | 433 | ||
| Palpation | 433 | ||
| Position of the Trachea | 433 | ||
| Thoracic Expansion | 434 | ||
| Tactile Fremitus | 434 | ||
| Percussion | 435 | ||
| Underlying Lung Structure | 435 | ||
| Diaphragmatic Excursion | 435 | ||
| Auscultation | 435 | ||
| Normal Breath Sounds | 436 | ||
| Abnormal Breath Sounds | 436 | ||
| Voice Sounds | 436 | ||
| ASSESSMENT FINDINGS OF COMMON DISORDERS | 438 | ||
| History | 444 | ||
| Focused Clinical Assessment | 444 | ||
| REFERENCES | 444 | ||
| 18 - Pulmonary Diagnostic Procedures | 445 | ||
| LABORATORY STUDIES | 445 | ||
| Arterial Blood Gases | 445 | ||
| Steps for Interpretation of Blood Gas Levels | 445 | ||
| Oxygen Saturation | 446 | ||
| Oxygen Content | 446 | ||
| Base Excess and Base Deficit | 447 | ||
| Classic Shunt Equation and Oxygen Tension Indices | 447 | ||
| Pao2/Fio2 Ratio | 448 | ||
| Pao2/Pao2 Ratio | 448 | ||
| Alveolar-Arterial Gradient | 448 | ||
| Dead Space Equation | 448 | ||
| Sputum Studies | 448 | ||
| DIAGNOSTIC PROCEDURES | 448 | ||
| Bronchoscopy | 448 | ||
| Thoracentesis | 449 | ||
| Bedside Pulmonary Function Tests | 450 | ||
| Ventilation/Perfusion Scanning | 451 | ||
| Chest Radiography | 451 | ||
| Bones | 451 | ||
| Mediastinum | 452 | ||
| Diaphragm | 452 | ||
| Pleural Space | 452 | ||
| Lung Tissue | 453 | ||
| Tubes, Wires, and Lines | 453 | ||
| Nursing Management | 453 | ||
| BEDSIDE MONITORING | 453 | ||
| Capnography | 453 | ||
| Pulse Oximetry | 454 | ||
| SUMMARY | 454 | ||
| Laboratory Studies | 454 | ||
| Diagnostic Procedures | 454 | ||
| Bedside Monitoring | 455 | ||
| REFERENCES | 455 | ||
| 19 - Pulmonary Disorders | 456 | ||
| ACUTE LUNG FAILURE | 456 | ||
| Description | 456 | ||
| Etiology | 456 | ||
| Pathophysiology | 456 | ||
| Alveolar Hypoventilation | 456 | ||
| Ventilation/Perfusion Mismatching | 456 | ||
| Intrapulmonary Shunting | 456 | ||
| Assessment and Diagnosis | 456 | ||
| Medical Management | 458 | ||
| Oxygenation | 458 | ||
| Ventilation | 458 | ||
| Pharmacology | 458 | ||
| Acidosis | 459 | ||
| Nutrition Support | 459 | ||
| Complications | 459 | ||
| Nursing Management | 460 | ||
| Optimize Oxygenation and Ventilation | 460 | ||
| Positioning. Positioning of a patient with ALF depends on the type of lung injury and the underlying cause of hypoxemia. For pat... | 460 | ||
| Educate the Patient and Family | 460 | ||
| ACUTE RESPIRATORY DISTRESS SYNDROME | 460 | ||
| Description | 460 | ||
| Etiology | 462 | ||
| Pathophysiology | 462 | ||
| Exudative Phase | 462 | ||
| Fibroproliferative Phase | 462 | ||
| Resolution Phase | 463 | ||
| Assessment and Diagnosis | 463 | ||
| Medical Management | 463 | ||
| Ventilation | 464 | ||
| Oxygen Therapy | 465 | ||
| Tissue Perfusion | 465 | ||
| Nursing Management | 465 | ||
| Optimize Oxygenation and Ventilation | 465 | ||
| Prone positioning. Numerous studies have shown that prone positioning of a patient with ARDS results in an improvement in oxygen... | 466 | ||
| PNEUMONIA | 466 | ||
| Description | 466 | ||
| Etiology | 466 | ||
| Severe Community-Acquired Pneumonia | 466 | ||
| Hospital-Acquired Pneumonia | 466 | ||
| Health Care–Associated Pneumonia | 467 | ||
| Pathophysiology | 467 | ||
| Assessment and Diagnosis | 467 | ||
| Medical Management | 468 | ||
| Antibiotic Therapy | 468 | ||
| Independent Lung Ventilation | 468 | ||
| Nursing Management | 468 | ||
| Optimize Oxygenation and Ventilation | 469 | ||
| Prevent Spread of Infection | 469 | ||
| ASPIRATION PNEUMONITIS | 469 | ||
| Description | 469 | ||
| Etiology | 470 | ||
| Pathophysiology | 470 | ||
| Acid Liquid | 470 | ||
| Acid Food Particles | 470 | ||
| Nonacid Liquid | 470 | ||
| Nonacid Food Particles | 470 | ||
| Assessment and Diagnosis | 471 | ||
| Medical Management | 471 | ||
| Nursing Management | 471 | ||
| Optimize Oxygenation and Ventilation | 471 | ||
| Prevent Aspiration | 471 | ||
| ACUTE PULMONARY EMBOLISM | 471 | ||
| Description | 471 | ||
| Etiology | 471 | ||
| Pathophysiology | 472 | ||
| Increased Dead Space | 472 | ||
| Bronchoconstriction | 472 | ||
| Compensatory Shunting | 472 | ||
| Hemodynamic Consequences | 472 | ||
| Assessment and Diagnosis | 472 | ||
| Medical Management | 474 | ||
| Prevention of Recurrence | 474 | ||
| Clot Dissolution | 474 | ||
| Reversal of Pulmonary Hypertension | 474 | ||
| Nursing Management | 474 | ||
| Optimize Oxygenation and Ventilation | 474 | ||
| Monitor for Bleeding | 475 | ||
| Educate the Patient and Family | 475 | ||
| STATUS ASTHMATICUS | 476 | ||
| Description | 476 | ||
| Etiology | 476 | ||
| Pathophysiology | 476 | ||
| Pulmonary Effects | 476 | ||
| Cardiovascular Effects | 476 | ||
| Assessment and Diagnosis | 476 | ||
| Medical Management | 476 | ||
| Bronchodilators | 476 | ||
| Systemic Corticosteroids | 477 | ||
| Oxygen Therapy | 477 | ||
| Intubation and Mechanical Ventilation | 477 | ||
| Nursing Management | 477 | ||
| Optimize Oxygenation and Ventilation | 477 | ||
| Educate the Patient and Family | 477 | ||
| AIR LEAK DISORDERS | 478 | ||
| Description | 478 | ||
| Etiology | 478 | ||
| Pathophysiology | 478 | ||
| Pneumothorax | 478 | ||
| Barotrauma | 478 | ||
| Assessment and Diagnosis | 479 | ||
| Medical Management | 479 | ||
| Tension Pneumothorax | 480 | ||
| Tension Pneumopericardium | 480 | ||
| Nursing Management | 480 | ||
| Optimize Oxygenation and Ventilation | 480 | ||
| Maintain Chest Drainage System | 480 | ||
| LONG-TERM MECHANICAL VENTILATOR DEPENDENCE | 480 | ||
| Description | 480 | ||
| Etiology and Pathophysiology | 481 | ||
| Medical and Nursing Management | 481 | ||
| Preweaning Stage | 481 | ||
| Weaning Process Stage | 482 | ||
| Weaning Outcome Stage | 484 | ||
| REFERENCES | 485 | ||
| 20 - Pulmonary Therapeutic Management | 487 | ||
| OXYGEN THERAPY | 487 | ||
| Principles of Therapy | 487 | ||
| Methods of Delivery | 487 | ||
| Low-Flow Systems | 487 | ||
| Reservoir Systems | 487 | ||
| High-Flow Systems | 487 | ||
| Complications of Oxygen Therapy | 487 | ||
| Oxygen Toxicity | 489 | ||
| Carbon Dioxide Retention | 489 | ||
| Absorption Atelectasis | 489 | ||
| Nursing Management | 489 | ||
| ARTIFICIAL AIRWAYS | 489 | ||
| Pharyngeal Airways | 489 | ||
| Oropharyngeal Airway | 490 | ||
| Nasopharyngeal Airway | 490 | ||
| Endotracheal Tubes | 490 | ||
| Rapid Sequence Intubation | 490 | ||
| Complications | 491 | ||
| Tracheostomy Tubes | 492 | ||
| Tracheostomy Procedure | 492 | ||
| Complications | 492 | ||
| Nursing Management | 492 | ||
| Humidification | 493 | ||
| Cuff Management | 495 | ||
| Suctioning | 496 | ||
| Communication | 497 | ||
| Oral Hygiene | 498 | ||
| Extubation and Decannulation | 498 | ||
| INVASIVE MECHANICAL VENTILATION | 499 | ||
| Indications | 499 | ||
| Use of Mechanical Ventilators | 499 | ||
| Types of Ventilators | 499 | ||
| Ventilator Mechanics | 499 | ||
| Modes of Ventilation | 499 | ||
| Ventilator Settings | 499 | ||
| Complications | 499 | ||
| Ventilator-Induced Lung Injury | 499 | ||
| Cardiovascular Compromise | 502 | ||
| Gastrointestinal Disturbances | 502 | ||
| Patient-Ventilator Dyssynchrony | 502 | ||
| Ventilator-Associated Pneumonia | 502 | ||
| Weaning | 503 | ||
| Readiness to Wean | 503 | ||
| Weaning Methods | 504 | ||
| Nursing Management | 505 | ||
| Patient Assessment | 505 | ||
| Symptom Management | 505 | ||
| ABCDEF Bundle | 505 | ||
| Ventilator Assessment | 505 | ||
| Patient Safety | 505 | ||
| NONINVASIVE VENTILATION | 505 | ||
| Nursing Management | 506 | ||
| POSITIONING THERAPY | 508 | ||
| Prone Positioning | 508 | ||
| Rotation Therapy | 509 | ||
| THORACIC SURGERY | 509 | ||
| Preoperative Care | 509 | ||
| Surgical Considerations | 509 | ||
| Complications and Medical Management | 509 | ||
| Acute Lung Failure | 509 | ||
| Bronchopleural Fistula | 509 | ||
| Hemorrhage | 511 | ||
| Cardiovascular Disturbances | 511 | ||
| Postoperative Nursing Management | 512 | ||
| Optimizing Oxygenation and Ventilation | 512 | ||
| Preventing Atelectasis | 512 | ||
| Patient positioning and early ambulation. When positioning the patient, the nurse considers the surgical incision site and the t... | 512 | ||
| Maintaining Chest Tube System | 512 | ||
| Assisting Patient to Return to Adequate Activity Level | 512 | ||
| PHARMACOLOGY | 513 | ||
| Bronchodilators and Adjuncts | 513 | ||
| Neuromuscular Blocking Agents | 513 | ||
| Peripheral Nerve Stimulator | 514 | ||
| REFERENCES | 517 | ||
| IV - Neurologic Alterations | 520 | ||
| 21 - Neurologic Anatomy and Physiology | 520 | ||
| DIVISIONS OF THE NERVOUS SYSTEM | 520 | ||
| Anatomic Divisions | 520 | ||
| Physiologic Divisions | 520 | ||
| MICROSTRUCTURE OF THE NERVOUS SYSTEM | 520 | ||
| Neuroglia | 520 | ||
| Neurons | 520 | ||
| CENTRAL NERVOUS SYSTEM | 524 | ||
| Cranial Protective Mechanisms | 524 | ||
| Cranium | 524 | ||
| Meninges | 524 | ||
| Ventricular System | 524 | ||
| Cerebrospinal Fluid | 526 | ||
| Blood–Brain Barrier | 526 | ||
| Cerebrum | 527 | ||
| Frontal Lobe | 527 | ||
| Parietal Lobe | 529 | ||
| Temporal Lobe | 530 | ||
| Occipital Lobe | 530 | ||
| Limbic Lobe | 530 | ||
| Internal Capsule | 530 | ||
| Basal Ganglia | 530 | ||
| Diencephalon | 531 | ||
| Thalamus | 531 | ||
| Hypothalamus | 531 | ||
| Cerebellum | 531 | ||
| Brainstem | 532 | ||
| Midbrain | 532 | ||
| Pons | 532 | ||
| Medulla Oblongata | 532 | ||
| Reticular Formation | 537 | ||
| Arterial Circulation | 539 | ||
| Anterior Circulation | 539 | ||
| Posterior Circulation | 540 | ||
| Circle of Willis | 540 | ||
| Venous Circulation | 540 | ||
| Spinal Cord | 540 | ||
| Spinal Protective Mechanisms | 541 | ||
| Vertebral Column | 541 | ||
| Intervertebral Disks | 541 | ||
| Meninges | 543 | ||
| Spinal Nerves | 543 | ||
| Gray and White Matter | 544 | ||
| Vascular Supply | 548 | ||
| REFERENCES | 549 | ||
| 22 - Neurologic Clinical Assessment and Diagnostic Procedures | 550 | ||
| HISTORY | 550 | ||
| FOCUSED CLINICAL ASSESSMENT | 550 | ||
| Level of Consciousness | 550 | ||
| Evaluation of Arousal | 550 | ||
| Appraisal of Awareness | 550 | ||
| Glasgow Coma Scale | 551 | ||
| Motor Function | 552 | ||
| Evaluation of Muscle Size and Tone | 552 | ||
| Estimation of Muscle Strength | 552 | ||
| Abnormal Motor Responses | 552 | ||
| Evaluation of Reflexes | 553 | ||
| Pupillary Function | 554 | ||
| Estimation of Pupil Size and Shape | 554 | ||
| Evaluation of Pupillary Reaction to Light | 554 | ||
| Assessment of Eye Movement | 555 | ||
| Respiratory Function | 557 | ||
| Observation of Respiratory Pattern | 557 | ||
| Evaluation of Airway Status | 558 | ||
| Vital Signs | 558 | ||
| Evaluation of Blood Pressure | 558 | ||
| Observation of Heart Rate and Rhythm | 558 | ||
| Rapid Neurologic Assessment | 558 | ||
| Conscious Patient | 558 | ||
| Unconscious Patient | 559 | ||
| Neurologic Changes Associated With Intracranial Hypertension | 559 | ||
| DIAGNOSTIC PROCEDURES | 559 | ||
| Radiologic Procedures | 560 | ||
| Skull and Spine Films | 560 | ||
| Computed Tomography | 560 | ||
| Magnetic Resonance Imaging | 560 | ||
| Cerebral Angiography | 561 | ||
| Myelography | 564 | ||
| Cerebral Blood Flow and Metabolism Imaging | 565 | ||
| Perfusion Computed Tomography | 565 | ||
| Xenon Computed Tomography | 565 | ||
| Perfusion Magnetic Resonance Imaging | 565 | ||
| Carotid Ultrasonography | 566 | ||
| Emission Tomography Studies | 566 | ||
| Electrophysiology Studies | 566 | ||
| Electroencephalography | 566 | ||
| Evoked Potentials | 567 | ||
| LABORATORY STUDIES | 567 | ||
| Cerebrospinal Fluid Analysis | 567 | ||
| MULTIMODAL BEDSIDE MONITORING | 567 | ||
| Intracranial Pressure Monitoring | 567 | ||
| Types of Intracranial Pressure Monitoring Devices | 567 | ||
| Intracranial Pressure Waves | 569 | ||
| Pupillometry | 570 | ||
| Cerebral Perfusion Pressure Monitoring | 570 | ||
| Cerebral Blood Flow Monitoring | 570 | ||
| Transcranial Doppler | 571 | ||
| Transcranial Color-Coded Duplex Sonography | 571 | ||
| Thermal Diffusion Flowmetry | 571 | ||
| Laser Doppler Flowmetry | 571 | ||
| Cerebral Oxygenation and Metabolic Monitoring | 571 | ||
| Brain Tissue Oxygen Pressure | 571 | ||
| Retrograde Jugular Bulb Oxygen Saturation | 572 | ||
| Near-Infrared Spectroscopy | 572 | ||
| Cerebral Microdialysis | 572 | ||
| Continuous Electroencephalography Monitoring | 572 | ||
| REFERENCES | 573 | ||
| 23 - Neurologic Disorders and Therapeutic Management | 575 | ||
| STROKE | 575 | ||
| Ischemic Stroke | 575 | ||
| Description | 575 | ||
| Etiology | 575 | ||
| Pathophysiology | 575 | ||
| Assessment and Diagnosis | 577 | ||
| Medical Management | 577 | ||
| Subarachnoid Hemorrhage | 578 | ||
| Description | 578 | ||
| Etiology | 579 | ||
| Pathophysiology | 579 | ||
| Assessment and Diagnosis | 581 | ||
| Medical Management | 582 | ||
| Hyponatremia | 584 | ||
| Hydrocephalus | 584 | ||
| Intracerebral Hemorrhage | 584 | ||
| Description | 584 | ||
| Etiology | 585 | ||
| Pathophysiology | 585 | ||
| Assessment and Diagnosis | 585 | ||
| Medical Management | 585 | ||
| Nursing Management | 585 | ||
| Monitor for Changes in Neurologic and Hemodynamic Status | 585 | ||
| Maintain Surveillance for Complications | 585 | ||
| Educate the Patient and Family | 588 | ||
| COMA | 588 | ||
| Description | 588 | ||
| Etiology | 589 | ||
| Pathophysiology | 589 | ||
| Assessment and Diagnosis | 589 | ||
| Medical Management | 590 | ||
| Nursing Management | 590 | ||
| Eye Care | 590 | ||
| GUILLAIN-BARRÉ SYNDROME | 591 | ||
| Description | 591 | ||
| Etiology | 591 | ||
| Pathophysiology | 591 | ||
| Assessment and Diagnosis | 591 | ||
| Medical Management | 592 | ||
| Nursing Management | 592 | ||
| Maintain Surveillance for Complications | 592 | ||
| Initiate Rehabilitation | 592 | ||
| Facilitate Nutrition Support | 592 | ||
| Provide Comfort and Emotional Support | 592 | ||
| Educate the Patient and Family | 592 | ||
| CRANIOTOMY | 593 | ||
| Types of Surgery | 593 | ||
| Preoperative Care | 593 | ||
| Surgical Considerations | 593 | ||
| Transcranial Approach | 594 | ||
| Transsphenoidal Approach | 594 | ||
| Postoperative Medical Management | 595 | ||
| Intracranial Hypertension | 595 | ||
| Surgical Hemorrhage | 595 | ||
| Fluid Imbalance | 595 | ||
| Cerebrospinal Fluid Leak | 596 | ||
| Deep Vein Thrombosis | 596 | ||
| Postoperative Nursing Management | 596 | ||
| Preserve Cerebral Perfusion | 596 | ||
| Promote Arterial Oxygenation | 597 | ||
| Provide Comfort and Emotional Support | 597 | ||
| Maintain Surveillance for Complications | 597 | ||
| Initiate Early Rehabilitation | 597 | ||
| Educate the Patient and Family | 597 | ||
| INTRACRANIAL HYPERTENSION | 597 | ||
| Pathophysiology | 597 | ||
| Volume-Pressure Curve | 598 | ||
| Cerebral Blood Flow and Autoregulation | 598 | ||
| Assessment and Diagnosis | 599 | ||
| Medical and Nursing Management | 599 | ||
| Positioning and Other Nursing Activities | 599 | ||
| Hyperventilation | 599 | ||
| Temperature Control | 599 | ||
| Blood Pressure Control | 599 | ||
| Seizure Control | 601 | ||
| Cerebrospinal Fluid Drainage | 601 | ||
| Hyperosmolar Therapy | 601 | ||
| Control of Metabolic Demand | 602 | ||
| Herniation Syndromes | 602 | ||
| Supratentorial Herniation | 602 | ||
| Infratentorial Herniation | 603 | ||
| PHARMACOLOGIC AGENTS | 603 | ||
| REFERENCES | 606 | ||
| V - Kidney Alterations | 608 | ||
| 24 - Kidney Anatomy and Physiology | 608 | ||
| MACROSCOPIC ANATOMY | 608 | ||
| VASCULAR ANATOMY | 608 | ||
| MICROSCOPIC STRUCTURE AND FUNCTION | 608 | ||
| Glomerulus | 609 | ||
| Bowman Capsule | 610 | ||
| Proximal Tubule | 610 | ||
| Loop of Henle | 610 | ||
| Distal Tubule | 610 | ||
| Collecting Duct | 610 | ||
| NERVOUS SYSTEM INNERVATION | 610 | ||
| URINE FORMATION | 611 | ||
| Glomerular Filtration | 611 | ||
| Tubular Resorption | 611 | ||
| Passive Transport | 611 | ||
| Active Transport | 612 | ||
| Tubular Secretion | 612 | ||
| FUNCTIONS OF THE KIDNEYS | 612 | ||
| Elimination of Metabolic Wastes | 612 | ||
| Urea | 612 | ||
| Creatinine | 612 | ||
| Blood Pressure Regulation | 612 | ||
| Erythrocyte Production | 613 | ||
| Vitamin D Activation | 613 | ||
| Prostaglandin Synthesis | 613 | ||
| Acid–Base Balance | 613 | ||
| FLUID BALANCE | 613 | ||
| Fluid Compartments | 613 | ||
| Electrolytes | 614 | ||
| Fluid Physiology | 614 | ||
| Tonicity | 614 | ||
| Hydrostatic Pressure | 615 | ||
| Osmotic Pressure | 615 | ||
| Diffusion, Osmosis, and Active Transport | 615 | ||
| Movement of Water | 615 | ||
| Factors Controlling Fluid Balance | 615 | ||
| Antidiuretic Hormone and Aquaporins | 615 | ||
| Aldosterone | 615 | ||
| Atrial Natriuretic Peptide | 615 | ||
| ELECTROLYTE BALANCE | 616 | ||
| Potassium | 616 | ||
| Sodium | 616 | ||
| Calcium | 616 | ||
| Phosphorus | 617 | ||
| Magnesium | 617 | ||
| Chloride | 617 | ||
| Bicarbonate | 618 | ||
| Effects of Aging | 618 | ||
| REFERENCES | 618 | ||
| 25 - Kidney Clinical Assessment and Diagnostic Procedures | 620 | ||
| HISTORY | 620 | ||
| PHYSICAL EXAMINATION | 620 | ||
| Inspection | 620 | ||
| Bleeding | 620 | ||
| Volume | 620 | ||
| Edema | 621 | ||
| Auscultation | 622 | ||
| Heart | 622 | ||
| Blood Pressure | 622 | ||
| Lungs | 622 | ||
| Palpation | 623 | ||
| Percussion | 623 | ||
| Kidneys | 623 | ||
| Abdomen | 623 | ||
| ADDITIONAL ASSESSMENTS | 623 | ||
| Weight Monitoring | 623 | ||
| Intake and Output Monitoring | 624 | ||
| Hemodynamic Monitoring | 624 | ||
| Other Observations | 624 | ||
| LABORATORY ASSESSMENT | 625 | ||
| Blood Urea Nitrogen | 625 | ||
| Creatinine | 625 | ||
| Blood Urea Nitrogen-to-Creatinine Ratio | 625 | ||
| Creatinine Clearance | 626 | ||
| Cystatin C | 626 | ||
| Osmolality | 626 | ||
| Anion Gap | 626 | ||
| Hemoglobin and Hematocrit | 627 | ||
| Albumin | 627 | ||
| Urinalysis | 627 | ||
| Urine Appearance | 627 | ||
| Urine pH | 627 | ||
| Urine Specific Gravity | 627 | ||
| Urine Osmolality | 628 | ||
| Urine Protein | 628 | ||
| Urine Glucose | 629 | ||
| Urine Ketones | 629 | ||
| Urine Electrolytes | 629 | ||
| Urine Sediment | 629 | ||
| Hematuria | 629 | ||
| URINE TOXICOLOGY SCREEN | 629 | ||
| IMAGING STUDIES | 629 | ||
| KIDNEY BIOPSY | 629 | ||
| REFERENCES | 630 | ||
| 26 - Kidney Disorders and Therapeutic Management | 631 | ||
| ACUTE KIDNEY INJURY | 631 | ||
| Critical Illness and Acute Kidney Injury | 631 | ||
| DEFINITIONS OF ACUTE KIDNEY INJURY | 631 | ||
| Types of Acute Kidney Injury | 632 | ||
| Prerenal Acute Kidney Injury | 632 | ||
| Intrarenal Acute Kidney Injury | 632 | ||
| Postrenal Acute Kidney Injury | 632 | ||
| Azotemia | 632 | ||
| ASSESSMENT AND DIAGNOSIS | 633 | ||
| Laboratory Assessment | 633 | ||
| Acidosis | 633 | ||
| Blood Urea Nitrogen | 633 | ||
| Serum Creatinine | 633 | ||
| Creatinine Clearance | 634 | ||
| Fractional Excretion of Sodium | 634 | ||
| AT-RISK DISEASE STATES AND ACUTE KIDNEY INJURY | 635 | ||
| Underlying Chronic Kidney Disease | 635 | ||
| Older Age and Acute Kidney Injury | 635 | ||
| Heart Failure and Acute Kidney Injury | 635 | ||
| Respiratory Failure and Acute Kidney Injury | 635 | ||
| Sepsis and Acute Kidney Injury | 635 | ||
| Trauma and Acute Kidney Injury | 635 | ||
| Trauma Admissions | 635 | ||
| Rhabdomyolysis | 635 | ||
| Contrast-Induced Nephrotoxic Injury and Acute Kidney Injury | 637 | ||
| Radiopaque Contrast Medium | 637 | ||
| Promote Hydration and Avoid Dehydration | 637 | ||
| Medications | 637 | ||
| Catheter-Associated Urinary Tract Infection | 637 | ||
| Hemodynamic Monitoring and Fluid Balance | 637 | ||
| Daily Weight | 637 | ||
| Physical Assessment | 638 | ||
| Electrolyte Balance | 638 | ||
| Potassium | 638 | ||
| Sodium | 639 | ||
| Calcium and Phosphorus | 639 | ||
| Calcium Replacement | 639 | ||
| Dietary Phosphorus–Binding Medications | 639 | ||
| Medical Management | 639 | ||
| Treatment Goals | 639 | ||
| Prevention | 639 | ||
| Fluid Resuscitation | 639 | ||
| Pharmacologic Management | 641 | ||
| Diuretics | 641 | ||
| Vaptans | 642 | ||
| Dopamine | 643 | ||
| Acetylcysteine | 643 | ||
| Dietary Phosphorus Binders | 643 | ||
| Nutrition | 643 | ||
| Nursing Management | 643 | ||
| Risk Factors for Acute Kidney Injury | 644 | ||
| Infectious Complications | 644 | ||
| Fluid Balance | 644 | ||
| Electrolyte Imbalance | 644 | ||
| Preventing Anemia | 644 | ||
| Patient Education | 644 | ||
| RENAL REPLACEMENT THERAPY: DIALYSIS | 644 | ||
| Hemodialysis | 645 | ||
| Hemodialyzer | 645 | ||
| Ultrafiltration | 645 | ||
| Anticoagulation | 645 | ||
| Vascular Access | 646 | ||
| Medical Management | 648 | ||
| Nursing Management | 648 | ||
| Continuous Renal Replacement Therapy | 648 | ||
| Continuous Renal Replacement Therapy Terminology | 649 | ||
| Modes of Continuous Renal Replacement | 649 | ||
| Continuous Venovenous Hemodialysis | 649 | ||
| Complications | 651 | ||
| Medical Management | 652 | ||
| Nursing Management | 652 | ||
| Peritoneal Dialysis | 653 | ||
| Catheter Placement | 653 | ||
| Infection | 653 | ||
| Nursing Management | 653 | ||
| REFERENCES | 655 | ||
| VI - Gastrointestinal Alterations | 657 | ||
| 27 - Gastrointestinal Anatomy and Physiology | 657 | ||
| MOUTH | 657 | ||
| Ingestion and Mastication | 657 | ||
| Salivation | 657 | ||
| ESOPHAGUS | 657 | ||
| Swallowing | 657 | ||
| STOMACH | 658 | ||
| Gastric Secretion | 660 | ||
| Gastric Motility | 660 | ||
| SMALL INTESTINE | 660 | ||
| Intestinal Secretion | 661 | ||
| Intestinal Motility | 662 | ||
| Digestion and Absorption | 662 | ||
| LARGE INTESTINE | 662 | ||
| Colonic Motility | 664 | ||
| Resorption | 664 | ||
| ACCESSORY ORGANS | 664 | ||
| Liver | 664 | ||
| Nutrient Metabolism | 665 | ||
| Hematologic Function | 665 | ||
| Detoxification and Storage | 665 | ||
| Bile | 665 | ||
| Bilirubin | 665 | ||
| Biliary System | 665 | ||
| Pancreas | 667 | ||
| Exocrine Functions | 668 | ||
| Endocrine Functions | 668 | ||
| REFERENCES | 668 | ||
| 28 - Gastrointestinal Clinical Assessment and Diagnostic Procedures | 669 | ||
| HISTORY | 669 | ||
| FOCUSED CLINICAL ASSESSMENT | 669 | ||
| Inspection | 669 | ||
| Auscultation | 669 | ||
| Percussion | 671 | ||
| Palpation | 672 | ||
| Assessment Findings for Common Disorders | 672 | ||
| LABORATORY STUDIES | 672 | ||
| Diagnostic Procedures | 672 | ||
| Endoscopy | 674 | ||
| VII - Endocrine Alterations | 705 | ||
| 30 - Endocrine Anatomy and Physiology | 705 | ||
| PANCREAS | 705 | ||
| Anatomy | 705 | ||
| Pancreas Blood Supply | 705 | ||
| Exocrine Cells | 705 | ||
| Endocrine Cells | 705 | ||
| Physiology | 705 | ||
| Insulin | 706 | ||
| Blood Glucose | 706 | ||
| Glucagon | 707 | ||
| Somatostatin | 708 | ||
| Pancreatic Polypeptide | 708 | ||
| Glucose Transporters | 708 | ||
| Incretins | 709 | ||
| PITUITARY GLAND AND HYPOTHALAMUS | 709 | ||
| Anatomy | 709 | ||
| Anterior Pituitary | 710 | ||
| Posterior Pituitary | 710 | ||
| Physiology | 710 | ||
| Antidiuretic Hormone | 710 | ||
| THYROID GLAND | 711 | ||
| Anatomy | 711 | ||
| Physiology | 711 | ||
| Pituitary Gland and Thyroid-Stimulating Hormone | 711 | ||
| Iodine and Iodide | 711 | ||
| Thyroglobulin | 712 | ||
| Triiodothyronine and Thyroxine | 712 | ||
| Calcitonin | 712 | ||
| Hypothalamic-Pituitary-Thyroid Axis Feedback Loop | 712 | ||
| ADRENAL GLAND | 712 | ||
| Anatomy | 712 | ||
| Adrenal Cortex | 712 | ||
| Adrenal Medulla | 712 | ||
| Adrenal Blood Supply | 713 | ||
| Physiology | 714 | ||
| Hormones of the Adrenal Cortex | 714 | ||
| Hormones of the Adrenal Medulla | 714 | ||
| Hypothalamic-Pituitary-Adrenal Axis | 714 | ||
| REFERENCES | 715 | ||
| 31 - Endocrine Clinical Assessment and Diagnostic Procedures | 716 | ||
| HISTORY | 716 | ||
| PANCREAS | 716 | ||
| Physical Assessment | 716 | ||
| Hyperglycemia | 716 | ||
| Laboratory Studies | 716 | ||
| Blood Glucose | 716 | ||
| Urine Glucose | 717 | ||
| Glycated Hemoglobin | 717 | ||
| Blood Ketones | 718 | ||
| Urine Ketones | 718 | ||
| PITUITARY GLAND | 718 | ||
| Physical Assessment | 718 | ||
| Hydration Status | 718 | ||
| Vital Signs | 718 | ||
| Weight Changes and Intake and Output | 718 | ||
| Laboratory Assessment | 718 | ||
| Serum Antidiuretic Hormone | 718 | ||
| Serum and Urine Osmolality | 719 | ||
| Antidiuretic Hormone Test | 719 | ||
| Diagnostic Procedures | 719 | ||
| Radiographic Examination | 719 | ||
| Computed Tomography | 719 | ||
| Magnetic Resonance Imaging | 719 | ||
| THYROID GLAND | 719 | ||
| Clinical Assessment | 719 | ||
| History | 719 | ||
| Physical Examination | 719 | ||
| Laboratory Studies | 720 | ||
| Thyroid-Stimulating Hormone | 720 | ||
| Thyroid Tests in Critically Ill Patients | 721 | ||
| Medications and Thyroid Testing | 721 | ||
| Diagnostic Procedures | 721 | ||
| ADRENAL GLAND | 721 | ||
| Primary Adrenal Disorders | 721 | ||
| Clinical Assessment | 722 | ||
| History | 722 | ||
| Physical Examination | 722 | ||
| Adrenal Cortex | 722 | ||
| Primary Aldosteronism | 722 | ||
| Adrenal Insufficiency | 722 | ||
| Adrenal Crisis | 723 | ||
| Critical Illness–Related Corticosteroid Insufficiency | 723 | ||
| Adrenal Medulla | 723 | ||
| Diagnostic Imaging Procedures | 723 | ||
| REFERENCES | 723 | ||
| 32 - Endocrine Disorders and Therapeutic Management | 725 | ||
| NEUROENDOCRINOLOGY OF STRESS AND CRITICAL ILLNESS | 725 | ||
| Acute Neuroendocrine Response to Critical Illness | 725 | ||
| Hypothalamic-Pituitary-Adrenal Axis in Critical Illness | 725 | ||
| Hyperglycemia in Critical Illness | 725 | ||
| Hyperglycemia Management in Critical Illness | 727 | ||
| Clinical Practice Guidelines for Blood Glucose Management in Critically Ill Patients | 727 | ||
| Insulin Management in Critically Ill Patients | 727 | ||
| Frequent Blood Glucose Monitoring | 727 | ||
| Continuous Insulin Infusion | 727 | ||
| Transition From Continuous to Intermittent Insulin Coverage | 728 | ||
| Corrective Insulin Coverage | 728 | ||
| Hypoglycemia Management | 728 | ||
| Nursing Management | 728 | ||
| Monitor Hyperglycemic Side Effects of Vasopressor Therapy | 729 | ||
| Administer Prescribed Corticosteroids | 729 | ||
| Monitor Blood Glucose and Insulin Effectiveness and Avoid Hypoglycemia | 731 | ||
| Provide Nutrition | 731 | ||
| Patient Education | 731 | ||
| DIABETES MELLITUS | 731 | ||
| Diagnosis of Diabetes | 731 | ||
| Types of Diabetes | 731 | ||
| Glycated Hemoglobin | 732 | ||
| Type 1 Diabetes | 732 | ||
| Management of Type 1 Diabetes | 732 | ||
| Type 2 Diabetes | 732 | ||
| Lifestyle Management for Type 2 Diabetes | 732 | ||
| Pharmacologic Management of Type 2 Diabetes | 732 | ||
| Polypharmacy in Diabetes | 733 | ||
| DIABETIC KETOACIDOSIS | 735 | ||
| Epidemiology and Etiology | 735 | ||
| Pathophysiology | 736 | ||
| Insulin Deficiency | 736 | ||
| Hyperglycemia | 738 | ||
| Fluid Volume Deficit | 738 | ||
| Ketoacidosis | 738 | ||
| Acid–Base Balance | 738 | ||
| Gluconeogenesis | 738 | ||
| Assessment and Diagnosis | 738 | ||
| Clinical Manifestations | 738 | ||
| Laboratory Studies | 738 | ||
| Medical Management | 738 | ||
| Reversing Dehydration | 738 | ||
| Insulin Administration | 740 | ||
| Reversing Ketoacidosis | 740 | ||
| Replenishing Electrolytes | 740 | ||
| Nursing Management | 740 | ||
| Administering Fluids, Insulin, and Electrolytes | 740 | ||
| Monitoring Response to Therapy | 741 | ||
| Surveillance for Complications | 741 | ||
| Patient Education | 742 | ||
| Collaborative Management | 743 | ||
| HYPERGLYCEMIC HYPEROSMOLAR STATE | 743 | ||
| Epidemiology and Etiology | 743 | ||
| Differences Between Hyperglycemic Hyperosmolar State and Diabetic Ketoacidosis | 743 | ||
| Pathophysiology | 743 | ||
| Assessment and Diagnosis | 745 | ||
| Clinical Manifestations | 745 | ||
| Laboratory Studies | 745 | ||
| Medical Management | 745 | ||
| Rapid Rehydration | 745 | ||
| Insulin Administration | 745 | ||
| . Type 2 diabetes in manifested not only by hyperglycemia but also by insulin resistance. HHS often develops secondary to an ill... | 745 | ||
| Electrolyte Replacement | 746 | ||
| Nursing Management | 746 | ||
| Administering Fluids, Insulin, and Electrolytes | 746 | ||
| Monitoring Response to Therapy | 746 | ||
| Surveillance for Complications | 747 | ||
| Patient Education | 747 | ||
| Collaborative Management | 747 | ||
| DIABETES INSIPIDUS | 747 | ||
| Etiology | 747 | ||
| Central Diabetes Insipidus | 748 | ||
| Nephrogenic Diabetes Insipidus | 748 | ||
| Dipsogenic Diabetes Insipidus | 748 | ||
| Pathophysiology | 748 | ||
| Assessment and Diagnosis | 748 | ||
| Clinical Manifestations | 748 | ||
| Laboratory Studies | 748 | ||
| Medical Management | 748 | ||
| Volume Restoration | 750 | ||
| Medications | 750 | ||
| Nursing Management | 750 | ||
| Administration of Fluids | 750 | ||
| Administration of Medications | 750 | ||
| Surveillance for Complications | 750 | ||
| Patient Education | 750 | ||
| Collaborative Management | 750 | ||
| SYNDROME OF INAPPROPRIATE SECRETION OF ANTIDIURETIC HORMONE | 751 | ||
| Etiology | 752 | ||
| Pathophysiology | 752 | ||
| Assessment and Diagnosis | 754 | ||
| Clinical Manifestations | 754 | ||
| Laboratory Values | 754 | ||
| Medical Management | 754 | ||
| Fluid Restriction | 754 | ||
| Sodium Replacement | 754 | ||
| Medications | 754 | ||
| . Vasopressin receptor antagonists are used to treat euvolemic hyponatremia such as SIADH. Medications in this class are also ca... | 754 | ||
| Nursing Management | 754 | ||
| Restriction of Fluids | 755 | ||
| Patient Education | 755 | ||
| Collaborative Management | 755 | ||
| THYROID STORM | 755 | ||
| Description | 755 | ||
| Etiology | 755 | ||
| Pathophysiology | 755 | ||
| Assessment and Diagnosis | 756 | ||
| Medical Management | 756 | ||
| Prevent Cardiovascular Collapse | 756 | ||
| Reduce Hyperthermia | 757 | ||
| Reverse Dehydration | 757 | ||
| Pharmacologic Management | 757 | ||
| Medications That Block Catecholamine Effect | 757 | ||
| Medications That Block Thyroid Synthesis | 757 | ||
| Medications That Block Release of Thyroid Hormone | 757 | ||
| Nursing Management | 758 | ||
| Medication Administration | 758 | ||
| Normalize Body Temperature | 758 | ||
| Rehydration and Correction of Metabolic Derangements | 758 | ||
| Patient Education | 759 | ||
| Collaborative Management | 759 | ||
| MYXEDEMA COMA | 759 | ||
| Description | 759 | ||
| Etiology | 759 | ||
| Pathophysiology | 759 | ||
| Skin | 759 | ||
| Cardiopulmonary System | 759 | ||
| Pulmonary System | 760 | ||
| Kidneys and Fluid and Electrolyte Balance | 760 | ||
| Nutrition and Elimination | 760 | ||
| Thermoregulation | 760 | ||
| Anemia | 760 | ||
| Assessment and Diagnosis | 760 | ||
| Clinical Presentation | 760 | ||
| Laboratory Studies | 761 | ||
| Medical Management | 761 | ||
| Pharmacologic Management | 761 | ||
| Nursing Management | 761 | ||
| Pulmonary Care | 761 | ||
| Cardiac Concerns | 761 | ||
| Thermoregulation | 761 | ||
| Thyroid Replacement Therapy | 761 | ||
| Skin Care | 761 | ||
| Elimination | 761 | ||
| Patient Education | 761 | ||
| Collaborative Management | 761 | ||
| REFERENCES | 762 | ||
| VIII - Multisystem Alterations | 764 | ||
| 33 - Trauma | 764 | ||
| DOMESTIC VIOLENCE AND TRAUMA | 764 | ||
| ALCOHOL AND SUBSTANCE ABUSE AND TRAUMA | 764 | ||
| MECHANISM OF INJURY | 764 | ||
| Blunt Trauma | 764 | ||
| Penetrating Trauma | 765 | ||
| PHASES OF TRAUMA CARE | 765 | ||
| Prehospital Care | 766 | ||
| Emergency Department | 766 | ||
| Primary Survey | 766 | ||
| Secondary Survey | 767 | ||
| Critical Care Phase | 769 | ||
| End Points in Trauma Resuscitation | 770 | ||
| SPECIFIC TRAUMA INJURIES | 770 | ||
| Traumatic Brain Injuries | 770 | ||
| Pathophysiology | 770 | ||
| Classification of Brain Injuries | 771 | ||
| Neurologic Assessment of Traumatic Brain Injury | 774 | ||
| Medical Management | 775 | ||
| Nursing Management | 775 | ||
| Spinal Cord Injuries | 776 | ||
| Pathophysiology | 776 | ||
| How the Spinal Cord Is Injured | 777 | ||
| Functional Injury of the Spinal Cord | 777 | ||
| Medical Management | 781 | ||
| Nursing Management | 782 | ||
| Maxillofacial Injuries | 784 | ||
| Physical Assessment and Diagnostic Procedures | 785 | ||
| Medical Management | 785 | ||
| Nursing Management | 785 | ||
| Thoracic Injuries | 785 | ||
| Specific Thoracic Traumatic Injuries | 785 | ||
| Pulmonary injuries | 787 | ||
| Specific cardiac and vascular thoracic injuries | 788 | ||
| Abdominal Injuries | 789 | ||
| Physical Assessment | 790 | ||
| Diagnostic Procedures | 790 | ||
| Abdominal Compartment Syndrome | 790 | ||
| Specific Abdominal Organ Injuries | 791 | ||
| Genitourinary Injuries | 792 | ||
| Physical Assessment | 792 | ||
| Specific Genitourinary Injuries | 792 | ||
| Nursing Management | 792 | ||
| Musculoskeletal Injuries | 792 | ||
| Pelvic Fractures | 792 | ||
| Physical Assessment and Diagnostic Procedures | 793 | ||
| Classification of Pelvic Fractures | 793 | ||
| Medical Management | 793 | ||
| Nursing Management | 794 | ||
| COMPLICATIONS OF TRAUMA | 794 | ||
| Central Nervous System Complications | 794 | ||
| Pain | 794 | ||
| Cardiovascular Complications | 794 | ||
| Compartment Syndrome | 794 | ||
| Venous Thromboembolism | 794 | ||
| Pulmonary Complications | 794 | ||
| Acute Respiratory Distress Syndrome | 794 | ||
| Gastrointestinal and Genitourinary Complications | 795 | ||
| Hypermetabolism | 795 | ||
| Acute Kidney Injury | 795 | ||
| Rhabdomyolysis and Myoglobinuria | 795 | ||
| Integumentary and Musculoskeletal Complications | 795 | ||
| Fat Embolism Syndrome | 795 | ||
| Other Complications in Adult Trauma Patients | 795 | ||
| Infection | 795 | ||
| Sepsis | 796 | ||
| Transfusion-Related Complications | 796 | ||
| Missed Injury | 796 | ||
| Multiple Organ Dysfunction Syndrome | 796 | ||
| SPECIAL CONSIDERATIONS | 796 | ||
| Trauma in Older Patients | 796 | ||
| Meeting Needs of Family Members and Significant Others | 797 | ||
| REFERENCES | 798 | ||
| 34 - Shock, Sepsis, and Multiple Organ Dysfunction Syndrome | 801 | ||
| SHOCK SYNDROME | 801 | ||
| Description | 801 | ||
| Etiology | 801 | ||
| Pathophysiology | 801 | ||
| Assessment and Diagnosis | 803 | ||
| Medical Management | 803 | ||
| Nursing Management | 804 | ||
| HYPOVOLEMIC SHOCK | 805 | ||
| Description | 805 | ||
| Etiology | 805 | ||
| Pathophysiology | 805 | ||
| Assessment and Diagnosis | 805 | ||
| Medical Management | 807 | ||
| Nursing Management | 807 | ||
| CARDIOGENIC SHOCK | 807 | ||
| Description | 807 | ||
| Etiology | 809 | ||
| Pathophysiology | 809 | ||
| Assessment and Diagnosis | 809 | ||
| Medical Management | 810 | ||
| Nursing Management | 810 | ||
| ANAPHYLACTIC SHOCK | 811 | ||
| Description | 811 | ||
| Etiology | 811 | ||
| Pathophysiology | 811 | ||
| Assessment and Diagnosis | 811 | ||
| Medical Management | 813 | ||
| Nursing Management | 814 | ||
| NEUROGENIC SHOCK | 815 | ||
| IX - Special Populations | 923 | ||
| 38 - The Obstetric Patient | 923 | ||
| PHYSIOLOGIC ALTERATIONS IN PREGNANCY | 923 | ||
| PHYSIOLOGIC CHANGES DURING LABOR AND DELIVERY | 923 | ||
| CARDIAC DISORDERS IN PREGNANCY | 925 | ||
| Congenital Cardiac Disorders | 925 | ||
| Atrial Septal Defect | 925 | ||
| Ventricular Septal Defect | 926 | ||
| Patent Ductus Arteriosus | 926 | ||
| Tetralogy of Fallot | 926 | ||
| Coarctation of the Aorta | 926 | ||
| Eisenmenger Syndrome | 926 | ||
| Acquired Cardiac Disorders | 926 | ||
| Mitral Stenosis | 926 | ||
| Aortic Stenosis | 926 | ||
| Marfan Syndrome | 927 | ||
| Peripartum Cardiomyopathy | 927 | ||
| Ischemic Cardiac Disease | 927 | ||
| Acute Myocardial Infarction | 927 | ||
| Prior Myocardial Infarction | 927 | ||
| Cardiac Arrest in Pregnancy | 928 | ||
| HYPERTENSIVE DISEASE | 928 | ||
| Classification of Hypertension | 928 | ||
| Preeclampsia and Eclampsia | 929 | ||
| Hemolysis, Elevated Liver Enzymes, and Low Platelet Syndrome | 930 | ||
| DISSEMINATED INTRAVASCULAR COAGULATION | 930 | ||
| Abruptio Placentae | 930 | ||
| Dead Fetus Syndrome | 931 | ||
| Septic Abortion | 931 | ||
| SHOCK | 931 | ||
| PULMONARY DYSFUNCTION | 931 | ||
| Asthma | 931 | ||
| Cystic Fibrosis | 932 | ||
| Pneumonia | 933 | ||
| Acute Respiratory Distress Syndrome | 933 | ||
| Management of Respiratory Failure | 933 | ||
| Pulmonary Embolism | 933 | ||
| Amniotic Fluid Embolism | 934 | ||
| TRAUMA | 934 | ||
| Types of Injuries | 938 | ||
| Cardiovascular Injuries | 938 | ||
| Pulmonary Injuries | 938 | ||
| Neurologic Injuries | 938 | ||
| Abdominal and Pelvic Injuries | 938 | ||
| Reproductive System Injuries | 938 | ||
| Fetal Injuries | 938 | ||
| POSTPARTUM HEMORRHAGE | 939 | ||
| Risk Factors and Causes | 939 | ||
| Prevention | 939 | ||
| RISKS TO FETAL DEVELOPMENT | 939 | ||
| Prematurity | 940 | ||
| REFERENCES | 940 | ||
| 39 - The Pediatric Patient | 943 | ||
| RESPIRATORY SYSTEM | 943 | ||
| Anatomy and Physiology | 943 | ||
| Upper Airway | 943 | ||
| Lower Airway | 943 | ||
| Chest Mechanics | 943 | ||
| Assessment and Oxygen Devices | 944 | ||
| Airway Positioning | 945 | ||
| Supplemental Oxygen Devices | 946 | ||
| Endotracheal Intubation | 947 | ||
| Procedure | 947 | ||
| Securing Endotracheal and Nasotracheal Tubes | 947 | ||
| Mechanical Ventilation | 947 | ||
| Extubation Complications | 949 | ||
| Tracheostomy | 950 | ||
| Bronchiolitis | 950 | ||
| Pathophysiology | 950 | ||
| A - Nursing Management Plans of Care | 1006 | ||
| B - Physiologic Formulas for Critical Care | 1049 | ||
| HEMODYNAMIC EQUATIONS | 1049 | ||
| Mean (Systemic) Arterial Pressure (MAP) | 1049 | ||
| Systemic Vascular Resistance (SVR) | 1049 | ||
| Systemic Vascular Resistance Index (SVRI) | 1049 | ||
| Pulmonary Vascular Resistance (PVR) | 1049 | ||
| Pulmonary Vascular Resistance Index (PVRI) | 1049 | ||
| Left Cardiac Work Index (LCWI) | 1049 | ||
| Left Ventricular Stroke Work Index (LVSWI) | 1049 | ||
| Right Cardiac Work Index (RCWI) | 1049 | ||
| Right Ventricular Stroke Work Index (RVSWI) | 1049 | ||
| Corrected Q–T Interval (Q–Tc) | 1049 | ||
| Body Surface Area (BSA) | 1049 | ||
| PULMONARY FORMULAS | 1050 | ||
| Shunt Equation (Qs/Qt) | 1050 | ||
| Pulmonary Capillary Oxygen Content (Cco2) | 1050 | ||
| Arterial Oxygen Content (Cao2) | 1050 | ||
| Venous Oxygen Content (Cvo2) | 1050 | ||
| Alveolar Pressure of Oxygen (Pao2) | 1050 | ||
| Arterial/Inspired Oxygen Ratio | 1050 | ||
| Arterial/Alveolar Oxygen Ratio | 1051 | ||
| Alveolar-Arterial Gradient | 1051 | ||
| Dead Space Equation (Vd/Vt) | 1051 | ||
| Static Compliance (CST) | 1051 | ||
| Dynamic Compliance (CDY) | 1051 | ||
| NEUROLOGIC FORMULAS | 1051 | ||
| Cerebral Perfusion Pressure (CPP) | 1051 | ||
| Arteriojugular Oxygen Difference (Ajdo2) | 1051 | ||
| ENDOCRINE FORMULAS | 1051 | ||
| Serum Osmolality | 1051 | ||
| Fluid Volume Deficit in Liters | 1051 | ||
| KIDNEY FORMULAS | 1051 | ||
| Anion Gap | 1051 | ||
| Clearance | 1051 | ||
| NUTRITIONAL FORMULAS | 1051 | ||
| Caloric and Protein Needs1 | 1051 | ||
| Estimating Caloric Needs | 1051 | ||
| Estimating Protein Needs | 1052 | ||
| REFERENCE | 1052 | ||
| INDEX | 1053 | ||
| A | 1053 | ||
| B | 1056 | ||
| C | 1058 | ||
| D | 1062 | ||
| E | 1064 | ||
| F | 1065 | ||
| G | 1066 | ||
| H | 1067 | ||
| I | 1070 | ||
| J | 1071 | ||
| K | 1071 | ||
| L | 1072 | ||
| M | 1073 | ||
| N | 1075 | ||
| O | 1076 | ||
| P | 1077 | ||
| Q | 1081 | ||
| R | 1081 | ||
| S | 1082 | ||
| T | 1084 | ||
| U | 1086 | ||
| V | 1086 | ||
| W | 1087 | ||
| X | 1087 | ||
| Z | 1087 | ||
| Special Features | ES2 | ||
| CONCEPT MAPS | ES2 | ||
| DATA COLLECTION | ES2 | ||
| EVIDENCE-BASED PRACTICE | ES2 | ||
| INFORMATICS | ES2 | ||
| NURSING DIAGNOSES | ES2 | ||
| PATIENT-CENTERED CARE | ES3 | ||
| PATIENT EDUCATION PLAN | ES3 | ||
| PATIENT SAFETY ALERTS | ES3 | ||
| PHARMACOLOGIC MANAGEMENT | ES3 | ||
| TEAMWORK AND COLLABORATION | ES3 |