ACCCN's Critical Care Nursing - E-Book

Doug Elliott; Leanne Aitken; Wendy Chaboyer

BOOK

ACCCN's Critical Care Nursing - E-Book

Doug Elliott | Leanne Aitken | Wendy Chaboyer

(2011)

Additional Information

Book Details

ISBN: 978-0-7295-8068-7
Edition: 2
Language: English
Pages: 836
Subjects: Nursing
Intensive care nursing

Abstract

A revised new edition of this comprehensive critical care nursing text, developed with the Australian College of Critical Care Nurses (ACCCN).

This second edition of ACCCN's Critical Care Nursing has been fully revised and updated for critical care nurses and students in Australia and New Zealand.

As well as featuring the most recent critical care research data, current clinical practice, policies, procedures and guidelines specific to Australia and New Zealand, this new edition offers new and expanded chapters and case studies.

The ultimate guide for critical care nurses and nursing students alike, ACCCN's Critical Care Nursing 2e has been developed in conjunction with the Australian College of Critical Care Nurses (ACCCN).

As with the first edition, the text in ACCCN's Critical Care Nursing 2e reflects the expertise of ACCCN's highly-qualified team of local and international critical care nursing academics and clinicians.

This authoritative nursing resource takes a patient-centred approach, encouraging practising critical care nurses and students to develop effective, high-quality critical care nursing practice.

ACCCN's Critical Care Nursing 2e outlines the scope of critical care nursing, before detailing the core components and specialty aspects of critical care nursing, such as intensive care, emergency nursing, cardiac nursing, neuroscience nursing and acute care.

Specific clinical conditions such as emergency presentations, trauma, resuscitation, and organ donation are featured to explore some of the more complex or unique aspects of specialty critical care nursing practice.

expanded chapters for cardiovascular, respiratory and neurological content
new chapters on Quality and Safety; Recovery and Rehabilitation; Psychological care; and Obstetric emergencies
new case studies elaborate on relevant care issues
critiques of recent research publications explore related topics
practice tips highlight areas of care particularly relevant to daily clinical practice
learning activities support knowledge, reflective learning and understanding

Section Title	Page	Action	Price
Front cover	cover
ACCCN's Critical Care Nursing	i
Copyright page	iv
Table of Contents	v
Foreword	vi
Preface	vii
About the Australian College of Critical Care Nurses (ACCCN)	ix
About the Editors	x
Contributors	xi
Reviewers	xiii
Acknowledgements	xiv
Detailed contents	xv
Abbreviations	xviii
1 Scope of Clinical Care	1
1 Scope of Critical Care Practice	3
Learning objectives	3
Key words	3
Introduction	3
Development of Critical Care Nursing	3
Critical Care Nursing Education	4
Specialist Critical Care Competencies	5
Critical Care Nursing Professional Organisations	5
Roles of Critical Care Nurses	6
Consultant	6
Advanced Practice Nurse/Nurse Practitioner	6
Clinical Decision Making	6
Theoretical Perspectives on Decision Making	6
Research on Decision Making in Critical Care Nursing	7
Recommendations for Developing Clinical Decision Making Skills	7
Leadership in Critical Care Nursing	7
Clinical Leadership	10
Developing a Body of Knowledge	11
Research	11
Summary	12
Online resources	12
Further reading	14
References	14
2 Resourcing Critical Care	17
Learning objectives	17
Key words	17
Introduction	17
Ethical Allocation and Utilisation of Resources	17
Historical Influences	18
Economic Considerations and Principles	19
Budget	20
Types of Budget	20
Personnel Budget	20
Operational Budget	20
Capital Budget	20
Budget Process	21
Budget Preparation and Approval	21
Budget Analysis and Reporting	21
Budget Control and Action	21
Developing A Business Case	21
Critical Care Environment	22
Organisational Design	22
Equipment	22
Initial Set-Up Requirements	22
Purchasing	22
Replacement and Maintenance	23
Staff	23
Staffing Roles	23
Staffing Levels	24
Nurse-To-Patient Ratios	24
Patient Dependency	24
Skill Mix	26
Rostering	27
Education and Training	27
Orientation	28
Continuing Education	28
Risk Management	28
Negligence	28
The Role of Leadership and Management	29
Managing Injury: Staff, Patient or Visitor	29
Contingency Plans and Rehearsal	30
Measures of Nursing Workload or Activity	30
Therapeutic Intervention Scoring System	30
Management of Pandemics	33
Development of A Surge Plan	33
Staff	33
Stuff	33
Space	33
Critical Care Surge Plan	33
Summary	34
Online resources	35
Further reading	35
References	35
3 Quality and Safety	38
Learning objectives	38
Key words	38
INTRoDUCTION	38
Evidence-Based Nursing	38
Translate a Clinical Query into a Structured Question	39
Locate the Best Evidence	39
Critically Appraise the Evidence	39
Integrate the Evidence into Practice	40
Evaluate Clinical Performance	40
Clinical Practice Guidelines	41
Developing, Implementing and Evaluating Clinical Practice Guidelines	41
Quality and Safety Monitoring	42
Care Bundles	43
Checklists	43
Information and Communication Technologies	44
Clinical Information Systems	44
Computerised Order Entry and Decision Support	48
Handheld Technologies	48
Telehealth Initiatives	49
Patient Safety	49
Safety Culture	50
Rapid Response Systems	50
Afferent Limb	50
Efferent Limb	51
Summary	52
Online resources	54
References	54
4 Recovery and Rehabilitation	57
Learning objectives	57
Key words	57
Introduction	57
Icu-Acquired Weakness	58
Clinical Assessment	58
Diagnostic Testing	58
Patient Outcomes Following a Critical Illness	59
Measures of Health-Related Quality of Life after a Critical Illness	59
Measures of Physical Function Following a Critical Illness	60
Measures of Psychological Function after a Critical Illness	60
Psychological Recovery	61
Anxiety and Depression	61
Posttraumatic Stress	63
Memories and Perceptions	63
Interventions to Improve Psychological Recovery	66
Rehabilitation and Mobility in Icu	66
Mobility and Walking	66
Ward-Based Post-ICU Recovery	68
Recovery after Hospital Discharge	68
ICU Follow-Up Clinics	68
Clinic Activities	69
Clinic Evaluation	70
Other considerations	71
Home-Based Care	71
Summary	72
Research vignette	72
Abstract	72
Introduction	72
Methods	72
Results	72
Conclusions	72
Critique	72
Learning activities	73
Online resources	74
Further reading	74
References	74
5 Ethical Issues in Critical Care	78
Learning objectives	78
Key words	78
Introduction	78
Principles, Rights and the Link with Law	78
The Distinction between Ethics and Morality	78
Ethical Principles	79
Autonomy	79
Beneficence and Non-maleficence	79
Justice	79
Ethics and the Law	80
Patients’ Rights	80
Consent	80
Consent to treatment	81
Consent to research involving humans	82
Consent to collection, use, disclosure of health information	83
Application of Ethical Principles in the Care of the Critically Ill	83
End-of-Life Decision Making	83
Withdrawing/Withholding Treatment	83
Decision-Making Principles	84
Quality of Life	85
Best Interests Principle	85
Patient Advocacy	86
Substituted Judgement Principle	86
Advance Directives	86
Medical Futility	86
Do-not-resuscitate Considerations in Critical Care	87
Palliative Care in Critical Care	87
Euthanasia	87
Nursing Advocacy	87
Conscientious Objection	88
Brain Death	88
Organ Donation	89
Donation after Cardiac Death	90
Nurses’ Attitudes to, and Knowledge of, Organ Donation	90
Ethics in Research	91
Application of Ethical Principles	92
Human Research Ethics Committees	92
Clinical Ethics	93
Privacy and Confidentiality	93
Research Involving Unconscious Persons	95
Responsible Research Practices	95
Data: Use and Disclosure	95
Ethics in Publication	95
Clinical Trials	95
Summary	96
Relevant Legislation	99
Online resources	99
Further reading	99
References	99
2 Principles and Practice of Critical Care	103
6 Essential Nursing Care of the Critically Ill Patient	105
Learning objectives	105
Key words	105
Introduction	105
Personal Hygiene	105
Assessment of Personal Hygiene	105
Basic Hygiene	106
Skin Tears	107
Eye Care	107
Eye Assessment	108
Essential Eye Care	108
Conjunctival Oedema (Chemosis)	108
Oral Hygiene	109
Oral Assessment	109
Essential Oral Care	109
Patient Positioning and Mobilisation	110
Assessment of Body Positioning	110
Positioning and Mobilising Patients	111
Active and Passive Exercises	111
Changing Body Position	112
Pressure Area Care	112
Rotational Therapy	114
Venous Thromboembolism (VTE) Prophylaxis	114
Bowel Management	115
Bowel Assessment	115
Essential Bowel Care	115
Diet and Fluids	115
Drugs	116
Constipation	116
Diarrhoea	116
Urinary Catheter Care	116
Assessment: Urinary Catheterisation	116
Essential Nursing Care: Urinary Catheterisation	117
Catheter Maintenance	117
Bariatric Considerations	117
Infection Control in the Critical Care Unit: General Principles	118
Surveillance	119
Prevention	120
Control	120
Hand Hygiene	120
Personal Protective Equipment (PPE)	120
Multi-Resistant Organisms	121
Healthcare Associated Infections	121
Ventilator-Associated Pneumonia	122
Central Line Associated Bacteraemia	122
Transport of Critically Ill Patients: General Principles	123
Assessment	123
Essential Nursing Care during Transport	124
Summary	125
Online resources	128
Further reading	128
References	129
7 Psychological Care	133
Learning objectives	133
Key words	133
Introduction	133
Anxiety	133
Anxiety Assessment	134
Anxiety Management	134
Non-pharmacological Treatments	135
Pharmacological Treatment for Anxiety	135
Delirium	136
Assessment of Delirium	137
Prevention and Treatment of Delirium	137
Sedation	138
Assessment of Sedation	138
Sedation Protocols	140
Pain	141
Pathophysiology of Pain	141
Pain Assessment	142
Pain Management	143
Non-Pharmacological Treatment for Pain	144
Pharmacological Treatment for Pain	144
Sleep	145
Sleep Assessment/Monitoring	146
Sleep Promotion and Maintenance	147
Comfort Measures	147
Care Activities	147
Environmental	147
Treatments	147
A Note on Melatonin	149
Summary	149
Online resources	152
Further reading	152
References	152
8 Family and Cultural Care of the Critically Ill Patient	156
Learning objectives	156
Key words	156
Introduction	156
Overview of Models of Care	157
Family-Centred Care	157
Needs of family during critical illness	158
Meeting information needs	158
Visiting practices	159
Communication	160
Cultural Care	161
Defining Culture	161
Differing World Views	162
Cultural Competence	162
Determining the Cultural Needs of Patient and Family	163
Individualised Care	164
Working with Culturally and Linguistically Diverse Patients and Families	165
Working with Māori Patients and Families	166
Working with Aboriginal and Torres Strait Islander People of Australia	168
Aboriginal view of health and health beliefs	168
Importance of family, community and land	168
Communication	169
Aboriginal Health Workers	169
Issues around death and dying	169
Religious Considerations	170
End-Of-Life Issues and Bereavement	172
Patient Comfort and Palliative Care	172
Family Care	172
Care of the Critical Care Nurse	173
Summary	173
Online resources	176
Further reading	176
References	176
9 Cardiovascular Assessment and Monitoring	180
Learning objectives	180
Key words	180
Introduction	180
Related Anatomy and Physiology	180
Cardiac Macrostructure	180
Coronary Perfusion	182
Physiological Principles	182
Mechanical Events of Contraction	182
Electrical events of Depolarisation, Resting Potential and Action Potential	183
Cardiac Macrostructure and Conduction	184
Cardiac Output	185
Determinants of Cardiac Output	185
Regulation of Cardiac Output	188
Autonomic nervous system control and regulation of heart rate	188
The Vascular System	189
Blood Pressure	189
Autonomic control	190
Hormonal control	190
Renal control	190
Assessment	190
Assessment of Pulse	190
Auscultation of Heart Sounds	191
Continuous Cardiac Monitoring	192
12-lead ECG	192
Key Components of the ECG	194
ECG Interpretation	195
Haemodynamic Monitoring	195
Principles of Haemodynamic Monitoring	196
Haemodynamic Accuracy	196
Data Trends	196
Haemodynamic Monitoring Standards	196
Blood Pressure Monitoring	196
Non-invasive Blood Pressure Monitoring	197
Invasive Intra-arterial Pressure Monitoring	198
Arterial waveform	198
Invasive arterial pressure versus cuff pressure	198
Invasive Cardiovascular Monitoring	199
Preload	199
Central venous pressure monitoring	200
Pulmonary artery pressure (PAP) monitoring	200
Pulmonary capillary wedge pressure (PCWP) monitoring	201
Left atrial pressure monitoring	202
Afterload	202
Systemic and pulmonary vascular resistance	202
Contractility	203
Cardiac Output	203
The Fick principle	203
Thermodilution methods	203
Pulse-induced contour cardiac output	203
Doppler ultrasound methods	204
Ultrasonic cardiac output monitor	205
Impedance cardiography	205
Diagnostics	206
Echocardiography	206
Blood Tests	206
Full Blood Count	206
Electrolytes	206
Cardiac Enzymes	206
Chest X-Ray	207
Cardiac Chest X-ray Interpretation	207
Chest X-ray in Diagnosing Cardiac Conditions	208
X-Ray Computed Tomography, Magnetic Resonance Imaging (MRI) and Nuclear Medicine Studies of the Heart	209
Cardiac Computed Tomography	209
Magnetic Resonance Imaging	209
Nuclear Medicine Cardiac Studies	209
Nursing Care of Patients Undergoing Cardiac CT, MRI and Nuclear Medicine Studies	210
Summary	210
Online resources	212
References	212
10 Cardiovascular Alterations and Management	215
Learning objectives	215
Key words	215
Introduction	215
Coronary Heart Disease	215
Myocardial Ischaemia	215
Angina	216
Unstable Angina and Acute Myocardial Infarction	216
Myocardial Infarction	216
Clinical Features	217
Patient Assessment and Diagnostic Features	217
Physical examination	217
Electrocardiographic examination	218
Typical ECG evolution pattern	218
Biochemical markers	218
Coronary angiography and left heart catheterisation	219
Exercise test	220
Chest radiography	220
Collaborative Management of Angina and Acute Coronary Syndrome	221
Reperfusion therapy	221
Thrombolytic therapy	221
Coronary angioplasty	223
Nursing management of ACS and MI	224
Nursing care for thrombolysis	224
Medications	225
Symptom control	225
Independent Practice	226
Emotional responses and patient and family support	226
Cardiac rehabilitation	226
Complications of Myocardial Infarction	227
Cardiogenic shock	227
Arrhythmias	227
Pericarditis	227
Structural defects	227
Heart Failure	227
Responses to Heart Failure	228
Left Ventricular Failure	230
Right Ventricular Failure	230
Patient Assessment, Diagnostic Procedures and Classification	231
Diagnostic Tests	233
Nursing Management	233
Lifestyle Modification and Self-care Management	237
Medications	237
Angiotensin-converting enzyme inhibitors	238
Beta-adrenergic blocking agents	239
Angiotensin receptor blocking agents	239
Diuretics	239
Inotropic agents	239
Cardiac glycosides	240
Acute Exacerbations of Heart Failure	240
Selected Cases	241
Cardiomyopathy	241
Dilated Cardiomyopathy	241
Diagnosis	241
Management	241
Hypertrophic Cardiomyopathy	241
3 Specialty Practice in Critical Care	579
22 Emergency Presentations	581
Learning objectives	581
Key words	581
Introduction	581
Background	581
Triage	582
History of Triage	582
Development of Triage Processes in Australia and New Zealand	582
The Process of Triage	582
Triage Categories	583
Triage Assessment	583
Patient History/interview	583
Primary Survey	583
Secondary Survey and Physical Examination	583
Approaches to Triage Assessment	584
Triage Assessment of Specific Patient Groups	585
Mental Health Presentations	585
Paediatric Presentations	585
Extended Roles	586
Nurse-Initiated X-Rays	586
Nurse-Initiated Analgesia	586
Clinical Initiative Nurse	586
Nurse Practitioner	586
Retrievals and Transport of Critically Ill Patients	587
Retrievals	587
Preparing a Patient for Interhospital Transport	587
Patient Monitoring During Transport	588
Multiple Patient Triage/Disaster	588
Emergency Department Response to an External Disaster: Receiving Patients	588
Department Preparation	588
Triage and Reception	589
Treatment	589
Transfer from the ED	589
Respiratory Presentations	589
Presenting Symptoms and Incidence	589
Assessment, Monitoring and Diagnostics	590
Candidate Diagnoses and Management	590
Asthma	590
Acute Respiratory Failure	591
Pneumonia	591
Chest Pain Presentations	591
Description of Presenting Symptoms and Incidence	592
Assessment, Monitoring and Diagnostics	592
Candidate Diagnoses and Management	592
Acute Coronary Syndrome	592
Thoracic Aortic Dissection	592
Abdominal Symptom Presentations	593
Assessment, Monitoring and Diagnostics	593
Candidate Diagnoses and Management	593
Abdominal Aortic Aneurysm	593
Appendicitis	593
Bowel Obstruction	594
Ectopic Pregnancy	594
Acute Stroke	594
Assessment, Monitoring and Diagnostics	595
Management	595
Overdose and Poisoning	596
Assessment, Monitoring and Diagnostics	596
Previous History	596
Suspected Toxin	597
Time of Poisoning	597
Physical Assessment	597
Diagnostics	597
Management: Preventing Toxin Absorption	597
Ingested Poisons	597
Inhaled Poisons	598
Contact Poisons	598
Management: Enhancing Toxin Elimination from the Blood	598
Alkalinisation of Urine	598
Haemodialysis or Haemoperfusion	598
Management: Preventing Complications and Specific Symptomatic Care	598
Central Nervous System Depressants	599
Assessment	599
Effects of Multiple Drug Use	600
Potential for Acute or Active Infections	600
Management	600
Central Nervous System Stimulants	600
Appendices	763
Part_Appendix A	763
Appendix A1 Declaration of Madrid: Education	763
Position Statement on the Provision of Critical Care Nursing Education – August 2005	763
Introduction	763
I. Preamble	763
II. Central Principles	763
III. Recommendations for critical care nursing education	764
References	764
Appendix A2 Declaration of Buenos Aires: Workforce	765
Position Statement on the Provision of Critical Care Nursing Workforce – August 2005	765
Introduction	765
I. Preamble	765
II. Central principles	765
III. Recommended critical care nursing workforce requirements	766
References	766
Appendix A3 Declaration of Manilla: Patient Rights	767
Position Statement on the Rights of the Critically Ill Patient – August 2007	767
Introduction	767
I. Preamble	767
II. Nurses and Human Rights	767
ICN Position	767
Human Rights and the nurse’s role	767
Nurses’ rights	767
Background	767
References	767
Appendix A4 Declaration of Vienna: Patient Safety in Intensive Care Medicine	768
Patient safety in Intensive Care Medicine: the Declaration of Vienna	768
A declaration by the Executive Committee of the European Society of Intensive Care Medicine	768
Patient safety in intensive care medicine	768
From efficacy to effectiveness	768
Why now: the changing demographics of intensive care medicine?	769
Error in intensive care	769
What are the causes of an unsafe Icu and how can we improve the safety culture and environment within our intensive care units?	770
The challenges for the future	770
Appendix 1	770
Appendix 2	771
References	771
Appendix B Australian College of Critical Care Nurses (ACCCN) Position Statements*	773
Appendix B1 Acccn Position Statement (2006) on the Provision of Critical Care Nursing Education	773
References	774
Appendix B2 ACCCN ICU Staffing Position Statement (2003) on Intensive Care Nursing Staffing	775
References	776
Appendix B3 Position Statement (2006) on the Use of Healthcare Workers Other Than Division 1* Registered Nurses in Intensive Care	777
Discussion	777
References	778
Appendix B4 Acccn Resuscitation Position Statement (2006) – Adult & Paediatric Resuscitation by Nurses	779
Appendix C Normal values	780
Reference	782
Glossary of terms	783
Picture Credits	790
Index	793
A	793
B	795
C	796
D	799
E	800
F	801
G	801
H	801
I	803
J	804
K	804
L	804
M	805
N	806
O	807
P	807
Q	809
R	809
S	811
T	812
U	813
V	813
W	814
X	814
Y	814

ACCCN's Critical Care Nursing - E-Book

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