AACN Essentials of Critical Care Nursing

by Chulay, Marianne; Burns, Suzanne M.

• ISBN13: 9780071447713
• ISBN10: 0071447717
• Edition: 1st
• Format: Paperback
• Copyright: 2005-07-29
• Publisher: McGraw-Hill Professional

Summary

Covering basic to advanced critical care concepts, this easy-to-use, evidence-based resource provides essential foundation for the nursing care of critically-ill patients. It is the ideal reference for nurses beginning their critical care experience as well as experienced nurses who may use the book as a user-friendly resource for both essential and advanced concepts. ECG rhythm interpretation and treatment and pharmacology also make it an excellent resource for progressive care nurses.

Author Biography

Marianne Chulay RN DNSc FAAN is a Consultant, Clinical Research and Critical Care Nursing in Chapel Hill, NC, USA

Suzanne M. Burns, RN, MSN, RRT, ACNP, CCRN, FAAN, FCCM is Professor of Nursing, Acute and Specialty Care at the University of Virginia, Charlottesville, VA, USA

The American Association of Critical-Care Nurses is the world's largest specialty nursing organization, representing more than 400,000 acute and critical care nurses and serving more than 100,000 members, certificants and nurse constituents. Web site: www.aacn.org

Table of Contents

Contributors	xv
Reviewers	xvii
Preface	xix
Section I. The Essentials	1	(212)
Assessment of Critically Ill Patients and Families	3	(14)
Mary Fran Tracy
Assessment Framework	3	(1)
Prearrival Assessment	4	(1)
Admission Quick Check	4	(1)
Comprehensive Admission Assessment	4	(1)
Ongoing Assessment	4	(1)
Prearrival Assessment: Before the Action Begins	4	(1)
Admission Quick Check Assessment: The First Few Minutes	5	(2)
Airway and Breathing	6	(1)
Circulation and Cerebral Perfusion	6	(1)
Chief Complaint	6	(1)
Drugs and Diagnostic Tests	6	(1)
Equipment	7	(1)
Comprehensive Admission Assessment	7	(7)
Past Medical History	8	(1)
Social History	8	(1)
Physical Assessment by Body System	9	(3)
Psychosocial Assessment	12	(2)
Ongoing Assessment	14	(3)
Planning Care for Critically Ill Patients and Families	17	(20)
Mary Fran Tracy
Multidisciplinary Plan of Care and Critical Pathways	17	(1)
Prevention of Common Complications	18	(8)
Physiologic Instability	18	(1)
Deep Venous Thrombosis	18	(5)
Hospital-Acquired Infections	23	(1)
Skin Breakdown	24	(1)
Sleep Pattern Disturbances	24	(1)
Psychosocial Impact	25	(1)
Patient and Family Education	26	(2)
Assessment of Learning Readiness	26	(1)
Strategies to Address Patient and Family Education	27	(1)
Outcome Measurement	27	(1)
Family-Focused Care	28	(1)
Transporting the Critically Ill Patient	29	(3)
Assessment of Risk for Complications	29	(1)
Level of Care Required During Transport	30	(1)
Preparation	31	(1)
Transport	31	(1)
Interfacility Transfers	32	(1)
Transitioning to the Next Stage of Care	32	(1)
Supporting Patients and Families During the Dying Process	33	(4)
Interpretation and Management of Basic Cardiac Rhythms	37	(28)
Carol Jacobson
Basic Electrophysiology	37	(1)
ECG Waveforms, Complexes, and Intervals	38	(1)
P Wave	38	(1)
QRS Complex	38	(1)
T and U Waves	38	(1)
ST Segment	38	(1)
PR Interval	38	(1)
QT Interval	39	(1)
Cardiac Monitoring	39	(3)
Determination of the Heart Rate	42	(1)
Determination of the Cardiac Rhythm	42	(1)
Common Arrhythmias	43	(1)
Rhythms Originating in the Sinus Node	43	(2)
Sinus Bradycardia	44	(1)
Sinus Tachycardia	44	(1)
Sinus Arrhythmia	45	(1)
Sinus Arrest	45	(1)
Arrhythmias Originating in the Atria	45	(4)
Premature Atrial Complexes	46	(1)
Wandering Atrial Pacemaker	46	(1)
Atrial Tachycardia	47	(1)
Atrial Flutter	47	(1)
Atrial Fibrillation	48	(1)
Arrhythmias Originating in the Atrioventricular Junction	49	(1)
Premature Junctional Complexes	50	(1)
Junctional Rhythm, Accelerated Junctional Rhythm and Junctional Tachycardia	50	(1)
Arrhythmias Originating in the Ventricles	50	(4)
Premature Ventricular Complexes	51	(1)
Ventricular Rhythm and Accelerated Ventricular Rhythm	51	(1)
Ventricular Tachycardia	52	(1)
Ventricular Fibrillation	53	(1)
Ventricular Asystole	53	(1)
Atrioventricular Blocks	54	(3)
First-Degree Atrioventricular Block	54	(1)
Second-Degree Atrioventricular Block	54	(2)
High-Grade Atrioventricular Block	56	(1)
Third-Degree Atrioventricular Block (Complete Block)	56	(1)
Temporary Pacing	57	(3)
Indications	57	(1)
Transvenous Pacing	57	(1)
Epicardial Pacing	57	(1)
Components of a Pacing System	57	(1)
Basics of Pacemaker Operation	58	(2)
ECG Characteristics of Paced Rhythms	60	(1)
Initiating Transvenous Ventricular Pacing	60	(1)
Initiating Epicardial Pacing	60	(1)
External (Transcutaneous) Pacemakers	60	(1)
Defibrillation and Cardioversion	60	(5)
Defibrillation	60	(1)
Automatic External Defibrillators	61	(1)
Cardioversion	62	(3)
Hemodynamic Monitoring	65	(46)
Leanna R. Miller
Hemodynamic Parameters	65	(7)
Cardiac Output	65	(2)
Components of Cardiac Output/Cardiac Index	67	(1)
Stroke Volume and Stroke Volume Index	68	(1)
Factors Affecting Stroke Volume/Stroke Volume Index	68	(4)
Basic Components of Hemodynamic Monitoring Systems	72	(2)
Pulmonary Artery Catheter	72	(1)
Arterial Catheter	72	(1)
Pressure Tubing	72	(1)
Pressure Transducer	73	(1)
Pressure Amplifier	74	(1)
Pressure Bag and Flush Device	74	(1)
Alarms	74	(1)
Obtaining Accurate Hemodynamic Values	74	(3)
Zeroing the Transducer	74	(1)
Leveling the Transducer to the Catheter Tip	75	(2)
Calibration of the Transducer/Amplifier System	77	(1)
Ensuring Accurate Waveform Transmission	77	(1)
Insertion and Removal of Catheters	77	(7)
Pulmonary Artery Catheters	77	(3)
Arterial Catheters	80	(4)
Obtaining and Interpreting Hemodynamic Waveforms	84	(13)
Patient Positioning	84	(1)
Interpretation	84	(7)
Artifacts in Hemodynamic Waveforms: Respiratory Influence	91	(1)
Cardiac Output	92	(5)
Continuous Mixed Venous Oxygen Monitoring	97	(2)
Svo2 Monitoring Principles	97	(1)
Selected Examples of Clinical Applications	98	(1)
Right Ventricular Ejection Fraction Catheters	99	(1)
Monitoring Principles	99	(1)
Troubleshooting	99	(1)
Minimally Invasive Hemodynamic Monitoring	100	(2)
Thoracic Bioimpedance	100	(1)
Esophageal Doppler Cardiac Output	100	(1)
Carbon Dioxide Rebreathing	100	(1)
Gastric Tonometry	100	(1)
Sublingual Capnometry	101	(1)
Application of Hemodynamic Parameters	102	(9)
Low Cardiac Output States	102	(4)
High Cardiac Output States	106	(5)
Airway and Ventilatory Management	111	(34)
Robert E. St. John
Respiratory Assessment Techniques, Diagnostic Tests, and Monitoring Systems	111	(7)
Arterial Blood Gas Monitoring	111	(1)
Analysis	112	(4)
Venous Blood Gas Monitoring	116	(1)
Pulse Oximetry	116	(2)
Assessing Pulmonary Function	118	(1)
Airway Management	118	(7)
Oropharyngeal Airway	118	(2)
Nasopharyngeal Airway	120	(1)
Artificial Airways	120	(5)
Oxygen Therapy	125	(4)
Complications	125	(2)
Oxygen Delivery	127	(2)
Basic Ventilatory Management	129	(16)
Indications	129	(1)
General Principles	129	(3)
Modes	132	(3)
Complications	135	(1)
Weaning From Short-Term Mechanical Ventilation	136	(2)
Troubleshooting Ventilators	138	(1)
Communication	139	(2)
Principles of Management	141	(4)
Pain, Sedation, and Neuromuscular Blockade Management	145	(20)
Joan Michiko Ching
Suzanne M. Burns
Physiologic Mechanisms of Pain	145	(2)
Peripheral Mechanisms	145	(2)
Spinal Cord Integration	147	(1)
Central Processing	147	(1)
Responses to Pain	147	(1)
Pain Assessment	148	(1)
A Multilevel Approach to Pain Management	148	(1)
Nonsteroidal Anti-Inflammatory Drugs	149	(1)
Side Effects	150	(1)
Opioids	150	(3)
Side Effects	150	(1)
Intravenous Opioids	151	(1)
Patient-Controlled Analgesia	151	(1)
Switching From IV to Oral Opioid Analgesia	152	(1)
Epidural Analgesia	153	(2)
Epidural Opioids	153	(1)
Epidural Local Anesthetics	154	(1)
Cutaneous Stimulation	155	(1)
Distraction	155	(1)
Imagery	155	(1)
Relaxation and Sedation Techniques	155	(1)
Deep Breathing and Progressive Relaxation	156	(1)
Presence	156	(1)
Special Considerations for Pain Management in the Elderly	156	(1)
Assessment	157	(1)
Interventions	157	(1)
Sedation	157	(2)
Reasons for Sedation	157	(1)
Drugs for Sedation	158	(1)
Goals of Sedation, Monitoring, and Management	159	(1)
Sedation Scales: Goals and Monitoring	159	(1)
Sedation Management	159	(1)
Neuromuscular Blockade	159	(6)
Neuromuscular Blocking Agents	160	(1)
Monitoring and Management	161	(4)
Pharmacology	165	(34)
Earnest Alexander
Medication Administration Methods	165	(2)
Intravenous	165	(1)
Intramuscular or Subcutaneous	165	(1)
Sublingual	166	(1)
Intranasal	166	(1)
Transdermal	166	(1)
Central Nervous System Pharmacology	167	(9)
Sedatives	167	(3)
Analgesics	170	(1)
Neuromuscular Blocking Agents	171	(2)
Anticonvulsants	173	(3)
Cardiovascular System Pharmacology	176	(9)
Miscellaneous Agents	176	(1)
Parenteral Vasodilators	177	(3)
Antiarrhythmics	180	(2)
Thrombolytic Agents	182	(1)
Vasoconstricting Agents	183	(1)
Inotropic Agents	184	(1)
Activated Protein C	185	(1)
Anti-Infective Pharmacology	185	(2)
Aminoglycosides	185	(1)
Vancomycin	186	(1)
Other Antibiotics	186	(1)
Pulmonary Pharmacology	187	(1)
Theophylline	187	(1)
Albuterol	187	(1)
Gastrointestinal Pharmacology	188	(2)
Stress Ulcer Prophylaxis	188	(1)
Acute Peptic Ulcer Bleeding	189	(1)
Variceal Hemorrhage	189	(1)
Renal Pharmacology	190	(1)
Diuretics	190	(1)
Hematologic Pharmacology	191	(2)
Anticoagulants	191	(2)
Direct Thrombin Inhibitors	193	(1)
Glycoprotein IIb/IIa Inhibitor	193	(1)
Immunosuppressive Agents	193	(2)
Cyclosporine	193	(1)
Tacrolimus (FK506)	194	(1)
Sirolimus (Rapamycin)	194	(1)
Special Dosing Considerations	195	(4)
Continuous Renal Replacement Therapy	195	(1)
Drug Disposition in the Elderly	195	(1)
Therapeutic Drug Monitoring	195	(4)
Ethical and Legal Considerations	199	(14)
Juanita Reigle
The Foundation for Ethical Decision Making	199	(5)
Professional Codes and Standards	199	(1)
Position Statement and Guidelines	200	(1)
Institutional Policies	200	(1)
Legal Standards	200	(1)
Principles of Ethics	201	(2)
Care	203	(1)
Patient Advocacy	204	(1)
The Process of Ethical Analysis	204	(1)
Assessment	204	(1)
Plan	204	(1)
Implementation	205	(1)
Evaluation	205	(1)
Contemporary Ethical Issues	205	(4)
Informed Consent	205	(1)
Determining Capacity	205	(1)
Advance Directives	206	(1)
End-of-Life Issues	207	(2)
Resuscitation Decisions	209	(1)
Building an Ethical Environment	209	(4)
Values Clarification	209	(1)
Provide Information and Clarify Issues	209	(1)
Recognize Moral Distress	210	(1)
Engage in Collaborative Decision Making	210	(3)
Section II. Pathologic Conditions	213	(176)
Cardiovascular System	215	(32)
Barbara Leeper
Special Assessment Techniques, Diagnostic Tests, and Monitoring Systems	215	(3)
Assessment of Chest Pain	215	(1)
Coronary Angiography	215	(1)
Percutaneous Coronary Interventions	216	(1)
Other Percutaneous Coronary Interventions	217	(1)
Pathologic Conditions	218	(29)
Acute Ischemic Heart Disease	218	(12)
Congestive Heart Failure	230	(8)
Shock	238	(5)
Hypertension	243	(4)
Respiratory System	247	(20)
Marianne Chulay
Special Assessment Techniques, Diagnostic Tests, and Monitoring Systems	247	(5)
Chest X-Rays	247	(4)
Computed Tomography and Magnetic Resonance Imaging	251	(1)
Chest Tubes	252	(1)
Pathologic Conditions	252	(15)
Acute Respiratory Failure	252	(4)
Acute Respiratory Distress Syndrome	256	(2)
Acute Respiratory Failure in the Patient With Chronic Obstructive Pulmonary Disease	258	(2)
Pneumonia	260	(3)
Pulmonary Embolism	263	(4)
Multisystem Problems	267	(12)
Ruth M. Kleinpell
Pathologic Conditions	267	(7)
Sepsis and Multiple Organ Dysfunction Syndrome	267	(7)
Overdoses	274	(5)
Etiology, Risk Factors, and Pathophysiology	274	(5)
Neurologic System	279	(26)
Dea Mahanes
Assessment Techniques	279	(8)
Level of Consciousness	279	(1)
Glasgow Coma Scale	280	(1)
Mental Status	281	(2)
Motor Assessment	283	(1)
Sensation	283	(2)
Cranial Nerve Assessment and Assessment of Brainstem Function	285	(1)
Vital Sign Alterations in Neurologic Dysfunction	286	(1)
Death by Neurologic Criteria	287	(1)
Diagnostic Testing	287	(3)
Lumbar Puncture	287	(1)
Computed Tomography	288	(1)
Magnetic Resonance Imaging	288	(1)
Cerebral Angiography	289	(1)
Transcranial Doppler Ultrasound	290	(1)
Electroencephalography	290	(1)
Electromyography	290	(1)
Intracranial Pressure: Concepts and Monitoring	290	(6)
Cerebral Blood Flow	291	(1)
Causes of Increased Intracranial Pressure	291	(5)
Acute Ischemic Stroke	296	(3)
Etiology, Risk Factors, and Pathophysiology	296	(1)
Diagnostic Tests	297	(2)
Hemorrhagic Stroke	299	(1)
Etiology, Risk Factors, and Pathophysiology	299	(1)
Clinical Presentation	300	(1)
Diagnostic Tests	300	(1)
Principles of Management of Intracerebral Hemorrhage	300	(1)
Seizures	300	(2)
Etiology, Risk Factors, and Pathophysiology	300	(1)
Clinical Presentation	300	(1)
Principles of Management of Seizures	301	(1)
Infections of the Central Nervous System	302	(1)
Meningitis	302	(1)
Encephalitis	302	(1)
Intracranial Abscess	302	(1)
Neuromuscular Diseases	303	(2)
Myasthenia Gravis	303	(1)
Guillain-Barre Syndrome	303	(2)
Hematology and Immunology Systems	305	(12)
Diane K. Dressler
Special Assessment Techniques, Diagnostic Tests, and Monitoring Systems	305	(3)
Complete Blood Count	305	(1)
Red Blood Cell Count	305	(1)
Hemoglobin	306	(1)
Hematocrit	306	(1)
Red Blood Cell Indices	306	(1)
Total White Blood Cell Count	306	(1)
White Blood Cell Differential	306	(1)
Platelet Count	307	(1)
Erythrocyte Sedimentation Rate	307	(1)
Coagulation Studies	307	(1)
Additional Tests and Procedures	308	(1)
Pathologic Conditions	308	(9)
Anemia	308	(2)
Immunocompromise	310	(2)
Coagulopathies	312	(5)
Gastrointestinal System	317	(24)
Joanne Krumberger
Carol Reese Parrish
Joe Krenitsky
Pathologic Conditions	317	(15)
Acute Upper Gastrointestinal Bleeding	317	(8)
Liver Failure	325	(5)
Acute Pancreatitis	330	(1)
Bowel Infarction/Obstruction	331	(1)
Nutritional Support for Critically Ill Patients	332	(9)
Nutrition Needs	332	(1)
Residual Volume	333	(1)
Aspiration	334	(1)
Bowel Sounds	335	(1)
Nausea and Vomiting	336	(1)
Osmolality or Hypertonicity of Formula	336	(1)
Diarrhea	337	(1)
Flow Rates and Hours of Infusion	337	(1)
Formula Selection	337	(4)
Renal System	341	(16)
Carol Hinkle
Special Assessment Techniques, Diagnostic Tests, and Monitoring Systems	341	(1)
Pathologic Conditions	341	(9)
Acute Renal Failure	341	(5)
Life-Threatening Electrolyte Imbalances	346	(4)
Renal Replacement Therapy	350	(7)
Access	351	(1)
Dialyzer/Hemofilters/Dialysate	352	(1)
Procedures	352	(1)
Indications for and Efficacy of Renal Replacement Therapy Modes	352	(3)
General Renal Replacement Therapy Interventions	355	(2)
Endocrine System	357	(14)
Joanne Krumberger
Special Assessment Techniques, Diagnostic Tests, and Monitoring Systems	357	(2)
Blood Glucose Monitoring	357	(2)
Pathologic Conditions	359	(12)
Hyperglycemic Emergencies	359	(5)
Acute Hypoglycemia	364	(1)
Syndrome of Inappropriate Antidiuretic Hormone Secretion	365	(2)
Diabetes Insipidus	367	(4)
Trauma	371	(18)
Carol A. Rauen
Jamie B. Sinks
Specialized Assessment Techniques, Diagnostic Tests, and Monitoring Systems	371	(7)
Primary and Secondary Trauma Survey Assessment	371	(3)
Diagnostic Studies	374	(2)
Mechanism of Injury	376	(1)
Physiologic Consequences of Trauma	377	(1)
Common Injuries in the Critically Ill Trauma Patient	378	(4)
Thoracic Trauma	378	(2)
Abdominal Trauma	380	(1)
Musculoskeletal Trauma	381	(1)
Complications of Traumatic Injury in Severe Multisystem Trauma	382	(3)
Acute Respiratory Distress Syndrome	384	(1)
Infection/Sepsis	385	(1)
Systemic Inflammatory Response Syndrome	385	(1)
Psychological Consequences of Trauma	385	(4)
Section III. Advanced Concepts in Caring for the Critically Ill Patient	389	(112)
Advanced ECG Concepts	391	(40)
Carol Jacobson
The 12-Lead Electrocardiogram	391	(20)
Axis Determination	396	(3)
Bundle Branch Block	399	(2)
Myocardial Ischemia, Injury, and Infarction	401	(6)
Preexcitation Syndromes	407	(4)
Advanced Arrhythmia Interpretation	411	(8)
Supraventricular Tachycardias	412	(3)
Differentiating Wide QRS Beats and Rhythms	415	(4)
ST-Segment Monitoring	419
Measuring the ST Segment	420	(1)
Choosing the Best Leads for ST-Segment Monitoring	421
Cardiac Pacemakers	418	(13)
Evaluating Pacemaker Function	423	(1)
VVI Pacemaker Evaluation	423	(4)
DDD Pacemaker Evaluation	427	(4)
Advanced Cardiovascular Concepts	431	(32)
Barbara Leeper
Pathologic Conditions	431	(32)
Cardiomyopathy	431	(5)
Valvular Disease	436	(5)
Pericarditis	441	(2)
Aortic Aneurysm	443	(3)
Cardiac Transplantation	446	(6)
Intra-Aortic Balloon Pump Therapy	452	(3)
Ventricular Assist Devices	455	(8)
Advanced Respiratory Concepts	463	(14)
Suzanne M. Burns
Advanced Modes of Mechanical Ventilation	463	(7)
New Concepts: Mechanical Ventilation	463	(1)
Volume Versus Pressure Ventilator	464	(5)
Alternative Ventilator Options	469	(1)
Weaning Patients From Long-Term Mechanical Ventilation	470	(7)
Wean Assessment	470	(1)
Wean Planning	471	(1)
Weaning Trials, Modes, and Methods	471	(1)
Respiratory Fatigue, Rest, and Conditioning	471	(1)
Wean Trial Protocols	472	(1)
Other Protocols for Use	473	(1)
Critical Pathways	473	(1)
Systematic Institutional Initiatives for the Management of the LTMV Patient Population	473	(4)
Advanced Neurologic Concepts	477	(24)
Dea Mahanes
Subarachnoid Hemorrhage	477	(4)
Etiology, Risk Factors, and Pathophysiology	477	(1)
Clinical Presentation	477	(2)
Diagnostic Tests	479	(2)
Traumatic Brain Injury	481	(6)
Etiology, Risk Factors, and Pathophysiology	481	(4)
Clinical Presentation	485	(1)
Diagnostic Tests	485	(2)
Traumatic Spinal Cord Injury	487	(7)
Etiology, Risk Factors, and Pathophysiology	487	(2)
Clinical Presentation	489	(1)
Diagnostic Tests	490	(1)
Future Spinal Cord Injury Treatment	490	(4)
Brain Tumors	494	(7)
Etiology, Risk Factors, and Pathophysiology	494	(1)
Diagnostic Tests	495	(2)
Advanced Technology: Brain Tissue Oxygen Monitoring	497	(4)
Section IV. Key Reference Information	501	(60)
Normal Values Table	503	(2)
Marianne Chulay
Pharmacology Tables	505	(14)
Earnest Alexander
Advanced Cardiac Life Support Algorithms	519	(10)
Marianne Chulay
Guidelines for the Transfer of Critically Ill Patients	529	(4)
Marianne Chulay
Transfers Within the Hospital	529	(1)
Transport Personnel	529	(1)
Transport Equipment Requirements	529	(1)
Monitoring During Transfer	529	(1)
Pretransfer Coordination and Communication	529	(1)
Transfers Between Hospitals	530	(3)
Transport Personnel	530	(1)
Transport Medication Requirements	530	(1)
Transfer Equipment	530	(1)
Monitoring During Transfer	531	(1)
Transfer Algorithm	532	(1)
Hemodynamic Monitoring Troubleshooting Guide	533	(6)
Leanna R. Miller
Ventilatory Troubleshooting Guide	539	(12)
Robert E. St. John
Suzanne M. Burns
Cardiac Rhythms, ECG Characteristics, and Treatment Guide	551	(10)
Carol Jacobson
Index	561