Core Curriculum for Critical Care Nursing

by AACN

• ISBN13: 9780721651477
• ISBN10: 072165147X
• Edition: 5th
• Format: Paperback
• Copyright: 1998-04-29
• Publisher: Saunders

Summary

The 5th Edition of this classic resource defines the knowledge base necessary for critical care nursing practice. Written under the authority of the American Association of Critical Care Nurses, it is a powerful study tool for the CCRN certification examination. Organized by body systems with an emphasis on the nursing process, the book also serves as a clinical reference, providing quick access to the essential information needed for competent care of critically ill patients.

Table of Contents

Chapter 1 The Pulmonary System	1	(136)
Robert E. St. John, M.S.N., R.N., RRT, CCRN, CS
PHYSIOLOGIC ANATOMY	1	(23)
The Respiratory Circuit	1	(1)
Steps in the Gas Exchange Process	2	(15)
Hypoxemia	17	(2)
Acid-Base Physiology and Blood Gases	19	(5)
NURSING ASSESSMENT DATA BASE	24	(17)
Nursing History	24	(4)
Nursing Examination of Patient	28	(8)
Diagnostic Studies	36	(5)
COMMONLY ENCOUNTERED NURSING DIAGNOSES	41	(43)
Ineffective Airway Clearance related to secretions	41	(8)
Ineffective Breathing Pattern related to respiratory muscle fatigue or impaired respiratory mechanics	49	(2)
Inability to Sustain Spontaneous Ventilation related to imbalance between ventilatory capacity and ventilatory demand	51	(24)
Impaired Gas Exchange	75	(9)
Ineffective Individual or Family Coping	84	(1)
PATIENT HEALTH PROBLEMS	84	(53)
Acute Respiratory Failure	84	(4)
Adult Respiratory Distress Syndrome	88	(2)
Chronic Obstructive Pulmonary Disease	90	(4)
Asthma and Status Asthmaticus (Severe Asthmatic Attack)	94	(3)
Pulmonary Embolism	97	(3)
Chest Trauma	100	(4)
Acute Pneumonia	104	(4)
Pulmonary Aspiration	108	(3)
Near-Drowning	111	(2)
Pulmonary Problems in Surgical Patients	113	(3)
Acute Pulmonary Inhalation Injuries	116	(2)
Neoplastic Lung Disease	118	(4)
Obstructive Sleep Apnea	122	(3)
End-Stage Pulmonary Conditions Eligible for Lung Transplantation	125	(12)
chapter 2 The Cardiovascular System	137	(202)
M. Lindsay Lessig, B.S.N., M.S.Ed., M.B.A.
Paul M. Lessig, M.D., FACC
PHYSIOLOGIC ANATOMY	137	(23)
Gross Anatomy	137	(2)
Structure of Cardiac Wall	139	(1)
Chambers of the Heart	140	(1)
Cardiac Valves	141	(1)
Coronary Vasculature	142	(2)
Neurologic Control of the Heart	144	(1)
Cardiac Muscle Microanatomy and Contractile Properties	145	(2)
Anatomy of the Cardiac Conduction System	147	(1)
Electrophysiology	148	(2)
Events in the Cardiac Cycle Produced by Depolarization and Repolarization	150	(2)
Variables Affecting Left Ventricular Function and Cardiac Output	152	(3)
Systemic Vasculature	155	(2)
Control of Peripheral Blood Flow	157	(2)
Arterial Pressure	159	(1)
NURSING ASSESSMENT DATA BASE	160	(39)
Nursing History	160	(1)
Nursing Examination of Patient	161	(10)
Diagnostic Studies	171	(28)
COMMONLY ENCOUNTERED NURSING DIAGNOSES	199	(6)
Decreased Cardiac Output Due to Cardiac Dysfunction, Either Mechanical or Electrical	199	(2)
Acute Pain Related to Coronary Ischemia or to Prolonged Bed Rest	201	(1)
Activity Intolerance Related to Cardiac Disease or Dysfunction	202	(1)
Anxiety Related to Threat of Death, Change in Health Status and Body Image, Threat to Socioeconomic Status	203	(1)
Knowledge Deficit Related to New Diagnosis, Medications, or Treatment Regimens or Related to Lack of Recall, or Misunderstanding or Misinterpretation of Information Regarding Condition and/or Care	204	(1)
PATIENT HEALTH PROBLEMS	205	(134)
Coronary Artery Disease	205	(3)
Angina Pectoris	208	(14)
Myocardial Infarction (MI)	222	(13)
Heart Failure	235	(9)
Pericardial Disease	244	(4)
Myocarditis	248	(4)
Infective Endocarditis	252	(5)
Cardiomyopathy	257	(6)
End-Stage Heart Disease	263	(4)
Cardiac Trauma	267	(4)
Cardiac Rhythm Disorders	271	(16)
Mitral Insufficiency	287	(3)
Mitral Stenosis	290	(3)
Aortic Insufficiency	293	(3)
Aortic Stenosis	296	(3)
Atrial Septal Defect	299	(3)
Ventricular Septal Defect	302	(3)
Patent Ductus Arteriosus	305	(4)
Coarctation of the Aorta	309	(3)
Hypertensive Crisis	312	(5)
Aortic and Peripheral Arterial Disease	317	(6)
Shock	323	(16)
chapter 3 The Neurologic System	339	(125)
Diana L. Nikas, R.N., M.N., CCRN, CNRN, FCCM
PHYSIOLOGIC ANATOMY	339	(34)
Brain	339	(18)
Spine and Spinal Cord	357	(6)
Peripheral Nervous System	363	(10)
NURSING ASSESSMENT DATA BASE	373	(19)
Nursing History	373	(1)
Nursing Examination of Patient	373	(13)
Diagnostic Studies	386	(6)
COMMONLY ENCOUNTERED NURSING DIAGNOSES	392	(7)
Alteration in Cerebral Tissue Perfusion Related to Increased Intracranial Pressure	392	(1)
Impaired Gas Exchange Related to Altered Oxygen Supply or Oxygen Carrying Capacity	392	(1)
Ineffective Breathing Pattern Related to Inadequate Airway from Depressed Level of Consciousness, Intracranial Pathology, or Metabolic Imbalance	392	(1)
Ineffective Airway Clearance Related to Increased Secretions, Depressed Level of Consciousness	393	(1)
Potential Fluid Volume Deficit Related to Excessive Loss, Decreased Intake, Diabetes Insipidus, Cerebral Salt Wasting Syndrome	393	(1)
Fluid Volume Excess Related to Syndrome of Inappropriate ADH	394	(1)
Potential for Infection Related to Invasive Lines, Monitoring and Therapeutic Devices, Traumatic and Surgical Wounds	394	(1)
Potential for Injury Related to Seizure Activity	395	(1)
Impaired Verbal Communication Related to Expressive/Receptive Dysphasia	396	(1)
Impaired Physical Mobility Related to Weakness or Paralysis of One or More Body Parts	397	(1)
Alteration in Thought Processes Related to Confusion, Short-Term Memory Loss, Short Attention Span	397	(1)
Ineffective Individual Coping Related to Situational Crisis, Loss of Control and Independence, Change in Role	398	(1)
Ineffective Family Coping Related to Disruption of Usual Family Roles, Burden of Care, Changes in Family Member's Present and Future Functioning	399	(1)
PATIENT HEALTH PROBLEMS	399	(65)
Increased Intracranial Pressure	399	(9)
Head Trauma	408	(13)
Hydrocephalus	421	(2)
Brain Tumors	423	(5)
Intracranial Aneurysms	428	(4)
Arteriovenous Malformations	432	(2)
Stroke	434	(4)
Meningitis	438	(3)
Acute Spinal Cord Injury	441	(7)
Status Epilepticus	448	(4)
Guillain-Barré Syndrome (Landry-Guillain-Barré-Strohl Syndrome, Polyneuritis, Polyradiculoneuritis, Infectious Polyneuritis)	452	(3)
Recovery from General Anesthesia	455	(4)
Encephalopathy	459	(5)
chapter 4 The Renal System	464	(101)
June L. Stark, R.N., B.S.N., M.Ed.
PHYSIOLOGIC ANATOMY	464	(15)
Process of Urine Formation	464	(5)
Renal Hemodynamics: Normal Blood Flow Patterns	469	(2)
Body Water Regulation: Maintenance of Volume and Concentration of Body Water Content via Thirst-Neurohypophyseal-Renal Axis	471	(1)
Electrolyte Regulation	472	(3)
Excretion of Metabolic Waste Products	475	(1)
Renal Regulation of Acid-Base Balance	476	(1)
Renal Regulation of Blood Pressure	477	(1)
Red Blood Cell Synthesis and Maturation	478	(1)
NURSING ASSESSMENT DATA BASE	479	(7)
Nursing History	479	(2)
Nursing Examination of Patient	481	(2)
Diagnostic Studies	483	(3)
COMMONLY ENCOUNTERED NURSING DIAGNOSES	486	(13)
Fluid Volume Excess	486	(1)
Fluid Volume Deficit	487	(1)
Altered Nutrition: Less Than Body Requirements Related to Uremia	488	(1)
Risk of Alterations in Blood Pressure: Hypertension	489	(4)
Risk of Acid-Base Imbalances: Metabolic Acidosis	493	(1)
Risk of Anemia	493	(1)
Risk of Uremic Syndrome	494	(1)
Risk of Infection	495	(1)
Risk of Bone Disease: Osteomalacia, Osteitis Fibrosa	495	(1)
Altered Metabolism and Excretion of Pharmacologic Agents Related to Renal Failure	496	(1)
Ineffective Patient and Family Coping	497	(2)
PATIENT HEALTH PROBLEMS	499	(66)
Acute Renal Failure	499	(20)
Chronic Renal Failure	519	(15)
Electrolyte Imbalances--Potassium Imbalance: Hyperkalemia	534	(2)
Electrolyte Imbalances--Potassium Imbalance: Hyperkalemia	536	(2)
Electrolyte Imbalances--Sodium Imbalance: Hypernatremia	538	(3)
Electrolyte Imbalances--Sodium Imbalance: Hyponatremia	541	(2)
Electrolyte Imbalances--Calcium Imbalance: Hypercalcemia	543	(2)
Electrolyte Imbalances--Calcium Imbalance: Hypocalcemia	545	(3)
Electrolyte Imbalances--Phosphate Imbalance: Hyperphosphatemia	548	(2)
Electrolyte Imbalances--Phosphate Imbalance: Hypophosphatemia	550	(1)
Electrolyte Imbalances--Magnesium Imbalance: Hypermagnesemia	551	(2)
Electrolyte Imbalances--Magnesium Imbalance: Hypomagnesemia	553	(2)
Renal Trauma	555	(10)
chapter 5 The Endocrine System	565	(36)
Kim Litwack, Ph.D., R.N., CPAN, CAPA, FAAN
PHYSIOLOGIC ANATOMY	565	(7)
Foundational Concepts	565	(1)
Pituitary Gland	566	(2)
Thyroid Gland	568	(1)
Parathyroid Glands	568	(1)
Adrenal Glands	569	(1)
Pancreas	570	(2)
Gonadal Hormones (Testosterone, Estrogen, Progesterone)	572	(1)
NURSING ASSESSMENT DATA BASE	572	(2)
Nursing History	572	(1)
Nursing Examination of Patient	573	(1)
Diagnostic Studies in the Critically Ill Patient	574	(1)
COMMONLY ENCOUNTERED NURSING DIAGNOSES	574	(3)
Fluid Volume Deficit (Actual or Potential)	574	(1)
Fluid Volume Excess (Actual or Potential)	575	(1)
Altered Nutrition, Less Than Body Requirements	576	(1)
Knowledge Deficit	576	(1)
Altered Health Maintenance Related to the Need for Hormonal Replacement and Regulation	577	(1)
PATIENT HEALTH PROBLEMS	577	(24)
Diabetes Insipidus	577	(2)
SIADH Secretion	579	(2)
Thyrotoxicosis (Thyroid Storm)	581	(3)
Myxedema Coma	584	(3)
Hypoparathyroidism and Hyperparathyroidism	587	(1)
Acute Adrenal Insufficiency (Addisonian Crisis)	588	(1)
Diabetic Ketoacidosis (DKA)	589	(5)
Hyperglycemic, Hyperosmolar Nonketotic Coma (Hyperglycemic, Nonacidotic Diabetic Coma)	594	(3)
Hypoglycemic Episode	597	(4)
chapter 6 Hematologic and Immunologic Systems	601	(46)
Stacey Young-McCaughan, R.N., Ph.D.(C), O.C.N., (R) Lieutenant Colonel, U.S. Army Nurse Corps
Bonnie Mowinski Jennings, R.N., D.N.Sc., FAAN, Colonel, U.S. Army Nurse Corps
PHYSIOLOGIC ANATOMY	601	(10)
Hematologic System	601	(4)
Immunologic System	605	(6)
NURSING ASSESSMENT DATA BASE	611	(7)
Nursing History	611	(2)
Nursing Examination of Patient	613	(1)
Diagnostic Studies	614	(4)
COMMONLY ENCOUNTERED NURSING DIAGNOSES	618	(8)
Altered Protection (Risk for Infection) Related to Disease or Treatment	618	(1)
Altered Protection (Risk for Hemorrhage) Related to Disease and/or Treatment	619	(1)
Potential Fluid Volume Deficit Related to Fever, Vomiting, Diarrhea, Hemorrhage, or Shock	619	(4)
Potential for Impaired Gas Exchange Related to Anemia, Hemoglobin Abnormalities, Blood Loss, or Disease	623	(2)
Potential for Activity Intolerance Related to Disease or Treatment	625	(1)
Potential for Pain Related to Disease or Treatment	626	(1)
Potential for Fear or Anxiety Related to Disease or Treatment	626	(1)
Potential for Altered Family Processes	626	(1)
PATIENT HEALTH PROBLEMS	626	(21)
Anemia	626	(2)
Disseminated Intravascular Coagulation	628	(1)
Thrombocytopenia	629	(2)
Hypercoagulable Disorders	631	(1)
Neutropenia	632	(2)
Acute Leukemia	634	(2)
Bone Marrow Transplantation and Peripheral Blood Stem Cell Transplantation	636	(3)
Transplant Rejection	639	(1)
Immunosuppression	640	(1)
HIV Infection	641	(2)
Anaphylactic Type I Hypersensitivity Reactions	643	(4)
chapter 7 The Gastrointestinal System	647	(68)
Susan L. Smith, R.N., Ph.D.
PHYSIOLOGIC ANATOMY	647	(12)
Upper Gastrointestinal (GI) System	647	(3)
Lower Gastrointestinal System	650	(4)
Gut Defenses	654	(1)
Accessory Organs of Digestion	655	(4)
NURSING ASSESSMENT DATA BASE	659	(7)
Nursing History	659	(2)
Nursing Examination of Patient	661	(2)
Diagnostic Studies	663	(3)
COMMONLY ENCOUNTERED NURSING DIAGNOSES	666	(8)
Altered Nutrition	666	(4)
Altered Oral Mucous Membrane	670	(3)
Risk for Fluid Volume Deficit	673	(1)
Pain (Acute)	674	(1)
PATIENT HEALTH PROBLEMS	674	(41)
Acute Pancreatitis	674	(4)
GI Bleeding	678	(9)
Hepatitis	687	(2)
Acute (Fulminant) Liver Failure	689	(7)
Chronic Liver Failure: Decompensated Cirrhosis	696	(5)
Acute Abdomen	701	(6)
Abdominal Trauma	707	(2)
Inflammatory Bowel Disease	709	(6)
chapter 8 Multisystem	715	(84)
Marilyn Sawyer Sommers, R.N., Ph.D., CCRN
PATIENT HEALTH PROBLEMS	715	(84)
Systemic Inflammatory Response Syndrome and Septic Shock	715	(15)
Multiple Organ Dysfunction Sydrome	730	(6)
Multisystem Trauma	736	(13)
Burns	749	(15)
Hypothermia	764	(15)
Toxic Ingestion	779	(20)
chapter 9 Psychosocial Aspects of Critical Care	799	(65)
John L. Carty, R.N.C., D.N.Sc., ARNP
GROWTH AND DEVELOPMENT	799	(4)
Definition	799	(1)
Discussion	799	(1)
Example	799	(3)
Nursing Assessment Data Base	802	(1)
Commonly Encountered Nursing Diagnosis: Altered Growth and Development	802	(1)
PERCEPTION	803	(2)
Definition	803	(1)
Discussion	803	(1)
Example	804	(1)
Nursing Assessment Data Base	804	(1)
Commonly Encountered Nursing Diagnosis: Sensory-Perceptual Alterations	804	(1)
SELF-CONCEPT	805	(3)
Definition	805	(1)
Discussion	806	(1)
Example	806	(1)
Nursing Assessment Data Base	806	(1)
Commonly Encountered Nursing Diagnosis: Self-Concept Disturbance	807	(1)
SELF-ESTEEM	808	(2)
Definition	808	(1)
Discussion	808	(1)
Examples	809	(1)
Nursing Assessment Data Base	809	(1)
Commonly Encountered Nursing Diagnosis: Disturbances in Self-Esteem	810	(1)
NEEDS	810	(3)
Definition	810	(1)
Discussion	810	(1)
Example	811	(1)
Nursing Assessment Data Base	811	(1)
Commonly Encountered Nursing Diagnosis: Need Disturbance	812	(1)
STRENGTHS, POTENTIALS, AND LIMITATIONS	813	(2)
Definition	813	(1)
Discussion	813	(1)
Example	814	(1)
Nursing Assessment Data Base	814	(1)
Commonly Encountered Nursing Diagnosis: Disturbance in Perception, Self-Concept, Self-Esteem, or Needs	815	(1)
STRESS	815	(3)
Definition	815	(1)
Discussion	816	(1)
Example	816	(1)
Nursing Assessment Data Base	816	(1)
Commonly Encountered Nursing Diagnosis: Alteration in Stress Level	817	(1)
PAIN	818	(2)
Definition	818	(1)
Discussion	818	(1)
Example	819	(1)
Nursing Assessment Data Base	819	(1)
Commonly Encountered Nursing Diagnosis: Pain	819	(1)
INTERPERSONAL COMMUNICATION	820	(3)
Definition	820	(1)
Discussion	820	(1)
Example	821	(1)
Nursing Assessment Data Base	821	(1)
Commonly Encountered Nursing Diagnosis: Impaired Communication	822	(1)
BODY IMAGE	823	(2)
Definition	823	(1)
Discussion	823	(1)
Example	823	(1)
Nursing Assessment Data Base	824	(1)
Commonly Encountered Nursing Diagnosis: Disturbance in Body Image	824	(1)
HUMAN SEXUALITY	825	(3)
Definition	825	(1)
Discussion	825	(1)
Example	826	(1)
Nursing Assessment Data Base	826	(1)
Commonly Encountered Nursing Diagnosis: Altered Patterns of Human Sexuality	827	(1)
ABUSE	828	(3)
Definition	828	(1)
Discussion	828	(1)
Example	829	(1)
Nursing Assessment Data Base	829	(1)
Commonly Encountered Nursing Diagnosis: Post-Trauma Response	830	(1)
FAMILY	831	(2)
Definition	831	(1)
Discussion	831	(1)
Example	832	(1)
Nursing Assessment Data Base	832	(1)
Commonly Encountered Nursing Diagnosis: Altered Family Processes	832	(1)
THE CRITICAL CARE ENVIRONMENT	833	(3)
Definition	833	(1)
Discussion	833	(1)
Example	834	(1)
Nursing Assessment Data Base	834	(1)
Commonly Encountered Nursing Diagnosis: Environmental Interpretation Syndrome	835	(1)
CRISIS	836	(2)
Definition	836	(1)
Discussion	836	(1)
Nursing Assessment Data Base	837	(1)
Commonly Encountered Nursing Diagnosis: Ineffective Individual Coping	837	(1)
FEAR AND ANXIETY	838	(3)
Definition	838	(1)
Discussion	838	(1)
Example	839	(1)
Nursing Assessment Data Base	839	(1)
Commonly Encountered Nursing Diagnosis: Fear and Anxiety	840	(1)
LONELINESS	841	(2)
Definition	841	(1)
Discussion	841	(1)
Example	841	(1)
Nursing Assessment Data Base	842	(1)
Commonly Encountered Nursing Diagnosis: Loneliness, Sense of Alienation	842	(1)
POWERLESSNESS	843	(2)
Definition	843	(1)
Discussion	843	(1)
Nursing Assessment Data Base	844	(1)
Commonly Encountered Nursing Diagnosis: Powerlessness	845	(1)
SENSORY OVERLOAD	845	(3)
Definition	845	(1)
Discussion	846	(1)
Nursing Assessment Data Base	847	(1)
Commonly Encountered Nursing Diagnosis: Sensory Overload	847	(1)
SENSORY DEPRIVATION	848	(2)
Definition	848	(1)
Discussion	848	(1)
Nursing Assessment Data Base	849	(1)
Commonly Encountered Nursing Diagnosis: Sensory Deprivation	849	(1)
ADDICTION	850	(2)
Definition	850	(1)
Discussion	850	(1)
Nursing Assessment Data Base	851	(1)
Commonly Encountered Nursing Diagnosis: Addiction	852	(1)
SUICIDAL PHENOMENON	852	(3)
Definition	852	(1)
Discussion	853	(1)
Nursing Assessment Data Base	854	(1)
Commonly Encountered Nursing Diagnosis: Risk for Self-Mutilation	854	(1)
THE DYING PROCESS AND DEATH	855	(5)
Definition	855	(1)
Discussion	855	(3)
Nursing Assessment Data Base	858	(1)
Commonly Encountered Nursing Diagnosis: Dysfunctional Grieving	859	(1)
CAREGIVER ROLE STRAIN	860	(4)
chapter 10 Legal and Ethical Aspects of Critical Care Nursing	864	(25)
Ginger Schafer Wlody, R.N., Ed.D., FCCM
LEGAL ASPECTS	864	(10)
Law	864	(1)
Sources of Law	864	(1)
State Nurse Practice Acts	864	(2)
Standards of Nursing Care	866	(1)
Documentation	867	(1)
Informed Consent	868	(2)
Declaring Death	870	(1)
Patient Rights	871	(1)
Do Not Resuscitate Orders	872	(1)
Advance Directives	872	(1)
Good Samaritan Acts	872	(1)
The Legal Process	873	(1)
ETHICAL ASPECTS	874	(8)
Ethical Principles	874	(1)
Moral Concepts and Theories	875	(1)
American Nurses Association Ethical Code for Nurses	875	(1)
American Hospital Association: Patient's Bill of Rights	876	(1)
Role of the Nurse in Addressing Ethical Issues	877	(5)
IDENTIFICATION OF ETHICAL AND LEGAL CONFLICTS IN THE CURRENT HEALTH CARE ENVIRONMENT	882	(7)
Allocation of Resources and Scare Resources	882	(3)
Patient Care Dilemmas	885	(1)
Use of Technology	885	(1)
Common Ethical Conflicts in Care of the Critically Ill	886	(1)
Institutional and Corporate Ethics	886	(3)
Index	889