Critical Care Nursing A Holistic Approach

by Morton, Patricia Gonce; Fontaine, Dorrie K.; Hudak, Carolyn M.; Gallo, Barbara M.

• ISBN13: 9780781727594
• ISBN10: 0781727596
• Edition: 8th
• Format: Hardcover
• Copyright: 2004-12-06
• Publisher: LWW

Summary

A classic in its field, this popular text provides clinical coverage of critical care nursing, with an emphasis on holism in practice to provide students with a solid grasp of the scientific and clinical knowledge they need to deliver safe and effective care. Beginning with the psychosocial concepts of care, the text progresses through assessment and management of a variety of disorders. Its comprehensive yet concise writing offers students a wealth of information and can be used as a future reference. Now under the head authorship of Tricia Morton, Critical Care Nursing maintains its popular holistic approach to the complexities of adult health and critical care. The Eighth Edition is now in full-color, and has been thoroughly updated to reflect recent changes and advances in critical care nursing. A CD-ROM in the back of this edition has common Critical Care Drug Monographs, Crisis Values of Lab Tests, Critical Care Nursing Procedures, Animations, and comprehensive critical care exams.

Author Biography

Patricia Gonce Morton, RN, PhD, ACNP, FANN: Editor-in-Chief, AACN Clinical Issues: Advanced Practice in Acute and Critical Care, Professor, Assistant Dean for Master's Studies, and Coordinator of the Acute Care Nurse Practitioner and Clinical Nurse Specialist Master's Program in Trauma, Critical Care, and Emergency Nursing University of Maryland School of Nursing, Baltimore, Maryland Dorrie Fontaine, RN, DNSc, FAAN: Immediate Past-President, American Association of Critical-Care Nurses (AACN) Associate Dean for Academic Programs, University of California, San Francisco School of Nursing, San Francisco, California Carolyn M. Hudak, RN, PhD: Adult Nurse Practitioner, Denver, Colorado Barbara M. Gallo, RN, MS, CNAA: Clinical Educator and Manager of Infusion Services, Visiting Nurse Association of Central Connecticut, Inc. New Britain, Connecticut

Table of Contents

PART 1 The Concept of Holism Applied to Critical Care Nursing Practice	1	(74)
Critical Care Nursing Practice: An Integration of Caring, Competence, and Commitment to Excellence	3	(9)
Evidence-Based Critical Care Nursing Practice	4	(1)
Critical Thinking is Essential to Critical Care	4	(1)
Certification and Critical Care Nursing Practice	5	(1)
The Synergy Model	6	(2)
Collaboration	7	(1)
The Family, Critical Illness, and Current Evidence	8	(1)
Spirituality and Caring During Critical Illness and at the End of Life	8	(1)
Professional Organizations and Resources	8	(1)
American Association of Critical-Care Nurses: A Commitment to Excellence	8	(1)
The Future of Critical Care Nursing	9	(3)
The Patient's Experience With Critical Illness	12	(15)
Perception of Critical Illness	13	(1)
Patients' Experiences	13	(1)
Anxiety	14	(1)
Causes of Anxiety	14	(1)
Responses to Anxiety	14	(1)
Patterns of Adaptation	14	(1)
Nursing Assessment	15	(1)
Nursing Interventions	15	(3)
Creating a Healing Environment	15	(1)
Fostering Trust	15	(1)
Providing Information	15	(1)
Allowing Control	16	(1)
Cultural Sensitivity	16	(1)
Presencing and Reassurance	16	(1)
Cognitive Techniques	16	(1)
Guided Imagery and Relaxation Training	17	(1)
Deep Breathing	17	(1)
Music Therapy	17	(1)
Humor	18	(1)
Massage and Therapeutic Touch	18	(1)
Meridian Therapy	18	(1)
Animal-Assisted Therapy	18	(1)
Restraints in Critical Care	18	(2)
Physical Restraints	18	(1)
Chemical Restraint	19	(1)
Alternatives to Restraints	19	(1)
Loss and Responses to Loss	20	(2)
Shock and Disbelief	20	(1)
Development of Awareness	21	(1)
Restitution	21	(1)
Resolution	22	(1)
Spirituality and Healing	22	(2)
Care at the End of Life	24	(3)
A Good Death	24	(1)
Barriers to Care	24	(1)
Nursing Interventions	25	(2)
The Family's Experience With Critical Illness	27	(9)
Stress, Critical Illness, and the Impact on the Family	28	(1)
Coping Mechanisms	28	(1)
The Family and the Nursing Process	29	(3)
Nursing Assessment	29	(1)
Nursing Interventions	29	(1)
Visitation Advocacy	30	(1)
Use of the Nurse-Family Relationship	31	(1)
Problem Solving With the Family	31	(1)
Collaborative Management	32	(1)
End-of-Life Issues in Critical Care	32	(2)
Nursing Interventions at the End of Life	32	(1)
After the Patient's Death	33	(1)
Cultural Issues Related to Critical Illness	34	(1)
Conclusion	34	(2)
Impact of the Critical Care Environment on the Patient	36	(10)
The Environment of the Health Care System and the Intensive Care Unit	36	(4)
The Intensive Care Unit: Physical Features	37	(2)
The Intensive Care Unit: Emotional Features	39	(1)
Assessment of the Patient--Environment Interface	40	(2)
Anxiety Assessment	40	(1)
Sleep Assessment	40	(1)
Delirium Assessment	41	(1)
The Vicious Cycle: Anxiety, Pain, and Sleeplessness	42	(1)
Creating A Healing Intensive Care Unit Environment	42	(4)
Controlling Excessive Noise and Lights	42	(1)
Using Nonpharmacological Therapies	42	(1)
Promoting Sleep	43	(1)
Family Visiting	44	(1)
Family Presence at the End of Life	44	(2)
Relieving Pain and Providing Comfort	46	(16)
Pain Defined	46	(1)
Pain in the Critically Ill	47	(1)
Procedural Pain	47	(1)
Consequences of Pain	48	(1)
Barriers to Effective Pain Control	48	(1)
Resources to Promote Effective Pain Control	49	(1)
Clinical Practice Guidelines	49	(1)
The Support Trial	50	(1)
Joint Commission on Accreditation of Healthcare Organizations Standards for Pain	50	(1)
Pain Assessment	50	(3)
Patient Self-Report	50	(2)
Observation	52	(1)
Physiological Parameters	52	(1)
Pain Intervention	53	(6)
Pharmacological Interventions	53	(5)
Nonpharmacological Comfort Measures	58	(1)
Patient Education	59	(1)
Pain Management in Special Populations	59	(3)
Patient and Family Education in Critical Care	62	(13)
Barriers to Learning	63	(2)
Critical Illness and Stress	63	(1)
Prolonged Illness and Stress	64	(1)
Environmental Stress	64	(1)
Cultural and Language Barriers	64	(1)
Education and Learning	65	(2)
Three Domains of Learning	65	(1)
Adult Learning Principles	66	(1)
The Process of Adult Education	67	(2)
Assessing Learning Needs in a Time of Crisis	67	(1)
Intervention: Effective Teaching Strategies in Critical Care	68	(1)
Evaluating the Learning Process	69	(1)
The Standards of Patient and Family Education	69	(6)
PART 2 Professional Practice Issues in Critical Care	75	(50)
Ethical Issues in Critical Care Nursing	77	(12)
Ethics and the Nurse	78	(1)
The Tools of Ethics	79	(6)
Approaches to Ethics	79	(1)
Principles of Bioethics and the Ethics of Care	79	(6)
Ethical Decision Making Within a Nursing Process Model	85	(1)
Gather the Relevant Facts	85	(1)
Identify the Problem	85	(1)
Analyze the Problem Using Ethical Principles and Rules	85	(1)
Analyze Alternatives and Act	86	(1)
Evaluate and Reflect	86	(1)
Bioethics Resources and Services	86	(3)
Ethics Committees and Consultant Services	86	(1)
Professional Nursing Organizations	86	(3)
Legal Issues in Critical Care Nursing	89	(11)
An Overview of Major Areas of the Law	89	(1)
Administrative Law	90	(1)
Civil Law	90	(1)
Criminal Law	90	(1)
Nursing Negligence in Critical Care	90	(5)
Duty and Breach of Duty	90	(1)
Causation	91	(1)
Injury	91	(1)
Vicarious Liability	92	(1)
Establishment of Protocols	93	(1)
The Questionable Medical Order	94	(1)
Liability for Defective Medical Equipment	94	(1)
The Need for Consent	94	(1)
Issues That Involve Life-Support Measures	95	(5)
Do Not Resuscitate (DNR) Orders	95	(1)
Refusal of Treatment for Religious Reasons	96	(1)
Advance Directives: Living Wills and Powers of Attorney	96	(1)
Patient Self-Determination Act	96	(1)
Withdrawal of Life-Support Measures	97	(1)
Brain Death	98	(1)
Organ Donation	98	(2)
Genetic Issues in Critical Care Nursing	100	(14)
Human Genome Project	100	(1)
Overview	100	(1)
Significance in Nursing	101	(1)
Core Competencies in Genetics (NCHPEG)	101	(1)
Role of the Nurse	101	(2)
Raising Client Awareness	101	(1)
Risk Reduction	101	(1)
Screening	101	(2)
Concepts in Genetics	103	(3)
Cells Contain DNA	103	(1)
Chromosomes Contain DNA	103	(1)
Segments of DNA Are Called Genes	103	(1)
Genes Code for Proteins	104	(1)
Mutations Can Cause Disease	105	(1)
Mitochondrial DNA	106	(1)
Genetically Determined Diseases	106	(5)
Chromosomal Disorders	106	(1)
Monogenic Conditions	106	(4)
Multifactorial Disorders	110	(1)
Somatic Cell Disorders	111	(1)
Mitochondrial Disease	111	(1)
Pharmacogenetics	111	(3)
Building a Professional Practice Model for Excellence in Critical Care Nursing	114	(11)
Defining the Critical Care Nurse	114	(1)
Defining Nursing Professionalism	115	(1)
Defining Nursing Excellence	116	(6)
Values	117	(1)
Vision	117	(1)
Mastery	118	(2)
Passion	120	(1)
Action	121	(1)
Balance	121	(1)
Conclusion	122	(3)
PART 3 Special Populations in Critical Care	125	(72)
The Critically III Pediatric Patient	127	(11)
Prominent Anatomical and Physiological Differences and Implications	127	(4)
Vital Signs	127	(1)
Neurological System	128	(1)
Cardiovascular System	128	(1)
Respiratory System	128	(1)
Gastrointestinal System	129	(1)
Renal System	129	(1)
Endocrine System	130	(1)
Selected Pediatric Challenges	131	(3)
Ventilatory Issues	131	(2)
Medication Administration	133	(1)
Pain Management	133	(1)
Interaction with Children and Families	134	(4)
The Critically Ill Pregnant Woman	138	(12)
Physiological Changes in Pregnancy	138	(2)
Cardiovascular Changes	138	(2)
Respiratory Changes	140	(1)
Renal Changes	140	(1)
Gastrointestinal and Metabolic Changes	140	(1)
Hematological Changes	140	(1)
Fetal and Placental Development Considerations	140	(1)
Critical Care Conditions in Pregnancy	140	(7)
Severe Preeclampsia	142	(3)
HELLP Syndrome	145	(1)
Disseminated Intravascular Coagulation	145	(1)
Amniotic Fluid Embolism	146	(1)
Acute Respiratory Distress Syndrome	146	(1)
Trauma	147	(1)
Providing Emotional Support	147	(1)
Conclusion	148	(2)
The Critically Ill Older Patient	150	(25)
Normal Psychobiological Characteristics of Aging	151	(1)
Biological Issues	151	(1)
Psychosocial Issues	151	(1)
Physical Challenges	152	(14)
Auditory Changes	152	(1)
Visual Changes	152	(4)
Other Sensory Changes	156	(1)
Sleep Changes	157	(1)
Skin Changes	158	(1)
Cardiovascular Changes	159	(1)
Respiratory Changes	160	(1)
Renal Changes	161	(2)
Gastrointestinal Changes	163	(1)
Musculoskeletal Changes	164	(1)
Endocrine Changes	164	(1)
Immunological Changes	165	(1)
Psychological Challenges	166	(4)
Cognitive Changes	166	(2)
Abuse of the Older Person	168	(2)
Alcohol Abuse	170	(1)
Challenges in Medication Use	170	(5)
Drug Absorption	170	(1)
Drug Distribution	171	(1)
Drug Metabolism	171	(1)
Drug Excretion	172	(3)
The Postanesthesia Patient	175	(14)
Collaboration Between the Anesthesia Provider and Nurse	175	(1)
Moderate Sedation	176	(1)
Potential Problems in the Postanesthesia Patient	177	(12)
Hypoxemia	177	(2)
Hypoventilation	179	(2)
Hypotension	181	(2)
Hypertension	183	(1)
Cardiac Dysrhythmias	184	(1)
Hypothermia	184	(1)
Hyperthermia	184	(1)
Malignant Hyperthermia	184	(2)
Nausea and Vomiting	186	(1)
Postoperative Pain	186	(3)
Interfacility Transport of the Critically Ill Patient	189	(8)
Modes of Transport	189	(1)
Air Transport of the Critically Ill Patient	190	(1)
Transfer Guidelines and Legal Implications	190	(2)
Phases of Transport	192	(5)
Phase One: Notification and Acceptance by the Receiving Facility	192	(2)
Phase Two: Preparation of the Patient by the Transport Team	194	(1)
Phase Three: The Transport Process	195	(1)
Phase Four: Turnover of the Patient to the Receiving Facility	195	(1)
Phase Five: Post-transport Continuous Quality Improvement Monitoring	195	(2)
PART 4 Cardiovascular System	197	(278)
Anatomy and Physiology of the Cardiovascular System	199	(12)
Cardiac Microstructure	199	(1)
Mechanical Events of Contraction	200	(1)
Electrical Events of Depolarization	200	(1)
Physiological Basis of the Resting Potential	201	(1)
Physiological Basis of the Action Potential	201	(1)
Cardiac Macrostructure	202	(1)
Cardiac Conduction	203	(2)
Electrocardiograms	203	(1)
Rhythmicity and Pacing	204	(1)
Cardiac Output	205	(2)
Regulation of Heart Rate	205	(1)
Regulation of Stroke Volume	206	(1)
Coronary Circulation	207	(1)
Peripheral Circulation	207	(4)
Blood Volume	208	(1)
Blood Pressure	208	(3)
Patient Assessment: Cardiovascular System	211	(81)
Cardiac History and Physical Examination	212	(9)
History	212	(3)
Physical Examination	215	(6)
Cardiac Laboratory Studies	221	(8)
Routine Laboratory Studies	221	(2)
Enzyme Studies	223	(4)
Biochemical Markers: Myocardial Proteins	227	(1)
Neurohumoral Hormones: Brain-type Natriuretic Peptide	228	(1)
Newer Diagnostic Markers	228	(1)
Cardiac Diagnostic Studies	229	(15)
Noninvasive Techniques	229	(11)
Invasive Techniques	240	(4)
Electrocardiographic Monitoring	244	(4)
Equipment Features	244	(3)
Procedure	247	(1)
Troubleshooting Electrocardiogram Monitor Problems	248	(1)
Arrhythmias and the 12-Lead Electrocardiogram	248	(19)
Evaluation of a Rhythm Strip	248	(4)
Normal Sinus Rhythm	252	(1)
Arrhythmias Originating at the Sinus Node	252	(2)
Atrial Arrhythmias	254	(2)
Junctional Arrhythmias	256	(1)
Ventricular Arrhythmias	257	(3)
Atrioventricular Blocks	260	(3)
The 12-Lead Electrocardiogram	263	(4)
Effects of Serum Electrolyte Abnormalities on the Electrocardiogram	267	(2)
Potassium	268	(1)
Calcium	268	(1)
Hemodynamic Monitoring	269	(23)
Pressure Monitoring System	269	(2)
Arterial Pressure Monitoring	271	(2)
Central Venous Pressure Monitoring	273	(2)
Pulmonary Artery Pressure Monitoring	275	(7)
Determination of Cardiac Output	282	(3)
Evaluation of Oxygen Delivery and Demand Balance	285	(7)
Patient Management: Cardiovascular System	292	(86)
Pharmacological Therapy	294	(1)
Fibrinolytics, Anticoagulants, and Platelet Inhibitors	294	(4)
Fibrinolytics	294	(1)
Anticoagulants	295	(1)
Platelet Inhibitors	296	(2)
Antidysrhythmics	298	(4)
Class I Antidysrhythmic Drugs	298	(1)
Class II Antidysrhythmic Drugs	298	(3)
Class III Antidysrhythmic Drugs	301	(1)
Class IV Antidysrhythmic Drugs	301	(1)
Unclassified Antidysrhythmic Drugs	301	(1)
Inotropes	302	(1)
Dopamine	302	(1)
Dobutamine	303	(1)
Epinephrine	303	(1)
Isoproterenol	303	(1)
Norepinephrine	303	(1)
Amrinone	303	(1)
Milrinone	303	(1)
Vasodilators	303	(1)
Nitrates	303	(1)
Nitroprusside Sodium	304	(1)
Angiotensin-Converting Enzyme Inhibitors	304	(1)
Antihyperlipidemics	304	(2)
Percutaneous Coronary Interventions and Percutaneous Balloon Valvuloplasty	306	(1)
Percutaneous Coronary Interventions	306	(18)
Historical Background	306	(1)
Physiological Principles	306	(1)
Comparisons Between PTCA and CABG	306	(1)
Diagnostic Tests for PTCA and CABG Patient Selection	307	(1)
Equipment Features	307	(2)
Indications for and Contraindications to Percutaneous Transluminal Coronary Angioplasty	309	(1)
Procedure	310	(3)
Results	313	(1)
Assessment and Management	313	(3)
Complications	316	(2)
Other Interventional Cardiology Techniques	318	(6)
Percutaneous Balloon Valvuloplasty	324	(4)
Historical Background	324	(1)
Pathophysiology of Stenotic Valves	324	(1)
Diagnostic Tests for Percutaneous Balloon Valvuloplasty and Valve Replacement	324	(1)
Equipment Features	324	(1)
Indications for and Contraindi cations to Percutaneous Balloon Valvuloplasty	325	(1)
Procedure	325	(1)
Results	326	(1)
Assessment and Management	326	(2)
Intra-Aortic Balloon Pump Counterpulsation and Mechanical Circulatory Support	328	(1)
Intra-Aortic Balloon Pump Counterpulsation	328	(7)
Physiological Principles	328	(1)
Equipment Features	329	(1)
Indications for Intra-aortic Balloon Pump Counterpulsation	329	(1)
Contraindications to Intra-aortic Balloon Pump Counterpulsation	330	(1)
Procedure	330	(1)
Interpretation of Results	331	(1)
Assessment and Management	332	(3)
Complications Specific to Intra-aortic Balloon Pump Therapy	335	(1)
Mechanical Circulatory Support	335	(5)
Physiological Principles	336	(1)
Devices	336	(3)
Nursing Implications	339	(1)
Complications Associated with Intra-Aortic Balloon Pump Therapy and Circulatory Support	340	(2)
Bleeding	340	(1)
Thromboembolic Events	341	(1)
Right Ventricular Failure	341	(1)
Infection	341	(1)
Dysrhythmias	342	(1)
Nutritional Deficits	342	(1)
Psychosocial Factors	342	(1)
Management of Dysrhythmias	342	(1)
Cardioversion	342	(2)
Procedure	343	(1)
Radiofrequency Catheter Ablation	344	(2)
Indications for Ablation	344	(1)
Procedure	345	(1)
Nursing Management	345	(1)
Cardiac Pacemakers	346	(15)
Indications for Cardiac Pacing	346	(1)
The Pacemaker System	347	(2)
Temporary Pacing Systems	349	(2)
Pacemaker Functioning	351	(1)
The Pacemaker Code	352	(2)
Pacing Modes	354	(1)
Pacemaker Malfunction	354	(3)
Pacemaker Complications	357	(1)
Nursing Management	358	(3)
Implantable Cardioverter--Defibrillators	361	(3)
Indications for Implantable Cardioverter--Defibrillators	361	(1)
The Implantable Cardioverter--Defibrillator System	361	(1)
Implantable Cardioverter-Defibrillator Functioning	362	(1)
The Implantable Cardioverter--Defibrillator Code	363	(1)
Nursing Management	363	(1)
Cardiopulmonary Resuscitation	364	(1)
Causes of Cardiopulmonary Arrest	364	(1)
Assessment and Management of the Patient in Cardiopulmonary Arrest	365	(2)
Determine Responsiveness	365	(1)
Position the Patient	365	(1)
Airway	366	(1)
Breathing	366	(1)
Circulation	366	(1)
Role of Resuscitation Team Members	367	(1)
Equipment Used in Cardiopulmonary Arrest	367	(1)
Medications	368	(1)
Defibrillation	368	(2)
Automated External Defibrillator	370	(1)
Transcutaneous Pacing	371	(1)
Therapeutic Hypothermia	371	(1)
Family Presence in Cardiac Arrest Situations	372	(6)
Common Cardiovascular Disorders	378	(15)
Infection and Inflammation of the Heart	378	(4)
Pericarditis	378	(1)
Myocarditis	379	(2)
Endocarditis	381	(1)
Cardiomyopathies	382	(2)
Pathophysiology	382	(1)
Assessment	383	(1)
Management	383	(1)
Peripheral Vascular Disease	384	(2)
Arterial Disease	384	(1)
Venous Disease	385	(1)
Aortic Disease	386	(4)
Aortic Aneurysm	386	(3)
Aortic Dissection	389	(1)
Hypertensive Crisis	390	(3)
Pathophysiology	390	(1)
Assessment	390	(1)
Management	390	(3)
Heart Failure	393	(29)
Definition	394	(1)
Classification	394	(1)
Acute Versus Chronic	394	(1)
Left-Sided Heart Failure Versus Right-Sided Heart Failure	394	(1)
Classification Systems	395	(1)
Factors that Determine Cardiac Output	395	(2)
Oxygen Demand	395	(1)
Mechanical Factors	395	(1)
Neurohormonal Mechanisms	396	(1)
Pathophysiology	397	(3)
Cardiomyopathy	397	(2)
Dysrhythmia	399	(1)
Acute Exacerbation of Chronic Heart Failure	400	(1)
Assessment	400	(8)
History	400	(2)
Physical Examination	402	(2)
Laboratory Studies	404	(1)
Diagnostic Studies	404	(2)
Hemodynamics	406	(1)
Pulse Oximetry	407	(1)
Management of Chronic Heart Failure	408	(5)
Pharmacological Treatment	408	(4)
Nonpharmacological Treatment	412	(1)
Management of Acute Exacerbations of Heart Failure	413	(9)
Airway and Breathing	413	(1)
Circulation	414	(2)
Discharge Planning and Patient Education	416	(6)
Acute Myocardial Infarction	422	(26)
Atherosclerosis	423	(2)
Pathophysiological Principles	423	(1)
Risk Factors	424	(1)
Acute Coronary Syndrome	425	(1)
Angina Pectoris	425	(4)
Pathophysiological Principles	425	(1)
Classification of Angina	426	(1)
Assessment	426	(2)
Management	428	(1)
Myocardial Infarction	429	(19)
Pathophysiological Principles	429	(2)
Assessment	431	(4)
Management	435	(7)
Complications	442	(3)
Cardiac Rehabilitation	445	(3)
Cardiac Surgery	448	(27)
Indications for Cardiac Surgery	448	(7)
Coronary Artery Disease	448	(3)
Valvular Disease	451	(4)
Cardiac Surgery	455	(15)
Preoperative Phase	455	(1)
Intraoperative Phase	455	(3)
Postoperative Phase	458	(12)
Carotid Endarterectomy	470	(5)
Indications for Carotid Endarterectomy	470	(1)
Surgical Procedure	470	(1)
Postoperative Care	471	(1)
Home Care Considerations	472	(3)
PART 5 Respiratory System	475	(152)
Anatomy and Physiology of the Respiratory System	477	(15)
Anatomy of the Respiratory System	477	(5)
The Thorax	477	(3)
The Conducting Airways	480	(1)
The Respiratory Airways	480	(1)
The Lung Circulation	481	(1)
The Pulmonary Lymphatics	482	(1)
Physiology of the Respiratory System	482	(10)
Ventilation	482	(3)
Diffusion	485	(1)
Perfusion	486	(1)
Relationship of Ventilation to Perfusion	487	(1)
Gas Transport	488	(1)
Regulation of Respiration	489	(3)
Patient Assessment: Respiratory System	492	(25)
History	492	(4)
Dyspnea	493	(1)
Chest Pain	493	(1)
Sputum Production	493	(1)
Cough	493	(3)
Physical Examination	496	(10)
Inspection	496	(2)
Palpation	498	(1)
Percussion	499	(1)
Auscultation	499	(7)
Respiratory Monitoring	506	(7)
Pulse Oximetry	506	(1)
End-Tidal Carbon Dioxide Monitoring	507	(1)
Arterial Blood Gases	508	(4)
Mixed Venous Oxygen Saturation	512	(1)
Respiratory Diagnostic Studies	513	(4)
Chest Radiography	513	(1)
Ventilation--Perfusion Scanning	514	(1)
Pulmonary Angiography	514	(1)
Bronchoscopy	514	(1)
Thoracentesis	514	(1)
Sputum Culture	514	(1)
Pulmonary Function Tests	514	(3)
Patient Management: Respiratory System	517	(49)
Bronchial Hygiene	518	(2)
Methods of Bronchial Hygiene	518	(2)
Oxygen Therapy	520	(3)
Patient Assessment	520	(1)
Oxygen Delivery Systems	521	(1)
Complications of Oxygen Delivery	522	(1)
Artificial Airways	523	(4)
Nasopharyngeal and Oropharyngeal Airways	523	(1)
Endotracheal Tubes	524	(3)
Chest Tubes	527	(5)
Physiological Principles	527	(1)
Equipment	527	(1)
Chest Tube Placement	528	(2)
Assessment and Management	530	(1)
Complications	531	(1)
Transporting the Patient With Chest Tubes	532	(1)
Pharmacological Agents	532	(4)
Bronchodilator Therapy	532	(3)
Antibiotics	535	(1)
Sedative Agents	535	(1)
Neuromuscular Blocking Agents	536	(1)
Ventilatory Support	536	(30)
Physiological Principles	537	(1)
Equipment	538	(1)
Ventilator Modes	539	(4)
Use of Mechanical Ventilators	543	(3)
Complications of Mechanical Ventilation	546	(2)
Assessment and Management	548	(9)
Weaning From Mechanical Ventilation	557	(4)
Home Care and Mechanical Ventilation	561	(2)
New Frontiers and Challenges for Ventilated Patients	563	(3)
Common Respiratory Disorders	566	(42)
Pneumonia	567	(5)
Etiology	567	(1)
Pathophysiology	567	(2)
Assessment	569	(1)
Management	570	(1)
Prevention	571	(1)
Pleural Effusion	572	(2)
Pathophysiology	572	(1)
Assessment	573	(1)
Management	574	(1)
Pneumothorax	574	(1)
Pathophysiology	574	(1)
Assessment	574	(1)
Management	575	(1)
Pulmonary Embolism	575	(3)
Pathophysiology	575	(1)
Assessment	576	(1)
Management	576	(2)
Prevention	578	(1)
Chronic Obstructive Pulmonary Disease	578	(14)
Pathophysiology	578	(1)
Assessment	579	(3)
Management	582	(6)
Prevention	588	(1)
Chronic Bronchitis	589	(1)
Emphysema	590	(2)
Acute Asthma	592	(5)
Pathophysiology	592	(1)
Assessment	593	(1)
Management	594	(1)
Status Asthmaticus	595	(2)
Acute Respiratory Failure	597	(11)
Pathophysiology	597	(1)
Classification	598	(2)
Assessment	600	(2)
Management	602	(6)
Acute Respiratory Distress Syndrome	608	(19)
Diagnostic Criteria and Incidence	608	(1)
Pathophysiology	609	(4)
Systemic Inflammatory Response Syndrome	610	(1)
Pathological Changes in Acute Respiratory Distress Syndrome	610	(1)
Stages of Acute Respiratory Distress Syndrome	610	(3)
Assessment	613	(3)
History	613	(1)
Physical Examination	613	(1)
Diagnostic Studies	614	(2)
Management	616	(5)
Oxygenation and Ventilation	616	(3)
Pharmacological Therapy	619	(1)
Nutritional Support	620	(1)
Prevention of Complications	621	(6)
PART 6 Renal System	627	(88)
Anatomy and Physiology of the Renal System	629	(11)
Macroscopic Anatomy of the Renal System	629	(2)
Microscopic Anatomy of the Renal System and Normal Renal Physiology	631	(5)
Juxtaglomerular Apparatus	632	(1)
Glomerulus	633	(2)
Tubules	635	(1)
Hormonal Influences	636	(1)
Antidiuretic Hormone	636	(1)
Renin	636	(1)
Aldosterone	636	(1)
Functions of the Renal System	636	(4)
Renal Clearance	636	(1)
Regulation	637	(2)
Other Renal Functions	639	(1)
Patient Assessment: Renal System	640	(18)
History	640	(1)
Physical Examination	641	(2)
Assessment of Renal Function	643	(4)
Laboratory Studies	643	(3)
Diagnostic Studies	646	(1)
Assessment of Electrolytes and Acid--Base Balance	647	(6)
Sodium Balance	649	(1)
Potassium Balance	649	(1)
Calcium and Phosphate Balance	649	(1)
Magnesium Balance	650	(1)
Acid-Base Balance	650	(3)
Assessment of Fluid Balance	653	(5)
Weight	653	(1)
Intake and Output	653	(1)
Hypovolemia and Hypervolemia	654	(1)
Hemodynamic Monitoring	655	(3)
Patient Management: Renal System	658	(30)
Physiology	659	(1)
Extracorporeal Therapies	659	(2)
Access to Circulation	659	(2)
Anticoagulation	661	(1)
Intermittent Hemodialysis	661	(6)
Indications for Hemodialysis	662	(1)
Contraindications to Hemodialysis	662	(1)
Equipment	662	(1)
Assessment and Management	663	(3)
Complications	666	(1)
Continuous Renal Replacement Therapies	667	(6)
Indications for Continuous Renal Replacement Therapy	668	(1)
Contraindications to Continuous Renal Replacement Therapy	668	(1)
Equipment	668	(1)
Assessment and Management	669	(2)
Technical Complications in Continuous Venovenous Hemofiltration With Dialysis	671	(1)
Physiological Complications in Continuous Venovenous Hemofiltration With Dialysis	672	(1)
Psychological Aspects of Renal Replacement Therapies	672	(1)
Hemodialysis Applied to Other Therapies	672	(1)
Peritoneal Dialysis	673	(4)
Equipment	673	(1)
Assessment and Management	673	(2)
Technical Complications	675	(1)
Physiological Complications	675	(1)
Peritoneal Dialysis as a Chronic Treatment	676	(1)
Pharmacological Management of Renal Dysfunction	677	(1)
Diuretics	677	(1)
Vasoactive Drugs	677	(1)
Disorders of Fluid Volume	678	(4)
Fluid Volume Deficit	679	(3)
Fluid Volume Excess	682	(1)
Management of Electrolyte Imbalances	682	(6)
Sodium	682	(1)
Potassium	682	(3)
Calcium	685	(1)
Magnesium	686	(1)
Phosphorus	686	(2)
Renal Failure	688	(27)
Acute Renal Failure	689	(7)
Causes of Acute Renal Failure	689	(1)
Pathophysiology of Acute Renal Failure	689	(5)
Clinical Course of Acute Tubular Necrosis	694	(1)
Diagnosis of Acute Renal Failure	694	(2)
Chronic Renal Failure	696	(3)
Pathophysiology of Chronic Renal Failure	697	(1)
Preventing the Progression of Chronic Renal Failure	698	(1)
Clinical Course of Chronic Renal Failure	699	(1)
Management of Renal Failure	699	(16)
Managing Fluid Balance Alterations	699	(5)
Managing Acid-Base Alterations	704	(1)
Managing Cardiovascular Alterations	704	(2)
Managing Pulmonary Alterations	706	(1)
Managing Gastrointestinal Alterations	707	(1)
Managing Neuromuscular Alterations	707	(1)
Managing Hematological Alterations	707	(2)
Managing Alterations in Drug Elimination	709	(1)
Managing Skeletal Alterations	709	(1)
Managing Integumentary Alterations	709	(2)
Managing Alterations in Dietary Intake	711	(1)
Managing Alterations in Psychosocial Functioning	712	(3)
PART 7 Nervous System	715	(176)
Anatomy and Physiology of the Nervous System	717	(33)
Cells of the Nervous System	718	(1)
Neuroglia	718	(1)
Neurons	718	(1)
Characteristics of Neurons	718	(3)
Resting Membrane Potential	718	(1)
Synaptic Transmission	719	(2)
Neuronal Thresholds and the Action Potential	721	(1)
Nerve Regeneration	721	(1)
Central Nervous System	722	(5)
Cerebrospinal Fluid	722	(2)
Brain	724	(3)
Spinal Cord	727	(1)
Peripheral Nervous System	727	(11)
Cranial Nerves	728	(1)
Spinal Nerves	729	(1)
Sensory Division	729	(4)
Motor Division	733	(5)
Reflexes	738	(3)
Brain Reflexes	739	(1)
Spinal Cord Reflexes	739	(2)
Pain	741	(2)
Pain Pathways and Their Modulation	742	(1)
Referred Pain	742	(1)
The Neurohormonal Stress Response	743	(4)
Homeostasis	743	(1)
Disruption of Homeostasis	744	(3)
Conclusion	747	(3)
Patient Assessment: Nervous System	750	(25)
History	751	(2)
Analysis of the Current Problem	752	(1)
Review of Systems	752	(1)
Pertinent Medical History	752	(1)
Physical Examination	753	(12)
Mental Status	753	(1)
Motor Function	754	(3)
Pupillary Changes	757	(1)
Vital Signs	757	(2)
Cranial Nerve Function	759	(4)
Reflexes	763	(1)
Sensation	763	(1)
Signs of Trauma or Infection	764	(1)
Signs of Increased Intracranial Pressure	764	(1)
Evaluation of Dysfunction in the Patient's Living Patterns	765	(1)
Neurodiagnostic Studies	765	(10)
Neuroradiological Techniques	765	(4)
Computed Tomography	769	(1)
Magnetic Resonance Imaging	770	(1)
Positron Emission Tomography and Single-Photon Emission Computed Tomography	770	(1)
Angiography and Digital Subtraction Angiography	770	(1)
Cerebral Blood Flow Studies	771	(1)
Myelography	771	(1)
Ultrasonography and Noninvasive Cerebrovascular Studies	771	(1)
Electrophysiological Studies	772	(1)
Lumbar Puncture for Cerebrospinal Fluid Examination	773	(2)
Patient Management: Nervous System	775	(21)
Physiological Principles	775	(2)
Intracranial Dynamics	775	(2)
Volume-Pressure Curve	777	(1)
Cerebral Perfusion Pressure	777	(1)
Causes of Increased Intracranial Pressure	777	(1)
Cushing's Syndrome	777	(1)
Cerebral Edema	778	(1)
Herniation	778	(1)
Intracranial Pressure Monitoring	778	(5)
Intracranial Pressure Monitoring Devices	778	(2)
Results of Intracranial Pressure Monitoring	780	(3)
Indications for Intracranial Pressure Monitoring	783	(1)
Management of Increased Intracranial Pressure	783	(13)
First-Tier Therapy	783	(3)
Second-Tier Therapy	786	(2)
Nursing Management	788	(4)
Seizure Prophylaxis	792	(4)
Common Neurosurgical and Neurological Disorders	796	(43)
Neuroanatomy	796	(2)
Cerebrum	796	(1)
Cerebellum	797	(1)
Brainstem	797	(1)
Ventricles	797	(1)
Brain Vasculature	797	(1)
Neuromuscular Junction	797	(1)
Neurological Surgery	798	(17)
Brain Tumors	798	(10)
Aneurysms	808	(4)
Arteriovenous Malformations	812	(1)
Surgical Approaches	813	(2)
Neurological Disorders	815	(24)
Cerebrovascular Disease	815	(1)
Stroke	815	(8)
Seizures	823	(5)
Guillain-Barre Syndrome	828	(3)
Myasthenia Gravis	831	(8)
Head Injury	839	(22)
Mechanisms of Head Injury	839	(2)
Pathophysiology	841	(5)
Primary Brain Injury	841	(2)
Secondary Brain Injury	843	(3)
Assessment	846	(4)
Physical Examination	846	(3)
Diagnostic Testing	849	(1)
Management	850	(6)
Monitoring and Controlling Intracranial Pressure	850	(1)
Maintaining Cerebral Perfusion	851	(1)
Preventing and Treating Seizures	851	(1)
Monitoring Fluid and Electrolyte Status	852	(2)
Managing Cardiovascular Complications	854	(1)
Managing Pulmonary Complications	854	(1)
Ensuring Optimal Nutrition	855	(1)
Managing Musculoskeletal and Integumentary Complications	855	(1)
Caring for the Family	855	(1)
Brain Death	856	(5)
Spinal Cord Injury	861	(30)
Classification of Injury	862	(1)
Mechanism of Injury	862	(1)
Type of Vertebral Injury	862	(1)
Level of Injury	862	(1)
Cause of Injury	862	(1)
Spinal Cord Syndromes	862	(1)
Central Cord Syndrome	862	(1)
Brown-Sequard Syndrome	862	(1)
Anterior Cord Syndrome	863	(1)
Posterior Cord Syndrome	863	(1)
Autonomic Nervous System Syndromes	863	(1)
Spinal Shock	863	(1)
Neurogenic Shock	864	(1)
Orthostatic Hypotension	864	(1)
Pathophysiology	864	(1)
Primary Injury	864	(1)
Secondary Injury	864	(1)
Initial Assessment and Management	864	(5)
Prehospital Management	864	(3)
In-Hospital Management	867	(2)
Ongoing Assessment and Management	869	(14)
Realignment and Stabilization of the Spine	869	(2)
Prevention of Respiratory Problems	871	(2)
Restoration of Hemodynamic Stability	873	(3)
Neurological Management	876	(1)
Pain Management	876	(1)
Medication Administration	876	(1)
Thermoregulation	876	(1)
Nutrition	876	(2)
Mobilization and Skin Care	878	(2)
Urinary Management	880	(1)
Bowel Management	880	(2)
Psychological Support	882	(1)
Addressing Concerns About Sexuality	882	(1)
Complications	883	(2)
Autonomic Dysreflexia	883	(1)
Pulmonary Complications	884	(1)
Paralytic Ileus and Stress Ulcers	885	(1)
Heterotropic Ossification	885	(1)
Spasticity	885	(1)
Patient Teaching and Discharge Planning	885	(6)
PART 8 Gastrointestinal System	891	(102)
Anatomy and Physiology of the Gastrointestinal System	893	(18)
Structure of the Gastrointestinal System	893	(6)
Macroscopic Anatomy of the Gastrointestinal System	893	(3)
Microscopic Anatomy of the Gastrointestinal System	896	(1)
Innervation	896	(2)
Circulation	898	(1)
Function of the Gastrointestinal System	899	(12)
Oropharynx	899	(2)
Esophagus	901	(1)
Stomach	902	(2)
Pancreas	904	(1)
Gallbladder	904	(1)
Small Intestine	905	(1)
Large Intestine	906	(1)
Liver	907	(4)
Patient Assessment: Gastrointestinal System	911	(21)
History	912	(1)
Physical Examination	913	(8)
Oral Cavity and Throat	913	(2)
Abdomen	915	(5)
Anus and Rectum	920	(1)
Nutritional Assessment	921	(1)
Laboratory Studies	922	(2)
Laboratory Studies Relating to Liver Function	922	(1)
Laboratory Studies Relating to Pancreatic Function	922	(2)
Other Laboratory Studies	924	(1)
Diagnostic Studies	924	(8)
Radiological and Imaging Studies	924	(5)
Endoscopic Studies	929	(1)
Other Diagnostic Studies	929	(3)
Patient Management: Gastrointestinal System	932	(21)
Enteral Nutrition	938	(8)
Methods of Enteral Nutrition Delivery	938	(5)
Types and Delivery of Enteral Formulas	943	(1)
Complications of Enteral Nutrition	944	(2)
Parenteral (Intravenous) Nutrition	946	(4)
Methods of Parenteral Nutrition Delivery	946	(2)
Complications of Parenteral Nutrition	948	(2)
Terminating Parenteral Nutrition	950	(1)
Role of the Nurse in Nutritional Support	950	(3)
Common Gastrointestinal Disorders	953	(40)
Acute Gastrointestinal Bleeding	953	(9)
Upper Gastrointestinal Bleeding	953	(7)
Lower Gastrointestinal Bleeding	960	(2)
Intestinal Obstruction and Ileus	962	(7)
Small Bowel Obstruction	963	(3)
Colonic Obstruction	966	(1)
Ileus	967	(2)
Acute Pancreatitis	969	(8)
Etiology	969	(1)
Pathophysiology	969	(1)
Clinical Presentation	969	(1)
Assessment	970	(1)
Complications	971	(2)
Management	973	(4)
Hepatitis	977	(6)
Etiology	977	(3)
Pathophysiology	980	(1)
Assessment	980	(2)
Management	982	(1)
Complications of Liver Disease	983	(10)
Cirrhosis	983	(5)
Hepatic Encephalopathy	988	(1)
Hepatorenal Syndrome	989	(1)
Spontaneous Bacterial Peritonitis	989	(4)
PART 9 Endocrine System	993	(66)
Anatomy and Physiology of the Endocrine System	995	(18)
The Hypothalamus and Pituitary Gland	996	(5)
Posterior Pituitary (Neurohypophysis) Hormones	998	(2)
Anterior Pituitary (Adenohypophysis) Hormones	1000	(1)
The Thyroid and Parathyroid Glands	1001	(3)
Thyroid Hormones	1002	(1)
Calcitonin and Parathyroid Hormone	1003	(1)
The Endocrine Pancreas	1004	(2)
Insulin	1004	(1)
Glucagon	1005	(1)
Somatostatin	1006	(1)
Pancreatic Polypeptide	1006	(1)
The Adrenal Glands	1006	(4)
Medullary Hormones	1007	(1)
Cortical Hormones	1008	(2)
Atrial Natriuretic Peptide (Natriuretic Hormone)	1010	(3)
Patient Assessment: Endocrine System	1013	(13)
The Hypothalamus and Pituitary Gland	1014	(2)
History and Physical Examination	1014	(1)
Laboratory Studies	1014	(2)
Diagnostic Studies	1016	(1)
The Thyroid Gland	1016	(4)
History and Physical Examination	1017	(2)
Laboratory Studies	1019	(1)
Diagnostic Studies	1020	(1)
The Parathyroid Gland	1020	(1)
History and Physical Examination	1020	(1)
Laboratory Studies	1021	(1)
Diagnostic Studies	1021	(1)
The Endocrine Pancreas	1021	(2)
History and Physical Examination	1021	(1)
Laboratory Studies	1021	(2)
The Adrenal Gland	1023	(3)
History and Physical Examination	1023	(1)
Laboratory Studies	1023	(2)
Diagnostic Studies	1025	(1)
Common Endocrine Disorders	1026	(33)
Thyroid Dysfunction	1026	(5)
Thyroid Crisis	1026	(4)
Myxedema Coma	1030	(1)
Adrenal Gland Dysfunction	1031	(2)
Adrenal Crisis	1031	(2)
Antidiuretic Hormone Dysfunction	1033	(4)
Syndrome of Inappropriate Antidiuretic Hormone Secretion	1033	(2)
Diabetes Insipidus	1035	(2)
Diabetic Emergencies	1037	(22)
Diabetic Ketoacidosis	1038	(12)
Hyperosmolar Hyperglycemic State	1050	(4)
Hypoglycemia	1054	(5)
PART 10 Hematological and Immune Systems	1059	(134)
Anatomy and Physiology of the Hematological and Immune Systems	1061	(13)
Hematological System	1061	(6)
Blood and Its Functions	1061	(1)
Components of Blood	1062	(3)
Blood Coagulation	1065	(2)
Immune System	1067	(7)
Immune Response	1067	(3)
Impaired Host Resistance	1070	(4)
Patient Assessment: Hematological and Immune Systems	1074	(14)
Assessment	1074	(2)
History	1074	(1)
Physical Examination	1075	(1)
Diagnostic Studies and Results Interpretation	1076	(9)
Tests to Evaluate Red Blood Cells	1076	(2)
Tests to Evaluate White Blood Cells	1078	(2)
Tests to Evaluate Disorders of Primary Hemostasis	1080	(3)
Tests to Evaluate Disorders of Secondary Hemostasis	1083	(1)
Tests to Evaluate Hematological and Immune Disorders	1084	(1)
Assessment of the Immunocompromised Patient	1085	(3)
History	1085	(1)
Risk Factors for Immunocompromise	1085	(3)
Organ and Hematopoietic Stem Cell Transplantation	1088	(48)
Indications for Transplantation	1089	(1)
Patient Evaluation and Contraindications to Transplantation	1089	(1)
Donor Selection	1090	(5)
Determining Compatibility	1092	(1)
Living Donors	1093	(1)
Cadaveric Donors	1094	(1)
Assessment and Management in Organ Transplantation	1095	(6)
Preoperative Phase	1095	(1)
Surgical Procedure	1095	(1)
Postoperative Phase	1096	(5)
Assessment and Management in Hematopoietic Stem Cell Transplantation	1101	(4)
Stem Cell Harvesting, Mobilization, and Collection	1101	(2)
Conditioning Regimen	1103	(1)
Transplantation/Hematopoietic Stem Cell Infusion	1104	(1)
Engraftment	1104	(1)
Immunosuppressive Therapy	1105	(1)
Complications of Transplantation	1105	(16)
Organ Transplantation	1105	(10)
Hematopoietic Stem Cell Transplantation	1115	(6)
Long-Term Considerations	1121	(15)
Common Immunological Disorders	1136	(38)
Human Immunodeficiency Virus Infection	1136	(18)
Epidemiology	1137	(1)
Pathophysiology	1137	(4)
Assessment	1141	(4)
Management	1145	(9)
Oncological Complications and Emergencies	1154	(20)
General Principles in the Critical Care of Patients With Cancer	1154	(1)
Hematological Complications	1155	(4)
Anatomical-Structural Complications	1159	(8)
Metabolic Complications	1167	(7)
Common Hematological Disorders	1174	(19)
Disorders of Red Blood Cells	1174	(4)
Deficiency Anemias	1174	(1)
Hemolytic Anemias	1175	(2)
Sickle Cell Anemia	1177	(1)
Polycythemia	1178	(1)
Disorders of White Blood Cells	1178	(3)
Neutropenia	1179	(1)
Lymphoproliferative Disorders	1179	(2)
Myeloproliferative Disorders	1181	(1)
Disorders of Bone Marrow Failure	1181	(1)
Aplastic Anemia	1181	(1)
Myelodysplastic Syndrome	1182	(1)
Myelofibrosis	1182	(1)
Disorders of Hemostasis	1182	(3)
Bleeding Disorders	1183	(1)
Immune Thrombocytopenic Purpura	1183	(1)
Thrombotic Thrombocytopenic Purpura	1183	(2)
Disseminated Intravascular Coagulation	1185	(8)
Pathophysiology	1185	(1)
Assessment	1186	(1)
Management	1187	(6)
PART 11 Integumentary System	1193	(56)
Anatomy and Physiology of the Integumentary System	1195	(5)
Epidermis	1195	(1)
Dermis	1195	(1)
Hypodermis	1196	(1)
Skin Appendages	1196	(2)
Sweat Glands	1196	(1)
Sebaceous Glands	1196	(1)
Hair	1196	(1)
Nails	1197	(1)
Functions of the Skin	1198	(1)
Skin of the Older Adult	1198	(1)
Skin of the Child	1198	(2)
Patient Assessment: Integumentary System	1200	(11)
History	1200	(1)
Physical Examination	1200	(5)
Inspection	1200	(4)
Palpation	1204	(1)
Assessment of Pressure Ulcers	1205	(1)
Assessment of Skin Tumors	1205	(3)
Assessment of the Skin in Older Adults	1208	(1)
Assessment of the Skin in Children	1209	(2)
Patient Management: Integumentary System	1211	(15)
Types of Wounds	1211	(2)
Pressure Ulcers	1212	(1)
Leg Ulcers	1212	(1)
Wound Healing	1213	(1)
Phases of Wound Healing	1213	(1)
Methods of Wound Healing	1214	(1)
Wound Assessment	1214	(2)
Wound Care	1216	(3)
Wound Closure	1216	(1)
Wound Drainage	1216	(1)
Wound Dressings	1217	(1)
Wound Debridement	1217	(1)
Wound Cultures	1218	(1)
Use of Pressure-Relieving Devices	1218	(1)
Pain Management	1218	(1)
Pharmacotherapy	1218	(1)
Care of Specific Wounds	1219	(1)
Pressure Ulcers	1219	(1)
Burns	1219	(1)
High-Volume Draining Wounds	1219	(1)
Nutrition and Wound Healing	1219	(3)
Patient Teaching and Discharge Planning	1222	(4)
Burns	1226	(23)
Classification of Burn Injuries	1226	(4)
Causative Agent	1227	(1)
Depth	1227	(2)
Severity	1229	(1)
Pathophysiology	1230	(2)
Localized Tissue Response	1230	(1)
Systemic Response	1230	(2)
Concomitant Problems	1232	(3)
Pulmonary Injury	1232	(2)
Infection	1234	(1)
Trauma	1234	(1)
Management	1235	(14)
Resuscitative Phase	1235	(1)
Reparative Phase	1236	(10)
Rehabilitative Phase	1246	(3)
PART 12 Multisystem Dysfunction	1249	(70)
Shock, Systemic Inflammatory Response Syndrome, and Multiple Organ Dysfunction Syndrome	1251	(26)
Pathophysiology of Shock	1252	(3)
Tissue Oxygenation and Perfusion	1252	(1)
Compensatory Mechanisms	1253	(2)
Classification of Shock	1255	(1)
Hypovolemic Shock	1255	(2)
Etiology	1255	(1)
Pathophysiology	1255	(1)
Assessment	1255	(1)
Management	1256	(1)
Complications	1257	(1)
Cardiogenic Shock	1257	(4)
Etiology	1257	(1)
Pathophysiology	1258	(1)
Assessment	1258	(1)
Management	1259	(2)
Anaphylactic Shock	1261	(1)
Etiology	1261	(1)
Pathophysiology	1261	(1)
Assessment	1262	(1)
Management	1262	(1)
Neurogenic Shock	1262	(1)
Septic Shock	1263	(7)
Etiology	1263	(1)
Pathophysiology	1263	(3)
Assessment	1266	(1)
Management	1266	(4)
Features Common to all Shock States	1270	(1)
Stages of Shock	1270	(1)
Systemic Inflammatory Response Syndrome	1270	(1)
Etiology	1270	(1)
Pathophysiology	1270	(1)
Multiple Organ Dysfunction Syndrome	1271	(6)
Etiology	1271	(1)
Pathophysiology	1271	(2)
Assessment: Monitoring Organ Function	1273	(1)
Management	1273	(4)
Trauma	1277	(24)
Mechanism of Injury	1277	(3)
Blunt Injury	1278	(1)
Penetrating Injury	1278	(2)
Stab Wounds and Impalements	1280	(1)
Initial Assessment and Management	1280	(4)
Prehospital Management	1280	(1)
In-Hospital Management	1281	(3)
Assessment and Management of Specific Injuries	1284	(12)
Thoracic Trauma	1284	(5)
Abdominal Trauma	1289	(4)
Musculoskeletal Injuries	1293	(2)
Maxillofacial Trauma	1295	(1)
Complications of Multiple Trauma	1296	(5)
Early Complications	1296	(1)
Late Complications	1296	(5)
Drug Overdose and Poisoning	1301	(18)
The Poisoned or Overdosed Patient	1301	(1)
Poisoning	1302	(1)
Substance Abuse and Overdose	1302	(1)
Assessment	1302	(1)
Triage	1302	(1)
History	1302	(1)
Physical Examination	1303	(1)
Laboratory Studies	1303	(1)
Management	1303	(16)
Stabilization	1303	(2)
Initial Decontamination	1305	(1)
Gastrointestinal Decontamination	1305	(2)
Enhanced Elimination of the Drug or Toxin	1307	(1)
Antagonists, Antitoxins, and Antivenins	1307	(1)
Continuous Patient Monitoring	1308	(1)
Patient Teaching	1309	(10)
Appendix 1 ACLS Guidelines	1319	(12)
Appendix 2 Answer Key to Study Questions With Rationales	1331	(16)
Index	1347