AACN essentials of critical care nursing

625 Pages·2014·37.36 MB·English

by  Burns, Suzanne M

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AACN Essentials of Critical Care Nursing of N
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Third Edition , C
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Suzanne M. Burns, MSN, RRT, ACNP, CCRN, FAAN, FCCM, FAANP .11
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Professor Emeritus, School of Nursing ] a
University of Virginia t [07
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Consultant, Critical and Progressive Care and Clinical Nursing Research 8/1
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Charlottesville, Virginia ]. C
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Marianne Chulay RN, PhD, FAAN, my dear friend and colleague, for her many contributions h
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and mentoring during the development of the first two editions of the Essentials of Critical Care ng
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Nursing and the Essentials of Progressive Care Nursing books. Her inspiration, drive, and ai U
thoughtful approach to the books continue to be an inspiration to me and niv
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the authors with whom she worked. rsity
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Contributors .........................................................................................................................................................................................................................................................xvii 5
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Reviewers ............................................................................................................................................................................................................................................................ xix .1
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Preface ................................................................................................................................................................................................................................................................ xxi 1
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Section I. The Essentials ..........................................................................................................................................................................................1 /18
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1. Assessment of Critically Ill Patients and Their Families .................................................................................................................3 ]. C
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Mary Fran Tracy py
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2. Planning Care for Critically Ill Patients and Their Families ..........................................................................................................19 t ©
Mary Fran Tracy M
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3. Interpretation and Management of Basic Cardiac Rhythms .........................................................................................................35 raw
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Carol Jacobson ill G
4. Hemodynamic Monitoring ................................................................................................................................................................69 lob
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Leanna R. Miller l E
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5. Airway and Ventilatory Management .............................................................................................................................................119 tio
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Robert E. St. John and Maureen A. Seckel H
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6. Pain, Sedation, and Neuromuscular Blockade Management ......................................................................................................159 ing
Yvonne D’Arcy and Suzanne M. Burns s, L
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7. Pharmacology ....................................................................................................................................................................................183 . N
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Earnest Alexander t to
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8. Ethical and Legal Considerations ....................................................................................................................................................215 re
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Sarah Delgado istrib
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Section II. Pathologic Conditions ...........................................................................................................................................................................231 r m
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9. Cardiovascular System ......................................................................................................................................................................233 ifie
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Barbara Leeper in
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10. Respiratory System ............................................................................................................................................................................263 w
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Maureen A. Seckel w
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11. Multisystem Problems ......................................................................................................................................................................293 u
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Ruth M. Kleinpell erm
12. Neurologic System .............................................................................................................................................................................311 issio
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Dea Mahanes
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vi Contents
13. Hematologic and Immune Systems.................................................................................................................................................337
Diane K. Dressler
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14. Gastrointestinal System ......................................................................................................................................................................351 w
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Deborah A. Andris, Elizabeth Krzywda, Carol Rees Parrish, and Joe Krenitsky loa
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15. Renal System ......................................................................................................................................................................................383 by
Carol Hinkle [ F
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16. Endocrine System ..............................................................................................................................................................................399 lty
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Christine Kessler f N
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17. Trauma ................................................................................................................................................................................................415 rsing
Allen C. Wolfe and Benjamin W. Hughes , Ch
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Section III. Advanced Concepts in Caring for the Critically Ill Patient ................................................................................................................................431 i U
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18. Advanced ECG Concepts .................................................................................................................................................................433 rsity
Carol Jacobson 5
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19. Advanced Cardiovascular Concepts ...............................................................................................................................................475 .15
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Barbara Leeper .11
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20. Advanced Respiratory Concepts: Modes of Ventilation .................................................................................................................507 t [0
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Suzanne M. Burns /1
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21. Advanced Neurologic Concepts ......................................................................................................................................................517 ]. C
Dea Mahanes op
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Section IV. Key Reference Information ....................................................................................................................................................................541 M
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22. Normal Values Table .........................................................................................................................................................................543 ra
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23. Pharmacology Tables ........................................................................................................................................................................545 lo
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Earnest Alexander l E
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24. Advanced Cardiac Life Support Algorithms ..................................................................................................................................559 atio
Suzanne M. Burns n H
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25. Hemodynamic Troubleshooting Guide ..........................................................................................................................................563 in
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Leanna R. Miller s, L
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26. Cardiac Rhythms, ECG Characteristics, and Treatment Guide ..................................................................................................571 . N
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Carol Jacobson t to
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Index ..............................................................................................................................................................................................................581 e re
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Contents in Detail y [ F
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Contributors ............................................................................................................................................................................................................................................................xvii 5
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Reviewers .................................................................................................................................................................................................................................................................xix .15
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Preface................................................................................................................................................................................................................xxi 17
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Section I. The Essentials ..........................................................................................................................................................................................1 /18
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1. Assessment of Critically Ill Patients and Their Families .................................................................................................................3 ]. C
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Mary Fran Tracy py
Assessment Framework 3 righ
Prearrival Assessment 4 / Admission Quick Check 4 / Comprehensive Initial Assessment 4 / t © M
Ongoing Assessment 4 / Patient Safety Considerations in Admission Assessments 4 c
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Prearrival Assessment: Before The Action Begins 5 raw
AdmAisisriwoany Qanudi cBkr eCathheinckg 6A /s sCeisrscmulaetniot:n Th aned FCierrsetb Frealw P eMrfiunsuiotnes 7 / 6Chief Complaint 7 / -Hill G
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Drugs and Diagnostic Tests 7 / Equipment 8 ba
Comprehensive Initial Assessment 8 l Ed
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Past Medical History 9 / Social History 9 / Physical Assessment by Body System 9 / atio
Psychosocial Assessment 14 n H
Ongoing Assessment 16 old
Selected Bibliography 16 ing
Critical Care Assessment 16 / Evidence-Based Practice 16 s, LL
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2. Planning Care for Critically Ill Patients and Their Families ..........................................................................................................19 . N
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Mary Fran Tracy t to
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Multidisciplinary Plan of Care 19 e re
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PPalatniennitn Sga Cfeatrye C Thonrsoiudgehra Stitoanffisn ign CPloannsnidinegra Ctiaornes 2200 istribu
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Prevention of Common Complications 21 d o
Physiologic Instability 21 / Deep Venous Thrombosis 22 / Hospital-Acquired Infections 22 / r m
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Skin Breakdown 23 / Sleep Pattern Disturbance 24 / Psychosocial Impact 24 difie
Patient and Family Education 26 d in
Assessment of Learning Readiness 26 / Strategies to Address Patient and Family Education 26 / an
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Principles for Educational Outcome Monitoring 27 w
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Family-Focused Care 27 y w
Transporting The Critically Ill Patient 28 ith
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Assessment of Risk for Complications 29 / Level of Care Required During Transport 30 / t p
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Preparation 30 / Transport 31 / Interfacility Transfers 32 rm
Transitioning to the Next Stage of Care 33 issio
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Supporting Patients and Families During the Dying Process 33 .
Selected Bibliography 33
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viii Contents in Detail
Patient and Family Needs 33 / Infection Control 33 / Patient and Family Education 34 /
Psychological Problems 34 / Sleep Deprivation 34 / Transport of Critically Ill Patients 34 /
Evidence-Based Practice 34 D
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3. Interpretation and Management of Basic Cardiac Rhythms .........................................................................................................35 lo
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Carol Jacobson ed
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Basic Electrophysiology 35 y
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ECG Waveforms, Complexes, and Intervals 36 a
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P Wave 36 / QRS Complex 37 / T Wave 37 / U Wave 37 / PR Interval 37 / ST Segment 37 / QT lty
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Interval 37 f N
Basic Electrocardiography 37 ursin
Cardiac Monitoring 37 g
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Determination of the Heart Rate 40 h
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Determination of Cardiac Rhythm 40 g
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Common Arrhythmias 41 i U
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Rhythms Originating in the Sinus Node 41 iv
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Normal Sinus Rhythm 41 / Sinus Bradycardia 41 / Sinus Tachycardia 42 / Sinus Arrhythmia 42 / rsity
Sinus Arrest 42 5
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Arrhythmias Originating in the Atria 43 2.1
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Premature Atrial Complexes 43 / Wandering Atrial Pacemaker 44 / Atrial Tachycardia 44 / Atrial 8.1
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Flutter 45 / Atrial Fibrillation 47 / Supraventricular Tachycardia (SVT) 51 7
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Arrhythmias Originating in the Atrioventricular Junction 52 t [0
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Premature Junctional Complexes 52 / Junctional Rhythm, Accelerated Junctional Rhythm, and /1
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Junctional Tachycardia 53 /1
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Arrhythmias Originating in the Ventricles 53 ]. C
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Premature Ventricular Complexes 53 / Ventricular Rhythm and Accelerated Ventricular Rhythm 54 / py
Ventricular Tachycardia 55 / Ventricular Fibrillation 56 / Ventricular Asystole 56 righ
Atrioventricular Blocks 57 t ©
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First-Degree Atrioventricular Block 57 / Second-Degree Atrioventricular Block 57 / High-Grade cG
Atrioventricular Block 58 / Third-Degree Atrioventricular Block (Complete Block) 59 raw
Temporary Pacing 60 -H
Indications 60 / Transvenous Pacing 61 / Epicardial Pacing 62 / Components of a Pacing System 62 / ill G
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Basics of Pacemaker Operation 62 / Initiating Transvenous Ventricular Pacing 64 / Initiating ba
Epicardial Pacing 64 / External (Transcutaneous) Pacemakers 64 l Ed
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Defibrillation and Cardioversion 64 ca
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Defibrillation 64 / Automatic External Defibrillators 65 / Cardioversion 65 n
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Selected Bibliography 66 old
Evidence-Based Practice 67 ing
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4. Hemodynamic Monitoring ................................................................................................................................................................69 LC
Leanna R. Miller . N
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Hemodynamic Parameters 69 t to
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Cardiac Output 69 / Components of Cardiac Output/Cardiac Index 71 / Stroke Volume and Stroke e re
BasicV Coloummep Ionndeenxt 7s 2o /f EHjeecmtioond yFnraacmtioicn M72o /n Fiatoctroinrsg A Sffyesctteimngs S tro7k6e Volume/Stroke Volume Index 72 distrib
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Pulmonary Artery Catheter 76 / Arterial Catheter 77 / Pressure Tubing 77 / Pressure Transducer 78 / ted
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Pressure Amplifier 78 / Pressure Bag and Flush Device 78 / Alarms 78 r m
Obtaining Accurate Hemodynamic Values 79 od
Zeroing the Transducer 79 / Leveling the Transducer to the Catheter Tip 79 / Calibration of the ified
Transducer/Amplifier System 80 / Ensuring Accurate Waveform Transmission 81 in a
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Insertion and Removal of Catheters 81 y w
Pulmonary Artery Catheters 81 / Arterial Catheters 85 ay
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Obtaining and Interpreting Hemodynamic Waveforms 85 ith
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Patient Positioning 88 / Interpretation 88 / Artifacts in Hemodynamic Waveforms: Respiratory ut p
Influence 95 / Cardiac Output 96 erm
Continuous Mixed and Central Venous Oxygen Monitoring 101 issio
Continuous Mixed and Central Venous Oxygen Monitoring 101 / Selected Examples of Clinical n.
Applications 103