Table Of Content

1 Overview of Critical Care Nursing, 2 2 Patient and Family Response to the Critical Care Experience, 14 3 Ethical and Legal Issues in Critical Care Nursing, 26 4 End-of-Life Care in the Critical Care Unit, 37 5 Comfort and Sedation, 48 6 Nutritional Support, 80 7 Dysrhythmia Interpretation and Management, 94 8 Hemodynamic Monitoring, 140 9 Ventilatory Assistance, 170 10 Rapid Response Teams and Code Management, 220 11 Shock, Sepsis, and Multiple Organ Dysfunction Syndrome, 250 BRIEF CONTENTS 12 Cardiovascular Alterations, 289 13 Nervous System Alterations, 345 14 Acute Respiratory Failure, 400 15 Acute Kidney Injury, 432 16 Hematological and Immune Disorders, 460 17 Gastrointestinal Alterations, 502 18 Endocrine Alterations, 543 19 Trauma and Surgical Management, 588 20 Burns, 614 21 Solid Organ Transplantation, 658 Appendix: Quality and Safety Education for Nurses (QSEN) Quality and Safety Competencies, 679 Critical Care NURSING Introduction to Once you register, you will have access to your FREE STUDY TOOLS: • Review Questions with instant scoring and feedback at the click of a button. • 15 Procedures from the new edition of Mosby’s Nursing Skills that demonstrate many of the primary procedures important in critical care nursing. • Animations and Video Clips that feature innovative content from supplemental materials. REGISTER TODAY! ACTIVATE THE COMPLETE LEARNING EXPERIENCE THAT COMES WITH YOUR BOOK BY REGISTERING AT http://evolve.elsevier.com/Sole/ MORE THAN A TEXTBOOK YOU’VE JUST PURCHASED iii Critical Care NURSING Introduction to S I X T H E D I T I O N Mary Lou Sole, PhD, RN, CCNS, CNL, FAAN, FCCM Orlando Health Distinguished Professor College of Nursing University of Central Florida; Research Scientist Orlando Health Orlando, Florida Deborah G. Klein, MSN, RN, APRN-BC, CCRN, FAHA Clinical Nurse Specialist Coronary ICU and Heart Failure ICU Cleveland Clinic; Clinical Instructor Frances Payne Bolton School of Nursing Case Western Reserve University Cleveland, Ohio; Adjunct Faculty College of Nursing Kent State University Kent, Ohio Marthe J. Moseley, PhD, RN, CCNS Associate Director Clinical Practice Office of Nursing Services Clinical Nurse Specialist, Critical Care Veterans Healthcare Administration Washington, DC; Professor Rocky Mountain University of Health Professions Provo, Utah; Adjunct Professor University of Texas Health Science Center School of Nursing San Antonio, Texas With approximately 300 illustrations 3251 Riverport Lane St. Louis, Missouri 63043 INTRODUCTION TO CRITICAL CARE NURSING, SIXTH EDITION 978-0-323-08848-0 Copyright © 2013, 2009, 2005, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc. No part of this publication may be reproduced or transmitted in any form or by any means, electronic or mechanical, including photocopying, recording, or any information storage and retrieval system, without permission in writing from the publisher. Details on how to seek permission, further information about the Publisher’s permissions policies and our arrangements with organizations such as the Copyright Clearance Center and the Copyright Licensing Agency, can be found at our website: www.elsevier.com/permissions. This book and the individual contributions contained in it are protected under copyright by the Publisher (other than as may be noted herein). Notices Knowledge and best practice in this field are constantly changing. As new research and experience broaden our understanding, changes in research methods, professional practices, or medical treatment may become necessary. Practitioners and researchers must always rely on their own experience and knowledge in evaluating and using any information, methods, compounds, or experiments described herein. In using such information or methods they should be mindful of their own safety and the safety of others, including parties for whom they have a professional responsibility. With respect to any drug or pharmaceutical products identified, readers are advised to check the most current information provided (i) on procedures featured or (ii) by the manufacturer of each product to be administered, to verify the recommended dose or formula, the method and duration of administration, and contraindications. It is the responsibility of practitioners, relying on their own experience and knowledge of their patients, to make diagnoses, to determine dosages and the best treatment for each individual patient, and to take all appropriate safety precautions. To the fullest extent of the law, neither the Publisher nor the authors, contributors, or editors, assume any liability for any injury and/or damage to persons or property as a matter of products liability, negligence or otherwise, or from any use or operation of any methods, products, instructions, or ideas contained in the material herein. Nursing Diagnoses – Definitions and Classification 2012-2014. Copyright © 2012, 1994-2012 by NANDA International. Used by arrangement with Blackwell Publishing Limited, a company of John Wiley & Sons, Inc. Library of Congress Cataloging-in-Publication Data Introduction to critical care nursing / [edited by] Mary Lou Sole, Deborah G. Klein, Marthe J. Moseley.— 6th ed. p. ; cm. Critical care nursing Includes bibliographical references and index. ISBN 978-0-323-08848-0 (pbk. : alk. paper) I. Sole, Mary Lou. II. Klein, Deborah G. III. Moseley, Marthe J. IV. Title: Critical care nursing. [DNLM: 1. Critical Care. 2. Nursing Care. WY 154] 616.02’8--dc23 2012008134 Executive Content Strategist: Tamara Myers Senior Content Development Specialist: Linda Thomas Publishing Services Manager: Jeff Patterson Senior Project Manager: Tracey Schriefer Design Direction: Amy Buxton Printed in China Last digit is the print number: 9 8 7 6 5 4 3 2 v DEDICATION A special dedication to my grandmother, Josephine Ferda, who has celebrated 100 years of health! To my husband, Bob, and daughter, Erin, for their encouragement and support of my many activities. To my parents, George and Margaret Ferda, who always encouraged me to shoot for the stars. Lastly, to my many students and colleagues, who inspire me and keep me grounded in clinical practice. MLS To the critical care nurses, patients, and their families, who guide the content of this book. To my husband, Ron, and my sons, David and Seth, for their support in all that I do. To my parents, Rena Sasson Goldenberg, RN, BSN, and Ira Goldenberg, MD, for their guidance and inspiration. DGK To my mom, sister, and son—Violet and Heidi Halvorson, and Nicholas—who are care receivers and givers both in and out of the hospital. For the Clinical Practice Portfolio—Chris Engstrom, Suzy Thorne-Odem, Evelyn Sommers, and Kelly Morrow—one of the best teams ever. For the lifelong influence and contributions of Marjory Olson. And to dear friends, Luann Mire and Lee White. MJM This page intentionally left blank vii MARY LOU SOLE Mary Lou Sole, PhD, RN, CCNS, CNL, FAAN, FCCM, has extensive experience in critical care practice, education, consultation, and research. She is the Orlando Health Distin- guished Professor and a Pega- sus Professor at the University of Central Florida (UCF) Col- lege of Nursing in Orlando, Florida. She coordinates the Clinical Nurse Specialist and Clinical Nurse Leader tracks at UCF, and regularly guest lectures during the undergraduate critical care course. She also holds a per diem appointment as a Research Scientist at Orlando Health. Her research focus is on airway management of the critically ill. She began her career as a diploma graduate from the Ohio Valley General Hospital School of Nursing in Wheeling, West Virginia. She received a BSN from Ohio University, a master’s degree in nursing from The Ohio State University, and a PhD in nursing from The University of Texas at Austin. Dr. Sole has published extensively in peer-reviewed journals and serves on many editorial boards. Dr. Sole has been active locally and nationally in many professional organizations, including the American Association of Critical-Care Nurses (AACN), the Society of Critical Care Medicine, and the American Academy of Nursing. She has received numerous local, state, and national awards for clinical practice, teaching, and research. She has been inducted as a fellow in both the American Academy of Nursing and the American College of Critical Care Medicine. She has received two prestigious awards from AACN—the Flame of Excellence Award and the Distinguished Research Lecturer. ABOUT THE AUTHORS DEBORAH G. KLEIN Deborah G. Klein, MSN, RN, APRN-BC, CCRN, FAHA, has more than 35 years of experience in critical care practice, education, consultation, and research. She is currently Clini- cal Nurse Specialist for the Cor- onary ICU, Heart Failure ICU, and Cardiac Short Stay/PACU/ CARU at the Cleveland Clinic in Cleveland, Ohio. She is a Clin- ical Instructor at Frances Payne Bolton School of Nursing, Case Western Reserve University; and Adjunct Faculty at Kent State University College of Nursing. She received her BSN and MSN from Frances Payne Bolton School of Nursing, Case Western Re- serve University, in Cleveland, Ohio. She is active both locally and nationally in professional organizations, including the American Association of Critical-Care Nurses and the American Heart Association. She has served on editorial boards of several critical care nursing journals and has published extensively on critical care topics in peer-reviewed journals. Mrs. Klein has received local and national awards for clinical practice and teaching. MARTHE J. MOSELEY Marthe J. Moseley, PhD, RN, CCNS, has more than 28 years of experience in critical care practice, education, consultation, and research. She is currently the Associate Director of Clinical Practice in the Office of Nursing Service with the Vet- erans Healthcare Administra- tion in Washington, DC, and a Clinical Nurse Specialist for Critical Care. She also holds faculty positions as a Professor at Rocky Mountain University of Health Professions in Provo, Utah, and an Adjunct Professor at The University of Texas Health Science Center San Antonio, Texas School of Nursing. Dr. Moseley received a bachelor of arts degree in nursing from Jamestown College in Jamestown, North Dakota, following the completion of a BA degree in health, physical education, and biology from Concordia College in Moor- head, Minnesota. She completed her MSN and PhD at The University of Texas Health Science Center San Antonio, Texas. She has been active locally and nationally in professional organizations, specifically the American Association of Critical-Care Nurses. She is on the editorial board for several critical care journals and has published in peer-reviewed journals on critical care topics. Dr. Moseley has received local and national awards for both clinical practice and teaching. This page intentionally left blank ix Katherine F. Alford, MSN, RN, CCRN, PCCN Acute Care Educator South Texas Veterans Health Care System San Antonio, Texas Chapter 17, Gastrointestinal Alterations David A. Allen, MSN, RN, CCRN, CCNS, CNS-BC Clinical Nurse Specialist Institute of Surgical Research Burn Center; Major, United States Army Nurse Corps Fort Sam Houston, Texas Chapter 8, Hemodynamic Monitoring Kathy Black, MSN, RN, NE-BC Patient Care Administrator Inpatient Surgery Units Orlando Regional Medical Center Orlando, Florida Chapter 3, Ethical and Legal Issues in Critical Care Nursing Jill T. Dickerson, MSN, RN, CNS-MS, FNP-BC, CWON Clinical Nurse Specialist South Texas Veterans Health Care System Audie L. Murphy Memorial Veterans Hospital San Antonio, Texas Chapter 16, Hematological and Immune Disorders Kathleen Hill, MSN, RN, CCNS-CSC Clinical Nurse Specialist Surgical Intensive Care Unit Cleveland Clinic Cleveland, Ohio Chapter 11, Shock, Sepsis, and Multiple Organ Dysfunction Syndrome Douglas Houghton, MSN, ARNP, ACNPC, CCRN, FAANP Nurse Practitioner Department of Trauma/Critical Care Jackson Health System Miami, Florida Chapter 4, End-of-Life Care in the Critical Care Unit Miranda Kelly, DNP, RN, ACNP-BC Nurse Practitioner Intensive Care Unit Memorial Hermann Healthcare System The Woodlands, Texas Chapter 6, Nutritional Support Kathleen Kerber, MSN, RN, ACNS-BC, CCRN Clinical Nurse Specialist Department of Nursing MetroHealth Medical Center Cleveland, Ohio Chapter 15, Acute Kidney Injury Karla S. Ahrns Klas, BSN, RN, CCRP Injury Prevention Education Specialist Trauma Burn Center University of Michigan Ann Arbor, Michigan Chapter 20, Burns Deborah G. Klein, MSN, RN, APRN-BC, CCRN, FAHA Clinical Nurse Specialist Cardiac ICU and Heart Failure ICU Cleveland Clinic Cleveland, Ohio; Clinical Instructor Frances Payne Bolton School of Nursing Case Western Reserve University Cleveland, Ohio; Adjunct Faculty College of Nursing Kent State University Kent, Ohio Chapter 10, Rapid Response Teams and Code Management Chapter 13, Nervous System Alterations Chapter 21, Solid Organ Transplantation Sandra J. Knapp, PhD, RN, CCRN, CNL Clinical Assistant Professor Adult and Elderly Department College of Nursing University of Florida Gainesville, Florida Chapter 2, Patient and Family Response to the Critical Care Experience Jacqueline LaManna, MSN, ARNP-BC, ADM, CDE Instructor College of Nursing University of Central Florida Orlando, Florida Chapter 18, Endocrine Alterations QSEN Exemplars boxes Mary Beth Flynn Makic, PhD, RN, CNS, CCNS, CCRN Research Nurse Scientist, Critical Care Professional Resources University of Colorado Hospital; Assistant Professor, Adjunct College of Nursing University of Colorado Aurora, Colorado Chapter 19, Trauma and Surgical Management Julie Marcum, MS, APRN-BC, CCRN-CMC Critical Care Clinical Nurse Specialist Department of Nursing Boise Veterans Administration Medical Center Boise, Idaho Chapter 7, Dysrhythmia Interpretation and Management Maximino Martell, MSN, RN, CCRN, CCNS, CNS-BC Critical Care Clinical Nurse Specialist Department of Hospital Education Brooke Army Medical Center Fort Sam Houston, Texas Chapter 8, Hemodynamic Monitoring Marthe J. Moseley, PhD, RN, CCNS Associate Director Clinical Practice Office of Nursing Services Clinical Nurse Specialist, Critical Care Veterans Healthcare Administration Washington, DC; Professor Rocky Mountain University of Health Professions Provo, Utah; Adjunct Professor University of Texas Health Science Center School of Nursing San Antonio, Texas Chapter 16, Hematological and Immune Disorders Linda Ohler, MSN, RN, CCTC, FAAN Clinical Administrator Transplant Institute Georgetown University Washington, DC Chapter 21, Solid Organ Transplantation CONTRIBUTORS CONTRIBUTORS x Lynelle N.B. Pierce, MSN, RN, CCRN Clinical Assistant Professor University of Kansas School of Nursing; Clinical Nurse Specialist, Critical Care Nursing The University of Kansas Hospital Kansas City, Kansas Chapter 9, Ventilatory Assistance Mamoona Arif Rahu, PhD, RN, CCRN School of Nursing Virginia Commonwealth University Health System Richmond, Virginia Chapter 5, Comfort and Sedation Maureen A. Seckel, MSN, RN, APN, ACNS-BC, CCNS, CCRN Clinical Nurse Specialist Medical Pulmonary Critical Care Christiana Care Health System; Adjunct Faculty, School of Nursing University of Delaware Newark, Delaware Chapter 14, Acute Respiratory Failure Mary Lou Sole, PhD, RN, CCNS, CNL, FAAN, FCCM Orlando Health Distinguished Professor College of Nursing University of Central Florida; Research Scientist Orlando Health Orlando, Florida Chapter 1, Overview of Critical Care Nursing Chapter 2, Patient and Family Response to the Critical Care Experience QSEN Exemplars Boxes Christina Stewart-Amidei, PhD, RN, CNRN, CCRN, FAAN Instructor College of Nursing University of Central Florida Orlando, Florida Chapter 13, Nervous System Alterations Chapter 18, Endocrine Alterations Tracy Evans Walker, MSN, RN, ANP-BC, CCTC Certified Nurse Practitioner Transplant Center Cleveland Clinic Cleveland, Ohio Chapter 21, Solid Organ Transplantation Colleen Walsh-Irwin, MS, RN, CCRN, ANP Nurse Practitioner, Division of Cardiology Northport VA Medical Center Northport, New York; Clinical Instructor, School of Nursing State University of New York Stony Brook, New York Chapter 12, Cardiovascular Alterations Jayne M. Willis, MSN, RN, NEA-BC Chief Nursing Officer Orlando Regional Medical Center Orlando, Florida Chapter 3, Ethical and Legal Issues in Critical Care Nursing Chris Winkelman, PhD, RN, CCRN, ACNP Associate Professor Frances Payne Bolton School of Nursing Case Western Reserve University Cleveland, Ohio Genetics boxes Patricia B. Wolff, MSN, RN, ACNS-BC, AOCNS Clinical Nurse Specialist, Medical Oncology South Texas Veterans Health Care System Audie L. Murphy Division San Antonio, Texas Chapter 16, Hematological and Immune Disorders xi REVIEWERS Zara Brenner, MS, RN-BC, ACNS-BC Assistant Professor The College at Brockport State University of New York Clinical Nurse Specialist Rochester General Hospital Rochester, New York Kenneth Brooks, BS, BSN, RN Staff Nurse Mayo Clinic; Doctoral Student University of Minnesota Rochester, Minnesota Janet E. Burton, MSN, BS, RN Instructor Department of Nursing Ivy Tech Community College Columbus, Indiana Marilyn T. Caldwell, MS, RN, ANP Assistant Professor Department of Nursing Morrisville State College Morrisville, New York Judy Crewell, PhD, RN, CNE Associate Professor Regis University Denver, Colorado Jane Haertlein, MS, RN, CNE Division of Nursing and Health Science Bob Jones University Greenville, South Carolina Rebecca Hickey, RN Adjunct Instructor University of Cincinnati-Raymond Walters Campus Blue Ash, Ohio Linda Howe, PhD, RN, CNS, CNE Associate Professor College of Nursing University of Central Florida Orlando, Florida Ruthanne Kuiper, PhD, RN, CNE, ANEF Associate Professor Department Chair, Adult Health and Learning Technology School of Nursing University of North Carolina Wilmington Wilmington, North Carolina Robert Lamb, PharmD REL & Associates, LLC Downingtown, Pennsylvania Kristine L’Ecuyer, MSN, RN, CCNS, CNL Associate Professor School of Nursing St. Louis University St. Louis, Missouri Lynn Rowe, MSN, RN Clinical Specialist Florida Hospital Critical Care Outcomes Orlando, Florida Jenny Sauls, DSN, RN, CNE Professor School of Nursing Middle Tennessee State University Murfreesboro, Tennessee Scott Thigpen, DNP, RN, CCRN, CEN Associate Professor of Nursing South Georgia College Douglas, Georgia; Staff Nurse Satilla Regional Medical Center Waycross, Georgia Jo Voss, PhD, RN Associate Professor College of Nursing South Dakota State University Rapid City, South Dakota Kathleen Whalen, PhD, RN, CNE Associate Professor Loretto Heights School of Nursing Regis University Denver, Colorado This page intentionally left blank xiii PREFACE Critical care nursing deals with human responses to life- threatening health problems. Critically ill patients continue to have high levels of acuity and complex care needs. These patients are cared for in critical care units, intermediate care units, outpatient settings, and at home. The critical care nurse is challenged to provide comprehensive care for these patients and their family members. The demand for critical care nurses who can work across the continuum of care continues to increase. A solid knowledge foundation in concepts of critical care nursing is essential for practice. Nurses must also learn the assessment and technical skills associated with management of the critically ill patient. The goal of this sixth edition of Introduction to Critical Care Nursing is to facilitate attainment of this foundation for care of the acutely and critically ill patient. The book continues to provide essential information in an easy-to- learn format. The textbook is targeted to both undergraduate nursing students and experienced nurses who are new to critical care. Both groups have found past editions of the book beneficial. In fact, undergraduate students who have taken a critical care course based on this textbook have easily passed critical care courses offered in their first nursing position! ORGANIZATION Introduction to Critical Care Nursing is organized into three sections. Part 1, Fundamental Concepts, introduces the reader to critical care nursing; psychosocial concepts related to patients, families, and nurses; and legal, ethical, and end-of-life issues related to critical care nursing practice. Part 2, Tools for the Critical Care Nurse, remains a unique feature of this text. Chapters in this section provide vital information concerning comfort and sedation, nutrition, recognition of dysrhythmias, hemodynamic monitoring, airway management and mechanical ventilation, and management of life-threatening emergen- cies. These chapters provide information related to the many treatments and technologies that acutely and critically ill patients receive. The final chapters of the book complete Part 3, Nursing Care during Critical Illness. The nursing process is used as an organizing framework for each chapter. Nursing care plans continue to be included so that nurses new to critical care become familiar with nursing diagnoses and interventions common to many critically ill patients. A summary of anatomy and physiology is provided, as are pathophysiology diagrams for common problems seen in critical care. Fea- tures of each chapter include pharmacology tables, evidence- based practice boxes, clinical and laboratory alerts, geriatric considerations, critical thinking exercises, case studies, genetics, and a new feature on bariatric considerations. Another new feature is exemplars related to the Quality and Safety Education for Nurses (QSEN) competencies. Addi- tions and revisions have been made based on reader feedback and current trends. SPECIAL FEATURES This edition features a full-color design with updated full- color figures to enhance reader understanding. Many new and revised learning aids appear in the sixth edition to highlight chapter content: • Evidence-Based Practice boxes identify problems in patient care, ask pertinent questions related to the problems, supply evidence addressing the questions, and offer implications for nursing practice. Most boxes provide references to system- atic reviews and meta-analyses that provide a greater synthe- sis of the research evidence related to a problem. New to this edition is the AACN’s new system for Level of Evidence: A, B, C, D, E, and M. • QSEN Exemplars present examples of quality and safety competencies in critical care. • Genetics boxes discuss disorders with a genetic compo- nent, including diabetes, Marfan syndrome, and cystic fibrosis. • Clinical Alerts highlight particular concerns, significance, and procedures in a variety of clinical settings to help students understand the potential problems encountered in that setting. • Laboratory Alerts detail both common and cutting-edge tests and procedures to alert students to the importance of laboratory results. • Geriatric Considerations alert the user to the special needs of the older patient in the critical care environment. • Bariatric Considerations provide information related to the bariatric patient because these patients often present unique challenges in the delivery of care. • Client-specific Case Studies with accompanying questions help students apply the chapter’s content to real- life situations while also testing their critical-thinking abilities. Answers for these questions and the Critical Thinking Exercises found at the end of each chapter, are included in the Lesson Plan on the companion Evolve Web site, which is free to instructors upon adoption. • Nursing Care Plans describe patient diagnoses, outcomes, nursing interventions, and rationales. • Pathophysiology Flow Charts expand analysis of the course and outcomes of particular injuries and disorders. • Pharmacology Tables reflect the most current and most commonly used critical care medications. • A new Appendix, presents the QSEN pre-licensure knowledge, skills, and attitudes.