Understanding the essentials of critical care nursing

640 Pages·2018·11.771 MB·English

by  MacLeod, Carrie Edgerly, Perrin, Kathleen Ouimet

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Third Edition
Understanding the Essentials of
CRITICAL CARE
NURSING
Kathleen Ouimet Perrin • Carrie Edgerly MacLeod
Understanding the
Essentials of Critical
Care Nursing
Third Edition
Kathleen Ouimet Perrin, PhD, RN, CCRN
Carrie Edgerly MacLeod PhD, APRN-BC
330 Hudson Street, NY, NY 10013
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Library of Congress Cataloging-in-Publication Data
Names: Perrin, Kathleen Ouimet, author. | MacLeod, Carrie Edgerly, author.
Title: Understanding the essentials of critical care nursing/Kathleen
Ouimet Perrin, PhD, RN, CCRN, Carrie Edgerly MacLeod PhD, APRN-BC.
Description: Third edition. | Boston : Pearson, [2018] | Includes
bibliographical references and index.
Identifiers: LCCN 2017001647| ISBN 9780134146348 | ISBN 0134146344
Subjects: LCSH: Intensive care nursing.
Classification: LCC RT120.I5 P47 2018 | DDC 616.02/8—dc23 LC record available
at https://lccn.loc.gov/2017001647
10 9 8 7 6 5 4 3 2 1
ISBN 10: 0-13-414634-4
ISBN 13: 978-0-13-414634-8
Brief Contents
1 What is Critical Care? 1 11 Care of the Patient with a Cerebral
or Cerebrovascular Disorder 274
2 Care of the Critically Ill Patient 23
12 Care of the Critically Ill Patient
3 Care of the Patient with Respiratory Experiencing Alcohol Withdrawal
Failure 51 and/or Liver Failure 302
4 Interpretation and Management 13 Care of the Patient with an
of Basic Dysrhythmias 81 Acute Gastrointestinal Bleed or
Pancreatitis 350
5 Cardiodynamics and Hemodynamic
Regulation 118 14 Care of the Patient with Problems
in Glucose Metabolism 383
6 Care of the Patient with
Acute Coronary Syndrome 137 15 Care of the Patient with Acute
Kidney Injury 410
7 Care of the Patient Experiencing
Heart Failure 169 16 Care of the Organ Donor and
Transplant Recipient 435
8 Care of the Patient Experiencing
Shock 188 17 Care of the Acutely Ill Burn Patient 465
9 Care of the Patient Following 18 Care of the Patient with Sepsis 501
a Traumatic Injury 208
19 Caring for the ICU Patient
10 Care of the Patient Experiencing at the End of Life 525
an Intracranial Dysfunction 237
iii
About the Authors
KATHLEEN OuIMET PERRIN, PhD, RN, CCRN, is pro- CARRIE EDgERLy MACLEOD PhD, APRN-BC cur-
fessor emerita and adjunct professor of nursing at Saint rently works as an assistant professor at Saint Anselm Col-
Anselm College in Manchester, New Hampshire, where she lege in Manchester, New Hampshire where she teaches
has taught critical care nursing, professional nursing, ethics, critical care nursing. She also works as a nurse practitioner
health assessment and understanding suffering. While in Cardiac Surgery in Massachusetts. She has worked in
teaching at the college, she received the AAUP award for critical care settings at major teaching institutions in New
Excellence in Teaching. She received her bachelor’s degree Hampshire and New York. She received her bachelor’s
from the University of Massachusetts, Amherst, her mas- degree from Saint Anselm College and both her master’s
ter’s degree from Boston College, and her PhD from Union degree and PhD from the William F. Connell School of
Institute and University in Cincinnati, Ohio. She has been a Nursing, Boston College. She has served as a faculty mem-
practicing critical care nurse for more than 40 years, and has ber at both at Saint Anselm and Boston College where she
been a member of the American Association of Critical Care taught pharmacology, pathophysiology, and critical care
(AACN) Nurses for nearly as long. Kathleen has served on nursing. She has published in the areas of patients’ and
the board of the Southern New Hampshire AACN and is a family caregivers’ experiences after cardiac surgery. Dr.
past president of the chapter. She has been on numerous MacLeod has lectured on management of the critically ill
review panels for the national AACN. She was a member of client at many symposiums across the United States. She
the board of directors and President of the Epsilon Tau chap- has received both academic and clinical awards for her
ter of Sigma Theta Tau International. She has published and contributions to critical care nursing and client care.
presented in the areas of critical care nursing, nursing ethics,
nursing history, suffering experienced by patients and
health care providers, and conflict among members of the
health care team. She has written two other nursing texts:
Nursing Concepts: Ethics and Conflict, and Palliative Care Nurs-
ing: Caring for Suffering Patients, which won an AJN Book of
the Year Award in 2011.
iv
Dedication
This book is dedicated to my husband, Robin. He I would like to dedicate this book to my husband, David,
insisted that I should write the first edition of this and my daughters, Annie and Kate. Like most things in my
book, and he has continued to support me as I life, I could not have taken this journey without the three of
developed each subsequent edition. you and the support you give me every day. I also want to
It is also dedicated to critical care nurses, specifically thank Kathleen Perrin for her guidance and mentoring
to those critical care nurses whom I have seen develop over these many years. She inspired me as my professor
from novice nurses into expert clinicians. It has been an and continues to do so as my friend. I would not be the
absolute joy to watch former students as they evolved from nurse I am today if not for her. Lastly, I would like also to
fledgling nurses into expert practitioners, capable of caring dedicate this book to my parents, James and Jean Edgerly,
for the very sickest of patients, educating future nurses, who are the reasons I became a nurse. Every time a nurse
and advancing the profession of nursing. One of the most helps to save a life, I think of them. I am so proud of our
fulfilling experiences in my life has been watching my for- profession and what we do as nurses each and every day.
mer students and seeing them develop into nurses far bet-
—Carrie Edgerly MacLeod PhD, APRN-BC
ter than I could ever hope to be. I hope this book will serve
as a foundation for nurses in the future as they make that
transition.
—Kathleen Ouimet Perrin PhD, RN, CCRN
v
Thank You
Our heartfelt thanks go out to our colleagues from the benefit of your collective experience as nurses and
schools of nursing across the country who have teachers, and we have made many improvements due
given their time generously to help us create to your efforts. Among those who contributed to this
this exciting new edition of our book. We have reaped edition are:
Textbook Contributors Ernest Grant PhD, RN
University of North Carolina at Greensboro
Allanah M. Bachman, MSN, ACNP, GNP Greensboro, North Carolina
Department of Cardiac Surgery North Shore Medical
Shirley Jackson, MS, RN, CCRN
Center
Critical Care Nurse Specialist
Salem, Massachusetts
Elliot Hospital
Sue Barnard MS, APRN, CCRN Manchester, New Hampshire
Trauma/Stroke Program Coordinator
June Kasper, MS RN
Saint Joseph Hospital
Clinical Educator, Endoscopy
Nashua, New Hampshire
Lahey Clinical Medical Center
Michele Bettinelli, BS, RN, CCRN Burlington, Massachusetts
Lahey Hospital and Medical Center
Mary Kazanowski PhD, APRN, ACHPN
Burlington, Massachusetts
APRN, Palliative Care Team,
Destiny Brady, MSN, RN, CCRN Elliot Hospital
Clinical Instructor Manchester, New Hampshire
Critical Care Nursing
Erin McDonough, DNP, AGACNP-BC
Saint Anselm College
Lead Critical Care Nurse Practitioner
Manchester, New Hampshire
Catholic Medical Center
Tricia Charise MS, ACNP Manchester, New Hampshire
Boston Medical Center, Department of Trauma Surgery
Betsy Swinny, MSN, RN, CCRN
Boston, Massachusetts
Faculty III & Critical Care Educator
Linda Edelman, PhD, BSN, RN Baptist Health System, School of Health Professions
Assistant Professor San Antonio, Texas
University of Utah College of Nursing
Salt Lake City, Utah
Reviewers
Katrina Allen-Thomas, RN, MSN, CCRN Predrag Miskin, DrHS, MScN, RN, PHN
Faulkner State Community College Samuel Merritt University
Bay Minette, Alabama San Mateo, California
Marylee Bressie, DNP, RN, CCNS, CCRN, CEN Bridget Nichols, RN, BAN, MSN, CCRN
Capella University University of South Dakota
Minneapolis, Minnesota Sioux Falls, South Dakota
Annie Grant, RN, BSN, MSN, CNS Jill Price, PhD, MSN, RN
Florence–Darlington Technical College Chamberlain College of Nursing
Florence, South Carolina Kapaa, Hawaii
Laura Logan, MSN, RN, CCRN
Stephen F. Austin State University
Nacogdoches, Texas
vi
Preface
This book is an introduction to critical care. It focuses Organization and Key
on elements that are essential for the novice critical
care nurse to understand—whether the novice is a Themes of This Book
student or a new graduate. When critical care nursing was
The topics for these chapters were chosen after reviewing
introduced as a specialty more than 50 years ago, the focus
suggestions for foundational critical care content from a
of care was on patient observation and prevention of
variety of nursing organizations, including the American
complications of the disease or treatment. Over the past
Association of Critical Care Nurses and the National Coun-
50 years, critical care has become curative care. Now, most
cil of State Boards of Nursing. The first chapter addresses
patients have favorable outcomes, surviving to return
what is unique about critical care and critical care nursing,
home following complex treatments that often include life
including legal and ethical issues nurses encounter. The
support. However, patient survival and well-being do not
second chapter focuses on the needs and concerns that are
just depend on the development of new and ever more
common to critically ill patients or their families, and it
complex treatments. Rather, the presence of well-edu-
explores ways nurses might meet those needs. The remain-
cated, expert nurses has been shown to have a significant
ing chapters describe the essentials of providing care to
impact on patient outcomes. This book focuses on the
patients with disorders that are commonly seen in critical
essentials for beginning critical care nurses so that they
care settings. There is no attempt to cover all possible con-
may deliver the safe, effective care that optimizes patients’
tent. Rather, the text concentrates on problems that the new
outcomes.
critical care nurse is most likely to encounter. Because
We are fortunate that critical care practice has
many patients die in critical care units, or shortly after
changed from the early years when health care providers
being transferred out of critical care units, the final chapter
learned as they went along, experimented with new
discusses care of the dying patient.
interventions on their patients, and often relied on intu-
A recurrent theme in this book is safe practice. As criti-
ition to choose those interventions. Intuition could not be
cal care has become more complex, the potential for error
trusted as a basis for practice, and the experiences pro-
has increased. Chapter 1 includes a discussion of some of
vided too small a sample to draw inferences. Whenever
the reasons why errors are common in critical care units.
possible, this book relies on evidence-based recommen-
Fortunately, there are documented ways in which nurses
dations for collaborative and nursing practice. It cites
can prevent or limit health care errors. One of the most
individual research studies, but more often cites meta-
effective ways to prevent errors is to improve communica-
analyses and evidence-based practice recommendations
tion and collaboration among members of the health care
made by respected professional organizations. When the
team, as described in Chapter 1. In each subsequent chap-
foundation for practice is based on evidence, it is far
ter, a Safety Initiative feature describes specific recommen-
more likely to be safe and effective.
dations by the Institute for Health Care Improvement and
Since the last edition of the text in 2013, much has
other national groups that, when implemented, can limit
changed in the provision of care to critically ill patients.
errors and enhance patient safety.
Evidence supports significant changes in the provision of
As we have gained expertise in critical care, we have
sedation and pain medication as well as the management
learned that not all adult patients with a particular diagnosis
of ventilation, heart failure, stroke, blood or volume resus-
are the same. Specifically, we have begun to realize that older
citation in trauma, palliative care and sepsis. All of these
and overweight adults have unique needs. With the increas-
new recommendations for practice are incorporated in the
ing numbers of people in these cohorts, knowledge of how to
third edition of this text.
care for them must be part of the foundation of critical care
Critical care nursing is an evolving specialty. Under-
practice. We have included information on gerontological
standing the Essentials of Critical Care Nursing is intended to
and bariatric patients as separate gerontologic Consider-
provide novice critical care nurses with a firm foundation
ations and Bariatric Considerations in each chapter.
so that they are able to understand the complexities of care,
In this text, Nursing Actions are a component of
deliver safe, effective care, and begin their transition to
Collaborative Management. The content in the Nursing
expert critical care nurses.
vii
viii Preface
Action sections emphasizes nursing interventions required panion Website, offering learners the opportunity to
for safe, effective medical and surgical management of the extend the textbook learning and submit responses to
patient—for example, what are the nursing actions when their instructors.
administering amiodarone, or what nursing assessments Critical Thinking Questions are also Located at the
are essential after a patient has a cardiac catheterization. In end of the chapter; these are designed to help students
contrast, the Nursing Care sections highlight interventions develop a deeper understanding of the content and explore
that focus on providing care to a patient and creating a relationships among concepts discussed in the section.
healing environment. Nursing Care sections focus on pro- Essentials identify evidence based practices, commu-
moting patient comfort, providing adequate nutrition, and nication strategies, safety measures, or system based prac-
assisting the patient and family to cope with the critical ill- tices that the novice nurse must know to practice safely.
ness or impending death. The areas chosen to be highlighted as essentials are derived
Nursing management of critical care patients includes from the Robert Wood Johnson Nurse of the Future initia-
using some of the latest technology developed for the tive. The goal of this feature is very similar to the overall
health field. Building Technology Skills text sections goal of QSEN (Quality and Safety Education for Nurses),
focus on specific technology that the nurse is most likely to which is “to meet the challenge of preparing future and
encounter when caring for patients experiencing the condi- new nurses who will have the knowledge, skills and atti-
tions discussed in the chapter, and the related skills tudes necessary to continuously improve the quality and
required to use that technology. safety of the healthcare system within which they work.”
A critically ill patient is a dynamic system of interre- Reflect On is a feature that promotes reflection and
lated factors. In order to help visual learners understand journaling on some of the difficult issues that nurses
the relationships between and among these factors, each encounter in their practice. This feature was added to the
chapter includes a least one Visual Map to illustrate the second edition because reflection on the difficult issues and
relationships among the disease states, collaborative inter- times in personal practice has been shown to facilitate a
ventions, and outcomes. novice nurse’s progression to expert nurse.
Commonly used Medications, those that are most In addition to the features that were retained from pre-
often prescribed for the conditions addressed in the chap- vious editions, a new feature added to this third edition.
ter are highlighted in these boxes. For each medication, Why/Why not? This feature asks students to critically
information is provided on dosing information, desired analyze WHY they should be implementing a specific col-
effects, nursing responsibilities, and potential side effects. laborative management strategy or nursing action for a
Safety is an essential focus in critical care settings. patient and why it might NOT be appropriate to imple-
Safety Initiative boxes highlight specific issues related to ment the strategy or action for that particular patient. The
the content in each chapter. Included are the purpose, the Why/Why not feature addresses questions concerning
rationale, and highlighted recommendations. medications, therapies, diagnostic testing, patient and fam-
In each chapter, a Case Study of a real-life patient ily interactions, collaborative communication, and more.
scenario illustrates the chapter content and provides an The feature can be used for in class discussion or individ-
example of collaborative and nursing management. Crit- ual student journaling concerning the most appropriate
ical thinking questions allow the reader to solve the collaborative management or nursing care to provide to
posed problems. The case studies continue on the Com- critically ill patients in complex situations.
Acknowledgments
We appreciate the energy, time, and thought that We could not have completed this task without the
the authors of all the chapters put into this edi- assistance and advice of our editors at Pearson who have
tion, giving up weekends and holidays, and remained with us from the previous editions. From the
persisting despite personal and family difficulties. They time Pamela Fuller developed the idea of this book, she has
brought their expertise in critical care nursing to each of been incredibly supportive. Barbara Price has been our
their chapters and their knowledge is one of the founda- constant e-mail companion, keeping us on track, helping
tions of this book. us understand the process of electronic publication, and
We appreciate the hard work of the reviewers who easing all the chapter authors through the rough spots.
made certain that all of our content was absolutely accu-
Kathleen Ouimet Perrin Ph. D., RN, CCRN
rate and up to date. We also benefitted from suggestions
Carrie Edgerly MacLeod PhD, APRN-BC
from our students who used the previous editions of this
book. Their thoughtful comments were the basis for revi-
sions in this edition.
ix