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AACN Essentials of Critical Care Nursing

ISBN: 9780071447713 | 0071447717
Edition: 1st
Format: Paperback
Publisher: McGraw-Hill Professional
Pub. Date: 7/29/2005

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SummaryTable of ContentsAuthor Biography
Covering basic to advanced critical care concepts, this easy-to-use, evidence-based resource provides essential foundation for the nursing care of critically-ill patients. It is the ideal reference for nurses beginning their critical care experience as well as experienced nurses who may use the book as a user-friendly resource for both essential and advanced concepts. ECG rhythm interpretation and treatment and pharmacology also make it an excellent resource for progressive care nurses.
With an emphasis on evidence... MORE
Contributorsxv
Reviewersxvii
Prefacexix
Section I. The Essentials
1(212)
As... MORE
3(14)
Mary Fran Tracy
Assessment Framework
3(1)
Prearrival Assessment
4(1)
Admission Quick Check
4(1)
Comprehensive Admission Assessment
4(1)
Ongoing Assessment
4(1)
Prearrival Assessment: Before the Action Begins
4(1)
Admission Quick Check Assessment: The First Few Minutes
5(2)
Airway and Breathing
6(1)
Circulation and Cerebral Perfusion
6(1)
Chief Complaint
6(1)
Drugs and Diagnostic Tests
6(1)
Equipment
7(1)
Comprehensive Admission Assessment
7(7)
Past Medical History
8(1)
Social History
8(1)
Physical Assessment by Body System
9(3)
Psychosocial Assessment
12(2)
Ongoing Assessment
14(3)
Planning Care for Critically Ill Patients and Families
17(20)
Mary Fran Tracy
Multidisciplinary Plan of Care and Critical Pathways
17(1)
Prevention of Common Complications
18(8)
Physiologic Instability
18(1)
Deep Venous Thrombosis
18(5)
Hospital-Acquired Infections
23(1)
Skin Breakdown
24(1)
Sleep Pattern Disturbances
24(1)
Psychosocial Impact
25(1)
Patient and Family Education
26(2)
Assessment of Learning Readiness
26(1)
Strategies to Address Patient and Family Education
27(1)
Outcome Measurement
27(1)
Family-Focused Care
28(1)
Transporting the Critically Ill Patient
29(3)
Assessment of Risk for Complications
29(1)
Level of Care Required During Transport
30(1)
Preparation
31(1)
Transport
31(1)
Interfacility Transfers
32(1)
Transitioning to the Next Stage of Care
32(1)
Supporting Patients and Families During the Dying Process
33(4)
Interpretation and Management of Basic Cardiac Rhythms
37(28)
Carol Jacobson
Basic Electrophysiology
37(1)
ECG Waveforms, Complexes, and Intervals
38(1)
P Wave
38(1)
QRS Complex
38(1)
T and U Waves
38(1)
ST Segment
38(1)
PR Interval
38(1)
QT Interval
39(1)
Cardiac Monitoring
39(3)
Determination of the Heart Rate
42(1)
Determination of the Cardiac Rhythm
42(1)
Common Arrhythmias
43(1)
Rhythms Originating in the Sinus Node
43(2)
Sinus Bradycardia
44(1)
Sinus Tachycardia
44(1)
Sinus Arrhythmia
45(1)
Sinus Arrest
45(1)
Arrhythmias Originating in the Atria
45(4)
Premature Atrial Complexes
46(1)
Wandering Atrial Pacemaker
46(1)
Atrial Tachycardia
47(1)
Atrial Flutter
47(1)
Atrial Fibrillation
48(1)
Arrhythmias Originating in the Atrioventricular Junction
49(1)
Premature Junctional Complexes
50(1)
Junctional Rhythm, Accelerated Junctional Rhythm and Junctional Tachycardia
50(1)
Arrhythmias Originating in the Ventricles
50(4)
Premature Ventricular Complexes
51(1)
Ventricular Rhythm and Accelerated Ventricular Rhythm
51(1)
Ventricular Tachycardia
52(1)
Ventricular Fibrillation
53(1)
Ventricular Asystole
53(1)
Atrioventricular Blocks
54(3)
First-Degree Atrioventricular Block
54(1)
Second-Degree Atrioventricular Block
54(2)
High-Grade Atrioventricular Block
56(1)
Third-Degree Atrioventricular Block (Complete Block)
56(1)
Temporary Pacing
57(3)
Indications
57(1)
Transvenous Pacing
57(1)
Epicardial Pacing
57(1)
Components of a Pacing System
57(1)
Basics of Pacemaker Operation
58(2)
ECG Characteristics of Paced Rhythms
60(1)
Initiating Transvenous Ventricular Pacing
60(1)
Initiating Epicardial Pacing
60(1)
External (Transcutaneous) Pacemakers
60(1)
Defibrillation and Cardioversion
60(5)
Defibrillation
60(1)
Automatic External Defibrillators
61(1)
Cardioversion
62(3)
Hemodynamic Monitoring
65(46)
Leanna R. Miller
Hemodynamic Parameters
65(7)
Cardiac Output
65(2)
Components of Cardiac Output/Cardiac Index
67(1)
Stroke Volume and Stroke Volume Index
68(1)
Factors Affecting Stroke Volume/Stroke Volume Index
68(4)
Basic Components of Hemodynamic Monitoring Systems
72(2)
Pulmonary Artery Catheter
72(1)
Arterial Catheter
72(1)
Pressure Tubing
72(1)
Pressure Transducer
73(1)
Pressure Amplifier
74(1)
Pressure Bag and Flush Device
74(1)
Alarms
74(1)
Obtaining Accurate Hemodynamic Values
74(3)
Zeroing the Transducer
74(1)
Leveling the Transducer to the Catheter Tip
75(2)
Calibration of the Transducer/Amplifier System
77(1)
Ensuring Accurate Waveform Transmission
77(1)
Insertion and Removal of Catheters
77(7)
Pulmonary Artery Catheters
77(3)
Arterial Catheters
80(4)
Obtaining and Interpreting Hemodynamic Waveforms
84(13)
Patient Positioning
84(1)
Interpretation
84(7)
Artifacts in Hemodynamic Waveforms: Respiratory Influence
91(1)
Cardiac Output
92(5)
Continuous Mixed Venous Oxygen Monitoring
97(2)
Svo2 Monitoring Principles
97(1)
Selected Examples of Clinical Applications
98(1)
Right Ventricular Ejection Fraction Catheters
99(1)
Monitoring Principles
99(1)
Troubleshooting
99(1)
Minimally Invasive Hemodynamic Monitoring
100(2)
Thoracic Bioimpedance
100(1)
Esophageal Doppler Cardiac Output
100(1)
Carbon Dioxide Rebreathing
100(1)
Gastric Tonometry
100(1)
Sublingual Capnometry
101(1)
Application of Hemodynamic Parameters
102(9)
Low Cardiac Output States
102(4)
High Cardiac Output States
106(5)
Airway and Ventilatory Management
111(34)
Robert E. St. John
Respiratory Assessment Techniques, Diagnostic Tests, and Monitoring Systems
111(7)
Arterial Blood Gas Monitoring
111(1)
Analysis
112(4)
Venous Blood Gas Monitoring
116(1)
Pulse Oximetry
116(2)
Assessing Pulmonary Function
118(1)
Airway Management
118(7)
Oropharyngeal Airway
118(2)
Nasopharyngeal Airway
120(1)
Artificial Airways
120(5)
Oxygen Therapy
125(4)
Complications
125(2)
Oxygen Delivery
127(2)
Basic Ventilatory Management
129(16)
Indications
129(1)
General Principles
129(3)
Modes
132(3)
Complications
135(1)
Weaning From Short-Term Mechanical Ventilation
136(2)
Troubleshooting Ventilators
138(1)
Communication
139(2)
Principles of Management
141(4)
Pain, Sedation, and Neuromuscular Blockade Management
145(20)
Joan Michiko Ching
Suzanne M. Burns
Physiologic Mechanisms of Pain
145(2)
Peripheral Mechanisms
145(2)
Spinal Cord Integration
147(1)
Central Processing
147(1)
Responses to Pain
147(1)
Pain Assessment
148(1)
A Multilevel Approach to Pain Management
148(1)
Nonsteroidal Anti-Inflammatory Drugs
149(1)
Side Effects
150(1)
Opioids
150(3)
Side Effects
150(1)
Intravenous Opioids
151(1)
Patient-Controlled Analgesia
151(1)
Switching From IV to Oral Opioid Analgesia
152(1)
Epidural Analgesia
153(2)
Epidural Opioids
153(1)
Epidural Local Anesthetics
154(1)
Cutaneous Stimulation
155(1)
Distraction
155(1)
Imagery
155(1)
Relaxation and Sedation Techniques
155(1)
Deep Breathing and Progressive Relaxation
156(1)
Presence
156(1)
Special Considerations for Pain Management in the Elderly
156(1)
Assessment
157(1)
Interventions
157(1)
Sedation
157(2)
Reasons for Sedation
157(1)
Drugs for Sedation
158(1)
Goals of Sedation, Monitoring, and Management
159(1)
Sedation Scales: Goals and Monitoring
159(1)
Sedation Management
159(1)
Neuromuscular Blockade
159(6)
Neuromuscular Blocking Agents
160(1)
Monitoring and Management
161(4)
Pharmacology
165(34)
Earnest Alexander
Medication Administration Methods
165(2)
Intravenous
165(1)
Intramuscular or Subcutaneous
165(1)
Sublingual
166(1)
Intranasal
166(1)
Transdermal
166(1)
Central Nervous System Pharmacology
167(9)
Sedatives
167(3)
Analgesics
170(1)
Neuromuscular Blocking Agents
171(2)
Anticonvulsants
173(3)
Cardiovascular System Pharmacology
176(9)
Miscellaneous Agents
176(1)
Parenteral Vasodilators
177(3)
Antiarrhythmics
180(2)
Thrombolytic Agents
182(1)
Vasoconstricting Agents
183(1)
Inotropic Agents
184(1)
Activated Protein C
185(1)
Anti-Infective Pharmacology
185(2)
Aminoglycosides
185(1)
Vancomycin
186(1)
Other Antibiotics
186(1)
Pulmonary Pharmacology
187(1)
Theophylline
187(1)
Albuterol
187(1)
Gastrointestinal Pharmacology
188(2)
Stress Ulcer Prophylaxis
188(1)
Acute Peptic Ulcer Bleeding
189(1)
Variceal Hemorrhage
189(1)
Renal Pharmacology
190(1)
Diuretics
190(1)
Hematologic Pharmacology
191(2)
Anticoagulants
191(2)
Direct Thrombin Inhibitors
193(1)
Glycoprotein IIb/IIa Inhibitor
193(1)
Immunosuppressive Agents
193(2)
Cyclosporine
193(1)
Tacrolimus (FK506)
194(1)
Sirolimus (Rapamycin)
194(1)
Special Dosing Considerations
195(4)
Continuous Renal Replacement Therapy
195(1)
Drug Disposition in the Elderly
195(1)
Therapeutic Drug Monitoring
195(4)
Ethical and Legal Considerations
199(14)
Juanita Reigle
The Foundation for Ethical Decision Making
199(5)
Professional Codes and Standards
199(1)
Position Statement and Guidelines
200(1)
Institutional Policies
200(1)
Legal Standards
200(1)
Principles of Ethics
201(2)
Care
203(1)
Patient Advocacy
204(1)
The Process of Ethical Analysis
204(1)
Assessment
204(1)
Plan
204(1)
Implementation
205(1)
Evaluation
205(1)
Contemporary Ethical Issues
205(4)
Informed Consent
205(1)
Determining Capacity
205(1)
Advance Directives
206(1)
End-of-Life Issues
207(2)
Resuscitation Decisions
209(1)
Building an Ethical Environment
209(4)
Values Clarification
209(1)
Provide Information and Clarify Issues
209(1)
Recognize Moral Distress
210(1)
Engage in Collaborative Decision Making
210(3)
Section II. Pathologic Conditions
213(176)
Cardiovascular System
215(32)
Barbara Leeper
Special Assessment Techniques, Diagnostic Tests, and Monitoring Systems
215(3)
Assessment of Chest Pain
215(1)
Coronary Angiography
215(1)
Percutaneous Coronary Interventions
216(1)
Other Percutaneous Coronary Interventions
217(1)
Pathologic Conditions
218(29)
Acute Ischemic Heart Disease
218(12)
Congestive Heart Failure
230(8)
Shock
238(5)
Hypertension
243(4)
Respiratory System
247(20)
Marianne Chulay
Special Assessment Techniques, Diagnostic Tests, and Monitoring Systems
247(5)
Chest X-Rays
247(4)
Computed Tomography and Magnetic Resonance Imaging
251(1)
Chest Tubes
252(1)
Pathologic Conditions
252(15)
Acute Respiratory Failure
252(4)
Acute Respiratory Distress Syndrome
256(2)
Acute Respiratory Failure in the Patient With Chronic Obstructive Pulmonary Disease
258(2)
Pneumonia
260(3)
Pulmonary Embolism
263(4)
Multisystem Problems
267(12)
Ruth M. Kleinpell
Pathologic Conditions
267(7)
Sepsis and Multiple Organ Dysfunction Syndrome
267(7)
Overdoses
274(5)
Etiology, Risk Factors, and Pathophysiology
274(5)
Neurologic System
279(26)
Dea Mahanes
Assessment Techniques
279(8)
Level of Consciousness
279(1)
Glasgow Coma Scale
280(1)
Mental Status
281(2)
Motor Assessment
283(1)
Sensation
283(2)
Cranial Nerve Assessment and Assessment of Brainstem Function
285(1)
Vital Sign Alterations in Neurologic Dysfunction
286(1)
Death by Neurologic Criteria
287(1)
Diagnostic Testing
287(3)
Lumbar Puncture
287(1)
Computed Tomography
288(1)
Magnetic Resonance Imaging
288(1)
Cerebral Angiography
289(1)
Transcranial Doppler Ultrasound
290(1)
Electroencephalography
290(1)
Electromyography
290(1)
Intracranial Pressure: Concepts and Monitoring
290(6)
Cerebral Blood Flow
291(1)
Causes of Increased Intracranial Pressure
291(5)
Acute Ischemic Stroke
296(3)
Etiology, Risk Factors, and Pathophysiology
296(1)
Diagnostic Tests
297(2)
Hemorrhagic Stroke
299(1)
Etiology, Risk Factors, and Pathophysiology
299(1)
Clinical Presentation
300(1)
Diagnostic Tests
300(1)
Principles of Management of Intracerebral Hemorrhage
300(1)
Seizures
300(2)
Etiology, Risk Factors, and Pathophysiology
300(1)
Clinical Presentation
300(1)
Principles of Management of Seizures
301(1)
Infections of the Central Nervous System
302(1)
Meningitis
302(1)
Encephalitis
302(1)
Intracranial Abscess
302(1)
Neuromuscular Diseases
303(2)
Myasthenia Gravis
303(1)
Guillain-Barre Syndrome
303(2)
Hematology and Immunology Systems
305(12)
Diane K. Dressler
Special Assessment Techniques, Diagnostic Tests, and Monitoring Systems
305(3)
Complete Blood Count
305(1)
Red Blood Cell Count
305(1)
Hemoglobin
306(1)
Hematocrit
306(1)
Red Blood Cell Indices
306(1)
Total White Blood Cell Count
306(1)
White Blood Cell Differential
306(1)
Platelet Count
307(1)
Erythrocyte Sedimentation Rate
307(1)
Coagulation Studies
307(1)
Additional Tests and Procedures
308(1)
Pathologic Conditions
308(9)
Anemia
308(2)
Immunocompromise
310(2)
Coagulopathies
312(5)
Gastrointestinal System
317(24)
Joanne Krumberger
Carol Reese Parrish
Joe Krenitsky
Pathologic Conditions
317(15)
Acute Upper Gastrointestinal Bleeding
317(8)
Liver Failure
325(5)
Acute Pancreatitis
330(1)
Bowel Infarction/Obstruction
331(1)
Nutritional Support for Critically Ill Patients
332(9)
Nutrition Needs
332(1)
Residual Volume
333(1)
Aspiration
334(1)
Bowel Sounds
335(1)
Nausea and Vomiting
336(1)
Osmolality or Hypertonicity of Formula
336(1)
Diarrhea
337(1)
Flow Rates and Hours of Infusion
337(1)
Formula Selection
337(4)
Renal System
341(16)
Carol Hinkle
Special Assessment Techniques, Diagnostic Tests, and Monitoring Systems
341(1)
Pathologic Conditions
341(9)
Acute Renal Failure
341(5)
Life-Threatening Electrolyte Imbalances
346(4)
Renal Replacement Therapy
350(7)
Access
351(1)
Dialyzer/Hemofilters/Dialysate
352(1)
Procedures
352(1)
Indications for and Efficacy of Renal Replacement Therapy Modes
352(3)
General Renal Replacement Therapy Interventions
355(2)
Endocrine System
357(14)
Joanne Krumberger
Special Assessment Techniques, Diagnostic Tests, and Monitoring Systems
357(2)
Blood Glucose Monitoring
357(2)
Pathologic Conditions
359(12)
Hyperglycemic Emergencies
359(5)
Acute Hypoglycemia
364(1)
Syndrome of Inappropriate Antidiuretic Hormone Secretion
365(2)
Diabetes Insipidus
367(4)
Trauma
371(18)
Carol A. Rauen
Jamie B. Sinks
Specialized Assessment Techniques, Diagnostic Tests, and Monitoring Systems
371(7)
Primary and Secondary Trauma Survey Assessment
371(3)
Diagnostic Studies
374(2)
Mechanism of Injury
376(1)
Physiologic Consequences of Trauma
377(1)
Common Injuries in the Critically Ill Trauma Patient
378(4)
Thoracic Trauma
378(2)
Abdominal Trauma
380(1)
Musculoskeletal Trauma
381(1)
Complications of Traumatic Injury in Severe Multisystem Trauma
382(3)
Acute Respiratory Distress Syndrome
384(1)
Infection/Sepsis
385(1)
Systemic Inflammatory Response Syndrome
385(1)
Psychological Consequences of Trauma
385(4)
Section III. Advanced Concepts in Caring for the Critically Ill Patient
389(112)
Advanced ECG Concepts
391(40)
Carol Jacobson
The 12-Lead Electrocardiogram
391(20)
Axis Determination
396(3)
Bundle Branch Block
399(2)
Myocardial Ischemia, Injury, and Infarction
401(6)
Preexcitation Syndromes
407(4)
Advanced Arrhythmia Interpretation
411(8)
Supraventricular Tachycardias
412(3)
Differentiating Wide QRS Beats and Rhythms
415(4)
ST-Segment Monitoring
419
Measuring the ST Segment
420(1)
Choosing the Best Leads for ST-Segment Monitoring
421
Cardiac Pacemakers
418(13)
Evaluating Pacemaker Function
423(1)
VVI Pacemaker Evaluation
423(4)
DDD Pacemaker Evaluation
427(4)
Advanced Cardiovascular Concepts
431(32)
Barbara Leeper
Pathologic Conditions
431(32)
Cardiomyopathy
431(5)
Valvular Disease
436(5)
Pericarditis
441(2)
Aortic Aneurysm
443(3)
Cardiac Transplantation
446(6)
Intra-Aortic Balloon Pump Therapy
452(3)
Ventricular Assist Devices
455(8)
Advanced Respiratory Concepts
463(14)
Suzanne M. Burns
Advanced Modes of Mechanical Ventilation
463(7)
New Concepts: Mechanical Ventilation
463(1)
Volume Versus Pressure Ventilator
464(5)
Alternative Ventilator Options
469(1)
Weaning Patients From Long-Term Mechanical Ventilation
470(7)
Wean Assessment
470(1)
Wean Planning
471(1)
Weaning Trials, Modes, and Methods
471(1)
Respiratory Fatigue, Rest, and Conditioning
471(1)
Wean Trial Protocols
472(1)
Other Protocols for Use
473(1)
Critical Pathways
473(1)
Systematic Institutional Initiatives for the Management of the LTMV Patient Population
473(4)
Advanced Neurologic Concepts
477(24)
Dea Mahanes
Subarachnoid Hemorrhage
477(4)
Etiology, Risk Factors, and Pathophysiology
477(1)
Clinical Presentation
477(2)
Diagnostic Tests
479(2)
Traumatic Brain Injury
481(6)
Etiology, Risk Factors, and Pathophysiology
481(4)
Clinical Presentation
485(1)
Diagnostic Tests
485(2)
Traumatic Spinal Cord Injury
487(7)
Etiology, Risk Factors, and Pathophysiology
487(2)
Clinical Presentation
489(1)
Diagnostic Tests
490(1)
Future Spinal Cord Injury Treatment
490(4)
Brain Tumors
494(7)
Etiology, Risk Factors, and Pathophysiology
494(1)
Diagnostic Tests
495(2)
Advanced Technology: Brain Tissue Oxygen Monitoring
497(4)
Section IV. Key Reference Information
501(60)
Normal Values Table
503(2)
Marianne Chulay
Pharmacology Tables
505(14)
Earnest Alexander
Advanced Cardiac Life Support Algorithms
519(10)
Marianne Chulay
Guidelines for the Transfer of Critically Ill Patients
529(4)
Marianne Chulay
Transfers Within the Hospital
529(1)
Transport Personnel
529(1)
Transport Equipment Requirements
529(1)
Monitoring During Transfer
529(1)
Pretransfer Coordination and Communication
529(1)
Transfers Between Hospitals
530(3)
Transport Personnel
530(1)
Transport Medication Requirements
530(1)
Transfer Equipment
530(1)
Monitoring During Transfer
531(1)
Transfer Algorithm
532(1)
Hemodynamic Monitoring Troubleshooting Guide
533(6)
Leanna R. Miller
Ventilatory Troubleshooting Guide
539(12)
Robert E. St. John
Suzanne M. Burns
Cardiac Rhythms, ECG Characteristics, and Treatment Guide
551(10)
Carol Jacobson
Index561

Marianne Chulay RN DNSc FAAN is a Consultant, Clinical Research and Critical Care Nursing in Chapel Hill, NC, USA

Suzanne M. Burns, RN, MSN, RRT, ACNP, CCRN, FAAN, FCCM is Professor of Nursing, Acute and Specialty Care at the University of Virginia, Charlottesville, VA, USA

The American Association of Critical-Care Nurses is the world's largest specialty nursing organization, representing more than 400,000 acute and critical care nurses and serving more than 100,000 members, certificants and nurse constituents. Web site: www.aacn.org

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