9780838537459

A supplement for a variety of junior/senior-level courses in Critical Care or Advanced Med-Surg Nursing courses and others throughout the nursing curriculum. Written by practicing nurses in acute care, this text provides students with a basic understanding of complex patients and the ability to provide nursing care across a variety of settings by using a series of reality-based, self-paced, self-contained modules that focus on multiple system problems frequently encountered in working with high acuity patients. Using a nuts and bolts approach, it addresses essentials by using examples, analogies, and metaphors; focuses on concepts and principles that can be applied across practice settings and patient populations; and includes nursing diagnoses. The modules progress from simple to complex and contain pretests and posttests with answers, learning objectives, glossary, abbreviations, and review questions and answers.

Preface

v

About the Authors

vii

Contributors

ix

Reviewers

xi

Acknowledgments

xiii

Part I: Special Topics

1

(104)

Caring for the Critically III Patient: Patient, Family, and Nursing Considerations

3

(26)

Acute Pain in the High-Acuity Patient

29

(22)

Fluid and Electrolyte Balance in the High-Acuity Patient

51

(24)

Organ Transplantation

75

(30)

Part II: Respiration And Ventilation

105

(116)

Respiratory Process

107

(36)

Arterial Blood Gas Analysis

143

(22)

Mechanical Ventilation

165

(40)

Nursing Care of the Patient with Altered Respiratory Function

205

(16)

Part III: Cellular Oxygenation

221

(54)

Oxygenation

223

(14)

Shock States

237

(16)

Multiple Organ Dysfunction Syndrome

253

(12)

Nursing Care of the Patient with Impaired Oxygenation

265

(10)

Part IV: Perfusion

275

(108)

Determinants of Cardiac Output

277

(12)

Hemodynamic Monitoring

289

(32)

Acute Cardiac Dysfunction and Electrocardiographic Monitoring

321

(48)

Nursing Care of the Patient with Altered Tissue Perfusion

369

(14)

Part V: Neurologic

383

(136)

Consciousness

385

(32)

Acute Cerebral Dysfunction

417

(58)

Nursing Care of the Patient with Altered Cerebral Function

475

(8)

Spinal Cord Injury

483

(30)

Nursing Care of the Patient with Spinal Cord Injury

513

(6)

Part VI: Metabolic

519

(162)

Metabolic Responses

521

(28)

Acute Hematologic Dysfunction

549

(30)

Altered Immune Function

579

(38)

Altered Glucose Metabolism

617

(28)

Acute Renal Dysfunction

645

(26)

Nursing Care of the Patient with Altered Metabolic Function

671

(10)

Part VII: Gastrointestinal

681

(98)

Acute Gastrointestinal Dysfunction

683

(34)

Acute Hepatic Dysfunction

717

(28)

Acute Pancreatic Dysfunction

745

(22)

Nursing Care of the Patient with Altered Gastrointestinal Function

767

(12)

Part VIII: Injury

779

(100)

Complex Wound Management

781

(24)

Acute Burn Injury

805

(26)

Trauma Assessment and Resuscitation

831

(34)

Nursing Care of the Patient with Multiple Injuries

865

(14)

Part IX: Life Span: Special Needs

879

(126)

Nursing Care of the Acutely III Pediatric Patient

881

(40)

Nursing Care of the Acutely III Obstetric Patient

921

(58)

Nursing Care of the Acutely III Elderly Patient

979

(26)

Index

1005

What is included with this book?

The New copy of this book will include any supplemental materials advertised. Please check the title of the book to determine if it should include any access cards, study guides, lab manuals, CDs, etc.

The Used, Rental and eBook copies of this book are not guaranteed to include any supplemental materials. Typically, only the book itself is included. This is true even if the title states it includes any access cards, study guides, lab manuals, CDs, etc.

PREFACE When the first edition ofHigh-Acuity Nursingwas published in 1992, the termhigh acuitywas largely confined to leveling patient acuity for determining hospital staffing needs rather than being applied to nursing education. Our choice of titles was unusual and perhaps a little risky since nursing programs were using medical-surgical nursing texts or sometimes critical care nursing texts for teaching complex care concepts. Today, there is a growing trend to offer a high-acuity nursing course as part of the required undergraduate nursing curriculum. This, we believe, reflects the changing nature of the acute care patient population and the need to adequately prepare new nurses (and retool experienced nurses) to meet these rapidly changing needs. The termhigh acuityrefers to a level of patient problems beyond uncomplicated acute illness on a health-illness continuum. Today, high-acuity patients are increasingly found outside of critical care units or even acute care institutions. The patient population is older and sicker upon entering the health care system, and hospitalized patients are being discharged earlier, often in a poorer state of health. In the home health setting, nurses are providing care to clients with mechanical ventilators, central intravenous lines, IV antibiotic therapy, and complicated injuries. Whereas critical care units are considered specialty areas within the hospital walls, much of the knowledge required to work within that specialty is generalist in nature. It is this generalist knowledge base that is needed by all nurses who work with patients experiencing complex care problems to assure competent and safe nursing practice. Purpose of the Text TheHigh-Acuity Nursingtext delivers information using learner-focused, active learning principles, and concise language and format. The format breaks down complex information into small, understandable chunks for easier understanding. Self-testing is provided throughout the text, using Pretests, short section quizzes, and Posttests. All answers are provided to give learners immediate feedback on their command of section content before proceeding to the next module section. The self-study modules in this book focus on the relationship between pathophysiology and the nursing process with the following goals in mind: Revisit and translate critical pathophysiologic concepts pertaining to the high-acuity patient in a clinically applicable manner Examine the interrelationships among physiologic concepts Enhance clinical decision-making skills Free class time to focus on clinical application Hold learners accountable for their own learning Provide immediate feedback to the learner regarding assimilation of concepts and principles Provide self-paced learning Ultimately, the goal for the learner is to be able to approach patient care conceptually, so that care is given with a strong underlying understanding of its rationale. This book is appropriate for use in multiple educational settings, for example, nursing students, novice nurses, novice critical care nurses, and community health/home health nurse. It is also a review book for the experienced nurse wanting to update knowledge in high-acuity nursing for continuing education purposes. Hospital staff development departments will find it useful as supplemental or required reading for nursing staff high-acuity or critical care classes. It has also been used for teaching basic pathophysiology, and as a review book for the NCLEX exam. Organization of the Text The book consists of nine parts: Special Topics, Respiration and Ventilation, Cellular Oxygenation, Perfusion, Neurologic, Metabolic, Gastrointestinal, Injury, and Life Span: Special Needs. For continuity, the modules in Parts I through VIII are written in a consistent manner, using a single concep

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High Acuity Nursing

High Acuity Nursing

0838537456

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