Critical Care Nursing

Name: Critical Care Nursing
Price: 8299 ISK
Availability: InStock
Author: Linda D. Urden, Kathleen M. Stacy, Mary E. Lough, Kimberly Sanchez
ISBN: 9780443118197

Höfundar: Linda D. Urden, Kathleen M. Stacy, Mary E. Lough, Kimberly Sanchez (Útgáfa: 10)

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**American Journal of Nursing (AJN) Book of the Year Awards, 2nd Place in Critical Care–Emergency Nursing, 2025****Selected for 2025 Doody’s Core Titles® in Critical Care**Winner of a Silver American Journal of Nursing Book of the Year award for its 9th edition!Prepare for the challenges of today’s progressive and critical care nursing environments! Critical Care Nursing: Diagnosis and Management, 10th Edition is a comprehensive guide to critical care nursing concepts as they apply to clinical assessment, diagnostic procedures, and therapeutic management.

Using a logical, body systems organization, this award-winning text uses an evidence-based approach to address the care of patients with critical physiological alterations. This new edition features an emphasis on diversity, equity, and inclusion to reflect the 2021 AACN Essentials and the 2020-2030 Future of Nursing Report. It also features new disorder summary figures, Social Determinants of Health boxes, Supporting the Well-Being of Nurses boxes, Informatics boxes, and expanded resources for the Next-Generation NCLEX® Examination.

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Útgefandi: Elsevier Health Sciences (US)

ISBN: 9780443118197

Print ISBN: 9780443115813

Format: ePub

Útgáfa: 10

Höfundar: Linda D. Urden, Kathleen M. Stacy, Mary E. Lough, Kimberly Sanchez

Tungumál: English

Útgefið: 2025-02-21

Prent takmörkun á líftíma: 10

Prent takmörkun: 1000

Afritunar takmörkun: 1000

Kaflar

Title of Book
Cover image
Title page
Table of Contents
Copyright
Dedication
About the Authors
Contributors
Preface
Organization
Special Features
New to This Edition
Acknowledgments
Unit I. Foundations of Critical Care Nursing
1. Critical Care Nursing Practice
History of Critical Care
Contemporary Critical Care
Critical Care Nursing Roles
Expanded-Role Nursing Positions
Advanced Practice Nurses
Social Determinants of Health (SDOH)
SDOH Domains
Disparities Among People
Inequities Among People5,6
SDOH Goal
Critical Care Professional Accountability
Critical Care Professional Organizations
Society of Critical Care Medicine (SCCM)
American Association of Critical Care Nurses (AACN)
Evidence-Based Nursing Practice
Factors Driving EBP
Tools to Assist Nurses With Adoption of Scientific Evidence
Diagnosis and Patient Care Management
Holistic Critical Care Nursing
Caring
Patient-Centered Care
Cultural Care
Complementary and Alternative Therapies
Mindfulness
Massage
Animal-Assisted Intervention
Music Therapy
Technology in Critical Care
New Technologies and Products
Tele-ICU
Interprofessional Collaborative Practice
Interprofessional Collaborative Practice
Rapid Response Teams (RRTs)
Interdisciplinary Care Management Models and Tools
Care Management
Case Management
Care Management Tools
Algorithm
Practice Guideline
Order Set
Managing and Tracking Outcome Variances
Quality, Safety, and Regulatory Issues in Critical Care
Quality and Safety Issues
Quality and Safety Regulations
Quality and Safety Resources
Challenges Facing Nurses
Compassion Fatigue
Monitor Alert and Alarm Fatigue
Incivility
Bullying
Workplace Violence (WPV)
Risk Factors for Client-on-Worker Violence
Supporting Health and Equity of the Nation
Supporting the Well-Being of Nurses
Healthy Work Environment (HWE)
Key Points
2. Ethical and Legal Issues
Ethical Issues
Morals Versus Ethics
Morals, Ethics, and Ethical Problems
Nurses, Moral Distress, and Moral Courage
Virtues
Principles of Health Care Ethics
Ethical Principles
Conflicting Principles, Paternalism, and Medical Futility
Professional Nursing Ethics and the Nursing Code of Ethics
Situational and Organizational Ethical Decision Making in Critical Care
The Nurse’s Role in Addressing Discrimination: Protecting and Promoting Inclusive Strategies
Frameworks for Resolving Ethical Problems
Strategies for the Promotion of Ethical Decision Making
Institutional Ethicists, Ethics Committees, and Ethics Consultation Services
Ethics Rounds and Conferences
Legal Issues
Administrative Law: Professional Regulation
Boards of Nursing and Nurse Practice Acts
Functions of Boards of Nursing
Scope of Practice
Standards of Practice
Nursing Practice Act
Nursing Standards of Care
Tort Law: Negligence and Professional Malpractice, Intentional Torts
Tort Law
Ordinary Negligence
Professional Malpractice
Duty
Breach
Harm Caused by the Breach
Damages
Professional Malpractice and the Nursing Process
Assessment Failure: Failure to Assess and Analyze the Level of Care Needed by the Patient
Assessment Failure: Failure to Assess and Clarify the Patient’s Condition
Planning Failure: Failure to Appropriately Diagnose
Implementation Failure: Failure to Communicate Patient Findings in a Timely Manner
Implementation Failure: Failure to Take Appropriate Action
Implementation Failure: Failure to Document
Implementation Failure: Failure to Preserve Patient Privacy
Evaluation Failure: Failure to Act as a Patient Advocate
Wrongful Death
Negligent Informed Consent
Assault and Battery
Constitutional Law: Patient Decision Making
U.S. Constitutional Right for Self-Determination (14th Amendment)
Patients with Decision-Making Capacity
Patients Without Decision-Making Capacity
Never and Not Yet Competent Patients
Previously Competent Patients
Advance Directives
Futile (or Nonbeneficial) Treatment and Orders Not to Resuscitate
Brain Death
Legal Issues Looking Forward
Key Points
3. Genetic Issues
Genetics and Genomics
Genetic and Genomic Structure and Function
Chromosomes
DNA and the Double Helix
DNA Replication
DNA Alphabet
Transcription
Translation
Telomeres
Genetic Variation
Mutation
Single Nucleotide Polymorphisms
Alleles
Genetic Inheritance
Chromosome Disorders
Single-Gene Disorders
Complex Gene and Gene-Environment Disorders
Mitochondrial Disorders
Genotype and Phenotype
Copy Number Variation
Genetic History and Family Pedigree
Homozygous Versus Heterozygous
Modes of Inheritance
Autosomal Dominant Inheritance
Autosomal Recessive Inheritance
Sex-Linked Inheritance
Obtaining Genetics and Genomics Information
Genetic Epidemiology and Phenotypes
Family-Based Genetic Studies
Genetic Association Studies
Case-Control Studies
Candidate Gene Studies
Genome-Wide Association Studies
Genome Mapping Projects
Human Genome Project
ENCODE Project
Exome Sequencing Project
Human Proteome Project
Human Microbiome Project
Genetic Diversity
Diversity, Haplotype Blocks, and Linkage Disequilibrium
Genetics in Critical Care
Thrombosis Genetics
Factor V Leiden and Thrombosis
Prothrombin Gene Mutation and Thrombosis
Cancer Genetics
The Cancer Genome Atlas
Cardiovascular Genetics
Long QT Syndrome
Familial Inherited Cardiomyopathies
Hypertrophic Cardiomyopathy
Dilated Cardiomyopathy
Arrhythmogenic Right Ventricular Cardiomyopathy
Pharmacogenetics
Cytochrome P450 and Medication Metabolism
Warfarin
Malignant Hyperthermia
Gene Editing—Crispr-Cas9 Technology
Sickle Cell Disease CRISPR Gene Editing
Genetics, Genomics, and Nursing
Ethical and Legal Issues in Genetics and Genomics
Direct-to-Consumer Tests
Genetic Information Nondiscrimination Act
Human Genetics Key Terms
Key Points
4. Facilitating Care Transitions
Care Transitions
Core Components to Any Care Transition
Management of Complex Health Issues and Medications
Medication Reconciliation
Patient and Family Education
Timing of Education
Education Strategies and Evaluation
Patient- and Family-Centered Education
Health Care Team Member Accountability
Handoff
Continuity of Care
Coordination of Physical Transport
Special Considerations During Care Transitions
Changes in Baseline Physical and Cognitive Function
Older Adults
Racial and Ethnic Disparities
Rural Communities
End of Life
Models or Programs for Care Transitions
Additional Resources
Key Points
5. Psychosocial and Spiritual Considerations
Stressors in Critical Care
Coping With Stress and Illness
Coping Mechanisms
Promoting Optimal Coping
Anxiety
Alterations in Self-Concept
Body Image Disturbance
Low Self-Esteem
Disturbed Personal Identity
Compromised Dignity
Enhancing Dignity
Powerlessness
Supporting Self-Control in Powerlessness in Critically Ill Patients
Spiritual Responses
Spiritual Distress
Hopelessness
Providing Support
Providing Holistic Care
Psychosocial Support
Caring Communication
Promoting Trust
Communicating With Compassion
Complementary and Alternative Therapies
Environmental Support
Family-Centered Care
Visitation Policies
Comorbid Psychiatric Disorders
Major Depressive Disorder
Posttraumatic Stress Disorder
Post–Intensive Care Syndrome
Prevention and Management of PICS
Key Points
6. Nutrition Alterations and Management
Nutrient Metabolism
Focused Assessment of Nutrition Status
Diet and Pertinent Health History
Clinical Signs and Physical Manifestations
Anthropometric Measurements
Laboratory Studies
Evaluating Nutrition Assessment Findings
Determining Nutrition Needs
Malnutrition
Etiology-Based Approach in Defining Malnutrition
Phenotypic and Etiologic Based Approach in Defining Malnutrition
Protein-Calorie Malnutrition
Metabolic Response to Starvation and Stress
Gluconeogenesis
Hypermetabolism
Oral Intake
Swallow Evaluation for Oral Intake
Screening Protocols
Instrumental Assessments
Oral Supplementation
Enteral and Parenteral Nutrition Support
Enteral Nutrition
Enteral Feeding Access
Location and Type of Feeding Tube
Assessment and Prevention of Feeding Tube Complications
Formula Delivery
Evaluating Enteral Nutritional Intake
Preventing Tubing and Catheter Misconnections
Parenteral Nutrition
Types of Parenteral Nutrition
Nursing Management of Potential Complications
Monitoring and Evaluation of Nutrition Support
Refeeding Syndrome
Nutritional Considerations for Alterations in Body Systems
Nutrition and Cardiovascular Alterations
Myocardial Infarction
Heart Failure
Cardiac Cachexia
Nutrition and Pulmonary Alterations
Prevent or Correct Undernutrition and Underweight
Avoid Overfeeding
Prevent Fluid Volume Excess
Nutrition and Neurologic Alterations
Oral Feedings
Tube Feedings
Prevention of Overweight and Obesity
Nutrition and Kidney Alterations
Protein
Fluid
Energy (Calories)
Other Nutrients
Nutrition and Gastrointestinal Alterations
Hepatic Failure
Pancreatitis
Nutrition and Endocrine Alterations
Nutrition Support and Blood Glucose Control
Severe Vomiting or Diarrhea in Patients With Type 1 Diabetes Mellitus
Nutrition Education in Diabetes
Nutrition and Surgery
Preoperative Nutrition Optimization
Preoperative Nutrition Preparation
Postoperative Nutrition Interventions
Evolution of Nutrition Science
Additional Resources
Key Points
Nutrient Metabolism
Focused Assessment of Nutrition Status
Malnutrition
Oral Intake
Enteral and Nutritional Nutrition Support
Refeeding Syndrome
Nutritional Considerations for Alterations in Body Systems
7. Pain and Pain Management
Pain
Definition and Description of Pain
Components of Pain
Types of Pain
Acute Pain
Chronic Pain
Nociceptive Pain
Neuropathic Pain
Nociplastic Pain
Physiology of Pain
Nociception
Transduction
Transmission
Perception
Modulation
Biologic Stress Response
Short-Term Direct Response
Midterm Indirect Response
Long-Term Indirect Response
Communication Framework for Pain Assessment
Pain Assessment
Personal Component of Pain Assessment
P: Provocative and Palliative or Aggravating Factors
Q: Quality
R: Region or Location, Radiation
S: Severity and Other Symptoms
T: Timing
U: Understanding
V: Values
Observable or Objective Component of Pain Assessment
Behavioral Pain Scale
Critical-Care Pain Observation Tool
Use of Cut-off Scores
Limitations Related to the Use of Behavioral Pain Scales
Physiologic Indicators
Challenges to Pain Assessment and Management
Communication
Altered Level of Consciousness and Unconsciousness
Older Adult Patients
Delirious Patients
Cultural Influences
Opioid-Related Tolerance and Physical Dependence
Opioid-Related Iatrogenic Withdrawal Syndrome
Opioid Use Disorder and Opioid Misuse
Health Organization Responsibilities in Pain Management
Pain Management
Pharmacologic Management of Pain
Opioid Analgesics
Morphine
Fentanyl
Hydromorphone
Meperidine
Codeine
Methadone
Remifentanil
Sufentanil
Preventing and Treating Opioid-Induced Respiratory Depression
Monitoring Opioid Analgesia
Opioid Reversal
Nonopioid Analgesics
Sedative With Analgesic Properties: Dexmedetomidine
Acetaminophen
Nonsteroidal Antiinflammatory Drugs
Ketorolac
Ketamine
Lidocaine
Anticonvulsants
Antidepressants
Delivery Methods
Patient-Controlled Analgesia
Intraspinal Pain Control
Intrathecal Analgesia
Epidural Analgesia
Equianalgesia
Nonpharmacologic Pain Management
Physical Techniques
Massage
Ice Therapy
Cognitive-Behavioral Techniques
Deep Breathing and Relaxation
Music
Bundle Interventions
Additional Resources
Key Points
8. Sedation, Agitation, and Delirium Management
Sedation
Sedation and Agitation Assessment Scales
Pain Assessment Scales
Levels of Sedation
Pharmacologic Management of Sedation
Benzodiazepines
Sedative-Hypnotic Agents—Propofol
Central Alpha Agonists—Dexmedetomidine
Daily Sedation Interruption
Agitation
Delirium
Pharmacologic Management of Delirium
Interventions to Prevent Delirium
Post–Intensive Care Unit Syndrome
Patient Diaries
Alcohol Withdrawal Syndrome and Delirium Tremens
Alcohol Use Screening Tools
Pharmacologic Management of Alcohol Withdrawal
Collaborative Management
Additional Resources
Key Points
9. Palliative and End-of-Life Care
End-of-Life Challenges
Language
Barriers
Values
Information
Evidence
End-of-Life Experience in Critical Care
Advance Directives
Physician Orders for Life-Sustaining Treatment
Advance Care Planning
Ethical and Legal Issues
Comfort Care
Goals
Cardiopulmonary Resuscitation
Effect of Do-Not-Resuscitate Orders
Prognostication and Prognostic Tools
Decision Making
Communication
Simple and Realistic Terms
Education for Professionals
Patients
Families
Strategies to Support Shared Decision Making
Daily Rounds
Family Meetings
Cultural and Spiritual Influences
Hospice Information
Withdrawal or Withholding of Treatment
Proactive Approach
Futility/Nonbeneficial Care Discussions
Steps Toward Comfort Care
Palliative Care
Symptom Management
Pain
Dyspnea
Nausea and Vomiting
Fever and Infection
Edema
Anxiety
Delirium
Metabolic Derangement
Near-Death Awareness
Withdrawal of Mechanical Ventilation
Creation of a Support Environment
Process of Withdrawing Life Support
Signs of Impending Death
Sedation During Withdrawal of Life Support
Ventilator Settings
Terminal Weaning Versus Extubation
Professional Issues
Health Care Settings
Emotional Support for the Nurse
Organ Donation
Legal Issues
Brain Death
Family Care
Waiting for Good News
Families in Crisis
Family Presence During Cardiopulmonary Resuscitation
Visiting Hours
After Death
Collaborative Care
Additional Resources
Key Points
Unit II. Cardiovascular Alterations
10. Cardiovascular Anatomy and Physiology
Anatomy
Major Structures of the Heart
Size, Weight, and Layers of the Heart
Pericardium
Pericardial Cavity and Fluid
Epicardium
Myocardium
Endocardium
Cardiac Chambers
Right Atrium
Left Atrium
Left Ventricle
Right Ventricle
Cardiac Valves
Mitral and Tricuspid Atrioventricular Valves
Papillary Muscles and Chordae Tendineae
Aortic and Pulmonic Valves
Conduction System
Sinoatrial Node
Atrioventricular Node
Bundle of His, Bundle Branches, and Purkinje Fibers
Coronary Blood Supply
Right Coronary Artery
Left Coronary Artery
Collateral Circulation
Coronary Veins
Thebesian Vessels
Major Blood Vessels
Aorta
Pulmonary Artery
Pulmonary Veins
Systemic Circulation
Arteries
Blood Flow and Blood Pressure
Microcirculation
Veins
Microscopic Cellular Structures
Cardiac Muscle Fibers
Cardiac Cells
Physiology
Electrical Activity of the Heart
Transmembrane Potentials
Resting Membrane Potential
Phases of the Action Potential
Phase 0
Phase 1
Phase 2
Phase 3
Phase 4
Cardiac Myocyte Conduction and Excitability
Absolute and Relative Refractory Periods
Mechanical Myocardial Action
Excitation-Contraction Coupling
Cardiac Cycle
Atrial Systole
Isovolumic Contraction
Ventricular Systole
Isovolumic Relaxation
Ventricular Diastole
Interplay of Heart and Blood Vessels: Cardiac Output
Preload
Afterload
Contractility
Heart Rate
Autonomic Nervous System Control
Baroreceptors
Chemoreceptors
Right Atrial Receptors
Natriuretic Peptides
Renin-Angiotensin-Aldosterone System
Respiratory Influences on Heart Rate
Control of Peripheral Systemic Circulation
Intrinsic Control of the Systemic Circulation
Extrinsic Control of the Systemic Circulation
Key Points
11. Cardiovascular Clinical Assessment
History
Evaluating Chest Pain
Physical examination
Inspection
Face
Nail Beds and Cyanosis
Thorax
Abdomen
Lower Extremities
Posture
Weight
Mentation
Jugular Veins
Abdominojugular Reflux
Thoracic Reference Points
Apical Impulse
Palpation
Arterial Pulses
Carotid Pulses
Brachial, Ulnar, and Radial Pulses
Femoral Pulses
Popliteal Pulses
Dorsalis Pedis and Posterior Tibial Pulses
Descending Aorta Pulse
Capillary Refill
Edema
Auscultation
Blood Pressure Measurement
Noninvasive Blood Pressure Monitoring
Orthostatic Hypotension
Blood Pressure Cuff Size
Korotkoff Sounds
Auscultatory Gap
Pulse Pressure
Pulsus Paradoxus
Pulsus Alternans
Vascular Bruits
Normal Heart Sounds
First and Second Heart Sounds
Physiologic Splitting of S1 and S2
Pathologic Splitting of S1 and S2
Abnormal Heart Sounds
Third and Fourth Heart Sounds
Heart Murmurs
Mitral Stenosis Murmur
Mitral Regurgitation Murmur
Aortic Stenosis Murmur
Aortic Insufficiency Murmur
Innocent Murmurs
Murmurs Associated With Myocardial Infarction
Papillary Muscle Rupture Murmur
Ventricular Septal Rupture Murmur
Pericardial Friction Rub
Key Points
12. Cardiovascular Diagnostic Procedures
Hemodynamic Monitoring
Hemodynamic Monitoring Equipment
Heparin
Calibration of Hemodynamic Monitoring Equipment
Zeroing the Transducer
Midaxillary Line
Levelling the Transducer
Patient Position During Hemodynamic Monitoring
Head of Bed Backrest Position
Lateral Position
Intraarterial Blood Pressure Monitoring
Indications
Catheters
Insertion and Allen Test
Nursing Management
Infection
Perfusion Pressure
Pulse Pressure
Noninvasive Cuff Blood Pressure
Arterial Pressure Waveform Interpretation
Decreased Arterial Perfusion
Pulse Deficit
Pulsus Paradoxus
Pulsus Alternans
Overdamped Waveform
Underdamped Waveform
Fast-Flush Square Waveform Test
Hemodynamic Monitoring Alarms
Invasive Hemodynamic Monitoring
Central Venous Pressure Monitoring
Central Venous Catheter Lumen Options
Specialized Central Venous Catheters
Site Selection
Internal Jugular Vein
Subclavian Vein
Femoral Vein
Insertion of a Central Venous Catheter
Complications
Air Embolus
Thrombus Formation
Infection
Nursing Management
Central Venous Pressure—Volume Assessment
Passive Leg Raise
Removal of a CVC
Patient Position
Central Venous Pressure Waveform
Cannon Waves
Pulmonary Artery Pressure Monitoring
Cardiac Output Determinants
Oxygen Supply and Demand
Preload
Clinical Estimation of Preload
Frank-Starling Law of the Heart
Ejection Fraction
Preload and Ventricular Dysfunction
Pulmonary Artery Diastolic Pressure and Pulmonary Artery Occlusion Pressure Relationship
Pulmonary Hypertension and PAD-PAOP
Valvular Heart Disease and PAD-PAOP
Mitral Regurgitation and PAD-PAOP
Afterload
Systemic Vascular Resistance
Systemic Vascular Resistance and Afterload Reduction
Pulmonary Vascular Resistance
Contractility
Optimizing Contractility
Pulmonary Artery Catheters
Right Atrial Lumen
Pulmonary Artery Lumen
Balloon Lumen
Thermistor Lumen
Additional PA Catheter Features
Insertion of the Pulmonary Artery Catheter
Pulmonary Artery Waveform Interpretation
Right Atrial Waveform
Right Ventricular Waveform
Pulmonary Artery Waveform
Pulmonary Artery Occlusion Waveform (Wedge)
Medical Management
Nursing Management
Patient Position
Respiratory Variation
Positive End-Expiratory Pressure and PAOP (Wedge)
Avoiding Complications With PA Catheters
Pulmonary Artery Catheter Removal
Cardiac Output Measurement With a Pulmonary Artery Catheter
Thermodilution Cardiac Output Bolus Measurement
Cardiac Output Curve
Injectate Temperature
Patient Position and Cardiac Output
Clinical Conditions That Alter Cardiac Output
Continuous Thermodilution Cardiac Output Measurement
Calculated Hemodynamic Profiles Using a Pulmonary Artery Catheter
Continuous Monitoring of Mixed Venous Oxygen Saturation and Central Venous Oxygen Saturation
SvO2 Catheter
ScvO2 Catheter
SvO2 or ScvO2 Calibration
Nursing Management
Normal SvO2 Values
Normal ScvO2 Values
SvO2 or ScvO2 and Arterial Oxygen Saturation
SvO2 or ScvO2 and Cardiac Output
SvO2 or ScvO2 and Hemoglobin
SvO2 or ScvO2 and Oxygen Consumption
Normal SvO2 or ScvO2
Low SvO2 or ScvO2
High SvO2
Less-Invasive Hemodynamic Monitoring
Arterial Waveform–Based Hemodynamic Monitoring Systems
Noninvasive—Finger Cuff Hemodynamic Monitoring Systems
Minimally Invasive—Pulse Wave Analysis Hemodynamic Monitoring Systems
Invasive—Transpulmonary Thermodilution Monitoring Systems
Visual Hemodynamic Monitoring Systens
Transesophageal Echocardiography
Ultrasound-Based Hemodynamic Monitoring
Doppler-Based Hemodynamic Monitoring Methods
Electrocardiography
Basic Principles of Electrocardiography
Phase 0
Phases 1 and 2
Phase 3
Phase 4
Electrocardiogram Leads
12-Lead Electrocardiogram Leads
Standard Limb Leads
Augmented Vector Leads
Precordial Leads
Right Ventricular Precordial Leads
Posterior Wall Leads
Baseline Distortion
Electrocardiogram Analysis
Specialized Electrocardiogram Paper
Calibration
ECG Waveforms
P Wave
QRS Complex
T Wave
Intervals Between Waveforms
PR Interval
QRS Duration
ST Segment
QT Interval
QRS Axis
Calculating the QRS Axis
Cardiac Monitor Lead Analysis
Lead II
Lead V1
Electrocardiogram Lead Selection for Optimal Bedside Monitoring
Continuous Dysrhythmia Monitoring
Continuous ST Segment Monitoring
Atrial Enlargement
Ventricular Hypertrophy
Myocardial Ischemia and Infarction
Electrocardiogram Changes Indicating Ischemia and Infarction
Infarct Location by 12-Lead Electrocardiogram
Infarction Progression on Electrocardiogram
Intraventricular Conduction Defects
Right and Left Bundle Branch Blocks
Right Bundle Branch Block
Left Bundle Branch Block
Hemiblocks
Bifascicular Block
Dysrhythmia Interpretation
Heart Rate Determination
Rhythm Determination
P Wave Evaluation
PR Interval Evaluation
QRS Complex Evaluation
QT Interval Evaluation
Sinus Rhythms
Normal Sinus Rhythm
Sinus Bradycardia
Sinus Tachycardia
Sinus Dysrhythmia
Atrial Dysrhythmias
Premature Atrial Contractions
Supraventricular Tachycardia
Supraventricular Tachycardia With Aberrant Conduction
Paroxysmal Supraventricular Tachycardia
Focal Atrial Tachycardia
Multifocal Atrial Tachycardia
Atrial Flutter
Pathogenesis of Atrial Flutter
Atrial and Ventricular Rates in Atrial Flutter
Atrial Flutter Management
Atrial Fibrillation
Pathogenesis of Atrial Fibrillation
Atrial Fibrillation Risk Factors
Atrial Fibrillation Management
Atrial Fibrillation Rhythm Control
Surgical Procedures to Manage Atrial Fibrillation
Catheter Procedures to Manage Atrial Fibrillation
Atrial Fibrillation Rate Control
Stroke Risk Assessment and Antithrombotic Therapy in Atrial Fibrillation
CHADS2
CHA2DS2-VASc
Junctional Dysrhythmias
Premature Junctional Contraction
Junctional Escape Rhythm
Junctional Tachycardia and Accelerated Junctional Rhythm
Ventricular Dysrhythmias
Premature Ventricular Contraction
Compensatory Pause
Describing Ventricular Ectopy
Premature Ventricular Complex Timing
Causes of Premature Ventricular Contractions
Premature Ventricular Complex Management
Idioventricular Rhythms
Ventricular Tachycardia
Ventricular Fibrillation
Differential Diagnosis of Wide QRS Complex Tachycardia
Significance of Wide QRS Complex Tachycardia
Clinical Differentiation of VT from SVT
Atrioventricular Blocks
First-Degree Atrioventricular Block
Second-Degree Atrioventricular Block
Mobitz Type I
Mobitz Type II
2:1 Conduction
Third-Degree Atrioventricular Block
Management of Atrioventricular Block
Laboratory Tests
Electrolytes
Potassium
Hyperkalemia
Hypokalemia
Calcium
Hypercalcemia
Hypocalcemia
Magnesium
Hypermagnesemia
Hypomagnesemia
Cardiac Biomarker Studies
Cardiac Biomarkers in Acute Coronary Syndrome
Troponin T and Troponin I
Natriuretic Peptide Biomarkers in Heart Failure
B-Type Natriuretic Peptide
N-Terminal Fragment of Pro-B-Type Natriuretic Peptide
Hematologic Studies
Red Blood Cells
White Blood Cells
Platelets
Blood Coagulation Studies
Prothrombin Time
International Normalized Ratio
Activated Partial Thromboplastin Time
Activated Clotting Time
Anti-Factor Xa Assay
Serum Lipid Studies
Total Cholesterol
Low-Density Lipoproteins
Very-Low-Density Lipoproteins and Triglycerides
High-Density Lipoproteins
Triglycerides
Cardiac Diagnostic Procedures
Cardiac Catheterization and Coronary Arteriography
Left-Heart Catheterization
Right-Heart Catheterization
Cardiac Catheterization Procedure
Nursing Management
Access Site Care
Peripheral Pulses
Rehydration
Angina
Dysrhythmias
Patient and Family Education
Electrophysiology Study
EPS Procedure
Atrial Measurements
Ventricular Measurements
Implantable Cardioverter Defibrillator
Chest Radiography for the Cardiovascular System
Tissue Densities on Radiography
Standard Views
Portable Chest Radiography
Nursing Interventions to Produce an Optimal Chest Radiograph
Chest Radiograph Indications
Chest Radiograph Analysis: Cardiac Factors
Heart Size
Pulmonary Edema
Chest Radiograph Analysis: Cardiac Lines and Tubes
Digital Radiography
Ambulatory Electrocardiography
Continuous Electrocardiogram Recording Systems
Intermittent Electrocardiogram Recording Systems
Remote Temporary ECG Monitoring Patches
Implantable Loop Recorder
Smart Watch Heart Rate and Rhythm Monitors
Stress Tests: Exercise With Electrocardiogram Monitoring
Physiology of Exercise on the Cardiovascular System
Stress Test Protocols
Heart Rate Criteria in Treadmill Stress Test
Clinical Reasons to Stop a Treadmill Test
Signal-Averaged Electrocardiogram
Echocardiography
Transthoracic Echocardiography
Transesophageal Echocardiography
Intravascular Ultrasound
Intracardiac Ultrasound
Two-Dimensional and Three-Dimensional Echocardiograms
Two-Dimensional Motion-Mode Echocardiography
Phonocardiogram
Color-Flow Doppler Echocardiography
Stress Echocardiography
Pharmacologic Stress Test
Magnetic Resonance Imaging
Magnetic Resonance Imaging Physics
Metal Objects
MRI Limitations
Cardiac MRI
Cardiac Computed Tomography Angiogram
Coronary Artery Calcium Score
Cardiac Radionuclide Imaging Studies
Purpose of Radionuclide Scans
Radionuclide Isotopes
Stress Myocardial Perfusion Imaging
Exercise Stress Myocardial Perfusion Imaging Procedure
Pharmacologic Stress Myocardial Perfusion Imaging Procedure
Radionuclide Test Results
Additional Resources
Key Points
Hemodynamic Monitoring
Electrocardiography
Laboratory Tests
Diagnostic Procedures
13. Cardiovascular Disorders
Population Level Heart-Health Promotion
Coronary Artery Disease
Description and Etiology
Risk Factors
Women and Heart Disease Risk
Heart Disease and Pregnancy
Heart Disease and Menopause
Prevention of Heart Disease in Women
Mortality From Heart Disease for Women
Major Adverse Cardiac Event—Multifactorial Risk
Chronic Coronary Disease
Primary Versus Secondary Prevention of Coronary Artery Disease
Pathophysiology of Coronary Artery Disease
Vascular Inflammation
Development of Atherosclerosis
Atherosclerotic Plaque Rupture
Plaque Regression
C-Reactive Protein
Acute Coronary Syndrome
Description and Etiology
Angina
Angina Symptom Equivalents
Women and Angina
Stable Angina
Unstable Angina
Call 911
Variant Angina
Silent Ischemia
Medical Management
Nursing Management
Recognizing Myocardial Ischemia
Relieving Chest Pain
Maintaining a Calm Environment
Educating the Patient and Family
Myocardial Infarction
Description and Etiology
Pathophysiology of Acute Myocardial Infarction
Ischemia
Injury
Infarction
Q Wave Myocardial Infarction
Twelve-Lead Electrocardiogram Changes
Myocardial Infarction Location
Anterior Wall Infarction
Left Lateral Wall Infarction
Inferior Wall Infarction
Right Ventricular Infarction
Posterior Wall Infarction
Non–ST Segment Elevation Myocardial Infarction
Cardiac Biomarkers During Myocardial Infarction
Complications of Acute Myocardial Infarction
Sinus Bradycardia
Sinus Tachycardia
Atrial Dysrhythmias
Ventricular Dysrhythmias
Atrioventricular Heart Block During Myocardial Infarction
Ventricular Aneurysm After Myocardial Infarction
Ventricular Septal Rupture After Myocardial Infarction
Papillary Muscle Rupture After Myocardial Infarction
Cardiac Wall Rupture After Myocardial Infarction
Pericarditis After Myocardial Infarction
Heart Failure and Acute Myocardial Infarction
Medical Management
Recanalization of Coronary Arteries
Anticoagulation
Antiplatelet Therapy
Dysrhythmia Prevention
Prevention of Ventricular Remodeling
Nursing Management
Balance of Myocardial Oxygen Supply and Demand
Prevention of Complications
Depression After Myocardial Infarction
Educating the Patient and Family
Sudden Cardiac Death
Description
Etiology
Medical Management
Heart Failure
Description and Etiology
Pathophysiology
Assessment and Diagnosis
Left Ventricular Failure—Signs and Symptoms
Right Ventricular Failure—Signs and Symptoms
Heart Failure Stages
Left Ventricular Dysfunction—Stage C Heart Failure
Heart Failure With a Reduced Ejection Fraction
Heart Failure With a Mildly Reduced Ejection Fraction
Heart Failure With Improved Ejection Fraction
Heart Failure With a Preserved Ejection Fraction
Left Ventricular Dysfunction—Stage D Heart Failure
Neurohormonal Compensatory Mechanisms in Heart Failure
Heart Failure and Sympathetic Nervous System Activation
Heart Failure and Renin Angiotensin Aldosterone System Activation
Heart Failure and Ventricular Hypertrophy
Heart Failure and Prevention of Ventricular Remodeling
Heart Failure and Atrial Dysrhythmias
Heart Failure and Ventricular Dysrhythmias
Heart Failure and Natriuretic Peptide Biomarkers
Heart Failure and Pulmonary Complications
Heart Failure and Breathlessness
Heart Failure and Pulmonary Edema
Pharmacologic Management in Heart Failure
RAAS Inhibitor Medications
Mineralocorticoid Receptor Antagonists
Beta-Blockers
Sodium Glucose Cotransporter-2 Inhibitors
Diuretics
Medical Management
Symptom Relief
Enhancement of Cardiac Output
Heart Failure and Nonpharmacologic Interventions
Heart Failure and Palliative Care
Nursing Management
Optimizing Cardiopulmonary Function
Promoting Comfort and Emotional Support
Monitoring Effects of Pharmacologic Therapy
Nutritional Intake
Educate the Patient and Family
Cardiomyopathy
Description and Etiology
Hypertrophic Cardiomyopathy
HCM Imaging
HCM Genotype and Phenotype
HCM Symptoms
HCM Management
Dilated Cardiomyopathy
Ischemic Dilated Cardiomyopathy
Familial Genetic Dilated Cardiomyopathy
Acquired or Nonischemic Dilated Cardiomyopathy
Idiopathic Dilated Cardiomyopathy
Restrictive Cardiomyopathy
Medical Management of Cardiomyopathy
Nursing Management
Educate the Patient and Family
Pulmonary Hypertension
Pulmonary Arterial Hypertension
PAH Definition
World Health Organization Classification of Pulmonary Hypertension
WHO Functional Classification of Pulmonary Hypertension
WHO Group I—Idiopathic Pulmonary Arterial Hypertension
WHO Group I—Heritable Pulmonary Arterial Hypertension—Genetics
WHO Group I—Pulmonary Arterial Hypertension
WHO Group I—Pulmonary Venoocclusive Disease and Pulmonary Capillary Hemangiomatosis
WHO Group II—Pulmonary Hypertension Caused by Left Heart Disease
WHO Group III—Pulmonary Hypertension Due to Lung Disease and/or Hypoxia
WHO Group IV—Pulmonary Hypertension Due to Pulmonary Artery Obstructions
WHO Group V—Pulmonary Hypertension With Unclear and/or Multifactorial Mechanisms
Pathophysiology of Pulmonary Hypertension
Assessment and Diagnosis
Physical Assessment
Diagnostic Tests for PAH
Vasoreactivity Test
Exercise Tolerance Assessment
Medical Management
Pharmacologic Management of Pulmonary Hypertension
Calcium Channel Blockers
Endothelin Receptor Antagonists
Phosphodiesterase Inhibitors and Soluble Guanylate Cyclase Stimulators
Nitric Oxide
Prostacyclin Analogs and Prostacyclin Receptor Agonists
Activin Signaling Inhibitors
Diuretics
Supplemental Oxygen
Acute Decompensated Right Ventricular Failure
Nursing Management
Educate the Patient and Family
Endocarditis
Description and Etiology
Pathophysiology
Assessment and Diagnosis
Modified Duke Criteria
Blood Cultures
Chest Radiograph
Echocardiogram
Complications
Medical Management
Nursing Management
Resolving the Infection
Preventing Complications
Educate the Patient and Family
Valvular Heart Disease
Description and Etiology
Pathophysiology
Mitral Valve Stenosis
Mitral Valve Regurgitation
Aortic Valve Stenosis
Aortic Valve Regurgitation
Tricuspid Valve Stenosis
Tricuspid Valve Regurgitation
Pulmonary Valve Disease
Mixed Valvular Lesions
Medical Management
Nursing Management
Cardiac Output
Fluid Balance
Educate the Patient and Family
Acute Aortic Syndromes
Description and Etiology
Aortic Aneurysm
Aortic Aneurysm Size
Aortic Dissection
Assessment and Diagnosis
Medical Management
Nursing Management
Hypertension Management
Pain Control
Educate the Patient and Family
Peripheral Artery Disease
Description and Etiology
Pathophysiology
Assessment and Diagnosis
Ankle-Brachial Index
Intermittent Claudication
Rest Pain
Acute Occlusion
Atrophic Tissue Changes
Medical Management
Nursing Management
Arterial Pulses
Skin Integrity
Pain Control
Educate the Patient and Family
Carotid Artery Disease
Description and Etiology
Pathophysiology
Medical Management
Nursing Management
Neurologic Assessment
Educate the Patient and Family
Venous Thromboembolism
Description and Etiology
Etiology
Assessment and Diagnosis
Venous Ultrasound and d-Dimer
Diagnosis of Pulmonary Embolism
Medical Management
Prevention of Venous Thromboembolism
Management of Diagnosed Venous Thromboembolism
Anticoagulation
Nursing Management
Activity With Deep Vein Thrombosis
Risk of Pulmonary Embolism
Anticoagulation
Educate the Patient and Family
Hypertensive Emergencies
Description
Etiology
Pathophysiology
Assessment and Diagnosis
Medical Management
Hypertensive Emergencies
Hypertensive Urgencies
Nursing Management
Educate the Patient and Family
Additional Resources
Key Points
Coronary Artery Disease
Acute Coronary Syndrome
Myocardial Infarction
Cardiomyopathy
Sudden Cardiac Death
Heart Failure
Pulmonary Hypertension
Endocarditis
Valvular Heart Disease
Atherosclerosis of the Aorta
Peripheral Artery Disease
Carotid Artery Disease
Venous Thromboembolism
Hypertensive Emergency
14. Cardiovascular Therapeutic Management
Pacemakers
Therapeutic Indications for Temporary Pacing
Prevent Conduction Disturbances
Overdrive Pacing
Diagnostic Indications for Temporary Pacing
Atrial Electrograms
Pacemaker System
Pacing Pulse Generator
Pacing Lead Systems
Pacing Routes
Transcutaneous Cardiac Pacing
Epicardial Pacing
Transvenous Endocardial Pacing
Five-Letter Pacemaker Codes
Three-Letter Pacemaker Code
Physiologic Pacing Modes
Pacemaker Settings
Pacemaker Rate Control
Pacemaker Output Control
Pacemaker Sensitivity Control
Pacemaker AV Interval Control
Pacemaker Upper and Lower Rate Controls
Pacemaker Emergency Pacing
Pacemaker Safety Features
Pacing Artifacts
Pacemaker Malfunction
Pacing Malfunction—Failure to Pace
Pacing Malfunction—Loss of Capture
Sensing Malfunction—Undersensing
Sensing Malfunction—Oversensing
Medical Management
Nursing Management
Prevention of Pacemaker Malfunction
Microshock Protection
Infection Risk
Educate the Patient and Family
Permanent Pacemakers
Cardiac Implantable Electronic Devices
Leadless Pacemakers
Cardiac Resynchronization Therapy
Medical Management
Nursing Management
Implantable Cardioverter Defibrillators
Indications for ICD
Prevention of Sudden Cardiac Death
Implantable Cardioverter Defibrillator System
Implantable Cardioverter Defibrillator Leads
Transvenous Implantable Cardioverter Defibrillator Implant
Subcutaneous Implantable Cardioverter Defibrillator Implant
Medical Management
Comprehensive Diagnostic Evaluation
Programming the ICD
Avoiding Inappropriate Shocks
Nursing Management
Educate the Patient and Family
Fibrinolytic Therapy
Fibrinolytic Actions
Eligibility Criteria
Exclusion Criteria for Fibrinolytic Therapy
Fibrinolytic Agents
Streptokinase
Tissue Plasminogen Activator
Recombinant Plasminogen Activator
Tenecteplase
Outcomes of Fibrinolytic Therapy
Evidence of Reperfusion
Pain and Reperfusion Dysrhythmias
ST Segment Monitoring Leads
Cardiac Biomarkers After Fibrinolytic Therapy
Residual Coronary Artery Stenosis
Nursing Management
Monitoring for Bleeding
Prevention of Bleeding
Educate the Patient and Family
Percutaneous Coronary Interventions
Indications for Percutaneous Coronary Interventions
Percutaneous Transluminal Coronary Angioplasty
Intravascular Ultrasound
Atherectomy
Rotational Atherectomy
Orbital Atherectomy
Thrombectomy
Embolic Protection Devices
Coronary Stents
Drug-Eluting Stents
Bioresorbable Stents
Stent Thrombosis
Antiplatelet Therapy After Stent Deployment
In-Stent Restenosis
PCI Procedure
Acute Complications After PCI
Nursing Management
Monitoring for Angina
Prevention of Contrast-Induced Acute Kidney Injury
Vascular Site Care—Radial Artery
Vascular Site Care—Femoral Artery
Vascular Closure Devices—Femoral Artery
Peripheral Ischemia
Educate the Patient and Family
Percutaneous Valve Repair
Mitral Regurgitation—Transcatheter Repair
Mitral Stenosis—Balloon Valvuloplasty
Aortic Stenosis—Transcatheter Aortic Valve Implantation
Cardiac Surgery
Coronary Artery Bypass Graft Surgery
Valvular Heart Surgery
Cardiopulmonary Bypass
Off-Pump Coronary Artery Bypass Graft Surgery
Nursing Postoperative Management After Coronary Artery Bypass Graft Surgery
Cardiovascular Support
Heart Rate Optimization
Preload Optimization
Afterload Optimization
Vasodilation.
Contractility Optimization
Mechanical Complications
Temperature Regulation
Control of Bleeding
Chest Tube Patency
Cardiac Tamponade
Pulmonary Care
Neurologic Complications
Infection
Blood Glucose Control
Acute Kidney Injury
Resuscitation of Patients Who Arrest After Cardiac Surgery
Guidelines for Coronary Artery Bypass Graft Surgery
Educate the Patient and Family
Minimally Invasive Cardiac Surgery
Totally Endoscopic Coronary Artery Bypass—Robotic Assisted
Surgical Treatment of Atrial Fibrillation
Left Atrial Appendage Surgical Occlusion
Percutaneous Treatment of Atrial Fibrillation
Mechanical Circulatory Support
Intra-Aortic Balloon Pump
Counterpulsation Physiology in IABP
Intra-Aortic Balloon Insertion
Nursing Management
Timing the IABP
Complications With IABP
Weaning From the Intra-Aortic Balloon Pump
Educate the Patient and Family
Short-Term Mechanical Circulatory Support Devices
TandemHeart—Left Atria to Aorta Assist Device
Impella—Left Ventricle to Aorta Mechanical Assist Device
Right Ventricular Assist Devices
Extracorporeal Membrane Oxygenation System
ECMO Hemodynamic Support
ECMO Pulmonary Support
ECMO Safety
Long-Term Ventricular Assist Devices
Nursing Management of a Patient With a Left Ventricular Assist Device
Assist Device Failure
Anticoagulation
Infection
Educate the Patient and Family
Vascular Surgery
Carotid Endarterectomy
Symptomatic Carotid Stenosis
Asymptomatic Carotid Stenosis
Carotid Endarterectomy Indications
Carotid Endarterectomy Procedure
Postoperative Management After Carotid Endarterectomy
Neurologic Assessment
Bleeding
Cardiovascular Monitoring
Arterial Pressure Monitoring
Carotid Stents
Aortic Aneurysm and Dissection Repair
Aortic Aneurysm Assessment
Aortic Dissection Assessment
Endovascular Stents for Abdominal Aneurysm or Dissection
Surgical Procedure for Abdominal Aneurysm or Dissection
Postoperative Nursing Management After Aortic Repair
Peripheral Vascular Procedures
Peripheral Arterial Disease Symptoms
Lifestyle and Pharmacologic Management
Revascularization for Peripheral Arterial Disease
Percutaneous Interventions for Peripheral Arterial Disease
Surgical Revascularization for Peripheral Arterial Disease
Nursing Management Following Peripheral Vascular Procedures
Cardiovascular Medications
Antidysrhythmic Medications
Class I—Sodium Channel Blockers
Class II—Beta-Blockers
Class III—Potassium Channel Blockers
Class IV—Calcium Channel Blockers
Unclassified Antidysrhythmics
Antidysrhythmic Medication Side Effects
Antidysrhythmic Medications and Atrial Fibrillation
Antithrombotic Medications for Atrial Fibrillation
Inotropic Medications
Sympathomimetic Agents
Dopamine
Dobutamine
Epinephrine
Norepinephrine
Isoproterenol
Phosphodiesterase Inhibitors
Vasopressor Medications
Hormone Vasoactive Agents—Vasopressin and Angiotensin II
Vasopressin
Angiotensin II
Vasodilator Medications
Direct Smooth Muscle Relaxants
Sodium Nitroprusside
Nitroglycerin
Hydralazine
Calcium Channel Blockers to Manage Hypertension
Nicardipine
Clevidipine
Alpha-Adrenergic Blockers
Phentolamine
Labetalol
Pharmacologic Treatment of Heart Failure
Angiotensin-Converting Enzyme Inhibitors
Angiotensin-Receptor Blockers
Digoxin
Nursing Management of Vasoactive Medications
Vasopressor Titration Strategies
Titration Parameters
Vasopressor Infusions in Peripheral Catheters
Additional Resources
Key Points
Pacemakers
Implantable Cardioverter Defibrillators
Fibrinolytic Therapy
Catheter-Based Interventions for Coronary Artery Disease
Catheter-Based Interventions for Cardiac Valvular Disease
Cardiac Surgery
Mechanical Circulatory Assist Devices
Vascular Surgery
Effects of Cardiovascular Medications
Unit III. Pulmonary Alterations
15. Pulmonary Anatomy and Physiology
Anatomy
Thorax
Thoracic Cage
Lungs
Pleura
Muscles of Ventilation
Conducting Airways
Upper Airways
Trachea
Bronchial Tree
Respiratory Airways
Respiratory Bronchioles
Alveoli
Pulmonary Blood and Lymph Supply
Pulmonary Circulation
Alveolar-Capillary Membrane
Bronchial Circulation
Physiologic Shunting
Lymphatic Circulation
Physiology
Ventilation
Work of Breathing
Pulmonary Volumes and Capacities
Regulation of Ventilation
Respiration
Diffusion
Ventilation/Perfusion Relationships
Distribution of Ventilation
Distribution of Perfusion
Ventilation/Perfusion Mismatch
Gas Transport
Oxygen Content
Carbon Dioxide Content
Key Points
Anatomy
Physiology
16. Pulmonary Clinical Assessment
History
Initial Presentation
Common Symptoms
Focused Physical Assessment
Inspection
Tongue and Sublingual Area
Chest Wall Configuration
Respiratory Effort
Additional Assessment Areas
Palpation
Position of the Trachea
Thoracic Expansion
Tactile Fremitus
Percussion
Underlying Lung Structure
Diaphragmatic Excursion
Auscultation
Normal Breath Sounds
Abnormal Breath Sounds
Voice Sounds
Assessment Findings of Common Disorders
Key Points
History
Focused Physical Assessment
17. Pulmonary Diagnostic Procedures
Laboratory Studies
Arterial Blood Gases
Steps for Interpretation of Blood Gas Levels
Oxygen Saturation
Oxygen Content
Base Excess and Base Deficit
Classic Shunt Equation and Oxygen Tension Indices
PaO2/FiO2 Ratio
PaO2/PAO2 Ratio
Alveolar–Arterial Gradient
Dead Space Equation
Sputum Studies
Diagnostic Procedures
Bronchoscopy
Indications
Procedural Considerations
Complications
Thoracentesis
Indications
Procedural Considerations
Complications
Bedside Pulmonary Function Tests
Indications
Static and Dynamic Compliance
Inspiratory Muscle Strength
Spirometry
Ventilation/Perfusion Scanning
Indications
Procedure
Results
Chest Radiography
Bones
Mediastinum
Diaphragm
Pleural Space
Lung Tissue
Tubes, Wires, and Lines
Other Diagnostic Procedures
Nursing Management
Bedside Monitoring
Capnography
Basic Principles
Use in Critical Care
Types
Caution
Pulse Oximetry
Basic Principles
Limitations
Caution
Additional Resources
Key Points
Laboratory Studies
Diagnostic Procedures
Bedside Monitoring
18. Pulmonary Disorders
Acute Respiratory Failure
Description and Etiology
Etiology
Pathophysiology
Alveolar Hypoventilation
Ventilation/Perfusion Mismatching
Intrapulmonary Shunting
Tissue Hypoxia
Assessment and Diagnosis
Assessment
Diagnosis
Medical Management
Oxygenation
Ventilation
Pharmacology
Acidosis
Nutrition Support
Complications
Nursing Management
Optimize Oxygenation and Ventilation
Educate the Patient and Family
Acute Respiratory Distress Syndrome
Description and Etiology
Etiology
Pathophysiology
Exudative Phase
Proliferative Phase
Fibrotic Phase
Assessment and Diagnosis
Assessment
Diagnosis
Medical Management
Ventilation
Oxygen Therapy
Tissue Perfusion
Nursing Management
Optimize Oxygenation and Ventilation
Pneumonia
Description and Etiology
Severe Community-Acquired Pneumonia
Hospital-Acquired Pneumonia
Ventilator-Associated Pneumonia
Pathophysiology
Assessment and Diagnosis
Assessment
Diagnosis
Medical Management
Antibiotic Therapy
Independent Lung Ventilation
Nursing Management
Optimize Oxygenation and Ventilation
Prevent Spread of Infection
Aspiration Pneumonitis
Description and Etiology
Etiology
Pathophysiology
Acid Liquid Gastric Contents
Nonacid Liquid Gastric Contents
Outcome
Assessment and Diagnosis
Assessment
Diagnosis
Medical Management
Nursing Management
Optimize Oxygenation and Ventilation
Prevent Aspiration
Acute Pulmonary Embolism
Description and Etiology
Etiology
Pathophysiology
Increased Dead Space
Bronchoconstriction
Compensatory Shunting
Hemodynamic Consequences
Assessment and Diagnosis
Assessment
Diagnosis
Medical Management
Prevention of Recurrence or Extension of the Thrombus
Clot Dissolution
Reversal of Pulmonary Hypertension
Nursing Management
Optimize Oxygenation and Ventilation
Monitor for Bleeding
Educate the Patient and Family
Critical Asthma Syndrome
Description and Etiology
Etiology
Pathophysiology
Pulmonary Effects
Cardiovascular Effects
Assessment and Diagnosis
Assessment
Diagnosis
Medical Management
Bronchodilators
Systemic Corticosteroids
Oxygen Therapy
Ventilation
Nursing Management
Optimize Oxygenation and Ventilation
Educate the Patient and Family
Pneumothorax
Description and Etiology
Etiology
Pathophysiology
Assessment and Diagnosis
Assessment
Diagnostic Procedures
Medical Management
Chest Tube Placement
Chest Drainage Systems
Nursing Management
Optimize Oxygenation and Ventilation
Maintain Chest Drainage System
Long-Term Mechanical Ventilator Dependence
Description
Etiology and Pathophysiology
Medical and Nursing Management
Preweaning Stage
Weaning Process Stage
Weaning Outcome Stage
Additional Resources
Key Points
Acute Respiratory Failure
Acute Respiratory Distress Syndrome
Pneumonia
Aspiration Pneumonitis
Pulmonary Embolism
Critical Asthma Syndrome
Pneumothorax
Long-Term Mechanical Ventilation Dependence
19. Pulmonary Therapeutic Management
Oxygen Therapy
Principles of Therapy
Indications
Monitoring
Methods of Delivery
Low-Flow Systems
Reservoir Systems
High-Flow Systems
Complications of Oxygen Therapy
Oxygen Toxicity
Carbon Dioxide Retention
Absorption Atelectasis
Nursing Management
Artificial Airways
Pharyngeal Airways
Oropharyngeal Airway
Nasopharyngeal Airway
Endotracheal Tubes
Rapid Sequence Intubation
Complications
Tracheostomy Tubes
Tracheostomy Procedure
Complications
Nursing Management
Humidification
Cuff Management
Suctioning
Communication
Oral Hygiene
Extubation and Decannulation
Indications
Use of Mechanical Ventilators
Types of Ventilators
Ventilator Mechanics
Modes of Ventilation
Ventilator Settings
Complications
Ventilator-Induced Lung Injury
Cardiovascular Compromise
Patient-Ventilator Dyssynchrony
Ventilator-Associated Pneumonia
Weaning
Readiness to Wean
Weaning Trial
Nursing Management
Patient Assessment
Symptom Management
ABCDEF Bundle
Ventilator Assessment
Patient Safety
Noninvasive Ventilation
Nursing Management
Positioning Therapy
Prone Positioning
Rotation Therapy
Thoracic Surgery
Preoperative Care
Surgical Considerations
Complications and Medical Management
Acute Respiratory Failure
Bronchopleural Fistula
Hemorrhage
Cardiovascular Disturbances
Postoperative Nursing Management
Optimizing Oxygenation and Ventilation
Preventing Atelectasis
Maintaining the Chest Tube System
Assisting the Patient to Return to Adequate Activity Level
Pharmacology
Bronchodilators and Adjuncts
Neuromuscular Blocking Agents
Peripheral Nerve Stimulator
Additional Resources
Key Points
Oxygen Therapy
Artificial Airways
Invasive Mechanical Ventilation
Noninvasive Mechanical Ventilation
Positioning Therapy
Thoracic Surgery
Pharmacology
Unit IV. Neurologic Alterations
20. Neurologic Anatomy and Physiology
Divisions of the Nervous System
Anatomic Divisions
Physiologic Divisions
Microstructure of the Nervous System
Neuroglia
Neurons
Cell Body
Dendrites
Saltatory Conduction
Neuronal Function
Neuronal Channels
Action Potentials
Neurotransmitters
Channel Receptors
Synaptic Termination
Central Nervous System
Cranial Protective Mechanisms
Cranium
Meninges
Ventricular System
Cerebrospinal Fluid
Blood-Brain Barrier
Cerebrum
Function
Frontal Lobe
Parietal Lobe
Temporal Lobe
Occipital Lobe
Limbic Lobe
Internal Capsule
Function
Basal Ganglia
Function
Diencephalon
Thalamus
Hypothalamus
Cerebellum
Function
Brainstem
Midbrain
Pons
Medulla Oblongata
Reticular Formation
Arterial Circulation
Anterior Circulation
Posterior Circulation
Circle of Willis
Venous Circulation
Spinal Cord
Spinal Protective Mechanisms
Vertebral Column
Intervertebral Disks
Meninges
Vascular Supply
Peripheral Nervous System
Spinal Nerves
Spinal Roots
Gray and White Matter
Cranial Nerves
Autonomic Nervous System
Key Points
Anatomy
Physiology
21. Neurologic Clinical Assessment and Diagnostic Procedures
History
Focused Physical Assessment
Level of Consciousness
Evaluation of Arousal
Appraisal of Awareness
Glasgow Coma Scale
Full Outline of UnResponsiveness Score
Motor Function
Evaluation of Muscle Size and Tone
Estimation of Muscle Strength
Peripheral Tactile Response
Abnormal Motor Responses
Evaluation of Reflexes
Pupillary Function
Estimation of Pupil Size and Shape
Evaluation of Pupillary Reaction to Light
Assessment of Eye Movement
Respiratory Function
Observation of Respiratory Pattern
Evaluation of Airway Status
Vital Signs
Evaluation of Blood Pressure
Observation of Heart Rate and Rhythm
Rapid Neurologic Assessment
Conscious Patient
Unconscious Patient
Neurologic Changes Associated With Intracranial Hypertension
Laboratory Studies
Cerebrospinal Fluid Analysis
Contraindications
Preprocedure Preparation
Procedure
Diagnostic Procedures
Radiologic Procedures
Skull and Spine Films
Computed Tomography
Magnetic Resonance Imaging
Cerebral Angiography
Myelography
Cerebral Blood Flow and Metabolism Imaging
Perfusion Computed Tomography
Xenon Computed Tomography
Perfusion Magnetic Resonance Imaging
Carotid Ultrasonography
Emission Tomography Studies
Electrophysiology Studies
Electroencephalography
Evoked Potentials
Bedside Monitoring
Intracranial Pressure Monitoring
Types of Intracranial Pressure Monitoring Devices
Intracranial Pressure Waves
Pupillometry
Cerebral Perfusion Pressure Monitoring
Cerebral Blood Flow Monitoring
Transcranial Doppler
Transcranial Color-Coded Duplex Sonography
Thermal Diffusion Flowmetry
Laser Doppler Flowmetry
Cerebral Oxygenation and Metabolic Monitoring
Partial Brain Tissue Oxygen Pressure
Retrograde Jugular Bulb Oxygen Saturation
Near-Infrared Spectroscopy
Cerebral Microdialysis
Continuous Electroencephalography Monitoring
Additional Resources
Key Points
History
Focused Physical Assessment
Diagnostic Procedures
Laboratory Studies
Bedside Monitoring
22. Neurologic Disorders and Therapeutic Management
Stroke
Ischemic Stroke
Description and Etiology
Pathophysiology
Assessment and Diagnosis
Medical Management
Subarachnoid Hemorrhage
Description and Etiology
Pathophysiology
Assessment and Diagnosis
Medical Management
Intracerebral Hemorrhage
Description and Etiology
Pathophysiology
Assessment and Diagnosis
Medical Management
Nursing Management
Monitor for Changes in Neurologic and Hemodynamic Status
Maintain Surveillance for Complications
Educate the Patient and Family
Coma
Description and Etiology
Etiology
Pathophysiology
Assessment and Diagnosis
Assessment
Diagnosis
Medical Management
Emergent Treatment
Supportive Treatment
Nursing Management
Eye Care
Guillain-Barré Syndrome
Description and Etiology
Etiology
Pathophysiology
Assessment and Diagnosis
Assessment
Diagnosis
Medical Management
Plasmapheresis and Intravenous Immunoglobulin
Nursing Management
Maintain Surveillance for Complications
Initiate Rehabilitation
Facilitate Nutrition Support
Provide Comfort and Emotional Support
Educate the Patient and Family
Neurosurgery
Types of Surgery
Preoperative Care
Preoperative Teaching
Psychosocial Preparation
Surgical Considerations
Transcranial Approach
Transsphenoidal Approach
Positioning
Postoperative Medical Management
Intracranial Hypertension
Surgical Hemorrhage
Fluid Imbalance
Cerebrospinal Fluid Leak
Deep Vein Thrombosis
Postoperative Nursing Management
Preserve Cerebral Perfusion
Promote Arterial Oxygenation
Provide Comfort and Emotional Support
Maintain Surveillance for Complications
Initiate Early Rehabilitation
Educate the Patient and Family
Intracranial Hypertension
Pathophysiology
Volume-Pressure Curve
Cerebral Blood Flow and Autoregulation
Assessment and Diagnosis
Monitoring Devices
Medical and Nursing Management
Positioning and Other Nursing Activities
Hyperventilation
Temperature Management
Blood Pressure Management
Seizure Management
Cerebrospinal Fluid Drainage
Hyperosmolar Therapy
Management of Metabolic Demand
Herniation Syndromes
Supratentorial Herniation
Infratentorial Herniation
Pharmacologic Agents
Additional Resources
Key Points
Stroke
Ischemic Stroke
Subarachnoid Hemorrhage
Intracerebral Hemorrhage
Coma
Guillain-Barré Syndrome
Neurosurgery
Intracranial Hypertension
Unit V. Kidney Alterations
23. Kidney Anatomy and Physiology
Anatomy
Macroscopic Anatomy
Microscopic Anatomy
Vascular Anatomy
Nervous System Innervation
Physiology
Urine Formation
Glomerular Filtration
Tubular Reabsorption
Tubular Secretion
Metabolic Waste Elimination
Hemodynamic Regulation
Renin-Angiotensin-Aldosterone System
Prostaglandins
Fluid Balance
Osmolality Gradients in the Kidney Cortex and Medulla
Neural and Hormonal Signals Affecting Concentration and Dilution of Urine
Electrolyte Balance
Potassium
Sodium
Chloride
Phosphate
Calcium
Magnesium
Acid–Base Balance
Other Kidney Functions
Erythrocyte Production
Vitamin D Activation
Urinary Drainage
Effects of Aging on the Anatomy and Physiology of the Kidney
Key Points
Anatomy
Physiology
24. Kidney Clinical Assessment and Diagnostic Procedures
History
Focused Physical Assessment
Fluid Volume Status
Edema
Skin Turgor
Oral Mucosa
Relevant Cardiac Assessments
Additional Assessments
Hemodynamic Monitoring
Weight Monitoring
Intake and Output Monitoring
Laboratory Studies
Biomarkers
Blood Urea Nitrogen
Creatinine
Blood Urea Nitrogen-to-Creatinine Ratio
Cystatin C
Other Biomarkers
Glomerular Filtration Rate
Creatinine Clearance
Additional Laboratory Studies
Urine Studies
Diagnostic Procedures
Kidney Biopsy
Key Points
History
Focused Physical Assessment
Laboratory Studies
Diagnostic Procedures
25. Kidney Disorders and Therapeutic Management
Acute Kidney Injury
Description and Etiology
Pathophysiology
Assessment and Diagnosis
Medical Management
Prevention
Fluid Balance
Electrolyte Balance
Acid–Base Balance
Nursing Management
Hemodynamic Monitoring
Weight Monitoring
Intake and Output Monitoring
Educate the Patient and Family
Chronic Kidney Disease
Description and Etiology
Pathophysiology
Assessment and Diagnosis
Medical Management
Blood Pressure Management
Anemia Management
Mineral and Bone Disorder Management
Lipid Management
Glycemic Management
Nutrition Management
Nursing Management
Educate the Patient and Family
Pharmacology
Diuretics
Electrolyte Management
Phosphorus Management
Sodium Management
Renal Replacement Therapy
Continuous Renal Replacement Therapy
Access
Mechanism
Modes
Anticoagulation
Nursing Management
Intermittent Hemodialysis
Access
Mechanism
Medical Management
Nursing Management
Peritoneal Dialysis
Nursing Management
Additional Resources
Key Points
Acute Kidney Injury
Chronic Kidney Disease
Pharmacology
Renal Replacement Therapy
Unit VI. Gastrointestinal Alterations
26. Gastrointestinal Anatomy and Physiology
Anatomy
Mouth
Esophagus
Stomach
Small Intestine
Large Intestine
Accessory Organs
Pancreas
Gallbladder
Liver
Physiology
Mechanical Digestion for Propulsion and Segmentation
Mouth
Esophagus
Stomach
Small Intestine
Large Intestine
Enzymatic Digestion for Absorption
Mouth and Esophagus
Stomach
Small Intestine
Large Intestine
Effects of Aging on the Anatomy and Physiology of the Gastrointestinal System
Key Points
Anatomy
Physiology
27. Gastrointestinal Clinical Assessment and Diagnostic Procedures
History
Focused Physical Assessment
Inspection
Observation of the Oral Cavity
Assessment of the Skin Over the Abdomen
Evaluation of the Shape of the Abdomen
Auscultation
Evaluation of Bowel Sounds
Assessment of Bruits
Percussion
Palpation
Laboratory Studies
Diagnostic Procedures
Endoscopy
Esophagogastroduodenoscopy
Enteroscopy
Colonoscopy and Sigmoidoscopy
Endoscopic Retrograde Cholangiopancreatography
Plain Abdominal Radiograph
Abdominal Ultrasound
Computed Tomography of the Abdomen and Pelvis
Magnetic Resonance Imaging
Radionuclide Imaging
Angiography
Liver Biopsy
Key Points
History
Focused Physical Assessment
Laboratory Studies
Diagnostic Procedures
28. Gastrointestinal Disorders and Therapeutic Management
Acute Gastrointestinal Hemorrhage
Description and Etiology
Nonvariceal Upper Gastrointestinal Hemorrhage
Variceal Upper Gastrointestinal Hemorrhage
Pathophysiology
Assessment and Diagnosis
Laboratory Studies
Medical Management
Prevention
Hemodynamic Stability
Bleeding Control (Nonvariceal)
Bleeding Control (Variceal)
Nursing Management
Gastrointestinal Intubation
Maintain Surveillance for Complications
Educate the Patient and Family
Acute Pancreatitis
Description and Etiology
Pathophysiology
Assessment and Diagnosis
Medical Management
Fluid Resuscitation
Nutrition Support
Complications
Nursing Management
Provide Comfort and Emotional Support
Maintain Surveillance for Complications
Educate the Patient and Family
Acute Liver Failure
Description and Etiology
Pathophysiology
Assessment and Diagnosis
Laboratory Studies
Medical Management
Complications
Nursing Management
Maintain Surveillance for Complications
Educate the Patient and Family
Other Gastrointestinal Disorders
Pharmacology
Additional Resources
Key Points
Acute Gastrointestinal Hemorrhage
Acute Pancreatitis
Acute Liver Failure
Other Gastrointestinal Disorders
Pharmacology
Unit VII. Endocrine Alterations
29. Endocrine Anatomy and Physiology
Pancreas
Anatomy
Blood Supply
Exocrine Cells
Endocrine Cells
Physiology
Insulin
Blood Glucose
Glucagon
Somatostatin
Pancreatic Polypeptide
Glucose Regulatory Pathways Outside of the Pancreas
Glucose Transporters
Incretins in the Gastrointestinal System
Sodium Glucose Cotransporter 2 in the Kidneys
Pituitary Gland and Hypothalamus
Anatomy
Hypothalamus
Pituitary Stalk
Pituitary Gland
Physiology
Antidiuretic Hormone
Thyroid Gland
Anatomy
Surrounding Nerves
Blood Supply
Parathyroid Glands
Physiology
Thyroid-Stimulating Hormone
Iodine and Iodide
Thyroglobulin
Triiodothyronine and Thyroxine
Calcitonin
Hypothalamic-Pituitary-Thyroid Axis Feedback Loop
Adrenal Gland
Anatomy
Adrenal Cortex
Adrenal Medulla
Adrenal Blood Supply
Physiology
Hypothalamic-Pituitary-Adrenal Axis
Adrenal Hormones
Key Points
Pancreas
Pituitary
Thyroid
Adrenal
30. Endocrine Clinical Assessment and Diagnostic Procedures
History
Pancreas
History
Focused Physical Assessment
Hyperglycemia
Laboratory Studies
Blood Glucose
Urine Glucose
Glycated Hemoglobin
Blood Ketones
Pituitary Gland
History
Focused Physical Assessment
Hydration Status
Vital Signs
Weight Changes and Intake and Output
Laboratory Studies
Serum Antidiuretic Hormone Level
Serum and Urine Osmolality
Antidiuretic Hormone Test
Copeptin
Diagnostic Procedures
Computed Tomography
Magnetic Resonance Imaging
Thyroid Gland
History
Focused Physical Assessment
Laboratory Studies
Thyroid-Stimulating Hormone
Thyroid Tests in Critically Ill Patients
Diagnostic Procedures
Adrenal Gland
History
Focused Physical Assessment
Adrenal Cortex
Primary Aldosteronism
Adrenal Insufficiency
Adrenal Crisis
Critical Illness–Related Corticosteroid Insufficiency
Adrenal Medulla
Diagnostic Procedures
Key Points
Pancreas
Pituitary
Thyroid
Adrenal
31. Endocrine Disorders and Therapeutic Management
Acute Neuroendocrine Response to Critical Illness
Hypothalamic-Pituitary-Adrenal Axis in Critical Illness
Hyperglycemia and Hypoglycemia in Critical Illness
Physiologic Stress and Glucagon Release
Physiologic Stress and GLUT Activation
Hyperglycemia Management Challenges in Critical Illness
Clinical Guidelines for Blood Glucose Management in Critical Illness
Glucose Variability
Insulin Management in Critically Ill Patients
Frequency of Blood Glucose Monitoring
Point-of-Care Testing for Blood Glucose in Critical Illness
Continuous Insulin Infusion
Glucose Closed Loop Systems
Glycemic Instability Protocol Guidelines
Transition From Continuous Insulin Infusion to Subcutaneous Insulin
Corrective Insulin Coverage
Supplemental Corrective Insulin
Hypoglycemia Management
Nursing Management
Monitor Blood Glucose and Insulin Effectiveness
Hypoglycemia Prevention
Monitor Hyperglycemic Side Effects of Vasopressor Therapy
Provide Nutrition
Educate the Patient and Family
Collaborative Management
Diabetes Mellitus
Diabetes Mellitus Diagnosis
Fasting Plasma Glucose
Glycated Hemoglobin A1c
Type 1 Diabetes
Management of Type 1 Diabetes
Type 2 Diabetes
Insulin Resistance
Lifestyle Management for Type 2 Diabetes
Pharmacologic Management of Type 2 Diabetes
Metformin
Sodium-Glucose Cotransporter-2 Inhibitors
Glucagon-Like Peptide-1 Receptor Agonists
Dipeptidyl Peptidase-4 Receptor Inhibitors
Thiazolidinediones
Sulfonylureas
Alpha-Glucosidase Inhibitors
Insulin in Type 2 Diabetes
Polypharmacy in Diabetes
Hyperglycemic Emergencies
Diabetic Ketoacidosis
Insulin Deficiency
Hyperglycemia
Fluid Volume Deficit
Ketoacidosis
Acid–Base Balance
Focused Physical Assessment in DKA
Clinical Manifestations
Laboratory Studies
Medical Management
Reversing Dehydration
Insulin Administration
Reversing Ketoacidosis
Replenishing Electrolytes
Nursing Management
Administering Fluids, Insulin, and Electrolytes
Monitoring Response to Therapy
Transition to Subcutaneous Insulin
Surveillance for Complications
Fluid Volume Overload
Hypoglycemia
Hypokalemia and Hyperkalemia
Hyponatremia
Level of Consciousness
Skin Care
Oral Care
Infection Prevention
Educate the Patient and Family
Collaborative Management
Hyperglycemic Hyperosmolar State
Differences Between Hyperglycemic Hyperosmolar State and Diabetic Ketoacidosis
Pathophysiology of HHS
Focused Physical Assessment in HHS
Laboratory Studies in HHS
Medical Management of HHS
Rapid Rehydration
Insulin Administration
Insulin Resistance
Electrolyte Replacement
Nursing Management
Administering Fluids, Insulin, and Electrolytes
Monitoring Response to Therapy
Surveillance for Complications
Educate the Patient and Family
Collaborative Management
Pituitary Gland Disorders
Diabetes Insipidus
Etiology
Central Diabetes Insipidus—AVP Deficiency
Nephrogenic Diabetes Insipidus—AVP Resistance
Pathophysiology of AVP Deficiency and Resistance
Focused Physical Assessment in AVP Deficiency
Laboratory Studies
Serum Sodium
Serum Osmolality
Urine Osmolality
Antidiuretic Hormone Measurement
Copeptin
Medical Management
Volume Restoration
Medications
Medications Used for Central Diabetes Insipidus
Medications Used for Nephrogenic Diabetes Insipidus
Nursing Management
Administration of Fluids
Administration of Medications
Surveillance for Complications
Patient and Family Education
Collaborative Management
Syndrome of Inappropriate Antidiuresis
Etiology
Pathophysiology
Focused Physical Assessment of SIAD
Laboratory Values
Copeptin
Medical Management
Fluid Restriction
Sodium Replacement
Pharmacologic Management
Vasopressin Receptor Antagonists—Vaptans
Nursing Management
Restriction of Fluids
Educate the Patient and Family
Collaborative Management
Thyroid Gland Disorders
Thyroid Storm
Etiology
Pathophysiology
Focused Physical Assessment and Diagnosis
Laboratory Studies
Medical Management
Prevent Cardiovascular Collapse
Reduce Hyperthermia
Fluid Replacement
Pharmacologic Management of Thyroid Storm
Medications That Block Catecholamine Effect
Medications That Block Thyroid Synthesis
Medications That Block Release of Thyroid Hormone
Adrenal Insufficiency and Thyroid Storm
Nursing Management
Medication Administration
Normalize Body Temperature
Rehydration and Correction of Metabolic Derangements
Educate the Patient and Family
Collaborative Management
Myxedema Coma
Etiology
Pathophysiology
Skin
Cardiopulmonary System
Pulmonary System
Kidneys and Fluid and Electrolyte Balance
Nutrition and Elimination
Thermoregulation
Anemia
Focused Physical Assessment and Diagnosis
Clinical Presentation
Laboratory Studies
Medical Management
Pharmacologic Management of Myxedema Coma
Nursing Management
Pulmonary Care
Cardiac Concerns
Thermoregulation
Thyroid Replacement Therapy
Skin Care
Elimination
Patient and Family Education
Collaborative Management
Adrenal Gland Disorders
Oversecretion of Adrenal Hormones
Primary Cushing Syndrome
Secondary Cushing Syndrome
Primary Aldosteronism
Pheochromocytoma
Undersecretion of Adrenal Hormones
Addison Disease
Additional Resources
Key Points
Stress of Critical Illness
Pancreas: Diabetic Ketoacidosis and Hyperglycemic Hyperosmolar State
Pituitary: Diabetes Insipidus and Syndrome of Inappropriate Antidiuresis (SIAD)
Thyroid: Thyroid Storm and Myxedema Coma
Adrenal
Unit VIII. Multisystem Alterations
32. Trauma
Mechanism of Injury
Blunt Trauma
Penetrating Trauma
Phases of Trauma Care
Prehospital Care
Emergency Department
Primary Survey
Secondary Survey
Critical Care Phase
Transfer Report
Repeat Primary and Secondary Survey
Prevention of Hypoxemia
Prevention of Acidosis, Hypothermia, and Coagulopathy
Endpoints in Trauma Resuscitation
Specific Trauma Injuries
Traumatic Brain Injuries
Degree of Traumatic Brain Injury
Etiology
Pathophysiology
Assessment and Diagnosis
Medical Management
Nursing Management
Spinal Cord Injuries
Etiology
Pathophysiology
Assessment and Diagnosis
Medical Management
Nursing Management
Maxillofacial Injuries
Etiology
Pathophysiology
Assessment and Diagnosis
Medical Management
Nursing Management
Thoracic Injuries
Etiology
Chest Wall Injuries
Lung Injuries
Heart and Vascular Injuries
Abdominal Injuries
Pathophysiology
Assessment and Diagnosis
Management
Genitourinary Injuries
Pathophysiology
Assessment and Diagnosis
Diagnosis
Management
Musculoskeletal Injuries
Pelvic Fractures
Complications of Trauma
Pain
Venous Thromboembolism
Acute Compartment Syndrome
Acute Respiratory Distress Syndrome
Hypermetabolism
Nutritional Support
Acute Kidney Injury
Rhabdomyolysis and Myoglobinuria
Fat Embolism Syndrome
Transfusion-Related Acute Lung Injury
Infection
Wound Management
Sepsis
Missed Injury
Multiple Organ Dysfunction Syndrome
Special Considerations in Trauma
Intimate Partner Violence and Trauma
Alcohol and Substance Abuse and Trauma
Trauma in Pregnancy
Modification of Standard Protocols
Placental Abruption
Trauma and the Older Adult
Etiology
Limited Physiologic Reserve
Assessment and Diagnosis
Modification of Standard Protocols
Outcomes
Discharge Planning
Mass Casualty Events
Mass Shootings
Triage
Disaster Planning
Meeting Needs of Family Members and Significant Others
Family Presence During Trauma Resuscitation
Family Participation in Care
Trauma Support Groups
Additional Resources
Key Points
Phases of Trauma Care
Specific Trauma Injuries
33. Sepsis, Shock, and Multiple Organ Dysfunction Syndrome
Sepsis
Description and Etiology
Pathophysiology
Assessment and Diagnosis
Medical Management
Hour-1 Bundle: Initial Resuscitation
Treatment of the Infection
Hemodynamic Management
Maintenance of Oxygenation and Ventilation
Prevention of Complications
Shock Syndrome
Description and Etiology
Pathophysiology
Assessment and Diagnosis
Medical Management
Hemodynamic Stability
Promote Oxygenation and Ventilation
Identify and Treat Underlying Cause
Prevent Complications
Multiple Organ Dysfunction Syndrome
Description and Etiology
Pathophysiology
Assessment and Diagnosis
Medical Management
Nursing Management
Patient Care Management Plans
Prevent and Monitor for Complications
Preventing Infection
Monitoring Intake and Output
Assessing Organ Perfusion
Promote Nutrition
Provide Comfort and Emotional Support
Educate the Patient and Family
Additional Resources
Key Points
Sepsis
Shock Syndrome
Multiple Organ Dysfunction Syndrome
Nursing Management
34. Burns
Anatomy and Functions of the Skin
Epidermis
Dermis
Hypodermis
Pathophysiology and Etiology of Burn Injury
Zones of Injury
Classification of Burn Injury
Size of Injury
Depth of Burn Injury
Partial-Thickness Burns
Full-Thickness Burns
Types of Injury
Thermal Burns
Electrical Burns
Chemical Burns
Radiation Burns
Location of Injury
Patient Age and History
Child Abuse
Initial Emergency Burn Management
Airway Management
Respiratory Management
Circulatory Management
Pathophysiology of Burn Shock
Kidney Management
Gastrointestinal System Management
Extremity Pulse Assessment
Laboratory Assessment
Wound Care
Burn Center Referral
Special Management Considerations
Inhalation Injury
Nonthermal Burns
Burn Nursing Management
Resuscitation Phase
Oxygenation Alterations
Fluid Resuscitation
Tissue Perfusion
Other Considerations in the Resuscitation Phase
Acute Care Phase
Physiologic Attempts to Restore Skin Integrity
Impaired Tissue Integrity
Definitive Burn Wound Closure
Other Considerations in the Acute Phase
Rehabilitation Phase
Impaired Physical Mobility
Scar Management
Itching
Age Considerations
Interprofessional Collaborative Care
Outpatient Burn Care
Support of the Patient With Burns
Stressors of Burn Nursing
Additional Resources
Key Points
35. Organ Donation and Transplantation
Organ Donation
Role of the Critical Care Nurse in Organ Donation
Organ Procurement Organization as Part of the Health Care Team
National Donation and Transplantation Laws
Uniform Anatomical Gift Act
Uniform Determination of Death Act
National Organ Transplant Act
Omnibus Budget Reconciliation Act
Medical Examiner/Coroner State Laws
Overview of the Donation Process
Types of Referrals
Death by Neurological Criteria
Cardiac Death
Donor Evaluation
Brain Death
Clinical Examination for Brain Death
Cerebral Motor Responses
Brainstem Reflexes
Pupillary Reflexes
Oculocephalic Reflex
Oculovestibular Reflex
Corneal and Jaw Reflexes
Gag and Cough Reflexes
Apnea Testing
Confirmatory Tests
Donation After Circulatory Determination of Death
Controlled Donation After Circulatory Determination of Death
Uncontrolled Donation After Circulatory Determination of Death
Outcomes in Donation After Circulatory Death
Authorization for Donation
Donor Management
Donor Management Goals
Organ Allocation
Organ Recovery
Tissue Donation
Organ Donation Nursing Responsibility
Immunology of Transplantation
Immune System
Cells of the Immune System
Lymphocytes
B Cells: Humoral Immunity
T Cells: Cell-Mediated Immunity
Helper T Cells
Cytotoxic T Cells
Graft Rejection
Hyperacute Rejection
Acute Rejection
Chronic Rejection
Immunosuppressive Medications
Maintenance Therapy
Corticosteroids
Cyclosporine
Tacrolimus
Azathioprine
Mycophenolate Mofetil
Sirolimus
Everolimus
Belatacept
Induction Therapy
Antithymocyte Globulin
Interleukin-2 Receptor Antagonists
Alemtuzumab
Rituximab
Acute Rejection Treatment
Transplant Candidate Evaluation
Evaluation Decision
Transplant Recipient Listing
Waiting for Transplant
Pretransplant Support Groups
Financial Stress 3>
Remaining on the Transplant List
Vaccinations
Available Organ
Patient and Family Education
Heart Transplantation
Indications and Selection
Heart Transplantation Surgical Procedure
Biatrial Technique
Bicaval Technique
Postoperative Medical and Nursing Management
Early Postoperative Complications
Primary Graft Dysfunction
Secondary Graft Dysfunction
Signs and Symptoms of Rejection
Rejection Surveillance
Infection Surveillance
Patient and Family Education
Long-Term Considerations
Cardiac Graft Vasculopathy
Pregnancy After Heart Transplant
Long-Term Functional Status
Heart-Lung Transplantation
Indications and Selection
Heart-Lung Transplant Surgical Procedure
Donor Heart-Lung Procurement Surgery
Recipient Heart-Lung Transplant Surgery
Postoperative Nursing and Medical Management after Heart-Lung Transplant
Mechanical Ventilation
Fluids
Pleural Drainage
Ischemia-Reperfusion Injury
Rejection Surveillance
Infection
Immunosuppression
Patient and Family Education
Long-Term Considerations
Bronchiolitis Obliterans Syndrome
Comorbidities
Single-Lung and Double-Lung Transplantation
COVID-19 and Lung Transplant
Lung Transplantation Surgical Procedures
Single-Lung Transplant Surgical Procedure
Double-Lung Transplantation Surgical Procedure
Lung Volume Reduction Surgery
Living Donor Lobar Lung Transplantation
Postoperative Nursing and Medical Management After Lung Transplant
Patient and Family Education
Long-Term Considerations
Liver Transplantation
Indications and Selection
Recipient Liver Transplant Evaluation
Model for End-Stage Liver Disease
Waitlist Placement and MELD Score
Pediatric End-Stage Liver Disease
Pretransplantation Phase
Hepatic Encephalopathy
Nutritional Support
Portal Hypertension
Spontaneous Bacterial Peritonitis
Determining Donor Liver Suitability
Living Donor Lobe Liver Transplant
Living Donor Liver Transplantation Complications
Donor Advocate
Postoperative Care of the Living Donor
Liver Transplantation Surgical Procedure
Recipient Hepatectomy
Vascular Anastomoses With Donor Liver
Biliary Anastomosis
Bile Drains
Postoperative Nursing and Medical Management
Hemodynamic Stabilization
Electrolyte Management
Pulmonary Management
Coagulopathy Management
Neurologic Management
Pain Management
Blood Glucose Management
Kidney Function
Infection Prevention
Nutrition Management
Liver Function Tests
Liver Graft Nonfunction
Rejection Surveillance
Transfer Out of Critical Care
Patient and Family Education
Long-Term Considerations After Liver Transplant
Future Considerations for Liver Transplantation
Kidney Transplantation
Indications and Selection
Kidney Donation
Deceased Kidney Donation
Living Kidney Donation
Living Kidney Paired Donation
Kidney Transplantation Surgical Procedure
Living Donor Kidney Laparoscopic Nephrectomy
Deceased Donor Kidney Transplantation
Kidney Transplant Recipient Surgery
Postoperative Nursing and Medical Management of the Kidney Transplant Recipient
Fluid Status
Electrolytes
Postoperative Complications
Immunosuppression
Infection Risk
Preparation for Discharge Home
Patient and Family Education
Long-Term Considerations
Pancreas Transplantation
Indications and Selection
Pancreas Transplantation Surgical Procedure
Arterial and Venous Revascularization
Exocrine Drainage
Enteric Exocrine Drainage
Bladder Exocrine Drainage
Postoperative Nursing and Medical Management
Patient and Family Education
Long-Term Considerations
Additional Resources
Key Points
Organ Donation
The Immune System
Immunosuppressive Medications
Transplant Candidate Evaluation
Heart Transplantation
Lung Transplantation
Liver Transplantation
Kidney Transplantation
Pancreas Transplantation
36. Hematologic and Oncologic Emergencies
Overview of Coagulation and Fibrinolysis
Coagulation Mechanism
Clot Formation
Regulatory Mechanisms
Fibrinolysis
Disseminated Intravascular Coagulation
Description and Etiology
Etiology
Pathophysiology
Assessment and Diagnosis
Assessment
Diagnosis
Medical Management
Nursing Management
Support Vital Functions
Initiate Bleeding Precautions
Provide Comfort and Emotional Support
Thrombocytopenia
Description and Etiology
Etiology
Pathophysiology
Assessment and Diagnosis
Assessment
Diagnosis
Medical Management
Nursing Management
Heparin-Induced Thrombocytopenia
Description and Etiology
Etiology
Pathophysiology
Assessment and Diagnosis
Assessment
Diagnosis
Medical Management
Direct Thrombin Inhibitors
Nursing Management
Decrease Incidence of Heparin Exposure
Maintain Surveillance for Complications
Educate the Patient and Family
Sickle Cell Anemia
Description and Etiology
Etiology
Pathophysiology
Assessment and Diagnosis
Assessment
Diagnosis
Medical Management
Prevent Infection
Pain Management
Transfusion Therapy
Administration of Hydroxyurea
Nursing Management
Support Vital Functions
Maintain Surveillance for Complications
Educate the Patient and Family
Tumor Lysis Syndrome
Description and Etiology
Etiology
Pathophysiology
Hyperuricemia
Hyperkalemia
Hyperphosphatemia and Hypocalcemia
Assessment and Diagnosis
Assessment
Diagnosis
Medical Management
Adequate Hydration
Metabolic Imbalances
Life-Threatening Complications
Nursing Management
Monitor Fluid and Electrolytes
Maintain Surveillance for Complications
Educate the Patient and Family
Hospital-Acquired Anemia
Etiology
Blood Conservation Strategies
Minimizing Blood Loss
Managing Oxygen Delivery and Consumption
Encouraging Safer Transfusions and Alternative Agents
Additional Resources
Key Points
Coagulation and Fibrinolysis
Disseminated Intravascular Coagulation
Idiopathic Thrombocytopenia Purpura
Heparin-Induced Thrombocytopenia
Sickle Cell Anemia
Tumor Lysis Syndrome
Hospital-Acquired Anemia
Unit IX. Special Populations
37. The Obstetric Patient
Physiologic Alterations in Pregnancy
Disorders Related to Pregnancy
Preeclampsia and Eclampsia
Description and Etiology
Pathophysiology
Medical Management
Hemolysis, Elevated Liver Enzymes, and Low Platelet Syndrome
Description and Etiology
Pathophysiology
Medical Management
Hemorrhage
Description and Etiology
Pathophysiology
Medical Management
Amniotic Fluid Embolism
Description and Etiology
Pathophysiology
Medical Management
Venous Thromboembolism
Description and Etiology
Medical Management
Disseminated Intravascular Coagulation
Description and Etiology
Pathophysiology
Medical Management
Peripartum Cardiomyopathy
Description and Etiology
Pathophysiology
Medical Management
Acute Myocardial Infarction
Description and Etiology
Medical Management
Other Disorders While Pregnant
Trauma
Pneumonia
Acute Respiratory Distress Syndrome
Cardiac Arrest
Pharmacology
Nursing Management
Maintain Surveillance for Complications
Maternal Monitoring
Fetal Monitoring
Additional Resources
Key Points
38. The Pediatric Patient
Admission to the Critical Care Unit
Cardiovascular System
Anatomy and Physiology
Congenital Heart Defects
Dysrhythmias
Bradydysrhythmias
Tachydysrhythmias
Shock
Hypovolemic Shock
Cardiogenic Shock
Septic Shock
Obstructive Shock
Cardiopulmonary Arrest
Intraosseous Access
Cardiopulmonary Resuscitation
Postresuscitation Management
Pulmonary System
Anatomy and Physiology
Upper Airway
Lower Airway
Chest Mechanics
Oxygenation and Ventilation Delivery Devices
Airway Positioning
Supplemental Oxygen Devices
Manual Resuscitation Bag
Endotracheal Intubation
Mechanical Ventilation
Tracheostomy
Bronchiolitis
Respiratory Syncytial Virus
Pathophysiology
Assessment
Management
Status Asthmaticus
Pathophysiology
Assessment and Diagnosis
Management
SARS-CoV-2
Neurological System
Anatomy and Physiology
Assessment
Responsiveness
Motor Function
Signs of Increased Intracranial Pressure
Seizures
Etiology
Nursing Management
Status Epilepticus
Bacterial Meningitis
Assessment
Nursing Management
Trauma
Head Trauma
Primary Phase
Secondary Phase
Classification of Head Injuries
Management
Gastrointestinal System
Anatomy and Physiology
Management
Fluid Replacement
Nutrition
Pain Management
Physiology
Assessment
Management of Pain
Nonsteroidal Antiinflammatory Drugs
Opioid Analgesics
Topical Anesthetics
Nonpharmacologic Management
Opioid-Related Issues
Psychosocial Issues of the Child and Family
The Ill Child’s Experience of Critical Illness
Parents’ Experience of a Child’s Critical Illness
Additional Resources
Key Points
39. The Older Adult Patient
Critical Care and the Older Adult
Future Trends in Older Adult Aging
Implications for Health Care Delivery
Older Adults in the Future Requiring Critical Care
Older Adults With Greater Chronicity and Morbidity
Transition to Future Models of Care to Address Changing Needs
Established Evidence-Based Eldercare Models
Immobility
Frailty
Family and Caregiver Discharge Assessment and Preparation
Age-Related Changes of the Cardiovascular System
Dysrhythmias
Myocardial Infarction
Heart Failure
Polyvascular Disease
Hypertension
Medication Management
Cardiac Medication Considerations in Older Adults
Age-Related Changes of the Respiratory System
Thorax Changes
Chest Wall Compliance and Pulmonary Function Studies
Acute Respiratory Failure
Pneumonia
Pulmonary Embolism
Neurocognitive Age-Related Changes
Delirium in the Older Adult
Delirium Subtypes
Pathology and Impact of Delirium
Orthostatic Hypotension
Cerebral Blood Flow
Age-Related Changes of Renal System
Aging Kidney
Decrease in Functional Nephrons
Dehydration and Hypertension
Impact of Diabetes Mellitus and Heart Failure on the Older Adult
Cardiorenal Syndrome
Chronic Kidney Disease
Acute Kidney Injury
Renal Replacement Therapy
Water Balance Syndromes
Diabetes in Older Adults
Diabetic Care Management
Age-Related Changes of the Gastrointestinal System and Nutrition
Aging Gastrointestinal Physiology Impact
Nutritional Screening Tools
Feeding Goals
Age-Related Changes of the Liver
Change in Liver Physiology and Liver Dysfunctions
Treatment for Liver Conditions
Hepatic Encephalopathy
Complications of Liver Failure
Age-Related Changes in the Immune System
Risk of Sepsis and Sepsis Shock in the Older Adult
Chronic Critical Illness Condition
Age-Related Changes in the Skin and Integumentary System
Age-Related Changes in the Musculoskeletal System
Key Points
Appendixes
Appendix A. Patient Care Management Plans
Appendix B. Physiologic Formulas for Critical Care
Hemodynamic Equations
Mean (Systemic) Arterial Pressure (MAP)
Systemic Vascular Resistance (SVR)
Systemic Vascular Resistance Index (SVRI)
Pulmonary Vascular Resistance (PVR)
Pulmonary Vascular Resistance Index (PVRI)
Left Cardiac Work Index (LCWI)
Left Ventricular Stroke Work Index (LVSWI)
Right Cardiac Work Index (RCWI)
Right Ventricular Stroke Work Index (RVSWI)
Corrected Q–T Interval (Q–Tc)
Body Surface Area (BSA)
Pulmonary Formulas
Shunt Equation (Qs/Qt)
Pulmonary Capillary Oxygen Content (CcO2)
Arterial Oxygen Content (CaO2)
Alveolar Pressure of Oxygen (PAO2)
Arterial/Inspired Oxygen Ratio
Arterial/Alveolar Oxygen Ratio
Alveolar-Arterial Gradient
Dead Space Equation (Vd/Vt)
Static Compliance (CST)
Dynamic Compliance (CDY)
Neurologic Formulas
Cerebral Perfusion Pressure (CPP)
Arteriojugular Oxygen Difference (Ajdo2)
Endocrine Formulas
Serum Osmolality
Fluid Volume Deficit in Liters
Kidney Formulas
Anion Gap
Clearance
Nutritional Formulas
Body Mass Index (BMI)
Caloric and Protein Needs
Estimating Caloric Needs
Estimating Protein Needs
Appendix C. Canadian Laboratory Values∗
Index
SPECIAL FEATURES
IBC
Patient-Centered Care
Patient-Centered Critical Care
Patient and Family Education Plans
Pharmacologic Management
Safety
Social Determinants of Health
Summary of Key Concepts
Supporting Nurse Well-being
Teamwork and Collaboration