Table of Contents
Part I Foundations of Progressive and Critical Care Nursing
Chapter 1 Professional Caring and Ethical Practice Anna Dermenchyan, MSN, RN, CCRM-K, CPHQ 1
American Association of Critical-Care Nurses Mission, Vision, and Values (AACN, 2020 a,b,c) 1
Mission 1
Vision 2
Values 2
Synergy of Caring 2
Key Responsibilities of Registered Nurses (American Nurses Association [ANA], 2020) 2
What Acute and Critical Care Nurses Do (AACN, 2019) 2
The Environment of Progressive and Critical Care Nurses (AACN, 2019) 2
The AACN Synergy Model for Patient Care 5
AACN Synergy Model for Patient Care (AACN, 2020a,b,c) 5
Origin of the Synergy Model 5
Purpose 5
Overview of the Synergy Model 5
Application of the Synergy Model 15
Family Presence: Visitation in the Adult ICU (AACN Practice Alert, 2016) 16
Healthy Work Environment Standards (AACN, 2016) 17
General Legal Considerations Relevant to Critical Care Nursing Practice 17
National Governing Bodies 17
State Nurse Practice Acts (Russell, 2017) 17
Scope of Practice 18
Standards of Care 18
Certification in a Specialty Area 19
Professional Liability 19
Documentation 22
Good Samaritan Laws 24
Ethical Clinical Practice 24
Foundation of Ethical Nursing Practice 24
Emergence of Clinical Ethics 24
Standard Ethical Theory 25
Ethical Principles (ANA, 2015b) 25
Common Ethical Distinctions 26
Advance Cars Planning 27
The Law in Clinical Ethics (Department of Health & Human Services, 2020) 29
Clinical Ethics Assessment 34
Nurse's Role as Patient Advocate and Moal Agent 36
Chapter 2 Psychosocial Aspects of Critical Care Deborah Chapa, PhD, ACNP-BC, FAANP, ACHPN Bimbola Fola Akintade, PhD, MBA, MHA, ACNP-BC, NEA-BC, FAANP 38
Systemwide Elements 38
Review of Psychosocial Concepts 38
Assessment 43
Pain, Agitation, Delirium, Immobility and Sleep Disruption (PADIS) (Devlin et al., 2018) 44
Sleep Deprivation 46
ASD and PTSD 46
Delirium (Acute Confusional State) 48
Powerlessness 50
Anxiety 51
Depression 53
Substance Misuse, Dependence, and Withdrawal 55
Aggression and Violence 57
Suicide 59
Dying Process and Death 61
Part II Critical Care of Patients with Issues Affecting Specific Body Systems
Chapter 3 Pulmonary System Daniel N. Storzer, DNP, ACNPC, ACNP-BC, CNBN, CCRN, CCEMT-P, FCCP FCCM 63
Systemwide Elements 63
Anatomy and Physiology Review 63
Assessment 85
Diagnostic Studies 105
Patient Care 109
Specific Patient Health Problems 136
Acute Respiratory Failure (ARF) 136
Chest Trauma 139
Acute Respiratory Distress Syndrome (ARDS) 139
Vaping 141
Transfusion-Related Lung Injury 142
Pulmonary Embolism 142
Chronic Obstructive Pulmonary Disease (COPD) 146
Asthma and Status Asthmaticus 150
Pneumonia 153
Ventilator-Associated Pneumonia and Event 157
Drowning 158
Pulmonary Problems in Surgical/Thoracic Surgery Patients 160
Air Leak Syndromes 162
Acute Pulmonary Inhalation Injuries 163
Neoplastic Lung Disease 163
Pulmonary Fibrosis 167
Obstructive Sleep Apnea 168
End-Stage Pulmonary Conditions: Lung Transplantation 169
Chapter 4 Cardiovascular System Andrea Efre, DNP, ARNP, ANP, FNP Bryan Boling, DNP, AG-ACNP, CCRN-CSC, CEN 176
Systemwide Elements 176
Anatomy and Physiology Review 176
Assessment 190
Diagnestic Studies 201
Patient Care 232
Specific Patient Health Problems 235
Acute Coronary Syndrome 235
Acute Myocardial Infarction-ST-Segment Elevation Myocardial Infarction 235
Non-ST Elevation Myocardial Infarction (See Acute Coronary Syndrome (NSTEMI- Acute Coronary Syndrome and Unstable Angina) 247
Chronic Stable Angina Pectoris 251
Coronary Artery Disease 253
Heart Failure 257
Pericardial Disease 266
Myocarditis 271
Infective Endocarditis 274
Cardiomyopathy 280
Cardiac Rhythm Disorders 286
Mitral Regurgitation 301
Mitral Stenosis 304
Aortic Regurgitation 307
Aortic Stenosis 310
Atrial Septal Defect 313
Ventricular Septal Defect 316
Patent Ductus Arteriosus 319
Coarctation of the Aorta 322
Hypertensive Crises 325
Aortic and Peripheral Arterial Disease 330
Shock 337
Mechanical Circulatory Support Devices 344
End-Stage Heart Disease: Cardiac Transplantation 350
Cardiac Trauma 353
Chapter 5 Neurologic System Patricia A. Blissitt, PhD, ARNP-CNS, CCRN, CNRN, SCRN, CCNS, CCM, ACNS-BC 354
Systemwide Elements 354
Anatomy and Physiology Review 354
Assessment 390
Diagnostic Studies 406
Patient Care 408
Specific Patient Health Problems 417
Increased Intracranial Pressure or Intracranial Hypertension 417
Stroke 426
Brain Tumor 455
Spinal and Spinal Cord Tumors 459
Intracranial Infections 461
Neuromuscular/Autoimmune Disease 468
Seizure Disorders 476
Encephalopathy 483
Coma 486
Brain Death 487
Neurosurgical Procedures 488
Chapter 6 Renal System Bryan Boling, DNP, AG-ACNP, CCRN-CSC, CEN 490
Systemwide Elements 490
Anatomy and Physiology Review 490
Assessment 504
Diagnostic Studies 507
Patient Care 511
Specific Patient Health Problems 520
Renal Trauma 520
Acute Kidney Injury 520
Chronic Kidney Disease 534
Electrons Imbalances-Potassium Imbalance: Hyperkalemia 540
Electrolyte Imbalances-Potassium Imbalance: Hypokalemia 546
Electrolyte imbalances-Sodium Imbalance: Hypernatremia 547
Electrolyte Imbalances-Sodium imbalance: Hyponatremia 549
Electrolyte imbalances-Calcium Imbalance: Hypercalcemia 551
Electrolyte Imbalances-Calcium Imbalance: Hypocalcemia 553
Electrolyte Imbalances-Phosphate Imbalance: Hyperphosphatemia 554
Electrolyte Imbalances-Phosphate Imbalance: Hypophosphatemia 556
Electrolyte Imbalances-Magnesium Imbalance: Hypermagnesemia 557
Electrolyte Imbalances-Magnesium Imbalance: Hypomagnesemia 558
Rhabdomyolysis 559
End-Stage Renal Condition: Renal Transplant 560
Chapter 7 Endocrine System Jennifer MacDermott, MS, RN, ACNS-BC, NP-C, CCRN 564
Systemwide Elements 564
Anatomy and Physiology Review 564
Hypothalamus 565
Pituitary Gland (Also Called Hypophysis) 565
Thyroid Gland 568
Parathyroid Glands 568
Adrenal Glands 569
Pancrees 570
Pineal Gland and Thymus Gland 571
Gonadal Hormones (Testosterone, Estrogen, Progesterone) 571
Assessment 571
Diagnostic Studies 574
Patient Care 575
Specific Patient Health Problems 576
Altered Glucose Metabolism 576
Altered Antidiuretic Hormone Production 584
Altered Thyroid Hormone Production 587
Acute Adrenal insufficiency or Crisis 591
Acute Hyperparathyroidism and Hypoparathyroidism 592
Chapter 8 Hematologic and Immunologic Systems Nicole Brurnfield, DNP, APRN, FNP-BC, AG-ACNP-BC 593
Systemwide Elements 593
Anatomy and Physiology Review 593
Assessment of Hematologic and Immunologic Systems 597
Diagnostic Studies 599
Patient Care 602
Specific Patient Health Problems 604
Thrombocytopenia 604
Disseminated Intravascular Coagulation 606
Medication-Induced Coagulopathy 608
Thromboembolic Disorders 611
Anemia 613
Sickle Cell Anemia 616
Neutropenia 618
Acute Leukemia 619
Malignant Pericardial Effusion 621
Hematopoietic Stem Cell Transplantation 622
Organ Transplant Rejection 624
Human Immunodeficiency Virus Infection 626
Anaphylactic Reaction 629
Chapter 9 Gastrointestinal System Patricia Radovich, PhD, CNS, FCCM 631
Systemwide Elements 631
Anatomy and Physiology Review 631
Accessory Organs of Digestion (Fig. 9.4) 639
Patient Assessment 644
Diagnostic Studies 648
Patient Care 650
Specific Patient Health Problems 652
Abdominal Trauma 652
Bowel Infarction (Obstruction, Perforation) 652
Functional Gastrointestinal Disorders (Obstruction, Motility [Ileus, Diabetic Gastroparesis, GERD, Inflammatory Bowel Syndrome]) 654
Gastrointestinal Infections (Clostridium Difficile) 656
Abdominal Compartment Syndrome 657
Acute Abdomen 659
Acute Liver Failure 661
Gastrointestinal Bleeding 663
Gastrointestinal Bariatric Surgery 667
Chronic Liver Failure: Decompensated Cirrhosis 667
Carcinoma of the Gastrointestinal Tracts 672
Acute Pancreatitis 675
Hepatitis 678
End-Stage Gastrointestinal System Condition: Liver Transplantation 682
Nutritional Support in the Critically III Patient 683
Part III Critical Care of Patients with Multisystem Issues
Chapter 10 Sepsis and Septic Shock Diane McLaughlin, DNP, AGACNP-BC, CCRN 686
Systemwide Elements 686
Anatomy and Physiology Review 686
Assessment 698
Patient Care 700
Chapter 11 Multisystem Trauma Renee M. Holleran, FNP-BC, PhD, CCRN (Alumnus), CEN, CFRN, CTRN (Retired), FAEN 706
Systemwide Elements 706
Trauma Concepts and Physiology Review 706
Assessment 712
Patient Care 718
Head and Spinal Trauma 721
Thoracic Trauma: Pulmonary and Cardiac 734
Pulmonary Trauma 734
Cardiac Trauma 737
Abdominal Trauma 741
Chapter 12 Burns Karah Cripe Sickler, RN, DNP, AG-ACNP-BC 745
Systemwide Elements 745
Anatomy and Physiology Review 745
Assessment 754
Patient Care 760
Chapter 13 Hypothermia Carrol Graves, MSN, RN, CORN, CNL 764
Systemwide Elements 764
Anatomy and Physiology Review 764
Assessment 769
Patient Care 772
Chapter 14 Toxin Exposure Shana Metzger, MS, FNP-BC, AG-ACNP-BC 776
Systemwide Elements 776
Anatomy and Physiologic Review 776
Assessment 787
Patient Care 790
Interventions for Ingestion of Toxic Substance (Fig. 14.1) 792
General Management Strategies for Gastric Decontamination 794
Treatment for Body Stuffing/Body Packing 795
Additional Interventions for the Purposeful Ingestion 795
Envenomation 796
Part IV Critical Care of Patients With Special Needs
Chapter 15 Bariatric Patients Angela Benefield, DNP, RN, AGCNS-BC, CCRN-CMC 799
Systemwide Elements 799
Anatomy and Physiology Review 799
Assessment 800
Patient Care 804
Care of the Bariatric Surgery Patient 806
Related Bariatric Care Issues 807
Chapter 16 Older Adult Patients Jenny G. Alderden, PhD, APRN, CCRN, CCNS 809
Age-Related Biologic and Behavioral Differences 809
Age-Related Changes in Medication Action and Clinical Implications 809
The Four Ms of Age-Friendly Health Care 814
Chapter 17 High-Risk Obstetric Patients Jennifer T.N. Treacy, MSN, APRN, FNP 820
Systemwide Elements 820
Anatomy and Physiology Review 820
Specific Patient Health Problems 823
Postpartum Hemorrhage 823
Hypertensive Disorders of Pregnancy 824
Hemolysis, Elevated Liver Enzymes, Low Platelet Count Syndrome 830
Amniotic Fluid Embolism 831
Acute Fatty Liver of Pregnancy 832
Special Considerations 833
Trauma 833
Cardiopulmonary Concerns in Pregnant Patients 835
Chapter 18 Patient Transport Renee M. Holleran, FNP-BC, PhD, CCRN (Alumnus), CEN, CFRN, CTRN (Retired), FAEN 836
Members of the Transport Team 837
Indications for Transport 837
Modes of Interfacility Transport 838
Risks and Stresses of Transport 839
Overriding Priorities in Patient Transport 841
Preparation for Transport 841
Patient Care During Transport 844
Legal and Ethical Issues Related to Transport 845
Chapter 19 Sedation Mary Beth Flynn Makic, PhD, RN, CCNS, CCRN-K, FAAN, FNAP, FCNS Catrina Cullen, RN, BSN, CCRN 846
Systemwide Elements 846
Considerations Before Sedation 846
Practice Considerations During Administration of Sedation 848
Specific Patient Health Problems 855
Procedural sedation and Analgesia for the Patient in High Acuity Settings 855
Chapter 20 Pain Tonya Sawyer-McGee, BSN, MSN, MBA, RN, DNP, ACNP-BC 860
Systemwide Elements 860
Anatomy and Physiology Review 860
Background 865
Assessment 869
Patient Care 873
Patient Education 880
Specific Clinical Problems Related to Pain Therapy 885
Specific Patient Health Problems 886
Chapter 21 Palliative and End-of-Life Care Clareen Wiencek, PhD, RN, ACNP, ACHPN, FAAN 888
Systemwide Elements 888
Concept Review 888
Assessment for Palliative Care, Hospice, or End-of-Life Cars Services 893
Patient Care 893
Transitioning Goals of Care to End-of-Life (Box 21.3) 895
Additional Considerations (See Ch. 2, Psychosocial Aspects of Critical Care) 897
Chapter 22 Perioperative Care Jan Odom-Forren, PhD, RN, CPAN, FASPAN, FAAN Denise O'Brien, DNP, RN, ACNS-BC, CPAN, CAPA, FASPAN, FCNS, FAAN 898
Systemwide Elements 898
Anatomy and Physiology Review 898
Assessment 899
Patient Care 901
Initial Arrival in Postanesthesia Care Unit or Intensive Care Unit 914
Ongoing Postanesthesia Care-Emergence from Anesthesia 914
Specific Patient Health Problems 917
Index 923
