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دانلود کتاب Critical Care Nursing Diagnosis and Management
دانلود کتاب تشخیص و مدیریت پرستاری مراقبت های ویژه
مشخصات کتاب
Critical Care Nursing Diagnosis and Management
ویرایش: [9 ed.] نویسندگان: Linda D. Urden, Kathleen M. Stacy, Mary E. Lough سری: ISBN (شابک) : 9780323642958 ناشر: Elsevier Inc. سال نشر: 2022 تعداد صفحات: 1139 زبان: English فرمت فایل : PDF (درصورت درخواست کاربر به PDF، EPUB یا AZW3 تبدیل می شود) حجم فایل: 59 Mb
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توجه داشته باشید کتاب تشخیص و مدیریت پرستاری مراقبت های ویژه نسخه زبان اصلی می باشد و کتاب ترجمه شده به فارسی نمی باشد. وبسایت اینترنشنال لایبرری ارائه دهنده کتاب های زبان اصلی می باشد و هیچ گونه کتاب ترجمه شده یا نوشته شده به فارسی را ارائه نمی دهد.
توضیحاتی در مورد کتاب تشخیص و مدیریت پرستاری مراقبت های ویژه
برای موفقیت در تنظیمات مراقبتی با دقت بالا، پیشرونده و حیاتی امروزی آماده شوید! Critical Care Nursing: Diagnosis and Management، نسخه نهم به شما کمک می کند تا اصول و مفاهیم پرستاری مراقبت های ویژه را در ارزیابی بالینی، روش های تشخیصی و مدیریت درمانی درک کرده و به کار ببرید. این کتاب درسی برجسته که به دلیل پوشش جامع خود شناخته شده است، از یک سازمان منطقی و سیستم های بدن برای رسیدگی به مراقبت از بیماران مبتلا به تغییرات فیزیولوژیکی استفاده می کند. ویژگی‌های مراقبت ویژه بیمار محور با هدف "انسانی کردن ICU" و همچنین مطالعات موردی به سبک امتحان NCLEXa نسل جدید برای کمک به شما در توسعه بیشتر مهارت‌های قضاوت بالینی و آمادگی برای آخرین آزمون مجوز پرستاری، در این نسخه جدید است. این کتاب همچنین برای آماده سازی امتحانات CCRNa و PCCNa ایده آل است، این کتاب یک منبع یک مرحله ای در مورد مفاهیم و مهارت های مورد نیاز برای پرستاری مراقبت های ویژه است! محتوای تست شده و با کیفیت بالا به تمام جنبه های پرستاری با دقت بالا، پیش رونده و مراقبت های ویژه امروزی می پردازد. سازمان منسجم در هر واحد بدن-سیستم یک چارچوب کارآمد برای یادگیری، برای تهیه گواهینامه CCRNa و PCCNa و برای مرجع در عمل بالینی فراهم می کند. محتوای جامع و مبتنی بر شواهد بسیار ارجاع است و شامل منابع اینترنتی برای تحقیق و مطالعه بیشتر است. ادغام آموزش با کیفیت و ایمنی برای پرستاران (QSEN) محتوای متنی را از طریق افزودن سؤالات مرتبط با QSEN در مطالعات موردی، ویژگی‌ها و جعبه‌های دارای برچسب QSEN، نمادهای محتوای QSEN و اطلاعات برجسته QSEN، به صلاحیت‌های QSEN پیوند می‌دهد.
توضیحاتی درمورد کتاب به خارجی
Prepare for success in today's high acuity, progressive, and critical care settings! Critical Care Nursing: Diagnosis and Management, 9th Edition helps you understand and apply critical care nursing principles and concepts to clinical assessment, diagnostic procedures, and therapeutic management. Known for its comprehensive coverage, this leading textbook uses a logical, body systems organization to address the care of patients with physiological alterations. New to this edition are illustrated Patient-Centered Critical Care features aimed at "humanizing the ICU" as well as Next Generation NCLEXa Exam-style case studies to help you further develop your clinical judgment skills and prepare for the latest nursing licensure exam. Also ideal for CCRNa and PCCNa exam preparation, this book is a one-stop resource on the concepts and skills required for critical care nursing! Time-tested, high-quality content addresses all aspects of today's high acuity, progressive, and critical care nursing. Consistent organization?within each body-system unit provides an efficient framework for learning, for CCRNa and PCCNa certification preparation, and for reference in clinical practice. Comprehensive, evidence-based content is highly referenced and includes internet resources for further research and study. Enhanced Quality and Safety Education for Nurses (QSEN) integration links text content to QSEN competencies, through the addition of QSEN-related questions in case studies, QSEN-labeled features and boxes, QSEN content icons, and highlighted QSEN information.
فهرست مطالب
Front Cover Contents Critical Care Nursing: Diagnosis and Management Copyright Page Dedication About the Authors Contributors Preface Organization Diagnosis And Patient Care Management Included in This Edition Special Features New to this Edition Changes In Terminology Evolve Resources for Critical Care Nursing Student Resources Instructor Resources Acknowledgments Contents I. Foundations of Critical Care Nursing 1 Critical Care Nursing Practice Overview History of Critical Care Critical Care Nursing Contemporary Critical Care Critical Care Nursing Roles Expanded-Role Nursing Positions Advanced Practice Nurses Critical Care Professional Accountability Evidence-Based Nursing Practice Diagnosis and Patient Care Management Concept Maps Holistic Critical Care Nursing Caring Patient-Centered Critical Care Cultural Care Complementary and Alternative Therapies Guided Imagery Massage Animal-Assisted Therapy Music Therapy Technology in Critical Care Interprofessional Collaborative Practice Interdisciplinary Care Management Models And Tools Care Management Case Management Care Management Tools Algorithm Practice Guideline Protocol 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 Healthy Work Environment Key Points References 2 Ethical Issues Morals Versus Ethics Nurses, Moral Distress, and Moral Courage Virtues Ethical Principles Respect for Persons/Autonomy Beneficence and Nonmaleficence Justice Conflicting Principles, Paternalism, and Medical Futility Professional Nursing Ethics and the Nursing Code of Ethics Situational and Organizational Ethical Decision Making in Critical Care Framework for Resolving Ethical Problems Sfno Model for Deliberation of Ethical Problems Strategies for the Promotion of Ethical Decision Making Institutional Ethicists, Ethics Committees, and Ethics Consultation Services Ethics Rounds and Conferences Key Points References 3 Legal Issues Overview Administrative Law: Professional Regulation Functions of Boards of Nursing Scope of Practice Standards of Practice Tort Law: Negligence And Professional Malpractice, Intentional Torts 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 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 References 4 Genetic Issues Genetics And Genomics Genetic And Genomic Structure And Function Chromosomes DNA and the Double Helix DNA Base Pairs DNA Replication DNA Alphabet Transcription Translation Telomeres Genetic Variation and Polymorphism Variation Mutation Single Nucleotide Polymorphisms Alleles Genetic Inheritance Genetic Disorders Chromosome Disorders Single-Gene Disorders Complex Gene and Multifactorial Disorders Mitochondrial Disorder Genotype and Phenotype Genetic History and Family Pedigree Homozygous Versus Heterozygous Modes of Inheritance Autosomal Dominant Inheritance Autosomal Recessive Inheritance Sex-Linked Inheritance Hemophilia A and hemophilia B Complex Gene–Gene and Gene–Environment Disorders Obtaining Information About Genetics And Genomics Genetic Epidemiology and Phenotypes Family-Based Genetic Studies Twin Studies Genetic Association Studies Case-Control Studies Candidate Gene Studies Genome-Wide Association Studies Genome Mapping Projects Human Genome Project ENCODE Project HapMap Project 1000 Genomes Project Exome Sequencing Project Human Proteome Project Human Microbiome Project Genetic Diversity Copy Number Variation Individual Genome Sequences Genetics In Critical Care Gene Editing—CRISPR-Cas9 Technology Cancer Genetics Somatic Mutations The Cancer Genome Atlas Cardiovascular Genetics Long QT Syndrome Cardiomyopathy Hypertrophic cardiomyopathy Dilated cardiomyopathy Restrictive cardiomyopathy Pharmacogenetics Cytochrome P450 Family and Medication Metabolism Warfarin Malignant Hyperthermia 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 References 5 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 Standardizing Handoffs Barriers to Handoff Communication 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 References 6 Psychosocial and Spiritual Considerations Stress Stress Response Initial Event Compensatory Phase Progressive Phase Refractory Stage Stressors in Critical Care Coping With Stress and Illness Coping Mechanisms Psychological Responses Psychological Defense Mechanisms Regression Denial Anxiety Alterations In Self-Concept Disturbed Body Image Low Self-Esteem Disturbed Personal Identity Compromised Dignity Powerlessness Spiritual Responses Spiritual Distress Hopelessness Psychosocial Support Providing Holistic Care Complementary and Alternative Therapies Psychosocial Interventions Caring Communication Promoting Trust Enhancing Dignity Communicating With Compassion Promoting Optimal Coping Supporting Self-Control Engaging Spiritual Resources Environmental Support Family-Centered Care Visitation Policies Comorbid Psychiatric Disorders Alcohol Withdrawal Attempted Suicide Post–Intensive Care Syndrome Critical Care Unit–Acquired Weakness Cognitive Impairment Psychiatric Conditions Posttraumatic Stress Disorder Major Depressive Disorder Anxiety Disorders Prevention and Management of PICS Self-Care For Nurses Key Points References 7 Nutrition Alterations and Management Nutrient Metabolism Energy-Yielding Nutrients Carbohydrates Proteins Lipids (Fats) Focused Assessment of Nutrition Status Anthropometric Measurements Biochemical Data Clinical or Physical Manifestations Diet and Health History Evaluating Nutrition Assessment Findings Determining Nutrition Needs Implications of Undernutrition for Sick or Stressed Patients Energy Deficiency Protein–Calorie Malnutrition Metabolic Response to Starvation and Stress Etiology-Based Approach in Defining Malnutrition Nutrition Support Nursing Management of Nutrition Support Oral Supplementation Enteral Nutrition Enteral feeding access Location and type of feeding tube Assessment and prevention of feeding tube complications Feeding tube occlusion Aspiration Gastrointestinal complications Formula delivery Adequacy of enteral nutrition Tubing and catheter misconnections Total Parenteral Nutrition Types of parenteral nutrition Nursing management of potential complications Lipid emulsion Monitoring and Evaluation of Nutrition Support Nutrition and Cardiovascular Alterations Focused Nutrition Assessment in Cardiovascular Alterations Nutrition Intervention and Education in Cardiovascular Alterations Myocardial Infarction Short-term interventions Long-term changes Heart Failure Cardiac Cachexia Nutrition and Pulmonary Alterations Focused Nutrition Assessment in Pulmonary Alterations Nutrition Intervention and Education in Pulmonary Alterations Prevent or Correct Undernutrition and Underweight Avoid Overfeeding Prevent Fluid Volume Excess Nutrition and Neurologic Alterations Focused Nutrition Assessment in Neurologic Alterations Nutrition Intervention and Education in Neurologic Alterations Prevention or Correction of Nutrition Deficits Oral feedings Tube feedings Prevention of overweight and obesity Nutrition and Kidney Alterations Focused Nutrition Assessment in Kidney Alterations Nutrition Intervention and Education in Renal Alterations Protein Fluid Energy (Calories) Other Nutrients Nutrition and Gastrointestinal Alterations Nutrition Focused Assessment in Gastrointestinal Alterations Nutrition Intervention and Education in Gastrointestinal Alterations Hepatic Failure Monitoring fluid and electrolyte status Provision of a nutritious diet and evaluation of response to dietary protein Pancreatitis Prevention of further damage to the pancreas and preventing nutrition deficits Nutrition and Surgery Nutritional Aspects of ERAS Protocols Preoperative Nutrition Optimization Preoperative Nutrition Preparation Postoperative Nutrition Interventions Nutrition and Endocrine Alterations Focused Nutrition Assessment in Endocrine Alterations Nutrition Intervention in Endocrine Alterations Nutrition Support and Blood Glucose Control Severe Vomiting or Diarrhea in Patients With Type 1 Diabetes Mellitus Nutrition Education in Diabetes Evolution of Nutrition Science Key Points Nutrient Metabolism Assessing Nutrition Status Implications of Undernutrition for Sick or Stressed Patients Patient Care Management of Nutrition Support Nutrition and Cardiovascular Alterations Nutrition and Pulmonary Alterations Nutrition and Neurologic Alterations Nutrition and Renal Alterations Nutrition and Gastrointestinal Alterations Nutrition and Surgery Nutrition and Endocrine Alterations References 8 Pain and Pain Management Pain Assessment 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 Summary Biologic Stress Response Short-Term Direct Response Midterm Indirect Response Long-Term Indirect Response Summary Framework for Pain Assessment and Definition Pain Assessment Subjective 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 Patient-Related Challenges to Pain Assessment and Management Communication Altered Level of Consciousness and Unconsciousness Older Adult Patients Delirious Patients Cultural Influences Tolerance, Physical Dependence, and Opioid-Related Iatrogenic Withdrawal Syndrome Opioid Use Disorder and Opioid Misuse Pain Management in the Health Organization Pain Management Pharmacologic Control of Pain Opioid Analgesics Morphine Fentanyl Hydromorphone Meperidine Codeine Methadone More potent opioids: remifentanil and sufentanil Preventing and Treating Opioid-Induced Respiratory Depression Monitoring Opioid reversal Sedative with Analgesic Properties: Dexmedetomidine Nonopioid Analgesics Acetaminophen Nonsteroidal antiinflammatory drugs Ketamine Lidocaine Anticonvulsants Antidepressants Delivery Methods Patient-Controlled Analgesia Intraspinal Pain Control Intrathecal Analgesia Epidural Analgesia Equianalgesia Nonpharmacologic Interventions of Pain Management Physical Techniques Massage Ice Therapy Cognitive–Behavioral Techniques Relaxation Music Bundle Interventions Additional Resources Key Points References 9 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 Central Alpha Agonists Daily Sedation Interruption Agitation Delirium Pharmacologic Management of Delirium Interventions to Prevent Delirium Alcohol Withdrawal Syndrome and Delirium Tremens Collaborative Management Additional Resources Key Points References 10 Palliative and End-of-Life Care End-Of-Life Experience In Critical Care Advance Directives Physician Orders for Life-Sustaining Treatment Advance Care Planning Ethical and Legal Issues Comfort Care Cardiopulmonary Resuscitation Effect of Do Not Resuscitate Orders Prognostication and Prognostic Tools Decision Making Communication and Decision Making Patients Families Strategies to Support Shared Decision Making Daily Rounds Family Meetings Cultural and Spiritual Influences on Communication 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 Sedation During Withdrawal of Life Support Ventilator Settings 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 References II. Cardiovascular Alterations 11 Cardiovascular Anatomy and Physiology Anatomy Macroscopic Structure Structures of the Heart Size and Weight of the Heart Layers of the Heart Pericardium Epicardium Epicardial fat Myocardium Endocardium Cardiac Chambers Cardiac Valves Mitral and tricuspid valves Aortic and pulmonary valves Conduction System Sinoatrial node Atrioventricular node Bundle of His, bundle branches, and Purkinje fibers Coronary Blood Supply Right coronary artery Left coronary artery Coronary veins Thebesian vessels Major Cardiac Vessels Aorta Pulmonary Artery Pulmonary Veins Systemic Circulation Arterial system Blood flow and blood pressure Microcirculation Venous System Microscopic Structure Cardiac Fibers Cardiac Cells Physiology Electrical Activity Transmembrane Potentials Resting Membrane Potential Phases of the Action Potential Phase 0 Phase 1 Phase 2 Phase 3 Phase 4 Fiber Conduction and Excitability Mechanical Activity Excitation-Contraction Coupling Cardiac Cycle Atrial Systole Isovolumic Contraction Ventricular Systole Isovolumic Relaxation Ventricular Diastole Interplay of Heart and Vessels: Cardiac Output Preload Afterload Contractility Regulation of Heartbeat Autonomic Nervous System Control Intrinsic Regulation Baroreceptors Chemoreceptors Right atrial receptors Natriuretic peptides Renin-angiotensin-aldosterone system Respiratory influences Control of Peripheral Circulation Intrinsic Control Extrinsic Control Key Points References 12 Cardiovascular Clinical Assessment History Physical Examination Inspection Face Thorax Abdomen Nail Beds and Cyanosis 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 Automated blood pressure devices 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 Mitral regurgitation Aortic stenosis Aortic insufficiency Innocent Murmurs Murmurs Associated With Myocardial Infarction Papillary muscle rupture Ventricular septal rupture Cardiac Rubs Pericardial friction rub Key Points References 13 Cardiovascular Diagnostic Procedures Hemodynamic Monitoring Hemodynamic Monitoring Equipment Heparin Calibration of Hemodynamic Monitoring Equipment Zeroing the Transducer Midaxillary Line (Phlebostatic Axis) Leveling 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 Damped waveform Underdamped waveform Fast-flush square waveform test Hemodynamic Monitoring Alarms Invasive Hemodynamic Monitoring Central Venous Pressure Monitoring Indications Central Venous Catheters Insertion Internal jugular vein Subclavian vein Femoral vein Central Venous Catheter Complications Air embolus Thrombus formation Infection Nursing Management Central venous pressure–volume assessment Passive leg raise Removal Patient position Central venous pressure waveform interpretation Cannon waves Specialized Central Venous Catheters Pulmonary Artery Pressure Monitoring Indications Cardiac Output Determinants Oxygen Supply and Demand Preload Estimation of preload Frank-Starling law of the heart Ejection fraction Cardiac dysfunction Pulmonary artery diastolic pressure and pulmonary artery occlusion pressure relationship Pulmonary hypertension Heart failure Mitral stenosis Mitral regurgitation 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 features Insertion 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 Avoiding complications 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 invasive cardiac output measurement Calculated hemodynamic profiles using a pulmonary artery catheter Continuous Monitoring of Mixed Venous and Central Venous Oxygen Saturation Indications Catheters 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 and Cardiac Output Methods Finger cuff hemodynamic monitoring systems Arterial pulse analysis hemodynamic monitoring systems Transpulmonary thermodilution monitoring systems Visual Hemodynamic Monitoring Methods Transesophageal echocardiography Ultrasound-based hemodynamic monitoring Doppler-Based Hemodynamic Monitoring Methods Less Common Hemodynamic Monitoring Methods Partial Carbon Dioxide Rebreathing Cardiac Output Thoracic Electrical Bioimpedance ELECTROCARDIOGRAPHY Basic Principles of Electrocardiography Phase 0 Phases 1 and 2 Phase 3 Phase 4 Electrocardiogram Leads 12-Lead electrocardiogram Standard limb leads Augmented vector leads Precordial leads Right ventricular precordial leads Posterior wall leads Baseline distortion Electrocardiogram Analysis Specialized Electrocardiogram Paper Calibration Waveforms P wave QRS complex T wave Intervals Between Waveforms PR interval QRS 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 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 Rhythm control Surgical procedures to manage atrial fibrillation Catheter procedures to manage 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 Contractions Compensatory pause Describing ventricular ectopy Premature ventricular contraction timing Causes of premature ventricular contractions Premature ventricular contraction management Idioventricular rhythms Ventricular tachycardia Ventricular Fibrillation Differential Diagnosis of Wide QRS Complex Tachycardia Significance of ventricular tachycardia and supraventricular tachycardia Clinical differentiation of ventricular tachycardia from supraventricular tachycardia 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 Hemoglobin Hematocrit 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 Diagnostic Procedures Cardiac Catheterization and Coronary Arteriography Left-Heart Catheterization Right-Heart Catheterization Procedure Nursing Management Access site care Peripheral pulses Rehydration Angina Dysrhythmias Patient Education Electrophysiology Study Indications EPS Procedure Atrial measurements Ventricular measurements Implantable cardioverter defibrillators Chest Radiography Basic Principles and Technique Tissue densities Standard views Portable chest radiography Nursing interventions to produce an optimal chest radiograph Indications Chest Radiograph Analysis: Cardiac Factors Heart size Pulmonary edema Chest Radiograph Analysis: Cardiac Lines and Tubes Central venous catheter Pulmonary artery catheter Endotracheal tube Enteric tube Chest tube Intra-aortic balloon catheter Pacemaker or implantable defibrillator Digital Radiography Ambulatory Electrocardiography Continuous Electrocardiogram Recording Systems Intermittent Electrocardiogram Recording Systems Remote electrocardiogram monitoring Implantable electrocardiogram recording systems Commercially available 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 How Magnetic Resonance Imaging Works Metal Objects Challenges With Magnetic Resonance Imaging Cardiac Indications Cardiac Computed Tomography Cardiac Radionuclide Imaging Studies Purpose of Radionuclide Scans Radionuclide Isotopes Thallium-201 Technetium-99m 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 References 14 Cardiovascular Disorders Coronary Artery Disease Description and Etiology Women and Heart Disease Vascular Inflammation C-Reactive Protein Coronary Artery Disease Risk Equivalents Multifactorial Risk Primary Versus Secondary Prevention of Coronary Artery Disease Pathophysiology of Coronary Artery Disease Development of Atherosclerosis Atherosclerotic Plaque Rupture Plaque Regression Acute Coronary Syndrome Angina Angina symptom equivalents Women and angina Stable angina Unstable angina Variant angina Silent ischemia Medical Management Nursing Management Recognizing Myocardial Ischemia Relieving Chest Pain Maintaining a Calm Environment Educate the Patient and Family Myocardial Infarction Description and Etiology Pathophysiology 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 Artery Anticoagulation Dysrhythmia Prevention Prevention of Ventricular Remodeling Nursing Management Balance of Myocardial Oxygen Supply and Demand Prevention of Complications Depression After Myocardial Infarction Educate the Patient and Family Sudden Cardiac Death Description Etiology Medical Management Heart Failure Description and Etiology Pathophysiology Assessment and Diagnosis Left Ventricular Failure Right Ventricular Failure Systolic Heart Failure Diastolic Heart Failure Systolic Heart Failure Versus Diastolic Heart Failure Acute Heart Failure Versus Chronic Heart Failure Neurohormonal Compensatory Mechanisms in Heart Failure Pulmonary Complications of Heart Failure Shortness of Breath in Heart Failure Pulmonary Edema in Heart Failure Arterial blood gases in pulmonary edema Cardiogenic pulmonary edema versus noncardiogenic pulmonary edema Dysrhythmias and Heart Failure Medical Management Relief of Symptoms and Enhancement of Cardiac Performance Correction of Precipitating Causes Palliative Care for End-Stage Heart Failure 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 Obstructive Cardiomyopathy Dilated Cardiomyopathy Ischemic dilated cardiomyopathy Idiopathic dilated cardiomyopathy Other causes of dilated cardiomyopathy Restrictive Cardiomyopathy Nursing Management Educate the Patient and Family Pulmonary Hypertension Description and Etiology World Health Organization Classification of Pulmonary Hypertension Functional Classification of Pulmonary Hypertension Idiopathic Pulmonary Artery Hypertension Heritable Pulmonary Artery Hypertension Associated Pulmonary Artery Hypertension Pulmonary Veno-occlusive Disease and Pulmonary Capillary Hemangiomatosis Pulmonary Hypertension Caused by Left Heart Disease Pulmonary Hypertension Associated with Lung Disease or Hypoxemia Chronic Thromboembolic Pulmonary Hypertension Pulmonary Hypertension with Unclear and Multifactorial Mechanisms Pathophysiology Assessment and Diagnosis Physical Assessment Medical Management Medications 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 Atherosclerotic Diseases of the Aorta Description Aortic Aneurysm Aortic Dissection Etiology Assessment and Diagnosis Aortic Aneurysm Aortic Dissection Medical Management Nursing Management Hypertension Management Pain Control Educate the Patient and Family Peripheral Artery Disease Description 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 Etiology Medical Management Nursing Management Neurologic Assessment Educate the Patient and Family Venous Thromboembolism Description 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 Emergency 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 References 15 Cardiovascular Therapeutic Management Pacemakers Indications for Temporary Pacing Therapeutic Indications Diagnostic Indications Pacemaker System Pacing Pulse Generator Pacing Lead Systems Pacing Routes Five-Letter Pacemaker Codes Pacemaker Settings Pacing Artifacts Pacemaker Malfunctions Pacing Abnormalities Sensing Abnormalities Undersensing Oversensing Medical Management Nursing Management Prevention of Pacemaker Malfunction Microshock Protection Infection Risk Educate the Patient and Family Permanent Pacemakers Cardiac Resynchronization Therapy Medical Management Nursing Management Implantable Cardioverter Defibrillators Implantable Cardioverter Defibrillator System Insertion of Implantable Cardioverter Defibrillator Medical Management Nursing Management Educate the Patient and Family Fibrinolytic Therapy Eligibility Criteria Fibrinolytic Agents Streptokinase Tissue Plasminogen Activator Recombinant Plasminogen Activator Tenecteplase Outcomes of Fibrinolytic Therapy Evidence of Reperfusion Pain and Reperfusion Dysrhythmias ST Segment Cardiac Biomarkers Residual Coronary Artery Stenosis Nursing Management Educate the Patient and Family Catheter-Based Interventions For Coronary Artery Disease Indications for Catheter-Based Interventions Percutaneous Transluminal Coronary Angioplasty Atherectomy Thrombectomy Embolic Protection Devices Coronary Stents Drug-Eluting Stents Stent Thrombosis In-Stent Restenosis Procedure Acute Complications Nursing Management Angina Prevention of Contrast-Induced Acute Injury Vascular Site Care Educate the Patient and Family Percutaneous Valve Repair Balloon Valvuloplasty Transcatheter Aortic Valve Replacement Cardiac Surgery Coronary Artery Bypass Graft Surgery Valvular Surgery Cardiopulmonary Bypass Off-Pump Coronary Artery Bypass Graft Surgery Postoperative Management Cardiovascular Support Heart rate Preload Afterload Contractility Mechanical Complications Temperature Regulation Control of Bleeding Chest Tube Patency Cardiac Tamponade Pulmonary Care Neurologic Complications Infection Acute Kidney Injury Resuscitation of Patients Who Arrest After Cardiac Surgery Guidelines for Coronary Artery Bypass Graft Surgery Patient and Family Education Technical Advances Minimally Invasive Cardiac Surgery Surgical Treatment of Cardiac Dysrhythmias Mechanical Circulatory Support Short-Term Mechanical Circulatory Support Devices Intra-aortic Balloon Pump Medical management Nursing management Timing Complications Weaning Educate the patient and family Left Atria to Aorta Assist Device Left Ventricle to Aorta Assist Device Right Ventricular Assist Devices Extracorporeal Membrane Oxygenation System Long-Term Ventricular Assist Devices Nursing Management Device failure Anticoagulation Infection Patient and family education Vascular Surgery Carotid Endarterectomy Postoperative Nursing Management Neurologic Assessment Bleeding Cardiovascular Monitoring Carotid Stents Abdominal Aortic Aneurysm Repair Surgical Repair Postoperative management Endovascular Stent Grafts Peripheral Vascular Procedures Surgical Revascularization Percutaneous Interventions Nursing management Cardiovascular Medications Antidysrhythmic Medications Class I Class II Class III Class IV Unclassified Antidysrhythmics Side Effects Treatment of Atrial Fibrillation Inotropic Medications Cardiac Glycosides Sympathomimetic Agents Phosphodiesterase Inhibitors Vasodilator Medications Direct Smooth Muscle Relaxants Calcium Channel Blockers Angiotensin-Converting Enzyme Inhibitors Angiotensin-Receptor Blockers Alpha-Adrenergic Blockers Dopamine Receptor Agonists Vasopressors Medication Treatment of Heart Failure Additional Resources Key Points Pacemakers Implantable Cardioverter Defibrillators Fibrinolytic Therapy Catheter-Based Interventions for Coronary Artery Disease Cardiac Surgery Mechanical Circulatory Assist Devices Vascular Surgery Effects of Cardiovascular Medications References III. Pulmonary Alterations 16 Pulmonary Anatomy and Physiology Thorax Thoracic Cage Lungs Lobes and Segments Mediastinum Pleura Intrapleural Pressure Muscles of Ventilation Inhalation Exhalation Accessory Muscles Conducting Airways Upper Airways Epiglottis Trachea Bronchial Tree Bronchi Bronchioles Defense System Respiratory Airways Respiratory Bronchioles Alveoli Type I Alveolar Epithelial Cells Collateral air passages Type II Alveolar Epithelial Cells Surfactant Defense System Pulmonary Blood and Lymph Supply Pulmonary Circulation Pulmonary Artery Pressures Alveolar-Capillary Membrane Membrane Layers Bronchial Circulation Physiologic Shunting Lymphatic Circulation Ventilation Work of Breathing Pulmonary Volumes and Capacities Physiologic Dead Space Regulation of Ventilation Controller Brainstem Cerebral cortex Effectors Sensors Central chemoreceptors Peripheral chemoreceptors Other receptors Respiration Diffusion Ventilation/Perfusion Relationships Distribution of Ventilation Distribution of Perfusion Ventilation/Perfusion Mismatch Hypoxic Vasoconstriction Gas Transport Oxygen Content Oxygen Content Formula Oxyhemoglobin Dissociation Curve Shifts in the oxyhemoglobin dissociation curve Shift to the right Shift to the left Abnormalities of Hemoglobin Carbon Dioxide Content Key Points Anatomy Physiology References 17 Pulmonary Clinical Assessment History 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 References 18 Pulmonary Diagnostic Procedures Laboratory Studies Arterial Blood Gases Steps for Interpretation of Blood Gas Levels Step 1 Step 2 Step 3 Step 4 Step 5 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 Thoracentesis Bedside Pulmonary Function Tests Ventilation/Perfusion Scanning Chest Radiography Bones Mediastinum Diaphragm Pleural Space Lung Tissue Tubes, Wires, and Lines Other Diagnostic Procedures Nursing Management Bedside Monitoring Capnography Pulse Oximetry Key Points Laboratory Studies Diagnostic Procedures Bedside Monitoring References 19 Pulmonary Disorders Acute Lung Failure Description and Etiology Pathophysiology Alveolar Hypoventilation Ventilation/Perfusion Mismatching Intrapulmonary Shunting Assessment and Diagnosis Medical Management Oxygenation Ventilation Pharmacology Acidosis Nutrition Support Complications Nursing Management Optimize Oxygenation and Ventilation Positioning Preventing desaturation Promoting secretion clearance Educate the Patient and Family Acute Respiratory Distress Syndrome Description and Etiology Pathophysiology Exudative Phase Fibroproliferative Phase Resolution Phase Assessment and Diagnosis Medical Management Ventilation Low tidal volume Permissive hypercapnia Pressure control ventilation Inverse ratio ventilation High-frequency oscillatory ventilation Oxygen Therapy Positive end-expiratory pressure Extracorporeal and intracorporeal gas exchange Tissue Perfusion Nursing Management Optimize Oxygenation and Ventilation Prone positioning Pneumonia Description and Etiology Severe Community-Acquired Pneumonia Hospital-Acquired Pneumonia Ventilator-Associated Pneumonia Pathophysiology Assessment and Diagnosis Medical Management Antibiotic Therapy Independent Lung Ventilation Nursing Management Optimize Oxygenation and Ventilation Prevent Spread of Infection Aspiration Pneumonitis Description and Etiology Pathophysiology Acid Liquid Acid Food Particles Nonacid Liquid Nonacid Food Particles Assessment and Diagnosis Medical Management Nursing Management Optimize Oxygenation and Ventilation Prevent Aspiration Acute Pulmonary Embolism Description and Etiology Pathophysiology Increased Dead Space Bronchoconstriction Compensatory Shunting Hemodynamic Consequences Assessment and Diagnosis Medical Management Prevention of Recurrence Clot Dissolution Reversal of Pulmonary Hypertension Nursing Management Optimize Oxygenation and Ventilation Monitor for Bleeding Educate the Patient and Family Status Asthmaticus Description and Etiology Pathophysiology Pulmonary Effects Cardiovascular Effects Assessment and Diagnosis Medical Management Bronchodilators Systemic Corticosteroids Oxygen Therapy Intubation and Mechanical Ventilation Nursing Management Optimize Oxygenation and Ventilation Educate the Patient and Family Air Leak Disorders Description and Etiology Pathophysiology Pneumothorax Barotrauma Assessment and Diagnosis Medical Management Tension Pneumothorax Tension Pneumopericardium 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 preparedness Weaning readiness Weaning approach Weaning method Weaning Process Stage Weaning initiation Weaning progress Weaning intolerance Facilitative therapies Weaning Outcome Stage Weaning completed Incomplete weaning Additional Resources Key Points Acute Lung Failure Acute Respiratory Distress Syndrome Pneumonia Aspiration Pneumonitis Pulmonary Embolism Status Asthmaticus Air Leak Disorders Long-Term Mechanical Ventilation Dependence References 20 Pulmonary Therapeutic Management Oxygen Therapy Principles of Therapy 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 Step 1: preparation Step 2: preoxygenation Step 3: pretreatment Step 4: paralysis with induction Step 5: protection and positioning Step 6: placement of endotracheal tube Step 7: postintubation management Complications Tracheostomy Tubes Tracheostomy Procedure Complications Nursing Management Humidification Cuff Management Cuff pressure monitoring Foam cuff tracheostomy tubes Subglottic secretion removal Suctioning Complications Suctioning protocol Closed tracheal suction system Communication Passy-Muir valve Oral Hygiene Extubation and Decannulation Invasive Mechanical Ventilation Indications Use of Mechanical Ventilators Types of Ventilators Ventilator Mechanics Trigger Limit Cycle Baseline Modes of Ventilation Ventilator Settings Complications Ventilator-Induced Lung Injury Cardiovascular Compromise Gastrointestinal Disturbances Patient-Ventilator Dyssynchrony Ventilator-Associated Pneumonia Semirecumbency Sedation vacation Other measures to reduce incidence of ventilator-associated pneumonia Weaning Readiness to Wean Weaning Trial Spontaneous breathing trials Synchronized intermittent mandatory ventilation trials Pressure support ventilation trials 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 Lung Failure Bronchopleural Fistula Hemorrhage Cardiovascular Disturbances Postoperative Nursing Management Optimizing Oxygenation and Ventilation Preventing Atelectasis Patient positioning and early ambulation Deep breathing and incentive spirometry Pain management 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 References IV. Neurologic Alterations 21 Neurologic Anatomy and Physiology Divisions of the Nervous System Anatomic Divisions Physiologic Divisions Microstructure of the Nervous System Neuroglia Neurons Central Nervous System Cranial Protective Mechanisms Cranium Meninges Dura mater Arachnoid mater Pia mater Ventricular System Cerebrospinal Fluid Blood–Brain Barrier Cerebrum Frontal Lobe Parietal Lobe Temporal Lobe Occipital Lobe Limbic Lobe Internal Capsule Basal Ganglia Diencephalon Thalamus Hypothalamus Cerebellum 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 Gray and White Matter Cranial Nerves Autonomic Nervous System Key Points Anatomy Physiology References 22 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 Cushing triad Rapid Neurologic Assessment Conscious Patient Unconscious Patient Neurologic Changes Associated with Intracranial Hypertension Diagnostic Procedures Radiologic Procedures Skull and Spine Films Computed Tomography Magnetic Resonance Imaging Cerebral Angiography Conventional angiography Digital subtraction angiography Magnetic resonance angiography Computed tomography angiography Myelography Cerebral Blood Flow and Metabolism Imaging Perfusion Computed Tomography Xenon Computed Tomography Perfusion Magnetic Resonance Imaging Carotid Ultrasonography Emission Tomography Studies Positive emission tomography Single-photon emission computed tomography Electrophysiology Studies Electroencephalography Evoked Potentials Laboratory Studies Cerebrospinal Fluid Analysis Multimodal Bedside Monitoring Intracranial Pressure Monitoring Types of Intracranial Pressure Monitoring Devices Intraventricular catheter monitoring device Intraparenchymal microsensor monitoring device Combination intraventricular/fiberoptic catheter Intracranial Pressure Waves Normal intracranial pressure waveform Abnormal intracranial pressure waveforms 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 Key Points History Focused Physical Assessment Diagnostic Procedures Laboratory Studies Multimodal Monitoring References 23 Neurologic Disorders and Therapeutic Management Stroke Ischemic Stroke Description and Etiology Pathophysiology Assessment and Diagnosis Medical Management Subarachnoid Hemorrhage Description and Etiology Pathophysiology Cerebral aneurysm Arteriovenous malformation Assessment and Diagnosis Medical Management Rebleeding Endovascular coiling of aneurysms Surgical clipping of aneurysms Surgical resection of arteriovenous malformations Embolization of arteriovenous malformations Delayed cerebral ischemia Normovolemic-induced hypertension Nimodipine Cerebral angioplasty Hyponatremia Hydrocephalus 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 Bleeding and vasospasm Increased intracranial pressure Damage to nondominant hemisphere Agnosia Visual field defects Apraxia Damage to dominant hemisphere Receptive aphasia Expressive aphasia Global aphasia Impaired swallowing Educate the Patient and Family COMA Description and Etiology Pathophysiology Assessment and Diagnosis Medical Management Nursing Management Eye Care Guillain-Barré Syndrome Description and Etiology Pathophysiology Assessment and Diagnosis Medical Management Nursing Management Maintain Surveillance for Complications Initiate Rehabilitation Facilitate Nutrition Support Provide Comfort and Emotional Support Educate the Patient and Family Craniotomy Types of Surgery Preoperative Care Surgical Considerations Transcranial Approach Transsphenoidal Approach Postoperative Medical Management Intracranial Hypertension Surgical Hemorrhage Fluid Imbalance Cerebrospinal Fluid Leak Deep Vein Thrombosis Postoperative Nursing Management Preserve Cerebral Perfusion Positioning Fluid management Avoidance of vomiting and fever Promote Arterial Oxygenation Provide Comfort and Emotional Support Maintain Surveillance for Complications Infection Corneal abrasions Injury Initiate Early Rehabilitation Educate the Patient and Family Intracranial Hypertension Pathophysiology Volume-Pressure Curve Cerebral Blood Flow and Autoregulation Assessment and Diagnosis Medical and Nursing Management Positioning and Other Nursing Activities Hyperventilation Temperature Control Blood Pressure Control Seizure Control Cerebrospinal Fluid Drainage Hyperosmolar Therapy Control of Metabolic Demand Barbiturate therapy Herniation Syndromes Supratentorial Herniation Uncal herniation Central herniation Cingulate herniation Transcalvarial herniation Infratentorial Herniation Upward transtentorial herniation Downward cerebellar herniation Pharmacologic Agents Additional Resources Key points Stroke Ischemic Stroke Subarachnoid Hemorrhage Intracerebral Hemorrhage Coma Guillain-Barré Syndrome Craniotomy Intracranial Hypertension References V. Kidney Alterations 24 Kidney Anatomy and Physiology Macroscopic Anatomy Vascular Anatomy Microscopic Structure and Function Glomerulus Bowman Capsule Proximal Tubule Loop of Henle Distal Tubule Collecting Duct Nervous System Innervation Urine Formation Glomerular Filtration Tubular Reabsorption Passive Transport Active Transport Tubular Secretion Functions of the Kidneys Elimination of Metabolic Wastes Urea Creatinine Blood Pressure Regulation Erythrocyte Production Vitamin D Activation Prostaglandin Synthesis Acid–Base Balance Fluid Balance Fluid Compartments Electrolytes Fluid Physiology Tonicity Hydrostatic Pressure Osmotic Pressure Diffusion, Osmosis, and Active Transport Movement of Water Fluid Balance Control Antidiuretic Hormone and Aquaporins Aldosterone Atrial Natriuretic Peptide Electrolyte Balance Potassium Sodium Calcium Magnesium Phosphorus Chloride Bicarbonate Effects of Aging Key Points Anatomy Physiology References 25 Kidney Clinical Assessment and Diagnostic Procedures History Physical Examination Inspection Bleeding Volume Edema Auscultation Heart Blood Pressure Lungs Palpation Percussion Kidneys Abdomen Additional Assessments Weight Monitoring Intake and Output Monitoring Hemodynamic Monitoring Other Observations Laboratory Assessment Blood Urea Nitrogen Creatinine Blood Urea Nitrogen-to-Creatinine Ratio Creatinine Clearance Cystatin C Osmolality Anion Gap Hemoglobin and Hematocrit Albumin Urinalysis Urine Appearance Urine pH Urine Specific Gravity Urine Osmolality Urine Protein Urine Glucose Urine Ketones Urine Electrolytes Urine sodium Urine Sediment Hematuria Urine Toxicology Screen Imaging Studies Kidney Biopsy Key Points Clinical Assessment Laboratory Studies Diagnostic Procedures References 26 Kidney Disorders and Therapeutic Management Acute Kidney Injury Critical Illness and Acute Kidney Injury Definitions of Acute Kidney Injury RIFLE Criteria Acute Kidney Injury Network Criteria Types of Acute Kidney Injury Prerenal Acute Kidney Injury Intrarenal Acute Kidney Injury Postrenal Acute Kidney Injury Assessment and Diagnosis Laboratory Assessment Acidosis Blood Urea Nitrogen Azotemia Serum Creatinine Creatinine Clearance Fractional Excretion of Sodium At-Risk Disease States and Acute Kidney Injury Chronic Kidney Disease Cardiorenal Syndrome Respiratory Failure and Acute Kidney Injury Sepsis and Acute Kidney Injury Trauma and Acute Kidney Injury Rhabdomyolysis Contrast-Induced Nephrotoxic Injury and Acute Kidney Injury Radiopaque Contrast Medium Promote Hydration and Avoid Dehydration Medications Catheter-Associated Urinary Tract Infection Hemodynamic Monitoring and Fluid Balance Daily Weight Physical Assessment Electrolyte Balance Potassium Sodium Calcium and Phosphorus Calcium Replacement Dietary Phosphorus–Binding Medications Medical Management Treatment Goals Prevention Fluid Resuscitation Crystalloids and colloids Crystalloids Colloids Intravenous fluid volume Fluid restriction in kidney failure Fluid removal Pharmacologic Management Diuretics Loop diuretics Thiazide diuretics Osmotic diuretics Carbonic anhydrase inhibitor diuretics Potassium-sparing diuretics Vaptans Dopamine Acetylcysteine Dietary Phosphorus Binders Nutrition Nursing Management Risk Factors for Acute Kidney Injury Catheter-Associated Urinary Tract Infection Urinary catheter management External urine collection options Fluid Balance Electrolyte Imbalance Preventing Anemia Erythropoiesis-stimulating medications Educate the Patient and Family Renal Replacement Therapy: Dialysis Hemodialysis Hemodialyzer Ultrafiltration Anticoagulation Vascular Access Temporary vascular access Permanent vascular access Arteriovenous fistula Arteriovenous grafts Tunneled catheters Medical Management Nursing Management Continuous Renal Replacement Therapy Continuous Renal Replacement Therapy Terminology Diffusion Convection Absorption Ultrafiltrate volume Replacement fluid Anticoagulation Modes of Continuous Renal Replacement Slow continuous ultrafiltration Continuous venovenous hemofiltration Continuous Venovenous Hemodialysis Continuous venovenous hemodiafiltration Complications Medical Management Nursing Management Peritoneal Dialysis Catheter Placement Infection Nursing Management Additional Resources Key Points Acute Kidney Injury Catheter-Associated Urinary Tract Infection Diuretics and Renal Replacement Therapies References VI. Gastrointestinal Alterations 27 Gastrointestinal Anatomy and Physiology Mouth Ingestion and Mastication Salivation Esophagus Swallowing Stomach Gastric Secretion Gastric Motility Small Intestine Intestinal Secretion Intestinal Motility Digestion and Absorption Large Intestine Colonic Motility Resorption Accessory Organs Liver Nutrient Metabolism Hematologic Function Detoxification and Storage Bile Bilirubin Biliary System Bile Pancreas Exocrine Functions Endocrine Functions Key Points Anatomy Physiology References 28 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 Assessment of Deep Organs Palpation Detection of Abdominal Pathologic Conditions Assessment Findings for Common Disorders Laboratory Studies Diagnostic Procedures Endoscopy Nursing Management Angiography Nursing Management Plain Abdominal Series Nursing Management Abdominal Ultrasound Nursing Management Computed Tomography of the Abdomen Nursing Management Hepatobiliary Scintigraphy Nursing Management Gastrointestinal Bleeding Scan Nursing Management Magnetic Resonance Imaging Nursing Management Percutaneous Liver Biopsy Nursing Management Key Points History Focused Physical Assessment Laboratory Studies Diagnostic Procedures References 29 Gastrointestinal Disorders and Therapeutic Management Acute Gastrointestinal Hemorrhage Description and Etiology Peptic Ulcer Disease Stress-Related Mucosal Disease Esophagogastric Varices Pathophysiology Assessment and Diagnosis Hematemesis Hematochezia and Melena Laboratory Studies Diagnostic Procedures Medical Management Stabilization Controlling Bleeding Peptic ulcer disease Stress-related mucosal disease Esophagogastric varices Surgical Intervention Peptic ulcer disease Stress-related mucosal disease Esophagogastric varices Nursing Management Administer Volume Replacement Initiate Gastric Lavage Maintain Surveillance for Complications Educate the Patient and Family Acute Pancreatitis Description and Etiology Pathophysiology Assessment and Diagnosis Physical Assessment Laboratory Studies Diagnostic Procedures Medical Management Fluid Management Nutrition Support Systemic Complications Local 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 Medical Management Ammonia Levels Complications Nursing Management Protect the Patient from Injury Maintain Surveillance for Complications Educate the Patient and Family Gastrointestinal Surgery Types of Surgery Esophagectomy Pancreaticoduodenectomy Bariatric Surgery Preoperative Care Complications and Medical Management Pulmonary Complications Anastomotic Leak Deep Vein Thrombosis and Pulmonary Embolism Bleeding Postoperative Nursing Management Pulmonary Management Pain Management Therapeutic Management Gastrointestinal Intubation Nasogastric Suction Tubes Long Intestinal Tubes Endoscopic Injection Therapy Endoscopic Variceal Ligation Transjugular Intrahepatic Portosystemic Shunt Pharmacologic Agents Antiulcer Agents Vasopressin Octreotide Additional Resources Key Points Acute Gastrointestinal Hemorrhage Acute Pancreatitis Acute Liver Failure Gastrointestinal Surgery Therapeutic Management References VII. Endocrine Alterations 30 Endocrine Anatomy and Physiology Pancreas Anatomy Pancreas Blood Supply Exocrine Cells Endocrine Cells Physiology Insulin Blood Glucose Carbohydrate anabolism Fat anabolism Protein conservation Glucagon Somatostatin Pancreatic Polypeptide Glucose Regulatory Pathways Beyond the Pancreas Glucose Transporters (GLUTs) GLUT1 and GLUT3 GLUT2 GLUT4 GLUT5 Incretins in the Gastrointestinal System Glucose-dependent insulinotropic polypeptide Glucagon-like peptide 1 Dipeptidyl peptidase-4 Sodium Glucose Co-Transporter-2 in the Kidneys SGL-2 Pituitary Gland And Hypothalamus Anatomy Anterior Pituitary Posterior Pituitary Physiology Antidiuretic Hormone Thyroid Gland Anatomy Physiology Pituitary Gland and 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 Hormones of the Adrenal Cortex Adrenal Cortex Hormones of the Adrenal Medulla Key Points Pancreas Pituitary Thyroid Adrenal References 31 Endocrine Clinical Assessment and Diagnostic Procedures History Pancreas Physical Assessment Hyperglycemia Laboratory Studies Blood Glucose Urine Glucose Glycated Hemoglobin Blood Ketones Pituitary Gland Physical Assessment Hydration Status Vital Signs Weight Changes and Intake and Output Laboratory Assessment Serum Antidiuretic Hormone Serum and Urine Osmolality Antidiuretic Hormone Test Copeptin Diagnostic Procedures Radiographic Examination Computed Tomography Magnetic Resonance Imaging Thyroid Gland Clinical Assessment History Physical Examination Laboratory Studies Thyroid-Stimulating Hormone Thyroid Tests in Critically Ill Patients Medications and Thyroid Testing Diagnostic Procedures Adrenal Gland Primary Adrenal Disorders Clinical Assessment History Physical Examination Adrenal Cortex Primary Cushing syndrome Secondary Cushing syndrome Primary Aldosteronism Adrenal Insufficiency Adrenal Crisis Critical Illness–Related Corticosteroid Insufficiency Adrenal Medulla Pheochromocytoma Diagnostic Imaging Procedures Key Points Pancreas Pituitary Thyroid Adrenal References 32 Endocrine Disorders and Therapeutic Management Acute Neuroendocrine Response To Critical Illness Hypothalamic–Pituitary–Adrenal Axis in Critical Illness Hyperglycemia in Critical Illness Hyperglycemia Management in Critical Illness Clinical Practice Guidelines for Blood Glucose Management in Critically Ill Patients Insulin Management In Critically Ill Patients Frequent Blood Glucose Monitoring Point-of-Care Testing for Blood Glucose in Critical Illness Continuous Insulin Infusion Transition From Continuous Insulin Infusion to Subcutaneous Insulin Corrective Insulin Coverage Supplemental Corrective Insulin Hypoglycemia Management Nursing Management Monitor Blood Glucose and Insulin Effectiveness and Avoid Hypoglycemia Monitor Hyperglycemic Side Effects of Vasopressor Therapy Provide Nutrition Patient and Family Education Collaborative Management Diabetes Mellitus Diabetes Mellitus Diagnosis Glycated Hemoglobin A1c Type 1 Diabetes Management of Type 1 Diabetes Type 2 Diabetes Lifestyle Management for Type 2 Diabetes Pharmacologic Management of Type 2 Diabetes Metformin Sulfonylureas Thiazolidinediones Dipeptidyl Peptidase-4 Receptor Inhibitors Sodium-Glucose Cotransporter 2 Inhibitors GLP-1 Receptor Agonists Alpha-Glucosidase Inhibitors Insulin in Type 2 Diabetes Polypharmacy in Diabetes Hyperglycemic Emergencies Diabetic Ketoacidosis Epidemiology and Etiology Pathophysiology Insulin deficiency Hyperglycemia Fluid volume deficit Ketoacidosis Acid–base balance Focused Physical Assessment and Diagnosis 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 Patient and family education Collaborative Management Hyperglycemic Hyperosmolar State Epidemiology and Etiology Differences Between Hyperglycemic Hyperosmolar State and Diabetic Ketoacidosis Pathophysiology Focused Physical Assessment and Diagnosis Clinical manifestations Laboratory studies Medical Management Rapid rehydration Insulin administration Insulin resistance Electrolyte replacement Nursing Management Administering fluids, insulin, and electrolytes Monitoring response to therapy Surveillance for complications Patient and family education Collaborative Management Pituitary Gland Disorders Diabetes Insipidus Etiology Central Diabetes Insipidus Nephrogenic Diabetes Insipidus Primary Polydipsia Pathophysiology Focused Physical Assessment and Diagnosis Clinical Manifestations 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 Secretion of Antidiuretic Hormone Etiology Pathophysiology Focused Physical Assessment and Diagnosis Clinical Manifestations Laboratory Values Copeptin Medical Management Fluid Restriction Sodium Replacement Medications Vasopressin receptor antagonists Nursing Management Restriction of Fluids Patient and Family Education Collaborative Management Thyroid Gland Disorders Thyroid Storm Description Etiology Pathophysiology Focused Physical Assessment and Diagnosis Medical Management Prevent Cardiovascular Collapse Reduce Hyperthermia Fluid Replacement Pharmacologic Management Medications That Block Catecholamine Effect Medications That Block Thyroid Synthesis Medications That Block Release of Thyroid Hormone Nursing Management Medication Administration Normalize Body Temperature Rehydration and Correction of Metabolic Derangements Patient and Family Education Collaborative Management Myxedema Coma Description 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 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 Secretion of Antidiuretic Hormone Thyroid: Thyroid Storm and Myxedema Coma Adrenal References VIII. Multisystem Alterations 33 Trauma Mechanism of Injury Blunt Trauma Penetrating Trauma Phases Of Trauma Care Prehospital Care Emergency Department Primary Survey Airway Breathing Circulation Disability Exposure Secondary Survey Hemorrhagic shock in trauma Damage control resuscitation Permissive hypotension Massive transfusion protocols Damage control surgery Critical Care Phase End Points in Trauma Resuscitation Specific Trauma Injuries Traumatic Brain Injuries Pathophysiology Primary injury Secondary injury Cerebral edema Hypotension Ischemia Hypercapnia Classification of Skull and Brain Injuries Skull fracture Concussion Contusion Cerebral hematoma Epidural hematoma Subdural hematoma Acute subdural hematoma Subacute subdural hematoma Chronic subdural hematoma Intracerebral hemorrhage and hematoma Penetrating brain injury Diffuse axonal injury Neurologic Assessment of Traumatic Brain Injury Degree of traumatic brain injury Mild brain injury Moderate brain injury Severe brain injury Nursing assessment of a patient with traumatic brain injury Diagnostic procedures Medical Management Surgical management Nonsurgical management Nursing Management Spinal Cord Injuries Pathophysiology How the Spinal Cord Is Injured Hyperflexion Hyperextension Rotation Axial loading Penetrating injuries Functional Injury of the Spinal Cord Complete injury Tetraplegia Paraplegia Incomplete injury Brown-Séquard syndrome Central cord syndrome Anterior cord syndrome Posterior cord syndrome Neurotrauma assessment of spinal cord injury Nursing assessment of a patient with spinal cord injury Diagnostic procedures Medical Management Surgical management Laminectomy Spinal fusion Other spinal cord surgical options Nonsurgical management Cervical injury Thoracolumbar injury Nursing Management Neurologic care Cardiovascular care Pulmonary care Gastrointestinal and genitourinary care Integumentary and musculoskeletal care Maximizing psychosocial adaptation Maxillofacial Injuries Maxillofacial skeletal injuries Physical Assessment and Diagnostic Procedures Medical Management Nursing Management Thoracic Injuries Specific Thoracic Traumatic Injuries Chest wall injuries Rib fractures Flail chest Lung injuries Pulmonary contusion Pneumothoraces in trauma Open pneumothorax Tension pneumothorax Massive hemothorax Heart and vascular injuries Blunt cardiac injury Cardiac tamponade Blunt traumatic aortic injury Abdominal Injuries Physical Assessment Diagnostic Procedures Specific Abdominal Organ Injuries Liver injuries Spleen injuries Hollow viscus injuries Abdominal Compartment Syndrome Nursing Management Genitourinary Injuries Physical Assessment Diagnostic Procedures Specific Genitourinary Injuries Kidney trauma Bladder trauma Nursing Management Musculoskeletal Injuries Pelvic Fractures Physical Assessment and Diagnostic Procedures Classification of Pelvic Fractures Anteroposterior compression pelvic injury Lateral compression pelvic injury Vertical shear Combined pelvic injuries Medical Management Nursing Management Complications of Trauma Central Nervous System Complications Pain Cardiovascular Complications Compartment Syndrome Venous Thromboembolism Pulmonary Complications Acute Respiratory Distress Syndrome Gastrointestinal and Genitourinary Complications Hypermetabolism Acute Kidney Injury Rhabdomyolysis and Myoglobinuria Integumentary and Musculoskeletal Complications Fat Embolism Syndrome Other Complications in Adult Trauma Patients Infection Sepsis Transfusion-Related Complications Missed Injury Multiple Organ Dysfunction Syndrome Special Considerations in Trauma Intimate Partner Violence and Trauma Alcohol and Substance Abuse and Trauma Trauma in Pregnancy Trauma and the Older Adult Meeting Needs of Family Members and Significant Others Additional Resources Key Points Phases of Trauma Care Specific Trauma Injuries References 34 Shock, Sepsis, and Multiple Organ Dysfunction Syndrome Shock Syndrome Description and Etiology Pathophysiology Assessment and Diagnosis Medical Management Nursing Management Hypovolemic Shock Description and Etiology Pathophysiology Assessment and Diagnosis Medical Management Nursing Management Cardiogenic Shock Description and Etiology Pathophysiology Assessment and Diagnosis Medical Management Nursing Management Anaphylactic Shock Description and Etiology Pathophysiology Assessment and Diagnosis Medical Management Nursing Management Neurogenic Shock Description and Etiology Pathophysiology Assessment and Diagnosis Medical Management Nursing Management Sepsis and Septic Shock Description and Etiology Pathophysiology Assessment and Diagnosis Medical Management Nursing Management Multiple Organ Dysfunction Syndrome Description and Etiology Pathophysiology Inflammatory Cells Neutrophils Monocytes and macrophages Mast cells Lymphocytes Endothelial cells Biochemical Mediators Reactive oxygen species Tumor necrosis factor-alpha Interleukins Platelet-activating factor Arachidonic acid metabolites Proteases Assessment and Diagnosis Gastrointestinal Dysfunction Hepatobiliary Dysfunction Pulmonary Dysfunction Kidney Dysfunction Cardiovascular and Hematologic System Dysfunction Medical Management Identification and Treatment of Infection Maintenance of Tissue Oxygenation Nutrition and Metabolic Support Nursing Management Additional Resources Key Points Shock Hypovolemic Shock Cardiogenic Shock Anaphylactic Shock Neurogenic Shock Sepsis and Septic Shock Multiple Organ Dysfunction Syndrome References 35 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 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 Carbon Monoxide Poisoning Upper Airway Injury Lower Airway Injury Nonthermal Burns Chemical Burns Electrical Burns Burn Nursing Management Resuscitation Phase Oxygenation Alterations Impaired gas exchange Ineffective airway clearance Fluid Resuscitation Deficient fluid volume Risk for Infection Tissue Perfusion Ineffective Kidney Tissue Perfusion Ineffective Cerebral Tissue Perfusion Ineffective Peripheral Tissue Perfusion Ineffective Gastrointestinal Tissue Perfusion Invasive monitoring Hypothermia Laboratory assessment Acute Care Phase Inflammatory Phase Proliferative Phase Maturation Phase Impaired Tissue Integrity Factors Affecting Healing of the Burn Wound Wound Cleansing Wound Care Topical Antibiotic Therapy Wound Débridement Mechanical débridement Enzymatic débridement Skin Substitutes Definitive Burn Wound Closure Autograft Biosynthetic Skin Substitutes Synthetic Skin Imbalanced Nutrition: Less Than Body Requirements Pain Management Rehabilitation Phase Impaired Physical Mobility Scar Management Itching Age Considerations Multidisciplinary Collaborative Care Outpatient Burn Care Support of the Patient with Burns Stressors of Burn Nursing Additional Resources Key Points References 36 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 State Laws Overview of Donation Process Types of Referrals 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 Authorization for Donation Donor Management Donor Management Goals Organ Allocation Role of Medical Examiners and Coroners in Organ and Tissue Donation 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 Antibodies Interleukin-2 Receptor Antagonists Alemtuzumab Acute Rejection Therapy Transplant Candidate Evaluation Evaluation Decision Transplant Recipient Listing Waiting for Transplant Patient and Family Education Available Organ Heart Transplantation Indications and Selection Heart Transplantation Surgical Procedure Biatrial Technique Bicaval Technique Postoperative Medical and Nursing Management 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 Criteria and Management for Heart-Lung Transplant Recipient Heart-Lung Transplant Surgery Postoperative Management of the Heart-Lung Transplant Recipient 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 Single-Lung Transplantation Indications Single-Lung Transplant Surgical Procedure Double-Lung Transplantation Surgical Procedure Lung Volume Reduction Surgery Living Donor Lobar Lung Transplantation Postoperative Management Patient and Family Education Long-Term Considerations Liver Transplantation Indications and Selection Recipient Evaluation Model for end-stage liver disease: MELD Waitlist placement Pediatric end-stage liver disease: PELD Pretransplantation Phase Determining Donor Suitability Living Donor Liver Transplantation 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 Medical and Nursing Management Hemodynamics 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 Follow-Up Future Considerations Kidney Transplantation Indications and Selection 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 Medical Management and Nursing Care of the Kidney Transplant Recipient Fluid Status Electrolytes Postoperative Complications Immunosuppression Infection Risk Preparation for Discharge Home 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 Medical and Nursing Management 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 References 37 Hematologic and Oncologic Emergencies Overview of Coagulation and Fibrinolysis Coagulation Mechanism Clot Formation Regulatory Mechanisms Fibrinolysis Disseminated Intravascular Coagulation Description and Etiology Pathophysiology Assessment and Diagnosis Clinical Manifestations Laboratory Findings Medical Management Nursing Management Support Vital Functions Initiate Bleeding Precautions Provide Comfort and Emotional Support Thrombocytopenia Description and Etiology Pathophysiology Assessment and Diagnosis Clinical Manifestations Laboratory Findings Medical Management Nursing Management Heparin-Induced Thrombocytopenia Description and Etiology Pathophysiology Assessment and Diagnosis Clinical Manifestations Laboratory Findings 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 Pathophysiology Assessment and Diagnosis Clinical Manifestations Laboratory Studies 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 Pathophysiology Hyperuricemia Hyperkalemia Hyperphosphatemia and Hypocalcemia Assessment and Diagnosis Clinical Manifestations Laboratory Findings Other Diagnostic Tests 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 References IX. Special Populations 38 The Obstetric Patient Physiologic Alterations in Pregnancy Physiologic Changes During Labor and Delivery Cardiac Disorders in Pregnancy Congenital Cardiac Disorders Atrial Septal Defect Ventricular Septal Defect Patent Ductus Arteriosus Tetralogy of Fallot Coarctation of the Aorta Eisenmenger Syndrome Acquired Cardiac Disorders Mitral Stenosis Aortic Stenosis Marfan Syndrome Peripartum Cardiomyopathy Ischemic Cardiac Disease Acute Myocardial Infarction Prior Myocardial Infarction Cardiac Arrest in Pregnancy Basic cardiac life support Advanced cardiac life support Hypertensive Disease Classification of Hypertension Preeclampsia and Eclampsia Hemolysis, Elevated Liver Enzymes, and Low Platelet Syndrome Disseminated Intravascular Coagulation Abruptio Placentae Dead Fetus Syndrome Septic Abortion Shock Pulmonary Dysfunction Asthma Cystic Fibrosis Pneumonia Acute Respiratory Distress Syndrome Management of Respiratory Failure Pulmonary Embolism Amniotic Fluid Embolism Trauma Types of Injuries Cardiovascular Injuries Pulmonary Injuries Neurologic Injuries Abdominal and Pelvic Injuries Reproductive System Injuries Fetal Injuries Postpartum Hemorrhage Risk Factors and Causes Prevention Risks to Fetal Development Prematurity Additional Resources Key Points References 39 The Pediatric Patient Respiratory System Anatomy and Physiology Upper Airway Lower Airway Chest Mechanics Assessment and Oxygen Devices Airway Positioning Supplemental Oxygen Devices Endotracheal Intubation Procedure Securing Endotracheal and Nasotracheal Tubes Mechanical Ventilation Extubation Complications Tracheostomy Bronchiolitis Pathophysiology Clinical Assessment Treatment Status Asthmaticus Pathophysiology Clinical Assessment Treatment Cardiovascular System Anatomy and Physiology Congenital Heart Defects Cardiac Monitoring Bradycardias Shock in Infants and Children Hypovolemic Shock Cardiogenic Shock Distributive Shock, Sepsis, and Septic Shock Obstructive Shock Cardiopulmonary Arrest Nervous System Anatomy Physiology Assessment Seizures Status Epilepticus Bacterial Meningitis Head Trauma Gastrointestinal System, Fluids, and Nutrition Anatomy and Physiology Assessment and Treatment Parenteral Nutrition Enteral Nutrition Pain Management Physiology and Pharmacokinetics Assessment Treatment of Pain Nonsteroidal Antiinflammatory Drugs Opioid Analgesics Topical Anesthetics Nonpharmacologic Management of Pain 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 References 40 The Older Adult Patient Overview Critical Care and the Older Adult Critical Care Unit Admission Age-Related Changes in the Older Adult Neurocognitive Age-Related Changes Physiologic Changes Cognitive Function Neurologic Assessment of the Older Adult Age-Related Changes of the Respiratory System And Pulmonary Disease Thoracic Wall and Respiratory Muscles Lung Parenchyma and Volumes Pulmonary Gas Exchange Acute Lung Failure and Pulmonary Diseases Age-Related Changes of the Cardiovascular System Myocardial Changes Vascular Changes Conduction and Beta-Adrenergic Changes Electrocardiogram Changes Left Ventricular Changes Baroreceptor Changes Heart Failure and Myocardial Infarction Hypertension Heart Disease Management Cardiac Medication Considerations in Older Adults Age-Related Changes of The Kidney System Acute Kidney Injury Age-Related Changes Of The Liver Age-Related Changes Of The Gastrointestinal System And Nutrition Diabetes In Older Adults Age-Related Changes In The Immune System Age-Related Changes In The Skin And Integumentary System Age-Related Changes In The Musculoskeletal System Complications of Critical Care For Older Adults Palliative and End-Of-Life Care For Older Adults Additional Resources Key Points References 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) Venous Oxygen Content (Cvo2) 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 Caloric and Protein Needs Estimating Caloric Needs Estimating Protein Needs Reference Appendix C: Canadian Laboratory Values Index Special Features Case Studies Concept Maps Data Collection Diagnosis and Patient Care Management Patient and Family Education Plans Patient Care Management Plans Patient-Centered Critical Care Pharmacologic Management QSEN: Evidence-Based Practice QSEN: Informatics QSEN: Patient-Centered Care QSEN: Quality Improvement QSEN: Safety QSEN: Teamwork and Collaboration
