AACN Essentials of Progressive Care Nursing by Chulay, Marianne -- Read -- Imperial Library of Trantor

Index

Cover Page AACN Essentials of Progressive Care Nursing Copyright Page Dedication Contents Contents in Detail Contributors Reviewers Preface Section I. The Essentials

1. Assessment of Progressive Care Patients and Their Families

Assessment Framework

Prearrival Assessment Arrival Quick Check Comprehensive Initial Assessment Ongoing Assessment Patient Safety Considerations in Admission Assessments

Prearrival Assessment: Before The Action Begins Arrival Quick Check Assessment

Airway and Breathing Circulation and Cerebral Perfusion Chief Complaint Drugs and Diagnostic Tests Equipment

Comprehensive Initial Assessment

Past Medical History Social History Physical Assessment by Body System Transition/Discharge Planning

Ongoing Assessment

2. Planning Care for Progressive Care Patients and Their Families

Multidisciplinary Plan of Care and Critical Pathways Patient Safety Considerations in Planning Care Prevention of Common Complications

Physiologic Instability Deep Venous Thrombosis Hospital-Acquired Infections Skin Breakdown Sleep Pattern Disturbance Psychosocial Impact

Patient and Family Education

Assessment of Learning Readiness Strategies to Address Patient and Family Education Outcome Measurement

Family-Focused Care Transporting the Progressive Care Patient

Assessment of Risk for Complications Level of Care Required During Transport Preparation Transport Interfacility Transfers

Transitioning to the Next Stage of Care Supporting Patients and Families During the Dying Process

3. Interpretation and Management of Basic Cardiac Rhythms

Basic Electrophysiology ECG Waveforms, Complexes, and Intervals

P Wave QRS Complex T Wave U Wave PR Interval ST Segment QT Interval

Basic Electrocardiography Cardiac Monitoring Determination of the Heart Rate Determination of Cardiac Rhythm Common Arrhythmias Rhythms Originating in the Sinus Node

Normal Sinus Rhythm Sinus Bradycardia Sinus Tachycardia Sinus Arrhythmia Sinus Arrest

Arrhythmias Originating in the Atria

Premature Atrial Complexes Wandering Atrial Pacemaker Atrial Tachycardia Atrial Flutter Atrial Fibrillation

Arrhythmias Originating in the Atrioventricular Junction

Premature Junctional Complexes Junctional Rhythm, Accelerated Junctional Rhythm, and Junctional Tachycardia

Arrhythmias Originating in the Ventricles

Premature Ventricular Complexes Ventricular Rhythm and Accelerated Ventricular Rhythm Ventricular Tachycardia Ventricular Fibrillation Ventricular Asystole

Atrioventricular Blocks

First-Degree Atrioventricular Block Second-Degree Atrioventricular Block High-Grade Atrioventricular Block Third-Degree Atrioventricular Block (Complete Block)

Temporary Pacing

Indications Transvenous Pacing Epicardial Pacing Components of a Pacing System Basics of Pacemaker Operation Initiating Transvenous Ventricular Pacing Initiating Epicardial Pacing External (Transcutaneous) Pacemakers

Defibrillation and Cardioversion

Defibrillation Automatic External Defibrillators Cardioversion

4. Hemodynamic Monitoring

Hemodynamic Parameters

Cardiac Output Components of Cardiac Output/Cardiac Index Stroke Volume and Stroke Volume Index Factors Affecting Stroke Volume/Stroke Volume Index

Basic Components of Hemodynamic Monitoring Systems

Pulmonary Artery Catheter Arterial Catheter Pressure Tubing Pressure Transducer Pressure Amplifier Pressure Bag and Flush Device Alarms

Obtaining Accurate CVP and Arterial Values

Zeroing the Transducer Leveling the Transducer to the Catheter Tip Calibration of the Transducer/Amplifier System Ensuring Accurate Waveform Transmission

Insertion and Removal of Catheters

Central Venous Catheters Arterial Catheters

Obtaining and Interpreting Hemodynamic Waveforms

Patient Positioning Interpretation Artifacts in Hemodynamic Waveforms: Respiratory Influence

Continuous Mixed and Central Venous Oxygen Monitoring (SvO2/ScvO2)

SvO2/ScvO2 Monitoring Principles

Minimally Invasive Hemodynamic Monitoring

Thoracic Bioimpedance

5. Airway and Ventilatory Management

Respiratory Assessment Techniques, Diagnostic Tests, and Monitoring Systems

Arterial Blood Gas Monitoring Venous Blood Gas Monitoring Pulse Oximetry Assessing Pulmonary Function

Airway Management

Oropharyngeal Airway Nasopharyngeal Airway Laryngeal Mask Airway Combitube Artificial Airways Endotracheal Suctioning

Oxygen Therapy

Complications Oxygen Delivery

Basic Ventilatory Management

Indications General Principles Patient-Ventilator System Modes Complications of Mechanical Ventilation Weaning from Short-Term Mechanical Ventilation Weaning from Long-Term Mechanical Ventilation Respiratory Fatigue, Rest, and Conditioning Wean Trial Protocols Other Protocols for Use Critical Pathways Systematic Institutional Initiatives for the Management of the LTMV Patient Population Troubleshooting Ventilators Oral Feedings Communication Principles of Management

6. Pain and Sedation Management

Physiologic Mechanisms of Pain

Peripheral Mechanisms Spinal Cord Integration Central Processing

Responses to Pain Pain Assessment A Multimodal Approach to Pain Management Nonsteroidal Anti-Inflammatory Drugs

Side Effects

Opioids

Side Effects Intravenous Opioids Patient-Controlled Analgesia Switching From IV to Oral Opioid Analgesia

Epidural Analgesia

Epidural Opioids Epidural Local Anesthetics

Cutaneous Stimulation Distraction Imagery Relaxation and Sedation Techniques

Deep Breathing and Progressive Relaxation Presence

Special Considerations for Pain Management in the Elderly

Assessment Interventions

Sedation

Reasons for Sedation Drugs for Sedation Drugs for Delirium Goals of Sedation, Monitoring, and Management

7. Pharmacology

Medication Safety Medication Administration Methods

Intravenous Intramuscular or Subcutaneous Oral Sublingual Intranasal Transdermal

Central Nervous System Pharmacology

Sedatives Analgesics Anticonvulsants

Cardiovascular System Pharmacology

Miscellaneous Agents Parenteral Vasodilators Antiarrhythmics Vasodilators and Remodeling Agents Thrombolytic Agents Vasoconstricting Agents Inotropic Agents

Anti-Infective Pharmacology

Aminoglycosides Vancomycin Other Antibiotics

Pulmonary Pharmacology

Theophylline Albuterol Levalbuterol

Gastrointestinal Pharmacology

Stress Ulcer Prophylaxis Acute Peptic Ulcer Bleeding Variceal Hemorrhage

Renal Pharmacology

Diuretics

Hematologic Pharmacology

Anticoagulants Direct Thrombin Inhibitors Glycoprotein IIb/IIIa Inhibitor

Immunosuppressive Agents

Cyclosporine Tacrolimus (FK506) Sirolimus (Rapamycin)

Special Dosing Considerations

Drug Disposition in the Elderly Therapeutic Drug Monitoring

8. Ethical and Legal Considerations

The Foundation for Ethical Decision Making

Professional Codes and Standards Position Statements and Guidelines Institutional Policies Legal Standards Principles of Ethics Care Paternalism Patient Advocacy

The Process of Ethical Analysis

Assessment Plan Implementation Evaluation

Contemporary Ethical Issues

Informed Consent Determining Capacity Advance Directives End-of-Life Issues Resuscitation Decisions

Building an Ethical Environment

Values Clarification Provide Information and Clarify Issues Recognize Moral Distress Engage in Collaborative Decision Making

Section II. Pathologic Conditions

9. Cardiovascular System

Special Assessment Techniques, Diagnostic Tests, and Monitoring Systems

Assessment of Chest Pain Coronary Angiography Percutaneous Coronary Interventions Other Percutaneous Coronary Interventions

Pathologic Conditions

Acute Ischemic Heart Disease Electrophysiology Studies Heart Failure Shock Hypertension

10. Respiratory System

Special Assessment Techniques, Diagnostic Tests, and Monitoring Systems

Chest X-Rays Computed Tomography and Magnetic Resonance Imaging Pulmonary Angiograms Chest Tubes Thoracic Surgery and Procedures

Pathologic Conditions

Acute Respiratory Failure Acute Respiratory Distress Syndrome Exacerabation Chronic Obstructive Pulmonary Disease Acute Asthma Interstial Lung Disease Pulmonary Hypertension Pneumonia Pulmonary Embolism

11. Multisystem Problems

Pathologic Conditions

Sepsis and Multiple Organ Dysfunction Syndrome

Overdoses

Etiology, Risk Factors, and Pathophysiology

12. Neurologic System

Special Assessment Techniques and Diagnostic Tests

Level of Consciousness Glasgow Coma Scale Full Outline of UnResponsiveness (FOUR) Score Mental Status Motor Assessment Sensation Cranial Nerve Assessment and Assessment of Brain Stem Function Vital Sign Alterations in Neurologic Dysfunction Death by Neurologic Criteria

Diagnostic Testing

Lumbar Puncture Computed Tomography Magnetic Resonance Imaging Cerebral Angiography Transcranial Doppler Ultrasound Electroencephalography Electromyography

Intracranial Pressure (ICP)

Cerebral Blood Flow Causes of Increased Intracranial Pressure Clinical Presentation Management of Increased ICP

Acute Ischemic Stroke

Etiology, Risk Factors, and Pathophysiology Clinical Presentation Diagnostic Tests Principles of Management of Acute Ischemic Stroke

Hemorrhagic Stroke

Etiology, Risk Factors, and Pathophysiology Clinical Presentation Diagnostic Tests Principles of Management of Intracerebral Hemorrhage

Seizures

Etiology, Risk Factors, and Pathophysiology Clinical Presentation Diagnostic Testing Principles of Management of Seizures

Infections of the Central Nervous System

Meningitis Encephalitis Intracranial Abscess

Neuromuscular Diseases

Myasthenia Gravis Guillain-Barré Syndrome Amyotrophic Lateral Sclerosis

13. Hematologic and Immune Systems

Special Assessment Techniques, Diagnostic Tests, and Monitoring Systems

Complete Blood Count Red Blood Cell Count Hemoglobin Hematocrit Red Blood Cell Indices Total White Blood Cell Count White Blood Cell Differential Platelet Count Erythrocyte Sedimentation Rate Coagulation Studies Additional Tests and Procedures

Pathologic Conditions

Anemia Immunocompromise Coagulopathies

14. Gastrointestinal System

Pathologic Conditions

Acute Upper Gastrointestinal Bleeding Liver Failure Acute Pancreatitis Intestinal Ischemia Bowel Obstruction Bariatric (Weight Loss) Surgery Surgical Procedure

Nutritional Support for Acutely Ill Patients

Nutrition Requirements Nutritional Case: Special population Postgastrectomy Syndromes Gastric Residual Volume Aspiration Bowel Sounds Nausea and Vomiting Osmolality or Hypertonicity of Formula Diarrhea Flow Rates and Hours of Infusion Formula Selection

15. Renal System

Special Assessment Techniques, Diagnostic Tests, and Monitoring Systems Pathologic Conditions

Acute Renal Failure Life-Threatening Electrolyte Imbalances

Renal Replacement Therapy

Access Dialyzer/Hemofilters/Dialysate Procedures Indications for and Efficacy of Renal Replacement Therapy Modes General Renal Replacement Therapy Interventions

16. Endocrine System

Special Assessment Techniques, Diagnostic Tests, and Monitoring Systems

Blood Glucose Monitoring

Pathologic conditions

Hyperglycemic States Hyperglycemic Emergencies Acute Hypoglycemia Syndrome of Inappropriate Antidiuretic Hormone Secretion Diabetes Insipidus

17. Trauma

Specialized Assessment Techniques, Diagnostic Tests, and Monitoring Systems

Primary and Secondary Trauma Survey Assessment Diagnostic Studies Mechanism of Injury Physiologic Consequences of Trauma

Common Injuries in the Trauma Patient

Thoracic Trauma Abdominal Trauma Musculoskeletal Trauma

Complications of Traumatic Injury in Severe Multisystem Trauma

Acute Respiratory Distress Syndrome Infection/Sepsis Systemic Inflammatory Response Syndrome

Psychological Consequences of Trauma

Section III. Advanced Concepts in Caring for the Acutely Ill Patient

18. Advanced ECG Concepts

The 12-Lead Electrocardiogram

Axis Determination Bundle Branch Block Acute Coronary Syndrome Preexcitation Syndromes Advanced Arrhythmia Interpretation Supraventricular Tachycardias Polymorphic Ventricular Tachycardias Differentiating Wide QRS Beats and Rhythms

ST-Segment Monitoring

Measuring the ST Segment Choosing the Best Leads for ST-Segment Monitoring

Cardiac Pacemakers

Evaluating Pacemaker Function VVI Pacemaker Evaluation DDD Pacemaker Evaluation

19. Advanced Cardiovascular Concepts

Pathologic Conditions

Cardiomyopathy Valvular Disease Pericarditis Aortic Aneurysm Cardiac Transplantation Ventricular Assist Devices

20. Advanced Neurologic Concepts

Subarachnoid Hemorrhage

Etiology, Risk Factors, and Pathophysiology Clinical Presentation Diagnostic Tests Principles of Management of Aneurysmal Subarachnoid Hemorrhage

Traumatic Brain Injury

Etiology, Risk Factors, and Pathophysiology Clinical Presentation Diagnostic Tests Principles of Management of Traumatic Brain Injury

Traumatic Spinal Cord Injury

Etiology, Risk Factors, and Pathophysiology Clinical Presentation Diagnostic Tests Principles of Management of Acute Spinal Cord Injury Future Spinal Cord Injury Treatment

Brain Tumors

Etiology, Risk Factors, and Pathophysiology Clinical Presentation Diagnostic Tests Principles of Management of Intracranial Tumors Special Considerations: Transsphenoidal Resection of Pituitary Tumors

Special Procedures: Invasive Monitoring of Intracranial Pressure (ICP)

ICP Waveforms

Special Procedures: Management of a Patient with a Lumbar Drain

Section IV. Key Reference Information

21. Normal Values Table 22. Pharmacology Tables 23. Advanced Cardiac Life Support Algorithms 24. Cardiac Rhythms, ECG Characteristics, and Treatment Guide

Index Footnotes

Ch02Fnote

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