Critical Care Nursing (eBook)

Monitoring and Treatment for Advanced Nursing Practice

Kathy J. Booker (Herausgeber)

eBook Download: PDF

2016
John Wiley & Sons (Verlag)
9781118939178 (ISBN)

Infos

Providing an easy-to-use reference, Critical Care Nursing outlines best practice for the assessment, monitoring and treatment of critically ill adult patients. Each chapter includes research and evidence-based strategies for treating commonly-seen conditions.

Initial chapters introduce ICU set-up and operation, the rapid response team, vitals measurement and shock management strategies.  Subsequent chapters, structured by organ system, focus on care relating to specific organ function and dysfunction, including the respiratory, cardiovascular, neurologic, renal and gastrointestinal systems.  Key information on monitoring for overdoses, special considerations in traumatic injury and end-of-life concerns is also included.

Critical Care Nursing is a comprehensive and informative resource for experienced staff nurses and advanced practice nurses working with critically ill patients on ICUs, PCUs, transitional care units and within emergency care departments.

Kathy Booker is Director and Professor, Millikin University School of Nursing, Illinois, USA. She has held former positions as Specialty Director of the Adult Advanced Practice Program in the School of Nursing, Yale University, Connecticut, USA, and Dean of the College of Professional Studies at Millikin University. She has been certified as a Critical Care Registered Nurse (CCRN) for over twenty years, currently holding alumnus status CCRN. She practiced as a critical care RN and Clinical Nurse Specialist for over twenty-five years.

Inhalt

Title Page 5
Copyright Page 6
Contents 7
Contributors 17
Critical Care Nursing: Monitoring and Treatment for Advanced Nursing Practice 19
Chapter 1 Philosophy and treatment in US critical care units 21
US critical care units 21
Organization of critical care delivery 21
Monitoring and surveillance in critical care 22
Surveillance 22
Nursing certification and competency in critical care units 23
US national critical care organizations 24
American Association of Critical Care Nurses 24
Society of Critical Care Medicine 25
Acute care advanced practice nursing 25
Clinical nurse specialists 26
Acute care nurse practitioners 26
Critical care and ACNP outcomes research 27
Evolution of families in the critical care unit 28
Progression and development of rapid response teams 29
References 30
Chapter 2 Vital measurements and shock syndromes in critically ill adults 33
Monitoring basic vital signs 33
Temperature monitoring 34
Hypothermia 34
Complications of cooling 35
Hyperthermia 37
Heatstroke management 37
Malignant hyperthermia 37
Heart rate monitoring 38
Blood pressure monitoring 39
Oscillometric blood pressure measurement 40
Aneroid measurement 40
Arterial pressure measurement 40
Respiratory monitoring 41
Capnography 41
Shock conditions in critically ill adults 42
Cardiogenic shock 43
Anaphylactic shock 44
Hypovolemic shock 44
Sepsis syndromes 46
SIRS, sepsis, and septic shock 46
Monitoring and treatment priorities in sepsis syndromes 48
Sepsis diagnosis 48
Body temperature 49
Cultures 49
Intravascular catheters 49
Other infectious complications in critically ill adults 49
Pulmonary infections 49
Urinary tract infections 50
Monitoring during transport 50
Conclusion 51
References 51
Chapter 3 Monitoring for respiratory dysfunction 55
Acid-base disturbances & anion gap
Metabolic acidosis 55
Metabolic alkalosis 57
Respiratory acidosis 57
Respiratory alkalosis 58
Mixed acid–base disorders 58
Oxygenation 58
Estimation of the PaO2 58
A–a Gradient 59
PaO2/FiO2 (P/F) ratio 59
Acute respiratory failure 60
Capnography 60
Monitoring ventilation with PetCO2 60
Monitoring blood flow 61
Modes of mechanical ventilation 61
Continuous positive airway pressure (CPAP) with pressure support 61
Synchronized intermittent mandatory ventilation (SIMV) 62
Assist/control ventilation (AC) 62
Pressure control ventilation 62
Airway pressure release ventilation (APRV) 62
Pressure-regulated volume control (PRVC) 62
Inverse ratio ventilation 63
Oscillatory ventilation 63
Overview of protective lung ventilation in ARDS 63
ARDSNet protocol goals 63
Monitoring for complications during mechanical ventilation 63
High peak airway pressures on mechanical ventilation 63
Response to bagging—monitoring and treatment 64
Auto-PEEP effect 64
Weaning from mechanical ventilation 64
Postextubation stridor: Monitoring and treatment 66
Noninvasive positive pressure ventilation 67
Tension pneumothorax 67
Emergent treatment—needle thoracostomy 67
Chest radiograph interpretation 68
Sleep-disordered breathing in the critical care unit 68
Obstructive sleep apnea 70
Central sleep apnea 70
Obesity hypoventilation syndrome 71
CPAP and BiPAP therapy 71
Approach to cardiogenic dyspnea in acute heart failure 72
Conclusions 73
References 73
Chapter 4 Electrocardiographic monitoring for cardiovascular dysfunction 77
Physiologic guidelines 77
Goals of monitoring 78
Post cardiopulmonary resuscitation 79
Monitoring elements 79
Evidence-based treatment guidelines 80
Acute coronary syndromes 80
Monitoring elements 82
Evidence-based treatment guidelines 82
Cardiac arrhythmias 84
Monitoring elements 85
Evidence-based treatment guidelines 85
Acute heart failure 87
Monitoring elements 87
Electrolyte abnormalities 87
Monitoring elements 88
Evidence-based treatment guidelines 88
Critical illnesses 88
Monitoring elements 88
Evidence-based treatment guidelines 88
Drug overdose 89
Monitoring elements 89
Evidenced-based guidelines 89
Unnecessary arrhythmia monitoring and underutilization of ischemia and QT-interval monitoring 89
References 90
Chapter 5 Hemodynamic monitoring in critical care 93
Hemodynamic monitoring overview 93
Hemodynamic monitoring systems 95
Pulmonary artery catheter monitoring 95
Central venous pressure monitoring and management 96
Central venous pressure trending limitations 97
Arterial line monitoring and management 98
Hemodynamic monitoring guidelines and outcomes 98
Functional indicators of hemodynamic monitoring 99
Perioperative optimization 99
Transesophageal monitoring 99
Volume responsiveness 100
Pulse contour analysis 101
FloTrac/Vigileo® 102
Transpulmonary dilution techniques 102
Passive leg raising 103
SVV protocols for management 104
References 104
Chapter 6 Monitoring for neurologic dysfunction 107
Physiological guidelines 107
Increased intracranial pressure 107
Decreased cerebral blood flow 108
Cerebral response to increased intracranial pressure 108
Rapid assessment of neurologic dysfunction in intensive care unit patients 109
Monitoring elements 109
Evidence-based treatment guidelines 110
Intracranial pressure monitoring 113
Monitoring elements 113
Evidence-based treatment guidelines 113
Measuring brain temperature 114
Evidence-based treatment guidelines 115
Brain tissue O2 monitoring 115
Monitoring elements 115
Evidence-based treatment guidelines 115
Microdialysis 115
Monitoring elements 115
Evidence-based treatment guidelines 115
Electrophysiological monitoring 116
Monitoring elements 116
Evidence-based treatment guidelines 116
The BiSpectral index monitoring 116
Monitoring elements 116
Evidence-based treatment guidelines 116
Transcranial Doppler ultrasonograpy 117
Monitoring elements 117
Evidence-based treatment guidelines 117
Shunts 118
Monitoring elements 118
Evidence-based treatment guidelines 118
Neuromuscular transmission 118
Monitoring elements 118
Evidence-based treatment guidelines 118
Management of cervical stabilization devices 118
Monitoring elements 118
Evidence-based treatment guidelines 119
Induced coma and sedation protocols 120
Monitoring elements 120
Evidence-based treatment guidelines 120
Research-based neurologic protocols 120
References 121
Chapter 7 Monitoring for renal dysfunction 124
Acute kidney injury 124
Physiological guidelines 125
Prerenal injury 125
Intrarenal injury 126
Acute tubular necrosis 127
Acute intersitial nephritis 127
Post renal injury 128
Monitoring elements 128
History and physical assessment 128
Laboratory analysis and data trending 129
Diagnostic imaging 131
Renal biopsy 131
Evidenced-based treatment guidelines 132
Prevention 132
Hemodynamic monitoring 132
Volume expansion 132
Management of electrolyte and acid–base imbalance 132
Pharmacologic interventions 133
Prevention of radiocontrast nephropathy 134
Nutrition 134
Renal replacement therapy 134
Intermittant hemodialysis 134
Continuous renal replacement therapies 134
Peritoneal dialysis 135
References 136
Chapter 8 Monitoring for blood glucose dysfunction in the intensive care unit 139
Diabetes management in the ICU 139
Effects of hyperglycemia 139
Hyperglycemia management recommendations 140
Glucose monitoring 140
Carbohydrate administration 140
Insulin therapy 141
Hypoglycemia management 141
Conclusion 141
References 144
Chapter 9 Monitoring for hepatic and GI dysfunction 146
Physiologic guidelines 146
Gastrointestinal dysfunction 146
Gastrointestinal bleeding 148
Monitoring elements: Nasogastric decompression 148
Evidence-based treatment guidelines 149
Gastric pH 149
Evidence-based treatment guidelines 150
Monitoring elements: laboratory tests for GI bleeding 150
Evidence-based treatment guidelines 150
Endoscopic procedures 150
Evidence-based treatment guidelines 151
Evidence-based treatment guidelines for stress ulcers 152
Monitoring elements: Gastric tonometry and capnometry 153
Evidence-based treatment guidelines 154
Radiographic diagnostics 154
Evidence-based treatment guidelines 155
Ultrasonography 155
Evidence-based treatment guidelines 155
Intraabdominal pressure management 155
Intraabdominal pressure measurement 156
Treatment of abdominal compartment syndrome 157
Diagnostics for liver function 157
Evidence-based treatment guidelines 158
Liver support devices 158
Evidence-based treatment guidelines 159
Balloon tamponade therapy 159
Evidence-based treatment guidelines 160
ICP monitoring in acute liver failure 160
Evidenced-based treatment guidelines 160
Ascites management 161
Evidence-based treatment guidelines: paracentesis 161
Nutritional assessment and treatment 162
Evidence-based treatment guidelines 162
Critical monitoring in acute pancreatitis 162
Evidence-based treatment guidelines for acute pancreatitis 163
Monitoring elements: pancreatitis 163
Evidence-based treatment guidelines for acute pancreatitis 163
Summary 163
References 163
Chapter 10 Traumatic injuries: Special considerations 166
Primary, secondary, and tertiary surveys 166
Fluid resuscitation 171
Fluid choice 171
End points of resuscitation 172
Intracompartmental monitoring 172
Complications 173
Thromboembolic events 173
Anticoagulation 174
Pain management 174
Early mobilization 174
Thoracic injury management 174
Abdominal trauma 175
Abdominal compartment syndrome 178
Musculoskeletal injuries and management 179
Ongoing hemorrhage 180
Pelvic fractures 181
Crush syndrome management 181
Pain management in orthopedic injury 182
Burns 182
Burn classification 182
Fluid management in burn therapy 184
Summary 185
References 185
Chapter 11 Oncologic emergencies in critical care 187
Evolution of oncology critical management 187
Sepsis in the immunocompromised host 187
Physiologic guidelines 187
Assessment and monitoring in neutropenic patients 188
Neutropenia management 188
Evidence-based guidelines 189
Research 191
Stem cell transplant 191
Infection 192
Graft-versus-host disease 192
Hepatic veno-occlusive disease 193
Pulmonary complications 194
Hematologic complications 195
Hemorrhagic complications 195
Thrombocytopenia 195
Monitoring elements 196
Management 196
Thrombotic microangiopathy 197
Physiologic guidelines 197
Monitoring elements 198
Management 199
Hyperviscosity syndromes 199
Physiologic guidelines 199
Monitoring elements 200
Management 200
Hyperleukocytosis and leukostasis 200
Physiologic guidelines 200
Monitoring elements 201
Management 201
Tumor lysis syndrome 201
Physiologic guidelines 201
Monitoring 202
Treatment 203
Management of electrolyte imbalances 204
Hyperkalemia 204
Hyperphosphatemia with secondary hypocalcemia 204
Hyperuricemia 205
Acute kidney injury 206
Evidence-based treatment guidelines 206
Structural emergencies 206
Cardiac tamponade 207
Physiologic guidelines 207
Monitoring 208
Management 209
Malignant airway obstruction 209
Physiologic guidelines 209
Monitoring 210
Management 210
Carotid blowout syndrome 212
Physiologic guidelines 212
Monitoring 213
Management 214
References 215
Chapter 12 End-of-life concerns 221
Introduction 221
Assessment and communication issues 221
Family presence 222
Advanced directives 222
Surrogate decision making 222
Delivering bad news 224
Palliative care in the ICU 224
Symptom management 226
Brain death 226
References 228
Chapter 13 Monitoring for overdoses 230
Introduction 230
General management of drug overdoses 230
Drug screening 230
New and emerging therapies 231
Indexing of drug and toxins seen in overdoses 232
Acetaminophen 233
Drug overview 233
Symptoms of overdose 233
Diagnostic testing and monitoring 233
Antidotes/binding agents 233
Salicylates and nonsteroidal anti-inflammatory drugs 234
Drug overview 234
Symptoms of overdose 234
Monitoring 234
Antidotes/binding agents/treatment 235
Methemoglobin 235
Drug overview 235
Symptoms of overdose 235
Diagnostic testing and monitoring 236
Antidotes/binding agents/treatment 236
Iron 237
Drug overview 237
Symptoms of overdose 237
Diagnostic testing and monitoring 237
Antidotes/binding agents/treatment 237
Drugs of abuse 238
Overview 238
Symptoms of overdose 238
Diagnostic testing 238
Benzodiazepines 238
Drug overview 238
Symptoms of overdose 238
Diagnostic testing and monitoring 239
Antidotes/binding agents/treatments 239
Opiods 239
Drug overview 239
Symptoms of overdose 239
Diagnostic testing and monitoring 240
Antidotes/binding agents/treatment 240
Cocaine 240
Drug overview 240
Symptoms of overdose 241
Diagnostic testing and monitoring 241
Antidotes/binding agents/treatment 242
Amphetamines 242
Drug overview 242
Symptoms of overdose 242
Diagnostic testing and monitoring 242
Antidotes/binding agents/treatments 243
Phencyclidine 243
Drug overview 243
Symptoms of overdose 243
Diagnostic testing and monitoring 243
Antidotes/binding agents/treatments 243
Barbituates 244
Drug overview 244
Symptoms of overdose 244
Diagnostic testing and monitoring 244
Antidotes/binding agents/treatments 244
Hallucinogens 244
Drug overview 244
Symptoms of overdose 245
Monitoring and treatment 245
Club drugs/date rape drugs 245
Drug overview 245
Symptoms of overdose 245
Diagnostic testing and monitoring 246
Antidotes/binding agents/treatments 246
Ketamine 246
Drug overview 246
Symptoms of overdose 246
Diagnostic testing and monitoring 247
Antidotes/binding agents/treatments 247
Fake marijuana 247
Drug overview 247
Symptoms 247
Diagnostic testing 247
Antidote 248
Dextromethorphan 248
Drug overview 248
Symptoms of overdose 248
Diagnostic testing and monitoring 248
Antidotes 249
Bath salts 249
Drug overview 249
Symptoms of overdose/use 249
Diagnostic testing and monitoring 249
Antidotes/binding agents/treatments 249
Skeletal muscle relaxants 250
Drug overview 250
Symptoms of overdose 250
Diagnostic testing and monitoring 250
Antidotes/binding agents/treatments 251
Psychiatric drugs 251
Drug overview 251
Selective serotonin reuptake inhibitors 251
Drug overview 251
Symptoms 251
Diagnostic testing and monitoring 254
Antidotes/binding agents/treatments 254
Monoamine oxidase inhibitors 254
Drug overview 254
Symptoms of overdose 255
Diagnostic testing and monitoring 255
Antidotes 255
Lithium 256
Drug overview 256
Symptom of overdose 256
Diagnostic testing and monitoring 256
Antidotes/binding agents/treatments 256
Neuroleptics 257
Drug overview 257
Symptoms of overdose 257
Diagnostic testing and monitoring 257
Antidotes/binding agents/treatments 257
Tricyclic antidepressants 258
Drug overview 258
Symptoms of overdose 258
Diagnostic testing and monitoring 258
Antidotes/binding agents/treatments 258
Carbon monoxide 259
Drug overview 259
Pharmacology 259
Symptoms 259
Diagnostic testing and monitoring 259
Antidotes/binding agents/treatments 260
Hydrocarbons and toxic inhalants 260
Drug overview 260
Pharmacology 260
Diagnostic testing and monitoring 261
Signs and symptoms 261
Antidotes/treatment 261
Cardiac medications 261
Drug overview 261
Antiarrhythmic agents 266
Toxic alcohols 268
Drug overview 268
Anticholinergics/Cholinergics/Antihistamines (ACA) 271
Drug overview 271
ACA symptoms of overdose 272
ACA diagnostic testing and monitoring 272
ACA antidotes/binding agents/treatment 272
Anticonvulsants 272
Drug overview 272
Anticonvulsants symptoms of overdose 273
Anticonvulsants diagnostic testing and monitoring 273
Anticonvulsants antidotes/ binding agents 273
Common toxidromes and treatments for poisoning conditions 273
Anticholinergic toxidrome 275
Benzodiazepine toxidrome 275
Cholinergic toxidrome 276
Opioid toxidrome 276
Sympathomimetic toxidromes 276
Rhabdomyolysis syndromes 277
Treatment of hyperkalemia 277
Packidrome 277
Alcohol withdrawal syndrome 278
Anion and non-anion gap acidosis and osmolar anion gap 278
Non-anion gap acidosis 279
Osmolar gap 279
Osmolarity corrected for elevated ETOH level 279
References 279
Index 284
EULA 293

Produkt-Details

• Erscheint lt. Verlag: 19.12.2016
• Sprache: englisch
• Themenwelt: Medizin / Pharmazie ► Gesundheitsfachberufe
• Themenwelt: Medizin / Pharmazie ► Medizinische Fachgebiete ► Intensivmedizin
• Themenwelt: Pflege ► Fachpflege ► Anästhesie / Intensivmedizin
• Schlagworte: Acute, Critical & Emergency Care • critical care, monitoring, advanced practice, best practice, ICU, operation, rapid response, vitals, shock, care, overdose, traumatic, injury, end-of-life, PCUs, care units, emergency care • Intensivpflege • Intensiv- u. Notfallpflege • Krankenpflege • Notfallpflege • nursing
• ISBN-13: 9781118939178 / 9781118939178