Critical Care Nursing: Monitoring and Treatment for Advanced Nursing Practice

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.

Table of Contents:
Contributors, xv Critical Care Nursing: Monitoring and Treatment for Advanced Nursing Practice, xvii Kathy J. Booker 1 Philosophy and treatment in US critical care units, 1 Kathy J. Booker US critical care units, 1 Organization of critical care delivery, 1 Monitoring and surveillance in critical care, 2 Surveillance, 2 Nursing certification and competency in critical care units, 3 US national critical care organizations, 4 American Association of Critical Care Nurses, 4 Society of Critical Care Medicine, 5 Acute care advanced practice nursing, 5 Clinical nurse specialists, 6 Acute care nurse practitioners, 6 Critical care and ACNP outcomes research, 7 Evolution of families in the critical care unit, 8 Progression and development of rapid response teams, 9 2 Vital measurements and shock syndromes in critically ill adults, 13 Kathy J. Booker and Laura Kierol Andrews Monitoring basic vital signs, 13 Temperature monitoring, 14 Hypothermia, 14 Complications of cooling, 15 Hyperthermia, 17 Heatstroke management, 17 Malignant hyperthermia, 17 Heart rate monitoring, 18 Blood pressure monitoring, 19 Oscillometric blood pressure measurement, 20 Aneroid measurement, 20 Arterial pressure measurement, 20 Respiratory monitoring, 21 Capnography, 21 Shock conditions in critically ill adults, 22 Cardiogenic shock, 23 Anaphylactic shock, 24 Hypovolemic shock, 24 Sepsis syndromes, 26 SIRS, sepsis, and septic shock, 26 Monitoring and treatment priorities in sepsis syndromes, 28 Sepsis diagnosis, 28 Body temperature, 29 Cultures, 29 Intravascular catheters, 29 Other infectious complications in critically ill adults, 29 Pulmonary infections, 29 Urinary tract infections, 30 Monitoring during transport, 30 3 Monitoring for respiratory dysfunction, 35 Alexander P. Johnson and Jennifer Abraham Acid-base disturbances & anion gap, 35 Metabolic acidosis, 35 Metabolic alkalosis, 37 Respiratory acidosis, 37 Respiratory alkalosis, 38 Mixed acid–base disorders, 38 Oxygenation, 38 Estimation of the PaO2, 38 A–a Gradient, 39 PaO2/FiO2 (P/F) ratio, 39 Acute respiratory failure, 40 Capnography, 40 Monitoring ventilation with PetCO2, 40 Monitoring blood flow, 41 Modes of mechanical ventilation, 41 Continuous positive airway pressure (CPAP) with pressure support, 41 Synchronized intermittent mandatory ventilation (SIMV), 42 Assist/control ventilation (AC), 42 Pressure control ventilation, 42 Airway pressure release ventilation (APRV), 42 Pressure-regulated volume control (PRVC), 42 Inverse ratio ventilation, 43 Oscillatory ventilation, 43 Overview of protective lung ventilation in ARDS, 43 ARDSNet protocol goals, 43 Monitoring for complications during mechanical ventilation, 43 High peak airway pressures on mechanical ventilation, 43 Response to bagging—monitoring and treatment, 44 Auto-PEEP effect, 44 Weaning from mechanical ventilation, 44 Postextubation stridor: monitoring and treatment, 46 Noninvasive positive pressure ventilation, 47 Tension pneumothorax, 47 Emergent treatment—needle thoracostomy, 47 Chest radiograph interpretation, 48 Sleep-disordered breathing in the critical care unit, 48 Obstructive sleep apnea, 50 Central sleep apnea, 50 Obesity hypoventilation syndrome, 51 CPAP and BiPAP therapy, 51 Approach to cardiogenic dyspnea in acute heart failure, 52 4 Electrocardiographic monitoring for cardiovascular dysfunction, 57 Catherine Winkler Physiologic guidelines, 57 Goals of monitoring, 58 Post cardiopulmonary resuscitation, 59 Evidence-based treatment guidelines, 60 Acute coronary syndromes, 60 Evidence-based treatment guidelines, 62 Cardiac arrhythmias, 64 Evidence-based treatment guidelines, 65 Acute heart failure, 67 Electrolyte abnormalities, 67 Monitoring elements, 68 Evidence-based treatment guidelines, 68 Critical illnesses, 68 Evidence-based treatment guidelines, 68 Drug overdose, 69 Evidenced-based guidelines, 69 Unnecessary arrhythmia monitoring and underutilization of ischemia and QT-interval monitoring, 69 5 Hemodynamic monitoring in critical care, 73 Kathy J. Booker Hemodynamic monitoring overview, 73 Hemodynamic monitoring systems, 75 Pulmonary artery catheter monitoring, 75 Central venous pressure monitoring and management, 76 Central venous pressure trending limitations, 77 Arterial line monitoring and management, 78 Hemodynamic monitoring guidelines and outcomes, 78 Functional indicators of hemodynamic monitoring, 79 Perioperative optimization, 79 Transesophageal monitoring, 79 Volume responsiveness, 80 Pulse contour analysis, 81 FloTrac/Vigileo®, 82 Transpulmonary dilution techniques, 82 Passive leg raising, 83 SVV protocols for management, 84 6 Monitoring for neurologic dysfunction, 87 Janice L. Hinkle and Carey Heck Physiological guidelines, 87 Increased intracranial pressure, 87 Decreased cerebral blood flow, 88 Cerebral response to increased intracranial pressure, 88 Rapid assessment of neurologic dysfunction in intensive care unit patients, 89 Evidence-based treatment guidelines, 90 Intracranial pressure monitoring, 93 Evidence-based treatment guidelines, 93 Measuring brain temperature, 94 Evidence-based treatment guidelines, 95 Brain tissue O2 monitoring, 95 Monitoring elements, 95 Evidence-based treatment guidelines, 95 Microdialysis, 95 Monitoring elements, 95 Evidence-based treatment guidelines, 95 Electrophysiological monitoring, 96 Monitoring elements, 96 Evidence-based treatment guidelines, 96 The BiSpectral index monitoring, 96 Monitoring elements, 96 Evidence-based treatment guidelines, 96 Transcranial Doppler ultrasonograpy, 97 Monitoring elements, 97 Evidence-based treatment guidelines, 97 Shunts, 98 Monitoring elements, 98 Evidence-based treatment guidelines, 98 Neuromuscular transmission, 98 Monitoring elements, 98 Evidence-based treatment guidelines, 98 Management of cervical stabilization devices, 98 Monitoring elements, 98 Evidence-based treatment guidelines, 99 Induced coma and sedation protocols, 100 Monitoring elements, 100 Evidence-based treatment guidelines, 100 Research-based neurologic protocols, 100 7 Monitoring for renal dysfunction, 104 Dawn Cooper Acute kidney injury, 104 Physiological guidelines, 105 Prerenal injury, 105 Intrarenal injury, 106 Acute tubular necrosis, 107 Acute intersitial nephritis, 107 Post renal injury, 108 Monitoring elements, 108 History and physical assessment, 108 Laboratory analysis and data trending, 109 Diagnostic imaging, 111 Renal biopsy, 111 Evidenced-based treatment guidelines, 112 Prevention, 112 Hemodynamic monitoring, 112 Volume expansion, 112 Management of electrolyte and acid–base imbalance, 112 Pharmacologic interventions, 113 Prevention of radiocontrast nephropathy, 114 Nutrition, 114 Renal replacement therapy, 114 Intermittant hemodialysis, 114 Continuous renal replacement therapies, 114 Peritoneal dialysis, 115 8 Monitoring for blood glucose dysfunction in the intensive care unit, 119 Laura Kierol Andrews Diabetes management in the ICU, 119 Effects of hyperglycemia, 119 Hyperglycemia management recommendations, 120 Glucose monitoring, 120 Carbohydrate administration, 120 Insulin therapy, 121 Hypoglycemia management, 121 9 Monitoring for hepatic and GI dysfunction, 126 Eleanor R. Fitzpatrick Physiologic guidelines, 126 Gastrointestinal dysfunction, 126 Gastrointestinal bleeding, 128 Monitoring elements: nasogastric decompression, 128 Evidence-based treatment guidelines, 129 Gastric pH, 129 Evidence-based treatment guidelines, 130 Monitoring elements: laboratory tests for GI bleeding, 130 Evidence-based treatment guidelines, 130 Endoscopic procedures, 130 Evidence-based treatment guidelines, 131 Evidence-based treatment guidelines for stress ulcers, 132 Monitoring elements: gastric tonometry and capnometry, 133 Evidence-based treatment guidelines, 134 Radiographic diagnostics, 134 Evidence-based treatment guidelines, 135 Ultrasonography, 135 Evidence-based treatment guidelines, 135 Intraabdominal pressure management, 135 Intraabdominal pressure measurement, 136 Treatment of abdominal compartment syndrome, 137 Diagnostics for liver function, 137 Evidence-based treatment guidelines, 138 Liver support devices, 138 Evidence-based treatment guidelines, 139 Balloon tamponade therapy, 139 Evidence-based treatment guidelines, 140 ICP monitoring in acute liver failure, 140 Evidenced-based treatment guidelines, 140 Ascites management, 141 Evidence-based treatment guidelines: paracentesis, 141 Nutritional assessment and treatment, 142 Evidence-based treatment guidelines, 142 Critical monitoring in acute pancreatitis, 142 Evidence-based treatment guidelines for acute pancreatitis, 143 Monitoring elements: pancreatitis, 143 Evidence-based treatment guidelines for acute pancreatitis, 143 10 Traumatic injuries: special considerations, 146 Catherine Bond and Mary Beth Voights Primary, secondary, and tertiary surveys, 146 Fluid resuscitation, 151 Fluid choice, 151 End points of resuscitation, 152 Intracompartmental monitoring, 152 Complications, 153 Thromboembolic events, 153 Anticoagulation, 154 Pain management, 154 Early mobilization, 154 Thoracic injury management, 154 Abdominal trauma, 155 Abdominal compartment syndrome, 158 Musculoskeletal injuries and management, 159 Ongoing hemorrhage, 160 Pelvic fractures, 161 Crush syndrome management, 161 Pain management in orthopedic injury, 162 Burns, 162 Burn classification, 162 Fluid management in burn therapy, 164 11 Oncologic emergencies in critical care, 167 Lisa M. Barbarotta Evolution of oncology critical management, 167 Sepsis in the immunocompromised host, 167 Physiologic guidelines, 167 Assessment and monitoring in neutropenic patients, 168 Neutropenia management, 168 Evidence-based guidelines, 169 Research, 171 Stem cell transplant, 171 Infection, 172 Graft-versus-host disease, 172 Hepatic veno-occlusive disease, 173 Pulmonary complications, 174 Hematologic complications, 175 Hemorrhagic complications, 175 Thrombocytopenia, 175 Management, 176 Thrombotic microangiopathy, 177 Physiologic guidelines, 177 Management, 179 Hyperviscosity syndromes, 179 Physiologic guidelines, 179 Management, 180 Hyperleukocytosis and leukostasis, 180 Physiologic guidelines, 180 Management, 181 Tumor lysis syndrome, 181 Physiologic guidelines, 181 Treatment, 183 Management of electrolyte imbalances, 184 Hyperkalemia, 184 Hyperphosphatemia with secondary hypocalcemia, 184 Hyperuricemia, 185 Acute kidney injury, 186 Evidence-based treatment guidelines, 186 Structural emergencies, 186 Cardiac tamponade, 187 Physiologic guidelines, 187 Management, 189 Malignant airway obstruction, 189 Physiologic guidelines, 189 Management, 190 Carotid blowout syndrome, 192 Physiologic guidelines, 192 Management, 194 12 End-of-life concerns, 201 Kathy J. Booker Introduction, 201 Assessment and communication issues, 201 Family presence, 202 Advanced directives, 202 Surrogate decision making, 202 Delivering bad news, 204 Palliative care in the ICU, 204 Symptom management, 206 Brain death, 206 13 Monitoring for overdoses, 210 Linda M. Dalessio Introduction, 210 General management of drug overdoses, 210 Drug screening, 210 New and emerging therapies, 211 Indexing of drug and toxins seen in overdoses, 212 Acetaminophen, 213 Drug overview, 213 Symptoms of overdose, 213 Diagnostic testing and monitoring, 213 Antidotes/binding agents, 213 Salicylates and nonsteroidal anti-inflammatory drugs, 214 Drug overview, 214 Symptoms of overdose, 214 Monitoring, 214 Antidotes/binding agents/treatment, 215 Methemoglobin, 215 Drug overview, 215 Symptoms of overdose, 215 Diagnostic testing and monitoring, 216 Antidotes/binding agents/treatment, 216 Iron, 217 Drug overview, 217 Symptoms of overdose, 217 Diagnostic testing and monitoring, 217 Antidotes/binding agents/treatment, 217 Drugs of abuse, 218 Overview, 218 Symptoms of overdose, 218 Diagnostic testing, 218 Benzodiazepines, 218 Drug overview, 218 Symptoms of overdose, 218 Diagnostic testing and monitoring, 219 Antidotes/binding agents/treatments, 219 Opiods, 219 Drug overview, 219 Symptoms of overdose, 219 Diagnostic testing and monitoring, 220 Antidotes/binding agents/treatment, 220 Cocaine, 220 Drug overview, 221 Symptoms of overdose, 221 Diagnostic testing and monitoring, 221 Antidotes/binding agents/treatment, 222 Amphetamines, 222 Drug overview, 222 Symptoms of overdose, 222 Diagnostic testing and monitoring, 222 Antidotes/binding agents/treatments, 223 Phencyclidine, 223 Drug overview, 223 Symptoms of overdose, 223 Diagnostic testing and monitoring, 223 Antidotes/binding agents/treatments, 223 Barbituates, 224 Drug overview, 224 Symptoms of overdose, 224 Diagnostic testing and monitoring, 224 Antidotes/binding agents/treatments, 224 Hallucinogens, 224 Drug overview, 224 Symptoms of overdose, 225 Monitoring and treatment, 225 Club drugs/date rape drugs, 225 Drug overview, 225 Symptoms of overdose, 225 Diagnostic testing and monitoring, 226 Antidotes/binding agents/treatments, 226 Ketamine, 226 Drug overview, 226 Symptoms of overdose, 226 Diagnostic testing and monitoring, 227 Antidotes/binding agents/treatments, 227 Fake marijuana, 227 Drug overview, 227 Symptoms, 227 Diagnostic testing, 227 Antidote, 228 Dextromethorphan, 228 Drug overview, 228 Symptoms of overdose, 228 Diagnostic testing and monitoring, 228 Antidotes, 229 Bath salts, 229 Drug overview, 229 Symptoms of overdose/use, 229 Diagnostic testing and monitoring, 229 Antidotes/binding agents/treatments, 229 Skeletal muscle relaxants, 230 Drug overview, 230 Symptoms of overdose, 230 Diagnostic testing and monitoring, 230 Antidotes/binding agents/treatments, 231 Psychiatric drugs, 231 Drug overview, 231 Selective serotonin reuptake inhibitors, 231 Drug overview, 231 Symptoms, 231 Diagnostic testing and monitoring, 234 Antidotes/binding agents/treatments, 234 Monoamine oxidase inhibitors, 234 Drug overview, 234 Symptoms of overdose, 235 Diagnostic testing and monitoring, 235 Antidotes, 235 Lithium, 236 Drug overview, 236 Symptom of overdose, 236 Diagnostic testing and monitoring, 236 Antidotes/binding agents/treatments, 236 Neuroleptics, 237 Drug overview, 237 Symptoms of overdose, 237 Diagnostic testing and monitoring, 237 Antidotes/binding agents/treatments, 237 Tricyclic antidepressants, 238 Drug overview, 238 Symptoms of overdose, 238 Diagnostic testing and monitoring, 238 Antidotes/binding agents/treatments, 238 Carbon monoxide, 239 Drug overview, 239 Pharmacology, 239 Symptoms, 239 Diagnostic testing and monitoring, 239 Antidotes/binding agents/treatments, 240 Hydrocarbons and toxic inhalants, 240 Drug overview, 240 Pharmacology, 240 Diagnostic testing and monitoring, 241 Signs and symptoms, 241 Antidotes/treatment, 241 Cardiac medications, 241 Drug overview, 241 Antiarrhythmic agents, 246 Toxic alcohols, 248 Drug overview, 248 Anticholinergics/Cholinergics/Antihistamines (ACA), 251 Drug overview, 251 ACA symptoms of overdose, 252 ACA diagnostic testing and monitoring, 252 ACA antidotes/binding agents/treatment, 252 Anticonvulsants, 252 Drug overview, 252 Anticonvulsants symptoms of overdose, 253 Anticonvulsants diagnostic testing and monitoring, 253 Anticonvulsants antidotes/binding agents, 253 Common toxidromes and treatments for poisoning conditions, 253 Anticholinergic toxidrome, 255 Benzodiazepine toxidrome, 255 Cholinergic toxidrome, 256 Opioid toxidrome, 256 Sympathomimetic toxidromes, 256 Rhabdomyolysis syndromes, 257 Treatment of hyperkalemia, 257 Packidrome, 257 Alcohol withdrawal syndrome, 258 Anion and non-anion gap acidosis and osmolar anion gap, 258 Non-anion gap acidosis, 259 Osmolar gap, 259 Osmolarity corrected for elevated ETOH level, 259 Index, 264