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Critical Care Nursing A HOLISTIC APPROACH TWELFTH EDITION

Patricia Gonce Morton Paul Thurman

Patricia Gonce Morton, PhD, RN, ACNP-BC, FAAN Dean Emeritus University of Utah College of Nursing Salt Lake City, Utah Paul A. Thurman, PhD, RN, ACNPC, CCNS, CCRN Nurse Scientist, Trauma and Critical Care R Adams Cowley Shock Trauma Center University of Maryland Medical Center Assistant Professor Adult Gerontology Acute Care Nurse Practitioner, Adult Gerontology Clinical Nurse Specialist DNP Program School of Nursing University of Maryland Baltimore, Maryland

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Copyright © 2018 Wolters Kluwer. Copyright © 2013, 2009 by Wolters Kluwer Health | Lippincott Williams & Wilkins. Copyright © 2005 by Lippincott Williams & Wilkins. Copyright © 1998 by Lippincott Raven Publishers. Copyright © 1994, 1990, 1986, 1982, 1977, 1973 by J. B. Lippincott Company. All rights reserved. This book is protected by copyright. No part of this book may be reproduced or transmitted in any form or by any means, including as pho tocopies or scanned-in or other electronic copies, or utilized by any information storage and retrieval system without written permission from the copyright owner, except for brief quotations embodied in critical articles and reviews. Materials appearing in this book prepared by individuals as part of their official duties as U.S. government employees are not covered by the above-mentioned copyright. To request permission, please contact Wolters Kluwer at Two Com merce Square, 2001 Market Street, Philadelphia, PA 19103, via email at permissions@lww.com, or via our website at shop.lww.com (products and services). 9 8 7 6 5 4 3 2 1 Printed in Mexico Library of Congress Cataloging-in-Publication Data Names: Morton, Patricia Gonce, 1952- editor. | Thurman, Paul A., editor. Title: Critical care nursing: a holistic approach / [edited by] Patricia Gonce Morton, Paul A. Thurman. Other titles: Critical care nursing (Hudak) Description: 12th edition. | Philadelphia: Lippincott Williams &

Wilkins/Wolters Kluwer, [2023] | Includes bibliographical references and index. | Summary: “Streamlined to include the most recent information, Critical Care Nursing: A Holistic Approach, 12e provides students with the theory and application knowledge necessary to fully prepare them for the highly specialized and complicated technical world of critical care nursing”—Provided by publisher. Identifiers: LCCN 2022016590 (print) | LCCN 2022016591 (ebook) | ISBN 9781975174453 (hardcover) | ISBN 9781975174460 (ebook) Subjects: MESH: Critical Care Nursing | Holistic Nursing Classification: LCC RC86.7 (print) | LCC RC86.7 (ebook) | NLM WY 154 | DDC 616.02/8—dc23/eng/20220906 LC record available at https://lccn.loc.gov/2022016590 LC ebook record available at https://lccn.loc.gov/2022016591

This work is provided “as is,” and the publisher disclaims any and all warranties, express or implied, including any warranties as to accuracy, comprehensive ness, or currency of the content of this work.

Copyright © 2022 Wolters Kluwer, Inc. Unauthorized reproduction of the content is prohibited. This work is no substitute for individual patient assessment based upon healthcare professionals’ examination of each patient and consideration of, among other things, age, weight, gender, current or prior medical conditions, medication history, laboratory data and other factors unique to the patient. The publisher does not provide medical advice or guidance and this work is merely a reference tool. Healthcare professionals, and not the publisher, are solely responsible for the use of this work including all medical judgments and for any resulting diagnosis and treatments. Given continuous, rapid advances in medical science and health information, independent professional verification of medical diagnoses, indications, ap propriate pharmaceutical selections and dosages, and treatment options should be made and healthcare professionals should consult a variety of sources. When prescribing medication, healthcare professionals are advised to consult the product information sheet (the manufacturer’s package insert) accompany ing each drug to verify, among other things, conditions of use, warnings and side effects and identify any changes in dosage schedule or contraindications, particularly if the medication to be administered is new, infrequently used or has a narrow therapeutic range. To the maximum extent permitted under applicable law, no responsibility is assumed by the publisher for any injury and/or damage to persons or property, as a matter of products liability, negligence law or otherwise, or from any reference to or use by any person of this work. shop.lww.com

To all nurses: Thank you for all you have done during the COVID-19 pandemic. You have truly performed miracles caring for patients with extremely complex cases in extraordinary circumstances. You are the backbone of the health care system making innovative contributions that will lead us forward to deliver high-quality compassionate care to patients and their families. Trish and Paul To my husband John, whose love, patience, and support made this project possible. Trish To Trish, Karen McQ, and KVR, thank you for your mentorship in making this project possible. Paul

Contributors

Anna M. Alder, MS, RN, PCCN, CCRN, NPD-BC Clinical Instructor University of Utah College of Nursing Salt Lake City, Utah Nathaniel M. Apatov, PhD, MSH, MSN, CRNA Associate Professor Old Dominion University Virginia Beach, Virginia Richard Arbour, MSN, RN, CCRN, CNRN, CCNS, CCTC, FAAN, FCCM Critical Care Clinical Nurse Specialist Temple University Hospital/Temple Health System Philadelphia, Pennsylvania Elyse Atkielski, BSN, RN RN Manager Banner University Medical Center Tucson Tucson, Arizona Mona N. Bahouth, MD, PhD Medical Director, Brain Rescue Unit School of Medicine Johns Hopkins University Baltimore, Maryland Micah Baker, MSN, RN, NPD-BC Nurse Professional Development Lead Specialist University of Utah Health Salt Lake City, Utah Kara C. Barquist, MSN, RN, CCRN Nurse Manager University of Iowa Hospitals and Clinics Iowa City, Iowa Dawn Barrett, BSN, RN Registered Nurse Specialist Wound Ostomy Care University of Utah Hospitals and Clinics Salt Lake City, Utah Kathryn S. Bizek, MSN, ACNS-BC, CCRN Nurse Practitioner, Cardiology Veterans Affairs Ann Arbor Healthcare System Ann Arbor, Michigan Nancy Blake, PhD, RN, CCRN-K, NHDP-BC, NEA-BC, FACHE, FAONL, FAAN Chief Nursing Officer Los Angeles County and University of Southern California Medical Center Los Angeles, California

Chad T. Bowman, MSN, RN, CFRN, CCRN, TCRN, NR-P Assistant Nurse Manager Johns Hopkins Lifeline Critical Care Transport Team Baltimore, Maryland Brooke N. Boyce, BSN, RN, CWON Wound and Ostomy Nurse Specialist University of Utah Hospital and Clinics Salt Lake City, Utah Shawn R. Brast, MSN, RN, CHPN, NR-P Clinical Education Manager Gilchrist Hospice Hunt Valley, Maryland Sharee Brinton, MBA, BSN, RN, CCRN Informatics Nurse University of Utah Health Salt Lake City, Utah Thanh Cao, MSN, CRNP Clinical Program Manager Marlene and Stewart Greenebaum Comprehensive Cancer Center University of Maryland Medical Center Baltimore, Maryland

Meredid Soto Caves, PhD, RN, AGACNP-BC Pulmonary/Critical Care Oncology Nurse Practitioner Johns Hopkins Medicine Baltimore, Maryland Ameera Chakravarthy, MSN, RN, ACNP-BC, FNP-BC Interim Specialty Director Adult Gerontology Acute Care Nurse Practitioner, Adult Gerontology Clinical Nurse Specialist DNP Program School of Nursing University of Maryland Baltimore, Maryland Garrett K. Chan, PhD, APRN, BC-PCM, CEN Director of Advanced Practice, Stanford Health Care

Clinical Associate Professor Stanford School of Medicine

Stanford University Stanford, California

Dennis J. Cheek, PhD, RN, FAHA Abell-Hanger Professor of Gerontological Nursing Harris College of Nursing and Health Sciences Texas Christian University Fort Worth, Texas

Contributors

Erin Johnson Cole, DNP, CNM, WHNP-BC Assistant Professor University of Utah College of Nursing Salt Lake City, Utah Jennifer P. Crumley, MSN, RN Clinical Care Supervisor and ECMO Coordinator University of Iowa Hospitals & Clinics Iowa City, Iowa Joan M. Davenport, PhD, RN Assistant Professor and Departmental Vice-Chair School of Nursing University of Maryland Baltimore, Maryland Meghan DelMastro, BSN, RN, CWOCN Wound & Ostomy Nurse Specialist St. Charles Healthcare System Bend, Oregon Angeline Dewey, MSN, RN, APRN, ACNS-BC, CCRN, CNRN Director of Education Bayhealth Hospital Dover, Delaware Tracy T. Douglas, DNP, RN, BMT-CN, NEA-BC Manager of Transplant Services Marlene and Stewart Greenebaum Comprehensive Cancer Center University of Maryland Medical Center Baltimore, Maryland Tamara J. Ekker, MS, RN, CCRN-K Clinical Instructor University of Utah College of Nursing Salt Lake City, Utah Heidi M. Favero, DNP, APRN, AG-ACNP-BC, CCRN Assistant Professor University of Utah College of Nursing Advanced Practice Registered Nurse Huntsman Intensive Care Unit and Medical Intensive Care Unit, Pulmonary Department

Kristy Gauthier, MS, RN Clinical Nurse University of Utah Health Salt Lake City, Utah Catherine J. Goodhue, MN, RN, CPNP Pediatric Nurse Practitioner/Division of Pediatric Surgery/Trauma Program Children’s Hospital Los Angeles Los Angeles, California Debby Greenlaw, MS, ACNPC, Retired CCRN Consultant Prosperity, South Carolina Former Director of Palliative Care, Acute Care Nurse Practitioner Providence Hospitals Columbia, South Carolina John C. Hagan, DNP, RN, CCRN, ACNP-BC, ACNPC Senior Acute Care Nurse Practitioner Pulmonary and Critical Care Division University of Maryland Medical Center Midtown Campus Baltimore, Maryland Beth Hammer, MSN, APRN, ANP-BC Program Manager, Nursing Excellence Nurse Practitioner Cardiology Clement J. Zablocki Veterans Affairs Medical Center Milwaukee, Wisconsin Jan M. Headley, BSHS, RN Principal Consultants in Acute and Critical Care Miami, Florida Janice J. Hoffman, PhD, RN, ANEF Clinical Professor Towson University Towson, Maryland Dorene M. Holcombe, MS, RN, ACNP, CCRN Nephrology Acute Care Nurse Practitioner School of Medicine Johns Hopkins University Baltimore, Maryland Alexandra M. Hunt, MSN, CRNP, AGACNP-BC Acute Care Nurse Practitioner R Adams Cowley Shock Trauma Center University of Maryland Medical Center Baltimore, Maryland Jace Dakota Johnny, DNP, APRN, AGACNP-BC, OCN, CCRN Critical Care Nurse Practitioner

School of Medicine University of Utah Salt Lake City, Utah Nancy Kern Feeley, MS, RN, CRNP Nephrology Adult Nurse Practitioner School of Medicine Johns Hopkins University Baltimore, Maryland Dorrie K. Fontaine, PhD, RN, FAAN Dean Emerita School of Nursing University of Virginia Charlottesville, Virginia Brianne M. Fowler, MSN, RN, CCRN Assistant Nurse Manager University of Iowa Hospital and Clinics Iowa City, Iowa

Huntsman Cancer Hospital University of Utah Health Salt Lake City, Utah Dennis W. Jones, DNP, RN, NR-P Safety and Quality Officer Johns Hopkins Lifeline Critical Care Transport Team Baltimore, Maryland

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Contributors

Roberta Kaplow, PhD, APRN-CCNS, AOCNS, CCRN Clinical Nurse Specialist Emory University Hospital Atlanta, Georgia

Esmeralda Liu Matthews, MS, RN, ACNP-BC Acute Care Nurse Practitioner Cardiac Surgery Progressive Care Unit University of Maryland Medical Center Baltimore, Maryland Lauren Maus, MSN, RN, CCRN, CNL Simulation Educator Kansas City Veteran’s Affair Medical Center Kansas City, Missouri Jennifer L. McAdam, PhD, RN Professor Samuel Merritt University San Mateo, California E. Jane McCarthy, PhD, CRNA, FAAN Professor

Jane Faith Kapustin, PhD, CRNP, BC-ADM, FAANP, FAAN Nurse Practitioner and Diabetes Co-director Riverside Medical Associates Riverdale, Maryland Justin Thomas Keate, BSN, RN, CCRN-CSC Inpatient Nurse II University of Utah Health Salt Lake City, Utah

Lydia A. Knuths, BAN, RN, CCRN Registered Nurse University of Utah Cardiovascular ICU University of Utah Health Salt Lake City, Utah

Brooks College of Health University of North Florida Jacksonville, Florida Patricia C. McMullen, PhD, JD, CRNP, FAANP, FAAN Dean Emerita and Ordinary Professor School of Nursing The Catholic University of America Washington, District of Columbia Jennifer E. Miller, DNP, CRNP, AGACNP-BC, ACCNS-AG Acute Care Nurse Practitioner R Adams Cowley Shock Trauma Center University of Maryland Medical Center Baltimore, Maryland Sandra A. Mitchell, PhD, CRNP, AOCN Research Scientist National Cancer Institute Rockville, Maryland Patricia A. Moloney-Harmon, MS, RN, CCNS, FAAN Former Clinical Nurse Specialist, Children’s Services Sinai Hospital of Baltimore Baltimore, Maryland Laurel A. Moody, MS, MSN, RN, CNE Assistant Professor of Nursing Stevenson University Owings Mills, Maryland Patricia Gonce Morton, PhD, RN, ACNP-BC, FAAN Dean Emeritus University of Utah College of Nursing Salt Lake City, Utah Donna M. Mower-Wade, DNP, APRN, ACNS-BC, CNRN Lead Neurological-Critical Care APN Christiana Care Health System Newark, Delaware John A. Nerges, DNP, RN, CCRN-K, SANE-A Assistant Professor University of Utah College of Nursing Salt Lake City, Utah

Christopher L. Kolokythas, MS, AGACNP-BC, ACCNS-AG, CRNP, APRN-CNS Nurse Practitioner

R Adams Cowley Shock Trauma Center University of Maryland Medical Center Baltimore, Maryland

Elizabeth Kozub, MS, APRN-CNS, CNRN, CCRN Clinical Nurse Specialist Abbott Northwestern Hospital Minneapolis, Minnesota Megan Cecere Lynn, PhD, RN, FNE-A Director of Nursing University of Maryland Access Center University of Maryland Medical System Baltimore, Maryland Rebecca E. MacIntyre, MSN, RN, ACNP-BC Neurocritical Care Nurse Practitioner

Christiana Hospital Newark, Delaware

Cathleen R. Maiolatesi, MS, RN Former Program Coordinator Informatics Advanced Practice Nurse High Risk Obstetrics Johns Hopkins Hospital Baltimore, Maryland

Duke University Hospital Durham, North Carolina

Gregory S. Marler, DNP, APRN, ACNP-BC, FCCP Assistant Professor Department of Nursing Appalachian State University Boone, North Carolina

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Contributors

Annette F. Newman, MS, RN, CCRN Community Outreach/Disaster Coordinator Western Region Burn Disaster Consortium Coordinator University of Utah Health Salt Lake City, Utah Colleen Krebs Norton, PhD, RN, CCRN Associate Professor and BSN Director Georgetown Emergency Response Medical Service School of Nursing Georgetown University Washington, District of Columbia Nayna Campbell Philipsen, JD, PhD, RN, FACCE, CFE Health Services Coordinator, Central Maryland Chapter Disaster Health Services American Red Cross Baltimore, Maryland Leigh Bastable Poitevent, RN, FNP-BC Nurse Practitioner MinuteClinic Cambridge, Massachusetts Cynthia Pullis, RN RN Manager Banner University Medical Center Tucson Tucson, Arizona Kim Reck, DNP, CRNP Senior Clinical Program Manager University of Maryland Medical System Baltimore, Maryland Barbara Resnick, PhD, CRNP, FAAN, FAANP Professor and Sonya Ziporkin Gershowitz Chair in Gerontology School of Nursing University of Maryland Baltimore, Maryland Sarah R. Rosenberger, MS, BSN, CRNP, CCNS Advanced Practice Clinical Manager and Senior Nurse Practitioner Division of Vascular Surgery University of Maryland Medical Center Baltimore, Maryland Valerie K. Sabol, PhD, MBA, ACNP, GNP, ANEF, FAANP, FAAN Interim Vice Dean, Academic Affairs

Natalie K. Schleicher, BSN, RN Wound and Ostomy Nurse Specialist University of Utah Hospitals and Clinics Salt Lake City, Utah

Deborah L. Schofield, PhD, DNP, CRNP, FAANP Director, Advanced Practice Greater Baltimore Medical Center Towson, Maryland

Eric Schuetz, BSPharm, CSPI Coordinator of Professional Education Maryland Poison Center Baltimore, Maryland

Julie Schuetz, MS, CRNP Lead Nurse Practitioner, Hematology/Medical Oncology University of Maryland St. Joseph Medical Center Towson, Maryland Brenda K. Shelton, MS, RN, CCRN, AOCN Critical Care Clinical Nurse Specialist The Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins Baltimore, Maryland Jo Ann Hoffman Sikora, MS, CRNP Senior Clinical Program Manager, Cardiac Surgery Advanced Practice University of Maryland Medical System Baltimore, Maryland Amanda Smith, MSN, CRNP Acute Care Nurse Practitioner Marlene and Stewart Greenebaum Comprehensive Cancer Center University of Maryland Medical Center Baltimore, Maryland Kara Adams Snyder, PhD, RN, CCNS RN Director, Perioperative Services Banner University Medical Center Tucson Tucson, Arizona Mandy L. Snyder, PhD, ACNP-BC Adjunct Faculty University of Utah College of Nursing Salt Lake City, Utah Transcatheter Heart Valve (THV) Clinical Specialist Edwards Lifesciences Irvine, California Lisa M. Spannbauer, DNP, APNP, FNP-BC Nurse Practitioner Clement J. Zablocki V.A. Medical Center Milwaukee, Wisconsin

School of Nursing Duke University Durham, North Carolina Mary G. Sayler, DNP, RN, CCRN-K, CNE Nursing Faculty North Hennepin Community College Brooklyn Park, Minnesota

Contributors

Rebecca Stecher, MS, RN, CCRN-K Nurse Manager of Blood and Marrow Transplant Marlene and Stewart Greenebaum Comprehensive Cancer Center University of Maryland Medical Center Baltimore, Maryland Paul A. Thurman, PhD, RN, ACNPC, CCNS, CCRN

Clareen Wiencek, PhD, RN, ACNP, ACHPN Director of Advanced Practice University of Virginia School of Nursing Charlottesville, Virginia AACN President, 2016-2017 Emily Clark Wierschke, MS, BS, RN, ACNP-BC Acute Care Nurse Practitioner Infectious Diseases, R Adams Cowley Shock Trauma Center University of Maryland Medical Center Baltimore, Maryland

Nurse Scientist, Trauma and Critical Care R Adams Cowley Shock Trauma Center University of Maryland Medical Center Assistant Professor

Adult Gerontology Acute Care Nurse Practitioner, Adult Gerontology Clinical Nurse Specialist DNP Program School of Nursing University of Maryland Baltimore, Maryland Kathleen M. Turner, DNP, RN Associate Professor School of Nursing Duke University Durham, North Carolina Kathryn Truter Von Rueden, MS, RN, CNS-BC, FCCM Critical Care Consultant Annapolis, Maryland Carol R. Wade, RN, DNP, CRNP Program Manager for Advanced Practice Thoracic Transplant, Heart Failure Clinic at the Coordinated Care Center, and VAD Program University of Maryland Medical Center Baltimore, Maryland Denise Evans Ward, DNP, ACNP-BC, FNP-BC Specialty Track Director of the Adult Gerontology Acute Care Nurse Practitioner Track in the Doctor of Nursing Practice Program University of Utah College of Nursing Salt Lake City, Utah Robert H. Welton, MSN, RN Former Director of Professional Development University of Maryland Medical Center Baltimore, Maryland Erin Tilson Wice, BSN, RN Clinical Course Coordinator Neurological Critical Care Unit University of Utah Hospital Salt Lake City, Utah

J. Bradley Wiggins, BSN, RN Former Burn Center Nurse Manager University of Utah Health Salt Lake City, Utah Tracey L. Wilson, DNP, ACNP Senior Acute Care Nurse Practitioner Medical Intensive Care Unit University of Maryland Medical Center Baltimore, Maryland

Amy M. Winkelman, RN, ACNP-BC Nurse Practitioner, Neurotrauma Program Coordinator Zuckerberg San Francisco General Hospital San Francisco, California

Teresa Wood, MSN, RN, ACNP-BC Critical Care Nurse Practitioner Duke University Medical Center Durham, North Carolina

Janet Armstead Wulf, DNP, AGPCNP-BC, CNE Assistant Professor School of Nursing University of Maryland Baltimore, Maryland Allison Steele York, BSN, MSN, CRNP-A Nurse Practitioner Division of Gastroenterology and Hepatology Veterans Affairs Maryland Health Care System Baltimore, Maryland Elizabeth K. Zink, PhD, MSN, RN, CCNS, CNRN Clinical Nurse Specialist, Neurosciences Critical Care Johns Hopkins Hospital Baltimore, Maryland

Preface

The practice of critical care nursing has changed dramatically since its inception in the 1960s. Critical care nurses, more than ever be fore, must possess an extensive body of knowledge to provide com petent and holistic care to patients who are critically ill and their families. Patients who are critically ill are no longer found just in intensive care units. Instead, they are cared for in the emergency de partment, in progressive care units, in postanesthesia care units, and in the home. The COVID-19 pandemic elucidated the extensive knowledge of pathophysiology and therapeutics needed to care for patients with complex cases and their families. Advances in nurs ing, medicine, and technology; the rapidly changing health care cli mate; and the shortage of nursing staff and faculty are other factors that have come together to effect great changes in the practice of critical care nursing. Some of the requisite knowledge for the practice of critical care nursing can be attained through formal education and textbooks, like this one. The rest can only be gained through experience. It is our goal, with this 12th edition of Critical Care Nursing: A Holistic Approach , to assist readers on their journey by providing a compre hensive, up-to-date resource and reference. As in past editions, this 12th edition promotes excellence in critical care nursing. Presenting theory and principles within the context of practical application helps the reader gain competence and confidence in caring for patients who are critically ill and their families. As always, the patient as the center of the health care team’s efforts is emphasized throughout. In the highly specialized and complicated technical environment of critical care, knowing how to deliver holistic care and demonstrating caring behaviors are just as important as knowing how to operate complex equipment and perform difficult procedures. Continuing in this 12th edition, the reader will find an emphasis on evidence-based practice and an even more streamlined text that focuses on the key knowledge and practices that all nurses need to care for patients who are critically ill. An Overview Critical Care Nursing: A Holistic Approach , 12th edition, consists of 12 parts. The following is a brief overview of those parts and the information they contain. The six chapters that make up Part 1 introduce the student to the concept of holistic care, as it applies in critical care practice. In Chapter 1, the student is introduced to critical care nursing practice. Chapter 2 reviews the psychosocial effects of critical illness and the practice environment on the patient and the family, provid ing actions the nurse can take to help reduce environment-induced stress and promote healing. Chapter 3 emphasizes the role of patient and family education in critical care. Chapter 4 focuses on strate gies for relieving pain and promoting comfort. Chapter 5 concen trates on palliative and end-of-life care. Finally, Chapter 6 explores the ethical and legal issues encountered in critical care. Part 1: The Concept of Holism Applied to Critical Care Nursing Practice

Part 2: Special Populations in Critical Care The four chapters in this part focus on the special needs of certain groups of people who are critically ill. Chapters 7, 8, and 9 focus on the pediatric patient, the pregnant patient, and the older adult patient, respectively. Chapter 10 describes the role of the nurse in caring for the patient who is recovering from anesthesia. Part 3: Special Situations in Critical Care This section opens with a chapter that focuses on the care of the pa tient who is being transported within or between facilities as well as the role of the rapid response team. The second chapter in this section describes the role of the critical care nurse in disaster management. Part 4: Cardiovascular System This part, the first of eight organ system–based parts, focuses on the care of the patient with a cardiovascular disorder. Each organ sys tem–based part begins with a chapter that reviews the anatomy and physiology of the organ system under discussion (e.g., Chapter 13). The part then continues with a chapter on patient assessment (e.g., Chapter 14), general patient management (e.g., Chapter 15), and common disorders (e.g., Chapter 16). In Part 4, heart failure and acute coronary syndrome are each given their own chapters (Chap ters 17 and 18, respectively). The unit concludes with a discussion of the most recent developments in cardiac surgery (Chapter 19). Throughout the unit, the latest diagnostic tests, the newest medi cations for treating cardiovascular disorders, and updates on tech nologies (such as the left ventricular assist device, the implantable cardioverter defibrillator, and the cardiac pacemaker) are discussed. Part 5: Respiratory System In this part, current assessment technologies (such as end-tidal car bon dioxide monitoring) and the newest modes of ventilation for pa tients in respiratory failure are discussed. Evidence-based treatment strategies for respiratory disorders such as pneumonia, pleural effusion, and chronic obstructive pulmonary disease are described. Chapter 24 is devoted to the latest developments in the assessment and manage ment of the patient with acute respiratory distress syndrome (ARDS). Part 6: Renal System In this edition of the text, Part 6 includes an in-depth discussion of the assessment and management of fluids, electrolytes, and acid–base balance. Updates on laboratory and diagnostic tests are included. The newest dialysis technologies and the latest drugs are discussed in Chapter 27. Chapter 28 focuses on common renal dis orders, including recent developments in the care of the patient with acute kidney injury and chronic kidney disease. Part 7: Nervous System This part offers updates on neurologic diagnostic studies and the newest approaches to treating the patient with increased intra cranial pressure. The latest drugs for treating neurologic disorders and the most recent developments in neurosurgery are addressed.

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Separate chapters are devoted to care of the patient with a head injury and spinal cord injury. Part 8: Gastrointestinal System In Part 8, the latest diagnostic tests for evaluating patients with gastrointestinal disorders are discussed. The management of pa tients with gastrointestinal disorders has been updated to include the newest drugs, the latest developments in the use of enteral and parenteral nutrition, and recent trends in the treatment of common disorders such as liver failure and hepatitis. Part 9: Endocrine System In this edition, Part 9 includes an assessment chapter covering mul tiple components of the endocrine system. The content is organized by the major gland, and for each gland addressed in the chapter, the reader is given information on the history, laboratory tests, and diagnostic tests. The most current information on the treatment of endocrine disorders, especially glycemic control and diabetic emer gencies, is included in Chapter 41. Part 10: Hematologic and Immune Systems This part continues to be a unique feature that is not included in many critical care texts. The numerous recent developments in organ and hematopoietic stem cell transplant are described in Chapter 44. Chapter 45 addresses up-to-date information on the as sessment and management of critically ill patients with HIV/AIDS as well as those with oncologic emergencies. The latest trends in the treatment of patients with hematologic disorders such as dissemi nated intravascular coagulation are included in Chapter 46. Part 11: Integumentary System This part includes three chapters not covered in other critical care texts: the anatomy and physiology of the integumentary system, as sessment of the integumentary system, and management of integu mentary disorders. Evidence-based assessment and management of wounds are addressed. In addition, care of the critically ill patients with burns is covered in Chapter 50. Part 12: Multisystem Dysfunction In Chapter 51, hypoperfusion states such as shock, systemic inflam matory response syndrome (SIRS), and multiple organ dysfunction syndrome (MODS) are discussed. The latest understanding of the pathophysiologic process is described, as well as how this knowledge guides the selection of the most recent interventions. Chapter 52 reviews care of the trauma patient, including the latest trends in the management of these complex patients. Chapter 53 reviews care of the patient with a traumatic injury, including, a problem that is becoming more common in the critical care setting. Features The features of the 12th edition of Critical Care Nursing: A Holistic Approach have been designed to assist readers with practice as well as learning. Practice-Oriented Features • Considerations for the Older Patient boxes highlight the special needs of this patient population that constitutes the largest num ber of critically ill patients.

• Health History boxes summarize key areas that should be cov ered and relevant information that may be revealed during the health history. • Teaching Guides help the nurse prepare patients and family members for procedures, assist patients and family members with understanding the illnesses they are confronting, and explain postprocedure or postoperative activities. Pedagogic Features Learning Objectives , at the beginning of each chapter, help focus the reader’s attention on important topics. Clinical Applicability Challenges, at the conclusion of each chapter, consist of three to five short-answer questions or a case study followed by three to five short-answer questions. New to This Edition • New case study/short-answer questions in every chapter guide the reader from knowledge to application. Discussion points for these questions are available on . • Updated Evidence-Based Practice Highlights help the reader understand the importance of research-based practice and in clude excerpts from the latest American Association of Critical Care Nurses (AACN) practice alerts as well as from recently published research. • Spotlight on Genetics boxes appear in select chapters and in clude important genetic information and summaries of select genetic disorders. These disorders may be the result of random genetic mutations, genetic mutations caused by environmental influences, or inherited mutated genes. • QSEN Because the Quality and Safety Education for Nurses (QSEN) competencies are such an important part of every nursing curriculum, a QSEN icon has been added to pertinent features to highlight this essential content related to the core competencies. • Patient Safety boxes alert readers to risk factors, signs and symp toms, side effects, and complications that the critical care nurse must anticipate and continuously monitor to maintain patient safety. • Collaborative Care Guides describe how the health care team works together to manage a patient’s illness and minimize compli cations. The information incorporates key physiologic concepts and emphasizes outcomes and interventions based on teamwork and collaboration. • Evidence-Based Practice Highlights help the reader understand the importance of research-based practice.

Student and Instructor Resources A wide variety of resources that support the student and instructor are available online on .

Copyright © 2022 Wolters Kluwer, Inc. Unauthorized reproduction of the content is prohibited. Student Resources Students who purchase this book have access to all of these addi tional resources via : • Journal articles

• Concepts in Action animations • Watch and Learn video clips • Heart and breath sounds

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to you. One of our primary goals in creating these resources has been to promote excellence in critical care nursing practice so that nurses can help patients and families cope with the consequences of critical illness. It is our intent that these resources will provide aspiring and currently practicing critical care nurses the tools to make their optimal contribution to the care of critically ill pa tients and their families and to the nursing profession. We hope that we have succeeded in that goal, and we welcome feedback from our readers.

Instructor Resources In addition to all of the student assets, instructors who adopt this text also have access to a special instructor’s resource section on , including: • Test generator featuring over 1,000 questions • Image bank, containing over 300 illustrations • PowerPoint presentations and accompanying guided lecture notes for each chapter • Answer Keys • QSEN Competency map It is with great pleasure that we introduce these resources—the textbook and the accompanying interactive resource package—

Patricia Gonce Morton Paul A. Thurman

Acknowledgments

This project required the help and cooperation of many people. First, we want to thank our many colleagues who contributed to the text by authoring chapters. Our publisher, Wolters Kluwer, through all editions of this book remains committed to producing the best text possible. We especially want to thank the development edi tor, Staci Wolfson, who took over the project and helped us move forward quickly. We appreciate all her hard work, dedication to excellence, and words of positive encouragement. Thanks too to Anthony Gonzalez who assisted us in every step of the project. We appreciate his great attention to all the details of the chapters. Our acquisitions editor, Jodi Rhomberg, was instrumental in keeping us on track and cheering us on to the finish line for the project.

Thanks to former coauthor Dorrie Fontaine who was a fabulous partner for four editions of the book. She guided and mentored many new authors and always submitted chapters of the highest quality. In addition, we wish to thank Dr. Dennis Cheek, a nationally known expert in genetics, for creating the genetics feature, Spotlight on Ge netics , that appears throughout the text. And finally, we wish to express a word of thanks to our families and nursing colleagues who endured the time we took to complete this project. Trish and Paul

Contents

Providing Required Information and Support 18 Explaining the ICU Environment and Patient’s Condition 18 Advocating for Visitation 19 Advancing the Nurse–Family Relationship 19 Helping the Family Problem Solve 19 Involving the Interprofessional Team 21 Incorporating Cultural Competence and Humility 21 Patient and Family Education in Critical Care 23 Standards of Patient and Family Education 23 Education, Teaching, and Learning 24 Three Domains of Learning 24 Adult Learning Principles 24 The Process of Adult Education 25 Assessing Learning Needs 25 Planning: Barriers to Teaching and Obstacles to Learning 26 Critical Illness and Stress 26 Prolonged Illness and Stress 26 Environmental Stress 27 Cultural and Language Differences 27 Health Literacy 28 Implementation: Effective Teaching Strategies 29 Learning Opportunities 29 The Family Connection 29 Verbal Instruction and Teach-Back 29 Providing Educational Materials and References 30 Sensory Deficits 30 Learning Needs for End-of-Life Care 30 Evaluating the Teaching and Learning Process 30 Summary 31 Relieving Pain and Providing Comfort 33 Pain Defined 33 Pain in Patients Who Are Critically Ill 33 Procedural Pain 34 Consequences of Pain 34 Barriers to Effective Pain Control 35 Resources for Promoting Effective Pain Control 36 Clinical Practice Guidelines 36 Palliative Care 37 Internet Resources 37 Pain Assessment 37 Patient Self-Report 38 Observation 39 Physiologic Parameters 39 Pain Intervention 39 Pharmacologic Interventions 39 Nonpharmacologic Comfort Measures 44 Pain Management in Specific Populations 46

Contributors v Preface xi Acknowledgments xv

PART 1 The Concept of Holism Applied to Critical Care Nursing Practice 1 1 Critical Care Nursing Practice 1

Critical Care Nursing 1 Value of Certification 2

Value to the Patient and Family 2 Value to Nurses and Employers 2 EBP in Critical Care Nursing 2 Levels of Evidence 3 Barriers to Implementation 3 Strategies to Promote Implementation 3 Healthy Work Environments 3 Standard 1: Skilled Communication 3 Standard 2: True Collaboration 4 Standard 3: Effective Decision Making 6

Standard 4: Appropriate Staffing 7 Standard 5: Meaningful Recognition 7 Standard 6: Authentic Leadership 7 Future Challenges in Critical Care Nursing 7 The Patient’s and Family’s Experience With Critical Illness 9 Perception of Critical Illness 9 Stress for the Patient 9 Acute Stress Response 10 Stress for the Family 10 Coping Mechanisms 11 Environmental Stressors in the ICU 11 Noise 11 Lights 12 Nursing Interventions for the Patient 12 Creating a Healing Environment 12 Promoting Rest and Sleep 13 Fostering Trust 14 Providing Information 14 Allowing Control 14 Encouraging Early Mobilization 15 Using “Presencing” and Reassurance 15 Employing Cognitive Techniques 15

Copyright © 2022 Wolters Kluwer, Inc. Unauthorized reproduction of the content is prohibited. Encouraging Deep Breathing 16 Implementing Music Therapy 16 Employing Humor 16 Offering Massage, Aromatherapy, and Therapeutic Touch 16

Using Animal-Assisted Therapy 17 Fostering Spirituality and Healing 17

Nursing Interventions for the Family 18 Promoting the Family’s Involvement in Care and Decision Making 18

Postintensive Care Syndrome 46 The Patient at the End of Life 46

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xviii

Contents

Legal Issues 64 Overview of Governmental Organization and Major Areas of the Law 65 Administrative Law 65 Criminal Law 66 Civil Law 66 Nursing Negligence in Critical Care 67 Duty 67 Breach of Duty 67 Causation 67 Damages 67 Vicarious Liability 69 The Questionable Medical Order 70 Establishment of Protocols 70 Liability for Defective Medical Equipment 70 Patient Decision Making Autonomy 70 Advance Directives: Living Wills and Powers of Attorney 71 Issues That Involve Life-Support Measures 71 DNR Orders 72 Right to Refuse Treatment for Religious Reasons 72 Landmark Legal Cases on Withdrawal of Treatment 72 Brain Death 74 Organ Donation 74

Palliative Care and End-of-Life Issues in Critical Care 48 The Need for Quality End-of-Life Care 48 Understanding Human Death 48 Palliative Care 50 Symptom Management 51 Pain 51 Dyspnea 51 Anxiety and Agitation 51 Depression 51 Delirium 52 Nausea and Vomiting 52 Palliative or EOL Sedation 52 Advanced Care Planning 52 Advance Directives 52 “Do Not Resuscitate” and “Do Not Attempt Resuscitation” Orders 52 Family-Centered Care 52 Family Presence During Resuscitation 53 Visitation 53 Family Conferences 53 Bereavement Care 53 Emotional, Psychological, Social, and Spiritual Care 54 Facilitating Communication 55 Assessing Patient and Family Learning Needs 55 Establishing Treatment Goals and Priorities 55 Ensuring Interdisciplinary Communication 56 Delivering Difficult or Serious News 56 Ethical Issues 57 Principle of Double Effect 57 Moral Distress 57 Withholding or Withdrawing Life-Sustaining Measures 57 Organ and Tissue Donation 57 Caring for the Nurse 58

PART 2 Special Populations in Critical Care 77 7 The Pediatric Patient Who Is Critically Ill 77 Prominent Anatomical and Physiologic Differences and Implications 77 Vital Signs 77 Neurologic System 78 Cardiovascular System 78 Respiratory System 78 Gastrointestinal System 79 Renal System 79

Ethical and Legal Issues in Critical Care Nursing 59

What Is Ethics? 59 Ethical Principles 59

Endocrine System 79 Immune System 79 Integumentary System 80 Select Pediatric Challenges 80 Ventilatory Issues 80 Medication Administration 81 Pain Management and Sedation 83 Interaction with Children and Families 83 The Pregnant Patient Who Is Critically Ill 87 Physiologic Changes in Pregnancy 87 Cardiovascular Changes 87 Respiratory Changes 88 Renal Changes 88 Gastrointestinal and Metabolic Changes 88 Hematologic Changes 89 Fetal and Placental Development Considerations 89 Critical Care Conditions in Pregnancy 90 Preeclampsia With Severe Features 90 HELLP Syndrome 91 Disseminated Intravascular Coagulation 92 Amniotic Fluid Embolism 93

Autonomy 59 Beneficence 60 Nonmaleficence 60

Veracity 61 Fidelity 61 Justice 61 Ethics as a Foundation for Nursing Practice 62 Nursing Code of Ethics 62 Ethical Issues 62 Withholding and Withdrawing Treatment 62 Medical Futility 63 Moral Distress 63 Ethical Decision Making: The Case Method Approach 63 Step 1: Assessing the Problem 63 Step 2: Defining the Issues 63 Step 3: Goal Setting, Decision Making, and Implementing 64 Step 4: Evaluating and Modifying Actions 64 Strategies for Promoting Ethical Decision Making 64

Institutional Ethics Committees 64 Ethics Rounds and Conferences 64

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Contents

Interfacility Transport 129 Modes of Interfacility Transport 129 Transfer Guidelines and Legal Implications 131 Phases of Interfacility Transport 133 Intrahospital Transport 136 Adverse Events During Intrahospital Transport 136 Team Composition for an Intrahospital Transport 136 Equipment Considerations During an Intrahospital Transports 137 Disaster Management: Implications for the Critical Care Nurse 139 Fundamentals of Disaster Science 139 Response to Mass Casualty Incidents 140 Response to Terrorism 142 Role of Hospital Emergency Incident Command System 142 Triage 142 Terrorist Attacks 144

Acute Respiratory Distress Syndrome 93 Trauma 93 Cardiovascular Disease in Pregnancy 94 Providing Emotional Support 94

The Older Adult Patient Who Is Critically Ill 96 Normal Psychobiologic Characteristics of Aging 96 Biologic Issues 96 Psychosocial Issues 97 Physical Challenges 97

Auditory Changes 97 Visual Changes 100 Other Sensory Changes 101 Sleep Changes 102 Skin Changes 102 Cardiovascular Changes 103 Respiratory Changes 104 Renal Changes 104

Explosions and Blast Attacks 144 Nuclear or Radiologic Attacks 144

Gastrointestinal Changes 106 Musculoskeletal Changes 107 Endocrine Changes 107 Immunologic Changes 109 Psychological Challenges 109 Cognitive Changes 109 Abuse of the Older Person 112 Substance Abuse 112 Challenges in Medication Use 112

Chemical Attacks 146 Biologic Attacks 147 Natural Disasters 148 Psychological Effects of Terrorism and Natural Disasters 148

PART 4 Cardiovascular System 151 13

Drug Absorption 113 Drug Distribution 113 Drug Metabolism 113 Drug Excretion 114

Anatomy and Physiology of the Cardiovascular System 151 Cardiac Microstructure 151 Mechanical Events of Contraction 152 Electrical Events of Depolarization 152 Physiologic Basis of the Resting Potential 152 Physiologic Basis of the Action Potential 153 Cardiac Macrostructure 153 Cardiac Conduction 154 Electrocardiograms 156 Rhythmicity and Pacing 156 Cardiac Output 156 Regulation of Heart Rate 157 Regulation of Stroke Volume 157 Patient Assessment: Cardiovascular System 162 Cardiac History and Physical Examination 162 History 162 Physical Examination 165 Cardiac Laboratory Studies 173 Routine Laboratory Studies 173 Enzyme Studies 175 Biochemical Markers: Myocardial Proteins 176 Neurohumoral Hormones: Brain-Type Natriuretic Peptide 176 Cardiac Diagnostic Studies 176 Standard 12-Lead ECG 177 Coronary Circulation 158 Peripheral Circulation 159 Blood Volume 160 Blood Pressure 160

The Patient Recovering From Anesthesia 116 Preoperative Anesthesia Patient Assessment 116 Postanesthesia Report to the PACU or ICU Nurse 116 Complications in the Patient Recovering From Anesthesia 117 Hypoxemia 117 Hypoventilation 119

Hypotension 119 Hypothermia 120 Postoperative Nausea and Vomiting 120 Postoperative Pain 121 Hypertension 121 Cardiac Dysrhythmias 122 Postoperative Emergence Delirium 122 Malignant Hyperthermia 123

Moderate IV Sedation Administered by Registered Nurse Versus Monitored Anesthesia Care 124

PART 3 Special Situations in Critical Care 127 11 Rapid Response Teams and Transport of the Patient Who Is Critically Ill 127 Rapid Response Teams 127 Benefits of RRTs 127 Limitations of RRTs 128 Strategies for Future Improvement of RRTs 128

Contents

Electrophysiologic Studies 179 Chest Radiography 180 Echocardiography 180 Stress Testing 182 Computed Tomography 186

Pathophysiology of Valvular Heart Disease 259 Diagnostic Tests 260 Equipment Features 260 Procedures 260 IABP Counterpulsation and Mechanical Circulatory Support 263 IABP Counterpulsation 263 Mechanical Circulatory Support 271 Complications Associated With IABP Therapy and Circulatory Support 274 Extracorporeal Membrane Oxygenation 275 Inclusion and Exclusion Criteria 275 Equipment 276 ECMO Physiology 277 Procedure of Cannulation 278 Bedside Care of the ECMO Patient 278 ECMO Emergencies 278 Management of Dysrhythmias 279

Magnetic Resonance Imaging 187 Positron Emission Tomography 187 Cardiac Catheterization, Coronary Angiography, and Coronary Intervention 187 Electrocardiographic Monitoring 190 Equipment Features 190 Procedure 193 Troubleshooting Electrocardiogram Monitor Problems 194 Dysrhythmias and the 12-Lead Electrocardiogram 194 Evaluation of a Rhythm Strip 194 Normal Sinus Rhythm 197 Dysrhythmias Originating at the Sinus Node 197 Atrial Dysrhythmias 198 Junctional Dysrhythmias 201 Ventricular Dysrhythmias 202 Atrioventricular Blocks 205 The 12-Lead Electrocardiogram 207 Effects of Serum Electrolyte Abnormalities on the Electrocardiogram 210 Potassium 211 Calcium 212 Hemodynamic Monitoring 212 PA Pressure Monitoring 220 Determination of CO 226 Evaluation of Oxygen Delivery and Demand Balance 232 Patient Management: Cardiovascular System 236 Pharmacologic Therapy 236 Fibrinolytics, Anticoagulants, and Platelet Inhibitors 236 Antiarrhythmics 239 Inotropes 241 Phosphodiesterase III Inhibitor 242 Vasoconstrictors 242 Vasodilators 242 Renin–Angiotensin Inhibitors 243 Antihyperlipidemic Agents 244 Percutaneous Coronary Interventions 244 Pressure Monitoring System 213 Arterial Pressure Monitoring 216 CVP Monitoring 218

Electrical Cardioversion 279 Steps for Cardioversion 279 Catheter Ablation 280 Cardiac Pacemakers 282

Implantable Cardioverter-Defibrillators 296 Cardiopulmonary Resuscitation 299 Causes of Cardiopulmonary Arrest 300 Assessment and Management of the Patient in Cardiopulmonary Arrest 300

Common Cardiovascular Disorders 312 Infection and Inflammation of the Heart 312

Pericarditis 312 Myocarditis 314 Endocarditis 314 Cardiomyopathies 315 Dilated Cardiomyopathy 316 Hypertrophic Cardiomyopathy 318 Peripheral Vascular Disease 319 Peripheral Arterial Disease 319 Venous Disease 320 Aortic Disease 321

Aortic Aneurysm 321 Aortic Dissection 322 Hypertensive Crisis 323 Pathophysiology 323

Assessment 323 Management 324

Historical Background 244 Physiologic Principles 244 Comparisons Between PCI and CABG 244 Diagnostic Tests for Patient Selection: PCI and CABG 245 Equipment Features 246 Indications for PCI 247 Contraindications to PCI 248 Procedure 248 Results 250 Assessment and Management 251 Complications 254 Other Interventional Cardiology Techniques 255 Interventions for PAD 258 Percutaneous Valvular Interventions 259 Historical Background 259

H eart Failure 325 Definition of Heart Failure 325 Classification of Heart Failure 326 Acute Versus Chronic Heart Failure 326

Left-Sided Heart Failure 326 Right-Sided Heart Failure 326 Classification Systems 326 Factors That Determine Cardiac Output 327 Oxygen Demand 327 Mechanical Factors and Heart Rate 327 Neurohormonal Mechanisms 328 Catecholamines 328 Pathophysiology of Heart Failure 329 Cardiomyopathy 329 Dysrhythmia 329

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