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AACN Essentials of Critical-Care Nursing Pocket Handbook, Second

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AACN Essentials of Critical-Care Nursing Pocket Handbook, Second AACN Essentials of Critical Care Nursing—Pocket Handbook Notice Medicine is an ever-changing science. As new research and clinical experience broaden our knowledge, changes in treatment and drug therapy are required. The editor and publisher of this work have checked with sources believed to be reliable in their efforts to provide information that is complete and generally in accord with the standards accepted at the time of publication. However, in view of the possibility of human error or changes in medical sciences, neither the editors nor the publisher nor any other party who has been involved in the preparation or publication of this work warrants that the information contained herein is in every respect accurate or complete, and they disclaim all responsibility for any errors or omissions or for the results obtained from use of the information contained in this work. Readers are encouraged to confirm the information contained herein with other sources. For example and in particular, readers are advised to check the product information sheet included in the package of each drug they plan to administer to be certain that the information contained in this work is accurate and that changes have not been made in the recommended dose or in the contraindications for administration. This recommendation is of particular importance in connection with new or infrequently used drugs. AACN Essentials of Critical Care Nursing Pocket Handbook Second Edition Marianne Chulay, RN, PhD, FAAN Consultant, Critical Care Nursing and Clinical Research Gainesville, Florida Suzanne M. Burns RN, MSN, RRT, ACNP, CCRN, FAAN, FCCM, FAANP Professor of Nursing, Acute and Specialty Care School of Nursing Advanced Practice Nurse Level 2, Director Professional Nursing Staff Organization Research Program University of Virginia Health System Charlottesville, Virginia New York Chicago San Francisco Lisbon London Madrid Mexico City Milan New Delhi San Juan Seoul Singapore Sydney Toronto Copyright © 2010, 2006 by The McGraw-Hill Companies, Inc. All rights reserved. Except as permitted under the United States Copyright Act of 1976, no part of this publication may be reproduced or distributed in any form or by any means, or stored in a database or retrieval system, without the prior written permission of the publisher. ISBN: 978-0-07-170273-7 MHID: 0-07-170273-3 The material in this eBook also appears in the print version of this title: ISBN: 978-0-07-166408-0, MHID: 0-07-166408-4. All trademarks are trademarks of their respective owners. Rather than put a trademark symbol after every occurrence of a trademarked name, we use names in an editorial fashion only, and to the benefi t of the trademark owner, with no intention of infringement of the trademark. Where such designa- tions appear in this book, they have been printed with initial caps. McGraw-Hill eBooks are available at special quantity discounts to use as premiums and sales promotions, or for use in corporate training programs. To contact a representative please e-mail us at [email protected]. TERMS OF USE This is a copyrighted work and The McGraw-Hill Companies, Inc. (“McGrawHill”) and its licensors reserve all rights in and to the work. Use of this work is subject to these terms. Except as permitted under the Copyright Act of 1976 and the right to store and retrieve one copy of the work, you may not decompile, disassemble, reverse engineer, reproduce, modify, create derivative works based upon, transmit, distribute, disseminate, sell, publish or sublicense the work or any part of it without McGraw-Hill’s prior consent. You may use the work for your own noncommercial and personal use; any other use of the work is strictly prohibited. Your right to use the work may be terminated if you fail to comply with these terms. THE WORK IS PROVIDED “AS IS.” McGRAW-HILL AND ITS LICENSORS MAKE NO GUARANTEES OR WARRANTIES AS TO THE ACCURACY, ADEQUACY OR COMPLETENESS OF OR RESULTS TO BE OBTAINED FROM USING THE WORK, INCLUDING ANY INFORMATION THAT CAN BE ACCESSED THROUGH THE WORK VIA HYPERLINK OR OTHERWISE, AND EXPRESSLY DISCLAIM ANY WARRANTY, EXPRESS OR IMPLIED, INCLUDING BUT NOT LIMITED TO IMPLIED WARRANTIES OF MERCHANTABILITY OR FITNESS FOR A PARTICULAR PURPOSE. McGraw-Hill and its licensors do not warrant or guarantee that the functions contained in the work will meet your requirements or that its operation will be uninterrupted or error free. Neither McGraw-Hill nor its licensors shall be liable to you or anyone else for any inaccuracy, error or omission, regardless of cause, in the work or for any damages resulting therefrom. McGraw-Hill has no responsibil- ity for the content of any information accessed through the work. Under no circumstances shall McGraw-Hill and/or its licensors be liable for any indirect, incidental, special, punitive, consequential or similar damages that result from the use of or inability to use the work, even if any of them has been advised of the possibility of such damages. This limitation of liability shall apply to any claim or cause whatsoever whether such claim or cause arises in contract, tort or otherwise. Contributors Earnest Alexander, PharmD, FCCM Suzanne M. Burns, RN, MSN, RRT, ACNP, Marianne Chulay, RN, PhD, FAAN Manager, Clinical Pharmacy Services CCRN, FAAN, FCCM, FAANP Consultant, Critical Care Nursing and Tampa General Hospital Professor of Nursing, Acute and Specialty Clinical Research Clinical Assistant Professor Care Gainesville, Florida University of Florida and Florida Advanced Practice Nuse Level 2, Director A&M University Professional Nursing Staff Organization Tampa, Florida Research Program School of Nursing University of Virginia Health System Charlottesville, Virginia v vi Carol Jacobson, RN, MN Dea Mahanes, RN, MSN, CCRN, CNRN, Robert E. St. John, MSN, RN, RRT Director, Quality Education Services CCNS Marketing Manager Seattle, Washington APN1, Nerancy Neuro-ICU Covidien Imaging & University of Virginia Health System Pharmaceutical Solutions Barbara Leeper, MN, RN, CCRN Charlottesville, Virginia Hazelwood, Missouri Clinical Nurse Specialist, Cardiovascular Services Leanna R. Miller, RN, MN, CCRN, CEN, NP Mary Fran Tracy, PhD, RN, CCRN, CCNS Baylor University Medical Center Educator for Trauma, Neuro, Flight Critical Care CNS Dallas, Texas Vanderbilt University Medical Center Fairview—University Medical Center Nashville, Tennessee Minneapolis, Minnesota Maureen Seckel, RN, APN, ACNS, BC Clinical Nurse Specialist, Medical Pulmonary Critical Care Christiana Care Health System Newark, Delaware Contents Preface / xi 2.3 Suggested Questions for Review of Past History 2.12 Peripheral Pulse Rating Scale / 21 Dedication / xii Categorized by Body System / 10 2.13 Physiologic Effects of Aging / 22 2.4 Ongoing Assessment Template / 12 Section 1. Normal Values .........................................1 2.5 Identification of Symptom Characteristics / 13 Section 3. ECG Concepts .......................................23 2.6 Chest Pain Assessment / 14 1.1 Normal Values Table / 2 3.1 ECG Lead Placement for a Three-Wire 2.7 Pain Assessment Tools Commonly Used System / 25 in Critically Ill Patients / 15 Section 2. Assessment .............................................7 3.2 ECG Lead Placement for a Five-Wire System / 27 2.8 CAM-ICU Worksheet / 16 3.3 Twelve-Lead ECG Placement / 28 2.1 Summary of Prearrival and Admission Quick 2.9 Glasgow Coma Scale / 18 3.4 Right Side ECG Chest Lead Check Assessments / 8 2.10 Sensory Dermatomes / 19 Placement / 29 2.2 Summary of Comprehensive Admission 2.11 Edema Rating Scale / 21 Assessment Requirements / 9 vii viii 3.5 Waves, Complexes, and Intervals / 30 3.16 Normal 12-Lead ECG Waves / 69 Section 4. Cardiovascular Concepts.......................83 3.6 Heart Rate Determination / 31 3.17 Normal ST Segment and T Waves / 70 4.1 Intra-Aortic Balloon Pump Frequency of 1:2 / 85 3.7 Heart Rate Determination Using the 3.18 Zones of Myocardial Ischemia, Injury, and 4.2 Intra-Aortic Balloon Pump Frequency of 1:1 / 86 Electrocardiogram Large Boxes / 32 Infarction with Associated ECG Changes / 71 4.3 Inaccurate Intra-Aortic Balloon Pump Timing / 87 3.8 Recommended Leads for Continuous ECG 3.19 ECG Patterns Associated with Myocardial 4.4 Advanced Cardiovascular Life Support (ACLS) Monitoring / 33 Ischemia / 72 Pulseless Arrest Algorithm / 89 3.9 Advantages of Common Monitoring Leads / 34 3.20 ECG Patterns Associated with Acute Myocardial 4.5 Advanced Cardiovascular Life Support (ACLS) 3.10 Evidence-Based Practice: Bedside Cardiac Injury / 73 Bradycardia Algorithm / 92 Monitoring for Arrhythmia Detection / 35 3.21 ECG Changes Associated with Myocardial 4.6 Advanced Cardiovascular Life Support (ACLS) 3.11 Evidence-Based Practice: ST-Segment Infarction / 74 Tachycardia Algorithm / 94 Monitoring / 36 3.22 Typical Plasma Profiles / 75 4.7 Problems Encountered with Arterial Catheters / 96 3.12 Cardiac Rhythms, ECG Characteristics, 3.23 Clinical Presentation of Myocardial Ischemia 4.8 Inaccurate Arterial Pressure Measurements / 98 and Treatment Guide / 37 and Infarction / 76 4.9 Pulmonary Artery Port Functions / 100 3.13 Guidelines for Management of Atrial Fibrillation 3.24 Evidence-Based Practice: Acute Coronary 4.10 Leveling of the PA Catheter / 101 and Atrial Flutter (Class I Recommendations Syndrome ST-Elevation MI and 4.11 Referencing and Zeroing the Hemodynamic Only) / 61 Non–ST-Elevation MI / 78 Monitoring System / 102 3.14 Guidelines for Management of Supraventricular Ar- 3.25 Summary of Causes of Axis Deviations / 79 4.12 Assessing Damping
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