Table Of Contents:

Chapter 1 The Pulmonary System 1(136)

Robert E. St. John, M.S.N., R.N., RRT, CCRN, CS

PHYSIOLOGIC ANATOMY 1(23)

The Respiratory Circuit 1(1)

Steps in the Gas Exchange Process 2(15)

Hypoxemia 17(2)

Acid-Base Physiology and Blood Gases 19(5)

NURSING ASSESSMENT DATA BASE 24(17)

Nursing History 24(4)

Nursing Examination of Patient 28(8)

Diagnostic Studies 36(5)

COMMONLY ENCOUNTERED NURSING DIAGNOSES 41(43)

Ineffective Airway Clearance related to secretions 41(8)

Ineffective Breathing Pattern related to respiratory muscle fatigue or impaired respiratory mechanics 49(2)

Inability to Sustain Spontaneous Ventilation related to imbalance between ventilatory capacity and ventilatory demand 51(24)

Impaired Gas Exchange 75(9)

Ineffective Individual or Family Coping 84(1)

PATIENT HEALTH PROBLEMS 84(53)

Acute Respiratory Failure 84(4)

Adult Respiratory Distress Syndrome 88(2)

Chronic Obstructive Pulmonary Disease 90(4)

Asthma and Status Asthmaticus (Severe Asthmatic Attack) 94(3)

Pulmonary Embolism 97(3)

Chest Trauma 100(4)

Acute Pneumonia 104(4)

Pulmonary Aspiration 108(3)

Near-Drowning 111(2)

Pulmonary Problems in Surgical Patients 113(3)

Acute Pulmonary Inhalation Injuries 116(2)

Neoplastic Lung Disease 118(4)

Obstructive Sleep Apnea 122(3)

End-Stage Pulmonary Conditions Eligible for Lung Transplantation 125(12)

chapter 2 The Cardiovascular System 137(202)

M. Lindsay Lessig, B.S.N., M.S.Ed., M.B.A.

Paul M. Lessig, M.D., FACC

PHYSIOLOGIC ANATOMY 137(23)

Gross Anatomy 137(2)

Structure of Cardiac Wall 139(1)

Chambers of the Heart 140(1)

Cardiac Valves 141(1)

Coronary Vasculature 142(2)

Neurologic Control of the Heart 144(1)

Cardiac Muscle Microanatomy and Contractile Properties 145(2)

Anatomy of the Cardiac Conduction System 147(1)

Electrophysiology 148(2)

Events in the Cardiac Cycle Produced by Depolarization and Repolarization 150(2)

Variables Affecting Left Ventricular Function and Cardiac Output 152(3)

Systemic Vasculature 155(2)

Control of Peripheral Blood Flow 157(2)

Arterial Pressure 159(1)

NURSING ASSESSMENT DATA BASE 160(39)

Nursing History 160(1)

Nursing Examination of Patient 161(10)

Diagnostic Studies 171(28)

COMMONLY ENCOUNTERED NURSING DIAGNOSES 199(6)

Decreased Cardiac Output Due to Cardiac Dysfunction, Either Mechanical or Electrical 199(2)

Acute Pain Related to Coronary Ischemia or to Prolonged Bed Rest 201(1)

Activity Intolerance Related to Cardiac Disease or Dysfunction 202(1)

Anxiety Related to Threat of Death, Change in Health Status and Body Image, Threat to Socioeconomic Status 203(1)

Knowledge Deficit Related to New Diagnosis, Medications, or Treatment Regimens or Related to Lack of Recall, or Misunderstanding or Misinterpretation of Information Regarding Condition and/or Care 204(1)

PATIENT HEALTH PROBLEMS 205(134)

Coronary Artery Disease 205(3)

Angina Pectoris 208(14)

Myocardial Infarction (MI) 222(13)

Heart Failure 235(9)

Pericardial Disease 244(4)

Myocarditis 248(4)

Infective Endocarditis 252(5)

Cardiomyopathy 257(6)

End-Stage Heart Disease 263(4)

Cardiac Trauma 267(4)

Cardiac Rhythm Disorders 271(16)

Mitral Insufficiency 287(3)

Mitral Stenosis 290(3)

Aortic Insufficiency 293(3)

Aortic Stenosis 296(3)

Atrial Septal Defect 299(3)

Ventricular Septal Defect 302(3)

Patent Ductus Arteriosus 305(4)

Coarctation of the Aorta 309(3)

Hypertensive Crisis 312(5)

Aortic and Peripheral Arterial Disease 317(6)

Shock 323(16)

chapter 3 The Neurologic System 339(125)

Diana L. Nikas, R.N., M.N., CCRN, CNRN, FCCM

PHYSIOLOGIC ANATOMY 339(34)

Brain 339(18)

Spine and Spinal Cord 357(6)

Peripheral Nervous System 363(10)

NURSING ASSESSMENT DATA BASE 373(19)

Nursing History 373(1)

Nursing Examination of Patient 373(13)

Diagnostic Studies 386(6)

COMMONLY ENCOUNTERED NURSING DIAGNOSES 392(7)

Alteration in Cerebral Tissue Perfusion Related to Increased Intracranial Pressure 392(1)

Impaired Gas Exchange Related to Altered Oxygen Supply or Oxygen Carrying Capacity 392(1)

Ineffective Breathing Pattern Related to Inadequate Airway from Depressed Level of Consciousness, Intracranial Pathology, or Metabolic Imbalance 392(1)

Ineffective Airway Clearance Related to Increased Secretions, Depressed Level of Consciousness 393(1)

Potential Fluid Volume Deficit Related to Excessive Loss, Decreased Intake, Diabetes Insipidus, Cerebral Salt Wasting Syndrome 393(1)

Fluid Volume Excess Related to Syndrome of Inappropriate ADH 394(1)

Potential for Infection Related to Invasive Lines, Monitoring and Therapeutic Devices, Traumatic and Surgical Wounds 394(1)

Potential for Injury Related to Seizure Activity 395(1)

Impaired Verbal Communication Related to Expressive/Receptive Dysphasia 396(1)

Impaired Physical Mobility Related to Weakness or Paralysis of One or More Body Parts 397(1)

Alteration in Thought Processes Related to Confusion, Short-Term Memory Loss, Short Attention Span 397(1)

Ineffective Individual Coping Related to Situational Crisis, Loss of Control and Independence, Change in Role 398(1)

Ineffective Family Coping Related to Disruption of Usual Family Roles, Burden of Care, Changes in Family Member's Present and Future Functioning 399(1)

PATIENT HEALTH PROBLEMS 399(65)

Increased Intracranial Pressure 399(9)

Head Trauma 408(13)

Hydrocephalus 421(2)

Brain Tumors 423(5)

Intracranial Aneurysms 428(4)

Arteriovenous Malformations 432(2)

Stroke 434(4)

Meningitis 438(3)

Acute Spinal Cord Injury 441(7)

Status Epilepticus 448(4)

Guillain-Barr茅 Syndrome (Landry-Guillain-Barr茅-Strohl Syndrome, Polyneuritis, Polyradiculoneuritis, Infectious Polyneuritis) 452(3)

Recovery from General Anesthesia 455(4)

Encephalopathy 459(5)

chapter 4 The Renal System 464(101)

June L. Stark, R.N., B.S.N., M.Ed.

PHYSIOLOGIC ANATOMY 464(15)

Process of Urine Formation 464(5)

Renal Hemodynamics: Normal Blood Flow Patterns 469(2)

Body Water Regulation: Maintenance of Volume and Concentration of Body Water Content via Thirst-Neurohypophyseal-Renal Axis 471(1)

Electrolyte Regulation 472(3)

Excretion of Metabolic Waste Products 475(1)

Renal Regulation of Acid-Base Balance 476(1)

Renal Regulation of Blood Pressure 477(1)

Red Blood Cell Synthesis and Maturation 478(1)

NURSING ASSESSMENT DATA BASE 479(7)

Nursing History 479(2)

Nursing Examination of Patient 481(2)

Diagnostic Studies 483(3)

COMMONLY ENCOUNTERED NURSING DIAGNOSES 486(13)

Fluid Volume Excess 486(1)

Fluid Volume Deficit 487(1)

Altered Nutrition: Less Than Body Requirements Related to Uremia 488(1)

Risk of Alterations in Blood Pressure: Hypertension 489(4)

Risk of Acid-Base Imbalances: Metabolic Acidosis 493(1)

Risk of Anemia 493(1)

Risk of Uremic Syndrome 494(1)

Risk of Infection 495(1)

Risk of Bone Disease: Osteomalacia, Osteitis Fibrosa 495(1)

Altered Metabolism and Excretion of Pharmacologic Agents Related to Renal Failure 496(1)

Ineffective Patient and Family Coping 497(2)

PATIENT HEALTH PROBLEMS 499(66)

Acute Renal Failure 499(20)

Chronic Renal Failure 519(15)

Electrolyte Imbalances--Potassium Imbalance: Hyperkalemia 534(2)

Electrolyte Imbalances--Potassium Imbalance: Hyperkalemia 536(2)

Electrolyte Imbalances--Sodium Imbalance: Hypernatremia 538(3)

Electrolyte Imbalances--Sodium Imbalance: Hyponatremia 541(2)

Electrolyte Imbalances--Calcium Imbalance: Hypercalcemia 543(2)

Electrolyte Imbalances--Calcium Imbalance: Hypocalcemia 545(3)

Electrolyte Imbalances--Phosphate Imbalance: Hyperphosphatemia 548(2)

Electrolyte Imbalances--Phosphate Imbalance: Hypophosphatemia 550(1)

Electrolyte Imbalances--Magnesium Imbalance: Hypermagnesemia 551(2)

Electrolyte Imbalances--Magnesium Imbalance: Hypomagnesemia 553(2)

Renal Trauma 555(10)

chapter 5 The Endocrine System 565(36)

Kim Litwack, Ph.D., R.N., CPAN, CAPA, FAAN

PHYSIOLOGIC ANATOMY 565(7)

Foundational Concepts 565(1)

Pituitary Gland 566(2)

Thyroid Gland 568(1)

Parathyroid Glands 568(1)

Adrenal Glands 569(1)

Pancreas 570(2)

Gonadal Hormones (Testosterone, Estrogen, Progesterone) 572(1)

NURSING ASSESSMENT DATA BASE 572(2)

Nursing History 572(1)

Nursing Examination of Patient 573(1)

Diagnostic Studies in the Critically Ill Patient 574(1)

COMMONLY ENCOUNTERED NURSING DIAGNOSES 574(3)

Fluid Volume Deficit (Actual or Potential) 574(1)

Fluid Volume Excess (Actual or Potential) 575(1)

Altered Nutrition, Less Than Body Requirements 576(1)

Knowledge Deficit 576(1)

Altered Health Maintenance Related to the Need for Hormonal Replacement and Regulation 577(1)

PATIENT HEALTH PROBLEMS 577(24)

Diabetes Insipidus 577(2)

SIADH Secretion 579(2)

Thyrotoxicosis (Thyroid Storm) 581(3)

Myxedema Coma 584(3)

Hypoparathyroidism and Hyperparathyroidism 587(1)

Acute Adrenal Insufficiency (Addisonian Crisis) 588(1)

Diabetic Ketoacidosis (DKA) 589(5)

Hyperglycemic, Hyperosmolar Nonketotic Coma (Hyperglycemic, Nonacidotic Diabetic Coma) 594(3)

Hypoglycemic Episode 597(4)

chapter 6 Hematologic and Immunologic Systems 601(46)

Stacey Young-McCaughan, R.N., Ph.D.(C), O.C.N., (R) Lieutenant Colonel, U.S. Army Nurse Corps

Bonnie Mowinski Jennings, R.N., D.N.Sc., FAAN, Colonel, U.S. Army Nurse Corps

PHYSIOLOGIC ANATOMY 601(10)

Hematologic System 601(4)

Immunologic System 605(6)

NURSING ASSESSMENT DATA BASE 611(7)

Nursing History 611(2)

Nursing Examination of Patient 613(1)

Diagnostic Studies 614(4)

COMMONLY ENCOUNTERED NURSING DIAGNOSES 618(8)

Altered Protection (Risk for Infection) Related to Disease or Treatment 618(1)

Altered Protection (Risk for Hemorrhage) Related to Disease and/or Treatment 619(1)

Potential Fluid Volume Deficit Related to Fever, Vomiting, Diarrhea, Hemorrhage, or Shock 619(4)

Potential for Impaired Gas Exchange Related to Anemia, Hemoglobin Abnormalities, Blood Loss, or Disease 623(2)

Potential for Activity Intolerance Related to Disease or Treatment 625(1)

Potential for Pain Related to Disease or Treatment 626(1)

Potential for Fear or Anxiety Related to Disease or Treatment 626(1)

Potential for Altered Family Processes 626(1)

PATIENT HEALTH PROBLEMS 626(21)

Anemia 626(2)

Disseminated Intravascular Coagulation 628(1)

Thrombocytopenia 629(2)

Hypercoagulable Disorders 631(1)

Neutropenia 632(2)

Acute Leukemia 634(2)

Bone Marrow Transplantation and Peripheral Blood Stem Cell Transplantation 636(3)

Transplant Rejection 639(1)

Immunosuppression 640(1)

HIV Infection 641(2)

Anaphylactic Type I Hypersensitivity Reactions 643(4)

chapter 7 The Gastrointestinal System 647(68)

Susan L. Smith, R.N., Ph.D.

PHYSIOLOGIC ANATOMY 647(12)

Upper Gastrointestinal (GI) System 647(3)

Lower Gastrointestinal System 650(4)

Gut Defenses 654(1)

Accessory Organs of Digestion 655(4)

NURSING ASSESSMENT DATA BASE 659(7)

Nursing History 659(2)

Nursing Examination of Patient 661(2)

Diagnostic Studies 663(3)

COMMONLY ENCOUNTERED NURSING DIAGNOSES 666(8)

Altered Nutrition 666(4)

Altered Oral Mucous Membrane 670(3)

Risk for Fluid Volume Deficit 673(1)

Pain (Acute) 674(1)

PATIENT HEALTH PROBLEMS 674(41)

Acute Pancreatitis 674(4)

GI Bleeding 678(9)

Hepatitis 687(2)

Acute (Fulminant) Liver Failure 689(7)

Chronic Liver Failure: Decompensated Cirrhosis 696(5)

Acute Abdomen 701(6)

Abdominal Trauma 707(2)

Inflammatory Bowel Disease 709(6)

chapter 8 Multisystem 715(84)

Marilyn Sawyer Sommers, R.N., Ph.D., CCRN

PATIENT HEALTH PROBLEMS 715(84)

Systemic Inflammatory Response Syndrome and Septic Shock 715(15)

Multiple Organ Dysfunction Sydrome 730(6)

Multisystem Trauma 736(13)

Burns 749(15)

Hypothermia 764(15)

Toxic Ingestion 779(20)

chapter 9 Psychosocial Aspects of Critical Care 799(65)

John L. Carty, R.N.C., D.N.Sc., ARNP

GROWTH AND DEVELOPMENT 799(4)

Definition 799(1)

Discussion 799(1)

Example 799(3)

Nursing Assessment Data Base 802(1)

Commonly Encountered Nursing Diagnosis: Altered Growth and Development 802(1)

PERCEPTION 803(2)

Definition 803(1)

Discussion 803(1)

Example 804(1)

Nursing Assessment Data Base 804(1)

Commonly Encountered Nursing Diagnosis: Sensory-Perceptual Alterations 804(1)

SELF-CONCEPT 805(3)

Definition 805(1)

Discussion 806(1)

Example 806(1)

Nursing Assessment Data Base 806(1)

Commonly Encountered Nursing Diagnosis: Self-Concept Disturbance 807(1)

SELF-ESTEEM 808(2)

Definition 808(1)

Discussion 808(1)

Examples 809(1)

Nursing Assessment Data Base 809(1)

Commonly Encountered Nursing Diagnosis: Disturbances in Self-Esteem 810(1)

NEEDS 810(3)

Definition 810(1)

Discussion 810(1)

Example 811(1)

Nursing Assessment Data Base 811(1)

Commonly Encountered Nursing Diagnosis: Need Disturbance 812(1)

STRENGTHS, POTENTIALS, AND LIMITATIONS 813(2)

Definition 813(1)

Discussion 813(1)

Example 814(1)

Nursing Assessment Data Base 814(1)

Commonly Encountered Nursing Diagnosis: Disturbance in Perception, Self-Concept, Self-Esteem, or Needs 815(1)

STRESS 815(3)

Definition 815(1)

Discussion 816(1)

Example 816(1)

Nursing Assessment Data Base 816(1)

Commonly Encountered Nursing Diagnosis: Alteration in Stress Level 817(1)

PAIN 818(2)

Definition 818(1)

Discussion 818(1)

Example 819(1)

Nursing Assessment Data Base 819(1)

Commonly Encountered Nursing Diagnosis: Pain 819(1)

INTERPERSONAL COMMUNICATION 820(3)

Definition 820(1)

Discussion 820(1)

Example 821(1)

Nursing Assessment Data Base 821(1)

Commonly Encountered Nursing Diagnosis: Impaired Communication 822(1)

BODY IMAGE 823(2)

Definition 823(1)

Discussion 823(1)

Example 823(1)

Nursing Assessment Data Base 824(1)

Commonly Encountered Nursing Diagnosis: Disturbance in Body Image 824(1)

HUMAN SEXUALITY 825(3)

Definition 825(1)

Discussion 825(1)

Example 826(1)

Nursing Assessment Data Base 826(1)

Commonly Encountered Nursing Diagnosis: Altered Patterns of Human Sexuality 827(1)

ABUSE 828(3)

Definition 828(1)

Discussion 828(1)

Example 829(1)

Nursing Assessment Data Base 829(1)

Commonly Encountered Nursing Diagnosis: Post-Trauma Response 830(1)

FAMILY 831(2)

Definition 831(1)

Discussion 831(1)

Example 832(1)

Nursing Assessment Data Base 832(1)

Commonly Encountered Nursing Diagnosis: Altered Family Processes 832(1)

THE CRITICAL CARE ENVIRONMENT 833(3)

Definition 833(1)

Discussion 833(1)

Example 834(1)

Nursing Assessment Data Base 834(1)

Commonly Encountered Nursing Diagnosis: Environmental Interpretation Syndrome 835(1)

CRISIS 836(2)

Definition 836(1)

Discussion 836(1)

Nursing Assessment Data Base 837(1)

Commonly Encountered Nursing Diagnosis: Ineffective Individual Coping 837(1)

FEAR AND ANXIETY 838(3)

Definition 838(1)

Discussion 838(1)

Example 839(1)

Nursing Assessment Data Base 839(1)

Commonly Encountered Nursing Diagnosis: Fear and Anxiety 840(1)

LONELINESS 841(2)

Definition 841(1)

Discussion 841(1)

Example 841(1)

Nursing Assessment Data Base 842(1)

Commonly Encountered Nursing Diagnosis: Loneliness, Sense of Alienation 842(1)

POWERLESSNESS 843(2)

Definition 843(1)

Discussion 843(1)

Nursing Assessment Data Base 844(1)

Commonly Encountered Nursing Diagnosis: Powerlessness 845(1)

SENSORY OVERLOAD 845(3)

Definition 845(1)

Discussion 846(1)

Nursing Assessment Data Base 847(1)

Commonly Encountered Nursing Diagnosis: Sensory Overload 847(1)

SENSORY DEPRIVATION 848(2)

Definition 848(1)

Discussion 848(1)

Nursing Assessment Data Base 849(1)

Commonly Encountered Nursing Diagnosis: Sensory Deprivation 849(1)

ADDICTION 850(2)

Definition 850(1)

Discussion 850(1)

Nursing Assessment Data Base 851(1)

Commonly Encountered Nursing Diagnosis: Addiction 852(1)

SUICIDAL PHENOMENON 852(3)

Definition 852(1)

Discussion 853(1)

Nursing Assessment Data Base 854(1)

Commonly Encountered Nursing Diagnosis: Risk for Self-Mutilation 854(1)

THE DYING PROCESS AND DEATH 855(5)

Definition 855(1)

Discussion 855(3)

Nursing Assessment Data Base 858(1)

Commonly Encountered Nursing Diagnosis: Dysfunctional Grieving 859(1)

CAREGIVER ROLE STRAIN 860(4)

chapter 10 Legal and Ethical Aspects of Critical Care Nursing 864(25)

Ginger Schafer Wlody, R.N., Ed.D., FCCM

LEGAL ASPECTS 864(10)

Law 864(1)

Sources of Law 864(1)

State Nurse Practice Acts 864(2)

Standards of Nursing Care 866(1)

Documentation 867(1)

Informed Consent 868(2)

Declaring Death 870(1)

Patient Rights 871(1)

Do Not Resuscitate Orders 872(1)

Advance Directives 872(1)

Good Samaritan Acts 872(1)

The Legal Process 873(1)

ETHICAL ASPECTS 874(8)

Ethical Principles 874(1)

Moral Concepts and Theories 875(1)

American Nurses Association Ethical Code for Nurses 875(1)

American Hospital Association: Patient's Bill of Rights 876(1)

Role of the Nurse in Addressing Ethical Issues 877(5)

IDENTIFICATION OF ETHICAL AND LEGAL CONFLICTS IN THE CURRENT HEALTH CARE ENVIRONMENT 882(7)

Allocation of Resources and Scare Resources 882(3)

Patient Care Dilemmas 885(1)

Use of Technology 885(1)

Common Ethical Conflicts in Care of the Critically Ill 886(1)

Institutional and Corporate Ethics 886(3)
Index 889