C C RITICAL ARE N URSING A HOLISTIC APPROACH Patricia Gonce Morton, RN, PhD, ACNP-BC, FAAN Professor, Associate Dean for Academic Affairs University of Maryland School of Nursing Baltimore, Maryland Acute Care Nurse Practitioner Peri-Operative Services University of Maryland Medical Center Baltimore, Maryland Dorrie K. Fontaine, RN, PhD, FAAN Sadie Heath Cabaniss Professor of Nursing and Dean University of Virginia School of Nursing Charlottesville, Virginia 10 Past-President, American Association of Critical-Care Nurses (AACN) EDITION MMoorrttoonn__FFMM..iinndddd ii 77//1177//22001122 1122::3355::2255 AAMM Executive Editor: Chris Richardson Senior Product Manager: Helen Kogut Editorial Assistant: Zachary Shapiro Design Coordinator: Joan Wendt Illustration Coordinator: Brett MacNaughton Manufacturing Coordinator: Karin Duffi eld Prepress Vendor: SPi Global 10th edition Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins. Copyright © 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 photocopies 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 offi cial duties as U.S. government employees are not covered by the above-mentioned copyright. To request permission, please contact Lippincott Williams & Wilkins at Two Commerce Square, 2001 Market Street, Philadelphia, PA 19103, via email at permissions@lww. com, or via our website at lww.com (products and services). 9 8 7 6 5 4 3 2 1 Printed in China Library of Congress Cataloging-in-Publication Data Critical care nursing : a holistic approach / [edited by] Patricia Gonce Morton, Dorrie K. Fontaine. — 10th ed. p. ; cm. Includes bibliographical references and index. ISBN 978-1-60913-749-6 I. Morton, Patricia Gonce, 1952- II. Fontaine, Dorrie K. [DNLM: 1. Critical Care. 2. Holistic Nursing. WY 154] 610.73'6—dc23 2012010189 Care has been taken to confi rm the accuracy of the information presented and to describe generally accepted practices. However, the author(s), editors, and publisher are not responsible for errors or omissions or for any consequences from application of the information in this book and make no warranty, expressed or implied, with respect to the currency, completeness, or accuracy of the contents of the publication. Application of this information in a particular situation remains the professional responsibility of the practitioner; the clinical treatments described and recommended may not be considered absolute and universal recommendations. The author(s), editors, and publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accordance with the current recommendations and practice at the time of publication. However, in view of ongoing research, changes in government regulations, and the constant fl ow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any change in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new or infrequently employed drug. Some drugs and medical devices presented in this publication have Food and Drug Administration (FDA) clearance for limited use in restricted research settings. It is the responsibility of the health care provider to ascertain the FDA status of each drug or device planned for use in his or her clinical practice. LWW.com MMoorrttoonn__FFMM..iinndddd iiii 77//1177//22001122 1122::3355::2277 AAMM To our former students. You have been our teachers and our source of inspiration. Thanks for all you do for critically ill patients and families. To our husbands John and Barry. Thanks for your never ending support, love, and encouragement. TRISH AND DORRIE MMoorrttoonn__FFMM..iinndddd iiiiii 77//1177//22001122 1122::3355::2277 AAMM MMoorrttoonn__FFMM..iinndddd iivv 77//1177//22001122 1122::3355::2277 AAMM Contributors Susan E. Anderson, RN, MSN Donna Charlebois, RN, MSN, ACNP-CS Senior Quality Assurance Specialist Acute Care Nurse Practitioner U.S. Army Graduate Program in Anesthesia Nursing Interventional Cardiology Fort Sam Houston, Texas University of Virginia Health System Charlottesville, Virginia Nathaniel M. Apatov, MSN, PhD, MHS, CRNA Program Director, Nurse Anesthesia Program Dennis J. Cheek, RN, PhD, FAHA Old Dominion University Abell-Hanger Professor of Gerontological Nursing Norfolk, Virginia Texas Christian University Harris College of Nursing and Health Sciences Sue Apple, RN, PhD Fort Worth, Texas Retired Formerly Assistant Professor Mary Ciechanowski, RN, MSN, ACNS-BC, CCRN Georgetown University Stroke Program Advanced Practice Nurse Washington, District of Columbia Christiana Care Health Systems Newark, Delaware Richard Arbour, RN, MSN, CCRN, CNRN, CCNS, FAAN Critical Care Nurse Specialist JoAnn Coleman, RN, DNP, ACNP, ANP, AOCN Albert Einstein Medical Center Acute Care Nurse Practitioner Philadelphia, Pennsylvania Gastrointestinal Surgical Oncology Johns Hopkins Hospital Carla A. Aresco, RN, MS, CRNP Baltimore, Maryland Nurse Practitioner, Shock Trauma R Adams Cowley Shock Trauma Center Vicki J. Coombs, RN, PhD, FAHA University of Maryland Medical Center Senior Vice President Baltimore, Maryland Spectrum Clinical Research Incorporated Towson, Maryland Mona N. Bahouth, MSN, CRNP Nurse Practitioner Kelley Caldwell Crusius, RN, CCRN Baltimore, Maryland Staff Nurse University Medical Center Kathryn S. Bizek, MSN, ACNS-BC, CCRN Tucson, Arizona Nurse Practitioner, Cardiac Electrophysiology Henry Ford Heart and Vascular Institute Joan M. Davenport, RN, PhD Henry Ford Health System Assistant Professor and Vice-Chair Detroit, Michigan Department of Organizational Systems and Adult Health Nancy Blake, RN, MN, CCRN, NEA-BC University of Maryland School of Nursing Director, PCS Critical Care Services Baltimore, Maryland Children’s Hospital Los Angeles Los Angeles, California Marla J. De Jong, RN, PhD, CCNS, Col Kay Blum, PhD, CRNP Dean United States Air Force School of Aerospace Nurse Practitioner and Coordinator Medicine Cardiac Risk Reduction Center Wright-Patterson Air Force Base, Ohio Southern Maryland Hospital Center Clinton, Maryland Emily Smith Des Champs, RN, MS, CCRN Garrett K. Chan, PhD, APRN, BC-PCM, CEN Clinical Nurse Specialist, Neurology Lead Advanced Practice Nurse University Medical Center Clinical Decision Area/Emergency Department Tucson, Arizona Stanford Hospital and Clinic Nancy Kern Feeley, RN, MS, CRNP, CNN Assistant Clinical Professor Nephrology Adult Nurse Practitioner Schools of Nursing and Medicine, University of California, Johns Hopkins University School of Medicine San Francisco Baltimore, Maryland San Francisco, California v MMoorrttoonn__FFMM..iinndddd vv 77//1177//22001122 1122::3355::2277 AAMM vi CONTRIBUTORS Charles Fisher, RN, MSN, CCRN, ACNP-BC Janie Heath, PhD, APRN-BC, FAAN Acute Care Nurse Practitioner Associate Dean for Academic Affairs Medical Intensive Care Unit University of Virginia School of Nursing University of Virginia Health System Charlottesville, Virginia Charlottesville, Virginia Genell Hilton, PhD, CRNP Dorrie K. Fontaine, RN, PhD, FAAN Nurse Practitioner, Trauma Services Sadie Heath Cabaniss Professor of Nursing and Dean San Francisco General Hospital University of Virginia School of Nursing San Francisco, California Charlottesville, Virginia Adjunct Faculty Past-President, American Association of Critical-Care Santa Rosa Junior College Nurses (AACN) Santa Rosa, California Conrad Gordon, RN, MS, ACNP Janice J. Hoffman, RN, PhD, CCRN Assistant Professor Assistant Dean for Baccalaureate Program and Assistant Department of Organizational Systems and Professor Adult Health University of Maryland School of Nursing University of Maryland School of Nursing Baltimore, Maryland Baltimore, Maryland Dorene M. Holcombe, RN, MS, ACNP, CCRN Christine Grady, RN, PhD Nephrology Acute Care Nurse Practitioner Head, Section on Human Subjects Research Johns Hopkins University School of Medicine Department of Bioethics Baltimore, Maryland Clinical Center National Institutes of Health Elizabeth Holderness, RN, MS, ACNP-BC Bethesda, Maryland Nurse Practitioner, Cardiac Surgery University of Maryland Medical Center Debby Greenlaw, MS, CCRN, ACNPC Baltimore, Maryland Acute Care Nurse Practitioner Providence Hospital Christina Hurlock-Chorostecki, PhD(c), APN Columbia, South Carolina Nurse Practitioner St. Joseph Health Care, London Thomasine D. Guberski, PhD, CRNP London, Ontario, Canada Director, Health Program-Nursing Institute of Human Virology Karen L. Johnson, RN, PhD University of Maryland School of Medicine Director of Nursing, Research, and Evidence-Based Baltimore, Maryland Practice University of Maryland Medical Center Kimberli Haas, RN, BSN Associate Professor Staff Nurse II University of Maryland School of Nursing University Medical Center Baltimore, Maryland Tucson, Arizona John C. Hagen, MS, CCRN, CRNP-AC Lisa M. Johnson, RN, MS, ACNP-BC, CCRN Major, U.S. Army Nurse Corps Acute Care Nurse Practitioner Nurse Manager, Burn Intensive Care Unit University of Maryland Medical Center U.S. Army Medical Department Baltimore, Maryland Sam Houston, Texas Jillian Hamel, MS, ACNP-BC, CCNS, CCRN Nurse Practitioner Dennis W. Jones, RN, DNP, CFRN University of Maryland Medical Center Critical Care Flight/Transport Nurse Baltimore, Maryland Johns Hopkins Hospital Baltimore, Maryland Kathy A. Hausman, RN, C, PhD Assistant Professor Kimmith M. Jones, RN, DNP, CCNS University of Maryland School of Nursing Advanced Practice Nurse in Critical Care Baltimore, Maryland Sinai Hospital of Baltimore Baltimore, Maryland Jan M. Headley, RN, BS Director, Clinical Marketing and Professional Roberta Kaplow, RN, PhD, AOCNS, CCNS, CCRN Education Clinical Nurse Specialist Edwards Lifesciences LLC Dekalb Medical Irvine, California Decatur, Georgia MMoorrttoonn__FFMM..iinndddd vvii 77//1177//22001122 1122::3355::2288 AAMM CONTRIBUTORS vii Jane Kapustin, PhD, CRNP, BC-ADM, FAANP, FAAN Paul K. Merrel, RN, MSN, CCNS Associate Professor Advanced Practice Nurse 2—CNS, Adult Critical Care Assistant Dean for Masters and Doctor of Nursing Practice University of Virginia Health System Programs Charlottesville, Virginia University of Maryland School of Nursing Adult Nurse Practitioner, Joslin Diabetes Center Sandra A. Mitchell, PhD, CRNP, AOCN University of Maryland Medical Center Nurse Scientist Baltimore, Maryland National Institute of Health Clinical Center Bethesda, Maryland Elizabeth Kozub, RN, MS, CCRN, CNRN Nurse Clinician III Patricia A. Moloney-Harmon, RN, MS, CCNS, FAAN Sharp Memorial Hospital Advanced Practice Nurse San Diego, California Children’s Services Sinai Hospital of Baltimore Sun-Ah Lee, RN, MS, CRNP Baltimore, Maryland Nurse Practitioner University of Maryland Medical System Patricia Gonce Morton, RN, PhD, ACNP-BC, FAAN Baltimore, Maryland Professor and Associate Dean for Academic Affairs University of Maryland School of Nursing Barbara Leeper, RN, MN, CNS, M-S, CCRN, FAHA Baltimore, Maryland Clinical Nurse Specialist, Cardiovascular Services Baylor University Medical Center Donna Mower-Wade, RN, MS, CNRN, ACNS-BC Dallas, Texas Trauma Clinical Nurse Specialist Christiana Care Health System Tara Leslie, RN, BSN Newark, Delaware RN Extender St. Joseph Cardiology Associates Nancy Munro, RN, MN, CCRN, ACNP Lexington, Kentucky Acute Care Nurse Practitioner Critical Care Medicine Department Susan Luchka, RN, MSN, CCRN, ET National Institutes of Health Director of Clinical Education Bethesda, Maryland Memorial Hospital York, Pennsylvania Angela C. Muzzy, RN, MSN, CCRN, CNS Clinical Nurse Specialist, Cardiovascular Intensive Care Unit Christine N. Lynch, RN, MS, ACNP, CCRN University Medical Center Acute Care Flight Nurse Practitioner Tucson, Arizona Cleveland Clinic, Critical Care Transport Cleveland, Ohio Colleen Krebs Norton, RN, PhD, CCRN Associate Professor and Director of the Baccalaureate Megan Cecere Lynn, RN, MS, MBA, FNE-A Nursing Program Clinical Instructor Georgetown University School of Nursing and Health University of Maryland School of Nursing Studies Baltimore, Maryland Washington, District of Columbia Cathleen R. Maiolatesi, RN, MS Dulce Obias-Manno, RN, MHSA, CCDS, CEPS, FHRS Advanced Practice Nurse Nurse Coordinator, Cardiac Arrhythmia Device Clinic Johns Hopkins Hospital Washington Hospital Center Baltimore, Maryland Washington, District of Columbia E. Jane McCarthy, PhD, CRNA, FAAN Mary O. Palazzo, RN, MS, FACHE Visiting Professor Senior Director of Transition Planning University of Maryland School of Nursing Mercy Medical Center Baltimore, Maryland Baltimore, Maryland Sandra W. McLeskey, RN, PhD Archana D. Patel, MS, CRNP Professor Acute Care Nurse Practitioner, Thoracic Surgery University of Maryland School of Nursing University of Maryland Medical Center Baltimore, Maryland Baltimore, Maryland Patricia C. McMullen, PhD, JD, CRNP Nayna C. Philipsen, RN, JD, PhD, CFE, FACCE Dean, School of Nursing Director of Program Development The Catholic University of America Coppin State University Washington, District of Columbia Baltimore, Maryland MMoorrttoonn__FFMM..iinndddd vviiii 77//1177//22001122 1122::3355::2288 AAMM viii CONTRIBUTORS Clifford C. Pyne, RN, MS, ACNP Jo Ann Hoffman Sikora, RN, MS, CRNP Nurse Practitioner—General Cardiology Nurse Practitioner, Cardiac Surgery Buffalo Cardiology and Pulmonary Associates University of Maryland Medical Center Williamsville, New York Baltimore, Maryland Kim Reck, RN, MS, CRNP Kara Adams Snyder, RN, MS, CCRN, CCNS Adult Nurse Practitioner Clinical Nurse Specialist, Surgical Trauma Clinical Program Manager, CRNP Critical Care Division of Cardiology University Medical Center University of Maryland Medical Center Tucson, Arizona Baltimore, Maryland Debbi S. Spencer, RN, MS Michael V. Relf, RN, PhD, CNE, ACNS-BC, Chief Nurse, Joint Trauma System AACRN, FAAN U.S. Army Institute of Surgical Research Associate Professor and Assistant Dean for Undergraduate Fort Sam Houston, Texas Education Duke University School of Nursing Allison G. Steele, RN, MSN, CRNP Durham, North Carolina Nurse Practitioner Division of Gastroenterology and Hepatology Kenneth J. Rempher, RN, PhD, MBA, CENP University Physicians Inc. Associate Chief Nursing Offi cer Baltimore, Maryland University of Iowa Hospitals and Clinics Iowa City, Iowa Louis R. Stout, RN, MS Lieutenant Colonel, United States Army Nurse Corps Cynthia L. Renn, RN, PhD United States Army Medical Department Assistant Professor Fort Lewis, Washington University of Maryland School of Nursing Baltimore, Maryland Paul A. Thurman, RN, MS, ACNPC, CCNS, CCRN, CNRN Barbara Resnick, PhD, CRNP, FAAN, FAANP Clinical Nurse Specialist Professor and Sonya Ziporkin Gershowitz Chair in R Adams Cowley Shock Trauma Center Gerontology University of Maryland Medical Center University of Maryland School of Nursing Baltimore, Maryland Baltimore, Maryland Sidenia S. Tribble, RN, MSN, ACNP-BC, CCRN Acute Care Nurse Practitioner Valerie K. Sabol, PhD, ACNP-BC, GNP-BC Augusta Health Associate Professor and Specialty Director Fisherville, Virginia Acute Care Nurse Practitioner and Critical Care Clinical Nurse Specialist Program Kathleen Turner, RN, DNP Duke University School of Nursing Assistant Professor Durham, North Carolina Duke University School of Nursing Durham, North Carolina Eric Schuetz, BS Pharm, CSPI Specialist in Poison Information Connie M. Ulrich, RN, PhD, FAAN Maryland Poison Center Associate Professor of Nursing and Bioethics Baltimore, Maryland University of Pennsylvania School of Nursing Philadelphia, Pennsylvania Julie Schuetz, MS, CRNP Nurse Practitioner Jeffrey S. Upperman, MD Department of Hematologic Malignancies Associate Professor of Surgery The Sidney Kimmel Comprehensive Cancer Director, Trauma Program Center Children’s Hospital Los Angeles Johns Hopkins Medicine Keck School of Medicine Baltimore, Maryland University of Southern California Los Angeles, California Brenda K. Shelton, RN, MS, CCRN, AOCN Critical Care Clinical Nurse Specialist Mary van Soeren, RN, PhD The Sidney Kimmel Comprehensive Cancer Center at Director Johns Hopkins Canadian Health Care Innovation Baltimore, Maryland Guelph, Ontario, Canada MMoorrttoonn__FFMM..iinndddd vviiiiii 77//1177//22001122 1122::3355::2288 AAMM