Fast Facts CritiCal Care Nurse L for the a Fast Facts n Critical Care Nursing in a Nutshell d r u m Michele Angell Landrum, ADN, RN, CCRN for the F a This pocket-sized reference for new and seasoned intensive care unit (ICU) s t nurses contains critical knowledge presented in the clear, precise, “Fact Facts” F CritiCal format. It provides quick access to a broad array of guidelines, procedures, and a c equipment used by ICU nurses daily as well as on a less frequent basis. t s The book covers assessment and procedural skills, medications, intravenous fo (IV)therapy, nutrition, wound care, sterile field setup, and patient preparation. r t Care It facilitates equipment mastery for respiratory and cardiac care along with h e troubleshooting tips for monitoring and mechanical devices. Also included is C information on specific types of critical care units, such as cardiac, surgical, r neuro, and the burn unit. Documentation, advance directives, organ donations, i t Nurse palliative and end-of-life care are also discussed. i C a The resource addresses the requirements of The Joint Commission and recom- l mendations of the Centers for Disease Control and Prevention, such as isolation C precautions and use of personal protective equipment. Other important informa- a tion is provided such as normal hemodynamic measurements, basic electrocar- r e diographic (EKG) rhythms, 12-lead EKG electrode placement, and a “Do Not Use” N abbreviation list in the appendix that will help prevent medication errors. u Critical r s Key Features: e Care • Provides quick access to information needed on a daily basis Nursing • Covers equipment, medications, procedures, and specialty care • I ncludes reliable data for basic EKG rhythms, abbreviations, expected in a treatments and patient care, and troubleshooting tips Nutshell • Targeted to new ICU nurses, and experienced critical care nurses alike • H elps nurses quickly access information with the “Fast Facts in a Nutshell” feature Michele Angell Landrum 11 W. 42nd Street New York, NY 10036-8002 www.springerpub.com Fast Facts For the critical care Nurse critical care Nursing in a Nutshell Michele Angell Landrum, ADN, RN, CCRN, received her asso- ciate degree in nursing from the University of Mobile in 1998. She has worked as a travel nurse in various facilities throughout the United States, such as Scripps Memorial Hospital, La Jolla in San Diego and Cedars-Sinai Hospital in Los Angeles. Her spe- cialties include the cardiac care unit, cardiovascular intensive care unit, surgical intensive care unit, emergency room, cardiac catheterization lab, and electrophysiology lab. Mrs. Landrum is currently employed by Springhill Medical Center in Mobile, Alabama, as a clinical nurse educator with the staff development department. Fast Facts For the critical care Nurse critical care Nursing in a Nutshell Michele Angell Landrum, ADN, RN, CCRN Copyright © 2012 Springer Publishing Company, LLC All rights reserved. No part of this publication may be reproduced, stored in a retrieval system, or transmitted in any form or by any means, electronic, mechanical, photocopying, recording, or other- wise, without the prior permission of Springer Publishing Company, LLC, or authoriza- tion through payment of the appropriate fees to the Copyright Clearance Center, Inc., 222 Rosewood Drive, Danvers, MA 01923, 978-750-8400, fax 978-646-8600, info@copyright. com or on the web at www.copyright.com. Springer Publishing Company, LLC 11 West 42nd Street New York, NY 10036 www.springerpub.com Acquisitions Editor: Margaret Zuccarini Composition: Newgen Imaging ISBN: 978-0-8261-0728-1 eISBN: 978-0-8261-0729-X 11 12 13 14 / 5 4 3 2 1 The author and the publisher of this Work have made every effort to use sources believed to be reliable to provide information that is accurate and compatible with the standards generally accepted at the time of publication. Because medical science is continually advancing, our knowledge base continues to expand. Therefore, as new information becomes available, changes in procedures become necessary. We recommend that the reader always consult current research and specific institutional policies before perform- ing any clinical procedure or administering any drug. The author and publisher shall not be liable for any special, consequential, or exemplary damages resulting, in whole or in part, from the readers’ use of, or reliance on, the information contained in this book. The publisher has no responsibility for the persistence or accuracy of URLs for external or third-party Internet Web sites referred to in this publication and does not guarantee that any content on such Web sites is, or will remain, accurate or appropriate. Cataloging-in-Publication Data is on file at the Library of Congress. Special discounts on bulk quantities of our books are available to corporations, professional associations, pharmaceutical companies, health care organizations, and other qualifying groups. If you are interested in a custom book, including chapters from more than one of our titles, we can provide that service as well. For details, please contact: Special Sales Department, Springer Publishing Company, LLC 11 West 42nd Street, 15th Floor, New York, NY 10036-8002 Phone: 877-687-7476 or 212-431-4370; Fax: 212-941-7842 Email: [email protected] Printed in the United States of America by Hamilton Printing. This book is dedicated to my husband Ted for his continued love, support, and encouragement, and also to my sons Carter and Cody, for it is their love, joy, patience, and understanding that makes every day a blessing. —M.A.L. contents Preface ix Acknowledgments xi Part I: Foundations of Critical Care 1. Critical Care Nursing Overview 3 2. The Importance of Documentation 11 3. Advance Directives and Organ Donation 19 4. Withdrawal of Treatment and Palliative Care 27 Part II: Critical Care Basics 5. Basic Patient Care in the Critical Care Setting 39 6. Patient Nutrition 57 7. The Sterile Field, Pre-procedural Patient Preparation, and Conscious Sedation 71 8. Isolation Precautions and Personal Protective Equipment 83 9. Everything IV 95 Part III: Critical Care Equipment Competencies 10. The Respiratory Station 113 vii viii contents 11. Arterial Blood Gases, Arterial Lines, and Pulmonary Artery Catheters 133 12. Discussing Dialysis and Continuous Renal Replacement Therapy 147 13. Cardiac Specialty Equipment 159 Part IV: The Specialty Critical Care Unit 14. Surgical and Orthopedic Recovery Guidelines 179 15. The Neuro ICU 193 16. G eneral Cardiac Care and Post-Coronary- Artery-Bypass-Graft Patients 205 17. Transplant Patients 217 18. Burn Unit Basics 227 Appendix A: “Do Not Use” List for Abbreviations, Acronyms, and Symbols 235 Appendix B: Basic EKG Rhythm Examples 237 Appendix C: 12 Lead EKG Electrode Placement 242 Appendix D: Normal Hemodynamic Values and Vital Signs 243 Appendix E: List of Abbreviations 245 References 249 Index 259 Preface Critical care nursing is one of the most challenging nurs- ing options available. It requires astute assessment skills, extremely specialized training, the ability to multitask, adaptability, top-notch communication skills, attention to detail while seeing the big picture, positive coping tech- niques, and numerous other traits. This guide is intended to help make practicing as a critical care nurse a little easier. The guide is designed to work as an assistant. It includes guidelines for documentation, advance directives, organ donation, withdrawal of treatment, and palliative care. Basic assessment and procedural skills are detailed, along with more in-depth acute care practices, such as managing an intra-aortic balloon pump. Aseptic technique, isolation precautions, IV therapy, central venous line and pulmonary artery catheter care, and continuous renal replacement ther- apy are explained in an easy-to-read manner. Applications pertaining to individual ICUs are also included. Several of the topics in this guide apply to current nurs- ing concerns nationwide. Joint Commission topics such as proper patient identification are discussed. Isolation precau- tions and personal protective equipment applications recom- mended by the Centers for Disease Control and Prevention are detailed, and information about performing palliative care in the ICU is provided. ix