AACN Core Curriculum for Progressive and Critical Care Nursing, 8th Edition (2023)
Get step-by-step guidance for your certification with AACN Core Curriculum for Progressive and Critical Care Nursing, 8th Edition (2023).
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AACN
Core Curriculum
for Progressive
and Critical Care
Nursing
TONJA M. HARTJES, Editor
DNP, APRN, CNS, CCRN, CNEcl, FAANP
Owner, Nurse Practitioner and Consultant
Nursing Department
Coastal Consultants and Education LLC
St. Augustine Beach, Florida
Edition
8
Core Curriculum
for Progressive
and Critical Care
Nursing
TONJA M. HARTJES, Editor
DNP, APRN, CNS, CCRN, CNEcl, FAANP
Owner, Nurse Practitioner and Consultant
Nursing Department
Coastal Consultants and Education LLC
St. Augustine Beach, Florida
Edition
8
Loading page 4...
3251 Riverport Lane
St. Louis, Missouri 63043
AACN CORE CURRICULUM FOR PROGRESSIVE ISBN: 978-0-323-77808-4
AND CRITICAL CARE NURSING, EIGHTH EDITION
Copyright © 2023 by Elsevier, Inc. All rights reserved.
No part of this publication may be reproduced or transmitted in any form or by any means, electronic or
mechanical, including photocopying, recording, or any information storage and retrieval system, without
permission in writing from the publisher. Details on how to seek permission, further information about
the Publisher’s permissions policies and our arrangements with organizations such as the Copyright
Clearance Center and the Copyright Licensing Agency, can be found at our website: www.elsevier.com/
permissions.
This book and the individual contributions contained in it are protected under copyright by the Publisher
(other than as may be noted herein).
Notice
Practitioners and researchers must always rely on their own experience and knowledge in evaluating
and using any information, methods, compounds or experiments described herein. Because of rapid
advances in the medical sciences, in particular, independent verification of diagnoses and drug dos-
ages should be made. To the fullest extent of the law, no responsibility is assumed by Elsevier, authors,
editors or contributors for any injury and/or damage to persons or property as a matter of products
liability, negligence or otherwise, or from any use or operation of any methods, products, instructions
or ideas contained in the material herein.
Previous editions copyrighted 2018, 2006, 1998, 1991, 1985, 1981, 1975.
Executive Content Strategist: Lee Henderson
Senior Content Development Manager: Lisa Newton
Senior Content Development Specialist: Laura Selkirk
Publishing Services Manager: Deepthi Unni
Senior Book Production Executive: Manchu Mohan
Senior Book Designer: Amy Buxton
Printed in India.
Last digit is the print number: 9 8 7 6 5 4 3 2 1
Elsevier
St. Louis, Missouri 63043
AACN CORE CURRICULUM FOR PROGRESSIVE ISBN: 978-0-323-77808-4
AND CRITICAL CARE NURSING, EIGHTH EDITION
Copyright © 2023 by Elsevier, Inc. All rights reserved.
No part of this publication may be reproduced or transmitted in any form or by any means, electronic or
mechanical, including photocopying, recording, or any information storage and retrieval system, without
permission in writing from the publisher. Details on how to seek permission, further information about
the Publisher’s permissions policies and our arrangements with organizations such as the Copyright
Clearance Center and the Copyright Licensing Agency, can be found at our website: www.elsevier.com/
permissions.
This book and the individual contributions contained in it are protected under copyright by the Publisher
(other than as may be noted herein).
Notice
Practitioners and researchers must always rely on their own experience and knowledge in evaluating
and using any information, methods, compounds or experiments described herein. Because of rapid
advances in the medical sciences, in particular, independent verification of diagnoses and drug dos-
ages should be made. To the fullest extent of the law, no responsibility is assumed by Elsevier, authors,
editors or contributors for any injury and/or damage to persons or property as a matter of products
liability, negligence or otherwise, or from any use or operation of any methods, products, instructions
or ideas contained in the material herein.
Previous editions copyrighted 2018, 2006, 1998, 1991, 1985, 1981, 1975.
Executive Content Strategist: Lee Henderson
Senior Content Development Manager: Lisa Newton
Senior Content Development Specialist: Laura Selkirk
Publishing Services Manager: Deepthi Unni
Senior Book Production Executive: Manchu Mohan
Senior Book Designer: Amy Buxton
Printed in India.
Last digit is the print number: 9 8 7 6 5 4 3 2 1
Elsevier
Loading page 5...
iii
Bimbola Fola Akintade, PhD, MBA, MHA, ACNP-BC, NEA-BC, FAANP
Associate Professor and Associate Dean for the MSN Program
Organizational Systems and Adult Health
University of Maryland, School of Nursing;
Acute Care Nurse Practitioner
Surgical Intensive Care Unit
University of Maryland Medical Center
Baltimore, Maryland
Chapter 2: Psychosocial Aspects of Critical Care
Jenny G. Alderden, PhD, APRN, CCRN, CCNS
Associate Professor
Boise State University, School of Nursing
Boise, Idaho
Chapter 16: Older Adult Patients
Angela Benefield, DNP, RN, AGCNS-BC, CCRN-CSC-CMC
Clinical Education Specialist/Clinical Consultant
Education and Professional Development
Independent Clinical Education Consultant
Temecula, California
Chapter 15: Bariatric Patients
Patricia A. Blissitt, PhD, ARNP-CNS, CCRN, CNRN, SCRN, CCNS, CCM, ACNS-BC
Neuroscience Clinical Nurse Specialist
Professional Development and Nursing Excellence
Harborview Medical Center;
Associate Professor, Clinical Faculty
University of Washington, School of Nursing;
Neuroscience Clinical Nurse Specialist
Clinical Education and Practice
Swedish Medical Center
Seattle, Washington
Chapter 5: Neurologic System
Bryan Boling, DNP, AG-ACNP, CCRN-CSC, CEN
Advanced Practice Provider
Anesthesiology, Critical Care Medicine
University of Kentucky
Lexington, Kentucky
Adjunct Faculty
AGACNP Program
Georgetown University
Washington, District of Columbia
Chapter 4: Cardiovascular System
Chapter 6: Renal System
Contributors
Bimbola Fola Akintade, PhD, MBA, MHA, ACNP-BC, NEA-BC, FAANP
Associate Professor and Associate Dean for the MSN Program
Organizational Systems and Adult Health
University of Maryland, School of Nursing;
Acute Care Nurse Practitioner
Surgical Intensive Care Unit
University of Maryland Medical Center
Baltimore, Maryland
Chapter 2: Psychosocial Aspects of Critical Care
Jenny G. Alderden, PhD, APRN, CCRN, CCNS
Associate Professor
Boise State University, School of Nursing
Boise, Idaho
Chapter 16: Older Adult Patients
Angela Benefield, DNP, RN, AGCNS-BC, CCRN-CSC-CMC
Clinical Education Specialist/Clinical Consultant
Education and Professional Development
Independent Clinical Education Consultant
Temecula, California
Chapter 15: Bariatric Patients
Patricia A. Blissitt, PhD, ARNP-CNS, CCRN, CNRN, SCRN, CCNS, CCM, ACNS-BC
Neuroscience Clinical Nurse Specialist
Professional Development and Nursing Excellence
Harborview Medical Center;
Associate Professor, Clinical Faculty
University of Washington, School of Nursing;
Neuroscience Clinical Nurse Specialist
Clinical Education and Practice
Swedish Medical Center
Seattle, Washington
Chapter 5: Neurologic System
Bryan Boling, DNP, AG-ACNP, CCRN-CSC, CEN
Advanced Practice Provider
Anesthesiology, Critical Care Medicine
University of Kentucky
Lexington, Kentucky
Adjunct Faculty
AGACNP Program
Georgetown University
Washington, District of Columbia
Chapter 4: Cardiovascular System
Chapter 6: Renal System
Contributors
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iv Contributors
Nicole Brumfield, DNP, APRN, FNP-BC, AG-ACNP-BC
Anesthesiology, Critical Care Medicine
University of Kentucky
Lexington, Kentucky
Chapter 8: Hematologic and Immunologic Systems
Deborah Chapa, PhD, ACNP-BC, FAANP, ACHPN
Associate Professor, Nursing
Marshall University
Huntington, West Virginia
Chapter 2: Psychosocial Aspects of Critical Care
Catrina Cullen, RN, BSN, CCRN
University of Colorado, College of Nursing
Denver, Colorado
Chapter 19: Sedation
Anna Dermenchyan, MSN, RN, CCRN-K, CPHQ
Director of Quality
Department of Medicine
University of California – Los Angeles Health
Los Angeles, California
Chapter 1: Professional Caring and Ethical Practice
Andrea Efre, DNP, ARNP, ANP, FNP
Owner, Nurse Practitioner and Consultant
Healthcare Education Consultants
Tampa, Florida
Chapter 4: Cardiovascular System
Carrol Graves, MSN, RN, CCRN, CNL
Clinical Nurse Leader
Critical Care
North Florida/South Georgia Veterans Health System
Gainesville, Florida
Chapter 13: Hypothermia
Renee M. Holleran, FNP-BC, PhD, CCRN (Alumnus), CEN, CFRN, CTRN
(Retired), FAEN
Nurse Practitioner
Anesthesia Chronic Pain
Veterans Health Administration;
Former Manager of Adult Transport
Intermountain Life Flight
Intermountain Health Care
Salt Lake City, Utah;
Former Chief Flight Nurse
University Air Care
University Hospital
Cincinnati, Ohio;
Family Nurse Practitioner
Hope Free Clinic
Midvale, Utah
Chapter 11: Multisystem Trauma
Nicole Brumfield, DNP, APRN, FNP-BC, AG-ACNP-BC
Anesthesiology, Critical Care Medicine
University of Kentucky
Lexington, Kentucky
Chapter 8: Hematologic and Immunologic Systems
Deborah Chapa, PhD, ACNP-BC, FAANP, ACHPN
Associate Professor, Nursing
Marshall University
Huntington, West Virginia
Chapter 2: Psychosocial Aspects of Critical Care
Catrina Cullen, RN, BSN, CCRN
University of Colorado, College of Nursing
Denver, Colorado
Chapter 19: Sedation
Anna Dermenchyan, MSN, RN, CCRN-K, CPHQ
Director of Quality
Department of Medicine
University of California – Los Angeles Health
Los Angeles, California
Chapter 1: Professional Caring and Ethical Practice
Andrea Efre, DNP, ARNP, ANP, FNP
Owner, Nurse Practitioner and Consultant
Healthcare Education Consultants
Tampa, Florida
Chapter 4: Cardiovascular System
Carrol Graves, MSN, RN, CCRN, CNL
Clinical Nurse Leader
Critical Care
North Florida/South Georgia Veterans Health System
Gainesville, Florida
Chapter 13: Hypothermia
Renee M. Holleran, FNP-BC, PhD, CCRN (Alumnus), CEN, CFRN, CTRN
(Retired), FAEN
Nurse Practitioner
Anesthesia Chronic Pain
Veterans Health Administration;
Former Manager of Adult Transport
Intermountain Life Flight
Intermountain Health Care
Salt Lake City, Utah;
Former Chief Flight Nurse
University Air Care
University Hospital
Cincinnati, Ohio;
Family Nurse Practitioner
Hope Free Clinic
Midvale, Utah
Chapter 11: Multisystem Trauma
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Contributors v
Jennifer MacDermott, MS, RN, ACNS-BC, NP-C, CCRN
Nurse Practitioner
Hospital Medicine
St. Luke’s Health System
Boise, Idaho
Chapter 7: Endocrine System
Mary Beth Flynn Makic, PhD, RN, CCNS, CCRN-K, FAAN, FNAP, FCNS
Professor
University of Colorado, College of Nursing
Aurora, Colorado;
Research Scientist
Denver Health
Denver, Colorado
Chapter 19: Sedation
Diane McLaughlin, DNP, AGACNP-BC, CCRN
Acute Care Nurse Practitioner
Neurocritical Care
University of Florida Health - Jacksonville;
Acute Care Nurse Practitioner
Critical Care Medicine
Mayo Clinic
Jacksonville, Florida;
Lecturer
Case Western Reserve University, School of Nursing
Cleveland, Ohio
Chapter 10: Sepsis and Septic Shock
Shana Metzger, MS, FNP-BC, AG-ACNP-BC
Adjunct Instructor
School of Nursing and Health Studies
Georgetown University
Washington, District of Columbia
Chapter 14: Toxin Exposure
Denise O’Brien, DNP, RN, ACNS-BC, CPAN, CAPA, FASPAN, FCNS, FAAN
Perianesthesia Clinical Nurse Specialist
Consultant
Self-Employed
Ypsilanti, Michigan
Chapter 22 Perioperative Care
Jan Odom-Forren, PhD, RN, CPAN, FASPAN, FAAN
Associate Professor
University of Kentucky, College of Nursing
Lexington, Kentucky;
Perianesthesia Nursing Consultant
Louisville, Kentucky
Chapter 22 Perioperative Care
Jennifer MacDermott, MS, RN, ACNS-BC, NP-C, CCRN
Nurse Practitioner
Hospital Medicine
St. Luke’s Health System
Boise, Idaho
Chapter 7: Endocrine System
Mary Beth Flynn Makic, PhD, RN, CCNS, CCRN-K, FAAN, FNAP, FCNS
Professor
University of Colorado, College of Nursing
Aurora, Colorado;
Research Scientist
Denver Health
Denver, Colorado
Chapter 19: Sedation
Diane McLaughlin, DNP, AGACNP-BC, CCRN
Acute Care Nurse Practitioner
Neurocritical Care
University of Florida Health - Jacksonville;
Acute Care Nurse Practitioner
Critical Care Medicine
Mayo Clinic
Jacksonville, Florida;
Lecturer
Case Western Reserve University, School of Nursing
Cleveland, Ohio
Chapter 10: Sepsis and Septic Shock
Shana Metzger, MS, FNP-BC, AG-ACNP-BC
Adjunct Instructor
School of Nursing and Health Studies
Georgetown University
Washington, District of Columbia
Chapter 14: Toxin Exposure
Denise O’Brien, DNP, RN, ACNS-BC, CPAN, CAPA, FASPAN, FCNS, FAAN
Perianesthesia Clinical Nurse Specialist
Consultant
Self-Employed
Ypsilanti, Michigan
Chapter 22 Perioperative Care
Jan Odom-Forren, PhD, RN, CPAN, FASPAN, FAAN
Associate Professor
University of Kentucky, College of Nursing
Lexington, Kentucky;
Perianesthesia Nursing Consultant
Louisville, Kentucky
Chapter 22 Perioperative Care
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vi Contributors
Patricia Radovich, PhD, CNS, FCCM
Director
Nursing Research
Loma Linda University Health Hospitals;
Assistant Professor
Loma Linda University, School of Nursing
Loma Linda, California;
Assistant Professor
California State University – Fullerton, School of Nursing
Fullerton, California;
Adjunct Professor
California State University - San Bernardino, School of Nursing
San Bernardino, California
Chapter 9: Gastrointestinal System
Tonya Sawyer-McGee, DNP, MBA, MSN, BSN, RN, ACNP-BC
Dean of Nursing
College of Nursing and Advanced Health Professions
The Chicago School of Professional Psychology
Richardson, Texas;
Adjunct Professor
Abilene Christian University, College of Nursing
Abilene, Texas
Chapter 20: Pain
Karah Cripe Sickler, RN, DNP, AG-ACNP-BC
Nurse Practitioner
Surgical Critical Care
University of Florida Health
Gainesville, Florida
Chapter 12: Burns
Daniel N. Storzer, DNP, ACNPC, ACNP-BC, CNRN, CCRN, CCEMT-P, FCCP, FCCM
Acute Care Nurse Practitioner
Pulmonary/Critical Care
Fox Valley Pulmonary Medicine
Neenah, Wisconsin;
Clinical Instructor
Acute Care Nurse Practitioner Program
Walden University;
Critical Care Paramedic
Waushara County EMS
Wautoma, Wisconsin
Chapter 3: Pulmonary System
Jennifer T.N. Treacy, MSN, APRN, FNP
Women, Infant, & Children Unit
Riverside Regional Medical Center
Newport News, Virginia
Chapter 17: High-Risk Obstetric Patients
Clareen Wiencek, PhD, RN, ACNP, ACHPN, FAAN
Associate Professor
Director of Advanced Practice
University of Virginia, School of Nursing
Charlottesville, Virginia
Chapter 21: Palliative and End-of-Life Care
Patricia Radovich, PhD, CNS, FCCM
Director
Nursing Research
Loma Linda University Health Hospitals;
Assistant Professor
Loma Linda University, School of Nursing
Loma Linda, California;
Assistant Professor
California State University – Fullerton, School of Nursing
Fullerton, California;
Adjunct Professor
California State University - San Bernardino, School of Nursing
San Bernardino, California
Chapter 9: Gastrointestinal System
Tonya Sawyer-McGee, DNP, MBA, MSN, BSN, RN, ACNP-BC
Dean of Nursing
College of Nursing and Advanced Health Professions
The Chicago School of Professional Psychology
Richardson, Texas;
Adjunct Professor
Abilene Christian University, College of Nursing
Abilene, Texas
Chapter 20: Pain
Karah Cripe Sickler, RN, DNP, AG-ACNP-BC
Nurse Practitioner
Surgical Critical Care
University of Florida Health
Gainesville, Florida
Chapter 12: Burns
Daniel N. Storzer, DNP, ACNPC, ACNP-BC, CNRN, CCRN, CCEMT-P, FCCP, FCCM
Acute Care Nurse Practitioner
Pulmonary/Critical Care
Fox Valley Pulmonary Medicine
Neenah, Wisconsin;
Clinical Instructor
Acute Care Nurse Practitioner Program
Walden University;
Critical Care Paramedic
Waushara County EMS
Wautoma, Wisconsin
Chapter 3: Pulmonary System
Jennifer T.N. Treacy, MSN, APRN, FNP
Women, Infant, & Children Unit
Riverside Regional Medical Center
Newport News, Virginia
Chapter 17: High-Risk Obstetric Patients
Clareen Wiencek, PhD, RN, ACNP, ACHPN, FAAN
Associate Professor
Director of Advanced Practice
University of Virginia, School of Nursing
Charlottesville, Virginia
Chapter 21: Palliative and End-of-Life Care
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vii
Staccie Anne Allen, DNP, BSBA, APRN, AGACNP-BC, FNP-C, CFRN, EMT-P
Nurse Practitioner/Paramedic
ShandsCair Critical Care Transport Program
University of Florida Department of Emergency Medicine
University of Florida Health Shands Hospital
Gainesville, Florida
Angie Atwood, PhD, RN
Assistant Professor of Nursing
Campbellsville University
Campbellsville, Kentucky
Michele Beatty Bachmann, MSN, RN
Instructor
Department of Primary Care
Southern Illinois University – Edwardsville
Edwardsville, Illinois
Beverly L. Banks, BSN, MSN, RN
Senior Full-Time Faculty
Nursing
Alpena Community College
Alpena, Michigan
Debra J. Behr, DNP, RN, CCRN-K
Director of Professional Development and Magnet Program
Lutheran Medical Center
Wheat Ridge, Colorado
Collin Bowman-Woodall, MSN, RN
Assistant Professor
Samuel Merritt University, School of Nursing
San Mateo, California
Mary Ann “Cammy” Christie, APRN, MSN, CCRN, CMC-CSC, PCCN
Acute Care Nurse Practitioner
Department of Critical Care Medicine and Surgery
University of Florida
Gainesville, Florida
Reviewers
Staccie Anne Allen, DNP, BSBA, APRN, AGACNP-BC, FNP-C, CFRN, EMT-P
Nurse Practitioner/Paramedic
ShandsCair Critical Care Transport Program
University of Florida Department of Emergency Medicine
University of Florida Health Shands Hospital
Gainesville, Florida
Angie Atwood, PhD, RN
Assistant Professor of Nursing
Campbellsville University
Campbellsville, Kentucky
Michele Beatty Bachmann, MSN, RN
Instructor
Department of Primary Care
Southern Illinois University – Edwardsville
Edwardsville, Illinois
Beverly L. Banks, BSN, MSN, RN
Senior Full-Time Faculty
Nursing
Alpena Community College
Alpena, Michigan
Debra J. Behr, DNP, RN, CCRN-K
Director of Professional Development and Magnet Program
Lutheran Medical Center
Wheat Ridge, Colorado
Collin Bowman-Woodall, MSN, RN
Assistant Professor
Samuel Merritt University, School of Nursing
San Mateo, California
Mary Ann “Cammy” Christie, APRN, MSN, CCRN, CMC-CSC, PCCN
Acute Care Nurse Practitioner
Department of Critical Care Medicine and Surgery
University of Florida
Gainesville, Florida
Reviewers
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viii Reviewers
Judy E. Davidson, DNP, RN, MCCM, FAAN
Nurse Scientist
University of California – San Diego Health Sciences;
Scientist
Department of Psychiatry
University of California – San Diego, School of Medicine
La Jolla, California;
Associate Editor
Journal of Nursing Management
Tina Deatherage, DNP, RN, CCNS, CCRN, CNRN, NEA-BC
Hospital Accreditation Program Surveyor
The Joint Commission;
Adjunct Faculty, Nursing
Queens University
Charlotte, North Carolina
Christina Flint, MSN, MBA, RN
Assistant Professor
University of Indianapolis, School of Nursing
Indianapolis, Indiana
Matthew J. Fox, MSN, RN-BC
Assistant Professor
Nursing
Ohio University
Zanesville, Ohio
Keble Frazer, BSN, RN-BC, CCRN, PCCN
Registered Nurse
Medical and Surgical Intensive Care Units
Orange Regional Medical Center
Middletown, New York;
Montefiore Medical Center
Bronx, New York
Kelly A. Gaiolini, RN
Staff Nurse, Neuro/Surgical Intensive Care Unit
Lawnwood Regional Medical Center
Fort Pierce, Florida
Charles R. Gold, BSN, RN, CCRN
Registered Nurse
Neurosurgical Intensive Care Unit
Atrium Health’s Carolinas Medical Center
Charlotte, North Carolina
Judy E. Davidson, DNP, RN, MCCM, FAAN
Nurse Scientist
University of California – San Diego Health Sciences;
Scientist
Department of Psychiatry
University of California – San Diego, School of Medicine
La Jolla, California;
Associate Editor
Journal of Nursing Management
Tina Deatherage, DNP, RN, CCNS, CCRN, CNRN, NEA-BC
Hospital Accreditation Program Surveyor
The Joint Commission;
Adjunct Faculty, Nursing
Queens University
Charlotte, North Carolina
Christina Flint, MSN, MBA, RN
Assistant Professor
University of Indianapolis, School of Nursing
Indianapolis, Indiana
Matthew J. Fox, MSN, RN-BC
Assistant Professor
Nursing
Ohio University
Zanesville, Ohio
Keble Frazer, BSN, RN-BC, CCRN, PCCN
Registered Nurse
Medical and Surgical Intensive Care Units
Orange Regional Medical Center
Middletown, New York;
Montefiore Medical Center
Bronx, New York
Kelly A. Gaiolini, RN
Staff Nurse, Neuro/Surgical Intensive Care Unit
Lawnwood Regional Medical Center
Fort Pierce, Florida
Charles R. Gold, BSN, RN, CCRN
Registered Nurse
Neurosurgical Intensive Care Unit
Atrium Health’s Carolinas Medical Center
Charlotte, North Carolina
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Reviewers ix
Ami Grek, DNP, APRN, ACNP-BC
Lead Advanced Practice Provider
Department of Critical Care
Associate Director
NP/PA Critical Care Fellowship Program
Assistant Professor of Medicine
Mayo Clinic School of Medicine
Jacksonville, Florida
Christopher Guelbert, DNP, RN, CCRN, CNML
Assistant Professor
Nursing
Barnes Jewish College
St. Louis, Missouri
Stephanie A. Gustman, BSN, MSN, DNP, RN
Associate Professor
Ferris State University
Big Rapids, Michigan
Christian Guzman, MS, CCRN, ACNPC-AG, APRN
Facility Director, Advanced Practice Providers
Intensivist Nurse Practitioner
Intensive Care Consortium
Gainesville, Florida
Jillian Hamel, MS, RN, ACNP-BC
Acute Care Nurse Practitioner
Emergency Department Observation Unit
Providence Regional Medical Center
Everett, Washington
Sonya Renae Hardin, PhD, MBA/MHA, CCRN, ACNS-BC, NP-C, FAAN
Dean and Professor
University of Louisville, School of Nursing
Louisville, Kentucky
Kiersten Henry, DNP, ACNP-BC, CCNS, CCRN-CMC
Chief Advanced Practice Clinician
MedStar Montgomery Medical Center
Olney, Maryland
Cheryl Holsworth, MSA, RN, CBN, CMSRN
Senior Specialist for Bariatric Surgery
Sharp Memorial Hospital
San Diego, California
Ami Grek, DNP, APRN, ACNP-BC
Lead Advanced Practice Provider
Department of Critical Care
Associate Director
NP/PA Critical Care Fellowship Program
Assistant Professor of Medicine
Mayo Clinic School of Medicine
Jacksonville, Florida
Christopher Guelbert, DNP, RN, CCRN, CNML
Assistant Professor
Nursing
Barnes Jewish College
St. Louis, Missouri
Stephanie A. Gustman, BSN, MSN, DNP, RN
Associate Professor
Ferris State University
Big Rapids, Michigan
Christian Guzman, MS, CCRN, ACNPC-AG, APRN
Facility Director, Advanced Practice Providers
Intensivist Nurse Practitioner
Intensive Care Consortium
Gainesville, Florida
Jillian Hamel, MS, RN, ACNP-BC
Acute Care Nurse Practitioner
Emergency Department Observation Unit
Providence Regional Medical Center
Everett, Washington
Sonya Renae Hardin, PhD, MBA/MHA, CCRN, ACNS-BC, NP-C, FAAN
Dean and Professor
University of Louisville, School of Nursing
Louisville, Kentucky
Kiersten Henry, DNP, ACNP-BC, CCNS, CCRN-CMC
Chief Advanced Practice Clinician
MedStar Montgomery Medical Center
Olney, Maryland
Cheryl Holsworth, MSA, RN, CBN, CMSRN
Senior Specialist for Bariatric Surgery
Sharp Memorial Hospital
San Diego, California
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x Reviewers
Robert C. Ingram, BSN, MSN, MHA, DNPc, RN, CEN
Assistant Professor
Lourdes University, College of Nursing
Sylvania, Ohio
Tonia Kennedy, MSN, EdD, RN-BC, CCRN-K
Associate Professor
Liberty University, School of Nursing
Lynchburg, Virgina
Sara Knippa, MS, RN, CCRN, PCCN, ACCNS-AG
Clinical Nurse Specialist and Educator
Cardiac ICU
University of Colorado Hospital
CHealth
Aurora, Colorado
Marianna LeCron Presley, MSN, RN, CCRN
Critical Care Nurse
Medical Intensive Care
Atrium Health Pineville
Charlotte, North Carolina
KellyAnne Lee, MSN, MBA, RN, CCRN
Healthcare Consultant
Coasta Consulting Group, LLC
Mount Pleasant, South Carolina
Tanaya C. Lindstrom, MSN, RN, CCRN, CNL
Clinical Nurse Educator
Surgical/Medical Intensive Care Units
North Florida South Georgia Veterans Health System
Gainesville, Florida
Yvette Lowery, MSN/Ed, DNP, FNP-c, CCRN, CEN, PCCN
Family Nurse Practitioner
Emergency Department
Memorial Hospital
Jacksonville, Florida
Karen A. Matos, MSN, RN, CCRN
Clinical Nurse Expert of Medical and Surgical Intensive Care Units and Telemetry
Nursing Education
Ralph H. Johnson Veterans Administration Hospital
Charleston, South Carolina
Paige McCraney, DNP, APRN
Adult Health Nurse Practitioner
Assistant Professor
University of North Georgia Department of Nursing
Dahlonega, Georgia
Robert C. Ingram, BSN, MSN, MHA, DNPc, RN, CEN
Assistant Professor
Lourdes University, College of Nursing
Sylvania, Ohio
Tonia Kennedy, MSN, EdD, RN-BC, CCRN-K
Associate Professor
Liberty University, School of Nursing
Lynchburg, Virgina
Sara Knippa, MS, RN, CCRN, PCCN, ACCNS-AG
Clinical Nurse Specialist and Educator
Cardiac ICU
University of Colorado Hospital
CHealth
Aurora, Colorado
Marianna LeCron Presley, MSN, RN, CCRN
Critical Care Nurse
Medical Intensive Care
Atrium Health Pineville
Charlotte, North Carolina
KellyAnne Lee, MSN, MBA, RN, CCRN
Healthcare Consultant
Coasta Consulting Group, LLC
Mount Pleasant, South Carolina
Tanaya C. Lindstrom, MSN, RN, CCRN, CNL
Clinical Nurse Educator
Surgical/Medical Intensive Care Units
North Florida South Georgia Veterans Health System
Gainesville, Florida
Yvette Lowery, MSN/Ed, DNP, FNP-c, CCRN, CEN, PCCN
Family Nurse Practitioner
Emergency Department
Memorial Hospital
Jacksonville, Florida
Karen A. Matos, MSN, RN, CCRN
Clinical Nurse Expert of Medical and Surgical Intensive Care Units and Telemetry
Nursing Education
Ralph H. Johnson Veterans Administration Hospital
Charleston, South Carolina
Paige McCraney, DNP, APRN
Adult Health Nurse Practitioner
Assistant Professor
University of North Georgia Department of Nursing
Dahlonega, Georgia
Loading page 13...
Reviewers xi
Denise M. McEnroe-Petitte, AS, BSN, MSN, PhD, RN
Associate Professor Nursing
Kent State University – Tuscarawas
New Philadelphia, Ohio
Katina M. Meyer, BSN, RN
Registered Nurse
Medical Intensive Care Unit
Stormont Vail Health
Topeka, Kansas
Samantha Palmer Noah, MSN, APRN, FNP-BC, AGACNP-BC
Nurse Practitioner
Flourish Health Network
Gainesville, Florida
DaiWai M. Olson, PhD, RN, CCRN, FNCS
Professor of Neurology & Neurotherapeutics
Professor of Neurosurgery
Distinguished Teaching Professor
University of Texas Southwestern Medical Center
Dallas, Texas
Sarah Peacock, DNP, APRN, ACNP-BC
Lead Advanced Provider
Department of Critical Care Medicine
Mayo Clinic
Jacksonville, Florida
Deidra Pennington, MSN, RN
Assistant Professor
Nursing
Jefferson College of Health Sciences
Roanoke, Virginia
Ruthie Robinson, PhD, RN, CNS, FAEN, CEN, NEA-BC
Director, Graduate Nursing Studies
JoAnne Gay Dishman School of Nursing
Lamar University
Beaumont, Texas
Emily Rogers, DNP, AGACNP-BC, CCRN, APRN
Nurse Practitioner, Department of Critical Care
Mayo Clinic
Jacksonville, Florida
Denise M. McEnroe-Petitte, AS, BSN, MSN, PhD, RN
Associate Professor Nursing
Kent State University – Tuscarawas
New Philadelphia, Ohio
Katina M. Meyer, BSN, RN
Registered Nurse
Medical Intensive Care Unit
Stormont Vail Health
Topeka, Kansas
Samantha Palmer Noah, MSN, APRN, FNP-BC, AGACNP-BC
Nurse Practitioner
Flourish Health Network
Gainesville, Florida
DaiWai M. Olson, PhD, RN, CCRN, FNCS
Professor of Neurology & Neurotherapeutics
Professor of Neurosurgery
Distinguished Teaching Professor
University of Texas Southwestern Medical Center
Dallas, Texas
Sarah Peacock, DNP, APRN, ACNP-BC
Lead Advanced Provider
Department of Critical Care Medicine
Mayo Clinic
Jacksonville, Florida
Deidra Pennington, MSN, RN
Assistant Professor
Nursing
Jefferson College of Health Sciences
Roanoke, Virginia
Ruthie Robinson, PhD, RN, CNS, FAEN, CEN, NEA-BC
Director, Graduate Nursing Studies
JoAnne Gay Dishman School of Nursing
Lamar University
Beaumont, Texas
Emily Rogers, DNP, AGACNP-BC, CCRN, APRN
Nurse Practitioner, Department of Critical Care
Mayo Clinic
Jacksonville, Florida
Loading page 14...
xii Reviewers
Janet Czermak Russell, DNP, RN, APN-BC
Associate Professor of Nursing
Nursing/Biology
Essex County College
Newark, New Jersey
Peter D. Smith, BA, MSN, RN
Clinical Education Specialist
Nursing Education
Kindred Healthcare
St. Louis, Missouri
Diane Fuller Switzer, DNP, ARNP, FNP-BC, ENP-BC, ENP-C, CCRN, CEN, FAEN
Assistant Clinical Professor
Seattle University, College of Nursing
Seattle, Washington
Ashley N. Thompson, DNP, AGACNP-BC
Acute Care Nurse Practitioner, Assistant Professor
UF Health/University of Florida
Gainesville, Florida
Janet Czermak Russell, DNP, RN, APN-BC
Associate Professor of Nursing
Nursing/Biology
Essex County College
Newark, New Jersey
Peter D. Smith, BA, MSN, RN
Clinical Education Specialist
Nursing Education
Kindred Healthcare
St. Louis, Missouri
Diane Fuller Switzer, DNP, ARNP, FNP-BC, ENP-BC, ENP-C, CCRN, CEN, FAEN
Assistant Clinical Professor
Seattle University, College of Nursing
Seattle, Washington
Ashley N. Thompson, DNP, AGACNP-BC
Acute Care Nurse Practitioner, Assistant Professor
UF Health/University of Florida
Gainesville, Florida
Loading page 15...
xiii
Since the early 1970s, the American Association of Critical-Care Nurses (AACN) and its
AACN Core Curriculum have stood at the forefront of the continuing evolution of criti-
cal care nursing to better meet the highly specialized needs of the patients and families
they serve. The AACN Core Curriculum has now undergone eight editions, during which
time it has maintained its reputation as the source of all things critical care. Among sev-
eral steps we took to help prepare for this edition, AACN and I issued a reader survey and
gathered together a cross-section of expert clinicians for a focus group during the organi-
zation’s National Teaching Institute & Critical Care Exposition in 2019. Our goal was to
gather information to ensure that this newest edition kept pace with the expanding role
of nurses in the critical care profession. Participants confirmed the many ways the AACN
Core Curriculum is used: as a clinical reference in caring for progressive and critical care
patients, as a resource for CCRN certification exam preparation, for the creation of critical
care courses and curricula, as a cornerstone for new nurse orientation, and in the develop-
ment of competency content. Several nurses with whom we spoke stated that the AACN
Core Curriculum was their “critical care bible,” affirming that after all these years it is still an
actively sought-after resource within critical care nursing practice.
As we listened to readers and collected information from multiple sources, we confirmed
that the purpose of the AACN Core Curriculum remains, as it always has been, to articulate
the knowledge base that underlies progressive and critical care nursing practice. Each edi-
tion of this work attempts to redefine that knowledge base for nurses who practice in this
ever-expanding specialty area.
The eighth edition has been retitled AACN Core Curriculum for Progressive and Critical
Care Nursing. Critical care practice and nursing have evolved over the past decade. Acutely
ill patients are treated in many units of the hospital, from the Medical-Surgical departments
to progressive and intermediate care units and elsewhere. Patients requiring critical care
also are found outside the intensive care unit. Specialty nursing units have been created to
meet these evolving health care needs; critical care nurses and patients are found in car-
diac catheterization labs, emergency departments, and tele-ICUs. Sometimes they are even
found at home awaiting heart transplant with inotropic medications and a left ventricular
assist device. Changing the title of the text as we have done brings the resource more in
line with the varied settings in which we find critically ill patients, and it signals to readers
outside the traditional ICU that they are included in our base of readers.
Several similarities still exist between the seventh and eighth editions. The current edi-
tion continues to use the CCRN Examination blueprint and task statements as a starting
point for determining relevant content and its apportionment throughout the book. We
continue with the embellished outline format, and body systems are again used to divide
the major content areas into chapters. Subsections related to physiologic anatomy, patho-
physiology, and patient assessment; generalized patient care; and unique characteristics of
specific disorders also have been retained.
Readers can still find the AACN Synergy Model for Patient Care woven throughout this
edition. When it was developed in the late 1990s, the Synergy Model became the conceptual
framework for certified practice in critical care and has since been widely incorporated
across the discipline. Chapter 1 describes the model in detail, and each chapter includes in
the assessment section a reminder of the model’s prevalence. A key premise of the Synergy
Model is that patient characteristics drive the competencies that nurses need in order to
Preface
Since the early 1970s, the American Association of Critical-Care Nurses (AACN) and its
AACN Core Curriculum have stood at the forefront of the continuing evolution of criti-
cal care nursing to better meet the highly specialized needs of the patients and families
they serve. The AACN Core Curriculum has now undergone eight editions, during which
time it has maintained its reputation as the source of all things critical care. Among sev-
eral steps we took to help prepare for this edition, AACN and I issued a reader survey and
gathered together a cross-section of expert clinicians for a focus group during the organi-
zation’s National Teaching Institute & Critical Care Exposition in 2019. Our goal was to
gather information to ensure that this newest edition kept pace with the expanding role
of nurses in the critical care profession. Participants confirmed the many ways the AACN
Core Curriculum is used: as a clinical reference in caring for progressive and critical care
patients, as a resource for CCRN certification exam preparation, for the creation of critical
care courses and curricula, as a cornerstone for new nurse orientation, and in the develop-
ment of competency content. Several nurses with whom we spoke stated that the AACN
Core Curriculum was their “critical care bible,” affirming that after all these years it is still an
actively sought-after resource within critical care nursing practice.
As we listened to readers and collected information from multiple sources, we confirmed
that the purpose of the AACN Core Curriculum remains, as it always has been, to articulate
the knowledge base that underlies progressive and critical care nursing practice. Each edi-
tion of this work attempts to redefine that knowledge base for nurses who practice in this
ever-expanding specialty area.
The eighth edition has been retitled AACN Core Curriculum for Progressive and Critical
Care Nursing. Critical care practice and nursing have evolved over the past decade. Acutely
ill patients are treated in many units of the hospital, from the Medical-Surgical departments
to progressive and intermediate care units and elsewhere. Patients requiring critical care
also are found outside the intensive care unit. Specialty nursing units have been created to
meet these evolving health care needs; critical care nurses and patients are found in car-
diac catheterization labs, emergency departments, and tele-ICUs. Sometimes they are even
found at home awaiting heart transplant with inotropic medications and a left ventricular
assist device. Changing the title of the text as we have done brings the resource more in
line with the varied settings in which we find critically ill patients, and it signals to readers
outside the traditional ICU that they are included in our base of readers.
Several similarities still exist between the seventh and eighth editions. The current edi-
tion continues to use the CCRN Examination blueprint and task statements as a starting
point for determining relevant content and its apportionment throughout the book. We
continue with the embellished outline format, and body systems are again used to divide
the major content areas into chapters. Subsections related to physiologic anatomy, patho-
physiology, and patient assessment; generalized patient care; and unique characteristics of
specific disorders also have been retained.
Readers can still find the AACN Synergy Model for Patient Care woven throughout this
edition. When it was developed in the late 1990s, the Synergy Model became the conceptual
framework for certified practice in critical care and has since been widely incorporated
across the discipline. Chapter 1 describes the model in detail, and each chapter includes in
the assessment section a reminder of the model’s prevalence. A key premise of the Synergy
Model is that patient characteristics drive the competencies that nurses need in order to
Preface
Loading page 16...
xiv Preface
provide holistic, healing care that achieves optimal patient outcomes. A knowledge base of
critical care nursing underlies clinical practice and reflects a foundational requirement for
the development of these nursing competencies.
AACN’s Competency Based Assessment (CBA) framework was incorporated as “lev-
eling” guidance using the Synergy Model for Patient Care and the expanded outline format
and embellishment items within the text. The terms novice, advanced beginner, proficient,
and expert were used to operationalize the nurse competency and leveling of content within
the AACN Core Curriculum.
The Novice or Advanced Beginner is encouraged to focus on the following content for
foundational knowledge:
Section 1: System Wide Elements
• Anatomy and Physiology Review
• Assessment
• Patient Care
• The new “Key Concept” highlight boxes have been expanded throughout the text,
and replace “Key Points” from the seventh edition
Proficient or Expert learners are encouraged to focus on the following content for
expert knowledge:
Section 2: Specific Patient Health Problems
• Health Problems
• Pathophysiology, Etiology, Signs and Symptoms, Diagnostic Findings, Management
of Patient Care, Complications, End Organ Diseases
• The new “Expert Tip” highlight boxes have been expanded throughout the text, and
replace the “Clinical Pearls” from the seventh edition
To keep pace with the expanding role of progressive and critical care nursing practice
and the evolving health care arena, the following items have been added or updated:
• Reorganization of content into four sections:
Part I: Foundations of Progressive and Critical Care Nursing
Part II: Critical Care of Patients with Issues Affecting Specific Body Systems
Part III: Critical Care of Patients with Multisystem Issues
Part IV: Critical Care of Patients with Special Needs
• Removal of all subchapters
• A new Perioperative Care chapter
• The text features improved navigation, format, and usability with a new, full-color, user-
friendly interior design that uses high-contrast text colors and a larger font.
• A Crosswalk was created at the beginning of each chapter that interfaces or maps foun-
dational nursing content within key educational and clinical documents including the
following:
• Quality and Safety in Nursing Education (QSEN) competencies
• National Patient Safety Goals
• American Nurses Association (ANA) Standards for Professional Nursing Practice
• American Association of Critical-Care Nurses (AACN) Standards for Progressive and
Critical Care Nursing Practice
• American Association of Critical-Care Nurses Healthy Work Environments
• Progressive and Critical Care Nursing Certification
• All chapters, tables, figures, boxes, and terminology are based on the most recently pub-
lished AACN/ANA Scope of Practice and Standards of Care.
• QSEN content has been incorporated within chapters of the text.
• The newest sepsis guidelines content has been added to Chapter 10.
provide holistic, healing care that achieves optimal patient outcomes. A knowledge base of
critical care nursing underlies clinical practice and reflects a foundational requirement for
the development of these nursing competencies.
AACN’s Competency Based Assessment (CBA) framework was incorporated as “lev-
eling” guidance using the Synergy Model for Patient Care and the expanded outline format
and embellishment items within the text. The terms novice, advanced beginner, proficient,
and expert were used to operationalize the nurse competency and leveling of content within
the AACN Core Curriculum.
The Novice or Advanced Beginner is encouraged to focus on the following content for
foundational knowledge:
Section 1: System Wide Elements
• Anatomy and Physiology Review
• Assessment
• Patient Care
• The new “Key Concept” highlight boxes have been expanded throughout the text,
and replace “Key Points” from the seventh edition
Proficient or Expert learners are encouraged to focus on the following content for
expert knowledge:
Section 2: Specific Patient Health Problems
• Health Problems
• Pathophysiology, Etiology, Signs and Symptoms, Diagnostic Findings, Management
of Patient Care, Complications, End Organ Diseases
• The new “Expert Tip” highlight boxes have been expanded throughout the text, and
replace the “Clinical Pearls” from the seventh edition
To keep pace with the expanding role of progressive and critical care nursing practice
and the evolving health care arena, the following items have been added or updated:
• Reorganization of content into four sections:
Part I: Foundations of Progressive and Critical Care Nursing
Part II: Critical Care of Patients with Issues Affecting Specific Body Systems
Part III: Critical Care of Patients with Multisystem Issues
Part IV: Critical Care of Patients with Special Needs
• Removal of all subchapters
• A new Perioperative Care chapter
• The text features improved navigation, format, and usability with a new, full-color, user-
friendly interior design that uses high-contrast text colors and a larger font.
• A Crosswalk was created at the beginning of each chapter that interfaces or maps foun-
dational nursing content within key educational and clinical documents including the
following:
• Quality and Safety in Nursing Education (QSEN) competencies
• National Patient Safety Goals
• American Nurses Association (ANA) Standards for Professional Nursing Practice
• American Association of Critical-Care Nurses (AACN) Standards for Progressive and
Critical Care Nursing Practice
• American Association of Critical-Care Nurses Healthy Work Environments
• Progressive and Critical Care Nursing Certification
• All chapters, tables, figures, boxes, and terminology are based on the most recently pub-
lished AACN/ANA Scope of Practice and Standards of Care.
• QSEN content has been incorporated within chapters of the text.
• The newest sepsis guidelines content has been added to Chapter 10.
Loading page 17...
Preface xv
• All references complement and reinforce current AACN and critical care standards and
guidelines of care.
• References and bibliographies for all chapters are now available online on the Evolve site
at http://evolve.elsevier.com/AACN/corecurriculum/.
• Each chapter was carefully reviewed by AACN clinical practice specialists as well as by
a nurse in current critical care practice. A clinical pharmacist also reviewed all medica-
tions for correct indication and dosages.
The contributors, reviewers, AACN clinical practice specialists, and I have worked tire-
lessly and made every attempt to provide the most current and relevant knowledge base
of information related to progressive and critical care nursing. I welcome your comments
about this edition and your suggestions for future editions of the AACN Core Curriculum.
Tonja M. Hartjes, DNP, APRN, CNS, CCRN, CNEcl, FAANP
Editor of the AACN Core Curriculum for Progressive
and Critical Care Nursing, 8th edition
tonjahartjes@gmail.com
• All references complement and reinforce current AACN and critical care standards and
guidelines of care.
• References and bibliographies for all chapters are now available online on the Evolve site
at http://evolve.elsevier.com/AACN/corecurriculum/.
• Each chapter was carefully reviewed by AACN clinical practice specialists as well as by
a nurse in current critical care practice. A clinical pharmacist also reviewed all medica-
tions for correct indication and dosages.
The contributors, reviewers, AACN clinical practice specialists, and I have worked tire-
lessly and made every attempt to provide the most current and relevant knowledge base
of information related to progressive and critical care nursing. I welcome your comments
about this edition and your suggestions for future editions of the AACN Core Curriculum.
Tonja M. Hartjes, DNP, APRN, CNS, CCRN, CNEcl, FAANP
Editor of the AACN Core Curriculum for Progressive
and Critical Care Nursing, 8th edition
tonjahartjes@gmail.com
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xvii
This eighth edition of the AACN Core Curriculum is possible only because of the tireless
dedication and professionalism of many others, whose commitment to this project made
all the difference.
First, I would like to thank the devoted readers of the AACN Core Curriculum, who pro-
vided their time and thoughtful comments over the years regarding the use of the text and
suggestions for its evolution as nursing practice has evolved. Improvements in content and
design come in large part from their recommendations.
Many thanks to the contributors and reviewers whose enthusiasm, expertise, and expe-
riences have been shared with the readers. Their continued strength and resilience during
this especially important time (during the pandemic) is a testament to their commitment
to nursing. Development of this resource is made possible through the sustained efforts of
each contributor, whose insightful comments created an effective and useful clinical refer-
ence and CCRN review.
Sincere thanks and special recognition go to AACN’s publishing staff, Michael Muscat
and Katie Spiller, and the clinical practice specialists who provided endless time and dedi-
cation to me, to the contributors, to critical care nurses, and to the patients and families
we serve. Special thanks to Linda Bell, Julie Miller, Mary Stahl, Cindy Cain, and Marian
Altman for painstakingly reading through each chapter to offer suggestions.
I also wish to acknowledge those involved directly with the publication process. The
Elsevier staff provided considerable administrative support, and their organizational skills
and resources were a tremendous asset in the planning, preparation, and execution of this
text: Lee Henderson, Laura Selkirk, and Manchu Mohan.
Special thanks to my friend and mentor Suzanne Burns, without whose prior contribu-
tions to critical care nursing I would not be in this position. She has served as a role model
and mentored me throughout my career and the publishing process.
As always, I thank my family and friends who have been patient with my necessary
absences and whose love, support, and encouragement have inspired me throughout this
journey.
Acknowledgments
This eighth edition of the AACN Core Curriculum is possible only because of the tireless
dedication and professionalism of many others, whose commitment to this project made
all the difference.
First, I would like to thank the devoted readers of the AACN Core Curriculum, who pro-
vided their time and thoughtful comments over the years regarding the use of the text and
suggestions for its evolution as nursing practice has evolved. Improvements in content and
design come in large part from their recommendations.
Many thanks to the contributors and reviewers whose enthusiasm, expertise, and expe-
riences have been shared with the readers. Their continued strength and resilience during
this especially important time (during the pandemic) is a testament to their commitment
to nursing. Development of this resource is made possible through the sustained efforts of
each contributor, whose insightful comments created an effective and useful clinical refer-
ence and CCRN review.
Sincere thanks and special recognition go to AACN’s publishing staff, Michael Muscat
and Katie Spiller, and the clinical practice specialists who provided endless time and dedi-
cation to me, to the contributors, to critical care nurses, and to the patients and families
we serve. Special thanks to Linda Bell, Julie Miller, Mary Stahl, Cindy Cain, and Marian
Altman for painstakingly reading through each chapter to offer suggestions.
I also wish to acknowledge those involved directly with the publication process. The
Elsevier staff provided considerable administrative support, and their organizational skills
and resources were a tremendous asset in the planning, preparation, and execution of this
text: Lee Henderson, Laura Selkirk, and Manchu Mohan.
Special thanks to my friend and mentor Suzanne Burns, without whose prior contribu-
tions to critical care nursing I would not be in this position. She has served as a role model
and mentored me throughout my career and the publishing process.
As always, I thank my family and friends who have been patient with my necessary
absences and whose love, support, and encouragement have inspired me throughout this
journey.
Acknowledgments
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xix
PART I Foundations of Progressive and Critical Care Nursing
Chapter 1 Professional Caring and Ethical Practice 1
Anna Dermenchyan, MSN, RN, CCRN-K, CPHQ
American Association of Critical-Care Nurses Mission, Vision, and Values
(AACN, 2020 a,b,c) 1
Mission 1
Vision 2
Values 2
Synergy of Caring 2
Key Responsibilities of Registered Nurses (American Nurses Association [ANA], 2020) 2
What Acute and Critical Care Nurses Do (AACN, 2019) 2
The Environment of Progressive and Critical Care Nurses (AACN, 2019) 2
The AACN Synergy Model for Patient Care 5
AACN Synergy Model for Patient Care (AACN, 2020a,b,c) 5
Origin of the Synergy Model 5
Purpose 5
Overview of the Synergy Model 5
Application of the Synergy Model 15
Family Presence: Visitation in the Adult ICU (AACN Practice Alert, 2016) 16
Healthy Work Environment Standards (AACN, 2016) 17
General Legal Considerations Relevant to Critical Care Nursing Practice 17
National Governing Bodies 17
State Nurse Practice Acts (Russell, 2017) 17
Scope of Practice 18
Standards of Care 18
Certification in a Specialty Area 19
Professional Liability 19
Documentation 22
Good Samaritan Laws 24
Ethical Clinical Practice 24
Foundation of Ethical Nursing Practice 24
Emergence of Clinical Ethics 24
Standard Ethical Theory 25
Ethical Principles (ANA, 2015b) 25
Common Ethical Distinctions 26
Advance Care Planning 27
The Law in Clinical Ethics (Department of Health & Human Services, 2020) 29
Clinical Ethics Assessment 34
Nurse’s Role as Patient Advocate and Moral Agent 36
Chapter 2 Psychosocial Aspects of Critical Care 38
Deborah Chapa, PhD, ACNP-BC, FAANP, ACHPN; Bimbola Fola Akintade, PhD, MBA, MHA, ACNP-BC, NEA-BC, FAANP
Systemwide Elements 38
Review of Psychosocial Concepts 38
Assessment 43
Contents
PART I Foundations of Progressive and Critical Care Nursing
Chapter 1 Professional Caring and Ethical Practice 1
Anna Dermenchyan, MSN, RN, CCRN-K, CPHQ
American Association of Critical-Care Nurses Mission, Vision, and Values
(AACN, 2020 a,b,c) 1
Mission 1
Vision 2
Values 2
Synergy of Caring 2
Key Responsibilities of Registered Nurses (American Nurses Association [ANA], 2020) 2
What Acute and Critical Care Nurses Do (AACN, 2019) 2
The Environment of Progressive and Critical Care Nurses (AACN, 2019) 2
The AACN Synergy Model for Patient Care 5
AACN Synergy Model for Patient Care (AACN, 2020a,b,c) 5
Origin of the Synergy Model 5
Purpose 5
Overview of the Synergy Model 5
Application of the Synergy Model 15
Family Presence: Visitation in the Adult ICU (AACN Practice Alert, 2016) 16
Healthy Work Environment Standards (AACN, 2016) 17
General Legal Considerations Relevant to Critical Care Nursing Practice 17
National Governing Bodies 17
State Nurse Practice Acts (Russell, 2017) 17
Scope of Practice 18
Standards of Care 18
Certification in a Specialty Area 19
Professional Liability 19
Documentation 22
Good Samaritan Laws 24
Ethical Clinical Practice 24
Foundation of Ethical Nursing Practice 24
Emergence of Clinical Ethics 24
Standard Ethical Theory 25
Ethical Principles (ANA, 2015b) 25
Common Ethical Distinctions 26
Advance Care Planning 27
The Law in Clinical Ethics (Department of Health & Human Services, 2020) 29
Clinical Ethics Assessment 34
Nurse’s Role as Patient Advocate and Moral Agent 36
Chapter 2 Psychosocial Aspects of Critical Care 38
Deborah Chapa, PhD, ACNP-BC, FAANP, ACHPN; Bimbola Fola Akintade, PhD, MBA, MHA, ACNP-BC, NEA-BC, FAANP
Systemwide Elements 38
Review of Psychosocial Concepts 38
Assessment 43
Contents
Loading page 22...
xx Contents
Pain, Agitation, Delirium, Immobility and Sleep Disruption (PADIS) (Devlin et al., 2018) 44
Sleep Deprivation 46
ASD and PTSD 46
Delirium (Acute Confusional State) 48
Powerlessness 50
Anxiety 51
Depression 53
Substance Misuse, Dependence, and Withdrawal 55
Aggression and Violence 57
Suicide 59
Dying Process and Death 61
PART II Critical Care of Patients with Issues Affecting Specific Body
Systems
Chapter 3 Pulmonary System 63
Daniel N. Storzer, DNP, ACNPC, ACNP-BC, CNRN, CCRN, CCEMT-P, FCCP, FCCM
Systemwide Elements 63
Anatomy and Physiology Review 63
Assessment 85
Diagnostic Studies 105
Patient Care 109
Specific Patient Health Problems 136
Acute Respiratory Failure (ARF) 136
Chest Trauma 139
Acute Respiratory Distress Syndrome (ARDS) 139
Vaping 141
Transfusion-Related Lung Injury 142
Pulmonary Embolism 142
Chronic Obstructive Pulmonary Disease (COPD) 146
Asthma and Status Asthmaticus 150
Pneumonia 153
Ventilator-Associated Pneumonia and Event 157
Drowning 158
Pulmonary Problems in Surgical/Thoracic Surgery Patients 160
Air Leak Syndromes 162
Acute Pulmonary Inhalation Injuries 163
Neoplastic Lung Disease 163
Pulmonary Fibrosis 167
Obstructive Sleep Apnea 168
End-Stage Pulmonary Conditions: Lung Transplantation 169
Chapter 4 Cardiovascular System 176
Andrea Efre, DNP, ARNP, ANP, FNP and Bryan Boling, DNP, AG-ACNP, CCRN-CSC, CEN
Systemwide Elements 176
Anatomy and Physiology Review 176
Assessment 190
Diagnostic Studies 201
Patient Care 232
Specific Patient Health Problems 235
Acute Coronary Syndrome 235
Acute Myocardial Infarction—ST-Segment Elevation Myocardial Infarction 235
Pain, Agitation, Delirium, Immobility and Sleep Disruption (PADIS) (Devlin et al., 2018) 44
Sleep Deprivation 46
ASD and PTSD 46
Delirium (Acute Confusional State) 48
Powerlessness 50
Anxiety 51
Depression 53
Substance Misuse, Dependence, and Withdrawal 55
Aggression and Violence 57
Suicide 59
Dying Process and Death 61
PART II Critical Care of Patients with Issues Affecting Specific Body
Systems
Chapter 3 Pulmonary System 63
Daniel N. Storzer, DNP, ACNPC, ACNP-BC, CNRN, CCRN, CCEMT-P, FCCP, FCCM
Systemwide Elements 63
Anatomy and Physiology Review 63
Assessment 85
Diagnostic Studies 105
Patient Care 109
Specific Patient Health Problems 136
Acute Respiratory Failure (ARF) 136
Chest Trauma 139
Acute Respiratory Distress Syndrome (ARDS) 139
Vaping 141
Transfusion-Related Lung Injury 142
Pulmonary Embolism 142
Chronic Obstructive Pulmonary Disease (COPD) 146
Asthma and Status Asthmaticus 150
Pneumonia 153
Ventilator-Associated Pneumonia and Event 157
Drowning 158
Pulmonary Problems in Surgical/Thoracic Surgery Patients 160
Air Leak Syndromes 162
Acute Pulmonary Inhalation Injuries 163
Neoplastic Lung Disease 163
Pulmonary Fibrosis 167
Obstructive Sleep Apnea 168
End-Stage Pulmonary Conditions: Lung Transplantation 169
Chapter 4 Cardiovascular System 176
Andrea Efre, DNP, ARNP, ANP, FNP and Bryan Boling, DNP, AG-ACNP, CCRN-CSC, CEN
Systemwide Elements 176
Anatomy and Physiology Review 176
Assessment 190
Diagnostic Studies 201
Patient Care 232
Specific Patient Health Problems 235
Acute Coronary Syndrome 235
Acute Myocardial Infarction—ST-Segment Elevation Myocardial Infarction 235
Loading page 23...
Contents xxi
Non—ST Elevation Myocardial Infarction (See Acute Coronary Syndrome
(NSTEMI- Acute Coronary Syndrome and Unstable Angina)) 247
Chronic Stable Angina Pectoris 251
Coronary Artery Disease 253
Heart Failure 257
Pericardial Disease 266
Myocarditis 271
Infective Endocarditis 274
Cardiomyopathy 280
Cardiac Rhythm Disorders 286
Mitral Regurgitation 301
Mitral Stenosis 304
Aortic Regurgitation 307
Aortic Stenosis 310
Atrial Septal Defect 313
Ventricular Septal Defect 316
Patent Ductus Arteriosus 319
Coarctation of the Aorta 322
Hypertensive Crises 325
Aortic and Peripheral Arterial Disease 330
Shock 337
Mechanical Circulatory Support Devices 344
End-Stage Heart Disease: Cardiac Transplantation 350
Cardiac Trauma 353
Chapter 5 Neurologic System 354
Patricia A. Blissitt, PhD, ARNP-CNS, CCRN, CNRN, SCRN, CCNS, CCM, ACNS-BC
Systemwide Elements 354
Anatomy and Physiology Review 354
Assessment 390
Diagnostic Studies 406
Patient Care 408
Specific Patient Health Problems 417
Increased Intracranial Pressure or Intracranial Hypertension 417
Stroke 426
Brain Tumor 455
Spinal and Spinal Cord Tumors 459
Intracranial Infections 461
Neuromuscular/Autoimmune Disease 468
Seizure Disorders 476
Encephalopathy 483
Coma 486
Brain Death 487
Neurosurgical Procedures 488
Chapter 6 Renal System 490
Bryan Boling, DNP, AG-ACNP, CCRN-CSC, CEN
Systemwide Elements 490
Anatomy and Physiology Review 490
Assessment 504
Non—ST Elevation Myocardial Infarction (See Acute Coronary Syndrome
(NSTEMI- Acute Coronary Syndrome and Unstable Angina)) 247
Chronic Stable Angina Pectoris 251
Coronary Artery Disease 253
Heart Failure 257
Pericardial Disease 266
Myocarditis 271
Infective Endocarditis 274
Cardiomyopathy 280
Cardiac Rhythm Disorders 286
Mitral Regurgitation 301
Mitral Stenosis 304
Aortic Regurgitation 307
Aortic Stenosis 310
Atrial Septal Defect 313
Ventricular Septal Defect 316
Patent Ductus Arteriosus 319
Coarctation of the Aorta 322
Hypertensive Crises 325
Aortic and Peripheral Arterial Disease 330
Shock 337
Mechanical Circulatory Support Devices 344
End-Stage Heart Disease: Cardiac Transplantation 350
Cardiac Trauma 353
Chapter 5 Neurologic System 354
Patricia A. Blissitt, PhD, ARNP-CNS, CCRN, CNRN, SCRN, CCNS, CCM, ACNS-BC
Systemwide Elements 354
Anatomy and Physiology Review 354
Assessment 390
Diagnostic Studies 406
Patient Care 408
Specific Patient Health Problems 417
Increased Intracranial Pressure or Intracranial Hypertension 417
Stroke 426
Brain Tumor 455
Spinal and Spinal Cord Tumors 459
Intracranial Infections 461
Neuromuscular/Autoimmune Disease 468
Seizure Disorders 476
Encephalopathy 483
Coma 486
Brain Death 487
Neurosurgical Procedures 488
Chapter 6 Renal System 490
Bryan Boling, DNP, AG-ACNP, CCRN-CSC, CEN
Systemwide Elements 490
Anatomy and Physiology Review 490
Assessment 504
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xxii Contents
Diagnostic Studies 507
Patient Care 511
Specific Patient Health Problems 520
Renal Trauma 520
Acute Kidney Injury 520
Chronic Kidney Disease 534
Electrolyte Imbalances—Potassium Imbalance: Hyperkalemia 540
Electrolyte Imbalances—Potassium Imbalance: Hypokalemia 546
Electrolyte Imbalances—Sodium Imbalance: Hypernatremia 547
Electrolyte Imbalances—Sodium Imbalance: Hyponatremia 549
Electrolyte Imbalances—Calcium Imbalance: Hypercalcemia 551
Electrolyte Imbalances—Calcium Imbalance: Hypocalcemia 553
Electrolyte Imbalances—Phosphate Imbalance: Hyperphosphatemia 554
Electrolyte Imbalances—Phosphate Imbalance: Hypophosphatemia 556
Electrolyte Imbalances—Magnesium Imbalance: Hypermagnesemia 557
Electrolyte Imbalances—Magnesium Imbalance: Hypomagnesemia 558
Rhabdomyolysis 559
End-Stage Renal Condition: Renal Transplant 560
Chapter 7 Endocrine System 564
Jennifer MacDermott, MS, RN, ACNS-BC, NP-C, CCRN
Systemwide Elements 564
Anatomy and Physiology Review 564
Hypothalamus 565
Pituitary Gland (Also Called Hypophysis) 565
Thyroid Gland 568
Parathyroid Glands 568
Adrenal Glands 569
Pancreas 570
Pineal Gland and Thymus Gland 571
Gonadal Hormones (Testosterone, Estrogen, Progesterone) 571
Assessment 571
Diagnostic Studies 574
Patient Care 575
Specific Patient Health Problems 576
Altered Glucose Metabolism 576
Altered Antidiuretic Hormone Production 584
Altered Thyroid Hormone Production 587
Acute Adrenal Insufficiency or Crisis 591
Acute Hyperparathyroidism and Hypoparathyroidism 592
Chapter 8 Hematologic and Immunologic Systems 593
Nicole Brumfield, DNP, APRN, FNP-BC, AG-ACNP-BC
Systemwide Elements 593
Anatomy and Physiology Review 593
Assessment of Hematologic and Immunologic Systems 597
Diagnostic Studies 599
Patient Care 602
Specific Patient Health Problems 604
Diagnostic Studies 507
Patient Care 511
Specific Patient Health Problems 520
Renal Trauma 520
Acute Kidney Injury 520
Chronic Kidney Disease 534
Electrolyte Imbalances—Potassium Imbalance: Hyperkalemia 540
Electrolyte Imbalances—Potassium Imbalance: Hypokalemia 546
Electrolyte Imbalances—Sodium Imbalance: Hypernatremia 547
Electrolyte Imbalances—Sodium Imbalance: Hyponatremia 549
Electrolyte Imbalances—Calcium Imbalance: Hypercalcemia 551
Electrolyte Imbalances—Calcium Imbalance: Hypocalcemia 553
Electrolyte Imbalances—Phosphate Imbalance: Hyperphosphatemia 554
Electrolyte Imbalances—Phosphate Imbalance: Hypophosphatemia 556
Electrolyte Imbalances—Magnesium Imbalance: Hypermagnesemia 557
Electrolyte Imbalances—Magnesium Imbalance: Hypomagnesemia 558
Rhabdomyolysis 559
End-Stage Renal Condition: Renal Transplant 560
Chapter 7 Endocrine System 564
Jennifer MacDermott, MS, RN, ACNS-BC, NP-C, CCRN
Systemwide Elements 564
Anatomy and Physiology Review 564
Hypothalamus 565
Pituitary Gland (Also Called Hypophysis) 565
Thyroid Gland 568
Parathyroid Glands 568
Adrenal Glands 569
Pancreas 570
Pineal Gland and Thymus Gland 571
Gonadal Hormones (Testosterone, Estrogen, Progesterone) 571
Assessment 571
Diagnostic Studies 574
Patient Care 575
Specific Patient Health Problems 576
Altered Glucose Metabolism 576
Altered Antidiuretic Hormone Production 584
Altered Thyroid Hormone Production 587
Acute Adrenal Insufficiency or Crisis 591
Acute Hyperparathyroidism and Hypoparathyroidism 592
Chapter 8 Hematologic and Immunologic Systems 593
Nicole Brumfield, DNP, APRN, FNP-BC, AG-ACNP-BC
Systemwide Elements 593
Anatomy and Physiology Review 593
Assessment of Hematologic and Immunologic Systems 597
Diagnostic Studies 599
Patient Care 602
Specific Patient Health Problems 604
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Contents xxiii
Thrombocytopenia 604
Disseminated Intravascular Coagulation 606
Medication-Induced Coagulopathy 608
Thromboembolic Disorders 611
Anemia 613
Sickle Cell Anemia 616
Neutropenia 618
Acute Leukemia 619
Malignant Pericardial Effusion 621
Hematopoietic Stem Cell Transplantation 622
Organ Transplant Rejection 624
Human Immunodeficiency Virus Infection 626
Anaphylactic Reaction 629
Chapter 9 Gastrointestinal System 631
Patricia Radovich, PhD, CNS, FCCM
Systemwide Elements 631
Anatomy and Physiology Review 631
Accessory Organs of Digestion (Fig. 9.4) 639
Patient Assessment 644
Diagnostic Studies 648
Patient Care 650
Specific Patient Health Problems 652
Abdominal Trauma 652
Bowel Infarction (Obstruction, Perforation) 652
Functional Gastrointestinal Disorders (Obstruction, Motility [Ileus, Diabetic Gastroparesis,
GERD, Inflammatory Bowel Syndrome]) 654
Gastrointestinal Infections (Clostridium Difficile) 656
Abdominal Compartment Syndrome 657
Acute Abdomen 659
Acute Liver Failure 661
Gastrointestinal Bleeding 663
Gastrointestinal Bariatric Surgery 667
Chronic Liver Failure: Decompensated Cirrhosis 667
Carcinoma of the Gastrointestinal Tract 672
Acute Pancreatitis 675
Hepatitis 678
End-Stage Gastrointestinal System Condition: Liver Transplantation 682
Nutritional Support in the Critically Ill Patient 683
PART III Critical Care of Patients with Multisystem Issues
Chapter 10 Sepsis and Septic Shock 686
Diane McLaughlin, DNP, AGACNP-BC, CCRN
Systemwide Elements 686
Anatomy and Physiology Review 686
Assessment 698
Patient Care 700
Thrombocytopenia 604
Disseminated Intravascular Coagulation 606
Medication-Induced Coagulopathy 608
Thromboembolic Disorders 611
Anemia 613
Sickle Cell Anemia 616
Neutropenia 618
Acute Leukemia 619
Malignant Pericardial Effusion 621
Hematopoietic Stem Cell Transplantation 622
Organ Transplant Rejection 624
Human Immunodeficiency Virus Infection 626
Anaphylactic Reaction 629
Chapter 9 Gastrointestinal System 631
Patricia Radovich, PhD, CNS, FCCM
Systemwide Elements 631
Anatomy and Physiology Review 631
Accessory Organs of Digestion (Fig. 9.4) 639
Patient Assessment 644
Diagnostic Studies 648
Patient Care 650
Specific Patient Health Problems 652
Abdominal Trauma 652
Bowel Infarction (Obstruction, Perforation) 652
Functional Gastrointestinal Disorders (Obstruction, Motility [Ileus, Diabetic Gastroparesis,
GERD, Inflammatory Bowel Syndrome]) 654
Gastrointestinal Infections (Clostridium Difficile) 656
Abdominal Compartment Syndrome 657
Acute Abdomen 659
Acute Liver Failure 661
Gastrointestinal Bleeding 663
Gastrointestinal Bariatric Surgery 667
Chronic Liver Failure: Decompensated Cirrhosis 667
Carcinoma of the Gastrointestinal Tract 672
Acute Pancreatitis 675
Hepatitis 678
End-Stage Gastrointestinal System Condition: Liver Transplantation 682
Nutritional Support in the Critically Ill Patient 683
PART III Critical Care of Patients with Multisystem Issues
Chapter 10 Sepsis and Septic Shock 686
Diane McLaughlin, DNP, AGACNP-BC, CCRN
Systemwide Elements 686
Anatomy and Physiology Review 686
Assessment 698
Patient Care 700
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xxiv Contents
Chapter 11 Multisystem Trauma 706
Renee M. Holleran, FNP-BC, PhD, CCRN (Alumnus), CEN, CFRN, CTRN (Retired), FAEN
Systemwide Elements 706
Trauma Concepts and Physiology Review 706
Assessment 712
Patient Care 718
Head and Spinal Trauma 721
Thoracic Trauma: Pulmonary and Cardiac 734
Pulmonary Trauma 734
Cardiac Trauma 737
Abdominal Trauma 741
Chapter 12 Burns 745
Karah Cripe Sickler, RN, DNP, AG-ACNP-BC
Systemwide Elements 745
Anatomy and Physiology Review 745
Assessment 754
Patient Care 760
Chapter 13 Hypothermia 764
Carrol Graves, MSN, RN, CCRN, CNL
Systemwide Elements 764
Anatomy and Physiology Review 764
Assessment 769
Patient Care 772
Chapter 14 Toxin Exposure 776
Shana Metzger, MS, FNP-BC, AG-ACNP-BC
Systemwide Elements 776
Anatomy and Physiologic Review 776
Assessment 787
Patient Care 790
Interventions for Ingestion of Toxic Substance (Fig. 14.1) 792
General Management Strategies for Gastric Decontamination 794
Treatment for Body Stuffing/Body Packing 795
Additional Interventions for the Purposeful Ingestion 795
Envenomation 796
PART IV Critical Care of Patients With Special Needs
Chapter 15 Bariatric Patients 799
Angela Benefield, DNP, RN, AGCNS-BC, CCRN-CSC-CMC
Systemwide Elements 799
Anatomy and Physiology Review 799
Assessment 800
Patient Care 804
Care of the Bariatric Surgery Patient 806
Related Bariatric Care Issues 807
Chapter 11 Multisystem Trauma 706
Renee M. Holleran, FNP-BC, PhD, CCRN (Alumnus), CEN, CFRN, CTRN (Retired), FAEN
Systemwide Elements 706
Trauma Concepts and Physiology Review 706
Assessment 712
Patient Care 718
Head and Spinal Trauma 721
Thoracic Trauma: Pulmonary and Cardiac 734
Pulmonary Trauma 734
Cardiac Trauma 737
Abdominal Trauma 741
Chapter 12 Burns 745
Karah Cripe Sickler, RN, DNP, AG-ACNP-BC
Systemwide Elements 745
Anatomy and Physiology Review 745
Assessment 754
Patient Care 760
Chapter 13 Hypothermia 764
Carrol Graves, MSN, RN, CCRN, CNL
Systemwide Elements 764
Anatomy and Physiology Review 764
Assessment 769
Patient Care 772
Chapter 14 Toxin Exposure 776
Shana Metzger, MS, FNP-BC, AG-ACNP-BC
Systemwide Elements 776
Anatomy and Physiologic Review 776
Assessment 787
Patient Care 790
Interventions for Ingestion of Toxic Substance (Fig. 14.1) 792
General Management Strategies for Gastric Decontamination 794
Treatment for Body Stuffing/Body Packing 795
Additional Interventions for the Purposeful Ingestion 795
Envenomation 796
PART IV Critical Care of Patients With Special Needs
Chapter 15 Bariatric Patients 799
Angela Benefield, DNP, RN, AGCNS-BC, CCRN-CSC-CMC
Systemwide Elements 799
Anatomy and Physiology Review 799
Assessment 800
Patient Care 804
Care of the Bariatric Surgery Patient 806
Related Bariatric Care Issues 807
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Contents xxv
Chapter 16 Older Adult Patients 809
Jenny G. Alderden, PhD, APRN, CCRN, CCNS
Age-Related Biologic and Behavioral Differences 809
Age-Related Changes in Medication Action and Clinical Implications 809
The Four Ms of Age-Friendly Health Care 814
Chapter 17 High-Risk Obstetric Patients 820
Jennifer T.N. Treacy, MSN, APRN, FNP
Systemwide Elements 820
Anatomy and Physiology Review 820
Specific Patient Health Problems 823
Postpartum Hemorrhage 823
Hypertensive Disorders of Pregnancy 824
Hemolysis, Elevated Liver Enzymes, Low Platelet Count Syndrome 830
Amniotic Fluid Embolism 831
Acute Fatty Liver of Pregnancy 832
Special Considerations 833
Trauma 833
Cardiopulmonary Concerns in Pregnant Patients 835
Chapter 18 Patient Transport 836
Renee M. Holleran, FNP-BC, PhD, CCRN (Alumnus), CEN, CFRN, CTRN (Retired), FAEN
Members of the Transport Team 837
Indications for Transport 837
Modes of Interfacility Transport 838
Risks and Stresses of Transport 839
Overriding Priorities in Patient Transport 841
Preparation for Transport 841
Patient Care During Transport 844
Legal and Ethical Issues Related to Transport 845
Chapter 19 Sedation 846
Mary Beth Flynn Makic, PhD, RN, CCNS, CCRN-K, FAAN, FNAP, FCNS and Catrina Cullen, RN, BSN, CCRN
Systemwide Elements 846
Considerations Before Sedation 846
Practice Considerations During Administration of Sedation 848
Specific Patient Health Problems 855
Procedural Sedation and Analgesia for the Patient in High Acuity Settings 855
Chapter 16 Older Adult Patients 809
Jenny G. Alderden, PhD, APRN, CCRN, CCNS
Age-Related Biologic and Behavioral Differences 809
Age-Related Changes in Medication Action and Clinical Implications 809
The Four Ms of Age-Friendly Health Care 814
Chapter 17 High-Risk Obstetric Patients 820
Jennifer T.N. Treacy, MSN, APRN, FNP
Systemwide Elements 820
Anatomy and Physiology Review 820
Specific Patient Health Problems 823
Postpartum Hemorrhage 823
Hypertensive Disorders of Pregnancy 824
Hemolysis, Elevated Liver Enzymes, Low Platelet Count Syndrome 830
Amniotic Fluid Embolism 831
Acute Fatty Liver of Pregnancy 832
Special Considerations 833
Trauma 833
Cardiopulmonary Concerns in Pregnant Patients 835
Chapter 18 Patient Transport 836
Renee M. Holleran, FNP-BC, PhD, CCRN (Alumnus), CEN, CFRN, CTRN (Retired), FAEN
Members of the Transport Team 837
Indications for Transport 837
Modes of Interfacility Transport 838
Risks and Stresses of Transport 839
Overriding Priorities in Patient Transport 841
Preparation for Transport 841
Patient Care During Transport 844
Legal and Ethical Issues Related to Transport 845
Chapter 19 Sedation 846
Mary Beth Flynn Makic, PhD, RN, CCNS, CCRN-K, FAAN, FNAP, FCNS and Catrina Cullen, RN, BSN, CCRN
Systemwide Elements 846
Considerations Before Sedation 846
Practice Considerations During Administration of Sedation 848
Specific Patient Health Problems 855
Procedural Sedation and Analgesia for the Patient in High Acuity Settings 855
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xxvi Contents
Chapter 20 Pain 860
Tonya Sawyer-McGee, BSN, MSN, MBA, RN, DNP, ACNP-BC
Systemwide Elements 860
Anatomy and Physiology Review 860
Background 865
Assessment 869
Patient Care 873
Patient Education 880
Specific Clinical Problems Related to Pain Therapy 885
Specific Patient Health Problems 886
Chapter 21 Palliative and End-of-Life Care 888
Clareen Wiencek, PhD, RN, ACNP, ACHPN, FAAN
Systemwide Elements 888
Concept Review 888
Assessment for Palliative Care, Hospice, or End-of-Life Care Services 893
Patient Care 893
Transitioning Goals of Care to End-of-Life (Box 21.3) 895
Additional Considerations (See Ch. 2, Psychosocial Aspects of Critical Care) 897
Chapter 22 Perioperative Care 898
Jan Odom-Forren, PhD, RN, CPAN, FASPAN, FAAN and Denise O’Brien, DNP, RN, ACNS-BC, CPAN, CAPA, FASPAN, FCNS, FAAN
Systemwide Elements 898
Anatomy and Physiology Review 898
Assessment 899
Patient Care 901
Initial Arrival in Postanesthesia Care Unit or Intensive Care Unit 914
Ongoing Postanesthesia Care—Emergence from Anesthesia 914
Specific Patient Health Problems 917
Index 923
Chapter 20 Pain 860
Tonya Sawyer-McGee, BSN, MSN, MBA, RN, DNP, ACNP-BC
Systemwide Elements 860
Anatomy and Physiology Review 860
Background 865
Assessment 869
Patient Care 873
Patient Education 880
Specific Clinical Problems Related to Pain Therapy 885
Specific Patient Health Problems 886
Chapter 21 Palliative and End-of-Life Care 888
Clareen Wiencek, PhD, RN, ACNP, ACHPN, FAAN
Systemwide Elements 888
Concept Review 888
Assessment for Palliative Care, Hospice, or End-of-Life Care Services 893
Patient Care 893
Transitioning Goals of Care to End-of-Life (Box 21.3) 895
Additional Considerations (See Ch. 2, Psychosocial Aspects of Critical Care) 897
Chapter 22 Perioperative Care 898
Jan Odom-Forren, PhD, RN, CPAN, FASPAN, FAAN and Denise O’Brien, DNP, RN, ACNS-BC, CPAN, CAPA, FASPAN, FCNS, FAAN
Systemwide Elements 898
Anatomy and Physiology Review 898
Assessment 899
Patient Care 901
Initial Arrival in Postanesthesia Care Unit or Intensive Care Unit 914
Ongoing Postanesthesia Care—Emergence from Anesthesia 914
Specific Patient Health Problems 917
Index 923
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1
CROSSWALK
• Quality and Safety in Nursing Education (QSEN): Patient-centered care, Teamwork and
collaboration, Evidence-based practice, Quality improvement, Safety, Informatics
• National Patient Safety Goals: Identifies patients correctly, Improve staff communication, Use
medicines safely, Uses alarms safely, Prevents infection, Identify patient safety risks, Prevents
mistakes in surgery
• American Nurses Association (ANA) standards for Professional Nursing Practice:
Standard 1. Assessment, Standard 2. Diagnosis, Standard 3. Outcomes identification, Standard
4. Planning, Standard 5. Implementation, Standard 6. Evaluation, Standard 7. Ethics, Standard 8.
Culturally congruent practice, Standard 9. Communication, Standard 10. Collaboration, Standard
11. Leadership, Standard 12. Education, Standard 13. Evidence-based practice and research,
Standard 14. Quality of practice, Standard 15. Professional practice evaluation, Standard 16.
Resource utilization, Standard 17. Environmental health
• AACN Scope and Standards for Progressive and Critical Care Nursing Practice:
Standard 1. Quality of practice, Standard 2. Professional practice evaluation, Standard 3.
Education, Standard 4. Communication, Standard 5. Ethics, Standard 6. Collaboration, Standard
7. Evidence-based practice/research/clinical inquiry, Standard 8. Resource utilization, Standard 9.
Leadership, Standard 10. Environmental health
• AACN Standards for Establishing and Sustaining Healthy Work Environments (HWE):
Skilled communication, True collaboration, Effective decision-making, Appropriate staffing,
Meaningful recognition, Authentic leadership
• PCCN content: Professional Caring and Ethical Practice—All items
• CCRN content: Professional Caring and Ethical Practice—All items
PART I
Foundations of Progressive and Critical Care Nursing
CHAPTER
1Professional Caring
and Ethical Practice
Anna Dermenchyan, MSN, RN, CCRN-K, CPHQ
AMERICAN ASSOCIATION OF CRITICAL-CARE NURSES MISSION,
VISION, AND VALUES (AACN, 2020 a,b,c)
MISSION
1. Patients and their families rely on nurses at the most vulnerable times of their lives.
Acute and critical care nurses rely on AACN for expert knowledge and the influence
to fulfill their promise to patients and their families. AACN drives excellence
because nothing less is acceptable.
CROSSWALK
• Quality and Safety in Nursing Education (QSEN): Patient-centered care, Teamwork and
collaboration, Evidence-based practice, Quality improvement, Safety, Informatics
• National Patient Safety Goals: Identifies patients correctly, Improve staff communication, Use
medicines safely, Uses alarms safely, Prevents infection, Identify patient safety risks, Prevents
mistakes in surgery
• American Nurses Association (ANA) standards for Professional Nursing Practice:
Standard 1. Assessment, Standard 2. Diagnosis, Standard 3. Outcomes identification, Standard
4. Planning, Standard 5. Implementation, Standard 6. Evaluation, Standard 7. Ethics, Standard 8.
Culturally congruent practice, Standard 9. Communication, Standard 10. Collaboration, Standard
11. Leadership, Standard 12. Education, Standard 13. Evidence-based practice and research,
Standard 14. Quality of practice, Standard 15. Professional practice evaluation, Standard 16.
Resource utilization, Standard 17. Environmental health
• AACN Scope and Standards for Progressive and Critical Care Nursing Practice:
Standard 1. Quality of practice, Standard 2. Professional practice evaluation, Standard 3.
Education, Standard 4. Communication, Standard 5. Ethics, Standard 6. Collaboration, Standard
7. Evidence-based practice/research/clinical inquiry, Standard 8. Resource utilization, Standard 9.
Leadership, Standard 10. Environmental health
• AACN Standards for Establishing and Sustaining Healthy Work Environments (HWE):
Skilled communication, True collaboration, Effective decision-making, Appropriate staffing,
Meaningful recognition, Authentic leadership
• PCCN content: Professional Caring and Ethical Practice—All items
• CCRN content: Professional Caring and Ethical Practice—All items
PART I
Foundations of Progressive and Critical Care Nursing
CHAPTER
1Professional Caring
and Ethical Practice
Anna Dermenchyan, MSN, RN, CCRN-K, CPHQ
AMERICAN ASSOCIATION OF CRITICAL-CARE NURSES MISSION,
VISION, AND VALUES (AACN, 2020 a,b,c)
MISSION
1. Patients and their families rely on nurses at the most vulnerable times of their lives.
Acute and critical care nurses rely on AACN for expert knowledge and the influence
to fulfill their promise to patients and their families. AACN drives excellence
because nothing less is acceptable.
Loading page 30...
2 PART I Foundations of Progressive and Critical Care Nursing
VISION
1. AACN is dedicated to creating a healthcare system driven by the needs of patients
and families where acute and critical care nurses make their optimal contribution.
VALUES
1. As AACN works to promote its mission and vision, it is guided by values that are
rooted in, and arise from, the Association’s rich history, traditions, and culture.
AACN’s members, volunteers, and staff will honor the following:
a. Ethical accountability and integrity in relationships, organizational decisions, and
stewardship of resources.
b. Leadership to enable individuals to make their optimal contribution through lifelong
learning, critical thinking, and inquiry.
c. Excellence and innovation at every level of the organization to advance the
profession.
d. Collaboration to ensure quality patient- and family-focused care.
SYNERGY OF CARING
KEY RESPONSIBILITIES OF REGISTERED NURSES (AMERICAN NURSES
ASSOCIATION [ANA], 2020)
1. Perform physical examinations and health histories before making critical decisions.
2. Provide health promotion, counseling, and education.
3. Administer medications and other personalized interventions.
4. Coordinate care, in collaboration with a wide array of healthcare professionals.
WHAT ACUTE AND CRITICAL CARE NURSES DO (AACN, 2019)
1. Restore, support, promote, rehabilitate, or palliate to maintain the physiologic and
psychosocial stability of patients of all ages across the life span.
2. Synthesize and prioritize information to take immediate and decisive evidence-
based, patient-focused action using clinical judgment and clinical inquiry.
3. Anticipate and respond with confidence, and adapt to rapidly changing patient
conditions.
4. Respond to the unique needs of patients and families coping with unanticipated
illness or injury and treatment, and advocate for their choices in quality-of-life and
end-of-life decisions.
5. Establish and maintain a healthy work environment that is safe, respectful,
healing, and caring for nurses, peers, patients, families, and the interprofessional
team.
6. Demonstrate the financial contribution of nursing through appropriate resource
utilization, cost effectiveness, innovation, and efficiency, resulting in optimal safety
and quality outcomes.
7. Demonstrate the contribution of nursing to the quality and financial stability of the
facility through stewardship of resources.
8. Promote and maintain care for self and coworkers to foster resilience.
9. Ensure the delivery of safe, compassionate, and high-quality patient care.
THE ENVIRONMENT OF PROGRESSIVE AND CRITICAL CARE NURSES
(AACN, 2019)
1. Acutely and critically ill patients require complex assessment and therapies, high-
intensity interventions, and continuous vigilance.
VISION
1. AACN is dedicated to creating a healthcare system driven by the needs of patients
and families where acute and critical care nurses make their optimal contribution.
VALUES
1. As AACN works to promote its mission and vision, it is guided by values that are
rooted in, and arise from, the Association’s rich history, traditions, and culture.
AACN’s members, volunteers, and staff will honor the following:
a. Ethical accountability and integrity in relationships, organizational decisions, and
stewardship of resources.
b. Leadership to enable individuals to make their optimal contribution through lifelong
learning, critical thinking, and inquiry.
c. Excellence and innovation at every level of the organization to advance the
profession.
d. Collaboration to ensure quality patient- and family-focused care.
SYNERGY OF CARING
KEY RESPONSIBILITIES OF REGISTERED NURSES (AMERICAN NURSES
ASSOCIATION [ANA], 2020)
1. Perform physical examinations and health histories before making critical decisions.
2. Provide health promotion, counseling, and education.
3. Administer medications and other personalized interventions.
4. Coordinate care, in collaboration with a wide array of healthcare professionals.
WHAT ACUTE AND CRITICAL CARE NURSES DO (AACN, 2019)
1. Restore, support, promote, rehabilitate, or palliate to maintain the physiologic and
psychosocial stability of patients of all ages across the life span.
2. Synthesize and prioritize information to take immediate and decisive evidence-
based, patient-focused action using clinical judgment and clinical inquiry.
3. Anticipate and respond with confidence, and adapt to rapidly changing patient
conditions.
4. Respond to the unique needs of patients and families coping with unanticipated
illness or injury and treatment, and advocate for their choices in quality-of-life and
end-of-life decisions.
5. Establish and maintain a healthy work environment that is safe, respectful,
healing, and caring for nurses, peers, patients, families, and the interprofessional
team.
6. Demonstrate the financial contribution of nursing through appropriate resource
utilization, cost effectiveness, innovation, and efficiency, resulting in optimal safety
and quality outcomes.
7. Demonstrate the contribution of nursing to the quality and financial stability of the
facility through stewardship of resources.
8. Promote and maintain care for self and coworkers to foster resilience.
9. Ensure the delivery of safe, compassionate, and high-quality patient care.
THE ENVIRONMENT OF PROGRESSIVE AND CRITICAL CARE NURSES
(AACN, 2019)
1. Acutely and critically ill patients require complex assessment and therapies, high-
intensity interventions, and continuous vigilance.
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American Association of Colleges of Nursing