ACCCN's Critical Care Nursing

778 A P P E N D I X B A U S T R A L I A N C O L L E G E O F C R I T I C A L C A R E N U R S E S ( A C C C N ) P O S I T I O N S TAT E M E N T S

suggests that unlicensed assistive personnel undertaking 6. Amaravadi RK, Dimick JB, Pronovost PJ, Lipsett PA. ICU nurse-to-patient ratio
basic patient care can limit the RNs capacity to assess the is associated with complications and resource use after esophagectomy. Inten-
sive Care Medicine 2000; 26: 1857–1862.
total patient condition in context, and as such could 7. Pronovost PJ, Jenckes MW, Dorman T, Garrett E, Breslow MJ, Rosenfeld BA,
impede response to clinical deterioration. 24 Lipsett PA, Bass E. Organizational characteristics of intensive care units related
to outcomes of abdominal aortic surgery. Journal of the American Medical
The introduction of less-skilled nurses or unlicensed per- Association 1999; 28(14): 1310–1317.
sonnel into the intensive care environment would greatly 8. Zimmerman P. The use of unlicensed assistive personnel: an update and
increase the supervisory workload of the current work- skeptical look at a role that may present more problems than solutions.
force. Given that several Australian and American studies Journal of Emergency Nursing 2000; 26(4): 312–317.
9. Wilson G. Health care assistants. Nursing Management 1997; 4(3): 18–19.
have identified workload as a major reason for nurses 10. Zimmerman P. Replacement of nurses with unlicensed assistive personnel:
leaving the profession, this strategy has the potential to the erosion of professional nursing and what we can do. Journal of Emergency
further exacerbate attrition, rather than provide a solu- Nursing 1995; 21(3): 208–212.
tion. 19-21 In addition, the notion of upskilling Division 2 11. Clarke T, Mackinnon E, England K, Burr G, Fowler S, Fairservice L. A review
RNs**/ENs and unlicensed personnel to fix a nursing of intensive care nurse staffing practices overseas: what lessons for Australia?
Australian Critical Care 1999; 12(3): 109–118.
shortage crisis ignores the underlying problems faced by 12. Pilcher T, Odell M. Position statement on nurse-patient ratios in critical care.
the nursing profession. Interestingly, these strategies are Nursing Standard 2000; 15(12): 38–41.
20
more likely to be considered by administrators than 13. Knaus W, Draper E, Wagner D, Zimmerman J. An evaluation of outcome from
nurses. 22,23 intensive care in major medical centers. Annals of Internal Medicine 1986;
104(3): 410–418.
In summary, systematic reviews in Australia and large 14. Papes K, Birnbach N, Sanders E. Mobilizing the public in support of quality
studies overseas have concluded that an all RN skill mix nursing care. International Nursing Review 1997; 44(5): 153–156.
is associated with improved patient outcomes (including 15. Morrison A, Beckmann U, Durie M, Carless R, Gillies D. The effects of nursing
staff inexperience (NSI) on the occurrence of adverse patient experiences in
satisfaction), quality of life after discharge, treatment ICUs. Australian Critical Care 2001; 14(3): 116–121.
compliance, decreased costs, and both reduced length of 16. British Association of Critical Care Nurses. Position statement on nurse–
stay and adverse events. patient ratios in critical care. Accessed online 07/03/2002. Available from
www.baccn.org.uk.
The introduction of healthcare workers other than Divi- 17. Canadian Association of Critical Care Nurses (CACCN) 1997. Position state-
sion 1* RNs to provide direct patient care in Australian ment: non-regulated health personnel in critical care areas. Accessed online
www.caccn.ca/non-regulated.htm on 28/01/2003.
intensive care units is considered inappropriate, problem- 18. Beckmann U, Baldwin I, Durie M, Morrison A, Shaw L. Problems associated
atic and hazardous; and therefore will not be supported with nursing staff shortage: an analysis of the first 3600 incident reports
by the ACCCN until there is evidence that clearly dem- submitted to the Australian Incident Monitoring Study (AIMS-ICU). Anaes-
onstrates it would be safe and beneficial to do so. thesia and Intensive Care 1998; 26(4): 396–400.
19. Best Practice Australia. Focusing on solutions, the dynamics of nursing attraction,
retention and turnover. Milton, Qld.
REFERENCES 20. Nurse Recruitment and Retention Committee. Final Report. Victorian Govern-
ment Department of Human Services. Policy and Strategic Projects Division,
1. ACCCN, Position Statement on Intensive Care Nurse Staffing. May 2001.
2. Joint Faculty of Intensive Care Medicine (JFICM). Minimum Standards for 21. Cowin L, Jacobsson D. The nursing shortage: part way down the slippery
Intensive Care Units, Melbourne, 2003. slope. Collegian 2003; 10(3): 31–35.
3. Australian Council on Healthcare Standards. Guidelines for Intensive Care Units. 22. Aitken L, Clarke SP, Sloane DM, Sochaski J, Silber JH. Hospital staffing and
Sydney, 1997. patient mortality, nurse burnout and job dissatisfaction. The Journal of the
4. Ball C, Walker G, Harper P, Sanders D, McElligot M. Moving from ‘patient American Medical Association 2002; 288: 1987–1993.
dependency’ and ‘nursing workload’ to managing risk in critical care. Intensive 23. Cowin L, Jacobsson D. Addressing Australia’s nursing shortage: is the gap
and Critical Care Nursing 2004; 20: 62–68. widening between workforce recommendations and the workplace. Collegian
5. Ball C, McElligot M. ‘Realising the potential of critical care nurses’: an explor- 2003; 10(4): 20–24.
atory study of the factors that effect and comprise the nursing contribution 24. Chaboyer W, McMurray A, Patterson E. 1998 Unlicensed assistive personnel
to the recovery of critically ill patients. Intensive and Critical Care Nursing 2003; in the critical care unit: what is their role? International Journal of Nursing
19: 226–238. Practice 4(4): 240.

A P P E N D I X B A U S T R A L I A N C O L L E G E O F C R I T I C A L C A R E N U R S E S ( A C C C N ) P O S I T I O N S TAT E M E N T S 779

APPENDIX B4 l advanced airway management, including intu-
ACCCN RESUSCITATION POSITION bation
STATEMENT (2006) – ADULT & l transcutaneous pacing
l post-resuscitation management
PAEDIATRIC RESUSCITATION l transport of a patient
BY NURSES
PALS
The Australian College of Critical Care Nurses Ltd recom-
mends that all nurses should receive Basic Life Support l advanced airway management
(BLS) training as a component of their entry-level l use of age appropriate equipment
qualification and that they be responsible for maintain- l administration of first-line pharmacological agents
ing their competence in BLS at minimum on an annual and fluid therapy according to weight
basis. ACCCN Ltd further recommends that, where l alternative access to circulation
semi-automatic defibrillators are accessible, competence l defibrillation
in their use should be considered a feature of BLS training l post-resuscitation management
and practice. l transport of a patient
In addition, ACCCN Ltd recommends that registered Where registered nurses are working in isolation and are
nurses working in critical care environments where primarily responsible for the health care and manage-
patients are at risk of sudden life-threatening emergencies ment of communities, competency in BLS, ALS and PALS
due to airway, breathing and/or circulatory conditions is recommended. The registered nurse should be sup-
should become competent in the provision of Advanced ported by appropriate education guidelines, protocols,
Life Support (ALS). Where registered nurses work in areas communication and ALS equipment to manage patients
where children are at risk of sudden life-threatening with life-threatening emergencies until support services
emergencies they should become competent in the provi- can arrive.
sion of Paediatric Advanced Life Support (PALS). Com-
petencies in ALS should be performed annually. As with BLS, the ACCCN Ltd recommends that registered
nurses formally reassess their competency in ALS/PALS
Healthcare agencies that provide critical care facilities on at least an annual basis. Informal, frequent self-
should define the registered nurse’s role in initiating and assessments, either through work performance in
maintaining ALS skills with or without a medical officer clinical sessions or through simulation exercises, are also
present. These skills may include: advised between formal assessments.

ALS In keeping with its member status of the Australian Resus-
citation Council (ARC), the ACCCN Ltd promotes and
l arrhythmia recognition supports the policies and guidelines of the ARC. Follow-
l defibrillation ing these national guidelines creates a consistent approach
l insertion of intravenous cannulae to life-threatening situations and thus the best possible
l administration of first-line pharmacological agents outcome for patients.

BIOCHEMISTRY
Parameter Application Normal range
Blood analysis
Adrenocorticotrophic hormone (ACTH) Aetiology of corticosteroid abnormality <50 ng/L
Albumin Hydration, Nutrition status, protein-related 32–45 g/L
disorders and liver disease
Alkaline phosphatase (ALP) Hepatobiliary or bone disease Neonate: 50–300 U/L
Child: 70–350 U/L
Adult: 25–100 U/L (higher during
pregnancy & age >50)
Alanine aminotransferase (ALT) Liver damage Neonate: <50 U/L
Adult: <35 U/L
Amylase Acute pancreatitis Varies based on laboratory method
Anion gap Aetiology of metabolic acidoses 8–16 mmol/L
Aspartate aminotransferase (AST) Liver damage Neonates: <80 U/L
Adults: <40 U/L
Base excess Metabolic component of acid-base disorders −3–+3 mmol/L
Bicarbonate (HCO 3 ) Acid-base disorders, particularly metabolic 22–32 mmol/L
component
Bilirubin Hepatobiliary disease and haemolysis Total: <20 µmol/L
Direct: <7 µmol/L
2+
Calcium (Ca ) Hyper/hypocalcaemia Total: 2.10–2.60 mmol/L
Corrected: 2.15–2.60 mmol/L
Ionised calcium: 1.16–1.30 mmol/L
Carboxyhaemoglobin Carbon monoxide exposure 0.2%–2.0% of total haemoglobin
normally, up to 8.5% in heavy smokers
−
Chloride (Cl ) Causes of acid-base disturbance 95–110 mmol/L
Cholesterol Lipid status Total: ≤4.0 mmol/L (recommended by
NHF)
HDL: 1.0–2.2 mmol/L (females)
0.9–2.0 mmol/L (males)
LDL: 2.0–3.4 mmol/L
Creatine kinase (CK) Diagnosis of myocardial damage Female: 30–180 U/L
Male: 60–220 U/L
Creatine kinase MB isoenzyme (CKMB) Diagnosis of myocardial damage 0%–5% of total CK
Creatinine (Cr) Renal function, particularly glomerular Child: 0.04–0.08 mmol/L
filtration Adult: 0.05–0.11 mmol/L (female)
0.06–0.12 mmol/L (male)
Glucose Hyper/hypoglycaemia Fasting: 3.0–5.4 mmol/L
Random: 3.0–7.7 mmol/L
Iron Iron deficiency or overload Varies according to laboratory method
L-lactate Metabolic acidosis Arterial: 0.3–0.8 mmol/L
Venous: 0.3–1.3 mmol/L
Lactate dehydrogenase (LD) Assessment of liver disease 110–230 U/L (method and age
dependent)

A P P E N D I X C N O R M A L V A L U E S 781


BIOCHEMISTRY—cont’d
Parameter Application Normal range
Magnesium (Mg) Hypomagnesaemia Neonate: 0.6–0.9 mmol/L
Adult: 0.8–1.0 mmol/L
Myoglobin Detection of muscle damage <70 μg/L
Osmolality Suspected poisoning with some substances, 280–300 mmol/kg
e.g. alcohol, methanol
Phosphate (PO ) 4 Renal failure, hyper-/hypo-parathyroidism 0.8–1.5 mmol/L
metabolic bone disease
+
Potassium (K ) Hyper/hypokalaemia Plasma: 3.4–4.5 mmol/L
Serum: 3.8–4.9 mmol/L
Protein Used in conjunction with albumin to Neonate: 40–75 g/L
calculate globulin, diagnosis of protein Child <2 years: 50–75 g/L
and nutrition related disorders Adults: 62–80 g/L
Sodium (Na ) Fluid and electrolyte status 135–145 mmol/L
+
Triglyceride Lipid status <1.7 mmol/L (fasting)
Troponin I or troponin T Myocardial infarction Normally not detected
Urea Renal function Neonate: 1.0–4.0 mmol/L
Adult: 3.0–8.0 mmol/L

URINE ANALYSIS
Parameter Application Normal Value
Albumin Diabetic nephropathy, renal disease <30 mg albumin/g creatinine
Calcium Renal calculi 2.5–7.5 mmol/24 hours
<0.4 mol/mol creatinine
Chloride Identification of site of chloride loss in electrolyte disturbance Dependent on intake, but usually
100–250 mmol/24 hours
Cortisol (free) Adrenocortical hyperfunction 100–300 nmol/24 hours
Creatinine clearance Glomerular filtration rate >70 ml/min in a young adult, typically falling
approx. 0.5 ml/min per year at ages over
30 years
Magnesium Urinary magnesium loss 2.5–8.0 mmol/24 hours (related to daily intake)
Myoglobin Suspected rhabdomyolysis Not normally detected
Osmolality Renal disease, syndrome of inappropriate antidiuretic 50–1200 mmol/kg
hormone, polyuric syndromes
Potassium Differentiation of renal potassium loss from other causes of 40–100 mmol/24 hours (related to daily intake)
hypokalaemia
Protein Renal disease <150 mg/24 hours
During pregnancy: <250 mg/24 hours
Sodium Causes of hyponatraemia <20 mmol/L
Urea Renal function, occasionally assessment of nitrogen balance 420–720 mmol/24 hours
in patients receiving parenteral nutrition

HAEMATOLOGY
Parameter Application Normal Value
Activated clotting time (ACT) Heparin therapy Varies based on product in use
Activated partial thromboplastin Coagulopathy and monitoring of heparin therapy Varies based on laboratory methods,
time (APTT) usually 25–35 seconds
Antithrombin III (AT III) Investigation of venous thromboembolism Varies based on laboratory method
Bleeding time Assessment in some bleeding disorders, e.g. von <9 minutes
Willebrand’s disease
D-dimers Indication of recent or ongoing fibrinolysis, Varies based on laboratory method
possibly indicating disseminated intravascular
coagulation (DIC)

782 A P P E N D I X C N O R M A L V A L U E S


HAEMATOLOGY—cont’d
Parameter Application Normal Value
Haemoglobin (Hb) Anaemia Infant (3–6 mth): 95–135 g/L
Child (1 yr): 105–135 g/L
Child (3–6 yr): 105–140 g/L
Child (10–12 yr): 115–145 g/L
Adult (female): 115–165 g/L
Adult (male): 130–180 g/L
International normalised ratio (INR) Oral anticoagulant therapy Varies based on reason for therapy,
typically 2.0–3.0, although a target of
up to 4.5 may be used in those with a
mechanical heart value
Packed cell volume (PCV) (also Anaemia Infant (3 mth): 0.32–0.44
referred to as haematocrit) Child (3–6 yr): 0.37–0.44
Child (10–12 yr): 0.37–0.45
Adult (female): 0.37–0.47
Adult (male): 0.40–0.54
Plasminogen Investigation of tendency towards clotting, 50%–150%
e.g. venous thromboembolism
Platelet count Excessive or inappropriate bleeding 150–400 × 10 /L
9
Prothrombin time (PT) Detection of coagulation factor deficiencies Varies based on laboratory method, but
due to vitamin K deficiency usually 11–15 seconds
Red cell count (RCC) Anaemia Infant (3 mth): 3.2–4.8 × 10 /L
12
Child (1 yr): 3.6–5.2 × 10 /L
12
12
Child (3–6 yr): 4.1–5.5 × 10 /L
Child (10–12 yr): 4.0–5.4 × 10 /L
12
12
Adult (female): 3.8–5.8 × 10 /L
Adult (male): 4.5–6.5 × 10 /L
12
Thrombin time (TT) Acquired or inherited disorders of haemostasis Varies based on laboratory method, but
usually 14–16 seconds
White cell count (WCC) Infection or inflammatory disease Neonate: 6.0–22.0 × 10 /L
9
9
Child (1 yr): 6.0–18.0 × 10 /L
Child (4–7 yr): 5.0–15.0 × 10 /L
9
Child (8–12 yr): 4.5–13.5 × 10 /L
9
9
Adult: 4.0–10.0 × 10 /L
BLOOD GASES
Parameter Normal Value
Arterial
pH 7.36–7.44
Partial pressure of oxygen (PaO 2 ) 80–100 mm Hg
Partial pressure of carbon dioxide (PaCO 2 ) 35–45 mm Hg
Oxygen saturation (SaO 2 ) >94%
Venous
pH 7.34–7.42
Partial pressure of oxygen (PvO 2 ) 37–42 mm Hg
Partial pressure of carbon dioxide (PvCO 2 ) 42–50 mm Hg
Oxygen saturation (SvO 2 ) >70%



REFERENCE

1. The Royal College of Pathologists of Australasia, RCPA Manual, version 46, 8
March 2011, www.rcpa.edu.au/Publications/?RCPAManual.htm, accessed 17
March 2011.

Glossary of terms








abdominal compartment syndrome. Describes the acute tubular necrosis (ATN). A collective term reflecting
pathophysiological consequences of raised intra-abdominal pathological renal changes from various renal insults of a
pressure and may be associated with any clinical condition that nephrotoxic or ischaemic origin.
increases such pressure, including massive intra-abdominal or adult guardian. An officer who is appointed to protect the interests
retroperitoneal haemorrhage, intestinal obstruction or severe gut and rights of adults with impaired decision-making capacity, no
oedema. matter the type or cause of impairment. The adult guardian is an
ablation. Therapy designed to destroy tissues that generate or sustain independent statutory officer.
arrhythmias. advance directives. A document that expresses the patient’s
Aboriginal. Refers here to both Aboriginal and Torres Strait Islander preferences for end-of-life issues.
peoples. advanced life support (ALS). The provision of effective airway
access catheter. A plastic tubing device with two central lumens management, ventilation of the lungs and production of a
placed percutaneously in a large vein of the body for the purpose circulation using techniques in addition to those of basic life
of drawing blood into a RRT circuit and enabling blood from the support.
RRT circuit to return to the patient again. afterload. The load imposed on the muscle during contraction, and
access catheter site. The position where the skin and large vein in the translates to systolic myocardial wall tension.
human body is punctured to provide for placement of the vascular allograft. Transplanted organ and tissue.
access catheter. amylase. An enzyme that breaks down starch, glycogen and dextrin
actigraph. Used for measuring movement, in particular to measure to form glucose, maltose and the limit dextrins.
the quantity of sleep. anabolism. The phase of metabolism in which simple substances
acute coronary syndrome (ACS). A broad spectrum of clinical (e.g. amino acids) are synthesised into complex materials (e.g.
presentations, spanning ST-segment-elevation myocardial proteins).
infarction, through to an accelerated pattern of angina without anaphylaxis. A life-threatening allergic reaction.
evidence of myonecrosis. antepartum haemorrhage. Any bleeding from the genital tract after
acute kidney injury (AKI). A term now more commonly used to 20 weeks’ gestation and before the birth of the baby.
replace the term acute renal failure (ARF) as it better describes the anticoagulation. The effect of a drug aimed at stopping the blood
spectrum of the illness including pathophysiological and clinical clotting.
changes and causative factors associated with an abrupt loss of anxiety. A disorder characterised by excessive concern or worry
urine production. with a difficulty controlling the level of concern with irritability,
acute liver failure (ALF). Liver cell injury occurring, over a short restlessness and disturbed sleep.
period of time, to a critical mass of liver cells. The liver is unable to APACHE score. Abbreviation for Acute Physiology and Chronic Health
maintain homeostasis. Evaluation. A numerical value determined from a collection of
acute lung injury (ALI). A distinct form of acute respiratory failure predetermined criteria that enables the severity of illness to be
characterised by progressive hypoxaemia, reduced lung classified. The score provides a risk of death calculation and
compliance and diffuse pulmonary infiltrates on a chest X-ray. or enables patients with critical illness to be compared in an
acute-on-chronic liver failure (AoCLF). AoCLF results from an acute objective manner.
decompensation of chronic liver disease and can be precipitated apoptosis. Normal physiologic programmed cell death; the main
by infection, bleeding, or intoxication. mechanism to eliminate dysfunctional cells.
acute-phase proteins. Proteins (also known as acute-phase reactants) arrhythmia. A broad term used to describe any rhythm other than
that are synthesised in the liver in response to inflammation; sinus rhythm.
include C-reactive protein, alpha-1-antitrypsin, coagulation factors arterial blood gas. An arterial blood sample taken to assess pH,
(e.g. fibrinogen, prothrombin, factor VIII, plasminogen), and bicarbonate, oxygen and carbon dioxide levels, and other
complement factors. electrolytes
acute renal failure (ARF). A sudden deterioration of kidney function arterio-venous (AV) circuit. A term describing the arterial and venous
to the point where there is retention of nitrogenous wastes, with vascular access cannulae or shunt and the associated tubing
or without loss of urine production. necessary to carry blood in and out of the haemofilter and the
acute respiratory distress syndrome (ARDS). A severe form of acute circulation.
lung injury, with a PaO 2:FiO 2 ratio <200 and bilateral infiltrates asterixis. A clinical sign indicating a lapse of posture, usually manifest
present on a chest X-ray. in a bilateral flapping tremor at the wrist, metacarpophalangeal 783

784 G L O S S A R Y O F T E R M S

and hip joints. It may also be seen in tongue, foot and any skeletal chronic liver failure (CLF). Liver cell injury occurring over a prolonged
muscle. Tremors are not symmetrical. period. The function of the residual liver cell mass is sufficient to
Australasian Donor Awareness Program Training (ADAPT). An maintain homeostasis.
Australasian program that provides a consistent and uniform chronic obstructive pulmonary disease. A progressive and
approach to educating health professionals in the care and irreversible disease condition that reduces inspiratory and
management of dying patients and their families, including those expiratory lung capacity. This increases airway resistance and there
patients who may become organ and tissue donors; in organ is a loss of lung recoil.
retrieval surgery; and in the organ and tissue donation process. chronic renal failure. A failure of normal kidney function with slow
Australasian Transplant Coordinators Association (ATCA). Formed insidious onset, often related to degenerative diseases such as
to promote communication and collaboration among organ and diabetes or chronic heart failure.
tissue donor and transplant coordinators, and to promote research clinical decision making. The cognitive processes and strategies that
and education and discussion of professional and ethical issues in nurses use when utilising data to make clinical decisions regarding
the field in Australasia. patient assessment and care.
Australians Donate. The peak body for the organ and tissue donation clinical practice guidelines. Statements about appropriate health
sector in Australia. Members include state and territory organ care for specific clinical circumstances that assist practitioners in
donation agencies, independent tissue and eye banks, community their day-to-day practice.
groups, clinicians, policy makers, academics and ethicists. clotting indices. Blood tests performed which indicate the potential
autonomy. Ethical principle of self-determination and independence. for blood to clot. They are usually time based or expressed as a
azotaemia. Accumulation of excessive amounts of nitrogenous waste ratio of normal times for normal blood to clot.
in the blood. coagulation factors. Elements of the blood which are responsible for
bacteraemia. The presence of viable bacteria in the blood. the formation of a blood clot, e.g platelet count.
basic life support (BLS). The support of life by the initial coagulopathy. Disorder of the clotting mechanism of the blood,
establishment of and/or maintenance of airway, breathing, which can be caused by pre-existing disease, medications,
circulation and related emergency care. pathophysiological conditions such as hypothermia and acidosis,
benefit–cost. The relative merits of an action based on the benefit or current treatment such as massive blood transfusion.
that will be achieved and the possible cost (financial or other) that cognitive impairment. Deficiency in ability to think, perceive, reason
might result from such an action. or remember that may result in loss of ability to attend to one’s
benefit–risk. The relative merits of an action based on the benefit that daily living needs.
will be achieved and the possible risk or adverse outcome that cold ischaemic time. The time from cross-clamp to when blood
might occur from such an action. supply is re-established to the organ during transplant surgery.
biphasic. Pattern of electrical flow where the current reverses direction complementary therapies. Treatments that have not been
in the middle of the waveform, flowing first from one electrode considered part of standard Western medicine but that are
pad, through the heart, to the second electrode pad, and then increasingly being used in combination with standard medical
from the second pad through the heart to the first. treatments. These may include therapies for pain, such as massage
brain death. Death from confirmed irreversible cessation of all and relaxation techniques, and some nutritional therapies.
function of the person’s brain and/or absent intracranial blood concept analysis. A systematic process involving identification of all
flow. uses of a term, verification of common attributes and identification
cadaveric donor. Donor of tissue and solid organs after death. of manifestations of the term.
capnography. The monitoring of expired carbon dioxide. confidentiality. The obligation of persons to whom private
cardiac arrest. The cessation of cardiac mechanical activity, with the information has been given: not to use the information for any
absence of a detectable pulse, and unresponsiveness and apnoea purpose other than for the primary purpose for which it was
(or agonal respirations). given.
cardiac pacing. The delivery of an electrical impulse to either or both consent. The voluntary agreement of a person or group, based on
the atria and ventricles to initiate or maintain normal cardiac adequate knowledge and understanding of relevant material, to
electrical activity. participate in research. Informed consent is one possible result of
cardiopulmonary resuscitation (CPR). A technique of heart the informed choice process; the other possible result is refusal.
compression and inflation of the lungs, used in an attempt to continuous arterio-venous haemofiltration (CAVH). A technique
revive a person who has suffered a cardiac arrest. of CRRT whereby blood is driven by the patient’s blood pressure
care bundle. A small collection of evidence-based activities applied to through a filter containing a highly permeable membrane via
selected patients. an extracorporeal circuit originating in an artery and terminating
carotid siphon. The twisted segment of the internal carotid artery that in a vein.
extends from the point where the artery enters the skull through continuous arterio-venous techniques. All techniques of CRRT
the carotid canal or foramen in the temporal bone, and bifurcates (hemofiltration, hemodialysis and hemodiafiltration) whereby the
into the anterior and middle cerebral arteries that form part of the patient’s blood pressure (instead of a blood pump) drives blood
cerebral artery circle: the circle of Willis. through a filter, which contains the highly permeable membrane.
catabolism. The phase of metabolism in which complex materials continuous positive airway pressure (CPAP). When a specific level
(e.g. polysaccharides) are broken down into simple substances of pressure is applied to the airways in both the inspiratory and
(e.g. monosaccharides) and release energy in the process. expiratory phases of ventilation.
chemoreceptor. A sensor that response to change in chemical continuous renal replacement therapy (CRRT). A treatment applied
composition in the blood. continuously to replace renal function, including continuous

G L O S S A R Y O F T E R M S 785

veno-venous haemofiltration (CVVH) and continuous veno-venous designated officer. According to Australian law, person(s) appointed
haemodiafiltration (CVVHDf). by the governing body of a health institution to authorise consent
continuous veno-venous haemofiltration (CVVH). A technique of for non-coronial postmortems and organ and tissue retrieval for
CRRT whereby blood is driven through a highly permeable transplant and research.
membrane by a peristaltic pump via an extracorporeal circuit designated specialist. According to Australian law, person(s)
originating in a vein and terminating in a vein. appointed by the governing body of a health institution with
continuous veno-venous haemodialysis (CVVHD). A technique of authority to confirm brain death.
CRRT whereby blood is driven through a highly permeable diabetic ketoacidosis (DKA). A metabolic derangement resulting
membrane by a blood pump and via an extracorporeal circuit. from a relative or absolute insulin deficiency.It is characterised by
Solute removal is achieved by diffusion (exchange of solutes hyperglycaemia, cellular dehydration and intravascular volume
dependent on a concentration gradient) of molecules across a depletion, ketosis, and electrolyte abnormalities.
membrane. diagnosis-related group (DRG). A method used to standardise the
continuous veno-venous haemo-diafiltration CVVHDF). A diagnoses used to classify patients into uniform groups. In
technique of CRRT that combines CVVH and CVVHD. During addition, this method allows for weighting/comparison of one
CVVHDF, solute removal is achieved by a combination of DRG to another so that relative resource utilisation of each can be
convection and diffusion. analysed.
controlled mechanical ventilation. A ventilation mode that requires dialysate. The solution administered into the ultrafiltrate-dialysate
the patient to receive neuromuscular blockade and sedation so compartment of the haemofilter of a haemodialyser in order to
that a fixed, non-triggered tidal volume and rate can be delivered. achieve solute clearance by diffusion.
convection. A process where dissolved solutes are removed with dialysis. Purification of blood by diffusion of waste substances through
blood plasma water as it is filtered through the haemofilter a membrane.
membrane. diffusion. A term which describes a type of solute transport across a
counterpulsation. Rapid inflation of the intra-aortic balloon catheter semipermeable membrane.
at the onset of diastole of each cardiac cycle and then deflation disseminate intravascular coagulation. Widespread formation of
immediately before the onset of the next systole. fibrin clots, platelet and coagulation protein consumption and
critical care nursing. Specialised nursing care of critically ill patients occlusion of microvasculature, resulting in impaired cellular tissue
who have an immediate life-threatening or potentially life- oxygen delivery.
threatening illness or injury. Donatelife Organ Donor Coordinator. Also referred to as Organ
critical illness. A state or disease process where life support Donor Coordinator, State Organ Donor Coordinator or State Donor
techniques and or machines are required to sustain life until the Nurse Consultant in various jurisdictions.
patient with the illness recovers. donation. Refers to organ and tissue donation. It should be
critically ill patients. Patients who have an immediate life-threatening recognised that an organ donor may also be a tissue donor. It
or potentially life-threatening illness or injury causing compromise should also be noted that there is a separate group of donors who
to the function of one or more organs. are tissue donors only.
cross-clamp. The act of clamping the aorta to achieve a controlled donation after cardiac death (DCD). Also known as non-heart-
arrest of the heart, ceasing blood flow to all organs, and beating donation (NHBD): donor of selective solid organs and
commencement of infusion of cold perfusion fluid during organ tissues after cardiac death rather than brain death.
retrieval surgery. Marks the beginning of cold ischaemic time. dose intensity. A term used to describe how much renal replacement
cytokine. Glycoproteins of low molecular weight that have immune therapy is applied or prescribed for a given time.
function activity are elevated as a result of bacterial multiplication drowning. The process of experiencing respiratory impairment from
and or inflammation. High levels of cytokines can suppress submersion or immersion in a liquid.
immune function. dry drowning. A submersion incident where no significant water
cytopathic anoxia. The inability of the cells to utilise oxygen even (liquid) is aspirated into the lungs.
when available. eclampsia. A severe variant of preeclampsia, characterised by
damage-control surgery. A four-stage surgical approach that, tonic–clonic seizures which are not caused by any preexisting
according to Schwab (2004), involves ‘early recognition of patients disease or other identifiable causes e.g. epilepsy, cerebral
that warrant damage control, salvage operation for haemorrhage haemorrhage.
and contamination control, intensive care management and finally emancipatory practice development. A continuous process
an operation for definitive repair and reconstruction’. used to improve an aspect of patient care through fostering
death. The final cessation of the integrated functioning of the body. empowerment of others and creation of a transformational culture.
Death is observed to have occurred when there is irreversible loss endotracheal tube. An artificial airway used in critical care settings, to
of brain function or irreversible cessation of circulation. enable delivery of mechanical ventilation and clearance of airway
defibrillation. The application of a controlled electrical shock to the secretions.
victim’s chest in order to terminate a life-threatening cardiac ethical/unethical. Right or morally acceptable/wrong or morally
rhythm. unacceptable.
denervation. Loss of direct autonomic nervous system innervation. ethics. The study of morals and values.
deontological. A philosophical view reflecting duty or a moral evidence-based nursing. ’The conscientious, explicit, and judicious
obligation to behave or act in a particular way. use of theory-derived, research-based information in making
depolarisation. The electrical state in an excitable cell where the decisions about care delivery to individuals or groups of patients.’
inside of the cell becomes less negative relative to the outside. (Garbett & McCormack, 2002).

786 G L O S S A R Y O F T E R M S

extracorporeal circuit (EC). The path for blood flow outside the heterotopic. Implantation of an organ into an abnormal anatomical
body. The EC includes the plastic tubing carrying the blood to position.
the filter (or haemofilter or dialyser) from the vascular access hybrid. A cross between two ‘species’; a mixture of approaches or
catheter and from the filter back to the body via the access techniques to provide renal replacement therapy, for example
catheter again. intermittent heamodialysis and haemofiltration.
extracorporeal membrane oxygenation (ECMO). Circulation of hyperglycaemic hyperosmolar non-ketotic state (HHNS). A
blood outside the body to provide total artificial support of cardiac metabolic derangement characterised by hyperglycaemia, cellular
and pulmonary function. dehydration and intravascular volume depletion, and electrolyte
eye care. Cleansing of the eyes, and the prevention of dry eyes and abnormalities. Insulin excretion is maintained in this condition, so
corneal abrasions by the use of artificial tears and measures to ketosis is not seen.
maintain eyelid closure. hypothalamic–pituitary–adrenal (HPA) axis. A system, activation of
family. Those closest to the person in knowledge, care and affection, which can lead to host defence response and release of
including the immediate biological family; the family of acquisition catecholamines.
(related by marriage or contract); and the family of choice and hypothalamus. A portion of the brain controlling, among other
friends (not related biologically or by marriage or contract). things, behavioural and emotional responses.
filter or dialyzer. A tubular-shaped device, which is made up of the immunoneuroendocrine axis. The nexus between immune response
plastic casing and the capillary fibres of the semi-permeable and the hypothalamic–pituitary–adrenal axis and the response
membrane within it. to stress.
filter life or functional life of the EC. The passage of blood through immunosuppression. Drug therapies to suppress the body’s natural
the EC, particularly if the haemofilter initiates blood clotting. response to reject non-self organs.
fulminant hepatic failure. The definition of ALF when associated with Indigenous person. Aboriginal or Torres Strait Islander person of
hepatic encephalopathy. Australia or Maori person of New Zealand.
gestation. The estimated gestational age of the baby in completed induction of labour. A procedure performed for the purpose of
weeks using all available obstetric information (clinical estimation, initiating and stimulating the process of labour. This may include
ultrasound, cycle length, etc.), counting from the first day of the the artificial rupture of the membranes and/or the use of uterine
woman’s last menstrual period. Commonly recorded as 35+2/40, stimulating medication.
indicating that the gestation is 35 weeks and 2 days. infant. A child under 1 year of age.
haemodiafiltration. A term which describes both convection and infection. An inflammatory response to the presence of
diffusion as mechanisms for removal of waste solutes in the microorganisms, or the invasion of normally sterile host tissue by
application of artificial kidney techniques. those organisms.
haemodialyser. A haemofilter designed principally to facilitate infection control. A series of policies and procedures aimed at
diffusion of plasma solutes from the blood. reducing the risk of hospital-acquired infection and limiting the
haemodynamic monitoring. The measurement of pressure, flow and spread of infection.
oxygenation within the cardiovascular system. innate immune system. A natural immune system.
haemofilter (blood filter). The primary functional component of the inoconstrictor. An inotrope with vasoconstrictor properties.
RRT system, responsible for separating plasma water from the inodilator. An inotrope with vasodilator properties.
blood and/or allowing the exchange of solutes across the filter intensivist. A medical specialist physician who diagnoses and
membrane by diffusion. prescribes treatment for a variety of life threatening illnesses
heat exhaustion. A severe form of heat illness that produces managed within the Intensive Care Unit.
hyperpyrexia and collapse due to the inability to sweat. intermittent haemodialysis (IHD). The diffusive treatment during
heat–moisture exchanger. A disposable humidification device that which blood and dialysate are circulated on the opposite sides
traps the water vapour from the expired breath within the filter, (within the tubes/fibres and outside the fibres) of a semipermeable
which moisturises the subsequent inhaled breaths. membrane in a counter-current direction in order to achieve
heat stroke. Form of heat illness associated with severe water or diffusive solute removal.
salt depletion due to excessive sweating and a temperature intra-aortic balloon pump (IABP). Mechanical assistance for a
lower than 40°C. failing heart based on the principles of diastolic augmentation
HELLP syndrome. A severe variant of preeclampsia characterised by and systolic unloading by counterpulsation of a balloon in the
haemolysis, elevated liver enzymes and low platelets. aorta.
heparin. A drug used to prevent blood clotting. Administered to justice. That which concerns fairness or equity, often divided into
prevent clot formation following surgery and to prevent clotting three parts: procedural justice, concerned with fair methods of
when extracorporeal blood flow is required for dialysis or heart making decisions and settling disputes; distributive justice,
bypass operations. concerned with the fair distribution of the benefits and burdens of
hepatic encephalopathy (HE). The cerebral effects of liver failure, society; and corrective justice, concerned with correcting wrongs
which may range from mild confusion to high risk of death from and harms through compensation or retribution.
severe cerebral oedema and raised intracranial pressure. legislation. The laws as deemed by the relevant Government which
hepatorenal syndrome (HRS). The development of renal failure in the define death and all aspects of organ and tissue donation.
setting of severe liver disease. It probably results from a reduction limbic system. The areas of the brain involved with emotions and
in renal perfusion caused by splanchnic vasodilation, which is a memory.
consequence of the production of the vasodilator substance nitric lipase. Any enzyme that is capable of degrading lipid molecules.
oxide by inflamed liver cells. Lipase breaks down lipids into simple fatty acids and glycerol that

G L O S S A R Y O F T E R M S 787

can be absorbed across the mucosa of the stomach and small Organ and Tissue Authority. The peak body that works with all
intestine. jurisdictions and sectors to provide a nationally coordinated
living donor. Donor of serum, tissue or solid organs while living. approach to organ and tissue donation for transplantation to
living will. An advance directive expressing an individual’s wishes maximise rates of donation.
regarding health care if they become terminally ill and lose the orthotopic. Implantation of an organ into a normal anatomical position.
ability to make decisions. partogram. Birth suite chart that records maternal and fetal
lysis. Cellular destruction. monitoring during labour, and the progress of labour, e.g. strength
margination. Adhesion to endothelium. and frequency of contractions, fetal descent.
mechanical circulatory support. Partial or total cardiovascular percutaneous coronary intervention (PCI). A group of technologies
support devices such as IABP and ventricular assist devices. used to treat coronary artery disease which include percutaneous
metabolites. Substances that are used by or produced by enzyme transluminal coronary angioplasty (PTCA), rotational, directional
reactions or other metabolic processes. and extraction atherectomy, laser angioplasty and implantation of
monophasic. Pattern of electrical flow where the current, throughout intracoronary stents.
the pulse, flows in one direction, from one electrode pad through personal information. Information by which individuals or
the heart to the other electrode pad. collectivities can be identified. This is defined in the Privacy Act
multiorgan donor. Donor of solid organs (i.e. kidneys, pancreas, heart, 1988 (Cth) as information or an opinion (including information or
lungs, liver) and tissue. an opinion forming part of a database), whether true or not, and
whether recorded in a material form or not, about an individual
multiorgan dysfunction syndrome (MODS). The presence of altered whose identity is apparent, or can reasonably be ascertained, from
organ function in an acutely ill patient where homeostasis cannot the information or opinion.
be maintained without intervention. personal protective equipment. A range of equipment, such as
near-drowning. Survival for at least 24 hours after a submersion gloves, eye protection and masks that is used to protect healthcare
incident. staff from infectious diseases.
necrosis. A form of cell death characterised by cellular swelling and phagocytosis. Ingestion and destruction of microorganisms and
loss of membrane integrity as a result of hypoxia or trauma. cellular debris by capable cells.
negligence. A legal term defined as ‘causing damage unintentionally polysomnography. The continuous recording of various physiologic
but carelessly’. A court will determine negligence based on variables during sleep; these variables typically include brain wave
reasonable foreseeability that the damage might have been activity, eye movement and muscle tone.
possible, the existence of a duty of care to the person damaged, a post dilution. The administration of replacement fluid into the
breach in that duty could be demonstrated and that damages patient’s blood via the EC after its exit from the haemofilter
were indeed experienced by the victim. (post-filter delivery).
nephrologist. A medical specialist doctor who diagnoses and postpartum haemorrhage. More than 500 mL blood loss from the
prescribes treatment, including dialysis, for kidney diseases and genital tract following birth. It is categorised as primary, within the
failure. first 24 hours following birth and secondary, from 24 hours to six
New Zealand National Transplant Donor Coordination. The central weeks postpartum.
coordinating office for retrieval of organs and tissues from potential multiorgan donor. A patient who is suspected of or is
deceased donors in New Zealand. confirmed as being brain dead.
nitric oxide (NO). A gas, used as an endothelium-derived relaxant practice development. A continuous process of improvement
factor via inhalation to produce selective pulmonary vasodilation. designed to promote increased effectiveness in patient-centred
non-invasive ventilation. Positive pressure ventilation delivered via a care; enables health care teams to develop their knowledge and
nasal or facial mask (i.e. not via an ETT or tracheostomy). skills, transforming the culture and context of care.
objective assessment. Assessment that is able to be measured. preeclampsia. A multisystem pregnancy disorder resulting from
older child. A child 9–14 years of age. widespread vasospasm that is often characterised by hypertension
oliguric renal failure. Renal failure with the additional characteristic of and proteinuria.
a urine output of less than 0.5 mL/kg/h in adults and 1 mL/kg/h in predilution. The administration of replacement fluid into the patient’s
infants. blood via the EC prior to its entry into the haemofilter (pre-filter
on-line water. Refers to the availability of tap water at a patient delivery).
bedside in order to further modify for the provision of a fluid as a preload. The load imposed by the initial fibre length of the cardiac
dialysis or intravenous solution used during a renal replacement muscle before contraction (i.e. at the end of diastole).
therapy. pressure ulcer. Any injury caused by unrelieved pressure that
‘opt-in’ donation. Specific consent for donation is required from the damages the skin and underlying tissue, usually over a bony
potential donors’ next of kin. prominence.
‘opt-out’ donation. A presumed consent system, where eligible pressure-controlled ventilation. A ventilatory mode used to
persons are considered for organ retrieval at the time of their minimise pulmonary volutrauma, where each breath is delivered
death if they have not previously indicated their explicit to a preset level of inspiratory pressure; tidal volumes may
objection. therefore vary.
oral hygiene. The prevention of plaque-related diseases by the use of pressure-regulated volume control. A ventilation mode in which a
mechanical toothbrushing and the use of other oral hygiene aids. mandatory rate and target tidal volume are set, and the ventilator
organ. A part of the body that performs vital function(s) to maintain delivers breaths using the lowest achievable pressure and a
life. These include the kidney, heart, lung, liver and pancreas. decelerating flow pattern.

788 G L O S S A R Y O F T E R M S

privacy. Control over the extent, timing and circumstances of sharing septic shock. A subset of severe sepsis, defined as sepsis-induced
oneself (physically, behaviourally or intellectually) with others. hypotension in the presence of perfusion abnormalities despite
Implies a zone of exclusivity, where individuals and collectivities adequate fluid resuscitation.
are free from the scrutiny of others. severe acute respiratory syndrome (SARS). The term given to a new
protocol. A document that provides the background, rationale and virulent respiratory infection.
objectives of the research and describes its design, methodology, severe sepsis. Sepsis associated with organ dysfunction,
organisation, conduct, and the conditions under which it is to be hypoperfusion or hypotension.
performed and managed. skill mix. The relative mix of skilled and experienced staff in a team.
pulmonary dynamic hyperinflation. Hyperinflation of a native lung For instance, in intensive care there may be very experienced and
with an obstructive lung disease and concurrent compression of qualified registered nurses, some not so experienced nurses with
the single lung allograft leading to respiratory failure and cardiac and without critical care qualifications, and some non-nursing
tamponade. personnel who provide basic care and tasks. Poor skill mix has a
pulse oximetry. The measurement of peripheral arterial oxygen higher proportion of the lower-order groups and a good skill mix
saturation. has a higher proportion of experienced and qualified staff.
recipient. A person who receives organs and/or tissues from another slow low efficiency dialysis (SLED). A dialysis based treatment similar
person (the donor). to IHD but where dialysate and blood flow rates are reduced to
refeeding syndrome. May occur in patients who have not received provide a slower clearance rate with an extended time of
nutritional support for some time. It involves life-threatening fluid treatment (e.g. 8–10 hours instead of 3–4 hours).
and electrolyte shifts after initiation of aggressive nutritional stress. A state of mental or emotional strain or suspense.
support therapies. submersion incident. Encompasses both drowning and near-
rejection. Destruction of the allograft due to the body’s ability to drowning events without the implication of time or prognosis.
identify self from non-self.
renal replacement therapy (RRT). Any treatment that replaces renal sudden cardiac arrest (SCA). Unexpected natural death from a
cardiac event reflected by an abrupt loss of consciousness and
function and includes intermittent haemodialysis and peritoneal generally less than 1 hour after onset of symptoms.
dialysis.
research. Systematic, rigorous investigation to establish facts, sympathetic nervous system. A part of the autonomic nervous
system or involuntary nervous system. It regulates tissues not
principles and new knowledge. under voluntary control (e.g. glands, heart, blood vessels and
research participant. Individual (or group of living individuals) about smooth muscle).
whom a researcher conducting research obtains data through
intervention or interaction with that person or their identifiable synchronised intermittent mandatory ventilation (SIMV). A
private information. ventilator mode that enables synchronisation of mandatory
respect for persons. Two fundamental aspects: (a) respect for breaths controlled by the ventilator with patient-initiated
the autonomy of those individuals who are capable of spontaneous breaths.
making informed choices and respect for their capacity systematic inflammatory response syndrome (SIRS). A non-specific
for self-determination; and (b) protection of persons with syndrome that occurs as a result of a wide variety of severe clinical
impaired or diminished autonomy; that is, those individuals insults.
who are incompetent or whose voluntary capacity is technical practice development. A continuous process used to
compromised. improve an aspect of patient care.
resuscitation. The preservation or restoration of life by establishing thalamus. Midbrain structure with a significant role in relaying
and/or maintaining airway, breathing and circulation and related information from the various sensory receptors to other brain
emergency care. areas.
retrieval. The removal of organs and or tissues from a donor for the thrombotic microangiopathy. Formation of microvascular platelet
purposes of transplantation into another human being. aggregates and occasionally fibrin formation typically in the
return of spontaneous circulation (ROSC). Signs include breathing setting of microvascular endothelium injury.
(more than a few gasps), coughing, a palpable pulse or measurable tidal volume. The volume of air that is moved into or out of the lungs
blood pressure. with each breath.
risk. The function of the magnitude of a harm and the probability of tissue. A group of specialised cells (e.g. cornea, heart valves, bone,
its occurrence. skin) that perform defined functions.
root cause analysis. A structured process of analysing each step in a tissue-only donor. Donor of musculoskeletal tissue (i.e. femur,
chain of events that led to a mistake or error. Commonly applied tibia, humerus, pelvis, ligaments, tendons, fascia, meniscus)
to the health setting, where a team of unbiased experts are called and/or cardiac tissue (i.e. bicuspid, tricuspid valves, aortic and
on to dispassionately investigate how and why an error might pulmonary tissue) and/or eye tissue (i.e. cornea and sclera)
have been caused by looking more at the system problems that and/or skin tissue.
emerged than at individual negligence. tissue typing. The process of laboratory testing to identify the human
sensory overload. A prolonged overstimulus of the senses that can leucocyte antigen (HLA) phenotype from the genes on
result from excessive or prolonged periods of noise, light, odours, chromosome 6 which will determine the tissue groups of a
and touch from both equipment and personnel. potential donor.
sepsis. A systemic inflammatory response to infection. transformational leadership. A style of leadership characterised by
sepsis-induced hypotension. A systolic blood pressure <90 mmHg or developing a shared vision, inspiring and communicating, valuing
a reduction of ≥40 mmHg from baseline in the absence of other others, challenging and stimulating, developing trust and enabling
causes of hypotension. others.

G L O S S A R Y O F T E R M S 789

transplant. The surgical implantation of one or more organs and veno-venous (VV) circuit. A term describing the vascular
tissues from one human being to another. access cannulas or shunt and the associated tubing
Transplant Nurses Association (TNA). Formed to advance the necessary to carry blood in and out of the haemofilter
education of nurses and other health professionals involved in and the circulation.
the transplant process. venous air-trap. A device preventing the inadvertent pumping of air
Transplant Society of Australia and New Zealand (TSANZ). via the pump into the patient causing air embolism.
A body with, as members, scientists, doctors, transplant ventilator-associated pneumonia (VAP). A nosocomial pneumonia
coordinators and research students with an interest in all that develops in a patient mechanically ventilated for 48 hours
forms of transplantation. or more.
transpulmonary gradient (TPG). Mean pulmonary artery pressure ventricular assist device (VAD). Full or partial ventricular assistance
minus pulmonary artery wedge pressure. provided by implantation of an artificial heart.
trypsin. An enzyme that acts to degrade protein. It is also referred to volume-controlled ventilation. Where the tidal volume and rate of
as a proteolytic enzyme or proteinase. ventilation is set and controlled.
ultrafiltrate. The fluid produced during ultrafiltration. voluntary. Free of coercion, duress or undue inducement.
ultrafiltration. A process where plasma water is removed from warm ischaemia. Time taken from withdrawal of ventilation and
the circulation through a haemofilter, achieving body fluid or treatment: to the confirmation of death of a donation after cardiac
water loss. death (DCD) donor: to the commencement of infusion of cold
unconsciousness. A condition where a victim fails to respond to perfusion fluid and/or organ retrieval.
verbal or tactile stimuli. wet drowning. Aspiration of water or liquid into the lungs with
utilitarian. Ethical theory that presupposes that an action is right resultant pulmonary damage during a submersion incident.
if it achieves the greatest good for the greatest number of work of breathing. The term applied to the physical effort a patient
people. exerts to achieve spontaneous breathing. It is affected by lung
vascular access catheter. A device inserted into a central vein to compliance, chest wall resistance muscle wasting (intercostals and
allow blood to be pumped in and out of a filter. diaphragm) and/or fatigue, and the use of secondary muscles to
vasoactive. Causing vasoconstriction or dilation. aid breathing.
vasopressor. A substance that promotes vasoconstriction. younger child. A child 1–8 years of age.

790








Picture Credits






The authors and publishers would like to thank and acknowledge the contributions below:




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FIGURES 9.2–9.4, 9.6, 9.7, 9.9, 9.10, 9.16, 9.20, 9.21 From: FIGURE 12.4 Courtesy Datascope Corporation, Fairfield, NJ.
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nursing: diagnosis and management, 5th edn. St Louis: (C) Courtesy Ventracor Limited.
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FIGURE 14.3 From Cooper CB. Determining the role of exer- D, Scheler F. Arteriovenous haemofiltration: a new and
cise in patients with chronic pulmonary disease. Med Sci simple method for treatment of overhydrated patients
Sports Exerc 1995; 27(2): 147–57. resistant to diuretics. Klin Wochenschr 1977; 55: 1121–2.
FIGURES 15.1-15.3 From: Davey A, Diba A. Ward’s anaes- FIGURE 18.18 Courtesy Hospal, Lyon, France.
thetic equipment, 5th edn. London: Elsevier Saunders; FIGURE 18.19 Courtesy Infomed, Geneva, Switzerland.
2005. FIGURE 19.2 Courtesy Australian National Liver Transplan-
FIGURES 15.4, 15.10 From: Pierce L. Management of the tation Unit.
mechanically ventilated patient, 2nd edn. St Louis: FIGURE 19.3 From: Kitabachi AE, Wall BM. Diabetic ketoaci-
Saunders: Elsevier; 2007. dosis. Med Clin North Am 1995; 79(1): 9–37.
FIGURES 15.5, 15.6, 15.9 Courtesy Drägerwerk AG & Co., FIGURE 21.1 From: Australian College of Critical Care
KGaA. Nurses. National Advanced Life Support Education Pack-
FIGURE 15.7 From: Dhand R. Ventilator graphics and respi- age: Pathophysiology of cellular dysfunction. Melbourne:
ratory mechanics in the patient with obstructive lung Cambridge Press; 2004.
disease. Respir Care 2006; 50(2): 246–61. FIGURES 21.2, 21.3 Courtesy Eli Lilly and Company.
FIGURE 16.1 From: Martini F, Nath J. Anatomy and phy- FIGURE 22.1 From: Dagiely S. An algorithm for triaging
siology, 8th edn. San Francisco: Pearson Benjamin commonly missed causes of acute abdominal pain.
Cummings; 2006. J Emerg Nurs 2006; 32(1): 9.
FIGURE 16.2 From: Porth C. Pathophysiology concepts of FIGURE 22.2 From: Hasibeder W. Drowning. Curr Opin
altered health states. 8th edn. Philadelphia: Lippincott, Anaesth 2003; 16(2): 139–45.
Williams & Wilkins; 2008. FIGURES 23.1, 23.7 From Newberry L, ed. Sheehy’s emer-
FIGURES 16.3, 16.4, 16.8 From: Purves D, Augustine G, gency nursing: principles and practice, 5th edn. St Louis:
Fitzpatrick D, Katz L, LaMantia A, McNamara J et al. Mosby; 2003.
Neuroscience, 2nd edn. New York: Sinauer Associates; FIGURE 23.2 From: Kozin S, Bertlet A. Pelvis and acetabu-
2001. lum. In: Kozin S, Bertlet A, eds. Handbook of common

792 P I C T U R E C R E D I T S

orthopaedic fractures, 2nd edn. Chester: Medical Surveil- FIGURES 25.1, 25.2 Courtesy the Australian College of
lance; 1992. Critical Care Nurses.
FIGURE 23.3 Courtesy SAM Medical Products. FIGURES 25.3, 25.4 Courtesy Paul de Sensi.
FIGURE 23.4 From: Maher AB, Salmond SW, Pellino TA. FIGURE 26.1 From: Fraser D, Cooper M, eds. Myles’ textbook
Orthopedic nursing, 2nd edn. Philadelphia: WB Saunders; for midwives, 15th edn. Oxford: Churchill Livingston/
1998. Elsevier; 2009.
FIGURE 23.5 Courtesy The Alfred, Melbourne. FIGURE 26.2 From: Hardy-Fairbanks AJ, Baker ER. Asthma
FIGURE 23.6 From: Hettiaratchy S, Dziewulski P. ABC of in pregnancy: pathophysiology, diagnosis and manage-
burns: pathophysiology and types of burns. BMJ 2004; ment. Obstetrics and Gynecology Clinics of North America
328(7453): 1427–9. 2010; 37(2): 159–72.
FIGURE 24.1Courtesy Koninklijke Philips Electronics NV. FIGURE 26.3 From: Brown HL. Trauma in pregnancy. Obstet-
FIGURE 24.2 From: Australian Resuscitation Council and rics & Gynecology 2009; 114(1): 147–60.
New Zealand Resuscitation Council (ARC NRC). Airway: FIGURES 27.1 Courtesy St George Hospital Radiology
Guideline 4. Available at: http://www.resus.org.au/. Department, Sydney.
FIGURES 24.3, 24.4 From: Australian Resuscitation Council FIGURE 27.2 Courtesy St George Hospital Nuclear Medicine
and New Zealand Resuscitation Council (ARC & NZRC). Department, Sydney.
The Australian Resuscitation Council Online. Available
from: http://www.resus.org.au/.

I N D E X 793








Index






A activated clotting time (ACT) 300 pregnancy and 364
AAA see abdominal aortic aneurysm active exercises 111 proliferative phase of 363
AACN see American Association of Critical-Care activities, ICU follow-up clinics and 69–70 acute stroke, ED presentation and 594–596
Nurses ACTR see Australian Clinical Trial Registry acute tubular necrosis (ATN) 479, 484–486,
abdominal aortic aneurysm (AAA) 593 acute care nurse practitioners (ACNPs), research 485f, 783
abdominal compartment syndrome (ACS) vignette 13b acute-on-chronic liver failure (AoCLF) 517–518,
640–641, 783 acute coronary syndrome (ACS) 216, 592 783
abdominal symptom presentation, in ED cardiac rehabilitation 226–227 acute/severity of illness, measurement in
593–594 emotional response and 226 ICU 26
abdominal aortic aneurysm 593 management 221, 222f ADAPT see Australasian Donor Awareness
algorithm for 594f medications for 225, 225t Program Training
appendicitis 593–594 nursing management of 224–226 ADEs see adverse drug events
bowel obstruction 594 research vignette 247b ADH see antidiuretic hormone
ectopic pregnancy 594 support of patient and family 226 adolescents
abdominal trauma 639–643 symptom control of 225–226 developmental considerations in 685
in children 702 acute kidney injury (AKI) 479, 484–486, 783 see also children
signs of 641t acute liver failure (ALF) 517–518, 783 adrenal insufficiency 568
ABGs see arterial blood gases acute liver injury (ALI) 783 adult guardian 783
ablation therapies 285, 783 acute lung injury (ALI) 334–335, 362–364 advance directives 86, 783
abnormal automaticity 252 transfusion-related 363 advance practice nurses 20
Aboriginal people 783 see also acute respiratory distress syndrome advanced life support (ALS) 661–670, 661f, 783
communication with 169 acute myocardial infarction (AMI) 216 airway management 663
contemporary and diversity of 168 acute organ dysfunction 567t for infants and children 662f
death and dying issues 169–170 acute phase proteins 783 medication administration during 663–666,
health and health beliefs view 168 acute physiology and chronic health evaluation 664t, 667t–668t
healthcare workers 169 (APACHE) score 26, 570, 783 pregnancy and 733
importance of family, community and acute rejection, of heart transplantation 313, rhythm 663
land 168–169 313t, 318t pulseless electrical activity 663, 665t
working with 167t, 168–170 acute renal failure (ARF) 479, 783 pulseless ventricular tachycardia 663
abruptio placentae 721 acute kidney injury 484–486 ventricular fibrillation 663
absolute humidity 389 acute tubular necrosis 484–486, 485f adverse drug events (ADEs) 42
A/C see assist control classification of 483–486 reduction of 43
ACCCN see Australian College of Critical Care clinical assessment of 486 adverse event (AE) 42
Nurses clinical management of 487–488 advocacy
accelerated idioventricular rhythm (AIVR) 259, insult reduction 487–488 nursing 87–88
259f consensus definition 486–487 patient 86
access catheters 783 diagnosis of 486 AE see adverse event
site 783 intrarenal (intrinsic) causes of 484 AEDs see automatic external defibrillators
vascular 789 glomerulonephritis 484 AFE see amniotic fluid embolism
ACE see angiotensin-converting enzyme nephrotoxicity 484 afferent limb, of RRS 50–51
inhibitors vascular insufficiency 484 afferent neurons 416f
acetylcholine 416 nutrition and 488 afterload 186
ACHS see Australian Council on Healthcare pathophysiology of 483–486 PVR 202–203
Standards indicators post heart transplantation 315, 318t SVR 202
acid, corrosive, exposure to 603–604, 603t postrenal causes of 484 Agency for Healthcare Research and Quality
acid-base control 333 prerenal causes of 483–484 (AHRQ) 43
renal system and 483, 483f RIFLE criteria 486–487, 487f AGREE see Appraisal of Guidelines for Research
ACNPs see acute care nurse practitioners RRR for 488–490, 488b and Evaluation
acquired weakness see intensive care unit- acute respiratory distress syndrome AHMAC see Australian Health Ministers
acquired weakness (ARDS) 334–335, 783 Advisory Council
ACS see abdominal compartment syndrome; aetiology of 363, 363t AHRQ see Agency for Healthcare Research and
acute coronary syndrome clinical manifestations of 363 Quality
ACT see activated clotting time assessment 363 AIMS-ICU see Australian Incident Monitoring
actigraphy 146, 783 collaborative practice 364 Study-Intensive Care Unit
actin filaments 183, 183f medications 364 airborne precautions 119, 119t
action potential 183–184, 184f prone positioning 364 airway
generation of 417t ventilation strategies 364 adult 682f
diagnosis of 363 in children 682f
edematous phase of 363 disease of lower see lower airway disease
elderly and 364 obstruction of see upper airway obstruction
Page numbers followed by ‘f’ indicate figures, ‘t’ fibrotic phase of 363 support 383
indicate tables, and ‘b’ indicate boxes. pathophysiology of 363 in ALS 663 793

794 I N D E X

anaphylaxis and 555 ANZICS see Australian and New Zealand asystole 665f
in BLS 657 Intensive Care Society ATC see automatic tube compensation
burns and 647 AoCLF see acute-on-chronic liver failure ATCA see Australasian Transplant Coordinators
Combitube 383 aortic aneurysm 244–245 Association
laryngeal mask 383, 384f dissecting 244, 244f atelectasis 345
nasopharyngeal 383, 384f fusiform 244, 244f ATN see acute tubular necrosis
oropharyngeal 383 pseudoaneurysm 244, 244f atria arrhythmias see arrhythmias
airway pressure release ventilation (APRV) 397t, sacculated 244, 244f atrial ectopy 254, 255f
398 aortic injuries 636 atrial fibrillation 256–257, 257f, 297
AIVR see accelerated idioventricular rhythm aortic regurgitation 292–293, 292f atrial flutter 255–256, 256f
AKI see acute kidney injury aortic stenosis 292, 292f atrial natriuretic peptide (ANP), renal system
alarm states, IABP and 306–308, 309t aortic valve disease 292–293 and 483
gas loss 307–308, 308f AOTA see Australian Organ and Tissue Authority atrial pacing 269, 269f
ALF see acute liver failure APACHE score see acute physiology and chronic AV block and 269, 270f
ALI see acute liver injury; acute lung injury health evaluation atrial tachycardia 255, 255f
alkalis, corrosive, exposure to 603t, 604 APH see antepartum haemorrhage atrioventricular (AV) block
allograft 783 apoptosis 783 first-degree 260, 260f
dysfunction and failure of appendicitis 593–594 second-degree 260–261, 260f
post heart transplantation 315–317, 318t Appraisal of Guidelines for Research and third-degree 261, 261f
post lung transplantation 371–373 Evaluation (AGREE) 41 atrial pacing and 269, 270f
ALS see advanced life support APRV see airway pressure release ventilation degrees of 260–261
alteplase 221 ARBs see angiotensin receptor blockers high-degree 261, 261f
altered level of consciousness, causes of 596t ARDS see acute respiratory distress syndrome nursing management during 261
alveolar ventilation 331 ARF see acute renal failure atrioventricular (AV) conduction
American Association of Critical-Care Nurses arousal assessment 431–433 disturbances 259–260
(AACN) 5–6 arrhythmias 227, 252–265, 783 atrioventricular nodal reentry tachycardia
AMI see acute myocardial infarction atrioventricular block see atrioventricular (AV) (AVNRT) 257–258, 258f
amniotic fluid embolism (AFE) 722 block atrioventricular (AV) node 184–185
amphetamines, overdose of 601 of AV node and atria see atrioventricular (AV) and atria arrhythmias 254–258
amputations, traumatic 633 node atrial ectopy 254, 255f
amylase 783 bradyarrhythmias see bradyarrhythmias atrial fibrillation 256–257, 257f
anabolism 783 post cardiac surgery 297 atrial flutter 255–256, 256f
Anaesthetists’ Non-Technical Skills (ANTS) 50 of SA and atria see sinoatrial node atrial tachycardia 255, 255f
analgesics 144–145, 145t sinus 253, 254f multifocal atrial tachycardia 255, 255f
nurse-initiated, in ED 586 ventricular see ventricular arrhythmias nursing management of 258
anaphylaxis 554–556, 783 arrhythmogenic mechanisms 252 reentry tachycardia 257–258, 258f
adjunctive support for 555 abnormal automaticity 252 supraventricular tachyarrhythmias, AV
airway management and 555 triggered activity 252 conduction during 255, 256f
clinical manifestations of 555, 555t arterial blood gases (ABGs) 341–344, 783 ATS see Australasian triage scale
collaborative care for 555 analysis of 342–343, 342t–343t Australasian Donor Awareness Program Training
nursing practice in 555 normal values of 782t (ADAPT) 784
preventative care for 556 oxygen tension derived indices 343–344 Australasian Transplant Coordinators
aneurysm sampling technique 341–342 Association (ATCA) 784
abdominal aortic 593 arterial spin labelling (ASL) 436 Australasian triage scale (ATS) 582, 584t
ventricular 245 arterial waveform 198, 198f Australian and New Zealand Human Tissue
angina 216 arteriovenous (AV) circuit 783 Acts 89
management of 221, 222f arteriovenous difference in oxygen Australian and New Zealand Intensive Care
unstable 216 (AVDO 2 ) 438 Society (ANZICS) 5, 83–84
angiotensin receptor blockers (ARBs) 238t, 239 arteriovenous malformations (AVMs) 463 brain death and 88–89
angiotensin-converting enzyme (ACE) artery(ies) 189, 189f Clinical Trials Group 12
inhibitors 226 of brain 427f organ donation and 89
for CHF 238, 238t circumflex 182, 183f Australian Clinical Trial Registry (ACTR) 96
in MODS, research vignette 573b–574b coronary Australian Code for the Responsible Conduct of
ANP see atrial natriuretic peptide left 182, 183f Research (2007) 95
antacids 515–516 location of 182, 183f Australian College of Critical Care Nurses
antepartum haemorrhage (APH) 721–722 right 182, 183f, 217 (ACCCN) 18
anterior cord syndrome 460 TIMI flow grades in 219–220, 221t competency standards 4–5
anticoagulation 783 left anterior descending 182, 183f ICU staffing position statement (2003) on
for CRRT 496–497, 496t ascites 519 intensive care nursing staff 775–776
antidiuretic hormone (ADH), renal system aseptic non-touch technique (ANTT) 121–122 nurse-to-patient ratios 24, 26
and 482 ASL see arterial spin labelling position statement (2006) on use of
antimicrobial therapy, for septic shock 553 aspirin see salicylate poisoning healthcare workers 777–778
ANTS see Anaesthetists’ Non-Technical Skills assent, consent and 686 on provision of critical care nursing
ANTT see aseptic non-touch technique assist control (A/C) 396, 397t education 773–774
anxiety 61–63, 62t, 133–136, 783 asterixis 783–784 resuscitation position statement (2006)
assessment of 134 asthma 364–366, 365f, 590, 591t 779
clinical indicators of 133–134, 134t assessment and diagnostics of 366 staffing 23–24, 26
faces anxiety scale 134, 135f in children 692–693, 692t Australian Commission on Safety and Quality in
management of 134–136 clinical manifestations of 365–366 Health Care, on RRS 50
non-pharmacological treatments 135, collaborative practice for 366 Australian Council on Healthcare Standards
135t medications 366 (ACHS) indicators 42–43
pharmacological treatments 135–136, pathophysiology of 365 Australian Health Ministers Advisory Council
136t pregnancy and 726–727, 727f (AHMAC) 94
precipitating factors for 133 systemic interrelationships in 366f Australian Incident Monitoring Study-Intensive
self-reporting scales 134, 135t astrocytes 417, 419t Care Unit (AIMS-ICU) 26,
VAS-A 134, 135t asynchronous pacing 268 42–43

I N D E X 795

Australian Nursing and Midwifery Council, betamethasone 720 bradycardic influences 258
–
Code of Ethics for Nurses 79b, 80 bicarbonate (HCO 3 ) 342–343, 342t–343t junctional escape rhythms 258, 259f
Australian Organ and Tissue Authority bicaval transplant technique 311, 312f ventricular escape rhythms 258–259, 259f
(AOTA) 91 bilateral sequential lung transplantation bradycardia 190–191, 258
Australians Donate 784 (BSLTx) 370 sinus 253, 253f
automated weaning 404 biochemical markers 218–219 bradycardic influences 258
automatic external defibrillators (AEDs) biochemical normalisation, for cardiogenic brain 417–424
280–281 shock 550–551 arteries of 427f
automatic tube compensation (ATC) 397t, 398 bioethics 78 basal ganglia 421t–422t, 423
autonomic nerve dysfunction 447 biogenic amines 416 brainstem 421t–422t, 423
autonomic nervous system 431, 432f biological agents 606 cerebellum 421t–422t, 423
enteric 431 BiPAP see biphasic positive airway pressure cerebral cortex 418–423
heart rate regulation and 188–189 biphasic 784 death 88–89, 784
parasympathetic 431, 432f biphasic positive airway pressure (BiPAP) ANZICS and 88–89
sympathetic 431, 432f 389–390, 397t, 398 imaging of 436, 437f
autonomy 79, 92, 784 BIS see bispectral index monitoring organ and tissue donation and 749–750,
autotransfusion 300 bispectral index (BIS) monitoring 139–140 749t, 750b, 750f
AV see arteriovenous circuit; atrioventricular Bjork-Shiley valve 295f testing 751f, 751t
block; atrioventricular node bladder washout solutions 117t hypothalamus 423–424
AVDO 2 see arteriovenous difference in oxygen bleeding injury
avian influenza virus (H5N1) 361 fractures and 632t prevention of secondary 472
AVMs see arteriovenous malformations IABP and, prevention and treatment of research vignette 442b
AVNRT see atrioventricular nodal reentry 305 traumatic see traumatic brain injury
tachycardia liver transplantation and 524 see also brain injury assessment
AVPU see awake, verbal, pain, unresponsive post cardiac surgery 298–300 limbic system 423–424
awake, verbal, pain, unresponsive (AVPU) autotransfusion for 300 organisation of 421t–422t
431–433 bedside assessment 300 protection and support of 424–430
awareness assessment 433 management of 300, 301t blood-brain-cerebral spinal fluid
axon 415, 416f blood alcohol level, GCS and, research barrier 425
azotemia 784 vignette 442b cerebral circulation 426–428, 427f–428f,
blood analysis, normal values 780t–781t 428t
cerebral spinal fluid 424–425, 426f
B blood pressure 189–190 brain injury assessment 435–438
autonomic control of 190
BACCN see British Association of Critical Care hormonal control of 190 cerebral perfusion assessment 438
Nurses ICH and 472 ICP monitoring 436–438
backwards, upwards, rightward pressure (BURP) mean, in children 681t pulse waveforms 437–438, 438f
manoeuvre 385 monitoring of 196–198 imaging techniques 435–436
bacteraemia 784 arterial waveform 198, 198f brain death and 436, 437f
bag-mask ventilation (BMV) 383 invasive intra-arterial 198 cerebral angiography 436
balloon deflation 304, 305b non-invasive 197–198 cerebral perfusion see cerebral perfusion
conventional timing in 304 pregnancy and 712 comparison of 436t
early 306, 307f renal control of 190 CT 419f, 435–436
late 306, 308f blood products, adverse reactions to, fMRI 436
real timing in 304, 305b hypovolaemic shock and 546t MRI 436
balloon inflation 303–304, 304f, 305b blood tests PTA scale for 434, 435t
early 306, 306f cardiovascular system and 206–207 brainstem 421t–422t, 423
late 306, 307f respiratory system and 344 injury, respiratory pattern and 449, 450f
barbiturates, for intracranial hypertension blood volume, pregnancy and 711–712 breast(s)
management 453 blood-brain barrier (BBB) 425 care of 736–738
bariatric patients see obese patients blood-brain-cerebral spinal fluid barrier feeding 736–738
basal ganglia 421t–422t, 423 425 breathing 657
basic life support (BLS) 657–661, 658f, 784 BLS see basic life support burns and 648
airway 657 BMV see bag-mask ventilation sounds
breathing 657 body positioning 110–115 abnormal 339t
compressions 657–659 assessment 110–111 normal 339t
devices to augment 659, 659t changing 112 see also work of breathing
defibrillation 660–661, 662t essential care goals 110 Bristol stool form scale 115, 115t
electrical 660–661 factors to consider 112t British Association of Critical Care Nurses
praecordial thump 660 see also positioning patient (BACCN) 27
pregnancy and 733 Borg scale 60 bronchial circulation 328
BBB see blood-brain barrier bowel bronchiolitis 691
Beck Anxiety Inventory 61 assessment of 115, 115b bronchoscopy 347
Beck Depression Inventory 61 care of, essential 115–116 Brown-Sêquard syndrome 460
bed-bath 106 constipation 116 BSLTx see bilateral sequential lung
Behavioural Pain Scale (BPS) 142, 143f, 143t diarrhoea 116 transplantation
beneficence 79, 92 diet 115–116 budget 20–22
benefit-cost 784 drugs 116 business case development 21–22, 21t
benefit-risk 784 fluids 115–116 heading samples 22b
benzodiazepine sedative 136t management of 115–116 process 21
bereavement 172–173 obstruction 594 analysis and reporting 21
care of critical care nurse and 173 box jellyfish envenomation 610–611 control and action 21
family care and 172–173 BPS see Behavioural Pain Scale preparation and approval 21
Bernoulli Effect 383 bradyarrhythmias 252, 258–261 types of 20
best interests principles 85–86 AIVR 259, 259f capital 20
beta-adrenergic blocking agents, for CHF 238t, atrioventricular conduction operational 20
239 disturbances 259–260 personnel 20

796 I N D E X

bundle of His 184–185 atrial 269, 269f IABP 550
burns 644 AV block and 269, 270f inotropic therapy for 548–550, 549t
airway and 647 capture and 267, 267f preload 548
breathing and 648 cardiac resynchronization therapy 279–280 respiratory support 550
circulation and 648 capturing failure recognition in 280, 281f haemodynamic change sequence in 547f
dressing for 648–649 non responders to 279–280 independent practice in 548
hyperkalaemia and 648 programming optimisation 280 assessment 548
hypothermia minimisation and 648 complications of 272–275 oxygen supply and demand
inhalation injury 645–646 capture failure 272, 272f optimisation 548
multitrauma patient 648 oversensing 274–275, 274f, 275b nursing practice in 548–551
nursing care after 647t pacing failure 273–274, 274b, 274f cardiomyopathy 241–242
nutrition and 648 sensing failure 272–273, 273f dilated 241
pathophysiology of 644–649 controls and settings 266, 267t hypertrophic 241–242
specialised centre treatment criteria 645b demand 268, 268f peripartum 725–726
systemic changes and 645t dual-chamber 269–272, 271f restrictive 242
TBSA assessment 646 DDD 270–272, 271f cardiopulmonary bypass (CPB) 294–295
BURP see backwards, upwards, rightward external 272 cardiopulmonary resuscitation (CPR) 655, 784
pressure manoeuvre nursing practice 275–277 for adults 659t
business case development 21–22, 21t battery depletion 275–276 ceasing 671
heading samples 22b function testing 276–277, 276f–277f for children 659t
microshock protection 275 do-not-resuscitate orders 87
C output and threshold 267 ethical considerations and 672
permanent 277–279
evaluation during 670
CABG see coronary artery bypass graft implantation activities 278 family presence during, research
CACCN see Canadian Association of Critical parameters 278–279, 278f vignette 174b–175b
Care Nurses principles of 265–266 for infants 659t
cadaveric donor 784 terminology 266–269, 267t in-hospital survival from 655
CAM-ICU see Confusion Assessment Method for ventricular 268–269, 269f legal considerations and 672
the Intensive Care Unit cardiac rehabilitation 226–227 out-of-hospital survival from 655
Canadian Association of Critical Care Nurses cardiac resynchronization therapy (CRT) postresuscitation phase 671
(CACCN) 27 279–280 cardiotocograph 732
CAP see community-acquired pneumonia capturing failure recognition in 280, 281f cardiovascular system
capillaries 189, 189f non responders to 279–280 anatomy of 180–190
capital budget 20 programming optimisation 280 assessment of 190–195
capnography 340–341, 341f, 386, 784 cardiac surgery 291–302 case study 210b–211b
capture failure 272, 272f case study 320b for CHF 231
case study 256f–258f, 285b–286b massage therapy postoperatively, research heart sounds auscultation 191–192, 191t
carbon dioxide (CO 2 ) vignette 321b pulse 190–191
narcosis 381–382 nursing management postoperatively blood pressure see blood pressure
transport 332 295–302 cardiac output 185–189
carbon monoxide (CO) poisoning 603 arrhythmias 297 determinants of 185–188, 186f
cardiac allograft vasculopathy (CAV), post heart bleeding assessment and regulation of 188–189
transplantation 317–318 management 298–300 in children 681–682
cardiac arrest 784 emotional responses 302 continuous monitoring of 192
see also sudden cardiac arrest family support 302 diagnostic tests for 206–210
cardiac biopsy grading 313t fluid and electrolyte management 302 blood tests 206–207
cardiac computed tomography 209–210 haemodynamic monitoring and cardiac CT 209–210
cardiac conduction system 184–185, 185f, support 296–297 cardiac enzymes 206–207, 208t
251–252 hypertension 296 chest x-ray 207–209
arrhythmogenic mechanisms 252 hypotension 296–297 echocardiography 206
abnormal automaticity 252 immediate period 295–296 electrolytes 206, 208t
reentry 252 pain assessment and management 302 full blood count 206
triggered activity 252 pericardial tamponade assessment and MRI 209–210
cardiac cycle 187–188, 187f management 300–301 nuclear medicine studies 209–210
cardiac death, donation after 785 rhythm monitoring 297 haemodynamic monitoring
cardiac enzymes 206–207, 208t ventilatory support 298, 299t invasive cardiovascular monitoring see
cardiac failure see heart failure procedures 293–295 invasive cardiovascular monitoring see
cardiac glycosides, for CHF 238t, 240 CABG 293–294 haemodynamic monitoring
cardiac macrostructure 180–182 CPB 294–295 liver transplantation and 524
conduction and 184–185 myocardial preservation 295 macrostructure 180–182
cardiac muscle, electron micrograph of valve repair and replacement 294, 295f conduction and 184–185
181–182, 182f for structural abnormalities 291–293 physiological principles 182–185
cardiac output (CO) 185–189, 203–206 aortic valve disease 292–293 action potential 183–184, 184f
decreased, lung transplantation and 371t ischaemic heart disease 293 depolarisation 183–184
determinants of 185–188, 186f mitral valve disease 293 mechanical events of contraction 182–183
Doppler ultrasound methods 204–205, valvular disease 291–293, 292f resting potential 183–184
205f cardiac tamponade, post heart pregnancy and 727–729
Fick principle 203 transplantation 315, 318t pregnancy physiology adaptation in 711–713,
pregnancy and 712 cardiac trauma 636 712t
pulse-induced contour 203–204, 204f cardiac troponin I (cTnI) 218–219 anatomical changes 711
regulation of 188–189 cardiac troponin T (cTnT) 218–219 blood pressure 712
thermodilution methods 203 cardiogenic shock 227, 545–551 blood volume 711–712
transthoracic bioimpedance 205–206 clinical manifestations of 546–548 cardiac output 712
ultrasonic cardiac output monitor 205 collaborative management of 548–550 heart rate 712
cardiac pacing 265–280, 784 afterload control 550 postpartum 712–713
asynchronous 268 biochemical normalisation 550–551 posture on haemodynamics 712

I N D E X 797

stroke volume 712 extracellular (vasogenic) oedema 448 CHF see chronic heart failure; congestive heart
systemic vascular resistance 712 hydrocephalus 448 failure
12-lead ECG see 12-lead echocardiogram intracellular (cytotoxic) oedema 448 children
cardioversion 280–284 intracranial hypertension 448–449, 449f–450f acute neurological dysfunction in see
elective 281–282 cerebral oedema 448 neurological dysfunction
implantable cardioverter defibrillators cerebral oxygen extraction (CEO 2 ) 438 ALS for 662f
282–284, 283f cerebral oxygenation anatomy in 680–684
death mechanisms 284 assessment cardiovascular system in 681–682
tachycardia detection and jugular venous oximetry 438–439 case study 703b–704b
classification 283–284, 284f microdialysis 439 CNS in 681
terminal care 284 partial brain tissue oxygenation comfort measures for 685–686
care bundles 43, 44t, 784 monitoring 439 pain and sedation assessment 685
by IHI 43, 44t management of 452 pain and sedation management 685–686
carotid siphon 784 optimisation 449–455, 451t consent and 686
catabolism 784 cerebral perfusion CPP target in 681t
catheters alterations 447–449 CPR for 659t
access see access catheters cerebral ischaemia 447–448, 447f developmental considerations in 684–685
central venous 122–123, 183–184 cerebral oedema 448 adolescents 685
locations for 200 extracellular (vasogenic) oedema 448 infants 684
for IABP 302–303, 303f hydrocephalus 448 preschool 684–685
in left heart 219–220 intracellular (cytotoxic) oedema 448 school-age 685
pulmonary artery see pulmonary artery intracranial hypertension 448–449, toddlers 684
catheter 449f–450f family issues and 686
sepsis from 122 assessment, brain injury and 438 feedings for 699
urinary see urinary catheterisation imaging 436, 437f gastrointestinal system of 683, 698–700
vascular access 789 ASL 436 genitourinary system in 683
for CRRT 493–495, 494f dynamic perfusion CT 436 glucose control in 699
CAV see cardiac allograft vasculopathy MRI dynamic susceptibility contrast 436 injuries to
CAVH see continuous arteriovenous PET 436 abdominal trauma 702
haemofiltration single photon emission CT 436 chest trauma 702
CBF see cerebral blood flow xenon-enhanced CT 436 incidence of 700
CBR see chemical, biological and radiological optimisation 449–455, 451t patterns of 700
events cerebral vasospasm prevention 454–455, resuscitation 700–701
CCOT see critical care outreach team 454f risk factors 700–701
CCPDT see critical care patient dependency tool intracranial hypertension see intracranial survey 700–701
CDSS see clinical decision support systems hypertension traumatic brain 701–702
CE see continuing education management of 452 integumentary system of 684
cEEG see continuous electroencephalography cerebral perfusion pressure (CPP) 426–428 intensive care admission, and effect on
cellular dysfunction, pathophysiology of 563f in children 681t parents 704b
central chemoreceptors 329–330 cerebral spinal fluid (CSF) 424–425, 426f intravenous therapy for 699
central cord syndrome 460 profiles in meningitis 465t liver disease in 699–700
central line associated bacteraemia cerebral vasospasm prevention 454–455, 454f lower airway disease in 691–693
(CLAB) 122–123 cerebral venous drainage 428f mean blood pressure in 681t
central nervous system (CNS) 417–424 cerebral venous thrombosis 464 on mechanical ventilation see mechanical
brain and see brain cerebrovascular disorders 462–464 ventilation
in children 681 stroke see stroke musculoskeletal system of 683–684
components of 420f cerebrovascular resistance (CVR) 426–428 nutrition and 698–699
depressants, overdose of 599–600, 600t cerebrum 421t–422t older 787
disorders cervical spine immobilisation procedure 627f physiology in 680–684
cerebrovascular disorders see chain of survival 656, 656f renal system in 698–700
cerebrovascular disorders CHD see coronary heart disease respiratory system in 682–683
infection and inflammation see infections Checklist of Nonverbal Pain Indicators sepsis in 682–683
neuromuscular alterations see (CNPI) 142, 143t shock in see shock
neuromuscular alterations checklists 43–44 supplements for 699
spinal cord injury see spinal cord injury chemical, biological and radiological (CBR) trauma and 700–702
traumatic brain injury see traumatic brain events 605–606 upper airway obstruction in see upper airway
injury chemical agents 606 obstruction
infections of 464–467 chemical synapses 415–416 water maintenance in 680t
spinal cord 428–430, 429f–430f chemoreceptors 784 younger 789
stimulants, overdose of 600–601 central 329–330 chronic heart failure (CHF) 227
subdivisions of 420f peripheral 329–330 ACE inhibitors for 238, 238t
central venous catheters 183–184 chemosis see conjunctival oedema beta-adrenergic blocking agents for 238t, 239
locations for 200 chest cardiac glycosides for 238t, 240
central venous pressure (CVP) monitoring 200 flail 636 cardiovascular assessment 231
CEO 2 see cerebral oxygen extraction radiography 220–221 classification of 231
cerebellum 421t–422t, 423 trauma 635–639 diagnostic algorithm for 232f
cerebral angiography 436 in children 702 diagnostic procedures 231–233
cerebral blood flow (CBF) 426–428 clinical manifestations of 637t diuretics for 238t, 239
cerebral circulation 426–428, 427f–428f, 428t drainage assessment 639t inotropic agents for 238t, 239–240
autoregulation by 426–428 x-ray see x-ray nursing management 233–241
cerebral cortex 418–423 chest pain 336 for acute exacerbations 240–241, 241f
cerebral ischaemia 447–448, 447f case study 246b–247b emergency therapy 241f
prevention of 472 ED presentation with 591–593 lifestyle modification 237
cerebral metabolism alterations 447–449 acute coronary syndrome 592 medications 237–240, 238t
cerebral ischaemia 447–448, 447f thoracic aortic dissection 592–593 patient education 237
cerebral oedema 448 PQRST for 217, 217t pharmacological treatment 234f–235f

798 I N D E X

with preserved systolic function 236f Combitube 383 roller pump 495, 495f
self-care 237 comfort measures, in children see children vascular access catheters for 493–495, 494f
pulmonary assessment 231 Commonwealth Privacy Act 1988 93–94 venous return line bubble trap
chronic liver failure (CLF) 517–518, 784 communication 158–161 chamber 495–496, 495f
chronic obstructive pulmonary disease Aboriginal people 169 citrate for 496, 496t
(COPD) 364–366, 365f, 784 community-acquired pneumonia (CAP) heparin for 496, 496t
assessment and diagnostics of 366 357–358, 359t IHD compared to 498
clinical manifestations of 365–366 diagnosis of 358 machines 498–499, 499f, 499t
collaborative practice for 366 severity assessment scoring 358 nursing practice 499–501
medications 366 competence, cultural 162–163 troubleshooting guide 499–501, 500t
exacerbation of, NIV for 390–391 complementary therapies 784 continuous venovenous haemodiafiltration
pathophysiology of 365 compressions 657–659 (CVVHDf) 490, 785
systemic interrelationships in 366f devices to augment 659, 659t case study 501b
chronic renal failure 784 computed tomography (CT) circuit and set-up for 493f
Ciguatera poisoning 611, 612t of brain injury 419f, 435–436 continuous venovenous haemodialysis
CIM see critical illness myopathy cardiac 209–210 (CVVHD) 785
CIN see clinical initiative nurse of cerebral perfusion continuous venovenous haemofiltration
CINM see critical illness neuromyopathy dynamic perfusion 436 (CVVH) 490, 785
CIOMS see Council for International single photon emission 436 circuit and set-up for 492f
Organizations of Medical Sciences xenon-enhanced 436 contractility 186–187, 203
CIP see critical illness polyneuropathy respiratory system and 346 contraction, mechanical events of 182–183
circulation, burns and 648 computed tomography pulmonary angiography contrast ECHO 206
circumflex (CX) artery 182, 183f (CTPA) 346–347 controlled mandatory ventilation (CMV) 396,
CIS see clinical information systems computerised physician order entry (CPOE) 48 397t
citrate concept analysis 784 controlled mechanical ventilation 785
for CRRT 496, 496t conduction, macrostructure and 184–185 convection 491–492, 785
heparin compared to, research vignettes 502b confidentiality 784 conventional timing, in balloon deflation 304
CK-MB see creatinine kinase-MB Confusion Assessment Method for the Intensive COPD see chronic obstructive pulmonary
CLAB see central line associated bacteraemia Care Unit (CAM-ICU) 137, 139f disease
classic laryngeal mask airway (cLMA) 383 congenital abnormalities, of airway, in corneal reflexes assessment 434
intubation and 383 children 687 coronary angiography 219–220
CLF see chronic liver failure congestive heart failure (CHF), exacerbation of, coronary arteries
clinical decision making 6–7, 784 NIV for 390–391 location of 182, 183f
recommendations for skills development 7, conjunctival oedema 108–109 TIMI flow grades in 219–220, 221t
9t conscientious objection 88 coronary artery bypass graft (CABG) 293–294
research in critical care nursing 7, 8t–9t consciousness alterations 445–446 coronary heart disease (CHD) 215–227
theoretical perspectives 6–7 in cognition 445–446 ACS 216
clinical decision support systems (CDSS) 48 coma 445–446 AMI 216
clinical ethics 93 seizures 446 angina 216
clinical information systems (CIS) 44–48 consent 80–83, 784 MI see myocardial infarction
research vignette on 53b assent and 686 myocardial ischaemia 215–216
clinical initiative nurse (CIN) 586 children and 686 prevalence of 215
clinical leadership 10–11 to health information collection, use, unstable angina 216
clinical nurse consultant (CNC) 23–24 disclosure 83 coronary perfusion 182
clinical nurse educator (CNE) 23–24 to human research 82–83 corticosteroids, for intracranial hypertension
clinical outcomes 40, 40t organ donation and 754, 754t management 453
clinical performance evaluation 40–41 to treatment 81–82 cough 336
clinical practice guidelines (CPGs) 41–42, 784 competency and 82 Council for International Organizations of
developing, implementing and criteria 82 Medical Sciences (CIOMS) 81
evaluating 41–42, 41t Consent to Medical Treatment and Palliative Care counterpulsation principles 303–304, 785
Clinical Trials Group (CTG), Australian and New Act 1995 80, 86 balloon deflation 304, 305b
Zealand Intensive Care Society 12 constipation 116 balloon inflation 303–304, 304f, 305b
cLMA see classic laryngeal mask airway consultants 6 CPAP see continuous positive airway pressure
closing capacity 330 contact precautions 119, 119t CPB see cardiopulmonary bypass
clotting indices 784 contingency plans and rehearsal 30 CPD see continuing professional development
CLRT see continuous lateral rotation therapy continuing education (CE) 28 CPGs see clinical practice guidelines
CMV see controlled mandatory ventilation continuing professional development (CPD) 49 CPM see cuff pressure measurement
CNC see clinical nurse consultant continuous arteriovenous haemofiltration CPOE see computerised physician order entry
CNE see clinical nurse educator (CAVH) 490, 784 CPOT see Critical Care Pain Observation Tool
CNPI see Checklist of Nonverbal Pain Indicators continuous arteriovenous techniques 784 CPP see cerebral perfusion pressure
CNS see central nervous system continuous cardiac monitoring 192 CPR see cardiopulmonary resuscitation
CO see carbon monoxide poisoning; cardiac lead placement for 192 cranial nerves, location and functions of 425t
output continuous electroencephalography (cEEG), for creatinine kinase-MB (CK-MB) 218–219
CO 2 see carbon dioxide nervous system assessment 439 credentialing 4
coagulation factors 784 continuous lateral rotation therapy (CLRT) 114 cricoid pressure 385
coagulopathy 628–629, 784 continuous positive airway pressure critical care environment 22
derangement of, liver failure and 519 (CPAP) 389, 396, 397t, 784 organisational design 22
liver transplantation and 524 continuous renal replacement therapy critical care nursing 173, 785
Code of Health and Disability Consumers’ (CRRT) 486–487, 784–785 bereavement situations and 173
Rights in New Zealand 81 benefits of 498 competencies 5
codes of ethics for nurses, patients’ rights case study 501b development of 3–6
and 80 circuit components for 493–498 education 4–5, 5f
cognition alterations 445–446 anticoagulation 496–497, 496t leadership 7–11
cognitive impairment 784 fluids and fluid balance 497–498, 497t practice 5f
cold ischaemic time 784 haemofilter 493, 493f professional organisations 5–6
coma 445–446 membrane 493 research program 11–12, 12f

I N D E X 799

roles of 6 CVVHD see continuous venovenous Department of Health and Human Services
training 5f haemodialysis (HHS) 82
critical care outreach team (CCOT) 51 CVVHDf see continuous venovenous depolarisation 183–184
Critical Care Pain Observation Tool haemodiafiltration depressants, CNS, overdose of 599–600, 600t
(CPOT) 142, 143t CX see circumflex artery depression 61–63, 62t
critical care patient dependency tool cytokines 785 HRQOL and 63
(CCPDT) 30 cytopathic anoxia 785 postnatal 731
critical care services, resourcing 17–18 postpartum 731
critical care surge plan template 33–34 psychological recovery from 61–63
critical care units, care delivery process in 43, D dermatomes 429–430, 430f
45t–47t DAI see diffuse axonal injury designated officers 785
critical illness 785 damage-control surgery 629, 785 designated specialist 785
continuum of 58f DAT see decision analysis theory designer drugs, overdose of 601
family needs during 158–160 data, use and disclosure of 95 diabetes
patient outcomes following 59–61 Davidson Trauma Scale 61 DKA see diabetic ketoacidosis
HRQOL measurement 59–60, 59t DCD see donation after cardiac death HHNS 526, 786
physical function measurement 60, 60t DCM see dilated cardiomyopathy treatment of 528t
psychological function measurement DDD pacing 270–272, 271f incidence of (in Australia) 526–528
60–61, 60t death 172, 785 diabetic ketoacidosis (DKA) 526, 785
in pregnancy see pregnancy Aboriginal patients and families and counterregulatory hormone effects in 526b
psychological recovery from 61–66 169–170 nursing practice 526–528
anxiety 61–63, 62t brain see brain pathological effects of 527t
assessment scale used in 61 critical care nurse and, care of 173 pathophysiology of 526, 527f
depression 61–63, 62t donation after cardiac see donation after treatment of 528t
interventions to improve 66 cardiac death diagnosis-related group (DRG) 18, 785
memories 63 family care and 172–173 dialysate 785
perceptions 63 in-hospital prediction of, early signs in dialysis 785
posttraumatic stress 63 critically ill patients and see also renal dialysis
recovery after hospital discharge 68–72 557b–558b dialyzer 786
home-based care 71–72 mechanisms, ICDs and 284 diaphragmatic injuries 636
ICU follow-up clinics 68–71, 69b near-death experiences 671–672 diarrhoea 116
critical illness myopathy (CIM) 58 decision analysis theory (DAT) 7 DIC see disseminated intravascular coagulation
critical illness neuromyopathy (CINM) 58, 569 decision making diencephalon 421t–422t
critical illness polyneuropathy (CIP) 58 clinical see clinical decision making diet, bowel function and 115–116
critically ill patients 785 research vignette 13b diffuse axonal injury (DAI) 456–457, 457f
early signs in, in-hospital death prediction decision-making principles, end-of-life diffusion 492, 785
and 557b–558b and 84–88, 85f digestion, enzymes for 506, 507t
glycemic control in 525–526 advance directives 86 dilated cardiomyopathy (DCM) 241
see also diabetes best interests principle 85–86 disaster triage 588–589
hypocaloric intake in 510 conscientious objection 88 external see emergency department
interhospital transport of 587–588 do-not-resuscitate issues 87 dissecting aortic aneurysm 244, 244f
monitoring during 588 euthanasia 87 disseminated intravascular coagulation
retrieval of 587–588 medical futility 86–87 (DIC) 785
transport of see transport of critically ill nursing advocacy 87–88 distributive shock states 551–554
patients palliative care 87 sepsis see sepsis
cross-clamp 785 patient advocacy 86 septic shock see septic shock
croup 689–690, 690t quality of life 85 diuretics, for CHF 238t, 239
CRRT see continuous renal replacement therapy substituted judgement principle 86 DKA see diabetic ketoacidosis
CRT see cardiac resynchronization therapy Declaration of Buenos Aries: workforce DNR see do-not-resuscitate
CSF see cerebral spinal fluid 765–766 DO 2 see oxygen delivery
CT see computed tomography Declaration of Helsinki 91–92 documentation
CTG see Clinical Trials Group Declaration of Madrid: education 763–764 of incident 30t
cTnI see cardiac troponin I Declaration of Manilla: patient rights 767 of respiratory system assessment 339
cTnT see cardiac troponin T Declaration of Vienna: patient safety in intensive domestic violence 729
CTPA see computed tomography pulmonary care medicine 49, 768–772 Donatelife Organ Donor Coordinator 754, 785
angiography deep vein thrombosis (DVT) 114, 367–368 donation 785
cuff management 385–386 postpartum patient and 736 opt-in 746–747, 787
cuff pressure measurement (CPM) 386 defibrillation 660–661, 662t, 785 opt-out 787
cultural care 161–170 automatic external 280–281 tissue see tissue
competence 162–163 electrical 660–661 types of 747
defining 161–162 praecordial thump 660 see also organ donation
differing world views 162 delirium 136–138 donation after cardiac death (DCD) 89–90,
individualised care 164 assessment of 137 757–758, 785
Aboriginal and Torres Strait Islander CAM-ICU for 137, 139f donors
people 167t, 168–170 ICDSC for 137, 138f. blood tests required for 756t
culturally and linguistically diverse pathophysiology of 136–137 family care 757
165–166 prevalence of 136 living 787
Mαori patients and families 166–168, prevention of 137–138 medical management of 756b
167t risk factors for 136–137 multiorgan 787
levels of practice 162–163, 163t subtypes of 136 potential 787
patient and family needs determination treatment of 137–138 retrieval surgery 756–757
163–164 demand pacing 268, 268f tissue-only 758, 788
CVP see central venous pressure monitoring dendrite 414–415, 416f types of 747
CVR see cerebrovascular resistance denervation 785 do-not-resuscitate (DNR) 87
CVVH see continuous venovenous post heart transplantation 317, 318t Doppler ultrasound
haemofiltration deontological principle 17–18, 785 methods 204–205, 205f

800 I N D E X

transcranial, for nervous system electron micrograph, of cardiac muscle Irukandli 611
assessment 439 181–182, 182f Katipo spider 606–607
Doppler waveforms, oesophageal 205, 205f electrophysiology, for ICU-AW 58 redback spider 606–607
dose intensity 785 emancipatory practice development (ePD) 785 snake bites 608–610, 609t
DRG see diagnosis-related group emergency department (ED) environment, sleep and 147
droplet precautions 119, 119t abdominal symptom presentations in see enzymes, for digestion 506, 507t
drowning 785 abdominal symptom presentation EPAP see expiratory positive airway pressure
dry 785 acute stroke and 594–596 ePD see emancipatory practice development
near 612–614, 787 case study 672b–673b epiglottitis 690, 690t
SCA and 669–670 chest pain presentation in 591–593 equation of motion 388, 388t
wet 789 acute coronary syndrome 592 equipment
drugs thoracic aortic dissection 592–593 for haemodynamic monitoring 196, 197f
bowel function and 116 extended roles in 586–587 for ICU 22–23
designer, overdose of 601 clinical initiative nurse 586 basic requirements 22, 22t
overdose see overdose nurse practitioner 586–587 purchasing 22–23
dry drowning 785 nurse-initiated analgesia 586 replacement and maintenance 23
DSC see dynamic susceptibility contrast nurse-initiated x-rays 586 intubation 385
dual-chamber pacing 269–272, 271f external disaster response see external disaster product evaluation criteria 23b
DDD 270–272, 271f response for transport of critically ill patients 124,
external 272 overdose see overdose 124t
DVT see deep vein thrombosis poisoning see poisoning error/error reporting, research vignette on
dying see death respiratory presentations in see respiratory 53b
dynamic perfusion computed tomography presentations ESBL-E see extended-spectrum beta-lactamase-
(PCT), of cerebral perfusion 436 see also trauma; triage producing Enterobacteriaceae
dynamic response test 196, 198f emergency nursing, background of 581–582 essential nursing care
dynamic susceptibility contrast (DSC), MRI, of EN see enteral nutrition bowel management 115–116
cerebral perfusion 436 encephalitis 465–467 case study 125b–127b
dynamometry, hand-held 58 aetiology of 465–466 eye care 108–109
dyspnoea 335–336 in children 698 oral hygiene 109–110
clinical features of 467 patient positioning 110
E collaborative management of 467 personal hygiene 105–107
diagnosis of 467
principles of practice 106t
early goal directed therapy (EGDT), in severe Murray Valley 466 transport of critically ill patients 124–125
sepsis 571t pathophysiology of 466–467 urinary catheter care 117
EBN see evidence-based nursing endocarditis, infective 243–244 ethical decision making 78, 80
ECG see 12-lead echocardiogram endocardium 182 ethical issues
ECHO see echocardiography endocrine system brain death 88–89
echocardiography (ECHO) 206 MODS and 566–567 case study on long-stay critical care
contrast 206 organ dysfunction in 568 patient 96b–97b
three-dimensional 206 adrenal insufficiency 568 CPR and 672
transoesophageal 206 glycaemic control 569 do-not-resuscitate orders 87
transthoracic 206 hypocalcaemia 569 end-of-life decision making 83–88
two-dimensional 206 steroid therapy 568–569 ethical principles 78–80, 785
ECMO see extracorporeal membrane end-of-life decision making see decision-making autonomy 79, 92
oxygenation principles beneficence 79, 92
economic considerations and principles 19–20 end-of-life issues 172–173 critically ill care and 83
ectopic pregnancy 594 critical care nurse, care of 173 human clinical research application 92
ectopy family care 172–173 justice 79–80, 92
atrial 254, 255f palliative care 172 non-maleficence 79
patterns 262, 262b patient comfort 172 ethics 78, 785
ventricular beats 297 endorsed enrolled nurses (EENs) 24 committees, human research and 87
ED see emergency department endotracheal tube (ETT) 109, 688f, 785 law and 80
education fixation 386 morality compared to 78–79
on CHF 237 intubation 384–385, 384f in publication 95
continuing 28 complications of 387 in research 91–96
critical care nursing 4–5 suctioning of 387 clinical trials 95–96
training and 27–28 for pulmonary dynamic hyperinflation 372, ethical principles application 92
EENs see endorsed enrolled nurses 372f human research ethics committees 92–93
efferent limb, of RRS 51–52 enteral nutrition (EN) 510–513 privacy and confidentiality 93–95
efferent neurons 416f case study 529b responsible practices 95
EFGCP see European Forum for Good Clinical commencement of 511 of unconscious persons 95
Practice complication management of 511–512 ETIC see Experience after Treatment in Intensive
eICU see remote critical care management feeding protocols 510 Care (ETIC) item scale
Einthoven triangle 192–193, 192f feeding regimens 511, 511t ETT see endotracheal tube
elastance 388 hypocaloric intake in critically ill 510 European Forum for Good Clinical Practice
elderly management of 510–513 (EFGCP) 91–92
ARDS and 364 pulmonary aspiration assessment 512–513 euthanasia 87
respiratory failure and 356 pulmonary aspiration prevention 512 evidence based process indicators 43t
elective cardioversion 281–282 routes of 510 evidence-based nursing (EBN) 38–41, 785
electrical defibrillation 660–661 stress-related mucosal disease and 516 clinical performance evaluation 40–41
electrical injuries, SCA and 669 tube placement assessment 510–511 clinical query translation into structured
electrical synapses 415–416 enteric nervous system 431 question 39, 40t
electrolytes 206, 208t envenomation 606–611 critical appraisal of 39–40
balance of, renal system and 483 box jellyfish 610–611 integration into practice 40
post cardiac surgery, management of 302 funnel-web spider 607–608 location of 39

I N D E X 801

schematic representation of 39f fetal assessment 732 GBS see Guillain-Barré syndrome
steps in 39f cardiotocograph 732 GCS see Glasgow Coma Scale
EVLW see extravascular lung water ultrasound 732 GEDV see global end-diastolic volume
EVLWI see extravascular lung water index fibrillation GEDVI see global end-diastolic volume index
excitatory aminoacids 416 atrial 256–257, 257f, 297 General Medicine Council 82
exercise(s) ventricular 263, 264f genitourinary system, of children 683
active 111 ALS and 663, 665f GFR see glomerular filtration rate regulation
passive 111 fibrinolytic therapy, in ischaemic stroke 595b Glasgow Coma Scale (GCS) 433–434, 435t
test 220 Fick principle 203 blood alcohol level and, research
Experience after Treatment in Intensive Care filter 786 vignette 442b
(ETIC) item scale 61 life of 786 global end-diastolic volume (GEDV) 203–204
expiratory positive airway pressure (EPAP) filtrate reabsorption 481f, 497–498 global end-diastolic volume index (GEDVI) 296
389 FiO 2 see fraction of inspired oxygen glomerular filtration rate (GFR) regulation 481f,
expiratory sensitivity 392t, 395 first heart sound (S1) 191 497–498
extended-spectrum beta-lactamase-producing first-degree atrioventricular block 260, 260f glomerulonephritis 484
Enterobacteriaceae (ESBL-E) 121 flail chest 636 glomerulus 480, 481f
external disaster response 588–589 flow, vs time scalar 399, 400f glycaemic control 569
preparation for 588–589 flow-volume loops 401 in children 699
reception 589 fluid aspiration, respiratory failure secondary in critical illness 525–526
transfer from 589 to 613f see also diabetes
treatment 589 fluid resuscitation glyceryl trinitrate (GTN) 225
external pacing 272 in hypovolaemic shock 543 grafts
extracellular (vasogenic) oedema 448 during SCA 666 dysfunction and rejection of, after liver
extracorporeal circuit 786 for septic shock 553 transplantation 524–525
functional life of 786 fluids see also specific grafts
extracorporeal liver support 521–522 bowel function and 115–116 graph paper, for 12-lead echocardiogram
extracorporeal membrane oxygenation CRRT and 497–498, 497t 193–194, 193f
(ECMO) 401–402, 786 post cardiac surgery, management of 302 grief 172–173
in children 694–695 flutter GTN see glyceryl trinitrate
extravascular lung water (EVLW) 204 atrial 255–256, 256f guardian, adult 783
extravascular lung water index (EVLWI) 296 ventricular 263, 263f Guedel oropharyngeal airway 383
extubation 387 fMRI see functional magnetic resonance imaging Guidelines on Ethics in Health Research 82
eye(s) focal brain injury 456 Guillain-Barré syndrome (GBS) 467–469
assessment of 108, 108t, 433 focused assessment with sonography for trauma aetiology of 467
movement 433 (FAST) 625–626 clinical manifestations of 467–468
care of 107–109, 786 foreign body aspiration 690–691 collaborative management 468–469
essential 108–109 fraction of inspired oxygen (FiO 2 ) 392–393, independent practice 468
eyelid assessment, movement 433 392t nursing practice 468
fractures pathophysiology of 467
F blood loss caused by 632t gut function
of pelvis, classification of 631f
assessment 115, 115b
faces anxiety scale 134, 135f of rib 636 lung transplantation and 374
facial symmetry assessment 434 of skull, TBI and 457 see also gastrointestinal physiology
family 786 Frank-Starling curve 188, 188f
care of heart failure and 228–229, 229f
during bereavement 172–173 FRC see functional residual capacity H
end-of-life and 172–173 full blood count (FBC) 206, 344 H1N1 121, 361–362
post cardiac surgery 302 fulminant hepatic failure 786 H 2 RAs see histamine-2-receptor antagonists
issues with, children and 686 functional magnetic resonance imaging (fMRI), H5N1 see avian influenza virus
participation of, in patient care 160t of brain injury 436 HADS see Hospital Anxiety and Depression
presence of, during CPR 174b–175b, functional residual capacity (FRC) 330 Scale
670–671 funnel-web spider bite 607–608 haematologic system, organ dysfunction
family-centred care (FCC) 157–160, 686 fusiform aortic aneurysm 244, 244f in 567–569
family needs during critical illness 158–160 futility, medical 86–87 haematology, normal values 781t–782t
family participation in patient care 160t haemodiafiltration 491–492, 786
information needs 158–159 haemodialyser 786
visiting practices 159–160 G haemodialysis 491–492
FAST see focused assessment with sonography gas transport principles 331–332 haemodynamic monitoring 195–206, 786
for trauma carbon dioxide 332 accuracy of 196, 197f
fast-flush square wave testing 196 oxygen 331 blood pressure see blood pressure
FASTHUG mnemonic see feeding, analgesia, oxygen-haemoglobin dissociation curve data trends 196
sedation, thromboembolic 331–332, 332f instability
prophylaxis, head of bed elevated, V/Q ratio 332, 333f liver failure and 519
ulcer prophylaxis, glycemic control gastric residual volume management, research lung transplantation and 373–374
fat embolism 630 vignette 530b–531b invasive 195–196
FBC see full blood count gastrointestinal physiology 506–508 invasive cardiovascular monitoring see
FCCs see family-centred care alterations to 507–508 invasive cardiovascular monitoring
feeding, analgesia, sedation, thromboembolic metabolism 508 non-invasive 195, 212b
prophylaxis, head of bed elevated, mucosal hypoperfusion 507 normal values 199t
ulcer prophylaxis, glycemic control enzymes for digestion 506, 507t post cardiac surgery 296–297
(FASTHUG mnemonic) protective mechanisms 507, 508t pressure 199t
for quality of care improvement 43 gastrointestinal system principles of 196
for shock 542, 542b of children 683 standards 196
feedings see nutrition liver transplantation and 524 haemofilter 493, 493f, 786
fentanyl 144, 145t pregnancy physiology adaptation of 714 haemofiltration 491–492

802 I N D E X

haemolysis elevated liver enzymes and low incidence of 309 HPS see hepatopulmonary syndrome
platelets (HELLP) syndrome 716, indications for 309–311 HRCNZ see Health Research Council of New
718t, 720b lifestyle issues 319 Zealand
haemorrhage nursing management postoperatively HREC see human research ethics committees
antepartum see antepartum haemorrhage 311–317 HRS see hepatorenal syndrome
intracerebral see intracerebral hemorrhage acute rejection 313, 313t, 318t HSV see herpes simplex virus
obstetric see obstetric haemorrhage acute renal failure 315, 318t Hudson face mask 383
post heart transplantation 315, 318t allograft dysfunction and failure 315–317, human research ethics committees (HREC)
postpartum see postpartum 318t 91–93
subarachnoid 463–464, 464t cardiac tamponade 315, 318t humidification 389
haemorrhagic stroke 463 denervation 317, 318t absolute 389
haemostasis system, pregnancy physiology haemorrhage 315, 318t heated 389
adaptation of 714, 714t hyperacute rejection 313 heat-moisture exchanger 389
haemostatic capability impairment immunosuppression therapy 313–314, relative 389
contributors 299–300 314t Hunt-Hess scale 464t
haemothorax 636 infection 314–315, 318t hybrid 786
HAI see hospital-acquired infection left ventricular dysfunction 316–317, 318t hydrocephalus 448
Hancock II porcine aortic valve 295f rhythm strip 312f hygiene
hand hygiene 120, 120b right ventricular dysfunction 316, 318t basic personal 106–107
handheld technologies 48–49 outcomes from 309 hand 120, 120b
Hawthorne effect 42 surgery forms 311 oral 109–110
HCM see hypertrophic cardiomyopathy heterotopic 311, 312f personal see personal hygiene
HCO 3 see bicarbonate orthotopic 311, 312f hyperacute rejection, of heart
–
HE see hepatic encephalopathy HeartMate®USA 310f transplantation 313
head of bed elevation, invasive mechanical heat exhaustion 786 hypercapnoeic respiratory failure 353–354
ventilation and 402 heat illness 615 hyperglycaemia, critical illness and see diabetes
Health Act 1956 80 heat stroke 786 hyperglycaemic hyperosmolar non-ketotic state
Health and Disability Ethics Committees 91–92 heated humidity (HH) 389 (HHNS) 526, 786
Health Research Council of New Zealand heat-moisture exchanger (HME) 122, 389, 786 treatment of 528t
(HRCNZ) 82, 91–92 HELLP see haemolysis elevated liver enzymes hyperkalaemia, burns and 648
Operational Standard for Ethics and low platelets syndrome hypertension
Committee 82 heparin 114, 786 intracranial 448–449, 449f–450f
healthcare associated infections 121–122, 122b citrate compared to, research vignettes 502b see also intracranial hypertension
health-related quality of life (HRQOL) 57–59 for CRRT 496, 496t post cardiac surgery 296
depression and 63 reversal 300 post heart transplantation 319
measurement of 59–60, 59t hepatic encephalopathy (HE) 518, 786 in pregnancy see preeclampsia
heart disease see coronary heart disease hepatic failure, fulminant 786 hypertensive emergencies 242–243
heart failure 227–241 hepatobiliary changes, pregnancy and 714 hyperthermia 453, 615
causes of 228 hepatopulmonary syndrome (HPS) 519 hypertrophic cardiomyopathy (HCM) 241–242
chronic see chronic heart failure hepatorenal syndrome (HRS) 518, 786 hyperventilation, for intracranial hypertension
congestive, NIV for 390–391 herpes simplex virus (HSV) 465–466 management 452
left ventricular 230, 230t heterotopic heart transplantation 311, 312f hypocalcaemia 569
NYHA functional classification of 231, 233t heterotropic 786 hypocaloric intake 510
pathology of 228 HFNC see high-flow nasal cannulae hypotension
pathophysiology of 229f HFOV see high frequency oscillatory ventilation post cardiac surgery 296–297
prevalence of 227–228 HFPSF see heart failure with preserved systolic sepsis-induced 788
responses to 228–230 function hypothalamic-pituitary-adrenal (HPA) axis 786
Frank-Starling curve 228–229, 229f HH see heated humidity hypothalamus 423–424, 786
neurohormonal 228, 230 HHNS see hyperglycaemic hyperosmolar non- hypothermia 614–615, 628
RAAS 228–229 ketotic state accidental, research vignette 650b–651b
sympathetic nervous system 228, 229f HHS see Department of Health and Human burns and 648
right ventricular 230–231, 230t Services physiological effects of 614t
signs and symptoms of 228 high frequency oscillatory ventilation after SCA 671, 671b, 673b–674b
heart failure with preserved systolic function (HFOV) 401 hypoventilation 381–382
(HFPSF) 236f in children 694 hypovolaemia 542
heart rate high-degree atrioventricular block 261, 261f hypovolaemic shock 542–545
calculation of, on ECG 195 high-flow nasal cannulae (HFNC) 382 blood product adverse reactions 546t
pregnancy and 712 hindbrain 421t–422t clinical manifestations of 542–543
regulation of, autonomic nervous system histamine-2-receptor antagonists (H 2 RAs) 516 collaborative management of 544–545
control and 188–189 HME see heat-moisture exchanger fluid resuscitation in 543
heart sounds, auscultation of 191–192, 191t home-based care 71–72 independent practice in 543–544
first 191 homunculus 423, 424f massive blood transfusion and
second 191 hormonal and neural regulation in renal indicators for 544f
late diastolic 191 system 482–483 physiological derangements of 543f
murmurs 191–192, 192t acid-base regulation 483, 483f nursing practice in 543–545
pericardial rub 191 ADH 482 platelet administration guidelines 545t
stethoscope placement for 191t ANP 483 preload management of 544–545
ventricular gallop 191 electrolyte balance 483 red blood cell administration guidelines
heart transplantation 308–319 endocrine organ role 483 545t
complications from, long-term RAAS 482–483, 482f signs and symptoms of 543t
cardiac allograft vasculopathy 317–318 SNS 482 hypoxaemia 333–334, 334f
hypertension 319 Hospital Anxiety and Depression Scale oxygen optimisation compensatory
malignancy 318 (HADS) 61 mechanisms 334
renal dysfunction 318–319 hospital-acquired infection (HAI) 121–122 refractory 401–402
costs associated with 311 hospital-acquired pneumonia 358–359 ECMO 401–402
history of 308–309 HPA see hypothalamic-pituitary-adrenal axis HFOV 401

I N D E X 803

nitric oxide 402 surveillance 119–120 mobility in 66, 67t
recruitment manoeuvres 401 VAP 122, 122t walking and 66
tissue hypoxia 334 VRE 121 postpartum patient in see postpartum
V/Q mismatch 334f encephalitis see encephalitis pregnancy and 731–735
hypoxaemic respiratory failure 353, 354f healthcare associated 121–122, 122b rehabilitation in 66
heart transplantation and 314–315, 318t ward-based recovery 68
I hospital-acquired 121–122 intensive care unit-acquired weakness
meningitis see meningitis
(ICU-AW) 58
IABP see intra-aortic balloon pumping MODS and 565 clinical assessment of 58
ICDs see implantable cardioverter defibrillators nosocomial 119–122 critical illness myopathy 58
ICDSC see Intensive Care Delirium Screening susceptibility to, liver failure and 519 critical illness neuromyopathy 58
Checklist treatment of, in MODS 571–572 critical illness polyneuropathy 58
ICH see intracerebral hemorrhage infective endocarditis 243–244 diagnostic testing for 58
ICN see International Council of Nurses inflammation electrophysiology 58
ICP see intracranial pressure monitoring CNS and see infections ultrasound 58
ICT see information and communication MODS and 565 risk factors for 58
technologies respiratory system and 334 intensivist 786
ICU see intensive care unit influenza 360 interhospital transport 587–588
ICU follow-up clinics 68–71, 69b avian virus 361 monitoring during 588
activities 69–70 H1N1 121, 361–362 intermittent haemodialysis (IHD) 486–487,
assessment tool 69, 69t pandemics 361–362 786
case study 72b pregnancy and 730, 739b–740b circuit and set-up for 492f
evaluation 70–71 Spanish 361 CRRT compared to 498
nurse-led follow-up service 71, 71t swine-origin virus 362 internal mammary artery (IMA) graft 293, 293f
ICU-AW see intensive care unit-acquired vaccinations 362 International Council of Nurses (ICN) 11, 80
weakness information and communication technologies International NPUAP-EPUAP Pressure Ulcer
I:E ratio see inspiratory:expiratory ratio (ICT) 44–49 Classification System 113
IES see Impact of Event Scale clinical information systems 44–48 intra-aortic balloon pumping (IABP) 302–308,
IHD see intermittent haemodialysis computerised order entry and decision 786
IHI see Institute for Healthcare Improvement support 48 alarm states 306–308, 309t
IMA see internal mammary artery graft handheld technologies 48–49 gas loss 307–308, 308f
immobility-related complication, IABP and 305 telehealth initiatives 49 for cardiogenic shock 550
immune system information processing theory (IPT) 7 catheter placement 302–303, 303f
MODS and 565 Informed HF 440 CRRT machine 499f complications of 304–305
pregnancy physiology adaptation of 715 inhalation injury 645–646 counterpulsation principles 303–304
immunoneuroendocrine axis 786 injury(ies) balloon deflation 304, 305b
immunosuppression 786 aortic 636 balloon inflation 303–304, 304f, 305b
therapy, heart transplantation and 313–314, to brain nursing management 305–306
314t traumatic see traumatic brain injury see bleeding prevention and treatment 305
Impact of Event Scale (IES) 61 brain injury immobility-related complication
impedance cardiography see transthoracic brainstem, respiratory pattern and 449, 450f prevention 305
bioimpedance burn see burns limb perfusion maintenance 305
implantable cardioverter defibrillators to children see children timing assessment 306
(ICDs) 282–284, 283f electrical, SCA and 669 timing errors 306
death mechanisms 284 inhalation 645–646 weaning 305–306
tachycardia detection and classification to liver 643 intra-arterial blood pressure monitoring,
283–284, 284f management – staff, patient or visitor 29–30, invasive 198
terminal care 284 29b intracellular (cytotoxic) oedema 448
incident, documentation of 30t penetrating 643–644 intracerebral hemorrhage (ICH) 471–472
indigenous person 786 of spinal cord see spinal cord injury clinical manifestations of 472
individualised cultural care 164 of spleen 642–643 nursing practice 472
Aboriginal and Torres Strait Islander tracheobronchial 636 blood pressure management 472
people 168–170 innate immune system 786 cerebral ischaemia prevention 472
culturally and linguistically diverse 165–166 inoconstrictor 786 intubation 472
Mαori patients and families 166–168, 167t inodilator 786 secondary brain injury prevention 472
infants 786 inotropic agents pathophysiology of 471–472
ALS for 662f for cardiogenic shock 548–550, 549t intracranial hypertension 448–449, 449f–450f
CPR for 659t for CHF 238t, 239–240 management of 452–454
developmental considerations in 684 for septic shock 554 barbiturates 453
sepsis in 682–683 inspiratory flow, flow pattern and 392t, 393, corticosteroids 453
infections 786 395f hyperventilation 452
of CNS 464–467 inspiratory positive airway pressure (IPAP) 389 normothermia 453
control 120, 786 inspiratory time 392t, 393 osmotherapy 452–453
CLAB 122–123 inspiratory trigger 392t, 393 sedatives 453
ESBL-E 121 inspiratory:expiratory (I:E) ratio 392t, 393 surgical interventions 453–454
guidelines 119b Institute for Healthcare Improvement (IHI), care intracranial pressure (ICP) monitoring, brain
hand hygiene 120, 120b bundles by 43, 44t injury and 436–438
healthcare associated 121–122 Institutional Ethics Committees 91–92 pulse waveforms 437–438, 438f
influenza H1N1 121 Institutional Review Board (IRB) 82 intrahospital transport 124
invasive device management 122b integumentary system, of children 684 intrarenal (intrinsic) acute renal failure 484
MRO 121 Intensive Care Delirium Screening Checklist glomerulonephritis 484
MRSA 121 (ICDSC) 137, 138f nephrotoxicity 484
PPE 120–121 intensive care unit (ICU) vascular insufficiency 484
prevention 119b, 120 acute/severity of illness measurement in 26 intrathoracic blood volume (ITBV) 203–204
SARS 121 equipment for see equipment intrathoracic blood volume index (ITBVI) 296
Standard Precautions 118, 120 liaison nurse 51–52 intravenous therapy, for children 699

804 I N D E X

Intruder, The 91b refractory hypoxaemia management see left ventricular end-diastolic volume
intubation 384–386 refractory hypoxaemia management (LVEDV) 186
in children, for upper airway weaning from 403–404 left ventricular failure (LVF) 230, 230t
obstruction 687–688, 688f, automated 404 left ventricular stroke work index (LVSWI) 203
689t current recommendations 403 legal considerations, CPR and 672
cLMA and 383 difficult-to-wean patient 404 legislation 786
ETT 384–385, 384f methods 403–404 Levine scale, for heart murmur
complications of 387 prediction of 403 classification 191t
suctioning of 387 protocols 403–404, 406b–407b liaison nurse (LN), ICU 51–52
ICH and 472 research vignette 406b–407b limb movement assessment 433–434
preparation for 385 spontaneous breathing trials 403 motor tone 434
drugs 385 IPAP see inspiratory positive airway pressure peripheral reflex response 434
equipment 385 IPT see information processing theory spastic flexor 433–434
patient 385 IRB see Institutional Review Board withdrawal flexor 433–434
procedure 385–386 Irukandli envenomation 611 limb perfusion maintenance, IABP and 305
backwards, upwards, rightward pressure ischaemia, warm 789 limbic system 423–424, 786
manoeuvre 385 ischaemic Linton tube 520–521
cricoid pressure 385 heart disease 293 lipase 786–787
cuff management 385–386 stroke 463, 463t liver
ETT fixation 386 fibrinolytic therapy in 595b anatomy of 516–517
oral vs nasal 385 isolation precautions, respiratory pandemics cell injury mechanisms 517
tube position confirmation 386 and 362 disease of, in children 699–700
invasive cardiovascular monitoring ITBV see intrathoracic blood volume dysfunction 516–522
afterload 202–203 ITBVI see intrathoracic blood volume index assessment and 520, 520t
PVR 202–203 collaborative practice 520–522
SVR 202 extracorporeal liver support for 521–522
cardiac output see cardiac output J independent practice 519–520
contractility 186–187, 203 Jackson/Cubbin pressure area risk neurological considerations in 519–520
preload see preload calculator 112–113, 112t nursing practice 519
invasive device management 122b jugular venous oximetry 438–439 oesophageal balloon tamponade
invasive haemodynamic monitoring 195–196 jugular venous oxygenation (SjvO 2 ) for 520–521
invasive intra-arterial blood pressure 438–439 TIPS for 520–521
monitoring 198 junctional escape rhythms 258, 259f treatment of 520–522, 521t
invasive mechanical ventilation 392–404 justice 79–80, 92, 786 injury to 643
complications of 404, 405t acute 783
graphics 398–401 physiology of 516–517
flow vs time scalar 399, 400f K pregnancy physiology adaptation of 714
flow-volume loops 401 Katipo spider bite 606–607 viral hepatitis epidemiology 517
loops 399–401 ketamine 144–145, 145t liver failure 517–518
pressure vs time scalar 398–399, 399f kidneys 480, 480f acute see acute liver failure
pressure-volume loops 399–401, acute injury to 479, 783 acute-on-chronic see acute-on-chronic liver
400f–401f see also renal system failure
scalar parameters 398–399 kinetic bed therapy 114 chronic see chronic liver failure
volume vs time scalar 399, 400f knowledge, body of, development of 11–12 consequences of 518–519
indications for 392 Kolff dialyser 488f ascites 519
modes 395–398, 397t coagulopathy derangement 519
A/C 396, 397t haemodynamic instability 519
APRV 397t, 398 L HE 518
ATC 397t, 398 lactate production, shock and 540, 541t HPS 519
BiPAP 397t, 398 lactation HRS 518
CMV 396, 397t initiation of 737–738, 737b, 737f infection susceptibility 519
CPAP 396, 397t medications and 738 metabolic derangement 519
NAVA 397t, 398 LAD see left anterior descending artery respiratory compromise 519
pressure control 396 LAP see left atrial pressure monitoring variceal bleeding 519
PRVC 397t, 398 laryngeal mask airways 383, 384f varices 519
PSV 396, 397t larynx 327f see also hepatic failure
SIMV 396, 397t late diastolic heart sound (S4) 191 liver injury scale 643t
volume control 396 law liver transplantation 522–525
parameters for 392, 399f ethics and 80 contraindications for 522
expiratory sensitivity 392t, 395 statute 80 indications for 522
FiO 2 392–393, 392t laxatives 115–116 postoperative management 523–525
I:E ratio 392t, 393 lead placement blood loss 524
inspiratory flow and flow pattern 392t, for continuous cardiac monitoring 192 cardiovascular 524
393, 395f for 12-lead echocardiogram 193, 193f coagulopathy 524
inspiratory time 392t, 393 leaders, characteristics of 10 gastrointestinal 524
inspiratory trigger 392t, 393 leadership 7–11 graft dysfunction and rejection 524–525
peak airway pressure 392t, 395 clinical 10–11 initial nursing considerations 523–524
PEEP 392t, 393–394 management role and 29 late complications 525
pressure support 392t, 393 transformational 9–10, 788 neurological 524
respiratory rate 392t, 393 left anterior descending (LAD) artery 182, 183f, renal 524
rise time 392t, 394 217 respiratory 524
V T 392t, 393, 394t left atrial pressure (LAP) monitoring 202 recipient selection for 522
positioning 402–403 left coronary artery 182, 183f surgical techniques 522–523
head of bed elevation 402 left heart catheterisation 219–220 living donor 523
lateral 402 left ventricular dysfunction, post heart orthotopic 523
prone 402–403 transplantation 316–317, 318t split-liver transplantation 523, 523f

I N D E X 805

living donor 787 invasive see invasive mechanical ventilation MOV see minimal occluding volume
liver transplantation 523 non-invasive see non-invasive ventilation MPM see mortality probability models
living will 787 physiologic indications for 388t MRC see Medical Research Council scale
LN liasion nurse pregnancy and 731–732 MRI see magnetic resonance imaging
lobar collapse 345 principles of 388–389 MRO see multi-resistant organisms
lochia, postpartum patient and 736 compliance 388 MRSA see methicillin-resistant Staphylococcus
locked-in syndrome 433 elastance 388 aureus
lower airway branches 327f equation of motion 388, 388t mucosal hypoperfusion 507
lower airway disease, in children 691–693 resistance 388–389 consequences of 507–508, 508t
asthma 692–693, 692t medical emergency team (MET) calling multifocal atrial tachycardia 255, 255f
bronchiolitis 691 criteria 51, 51t multiorgan donor 750–754, 787
lower respiratory tract, anatomy of 326 medical futility 86–87 potential 787
low-flow nasal cannulae 382 medical outcomes study see SF-36 multiple organ dysfunction syndrome
lung transplantation 369–374 Medical Research Council (MRC) scale 58 (MODS) 552t, 569–572, 787
allograft dysfunction and 371–373 medulla oblongata 421t–422t, 423 ACE-inhibitor therapy in, research
bilateral sequential 370 melatonin, sleep and 149 vignette 573b–574b
clinical manifestations of 370–374 MELD see model for end-stage liver disease case study 572b–573b
haemodynamic instability 373–374 scoring system nursing practice in 571–572
long-term sequelae 374 memories 63 effective shock resuscitation 571
pain 373 meningitis 464–465 infection treatment 571–572
psychosocial care 374 in children 697–698, 697t organ support 572
renal and gut dysfunction 374 classification of 466t secondary insult exclusion 572
respiratory dysfunction 371–373 collaborative care 465 pathophysiology of 563–564, 563f
forms of 370, 370t complications of 465 progression of 566f
indications for 369 CSF profiles in 465t scoring systems for 570
low cardiac output after 371t mental health systemic response 564–567
single 370 pregnancy and 731 compensatory mechanisms 567
lungs 326–328, 327f triage assessment presentations 585, 585t endocrine system 566–567
LVEDV see left ventricular end-diastolic volume mentorship 10–11 immune system 565
LVF see left ventricular failure MET see medical emergency team infection 565
LVSWI see left ventricular stroke work index metabolism inflammation 565
lysis 787 derangement, liver failure and 519 oedema 565
gastrointestinal alterations to 508 procoagulation 565–566
TPN and 513, 514t
stress response actions 566t
M metabolites 787 tissue factor pathway 564f
MAAS see Motor Activity Assessment Scale methicillin-resistant Staphylococcus aureus see also organ dysfunction
macroglia 417, 419t (MRSA) 121 multiple patient triage 588–589
magnetic resonance imaging (MRI) MEWS see modified early warning score multi-resistant organisms (MRO) 121
of brain injury 436 MI see myocardial infarction murmurs 191–192, 192t
functional 436 microdialysis 439 Murray Valley encephalitis (MVE) 466
cardiovascular system and 209–210 microglia 417, 419t muscles
DSC, of cerebral perfusion 436 microshock protection 275 cardiac, electron micrograph of 181–182,
respiratory system and 347 midbrain 421t–422t, 423 182f
malignancy, post heart transplantation 318 MIDCABG see minimally invasive direct waisting 58
malnutrition, consequences of 509 coronary artery bypass grafting limiting 59b
management role, leadership and 29 mild brain injury 457 musculoskeletal system
manual muscle testing (MMT) 58 minimal leak test (MLT) 386 assessment 111, 111t
Māori creation stories 166 minimal occluding volume (MOV) 386 of children 683–684
Māori patients and families minimally invasive direct coronary artery bypass MV see minute volume
case study 174b grafting (MIDCABG) 293–294 MVE see Murray Valley encephalitis
working with 166–168, 167t minute volume (MV) 331 myasthenia gravis 469–470
margination 787 mitral valve disease 293 aetiology 469
massage therapy, for post cardiac surgery, MLT see minimal leak test clinical manifestations of 469
research vignette 321b MMT see manual muscle testing nursing practice 469–470
massive blood transfusion, hypovolaemic shock mobilisation pathophysiology of 469
and in ICU 66, 67t myelin sheath 415
indicators for 544f walking and 66 myocardial infarction (MI) 216–227
physiological derangements of 543f positioning patient and 111–115 acute 216
maternal-fetal interface 715–716 of trauma patient 626–627, 628t angina management 221, 222f
maternal-infant attachment, promotion of 738 Mobitz type II 260–261 assessment and 217–221, 217t
maternal-placental interface 715, 715f model for end-stage liver disease (MELD) biochemical markers for 218–219
McGill short pain questionnaire 143t scoring system 522 cardiac rehabilitation 226–227
MCS see mechanical circulatory support models of care 157–161 chest radiography for 220–221
mechanical circulatory support (MCS) 308, communication 158–161 clinical features of 217
310f, 787 family-centred see family-centred care complications of 227
mechanical ventilation 388–389 modified early warning score (MEWS) 51, 51t arrhythmias 227
case study 406b MODS see multiple organ dysfunction syndrome cardiogenic shock 227
children and 693–695 monophasic 787 pericarditis 227
ECMO 694–695 morphine sulfate 144, 145t structural defects 227
HFOV 694 mortality probability models (MPM) 570 coronary angiography for 219–220
modes of 694–695 Motor Activity Assessment Scale (MAAS) 141t diagnostic features of 217–221
non-invasive 694 motor control 430–431 ECG evolution pattern 218, 219f–220f
pressure 694 motor function alterations 446–447 ECG examination 218
volume 694 motor tone 434 emotional response and 226
circuits 389 mouth care 109–110 exercise test for 220
humidification see humidification mouthwashes 109–110 left heart catheterisation for 219–220

806 I N D E X

medications for 225, 225t neurally-adjusted ventilatory assist New York Heart Association (NYHA) functional
nursing management for 224–226 (NAVA) 397t, 398 classification of heart failure 231,
physical examination and 217–218 neurogenic shock 461, 556–557 233t
PTCA for 223–224, 223f clinical manifestations of 556 New Zealand Bill of Rights 80
reperfusion therapy for 221–224 collaborative management for 556–557 New Zealand National Transplant Donor
support of patient and family 226 nursing practice in 556–557 Coordination 787
symptom control of 225–226 respiratory muscle innervation by cord New Zealand Nurses Organisations (NZNO),
thrombolysis, nursing care for 224 level 556t nurse-to-patient ratios 24
thrombolytic therapy 221–223 neuroglia 417, 419t NHMRC see National Health and Medical
myocardial ischaemia 215–216 neurohormonal response, to heart failure 228, Research Council
myocardial preservation 295 230 nine equivalents of nursing man power
myocardium 181–182 neurologic system, organ dysfunction in (NEMS) 30–32, 31t
myopathy, critical illness 58 569 NIPPV see non-invasive positive pressure
myosin filaments 183, 183f neurological assessment 431–440 ventilation
conscious state 431–434 NIPSV see non-invasive pressure support
ventilation
N arousal 431–433 NIRS see near-infrared spectroscopy
awareness 433
NAS see nursing activity scale corneal reflexes 434 nitric oxide (NO) 402, 787
nasal cannulae eye and eyelid movement 433 NIV see non-invasive ventilation
high-flow 382 eye and pupil 433 NO see nitric oxide
low-flow 382 facial symmetry 434 NOC see Nurses’ Observation Checklist
nasal intubation, vs oral intubation 385 limb movement 433–434 non-benzodiazepine sedative 136t
nasogastric tube sizes 689t oropharyngeal reflexes 434 non-invasive blood pressure monitoring
nasopharyngeal airways 383, 384f liver dysfunction and 519–520 197–198
nasopharyngeal aspirate (NPA) 344 liver transplantation and 524 non-invasive cardiac diagnostic tests, nursing
nasopharyngeal swab (NPS) 344 physical examination 431–435 care 210
National E-Health Transition Authority PTA scale 434–435, 435t non-invasive haemodynamic monitoring 195,
(NEHTA) 44 neurological dysfunction 445–449 212b
National Health and Medical Research Council autonomic nerve dysfunction 447 non-invasive positive pressure ventilation
(NHMRC) cerebral metabolism and perfusion (NIPPV) 389
ethics in research 89–90 alterations 447–449 non-invasive pressure support ventilation
on human research consent 82 cerebral ischaemia 447–448, 447f (NIPSV) 389–390
levels of evidence designation in studies of cerebral oedema 448 non-invasive ventilation (NIV) 389–392, 787
effectiveness 39, 40t extracellular (vasogenic) oedema 448 for children 694
outcome types 40, 40t hydrocephalus 448 complications from 391–392
National Statement on Ethical Conduct in intracellular (cytotoxic) oedema 448 failure detection 392
Human Research 82 intracranial hypertension 448–449, indications for 390–391, 390t
national triage scale (NTS) 582 449f–450f acute respiratory failure 390
NAVA see neurally-adjusted ventilatory assist in children 696–698 CHF exacerbation 390–391
near-death experiences 671–672 assessment 696 COPD exacerbation 390–391
near-drowning 612–614, 787 encephalitis 698 weaning 391
near-infrared spectroscopy (NIRS), for nervous meningitis 697–698, 697t initiation of 391
system assessment 440 seizures 696–697 interfaces and settings for 391
necrosis 787 consciousness 445–446 monitoring priorities 391, 391t
negligence 28–29, 787 in cognition 445–446 physiological benefits of 390
NEHTA see National E-Health Transition coma 445–446 terminology 389–390
Authority seizures 446 non-maleficence 79
NEMS see nine equivalents of nursing man motor function alterations 446–447 non-rapid eye movement (non-REM) 145–146
power sensory function alterations 446–447 non-REM see non-rapid eye movement
nephrologist 787 neurological therapeutic management non-ST elevation myocardial infarction (non-
nephron 480, 480f–481f 449–455 STEMI) 218
nephrotoxicity 484 cerebral perfusion and oxygenation non-STEMI see non-ST elevation myocardial
nervous system optimisation 449–455, 451t infarction
anatomy of 414–431 cerebral vasospasm prevention 454–455, non-steroidal anti-inflammatory drugs
autonomic see autonomic nervous system 454f (NSAIDs) 144, 145t
brain injury assessment see brain injury intracranial hypertension management see normothermia, for intracranial hypertension
assessment intracranial hypertension management 453
central see central nervous system management of 452 nosocomial infections 119–122
cerebral oxygenation assessment see cerebral neuromuscular alterations 467–470 see also hospital-acquired pneumonia
oxygenation Guillain-Barré syndrome 467–469 NP see nurse practitioner
components of 414–417, 415f aetiology of 467 NPA see nasopharyngeal aspirate
neuroglia 417, 419t clinical manifestations of 467–468 NPS see nasopharyngeal swab
neurons 414–415, 416f collaborative management 468–469 NSAIDs see non-steroidal anti-inflammatory
neurotransmitters 416–417 independent practice 468 drugs
synapses 415–417, 417t, 418f nursing practice 468 NTS see national triage scale
enteric 431 pathophysiology of 467 nuclear medicine studies 209–210
non-invasive assessment 439–440 myasthenia gravis 469–470 nurse practitioner (NP) 6, 586–587
cEEG 439 aetiology 469 research vignette
NIRS 440 clinical manifestations of 469 acute care 13b
TCD ultrasound 439 nursing practice 469–470 transitional role 617b–618b
parasympathetic 431, 432f pathophysiology of 469 nurse-initiated analgesia, in ED 586
peripheral see peripheral nervous system neuromyopathy, critical illness 58 nurse-initiated x-rays, in ED 586
physiology of 414–431 neurons 414–415, 416f nurse-led follow-up service 71, 71t
sympathetic see sympathetic nervous system neuropeptides 416 Nurses’ Observation Checklist (NOC) 146, 146t
neural regulation see hormonal and neural neuroprotection, for SCI 462 nurse-to-patient ratios 24, 25t
regulation in renal system neurotransmitters 416–417 nursing activity scale (NAS) 30, 31t–32t

I N D E X 807

nursing advocacy 87–88 organ dysfunction 567–569 external see external pacing
nursing care acute 567t transcutaneous see external pacing
essential see essential nursing care in endocrine system 568 pacing failure 273–274, 274b, 274f
for non-invasive cardiac diagnostic tests 210 adrenal insufficiency 568 PaCO 2 see partial pressure of carbon dioxide
Nursing Council of New Zealand, Code of glycaemia control 569 paediatric end-stage liver disease (PELD) scoring
Conduct for Nurses 79b, 80 hypocalcaemia 569 system 522
nutrition 508–509 steroid therapy 568–569 paediatrics
ARF and 488 in haematologic system 567–569 triage assessment presentations 585
assessment 509 in neurologic system 569 see also children; infants
of indices 509t organisational design, critical care pain 141–145
requirement determination 509 environment 22 assessment of 142–143
burns and 648 organophosphates 604–605 BPS for 142, 143f, 143t
enteral see enteral nutrition orientation 28 chest see chest pain
malnutrition consequences 509 oropharyngeal airways 383 CNPI for 142, 143t
parenteral see parenteral nutrition Guedel 383 CPOT for 142, 143t
support 509–513 oropharyngeal reflexes assessment 434 lung transplantation and 373
NYHA see New York Heart Association orthotopic 787 management of 143–145
functional classification of heart heart transplantation 311, 312f McGill short pain questionnaire 143t
failure liver transplantation 523 non-pharmacological treatment for 144, 144t
NZNO see New Zealand Nurses Organisations OSA see obstructive sleep apnea pathophysiology of 141–142
osmotherapy, for intracranial hypertension pharmacological treatment for 144–145,
management 452–453
145t
O overdose 596–611 post cardiac surgery 302
obese patients complication prevention 598–599, 599t research vignette 150b–151b
care of, essential 117–118 antidotes 599t VAS for 142, 143t
sedation 118 diagnostics 597 verbal numerical scale 142, 143t
VTE prophylaxis 118 physical assessment 597 pain management, palliative care and 172
positioning of 118 previous history 596–597 palliative care 87
objective assessment 787 suspected toxin 597 pain management and 172
obstetric haemorrhage 721–724 time of 597 patient comfort and 172
intra-operative cell salvage for 724 toxin absorption prevention 597–598 pandemic management 33–34
management of 723–724 contact poisons 598 critical care surge plan template 33–34
obstructive sleep apnea (OSA) 336 ingested poisons 597–598 research vignette 34b
occipital cortex 418–419, 422f inhaled poisons 598 surge plan development 33
oedema toxin elimination from blood 598 space 33
cerebral 448 haemodialysis 598 staff 33
conjunctival 108–109 haemoperfusion 598 supplies 33
extracellular (vasogenic) 448 urine alkalinisation 598 PaO 2 see partial pressure of oxygen
intracellular (cytotoxic) 448 see also specific drugs PAOP see pulmonary artery occlusion pressure
MODS and 565 oversensing 274–275, 274f, 275b PAP see pulmonary artery pressure monitoring
pulmonary 334–335, 345 oxygen PAR see patient-at-risk score
pathophysiology of 230, 231f, 334–335 fraction of inspired 392–393, 392t paracetamol poisoning 602
oesophageal balloon tamponade, for liver high-flow nasal vs high-flow face mask, parasympathetic nervous system 431, 432f
dysfunction 520–521 research vignette 375b–376b parenteral nutrition (PN) 513
oesophageal Doppler waveforms 205, 205f maintenance, respiratory failure and 354– see also total parenteral nutrition
off pump coronary artery bypass (OPCAB) 355 paroxysmal supraventricular tachycardia
293–294 toxicity 382, 382b (PSVT) 257
Office for Human Research Protections transport 331 partial brain tissue oxygenation monitoring 439
(OHRP) 82 oxygen consumption (VO 2 ) 331 partial pressure of carbon dioxide (PaCO 2 ) 342,
OHRP see Office for Human Research oxygen delivery (DO 2 ) 331 342t–343t
Protections determinants of 186f partial pressure of oxygen (PaO 2 ) 342, 342t
older child 787 oxygen masks 383 passive exercises 111
oligodendroglia 417, 419t oxygen optimisation compensatory pathophysiology
oliguric renal failure 787 mechanisms 334 of ARDS 363
on-line water 787 oxygen therapy 381–383 of ARF 483–486
OPCAB see off pump coronary artery bypass administration devices for 382 of asthma 365
operational budget 20 complications from 381–382 of burns 644–649
Operational Standard for Ethics Committee, CO 2 narcosis 381–382 of cellular dysfunction 563f
HRCNZ 82 hypoventilation 381–382 of DKA 526, 527f
opt-in donation 746–747, 787 oxygen toxicity 382, 382b of encephalitis 466–467
opt-out donation 787 indications for 381 of GBS 467
oral variable flow devices for 382–383 of ICH 471–472
assessment 109, 109b bag-mask ventilation 383 of myasthenia gravis 469
care, essential 109–110 high-flow nasal cannulae 382 of pain 141–142
hygiene 109–110, 787 low-flow nasal cannulae 382 of pneumonia 357
intubation, vs nasal intubation 385 oxygen masks 383 of pneumothorax 367
organ 787 Venturi systems 383 of preeclampsia 718b
Organ and Tissue Authority 747, 787 oxygen-haemoglobin dissociation curve of respiratory failure 353–354
organ donation 89–91 331–332, 332f secondary to fluid aspiration 613f
ANZICS and 89 of SCA 655
ICU nurse perception on, research of shock 539–541
vignette 760b P of skeletal trauma 629–630
identification of 749–755 P wave 194–195, 194f of TBI 454f, 455–457, 456f, 464t
legislation 747, 748t PAC see pulmonary artery catheter patient advocacy 86
nurses’ attitudes to and knowledge of 90–91 pacing patient dependency 24–26
organ donor care 755–757 cardiac see cardiac pacing patient positioning see positioning patient

808 I N D E X

patient safety see safety PINI see Prognostic Inflammatory Nutrition musculoskeletal assessment and 111t
patient-at-risk (PAR) score 51, 51t Index obesity and 118
patient-relevant outcomes 40, 40t PIRO staging system see predisposition, pressure area care 112–113
patients’ rights 80–83 infection, response, organ dysfunction rotational therapy 114
consent 80–83 placenta, role of 715–716 of trauma patient 626–627, 628t
to health information collection, use, placenta accreta 722b VTE prophylaxis and 114–115
disclosure 83 placenta praevia 721–722, 722b see also body positioning
to human research 82–83 placental abruption 721 positive end-expiratory pressure (PEEP) 108,
to treatment 81–82 plan-do-study-act (PDSA) 42 392t, 393–394
ethical principles application 83 plaque rupture 216, 216f positron emission tomography (PET), of
nurses’ code of ethics and 80 platelets, administration guidelines, cerebral perfusion 436
Payne-Martin classification system 107 hypovolaemic shock and 545t post dilution 787
PCT see dynamic perfusion computed pleura 326–328, 328f postcentral gyrus 418–419, 422f
tomography pleural effusion 345 posterior cord syndrome 460
PCWP see pulmonary capillary wedge pressure PN see parenteral nutrition postnatal depression (PND) 731
PDA see personal digital assistant PND see postnatal depression postpartum
PDH see pulmonary dynamic hyperinflation pneumonia 357–360, 591 depression 731
PDSA see plan-do-study-act aetiology of 357–359, 358t haemorrhage 721–722, 722b–723b
PDT see percutaneous dilatational technique clinical manifestations of 359–360 in ICU 735–738
PE see pulmonary embolism collaborative practice 360 breast care 736–738
peak airway pressure 392t, 395 medications 360, 361t breast feeding 736–738
PEEP see positive end-expiratory pressure community-acquired 357–358, 359t DVT 736
PELD see paediatric end-stage liver disease diagnosis of 358 lactation initiation 737–738, 737b, 737f
scoring system severity assessment scoring 358 lochia 736
pelvis hospital-acquired 358–359 perineal care 736
fracture classifications of 631f morbidity and mortality 360 uterine involution 735–736
stabilisation of 633–635 pathophysiology of 357 see also pregnancy
with binder application 634f pregnancy and 730 postrenal acute renal failure 484
with external fixateur 634f ventilator-associated 358–359 posttraumatic amnesia (PTA) scale 434–435,
penetrating injuries 643–644 diagnosis of 358–359 435t
perceptions 63 treatment of 358–359 posttraumatic stress disorder (PTSD) 63
percutaneous dilatational technique (PDT), Pneumonia Severity Index (PSI) 357 research vignette for 72b–73b
tracheostomy procedure using 386 pneumoperitoneum 345 posttraumatic stress symptoms (PTSS) 63,
percutaneous transluminal coronary angioplasty pneumothorax 345, 366–367, 636, 637f 64t–65t
(PTCA) 223–224, 223f clinical manifestations of 367 Post-Traumatic Stress Syndrome 10-Questions
nursing management after 223–224 collaborative practice for 367 Inventory (PTSS-10) 61
pericardial rub 191 medications 367, 368t potential multiorgan donor 787
pericardial tamponade, post cardiac pathophysiology of 367 PPE see personal protective equipment
surgery 300–301 tension 367 PPIs see proton pump inhibitors
pericarditis 227 PNS see peripheral nervous system PQRST, for chest pain assessment 217,
pericardium 181 poisoning 596–611 217t
perineal care, in postpartum patient 736 carbon monoxide 603 P-R interval 194–195, 194f
peripartum cardiomyopathy 725–726 Ciguatera 611, 612t practice development 787
peripheral chemoreceptors 329–330 complication prevention 598–599, 599t praecordial thump 660
peripheral nervous system (PNS) 430–431 antidotes 599t precentral gyrus 418–419, 422f
autonomic nervous system 431, 432f diagnostics 597 predilution 787
enteric 431 paracetamol 602 predisposition, infection, response, organ
parasympathetic 431, 432f physical assessment 597 dysfunction (PIRO staging
sympathetic 431, 432f previous history 596–597 system) 551, 551t
motor control 430–431 salicylate 601–602 preeclampsia 716–721, 718b–719b, 718t
sensory control 431 suspected toxin 597 pregnancy
peripheral reflex response 434 time of 597 ALS and 733
permanent pacing 277–279 toxin absorption prevention 597–598 amniotic fluid embolism 722
implantation activities 278 contact poisons 598 antepartum haemorrhage 721–722
parameters 278–279, 278f ingested poisons 597–598 ARDS and 364
personal digital assistant (PDA) 48–49 inhaled poisons 598 asthma and 726–727, 727f
personal hygiene 105–107 toxin elimination from blood 598 BLS and 733
assessment of 105–106 haemodialysis 598 cardiac disease and 727–729
basic 106–107 haemoperfusion 598 case study 739b
skin and tissue assessment 105–106, 106t urine alkalinisation 598 critical illness in 710–711, 711t
skin tears 107, 107t polymorphic ventricular tachycardias 263–264, ectopic 594
personal protective equipment (PPE) 120–121, 264f hepatobiliary changes in 714
787 polyneuropathy, critical illness 58 ICU and 731–735
respiratory pandemics and 362, 362t polysomnography (PSG) 145–146, 787 influenza and 730, 739b–740b
personnel budget 20 pons 421t–422t, 423 mechanical ventilation and 731–732
personnel information 787 population, intervention, comparison, outcome medication administration in 733–735
PET see positron emission tomography (PICO) format 39, 40t mental health disorders and 731
petroleum distillates 604 positioning patient 110–115 obstetric haemorrhage 721–724
PGD see primary graft dysfunction active and passive exercises 111 peripartum cardiomyopathy 725–726
pH 342, 342t–343t for ARDS 364 physiology adaptation of 711–716
phagocytosis 787 assessment 110–111 in cardiovascular system see cardiovascular
physical function, measurement of 60, 60t body position change 112 system
PiCCO see pulse contour cardiac output essential care goals 110 clinical implications of 716, 717t
PICO see population, intervention, comparison, factors to consider when 112t in gastrointestinal system see
outcome format mobilising and 111–115 gastrointestinal system

I N D E X 809

in haemostasis system see haemostasis psychosocial care, lung transplantation and 374 handheld technologies 48–49
system PTA scale see posttraumatic amnesia scale telehealth initiatives 49
in immune system see immune system PTCA see percutaneous transluminal coronary Quality in Australian Health Care Study
in liver see liver angioplasty (QAHCS) 42–43
maternal-fetal interface see maternal-fetal PTSD see posttraumatic stress disorder quality monitoring 42–49
interface PTSS see posttraumatic stress symptoms quality of life 85
in renal system see renal system PTSS-10 see Post-Traumatic Stress Syndrome quality use of medicines (QUM) 42
in respiratory system see respiratory system 10-Questions Inventory quantitative research 11
in white blood count see white cell count publication, ethics in 95 QUM see quality use of medicines
placenta accreta 722b puerperal psychosis 731
placenta praevia 721–722, 722b puerperium, psychology of 738
placenta role 715–716 pulmonary artery catheter (PAC) 200, 201f R
placental abruption 721 shock and 542 RAAS see renin-angiotensin-aldosterone system
pneumonia and 730 pulmonary artery occlusion pressure radiological materials 606
postpartum haemorrhage 721 (PAOP) 201–202 Ramsay Sedation Scale 141t
preeclampsia 716–721, 718b–719b, 718t pulmonary artery pressure (PAP) rapid eye movement (REM) 145–146
Rhesus disease prevention 733, 735t monitoring 200–201, 201f rapid response systems (RRS) 50–52
SCA and 669 waveform 202f afferent limb of 50–51
seatbelt position and 729, 729f pulmonary aspiration Australian Commission on Safety and Quality
trauma in 729–730 assessment of 512–513 in Health Care on 50
utero-placental gas exchange 716 prevention of 512 efferent limb of 51–52
preload 185–186, 199–202 pulmonary assessment, for CHF 231 elements of 50t
CVP monitoring 200 pulmonary capillary wedge pressure research on 52t
LAP monitoring 202 (PCWP) 186, 199–200, 296 rapid response team (RRT) 51
PAP monitoring 200–201, 201f monitoring of 201–202, 202f RAS see reticular activation system
PCWP monitoring 201–202, 202f pulmonary circulation 328, 328f–329f RASS see Richmond Agitation-Sedation Scale
prerenal acute renal failure 483–484 pulmonary contusion 636 RCA see right coronary artery; root cause analysis
preschool children, developmental pulmonary dynamic hyperinflation RCM see restrictive cardiomyopathy
considerations in 684–685 (PDH) 372–373, 372f, 788 RCSQ see Richards Campbell Sleep
pressure double-lumen ETT position for 372, 372f Questionnaire
area care 112–113 pulmonary embolism (PE) 114, 345, 367–369 real timing, in balloon deflation 304, 305b
control 396 assessment and diagnostics of 368 REBs see Research and Ethical Boards
sores clinical manifestations of 368 recipient 788
monitoring 113, 114t collaborative practice for 368–369 recombinant human activated protein C,
risk assessment 112–113, 112t–113t medications 369–374, 369t for septic shock 554
treatment of 113 risk factors for 368t recruitment manoeuvres (RMs) 401
vs time scalar 398–399, 399f pulmonary oedema 334–335, 345 red blood cell, administration guidelines,
ulcer 787 pathophysiology of 230, 231f hypovolaemic shock and 545t
pressure support ventilation (PSV) 392t, 393, pulmonary vascular resistance (PVR) 202–203 redback spider bite 606–607
396, 397t pulmonary volumes and capacities 330–331, reentry 252
pressure-controlled ventilation 787 330f reentry tachycardia 257–258, 258f
pressure-regulated volume control (PRVC) 397t, alveolar ventilation 331 refeeding syndrome 788
398, 787 pulmonic circulations 183f reflex(es)
pressure-volume loops 399–401, 400f–401f pulse, assessment of 190–191 controls 329f
primary graft dysfunction (PGD) 371 pulse contour cardiac output (PiCCO) 296 corneal 434
principles of practice 105, 106t pulse oximetry 339–340, 340f, 788 oropharyngeal 434
Prismaflex CRRT machine 499f research vignette 348b–349b refractory hypoxaemia management 401–402
privacy 788 pulse waveforms, ICP monitoring 437–438, ECMO 401–402
Privacy Act 1993 93–94 438f HFOV 401
privacy and confidentiality, health research pulse-induced contour 203–204, 204f nitric oxide 402
information and 93–95 pulseless ventricular tachycardia, ALS and recruitment manoeuvres 401
procoagulation, MODS and 565–566 663 regeneration, SCI and 462
professional organisations 5–6 pupil assessment 433 rehabilitation, in ICU 66
Prognostic Inflammatory Nutrition Index purchasing equipment 22–23 rejection 788
(PINI) 509 Purkinje fibers 184–185 of heart transplantation
prosthetic valves 294, 295f PVR see pulmonary vascular resistance acute 313, 313t, 318t
proteins, acute phase 783 hyperacute 313
protocol 788 relative humidity 389
proton pump inhibitors (PPIs) 516 Q religious beliefs and practices 170–171, 170t
PRVC see pressure-regulated volume control QAHCS see Quality in Australian Health Care recognising needs 171, 171t
pseudoaneurysm 244, 244f Study REM see rapid eye movement
PSG see polysomnography QI see quality improvement remote critical care management (eICU) 49
PSI see Pneumonia Severity Index QRS complex 194–195, 194f renal dialysis 482–483
PSV see pressure support ventilation Q-T interval 194, 194f history of 488–491, 488f, 489t
PSVT see paroxysmal supraventricular monitoring of, research vignette 287b nursing and 489, 490f
tachycardia qualitative research 11 renal replacement therapy refinement
psychological care quality improvement (QI) 42 and 490–491
anxiety 133–136 care bundles 43, 44t see also renal replacement therapy
case study 149b–150b case study 53b renal dysfunction
delirium 136–138 checklists 43–44 lung transplantation and 374
pain 141–145 information and communication post heart transplantation 318–319
sedation 138–141 technologies 44–49 renal failure
sleep 145–149 clinical information systems 44–48 acute see acute renal failure
psychological function, measurement of 60–61, computerised order entry and decision chronic 784
60t support 48 oliguric 787

810 I N D E X

renal replacement therapy (RRT) 788 hypercapnoeic 353–354 pulse oximetry 339–340, 340f
approaches to 491–501, 491f hypoxaemic 353, 354f ventilation 341
for ARF 488–490, 488b independent nursing practice 354–355 pandemics 360–362
continuous see continuous renal replacement NIV for 390 influenza 360
therapy oxygen maintenance and 354–355 isolation precautions and 362
convection 491–492 pathophysiology of 353–354 PPE and 362, 362t
diffusion 492 secondary to fluid aspiration 613f SARS 360–361
haemodiafiltration 491–492 type I 352–353, 354f pathophysiology 333–335
haemodialysis 491–492 type II 353–354 hypoxaemia 333–334, 334f
haemofiltration 491–492 post-anaesthesia support 357 inflammation 334
mode abbreviations for 491, 491t ventilation maintenance and 354–355 pulmonary oedema 334–335
refinement of 490–491 respiratory muscle innervation by cord pregnancy physiology adaptation of 713
ultrafiltration 492 level 556t breathing 713
renal system respiratory patterns 337t postpartum 713
anatomy of 480–483 brainstem injury and 449, 450f thorax 713
filtrate reabsorption 481f, 497–498 respiratory presentations, in ED 589–591 upper airway 713
GFR regulation 481f, 497–498 acute respiratory failure 591 pulmonary volumes and capacities 330–331,
glomerulus 480, 481f asthma 590, 591t 330f
kidneys 480, 480f pneumonia 591 alveolar ventilation 331
nephron 480, 480f–481f respiratory rate 392t, 393 support, for cardiogenic shock 550
urinary drainage system 480, 480f respiratory system ventilation control 328–330
urine production 481–482, 481f acid-base control 333 controller 328–329, 329f
hormonal and neural regulation in 482–483 alterations effectors 329
acid-base regulation 483, 483f case study 374b–375b sensors 329–330, 329f
ADH 482 incidence of 352–353, 353t work of breathing 331
ANP 483 anatomy of 326f, 328 responsible research practices 95
electrolyte balance 483 bronchial circulation 328 data use and disclosure 95
endocrine organ role 483 lower respiratory tract 326 ethics in publication 95
RAAS 482–483, 482f lungs 326–328, 327f resting potential 183–184
SNS 482 pleura 326–328, 328f restrictive cardiomyopathy (RCM) 242
liver transplantation and 524 pulmonary circulation 328, resuscitation 788
physiology of 480–483 328f–329f fluid see fluid resuscitation
pregnancy physiology adaptation of surfactant 326 injury to children and 700–701
713–714 thorax 326–328 SCI and 461
postpartum 714 upper respiratory tract 325–326, 327f SE and 470–471
renin-angiotensin-aldosterone system assessment 335–339 see also cardiopulmonary resuscitation
(RAAS) 190, 482–483, 482f auscultation 338–339, 338f, 339t reticular activation system (RAS) 421t–422t
heart failure and 228–229 current respiratory problems 335 retrieval 788
reperfusion therapy 221–224 documentation and charting 339 return of spontaneous circulation (ROSC) 788
research 11–12 family history 336 rhabdomyolysis 630
decision making in critical care nursing history-taking 335–336 Rhesus disease 733, 735t
8t–9t, 567–569 inspection 336–337, 337t rhythm
ethics in see ethics palpation 337–338, 338f post cardiac surgery, monitoring of 297
qualitative 11 personal history 336 sinus 252, 255f
quantitative 11 physical examination 336–339 strip 312f
responsible practices see responsible research previous respiratory problems 335 see also arrhythmias
practices symptoms 335–336 rib fractures 636
on RRS 52t bedside and laboratory investigations Richards Campbell Sleep Questionnaire
steps 11t 341–344 (RCSQ) 146, 146t
unconscious persons and 95 arterial blood gases 341–344 Richmond Agitation-Sedation Scale (RASS) 139,
Research and Ethical Boards (REBs) 91–92 blood tests 344 140f, 141t
research participant 788 nasopharyngeal aspirates 344 RIFLE criteria see risk, injury, and failure criteria
resistance 388–389 sputum sample 344 with outcomes of loss and end-stage
resources, ethical allocation and utilisation tracheal aspirates 344 renal disease
of 17–18 case study 348b right coronary artery (RCA) 182, 183f, 217
resourcing critical care services in children 682–683 right ventricular dysfunction, post heart
budget 20–22 compromise of, liver failure and 519 transplantation 316, 318t
case study 34b diagnostic procedures 344–347 right ventricular ejection fraction (RVEF) 203
economic considerations and principles bronchoscopy 347 right ventricular end-diastolic volume
19–20 chest x-ray 344–345, 345f, 346t (RVEDV) 203
equipment 22–23 CT 346 right ventricular end-diastolic volume index
historical influences 18–19 medical imaging 344–347 (RVEDVI) 203
pandemic management 33–34 MRI 347 right ventricular end-systolic volume
risk management 28–30 ultrasound 345–346 (RVESV) 203
staffing 23–28 V/Q scan 347 right ventricular end-systolic volume index
workload measures 30–33 disorders of see specific disorder (RVESVI) 203
respect for persons 788 dysfunction 371–373 right ventricular failure (RVF) 230–231, 230t
respiratory centres 329f gas transport principles 331–332 right ventricular stroke work index (RVSWI) 203
respiratory failure 353–357 carbon dioxide 332 rise time 392t, 394
acute 591 oxygen 331 risk 788
aetiology of 353 oxygen-haemoglobin dissociation risk, injury, and failure criteria with outcomes
clinical manifestations of 354 curve 331–332, 332f of loss and end-stage renal disease
collaborative practice 356, 356t V/Q ratio 332, 333f (RIFLE criteria) 486–487, 487f
medications 356 liver transplantation and 524 risk assessment scores 50–51, 51t
comorbidities and 356–357 monitoring of 339–341 risk management 28–30
elderly and 356 capnography 340–341, 341f clearly defined policies 29b

I N D E X 811

contingency plans and rehearsal 30 scales 139, 141t SIMV see synchronised intermittent mandatory
managing injury - staff, patient or visitor VICS for 139, 140f, 141t ventilation
29–30, 29b Sedation-Agitation Scale (SAS) 141t single photon emission computed tomography
negligence 28–29 sedative-hypnotic agent 136t (SPECT), of cerebral perfusion 436
research vignette 34b sedatives single-lung transplantation (SLTx) 370
role of leadership and management 29 benzodiazepine 136t sinoatrial (SA) node 184–185
RMs see recruitment manoeuvres for intracranial hypertension and atria arrhythmias 252–254, 253f
roller pump 495, 495f management 453 sinus arrest 253–254, 254f
root cause analysis (RCA) 30, 788 non-benzodiazepine 136t sinus arrhythmia 253, 254f
ROSC see return of spontaneous circulation SEE see Sentinel Events Evaluation study sinus bradycardia 253, 253f
rostering 27 seizures 446 sinus exit block 253–254, 254f
calculating staff requirements 27f in children 696–697 sinus pause 253–254, 254f
rotational therapy 114 Sellick manoeuvre 385 sinus tachycardia 252–253, 253f
RQOL see health-related quality of life Sengstaken-Blakemore tube 520–521, 522f sinus arrest 253–254, 254f
R-R intervals 195 sensing failure 272–273, 273f sinus arrhythmia 253, 254f
RRS see rapid response systems sensory control 431 sinus bradycardia 253, 253f
RRT see rapid response systems; renal sensory function alterations 446–447 sinus exit block 253–254, 254f
replacement therapy sensory overload 788 sinus pause 253–254, 254f
rule of nines 646f Sentinel Events Evaluation (SEE) study 28 sinus rhythm 252, 255f
RVEDV see right ventricular end-diastolic sepsis 551–552, 552t, 788 sinus tachycardia 252–253, 253f
volume bundle types 552b SIRS see systemic inflammatory response
RVEDVI see right ventricular end-diastolic from catheters 122 syndrome
volume index in children 682–683 SjvO 2 see jugular venous oxygenation
RVEF see right ventricular ejection fraction severe 551, 552t, 788 skeletal trauma 629–635
RVESV see right ventricular end-systolic volume EGDT in 571t fat embolism and 630
RVESVI see right ventricular end-systolic volume sepsis-induced hypotension 788 neurovascular observations in 632t
index septic shock 551–552, 788 pelvic fracture classifications 631f
RVF see right ventricular failure antimicrobial therapy for 553 rhabdomyolysis and 630
RVSWI see right ventricular stroke work clinical manifestations of 552–553 skill mix 26–27, 788
collaborative management in 553–554 skin and tissue assessment 105–107
S diagnosis of 553 skin tears 107
drug therapy for 553–554
treatment of 107t
S1 see first heart sound inotrope 554 skull fractures, TBI and 457
S2 see second heart sound recombinant human activated protein SLED see slow low efficiency dialysis
S3 see ventricular gallop C 554 sleep 145–149
S4 see late diastolic heart sound steroids 554 actigraphy and 146
SA see sinoatrial node vasopressors 554 assessment of 146, 146t
sacculated aortic aneurysm 244, 244f fluid resuscitation for 553 care activities for 147
safety 49–52 nursing practice in 553–554 comfort measures for 147
culture 50 progression of 566f environment and 147
monitoring 42–49 source control of 553 maintenance of 147–149
rapid response systems 50–52 Sequential Organ Failure Assessment (SOFA) medications for 148, 148t
afferent limb of 50–51 score 570, 570t melatonin and 149
efferent limb of 51–52 severe acute respiratory syndrome (SARS) monitoring of 146
research on 52t 360–361, 788 NOC for 146, 146t
Safety Attitudes Questionnaire (SAQ) 50 personal protective equipment and 121 non-REM 145–146
SAH see subarachnoid hemorrhage severe sepsis 551, 552t, 788 promotion of 147–149
salicylate poisoning 601–602 EGDT in 571t PSG and 145–146
saphenous vein graft (SVG) 293 SF-36 (medical outcomes study) 59–60, 59t RCSQ for 146, 146t
SAPS see simplified acute physiology score shock REM 145–146
SAQ see Safety Attitudes Questionnaire anaphylaxis see anaphylaxis SICQ for 146, 146t
SARS see severe acute respiratory syndrome cardiogenic see cardiogenic shock SWS 145–146
SARS coronavirus (SARS-CoV) 121 case study 557b treatments for 147–148
SARS-CoV see SARS coronavirus in children 695–696 TST 145–146
SAS see Sedation-Agitation Scale assessment 695–696 Sleep in Intensive Care Questionnaire
SBTs see spontaneous breathing trials clinical manifestations of 695 (SICQ) 146, 146t
SCA see sudden cardiac arrest diagnostics 695–696 slow low efficiency dialysis (SLED) 788
school-age children, developmental management of 696 slow wave sleep (SWS) 145–146
considerations in 685 distributive see distributive shock states SLTx see single-lung transplantation
Schwann cells 417, 419t effective resuscitation 571 snake bites 608–610, 609t
SCI see spinal cord injury hypovolaemic see hypovolaemic shock SNS see sympathetic nervous system
SE see status epilepticus invasive assessment for 542 SOFA see Sequential Organ Failure Assessment
seatbelt position, pregnancy and 729, 729f lactate production and 540, 541t score
second heart sound (S2) 191 management principles of 542, 542b soma 414–415, 416f
secondary brain injury, prevention of 472 neurogenic see neurogenic shock somnolence 445–446
second-degree atrioventricular block 260–261, non-invasive assessment for 541–542 space, surge plan development and 33
260f PAC and 542 Spanish influenza 361
sedation 138–141 pathophysiology of 539–541 spastic flexor 433–434
assessment of 138–140 patient assessment for 541–542 specialist critical care competencies 5
BIS monitoring 139–140 physiological changes in 541, 541t SPECT see single photon emission computed
MAAS for 141t septic see septic shock tomography
obese patients and 118 spinal see spinal shock spinal cord 428–430, 429f–430f
protocols 140–141 types of 539, 540t spinal cord injury (SCI) 457–462
Ramsay Sedation Scale for 141t SICQ see Sleep in Intensive Care Questionnaire anterior cord syndrome 460
RASS for 139, 140f, 141t simplified acute physiology score (SAPS) 26, Brown-Sêquard syndrome 460
SAS for 141t 570 central cord syndrome 460

812 I N D E X

classification of 458–460 H 2 RAs 516 sympathetic nervous system (SNS) 431, 432f,
mechanisms of 457–458 PPIs 516 788
nursing practice 461–462 sucralfate 516 heart failure and 228, 229f
collaborative management 462 protective mechanisms 515t renal system and 482
investigations and alignment 461–462 risk factors for 515 synapses 415–417, 417t, 418f
neuroprotection 462 stroke 462–463 synchronised intermittent mandatory ventilation
regeneration 462 acute, ED presentation and 594–596 (SIMV) 396, 397t, 788
resuscitation 461 aetiology of 462 systemic circulations 183f
pathophysiology of 460–461 cerebral venous thrombosis 464 systemic inflammatory response syndrome
posterior cord syndrome 460 collaborative management of 464 (SIRS) 551, 552t, 788
systemic effects of 461 haemorrhagic 463 progression of 566f
spinal meninges 429f ischaemic 463, 463t systemic vascular resistance (SVR) 202
spinal orthoses 635 fibrinolytic therapy in 595b pregnancy and 712
spinal precautions 635t SAH 463–464, 464t
spinal shock 461, 556–557 stroke volume (SV) 203
clinical manifestations of 556 pregnancy and 712 T
collaborative management for 556–557 structural abnormalities, cardiac surgery T wave 194, 194f
nursing practice in 556–557 for 291–293 tachyarrhythmias 252
respiratory muscle innervation by cord aortic valve disease 292–293 supraventricular, AV conduction during 255,
level 556t ischaemic heart disease 293 256f
spiritual wellness 171 mitral valve disease 293 tachycardia 190–191, 262–263, 263f
spleen injury 642–643 valvular disease 291–293, 292f atrial 255, 255f
spleen injury scale 643t structural defects 227 atrioventricular nodal reentry 257–258,
split-liver transplantation 523, 523f stupor 445 258f
spontaneous breathing trials (SBTs) 403 subarachnoid hemorrhage (SAH) 463–464, ICDs and, detection and classification
sputum analysis 336 464t of 283–284, 284f
sputum sample 344 submersion incident 788 multifocal atrial 255, 255f
ST elevation acute coronary syndrome substituted judgement principle 86 paroxysmal supraventricular 257
(STEACS) 218 sucralfate 516 polymorphic ventricular 263–264, 264f
ST elevation myocardial infarction (STEMI) sudden cardiac arrest (SCA) 788 reentry 257–258, 258f
218 aetiology of 654–655 sinus 252–253, 253f
St Jude Medical mechanical heart valve 295f causes of 655t supraventricular 254
ST segment 194, 194f chain of survival 656, 656f ventricular pulseless, ALS and 663, 665f
staffing 23–28 cooling techniques after 671, 671b, TAD see thoracic aortic dissection
critical care nursing 673b–674b TBI see traumatic brain injury
ACCCN position statement 24, 26 drowning and 669–670 TBSA see total body surface area assessment
WFCCN position statement 23–24 early recognition of 656–657, 656t TCD see transcranial Doppler ultrasound
education and training 27–28 electrical injuries and 669 Team Strategies and Tools to Enhance
expected standards 24, 25t fluid resuscitation during 666 Performance and Patient Safety
levels 24 incidence of 654–655 (TeamSTEPPS) 50
nurse-to-patient ratios 24, 25t maternal algorithm for 734b TeamSTEPPS see Team Strategies and Tools to
patient dependency 24–26 pacing 666 Enhance Performance and Patient
requirement calculation 27f pathophysiology of 655 Safety
roles 23–24 pregnancy and 669 technical practice development (tPD) 788
rostering 27 resuscitation systems and processes teeth cleaning 109
skill mix 26–27 655 TEG see thromboelastograph
surge plan development and 33 in-hospital survival 655 telehealth initiatives 49
STAI see State Trait Anxiety Inventory out-of-hospital survival 655 temporal cortex 418–419, 422f
Standard Precautions 118, 120 roles during 670 tenecteplase 221
standard transplant technique 311 ceasing CPR 671 tension pneumothorax 367
Starr-Edwards caged-ball valve 295f family presence during 670–671 terminal care, ICDs and 284
State Trait Anxiety Inventory (STAI) 61 postresuscitation phase 671 TGA see Therapeutic Goods Administration
status epilepticus (SE) 470–471 ultrasound imaging and 666–669 thalamus 788
clinical manifestations of 470 supplies, surge plan development and 33 Therapeutic Goods Administration (TGA)
nursing practice 470–471 supraventricular tachyarrhythmias, AV 95–96
collaborative practice 471 conduction during 255, 256f therapeutic intervention scoring system
post-SE assessment 471 supraventricular tachycardia (SVT) 254 (TISS) 26, 30–33, 31t
resuscitation 470–471 surfactant 326 thermodilution methods 203
pathophysiology of 470 surge plan development 33 third-degree atrioventricular block 261, 261f
statute law 80 critical care template 33–34 thoracic aortic dissection (TAD) 592–593
STEACS see ST elevation acute coronary space 33 thoracic expansion, assessment of 338f
syndrome staff 33 Thoratec USA VAD 310f
STEMI see ST elevation myocardial infarction supplies 33 thorax 326–328
steroid therapy 568–569 surgical technique (ST), tracheostomy procedure three-dimensional ECHO 206
for septic shock 554 using 386 thromboelastograph (TEG) 300
stethoscope 191t surrogate outcomes 40, 40t thrombolysis
stimulants, CNS, overdose of 600–601 surveillance, rates of nosocomial nursing care for 224
streptokinase 221 infections 119–120 nursing management after 221–223
stress 788 Surviving Sepsis campaign 551–552, 572b Thrombolysis in Myocardial Infarction (TIMI)
stress response actions, MODS and 566t SV see stroke volume flow grades, in coronary arteries
stress-related mucosal disease 513–516 SVG see saphenous vein graft 219–220, 221t
injury promoting factors to 515t SVR see systemic vascular resistance thrombolytic therapy 221–223
prevention of 515–516 SVT see supraventricular tachycardia thrombophylaxis 720
antacids 515–516 swine-origin influenza A virus 362 thrombotic microangiography 788
enteral nutrition 516 SWS see slow wave sleep tidal volume (V T ) 330, 392t, 393, 394t, 788

I N D E X 813

time scalar transplant 747–749, 789 TSANZ see Transplantation Society of Australia
vs flow 399, 400f heart see heart transplantation and New Zealand
vs pressure 398–399, 399f liver see liver transplantation TST see total sleep time
vs volume 399, 400f lung see lung transplantation 12-lead echocardiogram (ECG) 192–195
TIMI see Thrombolysis in Myocardial Infarction Transplant Nurses Association (TNA) 789 chest lead position 193, 193f
flow grades Transplantation Society of Australia and New Einthoven triangle 192–193, 192f
timing, IABP and Zealand (TSANZ) 789 graph paper 193–194, 193f
assessment 306 transport of critically ill patients 123–125 heart rate calculation using 195
conventional 304 assessment before 123, 124b interpretation of 195
errors 306 equipment for 124, 124t key components of 194–195
real 304, 305b intrahospital 124 MI and 218
TIPS see transjugular intrahepatic portosystemic monitoring during 125, 125t evolution pattern 218, 219f–220f
stent/shunt nursing care during 124–125 normal 194f
TISS see therapeutic intervention scoring system transpulmonary gradient (TPG) 789 two-dimensional ECHO 206
tissue 788 transthoracic bioimpedance 205–206
assessment see skin and tissue assessment transthoracic ECHO 206
donation trauma U
identification of 749–755 to abdomen see abdominal trauma U wave 194–195, 194f
legislation 747, 748t amputations 633 ulcer, pressure 787
typing and cross-matching 755–756 cardiac 636 ultrafiltration 492, 789
factor pathway 564f to chest 635–639 ultrasonic cardiac output monitor 205
hypoxia 334 in children 702 ultrasound
typing 788 clinical manifestations of 637t Doppler 204–205, 205f
tissue-only donors 758, 788 drainage assessment 639t methods 204–205, 205f
tissue-plasminogen activator (tPA) 221 children and 700–702 transcranial, for nervous system
TNA see Transplant Nurses Association clinical presentations 626–649 assessment 439
toddlers generic nursing practice 626–629 for fetal assessment 732
developmental considerations in 684 injury mechanism 626 for ICU-AW 58
see also children mobilisation 626–627, 628t respiratory system and 345–346
TOE see transoesophageal ECHO positioning 626–627, 628t SCA and 666–669
Torres Strait Islander people, working with trauma triad see trauma triad TCD, for nervous system assessment 439
168–170 in pregnancy see trauma unconsciousness 789
total body surface area (TBSA) assessment skeletal see skeletal trauma research involving 95
646 systems and process 623–626 unethical 785
total parenteral nutrition (TPN) 513 prehospital care 624 Uniform Determination of Death Act, US 88
components of 513, 513t radiological investigations 625–626 unstable angina 216
elements in 513, 513t reception 624–626 upper airway obstruction, in children 686–691
metabolic complications of 513, 514t surveys 625 congenital abnormalities 687
total sleep time (TST) 145–146 teams 626, 626t croup 689–690, 690t
toxin see overdose; poisoning transport of critically ill 624 description of 686–687
tPD see technical practice development trauma triad 627–629 diagnostics for 687
TPG see transpulmonary gradient coagulopathy 628–629 epiglottitis 690, 690t
tracheal aspirates 344 damage-control surgery 629 foreign body aspiration 690–691
tracheal suction 387 hypothermia 628 intubation for 687–688, 688f, 689t
adverse effects of 387 traumatic brain injury (TBI) 455–457 management of 687–688
methods of 387 aetiology of 455 manifestations of 686–687
closed 387 diffuse axonal injury 456–457, 457f monitoring of 687
open 387 focal injury 456 upper respiratory tract, anatomy of 325–326,
semi-closed 387 mild 457 327f
tracheobronchial injuries 636 nurse management 457 urinary catheterisation
tracheostomy 386–387 pathophysiology of 455–457, 456f, 464t assessment of 116
care of 387 skull fractures 457 bladder washout solutions 117t
complications of 387 treatment options, approaches to assessing 19t care of 116–117
procedure 386–387 Treaty of Waitangi 166 essential 117
using percutaneous dilatational triage 582–585 maintenance of 117
technique 386 assessment 583–585 urinary drainage system 480, 480f
using surgical technique 386 aids to 585t urine analysis, normal values 781t
suctioning of 387 approaches to 584–585 urine production 481–482, 481f
training, education and 27–28 of mental health presentations 585, uterine involution, in postpartum patient
TRALI see transfusion-related acute lung injury 585t 735–736
tramadol hydrochloride 145t of paediatric presentations 585 utero-placental gas exchange 716
transactional leaders, characteristics of 9–10 patient history/interview 583 utilitarian view 18, 789
transcranial Doppler (TCD) ultrasound, for physical examination 583–584
nervous system assessment 439 primary survey 583
transcutaneous pacing see external pacing secondary survey 583–584 V
transducer system, in haemodynamic case study 616b–617b vaccinations, influenza 362
monitoring 196 categories 583 VADs see ventricular assist devices
transformational leadership 9–10, 788 codes 582t valves
transfusion-related acute lung injury disaster 588–589 prosthetic 294, 295f
(TRALI) 363 history of 582 repair and replacement of 294, 295f
transjugular intrahepatic portosystemic multiple patient 588–589 see also specific valves
stent/shunt (TIPS), for liver process of 582–583 valvular disease 291–293, 292f
dysfunction 520–521 processes development 582 vancomycin-resistant Enterococcus (VRE) 121
Transmission-based Precautions 118–119, 119t triggered activity 252 Vancouver Interactive and Calmness Scale
transoesophageal (TOE) ECHO 206 trypsin 789 (VICS) 139, 140f, 141t

814 I N D E X

VAP see ventilator-associated pneumonia settings for 299t W
variable flow oxygen therapy devices 382–383 weaning approaches 298 walking, ICU mobility and 66
bag-mask ventilation 383 respiratory failure and 354–355 ward-based ICU recovery 68
high-flow nasal cannulae 382 see also mechanical ventilation warm ischaemia 789
low-flow nasal cannulae 382 VentrAssist 310f WCC see white cell count
oxygen masks 383 ventricular aneurysm 245 Wenckebach 260
Venturi systems 383 ventricular arrhythmias 259f, 261–264, 262f wet drowning 789
variceal bleeding, liver failure and 519 ectopy patterns 262, 262b WFCCN see World Federation of Critical Care
varices, liver failure and 519 fibrillation 263, 264f Nurses
VAS see visual analogue scale ALS and 663, 665f whαnau 166–168
VAS-A see visual analogue scale-anxiety flutter 263, 263f white cell count (WCC) 344
vascular access catheters 789 management of 264 pregnancy physiology adaptation of 715
for CRRT 493–495, 494f medications for 253f, 265, 266t wireless applications 48–49
vascular insufficiency 484 polymorphic ventricular tachycardias withdrawal flexor 433–434
vascular system 189–190, 189f 263–264, 264f withdrawing/withholding treatment 83–84
blood pressure 189–190 tachycardia 262–263, 263f WOB see work of breathing
autonomic control of 190 ALS and 663, 665f work of breathing (WOB) 331, 789
hormonal control of 190 ventricular assist devices (VADs) 308–309, 310f, cardiogenic shock and 550
renal control of 190 789 changes to 335
vasoactive 789 ventricular diastole workload measures 30–33, 31t
vasopressors 789 early 188 nursing activities scale 30, 31t–32t
for septic shock 554 late 188 therapeutic intervention scoring system 26,
veins 189, 189f ventricular dysfunction, post heart 30–33, 31t
venous air-trap 789 transplantation World Federation of Critical Care Nurses
venous blood gases, normal values of 782t left 316–317, 318t (WFCCN) 5–6
venous return line bubble trap chamber 495– right 316, 318t Declaration of Buenos Aries: workforce
496, 495f ventricular ectopic beats 297 765–766
venous thromboembolism (VTE) ventricular escape rhythms 258–259, 259f Declaration of Madrid: education 763–764
prophylaxis 114–115 ventricular gallop (S3) 191 Declaration of Manilla: patient rights 767
see also deep vein thrombosis; pulmonary ventricular pacing 268–269, 269f Declaration of Vienna: patient safety in
embolism ventricular systole 188 intensive care medicine 49,
venovenous (VV) circuit 789 ventriculostomy 437 768–772
ventilation control 328–330, 341 Venturi systems 383 staffing 23–24
controller 328–329, 329f verbal numerical scale 142, 143t
effectors 329 VICS see Vancouver Interactive and Calmness
sensors 329–330, 329f Scale X
ventilation support videoconferencing 49
ARDS and 364 visiting practices, of family 159–160 XeCT see xenon-enhanced computed
see also mechanical ventilation visual analogue scale (VAS) 142, 143t tomography
ventilation to perfusion (V/Q) visual analogue scale-anxiety (VAS-A) 134, xenon-enhanced computed tomography (XeCT),
mismatch 334f, 353, 354f 135t of cerebral perfusion 436
ratio 332, 333f VO 2 see oxygen consumption x-ray
scan, respiratory system and 347 volume of chest 207–209
ventilator-associated pneumonia (VAP) 122, control 396 for cardiac condition diagnosis 208–209
358–359, 789 vs time scalar 399, 400f interpretation of 207–208, 209f
diagnosis of 358–359 volume-controlled ventilation 789 respiratory system and 344–345, 345f,
prevention strategies for 122t voluntary 789 346t
research vignette 127b–128b V/Q see ventilation to perfusion nurse-initiated, in ED 586
treatment of 358–359 VRE see vancomycin-resistant Enterococcus
ventilatory support V T see tidal volume Y
complications of 355t VTE see venous thromboembolism
post cardiac surgery 298, 299t VV see venovenous circuit younger child 789