• F A Davis Company Always at your side Critical care 2nd Edition 4223_FM_ii-vi 28/08/14 4:13 PM Page ii Contacts • Phone/E-Mail Name Ph: e-mail: Name Ph: e-mail: Name Ph: e-mail: Name Ph: e-mail: Name Ph: e-mail: Name Ph: e-mail: Name Ph: e-mail: Name Ph: e-mail: Name Ph: e-mail: Name Ph: e-mail: Name Ph: e-mail: Name Ph: e-mail: 4223_FM_ii-vi 28/08/14 4:13 PM Page iii Critical Care 2nd Edition Notes Clinical Pocket Guide Janice Jones, PhD, RN, CNS Brenda Fix, MS, RN NP Purchase additional copies of this book at your health science bookstore or directly from F.A Davis by shopping online at www.fadavis.com or by calling 800-323-3555 (US) or 800-665-1148 (CAN) A Davis’s Notes Book 4223_FM_ii-vi 28/08/14 4:13 PM Page iv F A Davis Company 1915 Arch Street Philadelphia, PA 19103 www.fadavis.com Copyright © 2009, 2015 by F A Davis Company All rights reserved This book is protected by copyright No part of it may be reproduced, stored in a retrieval system, or transmitted in any form or by any means, electronic, mechanical, photocopying, recording, or otherwise, without written permission from the publisher Printed in China by Imago Last digit indicates print number: 10 Publisher, Nursing: Robert G Martone Director of Content Development: Darlene D Pedersen Content Project Manager: Jacalyn C Clay Illustration and Design Manager: Carolyn O’Brien Reviewers: Katrina Allen-Thomas, MSN, CCRN, RN; Marilu Alltop, MSN, RN, CNE; Mallory Antico, MSN, RN; Lisa Ann Behrend, RN, MSNc, CCRN-CSC; Cynthia Berry, RN, DNP, CNE; Laura Carousel, MSN, RN, CCRN; Melanie Cates, RN, HBScN, MSN, ENC(C); Nancy L Denny, MSN, RN-BC; Abimbola Farinde, PharmD, MS; Sarah Gabua, MSN, RN; Jayme Haynes, MSN, RN; Jeanie Krause-Bachand, MSN, EdD, RN, BC; Janice Garrison Lanham, RN, MSN, CCNS, FNP; Deborah Little, MSN, RN, CCRN, CNRN, APRN, BC; Angela Medina, RN, MSN; Candi MillerMorris, MSN, RN, CNS, CCRN, CEN, TNS; Michelle Murphy-Rozanski, PhD, MSN, RN, CRNP; Deborah Pool, MS, RN, CCRN; Margaret Sherer, MS, RN, CEN, CNE; Denise A Tucker, DSN, RN, CCRN; Tamra Weimer, RN, MS, CCRN, CNE; Danette Wood, EdD, MSN, RN, CCRN; Shawn Zembles, DNP, RN, CCRN, ACNS-BC As new scientific information becomes available through basic and clinical research, recommended treatments and drug therapies undergo changes The author(s) and publisher have done everything possible to make this book accurate, up to date, and in accord with accepted standards at the time of publication The author(s), editors, and publisher are not responsible for errors or omissions or for consequences from application of the book, and make no warranty, expressed or implied, in regard to the contents of the book Any practice described in this book should be applied by the reader in accordance with professional standards of care used in regard to the unique circumstances that may apply in each situation The reader is advised always to check product information (package inserts) for changes and new information regarding dose and contraindications before administering any drug Caution is especially urged when using new or infrequently ordered drugs Authorization to photocopy items for internal or personal use, or the internal or personal use of specific clients, is granted by F A Davis Company for users registered with the Copyright Clearance Center (CCC) Transactional Reporting Service, provided that the fee of $.25 per copy is paid directly to CCC, 222 Rosewood Drive, Danvers, MA 01923 For those organizations that have been granted a photocopy license by CCC, a separate system of payment has been arranged The fee code for users of the Transactional Reporting Service is: 978-0-8036-4223-3/15 + $.25 4223_FM_ii-vi 28/08/14 4:13 PM Page v Sticky Notes ✓HIPAA Compliant ✓OSHA Compliant Waterproof and Reusable Wipe-Free Pages Write directly onto any page of Critical Care Notes with a ballpoint pen Wipe old entries off with an alcohol pad and reuse BASICS CV MULTISYS CC MEDS RESP TOOLS GU NEURO GI HEMA/ ONCO ENDO 4223_FM_ii-vi 28/08/14 4:13 PM Page vi Look for other Davis’s Notes titles! RN Notes Nurse’s Clinical Pocket Guide Psych Notes Clinical Pocket Guide MedSurg Notes Nurse’s Clinical Pocket Guide NCLEX-RN® Notes Content Review & Exam Prep For a complete list of Davis’s Notes and other titles for health care providers, visit www.fadavis.com 4223_Tab01_001-044 29/08/14 10:46 AM Page 1 Physical Assessment Reusable Assessment Form Pt Identifier: Diagnosis: Room: Age: Diet: DNR/DNI: Surgeries/Past Hx: Activity: Allergies: Neurological/MS: ICP: Cardiac: VS/A-line: ECG: Hemodynamics: PAD IABP: Respiratory: Ventilator: ABGs/SpO2: GI: GU: Wounds/Incisions: Drainage tubes: Treatments: Special needs: Other: BASICS PAS PCWP CVP 4223_Tab01_001-044 29/08/14 10:46 AM Page BASICS Normal Arterial and Venous Blood Gases Blood Gas Components Arterial 7.35–7.45 80–100 mm Hg 35–45 mm Hg 22–26 mEq/L or mmol/L –2 to +2 mEq/L or mmol/L 95%–100% pH PO2 PCO2 HCO3Base excess (BE) O2 saturation Venous 7.31–7.41 35–40 mm Hg 41–51 mm Hg 22–26 mEq/L or mmol/L –2 to +2 mEq/L or mmol/L 68%–77% Values denoted are at sea level Quick Blood Gas Interpretation PCO2 ↑ HCO3- ↓ ↑ ↓ and (+) base excess ↑ and (–) base excess ↓ ↑ ↓ ↓ if compensating ↑ if compensating ↑ ↑ if compensating ↓ if compensating ↓ ↑ ↓ ↑ Acid-Base Disorder Respiratory acidosis Respiratory alkalosis Metabolic acidosis Metabolic alkalosis Mixed respiratory and metabolic acidosis Mixed respiratory and metabolic alkalosis pH Full or total compensation: pH will be within normal limits ↑ ↓ 4223_Tab01_001-044 29/08/14 10:46 AM Page 3 Blood Gas Results Arterial Venous pH PO2 PCO2 HCO3Base excess (BE) O2 saturation Compensation: ■ Respiratory problem → the kidneys compensate by conserving or excreting HCO3■ Metabolic problem → the lungs compensate by retaining or blowing off CO2 Also look for mixed respiratory and metabolic problems PaCO2 or HCO3- in a direction opposite its predicted direction or not close to predictive value May result from cardiac arrest, vomiting with renal failure and COPD as comorbidities, and salicylate toxicity Common Causes of Acid-Base Imbalances Respiratory acidosis Respiratory alkalosis Metabolic acidosis Metabolic alkalosis BASICS COPD, asthma, head injury, pulmonary edema, aspiration, pneumonia, ARDS, pneumothorax, cardiac arrest, respiratory depression, CNS depression, or head injury Hyperventilation, anxiety, fear, pain, fever, sepsis, brain tumor, mechanical overventilation Diabetes mellitus, acute and chronic renal failure, severe diarrhea, alcoholism, starvation, salicylate overdose, pancreatic fistulas Loss of gastric acid (vomiting, gastric suction), long-term diuretic therapy (thiazides, furosemide), excessive NaHCO3 administration, hypercalcemia 4223_Tab01_001-044 29/08/14 10:46 AM Page BASICS Pulse Oximetry SpO2 monitoring may be intermittent or continuous Indirectly monitors oxygen saturation SpO2 Level >95% 91%–94% 85%–90%