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Advanced Practice in Critical Care


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Table of Contents

Preface ix Contributors and acknowledgements xi 1 Challenges in contemporary critical care 1 Sarah McGloin Introduction 1 Critical care without walls 1 Advanced practice 2 Interprofessional roles within critical care 5 Conclusion 7 References 7 2 The physiological basis of critical illness 9 Mark Ranson Introduction 9 Patient scenario 9 Mechanisms of cellular damage 10 Impact of reduced perfusion on energy production 12 Evaluation of ischaemia: reperfusion injury 13 The inflammatory response and the role of mediators 14 Mechanisms for haemostasis in relation to critical illness 19 Conclusion 25 References 25 3 The patient with haemodynamic compromise leading to renal dysfunction 26 Tracey Bowden and Anne McLeod Introduction 26 Patient scenario 26 Underlying physiology and pathophysiology 27 Assessment and diagnosis 31 Evidence-based care 35 Ongoing patient scenario 39 Progressing pathophysiology 40 Ongoing assessment 47 Evidence-based care 54 Conclusion 65 References 65 4 The septic patient 71 Sarah McGloin Introduction 71 Patient scenario 71 Underlying physiology and pathophysiology 72 Assessment and diagnosis 76 Evidence-based care 81 Ongoing patient scenario 83 Progressing pathophysiology 84 Ongoing assessment 91 Evidence-based care 91 Conclusion 100 References 101 5 The patient with acute respiratory failure 105 Anne McLeod Introduction 105 Patient scenario 105 Underlying physiology and pathophysiology 106 Assessment and diagnosis 109 Arterial blood gas analysis 114 Evidence-based care 122 Ongoing patient scenario 127 Progressing pathophysiology 127 Ongoing assessment 128 Evidence-based care 136 Conclusion 140 References 140 6 The patient with chronic respiratory failure 143 Glenda Esmond and Anne McLeod Introduction 143 Patient scenario 144 Underlying physiology and pathophysiology 144 Assessment and diagnosis 145 Evidence-based care 148 Ongoing patient scenario 152 Weaning from ventilatory support 153 Ongoing care 157 Conclusion 158 References 158 7 The patient with an intracranial insult 161 Anne McLeod Introduction 161 Patient scenario 161 Underlying physiology and pathophysiology 162 Assessment and diagnosis 167 Evidence-based care 168 Ongoing patient scenario 172 Progressing pathophysiology 174 Ongoing assessment 177 Evidence-based care 180 Conclusion 185 References 185 8 The patient with a traumatic injury 188 Elaine Cole and Anne McLeod Introduction 188 Patient scenario 188 Mechanisms of injury 189 Assessment and diagnosis 190 Primary and secondary surveys 191 Underlying physiology and pathophysiology 192 Evidence-based care 193 Continuing patient scenario 196 Evidence-based care 197 Ongoing patient scenario 200 Progressing pathophysiology 201 Ongoing assessment 203 Evidence-based care 207 Management of his pelvic injury 211 Conclusion 212 References 212 9 The patient with a diabetic emergency 215 Sarah McGloin Introduction 215 Patient scenario 215 Underlying physiology and pathophysiology 216 Underlying pathophysiology 217 Assessment and diagnosis 221 Evidence-based care 223 Ongoing care 225 Conclusion 226 References 226 10 The long-term patient in intensive care unit 228 Phillipa Tredant Introduction 228 Patient scenario 228 Impact of being in the critical care environment 228 Psychological effects 230 Underlying physiology and physiological effects 235 Quality of life 240 Rehabilitation process 241 Conclusion 245 References 245 11 Ethical considerations in critical care 247 Anne McLeod Introduction 247 Patient scenario 247 Admission to critical care 247 What are ethics? 248 Biomedical ethical model 250 The role of outreach 252 Ongoing patient scenario 254 Futile situations 254 Withdrawal/withholding of treatment or euthanasia? 254 Patient autonomy 256 The process of withdrawing or withholding treatment 256 Role of the nurse 257 Collaborative decision-making 257 Conclusion 258 References 258 Index 261

About the Author

Sarah McGloin is Senior Lecturer in Acute Care at Anglia Ruskin University, UK. Anne McLeod is Senior Lecturer Critical Care at City University, UK.

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