Advanced Practice in Critical Care: A Case Study Approach

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