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Adult-Gero Acute Care Practice Guideline by Catherine Harris Ph.d. z-lib.org 1.pdf | |
Adult-Gerontology Acute Care Practice Guidelines | Adult-Gero Acute Care Practice Guideline by Catherine Harris Ph.d. z-lib.org 1.pdf |
Catherine Harris, Ph D, MBA, AGACNP, is an associate professor of graduate programs and a faculty in the Acute Care Nurse Practitioner Program at Thomas Jefferson University in Philadelphia. She earned her Ph D in nursing at the University of Pennsylvania and an MBA from Drexel University before becoming credentialed a... | Adult-Gero Acute Care Practice Guideline by Catherine Harris Ph.d. z-lib.org 1.pdf |
Adult-Gerontology Acute Care Practice Guidelines Catherine Harris, Ph D, MBA, AGACNP Editor | Adult-Gero Acute Care Practice Guideline by Catherine Harris Ph.d. z-lib.org 1.pdf |
Copyright © 2020 Springer Publishing Company, LLC All rights reserved. No part of this publication may be reproduced, stored in a retrieval system, or transmitted in any form or by any means, electronic, mechanical, photocopying, recording, or otherwise, without the prior permission of Springer Publishing Company, LLC,... | Adult-Gero Acute Care Practice Guideline by Catherine Harris Ph.d. z-lib.org 1.pdf |
To Matthew, My beautiful little boy, you are always in my heart, and I am so proud of you! Mom and Dad, Thank you for your encouragement and always being there for me. | Adult-Gero Acute Care Practice Guideline by Catherine Harris Ph.d. z-lib.org 1.pdf |
Adult-Gero Acute Care Practice Guideline by Catherine Harris Ph.d. z-lib.org 1.pdf | |
vii Contents Contributors xi Reviewers xv Foreword Harrison Reed, MMS, PA-C xvii Preface xix Organization xxi What Is Different About This Book xxiii Acknowledgments xxv Introduction xxvii I. ACUTE CARE GUIDELINES BY SYSTEM 1. ENT Guidelines Conjunctivitis 3 Pharyngitis 5 Rhinosinusitis 8 2. Pulmonary Guidelines Acute ... | Adult-Gero Acute Care Practice Guideline by Catherine Harris Ph.d. z-lib.org 1.pdf |
viii Status Epilepticus 152 Transient Ischemia Attack 155 7. Targeted Temperature Management Guidelines Fever Management 157 Hypothermia or Targeted Temperature Management After Cardiac Arrest 160 8. Endocrine Guidelines Adrenal Insufficiency 165 Diabetes Mellitus—Type 1 167 Diabetes Mellitus—Type 2 170 Diabetic Ketoac... | Adult-Gero Acute Care Practice Guideline by Catherine Harris Ph.d. z-lib.org 1.pdf |
ix II. PERIOPERATIVE CONSIDERATIONS 18. Preoperative Evaluation and Management Scope of Chapter 361 Considerations 361 Care Principles 362 Medication Management 364 19. Perioperative and Intraoperative Management Scope of Chapter 367Considerations 367 Care Principles 370 Medication Management 372 20. Postoperative Eval... | Adult-Gero Acute Care Practice Guideline by Catherine Harris Ph.d. z-lib.org 1.pdf |
Adult-Gero Acute Care Practice Guideline by Catherine Harris Ph.d. z-lib.org 1.pdf | |
xi Contributors Dana A. Albinson, MSN, BSN, AGACNP Adult-Gerontology Acute Care Nurse Practitioner Thomas Jefferson University Hospital Philadelphia, Pennsylvania Frank O. Amanze, MSN, AGACNP-BC, CFRN, CCRN, PHRN, NRP Nurse Practitioner Thomas Jefferson University Philadelphia, Pennsylvania M. Kamran Athar, MD Assistan... | Adult-Gero Acute Care Practice Guideline by Catherine Harris Ph.d. z-lib.org 1.pdf |
xii Jane S. Davis, DNP, MSN, BSN, CRNP University of Alabama at Birmingham Birmingham, Alabama Erin Michelle Dean, MS, PA-C, RD Physician Assistant Department of Surgical Oncology, MD Anderson Cancer Center Houston, Texas Michele De Castro, MSN, CRNP Nurse Practitioner Division of Hospital Medicine, Thomas Jefferson Un... | Adult-Gero Acute Care Practice Guideline by Catherine Harris Ph.d. z-lib.org 1.pdf |
xiii Amelita B. Marzan, MS, APRN, FNP-C, OCN Advanced Practice Provider MD Anderson Cancer Center Houston, Texas Sijimol Mathew, MSN, ACNP-BC Advanced Practice Provider MD Anderson Cancer Center Houston, Texas Juan A. Medaura, MD Assistant Professor of Medicine University of Maryland Medical Center Baltimore, Maryland ... | Adult-Gero Acute Care Practice Guideline by Catherine Harris Ph.d. z-lib.org 1.pdf |
xiv Cara M. Staley, MSN, RN-BC, AGACNP-BC Vascular Surgery Nurse Practitioner Thomas Jefferson University Hospital Philadelphia, Pennsylvania Jerrad M. Stoddard, MS, MA, PA-C Physician Assistant Texas Oncology Round Rock, Texas Frances M. Stokes, DNP, RN, ACNP-BC, CMNL Nurse Practitioner Intensivist Austin, Texas Julie... | Adult-Gero Acute Care Practice Guideline by Catherine Harris Ph.d. z-lib.org 1.pdf |
xv Reviewers M. Kamran Athar, MD Assistant Professor of Medicine and Neurological Surgery Thomas Jefferson University Philadelphia, Pennsylvania Ashley L. Barba, DNP, ANP Acute Care Nurse Practitioner Duke University Medical Center Durham, North Carolina Mark E. Baus, MSN, CRNP, RNFA Lead Orthopaedic Nurse Practitioner... | Adult-Gero Acute Care Practice Guideline by Catherine Harris Ph.d. z-lib.org 1.pdf |
xvi Northwest Internal Medicine Wydnmoor, Pennsylvania Mary Anne Mc Coy, Ph D, RN, ACNS, ACNP-BC Assistant Professor; Graduate Coordinator, AGACNP Specialty Wayne State University College of Nursing Detroit, Michigan Anne Bradley Mitchell, Ph D, MN, ANP-BC Assistant Professor of Nursing Jefferson University College of ... | Adult-Gero Acute Care Practice Guideline by Catherine Harris Ph.d. z-lib.org 1.pdf |
xvii Foreword There is no blueprint for acute care. The term itself is as broad and nebulous as the field it describes. Our patients reserve the right to present with any configuration of symptoms, to respond to our treat-ments when—and if—their bodies deem appropriate, and to decompensate without warning. Unlike the n... | Adult-Gero Acute Care Practice Guideline by Catherine Harris Ph.d. z-lib.org 1.pdf |
Adult-Gero Acute Care Practice Guideline by Catherine Harris Ph.d. z-lib.org 1.pdf | |
xix Preface The need for an acute care textbook has been growing. Although outpatient practices have long seen the value of uti-lizing advanced practice providers (APPs), the surge in acute care providers has been relatively recent. I remember when I was a registered nurse back in the 1990s, I had no idea there was suc... | Adult-Gero Acute Care Practice Guideline by Catherine Harris Ph.d. z-lib.org 1.pdf |
Adult-Gero Acute Care Practice Guideline by Catherine Harris Ph.d. z-lib.org 1.pdf | |
xxi Organization This book is organized into four major sections. Part I: Acute Care Guidelines by System—In Part I, the advanced practice provider (APP) is exposed to the most common medical conditions organized by system. Although it is by no means comprehensive or inclusive of every medical condition, the section is... | Adult-Gero Acute Care Practice Guideline by Catherine Harris Ph.d. z-lib.org 1.pdf |
Adult-Gero Acute Care Practice Guideline by Catherine Harris Ph.d. z-lib.org 1.pdf | |
xxiii What Is Different About This Book This book was created for advanced practice provider (APP) students in the acute care setting. In talking to students about their wants and needs in a textbook, I found students were not able to absorb and assimilate information in heavy, dense textbooks that we had been using. I... | Adult-Gero Acute Care Practice Guideline by Catherine Harris Ph.d. z-lib.org 1.pdf |
Adult-Gero Acute Care Practice Guideline by Catherine Harris Ph.d. z-lib.org 1.pdf | |
xxv Acknowledgments I have so many people to acknowledge in the creation of this textbook, particularly Dr. Ksenia Zukowsky, Dr. Carey Heck, and Dr. Jack Jallo. Dr. Zukowsky saw so much poten-tial in my plans. She pushed me to do things I was scared to do, and she made them seem possible. Her incredible stories have in... | Adult-Gero Acute Care Practice Guideline by Catherine Harris Ph.d. z-lib.org 1.pdf |
Adult-Gero Acute Care Practice Guideline by Catherine Harris Ph.d. z-lib.org 1.pdf | |
xxvii Introduction Information Overload No book can serve all the needs of students, nor should that be the goal. This book was specifically designed to provide a foundation of basic information about acute care that stu-dents or any advanced practice provider (APP) should know about a body system. Acute care is define... | Adult-Gero Acute Care Practice Guideline by Catherine Harris Ph.d. z-lib.org 1.pdf |
xxviii Hence, textbook learning has limitations that can only be remedied with practice. A student in the novice stage of a new role would be best advised to spend as much time as possible with patients, practicing active, focused listening and asking questions. This practice will help the new graduate APP gain confide... | Adult-Gero Acute Care Practice Guideline by Catherine Harris Ph.d. z-lib.org 1.pdf |
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I Acute Care Guidelines by System 1. ENT Guidelines 2. Pulmonary Guidelines 3. Cardiac Guidelines 4. Gastrointestinal Guidelines 5. Nephrology Guidelines 6. Neurology Guidelines 7. Targeted Temperature Management Guidelines 8. Endocrine Guidelines 9. Psychiatric Guidelines10. Infection Guidelines 11. Peripheral Vascula... | Adult-Gero Acute Care Practice Guideline by Catherine Harris Ph.d. z-lib.org 1.pdf |
Adult-Gero Acute Care Practice Guideline by Catherine Harris Ph.d. z-lib.org 1.pdf | |
3 1 ENT Guidelines Carey Heck Conjunctivitis Carey Heck Definition A. Inflammation of the conjunctiva, a thin transparent membrane that lines the inside of the eyelids and covers the sclera. B. Commonly called “pink eye. ” Incidence A. Allergic conjunctivitis. 1. Most common cause of conjunctivitis (15%-40% of populati... | Adult-Gero Acute Care Practice Guideline by Catherine Harris Ph.d. z-lib.org 1.pdf |
4 D. Review of systems. 1. Recent illnesses. Determine the onset and duration of symptoms. a. Abrupt or gradual onset. b. Determine if the patient or close contacts have any systemic illnesses. 2. Allergies. 3. Possible occupational exposure history. 4. Sexual history. 5. Pertinent systems review. a. Head, ear, eyes, n... | Adult-Gero Acute Care Practice Guideline by Catherine Harris Ph.d. z-lib.org 1.pdf |
5 D. Discharge instructions. 1. Symptoms should resolve in 5 to 7 days. 2. If symptoms continue or different symptoms appear, then follow-up is recommended. Follow-Up A. Instruct patients with acute bacterial conjunctivitis to follow-up in 1 to 2 days if symptoms worsen or do not improve. B. Instruct patients with othe... | Adult-Gero Acute Care Practice Guideline by Catherine Harris Ph.d. z-lib.org 1.pdf |
6 c. Tonsillar exudates. d. Anterior cervical lymphadenopathy. B. Common/typical scenario. 1. Patients typically complain of sore or scratchy throat, fever, and general malaise. C. Review of systems. 1. Past medical history. a. Recent illnesses. Determine the onset and duration of symptoms. i. Abrupt or gradual onset. ... | Adult-Gero Acute Care Practice Guideline by Catherine Harris Ph.d. z-lib.org 1.pdf |
7 b. Possibly indicated. i. In adults with negative RADT if high suspi-cion of GAS. ii. In adults at high risk for infection (immuno-compromised or other comorbidities). iii. Those who are in close contact with high risk populations. Differential Diagnosis A. Viral pharyngitis. B. Bacterial pharyngitis. C. Oropharyngea... | Adult-Gero Acute Care Practice Guideline by Catherine Harris Ph.d. z-lib.org 1.pdf |
8Rhinosinusitis Carey Heck Definition A. Inflammation of the nasal cavity and paranasal sinuses. B. Preferred terminology: “Rhinosinusitis” rather than “sinusitis” since inflammation of the sinuses rarely occurs without inflammation of the nasal mucosa as well. C. Classification. 1. Acute rhinosinusitis (ARS): Symptoms... | Adult-Gero Acute Care Practice Guideline by Catherine Harris Ph.d. z-lib.org 1.pdf |
9 C. Rhinopharyngitis. D. Headache. Evaluation and Management Plan A. General plan. 1. Use pain relief: Over-the-counter (OTC) analgesics and antipyretics. 2. Reduce mucosal inflammation: Topical nasal corticos-teroids. 3. Enhance sinus drainage: Saline irrigation. 4. Modulate environmental triggers. a. Treat concurren... | Adult-Gero Acute Care Practice Guideline by Catherine Harris Ph.d. z-lib.org 1.pdf |
Adult-Gero Acute Care Practice Guideline by Catherine Harris Ph.d. z-lib.org 1.pdf | |
11 2 Pulmonary Guidelines Acute Respiratory Distress Syndrome E. Mone ́e Carter-Griffin Definition A. Acute respiratory distress syndrome (ARDS) is defined by three variables. 1. Bilateral opacities on imaging. 2. Onset within 7 days of a clinical event or worsening respiratory symptoms. 3. Origin of pulmonary edema no... | Adult-Gero Acute Care Practice Guideline by Catherine Harris Ph.d. z-lib.org 1.pdf |
12 Respirat ory ABG: Assess for hypercapnia or hypoxemia D-dimer, ag e-adj usted : Can aid in ru ling out a pulm onary embolus. Chest CT/A ngiogr aphy: Assess for pne umonia, emph ysematous c hange s, /f_luid, honeycombing sugge stive of /f_ibrosis, pulmo nary embo lus. Pulmona ry function t esti ng: Assess for obstr u... | Adult-Gero Acute Care Practice Guideline by Catherine Harris Ph.d. z-lib.org 1.pdf |
13 Evaluation and Management Plan A. T reatment is dependent on the severity of ARDS. 1. Oxygen therapy (e. g., high flow nasal cannula, non-invasive positive pressure ventilation, invasive mechanical ventilation). a. In acute hypoxemic respiratory failure, high flow nasal cannula may be necessary. It resulted in impro... | Adult-Gero Acute Care Practice Guideline by Catherine Harris Ph.d. z-lib.org 1.pdf |
14 Guerin, C., Reignier, J., Richard, J. C., Beuret, P., Gacouin, A., Boulain, T.,... Ayzac, L. (2013). Prone positioning in severe acute respiratory distress syndrome. New England Journal of Medicine, 368, 2159-2168. doi:10. 1056/NEJMoa1214103 Papazian, L., Forel, J.-M., Gacouin, A., Penot-Ragon, C., Perrin, G., Loun-... | Adult-Gero Acute Care Practice Guideline by Catherine Harris Ph.d. z-lib.org 1.pdf |
15 Physical Ex amin ation General: Accessory muscle use? Diaphoresis? Flushing? Vital Signs: Febrile? Tachypnea? Tachycardia? Oxygen desaturations? HEENT: Facial or lip/oropharynx swelling? Central cyanosis? Rhinorrhea? Redness and/or watery eyes? Assessment of voice quality? Neck: Surgical scars? Old tracheostomy site... | Adult-Gero Acute Care Practice Guideline by Catherine Harris Ph.d. z-lib.org 1.pdf |
16 intravenous instead of oral corticosteroids (OCS) and possibly intravenous magnesium sulfate. d. Posttreatment, the PEF should be reassessed. e. Patients with an alteration in mental status (e. g., somnolence, confusion), absent breath sounds, worsening hypoxemia or hypercapnia, and hemo-dynamic instability should b... | Adult-Gero Acute Care Practice Guideline by Catherine Harris Ph.d. z-lib.org 1.pdf |
17 2. Diet. a. Restrictions: Specific diet based on whether the patient has underlying comorbid conditions such as diabetes or renal disease. b. No restrictions: Patient can resume a regular diet. 3. Medications. a. OCS: Usually prescribed for 5 to 7 days. b. Reliever medications such as SABA: Can be resumed on an as-n... | Adult-Gero Acute Care Practice Guideline by Catherine Harris Ph.d. z-lib.org 1.pdf |
18 2. Pulmonary Guidelines FIGURE 2. 3 Algorithm for the evaluation of cough. ACE, angiotensin-converting enzyme; COPD, chronic obstructive pulmonary disease; GERD, gastroesophageal reflux disease; HEENT, head, ear, eyes, nose, and throat. 2. Cough (see Figure 2. 3) with or without sputum pro-duction. a. Not uncommon f... | Adult-Gero Acute Care Practice Guideline by Catherine Harris Ph.d. z-lib.org 1.pdf |
19 4. Inspect for clubbing. 5. In more severe disease, cyanosis, elevated jugular venous pressure, and peripheral edema may be present. C. Respiratory examination. 1. Inspect the chest. a. Check for an increased anteroposterior chest diameter due to hyperinflation of the lungs, giving a barrel chest shape. b. Assess fo... | Adult-Gero Acute Care Practice Guideline by Catherine Harris Ph.d. z-lib.org 1.pdf |
20 b. Increased exercise tolerance. c. Improved health status. d. Reduction of mortality. e. Prevention of disease progression and exacerba-tions. f. Management should include pharmacological and nonpharmacological interventions. g. Smoking cessation and avoidance of occupational irritants are important. h. The GOLD gu... | Adult-Gero Acute Care Practice Guideline by Catherine Harris Ph.d. z-lib.org 1.pdf |
21 iv. LABAs: Duration of 12 hours or more; shown to improve lung function, dyspnea, and reduce exacerbations. d. Anticholinergics/antimuscarinics. i. Blockage of acetylcholine on muscarinic receptors leading to relaxation of airway smooth muscle. ii. Short-acting (SAMA) and long-acting (LAMA) antimuscarinics. iii. SAM... | Adult-Gero Acute Care Practice Guideline by Catherine Harris Ph.d. z-lib.org 1.pdf |
22 3. Assess continual need for oxygen therapy. Patients on chronic home O2should resume their baseline O2 requirements. 4. Check functional status. 5. Ensure adequate home resources. 6. Activity. a. Pulmonary rehabilitation. i. Shown to reduce hospitalizations, as well as improve dyspnea and health status. ii. Indicat... | Adult-Gero Acute Care Practice Guideline by Catherine Harris Ph.d. z-lib.org 1.pdf |
23 Incidence A. There are an estimated 1 to 1. 5 million cases annually. B. In general, the incidence is similar in both males and females. However, certain causes are more likely in males or females. Pathogenesis A. Pleural effusions are a manifestation of an underlying dis-ease process. B. Effusions can be transudati... | Adult-Gero Acute Care Practice Guideline by Catherine Harris Ph.d. z-lib.org 1.pdf |
24 FIGURE 2. 4 Chest x-ray of left pleural effusion. Source: By Tomatheart/Shutterstock. ii. Required for patients with a hemothorax (bloody pleural effusion). B. Patient/family teaching points. 1. Teach patients that it may help to cough or take a deep breath by holding a pillow against your chest to prevent pain. 2. ... | Adult-Gero Acute Care Practice Guideline by Catherine Harris Ph.d. z-lib.org 1.pdf |
25 Pathogenesis A. A pathogenic microorganism invades the lung parenchyma. Neutrophils aggregate to the site of invasion and begin to phagocytize the microorganisms and release an extracellular trap. B. The immune response is activated. Inflammatory media-tors are released, causing the capillaries to become permeable a... | Adult-Gero Acute Care Practice Guideline by Catherine Harris Ph.d. z-lib.org 1.pdf |
26 ventilation, invasive mechanical ventilation); this should be considered in those patients with hypoxemia and/or respiratory failure. 3. Patients presenting with sepsis due to pneumonia. These patients should receive care in accordance with the sepsis guidelines. 4. Guidelines suggest that antimicrobial therapy be d... | Adult-Gero Acute Care Practice Guideline by Catherine Harris Ph.d. z-lib.org 1.pdf |
27 E. Discharge instructions. 1. Discharge criteria. These primarily focus on improve-ment in the clinical status/condition. a. Resolution of fever (e. g., <38∘C). b. Improving symptoms (e. g., dyspnea, cough, spu-tum production). c. Heart rate less than 100 bpm. d. Respiratory rate less than 24/minute. e. Oxygen satur... | Adult-Gero Acute Care Practice Guideline by Catherine Harris Ph.d. z-lib.org 1.pdf |
28 Large enough obstructions can prevent blood flow to the affected area, creating a ventilation/perfusion mismatch lead-ing to respiratory failure and/or increase the pulmonary artery pressure, resulting in right-sided heart failure. Predisposing Factors A. Factor V mutation. B. Protein C or S deficiency. C. Malignanc... | Adult-Gero Acute Care Practice Guideline by Catherine Harris Ph.d. z-lib.org 1.pdf |
29 b. Submassive PEs: Patients with hemodynamic sta-bility but evidence of RV dysfunction on imaging and/or biomarker elevation. c. Massive PEs: Patient with hemodynamic instabil-ity, elevation in biomarkers, and evidence of RV dys-function. 4. Ideally, patients should have pretest clinical assess-ment, diagnostics wit... | Adult-Gero Acute Care Practice Guideline by Catherine Harris Ph.d. z-lib.org 1.pdf |
30 (Eds. ), Hall, Schmidt, and Wood's principles of critical care (4th ed., pp. 318-336). New York, NY: Mc Graw-Hill. Raja, A. S., Greenberg, J. O., Qaseem, A., Denberg, T. D., Fitterman, N., & Schuur, J. D. (2015). Evaluation of patients with suspected acute pulmonary embolism: Best practice advice from the clinical g... | Adult-Gero Acute Care Practice Guideline by Catherine Harris Ph.d. z-lib.org 1.pdf |
31 4. The forced expiratory volume in one second (FEV1) and forced vital capacity ratio is usually normal or increased. 5. The diffusing capacity of carbon monoxide is reduced in patients with an intrinsic etiology of restrictive disease. If the diffusing capacity is normal, then the etiology of restrictive disease is ... | Adult-Gero Acute Care Practice Guideline by Catherine Harris Ph.d. z-lib.org 1.pdf |
32 EXHIBIT 2. 1 Stepwise Approach for Managing Asthma Long Term The stepwise approach tailors the selection of medication to the level of asthma severity or asthma control. The stepwise approach is meant to help, not replace, the clinical decision making needed to meet individual patient needs. ASSESS CONTROL:STEP UP I... | Adult-Gero Acute Care Practice Guideline by Catherine Harris Ph.d. z-lib.org 1.pdf |
33 Restrictive Lung Disease EXHIBIT 2. 1 Step wise Approach for Managing Asthma Long Term (continued ) Ateach step: Patient education, envir onmental contr ol,and management ofcomorbid Ities Preferred Treatmentb SABAaas needed Low-dose ICSa Low-dose ICSa +LABAa OR medium-dose ICSa Medium-dose ICSa+ LABAa High-dose ICSa... | Adult-Gero Acute Care Practice Guideline by Catherine Harris Ph.d. z-lib.org 1.pdf |
Adult-Gero Acute Care Practice Guideline by Catherine Harris Ph.d. z-lib.org 1.pdf | |
35 3 Cardiac Guidelines Allison Rusgo Acute Coronary Syndromes Allison Rusgo Definition A. Umbrella term encompassing unstable angina (UA), non-ST-segment elevation myocardial infarction (NSTEMI), and ST-segment elevation myocardial infarction (STEMI). B. UA: No cardiac damage, no elevation in cardiac labora-tory bioma... | Adult-Gero Acute Care Practice Guideline by Catherine Harris Ph.d. z-lib.org 1.pdf |
36 Subjective Data A. Common complaints/symptoms. 1. Chest discomfort (vise-like or crushing, aching, pres-sure, tightness, or burning); less likely sharp/stabbing or knife-like. a. Reproducible chest tenderness in some cases. b. Classic: Left-sided or substernal chest discomfort that radiates to the jaw or left arm. c... | Adult-Gero Acute Care Practice Guideline by Catherine Harris Ph.d. z-lib.org 1.pdf |
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