1
INTRODUCTION TO CRITICAL CARE NURSING CERTIFICATION GUID
1 1 1 1 1 1
E 2026 UPDATED 1 1 1
1
1 Overview1of1Critical1Care1Nursing,121
2 Patient1and1Family1Response1to1the1Critical11Care1Experience,1141
3 Ethical1and1Legal1Issues1in1Critical1Care11Nursing,1261
4 End-of-Life1Care1in1the1Critical1Care1Unit,1371
5 Comfort1and1Sedation,1481
6 Nutritional1Support,1801
7 Dysrhythmia1Interpretation1and11Management,1941
8 Hemodynamic1Monitoring,11401
9 Ventilatory1Assistance,11701
10 Rapid1Response1Teams1and1Code11Management,12201
11 Shock,1Sepsis,1and1Multiple1Organ11
Dysfunction1Syndrome,12501
BRIEF1CONTENTS1
12 Cardiovascular1Alterations,12891
13 Nervous1System1Alterations,13451
14 Acute1Respiratory1Failure,14001
15 Acute1Kidney1Injury,14321
16 Hematological1and1Immune1Disorders,14601
17 Gastrointestinal1Alterations,15021
18 Endocrine1Alterations,15431
19 Trauma1and1Surgical1Management,15881
20 Burns,16141
21 Solid1Organ1Transplantation,16581
,Appendix:1Quality1and1Safety1Education1for11
Nurses1(QSEN)1Quality1and1Safety11
Competencies,16791
Critical1Care11NURSING
1
Introduction1to1
Critical1Care11NURSING
1
Introduction1to11
S1I1X1T1H1E1D1I1T1I1O1N1
Mary1Lou1Sole,1PhD,1RN,1CCNS,1CNL,1FAAN,1FCCM1
Orlando1Health1Distinguished1Professor1
College1of1Nursing1
University1of1Central1Florida;1
Research1Scientist1
Orlando1Health1
Orlando,1Florida1
Deborah1G.1Klein,1MSN,1RN,1APRN-
BC,1CCRN,1FAHA1Clinical1Nurse1Specialist1
Coronary1ICU1and1Heart1Failure1ICU1
Cleveland1Clinic;1
Clinical1Instructor1
Frances1Payne1Bolton1School1of1Nursing1
Case1Western1Reserve1University1
Cleveland,1Ohio;1Adjunct
1Faculty1
College1of1Nursing1
Kent1State1University1
Kent,1Ohio1
Marthe1J.1Moseley,1PhD,1RN,1CCNS1Associate1
Director1Clinical1Practice1
Office1of1Nursing1Services1
Clinical1Nurse1Specialist,1Critical1Care1
Veterans1Healthcare1Administration1
Washington,1DC;1
,Professor1
Rocky1Mountain1University1of1Health1Professions1
Provo,1Utah;1
Adjunct1Professor1
University1of1Texas1Health1Science1Center1School1of1Nursing1
San1Antonio,1Texas1
With1approximately13001illustrations1
32511Riverport1Lane1
St.1Louis,1Missouri1630431
INTRODUCTION1TO1CRITICAL1CARE1NURSING,1SIXTH1EDITION1 1 978-0-323-08848-01
Copyright1©12026,12019,12013,12009,12005,12001,11997,119931by1Saunders,1an1imprint1of1Elsevier1Inc.1
No1part1of1this1publication1may1be1reproduced1or1transmitted1in1any1form1or1by1any1means,1electronic1or11me
chanical,1including1photocopying,1recording,1or1any1information1storage1and1retrieval1system,1without11per
mission1in1writing1from1the1publisher.1Details1on1how1to1seek1permission,1further1information1about1the11
Publisher’s1permissions1policies1and1our1arrangements1with1organizations1such1as1the1Copyright1
Clearance11
Center1and1the1Copyright1Licensing1Agency,1can1be1found1at1our1website:1www.elsevier.com/permissions.11
This1book1and1the1individual1contributions1contained1in1it1are1protected1under1copyright1by1the1Publisher11(o
ther1than1as1may1be1noted1herein).11
Notices1
Knowledge1and1best1practice1in1this1field1are1constantly1changing.1As1new1research1and1experience1broaden
11our1understanding,1changes1in1research1methods,1professional1practices,1or1medical1treatment1may1become
11necessary.11
Practitioners1and1researchers1must1always1rely1on1their1own1experience1and1knowledge1in1evaluating11and1u
sing1any1information,1methods,1compounds,1or1experiments1described1herein.1In1using1such1informa-
1tion1or1methods1they1should1be1mindful1of1their1own1safety1and1the1safety1of1others,1including1parties 1for11w
hom1they1have1a1professional1responsibility.11
With1respect1to1any1drug1or1pharmaceutical1products1identified,1readers1are1advised1to1check1the1most11curre
nt1information1provided1(i)1on1procedures1featured1or1(ii)1by1the1manufacturer1of1each1product1to1be11admini
stered,1to1verify1the1recommended1dose1or1formula,1the1method1and1duration1of1administration,11and1contrai
ndications.1It1is1the1responsibility1of1practitioners,1relying1on1their1own1experience1and1knowl-
1edge1of1their1patients,1to1make1diagnoses,1to1determine1dosages1and1the1best1treatment1for1each1individual11
patient,1and1to1take1all1appropriate1safety1precautions.11
To1the1fullest1extent1of1the1law,1neither1the1Publisher1nor1the1authors,1contributors,1or1editors,1assume11any1li
ability1for1any1injury1and/or1damage1to1persons1or1property1as1a1matter1of1products1liability,11negligence1or1o
therwise,1or1from1any1use1or1operation1of1any1methods,1products,1instructions,1or1ideas11contained1in1the1mat
erial1herein.1
Nursing1Diagnoses1–1Definitions1and1Classification12012-2014.1
, Copyright1©12012,11994-20121by1NANDA1International.1Used1by1arrangement1with1Blackwell1Publishing11
Limited,1a1company1of1John1Wiley1&1Sons,1Inc.1
Library1of1Congress1Cataloging-in-Publication1Data1
Introduction1to1critical1care1nursing1/1[edited1by]1Mary1Lou1Sole,1Deborah1G.1Klein,1Marthe1J.1Moseley.—
116th1ed.1
p.1;1cm.1
Critical1care1nursing1
Includes1bibliographical1references1and1index.1
ISBN1978-0-323-08848-01(pbk.1:1alk.1paper)1
I.1Sole,1Mary1Lou.1II.1Klein,1Deborah1G.1III.1Moseley,1Marthe1J.1IV.1Title:1Critical1care1nursing.1[DNLM:11.
1Critical1Care.12.1Nursing1Care.1WY1154]1
616.02’8--dc231
20120081341
Executive1Content1Strategist:1Tamara1Myers1
Senior1Content1Development1Specialist:1Linda1Thomas1
Publishing1Services1Manager:1Jeff1Patterson1
Senior1Project1Manager:1Tracey1Schriefer1
Design1Direction:1Amy1Buxton1
Printed1in1China1
Last1digit1is1the1print1number:19181716151413121v1
DEDICATION1
A1special1dedication1to1my1grandmother,1Josephine1Ferda,1who1has1celebrated11001years1of11health!1
To1my1husband,1Bob,1and1daughter,1Erin,1for1their1encouragement1and1support1of1my11many1activitie
s.1To1my1parents,1George1and1Margaret1Ferda,1who1always1encouraged1me1to11shoot1for1the1stars.1La
stly,1to1my1many1students1and1colleagues,1who1inspire1me1and1keep1me11
grounded1in1clinical1practice.1
MLS1
To1the1critical1care1nurses,1patients,1and1their1families,1who1guide1the1content1of1this1book.11To1m
y1husband,1Ron,1and1my1sons,1David1and1Seth,1for1their1support1in1all1that1I1do.1To1my11
parents,1Rena1Sasson1Goldenberg,1RN,1BSN,1and1Ira1Goldenberg,1MD,1for1their1guidance1and11inspirati
on.1
DGK1
To1my1mom,1sister,1and1son—Violet1and1Heidi1Halvorson,1and1Nicholas—
who1are1care11receivers1and1givers1both1in1and1out1of1the1hospital.1For1the1Clinical1Practice1Portfol
io—Chris11Engstrom,1Suzy1Thorne-Odem,1Evelyn1Sommers,1and1Kelly1Morrow—
one1of1the1best1teams11
INTRODUCTION TO CRITICAL CARE NURSING CERTIFICATION GUID
1 1 1 1 1 1
E 2026 UPDATED 1 1 1
1
1 Overview1of1Critical1Care1Nursing,121
2 Patient1and1Family1Response1to1the1Critical11Care1Experience,1141
3 Ethical1and1Legal1Issues1in1Critical1Care11Nursing,1261
4 End-of-Life1Care1in1the1Critical1Care1Unit,1371
5 Comfort1and1Sedation,1481
6 Nutritional1Support,1801
7 Dysrhythmia1Interpretation1and11Management,1941
8 Hemodynamic1Monitoring,11401
9 Ventilatory1Assistance,11701
10 Rapid1Response1Teams1and1Code11Management,12201
11 Shock,1Sepsis,1and1Multiple1Organ11
Dysfunction1Syndrome,12501
BRIEF1CONTENTS1
12 Cardiovascular1Alterations,12891
13 Nervous1System1Alterations,13451
14 Acute1Respiratory1Failure,14001
15 Acute1Kidney1Injury,14321
16 Hematological1and1Immune1Disorders,14601
17 Gastrointestinal1Alterations,15021
18 Endocrine1Alterations,15431
19 Trauma1and1Surgical1Management,15881
20 Burns,16141
21 Solid1Organ1Transplantation,16581
,Appendix:1Quality1and1Safety1Education1for11
Nurses1(QSEN)1Quality1and1Safety11
Competencies,16791
Critical1Care11NURSING
1
Introduction1to1
Critical1Care11NURSING
1
Introduction1to11
S1I1X1T1H1E1D1I1T1I1O1N1
Mary1Lou1Sole,1PhD,1RN,1CCNS,1CNL,1FAAN,1FCCM1
Orlando1Health1Distinguished1Professor1
College1of1Nursing1
University1of1Central1Florida;1
Research1Scientist1
Orlando1Health1
Orlando,1Florida1
Deborah1G.1Klein,1MSN,1RN,1APRN-
BC,1CCRN,1FAHA1Clinical1Nurse1Specialist1
Coronary1ICU1and1Heart1Failure1ICU1
Cleveland1Clinic;1
Clinical1Instructor1
Frances1Payne1Bolton1School1of1Nursing1
Case1Western1Reserve1University1
Cleveland,1Ohio;1Adjunct
1Faculty1
College1of1Nursing1
Kent1State1University1
Kent,1Ohio1
Marthe1J.1Moseley,1PhD,1RN,1CCNS1Associate1
Director1Clinical1Practice1
Office1of1Nursing1Services1
Clinical1Nurse1Specialist,1Critical1Care1
Veterans1Healthcare1Administration1
Washington,1DC;1
,Professor1
Rocky1Mountain1University1of1Health1Professions1
Provo,1Utah;1
Adjunct1Professor1
University1of1Texas1Health1Science1Center1School1of1Nursing1
San1Antonio,1Texas1
With1approximately13001illustrations1
32511Riverport1Lane1
St.1Louis,1Missouri1630431
INTRODUCTION1TO1CRITICAL1CARE1NURSING,1SIXTH1EDITION1 1 978-0-323-08848-01
Copyright1©12026,12019,12013,12009,12005,12001,11997,119931by1Saunders,1an1imprint1of1Elsevier1Inc.1
No1part1of1this1publication1may1be1reproduced1or1transmitted1in1any1form1or1by1any1means,1electronic1or11me
chanical,1including1photocopying,1recording,1or1any1information1storage1and1retrieval1system,1without11per
mission1in1writing1from1the1publisher.1Details1on1how1to1seek1permission,1further1information1about1the11
Publisher’s1permissions1policies1and1our1arrangements1with1organizations1such1as1the1Copyright1
Clearance11
Center1and1the1Copyright1Licensing1Agency,1can1be1found1at1our1website:1www.elsevier.com/permissions.11
This1book1and1the1individual1contributions1contained1in1it1are1protected1under1copyright1by1the1Publisher11(o
ther1than1as1may1be1noted1herein).11
Notices1
Knowledge1and1best1practice1in1this1field1are1constantly1changing.1As1new1research1and1experience1broaden
11our1understanding,1changes1in1research1methods,1professional1practices,1or1medical1treatment1may1become
11necessary.11
Practitioners1and1researchers1must1always1rely1on1their1own1experience1and1knowledge1in1evaluating11and1u
sing1any1information,1methods,1compounds,1or1experiments1described1herein.1In1using1such1informa-
1tion1or1methods1they1should1be1mindful1of1their1own1safety1and1the1safety1of1others,1including1parties 1for11w
hom1they1have1a1professional1responsibility.11
With1respect1to1any1drug1or1pharmaceutical1products1identified,1readers1are1advised1to1check1the1most11curre
nt1information1provided1(i)1on1procedures1featured1or1(ii)1by1the1manufacturer1of1each1product1to1be11admini
stered,1to1verify1the1recommended1dose1or1formula,1the1method1and1duration1of1administration,11and1contrai
ndications.1It1is1the1responsibility1of1practitioners,1relying1on1their1own1experience1and1knowl-
1edge1of1their1patients,1to1make1diagnoses,1to1determine1dosages1and1the1best1treatment1for1each1individual11
patient,1and1to1take1all1appropriate1safety1precautions.11
To1the1fullest1extent1of1the1law,1neither1the1Publisher1nor1the1authors,1contributors,1or1editors,1assume11any1li
ability1for1any1injury1and/or1damage1to1persons1or1property1as1a1matter1of1products1liability,11negligence1or1o
therwise,1or1from1any1use1or1operation1of1any1methods,1products,1instructions,1or1ideas11contained1in1the1mat
erial1herein.1
Nursing1Diagnoses1–1Definitions1and1Classification12012-2014.1
, Copyright1©12012,11994-20121by1NANDA1International.1Used1by1arrangement1with1Blackwell1Publishing11
Limited,1a1company1of1John1Wiley1&1Sons,1Inc.1
Library1of1Congress1Cataloging-in-Publication1Data1
Introduction1to1critical1care1nursing1/1[edited1by]1Mary1Lou1Sole,1Deborah1G.1Klein,1Marthe1J.1Moseley.—
116th1ed.1
p.1;1cm.1
Critical1care1nursing1
Includes1bibliographical1references1and1index.1
ISBN1978-0-323-08848-01(pbk.1:1alk.1paper)1
I.1Sole,1Mary1Lou.1II.1Klein,1Deborah1G.1III.1Moseley,1Marthe1J.1IV.1Title:1Critical1care1nursing.1[DNLM:11.
1Critical1Care.12.1Nursing1Care.1WY1154]1
616.02’8--dc231
20120081341
Executive1Content1Strategist:1Tamara1Myers1
Senior1Content1Development1Specialist:1Linda1Thomas1
Publishing1Services1Manager:1Jeff1Patterson1
Senior1Project1Manager:1Tracey1Schriefer1
Design1Direction:1Amy1Buxton1
Printed1in1China1
Last1digit1is1the1print1number:19181716151413121v1
DEDICATION1
A1special1dedication1to1my1grandmother,1Josephine1Ferda,1who1has1celebrated11001years1of11health!1
To1my1husband,1Bob,1and1daughter,1Erin,1for1their1encouragement1and1support1of1my11many1activitie
s.1To1my1parents,1George1and1Margaret1Ferda,1who1always1encouraged1me1to11shoot1for1the1stars.1La
stly,1to1my1many1students1and1colleagues,1who1inspire1me1and1keep1me11
grounded1in1clinical1practice.1
MLS1
To1the1critical1care1nurses,1patients,1and1their1families,1who1guide1the1content1of1this1book.11To1m
y1husband,1Ron,1and1my1sons,1David1and1Seth,1for1their1support1in1all1that1I1do.1To1my11
parents,1Rena1Sasson1Goldenberg,1RN,1BSN,1and1Ira1Goldenberg,1MD,1for1their1guidance1and11inspirati
on.1
DGK1
To1my1mom,1sister,1and1son—Violet1and1Heidi1Halvorson,1and1Nicholas—
who1are1care11receivers1and1givers1both1in1and1out1of1the1hospital.1For1the1Clinical1Practice1Portfol
io—Chris11Engstrom,1Suzy1Thorne-Odem,1Evelyn1Sommers,1and1Kelly1Morrow—
one1of1the1best1teams11
