High Acuity Nursing (3rd Edition)
PREFACE    When the first edition of High-Acuity Nursing was published in 1992, the term high acuity was largely confined to leveling patient acuity for determining hospital staffing needs rather than being applied to nursing education. Our choice of titles was unusual and perhaps a little risky since nursing programs were using medical-surgical nursing texts or sometimes critical care nursing texts for teaching complex care concepts. Today, there is a growing trend to offer a high-acuity nursing course as part of the required undergraduate nursing curriculum. This, we believe, reflects the changing nature of the acute care patient population and the need to adequately prepare new nurses (and retool experienced nurses) to meet these rapidly changing needs.     The term high acuity refers to a level of patient problems beyond uncomplicated acute illness on a health-illness continuum. Today, high-acuity patients are increasingly found outside of critical care units or even acute care institutions. The patient population is older and sicker upon entering the health care system, and hospitalized patients are being discharged earlier, often in a poorer state of health. In the home health setting, nurses are providing care to clients with mechanical ventilators, central intravenous lines, IV antibiotic therapy, and complicated injuries. Whereas critical care units are considered specialty areas within the hospital walls, much of the knowledge required to work within that specialty is generalist in nature. It is this generalist knowledge base that is needed by all nurses who work with patients experiencing complex care problems to assure competent and safe nursing practice.   Purpose of the Text    The High-Acuity Nursing text delivers information using learner-focused, active learning principles, and concise language and format. The format breaks down complex information into small, understandable chunks for easier understanding. Self-testing is provided throughout the text, using Pretests, short section quizzes, and Posttests. All answers are provided to give learners immediate feedback on their command of section content before proceeding to the next module section.     The self-study modules in this book focus on the relationship between pathophysiology and the nursing process with the following goals in mind:Revisit and translate critical pathophysiologic concepts pertaining to the high-acuity patient in a clinically applicable manner Examine the interrelationships among physiologic concepts Enhance clinical decision-making skills Free class time to focus on clinical application Hold learners accountable for their own learning Provide immediate feedback to the learner regarding assimilation of concepts and principles Provide self-paced learning     Ultimately, the goal for the learner is to be able to approach patient care conceptually, so that care is given with a strong underlying understanding of its rationale.     This book is appropriate for use in multiple educational settings, for example, nursing students, novice nurses, novice critical care nurses, and community health/home health nurse. It is also a review book for the experienced nurse wanting to update knowledge in high-acuity nursing for continuing education purposes. Hospital staff development departments will find it useful as supplemental or required reading for nursing staff high-acuity or critical care classes. It has also been used for teaching basic pathophysiology, and as a review book for the NCLEX exam.   Organization of the Text    The book consists of nine parts: Special Topics, Respiration and Ventilation, Cellular Oxygenation, Perfusion, Neurologic, Metabolic, Gastrointestinal, Injury, and Life Span: Special Needs.     For continuity, the modules in Parts I through VIII are written in a consistent manner, using a single concept or nursing application format. The single concept modules contain an Introduction, Glossary, Abbreviation List, Objectives, Pretest, Review Questions, and a Posttest. Each module is divided into sections covering one facet of the module's topic (e.g., physiology, pathophysiology, or nursing management).     Parts II through VIII conclude with a nursing care module, which uses a case study problem-solving approach to test the learner's skill in applying the information presented in each part.     Part I, Special Topics, is composed of four modules. The topics included in this part apply to high-acuity patients in general or focus on a special procedure, as is the case with the organ transplantation module. Module 1 addresses the psychosocial needs of high-acuity patients, their families, and the nurses who care for them. Module 2 focuses on acute pain and the unique needs of high-acuity patients in pain assessment and management. Module 3 presents fluid and electrolyte concepts and problems. Finally, Module 4 provides an overview of organ transplantation from two perspectives: the donor and the recipient.     Parts II through VIII present topics that represent the complex problems, assessments, and treatments commonly associated with the nursing care of high-acuity patients. Ten modules focus on single organ system dysfunction (e.g., brain, spinal cord, lungs, heart, blood, kidneys, liver, pancreas, gastrointestinal, and skin). Three modules address concepts related to multiple organ dysfunction. Five modules focus on assessment (e.g., arterial blood gas analysis, hemodynamic monitoring, cardiac monitoring, responsiveness, and trauma assessment). Four modules address interventions (mechanical ventilation, management of stroke/brain attack, wound management, and trauma resuscitation). Finally, two modules focus on altered metabolic and immune responses.     Part IX, Life Span: Special Needs, addresses high-acuity pediatric, obstetric, and elderly patient concepts. In reality, the nurse may encounter these special needs patients in multiple settings, including acute care facilities, clinics, or home settings. In the hospital setting, nurses often encounter high-acuity pediatric patients who have been integrated into adult areas because of lack of pediatric bed availability. Obstetric patients who become acutely ill may also be admitted to a nonobstetric hospital area. Obstetric patients have special needs related to the physiologic changes encountered in pregnancy that must be addressed in planning and implementing nursing. The elderly comprise a large percentage of the high-acuity patient population in most settings that provide nursing care. The three modules in this part integrate multiple physiologic concepts with the nursing process.   New to This Edition    The third edition has added three new modules to reflect the needs of our text users, including Fluid and Electrolyte Balance in the High-Acuity Patient, Acute Hematologic Dysfunction, and Acute Gastrointestinal Dysfunction. In addition, all modules have been updated, and multiple modules have been substantially reorganized or streamlined. Test items have been revised to reflect the changes in content.   Summary    This text is a series of reality-based modules that focus on concepts frequently encountered in high-acuity patients. It is not designed as a comprehensive review of pathophysiology or medical-surgical nursing. The book's format reduces learner feelings of being overwhelmed by complex information. Learners are more apt to feel in command of the concepts, giving them the confidence to proceed to the more complex concepts. The third edition of High-Acuity Nursing has maintained the look and feel of the previous editions. Although the third edition has been expanded slightly (there are now 38 modules), we have not compromised on our approach. The ultimate goal of this book continues to be to enhance the preparation of nurses for practice in today's health care settings.Pamela Stinson Kidd  Kathleen Dorman Wagner