Clinical Neurosciences & Critical Care Nursing Sukhpal Kaur, Manjeet Singh
ABG report, interpretation of 450
Abnormal automaticity 115
Absorbent products 346
Accidental extubation 33
assess 102
Accommodation 149
Action potential initiation by autorythmic cells 58
Admission of patient in ICU 9
criteria 10
definition 10
introduction 9
Admit patients in ICU 11
Admitting patients in ICU
procedure of 12
purposes of 11
BLS algorithm 64f
chain of survival 66f
embolus 171
in line alarms 38
passage tracheostomy tube 98
contamination 418
precautions 418, 419
include standard precautions plus, components of 419
transmission 425
occurs, how 418
Air-in-line 34
Airway 5
devices during cardiac and respiratory arrest 69t
in mouth, insertion of 87f
patency 80
reaches uvula 87
insertion of 84
Alarm limits 46
Alert health care workers 424
Alternating pressure mattresses 309f
Alveolar collapse 24
Ambu bag 84, 91
parts of 90
steps of using 90
working of 90
works 91
Ambu, types of 91
Amino acids 247
Anemia disease 299
Animal waste 398
Ankle pumps 280f
Antiarrhythmic drugs 140
classification of 140t
Anticipated quality of life 10
Antiepileptic drugs 228t
Antioxidants 248
Apnea 368
Apply sterile dressing 97
causes of 116
disturbances 115
mechanisms of 115
of sinus origin 117
blood gas 446
cannula 20g 11
line with pressure transducer 187f
pressure line
care of 186, 188
insertion of 186
removal of 186, 190
puncture, contraindications of 449
Artery wedge pressure monitoring 201
airway 80
complications of 89
indications for use of 86
insertion of 84
life support with ventilators. 11
mechanical breathing unit 90
urinary sphincter 340f
Aseptic technique 420, 423
Asia impairment scale 160, 160t
Assist control ventiliation 20, 20f, 21
Assisted ventilation 21
Asystole 134f
ventricular asystole 134
Atelectasis 106
dysrrhythmias 116, 121
fibrillation 126, 126f
flutter 125, 125f
premature depolarization 128
tachycardia 123, 123f
Atrioventricular block 135
Audible alarm, volume of 30
Augmented limb leads 111
Autoclave 408
two types of 408
Automatic flushing system 187f
Azotemia 251
Back panel 30
valve mask 90
ventilation 68
Balloon of tracheostomy tube 95
Barotrauma 27
precautions in universal precautions 402t
to thrombolysis 333
Barthel index 323, 323t
Basic life support 59, 65f
steps of 60
Basic structure of heart 109f
Battery low 34
Baxter volumetric pump 35
Beck oral assessment scale 315t
Bed blocks 290f
additional equipment readily accessible to 79
cardiac monitor 41
system, components of 40
stage 3 304f
stage 4 304f
Biological death 368
Biomedical waste management 396
hospital 403
Biopatch dressing 169f
Biopsies 469
Biotechnology 399
Bite blocks 84
re-education 344
training 335, 344
Blades 399
Bleeding from tracheostomy site 98
Blood 24, 456
components in transfusion therapy 456
oxygen saturation 45
pressure monitoring 44f
transfusion 452
set 11
volume, increased 212
Body tissue, maintenance of 253
Bone infection 295
Braden scale 300, 300t
Bradyarrythmias, general management of 139
Brain 469
dead organ donors, nurse in management of 369
death 365, 368t
confirmation 368t
monitoring signs of 369
injured patient 106
tissue volume, increased 213
waves, classification of 436
Brainstem reflexes 159f
absence of 366
patterns 21
type 21
Breathing 81
control 278
improve 279
technique, active cycle of 279
Bridging 281f
Bronchospasm 106
Brudzinski’s sign 158, 158f
Bundle branch block 138, 139f
BVM, types of 91
Cables ending in electrodes 40f
Calcium 298
Calculate drug doses 54
requirements, calculations of 254
test 151
Calories based on stress, calculation of 246t
Cannula 37
Carbohydrates 246
arrest 7
indications of 59t
dysfunction 18
dysrhythmias 106
life support
advanced 65
steps of advanced 66
monitor 17
setting up of 39
with different monitored parameters 41f
output measurement
noninvasive methods of 194
techniques 194
pacing 139
pet scan, steps involved in 436
Cardiopulmonary resuscitation 57
effects 28
system assessment 81
definition of 378
of patients admitted in ICU, care of 377
wishes 11
changing 346
dislodgement 172
in between suctioning 105f
indwelling time 219
site dressing regimens 168
console 41
different monitored parameters of multiple patients 42f
bundle 166
care of 162, 165
indications for use of 163
cannula per age 11
catheter 163, 163f
dressing change and care, procedure for 169
types of 164
line flushing protocol 172
pressure 191
Cerebellar function 156
angiography 465
perfusion pressure 212
Cerebrospinal fluid volume, increased 212
Cervical traction 287
through skull traction 288
sterilizing agent 409
waste 400
Chemotherapy 33
drainage, principles of 234
exercises, instruction for 279
leads 112
problems, exercises for 278
tube 234
dislodgement of 7
insertion 234, 235f
indications of 231
procedure of 234
removal, assisting with 239
removing 239
mouthwash 12
skin antisepsis 166, 167
disease 10
of old age 10
health evaluation II score 10
Chylothorax 233
Circulation 5
Circulatory problems 295
Circumferential cleaning of pin site 294f
Clamp tubing before removal from pump 37f
Cleaning 411
summary of 413t
Clonic phase 224
Coarse VF 134f
Coexisting disease 10
Cognitive needs 379
Color codes for different sized airways 85t
Coma or unresponsiveness 365
Comfort devices 306, 306f
Communicate, assess ability to 102
Communication 386
chart for
basic needs 267
emergency needs 265
psychological needs 269
chart-experience, development of 263
methods of 261
systems 386
with donor family 370
with patient on
tracheostomy tube 260
ventilator 260
Complete blockage in delivery tubing 37
Complete heart block 138
Condom catheter 347g
block 115
disturbances 115
system 109
of heart 110f
Confirmatory findings on neurologic assessment 368t
Congestive heart failure 24
Conscious patients on
tracheostomy 261
ventilator 261
precautions include standard precautions plus, components of 418
transmission 424
occurs 417
Container plastic bag 400
Containment products 344
Continuous monitoring. 11
panal 28
bird ventilator 29f
different sections of 29f
Corneal reflex 150, 367f
Cotton ring placed under elbow 307f
Coughing 97, 279
CPR, articles required for 66
functions 148t
nerve 148t
examination 147
I, olfactory 148
II 149
II, optic 148
III 149
IV 149
IX 151
V 149
VI 149
VII 150
VIII 150
X 151
XI 151
XII 151
Crash cart 51f
pain observation tool 178t
unit 477
illness, definition of 243
Critically ill
bedridden, care of 307
definition, transfer of 2
introduction, transfer of 1
purposes, transfer of 2
transfer of 1
Current apnea interval settings 28
Cushing’s triad 213
complications with 170
in subclavian vein 163f
manometer set-up 194f
waveform, comparison of 202f
drugs 399
therapy 299
DC shock therapy 140f
Decreased blow tracheostomy tube 98
breathing 278
exercises 293
tendon reflexes 153
Defibrillate patient 67
Defibrillation, complications of 72
Delirium 480, 481
diagnostic tools for 484t
management of 485
subtypes 483t
Device malfunction 172
Dexterity test 157
requisition to dietary department 15
texture, modification of 250
Dietary management 348
Different color coded airways 85f
Different forms of PVC’s 130
contact transmission 417
observation of leakage 342
Discarded medicine 399
level of 405
summary of 413t
Disposable syringes 11
10cc 11
2cc 11
50cc 11
5cc 11
Documentation in intensive care unit 351
Doll’s eyes reflex 367f
Don sterile gloves 104f
Dose calculation 54
Double-checking selected tidal volume 24
Drain, care of 219
Drainage system, closed 346
Dressing change, frequency of 168
precautions 419, 420
transmission 424
affecting urinary elimination 337t
calculation, reference for 54
in ACLs, list of 70t
support, advanced 11
therapy 341
Dry stoma with dry sterile gauze 96
Duolin respules 12
Durapore 4 inch 12
Dynaplast 4 inch 12
characteristics 117128, 132134, 136139
electrodes 11
interpretation 108
steps for 113
monitoring 43
after-care 43
paper 112
recording 108
waveform 112
comparison of 202f
Educating caregiver 309
EEG electrodes applied to patient’s head 437f
Effect of critical illness on caregiver 378
resuscitation, signs of 74
sterilization, iondicators for 408
Elastic compression stockings 327f
Electrical events of heart conduction system 57
Electrode 40
placement 42
and lead selection 110
types of 40
Electroencephalography 436
Electrophysiology 109
Elevated ICP
signs of 213
symptoms of 213
crash cart 55t
management during seizures 227f
needs 379
turmoil of patient 295
Empyema 233
intubation 311f, 460, 463f
tube 12
dislodgement of 7
parts of 461
size of 462
Enhanced normal automaticity 115
Environmental stressors 478
catheter 214, 215
infusions 34
sensor 215
care of 39
complications of 17
faults 38
for suctioning 103f
needed 421
of lumbar traction 289f
required for CPR 66
Escape beats 119
Esophageal Doppler 197f
Essential equipment required bedside 79
ETO gas sterilization, requirement for 409
Extended position 95f
collection systems 347
jugular vein 164
Extraocular movements 150f
Extravasation 38, 38f
Eye protection 395
Factors affecting pulse, oximetry 47
Families of critically ill dying patients 371t
Fat overload syndrome 251
Fats 246
Fecal incontinence 298
causes 299
Femoral vein 164
Fever 97
Fiberoptic transducer tipped catheter, intraparenchymal of 214, 216
Fick’s method 195
Fifth breath 20
Figure of eight 158
Finger-finger test 157
Finger-nose test 157
First aid for seizures 225
First degree AV block 135, 135f
Fluid management 348
Flutter waves with constant R-R interval 125
Focal onset seizures 223
Foley’s catheter 12, 345f
Forms of sterilization to inactivate HIV and HBV 412t
Fracture 63
Fumigation 409
of theater, details of 409
rendal capacity 20
residual capacity 23
Gait 156
Gamma-knife surgeries 450, 451
Gardner-Wells tongs 286f
Gastrointestinal system 82
Generation of
cardiac electrical activitiy 58f
wave formation 58f
Glasgow coma scale 145, 145t
Glass 399
Glossopharyngeal and vagus 151
Gloves 393
change 415
remove 415
Gloving, procedure guidelines for 394t
Glucose monitoring strips 11
Gowning apron 391
Greek gravity traction 286f
Gugging swallowing screen 325t
for maintaining records 354
for writing 354
on apron, procedure 392t
Hemoglobin, concentration of 45
Halter traction equipment 288, 288f
Hand hygiene 166
Handle contaminated linen 415
Handwashing 387, 423
procedure guidelines on 389t
Hard rubber ring 307f
Hazards of health care waste 404
Head tilt chin lift maneuver 63f
application of 451
to patient, application of 451f
Healing environment in ICU, strategies for promoting 486
acquired infection in immunocompromized patients, prevention of 420
waste, aspects of 404
practices of nurse 425
professionals 410
anatomy of 108
chambers 108
physiology of 108
Heel to shin test 158
Hemodynamic monitoring 181
Hemopneumothorax 232
Hemorrhage 24
Hemothorax 171, 232, 233f
Hepatic steatosis 251
Hepatitis C 415
High level disinfection 406
High pressure
alarm 32
tubing 11
female 11
male 11
Hip flexion 281f
HIV hepatitis B 415
Hospital infection control committee 403
Hospital-acquired infections 311
Hospitals, disinfectants used in 407
Hot air oven 408
Housekeeping neuro intensive care units 410
Huffing 278
Human anatomical waste 398
Hydraulic system 181
Hypercapnia 252
Hyperglycemia 255
Hyperosmolarity 255
Hypertriglyceridemia 251
Hypoactive delirium versus depression 485
Hypodermic needle 11
16g 11
26g 11
Hypoglossal 151
Hypothermia 7
Hypovolemic shock 7
Hypoxemia 106
importance 214
indications 214
monitoring 214
interpretation of 216
pulse waveforms, significance of 217
psychosis 480, 485
etiology of 481
precipitating factor for 482t
stressors, physiological response to 479
Illness, severity of 10
Implantable venous access devices 166
Implementation Infection Control Program 423
Incineration ash 399
Incomplete records or information 7
Indirect contact transmission 417
control 422
committee 403
program, management of 423
into lungs, pathway of spread of 313f
Inflating balloon 96f
Infusion pump 4f, 17
complications of 36
setting up of 33
types, setting up of 33
Infusion schedules 255
FiO2 24
settings 23
setup 26
Initiate airway management protocols 68
Inner cannula 472
Insert airway, articles required to 87
nasopharyngeal airway 88
tube 96f
of catheter, assisting with 217
sites, selection of 164
Insulin 34
Intake of fluids 346
Integration of evidence 48
Intercostal drainage 231
Intermediate level disinfection 406
catheter 345f
mandatory ventilation 20
Internal jugular vein 164
Interruption to therapy 37
Intracranial pressure
causes of increased 212
monitoring 210
methods of 214
pulse waveform, components of 217f
Intrapleural space 232f
Intravenous cannula per age 11
Intraventricular conduction
abnormalities 135
disturbances 116
Intrinsic peep 28
Intubation, complications of 26
Invasive methods of cardiac output measurements 194
Involuntary movements 153
Ipratropium bromide 12
Irregular R-R interval 126f
IV cannulae
dislodgement of 7
of different
colors 457f
sizes 457f
open method 457
sites for 457
IV infusion set 11
Jaw thrust maneuvre 63f
Joints and limbs to prevent deformities, care of 276
Kernig’s sign 159, 159f
Kinked tube 37
extension 282f
flexion 281f
marching 283f
Lamp test checks leds 29
Lateral position 103f
Latex examination gloves box 12
Lead placement 42f, 43f
Left atrial pressure
line, indications for insertion of 207
monitoring 207
waveform 207f
Leveling of pressure transducer 185f
Levels of pacemaker of heart 110t
Light 479
absorption of 45
Limb leads 111
Limitations of pulse, oximeter 47
Liquefying secretions 100
Liquid waste 399
Lithium dilution cardiac output 198
Lobar pneumonia 24
Locating compression site patient’s sternum 61f
Locked elbows of rescuer 62f
Log rolling of patient 293f
level disinfection 406
minute volume alarm 33
pressure alarm 32
Lower extremities 158
puncture 444, 444f
traction 289
equipment 289f
Lundberg’s A, B, C waves 216
Mains cable 40
Maintaining quality practice setting 386
Major atelectasis 24
Mandatory breaths 21
Mask 395
remove 395
ventilation 68
Maximal barrier precautions 166
Measure size of airway 86
Mechanical ventilation 18
complications with 26
indications for 17
on different modes 11
CMV 11
patient, monitoring of 76
Medicines to kept in crash carts 52t
Meeting caregivers needs 381
Meningeal signs 158
Met need of caregivers 379
acidosis 450
alkalosis 450
complications 255
requirements 245
system 82
Microbiological monitoring 411
Microbiology 399
Microorganisms, type of 405
Migration 172
Mini mental status examination 146, 147t
Mobitz II 137f
Moisol eye drops 12
ICP, methods to 215f
make heart beat 47
Monitoring during transport 6
Monomorphic VT 131, 131f
Motor function 149, 150, 152
Mouth-to-mouth breathing 63f, 68f
delivery 63
atrial tachycardia 122, 122f
PVCs 130f
Muscle 469
biopsy 469f
bulk 152
power 152
strength grading scale 152t
tone 152
exercises to improve 280
related problems 280
airways 85, 85f
insertion 86f
catheter, insertion of 88f
Nasotracheal intubation 460
National institues of health stroke scale 321t
Nebulization set with T-piece 11
Neck stiffness 158
Needles 399
Nerve 469
abducens 149
conduction 441
studies 439f
facial 150
trigeminal 149
trochlear 149
vestibulocochlear 150
history taking 144
medical intensive care units 410
bladder 336
incontinence, management of 338
assessment 142
articles 144
definition 143
indications 143
procedure 144
purpose 143
examination, articles for 144t
status 159
system assessment 79
Neurology 5
Neuromuscular disease 18
Neurosurgical intensive care unit 411
Neutropenic precaution 420, 421
treatment requiring 422t
Noise 479
Nomenclature 18
Non-dominant hand 104f
methods 197
ventilation 11
Non-touch technique 388
blood flow 108
mechanism of 19f
physiology of 18
ECG measurements 112f
saline 11
SaO2 46
sinus rhythm 116, 116f
Norton scale 300, 302t
in acute stroke management, role of 319
patient with communication chart 262f
role acute phase of stroke 320
role of 33
actions to prevent free flow 36
care 31
after application of traction 292
during application of traction 292
of patient with chest tube 238
consideration 31
during defibrillation 70
with BPS 177
implications and steps of procedure 43
interventions 485
in intracranial pressure monitoring 220
management of brain dead organ donors 364
for maintenance of crash cart 52
in handling infusion pump 38
screening 243
support 248
for critically ill patients 242
goals of 244
assessment 243
plan 244
requirements, calculating 245
support, definition of 244
Obesity 300
Occlusive devices 347
Occupational health and safety 405
Oculocephalic reflex 367f
Oculomotor nerve 149
system 236f
water seal chest drainage apparatus 236
Open diaper sheet 12
Optimal catheter site selection 166
airway, measuring size for 86f
care for orally intubated patients 310
care of intubated patient 316
care, frequency of 315
cavity, assessment of 315
intubation, problems with 311
Organ transplant 11, 368
Oropharyngeal 99
airway 84
Orotracheal intubation 460
Overshoes 395
mask, remove 105
toxicity 27
Oxygenated blood absorbs 45
assessment 176
in ICU 174
classification of 175f
management 33
mechanism of 175, 176
Parenteral nutrition 248f, 252
goals of 253
indications for 253
types of 253
Parkinson’s disease 339
Paroxysmal coughing 106
Partial CO2 rebreathing 199
Pathological reflexes 154t
Pathway to HAP 312
assessment sheet 362
breathing circuit 12
cable 40
care of 38
controlled analgesis 34
education and health promotion 349
on ventilator, system wise assessment of 79
records in ICU, types of 352, 355
report 355
system wise assessment of 78t
temporarily increased susceptibility, caring for 421
CT-scan 429f
gamma-knife surgery 453f
MRI 431f
pet scan 435f
wishes 11
with incontinence, care of 335
Patting test 158
PCWP waveform, comparison of 202f
Pedal suction machine 101, 101f
floor muscle exercise 344
tilts 281f
Penile clamps 347f
Perform leak test 29
Performed in chair, exercises 281
Performing arterial puncture 447
Perineal care 346
Periodic inspection of the equipment 295
Peripherally inserted central catheter 165f
Personal protection equipment 416, 423
Phlebitis 172
Physical stressors 478
Pleural effusion 233, 233f
Pneumatic compression devices 328f
Pneumothorax 171
Polymorphic VT 131, 131f
oral hygiene, problems of 310
skin hygiene 299
defibrillator 3f
electrical suction machine 101, 101f
Positioning of potient during seizure 226f
Positive end expiratory pressure 25, 25f
Positive-pressure ventilators, classifications of 22
Post-cardiac arrest care among adults 73f
Post-defibrillation care 71
Posterior column
assessment of 155
position 155
vibration 155
Post-ictal phase 224
Post-resuscitative complications 72
adjustments 157
drainage guide 273t
Post-ventilator period 277
Potential complications of suctioning 105
PR interval 113, 114
to measuring ICP 220
using cardiac monitors 47
atrial contractions 128, 128f
ventricular contractions 129, 129f
Preparation of
bed 291
equipment 422
patient and ward 317
skin 291
Prepare for defibrillation 67
Prerequisite 94
Press monitor select to display tests 28
Pressing MS displays current bias flow 28
FRC, change in 23
on nail beds 366f
on supraorbital area 366f
relieving support surfaces 308
settings 25
transducer 182f
calibration of 185
system, setting up 181
ulcer 298f, 300
development of 297
early warning signs of 302
in critically ill patients, prevention of 297
sites of 302
stage 2
of 303f
stage I 303f
stages of 302
waves 216
Preventing injury to friction 308
Prevention of bedsores 304
Primary breath patterns 21
Prior drug therapy 421
Prior to suctioning, assessment of 102
development systems 386
judgment, application of 385
Properly inserted airway 88f, 89f
Protein 24
Protocol for cleaning 413t
Psychological stressors 478
artery pressure 201
waveform 201f
infection score 312f
contour cardiac output 199
oximeter 46
components of 45
measurement, mechanism of 45
physical properties of 45
oximetry 45, 46
Pump, setting up of 35
Pupillary reaction 149
Puritan bennet 29f
Push ups 283f
PVCS couplets 130f
P-wave 113
examination 114
QRS complex 113, 114
Radiofrequency catheter ablation 140
Raised intracranial pressure 106
Rankin scale, modified 323, 323t
Rapid alternating movements 157
Readiness for departure 6
Rebound test 157
Recent cardiopulmonary arrest 11
in ICU, instructions for writing 354
types of 356
Re-expanded lungs after chest tube insertion 232f
Refeeding syndrome 252
Reflex grading 153t
Reflexes 153, 368t
Rehabilitation management of patient on ventilator 271
Renal system 82
Reporting in ICU, importance of 355
Reserved volume 23
Residual volume, measurement of 343
acidosis 450
alkalosis 450
arrest 60
conditions 17
cycle, phases of 19
problems 7
assess 102
assessment 80
tract, care of 272
Response of treatment to date 11
Resuscitation trolley, setting up of 50
Reticular activating system 176
regularity of 114
strips, various 116
Right atrial pressure monitoring 191
Rinne’s test 151
Role of intensive care unit 369
Romberg’s test 155
Rope fixed for normal movement and turning 306f
Rotating syringe 448f
Rotation of airway 88f
Routine nursing care 371
RTPA, action of 330
Ryles tube per age 12
SA block 120
dropped beat 120
Safe environment 396
Safety checks 79
Salbutamol 12
Scalpels 399
breath 20
degree AV block 136
Secretion, clearance of 279
Sedation 34
causes of 224
classification of 223
generalized onset 223
management of 222
Semi fowler’s position 103f
function 150, 155t
loss 299
Serum electrolyte concentration, abnormalities of 255
Set alarms 30
Set apnea interval special functions 29
Set bias flow special functions 29
Set high pressure alarms 30
Set ventilation parameters 32f
alarms 28
correct pressure 102
modes 28
Severity of stroke, assessment of 321
Side effects of T-PA 332
Sighs rarely needed 26
arrest 119, 120f
arrhythmia 119, 119f
bradycardia 117, 117f
dysrrhythmias 120
exit block 120
pause 119, 120f
rhythms 117
tachycardia 118, 118f
Skeletal traction 290, 291, 292
care 293, 307, 348
in person with depressed sensorium, care of 272
integrity and mobility 82
precautions 420
requirement for 420t
traction 290292
Social needs 380
Solid waste 399
considerations arterial pressure lines 191
enteral formulas 250
functions 28
accessory 151
injury 63
nerve roots involved
main 153t
reflex 153t
traction 287
Spindle shapped pattern of QRS complexes 133
Spinothalamic tract, assessment of 156
Spontaneous breath 21
ST segment 113
Staffing and communication 5
limb leads 111
precautions, components of 415
safety measures in caring for patients 384
statements 385
after change of TT 97
of procedure 46
gloves 12
gown 12
suctioning tray containing 102
water 12
Sterilium 11
Sterilization 408, 412
by heat 408
summary of 413t
Sterilizing articles in ward 413t
Steroid therapy 299
Stressors types 478
Stretch reflexes 153
Stroke in emergency room scale, recognition of 320, 321t
Subarachnoid screw 214, 215
Subclavian vein 164
Subcutaneous emphysema 238
catheter 214, 215
screw 215
article for 102
age 11
right sized 101
chamber, assess 239
endotracheal 99
machine 11, 101
portable 11
wall 11
tip with tubing 11
Suitable treatment, availability of 11
Superficial reflexes 154, 154t
Supported ventilation 21
Suprapontine lesions 339
Suprasacral infrapontine 339
Supraventricular tachycardia 124, 124f
Sural nerve biopsy 470f
Surgery, types of 228
Surgical handrub 391
Synchronized intermittent mandatory ventilation 22
Syringes 399
pumps 33
parts of 33f
with loaded syringe 34f
tubing loose connection causes air leak 39f
T wave 113
Tachyarrythmias, general management of 139
Tactile discrimination 156
Tandem gait 157
Tegaderm 11
dressing 169f
Terminal nature of disease. 11
Terminate all articles properly 97
feasibility of communication chart 264
papillary reflex 366f
Therapeutic environment 396
Thermodilution method 195
Third degree AV block 138, 138f
Thoracic electrical bio-impedance 200
system 237f
water seal drainage system 237
contraindications to 331
pathway 329
treatment in stroke 328
agent, action of 330
therapy, administration of 330
Tie tracheostomy tube properly 97
Toe taps and heel lifts 282f
Toileting assistance 343
Tolerance, monitoring 251
Tonic phase 224
Torsade de point 132, 132f
Total lung capacity 23
Total parentral nutrition 33
TPN, contraindications of 253
Trace elements 248
Tracheal trauma 106
Tracheostomy 99, 472
blockage, signs of 94
care 93
purposes of 94
change 94
how to store 97
parts of 473f
side of 97
types of 472
articles used for 290f
evolution of 285
in neurological conditions 287
principle of 286
purposes of applying 289
related to neurological condition 285
types of 287
Training of
all staff 404
nurses for care of patient 333
Transesophageal echocardiography 198
Transmembrane resting potential 115
Transmission routes 414
Trauma 5
Treatment of UI 338
Trolley, transfer 2f
Trouble shooting 31
in ECG monitoring 44
pulmonary artery catheter waveforms 205
Truncal ataxia 157
Tube into antiseptic solution 97f
Tubing, disinfection of 411
Tunneled venous catheter 165f
Two point discrimination 156
system 237f
water seal drainage apparatus 236
Tying tube 97
causes of 337
types of 336
develop in prone position 301f
prone areas in
lateral position 301f
sitting position 301f
supine position 301f
Underlying disease 421
Unipolar chest leads 111f
Unit, design of 410
pain assessment tool 177f
precaution 423
measures on 401t
Unmet need of caregivers 379
Upper extremities 157
Urinalysis 342
incontinence 298, 335
problems 295
Urobag with urometer 12
Validation of first draft 263
Vascular disease 299
Vector borne 425
Vehicle transmission 424
Vein of
forearm 457
hand 457
Venous thrombosis 172
Venticular fibrillation 133f
Ventilation 5
modes of 18
parameters 28
Ventilator 29f
associated pneumonia 27
disinfection of 411
induced lung injury 27
setting up of 17
set-up 28
steps for setting up 28
support to brain dead 11
expiratory limb in 30f
inspiratory limb in 30f
asystole 134
bigeminy pvcs 130f
dysrrhythmias 116
fibrillation 133
quadrigeminy PVCS 130f
rhythms 128
tachycardia 131
classification of 131
trigeminy PVCS 130f
Ventriculostomy 214
Vestibulo-ocular reflex 367f
Visible blood 414
acuity 148
field 149
parameters 159
signs of infection, assess 102
symptoms of infection, assess 102
Vitamin 248
C 298
E 298
change in 23
controlled 20f
Volumetric pumps 33, 34, 34f
attachment in 35f
with latch 36
Volutrauma 27
electrical suction machine 101
fixed electrical suction machine 101f
suction machine with tubing 102
Wandering atrial pacemaker 121, 121f
Ward items, disinfection of 407
Wash hands 105, 415
classification of 397
protocol in hospital setting 404t
staff for training on 404t
segregation 424
sharps 399
Water 24
chamber, assess 238
drainage system 236
Wave forms 28
Way stopcock 11
with 10
cm extension 11
Weaning from
monitor 47
ventilator 26, 277
Wearing apron 391
Weber’s test 151
Whole blood cells 455f
Wolff-Parkinson-White syndrome 127, 127f
Writing of records 353
Xiphoid process over patient’s chest 61f
Zinc 298
Chapter Notes

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Editor Sukhpal Kaur PhD Lecturer National Institute of Nursing Education PGIMER, Chandigarh India Associate Editor Manjeet Singh MD (Medicine) Medical Officer Government Multi Specialty Hospital, Sector 16, Chandigarh India Foreword Yogesh Chawla Sandhya Ghai
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Clinical Neurosciences and Critical Care Nursing
First Edition: 2014
Printed at
3Dedicated to
My parents who have inspirited the spirit of hard work, honesty and truthfulness in my life
4Contributors 6Foreword
It gives me immense pleasure to pen the foreword for this book ‘Clinical Neurosciences and Critical Care Nursing’ edited by Dr Sukhpal Kaur. When your student authors a useful book, the happiness you enjoy cannot be expressed in words. It is just a few years back when Dr Sukhpal had come to me for her MSc thesis. Her interest in publishing was evident from the fact, that the moment her research work was over, she was ready with her paper for publication. Since then, she has never looked back, and has to her credit more than seventy publications in various reputed journals. She has already brought out seven books, a few of which have been given state awards. Her keen interest in research work in nursing is obvious from the fact that she has a large number of research projects funded from ICMR, DST, and DBT.
As medical field has now progressed from a number of specialities to super specialities and further subspecialities, a parallel growth of nursing professionals is the need of the hour. For any super specialized set-up, a matching level of nursing care is mandatory. With the advancement in medical sciences in particular, it becomes very important for the nurses to keep themselves updated with recent advances. Neurosciences becomes all the more important as during acute emergencies, a vigilant and updated nurse can help save many lives in ICU settings as well as go a long way in reducing morbidity and mortality.
I am sure the book ‘Clinical Neurosciences and Critical Care Nursing’ will help nurses and other paramedicals working in various ICUs and particularly in neurology and neurosurgery ICUs. It will help the readers to update their information in neurology and critical care nursing. As a large number of neurology patients remain on long-term follow-up, they can be helped to a large extent by nurse practitioners. This understanding will help in offloading the already overburdened neurologists and neurosurgeons, which are so few in number in our country. In fact, on the same lines, nurse practitioners are required as part of various specialized teams in our country like diabetes, arthritis, palliative care, oncology, organ donation, etc. to name a few.
This book ‘Clinical Neurosciences and Critical Care Nursing’ will be of immense help to nurses, undergraduate and postgraduate nursing students to help them manage critical neurology and neurosurgery patients in a more effective and professional manner. This book will also be a stimulus to others working in nursing academics and research to bring more updated literature in their respective areas of work. The chapter on organ donation would help in improving the concept and understanding of organ donation in society and particularly so amongst nursing, paramedical as well as medical fraternity. I wish the readers a pleasure and knowledgeable experience.
Yogesh Chawla dm (gastroenterology)
PGIMER, Chandigarh, India
Along with the growth of medical sciences, equal advancements and matching expectations from nurses are obvious. In all specialized and super-specialized medical set-ups, it is the need of the hour, that all the nurses must get latest knowledge updates to excel in their chosen disciplines. No nurse can do justice to her work without thorough theoretical knowledge and evidence-based practical skills related to the domains of her work. Therefore, every nurse in practice needs to learn more and more to widen her/his horizon. There is a huge demand for specialized nurses in all super specialized areas like obstetrics, psychiatry, cardiology, neurology, and critical care, etc. to name a few.
The book ‘Clinical Neurosciences and Critical Care Nursing’ is an endeavor by Dr Sukhpal to help medical-surgical nurses to upgrade themselves as ICU-nurses, Neuro-ICU nurses and Neurosurgey-ICU nurses. I appreciate the efforts by Dr Sukhpal and her team of esteemed co-authors for bringing out this excellent, readable and precious piece of literature. This book and similar efforts by todays’ nursing experts will go a long way to fulfill the dream of conceiving the concept of nurse practitioner and super-specialized nursing into the Indian medical and nursing mind set.
This book will prove to be a blessing not only for undergraduate and postgraduate students but also will be of immense help for the nurses and the technical staff working in various ICUs. This will help all the practicing nurses of the related specializations to update themselves and further polish their skills. I congratulate Dr Sukhpal and her team who have authored a state-of-the-art presentation and have scientifically dissected the best practices. They also deserve appreciation and best wishes so that they bring out more and more of such literature and work to the best of their capability to serve humanity through efficient nursing. Myself and our institute ‘National Institute of Nursing Education’ join to wish them success in their present and all the coming future endeavors.
Sandhya Ghai PhD
National Institute of Nursing Education
PGIMER, Chandigarh, India
In today's era of super specializations in nursing and the concept of nurse practitioners, a nurse no longer continues to be just an assistant, but is actually following up, monitoring, and treating the patients at her own. With the exponential growth of science in general and nursing sciences in particular, it becomes very important for present day nurses to keep themselves updated in recent advances. As the medical sciences have become vast, we all now need to select and then excel in the fields of our chosen nursing specializations, super specializations, and sub specializations.
Neurosciences and Critical Care Nursing becomes all the more important for nurses as during acute emergencies a vigilant and updated nurse can help save many lives in ICU settings as well as can go a long way to reduce morbidity and mortality. The role of a nurse expert acquires more importance in our society in view of limited availability of specialists and super specialists where patients are left with no choices except to go to unqualified and self-styled doctors. Our updated approach and proactive attitude can reduce this gap. The onus of uplifting the healthcare status of our society lies on our shoulders and we have to break the inertia of many of our professional colleagues and have to achieve new heights in the present day nursing arenas.
With this understanding, this book ‘Clinical Neurosciences and Critical Care Nursing’ has been brought out with a humble and sincere effort where nurses in our country will no longer limit themselves just to distributing tablets and capsules, giving injections, and doing beddings. In fact, they now qualify themselves for establishing and maintaining central lines, endotracheal tubes, ventilators, and much more.
Critical care nurses work in a variety of areas, with a diverse patient population. In order to meet the challenges of the complex healthcare system, today's nurses are expected to be knowledgeable and skilled in order to provide efficient and compassionate nursing care to the critically ill patients.
The ‘Clinical Neurosciences and Critical Care Nursing’ is an excellent overview of the care and management of critically ill patients. The contributors to the book are the eminent nursing and medical faculty from all over India. The contents are elaborated in 31 chapters. The target population for this book includes the nursing faculty, the postgraduate and undergraduate nursing students, and the nurses working in various intensive care units of the hospitals as well as other bedside nursing colleagues.
Research is an integral part of the scientific enterprise for improving the nation's health. The growing body of nursing research provides a scientific basis for patient care and this evidence-based information should be practiced by the nurses. Research is conducted to improve patient outcomes and promote the health and well-being of the patients. A unique feature of this book is that in majority of the chapters the evidences from research have been incorporated. Authors’ own professional experience and the addition of evidences from the other research studies regarding the topics under discussion, make the current book different. The topics covered in the book may not be exhaustive. Feedbacks from the readers are sincerely solicited by the undersigned.
We wish to sincerely thank all the contributors to the book without whose help this endeavor would not have been possible.
Sukhpal Kaur
Manjeet Singh
It is with a sense of immense relief and satisfaction at the conclusion of this book that I turned to the pleasant task of acknowledging the help of all those who made this work possible. No endeavor can be successful without the blessings of one and only God Almighty. I am grateful to divine Lord for the inspiration, motivation, encouragement and for providing me with the right tool to make and complete this onerous task. My sincere thanks to all the contributors for this book without whose efforts this project would have not been completed. I cannot refrain from thanking the office staff of Jaypee Jaypee Brothers Medical Publishers (P) Ltd, New Delhi, India especially Mr Bhupesh Arora (General Manager-Publishing) and Mrs Preeti Parashar (Author coordinator) for the help they offered me throughout.