A supplement for a variety of junior/senior-level courses in Critical Care or Advanced Med-Surg Nursing courses and others throughout the nursing curriculum. Written by practicing nurses in acute care, this text provides students with a basic understanding of complex patients and the ability to provide nursing care across a variety of settings by using a series of reality-based, self-paced, self-contained modules that focus on multiple system problems frequently encountered in working with high acuity patients. Using a nuts and bolts approach, it addresses essentials by using examples, analogies, and metaphors; focuses on concepts and principles that can be applied across practice settings and patient populations; and includes nursing diagnoses. The modules progress from simple to complex and contain pretests and posttests with answers, learning objectives, glossary, abbreviations, and review questions and answers.

PREFACE When the first edition ofHigh-Acuity Nursingwas published in 1992, the termhigh acuitywas 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 termhigh acuityrefers 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 TheHigh-Acuity Nursingtext 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 concep