UNDERSTANDING Medical Surgical Nursing THIRD EDITION docx

Introduction of New Systems Into Traditional AmericanHeat and Cold Application 54 Safety and Effectiveness of Alternative Therapies 54 Role of LPN/LVN 55 Nursing Applications 55 Review Q

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U NDERSTANDING Medical Surgical Nursing

THIRD EDITION

LINDA S WILLIAMS, MSN, RNBC

Professor of NursingJackson Community CollegeJackson, Michigan

PAULA D HOPPER, MSN, RN

Professor of NursingJackson Community CollegeJackson, Michigan

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Acquisitions Editors: Lisa B Deitch/Jonathan Joyce

Director of Content Development: Darlene D Pedersen

Special Projects Editor: Shirley A Kuhn

Senior Project Editor: Ilysa H Richman

Art and Design Manager: Carolyn O’Brien

As new scientiﬁc information becomes available through basic and clinical research, recommended treatments and drug therapies undergo changes The author(s) and publisher have done everything possible to make this book accurate, up to date, and in accord with accepted standards at the time of publication The author(s), editors, and publisher are not responsible for errors or omissions or for consequences from application of the book, and make no warranty, expressed or implied, in regard to the contents of the book Any practice described in this book should be applied by the reader in accordance with professional standards of care used

in regard to the unique circumstances that may apply in each situation The reader is advised always to check product information (package inserts) for changes and new information regarding dose and contraindications before administering any drug Caution is especially urged when using new or infrequently ordered drugs ISBN 13: 978-0-8036-1491-8

ISBN 10: 0-8036-1491-8

Library of Congress Cataloging-in-Publication Data

Understanding medical-surgical nursing / [edited by] Linda S Williams, Paula D

Hopper — 3rd ed.

p ; cm.

Includes bibliographical references and index.

ISBN 0-8036-1491-8

I Nursing 2 Surgical nursing I Williams, Linda S (Linda Sue), 1954-

II Hopper, Paula D

[DNLM: 1 Nursing Care 2 Nursing WY 100 U548 2007]

RT41.W576 2007

617 ′.0231—dc22

2006035577 Authorization to photocopy items for internal or personal use, or the internal or personal use of speciﬁc clients, is granted by F A Davis Company for users registered with the Copyright Clearance Center (CCC) Transactional Reporting Service, provided that the fee of $.10 per copy is paid directly to CCC, 222 Rosewood Drive, Danvers, MA 01923 For those organizations that have been granted a photocopy license by CCC, a separate system of payment has been arranged The fee code for users of the Transactional Reporting Service is: 8036-1491 07 / ⫹ $.10.

Disclaimer:

Some images in the original version of this book are not

available for inclusion in the eBook

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To our students, this is for you We hope it helps you achieve

your dreams.

Linda and Paula

In memory of my mother who was so proud of the book that she took it everywhere to show to people I will miss her joy in seeing this edition To my dad who has always been supportive and kept me company on my breaks from writing during this revision.

To my sister Lisa and her family Ken, Michael, and Nathan

for their ongoing support.

To Christine, Anna, and Suzee for encouragement and a

listening ear when it was needed most.

LINDA S WILLIAMS

To Dave, with love, for his continued love and support.

To Dan and Libby, my two other favorite people in the

world I am so proud of you both.

And to my Dad, who proudly displays our books even

though he doesn’t have to read them.

PAULAD HOPPER

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Welcome to the third edition of Understanding Medical

Surgical Nursing! We have fully updated all the material,

and have added exciting new information on home health

care, end-of-life care, disaster response and bioterrorism,

stroke, and more

We continue to work hard to provide a text written at anunderstandable level, with features that help students under-

stand, apply, and practice the challenging content required

to function as practical/vocational nurses We are thankful to

the many students who tell us they ﬁnd the book very

read-able, and actually enjoyable We are overjoyed to hear from

several nursing programs that their NCLEX scores soared

after adopting this textbook

We continue to emphasize understanding, criticalthinking, and application throughout the book We believe

that a student who learns to think critically will be better

able to apply information to new situations We hope both

students and instructors ﬁnd this third edition a practical tool

for learning and understanding medical-surgical nursing

FEATURES OF THE BOOK

We have kept our most popular features from the ﬁrst two

editions, and added new ones based on reader input

• Questions to Guide Your Reading begin each

chap-ter In our experience, the standard objectives found

in many textbooks have little meaning and providelittle assistance to students Literature suggests thatcomprehension increases when students read guid-ing questions before reading the text So we haveprovided a series of questions that students shouldkeep in mind as they read These questions can betranslated easily back into objectives by instructorswho prefer this format

• Special features written by actual patients, called

Patient Perspectives, were added in the second

edi-tion Many more have been added to this ediedi-tion

These stories help to make patients’ experienceswith illness more meaningful and personal for stu-dents

• Web links are included in the text to help students

do further research on topics of interest Everyeffort was made to use only major established websites that are unlikely to change in the near future

• One of our most popular features, Critical ThinkingExercises, has been expanded to help students prac-tice and think about what they are learning Wehave added more math calculations and documenta-tion practice to Critical Thinking Exercises whereapplicable

• Review questions at the end of each chapter havebeen updated and include alternate format items toreﬂect NCLEX-PN

• Suggested Answers for the Critical ThinkingExercises and Review Questions are included.Research supports the importance of immediatefeedback to reinforce learning, so we feel stronglythat students should have access to correct answerswhile they are studying, without having to wait fortheir next instructor contact Since there can bemany answers to some of the critical thinking ques-tions, we have provided sample answers to helpstimulate students’ thinking

• The effects of aging on body systems have beenconverted from text format to a mindmap format

We believe this visual representation is easier tounderstand and apply than the traditional text

• We have changed our Nursing Process format fromtext to bullet lists It is very easy to read, clearlystands out, and makes interventions with rationalevery clear to students

• More Learning Tips, a very popular feature in pasteditions, have been added New to the third editionare Nursing Care Tips and Safety Tips

• JCAHO National Patient Safety Goals are reﬂected

in many of the safety tips to give students an duction to these safety goals

intro-• Nursing assessment, laboratory tests, and tions have been placed in consistent tables that areeasy to read and understand

medica-vii

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• Summary boxes including nursing diagnoses

have been expanded and included for most majordisorders

• A pronunciation key for new words is found at the

beginning of each chapter

• A review of anatomy and physiology is presented at

the beginning of each unit

• Word-building footnotes are found throughout the

chapters to make complex medical terminology ier to understand

eas-• Nursing care plans with geriatric considerations

have been updated

• Boxed presentations of Cultural Considerations,

Gerontological Issues, Home Health Hints, EthicalConsiderations, and Nutrition Notes provide valu-able supplemental information and help studentsrelate text material to real life situations

• Many new photographs and drawings have been

added to illustrate important concepts

• A comprehensive, updated glossary of new words is

included in the appendix

TO STUDENTS: HOW TO USE

THIS BOOK

As you begin each chapter, carefully read the section labeled

Questions to Guide your Reading Then, when you are

ﬁn-ished reading each chapter, go back and make sure you can

answer each question

You will ﬁnd a list of new words and their

pronuncia-tions at the beginning of each chapter These words appear

in bold at their ﬁrst use in a chapter, and they also appear in

the glossary at the end of the book By learning the

mean-ings of these words as you encounter them, you will increase

your understanding of the material

You also will encounter other learning tips to increase

your understanding and retention of the material You may

want to develop your own memory techniques in addition to

those provided (If you think of a good one, send it to us and

you may ﬁnd it in the next edition!) Many of the learning

tips have been developed and used in our own classrooms

We ﬁnd them helpful in fostering understanding of complex

concepts or as memory aids However, we want to stress that

memorization is not the primary focus of the text but rather

a foundation for understanding and thinking about more

complex information Understanding and application will

serve you far better than memorization when dealing with

new situations

Each chapter includes critical thinking case studies

designed to help you apply material that has been presented

A series of questions related to the case study will help you

integrate the material with what you already know These

questions emphasize critical thinking, which is based on a

foundation of recall and understanding of material To

enhance your learning, try to answer the questions before

looking up the answers at the end of the chapter

Review questions appear at the end of each chapter tohelp you prepare for chapter tests, and also for the NCLEX-

PN Again, to assess your learning, try to answer the tions before looking up the answers at the back of the book

ques-A bibliography at the end of each unit provides sourcesfor additional reading material Web sites have beenincluded in many chapters We believe it is important foryou to interact with current technology to expand your infor-mation resources

The following appendices are included for easy ence:

refer-• NANDA nursing diagnoses

• Lab values

• Common medical abbreviations (Although it is stillimportant to know the abbreviations, many canincrease risk of errors Check www.JCAHO.org for

a list of abbreviations to avoid.)

• Common preﬁxes and suffixes to help learn wordbuilding techniques

SUPPLEMENTAL MATERIALS

• A new Electronic Student Guide is included with

the book This provides practice in the form ofobjective (ﬁll-in, labeling, and ﬂashcard) exercises,and case studies There are also review questionsand a practice NCLEX test We have also included abrief math tutorial using Unit Analysis, and practicecalculation problems Answers are provided to allexercises for immediate feedback

• A paperback Student Workbook is available to

pro-vide the student additional contact and practice withthe material Each chapter includes vocabulary prac-tice, objective exercises, a case study or other criti-cal thinking practice and review questions written inNCLEX-PN format Answers provide immediatefeedback Rationales are provided for non-anatomyreview question answers

• An Instructor’s Resource Disk includes an Electronic Instructor’s Guide that provides materi-

als for use in the classroom Each chapter has achapter outline with suggested classroom activities.Also included are student activities for printing andusing for individual practice or for collaborativelearning activities These activities help the student

to interact with the material, understand it, andapply it Many of the activities are based on realpatient cases and have been used with our ownpractical nursing students Feedback from studentshas helped to reﬁne the exercises We believe theuse of collaborative learning has greatly enhancedour students’ success in achieving their educationaland licensure goals Another beneﬁt is the sense ofcommunity the students develop as a result of work-ing in groups A brief introduction and guidelinesfor using collaborative learning techniques isviii Preface

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included Also included is an expanded Electronic Test Bank, available to instructors who adopt the

textbook, which provides test questions that assiststudents to prepare for NCLEX-PN These ques-tions have been prepared according to test itemwriting protocols The questions are in multiplechoice and alternate format, and test recall, applica-tion, and analysis of material Many of the testquestions have been developed, used and reﬁned bythe authors in their own medical-surgical courses

for practical nursing students The program allowsinstructors to choose and modify the questions thatbest suit their classroom needs Finally, for theinstructor’s convenience, there is a comprehensive

Power Point program for classroom presentations.

Images from the text have been added for the thirdedition Each presentation can be modiﬁed, reduced,

or expanded by individual instructors to suit theirneeds

Preface ix

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Many people helped us make this book a reality First and

foremost are our students, who provided us with the

inspira-tion to undertake this project We hope that they continue to

ﬁnd this text worth reading

The F.A Davis Company has been an exceptional lishing partner We feel fortunate to have had their continued

pub-enthusiasm and conﬁdence in our book The staff at F.A

Davis has guided us through this project for three editions to

help us create a student-friendly book that truly promotes

understanding of medical-surgical nursing

Lisa Deitch, Shirley Kuhn, Ilysa Richman, DarlenePedersen, Doris Wray, and many others have been extremely

patient and kind as we worked hard to provide a quality text

and meet deadlines

We thank the staff of W.A Foote Memorial Hospital inJackson, Michigan for allowing us access to their facility

and patients for a great photo shoot Our photographer,

Robert Conway, did a terriﬁc job of obtaining some

chal-lenging shots

Contributors from across the United States and Canada,

including many well-known experts in their ﬁelds, broughtexpertise and diversity to the content Their hard work ismuch appreciated Reviewers from throughout the UnitedStates provided insights that enhanced the quality of thetext Elizabeth Hopper provided invaluable organizationalassistance

Many of our co-workers have contributed to this bookand given us ongoing encouragement and validation of theworthiness of this project Elizabeth Ackley, Marina-Martinez Kratz, Sharon Nowak, Debra Perry-Philo, CarrollLutz, Suzanne Fox, Linda Nabozny, and Anna Ricks wereespecially helpful in providing material, advice, and encour-agement

We wish to thank everyone who played a role, howeverlarge or small, in helping us to provide a tool to help stu-dents realize their dreams of becoming an LPN or LVN Wehope this book will help train nurses who can provide safeand expert care because we have helped them to learn tothink critically

xi

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Nancy Ahern, RN, MSN

Instructor and Program Coordinator

University of Central Florida

Cocoa, Florida

Brenda Anderson

St Bernards Medical Center

Patient Care Manager-Education

Huron School of Nursing

East Cleveland, Ohio

Linda Hopper Cook RN, MN, PhD Candidate

Instructor

Grant MacEwan College School of Nursing

Edmonton, Alberta

Canada

Mary Dillinger, MS, RN, ACRN

Clinical Nurse SpecialistMunson Medical CenterTraverse City, Michigan

Susan Garbutt, RN, MSN, CIC

Faculty

St Petersburg College

St Petersburg, Florida

Karen P Hall, RN, MSHSA, CNA-BC

Director of Patient Care ServicesDoctors Medical Center

Jean Jeffries, BSN, RN

Registered NurseHuntsville HospitalHuntsville, Alabama

Rodney B Kebicz, RN, BN, MN

InstructorAssiniboine Community CollegeWinnipeg, Manitoba

Canada

Lynn Keegan, RN, PhD, AHN-BC, FAAN

DirectorHolistic Nursing ConsultantsPort Angeles, Washington

xiii

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Marty Kohn, RN, BSN, MS, FNP-CWOCN

Nurse Practitioner Wound Care Center

Foote Hospital

Jackson, Michigan

Linda Marie Lowe, RN, BSN

Assistant Professor

University of Northern British Columbia

Prince George, British Columbia

Canada

Carroll Lutz, BSN, MA, RN

Associate Professor Emerita

Jackson Community College

Adjunct Nursing Faculty

American River College

MaryAnne Pietraniec-Shannon, PhD, APRN, BC

ProfessorLake Superior State UniversitySault Sainte Marie, Michigan

Ruth Remington, PhD, APRN, BC

Assistant ProfessorUniversity of Massachusetts, LowellLowell, Massachusetts

Patrick M Shannon, JD, EdD, MPH

AttorneyBay Mills Community CollegeBrimley, Michigan

Susan Smith, BS, MS, RNC, CAN

President/Educator

SK Smith ConsultingWarriors Mark, Pennsylvania

Rita Bolek Troﬁno, MNEd, RN

Director of Healthcare Programming and InitiativesPennsylvania Highlands Community CollegeJohnstown, Pennsylvania

Deborah L Weaver, RN, PhD

Associate ProfessorValdosta State UniversityValdosta, Georgia

Jennifer Whitley, RN, MSN, CNOR

EducatorHuntsville HospitalHuntsville, Alabama

Bruce K Wilson, PhD, RN, CNS

ProfessorUniversity of Texas-Pan AmericanEdinburg, Texas

xiv Contributors

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Contributors to Previous Editions

Jeanette Acker, RN, BSN

Manager, Stepdown Unit

W.A Foote Memorial Hospital

ICU Staff Nurse

Hancock Medical Center

Bay St Louis, Mississippi

Kathleen R Culliton, APRN, MS, GNP

Assistant Professor

Weber State University

Ogden, Utah

Constance Monlezun Darbonne, RN, MPH, CFNP

Family Nurse Practitioner

Clinical Instructor, Community Health

McNeese State University

Lake Charles, Louisiana

Sharon Gordon Dawson, RN, MSN, CNOR

Educator, Surgical Services

Swedish Medical Center

Englewood, Colorado

Vera Dutro, RN, BSN, OCN

Infusion NurseZanesville Infusion TherapyZanesville, Ohio

Rowena Elliott, MS, RN, CNN, C, CLNC

Assistant ProfessorUniversity of MississippiJackson, Mississippi

Mary Friel Fanning, RN, MSN, CCRN

Director, Adult Cardiac Nursing UnitsWest Virginia University HospitalsMorgantown, West Virginia

Donna D Ignatavicius, MS, RN, CM

Clinical Nurse Specialist inMedical/Surgical/Gerontological NursingCalvert Memorial Hospital

Owner/Consultant, DI AssociatesPrince Frederick, Maryland

Cheryl L Ivey, RN, MSN

Department DirectorEmory University HospitalAtlanta, Georgia

Josephine Whitney Johns, RN, OCN, CRNI

South Mississippi Home HealthOncology Specialty NurseBoard of Director, Mississippi Cancer Pain InitiativeCo-founder, Mississippi Gulf Coast Chapter

Oncology Nurse AssociationGulfport, Mississippi

xv

We would like to acknowledge and thank the following individuals for their contributions to the ﬁrst two editions All

con-tributions have helped to make Understanding Medical Surgical Nursing what it has evolved into today.

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Elaine Kennedy, EdD, RN

Professor of Nursing

Wor-Wic Community College

Salisbury, Maryland

Gail Ladwig, RN, MSN, CHTP

Associate Professor of Nursing

Coordinator JCC/UM BSN Transfer Program

Jackson Community College

Sharon D Martin, MSN, BSN, APRN, BC

Associate Professor of Nursing

Saint Joseph’s College

Standish, Maine

Deborah J Mauffray, RN, MSN, CNS, CDE, CWOCN

Clinical Nurse Specialist in Wound, Ostomy, and

Incontinence

Memorial Hospital at Gulfport

Gulfport, Mississippi

Cindy Meredith, MSN, RN

Director and Instructor of Nursing

Spring Arbor University

Spring Arbor, Michigan

Deborah L Roush, RN, MSN

Assistant ProfessorValdosta State UniversityCollege of NursingValdosta, Georgia

Valerie C Scanlon, PhD

ProfessorCollege of Mount St VincentBronx, New York

Kate Schmitz, RN, MS

Clinical Nurse, Emergency Department

St Joseph HospitalCreighton University Medical CenterOmaha, Nebraska

Sally Schnell, RN, MSN, CNRN

Professional Education CoordinatorRegional Organ Bank of IllinoisChicago, Illinois

Jill Secord, RN, BSN, CRNI

University of Michigan Health System—-M-CAREJackson, Michigan

George B Smith, MSN, BSN, ADN

Nursing FacultyHillsborough Community CollegeTampa, Florida

Martha Spray, RN, BSN, MS

Adult PN InstructorMid East Ohio Vocational SchoolZanesville, Ohio

Rose Utley, PhD, RN

Associate ProfessorSouthwest Missouri State UniversityRogersville, Missouri

Kathleen Kelley Walsh, RN, MS

Professor of NursingJackson Community CollegeJackson, Mississippi

JoAnn Widner, RN, MS

Health EducatorCentral North Alabama Health Services, Inc.Huntsville, Alabama

xvi Contributors to Previous Editions

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William Beiswenger, RN, MA, CDE

Certiﬁed Diabetes Educator

W.A Foote Memorial Hospital Diabetes Center

Jackson, Michigan

Nicholle Bieberdorf, RN, BAN

Practical Nursing Instructor

Northwest Technical College

Chair, Health Science

Larleen B Wallace Community College, MacAuthor

Campus

Opp, Alaska

Jessie Chatman Williams, RN, MA

Nursing Instructor

Mineral Area College

Park Hills, Missouri

Michelle Colleran Cook, MS, RN

Kim DeEll, RN, BSN

Nursing InstructorMalaspina University CollegeDuncan, British Columbia, Canada

Carol Duell, MSN, CRNP

Nursing InstructorEastern Center for Arts and TechnologyWillow Grove, Pennsylvania

Madeline Gervase, MSN, CCRN, FNP, RN

Assistant ProfessorUnion County CollegePlainﬁeld, New Jersey

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Phyllis Sue Howard, RN, BSN

Administrator, PN Program

Ashland Community & Technical college

Ashland, Kentucky

Connie Hunt, RN, BSN

Instuctor, Practical Nursing

Indian Capital Technology Center

Ethel M Jones, RN, MSN, Ed S., DSNc

Coordinator, Practical Nursing

H Councill Trenholm State Technical College

Nichols Career Center

Loose Creek, Missouri

Cynthia L Lapp, RN, BS

LPN Instructor – Level 2

Charles H Bohlen Jr Technical Center

Watertown, New York

American Career College

Los Angeles, California

Patricia Marrow, RN, BSN, MA

Nursing Educator, LPN ProgramDaytona Beach Community CollegeDaytona Beach, Florida

Mary Patricia Norrell, RNC, BSN, MS

Chair, Practical Nursing ProgramIvy Tech State College

Columbus, Indiana

Darlene D Pedersen, MSN, APRN, BC

Director and PsychotherapistPsychOptions

Philadelphia, Pennsylvania

LuAnn J Reicks, RNBC, BS, MSN

Professor; PN CoordinatorIowa Central Community CollegeFort Dodge, Iowa

Carleen J Ronchetti, RN, MS

Nursing InstructorLake Superior CollegeDuluth, Minnesota

Denise Root, RN, ADN, BSN, MSN

Director, Nursing DepartmentOtero Junior College

LaJunta, Colorado

Glynda Renee Sherrill, RN, BSN,

PN InstructorIndian Capital Technology CenterTahlequah, Oklahoma

Penny Snyder, RN, BSN

Assistant ProfessorNorth Central State CollegeMansﬁeld, Ohio

Frances Swasey, RN, MN

Chair, Nursing DepartmentCollege of Eastern UtahPrice, Utah

Beverley D Turner, RN, MA

Campus DirectorDesert Career CollegePalm Springs, California

Rita Van Horn, RN, PHD

Director of NursingBellingham Technical CollegeBellingham, Washingtonxviii Reviewers

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Catherine Wardlow, RN, BS, Med, MS

Practical Nursing Instructor

Francis Tuttle Technology Center

Oklahoma City, Oklahoma

Deborah L Weaver, RN, PHD

Associate Professor, Nursing

Valdosta State University

Valdosta, Georgia

Martha Williams, BA, RN

ProfessorCentral Texas CollegeBrady, Texas

Christina Wilson, RN, BAN, PHN

Faculty, Practical Nursing DepartmentAnoka Technical College

Anoka, Minnesota

Reviewers xix

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UNIT ONE

Understanding Health Care Issues 1

Chapter 1 Critical Thinking and the Nursing Process 2

Paula D Hopper and Linda S.Williams

Critical Thinking and Safe Care 3

Critical Thinking Attitudes 3

Chapter 2 Issues in Nursing Practice 12

Lenetra Jefferson, Linda Marie Lowe, and Patrick M Shannon

Health-Care Delivery 13

Health-Illness Continuum 13

Health-Care Delivery Systems 13

Factors Inﬂuencing Health-Care Change 13

Economic Issues 13

Medicare and Diagnosis-Related Groups (DRGs) 13

Medicaid 14

Managed Health Care 14

Nursing and the Health-Care Team 14

Leadership in Nursing Practice 14

Leadership Styles 15

Management Functions 15

Leadership and Delegation of the LPN/LVN 16

Career Opportunities for LPN/LVNs 17

Ethics and Values 17

Ethical Obligations and Nursing 18

Nursing Code of Ethics 19

Building Blocks of Ethics 21

Ethical Decision Making 24

Legal Concepts 26

Regulation of Nursing Practice 26Health Insurance Portability and Accountability Act of

1996 (HIPPA) 26Nursing Liability and the Law 26Criminal and Civil Law 26Limitation of Liability 27

Review Questions 28

Chapter 3 Cultural Inﬂuences on Nursing Care 30

Nancy Ahern

Case Study 31 Concepts Related to Culture 31 Health-Care Values, Beliefs, and Practices 33

Nursing Assessment and Strategies 33

Characteristics of Cultural Diversity 34

Communication Styles 34Space 34

Time Orientation 35Social Organization 35Environmental Control 36Health-Care Practitioners 37Biological Variations 37Death and Dying and End of Life Issues 38

Ethnic and Cultural Groups 38

Cultural Groups in the United States 38African Americans/Blacks 40

American Indians/Alaskan Natives 45Arab Americans 45

Asian Americans/Paciﬁc Islanders 45

Culturally Competent Care 46 Reﬂections on Case Study 47 Review Questions 47

Chapter 4 Alternative and Complementary

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Introduction of New Systems Into Traditional American

Heat and Cold Application 54

Safety and Effectiveness of Alternative Therapies 54

Role of LPN/LVN 55

Nursing Applications 55

UNIT TWO

Understanding Health and Illness 57

Chapter 5 Nursing Care of Patients with Fluid,

Electrolyte, and Acid-Base Imbalances 58

Bruce K.Wilson

Fluid Balance 59

Control of Fluid Balance 59

Movement of Fluids and Electrolytes in the Body 59

Fluid Gains and Fluid Losses 60

Sources of Acids and Bases 72

Control of Acid-Base Balance 72

PiggyBack/Secondary Infusion 78

Methods of Infusion 78

Gravity Drip 78Electronic Control Devices 79Filters 79

Types of Fluids 79

Dextrose Solutions 79Sodium Chloride Solutions 79Electrolyte Solutions 79Tonicity of IV Solutions 79

Intravenous Access 80 Administering Peripheral Intravenous Therapy 80

Starting a Peripheral Line 80

Nursing Process for the Patient Receiving IV Therapy 85

Assessment/Data Collection 85Nursing Diagnosis, Planning, and Implementation 85Evaluation 87

Complications of IV Therapy 87 Alternative Access Routes 88

Central Venous Catheters 88Nursing Management of Central Access Devices 89

Nutritional Support 89 Home Intravenous Therapy 90 Reﬂections on Case Study 90 Review Questions 90

Chapter 7 Nursing Care of Patients with Infections 92

Susan Garbutt

The Infectious Process 93

Reservoir 93Causative Agents 93Mode of Transmission 94Portal of Entry 95Susceptible Host 95Portal of Exit 95

The Human Body’s Defense Mechanisms 96

Skin and Mucous Membranes 96Cilia 96

Gastric Juices 96Immunoglobulins 96Leukocytes and Macrophages 96Lysozymes 96

Interferon 96Inﬂammatory Response 96Immune System 96

Infectious Disease 97

General Clinical Manifestations of Infections 97Laboratory Assessment 97

Immunity 97Types of Diseases 97

Infection Control in the Community 98

xxii Contents

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Infection Control in Health-Care Agencies 98

Asepsis 98

Infection Prevention Guidelines 99

Prevention of Respiratory Tract Infections 100

Prevention of Genitourinary Tract Infections 100

Prevention of Surgical Wound Infections 102

Protection from Septicemia (Sepsis) 102

Respiratory Tract Infections 107

Gastrointestinal Tract Infections 107

Genitourinary Tract Infection 107

Chapter 8 Nursing Care of Patients in Shock 110

Cynthia Francis Bechtel

Pathophysiology of Shock 111

Metabolic and Hemodynamic Changes in Shock 111

Effect on Organs and Organ Systems 111

Complications from Shock 113

Therapeutic Interventions for Shock 115

Modiﬁed Trendelenburg Position 115

More Pain-Related Deﬁnitions 126

Mechanisms of Pain Transmission 127

Chapter 10 Nursing Care of Patients with Cancer 143

Lucy L Colo and Janice L Bradford

Review of Normal Anatomy and Physiology of Cells 144

Cell Structure 144Cytosol and Cell Organelles 144Nucleus 144

Genetic Code and Protein Synthesis 145Mitosis 145

Cell Cycle 146Cells and Tissues 146

Introduction to Cancer Concepts 146

Benign Tumors 146Cancer 146

Nursing Process for the Patient with Cancer 162

Assessment/Data Collection 162Nursing Diagnosis, Planning, and Implementation 163Evaluation 170

Hospice Care of the Patient with Cancer 170 Oncological Emergencies 170

Superior Vena Cava Syndrome 170Spinal Cord Compression 170Hypercalcemia 170

Pericardial Effusion/Cardiac Tamponade 171Disseminated Intravascular Coagulation 171

Factors Inﬂuencing Surgical Outcomes 175Preadmission Surgical Patient Assessment 178Preoperative Patient Admission 179

Nursing Process for Preoperative Patients 179Preoperative Consent 181

Preparation for Surgery 182Transfer to Surgery 184

Intraoperative Phase 184

Health-Care Team Member Roles 186Patient Arrival in Surgery 186Anesthesia 187

Transfer from Surgery 189

Postoperative Phase 189

Admission to the Postanesthesia Care Unit 190Nursing Process for Postoperative Patients

in PACU 190Family Visitation 192Discharge from the Postanesthesia Care Unit 192Transfer to Nursing Unit 192

Nursing Process for Postoperative Patients 193Postoperative Patient Discharge 201

Home Health Care 202

Contents xxiii

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Chapter 12 Nursing Care of Patients with Emergent

Conditions and Disaster/Bioterrorism Response 206

Poisoning and Drug Overdose 219

Nursing Process for the Patient with Ingested

Poisoning 219Inhaled Poisons 219

Chapter 13 Developmental Considerations in the

Nursing Care of Adults 228

Ruth Remington

Health, Wellness, and Illness 229 The Nurse’s Role in Supporting and Promoting Wellness 229

Developmental Stages 229

The Young Adult 229The Middle-Aged Adult 230The Older Adult 231

Chronic Illness 232

Incidence of Chronic Illness 233Types of Chronic Illnesses 233Gerontological Inﬂuence 233Effects of Chronic Illness 234Health Promotion 238Nursing Care 238

Chapter 14 Nursing Care of Older Adult Patients 242

MaryAnne Pietraniec-Shannon

What is Aging? 243 Physiological Changes 243

Common Physical Changes in Older Patients and TheirImplications for Nursing 243

Cognitive and Psychological Changes in the Older Patient 253

Cognition 253Coping Abilities 254Depression 254Dementia 254Sleep and Rest Patterns 254Medication Management 255

Health Promotional Role in Nursing Care of the Older Patient 255

The Home Health Care Team 261

The Physician 261The Registered Nurse 261The Home Health Aide 262The Physical Therapist 262The Occupational Therapist 262The Speech Therapist 262The Social Worker 262Assisted Living Facilities 263

Transition from Hospital-Based Nursing to Home Health Care 262

xxiv Contents

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The Role of the LPN/LVN in Home Health 264

Steps in the Home Health Visit 264

Preparing for the Visit 264

Other Types of Home Health Nursing 267

Private Duty Nursing 267

Identifying Impending Death 271

Advance Directives, Living Wills, and Durable Medical

Power of Attorney 271

End of Life Choices 272

Cardiopulmonary Resuscitation 272

Do Not Resuscitate Orders 272

Artiﬁcial Feeding and Hydration 273

Hospitalization 274

Hospice Care 275

Communicating with Patients and Their

Loved Ones 275

The Dying Process 276

Eating and Drinking 276

Nursing Process for the Grieving Family 283

The Nurse and Loss 284

Reﬂections on Case Study 284

UNIT FOUR

Understanding the Immune System 287

Chapter 17 Immune System Function, Assessment,

and Therapeutic Measures

Sharon M Nowak and Janice L Bradford

Normal Immune Anatomy and Physiology 289

Antigens 290Lymphocytes 290Antibodies 290Mechanisms of Immunity 290

Antibody Responses 291 Types of Immunity 292 Aging and the Immune System 292 Immune System Assessment 292

Nursing Assessment 292Diagnostic Tests 296Gene Testing 196

Therapeutic Interventions 296

Immunotherapy 299Medications 299Surgical Management 299New Therapies 299

Autoimmune Disorders 312

Pernicious Anemia 312Idiopathic Autoimmune Hemolytic Anemia 313Hashimoto’s Thyroiditis 313

Lupus Erythematosus 314Ankylosing Spondylitis 316

Progression 324

Prevention 325

Mode of Transmission 325Counseling 325

Sexual Transmission 325Parenteral Transmission 326Perinatal Transmission 326Health-Care Workers and HIV Prevention 326

Signs and Symptoms 327 Complications 328

AIDS Wasting Syndrome 328Opportunistic Infection and Cancer 328AIDS Dementia Complex 329

Contents xxv

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Diagnosis 329

HIV Antibody Tests 329

Complete Blood Cell Count/Lymphocyte Count 329

UNIT FIVE

Understanding the Cardiovascular System 345

Chapter 20 Cardiovascular System Function,

Assessment, and Therapeutic Measures 346

Linda S.Williams and Janice L Bradford

Review of Normal Anatomy and Physiology 347

Isolated Systolic Hypertension 375

Signs and Symptoms of Hypertension 375

Diagnosis of Hypertension 375

Diagnostic Tests 376

Risk Factors for Hypertension 376

Nonmodiﬁable Risk Factors 376

Modiﬁable Risk Factors 377

Complications of Hypertension 381 Special Considerations 381

Hypertensive Emergency 382 Hypertensive Urgency 382 Nursing Process 382

Nursing Assessment/Data Collection 382Nursing Diagnosis, Planning, Interventions, andEvaluation 382

Chapter 22 Nursing Care of Patients with Inﬂammatory

and Infectious Cardiovascular Disorders 387

Linda S.Williams

Inﬂammatory and Infectious Cardiac Disorders 388

Rheumatic Carditis 388Infective Endocarditis 389Pericarditis 391

Myocarditis 394Cardiac Trauma 395Cardiomyopathy 395

Pathophysiology 405Causes 405

Signs and Symptoms 405Diagnostic Tests 405Therapeutic Intervention 405

Coronary Artery Disease and Acute Coronary

Pathophysiology and Etiology 407Prevention 407

Therapeutic Interventions 408Nursing Process: The Patient with Athersclerosis andCoronary Artery Disease 411

Acute Coronary Syndromes 412

Angina Pectoris 412Myocardial Infarction 418

Peripheral Vascular System 430

Arterial Thrombosis and Embolism 430Peripheral Arterial Disease 430

Raynaud’s Disease 432Thromboangiitis Obliterans (Buerger’s Disease) 432Aneurysms 432

Varicose Veins 436Venous Insufficiency 437Vascular Surgery 438

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Chapter 24 Nursing Care of Patients with Cardiac

Nursing Assessment/Data Collection 451

Nursing Diagnosis, Planning, Intervention, and

Evaluation 451

Cardiac Valvular Surgical Interventions 451

Heart Valve Repairs 453

Heart Valve Replacement 453

Nursing Process for the Preoperative Cardiac Surgery

Electrocardiogram Graph Paper 460

Components of a Cardiac Cycle 460

Interpretation of Cardiac Rhythms 462

Five-Step Process for Dysrhythmia Interpretation 462

Normal Sinus Rhythm 463

Description 463

Normal Sinus Rhythm Rules 464

Dysrhythmias 464

Dysrhythmias Originating in the Sinoatrial Node 464

Dysrhythmias Originating in the Atria 465

Ventricular Dysrhythmias 468

Cardiac Pacemakers 471

Nursing Care for Patients with Pacemakers 472

Deﬁbrillation 473

Other Methods to Correct Dysrhythmias 474

Automatic External Deﬁbrillators 474Implantable Cardioverter Deﬁbrillator 474Cardioversion 474

Ablation 475

Nursing Process for the Patient with Dysrhythmias 475

Assessment/Data Collection 475Nursing Diagnosis, Planning and Implementation, andEvaluation 475

Compensatory Mechanisms to Maintain Cardiac Output 482

Pulmonary Edema 482

Pathophysiology 482Signs and Symptoms 482Diagnosis 483

Therapeutic Interventions 483

Chronic Heart Failure 483

Signs and Symptoms 483Complications of Heart Failure 485Diagnostic Tests 486

Therapeutic Interventions 486Nursing Process for Chronic Heart Failure 492

Cardiac Transplantation 496

Surgical Procedure 496Complications 497Therapeutic Interventions 498

Nursing Process for the Preoperative Cardiac Transplant Patient 498

Nursing Process for the Postoperative Cardiac Transplant Patient 498

Assessment/Data Collection 498Nursing Diagnosis, Planning, Interventions, andEvaluation 498

UNIT SIX Understanding the Hematopoietic and Lymphatic Systems 507

Chapter 27 Hematopoietic and Lymphatic System

Function, Assessment, and Therapeutic Measures 508

Janice L Bradford and Lucy L Colo

Normal Anatomy and Physiology 509

Blood 509Lymphatic System 511

Contents xxvii

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Chapter 28 Nursing Care of Patients with

Hematological and Lymphatic Disorders 520

Disseminated Intravascular Coagulation 530

Idiopathic Thrombocytopenic Purpura 531

Understanding the Respiratory System 547

Chapter 29 Respiratory System Function, Assessment,

and Therapeutic Measures 548

Paula D Hopper

Nose and Nasal Cavities 549

Pharynx 549

Larynx 550

Trachea and Bronchial Tree 550

Lungs and Pleural Membranes 550

Mechanism of Breathing 550

Transport of Bases in the Blood 551

Regulation of Respiration 551

Respiration and Acid-Base Balance 551

Effects of Aging on the Respiratory System 552

Nursing Assessment 552

Health History 552Physical Assessment 552

Diagnostic Tests 555

Laboratory Tests 555Other Tests 557

Therapeutic Measures 558

Smoking Cessation 558Deep Breathing and Coughing 559Huff Coughing 559

Breathing Exercises 559Positioning 559

Oxygen Therapy 559Nebulized Mist Treatments 561Inhalers 561

Incentive Spirometry 561Chest Physiotherapy 561Flutter Mucus Clearance Device 562Thoracentesis 562

Chest Drainage 563Tracheostomy 565Suctioning 567Intubation 570Mechanical Ventilation 572Noninvasive Positive-Pressure Ventilation 573

Chapter 30 Nursing Care of Patients with Upper

Respiratory Tract Disorders 576

Paula D Hopper

Disorders of the Nose and Sinuses 577

Epistaxis 577Nasal Polyps 578Deviated Septum 578Rhinoplasty 578Sinusitis 578

Infectious Disorders 579

Rhinitis/Common Cold 579Pharyngitis 582

Laryngitis 582Tonsillitis/Adenoiditis 582Inﬂuenza 583

Other Viral Infections 584

Malignant Disorders 584

Cancer of the Larynx 584

Chapter 31 Nursing Care of Patients with Lower

Respiratory Tract Disorders 590

Paula D Hopper

Infectious Disorders 591

Acute Bronchitis 591Bronchiectasis 591Pneumonia 591Tuberculosis 594xxviii Contents

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Nursing Process for The Patient with a Lower

Acute Respiratory Failure 619

Acute Respiratory Distress Syndrome/Acute Lung

Chapter 32 Gastrointestinal, Hepatic, and Pancreatic

Systems Function, Assessment, and TherapeuticMeasures 632

Lazette V Nowicki, Linda S.Williams, and Janice L Bradford

Review of Normal Gastrointestinal, Liver, Gallbladder, and Pancreas Anatomy and Physiology 633

Oral Cavity and Pharynx 633Esophagus 633

Stomach 633Small Intestine 634Large Intestine 634Liver 635

Gallbladder 636Pancreas 637Aging and the Gastrointestinal System, Liver,Gallbladder, and Pancreas 637

Nursing Assessment/Data Collection 638

Subjective Data 638Objective Data 643Diagnostic Studies 645Laboratory Tests 645Radiographic Tests 650Nuclear Scanning 651Angiography 651Liver Scan 651Endoscopy 651Gastric Analysis 653Ultrasonography 653Endoscopic Ultrasonography 653Percutaneous Liver Biopsy 653

Gastrointestinal Intubation 654Tube Feedings 655

Gastrointestinal Decompression 658Total Parenteral Nutrition 658Peripheral Parenteral Nutrition 658

Contents xxix

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Nursing Process for the Patient Who is Obese 668

Oral Health and Dental Care 669

Oral Inﬂammatory Disorders 669

Stomatitis 669

Oral Cancer 670

Pathophysiology and Etiology 670

Signs and Symptoms 670

Diagnosis 671

Nursing Management 671

Esophageal Cancer 671

Signs and Symptoms 678Therapeutic Interventions 680Nursing Process for the Patient with GastricBleeding 680

Vagotomy 681Nursing Process for the Patient Having GastricSurgery 681

Complications of Gastric Surgery 682Pyloric Obstruction 683

Inﬂammatory and Infectious Disorders 692

Appendicitis 692Peritonitis 693Diverticulosis and Diverticulitis 693Nursing Process for the Patient with an Inﬂammatory orInfectious Disorder 694

Inﬂammatory Bowel Disease 695

Crohn’s Disease (Regional Enteritis) 695Ulcerative Colitis 698

Nursing Process for the Patient with InﬂammatoryBowel Disease 699

Irritable Bowel Syndrome 700

Pathophysiology 700Etiology 700Signs and Symptoms 700Diagnostic Tests 701Therapeutic Interventions 701Nursing Process for the Patient with IBS 701

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Chapter 35 Nursing Care of Patients with Liver,

Gallbladder, and Pancreatic Disorders 719

Jean Jeffries

Disorders of the Liver 720

Hepatitis 720

Acute (Fulminant) Liver Failure 723

Chronic Liver Failure 724

Transplantation 731

Cancer of the Liver 732

Disorders of the Pancreas 732

Pancreatitis 732

Acute Pancreatitis 733

Cancer of the Pancreas 738

Disorders of the Gallbladder 741

Cholecystitis, Cholelithiasis, and

Choledocholithiasis 741

UNIT NINE

Understanding the Urinary System 749

Chapter 36 Urinary System Function, Assessment, and

Therapeutic Measures 750

Maureen McDonald and Janice L Bradford

Review of Anatomy and Physiology 751

Kidneys 751Formation of Urine 752The Kidneys and Acid-Base Balance 753Other Functions of the Kidneys 753Elimination of Urine 753

Characteristics of Urine 754Aging and the Urinary System 754

Nursing Assessment / Data Collection of the Urinary System 755

Subjective Data: Health History 755Objective Data: Physical Assessment 755

Diagnostic Tests of the Renal System 760

Laboratory Tests 760Diagnostic Procedures 762Endoscopic Procedures 762Renal Biopsy 769

Nursing Process for Diagnostic Tests of the RenalSystem Assessment 769

Management of Urinary Incontinence 770Management of Urine Retention 771Urinary Catheters 771

Chapter 37 Nursing Care of Patients with Disorders of

the Urinary System 777

Maureen McDonald

Urinary Tract Infections 778

Predisposing Factors for Urinary Tract Infections 778Signs and Symptoms 778

Types 778Nursing Process for the Patient with a Urinary TractInfection 781

Urological Obstructions 782

Urethral Strictures 782Renal Calculi 783Hydronephrosis 787

Tumors of the Renal System 788

Cancer of the Bladder 788Cancer of the Kidney 790

Renal System Trauma 791 Polycystic Kidney Disease 791 Chronic Renal Diseases 791

Diabetic Nephropathy 791Nephrotic Syndrome 792Nephrosclerosis 793

Glomerulonephritis 793

Pathophysiology 793Etiology 793Symptoms 793Diagnostic Tests 794Therapeutic Interventions 794Complications 794

Nursing Management 794

Contents xxxi

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Renal Failure 794

Acute Renal Failure 794

Chronic Renal Failure 796

Symptoms of Renal Failure 798

Therapeutic Interventions for Renal Failure 800

Kidney Transplantation 804

Nursing Process for the Patient with Renal Failure 805

UNIT TEN

Understanding the Endocrine System 813

Chapter 38 Endocrine System Function

and Assessment 814

Paula D Hopper and Janice L Bradford

Cancer of the Thyroid Gland 839

Nursing Process for the Patient Undergoing

Chapter 40 Nursing Care of Patients with Disorders of

the Endocrine Pancreas 851

Paula D Hopper

Diabetes Mellitus 852

Pathophysiology 852Types and Causes 852Signs and Symptoms of Diabetes 855Prevention 856

Therapeutic Interventions 856Acute Complications of Diabetes 863Long-Term Complications 866Special Considerations for the Patient UndergoingSurgery 868

Nursing Process for the Patient with DiabetesMellitus 869

Diabetes Self-Management Education 869

Reactive Hypoglycemia 871

Pathophysiology 872Signs and Symptoms 872Diagnosis 872

Therapeutic Intervention 872

UNIT ELEVEN Understanding the Genitourinary and Reproductive System 877

Chapter 41 Genitourinary and Reproductive System

Function and Assessment 878

Debra Perry-Philo and Janice L Bradford

Female Reproductive System 879Male Reproductive System 881Aging and the Reproductive System 883

Female Assessment 883

Normal Function Baselines 883History 883

Breast Assessment 885Diagnostic Tests of the Breasts 887Additional Diagnostic Tests of the Female ReproductiveSystem 888

Male Assessment 892

History 892Physical Examination 893Testicular Self-Examination 896Breast Self-Examination 896Diagnostic Tests of the Male Reproductive System896

xxxii Contents

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Chapter 42 Nursing Care of Women with Reproductive

System Disorders 899

Debra Perry-Philo and Linda Hopper Cook

Breast Disorders 900

Benign Breast Disorders 900

Malignant Breast Disorders 900

Breast Modiﬁcation Surgeries 904

Diagnostic Testing 910Nursing Care and Teaching of the Patient Undergoing

Treatment 910

Toxic Shock Syndrome 912

Pathophysiology, Etiologies, and Signs and

Symptoms 912Prevention 912

Nursing Care and Teaching 912

Disorders Related to the Development of the Genital

Organs 912

Pathophysiology, Etiologies, and Signs and

Symptoms 912Diagnositic Tests 912

Nursing Care and Teaching of the Patient Undergoing

Estrogen-Progestogen Contraceptive Ring 919

Transdermal Contraceptive Patch 919

Barrier Methods 919

Spermicides 921

Intrauterine Devices 921

Natural Family Planning 921

Less Effective Methods 922

Ongoing Research: Future Possibilities for

Contraceptive Choices 922Sterilization 922

Pregnancy Termination 923

Methods of Abortion 923Ethical Issues 925

Tumors of the Reproductive System 925

Benign Growths 925Malignant Disorders 927

Gynecological Surgery 929

Endoscopic Surgeries 929Hysterectomy 930

Penile Disorders 946

Peyronie’s Disease 946Priapism 946

Phimosis and Paraphimosis 946Cancer of the Penis 946

Testicular Disorders 947

Cryptorchidism 947Hydrocele 947Varicocele 947Epididymitis 947Orchitis 947Cancer of the Testes 947

Sexual Functioning 948

Vasectomy 948Erectile Dysfunction 948Infertility 953

Chapter 44 Nursing Care of Patients with Sexually

Transmitted Diseases 957

Debra Perry-Philo and Linda Hopper Cook

Disorders and Syndromes Related to Sexually Transmitted Diseases 958

Volvovaginitis 958Urethritis 958Proctitis and Enteristis 958Genital Ulcers 959Cellular Changes 959Pelvic Inﬂammatory Disease 959

Sexually Transmitted Infections 959

Chlamydia 959Gonorrhea 960Syphilis 960Trichomoniasis 963Herpes 963Genital Warts 964Hepatitis B 967Genital Parasites 967

Reporting of Sexually Transmitted Diseases 967

Contents xxxiii

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Nursing Process for Sexually Transmitted

Diseases 968

Assessment/Data Collection 968

Nursing Diagnoses, Planning, and

Implementation 968Evaluation 971

UNIT TWELVE

Understanding the Musculoskeletal System 975

Chapter 45 Musculoskeletal Function

and Assessment 976

Rodney B Kebicz and Janice L Bradford

Skeletal System Tissues and Their Functions 977

Bone Tissue and Growth of Bone 977

Structure of the Skeleton 977

Skull 978

Vertebral Column 979

Ribcage 980

Appendicular Skeleton 980

Structure of Synovial Joints 980

Muscle Structure and Arrangements 980

Role of the Nervous System 981

Neuromuscular Junction 981

Aging and the Musculoskeletal System 981

Nursing Assessment of the Musculoskeletal

Chapter 46 Nursing Care of Patients with

Musculoskeletal and Connective Tissue Disorders 991

Rotator Cuff Injury 992

Carpal Tunnel Syndrome 993

Chapter 47 Neurological Function, Assessment, and

Jennifer Whitley and Janice L Bradford

Nerve Tissue 1037Spinal Cord 1039Brain 1040Meninges and Cerebrospinal Fluid 1042Cranial Nerves 1042

Autonomic Nervous System 1042Aging and the Nervous System 1043

Nursing Assessment/Data Collection of the Neurological

Subjective Data 1046Physical Assessment 1046Assessment Summary 1050

Laboratory Tests 1050Lumbar Puncture 1050X-ray Examination 1051Computed Tomography 1051Magnetic Resonance Imaging 1051Angiogram 1052

Myelogram 1052Electroencephalogram 1052

Moving and Positioning 1053Activities of Daily Living 1053Communication 1053

Nutrition 1054

Family 1054 Review Questions 1055

Chapter 48 Nursing Care of Patients with Central

Nervous System Disorders 1056

Jennifer Whitley

Central Nervous System Infections 1057

Meningitis 1057Encephalitis 1058

Increased Intracranial Pressure 1059

Pathophysiology and Monitoring 1059Signs and Symptoms 1059

Monitoring 1060Nursing Process for the Patient with an Infectious orInﬂammatory Neurological Disorder 1061xxxiv Contents

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Nursing Process for the Patient with Seizures 1069

Traumatic Brain Injury 1070

Complications of Traumatic Brain Injury 1072

Nursing Process for the Patient with Traumatic Brain

Injury 1073Rehabilitation 1074

Brain Tumors 1074

Diagnostic Tests 1075

Acute and Long-Term Complications 1076

Nursing Process for the Patient with a Brain Tumor

1076

Intracranial Surgery 1076

Preoperative Care 1076

Nursing Process for the Postoperative Care of the

Patient Having Intracranial Surgery

Spinal Disorders 1078

Herniated Disks 1078

Nursing Process for the Patient Having Spinal

Surgery 1080Spinal Stenois 1081

Spinal Cord Injuries 1081

Pathophysiology 1081

Causes and Types 1081

Nursing Process fort eh Care of the Patient with a

Spinal Cord Injury 1085

Neurodegenerative Disorders and Disturbed Thought

Therapeutic Interventions 1112Prevention of Stroke 1114Long-Term Effects of Stroke 1114

Cerebral Aneurysm and Subarchnoid Hemorrhage 1116

Pathophysiology and Etiology 1116Signs and Symptoms 1116

Diagnostic Tests 1117Therapeutic Interventions 1117Complications 1117

Rehabilitation 1118Nursing Process for the Patient with a CerebrovascularDisorder 1118

Chapter 50 Nursing Care of Patients with Peripheral

Nervous System Disorders 1126

Deborah L.Weaver

Neuromuscular Disorders 1127

Multiple Sclerosis 1127Myasthenia Gravis 1129Amyotrophic Lateral Sclerosis 1134Guilain-Barrè Syndrome 1135Postpolio Syndrome 1136

Cranial Nerve Disorders 1137

Trigeminal Neuralgia 1138Bell’s Palsy 1138

UNIT FOURTEEN Understanding the Sensory System 1143

Chapter 51 Sensory System Function, Assessment, and

Therapeutic Measures:Vision and Hearing 1144

Debra Aucoin-Ratcliff, Lazette V Nowicki, and Janice L Bradford

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Chapter 52 Nursing Care of Patients with Sensory

Disorders:Vision and Hearing 1163

Lazette V Nowicki and Debra Aucoin-Ratcliff

UNIT FIFTEEN

Understanding the Integumentary System 1199

Chapter 53 Integumentary Function, Assessment, and

Rita Bolek Troﬁno, Marty Kohn, and Janice L Bradford

Aging and the Integumentary System 1202

Inﬂammatory Skin Disorders 1222

Dermatitis 1222Psoriasis 1224

Infectious Skin Disorders 1225

Herpes Simplex 1225Herpes Zoster (Shingles) 1228Fungal Infections 1228Cellulitis 1230

Acne Vulgaris 1231Nursing Process for the Patient with a Skin Infection1231

Parasitic Skin Disorders 1232

Pediculosis 1232Scabies 1233

Pemphigus 1234

Pathophysiology and Etiology 1234Signs and Symptoms 1234

Complications 1234Diagnostic Tests 1234Therapeutic Intervention 1234Nursing Care 1235

Skin Lesions 1235

Malignant Skin Lesions 1235

Dermatologic Surgery 1239 Review Questions 1240

Chapter 55 Nursing Care of Patients with Burns 1242

Rita Bolek Troﬁno

Pathophysiology and Signs and Symptoms 1243

Systemic Responses 1243Classiﬁcation of Burn Injuries 1244

Etiology 1244 Complications 1244 Diagnostic Tests 1245 Therapeutic Interventions 1245

Emergent Stage 1245Acute Stage 1246Rehabilitation Phase 1248

Nursing Process for a Burned Patient 1249

Assessment/Data Collection 1249Nursing Diagnosis, Planning, Implementation, andEvaluation 1250

UNIT SIXTEEN Understanding Mental Health Care 1259

Chapter 56 Mental Health Function, Assessment, and

Marina Martinez-Kratz

xxxvi Contents

Trang 36

Review of Anatomy and Physiology 1261

Mental Health and Mental Illness 1261

Etiologies 1261

Social and Cultural Environments 1261

Spirituality and Religion 1261

Distinguishing Physical Versus Mental Disorders 1264

Coping and Ego Defense Mechanisms 1266

Effective Coping Skills 1266

Ineffective Coping Skills 1266

Substance Abuse Disorders 1286

Mental Illness and The Older Adult 1290 Review Questions 1293

Appendix A North American Nursing Diagnosis Association (NANDA) Nursing Diagnoses 1295 Appendix B Normal Adult Reference Laboratory Values 1297

Appendix C Answers to Review Questions 1301 Appendix D Medical Abbreviations 1302 Appendix E Preﬁxes, Suffixes, and Combining

Glossary 1305 Index 1321

Contents xxxvii

Trang 37

Trang 38

unit ONE

UNDERSTANDING

HEALTH CARE

ISSUES

Trang 39

Critical Thinking and the Nursing Process

P A U L A D H O P P E R

A N D L I N D A S W I L L I A M S

QUESTIONS TO GUIDE YOUR READING

1 How is critical thinking of value in the nursing process?

2 What are objective and subjective data?

3 How can the documentation of data be improved?

4 How would you prioritize patient care based on Maslow’s hierarchy of human needs?

5 What is your role as a licensed practical nurse/licensed vocational nurse in using the nursing process?

6 What is a nursing diagnosis?

7 What is the evaluation phase of the nursing process?

nursing diagnosis (NER-sing DYE-ag-NOH-sis)

nursing process (NER-sing PRAH-sess)

objective data(ob-JEK-tiv DAY-tuh)

subjective data(sub-JEK-tiv DAY-tuh)

2

Trang 40

Excellence in the delivery of nursing care requires good

thinking Each day nurses make many decisions that will

affect the care of their patients For those decisions to be

effective, the thought processes behind them must be sound

CRITICAL THINKING AND SAFE CARE

Nurses must learn to think critically This means they must

use their knowledge and skills to make the best decisions

possible in patient care situations Halpern1says that

“criti-cal thinking is the use of those cognitive [knowledge] skills

or strategies that increase the probability of a desirable

out-come.” Critical thinking is sometimes called directed

think-ing because it focuses on a goal Other terms used when

talking about critical thinking include reasoning, common

sense, analysis, and inquiry Good thinking requires critical

thinking attitudes and skills, which are described below It

also requires a good knowledge base, so your thinking is

based upon correct factual material These are the topics of

the rest of this book

Critical Thinking Attitudes

Researchers have identiﬁed attitudes that are associated with

good critical thinking Green identiﬁes seven attitudes,

sum-marized below.2

Intellectual Humility

Have you ever known people who think they “know it all”?

They do not have intellectual humility People with

intellec-tual humility have the ability to say, “I am not sure about

that… I need more information.” Certainly, we want our

patients to think we are smart and know what we are doing,

but patients also respect nurses who can say, “I do not know;

let me ﬁnd out.” It is unsafe to care for patients when you are

not sure of what you need to do

Intellectual Courage

Intellectual courage allows you to look at other points of

view even when you do not agree with them at ﬁrst Maybe

you really believe that 8-hour shifts are best for nurses, and

have a lot of good reasons for your belief But if you have

intellectual courage, you will be willing to really listen to

the arguments for changing to 12-hour shifts Maybe you

will even be convinced Sometimes you have to have the

courage to say, “Okay, I see you were right after all.”

Intellectual Empathy

Consider the patient who snaps as you enter her room, “I’ve

been waiting all morning for my bath If you do not help me

with it right now I am going to call your supervisor.” The

ﬁrst response that comes into your head is, “I have ﬁve other

patients; you are lucky I am here now!” But, if you have

intellectual empathy, you will be able to think, “If I were

this patient, who is in chronic pain and is tired of being

in the hospital, how would I feel?” It might change how you

respond

Intellectual Integrity

Your patient seems to ask a hundred questions when youbring her a medication that has been newly prescribed forher high blood pressure But later you notice she is taking anherbal remedy from her purse It is good that she is asking alot of questions about her drug, which has been tested exten-sively by the Food and Drug Administration (FDA) Herbalremedies are not held to the same standards as medications

in the United States Someone with intellectual integritywould want the same kind of proof that both types of med-ications are safe and effective before using them

Intellectual Perseverance

Do not give up Consider this scenario You have concernsabout some side effects you have noticed when you admin-ister a new drug to your patients You mentioned it to thephysician and he said not to worry about it, but you are stillconcerned If you have intellectual perseverance, you might

do some research on the web, then go to your supervisor orthe pharmacist to discuss your concerns

Faith in Reason

If you have faith in reason, you believe in your heart thatgood thinking, and reason, will indeed result in the best out-comes for your patients And if you really believe, you will

be more likely to attend a seminar or read an article on ical thinking skills

crit-Intellectual Sense of Justice

One of your co-workers wants to change the medicationadministration schedule on your unit She says it is because

it will be better for the patients, but you think it might bebecause it ﬁts her break schedule better If you have an intel-lectual sense of justice, you will be sure that your thinking

is not biased by something that you just want for yourself,like your co-worker seems to be doing You should examineyour own motives as well as those of others when you aremaking decisions

So, what does this all mean to you as a nursing student?The term “metacognition” means to “think about thinking.”

It is important for you to try to develop the attitudes of a ical thinker, and to learn to think clearly and critically aboutyour patient care In order to do that, you need to constantlythink about your thinking Are you practicing intellectualhumility? Are you trying to be courageous and empathetic?These attitudes create an excellent base on which to build anursing knowledge base, and on which to develop furtherthinking skills

crit-Knowledge Base

Nurses must have a good knowledge base in order to safelycare for their patients You could not drive a car without ﬁrstlearning the basics of how a car works and how to follow therules of the road In the same way, you must understand thehuman body in health and illness before you can understandhow to take care of an ill patient This is the reason you aregoing to school and studying this book

Chapter 1 Critical Thinking and the Nursing Process 3

Tiêu đề	Understanding Medical Surgical Nursing Third Edition
Tác giả	Linda S. Williams, Paula D. Hopper
Trường học	Jackson Community College
Chuyên ngành	Medical Surgical Nursing
Thể loại	Textbook
Năm xuất bản	2007
Thành phố	Jackson

Định dạng
Số trang	1.390
Dung lượng	37,77 MB