Essentials for Nursing Practice - E-Book

Patricia A. Potter; Anne Griffin Perry; Patricia Stockert; Amy Hall

BOOK

Essentials for Nursing Practice - E-Book

Patricia A. Potter | Anne Griffin Perry | Patricia Stockert | Amy Hall

(2014)

Additional Information

Book Details

ISBN: 978-0-323-18881-4
Edition: 8
Language: English
Pages: 1248
Subjects: Oncology
Nursing fundamentals & skills

Abstract

Taking all the expert nursing content and student-friendly features of Potter and Perry’s Fundamentals text and streamlining it into a shorter format, Essentials for Nursing Practice, 8th Edition is the perfect choice to help busy nursing students master all the fundamental nursing principles in less time! This new 8th edition contains the nursing principles, concepts, skills, and easy-to-follow format that nursing students have come to love about Potter and Perry’s Basic Nursing — all updated with the latest information, visuals, and learning features. Plus, this reinvigorated Essentials text is streamlined and re-designed to work better with the rest of your books. It also comes with a wide array of online learning tools (free with book purchase) to help you master the important nursing concepts and skills with ease.

Progressive case studies are introduced at the beginning of the chapter and are then used to tie together the care plan, concept map, clinical decision-making exercises, and QSEN scenarios.
Safety guidelines for nursing skills sections precede each skills section to help you focus on safe and effective skills performance.
Nursing skills at the end of each chapter feature full-bleed coloring on the edge of the page to make them easy to locate.
UNIQUE! Clinical Decision-Making exercises coordinate directly with the progressive case study presented in the chapter.
Focused Patient Assessment tables include actual questions to help you learn how to effectively phrase questions to patients as well as target physical assessment techniques.
Evaluation boxes bring everything together after nursing interventions have been implemented.
Patient Teaching boxes help you plan effective teaching by first identifying an outcome, then developing strategies on how to teach, and finally, implementing measures to evaluate learning.
Care of the Older Adult boxes highlight key aspects of nursing assessment and care for this growing population.

NEW! QSEN scenarios present a clinical situation followed by an open-ended question designed to help you understand and apply these core competencies.
NEW! Chapter on professional nursing includes information on QSEN, prioritization, delegation, and professional levels.
NEW! Completely revised review questions contain a strong mix of clinical thinking and application-level questions.
NEW! Content on the impact of exercise covers its influence on disease reduction, compassion fatigue, lateral violence, cyber bullying, social media implications, caregiver strain, and safe patient handling.
NEW! Expanded use of Evidence-Based Practice boxes include a PICO question, summary of the results of a research study, and a description of how the study has affected nursing practice — in every chapter.
NEW! Patient-Centered Care boxes address racial and ethnic diversity along with the cultural differences that impact socioeconomic status, values, geography, and religion. These will related to the chapter case studies when possible.

Section Title	Page	Action	Price
Front Cover	cover
Inside Front Cover	ifc1
Brief Contents	i
Essentials for Nursing Practice 8E	iii
Copyright Page	iv
Contributors	v
Dedication	viii
Student Preface	ix
Preface to the Instructor	xiv
Features	xiv
New to This Edition	xiv
Learning Supplements for Students	xv
Teaching Supplements for Instructors	xv
Multimedia Supplements for Instructors and Students	xv
Acknowledgments	xvii
Table Of Contents	xix
Unit 1 Concepts in Nursing	1
1 The Nursing Profession	1
Objectives	1
Key Terms	1
History of Nursing	2
Florence Nightingale	3
The Civil War to the Beginning of the Twentieth Century	3
Twentieth Century	3
Twenty-First Century	3
Influences on Nursing	4
Health Care Reform and Costs	4
Demographic Changes	4
Medically Underserved	4
Need for Emergency Preparedness	4
Workplace Issues	4
Nursing Shortage	5
Professionalism	5
Licensed Practical Nurse/Licensed Vocational Nurse Education	5
Registered Nurse Education	5
Advanced Education	5
Continuing and In-Service Education	5
Theory	6
Service	6
Autonomy and Accountability	6
Code of Ethics	6
Standards of Nursing Practice	6
Nursing Practice	7
Nurse Practice Acts	7
Licensure and Certification	7
Licensure.	7
Certification.	7
Responsibilities and Roles of the Nurse	7
Caregiver	7
Advocate	7
Educator	7
Communicator	8
Provider of Care	8
Manager	8
Career Development	8
Advanced Practice Registered Nurse.	8
Clinical Nurse Specialist.	8
Nurse Practitioner.	8
Certified Nurse-Midwife.	8
Certified Registered Nurse Anesthetist.	8
Nurse Educator.	9
Nurse Administrator.	9
Nurse Researcher.	9
Professional Nursing Organizations	9
Trends in Nursing	10
Quality and Safety Education for Nurses	10
Genomics	11
Public Perception of Nursing	11
Effect of Nursing on Politics and Health Policy	11
Key Points	11
Clinical Decision-Making Exercises	11
QSEN Activity: Teamwork and Collaboration	12
Review Questions	12
References	13
2 Health and Wellness	15
Objectives	15
Key Terms	15
Definition of Health	15
Models of Health and Illness	16
Health Belief Model	16
Health Promotion Model	17
Basic Human Needs Model	17
Holistic Health Model	19
Healthy People Documents	19
Variables Influencing Health Beliefs and Health Practices	19
Internal Variables	19
Developmental Stage.	19
Intellectual Background.	20
Emotional Factors.	20
Spiritual Factors.	20
External Variables	20
Family Practices.	20
Socioeconomic Factors.	20
Cultural Background.	20
Health Promotion, Wellness, and Illness Prevention	20
The Three Levels of Prevention	21
Risk Factors	21
Genetic and Physiological Factors.	21
Age.	21
Physical Environment.	22
Lifestyle.	22
Risk Factor Identification.	23
Risk Factor Modification and Changing Health Behaviors.	23
Illness	24
Acute and Chronic Illness	24
Variables Influencing Illness Behavior	24
Internal Variables	25
External Variables	25
Impact of Illness on Patient and Family	25
Behavioral and Emotional Changes	25
Impact on Body Image	25
Impact on Self-Concept	25
Impact on Family Roles and Family Dynamics	26
Key Points	26
Clinical Decision-Making Exercises	26
QSEN Activity: Teamwork and Collaboration	26
Review Questions	27
References	27
3 The Health Care Delivery System	29
Objectives	29
Key Terms	29
Health Care Regulation and Competition	30
Levels of Health Care	31
Preventive and Primary Health Care Services	33
Secondary and Tertiary Care	33
Hospitals.	33
Discharge Planning.	34
Intensive Care.	35
Mental Health Facilities.	35
Rural Hospitals.	35
Restorative Care	36
Home Care.	36
Rehabilitation.	37
Extended Care Facilities.	37
Continuing Care	37
Nursing Centers or Facilities.	37
Assisted Living.	38
Respite Care.	38
Adult Day Care Centers.	39
Hospice.	39
Care Coordination	39
Issues in Health Care Delivery	39
Competency	40
Evidence-Based Practice	40
Quality Health Care	40
Patient Satisfaction.	41
Magnet Recognition Program.	41
Nursing-Sensitive Outcomes.	42
Technology in Health Care	44
Globalization of Health Care	44
The Future of Health Care	45
Key Points	45
Clinical Decision-Making Exercises	45
QSEN Activity: Quality Improvement	46
Review Questions	46
References	47
4 Community-Based Nursing Practice	49
Objectives	49
Key Terms	49
Community-Based Health Care	50
Achieving Healthy Populations and Communities	50
Public Health Nursing	51
Community Health Nursing	51
Nursing Practice in Community Health	52
Community-Based Nursing	52
Vulnerable Populations	53
Immigrant Populations.	53
Poor and Homeless People.	53
People with Mental Illness.	55
Older Adults.	55
Competency in Community-Based Nursing	55
Caregiver	55
Case Manager	55
Educator	55
Epidemiologist	57
Community Assessment	57
Changing Patients’ Health	58
Key Points	58
Clinical Decision-Making Exercises	58
QSEN Activity: Patient-Centered Care	58
Review Questions	59
References	60
5 Legal Principles in Nursing	61
Objectives	61
Key Terms	61
Legal Limits of Nursing	61
Sources of Law	61
Criminal Law	62
Torts	63
Standards of Care	63
Malpractice Insurance	64
Documentation	65
Risk Management and Quality Assurance	65
Good Samaritan Laws	65
Consent	66
Informed Consent	66
Restraints	67
Death and Dying	67
Advance Directives.	67
Organ and Tissue Donation.	68
Autopsies.	68
Confidentiality	68
Confidentiality and Social Media	69
Other Legal Issues in Nursing Practice	69
Health Care Provider Orders	69
Nursing Students	70
Patient Abandonment and Delegation Issues	70
Controlled Substances	70
Reporting Obligations	71
Key Points	71
Clinical Decision-Making Exercises	71
QSEN Activity: Safety	72
Review Questions	72
References	73
Statutes	73
Cases	73
6 Ethics	74
Objectives	74
Key Terms	74
Ethics	74
Basic Definitions	74
Ethical Principles	76
Codes of Ethics	76
Developing a Personal Point of View	78
Ethical Systems	79
Deontology	79
Utilitarianism	79
Feminist Ethics	79
Ethics of Care	79
How to Process an Ethical Dilemma	79
Ethical Issues in Nursing	81
End-of-Life Issues	81
Cultural and Religious Sensitivity	82
Social Networking Online	82
Key Points	83
Clinical Decision-Making Exercises	83
QSEN Activity: Informatics	83
Review Questions	84
References	85
7 Evidence-Based Practice	86
Objectives	86
Key Terms	86
A Case for Evidence-Based Practice	87
Evidence-Based Practice Steps	88
Ask the Clinical Question	88
Collect the Best Evidence	89
Critically Review and Evaluate the Evidence	91
Integrate the Evidence	93
Evaluate the Practice Decision or Change	94
Outcomes Measurement.	94
Process Measurement.	95
Communicate the Results	95
Sustain Knowledge Use	96
Nursing Research	96
Quality and Performance Improvement	96
Quality/Performance Improvement Programs	97
Key Points	98
Clinical Decision-Making Exercises	99
QSEN Activity: Evidence-Based Practice	99
Review Questions	99
References	101
Unit 2 Processes in Nursing Care	102
8 Critical Thinking	102
Objectives	102
Key Terms	102
Clinical Decisions in Nursing Practice	103
Critical Thinking Defined	103
Reflection	104
Language and Intuition	105
Thinking and Learning	105
Levels Of Critical Thinking in Nursing	106
Basic Critical Thinking	106
Complex Critical Thinking	106
Commitment	106
Critical Thinking Competencies	107
General Critical Thinking	107
Scientific Method.	107
Problem Solving.	107
Decision Making.	108
Specific Critical Thinking Competencies	108
Diagnostic Reasoning and Inference.	108
Clinical Decision Making.	108
The Nursing Process As a Competency.	109
A Critical Thinking Model	110
Specific Knowledge Base	110
Experience	111
Attitudes for Critical Thinking	111
Confidence.	112
Thinking Independently.	112
Fairness.	113
Responsibility and Accountability.	113
Risk Taking.	113
Discipline.	113
Perseverance.	113
Creativity.	113
Curiosity.	113
Integrity.	113
Humility.	113
Standards for Critical Thinking	113
Intellectual Standards.	114
Professional Standards.	114
Developing Critical Thinking Skills	114
Critical Thinking Synthesis	116
Key Points	116
Clinical Decision-Making Exercises	116
QSEN Activity: Patient-Centered Care	116
Review Questions	116
References	117
9 Nursing Process	119
Objectives	119
Key Terms	119
Assessment	120
Data Collection	121
Types of Data.	123
Sources of Data.	123
Patient.	123
Family and Significant Others.	124
Health Care Team.	124
Medical Records.	124
Other Records and the Literature.	124
Methods of Data Collection.	124
Interview and Health History.	124
Orientation Phase.	125
Working Phase.	125
Termination Phase.	125
Interview Techniques.	126
Physical Examination.	126
Observation of Patient’s Behavior.	126
Diagnostic and Laboratory Data.	126
Cultural Considerations in Assessment	127
Data Validation	127
Data Documentation and Communication	128
Nursing Diagnosis	128
Critical Thinking and the Nursing Diagnostic Process	128
Formulating the Nursing Diagnosis	129
Types of Nursing Diagnoses.	132
Components of a Nursing Diagnosis.	132
Diagnostic Label.	132
Related Factor.	132
Definition.	133
The PES Format.	133
Cultural Relevance of Nursing Diagnoses.	134
Concept Mapping Nursing Diagnoses.	134
Sources of Diagnostic Errors.	134
Errors in Data Collection.	134
Errors in Interpretation and Analysis.	134
Errors in Data Clustering.	134
Errors in the Diagnostic Statement.	135
Documentation and Informatics.	136
Planning	136
Establishing Priorities	136
Critical Thinking in Setting Goals and Expected Outcomes	137
Goals of Care.	137
Role of the Patient in Goal Setting.	137
Expected Outcomes.	138
Nursing Outcomes Classification.	139
Combining Goals and Outcome Statements.	139
Guidelines for Writing Goals and Expected Outcomes.	139
Critical Thinking in Planning Nursing Care	139
Types of Interventions.	140
Selection of Interventions.	140
Nursing Interventions Classification.	140
Systems for Planning Nursing Care	141
Student Care Plans.	142
Concept Mapping.	142
Critical Pathways.	147
Consulting Other Health Care Professionals	147
When to Consult.	147
How To Consult.	147
Implementation	147
Standard Nursing Interventions	148
Clinical Practice Guidelines and Protocols.	148
NIC Interventions.	148
Critical Thinking in Implementation	148
Implementation Process	149
Reassessing the Patient.	149
Reviewing and Revising the Care Plan.	149
Organizing Resources and Delivering Care.	149
Equipment.	149
Personnel.	149
Environment.	149
Patient.	150
Anticipating and Preventing Complications.	150
Identifying Areas of Assistance.	150
Implementation Skills.	150
Cognitive Skills.	150
Interpersonal Skills.	150
Psychomotor Skills.	150
Direct Care	151
Activities of Daily Living.	151
Instrumental Activities of Daily Living.	151
Physical Care Techniques.	151
Lifesaving Measures.	151
Counseling.	151
Teaching.	151
Controlling for Adverse Reactions.	152
Preventive Measures.	152
Indirect Care	152
Delegating, Supervising, and Evaluating the Work of Other Staff Members.	152
Evaluation	152
Critical Thinking and Evaluation	152
The Evaluation Process	153
Identifying Criteria and Standards.	153
Collecting Data.	153
Interpreting and Summarizing Findings.	153
Documenting Findings.	154
Care Plan Revision.	154
Discontinuing a Care Plan.	154
Modifying a Care Plan.	154
Key Points	155
Clinical Decision-Making Exercises	156
QSEN Activity: Patient-Centered Care	156
Review Questions	156
References	157
10 Informatics and Documentation	159
Objectives	159
Key Terms	159
Confidentiality	160
Standards	161
Interdisciplinary Communication within the Health Care Team	161
Purpose of Records	161
Communication	161
Legal Documentation	161
Reimbursement	163
Education	163
Research	163
Quality Process and Performance Improvement	163
Guidelines for Quality Documentation and Reporting	163
Factual	163
Accurate	164
Complete	164
Current	165
Organized	165
Methods of Documentation	165
Paper and Electronic Documentation	165
Problem-Oriented Medical Records	166
Database.	166
Problem List.	166
Care Plan.	167
Progress Notes.	167
Narrative Documentation.	167
SOAP Documentation.	167
PIE Documentation.	167
Focus Charting.	167
Charting by Exception	167
Case Management Plan and Critical Pathways	167
Common Record-Keeping Forms	168
Admission Nursing History Forms	168
Flow Sheets and Graphic Records	168
Patient Care Summary or Kardex	168
Standardized Care Plans	168
Discharge Summary Forms	168
Acuity Recording	168
Home Care Documentation	169
Long-Term Care Documentation	169
Reporting	169
Hand-Off Report	169
Change-of-Shift Report.	170
Transfer Reports.	170
Telephone Reports and Orders	170
Telephone Reports.	170
Telephone Orders and Verbal Orders.	172
Incident, Event, or Occurrence Reports	172
Health Informatics	172
Nursing Information Systems	174
Privacy, Confidentiality, and Security Mechanisms	175
Handling and Disposal of Information	176
Key Points	177
Clinical Decision-Making Exercises	177
QSEN Activity: Informatics	178
Review Questions	178
References	179
11 Communication	181
Objectives	181
Key Terms	181
The Power of Communication	182
Basic Elements of the Communication Process	182
Levels of Communication	183
Forms of Communication	183
Verbal Communication	183
Vocabulary.	183
Denotative and Connotative Meaning.	183
Pacing.	183
Intonation and Volume.	183
Clarity and Brevity.	184
Timing and Relevance.	184
Nonverbal Communication	184
Personal Appearance.	184
Posture and Gait.	184
Facial Expression.	184
Eye Contact.	184
Gestures.	185
Territoriality and Space.	185
Factors Influencing Communication	185
Heath Literacy	185
The Nurse-Patient Relationship	186
Nurse–Health Team Member Relationships	186
Communication Within Caring Relationships	188
Establishing a Therapeutic Relationship	188
Professionalism.	188
Courtesy.	189
Avoid Terms of Endearment and Excessive Socializing.	189
Confidentiality.	189
Trust.	189
Acceptance and Respect.	189
Presence.	189
Communication within the Nursing Process	190
Assessment	190
Physical and Emotional Factors.	190
Developmental Factors.	191
Sociocultural Factors.	191
Language.	191
Gender.	191
Nursing Diagnosis	191
Planning	192
Goals and Outcomes.	192
Setting Priorities.	192
Continuity of Care.	192
Implementation	192
Therapeutic Communication Techniques.	192
Conveying Empathy.	192
Active Listening.	192
Sharing Observations.	193
Using Silence.	193
Providing Information.	193
Clarifying.	193
Focusing.	193
Paraphrasing.	194
Summarizing.	194
Self-Disclosure.	194
Instilling Hope.	194
Nontherapeutic Communication Techniques.	194
Inattentive Listening.	194
Overusing Medical Vocabulary.	194
Prying or Asking Personal Questions.	194
Giving Approval or Disapproval.	194
Changing the Subject.	194
Automatic Responses.	194
False Reassurance.	194
Asking for Explanations.	194
Arguing.	194
Being Defensive.	195
Sympathy.	195
Decision Making and Communication.	195
Assertiveness and Autonomy.	195
Avoiding Passive Responses.	195
Avoiding Aggressive Responses.	195
Humor.	195
Touch.	195
Communicating with Patients with Special Needs.	196
Providing Alternative Communication Methods.	196
Communicating with Children.	197
Communicating with Older Adult Patients.	198
Evaluation	198
Patient Care.	198
Patient Expectations.	198
Key Points	199
Clinical Decision-Making Exercises	199
QSEN Activity: Patient-Centered Care	199
Review Questions	200
References	201
12 Patient Education	202
Objectives	202
Key Terms	202
Standards for Patient Education	203
Purposes of Patient Education	203
Maintenance and Promotion of Health and Illness Prevention	203
Restoration of Health	203
Coping with Impaired Functioning	203
Teaching and Learning	204
Role of the Nurse in Teaching and Learning	205
Domains of Learning	205
Basic Learning Principles	206
Motivation to Learn	206
Readiness to Learn	207
Ability to Learn	207
Developmental Capability.	207
Age-group.	207
Physical Capability.	209
Learning Environment	209
Integrating the Nursing and Teaching Processes	209
Assessment	209
Patient Expectations.	210
Motivation to Learn.	211
Teaching Environment.	211
Learning Styles.	211
Resources for Learning.	211
Language and Cultural Factors.	211
Health Literacy.	211
Special Needs of Children.	212
Older-Adult Considerations.	212
Nursing Diagnosis	212
Planning	213
Goals and Outcomes.	213
Setting Priorities.	213
Timing.	215
Organizing Teaching Material.	215
Collaborative Care.	215
Implementation	216
Teaching Approaches.	216
Telling.	217
Participating.	217
Entrusting.	217
Reinforcing.	217
Incorporating Teaching with Nursing Care.	217
Teaching Methods.	217
One-on-One Discussion.	217
Group Instruction.	217
Preparatory Instruction.	217
Demonstrations.	217
Analogies.	218
Role Play.	219
Simulation.	219
Use of Technology.	219
Maintaining Attention and Participation.	219
Illiteracy and Other Disabilities.	219
Cultural Awareness.	219
Evaluation	220
Patient Care.	220
Patient Expectations.	220
Documentation of Patient Teaching	221
Key Points	221
Clinical Decision-Making Exercises	221
QSEN Activity: Informatics	222
Review Questions	222
References	223
13 Managing Patient Care	225
Objectives	225
Key Terms	225
Building a Nursing Team	226
Nursing Care Delivery Models	227
Case Management	228
Decision Making	228
Staff Involvement	229
Leadership Skills for Nursing Students	230
Clinical Care Coordination	231
Clinical Decisions.	231
Priority Setting.	231
Organizational Skills.	231
Use of Resources.	232
Time Management.	232
Evaluation.	233
Team Communication	233
Delegation	234
Key Points	235
Clinical Decision-Making Exercises	236
QSEN Activity: Teamwork and Collaboration	236
Review Questions	236
References	237
Unit 3 Nursing Practice Foundations	239
14 Infection Prevention and Control	239
Objectives	239
Key Terms	239
Scientific Knowledge Base	240
Nature of Infection	240
Chain of Infection	240
Infectious Agent.	240
Reservoir.	240
Portal of Exit.	240
Modes of Transmission.	241
Portal of Entry.	241
Susceptible Host.	241
Course of Infection	242
Defenses Against Infection	243
Normal Flora.	243
Body System Defenses.	243
Inflammation.	243
Immune Response.	243
Health Care–Acquired Infection	243
Asepsis.	243
Nursing Knowledge Base	244
Nursing Process	246
Assessment	246
Patient Expectations.	247
Older Adult Considerations.	247
Nursing Diagnosis	247
Planning	248
Goals and Outcomes.	248
Setting Priorities.	248
Collaborative Care.	248
Implementation	248
Health Promotion.	248
Nutrition.	249
Hygiene.	249
Immunization.	249
Adequate Rest and Regular Exercise.	249
Acute Care.	249
Medical Asepsis.	250
Control or Elimination of Infectious Agents.	250
Cleaning.	250
Disinfection and Sterilization.	250
Control or Elimination of Reservoirs.	250
Control of Portals of Exit.	250
Control of Transmission.	251
Hand Hygiene.	251
Isolation and Barrier Protection.	254
Protective Environment.	258
Personal Protective Equipment.	259
Specimen Collection.	260
Bagging.	260
Removal of Protective Equipment.	260
Transporting Patients.	260
Control of Portals of Entry.	261
Protection of the Susceptible Host.	261
Role of the Infection Prevention and Control Department.	261
Health Promotion in Health Care Workers and Patients.	261
Surgical Asepsis.	261
Preparation for Sterile Procedures.	262
Principles of Surgical Asepsis.	262
Restorative and Continuing Care.	264
Long-Term Care.	264
Evaluation	264
Patient Care.	264
Patient Expectations.	265
Key Points	266
Clinical Decision-Making Exercises	267
QSEN Activity: Quality Improvement	267
Review Questions	267
References	268
15 Vital Signs	270
Objectives	270
Key Terms	270
Guidelines for Measuring Vital Signs	271
Body Temperature	272
Body Temperature Regulation	272
Neural and Vascular Control.	272
Heat Production.	272
Heat Loss.	273
Skin in Temperature Regulation.	273
Behavioral Control.	273
Considerations for Older Adults.	273
Temperature Alterations	273
Fever.	273
Hyperthermia.	275
Hypothermia.	275
Measurement of Temperature	275
Sites.	275
Thermometers.	277
Electronic Thermometers.	277
Chemical Thermometers.	278
Pulse	278
Locating a Peripheral Pulse	279
Using a Stethoscope	279
Assessment of Pulse	280
Pulse Rate.	280
Pulse Rhythm.	281
Strength and Equality.	281
Blood Pressure	282
Physiology of Arterial Blood Pressure	282
Blood Pressure Variations	282
Hypertension.	282
Hypotension.	282
Measurement of Blood Pressure	284
Blood Pressure Equipment.	284
Auscultation.	285
Ultrasonic Stethoscope.	286
Palpation.	286
Electronic Blood Pressure Machines.	287
Blood Pressure Assessment in Lower Extremities.	287
Assessment of Blood Pressure in Children.	287
Respiration	288
Assessment of Ventilation	289
Measurement of Respiration	289
Respiratory Rate.	289
Ventilatory Depth.	290
Ventilatory Rhythm.	290
Measurement of Oxygen Saturation (Pulse Oximetry)	290
Measurement of End-Tidal Carbon Dioxide	290
Special Considerations	290
Documenting Vital Signs	292
Safety Guidelines for Nursing Skills	292
Skill 15-1 Measuring Body Temperature	293
Delegation Considerations	293
Equipment	293
Recording and Reporting	298
Unexpected Outcomes and Related Interventions	298
Skill 15-2 Assessing the Radial and Apical Pulses	298
Delegation Considerations	298
Equipment	298
Recording and Reporting	302
Unexpected Outcomes and Related Interventions	302
Skill 15-3 Blood Pressure Measurement	302
Delegation Considerations	302
Equipment	303
Recording and Reporting	306
Unexpected Outcomes and Related Interventions	306
Skill 15-4 Assessing Respiration	307
Delegation Considerations	307
Equipment	307
Recording and Reporting	309
Unexpected Outcomes and Related Interventions	309
Skill 15-5 Measuring Oxygen Saturation (Pulse Oximetry)	309
Delegation Considerations	309
Equipment	309
Recording and Reporting	311
Unexpected Outcomes and Related Interventions	311
Key Points	311
Clinical Decision-Making Exercises	312
QSEN Activity: Evidence-Based Practice	312
Review Questions	312
References	313
16 Health Assessment and Physical Examination	315
Objectives	315
Key Terms	315
Purposes of Health Assessment and Physical Examination	316
Cultural Sensitivity	316
Integration of Physical Assessment with Nursing Care	316
Skills of Physical Assessment	317
Inspection	317
Palpation	317
Percussion	317
Auscultation	318
Olfaction	319
Preparation for Assessment	319
Environment	319
Equipment	319
Physical Preparation of a Patient	319
Positioning.	320
Psychological Preparation of a Patient	320
Assessment of Different Age-Groups	320
Organization of the Examination	322
General Survey	322
General Appearance and Behavior	322
Vital Signs	324
Height and Weight	324
Skin, Hair, and Nails	325
Skin	325
Nursing History.	325
Color.	325
Moisture.	327
Temperature.	327
Texture.	327
Turgor.	328
Vascularity.	328
Edema.	328
Lesions.	328
Hair and Scalp	328
Nursing History.	328
Nails	329
Nursing History.	329
Head and Neck	330
Head	330
Nursing History.	330
Eyes	331
Nursing History.	331
Visual Acuity.	332
Visual Fields.	332
External Eye Structures.	332
Position and Alignment.	332
Eyebrows.	332
Eyelids.	332
Lacrimal Apparatus.	333
Conjunctivae and Sclerae.	333
Corneas.	333
Pupils and Irises.	333
Internal Eye Structures.	333
Ears	333
Nursing History.	333
Auricles.	334
Ear Canals and Eardrums.	334
Hearing Acuity.	335
Nose and Sinuses	336
Nursing History.	336
Nose.	336
Sinuses.	336
Mouth and Pharynx	336
Nursing History.	337
Lips.	337
Buccal Mucosa, Gums, and Teeth.	337
Tongue and Floor of Mouth.	338
Palate.	338
Pharynx.	338
Neck	338
Nursing History.	338
Neck Muscles.	338
Lymph Nodes.	338
Thyroid Gland.	339
Carotid Artery and Jugular Vein.	340
Trachea.	340
Thorax and Lungs	340
Nursing History	341
Posterior Thorax	342
Lateral Thorax	344
Anterior Thorax	345
Heart	345
Nursing History	346
Inspection and Palpation	346
Auscultation	347
Vascular System	348
Health History	348
Carotid Arteries	348
Jugular Veins	349
Peripheral Arteries and Veins	349
Peripheral Arteries.	349
Ultrasound Stethoscopes.	351
Tissue Perfusion.	351
Peripheral Veins.	352
Lymphatic System	352
Breasts	352
Female Breasts	353
Nursing History.	353
Inspection.	353
Palpation.	355
Male Breasts	357
Abdomen	357
Nursing History	358
Inspection	358
Skin.	358
Umbilicus.	358
Contour and Symmetry.	358
Enlarged Organs or Masses.	358
Movement or Pulsations.	358
Auscultation	358
Bowel Motility.	359
Vascular Sounds.	359
Palpation	359
Aortic Pulsation.	360
Female Genitalia and Reproductive Tract	360
Nursing History	360
Preparation of the Patient	361
External Genitalia	361
Speculum Examination of Internal Genitalia	362
Male Genitalia	362
Nursing History	362
Sexual Maturity	363
Penis	363
Scrotum	364
Inguinal Ring and Canal	364
Rectum and Anus	365
Nursing History	365
Inspection	365
Digital Palpation	365
Musculoskeletal System	365
Nursing History	366
General Inspection	366
Palpation	367
Range of Joint Motion	367
Muscle Tone and Strength	367
Neurological System	369
Nursing History	369
Mental and Emotional Status	369
Level of Consciousness	369
Behavior and Appearance	370
Language	370
Intellectual Function	370
Memory.	370
Knowledge.	370
Abstract Thinking.	370
Judgment.	370
Cranial Nerve Function	370
Sensory Function	371
Motor Function	371
Coordination.	372
Balance.	373
Reflexes.	373
After the Examination	373
Key Points	374
Clinical Decision-Making Exercises	374
Qsen Activity: Patient-Centered Care	374
Review Questions	375
References	375
17 Administering Medications	377
Objectives	377
Key Terms	377
Scientific Knowledge Base	378
Medication Legislation and Standards	378
Governmental Regulation of Medications.	378
Health Care Institutions and Medication Laws.	378
Medication Regulations and Nursing Practice.	378
Nontherapeutic Medication Use.	379
Pharmacological Concepts	379
Medication Names.	379
Classification.	379
Medication Forms.	379
Pharmacokinetics as the Basis of Medication Actions	380
Absorption.	380
Route of Administration.	381
Ability of a Medication to Dissolve.	381
Blood Flow to the Area of Absorption.	381
Body Surface Area.	381
Lipid Solubility of the Medication.	381
Distribution.	381
Circulation.	381
Membrane Permeability.	381
Protein Binding.	381
Metabolism.	381
Excretion.	381
Types of Medication Action	382
Therapeutic Effects.	382
Adverse Effects.	382
Medication Interactions.	383
Medication Dose Responses.	383
Routes of Administration	384
Oral Routes.	385
Sublingual Administration.	385
Buccal Administration.	386
Parenteral Routes.	386
Topical Administration.	386
Inhalation Route.	386
Intraocular Route.	386
Systems of Medication Measurement	386
Metric System.	387
Household Measurements.	387
Solutions.	387
Nursing Knowledge Base	387
Clinical Calculations	388
Conversions Within One System.	388
Conversion Between Systems.	388
Dosage Calculations.	388
The Ratio and Proportion Method.	388
The Formula Method.	389
Dimensional Analysis.	389
Pediatric Calculations.	390
Administering Medications	390
Prescriber’s Role.	391
Types of Orders in Acute Care Agencies.	391
Standing Orders.	391
prn Orders.	391
Single (One-Time) Orders.	391
STAT Orders.	391
NOW Orders.	391
Prescriptions.	391
Pharmacist’s Role.	392
Distribution Systems.	392
Unit Dose.	392
Automated Medication Dispensing Systems.	392
Nurse’s Role.	393
Medication Errors	393
Critical Thinking	394
Synthesis	394
Knowledge.	394
Experience.	395
Attitudes.	395
Standards.	395
Right Medication.	395
Right Dose.	395
Right Patient.	396
Right Route.	396
Right Time.	396
Right Documentation.	397
Maintaining Patients’ Rights.	397
Nursing Process	397
Assessment	397
History.	397
Allergies.	398
Medication History.	398
Diet History.	398
Patient’s Perceptual or Coordination Problems.	398
Patient’s Current Condition.	398
Patient’s Attitude About Medication Use.	398
Older Adult Considerations.	398
Patient’s Knowledge and Understanding of Medication Therapy.	398
Patient Expectations.	399
Nursing Diagnosis	399
Planning	400
Goals and Outcomes.	400
Setting Priorities.	400
Collaborative Care.	401
Implementation	401
Health Promotion.	401
Patient and Family Teaching.	401
Acute Care Activities.	402
Receiving, Transcribing, and Communicating Medication Orders.	402
Accurate Dosage Calculation and Measurement.	402
Correct Administration.	402
Recording Medication Administration.	402
Restorative and Continuing Care.	402
Special Considerations for Administering Medications to Specific Age-Groups.	402
Infants and Children.	402
Older Adults.	403
Polypharmacy.	403
Evaluation	404
Patient Care.	404
Patient Expectations.	404
Oral Administration	405
Topical Medication Applications	407
Skin Applications	407
Mucous Membrane Applications	407
Nasal Instillation.	407
Eye Instillation.	409
Ear Instillation.	409
Vaginal Instillation.	409
Rectal Instillation.	409
Administering Medications by Inhalation	412
Administering Medications by Irrigation	414
Parenteral Administration of Medications	414
Equipment	414
Syringes.	414
Needles.	415
Disposable Injection Units.	415
Preparing an Injection From an Ampule	415
Preparing an Injection From a Vial	416
Mixing Medications	416
Mixing Medications from a Vial and an Ampule.	416
Mixing Medications from Two Vials.	417
Insulin Preparation	417
Administering Injections	418
Subcutaneous Injections.	419
Intramuscular Injections.	420
Sites.	420
Ventrogluteal.	420
Vastus Lateralis.	421
Deltoid.	421
Z-Track Method.	422
Intradermal Injections.	422
Intravenous Administration.	423
Safe Intravenous Medication Administration Principles.	423
Large-Volume Infusions.	423
Intravenous Bolus.	423
Volume-Controlled Infusions.	424
Piggyback.	424
Volume-Control Administration.	425
Mini-infusion Pump.	425
Intermittent Venous Access.	425
Safety in Administering Medications by Injection	425
Needleless Devices.	425
Safety Guidelines for Nursing Skills	426
Skill 17-1 Administering Oral Medications	427
Delegation Considerations	427
Equipment	427
Recording and Reporting	431
Unexpected Outcomes and Related Interventions	431
Skill 17-2 Administering Eye Medications	432
Delegation Considerations	432
Equipment	432
Recording and Reporting	435
Unexpected Outcomes and Related Interventions	435
Skill 17-3 Using Metered-Dose or Dry Powder Inhalers	436
Delegation Considerations	436
Equipment	436
Recording and Reporting	439
Unexpected Outcomes and Related Interventions	439
Skill 17-4 Preparing Injections from Vials and Ampules	440
Delegation Considerations	440
Equipment	440
Medication in an Ampule	440
Medication in a Vial	440
Both	440
Unexpected Outcomes and Related Interventions	444
Skill 17-5 Administering Injections	444
Delegation Considerations	444
Equipment	444
Recording and Reporting	449
Unexpected Outcomes and Related Interventions	449
Skill 17-6 Administering Medications by Intravenous Bolus	450
Delegation Considerations	450
Equipment	450
Recording and Reporting	453
Unexpected Outcomes and Related Interventions	453
Skill 17-7 Administering Intravenous Medications by Piggyback, Intermittent Intravenous Infusion Sets, and Mini-Infusion Pumps	454
Delegation Considerations	454
Equipment	454
Piggyback or Mini-infusion Pump	454
Volume-Control Administration Set	454
Recording and Reporting	458
Unexpected Outcomes and Related Interventions	458
Key Points	458
Clinical Decision-Making Exercises	458
QSEN Activity: Safety	459
Review Questions	459
References	460
18 Fluid, Electrolyte, and Acid-Base Balances	463
Objectives	463
Key Terms	463
Scientific Knowledge Base	464
Distribution of Body Fluids	464
Composition of Body Fluids	464
Movement of Water and Electrolytes	464
Fluid Balance.	466
Fluid Intake.	466
Fluid Distribution.	466
Fluid Output.	466
Antidiuretic Hormone.	466
Aldosterone.	466
Atrial Natriuretic Peptide.	467
Electrolyte Balance.	467
Sodium Regulation.	467
Potassium Balance.	467
Calcium Balance.	467
Magnesium Balance.	467
Chloride Regulation.	467
Bicarbonate Regulation.	467
Phosphate Balance.	467
Acid-Base Balance.	467
Acid Production.	467
Acid Buffering.	467
Acid Excretion.	468
Disturbances in Fluid, Electrolyte, and Acid-Base Balances	468
Fluid Imbalances.	468
Extracellular Fluid Volume Imbalances.	468
Osmolality Imbalances.	468
Electrolyte Imbalances	468
Potassium Imbalances.	468
Calcium Imbalances.	468
Magnesium Imbalances.	468
Chloride Imbalances.	468
Acid-Base Imbalances.	471
pH.	471
PaCO2.	471
PaO2.	471
SaO2 (Oxygen Saturation).	471
Base Excess.	471
Bicarbonate.	471
Types of Acid-Base Imbalances.	471
Nursing Knowledge Base	471
Critical Thinking	471
Synthesis	471
Knowledge.	471
Experience.	473
Attitudes.	473
Standards.	473
Nursing Process	473
Assessment	473
Nursing History.	473
Older Adult Considerations.	473
Medical History.	473
Environment.	474
Dietary Intake.	474
Lifestyle.	474
Medications.	474
Focused Physical Assessment.	474
Daily Weights and Fluid Intake and Output Measurement.	474
Laboratory Studies.	477
Patient Expectations.	477
Nursing Diagnosis	478
Planning	478
Goals and Outcomes.	478
Setting Priorities.	478
Collaborative Care.	478
Implementation	478
Health Promotion.	478
Acute Care.	480
Enteral Replacement of Fluids.	480
Restriction of Fluids.	481
Parenteral Replacement of Fluids and Electrolytes.	482
Parenteral Nutrition.	482
Intravenous Therapy.	482
Vascular Access Devices.	482
Types of Solutions.	483
Equipment.	483
Initiating Peripheral Intravenous Access.	483
Regulating the Infusion Flow Rate.	485
Maintaining the System.	486
Changing IV Fluid Containers, Tubing, and Dressings.	486
Helping Patients Protect IV Integrity.	487
Complications of Intravenous Therapy.	487
Discontinuing Peripheral Intravenous Access.	488
Blood Replacement.	488
Autologous Transfusion.	489
Allogeneic Transfusion.	490
ABO System.	490
Rh System.	490
Transfusion Reactions and Other Adverse Effects.	490
Interventions for Acid-Base Imbalances.	490
Arterial Blood Gas Measurement.	490
Restorative and Continuing Care.	490
Home Intravenous Therapy.	490
Nutritional Support.	491
Medication Safety.	491
Evaluation	491
Patient Care.	491
Patient Expectations.	491
Safety Guidelines for Nursing Skills	492
Skill 18-1 Initiating Intravenous Therapy	492
Delegation Considerations	492
Equipment	492
For Continuous IV Fluid Infusion, in Addition to Preceding List	492
Recording and Reporting	503
Unexpected Outcomes and Related Interventions	503
Skill 18-2 Regulating Intravenous Flow Rate	503
Delegation Considerations	503
Equipment	503
Recording and Reporting	507
Unexpected Outcomes and Related Interventions	507
Skill 18-3 Changing Intravenous Solution and Tubing	507
Delegation Considerations	507
Equipment	507
In Addition for Continuous Intravenous Infusion	507
In Addition for Intermittent Saline Lock	507
Recording and Reporting	511
Unexpected Outcomes and Related Interventions	511
Skill 18-4 Changing a Peripheral Intravenous Dressing	511
Delegation Considerations	511
Equipment	511
Recording and Reporting	513
Unexpected Outcomes and Related Interventions	513
Key Points	514
Clinical Decision-Making Exercises	514
QSEN Activity: Quality Improvement	514
Review Questions	514
References	515
Unit 4 Promoting Psychosocial Health	517
19 Caring in Nursing Practice	517
Objectives	517
Key Terms	517
Theoretical Views on Caring	518
Caring Is Primary	518
Leininger’s Transcultural Caring	519
Watson’s Transpersonal Theory of Caring	519
Swanson’s Theory of Caring	520
Summary of Theoretical Views	520
Patient Satisfaction	521
Mutual Problem Solving	521
Attentive Reassurance	522
Human Respect	522
Encouraging Manner	522
Appreciation of Unique Meanings	523
Healing Environment	523
Affiliation Needs	523
Basic Human Needs	523
Caring in Nursing Practice	523
Providing Presence	523
Touch	524
Listening	524
Knowing the Patient	525
Spiritual Caring	525
Relieving Pain and Suffering	525
Family Care	526
The Challenge of Caring	526
Key Points	526
Clinical Decision-Making Exercises	527
QSEN Activity: Patient-Centered Care	527
Review Questions	527
References	528
20 Cultural Awareness	530
Objectives	530
Key Terms	530
Health Disparities	531
Addressing Health Care Disparities	532
Intersectionality	532
World View	533
Culturally Congruent Care	533
Disease and Illness	534
Core Measures	534
Cultural Competence	535
Self-Awareness	535
World View of Providers and Patients	535
Skills and Interventions	536
Institutional Forces	536
Linguistic Competence	536
Evolution of Cultural Competence in Health Care	537
Cultural Assessment and Patient-Centered Care	537
Cultural Assessment	537
Establishing Relationships	538
Heath Literacy and Teach Back	539
Working with Interpreters	542
Key Points	542
Clinical Decision-Making Exercises	543
QSEN Activity: Safety	543
Review Questions	543
References	545
21 Spiritual Health	547
Objectives	547
Key Terms	547
Scientific Knowledge Base	548
Nursing Knowledge Base	548
Concepts in Spiritual Health	548
Spirituality.	548
Spiritual Well-Being.	549
Faith.	549
Religion.	549
Hope.	550
Spiritual Health	550
The Effect of Illness on Spirituality	550
Acute Illness.	550
Chronic Illness.	550
Terminal Illness.	550
Near-Death Experience.	551
Critical Thinking	552
Synthesis	552
Knowledge.	552
Experience.	553
Attitudes.	553
Standards.	553
Nursing Process	554
Assessment	554
Faith.	555
Life and Self-Responsibility.	555
Connectedness.	556
Life Satisfaction.	556
Fellowship and Community.	557
Ritual and Practice.	557
Vocation.	557
Older Adult Considerations.	557
Patient Expectations.	557
Nursing Diagnosis	557
Planning	558
Goals and Outcomes.	560
Setting Priorities.	560
Collaborative Care.	560
Implementation	561
Health Promotion.	561
Establishing Presence.	561
Supporting a Healing Relationship.	561
Acute Care.	561
Support Systems.	562
Diet Therapies.	562
Supporting Rituals.	562
Restorative and Continuing Care	562
Prayer and Meditation.	562
Evaluation	563
Patient Care.	563
Patient Expectations.	564
Key Points	564
Clinical Decision-Making Exercises	564
QSEN Activity: Evidence-Based Practice	564
Review Questions	565
References	566
22 Growth and Development	568
Objectives	568
Key Terms	568
Scientific Knowledge Base	568
Concept of Growth and Development	568
Theories of Human Development	569
Sigmund Freud.	569
Erik Erikson’s Eight Stages of Development.	569
Piaget’s Theory of Cognitive Development.	570
Kohlberg’s Moral Developmental Theory.	570
Maslow’s Theory of Human Needs.	570
Nursing Knowledge Base	570
Conception and Fetal Development	571
Health Promotion.	571
Neonate	571
Unit 5 Promoting Physical Health	677
27 Exercise and Activity	677
Objectives	677
Key Terms	677
Scientific Knowledge Base	678
Body Alignment	678
Body Balance	678
Coordinated Body Movement	678
Friction	679
Regulation of Movement	679
Skeletal System.	679
Joints.	679
Ligaments.	679
Tendons.	679
Cartilage.	679
Skeletal Muscle.	679
Muscles Concerned with Movement.	679
Muscles Concerned with Posture.	679
Muscle Groups.	679
Nervous System.	680
Proprioception.	680
Balance.	680
Body Mechanics	680
Pathological Influences on Body Alignment, Exercise, and Activity	680
Congenital Defects.	680
Disorders of Bones, Joints, and Muscles.	680
Central Nervous System Damage.	680
Musculoskeletal Trauma.	680
Nursing Knowledge Base	681
Growth and Development	681
Behavioral Aspects	681
Cultural and Ethnic Origin	681
Critical Thinking	681
Synthesis	681
Knowledge.	682
Experience.	682
Attitudes.	683
Standards.	683
Nursing Process	683
Assessment	683
Body Alignment.	683
Standing.	683
Sitting.	683
Recumbent.	684
Mobility.	684
Range of Motion.	684
Gait.	684
Exercise.	684
Activity Tolerance.	684
Patient Expectations.	684
Older Adult Considerations.	684
Nursing Diagnosis	685
Planning	686
Goals and Outcomes.	686
Setting Priorities.	687
Collaborative Care.	687
Implementation	687
Health Promotion.	687
Acute Care	689
Lifting Techniques.	689
Positioning Techniques.	689
Fowler’s and Semi-Fowler’s Positions.	689
Supine Position.	689
Prone Position.	691
Lateral Position.	691
Sims’ Position.	691
Transfer Techniques.	691
Joint Mobility and Ambulation	692
Range-of-Motion Exercises.	692
Walking.	692
Assisting a Patient to Walk.	692
Restorative and Continuing Care.	693
Assistive Devices for Walking	693
Walkers.	693
Canes.	694
Crutches.	694
Measuring for Crutches.	694
Crutch Gait.	695
Crutch Walking on Stairs.	696
Sitting in a Chair with Crutches.	696
Evaluation	696
Patient Care.	696
Patient Expectations.	697
Safety Guidelines for Nursing Skills	698
Skill 27-1 Moving and Positioning Patients in Bed	699
Delegation Considerations	699
Equipment	699
Recording and Reporting	706
Unexpected Outcomes and Related Interventions	706
Skill 27-2 Using Safe and Effective Transfer Techniques	707
Delegation Considerations	707
Equipment	707
Recording and Reporting	714
Unexpected Outcomes and Related Interventions	715
Key Points	715
Clinical Decision-Making Exercises	715
QSEN Activity: Informatics	715
Review Questions	716
References	717
28 Safety	718
Objectives	718
Key Terms	718
Scientific Knowledge Base	720
Basic Human Needs	721
Oxygen.	721
Nutrition.	721
Temperature.	721
Physical Hazards	722
Motor Vehicle Accidents.	722
Poison.	722
Fire.	723
Falls.	723
Disasters.	723
Pathogen Transmission.	723
Immunization.	723
Pollution.	723
Nursing Knowledge Base	723
Factors Influencing Patient Safety	723
Developmental Level	723
Infant, Toddler, and Preschooler.	723
School-Age Child.	723
Adolescent.	724
Adult.	724
Older Adult.	724
Other Risk Factors	724
Lifestyle.	724
Impaired Mobility.	724
Sensory Impairments.	724
Cognitive Impairments.	724
Safety Awareness.	724
Risks in the Health Care Agency	724
Chemical Exposure.	724
Falls.	725
Patient-Inherent Accidents.	725
Procedure-Related Accidents.	725
Equipment-Related Accidents.	725
Critical Thinking	726
Synthesis	726
Knowledge.	726
Experience.	726
Attitudes.	726
Standards.	726
Nursing Process	726
Assessment	726
Older Adult Considerations.	727
Patient Expectations.	727
Nursing Diagnosis	728
Planning	728
Goals and Outcomes.	728
Setting Priorities.	728
Collaborative Care.	731
Implementation	731
Health Promotion.	731
Developmental Interventions	731
Infant, Toddler, and Preschooler.	731
School-Age Child.	731
Adolescent.	731
Adult.	731
Older Adult.	731
Environmental Interventions.	732
Basic Needs.	732
General Preventive Measures.	734
Acute Care.	734
Falls.	734
Restraints.	734
Side Rails.	736
Fires.	736
Electrical Accidents.	737
Radiation.	737
Disasters.	737
Evaluation	737
Patient Care.	737
Patient Expectations.	738
Safety Guidelines for Nursing Skills	738
Skill 28-1 Applying Physical Restraints	738
Delegation Considerations	738
Equipment	738
Recording and Reporting	742
Unexpected Outcomes and Related Interventions	742
Key Points	743
Clinical Decision-Making Exercises	743
QSEN Activity: Informatics	743
Review Questions	743
References	744
29 Hygiene	747
Objectives	747
Key Terms	747
Scientific Knowledge Base	748
Skin	748
Feet, Hands, and Nails	748
Oral Cavity and Teeth	748
Hair	749
Eyes, Ears, and Nose	749
Nursing Knowledge Base	750
Physical and Mental Status	750
Socioeconomic Status	750
Developmental Stage	750
Skin.	750
Feet and Nails.	751
Mouth.	751
Hair.	751
Eyes, Ears, and Nose.	751
Personal Preferences	751
Cultural Variables	751
Critical Thinking	751
Synthesis	751
Knowledge.	752
Experience.	752
Attitudes.	752
Standards.	752
Nursing Process	752
Assessment	752
Self-Care Ability.	753
Assessment of the Skin.	754
Assessment of the Feet and Nails.	754
Assessment of the Oral Cavity.	754
Assessment of the Hair and Hair Care.	757
Assessment of the Eyes, Ears, and Nose.	757
Patients at Risk for Hygiene Problems.	757
Older Adult Considerations.	757
Patient Expectations.	760
Nursing Diagnosis	760
Planning	760
Goals and Outcomes.	760
Setting Priorities.	761
Collaborative Care.	763
Implementation	763
Health Promotion.	764
Skin Care.	764
Oral Care.	764
Care of Eyes, Ears, and Nose.	764
Nail and Foot Care.	764
Hair Care.	766
Acute Care.	766
Bathing and Skin Care.	766
Perineal Care.	768
Oral Care.	768
Denture Care.	771
Backrub.	771
Care of Eyes, Ears, and Nose.	771
Basic Eye Care.	771
Eyeglasses.	771
Contact Lenses.	772
Ear Care.	772
Nasal Care.	773
Nail and Foot Care.	773
Hair Care.	773
Shaving.	775
Mustache and Beard Care.	775
Continuing and Restorative Care.	775
Bathing and Skin Care.	775
Oral Care.	775
Hearing Aid Care.	775
Patient’s Room Environment	777
Maintaining Comfort	777
Room Equipment	778
Beds.	778
Bed Making.	778
Evaluation	779
Patient Care.	779
Patient Expectations.	779
Safety Guidelines for Nursing Skills	781
Safety Considerations	781
Skill 29-1 Bathing and Perineal Care	781
Delegation Considerations	781
Equipment	781
Skill 29-2 Making an Occupied Bed	791
Delegation Considerations	791
Equipment (Figure 29-4)	791
Key Points	795
Clinical Decision-Making Exercises	796
QSEN Activity: Evidence-based Practice	796
Review Questions	796
References	797
30 Oxygenation	799
Objectives	799
Key Terms	799
Scientific Knowledge Base	800
Cardiopulmonary Physiology	800
Structure and Function of the Pulmonary System	800
Regulation of Ventilation.	801
Oxygen Transport.	801
Carbon Dioxide Transport.	801
Alterations of the Pulmonary System: Factors Affecting Ventilation and Oxygen Transport	802
Hypoxia.	802
Hypoxemia.	802
Hypoventilation.	802
Hyperventilation.	802
Structure and Function of the Circulatory System	803
Regulation of Blood Flow.	803
Conduction System.	803
Alterations of the Circulatory System	804
Decreased Cardiac Output.	804
Myocardial Ischemia.	804
Impaired Valvular Function.	804
Left-Sided Heart Failure.	805
Right-Sided Heart Failure.	805
Hypovolemia.	805
Disturbances in Conduction.	805
Factors Affecting Oxygenation	807
Decreased Oxygen-Carrying Capacity.	807
Decreased Inspired Oxygen Concentration.	807
Increased Metabolic Rate.	807
Conditions Affecting Chest Wall Movement.	807
Musculoskeletal Abnormalities.	807
Nervous System Diseases.	807
Trauma.	807
Nursing Knowledge Base	808
Developmental Factors	808
Premature Infants.	808
Infants and Toddlers.	808
School-Age Children and Adolescents.	808
Young and Middle-Age Adults.	808
Older Adults.	808
Lifestyle Factors	808
Nutrition.	808
Hydration.	808
Exercise.	808
Cigarette Smoking.	809
Substance Abuse.	809
Stress.	809
Environmental Factors	810
Critical Thinking	810
Synthesis	810
Knowledge.	810
Experience.	810
Attitudes.	810
Standards.	810
Nursing Process	811
Assessment	811
Nursing History.	811
Risk Factors.	811
Fatigue.	811
Pain.	812
Breathing Patterns.	812
Cough.	812
Respiratory Infections.	812
Medication Use.	812
Older Adult Considerations.	813
Patient Expectations.	813
Physical Examination.	813
Diagnostic Tests.	813
Nursing Diagnosis	815
Planning	815
Goals and Outcomes.	815
Setting Priorities.	815
Collaborative Care.	818
Implementation	818
Health Promotion.	818
Influenza and Pneumococcal Vaccine.	818
Environmental Modifications.	819
Acute Care.	819
Dyspnea Management.	819
Oxygen Therapy.	819
Safety Precautions with Oxygen Therapy.	820
Oxygen Supply.	820
Methods of Oxygen Delivery.	820
Home Oxygen.	823
Mobilization of Pulmonary Secretions.	823
Hydration.	823
Humidification.	823
Nebulization.	823
Maintenance of a Patent Airway.	823
Coughing Techniques.	823
Cascade Cough.	823
Huff Cough.	823
Quad Cough.	823
Suctioning Techniques.	823
Oropharyngeal and Nasopharyngeal Suctioning.	824
Orotracheal and Nasotracheal Suctioning.	824
Tracheal Suctioning.	824
Artificial Airways.	824
Oral Airway.	824
Tracheal Airway.	824
Maintenance or Promotion of Lung Expansion.	825
Positioning.	825
Incentive Spirometry.	825
Chest Physiotherapy.	827
Postural Drainage.	827
Chest Percussion.	827
Vibration.	828
Chest Tubes.	828
Special Considerations.	829
Chest Tube Removal.	829
Noninvasive Ventilation.	829
Restoration of Cardiopulmonary Functioning.	829
Cardiopulmonary Resuscitation.	830
Restorative and Continuing Care.	830
Respiratory Muscle Training.	830
Breathing Exercises.	830
Evaluation	831
Patient Care.	831
Patient Expectations.	831
Safety Guidelines for Nursing Skills	831
Skill 30-1 Suctioning	832
Delegation Considerations	832
Equipment	832
If Not Using Closed-Suction Catheter	832
Recording and Reporting	838
Unexpected Outcomes and Related Interventions	838
Skill 30-2 Care of Patients with Chest Tubes	839
Delegation Considerations	839
Equipment	839
Recording and Reporting	843
Unexpected Outcomes and Related Interventions	843
Key Points	843
Clinical Decision-Making Exercises	843
QSEN Activity: Teamwork and Collaboration	844
Review Questions	844
References	845
31 Sleep	846
Objectives	846
Key Terms	846
Scientific Knowledge Base	846
Physiology of Sleep	846
Circadian Rhythms.	847
Sleep Regulation.	847
Stages of Sleep.	847
Sleep Cycle.	848
Functions of Sleep	848
Dreams.	849
Nursing Knowledge Base	849
Sleep and Rest	849
Normal Sleep Requirements and Patterns	849
Neonates.	849
Infants.	849
Toddlers and Preschoolers.	849
School-Age Children.	849
Adolescents.	849
Young Adults.	850
Middle Adults.	850
Older Adults.	850
Factors Affecting Sleep	850
Physical Illness.	850
Drugs and Substances.	851
Lifestyle.	851
Usual Sleep Patterns and Excessive Daytime Sleepiness.	851
Emotional Stress.	851
Environment.	852
Exercise and Fatigue.	852
Food and Caloric Intake.	852
Sleep Disorders	852
Insomnia.	852
Sleep Apnea.	852
Narcolepsy.	854
Sleep Deprivation.	854
Parasomnias.	854
Critical Thinking	854
Synthesis	854
Knowledge.	855
Experience.	855
Attitudes.	855
Standards.	855
Nursing Process	855
Assessment	855
Sources for Sleep Assessment.	855
Sleep History.	855
Sleep Pattern and Quality.	855
Description of Sleeping Problems.	856
Sleep Diary.	856
Physical Illness.	856
Medications.	857
Current Life Events.	857
Emotional and Mental Status.	857
Bedtime Routines.	857
Bedtime Environment.	857
Behaviors of Sleep Deprivation.	857
Older Adult Considerations.	857
Patient Expectations.	857
Nursing Diagnosis	857
Planning	858
Goals and Outcomes.	858
Setting Priorities.	858
Collaborative Care.	860
Implementation	861
Health Promotion.	861
Environmental Controls.	861
Promoting Bedtime Routines.	861
Promoting Comfort.	862
Promoting Activity.	862
Stress Reduction.	862
Bedtime Snacks.	863
Pharmacological Approaches to Promoting Sleep.	863
Managing Specific Sleep Disturbances.	864
Acute Care.	864
Managing Environmental Stimuli.	864
Safety.	864
Comfort Measures.	864
Restorative and Continuing Care.	865
Maintaining Activity.	865
Reducing Sleep Disruption.	865
Evaluation	865
Patient Care.	865
Patient Expectations.	866
Key Points	866
Clinical Decision-Making Exercises	866
QSEN Activity: Quality Improvement	866
Review Questions	866
References	867
32 Pain Management	869
Objectives	869
Key Terms	869
Scientific Knowledge Base	870
Nature of Pain	870
Physiology of Pain	870
Transduction.	870
Transmission.	870
Perception.	871
Modulation.	871
Neurotransmitters.	871
Gate Control Theory of Pain.	872
Physiological Responses.	872
Behavioral Responses.	872
Acute and Chronic Pain	872
Acute/Transient Pain.	873
Chronic/Persistent Noncancer Pain.	873
Chronic Episodic Pain.	873
Cancer Pain.	874
Idiopathic Pain.	874
Nursing Knowledge Base	874
Knowledge, Attitudes, and Beliefs	874
Factors Influencing Pain	874
Physiological Factors	874
Age.	874
Fatigue.	875
Neurological Function.	875
Gender.	875
Social Factors	875
Attention.	875
Previous Experience.	875
Family and Social Support.	875
Spiritual Factors.	875
Cultural Factors.	876
Psychological Factors	876
Meaning of Pain.	876
Anxiety.	876
Depression.	876
Coping Style.	876
Critical Thinking	876
Synthesis	876
Knowledge.	876
Experience.	877
Attitudes.	877
Standards.	877
Nursing Process	877
Assessment	877
Patient’s Expression of Pain.	878
Patients Unable to Self-Report Pain.	879
Characteristics of Pain.	879
Timing (Onset, Duration, and Pattern).	879
Precipitating Factors.	879
Quality.	879
Relief Measures.	879
Region/Location.	880
Severity.	880
Effect of Pain on Patient.	881
Concomitant Symptoms.	881
Patient Expectations.	881
Documentation.	882
Nursing Diagnosis	882
Planning	883
Goals and Outcomes.	883
Setting Priorities.	884
Collaborative Care.	885
Implementation	886
Health Promotion.	886
Maintaining Wellness.	886
Nonpharmacological Pain-Relief Measures.	887
Reducing Pain Reception and Perception.	887
Anticipatory Guidance.	887
Distraction.	887
Cutaneous Stimulation.	887
Relaxation and Guided Imagery.	888
Acute Care	889
Pharmacological Pain Therapy.	889
Analgesics.	889
Patient-Controlled Analgesia.	890
Perineural Local Anesthetic Infusion.	891
Local Anesthetics.	891
Epidural Analgesia.	892
Patients with Cancer Pain.	893
Restorative and Continuing Care.	895
Opioid Infusions.	895
Failure of Pain Control Medications with Chronic Pain.	896
Palliative Care.	896
Hospice.	896
Evaluation	896
Patient Care.	896
Patient Expectations.	897
Safety Guidelines for Nursing Skills	897
Skill 32-1 Patient-Controlled Analgesia	897
Delegation Considerations	897
Equipment	897
Recording and Reporting	899
Unexpected Outcomes and Related Interventions	900
Key Points	900
Clinical Decision-Making Exercises	900
QSEN Activity: Patient-Centered Care	901
Review Questions	901
References	902
33 Nutrition	904
Objectives	904
Key Terms	904
Scientific Knowledge Base	905
Principles of Nutrition	905
Nutrients.	905
Carbohydrates.	905
Proteins.	905
Fats.	906
Vitamins.	906
Minerals.	906
Water.	906
Digestion.	906
Absorption.	907
Metabolism.	907
Storage.	907
Elimination.	907
Dietary Guidelines	907
Food Guidelines.	907
Dietary Reference Intakes.	908
Other Dietary Guidelines.	908
Nursing Knowledge Base	908
Alternative Food Patterns	909
Developmental Needs	909
Infants Through School-Age.	909
Breastfeeding.	910
Formula.	910
Introduction to Solid Food.	910
Adolescents.	910
Young and Middle-Age Adults.	910
Pregnancy.	910
Lactation.	910
Older Adults.	911
Overweight and Obesity	911
Critical Thinking	911
Synthesis	911
Knowledge.	911
Experience.	911
Attitudes.	912
Standards.	912
Nursing Process	912
Assessment	912
Screening.	912
Nutritional Assessment.	912
Diet History.	912
Medication History.	913
Older Adult Considerations.	913
Patients at Risk for Nutritional Problems.	915
Physical Examination.	915
Anthropometry.	915
Laboratory Values.	915
Dysphagia.	915
Dysphagia Screening.	917
Patient Expectations.	917
Nursing Diagnosis	917
Planning	917
Goals and Outcomes.	917
Setting Priorities.	920
Collaborative Care.	920
Implementation	921
Health Promotion.	921
Acute Care.	921
Providing a Comfortable Environment.	923
Assisting Patients with Feeding.	923
Dysphagia.	923
Dysphagia Diet Management.	924
Patients with Disabilities.	924
Interventions for Those Unable to Meet Nutritional Needs Orally.	924
Enteral Tube Feedings.	924
Feeding Tube Insertion.	925
Gastrostomy/Jejunostomy Tubes and Tube Feedings.	926
Providing Parenteral Nutrition.	928
Initiating Parenteral Nutrition.	929
Caring for the Patient Receiving Parenteral Nutrition.	929
Restorative and Continuing Care	929
Diet Therapy in Disease Management.	929
Medical Nutrition Therapy.	930
Home Care.	930
Evaluation	930
Patient Care.	930
Patient Expectations.	930
Safety Guidelines for Nursing Skills	933
Skill 33-1 Aspiration Precautions	933
Delegation Considerations	933
Equipment	933
Recording and Reporting	935
Unexpected Outcomes and Related Interventions	935
Skill 33-2 Inserting a Nasogastric or Nasointestinal Feeding Tube	936
Delegation Considerations	936
Equipment	936
Tube Insertion	936
Tube Removal	936
Recording and Reporting	940
Unexpected Outcomes and Related Interventions	941
Skill 33-3 Administering Enteral Nutrition via Nasoenteric, Gastrostomy, or Jejunostomy Tubes	941
Delegation Considerations:	941
Equipment	941
Recording and Reporting	946
Unexpected Outcomes and Related Interventions	946
Key Points	947
Clinical Decision-Making Exercises	947
QSEN Activity: Safety	947
Review Questions	947
References	948
34 Urinary Elimination	951
Objectives	951
Key Terms	951
Scientific Knowledge Base	952
Anatomy and Physiology of the Urinary Tract	952
Kidneys.	952
Ureters.	952
Bladder.	952
Urethra.	953
Act of Urination	953
Factors Influencing Urination	953
Common Urinary Elimination Problems	953
Urinary Retention.	953
Urinary Tract Infections.	953
Urinary Incontinence.	953
Urinary Diversions.	954
Nursing Knowledge Base	957
Infection Control and Hygiene	957
Developmental Considerations	957
Psychosocial Implications	957
Critical Thinking	957
Synthesis	957
Knowledge.	958
Experience.	958
Attitudes.	958
Standards.	958
Nursing Process	958
Assessment	958
Nursing History.	958
Pattern of Urination.	958
Symptoms of Urinary Alterations.	959
Factors Affecting Voiding.	959
Older Adult Considerations.	959
Physical Assessment.	959
Kidneys.	959
Bladder.	959
External Genitalia and Urethral Meatus.	962
Perineal Skin.	963
Assessment of Urine.	963
Intake and Output.	963
Characteristics of Urine.	964
Color.	964
Clarity.	964
Odor.	964
Laboratory and Diagnostic Testing.	964
Urinalysis.	964
Timed Urine Tests.	964
Clean-Catch Midstream Specimen.	964
Urine for Culture and Sensitivity.	965
Diagnostic Examinations.	965
Nursing Diagnosis	967
Planning	967
Goals and Outcomes.	967
Setting Priorities.	967
Collaborative Care.	970
Implementation	970
Health Promotion.	970
Patient Education.	970
Promoting Normal Micturition.	970
Maintaining Elimination Habits.	970
Maintaining Adequate Fluid Intake.	970
Promoting Complete Bladder Emptying.	971
Preventing Infection.	971
Acute Care.	972
Catheterization.	972
Types of Catheters.	972
Catheter Sizes.	972
Catheter Changes.	973
Closed Drainage Systems.	973
Routine Catheter Care.	973
Catheter Removal.	973
Suprapubic Catheters.	974
Condom Catheters.	975
Urinary Diversions.	975
Medications.	977
Restorative Care.	977
Lifestyle Changes.	977
Pelvic Floor Muscle Training.	977
Bladder Retraining.	977
Toileting Schedules.	977
Intermittent Catheterization.	978
Skin Care.	978
Evaluation	978
Patient Care.	978
Patient Expectations.	979
Safety Guidelines for Nursing Skills	979
Safety Considerations	979
Skill 34-1 Inserting and Removing Straight/Intermittent or Indwelling Catheters	979
Delegation Considerations	979
Equipment	979
Catheter Insertion	979
Catheter Removal	979
Recording and Reporting	988
Unexpected Outcomes and Related Interventions	988
Key Points	989
Critical Decision-Making Exercises	989
QSEN Activity: Quality Improvement	989
Review Questions	989
References	990
35 Bowel Elimination	992
Objectives	992
Key Terms	992
Scientific Knowledge Base	992
Anatomy and Physiology of the Gastrointestinal Tract	992
Mouth.	993
Esophagus.	993
Stomach.	993
Small Intestine.	993
Large Intestine.	994
Anus.	994
Defecation.	994
Nursing Knowledge Base	994
Bowel Elimination Problems	994
Constipation.	994
Impaction.	996
Diarrhea.	996
Fecal Incontinence.	997
Flatulence.	997
Hemorrhoids.	997
Intestinal Diversions.	997
Ostomies.	997
Other Procedures.	998
Critical Thinking	998
Synthesis	998
Knowledge.	999
Experience.	999
Attitudes.	999
Standards.	999
Nursing Process	1000
Assessment	1000
Health History.	1000
Older Adult Considerations.	1001
Physical Assessment.	1001
Laboratory and Diagnostic Examinations	1001
Laboratory Tests.	1001
Fecal Specimens.	1001
Diagnostic Examinations.	1002
Patient Expectations.	1002
Nursing Diagnosis	1005
Planning	1005
Goals and Outcomes.	1005
Setting Priorities.	1005
Collaborative Care.	1005
Implementation	1005
Health Promotion.	1005
Diet.	1008
Exercise.	1008
Timing and Privacy.	1009
Promotion of Normal Defecation.	1009
Acute Care.	1009
Positioning on Bedpan.	1009
Medications.	1010
Nasogastric Tube for Gastric Decompression.	1011
Enemas.	1011
Digital Removal of Stool.	1012
Continuing and Restorative Care.	1012
Bowel Training.	1012
Ostomy Care.	1013
Care of Hemorrhoids.	1013
Maintenance of Skin Integrity.	1014
Evaluation	1014
Patient Care.	1014
Patient Expectations.	1015
Safety Guidelines for Nursing Skills	1015
Skill 35-1 Inserting and Maintaining a Nasogastric Tube for Gastric Decompression	1015
Delegation Considerations	1015
Equipment	1015
Recording and Reporting	1021
Unexpected Outcomes and Related Interventions	1021
Skill 35-2 Administering a Cleansing Enema	1021
Delegation Considerations	1021
Equipment	1021
Enema Bag Administration	1022
Prepackaged Enema	1022
Recording and Reporting	1025
Unexpected Outcomes and Related Interventions	1025
Skill 35-3 Pouching an Ostomy	1025
Delegation Considerations	1025
Equipment	1026
Recording and Reporting	1029
Unexpected Outcomes and Related Interventions	1029
Key Points	1029
Clinical Decision-Making Exercises	1029
QSEN Activity: Teamwork and Collaboration	1030
Review Questions	1030
References	1031
36 Immobility	1032
Objectives	1032
Key Terms	1032
Scientific Knowledge Base	1032
Movement	1032
Body Alignment and Balance	1033
Pathological Influences on Mobility	1033
Postural Abnormalities.	1033
Muscle Abnormalities.	1033
Damage to the Central Nervous System.	1033
Direct Trauma to the Musculoskeletal System.	1033
Nursing Knowledge Base	1033
Safe Patient Handling	1033
Immobility	1035
Respiratory Changes.	1035
Metabolic Changes.	1035
Fluid and Electrolyte Balances.	1035
Gastrointestinal Changes.	1035
Cardiovascular Changes.	1035
Musculoskeletal Changes.	1036
Integument Changes.	1036
Urinary Elimination Changes.	1036
Psychosocial Effects	1036
Developmental Effects	1037
Critical Thinking	1037
Synthesis	1037
Knowledge.	1037
Experience.	1037
Attitudes.	1038
Standards.	1038
Nursing Process	1038
Assessment	1038
Mobility.	1038
Respiratory System.	1039
Metabolic System.	1039
Cardiovascular System.	1042
Skin Integrity.	1042
Elimination System.	1042
Psychosocial Condition.	1042
Development.	1043
Older Adult Considerations.	1043
Nursing Diagnosis	1044
Planning	1044
Goals and Outcomes.	1046
Setting Priorities.	1047
Collaborative Care.	1048
Implementation	1048
Health Promotion.	1048
Respiratory System.	1048
Promoting Expansion of the Chest and Lungs.	1048
Preventing Stasis of Pulmonary Secretions.	1048
Metabolic System.	1048
Cardiovascular System.	1049
Preventing Thrombus Formation.	1049
Musculoskeletal System.	1049
Skin Integrity.	1049
Elimination System.	1050
Psychosocial Problems.	1050
Developmental Changes.	1050
Acute Care.	1050
Respiratory System.	1050
Maintaining a Patent Airway.	1050
Cardiovascular System.	1050
Musculoskeletal System.	1052
Integumentary System.	1055
Psychosocial Problems.	1055
Developmental Changes.	1055
Safe Patient Handling and Movement.	1056
Transfer Techniques.	1056
Moving and Transferring Patients.	1056
Restorative and Continuing Care.	1056
Evaluation	1056
Patient Care.	1056
Patient Expectations.	1056
Key Points	1057
Clinical Decision-Making Exercises	1057
QSEN Activity: Quality Improvement	1058
Review Questions	1058
References	1059
37 Skin Integrity and Wound Care	1060
Objectives	1060
Key Terms	1060
Scientific Knowledge Base	1061
Pressure Ulcers	1061
Factors Contributing to Pressure Ulcer Formation.	1062
Shear.	1062
Friction.	1062
Moisture.	1062
Nutrition.	1063
Infection.	1063
Age.	1063
Origins of Pressure Ulcers.	1063
Pressure Ulcer Classification.	1063
Wound Healing Process	1064
Partial-Thickness Wound Repair.	1065
Inflammatory Response.	1065
Epidermal Repair.	1065
Dermal Repair.	1066
Full-Thickness Wound Repair.	1066
Hemostasis Phase.	1066
Inflammation Phase.	1066
Proliferative Phase.	1066
Remodeling Phase.	1066
Complications of Wound Healing	1066
Hemorrhage.	1066
Infection.	1066
Dehiscence.	1066
Evisceration.	1066
Nursing Knowledge Base	1066
Prediction and Prevention	1067
Critical Thinking	1067
Synthesis	1067
Knowledge.	1068
Experience.	1069
Attitudes.	1069
Standards.	1069
Nursing Process	1069
Assessment	1069
Pressure Ulcers.	1069
Skin.	1070
Mobility.	1071
Nutritional Status.	1071
Wounds.	1072
Emergency Setting.	1072
Stable Setting.	1072
Wound Cultures.	1073
Patient Expectations.	1073
Nursing Diagnosis	1074
Planning	1074
Goals and Outcomes.	1074
Setting Priorities.	1076
Collaborative Care.	1077
Implementation	1077
Health Promotion.	1077
Topical Skin Care.	1077
Positioning.	1077
Support Surfaces.	1078
Nutrition.	1078
Acute Care	1079
Pressure Ulcers.	1079
Wounds	1082
First Aid for Wounds.	1082
Hemostasis.	1082
Cleansing.	1082
Protection.	1082
Dressings.	1082
Purpose.	1083
Type.	1083
Changing Dressings.	1084
Securing Dressings.	1084
Comfort Measures.	1084
Wound Cleansing.	1084
Wound Irrigation.	1084
Suture Care.	1085
Drainage Evacuation.	1085
Bandages and Binders.	1086
Principles for Application of Bandages and Binders.	1086
Binder Application.	1086
Abdominal Binder.	1087
Slings.	1087
Bandage Application.	1088
Heat and Cold Therapy.	1088
Body Responses to Heat and Cold.	1088
Local Effects of Heat and Cold.	1088
Factors Influencing Heat and Cold Tolerance.	1089
Assessment for Temperature Tolerance.	1089
Patient Education and Safety.	1090
Applying Heat and Cold.	1090
Choice of Moist or Dry.	1090
Warm Moist Compresses.	1090
Warm Soaks.	1090
Sitz Bath.	1090
Commercial Hot Packs.	1091
Hot-Water Bottles.	1091
Electric Heating Pads.	1091
Cold Moist Compresses.	1091
Cold Soaks.	1091
Ice Bag or Collar.	1091
Commercial Cold Packs.	1091
Restorative and Continuing Care.	1091
Evaluation	1091
Patient Care.	1091
Patient Expectations.	1092
Safety Guidelines for Nursing Skills	1092
Skill 37-1 Assessment of Patient for Pressure Ulcer: Risk and Skin Assessment	1092
Delegation Considerations	1092
Equipment	1092
Recording and Reporting	1094
Unexpected Outcomes and Related Interventions	1094
Skill 37-2 Treating Pressure Ulcers	1094
Delegation Considerations	1094
Equipment	1094
Recording and Reporting	1097
Unexpected Outcomes and Related Interventions	1097
Skill 37-3 Negative-Pressure Wound Therapy	1098
Delegation Considerations	1098
Equipment	1098
Recording and Reporting	1100
Unexpected Outcomes and Related Interventions	1100
Skill 37-4 Applying Dressings: Dry, Moist, and Transparent	1101
Delegation Considerations	1101
Equipment	1101
Recording and Reporting	1104
Unexpected Outcomes and Related Interventions	1105
Skill 37-5 Performing Wound Irrigation	1105
Delegation Considerations	1105
Equipment	1105
Recording and Reporting	1107
Unexpected Outcomes and Related Interventions	1108
Key Points	1108
Clinical Decision-Making Exercises	1108
QSEN Activity: Evidence-Based Practice	1108
Review Questions	1109
References	1110
38 Sensory Alterations	1111
Objectives	1111
Key Terms	1111
Scientific Knowledge Base	1111
Normal Sensation	1111
Types of Sensory Alterations	1112
Sensory Deficits.	1112
Sensory Deprivation.	1112
Sensory Overload.	1112
Nursing Knowledge Base	1113
Critical Thinking	1115
Synthesis	1115
Knowledge.	1115
Experience.	1116
Attitudes.	1116
Standards.	1116
Nursing Process	1116
Assessment	1116
Patients at Risk.	1116
Older Adult Considerations.	1116
Sensory Status.	1116
Patient’s Lifestyle.	1116
Socialization.	1116
Self-Care Management.	1116
Psychosocial Adjustment.	1117
Health Promotion Practices.	1117
Hazards.	1117
Meaningful Stimuli.	1117
Environment.	1117
Communication Methods.	1118
Physical Examination.	1118
Patient Expectations.	1118
Nursing Diagnosis	1119
Planning	1119
Goals and Outcomes.	1119
Setting Priorities.	1122
Collaborative Care.	1122
Implementation	1122
Health Promotion.	1122
Screening and Prevention.	1122
Preventive Safety.	1122
Use of Assistive Aids.	1123
Promoting Meaningful Stimulation.	1123
Establishing Safe Environments.	1123
Visual Adaptations.	1123
Hearing Adaptations.	1124
Smell and Tactile Adaptations.	1124
Communication.	1124
Acute Care.	1124
Orientation to the Environment.	1125
Safety Measures.	1125
Communication.	1125
Controlling Sensory Stimuli.	1125
Restorative and Continuing Care.	1126
Promoting Self-Care.	1126
Socialization.	1126
Evaluation	1126
Patient Care.	1126
Patient Expectations.	1127
Key Points	1127
Clinical Decision-Making Exercises	1127
QSEN Activity: Safety	1128
Review Questions	1128
References	1129
39 Surgical Patient	1130
Objectives	1130
Key Terms	1130
Scientific Knowledge Base	1131
Classification of Surgery	1131
Surgical Risk Factors	1131
Smoking.	1131
Age.	1131
Nutrition.	1131
Obesity.	1131
Obstructive Sleep Apnea.	1132
Immunocompetence.	1132
Fluid and Electrolyte Balance.	1132
Pregnancy.	1133
Nursing Knowledge Base	1133
Perioperative Communication	1133
Complication Prevention	1133
Gylcemic Control and Infection Prevention	1133
Pressure Ulcer Prevention	1133
Critical Thinking	1134
Synthesis	1134
Knowledge.	1134
Experience.	1134
Attitudes.	1134
Standards.	1134
Preoperative Surgical Phase	1134
Nursing Process	1135
Assessment	1135
Nursing History.	1135
Medical History.	1135
Previous Surgeries.	1135
Medication History.	1135
Allergies.	1135
Smoking Habits.	1136
Alcohol and Controlled Substance Use and Abuse.	1136
Family Support.	1136
Occupation.	1137
Feelings.	1137
Cultural and Spiritual Factors.	1137
Coping Resources.	1138
Body Image.	1138
Patient Expectations.	1138
Physical Examination.	1138
General Survey.	1138
Head and Neck.	1138
Skin.	1139
Thorax and Lungs.	1139
Heart and Vascular System.	1139
Abdomen.	1139
Neurological Status.	1139
Risk Factors.	1139
Diagnostic Screening.	1140
Older Adult Considerations.	1140
Nursing Diagnosis	1140
Planning	1142
Goals and Outcomes.	1142
Setting Priorities.	1142
Collaborative Care.	1142
Implementation	1142
Informed Consent.	1142
Health Promotion.	1144
Preoperative Teaching.	1144
Timing.	1144
Content.	1144
Surgical Procedure.	1144
Preoperative Routines.	1145
Intraoperative Routines.	1145
Postoperative Routines.	1145
Sensory Preparation.	1145
Pain Relief.	1146
Postoperative Exercises.	1146
Activity Resumption.	1146
Promotion of Nutrition.	1146
Promotion of Rest.	1146
Acute Care.	1147
Minimize Risk for Surgical Wound Infection.	1147
Prevention of Bowel Incontinence and Contamination.	1147
Interventions on Day of Surgery.	1147
Documentation.	1147
Assessment of Vital Signs.	1147
Hygiene.	1147
Preparation of Hair and Removal of Cosmetics.	1148
Removal of Prostheses.	1148
Preparation of Bowel and Bladder.	1148
Application of Antiembolism Devices.	1148
Promotion of Patient’s Dignity.	1148
Performing Special Procedures.	1148
Safeguarding Valuables.	1148
Administering Preoperative Medications.	1148
Evaluation	1149
Patient Care.	1149
Patient Expectations.	1149
Transport to the Operating Room	1149
Preanesthesia Care Unit.	1149
Intraoperative Surgical Phase	1150
Nurse’s Role During Surgery	1150
Nursing Process	1150
Assessment	1150
Nursing Diagnosis	1150
Planning	1150
Goals and Outcomes.	1150
Implementation	1151
Acute Care	1151
Admission to the Operating Room.	1151
Physical Preparation.	1151
Intraoperative Warming.	1151
Psychological Support.	1151
Positioning.	1151
Introduction of Anesthesia.	1152
General Anesthesia.	1152
Regional Anesthesia.	1152
Local Anesthesia.	1152
Moderate Sedation (Conscious Sedation).	1152
Documentation of Intraoperative Care.	1153
Evaluation	1153
Patient Care.	1153
Patient Expectations.	1153
Postoperative Surgical Phase	1153
Recovery	1153
Postanesthesia Care in Ambulatory Surgery	1153
Recovery Phase	1154
Nursing Process	1154
Assessment	1154
Respiration.	1154
Circulation.	1154
Temperature Control.	1154
Neurological Function.	1156
Fluid and Electrolyte Balance.	1156
Skin Integrity and Condition of the Wound.	1156
Genitourinary Function.	1156
Gastrointestinal Function.	1156
Comfort.	1156
Nursing Diagnosis	1158
Planning	1158
Goals and Outcomes.	1159
Setting Priorities.	1159
Continuity of Care.	1159
Implementation	1159
Respiration.	1160
Circulation.	1162
Temperature Control.	1162
Neurological Function.	1163
Fluid and Electrolyte Balance.	1163
Genitourinary Function.	1163
Gastrointestinal Function.	1163
Comfort.	1164
Promoting Wound Healing.	1164
Maintaining Self-Concept.	1164
Restorative and Continuing Care.	1165
Evaluation	1165
Patient Care.	1165
Patient Expectations.	1165
Safety Guidelines for Nursing Skills	1166
Skill 39-1 Teaching Postoperative Exercises	1166
Delegation Considerations	1166
Equipment	1166
Recording and Reporting	1171
Unexpected Outcomes and Related Interventions	1171
Key Points	1172
Clinical Decision-Making Exercises	1172
QSEN Activity: Quality Improvement	1172
Review Questions	1173
References	1174
Glossary	1175
A	1175
B	1176
C	1177
D	1179
E	1180
F	1180
G	1181
H	1181
I	1182
J	1183
K	1183
L	1183
M	1184
N	1185
O	1185
P	1186
Q	1187
R	1187
S	1188
T	1190
U	1190
V	1190
W	1191
X	1191
Y	1191
Z	1191
Index	1192
A	1192
B	1194
C	1195
D	1198
E	1200
F	1201
G	1203
H	1203
I	1206
J	1208
K	1208
L	1208
M	1209
N	1210
O	1213
P	1214
Q	1218
R	1218
S	1219
T	1222
U	1224
V	1224
W	1225
X	1225
Y	1225
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