BOOK
Fundamentals of Nursing - E-Book
Patricia A. Potter | Anne Griffin Perry | Patricia Stockert | Amy Hall
(2013)
Additional Information
Book Details
Abstract
Learn fundamental nursing principles, concepts, and skills with ease! Fundamentals of Nursing, 8th Edition includes accurate, cutting-edge content, active learning strategies, and the latest evidence-based research to help you excel in your classes and prepare for success in today's competitive nursing field. An expert author team led by Patricia Potter and Anne Griffin Perry provides a trusted, comprehensive resource, thoroughly reviewed by nursing experts and peers to ensure the most accurate content. With practical, fully integrated study support, this edition makes it easier than ever to build the understanding and clinical reasoning essential to providing excellent patient care.
Table of Contents
| Section Title | Page | Action | Price |
|---|---|---|---|
| Front cover | cover | ||
| Inside front cover | ifc1 | ||
| Half title page | i | ||
| Evolve page | ii | ||
| Fundamentals of Nursing | iii | ||
| Copyright page | iv | ||
| Contributors | v | ||
| Reviewers | vii | ||
| Contributors to Previous Editions | xi | ||
| Dedication | xiii | ||
| Student Preface | xv | ||
| Preface to The Instructor | xxi | ||
| Key Features | xxi | ||
| New to this Edition | xxi | ||
| Learning Supplements for Students | xxii | ||
| Teaching Supplements for Instructors | xxii | ||
| Multimedia Supplements for Instructors and Students | xxiii | ||
| Acknowledgments | xxv | ||
| Table of Contents | xxvii | ||
| Unit 1 Nursing and the Health Care Environment | 1 | ||
| Chapter 1 Nursing Today | 1 | ||
| Objectives | 1 | ||
| Key Terms | 1 | ||
| Historical Highlights | 2 | ||
| Florence Nightingale | 2 | ||
| The Civil War to the Beginning of the Twentieth Century | 2 | ||
| Twentieth Century | 2 | ||
| Twenty-First Century | 3 | ||
| Influences on Nursing | 3 | ||
| Health Care Reform | 3 | ||
| Demographic Changes | 3 | ||
| Medically Underserved | 3 | ||
| Threat of Bioterrorism | 3 | ||
| Rising Health Care Costs | 3 | ||
| Nursing Shortage | 4 | ||
| Nursing as a Profession | 4 | ||
| Scope and Standards of Practice | 4 | ||
| Standards of Practice. | 4 | ||
| Standards of Professional Performance. | 4 | ||
| Code of Ethics. | 4 | ||
| Nursing Education | 5 | ||
| Professional Registered Nurse Education | 5 | ||
| Graduate Education | 5 | ||
| Doctoral Preparation. | 5 | ||
| Continuing and In-Service Education | 5 | ||
| Nursing Practice | 6 | ||
| Nurse Practice Acts | 6 | ||
| Licensure and Certification | 6 | ||
| Licensure. | 6 | ||
| Certification. | 6 | ||
| Science and Art of Nursing Practice | 6 | ||
| Professional Responsibilities and Roles | 6 | ||
| Autonomy and Accountability | 6 | ||
| Caregiver | 7 | ||
| Advocate | 7 | ||
| Educator | 7 | ||
| Communicator | 7 | ||
| Manager | 7 | ||
| Career Development | 7 | ||
| Provider of Care. | 7 | ||
| Advanced Practice Registered Nurses. | 7 | ||
| Clinical Nurse Specialist. | 8 | ||
| Nurse Practitioner. | 8 | ||
| Certified Nurse-Midwife. | 8 | ||
| Certified Registered Nurse Anesthetist. | 8 | ||
| Nurse Educator. | 8 | ||
| Nurse Administrator. | 8 | ||
| Nurse Researcher. | 8 | ||
| Professional Nursing Organizations | 9 | ||
| Trends in Nursing | 9 | ||
| Quality and Safety Education for Nurses | 9 | ||
| Genomics | 10 | ||
| Public Perception of Nursing | 10 | ||
| Impact of Nursing on Politics and Health Policy | 10 | ||
| Key Points | 11 | ||
| Clinical Application Questions | 11 | ||
| Preparing for clinical practice | 11 | ||
| Review Questions | 11 | ||
| Are you ready to test your Nursing knowledge? | 11 | ||
| References | 12 | ||
| Research References | 13 | ||
| Chapter 2 The Health Care Delivery System | 14 | ||
| Objectives | 14 | ||
| Key Terms | 14 | ||
| Health Care Regulation and Competition | 15 | ||
| Emphasis on Population Wellness | 15 | ||
| Health Care Settings and Services | 16 | ||
| Preventive and Primary Health Care | 17 | ||
| Secondary and Tertiary Care | 17 | ||
| Hospitals. | 18 | ||
| Intensive Care. | 19 | ||
| Psychiatric Facilities. | 19 | ||
| Rural Hospitals. | 19 | ||
| Restorative Care | 20 | ||
| Home Health Care (Home Care). | 20 | ||
| Rehabilitation. | 20 | ||
| Extended Care Facilities. | 20 | ||
| Continuing Care | 21 | ||
| Nursing Centers or Facilities. | 21 | ||
| Assisted Living. | 21 | ||
| Respite Care. | 22 | ||
| Adult Day Care Centers. | 22 | ||
| Hospice. | 22 | ||
| Issues in Health Care Delivery | 22 | ||
| Nursing Shortage | 22 | ||
| Competency | 22 | ||
| Evidence-Based Practice | 23 | ||
| Quality and Safety in Health Care | 23 | ||
| Patient Satisfaction. | 24 | ||
| Magnet Recognition Program | 25 | ||
| Nursing-Sensitive Outcomes. | 26 | ||
| Nursing Informatics and Technological Advancements | 26 | ||
| Globalization of Health Care | 27 | ||
| The Future of Health Care | 28 | ||
| Key Points | 28 | ||
| Clinical Application Questions | 28 | ||
| Preparing for clinical practice | 28 | ||
| Review Questions | 28 | ||
| Are you ready to test your nursing knowledge? | 28 | ||
| References | 30 | ||
| Research References | 30 | ||
| Chapter 3 Community-Based Nursing Practice | 31 | ||
| Objectives | 31 | ||
| Key Terms | 31 | ||
| Community-Based Health Care | 31 | ||
| Achieving Healthy Populations and Communities | 31 | ||
| Community Health Nursing | 32 | ||
| Nursing Practice in Community Health | 33 | ||
| Community-Based Nursing | 33 | ||
| Vulnerable Populations | 33 | ||
| Immigrant Population. | 34 | ||
| Effects of Poverty and Homelessness. | 34 | ||
| Patients Who Are Abused. | 34 | ||
| Patients Who Abuse Substances. | 35 | ||
| Patients with Mental Illnesses. | 35 | ||
| Older Adults. | 35 | ||
| Competency in Community-Based Nursing | 35 | ||
| Caregiver. | 35 | ||
| Case Manager. | 36 | ||
| Change Agent. | 36 | ||
| Patient Advocate. | 36 | ||
| Collaborator. | 36 | ||
| Counselor. | 36 | ||
| Educator. | 36 | ||
| Epidemiologist. | 36 | ||
| Community Assessment | 37 | ||
| Changing Patients’ Health | 37 | ||
| Key Points | 37 | ||
| Clinical Application Questions | 38 | ||
| Preparing for clinical practice | 38 | ||
| Review Questions | 38 | ||
| Are you ready to test your nursing knowledge? | 38 | ||
| References | 39 | ||
| Research References | 39 | ||
| Chapter 4 Theoretical Foundations of Nursing Practice | 40 | ||
| Objectives | 40 | ||
| Key Terms | 40 | ||
| The Domain of Nursing | 40 | ||
| Theory | 41 | ||
| Components of a Theory | 41 | ||
| Phenomenon. | 41 | ||
| Concepts. | 41 | ||
| Definitions. | 42 | ||
| Assumptions. | 42 | ||
| Types of Theory | 42 | ||
| Theory-Based Nursing Practice | 42 | ||
| Interdisciplinary Theories | 43 | ||
| Systems Theory | 43 | ||
| Basic Human Needs | 43 | ||
| Developmental Theories | 44 | ||
| Psychosocial Theories | 44 | ||
| Selected Nursing Theories | 44 | ||
| Nightingale’s Theory | 44 | ||
| Peplau’s Theory | 44 | ||
| Henderson’s Theory | 44 | ||
| Orem’s Theory | 44 | ||
| Leininger’s Theory | 45 | ||
| Betty Neuman’s Theory | 45 | ||
| Roy’s Theory | 46 | ||
| Watson’s Theory | 46 | ||
| Benner and Wrubel’s Theory | 46 | ||
| Link between Theory and Knowledge Development in Nursing | 46 | ||
| Relationship Between Nursing Theory and Nursing Research | 46 | ||
| Key Points | 47 | ||
| Clinical Application Questions | 47 | ||
| Preparing for Clinical Practice | 47 | ||
| Review Questions | 47 | ||
| Are You Ready to Test Your Nursing Knowledge? | 47 | ||
| References | 48 | ||
| Research References | 49 | ||
| Chapter 5 Evidence-Based Practice | 50 | ||
| Objectives | 50 | ||
| Key Terms | 50 | ||
| A Case for Evidence | 50 | ||
| Steps of Evidence-Based Practice | 51 | ||
| Ask a Clinical Question. | 52 | ||
| Collect the Best Evidence. | 52 | ||
| Critically Appraise the Evidence. | 54 | ||
| Integrate the Evidence. | 55 | ||
| Evaluate the Practice Decision or Change. | 55 | ||
| Share the Outcomes with Others. | 55 | ||
| Nursing Research | 56 | ||
| Outcomes Management Research | 56 | ||
| Scientific Method | 57 | ||
| Nursing and the Scientific Approach | 57 | ||
| Quantitative Research. | 57 | ||
| Experimental Research. | 57 | ||
| Nonexperimental Research. | 58 | ||
| Surveys. | 58 | ||
| Evaluation Research. | 58 | ||
| Qualitative Research. | 59 | ||
| Research Process | 59 | ||
| Quality and Performance Improvement | 60 | ||
| Quality Improvement Programs | 61 | ||
| Key Points | 62 | ||
| Clinical Application Questions | 62 | ||
| Preparing for Clinical Practice | 62 | ||
| Review Questions | 62 | ||
| Are You Ready to Test Your Nursing Knowledge? | 62 | ||
| References | 64 | ||
| Research References | 64 | ||
| Unit 2 Caring Throughout the Life Span | 65 | ||
| Chapter 6 Health and Wellness | 65 | ||
| Objectives | 65 | ||
| Key Terms | 65 | ||
| Healthy People Documents | 65 | ||
| Definition of Health | 66 | ||
| Models of Health and Illness | 66 | ||
| Health Belief Model | 66 | ||
| Health Promotion Model | 66 | ||
| Maslow’s Hierarchy of Needs | 67 | ||
| Holistic Health Models | 67 | ||
| Variables Influencing Health and Health Beliefs and Practices | 68 | ||
| Internal Variables | 68 | ||
| Developmental Stage. | 68 | ||
| Intellectual Background. | 69 | ||
| Perception of Functioning. | 70 | ||
| Emotional Factors. | 70 | ||
| Spiritual Factors. | 70 | ||
| External Variables | 70 | ||
| Family Practices. | 70 | ||
| Socioeconomic Factors. | 70 | ||
| Cultural Background. | 70 | ||
| Health Promotion, Wellness, and Illness Prevention | 70 | ||
| Levels of Preventive Care | 71 | ||
| Primary Prevention. | 71 | ||
| Secondary Prevention. | 71 | ||
| Tertiary Prevention. | 71 | ||
| Risk Factors | 71 | ||
| Genetic and Physiological Factors | 72 | ||
| Age | 72 | ||
| Environment | 72 | ||
| Lifestyle | 72 | ||
| Risk-Factor Modification and Changing Health Behaviors | 73 | ||
| Illness | 73 | ||
| Acute and Chronic Illness | 74 | ||
| Illness Behavior | 74 | ||
| Variables Influencing Illness and Illness Behavior | 75 | ||
| Internal Variables. | 75 | ||
| External Variables. | 75 | ||
| Impact of Illness on the Patient and Family | 75 | ||
| Behavioral and Emotional Changes. | 75 | ||
| Impact on Body Image. | 75 | ||
| Impact on Self-Concept. | 75 | ||
| Impact on Family Roles. | 76 | ||
| Impact on Family Dynamics. | 76 | ||
| Key Points | 76 | ||
| Clinical Application Questions | 76 | ||
| Preparing for Clinical Practice | 76 | ||
| Review Questions | 76 | ||
| Are You Ready to Test Your Nursing Knowledge? | 76 | ||
| References | 78 | ||
| Research Reference | 78 | ||
| Chapter 7 Caring in Nursing Practice | 79 | ||
| Objectives | 79 | ||
| Key Terms | 79 | ||
| Theoretical Views on Caring | 80 | ||
| Caring Is Primary | 80 | ||
| Leininger’s Transcultural Caring | 80 | ||
| Watson’s Transpersonal Caring | 81 | ||
| Swanson’s Theory of Caring | 81 | ||
| Summary of Theoretical Views | 81 | ||
| Patients’ Perceptions of Caring | 82 | ||
| Ethic of Care | 83 | ||
| Caring in Nursing Practice | 83 | ||
| Providing Presence | 83 | ||
| Touch | 84 | ||
| Listening | 84 | ||
| Knowing the Patient | 85 | ||
| Spiritual Caring | 85 | ||
| Relieving Pain and Suffering | 85 | ||
| Family Care | 86 | ||
| The Challenge of Caring | 86 | ||
| Key Points | 87 | ||
| Clinical Application Questions | 87 | ||
| Preparing for Clinical Practice | 87 | ||
| Review Questions | 87 | ||
| Are You Ready to Test Your Nursing Knowledge? | 87 | ||
| References | 88 | ||
| Research References | 89 | ||
| Chapter 8 Caring for the Cancer Survivor | 90 | ||
| Objectives | 90 | ||
| Key Terms | 90 | ||
| The Effects of Cancer on Quality of Life | 91 | ||
| Physical Well-Being and Symptoms | 91 | ||
| Psychological Well-Being | 92 | ||
| Social Well-Being | 93 | ||
| Spiritual Well-Being | 94 | ||
| Cancer and Families | 94 | ||
| Family Distress | 94 | ||
| Implications for Nursing | 94 | ||
| Survivor Assessment | 94 | ||
| Patient Education | 95 | ||
| Providing Resources | 96 | ||
| Components of Survivorship Care | 97 | ||
| Survivorship Care Plan | 97 | ||
| Key Points | 97 | ||
| Clinical Application Questions | 98 | ||
| Preparing for Clinical Practice | 98 | ||
| Review Questions | 98 | ||
| Are You Ready to Test Your Nursing Knowledge? | 98 | ||
| References | 100 | ||
| Research References | 100 | ||
| Chapter 9 Culture and Ethnicity | 101 | ||
| Objectives | 101 | ||
| Key Terms | 101 | ||
| Health Disparities | 101 | ||
| Understanding Cultural Concepts | 102 | ||
| Culturally Congruent Care | 103 | ||
| Cultural Conflicts | 103 | ||
| Cultural Context of Health and Caring | 103 | ||
| Cultural Healing Modalities and Healers | 104 | ||
| Culture-Bound Syndrome | 104 | ||
| Culture and Life Transitions | 105 | ||
| Pregnancy | 105 | ||
| Childbirth | 105 | ||
| Newborn | 106 | ||
| Postpartum Period | 106 | ||
| Grief and Loss | 106 | ||
| Cultural Assessment | 107 | ||
| Census Data | 107 | ||
| Asking Questions | 107 | ||
| Establishing Relationships | 107 | ||
| Selected Components of Cultural Assessment | 110 | ||
| Family Structure. | 110 | ||
| Ethnic Heritage and Ethnohistory. | 110 | ||
| Bicultural Effects on Health. | 110 | ||
| Social Organization. | 110 | ||
| Religious and Spiritual Beliefs. | 111 | ||
| Foods with Cultural Significance. | 112 | ||
| Communication Patterns. | 112 | ||
| Time Orientation | 112 | ||
| Caring Beliefs and Practices | 112 | ||
| Experience with Professional Health Care | 112 | ||
| Culturally Congruent Care | 113 | ||
| Key Points | 113 | ||
| Clinical Application QUESTIONS | 113 | ||
| Preparing for Clinical Practice | 113 | ||
| Review Questions | 113 | ||
| Are You Ready to Test Your Nursing Knowledge? | 113 | ||
| References | 114 | ||
| Research References | 115 | ||
| Chapter 10 Caring for Families | 116 | ||
| Objectives | 116 | ||
| Key Terms | 116 | ||
| The Family | 116 | ||
| Concept of Family | 116 | ||
| Definition: What Is a Family? | 116 | ||
| Current Trends and New Family Forms | 117 | ||
| Changing Economic Status | 118 | ||
| Homelessness | 118 | ||
| Family Violence | 118 | ||
| Acute or Chronic Illness | 119 | ||
| Trauma. | 119 | ||
| End-of-Life Care. | 119 | ||
| Theoretical Approaches: An Overview | 119 | ||
| Family Health System | 119 | ||
| Developmental Stages | 119 | ||
| Attributes of Families | 120 | ||
| Structure | 120 | ||
| Function | 121 | ||
| The Family and Health | 121 | ||
| Attributes of Healthy Families. | 121 | ||
| Family Nursing | 121 | ||
| Family As Context | 122 | ||
| Family As Patient | 122 | ||
| Family As System | 122 | ||
| Nursing Process for the Family | 123 | ||
| Assessing the Needs of the Family | 123 | ||
| Family-Focused Care | 125 | ||
| Challenges for Family Nursing | 125 | ||
| Implementing Family-Centered Care | 125 | ||
| Health Promotion. | 125 | ||
| Acute Care. | 126 | ||
| Restorative and Continuing Care. | 126 | ||
| Family Caregiving. | 126 | ||
| Key Points | 127 | ||
| Clinical Application Questions | 127 | ||
| Preparing for Clinical Practice | 127 | ||
| Review Questions | 127 | ||
| Are You Ready to Test Your Nursing Knowledge? | 127 | ||
| References | 129 | ||
| Research References | 129 | ||
| Chapter 11 Developmental Theories | 130 | ||
| Objectives | 130 | ||
| Key Terms | 130 | ||
| Developmental Theories | 130 | ||
| Biophysical Developmental Theories | 131 | ||
| Gesell’s Theory of Development. | 131 | ||
| Psychoanalytical/Psychosocial Theory | 131 | ||
| Sigmund Freud. | 131 | ||
| Stage 1: Oral (Birth to 12 to 18 Months). | 131 | ||
| Stage 2: Anal (12 to 18 Months to 3 Years). | 131 | ||
| Stage 3: Phallic or Oedipal (3 to 6 Years). | 131 | ||
| Stage 4: Latency (6 to 12 Years). | 131 | ||
| Stage 5: Genital (Puberty Through Adulthood). | 131 | ||
| Erik Erikson. | 132 | ||
| Trust versus Mistrust (Birth to 1 Year). | 132 | ||
| Autonomy versus Sense of Shame and Doubt (1 to 3 Years). | 132 | ||
| Initiative versus Guilt (3 to 6 Years). | 132 | ||
| Industry versus Inferiority (6 to 11 Years). | 132 | ||
| Identity versus Role Confusion (Puberty). | 132 | ||
| Intimacy versus Isolation (Young Adult). | 132 | ||
| Generativity versus Self-Absorption and Stagnation (Middle Age). | 132 | ||
| Integrity versus Despair (Old Age). | 132 | ||
| Theories Related to Temperament. | 133 | ||
| Perspectives on Adult Development | 133 | ||
| Stage-Crisis Theory. | 133 | ||
| Life Span Approach. | 133 | ||
| Cognitive Developmental Theory | 134 | ||
| Jean Piaget. | 134 | ||
| Period I: Sensorimotor (Birth to 2 Years). | 134 | ||
| Period II: Preoperational (2 to 7 Years). | 134 | ||
| Period III: Concrete Operations (7 to 11 Years). | 134 | ||
| Period IV: Formal Operations (11 Years to Adulthood). | 134 | ||
| Research in Adult Cognitive Development. | 134 | ||
| Moral Developmental Theory | 135 | ||
| Lawrence Kohlberg’s Theory of Moral Development. | 135 | ||
| Level I: Preconventional Reasoning. | 135 | ||
| Stage 1: Punishment and Obedience Orientation. | 135 | ||
| Stage 2: Instrumental Relativist Orientation. | 135 | ||
| Level II: Conventional Reasoning. | 135 | ||
| Stage 3: Good Boy–Nice Girl Orientation. | 135 | ||
| Stage 4: Society-Maintaining Orientation. | 135 | ||
| Level III: Postconventional Reasoning. | 136 | ||
| Stage 5: Social Contract Orientation. | 136 | ||
| Stage 6: Universal Ethical Principle Orientation. | 136 | ||
| Kohlberg’s Critics. | 136 | ||
| Moral Reasoning and Nursing Practice. | 136 | ||
| Key Points | 136 | ||
| Clinical Application Questions | 137 | ||
| Preparing for Clinical Practice | 137 | ||
| Review Questions | 137 | ||
| Are You Ready to Test Your Nursing Knowledge? | 137 | ||
| References | 138 | ||
| Research References | 138 | ||
| Chapter 12 Conception Through Adolescence | 139 | ||
| Objectives | 139 | ||
| Key Terms | 139 | ||
| Stages of Growth and Development | 139 | ||
| Selecting a Developmental Framework for Nursing | 139 | ||
| Intrauterine Life | 139 | ||
| Health Promotion During Pregnancy | 140 | ||
| Transition from Intrauterine to Extrauterine Life | 140 | ||
| Physical Changes | 140 | ||
| Psychosocial Changes | 140 | ||
| Newborn | 141 | ||
| Physical Changes | 141 | ||
| Cognitive Changes | 142 | ||
| Psychosocial Changes | 142 | ||
| Health Promotion | 142 | ||
| Screening. | 142 | ||
| Car Seats. | 142 | ||
| Cribs and Sleep. | 143 | ||
| Infant | 143 | ||
| Physical Changes | 143 | ||
| Cognitive Changes | 144 | ||
| Language. | 144 | ||
| Psychosocial Changes | 144 | ||
| Separation and Individuation. | 144 | ||
| Play. | 144 | ||
| Health Risks | 144 | ||
| Injury Prevention. | 144 | ||
| Child Maltreatment. | 144 | ||
| Health Promotion | 145 | ||
| Nutrition. | 145 | ||
| Supplementation. | 145 | ||
| Immunizations. | 145 | ||
| Sleep. | 145 | ||
| Toddler | 146 | ||
| Physical Changes | 146 | ||
| Cognitive Changes | 146 | ||
| Language. | 146 | ||
| Psychosocial Changes | 146 | ||
| Play. | 146 | ||
| Health Risks | 146 | ||
| Health Promotion | 147 | ||
| Nutrition. | 147 | ||
| Toilet Training. | 147 | ||
| Preschoolers | 147 | ||
| Physical Changes | 147 | ||
| Cognitive Changes | 147 | ||
| Language. | 148 | ||
| Psychosocial Changes | 148 | ||
| Play. | 148 | ||
| Health Risks | 148 | ||
| Health Promotion | 148 | ||
| Nutrition. | 148 | ||
| Sleep. | 149 | ||
| Vision. | 149 | ||
| School-Age Children and Adolescents | 149 | ||
| School-Age Children | 149 | ||
| Physical Changes | 149 | ||
| Cognitive Changes | 149 | ||
| Language Development. | 150 | ||
| Psychosocial Changes | 150 | ||
| Peer Relationships. | 150 | ||
| Sexual Identity. | 150 | ||
| Stress. | 150 | ||
| Health Risks | 150 | ||
| Health Promotion | 150 | ||
| Perceptions. | 150 | ||
| Health Education. | 150 | ||
| Health Maintenance. | 151 | ||
| Safety. | 151 | ||
| Nutrition. | 151 | ||
| Adolescents | 151 | ||
| Physical Changes | 151 | ||
| Cognitive Changes | 152 | ||
| Language Skills. | 152 | ||
| Psychosocial Changes | 152 | ||
| Sexual Identity. | 152 | ||
| Group Identity. | 152 | ||
| Family Identity. | 153 | ||
| Health Identity. | 153 | ||
| Health Risks | 153 | ||
| Accidents. | 153 | ||
| Violence and Homicide. | 153 | ||
| Suicide. | 154 | ||
| Substance Abuse. | 154 | ||
| Eating Disorders. | 154 | ||
| Sexually Transmitted Infections. | 154 | ||
| Pregnancy. | 154 | ||
| Health Promotion | 154 | ||
| Health Education. | 154 | ||
| Minority Adolescents. | 154 | ||
| Gay, Lesbian, and Bisexual Adolescents. | 154 | ||
| Key Points | 155 | ||
| Clinical Application Questions | 155 | ||
| Preparing for Clinical Practice | 155 | ||
| Review Questions | 155 | ||
| Are You Ready to Test Your Nursing Knowledge? | 155 | ||
| References | 156 | ||
| Research References | 156 | ||
| Chapter 13 Young and Middle Adults | 157 | ||
| Objectives | 157 | ||
| Key Terms | 157 | ||
| Young Adults | 157 | ||
| Physical Changes | 158 | ||
| Cognitive Changes | 158 | ||
| Psychosocial Changes | 158 | ||
| Lifestyle. | 158 | ||
| Career. | 158 | ||
| Sexuality. | 159 | ||
| Childbearing Cycle. | 159 | ||
| Types of Families. | 159 | ||
| Singlehood. | 159 | ||
| Parenthood. | 160 | ||
| Alternative Family Structures and Parenting. | 160 | ||
| Hallmarks of Emotional Health. | 160 | ||
| Health Risks | 160 | ||
| Family History. | 160 | ||
| Personal Hygiene Habits. | 160 | ||
| Violent Death and Injury. | 160 | ||
| Substance Abuse. | 161 | ||
| Unplanned Pregnancies. | 161 | ||
| Sexually Transmitted Infections. | 161 | ||
| Environmental or Occupational Factors. | 161 | ||
| Health Concerns | 161 | ||
| Health Promotion. | 161 | ||
| Psychosocial Health. | 162 | ||
| Job Stress. | 162 | ||
| Family Stress. | 162 | ||
| Infertility. | 162 | ||
| Obesity. | 162 | ||
| Exercise. | 162 | ||
| Pregnant Woman and Childbearing Family. | 162 | ||
| Health Practices. | 163 | ||
| Prenatal Care. | 163 | ||
| Physiological Changes. | 163 | ||
| Puerperium. | 163 | ||
| Needs for Education. | 163 | ||
| Psychosocial Changes. | 163 | ||
| Health Concerns. | 163 | ||
| Acute Care. | 163 | ||
| Restorative and Continuing Care. | 163 | ||
| Middle Adults | 163 | ||
| Physical Changes | 164 | ||
| Perimenopause and Menopause. | 164 | ||
| Climacteric. | 164 | ||
| Cognitive Changes | 164 | ||
| Psychosocial Changes | 164 | ||
| Career Transition. | 164 | ||
| Sexuality. | 164 | ||
| Family Psychosocial Factors. | 166 | ||
| Singlehood. | 166 | ||
| Marital Changes. | 166 | ||
| Family Transitions. | 166 | ||
| Care of Aging Parents. | 166 | ||
| Health Concerns | 166 | ||
| Health Promotion and Stress Reduction. | 166 | ||
| Obesity. | 166 | ||
| Forming Positive Health Habits. | 166 | ||
| Psychosocial Health | 167 | ||
| Anxiety. | 167 | ||
| Depression. | 167 | ||
| Community Health Programs. | 167 | ||
| Acute Care. | 167 | ||
| Restorative and Continuing Care. | 167 | ||
| Key Points | 168 | ||
| Clinical Application Questions | 168 | ||
| Preparing for Clinical Practice | 168 | ||
| Review Questions | 168 | ||
| Are You Ready to Test Your Nursing Knowledge? | 168 | ||
| References | 169 | ||
| Research References | 170 | ||
| Chapter 14 Older Adults | 171 | ||
| Objectives | 171 | ||
| Key Terms | 171 | ||
| Variability Among Older Adults | 171 | ||
| Myths and Stereotypes | 172 | ||
| Nurses’ Attitudes Toward Older Adults | 173 | ||
| Theories of Aging | 173 | ||
| Developmental Tasks for Older Adults | 173 | ||
| Community-Based and Institutional Health Care Services | 174 | ||
| Assessing the Needs of Older Adults | 174 | ||
| Physiological Changes | 176 | ||
| General Survey. | 177 | ||
| Integumentary System. | 177 | ||
| Head and Neck. | 177 | ||
| Thorax and Lungs. | 177 | ||
| Heart and Vascular System. | 177 | ||
| Breasts. | 177 | ||
| Gastrointestinal System and Abdomen. | 177 | ||
| Reproductive System. | 177 | ||
| Urinary System. | 178 | ||
| Musculoskeletal System. | 178 | ||
| Neurological System. | 178 | ||
| Functional Changes | 178 | ||
| Cognitive Changes | 178 | ||
| Delirium. | 179 | ||
| Dementia. | 179 | ||
| Depression. | 180 | ||
| Psychosocial Changes | 180 | ||
| Retirement. | 180 | ||
| Social Isolation. | 181 | ||
| Sexuality. | 181 | ||
| Housing and Environment. | 181 | ||
| Death. | 182 | ||
| Addressing the Health Concerns of Older Adults | 182 | ||
| Health Promotion and Maintenance: Physiological Concerns | 182 | ||
| Heart Disease. | 183 | ||
| Cancer. | 183 | ||
| Stroke (Cerebrovascular Accident). | 183 | ||
| Smoking. | 183 | ||
| Alcohol Abuse. | 183 | ||
| Nutrition. | 184 | ||
| Dental Problems. | 184 | ||
| Exercise. | 184 | ||
| Falls. | 184 | ||
| Sensory Impairments. | 185 | ||
| Pain. | 185 | ||
| Medication Use. | 185 | ||
| Health Promotion and Maintenance: Psychosocial Health Concerns | 186 | ||
| Therapeutic Communication. | 186 | ||
| Touch. | 186 | ||
| Reality Orientation. | 186 | ||
| Validation Therapy. | 186 | ||
| Reminiscence. | 187 | ||
| Body-Image Interventions. | 187 | ||
| Older Adults and the Acute Care Setting | 187 | ||
| Older Adults and Restorative Care | 188 | ||
| Key Points | 188 | ||
| Clinical Application Questions | 188 | ||
| Preparing for Clinical Practice | 188 | ||
| Review Questions | 189 | ||
| Are You Ready to Test Your Nursing Knowledge? | 189 | ||
| References | 190 | ||
| Research References | 191 | ||
| Unit 3 Critical Thinking in Nursing Practice | 192 | ||
| Chapter 15 Critical Thinking in Nursing Practice | 192 | ||
| Objectives | 192 | ||
| Key Terms | 192 | ||
| Clinical Decisions in Nursing Practice | 192 | ||
| Critical Thinking Defined | 193 | ||
| Thinking and Learning | 193 | ||
| Levels of Critical Thinking in Nursing | 194 | ||
| Basic Critical Thinking | 194 | ||
| Complex Critical Thinking | 194 | ||
| Commitment | 195 | ||
| Critical Thinking Competencies | 195 | ||
| General Critical Thinking | 195 | ||
| Scientific Method. | 195 | ||
| Problem Solving. | 195 | ||
| Decision Making. | 195 | ||
| Specific Critical Thinking | 196 | ||
| Diagnostic Reasoning and Inference. | 196 | ||
| Clinical Decision Making. | 196 | ||
| Nursing Process as a Competency | 197 | ||
| A Critical Thinking Model for Clinical Decision Making | 198 | ||
| Specific Knowledge Base | 198 | ||
| Experience | 198 | ||
| The Nursing Process Competency | 199 | ||
| Attitudes for Critical Thinking | 199 | ||
| Confidence. | 199 | ||
| Thinking Independently. | 199 | ||
| Fairness. | 199 | ||
| Responsibility and Accountability. | 200 | ||
| Risk Taking. | 200 | ||
| Discipline. | 200 | ||
| Perseverance. | 200 | ||
| Creativity. | 201 | ||
| Curiosity. | 201 | ||
| Integrity. | 201 | ||
| Humility. | 201 | ||
| Standards for Critical Thinking | 201 | ||
| Intellectual Standards. | 201 | ||
| Professional Standards. | 201 | ||
| Developing Critical Thinking Skills | 202 | ||
| Reflective Journaling | 202 | ||
| Meeting with Colleagues | 202 | ||
| Concept Mapping | 202 | ||
| Critical Thinking Synthesis | 202 | ||
| Key Points | 203 | ||
| Clinical Application Questions | 203 | ||
| Preparing for Clinical Practice | 203 | ||
| Review Questions | 203 | ||
| Are You Ready to Test Your Nursing Knowledge? | 203 | ||
| References | 205 | ||
| Research References | 205 | ||
| Chapter 16 Nursing Assessment | 206 | ||
| Objectives | 206 | ||
| Key Terms | 206 | ||
| Critical Thinking Approach to Assessment | 207 | ||
| Data Collection | 207 | ||
| Types of Data. | 210 | ||
| Sources of Data. | 210 | ||
| Patient. | 210 | ||
| Family and Significant Others. | 210 | ||
| Health Care Team. | 211 | ||
| Medical Records. | 211 | ||
| Other Records and the Scientific Literature. | 211 | ||
| Nurse’s Experience. | 211 | ||
| Methods of Data Collection | 211 | ||
| Patient-Centered Interview. | 211 | ||
| Setting the Stage. | 212 | ||
| Set an Agenda. | 212 | ||
| Collect the Assessment or Nursing Health History. | 212 | ||
| Terminating the Interview. | 213 | ||
| Interview Techniques. | 213 | ||
| Open-ended Questions. | 213 | ||
| Back Channeling. | 213 | ||
| Probing. | 213 | ||
| Closed-ended Questions. | 214 | ||
| Cultural Considerations in Assessment | 214 | ||
| Nursing Health History | 214 | ||
| Biographical Information. | 214 | ||
| Reason for Seeking Health Care. | 214 | ||
| Patient Expectations. | 214 | ||
| Present Illness or Health Concerns. | 214 | ||
| Health History. | 215 | ||
| Family History. | 216 | ||
| Environmental History. | 216 | ||
| Psychosocial History. | 216 | ||
| Spiritual Health. | 216 | ||
| Review of Systems. | 216 | ||
| Documentation of History Findings. | 216 | ||
| Physical Examination | 216 | ||
| Observation of Patient Behavior | 216 | ||
| Diagnostic and Laboratory Data | 216 | ||
| Interpreting and Validating Assessment Data | 217 | ||
| Interpretation. | 217 | ||
| Data Validation. | 217 | ||
| Data Documentation | 217 | ||
| Concept Mapping | 218 | ||
| Key Points | 219 | ||
| Critical Thinking Exercises | 219 | ||
| Preparing for Clinical Practice | 219 | ||
| Review Questions | 219 | ||
| Are You Ready to Test Your Nursing Knowledge? | 219 | ||
| References | 221 | ||
| Research References | 221 | ||
| Chapter 17 Nursing Diagnosis | 222 | ||
| Objectives | 222 | ||
| Key Terms | 222 | ||
| History of Nursing Diagnosis | 223 | ||
| Critical Thinking and the Nursing Diagnostic Process | 224 | ||
| Data Clustering | 226 | ||
| Interpretation—Identifying Health Problems | 227 | ||
| Formulating a Nursing Diagnosis | 227 | ||
| Types of Nursing Diagnoses | 227 | ||
| Components of a Nursing Diagnosis | 228 | ||
| Diagnostic Label. | 228 | ||
| Related Factors. | 229 | ||
| The PES Format. | 229 | ||
| Cultural Relevance of Nursing Diagnoses | 230 | ||
| Concept Mapping Nursing Diagnoses | 230 | ||
| Sources of Diagnostic Errors | 231 | ||
| Errors in Interpretation and Analysis of Data | 232 | ||
| Errors in Data Clustering | 232 | ||
| Errors in the Diagnostic Statement | 232 | ||
| Documentation and Informatics | 233 | ||
| Nursing Diagnoses: Application to Care Planning | 233 | ||
| Key Points | 233 | ||
| Clinical Application Questions | 234 | ||
| Preparing for Clinical Practice | 234 | ||
| Review Questions | 234 | ||
| Are You Ready to Test Your Nursing Knowledge? | 234 | ||
| References | 235 | ||
| Research References | 235 | ||
| Chapter 18 Planning Nursing Care | 236 | ||
| Objectives | 236 | ||
| Key Terms | 236 | ||
| Establishing Priorities | 237 | ||
| Priorities in Practice | 238 | ||
| Critical Thinking in Setting Goals and Expected Outcomes | 238 | ||
| Goals of Care | 239 | ||
| Role of the Patient in Goal Setting. | 239 | ||
| Expected Outcomes | 240 | ||
| Nursing Outcomes Classification. | 240 | ||
| Guidelines for Writing Goals and Expected Outcomes | 240 | ||
| Patient-Centered. | 240 | ||
| Singular Goal or Outcome. | 241 | ||
| Observable. | 241 | ||
| Measurable. | 241 | ||
| Time-Limited. | 241 | ||
| Mutual Factors. | 241 | ||
| Realistic. | 241 | ||
| Critical Thinking in Planning Nursing Care | 241 | ||
| Types of Interventions | 242 | ||
| Selection of Interventions | 242 | ||
| Nursing Interventions Classification. | 242 | ||
| Systems for Planning Nursing Care | 243 | ||
| Change of Shift | 244 | ||
| Student Care Plans | 245 | ||
| Care Plans for Community-Based Settings. | 247 | ||
| Critical Pathways. | 247 | ||
| Concept Maps | 248 | ||
| Consulting Other Health Care Professionals | 249 | ||
| When to Consult | 249 | ||
| How to Consult | 249 | ||
| Key Points | 249 | ||
| Clinical Application Questions | 250 | ||
| Preparing for Clinical Practice | 250 | ||
| Review Questions | 250 | ||
| Are You Ready to Test Your Nursing Knowledge? | 250 | ||
| References | 252 | ||
| Research References | 252 | ||
| Chapter 19 Implementing Nursing Care | 253 | ||
| Objectives | 253 | ||
| Key Terms | 253 | ||
| Critical Thinking in Implementation | 254 | ||
| Standard Nursing Interventions | 255 | ||
| Clinical Practice Guidelines and Protocols | 255 | ||
| Standing Orders | 256 | ||
| NIC Interventions | 256 | ||
| Standards of Practice | 256 | ||
| Implementation Process | 256 | ||
| Reassessing the Patient | 256 | ||
| Reviewing and Revising the Existing Nursing Care Plan | 257 | ||
| Organizing Resources and Care Delivery | 258 | ||
| Equipment. | 258 | ||
| Personnel. | 258 | ||
| Environment. | 258 | ||
| Patient. | 258 | ||
| Anticipating and Preventing Complications | 258 | ||
| Identifying Areas of Assistance. | 259 | ||
| Implementation Skills | 259 | ||
| Cognitive Skills. | 259 | ||
| Interpersonal Skills. | 259 | ||
| Psychomotor Skills. | 259 | ||
| Direct Care | 259 | ||
| Activities of Daily Living | 259 | ||
| Instrumental Activities of Daily Living | 260 | ||
| Physical Care Techniques | 260 | ||
| Lifesaving Measures | 260 | ||
| Counseling | 260 | ||
| Teaching | 261 | ||
| Controlling for Adverse Reactions | 261 | ||
| Preventive Measures | 261 | ||
| Indirect Care | 261 | ||
| Communicating Nursing Interventions | 262 | ||
| Delegating, Supervising, and Evaluating the Work of Other Staff Members | 262 | ||
| Achieving Patient Goals | 262 | ||
| Key Points | 262 | ||
| Clinical Application Questions | 263 | ||
| Preparing for Clinical Practice | 263 | ||
| Review Questions | 263 | ||
| Are You Ready to Test Your Nursing Knowledge? | 263 | ||
| References | 264 | ||
| Research References | 264 | ||
| Chapter 20 Evaluation | 265 | ||
| Objectives | 265 | ||
| Key Terms | 265 | ||
| Standards for Evaluation | 267 | ||
| Criterion-Based Evaluation | 267 | ||
| Goals. | 267 | ||
| Expected Outcomes. | 267 | ||
| Collaborate and Evaluate Effectiveness of Interventions | 268 | ||
| Evaluative Measures. | 268 | ||
| Interpreting and Summarizing Findings. | 269 | ||
| Document Results | 270 | ||
| Care Plan Revision | 270 | ||
| Discontinuing a Care Plan. | 270 | ||
| Modifying a Care Plan. | 271 | ||
| Reassessment. | 271 | ||
| Redefining Diagnoses. | 271 | ||
| Goals and Expected Outcomes. | 271 | ||
| Interventions. | 271 | ||
| Key Points | 271 | ||
| Clinical Application Questions | 272 | ||
| Preparing for Clinical Practice | 272 | ||
| Review Questions | 272 | ||
| Are You Ready to Test Your Nursing Knowledge? | 272 | ||
| References | 273 | ||
| Research References | 273 | ||
| Chapter 21 Managing Patient Care | 274 | ||
| Objectives | 274 | ||
| Key Terms | 274 | ||
| Building a Nursing Team | 274 | ||
| Magnet Recognition | 275 | ||
| Nursing Care Delivery Models | 275 | ||
| Decision Making | 277 | ||
| Staff Involvement. | 278 | ||
| Leadership Skills for Nursing Students | 279 | ||
| Clinical Care Coordination | 279 | ||
| Clinical Decisions. | 279 | ||
| Priority Setting. | 279 | ||
| Organizational Skills. | 279 | ||
| Use of Resources. | 280 | ||
| Time Management. | 280 | ||
| Evaluation. | 280 | ||
| Team Communication | 281 | ||
| Delegation | 281 | ||
| Knowledge Building | 283 | ||
| Key Points | 283 | ||
| Clinical Application Questions | 283 | ||
| Preparing for Clinical Practice | 283 | ||
| Review Questions | 283 | ||
| Are You Ready to Test Your Nursing Knowledge? | 283 | ||
| References | 285 | ||
| Research References | 285 | ||
| Unit 4 Professional Standards in Nursing Practice | 286 | ||
| Chapter 22 Ethics and Values | 286 | ||
| Objectives | 286 | ||
| Key Terms | 286 | ||
| Basic Terms in Health Ethics | 286 | ||
| Autonomy | 286 | ||
| Beneficence | 286 | ||
| Nonmaleficence | 287 | ||
| Justice | 287 | ||
| Fidelity | 287 | ||
| Professional Nursing Code of Ethics | 287 | ||
| Advocacy | 287 | ||
| Responsibility | 287 | ||
| Accountability | 287 | ||
| Confidentiality | 287 | ||
| Values | 288 | ||
| Value Formation | 288 | ||
| Values Clarification | 288 | ||
| Ethics and Philosophy | 288 | ||
| Deontology | 288 | ||
| Utilitarianism | 289 | ||
| Feminist Ethics | 289 | ||
| Ethics of Care | 289 | ||
| Consensus in Bioethics | 290 | ||
| Nursing Point of View | 290 | ||
| Processing an Ethical Dilemma | 290 | ||
| Institutional Resources | 292 | ||
| Issues in Health Care Ethics | 292 | ||
| Quality of Life | 292 | ||
| Genetic Screening | 292 | ||
| Care at the End of Life | 293 | ||
| Access to Care | 293 | ||
| Key Points | 293 | ||
| Clinical Application Questions | 293 | ||
| Preparing for Clinical Practice | 293 | ||
| Review Questions | 294 | ||
| Are You Ready to Test Your Nursing Knowledge? | 294 | ||
| References | 295 | ||
| Research References | 295 | ||
| Chapter 23 Legal Implications in Nursing Practice | 296 | ||
| Objectives | 296 | ||
| Key Terms | 296 | ||
| Legal Limits of Nursing | 296 | ||
| Sources of Law | 296 | ||
| Standards of Care | 297 | ||
| Federal Statutory Issues in Nursing Practice | 298 | ||
| Americans with Disabilities Act | 298 | ||
| Emergency Medical Treatment and Active Labor Act | 298 | ||
| Mental Health Parity Act | 298 | ||
| Advance Directives | 298 | ||
| Living Wills. | 298 | ||
| Health Care Proxies or Durable Power of Attorney for Health Care. | 299 | ||
| Uniform Anatomical Gift Act | 299 | ||
| Health Insurance Portability and Accountability Act | 299 | ||
| Restraints | 300 | ||
| State Statutory Issues in Nursing Practice | 300 | ||
| Licensure | 300 | ||
| Good Samaritan Laws | 300 | ||
| Public Health Laws | 300 | ||
| The Uniform Determination of Death Act | 300 | ||
| Autopsy | 301 | ||
| Physician-Assisted Suicide | 301 | ||
| Civil and Common Law Issues in Nursing Practice | 301 | ||
| Torts | 301 | ||
| Intentional Torts | 301 | ||
| Assault. | 301 | ||
| Battery. | 301 | ||
| False Imprisonment. | 301 | ||
| Quasi-Intentional Torts | 301 | ||
| Invasion of Privacy. | 301 | ||
| Defamation of Character. | 302 | ||
| Unintentional Torts | 302 | ||
| Negligence. | 302 | ||
| Malpractice. | 302 | ||
| Consent | 302 | ||
| Informed Consent. | 302 | ||
| Abortion Issues | 303 | ||
| Nursing Students | 303 | ||
| Malpractice Insurance | 304 | ||
| Abandonment and Assignment Issues | 304 | ||
| Short Staffing. | 304 | ||
| Floating. | 304 | ||
| Health Care Providers’ Orders. | 305 | ||
| Risk Management | 305 | ||
| Professional Involvement | 305 | ||
| Key Points | 305 | ||
| Clinical Application Questions | 306 | ||
| Preparing for Clinical Practice | 306 | ||
| Review Questions | 306 | ||
| Are You Ready to Test Your Nursing Knowledge? | 306 | ||
| References | 308 | ||
| Research References | 308 | ||
| Statutes | 308 | ||
| Cases | 308 | ||
| Chapter 24 Communication | 309 | ||
| Objectives | 309 | ||
| Key Terms | 309 | ||
| Communication and Nursing Practice | 309 | ||
| Communication and Interpersonal Relationships | 309 | ||
| Developing Communication Skills | 310 | ||
| Levels of Communication | 311 | ||
| Basic Elements of the Communication Process | 312 | ||
| Referent | 312 | ||
| Sender and Receiver | 312 | ||
| Messages | 312 | ||
| Channels | 312 | ||
| Feedback | 312 | ||
| Interpersonal Variables | 312 | ||
| Environment | 312 | ||
| Forms of Communication | 313 | ||
| Verbal Communication | 313 | ||
| Vocabulary. | 313 | ||
| Denotative and Connotative Meaning. | 313 | ||
| Pacing. | 313 | ||
| Intonation. | 313 | ||
| Clarity and Brevity. | 313 | ||
| Timing and Relevance. | 313 | ||
| Nonverbal Communication | 313 | ||
| Personal Appearance. | 313 | ||
| Posture and Gait. | 313 | ||
| Facial Expression. | 313 | ||
| Eye Contact. | 314 | ||
| Gestures. | 314 | ||
| Sounds. | 314 | ||
| Territoriality and Personal Space. | 314 | ||
| Symbolic Communication | 314 | ||
| Metacommunication | 314 | ||
| Professional Nursing Relationships | 314 | ||
| Nurse-Patient Helping Relationships | 314 | ||
| Nurse-Family Relationships | 315 | ||
| Nurse–Health Care Team Relationships | 315 | ||
| Nurse-Community Relationships | 316 | ||
| Elements of Professional Communication | 316 | ||
| Courtesy | 316 | ||
| Use of Names | 316 | ||
| Trustworthiness | 317 | ||
| Autonomy and Responsibility | 317 | ||
| Assertiveness | 317 | ||
| Nursing Process | 317 | ||
| n n n Assessment | 317 | ||
| Through the Patient’s Eyes. | 317 | ||
| Physical and Emotional Factors. | 317 | ||
| Developmental Factors. | 318 | ||
| Sociocultural Factors. | 318 | ||
| Gender. | 319 | ||
| n n n Nursing Diagnosis | 319 | ||
| n n n Planning | 319 | ||
| Goals and Outcomes. | 319 | ||
| Setting Priorities. | 319 | ||
| Teamwork and Collaboration. | 319 | ||
| n n n Implementation | 319 | ||
| Therapeutic Communication Techniques. | 320 | ||
| Active Listening. | 320 | ||
| Sharing Observations. | 320 | ||
| Sharing Empathy. | 320 | ||
| Sharing Hope. | 320 | ||
| Sharing Humor. | 320 | ||
| Sharing Feelings. | 321 | ||
| Using Touch. | 321 | ||
| Using Silence. | 321 | ||
| Providing Information. | 321 | ||
| Clarifying. | 321 | ||
| Focusing. | 321 | ||
| Paraphrasing. | 322 | ||
| Asking Relevant Questions. | 322 | ||
| Summarizing. | 322 | ||
| Self-Disclosure. | 322 | ||
| Confrontation. | 322 | ||
| Nontherapeutic Communication Techniques. | 322 | ||
| Asking Personal Questions. | 322 | ||
| Giving Personal Opinions. | 322 | ||
| Changing the Subject. | 322 | ||
| Automatic Responses. | 322 | ||
| False Reassurance. | 323 | ||
| Sympathy. | 323 | ||
| Asking for Explanations. | 323 | ||
| Approval or Disapproval. | 323 | ||
| Defensive Responses. | 323 | ||
| Passive or Aggressive Responses. | 323 | ||
| Arguing. | 323 | ||
| Adapting Communication Techniques for the Patient with Special Needs. | 323 | ||
| n n n Evaluation | 324 | ||
| Through the Patient’s Eyes. | 324 | ||
| Patient Outcomes. | 324 | ||
| Key Points | 325 | ||
| Clinical Application Questions | 325 | ||
| Preparing for Clinical Practice | 325 | ||
| Review Questions | 326 | ||
| Are You Ready to Test Your Nursing Knowledge? | 326 | ||
| References | 327 | ||
| Research References | 327 | ||
| Chapter 25 Patient Education | 328 | ||
| Objectives | 328 | ||
| Key Terms | 328 | ||
| Standards for Patient Education | 328 | ||
| Purposes of Patient Education | 329 | ||
| Maintenance and Promotion of Health and Illness Prevention | 329 | ||
| Restoration of Health | 329 | ||
| Coping with Impaired Functions | 329 | ||
| Teaching and Learning | 329 | ||
| Role of the Nurse in Teaching and Learning | 329 | ||
| Teaching as Communication | 330 | ||
| Domains of Learning | 330 | ||
| Cognitive Learning | 330 | ||
| Affective Learning | 331 | ||
| Psychomotor Learning | 331 | ||
| Basic Learning Principles | 331 | ||
| Motivation to Learn | 332 | ||
| Attentional Set. | 332 | ||
| Motivation. | 332 | ||
| Use of Theory to Enhance Motivation and Learning. | 332 | ||
| Psychosocial Adaptation to Illness. | 332 | ||
| Active Participation. | 333 | ||
| Ability to Learn | 333 | ||
| Developmental Capability. | 333 | ||
| Learning in Children. | 333 | ||
| Adult Learning. | 334 | ||
| Physical Capability. | 334 | ||
| Learning Environment | 334 | ||
| Nursing Process | 335 | ||
| n n n ASSESSMENT | 335 | ||
| Through the Patient’s Eyes. | 335 | ||
| Learning Needs. | 335 | ||
| Motivation to Learn. | 336 | ||
| Ability to Learn. | 336 | ||
| Teaching Environment. | 336 | ||
| Resources for Learning. | 336 | ||
| Health Literacy and Learning Disabilities. | 337 | ||
| n n n Nursing Diagnosis | 337 | ||
| n n n Planning | 338 | ||
| Goals and Outcomes. | 338 | ||
| Setting Priorities. | 338 | ||
| Timing. | 338 | ||
| Organizing Teaching Material. | 338 | ||
| Teamwork and Collaboration. | 339 | ||
| n n n Implementation | 340 | ||
| Maintaining Learning Attention and Participation. | 340 | ||
| Building on Existing Knowledge. | 340 | ||
| Teaching Approaches. | 340 | ||
| Telling. | 340 | ||
| Participating. | 340 | ||
| Entrusting. | 340 | ||
| Reinforcing. | 340 | ||
| Incorporating Teaching with Nursing Care. | 340 | ||
| Instructional Methods. | 341 | ||
| One-on-One Discussion. | 341 | ||
| Group Instruction. | 341 | ||
| Preparatory Instruction. | 341 | ||
| Demonstrations. | 341 | ||
| Analogies. | 341 | ||
| Role Play. | 342 | ||
| Simulation. | 342 | ||
| Illiteracy and Other Disabilities. | 342 | ||
| Cultural Diversity. | 342 | ||
| Using Teaching Tools. | 343 | ||
| Special Needs of Children and Older Adults. | 343 | ||
| n n n Evaluation | 344 | ||
| Through the Patient’s Eyes. | 344 | ||
| Patient Outcomes. | 344 | ||
| Key Points | 344 | ||
| Clinical Application Questions | 345 | ||
| Preparing for Clinical Practice | 345 | ||
| Review Questions | 345 | ||
| Are You Ready to Test Your Nursing Knowledge? | 345 | ||
| References | 346 | ||
| Research References | 347 | ||
| Chapter 26 Documentation and Informatics | 348 | ||
| Objectives | 348 | ||
| Key Terms | 348 | ||
| Confidentiality | 349 | ||
| Standards | 349 | ||
| Interdisciplinary Communication within the Health Care Team | 349 | ||
| Purposes of Records | 349 | ||
| Communication | 350 | ||
| Legal Documentation | 350 | ||
| Reimbursement | 350 | ||
| Education | 350 | ||
| Research | 350 | ||
| Auditing and Monitoring | 350 | ||
| Guidelines for Quality Documentation and Reporting | 350 | ||
| Factual | 350 | ||
| Accurate | 351 | ||
| Complete | 352 | ||
| Current | 352 | ||
| Organized | 353 | ||
| Methods of Documentation | 353 | ||
| Paper and Electronic Health Records | 353 | ||
| Narrative Documentation | 353 | ||
| Problem-Oriented Medical Record | 353 | ||
| Database. | 354 | ||
| Problem List. | 354 | ||
| Care Plan. | 354 | ||
| Progress Notes. | 354 | ||
| Source Records | 354 | ||
| Charting by Exception | 354 | ||
| Case Management Plan and Critical Pathways | 355 | ||
| Common Record-Keeping Forms | 355 | ||
| Admission Nursing History Forms | 356 | ||
| Flow Sheets and Graphic Records | 356 | ||
| Patient Care Summary or Kardex | 356 | ||
| Standardized Care Plans | 356 | ||
| Discharge Summary Forms | 356 | ||
| Acuity Records | 356 | ||
| Home Care Documentation | 357 | ||
| Long-Term Health Care Documentation | 357 | ||
| Reporting | 357 | ||
| Hand-Off Report | 357 | ||
| Telephone Reports and Orders | 358 | ||
| Telephone Reports. | 358 | ||
| Telephone and Verbal Orders. | 358 | ||
| Incident or Occurrence Reports | 358 | ||
| Health Informatics | 359 | ||
| Nursing Informatics | 359 | ||
| Nursing Information Systems | 360 | ||
| Advantages of a Nursing Information System. | 360 | ||
| Privacy, Confidentiality, and Security Mechanisms. | 361 | ||
| Handling and Disposal of Information. | 361 | ||
| Clinical Information Systems | 362 | ||
| Key Points | 362 | ||
| Clinical Application Questions | 362 | ||
| Preparing for Clinical Practice | 362 | ||
| Review Questions | 363 | ||
| Are You Ready to Test Your Nursing Knowledge? | 363 | ||
| References | 364 | ||
| Research References | 364 | ||
| Unit 5 Foundations For Nursing Practice | 365 | ||
| Chapter 27 Patient Safety | 365 | ||
| Objectives | 365 | ||
| Key Terms | 365 | ||
| Scientific Knowledge Base | 365 | ||
| Environmental Safety | 365 | ||
| Basic Needs. | 366 | ||
| Oxygen. | 366 | ||
| Nutrition. | 366 | ||
| Temperature. | 366 | ||
| Physical Hazards. | 366 | ||
| Motor Vehicle Accidents. | 366 | ||
| Poison. | 367 | ||
| Falls. | 367 | ||
| Fire. | 367 | ||
| Disasters. | 367 | ||
| Transmission of Pathogens. | 367 | ||
| Pollution. | 368 | ||
| Nursing Knowledge Base | 368 | ||
| Factors Influencing Patient Safety | 368 | ||
| Risks at Developmental Stages. | 368 | ||
| Infant, Toddler, and Preschooler. | 368 | ||
| School-Age Child. | 368 | ||
| Adolescent. | 368 | ||
| Adult. | 368 | ||
| Older Adult. | 369 | ||
| Individual Risk Factors. | 369 | ||
| Lifestyle. | 369 | ||
| Impaired Mobility. | 369 | ||
| Sensory or Communication Impairment. | 369 | ||
| Lack of Safety Awareness. | 369 | ||
| Risks in the Health Care Agency. | 369 | ||
| Falls. | 371 | ||
| Patient-Inherent Accidents. | 371 | ||
| Procedure-Related Accidents. | 371 | ||
| Equipment-Related Accidents. | 371 | ||
| Critical Thinking | 371 | ||
| Nursing Process | 372 | ||
| n n n Assessment | 372 | ||
| Through the Patient’s Eyes. | 372 | ||
| Nursing History. | 372 | ||
| Health Care Environment. | 373 | ||
| Risk for Falls. | 373 | ||
| Risk for Medical Errors. | 374 | ||
| Disasters. | 374 | ||
| Patient’s Home Environment. | 374 | ||
| n n n Nursing Diagnosis | 374 | ||
| n n n Planning | 375 | ||
| Goals and Outcomes. | 375 | ||
| Setting Priorities. | 375 | ||
| Teamwork and Collaboration. | 378 | ||
| n n n Implementation | 378 | ||
| Health Promotion. | 378 | ||
| Developmental Interventions | 378 | ||
| Infant, Toddler, and Preschooler. | 378 | ||
| School-Age Child. | 378 | ||
| Adolescent. | 378 | ||
| Adult. | 378 | ||
| Older Adult. | 380 | ||
| Environmental Interventions. | 382 | ||
| Basic Needs. | 382 | ||
| General Preventive Measures. | 382 | ||
| Acute Care. | 383 | ||
| Falls. | 384 | ||
| Restraints. | 384 | ||
| Side Rails. | 386 | ||
| Fires. | 386 | ||
| Electrical Hazards. | 387 | ||
| Seizures. | 387 | ||
| Radiation. | 387 | ||
| Disasters. | 387 | ||
| n n n Evaluation | 387 | ||
| Through the Patient’s Eyes. | 387 | ||
| Patient Outcomes. | 388 | ||
| Safety Guidelines for Nursing Skills | 388 | ||
| Skill 27-1 Applying restraints | 388 | ||
| Unexpected Outcomes and Related Interventions | 389 | ||
| Recording and Reporting | 392 | ||
| Home Care Considerations | 392 | ||
| Skill 27-2 Seizure Precautions | 392 | ||
| Unexpected Outcomes and Related Interventions | 394 | ||
| Recording and Reporting | 394 | ||
| Home Care Considerations | 394 | ||
| Key Points | 394 | ||
| Clinical Application Questions | 395 | ||
| Preparing for Clinical Practice | 395 | ||
| Review Questions | 395 | ||
| Are You Ready to Test Your Nursing Knowledge? | 395 | ||
| References | 396 | ||
| Research References | 397 | ||
| Chapter 28 Infection Prevention and Control | 398 | ||
| Objectives | 398 | ||
| Key Terms | 398 | ||
| Scientific Knowledge Base | 399 | ||
| Nature of Infection | 399 | ||
| Chain of Infection | 399 | ||
| Infectious Agent. | 399 | ||
| Reservoir. | 399 | ||
| Food. | 399 | ||
| Oxygen. | 399 | ||
| Water. | 399 | ||
| Temperature. | 400 | ||
| pH. | 400 | ||
| Light. | 400 | ||
| Port of Exit. | 400 | ||
| Skin and Mucous Membranes. | 400 | ||
| Respiratory Tract. | 400 | ||
| Urinary Tract. | 400 | ||
| Gastrointestinal Tract. | 400 | ||
| Reproductive Tract. | 400 | ||
| Blood. | 400 | ||
| Modes of Transmission. | 400 | ||
| Port of Entry. | 401 | ||
| Susceptible Host. | 401 | ||
| The Infectious Process | 401 | ||
| Defenses Against Infection | 401 | ||
| Normal Floras. | 402 | ||
| Body System Defenses. | 402 | ||
| Inflammation. | 402 | ||
| Vascular and Cellular Responses. | 403 | ||
| Inflammatory Exudate. | 403 | ||
| Tissue Repair. | 403 | ||
| Health Care–Associated Infections | 403 | ||
| Nursing Knowledge Base | 404 | ||
| Factors Influencing Infection Prevention and Control | 404 | ||
| Age. | 404 | ||
| Nutritional Status. | 405 | ||
| Stress. | 405 | ||
| Disease Process. | 405 | ||
| Nursing Process | 405 | ||
| n n n Assessment | 405 | ||
| Through the Patient’s Eyes. | 405 | ||
| Status of Defense Mechanisms. | 406 | ||
| Patient Susceptibility. | 406 | ||
| Medical Therapy. | 406 | ||
| Clinical Appearance. | 406 | ||
| Laboratory Data. | 406 | ||
| n n n Nursing Diagnosis | 407 | ||
| n n n Planning | 407 | ||
| Goals and Outcomes. | 407 | ||
| Setting Priorities. | 407 | ||
| Teamwork and Collaboration. | 407 | ||
| n n n Implementation | 409 | ||
| Health Promotion. | 409 | ||
| Acute Care. | 410 | ||
| Asepsis. | 410 | ||
| Cleaning, Disinfection, and Sterilization. | 411 | ||
| Cleaning. | 411 | ||
| Disinfection and Sterilization. | 412 | ||
| Infection Prevention and Control—Patient Safety. | 412 | ||
| Isolation and Isolation Precautions. | 415 | ||
| Psychological Implications of Isolation. | 416 | ||
| The Isolation Environment. | 416 | ||
| Personal Protective Equipment. | 416 | ||
| Gowns. | 416 | ||
| Respiratory Protection. | 419 | ||
| Eye Protection. | 419 | ||
| Gloves. | 419 | ||
| Specimen Collection. | 420 | ||
| Bagging Trash or Linen. | 420 | ||
| Transporting Patients. | 420 | ||
| Role of the Infection Control Professional. | 420 | ||
| Infection Prevention and Control for Hospital Personnel. | 421 | ||
| Patient Education. | 421 | ||
| Surgical Asepsis. | 421 | ||
| Patient Preparation. | 421 | ||
| Principles of Surgical Asepsis. | 421 | ||
| Performing Sterile Procedures. | 422 | ||
| Donning and Removing Caps, Masks, and Eyewear. | 422 | ||
| Opening Sterile Packages. | 422 | ||
| Opening a Sterile Item on a Flat Surface. | 423 | ||
| Opening a Sterile Item While Holding It. | 423 | ||
| Preparing a Sterile Field. | 423 | ||
| Pouring Sterile Solutions. | 423 | ||
| Surgical Scrub. | 423 | ||
| Applying Sterile Gloves. | 423 | ||
| Donning a Sterile Gown. | 424 | ||
| n n n Evaluation | 424 | ||
| Through the Patient’s Eyes. | 424 | ||
| Patient Outcomes. | 424 | ||
| Exposure Issues. | 424 | ||
| Safety Guidelines for Nursing Skills | 425 | ||
| Skill 28-1 Hand Hygiene | 425 | ||
| Delegation Considerations | 425 | ||
| Equipment | 425 | ||
| Home Care Considerations | 427 | ||
| Skill 28-2 Preparation of Sterile Field | 427 | ||
| Delegation Considerations | 427 | ||
| Equipment | 427 | ||
| Recording and Reporting | 431 | ||
| Skill 28-3 Surgical Hand Asepsis | 431 | ||
| Delegation Considerations | 431 | ||
| Equipment | 431 | ||
| Recording and Reporting | 433 | ||
| Skill 28-4 Applying a Sterile Gown and Performing Closed Gloving | 434 | ||
| Delegation Considerations | 434 | ||
| Equipment | 434 | ||
| Recording and Reporting | 436 | ||
| Skill 28-5 Open Gloving | 436 | ||
| Delegation Considerations | 436 | ||
| Equipment | 436 | ||
| Recording and Reporting | 437 | ||
| Key Points | 438 | ||
| Clinical Application Questions | 438 | ||
| Preparing for Clinical Practice | 438 | ||
| Review Questions | 438 | ||
| Are You Ready to Test Your Nursing Knowledge? | 438 | ||
| References | 439 | ||
| Research References | 440 | ||
| Chapter 29 Vital Signs | 441 | ||
| Objectives | 441 | ||
| Key Terms | 441 | ||
| Guidelines for Measuring Vital Signs | 442 | ||
| Body Temperature | 442 | ||
| Physiology | 442 | ||
| Regulation. | 443 | ||
| Neural and Vascular Control. | 443 | ||
| Heat Production. | 443 | ||
| Heat Loss. | 443 | ||
| Skin in Temperature Regulation. | 444 | ||
| Behavioral Control. | 444 | ||
| Factors Affecting Body Temperature | 444 | ||
| Age. | 444 | ||
| Exercise. | 444 | ||
| Hormone Level. | 444 | ||
| Circadian Rhythm. | 445 | ||
| Stress. | 445 | ||
| Environment. | 445 | ||
| Temperature Alterations. | 445 | ||
| Fever. | 445 | ||
| Hyperthermia. | 446 | ||
| Heatstroke. | 446 | ||
| Heat Exhaustion. | 446 | ||
| Hypothermia. | 446 | ||
| Nursing Process | 446 | ||
| n n n Assessment | 446 | ||
| Through the Patient’s Eyes. | 446 | ||
| Sites. | 447 | ||
| Thermometers. | 447 | ||
| Electronic Thermometer. | 447 | ||
| Chemical Dot Thermometers. | 447 | ||
| n n n Nursing Diagnosis | 449 | ||
| n n n Planning | 450 | ||
| Goals and Outcomes. | 450 | ||
| Setting Priorities. | 450 | ||
| Teamwork and Collaboration. | 450 | ||
| n n n Implementation | 450 | ||
| Health Promotion. | 450 | ||
| Acute Care | 450 | ||
| Fever. | 450 | ||
| Heatstroke. | 452 | ||
| Hypothermia. | 452 | ||
| Restorative and Continuing Care. | 452 | ||
| n n n Evaluation | 452 | ||
| Through the Patient’s Eyes. | 452 | ||
| Patient Outcomes. | 452 | ||
| Pulse | 452 | ||
| Physiology and Regulation | 452 | ||
| Assessment of Pulse | 453 | ||
| Use of a Stethoscope. | 453 | ||
| Character of the Pulse | 454 | ||
| Rate. | 454 | ||
| Rhythm. | 455 | ||
| Strength. | 455 | ||
| Equality. | 455 | ||
| Nursing Process and Pulse Determination | 455 | ||
| Respiration | 455 | ||
| Physiological Control | 456 | ||
| Mechanics of Breathing | 456 | ||
| Assessment of Ventilation | 456 | ||
| Respiratory Rate. | 456 | ||
| Ventilatory Depth. | 456 | ||
| Ventilatory Rhythm. | 456 | ||
| Assessment of Diffusion and Perfusion | 457 | ||
| Measurement of Arterial Oxygen Saturation. | 458 | ||
| Nursing Process and Respiratory Vital Signs | 458 | ||
| Blood Pressure | 458 | ||
| Physiology of Arterial Blood Pressure | 459 | ||
| Cardiac Output. | 459 | ||
| Peripheral Resistance. | 459 | ||
| Blood Volume. | 459 | ||
| Viscosity. | 459 | ||
| Elasticity. | 459 | ||
| Factors Influencing Blood Pressure | 459 | ||
| Age. | 459 | ||
| Stress. | 459 | ||
| Ethnicity. | 459 | ||
| Gender. | 459 | ||
| Daily Variation. | 460 | ||
| Medications. | 460 | ||
| Activity and Weight. | 460 | ||
| Smoking. | 460 | ||
| Hypertension | 460 | ||
| Hypotension | 461 | ||
| Measurement of Blood Pressure | 461 | ||
| Blood Pressure Equipment. | 461 | ||
| Auscultation. | 462 | ||
| Assessment in Children. | 462 | ||
| Ultrasonic Stethoscope. | 463 | ||
| Palpation. | 463 | ||
| Lower-Extremity Blood Pressure. | 463 | ||
| Electronic Blood Pressure Devices. | 463 | ||
| Self-Measurement of Blood Pressure. | 465 | ||
| Nursing Process and Blood Pressure Determination | 465 | ||
| Health Promotion and Vital Signs | 465 | ||
| Recording Vital Signs | 466 | ||
| Safety Guidelines For Nursing Skills | 467 | ||
| Skill 29-1 Measuring Body Temperature | 467 | ||
| Delegation Considerations | 467 | ||
| Equipment | 467 | ||
| Unexpected Outcomes and Related Interventions | 471 | ||
| Recording and Reporting | 471 | ||
| Home Care Considerations | 471 | ||
| Skill 29-2 Assessing the Radial and Apical Pulses | 472 | ||
| Delegation Considerations | 472 | ||
| Equipment | 472 | ||
| Unexpected Outcomes and Related Interventions | 475 | ||
| Recording and Reporting | 475 | ||
| Home Care Considerations | 475 | ||
| Skill 29-3 Assessing Respirations | 476 | ||
| Delegation Considerations | 476 | ||
| Equipment | 476 | ||
| Unexpected Outcomes and Related Interventions | 478 | ||
| Recording and Reporting | 478 | ||
| Home Care Considerations | 478 | ||
| Skill 29-4 Measuring Oxygen Saturation (Pulse Oximetry) | 478 | ||
| Delegation Considerations | 478 | ||
| Equipment | 478 | ||
| Unexpected Outcomes and Related Interventions | 480 | ||
| Recording and Reporting | 480 | ||
| Home Care Considerations | 480 | ||
| Skill 29-5 Measuring Blood Pressure | 480 | ||
| Delegation Considerations | 480 | ||
| Equipment | 480 | ||
| Unexpected Outcomes and Related Interventions | 484 | ||
| Recording and Reporting | 484 | ||
| Home Care Considerations | 484 | ||
| Key Points | 484 | ||
| Clinical Application Questions | 485 | ||
| Preparing for Clinical Practice | 485 | ||
| Review Questions | 485 | ||
| Are You Ready to Test Your Nursing Knowledge? | 485 | ||
| References | 486 | ||
| Research References | 486 | ||
| Chapter 30 Health Assessment and Physical Examination | 487 | ||
| Objectives | 487 | ||
| Key Terms | 487 | ||
| Purposes of the Physical Examination | 488 | ||
| Cultural Sensitivity | 488 | ||
| Preparation for Examination | 488 | ||
| Infection Control | 488 | ||
| Environment | 488 | ||
| Equipment | 489 | ||
| Physical Preparation of the Patient | 489 | ||
| Positioning. | 489 | ||
| Psychological Preparation of a Patient | 491 | ||
| Assessment of Age-Groups | 491 | ||
| Organization of the Examination | 491 | ||
| Techniques of Physical Assessment | 493 | ||
| Inspection | 493 | ||
| Palpation | 493 | ||
| Percussion | 494 | ||
| Auscultation | 494 | ||
| General Survey | 495 | ||
| General Appearance and Behavior | 495 | ||
| Vital Signs | 496 | ||
| Height and Weight | 496 | ||
| Skin, Hair, and Nails | 498 | ||
| Skin | 498 | ||
| Color. | 500 | ||
| Moisture. | 501 | ||
| Temperature. | 501 | ||
| Texture. | 502 | ||
| Turgor. | 502 | ||
| Vascularity. | 502 | ||
| Edema. | 502 | ||
| Lesions. | 502 | ||
| Hair and Scalp | 503 | ||
| Inspection. | 504 | ||
| Nails | 506 | ||
| Inspection and Palpation. | 506 | ||
| Head and Neck | 507 | ||
| Head | 508 | ||
| Inspection and Palpation. | 508 | ||
| Eyes | 508 | ||
| Visual Acuity. | 508 | ||
| Extraocular Movements. | 509 | ||
| Visual Fields. | 510 | ||
| External Eye Structures. | 510 | ||
| Position and Alignment. | 510 | ||
| Eyebrows. | 510 | ||
| Eyelids. | 510 | ||
| Lacrimal Apparatus. | 511 | ||
| Conjunctivae and Sclerae. | 511 | ||
| Corneas. | 511 | ||
| Pupils and Irises. | 511 | ||
| Internal Eye Structures. | 512 | ||
| Ears | 512 | ||
| Auricles. | 512 | ||
| Ear Canals and Eardrums. | 513 | ||
| Hearing Acuity. | 514 | ||
| Nose and Sinuses | 516 | ||
| Nose. | 516 | ||
| Sinuses. | 516 | ||
| Mouth and Pharynx | 516 | ||
| Lips. | 516 | ||
| Buccal Mucosa, Gums, and Teeth. | 517 | ||
| Tongue and Floor of Mouth. | 518 | ||
| Palate. | 519 | ||
| Pharynx. | 519 | ||
| Neck | 519 | ||
| Neck Muscles. | 520 | ||
| Lymph Nodes. | 520 | ||
| Thyroid Gland. | 520 | ||
| Carotid Artery and Jugular Vein. | 521 | ||
| Trachea. | 522 | ||
| Thorax and Lungs | 522 | ||
| Posterior Thorax | 522 | ||
| Lateral Thorax | 526 | ||
| Anterior Thorax | 526 | ||
| Heart | 527 | ||
| Inspection and Palpation | 528 | ||
| Auscultation | 529 | ||
| Vascular System | 531 | ||
| Blood Pressure | 531 | ||
| Carotid Arteries | 531 | ||
| Jugular Veins | 532 | ||
| Peripheral Arteries and Veins | 533 | ||
| Peripheral Arteries. | 533 | ||
| Ultrasound Stethoscopes. | 535 | ||
| Tissue Perfusion. | 535 | ||
| Peripheral Veins. | 536 | ||
| Lymphatic System | 537 | ||
| Breasts | 537 | ||
| Female Breasts | 537 | ||
| Inspection. | 538 | ||
| Palpation. | 540 | ||
| Male Breasts | 542 | ||
| Abdomen | 542 | ||
| Inspection | 543 | ||
| Skin. | 543 | ||
| Umbilicus. | 543 | ||
| Contour and Symmetry. | 543 | ||
| Enlarged Organs or Masses. | 544 | ||
| Movement or Pulsations. | 544 | ||
| Auscultation | 544 | ||
| Bowel Motility. | 544 | ||
| Vascular Sounds. | 544 | ||
| Kidney Tenderness. | 544 | ||
| Palpation | 544 | ||
| Aortic Pulsation. | 545 | ||
| Female Genitalia and Reproductive Tract | 545 | ||
| Preparation of the Patient | 545 | ||
| External Genitalia | 546 | ||
| Speculum Examination of Internal Genitalia | 547 | ||
| Male Genitalia | 547 | ||
| Sexual Maturity | 548 | ||
| Penis | 548 | ||
| Scrotum | 549 | ||
| Inguinal Ring and Canal | 550 | ||
| Rectum and Anus | 550 | ||
| Inspection | 550 | ||
| Digital Palpation | 550 | ||
| Musculoskeletal System | 551 | ||
| General Inspection | 551 | ||
| Palpation | 552 | ||
| Range of Joint Motion | 553 | ||
| Muscle Tone and Strength | 554 | ||
| Neurological System | 555 | ||
| Mental and Emotional Status | 555 | ||
| Level of Consciousness. | 556 | ||
| Behavior and Appearance. | 556 | ||
| Language. | 557 | ||
| Intellectual Function | 557 | ||
| Memory. | 557 | ||
| Knowledge. | 557 | ||
| Abstract Thinking. | 557 | ||
| Association. | 557 | ||
| Judgment. | 557 | ||
| Cranial Nerve Function | 557 | ||
| Sensory Function | 557 | ||
| Motor Function | 558 | ||
| Coordination. | 558 | ||
| Balance. | 559 | ||
| Reflexes | 559 | ||
| After the Examination | 560 | ||
| Key Points | 561 | ||
| Clinical Application Questions | 562 | ||
| Preparing for Clinical Practice | 562 | ||
| Review Questions | 562 | ||
| References | 563 | ||
| Research References | 564 | ||
| Chapter 31 Medication Administration | 565 | ||
| Objectives | 565 | ||
| Key Terms | 565 | ||
| Scientific Knowledge Base | 565 | ||
| Medication Legislation and Standards | 566 | ||
| Federal Regulations. | 566 | ||
| State and Local Regulation of Medication. | 566 | ||
| Health Care Institutions and Medication Laws. | 566 | ||
| Medication Regulations and Nursing Practice. | 566 | ||
| Pharmacological Concepts | 566 | ||
| Medication Names. | 566 | ||
| Classification. | 566 | ||
| Medication Forms. | 566 | ||
| Pharmacokinetics As the Basis of Medication Actions | 567 | ||
| Absorption. | 567 | ||
| Route of Administration. | 567 | ||
| Ability of the Medication to Dissolve. | 567 | ||
| Blood Flow to the Site of Administration. | 568 | ||
| Body Surface Area. | 568 | ||
| Lipid Solubility. | 568 | ||
| Distribution. | 568 | ||
| Circulation. | 568 | ||
| Membrane Permeability. | 568 | ||
| Protein Binding. | 568 | ||
| Metabolism. | 568 | ||
| Excretion. | 568 | ||
| Types of Medication Action | 568 | ||
| Therapeutic Effects. | 569 | ||
| Side Effects/Adverse Effects. | 569 | ||
| Toxic Effects. | 569 | ||
| Idiosyncratic Reactions. | 569 | ||
| Allergic Reactions. | 569 | ||
| Medication Interactions | 569 | ||
| Timing of Medication Dose Responses | 569 | ||
| Routes of Administration | 571 | ||
| Oral Routes. | 571 | ||
| Sublingual Administration. | 571 | ||
| Buccal Administration. | 572 | ||
| Parenteral Routes. | 572 | ||
| Epidural. | 572 | ||
| Intrathecal. | 572 | ||
| Intraosseous. | 572 | ||
| Intraperitoneal. | 572 | ||
| Intrapleural. | 572 | ||
| Intraarterial. | 572 | ||
| Topical Administration. | 572 | ||
| Inhalation Route. | 572 | ||
| Intraocular Route. | 573 | ||
| Systems of Medication Measurement | 573 | ||
| Metric System. | 573 | ||
| Household Measurements. | 573 | ||
| Solutions. | 573 | ||
| Nursing Knowledge Base | 574 | ||
| Clinical Calculations | 574 | ||
| Conversions Within One System. | 574 | ||
| Conversion Between Systems. | 574 | ||
| Dose Calculations. | 574 | ||
| The Ratio and Proportion Method. | 575 | ||
| The Formula Method. | 575 | ||
| Dimensional Analysis. | 575 | ||
| Pediatric Doses. | 576 | ||
| Prescriber’s Role | 577 | ||
| Types of Orders in Acute Care Agencies | 577 | ||
| Standing Orders or Routine Medication Orders. | 577 | ||
| prn Orders. | 578 | ||
| Single (One-Time) Orders. | 578 | ||
| STAT Orders. | 578 | ||
| Now Orders. | 578 | ||
| Prescriptions. | 581 | ||
| Pharmacist’s Role | 581 | ||
| Distribution Systems | 581 | ||
| Unit Dose. | 581 | ||
| Automated Medication Dispensing Systems. | 582 | ||
| Nurse’s Role | 582 | ||
| Medication Errors | 582 | ||
| Critical Thinking | 584 | ||
| Knowledge | 584 | ||
| Experience | 584 | ||
| Attitudes | 584 | ||
| Standards | 584 | ||
| Right Medication. | 584 | ||
| Right Dose. | 585 | ||
| Right Patient. | 585 | ||
| Right Route. | 585 | ||
| Right Time. | 586 | ||
| Right Documentation. | 586 | ||
| Maintaining Patients’ Rights. | 587 | ||
| Nursing Process | 587 | ||
| n n n Assessment | 587 | ||
| Through the Patient’s Eyes. | 587 | ||
| History. | 587 | ||
| Allergies. | 587 | ||
| Medications. | 588 | ||
| Diet History. | 588 | ||
| Patient’s Perceptual or Coordination Problems. | 588 | ||
| Patient’s Current Condition. | 588 | ||
| Patient’s Attitude About Medication Use. | 588 | ||
| Patient’s Understanding of and Adherence to Medication Therapy. | 588 | ||
| Patient’s Learning Needs. | 588 | ||
| n n n Nursing Diagnosis | 588 | ||
| n n n Planning | 589 | ||
| Goals and Outcomes. | 589 | ||
| Setting Priorities. | 589 | ||
| Teamwork and Collaboration. | 589 | ||
| n n n Implementation | 589 | ||
| Health Promotion. | 589 | ||
| Patient and Family Teaching. | 589 | ||
| Acute Care. | 589 | ||
| Receiving, Transcribing, and Communicating Medication Orders. | 589 | ||
| Accurate Dose Calculation and Measurement. | 590 | ||
| Correct Administration. | 590 | ||
| Recording Medication Administration. | 591 | ||
| Restorative Care. | 591 | ||
| Special Considerations for Administering Medications to Specific Age-Groups. | 591 | ||
| Infants and Children. | 591 | ||
| Older Adults. | 591 | ||
| Polypharmacy. | 591 | ||
| n n n Evaluation | 592 | ||
| Through the Patient’s Eyes. | 592 | ||
| Patient Outcomes. | 593 | ||
| Medication Administration | 593 | ||
| Oral Administration | 593 | ||
| Topical Medication Applications | 595 | ||
| Skin Applications. | 595 | ||
| Nasal Instillation. | 595 | ||
| Eye Instillation. | 596 | ||
| Intraocular Administration. | 597 | ||
| Ear Instillation. | 597 | ||
| Vaginal Instillation. | 597 | ||
| Rectal Instillation. | 597 | ||
| Administering Medications by Inhalation | 599 | ||
| Administering Medications by Irrigations | 600 | ||
| Parenteral Administration of Medications | 600 | ||
| Equipment. | 600 | ||
| Syringes. | 600 | ||
| Needles. | 601 | ||
| Disposable Injection Units. | 601 | ||
| Preparing an Injection From an Ampule. | 602 | ||
| Preparing an Injection From a Vial. | 602 | ||
| Mixing Medications. | 602 | ||
| Mixing Medications From a Vial and an Ampule. | 603 | ||
| Mixing Medications From Two Vials. | 603 | ||
| Insulin Preparation. | 603 | ||
| Administering Injections | 604 | ||
| Subcutaneous Injections. | 604 | ||
| Intramuscular Injections. | 605 | ||
| Sites. | 606 | ||
| Ventrogluteal. | 606 | ||
| Vastus Lateralis. | 606 | ||
| Deltoid. | 607 | ||
| Use of the Z-Track Method in Intramuscular Injections. | 607 | ||
| Intradermal Injections. | 608 | ||
| Safety in Administering Medications by Injection | 608 | ||
| Needleless Devices. | 608 | ||
| Intravenous Administration. | 608 | ||
| Large-Volume Infusions. | 609 | ||
| Intravenous Bolus. | 610 | ||
| Volume-Controlled Infusions. | 610 | ||
| Piggyback. | 610 | ||
| Volume-Control Administration. | 611 | ||
| Mini-Infusion Pump. | 611 | ||
| Intermittent Venous Access. | 611 | ||
| Administration of Intravenous Therapy in the Home. | 611 | ||
| Safety Guidelines for Nursing Skills | 611 | ||
| Skill 31-1 Administering Oral Medications | 612 | ||
| Delegation Considerations | 612 | ||
| Equipment | 612 | ||
| Unexpected Outcomes and Related Interventions | 615 | ||
| Recording and Reporting | 615 | ||
| Home Care Considerations | 615 | ||
| Skill 31-2 Administering Ophthalmic Medications | 616 | ||
| Delegation Considerations | 616 | ||
| Equipment | 616 | ||
| Unexpected Outcomes and Related Interventions | 619 | ||
| Recording and Reporting | 619 | ||
| Home Care Considerations | 619 | ||
| Skill 31-3 Using Metered-Dose Or Dry Powder Inhalers | 619 | ||
| Delegation Considerations | 619 | ||
| Equipment | 619 | ||
| Unexpected Outcomes and Related Interventions | 622 | ||
| Recording and Reporting | 622 | ||
| Home Care Considerations | 622 | ||
| Skill 31-4 Preparing Injections | 622 | ||
| Delegation Considerations | 622 | ||
| Equipment | 622 | ||
| Unexpected Outcomes and Related Interventions | 626 | ||
| Skill 31-5 Administering Injections | 626 | ||
| Delegation Considerations | 626 | ||
| Equipment | 626 | ||
| Unexpected Outcomes and Related Interventions | 631 | ||
| Recording and Reporting | 631 | ||
| Home Care Considerations | 631 | ||
| Skill 31-6 Administering Medications By Intravenous Bolus | 631 | ||
| Delegation Considerations | 631 | ||
| Equipment | 631 | ||
| Unexpected Outcomes and Related Interventions | 635 | ||
| Recording and Reporting | 635 | ||
| Skill 31-7 Administering Intravenous Medications by Piggyback, Intermittent Intravenous Infusion Sets, and Mini-Infusion Pumps | 635 | ||
| Delegation Considerations | 635 | ||
| Equipment | 635 | ||
| Unexpected Outcomes and Related Interventions | 639 | ||
| Recording and Reporting | 639 | ||
| Home Care Considerations | 639 | ||
| Key Points | 639 | ||
| Clinical Application Questions | 639 | ||
| Preparing for Clinical Practice | 639 | ||
| Review Questions | 639 | ||
| Are You Ready to Test Your Nursing Knowledge? | 639 | ||
| References | 641 | ||
| Research References | 642 | ||
| Chapter 32 Complementary and Alternative Therapies | 643 | ||
| Objectives | 643 | ||
| Key Terms | 643 | ||
| Complementary and Alternative Approaches to Health | 643 | ||
| Nursing-Accessible Therapies | 644 | ||
| Relaxation Therapy | 644 | ||
| Clinical Applications of Relaxation Therapy. | 647 | ||
| Limitations of Relaxation Therapy. | 647 | ||
| Meditation and Breathing | 648 | ||
| Clinical Applications of Meditation. | 648 | ||
| Limitations of Meditation. | 648 | ||
| Imagery | 648 | ||
| Clinical Applications of Imagery. | 648 | ||
| Limitations of Imagery. | 649 | ||
| Training-Specific Therapies | 649 | ||
| Biofeedback | 649 | ||
| Clinical Applications of Biofeedback. | 649 | ||
| Limitations of Biofeedback. | 649 | ||
| Acupuncture | 649 | ||
| Clinical Applications of Acupuncture. | 650 | ||
| Limitations of Acupuncture. | 650 | ||
| Therapeutic Touch | 650 | ||
| Clinical Applications of Therapeutic Touch. | 650 | ||
| Limitations of Therapeutic Touch. | 650 | ||
| Chiropractic Therapy | 650 | ||
| Clinical Applications of Chiropractic Therapy. | 651 | ||
| Limitations of Chiropractic Therapy. | 651 | ||
| Traditional Chinese Medicine | 651 | ||
| Clinical Applications of Traditional Chinese Medicine. | 652 | ||
| Limitations of Traditional Chinese Medicine. | 652 | ||
| Natural Products and Herbal Therapies | 652 | ||
| Clinical Applications of Herbal Therapy. | 652 | ||
| Limitations of Herbal Therapy. | 652 | ||
| Nursing Role in Complementary and Alternative Therapies | 654 | ||
| Key Points | 655 | ||
| Clinical Application Questions | 655 | ||
| Preparing for Clinical Practice | 655 | ||
| Review Questions | 655 | ||
| Are You Ready to Test Your Nursing Knowledge? | 655 | ||
| References | 657 | ||
| Research References | 657 | ||
| Unit 6 Sychosocial Basis For Nursing Practice | 658 | ||
| Chapter 33 Self-Concept | 658 | ||
| Objectives | 658 | ||
| Key Terms | 658 | ||
| Scientific Knowledge Base | 658 | ||
| Nursing Knowledge Base | 659 | ||
| Development of Self-Concept | 659 | ||
| Components and Interrelated Terms of Self-Concept | 660 | ||
| Identity. | 660 | ||
| Body Image. | 660 | ||
| Role Performance. | 661 | ||
| Self-Esteem. | 661 | ||
| Factors Influencing Self-Concept | 661 | ||
| Identity Stressors. | 662 | ||
| Body Image Stressors. | 662 | ||
| Role Performance Stressors. | 663 | ||
| Self-Esteem Stressors. | 663 | ||
| Family Effect on Self-Concept Development | 664 | ||
| Nurse’s Effect on Patient’s Self-Concept | 664 | ||
| Critical Thinking | 665 | ||
| Nursing Process | 665 | ||
| n n n Assessment | 665 | ||
| Through the Patient’s Eyes. | 665 | ||
| Coping Behaviors. | 666 | ||
| Significant Others. | 666 | ||
| n n n Nursing Diagnosis | 666 | ||
| n n n Planning | 667 | ||
| Goals and Outcomes. | 667 | ||
| Setting Priorities. | 667 | ||
| Teamwork and Collaboration. | 667 | ||
| n n n Implementation | 670 | ||
| Health Promotion. | 670 | ||
| Acute Care. | 670 | ||
| Restorative and Continuing Care. | 670 | ||
| n n n Evaluation | 671 | ||
| Through the Patient’s Eyes. | 671 | ||
| Patient Outcomes. | 671 | ||
| Key Points | 671 | ||
| Clinical Application Questions | 671 | ||
| Preparing for Clinical Practice | 671 | ||
| Review Questions | 672 | ||
| Are You Ready to Test Your Nursing Knowledge? | 672 | ||
| References | 673 | ||
| Research References | 673 | ||
| Chapter 34 Sexuality | 674 | ||
| Objectives | 674 | ||
| Key Terms | 674 | ||
| Scientific Knowledge Base | 674 | ||
| Sexual Development | 674 | ||
| Infancy and Early Childhood. | 674 | ||
| School-Age Years. | 675 | ||
| Puberty/Adolescence. | 675 | ||
| Young Adulthood. | 675 | ||
| Middle Adulthood. | 675 | ||
| Older Adulthood. | 675 | ||
| Sexual Orientation | 676 | ||
| Contraception | 676 | ||
| Nonprescription Contraceptive Methods. | 676 | ||
| Methods That Require a Health Care Provider’s Intervention. | 676 | ||
| Sexually Transmitted Infections | 677 | ||
| Human Immunodeficiency Virus Infection. | 677 | ||
| Human Papillomavirus Infection. | 677 | ||
| Chlamydia. | 677 | ||
| Nursing Knowledge Base | 677 | ||
| Factors Influencing Sexuality | 677 | ||
| Sociocultural Dimensions of Sexuality | 678 | ||
| Impact of Pregnancy and Menstruation on Sexuality. | 678 | ||
| Discussing Sexual Issues. | 678 | ||
| Decisional Issues | 678 | ||
| Contraception. | 678 | ||
| Abortion. | 678 | ||
| Prevention of Sexually Transmitted Infections. | 678 | ||
| Alterations in Sexual Health | 679 | ||
| Infertility. | 679 | ||
| Sexual Abuse. | 679 | ||
| Personal and Emotional Conflicts. | 679 | ||
| Sexual Dysfunction. | 679 | ||
| Critical Thinking | 679 | ||
| Nursing Process | 680 | ||
| n n n Assessment | 680 | ||
| Through the Patient’s Eyes. | 680 | ||
| Factors Affecting Sexuality. | 680 | ||
| Sexual Health History. | 681 | ||
| Sexual Dysfunction. | 682 | ||
| Physical Assessment. | 682 | ||
| n n n Nursing Diagnosis | 682 | ||
| n n n Planning | 682 | ||
| Goals and Outcomes. | 682 | ||
| Setting Priorities. | 684 | ||
| Teamwork and Collaboration. | 684 | ||
| n n n Implementation | 684 | ||
| Health Promotion. | 684 | ||
| Acute Care. | 686 | ||
| Restorative and Continuing Care. | 687 | ||
| n n n Evaluation | 687 | ||
| Through the Patient’s Eyes. | 687 | ||
| Patient Outcomes. | 687 | ||
| Key Points | 687 | ||
| Clinical Application Questions | 688 | ||
| Preparing for Clinical Practice | 688 | ||
| Review Questions | 688 | ||
| Are You Ready to Test Your Nursing Knowledge? | 688 | ||
| References | 689 | ||
| Research References | 690 | ||
| Chapter 35 Spiritual Health | 691 | ||
| Objectives | 691 | ||
| Key Terms | 691 | ||
| Scientific Knowledge Base | 691 | ||
| Nursing Knowledge Base | 692 | ||
| Current Concepts in Spiritual Health | 692 | ||
| Spirituality. | 692 | ||
| Spiritual Well-Being. | 692 | ||
| Faith. | 693 | ||
| Religion. | 693 | ||
| Hope. | 693 | ||
| Spiritual Health | 693 | ||
| Factors Influencing Spirituality | 693 | ||
| Acute Illness. | 693 | ||
| Chronic Illness. | 693 | ||
| Terminal Illness. | 694 | ||
| Near-Death Experience. | 694 | ||
| Critical Thinking | 694 | ||
| Nursing Process | 695 | ||
| n n n Assessment | 695 | ||
| Through the Patient’s Eyes. | 695 | ||
| Faith/Belief. | 696 | ||
| Life and Self-Responsibility. | 696 | ||
| Connectedness. | 696 | ||
| Life Satisfaction. | 696 | ||
| Culture. | 696 | ||
| Fellowship and Community. | 696 | ||
| Ritual and Practice. | 698 | ||
| Vocation. | 698 | ||
| n n n Nursing Diagnosis | 698 | ||
| n n n Planning | 699 | ||
| Goals and Outcomes. | 699 | ||
| Setting Priorities. | 699 | ||
| Teamwork and Collaboration. | 700 | ||
| n n n Implementation | 702 | ||
| Health Promotion. | 702 | ||
| Establishing Presence. | 702 | ||
| Supporting a Healing Relationship. | 702 | ||
| Acute Care. | 702 | ||
| Support Systems. | 702 | ||
| Diet Therapies. | 702 | ||
| Supporting Rituals. | 702 | ||
| Restorative and Continuing Care. | 703 | ||
| Prayer. | 703 | ||
| Meditation. | 703 | ||
| Supporting Grief Work. | 703 | ||
| n n n Evaluation | 704 | ||
| Through the Patient’s Eyes. | 704 | ||
| Patient Outcomes. | 704 | ||
| Key Points | 704 | ||
| Clinical Application Questions | 704 | ||
| Preparing for Clinical Practice | 704 | ||
| Review Questions | 705 | ||
| Are You Ready to Test Your Nursing Knowledge? | 705 | ||
| References | 706 | ||
| Research References | 706 | ||
| Chapter 36 The Experience of Loss, Death, and Grief | 708 | ||
| Objectives | 708 | ||
| Key Terms | 708 | ||
| Scientific Knowledge Base | 709 | ||
| Loss | 709 | ||
| Grief | 709 | ||
| Normal Grief. | 709 | ||
| Anticipatory Grief. | 710 | ||
| Disenfranchised Grief. | 710 | ||
| Ambiguous Loss. | 710 | ||
| Complicated Grief. | 710 | ||
| Exaggerated Grief. | 710 | ||
| Delayed Grief. | 710 | ||
| Masked Grief. | 710 | ||
| Theories of Grief and Mourning | 710 | ||
| Stages of Dying. | 710 | ||
| Attachment Theory. | 710 | ||
| Grief Tasks Model. | 711 | ||
| Rando’s “R” Process Model. | 711 | ||
| Dual Process Model. | 711 | ||
| Post Modern Grief Theories. | 711 | ||
| Nursing Knowledge Base | 711 | ||
| Factors Influencing Loss and Grief | 711 | ||
| Human Development. | 711 | ||
| Personal Relationships. | 711 | ||
| Nature of the Loss. | 712 | ||
| Coping Strategies. | 712 | ||
| Socioeconomic Status. | 712 | ||
| Culture and Ethnicity. | 712 | ||
| Spiritual and Religious Beliefs. | 712 | ||
| Critical Thinking | 713 | ||
| Nursing Process | 713 | ||
| n n n Assessment | 713 | ||
| Through the Patient’s Eyes. | 714 | ||
| Grief Variables. | 714 | ||
| Grief Reactions. | 715 | ||
| n n n Nursing Diagnosis | 715 | ||
| n n n Planning | 716 | ||
| Goals and Outcomes. | 716 | ||
| Setting Priorities. | 716 | ||
| Teamwork and Collaboration. | 719 | ||
| n n n Implementation | 719 | ||
| Health Promotion. | 719 | ||
| Palliative Care in Acute and Restorative Settings. | 719 | ||
| Hospice Care. | 719 | ||
| Use Therapeutic Communication. | 720 | ||
| Provide Psychosocial Care. | 720 | ||
| Manage Symptoms. | 720 | ||
| Promote Dignity and Self-Esteem. | 720 | ||
| Maintain a Comfortable and Peaceful Environment. | 721 | ||
| Promote Spiritual Comfort and Hope. | 722 | ||
| Protect Against Abandonment and Isolation. | 722 | ||
| Support the Grieving Family. | 722 | ||
| Assist with End-of-Life Decision Making. | 723 | ||
| Facilitate Mourning. | 723 | ||
| Care After Death. | 723 | ||
| n n n Evaluation | 724 | ||
| Through the Patient’s Eyes. | 724 | ||
| Patient Outcomes. | 725 | ||
| Importance of Nurses’ Self-Care | 725 | ||
| Key Points | 727 | ||
| Clinical Application Questions | 727 | ||
| Preparing for Clinical Practice | 727 | ||
| Review Questions | 728 | ||
| Are You Ready to Test Your Nursing Knowledge? | 728 | ||
| References | 729 | ||
| Research References | 730 | ||
| Chapter 37 Stress and Coping | 731 | ||
| Objectives | 731 | ||
| Key Terms | 731 | ||
| Scientific Knowledge Base | 731 | ||
| Medulla Oblongata | 732 | ||
| Reticular Formation | 732 | ||
| Pituitary Gland | 732 | ||
| General Adaptation Syndrome | 732 | ||
| Reaction to Psychological Stress. | 732 | ||
| Types of Stress | 733 | ||
| Nursing Knowledge Base | 734 | ||
| Nursing Theory and the Role of Stress | 734 | ||
| Factors Influencing Stress and Coping | 734 | ||
| Situational Factors. | 734 | ||
| Maturational Factors. | 734 | ||
| Sociocultural Factors. | 735 | ||
| Critical Thinking | 735 | ||
| Nursing Process | 736 | ||
| n n n Assessment | 736 | ||
| Through the Patient’s Eyes. | 736 | ||
| Subjective Findings. | 737 | ||
| Objective Findings. | 737 | ||
| n n n Nursing Diagnosis | 737 | ||
| n n n Planning | 737 | ||
| Goals and Outcomes. | 737 | ||
| Setting Priorities. | 738 | ||
| Teamwork and Collaboration. | 738 | ||
| n n n Implementation | 740 | ||
| Health Promotion. | 740 | ||
| Regular Exercise. | 740 | ||
| Support Systems. | 741 | ||
| Time Management. | 741 | ||
| Guided Imagery and Visualization. | 741 | ||
| Progressive Muscle Relaxation. | 741 | ||
| Assertiveness Training. | 741 | ||
| Journal Writing. | 741 | ||
| Stress Management in the Workplace. | 741 | ||
| Acute Care | 741 | ||
| Crisis Intervention. | 741 | ||
| Restorative and Continuing Care. | 743 | ||
| n n n Evaluation | 743 | ||
| Through the Patient’s Eyes. | 743 | ||
| Patient Outcomes. | 743 | ||
| Key Points | 743 | ||
| Clinical Application Questions | 744 | ||
| Preparing for Clinical Practice | 744 | ||
| Review Questions | 744 | ||
| Are You Ready to Test Your Nursing Knowledge? | 744 | ||
| References | 745 | ||
| Research References | 745 | ||
| Unit 7 Physiological Basis for Nursing Practice | 746 | ||
| Chapter 38 Activity and Exercise | 746 | ||
| Objectives | 746 | ||
| Key Terms | 746 | ||
| Scientific Knowledge Base | 746 | ||
| Overview of Exercise and Activity | 746 | ||
| Body Alignment. | 746 | ||
| Body Balance. | 747 | ||
| Coordinated Body Movement. | 747 | ||
| Friction. | 747 | ||
| Exercise and Activity. | 747 | ||
| Regulation of Movement | 747 | ||
| Skeletal System. | 747 | ||
| Joints. | 747 | ||
| Ligaments, Tendons, and Cartilage. | 747 | ||
| Skeletal Muscle. | 748 | ||
| Muscles Concerned with Movement. | 748 | ||
| Muscles Concerned with Posture. | 748 | ||
| Muscle Groups. | 748 | ||
| Nervous System. | 748 | ||
| Proprioception. | 748 | ||
| Balance. | 748 | ||
| Principles of Transfer and Positioning Techniques | 748 | ||
| Pathological Influences on Body Alignment and Mobility. | 748 | ||
| Congenital Defects. | 749 | ||
| Disorders of Bones, Joints, and Muscles. | 749 | ||
| Central Nervous System Damage. | 749 | ||
| Musculoskeletal Trauma. | 749 | ||
| Nursing Knowledge Base | 749 | ||
| Factors Influencing Activity and Exercise | 749 | ||
| Developmental Changes. | 749 | ||
| Infants Through School-Age Children. | 749 | ||
| Adolescence. | 749 | ||
| Young to Middle Adults. | 749 | ||
| Older Adults. | 750 | ||
| Behavioral Aspects. | 750 | ||
| Environmental Issues | 750 | ||
| Work Site. | 750 | ||
| Schools. | 750 | ||
| Community. | 750 | ||
| Cultural and Ethnic Influences. | 750 | ||
| Family and Social Support. | 750 | ||
| Critical Thinking | 750 | ||
| Nursing Process | 751 | ||
| n n n Assessment | 751 | ||
| Through the Patient’s Eyes. | 751 | ||
| Standing. | 751 | ||
| Sitting. | 751 | ||
| Recumbent Position. | 752 | ||
| Mobility. | 752 | ||
| Range of Motion. | 752 | ||
| Gait. | 753 | ||
| Exercise. | 753 | ||
| Activity Tolerance. | 753 | ||
| n n n Nursing Diagnosis | 753 | ||
| n n n Planning | 753 | ||
| Goals and Outcomes. | 753 | ||
| Setting Priorities. | 754 | ||
| Teamwork and Collaboration. | 754 | ||
| n n n Implementation | 757 | ||
| Health Promotion. | 757 | ||
| Body Mechanics. | 758 | ||
| Acute Care. | 758 | ||
| Musculoskeletal System. | 759 | ||
| Joint Mobility. | 759 | ||
| Walking. | 759 | ||
| Helping a Patient to Walk. | 759 | ||
| Restorative and Continuing Care. | 760 | ||
| Assistive Devices for Walking. | 760 | ||
| Walkers. | 760 | ||
| Canes. | 760 | ||
| Crutches. | 760 | ||
| Measuring for Crutches. | 761 | ||
| Crutch Gait. | 761 | ||
| Crutch Walking on Stairs. | 762 | ||
| Sitting in a Chair with Crutches. | 763 | ||
| Restoration of Activity and Chronic Illness. | 763 | ||
| Coronary Heart Disease. | 763 | ||
| Hypertension. | 764 | ||
| Chronic Obstructive Pulmonary Disease. | 764 | ||
| Diabetes Mellitus. | 764 | ||
| n n n Evaluation | 764 | ||
| Through the Patient’s Eyes. | 764 | ||
| Patient Outcomes. | 764 | ||
| Key Points | 765 | ||
| Clinical Application Questions | 765 | ||
| Preparing for Clinical Practice | 765 | ||
| Review Questions | 765 | ||
| Are You Ready to Test Your Nursing Knowledge? | 765 | ||
| References | 767 | ||
| Research References | 767 | ||
| Chapter 39 Hygiene | 768 | ||
| Objectives | 768 | ||
| Key Terms | 768 | ||
| Scientific Knowledge Base | 768 | ||
| The Skin | 769 | ||
| The Feet, Hands, and Nails | 769 | ||
| The Oral Cavity | 770 | ||
| The Hair | 770 | ||
| The Eyes, Ears, and Nose | 770 | ||
| Nursing Knowledge Base | 770 | ||
| Factors Influencing Hygiene | 770 | ||
| Social Practices. | 770 | ||
| Personal Preferences. | 770 | ||
| Body Image. | 770 | ||
| Socioeconomic Status. | 770 | ||
| Health Beliefs and Motivation. | 770 | ||
| Cultural Variables. | 771 | ||
| Developmental Stage. | 771 | ||
| Skin. | 771 | ||
| Feet and Nails. | 771 | ||
| The Mouth. | 771 | ||
| Hair. | 772 | ||
| Eyes, Ears, and Nose. | 772 | ||
| Physical Condition. | 772 | ||
| Critical Thinking | 772 | ||
| Nursing Process | 773 | ||
| n n n Assessment | 773 | ||
| Through the Patient’s Eyes. | 773 | ||
| Assessment of Self-Care Ability. | 773 | ||
| Assessment of the Skin. | 774 | ||
| Assessment of the Feet and Nails. | 775 | ||
| Assessment of the Oral Cavity. | 775 | ||
| Assessment of the Hair and Hair Care. | 776 | ||
| Assessment of the Eyes, Ears, and Nose. | 776 | ||
| Use of Sensory Aids. | 777 | ||
| Assessment of Hygiene Care Practices. | 777 | ||
| Assessment of Cultural Influences. | 777 | ||
| Patients at Risk for Hygiene Problems. | 777 | ||
| n n n Nursing Diagnosis | 778 | ||
| n n n Planning | 779 | ||
| Goals and Outcomes. | 779 | ||
| Setting Priorities. | 780 | ||
| Teamwork and Collaboration. | 782 | ||
| n n n Implementation | 782 | ||
| Health Promotion. | 782 | ||
| Acute, Restorative, and Continuing Care. | 783 | ||
| Bathing and Skin Care. | 783 | ||
| Bag Baths. | 784 | ||
| Perineal Care. | 784 | ||
| Back Rub. | 785 | ||
| Foot and Nail Care. | 785 | ||
| Oral Hygiene. | 785 | ||
| Brushing. | 786 | ||
| Flossing. | 786 | ||
| Patients with Special Needs. | 786 | ||
| Denture Care. | 787 | ||
| Hair and Scalp Care. | 787 | ||
| Brushing and Combing. | 787 | ||
| Shampooing. | 788 | ||
| Shaving. | 788 | ||
| Mustache and Beard Care. | 788 | ||
| Care of the Eyes, Ears, and Nose. | 789 | ||
| Basic Eye Care. | 789 | ||
| Eyeglasses. | 789 | ||
| Contact Lenses. | 790 | ||
| Artificial Eyes. | 790 | ||
| Ear Care. | 791 | ||
| Hearing Aid Care. | 791 | ||
| Nasal Care. | 792 | ||
| Patient’s Room Environment. | 792 | ||
| Maintaining Comfort. | 792 | ||
| Room Equipment. | 792 | ||
| Beds. | 793 | ||
| Bed Making. | 793 | ||
| Linens. | 794 | ||
| n n n Evaluation | 796 | ||
| Through the Patient’s Eyes. | 796 | ||
| Patient Outcomes. | 796 | ||
| Safety Guidelines for Nursing Skills | 796 | ||
| Skill 39-1 Bathing and Perineal Care | 797 | ||
| Skill 39-2 Performing Nail and Foot Care | 805 | ||
| Skill 39-3 Providing Oral Hygiene | 808 | ||
| Skill 39-4 Performing Mouth Care for an Unconscious or Debilitated Patient | 811 | ||
| Skill 39-5 Making an Occupied Bed | 813 | ||
| Key Points | 818 | ||
| Clinical Application Questions | 818 | ||
| Preparing for Clinical Practice | 818 | ||
| Review Questions | 818 | ||
| Are You Ready to Test Your Nursing Knowledge? | 818 | ||
| References | 819 | ||
| Research References | 820 | ||
| Chapter 40 Oxygenation | 821 | ||
| Objectives | 821 | ||
| Key Terms | 821 | ||
| Scientific Knowledge Base | 821 | ||
| Respiratory Physiology | 821 | ||
| Structure and Function. | 822 | ||
| Work of Breathing. | 822 | ||
| Lung Volumes. | 822 | ||
| Pulmonary Circulation. | 822 | ||
| Respiratory Gas Exchange. | 823 | ||
| Oxygen Transport. | 823 | ||
| Carbon Dioxide Transport. | 823 | ||
| Regulation of Respiration. | 823 | ||
| Cardiovascular Physiology | 823 | ||
| Structure and Function. | 823 | ||
| Myocardial Pump. | 823 | ||
| Myocardial Blood Flow. | 823 | ||
| Coronary Artery Circulation. | 824 | ||
| Systemic Circulation. | 824 | ||
| Blood Flow Regulation. | 824 | ||
| Conduction System. | 825 | ||
| Factors Affecting Oxygenation | 825 | ||
| Physiological Factors. | 825 | ||
| Decreased Oxygen-Carrying Capacity. | 826 | ||
| Hypovolemia. | 826 | ||
| Decreased Inspired Oxygen Concentration. | 826 | ||
| Increased Metabolic Rate. | 826 | ||
| Conditions Affecting Chest Wall Movement. | 826 | ||
| Pregnancy. | 826 | ||
| Obesity. | 826 | ||
| Musculoskeletal Abnormalities. | 826 | ||
| Trauma. | 826 | ||
| Neuromuscular Diseases. | 826 | ||
| Central Nervous System Alterations. | 826 | ||
| Influences of Chronic Disease. | 826 | ||
| Alterations in Respiratory Functioning | 826 | ||
| Hypoventilation. | 827 | ||
| Hyperventilation. | 827 | ||
| Hypoxia. | 827 | ||
| Alterations in Cardiac Functioning | 827 | ||
| Disturbances in Conduction. | 827 | ||
| Altered Cardiac Output. | 828 | ||
| Left-Sided Heart Failure. | 828 | ||
| Right-Sided Heart Failure. | 828 | ||
| Impaired Valvular Function. | 828 | ||
| Myocardial Ischemia. | 828 | ||
| Angina. | 828 | ||
| Myocardial Infarction. | 828 | ||
| Nursing Knowledge Base | 828 | ||
| Factors Influencing Oxygenation | 828 | ||
| Developmental Factors. | 828 | ||
| Infants and Toddlers. | 828 | ||
| School-Age Children and Adolescents. | 828 | ||
| Young and Middle-Age Adults. | 828 | ||
| Older Adults. | 829 | ||
| Lifestyle Factors. | 829 | ||
| Nutrition. | 829 | ||
| Exercise. | 829 | ||
| Smoking. | 829 | ||
| Substance Abuse. | 830 | ||
| Stress. | 830 | ||
| Environmental Factors. | 830 | ||
| Critical Thinking | 830 | ||
| Nursing Process | 830 | ||
| n n n Assessment | 830 | ||
| Through the Patient’s Eyes. | 831 | ||
| Nursing History. | 831 | ||
| Pain. | 831 | ||
| Fatigue. | 831 | ||
| Dyspnea. | 831 | ||
| Cough. | 832 | ||
| Wheezing. | 832 | ||
| Environmental or Geographical Exposures. | 832 | ||
| Smoking. | 832 | ||
| Respiratory Infections. | 832 | ||
| Allergies. | 832 | ||
| Health Risks. | 832 | ||
| Medications. | 832 | ||
| Physical Examination. | 833 | ||
| Inspection. | 834 | ||
| Palpation. | 834 | ||
| Percussion. | 834 | ||
| Auscultation. | 834 | ||
| Diagnostic Tests. | 834 | ||
| n n n Nursing Diagnosis | 835 | ||
| n n n Planning | 837 | ||
| Goals and Outcomes. | 838 | ||
| Setting Priorities. | 838 | ||
| Teamwork and Collaboration. | 838 | ||
| n n n Implementation | 840 | ||
| Health Promotion. | 840 | ||
| Vaccinations. | 840 | ||
| Healthy Lifestyle. | 841 | ||
| Environmental Pollutants. | 841 | ||
| Acute Care. | 841 | ||
| Dyspnea Management. | 841 | ||
| Airway Maintenance. | 842 | ||
| Mobilization of Pulmonary Secretions. | 842 | ||
| Hydration. | 842 | ||
| Humidification. | 842 | ||
| Nebulization. | 842 | ||
| Coughing and Deep-Breathing Techniques. | 842 | ||
| Chest Physiotherapy. | 842 | ||
| Suctioning Techniques. | 844 | ||
| Oropharyngeal and Nasopharyngeal Suctioning. | 845 | ||
| Orotracheal and Nasotracheal Suctioning. | 845 | ||
| Tracheal Suctioning. | 845 | ||
| Artificial Airways. | 845 | ||
| Oral Airway. | 845 | ||
| Endotracheal and Tracheal Airway. | 846 | ||
| Maintenance and Promotion of Lung Expansion. | 847 | ||
| Ambulation. | 847 | ||
| Positioning. | 848 | ||
| Incentive Spirometry. | 848 | ||
| Noninvasive Ventilation. | 848 | ||
| Chest Tubes. | 849 | ||
| Special Considerations. | 850 | ||
| Maintenance and Promotion of Oxygenation. | 850 | ||
| Oxygen Therapy. | 850 | ||
| Safety Precautions. | 850 | ||
| Supply of Oxygen. | 850 | ||
| Methods of Oxygen Delivery. | 851 | ||
| Nasal Cannula. | 851 | ||
| Oxygen Masks. | 851 | ||
| Home Oxygen Therapy. | 852 | ||
| Restoration of Cardiopulmonary Functioning. | 853 | ||
| Cardiopulmonary Resuscitation. | 853 | ||
| Restorative and Continuing Care. | 854 | ||
| Respiratory Muscle Training. | 854 | ||
| Breathing Exercises. | 854 | ||
| Pursed-Lip Breathing. | 854 | ||
| Diaphragmatic Breathing. | 854 | ||
| n n n Evaluation | 854 | ||
| Through the Patient’s Eyes. | 854 | ||
| Patient Outcomes. | 854 | ||
| Safety Guidelines for Nursing Skills | 855 | ||
| Skill 40-1 Suctioning | 855 | ||
| Unexpected Outcomes and Related Interventions | 861 | ||
| Recording and Reporting | 861 | ||
| Home Care Considerations | 861 | ||
| Skill 40-2 Care of an Artificial Airway | 861 | ||
| Unexpected Outcomes and Related Interventions | 868 | ||
| Recording and Reporting | 869 | ||
| Home Care Considerations Tracheostomy Only (Cleveland Clinic, 2010a). | 869 | ||
| Skill 40-3 Care of Patients With Chest Tubes | 869 | ||
| Unexpected Outcomes and Related Interventions | 872 | ||
| Recording and Reporting | 872 | ||
| Home Care Considerations | 873 | ||
| Skill 40-4 Applying a Nasal Cannula or Oxygen Mask | 873 | ||
| Unexpected Outcomes and Related Interventions | 875 | ||
| Recording and Reporting | 875 | ||
| Skill 40-5 Using Home Oxygen Equipment | 875 | ||
| Unexpected Outcomes and Related Interventions | 878 | ||
| Recording and Reporting | 878 | ||
| Key Points | 878 | ||
| Clinical Application Questions | 878 | ||
| Preparing for Clinical Practice | 878 | ||
| Review Questions | 879 | ||
| Are You Ready to Test Your Nursing Knowledge? | 879 | ||
| References | 880 | ||
| Research References | 881 | ||
| Chapter 41 Fluid, Electrolyte, and Acid-Base Balance | 882 | ||
| Objectives | 882 | ||
| Key Terms | 882 | ||
| Scientific Knowledge Base | 883 | ||
| Location and Movement of Water and Electrolytes | 883 | ||
| Fluid Compartments. | 883 | ||
| Movement of Water and Electrolytes. | 884 | ||
| Active Transport. | 884 | ||
| Diffusion. | 884 | ||
| Osmosis. | 884 | ||
| Filtration. | 884 | ||
| Fluid Balance | 885 | ||
| Fluid Intake. | 885 | ||
| Fluid Distribution. | 885 | ||
| Fluid Output. | 886 | ||
| Antidiuretic Hormone. | 886 | ||
| Renin-Angiotensin-Aldosterone System. | 887 | ||
| Atrial Natriuretic Peptide. | 887 | ||
| Fluid Imbalances | 887 | ||
| Extracellular Fluid Volume Imbalances. | 887 | ||
| Osmolality Imbalances. | 887 | ||
| Clinical Dehydration. | 887 | ||
| Electrolyte Balance | 887 | ||
| Electrolyte Imbalances | 889 | ||
| Potassium Imbalances. | 889 | ||
| Calcium Imbalances. | 889 | ||
| Magnesium Imbalances. | 890 | ||
| Acid-Base Balance | 891 | ||
| Acid Production. | 891 | ||
| Acid Buffering. | 891 | ||
| Acid Excretion. | 892 | ||
| Excretion of Carbonic Acid. | 892 | ||
| Excretion of Metabolic Acids. | 893 | ||
| Acid-Base Imbalances | 893 | ||
| Respiratory Acidosis. | 893 | ||
| Respiratory Alkalosis. | 893 | ||
| Metabolic Acidosis. | 893 | ||
| Metabolic Alkalosis. | 893 | ||
| Nursing Knowledge Base | 893 | ||
| Critical Thinking | 893 | ||
| Nursing Process | 895 | ||
| n n n Assessment | 895 | ||
| Through the Patient’s Eyes. | 895 | ||
| Nursing History | 895 | ||
| Age. | 896 | ||
| Environment. | 896 | ||
| Dietary Intake. | 897 | ||
| Lifestyle. | 897 | ||
| Medications. | 897 | ||
| Medical History | 897 | ||
| Recent Surgery. | 897 | ||
| Gastrointestinal Output. | 897 | ||
| Acute Illness or Trauma. | 897 | ||
| Respiratory Disorders. | 897 | ||
| Burns. | 898 | ||
| Trauma. | 898 | ||
| Chronic Illness. | 898 | ||
| Cancer. | 898 | ||
| Heart Failure. | 898 | ||
| Oliguric Renal Disease. | 898 | ||
| Physical Assessment | 898 | ||
| Daily Weights and Fluid Intake and Output Measurement. | 898 | ||
| Laboratory Values | 900 | ||
| n n n Nursing Diagnosis | 900 | ||
| n n n Planning | 900 | ||
| Goals and Outcomes. | 901 | ||
| Setting Priorities. | 901 | ||
| Teamwork and Collaboration. | 901 | ||
| n n n Implementation | 903 | ||
| Health Promotion. | 903 | ||
| Acute Care. | 904 | ||
| Enteral Replacement of Fluids. | 904 | ||
| Restriction of Fluids. | 904 | ||
| Parenteral Replacement of Fluids and Electrolytes. | 904 | ||
| Parenteral Nutrition. | 904 | ||
| Intravenous Therapy (Crystalloids). | 905 | ||
| Types of Solutions. | 905 | ||
| Vascular Access Devices. | 906 | ||
| Equipment. | 906 | ||
| Initiating the Intravenous Line. | 906 | ||
| Regulating the Infusion Flow Rate. | 907 | ||
| Maintaining the System. | 907 | ||
| Changing Intravenous Fluid Containers, Tubing, and Dressings. | 908 | ||
| Assisting Patients to Protect Intravenous Integrity. | 909 | ||
| Complications of Intravenous Therapy. | 909 | ||
| Discontinuing Peripheral Intravenous Access. | 909 | ||
| Blood Transfusion. | 909 | ||
| Blood Groups and Types. | 909 | ||
| Autologous Transfusion. | 911 | ||
| Transfusing Blood. | 911 | ||
| Transfusion Reactions and Other Adverse Effects. | 912 | ||
| Interventions for Electrolyte Imbalances. | 912 | ||
| Interventions for Acid-Base Imbalances. | 914 | ||
| Arterial Blood Gases. | 914 | ||
| Restorative Care. | 914 | ||
| Home Intravenous Therapy. | 914 | ||
| Nutritional Support. | 914 | ||
| Medication Safety. | 914 | ||
| n n n Evaluation | 914 | ||
| Through the Patient’s Eyes. | 914 | ||
| Patient Outcomes. | 915 | ||
| Safety Guidelines for Nursing Skills | 915 | ||
| Skill 41-1 Initiating Intravenous Therapy | 916 | ||
| Unexpected Outcomes and Related Interventions | 925 | ||
| Recording and Reporting | 925 | ||
| Home Care Considerations | 925 | ||
| Skill 41-2 Regulating Intravenous Flow Rate | 925 | ||
| Unexpected Outcomes and Related Interventions | 928 | ||
| Recording and Reporting | 928 | ||
| Home Care Considerations | 929 | ||
| Skill 41-3 Maintenance of Intravenous System | 929 | ||
| Unexpected Outcomes and Related Interventions | 934 | ||
| Recording and Reporting | 934 | ||
| Home Care Considerations | 934 | ||
| Skill 41-4 Changing a Peripheral Intravenous Dressing | 934 | ||
| Unexpected Outcomes and Related Interventions | 936 | ||
| Recording and Reporting | 936 | ||
| Key Points | 936 | ||
| Clinical Application Questions | 937 | ||
| Preparing for Clinical Practice | 937 | ||
| Review Questions | 937 | ||
| Are You Ready to Test Your Nursing Knowledge? | 937 | ||
| References | 938 | ||
| Research References | 938 | ||
| Chapter 42 Sleep | 939 | ||
| Objectives | 939 | ||
| Key Terms | 939 | ||
| Scientific Knowledge Base | 939 | ||
| Physiology of Sleep | 939 | ||
| Circadian Rhythms. | 939 | ||
| Sleep Regulation. | 940 | ||
| Stages of Sleep. | 940 | ||
| Sleep Cycle. | 940 | ||
| Functions of Sleep | 941 | ||
| Dreams. | 941 | ||
| Physical Illness | 942 | ||
| Sleep Disorders | 942 | ||
| Insomnia. | 942 | ||
| Sleep Apnea. | 943 | ||
| Narcolepsy. | 944 | ||
| Sleep Deprivation. | 944 | ||
| Parasomnias. | 944 | ||
| Nursing Knowledge Base | 944 | ||
| Sleep and Rest | 944 | ||
| Normal Sleep Requirements and Patterns | 944 | ||
| Neonates. | 945 | ||
| Infants. | 945 | ||
| Toddlers. | 945 | ||
| Preschoolers. | 945 | ||
| School-Age Children. | 945 | ||
| Adolescents. | 945 | ||
| Young Adults. | 945 | ||
| Middle Adults. | 945 | ||
| Older Adults. | 945 | ||
| Factors Influencing Sleep | 945 | ||
| Drugs and Substances. | 945 | ||
| Lifestyle. | 945 | ||
| Usual Sleep Patterns. | 945 | ||
| Emotional Stress. | 946 | ||
| Environment. | 946 | ||
| Exercise and Fatigue. | 946 | ||
| Food and Caloric Intake. | 946 | ||
| Critical Thinking | 946 | ||
| Nursing Process | 947 | ||
| n n n Assessment | 947 | ||
| Through the Patient’s Eyes. | 947 | ||
| Sleep Assessment. | 947 | ||
| Sources for Sleep Assessment. | 947 | ||
| Tools for Sleep Assessment. | 948 | ||
| Sleep History. | 948 | ||
| Description of Sleeping Problems. | 948 | ||
| Usual Sleep Pattern. | 948 | ||
| Physical and Psychological Illness. | 949 | ||
| Current Life Events. | 949 | ||
| Emotional and Mental Status. | 949 | ||
| Bedtime Routines. | 949 | ||
| Bedtime Environment. | 949 | ||
| Behaviors of Sleep Deprivation. | 949 | ||
| n n n Nursing Diagnosis | 949 | ||
| n n n Planning | 950 | ||
| Goals and Outcomes. | 950 | ||
| Setting Priorities. | 952 | ||
| Teamwork and Collaboration. | 952 | ||
| n n n Implementation | 952 | ||
| Health Promotion. | 952 | ||
| Environmental Controls. | 952 | ||
| Promoting Bedtime Routines. | 953 | ||
| Promoting Safety. | 954 | ||
| Promoting Comfort. | 954 | ||
| Establishing Periods of Rest and Sleep. | 954 | ||
| Stress Reduction. | 954 | ||
| Bedtime Snacks. | 955 | ||
| Pharmacological Approaches. | 955 | ||
| Acute Care. | 955 | ||
| Environmental Controls. | 956 | ||
| Promoting Comfort. | 956 | ||
| Establishing Periods of Rest and Sleep. | 956 | ||
| Promoting Safety. | 957 | ||
| Stress Reduction. | 957 | ||
| Restorative or Continuing Care. | 957 | ||
| Promoting Comfort. | 957 | ||
| Controlling Physiological Disturbances. | 957 | ||
| Pharmacological Approaches. | 957 | ||
| n n n Evaluation | 958 | ||
| Through the Patient’s Eyes. | 958 | ||
| Patient Outcomes. | 958 | ||
| Key Points | 959 | ||
| Clinical Application Questions | 959 | ||
| Preparing for Clinical Practice | 959 | ||
| Review Questions | 959 | ||
| Are You Ready to Test Your Nursing Knowledge? | 959 | ||
| References | 960 | ||
| Research References | 961 | ||
| Chapter 43 Pain Management | 962 | ||
| Objectives | 962 | ||
| Key Terms | 962 | ||
| Scientific Knowledge Base | 963 | ||
| Nature of Pain | 963 | ||
| Physiology of Pain | 963 | ||
| Gate-Control Theory of Pain. | 964 | ||
| Physiological Responses. | 964 | ||
| Behavioral Responses. | 964 | ||
| Types of Pain | 965 | ||
| Acute/Transient Pain. | 965 | ||
| Chronic/Persistent Noncancer Pain. | 965 | ||
| Chronic Episodic Pain. | 965 | ||
| Cancer Pain. | 965 | ||
| Pain by Inferred Pathological Process. | 965 | ||
| Idiopathic Pain. | 966 | ||
| Nursing Knowledge Base | 966 | ||
| Knowledge, Attitudes, and Beliefs | 966 | ||
| Factors Influencing Pain | 966 | ||
| Physiological Factors | 967 | ||
| Age. | 967 | ||
| Fatigue. | 967 | ||
| Genes. | 967 | ||
| Neurological Function. | 967 | ||
| Social Factors | 967 | ||
| Attention. | 967 | ||
| Previous Experience. | 967 | ||
| Family and Social Support. | 968 | ||
| Spiritual Factors. | 968 | ||
| Psychological Factors | 968 | ||
| Anxiety. | 968 | ||
| Coping Style. | 968 | ||
| Cultural Factors. | 969 | ||
| Critical Thinking | 969 | ||
| Nursing Process | 969 | ||
| n n n Assessment | 969 | ||
| Through the Patient’s Eyes. | 969 | ||
| Patient’s Expression of Pain. | 970 | ||
| Characteristics of Pain. | 972 | ||
| Onset and Duration. | 972 | ||
| Location. | 972 | ||
| Intensity. | 972 | ||
| Quality. | 972 | ||
| Pain Pattern. | 974 | ||
| Relief Measures. | 974 | ||
| Contributing Symptoms. | 974 | ||
| Effects of Pain on the Patient. | 974 | ||
| Behavioral Effects. | 974 | ||
| Influence on Activities of Daily Living. | 974 | ||
| n n n Nursing Diagnosis | 975 | ||
| n n n Planning | 975 | ||
| Goals and Outcomes. | 975 | ||
| Setting Priorities. | 977 | ||
| Teamwork and Collaboration. | 977 | ||
| n n n Implementation | 977 | ||
| Health Promotion. | 977 | ||
| Nonpharmacological Pain-Relief Interventions. | 977 | ||
| Relaxation and Guided Imagery. | 978 | ||
| Distraction. | 978 | ||
| Music. | 978 | ||
| Cutaneous Stimulation. | 978 | ||
| Herbals. | 981 | ||
| Reducing Pain Perception. | 981 | ||
| Acute Care | 981 | ||
| Acute Pain Management. | 981 | ||
| Pharmacological Pain-Relief Interventions. | 981 | ||
| Analgesics. | 981 | ||
| Patient-Controlled Analgesia. | 983 | ||
| Perineural Local Anesthetic Infusion. | 984 | ||
| Topical Analgesics. | 984 | ||
| Local and Regional Anesthetics. | 985 | ||
| Nursing Implications. | 985 | ||
| Invasive Interventions for Pain Relief. | 986 | ||
| Procedure Pain Management. | 986 | ||
| Chronic Noncancer and Cancer Pain Management. | 986 | ||
| Barriers to Effective Pain Management. | 988 | ||
| Placebos. | 989 | ||
| Restorative and Continuing Care | 989 | ||
| Pain Clinics, Palliative Care, and Hospices. | 989 | ||
| n n n Evaluation | 989 | ||
| Through the Patient’s Eyes. | 989 | ||
| Patient Outcomes. | 989 | ||
| Safety Guidelines for Nursing Skills | 990 | ||
| Skill 43-1 Patient-Controlled Analgesia | 990 | ||
| Unexpected Outcomes and Related Interventions | 992 | ||
| Recording and Reporting | 992 | ||
| Key Points | 992 | ||
| Clinical Application Questions | 993 | ||
| Preparing for Clinical Practice | 993 | ||
| Review Questions | 993 | ||
| Are You Ready to Test Your Nursing Knowledge? | 993 | ||
| References | 994 | ||
| Research References | 995 | ||
| Chapter 44 Nutrition | 996 | ||
| Objectives | 996 | ||
| Key Terms | 996 | ||
| Scientific Knowledge Base | 997 | ||
| Nutrients: The Biochemical Units of Nutrition | 997 | ||
| Carbohydrates. | 997 | ||
| Proteins. | 997 | ||
| Fats. | 998 | ||
| Water. | 998 | ||
| Vitamins. | 998 | ||
| Fat-Soluble Vitamins. | 998 | ||
| Water-Soluble Vitamins. | 998 | ||
| Minerals. | 998 | ||
| Anatomy and Physiology of the Digestive System | 998 | ||
| Digestion. | 998 | ||
| Absorption. | 1000 | ||
| Metabolism and Storage of Nutrients. | 1000 | ||
| Elimination. | 1001 | ||
| Dietary Guidelines | 1001 | ||
| Dietary Reference Intakes. | 1001 | ||
| Food Guidelines. | 1001 | ||
| Daily Values. | 1001 | ||
| Nursing Knowledge Base | 1001 | ||
| Factors Influencing Nutrition | 1001 | ||
| Environmental Factors. | 1001 | ||
| Developmental Needs | 1002 | ||
| Infants Through School-Age. | 1002 | ||
| Breastfeeding. | 1002 | ||
| Formula. | 1002 | ||
| Introduction to Solid Food. | 1002 | ||
| Adolescents. | 1002 | ||
| Young and Middle Adults. | 1003 | ||
| Pregnancy. | 1003 | ||
| Lactation. | 1003 | ||
| Older Adults. | 1003 | ||
| Alternative Food Patterns | 1005 | ||
| Vegetarian Diet. | 1006 | ||
| Critical Thinking | 1006 | ||
| Nursing Process | 1007 | ||
| n n n Assessment | 1007 | ||
| Through the Patient’s Eyes. | 1007 | ||
| Screening. | 1007 | ||
| Anthropometry. | 1009 | ||
| Laboratory and Biochemical Tests. | 1009 | ||
| Diet History and Health History. | 1009 | ||
| Physical Examination. | 1010 | ||
| Dysphagia. | 1010 | ||
| n n n Nursing Diagnosis | 1010 | ||
| n n n Planning | 1012 | ||
| Goals and Outcomes. | 1012 | ||
| Setting Priorities. | 1014 | ||
| Teamwork and Collaboration. | 1014 | ||
| n n n Implementation | 1015 | ||
| Health Promotion. | 1015 | ||
| Acute Care. | 1016 | ||
| Advancing Diets. | 1017 | ||
| Promoting Appetite. | 1017 | ||
| Assisting Patients with Oral Feeding. | 1018 | ||
| Enteral Tube Feeding. | 1018 | ||
| Enteral Access Tubes. | 1019 | ||
| Parenteral Nutrition. | 1021 | ||
| Initiating Parenteral Nutrition. | 1021 | ||
| Preventing Complications. | 1023 | ||
| Restorative and Continuing Care. | 1024 | ||
| Medical Nutrition Therapy. | 1024 | ||
| Gastrointestinal Diseases. | 1024 | ||
| Diabetes Mellitus. | 1024 | ||
| Cardiovascular Diseases. | 1024 | ||
| Cancer and Cancer Treatment. | 1025 | ||
| Human Immunodeficiency Virus/Acquired Immunodeficiency Syndrome. | 1025 | ||
| n n n Evaluation | 1025 | ||
| Through the Patient’s Eyes. | 1025 | ||
| Patient Outcomes. | 1025 | ||
| Safety Guidelines for Nursing Skills | 1026 | ||
| Skill 44-1 Aspiration Precautions | 1026 | ||
| Unexpected Outcomes and Related Interventions | 1027 | ||
| Recording and Reporting | 1027 | ||
| Skill 44-2 Inserting a Small-bore Nasoenteric Tube for Enteral Feedings | 1028 | ||
| Unexpected Outcomes and Related Interventions | 1031 | ||
| Recording and Reporting | 1031 | ||
| Skill 44-3 Administering Enteral Feedings via Nasoenteric, Gastrostomy, or Jejunostomy Tubes | 1031 | ||
| Unexpected Outcomes and Related Interventions (in addition to those in Skill 44-1) | 1035 | ||
| Recording and Reporting | 1035 | ||
| Home Care Considerations | 1035 | ||
| Skill 44-4 Blood Glucose Monitoring | 1035 | ||
| Unexpected Outcomes and Related Interventions | 1038 | ||
| Recording and Reporting | 1039 | ||
| Key Points | 1039 | ||
| Clinical Application Questions | 1039 | ||
| Preparing for Clinical Practice | 1039 | ||
| Review Questions | 1039 | ||
| Are You Ready to Test Your Nursing Knowledge? | 1039 | ||
| References | 1040 | ||
| Research References | 1041 | ||
| Chapter 45 Urinary Elimination | 1042 | ||
| Objectives | 1042 | ||
| Key Terms | 1042 | ||
| Scientific Knowledge Base | 1042 | ||
| Kidneys | 1042 | ||
| Ureters | 1044 | ||
| Bladder | 1044 | ||
| Urethra | 1044 | ||
| Act of Urination | 1044 | ||
| Factors Influencing Urination. | 1044 | ||
| Disease Conditions. | 1044 | ||
| Sociocultural Factors. | 1045 | ||
| Psychological Factors. | 1045 | ||
| Fluid Balance. | 1045 | ||
| Surgical Procedures. | 1045 | ||
| Medications. | 1046 | ||
| Diagnostic Examination. | 1046 | ||
| Alterations in Urinary Elimination. | 1046 | ||
| Urinary Retention. | 1046 | ||
| Urinary Tract Infections. | 1046 | ||
| Urinary Incontinence. | 1047 | ||
| Urinary Diversions. | 1047 | ||
| Nursing Knowledge Base | 1048 | ||
| Infection Control and Hygiene | 1048 | ||
| Factors Influencing Urination | 1048 | ||
| Growth and Development. | 1048 | ||
| Muscle Tone. | 1049 | ||
| Critical Thinking | 1049 | ||
| Nursing Process | 1049 | ||
| n n n Assessment | 1049 | ||
| Through the Patient’s Eyes. | 1049 | ||
| Identifying Urinary Alterations. | 1049 | ||
| Nursing History. | 1049 | ||
| Pattern of Urination. | 1049 | ||
| Symptoms of Urinary Alterations. | 1050 | ||
| Physical Assessment. | 1050 | ||
| Skin and Mucosal Membranes. | 1050 | ||
| Kidneys. | 1050 | ||
| Bladder. | 1051 | ||
| Urethral Meatus. | 1051 | ||
| Assessment of Urine. | 1052 | ||
| Intake and Output. | 1052 | ||
| Characteristics of Urine. | 1052 | ||
| Color. | 1052 | ||
| Clarity. | 1052 | ||
| Odor. | 1052 | ||
| Urine Testing. | 1052 | ||
| Specimen Collection. | 1052 | ||
| Urine Collection in Children. | 1052 | ||
| Common Urine Tests | 1053 | ||
| Urinalysis. | 1053 | ||
| Specific Gravity. | 1053 | ||
| Urine Culture. | 1053 | ||
| Diagnostic Examinations. | 1053 | ||
| n n n Nursing Diagnosis | 1054 | ||
| n n n Planning | 1056 | ||
| Goals and Outcomes. | 1056 | ||
| Setting Priorities. | 1056 | ||
| Teamwork and Collaboration. | 1056 | ||
| n n n Implementation | 1059 | ||
| Health Promotion. | 1059 | ||
| Patient Education. | 1059 | ||
| Promoting Normal Micturition. | 1059 | ||
| Stimulating Micturition Reflex. | 1059 | ||
| Maintaining Elimination Habits. | 1059 | ||
| Maintaining Adequate Fluid Intake. | 1059 | ||
| Promoting Complete Bladder Emptying. | 1060 | ||
| Preventing Infection. | 1060 | ||
| Acute Care | 1061 | ||
| Maintaining Elimination Habits. | 1061 | ||
| Medications. | 1061 | ||
| Catheterization. | 1061 | ||
| Types of Catheterization. | 1061 | ||
| Catheter Insertion. | 1062 | ||
| Closed Drainage Systems. | 1062 | ||
| Perineal Hygiene. | 1062 | ||
| Catheter Care. | 1062 | ||
| Fluid Intake. | 1062 | ||
| Preventing Infection. | 1062 | ||
| Catheter Irrigations and Instillations. | 1062 | ||
| Removal of Indwelling Catheter. | 1064 | ||
| Alternatives to Urethral Catheterization. | 1064 | ||
| Suprapubic Catheterization. | 1064 | ||
| Condom Catheter. | 1064 | ||
| Restorative Care. | 1066 | ||
| Strengthening Pelvic Floor Muscles. | 1066 | ||
| Bladder Retraining. | 1066 | ||
| Habit Training. | 1066 | ||
| Self-Catheterization. | 1066 | ||
| Maintenance of Skin Integrity. | 1066 | ||
| Promotion of Comfort. | 1066 | ||
| n n n Evaluation | 1067 | ||
| Through the Patient’s Eyes. | 1067 | ||
| Patient Outcomes. | 1067 | ||
| Safety Guidelines for Nursing Skills | 1067 | ||
| Skill 45-1 Collecting Midstream (Clean-Voided) Urine Specimen | 1068 | ||
| Unexpected Outcomes and Related Interventions | 1070 | ||
| Recording and Reporting | 1070 | ||
| Home Care Considerations | 1070 | ||
| Skill 45-2 Inserting a Straight or Indwelling Catheter | 1071 | ||
| Unexpected Outcomes and Related Interventions | 1078 | ||
| Recording and Reporting | 1079 | ||
| Home Care Considerations | 1079 | ||
| Skill 45-3 Indwelling Catheter Care | 1079 | ||
| Unexpected Outcomes and Related Interventions | 1081 | ||
| Recording and Reporting | 1081 | ||
| Home Care Considerations | 1081 | ||
| Skill 45-4 Closed Catheter Irrigation | 1081 | ||
| Unexpected Outcomes and Related Interventions | 1084 | ||
| Recording and Reporting | 1084 | ||
| Home Care Considerations | 1084 | ||
| Key Points | 1084 | ||
| Clinical Application Questions | 1084 | ||
| Preparing for Clinical Practice | 1084 | ||
| Review Questions | 1085 | ||
| Are You Ready to Test Your Nursing Knowledge? | 1085 | ||
| References | 1086 | ||
| Research References | 1086 | ||
| Chapter 46 Bowel Elimination | 1087 | ||
| Objectives | 1087 | ||
| Key Terms | 1087 | ||
| Scientific Knowledge Base | 1087 | ||
| Mouth | 1087 | ||
| Esophagus | 1087 | ||
| Stomach | 1088 | ||
| Small Intestine | 1088 | ||
| Large Intestine | 1088 | ||
| Anus | 1089 | ||
| Defecation | 1089 | ||
| Nursing Knowledge Base | 1089 | ||
| Factors Influencing Bowel Elimination | 1089 | ||
| Age. | 1089 | ||
| Diet. | 1089 | ||
| Fluid Intake. | 1090 | ||
| Physical Activity. | 1090 | ||
| Psychological Factors. | 1090 | ||
| Personal Habits. | 1090 | ||
| Position During Defecation. | 1090 | ||
| Pain. | 1090 | ||
| Pregnancy. | 1090 | ||
| Surgery and Anesthesia. | 1090 | ||
| Medications. | 1091 | ||
| Diagnostic Tests. | 1091 | ||
| Common Bowel Elimination Problems | 1091 | ||
| Constipation. | 1091 | ||
| Impaction. | 1091 | ||
| Diarrhea. | 1092 | ||
| Incontinence. | 1092 | ||
| Flatulence. | 1092 | ||
| Hemorrhoids. | 1092 | ||
| Bowel Diversions | 1092 | ||
| Ostomies. | 1093 | ||
| Loop Colostomy. | 1093 | ||
| End Colostomy. | 1094 | ||
| Double-Barrel Colostomy. | 1094 | ||
| Alternative Procedures | 1094 | ||
| Ileoanal Pouch Anastomosis. | 1094 | ||
| Kock Continent Ileostomy. | 1095 | ||
| Macedo-Malone Antegrade Continence Enema. | 1095 | ||
| Psychological Considerations. | 1095 | ||
| Critical Thinking | 1096 | ||
| Nursing Process | 1096 | ||
| n n n Assessment | 1096 | ||
| Through the Patient’s Eyes. | 1096 | ||
| Nursing History. | 1096 | ||
| Physical Assessment. | 1097 | ||
| Mouth. | 1097 | ||
| Abdomen. | 1097 | ||
| Rectum. | 1097 | ||
| Laboratory Tests. | 1097 | ||
| Fecal Specimens. | 1097 | ||
| Fecal Characteristics. | 1100 | ||
| Diagnostic Examinations. | 1100 | ||
| n n n Nursing Diagnosis | 1101 | ||
| n n n Planning | 1101 | ||
| Goals and Outcomes. | 1102 | ||
| Setting Priorities. | 1102 | ||
| Teamwork and Collaboration. | 1102 | ||
| n n n Implementation | 1102 | ||
| Health Promotion. | 1102 | ||
| Promotion of Normal Defecation. | 1102 | ||
| Sitting Position. | 1104 | ||
| Positioning on Bedpan. | 1104 | ||
| Privacy. | 1105 | ||
| Acute Care. | 1105 | ||
| Medications. | 1106 | ||
| Cathartics and Laxatives. | 1106 | ||
| Antidiarrheal Agents. | 1107 | ||
| Enemas. | 1107 | ||
| Cleansing Enemas. | 1107 | ||
| Tap Water. | 1107 | ||
| Normal Saline. | 1107 | ||
| Hypertonic Solutions. | 1107 | ||
| Soapsuds. | 1107 | ||
| Oil Retention. | 1107 | ||
| Other Types of Enemas. | 1107 | ||
| Enema Administration. | 1107 | ||
| Digital Removal of Stool. | 1107 | ||
| Inserting and Maintaining a Nasogastric Tube. | 1108 | ||
| Continuing and Restorative Care. | 1109 | ||
| Care of Ostomies. | 1109 | ||
| Irrigating a Colostomy. | 1109 | ||
| Pouching Ostomies. | 1109 | ||
| Nutritional Considerations for Patients with Ostomies. | 1110 | ||
| Bowel Training. | 1110 | ||
| Maintenance of Proper Fluid and Food Intake. | 1111 | ||
| Promotion of Regular Exercise. | 1111 | ||
| Hemorrhoids. | 1111 | ||
| Maintenance of Skin Integrity. | 1111 | ||
| n n n Evaluation | 1112 | ||
| Through the Patient’s Eyes. | 1112 | ||
| Patient Outcomes. | 1112 | ||
| Safety Guidelines for Nursing Skills | 1112 | ||
| Skill 46-1 Administering a Cleansing Enema | 1112 | ||
| Unexpected Outcomes and Related Interventions | 1115 | ||
| Recording and Reporting | 1115 | ||
| Home Care Considerations | 1115 | ||
| Skill 46-2 Inserting and Maintaining a Nasogastric Tube for Gastric Decompression | 1115 | ||
| Unexpected Outcomes and Related Interventions | 1120 | ||
| Recording and Reporting | 1120 | ||
| Skill 46-3 Pouching an Ostomy | 1121 | ||
| Unexpected Outcomes and Related Interventions | 1124 | ||
| Recording and Reporting | 1124 | ||
| Home Care Considerations | 1124 | ||
| Key Points | 1124 | ||
| Clinical Application Questions | 1125 | ||
| Preparing for Clinical Practice | 1125 | ||
| Review Questions | 1125 | ||
| Are You Ready to Test Your Nursing Knowledge? | 1125 | ||
| References | 1126 | ||
| Research References | 1126 | ||
| Chapter 47 Mobility and Immobility | 1127 | ||
| Objectives | 1127 | ||
| Key Terms | 1127 | ||
| Scientific Knowledge Base | 1127 | ||
| Nature of Movement | 1127 | ||
| Alignment and Balance. | 1128 | ||
| Gravity and Friction. | 1128 | ||
| Physiology and Regulation of Movement | 1128 | ||
| Skeletal System. | 1128 | ||
| Joints. | 1128 | ||
| Ligaments. | 1128 | ||
| Tendons. | 1129 | ||
| Cartilage. | 1129 | ||
| Skeletal Muscle. | 1129 | ||
| Muscle Movement and Posture. | 1130 | ||
| Muscle Regulation of Posture and Movement. | 1130 | ||
| Nervous System. | 1130 | ||
| Pathological Influences on Mobility | 1130 | ||
| Postural Abnormalities. | 1130 | ||
| Muscle Abnormalities. | 1130 | ||
| Damage to the Central Nervous System. | 1130 | ||
| Direct Trauma to the Musculoskeletal System. | 1130 | ||
| Nursing Knowledge Base | 1131 | ||
| Safe Patient Handling | 1131 | ||
| Factors Influencing Mobility-Immobility | 1132 | ||
| Systemic Effects. | 1132 | ||
| Metabolic Changes. | 1132 | ||
| Respiratory Changes. | 1132 | ||
| Cardiovascular Changes. | 1133 | ||
| Musculoskeletal Changes. | 1134 | ||
| Muscle Effects. | 1134 | ||
| Skeletal Effects. | 1134 | ||
| Urinary Elimination Changes. | 1134 | ||
| Integumentary Changes. | 1135 | ||
| Psychosocial Effects. | 1135 | ||
| Developmental Changes | 1135 | ||
| Infants, Toddlers, and Preschoolers. | 1135 | ||
| Adolescents. | 1135 | ||
| Adults. | 1135 | ||
| Older Adults. | 1135 | ||
| Critical Thinking | 1136 | ||
| Nursing Process | 1136 | ||
| n n n Assessment | 1136 | ||
| Through the Patient’s Eyes. | 1136 | ||
| Mobility. | 1136 | ||
| Range of Motion. | 1136 | ||
| Neck. | 1139 | ||
| Shoulder. | 1139 | ||
| Elbow. | 1139 | ||
| Forearm. | 1139 | ||
| Wrist. | 1139 | ||
| Fingers and Thumb. | 1139 | ||
| Hip. | 1139 | ||
| Knee. | 1139 | ||
| Ankle and Foot. | 1139 | ||
| Toes. | 1139 | ||
| Gait. | 1139 | ||
| Exercise and Activity Tolerance. | 1139 | ||
| Body Alignment. | 1140 | ||
| Standing. | 1140 | ||
| Sitting. | 1140 | ||
| Lying. | 1140 | ||
| Immobility. | 1141 | ||
| Metabolic System. | 1141 | ||
| Respiratory System. | 1141 | ||
| Cardiovascular System. | 1141 | ||
| Musculoskeletal System. | 1142 | ||
| Integumentary System. | 1142 | ||
| Elimination System. | 1142 | ||
| Psychosocial Assessment. | 1142 | ||
| Developmental Assessment. | 1142 | ||
| n n n Nursing Diagnosis | 1143 | ||
| n n n Planning | 1143 | ||
| Goals and Outcomes. | 1143 | ||
| Setting Priorities. | 1145 | ||
| Teamwork and Collaboration. | 1145 | ||
| n n n Implementation | 1145 | ||
| Health Promotion. | 1145 | ||
| Prevention of Work-Related Musculoskeletal Injuries. | 1145 | ||
| Exercise. | 1147 | ||
| Bone Health in Patients with Osteoporosis. | 1147 | ||
| Acute Care. | 1147 | ||
| Metabolic System. | 1148 | ||
| Respiratory System. | 1148 | ||
| Cardiovascular System. | 1148 | ||
| Reducing Orthostatic Hypotension. | 1148 | ||
| Reducing Cardiac Workload. | 1148 | ||
| Preventing Thrombus Formation. | 1149 | ||
| Musculoskeletal System. | 1149 | ||
| Integumentary System. | 1149 | ||
| Elimination System. | 1150 | ||
| Psychosocial Changes. | 1152 | ||
| Developmental Changes. | 1152 | ||
| Positioning Techniques. | 1152 | ||
| Supported Fowler’s Position. | 1153 | ||
| Supine Position. | 1153 | ||
| Prone Position. | 1153 | ||
| Side-Lying Position. | 1153 | ||
| Sims’ Position. | 1154 | ||
| Transfer Techniques. | 1154 | ||
| Moving Patients. | 1154 | ||
| Transferring a Patient from a Bed to a Chair. | 1155 | ||
| Transferring a Patient from a Bed to a Stretcher. | 1157 | ||
| Restorative and Continuing Care. | 1157 | ||
| Range-of-Motion Exercises. | 1158 | ||
| Walking. | 1158 | ||
| n n n Evaluation | 1158 | ||
| Through the Patient’s Eyes. | 1158 | ||
| Patient Outcomes. | 1159 | ||
| Safety Guidelines for Nursing Skills | 1159 | ||
| Skill 47-1 Moving and Positioning Patients in Bed | 1159 | ||
| Unexpected Outcomes and Related Interventions | 1166 | ||
| Recording and Reporting | 1166 | ||
| Home Care Considerations | 1166 | ||
| Skill 47-2 Using Safe and Effective Transfer Techniques | 1166 | ||
| Unexpected Outcomes and Related Interventions | 1173 | ||
| Recording and Reporting | 1173 | ||
| Home Care Considerations | 1173 | ||
| Key Points | 1173 | ||
| Clinical Application Questions | 1173 | ||
| Preparing for Clinical Practice | 1173 | ||
| Review Questions | 1174 | ||
| Are You Ready to Test Your Nursing Knowledge? | 1174 | ||
| References | 1175 | ||
| Research References | 1175 | ||
| Chapter 48 Skin Integrity and Wound Care | 1176 | ||
| Objectives | 1176 | ||
| Key Terms | 1176 | ||
| Scientific Knowledge Base | 1176 | ||
| Skin | 1176 | ||
| Pressure Ulcers | 1177 | ||
| Pathogenesis of Pressure Ulcers. | 1177 | ||
| Pressure Intensity. | 1177 | ||
| Pressure Duration. | 1178 | ||
| Tissue Tolerance. | 1178 | ||
| Risk Factors for Pressure Ulcer Development. | 1178 | ||
| Impaired Sensory Perception. | 1178 | ||
| Impaired Mobility. | 1178 | ||
| Alteration in Level of Consciousness. | 1178 | ||
| Shear. | 1178 | ||
| Friction. | 1178 | ||
| Moisture. | 1178 | ||
| Classification of Pressure Ulcers | 1179 | ||
| Stage I: Nonblanchable Redness of Intact Skin. | 1179 | ||
| Stage II: Partial-thickness Skin Loss or Blister. | 1179 | ||
| Stage III: Full-thickness Skin Loss (Fat Visible). | 1179 | ||
| Stage IV: Full-thickness Tissue Loss (Muscle/Bone Visible). | 1179 | ||
| Unstageable/Unclassified: Full-thickness Skin or Tissue Loss—Depth Unknown. | 1179 | ||
| Suspected Deep-Tissue Injury—Depth Unknown. | 1179 | ||
| Wound Classifications | 1181 | ||
| Process of Wound Healing. | 1181 | ||
| Wound Repair. | 1181 | ||
| Partial-Thickness Wound Repair. | 1181 | ||
| Full-Thickness Wound Repair. | 1182 | ||
| Hemostasis. | 1182 | ||
| Inflammatory Phase. | 1182 | ||
| Proliferative Phase. | 1183 | ||
| Remodeling. | 1183 | ||
| Complications of Wound Healing | 1183 | ||
| Hemorrhage. | 1183 | ||
| Infection. | 1183 | ||
| Dehiscence. | 1184 | ||
| Evisceration. | 1184 | ||
| Nursing Knowledge Base | 1184 | ||
| Prediction and Prevention of Pressure Ulcers | 1184 | ||
| Risk Assessment. | 1184 | ||
| Prevention. | 1184 | ||
| Economic Consequences of Pressure Ulcers. | 1184 | ||
| Factors Influencing Pressure Ulcer Formation and Wound Healing | 1184 | ||
| Nutrition. | 1184 | ||
| Tissue Perfusion. | 1186 | ||
| Infection. | 1186 | ||
| Age. | 1186 | ||
| Psychosocial Impact of Wounds. | 1186 | ||
| Critical Thinking | 1186 | ||
| Nursing Process | 1187 | ||
| n n n Assessment | 1187 | ||
| Through the Patient’s Eyes. | 1187 | ||
| Skin. | 1188 | ||
| Pressure Ulcers. | 1188 | ||
| Predictive Measures. | 1188 | ||
| Mobility. | 1188 | ||
| Nutritional Status. | 1189 | ||
| Body Fluids. | 1189 | ||
| Pain. | 1189 | ||
| Wounds. | 1189 | ||
| Emergency Setting. | 1190 | ||
| Stable Setting. | 1190 | ||
| Wound Appearance. | 1190 | ||
| Character of Wound Drainage. | 1190 | ||
| Drains. | 1190 | ||
| Wound Closures. | 1191 | ||
| Palpation of Wound. | 1191 | ||
| Wound Cultures. | 1191 | ||
| n n n Nursing Diagnosis | 1191 | ||
| n n n Planning | 1192 | ||
| Goals and Outcomes. | 1193 | ||
| Setting Priorities. | 1194 | ||
| Teamwork and Collaboration. | 1194 | ||
| n n n Implementation | 1195 | ||
| Health Promotion. | 1195 | ||
| Prevention of Pressure Ulcers. | 1195 | ||
| Topical Skin Care and Incontinence Management. | 1196 | ||
| Positioning. | 1196 | ||
| Support Surfaces (Therapeutic Beds and Mattresses). | 1197 | ||
| Acute Care | 1199 | ||
| Management of Pressure Ulcers. | 1199 | ||
| Wound Management. | 1199 | ||
| Education. | 1200 | ||
| Nutritional Status. | 1200 | ||
| Protein Status. | 1200 | ||
| Hemoglobin. | 1200 | ||
| First Aid for Wounds. | 1200 | ||
| Hemostasis. | 1200 | ||
| Cleaning. | 1200 | ||
| Protection. | 1201 | ||
| Dressings. | 1201 | ||
| Purposes of Dressings. | 1201 | ||
| Types of Dressings. | 1201 | ||
| Changing Dressings. | 1204 | ||
| Packing a Wound. | 1204 | ||
| Securing Dressings. | 1205 | ||
| Comfort Measures. | 1206 | ||
| Cleaning Skin and Drain Sites. | 1206 | ||
| Basic Skin Cleaning. | 1206 | ||
| Irrigation. | 1207 | ||
| Wound Irrigations. | 1207 | ||
| Suture Care. | 1207 | ||
| Drainage Evacuation. | 1208 | ||
| Bandages and Binders. | 1208 | ||
| Principles for Applying Bandages and Binders. | 1208 | ||
| Binder Application. | 1209 | ||
| Abdominal Binders. | 1209 | ||
| Slings. | 1209 | ||
| Bandage Application. | 1209 | ||
| Heat and Cold Therapy | 1209 | ||
| Assessment for Temperature Tolerance. | 1209 | ||
| Bodily Responses to Heat and Cold. | 1210 | ||
| Local Effects of Heat and Cold. | 1210 | ||
| Effects of Heat Application. | 1210 | ||
| Effects of Cold Application. | 1210 | ||
| Factors Influencing Heat and Cold Tolerance. | 1210 | ||
| Application of Heat and Cold Therapies. | 1210 | ||
| Choice of Moist or Dry. | 1211 | ||
| Warm, Moist Compresses. | 1211 | ||
| Warm Soaks. | 1211 | ||
| Sitz Baths. | 1212 | ||
| Commercial Hot Packs. | 1212 | ||
| Cold, Moist, and Dry Compresses. | 1212 | ||
| Cold Soaks. | 1212 | ||
| Ice Bags or Collars. | 1212 | ||
| n n n Evaluation | 1212 | ||
| Through the Patient’s Eyes. | 1212 | ||
| Patient Outcomes. | 1212 | ||
| Safety Guidelines for Nursing Skills | 1213 | ||
| Skill 48-1 Assessment for Risk for Pressure Ulcer Development | 1213 | ||
| Skill 48-2 Treating Pressure Ulcers | 1215 | ||
| Skill 48-3 Applying Dry and Moist Dressings | 1218 | ||
| Skill 48-4 Implementation of Negative-Pressure Wound Therapy | 1221 | ||
| Skill 48-5 Performing Wound Irrigation | 1224 | ||
| Skill 48-6 Applying an Abdominal Binder | 1226 | ||
| Skill 48-7 Applying an Elastic Bandage | 1228 | ||
| Key Points | 1230 | ||
| Clinical Application Questions | 1230 | ||
| Preparing for Clinical Practice | 1230 | ||
| Review Questions | 1230 | ||
| Are You Ready to Test Your Nursing Knowledge? | 1230 | ||
| References | 1231 | ||
| Research References | 1232 | ||
| Chapter 49 Sensory Alterations | 1233 | ||
| Objectives | 1233 | ||
| Key Terms | 1233 | ||
| Scientific Knowledge Base | 1233 | ||
| Normal Sensation | 1233 | ||
| Sensory Alterations | 1234 | ||
| Sensory Deficits. | 1234 | ||
| Sensory Deprivation. | 1234 | ||
| Sensory Overload. | 1235 | ||
| Nursing Knowledge Base | 1236 | ||
| Factors Influencing Sensory Function | 1236 | ||
| Age. | 1236 | ||
| Meaningful Stimuli. | 1236 | ||
| Amount of Stimuli. | 1236 | ||
| Social Interaction. | 1236 | ||
| Environmental Factors. | 1236 | ||
| Cultural Factors. | 1236 | ||
| Critical Thinking | 1236 | ||
| Nursing Process | 1237 | ||
| n n n Assessment | 1237 | ||
| Through the Patient’s Eyes. | 1237 | ||
| Persons at Risk. | 1238 | ||
| Sensory Alterations History. | 1238 | ||
| Mental Status. | 1239 | ||
| Physical Assessment. | 1239 | ||
| Ability to Perform Self-Care. | 1239 | ||
| Health Promotion Habits. | 1240 | ||
| Environmental Hazards. | 1240 | ||
| Communication Methods. | 1240 | ||
| Social Support. | 1240 | ||
| Use of Assistive Devices. | 1240 | ||
| Other Factors Affecting Perception. | 1241 | ||
| n n n Nursing Diagnosis | 1241 | ||
| n n n Planning | 1241 | ||
| Goals and Outcomes. | 1241 | ||
| Setting Priorities. | 1241 | ||
| Teamwork and Collaboration. | 1242 | ||
| n n n Implementation | 1242 | ||
| Health Promotion. | 1242 | ||
| Screening. | 1242 | ||
| Preventive Safety. | 1243 | ||
| Use of Assistive Devices. | 1245 | ||
| Promoting Meaningful Stimulation. | 1245 | ||
| Vision. | 1245 | ||
| Hearing. | 1245 | ||
| Taste and Smell. | 1245 | ||
| Touch. | 1246 | ||
| Establishing Safe Environments. | 1246 | ||
| Adaptations for Visual Loss. | 1246 | ||
| Adaptations for Reduced Hearing. | 1246 | ||
| Adaptations for Reduced Olfaction. | 1246 | ||
| Adaptations for Reduced Tactile Sensation. | 1246 | ||
| Communication. | 1246 | ||
| Acute Care. | 1247 | ||
| Orientation to the Environment. | 1247 | ||
| Communication. | 1248 | ||
| Controlling Sensory Stimuli. | 1248 | ||
| Safety Measures. | 1248 | ||
| Restorative and Continuing Care | 1249 | ||
| Maintaining Healthy Lifestyles. | 1249 | ||
| Understanding Sensory Loss. | 1249 | ||
| Socialization. | 1249 | ||
| Promoting Self-Care. | 1249 | ||
| n n n Evaluation | 1250 | ||
| Through the Patient’s Eyes. | 1250 | ||
| Patient Outcomes. | 1250 | ||
| Key Points | 1250 | ||
| Critical Application Questions | 1251 | ||
| Preparing for Clinical Practice | 1251 | ||
| Review Questions | 1251 | ||
| Are You Ready to Test Your Nursing Knowledge? | 1251 | ||
| References | 1252 | ||
| Research References | 1253 | ||
| Chapter 50 Care of Surgical Patients | 1254 | ||
| Objectives | 1254 | ||
| Key Terms | 1254 | ||
| History of Surgical Nursing | 1254 | ||
| Ambulatory Surgery | 1255 | ||
| Scientific Knowledge Base | 1255 | ||
| Classification of Surgery | 1255 | ||
| Nursing Knowledge Base | 1255 | ||
| Critical Thinking | 1255 | ||
| Preoperative Surgical Phase | 1256 | ||
| Nursing Process | 1256 | ||
| n n n Assessment | 1257 | ||
| Through the Patient’s Eyes. | 1257 | ||
| Nursing History. | 1257 | ||
| Medical History. | 1257 | ||
| Risk Factors. | 1257 | ||
| Age. | 1258 | ||
| Nutrition. | 1259 | ||
| Obesity. | 1259 | ||
| Obstructive Sleep Apnea. | 1260 | ||
| Immunocompromise. | 1260 | ||
| Fluid and Electrolyte Imbalance. | 1260 | ||
| Pregnancy. | 1260 | ||
| Perceptions and Knowledge Regarding Surgery. | 1260 | ||
| Medication History. | 1261 | ||
| Allergies. | 1261 | ||
| Smoking Habits. | 1262 | ||
| Alcohol Ingestion and Substance Use and Abuse. | 1262 | ||
| Support Sources. | 1262 | ||
| Occupation. | 1262 | ||
| Preoperative Pain Assessment. | 1262 | ||
| Review of Emotional Health. | 1262 | ||
| Self-Concept. | 1262 | ||
| Body Image. | 1262 | ||
| Coping Resources. | 1262 | ||
| Culture and Religion. | 1263 | ||
| Physical Examination. | 1263 | ||
| General Survey. | 1263 | ||
| Head and Neck. | 1263 | ||
| Integument. | 1263 | ||
| Thorax and Lungs. | 1263 | ||
| Heart and Vascular System. | 1263 | ||
| Abdomen. | 1264 | ||
| Neurological Status. | 1264 | ||
| Diagnostic Screening. | 1264 | ||
| n n n Nursing Diagnosis | 1265 | ||
| n n n Planning | 1265 | ||
| Goals and Outcomes. | 1267 | ||
| Setting Priorities. | 1267 | ||
| Teamwork and Collaboration. | 1267 | ||
| n n n Implementation | 1267 | ||
| Informed Consent. | 1267 | ||
| Health Promotion. | 1267 | ||
| Preoperative Teaching. | 1267 | ||
| Patient Cites Reasons for Preoperative Instructions and Exercises. | 1268 | ||
| Patient States Time of Surgery. | 1268 | ||
| Patient States Postoperative Unit and Location of Family During Surgery and Recovery. | 1268 | ||
| Patient Discusses Anticipated Postoperative Monitoring and Therapies. | 1268 | ||
| Patient Describes Surgical Procedures and Postoperative Treatment. | 1268 | ||
| Patient Describes Postoperative Activity Resumption. | 1268 | ||
| Patient Verbalizes Pain-Relief Measures. | 1268 | ||
| Patient Expresses Feelings Regarding Surgery. | 1268 | ||
| Acute Care. | 1268 | ||
| Physical Preparation. | 1268 | ||
| Maintaining Normal Fluid and Electrolyte Balance. | 1268 | ||
| Reducing Risk of Surgical Site Infection. | 1269 | ||
| Preventing Bowel and Bladder Incontinence. | 1269 | ||
| Promoting Rest and Comfort. | 1269 | ||
| Preparation on the Day of Surgery. | 1269 | ||
| Hygiene. | 1269 | ||
| Hair and Cosmetics. | 1269 | ||
| Removal of Prostheses. | 1270 | ||
| Safeguarding Valuables. | 1270 | ||
| Preparing the Bowel and Bladder. | 1270 | ||
| Vital Signs. | 1270 | ||
| Documentation. | 1270 | ||
| Other Procedures. | 1270 | ||
| Administering Preoperative Medications. | 1270 | ||
| Eliminating Wrong Site and Wrong Procedure Surgery. | 1270 | ||
| n n n Evaluation | 1270 | ||
| Through the Patient’s Eyes. | 1271 | ||
| Patient Outcomes. | 1271 | ||
| Transport to the Operating Room | 1271 | ||
| Intraoperative Surgical Phase | 1271 | ||
| Preoperative (Holding) Area | 1271 | ||
| Admission to the Operating Room | 1271 | ||
| Nursing Process | 1272 | ||
| n n n Assessment | 1272 | ||
| n n n Nursing Diagnosis | 1272 | ||
| n n n Planning | 1272 | ||
| Goals and Outcomes. | 1272 | ||
| Setting Priorities. | 1272 | ||
| Teamwork and Collaboration. | 1272 | ||
| n n n Implementation | 1272 | ||
| Acute Care | 1272 | ||
| Physical Preparation. | 1272 | ||
| Latex Sensitivity/Allergy. | 1272 | ||
| Introduction of Anesthesia. | 1272 | ||
| General Anesthesia. | 1272 | ||
| Regional Anesthesia. | 1273 | ||
| Local Anesthesia. | 1273 | ||
| Conscious Sedation. | 1273 | ||
| Positioning the Patient for Surgery. | 1274 | ||
| Documentation of Intraoperative Care. | 1274 | ||
| n n n Evaluation | 1274 | ||
| Through the Patient’s Eyes. | 1274 | ||
| Patient Outcomes. | 1274 | ||
| Postoperative Surgical Phase | 1274 | ||
| Immediate Postoperative Recovery (Phase I) | 1274 | ||
| Recovery in Ambulatory Surgery (Phase II) | 1275 | ||
| Postoperative Convalescence | 1276 | ||
| Nursing Process | 1277 | ||
| n n n Assessment | 1277 | ||
| Through the Patient’s Eyes. | 1277 | ||
| Airway and Respiration. | 1277 | ||
| Circulation. | 1277 | ||
| Temperature Control. | 1278 | ||
| Fluid and Electrolyte Balance. | 1278 | ||
| Neurological Functions. | 1278 | ||
| Skin Integrity and Condition of the Wound. | 1278 | ||
| Metabolism. | 1278 | ||
| Genitourinary Function. | 1278 | ||
| Gastrointestinal Function. | 1278 | ||
| Comfort. | 1279 | ||
| n n n Nursing Diagnosis | 1279 | ||
| n n n Planning | 1279 | ||
| Goals and Outcomes. | 1279 | ||
| Setting Priorities. | 1279 | ||
| Teamwork and Collaboration. | 1279 | ||
| n n n Implementation | 1280 | ||
| Acute Care. | 1280 | ||
| Maintaining Respiratory Function. | 1280 | ||
| Preventing Circulatory Complications. | 1282 | ||
| Achieving Rest and Comfort. | 1283 | ||
| Temperature Regulation. | 1284 | ||
| Maintaining Neurological Function. | 1284 | ||
| Maintaining Fluid and Electrolyte Balance. | 1284 | ||
| Promoting Normal Bowel Elimination and Adequate Nutrition. | 1284 | ||
| Promoting Urinary Elimination. | 1285 | ||
| Promoting Wound Healing. | 1285 | ||
| Maintaining/Enhancing Self-Concept. | 1285 | ||
| Restorative and Continuing Care. | 1286 | ||
| n n n Evaluation | 1286 | ||
| Through the Patient’s Eyes. | 1286 | ||
| Patient Outcomes. | 1286 | ||
| Safety Guidelines For Nursing Skills | 1287 | ||
| Skill 50-1 Demonstrating Postoperative Exercises | 1287 | ||
| Unexpected Outcomes and Related Interventions | 1292 | ||
| Recording and Reporting | 1292 | ||
| Home Care Considerations | 1292 | ||
| Key Points | 1292 | ||
| Clinical Application Questions | 1292 | ||
| Preparing for Clinical Practice | 1292 | ||
| Review Questions | 1293 | ||
| Are You Ready to Test Your Nursing Knowledge? | 1293 | ||
| References | 1294 | ||
| Research References | 1295 | ||
| GLOSSARY | 1296 | ||
| A | 1296 | ||
| B | 1297 | ||
| C | 1298 | ||
| D | 1300 | ||
| E | 1301 | ||
| F | 1301 | ||
| G | 1302 | ||
| H | 1303 | ||
| I | 1303 | ||
| J | 1304 | ||
| K | 1304 | ||
| L | 1304 | ||
| M | 1305 | ||
| N | 1306 | ||
| O | 1306 | ||
| P | 1307 | ||
| Q | 1308 | ||
| R | 1308 | ||
| S | 1309 | ||
| T | 1311 | ||
| U | 1311 | ||
| V | 1311 | ||
| W | 1312 | ||
| Y | 1312 | ||
| Z | 1312 | ||
| Index | 1313 | ||
| A | 1313 | ||
| B | 1316 | ||
| C | 1318 | ||
| D | 1323 | ||
| E | 1325 | ||
| F | 1327 | ||
| G | 1329 | ||
| H | 1330 | ||
| I | 1332 | ||
| J | 1335 | ||
| K | 1335 | ||
| L | 1336 | ||
| M | 1337 | ||
| N | 1339 | ||
| O | 1342 | ||
| P | 1343 | ||
| Q | 1348 | ||
| R | 1348 | ||
| S | 1349 | ||
| T | 1354 | ||
| U | 1356 | ||
| V | 1357 | ||
| W | 1357 | ||
| X | 1358 | ||
| Y | 1358 | ||
| Z | 1358 | ||
| Inside back cover | ibc1 |