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Medical-Surgical Nursing - E-Book

Medical-Surgical Nursing - E-Book

Sharon L. Lewis | Linda Bucher | Margaret M. Heitkemper | Shannon Ruff Dirksen

(2014)

Additional Information

Book Details

Abstract

Over the past three decades, more and more nursing educators have turned to Lewis: Medical-Surgical Nursing for its accurate and up-to-date coverage of the latest trends, hot topics, and clinical developments in the field of medical-surgical nursing — and the new ninth edition is no exception! Written by a dedicated team of expert authors led by Sharon Lewis, Medical-Surgical Nursing, 9th Edition offers the same easy-to-read style that students have come to love, along with the timely and thoroughly accurate content that educators have come to trust. Completely revised and updated content explores patient care in various clinical settings and focuses on key topics such as prioritization, critical thinking, patient safety, and NCLEX® exam preparation. Best of all — a complete collection of interactive student resources creates a more engaging learning environment to prepare you for clinical practice.

  • Highly readable format gives you a strong foundation in medical-surgical nursing.
  • Content written and reviewed by leading experts in the field ensures that the information is comprehensive, current, and clinically accurate.
  • Bridge to NCLEX Examination review questions at the end of each chapter reinforce key content while helping you prepare for the NCLEX examination with both standard and alternate item format questions.
  • UNIQUE! "Levels of Care" approach explains how nursing care varies for different levels of health and illness.
  • More than 50 comprehensive nursing care plans in the book and online incorporate NIC, NOC, and current NANDA diagnoses, defining characteristics, expected outcomes, specific nursing interventions with rationales, evaluation criteria, and collaborative problems.
  • Over 800 full-color illustrations and photographs clearly demonstrate disease processes and related anatomy and physiology.
  • NEW! Unfolding case studies included throughout each assessment chapter help you apply important concepts and procedures to real-life patient care.
    • NEW! Managing Multiple Patients case studies at the end of each section give you practice applying your knowledge of various disorders and help you prioritize and delegate patient care.
  • NEW! Informatics boxes discuss how technology is used by nurses and patients in health care settings.
  • NEW! Expanded coverage of evidence-based practice helps you understand how to apply the latest research to real-life patient care.
  • NEW! Expanded Safety Alerts throughout the book cover surveillance for high-risk situations.
  • NEW! Separate chapter on genetics expands on this key topic that impacts nearly every condition with a focus on the practical application to nursing care of patients.
  • NEW! Expanded coverage of delegation includes additional Delegation Decisions boxes covering issues such as hypertension and postoperative patient care.
  • NEW! Genetic Risk Alerts and Genetic Link headings highlight specific genetic issues related to body system assessments and disorders.
  • NEW! Revised art program enhances the book’s visual appeal and lends a more contemporary look throughout.

Table of Contents

Section Title Page Action Price
Front Cover cover
End sheet 2 IFC2
End sheet 3 IFC3
End sheet 4 IFC4
Medical-Surgical Nursing, 9/e i
Copyright Page iv
About the Authors v
Sharon L. Lewis, RN, PhD, FAAN v
Shannon Ruff Dirksen, RN, PhD, FAAN v
Margaret MCLEAN Heitkemper, RN, PhD, FAAN v
Linda Bucher, RN, PhD, CEN, CNE vi
Contributors vii
Reviewers ix
Dedication xiii
Preface xv
Organization xv
Classic Features xv
New Features xvi
Learning Supplements for Students xvi
Teaching Supplements for Instructors xvii
Acknowledgments xvii
Authors of Teaching and Learning Resources xix
Table Of Contents xxi
Special Features xxiv
Assessment Abnormalities Tables xxiv
Case Studies xxiv
End-of-Chapter Case Studies xxiv
Managing Multiple Patients Case Studies xxiv
Assessment Case Studies xxiv
Collaborative Care Tables xxiv
Complementary & Alternative Therapies Boxes xxv
Cultural & Ethnic Health Disparities Boxes xxv
Delegation Decisions Boxes xxvi
Diagnostic Studies Tables xxvi
Drug Therapy Tables xxvi
Emergency Management Tables xxvii
Ethical/Legal Dilemmas Boxes xxvii
1 Concepts in Nursing Practice 1
1 Professional Nursing Practice 2
Learning Outcomes 2
Key Terms 2
eFigures 2
eTables 2
Professional Nursing Practice 2
Domain of Nursing Practice 2
Definitions of Nursing 3
Nursing’s View of Humanity 3
Scope of Nursing Practice 3
Influences on Professional Nursing Practice 4
Complex Health Care Environments 4
Expanding Knowledge and Technology. 4
Diverse Populations. 4
Consumerism. 4
Influences on Health Care Systems 4
Health Care Financing. 4
Healthy People Initiative. 5
Supporting Professional Practice 5
Professional Nursing Organizations. 5
QSEN. 5
Patient-Centered Care 5
Delivery of Nursing Care 5
Continuum of Patient Care 6
Critical Thinking 6
Nursing Process 6
Standardized Nursing Terminologies 7
NANDA-I Nursing Diagnoses. 7
Nursing Outcomes Classification (NOC). 7
Nursing Interventions Classification (NIC). 7
NANDA-NOC-NIC Linkages. 8
Nursing Care Plans 8
Informatics and Technology 10
Information and Technology in Practice 10
Clinical Information Systems and Electronic Health Records 10
Nursing Informatics 10
Computer Languages 10
Telehealth 11
Evidence-Based Practice 11
Steps of EBP Process 12
Step 0 of EBP. 12
Step 1 of EBP. 12
Step 2 of EBP. 12
Step 3 of EBP. 12
Step 4 of EBP. 12
Step 5 of EBP. 12
Step 6 of EBP. 13
Implementing EBP 13
Safety and Quality Improvement 13
National Patient Safety Goals 13
Teamwork and Collaboration 13
Interdisciplinary Team Members 13
Coordinating Care Among Health Care Team Members 14
Communication. 14
Case Management. 14
Clinical Pathways. 15
Delegation and Assignment. 15
Bridge to NCLEX Examination 16
References 17
Resources 18
2 Health Disparities and Culturally Competent Care 19
Learning Outcomes 19
Key Terms 19
eTables 19
Determinants of Health 19
Health Disparities and Health Equity 20
Factors and Conditions Leading to Health Disparities 20
Ethnicity and Race. 21
Place and Health. 21
Income, Education, and Occupation. 22
Gender. 22
Age. 22
Sexual Orientation. 22
Health Care Provider Attitudes. 23
Culture 23
Cultural Competence 24
Cultural Diversity in the Health Care Workplace 25
Cultural Factors Affecting Health and Health Care 26
Folk Healers 26
Spirituality and Religion 26
Cross-Cultural Communication 27
Family Roles and Relationships 28
Personal Space 28
Touch 28
Nutrition 29
Immigrants and Immigration 29
Medications 29
Psychologic Factors 30
Nursing Management Reducing Health Disparities and Increasing Cultural Competency 30
Nurse’s Self-Assessment 30
Patient Assessment 31
Nursing Implementation 31
Advocacy. 31
Standardized Guidelines. 31
Communication. 32
Bridge to NCLEX Examination 33
References 34
Resources 35
3 Health History and Physical Examination 36
Learning Outcomes 36
Key Terms 36
eTables 36
Data Collection 36
Medical Focus 36
Nursing Focus 37
Types of Data 37
Interview Considerations 37
Symptom Investigation 37
Data Organization 38
Culturally Competent Care 38
Assessment 38
Nursing History: Subjective Data 38
Important Health Information 38
Past Health History. 38
Medications. 38
Allergies. 39
Surgery or Other Treatments. 39
Functional Health Patterns 39
Health Perception–Health Management Pattern. 39
Nutritional-Metabolic Pattern. 39
Elimination Pattern. 39
Activity-Exercise Pattern. 39
Sleep-Rest Pattern. 39
Cognitive-Perceptual Pattern. 39
Self-Perception–Self-Concept Pattern. 39
Role-Relationship Pattern. 41
Sexuality-Reproductive Pattern. 41
Coping–Stress Tolerance Pattern. 41
Value-Belief Pattern. 41
Physical Examination: Objective Data 41
General Survey 41
Physical Examination 41
Techniques. 41
Inspection. 41
Palpation. 41
Percussion. 41
Auscultation. 41
Equipment. 42
Organization of Examination. 42
Recording Physical Examination. 42
Types of Assessment 42
Comprehensive Assessment 42
Focused Assessment 44
Emergency Assessment 44
Using Assessment Approaches 44
Problem Identification and Nursing Diagnoses 45
Bridge to NCLEX Examination 46
References 46
4 Patient and Caregiver Teaching 47
Learning Outcomes 47
Key Terms 47
eFigures 47
eTable 47
Role of Patient and Caregiver Teaching 47
Teaching-Learning Process 48
Adult Learner 48
Adult Learning Principles. 48
Models to Promote Health. 48
Nurse as Teacher 50
Required Competencies 50
Knowledge of Subject Matter. 50
Communication Skills. 50
Challenges to Nurse-Teacher Effectiveness. 50
Caregiver Support in the Teaching-Learning Process 50
Caregiver Stress. 51
Regulatory Mandates for Patient Teaching 52
Process of Patient Teaching 52
Assessment 52
Physical Factors. 52
Psychologic Factors. 53
Sociocultural Factors 53
Health Literacy. 53
Cultural Considerations. 53
Socioeconomic Considerations. 54
Learner Factors. 54
Learning Needs. 54
Readiness to Learn. 54
Learning Style. 54
Planning 54
Setting Goals. 55
Selecting Teaching Strategies. 55
Learning Materials. 55
Implementation 57
Evaluation 57
Bridge to NCLEX Examination 59
References 59
Resources 60
5 Chronic Illness and Older Adults 61
Learning Outcomes 61
Key Terms 61
eTable 61
Chronic Illness 61
Trajectory of Chronic Illness 62
Preventing and Managing a Crisis. 63
Carrying Out Prescribed Treatment Regimens. 63
Controlling Symptoms. 63
Reordering Time. 63
Adjusting to Changes in Course of Disease. 63
Preventing Social Isolation. 63
Attempting to Normalize Interactions With Others. 63
Prevention of Chronic Illness 63
Nursing Management Chronic Illness 63
Older Adults 64
Demographics of Aging 64
Attitudes Toward Aging 64
Biologic Aging 65
Age-Related Physiologic Changes 65
Special Older Adult Populations 65
Chronically Ill Older Adults 65
Older Adult Women 65
Cognitively Impaired Older Adults 66
Rural Older Adults 66
Homeless Older Adults 67
Frail Older Adults 67
Culturally Competent Care 67
Older Adults 67
Social Support for Older Adults 67
Family Caregivers 68
Elder Mistreatment or Abuse 68
Self-Neglect 68
Social Services for Older Adults 68
Medicare and Medicaid 68
Care Alternatives for Older Adults 69
Adult Day Care and Adult Day Health Care 70
Home Health Care. 70
Long-Term Care Facilities 70
Legal and Ethical Issues 70
Nursing Management Older Adults 71
Nursing Assessment 71
Planning 71
Nursing Implementation 71
Health Promotion. 72
Acute Care. 72
Care Transitions. 72
Rehabilitation. 72
Assistive Devices. 73
Safety. 73
Medication Use. 73
Depression. 74
Use of Restraints. 75
Sleep. 75
Evaluation 75
Bridge to NCLEX Examination 76
References 77
Resources 78
6 Complementary and Alternative Therapies 79
Learning Outcomes 79
Key Terms 79
Complementary and Alternative Therapies 80
NCCAM Categories 80
Natural Products 81
Mind-Body Medicine 82
Acupuncture. 83
Manipulative and Body-Based Practices 83
Massage. 83
Massage Techniques. 84
Other CAT Practices 85
Energy Therapies. 85
Gerontologic Considerations 85
Complementary and Alternative Therapies 85
Nursing Management Complementary and Alternative Therapies 85
Professional Practice 85
Knowledge of Therapies. 85
Assessment of Complementary and Alternative Therapy Use. 85
Promoting Safe Use of Therapies. 85
Incorporating Therapies in Practice. 85
Self-Care Practice 86
Bridge to NCLEX Examination 86
References 87
Resources 87
7 Stress and Stress Management 88
Learning Outcomes 88
Key Terms 88
eTable 88
Definition of Stress 88
Factors Affecting Response to Stress 89
Physiologic Response to Stress 89
Nervous System 90
Cerebral Cortex. 90
Limbic System. 90
Reticular Formation. 90
Hypothalamus. 90
Endocrine System 90
Summary of Stress Response 90
Immune System 91
Effects of Stress on Health 92
Coping 92
Relaxation Strategies 93
Relaxation Breathing 93
Meditation 94
Imagery 94
Music for Relaxation 95
Massage 95
Nursing Management Stress 95
Nursing Assessment 95
Nursing Implementation 96
Bridge to NCLEX Examination 97
References 98
Resources 98
8 Sleep and Sleep Disorders 99
Learning Outcomes 99
Key Terms 99
eFigure 99
eTables 99
Sleep 99
Physiologic Sleep Mechanisms 100
Sleep-Wake Cycle 100
Wake Behavior. 100
Sleep Behavior. 100
Circadian Rhythms. 101
Sleep Architecture 101
NREM Sleep. 101
REM Sleep. 101
Insufficient Sleep and Sleep Disorders 101
Insomnia 101
Etiology and Pathophysiology 101
Clinical Manifestations 103
Diagnostic Studies 103
Self-Report. 103
Actigraphy. 103
Polysomnography. 103
Collaborative Care 103
Cognitive-Behavioral Therapy for Insomnia. 103
Drug Therapy. 104
Benzodiazepines. 104
Benzodiazepine-Receptor–like Agents. 104
Melatonin-Receptor Agonist. 104
Antidepressants. 104
Antihistamines. 104
Complementary and Alternative Therapies. 104
Nursing Management Insomnia 105
Nursing Assessment 105
Nursing Diagnoses 105
Nursing Implementation 105
Sleep Disturbances in the Hospital 106
Narcolepsy 106
Etiology and Pathophysiology 106
Clinical Manifestations and Diagnostic Studies 106
Nursing and Collaborative Management 107
Drug Therapy. 107
Behavioral Therapy. 107
Circadian Rhythm Disorders 107
Sleep-Disordered Breathing 107
Obstructive Sleep Apnea 107
Clinical Manifestations and Diagnostic Studies. 108
Nursing and Collaborative Management Sleep Apnea 108
Conservative Treatment 108
Surgical Treatment 109
Periodic Limb Movement Disorder 109
Gerontologic Considerations 109
Sleep 109
Parasomnias 110
Special Sleep Needs of Nurses 110
Bridge to NCLEX Examination 111
References 112
Resources 113
9 Pain 114
Learning Outcomes 114
Key Terms 114
eFigures 114
Magnitude of Pain Problem 114
Definitions and Dimensions of Pain 115
Pain Mechanisms 116
Transduction. 116
Transmission. 117
Transmission to Spinal Cord. 117
Dorsal Horn Processing. 117
Transmission to Thalamus and Cortex. 117
Perception. 118
Modulation. 118
Classification of Pain 118
Nociceptive Pain 119
Neuropathic Pain 119
Acute and Chronic Pain 119
Pain Assessment 120
Elements of a Pain Assessment 120
Pain Pattern. 120
Location. 121
Intensity. 121
Quality. 121
Associated Symptoms. 121
Management Strategies. 121
Impact of Pain. 122
Patient’s Beliefs, Expectations, and Goals. 122
Documentation 122
Reassessment 122
Pain Treatment 122
Basic Principles 122
Drug Therapy for Pain 123
Nonopioids. 123
Opioids. 124
Types of Opioids. 124
Mixed Mu Agonist Opioid and Dual Mechanism Agents. 124
Opioids to Avoid. 126
Side Effects of Opioids. 126
Adjuvant Analgesic Therapy. 127
Corticosteroids. 127
Antidepressants. 127
Antiseizure Drugs. 127
GABA Receptor Agonist. 127
α2-Adrenergic Agonists. 127
Local Anesthetics. 127
Cannabinoids. 128
Administration 129
Scheduling. 129
Titration. 129
Equianalgesic Dosing. 129
Administration Routes. 129
Oral. 129
Transmucosal and Buccal Routes. 129
Intranasal Route. 129
Rectal. 129
Transdermal Route. 129
Parenteral Routes. 130
Intraspinal Delivery. 130
Implantable Pumps. 131
Patient-Controlled Analgesia. 131
Interventional Therapy 131
Therapeutic Nerve Blocks. 131
Neuroablative Techniques. 131
Neuroaugmentation. 131
Nondrug Therapies for Pain 132
Physical Pain Relief Strategies 132
Massage. 132
Exercise. 132
Transcutaneous Electrical Nerve Stimulation. 132
Acupuncture. 132
Heat Therapy. 132
Cold Therapy. 133
Cognitive Therapies. 133
Distraction. 133
Hypnosis. 133
Relaxation Strategies. 133
Nursing and Collaborative Management Pain 133
Effective Communication 133
Challenges to Effective Pain Management 133
Tolerance. 133
Physical Dependence. 134
Pseudoaddiction. 134
Addiction. 134
Institutionalizing Pain Education and Management 135
Ethical Issues in Pain Management 135
Fear of Hastening Death by Administering Analgesics 135
Requests for Assisted Suicide 136
Use of Placebos in Pain Assessment and Treatment 136
Gerontologic Considerations 136
Pain 136
Managing Pain in Special Populations 136
Patients Unable to Self-Report Pain 136
Patients With Substance Abuse Problems 137
Bridge to NCLEX Examination 137
References 138
Resources 139
10 Palliative Care at End of Life 140
Learning Outcomes 140
Key Terms 140
Palliative Care 140
Hospice Care 141
Death 142
End-of-Life Care 142
Physical Manifestations at End of Life 142
Psychosocial Manifestations at End of Life 143
Bereavement and Grief 143
Spiritual Needs 144
Culturally Competent Care 145
End of Life 145
Legal and Ethical Issues Affecting End-of-Life Care 145
Organ and Tissue Donation 146
Advance Care Planning and Advance Directives 146
Resuscitation 146
Nursing Management End of Life 147
Nursing Assessment 147
Planning 148
Nursing Implementation 148
Psychosocial Care. 148
Anxiety and Depression. 148
Anger. 148
Hopelessness and Powerlessness. 148
Fear. 148
Fear of Pain. 148
Fear of Shortness of Breath. 149
Fear of Loneliness and Abandonment. 149
Fear of Meaninglessness. 149
Communication. 149
Physical Care. 149
Postmortem Care. 149
Special Needs of Caregivers and Nurses in End-of-Life Care 149
Special Needs of Family Caregivers 149
Special Needs of Nurses 151
Bridge to NCLEX Examination 152
References 153
Resources 153
11 Substance Abuse 154
Learning Outcomes 154
Key Terms 154
eTable 154
Common Drugs of Abuse 155
Nicotine 155
Effects of Use and Complications 155
Nursing and Collaborative Care Tobacco Use 156
Tobacco Cessation 156
Alcohol 159
Effects of Use and Complications 159
Nursing and Collaborative Care Alcohol Dependence 159
Alcohol Intoxication 159
Alcohol Withdrawal Syndrome 160
Other Drugs of Abuse 162
Stimulants 162
Nursing and Collaborative Care Stimulant Abuse 162
Overdose 162
Withdrawal 162
Depressants 162
Sedative-Hypnotics 162
Opioids 162
Nursing and Collaborative Care Depressant Abuse 163
Overdose 163
Sedative-Hypnotics. 163
2 Pathophysiologic Mechanisms of Disease 171
12 Inflammation and Wound Healing 172
Learning Outcomes 172
Key Terms 172
eFigures 172
eTables 172
Inflammatory Response 172
Vascular Response 173
Cellular Response 173
Neutrophils. 173
Monocytes. 173
Lymphocytes. 174
Chemical Mediators 174
Complement System. 174
Prostaglandins and Leukotrienes. 174
Exudate Formation 174
Clinical Manifestations 174
Fever. 174
Types of Inflammation 175
Nursing and Collaborative Management Inflammation 176
Nursing Implementation 176
Health Promotion. 176
Acute Intervention 176
Observation and Vital Signs. 176
Fever. 176
Drug Therapy. 176
RICE. 177
Rest. 177
Cold and Heat. 177
Compression and Immobilization. 177
Elevation. 177
Healing Process 177
Regeneration 177
Repair 177
Primary Intention. 177
Initial Phase. 177
Granulation Phase. 178
Maturation Phase and Scar Contraction. 178
Secondary Intention. 178
Tertiary Intention. 178
Wound Classification 178
Complications of Healing 178
Nursing and Collaborative Management Wound Healing 178
Nursing Assessment 178
Nursing Implementation 179
Red, Yellow, and Black Wounds. 180
Red Wounds. 180
Yellow Wounds. 181
Black Wounds. 181
Negative-Pressure Wound Therapy. 181
Hyperbaric Oxygen Therapy. 182
Drug Therapy. 183
Nutritional Therapy. 183
Infection Prevention and Control. 184
Psychologic Implications. 184
Patient Teaching. 184
Pressure Ulcers 184
Etiology and Pathophysiology 184
Clinical Manifestations 184
Nursing and Collaborative Management Pressure Ulcers 185
Nursing Assessment 186
Nursing Diagnoses 186
Planning 186
Nursing Implementation 186
Health Promotion. 186
Acute Intervention. 186
Ambulatory and Home Care. 188
Evaluation 188
Bridge to NCLEX Examination 188
References 189
Resources 189
13 Genetics and Genomics 190
Learning Outcomes 190
Key Terms 190
eFigure 190
Genetics and Genomics 190
Basic Principles of Genetics 190
Genes. 190
Chromosomes. 191
DNA. 191
RNA. 192
Protein Synthesis. 192
Mitosis. 192
Meiosis. 192
Genetic Mutations 192
Types of Mutations. 193
Inheritance Patterns 193
Human Genome Project 194
Genetic Disorders 194
Classification of Genetic Disorders 194
Single Gene Disorders. 194
Multifactorial Genetic Disorders. 194
Epigenetics. 194
Chromosome Disorders. 195
Genetic Testing 195
Interpreting Genetic Test Results 197
Direct-to-Consumer Genetic Tests 197
Genetic Technology 197
DNA Finger Printing. 197
DNA Microarray (DNA Chip). 197
Genome-Wide Association Study (GWAS) 198
Pharmacogenetics and Pharmacogenomics 198
Gene Therapy 199
Stem Cell Therapy 200
Nursing Management Genetics and Genomics 200
Nursing Assessment Family History 201
Bridge to NCLEX Examination 202
References 202
Resources 202
14 Altered Immune Responses and Transplantation 203
Learning Outcomes 203
Key Terms 203
eFigures 203
eTables 203
Normal Immune Response 203
Antigens 203
Types of Immunity 204
Innate Immunity. 204
Acquired Immunity. 204
Active Acquired Immunity. 204
Passive Acquired Immunity. 204
Lymphoid Organs 204
Cells Involved in Immune Response 204
Mononuclear Phagocytes. 204
Lymphocytes. 205
B Lymphocytes. 205
T Lymphocytes. 205
T Cytotoxic Cells. 205
T Helper Cells. 205
Natural Killer Cells. 205
Dendritic Cells. 206
Cytokines 206
Comparison of Humoral and Cell-Mediated Immunity 207
Humoral Immunity. 207
Cell-Mediated Immunity. 208
Gerontologic Considerations 208
Effects of Aging on the Immune System 208
Altered Immune Response 209
Hypersensitivity Reactions 209
Type I: IgE-Mediated Reactions. 209
Anaphylaxis. 210
Atopic Reactions. 210
Type II: Cytotoxic and Cytolytic Reactions. 211
Hemolytic Transfusion Reactions. 211
Goodpasture Syndrome. 212
Type III: Immune-Complex Reactions. 212
Type IV: Delayed Hypersensitivity Reactions. 212
Contact Dermatitis. 212
Microbial Hypersensitivity Reactions. 212
Allergic Disorders 212
Assessment 212
Diagnostic Studies 213
Skin Tests. 213
Procedure. 213
Results. 213
Precautions. 214
Collaborative Care 214
Anaphylaxis. 214
Chronic Allergies. 214
Allergen Recognition and Control. 214
Drug Therapy. 215
Antihistamines. 215
Sympathomimetic/Decongestant Drugs. 215
Corticosteroids. 215
Antipruritic Drugs. 215
Mast Cell–Stabilizing Drug. 215
Leukotriene Receptor Antagonists. 215
Immunotherapy. 215
Mechanism of Action. 215
Method of Administration. 215
Subcutaneous Immunotherapy. 215
Sublingual Immunotherapy. 215
Nursing Management Immunotherapy 215
Latex Allergies 216
Types of Latex Allergies. 216
Latex-Food Syndrome. 216
Nursing and Collaborative Management Latex Allergies 216
Multiple Chemical Sensitivity 216
Autoimmunity 217
Autoimmune Diseases 217
Apheresis 217
Plasmapheresis. 218
Immunodeficiency Disorders 218
Primary Immunodeficiency Disorders 218
Secondary Immunodeficiency Disorders 218
Human Leukocyte Antigen System 219
Human Leukocyte Antigen and Disease Associations 219
Organ Transplantation 219
Tissue Typing 220
HLA Typing. 220
Panel of Reactive Antibodies. 220
Crossmatch. 220
Transplant Rejection 221
Hyperacute Rejection. 221
Acute Rejection. 221
Chronic Rejection. 221
Immunosuppressive Therapy 221
Calcineurin Inhibitors. 222
Sirolimus. 223
Mycophenolate Mofetil. 223
Monoclonal Antibodies. 223
Polyclonal Antibody. 223
Graft-Versus-Host Disease 223
Bridge to NCLEX Examination 224
References 225
Resource 225
15 Infection and Human Immunodeficiency Virus Infection 226
Learning Outcomes 226
Key Terms 226
eTables 226
Infections 226
Types of Pathogens 227
Emerging Infections 228
Reemerging Infections 228
Antibiotic-Resistant Organisms 229
Health Care–Associated Infections 230
Gerontologic Considerations 230
Infections in Older Adults 230
Infection Prevention and Control 231
Occupational Safety and Health Administration (OSHA) Guidelines 231
Infection Precautions 231
Human Immunodeficiency Virus Infection 231
Significance of Problem 231
Transmission of HIV 231
Sexual Transmission. 232
Contact With Blood and Blood Products. 232
Perinatal Transmission. 232
Pathophysiology 232
Clinical Manifestations and Complications 233
Acute Infection. 233
Chronic HIV Infection 234
Asymptomatic Infection. 234
Symptomatic Infection. 234
AIDS. 234
Diagnostic Studies 235
Diagnosis of HIV Infection. 235
Laboratory Studies in HIV Infection. 235
Collaborative Care 235
Drug Therapy for HIV Infection. 237
Drug Therapy for Opportunistic Diseases. 238
Preventing Transmission of HIV. 238
Nursing Management HIV Infection 238
Nursing Assessment 238
Planning 238
Nursing Implementation 238
Health Promotion. 239
Prevention of HIV Infection. 239
Decreasing Risks Related to Sexual Intercourse. 240
Decreasing Risks Related to Drug Use. 241
Decreasing Risks of Perinatal Transmission. 241
Decreasing Risks at Work. 241
HIV Testing. 241
Acute Intervention 241
Early Intervention. 241
Initial Response to Diagnosis of HIV. 241
Antiretroviral Therapy. 241
Delaying Disease Progression. 242
Acute Exacerbations. 242
Ambulatory and Home Care. 243
Stigma of HIV. 243
Disease and Drug Side Effects. 243
End-of-Life Care. 243
Evaluation 244
Gerontologic Considerations 244
HIV Infection 244
Bridge to NCLEX Examination 245
References 245
Resources 246
16 Cancer 247
Learning Outcomes 247
Key Terms 247
eFigure 247
eTables 247
Biology of Cancer 248
Defect in Cell Proliferation 248
Defect in Cell Differentiation 249
Genetic Link 249
Development of Cancer 250
Initiation. 250
Genetic Link 250
Carcinogens. 250
Chemical Carcinogens. 250
Radiation. 250
Viral Carcinogens. 251
Promotion. 251
Progression. 251
Role of the Immune System 252
Escape Mechanisms From Immunologic Surveillance. 253
Oncofetal Antigens and Tumor Markers. 253
Benign Versus Malignant Neoplasms 253
Classification of Cancer 253
Anatomic Site Classification 254
Histologic Classification 254
Extent of Disease Classification 254
Clinical Staging. 254
TNM Classification System. 254
Prevention and Early Detection of Cancer 255
Diagnosis of Cancer 255
Biopsy. 256
Collaborative Care 256
Treatment Goals 256
Cure. 257
Control. 257
Palliation. 257
Surgical Therapy 258
Prevention 258
Cure or Control 258
Supportive and Palliative Care 258
Chemotherapy 258
Effect on Cells 259
Classification of Chemotherapy Drugs 259
Preparation of Chemotherapy 260
Methods of Administration 260
Regional Chemotherapy Administration 261
Intraarterial Chemotherapy. 261
Intraperitoneal Chemotherapy. 261
Intrathecal or Intraventricular Chemotherapy. 261
Intravesical Bladder Chemotherapy. 261
Effects of Chemotherapy on Normal Tissues 261
Treatment Plan 262
Radiation Therapy 262
Effects of Radiation 262
Principles of Radiobiology 262
Simulation and Treatment Planning 263
Treatment 263
External Radiation. 263
Internal Radiation. 264
Nursing Management Chemotherapy and Radiation Therapy 265
Nursing Implementation 265
Bone Marrow Suppression. 265
Fatigue. 265
Gastrointestinal Effects. 265
Nausea and Vomiting. 268
Diarrhea. 268
Mucositis. 268
Anorexia. 269
Skin Reactions 269
Radiation Skin Changes. 269
Chemotherapy Skin Changes. 269
Pulmonary Effects. 270
Cardiovascular Effects. 270
Reproductive Effects. 270
Coping with Therapy. 271
Late Effects of Radiation and Chemotherapy 271
Biologic and Targeted Therapy 271
Side Effects of Biologic and Targeted Therapy 273
Nursing Management Biologic and Targeted Therapy 273
Hematopoietic Growth Factors 273
Hematopoietic Stem Cell Transplantation 274
Types of Hematopoietic Stem Cell Transplants 274
Procedures 275
Harvest Procedures. 275
Preparative Regimens and Stem Cell Infusions. 275
Complications. 276
Gene Therapy 276
Complications Resulting From Cancer 276
Nutritional Problems 276
Malnutrition 276
Altered Taste Sensation (Dysgeusia) 277
Infection 277
Oncologic Emergencies 277
Obstructive Emergencies 277
Superior Vena Cava Syndrome. 277
Spinal Cord Compression. 277
Third Space Syndrome. 277
Metabolic Emergencies 277
Syndrome of Inappropriate Antidiuretic Hormone Secretion. 278
Hypercalcemia. 278
Tumor Lysis Syndrome. 278
Infiltrative Emergencies 278
Cardiac Tamponade. 278
Carotid Artery Rupture. 278
Cancer Pain 279
Pain Assessment 279
Pain Management 279
Psychologic Support 279
Gerontologic Considerations 280
Cancer 280
Cancer Survivorship 281
Culturally Competent Care 281
Cancer 281
Bridge to NCLEX Examination 282
References 283
Resources 284
17 Fluid, Electrolyte, and Acid-Base Imbalances 285
Learning Outcomes 285
Key Terms 285
Homeostasis 285
Water Content of the Body 286
Body Fluid Compartments 286
Calculation of Fluid Gain or Loss 286
Electrolytes 286
Measurement of Electrolytes 286
Electrolyte Composition of Fluid Compartments 286
Mechanisms Controlling Fluid and Electrolyte Movement 287
Diffusion 287
Facilitated Diffusion 287
Active Transport 287
Osmosis 287
Measurement of Osmolality. 288
Osmotic Movement of Fluids. 288
Hydrostatic Pressure 288
Oncotic Pressure 288
Fluid Movement in Capillaries 288
Fluid Shifts 289
Shifts of Plasma to Interstitial Fluid. 289
Elevation of Venous Hydrostatic Pressure. 289
Decrease in Plasma Oncotic Pressure. 289
Elevation of Interstitial Oncotic Pressure. 289
Shifts of Interstitial Fluid to Plasma. 289
Fluid Spacing 289
Regulation of Water Balance 289
Hypothalamic-Pituitary Regulation 289
Renal Regulation 289
Adrenal Cortical Regulation 290
Cardiac Regulation 290
Gastrointestinal Regulation 290
Insensible Water Loss 291
Gerontologic Considerations 291
Fluid and Electrolytes 291
Fluid and Electrolyte Imbalances 291
Extracellular Fluid Volume Imbalances 291
Fluid Volume Deficit 291
3 Perioperative Care 316
18 Nursing Management 317
Learning Outcomes 317
Key Terms 317
Surgical Settings 318
Patient Interview 318
Nursing Assessment of Preoperative Patient 318
Subjective Data 319
Psychosocial Assessment. 319
Anxiety. 319
Common Fears. 319
Hope. 320
Past Health History. 320
Medications. 320
Allergies. 321
Review of Systems. 321
Cardiovascular System. 321
Respiratory System. 321
Neurologic System. 321
Genitourinary System. 322
Hepatic System. 322
Integumentary System. 322
Musculoskeletal System. 322
Endocrine System. 322
Immune System. 322
Fluid and Electrolyte Status. 322
Nutritional Status. 322
Objective Data 323
Physical Examination. 323
Laboratory and Diagnostic Testing. 323
Nursing Management Preoperative Patient 323
Preoperative Teaching 323
General Surgery Information. 324
Ambulatory Surgery Information. 325
Legal Preparation For Surgery 325
Consent for Surgery. 325
Day-of-Surgery Preparation 327
Nursing Role. 327
Preoperative Medications. 327
Transportation to the Operating Room 328
Culturally Competent Care 328
Preoperative Patient 328
Gerontologic Considerations 329
Preoperative Patient 329
Bridge to NCLEX Examination 330
References 331
Resources 332
19 Nursing Management 333
Learning Outcomes 333
Key Terms 333
eFigures 333
eTable 333
Physical Environment of Operating Room 333
Department Layout 333
Holding Area 334
Operating Room 334
Surgical Team 334
Registered Nurse 334
Licensed Practical/Vocational Nurse and Surgical Technologist 335
Surgeon and Assistant 335
Registered Nurse First Assistant 336
Anesthesia Care Provider 336
Nursing Management Patient before Surgery 337
Psychosocial Assessment 337
Physical Assessment 337
Chart Review 337
Admitting the Patient 337
Nursing Management Patient During Surgery 337
Room Preparation 337
Transferring Patient 338
Scrubbing, Gowning, and Gloving 338
Basic Aseptic Technique 338
Assisting Anesthesia Care Provider 338
Safety Considerations 339
Positioning Patient 339
Preventing Hypothermia 340
Preparing Surgical Site 340
Patient After Surgery 340
Anesthesia 340
Classification of Anesthesia 340
General Anesthesia 341
Intravenous Agents. 341
Inhalation Agents. 341
Adjuncts to General Anesthesia. 341
Dissociative Anesthesia. 342
Local and Regional Anesthesia 342
Methods of Administration. 344
Spinal and Epidural Anesthesia. 345
Gerontologic Considerations 345
Patient during Surgery 345
Catastrophic Events in Operating Room 345
Anaphylactic Reactions 346
Malignant Hyperthermia 346
Future Considerations 346
Bridge to NCLEX Examination 347
References 347
Resources 348
20 Nursing Management 349
Learning Outcomes 349
Key Terms 349
eTable 349
Postoperative Care of the Surgical Patient 349
Postanesthesia Care Unit Admission 349
PACU Progression. 349
Phase I Initial Assessment. 350
Respiratory Problems 351
Etiology 351
PACU. 351
Clinical Unit. 353
Nursing Management Respiratory Problems 353
Nursing Assessment 353
Nursing Diagnoses 354
Nursing Implementation 354
Cardiovascular Problems 355
Etiology 355
PACU. 355
Clinical Unit. 355
Nursing Management Cardiovascular Problems 356
Nursing Assessment 356
Nursing Diagnoses 356
Nursing Implementation 356
PACU. 356
Clinical Unit. 356
Neurologic and Psychologic Problems 357
4 Problems Related to Altered Sensory Input 367
21 Nursing Assessment 368
Learning Outcomes 368
Key Terms 368
eFigures 368
eTable 368
Visual System 368
Structures and Functions of Visual System 368
Structures and Functions of Vision 369
Eyeball. 369
Refractive Media. 369
Refractive Errors. 369
Visual Pathways. 369
External Structures and Functions 369
Internal Structures and Functions 370
Gerontologic Considerations 371
Effects of Aging on Visual System 371
Assessment of Visual System 371
Subjective Data 371
Important Health Information 371
Past Health History. 371
Medications. 372
Surgery or Other Treatments. 372
Functional Health Patterns. 372
Health Perception–Health Management Pattern. 372
Nutritional-Metabolic Pattern. 373
Elimination Pattern. 373
Activity-Exercise Pattern. 373
Sleep-Rest Pattern. 373
Cognitive-Perceptual Pattern. 373
Self-Perception–Self-Concept Pattern. 373
Role-Relationship Pattern. 373
Sexuality-Reproductive Pattern. 374
Coping–Stress Tolerance Pattern. 374
Value-Belief Pattern. 374
Objective Data 374
Physical Examination. 374
Initial Observation. 374
Assessing Functional Status 374
Visual Acuity. 374
Extraocular Muscle Functions. 375
Pupil Function and Intraocular Pressure. 375
Assessing Structures. 375
Eyebrows, Eyelashes, and Eyelids. 375
Conjunctiva and Sclera. 375
Cornea. 377
Iris. 377
Retina and Optic Nerve. 377
Special Assessment Techniques 377
Color Vision. 377
Stereopsis. 377
Diagnostic Studies of Visual System 377
Auditory System 377
Structures and Functions of Auditory System 377
External Ear 377
Middle Ear 378
Inner Ear 378
Transmission of Sound. 378
Gerontologic Considerations 379
Effects of Aging on Auditory System 379
Assessment of Auditory System 379
Subjective Data 379
Important Health Information 379
Past Health History. 379
Medications. 380
Surgery or Other Treatments. 381
Functional Health Patterns. 381
Health Perception–Health Management Pattern. 381
Nutritional-Metabolic Pattern. 381
Elimination Pattern. 381
Activity-Exercise Pattern. 381
Sleep-Rest Pattern. 381
Cognitive-Perceptual Pattern. 381
Self-Perception–Self-Concept Pattern. 381
Role-Relationship Pattern. 381
Sexuality-Reproductive Pattern. 381
Coping–Stress Tolerance Pattern. 381
Value-Belief Pattern. 381
Objective Data 381
Physical Examination. 381
External Ear. 382
External Auditory Canal and Tympanum. 382
Diagnostic Studies of Auditory System 382
Tests for Hearing Acuity 382
Tuning Fork Tests. 382
Audiometry. 382
Screening Audiometry. 384
Specialized Tests 384
Test for Vestibular Function 384
Bridge to NCLEX Examination 384
References 385
Resources 385
22 Nursing Management 386
Learning Outcomes 386
Key Terms 386
eFigures 386
eTables 386
Visual Problems 387
Correctable Refractive Errors 387
Nonsurgical Corrections 387
Corrective Glasses. 387
Contact Lenses. 387
Surgical Therapy 387
Laser. 387
Implant. 387
Uncorrectable Visual Impairment 388
Nursing Management Visual Impairment 388
Nursing Assessment 388
Planning 388
Nursing Implementation 388
Health Promotion. 388
Acute Intervention. 388
Ambulatory and Home Care. 388
Optical Devices for Vision Enhancement. 389
Nonoptical Methods for Vision Enhancement. 389
Evaluation 389
Gerontologic Considerations 389
Visual Impairment 389
Eye Trauma 389
Extraocular Disorders 389
Inflammation and Infection 389
Conjunctivitis 390
Bacterial Infections. 390
Viral Infections. 390
Chlamydial Infections. 390
Allergic Conjunctivitis. 391
Keratitis 391
Bacterial Infections. 391
Viral Infections. 391
Other Causes of Keratitis. 391
Corneal Ulcer. 391
Nursing Management Inflammation and Infection 392
Dry Eye Disorders 392
Strabismus 392
Corneal Disorders 392
Corneal Scars and Opacities 392
Keratoconus 392
Intraocular Disorders 393
Cataract 393
Etiology and Pathophysiology 393
Clinical Manifestations and Diagnostic Studies 393
Collaborative Care 393
Nonsurgical Therapy. 393
Surgical Therapy. 393
Preoperative Phase. 393
Intraoperative Phase. 394
Postoperative Phase. 394
Nursing Management Cataracts 394
Nursing Assessment 394
Nursing Diagnoses 394
Planning 394
Nursing Implementation 394
Health Promotion. 394
Acute Intervention. 394
Ambulatory and Home Care. 395
Evaluation 395
Gerontologic Considerations 395
Cataracts 395
Retinopathy 395
Retinal Detachment 396
Etiology and Pathophysiology 396
Clinical Manifestations and Diagnostic Studies 396
Collaborative Care 396
Surgical Therapy 396
Laser Photocoagulation and Cryopexy. 396
Scleral Buckling. 397
Intraocular Procedures. 397
Postoperative Considerations. 397
Age-Related Macular Degeneration 397
Etiology and Pathophysiology 397
Clinical Manifestations and Diagnostic Studies 398
Collaborative Care 398
Glaucoma 398
Etiology and Pathophysiology 398
Clinical Manifestations 398
Diagnostic Studies 399
Collaborative Care 399
Chronic Open-Angle Glaucoma 399
Acute Angle-Closure Glaucoma. 399
Nursing Management Glaucoma 401
Nursing Assessment 401
Nursing Diagnoses 401
Planning 401
Nursing Implementation 401
Health Promotion. 401
Acute Intervention. 401
Ambulatory and Home Care. 401
Evaluation 401
Gerontologic Considerations 401
Glaucoma 401
Intraocular Inflammation and Infection 401
Ocular Tumors 402
Enucleation 402
Ocular Manifestations of Systemic Diseases 402
Auditory Problems External Ear and Canal 402
Trauma 402
External Otitis 403
Nursing and Collaborative Management External Otitis 403
Cerumen and Foreign Bodies in External Ear Canal 403
Malignancy of External Ear 403
Middle Ear and Mastoid 404
Otitis Media 404
Acute Otitis Media 404
Otitis Media With Effusion 404
Chronic Otitis Media and Mastoiditis 404
Nursing and Collaborative Management Chronic Otitis Media 404
Otosclerosis 405
Inner Ear Problems 405
Ménière’s Disease 405
Nursing and Collaborative Management Ménière’s Disease 405
Benign Paroxysmal Positional Vertigo 406
Acoustic Neuroma 406
Hearing Loss and Deafness 406
Types of Hearing Loss 406
Conductive Hearing Loss. 406
Sensorineural Hearing Loss. 407
Mixed Hearing Loss. 407
Central and Functional Hearing Loss. 407
Classification of Hearing Loss. 407
Clinical Manifestations 407
Tinnitus and Hearing Loss. 407
Nursing and Collaborative Management Hearing Loss and Deafness 408
Health Promotion 408
Environmental Noise Control. 408
Immunizations. 408
Ototoxic Substances. 409
Assistive Devices and Techniques 409
Hearing Aids. 409
Speech Reading. 410
Sign Language. 410
Cochlear Implant. 410
Assisted Listening Devices. 410
Gerontologic Considerations 410
Hearing Loss 410
Bridge to NCLEX Examination 412
References 412
Resources 413
23 Nursing Assessment 414
Learning Outcomes 414
Key Terms 414
Structures and Functions of Skin and Appendages 414
Structures 414
Epidermis. 414
Dermis. 415
Subcutaneous Tissue. 415
Skin Appendages. 415
Functions of Integumentary System 416
Gerontologic Considerations 416
Effects of Aging on Integumentary System 416
Assessment of Integumentary System 417
Subjective Data 417
Important Health Information 417
Past Health History. 417
Medications. 418
Surgery or Other Treatments. 418
Functional Health Patterns 418
Health Perception–Health Management Pattern. 418
Nutritional-Metabolic Pattern. 419
Elimination Pattern. 419
Activity-Exercise Pattern. 419
Sleep-Rest Pattern. 419
Cognitive-Perceptual Pattern. 419
Self-Perception–Self-Concept Pattern. 419
Role-Relationship Pattern. 419
Sexuality-Reproductive Pattern. 419
Coping–Stress Tolerance Pattern. 419
Value-Belief Pattern. 419
Objective Data 419
Physical Examination. 419
Inspection. 419
Palpation. 422
Assessment of Dark Skin 423
Diagnostic Studies of Integumentary System 424
Bridge to NCLEX Examination 425
References 426
Resources 426
24 Nursing Management 427
Learning Outcomes 427
Key Terms 427
eFigures 427
eTable 427
Health Promotion 427
Environmental Hazards 427
Sun Exposure. 427
Irritants and Allergens. 429
Radiation. 430
Rest and Sleep 430
Exercise 430
Hygiene 430
Nutrition 430
Self-Treatment 430
Malignant Skin Neoplasms 430
Risk Factors 431
Nonmelanoma Skin Cancers 431
Actinic Keratosis 431
Basal Cell Carcinoma 431
Squamous Cell Carcinoma 431
Malignant Melanoma 432
Clinical Manifestations 433
Collaborative Care 433
Atypical or Dysplastic Nevus 434
Skin Infections and Infestations 435
Bacterial Infections 435
Viral Infections 435
Fungal Infections 435
Infestations and Insect Bites 437
Allergic Dermatologic Problems 437
Benign Dermatologic Problems 437
Diseases with Dermatologic Manifestations 438
Collaborative Care Dermatologic Problems 440
Diagnostic Studies 440
Collaborative Therapy 440
Phototherapy. 440
Radiation Therapy. 440
Laser Technology. 440
Drug Therapy 441
Antibiotics. 441
Corticosteroids. 441
Antihistamines. 441
Topical Fluorouracil. 441
Immunomodulators. 442
Diagnostic and Surgical Therapy 442
Skin Scraping. 442
Electrodesiccation and Electrocoagulation. 442
Curettage. 442
Punch Biopsy. 442
Cryosurgery. 442
Excision. 442
Nursing Management Dermatologic Problems 443
Ambulatory and Home Care 443
Wet Dressings. 443
Baths. 443
Topical Medications. 443
Control of Pruritus. 443
Prevention of Spread. 444
Prevention of Secondary Infections. 444
Specific Skin Care. 444
Psychologic Effects of Chronic Dermatologic Problems. 444
Physiologic Effects of Chronic Dermatologic Problems. 444
Cosmetic Procedures 445
Elective Surgery 445
Laser Surgery. 445
Face-Lift. 445
Liposuction. 446
Nursing Management Cosmetic Surgery 446
Preoperative Management 446
Postoperative Management 446
Skin Grafts 447
Uses 447
Types 447
Bridge to NCLEX Examination 448
References 448
Resources 449
25 Nursing Management 450
Learning Outcomes 450
Key Terms 450
eFigure 450
Types of Burn Injury 451
Thermal Burns 451
Chemical Burns 451
Smoke and Inhalation Injury 451
Metabolic Asphyxiation. 452
Upper Airway Injury. 452
Lower Airway Injury. 452
Electrical Burns 452
Cold Thermal Injury 452
Classification of Burn Injury 453
Depth of Burn 453
Extent of Burn 453
Location of Burn 453
Patient Risk Factors 454
Phases of Burn Management 454
Prehospital Care 454
Emergent Phase 455
Pathophysiology 457
Fluid and Electrolyte Shifts. 457
Inflammation and Healing. 458
Immunologic Changes. 458
Clinical Manifestations 458
Complications 458
Cardiovascular System. 458
Respiratory System. 459
Other Cardiopulmonary Problems. 459
Urinary System. 459
Nursing and Collaborative Management Emergent Phase 459
Airway Management 459
Fluid Therapy 459
Wound Care 461
Other Care Measures 462
Drug Therapy 462
Analgesics and Sedatives. 462
Tetanus Immunization. 462
Antimicrobial Agents. 462
Venous Thromboembolism Prophylaxis. 463
Nutritional Therapy 463
Acute Phase 464
Pathophysiology 464
Clinical Manifestations 464
Laboratory Values 464
Sodium. 464
Potassium. 464
Complications 464
Infection. 464
Cardiovascular and Respiratory Systems. 464
Neurologic System. 464
Musculoskeletal System. 465
Gastrointestinal System. 465
Endocrine System. 465
Nursing and Collaborative Management Acute Phase 465
Wound Care 465
Excision and Grafting 465
Cultured Epithelial Autografts. 466
Artificial Skin. 466
Pain Management 467
Physical and Occupational Therapy 467
Nutritional Therapy 467
Rehabilitation Phase 468
Pathophysiologic Changes and Clinical Manifestations 468
Complications 468
Nursing and Collaborative Management Rehabilitation Phase 468
Gerontologic Considerations 469
Burns 469
Emotional/Psychologic Needs of Patients and Caregivers 469
Special Needs of Nurses 470
Bridge to NCLEX Examination 471
References 471
Resources 472
5 Problems of Oxygenation: Ventilation 474
26 Nursing Assessment 475
Learning Outcomes 475
Key Terms 475
eFigures 475
eTable 475
Structures and Functions of Respiratory System 475
Upper Respiratory Tract 475
Lower Respiratory Tract 476
Surfactant. 477
Blood Supply. 477
Chest Wall 478
Physiology of Respiration 478
Ventilation. 478
Compliance. 478
Diffusion. 478
Arterial Blood Gases. 478
Mixed Venous Blood Gases. 479
Oximetry. 479
Carbon Dioxide Monitoring. 479
Control of Respiration 480
Chemoreceptors. 480
Mechanical Receptors. 480
Respiratory Defense Mechanisms 480
Filtration of Air. 480
Mucociliary Clearance System. 480
Cough Reflex. 481
Reflex Bronchoconstriction. 481
Alveolar Macrophages. 481
Gerontologic Considerations 481
Effects of Aging on Respiratory System 481
Assessment of Respiratory System 481
Subjective Data 482
Important Health Information 482
Past Health History. 482
Medications. 482
Surgery or Other Treatments. 482
Functional Health Patterns. 482
Health Perception–Health Management Pattern. 482
Nutritional-Metabolic Pattern. 484
Elimination Pattern. 484
Activity-Exercise Pattern. 484
Sleep-Rest Pattern. 484
Cognitive-Perceptual Pattern. 484
Self-Perception–Self-Concept Pattern. 484
Role-Relationship Pattern. 484
Sexuality-Reproductive Pattern. 484
Coping–Stress Tolerance Pattern. 485
Value-Belief Pattern. 485
Objective Data 485
Physical Examination. 485
Nose. 485
Mouth and Pharynx. 485
Neck. 485
Thorax and Lungs. 485
Inspection. 485
Palpation. 486
Percussion. 486
Auscultation. 487
Diagnostic Studies of Respiratory System 490
Sputum Studies 490
Skin Tests 490
Endoscopic Examinations 490
Bronchoscopy. 490
Lung Biopsy 493
Thoracentesis 494
Pulmonary Function Tests 494
Bridge to NCLEX Examination 495
References 496
Resources 496
27 Nursing Management 497
Learning Outcomes 497
Key Terms 497
eFigure 497
Problems of Nose and Paranasal Sinuses 497
Deviated Septum 497
Nasal Fracture 497
Rhinoplasty 498
Nursing Management Nasal Surgery 498
Epistaxis 498
Nursing and Collaborative Management Epistaxis 499
Allergic Rhinitis 499
Clinical Manifestations 500
Nursing and Collaborative Management Allergic Rhinitis 500
Acute Viral Rhinitis 500
Nursing and Collaborative Management Acute Viral Rhinitis 502
Influenza 503
Etiology and Pathophysiology 503
Clinical Manifestations 503
Diagnostic Studies 503
Nursing and Collaborative Management Influenza 504
Sinusitis 504
Clinical Manifestations 505
Nursing and Collaborative Management Sinusitis 505
Obstruction of Nose and Sinuses 506
Nasal Polyps 506
Foreign Bodies 506
Problems of Pharynx 506
Acute Pharyngitis 506
Clinical Manifestations 506
Nursing and Collaborative Management Acute Pharyngitis 506
Peritonsillar Abscess 507
Problems of Trachea and Larynx 507
Airway Obstruction 507
Tracheostomy 507
Nursing Management Tracheostomy 508
Providing Tracheostomy Care 508
Swallowing Dysfunction 510
Speech With a Tracheostomy Tube 511
Decannulation 512
Laryngeal Polyps 512
Head and Neck Cancer 512
Clinical Manifestations 512
Diagnostic Studies 513
Collaborative Care 513
Nutritional Therapy. 514
Nursing Management Head and Neck Cancer 514
Nursing Assessment 514
Nursing Diagnoses 515
Planning 515
Nursing Implementation 515
Health Promotion. 515
Acute Intervention. 515
Radiation Therapy. 515
Surgical Therapy. 516
Voice Rehabilitation. 516
Stoma Care. 517
Depression. 517
Sexuality. 518
Ambulatory and Home Care. 518
Evaluation 518
Bridge to NCLEX Examination 519
References 520
Resources 520
28 Nursing Management 521
Learning Outcomes 521
Key Terms 521
eTables 521
Lower Respiratory Tract Infections 522
Acute Bronchitis 522
Pertussis 522
Pneumonia 522
Etiology 522
Types of Pneumonia 523
Community-Acquired Pneumonia. 523
Medical Care–Associated Pneumonia. 523
Aspiration Pneumonia. 524
Opportunistic Pneumonia. 524
Pathophysiology 524
Clinical Manifestations 524
Complications 525
Diagnostic Studies 525
Collaborative Care 525
Drug Therapy. 526
Nutritional Therapy. 527
Nursing Management Pneumonia 527
Nursing Assessment 527
Nursing Diagnoses 527
Planning 527
Nursing Implementation 527
Health Promotion. 527
Acute Intervention. 528
Ambulatory and Home Care. 528
Evaluation 528
Tuberculosis 528
Etiology and Pathophysiology 528
Classification 529
Clinical Manifestations 529
Complications 530
Diagnostic Studies 530
Tuberculin Skin Test. 530
Interferon-γ Release Assays. 530
Chest X-Ray. 530
Bacteriologic Studies. 530
Collaborative Care 530
Drug Therapy 531
Active TB Disease. 531
Latent Tuberculosis Infection. 532
Vaccine. 532
Nursing Management Tuberculosis 532
Nursing Assessment 532
Nursing Diagnoses 532
Planning 533
Nursing Implementation 533
Health Promotion. 533
Acute Intervention. 533
Ambulatory and Home Care. 533
Evaluation 533
Atypical Mycobacteria 533
Pulmonary Fungal Infections 533
Lung Abscess 534
Etiology and Pathophysiology 534
Clinical Manifestations and Complications 534
Diagnostic Studies 534
Nursing and Collaborative Management Lung Abscess 534
Environmental Lung Diseases 535
Clinical Manifestations 535
Collaborative Care 535
Lung Cancer 535
Etiology 535
Pathophysiology 536
Paraneoplastic Syndrome. 536
Clinical Manifestations 537
Diagnostic Studies 538
Staging. 538
Screening for Lung Cancer. 538
Collaborative Care 538
Surgical Therapy. 538
Radiation Therapy. 539
Stereotactic Body Radiotherapy. 539
Chemotherapy. 539
Targeted Therapy. 539
Other Therapies 539
Prophylactic Cranial Radiation. 539
Bronchoscopic Laser Therapy. 539
Photodynamic Therapy. 539
Airway Stenting. 539
Radiofrequency Ablation. 539
Nursing Management Lung Cancer 539
Nursing Assessment 539
Nursing Diagnoses 539
Planning 540
Nursing Implementation 540
Health Promotion. 540
Acute Intervention. 540
Ambulatory and Home Care. 540
Evaluation 541
Other Types of Lung Tumors 541
Chest Trauma and Thoracic Injuries 541
Pneumothorax 542
Types of Pneumothorax 542
Spontaneous Pneumothorax. 542
Iatrogenic Pneumothorax. 542
Traumatic Pneumothorax. 542
Tension Pneumothorax. 543
Hemothorax. 543
Chylothorax. 543
Collaborative Care 543
Fractured Ribs 543
Flail Chest 543
Chest Tubes and Pleural Drainage 544
Chest Tube Insertion 544
Flutter or Heimlich Valve 545
Pleural Drainage 545
Nursing Management Chest Drainage 547
Chest Tube Removal 547
Chest Surgery 547
Preoperative Care 547
Surgical Procedures 548
Thoracotomy. 548
Video-Assisted Thoracic Surgery. 548
Postoperative Care 549
Restrictive Respiratory Disorders 549
Pleural Effusion 549
Types 549
Clinical Manifestations 550
Thoracentesis 550
Collaborative Care 550
Pleurisy 550
Atelectasis 550
Interstitial Lung Diseases 550
Idiopathic Pulmonary Fibrosis 551
Sarcoidosis 551
Vascular Lung Disorders 551
Pulmonary Edema 551
Pulmonary Embolism 551
Etiology and Pathophysiology 551
Clinical Manifestations 552
Complications 552
Diagnostic Studies 552
Collaborative Care 553
Drug Therapy. 553
Surgical Therapy. 553
Nursing Management Pulmonary Embolism 553
Nursing Implementation 553
Evaluation 553
Pulmonary Hypertension 553
Idiopathic Pulmonary Arterial Hypertension 554
Etiology and Pathophysiology 554
Clinical Manifestations and Diagnostic Studies 554
Nursing and Collaborative Management Pulmonary Hypertension 554
Secondary Pulmonary Arterial Hypertension 554
Cor Pulmonale 555
Clinical Manifestations and Diagnostic Studies 555
Collaborative Care 555
Lung Transplantation 556
Preoperative Care 556
Surgical Procedure 556
Postoperative Care 556
Bridge to NCLEX Examination 557
References 558
Resources 559
29 Nursing Management 560
Learning Outcomes 560
Key Terms 560
eFigures 560
eTables 560
Asthma 561
Risk Factors for Asthma and Triggers of Asthma Attacks 561
Genetics. 561
Immune Response. 562
Allergens. 562
Exercise. 562
Air Pollutants. 562
Occupational Factors. 562
Respiratory Tract Infections. 562
Nose and Sinus Problems. 562
Drugs and Food Additives. 562
Gastroesophageal Reflux Disease. 562
Psychologic Factors. 562
Pathophysiology 562
Clinical Manifestations 564
Classification of Asthma 565
Complications 565
Severe and Life-Threatening Asthma Exacerbations. 565
Diagnostic Studies 565
Collaborative Care 567
Intermittent and Persistent Asthma. 568
Acute Asthma Exacerbations. 568
Severe and Life-Threatening Asthma Exacerbations. 569
Drug Therapy 569
Antiinflammatory Drugs 569
Corticosteroids. 569
Leukotriene Modifiers. 571
Anti-IgE. 572
Bronchodilators. 572
β2-Adrenergic Agonist Drugs. 572
Methylxanthines. 572
Anticholinergic Drugs. 572
Inhalation Devices for Drug Delivery. 572
Inhalers. 572
Nebulizers. 574
Patient Teaching Related to Drug Therapy. 575
Nonprescription Combination Drugs. 575
Nursing Management Asthma 575
Nursing Assessment 575
Nursing Diagnoses 575
Planning 575
Nursing Implementation 577
Health Promotion. 577
Acute Intervention. 577
Ambulatory and Home Care. 578
Evaluation 580
Chronic Obstructive Pulmonary Disease 580
Etiology 580
Cigarette Smoking. 580
Occupational Chemicals and Dusts. 582
Air Pollution. 582
Infection. 582
Genetics. 582
α1-Antitrypsin (AAT) Deficiency. 582
Genetic Link 582
Aging. 583
Pathophysiology 583
Clinical Manifestations 585
Classification of COPD. 585
Complications 585
Cor Pulmonale. 585
COPD Exacerbations. 586
Acute Respiratory Failure. 587
Depression and Anxiety. 587
Diagnostic Studies 587
Collaborative Care 588
Smoking Cessation. 588
Drug Therapy. 588
Oxygen Therapy. 589
Indications for Use. 589
Methods of Administration. 589
Humidification and Nebulization. 591
Complications 592
Combustion. 592
Carbon Dioxide Narcosis. 592
Oxygen Toxicity. 592
Absorption Atelectasis. 592
Infection. 592
Chronic Oxygen Therapy at Home. 592
Breathing Retraining. 593
Airway Clearance Techniques. 594
Effective Coughing. 594
Chest Physiotherapy. 594
Postural Drainage. 594
Percussion. 594
Vibration. 594
Airway Clearance Devices. 595
High-Frequency Chest Wall Oscillation. 595
Nutritional Therapy. 595
Surgical Therapy for COPD. 596
Nursing Management Chronic Obstructive Pulmonary Disease 596
Nursing Assessment 596
Nursing Diagnoses 596
Planning 596
Nursing Implementation 596
Health Promotion. 596
Acute Intervention. 596
Ambulatory and Home Care. 597
Pulmonary Rehabilitation. 597
Activity Considerations. 597
Sexuality and Sexual Activity. 600
Sleep. 600
Psychosocial Considerations. 601
Evaluation 601
Cystic Fibrosis 601
Etiology and Pathophysiology 601
Genetic Link 601
Clinical Manifestations 603
Complications 603
Diagnostic Studies 604
Collaborative Care 604
Nursing Management Cystic Fibrosis 605
Nursing Assessment 605
Nursing Diagnoses 605
Planning 605
Nursing Implementation 605
Bronchiectasis 606
Etiology and Pathophysiology 606
Clinical Manifestations 606
Diagnostic Studies 606
Collaborative Care 606
Nursing Management Bronchiectasis 607
Bridge to NCLEX Examination 608
References 608
Resources 610
6 Problems of Oxygenation: Transport 612
30 Nursing Assessment 613
Learning Outcomes 613
Key Terms 613
eFigure 613
eTable 613
Structures and Functions of Hematologic System 613
Bone Marrow 613
Blood 614
Plasma. 614
Blood Cells. 614
Erythrocytes. 615
Leukocytes. 615
Granulocytes. 616
Lymphocytes. 616
Monocytes. 616
Thrombocytes. 616
Normal Iron Metabolism 616
Normal Clotting Mechanisms 616
Vascular Response. 616
Platelet Plug Formation. 617
Plasma Clotting Factors. 617
Lysis of Clot. 618
Spleen 618
Lymph System 618
Liver 619
Gerontologic Considerations 619
Hematologic System 619
Assessment of Hematologic System 619
Subjective Data 619
Important Health Information 619
Past Health History. 619
Medications. 619
Surgery or Other Treatments. 620
Functional Health Patterns. 620
Health Perception–Health Management Pattern. 620
Nutritional-Metabolic Pattern. 620
Elimination Pattern. 621
Activity-Exercise Pattern. 621
Sleep-Rest Pattern. 621
Cognitive-Perceptual Pattern. 621
Self-Perception–Self-Concept Pattern. 622
Role-Relationship Pattern. 622
Sexuality-Reproductive Pattern. 622
Coping–Stress Tolerance Pattern. 622
Value-Belief Pattern. 622
Objective Data 622
Physical Examination. 622
Lymph Node Assessment. 622
Palpation of Liver or Spleen. 624
Skin Assessment. 624
Diagnostic Studies of Hematologic System 625
Laboratory Studies 625
Complete Blood Count. 625
Red Blood Cells. 625
White Blood Cells. 625
Platelet Count. 626
Blood Typing and Rh Factor. 626
Iron Metabolism. 627
Radiologic Studies 628
Biopsies 628
Bone Marrow Examination. 628
Lymph Node Biopsy. 630
Molecular Cytogenetics and Gene Analysis 630
Bridge to NCLEX Examination 630
References 631
Resources 631
31 Nursing Management 632
Learning Outcomes 632
Key Terms 632
Anemia 633
Definition and Classification 633
Clinical Manifestations 633
Integumentary Changes. 633
Cardiopulmonary Manifestations. 633
Nursing Management Anemia 634
Nursing Assessment 634
Nursing Diagnoses 634
Planning 634
Nursing Implementation 634
Gerontologic Considerations 634
Anemia 634
Anemia Caused by Decreased Erythrocyte Production 636
Iron-Deficiency Anemia 637
Etiology 637
Clinical Manifestations 637
Diagnostic Studies 637
Collaborative Care 638
Drug Therapy. 638
Nursing Management Iron-Deficiency Anemia 638
Thalassemia 639
Etiology 639
Genetic Link 639
Clinical Manifestations 639
Collaborative Care 639
Megaloblastic Anemias 640
Cobalamin (Vitamin B12) Deficiency 640
Etiology 640
Pernicious Anemia. 640
Other Causes of Cobalamin Deficiency. 640
Clinical Manifestations 640
Diagnostic Studies 640
Collaborative Care 641
Folic Acid Deficiency 641
Nursing Management Megaloblastic Anemia 641
Anemia of Chronic Disease 641
Aplastic Anemia 642
Etiology 642
7 Problems of Oxygenation: Perfusion 685
32 Nursing Assessment 686
Learning Outcomes 686
Key Terms 686
eFigures 686
Structures and Functions of Cardiovascular System 687
Heart 687
Structure. 687
Blood Flow Through Heart. 687
Cardiac Valves. 687
Blood Supply to Myocardium. 687
Conduction System. 687
Electrocardiogram. 688
Mechanical System. 689
Factors Affecting Cardiac Output. 689
Cardiac Reserve. 689
Vascular System 689
Blood Vessels. 689
Arteries and Arterioles. 689
Capillaries. 689
Veins and Venules. 689
Regulation of Cardiovascular System 690
Autonomic Nervous System. 690
Effect on Heart. 690
Effect on Blood Vessels. 690
Baroreceptors. 690
Chemoreceptors. 690
Blood Pressure 690
Measurement of Arterial Blood Pressure. 690
Pulse Pressure and Mean Arterial Pressure. 690
Gerontologic Considerations 691
Effects of Aging on the Cardiovascular System 691
Assessment of Cardiovascular System 691
Subjective Data 691
Important Health Information 691
History of Present Illness. 691
Past Health History. 692
Medications. 692
Surgery or Other Treatments. 692
Functional Health Patterns. 692
Health Perception–Health Management Pattern. 692
Nutritional-Metabolic Pattern. 693
Elimination Pattern. 693
Activity-Exercise Pattern. 693
Sleep-Rest Pattern. 693
Cognitive-Perceptual Pattern. 694
Self-Perception–Self-Concept Pattern. 694
Role-Relationship Pattern. 694
Sexuality-Reproductive Pattern. 694
Coping–Stress Tolerance Pattern. 694
Values-Belief Pattern. 694
Objective Data 694
Physical Examination 694
Vital Signs. 694
Peripheral Vascular System 694
Inspection. 694
Palpation. 694
Auscultation. 695
Thorax 695
Inspection and Palpation. 695
Auscultation. 697
Diagnostic Studies of Cardiovascular System 698
Blood Studies 698
Cardiac Biomarkers. 698
C-Reactive Protein. 698
Homocysteine. 698
Cardiac Natriuretic Peptide Markers. 698
Serum Lipids. 698
Lipoprotein-Associated Phospholipase A2. 704
Chest X-Ray 704
Electrocardiogram 704
Event Monitor or Loop Recorder. 704
Exercise or Stress Testing 704
Echocardiogram 704
Nuclear Cardiology 705
Cardiovascular Magnetic Resonance Imaging 706
Cardiac Computed Tomography 706
Cardiac Catheterization 706
Intracoronary Ultrasound. 707
Fractional Flow Reserve. 707
Electrophysiology Study 707
Bridge to NCLEX Examination 707
References 708
Resources 708
33 Nursing Management 709
Learning Outcomes 709
Key Terms 709
eTables 709
Normal Regulation of Blood Pressure 710
Sympathetic Nervous System 710
Baroreceptors. 711
Vascular Endothelium 711
Renal System 711
Endocrine System 711
Hypertension 712
Classification of Hypertension 712
Etiology 712
Primary Hypertension. 712
Secondary Hypertension. 712
Pathophysiology of Primary Hypertension 712
Genetic Link 712
Water and Sodium Retention. 712
Altered Renin-Angiotensin-Aldosterone Mechanism. 713
Stress and Increased Sympathetic Nervous System Activity. 713
Insulin Resistance and Hyperinsulinemia. 713
Endothelium Dysfunction. 713
Clinical Manifestations 713
Complications 713
Hypertensive Heart Disease 713
Coronary Artery Disease. 713
Left Ventricular Hypertrophy. 714
Heart Failure. 714
Cerebrovascular Disease. 714
Peripheral Vascular Disease. 714
Nephrosclerosis. 714
Retinal Damage. 714
Diagnostic Studies 715
Ambulatory Blood Pressure Monitoring. 715
Collaborative Care 715
Lifestyle Modifications. 715
Weight Reduction. 715
DASH Eating Plan. 715
Dietary Sodium Reduction. 716
Moderation of Alcohol Consumption. 716
Physical Activity. 716
Avoidance of Tobacco Products. 716
Management of Psychosocial Risk Factors. 716
Drug Therapy. 717
Patient and Caregiver Teaching Related to Drug Therapy. 720
Resistant Hypertension. 722
Nursing Management Primary Hypertension 722
Nursing Assessment 722
Nursing Diagnoses 722
Planning 722
Nursing Implementation 722
Health Promotion. 722
Individual Patient Evaluation. 723
Blood Pressure Measurement. 723
Screening Programs. 724
Cardiovascular Risk Factor Modification. 724
Ambulatory and Home Care 724
Home BP Monitoring. 724
Patient Adherence. 725
Evaluation 725
Gerontologic Considerations 725
Hypertension 725
Hypertensive Crisis 726
Clinical Manifestations 726
Nursing and Collaborative Management Hypertensive Crisis 726
Bridge to NCLEX Examination 728
References 728
Resources 729
34 Nursing Management 730
Learning Outcomes 730
Key Terms 730
eFigures 730
eTable 730
Coronary Artery Disease 731
Etiology and Pathophysiology 731
Developmental Stages. 731
Fatty Streak. 731
Fibrous Plaque. 731
Complicated Lesion. 731
Collateral Circulation. 732
Risk Factors for Coronary Artery Disease 732
Nonmodifiable Risk Factors 732
Age, Gender, and Ethnicity. 732
Genetic Link 733
Major Modifiable Risk Factors 733
Elevated Serum Lipids. 733
Hypertension. 734
Tobacco Use. 734
Physical Inactivity. 734
Obesity. 735
Contributing Modifiable Risk Factors 735
Diabetes Mellitus. 735
Metabolic Syndrome. 735
Psychologic States. 735
Homocysteine. 735
Substance Abuse. 735
Nursing and Collaborative Management Coronary Artery Disease 735
Health Promotion 735
Identification of High-Risk People. 736
Management of High-Risk People. 736
Physical Activity 737
Nutritional Therapy 737
Lipid-Lowering Drug Therapy 737
Drugs That Restrict Lipoprotein Production. 738
Drugs That Increase Lipoprotein Removal. 740
Drugs That Decrease Cholesterol Absorption. 740
Antiplatelet Therapy 740
Gerontologic Considerations 740
Coronary Artery Disease 740
Chronic Stable Angina 740
Silent Ischemia 742
Nocturnal Angina and Angina Decubitus 742
Prinzmetal’s Angina 742
Microvascular Angina 742
Collaborative Care Chronic Stable Angina 742
Drug Therapy 743
Short-Acting Nitrates. 743
Sublingual Nitroglycerin. 743
Long-Acting Nitrates. 743
Nitroglycerin Ointment. 745
Transdermal Controlled-Release Nitrates. 745
Angiotensin-Converting Enzyme Inhibitors. 745
β-Adrenergic Blockers. 745
Calcium Channel Blockers. 745
Sodium Current Inhibitor. 745
Diagnostic Studies 745
Cardiac Catheterization. 745
Acute Coronary Syndrome 746
Unstable Angina 747
Myocardial Infarction 747
Clinical Manifestations of Myocardial Infarction 747
Pain. 747
Sympathetic Nervous System Stimulation. 748
Cardiovascular Manifestations. 748
Nausea and Vomiting. 748
Fever. 748
Healing Process 748
Complications of Myocardial Infarction 748
Dysrhythmias. 748
Heart Failure. 748
Cardiogenic Shock. 748
Papillary Muscle Dysfunction. 749
Ventricular Aneurysm. 749
Pericarditis. 749
Dressler Syndrome. 749
Diagnostic Studies Acute Coronary Syndrome 749
Electrocardiogram Findings 749
Serum Cardiac Markers 749
Coronary Angiography 750
Other Measures 750
Collaborative Care Acute Coronary Syndrome 750
Emergent PCI 751
Thrombolytic Therapy 751
Indications and Contraindications. 751
Procedure. 751
Coronary Surgical Revascularization 752
Coronary Artery Bypass Graft Surgery. 752
Minimally Invasive Direct Coronary Artery Bypass. 752
Off-Pump Coronary Artery Bypass. 753
Robot-Assisted Cardiothoracic Surgery. 753
Transmyocardial Laser Revascularization. 753
Drug Therapy 753
IV Nitroglycerin. 753
Morphine Sulfate. 753
β-Adrenergic Blockers. 753
Angiotensin-Converting Enzyme Inhibitors. 753
Antidysrhythmic Drugs. 753
Lipid-Lowering Drugs. 753
Stool Softeners. 753
Nutritional Therapy 753
Nursing Management Chronic Stable Angina and Acute Coronary Syndrome 753
Nursing Assessment 753
Nursing Diagnoses 753
Planning 753
Nursing Implementation: Chronic Stable Angina 753
Health Promotion. 753
8 Problems of Ingestion, Digestion, Absorption, and Elimination 864
39 Nursing Assessment 865
Learning Outcomes 865
Key Terms 865
eFigures 865
Structures and Functions of Gastrointestinal System 866
Ingestion 866
Mouth. 867
Pharynx. 867
Esophagus. 867
Digestion and Absorption 867
Stomach. 867
Small Intestine. 867
Physiology of Digestion. 867
Elimination 868
Large Intestine. 868
Liver, Biliary Tract, and Pancreas 869
Liver. 869
Biliary Tract. 870
Bilirubin Metabolism. 870
Pancreas. 870
Gerontologic Considerations 871
Effects of Aging on Gastrointestinal System 871
Assessment of Gastrointestinal System 871
Subjective Data 871
Important Health Information 871
Past Health History. 871
Medications. 871
Surgery or Other Treatments. 872
Functional Health Patterns. 872
Health Perception–Health Management Pattern. 872
Nutritional-Metabolic Pattern. 873
Elimination Pattern. 873
Activity-Exercise Pattern. 873
Sleep-Rest Pattern. 873
Cognitive-Perceptual Pattern. 874
Self-Perception–Self-Concept Pattern. 874
Role-Relationship Pattern. 874
Sexuality-Reproductive Pattern. 874
Coping–Stress Tolerance Pattern. 874
Value-Belief Pattern. 874
Objective Data 874
Physical Examination 874
Mouth 874
Inspection. 874
Palpation. 874
Abdomen. 874
Inspection. 875
Auscultation. 875
Percussion. 875
Palpation. 876
Rectum and Anus. 877
Diagnostic Studies of Gastrointestinal System 877
Radiologic Studies 879
Upper Gastrointestinal Series. 879
Lower Gastrointestinal Series. 879
Virtual Colonoscopy. 882
Endoscopy 882
Liver Biopsy 883
Liver Function Studies 883
Bridge to NCLEX Examination 884
References 885
Resources 885
40 Nursing Management 886
Learning Outcomes 886
Key Terms 886
eTables 886
Nutritional Problems 886
Normal Nutrition 887
Special Diet: Vegetarian Diet 889
Culturally Competent Care 889
Nutrition 889
Malnutrition 890
Etiology of Malnutrition 890
Contributing Factors to Malnutrition 890
Socioeconomic Factors. 890
Physical Illnesses. 890
Incomplete Diets. 891
Food-Drug Interactions. 891
Pathophysiology of Starvation 891
Impact of Inflammation. 892
Clinical Manifestations 892
Diagnostic Studies 892
History and Physical Examination. 892
Laboratory Studies. 892
Anthropometric Measurements. 893
Functional Measurements. 893
Nursing and Collaborative Management Malnutrition 893
Nursing Assessment 893
Nursing Diagnoses 894
Planning 894
Nursing Implementation 894
Health Promotion. 894
Acute Intervention. 895
Ambulatory and Home Care. 895
Evaluation 896
Gerontologic Considerations 896
Malnutrition 896
Types of Specialized Nutritional Support 896
Oral Feeding 896
Enteral Nutrition 897
Orogastric, Nasogastric, and Nasointestinal Tubes. 898
Gastrostomy and Jejunostomy Tubes. 898
Tube Feedings and Safety. 899
Patient Position. 899
Aspiration Risk. 899
Residual Volumes. 899
Tube Position. 899
Complications Related to Tubes and Feedings. 900
Gerontologic Considerations 900
Enteral Nutrition 900
Parenteral Nutrition 901
Composition. 901
Calories. 901
Protein. 901
Electrolytes. 902
Trace Elements and Vitamins. 902
Methods of Administration. 902
Central Parenteral Nutrition. 902
Peripheral Parenteral Nutrition. 902
Comparison of Central and Peripheral Parenteral Nutrition. 902
Nursing Management Parenteral Nutrition 902
Complications 902
Home Nutritional Support 902
Eating Disorders 902
Anorexia Nervosa 903
Bulimia Nervosa 903
Bridge to NCLEX Examination 904
References 904
Resources 905
41 Nursing Management 906
Learning Outcomes 906
Key Terms 906
eFigure 906
eTables 906
Obesity 906
Classifications of Body Weight and Obesity 906
Body Mass Index. 906
Waist Circumference. 907
Waist-to-Hip Ratio. 907
Body Shape. 907
Epidemiology of Obesity 907
Etiology and Pathophysiology 908
Genetic Link 908
Physiologic Regulatory Mechanisms in Obesity. 909
Environmental Factors. 910
Psychosocial Factors. 910
Health Risks Associated with Obesity 910
Cardiovascular Problems 910
Diabetes Mellitus 910
Gastrointestinal and Liver Problems 911
Respiratory and Sleep Problems 911
Musculoskeletal Problems 911
Cancer 911
Metabolic Syndrome 912
Psychosocial Problems 912
Nursing and Collaborative Management Obesity 912
Nursing Assessment 912
Planning 912
Nursing Implementation 913
Nutritional Therapy. 913
Exercise. 915
Behavior Modification. 915
Support Groups. 915
Drug Therapy 915
Appetite-Suppressing Drugs 915
Nutrient Absorption–Blocking Drugs 916
Serotonin Agonist 916
Phentermine and Topiramate (Qsymia) 916
Nursing Interventions Related to Drug Therapy 916
Surgical Therapy 916
Restrictive Surgeries 916
Adjustable Gastric Banding. 916
Vertical Sleeve Gastrectomy. 916
Combination of Restrictive and Malabsorptive Surgery 916
Roux-en-Y Gastric Bypass. 916
Cosmetic Surgeries to Reduce Fatty Tissue and Skinfolds 917
Lipectomy. 917
Liposuction. 917
Nursing Management Perioperative Care of the Obese Patient 918
Nursing Implementation 918
Preoperative Care. 918
9 Problems of Urinary Function 1045
45 Nursing Assessment 1046
Learning Outcomes 1046
Key Terms 1046
Structures and Functions of Urinary System 1046
Kidneys 1046
Macrostructure. 1046
Microstructure. 1047
Blood Supply. 1047
Physiology of Urine Formation. 1048
Glomerular Function. 1048
Tubular Function. 1048
Other Functions of Kidneys. 1049
Ureters 1049
Bladder 1050
Urethra 1050
Urethrovesical Unit 1050
Gerontologic Considerations 1050
Effects of Aging on Urinary System 1050
Assessment of Urinary System 1051
Subjective Data 1051
Important Health Information 1051
Past Health History. 1051
Medications. 1052
Surgery or Other Treatments. 1052
Functional Health Patterns. 1052
Health Perception–Health Management Pattern. 1053
Nutritional-Metabolic Pattern. 1053
Elimination Pattern. 1053
Activity-Exercise Pattern. 1054
Sleep-Rest Pattern. 1054
Cognitive-Perceptual Pattern. 1054
Self-Perception–Self-Concept Pattern. 1054
Role-Relationship Pattern. 1054
Sexuality-Reproductive Pattern. 1054
Objective Data 1054
Physical Examination 1054
Inspection. 1054
Palpation. 1054
Percussion. 1054
Auscultation. 1055
Diagnostic Studies of Urinary System 1055
Urine Studies 1061
Urinalysis. 1061
Creatinine Clearance. 1061
Urodynamic Studies 1062
Bridge to NCLEX Examination 1063
References 1063
Resources 1063
46 Nursing Management 1064
Learning Outcomes 1064
Key Terms 1064
eTables 1064
Infectious and Inflammatory Disorders of Urinary System 1064
Urinary Tract Infection 1064
Classification of Urinary Tract Infection 1065
Etiology and Pathophysiology 1065
Clinical Manifestations 1066
Diagnostic Studies 1066
Collaborative Care 1067
Nursing Management Urinary Tract Infection 1067
Nursing Assessment 1067
Nursing Diagnoses 1067
Planning 1068
Nursing Implementation 1068
Health Promotion. 1068
Acute Intervention. 1069
Ambulatory and Home Care. 1069
Evaluation 1069
Acute Pyelonephritis 1069
Etiology and Pathophysiology 1069
Clinical Manifestations and Diagnostic Studies 1070
Collaborative Care 1070
Nursing Management Acute Pyelonephritis 1070
Nursing Assessment 1070
Nursing Diagnoses 1070
Planning 1070
Nursing Implementation 1070
Evaluation 1071
Chronic Pyelonephritis 1071
Urethritis 1071
Urethral Diverticula 1071
Interstitial Cystitis/ Painful Bladder Syndrome 1071
Clinical Manifestations and Diagnostic Studies 1072
Collaborative Care 1072
Nursing Management Interstitial Cystitis/ Painful Bladder Syndrome 1072
Renal Tuberculosis 1072
Immunologic Disorders of Kidney 1073
Glomerulonephritis 1073
Acute Poststreptococcal Glomerulonephritis 1074
Nursing and Collaborative Management Acute Poststreptococcal Glomerulonephritis 1074
Goodpasture Syndrome 1074
Rapidly Progressive Glomerulonephritis 1074
Chronic Glomerulonephritis 1074
Nephrotic Syndrome 1075
Etiology and Clinical Manifestations 1075
Nursing and Collaborative Management Nephrotic Syndrome 1075
Obstructive Uropathies 1076
Urinary Tract Calculi 1076
Etiology and Pathophysiology 1076
Types of Urinary Calculi 1077
Clinical Manifestations 1077
Diagnostic Studies 1078
Collaborative Care 1078
Endourologic Procedures. 1079
Lithotripsy. 1079
Surgical Therapy. 1079
Nutritional Therapy. 1080
Nursing Management Urinary Tract Calculi 1080
Nursing Assessment 1080
Nursing Diagnoses 1080
Planning 1080
Nursing Implementation 1081
Evaluation 1081
Strictures 1081
Ureteral Strictures 1081
Urethral Strictures 1081
Renal Trauma 1081
Renal Vascular Problems 1082
Nephrosclerosis 1082
Renal Artery Stenosis 1082
Renal Vein Thrombosis 1082
Hereditary Kidney Diseases 1082
Polycystic Kidney Disease 1082
Genetic Link 1082
Nursing and Collaborative Management Polycystic Kidney Disease 1083
Medullary Cystic Disease 1083
Alport Syndrome 1083
Urinary Tract Tumors 1084
Kidney Cancer 1084
Clinical Manifestations and Diagnostic Studies 1084
Nursing and Collaborative Management Kidney Cancer 1084
Bladder Cancer 1085
Clinical Manifestations and Diagnostic Studies 1085
Nursing and Collaborative Management Bladder Cancer 1085
Surgical Therapy 1085
Radiation Therapy and Chemotherapy 1086
Intravesical Therapy 1086
Bladder Dysfunction 1086
Urinary Incontinence 1086
Etiology and Pathophysiology 1086
Diagnostic Studies 1087
Collaborative Care 1087
Drug Therapy. 1087
Surgical Therapy. 1089
Nursing Management Urinary Incontinence 1089
Urinary Retention 1090
Etiology and Pathophysiology 1091
Diagnostic Studies 1091
Collaborative Care 1091
Drug Therapy. 1092
Surgical Therapy. 1092
Nursing Management Urinary Retention 1092
Catheterization 1092
Indications for and Complications of Catheterization 1092
Catheter Construction 1093
Types of Catheters 1093
Urethral Catheters 1093
Ureteral Catheters 1093
Suprapubic Catheters 1094
Nephrostomy Tubes 1094
Intermittent Catheterization 1094
Surgery of the Urinary Tract 1094
Renal and Ureteral Surgery 1094
Surgical Procedure 1095
Laparoscopic Nephrectomy. 1095
Preoperative Management 1095
Postoperative Management 1095
Urine Output. 1095
Respiratory Status. 1095
Abdominal Distention. 1095
Urinary Diversion 1095
Incontinent Urinary Diversion 1095
Continent Urinary Diversions 1095
Orthotopic Bladder Reconstruction 1097
Nursing Management Urinary Diversion 1097
Preoperative Management 1097
Postoperative Management 1097
Bridge to NCLEX Examination 1099
References 1099
Resources 1100
47 Nursing Management 1101
Learning Outcomes 1101
Key Terms 1101
eTables 1101
Acute Kidney Injury 1101
Etiology and Pathophysiology 1102
Prerenal. 1102
Intrarenal. 1102
Postrenal. 1103
Clinical Manifestations 1103
Oliguric Phase. 1103
Urinary Changes. 1103
Fluid Volume. 1104
Metabolic Acidosis. 1104
Sodium Balance. 1104
Potassium Excess. 1104
Hematologic Disorders. 1104
Waste Product Accumulation. 1104
Neurologic Disorders. 1104
Diuretic Phase. 1104
Recovery Phase. 1104
Diagnostic Studies 1104
Collaborative Care 1105
Nutritional Therapy. 1106
Nursing Management Acute Kidney Injury 1106
Nursing Assessment 1106
Nursing Diagnoses 1106
Planning 1106
Nursing Implementation 1106
Health Promotion. 1106
Acute Intervention. 1107
Ambulatory And Home Care. 1107
Evaluation 1107
Gerontologic Considerations 1107
Acute Kidney Injury 1107
Chronic Kidney Disease 1107
Clinical Manifestations 1108
Urinary System. 1108
Metabolic Disturbances 1108
Waste Product Accumulation. 1108
Altered Carbohydrate Metabolism. 1108
Elevated Triglycerides. 1109
Electrolyte and Acid-Base Imbalances 1109
Potassium. 1109
Sodium. 1109
Calcium and Phosphate. 1109
Magnesium. 1109
Metabolic Acidosis. 1109
Hematologic System 1109
Anemia. 1109
Bleeding Tendencies. 1110
Infection. 1110
Cardiovascular System. 1110
Respiratory System. 1110
Gastrointestinal System. 1110
Neurologic System. 1110
Musculoskeletal System. 1110
Integumentary System. 1111
Reproductive System. 1111
Psychologic Changes. 1111
Diagnostic Studies 1111
Collaborative Care 1112
Drug Therapy 1112
Hyperkalemia. 1112
Hypertension. 1112
CKD-MBD. 1113
Anemia. 1113
Dyslipidemia. 1114
Complications of Drug Therapy. 1114
Nutritional Therapy 1114
Protein Restriction. 1114
Water Restriction. 1115
Sodium and Potassium Restriction. 1115
Phosphate Restriction. 1115
Nursing Management Chronic Kidney Disease 1115
Nursing Assessment 1115
Nursing Diagnoses 1115
Planning 1116
Nursing Implementation 1116
Health Promotion. 1116
Acute Intervention. 1116
Ambulatory And Home Care. 1116
Evaluation 1117
Dialysis 1117
General Principles of Dialysis 1117
Peritoneal Dialysis 1118
Catheter Placement 1118
Dialysis Solutions and Cycles 1118
Peritoneal Dialysis Systems 1119
Automated Peritoneal Dialysis. 1119
Continuous Ambulatory Peritoneal Dialysis. 1119
Complications of Peritoneal Dialysis 1119
Exit Site Infection. 1119
Peritonitis. 1119
Hernias. 1119
Lower Back Problems. 1119
Bleeding. 1119
Pulmonary Complications. 1119
Protein Loss. 1119
Effectiveness of Chronic Peritoneal Dialysis 1120
Hemodialysis 1120
Vascular Access 1120
Arteriovenous Fistulas and Grafts. 1120
Temporary Vascular Access. 1120
Dialyzers. 1121
Procedure for Hemodialysis 1121
Settings and Schedules for Hemodialysis. 1122
Complications of Hemodialysis 1122
Hypotension. 1122
Muscle Cramps. 1122
Loss of Blood. 1122
Hepatitis. 1122
Effectiveness of Hemodialysis 1123
Continuous Renal Replacement Therapy 1123
Kidney Transplantation 1124
Recipient Selection 1124
Histocompatibility Studies 1124
Donor Sources 1124
Live Donors. 1125
Deceased Donors. 1125
Surgical Procedure 1126
Live Donor. 1126
Kidney Transplant Recipient. 1126
Nursing Management Kidney Transplant Recipient 1127
Preoperative Care 1127
Postoperative Care 1127
Live Donor. 1127
Kidney Transplant Recipient. 1127
Immunosuppressive Therapy 1127
Complications of Transplantation 1127
Rejection. 1127
Infection. 1127
Cardiovascular Disease. 1128
Malignancies. 1128
Recurrence of Original Kidney Disease. 1128
Corticosteroid-Related Complications. 1128
Gerontologic Considerations 1128
Chronic Kidney Disease 1128
Bridge to NCLEX Examination 1130
References 1131
Resources 1131
10 Problems Related to Regulatory and Reproductive Mechanisms 1133
48 Nursing Assessment 1134
Learning Outcomes 1134
Key Terms 1134
eFigure 1134
Structures and Functions of Endocrine System 1134
Glands 1134
Hormones 1134
Hormone Receptors. 1135
Lipid-Soluble and Water-Soluble Hormones. 1135
Regulation of Hormonal Secretion. 1137
Simple Feedback. 1137
Nervous System Control. 1137
Rhythms. 1137
Hypothalamus 1137
Pituitary 1137
Anterior Pituitary. 1138
Posterior Pituitary. 1138
Pineal Gland 1139
Thyroid Gland 1139
Thyroxine and Triiodothyronine. 1139
Calcitonin. 1139
Parathyroid Glands 1139
Parathyroid Hormone. 1139
Adrenal Glands 1140
Adrenal Medulla. 1140
Adrenal Cortex. 1140
Cortisol. 1140
Aldosterone. 1140
Adrenal Androgens. 1140
Pancreas 1140
Glucagon. 1140
Insulin. 1140
Gerontologic Considerations 1141
Effects of Aging on Endocrine System 1141
Assessment of Endocrine System 1141
Subjective Data 1141
Important Health Information 1141
Past Health History. 1141
Medications. 1142
Surgery or Other Treatments. 1142
Functional Health Patterns. 1142
Health Perception–Health Management Pattern. 1142
Nutritional-Metabolic Pattern. 1143
Elimination Pattern. 1143
Activity-Exercise Pattern. 1143
Sleep-Rest Pattern. 1143
Cognitive-Perceptual Pattern. 1144
Self-Perception–Self-Concept Pattern. 1144
Role-Relationship Pattern. 1144
Sexuality-Reproductive Pattern. 1144
Coping–Stress Tolerance Pattern. 1144
Value-Belief Pattern. 1144
Objective Data 1144
Physical Examination. 1144
Integument. 1144
Head. 1144
Neck. 1144
Thorax. 1145
Abdomen. 1145
Extremities. 1145
Genitalia. 1145
Diagnostic Studies of Endocrine System 1145
Bridge to NCLEX Examination 1151
References 1152
Resources 1152
49 Nursing Management 1153
Learning Outcomes 1153
Key Terms 1153
eFigure 1153
eTable 1153
Diabetes Mellitus 1153
Etiology and Pathophysiology 1154
Normal Insulin Metabolism. 1154
Type 1 Diabetes Mellitus. 1155
Etiology and Pathophysiology. 1155
Genetic Link 1155
11 Problems Related to Movement and Coordination 1334
56 Nursing Assessment 1335
Learning Outcomes 1335
Key Terms 1335
eFigure 1335
eTable 1335
Structures and Functions of Nervous System 1336
Cells of Nervous System 1336
Neurons. 1336
Glial Cells. 1336
Nerve Regeneration 1336
Nerve Impulse 1336
Synapse. 1337
Neurotransmitters. 1337
Central Nervous System 1337
Spinal Cord. 1337
Ascending Tracts. 1337
Descending Tracts. 1338
Lower and Upper Motor Neurons. 1338
Reflex Arc. 1338
Brain. 1338
Cerebrum. 1338
Brainstem. 1339
Cerebellum. 1339
Ventricles and Cerebrospinal Fluid. 1340
Peripheral Nervous System 1340
Spinal Nerves. 1340
Cranial Nerves. 1340
Autonomic Nervous System. 1340
Cerebral Circulation 1342
Blood-Brain Barrier. 1342
Protective Structures 1342
Meninges. 1342
Skull. 1342
Vertebral Column. 1342
Gerontologic Considerations 1343
Effects of Aging on Nervous System 1343
Assessment of Nervous System 1343
Subjective Data 1343
Important Health Information 1343
Past Health History. 1343
Medications. 1343
Surgery or Other Treatments. 1343
Functional Health Patterns. 1343
Health Perception–Health Management Pattern. 1343
Nutritional-Metabolic Pattern. 1344
Elimination Pattern. 1344
Activity-Exercise Pattern. 1345
Sleep-Rest Pattern. 1345
Cognitive-Perceptual Pattern. 1345
Self-Perception–Self-Concept Pattern. 1345
Role-Relationship Pattern. 1346
Sexuality-Reproductive Pattern. 1346
Coping–Stress Tolerance Pattern. 1346
Value-Belief Pattern. 1346
Objective Data 1346
Physical Examination. 1346
Mental Status. 1346
Cranial Nerves. 1346
Olfactory Nerve. 1346
Optic Nerve. 1346
Oculomotor, Trochlear, and Abducens Nerves. 1347
Trigeminal Nerve. 1347
Facial Nerve. 1347
Vestibulocochlear (Acoustic) Nerve. 1347
Glossopharyngeal and Vagus Nerves. 1347
Accessory Nerve. 1348
Hypoglossal Nerve. 1348
Motor System. 1348
Sensory System. 1348
Touch, Pain, and Temperature. 1348
Vibration Sense. 1348
Position Sense. 1348
Cortical Sensory Functions. 1348
Reflexes. 1348
Diagnostic Studies of Nervous System 1349
Cerebrospinal Fluid Analysis 1349
Lumbar Puncture. 1349
Radiologic Studies 1351
Computed Tomography. 1351
Magnetic Resonance Imaging. 1351
Cerebral Angiography. 1351
Electrographic Studies 1351
Electroencephalography. 1351
Electromyography and Nerve Conduction Studies. 1351
Evoked Potentials. 1354
Bridge to NCLEX Examination 1354
References 1355
Resources 1355
57 Nursing Management 1356
Learning Outcomes 1356
Key Terms 1356
eFigure 1356
Intracranial Pressure 1356
Regulation and Maintenance of Intracranial Pressure 1357
Normal Intracranial Pressure. 1357
Normal Compensatory Adaptations. 1357
Cerebral Blood Flow 1357
Autoregulation of Cerebral Blood Flow. 1357
Pressure Changes. 1358
Factors Affecting Cerebral Blood Flow. 1358
Increased Intracranial Pressure 1358
Mechanisms of Increased Intracranial Pressure 1358
Cerebral Edema 1359
Vasogenic Cerebral Edema. 1359
Cytotoxic Cerebral Edema. 1359
Interstitial Cerebral Edema. 1360
Clinical Manifestations 1360
Change in Level of Consciousness. 1360
Changes in Vital Signs. 1360
Ocular Signs. 1360
Decrease in Motor Function. 1360
Headache. 1360
Vomiting. 1360
Complications 1361
Diagnostic Studies 1361
Monitoring Intracranial Pressure and Cerebral Oxygenation 1361
Indications for Intracranial Pressure Monitoring. 1361
Methods of Measuring Intracranial Pressure. 1361
Cerebrospinal Fluid Drainage. 1363
Cerebral Oxygenation Monitoring. 1363
Collaborative Care 1363
Drug Therapy. 1364
Nutritional Therapy. 1365
Nursing Management Increased Intracranial Pressure 1365
Nursing Assessment 1365
Glasgow Coma Scale. 1365
Neurologic Assessment. 1365
Nursing Diagnoses 1366
Planning 1367
Nursing Implementation 1367
Acute Intervention 1367
Respiratory Function. 1367
Fluid and Electrolyte Balance. 1367
Monitoring Intracranial Pressure. 1367
Body Position. 1367
Protection From Injury. 1368
Psychologic Considerations. 1368
Evaluation 1368
Head Injury 1368
Types of Head Injuries 1368
Scalp Lacerations. 1368
Skull Fractures. 1368
Head Trauma. 1369
Diffuse Injury. 1369
Diffuse Axonal Injury. 1370
Focal Injury. 1370
Complications 1370
Epidural Hematoma. 1370
Subdural Hematoma. 1371
Intracerebral Hematoma. 1371
Diagnostic Studies and Collaborative Care 1371
Nursing Management Head Injury 1372
Nursing Assessment 1372
Nursing Diagnoses 1372
Planning 1373
Nursing Implementation 1373
Health Promotion. 1373
Acute Intervention. 1373
Ambulatory and Home Care. 1374
Evaluation 1375
Brain Tumors 1375
Types 1375
Clinical Manifestations and Complications 1376
Diagnostic Studies 1377
Collaborative Care 1377
Surgical Therapy. 1377
Ventricular Shunts. 1377
Radiation Therapy and Stereotactic Radiosurgery. 1377
Chemotherapy and Targeted Therapy. 1377
Other Therapies. 1377
Nursing Management Brain Tumors 1378
Nursing Assessment 1378
Nursing Diagnoses 1378
Planning 1378
Nursing Implementation 1378
Evaluation 1378
Cranial Surgery 1379
Types 1379
Craniotomy. 1379
Stereotactic Radiosurgery. 1379
Nursing Management Cranial Surgery 1379
Nursing Implementation 1379
Acute Intervention. 1379
Ambulatory and Home Care. 1380
Inflammatory Conditions of the Brain 1381
Brain Abscess 1381
Bacterial Meningitis 1381
Etiology and Pathophysiology 1381
Clinical Manifestations 1382
Complications 1382
Diagnostic Studies 1382
Collaborative Care 1382
Nursing Management Bacterial Meningitis 1383
Nursing Assessment 1383
Nursing Diagnoses 1383
Planning 1383
Nursing Implementation 1383
Health Promotion. 1383
Acute Intervention. 1383
Ambulatory and Home Care. 1383
Evaluation 1383
Viral Meningitis 1384
Encephalitis