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Medical-Surgical Nursing - E-Book

Medical-Surgical Nursing - E-Book

Donna D. Ignatavicius | M. Linda Workman

(2015)

Additional Information

Book Details

Abstract

Using a unique collaborative care approach to adult health nursing, Medical-Surgical Nursing: Patient-Centered Collaborative Care, 8th Edition covers the essential knowledge you need to succeed at the RN level of practice. Easy-to-read content includes evidence-based treatment guidelines, an enhanced focus on QSEN competencies, and an emphasis on developing clinical judgment skills. This edition continues the book’s trendsetting tradition with increased LGBTQ content and a new Care of Transgender Patients chapter. Written by nursing education experts Donna Ignatavicius and M. Linda Workman, this bestselling text also features NCLEX® Exam-style challenge questions to prepare you for success on the NCLEX Exam. Cutting-edge coverage of the latest trends in nursing practice and nursing education prepares you not just for today’s nursing practice but also for tomorrow’s.

  • UNIQUE! Collaborative care approach organizes all medical, surgical, nursing, and other interventions within the framework of the nursing process, mirroring the nurse’s role in the coordination/management of care in the real world of medical-surgical nursing.
  • UNIQUE! A focus on nursing concepts relates concepts learned in Nursing Fundamentals with the disorders you will study in Medical-Surgical Nursing.
  • Easy to read, direct-address writing style makes this one of the most readable medical-surgical nursing textbooks available.
  • UNIQUE! A focus on QSEN emphasizes patient safety and evidence-based practice with Nursing Safety Priority boxes including Drug Alerts, Critical Rescues, and Action Alerts.
  • UNIQUE! Emphasis on clinical judgment teaches you to develop skills in clinical reasoning and clinical decision-making when applying concepts to clinical situations, with Clinical Judgment Challenge questions throughout the chapters.
  • An emphasis on prioritization stresses the most important patient problems and nursing interventions, with patient problems presented in a single prioritized list of nursing diagnoses and collaborative problems. 
  • UNIQUE! NCLEX preparation tools include chapter-opening Learning Outcomes and chapter-ending Get Ready for the NCLEX Examination! sections organized by NCLEX® Client Needs Categories, plus NCLEX Examination Challenge questions, with an answer key in the back of the book and on the Evolve companion website.
  • Practical learning aids include NCLEX Examination Challenges, Clinical Judgment Challenges, Best Practice for Patient Safety & Quality Care charts, common examples of drug therapy, concept maps, laboratory profiles, and more.
  • A clear alignment with the language of clinical practice reflects the real world of nursing practice with NANDA diagnostic labels where they make sense, and non-NANDA diagnostic labels when these are more common descriptions of patient problems. 
  • Student Resources on an Evolve companion website help you prepare for class, clinicals, or lab with video and audio clips, animations, case studies, a concept map creator, NCLEX exam-style review questions, and more. 
  • UNIQUE! Concentration on essential knowledge for the RN level of medical-surgical nursing practice focuses your attention on need-to-know content to pass the NCLEX Examination and practice safety as a beginning nurse.

Table of Contents

Section Title Page Action Price
Front Cover cover
Evolve page endshee-2
Brief TOC endshee-3
Endsheet 4 endshee-4
Medical-Surgical Nursing i
Copyright Page iv
Consultants and Contributors v
Reviewers vii
Preface viii
Key Themes for the 8th Edition viii
Clinical Currency and Accuracy ix
Outstanding Readability x
Ease of Access x
A Patient-Centered Collaborative Care Approach x
Organization xi
Multinational, Multicultural, Multigenerational Focus xi
Additional Learning Aids xi
An Integrated Multimedia Resource Based on Proven Strategies for Student Engagement and Learning xii
Resources for Instructors xii
Resources for Students xiii
Dedication xiv
About the Authors xv
Acknowledgments xvi
Table Of Contents xvii
Guide to Special Features xxvii
Best Practice for Patient Safety & Quality Care xxvii
Common Examples of Drug Therapy xxviii
Concept Map xxviii
Evidence-Based Practice xxviii
Focused Assessment xxix
Home Care Assessment xxix
Key Features xxix
Laboratory Profile xxx
Nursing Focus on the Older Adult xxx
Patient and Family Education: Preparing for Self-Management xxx
Quality Improvement xxxi
Unit I Foundations for Medical-Surgical Nursing 1
1 Introduction to Medical-Surgical Nursing Practice 1
Priority Concepts 1
Learning Outcomes 1
Scope of Medical-Surgical Nursing Practice 1
Priority Focus on Safety and Quality of Care 2
Protecting Five Million Lives from Harm 2
Quality and Safety Education for Nurses Core Competencies 3
Patient-Centered Care 3
Ethical Principles. 4
Special Needs of the LGBTQ Population. 4
Teamwork and Collaboration 4
Communication. 5
Delegation and Supervision. 6
Evidence-Based Practice 6
Quality Improvement 6
Informatics 7
Safety 7
Get Ready for the NCLEX® Examination! 8
Key Points 8
Safe and Effective Care Environment 8
2 Common Health Problems of Older Adults 9
Priority Concepts 9
Learning Outcomes 9
Overview 9
Health Issues for Older Adults in Community-Based Settings 10
Decreased Nutrition and Hydration 10
Decreased Mobility 11
Stress and Loss 12
Accidents 13
Fall Prevention 13
Driving Safety 13
Drug Use and Misuse 13
Effects of Drugs on Older Adults 14
Self-Administration of Drugs 14
Complementary and Alternative Therapies. 15
Medication Assessment and Health Teaching 15
Mental Health/Behavioral Health Problems 16
Depression 16
Dementia 16
Delirium 18
Alcohol Use and Abuse 18
Elder Neglect and Abuse 19
Health Care Issues for Older Adults in Hospitals and Long-Term Care Settings 19
Problems of Sleep, Nutrition, and Continence 20
Confusion, Falls, and Skin Breakdown 20
Care Transition from the Hospital or Long-Term Care Setting to Home 22
Get Ready for the NCLEX® Examination! 23
Key Points 23
Safe and Effective Care Environment 23
Health Promotion and Maintenance 23
Psychosocial Integrity 23
Physiological Integrity 23
3 Assessment and Care of Patients with Pain 24
Priority Concepts 24
Learning Outcomes 24
Overview 24
Scope of the Problem 25
Definitions of Pain 25
Categorization of Pain by Duration 25
Acute Pain 25
Chronic Pain 26
Chronic Cancer Pain 26
Chronic Non-Cancer Pain 26
Categorization of Pain by Underlying Mechanisms 26
Nociceptive Pain 26
Neuropathic Pain 28
Patient-Centered Collaborative Care 28
Pain Assessment 28
The Comprehensive Pain Assessment 29
Psychosocial Assessment 32
Assessment Challenges 33
Pharmacologic Management of Pain 34
Multimodal Analgesia 34
Routes of Administration 34
Around-the-Clock Dosing 34
Patient-Controlled Analgesia 35
The Three Analgesic Groups 35
Non-opioid Analgesics. 35
Acetaminophen. 35
NSAIDs. 37
Health Teaching. 37
Opioid Analgesics. 37
Key Principles of Opioid Administration. 38
Physical Dependence, Tolerance, and Addiction. 38
Opioid Naïve versus Opioid Tolerant. 40
Equianalgesia. 40
Drug Formulation Terminology. 40
Selected Opioid Analgesics. 41
Dual Mechanism Analgesics. 42
Opioids to Avoid. 42
Intraspinal Analgesia. 42
Adverse Effects of Opioid Analgesics. 43
Adjuvant Analgesics. 45
Anticonvulsants and Antidepressants. 45
Local Anesthetics. 45
Use of Placebos 45
Nonpharmacologic Management of Pain 46
Physical Modalities 46
Cognitive-Behavioral Strategies 47
Community-Based Care 48
Home Care Management 48
Self-Management Education 48
Health Care Resources 48
Get Ready for the NCLEX® Examination! 49
Key Points 49
Safe and Effective Care Environment 49
Health Promotion and Maintenance 49
Psychosocial Integrity 49
Physiological Integrity 49
4 Genetic and Genomic Concepts for Medical-Surgical Nursing 51
Priority Concepts 51
Learning Outcomes 51
Genetic Biology Review 51
DNA 52
DNA Structure 52
DNA Replication 53
Chromosomes 53
Gene Structure and Function 54
Phenotype 55
Genotype 55
Gene Expression 55
Protein Synthesis 55
Mutations 56
Patterns of Inheritance 56
Pedigree 57
Autosomal Dominant Pattern of Inheritance 57
Penetrance 58
Expressivity 58
Autosomal Recessive Pattern of Inheritance 58
Sex-Linked Recessive Pattern of Inheritance 58
Complex Inheritance and Familial Clustering 59
Genetic Testing 59
Purpose of Genetic Testing 59
Benefits and Risks of Genetic Testing 59
Genetic Counseling 60
Ethical Issues 61
The Role of the Medical-Surgical Nurse in Genetic Counseling 61
Communication 61
Privacy and Confidentiality 62
Information Accuracy 62
Patient Advocacy and Support 62
Get Ready for the NCLEX® Examination! 63
Key Points 63
Safe and Effective Care Environment 63
Health Promotion and Maintenance 63
Psychosocial Integrity 63
Physiological Integrity 63
5 Evidence-Based Practice in Medical-Surgical Nursing 64
Priority Concepts 64
Learning Outcomes 64
Overview 64
Definitions of Evidence-Based Practice 64
Steps of the Evidence-Based Practice Process 65
Asking “Burning” Clinical Questions 65
Qualitative Versus Quantitative Questions. 65
PICO(T) Format. 65
Finding the Best Evidence 66
Critically Appraising and Synthesizing Evidence 67
Making Recommendations to Improve Practice 67
Implementing Recommendations 67
Evaluating Outcomes 68
Models and Frameworks for Implementing Evidence-Based Practice 68
Iowa Model 68
Reavy and Tavernier Model 69
ARCC Model 69
Evidence-Based Practice Improvement (EBPI) Model 70
Steps of the EBPI Model 70
Application of the EBPI Model to Clinical Practice: A Case Study 70
Describe the Practice Problem 70
Formulate a Focused Clinical Question 71
Search for Evidence 71
Appraise and Synthesize the Evidence 71
Develop the Aim Statement 72
Implement the PDSA Cycles 72
Disseminate Best Practices 73
Get Ready for the NCLEX® Examination! 73
Key Points 73
Safe and Effective Care Environment 73
6 Rehabilitation Concepts for Chronic and Disabling Health Problems 74
Priority Concepts 74
Learning Outcomes 74
Overview 74
Chronic and Disabling Health Problems 74
Rehabilitation Settings 75
The Rehabilitation Team 75
Patient-Centered Collaborative Care 77
Assessment 77
History. 77
Physical Assessment/Clinical Manifestations. 77
Cardiovascular and Respiratory Assessment. 77
Gastrointestinal and Nutritional Assessment. 78
Renal and Urinary Assessment. 78
Neurologic and Musculoskeletal Assessment. 78
Skin Assessment. 79
Functional Assessment. 79
Psychosocial Assessment. 80
Vocational Assessment. 80
Analysis 80
Planning and Implementation 80
Improving Physical Mobility 80
Planning: Expected Outcomes. 80
Interventions. 80
Safe Patient Handling Practices. 80
Gait Training. 81
Increasing Functional Ability 84
Planning: Expected Outcomes. 84
Interventions. 84
Maintaining Skin Integrity 85
Unit II Concepts of Emergency Care and Disaster Preparedness 105
8 Concepts of Emergency and Trauma Nursing 105
Priority Concepts 105
Learning Outcomes 105
The Emergency Department Environment of Care 106
Demographic Data and Vulnerable Populations 106
Special Nursing Teams 106
Interdisciplinary Team Collaboration 106
Staff and Patient Safety Considerations 108
Staff Safety 108
Patient Safety 108
Scope of Emergency Nursing Practice 109
Core Competencies 110
Training and Certification 111
Emergency Nursing Principles 111
Triage 111
Emergent, Urgent, and Nonurgent Categories 111
Other Multi-Tiered Models 112
Disposition 112
Case Management 113
Patient and Family Education 113
Death in the Emergency Department 114
The Impact of Homelessness 114
Trauma Nursing Principles 114
Trauma Centers and Trauma Systems 115
Trauma Centers 115
Trauma Systems 116
Mechanism of Injury 116
Primary Survey and Resuscitation Interventions 116
A: Airway/Cervical Spine 116
B: Breathing 116
C: Circulation 117
D: Disability 117
E: Exposure 117
The Secondary Survey and Resuscitation Interventions 118
Disposition 118
Get Ready for the NCLEX® Examination! 118
Key Points 118
Safe and Effective Care Environment 118
Psychosocial Integrity 119
Physiological Integrity 119
9 Care of Patients with Common Environmental Emergencies 120
Priority Concepts 120
Learning Outcomes 120
Heat-Related Illnesses 120
Health Promotion and Maintenance 121
Heat Exhaustion 121
Unit III Management of Patients with Fluid, Electrolyte, and Acid-Base Imbalances 148
11 Assessment and Care of Patients with Fluid and Electrolyte Imbalances 148
Priority Concepts 148
Learning Outcomes 148
Homeostasis 148
Physiologic Influences on Fluid and Electrolyte Balance 148
Filtration 149
Physiologic Action 149
Clinical Significance 149
Diffusion 150
Physiologic Action 150
Clinical Significance 150
Osmosis 151
Physiologic Action 151
Clinical Significance 151
Fluid Balance 152
Body Fluids 152
Hormonal Regulation of Fluid Balance 153
Significance of Fluid Balance 154
The Renin-Angiotensin II Pathway 154
Clinical Application 155
Fluid Imbalances 155
Dehydration 155
Pathophysiology 155
Health Promotion and Maintenance 156
Patient-Centered Collaborative Care 156
Assessment 156
History. 156
Physical Assessment/Clinical Manifestations. 156
Laboratory Assessment. 157
Interventions 157
Fluid Overload 158
Pathophysiology 158
Patient-Centered Collaborative Care 158
Assessment 158
Interventions 158
Electrolyte Balance and Imbalances 160
Sodium 161
Hyponatremia 161
Pathophysiology 161
Patient-Centered Collaborative Care 161
Assessment 161
Interventions 162
Hypernatremia 162
Pathophysiology 162
Patient-Centered Collaborative Care 162
Assessment 162
Interventions 163
Potassium 163
Hypokalemia 163
Pathophysiology 163
Patient-Centered Collaborative Care 164
Assessment 164
Interventions 164
Hyperkalemia 166
Pathophysiology 166
Patient-Centered Collaborative Care 166
Assessment 166
Interventions 166
Calcium 167
Hypocalcemia 167
Pathophysiology 167
Patient-Centered Collaborative Care 168
Assessment 168
Unit IV Management of Perioperative Patients 215
14 Care of Preoperative Patients 215
Priority Concepts 215
Learning Outcomes 215
Overview 216
Categories and Purposes of Surgery 217
Surgical Settings 218
Patient-Centered Collaborative Care 219
Assessment 219
History. 219
Physical Assessment/Clinical Manifestations. 221
Psychosocial Assessment. 222
Laboratory Assessment. 223
Imaging Assessment. 224
Other Diagnostic Assessment. 225
Analysis 225
Planning and Implementation 225
Providing Information 225
Planning: Expected Outcomes. 225
Interventions. 225
Ensuring Informed Consent. 226
Patient Self-Determination. 228
Implementing Dietary Restrictions. 228
Administering Regularly Scheduled Drugs. 228
Intestinal Preparation. 228
Skin Preparation. 228
Preparing the Patient for Tubes, Drains, and Vascular Access. 229
Postoperative Procedures and Exercises. 230
Procedures and Exercises to Prevent Respiratory Complications. 230
Procedures and Exercises to Prevent Cardiovascular Complications. 231
Minimizing Anxiety 233
Planning: Expected Outcomes. 233
Interventions. 233
Preoperative Chart Review. 233
Preoperative Patient Preparation. 234
Preoperative Drugs. 234
Patient Transfer to the Surgical Suite. 234
Evaluation: Outcomes 236
Nursing Concepts and Clinical Judgment Review 236
Vital signs: 236
Physical assessment: 236
Psychological assessment: 236
Laboratory assessment: 236
Get Ready for the Nclex® Examination! 236
Key Points 236
Safe and Effective Care Environment 236
Health Promotion and Maintenance 236
Psychosocial Integrity 236
Physiological Integrity 237
15 Care of Intraoperative Patients 238
Priority Concepts 238
Learning Outcomes 238
Overview 238
Members of the Surgical Team 238
Surgeon and Surgical Assistant 238
Anesthesia Providers 239
Perioperative Nursing Staff 239
Preparation of the Surgical Suite and Team Safety 241
Layout 241
Minimally Invasive and Robotic Surgery 242
Health and Hygiene of the Surgical Team 242
Surgical Attire 243
Surgical Scrub 243
Anesthesia 244
General Anesthesia 245
Stages of General Anesthesia. 245
Administration of General Anesthesia. 245
Complications of General Anesthesia. 246
Local or Regional Anesthesia 248
Local Anesthesia. 248
Regional Anesthesia. 248
Complications of Local or Regional Anesthesia. 249
Moderate Sedation 249
Patient-Centered Collaborative Care 250
Assessment 250
History. 250
Medical Record Review. 250
Advance Directives and Do-Not-Resuscitate Orders. 250
Allergies and Previous Reactions to Anesthesia or Transfusions. 251
Autologous Blood Transfusion. 251
Laboratory and Diagnostic Test Results. 251
Medical History and Physical Examination Findings. 251
Analysis 252
Planning and Implementation 252
Preventing Injury 252
Planning: Expected Outcomes. 252
Interventions. 252
Preventing Infection 253
Unit V Problems of Protection: Management of Patients with Problems of the Immune System 275
Concept Overview 274
17 Inflammation and Immunity 275
Priority Concepts 275
Learning Outcomes 275
Overview 275
Self Versus Non-Self 276
Organization of the Immune System 276
Inflammation 277
Infection 278
Cell Types Involved in Inflammation 278
Neutrophils 278
Macrophages 279
Basophils 279
Eosinophils 280
Tissue Mast Cells 280
Phagocytosis 280
Sequence of Inflammation 280
Immunity 281
Antibody-Mediated Immunity 281
Antigen-Antibody Interactions 281
Antibody Classification 284
Acquiring Antibody-Mediated Immunity 284
Cell-Mediated Immunity 285
Cell Types Involved in Cell-Mediated Immunity 285
Cytokines 286
Protection Provided by Cell-Mediated Immunity 286
Transplant Rejection 286
Hyperacute Rejection 286
Acute Rejection 287
Chronic Rejection 287
Management of Transplant Rejection 287
Nursing Concepts and Clinical Judgment Review 289
Vital signs: 289
Physical assessment: 289
Laboratory assessment: 289
Get Ready for the NCLEX® Examination! 289
Key Points 289
Physiological Integrity 289
18 Care of Patients with Arthritis and Other Connective Tissue Diseases 290
Priority Concepts 290
Learning Outcomes 290
Osteoarthritis 291
Pathophysiology 291
Etiology and Genetic Risk 291
Incidence and Prevalence 291
Health Promotion and Maintenance 292
Patient-Centered Collaborative Care 292
Assessment 292
History. 292
Physical Assessment/Clinical Manifestations. 292
Psychosocial Assessment. 293
Laboratory Assessment. 293
Imaging Assessment. 293
Analysis 293
Planning and Implementation 293
Managing Chronic Pain 293
Planning: Expected Outcomes. 293
Interventions. 293
Nonsurgical Management. 293
Drug Therapy. 293
Nonpharmacologic Interventions. 294
Complementary and Alternative Therapies. 294
Surgical Management. 295
Total Hip Arthroplasty. 295
Preoperative Care. 296
Operative Procedures. 296
Postoperative Care. 297
Preventing Hip Dislocation. 297
Preventing Venous Thromboembolism. 298
Preventing Infection. 299
Assessing for Bleeding and Managing Anemia. 299
Assessing for Neurovascular Compromise. 299
Managing Pain. 299
Promoting Mobility and Activity. 299
Promoting Self-Management. 300
Total Knee Arthroplasty. 300
Preoperative Care. 300
Operative Procedures. 301
Complementary and Alternative Therapies. 301
Postoperative Care. 301
Other Joint Arthroplasties. 302
Improving Mobility 303
Planning: Expected Outcomes. 303
Interventions. 303
Community-Based Care 304
Home Care Management. 304
Self-Management Education. 304
Health Care Resources. 304
Evaluation: Outcomes 304
Rheumatoid Arthritis 304
Pathophysiology 304
Patient-Centered Collaborative Care 305
Assessment 305
Physical Assessment/Clinical Manifestations 305
Early Disease Manifestations. 305
Late Disease Manifestations. 305
Joint Involvement. 306
Systemic Complications and Associated Syndromes. 306
Psychosocial Assessment. 306
Laboratory Assessment. 307
Other Diagnostic Assessment. 307
Interventions 308
Managing Inflammation and Pain. 308
Drug Therapy. 308
First-Line Disease-Modifying Antirheumatic Drugs. 308
Nonsteroidal Anti-inflammatory Drugs. 310
Biological Response Modifiers. 310
Other Drugs. 311
Nonpharmacologic Interventions. 311
Complementary and Alternative Therapies. 312
Promoting Self-Management. 312
Managing Fatigue. 312
Enhancing Body Image. 312
Community-Based Care 313
Home Care Management. 313
Self-Management Education. 313
Health Care Resources. 313
Lupus Erythematosus 313
Pathophysiology 313
Patient-Centered Collaborative Care 314
Assessment 314
Physical Assessment/Clinical Manifestations 314
Skin Involvement. 314
Other Manifestations. 315
Psychosocial Assessment. 315
Laboratory Assessment. 315
Interventions 315
Managing Lupus with Drug Therapy. 315
Protecting the Skin. 316
Community-Based Care 316
Systemic Sclerosis 317
Pathophysiology 317
Patient-Centered Collaborative Care 317
Assessment 317
Physical Assessment/Clinical Manifestations. 317
Laboratory Assessment. 318
Interventions 318
Community-Based Care 319
Gout 319
Pathophysiology 319
Patient-Centered Collaborative Care 319
Assessment 319
Interventions 320
Drug Therapy. 320
Nutrition Therapy and Lifestyle Recommendations. 320
Infectious Arthritis 320
Lyme Disease 320
Psoriatic Arthritis 321
Fibromyalgia Syndrome 321
Chronic Fatigue Syndrome 322
Other Connective Tissue Diseases 322
Other Disease-Associated Arthritis 322
Mixed Connective Tissue Disease 322
Nursing Concepts and Clinical Judgment Review 324
Perform and interpret focused physical assessment findings, including: 324
Respond: 324
Get Ready for the NCLEX® Examination! 324
Key Points 324
Safe and Effective Care Environment 324
Health Promotion and Maintenance 324
Psychosocial Integrity 325
Physiological Integrity 325
19 Care of Patients with HIV Disease and Other Immune Deficiencies 326
Priority Concepts 326
Learning Outcomes 326
Acquired (Secondary) Immune Deficiencies 326
HIV Infection and AIDS 326
Pathophysiology 326
Etiology and Genetic Risk 326
The HIV Infectious Process. 327
HIV Classification. 328
HIV Progression. 328
Incidence and Prevalence 328
Health Promotion and Maintenance 329
Sexual Transmission 330
Parenteral Transmission 331
Perinatal Transmission 332
Transmission and Health Care Workers 332
Testing 332
Patient-Centered Collaborative Care 333
Assessment 333
History. 333
Physical Assessment/Clinical Manifestations. 333
Opportunistic Infections. 333
Malignancies. 335
Endocrine Complications. 335
Other Clinical Manifestations. 336
Psychosocial Assessment. 336
Laboratory Assessment 336
Lymphocyte Counts. 336
Antibody Tests. 336
Viral Load Testing. 337
Other Laboratory Assessment. 337
Other Diagnostic Assessment. 337
Analysis 337
Planning and Implementation 337
Preventing Infection. 337
Planning: Expected Outcomes. 338
Interventions. 338
Drug Therapy. 338
Immune Enhancement. 340
Complementary and Alternative Therapies. 340
Enhancing Oxygenation 340
Planning: Expected Outcomes. 340
Interventions. 340
Managing Pain. 340
Unit VI Problems of Protection: Management of Patients with Problems of the Skin, Hair, and Nails 415
24 Assessment of the Skin, Hair, and Nails 415
Priority Concepts 415
Learning Outcomes 415
Anatomy and Physiology Review 415
Structure of the Skin 415
Structure of the Skin Appendages 417
Functions of the Skin 417
Skin Changes Associated with Aging 417
Assessment Methods 420
Patient History 420
Nutrition Status 420
Family History and Genetic Risk 421
Current Health Problems 421
Skin Assessment 421
Inspection 421
Palpation 424
Hair Assessment 424
Nail Assessment 425
Skin Assessment Techniques for Patients with Darker Skin 428
Psychosocial Assessment 428
Diagnostic Assessment 429
Laboratory Tests 429
Other Diagnostic Tests 429
Skin Biopsy. 429
Patient Preparation. 429
Procedure. 429
Follow-up Care. 429
Wood’s Light Examination. 429
Diascopy. 429
Nursing Concepts and Clinical Judgment Review 430
Vital signs: 430
Physical assessment: 430
Psychological assessment: 430
Get Ready for the NCLEX® Examination! 430
Key Points 430
Safe and Effective Care Environment 430
Health Promotion and Maintenance 430
Psychosocial Integrity 430
Physiological Integrity 430
25 Care of Patients with Skin Problems 432
Priority Concepts 432
Learning Outcomes 432
Minor Skin Irritations 432
Pruritus 432
Pathophysiology 432
Patient-Centered Collaborative Care 433
Urticaria 433
Trauma 433
Pathophysiology 433
Phases of Wound Healing 433
Mechanisms of Wound Healing 435
Partial-Thickness Wounds. 435
Full-Thickness Wounds. 435
Patient-Centered Collaborative Care 436
Pressure Ulcers 436
Pathophysiology 436
Mechanical Forces 437
Incidence and Prevalence 437
Health Promotion and Maintenance 437
Identification of High-Risk Patients 437
Pressure-Relieving and Pressure-Reducing Techniques 440
Patient-Centered Collaborative Care 441
Assessment 441
History. 441
Physical Assessment/Clinical Manifestations. 441
Wound Assessment. 441
Psychosocial Assessment. 443
Laboratory Assessment. 444
Other Diagnostic Assessments. 444
Analysis 444
Planning and Implementation 444
Managing Wounds 444
Planning: Expected Outcomes. 444
Interventions. 444
Nonsurgical Management. 444
Dressings. 444
Physical Therapy. 446
Drug Therapy. 446
Nutrition Therapy. 446
New Technologies. 446
Surgical Management. 447
Preventing Infection and Wound Deterioration 447
Planning: Expected Outcomes. 447
Interventions. 447
Community-Based Care 447
Home Care Management. 447
Self-Management Education. 449
Health Care Resources. 449
Evaluation: Outcomes 449
Common Infections 449
Pathophysiology 449
Bacterial Infections 450
Viral Infections 451
Fungal Infections 451
Health Promotion and Maintenance 452
Patient-Centered Collaborative Care 452
Assessment 452
History. 452
Physical Assessment/Clinical Manifestations. 452
Laboratory Assessment. 452
Interventions 452
Cutaneous Anthrax 453
Parasitic Disorders 453
Pediculosis 453
Scabies 454
Bedbugs 454
Common Inflammations 455
Pathophysiology 455
Patient-Centered Collaborative Care 455
Psoriasis 456
Pathophysiology 456
Patient-Centered Collaborative Care 456
Assessment 456
History. 456
Physical Assessment/Clinical Manifestations. 456
Interventions 456
Topical Therapy. 457
Light Therapy. 457
Systemic Therapy. 458
Emotional Support. 458
Skin Cancer 458
Pathophysiology 458
Etiology and Genetic Risk 458
Incidence and Prevalence 460
Health Promotion and Maintenance 460
Patient-Centered Collaborative Care 460
Assessment 460
Interventions 460
Surgical Management. 460
Nonsurgical Management. 461
Other Skin Disorders 461
Toxic Epidermal Necrolysis 461
Stevens-Johnson Syndrome 461
Plastic Surgery 462
Assessment 462
Interventions 463
Nursing Concepts and Clinical Judgment Review 463
Perform and interpret physical assessment, including: 463
Respond by: 463
Get Ready for the NCLEX® Examination! 464
Key Points 464
Safe and Effective Care Environment 464
Health Promotion and Maintenance 464
Psychosocial Integrity 464
Physiological Integrity 464
26 Care of Patients with Burns 465
Priority Concepts 465
Learning Outcomes 465
Pathophysiology of Burn Injury 465
Skin Changes Resulting from Burn Injury 465
Anatomic Changes 465
Functional Changes 466
Depth of Burn Injury 466
Superficial-Thickness Wounds. 467
Partial-Thickness Wounds. 467
Full-Thickness Wounds. 468
Deep Full-Thickness Wounds. 469
Vascular Changes Resulting from Burn Injuries 469
Cardiac Changes Resulting from Burn Injury 470
Pulmonary Changes Resulting from Burn Injury 470
Gastrointestinal Changes Resulting from Burn Injury 470
Metabolic Changes Resulting from Burn Injury 470
Immunologic Changes Resulting from Burn Injury 470
Compensatory Responses to Burn Injury 470
Etiology of Burn Injury 470
Incidence and Prevalence of Burn Injury 472
Health Promotion and Maintenance 472
Resuscitation Phase of Burn Injury 473
Patient-Centered Collaborative Care 473
Assessment 473
History. 473
Physical Assessment/Clinical Manifestations. 473
Respiratory Assessment. 473
Direct Airway Injury. 473
Carbon Monoxide Poisoning. 474
Thermal (Heat) Injury. 474
Smoke Poisoning. 475
Pulmonary Fluid Overload. 475
External Factors. 475
Cardiovascular Assessment. 475
Kidney/Urinary Assessment. 475
Skin Assessment. 476
Gastrointestinal Assessment. 476
Laboratory Assessment. 476
Imaging Assessment. 476
Other Diagnostic Assessment. 476
Analysis 477
Planning and Implementation 477
Supporting Oxygenation 477
Planning: Expected Outcomes. 477
Interventions. 477
Nonsurgical Management. 477
Surgical Management. 478
Preventing Hypovolemic Shock and Inadequate Oxygenation 478
Planning: Expected Outcomes. 478
Interventions. 478
Nonsurgical Management. 478
Surgical Management. 479
Managing Pain. 479
Planning: Expected Outcomes. 479
Interventions. 479
Nonsurgical Management. 480
Surgical Management. 480
Preventing Acute Respiratory Distress Syndrome 480
Planning: Expected Outcome. 480
Interventions. 480
Acute Phase of Burn Injury 481
Patient-Centered Collaborative Care 481
Assessment 481
Physical Assessment/Clinical Manifestations 481
Cardiopulmonary Assessment. 481
Neuroendocrine Assessment. 481
Immune Assessment. 481
Musculoskeletal Assessment. 482
Analysis 482
Planning and Implementation 482
Managing Wound Care 482
Planning: Expected Outcomes. 482
Interventions. 482
Nonsurgical Management. 482
Mechanical Débridement. 482
Enzymatic Débridement. 483
Dressing the Burn Wound. 483
Standard Wound Dressings. 483
Biologic Dressings. 483
Biosynthetic Wound Dressings. 483
Synthetic Dressings. 483
Surgical Management. 483
Surgical Excision. 484
Wound Covering. 484
Minimizing Infection. 485
Planning: Expected Outcomes. 485
Interventions. 485
Nonsurgical Management. 485
Drug Therapy for Infection Prevention. 485
Drug Therapy for Treatment of Infection. 485
Providing a Safe Environment. 485
Surgical Management. 485
Minimizing Weight Loss 486
Planning: Expected Outcomes. 486
Interventions. 486
Maintaining Mobility 487
Planning: Expected Outcomes. 487
Interventions. 487
Nonsurgical Management. 487
Unit VII Problems of Oxygenation: Management of Patients with Problems of the Respiratory Tract 494
Concept Overview 492
27 Assessment of the Respiratory System 494
Priority Concepts 494
Learning Outcomes 494
Health Promotion and Maintenance 494
Anatomy and Physiology Review 496
Upper Respiratory Tract 496
Nose and Sinuses 496
Pharynx 497
Larynx 497
Lower Respiratory Tract 498
Airways 498
Lungs 499
Accessory Muscles of Respiration 499
Oxygen Delivery and the Oxygen-Hemoglobin Dissociation Curve 499
Respiratory Changes Associated with Aging 500
Assessment Methods 500
Patient History 500
Nutrition Status 502
Family History and Genetic Risk 502
Current Health Problems 502
Physical Assessment 503
Assessment of the Nose and Sinuses 503
Assessment of the Pharynx, Trachea, and Larynx 503
Assessment of the Lungs and Thorax 503
Inspection. 503
Palpation. 504
Percussion. 504
Auscultation. 505
Other Indicators of Respiratory Adequacy 506
Psychosocial Assessment 506
Diagnostic Assessment 507
Laboratory Assessment 507
Imaging Assessment 507
Other Noninvasive Diagnostic Assessment 508
Pulse Oximetry. 508
Capnometry and Capnography. 509
Pulmonary Function Tests. 509
Patient Preparation. 509
Procedure. 509
Follow-up Care. 509
Exercise Testing. 509
Skin Tests. 509
Other Invasive Diagnostic Assessment 509
Endoscopic Examinations. 509
Patient Preparation. 510
Procedure. 510
Unit VIII Problems of Cardiac Output and Tissue Perfusion: Management of Patients with Problems of the Cardiovascular System 627
33 Assessment of the Cardiovascular System 627
Priority Concepts 627
Learning Outcomes 627
Anatomy and Physiology Review 627
Heart 627
Structure 627
Function 629
Sequence of Events During the Cardiac Cycle. 629
Mechanical Properties of the Heart. 630
Vascular System 631
Arterial System 631
Venous System 632
Cardiovascular Changes Associated with Aging 632
Assessment Methods 632
Patient History 632
Nutrition History 634
Family History and Genetic Risk 634
Current Health Problems 634
Functional History 636
Physical Assessment 636
General Appearance 637
Skin 637
Extremities 637
Blood Pressure 637
Venous and Arterial Pulses 638
Precordium 639
Inspection. 639
Auscultation. 639
Normal Heart Sounds. 639
Abnormal Heart Sounds. 640
Psychosocial Assessment 640
Diagnostic Assessment 640
Laboratory Assessment 640
Serum Markers of Myocardial Damage. 640
Serum Lipids. 641
Other Laboratory Tests. 642
Other Diagnostic Assessment 642
Cardiac Catheterization. 643
Patient Preparation. 643
Procedure. 643
Follow-up Care. 644
Electrocardiography. 644
Electrophysiologic Studies. 645
Exercise Electrocardiography (Stress Test). 645
Patient Preparation. 645
Procedure. 645
Follow-up Care. 645
Echocardiography. 645
Transesophageal Echocardiography. 646
Myocardial Nuclear Perfusion Imaging. 646
Magnetic Resonance Imaging. 647
Nursing Concepts and Clinical Judgment Review 647
Physical assessment: 647
Diagnostic assessment: 647
Get Ready for the NCLEX® Examination! 647
Key Points 647
Safe and Effective Care Environment 647
Health Promotion and Maintenance 647
Psychosocial Integrity 647
Physiological Integrity 647
34 Care of Patients with Dysrhythmias 649
Priority Concepts 649
Learning Outcomes 649
Review of Cardiac Conduction System 649
Electrocardiography 650
Lead Systems 651
Continuous Electrocardiographic Monitoring 652
Electrocardiographic Complexes, Segments, and Intervals 652
Determination of Heart Rate 654
Electrocardiographic Rhythm Analysis 655
Overview of Normal Cardiac Rhythms 656
Common Dysrhythmias 656
Pathophysiology 656
Etiology 657
Patient-Centered Collaborative Care 657
Drug Classifications 657
Sinus Dysrhythmias 662
Sinus Tachycardia. 662
Sinus Bradycardia. 663
Assessment. 664
Interventions. 664
Temporary Pacing. 664
Permanent Pacemaker. 664
Atrial Dysrhythmias 665
Premature Atrial Complexes. 665
Supraventricular Tachycardia. 665
Assessment. 665
Interventions. 665
Atrial Fibrillation. 666
Assessment. 666
Interventions. 667
Drug Therapy. 667
Cardioversion. 668
Radiofrequency Catheter Ablation. 668
Other Nonsurgical Management. 669
Ventricular Dysrhythmias 669
Premature Ventricular Complexes. 669
Assessment. 670
Interventions. 670
Ventricular Tachycardia. 670
Ventricular Fibrillation. 670
Emergency Care: Ventricular Fibrillation. 671
Ventricular Asystole. 671
Assessment. 671
Interventions. 671
Cardiopulmonary Resuscitation and Defibrillation. 671
Automated External Defibrillation. 672
Implantable Cardioverter/Defibrillator. 673
Community-Based Care 673
Home Care Management. 673
Self-Management Education. 673
Health Care Resources. 676
Nursing Concepts and Clinical Judgment Review 676
Perform and interpret physical assessment, including: 676
Respond by: 676
Get Ready for the NCLEX® Examination! 676
Key Points 676
Safe and Effective Care Environment 676
Health Promotion and Maintenance 676
Physiological Integrity 677
35 Care of Patients with Cardiac Problems 678
Priority Concepts 678
Learning Outcomes 678
Heart Failure 678
Pathophysiology 679
Types of Heart Failure 679
Classification and Staging of Heart Failure 679
Compensatory Mechanisms 679
Etiology 681
Incidence and Prevalence 681
Patient-Centered Collaborative Care 681
Assessment 681
History. 681
Unit IX Problems of Tissue Perfusion: Management of Patients with Problems of the Hematologic System 785
39 Assessment of the Hematologic System 785
Priority Concepts 785
Learning Outcomes 785
Anatomy and Physiology Review 785
Bone Marrow 785
Blood Components 786
Accessory Organs of Blood Formation 787
Hemostasis and Blood Clotting 787
Anti-Clotting Forces 788
Hematologic Changes Associated with Aging 788
Assessment Methods 788
Patient History 788
Nutrition Status 791
Family History and Genetic Risk 791
Current Health Problems 792
Physical Assessment 792
Skin Assessment 792
Head and Neck Assessment 792
Respiratory Assessment 792
Cardiovascular Assessment 792
Kidney and Urinary Assessment 792
Musculoskeletal Assessment 793
Abdominal Assessment 793
Central Nervous System Assessment 793
Psychosocial Assessment 793
Diagnostic Assessment 793
Laboratory Tests 793
Tests of Cell Number and Function. 793
Tests Measuring Bleeding and Coagulation. 795
Imaging Assessment 795
Bone Marrow Aspiration and Biopsy 795
Patient Preparation. 795
Procedure. 796
Follow-Up Care. 796
Nursing Concepts and Clinical Judgment Review 796
Vital signs: 796
Physical assessment: 796
Psychological assessment: 796
Laboratory assessment: 796
Get Ready for the NCLEX® Examination! 797
Key Points 797
Safe and Effective Care Environment 797
Health Promotion and Maintenance 797
Psychosocial Integrity 797
Physiological Integrity 797
40 Care of Patients with Hematologic Problems 798
Priority Concepts 798
Learning Outcomes 798
Red Blood Cell Disorders 798
Anemias Resulting From Increased Destruction of Red Blood Cells 799
Sickle Cell Disease 799
Pathophysiology 799
Etiology and Genetic Risk 800
Incidence and Prevalence 800
Patient-Centered Collaborative Care 800
Assessment 800
History. 800
Physical Assessment/Clinical Manifestations. 800
Psychosocial Assessment. 801
Laboratory Assessment. 801
Imaging Assessment. 801
Other Diagnostic Assessment. 801
Analysis 801
Interventions 801
Managing Pain. 801
Preventing Sepsis, Multiple Organ Dysfunction, and Death. 802
Community-Based Care 803
Glucose-6-Phosphate Dehydrogenase Deficiency Anemia 803
Pathophysiology 803
Patient-Centered Collaborative Care 803
Immunohemolytic Anemia 803
Anemias Resulting From Decreased Production of Red Blood Cells 804
Disorders of Excess Red Blood Cells or Iron 805
Polycythemia Vera 805
Pathophysiology 805
Patient-Centered Collaborative Care 805
Hereditary Hemochromatosis 806
Myelodysplastic Syndromes 806
Unit X Problems of Mobility, Sensory Perception, and Cognition: Management of Patients with Problems of the Nervous System 829
Concept Overview 828
41 Assessment of the Nervous System 829
Priority Concepts 829
Learning Outcomes 829
Anatomy and Physiology Review 829
Nervous System Cells: Structure and Function 830
Central Nervous System: Structure and Function 830
Brain 830
Major Parts of the Brain. 830
Circulation in the Brain. 832
Spinal Cord 832
Ascending Tracts. 833
Descending Tracts. 833
Peripheral Nervous System: Structure and Function 833
Autonomic Nervous System: Structure and Function 835
Neurologic Changes Associated with Aging 836
Assessment Methods 837
Patient History 837
Physical Assessment 837
Complete Neurologic Assessment 837
Assessment of Mental Status. 838
Assessment of Cranial Nerves. 840
Assessment of Motor Function. 840
Assessment of Reflex Activity. 841
Assessment of Sensory Function. 841
Assessment of Cerebellar Function. 842
Rapid Neurologic Assessment 843
Psychosocial Assessment 844
Diagnostic Assessment 844
Laboratory Assessment 844
Imaging Assessment 844
Plain X-Rays. 844
Cerebral Angiography. 845
Computed Tomography. 845
Magnetic Resonance Imaging. 847
Positron Emission Tomography. 848
Single-Photon Emission Computed Tomography. 848
Magnetoencephalography. 848
Other Diagnostic Assessment 848
Electromyography. 848
Electroencephalography. 848
Evoked Potentials. 849
Cerebral Blood Flow Evaluation. 849
Lumbar Puncture. 849
Transcranial Doppler Ultrasonography. 850
Muscle and Nerve Biopsies. 850
Nursing Concepts and Clinical Judgment Review 851
Physical assessment: 851
Diagnostic assessment: 851
Get Ready for the NCLEX® Examination! 851
Key Points 851
Safe and Effective Care Environment 851
Health Promotion and Maintenance 851
Psychosocial Integrity 851
Physiological Integrity 851
42 Care of Patients with Problems of the Central Nervous System: 853
Priority Concepts 853
Learning Outcomes 853
Headaches 853
Migraine Headache 854
Pathophysiology 854
Patient-Centered Collaborative Care 854
Assessment 854
Interventions 855
Abortive Therapy. 855
Preventive Therapy. 856
Complementary and Alternative Therapies. 856
Cluster Headache 857
Pathophysiology 857
Patient-Centered Collaborative Care 857
Assessment 857
Interventions 857
Seizures and Epilepsy 858
Pathophysiology 858
Types of Seizures 858
Etiology and Genetic Risk 858
Patient-Centered Collaborative Care 859
Assessment 859
Interventions 859
Nonsurgical Management. 859
Drug Therapy. 859
Self-Management Education. 859
Seizure Precautions. 860
Seizure Management. 861
Emergency Care: Acute Seizure and Status Epilepticus Management. 861
Surgical Management. 862
Vagal Nerve Stimulation. 862
Conventional Surgical Procedures. 862
Infections 863
Meningitis 863
Pathophysiology 863
Patient-Centered Collaborative Care 863
Assessment 863
Interventions 864
Encephalitis 865
Pathophysiology 865
Patient-Centered Collaborative Care 866
Assessment 866
Interventions 866
Parkinson Disease 867
Pathophysiology 867
Patient-Centered Collaborative Care 867
Assessment 867
Interventions 868
Nonsurgical Management. 868
Drug Therapy. 868
Other Interventions. 870
Psychosocial Support. 870
Surgical Management. 871
Stereotactic Pallidotomy/Thalamotomy. 871
Deep Brain Stimulation. 871
Fetal Tissue Transplantation. 871
Dementia 871
Pathophysiology 871
Etiology and Genetic Risk 872
Incidence and Prevalence 872
Health Promotion and Maintenance 872
Patient-Centered Collaborative Care 872
Assessment 872
History. 872
Physical Assessment/Clinical Manifestations 873
Stages of Alzheimer’s Disease. 873
Changes in Cognition. 873
Changes in Behavior and Personality. 874
Changes in Self-Management Skills. 874
Psychosocial Assessment. 875
Laboratory and Imaging Assessment. 875
Analysis 875
Planning and Implementation 875
Managing Chronic Confusion 875
Planning: Expected Outcomes. 875
Interventions. 875
Nonpharmacologic Management. 875
Drug Therapy. 877
Preventing Injury 878
Planning: Expected Outcomes. 878
Interventions. 878
Managing Caregiver Role Strain 879
Planning: Expected Outcomes. 879
Interventions. 879
Community-Based Care 879
Home Care Management. 879
Self-Management Education. 880
Health Care Resources. 880
Evaluation: Outcomes 880
Huntington Disease 881
Pathophysiology 881
Patient-Centered Collaborative Care 881
Nursing Concepts and Clinical Judgment Review 882
Perform and interpret physical assessment, including: 882
Respond by: 882
Get Ready for the NCLEX® Examination! 882
Key Points 882
Safe and Effective Care Environment 882
Health Promotion and Maintenance 883
Psychosocial Integrity 883
Physiological Integrity 883
43 Care of Patients with Problems of the Central Nervous System: 884
Priority Concepts 884
Learning Outcomes 884
Back Pain 885
Low Back Pain (Lumbosacral Back Pain) 885
Pathophysiology 885
Health Promotion and Maintenance 886
Patient-Centered Collaborative Care 886
Assessment 886
Physical Assessment/Clinical Manifestations. 886
Imaging Assessment. 886
Interventions 887
Nonsurgical Management. 887
Acute Low Back Pain. 887
Chronic Low Back Pain. 887
Complementary and Alternative Therapies. 888
Surgical Management 888
Preoperative Care. 888
Operative Procedures. 888
Postoperative Care. 889
Minimally Invasive Surgery. 889
Conventional Open Surgery. 889
Community-Based Care 890
Home Care Management. 890
Self-Management Education. 890
Health Care Resources. 891
Cervical Neck Pain 891
Pathophysiology 891
Patient-Centered Collaborative Care 891
Spinal Cord Injury 892
Pathophysiology 892
Mechanisms of Injury 892
Etiology 894
Incidence and Prevalence 894
Patient-Centered Collaborative Care 894
Assessment 894
History. 894
Physical Assessment/Clinical Manifestations 894
Initial Assessment. 894
Sensory and Motor Assessment. 894
Cardiovascular and Respiratory Assessment. 895
Gastrointestinal and Genitourinary Assessment. 895
Assessment of Patients for Long-Term Complications. 895
Laboratory and Imaging Assessment. 895
Analysis 895
Planning and Implementation 896
Managing the Airway and Improving Breathing 896
Unit XI Problems of Sensory Perception: Management of Patients with Problems of the Sensory System 966
46 Assessment of the Eye and Vision 966
Priority Concepts 966
Learning Outcomes 966
Anatomy and Physiology Review 966
Structure 966
Layers of the Eyeball 966
Refractive Structures and Media 967
External Structures 967
Muscles, Nerves, and Blood Vessels 967
Function 968
Eye Changes Associated with Aging 969
Health Promotion and Maintenance 970
Assessment Methods 971
Patient History 971
Nutrition History 971
Family History and Genetic Risk 971
Current Health Problems 971
Physical Assessment 972
Inspection 972
Vision Testing 972
Psychosocial Assessment 973
Diagnostic Assessment 973
Laboratory Assessment 973
Imaging Assessment 973
Other Diagnostic Assessment 973
Nursing Concepts and Clinical Judgment Review 976
Physical assessment: 976
Psychological assessment: 976
Get Ready for the NCLEX® Examination! 976
Key Points 976
Safe and Effective Care Environment 976
Health Promotion and Maintenance 976
Psychosocial Integrity 976
Physiological Integrity 976
47 Care of Patients with Eye and Vision Problems 977
Priority Concepts 977
Learning Outcomes 977
Eyelid Disorders 977
Entropion and Ectropion 977
Hordeolum 978
Chalazion 978
Keratoconjunctivitis Sicca 978
Conjunctival Disorders 978
Conjunctivitis 979
Trachoma 980
Corneal Disorders 980
Corneal Abrasion, Ulceration, and Infection 980
Pathophysiology 980
Patient-Centered Collaborative Care 980
Keratoconus and Corneal Opacities 981
Pathophysiology 981
Patient-Centered Collaborative Care 981
Cataract 982
Pathophysiology 982
Etiology and Genetic Risk 982
Incidence and Prevalence 982
Health Promotion and Maintenance 982
Patient-Centered Collaborative Care 982
Assessment 982
History. 982
Physical Assessment/Clinical Manifestations. 983
Psychosocial Assessment. 983
Planning and Implementation 983
Improving Vision 983
Planning: Expected Outcomes. 983
Interventions. 983
Preoperative Care. 983
Operative Procedures. 983
Postoperative Care. 984
Community-Based Care 984
Home Care Management. 984
Self-Management Education. 984
Health Care Resources. 985
Evaluation: Outcomes 985
Glaucoma 985
Pathophysiology 985
Patient-Centered Collaborative Care 985
Assessment 985
Physical Assessment/Clinical Manifestations. 985
Diagnostic Assessment. 985
Interventions 987
Nonsurgical Management. 987
Surgical Management. 988
Retinal Disorders 989
Macular Degeneration 989
Unit XII Problems of Mobility: Management of Patients with Problems of the Musculoskeletal System 1017
49 Assessment of the Musculoskeletal System 1017
Priority Concepts 1017
Learning Outcomes 1017
Anatomy and Physiology Review 1017
Skeletal System 1017
Bones 1017
Types and Structure. 1017
Function. 1018
Joints 1019
Muscular System 1019
Musculoskeletal Changes Associated with Aging 1020
Assessment Methods 1020
Patient History 1020
Nutrition History 1021
Family History and Genetic Risk 1021
Current Health Problems 1021
Assessment of the Skeletal System 1021
General Inspection 1021
Posture and Gait. 1021
Mobility and Functional Assessment. 1022
Specific Assessments 1023
Neurovascular Assessment 1023
Assessment of the Muscular System 1023
Psychosocial Assessment 1024
Diagnostic Assessment 1024
Laboratory Assessment 1024
Imaging Assessment 1025
Radiography. 1025
Nuclear Scans. 1025
Magnetic Resonance Imaging. 1025
Ultrasonography. 1026
Other Diagnostic Assessment 1026
Biopsies. 1026
Electromyography. 1026
Arthroscopy. 1026
Patient Preparation. 1026
Procedure. 1026
Postprocedure Care. 1027
Nursing Concepts and Clinical Judgment Review 1027
Physical assessment: 1027
Diagnostic assessment: 1027
Get Ready for the NCLEX® Examination! 1027
Key Points 1027
Safe and Effective Care Environment 1027
Health Promotion and Maintenance 1027
Psychosocial Integrity 1028
Physiological Integrity 1028
50 Care of Patients with Musculoskeletal Problems 1029
Priority Concepts 1029
Learning Outcomes 1029
Metabolic Bone Diseases 1029
Osteoporosis 1029
Pathophysiology 1029
Etiology and Genetic Risk 1030
Incidence and Prevalence 1031
Health Promotion and Maintenance 1031
Patient-Centered Collaborative Care 1032
Assessment 1032
Physical Assessment/Clinical Manifestations. 1032
Psychosocial Assessment. 1032
Laboratory Assessment. 1032
Imaging Assessment. 1033
Analysis 1033
Planning and Implementation 1033
Planning: Expected Outcomes. 1033
Interventions. 1033
Nutrition Therapy. 1033
Lifestyle Changes. 1033
Drug Therapy. 1034
Calcium and Activated Vitamin D (D3). 1034
Bisphosphonates. 1034
Estrogen Agonist/Antagonists. 1034
Monoclonal Antibodies. 1034
Community-Based Care 1036
Osteomalacia 1036
Pathophysiology 1036
Health Promotion and Maintenance 1036
Patient-Centered Collaborative Care 1037
Assessment 1037
Interventions 1037
Paget’s Disease of the Bone 1037
Pathophysiology 1037
Patient-Centered Collaborative Care 1038
Assessment 1038
Physical Assessment/Clinical Manifestations. 1038
Diagnostic Assessment. 1038
Interventions 1039
Drug Therapy. 1039
Other Interventions. 1039
Osteomyelitis 1039
Pathophysiology 1039
Patient-Centered Collaborative Care 1040
Assessment 1040
Interventions 1041
Nonsurgical Management. 1041
Surgical Management. 1041
Benign Bone Tumors 1042
Unit XIII Problems of Digestion, Nutrition, and Elimination: Management of Patients with Problems of the Gastrointestinal System 1084
Concept Overview 1082
52 Assessment of the Gastrointestinal System 1084
Priority Concepts 1084
Learning Outcomes 1084
Anatomy and Physiology Review 1084
Structure 1084
Function 1084
Oral Cavity 1085
Esophagus 1085
Stomach 1085
Pancreas 1086
Liver and Gallbladder 1086
Small Intestine 1087
Large Intestine 1087
Gastrointestinal Changes Associated with Aging 1087
Assessment Methods 1087
Patient History 1087
Nutrition History 1087
Family History and Genetic Risk 1089
Current Health Problems 1089
Physical Assessment 1089
Inspection 1090
Auscultation 1090
Percussion 1090
Palpation 1090
Psychosocial Assessment 1091
Diagnostic Assessment 1091
Laboratory Assessment 1091
Serum Tests. 1091
Urine Tests. 1091
Stool Tests. 1091
Imaging Assessment 1093
Other Diagnostic Assessment 1093
Esophagogastroduodenoscopy. 1093
Endoscopic Retrograde Cholangiopancreatography. 1094
Small Bowel Capsule Endoscopy. 1095
Colonoscopy. 1095
Patient Preparation. 1095
Procedure. 1095
Follow-Up Care. 1095
Virtual Colonoscopy. 1096
Sigmoidoscopy. 1096
Gastric Analysis. 1097
Ultrasonography. 1097
Endoscopic Ultrasonography. 1097
Liver-Spleen Scan. 1097
Nursing Concepts and Clinical Judgment Review 1097
Physical assessment: 1097
Diagnostic assessment: 1097
Get Ready for the NCLEX® Examination! 1098
Key Points 1098
Safe and Effective Care Environment 1098
Health Promotion and Maintenance 1098
Psychosocial Integrity 1098
Physiological Integrity 1098
53 Care of Patients with Oral Cavity Problems 1099
Priority Concepts 1099
Learning Outcomes 1099
Stomatitis 1100
Pathophysiology 1100
Patient-Centered Collaborative Care 1100
Assessment 1100
Interventions 1101
Oral Tumors 1102
Premalignant Lesions 1102
Oral Cancer 1102
Pathophysiology 1102
Patient-Centered Collaborative Care 1103
Assessment 1103
Interventions 1104
Nonsurgical Management. 1104
Surgical Management. 1105
Preoperative Care. 1105
Operative Procedures. 1105
Postoperative Care. 1105
Community-Based Care 1106
Home Care Management. 1106
Self-Management Education. 1106
Health Care Resources. 1107
Disorders of the Salivary Glands 1107
Acute Sialadenitis 1107
Pathophysiology 1107
Patient-Centered Collaborative Care 1108
Post-Irradiation Sialadenitis 1108
Salivary Gland Tumors 1108
Nursing Concepts and Clinical Judgment Review 1108
Perform and interpret focused physical assessment findings, including: 1108
Respond by: 1109
Get Ready for the NCLEX® Examination! 1109
Key Points 1109
Safe and Effective Care Environment 1109
Health Promotion and Maintenance 1109
Psychosocial Integrity 1109
Physiological Integrity 1109
54 Care of Patients with Esophageal Problems 1110
Priority Concepts 1110
Learning Outcomes 1110
Gastroesophageal Reflux Disease 1110
Pathophysiology 1110
Patient-Centered Collaborative Care 1111
Assessment 1111
Physical Assessment/Clinical Manifestations. 1111
Diagnostic Assessment. 1112
Interventions 1112
Nonsurgical Management. 1112
Nonpharmacologic Interventions. 1112
Drug Therapy. 1113
Endoscopic Therapies. 1114
Surgical Management. 1114
Hiatal Hernia 1114
Pathophysiology 1114
Patient-Centered Collaborative Care 1115
Assessment 1115
Interventions 1115
Nonsurgical Management. 1115
Surgical Management. 1115
Preoperative Care. 1115
Operative Procedures. 1115
Postoperative Care. 1116
Community-Based Care 1117
Esophageal Tumors 1117
Pathophysiology 1117
Patient-Centered Collaborative Care 1118
Assessment 1118
History. 1118
Physical Assessment/Clinical Manifestations. 1118
Psychosocial Assessment. 1118
Diagnostic Assessment. 1118
Analysis 1118
Planning and Implementation 1118
Promoting Nutrition 1118
Planning: Expected Outcomes. 1118
Interventions. 1119
Nonsurgical Management. 1119
Nutrition and Swallowing Therapy. 1119
Chemotherapy and Radiation. 1119
Other Therapies. 1119
Surgical Management. 1120
Preoperative Care. 1120
Operative Procedures. 1120
Postoperative Care. 1121
Community-Based Care 1122
Home Care Management. 1122
Self-Management Education. 1122
Health Care Resources. 1122
Evaluation: Expected Outcomes 1123
Esophageal Diverticula 1123
Esophageal Trauma 1123
Nursing Concepts and Clinical Judgment Review 1124
Perform and interpret focused physical findings, including: 1124
Respond by: 1124
Get Ready for the NCLEX® Examination! 1124
Key Points 1124
Safe and Effective Care Environment 1124
Health Promotion and Maintenance 1124
Psychosocial Integrity 1124
Physiological Integrity 1125
55 Care of Patients with Stomach Disorders 1126
Priority Concepts 1126
Learning Outcomes 1126
Gastritis 1126
Pathophysiology 1126
Types of Gastritis 1126
Etiology and Genetic Risk 1127
Health Promotion and Maintenance 1127
Patient-Centered Collaborative Care 1127
Assessment 1127
Interventions 1128
Peptic Ulcer Disease 1128
Pathophysiology 1129
Types of Ulcers 1129
Complications of Ulcers 1130
Etiology and Genetic Risk 1131
Incidence and Prevalence 1131
Patient-Centered Collaborative Care 1131
Assessment 1131
History. 1131
Physical Assessment/Clinical Manifestations. 1131
Psychosocial Assessment. 1131
Laboratory Assessment. 1132
Imaging Assessment. 1132
Other Diagnostic Assessment. 1132
Analysis 1132
Planning and Implementation 1132
Managing Acute Pain or Chronic Pain 1132
Planning: Expected Outcomes. 1132
Interventions. 1132
Drug Therapy. 1132
Nutrition Therapy. 1135
Complementary and Alternative Therapies. 1136
Managing Upper GI Bleeding 1136
Planning: Expected Outcomes. 1136
Interventions. 1136
Nonsurgical Management. 1136
Emergency: Upper GI Bleeding. 1136
Nasogastric Tube Placement and Lavage. 1136
Endoscopic Therapy. 1136
Interventional Radiologic Procedures. 1137
Acid Suppression. 1137
Surgical Management. 1137
Community-Based Care 1137
Home Care Management. 1137
Self-Management Education. 1138
Health Care Resources. 1138
Evaluation: Outcomes 1138
Gastric Cancer 1138
Pathophysiology 1138
Etiology and Genetic Risk 1138
Incidence and Prevalence 1139
Health Promotion and Maintenance 1139
Patient-Centered Collaborative Care 1139
Assessment 1139
Interventions 1139
Nonsurgical Management. 1139
Surgical Management. 1139
Preoperative Care. 1140
Operative Procedures. 1140
Postoperative Care. 1140
Community-Based Care 1141
Home Care Management. 1141
Self-Management Education. 1142
Health Care Resources. 1142
Nursing Concepts and Clinical Judgment Review 1142
Perform and interpret physical assessment, including: 1142
Respond by: 1142
Get Ready for the NCLEX® Examination! 1142
Key Points 1142
Safe and Effective Care Environment 1142
Health Promotion and Maintenance 1142
Psychosocial Integrity 1143
Physiological Integrity 1143
56 Care of Patients with Noninflammatory Intestinal Disorders 1144
Priority Concepts 1144
Learning Outcomes 1144
Irritable Bowel Syndrome 1144
Pathophysiology 1144
Patient-Centered Collaborative Care 1145
Assessment 1145
Interventions 1145
Complementary and Alternative Therapies. 1146
Herniation 1146
Pathophysiology 1146
Patient-Centered Collaborative Care 1147
Assessment 1147
Interventions 1147
Nonsurgical Management. 1147
Surgical Management. 1147
Colorectal Cancer 1148
Pathophysiology 1148
Etiology and Genetic Risk 1149
Incidence and Prevalence 1149
Health Promotion and Maintenance 1149
Patient-Centered Collaborative Care 1150
Assessment 1150
History. 1150
Physical Assessment/Clinical Manifestations. 1150
Psychosocial Assessment. 1151
Laboratory Assessment. 1151
Imaging Assessment. 1151
Other Diagnostic Assessment. 1151
Analysis 1151
Planning and Implementation 1151
Preventing or Controlling Metastasis 1151
Planning: Expected Outcomes. 1151
Interventions. 1151
Nonsurgical Management. 1151
Surgical Management. 1152
Preoperative Care. 1152
Operative Procedures. 1153
Postoperative Care. 1154
Colostomy Management. 1154
Wound Management. 1154
Assisting with the Grieving Process 1155
Planning: Expected Outcomes. 1155
Interventions. 1155
Community-Based Care 1155
Home Care Management. 1155
Self-Management Education. 1155
Colostomy Care. 1156
Psychosocial Concerns. 1156
Health Care Resources. 1157
Evaluation: Outcomes 1157
Intestinal Obstruction 1157
Pathophysiology 1157
Patient-Centered Collaborative Care 1158
Assessment 1158
History. 1158
Physical Assessment/Clinical Manifestations. 1158
Diagnostic Assessment. 1159
Interventions 1159
Nonsurgical Management. 1159
Nasogastric Tubes. 1159
Other Nonsurgical Interventions. 1160
Surgical Management. 1160
Preoperative Care. 1160
Operative Procedures. 1160
Postoperative Care. 1160
Community-Based Care 1161
Home Care Management. 1161
Self-Management Education. 1161
Health Care Resources. 1161
Abdominal Trauma 1161
Pathophysiology 1161
Patient-Centered Collaborative Care 1162
Assessment 1162
Interventions 1162
Emergency Care: Abdominal Trauma. 1162
Intra-Abdominal Pressure Monitoring. 1163
Surgical Management. 1163
Polyps 1163
Pathophysiology 1163
Patient-Centered Collaborative Care 1163
Hemorrhoids 1164
Pathophysiology 1164
Health Promotion and Maintenance 1164
Patient-Centered Collaborative Care 1164
Assessment 1164
Interventions 1164
Malabsorption Syndrome 1165
Pathophysiology 1165
Patient-Centered Collaborative Care 1165
Assessment 1165
Interventions 1166
Nursing Concepts and Clinical Judgment Review 1166
Perform and interpret focused physical assessment findings, including: 1166
Respond by: 1166
Get Ready for the NCLEX® Examination! 1167
Key Points 1167
Safe and Effective Care Environment 1167
Health Promotion and Maintenance 1167
Psychosocial Integrity 1167
Physiological Integrity 1167
57 Care of Patients with Inflammatory Intestinal Disorders 1168
Priority Concepts 1168
Learning Outcomes 1168
Acute Inflammatory Bowel Disorders 1168
Appendicitis 1168
Pathophysiology 1168
Patient-Centered Collaborative Care 1169
Assessment 1169
Interventions 1169
Nonsurgical Management. 1169
Surgical Management. 1169
Peritonitis 1170
Pathophysiology 1170
Patient-Centered Collaborative Care 1170
Assessment 1170
Interventions 1171
Nonsurgical Management. 1171
Surgical Management. 1171
Community-Based Care 1171
Gastroenteritis 1172
Pathophysiology 1172
Health Promotion and Maintenance 1172
Patient-Centered Collaborative Care 1172
Assessment 1172
Interventions 1173
Chronic Inflammatory Bowel Disease 1173
Ulcerative Colitis 1174
Pathophysiology 1174
Etiology and Genetic Risk 1174
Incidence and Prevalence 1174
Patient-Centered Collaborative Care 1175
Assessment 1175
History. 1175
Physical Assessment/Clinical Manifestations. 1175
Psychosocial Assessment. 1175
Laboratory Assessment. 1175
Other Diagnostic Assessment. 1175
Analysis 1175
Planning and Implementation 1175
Decreasing Diarrhea 1175
Planning: Expected Outcomes. 1175
Interventions. 1175
Nonsurgical Management. 1175
Drug Therapy. 1176
Nutrition Therapy and Rest. 1177
Complementary and Alternative Therapies. 1177
Surgical Management. 1177
Preoperative Care. 1177
Operative Procedures. 1177
Restorative Proctocolectomy with Ileo Pouch–Anal Anastomosis (RPC-IPAA). 1177
Total Proctocolectomy with a Permanent Ileostomy. 1177
Postoperative Care. 1178
Minimizing Pain 1179
Unit XIV Problems of Regulation and Metabolism: Management of Patients with Problems of the Endocrine System 1255
61 Assessment of the Endocrine System 1255
Priority Concepts 1255
Learning Outcomes 1255
Anatomy and Physiology Review 1256
Hypothalamus and Pituitary Glands 1257
Gonads 1257
Adrenal Glands 1257
Adrenal Cortex 1258
Adrenal Medulla 1259
Thyroid Gland 1259
Parathyroid Glands 1260
Pancreas 1260
Endocrine Changes Associated with Aging 1260
Assessment Methods 1261
Patient History 1261
Nutrition History 1261
Family History and Genetic Risk 1262
Current Health Problems 1262
Physical Assessment 1262
Inspection 1262
Palpation 1262
Auscultation 1263
Psychosocial Assessment 1263
Diagnostic Assessment 1263
Laboratory Assessment 1263
Assays. 1263
Stimulation/Suppression Tests. 1263
Venous Sampling. 1264
Urine Tests. 1264
Tests for Glucose. 1264
Imaging Assessment 1264
Other Diagnostic Assessment 1264
Nursing Concepts and Clinical Judgment Review 1264
Vital signs: 1264
Physical assessment: 1264
Psychological assessment: 1264
Laboratory assessment: 1264
Get Ready for the NCLEX® Examination! 1265
Key Points 1265
Health Promotion and Maintenance 1265
Psychosocial Integrity 1265
Physiological Integrity 1265
62 Care of Patients with Pituitary and Adrenal Gland Problems 1266
Priority Concepts 1266
Learning Outcomes 1266
Disorders of the Anterior Pituitary Gland 1266
Hypopituitarism 1266
Pathophysiology 1266
Patient-Centered Collaborative Care 1267
Assessment 1267
Interventions 1268
Hyperpituitarism 1268
Pathophysiology 1268
Patient-Centered Collaborative Care 1269
Assessment 1269
Interventions 1269
Nonsurgical Management. 1269
Surgical Management. 1270
Preoperative Care. 1270
Operative Procedures. 1270
Postoperative Care. 1270
Disorders of the Posterior Pituitary Gland 1271
Diabetes Insipidus 1271
Pathophysiology 1271
Patient-Centered Collaborative Care 1271
Assessment 1271
Interventions 1271
Syndrome of Inappropriate Antidiuretic Hormone 1272
Pathophysiology 1272
Patient-Centered Collaborative Care 1272
Assessment 1272
Interventions 1273
Disorders of the Adrenal Gland 1273
Adrenal Gland Hypofunction 1273
Pathophysiology 1273
Patient-Centered Collaborative Care 1274
Assessment 1274
History. 1274
Physical Assessment/Clinical Manifestations. 1274
Psychosocial Assessment. 1275
Diagnostic Assessment. 1275
Imaging Assessment. 1275
Interventions 1275
Adrenal Gland Hyperfunction 1276
Hypercortisolism (Cushing’s Disease) 1276
Pathophysiology 1276
Etiology 1277
Incidence and Prevalence 1277
Patient-Centered Collaborative Care 1277
Assessment 1277
History. 1277
Physical Assessment/Clinical Manifestations. 1277
Psychosocial Assessment. 1278
Laboratory Assessment. 1278
Imaging Assessment. 1278
Analysis 1278
Planning and Implementation 1278
Restoring Fluid Volume Balance 1278
Planning: Expected Outcomes. 1278
Interventions. 1278
Nonsurgical Management. 1279
Surgical Management. 1279
Preoperative Care. 1279
Operative Procedures. 1279
Postoperative Care. 1280
Preventing Injury. 1280
Unit XV Problems of Excretion: Management of Patients with Problems of the Renal/Urinary System 1344
Concept Overview 1342
65 Assessment of the Renal/Urinary System 1344
Priority Concepts 1344
Learning Outcomes 1344
Anatomy and Physiology Review 1345
Kidneys 1345
Structure 1345
Gross Anatomy. 1345
Microscopic Anatomy. 1346
Function 1346
Regulatory Functions. 1346
Hormonal Functions. 1349
Ureters 1350
Urinary Bladder 1350
Structure 1350
Function 1350
Urethra 1350
Kidney and Urinary System Changes Associated with Aging 1351
Kidney Changes 1351
Urinary Changes 1351
Assessment Methods 1352
Patient History 1352
Nutrition History 1352
Medication History 1352
Family History and Genetic Risk 1353
Current Health Problem 1353
Physical Assessment 1353
Assessment of the Kidneys, Ureters, and Bladder 1353
Assessment of the Urethra 1354
Psychosocial Assessment 1354
Diagnostic Assessment 1354
Laboratory Assessment 1354
Blood Tests. 1354
Urine Tests 1355
Urinalysis. 1355
Urine for Culture and Sensitivity. 1358
Composite Urine Collections. 1358
Creatinine Clearance. 1358
Urine Electrolytes. 1358
Urine Osmolarity. 1358
Bedside Sonography/Bladder Scanners. 1359
Imaging Assessment 1360
Kidney, Ureter, and Bladder X-rays. 1360
Computed Tomography. 1360
Magnetic Resonance Imaging of the Kidney. 1361
Kidney Ultrasonography. 1361
Renal Scan. 1361
Patient Preparation and Procedural Care. 1361
Renal Arteriography (Angiography). 1361
Cystoscopy and Cystourethroscopy 1361
Patient Preparation. 1361
Procedure. 1362
Follow-up Care. 1362
Cystography and Cystourethrography. 1362
Patient Preparation and Procedural Care. 1362
Retrograde Procedures. 1362
Other Diagnostic Assessments 1362
Urodynamic Studies. 1362
Kidney Biopsy 1363
Patient Preparation. 1363
Procedure. 1363
Follow-up Care. 1363
Nursing Concepts and Clinical Judgment Review 1364
Vital signs: 1364
Physical assessment: 1364
Psychological assessment: 1364
Laboratory assessment: 1364
Get Ready for the NCLEX® Examination! 1364
Key Points 1364
Safe and Effective Care Environment 1364
Health Promotion and Maintenance 1364
Psychosocial Integrity 1364
Physiological Integrity 1365
66 Care of Patients with Urinary Problems 1366
Priority Concepts 1366
Learning Outcomes 1366
Infectious Disorders 1366
Cystitis 1367
Pathophysiology 1367
Etiology and Genetic Risk 1367
Incidence and Prevalence 1369
Health Promotion and Maintenance 1369
Patient-Centered Collaborative Care 1369
Assessment 1369
Physical Assessment/Clinical Manifestations. 1369
Laboratory Assessment. 1369
Other Diagnostic Assessment. 1370
Interventions 1370
Nonsurgical Management. 1370
Drug Therapy. 1370
Fluid Intake. 1372
Comfort Measures. 1372
Surgical Management. 1372
Community-Based Care 1373
Urethritis 1373
Unit XVI Problems of Reproduction: Management of Patients with Problems of the Reproductive System 1449
Concept Overview 1448
69 Assessment of the Reproductive System 1449
Priority Concepts 1449
Learning Outcomes 1449
Anatomy and Physiology Review 1449
Structure and Function of the Female Reproductive System 1449
External Genitalia 1449
Internal Genitalia 1450
Breasts 1450
Structure and Function of the Male Reproductive System 1451
Reproductive Changes Associated with Aging 1452
Assessment Methods 1452
Patient History 1452
Nutrition History 1453
Family History and Genetic Risk 1453
Current Health Problems 1453
Physical Assessment 1454
Assessment of the Female Reproductive System 1454
Assessment of the Male Reproductive System 1454
Psychosocial Assessment 1454
Diagnostic Assessment 1454
Laboratory Assessment 1454
Imaging Assessment 1456
Computed Tomography. 1456
Hysterosalpingography. 1456
Mammography. 1456
Other Diagnostic Assessment 1456
Ultrasonography. 1456
Magnetic Resonance Imaging. 1457
Endoscopic Studies 1457
Colposcopy. 1457
Laparoscopy. 1457
Hysteroscopy. 1458
Biopsy Studies 1458
Cervical Biopsy. 1458
Endometrial Biopsy. 1458
Breast Biopsy. 1458
Prostate Biopsy. 1459
Nursing Concepts and Clinical Judgment Review 1459
Physical assessment: 1459
Psychosocial assessment: 1459
Laboratory assessment: 1459
Get Ready for the NCLEX® Examination! 1459
Key Points 1459
Health Promotion and Maintenance 1459
Psychosocial Integrity 1459
Physiological Integrity 1459
70 Care of Patients with Breast Disorders 1461
Priority Concepts 1461
Learning Outcomes 1461
Benign Breast Disorders 1461
Fibroadenoma 1461
Fibrocystic Breast Condition 1462
Pathophysiology 1462
Patient-Centered Collaborative Care 1462
Ductal Ectasia 1462
Intraductal Papilloma 1463
Issues of Large-Breasted Women 1463
Issues of Small-Breasted Women 1463
Gynecomastia 1463
Breast Cancer 1464
Pathophysiology 1464
Noninvasive Breast Cancers 1464
Invasive Breast Cancers 1464
Breast Cancer in Men 1465
Breast Cancer in Young Women 1465
Etiology and Genetic Risk 1465
Incidence and Prevalence 1465
Health Promotion and Maintenance 1465
Mammography 1467
Breast Self-Awareness/Self-Examination 1467
Clinical Breast Examination 1467
Options for High-Risk Women 1468
Patient-Centered Collaborative Care 1469
Assessment 1469
History. 1469
Physical Assessment/Clinical Manifestations. 1469
Psychosocial Assessment. 1469
Laboratory Assessment. 1470
Imaging Assessment. 1470
Other Diagnostic Assessment. 1470
Analysis 1470
Planning and Implementation 1470
Developing Coping Strategies 1470
Planning: Expected Outcomes. 1470
Bibliography 1546
General References 1546
Chapter 1 1546
Chapter 2 1546
Chapter 3 1547
Chapter 4 1548
Chapter 5 1548
Chapter 6 1549
Chapter 7 1549
Chapter 8 1550
Chapter 9 1551
Chapter 10 1552
Chapter 11 1552
Chapter 12 1552
Chapter 13 1552
Chapter 14 1553
Chapter 15 1554
Chapter 16 1555
Chapter 17 1555
Chapter 18 1555
Chapter 19 1555
Chapter 20 1556
Chapter 21 1556
Chapter 22 1556
Chapter 23 1557
Chapter 24 1558
Chapter 25 1558
Chapter 26 1559
Chapter 27 1559
Chapter 28 1560
Chapter 29 1560
Chapter 30 1560
Chapter 31 1561
Chapter 32 1562
Chapter 33 1563
Chapter 34 1563
Chapter 35 1565
Chapter 36 1565
Chapter 37 1566
Chapter 38 1566
Chapter 39 1567
Chapter 40 1567
Chapter 41 1568
Chapter 42 1568
Chapter 43 1569
Chapter 44 1570
Chapter 45 1571
Chapter 46 1571
Chapter 47 1571
Chapter 48 1571
Chapter 49 1572
Chapter 50 1572
Chapter 51 1572
Chapter 52 1573
Chapter 53 1573
Chapter 54 1574
Chapter 55 1574
Chapter 56 1574
Chapter 57 1575
Chapter 58 1575
Chapter 59 1576
Chapter 60 1576
Chapter 61 1577
Chapter 62 1577
Chapter 63 1577
Chapter 64 1577
Chapter 65 1578
Chapter 66 1579
Chapter 67 1580
Chapter 68 1580
Chapter 69 1581
Chapter 70 1581
Chapter 71 1582
Chapter 72 1583
Chapter 73 1583
Chapter 74 1584
Glossary 1586
A 1586
B 1589
C 1590
D 1594
E 1595
F 1597
G 1598
H 1599
I 1602
J 1603
K 1603
L 1603
M 1605
N 1607
O 1608
P 1609
Q 1613
R 1613
S 1614
T 1617
U 1619
V 1619
W 1620
X 1621
NCLEX® Examination Challenges—Answer Key AK-1
Chapter 2 AK-1
Chapter 3 AK-1
Chapter 4 AK-1
Chapter 6 AK-1
Chapter 7 AK-1
Chapter 8 AK-1
Chapter 9 AK-1
Chapter 10 AK-1
Chapter 11 AK-1
Chapter 12 AK-1
Chapter 13 AK-1
Chapter 14 AK-1
Chapter 15 AK-1
Chapter 16 AK-1
Chapter 17 AK-1
Chapter 18 AK-1
Chapter 19 AK-1
Chapter 20 AK-1
Chapter 21 AK-1
Chapter 22 AK-1
Chapter 23 AK-1
Chapter 24 AK-1
Chapter 25 AK-1
Chapter 26 AK-1
Chapter 27 AK-1
Chapter 28 AK-1
Chapter 29 AK-1
Chapter 30 AK-1
Chapter 31 AK-1
Chapter 32 AK-1
Chapter 33 AK-1
Chapter 34 AK-2
Chapter 35 AK-2
Chapter 36 AK-2
Chapter 37 AK-2
Chapter 38 AK-2
Chapter 39 AK-2
Chapter 40 AK-2
Chapter 41 AK-2
Chapter 42 AK-2
Chapter 43 AK-2
Chapter 44 AK-2
Chapter 45 AK-2
Chapter 46 AK-2
Chapter 47 AK-2
Chapter 48 AK-2
Chapter 49 AK-2
Chapter 50 AK-2
Chapter 51 AK-2
Chapter 52 AK-2
Chapter 53 AK-2
Chapter 54 AK-2
Chapter 55 AK-2
Chapter 56 AK-2
Chapter 57 AK-2
Chapter 58 AK-2
Chapter 59 AK-2
Chapter 60 AK-2
Chapter 61 AK-2
Chapter 62 AK-2
Chapter 63 AK-2
Chapter 64 AK-3
Chapter 65 AK-3
Chapter 66 AK-3
Chapter 67 AK-3
Chapter 68 AK-3
Chapter 69 AK-3
Chapter 70 AK-3
Chapter 71 AK-3
Chapter 72 AK-3
Chapter 73 AK-3
Chapter 74 AK-3
Illustration Credits IC-1
Chapter 1 IC-1
Chapter 2 IC-1
Chapter 3 IC-1
Chapter 4 IC-1
Chapter 5 IC-1
Chapter 6 IC-1
Chapter 7 IC-1
Chapter 9 IC-1
Chapter 10 IC-1
Chapter 11 IC-1
Chapter 12 IC-1
Chapter 13 IC-1
Chapter 14 IC-1
Chapter 15 IC-1
Chapter 16 IC-1
Chapter 17 IC-1
Chapter 18 IC-1
Chapter 19 IC-1
Chapter 20 IC-2
Chapter 22 IC-2
Chapter 23 IC-2
Chapter 24 IC-2
Chapter 25 IC-2
Chapter 26 IC-2
Chapter 27 IC-2
Chapter 28 IC-2
Chapter 29 IC-2
Chapter 30 IC-2
Chapter 31 IC-2
Chapter 32 IC-2
Chapter 33 IC-2
Chapter 34 IC-2
Chapter 35 IC-2
Chapter 36 IC-2
Chapter 38 IC-2
Chapter 40 IC-2
Chapter 41 IC-2
Chapter 42 IC-2
Chapter 43 IC-2
Chapter 45 IC-2
Chapter 46 IC-3
Chapter 47 IC-3
Chapter 50 IC-3
Chapter 51 IC-3
Chapter 53 IC-3
Chapter 56 IC-3
Chapter 57 IC-3
Chapter 58 IC-3
Chapter 60 IC-3
Chapter 61 IC-3
Chapter 62 IC-3
Chapter 64 IC-3
Chapter 65 IC-3
Chapter 66 IC-3
Chapter 67 IC-3
Chapter 68 IC-3
Chapter 70 IC-3
Chapter 72 IC-3
Chapter 74 IC-3
Index I-1
A I-1
B I-5
C I-8
D I-15
E I-19
F I-22
G I-24
H I-25
I I-30
J I-34
K I-35
L I-35
M I-37
N I-40
O I-42
P I-44
Q I-52
R I-52
S I-55
T I-60
U I-62
V I-63
W I-65
X I-65
Y I-65
Z I-65
Endsheets 5-7 endshee-5