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Medical-Surgical Nursing - E-Book

Medical-Surgical Nursing - E-Book

Sharon L. Lewis | Linda Bucher | Margaret M. Heitkemper | Mariann M. Harding | Jeffrey Kwong | Dottie Roberts

(2016)

Additional Information

Book Details

Abstract

Awarded first place in the 2017 AJN Book of the Year Awards in the Medical-Surgical Nursing category. Learn how to become an exceptional caregiver in today’s evolving healthcare environment! Written by a dedicated team of expert authors led by Sharon Lewis, Medical-Surgical Nursing, 10th Edition offers up-to-date coverage of the latest trends, hot topics, and clinical developments in the field. Completely revised and updated content explores patient care in various clinical settings and focuses on key topics such as patient safety, NCLEX exam preparation, evidence-based practice, and teamwork. A variety of helpful boxes and tables make it easy for you to find essential information and the accessible writing style and building-block approach make even the most complex concepts easy to grasp. Best of all — a complete collection of learning and study resources helps you learn more effectively and offers valuable, real-world preparation for clinical practice.

  • Highly readable format offers you a strong foundation in medical-surgical nursing.
  • Content written and reviewed by leading experts in the field ensures that information is comprehensive, current, and clinically accurate.
  • Informatics boxes discuss how technology is used by nurses and patients in healthcare settings.
  • Expanded coverage of evidence-based practice helps you understand how to apply the latest research to real-life patient care.
  • Expanded Safety Alerts throughout the book highlight patient safety issues and focus on the latest National Patient Safety Goals.
  • UNIQUE! "Levels of Care" approach explains how nursing care varies for different levels of health and illness.
  • 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.
  • Unfolding case studies included throughout each assessment chapter help you apply concepts and procedures to real-life patient care.
  • Managing Care of Multiple Patients case studies at the end of each section help you apply your knowledge of various disorders and prioritize and delegate patient care.
  • Separate chapter on genetics focuses on the practical application to nursing care of patients.
  • Genetics in Clinical Practice boxes address key topics such as genetic testing, Alzheimer’s disease, sickle cell disease, and genetics-related ethical issues.
  • Genetic Risk Alerts and Genetic Link headings highlight specific genetic issues related to body system assessments and disorders.

Table of Contents

Section Title Page Action Price
Front Cover cover
Inside Front Cover ifc1
Evolve page ES-4
Medical-Surgical Nursing i
Copyright Page iv
About the Authors v
Contributors vii
Reviewers ix
Dedication xiii
Preface xv
Organization xv
Classic Features xv
New Features xvi
Learning Supplements for Students xvi
Acknowledgments xvii
Authors of Teaching and Learning Resources xix
Table Of Contents xxi
Special Features xxiii
Assessment Abnormalities Tables xxiii
Becoming A Nurse Leader Boxes xxiii
Case Studies xxiii
End-of-Chapter Case Studies xxiii
Managing Care of Multiple Patients Case Studies xxiii
Assessment Case Studies xxiii
Complementary & Alternative TherapIES Boxes xxiv
Cultural & Ethnic Health Disparities Boxes xxiv
Diagnostic Studies Tables xxiv
Drug Therapy Tables xxiv
Emergency Management Tables xxv
Ethical/Legal Dilemmas Boxes xxv
Evidence-Based Practice Boxes xxv
Applying the Evidence Boxes xxv
Translating Research Into Practice Boxes xxvi
Focused Assessment Boxes xxvi
Gender Differences Boxes xxvi
Genetics In Clinical Practice Boxes xxvi
Gerontologic Assessment Differences Tables xxvi
Health History Tables xxvii
Healthy People Boxes xxvii
Informatics in Practice Boxes xxvii
Interprofessional Care Tables xxvii
Nursing Assessment Tables xxviii
Nursing ManagemenT Tables xxviii
Nutritional Therapy Tables xxviii
Patient & Caregiver Teaching Tables xxix
Teamwork & Collaboration Boxes xxix
Second half title page_single volume xxxi
1 Concepts in Nursing Practice 1
1 Professional Nursing Practice 2
Learning Outcomes 2
Key Terms 2
Professional Nursing Practice 2
Domain of Nursing Practice 2
Definitions of Nursing 2
Nursing’s View of Humanity 3
Scope of Nursing Practice 3
Influences on Professional Nursing Practice 3
Complex Health Care Environments 3
Expanding Knowledge and Technology. 3
Diverse Populations. 4
Consumerism. 4
Health Care Systems 4
Health Care Financing. 4
Health Policy. 4
Healthy People Initiative 4
Organizational Influences 5
Professional Nursing Organizations. 5
Quality and Safety Education for Nurses (QSEN). 5
Patient-Centered Care 5
Nursing Process 5
Standardized Nursing Terminologies 5
NANDA-I Nursing Diagnoses. 7
Nursing Outcomes Classification (NOC). 7
Nursing Interventions Classification (NIC). 7
NANDA-NOC-NIC Linkages. 7
Nursing Care Plans 7
Continuum of Patient Care 8
Delivery of Nursing Care 9
Critical Thinking 9
Teamwork and Collaboration 9
Interprofessional Team 9
Coordinating Care 10
Communication. 10
Clinical Pathways. 10
Delegation and Assignment. 11
Safety 12
Serious Reportable Events 12
National Patient Safety Goals 12
Quality Improvement 12
National Database of Nursing Quality Indicators 13
Informatics 13
Electronic Health Records 14
Evidence-Based Practice 15
Steps of EBP Process 15
Step 1. 15
Step 2. 15
Step 3. 15
Step 4. 16
Step 5. 16
Step 6. 16
Implementing EBP 16
Bridge to NCLEX Examination 16
Evolve Website 17
References 17
2 Health Disparities and Culturally Competent Care 18
Learning Outcomes 18
Key Terms 18
Determinants of Health 18
Health Disparities and Health Equity 19
Factors and Conditions Leading to Health Disparities 19
Ethnicity and Race. 19
Place. 20
Income, Education, and Occupation. 20
Health Literacy. 20
Gender. 20
Age. 20
Sexual Orientation. 21
Lesbian, Gay, Bisexual, and Transgender (LGBT). 21
Health Care Provider Attitudes. 21
Culture 21
Cultural Competence 23
Cultural Diversity in the Health Care Workplace 24
Cultural Factors Affecting Health and Health Care 24
Folk Healers and Traditions 24
Spirituality and Religion 24
Cross-Cultural Communication 25
Family Roles and Relationships 26
Personal Space 27
Touch 27
Nutrition 28
Immigrants and Immigration 28
Medications 28
Psychologic Factors 29
Nursing Management: Reducing Health Disparities and Increasing Cultural Competency 29
Nurse’s Self-Assessment 29
Patient Assessment 29
Nursing Implementation 30
Advocacy. 30
Standardized Guidelines. 30
Communication. 30
Bridge to NCLEX Examination 32
Evolve Website 33
References 33
3 Health History and Physical Examination 34
Learning Outcomes 34
Key Terms 34
Data Collection 34
Medical Focus 34
Nursing Focus 34
Types of Data 35
Interview Considerations 35
Symptom Investigation 35
Data Organization 35
Culturally Competent Care: Assessment 36
Nursing History: Subjective Data 36
Important Health Information 36
Past Health History. 36
Medications. 36
Allergies. 36
Surgery or Other Treatments. 36
Functional Health Patterns 38
Health Perception–Health Management Pattern. 38
Nutritional-Metabolic Pattern. 38
Elimination Pattern. 38
Activity-Exercise Pattern. 38
Sleep-Rest Pattern. 38
Cognitive-Perceptual Pattern. 38
Self-Perception–Self-Concept Pattern. 38
Role-Relationship Pattern. 38
Sexuality-Reproductive Pattern. 39
Coping–Stress Tolerance Pattern. 39
Value-Belief Pattern. 39
Physical Examination: Objective Data 39
General Survey 39
Physical Examination 39
Techniques. 39
Inspection. 39
Palpation. 39
Percussion. 39
Auscultation. 40
Equipment. 40
Organization of Examination. 40
Recording Physical Examination. 40
Types of Assessment 40
Emergency Assessment 40
Comprehensive Assessment 40
Focused Assessment 40
Using Assessment Approaches 42
Problem Identification and Nursing Diagnoses 44
Bridge to NCLEX Examination 45
Evolve Website 45
References 45
4 Patient and Caregiver Teaching 46
Learning Outcomes 46
Key Terms 46
Role of Patient and Caregiver Teaching 46
Teaching-Learning Process 46
Adult Learner 47
Adult Learning Principles. 47
Models to Promote Health. 47
Nurse as Teacher 48
Required Competencies 48
Knowledge of Subject Matter. 48
Communication Skills. 48
Challenges to Nurse-Teacher Effectiveness. 49
Caregiver Support in the Teaching-Learning Process 49
Caregiver Stress. 50
Regulatory Mandates for Patient Teaching 50
Process of Patient Teaching 51
Assessment 51
Physical Factors. 51
Psychologic Factors. 51
Sociocultural Factors 52
Health Literacy. 52
Cultural Considerations. 52
Socioeconomic Considerations. 52
Learner Factors. 53
Learning Needs. 53
Readiness to Learn. 53
Learning Style. 53
Planning 54
Setting Goals. 54
Selecting Teaching Strategies. 54
Learning Materials. 54
Using Technology. 55
Implementation 55
Evaluation 56
Bridge to NCLEX Examination 58
Evolve Website 58
References 58
5 Chronic Illness and Older Adults 60
Learning Outcomes 60
Key Terms 60
Chronic Illness 60
Trajectory of Chronic Illness 60
Preventing and Managing a Crisis. 60
Carrying Out Prescribed Treatment Regimen. 61
Controlling Symptoms. 61
Reordering Time. 61
Adjusting to Changes in the Course of Disease. 61
Preventing Social Isolation. 61
Attempting to Normalize Interactions With Others. 61
Prevention of Chronic Illness 61
Nursing Management: Chronic Illness 62
Older Adults 63
Demographics of Aging 63
Attitudes Toward Aging 63
Biologic Aging 63
Age-Related Physiologic Changes 64
Special Older Adult Populations 64
Chronically Ill Older Adults 64
Cognitively Impaired Older Adults 64
Rural Older Adults 64
Homeless Older Adults 65
Frail Older Adults 65
Culturally Competent Care: Older Adults 66
Social Support for Older Adults 66
Family Caregivers 66
Elder Mistreatment 66
Self-Neglect 67
Social Services for Older Adults 67
Medicare and Medicaid 68
Care Alternatives for Older Adults 68
Adult Day Care and Adult Day Health Care 68
Home Health Care 68
Long-Term Care Facilities 68
Programs for All-Inclusive Care for the Elderly (PACE) 69
Legal and Ethical Issues 69
Nursing Management: Older Adults 69
Nursing Assessment 69
Planning 70
Nursing Implementation 70
Health Promotion. 70
Acute and Ambulatory Care. 71
Care Transitions. 71
Rehabilitation. 71
Assistive Devices. 72
Safety. 72
Medication Use. 72
Depression. 73
Use of Restraints. 74
Sleep. 74
Evaluation 74
Bridge to NCLEX Examination 75
Evolve Website 76
References 76
6 Stress and Stress Management 77
Learning Outcomes 77
Key Terms 77
What is Stress? 77
Is Stress Bad or Good? 77
Factors Affecting Response to Stress 78
Physiologic Response to Stress 78
Nervous System 79
Cerebral Cortex. 79
Limbic System. 79
Reticular Formation. 79
Hypothalamus. 79
Endocrine System 79
Summary of Stress Response 80
Immune System 80
Mind-Body-Spirit Connection 81
Effects of Stress on Health 81
Coping Strategies 82
Relaxation Strategies 83
Relaxation Breathing 83
Meditation 84
Prayer. 84
Imagery 84
Music 85
Massage 85
Nursing Management: Stress 86
Nursing Assessment 86
Nursing Implementation 86
Bridge to NCLEX Examination 88
Evolve Website 88
References 88
7 Sleep and Sleep Disorders 89
Learning Outcomes 89
Key Terms 89
Sleep 89
Physiologic Sleep Mechanisms 90
Sleep-Wake Cycle 90
Wake Behavior. 90
Sleep Behavior. 90
Circadian Rhythms. 90
Sleep Architecture 90
NREM Sleep. 91
REM Sleep. 91
Insufficient Sleep and Sleep Disturbances 91
Sleep Disturbances in the Hospital 91
Sleep Disorders 91
Insomnia 91
Etiology and Pathophysiology 92
Clinical Manifestations 93
Diagnostic Studies 93
Self-Report. 93
Actigraphy. 93
Polysomnography. 93
Interprofessional Care 93
Cognitive-Behavioral Therapy for Insomnia. 93
Drug Therapy. 94
Benzodiazepine Hypnotics. 94
Non-Benzodiazepine Hypnotics. 94
Orexin-Receptor Antagonist. 94
Melatonin-Receptor Agonist. 94
Antidepressants. 94
Antihistamines. 94
Complementary and Alternative Therapy. 95
Nursing Management: Insomnia 95
Nursing Assessment 95
Nursing Diagnoses 95
Nursing Implementation 95
Obstructive Sleep Apnea 96
Clinical Manifestations 97
Diagnostic Studies 97
Nursing and Interprofessional Management: Sleep Apnea 97
Conservative Treatment 97
Surgical Treatment 98
Periodic Limb Movement Disorder 98
Circadian Rhythm Disorders 98
Narcolepsy 98
Parasomnias 99
Gerontologic Considerations: Sleep 99
Special Sleep Needs of Nurses 100
Bridge to NCLEX Examination 100
Evolve Website 101
References 101
8 Pain 102
Learning Outcomes 102
Key Terms 102
Magnitude of Pain Problem 102
Definitions and Dimensions of Pain 102
Pain Mechanisms 103
Transduction. 103
Transmission. 104
Transmission to Spinal Cord. 104
Dorsal Horn Processing. 105
Transmission to Thalamus and Cortex. 105
Perception. 106
Modulation. 106
Classification of Pain 106
Nociceptive Pain 106
Neuropathic Pain 106
Acute and Chronic Pain 107
Pain Assessment 107
Elements of a Pain Assessment 107
Pain Pattern. 108
Location. 109
Intensity. 109
Quality. 109
Associated Symptoms. 109
Management Strategies. 109
Impact of Pain. 109
Patient’s Beliefs, Expectations, and Goals. 110
Documentation 110
Reassessment 110
Pain Treatment 110
Basic Principles 110
Drug Therapy for Pain 111
Nonopioids. 111
Opioids. 112
Types of Opioids. 112
Dual-Mechanism Agents. 114
Opioids to Avoid. 114
Side Effects of Opioids. 114
Adjuvant Analgesic Therapy. 115
Corticosteroids. 115
Antidepressants. 117
Antiseizure Drugs. 117
GABA-Receptor Agonist. 117
α2-Adrenergic Agonists. 117
Local Anesthetics. 117
Cannabinoids. 117
Administration 117
Scheduling. 117
Titration. 117
Equianalgesic Dosing. 117
Administration Routes. 118
Oral. 118
Transmucosal and buccal routes. 118
Intranasal route. 118
Rectal. 118
Transdermal route. 118
Parenteral routes. 119
Intraspinal delivery. 119
Implantable pumps. 120
Patient-controlled analgesia. 120
Interventional Therapy 120
Therapeutic Nerve Blocks. 120
Neuroablative Techniques. 120
Neuroaugmentation. 121
Nondrug Therapies for Pain 121
Physical Pain Relief Strategies 121
Massage. 121
Exercise. 121
Transcutaneous Electrical Nerve Stimulation. 121
Acupuncture. 121
Heat Therapy. 122
Cold Therapy. 122
Cognitive Therapies. 122
Distraction. 122
Hypnosis. 122
Relaxation Strategies. 122
Nursing and Interprofessional Management: Pain 122
Effective Communication 122
Challenges to Effective Pain Management 122
Tolerance. 122
Physical Dependence. 123
Pseudoaddiction. 123
Addiction. 123
Risk Monitoring. 123
Institutionalizing Pain Education and Management 123
Ethical Issues in Pain Management 124
Fear of Hastening Death by Administering Analgesics 124
Requests for Assisted Suicide 125
Use of Placebos in Pain Assessment and Treatment 125
Gerontologic Considerations: Pain 125
Managing Pain in Special Populations 126
Patients Unable to Self-Report Pain 126
Patients With Substance Abuse Problems 126
Bridge to NCLEX Examination 127
Evolve Website 128
References 128
9 Palliative Care at End of Life 129
Learning Outcomes 129
Key Terms 129
Palliative Care 129
Hospice Care 130
Death 131
End-of-Life Care 132
Physical Manifestations at End of Life 132
Psychosocial Manifestations at End of Life 132
Bereavement and Grief 133
Spiritual Needs 134
Culturally Competent Care: End of Life 134
Legal and Ethical Issues Affecting End-of-Life Care 135
Organ and Tissue Donation 135
Advance Care Planning and Advance Directives 135
Resuscitation 135
Nursing Management: End of Life 137
Nursing Assessment 137
Planning 138
Nursing Implementation 138
Psychosocial Care. 138
Anxiety and Depression. 138
Anger. 138
Hopelessness and Powerlessness. 138
Fear. 139
Fear of pain. 139
Fear of shortness of breath. 139
Fear of loneliness and abandonment. 139
Fear of meaninglessness. 139
Communication. 139
Physical Care. 139
Postmortem Care. 139
Special Needs of Caregivers and Nurses in End-of-Life Care 142
Special Needs of Family Caregivers 142
Special Needs of Nurses 142
Bridge to NCLEX Examination 143
Evolve Website 144
References 144
10 Substance Use Disorders 145
Learning Outcomes 145
Key Terms 145
Drugs Associated With Substance Use Disorder 145
Nicotine 145
Effects of Use and Complications 146
Nursing and Interprofessional Management: Tobacco Use Disorder 146
Tobacco Cessation 146
Alcohol 148
Effects of Use and Complications 148
Nursing and Interprofessional Management: Alcohol Use Disorder 149
Alcohol Toxicity 149
Alcohol Withdrawal Syndrome 150
Use of Other Substances 150
Stimulants 150
Nursing and Interprofessional Management: Stimulant Use 151
Toxicity 151
Withdrawal 151
Depressants 152
Sedative-Hypnotics 152
Opioids 152
Nursing and Interprofessional Management: Depressant Use 152
Toxicity 152
2 Pathophysiologic Mechanisms of Disease 159
11 Inflammation and Wound Healing 160
Learning Outcomes 160
Key Terms 160
Inflammatory Response 160
Vascular Response 160
Cellular Response 161
Neutrophils. 161
Monocytes. 161
Lymphocytes. 161
Chemical Mediators 161
Complement System. 161
Prostaglandins and Leukotrienes. 162
Exudate Formation 162
Clinical Manifestations 162
Fever. 163
Types of Inflammation 163
Nursing and Interprofessional Management: Inflammation 163
Nursing Implementation 163
Health Promotion. 163
Acute Care 164
Observation and Vital Signs. 164
Fever. 164
Drug Therapy. 164
RICE. 165
Rest. 165
Cold and heat. 165
Compression and immobilization. 165
Elevation. 165
Healing Process 165
Regeneration 165
Repair 165
Primary Intention. 165
Initial Phase. 166
Granulation Phase. 166
Maturation Phase and Scar Contraction. 166
Secondary Intention. 166
Tertiary Intention. 166
Wound Classification 166
Complications of Healing 166
Nursing and Interprofessional Management: Wound Healing 166
Nursing Assessment 166
Nursing Implementation 168
Clean Wounds. 168
Contaminated Wounds. 168
Negative-Pressure Wound Therapy. 169
Hyperbaric Oxygen Therapy. 170
Drug Therapy. 170
Nutritional Therapy. 170
Infection Prevention and Control. 171
Psychologic Implications. 171
Patient Teaching. 171
Pressure Ulcers 172
Etiology and Pathophysiology 172
Clinical Manifestations 172
Nursing and Interprofessional Management: Pressure Ulcers 172
Nursing Assessment 172
Nursing Diagnoses 172
Planning 172
Nursing Implementation 174
Health Promotion. 174
Acute Care. 174
Ambulatory Care. 175
Evaluation 176
Bridge to NCLEX Examination 176
Evolve Website 177
References 177
12 Genetics and Genomics 178
Learning Outcomes 178
Key Terms 178
Genetics and Genomics 178
Basic Principles of Genetics 178
Genes. 178
Chromosomes. 179
DNA. 179
RNA. 180
Protein Synthesis. 180
Mitosis. 180
Meiosis. 180
Genetic Mutations 180
Types of Mutations. 181
Inheritance Patterns 181
Human Genome Project 182
Genetic Disorders 182
Classification of Genetic Disorders 182
Single Gene Disorders. 182
Multifactorial Genetic Disorders. 182
Epigenetics. 183
Chromosome Disorders. 183
Genetic Testing 183
Interpreting Genetic Test Results 183
Direct-to-Consumer Genetic Tests 185
Genetic Technology 186
DNA Fingerprinting. 186
DNA Microarray (DNA Chip). 186
Genome-Wide Association Study (GWAS) 186
Pharmacogenomics and Pharmacogenetics 186
Gene Therapy 187
Stem Cell Therapy 187
Nursing Management: Genetics and Genomics 188
Nursing Assessment: Family History 189
Bridge to NCLEX Examination 190
Evolve Website 190
References 190
13 Altered Immune Responses and Transplantation 191
Learning Outcomes 191
Key Terms 191
Normal Immune Response 191
Antigens 191
Types of Immunity 191
Innate Immunity. 191
Acquired Immunity. 192
Active Acquired Immunity. 192
Passive Acquired Immunity. 192
Lymphoid Organs 192
Cells Involved in Immune Response 192
Mononuclear Phagocytes. 192
Lymphocytes. 192
B Lymphocytes. 192
T Lymphocytes. 192
T cytotoxic cells. 194
T helper cells. 194
Natural Killer Cells. 194
T Dendritic Cells. 194
Cytokines 194
Comparison of Humoral and Cell-Mediated Immunity 194
Humoral Immunity. 195
Cell-Mediated Immunity. 196
Gerontologic Considerations: Effects of Aging on the Immune System 196
Altered Immune Response 196
Hypersensitivity Reactions 197
Type I: IgE-Mediated Reactions. 197
Anaphylaxis. 197
Atopic Reactions. 198
Type II: Cytotoxic and Cytolytic Reactions. 199
Hemolytic Transfusion Reactions. 199
Goodpasture Syndrome. 199
Type III: Immune-Complex Reactions. 199
Type IV: Delayed Hypersensitivity Reactions. 199
Contact Dermatitis. 200
Microbial Hypersensitivity Reactions. 200
Allergic Disorders 200
Assessment 200
Diagnostic Studies 200
Skin Tests. 200
Procedure. 201
Results. 201
Precautions. 201
Interprofessional Care 201
Anaphylaxis. 201
Chronic Allergies. 201
Allergen Recognition and Control. 201
Drug Therapy. 202
Antihistamines. 202
Sympathomimetic/Decongestant Drugs. 202
Corticosteroids. 202
Antipruritic Drugs. 202
Mast Cell–Stabilizing Drugs. 202
Leukotriene Receptor Antagonists. 202
Immunotherapy. 202
Mechanism of Action. 203
Method of Administration. 203
Subcutaneous immunotherapy. 203
Sublingual immunotherapy. 203
Nursing Management: Immunotherapy 203
Latex Allergies 203
Types of Latex Allergies. 203
Latex-Food Syndrome. 203
Nursing and Interprofessional Management: Latex Allergies 204
Multiple Chemical Sensitivity 204
Autoimmunity 204
Autoimmune Diseases 205
Apheresis 205
Plasmapheresis. 205
Immunodeficiency Disorders 205
Primary Immunodeficiency Disorders 206
Secondary Immunodeficiency Disorders 206
Human Leukocyte Antigen System 206
Human Leukocyte Antigen and Disease Associations 206
Organ Transplantation 207
Tissue Typing 208
HLA Typing. 208
Panel of Reactive Antibodies. 208
Crossmatch. 208
Transplant Rejection 208
Hyperacute Rejection. 208
Acute Rejection. 208
Chronic Rejection. 208
Immunosuppressive Therapy 209
Calcineurin Inhibitors. 209
Mycophenolate Mofetil. 209
Sirolimus. 209
Monoclonal Antibodies. 209
Polyclonal Antibodies. 210
Graft-Versus-Host Disease 210
Bridge to NCLEX Examination 211
Evolve Website 212
References 212
14 Infection and Human Immunodeficiency Virus Infection 213
Learning Outcomes 213
Key Terms 213
Infections 213
Types of Pathogens 213
Emerging Infections 215
Reemerging Infections 215
Antimicrobial-Resistant Organisms 216
Health Care–Associated Infections 217
Gerontologic Considerations: Infections in Older Adults 217
Infection Prevention and Control 218
Occupational Safety and Health Administration (OSHA) Guidelines 218
Infection Precautions 218
Human Immunodeficiency Virus Infection 218
Transmission of HIV 218
Sexual Transmission. 219
Contact With Blood and Blood Products. 219
Perinatal Transmission. 219
Pathophysiology 219
Clinical Manifestations and Complications 219
Acute Infection. 219
Chronic HIV Infection 220
Asymptomatic Infection. 220
Symptomatic Infection. 221
AIDS. 221
Diagnostic Studies 221
Diagnosis of HIV Infection. 221
Laboratory Studies in HIV Infection. 222
Interprofessional Care 223
Drug Therapy for HIV Infection. 223
Drug Therapy for Opportunistic Diseases. 223
Preventing Transmission of HIV. 223
Nursing Management: HIV Infection 223
Nursing Assessment 223
Planning 224
Nursing Implementation 224
Health Promotion. 224
Prevention of HIV Infection. 224
Decreasing risks related to sexual intercourse. 225
Decreasing risks related to drug use. 225
Decreasing risks of perinatal transmission. 226
Decreasing risks at work. 226
HIV Testing. 227
Acute Care 227
Early Intervention. 227
Initial response to diagnosis of HIV. 227
Antiretroviral therapy. 227
Delaying disease progression. 228
Acute Exacerbations. 229
Ambulatory Care. 229
Stigma of HIV. 229
Disease and Drug Side Effects. 230
End-of-Life Care. 230
Evaluation 230
Gerontologic Considerations: HIV Infection 231
Bridge to NCLEX Examination 232
Evolve Website 232
References 232
15 Cancer 234
Learning Outcomes 234
Key Terms 234
Biology of Cancer 235
Defect in Cell Proliferation 235
Defect in Cell Differentiation 236
Genetic Link 236
Development of Cancer 236
Initiation. 236
Genetic Link 237
Carcinogens. 237
Chemical carcinogens. 237
Radiation. 237
Viral carcinogens. 237
Promotion. 237
Progression. 238
Role of the Immune System 238
Escape Mechanisms From Immunologic Surveillance. 239
Oncofetal Antigens and Tumor Markers. 239
Benign Versus Malignant Neoplasms 240
Classification of Cancer 240
Anatomic Site Classification 240
Histologic Classification 241
Extent of Disease Classification 241
Clinical Staging. 241
TNM Classification System. 241
Prevention and Early Detection of Cancer 241
Diagnosis of Cancer 242
Biopsy. 243
Interprofessional Care 243
Treatment Goals 243
Cure. 243
Control. 244
Palliation. 244
Personalized Cancer Medicine 244
Surgical Therapy 245
Prevention 245
Cure or Control 245
Supportive and Palliative Care 245
Chemotherapy 245
Effect on Cells 245
Classification of Chemotherapy Drugs 246
Preparation of Chemotherapy 246
Methods of Administration 246
Regional Chemotherapy Administration 246
Intraarterial Chemotherapy. 246
Intraperitoneal Chemotherapy. 247
Intrathecal or Intraventricular Chemotherapy. 248
Intravesical Bladder Chemotherapy. 248
Effects of Chemotherapy on Normal Tissues 248
Treatment Plan 248
Radiation Therapy 248
Effects of Radiation 249
Principles of Radiobiology 249
Simulation and Treatment Planning 249
Treatment 249
External Radiation. 250
Internal Radiation. 250
Nursing Management: Chemotherapy and Radiation Therapy 250
Nursing Implementation 250
Bone Marrow Suppression. 250
Fatigue. 253
Gastrointestinal Effects. 253
Nausea and Vomiting. 253
Diarrhea. 254
Mucositis. 254
Anorexia. 254
Skin Reactions 255
Radiation Skin Changes. 255
Chemotherapy Skin Changes. 255
Pulmonary Effects. 256
Cardiovascular Effects. 256
Cognitive Effects. 256
Reproductive Effects. 256
Late Effects of Radiation and Chemotherapy 256
Immunotherapy and Targeted Therapy 257
Side Effects of Immunotherapy and Targeted Therapy 257
Nursing Management: Immunotherapy and Targeted Therapy 258
Hormone Therapy 259
Hematopoietic Growth Factors 259
Hematopoietic Stem Cell Transplantation 259
Types of Hematopoietic Stem Cell Transplants 260
Procedures 260
Harvest Procedures. 260
Preparative Regimens and Stem Cell Infusions. 261
Complications. 261
Gene Therapy 261
Complications of Cancer 261
Nutritional Problems 261
Malnutrition 261
Altered Taste Sensation (Dysgeusia) 262
Cancer Cachexia 262
Infection 262
Oncologic Emergencies 262
Obstructive Emergencies 264
Metabolic Emergencies 264
Infiltrative Emergencies 264
Cancer Pain 264
Pain Assessment 264
Pain Management 264
Coping with Cancer and Treatment 265
Gerontologic Considerations: Cancer 266
Cancer Survivorship 266
Culturally Competent Care: Cancer 267
Bridge to NCLEX Examination 267
Evolve Website 268
References 268
16 Fluid, Electrolyte, and Acid-Base Imbalances 270
Learning Outcomes 270
Key Terms 270
Homeostasis 270
Water Content of the Body 270
Body Fluid Compartments 271
Calculation of Fluid Gain or Loss 271
Electrolytes 271
Measurement of Electrolytes 271
Electrolyte Composition of Fluid Compartments 271
Mechanisms Controlling Fluid and Electrolyte Movement 271
Diffusion 271
Facilitated Diffusion 272
Active Transport 272
Osmosis 272
Measurement of Osmolality. 273
Osmotic Movement of Fluids. 273
Hydrostatic Pressure 273
Oncotic Pressure 273
Fluid Movement in Capillaries 273
Fluid Shifts 273
Shifts of Plasma to Interstitial Fluid. 273
Elevation of Venous Hydrostatic Pressure. 274
Decrease in Plasma Oncotic Pressure. 274
Elevation of Interstitial Oncotic Pressure. 274
Shifts of Interstitial Fluid to Plasma. 274
Fluid Spacing 274
Regulation of Water Balance 274
Hypothalamic-Pituitary Regulation 274
Renal Regulation 275
Adrenal Cortical Regulation 275
Cardiac Regulation 275
Gastrointestinal Regulation 275
Gerontologic Considerations: Fluid and Electrolytes 276
Fluid Volume Imbalances 276
Fluid Volume Deficit 276
3 Perioperative Care 300
17 Preoperative Care 301
Learning Outcomes 301
Key Terms 301
Surgical Settings 301
Patient Interview 302
Nursing Assessment of Preoperative Patient 302
Subjective Data 302
Psychosocial Assessment. 302
Anxiety. 302
Common Fears. 303
Hope. 304
Past Health History. 304
Medications. 304
Allergies. 305
Review of Systems. 305
Cardiovascular System. 305
Respiratory System. 305
Neurologic System. 305
Genitourinary System. 306
Hepatic System. 306
Integumentary System. 306
Musculoskeletal System. 306
Endocrine System. 306
Immune System. 306
Fluid and Electrolyte Status. 306
Nutritional Status. 306
Objective Data 307
Physical Examination. 307
Diagnostic Studies. 308
Nursing Management: Preoperative Patient 308
Preoperative Teaching 308
General Surgery Information. 308
Ambulatory Surgery Information. 309
Legal Preparation for Surgery 309
Consent for Surgery. 309
Day-of-Surgery Preparation 310
Nursing Role. 310
Preoperative Medications. 311
Transportation to Operating Room 311
Culturally Competent Care: Preoperative Patient 311
Gerontologic Considerations: Preoperative Patient 312
Bridge to NCLEX Examination 313
Evolve Website 314
References 314
18 Intraoperative Care 315
Learning Outcomes 315
Key Terms 315
Physical Environment of the Operating Room 315
Department Layout 315
Holding Area 315
Operating Room 316
Surgical Team 316
Registered Nurse 316
Licensed Practical/Vocational Nurse and Surgical Technologist 317
Surgeon and Assistant 317
Registered Nurse First Assistant 317
Anesthesia Care Provider 318
Nursing Management: Patient Before Surgery 318
Psychosocial Assessment 318
Physical Assessment 318
Chart Review 319
Admitting the Patient 319
Nursing Management: Patient During Surgery 319
Room Preparation 319
Transferring Patient 319
Scrubbing, Gowning, and Gloving 320
Basic Aseptic Technique 320
Assisting Anesthesia Care Provider 320
Safety Considerations 321
Positioning Patient 321
Preventing Hypothermia 322
Preparing Surgical Site 322
Nursing Management: Patient After Surgery 322
Anesthesia 322
Anesthesia Techniques 322
Moderate to Deep Sedation 322
Monitored Anesthesia Care 322
General Anesthesia 322
IV Agents. 323
Inhalation Agents. 323
Adjuncts to General Anesthesia. 323
Dissociative Anesthesia. 323
Local and Regional Anesthesia 324
Methods of Administration. 324
Spinal and Epidural Anesthesia. 325
Gerontologic Considerations: Patient During Surgery 327
Catastrophic Events in the Operating Room 327
Anaphylactic Reactions 327
Malignant Hyperthermia 327
Bridge to NCLEX Examination 328
Evolve Website 329
References 329
19 Postoperative Care 330
Learning Outcomes 330
Key Terms 330
Postoperative Care of Surgical Patient 330
Postanesthesia Care Unit Admission 330
PACU Progression. 330
Phase I Initial Assessment. 331
Respiratory Problems 332
Etiology 332
PACU. 332
Clinical Unit. 335
Nursing Management: Respiratory Problems 335
Nursing Assessment 335
Nursing Diagnoses 335
Nursing Implementation 336
Cardiovascular Problems 336
Etiology 336
PACU. 336
Clinical Unit. 337
Nursing Management: Cardiovascular Problems 337
Nursing Assessment 337
Nursing Diagnoses 338
Nursing Implementation 338
4 Problems Related to Altered Sensory Input 349
20 Assessment of Visual and Auditory Systems 350
Learning Outcomes 350
Key Terms 350
Visual System 350
Structures and Functions of Visual System 350
Structures and Functions of Vision 350
Eyeball. 350
Refractive Media. 350
Refractive Errors. 351
Visual Pathways. 351
External Structures and Functions 352
Internal Structures and Functions 352
Gerontologic Considerations: Effects of Aging on Visual System 352
Assessment of Visual System 352
Subjective Data 352
Important Health Information 352
Past Health History. 352
Medications. 354
Surgery or Other Treatments. 354
Functional Health Patterns. 354
Health Perception–Health Management Pattern. 354
Nutritional-Metabolic Pattern. 355
Elimination Pattern. 355
Activity-Exercise Pattern. 355
Sleep-Rest Pattern. 355
Cognitive-Perceptual Pattern. 355
Self-Perception–Self-Concept Pattern. 355
Role-Relationship Pattern. 355
Sexuality-Reproductive Pattern. 355
Coping–Stress Tolerance Pattern. 355
Value-Belief Pattern. 355
Objective Data 355
Physical Examination. 355
Initial Observation. 355
Assessing Functional Status 358
Visual acuity. 358
Extraocular muscle functions. 358
Pupil function and intraocular pressure. 358
Assessing Structures. 358
Eyebrows, eyelashes, and eyelids. 358
Conjunctiva and sclera. 358
Cornea. 358
Iris. 358
Retina and optic nerve. 358
Special Assessment Techniques 359
Color Vision. 359
Stereopsis. 359
Diagnostic Studies of Visual System 359
Auditory System 360
Structures and Functions of Auditory System 360
External Ear 360
Middle Ear 360
Inner Ear 361
Transmission of Sound. 361
Gerontologic Considerations: Effects of Aging on Auditory System 361
Assessment of Auditory System 361
Subjective Data 362
Important Health Information 362
Past Health History. 362
Medications. 362
Surgery or Other Treatments. 362
Functional Health Patterns. 362
Health Perception–Health Management Pattern. 363
Nutritional-Metabolic Pattern. 363
Elimination Pattern. 363
Activity-Exercise Pattern. 363
Sleep-Rest Pattern. 363
Cognitive-Perceptual Pattern. 363
Self-Perception–Self-Concept Pattern. 363
Role-Relationship Pattern. 363
Sexuality-Reproductive Pattern. 363
Coping–Stress Tolerance Pattern. 363
Value-Belief Pattern. 363
Objective Data 363
Physical Examination. 363
External Ear. 364
External Auditory Canal and Tympanum. 364
Diagnostic Studies of Auditory System 364
Audiometry 364
Specialized Tests 364
Bridge to NCLEX Examination 366
Evolve Website 366
References 366
21 Visual and Auditory Problems 367
Learning Outcomes 367
Key Terms 367
Visual Problems 367
Refractive Errors 367
Nonsurgical Corrections 368
Corrective Glasses. 368
Contact Lenses. 368
Surgical Therapy 368
Laser. 368
Implant. 368
Visual Impairment 368
Nursing Management: Visual Impairment 369
Nursing Assessment 369
Planning 369
Nursing Implementation 369
Health Promotion. 369
Acute Care. 369
Ambulatory Care. 369
Optical Devices for Vision Enhancement. 369
Nonoptical Methods for Vision Enhancement. 369
Non–24-Hour Sleep-Wake Disorder. 369
Evaluation 370
Gerontologic Considerations: Visual Impairment 370
Eye Trauma 370
Extraocular Disorders 370
Inflammation and Infection 370
Conjunctivitis 371
Bacterial Infections. 371
Viral Infections. 371
Chlamydial Infections. 371
Allergic Conjunctivitis. 371
Keratitis 372
Bacterial Infections. 372
Viral Infections. 372
Other Causes of Keratitis. 372
Corneal Ulcer. 372
Nursing Management: Inflammation and Infection 372
Dry Eye Disorders 373
Strabismus 373
Corneal Disorders 373
Corneal Scars 373
Keratoconus 373
Corneal Transplant. 373
Intraocular Disorders 373
Cataract 373
Etiology and Pathophysiology 374
Clinical Manifestations and Diagnostic Studies 374
Interprofessional Care 374
Nonsurgical Therapy. 374
Surgical Therapy. 374
Preoperative Phase. 374
Intraoperative Phase. 374
Postoperative Phase. 375
Nursing Management: Cataracts 375
Nursing Assessment 375
Nursing Diagnoses 375
Planning 375
Nursing Implementation 375
Health Promotion. 375
Acute Care. 375
Ambulatory Care. 376
Evaluation 376
Gerontologic Considerations: Cataracts 376
Retinopathy 376
Retinal Detachment 376
Etiology and Pathophysiology 377
Clinical Manifestations and Diagnostic Studies 377
Interprofessional Care 377
Surgical Therapy 377
Laser Photocoagulation and Cryopexy. 377
Scleral Buckling. 377
Intraocular Procedures. 377
Postoperative Considerations. 378
Age-Related Macular Degeneration 378
Etiology and Pathophysiology 378
Clinical Manifestations and Diagnostic Studies 378
Interprofessional Care 378
Glaucoma 379
Etiology and Pathophysiology 379
Clinical Manifestations 379
Diagnostic Studies 379
Interprofessional Care 379
Chronic Open-Angle Glaucoma. 380
Acute Angle-Closure Glaucoma. 380
Nursing Management: Glaucoma 380
Nursing Assessment 380
Nursing Diagnoses 380
Planning 380
Nursing Implementation 380
Health Promotion. 380
Acute Care. 382
Ambulatory Care. 382
Evaluation 382
Gerontologic Considerations: Glaucoma 382
Intraocular Inflammation and Infection 382
Ocular Tumors 382
Enucleation 382
Ocular Manifestations of Systemic Diseases 383
Auditory Problems: External Ear and Canal 383
Trauma 383
External Otitis 383
Nursing and Interprofessional Management: External Otitis 383
Cerumen and Foreign Bodies in External Ear Canal 384
Malignancy of External Ear 384
Middle Ear and Mastoid 384
Otitis Media 384
Acute Otitis Media 384
Otitis Media With Effusion 384
Chronic Otitis Media and Mastoiditis 384
Nursing and Interprofessional Management: Chronic Otitis Media 385
Otosclerosis 385
Inner Ear Problems 386
Ménière’s Disease 386
Nursing and Interprofessional Management: Ménière’s Disease 386
Benign Paroxysmal Positional Vertigo 386
Acoustic Neuroma 387
Hearing Loss and Deafness 387
Types of Hearing Loss 387
Conductive Hearing Loss. 387
Sensorineural Hearing Loss. 387
Mixed Hearing Loss. 387
Central and Functional Hearing Loss. 387
Classification of Hearing Loss. 388
Clinical Manifestations 388
Tinnitus and Hearing Loss. 388
Nursing and Interprofessional Management: Hearing Loss and Deafness 388
Health Promotion 388
Environmental Noise Control. 388
Immunizations. 389
Ototoxic Substances. 389
Assistive Devices and Techniques 389
Hearing Aids. 389
Speech Reading. 390
Sign Language. 390
Cochlear Implant. 390
Assistive Listening Devices. 391
Gerontologic Considerations: Hearing Loss 391
Bridge to NCLEX Examination 392
Evolve Website 393
References 393
22 Assessment of Integumentary System 394
Learning Outcomes 394
Key Terms 394
Structures and Functions of Skin and Appendages 394
Structures 394
Epidermis. 394
Dermis. 395
Subcutaneous Tissue. 395
Skin Appendages. 395
Functions of Integumentary System 396
Gerontologic Considerations: Effects of Aging on Integumentary System 396
Assessment of Integumentary System 397
Subjective Data 397
Important Health Information 398
Past Health History. 398
Medications. 398
Surgery or Other Treatments. 398
Functional Health Patterns 398
Health Perception–Health Management Pattern. 398
Nutritional-Metabolic Pattern. 399
Elimination Pattern. 399
Activity-Exercise Pattern. 400
Sleep-Rest Pattern. 400
Cognitive-Perceptual Pattern. 400
Self-Perception–Self-Concept Pattern. 400
Role-Relationship Pattern. 400
Sexuality-Reproductive Pattern. 400
Coping–Stress Tolerance Pattern. 400
Value-Belief Pattern. 400
Objective Data 400
Physical Examination. 400
Inspection. 400
Palpation. 401
Assessment of Dark Skin 402
Diagnostic Studies of Integumentary System 405
Bridge to NCLEX Examination 406
Evolve Website 406
References 406
23 Integumentary Problems 407
Learning Outcomes 407
Key Terms 407
Health Promotion 407
Environmental Hazards 407
Sun Exposure. 407
Irritants and Allergens. 409
Radiation. 409
Rest and Sleep 409
Exercise 409
Hygiene 409
Nutrition 409
Self-Treatment 410
Skin Cancer 410
Risk Factors 410
Nonmelanoma Skin Cancer 410
Actinic Keratosis 411
Basal Cell Carcinoma 411
Squamous Cell Carcinoma 411
Malignant Melanoma 411
Clinical Manifestations 411
Interprofessional Care 411
Atypical or Dysplastic Nevus 413
Skin Infections and Infestations 413
Bacterial Infections 413
Viral Infections 415
Infestations and Insect Bites 415
Fungal Infections 417
Allergic Dermatologic Problems 417
Benign Dermatologic Problems 417
Interprofessional Care: Dermatologic Problems 420
Diagnostic Studies 420
Interprofessional Therapy 420
Phototherapy. 420
Radiation Therapy. 420
Laser Technology. 420
Drug Therapy 420
Antibiotics. 420
Corticosteroids. 421
Antihistamines. 421
Topical Fluorouracil. 421
Immunomodulators. 421
Diagnostic and Surgical Therapy 422
Skin Scraping. 422
Electrodessication and Electrocoagulation. 422
Curettage. 422
Punch Biopsy. 422
Cryosurgery. 422
Excision. 422
Nursing Management: Dermatologic Problems 422
Ambulatory Care 422
Wet Compresses. 422
Baths. 423
Topical Medications. 423
Control of Pruritus. 424
Prevention of Spread. 424
Prevention of Secondary Infections. 424
Specific Skin Care. 424
Psychologic Effects of Chronic Dermatologic Problems. 424
Cosmetic Procedures 425
Elective Surgery 425
Laser Surgery. 425
Face-Lift. 425
Liposuction. 426
Nursing Management: Cosmetic Surgery 426
Preoperative Management 426
Postoperative Management 426
Skin Grafts 426
Uses 426
Types 427
Bridge to NCLEX Examination 428
Evolve Website 428
References 428
24 Burns 429
Learning Outcomes 429
Key Terms 429
Types of Burn Injury 429
Thermal Burns 429
Chemical Burns 429
Smoke and Inhalation Injury 430
Metabolic Asphyxiation. 430
Upper Airway Injury. 430
Lower Airway Injury. 431
Electrical Burns 431
Cold Thermal Injury 431
Classification of Burn Injury 431
Depth of Burn 431
Extent of Burn 432
Location of Burn 433
Patient Risk Factors 433
Prehospital and Emergency Care 433
Phases of Burn Management 434
Emergent Phase 434
Pathophysiology 434
Fluid and Electrolyte Shifts. 434
Inflammation and Healing. 436
Immunologic Changes. 437
Clinical Manifestations 437
Complications 437
Cardiovascular System. 437
Respiratory System. 437
Other Cardiopulmonary Problems. 437
Urinary System. 438
Nursing and Interprofessional Management: Emergent Phase 438
Airway Management 438
Fluid Therapy 439
Wound Care 439
Other Care Measures 441
Drug Therapy 441
Analgesics and Sedatives. 441
Tetanus Immunization. 441
Antimicrobial Agents. 441
Venous Thromboembolism Prophylaxis. 442
Nutritional Therapy 442
Acute Phase 442
Pathophysiology 442
Clinical Manifestations 442
Laboratory Values 442
Sodium. 442
Potassium. 443
Complications 443
Infection. 443
Cardiovascular and Respiratory Systems. 443
Neurologic System. 443
Musculoskeletal System. 443
Gastrointestinal System. 443
Endocrine System. 443
Nursing and Interprofessional Management: Acute Phase 443
Wound Care 443
Excision and Grafting 444
Cultured Epithelial Autografts. 445
Artificial Skin. 445
Pain Management 445
Physical and Occupational Therapy 446
Nutritional Therapy 446
Rehabilitation Phase 446
Pathophysiologic Changes and Clinical Manifestations 446
Complications 446
Nursing and Interprofessional Management: Rehabilitation Phase 447
Gerontologic Considerations: Burns 447
Emotional/Psychologic Needs of Patients and Caregivers 447
Special Needs of Nurses 448
Bridge to NCLEX Examination 449
Evolve Website 450
References 450
5 Problems of Oxygenation: Ventilation 452
25 Assessment of Respiratory System 453
Learning Outcomes 453
Key Terms 453
Structures and Functions of Respiratory System 453
Upper Respiratory Tract 453
Lower Respiratory Tract 454
Surfactant. 455
Blood Supply. 455
Chest Wall 455
Physiology of Respiration 456
Oxygenation. 456
Ventilation. 456
Compliance and Resistance. 456
Arterial Blood Gases. 456
Mixed Venous Blood Gases. 456
Oximetry. 457
CO2 Monitoring. 457
Control of Respiration 458
Chemoreceptors. 458
Mechanical Receptors. 458
Respiratory Defense Mechanisms 458
Filtration of Air. 458
Mucociliary Clearance System. 458
Cough Reflex. 458
Reflex Bronchoconstriction. 459
Alveolar Macrophages. 459
Gerontologic Considerations: Effects of Aging on Respiratory System 459
Assessment of Respiratory System 459
Subjective Data 459
Important Health Information 459
Past Health History. 459
Medications. 460
Surgery or Other Treatments. 460
Functional Health Patterns. 460
Health Perception–Health Management Pattern. 460
Nutritional-Metabolic Pattern. 462
Elimination Pattern. 462
Activity-Exercise Pattern. 462
Sleep-Rest Pattern. 462
Cognitive-Perceptual Pattern. 462
Self-Perception–Self-Concept Pattern. 462
Role-Relationship Pattern. 462
Sexuality-Reproductive Pattern. 462
Coping–Stress Tolerance Pattern. 462
Value-Belief Pattern. 463
Objective Data 463
Physical Examination. 463
Nose. 463
Mouth and Pharynx. 463
Neck. 463
Thorax and Lungs. 463
Inspection. 463
Palpation. 464
Percussion. 465
Auscultation. 466
Diagnostic Studies of Respiratory System 467
Sputum Studies 467
Skin Tests 467
Endoscopy 467
Bronchoscopy. 467
Lung Biopsy 471
Thoracentesis 472
Pulmonary Function Tests 472
Bridge to NCLEX Examination 473
Evolve Website 474
References 474
26 Upper Respiratory Problems 475
Learning Outcomes 475
Key Terms 475
Problems of Nose and Paranasal Sinuses 475
Deviated Septum 475
Nasal Fracture 475
Rhinoplasty 476
Nursing Management: Nasal Surgery 476
Epistaxis 476
Nursing and Interprofessional Management: Epistaxis 476
Allergic Rhinitis 477
Clinical Manifestations 478
Nursing and Interprofessional Management: Allergic Rhinitis 478
Acute Viral Rhinitis 478
Nursing and Interprofessional Management: Acute Viral Rhinitis 480
Influenza 480
Etiology and Pathophysiology 480
Clinical Manifestations 481
Diagnostic Studies 481
Nursing and Interprofessional Management: Influenza 481
Sinusitis 482
Clinical Manifestations 483
Nursing and Interprofessional Management: Sinusitis 483
Obstruction of Nose and Sinuses 483
Nasal Polyps 483
Foreign Bodies 484
Problems of Pharynx 484
Acute Pharyngitis 484
Clinical Manifestations 484
Nursing and Interprofessional Management: Acute Pharyngitis 484
Peritonsillar Abscess 484
Problems of Trachea and Larynx 484
Airway Obstruction 484
Tracheostomy 485
Nursing Management: Tracheostomy 486
Acute Care 486
Chronic Care 489
Swallowing Dysfunction 489
Speech With a Tracheostomy Tube 489
Decannulation 490
Laryngeal Polyps 490
Head and Neck Cancer 491
Clinical Manifestations 491
Diagnostic Studies 491
Staging of Head and Neck Cancer 491
Interprofessional Care 491
Surgical Therapy. 491
Radiation Therapy. 492
Chemotherapy and Targeted Therapy. 492
Nutritional Therapy. 492
Physical Therapy. 493
Speech Therapy. 493
Nursing Management: Head and Neck Cancer 493
Nursing Assessment 493
Nursing Diagnoses 493
Planning 494
Nursing Implementation 494
Health Promotion. 494
Acute Care. 494
Surgical Therapy. 494
Radiation Therapy. 495
Stoma Care. 495
Psychosocial Needs. 495
Ambulatory Care. 495
Evaluation 496
Bridge to NCLEX Examination 497
Evolve Website 497
References 497
27 Lower Respiratory Problems 499
Learning Outcomes 499
Key Terms 499
Lower Respiratory Tract Infections 499
Acute Bronchitis 499
Pertussis 500
Pneumonia 500
Etiology 500
Types of Pneumonia 501
Community-Acquired Pneumonia. 501
Hospital-Acquired Pneumonia. 501
Aspiration Pneumonia. 501
Necrotizing Pneumonia. 502
Opportunistic Pneumonia. 502
Pathophysiology 502
Clinical Manifestations 502
Complications 503
Diagnostic Studies 503
Interprofessional Care 503
Drug Therapy. 504
Nutritional Therapy. 504
Nursing Management: Pneumonia 505
Nursing Assessment 505
Nursing Diagnoses 505
Planning 505
Nursing Implementation 505
Health Promotion. 505
Acute Care. 506
Ambulatory Care. 506
Evaluation 506
Tuberculosis 506
Etiology and Pathophysiology 506
Classification 507
Clinical Manifestations 507
Complications 508
Diagnostic Studies 508
Tuberculin Skin Test. 508
Interferon-γ Release Assays. 508
Chest X-ray. 508
Bacteriologic Studies. 508
Interprofessional Care 508
Drug Therapy 509
Active TB Disease. 509
Latent Tuberculosis Infection. 509
Bacille-Calmette-Guerin Vaccine. 510
Nursing Management: Tuberculosis 510
Nursing Assessment 510
Nursing Diagnoses 511
Planning 511
Nursing Implementation 511
Health Promotion. 511
Acute Care. 511
Ambulatory Care. 511
Evaluation. 511
Atypical Mycobacteria 511
Pulmonary Fungal Infections 512
Lung Abscess 512
Etiology and Pathophysiology 512
Clinical Manifestations and Complications 512
Diagnostic Studies 512
Nursing and Interprofessional Management: Lung Abscess 512
Environmental Lung Diseases 513
Clinical Manifestations 513
Interprofessional Care 513
Lung Cancer 513
Etiology 514
Pathophysiology 514
Paraneoplastic Syndrome. 514
Clinical Manifestations 515
Diagnostic Studies 515
Staging. 516
Screening for Lung Cancer. 516
Interprofessional Care 516
Surgical Therapy. 516
Radiation Therapy. 516
Stereotactic Body Radiotherapy. 516
Chemotherapy. 516
Targeted Therapy. 516
Immunotherapy. 517
Other Therapies 517
Prophylactic Cranial Radiation. 517
Bronchoscopic Laser Therapy. 517
Photodynamic Therapy. 517
Airway Stenting. 517
Radiofrequency Ablation. 517
Nursing Management: Lung Cancer 517
Nursing Assessment 517
Nursing Diagnoses 517
Planning 517
Nursing Implementation 517
Health Promotion. 517
Acute Care. 517
Ambulatory Care. 518
Evaluation 518
Other Types of Lung Tumors 518
Chest Trauma and Thoracic Injuries 519
Pneumothorax 519
Types of Pneumothorax 519
Spontaneous Pneumothorax. 519
Iatrogenic Pneumothorax. 520
Tension Pneumothorax. 520
Hemothorax. 520
Chylothorax. 521
Interprofessional Care 521
Fractured Ribs 521
Flail Chest 521
Chest Tubes and Pleural Drainage 522
Chest Tube Insertion 522
Flutter or Heimlich Valve 522
Pleural Drainage 522
Nursing Management: Chest Drainage 524
Chest Tube Removal 524
Chest Surgery 524
Preoperative Care 524
Surgical Procedures 524
Thoracotomy. 524
Video-Assisted Thoracic Surgery. 526
Postoperative Care 527
Restrictive Respiratory Disorders 527
Pleural Effusion 527
Types 527
Clinical Manifestations 527
Thoracentesis 527
Interprofessional Care 528
Pleurisy 528
Atelectasis 528
Interstitial Lung Diseases 528
Idiopathic Pulmonary Fibrosis 528
Sarcoidosis 528
Vascular Lung Disorders 529
Pulmonary Edema 529
Pulmonary Embolism 529
Etiology and Pathophysiology 529
Clinical Manifestations 529
Complications 529
Diagnostic Studies 530
Interprofessional Care 530
Drug Therapy. 530
Surgical Therapy. 531
Nursing Management: Pulmonary Embolism 531
Nursing Implementation 531
Evaluation 531
Pulmonary Hypertension 531
Idiopathic Pulmonary Arterial Hypertension 531
Etiology and Pathophysiology 531
Clinical Manifestations and Diagnostic Studies 531
Nursing and Interprofessional Management: Pulmonary Hypertension 532
Secondary Pulmonary Arterial Hypertension 533
Cor Pulmonale 533
Clinical Manifestations and Diagnostic Studies 533
Nursing and Interprofessional Management: Cor Pulmonale 533
Lung Transplantation 533
Preoperative Care 533
Surgical Procedure 534
Postoperative Care 534
Bridge to NCLEX Examination 535
Evolve Website 536
References 536
28 Obstructive Pulmonary Diseases 538
Learning Outcomes 538
Key Terms 538
Asthma 539
Risk Factors for Asthma and Triggers of Asthma Attacks 539
Genetics. 539
Immune Response. 539
Allergens. 539
Exercise. 539
Air Pollutants. 539
Occupational Factors. 540
Respiratory Tract Infections. 540
Nose and Sinus Problems. 540
Drugs and Food Additives. 540
Gastroesophageal Reflux Disease. 540
Psychologic Factors. 540
Pathophysiology 540
Clinical Manifestations 542
Classification of Asthma 542
Complications 543
Diagnostic Studies 543
Interprofessional Care 544
Intermittent and Persistent Asthma. 544
Acute Asthma Exacerbations. 545
Drug Therapy 547
Antiinflammatory Drugs 547
Corticosteroids. 547
Leukotriene Modifiers. 547
Anti-IgE. 549
Anti-Interleukin 5. 549
Bronchodilators. 549
β2-Adrenergic Agonist Drugs. 549
Methylxanthines. 551
Anticholinergic Drugs. 551
Inhalation Devices for Drug Delivery. 551
Inhalers. 551
Nebulizers. 551
Patient Teaching Related to Drug Therapy. 552
Nonprescription Combination Drugs. 553
Nursing Management: Asthma 553
Nursing Assessment 553
Nursing Diagnoses 553
Planning 553
Nursing Implementation 554
Health Promotion. 554
Acute Care. 554
Ambulatory Care. 554
Evaluation 557
Chronic Obstructive Pulmonary Disease 557
Etiology 558
Cigarette Smoking. 558
Occupational Chemicals and Dusts. 558
Air Pollution. 558
Infection. 558
Genetics. 558
α1-Antitrypsin (AAT) Deficiency. 558
Genetic Link 558
Aging. 559
Asthma. 559
Gender. 559
Pathophysiology 559
Clinical Manifestations 560
Complications 561
Diagnostic Studies 561
Classification of COPD 562
Interprofessional Care: Stable COPD 562
Smoking Cessation. 562
Drug Therapy. 562
Interprofessional Care: COPD Complications 563
Cor Pulmonale. 563
Acute Exacerbations. 564
Acute Respiratory Failure. 565
Interprofessional Care: Other COPD Treatments 565
Oxygen Therapy. 565
Methods of Administration. 565
Humidification and Nebulization. 565
Complications 565
Combustion. 565
CO2 narcosis. 565
O2 toxicity. 565
Infection. 565
Chronic Oxygen Therapy at Home. 568
Breathing Retraining. 568
Airway Clearance Techniques. 569
Effective Coughing. 569
Chest Physiotherapy. 569
Postural drainage. 570
Percussion. 570
Vibration. 570
Airway Clearance Devices. 570
High-Frequency Chest Wall Oscillation. 570
Nutritional Therapy for COPD. 570
Surgical Therapy for COPD. 571
Gerontologic Considerations: COPD 571
Nursing Management: Chronic Obstructive Pulmonary Disease 572
Nursing Assessment 572
Nursing Diagnoses 572
Planning 572
Nursing Implementation 572
Health Promotion. 572
Acute Care. 573
Ambulatory Care. 573
Pulmonary Rehabilitation. 573
Activity Considerations. 573
Psychosocial Considerations. 574
Sexuality and Sexual Activity. 575
Sleep. 575
End-of-Life Considerations. 575
Evaluation 576
Cystic Fibrosis 576
Etiology and Pathophysiology 576
Genetic Link. 576
Clinical Manifestations 577
Complications 578
Diagnostic Studies 578
Interprofessional Care 578
Nursing Management: Cystic Fibrosis 579
Nursing Assessment 579
Nursing Diagnoses 579
Planning 579
Nursing Implementation 579
Bronchiectasis 580
Etiology and Pathophysiology 580
Clinical Manifestations 580
Diagnostic Studies 580
Interprofessional Care 581
Nursing Management: Bronchiectasis 581
Bridge to NCLEX Examination 582
Evolve Website 583
References 583
6 Problems of Oxygenation: Transport 586
29 Assessment of Hematologic System 587
Learning Outcomes 587
Key Terms 587
Structures and Functions of Hematologic System 587
Bone Marrow 587
Blood 587
Plasma. 587
Blood Cells. 588
Erythrocytes. 588
Leukocytes. 589
Granulocytes. 589
Lymphocytes. 590
Monocytes. 590
Thrombocytes. 590
Normal Iron Metabolism 590
Normal Clotting Mechanisms 590
Vascular Injury and Subendothelial Exposure. 590
Platelet Adhesion. 591
Platelet Activation. 591
Platelet Aggregation. 591
Platelet Plug Formation. 591
Clot Retraction and Dissolution. 591
Spleen 592
Lymph System 592
Liver 592
Gerontologic Considerations: Effects of Aging on Hematologic System 593
Assessment of Hematologic System 593
Subjective Data 593
Important Health Information 593
Past Health History. 593
Medications. 593
Surgery or Other Treatments. 594
Functional Health Patterns. 594
Health Perception–Health Management Pattern. 594
Nutritional-Metabolic Pattern. 594
Elimination Pattern. 594
Activity-Exercise Pattern. 594
Sleep-Rest Pattern. 594
Cognitive-Perceptual Pattern. 594
Self-Perception–Self-Concept Pattern. 594
Role-Relationship Pattern. 595
Sexuality-Reproductive Pattern. 595
Coping–Stress Tolerance Pattern. 595
Value-Belief Pattern. 596
Objective Data 596
Physical Examination. 596
Lymph Node Assessment. 596
Palpation of Liver or Spleen. 598
Skin Assessment. 598
Diagnostic Studies of Hematologic System 599
Laboratory Studies 599
Complete Blood Count. 599
Red Blood Cells. 599
White Blood Cells. 599
Platelet Count. 600
Blood Typing and Rh Factor. 600
Iron Metabolism. 601
Biopsies 602
Bone Marrow Examination. 602
Lymph Node Biopsy. 604
Molecular Cytogenetics and Gene Analysis 604
Bridge to NCLEX Examination 605
Evolve Website 605
References 605
30 Hematologic Problems 606
Learning Outcomes 606
Key Terms 606
Anemia 606
Definition and Classification 606
Clinical Manifestations 607
Integumentary Manifestations. 607
Cardiopulmonary Manifestations. 608
Nursing and Interprofessional Management: Anemia 608
Nursing Assessment 608
Nursing Diagnoses 608
Planning 608
Nursing Implementation 608
Gerontologic Considerations: Anemia 608
Anemia Caused by Decreased Erythrocyte Production 609
Iron-Deficiency Anemia 609
Etiology 609
Clinical Manifestations 610
Diagnostic Studies 610
Interprofessional Care 610
Drug Therapy. 610
Nursing Management: Iron-Deficiency Anemia 611
Thalassemia 611
Etiology 611
Genetic Link. 611
Clinical Manifestations 611
Interprofessional Care 612
Megaloblastic Anemias 612
Megaloblastic Anemia: Cobalamin (Vitamin B12) Deficiency 612
Etiology 612
Pernicious Anemia. 612
Other Causes of Cobalamin Deficiency. 612
Clinical Manifestations 612
Diagnostic Studies 613
Interprofessional Care 613
Megaloblastic Anemia: Folic Acid Deficiency 613
Nursing Management: Megaloblastic Anemia 613
Anemia of Chronic Disease 613
Aplastic Anemia 614
Etiology 614
Clinical Manifestations 614
Diagnostic Studies 614
Nursing and Interprofessional Management: Aplastic Anemia 614
Anemia Caused by Blood Loss 614
Acute Blood Loss 614
Clinical Manifestations 615
Diagnostic Studies 615
Interprofessional Care 615
Nursing Management: Acute Blood Loss 615
Chronic Blood Loss 615
Anemia Caused by Increased Erythrocyte Destruction 615
Sickle Cell Disease 616
Etiology and Pathophysiology 616
Genetic Link. 616
Sickling Episodes. 616
Clinical Manifestations 617
Complications 617
Diagnostic Studies 617
Nursing and Interprofessional Management: Sickle Cell Disease 617
Acquired Hemolytic Anemia 619
Other Red Blood Cell Disorders 619
Hemochromatosis 619
7 Problems of Oxygenation: Perfusion 657
31 Assessment of Cardiovascular System 658
Learning Outcomes 658
Key Terms 658
Structures and Functions of Cardiovascular System 658
Heart 658
Structure. 658
Blood Flow Through Heart. 658
Heart Valves. 658
Blood Supply to Myocardium. 658
Conduction System. 659
Electrocardiogram. 660
Mechanical System. 660
Factors Affecting Cardiac Output. 660
Cardiac Reserve. 661
Vascular System 661
Blood Vessels. 661
Arteries and Arterioles. 661
Capillaries. 661
Veins and Venules. 661
Regulation of Cardiovascular System 661
Autonomic Nervous System. 661
Effect on Heart. 661
Effect on Blood Vessels. 661
Baroreceptors. 661
Chemoreceptors. 662
Blood Pressure 662
Measurement of Arterial Blood Pressure. 662
Pulse Pressure and Mean Arterial Pressure. 662
Gerontologic Considerations: Effects of Aging on the Cardiovascular System 662
Assessment of Cardiovascular System 663
Subjective Data 663
Important Health Information 663
History of Present Illness. 663
Past Health History. 663
Medications. 663
Surgery or Other Treatments. 663
Functional Health Patterns. 663
Health Perception–Health Management Pattern. 664
Nutritional-Metabolic Pattern. 664
Elimination Pattern. 664
Activity-Exercise Pattern. 664
Sleep-Rest Pattern. 664
Cognitive-Perceptual Pattern. 664
Self-Perception–Self-Concept Pattern. 664
Role-Relationship Pattern. 664
Sexuality-Reproductive Pattern. 665
Coping–Stress Tolerance Pattern. 665
Values-Belief Pattern. 666
Objective Data 666
Physical Examination 666
Vital Signs. 666
Peripheral Vascular System 666
Inspection. 666
Palpation. 666
8 Problems of Ingestion, Digestion, Absorption, and Elimination 832
38 Assessment of Gastrointestinal System 833
Learning Outcomes 833
Key Terms 833
Structures and Functions of Gastrointestinal System 833
Ingestion 834
Mouth. 834
Pharynx. 834
Esophagus. 835
Digestion and Absorption 835
Stomach. 835
Small Intestine. 835
Physiology of Digestion. 835
Elimination 836
Large Intestine. 836
Liver, Biliary Tract, and Pancreas 837
Liver. 837
Bilirubin Metabolism. 837
Biliary Tract. 838
Pancreas. 838
Gerontologic Considerations: Effects of Aging on Gastrointestinal System 839
Assessment of Gastrointestinal System 839
Subjective Data 839
Important Health Information 839
Past Health History. 839
Medications. 839
Surgery or Other Treatments. 840
Functional Health Patterns. 840
Health Perception–Health Management Pattern. 840
Nutritional-Metabolic Pattern. 841
Elimination Pattern. 842
Activity-Exercise Pattern. 842
Sleep-Rest Pattern. 842
Cognitive-Perceptual Pattern. 842
Self-Perception–Self-Concept Pattern. 842
Role-Relationship Pattern. 842
Sexuality-Reproductive Pattern. 842
Coping–Stress Tolerance Pattern. 842
Value-Belief Pattern. 842
Objective Data 842
Physical Examination 842
Mouth 842
Inspection. 842
Palpation. 842
Abdomen. 843
Inspection. 843
Auscultation. 843
Percussion. 844
Palpation. 844
Rectum and Anus. 845
Diagnostic Studies of Gastrointestinal System 845
Radiologic Studies 845
Upper Gastrointestinal Series. 845
Lower Gastrointestinal Series. 845
Virtual Colonoscopy. 851
Endoscopy 851
Liver Biopsy 851
Liver Function Studies 852
Bridge to NCLEX Examination 853
Evolve Website 853
References 853
39 Nutritional Problems 854
Learning Outcomes 854
Key Terms 854
Nutritional Problems 854
Normal Nutrition 854
Vegetarian Diet 855
Culturally Competent Care: Nutrition 856
Malnutrition 856
Etiology of Malnutrition 856
Contributing Factors to Malnutrition 857
Socioeconomic Factors. 857
Physical Illnesses. 857
Incomplete Diets. 857
Drug-Nutrient Interactions. 858
Pathophysiology of Starvation 858
Impact of Inflammation. 858
Clinical Manifestations 859
Diagnostic Studies 859
History and Physical Examination. 859
Laboratory Studies. 859
Anthropometric Measurements. 859
Functional Measurements. 859
Nursing and Interprofessional Management: Malnutrition 859
Nursing Assessment 859
Nursing Diagnoses 861
Planning 861
Nursing Implementation 861
Health Promotion. 861
Acute Care. 862
Ambulatory Care. 863
Evaluation 863
Gerontologic Considerations: Malnutrition 863
Specialized Nutritional Support 865
Oral Feeding 865
Enteral Nutrition 865
Orogastric, Nasogastric, and Nasointestinal Tubes. 865
Gastrostomy and Jejunostomy Tubes. 865
Tube Feedings and Safety. 866
Patient Position. 866
Aspiration Risk. 866
Tube Position. 867
Site Care. 868
Tube Patency. 868
Misconnection. 868
Gerontologic Considerations: Enteral Nutrition 868
Parenteral Nutrition 869
Composition. 869
Calories. 869
Protein. 869
Electrolytes. 869
Trace Elements and Vitamins. 869
Methods of Administration. 869
Central Parenteral Nutrition. 869
Peripheral Parenteral Nutrition. 870
Nursing Management: Parenteral Nutrition 870
Complications 870
Home Nutritional Support 871
Eating Disorders 871
Anorexia Nervosa 871
Bulimia Nervosa 872
Bridge to NCLEX Examination 872
Evolve Website 873
References 873
40 Obesity 874
Learning Outcomes 874
Key Terms 874
Obesity 874
Classifications of Body Weight and Obesity 874
Body Mass Index. 874
Waist Circumference. 874
Waist-to-Hip Ratio. 875
Body Shape. 875
Epidemiology of Obesity 875
Etiology and Pathophysiology 875
Genetic Link 877
Physiologic Regulatory Mechanisms in Obesity. 877
Environmental Factors. 878
Psychosocial Factors. 878
Health Risks Associated With Obesity 878
Cardiovascular Problems 879
Diabetes Mellitus 879
Gastrointestinal and Liver Problems 879
Respiratory and Sleep Problems 880
Musculoskeletal Problems 880
Cancer 880
Metabolic Syndrome 880
Psychosocial Problems 880
Nursing and Interprofessional Management: Obesity 880
Nursing Assessment 880
Planning 881
Nursing Implementation 881
Nutritional Therapy. 881
Exercise. 883
Behavior Modification. 883
Support Groups. 884
Drug Therapy 884
Appetite-Suppressing Drugs. 884
Nursing Interventions Related to Drug Therapy. 884
Bariatric Surgical Therapy 885
Restrictive Surgeries 885
Adjustable Gastric Banding. 885
Sleeve Gastrectomy (Gastric Sleeve). 885
Gastric Plication. 885
Intragastric Balloons. 885
Combination of Restrictive and Malabsorptive Surgery 885
Roux-en-Y Gastric Bypass. 885
Implantable Gastric Stimulation 887
Nursing Management: Perioperative Care of the Obese Patient 887
Nursing Implementation 887
Preoperative Care. 888
9 Problems of Urinary Function 1014
44 Assessment of Urinary System 1015
Learning Outcomes 1015
Key Terms 1015
Structures and Functions of Urinary System 1015
Kidneys 1015
Macrostructure. 1015
Microstructure. 1016
Blood Supply. 1016
Physiology of Urine Formation. 1016
Glomerular Function. 1016
Tubular Function. 1017
Other Functions of Kidneys. 1017
Ureters 1018
Bladder 1018
Urethra 1019
Urethrovesical Unit 1019
Gerontologic Considerations: Effects of Aging on Urinary System 1019
Assessment of Urinary System 1020
Subjective Data 1020
Important Health Information 1020
Past Health History. 1020
Medications. 1020
Surgery or Other Treatments. 1020
Functional Health Patterns. 1020
Health Perception–Health Management Pattern. 1020
Nutritional-Metabolic Pattern. 1021
Elimination Pattern. 1021
Activity-Exercise Pattern. 1022
Sleep-Rest Pattern. 1022
Cognitive-Perceptual Pattern. 1022
Self-Perception–Self-Concept Pattern. 1022
Role-Relationship Pattern. 1022
Sexuality-Reproductive Pattern. 1022
Objective Data 1023
Physical Examination 1023
Inspection. 1023
Palpation. 1023
Percussion. 1023
Auscultation. 1023
Diagnostic Studies of Urinary System 1024
Urine Studies 1024
Urinalysis. 1024
Creatinine Clearance. 1031
Urodynamic Studies 1031
Bridge to NCLEX Examination 1031
Evolve Website 1032
References 1032
45 Renal and Urologic Problems 1033
Learning Outcomes 1033
Key Terms 1033
Infectious and Inflammatory Disorders of Urinary System 1033
Urinary Tract Infection 1033
Classification of Urinary Tract Infection 1034
Etiology and Pathophysiology 1034
Clinical Manifestations 1034
Diagnostic Studies 1035
Interprofessional Care 1036
Nursing Management: Urinary Tract Infection 1036
Nursing Assessment 1036
Nursing Diagnoses 1036
Planning 1036
Nursing Implementation 1036
Health Promotion. 1036
Prevention of CAUTI. 1037
Acute Care. 1037
Ambulatory Care. 1037
Evaluation 1038
Acute Pyelonephritis 1038
Etiology and Pathophysiology 1038
Clinical Manifestations and Diagnostic Studies 1038
Interprofessional Care 1038
Nursing Management: Acute Pyelonephritis 1038
Nursing Assessment 1038
Nursing Diagnoses 1039
Planning 1039
Nursing Implementation 1039
Evaluation 1039
Chronic Pyelonephritis 1039
Urethritis 1039
Urethral Diverticula 1040
Interstitial Cystitis/Painful Bladder Syndrome 1040
Clinical Manifestations and Diagnostic Studies 1040
Interprofessional Care 1040
Nursing Management: Interstitial Cystitis/Painful Bladder Syndrome 1041
Genitourinary Tuberculosis 1041
Immunologic Disorders of Kidney 1041
Glomerulonephritis 1041
Acute Poststreptococcal Glomerulonephritis 1041
Nursing and Interprofessional Management: Acute Poststreptococcal Glomerulonephritis 1042
Goodpasture Syndrome 1043
Rapidly Progressive Glomerulonephritis 1043
Chronic Glomerulonephritis 1043
Nephrotic Syndrome 1043
Etiology and Clinical Manifestations 1043
Nursing and Interprofessional Management: Nephrotic Syndrome 1044
Obstructive Uropathies 1044
Urinary Tract Calculi 1045
Etiology and Pathophysiology 1045
Types of Urinary Calculi 1045
Clinical Manifestations 1046
Diagnostic Studies 1046
Interprofessional Care 1047
Endourologic Procedures. 1047
Lithotripsy. 1047
Surgical Therapy. 1048
Nutritional Therapy. 1048
Nursing Management: Urinary Tract Calculi 1048
Nursing Assessment 1048
Nursing Diagnoses 1048
Planning 1049
Nursing Implementation 1049
Evaluation 1049
Strictures 1049
Ureteral Strictures 1049
Urethral Strictures 1050
Renal Trauma 1050
Renal Vascular Problems 1050
Nephrosclerosis 1050
Renal Artery Stenosis 1050
Renal Vein Thrombosis 1051
Hereditary Kidney Diseases 1051
Polycystic Kidney Disease 1051
Genetic Link 1051
Nursing and Interprofessional Management: Polycystic Kidney Disease 1052
Medullary Cystic Disease 1052
Alport Syndrome 1052
Urinary Tract Tumors 1052
Kidney Cancer 1052
Clinical Manifestations and Diagnostic Studies 1053
Nursing and Interprofessional Management: Kidney Cancer 1053
Bladder Cancer 1053
Clinical Manifestations and Diagnostic Studies 1054
Nursing and Interprofessional Management: Bladder Cancer 1054
Surgical Therapy 1054
Radiation Therapy, Chemotherapy, and Immunotherapy 1055
Intravesical Therapy 1055
Bladder Dysfunction 1055
Urinary Incontinence 1055
Etiology and Pathophysiology 1055
Diagnostic Studies 1055
Interprofessional Care 1055
Drug Therapy. 1057
Surgical Therapy. 1057
Nursing Management: Urinary Incontinence 1058
Urinary Retention 1059
Etiology and Pathophysiology 1060
Diagnostic Studies 1060
Interprofessional Care 1060
Drug Therapy. 1060
Surgical Therapy. 1060
Nursing Management: Urinary Retention 1060
Catheterization 1060
Indications for and Complications of Catheterization 1060
Catheter Construction 1061
Types of Catheters 1061
Urethral Catheterization 1061
Ureteral Catheters 1062
Suprapubic Catheters 1062
Nephrostomy Tubes 1062
Intermittent Catheterization 1062
Surgery of the Urinary Tract 1063
Renal and Ureteral Surgery 1063
Surgical Procedure 1063
Laparoscopic Nephrectomy. 1063
Preoperative Management 1063
Postoperative Management 1063
Urine Output. 1063
Respiratory Status. 1063
Abdominal Distention. 1063
Urinary Diversion 1063
Incontinent Urinary Diversion 1064
Continent Urinary Diversions 1065
Orthotopic Bladder Reconstruction 1065
Nursing Management: Urinary Diversion 1065
Preoperative Management 1065
Postoperative Management 1065
Bridge to NCLEX Examination 1067
Evolve Website 1068
References 1068
46 Acute Kidney Injury and Chronic Kidney Disease 1069
Learning Outcomes 1069
Key Terms 1069
Acute Kidney Injury 1069
Etiology and Pathophysiology 1070
Prerenal. 1070
Intrarenal. 1070
Postrenal. 1071
Clinical Manifestations 1071
Oliguric Phase. 1071
Urinary Changes. 1071
Fluid Volume. 1072
Metabolic Acidosis. 1072
Sodium Balance. 1072
Potassium Excess. 1072
Hematologic Disorders. 1072
Waste Product Accumulation. 1072
Neurologic Disorders. 1072
Diuretic Phase. 1072
Recovery Phase. 1072
Diagnostic Studies 1072
Interprofessional Care 1073
Nutritional Therapy. 1074
Nursing Management: Acute Kidney Injury 1074
Nursing Assessment 1074
Nursing Diagnoses 1074
Planning 1074
Nursing Implementation 1074
Health Promotion. 1074
Acute Care. 1075
Ambulatory Care. 1075
Evaluation 1075
Gerontologic Considerations: Acute Kidney Injury 1075
Chronic Kidney Disease 1075
Clinical Manifestations 1076
Urinary System. 1076
Metabolic Disturbances 1076
Waste Product Accumulation. 1076
Altered Carbohydrate Metabolism. 1076
Elevated Triglycerides. 1077
Electrolyte and Acid-Base Imbalances 1077
Potassium. 1077
Sodium. 1077
Calcium and Phosphate. 1077
Magnesium. 1077
Metabolic Acidosis. 1077
Hematologic System 1077
Anemia. 1077
Bleeding Tendencies. 1078
Infection. 1078
Cardiovascular System. 1078
Respiratory System. 1078
Gastrointestinal System. 1078
Neurologic System. 1078
Musculoskeletal System. 1078
Integumentary System. 1079
Reproductive System. 1079
Psychologic Changes. 1079
Diagnostic Studies 1079
Interprofessional Care 1079
Drug Therapy 1080
Hyperkalemia. 1080
Hypertension. 1081
CKD-MBD. 1081
Anemia. 1081
Dyslipidemia. 1082
Complications of Drug Therapy. 1082
Nutritional Therapy 1082
Protein Restriction. 1082
Fluid Restriction. 1082
Sodium and Potassium Restriction. 1083
Phosphate Restriction. 1083
Nursing Management: Chronic Kidney Disease 1083
Nursing Assessment 1083
Nursing Diagnoses 1083
Planning 1083
Nursing Implementation 1083
Health Promotion. 1083
Acute Care. 1084
Ambulatory Care. 1084
Evaluation 1084
Dialysis 1084
General Principles of Dialysis 1085
Peritoneal Dialysis 1085
Catheter Placement 1085
Dialysis Solutions and Cycles 1086
Peritoneal Dialysis Systems 1086
Automated Peritoneal Dialysis. 1086
Continuous Ambulatory Peritoneal Dialysis. 1086
Complications of Peritoneal Dialysis 1087
Exit Site Infection. 1087
Peritonitis. 1087
Hernias. 1087
Lower Back Problems. 1087
Bleeding. 1087
Pulmonary Complications. 1087
Protein Loss. 1087
Effectiveness of Chronic Peritoneal Dialysis 1087
Hemodialysis 1087
Vascular Access Sites 1087
Arteriovenous Fistulas and Grafts. 1087
Temporary Vascular Access. 1088
Dialyzers 1089
Procedure for Hemodialysis 1089
Settings and Schedules for Hemodialysis. 1090
Complications of Hemodialysis 1090
Hypotension. 1090
Muscle Cramps. 1090
Loss of Blood. 1091
Hepatitis. 1091
Effectiveness of Hemodialysis 1091
Continuous Renal Replacement Therapy 1091
Wearable Artificial Kidney 1092
Kidney Transplantation 1092
Recipient Selection 1092
Histocompatibility Studies 1093
Donor Sources 1093
Live Donors. 1093
Deceased Donors. 1093
Surgical Procedure 1094
Live Donor. 1094
Kidney Transplant Recipient. 1094
Nursing Management: Kidney Transplant Recipient 1095
Preoperative Care 1095
Postoperative Care 1095
Live Donor. 1095
Kidney Transplant Recipient. 1095
Immunosuppressive Therapy 1095
Complications of Transplantation 1095
Rejection. 1095
Infection. 1095
Cardiovascular Disease. 1096
Malignancies. 1096
Recurrence of Original Kidney Disease. 1096
Corticosteroid-Related Complications. 1096
Gerontologic Considerations: Chronic Kidney Disease 1096
Bridge to NCLEX Examination 1098
Evolve Website 1099
References 1099
10 Problems Related to Regulatory and Reproductive Mechanisms 1101
47 Assessment of Endocrine System 1102
Learning Outcomes 1102
Key Terms 1102
Structures and Functions of Endocrine System 1102
Glands 1102
Hormones 1102
Hormone Receptors. 1103
Lipid-Soluble and Water-Soluble Hormones. 1103
Regulation of Hormonal Secretion. 1103
Simple Feedback. 1103
Nervous System Control. 1104
Rhythms. 1105
Hypothalamus 1105
Pituitary 1105
Anterior Pituitary. 1105
Posterior Pituitary. 1105
Pineal Gland 1106
Thyroid Gland 1106
Thyroxine and Triiodothyronine. 1107
Calcitonin. 1107
Parathyroid Glands 1107
Parathyroid Hormone. 1107
Adrenal Glands 1107
Adrenal Medulla. 1107
Adrenal Cortex. 1107
Cortisol. 1107
Aldosterone. 1108
Adrenal Androgens. 1108
Pancreas 1108
Glucagon. 1108
Insulin. 1108
Gerontologic Considerations: Effects of Aging on Endocrine System 1108
Assessment of Endocrine System 1108
Subjective Data 1109
Important Health Information 1109
Past Health History. 1109
Medications. 1109
Surgery or Other Treatments. 1109
Functional Health Patterns. 1109
Health Perception–Health Management Pattern. 1109
Nutritional-Metabolic Pattern. 1109
Elimination Pattern. 1109
Activity-Exercise Pattern. 1109
Sleep-Rest Pattern. 1110
Cognitive-Perceptual Pattern. 1110
Self-Perception–Self-Concept Pattern. 1110
Role-Relationship Pattern. 1110
Sexuality-Reproductive Pattern. 1111
Coping–Stress Tolerance Pattern. 1111
Value-Belief Pattern. 1111
Objective Data 1111
Physical Examination. 1111
Integument. 1111
Head. 1112
Neck. 1112
Thorax. 1112
Abdomen. 1112
Extremities. 1112
Genitalia. 1112
Diagnostic Studies of Endocrine System 1114
Bridge to NCLEX Examination 1119
Evolve Website 1119
References 1119
48 Diabetes Mellitus 1120
Learning Outcomes 1120
Key Terms 1120
Diabetes Mellitus 1120
Etiology and Pathophysiology 1120
Normal Glucose and Insulin Metabolism. 1120
Type 1 Diabetes Mellitus. 1121
11 Problems Related to Movement and Coordination 1293
55 Assessment of Nervous System 1294
Learning Outcomes 1294
Key Terms 1294
Structures and Functions of Nervous System 1294
Cells of Nervous System 1294
Neurons. 1294
Glial Cells. 1294
Nerve Regeneration 1295
Nerve Impulse 1295
Synapse. 1295
Neurotransmitters. 1295
Central Nervous System 1296
Spinal Cord. 1296
Ascending Tracts. 1296
Descending Tracts. 1296
Reflex Arc. 1296
Lower and Upper Motor Neurons. 1296
Brain. 1296
Cerebrum. 1296
Brainstem. 1297
Cerebellum. 1297
Ventricles and Cerebrospinal Fluid. 1298
Peripheral Nervous System 1298
Spinal Nerves. 1298
Cranial Nerves. 1299
Autonomic Nervous System. 1299
Cerebral Circulation 1299
Blood-Brain Barrier. 1299
Protective Structures 1300
Meninges. 1300
Skull. 1300
Vertebral Column. 1300
Gerontologic Considerations: Effects of Aging on Nervous System 1301
Assessment of Nervous System 1301
Subjective Data 1301
Important Health Information 1301
Past Health History. 1301
Medications. 1302
Surgery or Other Treatments. 1302
Functional Health Patterns. 1302
Health Perception–Health Management Pattern. 1302
Nutritional-Metabolic Pattern. 1302
Elimination Pattern. 1303
Activity-Exercise Pattern. 1303
Sleep-Rest Pattern. 1303
Cognitive-Perceptual Pattern. 1303
Self-Perception–Self-Concept Pattern. 1304
Role-Relationship Pattern. 1304
Sexuality-Reproductive Pattern. 1304
Coping–Stress Tolerance Pattern. 1304
Value-Belief Pattern. 1304
Objective Data 1304
Physical Examination. 1304
Mental Status. 1304
Cranial Nerves. 1304
Olfactory nerve. 1306
Optic nerve. 1306
Oculomotor, trochlear, and abducens nerves. 1306
Motor System. 1306
Sensory System. 1306
Touch, pain, and temperature. 1306
Vibration sense. 1307
Position sense. 1307
Cortical sensory functions. 1307
Reflexes. 1307
Diagnostic Studies of Nervous System 1307
Bridge to NCLEX Examination 1312
Evolve Website 1313
References 1313
56 Acute Intracranial Problems 1314
Learning Outcomes 1314
Key Terms 1314
Intracranial Pressure 1314
Regulation and Maintenance of Intracranial Pressure 1314
Normal Intracranial Pressure. 1314
Normal Compensatory Adaptations. 1315
Cerebral Blood Flow 1315
Autoregulation of Cerebral Blood Flow. 1315
Pressure Changes. 1315
Factors Affecting Cerebral Blood Flow. 1316
Increased Intracranial Pressure 1316
Mechanisms of Increased Intracranial Pressure 1316
Cerebral Edema 1316
Vasogenic Cerebral Edema. 1316
Cytotoxic Cerebral Edema. 1317
Interstitial Cerebral Edema. 1317
Clinical Manifestations 1317
Change in Level of Consciousness. 1317
Changes in Vital Signs. 1318
Ocular Signs. 1318
Decrease in Motor Function. 1318
Headache. 1318
Vomiting. 1318
Complications 1318
Diagnostic Studies 1319
Monitoring ICP and Cerebral Oxygenation 1319
Indications for Intracranial Pressure Monitoring. 1319
Methods of Measuring ICP. 1319
Cerebrospinal Fluid Drainage. 1320
Cerebral Oxygenation Monitoring. 1321
Interprofessional Care 1322
Drug Therapy. 1322
Nutritional Therapy. 1322
Nursing Management: Increased Intracranial Pressure 1323
Nursing Assessment 1323
Glasgow Coma Scale. 1323
Neurologic Assessment. 1323
Nursing Diagnoses 1324
Planning 1324
Nursing Implementation 1324
Acute Care 1324
Respiratory Function. 1324
Fluid and Electrolyte Balance. 1325
Monitoring ICP. 1325
Body Position. 1325
Protection From Injury. 1325
Psychologic Considerations. 1326
Evaluation 1326
Head Injury 1326
Types of Head Injuries 1326
Scalp Lacerations. 1326
Skull Fractures. 1326
Head Trauma. 1327
Diffuse Injury. 1327
Diffuse axonal injury. 1327
Focal Injury. 1327
Complications 1328
Epidural Hematoma. 1328
Subdural Hematoma. 1329
Intracerebral Hematoma. 1329
Diagnostic Studies and Interprofessional Care 1329
Nursing Management: Head Injury 1330
Nursing Assessment 1330
Nursing Diagnoses 1330
Planning 1330
Nursing Implementation 1330
Health Promotion. 1330
Acute Care. 1330
Ambulatory Care. 1332
Evaluation 1333
Brain Tumors 1333
Types 1333
Clinical Manifestations and Complications 1333
Diagnostic Studies 1334
Interprofessional Care 1334
Surgical Therapy. 1334
Ventricular Shunts. 1335
Radiation Therapy and Stereotactic Radiosurgery. 1335
Chemotherapy and Targeted Therapy. 1335
Other Therapies. 1335
Nursing Management: Brain Tumors 1335
Nursing Assessment 1335
Nursing Diagnoses 1335
Planning 1336
Nursing Implementation 1336
Evaluation 1336
Cranial Surgery 1336
Types 1336
Craniotomy. 1336
Stereotactic Radiosurgery. 1337
Nursing Management: Cranial Surgery 1337
Nursing Implementation 1337
Acute Care. 1337
Ambulatory Care. 1338
Inflammatory Conditions of the Brain 1338
Brain Abscess 1338
Bacterial Meningitis 1339
Etiology and Pathophysiology 1339
Clinical Manifestations 1339
Complications 1339
Diagnostic Studies 1340
Interprofessional Care 1340
Nursing Management: Bacterial Meningitis 1340
Nursing Assessment 1340
Nursing Diagnoses 1340
Planning 1340
Nursing Implementation 1340
Health Promotion. 1340
Acute Care. 1340
Ambulatory Care. 1341
Evaluation 1341
Viral Meningitis 1341
Encephalitis 1341
Clinical Manifestations and Diagnostic Studies 1342
Nursing and Interprofessional Management: Encephalitis 1342
Bridge to NCLEX Examination 1343
Evolve Website 1343
References 1343
57 Stroke 1345
Learning Outcomes 1345
Key Terms 1345
Pathophysiology of Stroke 1346
Anatomy of Cerebral Circulation 1346
Regulation of Cerebral Blood Flow 1346
Risk Factors for Stroke 1346
Nonmodifiable Risk Factors 1347
Modifiable Risk Factors 1347
Transient Ischemic Attack 1347
Types of Stroke 1348
Ischemic Stroke 1348
Thrombotic Stroke. 1348
Embolic Stroke. 1349
Hemorrhagic Stroke 1349
Intracerebral Hemorrhage. 1349
Subarachnoid Hemorrhage. 1349
Clinical Manifestations of Stroke 1350
Motor Function 1350
Communication 1351
Affect 1351
Intellectual Function 1351
Spatial-Perceptual Alterations 1351
Elimination 1352
Diagnostic Studies for Stroke 1352
Interprofessional Care for Stroke 1353
Preventive Therapy 1353
Preventive Drug Therapy. 1353
Left Atrial Appendage Occlusion. 1353
Surgical/Endovascular Therapy for TIA and Stroke Prevention. 1353
Acute Care for Ischemic Stroke 1354
Drug Therapy for Ischemic Stroke. 1355
Endovascular Therapy for Ischemic Stroke. 1355
Acute Care for Hemorrhagic Stroke 1355
Drug Therapy for Hemorrhagic Stroke. 1355
Surgical Therapy for Hemorrhagic Stroke. 1355
Rehabilitation Care 1356
Core Measures for Stroke 1356
Nursing Management: Stroke 1356
Nursing Assessment 1356
Nursing Diagnoses 1357
Planning 1357
Nursing Implementation 1358
Health Promotion. 1358
Acute Care 1358
Respiratory System. 1358
Neurologic System. 1359
Cardiovascular System. 1359
Musculoskeletal System. 1359
Integumentary System. 1360
Gastrointestinal System. 1360
Urinary System. 1360
Nutrition. 1360
Communication. 1361
Sensory-Perceptual Alterations. 1361
Coping. 1362
Ambulatory Care. 1362
Rehabilitation. 1363
Musculoskeletal Function. 1363
Stroke Survivorship and Coping. 1364
Sexual Function. 1365
Community Integration. 1365
Gerontologic Considerations: Stroke 1365
Bridge to NCLEX Examination 1366
Evolve Website 1367
References 1367
58 Chronic Neurologic Problems 1368
Learning Outcomes 1368
Key Terms 1368
Headaches 1368
Tension-Type Headache 1370
12 Nursing Care in Critical Care Settings 1553
65 Critical Care 1554
Learning Outcomes 1554
Key Terms 1554
Critical Care Nursing 1554
Critical Care Units 1554
Critical Care Nurse 1555
Critical Care Patient 1555
Common Problems of Critical Care Patients. 1556
Anxiety. 1556
Pain. 1556
Impaired Communication. 1556
Sleep. 1556
Sensory-Perceptual Problems. 1557
Nutrition. 1557
Issues Related to Caregivers 1557
Culturally Competent Care: Critical Care Patients 1558
Hemodynamic Monitoring 1558
Hemodynamic Terminology 1559
Cardiac Output and Cardiac Index. 1559
Preload. 1559
Afterload. 1560
Vascular Resistance. 1560
Contractility. 1560
Principles of Invasive Pressure Monitoring 1560
Types of Invasive Pressure Monitoring 1561
Arterial Blood Pressure. 1561
Measurements. 1561
Complications. 1562
Arterial Pressure–Based Cardiac Output. 1562
Measurements. 1562
Pulmonary Artery Flow-Directed Catheter. 1563
Pulmonary Artery Catheter Insertion. 1564
Central Venous or Right Atrial Pressure Measurement. 1564
Venous Oxygen Saturation Monitoring. 1564
Noninvasive Arterial Oxygenation Monitoring 1565
Noninvasive Hemodynamic Monitoring: Impedance Cardiography 1566
Nursing and Interprofessional Management: Hemodynamic Monitoring 1566
Circulatory Assist Devices 1566
Intraaortic Balloon Pump 1566
Effects of Counterpulsation. 1567
Complications With IABP Therapy. 1567
Ventricular Assist Devices 1568
Implantable Artificial Heart 1569
Nursing and Interprofessional Management: Circulatory Assist Devices 1569
Artificial Airways 1569
Endotracheal Tubes 1569
Endotracheal Intubation Procedure 1570
Nursing and Interprofessional Management: Artificial Airway 1570
Maintaining Correct Tube Placement 1571
Maintaining Proper Cuff Inflation 1571
Monitoring Oxygenation and Ventilation 1571
Maintaining Tube Patency 1571
Providing Oral Care and Maintaining Skin Integrity 1572
Fostering Comfort and Communication 1573
Complications of Endotracheal Intubation 1573
Mechanical Ventilation 1574
Types of Mechanical Ventilation 1574
Negative Pressure Ventilation. 1574
Positive Pressure Ventilation. 1574
Volume Ventilation. 1574
Pressure Ventilation. 1574
Settings of Mechanical Ventilators 1574
Modes of Volume Ventilation 1575
Assist-Control Ventilation. 1575
Synchronized Intermittent Mandatory Ventilation. 1576
Modes of Pressure Ventilation 1576
Pressure Support Ventilation. 1576
Pressure-Control and Pressure-Control Inverse Ratio Ventilation. 1576
Airway Pressure Release Ventilation. 1577
Other Modes. 1577
Other Ventilatory Maneuvers 1577
Positive End-Expiratory Pressure. 1577
Continuous Positive Airway Pressure. 1577
Automatic Tube Compensation. 1577
Bilevel Positive Airway Pressure. 1577
High-Frequency Oscillatory Ventilation. 1578
Nitric Oxide. 1578
Prone Positioning. 1578
Extracorporeal Membrane Oxygenation. 1578
Complications of Positive Pressure Ventilation 1578
Cardiovascular System. 1578
Pulmonary System 1578
Barotrauma. 1578
Volutrauma. 1578
Alveolar Hypoventilation. 1578
Alveolar Hyperventilation. 1579
Ventilator-Associated Pneumonia. 1579
Sodium and Water Imbalance. 1579
Neurologic System. 1579
Gastrointestinal System. 1580
Musculoskeletal System. 1580
Psychosocial Needs. 1580
Ventilator Disconnection or Malfunction. 1581
Nutritional Therapy: Patient Receiving Positive Pressure Ventilation 1581
Weaning From Positive Pressure Ventilation and Extubation 1582
Chronic Mechanical Ventilation 1582
Nursing Management: Mechanical Ventilation 1584
Other Critical Care Content 1584
Bridge to NCLEX Examination 1585
Evolve Website 1585
References 1585
66 Shock, Sepsis, and Multiple Organ Dysfunction Syndrome 1587
Learning Outcomes 1587
Key Terms 1587
Shock 1587
Classification of Shock 1587
Cardiogenic Shock. 1587
Hypovolemic Shock. 1589
Distributive Shock 1590
Neurogenic Shock. 1590
Anaphylactic Shock. 1590
Septic Shock. 1592
Obstructive Shock. 1593
Stages of Shock 1594
Initial Stage. 1594
Compensatory Stage. 1594
Progressive Stage. 1594
Refractory Stage. 1596
Diagnostic Studies 1596
Interprofessional Care: General Measures 1596
Oxygen and Ventilation. 1596
Fluid Resuscitation. 1596
Drug Therapy. 1598
Sympathomimetic Drugs. 1598
Vasodilator Drugs. 1598
Nutritional Therapy. 1598
Interprofessional Care: Specific Measures 1598
Cardiogenic Shock. 1598
Hypovolemic Shock. 1601
Septic Shock. 1601
Neurogenic Shock. 1601
Anaphylactic Shock. 1601
Obstructive Shock. 1602
Nursing Management: Shock 1602
Nursing Assessment 1602
Nursing Diagnoses 1602
Planning 1602
Nursing Implementation 1602
Health Promotion. 1602
Acute Care. 1602
Neurologic Status. 1603
Cardiovascular Status. 1603
Respiratory Status. 1603
Renal Status. 1603
Body Temperature and Skin Changes. 1603
Gastrointestinal Status. 1603
Personal Hygiene. 1603
Emotional Support and Comfort. 1604
Ambulatory Care. 1604
Evaluation 1604
Systemic Inflammatory Response Syndrome and Multiple Organ Dysfunction Syndrome 1604
Etiology and Pathophysiology 1604
Organ and Metabolic Dysfunction. 1605
Clinical Manifestations of SIRS and MODS 1605
Nursing and Interprofessional Management: SIRS and MODS 1606
Prevention and Treatment of Infection 1606
Maintenance of Tissue Oxygenation 1607
Nutritional and Metabolic Needs 1607
Support of Failing Organs 1607
Bridge to NCLEX Examination 1608
Evolve Website 1608
References 1608
67 Acute Respiratory Failure and Acute Respiratory Distress Syndrome 1609
Learning Outcomes 1609
Key Terms 1609
Acute Respiratory Failure 1609
Etiology and Pathophysiology 1610
Hypoxemic Respiratory Failure. 1610
Ventilation-Perfusion Mismatch. 1610
Shunt. 1611
Diffusion Limitation. 1611
Alveolar Hypoventilation. 1612
Interrelationship of Mechanisms. 1612
Hypercapnic Respiratory Failure. 1612
Airway and Alveoli Abnormalities. 1612
Central Nervous System Abnormalities. 1612
Chest Wall Abnormalities. 1612
Neuromuscular Conditions. 1612
Tissue Oxygen Needs. 1612
Clinical Manifestations 1612
Consequences of Hypoxemia and Hypoxia. 1613
Specific Clinical Manifestations. 1613
Diagnostic Studies 1614
Nursing and Interprofessional Management: Acute Respiratory Failure 1614
Nursing Assessment 1615
Nursing Diagnoses 1615
Planning 1615
Prevention 1615
Respiratory Therapy 1615
Oxygen Therapy. 1615
Mobilization of Secretions. 1616
Effective Coughing and Positioning. 1616
Hydration. 1617
Humidification. 1617
Chest Physiotherapy. 1617
Airway Suctioning. 1617
Positive Pressure Ventilation. 1617
Drug Therapy 1618
Relief of Bronchospasm. 1618
Reduction of Airway Inflammation. 1618
Reduction of Pulmonary Congestion. 1618
Treatment of Pulmonary Infections. 1618
Reduction of Anxiety, Pain, and Agitation. 1618
Medical Supportive Therapy 1619
Treating the Underlying Cause. 1619
Maintaining Adequate Cardiac Output. 1619
Maintaining Adequate Hemoglobin Concentration. 1619
Nutritional Therapy 1619
Evaluation 1619
Gerontologic Considerations: Respiratory Failure 1619
Acute Respiratory Distress Syndrome 1620
Etiology and Pathophysiology 1620
Injury or Exudative Phase. 1621
Reparative or Proliferative Phase. 1622
Fibrotic Phase. 1622
Clinical Progression 1622
Clinical Manifestations and Diagnostic Studies 1622
Complications 1623
Ventilator-Associated Pneumonia. 1623
Barotrauma. 1623
Volutrauma. 1623
Stress Ulcers. 1623
Renal Failure. 1623
Nursing and Interprofessional Management: Acute Respiratory Distress Syndrome 1623
Nursing Assessment 1624
Nursing Diagnoses 1624
Planning 1624
Oxygen Administration. 1624
Positive Pressure Ventilation. 1624
Positioning Strategies. 1624
Medical Supportive Therapy 1625
Maintenance of Cardiac Output and Tissue Perfusion. 1625
Maintenance of Nutrition and Fluid Balance. 1625
Evaluation 1625
Bridge to NCLEX Examination 1627
Evolve Website 1627
References 1627
68 Emergency and Disaster Nursing 1628
Learning Outcomes 1628
Key Terms 1628
Care of Emergency Patient 1628
Triage 1628
Primary Survey 1630
A = Alertness and Airway. 1630
B = Breathing. 1630
C = Circulation. 1630
D = Disability. 1632
E = Exposure and Environmental Control. 1632
F = Facilitate Adjuncts and Family. 1632
G = Get Resuscitation Adjuncts. 1632
Secondary Survey 1632
H = History and Head-to-Toe Assessment. 1632
Head, Neck, and Face. 1633
Chest. 1633
Abdomen and Flanks. 1633
Pelvis and Perineum. 1634
Extremities. 1634
I = Inspect Posterior Surfaces. 1634
Acute Care and Evaluation 1634
Cardiac Arrest and Therapeutic Hypothermia 1634
Death in the Emergency Department 1635
Gerontologic Considerations: Emergency Care 1635
Environmental Emergencies 1636
Heat-Related Emergencies 1636
Heat Cramps 1637
Heat Exhaustion 1637
Heatstroke 1637
Interprofessional Care. 1637
Cold-Related Emergencies 1637
Frostbite 1637
Hypothermia 1638
Interprofessional Care. 1639
Submersion Injuries 1639
Interprofessional Care 1640
Stings and Bites 1640
Hymenopteran Stings 1640
Tick Bites 1641
Animal and Human Bites 1641
Interprofessional Care. 1642
Poisonings 1642
Violence 1644
Agents of Terrorism 1645
Emergency and Mass Casualty Incident Preparedness 1645
Bridge to NCLEX Examination 1647
Evolve Website 1647
References 1648
Appendixes 1650
Appendix A Basic Life Support for Health Care Professionals 1650
Cardiopulmonary Resuscitation 1650
Chest Compressions 1650
Defibrillation 1651
Airway and Breathing 1651
Hands-Only CPR 1652
References* 1652
Appendix B Nursing Diagnoses 1653
Appendix C Laboratory Reference Intervals 1655
Glossary 1663
A 1663
B 1663
C 1663
D 1664
E 1665
F 1665
G 1665
H 1665
I 1666
J 1666
K 1666
L 1667
M 1667
N 1667
O 1668
P 1668
R 1669
S 1669
T 1670
U 1670
V 1670
W 1670
Index I-1
A I-1
B I-7
C I-10
D I-17
E I-20
F I-23
G I-25
H I-27
I I-31
J I-34
K I-35
L I-35
M I-37
N I-40
O I-42
P I-44
Q I-51
R I-51
S I-53
T I-58
U I-61
V I-62
W I-64
X I-65
Y I-65
Z I-65
Endsheet 5 IBC5
Abbreviations IBC6