BOOK
Canadian Fundamentals of Nursing - E-Book
Patricia A. Potter | Anne Griffin Perry | Patricia Stockert | Amy Hall | Barbara J. Astle | Wendy Duggleby
(2018)
Additional Information
Book Details
Abstract
With a greater emphasis on, and integration of, interprofessional collaboration, health literacy, and clinical reasoning, Canadian Fundamentals of Nursing, Sixth Edition provides you with the solid educational foundation to learn nursing principles, concepts, and skills with ease. The text’s proven, reader-friendly approach describes the principles, concepts, and skills essential to your success. The Sixth edition includes new chapters focused on the health needs of Indigenous people along with information on how to collaborate among interprofessional disciplines. Thoroughly reviewed by Canadian nursing experts, this edition ensures that you are well prepared to practise in Canada.
- Case studies include unique clinical application questions and exercises, allowing students to practise using care plans and concept maps.
- New photos capture the latest updates in skills and equipment relevant to Canadian nursing practice.
- Key points and key terms in each chapter summarize important content for more efficient review and study.
- More than 50 skills demonstrations provide illustrated, step-by-step instructions for safe nursing care — and include rationales for each step.
- The 5-step nursing process provides a consistent framework for care, and is demonstrated in more than 20 care plans.
- More than 20 concept maps show care planning for clients with multiple nursing diagnoses.
- A glossary provides quick access to definitions for all key terms.
- Cultural Aspects of Care boxes summarize cultural considerations related to the chapter topic and provide practical guidelines for how to meet patients’ cultural needs and preferences.
- Patient Teaching boxes help you plan effective teaching by first identifying outcomes, then developing strategies on how to teach, and, finally, implementing measures to evaluate learning.
- Focus on Older Persons boxes highlight key aspects of nursing assessment and care for this population.
- Planning sections help nurses plan and prioritize care by emphasizing Goals and Outcomes, Setting Priorities, and Teamwork and Collaboration.
- Implementation sections cover health promotion, acute care, and continuing care to prepare you for all levels of care in all settings.
- Unexpected Outcomes and Related Interventions for each skill offer alerts to potential problems and appropriate nursing actions.
- Procedural guidelines provide streamlined, step-by-step instructions for performing basic skills.
- UNIQUE! Critical Thinking Models in each clinical chapter show students how to apply the nursing process and critical thinking to achieve successful clinical outcomes.
- NOC outcomes, NIC interventions, and NANDA diagnoses are incorporated into care plans to reflect national standards.
- Evidence-Informed Practice chapter includes the concept of research literacy and discusses quality improvement (QI)
Table of Contents
| Section Title | Page | Action | Price |
|---|---|---|---|
| Front Cover | cover | ||
| Endsheet 2 | IFC2 | ||
| Endsheets 3-4 | IFC3 | ||
| Canadian Fundamentals of Nursing | i | ||
| Copyright Page | ii | ||
| Table Of Contents | iii | ||
| Preface to the Student | xvi | ||
| Preface to the Instructor | xxvi | ||
| Classic Features | xxvi | ||
| New Features | xxvi | ||
| Learning Supplements for Students | xxvii | ||
| Teaching Supplements for Instructors | xxvii | ||
| Multimedia Supplements for Instructors and Students | xxviii | ||
| Acknowledgements | xxix | ||
| Contributors | xxx | ||
| Reviewers | xxxiv | ||
| Unit I Health and Health Care in Canada | 1 | ||
| 1 Health and Wellness | 1 | ||
| Objectives | 1 | ||
| Key Terms | 1 | ||
| Media Resources | 1 | ||
| Conceptualizations of Health | 1 | ||
| Classifications of Health Conceptualizations | 2 | ||
| Historical Approaches to Health in Canada | 3 | ||
| Medical Approach | 3 | ||
| Behavioural Approach | 3 | ||
| Socioenvironmental Approach | 4 | ||
| Ottawa Charter. | 4 | ||
| Achieving Health for All. | 4 | ||
| Risk Factors and Risk Conditions. | 5 | ||
| Strategies for Population Health. | 5 | ||
| Jakarta Declaration. | 6 | ||
| Bangkok Charter. | 6 | ||
| Toronto Charter. | 6 | ||
| Determinants of Health and Social Determinants of Health | 6 | ||
| Income and Social Status (Income and Its Distribution) | 6 | ||
| Social Support Networks | 7 | ||
| Education and Literacy | 7 | ||
| Employment and Working Conditions (Unemployment and Employment Security) | 7 | ||
| Physical Environments (Geography, Housing, Food Security) | 8 | ||
| Biological and Genetic Endowment | 8 | ||
| Individual Health Practices and Coping Skills | 8 | ||
| Healthy Child Development (Early Life) | 9 | ||
| Health Services (Health Care Services) | 9 | ||
| Gender | 9 | ||
| Culture (Immigrant Status, Race, Indigenous Ancestry) | 9 | ||
| Social Environments (Social Safety Net, Social Exclusion, Disability) | 10 | ||
| Strategies to Influence Health Determinants | 11 | ||
| Health Promotion and Disease Prevention | 11 | ||
| Health Promotion Strategies | 11 | ||
| 1. Build Healthy Public Policy. | 11 | ||
| 2. Create Supportive Environments. | 12 | ||
| 3. Strengthen Community Action. | 12 | ||
| 4. Develop Personal Skills. | 12 | ||
| 5. Reorient Health Services. | 12 | ||
| Population Health Promotion Model: Putting It All Together | 12 | ||
| Summary | 13 | ||
| Key Concepts | 13 | ||
| Critical Thinking Exercises | 14 | ||
| Review Questions | 14 | ||
| Recommended Websites | 14 | ||
| References | 15 | ||
| 2 The Canadian Health Care Delivery System | 18 | ||
| Objectives | 18 | ||
| Key Terms | 18 | ||
| Media Resources | 18 | ||
| Evolution of the Canadian Health Care System | 19 | ||
| Early Health Care in Canada | 19 | ||
| Indigenous Health Care | 20 | ||
| Organization and Governance of Health Care | 22 | ||
| Federal Jurisdiction | 22 | ||
| Provincial and Territorial Jurisdiction | 22 | ||
| Professional Jurisdiction | 22 | ||
| Health Care Spending | 22 | ||
| Trends and Reforms in Canada’s Health Care System | 22 | ||
| Role of Nurses in Health Care Policy | 23 | ||
| Right to Health Care | 23 | ||
| Rights Within the Health Care System | 23 | ||
| Primary Health Care | 23 | ||
| Barriers to Primary Health Care | 24 | ||
| Future of Primary Health Care | 25 | ||
| Settings for Health Care Delivery | 26 | ||
| Institutional Sector | 26 | ||
| Hospitals. | 26 | ||
| Long-Term Care (LTC) Facilities. | 26 | ||
| Psychiatric Facilities. | 26 | ||
| Rehabilitation Centres. | 26 | ||
| Community Sector | 27 | ||
| Public Health. | 27 | ||
| Physician Offices. | 27 | ||
| Community Health Centres (CHCs) and Clinics. | 27 | ||
| Assisted Living. | 27 | ||
| Home Care. | 27 | ||
| Adult Day Support Programs (ADSPs). | 27 | ||
| Community and Voluntary Agencies. | 27 | ||
| Occupational Health. | 28 | ||
| Hospice and Palliative Care. | 28 | ||
| Parish Nursing. | 28 | ||
| Levels of Care | 28 | ||
| Level 1: Health Promotion | 28 | ||
| Level 2: Disease and Injury Prevention | 28 | ||
| Level 3: Diagnosis and Treatment | 28 | ||
| Level 4: Rehabilitation | 28 | ||
| Level 5: Supportive Care | 29 | ||
| Challenges to the Health Care System | 29 | ||
| Cost Accelerators | 29 | ||
| Digital Health Technologies. | 29 | ||
| Demographics. | 29 | ||
| Consumer Involvement and Personalized Medicine. | 29 | ||
| Equality and Quality | 29 | ||
| Cultural Competence, Safety, and Humility. | 29 | ||
| Evidence-Informed Practice (EIP). | 29 | ||
| Quality and Patient Safety. | 29 | ||
| Quality Workplaces. | 30 | ||
| Privatization of Services. | 30 | ||
| Health Care Human Resources. | 30 | ||
| Improved Patient Outcome Metrics. | 30 | ||
| Nursing’s Future in the Emerging Health Care System | 30 | ||
| Key Concepts | 30 | ||
| Critical Thinking Exercises | 30 | ||
| Review Questions | 31 | ||
| Recommended Websites | 31 | ||
| References | 32 | ||
| 3 The Development of Nursing in Canada | 34 | ||
| Objectives | 34 | ||
| Key Terms | 34 | ||
| Media Resources | 34 | ||
| Why Nursing History Matters | 34 | ||
| Care of Strangers: the Early History of Nursing | 35 | ||
| The First Nurses and Hospitals in New France | 35 | ||
| The Birth of Home Visiting | 35 | ||
| Health Care in the West and the Grey Nuns | 35 | ||
| The Lady With the Lamp: Florence Nightingale | 36 | ||
| Globalization and the Emergence of Modern Nursing | 37 | ||
| Missionary Nursing | 37 | ||
| Nursing in Remote Regions and Indigenous Communities | 38 | ||
| Gender and Diversity in Nursing | 38 | ||
| Nursing Education in Canada | 39 | ||
| The First Canadian Nursing Schools | 39 | ||
| The Impact of Nursing Organizations on Nursing Education | 39 | ||
| The Victorian Order of Nurses. | 39 | ||
| The International Council of Nurses. | 39 | ||
| The Origins of the Canadian Nurses Association and Provincial Nursing Associations | 40 | ||
| The First University Programs | 41 | ||
| Health Care and Educational Reform | 41 | ||
| The Weir Report | 41 | ||
| Education Reform | 41 | ||
| Baccalaureate as Entry-to-Practice | 41 | ||
| Influence of Periods of Social Upheaval on Nursing | 42 | ||
| Public Health, Military Conflicts, and the Emergence of University Nursing Education | 42 | ||
| From the Depression to the Post–World War II Years | 42 | ||
| Emerging From Economic and Military Crises | 43 | ||
| Nursing Education Today | 43 | ||
| Conclusion | 44 | ||
| Key Concepts | 45 | ||
| Critical Thinking Exercises | 45 | ||
| Review Questions | 45 | ||
| Recommended Websites | 45 | ||
| References | 45 | ||
| 4 Community Health Nursing Practice | 48 | ||
| Objectives | 48 | ||
| Key Terms | 48 | ||
| Media Resources | 48 | ||
| Promoting the Health of Populations and Community Groups | 48 | ||
| Community Health Nursing Practice | 49 | ||
| Public Health Nursing | 51 | ||
| Home Health Nursing | 53 | ||
| The Changing Focus of Community Health Nursing Practice | 53 | ||
| Vulnerable Populations: People Who Live in Vulnerable Circumstances | 53 | ||
| People Who Live in Poverty or Are Homeless. | 54 | ||
| People in Precarious Circumstances. | 55 | ||
| People Living With Chronic Conditions and Disabilities. | 55 | ||
| People Who Engage in Stigmatizing Risk Behaviours. | 55 | ||
| Standards, Competencies, Roles, and Activities in Community Health Nursing | 56 | ||
| Communication. | 56 | ||
| Facilitation. | 56 | ||
| Leadership. | 56 | ||
| Advocacy. | 57 | ||
| Consultation. | 57 | ||
| Team Building and Collaboration. | 57 | ||
| Building Capacity. | 58 | ||
| Building Coalitions and Networks. | 58 | ||
| Outreach. | 58 | ||
| Resource Management, Planning, Coordination. | 58 | ||
| Case Management. | 58 | ||
| Care/Counselling. | 58 | ||
| Referral and Follow-Up. | 58 | ||
| Screening. | 58 | ||
| Surveillance. | 58 | ||
| Health Threat Response. | 58 | ||
| Health Education. | 58 | ||
| Community Development. | 58 | ||
| Policy Development and Implementation. | 58 | ||
| Research and Evaluation. | 58 | ||
| Community Assessment | 58 | ||
| Promoting Clients’ Health | 59 | ||
| Key Concepts | 59 | ||
| Critical Thinking Exercises | 59 | ||
| Review Questions | 60 | ||
| Recommended Websites | 60 | ||
| References | 60 | ||
| Unit II Foundations of Nursing Practice | 63 | ||
| 5 Theoretical Foundations of Nursing Practice | 63 | ||
| Objectives | 63 | ||
| Key Terms | 63 | ||
| Media Resources | 63 | ||
| Early Nursing Practice and the Emergence of Theory | 63 | ||
| Nursing Process | 65 | ||
| Conceptual Frameworks | 65 | ||
| Metaparadigm Concepts | 65 | ||
| Client and Person | 66 | ||
| Environment | 66 | ||
| Health | 66 | ||
| Nursing | 66 | ||
| Philosophy of Nursing Science | 66 | ||
| Scientific Revolutions | 66 | ||
| Complexity Science | 67 | ||
| Ways of Knowing in Nursing Practice | 67 | ||
| Paradigm Debates Within Nursing | 67 | ||
| Nursing Diagnosis | 67 | ||
| Reflections on Conceptualizing Nursing | 67 | ||
| Major Theoretical Models | 68 | ||
| Practice-Based Theories | 68 | ||
| Florence Nightingale. | 68 | ||
| The McGill Model. | 69 | ||
| Needs Theories | 69 | ||
| Virginia Henderson. | 69 | ||
| Dorothea Orem. | 69 | ||
| Interactionist Theories | 69 | ||
| Hildegard Peplau. | 69 | ||
| Joyce Travelbee. | 70 | ||
| Evelyn Adam. | 70 | ||
| Systems Theories | 70 | ||
| Dorothy Johnson. | 70 | ||
| The University of British Columbia Model. | 70 | ||
| Betty Neuman. | 70 | ||
| Sister Callista Roy. | 70 | ||
| Simultaneity Theories | 70 | ||
| Martha Rogers. | 71 | ||
| Rosemarie Parse. | 71 | ||
| Jean Watson. | 71 | ||
| Theorizing in the Future | 71 | ||
| Key Concepts | 72 | ||
| Critical Thinking Exercises | 72 | ||
| Review Questions | 72 | ||
| References | 73 | ||
| 6 Evidence-Informed Practice | 75 | ||
| Objectives | 75 | ||
| Key Terms | 75 | ||
| Media Resources | 75 | ||
| Why Evidence? | 75 | ||
| Relationship Between Evidence-Informed Decision Making, Research, and Quality Improvement | 76 | ||
| Development of Nursing Knowledge | 76 | ||
| Researching the Evidence | 77 | ||
| Ask the Clinical Question | 77 | ||
| Collect the Best Evidence | 77 | ||
| Research Literacy—Critique the Evidence | 78 | ||
| Integrate the Evidence | 78 | ||
| Evaluate the Practice Design or Change | 79 | ||
| Support for Evidence-Informed Practice | 79 | ||
| The Development of Research in Nursing | 79 | ||
| The History of Nursing Research in Canada | 79 | ||
| Nursing Research | 80 | ||
| Research Designs | 81 | ||
| Quantitative Nursing Research | 81 | ||
| Experimental Research. | 81 | ||
| Descriptive Survey Designs. | 82 | ||
| Exploratory Descriptive Designs. | 82 | ||
| Data Analysis. | 82 | ||
| Qualitative Nursing Research | 83 | ||
| Conducting Nursing Research | 83 | ||
| Ethical Issues in Research | 83 | ||
| Rights of Other Research Participants | 85 | ||
| Applying Research Findings in Nursing Practice | 85 | ||
| Key Concepts | 85 | ||
| Critical Thinking Exercises | 85 | ||
| Review Questions | 86 | ||
| Recommended Websites | 86 | ||
| References | 86 | ||
| 7 Nursing Values and Ethics | 87 | ||
| Objectives | 87 | ||
| Key Terms | 87 | ||
| Media Resources | 87 | ||
| Values | 88 | ||
| Values Formation | 88 | ||
| Values Clarification | 88 | ||
| Ethics | 88 | ||
| Nursing and Ethics | 89 | ||
| Codes of Ethics. | 89 | ||
| Responsibility. | 89 | ||
| Accountability. | 89 | ||
| Advocacy. | 89 | ||
| Ethical Theory | 90 | ||
| Deontology. | 91 | ||
| Utilitarianism. | 91 | ||
| Bioethics. | 91 | ||
| Autonomy. | 91 | ||
| Beneficence. | 91 | ||
| Nonmaleficence. | 91 | ||
| Justice. | 92 | ||
| Feminist Ethics. | 92 | ||
| Relational Ethics. | 92 | ||
| Ethical Analysis and Nursing | 92 | ||
| Ethical Issues in Nursing Practice | 95 | ||
| Patient Care Issues | 95 | ||
| Futile Care. | 95 | ||
| Medical Assistance in Dying (MAID). | 96 | ||
| Issues of Safety and Ethics Related to the Work Environment | 96 | ||
| Social Networking and Safety. | 96 | ||
| Working With a Health Care Team to Promote Safe Care. | 97 | ||
| Key Concepts | 98 | ||
| Critical Thinking Exercises | 98 | ||
| Review Questions | 98 | ||
| Recommended Websites | 99 | ||
| References | 99 | ||
| 8 Legal Implications in Nursing Practice | 101 | ||
| Objectives | 101 | ||
| Key Terms | 101 | ||
| Media Resources | 101 | ||
| Legal Limits of Nursing | 101 | ||
| Sources of Law | 101 | ||
| Professional Regulation | 102 | ||
| Regulation of Nurse Practitioners | 102 | ||
| Standards of Care | 102 | ||
| Legal Liability Issues in Nursing Practice | 103 | ||
| Torts | 103 | ||
| Intentional Torts | 103 | ||
| Assault. | 103 | ||
| Battery. | 103 | ||
| Invasion of Privacy. | 103 | ||
| Computers and Confidentiality. | 104 | ||
| False Imprisonment. | 104 | ||
| Unintentional Torts | 104 | ||
| Negligence. | 104 | ||
| Preventing Negligence. | 105 | ||
| Criminal Liability | 105 | ||
| Consent | 105 | ||
| Informed Consent | 106 | ||
| Nursing Students and Legal Liability | 107 | ||
| Professional Liability Protection | 107 | ||
| Abandonment, Assignment, and Contract Issues | 107 | ||
| Short Staffing. | 107 | ||
| Floating. | 108 | ||
| Prescriber’s Orders. | 108 | ||
| Dispensing Advice Over the Phone. | 108 | ||
| Contracts and Employment Agreements. | 108 | ||
| Legal Issues in Nursing Practice | 108 | ||
| Abortion | 108 | ||
| Drug Regulations and Nurses | 108 | ||
| Cannabis. | 109 | ||
| Communicable Diseases | 109 | ||
| End-of-Life Issues | 109 | ||
| Homicide or Natural Death? | 109 | ||
| Advance Directives and Health Care Surrogates | 110 | ||
| Organ Donation | 110 | ||
| Mental Health Issues | 111 | ||
| Public Health Issues | 111 | ||
| Risk Management | 111 | ||
| Professional Involvement | 111 | ||
| Key Concepts | 112 | ||
| Critical Thinking Exercises | 112 | ||
| Review Questions | 112 | ||
| Recommended Websites | 113 | ||
| References | 113 | ||
| 9 Global Health | 115 | ||
| Objectives | 115 | ||
| Key Terms | 115 | ||
| Media Resources | 115 | ||
| Global Health | 116 | ||
| Environmental Sustainability | 116 | ||
| Health Equity | 117 | ||
| Global Burden of Disease (GBD) | 117 | ||
| Millennium Development Goals (MDGs) and Sustainable Development Goals (SDGs) | 117 | ||
| Noncommunicable Diseases | 118 | ||
| Neglected Tropical Diseases | 118 | ||
| Global Violence | 118 | ||
| Gender Equality | 119 | ||
| Intersectionality | 119 | ||
| Intersectoral Action for Health (IAH) | 120 | ||
| Global Citizenship | 120 | ||
| Cultural Diversity | 120 | ||
| Immigration and Migration | 121 | ||
| Understanding Cultural Concepts | 122 | ||
| Cultural Conflicts | 123 | ||
| Historical Development of the Concept of Culture | 123 | ||
| Cultural Safety and Humility | 124 | ||
| Cultural Assessment | 126 | ||
| Selected Components of Cultural Assessment | 126 | ||
| Ethnohistory. | 126 | ||
| Social Organization. | 126 | ||
| Socioeconomic Status, Biocultural Ecology, and Health Risks. | 126 | ||
| Language and Communication. | 126 | ||
| Religion and Spirituality. | 127 | ||
| Caring Beliefs and Practices. | 127 | ||
| Experience With Professional Health Care. | 127 | ||
| Global Health Nursing | 128 | ||
| Interprofessional Education and Collaborative Practice | 128 | ||
| Global Health Education/Global Health Competencies for Nursing | 128 | ||
| National and International Organizations for Global Health | 128 | ||
| Implications for Nursing | 129 | ||
| Key Concepts | 129 | ||
| Critical Thinking Exercises | 129 | ||
| Review Questions | 129 | ||
| Recommended Websites | 130 | ||
| References | 130 | ||
| 10 Indigenous Health | 133 | ||
| Objectives | 133 | ||
| Key Terms | 133 | ||
| Media Resources | 133 | ||
| Indigenous Diversity—the Canadian Perspective | 133 | ||
| Indigenous History in Canada | 134 | ||
| Colonialism | 136 | ||
| Residential Schools | 137 | ||
| Truth and Reconciliation | 137 | ||
| Structural Racism | 138 | ||
| Child Welfare. | 139 | ||
| Poverty. | 140 | ||
| The Justice System. | 140 | ||
| Cultural Orientations | 141 | ||
| Nursing Considerations and Indigenous Health | 143 | ||
| Illness Experiences—Chronic Diseases | 143 | ||
| Implications for Nursing | 143 | ||
| Diabetes Mellitus | 145 | ||
| Indigenous Perspective. | 145 | ||
| HIV and AIDS | 146 | ||
| Indigenous Perspective. | 146 | ||
| Cancer | 147 | ||
| Unit III Approaches to Nursing Care | 174 | ||
| 12 Critical Thinking in Nursing Practice | 174 | ||
| Objectives | 174 | ||
| Key Terms | 174 | ||
| Media Resources | 174 | ||
| Critical Thinking Defined | 174 | ||
| A Critical Thinking Model for Clinical Decision Making | 176 | ||
| Levels of Critical Thinking in Nursing | 176 | ||
| Basic Critical Thinking | 177 | ||
| Complex Critical Thinking | 177 | ||
| Commitment | 177 | ||
| Components of Critical Thinking in Nursing | 177 | ||
| Specific Knowledge Base | 177 | ||
| Experience | 178 | ||
| Critical Thinking Competencies | 178 | ||
| General Critical Thinking Competencies | 178 | ||
| Scientific Method. | 178 | ||
| Problem Solving. | 179 | ||
| Decision Making. | 179 | ||
| Specific Critical Thinking Competencies in Clinical Situations | 179 | ||
| Diagnostic Reasoning and Clinical Inference. | 179 | ||
| Clinical Decision Making. | 180 | ||
| Nursing Process as a Critical Thinking Competency | 181 | ||
| Attitudes for Critical Thinking | 181 | ||
| Standards for Critical Thinking | 181 | ||
| Intellectual Standards. | 181 | ||
| Professional Standards. | 181 | ||
| Ethical Criteria for Nursing Judgement. | 181 | ||
| Criteria for Evaluation. | 182 | ||
| Professional Responsibility. | 182 | ||
| Developing Critical Thinking Skills | 182 | ||
| Case-Based Learning | 182 | ||
| Reflective Writing | 182 | ||
| Concept Mapping | 182 | ||
| Critical Thinking Synthesis | 183 | ||
| Key Concepts | 184 | ||
| Critical Thinking Exercises | 184 | ||
| Review Questions | 184 | ||
| Recommended Websites | 185 | ||
| References | 186 | ||
| 13 Nursing Assessment, Diagnosis, and Planning | 187 | ||
| Objectives | 187 | ||
| Key Terms | 187 | ||
| Media Resources | 187 | ||
| Critical Thinking Approach to Assessment | 188 | ||
| Assessment | 189 | ||
| Types of Data | 191 | ||
| Sources of Data | 191 | ||
| Primary Sources | 192 | ||
| Client. | 192 | ||
| Secondary Sources | 192 | ||
| Family and Significant Others. | 192 | ||
| Health Care Team. | 192 | ||
| Medical Records. | 192 | ||
| Tertiary Sources | 192 | ||
| Literature. | 192 | ||
| Nurse’s Experience. | 192 | ||
| Methods of Data Collection | 192 | ||
| Interview. | 192 | ||
| Orientation Phase. | 193 | ||
| Working Phase. | 193 | ||
| Termination Phase. | 193 | ||
| Cultural Considerations in Assessment | 193 | ||
| Approaches to Indigenous Health Assessment | 193 | ||
| Nursing Health History | 194 | ||
| Family History | 194 | ||
| Documentation of History Findings | 194 | ||
| Physical Examination | 194 | ||
| Observation of Client Behaviour. | 194 | ||
| Diagnostic and Laboratory Data. | 194 | ||
| Interpreting Assessment Data and Making Nursing Judgements. | 194 | ||
| Data Validation. | 194 | ||
| Analysis and Interpretation. | 195 | ||
| Data Documentation | 195 | ||
| Concept Mapping | 195 | ||
| Nursing Diagnosis | 196 | ||
| Critical Thinking and Nursing Diagnostic Process | 197 | ||
| Formulation of the Nursing Diagnosis | 199 | ||
| Components of a Nursing Diagnosis | 199 | ||
| Diagnostic Label. | 199 | ||
| Related Factors. | 199 | ||
| Definition. | 200 | ||
| Risk Factors. | 200 | ||
| Support of the Diagnostic Statement. | 200 | ||
| Concept Mapping for Nursing Diagnoses | 200 | ||
| Sources of Diagnostic Errors | 202 | ||
| Errors in Data Collection | 202 | ||
| Errors in Interpretation and Analysis of Data | 202 | ||
| Errors in Data Clustering | 202 | ||
| Errors in the Diagnostic Statement | 203 | ||
| Documentation | 203 | ||
| Nursing Diagnoses: Application to Care Planning | 203 | ||
| Planning | 203 | ||
| Establishing Priorities | 203 | ||
| Critical Thinking in Establishing Goals and Expected Outcomes | 204 | ||
| Goals of Care | 205 | ||
| Role of the Client in Goal Setting. | 205 | ||
| Expected Outcomes | 205 | ||
| Nursing Outcomes Classification. | 206 | ||
| Combining Goals and Outcome Statements | 206 | ||
| Guidelines for Writing Goals and Expected Outcomes | 206 | ||
| Client Goal or Outcome. | 206 | ||
| Singular Goal or Outcome. | 206 | ||
| Observable Goal or Outcome. | 206 | ||
| Measurable Goal or Outcome. | 206 | ||
| Time-Limited Goal or Outcome. | 206 | ||
| Mutual Goal or Outcome. | 206 | ||
| Realistic Goal or Outcome. | 206 | ||
| Written Plans of Care | 206 | ||
| Institutional Care Plans | 207 | ||
| Computerized Care Plans. | 207 | ||
| Care Plans for Community-Based Settings. | 207 | ||
| Critical Pathways. | 207 | ||
| Consulting Other Health Care Providers | 207 | ||
| Conclusion | 207 | ||
| Using the Nursing Process to Answer Multiple-Choice and Multiple-Response Exam Questions | 207 | ||
| Key Concepts | 209 | ||
| Review Questions | 210 | ||
| Recommended Websites | 211 | ||
| References | 211 | ||
| 14 Implementing and Evaluating Nursing Care | 212 | ||
| Objectives | 212 | ||
| Key Terms | 212 | ||
| Media Resources | 212 | ||
| Introduction | 212 | ||
| Implementation | 213 | ||
| Types of Nursing Interventions | 214 | ||
| Selection of Interventions | 215 | ||
| Nursing Interventions Classification (NIC) | 215 | ||
| Critical Thinking in Implementation | 217 | ||
| Standard Nursing Interventions | 218 | ||
| Clinical Practice Guidelines and Protocols | 218 | ||
| Medical Directives or Standing Orders | 218 | ||
| Implementation Process | 219 | ||
| Reassessing the Client | 219 | ||
| Reviewing and Revising the Existing Nursing Care Plan | 219 | ||
| Organizing Resources and Care Delivery | 220 | ||
| Equipment. | 220 | ||
| Personnel. | 220 | ||
| Environment. | 220 | ||
| Client. | 220 | ||
| Anticipating and Preventing Complications | 220 | ||
| Identifying Areas of Assistance. | 220 | ||
| Implementation Skills | 220 | ||
| Cognitive Skills. | 220 | ||
| Interpersonal Skills. | 220 | ||
| Psychomotor Skills. | 220 | ||
| Direct Care | 221 | ||
| Activities of Daily Living | 221 | ||
| Instrumental Activities of Daily Living | 221 | ||
| Physical Care Techniques | 221 | ||
| Controlling for Adverse Reactions | 221 | ||
| Life-Saving Measures | 221 | ||
| Counselling | 221 | ||
| Teaching | 222 | ||
| Preventive Measures | 222 | ||
| Indirect Care | 222 | ||
| Communicating Nursing Interventions | 222 | ||
| Delegating, Supervising, and Evaluating the Work of Other Staff Members | 222 | ||
| Achieving Client-Centred Goals | 222 | ||
| Evaluation | 222 | ||
| Critical Thinking and Evaluation | 223 | ||
| Evaluation Process | 224 | ||
| Identifying Criteria and Standards | 224 | ||
| Goals. | 224 | ||
| Expected Outcomes. | 225 | ||
| Collecting Evaluative Data | 225 | ||
| Interpreting and Summarizing Findings | 226 | ||
| Documenting Findings | 226 | ||
| Care Plan Revision | 227 | ||
| Discontinuing a Care Plan | 227 | ||
| Modifying a Care Plan | 227 | ||
| Goals and Expected Outcomes | 228 | ||
| Conclusion | 228 | ||
| Using the Nursing Process as a Guide for Exam Preparation for Test-Taking Strategies | 228 | ||
| The Nursing Process and Studying Disease Management | 229 | ||
| Key Concepts | 230 | ||
| Critical Thinking Exercises | 230 | ||
| Review Questions | 231 | ||
| Recommended Websites | 231 | ||
| References | 231 | ||
| 15 Documenting and Reporting | 233 | ||
| Objectives | 233 | ||
| Key Terms | 233 | ||
| Media Resources | 233 | ||
| Purposes of Medical Records | 234 | ||
| Communication and Care Planning | 234 | ||
| Legal Documentation | 234 | ||
| Funding and Resource Management | 234 | ||
| Auditing and Monitoring | 234 | ||
| Research | 234 | ||
| Education | 236 | ||
| The Shift to Electronic Documentation | 236 | ||
| Interprofessional Communication Within the Medical Record | 237 | ||
| Confidentiality | 237 | ||
| Privacy, Confidentiality, and Security Mechanisms | 237 | ||
| Handling and Disposing of Information | 238 | ||
| Interprofessional Communication Within the Health Care Team | 238 | ||
| Guidelines for Quality Documentation and Reporting | 239 | ||
| Factual | 239 | ||
| Accurate | 239 | ||
| Complete | 240 | ||
| Current | 240 | ||
| Organized | 241 | ||
| Compliant With Standards | 241 | ||
| Methods of Documentation | 241 | ||
| Narrative Documentation | 241 | ||
| Problem-Oriented Medical Records or Health Care Records | 242 | ||
| Database. | 242 | ||
| Problem List. | 242 | ||
| Care Plan. | 242 | ||
| Progress Notes. | 242 | ||
| Source Records | 242 | ||
| Charting by Exception | 242 | ||
| Case Management and Use of Critical Pathways | 243 | ||
| Common Record-Keeping Forms | 244 | ||
| Admission Nursing History Form | 244 | ||
| Flow Sheets and Graphic Records | 244 | ||
| Patient Care Summary or Kardex | 244 | ||
| Standardized Care Plans | 244 | ||
| Discharge Summary Forms | 245 | ||
| Acuity Rating Systems | 245 | ||
| Documentation in the Home Health Care Setting | 245 | ||
| Documentation in the Long-Term Health Care Setting | 246 | ||
| Documenting Communication With Providers and Unique Events | 246 | ||
| Telephone Calls Made to a Health Care Provider | 246 | ||
| Telephone and Verbal Orders | 246 | ||
| Change-of-Shift Reports | 246 | ||
| Transfer Reports | 248 | ||
| Using SBAR or I-SBAR-R for Communication | 248 | ||
| Incident or Occurrence Reports | 248 | ||
| Information Management in Health Care | 249 | ||
| Clinical Information Systems | 249 | ||
| Nursing Clinical Information Systems | 250 | ||
| Advantages of a Nursing Clinical Information System. | 250 | ||
| Key Concepts | 251 | ||
| Critical Thinking Exercises | 251 | ||
| Review Questions | 251 | ||
| Recommended Websites | 252 | ||
| References | 253 | ||
| 16 Nursing Informatics and Canadian Nursing Practice | 254 | ||
| Objectives | 254 | ||
| Key Terms | 254 | ||
| Media Resources | 254 | ||
| Nursing Informatics and the Canadian Health Care System | 255 | ||
| Defining Nursing Informatics | 255 | ||
| Evolution of Informatics in the Canadian Health Care System | 255 | ||
| Standards and Clinical Interoperability | 257 | ||
| Standardizing Nursing Language | 259 | ||
| Health Information: Nursing Components | 259 | ||
| International Classification for Nursing Practice | 260 | ||
| Canadian Privacy Legislation | 262 | ||
| Informatics Competencies as a Strategic Direction | 264 | ||
| Clinician Engagement and Informatics Communities | 266 | ||
| Critical Thinking Exercises | 268 | ||
| Review Questions | 268 | ||
| Recommended Websites | 269 | ||
| References | 269 | ||
| Unit IV Working With Patients and Families | 271 | ||
| 17 Communication and Relational Practice | 271 | ||
| Objectives | 271 | ||
| Key Terms | 271 | ||
| Media Resources | 271 | ||
| Communication and Interpersonal Relationships | 272 | ||
| Developing Communication Skills | 272 | ||
| Levels of Communication | 273 | ||
| Intrapersonal Communication | 273 | ||
| Interpersonal Communication | 273 | ||
| Transpersonal Communication | 273 | ||
| Small-Group Communication | 274 | ||
| Public Communication | 274 | ||
| Basic Elements of the Communication Process | 274 | ||
| Referent | 274 | ||
| Sender and Receiver | 274 | ||
| Messages | 274 | ||
| Channels | 274 | ||
| Feedback | 274 | ||
| Interpersonal Variables | 275 | ||
| Environment | 275 | ||
| Forms of Communication | 275 | ||
| Verbal Communication | 275 | ||
| Vocabulary. | 275 | ||
| Denotative and Connotative Meaning. | 275 | ||
| Pacing. | 275 | ||
| Intonation. | 275 | ||
| Clarity and Brevity. | 275 | ||
| Timing and Relevance. | 275 | ||
| Nonverbal Communication | 275 | ||
| Personal Appearance. | 275 | ||
| Posture and Gait. | 276 | ||
| Facial Expression. | 276 | ||
| Eye Contact. | 276 | ||
| Gestures. | 276 | ||
| Sounds. | 276 | ||
| Personal Space. | 276 | ||
| Symbolic Communication | 277 | ||
| Metacommunication | 277 | ||
| Professional Nursing Relationships | 277 | ||
| Nurse–Patient Helping Relationships | 277 | ||
| Nurse–Family Relationships | 278 | ||
| Interprofessional Collaborative Practice (ICP) Relationships | 278 | ||
| Nurse–Community Relationships | 278 | ||
| Elements of Professional Communication | 279 | ||
| Courtesy | 279 | ||
| Use of Names | 279 | ||
| Trustworthiness | 279 | ||
| Autonomy and Responsibility | 279 | ||
| Assertiveness | 279 | ||
| Communication Within The Nursing Process | 279 | ||
| Assessment | 279 | ||
| Physical and Emotional Factors. | 279 | ||
| Developmental Factors. | 280 | ||
| Sociocultural Factors. | 280 | ||
| Gender. | 281 | ||
| Nursing Diagnosis | 281 | ||
| Planning | 281 | ||
| Goals and Outcomes. | 281 | ||
| Setting of Priorities. | 282 | ||
| Continuity of Care. | 282 | ||
| Implementation | 282 | ||
| Therapeutic Communication Techniques. | 282 | ||
| Active Listening. | 282 | ||
| Sharing Observations. | 282 | ||
| Sharing Empathy. | 282 | ||
| Sharing Hope. | 282 | ||
| Sharing Humour. | 282 | ||
| Sharing Feelings. | 283 | ||
| Using Touch. | 283 | ||
| Using Silence. | 283 | ||
| Providing Information. | 284 | ||
| Clarifying. | 284 | ||
| Focusing. | 284 | ||
| Paraphrasing. | 284 | ||
| Asking Relevant Questions. | 284 | ||
| Summarizing. | 284 | ||
| Self-Disclosure. | 284 | ||
| Confrontation. | 285 | ||
| Nontherapeutic Communication Techniques. | 285 | ||
| Asking Personal Questions. | 285 | ||
| Giving Personal Opinions. | 285 | ||
| Changing the Subject. | 285 | ||
| Automatic Responses. | 285 | ||
| False Reassurance. | 285 | ||
| Sympathy. | 285 | ||
| Asking for Explanations. | 285 | ||
| Approval or Disapproval. | 285 | ||
| Defensive Responses. | 286 | ||
| Passive or Aggressive Responses. | 286 | ||
| Arguing. | 286 | ||
| Adapting Communication Techniques for the Patient With Special Needs. | 286 | ||
| Evaluation | 286 | ||
| Key Concepts | 288 | ||
| Critical Thinking Exercises | 288 | ||
| Review Questions | 289 | ||
| Recommended Websites | 289 | ||
| References | 290 | ||
| 18 Patient-Centred Care | 291 | ||
| Objectives | 291 | ||
| Key Terms | 291 | ||
| Media Resources | 291 | ||
| Jane Black’s Story | 292 | ||
| Knowing | 292 | ||
| Ways of Knowing | 292 | ||
| Professional Patterns of Knowing | 293 | ||
| Empirical Pattern of Knowing. | 293 | ||
| Aesthetic Knowing. | 293 | ||
| Personal Knowing. | 293 | ||
| Ethical Knowing. | 293 | ||
| Thinking | 295 | ||
| Nursing Process | 295 | ||
| Clinical Judgement Model | 296 | ||
| Noticing | 296 | ||
| Interpreting | 297 | ||
| Responding | 298 | ||
| Reflecting | 298 | ||
| An Assessment Rubric for Tanner’s Model | 298 | ||
| Interacting | 299 | ||
| Interprofessional Communication | 301 | ||
| Situation, Background, Assessment, and Recommendation (SBAR). | 301 | ||
| Role Clarification. | 302 | ||
| Team Functioning. | 302 | ||
| Collaborative Leadership. | 303 | ||
| Interprofessional Conflict Resolution. | 303 | ||
| Key Concepts | 303 | ||
| Critical Thinking Exercises | 304 | ||
| Review Questions | 305 | ||
| Recommended Websites | 305 | ||
| References | 306 | ||
| 19 Family Nursing | 307 | ||
| Objectives | 307 | ||
| Key Terms | 307 | ||
| Media Resources | 307 | ||
| What Is a Family? | 308 | ||
| Current Trends in the Canadian Family | 308 | ||
| Family Forms | 308 | ||
| Family Changes and Challenges: Understanding the Influence of Sociocultural Contexts | 309 | ||
| Pregnancy for Teens and Older Moms | 309 | ||
| Domestic Roles | 309 | ||
| Economic Status | 309 | ||
| Indigenous Families | 309 | ||
| Family Caregivers | 310 | ||
| The Family and Health | 310 | ||
| Attributes of Healthy Families | 310 | ||
| Family Nursing Care | 311 | ||
| Family as Context | 311 | ||
| Family as Patient | 311 | ||
| Understanding Family in Context: Relational Inquiry With Individuals and Families | 311 | ||
| Assessing the Challenges, Strengths, and Needs of the Family: The Calgary Family Assessment Model | 312 | ||
| Structural Assessment | 313 | ||
| Internal Structure. | 313 | ||
| Family Composition. | 313 | ||
| Unit V Caring Throughout the Lifespan | 343 | ||
| 21 Developmental Theories | 343 | ||
| Objectives | 343 | ||
| Key Terms | 343 | ||
| Media Resources | 343 | ||
| Growth and Development | 344 | ||
| Physical Growth | 344 | ||
| Development | 344 | ||
| Factors Influencing Growth and Development | 344 | ||
| Traditions of Developmental Theories | 344 | ||
| Organicism | 344 | ||
| Biophysical Developmental Theories | 344 | ||
| Gesell’s Theory of Maturational Development. | 345 | ||
| Mechanisms of Maturational Development. | 346 | ||
| Nursing Implications of Maturational Development. | 346 | ||
| Chess and Thomas’s Theory of Temperament Development. | 346 | ||
| Mechanisms of Temperament Development. | 346 | ||
| Nursing Implications of Temperament Development. | 346 | ||
| Cognitive Developmental Theories | 346 | ||
| Piaget’s Theory of Cognitive Development. | 347 | ||
| Mechanisms of Cognitive Development. | 347 | ||
| Nursing Implications of Cognitive Development. | 348 | ||
| Moral Developmental Theories | 348 | ||
| Piaget’s Theory of Moral Development. | 348 | ||
| Kohlberg’s Theory of Moral Development. | 348 | ||
| Kohlberg’s Critics. | 348 | ||
| Gilligan’s Theory. | 348 | ||
| Psychoanalytic and Psychosocial Tradition | 349 | ||
| Sigmund Freud | 349 | ||
| Mechanisms of Freud’s Theory. | 350 | ||
| Nursing Implications of Freud’s Theory. | 350 | ||
| Erikson’s Theory of Eight Stages of Life | 350 | ||
| Mechanisms of Erikson’s Theory. | 352 | ||
| Nursing Implications of Erikson’s Theory. | 352 | ||
| John Bowlby | 352 | ||
| Mechanisms of Bowlby’s Theory. | 352 | ||
| Extensions to Bowlby’s Theory of Attachment and Separation | 352 | ||
| Mechanisms of the Dynamic Maturational Model of Attachment. | 352 | ||
| Nursing Implications of the Dynamic Maturational Model of Attachment. | 353 | ||
| Havighurst’s Developmental Tasks | 353 | ||
| Mechanisms and Nursing Implications of Havighurst’s Theory. | 354 | ||
| Mechanistic Tradition | 354 | ||
| Contextualism | 354 | ||
| Bioecological Theory | 354 | ||
| Mechanisms of the Bioecological Theory. | 355 | ||
| Nursing Implications of the Bioecological Theory. | 355 | ||
| Dialecticism | 355 | ||
| Keating and Hertzman’s Population Health Theory | 355 | ||
| Mechanisms of the Population Health Theory. | 356 | ||
| Community Nursing Care Implications of the Population Health Theory. | 356 | ||
| Resilience Theory | 356 | ||
| Mechanisms of Resilience. | 356 | ||
| Nursing Implications of Resilience. | 356 | ||
| Developmental Theories and Nursing | 356 | ||
| Key Concepts | 357 | ||
| Critical Thinking Exercises | 357 | ||
| Review Questions | 358 | ||
| Recommended Websites | 358 | ||
| References | 359 | ||
| 22 Conception Through Adolescence | 360 | ||
| Objectives | 360 | ||
| Key Terms | 360 | ||
| Media Resources | 360 | ||
| Selecting a Developmental Framework for Nursing | 361 | ||
| Conception | 361 | ||
| Intrauterine Life | 361 | ||
| First Trimester. | 362 | ||
| Second Trimester. | 362 | ||
| Third Trimester. | 362 | ||
| Health Promotion | 362 | ||
| Transition From Intrauterine to Extrauterine Life | 362 | ||
| Physical Changes | 362 | ||
| Psychosocial Changes | 362 | ||
| Newborn | 364 | ||
| Physical Changes | 364 | ||
| Cognitive Changes | 365 | ||
| Psychosocial Changes | 365 | ||
| Health Risks | 366 | ||
| Health Concerns | 366 | ||
| Screening. | 366 | ||
| Circumcision. | 366 | ||
| Infant | 366 | ||
| Physical Changes | 366 | ||
| Cognitive Changes | 366 | ||
| Language. | 366 | ||
| Psychosocial Changes | 366 | ||
| Separation. | 366 | ||
| Play. | 367 | ||
| Health Risks | 367 | ||
| Sudden Infant Death Syndrome. | 367 | ||
| Accidental Injury. | 367 | ||
| Child Maltreatment. | 367 | ||
| Health Concerns | 367 | ||
| Nutrition. | 367 | ||
| Feeding Alternatives. | 367 | ||
| Supplementation. | 370 | ||
| Overfeeding and Infant Obesity. | 370 | ||
| Dentition. | 370 | ||
| Immunizations. | 370 | ||
| Sleep. | 371 | ||
| Toddler | 371 | ||
| Physical Changes | 372 | ||
| Cognitive Changes | 372 | ||
| Language. | 372 | ||
| Psychosocial Changes | 372 | ||
| Health Risks | 375 | ||
| Health Concerns | 376 | ||
| Nutrition. | 376 | ||
| Preschooler | 376 | ||
| Physical Changes | 376 | ||
| Cognitive Changes | 376 | ||
| Language. | 379 | ||
| Psychosocial Changes | 379 | ||
| Play. | 379 | ||
| Health Risks | 379 | ||
| Health Concerns | 379 | ||
| Nutrition. | 379 | ||
| Sleep. | 379 | ||
| Vision. | 379 | ||
| School-Age Children and Adolescents | 379 | ||
| School-Age Child | 381 | ||
| Physical Changes | 381 | ||
| Cognitive Changes | 382 | ||
| Language Development. | 383 | ||
| Psychosocial Changes | 383 | ||
| Moral Development. | 383 | ||
| Peer Relationships. | 383 | ||
| Sexual Identity. | 384 | ||
| Health Risks | 384 | ||
| Health Concerns | 385 | ||
| Health Education. | 385 | ||
| Safety. | 386 | ||
| Nutrition. | 386 | ||
| Adolescence | 387 | ||
| Physical Changes | 387 | ||
| Cognitive Changes | 389 | ||
| Language Skills. | 389 | ||
| Psychosocial Changes | 390 | ||
| Gender Identity. | 390 | ||
| Group Identity. | 390 | ||
| Family Identity. | 390 | ||
| Vocational Identity. | 390 | ||
| Moral Identity. | 390 | ||
| Health Identity. | 391 | ||
| Health Risks | 391 | ||
| Injuries. | 391 | ||
| Suicide. | 391 | ||
| Substance Abuse. | 391 | ||
| Eating Disorders. | 392 | ||
| Obesity and Physical Inactivity. | 392 | ||
| Sexual Experimentation. | 392 | ||
| Sexually Transmitted Infections. | 392 | ||
| Pregnancy. | 392 | ||
| Health Concerns | 392 | ||
| Health Education. | 392 | ||
| Adolescents in Rural Communities. | 393 | ||
| Minority Adolescents. | 393 | ||
| Indigenous Adolescents. | 393 | ||
| Lesbian, Gay, Bisexual, Transgender, Queer or Questioning, and 2 Spirit (LGBTQ2). | 393 | ||
| Key Concepts | 394 | ||
| Critical Thinking Exercises | 394 | ||
| Review Questions | 394 | ||
| Recommended Websites | 395 | ||
| References | 395 | ||
| 23 Young to Middle Adulthood | 397 | ||
| Objectives | 397 | ||
| Key Terms | 397 | ||
| Media Resources | 397 | ||
| Young Adulthood | 398 | ||
| Physical Changes | 398 | ||
| Cognitive Changes | 398 | ||
| Psychosocial Changes | 398 | ||
| Career. | 399 | ||
| Sexuality. | 399 | ||
| Singlehood. | 399 | ||
| Marriage. | 399 | ||
| Child-Bearing Cycle. | 399 | ||
| Parenthood. | 399 | ||
| Alternative Family Structures and Parenting. | 399 | ||
| Hallmarks of Emotional Health | 400 | ||
| Social Support in Health and Illness | 400 | ||
| Health Risks | 400 | ||
| Lifestyle. | 400 | ||
| Family History. | 400 | ||
| Accidental Death and Injury. | 400 | ||
| Substance Abuse. | 401 | ||
| Unplanned Pregnancies. | 401 | ||
| Sexually Transmitted Infections. | 401 | ||
| Environmental or Occupational Factors. | 401 | ||
| Health Concerns | 401 | ||
| Infertility. | 401 | ||
| Exercise. | 401 | ||
| Routine Health Screening. | 401 | ||
| Job Stress. | 402 | ||
| Family Stress. | 402 | ||
| Pregnancy. | 402 | ||
| Prenatal Care. | 402 | ||
| Physiological Changes. | 403 | ||
| Psychosocial Changes. | 404 | ||
| Acute Care. | 404 | ||
| Restorative and Continuing Care. | 404 | ||
| Middle Adulthood | 404 | ||
| Physical Changes | 404 | ||
| Perimenopause and Menopause. | 405 | ||
| Cognitive Changes | 405 | ||
| Psychosocial Changes | 405 | ||
| Career Transition. | 405 | ||
| Sexuality. | 405 | ||
| Family Types. | 405 | ||
| Singlehood. | 405 | ||
| Marital Changes. | 405 | ||
| Family Transitions. | 405 | ||
| Care of Aging Parents. | 406 | ||
| Health Concerns | 406 | ||
| Stress and Stress Reduction. | 406 | ||
| Levels of Wellness. | 406 | ||
| Obesity. | 406 | ||
| Forming Positive Health Habits. | 406 | ||
| Anxiety. | 407 | ||
| Depression. | 407 | ||
| Primary Health Care Programs. | 407 | ||
| Acute Care. | 407 | ||
| Restorative and Continuing Care. | 407 | ||
| Key Concepts | 408 | ||
| Critical Thinking Exercises | 408 | ||
| Review Questions | 408 | ||
| Recommended Websites | 409 | ||
| References | 409 | ||
| 24 Older Persons | 411 | ||
| Objectives | 411 | ||
| Key Terms | 411 | ||
| Media Resources | 411 | ||
| Variability Among Older Persons | 412 | ||
| Myths and SterEotypes | 412 | ||
| Nurses’ Attitudes Toward Older Persons | 413 | ||
| Developmental Tasks for Older Persons | 413 | ||
| Aging Well and Quality of Life | 413 | ||
| Community-Based and Institutional Health Care Services | 414 | ||
| Assessing the Needs of Older Persons | 414 | ||
| Physiological Changes | 415 | ||
| General Survey. | 415 | ||
| Functional Changes | 415 | ||
| Cognitive Changes | 416 | ||
| Delirium. | 418 | ||
| Dementia. | 418 | ||
| Depression. | 419 | ||
| Psychosocial Changes | 419 | ||
| Retirement. | 419 | ||
| Social Isolation. | 420 | ||
| Abuse. | 420 | ||
| Sexuality. | 420 | ||
| Housing and Environment. | 421 | ||
| Death. | 421 | ||
| Addressing the Health Concerns of Older Persons | 421 | ||
| Health Promotion and Maintenance: Physiological Health Concerns | 422 | ||
| Cancer. | 423 | ||
| Heart Disease. | 423 | ||
| Smoking. | 423 | ||
| Alcohol Abuse. | 424 | ||
| Nutrition. | 424 | ||
| Oral Health. | 424 | ||
| Exercise. | 424 | ||
| Arthritis. | 424 | ||
| Falls. | 425 | ||
| Sensory Impairments. | 425 | ||
| Pain. | 425 | ||
| Medication Use. | 426 | ||
| Health Promotion and Maintenance: Psychosocial Health Concerns | 426 | ||
| Therapeutic Communication. | 426 | ||
| Touch. | 426 | ||
| Cognitive Stimulation. | 427 | ||
| Reminiscence. | 427 | ||
| Body-Image Interventions. | 427 | ||
| Older Persons and the Acute Care Setting | 427 | ||
| Older Persons and Restorative Care | 428 | ||
| Older Persons and Palliative Care | 428 | ||
| Key Concepts | 429 | ||
| Critical Thinking Exercises | 429 | ||
| Review Questions | 429 | ||
| Recommended Websites | 430 | ||
| References | 430 | ||
| 25 The Experience of Loss, Death, and Grief | 432 | ||
| Objectives | 432 | ||
| Key Terms | 432 | ||
| Media Resources | 432 | ||
| Scientific Knowledge Base | 433 | ||
| Loss | 433 | ||
| Grief | 433 | ||
| Selected Theories of Grief | 434 | ||
| Kübler-Ross’s Stages of Grief. | 434 | ||
| Bowlby’s Phases of Mourning. | 434 | ||
| Worden’s Four Tasks of Mourning. | 434 | ||
| Types of Grief. | 434 | ||
| Normal Grief. | 434 | ||
| Anticipatory Grief. | 435 | ||
| Complicated Grief. | 435 | ||
| Disenfranchised Grief. | 435 | ||
| Application of Grief Theory to Other Types of Loss. | 435 | ||
| Nursing Knowledge Base | 435 | ||
| Factors Influencing Loss and Grief | 435 | ||
| Human Development. | 435 | ||
| Psychosocial Perspectives of Loss and Grief. | 435 | ||
| Socioeconomic Status. | 436 | ||
| Personal Relationships. | 436 | ||
| Nature of the Loss. | 436 | ||
| Culture and Ethnicity. | 436 | ||
| Spiritual Beliefs. | 437 | ||
| Coping With Grief and Loss | 437 | ||
| Hope. | 437 | ||
| Critical Thinking | 437 | ||
| The Nursing Process And Grief | 438 | ||
| Assessment | 438 | ||
| Type and Stage of Grief. | 438 | ||
| Grief Reactions. | 438 | ||
| Factors That Affect Grief. | 439 | ||
| End-of-Life Decisions. | 439 | ||
| Nurses’ Experience With Grief. | 441 | ||
| Patient Expectations. | 442 | ||
| Nursing Diagnosis | 442 | ||
| Planning | 443 | ||
| Goals and Outcomes. | 443 | ||
| Setting Priorities. | 445 | ||
| Continuity of Care. | 446 | ||
| Implementation | 446 | ||
| Health Promotion. | 446 | ||
| Therapeutic Communication. | 446 | ||
| Promoting Hope. | 446 | ||
| Facilitating Mourning. | 446 | ||
| Acute Care. | 447 | ||
| Palliative Care. | 447 | ||
| Symptom control. | 447 | ||
| Maintaining dignity and self-esteem. | 448 | ||
| Preventing abandonment and isolation. | 448 | ||
| Providing a comfortable and peaceful environment. | 448 | ||
| Fear of dying and death. | 448 | ||
| Support for the Grieving Family. | 450 | ||
| Hospice Care. | 450 | ||
| Care After Death. | 451 | ||
| The Grieving Nurse. | 453 | ||
| Evaluation | 453 | ||
| Patient Care. | 453 | ||
| Patient Expectations. | 454 | ||
| Key Concepts | 454 | ||
| Critical Thinking Exercises | 454 | ||
| Review Questions | 454 | ||
| Recommended Websites | 455 | ||
| References | 455 | ||
| Unit VI Psychosocial Considerations | 457 | ||
| 26 Self-Concept | 457 | ||
| Objectives | 457 | ||
| Key Terms | 457 | ||
| Media Resources | 457 | ||
| Scientific Knowledge Base | 457 | ||
| Nursing Knowledge Base | 458 | ||
| Development of Self-Concept | 458 | ||
| Components and Interrelated Terms of Self-Concept | 459 | ||
| Identity. | 459 | ||
| Body Image. | 460 | ||
| Role Performance. | 460 | ||
| Self-Esteem. | 461 | ||
| Stressors Affecting Self-Concept | 461 | ||
| Identity Stressors. | 463 | ||
| Body Image Stressors. | 463 | ||
| Role Performance Stressors. | 463 | ||
| Self-Esteem Stressors. | 463 | ||
| The Family’s Effect on the Development of Self-Concept | 464 | ||
| The Nurse’s Effect on the Client’s Self-Concept | 465 | ||
| Critical Thinking | 466 | ||
| Self-Concept and the Nursing Process | 466 | ||
| Assessment | 466 | ||
| Coping Behaviours. | 467 | ||
| Significant Others. | 467 | ||
| Clients’ Expectations. | 467 | ||
| Nursing Diagnosis | 467 | ||
| Planning | 468 | ||
| Goals and Outcomes. | 469 | ||
| Setting Priorities. | 469 | ||
| Continuity of Care. | 469 | ||
| Implementation | 469 | ||
| Health Promotion. | 469 | ||
| Acute Care. | 469 | ||
| Restorative Care. | 472 | ||
| Evaluation | 473 | ||
| Client Care. | 473 | ||
| Client Expectations. | 473 | ||
| Key Concepts | 473 | ||
| Critical Thinking Exercises | 473 | ||
| Review Questions | 474 | ||
| Recommended Websites | 474 | ||
| References | 474 | ||
| 27 Sexuality | 476 | ||
| Objectives | 476 | ||
| Key Terms | 476 | ||
| Media Resources | 476 | ||
| Scientific Knowledge Base | 477 | ||
| Sexual and Gender Identity | 477 | ||
| Sexual Orientation | 477 | ||
| Sexual Development | 478 | ||
| Infancy and Childhood. | 478 | ||
| Puberty and Adolescence. | 478 | ||
| Adulthood. | 478 | ||
| Older Personhood. | 478 | ||
| Sexual Response Cycle. | 478 | ||
| Sexual Behaviour | 479 | ||
| High-Risk Sexual Behaviour. | 479 | ||
| Sexually Transmitted Infections | 480 | ||
| Human Papillomavirus. | 480 | ||
| Chlamydia. | 480 | ||
| Syphilis. | 480 | ||
| Gonorrhea. | 481 | ||
| Genital Herpes. | 481 | ||
| Human Immunodeficiency Virus Infection. | 481 | ||
| Prevention of Sexually Transmitted Infections. | 481 | ||
| Safer Sex. | 481 | ||
| Using Condoms. | 481 | ||
| Contraception | 481 | ||
| Emergency Contraception. | 482 | ||
| Abortion | 483 | ||
| Nursing Knowledge Base | 483 | ||
| Sociocultural Dimensions of Sexuality | 483 | ||
| Discussing Sexual Issues | 483 | ||
| Alterations in Sexual Health | 483 | ||
| Infertility. | 483 | ||
| Sexual Abuse. | 483 | ||
| Sexual Dysfunction. | 484 | ||
| Sexual Dysfunction in Women. | 484 | ||
| Sexual Dysfunction in Men. | 484 | ||
| Patients With Particular Sexual Health Concerns | 485 | ||
| Pregnant and Postpartum Women. | 485 | ||
| Patients Recovering From Surgery. | 485 | ||
| Patients With Illness or Disabilities. | 485 | ||
| Critical Thinking | 486 | ||
| Sexuality and The Nursing Process | 486 | ||
| Assessment | 486 | ||
| Factors Affecting Sexuality. | 486 | ||
| Sexual Health History. | 486 | ||
| Physical Assessment. | 487 | ||
| Patient Expectations. | 487 | ||
| Nursing Diagnosis | 487 | ||
| Planning | 488 | ||
| Goals and Outcomes. | 488 | ||
| Setting Priorities. | 488 | ||
| Continuity of Care. | 488 | ||
| Implementation | 488 | ||
| Health Promotion. | 488 | ||
| Acute Care. | 488 | ||
| Restorative Care. | 490 | ||
| Evaluation | 490 | ||
| Patient Care. | 490 | ||
| Patient Expectations. | 491 | ||
| Key Concepts | 491 | ||
| Critical Thinking Exercises | 491 | ||
| Review Questions | 492 | ||
| Recommended Websites | 492 | ||
| References | 492 | ||
| 28 Spirituality in Health and Health Care | 494 | ||
| Objectives | 494 | ||
| Key Terms | 494 | ||
| Media Resources | 494 | ||
| Historical Perspectives | 494 | ||
| Spirituality and Health: Empirical Evidence | 495 | ||
| Spirituality and Nursing Theory | 495 | ||
| Conceptualizing Spirituality and Religion | 495 | ||
| Spirituality and the Life Journey | 496 | ||
| Developing and Maintaining Spirituality | 496 | ||
| Mindfulness. | 497 | ||
| Spirituality and Illness | 497 | ||
| Critical Thinking | 497 | ||
| Understanding Patients’ Spirituality | 499 | ||
| Ethical Spiritual Care | 500 | ||
| Providing Spiritual Care | 501 | ||
| Facilitating Spiritual Practices | 503 | ||
| Reflecting on Nurses’ Spiritual Care | 504 | ||
| Key Concepts | 504 | ||
| Critical Thinking Exercises | 505 | ||
| Review Questions | 505 | ||
| Recommended Websites | 506 | ||
| References | 506 | ||
| 29 Stress and Adaptation | 508 | ||
| Objectives | 508 | ||
| Key Terms | 508 | ||
| Media Resources | 508 | ||
| Conceptualizations of Stress | 509 | ||
| Physiological Conceptualizations | 509 | ||
| Psychological Conceptualizations | 509 | ||
| Stress Response Systems | 510 | ||
| Sympathetic–Adrenal–Medullary System | 510 | ||
| Hypothalamic–Pituitary–Adrenal Axis | 511 | ||
| Stress and the Immune System | 511 | ||
| The Relationship Between Type of Stressor and Health | 511 | ||
| Stress-Related Disorders | 512 | ||
| Acute Stress Disorder. | 512 | ||
| Post-Traumatic Stress Disorder (PTSD). | 512 | ||
| Nursing Knowledge Base | 513 | ||
| Nursing Theory and the Role of Stress | 513 | ||
| Situational, Maturational, and Sociocultural Factors | 513 | ||
| Situational Factors. | 513 | ||
| Maturational Factors. | 514 | ||
| Sociocultural Factors. | 514 | ||
| Critical Thinking | 514 | ||
| Nursing Process | 515 | ||
| Assessment | 515 | ||
| Subjective Findings. | 515 | ||
| Objective Findings. | 515 | ||
| Patient Expectations. | 515 | ||
| Nursing Diagnosis | 515 | ||
| Planning | 517 | ||
| Goals and Outcomes. | 517 | ||
| Setting Priorities. | 517 | ||
| Continuity of Care. | 517 | ||
| Implementation | 517 | ||
| Health Promotion. | 517 | ||
| Regular Exercise. | 517 | ||
| Support Systems. | 520 | ||
| Time Management. | 520 | ||
| Guided Imagery and Visualization. | 520 | ||
| Progressive Muscle Relaxation. | 520 | ||
| Assertiveness Training. | 520 | ||
| Journal Writing. | 520 | ||
| Stress Management in the Workplace. | 521 | ||
| Acute Care | 521 | ||
| Crisis Intervention. | 521 | ||
| Restorative and Continuing Care. | 522 | ||
| Evaluation | 522 | ||
| Patient Care. | 522 | ||
| Patient Expectations. | 522 | ||
| Key Concepts | 523 | ||
| Critical Thinking Exercises | 523 | ||
| Review Questions | 523 | ||
| Recommended Websites | 524 | ||
| References | 524 | ||
| Unit VII Scientific Basis for Nursing Practice | 526 | ||
| 30 Vital Signs | 526 | ||
| Objectives | 526 | ||
| Key Terms | 526 | ||
| Media Resources | 526 | ||
| Guidelines for Measuring Vital Signs | 527 | ||
| Body Temperature | 528 | ||
| Physiology | 528 | ||
| Regulation. | 528 | ||
| Neural and Vascular Control. | 528 | ||
| Heat Production. | 528 | ||
| Heat Loss. | 529 | ||
| Skin in Temperature Regulation. | 529 | ||
| Behavioural Control. | 529 | ||
| Factors Affecting Body Temperature | 529 | ||
| Age. | 529 | ||
| Exercise. | 530 | ||
| Hormone Level. | 530 | ||
| Circadian Rhythm. | 530 | ||
| Stress. | 530 | ||
| Environment. | 530 | ||
| Temperature Alterations. | 530 | ||
| Fever. | 530 | ||
| Hyperthermia. | 531 | ||
| Heatstroke. | 531 | ||
| Heat Exhaustion. | 531 | ||
| Hypothermia. | 531 | ||
| Nursing Process and Thermoregulation | 531 | ||
| Assessment | 531 | ||
| Sites. | 531 | ||
| Thermometers. | 532 | ||
| Electronic Thermometer. | 532 | ||
| Chemical Strip Thermometers. | 538 | ||
| Glass Thermometers. | 538 | ||
| Nursing Diagnosis | 539 | ||
| Planning | 539 | ||
| Goals and Outcomes. | 539 | ||
| Setting Priorities | 539 | ||
| Continuity of Care. | 539 | ||
| Implementation | 539 | ||
| Health Promotion. | 539 | ||
| Acute Care | 541 | ||
| Fever. | 541 | ||
| Heatstroke. | 541 | ||
| Hypothermia. | 541 | ||
| Restorative and Continuing Care. | 542 | ||
| Evaluation | 542 | ||
| Pulse | 542 | ||
| Physiology and Regulation | 542 | ||
| Assessment of Pulse | 542 | ||
| Use of a Stethoscope. | 542 | ||
| Character of the Pulse | 547 | ||
| Rate. | 547 | ||
| Rhythm. | 548 | ||
| Strength. | 548 | ||
| Equality. | 548 | ||
| Nursing Process and Pulse Determination | 548 | ||
| Respiration | 549 | ||
| Physiological Control | 549 | ||
| Mechanics of Breathing | 549 | ||
| Assessment of Ventilation | 549 | ||
| Respiratory Rate. | 549 | ||
| Ventilatory Depth. | 549 | ||
| Ventilatory Rhythm. | 552 | ||
| Assessment of Diffusion and Perfusion | 553 | ||
| Measurement of Arterial Oxygen Saturation. | 553 | ||
| Nursing Process and Respiratory Vital Signs | 556 | ||
| Blood Pressure | 557 | ||
| Physiology of Arterial Blood Pressure | 557 | ||
| Cardiac Output. | 557 | ||
| Peripheral Resistance. | 557 | ||
| Blood Volume. | 557 | ||
| Viscosity. | 557 | ||
| Elasticity. | 557 | ||
| Factors Influencing Blood Pressure | 557 | ||
| Age. | 557 | ||
| Stress. | 557 | ||
| Ethnicity. | 558 | ||
| Gender. | 558 | ||
| Daily Variation. | 558 | ||
| Medications. | 558 | ||
| Activity, Weight, and Smoking. | 558 | ||
| Hypertension | 558 | ||
| Hypotension | 559 | ||
| Measurement of Blood Pressure | 560 | ||
| Blood Pressure Equipment. | 560 | ||
| Auscultation. | 560 | ||
| Assessment in Children. | 565 | ||
| Ultrasonic Stethoscope. | 566 | ||
| Palpation. | 566 | ||
| Lower Extremity Blood Pressure. | 566 | ||
| Automatic Blood Pressure Devices. | 567 | ||
| Self-Measurement of Blood Pressure. | 567 | ||
| Nursing Process and Blood Pressure Determination | 568 | ||
| Health Promotion and Vital Signs | 569 | ||
| Recording Vital Signs | 569 | ||
| Key Concepts | 570 | ||
| Critical Thinking Exercises | 570 | ||
| Review Questions | 572 | ||
| Recommended Websites | 572 | ||
| References | 573 | ||
| 31 Pain Assessment and Management | 575 | ||
| Objectives | 575 | ||
| Key Terms | 575 | ||
| Media Resources | 575 | ||
| Scientific Knowledge Base | 576 | ||
| Nature of Pain | 576 | ||
| Physiology of Pain | 576 | ||
| Theory of Pain. | 578 | ||
| Physiological Responses. | 578 | ||
| Behavioural Responses. | 578 | ||
| Types of Pain | 579 | ||
| Acute Pain. | 579 | ||
| Chronic Pain. | 579 | ||
| Cancer Pain. | 579 | ||
| Pain by Inferred Pathology Process. | 579 | ||
| Breakthrough Pain. | 579 | ||
| Nursing Knowledge Base | 580 | ||
| Knowledge, Attitudes, and Beliefs | 580 | ||
| Factors Influencing Pain | 581 | ||
| Physiological Factors | 581 | ||
| Age. | 581 | ||
| Sleep. | 581 | ||
| Heredity. | 582 | ||
| Neurological Function. | 582 | ||
| Social Factors | 582 | ||
| Attention. | 582 | ||
| Previous Experience. | 582 | ||
| Family and Social Support. | 582 | ||
| Psychological Factors | 583 | ||
| Anxiety. | 583 | ||
| Meaning of Pain. | 583 | ||
| Spiritual Factors. | 583 | ||
| Cultural Factors. | 583 | ||
| Critical Thinking | 584 | ||
| Nursing Process and Pain | 584 | ||
| Assessment | 584 | ||
| Expression of Pain. | 585 | ||
| Characteristics of Pain. | 586 | ||
| Onset, Duration, and Sequence of Pain. | 586 | ||
| Provocation/Pain Pattern. | 586 | ||
| Palliation/Relief Measures. | 586 | ||
| Quality. | 586 | ||
| Radiation/Location. | 586 | ||
| Severity/Intensity. | 586 | ||
| Contributing Symptoms. | 588 | ||
| Effects of Pain. | 588 | ||
| Behavioural effects and nonverbal indicators. | 588 | ||
| Influence on activities of daily living. | 589 | ||
| Patient Expectations. | 589 | ||
| Nursing Diagnosis | 589 | ||
| Planning | 590 | ||
| Goals and Outcomes. | 591 | ||
| Setting Priorities. | 591 | ||
| Collaborative Pain Care. | 591 | ||
| Implementation | 591 | ||
| Health Promotion. | 591 | ||
| Nonpharmacological Pain-Relief Interventions. | 594 | ||
| Relaxation and guided imagery. | 594 | ||
| Distraction. | 594 | ||
| Music. | 594 | ||
| Biofeedback. | 594 | ||
| Acupuncture. | 595 | ||
| Cutaneous stimulation. | 595 | ||
| Herbal supplements. | 596 | ||
| Reducing pain perception. | 596 | ||
| Acute Pain Management. | 596 | ||
| Pharmacological Pain-Relief Interventions. | 597 | ||
| Analgesics. | 597 | ||
| Patient-controlled analgesia. | 598 | ||
| Local analgesic infusion pump. | 599 | ||
| Topical analgesics and anaesthetics. | 599 | ||
| Sucrose. | 599 | ||
| Local and regional anaesthetics and analgesics. | 600 | ||
| Nursing implications. | 600 | ||
| Invasive Interventions for Pain Relief. | 601 | ||
| Procedure Pain Management. | 602 | ||
| Cancer Pain Management. | 602 | ||
| Barriers to Effective Pain Management. | 603 | ||
| Restorative and Continuing Care | 604 | ||
| Pain Clinics, Palliative Care, and Hospices. | 604 | ||
| Evaluation | 604 | ||
| Patient Care. | 604 | ||
| Patient Perceptions. | 604 | ||
| Key Concepts | 605 | ||
| Critical Thinking Exercises | 605 | ||
| Review Questions | 606 | ||
| Recommended Websites | 606 | ||
| References | 607 | ||
| 32 Health Assessment and Physical Examination | 611 | ||
| Objectives | 611 | ||
| Key Terms | 611 | ||
| Media Resources | 612 | ||
| Social and Cultural Considerations | 612 | ||
| Purposes of Physical Examination | 612 | ||
| Gathering a Health History | 613 | ||
| Developing Nursing Diagnoses and a Care Plan | 613 | ||
| Managing Patient Problems | 613 | ||
| Evaluating Nursing Care | 613 | ||
| Skills of Physical Assessment | 613 | ||
| Inspection | 613 | ||
| Palpation | 613 | ||
| Percussion | 614 | ||
| Auscultation | 614 | ||
| Olfaction | 615 | ||
| Preparation for Examination | 615 | ||
| Infection Control | 615 | ||
| Environment | 615 | ||
| Equipment | 615 | ||
| Physical Preparation of the Patient | 615 | ||
| Positioning. | 616 | ||
| Psychological Preparation of the Patient | 616 | ||
| Assessment of Age Groups | 616 | ||
| Organization of the Examination | 616 | ||
| General Survey | 618 | ||
| General Appearance and Behaviour | 618 | ||
| Vital Signs | 620 | ||
| Height and Weight | 620 | ||
| The Integumentary System: Skin, Hair, and Nails | 622 | ||
| Skin | 622 | ||
| Colour. | 623 | ||
| Moisture. | 624 | ||
| Temperature. | 625 | ||
| Texture. | 625 | ||
| Turgor. | 625 | ||
| Vascularity. | 625 | ||
| Edema. | 625 | ||
| Lesions. | 625 | ||
| Hair and Scalp | 625 | ||
| Inspection. | 625 | ||
| Nails | 628 | ||
| Inspection and Palpation. | 628 | ||
| Head and Neck | 631 | ||
| Head | 631 | ||
| Inspection and Palpation. | 631 | ||
| Eyes | 631 | ||
| External Eye Structures. | 631 | ||
| Position and Alignment. | 631 | ||
| Eyebrows. | 631 | ||
| Eyelids. | 631 | ||
| Lacrimal Apparatus. | 633 | ||
| Conjunctivae and Sclerae. | 633 | ||
| Corneas. | 633 | ||
| Pupils and Irises. | 633 | ||
| Internal Eye Structures. | 633 | ||
| Extraocular Movements. | 634 | ||
| Visual Fields. | 634 | ||
| Visual Acuity. | 634 | ||
| Ears | 634 | ||
| Auricles. | 635 | ||
| Ear Canals and Eardrums. | 636 | ||
| Hearing Acuity. | 636 | ||
| Nose and Sinuses | 637 | ||
| Nose. | 637 | ||
| Sinuses. | 637 | ||
| Mouth and Pharynx | 638 | ||
| Lips. | 638 | ||
| Buccal Mucosa, Gums, and Teeth. | 638 | ||
| Tongue and Floor of Mouth. | 639 | ||
| Palate. | 639 | ||
| Pharynx. | 639 | ||
| Neck | 640 | ||
| Neck Muscles. | 641 | ||
| Lymph Nodes. | 641 | ||
| Thyroid Gland. | 642 | ||
| Carotid Artery and Jugular Vein. | 642 | ||
| Trachea. | 642 | ||
| Thorax and Lungs | 642 | ||
| Posterior Thorax | 644 | ||
| Lateral Thorax | 646 | ||
| Anterior Thorax | 646 | ||
| Heart | 647 | ||
| Inspection and Palpation | 649 | ||
| Auscultation | 650 | ||
| Vascular System | 651 | ||
| Blood Pressure | 651 | ||
| Carotid Arteries | 651 | ||
| Jugular Veins | 652 | ||
| Peripheral Arteries and Veins | 654 | ||
| Peripheral Arteries. | 654 | ||
| Tissue Perfusion. | 656 | ||
| Peripheral Veins. | 656 | ||
| Lymphatic System | 657 | ||
| Breasts | 657 | ||
| Female Breasts | 657 | ||
| Inspection. | 657 | ||
| Palpation. | 659 | ||
| Male Breasts | 660 | ||
| Abdomen | 660 | ||
| Inspection | 661 | ||
| Skin. | 661 | ||
| Umbilicus. | 661 | ||
| Contour and Symmetry. | 661 | ||
| Enlarged Organs or Masses. | 662 | ||
| Movement or Pulsations. | 662 | ||
| Auscultation | 662 | ||
| Bowel Motility. | 662 | ||
| Vascular Sounds. | 662 | ||
| Kidney Tenderness. | 662 | ||
| Palpation | 662 | ||
| Aortic Pulsation. | 663 | ||
| Female Genitalia and Reproductive Tract | 663 | ||
| Preparation of the Patient | 663 | ||
| External Genitalia | 664 | ||
| Speculum Examination of Internal Genitalia | 666 | ||
| Male Genitalia | 666 | ||
| Sexual Maturity | 666 | ||
| Penis | 666 | ||
| Scrotum | 667 | ||
| Inguinal Ring and Canal | 667 | ||
| Rectum and Anus | 668 | ||
| Inspection | 668 | ||
| Digital Palpation | 669 | ||
| Musculoskeletal System | 669 | ||
| General Inspection | 670 | ||
| Palpation | 671 | ||
| Range of Joint Motion | 671 | ||
| Muscle Tone and Strength | 672 | ||
| Neurological System | 673 | ||
| Mental and Emotional Status | 673 | ||
| Level of Consciousness. | 674 | ||
| Behaviour and Appearance. | 675 | ||
| Language. | 675 | ||
| Intellectual Function | 675 | ||
| Memory. | 675 | ||
| Knowledge. | 675 | ||
| Abstract Thinking. | 675 | ||
| Association. | 675 | ||
| Judgement. | 675 | ||
| Cranial Nerve Function | 675 | ||
| Sensory Function | 676 | ||
| Motor Function | 676 | ||
| Coordination. | 676 | ||
| Balance. | 677 | ||
| Reflexes | 677 | ||
| After the Examination | 679 | ||
| Integration of Physical Assessment With Nursing Care | 680 | ||
| Key Concepts | 680 | ||
| Critical Thinking Exercises | 680 | ||
| Review Questions | 680 | ||
| Recommended Websites | 681 | ||
| References | 682 | ||
| 33 Infection Control | 683 | ||
| Objectives | 683 | ||
| Key Terms | 683 | ||
| Media Resources | 683 | ||
| Scientific Knowledge Base | 684 | ||
| Chain of Infection | 684 | ||
| Infectious Agents. | 684 | ||
| Reservoir. | 684 | ||
| Food. | 685 | ||
| Oxygen. | 685 | ||
| Water. | 685 | ||
| Temperature. | 685 | ||
| pH. | 685 | ||
| Minimal Light. | 685 | ||
| Portal of Exit. | 685 | ||
| Modes of Transmission. | 686 | ||
| Portal of Entry. | 687 | ||
| Susceptible Host. | 687 | ||
| Infectious Process | 687 | ||
| Defences Against Infection | 687 | ||
| Normal Flora. | 687 | ||
| Body System Defences. | 688 | ||
| Inflammation. | 688 | ||
| Vascular and Cellular Responses. | 689 | ||
| Inflammatory Exudates. | 689 | ||
| Tissue Repair. | 689 | ||
| Health Care–Associated Infections | 689 | ||
| Nursing Process In Infection Control | 689 | ||
| Assessment | 689 | ||
| Status of Defence Mechanisms | 690 | ||
| Patient Susceptibility | 692 | ||
| Age. | 692 | ||
| Nutritional Status. | 692 | ||
| Stress. | 692 | ||
| Disease Process. | 692 | ||
| Medical Therapy. | 693 | ||
| Clinical Appearance | 693 | ||
| Laboratory Data | 694 | ||
| Patients With Infection | 694 | ||
| Nursing Diagnosis | 694 | ||
| Planning | 695 | ||
| Goals and Outcomes. | 695 | ||
| Setting Priorities. | 695 | ||
| Continuity of Care. | 695 | ||
| Implementation | 695 | ||
| Health Promotion. | 697 | ||
| Acute Care Measures. | 697 | ||
| Asepsis | 697 | ||
| Control or Elimination of Infectious Agents. | 697 | ||
| Cleaning. | 698 | ||
| Disinfection and Sterilization. | 698 | ||
| Control or Elimination of Reservoirs. | 698 | ||
| Control of Portals of Exit. | 698 | ||
| Control of Transmission. | 699 | ||
| Hand Hygiene. | 700 | ||
| Control of Portals of Entry. | 700 | ||
| Protection of the Susceptible Host. | 705 | ||
| Isolation Guidelines. | 705 | ||
| Psychological implications of isolation precautions. | 705 | ||
| Protective Environment. | 708 | ||
| Personal protective equipment. | 709 | ||
| Specimen collection. | 710 | ||
| Bagging waste or linen. | 710 | ||
| Transporting patients. | 711 | ||
| Role of the Infection Control Professional. | 711 | ||
| Infection Prevention and Control for Hospital Personnel. | 711 | ||
| Patient Education. | 711 | ||
| Surgical Asepsis. | 712 | ||
| Patient Preparation. | 712 | ||
| Principles of Surgical Asepsis. | 712 | ||
| Performing Sterile Procedures. | 713 | ||
| Donning and removing caps, masks, and eyewear. | 713 | ||
| Opening sterile packages. | 713 | ||
| Opening a sterile item on a flat surface. | 714 | ||
| Opening a sterile item while holding it. | 714 | ||
| Preparing a sterile field. | 714 | ||
| Pouring sterile solutions. | 716 | ||
| Surgical hand scrub. | 716 | ||
| Applying sterile gloves. | 717 | ||
| Donning a sterile gown. | 717 | ||
| Evaluation | 720 | ||
| Key Concepts | 724 | ||
| Critical Thinking Exercises | 725 | ||
| Review Questions | 725 | ||
| Recommended Websites | 725 | ||
| References | 726 | ||
| 34 Medication Administration | 727 | ||
| Objectives | 727 | ||
| Key Terms | 727 | ||
| Media Resources | 727 | ||
| Scientific Knowledge Base | 728 | ||
| Pharmacological Concepts | 728 | ||
| Drug Names. | 728 | ||
| Classification. | 728 | ||
| Medication Forms. | 728 | ||
| Medication Legislation and Standards | 729 | ||
| Canadian Drug Legislation. | 729 | ||
| Drug Standards. | 730 | ||
| Control. | 730 | ||
| Provincial, Territorial, and Local Regulation of Medication. | 730 | ||
| Medication Regulation and Nursing Practice. | 730 | ||
| Pharmacokinetics as the Basis of Medication Actions | 730 | ||
| Absorption. | 731 | ||
| Route of Administration. | 731 | ||
| Ability of the Medication to Dissolve. | 731 | ||
| Blood Flow to the Site of Administration. | 731 | ||
| Body Surface Area. | 731 | ||
| Lipid Solubility of a Medication. | 731 | ||
| Distribution. | 731 | ||
| Circulation. | 731 | ||
| Membrane Permeability. | 731 | ||
| Protein Binding. | 731 | ||
| Metabolism. | 731 | ||
| Excretion. | 731 | ||
| Types of Medication Action | 732 | ||
| Therapeutic Effects. | 732 | ||
| Side Effects. | 732 | ||
| Adverse Effects. | 732 | ||
| Toxic Effects. | 732 | ||
| Idiosyncratic Reactions. | 732 | ||
| Allergic Reactions. | 732 | ||
| Medication Interactions | 733 | ||
| Medication Dose Responses | 733 | ||
| Routes of Administration | 733 | ||
| Oral Routes. | 734 | ||
| Sublingual Administration. | 734 | ||
| Buccal Administration. | 734 | ||
| Parenteral Routes. | 734 | ||
| Epidural Route. | 734 | ||
| Intrathecal Route. | 734 | ||
| Intraosseous Route. | 735 | ||
| Intraperitoneal Route. | 735 | ||
| Intrapleural Route. | 735 | ||
| Intra-Arterial Route. | 736 | ||
| Topical Administration. | 736 | ||
| Inhalation Route. | 736 | ||
| Intraocular Route. | 736 | ||
| Systems of Medication Measurement | 736 | ||
| Metric System. | 736 | ||
| Solutions. | 737 | ||
| Household Measurements. | 737 | ||
| Nursing Knowledge Base | 737 | ||
| Clinical Calculations | 737 | ||
| Conversions Within One System. | 738 | ||
| Dose Calculations. | 738 | ||
| Pediatric Doses. | 738 | ||
| Prescriber’s Role | 739 | ||
| Types of Orders | 740 | ||
| Routine Medication Orders. | 741 | ||
| As-Needed (prn) Orders | 741 | ||
| Single (One-Time) Orders. | 741 | ||
| STAT Orders. | 741 | ||
| Now Orders. | 741 | ||
| Prescriptions. | 741 | ||
| Pharmacist’s Role | 742 | ||
| Distribution Systems | 742 | ||
| Stock Supply System. | 742 | ||
| Unit-Dose System. | 742 | ||
| Automated Dispensing Systems. | 742 | ||
| Nurse’s Role | 743 | ||
| Medication Errors | 743 | ||
| Critical Thinking | 744 | ||
| Knowledge | 744 | ||
| Experience | 746 | ||
| Cognitive and Behavioural Attributes | 746 | ||
| Standards | 746 | ||
| Right Medication. | 746 | ||
| Right Dose. | 746 | ||
| Right Patient. | 747 | ||
| Right Route. | 747 | ||
| Right Time and Frequency. | 747 | ||
| Right Documentation. | 748 | ||
| Right Reason. | 748 | ||
| Right to Refuse. | 748 | ||
| Right Patient Education. | 748 | ||
| Right Evaluation. | 748 | ||
| Risk Management: Agency Policy and Procedure. | 749 | ||
| Maintaining Patients’ Rights. | 749 | ||
| Nursing Process and Medication Administration | 749 | ||
| Assessment | 749 | ||
| History. | 749 | ||
| History of Allergies. | 749 | ||
| Medication Data. | 749 | ||
| Diet History. | 749 | ||
| Patient’s Perceptual or Coordination Problems. | 749 | ||
| Patient’s Current Condition. | 750 | ||
| Patient’s Attitude Toward Medication Use. | 750 | ||
| Patient’s Knowledge and Understanding of Medication Therapy. | 750 | ||
| Patient’s Learning Needs. | 750 | ||
| Nursing Diagnosis | 750 | ||
| Planning | 750 | ||
| Goals and Outcomes. | 751 | ||
| Setting Priorities. | 751 | ||
| Collaborative Care. | 751 | ||
| Implementation | 751 | ||
| Health Promotion. | 751 | ||
| Acute Care. | 752 | ||
| Receiving Medication Orders. | 752 | ||
| Correct Transcription and Communication of Orders. | 752 | ||
| Accurate Dose Calculation and Measurement. | 752 | ||
| Correct Administration. | 752 | ||
| Recording Medication Administration. | 754 | ||
| Restorative Care. | 754 | ||
| Special Considerations for Administering Medications to Specific Age Groups. | 754 | ||
| Infants and Children. | 754 | ||
| Older Persons. | 754 | ||
| Polypharmacy. | 754 | ||
| Nonadherence. | 755 | ||
| Evaluation | 756 | ||
| Medication Administration | 756 | ||
| Oral Administration | 756 | ||
| Topical Medication Applications | 761 | ||
| Skin Applications. | 761 | ||
| Nasal Instillation. | 762 | ||
| Eye Instillation. | 762 | ||
| Intraocular Administration. | 764 | ||
| Ear Instillation. | 764 | ||
| Vaginal Instillation. | 768 | ||
| Rectal Instillation. | 768 | ||
| Administering Medications by Inhalation | 768 | ||
| Administering Medications by Irrigations | 775 | ||
| Administering Parenteral Medications | 775 | ||
| Equipment. | 775 | ||
| Syringes. | 775 | ||
| Needles. | 776 | ||
| Disposable Injection Units. | 776 | ||
| Preparing an Injection From an Ampule. | 776 | ||
| Preparing an Injection From a Vial. | 777 | ||
| Mixing Medications. | 777 | ||
| Mixing Medications From Two Vials. | 777 | ||
| Mixing Medications From One Vial and One Ampule. | 783 | ||
| Insulin Preparation. | 783 | ||
| Administering Injections | 785 | ||
| Subcutaneous Injections. | 785 | ||
| Intramuscular Injections. | 792 | ||
| Sites. | 792 | ||
| Ventrogluteal muscle. | 792 | ||
| Vastus lateralis muscle. | 793 | ||
| Dorsogluteal muscle. | 793 | ||
| Deltoid muscle. | 793 | ||
| Technique for Intramuscular Injections. | 794 | ||
| Intradermal Injections. | 794 | ||
| Safety in Administering Medications by Injection | 794 | ||
| Needleless Devices. | 794 | ||
| Intravenous Administration. | 795 | ||
| Large-Volume Infusions. | 796 | ||
| Intravenous Bolus. | 796 | ||
| Volume-Controlled Infusions. | 796 | ||
| Volume-Control Administration. | 796 | ||
| Piggyback. | 796 | ||
| Tandem. | 804 | ||
| Mini-Infusion Pump. | 804 | ||
| Intermittent Venous Access. | 804 | ||
| Administration of IV Therapy in the Home. | 810 | ||
| Subcutaneous Butterfly Catheters. | 810 | ||
| Key Concepts | 812 | ||
| Critical Thinking Exercises | 812 | ||
| Review Questions | 812 | ||
| Recommended Websites | 813 | ||
| References | 813 | ||
| 35 Complementary and Alternative Approaches in Health Care | 815 | ||
| Objectives | 815 | ||
| Key Terms | 815 | ||
| Media Resources | 815 | ||
| Complementary, Alternative, and Integrative Approaches in Health Care | 816 | ||
| Public Interest in Complementary and Alternative Medicine Approaches | 817 | ||
| Complementary and Alternative Medicine Approaches and Holistic Nursing | 819 | ||
| Nursing-Accessible Approaches | 820 | ||
| Relaxation Therapy | 821 | ||
| Clinical Applications of Relaxation Therapy. | 821 | ||
| Meditation and Breathing | 821 | ||
| Clinical Applications of Meditation. | 821 | ||
| Imagery | 821 | ||
| Clinical Applications of Imagery. | 821 | ||
| Complementary and Alternative Medicine Approaches Requiring Education | 822 | ||
| Biofeedback | 822 | ||
| Clinical Applications of Biofeedback. | 822 | ||
| Therapeutic Touch and Healing Touch | 822 | ||
| Clinical Applications of Therapeutic Touch and Healing Touch. | 822 | ||
| Chiropractic Medicine | 822 | ||
| Clinical Applications of Chiropractic Therapy. | 822 | ||
| Traditional Chinese Medicine | 822 | ||
| Naturopathic Medicine | 823 | ||
| Clinical Applications of Naturopathic Medicine. | 823 | ||
| Acupuncture | 823 | ||
| Clinical Applications of Acupuncture. | 823 | ||
| Cupping | 823 | ||
| Massage Therapy | 823 | ||
| Clinical Applications of Massage Therapy. | 823 | ||
| Health Promotion: Nutrition in Disease Prevention | 824 | ||
| Botanicals/Natural Health Products | 824 | ||
| Clinical Applications of Botanicals/Natural Health Products. | 825 | ||
| Limitations of Botanicals/Natural Health Products. | 825 | ||
| Nursing Role for Interprofessional Collaboration in CAM | 826 | ||
| Key Concepts | 828 | ||
| Critical Thinking Exercises | 828 | ||
| Review Questions | 828 | ||
| Recommended Websites | 829 | ||
| References | 829 | ||
| Unit VIII Basic Physiological Needs | 832 | ||
| 36 Activity and Exercise | 832 | ||
| Objectives | 832 | ||
| Key Terms | 832 | ||
| Media Resources | 832 | ||
| Scientific Knowledge Base | 833 | ||
| Overview of Exercise and Activity | 833 | ||
| Body Alignment. | 833 | ||
| Body Balance. | 833 | ||
| Friction. | 833 | ||
| Exercise and Activity. | 833 | ||
| Regulation of Movement | 834 | ||
| Skeletal System. | 834 | ||
| Joints. | 834 | ||
| Ligaments, Tendons, and Cartilage. | 834 | ||
| Skeletal Muscle. | 835 | ||
| Muscle Groups. | 836 | ||
| Nervous System. | 836 | ||
| Proprioception. | 836 | ||
| Balance. | 836 | ||
| Principles of Body Mechanics, Safe Patient Transfer, and Positioning Techniques | 836 | ||
| Pathological Influences on Body Mechanics and Movement | 836 | ||
| Congenital Abnormalities. | 837 | ||
| Disorders of Bones, Joints, and Muscles. | 837 | ||
| Central Nervous System Damage and Disorders. | 837 | ||
| Musculoskeletal Trauma. | 837 | ||
| Other Chronic Diseases. | 837 | ||
| Nursing Knowledge Base | 837 | ||
| Deconditioning | 837 | ||
| Safety Guidelines for Nursing Skills | 838 | ||
| Safe Patient Handling | 839 | ||
| Transfer Techniques. | 847 | ||
| Factors Influencing Activity and Exercise | 848 | ||
| Developmental Changes. | 848 | ||
| Infants Through School-Aged Children. | 848 | ||
| Adolescence. | 848 | ||
| Young to Middle-Aged Adults. | 848 | ||
| Older Persons. | 848 | ||
| Behavioural Aspects. | 850 | ||
| Environmental Issues | 852 | ||
| Work Sites. | 852 | ||
| Schools. | 852 | ||
| Community. | 852 | ||
| Cultural and Ethnic Influences. | 852 | ||
| Family and Social Support | 852 | ||
| Critical Thinking | 852 | ||
| Nursing Process | 853 | ||
| Assessment | 853 | ||
| Patient Expectations | 853 | ||
| Body Alignment | 854 | ||
| Standing. | 854 | ||
| Mobility | 854 | ||
| Range of Motion. | 854 | ||
| Gait. | 854 | ||
| Exercise and Activity. | 854 | ||
| Activity Tolerance. | 854 | ||
| Nursing Diagnosis | 855 | ||
| Planning | 855 | ||
| Goals and Outcomes | 855 | ||
| Setting Priorities | 856 | ||
| Teamwork and Collaboration | 856 | ||
| Implementation | 856 | ||
| Health Promotion | 856 | ||
| Body Mechanics. | 859 | ||
| Acute Care | 859 | ||
| Musculoskeletal System. | 859 | ||
| Joint Mobility. | 861 | ||
| Walking. | 861 | ||
| Helping a Patient Walk | 861 | ||
| Restorative and Continuing Care | 861 | ||
| Assistive Devices for Walking | 862 | ||
| Walkers. | 862 | ||
| Canes. | 863 | ||
| Crutches. | 863 | ||
| Measuring for Crutches. | 864 | ||
| Crutch Gait. | 864 | ||
| Crutch Walking on Stairs. | 865 | ||
| Sitting in a Chair With Crutches. | 865 | ||
| Restoration of Activity and Chronic Illness | 866 | ||
| Coronary Heart Disease (CHD). | 866 | ||
| Hypertension. | 867 | ||
| Chronic Obstructive Pulmonary Disease (COPD). | 867 | ||
| Diabetes Mellitus. | 867 | ||
| Evaluation | 867 | ||
| Patient Expectations. | 867 | ||
| Patient Outcomes. | 868 | ||
| Key Concepts | 868 | ||
| Critical Thinking Exercises | 868 | ||
| Review Questions | 868 | ||
| Recommended Websites | 869 | ||
| References | 870 | ||
| 37 Quality and Patient Safety | 872 | ||
| Objectives | 872 | ||
| Key Terms | 872 | ||
| Media Resources | 872 | ||
| Scientific Knowledge Base | 873 | ||
| Factors Influencing Safety | 873 | ||
| Patient and Provider Factors. | 873 | ||
| Task Factors. | 873 | ||
| Technology Factors. | 873 | ||
| Environmental Factors. | 873 | ||
| Organizational Factors. | 874 | ||
| Systems Thinking and Quality Improvement | 874 | ||
| Safety Analysis or Safety Improvement Techniques. | 874 | ||
| Human Factors. | 874 | ||
| Interdisciplinary Teamwork, Communication and Feedback Skills. | 875 | ||
| Nursing Knowledge Base | 875 | ||
| Risks in Health Care Settings | 875 | ||
| Staff Safety | 875 | ||
| Environmental Risk. | 875 | ||
| Infection Prevention and Control. | 875 | ||
| Violence. | 875 | ||
| Patient Safety. | 875 | ||
| Falls. | 875 | ||
| Procedure-Related Accidents. | 876 | ||
| Equipment-Related Accidents. | 877 | ||
| Risks at Developmental Stages | 877 | ||
| Infants and Children. | 877 | ||
| Adolescents. | 877 | ||
| Adults. | 877 | ||
| Older Persons. | 877 | ||
| Individual Risk Factors | 878 | ||
| Impaired Mobility. | 878 | ||
| Sensory or Communication Impairment. | 878 | ||
| Lack of Safety Awareness. | 878 | ||
| Critical Thinking | 878 | ||
| Safety and the Nursing Process | 878 | ||
| Assessment | 878 | ||
| Health History. | 878 | ||
| Patient’s Home Environment. | 879 | ||
| Health Care Environment. | 879 | ||
| Risk for Falls. | 879 | ||
| Risk for Medical Errors. | 879 | ||
| Patient Expectations. | 880 | ||
| Nursing Diagnosis | 880 | ||
| Planning | 880 | ||
| Goals and Outcomes. | 880 | ||
| Setting Priorities. | 882 | ||
| Continuity of Care. | 883 | ||
| Implementation | 883 | ||
| Health Promotion. | 883 | ||
| Developmental Interventions. | 883 | ||
| Infants, Toddlers, and Preschoolers. | 883 | ||
| School-Aged Children. | 883 | ||
| Adolescents. | 886 | ||
| Adults. | 886 | ||
| Older Persons. | 886 | ||
| Environmental Interventions. | 887 | ||
| Other Environmental Interventions. | 887 | ||
| Limiting Specific Risks to Patient Safety | 888 | ||
| Falls. | 888 | ||
| Restraints. | 888 | ||
| Side Rails. | 897 | ||
| Electrical Hazards. | 898 | ||
| Evaluation | 898 | ||
| Patient Care. | 898 | ||
| Patient Expectations | 898 | ||
| Key Concepts | 899 | ||
| Critical Thinking Exercises | 899 | ||
| Review Questions | 899 | ||
| Recommended Websites | 900 | ||
| References | 900 | ||
| 38 Hygiene | 902 | ||
| Objectives | 902 | ||
| Key Terms | 902 | ||
| Media Resources | 902 | ||
| Scientific Knowledge Base | 902 | ||
| The Skin | 903 | ||
| The Feet, Hands, and Nails | 903 | ||
| The Oral Cavity | 903 | ||
| The Hair | 904 | ||
| The Eyes, Ears, and Nose | 904 | ||
| Nursing Knowledge Base | 904 | ||
| Social Practices | 904 | ||
| Personal Preferences | 905 | ||
| Body Image | 905 | ||
| Socioeconomic Status | 905 | ||
| Health Beliefs and Motivation | 905 | ||
| Cultural Variables | 905 | ||
| Physical Condition | 905 | ||
| Critical Thinking | 905 | ||
| Nursing Process | 906 | ||
| Assessment | 906 | ||
| Physical Examination. | 906 | ||
| The Skin. | 906 | ||
| The Feet and Nails. | 906 | ||
| The Oral Cavity. | 908 | ||
| The Hair. | 908 | ||
| The Eyes, Ears, and Nose. | 908 | ||
| Developmental Changes. | 911 | ||
| The Skin. | 911 | ||
| The Feet and Nails. | 911 | ||
| The Oral Cavity. | 911 | ||
| The Eyes, Ears, and Nose. | 911 | ||
| Use of Sensory Aids. | 911 | ||
| Self-Care Ability. | 911 | ||
| Hygiene Practices. | 912 | ||
| Cultural Factors. | 912 | ||
| Patients at Risk for Hygiene Problems. | 912 | ||
| Special Considerations in Hygiene Assessment. | 913 | ||
| Patient Expectations. | 914 | ||
| Nursing Diagnosis | 914 | ||
| Planning | 915 | ||
| Goals and Outcomes. | 915 | ||
| Setting Priorities. | 917 | ||
| Continuity of Care. | 917 | ||
| Implementation | 917 | ||
| Health Promotion. | 917 | ||
| Acute and Restorative Care. | 917 | ||
| Bathing and Skin Care | 917 | ||
| Bag Baths. | 926 | ||
| Perineal Care. | 926 | ||
| Back Rub. | 926 | ||
| Foot and Nail Care. | 926 | ||
| Oral Hygiene | 930 | ||
| Brushing and Flossing. | 930 | ||
| Flossing. | 931 | ||
| Patients With Special Needs. | 931 | ||
| Denture Care. | 931 | ||
| Hair and Scalp Care | 935 | ||
| Brushing and Combing. | 936 | ||
| Shampooing. | 937 | ||
| Shaving. | 937 | ||
| Moustache and Beard Care | 937 | ||
| Care of the Eyes, Ears, and Nose | 937 | ||
| Basic Eye Care. | 937 | ||
| Eyeglasses. | 939 | ||
| Contact Lenses. | 939 | ||
| Artificial Eyes. | 939 | ||
| Ear Care. | 940 | ||
| Hearing Aid Care. | 940 | ||
| Nasal Care. | 940 | ||
| Patient’s Room Environment | 941 | ||
| Maintaining Comfort. | 941 | ||
| Room Equipment. | 941 | ||
| Beds. | 942 | ||
| Bed making. | 943 | ||
| Linens. | 948 | ||
| Evaluation | 949 | ||
| Patient Care. | 949 | ||
| Patient Expectations. | 950 | ||
| Key Concepts | 950 | ||
| Critical Thinking Exercises | 950 | ||
| Review Questions | 950 | ||
| Recommended Websites | 951 | ||
| References | 951 | ||
| 39 Cardiopulmonary Functioning and Oxygenation | 953 | ||
| Objectives | 953 | ||
| Key Terms | 953 | ||
| Media Resources | 953 | ||
| Scientific Knowledge Base | 954 | ||
| Cardiovascular Physiology | 954 | ||
| Structure and Function. | 954 | ||
| Myocardial Pump. | 954 | ||
| Myocardial Blood Flow. | 954 | ||
| Coronary Artery Circulation. | 954 | ||
| Systemic Circulation. | 954 | ||
| Blood Flow Regulation. | 954 | ||
| Conduction System. | 955 | ||
| Respiratory Physiology | 956 | ||
| Structure and Function. | 956 | ||
| Work of Breathing. | 957 | ||
| Lung Volumes and Capacities. | 957 | ||
| Pulmonary Circulation. | 957 | ||
| Respiratory Gas Exchange. | 958 | ||
| Oxygen Transport. | 958 | ||
| Carbon Dioxide Transport. | 958 | ||
| Regulation of Respiration. | 958 | ||
| Factors Affecting Oxygenation | 958 | ||
| Physiological Factors. | 958 | ||
| Decreased Oxygen-Carrying Capacity. | 958 | ||
| Decreased Inspired Oxygen Concentration. | 959 | ||
| Hypovolemia. | 959 | ||
| Increased Metabolic Rate. | 959 | ||
| Conditions Affecting Chest Wall Movement. | 959 | ||
| Pregnancy. | 959 | ||
| Obesity. | 959 | ||
| Musculoskeletal Abnormalities. | 960 | ||
| Trauma. | 960 | ||
| Neuromuscular Diseases. | 960 | ||
| Central Nervous System Alterations. | 960 | ||
| Influences of Chronic Disease. | 960 | ||
| Alterations in Cardiac Functioning | 960 | ||
| Disturbances in Conduction. | 960 | ||
| Altered Cardiac Output. | 960 | ||
| Left-Sided Heart Failure. | 961 | ||
| Right-Sided Heart Failure. | 961 | ||
| Impaired Valvular Function. | 962 | ||
| Myocardial Ischemia. | 962 | ||
| Angina Pectoris. | 963 | ||
| Myocardial Infarction. | 963 | ||
| Acute Coronary Syndrome. | 964 | ||
| Alterations in Respiratory Functioning | 964 | ||
| Hyperventilation. | 964 | ||
| Hypoventilation. | 964 | ||
| Hypoxia. | 964 | ||
| Nursing Knowledge Base | 965 | ||
| Developmental Factors | 965 | ||
| Infants and Toddlers. | 965 | ||
| School-Aged Children and Adolescents. | 965 | ||
| Young and Middle-Aged Adults. | 965 | ||
| Older Persons. | 965 | ||
| Lifestyle Risk Factors | 965 | ||
| Poor Nutrition. | 966 | ||
| Inadequate Exercise. | 966 | ||
| Smoking. | 966 | ||
| Substance Abuse. | 966 | ||
| Stress. | 966 | ||
| Environmental Factors | 966 | ||
| Critical Thinking | 966 | ||
| Nursing Process | 967 | ||
| Assessment | 967 | ||
| Health History | 967 | ||
| Pain. | 967 | ||
| Fatigue. | 967 | ||
| Smoking. | 967 | ||
| Dyspnea. | 967 | ||
| Cough. | 968 | ||
| Wheezing. | 968 | ||
| Environmental or Geographical Exposures. | 968 | ||
| Respiratory Infections. | 968 | ||
| Allergies. | 969 | ||
| Health Risks. | 969 | ||
| Medications. | 969 | ||
| Physical Examination | 969 | ||
| Inspection. | 969 | ||
| Palpation. | 969 | ||
| Percussion. | 969 | ||
| Auscultation. | 969 | ||
| Diagnostic Tests | 971 | ||
| Patient Expectations | 971 | ||
| Nursing Diagnosis | 972 | ||
| Planning | 973 | ||
| Goals and Outcomes. | 973 | ||
| Setting Priorities. | 973 | ||
| Collaborative Care. | 973 | ||
| Implementation | 975 | ||
| Health Promotion | 975 | ||
| Vaccinations. | 977 | ||
| Healthy Lifestyle Behaviour. | 978 | ||
| Environmental Pollutants. | 978 | ||
| Acute Care | 979 | ||
| Dyspnea Management. | 979 | ||
| Airway Maintenance. | 979 | ||
| Mobilization of Pulmonary Secretions. | 979 | ||
| Humidification. | 979 | ||
| Nebulization. | 979 | ||
| Chest physiotherapy. | 979 | ||
| Suctioning Techniques. | 980 | ||
| Oropharyngeal and Nasopharyngeal Suctioning. | 980 | ||
| Orotracheal and Nasotracheal Suctioning. | 980 | ||
| Tracheal Suctioning. | 980 | ||
| Artificial Airways. | 989 | ||
| Oral Airway. | 989 | ||
| Endotracheal and Tracheal Airway. | 990 | ||
| Maintenance and Promotion of Lung Expansion. | 990 | ||
| Ambulation. | 990 | ||
| Positioning. | 990 | ||
| Incentive Spirometry. | 997 | ||
| Chest Tubes. | 998 | ||
| Special considerations. | 1002 | ||
| Maintenance and Promotion of Oxygenation. | 1002 | ||
| Oxygen Therapy. | 1002 | ||
| Safety precautions. | 1002 | ||
| Supply of Oxygen. | 1002 | ||
| Methods of Oxygen Delivery. | 1002 | ||
| Nasal cannula. | 1002 | ||
| Oxygen masks. | 1004 | ||
| Home Oxygen Therapy. | 1005 | ||
| Restoration of Cardiopulmonary Functioning. | 1005 | ||
| Cardiopulmonary Resuscitation. | 1005 | ||
| Restorative and Continuing Care | 1006 | ||
| Hydration. | 1006 | ||
| Coughing Techniques. | 1009 | ||
| Respiratory Muscle Training. | 1009 | ||
| Breathing Exercises. | 1009 | ||
| Pursed-Lip Breathing. | 1009 | ||
| Diaphragmatic Breathing. | 1009 | ||
| Evaluation | 1010 | ||
| Patient Care. | 1010 | ||
| Patient Expectations. | 1010 | ||
| Key Concepts | 1010 | ||
| Critical Thinking Exercises | 1011 | ||
| Review Questions | 1011 | ||
| Recommended Websites | 1012 | ||
| References | 1012 | ||
| 40 Fluid, Electrolyte, and Acid–Base Balances | 1015 | ||
| Objectives | 1015 | ||
| Key Terms | 1015 | ||
| Media Resources | 1016 | ||
| Scientific Knowledge Base | 1016 | ||
| Distribution of Body Fluids | 1016 | ||
| Composition of Body Fluids | 1016 | ||
| Movement of Water and Electrolytes | 1017 | ||
| Osmosis. | 1017 | ||
| Diffusion. | 1017 | ||
| Active Transport. | 1017 | ||
| Filtration. | 1018 | ||
| Fluid Homeostasis | 1018 | ||
| Fluid Output Regulation. | 1018 | ||
| Fluid Intake Regulation. | 1019 | ||
| Hormonal Regulation of Fluid | 1019 | ||
| Regulation of Electrolytes | 1019 | ||
| Cations. | 1019 | ||
| Sodium Regulation. | 1019 | ||
| Potassium Regulation. | 1020 | ||
| Calcium Regulation. | 1020 | ||
| Magnesium Regulation. | 1020 | ||
| Anions. | 1020 | ||
| Chloride Regulation. | 1020 | ||
| Bicarbonate Regulation. | 1020 | ||
| Phosphate Regulation. | 1020 | ||
| Regulation of Acid–Base Balance | 1021 | ||
| Buffers. | 1021 | ||
| Regulatory Mechanisms. | 1021 | ||
| Disturbances in Electrolyte, Fluid, and Acid–Base Balances | 1021 | ||
| Fluid Disturbances. | 1021 | ||
| Electrolyte Imbalances. | 1023 | ||
| Sodium Imbalances. | 1023 | ||
| Potassium Imbalances. | 1023 | ||
| Calcium Imbalances. | 1024 | ||
| Magnesium Imbalances. | 1024 | ||
| Chloride Imbalances. | 1024 | ||
| Acid–Base Balance. | 1024 | ||
| Measurements of Acidity or Alkalinity of Fluids. | 1025 | ||
| Paco2. | 1025 | ||
| PaO2. | 1025 | ||
| Oxygen Saturation. | 1025 | ||
| Base Excess. | 1025 | ||
| Bicarbonate. | 1025 | ||
| Types of Acid–Base Imbalances | 1025 | ||
| Respiratory Acidosis. | 1025 | ||
| Respiratory Alkalosis. | 1025 | ||
| Metabolic Acidosis. | 1026 | ||
| Metabolic Alkalosis. | 1027 | ||
| Knowledge Base of Nursing Practice | 1027 | ||
| Critical Thinking | 1027 | ||
| Nursing Process | 1028 | ||
| Assessment | 1028 | ||
| Patient Expectations. | 1028 | ||
| Health History. | 1028 | ||
| Age. | 1028 | ||
| Environmental Factors. | 1028 | ||
| Diet. | 1028 | ||
| Lifestyle. | 1029 | ||
| Medication. | 1029 | ||
| Medical History | 1029 | ||
| Acute Illness. | 1029 | ||
| Burns. | 1029 | ||
| Respiratory disorders. | 1030 | ||
| Gastrointestinal disturbances. | 1030 | ||
| Trauma. | 1030 | ||
| Head injury. | 1030 | ||
| Recent surgery. | 1030 | ||
| Chronic Illness. | 1031 | ||
| Cancer. | 1031 | ||
| Cardiovascular disease. | 1031 | ||
| Renal disorders. | 1031 | ||
| Gastrointestinal disorders. | 1031 | ||
| Physical Assessment. | 1031 | ||
| Assessing Fluid Intake and Output. | 1031 | ||
| Laboratory Studies. | 1033 | ||
| Arterial Blood Gases. | 1033 | ||
| Patient Expectations. | 1033 | ||
| Nursing Diagnosis | 1033 | ||
| Planning | 1033 | ||
| Goals and Outcomes. | 1033 | ||
| Setting Priorities. | 1034 | ||
| Teamwork and Collaboration. | 1034 | ||
| Infusion Therapy Team. | 1034 | ||
| Implementation | 1034 | ||
| Health Promotion. | 1034 | ||
| Acute Care. | 1037 | ||
| Enteral Replacement of Fluids. | 1037 | ||
| Restriction of Fluids. | 1038 | ||
| Interventions for Acid–Base Imbalances. | 1038 | ||
| Parenteral Replacement of Fluids and Electrolytes. | 1038 | ||
| Types of solutions. | 1038 | ||
| Vascular Access Devices. | 1038 | ||
| Peripheral vascular access devices: Nursing considerations. | 1040 | ||
| Central vascular access devices: Nursing considerations. | 1050 | ||
| Administration of Intravenous Therapy | 1052 | ||
| Types of solutions. | 1052 | ||
| Equipment. | 1052 | ||
| Initiating an intravenous line. | 1052 | ||
| Venipuncture site. | 1053 | ||
| Regulating the infusion flow rate. | 1053 | ||
| Maintaining the system. | 1057 | ||
| Complications of intravenous therapy. | 1064 | ||
| Discontinuing intravenous infusions. | 1064 | ||
| Safety and Quality Improvement. | 1064 | ||
| Blood Transfusion. | 1064 | ||
| Blood Groups and Types. | 1064 | ||
| Autologous Transfusion. | 1065 | ||
| Blood Transfusions. | 1065 | ||
| Transfusion Reactions and Complications. | 1066 | ||
| Restorative Care | 1066 | ||
| Home Intravenous Therapy. | 1066 | ||
| Nutritional Support. | 1066 | ||
| Medication Safety. | 1066 | ||
| Evaluation | 1066 | ||
| Patient Expectations. | 1066 | ||
| Patient Outcomes. | 1068 | ||
| Key Concepts | 1068 | ||
| Critical Thinking Exercises | 1069 | ||
| Review Questions | 1069 | ||
| Recommended Websites | 1069 | ||
| References | 1070 | ||
| 41 Sleep | 1072 | ||
| Objectives | 1072 | ||
| Key Terms | 1072 | ||
| Media Resources | 1072 | ||
| Scientific Knowledge Base | 1073 | ||
| Definition of Sleep | 1073 | ||
| Physiology of Sleep | 1073 | ||
| Circadian Rhythms. | 1073 | ||
| Sleep Regulation. | 1073 | ||
| Stages of Sleep. | 1074 | ||
| Sleep Cycle. | 1074 | ||
| Functions of Sleep | 1075 | ||
| Dreams. | 1075 | ||
| Physical Illness | 1075 | ||
| Sleep Disorders | 1075 | ||
| Insomnia. | 1076 | ||
| Sleep Apnea. | 1076 | ||
| Narcolepsy. | 1077 | ||
| Parasomnias. | 1078 | ||
| Shift Work. | 1078 | ||
| Sleep Deprivation. | 1078 | ||
| Nursing Knowledge Base | 1079 | ||
| Sleep and Rest | 1079 | ||
| Normal Sleep Requirements and Patterns | 1079 | ||
| Neonates. | 1079 | ||
| Infants. | 1079 | ||
| Toddlers. | 1079 | ||
| Preschoolers. | 1079 | ||
| School-Aged Children. | 1080 | ||
| Adolescents. | 1080 | ||
| Young Adults. | 1080 | ||
| Middle-aged Adults. | 1080 | ||
| Older Persons. | 1080 | ||
| Factors Affecting Sleep | 1080 | ||
| Drugs and Substances. | 1080 | ||
| Lifestyle. | 1080 | ||
| Usual Sleep Patterns. | 1080 | ||
| Emotional Stress. | 1081 | ||
| Environment. | 1081 | ||
| Exercise and Fatigue. | 1081 | ||
| Food and Caloric Intake. | 1082 | ||
| Critical Thinking | 1082 | ||
| Nursing Process | 1082 | ||
| Assessment | 1082 | ||
| Sleep Assessment | 1082 | ||
| Sources for Sleep Assessment. | 1082 | ||
| Tools for Sleep Assessment. | 1083 | ||
| Sleep History | 1083 | ||
| Description of Sleeping Problems. | 1083 | ||
| Usual Sleep Pattern. | 1083 | ||
| Physical and Psychological Illness. | 1084 | ||
| Current Life Events. | 1084 | ||
| Bedtime Routines. | 1084 | ||
| Bedroom Environment. | 1084 | ||
| Behaviours of Sleep Deprivation. | 1085 | ||
| Patient Expectations | 1085 | ||
| Nursing Diagnosis | 1085 | ||
| Planning | 1086 | ||
| Goals and Outcomes. | 1086 | ||
| Setting Priorities. | 1086 | ||
| Collaborative Care. | 1086 | ||
| Implementation | 1086 | ||
| Health Promotion | 1086 | ||
| Environmental Controls. | 1088 | ||
| Promoting Bedtime Routines. | 1088 | ||
| Promoting Safety. | 1090 | ||
| Promoting Comfort. | 1090 | ||
| Establishing Periods of Rest and Sleep. | 1090 | ||
| Stress Reduction. | 1090 | ||
| Bedtime Snacks. | 1090 | ||
| Pharmacological Approaches. | 1090 | ||
| Acute Care | 1091 | ||
| Environmental Controls. | 1091 | ||
| Promoting Comfort. | 1091 | ||
| Establishing Periods of Rest and Sleep. | 1091 | ||
| Promoting Safety. | 1092 | ||
| Stress Reduction. | 1092 | ||
| Restorative or Continuing Care | 1092 | ||
| Promoting Comfort. | 1092 | ||
| Controlling Physiological Disturbances. | 1092 | ||
| Pharmacological Approaches. | 1092 | ||
| Evaluation | 1093 | ||
| Key Concepts | 1093 | ||
| Critical Thinking Exercises | 1094 | ||
| Review Questions | 1094 | ||
| Recommended Websites | 1095 | ||
| References | 1095 | ||
| 42 Nutrition | 1097 | ||
| Objectives | 1097 | ||
| Key Terms | 1097 | ||
| Media Resources | 1098 | ||
| Scientific Knowledge Base | 1098 | ||
| Nutrients: the Biochemical Units of Nutrition | 1098 | ||
| Carbohydrates. | 1099 | ||
| Proteins. | 1099 | ||
| Fats. | 1100 | ||
| Water. | 1100 | ||
| Vitamins. | 1100 | ||
| Fat-Soluble Vitamins. | 1100 | ||
| Water-Soluble Vitamins. | 1101 | ||
| Minerals. | 1101 | ||
| Anatomy and Physiology of the Digestive System | 1101 | ||
| Digestion. | 1101 | ||
| Absorption. | 1102 | ||
| Metabolism and Storage of Nutrients. | 1102 | ||
| Elimination. | 1103 | ||
| Dietary Guidelines | 1103 | ||
| Dietary Reference Intakes. | 1103 | ||
| Food Guidelines. | 1103 | ||
| The Nutrition Label. | 1106 | ||
| Health Promotion and Disease Prevention: A Call to Action from Dietitians. | 1106 | ||
| Nursing Knowledge Base | 1106 | ||
| Nutrition During Human Growth and Development | 1106 | ||
| Infants Through School-Aged Children. | 1106 | ||
| Breastfeeding. | 1107 | ||
| Formula. | 1107 | ||
| Introduction to Solid Food. | 1107 | ||
| Adolescents. | 1108 | ||
| Young and Middle-Aged Adults. | 1109 | ||
| Pregnancy. | 1109 | ||
| Lactation. | 1110 | ||
| Older Persons. | 1110 | ||
| Alternative Food Patterns | 1111 | ||
| Vegetarian Diet. | 1111 | ||
| Critical Thinking | 1112 | ||
| Nursing Process and Nutrition | 1112 | ||
| Assessment | 1112 | ||
| Anthropometry. | 1113 | ||
| Laboratory and Biochemical Tests. | 1114 | ||
| Dietary History and Health History. | 1114 | ||
| Clinical Observation and Physical Examination. | 1114 | ||
| Patient Expectations. | 1119 | ||
| Nursing Diagnosis | 1119 | ||
| Planning | 1119 | ||
| Goals and Outcomes. | 1119 | ||
| Setting Priorities. | 1120 | ||
| Continuity of Care. | 1120 | ||
| Diet Planning. | 1120 | ||
| Example of Diabetic Meal Planning. | 1120 | ||
| Implementation | 1120 | ||
| Chronic Disease, Nutrition, and Prevention. | 1120 | ||
| Health Promotion/Illness Prevention. | 1124 | ||
| Acute Care. | 1125 | ||
| Promoting Appetite. | 1125 | ||
| Assisting Patients With Feeding | 1126 | ||
| Before Feeding. | 1126 | ||
| During Feeding. | 1128 | ||
| After Feeding. | 1128 | ||
| Restorative and Continuing Care | 1128 | ||
| Evaluation | 1129 | ||
| Patient Care. | 1129 | ||
| Patient Expectations. | 1129 | ||
| Self-Monitoring of Blood Glucose | 1129 | ||
| Enteral Tube Feeding | 1135 | ||
| Initiating Enteral Tube Feedings | 1141 | ||
| Preventing Complications | 1148 | ||
| Large-Bore Tube and Nasogastric or Orogastric Suctioning | 1149 | ||
| Medication | 1149 | ||
| Parenteral Nutrition | 1149 | ||
| Initiating Parenteral Nutrition | 1156 | ||
| Preventing Complications | 1157 | ||
| Key Concepts | 1157 | ||
| Critical Thinking Exercises | 1159 | ||
| Review Questions | 1159 | ||
| Recommended Websites | 1160 | ||
| References | 1160 | ||
| 43 Urinary Elimination | 1166 | ||
| Objectives | 1166 | ||
| Key Terms | 1166 | ||
| Media Resources | 1166 | ||
| Scientific Knowledge Base | 1166 | ||
| Upper Urinary Tract | 1166 | ||
| Kidneys. | 1166 | ||
| Ureters. | 1167 | ||
| Lower Urinary Tract | 1167 | ||
| Bladder. | 1167 | ||
| Urethra. | 1167 | ||
| Act of Urination | 1167 | ||
| Factors Influencing Urination | 1168 | ||
| Common Alterations in Urinary Elimination | 1168 | ||
| Urinary Tract Infections. | 1168 | ||
| Urinary Incontinence and Other Lower Urinary Tract Symptoms. | 1169 | ||
| Nocturia. | 1169 | ||
| Urinary Retention. | 1169 | ||
| Urinary Diversions. | 1171 | ||
| Renal Failure. | 1171 | ||
| Nursing Knowledge Base | 1172 | ||
| Infection Control and Hygiene | 1172 | ||
| Growth and Development | 1172 | ||
| Psychosocial and Cultural Considerations | 1172 | ||
| Critical Thinking | 1173 | ||
| Nursing Process and Alterations in Urinary Function | 1173 | ||
| Assessment | 1173 | ||
| Health History. | 1173 | ||
| Pattern of Urination. | 1174 | ||
| Factors Affecting Urination. | 1174 | ||
| Physical Assessment. | 1174 | ||
| Skin and Mucosal Membranes. | 1174 | ||
| Kidneys. | 1174 | ||
| Bladder. | 1174 | ||
| The Female Perineum. | 1175 | ||
| The Male Perineum. | 1175 | ||
| Assessment of Urine. | 1176 | ||
| Intake and Output. | 1176 | ||
| Characteristics of Urine. | 1176 | ||
| Colour. | 1176 | ||
| Clarity. | 1176 | ||
| Odour. | 1177 | ||
| Urine Testing. | 1177 | ||
| Specimen collection. | 1177 | ||
| Urine collection in children. | 1177 | ||
| Common Urine Tests | 1177 | ||
| Urinalysis. | 1177 | ||
| Specific gravity. | 1177 | ||
| Urine culture. | 1180 | ||
| Diagnostic Examinations. | 1180 | ||
| Patient Expectations. | 1180 | ||
| Nursing Diagnosis | 1181 | ||
| Planning | 1183 | ||
| Goals and Outcomes. | 1183 | ||
| Setting Priorities. | 1183 | ||
| Continuity of Care. | 1183 | ||
| Implementation | 1183 | ||
| Health Promotion. | 1185 | ||
| Patient Education. | 1185 | ||
| Promoting Regular Micturition. | 1185 | ||
| Stimulating micturition reflex. | 1186 | ||
| Maintaining elimination habits. | 1186 | ||
| Maintaining adequate fluid intake. | 1186 | ||
| Promoting Complete Bladder Emptying. | 1186 | ||
| Preventing Infection. | 1186 | ||
| Catheters and Incontinence Products. | 1187 | ||
| Special Considerations in Acute Care. | 1187 | ||
| Maintaining Elimination Habits. | 1187 | ||
| Catheterization. | 1188 | ||
| Types of catheterization. | 1189 | ||
| Catheter insertion. | 1189 | ||
| Closed drainage systems. | 1189 | ||
| Routine catheter care. | 1198 | ||
| Perineal hygiene. | 1198 | ||
| Catheter care. | 1198 | ||
| Fluid intake. | 1198 | ||
| Preventing infection. | 1198 | ||
| Catheter irrigations and instillations. | 1198 | ||
| Removal of in-dwelling catheter. | 1200 | ||
| Alternatives to Urethral Catheterization. | 1203 | ||
| Absorbent pads. | 1203 | ||
| Suprapubic catheterization. | 1203 | ||
| Condom catheters. | 1204 | ||
| Maintenance of Skin Integrity. | 1204 | ||
| Conservative Management to Promote Continence. | 1206 | ||
| Lifestyle Modification. | 1206 | ||
| Pelvic Floor Muscle Exercises and Training. | 1206 | ||
| Bladder Training. | 1206 | ||
| Prompted Voiding, Timed Toileting, and Habit Retraining. | 1207 | ||
| Intermittent Self-Catheterization. | 1207 | ||
| Pharmacological Strategies. | 1207 | ||
| Evaluation | 1208 | ||
| Patient Care. | 1208 | ||
| Patient Expectations. | 1208 | ||
| Key Concepts | 1208 | ||
| Critical Thinking Exercises | 1208 | ||
| Review Questions | 1209 | ||
| Recommended Websites | 1209 | ||
| References | 1209 | ||
| 44 Bowel Elimination | 1211 | ||
| Objectives | 1211 | ||
| Key Terms | 1211 | ||
| Media Resources | 1211 | ||
| Scientific Knowledge Base | 1211 | ||
| Mouth | 1212 | ||
| Esophagus | 1212 | ||
| Stomach | 1212 | ||
| Small Intestine | 1213 | ||
| Large Intestine | 1213 | ||
| Anus and Rectum | 1214 | ||
| Nursing Knowledge Base | 1214 | ||
| Process of Defecation | 1214 | ||
| Position During Defecation. | 1215 | ||
| Promotion of Normal Defecation. | 1215 | ||
| Sitting Position. | 1215 | ||
| Positioning on Bedpan. | 1215 | ||
| Factors Affecting Normal Bowel Elimination | 1216 | ||
| Diet. | 1216 | ||
| Fluid Intake. | 1216 | ||
| Physical Activity. | 1216 | ||
| Personal Bowel Elimination Habits. | 1217 | ||
| Privacy. | 1217 | ||
| Critical Thinking | 1217 | ||
| Nursing Process and Bowel Elimination | 1217 | ||
| Assessment | 1217 | ||
| Health History. | 1217 | ||
| Physical Assessment. | 1218 | ||
| Mouth. | 1218 | ||
| Abdomen. | 1218 | ||
| Rectum. | 1219 | ||
| Factors Related to Altered Patterns of Bowel Elimination | 1219 | ||
| Age-Related Changes. | 1219 | ||
| Infectious Disease. | 1219 | ||
| Irritable Bowel Syndrome. | 1219 | ||
| Inflammatory Bowel Disease. | 1220 | ||
| Diabetes. | 1220 | ||
| Pain. | 1220 | ||
| Pelvic Floor Trauma. | 1220 | ||
| Acute Illness, Surgery, and Anaesthesia. | 1220 | ||
| Enteral Feeding. | 1220 | ||
| Medications That Affect Elimination. | 1220 | ||
| Laboratory Tests. | 1220 | ||
| Fecal Specimens. | 1220 | ||
| Fecal characteristics. | 1222 | ||
| Diagnostic Examinations. | 1222 | ||
| Diagnostic Tests. | 1222 | ||
| Nursing Diagnosis | 1224 | ||
| Common Bowel Elimination Problems. | 1224 | ||
| Constipation. | 1224 | ||
| Impaction. | 1225 | ||
| Diarrhea. | 1226 | ||
| Incontinence. | 1226 | ||
| Flatulence. | 1226 | ||
| Hemorrhoids. | 1226 | ||
| Planning | 1227 | ||
| Goals and Outcomes. | 1227 | ||
| Setting Priorities. | 1227 | ||
| Continuity of Care. | 1227 | ||
| Implementation | 1227 | ||
| Patient Expectations. | 1227 | ||
| Management of Bowel Elimination. | 1229 | ||
| Maintenance of Proper Fluid and Food Intake. | 1229 | ||
| Promotion of Regular Exercise. | 1229 | ||
| Bowel Retraining. | 1229 | ||
| Hemorrhoids. | 1230 | ||
| Maintenance of Skin Integrity. | 1230 | ||
| Medications. | 1230 | ||
| Cathartics and laxatives. | 1230 | ||
| Electrolyte Balance and Antidiarrheal Agents. | 1230 | ||
| Rectal Suppositories. | 1230 | ||
| Enemas. | 1230 | ||
| Cleansing enemas. | 1230 | ||
| Tap water. | 1232 | ||
| Normal saline. | 1232 | ||
| Hypertonic solutions. | 1232 | ||
| Soapsuds. | 1232 | ||
| Oil-Retention Enemas. | 1232 | ||
| Other Types of Enemas. | 1232 | ||
| Enema Administration. | 1232 | ||
| Surgical Management of Bowel Elimination | 1232 | ||
| Inserting and Maintaining a Nasogastric Tube. | 1232 | ||
| Bowel Diversions. | 1236 | ||
| Ostomies. | 1236 | ||
| Loop colostomy. | 1236 | ||
| End colostomy. | 1236 | ||
| Double-barrel colostomy. | 1236 | ||
| Kock continent ileostomy. | 1236 | ||
| Psychological Considerations. | 1237 | ||
| Care of Ostomies. | 1237 | ||
| Irrigating a Colostomy. | 1237 | ||
| Pouching Ostomies. | 1238 | ||
| Nutritional Considerations for Patients With Ostomies. | 1239 | ||
| Evaluation | 1242 | ||
| Patient Care. | 1242 | ||
| Patient Expectations. | 1242 | ||
| Key Concepts | 1242 | ||
| Critical Thinking Exercises | 1243 | ||
| Review Questions | 1243 | ||
| Recommended Websites | 1244 | ||
| References | 1244 | ||
| Unit IX Patients With Special Needs | 1246 | ||
| 45 Mobility and Immobility | 1246 | ||
| Objectives | 1246 | ||
| Key Terms | 1246 | ||
| Media Resources | 1246 | ||
| Scientific Knowledge Base | 1247 | ||
| Nature of Movement | 1247 | ||
| Alignment and Balance. | 1247 | ||
| Gravity and Friction. | 1247 | ||
| Pathological Influences on Mobility | 1247 | ||
| Postural Abnormalities. | 1247 | ||
| Impaired Muscle Development. | 1247 | ||
| Damage to the Central Nervous System. | 1247 | ||
| Direct Trauma to the Musculoskeletal System. | 1248 | ||
| Nursing Knowledge Base | 1249 | ||
| Mobility–Immobility | 1249 | ||
| Factors Influencing Mobility–Immobility. | 1249 | ||
| Systemic Effects of Immobility. | 1249 | ||
| Metabolic Changes. | 1249 | ||
| Respiratory Changes. | 1250 | ||
| Cardiovascular Changes. | 1250 | ||
| Musculoskeletal Changes. | 1250 | ||
| Muscle effects. | 1251 | ||
| Skeletal effects. | 1251 | ||
| Urinary Elimination Changes. | 1252 | ||
| Integumentary Changes. | 1252 | ||
| Psychosocial Effects of Immobility. | 1252 | ||
| Developmental Changes. | 1252 | ||
| Infants, Toddlers, and Preschoolers. | 1252 | ||
| Adolescents. | 1253 | ||
| Adults. | 1253 | ||
| Older Persons. | 1253 | ||
| Critical Thinking | 1253 | ||
| Nursing Process | 1253 | ||
| Assessment | 1253 | ||
| Patient Expectations. | 1254 | ||
| Mobility. | 1254 | ||
| Range of Motion. | 1254 | ||
| Gait. | 1254 | ||
| Exercise and Activity Tolerance. | 1258 | ||
| Body Alignment. | 1259 | ||
| Standing. | 1259 | ||
| Sitting. | 1259 | ||
| Lying. | 1260 | ||
| Immobility | 1260 | ||
| Physiological Assessment. | 1260 | ||
| Metabolic system. | 1260 | ||
| Respiratory system. | 1260 | ||
| Cardiovascular system. | 1261 | ||
| Musculoskeletal system. | 1261 | ||
| Integumentary system. | 1262 | ||
| Elimination system. | 1262 | ||
| Psychosocial Assessment. | 1262 | ||
| Developmental Assessment. | 1263 | ||
| Patient Expectations | 1263 | ||
| Nursing Diagnosis | 1263 | ||
| Planning | 1263 | ||
| Goals and Outcomes. | 1264 | ||
| Setting Priorities. | 1264 | ||
| Teamwork and Collaboration. | 1264 | ||
| Implementation | 1264 | ||
| Health Promotion. | 1264 | ||
| Prevention of Work-Related Musculoskeletal Injuries. | 1266 | ||
| Exercise. | 1267 | ||
| Acute Care | 1267 | ||
| Metabolic System. | 1267 | ||
| Respiratory System. | 1267 | ||
| Promoting Expansion of the Chest and Lungs. | 1267 | ||
| Preventing Stasis of Pulmonary Secretions. | 1267 | ||
| Maintaining a Patent Airway. | 1267 | ||
| Cardiovascular System. | 1267 | ||
| Reducing Orthostatic Hypotension. | 1267 | ||
| Reducing Cardiac Workload. | 1268 | ||
| Preventing Thrombus Formation. | 1268 | ||
| Musculoskeletal System. | 1269 | ||
| Elimination System. | 1270 | ||
| Integumentary System. | 1270 | ||
| Psychosocial Changes. | 1270 | ||
| Developmental Changes in Children. | 1270 | ||
| Positioning Devices and Techniques. | 1271 | ||
| Supported Fowler’s Position. | 1272 | ||
| Supine Position. | 1280 | ||
| Prone Position. | 1281 | ||
| Side-Lying Position. | 1281 | ||
| Sims’ Position. | 1281 | ||
| Transfer Techniques. | 1281 | ||
| Repositioning Patients. | 1281 | ||
| Restorative Care | 1282 | ||
| Range-of-Motion (ROM) Exercises. | 1282 | ||
| Evaluation | 1284 | ||
| Patient Care. | 1284 | ||
| Patient Expectations. | 1285 | ||
| Key Concepts | 1285 | ||
| Critical Thinking Exercises | 1285 | ||
| Review Questions | 1285 | ||
| Recommended Websites | 1287 | ||
| References | 1287 | ||
| 46 Skin Integrity and Wound Care | 1288 | ||
| Objectives | 1288 | ||
| Key Terms | 1288 | ||
| Media Resources | 1288 | ||
| Scientific Knowledge Base | 1289 | ||
| Skin | 1289 | ||
| Pressure Injury | 1289 | ||
| Pathogenesis of Pressure Injury. | 1290 | ||
| Pressure Intensity. | 1290 | ||
| Pressure Duration. | 1291 | ||
| Tissue Tolerance. | 1291 | ||
| Nursing Knowledge Base | 1291 | ||
| Prediction and Prevention of Pressure Injury | 1291 | ||
| Risk Factors for Pressure Injury Development. | 1291 | ||
| Impaired Sensory Perception. | 1292 | ||
| Impaired Mobility. | 1292 | ||
| Alteration in Level of Consciousness. | 1292 | ||
| Shear. | 1292 | ||
| Friction. | 1292 | ||
| Moisture. | 1292 | ||
| Nutrition. | 1292 | ||
| Tissue Perfusion. | 1292 | ||
| Infection. | 1292 | ||
| Pain. | 1292 | ||
| Age. | 1292 | ||
| Psychosocial Impact of Wounds. | 1292 | ||
| Critical Thinking | 1293 | ||
| Nursing Process | 1295 | ||
| Assessment | 1295 | ||
| Skin | 1295 | ||
| Risk Assessment | 1295 | ||
| Braden Scale | 1295 | ||
| Case Example. | 1299 | ||
| Classification of Pressure Injury | 1299 | ||
| Wound Classifications | 1301 | ||
| Process of Wound Healing | 1301 | ||
| Wound Repair | 1302 | ||
| Partial-Thickness Wound Repair. | 1303 | ||
| Full-Thickness Wound Repair. | 1303 | ||
| Inflammatory Phase. | 1303 | ||
| Proliferative Phase. | 1303 | ||
| Remodelling. | 1303 | ||
| Skin Tears | 1303 | ||
| Venous and Arterial Wounds | 1304 | ||
| Venous Ulcers. | 1304 | ||
| Treatment of Venous Leg Ulcers. | 1304 | ||
| Arterial Ulcers. | 1304 | ||
| Diabetic Ulcers | 1304 | ||
| Assessment. | 1305 | ||
| Diabetic Wound Treatment. | 1305 | ||
| Malignant or Fungating Wounds | 1305 | ||
| Acute and Surgical Wounds | 1306 | ||
| Emergency Setting, or Acute, Wounds. | 1306 | ||
| Stable Setting, or Surgical Wounds. | 1306 | ||
| Wound Appearance. | 1306 | ||
| Character of Wound Drainage. | 1306 | ||
| Drains. | 1307 | ||
| Wound Closures. | 1307 | ||
| Palpation of the Wound. | 1307 | ||
| Wound Cultures. | 1308 | ||
| Complications of Wound Healing | 1308 | ||
| Hemorrhage. | 1308 | ||
| Infection. | 1309 | ||
| Dehiscence. | 1309 | ||
| Evisceration. | 1309 | ||
| Fistulas. | 1309 | ||
| Nursing Diagnosis | 1309 | ||
| Planning | 1310 | ||
| Goals and Outcomes | 1310 | ||
| Setting Priorities | 1310 | ||
| Collaborative Care | 1311 | ||
| Implementation: Preventing Skin Breakdown | 1311 | ||
| Health Promotion. | 1311 | ||
| Topical Skin Care. | 1311 | ||
| Positioning. | 1313 | ||
| Support Surfaces (Therapeutic Beds and Mattresses). | 1313 | ||
| Education. | 1313 | ||
| Management of Pressure Injury. | 1314 | ||
| Wound Management. | 1314 | ||
| Cleaning a Wound. | 1314 | ||
| Irrigation. | 1316 | ||
| Debridement. | 1317 | ||
| Growth Factors. | 1317 | ||
| Nutritional Status. | 1317 | ||
| Protein Status. | 1317 | ||
| Hemoglobin. | 1318 | ||
| Dressings | 1318 | ||
| Purposes of Dressings. | 1318 | ||
| Types of Dressings. | 1318 | ||
| Woven Gauze Dressings. | 1318 | ||
| Transparent Film Dressings. | 1322 | ||
| Nonadherent Contact Layer Dressings. | 1323 | ||
| Soft Silicone Dressings. | 1324 | ||
| Hydrocolloid Dressings. | 1324 | ||
| Hydrogel Dressings. | 1324 | ||
| Foam Dressings. | 1325 | ||
| Calcium Alginate Dressings. | 1325 | ||
| Composite Dressings. | 1325 | ||
| Topical Treatment for Infected Wounds. | 1325 | ||
| Hypertonic Dressings. | 1325 | ||
| Cadexomer Iodine. | 1325 | ||
| Silver Dressings. | 1325 | ||
| Honey (Medical-Grade Leptosperum Honey). | 1325 | ||
| Gentian Violet/Methylene Blue. | 1325 | ||
| Negative Pressure Wound Therapy. | 1325 | ||
| Changing Dressings. | 1326 | ||
| Clean or Sterile Technique. | 1326 | ||
| Preparing for Dressing Change (in Any Care Setting). | 1326 | ||
| Packing a Wound. | 1326 | ||
| Securing Dressings. | 1326 | ||
| Comfort Measures. | 1327 | ||
| Surgical or Traumatic Wound Considerations | 1327 | ||
| Basic Skin Cleaning for Surgical or Traumatic Wounds. | 1327 | ||
| Cleaning Skin and Drain Sites. | 1327 | ||
| Irrigation. | 1327 | ||
| Wound Irrigation. | 1327 | ||
| Sutures. | 1329 | ||
| Suture Removal. | 1330 | ||
| Drainage Evacuation. | 1330 | ||
| Bandages and Binders. | 1330 | ||
| Principles for Applying Bandages and Binders. | 1331 | ||
| Binder application. | 1331 | ||
| Abdominal binders. | 1331 | ||
| Bandage application. | 1331 | ||
| The Whole Person, the Whole Team | 1331 | ||
| Case Study. | 1331 | ||
| Evaluation | 1331 | ||
| Key Concepts | 1335 | ||
| Critical Thinking Exercises | 1336 | ||
| Review Questions | 1336 | ||
| Recommended Websites | 1337 | ||
| References | 1337 | ||
| 47 Sensory Alterations | 1339 | ||
| Objectives | 1339 | ||
| Key Terms | 1339 | ||
| Media Resources | 1339 | ||
| Scientific Knowledge Base | 1340 | ||
| Normal Sensation | 1340 | ||
| Sensory Deficits | 1341 | ||
| Visual Deficits. | 1341 | ||
| Age-Related Macular Degeneration. | 1342 | ||
| Cataract. | 1342 | ||
| Diabetic Retinopathy. | 1342 | ||
| Glaucoma. | 1343 | ||
| Dry Eyes. | 1343 | ||
| Refractive Errors. | 1343 | ||
| Retinal Detachment. | 1343 | ||
| Hearing Deficits | 1343 | ||
| Conductive Hearing Loss. | 1343 | ||
| Presbycusis. | 1343 | ||
| Central Auditory Processing Disorders. | 1343 | ||
| Cerumen Accumulation. | 1343 | ||
| Ménière’s Disease. | 1343 | ||
| Otitis Media. | 1343 | ||
| Otosclerosis. | 1343 | ||
| Sensorineural Hearing Loss. | 1343 | ||
| Tinnitus. | 1343 | ||
| Balance Deficit. | 1343 | ||
| Taste Deficits. | 1343 | ||
| Neurological Deficits. | 1343 | ||
| Sensory Alterations | 1343 | ||
| Sensory Deprivation. | 1343 | ||
| Sensory Overload. | 1344 | ||
| Nursing Knowledge Base | 1344 | ||
| Factors Influencing Sensory Function | 1344 | ||
| Age. | 1344 | ||
| Stimuli. | 1345 | ||
| Family Support. | 1345 | ||
| Environment. | 1345 | ||
| Medications. | 1346 | ||
| Ethnicity. | 1346 | ||
| Critical Thinking | 1346 | ||
| Nursing Process | 1347 | ||
| Assessment | 1347 | ||
| Use of Assistive Devices. | 1347 | ||
| Sensory Alterations History. | 1348 | ||
| Screening. | 1348 | ||
| Mental Status. | 1349 | ||
| Physical Assessment. | 1350 | ||
| Ability to Perform Self-Care. | 1350 | ||
| Health Promotion Habits. | 1351 | ||
| Hazards. | 1351 | ||
| Nursing Diagnosis | 1351 | ||
| Planning | 1352 | ||
| Goals and Outcomes. | 1352 | ||
| Setting Priorities. | 1352 | ||
| Implementation | 1353 | ||
| Preventive Safety. | 1354 | ||
| Adaptations for Visual Loss. | 1355 | ||
| Adaptations for Reduced Hearing. | 1356 | ||
| Adaptations for Reduced Taste and Olfaction. | 1357 | ||
| Adaptations for Reduced Tactile Sensation. | 1357 | ||
| Adaptations to the Environment. | 1357 | ||
| Promoting Self-Care. | 1358 | ||
| Evaluation | 1358 | ||
| Evaluation of Patient Care. | 1358 | ||
| Patient Outcomes. | 1358 | ||
| Acknowledgment | 1359 | ||
| Key Concepts | 1359 | ||
| Critical Thinking Exercises | 1359 | ||
| Review Questions | 1359 | ||
| Recommended Websites | 1360 | ||
| References | 1360 | ||
| 48 Care of Surgical Patients | 1363 | ||
| Objectives | 1363 | ||
| Key Terms | 1363 | ||
| Media Resources | 1363 | ||
| History of Surgical Nursing | 1364 | ||
| Same-Day (Ambulatory) Surgery | 1364 | ||
| Role of Registered Nurse First Assistant (RNFA). | 1365 | ||
| Introduction of Anaesthetist’s Assistant (AA). | 1365 | ||
| Scientific Knowledge Base | 1365 | ||
| Classification of Surgery | 1365 | ||
| Nursing Knowledge Base | 1365 | ||
| Critical Thinking | 1365 | ||
| Nursing Process in the Preoperative Surgical Phase | 1367 | ||
| Assessment | 1367 | ||
| Nursing Health History. | 1367 | ||
| Medical History. | 1367 | ||
| Risk Factors. | 1368 | ||
| Age. | 1368 | ||
| Nutrition. | 1368 | ||
| Obesity. | 1368 | ||
| Immunocompetence. | 1370 | ||
| Fluid and Electrolyte Imbalances. | 1370 | ||
| Pregnancy. | 1370 | ||
| Previous Surgeries. | 1370 | ||
| Perceptions and Understanding of Surgery. | 1370 | ||
| Medication History. | 1370 | ||
| Allergies. | 1371 | ||
| Smoking Habits. | 1371 | ||
| Alcohol Ingestion and Substance Use and Abuse. | 1371 | ||
| Family Support. | 1371 | ||
| Occupation. | 1372 | ||
| Preoperative Preparation for Pain Assessment and Management. | 1372 | ||
| Review of Emotional Health. | 1372 | ||
| Body Image. | 1372 | ||
| Coping Resources. | 1373 | ||
| Culture. | 1373 | ||
| Patient Expectations. | 1373 | ||
| Physical Examination. | 1373 | ||
| General Survey. | 1373 | ||
| Head and Neck. | 1373 | ||
| Integument. | 1373 | ||
| Thorax and Lungs. | 1373 | ||
| Heart and Vascular System. | 1374 | ||
| Abdomen. | 1374 | ||
| Neurological Status. | 1374 | ||
| Diagnostic Screening. | 1374 | ||
| Nursing Diagnosis | 1374 | ||
| Planning | 1375 | ||
| Goals and Outcomes. | 1376 | ||
| Setting Priorities. | 1376 | ||
| Implementation | 1376 | ||
| Informed Consent. | 1378 | ||
| Preoperative Teaching. | 1378 | ||
| Patient Cites Reasons for Preoperative Instructions and Exercises. | 1378 | ||
| Patient States the Time of Surgery. | 1378 | ||
| Patient Knows Where the Postoperative Unit Is and Where the Family Will Be During Surgery and Recovery. | 1389 | ||
| Patient Discusses Anticipated Postoperative Monitoring and Therapies. | 1389 | ||
| Patient Describes Surgical Procedures and Postoperative Treatment. | 1389 | ||
| Patient Describes Postoperative Activity Resumption. | 1389 | ||
| Patient Describes Pain-Relief Measures. | 1391 | ||
| Patient Expresses Feelings Regarding Surgery. | 1391 | ||
| Acute Care. | 1391 | ||
| Physical Preparation. | 1391 | ||
| Maintenance of normal fluid and electrolyte balances. | 1391 | ||
| Reduction of risk of surgical wound infection. | 1391 | ||
| Precautions for patient requiring infection-control procedures. | 1392 | ||
| Prevention of bowel incontinence. | 1392 | ||
| Promotion of rest and comfort. | 1392 | ||
| Preparation on the Day of Surgery. | 1392 | ||
| Hygiene. | 1392 | ||
| Hair and cosmetics. | 1392 | ||
| Removal of prostheses. | 1392 | ||
| Safeguarding valuables. | 1392 | ||
| Preparing the bowel and bladder. | 1392 | ||
| Vital signs. | 1392 | ||
| Documentation. | 1392 | ||
| Performing special procedures. | 1392 | ||
| Administering preoperative medications. | 1394 | ||
| Latex sensitivity or allergy. | 1394 | ||
| Surgical safety checklist. | 1394 | ||
| Eliminating wrong site and wrong procedure surgery. | 1394 | ||
| Evaluation | 1395 | ||
| Patient Care. | 1395 | ||
| Patient Expectations. | 1395 | ||
| Transport to the Operating Room | 1395 | ||
| Intraoperative Surgical Phase | 1395 | ||
| Preoperative (Holding) Area | 1395 | ||
| Admission to the Operating Room | 1396 | ||
| Nursing Process in the Intraoperative Surgical Phase | 1396 | ||
| Assessment | 1396 | ||
| Nursing Diagnosis | 1396 | ||
| Planning | 1396 | ||
| Goals and Outcomes. | 1396 | ||
| Implementation | 1396 | ||
| Physical Preparation. | 1396 | ||
| Introduction of Anaesthesia. | 1396 | ||
| General Anaesthesia. | 1396 | ||
| Regional Anaesthesia. | 1396 | ||
| Local Anaesthesia. | 1397 | ||
| Procedural sedation. | 1397 | ||
| Positioning the Patient for Surgery. | 1397 | ||
| Documentation of Intraoperative Care. | 1397 | ||
| Evaluation | 1397 | ||
| Patient Care. | 1397 | ||
| Patient Expectations. | 1397 | ||
| Postoperative Surgical Phase | 1397 | ||
| Immediate Postoperative Recovery | 1398 | ||
| Discharge From the Postanaesthesia Care Unit | 1398 | ||
| Recovery in Ambulatory Surgery | 1399 | ||
| Postoperative Convalescence | 1400 | ||
| Nursing Process in Postoperative Care | 1400 | ||
| Assessment | 1400 | ||
| Respiration. | 1400 | ||
| Circulation. | 1400 | ||
| Temperature Control. | 1401 | ||
| Fluid and Electrolyte Balances. | 1401 | ||
| Neurological Functions. | 1401 | ||
| Skin Integrity and Condition of the Wound. | 1401 | ||
| Genitourinary Function. | 1402 | ||
| Gastrointestinal Function. | 1402 | ||
| Pain and Comfort. | 1402 | ||
| Patient Expectations. | 1402 | ||
| Nursing Diagnosis | 1402 | ||
| Planning | 1402 | ||
| Goals and Outcomes. | 1403 | ||
| Setting Priorities. | 1403 | ||
| Continuity of Care. | 1403 | ||
| Implementation | 1403 | ||
| Health Promotion. | 1403 | ||
| Maintaining Respiratory Function. | 1403 | ||
| Preventing Circulatory Complications. | 1405 | ||
| Achieving Rest and Comfort. | 1406 | ||
| Acute Care | 1406 | ||
| Temperature Regulation. | 1406 | ||
| Maintaining Neurological Function. | 1406 | ||
| Maintaining Fluid and Electrolyte Balances. | 1406 | ||
| Promoting Normal Bowel Elimination and Adequate Nutrition. | 1406 | ||
| Promoting Urinary Elimination. | 1407 | ||
| Promoting Wound Healing. | 1407 | ||
| Maintaining and Enhancing Self-Concept. | 1407 | ||
| Restorative and Continuing Care. | 1408 | ||
| Evaluation | 1408 | ||
| Patient Care. | 1408 | ||
| Patient Expectations. | 1408 | ||
| Key Concepts | 1408 | ||
| Critical Thinking Exercises | 1409 | ||
| Review Questions | 1409 | ||
| Recommended Websites | 1409 | ||
| References | 1410 | ||
| Appendix A Practical Nursing in Canada | 1412 | ||
| Objectives | 1412 | ||
| Key Terms | 1412 | ||
| History of Practical Nursing in Canada | 1412 | ||
| The Evolution of Practical Nursing | 1412 | ||
| Canada. | 1412 | ||
| United States. | 1413 | ||
| United Kingdom. | 1413 | ||
| The Demand for Practical Nursing | 1413 | ||
| Political and Economic Pressures. | 1413 | ||
| Changes Within Nursing | 1413 | ||
| Nursing Education. | 1413 | ||
| Registration Laws. | 1413 | ||
| Development of Categories Within the Nursing Profession. | 1413 | ||
| Ecological and Sociological Factors | 1413 | ||
| Ecology Theory Applied to Nursing. | 1413 | ||
| Sociology Applied to Nursing. | 1415 | ||
| Practical Nursing Today: Issues and Trends | 1415 | ||
| Educational Preparation and Entry-to-Practice Competencies | 1415 | ||
| Entry to a Practical Nurse Program. | 1416 | ||
| Location and Length of Program. | 1416 | ||
| Instructors in Practical Nursing Programs. | 1416 | ||
| Student Clinical Practice. | 1416 | ||
| Requirements for Practice as a Licensed Practical Nurse | 1416 | ||
| Educational Preparation. | 1416 | ||
| Evidence of Practice. | 1416 | ||
| Registration Examinations. | 1416 | ||
| Other Requirements. | 1417 | ||
| Continuing Education Issues | 1417 | ||
| Laddering. | 1417 | ||
| Postgraduate Certification. | 1417 | ||
| The Role of the Practical Nurse | 1417 | ||
| Workplace Issues | 1417 | ||
| Workforce Trends | 1418 | ||
| Standards and Scope of Practice | 1419 | ||
| Standards of Practice | 1419 | ||
| Ethics in Nursing | 1419 | ||
| Scope of Practice | 1419 | ||
| Challenges to Working to Full Scope of Practice. | 1419 | ||
| Interprofessional and Intraprofessional Collaborative Practice | 1421 | ||
| Leadership: Supervising and Delegating | 1421 | ||
| Supervision. | 1421 | ||
| Delegation. | 1421 | ||
| Continuing Education and Expanded Competencies | 1421 | ||
| Legislation, Regulatory Bodies, and Professional Associations | 1421 | ||
| Legislation | 1421 | ||
| Acts That Govern Specific Health Care Professions. | 1421 | ||
| Acts That Govern Multiple Health Care Professions. | 1421 | ||
| Regulatory Bodies | 1422 | ||
| Functions of the Regulatory Body. | 1422 | ||
| Protecting or Reserving Titles. | 1423 | ||
| Self-Regulation. | 1423 | ||
| The Registration Process for the Practical Nurse (Credentialling). | 1423 | ||
| Professional Associations | 1423 | ||
| Benefits of Membership in the Professional Association. | 1423 | ||
| The Future of Practical Nursing in Canada | 1424 | ||
| General Health Care Trends | 1424 | ||
| Implications for Practical Nursing | 1424 | ||
| Possible Evolution of the Practical Nurse Role | 1424 | ||
| Changes in Educational Standards for Entry to Practice. | 1424 | ||
| Scope of Practice and New Competencies. | 1425 | ||
| What Is the Final Answer? | 1425 | ||
| Key Concepts | 1425 | ||
| Critical Thinking Exercises | 1425 | ||
| Review Questions | 1426 | ||
| References | 1426 | ||
| Appendix B Laboratory Values | 1428 | ||
| Review Question Rationales | 1439 | ||
| Chapter 1 | 1439 | ||
| Chapter 2 | 1439 | ||
| Chapter 3 | 1440 | ||
| Chapter 4 | 1440 | ||
| Chapter 5 | 1440 | ||
| Chapter 6 | 1441 | ||
| Chapter 7 | 1441 | ||
| Chapter 8 | 1441 | ||
| Chapter 9 | 1442 | ||
| Chapter 10 | 1442 | ||
| Chapter 11 | 1442 | ||
| Chapter 12 | 1443 | ||
| Chapter 13 | 1443 | ||
| Chapter 14 | 1444 | ||
| Chapter 15 | 1444 | ||
| Chapter 16 | 1444 | ||
| Chapter 17 | 1445 | ||
| Chapter 18 | 1445 | ||
| Chapter 19 | 1446 | ||
| Chapter 20 | 1446 | ||
| Chapter 21 | 1447 | ||
| Chapter 22 | 1448 | ||
| Chapter 23 | 1448 | ||
| Chapter 24 | 1449 | ||
| Chapter 25 | 1449 | ||
| Chapter 26 | 1450 | ||
| Chapter 27 | 1450 | ||
| Chapter 28 | 1451 | ||
| Chapter 29 | 1451 | ||
| Chapter 30 | 1451 | ||
| Chapter 31 | 1452 | ||
| Chapter 32 | 1453 | ||
| Chapter 33 | 1453 | ||
| Chapter 34 | 1454 | ||
| Chapter 35 | 1454 | ||
| Chapter 36 | 1455 | ||
| Chapter 37 | 1455 | ||
| Chapter 38 | 1456 | ||
| Chapter 39 | 1456 | ||
| Chapter 40 | 1457 | ||
| Chapter 41 | 1457 | ||
| Chapter 42 | 1458 | ||
| Chapter 43 | 1458 | ||
| Chapter 44 | 1458 | ||
| Chapter 45 | 1459 | ||
| Chapter 46 | 1459 | ||
| Chapter 47 | 1460 | ||
| Chapter 48 | 1460 | ||
| Appendix A | 1461 | ||
| Index | 1463 | ||
| A | 1463 | ||
| B | 1465 | ||
| C | 1467 | ||
| D | 1471 | ||
| E | 1474 | ||
| F | 1476 | ||
| G | 1477 | ||
| H | 1478 | ||
| I | 1480 | ||
| J | 1482 | ||
| K | 1482 | ||
| L | 1483 | ||
| M | 1484 | ||
| N | 1486 | ||
| O | 1488 | ||
| P | 1489 | ||
| Q | 1493 | ||
| R | 1493 | ||
| S | 1495 | ||
| T | 1499 | ||
| U | 1501 | ||
| V | 1501 | ||
| W | 1502 | ||
| X | 1502 | ||
| Y | 1502 | ||
| Z | 1502 | ||
| Special Features | IBC2 | ||
| Patient Teaching | IBC2 | ||
| Concept Maps | IBC2 | ||
| Research Highlights | IBC2 | ||
| Nursing Care Plans | IBC3 | ||
| Procedural Guidelines | IBC3 | ||
| Skills | IBC3 |