9781608317875

Table of Contents


UNIT 1	EXPLORING CONTEMPORARY NURSING	1
1	Nursing Foundations	2
	Nursing Origins	2
	The Nightingale Reformation	3
	The Crimean War	3
	Nightingale’s Contributions	4
	Nursing in the United States	4
	US Nursing Schools	4
	Expanding Horizons of Practice	4
	Contemporary Nursing	5
	Combining Nursing Art with Science	5
	Integrating Nursing Theory	6
	Defining Nursing	6
	The Educational Ladder	6
	Practical/Vocational Nursing	6
	Registered Nursing	9
	Future Trends	11
	Governmental Responses	11
	Proactive Strategies	11
	Unique Nursing Skills	15
	Assessment Skills	15
	Caring Skills	15
	Counseling Skills	15
	Comforting Skills	15
2	Nursing Process	17
	Definition of the Nursing Process	17
	Characteristics of the Nursing Process	18
	Steps of the Nursing Process	18
	Assessment	18
	Diagnosis	21
	Planning	23
	Implementation	25
	Evaluation	26
	Use of the Nursing Process	26
	Concept Mapping	26
	End of Unit Exercises	29
UNIT 2	INTEGRATING BASIC CONCEPTS	33
3	Laws and Ethics	34
	Laws	34
	Constitutional Law	34
	Statutory Laws	34
	Administrative Laws	35
	Common Law	37
	Criminal Laws	37
	Civil Laws	37
	Professional Liability	40
	Liability Insurance	41
	Reducing Liability	41
	Malpractice Litigation	42
	Ethics	42
	Codes of Ethics	42
	Ethical Dilemmas	42
	Ethical Theories	42
	Ethical Principles	45
	Values and Ethical Decision Making	46
	Ethics Committees	46
	Common Ethical Issues	46
4	Health and Illness	50
	Health	50
	Health: A Limited Resource	51
	Health: A Right	51
	Health: A Personal Responsibility	51
	Wellness	51
	Holism	51
	Hierarchy of Human Needs	51
	Illness	52
	Morbidity and Mortality	52
	Acute, Chronic, and Terminal Illnesses	52
	Primary and Secondary Illnesses	53
	Remission and Exacerbation	53
	Hereditary, Congenital, and Idiopathic Illnesses	53
	Health Care System	53
	Primary, Secondary, and Tertiary Care	53
	Extended Care	54
	Health Care Services	54
	Access to Care	54
	Financing Health Care	54
	Outcomes of Structured Reimbursement	56
	National Health Goals	56
	Nursing Team	57
	Functional Nursing	58
	Case Method	58
	Team Nursing	58
	Primary Nursing	58
	Nurse-Managed Care	58
	Continuity of Health Care	58
5	Homeostasis, Adaptation, and Stress	60
	Homeostasis	60
	Holism	60
	Adaptation	61
	Stress	64
	Physiologic Stress Response	65
	Psychological Stress Responses	67
	Stress-Related Disorders	67
	Nursing Implications	68
	Assessment of Stressors	68
	Prevention of Stressors	68
	Stress-Reduction Techniques	69
	Stress Management Techniques	69
6	Culture and Ethnicity	72
	Concepts Related to Culture	72
	Culture	72
	Race	73
	Minority	73
	Ethnicity	73
	Factors that Impact Perception of Individuals	73
	Stereotyping	73
	Generalization	74
	Ethnocentrism	74
	Culture and Subcultures in the United States	74
	Transcultural Nursing	75
	Cultural Assessment	75
	Culturally Sensitive Nursing	84
	End of Unit Exercises	86
UNIT 3	FOSTERING COMMUNICATION	93
7	The Nurse-Client Relationship	94
	Nursing Roles Within the Nurse—Client Relationship	94
	The Nurse as Caregiver	95
	The Nurse as Educator	95
	The Nurse as Collaborator	95
	The Nurse as Delegator	96
	The Therapeutic Nurse-Client Relationship	96
	Underlying Principles	96
	Phases of the Nurse-Client Relationship	96
	Barriers to a Therapeutic Relationship	97
	Communication	97
	Verbal Communication	97
	Nonverbal Communication	100
	Communicating With Special Populations	103
8	Client Teaching	105
	Importance of Client Teaching	105
	Scope and Consequences of Client Teaching	106
	Assessing the Learner	106
	Learning Styles	106
	Age and Developmental Level	107
	Capacity to Learn	108
	Motivation	109
	Learning Readiness	109
	Learning Needs	110
	Informal and Formal Teaching	110
9	Recording and Reporting	114
	Medical Records	114
	Uses	115
	Client Access to Records	117
	Types of Client Records	117
	Methods of Charting	117
	Narrative Charting	117
	SOAP Charting	117
	Focus Charting	119
	PIE Charting	119
	Charting by Exception	119
	Computerized Charting	119
	Protecting Health Information	121
	Privacy Standards	121
	Workplace Applications	121
	Data Security	122
	Documenting Information	122
	Using Abbreviations	122
	Indicating Documentation Time	123
	Communication for Continuity and Collaboration	124
	Written Forms of Communication	124
	Interpersonal Communication	126
	End of Unit Exercises	131
UNIT 4	PERFORMING BASIC CLIENT CARE	139
10	Asepsis	140
	Microorganisms	140
	Types of Microorganisms	141
	Survival of Microorganisms	142
	Chain of Infection	142
	Infectious Agents	142
	Reservoir	143
	Exit Route	144
	Means of Transmission	144
	Portal of Entry	144
	Susceptible Host	144
	Asepsis	145
	Medical Asepsis	145
	Using Antimicrobial Agents	145
	Surgical Asepsis	150
	Nursing Implications	153
11	Admission, Discharge, Transfer, and Referrals	168
	The Admission Process	168
	Medical Authorization	169
	The Admitting Department	169
	Nursing Admission Activities	169
	Initial Nursing Plan for Care	171
	Medical Admission Responsibilities	171
	Common Responses to Admission	171
	The Discharge Process	174
	Discharge Planning	174
	Obtaining Authorization for Medical Discharge	175
	Providing Discharge Instructions	175
	Notifying the Business Office	176
	Discharging a Client	176
	Writing a Discharge Summary	176
	Terminal Cleaning	177
	The Transfer Process	177
	Transfer Activities	177
	Extended Care Facilities	178
	The Referral Process	180
	Considering Referrals	180
	Home Health Care	181
12	Vital Signs	187
	Body Temperature	188
	Temperature Measurement	188
	Normal Body Temperature	188
	Assessment Sites	191
	Thermometers	192
	Elevated Body Temperature	196
	Subnormal Body Temperature	198
	Pulse	200
	Pulse Rate	200
	Pulse Rhythm	200
	Pulse Volume	200
	Assessment Sites	201
	Doppler Ultrasound Device	202
	Respiration	202
	Respiratory Rate	202
	Breathing Patterns and Abnormal Characteristics	203
	Blood Pressure	203
	Factors Affecting Blood Pressure	204
	Pressure Measurements	204
	Assessment Sites	205
	Equipment for Measuring Blood Pressure	205
	Measuring Blood Pressure	207
	Alternative Assessment Techniques	208
	Abnormal Blood Pressure Measurements	208
	Documenting Vital Signs	209
	Nursing Implications	210
13	Physical Assessment	227
	Overview of Physical Assessment	227
	Purposes	227
	Techniques	228
	Equipment	229
	Environment	229
	Performing a Physical Assessment	229
	Gathering General Data	229
	Draping and Positioning	230
	Selecting an Approach for Data Collection	231
	Examining the Client	231
	Data Collection	231
	Head and Neck	231
	Chest and Spine	236
	Extremities	241
	Abdomen	242
	Genitalia	244
	Anus and Rectum	245
	Nursing Implications	245
14	Special Examinations and Tests	249
	Examinations and Test	249
	General Nursing Responsibilities	250
	Common Diagnostic Examinations	254
	Diagnostic Laboratory Tests	259
	Nursing Implications	263
	End of Unit Exercises	273
UNIT 5	ASSISTING WITH BASIC NEEDS	283
15	Nutrition	284
	Overview of Nutrition	285
	Human Nutritional Needs	285
	Nutritional Strategies	289
	Nutritional Patterns and Practice	291
	Influences on Eating Habits	291
	Vegetarianism	291
	Nutritional Status Assessment	291
	Subjective Data	292
	Objective Data	292
	Management of Problems Interfering With Nutrition	295
	Obesity	295
	Emaciation	296
	Anorexia	296
	Nausea	297
	Vomiting	297
	Stomach Gas	297
	Management of Client Nutrition	298
	Common Hospital Diets	298
	Meal Trays	299
	Feeding Assistance	299
16	Fluid and Chemical Balance	305
	Body Fluid	305
	Water	305
	Fluid Compartments	306
	Electrolytes	306
	Blood	307
	Fluid and Electrolyte Distribution Mechanisms	307
	Fluid Regulation	308
	Fluid Volume Assessment	308
	Fluid Intake	309
	Fluid Output	311
	Common Fluid Imbalances	311
	Hypovolemia	311
	Hypervolemia	312
	Third-Spacing	313
	Intravenous Fluid Administration	314
	Types of Solutions	314
	Infusion Techniques	318
	Venipuncture	318
	Infusion Monitoring and Maintenance	319
	Discontinuation of an Intravenous Infusion	322
	Insertion of an Intermittent Venous Access Device	322
	Blood Administration	323
	Blood Collection and Storage	323
	Blood Safety	323
	Blood Compatibility	323
	Blood Transfusion	323
	Parenteral Nutrition	325
	Peripheral Parenteral Nutrition	325
	Total Parenteral Nutrition	325
	Lipid Emulsions	325
	Nursing Implications	326
17	Hygiene	345
	The Integumentary System	345
	Skin	346
	Mucous Membranes	346
	Hair	347
	Nails	347
	Teeth	347
	Hygiene Practices	347
	Bathing	348
	Shaving	350
	Oral Hygiene	352
	Hair Care	354
	Nail Care	355
	Visual and Hearing Devices	355
	Eyeglasses	355
	Contact Lenses	355
	Artificial Eyes	357
	Hearing Aids	357
	Infrared Listening Devices	359
	Nursing Implications	359
18	Comfort, Rest, and Sleep	374
	Client Environment	374
	Client Rooms	374
	Room Furnishings	375
	Sleep and Rest	377
	Functions of Sleep	377
	Sleep Phases	378
	Sleep Cycles	378
	Sleep Requirements	378
	Factors Affecting Sleep	379
	Sleep Assessment	382
	Questionnaires	382
	Sleep Diary	382
	Nocturnal Polysomnography	382
	Multiple Sleep Latency Test	383
	Sleep Disorders	383
	Insomnia	383
	Hypersomnia	383
	Sleep-Wake Cycle Disturbances	384
	Parasomnia	385
	Nursing Implications	385
	Progressive Relaxation	387
	Back Massage	387
19	Safety	399
	Age-Related Safety Factors	400
	Infants and Toddlers	400
	School-Aged Children and Adolescents	400
	Adults	400
	Environmental Hazards	400
	Latex Sensitization	401
	Burns	402
	Asphyxiation	404
	Electrical Shock	405
	Falls	406
	Restraints	408
	Legislation	409
	Accreditation Standards	409
	Restraint Alternatives	410
	Use of Restraints	410
	Nursing Implications	411
20	Pain Management	417
	Pain	417
	The Process of Pain	418
	Pain Theories	419
	Types of Pain	419
	Pain Assessment Standards	421
	Pain Assessment Data	422
	Pain Intensity Assessment Tools	422
	Pain Management	423
	Treatment Biases	423
	Pain Management Techniques	423
	Drug Therapy	423
	Surgical Approaches	427
	Nondrug and Nonsurgical Interventions	427
	Nursing Implications	430
	Addiction	430
	Placebos	430
21	Oxygenation	438
	Anatomy and Physiology of Breathing	438
	Assessing Oxygenation	440
	Physical Assessment	440
	Arterial Blood Gases	440
	Pulse Oximetry	440
	Promoting Oxygenation	442
	Positioning	442
	Breathing Techniques	442
	Oxygen Therapy	444
	Oxygen Sources	444
	Equipment Used in Oxygen Administration	445
	Common Delivery Devices	447
	Additional Delivery Devices	452
	Oxygen Hazards	453
	Related Oxygenation Techniques	453
	Water-Seal Chest Tube Drainage	453
	Hyperbaric Oxygen Therapy	454
	Nursing Implications	454
22	Infection Control	467
	Infection	467
	Infection Control Precautions	468
	Standard Precautions	469
	New Standard Precaution Recommendations	469
	Transmission-Based Precautions	471
	Infection Control Measures	473
	Client Environment	473
	Personal Protective Equipment	474
	Discarding Biodegradable Trash	476
	Removing Reusable Items	476
	Delivering Laboratory Specimens	476
	Transporting Clients	476
	Pyschological Implications	477
	Promoting Social Interaction	477
	Combating Sensory Deprivation	477
	Nursing Implications	477
	End of Unit Exercises	83
UNIT 6	ASSISTING THE INACTIVE CLIENT	493
23	Body Mechanics, Positioning, and Moving	494
	Maintaining Good Posture	495
	Standing	495
	Sitting	496
	Lying Down	496
	Body Mechanics	496
	Ergonomics	497
	Positioning Clients	498
	Common Positions	498
	Positioning Devices	500
	Turning and Moving Clients	501
	Protective Devices	503
	Side Rails	503
	Mattress Overlays	503
	Cradle	504
	Specialty Beds	504
	Transferring Clients	506
	Transfer Handle	506
	Transfer Belt	506
	Transfer Boards	506
	Nursing Implications	508
24	Therapeutic Exercise	519
	Fitness Assessment	519
	Body Composition	519
	Vital Signs	520
	Fitness Tests	520
	Walk-a-Mile Test	521
	Exercise Prescriptions	521
	Target Heart Rate	521
	Metabolic Energy Equivalent	522
	Types of Exercise	522
	Fitness Exercise	522
	Therapeutic Exercise	523
	Nursing Implications	525
25	Mechanical Immobilization	537
	Purposes of Mechanical Immobilization	537
	Mechanical Immobilizing Devices	538
	Splints	538
	Slings	540
	Braces	541
	Casts	541
	Traction	543
	External Fixators	544
	Nursing Implications	546
26	Ambulatory Aids	560
	Preparing for Ambulation	561
	Isometric Exercises	561
	Upper Arm Strengthening	561
	Dangling	561
	Using a Tilt Table	561
	Assistive Devices	562
	Ambulatory Aids	563
	Canes	563
	Walkers	565
	Crutches	565
	Crutch-Walking Gaits	566
	Prosthetic Limbs	566
	Temporary Prosthetic Limb	566
	Permanent Prosthetic Components	566
	Client Care	568
	Ambulation With a Lower Limb Prosthesis	568
	Nursing Implications	568
	End of Unit Exercises	58O
UNIT 7	THE SURGICAL CLIENT	587
27	Perioperative Care	588
	Preoperative Period	589
	Inpatient Surgery	589
	Outpatient Surgery	589
	Informed Consent	590
	Preoperative Blood Donation	591
	Immediate Preoperative Care	592
	Intraoperative Period	598
	Receiving Room	598
	Operating Room	598
	Surgical Waiting Area	599
	Postoperative Period	599
	Immediate Postoperative Care	599
	Continuing Postoperative Care	600
	Nursing Implications	603
28	Wound Care	610
	Wounds	610
	Wound Repair	611
	Inflammation	611
	Proliferation	611
	Remodeling	612
	Wound Healing	612
	Wound-Healing Complications	613
	Wound Management	614
	Dressings	614
	Drains	615
	Sutures and Staples	616
	Bandages and Binders	616
	Debridement	617
	Heat and Cold Applications	620
	Pressure Ulcers	622
	Stages of Pressure Ulcers	622
	Prevention of Pressure Ulcers	624
	Nursing Implications	625
29	Gastrointestinal Intubation	635
	Intubation	635
	Types of Tubes	636
	Orogastric Tubes	636
	Nasogastric Tubes	636
	Nasointestinal Tubes	637
	Transabdominal Tubes	638
	Nasogastric Tube Management	639
	Insertion	639
	Use and Maintenance	640
	Removal	642
	Nasointestinal Tube Management	642
	Insertion	642
	Checking Tube Placement	643
	Transabdominal Tube Management	643
	Tube Feedings	643
	Benefits and Risks	643
	Formula Considerations	644
	Tube-Feeding Schedules	645
	Client Assessment	646
	Nursing Management	647
	Intestinal Decompression	649
	Tube Insertion	649
	Removal	649
	Nursing Implications	650
	End of Unit Exercises	667
UNIT 8	PROMOTING ELIMINATION	673
30	Urinary Elimination	674
	Overview of Urinary Elimination	674
	Characteristics of Urine	675
	Factors Affecting Urinary Elimination	675
	Urine Specimen Collection	675
	Abnormal Urine Characteristics	676
	Abnormal Urinary Elimination Patterns	676
	Anuria	677
	Oliguria	677
	Polyuria	677
	Nocturia	677
	Dysuria	677
	Incontinence	677
	Assisting Clients With Urinary Elimination	678
	Commode	678
	Urinal	678
	Using a Bedpan	678
	Managing Incontinence	678
	Catheterization	680
	Types of Catheters	680
	Inserting a Catheter	682
	Connecting a Closed Drainage System	682
	Providing Catheter Care	683
	Catheter Irrigation	684
	Indwelling Catheter Removal	684
	Urinary Diversions	685
	Nursing Implications	685
31	Bowel Elimination	705
	Defecation	705
	Assessment of Bowel Elimination	706
	Elimination Patterns	706
	Stool Characteristics	706
	Common Alterations in Bowel Elimination	707
	Constipation	707
	Fecal Impaction	708
	Flatulence	708
	Diarrhea	708
	Fecal Incontinence	709
	Measures to Promote Bowel Elimination	709
	Inserting a Rectal Suppository	710
	Administering an Enema	710
	Ostomy Care	712
	Providing Peristomal Care	712
	Applying an Ostomy Appliance	713
	Draining a Continent Ileostomy	713
	Irrigating a Colostomy	713
	Nursing Implications	714
	End of Unit Exercises	729
UNIT 9	MEDICATION ADMINISTRATION	735
32	Oral Medications	736
	Medication Orders	736
	Components of a Medication Order	737
	Verbal and Telephone Orders	738
	Documentation in the Medication Administration Record	739
	Methods of Supplying Medications	739
	Storing Medications	739
	Accounting for Narcotics	739
	Medication Administration	739
	Applying the Five Rights	740
	Calculating Dosages	741
	Administering Oral Medications	741
	Administering Oral Medications by Enteral Tube	743
	Documentation	743
	Medication Errors	744
	Nursing Implications	744
33	Topical and Inhalant Medications	751
	Topical Route	751
	Cutaneous Applications	751
	Ophthalmic Applications	753
	Otic Applications	754
	Nasal Applications	755
	Sublingual and Buccal Applications	755
	Vaginal Applications	755
	Rectal Applications	755
	Inhalant Route	755
	Nursing Implications	757
34	Parenteral Medications	762
	Parenteral Administration Equipment	762
	Syringes	763
	Needles	763
	Modified Safety Injection Equipment	763
	Drug Preparation	764
	Ampules	764
	Vials	764
	Prefilled Cartridges	765
	Combining Medications in One Syringe	765
	Injection Routes	766
	Intradermal Injections	766
	Subcutaneous Injections	767
	Intramuscular Injections	770
	Reducing Injection Discomfort	774
	Nursing Implications	774
35	Intravenous Medications	783
	Intravenous Medication Administration	784
	Continuous Administration	784
	Intermittent Administration	784
	Central Venous Catheters	787
	Nontunneled Percutaneous Catheters	788
	Tunneled Catheters	788
	Implanted Catheters	789
	Medication Administration Using a Central Venous Catheter	789
	Nursing Implications	790
	End of Unit Exercises	8O1
UNIT 1O	INTERVENING IN EMERGENCY SITUATIONS	809
36	Airway Management	810
	The Airway	811
	Natural Airway Management	811
	Liquefying Secretions	811
	Mobilizing Secretions	812
	Suctioning Secretions	813
	Artificial Airway Management	814
	Oral Airway	814
	Tracheostomy	814
	Nursing Implications	816
37	Resuscitation	825
	Airway Obstruction	825
	Identifying Signs of Airway Obstruction	826
	Relieving an Obstruction	826
	Chain of Survival	827
	Early Recognition and Access of Emergency Services	828
	Early Cardiopulmonary Resuscitation	828
	Early Defibrillation	830
	Early Advanced Life Support	832
	Recovery	832
	Discontinuing Resuscitation	832
	Nursing Implications	832
	End off Unit Exercises	835
UNIT 11	CARING FOR THE TERMINALLY III	841
38	End-of-Life Care	842
	Terminal Illness and Care	842
	Stages of Dying	843
	Promoting Acceptance	843
	Providing Terminal Care	846
	Family Involvement	847
	Approaching Death	847
	Confirming Death	849
	Performing Postmortem Care	851
	Grieving	851
	Pathologic Grief	851
	Resolution of Grief	851
	Nursing Implications	851
	End of Unit Exercises	856
	References and Suggested Readings	861
Appendix A	Chapter summaries	875
Appendix B	Commonly used abbreviations and acronyms	887
	Glossary of Key Terms	889
	Index	9O5