xvii ● Contents Unit 1 Basic Concepts in Nursing Practice 2 1 Health Care Delivery and Nursing Practice 4 THE HEALTH CARE INDUSTRY AND THE NURSING PROFESSION 5 Nursing Defined 5 The Patient/Client: Consumer of Nursing and Health Care 5 Health Care in Transition 6 HEALTH, WELLNESS, AND HEALTH PROMOTION 6 Health 6 Wellness 6 Health Promotion 6 INFLUENCES ON HEALTH CARE DELIVERY 6 Population Demographics 7 Changing Patterns of Disease 7 Advances in Technology and Genetics 8 Economic Changes 8 Demand for Quality Care 8 Alternative Health Care Delivery Systems 9 ROLES OF THE NURSE 14 Practitioner Role 14 Leadership Role 15 Research Role 15 MODELS OF NURSING CARE DELIVERY 15 Team Nursing 15 Primary Nursing 15 Community-Based Nursing and Community Health–Public Health Nursing 16 EXPANDED NURSING ROLES 16 Collaborative Practice 17 2 Community-Based Nursing Practice 19 THE GROWING NEED FOR COMMUNITY-BASED HEALTH CARE 20 Community-Based Care 20 Home Health Care 21 HOSPITAL AND COMMUNITY-BASED NURSING 21 DISCHARGE PLANNING FOR HOME CARE 22 COMMUNITY RESOURCES AND REFERRALS 22 PREPARING FOR A HOME VISIT 22 CONDUCTING A HOME VISIT 22 Personal Safety Precautions 22 Initial Home Visit 23 Determining the Need for Future Visits 23 Closing the Visit 24 OTHER COMMUNITY-BASED HEALTH CARE SETTINGS 24 Ambulatory Settings 24 Occupational Health Programs 24 School Health Programs 24 Care for the Homeless 25 3 Critical Thinking, Ethical Decision Making, and the Nursing Process 26 DEFINITION OF CRITICAL THINKING 27 CRITICAL THINKING PROCESS 27 Rationality and Insight 27 Components of Critical Thinking 27 Critical Thinking in Nursing Practice 27 ETHICAL NURSING CARE 28 DOMAIN OF NURSING ETHICS 28 Ethics Versus Morality 28 Ethics Theories 29 Approaches to Ethics 29 Moral Situations 30 Types of Ethical Problems in Nursing 30 PREVENTIVE ETHICS 33 Advance Directives 33 ETHICAL DECISION MAKING 34 STEPS OF THE NURSING PROCESS 34 USING THE NURSING PROCESS 34 Assessment 34 Diagnosis 37 Planning 37 Implementation 40 Evaluation 40 Documentation of Outcomes and Revision of Plan 41 4 Health Education and Health Promotion 45 HEALTH EDUCATION TODAY 46 The Purpose of Health Education 46 ADHERENCE TO THE THERAPEUTIC REGIMEN 46 THE NATURE OF TEACHING AND LEARNING 47 Learning Readiness 47 The Learning Environment 48 Teaching Techniques 49 Teaching People With Disabilities 49 THE NURSING PROCESS IN PATIENT TEACHING 51 Assessment 51 Nursing Diagnosis 51 Planning 51 Implementation 52 Evaluation 52 HEALTH PROMOTION 52 Health and Wellness 53 Health Promotion Models 53 Definition of Health Promotion 53 Health Promotion Principles 54 HEALTH PROMOTION THROUGHOUT THE LIFE SPAN 54 Children and Adolescents 55 Young and Middle-Aged Adults 55 Elderly Adults 55 IMPLICATIONS FOR NURSING 56 5 Health Assessment 59 THE ROLE OF THE NURSE IN ASSESSMENT 60 BASIC GUIDELINES FOR CONDUCTING A HEALTH ASSESSMENT 60 ETHICAL USE OF HISTORY OR PHYSICAL EXAMINATION DATA 60 THE HEALTH HISTORY 60 The Informant 61 Cultural Considerations 61 Content of the Health History 61 Past Life Events Related to Health 62 Education and Occupation 63 Environment 63 Lifestyle 65 Physical or Mental Disability 65 Self-Concept 65 Sexuality 65 Risk for Abuse 66 Stress and Coping Responses 66 Other Health History Formats 66 PHYSICAL ASSESSMENT 67 Inspection 67 Palpation 68 Percussion 68 Auscultation 69 NUTRITIONAL ASSESSMENT 69 Body Mass Index 70 Biochemical Assessment 71 Clinical Examination 71 Dietary Data 71 Conducting the Dietary Interview 71 Evaluating the Dietary Information 72 Factors Influencing Nutritional Status in Varied Situations 72 Analysis of Nutritional Status 74 ASSESSMENT IN THE HOME AND COMMUNITY 74 Unit 2 Biophysical and Psychosocial Concepts in Nursing Practice 78 6 Homeostasis, Stress, and Adaptation 80 STRESS AND FUNCTION 81 DYNAMIC BALANCE: THE STEADY STATE 81 Historical Theories of the Steady State 82 Stress and Adaptation 82 STRESSORS: THREATS TO THE STEADY STATE 82 Types of Stressors 82 Stress as a Stimulus for Disease 83 Psychological Responses to Stress 83 Physiologic Response to Stress 84 Maladaptive Responses to Stress 87 Indicators of Stress 87 Nursing Implications 88 STRESS AT THE CELLULAR LEVEL 88 Control of the Steady State 88 Cellular Adaptation 89 Cellular Injury 90 Cellular Response to Injury: Inflammation 92 Cellular Healing 93 Nursing Implications 93 STRESS MANAGEMENT: NURSING INTERVENTIONS 93 Promoting a Healthy Lifestyle 94 Enhancing Coping Strategies 94 Teaching Relaxation Techniques 94 Educating About Stress Management 95 Enhancing Social Support 96 Recommending Support and Therapy Groups 96 7 Individual and Family Considerations Related to Illness 99 HOLISTIC APPROACH TO HEALTH AND HEALTH CARE 100 THE BRAIN AND PHYSICAL AND EMOTIONAL HEALTH 100 EMOTIONAL HEALTH AND EMOTIONAL DISTRESS 101 FAMILY HEALTH AND DISTRESS 102 ANXIETY 103 POSTTRAUMATIC STRESS DISORDER 104 DEPRESSION 105 SUBSTANCE ABUSE 107 LOSS AND GRIEF 108 DEATH AND DYING 109 SPIRITUALITY AND SPIRITUAL DISTRESS 109 8 Perspectives in Transcultural Nursing 113 DEFINITIONS OF CULTURE 114 Subcultures and Minorities 114 TRANSCULTURAL NURSING 115 CULTURALLY COMPETENT NURSING CARE 115 Cross-Cultural Communication 115 CULTURALLY MEDIATED CHARACTERISTICS 116 Space and Distance 116 Eye Contact 117 Time 117 Touch 117 Communication 118 Observance of Holidays 118 Diet 118 Biologic Variations 119 Complementary and Alternative Therapies 119 CAUSES OF ILLNESS 119 Biomedical or Scientific 119 Naturalistic or Holistic 120 Magico-Religious 120 FOLK HEALERS 120 CULTURAL ASSESSMENT 120 ADDITIONAL CULTURAL CONSIDERATIONS: KNOW THYSELF 121 THE FUTURE OF TRANSCULTURAL NURSING CARE 121 9 Genetics Perspectives in Nursing 123 A FRAMEWORK FOR INTEGRATING GENETICS INTO NURSING PRACTICE 124 xviii Contents GENETICS CONCEPTS 125 Genes and Their Role in Human Variation 126 Inheritance Patterns in Families 128 Chromosomal Differences and Genetic Conditions 132 CLINICAL APPLICATIONS OF GENETICS 132 Genetic Testing 132 Genetic Screening 133 Testing and Screening for Adult-Onset Conditions 133 Individualizing Genetic Profiles 137 APPLICATIONS OF GENETICS IN NURSING PRACTICE 137 Genetics and Health Assessment 138 Genetic Counseling and Evaluation Services 140 ETHICAL ISSUES 143 10 Chronic Illness 146 THE PHENOMENON OF CHRONICITY 147 Definition of Chronic Conditions 147 Prevalence and Causes of Chronic Conditions 147 THE CHARACTERISTICS OF CHRONIC CONDITIONS 149 The Problems of Managing Chronic Conditions 150 Implications for Nursing 151 Phases of Chronic Illness 151 Care by Phase: Applying the Nursing Process 152 PROMOTING HOME AND COMMUNITY-BASED CARE 155 Teaching Patients Self-Care 155 Continuing Care 155 Nursing Care for Special Populations With Chronic Illness 155 11 Principles and Practices of Rehabilitation 158 AMERICANS WITH DISABILITIES ACT 159 RIGHT TO ACCESS TO HEALTH CARE AND HEALTH PROMOTION 160 FOCUS OF REHABILITATION 160 THE REHABILITATION TEAM 161 AREAS OF SPECIALTY PRACTICE 162 ASSESSMENT OF FUNCTIONAL ABILITIES 163 Nursing Process: The Patient With Self-Care Deficit in Activities of Daily Living 163 Nursing Process: The Patient With Impaired Physical Mobility 165 Nursing Process: The Patient With Impaired Skin Integrity 175 Nursing Process: The Patient With Altered Elimination Patterns 181 DISABILITY AND SEXUALITY ISSUES 183 FATIGUE 183 HOME AND COMMUNITY-BASED CARE 183 COMPLEMENTARY THERAPIES 184 CONTINUING CARE 184 12 Health Care of the Older Adult 188 OVERVIEW OF AGING 189 Demographics of Aging 189 Health Costs of Aging 189 Ethical and Legal Issues Affecting the Older Adult 190 Nursing Care of Older Adults 191 NORMAL AGE-RELATED CHANGES AND HEALTH PROMOTION ACTIVITIES 191 Physical Aspects of Aging 191 Psychosocial Aspects of Aging 197 Cognitive Aspects of Aging 198 Environmental Aspects of Aging 198 Pharmacologic Aspects of Aging 201 PHYSICAL HEALTH PROBLEMS IN OLDER POPULATIONS 201 Geriatric Syndromes: Multiple Problems With Multiple Etiologic Factors 201 Acquired Immunodeficiency Syndrome in Older Adults 203 COMMON MENTAL HEALTH PROBLEMS IN OLDER POPULATIONS 204 Depression 204 Delirium 204 The Dementias: Multi-Infarct Dementia and Alzheimer’s Disease 205 THE OLDER ADULT IN AN ACUTE CARE SETTING: ALTERED RESPONSES TO ILLNESS 210 Increased Susceptibility to Infection 210 Altered Pain and Febrile Responses 211 Altered Emotional Impact 211 Altered Systemic Response 211 Unit 3 Concepts and Challenges in Patient Management 214 13 Pain Management 216 THE FIFTH VITAL SIGN 217 TYPES OF PAIN 217 Acute Pain 218 Chronic (Nonmalignant) Pain 218 Cancer-Related Pain 218 Pain Classified by Location 218 Pain Classified by Etiology 218 HARMFUL EFFECTS OF PAIN 218 Effects of Acute Pain 218 Effects of Chronic Pain 218 PATHOPHYSIOLOGY OF PAIN 220 Pain Transmission 220 Factors Influencing the Pain Response 223 NURSING ASSESSMENT OF PAIN 226 Characteristics of Pain 226 Instruments for Assessing the Perception of Pain 228 Nurse’s Role in Pain Management 230 PAIN MANAGEMENT STRATEGIES 232 Pharmacologic Interventions 232 Routes of Administration 237 Nonpharmacologic Interventions 240 NEUROLOGIC AND NEUROSURGICAL APPROACHES TO PAIN MANAGEMENT 241 Stimulation Procedures 242 Alternative Therapies 243 PROMOTING HOME AND COMMUNITY-BASED CARE 243 Teaching Patients Self-Care 243 Continuing Care 244 EVALUATING PAIN MANAGEMENT STRATEGIES 244 Reassessments 245 14 Fluid and Electrolytes: Balance and Distribution 249 FUNDAMENTAL CONCEPTS 250 Amount and Composition of Body Fluids 250 Regulation of Body Fluid Compartments 251 Contents xix Routes of Gains and Losses 252 Laboratory Tests for Evaluating Fluid Status 252 Homeostatic Mechanisms 253 FLUID VOLUME DISTURBANCES 256 Fluid Volume Deficit (Hypovolemia) 256 Fluid Volume Excess (Hypervolemia) 260 ELECTROLYTE IMBALANCES 261 Significance of Sodium 261 Sodium Deficit (Hyponatremia) 263 Sodium Excess (Hypernatremia) 265 Significance of Potassium 266 Potassium Deficit (Hypokalemia) 266 Potassium Excess (Hyperkalemia) 268 Significance of Calcium 270 Calcium Deficit (Hypocalcemia) 270 Calcium Excess (Hypercalcemia) 272 Significance of Magnesium 273 Magnesium Deficit (Hypomagnesemia) 273 Magnesium Excess (Hypermagnesemia) 274 Significance of Phosphorus 275 Phosphorus Deficit (Hypophosphatemia) 275 Phosphorus Excess (Hyperphosphatemia) 276 Significance of Chloride 277 Chloride Deficit (Hypochloremia) 277 Chloride Excess (Hyperchloremia) 277 ACID–BASE DISTURBANCES 278 Buffer Systems 278 Acute and Chronic Metabolic Acidosis (Base Bicarbonate Deficit) 278 Acute and Chronic Metabolic Alkalosis (Base Bicarbonate Excess) 279 Acute and Chronic Respiratory Acidosis (Carbonic Acid Excess) 280 Acute and Chronic Respiratory Alkalosis (Carbonic Acid Deficit) 281 Mixed Acid–Base Disorders 281 Compensation 281 Blood Gas Analysis 281 PARENTERAL FLUID THERAPY 282 Purpose 282 Types of IV Solutions 282 15 Shock and Multisystem Failure 295 SIGNIFICANCE OF SHOCK 296 CONDITIONS PRECIPITATING SHOCK 296 Classification of Shock 296 Normal Cellular Function 296 Pathophysiology 296 STAGES OF SHOCK 298 Compensatory Stage 299 Progressive Stage 300 Irreversible Stage 301 OVERALL MANAGEMENT STRATEGIES IN SHOCK 302 Fluid Replacement 302 Vasoactive Medication Therapy 303 Nutritional Support 303 HYPOVOLEMIC SHOCK 304 CARDIOGENIC SHOCK 306 CIRCULATORY SHOCK 309 Septic Shock 309 Neurogenic Shock 311 Anaphylactic Shock 311 MULTIPLE ORGAN DYSFUNCTION SYNDROME 312 16 Oncology: Nursing Management in Cancer Care 315 EPIDEMIOLOGY 316 PATHOPHYSIOLOGY OF THE MALIGNANT PROCESS 316 Proliferative Patterns 316 Characteristics of Malignant Cells 317 Invasion and Metastasis 318 Etiology 320 Role of the Immune System 321 DETECTION AND PREVENTION OF CANCER 322 Primary Prevention 322 Secondary Prevention 322 DIAGNOSIS OF CANCER AND RELATED NURSING CONSIDERATIONS 323 Tumor Staging and Grading 323 MANAGEMENT OF CANCER 325 Surgery 325 Radiation Therapy 328 Chemotherapy 329 Bone Marrow Transplantation 343 Hyperthermia 345 Biologic Response Modifiers 345 Photodynamic Therapy 349 Gene Therapy 349 Unproven and Unconventional Therapies 349 Nursing Process: The Patient With Cancer 350 CANCER REHABILITATION 358 CARE OF THE PATIENT WITH ADVANCED CANCER 360 Hospice 361 ONCOLOGIC EMERGENCIES 361 17 End-of-Life Care 369 NURSING AND END-OF-LIFE CARE 370 The Context for Death and Dying in America 370 Technology and End-of-Life Care 370 Sociocultural Context 371 SETTINGS FOR END-OF-LIFE CARE: PALLIATIVE CARE PROGRAMS AND HOSPICE 373 Palliative Care 373 Hospice Care 374 NURSING CARE OF THE TERMINALLY ILL PATIENT 375 Psychosocial Issues 376 Communication 376 Providing Culturally Sensitive Care at the End of Life 378 Goal Setting in Palliative Care at the End of Life 380 Spiritual Care 380 Hope 382 Managing Physiologic Responses to Illness 382 Palliative Sedation at the End of Life 386 NURSING CARE OF THE PATIENT WHO IS CLOSE TO DEATH 387 Expected Physiologic Changes When the Patient Is Close to Death 387 The Death Vigil 387 After-Death Care 387 Grief, Mourning, and Bereavement 389 COPING WITH DEATH AND DYING: PROFESSIONAL CAREGIVER ISSUES 391 xx Contents Unit 4 Perioperative Concepts and Nursing Management 396 18 Preoperative Nursing Management 398 PERIOPERATIVE AND PERIANESTHESIA NURSING 399 Preoperative Phase 399 Intraoperative Phase 399 Postoperative Phase 400 SURGICAL CLASSIFICATIONS 402 PRELIMINARIES TO SURGERY 402 Informed Consent 402 Assessment of Health Factors That Affect Patients Preoperatively 403 SPECIAL CONSIDERATIONS 407 The Ambulatory Surgery Patient 408 Elderly Patients 408 Obese Patients 408 Patients With Disabilities 408 Patients Undergoing Emergency Surgery 409 PREOPERATIVE NURSING INTERVENTIONS 409 Preoperative Teaching 409 Preoperative Psychosocial Interventions 412 General Preoperative Nursing Interventions 412 Immediate Preoperative Nursing Interventions 412 Nursing Process: Care of the Patient in the Preoperative Period 414 19 Intraoperative Nursing Management 417 THE SURGICAL TEAM 418 The Patient 418 The Circulating Nurse 419 The Scrub Role 419 The Surgeon 419 The Registered Nurse First Assistant 419 The Anesthesiologist and Anesthetist 420 THE SURGICAL ENVIRONMENT 420 Principles of Surgical Asepsis 421 Health Hazards Associated With the Surgical Environment 422 THE SURGICAL EXPERIENCE 423 Sedation and Anesthesia 423 Methods of Anesthesia Administration 424 POTENTIAL INTRAOPERATIVE COMPLICATIONS 429 Nausea and Vomiting 429 Anaphylaxis 430 Hypoxia and Other Respiratory Complications 430 Hypothermia 431 Malignant Hyperthermia 431 Disseminated Intravascular Coagulopathy 431 Nursing Process: The Patient During Surgery 431 20 Postoperative Nursing Management 436 THE POSTANESTHESIA CARE UNIT 437 Phases of Postanesthesia Care 437 Admitting the Patient to the PACU 437 Nursing Management in the PACU 438 THE HOSPITALIZED POSTOPERATIVE PATIENT 442 Receiving the Patient in the Clinical Unit 443 Nursing Management After Surgery 443 Nursing Process: The Hospitalized Patient Recovering From Surgery 444 Unit 5 Gas Exchange and Respiratory Function 460 21 Assessment of Respiratory Function 462 ANATOMIC AND PHYSIOLOGIC OVERVIEW 463 Anatomy of the Upper Respiratory Tract 463 Anatomy of the Lower Respiratory Tract: Lungs 464 Function of the Respiratory System 466 ASSESSMENT 471 Health History 471 Physical Assessment of the Upper Respiratory Structures 475 Physical Assessment of the Lower Respiratory Structures and Breathing 476 Physical Assessment of Breathing Ability in the Acutely Ill Patient 482 DIAGNOSTIC EVALUATION 483 Pulmonary Function Tests 483 Arterial Blood Gas Studies 484 Pulse Oximetry 484 Cultures 485 Sputum Studies 485 Imaging Studies 485 Endoscopic Procedures 486 Thoracentesis 488 Biopsy 488 22 Management of Patients With Upper Respiratory Tract Disorders 494 UPPER AIRWAY INFECTIONS 495 Rhinitis 495 Viral Rhinitis (Common Cold) 496 Acute Sinusitis 497 Chronic Sinusitis 499 Acute Pharyngitis 500 Chronic Pharyngitis 501 Tonsillitis and Adenoiditis 501 Peritonsillar Abscess 502 Laryngitis 502 Nursing Process: The Patient With Upper Airway Infection 503 OBSTRUCTION AND TRAUMA OF THE UPPER RESPIRATORY AIRWAY 505 Obstruction During Sleep 505 Epistaxis (Nosebleed) 506 Nasal Obstruction 507 Fractures of the Nose 507 Laryngeal Obstruction 507 CANCER OF THE LARYNX 508 Nursing Process: The Patient Undergoing Laryngectomy 512 Contents xxi 23 Management of Patients With Chest and Lower Respiratory Tract Disorders 518 ATELECTASIS 519 RESPIRATORY INFECTIONS 521 Acute Tracheobronchitis 521 Pneumonia 522 Nursing Process: The Patient With Pneumonia 531 Pulmonary Tuberculosis 534 Nursing Process: The Patient With Tuberculosis 538 Lung Abscess 540 PLEURAL CONDITIONS 542 Pleurisy 542 Pleural Effusion 542 Empyema 543 PULMONARY EDEMA 544 ACUTE RESPIRATORY FAILURE 545 ACUTE RESPIRATORY DISTRESS SYNDROME 546 PULMONARY HYPERTENSION 548 PULMONARY HEART DISEASE (COR PULMONALE) 549 PULMONARY EMBOLISM 550 SARCOIDOSIS 554 OCCUPATIONAL LUNG DISEASES: PNEUMOCONIOSES 554 Silicosis 555 Asbestosis 555 Coal Workers’ Pneumoconiosis 555 CHEST TUMORS 556 Lung Cancer (Bronchogenic Carcinoma) 556 Tumors of the Mediastinum 559 CHEST TRAUMA 559 Blunt Trauma 560 Penetrating Trauma: Gunshot and Stab Wounds 562 Pneumothorax 563 Cardiac Tamponade 564 Subcutaneous Emphysema 565 ASPIRATION 565 24 Management of Patients With Chronic Obstructive Pulmonary Disorders 570 CHRONIC OBSTRUCTIVE PULMONARY DISEASE 571 Nursing Process: The Patient With COPD 580 BRONCHIECTASIS 583 ASTHMA 589 Status Asthmaticus 597 CYSTIC FIBROSIS 597 25 Respiratory Care Modalities 601 NONINVASIVE RESPIRATORY THERAPIES 602 Oxygen Therapy 602 Intermittent Positive-Pressure Breathing 607 Mini-nebulizer Therapy 607 Incentive Spirometry (Sustained Maximal Inspiration) 608 Chest Physiotherapy 608 AIRWAY MANAGEMENT 612 Emergency Management of Upper Airway Obstruction 612 Endotracheal Intubation 612 Tracheostomy 614 MECHANICAL VENTILATION 615 Indications for Mechanical Ventilation 615 Classification of Ventilators 615 Adjusting the Ventilator 619 Assessing the Equipment 619 Problems With Mechanical Ventilation 620 Nursing Process: The Patient on a Ventilator 622 Weaning the Patient From the Ventilator 624 THE PATIENT UNDERGOING THORACIC SURGERY 628 Preoperative Management 628 Preoperative Nursing Management 628 Postoperative Management 630 Nursing Process: The Patient Undergoing Thoracic Surgery 635 Unit 6 Cardiovascular, Circulatory, and Hematologic Function 644 26 Assessment of Cardiovascular Function 646 ANATOMIC AND PHYSIOLOGIC OVERVIEW 647 Anatomy of the Heart 647 Function of the Heart: Conduction System 649 Gender Differences in Cardiac Structure and Function 653 ASSESSMENT 653 Health History and Clinical Manifestations 654 Physical Assessment 661 DIAGNOSTIC EVALUATION 668 Laboratory Tests 668 Chest X-ray and Fluoroscopy 670 Electrocardiography 670 Cardiac Stress Testing 671 Echocardiography 672 Radionuclide Imaging 673 Cardiac Catheterization 675 Angiography 675 Electrophysiologic Testing 676 Hemodynamic Monitoring 677 27 Management of Patients With Dysrhythmias and Conduction Problems 682 DYSRHYTHMIAS 683 Normal Electrical Conduction 683 Interpretation of the Electrocardiogram 684 Analyzing the Electrocardiogram Rhythm Strip 687 Nursing Process: The Patient With a Dysrhythmia 698 ADJUNCTIVE MODALITIES AND MANAGEMENT 699 Pacemaker Therapy 700 Nursing Process: The Patient With a Pacemaker 703 Cardioversion and Defibrillation 705 Electrophysiologic Studies 708 Cardiac Conduction Surgery 709 28 Management of Patients With Coronary Vascular Disorders 712 CORONARY ARTERY DISEASE 713 Coronary Atherosclerosis 713 Angina Pectoris 719 xxii Contents Nursing Process: The Patient With Angina Pectoris 723 Myocardial Infarction 725 Nursing Process: The Patient With Myocardial Infarction 729 INVASIVE CORONARY ARTERY PROCEDURES 733 Invasive Interventional Procedures 733 Surgical Procedures 737 Nursing Process: The Patient Awaiting Cardiac Surgery 739 Intraoperative Nursing Management 748 Nursing Process: The Patient Who Has Had Cardiac Surgery 748 29 Management of Patients With Structural, Infectious, and Inflammatory Cardiac Disorders 763 ACQUIRED VALVULAR DISORDERS 764 Mitral Valve Prolapse 764 Mitral Regurgitation 766 Mitral Stenosis 767 Aortic Regurgitation 767 Aortic Stenosis 767 Valvular Heart Disorders: Nursing Management 768 VALVE REPAIR AND REPLACEMENT PROCEDURES 768 Valvuloplasty 768 Valve Replacement 770 Valvuloplasty and Replacement: Nursing Management 772 SEPTAL REPAIR 772 CARDIOMYOPATHIES 772 Nursing Process: The Patient With Cardiomyopathy 776 CARDIAC TUMOR AND TRAUMA SURGERY 778 Tumor Excision 778 Trauma Repair 778 INFECTIOUS DISEASES OF THE HEART 778 Rheumatic Endocarditis 778 Infective Endocarditis 780 Myocarditis 782 Pericarditis 783 Nursing Process: The Patient With Pericarditis 784 30 Management of Patients With Complications From Heart Disease 787 CARDIAC HEMODYNAMICS 788 Noninvasive Assessment of Cardiac Hemodynamics 789 Invasive Assessment of Cardiac Hemodynamics 789 HEART FAILURE 789 Chronic Heart Failure 789 Nursing Process: The Patient With Heart Failure 801 Acute Heart Failure (Pulmonary Edema) 805 OTHER COMPLICATIONS 806 Cardiogenic Shock 806 Thromboembolism 808 Pericardial Effusion and Cardiac Tamponade 809 Myocardial Rupture 810 Cardiac Arrest 810 31 Assessment and Management of Patients With Vascular Disorders and Problems of Peripheral Circulation 815 ANATOMIC AND PHYSIOLOGIC OVERVIEW 816 Anatomy of the Vascular System 816 Function of the Vascular System 817 Pathophysiology of the Vascular System 819 ASSESSMENT 820 Health History and Clinical Manifestations 820 DIAGNOSTIC EVALUATION 821 Doppler Ultrasound Flow Studies 821 Exercise Testing 822 Duplex Ultrasonography 822 Computed Tomography 823 Angiography 823 Air Plethysmography 824 Contrast Phlebography 824 Lymphangiography 824 Lymphoscintigraphy 824 MANAGEMENT OF ARTERIAL DISORDERS 824 Arteriosclerosis and Atherosclerosis 824 Nursing Process: The Patient Who Has Peripheral Arterial Insufficiency of the Extremities 826 Peripheral Arterial Occlusive Disease 830 Thromboangiitis Obliterans (Buerger’s Disease) 834 Aortitis 835 Aortoiliac Disease 835 Aortic Aneurysm 835 Dissecting Aorta 839 Other Aneurysms 839 Arterial Embolism and Arterial Thrombosis 840 Raynaud’s Disease 841 MANAGEMENT OF VENOUS DISORDERS 842 Venous Thrombosis, Deep Vein Thrombosis (DVT), Thrombophlebitis, and Phlebothrombosis 842 Chronic Venous Insufficiency 845 Leg Ulcers 846 Nursing Process: The Patient Who Has Leg Ulcers 848 Varicose Veins 849 CELLULITIS 850 MANAGEMENT OF LYMPHATIC DISORDERS 851 Lymphangitis and Lymphadenitis 851 Lymphedema and Elephantiasis 851 32 Assessment and Management of Patients With Hypertension 854 HYPERTENSION DEFINED 855 PRIMARY HYPERTENSION 855 Nursing Process: The Patient With Hypertension 858 HYPERTENSIVE CRISES 865 Hypertensive Emergency 865 Hypertensive Urgency 865 33 Assessment and Management of Patients With Hematologic Disorders 867 ANATOMIC AND PHYSIOLOGIC OVERVIEW 868 Blood 869 Bone Marrow 869 Blood Cells 869 Plasma and Plasma Proteins 873 Reticuloendothelial System 874 Hemostasis 874 Pathophysiology of the Hematologic System 875 MANAGEMENT OF HEMATOLOGIC DISORDERS 877 Anemia 877 Nursing Process: The Patient With Anemia 879 Contents xxiii HYPOPROLIFERATIVE ANEMIAS 881 HEMOLYTIC ANEMIAS 886 Sickle Cell Anemia 886 Nursing Process: The Patient With Sickle Cell Crisis 889 Thalassemia 891 Glucose-6-Phosphate Dehydrogenase Deficiency 891 Hereditary Spherocytosis 892 Immune Hemolytic Anemia 892 Hereditary Hemochromatosis 893 THE POLYCYTHEMIAS 894 Polycythemia Vera 894 Secondary Polycythemia 895 LEUKOPENIA AND NEUTROPENIA 895 LEUKOCYTOSIS AND THE LEUKEMIAS 896 Acute Myeloid Leukemia 897 Chronic Myeloid Leukemia 900 Acute Lymphocytic Leukemia 900 Chronic Lymphocytic Leukemia 901 Nursing Process: The Patient With Acute Leukemia 902 Agnogenic Myeloid Metaplasia (AMM) 905 THE LYMPHOMAS 906 Hodgkin’s Disease 906 Non-Hodgkin’s Lymphomas 907 Multiple Myeloma 908 BLEEDING DISORDERS 909 Primary Thrombocythemia 910 Secondary Thrombocytosis 911 Thrombocytopenia 911 Idiopathic Thrombocytopenic Purpura (ITP) 912 Platelet Defects 913 Hemophilia 913 Von Willebrand’s Disease 915 ACQUIRED COAGULATION DISORDERS 915 Liver Disease 915 Vitamin K Deficiency 915 Complications of Anticoagulant Therapy 916 Disseminated Intravascular Coagulation (DIC) 916 Nursing Process: The Patient With Disseminated Intravascular Coagulation (DIC) 916 Thrombotic Disorders 919 THERAPIES FOR BLOOD DISORDERS 922 Splenectomy 922 Therapeutic Apheresis 923 Therapeutic Phlebotomy 923 Blood and Blood Component Therapy 923 Special Preparations 923 PROCURING BLOOD AND BLOOD PRODUCTS 924 Blood Donation 924 Complications of Blood Donation 926 Blood Processing 926 Transfusion 926 TRANSFUSION COMPLICATIONS 928 Diseases Transmitted by Blood Transfusion 930 Complications of Long-Term Transfusion Therapy 930 Nursing Management for Transfusion Reactions 930 Pharmacologic Alternatives to Blood Transfusions 931 Peripheral Blood Stem Cell Transplantation (PBSCT) and Bone Marrow Transplantation (BMT) 931 Unit 7 Digestive and Gastrointestinal Function 938 34 Assessment of Digestive and Gastrointestinal Function 940 ANATOMIC AND PHYSIOLOGIC OVERVIEW 941 Anatomy of the Gastrointestinal Tract 941 Function of the Digestive System 941 ASSESSMENT 945 Health History and Clinical Manifestations 945 Physical Assessment 946 DIAGNOSTIC EVALUATION 947 Stool Tests 947 Breath Tests 948 Abdominal Ultrasonography 948 DNA Testing 949 Imaging Studies 949 Endoscopic Procedures 951 Manometry and Electrophysiologic Studies 954 Gastric Analysis, Gastric Acid Stimulation Test, and pH Monitoring 955 Laparoscopy (Peritoneoscopy) 955 PATHOPHYSIOLOGIC AND PSYCHOLOGICAL CONSIDERATIONS 956 35 Management of Patients With Oral and Esophageal Disorders 958 DISORDERS OF THE TEETH 959 Dental Plaque and Caries 959 Dentoalveolar Abscess or Periapical Abscess 961 Malocclusion 962 DISORDERS OF THE JAW 962 Temporomandibular Disorders 962 DISORDERS OF THE SALIVARY GLANDS 963 Parotitis 963 Sialadenitis 963 Salivary Calculus (Sialolithiasis) 963 Neoplasms 964 CANCER OF THE ORAL CAVITY 964 Nursing Process: The Patient With Conditions of the Oral Cavity 965 NECK DISSECTION 968 Nursing Process: The Patient Undergoing a Neck Dissection 969 DISORDERS OF THE ESOPHAGUS 972 Dysphagia 972 Achalasia 972 Diffuse Spasm 975 Hiatal Hernia 977 Diverticulum 977 Perforation 978 Foreign Bodies 978 Chemical Burns 978 Gastroesophageal Reflux Disease 979 Barrett’s Esophagus 979 Benign Tumors of the Esophagus 979 Cancer of the Esophagus 979 Nursing Process: The Patient With a Condition of the Esophagus 981 xxiv Contents 36 Gastrointestinal Intubation and Special Nutritional Modalities 984 GASTROINTESTINAL INTUBATION 985 Short Tubes 985 Medium Tubes 986 Long Tubes 986 Nursing Management of Patients Undergoing Nasogastric or Nasoenteric Intubation 987 TUBE FEEDINGS WITH NASOGASTRIC AND NASOENTERIC DEVICES 992 Osmosis and Osmolality 992 Tube Feeding Formulas 992 Tube Feeding Administration Methods 993 Nursing Process: The Patient Receiving a Tube Feeding 993 GASTROSTOMY 998 Nursing Process: The Patient With a Gastrostomy 999 PARENTERAL NUTRITION 1001 Establishing Positive Nitrogen Balance 1001 Clinical Indications 1002 Formulas 1002 Initiating Therapy 1002 Administration Methods 1002 Discontinuing Parenteral Nutrition 1004 Nursing Process: The Patient Receiving Parenteral Nutrition 1004 37 Management of Patients With Gastric and Duodenal Disorders 1010 GASTRITIS 1011 Nursing Process: The Patient With Gastritis 1011 GASTRIC AND DUODENAL ULCERS 1015 Nursing Process: The Patient With Ulcer Disease 1017 MORBID OBESITY 1021 GASTRIC CANCER 1022 Nursing Process: The Patient With Gastric Cancer 1023 GASTRIC SURGERY 1025 Nursing Process: The Patient Undergoing Gastric Surgery 1025 38 Management of Patients With Intestinal and Rectal Disorders 1028 ABNORMALITIES OF FECAL ELIMINATION 1029 Constipation 1029 Diarrhea 1030 Fecal Incontinence 1032 Irritable Bowel Syndrome 1033 Conditions of Malabsorption 1034 ACUTE INFLAMMATORY INTESTINAL DISORDERS 1034 Appendicitis 1034 Diverticular Disease 1037 Nursing Process: The Patient With Diverticulitis 1038 Peritonitis 1039 INFLAMMATORY BOWEL DISEASE 1040 Regional Enteritis (Crohn’s Disease) 1041 Ulcerative Colitis 1042 Nursing Process: Management of the Patient With Inflammatory Bowel Disease 1044 Nursing Management of the Patient Requiring an Ileostomy 1047 INTESTINAL OBSTRUCTION 1054 Small Bowel Obstruction 1055 Large Bowel Obstruction 1056 Colorectal Cancer 1056 Nursing Process: The Patient With Colorectal Cancer 1058 Polyps of the Colon and Rectum 1065 DISEASES OF THE ANORECTUM 1066 Anorectal Abscess 1066 Anal Fistula 1066 Anal Fissure 1066 Hemorrhoids 1066 Sexually Transmitted Anorectal Diseases 1067 Pilonidal Sinus or Cyst 1067 Nursing Process: The Patient With an Anorectal Condition 1068 Unit 8 Metabolic and Endocrine Function 1072 39 Assessment and Management of Patients With Hepatic Disorders 1074 ANATOMIC AND PHYSIOLOGIC OVERVIEW 1075 Anatomy of the Liver 1075 Functions of the Liver 1076 ASSESSMENT 1077 Health History 1077 Physical Examination 1078 DIAGNOSTIC EVALUATION 1078 Liver Function Tests 1078 Liver Biopsy 1078 Other Diagnostic Tests 1081 HEPATIC DYSFUNCTION 1081 Jaundice 1081 Portal Hypertension 1082 Ascites 1082 Esophageal Varices 1085 Hepatic Encephalopathy and Coma 1090 Other Manifestations of Liver Dysfunction 1093 MANAGEMENT OF PATIENTS WITH VIRAL HEPATIC DISORDERS 1093 Viral Hepatitis 1093 Hepatitis A Virus (HAV) 1094 Hepatitis B Virus (HBV) 1097 Hepatitis C Virus (HCV) 1099 Hepatitis D Virus 1100 Hepatitis E Virus 1100 Hepatitis G (HGV) and GB Virus-C 1100 MANAGEMENT OF PATIENTS WITH NONVIRAL HEPATIC DISORDERS 1100 Toxic Hepatitis 1100 Drug-Induced Hepatitis 1100 Fulminant Hepatic Failure 1101 Hepatic Cirrhosis 1101 Nursing Process: The Patient With Hepatic Cirrhosis 1103 CANCER OF THE LIVER 1113 Primary Liver Tumors 1113 Liver Metastases 1113 Contents xxv LIVER TRANSPLANTATION 1115 Surgical Procedure 1116 Complications 1117 LIVER ABSCESSES 1118 40 Assessment and Management of Patients With Biliary Disorders 1123 ANATOMIC AND PHYSIOLOGIC OVERVIEW 1124 Anatomy of the Gallbladder 1124 Function of the Gallbladder 1124 The Pancreas 1124 DISORDERS OF THE GALLBLADDER 1126 Cholecystitis 1126 Cholelithiasis 1126 Nursing Process: The Patient Undergoing Surgery for Gallbladder Disease 1133 DISORDERS OF THE PANCREAS 1135 Acute Pancreatitis 1135 Nursing Process: The Patient With Acute Pancreatitis 1138 Chronic Pancreatitis 1142 Pancreatic Cysts 1143 Cancer of the Pancreas 1144 Tumors of the Head of the Pancreas 1145 Pancreatic Islet Tumors 1147 Hyperinsulinism 1147 Ulcerogenic Tumors 1147 41 Assessment and Management of Patients With Diabetes Mellitus 1149 CLASSIFICATION OF DIABETES 1151 Overview 1151 Physiology and Pathophysiology of Diabetes 1151 Type 1 Diabetes 1153 Type 2 Diabetes 1153 Gestational Diabetes 1154 DIABETES MANAGEMENT 1155 Nutritional Management 1156 Exercise 1160 Monitoring: Glucose Levels and Ketones 1161 Pharmacologic Therapy 1163 NURSING MANAGEMENT 1171 Education 1171 Developing a Diabetic Teaching Plan 1172 Implementing the Plan 1173 ACUTE COMPLICATIONS OF DIABETES 1178 Hypoglycemia (Insulin Reactions) 1178 Diabetic Ketoacidosis 1180 Hyperglycemic Hyperosmolar Nonketotic Syndrome 1183 Nursing Process: The Patient Newly Diagnosed With Diabetes Mellitus 1184 LONG-TERM COMPLICATIONS OF DIABETES 1188 Macrovascular Complications 1188 Microvascular Complications and Diabetic Retinopathy 1189 Nephropathy 1191 Diabetic Neuropathies 1192 Foot and Leg Problems 1194 SPECIAL ISSUES IN DIABETES CARE 1195 The Patient With Diabetes Undergoing Surgery 1195 Management of Hospitalized Diabetic Patients 1196 Nursing Process: The Patient With Diabetes as a Secondary Diagnosis 1198 42 Assessment and Management of Patients With Endocrine Disorders 1204 ANATOMIC AND PHYSIOLOGIC OVERVIEW 1205 Glands of the Endocrine System 1205 Function and Regulation of Hormones 1206 Classification and Action of Hormones 1206 ASSESSMENT 1206 Health History and Clinical Manifestations 1206 Physical Assessment 1207 DIAGNOSTIC EVALUATION 1207 MANAGEMENT OF PATIENTS WITH PITUITARY DISORDERS 1209 Pituitary Function and Dysfunction 1209 Diabetes Insipidus 1211 Syndrome of Inappropriate Antidiuretic Hormone Secretion 1212 MANAGEMENT OF PATIENTS WITH THYROID DISORDERS 1212 Thyroid Function and Dysfunction 1212 Abnormal Thyroid Function 1215 Hypothyroidism 1215 Hyperthyroidism 1221 Nursing Process: The Patient With Hyperthyroidism 1224 Thyroiditis 1226 Thyroid Tumors 1226 Endemic (Iodine-Deficient) Goiter 1227 Nodular Goiter 1227 Thyroid Cancer 1228 MANAGEMENT OF PATIENTS WITH PARATHYROID DISORDERS 1231 Parathyroid Function 1231 Hyperparathyroidism 1231 Hypoparathyroidism 1232 MANAGEMENT OF PATIENTS WITH ADRENAL DISORDERS 1234 Adrenal Function 1234 Pheochromocytoma 1235 Adrenocortical Insufficiency (Addison’s Disease) 1237 Cushing’s Syndrome 1239 Nursing Process: The Patient With Cushing’s Syndrome 1240 CORTICOSTEROID THERAPY 1243 Side Effects 1244 Therapeutic Uses of Corticosteroids 1244 Dosage 1244 Tapering 1245 Unit 9 Urinary Tract Function 1248 43 Assessment of Renal and Urinary Tract Function 1250 ANATOMIC AND PHYSIOLOGIC OVERVIEW 1251 Anatomy of the Upper and Lower Urinary Tracts 1251 Physiology of the Upper and Lower Urinary Tracts 1253 ASSESSMENT 1257 Health History 1257 Physical Examination 1259 xxvi Contents [...]... art and science of adult medical- surgical nursing It addresses nursing care issues from a physiological, pathophysiological, and psychosocial context and assists the reader to identify priorities of care from that context ABOUT THE TENTH EDITION The tenth edition of Brunner and Suddarth’s Textbook of Medical Surgical Nursing was constructed to provide today’s nursing students with an understanding of. .. and searchable image collection, among other features Supplemental cartridges for Blackboard and WebCT Connection Website—Get connected at connection.LWW com/go/smeltzer The tenth edition of Brunner and Suddarth’s Textbook of Medical- Surgical Nursing continues the tradition of presenting up-to-date content that addresses the art and science of nursing practice The updating of the material and use of. .. scientific advances, and the ethical dilemmas inherent in many areas of clinical practice More than ever, today’s nurses need to think critically, creatively, and compassionately This tenth edition of Brunner & Suddarth’s Textbook of MedicalSurgical Nursing is designed for the 21st century and nurses’ need to be knowledgeable, highly skilled, perceptive, caring, and compassionate A goal of the textbook is to... Professor School of Nursing University of Central Florida Orlando, Florida Chapter 21: Assessment of Respiratory Function Kim Cantwell-Gab, BSN, RN, CVN, RVT, RDMS Vascular Surgery Nurse Specialist Department of Surgery, Division of Vascular Surgery University of Washington School of Medicine Seattle, Washington Chapter 31: Assessment and Management of Patients With Vascular Disorders and Problems of. .. Textbook of Medical- Surgical Nursing has long used nursing diagnoses developed by the North American Nursing Diagnosis Association (NANDA), this edition presents the links between the NANDA diagnoses and the Nursing Interventions Classification (NIC) and Nursing- sensitive Outcomes Classification (NOC) The opening page of each unit presents a concept map illustrating these three classification systems and their... Assistant Professor of Physical Medicine and Rehabilitation Medicine (PM&R) University of Illinois Chicago, Illinois How to use Brunner & Suddarth’s Textbook of Medical- Surgical Nursing 10th edition receives the nursing diagnoses Risk for Impaired Gas Exchange requires requires nursing interventions outcomes should show improvement in Anxiety Control Respiratory Monitoring may be reduced by and and ▲ The... Understanding the needs of health care consumers and the health care delivery system, including the forces that affect nursing and health care delivery, will provide a foundation for examining the delivery of nursing care Esteem and self-respect Belongingness and affection Safety and security THE PATIENT/CLIENT: CONSUMER OF NURSING AND HEALTH CARE The central figure in health care services is, of course,... text and round out the applied-learning experience Each chapter concludes with Critical Thinking Exercises, References and Selected Readings, and a list of specialized Resources and Websites MANY MORE OF THE LATEST RESOURCES Additional learning tools accompany the tenth edition and offer visual, tactile, and auditory reinforcement of the text These resources include: • • • • their understanding of medical- surgical. .. role in health and illness within evolving practice environments and across the spectrum of health and illness The textbook s content has been revised and updated by experts in the field to reflect current practice and advances in health care and technology NEW CHAPTERS: GENETICS, END -OF- LIFE CARE, AND BIOTERRORISM Nursing knowledge is constantly expanding Chapter 9, Genetics Perspectives in Nursing Practice,... of nursing care has been affected by changes occurring in the health care system, the definition of nursing has continued to distinguish nursing care and identify the major aspects of nursing care NURSING DEFINED Since the time of Florence Nightingale, who wrote in 1858 that the goal of nursing was “to put the patient in the best condition for nature to act upon him,” nursing leaders have described nursing . 15 MODELS OF NURSING CARE DELIVERY 15 Team Nursing 15 Primary Nursing 15 Community-Based Nursing and Community Health–Public Health Nursing 16 EXPANDED NURSING. FAHA Professor Department of Biobehavioral Nursing and Health Systems University of Washington School of Nursing Seattle, Washington Chapter 32: Assessment and