Brunner and Suddarth's Textbook of Medical-Surgical Nursing

2227 Pages·2009·41.37 MB·English

by  Suzanne C. Smeltzer

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