Table Of ContentBrief CONTeNTS 37 Caring for Clients with Exocrine Pancreatic
Disorders ..............................................753
Unit 1 Introduction to Medical-Surgical Nursing / 1 38 Managing Clients with A Fecal Diversion ...........764
1 Role of Medical-Surgical Nursing ........................3
2 Assessing Family Processes and Issues ............. 17 Unit 10 Nursing Care of Clients with Neurosensory
3 Communicating with Clients with Personal Disorders / 787
and Family Issues .................................... 30 39 Assessment of the Neurological System ...........789
40 Caring for Clients with Brain Disorders .............805
Unit 2 Concepts Integral to Medical-Surgical 41 Caring for Clients with Spinal Cord Disorders .....821
Nursing / 43 42 Caring for Clients with Neurological Disorders ....838
4 Complementary and Alternative Therapies ........... 45 43 Managing Clients with Sensory Disorders .........857
5 Inflammation and Infection .............................. 64 44 Assessing and Caring for Clients with Eye
6 Caring for Clients in Shock .............................. 80 and Visual Disorders ................................864
7 Pain Assessment and Management ...................108 45 Assessing and Caring for Clients with Ear,
8 Cancer .....................................................133 Auditory, and Balance Disorders ..................884
9 Palliative and End-of-Life Care.........................159
Unit 11 Nursing Care of Clients with Musculoskeletal
Unit 3 Nursing Care of Clients with Fluid and Disorders / 911
Electrolyte Needs / 197 46 Assessment of the Musculoskeletal System .......913
10 Assessing and Caringfor Clients with Fluid and 47 Caring for Clients with Musculoskeletal Trauma ..928
Electrolyte Disturbances ...........................199 48 Caring for Clients with Musculoskeletal
11 Assessing and Caring for Clients with Conditions ............................................940
Acid–Base Disturbances ...........................221 49 Caring for Clients with Inflammatory Disorders ...954
12 IV Therapy................................................246 50 Caring for Clients with Degenerative Disorders ...959
Unit 4 Perioperative Nursing Care / 271 Unit 12 Nursing Care of Clients with Lymph,
13 Caring for Surgical Clients ............................272 Immune, or Infectious Disorders / 979
Unit 5 Nursing Care of Clients with Respiratory 51 Assessment of Lymph and Immune Function .....981
52 Caring for Clients with Lymphatic and Plasma
Disorders / 315
14 Assessment of The Respiratory System ............317 Cell Disorders ........................................994
53 Caring for Clients with Immunodeficiency
15 Caring for Clients with Upper Respiratory Tract
Disorders ..............................................332 and Aids ............................................. 1004
54 Caring for Clients with Hypersensitive Immune
16 Caring for Clients with Lower Respiratory Tract
Disorders ..............................................346 Response ............................................1019
55 Caring for Clients with Autoimmune
17 Caring for Clients with Acute Respiratory
Disorders ..............................................375 Diseases ............................................ 1029
Unit 13 Nursing Care of Clients with Integumentary
Unit 6 Nursing Care of Clients with Cardiovascular
Disorders / 1047
and Hematologic Disorders / 393
18 Assessment of the Cardiovascular System ........395 56 Assessment of the Integumentary System ....... 1049
57 Caring for Clients with Integumentary
19 Caring for Clients with Dysrhythmias ...............414
20 Caring for Clients with Inflammatory/Infectious Disorders ............................................ 1065
Cardiac Disorders ...................................423 58 Caring for Clients with Burn Injury ................ 1097
21 Caring for Clients with Occlusive Disorders and Unit 14 Nursing Care of Clients with Reproductive
Heart Failure ..........................................431 and Sexual Health Disorders / 1113
22 Caring for Clients with Peripheral Vascular 59 Assessment of the Reproductive System .........1115
Disorders ..............................................452 60 Caring for Female Clients with Gynecological
23 Caring for Clients with Hypertension ...............464 Disorders .............................................1130
24 Assessment of the Hematologic System ........... 474 61 Infertility and Contraceptive Methods ..............1153
25 Caring for Clients with Hematologic Disorders ....482 62 Caring for Clients with Breast Disorders ..........1163
63 Caring for Male Clients with Reproductive
Unit 7 Nursing Care of Clients with Renal and
Urinary Disorders / 513 Disorders .............................................1176
64 Assessing and Caring for Clients with Sexually
26 Assessment of the Renal System ....................515
27 Caring for Clients with Urinary Disorders ..........529 Transmitted Infections .............................1194
28 Caring for Clients with Renal Disorders ............544 Unit 15 Mental Health / 1217
65 Assessing and Caring for Clients with Mental
Unit 8 Nursing Care of Clients with Endocrine
Disorders / 577 Health Disorders ................................... 1219
29 Assessment of the Endocrine System ..............579 66 Caring for Clients with Substance Abuse ........ 1259
67 Caring for Clients with Psychobiological
30 Caring for Clients with Endocrine Disorders .......594
31 Caring for Clients with Diabetes Mellitus ...........624 Disorders ............................................ 1283
Unit 16 Nursing Care of Older Adult Clients / 1313
Unit 9 Nursing Care of Clients with Gastrointestinal
Disorders / 649 68 Health Care Issues of the Older Adult ............. 1314
32 Assessment of the Gastrointestinal System .......651 Unit 17 Special Considerations in Medical-Surgical
33 Managing Clients with Nutritional Disorders.......668 Nursing / 1347
34 Caring for Clients with Upper Gastrointestinal 69 Bioterrorism and Mass Casualty Care ............ 1348
Disorders ..............................................690 70 Emergency Nursing Care Principles and
35 Caring for Clients with Lower Gastrointestinal Triage ................................................ 1362
Disorders ..............................................707 71 Applying Critical Thinking with Multiple
36 Caring for Clients with Hepatobiliary Disorders ...731 Systems ............................................. 1387
Copyright 2012 Cengage Learning. All Rights Reserved. May not be copied, scanned, or duplicated, in whole or in part. Due to electronic rights, some third party content may be suppressed from the eBook and/or eChapter(s). Editorial review has
deemed that any suppressed content does not materially affect the overall learning experience. Cengage Learning reserves the right to remove additional content at any time if subsequent rights restrictions require it.
DESIGN SERVICES OF
88021_IFC_a.indd 2 12/29/11 3:48 PM
Medical-Surgical
Nursing
Third Edition
Copyright 2012 Cengage Learning. All Rights Reserved. May not be copied, scanned, or duplicated, in whole or in part. Due to electronic rights, some third party content may be suppressed from the eBook and/or eChapter(s). Editorial review has
deemed that any suppressed content does not materially affect the overall learning experience. Cengage Learning reserves the right to remove additional content at any time if subsequent rights restrictions require it.
88021_FM_i_liv.indd 1 12/30/11 4:13 PM
DeDicatioNS
Gena Duncan:
To my husband, John, who is always there. Thanks.
To Dr. Lois White, who guided me through the first edition of Medical-Surgical
Nursing: An Integrated Approach. I admire your brilliant mind, meticulous style, and
forward stride. Thanks for still being my confidante and friend.
Wendy Baumle:
To my family, friends, and peers ~ you are my inspiration.
To my past, current, and future nursing students ~ continue to light your candles and
strive to be the best nurse possible.
Nursing is a profession full of endless possibilities ~ embrace it.
Copyright 2012 Cengage Learning. All Rights Reserved. May not be copied, scanned, or duplicated, in whole or in part. Due to electronic rights, some third party content may be suppressed from the eBook and/or eChapter(s). Editorial review has
deemed that any suppressed content does not materially affect the overall learning experience. Cengage Learning reserves the right to remove additional content at any time if subsequent rights restrictions require it.
88021_FM_i_liv.indd 2 12/30/11 4:13 PM
Medical-Surgical
Nursing
Third Edition
Lois White, PhD, RN
Former Chairperson and Professor,
Department of Vocational Nurse Education,
Del Mar College, Corpus Christi, Texas
Gena Duncan, MSEd, MSN, RN
Former Associate Professor of Nursing, Ivy Tech
Community College, Fort Wayne, Indiana
Wendy Baumle, MSN, RN, CNE
Northwest State Community College, Archbold, Ohio
Australia • Brazil • Japan • Korea • Mexico • Singapore • Spain • United Kingdom • United States
Copyright 2012 Cengage Learning. All Rights Reserved. May not be copied, scanned, or duplicated, in whole or in part. Due to electronic rights, some third party content may be suppressed from the eBook and/or eChapter(s). Editorial review has
deemed that any suppressed content does not materially affect the overall learning experience. Cengage Learning reserves the right to remove additional content at any time if subsequent rights restrictions require it.
88021_FM_i_liv.indd 3 12/30/11 4:13 PM
Medical-Surgical Nursing: An Integrated © 2013, 2002, 1998 Delmar, Cengage Learning
Approach, Third edition
ALL RIGHTS RESERVED. No part of this work covered by the copyright
Lois White, PhD, RN, Gena Duncan, MSed, MSN,
herein may be reproduced, transmitted, stored, or used in any form or by any
RN, and Wendy Baumle, MSN, RN, cNe
means graphic, electronic, or mechanical, including but not limited to photo-
copying, recording, scanning, digitizing, taping, Web distribution, information
Vice President, Editorial: Dave Garza
networks, or information storage and retrieval systems, except as permitted
Executive Editor: Stephen Helba under Section 107 or 108 of the 1976 United States Copyright Act, without
the prior written permission of the publisher.
Associate Acquisitions Editor: Delia K. Uherec
Managing Editor: Marah Bellegarde
Senior Product Manager: Juliet Steiner For product information and technology assistance, contact us at
Editorial Assistant: Jennifer Wheaton cengage Learning customer & Sales Support, 1-800-354-9706
Vice President, Marketing: Jennifer Baker For permission to use material from this text or product,
submit all requests online at www.cengage.com/permissions.
Marketing Director: Wendy E. Mapstone
Further permissions questions can be e-mailed to
Executive Marketing Manager: Michele McTighe [email protected]
Associate Marketing Manager: Scott A. Chrysler
Production Director: Wendy Troeger
Library of Congress Control Number: 2011944933
Production Manager: Andrew Crouth
ISBN-13: 978-1-4354-8802-1
Content Project Manager: Brooke Greenhouse
ISBN-10: 1-4354-8802-4
Senior Art Director: Jack Pendleton
Delmar
Technology Project Manager: Mary Colleen Liburdi 5 Maxwell Drive
Clifton Park, NY 12065-2919
USA
Cengage Learning is a leading provider of customized learning solutions with
office locations around the globe, including Singapore, the United Kingdom,
Australia, Mexico, Brazil, and Japan. Locate your local office at:
international.cengage.com/region
Cengage Learning products are represented in Canada by Nelson Education,
Ltd.
To learn more about Delmar, visit www.cengage.com/delmar
Purchase any of our products at your local college store or at our preferred
online store www.cengagebrain.com
Notice to the Reader
Publisher does not warrant or guarantee any of the products described herein or perform any independent analysis in connection with any of
the product information contained herein. Publisher does not assume, and expressly disclaims, any obligation to obtain and include informa-
tion other than that provided to it by the manufacturer. The reader is expressly warned to consider and adopt all safety precautions that might
be indicated by the activities described herein and to avoid all potential hazards. By following the instructions contained herein, the reader
willingly assumes all risks in connection with such instructions. The publisher makes no representations or warranties of any kind, including
but not limited to, the warranties of fitness for particular purpose or merchantability, nor are any such representations implied with respect to
the material set forth herein, and the publisher takes no responsibility with respect to such material. The publisher shall not be liable for any
special, consequential, or exemplary damages resulting, in whole or part, from the readers’ use of, or reliance upon, this material.
Printed in the United States of America
1 2 3 4 5 6 7 14 13 12 11
Copyright 2012 Cengage Learning. All Rights Reserved. May not be copied, scanned, or duplicated, in whole or in part. Due to electronic rights, some third party content may be suppressed from the eBook and/or eChapter(s). Editorial review has
deemed that any suppressed content does not materially affect the overall learning experience. Cengage Learning reserves the right to remove additional content at any time if subsequent rights restrictions require it.
DESIGN SERVICES OF
88021_FM_i_liv.indd 4 12/30/11 4:13 PM
This is an electronic version of the print textbook. Due to electronic rights restrictions, some third party content may be suppressed. Editorial
review has deemed that any suppressed content does not materially affect the overall learning experience. The publisher reserves the right to
remove content from this title at any time if subsequent rights restrictions require it. For valuable information on pricing, previous
editions, changes to current editions, and alternate formats, please visit www.cengage.com/highered to search by
ISBN#, author, title, or keyword for materials in your areas of interest.
Copyright 2012 Cengage Learning. All Rights Reserved. May not be copied, scanned, or duplicated, in whole or in part. Due to electronic rights, some third party content may be suppressed from the eBook and/or eChapter(s). Editorial review has
deemed that any suppressed content does not materially affect the overall learning experience. Cengage Learning reserves the right to remove additional content at any time if subsequent rights restrictions require it.
coNteNtS
Contributors / xxix Roles of the Medical-Surgical Nurse ................11
Reviewers / xxxi Case Study ..................................................11
Preface / xxxiii Director of Care ............................................12
Acknowledgments / xxxviii Caregiver ...................................................12
Educator ....................................................12
About the Author / xxxix
Client Advocate ............................................13
How to Use This Text / xl
Job Opportunities .........................................13
Professional Affiliations and Certifications ........13
Standards of Practice ....................................13
UNIT 1 Code of Ethics .............................................13
Evidence-Based Practice ...............................13
Introduction to Medical-Surgical
Quality and Safety Education for Nurses ...........14
Nursing / 1 Informatics ..................................................14
Genetics and Genomics .................................14
5-Fluorouracil and Genetics ..............................15
CHAPTER 1: ROLE OF MEDICAL-
Conclusion ..................................................16
SURGICAL NURSING / 3
CHAPTER 2: ASSESSING FAMILY
Introduction .................................................. 4 PROCESSES AND ISSUES / 17
Characteristics of the Medical-Surgical Nurse ..... 4
Prioritization and Organization Skills ...................... 4 Introduction .................................................18
Critical Thinker .............................................. 5 Diverse Families across the Life Span ..............18
Innovative Problem Solver ................................. 6 Intergenerational Families ................................18
Critical Thinking ............................................ 7 Nuclear Families ...........................................20
Critical Thinking and Problem Solving Require Single-Parent Families ....................................20
Discipline .................................................. 7 Gay and Lesbian Families ................................20
Nursing Guideline to Critical Thinking and Problem Grandparents Raising Grandchildren ....................21
Solving .................................................... 7 Stepfamilies and Blended Families.......................21
Critical Thinking and Problem Solving Are Circular ...... 8 Cultural Variations within Families ...................21
Critical Thinking and Problem Solving to a Higher Asian American Families ..................................21
Standard .................................................. 8 Hispanic Families ..........................................22
Standards Related to Critical Thinking and Problem African American Families ................................22
Solving .................................................... 9 Native American Families .................................22
Critical Thinking and Problem Solving Require Amish Families .............................................22
Knowledge ...............................................11 Families of Middle Eastern Descent .....................23
v
Copyright 2012 Cengage Learning. All Rights Reserved. May not be copied, scanned, or duplicated, in whole or in part. Due to electronic rights, some third party content may be suppressed from the eBook and/or eChapter(s). Editorial review has
deemed that any suppressed content does not materially affect the overall learning experience. Cengage Learning reserves the right to remove additional content at any time if subsequent rights restrictions require it.
DDEESSIIGGNN SSEERRVVIICCEESS OOFF
88021_FM_i_liv.indd 5 12/30/11 4:13 PM
vi CONTENTS
Family Roles ................................................23 Introduction .................................................46
Psychosocial Growth and Development .................23 Legal Aspects ..............................................46
Economic Support .........................................23 Historic Foundation ......................................46
Health Promotion and Wellness ..........................25 Ancient Greece ............................................46
Spiritual and Personal Growth and Development .......25 The Far East ...............................................46
Parenting Styles ...........................................25 India ........................................................46
Authoritarian ...............................................25 Shamanistic Practices .....................................47
Authoritative ................................................26 Current Trends .............................................47
Permissive..................................................26 Mind/Body Research ......................................47
Characteristics Found in Healthy Families.........26 Holism and Nursing .......................................48
Characteristics of Distressed Families ..............26 Complementary and Alternative Therapies ........48
Potential Family Crisis ...................................26 Mind/Body Interventions ..................................49
Domestic Violence .........................................27 Case Study ..................................................49
Family Member with Mental Illness ......................27 Biofeedback ................................................50
Familial Genetic Disorders ................................27 Spiritual Therapies .........................................50
Teen Pregnancy ............................................27 Manipulative and Body-Based Methods .................51
Unplanned Pregnancy .....................................27 Energy Therapies ..........................................52
Family Member with Cancer ..............................27 Case Study ..................................................53
Family Member with Chronic Illness .....................28 Biologically Based Therapies .............................54
Child Abuse ................................................28 Other Methodologies ......................................61
Family Member with Substance Abuse ..................28 Conclusion ..................................................63
Divorce .....................................................28
Parental Stressors ........................................28 CHAPTER 5: INFLAMMATION
Management of Parental Stressors ......................28 AND INFECTION / 64
Conclusion ..................................................29
Introduction .................................................65
CHAPTER 3: COMMUNICATING Inflammation ................................................65
WITH CLIENTS WITH PERSONAL Medical Management .....................................65
AND FAMILY ISSUES / 30 Infection ......................................................66
Flora ........................................................66
Introduction .................................................31 Pathogenicity and Virulence ..............................66
Communication When Personal or Family Bacteria .....................................................66
Issues Are Present ........................................31 Viruses .....................................................66
Communicative Traits or Tendencies in Healthy Fungi ........................................................67
Families ......................................................31 Protozoa ....................................................67
Communicative Traits or Tendencies Rickettsia ...................................................67
in Distressed Families ...................................31 Chain of Infection .........................................67
Therapeutic Communication ...........................32 Agent .......................................................67
Keys to Effective Listening .............................32 Reservoir ...................................................67
Special Communicative Challenges for Nurses ..33 Portal of Exit ...............................................67
Areas of Special Challenge for Families ............33 Modes of Transmission ....................................67
Portal of Entry ..............................................69
Divorced Families ..........................................33
Host .........................................................70
Domestic Violence .........................................33
Productive Confrontation ...............................33 Breaking the Chain of Infection .......................71
Between Agent and Reservoir ............................71
Challenging Communication across Cultures ....34 Between Reservoir and Portal of Exit ....................71
Conclusion ..................................................35 Between Portal of Exit and Mode
of Transmission ..........................................72
Between Mode of Transmission and Portal
UNIT 2
of Entry ...................................................72
Between Portal of Entry and Host ........................72
Concepts Integral to Medical-
Between Host and Agent .................................72
Surgical Nursing / 43 Body Defenses .............................................73
Nonspecific Immune Defense ............................73
Specific Immune Defense .................................74
CHAPTER 4: COMPLEMENTARY
Types and Stages of Infections .......................74
AND ALTERNATIVE THERAPIES / 45 Incubation Stage ...........................................74
Copyright 2012 Cengage Learning. All Rights Reserved. May not be copied, scanned, or duplicated, in whole or in part. Due to electronic rights, some third party content may be suppressed from the eBook and/or eChapter(s). Editorial review has
deemed that any suppressed content does not materially affect the overall learning experience. Cengage Learning reserves the right to remove additional content at any time if subsequent rights restrictions require it.
DESIGN SERVICES OF
88021_FM_i_liv.indd 6 12/30/11 4:14 PM
