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Copyright, vi
Dedications, vii
Preface, viii
Acknowledgments, xiv
Contributors, xv
Reviewers, xviii
Special Features, xlv
Unit 1. How Nurses Think, 1
Chapter 1. Evolution of Nursing Thought & Action, 2
Nursing Images Throughout History, 4
Angel of Mercy, 4
Handmaiden, 5
Battle-Ax, 7
Naughty Nurse, 7
Military Image, 8
Caucasian Woman, 9
Full-Spectrum Nurse, 10
Contemporary Nursing Practice: Education, Regulation, and Organization, 11
How Is Nursing Defined?, 11
How Do Nurses' Educational Paths Differ?, 14
How Is Nursing Practice Regulated?, 16
What Are Some Important Nursing Organizations?, 16
Contemporary Nursing Practice: Caring for Clients, 19
Who Are the Recipients of Nursing Care?, 19
What Are the Purposes of Nursing Care?, 19
Where Do Nurses Work?, 20
What Factors Influence Contemporary Nursing Practice?, 21
Trends in Society, 21
Trends in Nursing and Health Care, 22
Chapter 2. Critical Thinking & the Nursing Process, 24
What Is Your View of Nursing?, 25
Theoretical Knowledge: Knowing Why, 26
What Is Critical Thinking?, 26
What Are Critical-Thinking Skills?, 26
What Are Critical-Thinking Attitudes?, 27
Why Is Critical Thinking Important for Nurses?, 27
Nurses Deal with Complex Situations, 27
Clients Are Unique, 28
Nurses Apply Knowledge to Provide Holistic Care, 28
What Are the Different Kinds of Nursing Knowledge?, 29
A Model for Critical Thinking, 29
Practical Knowledge: Knowing How, 31
What Is the Nursing Process?, 31
What Are the Phases of the Nursing Process?, 32
How Is the Nursing Process Related to Critical Thinking?, 33
What Is Full-Spectrum Nursing?, 33
What Concepts Are Used in the Model?, 33
How Does the Model Work?, 34
Chapter 3. Nursing Process: Assessment, 37
Assessment: The First Step of the Nursing Process, 38
How Is Assessment Related to Other Steps of the Nursing Process?, 38
How Does Nursing Assessment Fit into Collaborative Care?, 39
What Do Professional Standards Say About Assessment?, 39
Can I Delegate Assessments?, 39
Sources of Data, 41
Types of Assessment, 42
What Is Included in a Comprehensive Assessment?, 44
Observation, 44
Physical Assessment, 44
The Nursing Interview, 46
How and When Should I Validate Data?, 49
How Can I Organize Data?, 50
Nonnursing Models, 50
Nursing Models, 50
How Should I Document Data?, 50
Guidelines for Recording Assessment Data, 52
Tools for Recording Assessment Data, 52
Reflecting Critically About Assessment, 52
Chapter 4. Nursing Process: Diagnosis, 55
Theoretical Knowledge: Knowing Why, 56
Diagnosis: The Second Step of the Nursing Process, 56
What Are the Origins of Nursing Diagnosis?, 58
What Are Health Problems?, 59
Types of Nursing Diagnoses, 61
What Is Diagnostic Reasoning?, 63
Analyzing and Interpreting Data, 63
Drawing Conclusions about Health Status, 65
Verifying Problems with the Patient, 66
Prioritizing Problems, 66
Computer-Assisted Diagnosing, 68
Reflecting Critically on Your Diagnostic Reasoning Process, 68
Think About Your Theoretical Knowledge, 68
Think About Your Self Knowledge, 68
Think About Your Analysis and Conclusions, 69
Practical Knowledge: Knowing How, 69
How Are Diagnostic Statements Written?, 69
Standardized Nursing Languages, 69
What Is a Taxonomy?, 70
NANDA Taxonomy of Diagnostic Terminology, 71
Formats for Diagnostic Statements, 73
How Does the Nursing Diagnosis Relate to Outcomes and Interventions?, 77
Reflecting Critically About Diagnostic Statements, 77
Guidelines for Judging the Quality of Diagnostic Statements, 77
Critiquing the NANDA System, 79
Chapter 5. Nursing Process: Planning Outcomes, 81
What Is Planning?, 82
How Is Planning Related to Other Steps of the Nursing Process?, 82
Initial and Ongoing Planning, 83
Discharge Planning, 84
Nursing Care Plans, 85
Why Is a Written Nursing Care Plan Important?, 85
What Information Does a Comprehensive Nursing Care Plan Contain?, 85
What Documents Make Up a Comprehensive Nursing Care Plan?, 85
What Is the Process for Writing an Individualized Nursing Care Plan?, 92
Planning Patient Goals/Outcomes, 92
What Do the Terms Goal and Outcome Mean?, 92
What Is the Purpose of Goal/Outcome Statements?, 93
How Do I Distinguish Between Short-Term and Long-Term Goals?, 93
What Are the Components of a Goal Statement?, 93
How Do Goals Relate to Nursing Diagnoses?, 94
How Do I Use Standardized Terminology for Outcomes?, 97
Outcomes for Special Teaching Plans, 100
Reflecting Critically About Expected Outcomes/Goals, 100
Chapter 6. Nursing Process: Planning Interventions, 103
What Are Nursing Interventions?, 105
Nursing Interventions Reflect Direct and Indirect Care, 105
Nursing Interventions Include Independent, Dependent, and Collaborative Actions, 105
How Do I Decide Which Interventions to Use?, 106
How Do Theories Influence My Choice of Interventions?, 106
How Does Nursing Research Influence My Choice of Interventions?, 106
How Does Problem Status Influence Nursing Interventions?, 109
What Process Can I Use for Generating and Selecting Interventions?, 109
Computer-Generated Interventions, 113
How Can I Use Standardized Language in Planning Interventions?, 113
What Is the Nursing Interventions Classification (NIC)?, 113
Standardized Languages for Home Health and Community Care, 114
Does Standardized Language Interfere with Holistic Care?, 115
What Are Nursing Orders, and How Do I Write Them?, 116
Components of a Nursing Order, 116
Reflecting Critically About Nursing Orders, 118
Chapter 7. Nursing Process: Implementation & Evaluation, 119
Implementation: The Action Phase of the Nursing Process, 121
How Is Implementation Related to Other Steps of the Nursing Process?, 121
How Should I Prepare for Implementation?, 121
Implementing the Plan: Doing or Delegating, 125
Documenting:The Final Step of Implementation, 128
Reflecting Critically About Implementation, 128
Evaluation: The Final Step of the Nursing Process, 128
Why Is Evaluation Essential to Full-Spectrum Nursing?, 128
How Are Standards and Criteria Used in Evaluation?, 129
Types of Evaluation, 130
How Is Evaluation Related to Other Steps of the Nursing Process?, 132
How Do I Evaluate Patient Progress?, 132
Evaluating and Revising the Care Plan, 135
Reflecting Critically About Evaluation, 136
Evaluating the Quality of Care in a Healthcare Setting, 136
Chapter 8. Nursing Theory & Research, 138
The Importance of Nursing Theory and Research, 139
Nursing Theories, 141
Theoretical Knowledge: Knowing Why, 141
What Are the Components of a Theory?, 141
Theory, Framework, Model, or Paradigm?, 142
How Are Theories Developed?, 143
What Are the Essential Concepts of a Nursing Theory?, 144
How Do Nurses Use Theories?, 144
Who Are Some Important Nurse Theorists?, 145
How Do Nurses Use Theories from Other Disciplines?, 149
Practical Knowledge: Knowing How, 152
Nursing Research, 154
Theoretical Knowledge: Knowing Why, 154
What Is the History of Nursing Research?, 154
How Are Priorities for Nursing Research Developed?, 154
What Educational Preparation Is Necessary to Do Nursing Research?, 155
Practical Knowledge: Knowing How, 155
What Is the Scientific Method?, 155
What Are the Steps of the Research Process?, 157
What Are the Rights of Research Participants?, 158
How Can I Help Identify Clinical Nursing Problems?, 158
How Do I Analyze the Research That I Read?, 159
How Do I Find Research Articles Related to My Practice?, 161
What Is Research Utilization?, 161
Unit 2. Factors Affecting Health, 163
Chapter 9. Growth & Development through the Life Span, 164
Theoretical Knowledge: Knowing Why, 165
What Are Growth and Development?, 165
Principles of Growth and Development, 166
Theories of Growth and Development, 166
Applying Concepts of Growth and Development, 168
Summary, 168
Chapter 10. Experiencing Health & Illness, 169
Theoretical Knowledge: Knowing Why, 170
How Do We Understand Health and Illness?, 170
Nurses Understand Health and Illness as Individual Experiences, 171
Nurses Use Conceptual Models to Understand Health and Illness, 172
How Do People Experience Health and Illness?, 173
Nutrition, 174
Physical Activity, 174
Sleep and Rest, 174
Meaningful Work, 174
Lifestyle Choices, 174
Family Relationships, 175
Culture, 175
Religion and Spirituality, 175
Environmental Factors, 176
Finances, 176
What Factors Disrupt Health?, 176
Physical Disease, 176
Injury, 176
Mental Illness, 177
Pain, 177
Loss, 177
Impending Death, 177
Competing Demands, 178
The Unknown, 178
Imbalance, 178
Isolation, 179
How Do People Experience Illness?, 179
Stages of Illness Behavior, 179
The Nature of the Illness, 180
Hardiness, 180
The Intensity, Duration, and Multiplicity of the Disruption, 181
Practical Knowledge: Knowing How, 181
Using the Nursing Process to Promote Health, 181
How Can I Honor Each Client's Unique Health/Illness Experience?, 182
Examine Life's Uncertainties, 183
Envision Wellness for Your Clients and Yourself, 183
Establish Trust at Your First Patient Contact, 183
Provide a Healing Presence, 185
Is a Healthy Life Attainable?, 185
Critical Aspects of Procedure 10–1: Admitting a Patient to a Nursing Unit, 185
Chapter 11. Psychosocial Health & Illness, 186
Psychosocial Health, 187
Theoretical Knowledge: Knowing Why, 187
What Is Self-Concept?, 188
What Are the Components of Self-Concept?, 190
Practical Knowledge: Knowing How, 192
Psychosocial Illness: Anxiety and Depression, 199
Theoretical Knowledge: Knowing Why, 199
Anxiety, 199
Depression, 200
Practical Knowledge: Knowing How, 202
Nursing Care for Anxiety, 202
Nursing Care for Depression, 204
Chapter 12. The Family, 209
Theoretical Knowledge: Knowing Why, 210
What Is a Family?, 210
Family Structures, 210
Approaches to Family Nursing, 211
What Theories Are Useful for Family Care?, 211
General Systems Theory, 212
Structural-Functional Theories, 212
Developmental Theories, 213
What Are Some Family Health Risk Factors?, 213
Childless and Childbearing Couples, 213
Families with Young Children, 214
Families with Adolescents, 214
Families with Middle-Aged Adults, 214
Families with Older Adults, 214
What Are Some Challenges to Family Health?, 215
Poverty and Unemployment, 215
Infectious Diseases, 215
Homelessness, 216
Violence and Neglect Within Families, 216
Practical Knowledge: Knowing How, 217
Assessing the Family's Health Beliefs, 217
Assessing the Family's Communication Patterns, 217
Assessing the Family's Coping Processes, 217
Promoting Family Wellness, 219
Interventions When a Family Member Is Ill, 219
Interventions When There Is a Death in the Family, 219
Chapter 13. Culture & Ethnicity, 221
Theoretical Knowledge: Knowing Why, 222
What Concepts Are Related to Culture?, 223
Dominant Cultures, Subcultures, and Minority Groups, 224
Ethnicity, Race, and Religion, 225
Socialization, Acculturation, and Assimilation, 227
How Do Cultural Values, Beliefs, and Practices Affect Health?, 227
What Are Culture Specifics?, 227
How Do Culture Specifics Affect Health?, 227
What Is the “Culture of Health Care”?, 231
What Are Health and Illness Beliefs?, 231
What Are Health and Illness Practices?, 232
What Is the Culture of the North American Healthcare System?, 232
Nursing and Other Professional Subcultures, 232
Traditional and Alternative Healing, 233
What Is Culturally Competent Care?, 235
Purnell and Paulanka, 236
Leininger, 237
Campinha-Bacote, 237
What Are Some Barriers to Culturally Competent Care?, 237
Practical Knowledge: Knowing How, 238
The Health History, 238
Physical Assessment, 239
Assessing for Pain, 239
Cultural Assessment Models and Tools, 239
Nursing Strategies for Providing Culturally Competent Care, 241
How Can I Become Culturally Competent?, 244
Chapter 14. Spirituality, 245
Theoretical Knowledge: Knowing Why, 246
History of Spirituality in Nursing, 246
What Are Religion and Spirituality?, 247
What Is Religion?, 247
What Is Spirituality?, 248
How Might Spiritual Beliefs Affect Health?, 249
Major Religions: What Should I Know?, 250
Judaism, 250
Christianity, 251
Islam, 251
Baha'i, 252
Hinduism, 252
Sikhism, 252
Buddhism, 252
Native American Religions, 253
Rastafarianism, 253
Self-Knowledge: What Every Nurse Should Know, 254
What Are Your Personal Biases?, 254
What Are Some Barriers to Spiritual Care?, 254
Practical Knowledge: Knowing How, 255
Spiritual Assessment Tools, 256
Levels of Spiritual Assessment, 256
Sources of Information About Spirituality, 256
Diagnoses Related to Spirituality, 256
Other Diagnoses Related to Spirituality, 257
What Are Spiritual Interventions?, 258
Prayer, 259
Cures, Miracles and Spiritual Healing, 260
Chapter 15. Loss, Grief, & Dying, 263
Theoretical Knowledge: Knowing Why, 264
Loss and Grief, 264
What Is Loss?, 264
What Is Grief?, 265
Death and Dying, 269
How Is Death Defined?, 269
What Are the Stages of Dying?, 270
What Is End-of-Life Care?, 271
What Are Some Legal/Ethical Considerations?, 273
Practical Knowledge: Knowing How, 276
Therapeutic Communication, 282
Facilitating Grief Work, 282
Helping Families of Dying Patients, 283
Care of the Dying Person, 283
Providing Postmortem Care, 285
Providing Grief Education, 285
Helping Children Deal with Loss, 285
Taking Care of Yourself, 286
Unit 3. Essential Nursing Interventions, 287
Chapter 16. Documenting & Reporting, 288
Theoretical Knowledge: Knowing Why, 289
Documentation, 289
Why Do Healthcare Providers Use Written Communication?, 289
What Are the Two Main Documentation Systems?, 290
What Are Some Common Types of Charting?, 291
What Forms Do Nurses Use to Document Care?, 293
Computerized Charting, 298
What Is Unique About Documentation in Home Health Care?, 299
What Is Unique About Documentation in Long-Term Care?, 299
Oral Reporting, 299
How Do I Give Change-of-Shift Report?, 299
What Are Transfer Reports?, 300
How Do I Receive and Document Telephone Orders and Verbal Orders?, 300
Practical Knowledge: Knowing How, 301
Guidelines for Documenting Care, 301
Can I Delegate Charting?, 302
How Do I Question a Physician's Order?, 302
Chapter 17. Measuring Vital Signs, 304
What Are Vital Signs, 305
When Should I Measure a Patient's Vital Signs?, 306
How Do I Record Vital Signs?, 306
Body Temperature, 306
Theoretical Knowledge: Knowing Why, 307
What Is a Normal Temperature?, 307
How Does the Body Regulate Temperature?, 307
What Factors Influence Body Temperature?, 309
Practical Knowledge: Knowing How, 310
Critical Aspects of Procedure 17–1: Assessing Body Temperature, 311
Critical Aspects of Procedure 17–2: Assessing Peripheral Pulses, 311
Critical Aspects of Procedure 17–3: Assessing Apical Pulse, 311
Critical Aspects of Procedure 17–4: Assessing for an Apical-Radial Pulse Deficit, 311
Critical Aspects of Procedure 17–5: Assessing Respirations, 311
Critical Aspects of Procedure 17–6: Measuring Blood Pressure, 311
What Is Fever?, 314
What Is Hypothermia?, 316
Pulse, 317
Theoretical Knowledge: Knowing Why, 317
What Is a Normal Pulse Rate?, 317
How Does the Body Produce and Regulate the Pulse?, 317
What Factors Influence Pulse Rate?, 317
Practical Knowledge: Knowing How, 318
Respiration, 322
Theoretical Knowledge: Knowing Why, 322
What Is a Normal Respiratory Rate?, 322
How Does the Body Regulate Respiration?, 322
Mechanics of Breathing, 322
What Factors Influence Respiration?, 323
Practical Knowledge: Knowing How, 324
What Are Some Alterations in Respiration?, 326
Blood Pressure, 326
Theoretical Knowledge: Knowing Why, 327
What Is a Normal Blood Pressure Reading?, 327
How Does the Body Regulate Blood Pressure?, 328
What Factors Influence Blood Pressure?, 328
Practical Knowledge: Knowing How, 329
What Is Hypotension?, 333
What Is Hypertension?, 334
Putting It All Together, 335
Evaluating Vital Signs, 335
Delegating Vital Signs, 336
Chapter 18. Communicating & the Therapeutic Relationship, 337
Theoretical Knowledge: Knowing Why, 338
What Is Communication?, 338
Communication Occurs on Three Levels, 338
Communication Involves Both Content and Process, 339
Communication Can Be Verbal or Nonverbal, 340
What Factors Affect Communication?, 343
Environment, 343
Developmental Variations, 343
Gender, 344
Personal Space, 344
Territoriality, 345
Sociocultural Factors, 345
Roles and Relationships, 345
What Is the Role of Communication in Therapeutic Relationships?, 345
Communication Is Essential to All Phases of the Therapeutic Relationship, 346
Therapeutic Communication Has Five Key Characteristics, 346
Communication Is Also Important in Group Helping Relationships, 347
Practical Knowledge: Knowing How, 348
Etiologies of Communication Diagnoses, 349
Communication as Etiology of Other Nursing Diagnoses, 349
Enhancing Therapeutic Communication, 349
Barriers to Therapeutic Communication, 351
Using a Translator, 355
Enhancing Communication with Clients with Impaired Hearing or Speech, 355
Enhancing Communication with Clients with Impaired Cognition or Reduced Level of Consciousness, 355
Chapter 19. Health Assessment: Performing a Physical Examination, 356
Theoretical Knowledge: Knowing Why, 357
Physical Examination, 357
What Are the Purposes of a Physical Examination?, 357
How Do I Prepare to Perform a Physical Examination?, 359
How Do I Position the Client for a Physical Examination?, 360
What Skills Do I Need to Perform a Physical Examination?, 360
How Do I Modify Assessment for Different Age Groups?, 363
Practical Knowledge: Knowing How, 364
The General Survey, 365
Appearance and Behavior, 365
Body Type and Posture, 365
Speech, 365
Dress, Grooming, and Hygiene, 365
Mental State, 365
Vital Signs, 365
Height and Weight, 365
The Integumentary System, 366
The Skin, 366
The Hair, 369
The Nails, 369
The Head, 370
The Skull and Face, 370
The Eyes, 370
The Ears and Hearing, 372
The Nose, 374
The Mouth and Oropharynx, 374
The Neck, 375
The Thyroid Gland, 376
The Cervical Lymph Nodes, 376
The Breasts and Axillae, 376
The Chest and Lungs, 377
Chest Landmarks, 377
Chest Shape and Size, 378
Breath Sounds, 379
The Cardiovascular System, 380
The Cardiac Cycle, 380
Cardiac Landmarks, 380
Inspection and Palpation of the Heart, 381
Heart Sounds, 381
The Vascular System, 382
The Abdomen, 383
The Musculoskeletal System, 384
Body Shape and Symmetry, 384
Balance, Coordination, and Movement, 385
Joint Mobility and Muscle Function, 385
The Neurological System, 385
Cerebral Function, 386
Cranial Nerve Function, 387
Reflex Function, 387
Sensory Function, 389
Motor and Cerebellar Function, 389
The Genitourinary System, 390
The Male Genitourinary System, 390
The Female Genitourinary System, 390
The Anus, Rectum, and Prostate, 392
Documenting Physical Assessment Findings, 392
Critical Aspects of Procedures 19–1 through 19–19: Comprehensive Physical Examination: Summary, 393
Chapter 20. Promoting Asepsis & Preventing Infection, 397
Theoretical Knowledge: Knowing Why, 398
How Does Infection Occur?, 398
Infections Develop in Response to a Chain of Factors, 398
Infections Can Be Classified by Location and Duration, 401
Infections Follow Predictable Stages, 401
What Are the Body's Defenses Against Infection?, 401
Primary Defenses, 401
Secondary Defenses, 402
Tertiary Defenses, 402
How Can the Host Defenses Be Supported?, 404
Nutrition, 404
Hygiene, 405
Rest and Exercise, 405
Stress Reduction, 405
Immunizations, 405
What Factors Increase the Risk for Infection?, 405
Practical Knowledge: Knowing How, 406
Nursing History, 406
Physical Assessment, 406
Medical Asepsis, 408
Critical Aspects of Procedure 20–1: Hand Washing, 410
Surgical Asepsis, 413
Critical Aspects of Procedure 20–2: Donning and Removing Personal Protective Equipment, 414
Critical Aspects of Procedure 20–3: Surgical Hand Washing, 414
Critical Aspects of Procedure 20–4: Donning Sterile Gown and Gloves (Closed Method), 414
Critical Aspects of Procedure 20–5: Applying Sterile Gloves (Open Method), 414
Critical Aspects of Procedure 20–6: Preparing and Maintaining a Sterile Field, 414
Infection Control for Healthcare Workers, 416
What Should I Do If I Am Exposed to Blood-Borne Pathogens?, 416
What Role Does the Infection Control Nurse Play?, 417
How Can I Minimize the Effects of Bioterrorism and Infectious Outbreaks?, 417
Chapter 21. Promoting Safety, 419
Theoretical Knowledge: Knowing Why, 420
What Factors Affect Safety?, 421
Developmental Factors, 421
Individual Risk Factors, 421
What Safety Hazards Are in the Home?, 422
Poisoning, 422
Carbon Monoxide Poisoning, 424
Scalds and Burns, 425
Fires, 425
Falls, 425
Firearm Injuries, 426
Suffocation and Asphyxiation, 427
Take-Home Toxins, 428
What Safety Hazards Are in the Community?, 428
Motor Vehicle Accidents, 428
Pathogens, 429
Pollution, 430
Electrical Storms, 431
What Safety Hazards Are in the Healthcare Facility?, 432
Falls, 432
Equipment-Related Accidents, 433
Fires and Electrical Hazards, 433
Restraints, 434
Critical Aspects of Procedure 21–1: Using a Bed-Monitoring Device, 435
Critical Aspects of Procedure 21–2: Using Restraints, 435
Mercury Poisoning, 436
Hazards to Healthcare Workers, 437
Practical Knowledge: Knowing How, 438
Morse Fall Scale, 438
Home Safety Assessment, 438
Nursing Activities Related to Safety, 439
Which Safety Interventions Can I Delegate?, 439
Chapter 22. Facilitating Hygiene, 441
Theoretical Knowledge: Knowing Why, 442
Hygiene and Self-Care, 442
What Factors Influence Hygiene Practices?, 442
How Does Health Status Affect Self-Care Ability?, 443
Practical Knowledge: Knowing How, 444
Assessing Self-Care Abilities, 444
Nursing Diagnoses Related to Self-Care, 445
Types of Scheduled Hygiene Care, 446
Delegating Hygiene Care to Unlicensed Assistive Personnel, 446
Care of the Skin, 447
Theoretical Knowledge: Knowing Why, 447
Anatomy and Physiology of the Skin, 447
Functions of the Skin, 447
Factors Affecting the Skin, 447
Practical Knowledge: Knowing How, 448
Subjective Data, 448
Objective Data, 448
Impaired Skin Integrity as Problem, 449
Impaired Skin Integrity as Etiology, 449
Rationale for Bathing, 450
Choosing the Type of Bath to Meet Patient Needs, 450
Critical Aspects of Procedures 22–1 through 22–14: Hygiene Procedures, 451
Back Massage, 455
Care of the Feet, 455
Theoretical Knowledge: Knowing Why, 455
Developmental Variations, 455
Common Foot Problems and Nursing Implications, 455
Practical Knowledge: Knowing How, 456
Diabetic Foot Care, 457
Care of the Nails, 457
Oral Hygiene, 459
Theoretical Knowledge: Knowing Why, 459
Developmental Variations, 459
Risk Factors for Oral Problems, 459
Common Problems of the Mouth, 460
Practical Knowledge: Knowing How, 461
Oral Care for Unconscious Patients, 462
Denture Care, 463
Care of the Hair, 464
Hair Care, 465
Beard and Mustache Care, 465
Shaving, 465
Care of the Eyes, 466
Eye Care for the Unconscious Client, 466
Caring for Eyeglasses and Contact Lenses, 466
Caring for Artificial Eyes, 467
Care of the Ears, 468
Providing Ear Care, 468
Care of Hearing Aids, 468
Care of the Nose, 469
The Client's Environment, 469
Practical Knowledge: Knowing How, 469
Ventilation, 469
Room Temperature, 469
Noise, 469
Hospital Beds, 470
Mattresses and Linens, 470
Bed Making, 470
Chapter 23. Administering Medications, 472
Theoretical Knowledge: Knowing Why, 474
How Are Drugs Named and Classified?, 474
Drug Names, 474
Drug Classifications, 474
What Mechanisms Promote Drug Quality and Safety?, 474
Drug Listings and Directories, 474
Legal Considerations, 476
Systems for Storing and Distributing Medications, 477
What Is Pharmacokinetics?, 478
What Factors Affect Drug Absorption?, 479
How Are Drugs Distributed Throughout the Body?, 484
How Are Drugs Metabolized in the Body?, 485
How Are Drugs Excreted from the Body?, 485
Concepts Relevant to Drug Effectiveness, 485
What Factors Affect Pharmacokinetics?, 487
What Is Pharmacodynamics?, 488
What Are Primary Effects?, 488
What Are Secondary Effects?, 488
How Do Medications Interact?, 491
What Should I Know About Drug Abuse or Misuse?, 491
How Do I Measure and Calculate Dosage?, 492
Medication Measurement Systems, 492
Calculating Dosages, 492
What Must I Know About Medication Orders?, 492
What Abbreviations Are Used in Medication Orders?, 493
Types of Medication Orders, 494
How Are Medication Orders Communicated?, 494
What Steps Should I Take If I Think an Order Is Incorrect?, 494
Practical Knowledge: Knowing How, 495
Risk for Injury, 496
Noncompliance, 496
Ensuring Safe Medication Administration, 497
Six Rights, 499
Other Rights, 499
Administering Oral Medications, 499
Pouring Liquid Medications, 500
Buccal and Sublingual Medications, 500
Enteral (Nasogastric and Gastrostomy) Medications, 500
Special Situations, 500
Medicating Children, 501
Medicating Older Adults, 501
Administering Topical Medications, 502
Skin Applications: Lotions, Creams, and Ointments, 502
Transdermal Medications, 502
Performing Irrigations and Instillations, 503
Administering Respiratory Inhalations, 504
Types of Nebulizers, 504
Metered-Dose Inhalers, 505
Administering Parenteral Medications, 505
Preparing Injectable Medications, 507
Administering Parenteral Injections, 511
Medication Errors, 521
Why Do Errors Occur?, 521
How Can I Avoid Errors?, 521
Critical Aspects of Procedure 23–1: Administering Oral Medications, 522
Critical Aspects of Procedure 23–2: Administering Ophthalmic Medications, 522
Critical Aspects of Procedure 23–3: Administering Otic Medications, 522
Critical Aspects of Procedure 23–4: Administering Nasal Medications, 522
Critical Aspects of Procedure 23–5: Administering Vaginal Medications, 523
Critical Aspects of Procedure 23–6: Inserting a Rectal Suppository, 523
Critical Aspects of Procedure 23–7: Preparing and Drawing Up Medications, 523
Critical Aspects of Procedure 23–8: Mixing Medications in One Syringe, 523
Critical Aspects of Procedure 23–9: Recapping Needles Using One-Handed Technique, 524
Critical Aspects of Procedure 23–10: Administering Intradermal Medications, 524
Critical Aspects of Procedure 23–11: Administering Subcutaneous Medications, 524
Critical Aspects of Procedure 23–12: Locating Intramuscular Injection Sites, 524
Critical Aspects of Procedure 23–13: Administering Intramuscular Injections, 524
Critical Aspects of Procedure 23–14: Adding Medications to Intravenous Fluids, 525
Critical Aspects of Procedure 23–15: Administering IV Push Medications, 525
Critical Aspects of Procedure 23–16: Administering Medications by Intermittent Infusion, 525
What Should I Do If I Commit a Medication Error?, 525
Chapter 24. Teaching Clients, 527
Theoretical Knowledge: Knowing Why, 528
Who Are the Learners?, 528
What Are My Teaching Responsibilities?, 529
What Are Some Basic Learning Concepts and Principles?, 529
Learning Occurs in Three Domains, 529
Many Factors Affect Client Learning, 531
Barriers to Teaching and Learning, 536
Practical Knowledge: Knowing How, 537
Deficient Knowledge as Primary Problem, 538
Deficient Knowledge as Etiology, 538
Wellness Diagnoses, 538
Incorrect Uses of Deficient Knowledge, 538
Creating Teaching Plans, 540
Documentation of Teaching and Learning, 547
Unit 4. How Nurses Support Physiological Functioning, 549
Chapter 25. Stress & Adaptation, 550
Theoretical Knowledge: Knowing Why, 551
What Is Stress?, 551
Types of Stressors, 551
Models of Stress, 552
How Do Coping and Adaptation Relate to Stress?, 553
Three Approaches to Coping Are Commonly Used, 553
The Outcome of Stress Is Either Adaptation or Disease, 553
Personal Factors Influence Adaptation, 553
How Do People Respond to Stressors?, 554
The General Adaptation Syndrome Includes Nonspecific, Systemic Responses, 554
The Local Adaptation Syndrome Involves a Specific, Local Response, 557
Psychological Responses to Stress Include Feelings, Thoughts, and Behaviors, 558
Spiritual Responses to Stress Are Multifaceted, 562
What Happens When Adaptation Fails?, 562
Stress-Induced Organic Responses, 562
Somatoform Disorders, 563
Stress-Induced Psychological Disorders, 563
Practical Knowledge: Knowing How, 564
Assess Stressors, Risk Factors, and Coping and Adaptation, 565
Assess Support Systems, 565
Health Promotion Activities, 567
Relieving Anxiety, 568
Anger Management, 570
Stress Management Techniques, 570
Changing Perception of Stressors or Self, 571
Identifying and Using Support Systems, 572
Providing Spiritual Support, 572
Crisis Intervention, 572
Stress Management in the Workplace, 572
Making Referrals, 572
Chapter 26. Nutrition, 574
Theoretical Knowledge: Knowing Why, 575
What Are the Energy Nutrients?, 575
Carbohydrates, 577
Proteins, 577
Lipids, 579
What Are the Micronutrients?, 581
Vitamins, 581
Minerals, 581
Why Is Water an Essential Nutrient?, 582
What Are Some Reliable Sources of Nutrition Information?, 582
Dietary Reference Intakes (DRIs), 582
USDA Dietary Guidelines, 587
Canada's Food Guide for Healthy Eating, 587
USDA Food Guide Pyramid, 587
Nutrition Facts Panels, 591
What Must I Know About Energy Balance?, 591
What Is Basal Metabolic Rate?, 592
How Do I Calculate a Client's Total Energy Needs?, 593
What Are Some Body Weight Standards?, 594
What Factors Affect Nutrition?, 594
Developmental Stage, 594
Lifestyle Choices, 598
Ethnicity, Culture, and Religious Practices, 599
Disease Processes and Functional Limitations, 599
What Are Special Diets?, 600
Regular Diet, 601
NPO, 601
Diets Modified by Consistency, 601
Diets Modified for Disease, 601
Practical Knowledge: Knowing How, 602
How Do I Screen Clients for Nutritional Problems?, 602
How Can I Assess Body Composition?, 602
What Physical Examination Findings Are Cues to Nutrient Imbalance?, 604
What Are the Signs of Severe Malnutrition?, 604
What Laboratory Values Indicate Nutritional Status?, 605
Delegating Nutritional Assessment, 606
Nutrition as the Problem, 606
Nutrition as the Etiology, 606
Vitamin and Mineral Supplementation, 607
Nutritious Foods on a Limited Budget, 608
Supporting Special Nutritional Needs, 608
Assisting Patients with Meals, 609
What Are Overweight and Obesity?, 609
What Are Underweight and Undernutrition?, 611
Critical Aspects of Procedure 26–1: Checking Fingerstick (Capillary) Blood Glucose Levels, 612
Critical Aspects of Procedure 26–2: Inserting Nasogastric and Nasoenteric Tubes, 612
Critical Aspects of Procedure 26–3: Administering Feedings Through Gastric and Enteric Tubes, 612
Critical Aspects of Procedure 26–4: Removing a Nasogastric or Nasoenteric Tube, 612
Improving the Patient's Appetite, 612
Alternative Feeding Methods, 613
Chapter 27. Urinary Elimination, 618
Theoretical Knowledge: Knowing Why, 619
How Does the Urinary System Work?, 619
The Kidneys Filter and Regulate, 619
The Nephrons Form Urine, 620
The Ureters Transport Urine, 621
The Urinary Bladder Stores Urine, 621
The Urethra Transports Urine, 622
How Does Urinary Elimination Occur?, 622
Normal Urination Patterns, 622
Characteristics of Normal Urine, 622
What Factors Affect Urinary Elimination?, 623
Developmental Factors, 623
Personal, Sociocultural, and Environmental Factors, 623
Nutrition, Hydration, and Activity Level, 623
Medications, 625
Surgery and Anesthesia, 625
Pathological Conditions, 625
Practical Knowledge: Knowing How, 626
Nursing History, 626
Physical Assessment, 626
Assessing the Urine, 626
Urinary Tract Infections, 635
Urinary Retention, 636
Urinary Incontinence, 637
Conditions Requiring Urinary Diversions, 638
Promoting Normal Urination, 639
Teaching Prevention of Urinary Tract Infection, 640
Managing Urinary Retention, 640
Critical Aspects of Procedure 27–1: Collecting a Clean-Catch Urine Specimen, 645
Critical Aspects of Procedure 27–2: Inserting a Urinary Catheter, 645
Critical Aspects of Procedure 27–3: Intermittent Bladder or Catheter Irrigation, 645
Critical Aspects of Procedure 27–4: Continuous Bladder Irrigation, 645
Critical Aspects of Procedure 27–5: Applying an External (Condom) Catheter, 645
Managing Urinary Incontinence, 646
Caring for a Patient With a Urinary Diversion, 649
Chapter 28. Bowel Elimination, 650
Theoretical Knowledge: Knowing Why, 651
What Are the Anatomical Structures of the Gastrointestinal Tract?, 651
The Mouth, 651
The Esophagus, 651
The Stomach, 651
The Small Intestine, 652
The Large Intestine, 653
The Rectum and Anus, 653
How Does the Bowel Eliminate Waste?, 654
The Process of Defecation, 654
Normal Defecation Patterns, 654
What Factors Affect Bowel Elimination?, 655
Developmental Stage, 655
Personal and Sociocultural Factors, 655
Nutrition, Hydration, and Activity Level, 655
Medications and Procedures, 656
Pregnancy, 657
Pathological Conditions, 657
Bowel Diversions, 657
Practical Knowledge: Knowing How, 659
Nursing History, 659
Physical Assessment, 659
Diagnostic Tests, 660
Critical Aspects of Procedure 28–1: Testing Stool for Occult Blood, 662
Critical Aspects of Procedure 28–2: Placing and Removing a Bedpan, 662
Critical Aspects of Procedure 28–3: Administering an Enema, 662
Critical Aspects of Procedure 28–4: Removing Stool Digitally, 662
Critical Aspects of Procedure 28–5: Changing an Ostomy Appliance, 663
Critical Aspects of Procedure 28–6: Irrigating a Colstomy, 663
Promoting Normal or Regular Defecation, 665
Managing Diarrhea, 666
Managing Constipation, 667
Managing Fecal Impaction, 667
Enemas, 668
Digital Removal of Stool, 670
Managing Flatulence, 670
Managing Bowel Incontinence, 670
Caring for a Patient With a Bowel Diversion, 671
Chapter 29. Sensory Perception, 679
Theoretical Knowledge: Knowing Why, 680
Components of the Sensory Experience, 680
Reception, 680
Perception, 681
Arousal Mechanism, 681
Responding to Sensations, 682
Factors Affecting Sensory Function, 682
Developmental Variations, 682
Culture, 682
Illness and Medications, 683
Stress, 683
Personality and Lifestyle, 683
Sensory Alterations, 684
Sensory Deprivation, 684
Sensory Overload, 684
Sensory Deficits, 685
Practical Knowledge: Knowing How, 689
Nursing History, 689
Physical Examination, 691
Promoting Optimal Sensory Function, 692
Preventing Sensory Deprivation, 692
Preventing Sensory Overload, 694
Caring for Clients with Sensory Deficits, 694
Critical Aspects of Procedure 29–1: Otic Irrigation, 695
Chapter 30. Pain Management, 698
Theoretical Knowledge: Knowing Why, 699
What Is Pain?, 699
Origin of Pain, 699
Cause of Pain, 700
Duration of Pain, 700
Quality of Pain, 701
What Happens When Someone Has Pain?, 701
Transduction, 701
Transmission, 701
Pain Perception, 702
Pain Modulation, 702
What Factors Influence Pain?, 703
Emotions, 703
Developmental Stage, 704
Sociocultural Factors, 704
Communication and Cognitive Impairments, 705
How Does the Body React to Pain?, 705
Unrelieved Pain, 706
Practical Knowledge: Knowing How, 706
Pain, the Fifth Vital Sign, 707
Assessing Pain in Children, 707
How Do I Assess for Nonverbal Signs of Pain?, 707
How Do I Use Pain Scales?, 708
Nonpharmacological Pain Relief Measures, 709
Pharmacological Pain Relief Measures, 712
Chemical Pain Relief Measures, 716
Critical Aspects of Procedure 30–1: Connecting a Patient-Controlled Analgesia Pump, 716
Surgical Interruption of Pain Conduction Pathways, 718
Misconceptions That Interfere with Pain Management, 718
Managing Pain in Older Patients, 719
Managing Pain in Patients with Substance Abuse or Active Addiction, 719
Pain Relief from Placebos, 719
Teaching the Patient and Family About Pain, 720
Documentation, 720
Nursing Process in Action, 720
Chapter 31. Activity & Exercise, 724
Theoretical Knowledge: Knowing Why, 725
Physiology of Movement, 725
Skeletal System, 725
Muscles, 726
Nervous System, 728
Body Mechanics, 729
Body Alignment, 729
Balance, 729
Coordination, 730
Joint Mobility, 730
Body Mechanics Guidelines, 730
Exercise, 731
Types of Exercise, 731
Exercise Program Guidelines, 731
Benefits of Regular Exercise, 732
Risks Associated with Exercise, 733
Factors Affecting Mobility and Activity, 735
Developmental Stage, 735
Nutrition, 735
Lifestyle, 735
Stress, 735
External Factors, 735
Diseases and Abnormalities, 737
Hazards of Immobility, 739
Effect of Immobility on Muscles and Bones, 739
Effects of Immobility on the Lungs, 739
Effect of Immobility on the Heart and Vessels, 739
Effects of Immobility on Metabolism, 739
Effects of Immobility on the Integument, 740
Effects of Immobility on the Gastrointestinal System, 740
Effects of Immobility on the Genitourinary System, 740
Psychological Effects of Imobillity, 740
Practical Knowledge: Knowing How, 740
Nursing History, 741
Physical Assessment, 741
Promoting Exercise, 748
Preventing Injury from Exercise, 748
Positioning Patients, 748
Moving Patients in Bed, 752
Transferring Patients Out of Bed, 754
Critical Aspects of Procedure 31–1A: Moving a Patient Up in Bed, 754
Critical Aspects of Procedure 31–1B:Turning a Patient in Bed, 754
Critical Aspects of Procedure 31–1C: Logrolling a Patient, 754
Critical Aspects of Procedure 31–2A:Transferring Patient from Bed to Stretcher, 754
Critical Aspects of Procedure 31–2B: Dangling a Patient at the Side of the Bed, 754
Critical Aspects of Procedure 31–2C:Transferring a Patient from Bed to Chair, 755
Critical Aspects of Procedure 31–3: Assisting with Ambulation, 755
Performing Range-of-Motion Exercises, 757
Assisting with Ambulation, 757
Chapter 32. Sexual Health, 762
Theoretical Knowledge: Knowing Why, 763
Sexual and Reproductive Anatomy and Physiology, 763
Female Reproductive Organs, 764
The Menstrual Cycle, 764
Male Reproductive Organs, 764
Sexuality, 765
What Is Gender?, 765
What Is Sexual Orientation?, 767
How Does Sexuality Develop?, 768
What Factors Affect Sexuality?, 770
Sexual Health, 774
What Is the Sexual Response Cycle?, 774
What Are Some Forms of Sexual Expression?, 776
What Problems Affect Sexuality?, 778
Practical Knowledge: Knowing How, 781
Sexual History, 781
Physical Examination, 781
Etiologies of Sexuality Diagnoses, 782
Sexuality Problems as Etiologies of Other Diagnoses, 783
Teaching About Sexual Health, 783
Counseling for Sexual Problems, 789
Dealing with Inappropriate Sexual Behavior, 790
Putting It All Together, 791
Chapter 33. Sleep & Rest, 792
Theoretical Knowledge: Knowing Why, 793
Why Do We Need to Sleep?, 794
How Much Sleep Do We Need?, 794
Physiology of Sleep, 795
How Do Circadian Rhythms Influence Sleep?, 795
How Is Sleep Regulated?, 796
What Are the Stages of Sleep?, 796
What Factors Affect Sleep?, 799
Age, 799
Lifestyle Factors, 799
Illness, 800
Environmental Factors, 800
What Are Some Common Sleep Disorders?, 800
Insomnia, 801
Sleep-Wake Schedule (Circadian) Disorders, 801
Restless Leg Syndrome (RLS), 801
Sleep Deprivation, 801
Hypersomnia, 801
Sleep Apnea, 801
Snoring, 802
Narcolepsy, 802
Parasomnias, 802
Secondary Sleep Disorders, 803
Disorders That Are Provoked by Sleep, 803
Practical Knowledge: Knowing How, 804
Sleep as the Problem, 804
Sleep Pattern as an Etiology, 805
Sleep Pattern as a Symptom, 805
Schedule Nursing Care to Avoid Interrupting Sleep, 805
Create a Restful Environment, 806
Critical Aspects of Procedure 33–1: Giving a Back Massage, 806
Promote Comfort, 806
Support Bedtime Rituals and Routines, 806
Offer Appropriate Bedtime Snacks or Beverages, 806
Promote Relaxation, 806
Maintain Patient Safety, 807
Teach About Sleep Hygiene, 807
Administer and Teach About Medications to Produce Sleep, 807
Putting It All Together, 808
Chapter 34. Skin Integrity & Wound Healing, 810
Theoretical Knowledge: Knowing Why, 811
Factors Affecting Skin Integrity, 811
Age-Related Variations, 812
Impaired Mobility, 812
Nutrition and Hydration, 813
Diminished Sensation, 813
Impaired Circulation, 813
Medications, 813
Moisture on the Skin, 813
Fever, 814
Contamination or Infection, 814
Lifestyle, 814
Wounds, 814
Types of Wounds, 814
Wound Healing Process, 816
Wound Closures, 818
Collaborative Wound Treatments, 818
Types of Wound Drainage, 819
Complications of Wound Healing, 819
Pressure Ulcers, 820
Pressure Ulcer Development, 820
Staging of Pressure Ulcers, 822
Practical Knowledge: Knowing How, 823
Nursing History, 823
Physical Examination, 825
Laboratory Data, 826
What Assessments Can I Delegate?, 829
Critical Aspects of Procedure 34–1: Obtaining a Wound Culture by Swab, 829
Critical Aspects of Procedure 34–2: Obtaining a Needle Aspiration Culture from a Wound, 829
Critical Aspects of Procedure 34–3: Performing a Sterile Wound Irrigation, 830
Critical Aspects of Procedure 34–4: Removing and Applying Dry Dressings, 830
Critical Aspects of Procedure 34–5: Removing and Applying Wet-to-Damp Dressings, 830
Critical Aspects of Procedure 34–6: Applying a Transparent Film Dressing, 830
Critical Aspects of Procedure 34–7: Applying a Hydrocolloid Dressing, 830
Preventing Pressure Ulcers, 831
Providing Wound Care, 833
Supporting and Immobilizing Wounds, 841
Applying Heat and Cold Therapy, 842
Chapter 35. Oxygenation, 844
Theoretical Knowledge: Knowing Why, 845
The Pulmonary System, 845
What Are the Structures of the Airway?, 845
What Are the Structures of the Lungs?, 847
What Are the Functions of the Pulmonary System?, 848
How Is Breathing Controlled?, 850
The Cardiovascular System, 851
What Are the Structures of the Cardiovascular System?, 851
How Are Oxygen and Carbon Dioxide Transported?, 853
How Is Cardiovascular Function Regulated?, 853
What Factors Influence Oxygenation?, 854
Developmental Stage, 854
Environment, 855
Lifestyle, 856
Medications, 858
Pathophysiological Conditions, 859
Practical Knowledge: Knowing How, 861
Assessing Risk for Impaired Oxygenation, 861
Physical Examination, 861
Critical Aspects of Procedure 35–1A: Obtaining an Expectorated Specimen, 864
Critical Aspects of Procedure 35–1B: Obtaining a Specimen by Suction, 864
Critical Aspects of Procedure 35–2: Monitoring Pulse Oximetry (Arterial Oxygen Saturation), 864
Critical Aspects of Procedure 35–3: Applying and Caring for a Patient with a Cardiac Monitor, 864
Critical Aspects of Procedure 35–4: Performing Percussion, Vibration, and Postural Drainage, 864
Critical Aspects of Procedure 35–5: Administering Oxygen by Cannula, Face Mask, or Face Tent, 865
Critical Aspects of Procedure 35–6: Performing Tracheostomy Care, 865
Critical Aspects of Procedure 35–7: Performing Oropharyngeal and Nasopharygeal Suctioning, 865
Critical Aspects of Procedure 35–8: Performing Orotracheal and Nasotracheal Suctioning, 865
Critical Aspects of Procedure 35–9: Performing Tracheostomy or Endotracheal Suctioning, 866
Critical Aspects of Procedure 35–9A: Performing Tracheostomy or Endotracheal Suctioning Using Inline Suction Equipment, 866
Critical Aspects of Procedure 35–10: Caring for a Patient on a Mechanical Ventilator, 867
Critical Aspects of Procedure 35–11: Caring for the Patient with Chest Tubes (Disposable Water Seal System), 867
Critical Aspects of Procedure 35–12: Performing Cardiopulmonary Resuscitation, One- and Two-Person, 867
Diagnostic Testing, 868
Problems of Ventilation and Gas Exchange, 872
Problems of Circulation, 872
Impaired Oxygenation as Etiology, 872
Promoting Optimal Respiratory Function, 873
Mobilizing Secretions, 874
Supplying Oxygen Therapy, 876
Using Artificial Airways, 877
Suctioning Airways, 879
Caring for a Patient on a Mechanical Ventilator, 880
Caring for a Patient Requiring Chest Tubes, 881
Promoting Circulation, 883
Administering Medications, 884
Performing Cardiopulmonary Resuscitation, 885
Chapter 36. Fluids, Electrolytes, & Acid-Base Balance, 886
Theoretical Knowledge: Knowing Why, 887
Body Fluids, 887
What Are the Body Fluids Compartments?, 887
What Electrolytes Are Present in Body Fluids?, 888
How Do Fluids and Electrolytes Move in the Body?, 889
How Does the Body Regulate Fluids?, 890
How Does the Body Regulate Electrolytes?, 891
How Is Acid-Base Balance Regulated?, 895
Fluid, Electrolyte, and Acid-Base Imbalances, 895
Fluid Imbalances, 896
Electrolyte Imbalances, 896
Acid-Base Imbalances, 898
Practical Knowledge: Knowing How, 901
Nursing History, 901
Physical Assessment, 901
Laboratory Studies, 902
Preventing Fluid and Electrolyte Imbalances, 904
Modifying Oral Fluid Intake, 905
Parenteral Replacement of Fluids and Electrolytes, 905
Critical Aspects of Procedure 36–1: Initiating a Peripheral Intravenous Infusion, 912
Critical Aspects of Procedure 36–2: Regulating the IV Flow Rate, 912
Critical Aspects of Procedure 36–3: Setting Up and Using IV Pumps, 912
Critical Aspects of Procedure 36–4: Changing IV Solutions, Tubing, and Dressings, 913
Critical Aspects of Procedure 36–5: Converting a Primary Line to a Heparin or Saline Lock, 913
Critical Aspects of Procedure 36–6: Discontinuing an IV Line, 913
Critical Aspects of Procedure 36–7: Administering a Blood Transfusion, 914
Replacement of Blood and Blood Products, 918
Chapter 37. Perioperative Nursing, 922
Preoperative Care, 923
Theoretical Knowledge: Knowing Why, 923
How Can Surgeries Be Classified?, 924
What Factors Affect Surgical Risk?, 924
Practical Knowledge: Knowing How, 926
Perioperative Nursing Data Set (PNDS), 926
Nursing History, 927
Physical Assessment, 930
Diagnostic Testing, 930
Confirm That Surgical Consent Has Been Obtained, 931
Provide Preoperative Teaching, 932
Prepare the Patient Physically for Surgery, 932
Critical Aspects of Procedure 37–1:Teaching a Patient to Cough and Deep Breathe, Move in Bed, Perform Leg Exercises, 934
Critical Aspects of Procedure 37–2: Applying Antiembolism Stockings, 934
Critical Aspects of Procedure 37–3: Applying Sequential Compression Devices, 934
Transfer to the Operative Suite, 936
Intraoperative Care, 936
Theoretical Knowledge: Knowing Why, 936
Operative Personnel, 936
Types of Anesthesia, 937
Practical Knowledge: Knowing How, 940
Skin Preparation, 941
Positioning, 941
Intraoperative Safety Measures, 942
Postoperative Care, 942
Theoretical Knowledge: Knowing Why, 942
Recovery from Anesthesia, 942
Recovery from Surgery, 942
Practical Knowledge: Knowing How, 943
Nursing Care in the Postanesthesia Care Unit, 943
Postoperative Nursing Care on the Surgical Unit, 943
Postoperative Teaching, 948
Unit 5. Nursing Functions, 951
Chapter 38. Leading & Managing, 952
Theoretical Knowledge: Knowing Why, 953
What Is Leadership?, 953
Leadership Theories, 953
What Is Management?, 955
Management Theories, 955
Qualities of an Effective Manager, 956
Activities of an Effective Manager, 956
Getting Ready to Become a Leader and Manager, 956
Mentors and Preceptors, 957
How Will This Change as I Grow in My Nursing Career?, 958
What Is Followership?, 958
What Are the Challenges to Being an Effective Leader and Manager?, 959
Economic Climate of Health Care, 960
Nursing Labor Market, 960
What Are Power and Empowerment?, 960
Sources of Power, 960
Sources of Empowerment, 961
Practical Knowledge: Knowing How, 962
Communicating, 962
Delegating, 962
What if I Lack the Experience to Delegate?, 962
What Are the Concerns About Delegating?, 962
Managing Change, 963
The Comfort Zone, 963
Resistance to Change, 963
Implementing the Change, 964
Integrating the Change, 964
Conflict, 965
Conflicts Occur at all Levels, 965
“Win-Win” Resolutons, 965
Conflict Resolution, 966
Informal Negotiation, 966
Time Management, 967
Setting Your Own Goals, 967
Organizing Your Work, 967
Summary, 968
Putting it all Together, 969
Chapter 39. Nursing Informatics, 970
Theoretical Knowledge: Knowing Why, 971
What Is Nursing Informatics?, 971
Data, 972
Information, 972
Knowledge, 972
Wisdom, 972
Understanding Computers and Connectivity, 973
How Do Computers Work?, 973
What Are Some Different Types of Connectivity?, 974
What Are Some Electronic Forms of Communication?, 974
The Role of Informatics in Nursing Practice, 977
Why Are Computers Important for Evidence-Based Practice?, 977
What Are the Benefits of an Electronic Health Record?, 978
Why Are Standardized Nursing Languages Needed for ESRs?, 979
How Does Automation Decrease Error in Healthcare?, 980
How Can I Use Electronic Health Records Ethically?, 980
Practical Knowledge: Knowing How, 981
Using Informatics to Support Evidence-Based Practice, 981
How Do Computers Reduce Barriers to Evidence-Based Practice?, 981
How Do I Use Computers to Search the Literature?, 982
How Do I Evaluate Evidence and Determine a Solution?, 985
Chapter 40. Holistic Healing, 987
Theoretical Knowledge: Knowing Why, 988
Holism, 988
What Is Holistic Healthcare?, 989
What Is a Holistic Patient?, 990
What Is Holistic Nursing?, 991
What Healing Modalities Are Commonly Used?, 991
Alternative Medical Systems, 992
Mind-Body Interventions, 995
Biologically Based Therapies, 996
Manipulative and Body-Based Methods, 998
Energy Therapies, 999
Practical Knowledge: Knowing How, 1001
Chapter 41. Promoting Health, 1003
Theoretical Knowledge: Knowing Why, 1004
What Is Health Promotion?, 1004
Health Promotion versus Health Protection, 1004
Levels of Prevention, 1005
Healthy People 2010, 1005
Health Promotion Models, 1005
Health Promotion Programs, 1008
Health Promotion Throughout the Life Span, 1009
Practical Knowledge: Knowing How, 1009
History and Physical Examination, 1009
Physical Fitness Assessment, 1009
Lifestyle and Risk Appraisal, 1012
Life Stress Review, 1012
Health Beliefs, 1012
Nutritional Assessment, 1013
Health Screening Activities, 1013
Role Modeling, 1016
Providing Counseling, 1016
Providing and Facilitating Support for Lifestyle Change, 1017
Unit 6. The Context for Nurses' Work, 1019
Chapter 42. Community Nursing, 1020
Theoretical Knowledge: Knowing Why, 1021
Understanding Communities, 1021
What Are the Components of a Community?, 1022
What Makes a Community Healthy?, 1022
What Makes a Population Vulnerable?, 1023
Understanding Community Nursing, 1023
Community-Based Care, 1023
Who Were Some Pioneers of Community Nursing?, 1025
Working Within Communities, 1025
What Are Roles of Community Nurses?, 1025
How Are Community Nursing Interventions Classified?, 1026
What Career Opportunities Are Available for Community-Based Nurses?, 1027
Practical Knowledge: Knowing How, 1029
Putting It All Together, 1031
Chapter 43. Nursing in Home Care, 1032
Theoretical Knowledge: Knowing Why, 1033
What Is Home Healthcare?, 1033
Goals of Home Healthcare, 1034
Advantages and Disadvantages, 1034
Who Provides Home Healthcare?, 1035
Home Health Agencies, 1035
The Home Health Team, 1035
The Home Health Nurse, 1035
Hospice Nurses, 1036
Home Health Reimbursement, 1036
What Is the Future of Home Healthcare?, 1037
Practical Knowledge: Knowing How, 1037
How Are Clients Referred to Home Healthcare?, 1037
How Do I Make a Home Visit?, 1037
Before the Visit, 1038
At the Visit, 1039
Chapter 44. Ethics & Values, 1044
Theoretical Knowledge: Knowing Why, 1045
Ethics and Morals, 1045
How Are Morals Developed?, 1046
What Is Nursing Ethics?, 1047
What Factors Affect Moral Decisions?, 1050
Values, Attitudes, and Beliefs, 1051
How Are Values, Morals, and Ethics Related?, 1054
Moral Principles, 1054
Moral Frameworks, 1057
Professional Guidelines, 1059
Ethical Issues in Healthcare, 1062
Practical Knowledge: Knowing How, 1062
Values Clarification, 1062
How Can I Clarify My Values?, 1062
How Can I Help Clients to Clarify Their Values?, 1062
Ethical Decision Making, 1063
Problem or Dilemma?, 1064
What Are Some Decision-Making Models?, 1064
How Do I Work Through an Ethical Problem?, 1064
What Are My Obligations in Ethical Decisions?, 1067
Chapter 45. Legal Issues, 1070
Theoretical Knowledge: Knowing Why, 1071
What Are the Sources of Law?, 1071
What Laws and Regulations Guide Nursing Practice?, 1072
Federal Laws, 1072
State Laws, 1074
Standards of Practice, 1075
Other Guidelines for Practice, 1076
What Is Criminal Law?, 1077
What Is Civil Law?, 1078
Contract Law, 1078
Tort Law, 1078
Litigation in Civil Claims, 1080
Practical Knowledge: Knowing How, 1081
What Are the Most Common Malpractice Claims?, 1081
Failure to Assess and Diagnose, 1081
Failure to Plan, 1082
Failure to Implement a Plan of Care, 1082
Failure to Evaluate, 1083
How Can You Minimize Your Malpractice Risks?, 1083
Observe Mandatory Standards of Care, 1083
Use the Nursing Process and Follow Professional Standards of Care, 1083
Avoid Medication and Treatment Errors, 1083
Report and Document, 1084
Obtain Informed Consent, 1085
Attend to Patient Safety, 1086
Maintain Confidentiality and Privacy, 1086
Provide Education and Counseling, 1086
Assign, Delegate, and Supervise According to Guidelines, 1086
Accept Assignments for Which You Are Qualified, 1086
Participate in Continuing Education, 1086
Observe Professional Boundaries, 1087
Observe Mandatory Reporting Regulations, 1087
Legal Safeguards for Nurses, 1087
What Are Some Major Legal Issues in Nursing Practice?, 1089
Text, Photo & Illustration Credits, C-1
Index, I-1

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