Table Of Content

LWBK330-FM_pi-xxvii.qxd 9/2/09 1:03 AM Page i Aptara T W E L F T H E D I T I O N Suzanne C. Smeltzer, EdD, RN, FAAN Janice L. Hinkle, PhD, RN, CNRN Professor and Director, Center for Nursing Research Formerly, Senior Research Fellow, Acute Stroke Programme Villanova University College of Nursing Oxford Brookes University and John Radcliffe Hospital Villanova, Pennsylvania Oxford, United Kingdom Brenda G. Bare, RN, MSN Kerry H. Cheever, PhD, RN Formerly, Associate Administrator/Chief Nurse Executive Professor and Chairperson Inova Mount Vernon Hospital St. Luke’s School of Nursing at Moravian College Alexandria, Virginia Assistant Vice President St. Luke’s Hospital & Health Network Bethlehem, Pennsylvania i LWBK330-FM_pi-xxvii.qxd 9/2/09 1:03 AM Page ii Aptara Senior Acquisitions Editor:Hilarie Surrena Product Director:Renee Gagliardi Developmental Editors: Martha Cushman/Megan Klim Duttera Senior Marketing Manager:Jodi Bukowski Art Director, Design:Joan Wendt Art Director, Illustration:Brett MacNaughton/Bob Galindo Manufacturing Coordinator:Karin Duffield Compositor:Aptara, Inc. Twelfth Edition Copyright © 2010 by Wolters Kluwer Health / Lippincott Williams & Wilkins. Copyright © 2008 by Lippincott Williams & Wilkins, a Wolters Kluwer business. Copyright © 2004, 2000 by Lippincott Williams & Wilkins. Copyright © 1996 by Lippincott-Raven Publishers. Copyright © 1992, 1988, 1984, 1980, 1975, 1970, 1964 by J. B. Lippincott Company. All rights reserved. This book is protected by copyright. No part of this book may be reproduced or transmitted in any form or by any means, including as photocopies or scanned-in or other electronic copies, or utilized by any information storage and retrieval system without written permission from the copyright owner, except for brief quotations embodied in critical articles and reviews. Materials appearing in this book prepared by individuals as part of their official duties as U.S. government employees are not covered by the above-mentioned copyright. To request permission, please contact Lippincott Williams & Wilkins at 530 Walnut Street, Philadelphia, PA 19106, via email at [email protected], or via our website at lww.com (products and services). Printed in China. 9 8 7 6 5 4 3 2 1 Library of Congress Cataloging-in-Publication Data Brunner & Suddarth’s textbook of medical-surgical nursing. — 12th ed. / Suzanne C. Smeltzer ... [et al.]. p. ; cm. Includes bibliographical references and index. ISBN 978-0-7817-8589-1 (1 volume American ed. : alk. paper) — ISBN 978-0-7817-8590-7 (2 volume American ed. : alk. paper) — ISBN 978-1-60831-080-7 (1 volume international ed.) — ISBN 978-1-60831-088-3 (2 volume international ed.) 1. Nursing. 2. Surgical nursing. I. Brunner, Lillian Sholtis. II. Smeltzer, Suzanne C. O’Connell. III. Title: Brunner and Suddarth’s textbook of medical-surgical nursing. IV. Title: Textbook of medical-surgical nursing. [DNLM: 1. Nursing Care. 2. Perioperative Nursing. WY 150 B8972 2010] RT41.T46 2010 617'.0231—dc22 2009029135 Care has been taken to confirm the accuracy of the information presented and to describe generally accepted practices. How- ever, the authors, editors, and publisher are not responsible for errors or omissions or for any consequences from application of the information in this book and make no warranty, express or implied, with respect to the content of the publication. The authors, editors, and publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accordance with the current recommendations and practice at the time of publication. However, in view of ongoing research, changes in government regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any change in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new or infrequently employed drug. Some drugs and medical devices presented in this publication have Food and Drug Administration (FDA) clearance for limited use in restricted research settings. It is the responsibility of the health care provider to ascertain the FDA status of each drug or device planned for use in his or her clinical practice. LWW.com LWBK330-FM_pi-xxvii.qxd 9/2/09 1:03 AM Page iii Aptara CC OO NN TT RR II BB UU TTOO RR SS Linda L. Altizer, RN, MSN, ONC, FNE Kim Cantwell-Gab, MN, ARNP-BC, CVN, RVT, RDMS Health Professions Coordinator Acute Care and Adult ARNP Hagerstown Community College SW Washington Medical Center –Thoracic and Hagerstown, Maryland Vascular Surgery Vancouver, Washington Chapter 66: Assessment of Musculoskeletal Function Chapter 69: Management of Patients With Musculoskeletal Chapter 31: Assessment and Management of Patients With Vascular Disorders and Problems of Peripheral Circulation Trauma Roberta H. Baron, MSN, RN, AOCN Patricia E. Casey, RN, MSN Clinical Nurse Specialist Director, NCDR Training and Orientation Memorial Sloan-Kettering Cancer Center American College of Cardiology New York, New York Washington, District of Columbia Chapter 48: Assessment and Management of Patients With Chapter 27: Management of Patients With Dysrhythmias and Breast Disorders Conduction Problems Janice M. Beitz, RN, PhD, CS, CNOR, Jill Cash,RN, MSN, APRN, CNP Family Nurse Practitioner CWOCN, CRNP Professor Logan Primary Care La Salle University West Frankfort, Illinois Philadelphia, Pennsylvania Chapter 59: Assessment and Management of Patients With Hearing and Balance Disorders Chapter 38: Management of Patients With Intestinal and Rectal Disorders Kerry H. Cheever, PhD, RN Catherine M. Belt, MSN, RN, AOCN Professor and Chairperson Cancer Network Administrator St. Luke’s School of Nursing at Moravian College Abramson Cancer Center of the University Assistant Vice President of Pennsylvania St. Luke’s Hospital & Health Network Philadelphia, Pennsylvania Bethlehem, Pennsylvania Chapter 16: Oncology: Nursing Management in Cancer Care Chapter 68: Management of Patients with Musculoskeletal Disorders Elizabeth Blunt, PhD, RN, APRN-BC Linda Carman Copel, PhD, RN, PHMCNS, BC, Coordinator Nurse Practitioner Programs CNE, FAPA Villanova University College of Nursing Professor Villanova, Pennsylvania Villanova University Villanova, Pennsylvania Chapter 53: Assessment and Management of Patients With Allergic Disorders Chapter 4:Health Education and Health Promotion Chapter 6: Homeostasis, Stress, and Adaptation Lisa Bowman,MSN, RN, CRNP, CNRN Chapter 7:Individual and Family Considerations Related to Illness Nurse Practitioner, Division of Cerebrovascular Disease and Neurological Critical Care Susanna Garner Cunningham, PhD, BSN, MA, Thomas Jefferson University Hospital FAAN, FAHA Philadelphia, Pennsylvania Professor Chapter 62: Management of Patients With University of Washington Cerebrovascular Disorders Seattle, Washington Chapter 32: Assessment and Management of Patients Jo Ann Brooks,DNS, RN, FCCP, FAAN With Hypertension Vice President, Quality Clarian Health Elizabeth Petit de Mange, PhD, MSN, NP-C, RN Indianapolis, Indiana Assistant Professor Chapter 23: Management of Patients With Chest and Lower Villanova University College of Nursing Respiratory Tract Disorders Villanova, Pennsylvania Chapter 24: Management of Patients With Chronic Pulmonary Chapter 42: Assessment and Management of Patients With Disease Endocrine Disorders iii LWBK330-FM_pi-xxvii.qxd 9/2/09 1:03 AM Page iv Aptara iv Contributors Susan K. Dempsey-Walls, MN, RN, AOCNS, ACHPN Theresa Lynn Green, PhD, MSCHRM, BSCN, RN Oncology Clinical Nurse Specialist Assistant Professor Orlando Health/M. D. Anderson Cancer Center Orlando University of Calgary Orlando, Florida Calgary, Alberta Chapter 49: Assessment and Management of Problems Related to Male Chapter 11: Principles and Practices of Rehabilitation Reproductive Processes Margaret J. Griffiths, MSN, RN, CNE Nancy Donegan, RN, BSN, MPH Assistant Dean, Curricular Initiatives Director, Infection Control University of Pennsylvania School of Nursing Washington Hospital Center Philadelphia, Pennsylvania Washington, District of Columbia Chapter 50: Assessment of Immune Function Chapter 70: Management of Patients With Infectious Diseases Chapter 51: Management of Patients With Immunodeficiency Diane K. Dressler, MSN, RN, CCRN Janice L. Hinkle, PhD, RN, CNRN Clinical Assistant Professor Formerly, Senior Research Fellow, Acute Stroke Programme Marquette University College of Nursing Oxford Brookes University and John Radcliffe Hospital Milwaukee, Wisconsin Oxford, United Kingdom Chapter 28: Management of Patients With Coronary Vascular Disorders Chapter 5: Adult Health and Nutritional Assessment Chapter 30: Management of Patients With Complications from Chapter 54: Assessment and Management of Patients With Rheumatic Heart Disease Disorders Chapter 64: Management of Patients With Neurologic Infections, Phyllis Dubendorf, RN, MSN, CRNP, CNRN Autoimmune Disorders, and Neuropathies Clinical Nurse Specialist Chapter 65: Management of Patients With Oncologic or Degenerative Hospital of the University of Pennsylvania Neurologic Disorders Philadelphia, Pennsylvania Chapter 61:Management of Patients With Neurologic Dysfunction Joyce Young Johnson, RN, MN, PhD Dean, College of Sciences and Health Professions Susan M. Fallone,MS, RN, CNN Department of Nursing Clinical Nurse Specialist, Adult and Pediatric Dialysis Albany State University Albany Medical Center Albany, Georgia Albany, New York Chapter 1: Health Care Delivery and Nursing Practice Chapter 43: Assessment of Renal and Urinary Tract Function Chapter 2: Community-Based Nursing Practice Chapter 3: Critical Thinking, Ethical Decision Making, and Jacqueline D. K. Fenicle, RN, MSN the Nursing Process Director of Patient Care Services Chapter 8: Perspectives in Transcultural Nursing Regional Burn Center and Burn Recovery Lehigh Valley Health Network Tamara M. Kear, MSN, RN, CNN Allentown, Pennsylvania Assistant Professor Chapter 57: Management of Patients With Burn Injury Gwynedd-Mercy College Gwynedd Valley, Pennsylvania Eleanor R. Fitzpatrick, RN, BSN, MSN, CCRN Chapter 45: Management of Patients With Urinary Disorders Clinical Nurse Specialist Elizabeth K. Keech, PhD, MA, BSN Thomas Jefferson University Hospital Assistant Professor Philadelphia, Pennsylvania Villanova University College of Nursing Chapter 39: Assessment and Management of Patients Villanova University With Hepatic Disorders Villanova, Pennsylvania Chapter 40: Assessment and Management of Patients Chapter 12: Health Care of the Older Adult With Biliary Disorders H. Lynne Kennedy, MSN, RN, RNFA, CNOR, CLNC, Kathleen Kelleher Furniss, RNC, MSN, WHNP-BC, DMH AlumnusCCRN Coordinator, Women’s Imaging and Women’s Health NP RNFA, OR Fellowship Instructor, CEU/CME Seminar Mountainside Hospital and Drew University Planner/Instructor Montclair, New Jersey Inova Fair Oaks Hospital Fairfax, Virginia Chapter 46: Assessment and Management of Female Physiologic Processes Chapter 18: Preoperative Nursing Management Chapter 47: Management of Patients With Female Chapter 19: Intraoperative Nursing Management Reproductive Disorders Chapter 20: Postoperative Nursing Management LWBK330-FM_pi-xxvii.qxd 9/2/09 1:03 AM Page v Aptara Contributors v Mary Beth Flynn Makic, PhD, RN, CNS, Janet A. Parkosewich, DNSC, RN, CCRN, FAHA CCNS, CCRN Interim Nurse Researcher Research Nurse Scientist Yale New Haven Hospital Critical Care and Assistant Professor New Haven, Connecticut University of Colorado Hospital Chapter 26:Assessment of Cardiovascular Function University of Colorado Denver-College of Nursing Aurora, Colorado M. Miki Patterson, PhD, PNP, ONP Chapter 15: Shock and Multiple Organ Disfunction Syndrome Visiting Professor University of Massachusetts Lowell Barbara J. Maschak-Carey, MSN, RN, CDE Lowell, Massachusetts Diabetes Clinical Nurse Specialist Chapter 67: Musculoskeletal Care Modalities Program Coordinator, Look AHEAD Study University of Pennsylvania Jana L. Perun, MS, ARNP, AOCNP Philadelphia, Pennsylvania Advanced Registered Nurse Practitioner Chapter 41: Assessment and Management of Patients Cancer Institute of Florida With Diabetes Mellitus Altamonte Springs, Florida Chapter 22:Management of Patients With Upper Respiratory Tract Disorders Agnes Masny, MSN, RN, MPH, CRNP Nurse Practitioner Kimberly L. Quinn, MSN, RN, ACNP, ANP, Fox Chase Cancer Center CCRN, ANCP-C Philadelphia, Pennsylvania Nurse Practitioner for Thoracic Surgery Union Memorial Hospital Chapter 9: Genetics and Genomics Perspectives in Nursing Baltimore, Maryland Phyllis J. Mason,MS, ANP-BC Chapter 35: Management of Patients With Oral and Esophageal Disorders Instructor The Johns Hopkins University School of Nursing JoAnne Reifsnyder, PhD, ACHPN Baltimore, Maryland Assistant Professor and Program Director Chronic Care Management Chapter 34: Assessment of Digestive and Gastrointestinal Function Jefferson School of Population Health Chapter 37: Management of Patients With Gastric and Thomas Jefferson University Duodenal Disorders Philadelphia, Pennsylvania Chapter 17: End-of-Life Care Martha Mulvey,MSN, RN, ANP-BC, ACNS-BC ANP Neurosciences Epilepsy Program Adult and Pediatrics Judith Reishtein, PhD, RN The University Hospital Assistant Professor Newark, New Jersey College of Nursing & Health Professions Chapter 14: Fluid and Electrolytes: Balance and Disturbance Drexel University Philadelphia, Pennsylvania Victoria B. Navarro, MAS, MSN, RN Chapter 21: Assessment of Respiratory Function Director of Nursing The Wilmer Eye Institute at Johns Hopkins Chapter 25: Respiratory Care Modalities Baltimore, Maryland Catherine Stewart Sackett, BS, CRNP Chapter 58: Assessment and Management of Patients With Eye and Nurse Practitioner Vision Disorders Wilmer Eye Institute at Johns Hopkins Medstar Research Institute Donna Nayduch, MSN, RN, ACNP Baltimore, Maryland Trauma Consultant Chapter 58: Assessment and Management of Patients With Eye K-Force Consulting and Vision Disorders Tampa, Florida Chapter 71: Emergency Nursing Linda Schakenbach, MSN, RN, CNS, CCRN, Chapter 72: Terrorism, Mass Casualty, and Disaster Nursing CWCN, ACNS-BC Clinical Nurse Specialist Kathleen M. Nokes, PhD, RN, FAAN Medical Cardiac Nursing Professor and Director of the Graduate Nursing Program Inova Fairfax Hospital Hunter College, CUNY Hunter College School of Nursing Inova Heart and Vascular Institute New York, New York Falls Church, Virginia Chapter 52: Management of Patients With Chapter 29: Management of Patients With Structural, Infectious, and HIV Infection and AIDS Inflammatory Cardiac Disorders LWBK330-FM_pi-xxvii.qxd 9/2/09 1:03 AM Page vi Aptara vi Contributors Suzanne C. Smeltzer, EdD, RN, FAAN Jean Smith Temple, DNS, MSN, BSN Professor and Director, Center for Nursing Research Associate Dean & Associate Professor Villanova University College of Nursing Valdosta State University College of Nursing Villanova, Pennsylvania Valdosta, Georgia Chapter 10: Chronic Illness and Disability Chapter 1:Health Care Delivery and Nursing Practice Chapter 2: Community-Based Nursing Practice Karen A. Steffen-Albert, MSN, RN, CCRN, CNRN Chapter 3: Critical Thinking, Ethical Decision Making, and Clinical Nurse Specialist, Nursing Research & Quality the Nursing Process Thomas Jefferson University Hospital Chapter 8: Perspectives in Transcultural Nursing Philadelphia, Pennsylvania Chapter 63: Management of Patients With Neurologic Trauma Mary L. Thomas, MS, RN, AOCN Hematology Clinical Nurse Specialist Cindy Stern, MSN, RN, CCRP VA Palo Alto Health Care System Cancer Network Administrator Palo Alto, California Abramson Cancer Center of the University of Chapter 33: Assessment and Management of Patients With Pennsylvania Health System Hematologic Disorders Philadelphia, Pennsylvania Chapter 16: Oncology: Nursing Management in Cancer Care Renay D. Tyler, MSN, RN, ACNP, CNSN Acute Care Nurse Practitioner Caroline Steward, RN, MSN, APN-C, CCRN, CNN The Parenteral–Enteral Support Service Nurse Educator Fresenius Medical Care North America The Johns Hopkins Hospital Northern Region Eastern Division Baltimore, Maryland Ewing, New Jersey Chapter 36: Gastrointestinal Intubation and Special Chapter 44: Management of Patients With Renal Disorders Nutritional Modalities Christina Stewart-Amidei, RN, MSN, CNRN, CCRN Joyce S. Willens, PhD, RN, BC Instructor Assistant Professor University of Central Florida Villanova University College of Nursing Orlando, Florida Villanova, Pennsylvania Chapter 60: Assessment of Neurologic Function Chapter 13: Pain Management Christine Tea, MSN, RN, NEA-BC, CBN Iris Woodard, BSN, RN-CS, ANP Service Line Director Nurse Practitioner Inova Fair Oaks Hospital Kaiser Permanente Fairfax, Virginia Rockville, Maryland Chapter 18:Preoperative Nursing Management Chapter 55: Assessment of Integumentary Function Chapter 19: Intraoperative Nursing Management Chapter 56: Management of Patients With Dermatologic Problems Chapter 20: Postoperative Nursing Management Acknowledgments The authors gratefully acknowledge the contributions and expertise of Dale Halsey Lea, MS, RN, MPH, FAAN. LWBK330-FM_pi-xxvii.qxd 9/2/09 1:03 AM Page vii Aptara PPRREEFFAACCEE The first edition of Brunner & Suddarth’s Textbook of Features Medical-Surgical Nursing was published in 1964 under the Practice-Oriented Features leadership of Lillian Sholtis Brunner and Doris Smith Sud- darth. Lillian and Doris pioneered a medical-surgical nurs- Nurses assume many different roles when caring for pa- ing textbook that has become a classic. Medical-surgical tients. Many of the features in this textbook have been de- nursing has come a long way since 1964 but continues to be veloped to help nurses fulfill these varied roles. strongly influenced by the expansion of science, medicine, The Nurse as Practitioner surgery, and technology, as well as a myriad of social, cul- tural, economic, and environmental changes throughout One of the central roles of the nurse is to provide holistic care the world. Nurses must be particularly skilled in critical to patients and their families, both independently and through thinking and clinical decision-making as well as in consult- collaboration with other health care professionals. Many fea- ing and collaborating with other members of the multidis- tures in Brunner & Suddarth’s Textbook of Medical-Surgical ciplinary health care team. Nursingare designed to assist students with clinical practice. Along with the challenges that today’s nurses confront, Nursing Process sections. The nursing process is the basis there are many opportunities to provide skilled, compas- for all nursing practice. Special sections throughout the sionate nursing care in a variety of health care settings, for text, organized according to the nursing process framework, patients in the various stages of illness, and for patients clarify the nurse’s responsibilities in caring for patients with across the age continuum. At the same time, there are sig- selected disorders. nificant opportunities for fostering health promotion activ- Plans of Nursing Care. These plans, provided for se- ities for individuals and groups; this is an integral part of lected disorders, illustrate how the nursing process is providing nursing care. applied to meet the person’s health care and nursing needs. Continuing the tradition of Lillian’s and Doris’s first edition, this 12th edition of Brunner & Suddarth’s Textbook of Applying Concepts from NANDA, NIC, and NOC. Medical-Surgical Nursing is designed to assist nurses in Each unit begins with a case study and a chart presenting preparing for their roles and responsibilities within the examples of NANDA, NIC, and NOC terminologies related complex health care delivery system. A goal of the textbook to the case study. Concept maps, which provide a visual repre- is to provide balanced attention to the art and science of sentation of the NANDA, NIC, and NOC chart for each case adult medical-surgical nursing. The textbook focuses on study, are found on the accompanying Web site to physiologic, pathophysiologic, and psychosocial concepts as this book at thepoint.lww.com/Smeltzer12e. This feature in- they relate to nursing care, and emphasis is placed on inte- troduces the student to the NIC and NOC language and clas- grating a variety of concepts from other disciplines such as sifications and brings them to life in graphic form. nutrition, pharmacology, and gerontology. Content relative Assessment charts. These charts help to focus the to health care needs of people with disabilities, nursing re- student’s attention on data that should be collected as search findings, ethical considerations, and evidence-based part of the assessment step of the nursing process. practice has been expanded to provide opportunities for the nurse to refine clinical decision-making skills. Risk Factor charts. These charts draw the student’s attention to factors that can impair health. Organization Guidelines charts. These charts review key nursing Brunner & Suddarth’s Textbook of Medical-Surgical Nursing, interventions, and the rationales for those interven- 12th edition, is organized into 16 units. Units 1 through 4 tions, for specific patient care situations. cover core concepts related to medical-surgical nursing Pharmacology charts and tables. Pharmacology practice. Units 5 through 16 discuss adult health conditions charts and tables remind the student of important con- that are treated medically or surgically. Each unit covering siderations relative to administering medications and mon- adult health conditions is structured in the following way, itoring drug therapy. to facilitate understanding: • The first chapter in the unit covers assessment and in- Nursing Alerts. These special sections offer brief tips cludes a review of normal anatomy and physiology of for clinical practice and red-flag warnings to help stu- the body system being discussed. dents avoid common mistakes. • The subsequent chapters in the unit cover manage- Critical Care. These special sections highlight nursing ment of specific disorders. Pathophysiology, clinical process considerations for the critically ill patient. manifestations, assessment and diagnostic findings, medical management, and nursing management are Gerontologic Considerations. In the United States, presented. Special “Nursing Process” sections, pro- older adults comprise the fastest-growing segment of vided for selected conditions, clarify and expand on the population. This icon is applied to headings, charts, and the nurse’s role in caring for patients with these con- tables as appropriate to highlight information that pertains ditions. specifically to the care of the older adult patient. vii LWBK330-FM_pi-xxvii.qxd 9/2/09 1:03 AM Page viii Aptara viii Preface Genetics in Nursing Practice charts. These charts reading the chapter, and also serve as a useful reference tool summarize and highlight the role that genetics play in while reading. many disorders. Critical Thinking Exercises. These questions, which ap- Physiology/Pathophysiology figures. These illustrations pear at the end of each chapter, foster critical thinking by and algorithms help students to understand normal physio- challenging the student to apply textbook knowledge to logic and pathophysiologic processes. clinical scenarios. The Nurse as Educator References and Selected Readings. A list of current references cited is given at the end of each chapter. Health education is a primary responsibility of the nursing profession. Nursing care is directed toward promoting, main- Resources. A resource list at the end of each chapter di- taining, and restoring health; preventing illness; and helping rects the reader to sources of additional information, Web patients and families adapt to the residual effects of illness. sites, agencies, and patient education materials. Teaching, in the form of patient education and health pro- A Comprehensive Package for motion, is central to all of these nursing activities. Teaching and Learning Patient Education charts. These charts help the nurse to prepare the patient and family for procedures, To further facilitate teaching and learning, a carefully de- assist them with understanding the patient’s condition, and signed ancillary package is available. In addition to the usual explain to them how to provide for self-care after discharge print resources, we are pleased to present multimedia tools from the health care facility. that have been developed in conjunction with the text. Home Care checklists. These checklists review points Resources for Students that should be covered as part of patient education Interactive DVD-ROM. Packaged with the textbook prior to discharge from the health care facility. at no additional charge, this DVD helps students test Health Promotion charts. These charts review impor- their knowledge and enhance their understanding of tant points that the nurse should discuss with the pa- medical-surgical nursing. This DVD includes: tient to prevent common health problems from developing. • More than 700 study questions organized by unit • 3,500 NCLEX-style cross-disciplinary questions The Nurse as Patient Advocate • Concepts in Action™Animations Nurses advocate for patients by protecting their rights (in- • Nursing in Action™ Videos cluding the right to health care) and assisting patients and • Clinical Simulations their families to make informed decisions about health care. • Spanish-English Audioglossary • Drug Monographs Ethics and Related Issues charts. These charts pres- • Other Learning Tools ent a scenario, a description of potential ethical dilem- mas that could arise as a result of the scenario, and a list Study Guide to Accompany Smeltzer, Bare, Hinkle & of questions about the scenario to stimulate thought and Cheever: Brunner & Suddarth’s Textbook of Medical- discussion. Surgical Nursing, 12th edition. Available at student book- stores or at www.LWW.com, this study guide presents a va- The Nurse as Researcher riety of exercises to reinforce the textbook content and Nurses identify potential research problems and questions enhance learning. to increase nursing knowledge and improve patient care. Handbook to Accompany Smeltzer, Bare, Hinkle & Use and evaluation of research findings in nursing practice Cheever: Brunner & Suddarth’s Textbook of Medical- are essential to further the science of nursing. Surgical Nursing, 12th edition. Available at student book- Nursing Research Profiles. These charts identify the im- stores or at www.LWW.com, this clinical reference presents plications and applications of nursing research findings for need-to-know information on nearly 200 commonly en- nursing practice. countered disorders in an easy-to-use alphabetized outline format. Evidence-Based Practice (EBP) questions. This icon appears next to critical thinking exercises that en- Resources for Instructors courage the student to think about the evidence base for specific nursing interventions. A journals supplement offers Instructor’s Resource DVD-ROM. The instructor’s re- students free online access to over 70 journal articles that source DVD contains the following items: relate to the evidence-based practice questions in the text. • A thoroughly revised and augmented test generator, containing more than 2,000 NCLEX-style questions Pedagogical Features • Sample syllabi for one-, two-, and three-semester courses Learning Objectives. Each chapter begins with a list of • Strategies for effective teaching learning objectives. These give the student an overview of • PowerPoint™ lectures, guided lecture notes, and pre- the chapter and help to focus his or her reading. lecture quizzes Glossaries. Glossaries provided at the beginning of each • An image bank chapter let the student review vocabulary words before • Discussion topics and assignments