Brunner&Suddart's Textbook of Medical-Surgical nursing PDF
Preview Brunner&Suddart's Textbook of Medical-Surgical nursing
CCoonnttrriibbuuttoorrss ●● Sandra M. Annesi, RN, MSN Jill Cash, MSN, APRN, BC Assistant Professor Family Nurse Practitioner Nursing Program Southern Illinois OB-GYN Associates, SC Daytona Beach Community College Carbondale, Illinois DeLand, Florida Chapter 59: Assessment and Management of Patients With Hearing Chapter 25: Respiratory Care Modalities and Balance Disorders Judith C. Bautch, PhD, RN, CS Linda Carman Copel, PhD, RN, CS, CGP, DAPA Professor Associate Professor Department of Nursing Villanova University College of Nursing Winona State University Villanova, Pennsylvania Winona, Minnesota Chapter 4: Health Education and Health Promotion Chapter 54: Assessment and Management of Patients With Chapter 6: Homeostasis, Stress, and Adaptation Rheumatic Disorders Chapter 7: Individual and Family Considerations Related to Illness Jo Ann Brooks-Brunn, DNS, RN, FAAN, FCCP Juliet Corbin, RNC, DNS, FNP Assistant Professor Lecturer Thoracic Surgery School of Nursing Pulmonary and Critical Care Medicine San Jose State University Indiana University School of Medicine San Jose, California Indianapolis, Indiana Chapter 10: Chronic Illness Chapter 23: Management of Patients With Chest and Lower Respiratory Tract Disorders Susanna G. Cunningham, RN, PhD, FAAN, FAHA Chapter 24: Management of Patients With Chronic Obstructive Professor Pulmonary Disorders Department of Biobehavioral Nursing and Health Systems University of Washington School of Nursing Jacqueline Fowler Byers, PhD, RN, CNAA Seattle, Washington Associate Professor Chapter 32: Assessment and Management of Patients School of Nursing With Hypertension University of Central Florida Orlando, Florida Lana Currance, RN, BSN, CCRN Chapter 21: Assessment of Respiratory Function Chief Nursing Officer National Medical Response System Kim Cantwell-Gab, BSN, RN, CVN, RVT, RDMS Colorado 2 DMAT/Central U.S. NMRT-Weapons of Vascular Surgery Nurse Specialist Mass Destruction Department of Surgery, Division of Vascular Surgery Parker, Colorado University of Washington School of Medicine Chapter 72: Terrorism, Mass Casualty, and Disaster Nursing Seattle, Washington Chapter 31: Assessment and Management of Patients With Vascular Margaret A. Degler, RN, MSN, CRNP, CUNP Disorders and Problems of Peripheral Circulation Director, Continence Program West Office of the Center for Urologic Care of Berks County, P.C. Patricia E. Casey, RN, MSN West Reading, Pennsylvania Director, Regional Cardiovascular Program Chapter 12: Health Care of the Older Adult Kaiser Permanente Mid-Atlantic Region Chapter 43: Assessment of Renal and Urinary Tract Function Rockville, Maryland Chapter 44: Management of Patients With Upper or Lower Urinary Chapter 27: Management of Patients With Dysrhythmias Tract Dysfunction and Conduction Problems Chapter 45: Management of Patients With Urinary Disorders Chapter 28: Management of Patients With Coronary Vascular Disorders Nancy E. Donegan, RN, BS, MPH Chapter 29: Management of Patients With Structural, Infectious, Director, Infection Control and Inflammatory Cardiac Disorders Washington Hospital Center Chapter 30: Management of Patients With Complications Washington, D.C. From Heart Disease Chapter 70: Management of Patients With Infectious Diseases v vi Contributors Phyllis Dubendorf, RN, MSN, CS-ACNP Janice L. Hinkle, PhD, RN, CNRN Lecturer, Acute Care Nurse Practitioner Program Assistant Professor School of Nursing Villanova University College of Nursing University of Pennsylvania Villanova, Pennsylvania Philadelphia, Pennsylvania Chapter 5: Health Assessment Chapter 61: Management of Patients With Neurologic Dysfunction Chapter 62: Management of Patients With Cerebrovascular Disorders Chapter 65: Management of Patient With Oncologic Eleanor Fitzpatrick, RN, MSN, CRNP, CCRN and Degenerative Neurologic Disorders Clinical Nurse Specialist Surgical ICU/Intermediate Surgical ICU Ryan R. Iwamoto, ARNP, MN, AOCN Thomas Jefferson University Hospital Oncology Clinical Coordinator Philadelphia, Pennsylvania Genentech BioOncology, Inc. Chapter 39: Assessment and Management of Patients With South San Francisco, California Hepatic Disorders Nurse Practitioner Chapter 40: Assessment and Management of Patients With Biliary Department of Radiation Oncology Disorders Virginia Mason Medical Center Clinical Instructor Mary Beth Flynn, RN, MS University of Washington and Seattle University CNS/Clinical Educator Seattle, Washington University of Colorado Hospital Chapter 49: Assessment and Management of Problems Related to Male Clinical Faculty Reproductive Processes University of Colorado Health Science Center Joyce Young Johnson, RN, PhD, CCRN Denver, Colorado Assistant Chair Chapter 15: Shock and Multisystem Failure Department of Nursing Georgia Perimeter College Kathleen K. Furniss, MSN, APN-C Clarkston, Georgia Nurse Practitioner, Women’s Health Chapter 1: Health Care Delivery and Nursing Practice Women’s Health Initiative Chapter 2: Community-Based Nursing Practice University of Medicine and Dentistry of New Jersey and Associates in Chapter 3: Critical Thinking, Ethical Decision Making, Women’s Health Care and the Nursing Process Newark, New Jersey Chapter 8: Perspectives in Transcultural Nursing Chapter 46: Assessment and Management of Female Physiologic Processes Rhonda Kyanko, RN, MS Chapter 47: Management of Patients With Female Nursing Education Coordinator Reproductive Disorders National Rehabilitation Hospital Washington, DC Paula Graling, RN, MSN, CNS Chapter 11: Principles and Practices of Rehabilitation Clinical Nurse Specialist Perioperative Services Pamela J. LaBorde, MSN, RN Inova Fairfax Hospital Clinical Nurse Specialist, Patient Care Services Falls Church, Virginia University of Arkansas Medical Sciences Center Chapter 18: Preoperative Nursing Management Little Rock, Arkansas Chapter 19: Intraoperative Nursing Management Formerly, Clinical Nurse Specialist, Burn Unit Chapter 20: Postoperative Nursing Management Orlando Regional Medical Center Orlando, Florida Randolph E. Gross, RN, MS, CS, AOCN Chapter 57: Management of Patients With Burn Injury Clinical Nurse Specialist Evelyn H. Louder Breast Center Dale Halsey Lea, RN, MPH, CGC, APGN, FAAN Memorial Sloan-Kettering Cancer Center Assistant Director New York, New York Southern Maine Regional Genetics Services Chapter 48: Assessment and Management of Patients Foundations for Blood Research With Breast Disorders Scarborough, Maine Chapter 9: Genetics Perspectives in Nursing Practice Doreen Grzelak, RN, MSN, AOCN Operations Manager Dorothy B. Liddel, RN, MSN, ONC Medical Imaging Center Associate Professor (Retired) Department of Radiology Department of Nursing Reston Hospital Center Columbia Union College Reston, Virginia Tacoma Park, Maryland Chapter 35: Management of Patients With Oral and Esophageal Chapter 66: Assessment of Musculoskeletal Function Disorders Chapter 67: Musculoskeletal Care Modalities Chapter 37: Management of Patients With Gastric and Duodenal Chapter 68: Management of Patients With Musculoskeletal Disorders Disorders Chapter 69: Management of Patients With Musculoskeletal Trauma Contributors vii Martha V. Manning, RN, MSN Kathleen Nokes, PhD, RN, FAAN Nurse Clinician Professor Inova Emergency Care Center at Fairfax Hunter-Bellevue School of Nursing Fairfax, Virginia New York, New York Chapter 34: Assessment of Digestive and Gastrointestinal Function Chapter 52: Management of Patients With HIV Infection and AIDS Chapter 38: Management of Patients With Intestinal and Rectal Disorders Janet A. Parkosewich, RN, MSN, CCRN Cardiac Clinical Nurse Specialist Barbara J. Maschak-Carey, RN, MSN, CDE Department of Patient Services Clinical Nurse Specialist Yale-New Haven Hospital Department of Endocrinology, Diabetes and Metabolism New Haven, Connecticut University of Pennsylvania Health System Chapter 26: Assessment of Cardiovascular Function Philadelphia, Pennsylvania Chapter 41: Assessment and Management of Patients Anne Gallagher Peach, RN, MSN With Diabetes Mellitus Chief Operating Officer M.D. Anderson Cancer Center Orlando Agnes Masny, RN, MPH, MSN, CRNP Orlando, Florida Research Associate/Nurse Practitioner Chapter 22: Management of Patients With Upper Respiratory Population Science Division, Family Risk Assessment Program Tract Disorders Fox Chase Cancer Center Philadelphia, Pennsylvania JoAnne Reifsnyder, PhD, RN, AOCN Chapter 9: Genetics Perspectives in Nursing Postdoctoral fellow, Psychosocial Oncology School of Nursing Lou Ann McGinty, MSN, RN University of Pennsylvania Nurse Science Clinical Specialist Philadelphia, Pennsylvania Capitol Health System Chapter 17: End-of-Life Care Trenton, New Jersey Chapter 64: Management of Patients With Infectious, Inflammatory, Susan A. Rokita, RN, MS, CRNP and Autoimmune Neurologic Disorders Nurse Coordinator, Cancer Center Oncology Clinical Nurse Specialist Nancy A. Morrissey, RN,C, PhD Milton S. Hershey Medical Center of Pennsylvania State University Patient Care Director Hershey, Pennsylvania Mental Health and Behavioral Center Chapter 16: Oncology: Nursing Management in Cancer Care Inova Alexandria Hospital Alexandria, Virginia Al Rundio, PhD, RN, ANP Chapter 36: Gastrointestinal Intubation and Special Associate Professor Nutritional Modalities Medical College of Pennsylvania/Hahnemann University College of Nursing and Health Professions Martha A. Mulvey, RN, MS, CNS Philadelphia, Pennsylvania Advanced Practice Nurse Chapter 50: Assessment of Immune Function Neurosciences Chapter 51: Management of Patients With Immunodeficiency University of Medicine and Dentistry of New Jersey, Chapter 53: Assessment and Management of Patients University Hospital With Allergic Disorders Newark, New Jersey Chapter 14: Fluids and Electrolytes: Balance and Distribution Catherine Sackett, RN, BS, CANP Ophthalmic Research Nurse Practitioner Victoria Navarro, RN, MAS, MSN Wilmer Eye Institute Director of Clinical Services Retinal Vascular Center Wilmer Eye Institute The Johns Hopkins Medical Institutions The Johns Hopkins Medical Institutions Baltimore, Maryland Baltimore, Maryland Chapter 58: Assessment and Management of Patients With Eye Chapter 58: Assessment and Management of Patients With Eye and Vision Disorders and Vision Disorders Linda Schakenbach, RN, CNS, MSN, CCRN, COCN, CWCN, CS Donna Nayduch, RN-CS, MSN, CCRN Clinical Nurse Specialist, Critical Care Trauma Regional Director Inova Alexandria Hospital Banner Health Alexandria, Virginia Greeley, Colorado Chapter 27: Management of Patients With Dysrhythmias Chapter 71: Emergency Nursing and Conduction Problems Chapter 72: Terrorism, Mass Casualty, and Disaster Nursing Chapter 28: Management of Patients With Coronary Vascular Disorders Chapter 29: Management of Patients With Structural, Infectious, and Inflammatory Cardiac Disorders viii Contributors Margaret A. Spera, NP, APRN Dorraine Day Watts, PhD, RN Nurse Practitioner Interim Director of Research and Education Family Medical Associates Inova Health System Ridgefield, Connecticut Falls Church, Virginia Assistant Clinical Professor Chapter 63: Management of Patients With Neurologic Trauma Yale University School of Nursing New Haven, Connecticut Joan Webb, RN, MSN Chapter 60: Assessment of Neurologic Function Instructor College of Nursing Cindy Stern, RN, MSN Widener University Cancer Network Coordinator Chester, Pennsylvania University of Pennsylvania Cancer Center Chapter 40: Assessment and Management of Patients University of Pennsylvania Health System With Biliary Disorders Philadelphia, Pennsylvania Chapter 42: Assessment and Management of Patients Chapter 16: Oncology: Nursing Management in With Endocrine Disorders Cancer Care Joyce S. Willens, RN, PhD Christine Tea, RN, MSN, CNA Assistant Professor Patient Care Director College of Nursing Main OR Perioperative Services Villanova University Inova Fairfax Hospital Villanova, Pennsylvania Falls Church, Virginia Chapter 13: Pain Management Chapter 18: Preoperative Nursing Management Chapter 19: Intraoperative Nursing Management Iris Woodard, RN-CS, BSN, ANP Chapter 20: Postoperative Nursing Management Nurse Practitioner Department of Dermatology Mary Laudon Thomas, RN, MS, AOCN Kaiser Permanente Hematology Clinical Nurse Specialist Springfield, Virginia Veterans’ Administration, Palo Alto Health Care System Chapter 55: Assessment of Integumentary Function Palo Alto, California Chapter 56: Management of Patients With Dermatologic Problems Chapter 33: Assessment and Management of Patients With Hematologic Disorders CCoonntsruilbtuatnotrss and Reviewers ●● Debbie Amason, BSN, MS, RN Lynn Browning, RN, MSN BC Mary Elliot, BScN, MEd, RN Assistant Professor Assistant Professor of Nursing Professor Floyd College Derry Patterson Wingo School of Nursing Humber College of Applied Arts & Technology Rome, Georgia Charleston Southern University Etobicoke, Ontario, Canada Charleston, South Carolina William Ames, MSN, RN, FNP Cheryl Fenton, BHSc, RN Associate Professor Elizabeth Bruce, RN, MSN Professor Elizabethtown Community College St. Clair Community College Mohawk College Elizabethtown, Kentucky Chatham, Ontario Burlington, Ontario, Canada Susan Arbogast, MS, RN Shirley Cantrell, PhD, RN Kathie Folsom, RN, BSN, MS Faculty Associate Professor Department Chair Maricopa Community College District Piedmont College Skagit Valley College Nursing Program, Phoenix College Demorest, Georgia Oak Harbor, Washington Campus Phoenix, Arizona Donna Cartwright, MS, APRN Donna Funk, MN/E ONC, RN Dean, Professional and Applied Technology Professor of Nursing Gail Armstrong, ND, RN Education Brigham Young University Assistant Professor College of Eastern Utah Rexburg, Idaho University of Colorado School of Nursing Price, Utah Denver, Colorado Vicki Garlock, BSN, MSN, RN Pattie Garrett Clark, MSN, RN Professor, Nursing Department Denise M. Ayers, MSN, RN Associate Professor of Nursing Pensacola Junior College Assistant Professor, Nursing Abraham Baldwin College Pensacola, Florida Kent State University at Tuscarawas Tifton, Georgia New Philadelphia, Ohio Mary Catherine Gebhart, MSN, CRRN, RN Terry Cicero, MN, CCRN, RN Instructor Valerie Benedix, BSN, RN Instructor, School of Nursing Georgia State University Nursing Instructor Seattle University Atlanta, Georgia Clovis Community College Seattle, Washington Clovis, New Mexico Donna Gullette, DNS, RN Tracey D. Cooper, RN, MSN Associate Professor, Critical Care Chair Ilene Borze, MS, CEN, RN Director, Nursing Learning Resources Lab Mississippi University for Women Director, Nursing Continuing Education Instructor, South Plains College Columbus, Mississippi Faculty Levelland, Texas Gateway Community College Carol Heinrich, PhD, RN Phoenix, Arizona Dolly I. Daniel, BSN, CDE, RNC Associate Professor Diabetes Nurse Specialist Department of Nursing Donna Bowren, RN, MSN, CNOR, CRNFA Inova Alexandria Hospital East Stroudsburg University Interim Chairperson, Division of Nursing Alexandria, Virginia East Stroudsburg, Pennsylvania and Allied Health University of Arkansas Community College Toni Doherty, MSN, RN Sandra Hendelman, MS, RN at Batesville Associate Professor Adjunct Professor of Nursing Batesville, Arkansas Department Head, Nursing Palm Beach Community College Dutchess Community College Lake Worth, Florida Pat Bradley, RN, MEd MS Poughkeepsie, New York South College Nursing Faculty Grossmont College Sandra Edwards, BScN, RN Judith Ann Hughes, EdD, RN El Cajon, California Instructor Associate Degree Nursing Coordinator Grant MacEwan College Southwestern Community College Edmonton, Alberta, Canada Sylva, North Carolina ix x Consultants and Reviewers Sadie Pauline Hutson, MSN, RN, CRNP Halton Healthcare Services Kathleen L. Russ, MSN, RN Cancer Research Training Award Oakville, Ontario Dean of Student Support/Health Careers PreDoctoral Fellow Clinical Faculty Gateway Technical College National Cancer Institute, McMaster University School of Nursing Kenosha, Wisconsin Clinical Genetics Branch Hamilton, Ontario Rockville, MD Esther Salinas, MSN, MSEd, RN Lauren O’Hare, MSN, EdD, RN Associate Professor of Nursing Jennifer Johnson. MSN, RN C Assistant Professor of Nursing Del Mar College Assistant Professor of Nursing Wagner College Corpus Christi, Texas Kent State University, Tuscarawas Campus Staten Island, New York New Philadelphia, Ohio Marsha Sharp, MSN, RN Caroline Ostand, BC, MSN, RN Associate Professor Susan J. Lamanna, MA, MSN, RN ANP Clinical Instructor Elizabethtown Community College Associate Professor University of Charleston Elizabethtown, Kentucky Onondaga Community College Charleston, West Virginia Syracuse, New York Kelli Simmons, MS, CS, M-SCNS, RN Thena E. Parrott, PhD, RNCS Cardiothoracic Clinical Nurse Specialist Joan Ann Leach, MS, ME, RNC Director, Associate Degree Nursing Program University of Missouri Hospitals and Clinics Professor of Nursing Blinn College Columbia, Missouri Capital Community College Bryan, Texas Hartford, Connecticut Terri Small, MSN, RN C Billie Phillips, PhD, RN, CDFS Assistant Professor of Nursing Gayle Lee, PhD, RN, CCRN Assistant Professor Waynesburg College Faculty Tennessee Wesleyan College Waynesburg, Pennsylvania Brigham Young University Fort Sanders Nursing Department Rexburg, Idaho Athens, Tennessee Darla R. Ura, MA, ANP-CS, RN Clinical Associate Professor Brenda Lohri-Posey, EdD, RN Pam Primus, BSN, RN Emory University Assistant Dean of Learning, Nursing Nurse Educator Atlanta, Georgia & Program Coordination Casper College Belmont Technical College Casper, Wyoming Weibin Yang, MD St. Clairesville, Ohio Assistant Professor of Physical Medicine and Betty E. Richards, RN, MSN Rehabilitation Medicine (PM&R) Rhonda McLain, MN, RN Professor of Nursing University of Illinois Assistant Professor of Nursing Middle Georgia College Chicago, Illinois Clayton College & State University Cochran, Georgia Morrow, Georgia Patsy Ruppert Rider, MSN, CS, RN Pat Nashef, MHSc BA (CPMHN)c, RN Clinical Instructor in Nursing Professional Practice Clinician, University of Texas at Austin School of Nursing Mental Health Services Austin, Texas Preface ● A s the 21st century begins, nurses face a future characterized NEW CHAPTERS: GENETICS, END-OF-LIFE by changes comparable to those of no preceding century: CARE,AND BIOTERRORISM • Science and technology have made the world smaller by Nursing knowledge is constantly expanding. Chapter 9, Genetics making it more accessible. Perspectives in Nursing Practice,was written in response to genetics • Mass communication is more widespread, and information information identified during the last few years. Every nurse needs is now just an instant away and very easy to obtain. to be aware of the influence of genetics on health and illness, and • Economies are more global than regional. every nurse needs to have the knowledge and skill to answer pa- • Industrial and social changes have made world travel and tients’ questions concerning their heredity and health. In addition cultural exchange common. to Chapter 9, genetics content has been incorporated into each clinical unit of the textbook. Today’s nurses enter a realm of opportunities and challenges for Chapter 17, End-of-Life Care,also new to the tenth edition, ad- providing high-quality, evidence-based care in traditional as well as dresses some of the questions posed by technologies that can pro- new and innovative health care settings. The rapid changes in long life, often in the face of insurmountable obstacles. The chapter health care mandate that nurses be prepared to provide or plan care discusses the nurse’s role as it pertains to quality of life, prolonga- across the continuum of settings—from hospital or clinic, to home, tion of dying, pain relief, allocation of resources, ethical issues, to community agencies or hospice settings—and during all phases communication, healing, spirituality, and patient and family care. of illness. Recent research has indicated that nurses make significant It emphasizes the pivotal role of the nurse in providing end-of-life contributions to the health care outcomes of patients who are hos- care. pitalized. Therefore, today’s nurses must be prepared to identify A third new chapter—Chapter 72, Terrorism, Mass Casualty, patients’ short- and long-term needs quickly and to collaborate ef- and Disaster Nursing—completes the text by reviewing the nurse’s fectively with patients and families, other members of the health care role in relation to patients affected by terrorism and other disasters. team, and community agencies to create a seamless system of care. Among the issues addressed are emergency preparedness and plan- The continued emphasis on health promotion efforts to keep well ning, triage in cases of mass casualty, radiation, chemical and bio- people healthy and to promote a higher level of well-being among logic weapons, ethical conflict, stress management, and survival. those with acute and chronic illnesses requires today’s nurses to as- sist patients in adopting healthy lifestyles and strategies. Mapping NANDA, NIC, NOC: LINKS, LANGUAGES, of the human genome and other advances in genetics have moved the issue of genetics to the bedside and increased the need for nurses AND CONCEPT MAPS to become knowledgeable about genetics-related issues. Although Brunner & Suddarth’s Textbook of Medical-Surgical In preparing for these vast opportunities and responsibilities, Nursinghas long used nursing diagnoses developed by the North today’s nurses must be well informed and up-to-date, not only in American Nursing Diagnosis Association (NANDA), this edition nursing knowledge and skills but also in research findings, scien- presents the links between the NANDA diagnoses and the Nurs- tific advances, and the ethical dilemmas inherent in many areas of ing Interventions Classification (NIC) and Nursing-sensitive Out- clinical practice. More than ever, today’s nurses need to think crit- comes Classification (NOC). The opening page of each unit ically, creatively, and compassionately. presents a concept map illustrating these three classification sys- This tenth edition of Brunner & Suddarth’s Textbook of Medical- tems and their relationships. Each unit’s concept map is accom- Surgical Nursingis designed for the 21st century and nurses’ need to panied by a case study and a chart presenting examples of actual be knowledgeable, highly skilled, perceptive, caring, and compas- NANDA, NIC, and NOC terminologies related to the case study. sionate. A goal of the textbook is to provide balanced attention to This material is included to introduce the reader to the NIC and the art and science of adult medical-surgical nursing. It addresses NOC language and classifications and bring them to life in the nursing care issues from a physiological, pathophysiological, and clinical realm. Faculty and students alike may use some of the psychosocial context and assists the reader to identify priorities of issues presented in the case studies as a springboard for develop- care from that context. ing their own concept maps. ABOUT THE TENTH EDITION RECENT NURSING RESEARCH The tenth edition of Brunner and Suddarth’s Textbook of Medical AND OTHER FEATURES Surgical Nursingwas constructed to provide today’s nursing stu- dents with an understanding of the nurse’s role in health and illness As before, Nursing Research Profiles included in the chapters within evolving practice environments and across the spectrum of identify the implications and applications of recent nursing re- health and illness. The textbook’s content has been revised and up- search findings for nursing practice. The chapters also include dated by experts in the field to reflect current practice and advances charts and text detailing special considerations in caring for the in health care and technology. elderly patient and for those with disabilities. xi xii Preface TEACHING TOOLBOX • CD-ROMto help students test their knowledge and enhance their understanding of medical-surgical nursing. This CD in- Each chapter opens with Learning Objectives and a Glossary. cludes 500 self-study questions organized by unit; 3000 bonus Throughout the text the reader will find Nursing Alerts as well as NCLEX-style cross-disciplinary questions; 3-D animated il- specialized charts focusing on lustrations that explain common disease processes; and in- • Physiology/Pathophysiology teractive clinical simulations. • Risk Factors • Student Study Guideto further enhance the learning ex- • Assessment perience (available at student bookstores) • Plans of Nursing Care • Instructor’s Resource CD-ROM to help facilitate class- • Pharmacology room preparation, with an instructor’s manual, test gener- • Home Care ator, and searchable image collection, among other features • Patient Education • Supplemental cartridges for BlackboardandWebCT • Health Promotion • Connection Website—Get connected at connection.LWW. • Ethics and Related Issues com/go/smeltzer. • Guidelines The tenth edition of Brunner and Suddarth’s Textbook of • Gerontological Considerations Medical-Surgical Nursing continues the tradition of presenting • Genetics in Nursing Practice up-to-date content that addresses the art and science of nursing Illustrations, photographs, charts, and tables supplement the practice. The updating of the material and use of a variety of text and round out the applied-learning experience. Each chapter teaching methods to convey that content are intended to provide concludes with Critical Thinking Exercises, References and Selected the nursing student and other users of the textbook with infor- Readings, and a list of specialized Resources and Websites. mation needed to provide quality care to patients and families across health care settings and in the home. MANY MORE OF THE LATEST RESOURCES Suzanne C. O’Connell Smeltzer, RN, EDD, FAAN Brenda G. Bare, RN, MSN Additional learning tools accompany the tenth edition and offer visual, tactile, and auditory reinforcement of the text. These re- sources include: How to use Brunner & Suddarth’s Textbook of Medical -Surgical Nursing 10th edition The patient recovering from abdominal surgery with reluctance to move and a history of smoking receives the requires nursing outcomes should show ▲ Concept Maps—with NANDA, nursing diagnoses interventions improvement in NIC, and NOC illustrate reality- based clinical scenarios for the Risk for Impaired Respiratory Anxiety Gas Exchange requires Monitoring Control visual learner. may be reduced by improves and and outcomes in and requires RAisirkw faoyr CInleeaffreacntcivee remduacye db eby EnhCaonucegmhent ouimtcpormovese sin RSEteaxstcpuhisra:an Gtgoaersy and and limits and ▼ Plans of Nursing Care— ThromRibsokp fholrebitis requires PrEemcabuotliuosns Pain Level illustrate applications of the reduces nursing process to diseases risk for and disorders. secondary to and and improves Plan ofI mNmuorbsiliitnyg Care Acute Pain lesmseanye bde by ManaPgaeinment hperelpvse ntot CarCe oPonhfs yteshqioeul eoPngacicetise:nt With COPD (Continued) Nursing Interventions Rationale Expected Outcomes and lesmseanye bde by and hperelpvseN ntoutrsing Diagnosis:Inaenffedctive breathing pattern related to shortness of breath, mucus, bronchoconstriction, and airway irritants Goal:Improvement in breathing pattern ImpaiMreodb iPlihtyysical requires TeAacchtiivnigty: /PErxeesrccrisibeed imlepadrosv 1t.eodlTipe abcrhe aptahtiineng.t diapMhraogbmialtiitcy a nLde pvuersled- 1.Hanedl pdse pcraetaiesnest apirro tlroanpgp ienxgp.i rWatiitohn tthimesee •Pbrreaactthiciensg p aunrdse uds-elisp t hanemd dwiahpehnr ashgomrat toicf techniques, patient will breathe more breath and with activity efficiently and effectively. •Shows signs of decreased respiratory effort 2.Encourage alternating activity with rest 2.Pacing activities permits patient to per- and paces activities periods. Allow patient to make some de- form activities without excessive distress. •Uses inspiratory muscle trainer as pre- cisions (bath, shaving) about care based scribed on tolerance level. 3.Encourage use of an inspiratory muscle 3.Strengthens and conditions the respira- trainer if prescribed. tory muscles. Nursing Diagnosis:Self-care deficits related to fatigue secondary to increased work of breathing and insufficient ventilation and oxygenation Goal:Independence in self-care activities 1.Teach patient to coordinate diaphragmatic 1.This will allow the patient to be more ac- •Uses controlled breathing while bathing, breathing with activity (eg, walking, tive and to avoid excessive fatigue or dys- bending, and walking bending). pnea during activity. •Paces activities of daily living to alternate 2.Encourage patient to begin to bathe self, 2.As condition resolves, patient will be able with rest periods to reduce fatigue and dress self, walk, and drink fluids. Discuss to do more but needs to be encouraged to dyspnea energy conservation measures. avoid increasing dependence. •Describes energy conservation strategies 3.Teach postural drainage if appropriate. 3.Encourages patient to become involved •Performs same self-care activities as before in own care. Prepares patient to manage •Performs postural drainage correctly at home. Nursing Diagnosis:Activity intolerance due to fatigue, hypoxemia, and ineffective breathing patterns Goal:Improvement in activity tolerance Chart 16-5 1.Support patient in establishing a regular 1.Muscles that are deconditioned consume •Performs activities with less shortness of regimen of exercise using treadmill and more oxygen and place an additional bur- breath Home Care Checklist • Chemotherapy Administration exercycle, walking, or other appropriate den on the lungs. Through regular, graded •Verbalizes need to exercise daily and exercises, such as mall walking. exercise, these muscle groups become demonstrates an exercise plan to be carried At the completion of the home care instruction, the patient or caregiver will be able to: a.Afusnsecstsio tnhien pga atniedn td’se vceulrorpe netx elervciesle o pflaPnatientmmoorrCee cwaoirnthedogituiiotv ngeeertdt,i nagn da st hsheo prat toief nbtr ecaatnh d.o •oWuat lakts haonmd egradually increases walking •Demonstrate how to administer the chemotherapy agent in the home. based on baseline functional status. ✓ Graded ex✓ercise breaks the cycle of time and distance to improve physical b.Suggest consultation with a physical debilitation. condition •Demonstrate safe disposal of needles, syringes, IV supplies, or unused chemotherapy medicatithoenrasp.ist or pulmonary rehabilitation ✓ ✓ •Exercises both upper and lower body •List possible side effects of chemotherapeutic agents. pgrraomgr asmpe ctiofi dcettoe rtmhei npea tainen etx’se rccaipsea bpirloit-y.✓ ✓ muscle groups •List complications of medications necessitating a call to the nurse or physician. Have portable oxygen unit available if✓ ✓ oxygen is prescribed for exercise. •List complications of medications necessitating a visit to the emergency department. ✓ ✓ •List names and telephone numbers of resource personnel involved in care (ie, home care nNuurrssei,n ign Dfuisaigonno sis:Ineffective coping related to reduced socialization, anxiety, depression, lower activity level, services, IV vendor, equipment company). and the inability to work ✓ ✓ •Explain treatment plan (protocol) and importance of upcoming visits to physician. Goal:Attainment of an optimal leve✓l of coping ✓ 1.Help the patient develop realistic goals. 1.Developing realistic goals will promote a •Expresses interest in the future sense of hope and accomplishment rather •Participates in the discharge plan than defeat and hopelessness. •Discusses activities or methods that can be 2.Encourage activity to level of symptom 2.Activity reduces tension and decreases performed to ease shortness of breath ▲ Home Care Checklists—include guidelines tolerance. dcoengrdeiet ioofn dedy.spnea as patient becomes ••UExspesr ersesleasx aintitoenre tset cihnn ai qpuuelsm aopnparroyp rreiahtaeblyili- tation program on goals and management of home-based patients. (continued) Physiology/Pathophysiology Chart 17-6 • ASSESSMENT A. Rhinitis Nursing Assessment of Symptoms Associated With Terminal Illness Edematous • How is this symptom affecting the patient’s life? conchae; polyps may develop • What is the meaning of the symptom to the patient? To the family? • How does the symptom affect physical functioning, mobility, comfort, sleep, nutritional status, elimination, activity level, and relationships with others? Occluded • What makes the symptom better? sinus • What makes it worse? openings • Is it worse at any particular time of the day? Enlarged • What are the patient’s expectations and goals for managing the nasal mucosa Dmiusccuhsarging •• sHWymohwapt t ioiss m tthh?e eT pehacetoi enfanomtm cilioycp’ sei?nffge cwt iotfh tthhee ssyymmppttoomm ?and its CIannhvdae rCsttli i1gna6itc-ia4oln Ta•rli AaPlnHstiAnReoMplAasCtiOc TLhOeGraYpies management? B. Sinusitis Evaluation of the effectiveness and toxic potential of promising new Adapted from Jacox, A., Carr, D.B., & Payne, R. (1994). Managmemodeanlitt ioefs for preventing, diagnosing, and treating cancer is accom- plished through clinical trials. Before new chemotherapy agents are Thick mucus cancer pain.Rockville, MD: AHCPR. approved for clinical use, they are subjected to rigorous and lengthy osaicnncdul usp drceeavsveitnyts eva•luaPthioanses Itoc liidneicnatli ftyr ibaelsn defietceiarml eifnfeec otsp, taidmvaelr sdeo esfifnegc,t ss,c ahnedd usalifnegty,. drainage and toxicity. ▲ Assessment Displays— •tPyhpaesse aInIdtr ifaulrst hdeerte drmefiinnee teoffxeicctitivieesn. ePsas rwtiictihp asnptesc iifinc t htuemse oerarly trials are most often those who have not responded to stan- provide clinical features dard forms of treatment. Because phase I and II trials may be viewed as last-chance efforts, patients and families are of diseases and disorders fully informed about the experimental nature of the trial therapies. Although it is hoped that investigational therapy and include guidelines for will effectively treat the disease, the purpose of early phase trials is to gather information concerning maximal tolerated assessing health history and doses, adverse effects, and effects of the antineoplastic agents FIGURE 22-1Pathophysiologic processes in rhinitis and sinusitis. Although on tumor growth. pfeartehnotp shtryusciotuloregsic. Ipnr orhceinssietiss a (rAe )s,i mthiel amr iunc orhuisn mitiesm anbdra sninesu lsiintiisn,g t htheye nafafseaclt pdaisf-- exam findings. •Pmheadsiec IaItIiocnlisn oicra pl rtoricaelds uesrteasb alsis cho tmhep aerfefedc wtivitehn ecsosn ovfe nnetiwonal sages become inflamed, congested, and edematous. The swollen nasal conchae approaches. Nurses may assist in the recruitment, consent, b(sBelco)rc eikst itaohlnseos s fiminllauinrsk goe ptdhe ben yisn iingnusfl,s a acmnadvm imtaiteuisoc anun sad in so ddc iccsolcunhdgairengsgtei doth nfer,o owmpite htnh itenh gnicso.ksetrnielsd. Sminuucsoiutiss amnadn eyd cuacsaetsi,o nnu prsreosc aersese isn fsotrru pmateinentatls iwn hmo opnairttoicriinpgat aed. hIner- ence, assisting patients to adhere to the parameters of the Pharmacology Charts—review ▲ trial, and documenting data describing patients’ responses. The physical and emotional needs of patients in clinical tri- ▲Pathophysiology Displays— recent or common drug therapies awlsh oar ree acdeidvree ssstaedn dinar md fuocrhm tsh oe fs caamnec ewr atyr eaast mtheonste. of patients •Phase IVtesting further investigates medications in terms of utilize illustrations and algorithms with discussion of clinical trials new uses, dosing schedule, and toxicities. to demonstrate processes. where appropriate. ▲ Risk Factor Chart 25-3 • PATIENT EDUCATION Chart 21-8 Charts—outline Breathing Exercises Risk Factors for Hypoventilation factors that may impair General Instructions health (eg, carcinogens, • Limited neurologic impulses transmitted from the brain to the • Breathe slowly and rhythmically to exhale completely and empty the lungs completely. respiratory muscles, as in spinal cord trauma, cerebrovascular environmental factors), • Inhale through the nose to filter, humidify, and warm the accidents, tumors, myasthenia gravis, Guillain-Barré air before it enters the lungs. syndrome, polio, and drug overdose and offer preventive • If you feel out of breath, breathe more slowly by prolonging • Depressed respiratory centers in the medulla, as with anesthesia measures to sidestep the exhalation time. • Keep the air moist with a humidifier. and drug overdose them. • Limited thoracic movement (kyphoscoliosis), limited lung Diaphragmatic Breathing Goal: To use and strengthen the diaphragm during breathing movement (pleural effusion, pneumothorax), or reduced • Place one hand on the abdomen (just below the ribs) and functional lung tissue (chronic pulmonary diseases, severe the other hand on the middle of the chest to increase the pulmonary edema) awareness of the position of the diaphragm and its function in breathing. • Breathe in slowly and deeply through the nose, letting the abdomen protrude as far as possible. • Breathe out through pursed lips while tightening (contract- ing) the abdominal muscles. • Pressfirmly inward and upward on the abdomen while breathing out. • Repeat for 1 minute; follow with a rest period of 2 minutes. Gerontologic Considerations • Gradually increase duration up to 5 minutes, several times a day (before meals and at bedtime). Factors Contributing to Urinary Tract Infection Pursed-Lip Breathing in Older Adults Goal: To prolong exhalation and increase airway pressure during ex- Gerontologic ▲ piration, thus reducing the amount of trapped air and the amount • High incidence of chronic illness of airway resistance. Considerations— • Frequent use of antimicrobial agents • Inhale through the nose while counting to 3—the amount • Presence of infected pressure ulcers of time needed to say “Smell a rose.” provide specific • Immobility and incomplete emptying of bladder • Exhale slowly and evenly against pursed lips while tighten- ing the abdominal muscles. (Pursing the lips increases intra- information relevant to • Use of a bedpan rather than a commode or toilet tracheal pressure; exhaling through the mouth offers less resistance to expired air.) the older population. • Count to 7 while prolonging expiration through pursed lips—the length of time to say “Blow out the candle.” • While sitting in a chair: Fold arms over the abdomen. Inhale through the nose while counting to 3. Bend forward and exhale slowly through pursed lips while counting to 7. • While walking: ▲ Patient Education Boxes—provide Inhale while walking two steps. Exhale through pursed lips while walking four or five steps. suggestions on such topics as self-care, or how to cope with health challenges.
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