Foundations of Adult Health Nursing

866 Pages·2011·35.29 MB·English

by  Lois White

This is an electronic version of the print textbook. Due to electronic rights
restrictions, some third party content may be suppressed. Editorial
review has deemed that any suppressed content does not materially
a ffect the overall learning experience. The publisher reserves the
right to remove content from this title at any time if subsequent
rights restrictions require it. For valuable information on pricing, previous
editions, changes to current editions, and alternate formats, please visit
w ww.cengage.com/highered to search by ISBN#, author, title, or keyword
for materials in your areas of interest.

Copyright 2010 Cengage Learning, Inc. All Rights Reserved. May not be copied, scanned, or duplicated, in whole or in part.
5522660099__0000__ffmm__ppii--ppxxxxvvii..iinndddd iiii 22//11//1100 1111::3377::4433 PPMM
FFoouunnddaattiioonnss
ooff AAdduulltt HHeeaalltthh
NNuurrssiinngg
Th ird Edition
Copyright 2010 Cengage Learning, Inc. All Rights Reserved. May not be copied, scanned, or duplicated, in whole or in part.
DEDICATIONS
Lois White:
To my beloved husband, John, who is on his last great adventure and learning
experience.
Gena Duncan:
To my husband, who gives me unconditional love and brings balance, calmness, and
excitement to my life.
To Lois White, who modeled the role of an author and committed much of her life
to this textbook.
To Wendy Baumle, for her hard work and dedication in developing this textbook.
Thanks.
To future nurses who are caring and competent.
Wendy Baumle:
This book is dedicated to my beloved family—Patrick, Taylor, Madeline, Blair,
Connor, Janet, and Robert—for their love and support, to Juliet Steiner for inspiring
me and for making a difference in my life, to Gena Duncan for her guidance and
friendship, and to my friends, colleagues, and students for their support and valuable
insight into today’s nursing education.
Copyright 2010 Cengage Learning, Inc. All Rights Reserved. May not be copied, scanned, or duplicated, in whole or in part.
Foundations
of Adult Health
Nursing
Th ird Edition
Lois White,
RN, PhD
Former Chairperson and Professor Department of Vocational
Nurse Education, Del Mar College, Corpus Christi, Texas
Gena Duncan,
RN, MSEd, MSN
Former Associate Professor of Nursing, Ivy Tech Community
College, Fort Wayne, Indiana
Wendy Baumle,
RN, MSN
James A. Rhodes State College, School of Nursing, Lima, Ohio
Australia (cid:129) Brazil (cid:129) Japan (cid:129) Korea (cid:129) Mexico (cid:129) Singapore (cid:129) Spain (cid:129) United Kingdom (cid:129) United States
Copyright 2010 Cengage Learning, Inc. All Rights Reserved. May not be copied, scanned, or duplicated, in whole or in part.
Foundations of Adult Health Nursing, Th ird © 2011, 2005, 2001 Delmar Cengage Learning
Edition
ALL RIGHTS RESERVED. No part of this work covered by the copyright
Lois White, RN, PhD, Gena Duncan, RN, MSEd,
herein may be reproduced, transmitt ed, stored, or used in any form or by
MSN, and Wendy Baumle, RN, MSN
any means graphic, electronic, or mechanical, including but not limited
Vice President, Career and Professional Editorial: to photocopying, recording, scanning, digitizing, taping, Web distribution,
Dave Garza information networks, or information storage and retrieval systems,
except as permitt ed under Section 107 or 108 of the 1976 United States
Director of Learning Solutions: Matt Kane
Copyright Act, without the prior writt en permission of the publisher.
Executive Editor: Steven Helba
Managing Editor: Marah Bellegarde
For product information and technology assistance, contact us at
Senior Product Manager: Juliet Steiner Cengage Learning Customer & Sales Support, 1-800-354-9706
Editorial Assistant: Meghan E. Orvis For permission to use material from this text or product,
submit all requests online at www.cengage.com/permissions.
Vice President, Career and Professional Marketing:
Further permissions questions can be e-mailed to
Jennifer Ann Baker
[email protected]
Marketing Director: Wendy Mapstone
Senior Marketing Manager: Michele McTighe
Library of Congress Control Number: 2010920751
Marketing Coordinator: Scott Chrysler ISBN-13: 9781428317758
Production Director: Carolyn Miller ISBN-10: 1-4283-1775-9
Production Manager: Andrew Crouth
Delmar
Senior Content Project Manager: James Zayicek
5 Maxwell Drive
Senior Art Director: Jack Pendleton
Clift on Park, NY 12065-2919
Technology Project Manager: Mary Colleen USA
Liburdi
Production Technology Analyst: Patricia Allen
Cengage Learning is a leading provider of customized learning
Production Technology Analyst: Ben Knapp solutions with offi ce locations around the globe, including Singapore, the
United Kingdom, Australia, Mexico, Brazil, and Japan. Locate your local
offi ce at: international.cengage.com/region
Cengage Learning products are represented in Canada by Nelson
Education, Ltd.
To learn more about Delmar, visit www.cengage.com/delmar
Purchase any of our products at your local college store or at our preferred
online store www.CengageBrain.com
Notice to the Reader
Publisher does not warrant or guarantee any of the products described herein or perform any independent analysis in connection with any
of the product information contained herein. Publisher does not assume, and expressly disclaims, any obligation to obtain and include infor-
mation other than that provided to it by the manufacturer. Th e reader is expressly warned to consider and adopt all safety precautions that
might be indicated by the activities described herein and to avoid all potential hazards. By following the instructions contained herein, the
reader willingly assumes all risks in connection with such instructions. Th e publisher makes no representations or warranties of any kind, in-
cluding but not limited to, the warranties of fi tness for particular purpose or merchantability, nor are any such representations implied with
respect to the material set forth herein, and the publisher takes no responsibility with respect to such material. Th e publisher shall not be li-
able for any special, consequential, or exemplary damages resulting, in whole or part, from the readers’ use of, or reliance upon, this material.
Printed in the United States of America
1 2 3 4 5 6 7 12 11 10
Copyright 2010 Cengage Learning, Inc. All Rights Reserved. May not be copied, scanned, or duplicated, in whole or in part.
BRIEF CONTENTS
Unit 1: Essential Concepts / 1 Unit 6: Nursing Care of
the Client: Body
1 Anesthesia ...........................................................2
2 Surgery ..............................................................15
Defenses / 499
3 Oncology ...........................................................44
15 Integumentary System....................................500
Unit 2: Nursing Care of the 16 Immune System ...............................................543
Client: Oxygenation
Unit 7: Nursing Care of the
and Perfusion / 69
Client: Physical and
4 Respiratory System ...........................................70
Mental Integrity / 581
5 Cardiovascular System ...................................119
6 Hematologic and Lymphatic 17 Mental Illness ..................................................582
Systems ........................................................163 18 Substance Abuse ............................................617
Unit 3: Nursing Care of the Unit 8: Nursing Care of
Client: Digestion and the Client: Older
Elimination / 195 Adult / 645
7 Gastrointestinal System .................................196 19 The Older Adult ...............................................646
8 Urinary System ................................................238
Unit 9: Nursing Care of the
Unit 4: Nursing Care of the
Client: Health Care in
Client: Mobility,
the Community / 677
Coordination, and
20 Ambulatory, Restorative, and Pallative
Regulation / 275
Care in Community Settings ......................678
9 Musculoskeletal System .................................276
Unit 10: Applications / 697
10 Neurological System .......................................305
11 Sensory System ..............................................359 21 Responding to Emergencies .........................698
12 Endocrine System ...........................................388 22 Integration .......................................................725
Unit 5: Nursing Care of the
Client: Reproductive
and Sexual Health / 429
13 Reproductive System......................................430
14 Sexually Transmitted Infections .....................481
Copyright 2010 Cengage Learning, Inc. All Rights Reserved. May not be copied, scanned, or duplicated, in whole or in part.
CONTENTS
Contributors / xxxi General Anesthesia ..................................................8
Reviewers / xxxiii Induction and Airway Management .................................8
Maintenance ...................................................................8
Market Reviewers and Class Test Participants / xxxiv
Skeletal Muscle Relaxation ..........................................9
Preface / xxxvii
Emergence .....................................................................9
About the Authors / xli
Recovery .........................................................................9
Acknowledgments / xlii Oxygenation and Ventilation .........................................9
How to Use This Text / xliii Heart Rate and Blood Pressure ...................................9
How to Use StudyWARE™ / xlvii Temperature Regulation and Shivering ........................9
Fluid Balance ..............................................................10
Postoperative Pain Management ...........................10
Patient-Controlled Analgesia ..........................................10
UNIT 1
Regional Analgesia ........................................................10
Local Anesthetics ........................................................10
Essential Concepts / 1 Opioids ........................................................................11
Case Study ..............................................................12
CHAPTER 1: ANESTHESIA / 2
CHAPTER 2: SURGERY / 15
Introduction ...............................................................3
Preanesthetic Preparation .......................................3 Introduction .............................................................16
Oral Intake ......................................................................3 Preoperative Phase ................................................16
Preoperative Medication .................................................4 Preoperative Physiologic Assessment ...........................16
Consent ..........................................................................4 Age ..............................................................................17
Sedation ....................................................................5 Nutritional Status .........................................................17
Sedation and Monitoring .................................................5 Fluid and Electrolyte Status ........................................18
Residual Effects of Sedation ...........................................5 Respiratory Status .......................................................18
Regional Anesthesia ................................................5 Cardiovascular Status .................................................18
Types of Regional Anesthesia .........................................5 Renal and Hepatic Status ...........................................18
Local Anesthesia ..........................................................5 Neurological, Musculoskeletal, and Integumentary
Nerve Blocks ................................................................6 Status ..........................................................................18
Spinal and Epidural Blocks ..........................................6 Endocrine and Immunological Status .........................19
Residual Effects of Regional Anesthesia ........................7 Medications .................................................................19
Residual Motor Block ...................................................7 Psychosocial Health Assessment .................................20
Residual Sensory Block ...............................................7 Surgical Consent ..........................................................20
Residual Sympathetic Block ........................................8 Preoperative Teaching ...................................................20
v
Copyright 2010 Cengage Learning, Inc. All Rights Reserved. May not be copied, scanned, or duplicated, in whole or in part.
vi CONTENTS
Physical Preparation .....................................................20 Ascites ..........................................................................58
Intraoperative Phase ..............................................24 Sexual Alterations .........................................................58
Physical Description of the Operating Room Medical Emergencies .............................................58
Environment ..................................................................24 Hypercalcemia ........................................................58
Members of the Surgical Team .....................................24 Spinal Cord Compression......................................58
Asepsis .........................................................................24 Superior Vena Cava Syndrome ..............................58
Surgical Hand Scrub .....................................................25
Cardiac Tamponade ................................................59
Surgical Skin Preparation..............................................25
Psychosocial Alterations .......................................59
Intraoperative Nursing Care ..........................................25
Nursing Process .....................................................59
Postoperative Phase...............................................26
Assessment ..................................................................59
Postoperative Nursing Care ..........................................26
Subjective Data ..........................................................59
Continuing Nursing Care in the PACU ..........................29
Objective Data ...........................................................59
Later Postoperative Nursing Care .................................29
Sample Nursing Care Plan: The Client with
Ambulatory Surgery ...............................................36
Lung Cancer ............................................................61
Elderly Clients Having Surgery .............................39
Case Study ..............................................................64
Case Study ..............................................................41
UNIT 2
CHAPTER 3: ONCOLOGY / 44
Introduction .............................................................45 Nursing Care of the Client:
Incidence .................................................................45
Oxygenation and Perfusion / 69
Pathophysiology .....................................................45
Risk Factors ............................................................46
Environmental Factors ..................................................46 CHAPTER 4: RESPIRATORY
Lifestyle Factors ............................................................46 SYSTEM / 70
Genetic Factors .............................................................47
Viral Factors ..................................................................47 Introduction .............................................................71
Detection .................................................................48 Anatomy and Physiology Review ..........................71
Common Diagnostic Tests .....................................48 Thoracic Cavity .............................................................71
Staging of Tumors...................................................48 Conducting Airways ......................................................71
Respiratory Tissues ......................................................72
Grading of Tumors ..................................................48
Respiration ....................................................................72
Treatment Modalities ..............................................49
Neuromuscular Control of Respiration ..........................72
Surgery .........................................................................49
Gas Exchange ..............................................................73
Radiation Therapy .........................................................50
Assessment ............................................................73
External Radiation ......................................................50
Health History ...............................................................73
Internal Radiation .......................................................50
Inspection ......................................................................74
Chemotherapy ..............................................................52
Palpation and Percussion ..............................................74
Biotherapy .....................................................................54
Auscultation ...................................................................74
Photodynamic Therapy .................................................54
Normal Breath Sounds ................................................74
Hormone Therapy .........................................................54
Adventitious Breath Sounds .......................................75
Targeted Cancer Therapy ..............................................54
Common Diagnostic Tests .....................................75
Bone Marrow Transplantation .......................................54
Symptom Management ..........................................55 Infectious/Infl ammatory Disorders .......................75
Bone Marrow Dysfunction .............................................55 Infectious/Infl ammatory Disorders of the Upper
Nutritional Alterations ....................................................55 Respiratory Tract .....................................................78
Anorexia .....................................................................55 Medical–Surgical Management ....................................78
Nausea and Vomiting .................................................55 Medical ......................................................................78
Altered Taste Sensation ..............................................56 Surgical ......................................................................78
Mucosal Infl ammation ................................................56 Pharmacological ........................................................78
Dysphagia ..................................................................56 Diet .............................................................................79
Pain ...............................................................................56 Activity ........................................................................79
Fatigue ..........................................................................57 Nursing Management ...................................................79
Alopecia ........................................................................57 Nursing Process .....................................................79
Odors ............................................................................57 Assessment ..................................................................79
Dyspnea ........................................................................57 Subjective Data ..........................................................79
Bowel Dysfunctions .......................................................57 Objective Data ...........................................................79
Pathological Fractures ..................................................58 Pneumonia ..............................................................79
Copyright 2010 Cengage Learning, Inc. All Rights Reserved. May not be copied, scanned, or duplicated, in whole or in part.
CONTENTS vii
Medical–Surgical Management ....................................80 Diet .............................................................................95
Medical ......................................................................80 Activity ........................................................................95
Pharmacological ........................................................80 Nursing Management ...................................................95
Diet .............................................................................81 Nursing Process .....................................................96
Activity ........................................................................81 Assessment ..................................................................96
Health Promotion ........................................................81 Subjective Data ..........................................................96
Nursing Management ...................................................81 Objective Data ...........................................................96
Nursing Process .....................................................82 Pulmonary Edema ..................................................96
Assessment ..................................................................82 Medical–Surgical Management ....................................97
Subjective Data ..........................................................82 Medical ......................................................................97
Objective Data ...........................................................82 Pharmacological ........................................................97
Tuberculosis ............................................................82 Diet .............................................................................97
Medical–Surgical Management ....................................84 Activity ........................................................................97
Medical ......................................................................84 Nursing Management ...................................................97
Surgical ......................................................................84 Nursing Process .....................................................97
Pharmacological ........................................................84 Assessment ..................................................................97
Diet .............................................................................86 Subjective Data ..........................................................97
Activity ........................................................................86 Objective Data ...........................................................97
Health Promotion ........................................................86 Acute Respiratory Distress Syndrome .................98
Nursing Management ...................................................86 Medical–Surgical Management ....................................98
Nursing Process .....................................................86 Medical ......................................................................98
Assessment ..................................................................86 Pharmacological ........................................................98
Subjective Data .........................................................86 Diet .............................................................................99
Objective Data ...........................................................86 Activity ........................................................................99
Sample Nursing Care Plan: The Client Nursing Management ...................................................99
with TB .....................................................................87 Nursing Process .....................................................99
Pleurisy/Pleural Effusion........................................90 Assessment ..................................................................99
Medical–Surgical Management ....................................91 Subjective Data ..........................................................99
Medical ......................................................................91 Objective Data ...........................................................99
Surgical ......................................................................91 Acute Respiratory Failure ......................................99
Pharmacological ........................................................91 Chronic Respiratory Tract Disorders ....................99
Activity ........................................................................91 Asthma ..................................................................100
Nursing Management ...................................................91 Medical–Surgical Management ...................................100
Nursing Process .....................................................91 Medical .....................................................................100
Assessment ..................................................................91 Pharmacological .......................................................100
Subjective Data ..........................................................91 Diet ............................................................................100
Objective Data ...........................................................92 Activity .......................................................................100
Severe Acute Respiratory Syndrome ....................92 Nursing Management ..................................................100
Nursing Management ...................................................92 Nursing Process ...................................................101
Acute Respiratory Tract Disorders ........................92 Assessment .................................................................101
Atelectasis ...............................................................92 Subjective Data .........................................................101
Medical–Surgical Management ....................................93 Objective Data ..........................................................101
Medical ......................................................................93 Chronic Obstructive Pulmonary Disease ...........102
Surgical ......................................................................93 Chronic Bronchitis ...............................................102
Pharmacological ........................................................93 Medical–Surgical Management ...................................102
Diet .............................................................................93 Medical .....................................................................102
Activity ........................................................................93 Pharmacological .......................................................102
Nursing Management ...................................................93 Diet ............................................................................102
Nursing Process .....................................................93 Activity .......................................................................102
Assessment ..................................................................93 Nursing Management ..................................................102
Subjective Data ..........................................................93 Nursing Process ...................................................103
Objective Data ...........................................................93 Assessment .................................................................103
Pulmonary Embolism .............................................94 Subjective Data .........................................................103
Medical–Surgical Management ....................................95 Objective Data ..........................................................103
Medical ......................................................................95 Emphysema ..........................................................104
Surgical ......................................................................95 Medical–Surgical Management ...................................104
Pharmacological ........................................................95 Medical .....................................................................104
Copyright 2010 Cengage Learning, Inc. All Rights Reserved. May not be copied, scanned, or duplicated, in whole or in part.