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Nursing Procedures PDF

589 Pages·2015·12.59 MB·English
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~ A vance Practice Nursing Procedures Margaret R. Colyar Advanced Practice Nursing Procedures Margaret R. Colyar, DSN, APRN, C-FNP Family Nurse Practitioner Hannibal Clinic Hannibal, Missouri 4206_FM_i-xiv.indd i 4206_FM_i-xiv.indd i 12/30/2014 10:56:42 AM 12/30/2014 10:56:42 AM Process Cyan Process CyanProcess Magenta Process MagentaProcess Yellow Process YellowProcess Black Process Black F. A. Davis Company 1915 Arch Street Philadelphia, PA 19103 www.fadavis.com Copyright © 2015 by F. A. Davis Company Copyright © 2015 by F. A. Davis Company. All rights reserved. This book is protected by copyright. No part of it may be reproduced, stored in a retrieval system, or transmitted in any form or by any means, electronic, mechanical, photocopying, recording, or otherwise, without written permission from the publisher. Printed in the United States of America Last digit indicates print number: 10 9 8 7 6 5 4 3 2 1 Publisher, Nursing: Joanne Patzek DaCunha, RN, MSN Senior Acquisitions Editor: Susan R. Rhyner Content Development Manager: Darlene Pedersen Content Project Manager: Christina L. Snyder Design and Illustration Manager: Carolyn O’Brien As new scientific information becomes available through basic and clinical research, recommended treatments and drug therapies undergo changes. The author(s) and publisher have done everything possible to make this book accurate, up to date, and in accord with accepted standards at the time of publication. The author(s), editors, and publisher are not responsible for errors or omissions or for consequences from application of the book, and make no warranty, expressed or implied, in regard to the contents of the book. Any practice described in this book should be applied by the reader in accordance with professional standards of care used in regard to the unique circumstances that may apply in each situation. The reader is advised always to check product information (package inserts) for changes and new information regarding dose and contraindications before administering any drug. Caution is especially urged when using new or infrequently ordered drugs. Library of Congress Control Number 2014959076 Authorization to photocopy items for internal or personal use, or the internal or personal use of specific clients, is granted by F. A. Davis Company for users registered with the Copyright Clearance Center (CCC) Transactional Reporting Service, provided that the fee of $.25 per copy is paid directly to CCC, 222 Rosewood Drive, Danvers, MA 01923. For those organizations that have been granted a photocopy license by CCC, a separate system of payment has been arranged. The fee code for users of the Transactional Reporting Service is: 978-0-8036-4206-5/15 0 + $.25. 4206_FM_i-xiv.indd ii 4206_FM_i-xiv.indd ii 12/30/2014 10:56:42 AM 12/30/2014 10:56:42 AM Process Cyan Process CyanProcess Magenta Process MagentaProcess Yellow Process YellowProcess Black Process Black Proudly sourced and uploaded by [StormRG] Kickass Torrents | TPB | ET | h33t This book is lovingly dedicated to Stephen Colyar, Andrea Brown, Michelle Bailey, and Courtney Kaul. 4206_FM_i-xiv.indd iii 4206_FM_i-xiv.indd iii 12/30/2014 10:56:42 AM 12/30/2014 10:56:42 AM Process Cyan Process CyanProcess Magenta Process MagentaProcess Yellow Process YellowProcess Black Process Black GREAT NURSING CARE BEGINS WITH GREAT RESOURCES now and throughout your career! Fitzgerald ������������������������������� Examination and Practice Preparation Winland-Brown & Dunphy Adult-Gerontology and Family Nurse �������������������������������������� Review Questions and Strategies Goolsby Advanced Assessment Interpreting Findings and Formulating Differential Diagnoses Kennedy-Malone Advanced Practice Nursing in the Care of Older Adults Perese Psychiatric Advanced Practice Nursing A Biopsychosocial Foundation for Practice McCaffrey & Youngkin NP Notes Nurse Practitioner’s Clinical Pocket Guide www.FADavis.com BUY YOURS TODAY! 4206_FM_i-xiv.indd iv 4206_FM_i-xiv.indd iv 12/30/2014 10:56:42 AM 12/30/2014 10:56:42 AM Process Cyan Process CyanProcess Magenta Process MagentaProcess Yellow Process YellowProcess Black Process Black v Preface The new nurse practitioner and the practicing nurse practitioner in the ambulatory care setting must be prepared to perform an increasing array of skills competently to meet patient care needs. The inspiration for this book came when, on graduating from a nurse practitioner program, I found no procedural resources directed toward the needs of the nurse practitioner in ambulatory care. The need to perform many procedures—those not taught in my nurse practitioner program—was apparent. The physician I practiced with required a knowledge base in procedural skills greater than the one I possessed. Fortunately, this physician was willing to teach me the necessary procedures. This improved care to our patients and decreased the necessity to refer many patients for procedures easily performed in the ambulatory care (outpatient) setting. This text was developed to assist in the many demands on the newly graduated nurse practitioner and the nurse practitioner currently in practice. We believe the procedures outlined will improve the marketability of the nurse practitioner and serve as a good reference tool for family and/or adult nurse practitioners in an ambulatory care setting. Prerequisites for this book are basic anatomy and physiology, microbiology, pharmacology, principles of aseptic technique, and basic nursing skills. This book would be an appropriate text for incorporation of procedural techniques throughout a family or an adult nurse practitioner curriculum. It also would be appropriate for an elective on minor surgery and diagnostic procedures and inter- pretation. Another potential use for this book would be as part of the protocol/ guidelines in the nurse practitioner’s practice. Many procedures performed by primary care physicians are not currently appro- priate for the nurse practitioner to perform. The procedures in this book were chosen based on a comprehensive study of types of procedures currently used in the nurse practitioner’s practice. Many of the procedures can be used in any ambulatory setting. Twenty-eight new procedures have been added to this edition: Suture selec- tion, ulcer debridement, compartment syndrome and pressure testing, bladder cath- eterization, breast examination, administration of vaginal medications and condoms, Nexplanon insertion and removal, vaginal examination, fetal assessment, Leopold’s maneuver, fundal assessment, obstetric ultrasound, emergency delivery, teaching breast feeding, eye drop insertion, laryngoscopy, nasal lavage, cardiac stress testing, type of pacemakers, defibrillation, assessing for respiratory distress, pulmonary stress test, hemoccult, urea breath test, perianal skin tags and external hemorrhoidal skin tabs, pilonidal cyst, prostate massage, and rectal prolapsed reduction. Some of the procedures need specialized equipment, and some use equip- ment commonly found in any office. A few of the procedures—flexible chest tube insertion, circumcision, colposcopy, endometrial biopsy, IUD insertion and re- moval, lumbar puncture, occipital nerve block, paracentesis, sigmoidoscopy, and 4206_FM_i-xiv.indd v 4206_FM_i-xiv.indd v 12/30/2014 10:56:42 AM 12/30/2014 10:56:42 AM Process Cyan Process CyanProcess Magenta Process MagentaProcess Yellow Process YellowProcess Black Process Black vi Preface thrombosed hemorrhoid removal—require additional training. They are included for reference only. Check with your State Board of Nursing if you are unsure whether or not a certain procedure may be performed by nurse practitioners in the state in which you practice. The major theme of this book is clinical application of knowledge and clinical skills. There are seven sections in the book. These sections are based on body systems for ease of classification. Each major section begins with diagnostic procedures the nurse practitioner performs with the basis for their interpretation. Next in each section, listed in alphabetical order, are procedures performed in an ambulatory care setting. Each procedure contains seven parts. First, an Overview is presented, outlining causes, incidence, and other specific information intrinsic to each procedure. The Health Promotion/Prevention section gives tips to the nurse practitioner to pass on to the client to help promote health or prevent the need for the procedure in the future. Options lists one to four methods of performing the procedure and gives a choice of how to perform the procedure. The Rationale section gives reasons to perform the procedure. Indications tell the nurse practitioner when the procedure should be performed, and Contraindications tells the nurse practitioner when not to perform the procedure. The Procedure section lists the necessary equipment and gives step- by-step instructions for performing each procedure listed under Options. Client Instructions assist the nurse practitioner with postprocedure instructions, listing what the client must and must not do to have an optimal recovery period. At the end of each is the Bibliography for further information gathering. We hope you will find this text to be a good learning tool and a great resource in your practice. 4206_FM_i-xiv.indd vi 4206_FM_i-xiv.indd vi 12/30/2014 10:56:42 AM 12/30/2014 10:56:42 AM Process Cyan Process CyanProcess Magenta Process MagentaProcess Yellow Process YellowProcess Black Process Black vii Acknowledgments We acknowledge the following people for their contributions, assistance, and patience while compiling this book: Joanne DaCunha, RN, MSN, Nursing Acquisitions Editor at F.A. Davis, for believing in the merits of this book, and Denise Melomo, artist, for her expertise in sketching the line drawings from which the illustrations in this book were made. Many colleagues at Tri County Family Health Care in Madison, Florida, and Family Health Service in Ocala, Florida, were instrumental in this book. Colleagues at Rapides Regional Medical Center, Alexandria, Louisiana; Jackson Parish Hospital, Jonesboro, Louisiana; and Stansbury Medical Center, Stansbury Park, Utah, posed for the photographs in the book. These models include Linda Alby, Steve Colyar, Hugh Gentry, Cindy Grappe, Aleene Hale, Lane Helm, Debra Lefler, Anne Martin, and Shaneal Wright. 4206_FM_i-xiv.indd vii 4206_FM_i-xiv.indd vii 12/30/2014 10:56:42 AM 12/30/2014 10:56:42 AM Process Cyan Process CyanProcess Magenta Process MagentaProcess Yellow Process YellowProcess Black Process Black viii Contributors Tracy Call-Schmidt, MS, C-FNP Pain Management Specialist Salt Lake City, Utah Margaret Colyar, DSN, APRN, C-FNP Hannibal Clinic Hannibal, Missouri Cynthia Ehrhardt, RN, ARNP, MSN, FNP-CS Adjunct Faculty University of Central Florida Ocala, Florida 4206_FM_i-xiv.indd viii 4206_FM_i-xiv.indd viii 12/30/2014 10:56:42 AM 12/30/2014 10:56:42 AM Process Cyan Process CyanProcess Magenta Process MagentaProcess Yellow Process YellowProcess Black Process Black ix Contents Section One: DERMATOLOGICAL PROCEDURES, 1 Diagnostic Testing 1. Punch Biopsy, 1 2. Skin Biopsy, 5 3. Wood’s Light Examination, 11 Procedures 4. Abscesses—Incision and Drainage: Furuncle, Felon, Paronychia, Pilonidal Cyst, Perianal Cyst, 13 5. Bites: Ants, Arthropods (Spiders), Bees, and Wasps, 20 6. Bites—Cats, Dogs, and Humans, 24 7. Burns—Debridement, 27 8. Digital Nerve Block, 34 9. Fishhook Removal, 36 10. Nail Removal, 41 11. Ring Removal, 48 12. Sebaceous Cyst Removal, 54 13. Skin Closure—Dermabond Application, 59 14. Skin Lesion Removal—Cautery and Cryosurgery, 62 15. Skin Lesion Removal—Keloids, Moles, Corns, Calluses, 68 16. Skin Tag (Acrochordon) Removal, 73 17. Soft Tissue Aspiration, 79 18. Staple Insertion, 82 19. Staple Removal, 84 20. Steri-Strip Application, 87 21. Subungual Hematoma Excision, 89 22. Suture Insertion, 94 23. Suture Selection, 101 24. Suture Removal, 103 25. Tick Removal, 107 26. Topical Hemostatic Agent Application, 114 27. Ulcer Debridement, 117 4206_FM_i-xiv.indd ix 4206_FM_i-xiv.indd ix 12/30/2014 10:56:42 AM 12/30/2014 10:56:42 AM Process Cyan Process CyanProcess Magenta Process MagentaProcess Yellow Process YellowProcess Black Process Black x Contents Section Two: MUSCULOSKELETAL PROCEDURES, 121 Diagnostic Testing 28. Bone Marrow Aspiration and Biopsy, 121 29. Lumbar Puncture, 126 30. X-Ray Interpretation—Bones, 131 31. Arthrocentesis, 135 32. Compartment Syndrome Assessment, 138 Procedures 33. Clavicle Immobilization Techniques: Clavicle Strap, Figure Eight, Sling and Swath, 143 34. Crutch Walking, 146 35. Dislocation Reduction, 152 36. Ganglion Cyst Aspiration and Injection, 166 37. Intra-Articular and Bursa Corticosteroid Injection, 170 38. Sling Application, 180 39. Splinting and Taping, 183 40. Trigger Point Injection, 202 Section Three: GENITOURINARY AND BREAST PROCEDURES, 205 Diagnostic Testing 41. Bladder Catheterization Insertion and Removal, 205 42. Breast Biopsy—Fine Needle Aspiration, 211 43. Breast Examination, 214 44. Colposcopy—Endocervical Curettage and Cervical Biopsy, 221 45. Endometrial Biopsy, 227 46. Specimen Collection—Gram Stain, Wet Mount (Saline and KOH), 230 47. Specimen Collection—Papanicolaou (Pap) Smear, 234 Procedures 48. Administration of Vaginal Medications and Condoms, 240 49. Bartholin Cyst Abscess—Incision and Drainage, 243 50. Cervical Cap Fitting, Insertion, and Removal, 246 51. Cervical Lesions—Cryotherapy, 249 52. Circumcision and Dorsal Penile Nerve Block, 252 53. Condyloma Acuminata Removal, 258 54. Diaphragm Fitting, Insertion, and Removal, 263 4206_FM_i-xiv.indd x 4206_FM_i-xiv.indd x 12/30/2014 10:56:42 AM 12/30/2014 10:56:42 AM Process Cyan Process CyanProcess Magenta Process MagentaProcess Yellow Process YellowProcess Black Process Black Contents xi 55. IUD Fitting, Insertion, and Removal, 266 56. Nexplanon Insertion, 274 57. Nexplanon Removal, 277 58. Paracervical Nerve Block, 279 59. Pessary Insertion, 281 Diagnostic Testing 60. Vaginal Examination, 285 61. Vasectomy, 289 62. At-Risk Fetal Assessment—Third Trimester Testing, 294 63. Leopold's Maneuver, 297 64. Fundal Assessment, 300 65. Obstetric Ultrasound, 302 Procedures 66. Emergency Delivery, 305 67. Teaching Breastfeeding, 308 Section Four: HEAD: EYES, EARS, NOSE, AND MOUTH, 313 Diagnostic Testing 68. Audiometry Testing, 313 69. Occipital Nerve Block, 317 70. Tympanometry, 321 71. Visual Function Evaluation—Snellen, Illiterate E, Pictorial, 330 Procedures—Eyes 72. Corneal Abrasion and Foreign Body Removal—Eye, 335 73. Eye Drop Insertion, 341 74. Eye Irrigation, 345 75. Eye Trauma Stabilization, 348 76. Eyebrow Laceration Repair, 354 77. Eyelid Eversion, 358 Procedures—Ears/Nose 78. Auricular Hematoma Evacuation, 360 79. Cerumen Impaction Removal—Irrigation of the Ear and Curette Technique, 363 80. Ear Piercing, 367 81. Epistaxis Control, 370 4206_FM_i-xiv.indd xi 4206_FM_i-xiv.indd xi 12/30/2014 10:56:42 AM 12/30/2014 10:56:42 AM Process Cyan Process CyanProcess Magenta Process MagentaProcess Yellow Process YellowProcess Black Process Black xii Contents Procedures—Mouth 82. Laryngoscopy—Indirect and Direct Flexible, 380 83. Nasal Lavage (Irrigation), 383 84. Removal of Foreign Body—Ear and Nose, 387 85. Frenotomy for Ankyloglossia, 390 86. Lip Laceration Repair, 393 87. Tongue Laceration Repair, 396 88. Tooth Avulsion and Fracture, 399 Section Five: CARDIOVASCULAR PROCEDURES, 403 Diagnostic Testing 89. Doppler Technique, 403 90. Electrocardiogram (EKG) Interpretation, 406 91. Electrocardiogram (EKG) Lead Placement, 424 92. Holter Monitor Application—Continuous 24-Hour Ambulatory Cardiac Monitoring, 427 93. Stress Testing (Stress EKG), 430 94. Types of Pacemakers, 435 Procedures 95. Arterial Puncture, 437 96. Blood Culture Specimen Collection, 441 97. Capillary Blood Collection—Heel/Finger Stick, 445 98. Central Venous Catheter Access (Portacath), 447 99. Defibrillation, 451 100. Unna’s Boot Application, 453 101. Venipuncture, 457 Section Six: RESPIRATORY PROCEDURES, 463 102. Aerosol/Inhalation Administration (Nebulizer), 463 103. Assessing Respiratory Distress, 466 104. Peak Flowmeter, 469 105. Pulmonary Function Testing (Spirometry), 472 106. Pulmonary Stress Test, 476 107. X-Ray Interpretation—Chest, 480 4206_FM_i-xiv.indd xii 4206_FM_i-xiv.indd xii 12/30/2014 10:56:42 AM 12/30/2014 10:56:42 AM Process Cyan Process CyanProcess Magenta Process MagentaProcess Yellow Process YellowProcess Black Process Black Contents xiii Procedures 108. Chest Tubes for Emergency Transport, 488 109. Flail Chest Stabilization—With or Without Open Chest Wound, 491 110. Stab/Penetrating Wound Stabilization, 496 Section Seven: GASTROINTESTINAL PROCEDURES, 499 Diagnostic Testing 111. Anoscopy, 499 112. Hemoccult, 502 113. Flexible Sigmoidoscopy, 504 114. Urea Breath Test, 512 115. X-Ray Interpretation—Abdominal, 514 Procedures 116. Abdominal Paracentesis, 521 117. Gastric Lavage, 524 118. Inguinal Hernia Reduction, 529 119. Nasogastric Tube Insertion, 532 120. Percutaneous Endoscopic Gastrostomy (PEG) Tube Reinsertion, 534 121. Perianal Skin Tags/External Hemorrhoidal Skin Tags, 539 122. Pilonidal Cyst/Abscess Incision and Drainage (I&D), 541 123. Prostate Massage, 544 124. Rectal Prolapse Reduction, 547 125. Thrombosed Hemorrhoid Removal, 549 Glossary, 553 Index, 563 4206_FM_i-xiv.indd xiii 4206_FM_i-xiv.indd xiii 12/30/2014 10:56:42 AM 12/30/2014 10:56:42 AM Process Cyan Process CyanProcess Magenta Process MagentaProcess Yellow Process YellowProcess Black Process Black Carry Taber’s today and SAVE 20% Use promo code: CARRYTABERS www.FADavis.com KEEP CALM AND CARRY www.Tabers.com 4206_FM_i-xiv.indd xiv 4206_FM_i-xiv.indd xiv 12/30/2014 10:56:42 AM 12/30/2014 10:56:42 AM Process Cyan Process CyanProcess Magenta Process MagentaProcess Yellow Process YellowProcess Black Process Black

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