Procedures / xxvii Contributors / xxx Reviewers / xxxiii Preface / xxxvi How to Use This Text / xli Acknowledgments / xlv About the Authors / xlvi Unit I Nursing s Perspective: Past, Present, and Future Chapter 1 Evolution of Nursing and Nursing Education Evolution of Nursing / 4 Origins of Nursing / 4 Religious Influences / 7 Demands of War / 8 Florence Nightingale (1820 1910) / 8 Nursing Pioneers and Leaders / 9 Nursing in the 20th Century / 13 Social Forces Affecting Nursing / 17 Nursing Education Overview / 18 Diploma Education / 20 Associate Degree Programs / 20 Baccalaureate Programs / 21 Master s Programs / 21 Doctoral Programs / 22 Staff Development and Continuing Education / 22 Preparing Nurses for Tomorrow s Challenges / 23 Differentiated Practice / 23 Accelerated Degree Programs / 24 Technology Changes in Nursing Education / 25 Work-Study Scholarship Program / 25 Service Learning / 25 Chapter 2 Nursing Theory Components of the Theoretical Foundation / 28 What Is a Concept? / 28 What Is a Proposition? / 28 What Is a Theory? / 29
vii Use of Theories from Other Disciplines / 29 Importance of Nursing Theories / 29 Scope of Theories / 30 Grand Theories / 30 Middle-Range Theories / 30 Micro-Range Theories / 31 Evolution of Nursing Theory / 31 Knowledge Development in Nursing / 31 Metaparadigm of Nursing / 31 Paradigms in Nursing / 34 Selected Nursing Theories / 35 Florence Nightingale / 35 Early Nursing Theories / 37 Contemporary Nursing Theories / 38 Theories for the New Worldview of Nursing / 43 Continuing Evolution of Nursing Theory / 45 Chapter 3 Research and Evidence-Based Practice Research: Substantiating the Science of Nursing / 48 Historical Development / 48 Framework / 50 Research Utilization / 53 Nursing Students / 55 Evidenced-Based Practice / 55 Evidence Reports / 56 Trends in Research and Evidence-Based Practice / 57 Chapter 4 Health Care Delivery, Quality, and the Continuum of Care Health Care Delivery: Organizational Frameworks / 60 Public Sector / 60 Private Sector / 61 Health Care Team / 62 Nurse: Roles and Functions / 62 Advanced Practice Nurse: Roles and Functions / 62 Reimbursement Methods / 62 Private Insurance / 62 Managed Care / 62 Government Plans / 65 Factors Influencing the Delivery of Health Care / 66 Cost / 67 Access / 67 Quality / 67 Nursing Supply and Demand / 68 Responses to Health Care Changes / 68 Nursing Agenda for Health Care Reform / 68 Public versus Private Programs / 68 Vulnerable Populations / 69 Community Nursing Organizations / 70 Continuum of Care / 70 Levels of Care / 70 Health Care Settings / 71 Fragmentation of Care / 71
viii Contents Quality Management in Health Care / 72 Defining Quality / 72 Factors Influencing Quality in Health Care / 75 Quality and Health Care Economics / 76 Principles of Quality Improvement / 77 Customer Satisfaction / 77 Organizational Structure for Quality Management / 78 Leadership / 78 Teamwork / 78 Process Improvement / 78 Tools for Measuring Quality / 78 Nursing s Role in Quality Management / 80 Trends in Health Care Delivery / 80 Unit II Nursing Process: The Standard of Care Chapter 5 Critical Thinking, Decision Making, and the Nursing Process Critical Thinking / 85 Components of Critical Thinking / 85 Development of Critical Thinking Skills / 86 Critical Thinking and Creativity / 87 Critical Thinking and Problem Solving / 88 Critical Thinking and Decision Making / 88 The Nursing Process / 89 Historical Perspective / 89 Overview of the Nursing Process / 89 Assessment / 90 Diagnosis / 91 Outcome Identification and Planning / 93 Implementation / 94 Evaluation / 96 Critical Thinking Applied in Nursing / 96 Chapter 6 Assessment Purpose of Assessment / 99 Types of Assessment / 99 Comprehensive Assessment / 99 Focused Assessment / 100 Ongoing Assessment / 100 Data Collection / 100 Types of Data / 101 Sources of Data / 101 Methods of Data Collection / 102 Data Verification / 107 Data Organization / 107 Assessment Models / 107 Data Interpretation / 109 Data Documentation / 109 Types of Assessment Formats / 109
ix Chapter 7 Nursing Diagnosis What Is a Nursing Diagnosis? / 120 Comparison of Nursing and Medical Diagnoses / 121 Historical Perspective / 122 Research / 122 Purposes of Nursing Diagnoses / 123 Nursing Diagnoses and Diagnostic-Related Groups / 124 Nursing Diagnoses and Nursing Informatics / 125 Components of a Nursing Diagnosis / 125 The Two-Part Statement / 126 The Three-Part Statement / 126 Categories of Nursing Diagnoses / 126 Taxonomy of Nursing Diagnoses / 127 Clinical Judgment in Nursing: Developing Nursing Diagnoses / 128 Generating Cues / 128 Validating Cues / 128 Interpreting Cues / 129 Clustering Cues / 129 Using NANDA-Approved Nursing Diagnoses / 129 Writing the Nursing Diagnosis Statement / 130 Avoiding Errors in Development and Use of Nursing Diagnoses / 130 Assessment Errors / 130 Diagnostic Errors / 130 Limitations of Nursing Diagnosis / 131 Overcoming Barriers to Nursing Diagnosis / 132 Chapter 8 Planning and Outcome Identification Purposes of Planning and Outcome Identification / 137 Process of Planning and Outcome Identification / 137 Critical Thinking / 137 Establishing Priorities / 138 Establishing Goals and Expected Outcomes / 139 Problems Frequently Encountered in Planning / 142 Planning Nursing Interventions / 143 Evaluating Care / 146 Nursing Outcomes Classification (NOC) / 146 Plan of Care / 147 Types of Care Plans / 147 Strategies for Effective Care Planning / 148 Chapter 9 Implementation Purposes of Implementation / 152 Requirements for Effective Implementation / 152 Cognitive Skills / 152 Psychomotor Skills / 152 Interpersonal Skills / 153 Implementation Activities / 153 Ongoing Assessment / 153 Establishment of Priorities / 153 Allocation of Resources / 154 Nursing Interventions / 158
x Contents Evaluating Interventions / 163 Documentation of Interventions / 163 Chapter 10 Evaluation Evaluation of Client Care / 166 Components of Evaluation / 166 Techniques / 166 Sources of Data / 167 Goals and Expected Outcomes / 167 Methods of Evaluation / 167 Establishing Standards / 167 Collecting Data / 167 Determining Goal Achievement / 167 Relating Nursing Actions to Client Status / 167 Judging the Value of Nursing Interventions / 167 Reassessing the Client s Status / 168 Modifying the Plan of Care / 168 Critical Thinking and Evaluation / 168 Evaluation and Quality of Care / 168 Elements in Evaluating the Quality of Care / 169 Nursing Audit / 170 Peer Evaluation / 170 Evaluation and Accountability / 171 Multidisciplinary Collaboration in Evaluation / 174 Unit III Professional Accountability Chapter 11 Leadership, Delegation, and Power Professional Nursing Practice / 177 Criteria of a Profession / 177 Professional Accountability / 180 Elements of Professional Accountability / 180 Legislative Accountability / 182 Individual Accountability / 184 Student Accountability / 185 Advanced Practice Nursing / 185 Leadership in Nursing / 188 Managerial Functions / 188 Leadership Styles / 188 Leadership Characteristics / 189 Power / 192 Mentoring / 194 Networking / 194 Empowerment / 194 Politics of Nursing / 195 Chapter 12 Legal and Ethical Responsibilities Legal Foundations of Nursing / 198 Sources of Law / 198
xi The Judicial Process / 200 Legal Liability in Nursing / 200 Legal Responsibilities and Roles / 206 Legal Responsibilities of Students / 207 Legal Safeguards for Nursing Practice / 207 Legislation Affecting Nursing Practice / 208 Legal Issues Related to Death and Dying / 210 Ethical Foundations of Nursing / 211 Concept of Ethics / 212 Ethical Theories / 213 Ethical Principles / 213 Values and Ethics / 216 Ethical Codes / 216 Clients Rights / 217 Ethical Dilemmas / 218 Ethical Roles and Responsibilities of Professional Nurses / 221 Ethical Decision Making / 222 Chapter 13 Documentation and Informatics Documentation as Communication / 226 Documentation Defined / 226 Purposes of Health Care Documentation / 227 Principles of Effective Documentation / 231 Elements of Effective Documentation / 233 Methods of Documentation / 235 Narrative Charting / 235 Source-Oriented Charting / 235 Problem-Oriented Charting / 235 PIE Charting / 236 Focus Charting / 236 Charting by Exception / 236 Case Management Process / 237 Forms for Recording Data / 238 Kardex / 238 Flow Sheets / 238 Nurses Progress Notes / 238 Discharge Summary / 238 Computerized Documentation / 238 Electronic Medication Administration and Record / 245 Trends in Documentation / 245 Nursing Minimum Data Set (NMDS) / 245 Nursing Diagnoses / 246 Nursing Outcomes Classification (NOC) / 247 Nursing Intervention Classification (NIC) / 247 Reporting / 247 Summary Reports / 248 Walking Rounds / 248 Telephone Reports and Orders / 249 Incident Reports / 250
xii Contents Unit IV Promoting Client Health Chapter 14 Nursing, Healing, and Caring Nursing s Therapeutic Value / 255 Definition of Nursing / 255 Nursing: A Blend of Art and Science / 255 Purposes of Nursing / 255 Nursing and Healing / 256 Theoretical Perspectives of Caring / 256 Care in the High-Technology Environment / 258 Nurse-Client Relationship / 258 Phases of Therapeutic Relationship / 259 Therapeutic Use of Self / 261 Caring and Communication / 261 Characteristics of Therapeutic Relationships / 262 Warmth / 262 Hope / 262 Rapport / 263 Trust / 263 Empathy / 263 Acceptance / 264 Active Listening / 264 Humor / 264 Compassion / 265 Self-Awareness / 265 Nonjudgmental Approach / 266 Flexibility / 266 Risk Taker / 266 Therapeutic Value of the Nursing Process / 266 Nursing Roles / 266s Chapter 15 Communication The Communication Process / 270 Components of the Communication Process / 270 Factors Influencing Communication / 272 Levels of Communication / 272 Modes of Communication / 274 Verbal Messages / 274 Nonverbal Messages / 275 Metacommunication / 277 Types of Communication / 277 Interdisciplinary Communication / 277 Therapeutic Communication / 277 Therapeutic Approaches with Clients / 280 Barriers to Therapeutic Interaction / 280 Language Differences / 280 Cultural Differences / 280 Gender / 280 Health Status / 280 Developmental Level / 280
xiii Knowledge Differences / 283 Emotional Distance / 283 Emotions / 283 Daydreaming / 283 Use of Health Care Jargon / 283 Communication Blocks / 283 Communication,Critical Thinking, and Nursing Process / 285 Assessment / 285 Nursing Diagnosis / 285 Planning and Outcome Identification / 286 Implementation / 286 Evaluation / 288 Chapter 16 Health and Wellness Promotion Health, Illness, and Wellness / 290 Models of Health / 290 Illness Perspectives / 292 Wellness Perspectives / 292 Health Behaviors / 293 Variables Influencing Health Behaviors / 293 Health Promotion / 295 The Individual as a Holistic Being / 298 Needs and Health / 298 Physiological Dimension / 299 Psychological Dimension / 299 Sociocultural Dimension / 300 Intellectual Dimension / 300 Spiritual Dimension / 300 Promoting Sexual Health / 300 Development of Sexuality / 300 Gender Identity / 301 Needs / 301 Human Sexual Response / 301 Sexuality and Health / 301 Nursing Process and Sexuality / 302 Chapter 17 Family and Community Health Family Health / 307 Family Structure / 307 Family Roles and Functions / 308 Characteristics of Healthy Families / 308 Family Development Theories / 309 Threats to Family Integrity / 310 Community Health / 313 Public Health Nursing / 313 Disaster Preparedness / 314 Chapter 18 The LIfe Cycle Fundamental Concepts of Growth and Development / 317 Principles of Growth and Development / 317 Factors Influencing Growth and Development / 318
xiv Contents Theoretical Perspectives of Human Development / 319 Physiological Dimension / 319 Psychosocial Dimension / 319 Cognitive Dimension / 321 Moral Dimension / 323 Spiritual Dimension / 325 Holistic Framework for Nursing / 325 Stages of the Life Cycle / 326 Prenatal Period / 326 Neonatal Period / 329 Infancy / 332 Toddler / 336 Preschooler / 339 School-Age Child / 341 Preadolescent / 343 Adolescent / 346 Young Adult / 350 Middle-Aged Adult / 354 Older Adult / 358 Chapter 19 The Older Client Defining Old Age / 366 Theories of Aging / 366 Myths and Stereotypes of Aging / 367 Quality of Life among Older Adults / 367 Changes Associated with Aging / 368 Developmental Changes / 368 Physiological Changes / 369 Cardiovascular Changes / 370 Psychosocial Changes / 374 Medications and the Older Adult / 377 Responses to Medication / 377 Compliance / 378 Mistreatment of the Older Adult / 378 Nursing Process and the Older Adult / 379 Assessment / 379 Nursing Diagnosis / 380 Outcome Identification and Planning / 380 Implementation / 380 Evaluation / 385 Chapter 20 Cultural Diversity Concepts of Culture / 388 Culture / 388 Ethnicity and Race / 388 Labeling and Stereotyping / 389 Dominant Values in the United States / 389 Multiculturalismin the United States / 390 Value of Diversity / 390 Organizing Phenomena of Culture / 391 Communication / 391 Space / 391 Orientation to Time / 391
xv Social Organization / 396 Gender / 396 Lifestyle / 396 Religion / 397 Cultural Disparities in Health and Health Care Delivery / 397 Vulnerable Populations / 398 Environmental Control / 400 Folk Medicine / 400 Biologic Variations / 400 Transcultural Nursing / 400 Cultural Competence / 403 Cultural Competence and Nursing Process / 403 Assessment / 404 Nursing Diagnosis / 404 Planning and Outcome Identification / 405 Implementation / 405 Evaluation / 407 Chapter 21 Client Education The Teaching-Learning Process / 410 Purposes of Client Teaching / 410 Facilitators of Learning / 411 Barriers to Learning / 412 Domains of Learning / 412 Professional Responsibilities Related to Teaching / 413 Legal Aspects / 413 Documentation / 413 Learning Throughout the Life Cycle / 414 Children / 414 Adolescents / 414 Older Adults / 414 Teaching-Learning and the Nursing Process / 419 Assessment / 419 Nursing Diagnosis / 422 Planning and Outcome Identification / 422 Implementation / 424 Evaluation / 425 Evaluation of Learning / 425 Unit V Responding to Basic Psychosocial Needs Chapter 22 Self-Concept Components of Self-Concept / 431 Identity / 431 Body Image / 432 Self-Esteem / 432 Role Performance / 432 Development Of Self-Concept / 433 Childhood / 433 Adolescence / 434 Adulthood / 434
xvi Contents Factors Affecting Self-Concept / 435 Altered Health Status / 435 Developmental Transitions / 436 Experience / 436 Assessment / 437 Diagnosis / 438 Outcome Identification and Planning / 438 Implementation / 439 Initiate Therapeutic Interaction / 439 Support Healthy Defense Mechanisms / 439 Ensure Satisfaction of Needs / 439 Promote Positive Self-Esteem across the Life Span / 440 Evaluation / 441 Chapter 23 Stress, Anxiety, Adaptation, and Change Stress, Anxiety,and Adaptation / 445 Sources of Stress / 445 Responses to Stress / 445 Physiological Response to Stress / 445 Manifestations of Stress / 447 Outcomes of Stress / 447 Stress and Illness / 450 Impact of Illness and Treatment / 450 Stress and Change / 452 Types of Change / 453 Theories of Change / 453 Resistance to Change / 454 Changing Paradigms / 454 Nurse as Change Agent / 455 Assessment / 455 Nursing Diagnosis / 456 Outcome Identification and Planning / 456 Implementation / 456 Meeting Basic Needs / 458 Environmental Strategies / 458 Verbalization / 458 Involvement of Family and Significant Others / 458 Stress Management Techniques / 459 Crisis Intervention / 461 Evaluation / 462 Personal Stress Management Approaches for the Nurse / 463 Burnout and Nurses / 463 Chapter 24 Spirituality Spirituality Defined / 469 Nursing Process and Spirituality / 470 Assessment / 474 Diagnosis / 474 Planning and Outcome Identification / 475 Implementation / 477 Evaluation / 478
xvii Chapter 25 Loss and Grief Loss / 481 Loss as Crisis / 481 Types of Loss / 481 Grief / 482 Theories of the Grieving Process / 482 Types of Grief / 484 Factors Affecting Grief / 485 Nursing Care of the Grieving Person / 490 Death / 493 End-of-Life (EOL) Care / 493 Stages of Death and Dying / 493 Ethical Implications / 495 Assessment / 495 Diagnosis / 495 Outcome Identification and Planning / 495 Implementation / 496 Care After Death / 500 Care of the Body / 500 Legal Aspects / 500 Care of the Family / 502 Nurse s Self-Care / 502 Unit VI Responding to Basic Physiological Needs Chapter 26 Vital Signs Vital Signs / 506 Physiological Function / 507 Factors Influencing Vital Signs / 510 Age / 511 Gender / 511 Heredity / 512 Race / 512 Lifestyle / 512 Environment / 512 Medications / 513 Pain / 513 Other Factors / 513 Measuring Vital Signs / 514 Equipment / 514 Measurement of Height and Weight / 514 The Nursing Process and Vital Signs / 518 Nursing Process and Thermoregulation / 519 Pulse / 523 Respirations / 525 Blood Pressure / 526 Chapter 27 Physical Assessment Physical Examination / 548 Preparation / 549
xviii Contents General Survey / 549 Techniques / 553 Integument / 554 Head and Neck / 555 Thorax and Lungs / 575 Heart and Vascular System / 576 Breasts and Axillae / 583 Abdomen / 593 Female Genitalia, Anus, and Rectum / 594 Male Genitalia, Anus, and Rectum / 594 Musculoskeletal System / 598 Neurologic System / 601 Care of the Client after the Examination / 610 Data Documentation / 610 Chapter 28 Diagnostic Testing Overview of Noninvasive and Invasive Diagnostic Testing / 614 Nursing Care of the Client / 614 Laboratory Tests / 620 Specimen Collection / 620 Hematologic System / 626 Type and Crossmatch / 629 Blood Chemistry / 630 Urine Analysis / 637 Stool Analysis / 639 Culture and Sensitivity Tests / 639 Papanicolaou Test / 640 Radiologic Studies / 640 Contrast-Mediated Studies / 641 Plain Films / 641 Risks of Exposure to Radiation / 641 Mammography / 641 Angiography Studies / 643 Ultrasonography / 644 Echocardiograms / 645 Doppler Ultrasonography / 645 Non-Nuclear Scan Studies / 645 Computed Tomography / 645 Magnetic Resonance Imaging / 646 Radioactive Studies / 646 Electrodiagnostic Studies / 646 Electrocardiography / 646 Electroencephalography / 648 Endoscopy / 648 Aspiration and Biopsy / 648 Amniocentesis / 650 Bone Marrow Aspiration and Biopsy / 650 Paracentesis / 650 Thoracentesis / 651 Cerebrospinal Fluid Aspiration / 651
xix Chapter 29 Safety, Infection Control, and Hygiene Creating a Culture of Client Safety / 669 Factors Affecting Safety / 671 Types of Accidents / 672 Potential Occupational Hazards / 673 Infection Control Principles / 674 Pathogens, Infection, and Colonization / 674 Chain of Infection / 675 Normal Defense Mechanisms / 676 Stages of the Infectious Process / 678 Emerging Infections / 679 Nosocomial Infections / 680 Hygiene / 680 Factors Influencing Hygienic Practice / 681 Assessment / 682 Health History / 682 Physical Examination / 683 Diagnostic and Laboratory Data / 684 Nursing Diagnosis / 686 Risk for Injury / 686 Risk for Infection / 686 Self-Care Deficits / 686 Other Nursing Diagnoses / 686 Outcome Identification and Planning / 687 Implementation / 689 Raise Safety Awareness and Knowledge / 689 Prevent Falls / 689 Prevent Fire / 695 Ensure Safe Operation of Electrical Equipment / 695 Reduce Exposure to Radiation / 696 Prevent Poisoning / 696 Reduce Noise Pollution / 696 Ensure Asepsis / 696 Reduce or Eliminate Infectious Agents / 699 Practice Standard and Isolation Precautions / 701 Alternative Therapies / 705 Provide for Client Bathing Needs / 706 Provide Clean Bed Linens / 707 Provide Skin Care / 707 Back Rubs / 708 Provide Foot and Nail Care / 708 Provide Oral Care / 709 Provide Hair Care / 709 Provide Eye, Ear, and Nose Care / 711 Evaluation / 713 Chapter 30 Medication Administration Drug Standards and Legislation / 773 Standards / 773 Federal Legislation / 774 State and Local Legislation / 774 Health Care Institution Regulations / 774
xx Contents Pharmacokinetics / 775 Absorption / 775 Distribution / 776 Metabolism / 776 Excretion / 776 Drug Nomenclature / 777 Drug Action / 777 Pharmacology / 777 Drug Interaction / 780 Side Effects and Adverse Reactions / 780 Factors Influencing Drug Action / 781 Professional Roles in Medication Administration / 782 Types of Medication Orders / 783 Parts of the Drug Order / 784 Systems of Weight and Measure / 784 Metric System / 785 Apothecary System / 785 Household System / 785 Approximate Dose Equivalents / 785 Converting Units of Weight and Volume / 785 Drug Dose Calculations / 787 Safe Drug Administration / 787 Guidelines for Medication Administration / 788 Documentation of Drug Administration / 790 Drug Supply and Storage / 791 Drug Abuse / 792 Medication Compliance / 793 Legal Aspects of Administering Medications / 794 Medication Errors / 794 Preventing Medication Errors / 794 Assessment / 796 Medical History / 796 Drug History / 796 Biographical Data / 798 Cultural Diversity / 798 Lifestyle and Beliefs / 798 Sensory and Cognitive Status / 799 Physical Examination / 799 Diagnostic and Laboratory Data / 799 Nursing Diagnosis / 799 Planning and Outcome Identification / 799 Implementation / 800 Medication Administration: Oral / 801 Medication Administration: Enteral / 801 Medication Administration: Parenteral / 802 Medication Administration: Topical / 811 Evaluation / 817 Chapter 31 Complementary and Alternative Modalities Historical Influences on Contemporary Practices / 865 From Ancient Tradition to Early Science / 865 Shamanistic Tradition / 866
xxi Allopathic Medicine / 867 Contemporary Trends / 867 Mind-Body Medicine and Research / 868 Holism and Nursing Practice / 868 The Nature of Healing / 869 Complementary and Alternative Interventions / 869 Mind-Body: Self-Regulatory Techniques / 869 Body-Movement: Manipulation Strategies / 871 Energetic-Touch Healing / 872 Spiritual Therapies / 878 Nutritional Therapies / 878 Other CAM Methodologies / 882 Nursing and Complementary/Alternative Approaches / 885 Nurse as Instrument of Healing / 886 Chapter 32 Oxygenation Physiology of Oxygenation / 892 Ventilation / 892 Alveolar Gas Exchange / 894 Oxygen Transport and Delivery / 894 Cellular Respiration / 897 Factors Affecting Oxygenation / 897 Age / 897 Environmental and Lifestyle Factors / 898 Disease Processes / 898 Heart Failure / 900 Physiological Responses to Reduced Oxygenation / 901 Assessment / 902 Health History / 902 Physical Examination / 903 Diagnostic and Laboratory Data / 904 Nursing Diagnosis / 905 Ineffective Airway Clearance / 905 Ineffective Breathing Patterns / 906 Impaired Gas Exchange / 908 Decreased Cardiac Output / 908 Ineffective Tissue Perfusion / 908 Other Nursing Diagnoses / 908 Planning and Outcomes / 909 Collaboration / 910 Implementation / 910 Interventions to Promote Airway Clearance / 910 Interventions to Improve Breathing Patterns / 914 Interventions to Improve Oxygen Uptake and Delivery / 914 Interventions to Increase Cardiac Output and Tissue Perfusion / 916 Emergency Interventions / 917 Interventions to Address Associated Nursing Diagnoses / 918 Complementary Therapies / 920 Evaluation / 922 Chapter 33 Fluids and Electrolytes Physiology of Fluid and Acid-Base Balance / 956
xxii Contents Fluid Compartments / 956 Body Water Distribution / 957 Electrolytes / 957 Movement of Body Fluids / 959 Regulators of Fluid Balance / 959 Acid-Base Balance / 961 Regulators of Acid-Base Balance / 962 Factors Affecting Fluid and Electrolyte Balance / 962 Age / 963 Lifestyle / 963 Disturbances in Electrolyte and Acid-Base Balance / 963 Electrolyte Disturbances / 963 Acid-Base Disturbances / 971 Assessment / 975 Health History / 975 Physical Examination / 975 Diagnostic and Laboratory Data / 977 Nursing Diagnosis / 979 Excess Fluid Volume / 979 Deficient Fluid Volume / 979 Risk for Deficient Fluid Volume / 980 Other Nursing Diagnoses / 980 Planning and Outcomes / 981 Collaboration / 981 Implementation / 982 Monitor Daily Weight / 982 Measure Vital Signs / 982 Measure Intake and Output / 982 Provide Oral Hygiene / 982 Initiate Oral Fluid Therapy / 983 Maintain Tube Feeding / 984 Monitor Intravenous Therapy / 984 Complementary Therapy / 998 Evaluation / 999 Chapter 34 Nutrition Physiology of Nutrition / 1035 Digestion / 1036 Absorption / 1036 Metabolism / 1037 Energy / 1038 Excretion / 1038 Nutrients / 1038 Water / 1038 Vitamins / 1039 Minerals / 1039 Carbohydrates / 1041 Proteins / 1043 Lipids / 1044 Promoting Proper Nutrition / 1045 Dietary Reference Intakes and Recommended Daily Allowances / 1045 The Food Guide Pyramid / 1046
xxiii Societal Concerns / 1047 Weight Management / 1048 Factors Affecting Nutrition / 1049 Age / 1049 Lifestyle / 1050 Ethnicity, Culture, and Religious Practices / 1051 Other Factors / 1051 Assessment / 1052 Nutritional History / 1052 Physical Examination / 1054 Diagnostic and Laboratory Data / 1057 Nursing Diagnosis / 1057 Imbalanced Nutrition: Less Than Body Requirements / 1058 Imbalanced Nutrition: More Than Body Requirements or Risk for Imbalanced Nutrition: More Than Body Requirements / 1058 Other Nursing Diagnoses / 1059 Planning and Outcome Identification / 1059 Collaboration / 1059 Implementation / 1059 Monitoring Weight and Intake / 1060 Initiating Diet Therapy / 1060 Assistance with Feeding / 1061 Providing Nutrition Support / 1061 Enteral Tube Feeding / 1062 Parenteral Nutrition / 1065 Administering Medication through a Feeding Tube / 1067 Evaluation / 1074 Chapter 35 Comfort and Sleep Pain / 1086 Nature of Pain / 1087 Physiology of Pain / 1089 Factors Affecting the Pain Experience / 1093 Assessment / 1093 Nursing Diagnosis / 1098 Planning and Outcomes / 1098 Collaboration / 1099 Implementation / 1099 Evaluation / 1114 Rest and Sleep / 1115 Physiology of Rest and Sleep / 1115 Biological Clock / 1118 Factors Affecting Rest and Sleep / 1119 Illness or Hospitalization / 1120 Alteration in Sleep Patterns / 1121 Hypersomnia or Narcolepsy / 1121 Assessment / 1122 Nursing Diagnosis / 1122 Planning and Outcomes / 1122 Implementation / 1123 Evaluation / 1126
xxiv Contents Chapter 36 Mobility Overview of Mobility / 1135 Body Alignment / 1135 Body Mechanics / 1137 Physiology of Mobility / 1137 Musculoskeletal System / 1137 Neurological System / 1138 Exercise / 1139 Types of Exercise / 1139 Physical Fitness / 1140 Factors Affecting Mobility / 1140 Health Status / 1140 Developmental Stage / 1145 Environment / 1147 Attitudes and Beliefs / 1147 Lifestyle / 1147 Physiological Effects of Mobility and Immobility / 1147 Neurological Effects and Mental Status / 1147 Cardiovascular Effects / 1147 Respiratory Effects / 1148 Musculoskeletal Effects / 1148 Digestive Effects / 1149 Elimination Effects / 1149 Integumentary Effects / 1149 Assessment / 1149 Health History / 1149 Physical Examination / 1150 Neurological Assessment / 1154 Nursing Diagnosis / 1154 Planning and Outcome Identification / 1155 Collaboration / 1155 Bed Rest / 1156 Restorative Nursing Care / 1157 Health Promotion and Fitness / 1157 Implementation / 1158 Meeting Psychosocial Needs / 1158 Applying Principles of Body Mechanics / 1158 Maintaining Body Alignment: Positioning / 1159 Performing Range-of-Motion Exercises / 1163 Transfer Techniques / 1163 Assisting with Ambulation / 1166 Wellness Promotion / 1170 Complementary and Alternative Treatment Modalities / 1170 Evaluation / 1170 Chapter 37 Skin Integrity and Wound Healing Wounds / 1209 Physiology of Wound Healing / 1209 Factors Affecting Wound Healing / 1211 Wound Classification / 1212 Assessment / 1214 Nursing Diagnoses / 1218
xxv Planning and Outcomes / 1218 Implementation / 1219 Evaluation / 1227 Pressure Ulcers / 1228 Physiology of Pressure Ulcers / 1228 Risk Factors for Pressure Ulcers / 1228 Assessment / 1230 Nursing Diagnoses / 1231 Planning and Outcomes / 1231 Implementation / 1231 Evaluation / 1239 Chapter 38 Sensation, Perception, and Cognition Physiology of Sensation, Perception, and Cognition / 1256 Components of Sensation and Perception / 1257 Components of Cognition / 1257 Factors Affecting Sensation, Perception, and Cognition / 1261 Age / 1261 Environment / 1261 Lifestyle / 1262 Sensory, Perceptual, and Cognitive Alterations / 1262 Sensory Deficits / 1262 Sensory Deprivation / 1263 Sensory Overload / 1263 Assessment / 1264 Health History / 1264 Physical Examination / 1264 Mental Status Assessment / 1265 Functional Abilities / 1267 Environment / 1267 Diagnosis / 1268 Planning and Outcome Identification / 1268 Implementation / 1270 Managing Sensory Deficits / 1270 Managing Sensory Deprivation / 1272 Managing Sensory Overload / 1272 Caring for the Unconscious Client / 1273 Use of Restraints / 1274 Complementary and Alternative Therapies / 1274 Evaluation / 1275 Chapter 39 Elimination Physiology of Elimination / 1280 Urinary Elimination / 1280 Bowel Elimination / 1282 Factors Affecting Elimination / 1284 Age / 1284 Diet / 1284 Exercise / 1284 Medications / 1284 Common Alterations in Elimination / 1285 Urinary Elimination / 1285
xxvi Contents Chronic Urinary Incontinence / 1285 Bowel Elimination / 1287 Assessment / 1289 Health History / 1289 Physical Examination / 1291 Diagnostic and Laboratory Data / 1292 Nursing Diagnosis / 1293 Impaired Urinary Elimination / 1293 Stress Urinary Incontinence / 1293 Reflex Urinary Incontinence / 1293 Urge Urinary Incontinence / 1293 Functional Urinary Incontinence / 1294 Total Urinary Incontinence / 1294 Urinary Retention / 1294 Constipation / 1294 Perceived Constipation / 1294 Diarrhea / 1294 Bowel Incontinence / 1294 Other Diagnoses / 1294 Planning and Outcomes / 1295 Implementation / 1295 Maintain Elimination Health / 1295 Initiate Exercise Regimen / 1297 Suggest Environmental Modifications / 1298 Initiate Behavioral Interventions / 1298 Monitor Skin Integrity / 1299 Apply a Containment Device / 1299 Initiate Diet and Fluid Therapy / 1300 Administer Medications / 1301 Perform Catheterization / 1302 Administer Enemas / 1303 Initiate Rectal Stimulation / 1304 Monitor Elimination Diversions / 1305 Monitor Surgical Management / 1306 Complementary Therapies / 1306 Evaluation / 1309 Chapter 40 Nursing Care of the Perioperative Client Surgical Interventions / 1349 Setting / 1350 Client Safety / 1350 Anesthesia / 1351 General Anesthesia / 1351 Regional Anesthesia / 1352 Local Anesthesia / 1352 Preoperative Phase / 1353 Assessment / 1353 Diagnosis / 1356 Planning and Outcomes / 1358 Implementation / 1360 Evaluation / 1370 Documentation / 1370
xxvii Intraoperative Phase / 1370 Surgical Environment / 1370 Assessment / 1371 Nursing Diagnoses / 1372 Planning and Outcomes / 1372 Interventions / 1373 Evaluation / 1375 Transfer to Postanesthesia Care Unit / 1376 Postoperative Phase / 1376 Assessment / 1376 Nursing Diagnosis / 1378 Planning and Outcomes / 1378 Interventions / 1379 Evaluation and Discharge from the PACU / 1381 Ongoing Postoperative Care / 1382 Evaluation / 1384 Glossary / 1392 References / 1411 Index / 1430