PRIMARY NURSING TECHNIQUE
UNIT I INTRODUCTION TO NURSING AND THE HEALTH CARE SYSTEM, 1 1 Nursing and the Health Care System, 1 Historical Overview, 1 Nursing in England and Europe, 1 Nursing in North America, 2 The Art and Science of Nursing, 3 Evidence-based Practice, 4 Current Nursing Practice, 5 Nursing Education Pathways, 7 Practical Nursing, 7 Registered Nursing, 8 Advanced Practice Nursing, 8 Delivery of Nursing Care, 9 Practice Settings, 9 Today’s Health Care System, 10 Health Maintenance Organizations, 10 Preferred Provider Organizations, 11 The Patient Protection and Affordable Care Act, 12 2 Concepts of Health, Illness, Stress, and Health Promotion, 14 Health and Illness, 14 Traditional Views of Health And Illness, 15 Stages of Illness, 15 Current Views of Health and Illness, 16 Implications of Current Views, 16 The Consumer Concept of Health and Illness, 17 Health and Illness Behaviors, 17 Cultural Influences on Concepts of Health and Illness, 17 The Holistic Approach, 18 Maslow’s Theory of Basic Needs, 18 Homeostasis, 22 Adaptation, 23 The Effects of Stress, 24 Stress Reduction Techniques, 25 Health Promotion and Illness Prevention, 25 3 Legal and Ethical Aspects of Nursing, 31 Source of Law, 32 Civil and Criminal Law, 33 Laws Related to Nursing Practice and Licensure, 33 Nurse Practice Act, 33 Scope of Practice, 33 Licensure, 33 Professional Accountability, 34 Professional Discipline, 34 Continuing Education, 34 Laws and Guidelines Affecting Nursing Practice, 34 Occupational Safety and Health Administration, 34 Child Abuse Prevention and Treatment Act, 35 Discrimination, 35 Sexual Harassment, 36 Good Samaritan Laws, 36 Patient’s Rights, 36 National Patient Safety Goals, 36 Legal Documents, 37 The Medical Record, 37 Health Insurance Portability and Accountability Act, 38 Consents and Releases, 39 Witnessing Wills or Other Legal Documents, 40 Advance Directives, 40 Violations of Law, 40 Negligence and Malpractice, 40 Common Legal Issues, 41 Decreasing Legal Risk, 43 Ethics in Nursing, 44 Codes of Ethics, 46 Ethics Committees, 46 Ethical Dilemmas, 46 UNIT II THE NURSING PROCESS AND CLINICAL JUDGMENT MODEL, 50 4 The Nursing Process, Critical Thinking, and Clinical Judgment, 50 The Nursing Process, 50 Critical Thinking, 52 Problem Solving and Decision Making, 52 Skills for Critical Thinking, 53 Critical Thinking in Nursing, 54 Priority Setting and Work Organization, 55 Application of Problem Solving, Clinical Reasoning, and Using the Clinical Judgment Model, 56 Contents 5 Assessment, Data Analysis/Problem Identification, and Planning, 59 Assessment (Data Collection), 59 The Interview, 61 Medical Records Review, 61 Physical Assessment, 64 Assessment in Long-Term Care, 66 Assessment in Home Health Care, 66 Data Analysis/Problem Identification, 66 Etiologic Factors, 67 Defining Characteristics, 67 Prioritization of Problems, 67 Problem Statements in Long-Term Care, 68 Problem Statements in Home Health Care, 68 Planning, 68 Expected Outcomes (Goals), 68 Planning in Long-Term Care Facilities, 70 Planning in Home Health Care, 70 Interventions (Nursing Orders), 70 Documentation of the Plan, 70 6 Implementation and Evaluation, 75 Implementation, 75 Priority Setting, 75 Considerations for Care Delivery, 76 Interdisciplinary Care, 77 Implementing Care, 77 Documentation of the Nursing Process, 78 Evaluation, 79 Evaluation in Long-Term Care, 79 Evaluation in Home Health Care, 79 Revision of the Nursing Care Plan, 79 Quality Improvement, 79 Constructing a Nursing Care Plan, 80 UNIT III COMMUNICATION IN NURSING, 86 7 Documentation of Nursing Care, 86 Purposes of Documentation, 86 Documentation and the Nursing Process, 88 The Medical Record, 89 Methods of Documentation (Charting), 89 Source-Oriented or Narrative Charting, 89 Problem-Oriented Medical Record Charting, 89 Focus Charting, 91 Charting by Exception, 93 Computer-Assisted Charting, 93 Case Management System Charting, 96 The Documentation Process, 96 Accuracy in Documentation, 97 Brevity in Documentation, 97 Legibility and Completeness in Documentation, 97 What to Document, 100 8 Communication and the Nurse-Patient Relationship, 104 The Communication Process, 104 Factors Affecting Communication, 105 Communication Skills, 106 Therapeutic Communication Techniques, 107 Using Silence, 107 Asking Open-Ended Questions, 108 Restating, 109 Clarifying, 109 Using Touch, 109 Using General Leads, 109 Offering of Self, 109 Encouraging Elaboration, 109 Providing Patient Education, 109 Looking at Alternatives, 109 Summarizing, 109 Blocks to Effective Communication, 112 Changing the Subject, 112 Offering False Reassurance, 112 Giving Advice, 112 Using Defensive Comments, 112 Asking Prying or Probing Questions, 113 Using Clichés, 113 Listening Inattentively, 113 Interviewing Skills, 114 The Nurse-Patient Relationship, 114 Empathy, 115 Becoming Nonjudgmental, 115 Maintaining Hope, 115 Nurse-Patient Communication, 115 Communicating With the Hearing-Impaired Patient, 116 Communicating With an Aphasic Patient, 116 Communicating With Older Adults, 117 Communicating With Children, 117 Communication Within the Health Care Team, 118 End-of-Shift Report, 118 Telephoning Primary Care Providers, 119 Assignment Considerations and Delegating, 120 Computer Communication, 120 Communication in the Home and Community, 121 9 Patient Education and Health Promotion, 124 Purposes of Patient Education, 124 Modes of Learning, 125 Assessment of Learning Needs, 125 Factors Affecting Learning, 126 The Patient Education Plan, 129 Resources for Patient Education, 129 Implementing the Plan, 129 Evaluation, 130 Documentation, 130 Coordination with Discharge Planning, 130 10 Delegation, Leadership, and Management, 133 The Chain of Command, 134 Leadership Styles, 134 Keys to Effective Leadership, 134 Effective Communication and Relationships, 134 Clinical Competence and Confidence, 136 Organization, 136 Delegation, 136 Leadership Roles, 138 Beginning Leadership Roles, 138 Advanced Leadership Roles, 138 Management Skills for the Licensed Practical Nurse/Licensed Vocational Nurse, 138 Time Management, 139 Using the Computer, 139 Receiving New Orders, 140 Taking Verbal Orders, 141 Documenting for Reimbursement, 142 Risk Management, 142 UNIT IV DEVELOPMENTAL, PSYCHOSOCIAL, AND CULTURAL CONSIDERATIONS, 145 11 Growth and Development: Infancy Through Adolescence, 145 Overview of Structure and Function, 146 Prenatal Development, 146 Adolescent Development, 147 Age Groups, 147 Theories of Development, 147 Principles of Growth and Development, 149 Prenatal Development, 149 Events in Prenatal Development, 150 Maternal Influences, 150 Infants, 150 Nutrition, 151 Appearance and Capabilities of Newborns, 151 Physical Development, 151 Motor Development, 152 Cognitive Development, 152 Psychosocial Development, 153 Young Children, 153 Physical Development, 153 Motor Development, 154 Cognitive Development, 154 Psychosocial Development, 155 Day Care and Early Education, 156 Middle and Older Children, 156 Physical Development, 157 Cognitive Development, 157 Psychosocial Development, 157 Parenting, 158 Child Abuse, 158 Adolescents, 159 Physical Development, 159 Sexuality, 159 Psychosocial Development, 160 Tasks of Adolescence, 161 Concerns in Adolescent Development, 161 12 Adulthood and the Family, 164 Adulthood as Continuing Change, 164 Theories of Development, 165 Schaie’s Theory of Cognitive Development, 165 Erikson’s Stages of Adult Psychosocial Development, 165 Families, 165 Types of Families, 165 Historical Changes in Families, 166 Divorce and Families, 166 Young Adults, 166 Physical Development, 167 Health Concerns of Young Adults, 167 Cognitive Development, 168 Psychosocial Development, 169 Developmental Tasks, 169 Middle Adulthood, 170 Physical Development, 170 Health Concerns, 171 Cognitive Development, 171 Psychosocial Development, 172 13 Promoting Healthy Adaptation to Aging, 176 Overview of Aging, 176 Theories of Aging, 177 Longevity, 177 Demographics, 178 Physical Changes, 178 Health Concerns, 180 Health Promotion Behaviors, 180 Cognitive Aspects of Aging, 181 Wisdom and Learning, 181 Memory Issues, 181 Employment and Retirement, 182 Health Promotion Behaviors, 182 Psychosocial Aspects of Aging, 182 Life Review, 182 Family Relationships, 183 Social Activity, 183 Living Arrangements, 183 Health Promotion Behaviors, 183 When a Parent Needs Help, 184 Planning Ahead, 184 Observing Changes, 184 Resources for Families, 184 14 Cultural and Spiritual Aspects of Patient Care, 187 Transcultural Care, 187 What is Culture?, 188 Understanding Spirituality, 189 Major Religions in the United States and Canada, 189 Christianity, 189 Islam, 190 Hinduism, Buddhism, and Taoism, 192 Developing Cultural Competence, 193 Barriers to Cultural Competence, 194 Cultural Differences, 194 Communication, 194 View of Time, 195 Personal Space, 195 Family Organization and Structure, 195 Nutritional Practices, 195 Death and Dying, 196 Health Care Beliefs, 196 Susceptibility to Disease, 198 Nursing Process and Clinical Judgment Model in Transcultural Nursing, 198 Assessment (Data Collection), 198 Data Analysis/Problem Identification, 199 Planning, 199 Implementation, 199 Evaluation, 200 15 Loss, Grief, and End-of-Life Care, 203 Nurses’ Attitudes Toward End-of-Life Care, 204 Change, Loss, and Grief, 204 Change, 204 Loss, 204 Grief, 204 Stages of Grief, 205 Death and Dying, 206 End-of-Life Care Within the Health Care System, 206 Hospice and Palliative Care, 206 The Dying Process, 207 Nursing and the Dying Process, 209 Application of the Nursing Process/Clinical Judgment Model, 210 Assessment (Data Collection), 210 Data Analysis/Problem Identification, 210 Planning, 210 Implementation, 211 Evaluation, 213 Signs of Impending Death, 213 Physical Signs, 213 Psychosocial and Spiritual Aspects of Dying, 213 Legal and Ethical Aspects of Life-and-Death Issues, 214 Advance Directives, 214 Euthanasia, 214 Adequate Pain Control, 215 Organ and Tissue Donation, 215 Postmortem (After Death) Care, 216 UNIT V BASIC NURSING SKILLS, 221 16 Infection Prevention and Control: Protective Mechanisms and Asepsis, 221 Infectious Agents, 222 Bacteria, 222 Prions, 224 Viruses, 224 Rickettsia, 224 Fungi, 224 Helminths, 224 Other Infectious Agents, 224 Process (Chain) of Infection, 224 Causative Agent (Link One), 224 Reservoir (Link Two), 225 Portal of Exit (Link Three), 225 Mode of Transfer (Link Four), 225 Portal of Entry (Link Five), 226 Susceptible Host (Link Six), 226 Body Defenses Against Infection, 226 Inflammatory Response, 229 Immune Response, 229 Asepsis and Control of Microorganisms, 230 Medical Asepsis and Surgical Asepsis, 230 Hand Hygiene, 230 Standard Precautions, 231 Cleaning and Disinfection, 240 Sepsis in the Home Environment, 241 Infection Control Surveillance, 244 17 Infection Prevention and Control in the Hospital and Home, 247 Infection, 247 Stages of Infection, 247 Health Care–Associated Infections, 248 Infection Prevention and Control, 249 Personal Protective Equipment, 250 Needle Stick Injuries, 251 Application of the Nursing Process/Clinical Judgment Model, 251 Assessment (Data Collection), 251 Data Analysis/Problem Identification, 251 Planning, 251 Implementation, 252 Evaluation, 264 18 Safely Lifting, Moving, and Positioning Patients, 272 Overview of the Structure and Function of the Musculoskeletal System, 273 Which Structures are Involved in Positioning and Moving Patients?, 273 What are the Functions of Bones for Positioning and Moving Patients?, 273 What are the Functions of Muscles for Positioning and Moving Patients?, 273 What Changes in the System Occur With Aging?, 273 Principles of Body Movement for Nurses, 274 Obtain Help Whenever Possible, 274 Use Your Leg Muscles, 274 Provide Stability for Movement, 275 Use Smooth, Coordinated Movements, 275 Keep Loads Close to the Body, 275 Keep Loads Near the Center of Gravity, 275 Principles of Body Movement for Patients, 276 Hazards of Improper Alignment and Positioning, 276 Application of the Nursing Process/Clinical Judgment Model, 276 Assessment (Data Collection), 276 Data Analysis/Problem Identification, 277 Planning, 277 Implementation, 277 Evaluation, 298 19 Assisting With Hygiene, Personal Care, Skin Care, and the Prevention of Pressure Injuries, 301 Overview of the Structure and Function of the Integumentary System, 302 What is the Structure of the Skin?, 302 What are the Functions of the Skin and its Structures?, 302 What Changes in the System Occur with Aging?, 302 Application of the Nursing Process/Clinical Judgment Model, 303 Assessment (Data Collection), 303 Data Analysis/Problem Identification, 307 Planning, 307 Implementation, 307 Evaluation, 324 20 Patient Environment and Safety, 327 Factors Affecting the Environment, 327 Temperature, 327 Ventilation, 327 Humidity, 328 Lighting, 328 Odor Control, 328 Noise Control, 328 Interior Design, 328 Neatness, 329 Privacy, 329 Patient Unit, 329 Beds, 329 Bed Positions, 329 Bed Making, 329 Safety, 335 Hazards, 335 Hazardous Materials, 338 Protective Devices, 341 Legal Implications of Using Protective Devices, 341 Alternatives to Protective Devices, 341 Principles Related to the use of Protective Devices, 342 Documentation of the use of Protective Devices, 345 21 Measuring Vital Signs, 349 Overview of Structure and Function Related to the Regulation of Vital Signs, 350 What Factors Affect Body Heat Production?, 350 How is Body Temperature Regulated?, 350 How Does Fever Occur, and What are its Physiologic Effects?, 351 What Physiologic Mechanisms Control the Pulse?, 351 What is Respiration?, 352 What are the Organs of Respiration?, 352 How is Respiration Controlled?, 352 What is Blood Pressure?, 353 What Physiologic Factors Directly Affect the Blood Pressure?, 353 What Changes Occur in Vital Signs With Aging?, 353 Measuring Body Temperature, 353 Factors Influencing Temperature Readings, 353 Problems of Temperature Regulation, 354 Measuring Body Temperature, 356 Glass Thermometers, 356 Electronic Thermometers, 357 Disposable Thermometers, 358 Application of the Nursing Process/Clinical Judgment Model, 359 Assessment (Data Collection), 359 Data Analysis/Problem Identification, 361 Planning, 361 Implementation, 361 Evaluation, 361 Measuring the Pulse, 363 Common Pulse Points, 363 Pulse Rate, 364 Pulse Characteristics, 364 Application of the Nursing Process/Clinical Judgment Model, 367 Measuring Respirations, 367 Respiratory Patterns, 368 Measuring Oxygen Saturation of the Blood, 369 Measuring the Blood Pressure, 369 Equipment Used for Measuring Blood Pressure, 370 Korotkoff Sounds, 370 Hypertension, 372 Hypotension, 372 Application of the Nursing Process/Clinical Judgment Model, 375 Pain, the Fifth Vital Sign, 375 Automated Vital Sign Monitors, 375 Documenting Vital Signs, 376 Recording Temperature Measurements, 377 Recording Pulse Measurements, 377 Recording Respiration Measurements, 377 Recording Blood Pressure Measurements, 377 Evaluating Vital Sign Trends, 377 22 Assessing Health Status, 380 Data Collection and Assessment, 380 Application of the Nursing Process/Clinical Judgment Model, 381 Data Analysis/Problem Identification, 393 Planning, 393 Implementation, 393 Evaluation, 401 23 Admitting, Transferring, and Discharging Patients, 404 Types of Admissions, 404 Routine Admissions, 404 Emergency Admissions, 405 Admission Process, 405 Preadmission Procedures and Requirements, 405 Day of Admission, 405 Reactions to Admission, 408 Plan of Care, 408 Patient Transfer to Another Hospital Unit, 408 Discharging the Patient, 408 Discharge to an Extended-Care or Rehabilitation Facility, 409 Discharge Home, 409 Death of a Patient, 410 Providing Support For Significant Others, 410 Pronouncement of Death, 410 Autopsies, 411 Organ Donation, 411 24 Diagnostic Tests and Specimen Collection, 413 Diagnostic Tests and Procedures, 413 Application of the Nursing Process/Clinical Judgment Model, 414 Assessment (Data Collection), 414 Data Analysis/Problem Identification, 415 Planning, 415 Implementation, 415 Evaluation, 437 UNIT VI MEETING BASIC PHYSIOLOGIC NEEDS, 444 25 Fluid, Electrolyte, and Acid-Base Balance, 444 Composition of Body Fluids, 444 Water, 444 Electrolytes, 446 Nonelectrolytes, 446 Blood, 446 Distribution of Body Fluids, 446 Movement of Fluid and Electrolytes, 446 Fluid and Electrolyte Imbalances, 449 Fluid Volume Deficit, 449 Fluid Volume Overload, 450 Electrolyte Imbalances, 450 Acid-Base Balance, 455 pH, 455 Bicarbonate, 455 Control Mechanisms, 455 Acid-Base Imbalances, 455 Respiratory Acidosis, 457 Respiratory Alkalosis, 457 Metabolic Alkalosis, 458 Application of the Nursing Process/Clinical Judgment Model, 458 Assessment (Data Collection), 458 Data Analysis/Problem Identification, 459 Planning, 459 Implementation, 459 Evaluation, 463 26 Concepts of Basic Nutrition and Cultural Considerations, 466 Overview of the Structure and Function of the Gastrointestinal System, 467 Which Structures are Involved in the Gastrointestinal (Digestive) System?, 467 What are the Functions of the Organs of the Gastrointestinal System?, 467 What Changes in the Digestive System Occur With Aging?, 468 Dietary Guidelines, 468 USDA MyPlate and the 2015 Dietary Guidelines for Americans, 468 Protein, 470 Functions of Protein, 470 Food Sources of Protein, 470 Dietary Reference Intakes of Protein, 470 Protein Deficiency, 471 Protein Excess, 471 Vegetarian Diets, 471 Carbohydrates, 472 Functions of Carbohydrates, 472 Simple Carbohydrates, 472 Complex Carbohydrates (Starches), 472 Recommendations for Intake, 473 Fiber, 473 Fats (Lipids), 473 Functions of Fat, 473 Food Sources of Fat, 474 Vitamins, 474 Minerals, 474 Water, 475 Factors That Influence Nutrition, 475 Age, 477 Illness, 479 Emotional Status, 480 Economic Status, 480 Religion, 480 Culture, 480 Food Safety, 480 Cultural Influences on Nutrition, 480 African American, 480 Hispanic American, 481 Asian American, 481 Middle Eastern American, 481 Nutrition Counseling, 481 Nutritional Needs Throughout the Life Span, 481 Infants, 481 School-Age Children, 482 Adolescents, 483 Adults, 483 Older Adults, 484 Application of the Nursing Process/Clinical Judgment Model, 484 Assessment (Data Collection), 484 Data Analysis/Problem Identification, 485 Planning, 486 Implementation, 487 Evaluation, 487 27 Nutritional Therapy and Assisted Feeding, 491 The Goals of Nutritional Therapy, 492 The Postoperative Patient, 492 Health Issues Related to Nutrition, 495 Feeding and Eating Disorders, 495 Obesity, 496 Pregnancy, 497 Substance-Related and Addictive Disorders, 497 Disease Processes that Benefit from Nutritional Therapy, 498 Cardiovascular Disease, 498 Diabetes Mellitus, 498 HIV/AIDS, 499 Assisted Feeding, 501 Nasogastric And Enteral Tubes, 501 Percutaneous Endoscopic Gastrostomy or Jejunostomy Tubes, 506 Feeding Tubes and Pumps, 507 Total Parenteral Nutrition, 511 Application of the Nursing Process/Clinical Judgment Model, 512 Assessment (Data Collection), 512 Data Analysis/Problem Identification, 512 Planning, 513 Implementation, 513 Evaluation, 513 28 Assisting With Respiration and Oxygen Delivery, 516 Overview of the Structure and Function of the Respiratory System, 516 Which Structures are Involved in Respiration?, 516 What are the Functions of the Respiratory Structures?, 517 What Changes Occur with Aging that Affect Respiration?, 518 Hypoxemia, 518 Symptoms of Hypoxia, 518 Pulse Oximetry, 519 Airway Obstruction and Respiratory Arrest, 521 Clearing Respiratory Secretions, 521 The Effective Cough, 521 Postural Drainage, 525 Oxygen Administration, 526 Cannula, 530 Masks, 530 Artificial Airways, 532 Nasopharyngeal Suctioning, 532 Tracheobronchial Suctioning, 533 Tracheostomy, 533 Chest Drainage Tubes, 533 Application of the Nursing Process/Clinical Judgment Model, 538 Assessment (Data Collection), 538 Data Analysis/Problem Identification, 539 Planning, 540 Implementation, 540 Evaluation, 547 29 Promoting Urinary Elimination, 550 Overview of Structure and Function of the Urinary System, 550 Which Structures are Involved in Urinary Elimination?, 550 What are the Functions of the Urinary Structures for Elimination?, 551 What Factors can Interfere with Urinary Elimination?, 551 What Changes in the System Occur with aging?, 552 Normal Urinary Elimination, 552 Factors Affecting Normal Urination, 552 Characteristics of Normal Urine, 552 Alterations in Urinary Elimination, 553 Application of the Nursing Process/Clinical Judgment Model, 553 Assessment (Data Collection), 553 Data Analysis/Problem Identification, 556 Planning, 556 Implementation, 557 Evaluation, 578 30 Promoting Bowel Elimination, 582 Overview of the Structure and Function of the Intestinal System, 583 Which Structures of the Intestinal System are Involved in Waste Elimination?, 583 What are the Functions of the Intestines?, 583 What Effect Does Aging Have on the Intestinal Tract?, 584 Characteristics of Stool, 584 Normal Characteristics of Stool, 584 Abnormal Characteristics of Stool, 584 Hypoactive Bowel and Constipation, 584 Hyperactive Bowel and Diarrhea, 586 Fecal Incontinence, 587 Application of the Nursing Process/Clinical Judgment Model, 587 Assessment (Data Collection), 587 Data Analysis/Problem Identification, 587 Planning, 587 Implementation, 588 Evaluation, 589 Rectal Suppositories, 590 Enemas, 590 Types of Enemas, 590 Amount and Temperature of Solution, 591 Recommended Position, 591 Rectal Tube, 591 Fecal Impaction, 591 Bowel Training for Incontinence, 594 Bowel Ostomy, 595 Ostomy Care, 595 31 Pain, Comfort, and Sleep, 604 Pain and Discomfort, 605 Theories of Pain, 605 Types of Pain, 606 Application of the Nursing Process/Clinical Judgment Model, 608 Assessment (Data Collection), 608 Data Analysis/Problem Identification, 610 Planning, 610 Implementation, 610 Evaluation, 619 Sleep, 619 Functions of Sleep, 620 Stages of Sleep, 620 Normal Sleep Requirements, 620 Factors Affecting Sleep, 621 Sleep Disorders, 621 Application of the Nursing Process/Clinical Judgment Model, 622 Assessment (Data Collection), 622 Data Analysis/Problem Identification, 622 Planning, 622 Implementation, 622 Evaluation, 623 32 Complementary Health Approaches, 626 Complementary Health Approaches, 626 Mind and Body Interventions, 627 Acupuncture, 627 Yoga, 627 Chiropractic, 627 Massage Therapy, 628 Relaxation Therapy, 628 Imagery, 628 Meditation, 628 Biofeedback, 628 Biofield Therapies, 628 Hypnotherapy, 629 Music, Art, and Dance Therapy, 629 Humor, 629 Prayer, 629 Natural Products, 629 Herbal Therapy and Dietary Supplements, 629 Aromatherapy, 631 Other Complementary Interventions, 631 Homeopathic Medicine, 631 Naturopathic Medicine, 631 Traditional Chinese Medicine, 631 Ayurveda, 631 Shamanism, 631 Folk Medicine, 632 American Indian Medicine, 632 The Nurse’s Role in Complementary Health Approaches, 632 UNIT VII MEDICATION ADMINISTRATION, 635 33 Pharmacology and Preparation for Drug Administration, 635 Pharmacology, 635 Classification of Drugs, 636 Legal Control of Drugs, 638 Basic Concepts of Pharmacology, 639 Medication Administration and Safety, 642 Considerations for Infants and Children, 643 Considerations for the Older Adult, 644 Considerations for Home Care, 646 Problems of Nonadherence, 646 Application of the Nursing Process/Clinical Judgment Model, 647 Assessment (Data Collection), 647 Data Analysis/Problem Identification, 648 Planning, 648 Implementation, 650 Evaluation, 655 34 Administering Oral, Topical, and Inhalant Medications, 658 Nursing Responsibilities in Medication Administration, 659 Medication Orders, 659 Types of Orders, 660 Regularly Scheduled or Routine Medication Orders, 661 Dosage of Medications, 661 Routes of Oral and Topical Medication Administration, 661 Medication Administration and Technology, 661 Medication Administration Record, 663 Medication Administration Systems, 663 Unit-Dose System, 663 Prescription System, 664 Preparation of Oral Controlled Substances From a Dispenser, 664 Topical Drugs, 666 Application of the Nursing Process/Clinical Judgment Model, 666 Assessment (Data Collection), 666 Data Analysis/Problem Identification, 666 Planning, 667 Implementation, 667 Evaluation, 683 Medication Errors, 684 35 Administering Intradermal, Subcutaneous, and Intramuscular Injections, 687 Principles of Parenteral Injections, 688 Routes for Parenteral Medication, 688 Intradermal Route, 689 Subcutaneous Route, 689 Intramuscular Route, 689 Injection Equipment, 690 Types of Syringes, 690 Measurement Scales, 690 Needle Gauge and Length, 690 Preventing Needle Sticks, 691 Syringe and Needle Selection, 692 Preparing the Syringe for Use, 692 Parenteral Solutions, 692 Using a Medication Ampule, 692 Using a Medication Vial, 694 Reconstitution of a Drug, 695 Compatibility of Medications, 695 Application of the Nursing Process/Clinical Judgment Model, 697 Assessment (Data Collection), 697 Data Analysis/Problem Identification, 697 Planning, 697 Implementation, 698 Evaluation, 710 36 Administering Intravenous Solutions and Medications, 714 Intravenous Therapy, 715 Licensed Practical Nurse/Licensed Vocational Nurse’s Role in Intravenous Therapy, 715 Types of Intravenous Solutions, 715 Equipment for Intravenous Administration, 718 Administration Sets, 718 Infusion Pumps and Controllers, 721 Venous Access Devices, 722 Complications of Intravenous Therapy, 724 Infiltration, 724 Extravasation, 725 Phlebitis, 725 Bloodstream Infection, 725 Other Complications, 725 Application of the Nursing Process/Clinical Judgment Model, 726 Assessment (Data Collection), 726 Data Analysis/Problem Identification, 727 Planning, 727 Implementation, 728 Evaluation, 746 UNIT VIII CARE OF THE SURGICAL AND IMMOBILE PATIENT, 749 37 Care of the Surgical Patient, 749 Reasons for Surgery, 750 Patients at Higher Risk for Surgical Complica Perioperative Nursing, 751 Enhancements to Surgical Technique, 751 Laser Surgery, 751 Fiberoptic Surgery, 751 Robotic Surgery, 752 Anesthesia, 752 General Anesthesia, 752 Regional Anesthesia, 752 Procedural (Moderate) Sedation Anesthesia, 752 Local Anesthesia, 752 Preoperative Procedures, 753 Surgical Consent, 753 Physical Examination, 753 Application of the Nursing Process/Clinical Judgment Model, 754 Preoperative Care, 754 Assessment (Data Collection), 754 Data Analysis/Problem Identification, 755 Planning, 755 Implementation, 755 Evaluation, 758 Intraoperative Care, 758 Role of the Scrub Person and Circulating Nurse, 760 Postanesthesia Immediate Care, 760 Postanesthesia Care in the Same-Day Surgery Unit, 764 Postoperative Care, 765 Assessment (Data Collection), 765 Data Analysis/Problem Identification, 766 Planning, 766 Implementation, 766 Evaluation, 772 38 Providing Wound Care and Treating Pressure Injuries, 775 Types of Wounds and the Healing Process, 776 Phases of Wound Healing, 777 Factors Affecting Wound Healing, 778 Age, 778 Nutrition, 778 Lifestyle, 780 Medications, 780 Infection, 780 Chronic Illness, 780 Complications of Wound Healing, 781 Hemorrhage, 781 Infection, 781 Dehiscence and Evisceration, 782 Treatment of Wounds, 782 Wound Closure, 782 Drains and Drainage Devices, 783 Debridement, 783 Dressings, 784 Binders, 786 Negative Pressure Wound Therapy, 786 Treatment of Pressure Injuries or Vascular Ulcers, 787 Application of the Nursing Process/Clinical Assessment (Data Collection), 788 Data Analysis/Problem Identification, 788 Planning, 789 Implementation, 789 Evaluation, 803 39 Promoting Musculoskeletal Function, 805 Systemic Effect of Immobilization, 806 Psychosocial Effects of Immobilization, 807 Types of Immobilization, 808 Splints, 808 Traction, 808 Casts, 810 External Fixators, 812 Devices Used to Prevent Problems of Immobility, 812 Specialty Beds, 812 Pressure Relief Devices, 813 Continuous Passive Motion Machine, 814 Therapeutic Exercise, 814 Application of the Nursing Process/Clinical Judgment Model, 814 Assessment (Data Collection), 814 Data Analysis/Problem Identification, 815 Planning, 816 Implementation, 816 Evaluation, 828 UNIT IX CARING FOR OLDER ADULTS, 832 40 Common Physical Care Problems of the Older Adult, 832 Getting Older, 832 Immobility, 832 Nursing Interventions to Promote Mobility, 833 Preventing Falls, 835 Alteration in Elimination, 836 Urinary Incontinence, 836 Constipation and Fecal Impaction, 837 Alteration in Nutrition, 837 Nursing Interventions for Nutritional Support, 838 Sensory Deficits, 839 Vision Deficits, 839 Hearing Deficit, 840 Sexuality, 841 Polypharmacy, 841 Nursing Interventions for Polypharmacy, 842 41 Common Psychosocial Care Problems of the Older Adult, 848 Changes in Cognitive Functioning in Older Adults, 848 Assessment of Cognitive Changes in Older Adults, 849 Common Cognitive Disorders in Older Adults, 849 Confusion, 849 Delirium, 849 Dementia, 850 Alzheimer Disease, 852 Safety for the Cognitively Impaired Older Adult, 853 Behaviors Associated With Cognitive Disorders, 854 Depression, Alcohol Use Disorder, and Suicide, 855 Interventions for Depression, Alcohol Use Disorder, and Suicide Prevention, 856 Crimes Against Older Adults, 857 Elder Abuse, 857 Scams and White Collar Crime, 858 Future Issues of Concern to Older Adults, 859 Planning for the Future, 859