,Study JGuide Jfor
Medical-Surgical Nursing: J
Assessment and Management
J J J
of Clinical Problems
J J J
Ninth J Edition
Prepared Jby:
Susan JA. JSandstrom, JRN, JMSN, JBC,
JCNE JAssociate JProfessor Jin JNursing,
JRetired JCollege Jof JSaint JMary
Omaha, J Nebraska
Sharon JL. JLewis, JRN, JPhD, JFAAN
JShannon JRuff JDirksen, JRN, JPhD,
JFAAN
Margaret JMcLean JHeitkemper, JRN, JPhD, JFAAN
JLinda JBucher, JRN, JPhD, JCEN, JCNE
Reviewed Jby:
Charles JD. JRogers, JRN, JMSN
JAdvanced JCardiac JLife JSupport
JProvider JAssistant JProfessor Jof
JNursing JMorehead JState JUniversity
Morehead, J Kentucky
Collin JBowman-Woodall, JRN, JMS
Assistant JProfessor
JSamuel JMerritt
JUniversity
San JFrancisco JPeninsula JCampus
JSan JMateo, JCalifornia
, 3251 JRiverport JLane
St. JLouis, JMissouri J63043
STUDY JGUIDE JFOR JMEDICAL-SURGICAL JNURSING: ISBN: J978-0-323-09147-
3 J ASSESSMENT JAND JMANAGEMENT JOF JCLINICAL JPROBLEMS
Copyright J© J2014 Jby JMosby, Jan Jimprint Jof JElsevier JInc. JAll Jrights Jreserved.
Copyright J© J2011, J2007, J2004, J2000, J1996, J1992, J1987, J1983 Jby JMosby, JInc., Jan Jaffiliate Jof JElsevier JInc.
All Jrights Jreserved. JNo Jpart Jof Jthis Jpublication Jmay Jbe Jreproduced Jor Jtransmitted Jin Jany Jform Jor Jby
Jany Jmeans, J electronic Jor Jmechanical, Jincluding Jphotocopy, Jrecording, Jor Jany Jinformation Jstorage Jand
Jretrieval Jsystem, Jwithout J permission Jin Jwriting Jfrom Jthe Jpublisher. JDetails Jon Jhow Jto Jseek
Jpermission, Jfurther Jinformation Jabout Jthe J Publisher’s Jpermissions Jpolicies Jand Jour Jarrangements Jwith
Jorganizations Jsuch Jas Jthe JCopyright JClearance JCenter J and Jthe JCopyright JLicensing JAgency, Jcan Jbe
Jfound Jat Jour Jwebsite: Jwww.elsevier.com/permissions.
This Jbook Jand Jthe Jindividual Jcontributions Jcontained Jin Jit Jare Jprotected Junder Jcopyright Jby Jthe
JPublisher J(other J than Jas Jmay Jbe Jnoted Jherein).
Although Jfor Jmechanical Jreasons Jall Jpages Jof Jthis Jpublication Jare Jperforated, Jonly Jthose Jpages
Jimprinted Jwith Jan J Elsevier JInc. Jcopyright Jnotice Jare Jintended Jfor Jremoval.
Notices
Knowledge Jand Jbest Jpractice Jin Jthis Jfield Jare Jconstantly Jchanging. JAs Jnew Jresearch Jand
Jexperience Jbroaden J our Junderstanding, Jchanges Jin Jresearch Jmethods, Jprofessional Jpractices, Jor
Jmedical Jtreatment Jmay Jbecome J necessary.
Practitioners Jand Jresearchers Jmust Jalways Jrely Jon Jtheir Jown Jexperience Jand Jknowledge Jin
Jevaluating Jand J using Jany Jinformation, Jmethods, Jcompounds, Jor Jexperiments Jdescribed Jherein. JIn
Jusing Jsuch Jinformation Jor J methods Jthey Jshould Jbe Jmindful Jof Jtheir Jown Jsafety Jand Jthe Jsafety
Jof Jothers, Jincluding Jparties Jfor Jwhom Jthey J have Ja Jprofessional Jresponsibility.
With Jrespect Jto Jany Jdrug Jor Jpharmaceutical Jproducts Jidentified, Jreaders Jare Jadvised Jto Jcheck
Jthe Jmost J current Jinformation Jprovided J(i) Jon Jprocedures Jfeatured Jor J(ii) Jby Jthe Jmanufacturer
Jof Jeach Jproduct Jto Jbe J administered, Jto Jverify Jthe Jrecommended Jdose Jor Jformula, Jthe Jmethod
Jand Jduration Jof Jadministration, Jand J contraindications. JIt Jis Jthe Jresponsibility Jof Jpractitioners,
Jrelying Jon Jtheir Jown Jexperience Jand Jknowledge Jof J their Jpatients, Jto Jmake Jdiagnoses, Jto
Jdetermine Jdosages Jand Jthe Jbest Jtreatment Jfor Jeach Jindividual Jpatient, Jand J to Jtake Jall
Jappropriate Jsafety Jprecautions.
To Jthe Jfullest Jextent Jof Jthe Jlaw, Jneither Jthe JPublisher Jnor Jthe Jauthors, Jcontributors, Jor Jeditors,
Jassume Jany J liability Jfor Jany Jinjury Jand/or Jdamage Jto Jpersons Jor Jproperty Jas Ja Jmatter Jof
Jproducts Jliability, Jnegligence Jor J otherwise, Jor Jfrom Jany Juse Jor Joperation Jof Jany Jmethods,
Jproducts, Jinstructions, Jor Jideas Jcontained Jin Jthe J material Jherein.
NANDA JInternational JNursing JDiagnoses: JDefinitions Jand JClassifications J2012-2014; JHerdman JT.H.
J(ED); J copyright J© J2012, J1994-2012 JNANDA JInternational; Jpublished Jby JJohn JWiley J& JSons,
JLimited.
ISBN: J9780323091473
Executive JContent JStrategist: JKristin JGeen
Content JManager: JJamie JRandall
Associate JContent JDevelopment JSpecialist: JMelissa JRawe
Publishing JServices JManager: JJeff JPatterson
Project JManager: JMegan
JIsenberg J Design JDirection:
JMaggie JReid J Cover
JDesigner: JMaggie JReid
Printed Jin Jthe JUnited JStates Jof JAmerica
Last Jdigit Jis Jthe Jprint Jnumber: J J 9 J J 8 J J 7 J J 6 J J 5 J J 4 J J 3 J J 2 J J 1
, Contents
Section J1: JConcepts Jin JNursing JPractice
1 Professional JNursing JPractice, J1
2 Health JDisparities Jand JCulturally JCompetent JCare, J5
3 Health JHistory Jand JPhysical JExamination, J8
4 Patient Jand JCaregiver JTeaching, J11
5 Chronic JIllness Jand JOlder JAdults, J15
6 Complementary Jand JAlternative JTherapies, J19
7 Stress Jand JStress JManagement, J22
8 Sleep Jand JSleep JDisorders, J26
9 Pain, J29
10 Palliative JCare Jat JEnd Jof JLife, J33
11 Substance JAbuse, J36
Section J2: JPathophysiologic JMechanisms Jof JDisease
12 Inflammation Jand JWound JHealing, J40
13 Genetics Jand JGenomics, J44
14 Altered JImmune JResponses Jand JTransplantation, J47
15 Infection Jand JHuman JImmunodeficiency JVirus JInfection, J51
16 Cancer, J55
17 Fluid, JElectrolyte, Jand JAcid-Base JImbalances, J60
Section J3: JPerioperative JCare
18 Nursing JManagement: JPreoperative JCare, J66
19 Nursing JManagement: JIntraoperative JCare, J69
20 Nursing JManagement: JPostoperative JCare, J72
Section J4: JProblems JRelated Jto JAltered JSensory JInput
21 Nursing JAssessment: JVisual Jand JAuditory JSystems, J75
22 Nursing JManagement: JVisual Jand JAuditory JProblems, J80
23 Nursing JAssessment: JIntegumentary JSystem, J85
24 Nursing JManagement: JIntegumentary JProblems, J88
25 Nursing JManagement: JBurns, J92
Section J5: JProblems Jof JOxygenation: JVentilation
26 Nursing JAssessment: JRespiratory JSystem, J97
27 Nursing JManagement: JUpper JRespiratory JProblems, J101
28 Nursing JManagement: JLower JRespiratory JProblems, J105
29 Nursing JManagement: JObstructive JPulmonary JDiseases, J111
Section J6: JProblems Jof JOxygenation: JTransport
30 Nursing JAssessment: JHematologic JSystem, J117
31 Nursing JManagement: JHematologic JProblems, J120
Section J7: JProblems Jof JOxygenation: JPerfusion
32 Nursing JAssessment: JCardiovascular JSystem, J127
33 Nursing JManagement: JHypertension, J134
34 Nursing JManagement: JCoronary JArtery JDisease Jand JAcute JCoronary JSyndrome, J138
35 Nursing JManagement: JHeart JFailure, J145
36 Nursing JManagement: JDysrhythmias, J149
37 Nursing JManagement: JInflammatory Jand JStructural JHeart JDisorders, J156
38 Nursing JManagement: JVascular JDisorders, J161
iii
Medical-Surgical Nursing: J
Assessment and Management
J J J
of Clinical Problems
J J J
Ninth J Edition
Prepared Jby:
Susan JA. JSandstrom, JRN, JMSN, JBC,
JCNE JAssociate JProfessor Jin JNursing,
JRetired JCollege Jof JSaint JMary
Omaha, J Nebraska
Sharon JL. JLewis, JRN, JPhD, JFAAN
JShannon JRuff JDirksen, JRN, JPhD,
JFAAN
Margaret JMcLean JHeitkemper, JRN, JPhD, JFAAN
JLinda JBucher, JRN, JPhD, JCEN, JCNE
Reviewed Jby:
Charles JD. JRogers, JRN, JMSN
JAdvanced JCardiac JLife JSupport
JProvider JAssistant JProfessor Jof
JNursing JMorehead JState JUniversity
Morehead, J Kentucky
Collin JBowman-Woodall, JRN, JMS
Assistant JProfessor
JSamuel JMerritt
JUniversity
San JFrancisco JPeninsula JCampus
JSan JMateo, JCalifornia
, 3251 JRiverport JLane
St. JLouis, JMissouri J63043
STUDY JGUIDE JFOR JMEDICAL-SURGICAL JNURSING: ISBN: J978-0-323-09147-
3 J ASSESSMENT JAND JMANAGEMENT JOF JCLINICAL JPROBLEMS
Copyright J© J2014 Jby JMosby, Jan Jimprint Jof JElsevier JInc. JAll Jrights Jreserved.
Copyright J© J2011, J2007, J2004, J2000, J1996, J1992, J1987, J1983 Jby JMosby, JInc., Jan Jaffiliate Jof JElsevier JInc.
All Jrights Jreserved. JNo Jpart Jof Jthis Jpublication Jmay Jbe Jreproduced Jor Jtransmitted Jin Jany Jform Jor Jby
Jany Jmeans, J electronic Jor Jmechanical, Jincluding Jphotocopy, Jrecording, Jor Jany Jinformation Jstorage Jand
Jretrieval Jsystem, Jwithout J permission Jin Jwriting Jfrom Jthe Jpublisher. JDetails Jon Jhow Jto Jseek
Jpermission, Jfurther Jinformation Jabout Jthe J Publisher’s Jpermissions Jpolicies Jand Jour Jarrangements Jwith
Jorganizations Jsuch Jas Jthe JCopyright JClearance JCenter J and Jthe JCopyright JLicensing JAgency, Jcan Jbe
Jfound Jat Jour Jwebsite: Jwww.elsevier.com/permissions.
This Jbook Jand Jthe Jindividual Jcontributions Jcontained Jin Jit Jare Jprotected Junder Jcopyright Jby Jthe
JPublisher J(other J than Jas Jmay Jbe Jnoted Jherein).
Although Jfor Jmechanical Jreasons Jall Jpages Jof Jthis Jpublication Jare Jperforated, Jonly Jthose Jpages
Jimprinted Jwith Jan J Elsevier JInc. Jcopyright Jnotice Jare Jintended Jfor Jremoval.
Notices
Knowledge Jand Jbest Jpractice Jin Jthis Jfield Jare Jconstantly Jchanging. JAs Jnew Jresearch Jand
Jexperience Jbroaden J our Junderstanding, Jchanges Jin Jresearch Jmethods, Jprofessional Jpractices, Jor
Jmedical Jtreatment Jmay Jbecome J necessary.
Practitioners Jand Jresearchers Jmust Jalways Jrely Jon Jtheir Jown Jexperience Jand Jknowledge Jin
Jevaluating Jand J using Jany Jinformation, Jmethods, Jcompounds, Jor Jexperiments Jdescribed Jherein. JIn
Jusing Jsuch Jinformation Jor J methods Jthey Jshould Jbe Jmindful Jof Jtheir Jown Jsafety Jand Jthe Jsafety
Jof Jothers, Jincluding Jparties Jfor Jwhom Jthey J have Ja Jprofessional Jresponsibility.
With Jrespect Jto Jany Jdrug Jor Jpharmaceutical Jproducts Jidentified, Jreaders Jare Jadvised Jto Jcheck
Jthe Jmost J current Jinformation Jprovided J(i) Jon Jprocedures Jfeatured Jor J(ii) Jby Jthe Jmanufacturer
Jof Jeach Jproduct Jto Jbe J administered, Jto Jverify Jthe Jrecommended Jdose Jor Jformula, Jthe Jmethod
Jand Jduration Jof Jadministration, Jand J contraindications. JIt Jis Jthe Jresponsibility Jof Jpractitioners,
Jrelying Jon Jtheir Jown Jexperience Jand Jknowledge Jof J their Jpatients, Jto Jmake Jdiagnoses, Jto
Jdetermine Jdosages Jand Jthe Jbest Jtreatment Jfor Jeach Jindividual Jpatient, Jand J to Jtake Jall
Jappropriate Jsafety Jprecautions.
To Jthe Jfullest Jextent Jof Jthe Jlaw, Jneither Jthe JPublisher Jnor Jthe Jauthors, Jcontributors, Jor Jeditors,
Jassume Jany J liability Jfor Jany Jinjury Jand/or Jdamage Jto Jpersons Jor Jproperty Jas Ja Jmatter Jof
Jproducts Jliability, Jnegligence Jor J otherwise, Jor Jfrom Jany Juse Jor Joperation Jof Jany Jmethods,
Jproducts, Jinstructions, Jor Jideas Jcontained Jin Jthe J material Jherein.
NANDA JInternational JNursing JDiagnoses: JDefinitions Jand JClassifications J2012-2014; JHerdman JT.H.
J(ED); J copyright J© J2012, J1994-2012 JNANDA JInternational; Jpublished Jby JJohn JWiley J& JSons,
JLimited.
ISBN: J9780323091473
Executive JContent JStrategist: JKristin JGeen
Content JManager: JJamie JRandall
Associate JContent JDevelopment JSpecialist: JMelissa JRawe
Publishing JServices JManager: JJeff JPatterson
Project JManager: JMegan
JIsenberg J Design JDirection:
JMaggie JReid J Cover
JDesigner: JMaggie JReid
Printed Jin Jthe JUnited JStates Jof JAmerica
Last Jdigit Jis Jthe Jprint Jnumber: J J 9 J J 8 J J 7 J J 6 J J 5 J J 4 J J 3 J J 2 J J 1
, Contents
Section J1: JConcepts Jin JNursing JPractice
1 Professional JNursing JPractice, J1
2 Health JDisparities Jand JCulturally JCompetent JCare, J5
3 Health JHistory Jand JPhysical JExamination, J8
4 Patient Jand JCaregiver JTeaching, J11
5 Chronic JIllness Jand JOlder JAdults, J15
6 Complementary Jand JAlternative JTherapies, J19
7 Stress Jand JStress JManagement, J22
8 Sleep Jand JSleep JDisorders, J26
9 Pain, J29
10 Palliative JCare Jat JEnd Jof JLife, J33
11 Substance JAbuse, J36
Section J2: JPathophysiologic JMechanisms Jof JDisease
12 Inflammation Jand JWound JHealing, J40
13 Genetics Jand JGenomics, J44
14 Altered JImmune JResponses Jand JTransplantation, J47
15 Infection Jand JHuman JImmunodeficiency JVirus JInfection, J51
16 Cancer, J55
17 Fluid, JElectrolyte, Jand JAcid-Base JImbalances, J60
Section J3: JPerioperative JCare
18 Nursing JManagement: JPreoperative JCare, J66
19 Nursing JManagement: JIntraoperative JCare, J69
20 Nursing JManagement: JPostoperative JCare, J72
Section J4: JProblems JRelated Jto JAltered JSensory JInput
21 Nursing JAssessment: JVisual Jand JAuditory JSystems, J75
22 Nursing JManagement: JVisual Jand JAuditory JProblems, J80
23 Nursing JAssessment: JIntegumentary JSystem, J85
24 Nursing JManagement: JIntegumentary JProblems, J88
25 Nursing JManagement: JBurns, J92
Section J5: JProblems Jof JOxygenation: JVentilation
26 Nursing JAssessment: JRespiratory JSystem, J97
27 Nursing JManagement: JUpper JRespiratory JProblems, J101
28 Nursing JManagement: JLower JRespiratory JProblems, J105
29 Nursing JManagement: JObstructive JPulmonary JDiseases, J111
Section J6: JProblems Jof JOxygenation: JTransport
30 Nursing JAssessment: JHematologic JSystem, J117
31 Nursing JManagement: JHematologic JProblems, J120
Section J7: JProblems Jof JOxygenation: JPerfusion
32 Nursing JAssessment: JCardiovascular JSystem, J127
33 Nursing JManagement: JHypertension, J134
34 Nursing JManagement: JCoronary JArtery JDisease Jand JAcute JCoronary JSyndrome, J138
35 Nursing JManagement: JHeart JFailure, J145
36 Nursing JManagement: JDysrhythmias, J149
37 Nursing JManagement: JInflammatory Jand JStructural JHeart JDisorders, J156
38 Nursing JManagement: JVascular JDisorders, J161
iii
