Medical-Surgical Nursing in Canada: Assessment and Management of Clinical Problems Lewis, Bucher, Heitkemper, Harding, Barry, Lok, Tyerman, Goldsworthy 2024 Updated

Medical-Surgical Nursing in Canada: Assessment and Management of Clinical Problems Lewis, Bucher, Heitkemper, Harding, Barry, Lok, Tyerman, Goldsworthy Table of contents : Front Cover Brief Contents Title Page Copyright Page Table Of Contents About the Authors Sharon L. Lewis, RN, PhD, FAAN Linda Bucher, RN, PhD, CEN, CNE Margaret McLean Heitkemper, RN, PhD, FAAN Mariann M. Harding, RN, PhD, CNE Maureen A. Barry, RN, MScN Jana Lok, RN, MN, PhD, ENC(C) Jane Tyerman, RN, MScN, PhD Sandra Goldsworthy, RN, MSc, PhD, CNCC(C), CMSN(C) Section Editors for the US 10th Edition Jeffrey Kwong, DNP, MPH, ANP-BC, FAANP Dottie Roberts, RN, EdD, MSN, MACI, RN, OCNS-C, CMSRN, CNE Contributors Reviewers Dedication Preface Organization Classic Features New Features A Word on Terminology A Word on Laboratory Values Learning Supplements for the Student Teaching Supplements for Instructors Acknowledgements Section 1 - Concepts in Nursing Practice 1. Introduction to Medical-Surgical Nursing Practice in Canada Learning Objectives Key Terms The Canadian Health Care Context Complex Health Care Environments Diverse Populations. Determinants of Health. Patient-Centred Care Patient Safety and Quality Improvement. Quality and Safety Education for Nurses (QSEN). The Profession of Nursing in Canada Standards of Practice. Advanced Nursing Practice. Teamwork and Interprofessional Collaboration Interprofessional Teams. Communication Among Health Care Team Members. Delegation and Assignment. Informatics and Technology Nursing Informatics. Electronic Health Records. What Is Medical-Surgical Nursing? Critical Thinking in Nursing Evidence-Informed Practice Steps in the Evidence-Informed Practice Process. Step 1. Step 2. Step 3. Step 4. Step 5. Step 6. Implementation of Evidence-Informed Practice. The Nursing Process Phases of the Nursing Process Interrelatedness of Phases Assessment Phase Data Collection. Diagnosis Phase Data Analysis and Problem Identification. Nursing Diagnosis. Diagnostic Process. Identifying the Problem. Etiology. Signs and Symptoms. Collaborative Problems. Planning Phase Priority Setting. Identifying Outcomes. Determining Interventions. Implementation Phase. Evaluation Phase. Nursing Care Plans Concept Maps Clinical (Critical) Pathways Documentation Charting Future Challenges of Nursing Review Questions References Resources 2. Cultural Competence and Health Equity in Nursing Care Learning Objectives Key Terms The Need for Cultural Competence Health Equity Health Inequities Among Indigenous and Other Marginalized Populations Health Literacy Equity in Nursing Care Culture as a Determinant of Health Exploring the Concepts: Definitions and Meanings Cultural Safety and Cultural Competence “Culture” and Other Related Terms Cultural Competence Affective Domain Behavioural Domain Cross-Cultural Communication. Verbal and Nonverbal Communication. Culturally Competent Care Communication Skills Providing Effective Language Support. Cognitive Domain Generic Cultural Knowledge Care, Cure, Caregivers, and Healing Systems. Culturally Competent Care Clock Time Biology, Physiology, and Pharmacology. Family Roles and Relationships. Spirituality and Religion. Migration and Settlement. Dynamics of Difference Environment and Equity Understanding the Difference Between Equity and Equality Nurse’s Self-Assessment Culturally Competent Patient Assessment Bridging Cultural Distances: The LEARN Model Working in Diverse Teams Conclusion Review Questions References Resources 3. Health History and Physical Examination Learning Objectives Key Terms Data Collection Interviewing Considerations Teamwork and Collaboration Data Organization Culturally Competent Care Assessment Nursing History: Subjective Data Biographical Data Reason for Seeking Care Current Health or History of Current Illness Past Health History Medications. Allergies. Surgery or Other Treatments. Family History Functional Health Assessment Health Perception–Health Management. Nutrition–Metabolic. Elimination. Activity–Exercise. Sleep–Rest. Cognitive–Perceptual. Self-Perception–Self-Concept. Role–Relationship. Sexuality–Reproductive. Coping–Stress Tolerance. Value–Belief. Physical Examination: Objective Data General Survey Physical Examination Techniques. Inspection. Palpation. Percussion. Auscultation. Equipment. Organization of the Examination. Recording Physical Examination. Types of Assessment Comprehensive Assessment Focused Assessment Emergency Assessment Using Assessment Approaches Problem Identification and Nursing Diagnoses Review Questions References 4. Patient and Caregiver Teaching Learning Objectives Key Terms Role of Patient and Caregiver Teaching Teaching–Learning Process Adult Learners Adult Learning Principles. Determinants of Learning. Motivation of Adult Learners. Nurse as Teacher Required Competencies Knowledge of Subject Matter. Communication Skills. Empathy. Challenges to Nurse–Teacher Effectiveness. Caregiver and Holistic Support Process of Patient Teaching Assessment Physical Characteristics. Psychological Characteristics. Sociocultural Characteristics. Socioeconomic Factors. Literacy and Health Literacy. Housing Arrangements and Living Location. Culturally Competent Care Learner Characteristics. Learning Needs. Readiness to Learn. Learning Style. Diagnosis Planning Selecting Teaching Strategies. Patient Workshop. Discussion. Group Teaching. Demonstration–Return Demonstration. Role Play. Use of Audiovisual Materials. Use of the Internet. Use of Printed Materials. Games and Simulation. Implementation Evaluation Continuity of Educational Care Documentation of the Educational Process The Standardized Teaching Plan Review Questions References Resources 5. Chronic Illness Learning Objectives Key Terms The Epidemiology of Chronic Diseases Health, Acute Illness, and Chronic Illness Factors Contributing to Chronic Illness Risk Factors for Chronic Illness Prevention of Chronic Illness The Role of Genetics The Role of Aging Disability in Chronic Illness Psychosocial Dimensions of Chronic Illness Illness Behaviour Self-Efficacy Health-Related Hardiness Mood Disorders Fatigue Stigma Quality of Life Living With Chronic Illness Chronic Illness and Caregiving Conceptual Models of Chronic Illness Illness Trajectory Shifting Perspectives Model of Chronic Illness Self-Management The Emerging Paradigm of Chronic Care Review Questions References Resources 6. Community-Based Nursing and Home Care Learning Objectives Key Terms The History of Home Health Nursing Community Health Nursing Roles A Health Care System Under Pressure Changing Demographics Health Human Resources. Patient Safety. Sustainability of the Health Care System Primary Health Care. Home Care Definition and Importance of Home Care Home Care Services Quality and Accountability in Home Care Funding and Utilization of Home Care Services Home Health Care Team Nursing Roles. Home Health Care Patients Home Health Nursing Practice Overview. Home Health Nursing and Family-Centred Care. Culturally Competent Care Home Health Nursing Practice Home Health Nursing Practice Knowledge and Skills. Trends in Home Health Nursing New Nursing Graduates and Licensed Practical Nurses in Home Health Nursing. Technology in Home Health Nursing Practice Measurement of Nursing-Sensitive Outcomes Summary Review Questions References Resources 7. Older Adults Learning Objectives Key Terms Demographics of Aging Attitudes Toward Aging Biological Theories of Aging Free Radical Theory Cross-Link Theory Immunological Theory Age-Related Physiological Changes Older Populations at High Risk Older Women Older Adults With Cognitive Impairments Older Adults Living in Rural Settings Older Adults Who Are Homeless Frail Older Adults Older Adults With Chronic Illness Socially Isolated Older Adults Culturally Competent Care Older Adults Social Support and the Older Adult Caregivers Elder Mistreatment and Abuse Universal Health Care Care Alternatives for Older Adults Independent Living Options Community-Based Care for Older Adults Adult Day Care Programs. Home Health Care. Long-Term Care Facilities Legal and Ethical Issues Nursing Management Older Adults Nursing Assessment Nursing Diagnoses Planning Nursing Implementation Health Promotion. Teaching Older Adults. Acute Care Settings. Geriatric Rehabilitation. Assistive Devices. Safety. Medication Use. Depression. Sleep. Behavioural Management. Use of Restraints. Evaluation. Review Questions References Resources 8. Stress and Stress Management Learning Objectives Key Terms Definition of Stress Work-Related Stress Theories of Stress General Adaptation Syndrome Factors Affecting Response to Stress Physiological Response to Stress Nervous System Cerebral Cortex. Limbic System. Reticular Formation. Hypothalamus. Endocrine System Summary of Neuroendocrine System Stress Response Immune System Effects of Stress on Health Coping Relaxation Strategies Relaxation Breathing Meditation Imagery Music for Relaxation Muscle Relaxation Nursing Management Stress Nursing Assessment Demands. Human Responses to Stress. Coping. Nursing Implementation Review Questions References Resources 9. Sleep and Sleep Disorders Learning Objectives Key Terms Sleep Physiological Sleep Mechanisms Sleep–Wake Cycle Wake Behaviour. Sleep Behaviour. Circadian Rhythms Sleep Architecture Non–Rapid Eye Movement Sleep. Rapid Eye Movement Sleep. Effects of Sleep Deprivation Sleep Disturbances in the Hospital Sleep Disorders Insomnia Etiology and Pathophysiology Clinical Manifestations Diagnostic Studies Self-Report. Actigraphy. Polysomnography. Collaborative Care Cognitive–Behavioural Therapies. Drug Therapy. Benzodiazepines. Benzodiazepine Receptor–like Agents. Antidepressants. Antihistamines. Complementary and Alternative Therapies. Herbal Supplements. Acupuncture. Other Therapeutic Sleep Aids. Nursing Management Insomnia Nursing Assessment Nursing Diagnoses Nursing Implementation Narcolepsy Etiology and Pathophysiology Diagnostic Studies Collaborative Care Drug Therapy. Behavioural Therapy. Circadian Rhythm Sleep–Wake Disorders Sleep-Disordered Breathing Obstructive Sleep Apnea Clinical Manifestations and Diagnostic Studies Nursing and Collaborative Management Sleep Apnea Surgical Interventions Special Concerns for Hospitalization With Obstructive Sleep Apnea Sleep Movement Disorders Parasomnias Rapid Eye Movement Parasomnias. Non–Rapid Eye Movement Parasomnias. Age-Related Considerations Sleep Special Sleep Needs of Nurses Review Questions References Resources 10. Pain Learning Objectives Key Terms Pain Magnitude of the Pain Problem Definitions of Pain Dimensions of Pain and the Pain Process Physiological Dimension of Pain Transduction. Transmission. Transmission to the Spinal Cord. Dorsal Horn Processing. Transmission to the Thalamus and the Cortex. Perception. Modulation. Sensory-Discriminative, Motivational–Affective, Behavioural, Cognitive–Evaluative, and Sociocultural Dimensions of Pain Causes and Types of Pain Nociceptive Pain Neuropathic Pain Pain Assessment Sensory-Discriminative Component Pattern of Pain. Area of Pain. Intensity of Pain. Nature of Pain. Motivational–Affective, Behavioural, Cognitive–Evaluative, and Sociocultural Components Advances in Pain Assessment Research Pain Treatment Basic Principles Drug Therapy for Pain Equianalgesic Dose. Scheduling Analgesics. Titration. Analgesic Ladder. Drug Therapy for Mild Pain. Drug Therapy for Mild to Moderate Pain. Drug Therapy for Moderate to Severe Pain. Adjuvant Analgesic Therapy. Antidepressants. Antiseizure Drugs. Corticosteroids. Local Anaesthetics. Administration Routes. Oral. Sublingual and Buccal. Intranasal. Rectal. Transdermal. Parenteral Routes. Intraspinal Delivery. Patient-Controlled Analgesia. Surgical Therapy for Pain Nerve Blocks. Interventional Therapy Therapeutic Nerve Blocks. Neuroablative Techniques. Neuroaugmentation. Nonpharmacological Therapy for Pain Physical Pain Relief Strategies Massage. Exercise. Transcutaneous Electrical Nerve Stimulation. Application of Heat. Application of Cold. Cognitive Techniques. Distraction. Relaxation Strategies. Self-Management. Nursing and Collaborative Management Pain Effective Communication Barriers to Effective Pain Management Tolerance. Physical Dependence. Addiction. Institutionalizing Pain Education and Management Ethical Issues in Pain Management Fear of Hastening Death by Administering Analgesics Use of Placebos in Pain Assessment and Treatment Age-Related Considerations Pain Special Populations Cognitively Impaired Individuals Patients With Substance use Problems Review Questions References Resources 11. Substance Use Learning Objectives Key Terms Substance Use in Canada Substance Use From a Continuum of Use Perspective Neurophysiology of Substances of Abuse Attitudes Toward People Experiencing Substance-Related Problems The Harm-Reduction Perspective Health Complications of Substance Use Nursing Management Substance Use Assessment Nursing Diagnoses Planning Nursing Implementation Urgent Care Situations. Overdose. Withdrawal. Perioperative Care. Acute Pain Management Considerations. Stimulants and Stimulant Withdrawal Nicotine Characteristics Physiological Effects of Use Health Complications Collaborative Care: Nursing Interventions for Tobacco Use Disorder Tobacco Use Cessation. Nicotine Replacement Therapy and Pharmacotherapeutic Interventions for Nicotine Dependence. Cocaine and Other Stimulants Characteristics Effects of Use Withdrawal Complications Collaborative Care Caffeine Characteristics Effects of Use Complications Collaborative Care Depressants Alcohol Characteristics Effects of Use Alcohol Intoxication Acute Alcohol Intoxication. Alcohol Withdrawal Complications Complications Associated With Chronic Alcoholism. Collaborative Care Sedative–Hypnotics Characteristics Effects of Use Complications Withdrawal From Sedative–Hypnotics. Collaborative Care Opioids Characteristics Effects of Use Opioid Overdose Opioid Withdrawal Complications Collaborative Care Withdrawal Management. Methadone. Buprenorphine. Maintenance. Hallucinogens Characteristics Effects of Use Collaborative Care Inhalants Nursing Management Addictive Behaviours Nursing Assessment and Screening Nursing Diagnoses Planning Nursing Implementation Health Promotion. Motivational Interviewing: Engaging in a Supportive Dialogue With People With Problematic Substance Use. Age-Related Considerations Review Questions References Resources 12. Complementary and Alternative Therapies Learning Objectives Key Terms Alternative Medical Systems Traditional Chinese Medicine Acupuncture. Acupressure. Mind–Body Medicines Natural Products Herbal Therapies Clinical Applications of Herbal Therapy. Manipulative and Body-Based Practices Massage Therapy Clinical Applications of Massage Therapy. Massage Techniques. Hand-Mediated Biofield Energies Therapeutic Touch. Clinical Applications of Therapeutic Touch. Healing Touch. Clinical Applications of Healing Touch. Other Complementary and Alternative Medicine Practices Spiritual Therapies Prayer. Forms of Prayer. Clinical Applications of Prayer. Age-Related Considerations Complementary and Alternative Therapies Nursing Management Complementary and Alternative Therapies Assessment Serving as a Resource and Promoting Safety Providing Holistic Self-Care and Holistic Nursing Practice Serving as a Provider Participating in Research Review Questions References Resources 13. Palliative Care at the End of Life Learning Objectives Key Terms Hospice Palliative Care Integrated Hospice Palliative Care Approach End-of-Life Care Death Physical Manifestations of the End of Life Psychosocial Manifestations of the End of Life Grief and Bereavement Spiritual Needs Culturally Competent Care At the End of Life Legal and Ethical Issues Affecting End-of-Life Care Advance Care Planning and Advance Directives Resuscitation Physician-Assisted Dying Palliative Sedation Organ and Tissue Donation Nursing Management End of Life Nursing Assessment Nursing Diagnoses Planning Nursing Implementation Psychosocial Care. Anxiety and Depression. Anger. Hopelessness and Powerlessness. Fear. Fear of Pain. Fear of Shortness of Breath. Fear of Loneliness and Abandonment. Fear of Meaninglessness. Communication. Physical Care. Postmortem Care. Special Needs of Caregivers in End-of-Life Care Special Needs of Family Caregivers Special Needs of Nurses Review Questions References Resources Section 2 - Pathophysiological Mechanisms of Disease 14. Inflammation and Wound Healing Learning Objectives Key Terms Cell Injury Cell Adaptation to Sublethal Injury Hypertrophy. Hyperplasia. Atrophy. Metaplasia. Dysplasia. Anaplasia. Causes of Lethal Cell Injury Cell Apoptosis and Necrosis Defence Against Injury Mononuclear Phagocyte System Inflammatory Response Vascular Response. Cellular Response. Neutrophils. Monocytes. Lymphocytes. Eosinophils and Basophils. Chemical Mediators. Complement System. Prostaglandins and Leukotrienes. Exudate Formation. Clinical Manifestations. Fever. Types of Inflammation. Healing Process. Regeneration. Repair. Primary Intention. Initial (Inflammatory) Phase. Granulation (Proliferative/Reconstructive) Phase. Maturation Phase and Scar Contraction. Secondary Intention. Tertiary Intention. Wound Classification. Delay of Healing. Complications of Healing. Adhesions. Contractures. Dehiscence and Evisceration. Excess Granulation Tissue. Fistula Formation. Infection. Hemorrhage. Formation of Hypertrophic Scars and Keloids. Nursing Management Inflammation and Healing Nursing Implementation Health Promotion. Acute Intervention Observation and Vital Signs. Fever. RICE. Rest. Ice and Heat. Compression and Immobilization. Elevation. Wound Management. Red Wound. Yellow Wound. Black Wound. Negative-Pressure Wound Therapy. Hyperbaric Oxygen Therapy. Electrical Stimulation. Psychological Implications. Ambulatory and Home Care. Pressure Injuries Causes and Pathophysiological Features Clinical Manifestations Nursing and Collaborative Management Pressure Injuries Nursing Assessment Nursing Diagnoses Planning Nursing Implementation Health Promotion. Acute Intervention. Measuring the Wound. Documentation. Wound Irrigation. Local Wound Care. Ambulatory and Home Care. Evaluation Review Questions References Resources 15. Genetics Learning Objectives Key Terms Human Genome Project Basic Principles of Genetics Chromosomes, Genes, and DNA How Proteins Are Made Primary Categories of Genetic Conditions Single-Gene Disorders Autosomal Dominant. Autosomal Recessive. X-Linked. Chromosomal Disorders Multifactorial Inheritance Genetics in Clinical Practice Taking a Family History Genetic Testing Prenatal Diagnosis and Screening. Amniocentesis. Chorionic Villus Sampling. Screening for Carriers of Genetic Disease. Presymptomatic and Predisposition Testing. Genetic Counselling Gene Therapy Methods of Gene Delivery. Examples of Gene Therapy for Cancer. Gene Editing: Using the CRISPR-Cas9 System in Gene Therapy. Nursing Management Genetics Review Questions References Resources 16. Altered Immune Response and Transplantation Learning Objectives Key Terms Normal Immune Response Antigens Types of Immunity Innate Immunity. Acquired Immunity. Active Acquired Immunity. Passive Acquired Immunity. Lymphoid Organs Cells Involved in Immune Response Mononuclear Phagocytes. Lymphocytes. B Lymphocytes. T Lymphocytes. T Cytotoxic Cells. T Helper Cells. Natural Killer Cells. Dendritic Cells. Cytokines Comparison of Humoral and Cell-Mediated Immunity Humoral Immunity. Cell-Mediated Immunity. Age-Related Considerations Effects of Aging on the Immune System Altered Immune Response Hypersensitivity Reactions Type I: IgE-Mediated Reactions. Anaphylaxis. Atopic Reactions. Type II: Cytotoxic and Cytolytic Reactions. Hemolytic Transfusion Reactions. Goodpasture’s Syndrome. Type III: Immune-Complex Reactions. Type IV: Delayed Hypersensitivity Reactions. Contact Dermatitis. Microbial Hypersensitivity Reactions. Allergic Disorders Assessment Health History. Physical Examination. Diagnostic Studies Skin Tests. Procedure. Results. Precautions. Collaborative Care Anaphylaxis. Chronic Allergies. Allergen Recognition and Control. Drug Therapy. Antihistamines. Sympathomimetic or Decongestant Drugs. Corticosteroids. Antipruritic Drugs. Mast Cell–Stabilizing Drugs. Leukotriene Receptor Antagonists. Immunotherapy. Mechanism of Action. Method of Administration. Subcutaneous Immunotherapy. Sublingual Immunotherapy. Nursing Management Immunotherapy Latex Allergies Types of Latex Allergies. Latex-Food Syndrome. Nursing and Collaborative Management Latex Allergies Multiple Chemical Sensitivities Autoimmunity Autoimmune Diseases Apheresis Plasmapheresis. Immunodeficiency Disorders Primary Immunodeficiency Disorders Secondary Immunodeficiency Disorders Human Leukocyte Antigen System Human Leukocyte Antigen and Disease Associations. Organ Transplantation Tissue Typing HLA Typing. Panel of Reactive Antibodies. Crossmatch. Transplant Rejection Hyperacute Rejection. Acute Rejection. Chronic Rejection. Immuno-Suppressive Therapy Calcineurin Inhibitors Mycophenolate Mofetil (CellCept) Sirolimus (Rapamune) Monoclonal Antibodies Polyclonal Antibodies Graft-Versus-Host Disease Alternative Strategies Transplantation of Organs From Deceased Donor Xenotransplantation Ex Vivo Transplantation Stem Cell Transplantation New Technologies in Immunology Hybridoma Technology: Monoclonal Antibodies Review Questions References Resources 17. Infection and Human Immunodeficiency Virus Infection Learning Objectives Key Terms Infections Causes of Infections Emerging Infections Re-Emerging Infections Resistant Organisms Health Care–Associated Infections Age-Related Considerations Infection in Older Adults Infection Prevention and Control Infection Precautions Preventing Occupational Infections in Health Care Workers Human Immunodeficiency Virus Infection Significance of the Problem Transmission of Human Immunodeficiency Virus Sexual Transmission Contact With Blood and Blood Products Perinatal Transmission Pathophysiology Clinical Manifestations and Complications Acute Infection Chronic Infection Early Chronic Infection. Intermediate Chronic Infection. Late Chronic Infection or Acquired Immune Deficiency Syndrome. Diagnostic Studies Diagnosis of Human Immunodeficiency Virus Infection Laboratory Studies in Human Immunodeficiency Virus Infection Collaborative Care Drug Therapy for Human Immunodeficiency Virus Infection Preventing Transmission of Human Immunodeficiency Virus Drug Therapy for Opportunistic Diseases Vaccination Nursing Management Human Immunodeficiency Virus Infection Nursing Assessment Nursing Diagnoses Planning Nursing Implementation Health Promotion. Prevention of Human Immunodeficiency Virus Infection. Decreasing Risks Related to Sexual Intercourse. Decreasing Risks Related to Substance Misuse. Decreasing Risks of Perinatal Transmission. Decreasing Risks at Work. Human Immunodeficiency Virus Testing and Counselling. Acute Intervention Early Intervention. Initial Response to a Diagnosis of Human Immunodeficiency Virus Infection. Antiretroviral Therapy. When to Start Antiretroviral Therapy. Adherence. Health Promotion. Acute Exacerbations. Ongoing Care. Disease and Drug Adverse Effects. End-of-Life Care. Evaluation Review Questions References Resources 18. Cancer Learning Objectives Key Terms Definition and Incidence Progress Made in Cancer Prevention: Modifiable Risk Factors Biological Processes of Cancer Defects in Cellular Proliferation Defects in Cellular Differentiation Development of Cancer Initiation. Chemical Carcinogens. Radiation. Viral and Bacterial Carcinogens. Genetic Susceptibility. Promotion. Progression. Role of the Immune System Mechanisms of Escape From Immunological Surveillance. Oncofetal Antigens. Classification of Cancer Anatomical Site Classification Histological Analysis Classification Classifying Extent of Disease Clinical Staging. TNM Classification System. Prevention and Detection of Cancer Diagnosis of Cancer Biopsy. Collaborative Care Goals and Modalities Clinical Trials Surgical Therapy Cure and Control Supportive and Palliative Surgical Procedures Rehabilitative Management Chemotherapy Effect on Cells Classification of Chemotherapeutic Drugs Preparation and Administration of Chemotherapeutic Agents Methods of Administration Infusion Pumps. Regional Administration of Chemotherapeutic Agents. Intra-Arterial Chemotherapy. Intraperitoneal Chemotherapy. Intrathecal or Intraventricular Chemotherapy. Intravesical Bladder Chemotherapy. Effects of Chemotherapy on Normal Tissues Treatment Plan Radiation Therapy Effects of Radiation Cellular Death and Tissue Reactions. Simulation and Treatment External Radiation. Internal Radiation. Measurement of Radiation Goals of Radiation Therapy Nursing Management Radiation Therapy and Chemotherapy Nursing Implementation Fatigue. Anorexia. Bone Marrow Suppression. Skin Reactions. Oral, Oropharyngeal, and Esophageal Reactions. Pulmonary Effects. Gastro-intestinal Effects. Reproductive Effects. Late Effects of Radiation Treatment and Chemotherapy Biological and Targeted Therapy Hematopoietic Growth Factors Colony-Stimulating Factors. Erythropoietin. Toxic and Adverse Effects of Biological Agents Nursing Management Biological Therapy Bone Marrow and Stem Cell Transplantation Types of Bone Marrow Transplants Procedures Harvest Procedures. Preparative Regimens. Complications. Peripheral Stem Cell Transplantation Cord Blood Stem Cells Gene Therapy Complications Resulting From Cancer Nutritional Problems Malnutrition. Altered Taste Sensation. Infection Oncological Emergencies Obstructive Emergencies. Superior Vena Cava Syndrome. Spinal Cord Compression. Third Space Syndrome. Intestinal Obstruction. Metabolic Emergencies. Syndrome of Inappropriate Antidiuretic Hormone. Hypercalcemia. Tumour Lysis Syndrome. Septic Shock and Disseminated Intravascular Coagulation. Infiltrative Emergencies. Cardiac Tamponade. Carotid Artery Rupture. Management of Cancer Pain Psychosocial Care Age-Related Considerations Cancer Review Questions References Resources 19. Fluid, Electrolyte, and Acid–Base Imbalances Learning Objectives Key Terms Homeostasis Water Content of the Body Body Fluid Compartments Calculation of Fluid Gain or Loss Electrolytes Measurement of Electrolytes Electrolyte Composition of Fluid Compartments Mechanisms Controlling Fluid and Electrolyte Movement Diffusion Facilitated Diffusion Active Transport Osmosis Measurement of Osmolality. Osmotic Movement of Fluids. Hydrostatic Pressure Oncotic Pressure Fluid Movement in Capillaries Fluid Shifts Shifts of Plasma to Interstitial Fluid. Elevation of Venous Hydrostatic Pressure. Decrease in Plasma Oncotic Pressure. Elevation of Interstitial Oncotic Pressure. Shifts of Interstitial Fluid to Plasma. Fluid Movement Between Extracellular Fluid and Intracellular Fluid Fluid Spacing Regulation of Water Balance Hypothalamic Regulation Pituitary Regulation Adrenal Cortical Regulation Renal Regulation Cardiac Regulation Gastro-intestinal Regulation Insensible Water Loss Age-Related Considerations Fluid and Electrolytes Fluid and Electrolyte Imbalances Sodium and Extracellular Fluid Volume Imbalances Hypernatremia. Collaborative Care. Hyponatremia. Collaborative Care. Extracellular Fluid Volume Imbalances. Collaborative Care. Nursing Management Sodium and Volume Imbalances Nursing Diagnoses Nursing Implementation Intake and Output. Cardiovascular Changes. Respiratory Changes. Neurological Changes. Daily Weight Measurements. Skin Assessment and Care. Other Nursing Measures. Potassium Imbalances Hyperkalemia. Clinical Manifestations. Nursing and Collaborative Management Hyperkalemia Nursing Diagnoses Nursing Implementation Hypokalemia. Clinical Manifestations. Nursing and Collaborative Management Hypokalemia Nursing Diagnoses Nursing Implementation. Calcium Imbalances Hypercalcemia. Nursing and Collaborative Management Hypercalcemia Nursing Diagnoses Nursing Implementation Hypocalcemia. Nursing and Collaborative Management Hypocalcemia Nursing Diagnoses Nursing Implementation Phosphate Imbalances Hyperphosphatemia. Hypophosphatemia. Magnesium Imbalances Hypermagnesemia. Hypomagnesemia. Protein Imbalances Acid–Base Imbalances pH and Hydrogen Ion Concentration. Acid–Base Regulation. Buffer System. Respiratory System. Renal System. Alterations in Acid–Base Balance. Respiratory Acidosis. Respiratory Alkalosis. Metabolic Acidosis. Metabolic Alkalosis. Mixed Acid–Base Disorders. Clinical Manifestations. Blood Gas Values Assessment of Fluid, Electrolyte, and Acid–Base Imbalances Subjective Data Important Health Information Past Health History. Medications. Surgery or Other Treatments. Other Subjective Data. Objective Data Physical Examination. Laboratory Values. Oral Fluid and Electrolyte Replacement Intravenous Fluid and Electrolyte Replacement Solutions Hypotonic. Isotonic. Hypertonic. Intravenous Additives. Plasma Expanders. Central Venous Access Devices Centrally Inserted Catheters Peripherally Inserted Central Catheters Implanted Infusion Ports Complications Nursing Management Central Venous Access Devices Removal of Central Venous Access Devices Review Questions References Resources Section 3 - Perioperative Care 20. Nursing Management: Preoperative Care Learning Objectives Key Terms Surgical Settings Surgical Wait Times Elective Inpatient Surgery Ambulatory Surgery. Preoperative Admission Assessment Day-of-Surgery Assessment Subjective Data Psychosocial Assessment. Anxiety. Common Fears. Coping With Surgery. Health History. Medications. Allergies. Review of Systems. Nervous System. Cardiovascular System. Respiratory System. Urinary System. Integumentary System. Musculo-Skeletal System. Endocrine System. Immune System. Fluid and Electrolyte Status. Nutritional Status. Nursing Assessment: Patient About to Undergo Surgery. Objective Data Physical Examination. Laboratory and Diagnostic Testing. Nursing Management Patient About to Undergo Surgery Preoperative Education General Surgery Information. Ambulatory Surgery Information. Legal Preparation for Surgery Consent for Surgery. Voluntary Consent. Capacity to Consent. Life-Threatening Situations. Properly Informing the Patient. Day-of-Surgery Preparation Nursing Role Preoperative Medications. Transportation to the Operating Room Culturally Competent Care Patient About to Undergo Surgery Age-Related Considerations Older-Adult Patient About to Undergo Surgery Review Questions References Resources 21. Nursing Management: Intraoperative Care Learning Objectives Key Terms Physical Environment Department Layout Preoperative Holding Area Operating Room Surgical Team Registered Nurse Circulating Role. Practical Nurse Scrub Role. Surgeon and Assistant Registered Nurse First Assistant Anaesthesiologist Advanced Nursing Practice Roles Registered Nurse Anaesthesia Assistant. Nursing Management Patient Before Surgery Psychosocial Assessment Physical Assessment Chart Review Admitting the Patient Nursing Management Intraoperative Care Room Preparation Transferring the Patient. Scrubbing, Gowning, and Gloving. Basic Aseptic Technique Assisting the Anaesthesiologist Positioning the Patient Preparing the Surgical Site Safety Considerations Classification of Anaesthesia General Anaesthesia Intravenous Induction Agents. IV Drugs and General Anaesthesia. Opioids. Benzodiazepines. Neuro-Muscular Blocking Drugs. Antiemetics. Local Anaesthesia Methods of Administration. Spinal and Epidural Anaesthesia (Neuraxial Blocks). Procedural (Conscious) Sedation Patient After Surgery Age-Related Considerations Patient During Surgery Exceptional Clinical Events in the Operating Room Anaphylactic Reactions Malignant Hyperthermia Major Blood Loss New and Future Considerations Review Questions References Resources 22. Nursing Management: Postoperative Care Learning Objectives Key Terms Postoperative Care in the Postanaesthesia Care Unit Postanaesthesia Care Unit Admission Postanaesthesia Care Unit Progression Initial Assessment Potential Alterations in Respiratory Function Etiology Postanaesthesia Care Unit. Clinical Unit. Nursing Management Respiratory Complications Nursing Assessment Nursing Diagnoses Nursing Implementation Postanaesthesia Care Unit. Clinical Unit. Potential Alterations in Cardiovascular Function Etiology Postanaesthesia Care Unit. Clinical Unit. Nursing Management Cardiovascular Problems Nursing Assessment Nursing Diagnoses Nursing Implementation Postanaesthesia Care Unit. Clinical Unit. Potential Alterations in Neurological Function Etiology Postanaesthesia Care Unit. Nursing Management Neurological Complications Nursing Assessment Nursing Diagnoses Nursing Implementation Postanaesthesia Care Unit. Clinical Unit. Pain and Discomfort Etiology Postanaesthesia Care Unit. Clinical Unit. Nursing Management Pain Nursing Assessment Postanaesthesia Care Unit. Clinical Unit. Nursing Diagnoses Nursing Implementation Postanaesthesia Care Unit. Clinical Unit. Potential Alterations in Temperature Etiology Postanaesthesia Care Unit. Clinical Unit. Nursing Management Potential Temperature Complications Nursing Assessment Nursing Diagnoses Nursing Implementation Postanaesthesia Care Unit. Clinical Unit. Potential Gastro-Intestinal Problems Etiology Postanaesthesia Care Unit. Clinical Unit. Nursing Management Gastro-Intestinal Problems Nursing Assessment Nausea and Vomiting. Ileus Postoperative Ileus. Paralytic Ileus. Nursing Diagnoses Nursing Implementation Postanaesthesia Care Unit. Clinical Unit. Potential Alterations in Urinary Function Etiology Low Urine Output. Nursing Management Potential Urinary Problems Nursing Assessment Nursing Diagnoses Nursing Implementation Potential Alterations in the Integument Etiology Nursing Management Surgical Wounds Nursing Assessment Nursing Diagnoses Nursing Implementation Potential Alterations in Psychological Function Etiology Nursing Management Psychological Function Nursing Diagnoses Nursing Implementation Discharge From the Postanaesthesia Care Unit Care of the Postoperative Patient on the Clinical Unit Planning for Discharge and Follow-Up Care Ambulatory and Inpatient Surgery Discharge Ambulatory Surgery Discharge. Discharge From the Clinical Unit. Age-Related Considerations Patient After Surgery Review Questions References Resources Section 4 - Problems Related to Altered Sensory Input 23. Nursing Assessment: Visual and Auditory Systems Learning Objectives Key Terms The Visual System Structures and Functions Structures and Functions of Vision Eyeball. Refractive Media. Refractive Errors. Visual Pathways. External Structures and Functions Eyebrows, Eyelids, and Eyelashes. Internal Structures and Functions Age-Related Considerations The Visual System Assessment Subjective Data Past Health History. Medications. Surgery or Other Treatments. Self-Care History. Social and Occupational Health History. Coping Abilities. Objective Data Physical Examination. Assessing Functional Status Visual Acuity. Extraocular Muscle Functions. Pupil Function. Assessing Structures. Eyebrows, Eyelashes, and Eyelids. Conjunctiva and Sclera. Cornea. Iris. Retina and Optic Nerve. Focused Assessment. Special Assessment Techniques Colour Vision. Stereopsis. Intraocular Pressure. Diagnostic Studies The Auditory System Structures and Functions External Ear Middle Ear Inner Ear Transmission of Sound and Implications for Hearing Loss Age-Related Considerations The Auditory System Assessment Subjective Data Important Health History Current Health of Auditory System. Past Health History. Medications. Surgery or Other Treatments. Nutrition and Elimination. Activities of Daily Living and Exercise. Self-Care History. Coping Abilities. Objective Data Physical Examination. External Ear. External Auditory Canal and Tympanum. Focused Assessment. Diagnostic Studies Tests for Hearing Acuity Tuning-Fork Tests. Audiometry. Screening Audiometry. Pure-Tone Audiometry. Specialized Tests Test for Vestibular Function Review Questions References Resources 24. Nursing Management: Visual and Auditory Problems Learning Objectives Key Terms Visual Problems Correctable Refractive Errors Nonsurgical Corrections Corrective Glasses. Contact Lenses. Surgical Therapy Laser Surgery. Implantation. Uncorrectable Visual Impairment Levels of Visual Impairment Nursing Management Visual Impairment Nursing Assessment Nursing Diagnoses Planning Nursing Implementation Health Promotion. Acute Intervention. Ambulatory and Home Care. Optical Devices for Vision Enhancement. Nonoptical Methods for Vision Enhancement. Evaluation Age-Related Considerations Visual Impairment Eye Trauma Extraocular Disorders Inflammation and Infection Hordeolum. Chalazion. Blepharitis. Conjunctivitis. Bacterial Infections. Viral Infections. Chlamydial Infections. Allergic Conjunctivitis. Keratitis. Bacterial Infections. Viral Infections. Other Causes of Keratitis. Corneal Ulcer. Nursing Management Inflammation and Infection Nursing Assessment Nursing Diagnoses Planning Nursing Implementation Health Promotion. Acute Intervention. Ambulatory and Home Care. Evaluation Dry Eye Disorders Strabismus Corneal Disorders Corneal Scars and Opacities Keratoconus Intraocular Disorders Cataract Causes and Pathophysiological Processes. Clinical Manifestations. Diagnostic Studies. Collaborative Care. Nonsurgical Therapy. Surgical Therapy. Preoperative Phase. Intraoperative Phase. Postoperative Phase. Nursing Management Cataracts Nursing Assessment Nursing Diagnoses Planning Nursing Implementation Health Promotion. Acute Intervention. Ambulatory and Home Care. Evaluation Age-Related Considerations Retinopathy Retinal Detachment Etiology and Pathophysiology Clinical Manifestations Diagnostic Studies Collaborative Care Surgical Therapy Laser Photocoagulation and Cryopexy. Scleral Buckling. Intraocular Procedures. Postoperative Considerations in Scleral Buckling and Intraocular Procedures. Age-Related Macular Degeneration Etiology and Pathophysiology Clinical Manifestations Diagnostic Studies Collaborative Care Glaucoma Etiology and Pathophysiology Clinical Manifestations Diagnostic Studies Collaborative Care Chronic Open-Angle Glaucoma. Acute Angle-Closure Glaucoma. Nursing Management Glaucoma Nursing Assessment Nursing Diagnoses Planning Nursing Implementation Health Promotion. Acute Intervention. Ambulatory and Home Care. Evaluation Age-Related Considerations Intraocular Inflammation and Infection Enucleation Ocular Tumours Ocular Manifestations of Systemic Diseases Auditory Problems External Ear and Canal Trauma External Otitis Causes. Clinical Manifestations and Complications. Nursing and Collaborative Management External Otitis Cerumen and Foreign Bodies in the External Ear Canal Malignancy of the External Ear Middle Ear and Mastoid Acute Otitis Media Otitis Media With Effusion Chronic Otitis Media and Mastoiditis Etiology and Pathophysiology. Clinical Manifestations. Complications. Diagnostic Studies. Collaborative Care. Surgical Therapy. Nursing Management Chronic Otitis Media After Tympanoplasty Otosclerosis Collaborative Care. Nursing Management Otosclerosis Inner Ear Problems Ménière’s Disease Nursing and Collaborative Management Ménière’s Disease Benign Paroxysmal Positional Vertigo Acoustic Neuroma Hearing Loss and Deafness Types of Hearing Loss Conductive Hearing Loss. Sensorineural Hearing Loss. Mixed Hearing Loss. Central and Functional Hearing Loss. Classification of Hearing Loss. Clinical Manifestations. Nursing and Collaborative Management Hearing Loss and Deafness Health Promotion Environmental Noise Control. Immunizations. Ototoxic Substances. Assistive Devices and Techniques Hearing Aids. Speech Reading. Sign Language. Cochlear Implant. Assisted Listening Devices. Age-Related Considerations Hearing Loss Review Questions References Resources 25. Nursing Assessment: Integumentary System Learning Objectives Key Terms Structures and Functions of the Skin and Appendages Structures Epidermis. Dermis. Subcutaneous Tissue. Skin Appendages. Functions of the Integumentary System Age-Related Considerations Effects of Aging on the Integumentary System Assessment of the Integumentary System Subjective Data Past Medical History. Medications. Surgery or Other Treatments. Family History. Self-Care History. Nutritional History. Social, Environmental, and Occupational Health History. Cognitive–Perceptual. Coping Abilities. Objective Data Physical Examination. Inspection. Palpation. Assessment of Dark Skin Colour Diagnostic Studies of the Integumentary System Review Questions References 26. Nursing Management: Integumentary Problems Learning Objectives Key Terms Health Promotion Environmental Hazards Sun Exposure. Cold Exposure. Irritants and Allergens. Radiation. Rest and Sleep Exercise Hygiene Nutrition Self-Treatment Malignant Skin Neoplasms Risk Factors Nonmelanoma Skin Cancers Actinic Keratosis Basal Cell Carcinoma Squamous Cell Carcinoma Malignant Melanoma Clinical Manifestations Collaborative Care Atypical/Dysplastic Nevus Skin Infections and Infestations Bacterial Infections Viral Infections Fungal Infections Infestations and Insect Bites Allergic Dermatological Problems Benign Dermatological Problems Collaborative Care: Dermatological Problems Diagnostic Studies Collaborative Care Phototherapy. Radiation Therapy. Laser Technology. Drug Therapy. Antibiotics. Corticosteroids. Antihistamines. Topical Fluorouracil. Immuno-Modulators. Diagnostic and Surgical Therapy Skin Scraping. Electrodesiccation and Electrocoagulation. Curettage. Punch Biopsy. Cryosurgery. Excision. Nursing Management Dermatological Problems Ambulatory and Home Care Wet Dressings. Baths. Topical Medications. Control of Pruritus. Prevention of Spread. Prevention of Secondary Infections. Specific Skin Care. Psychological Effects of Chronic Dermatological Problems Physiological Effects of Chronic Dermatological Problems Cosmetic Procedures Body Art and Tattoos Elective Surgery Laser Surgery. Facelift. Liposuction. Nursing Management Cosmetic Surgery Preoperative Management Postoperative Management Skin Grafts Uses Types Review Questions References Resources 27. Nursing Management: Burns Learning Objectives Key Terms Types of Burn Injury Thermal Burns Chemical Burns Smoke and Inhalation Injury Electrical Burns Cold Thermal Injury Classification of Burn Injury Depth of Burn Extent of Burn Location of Burn Patient Risk Factors Phases of Burn Management Prehospital Care Emergent Phase Pathophysiological Changes Fluid and Electrolyte Shifts. Inflammation and Healing. Immunological Changes. Clinical Manifestations Complications Cardiovascular System. Respiratory System. Upper Airway Injury. Lower Airway Injury. Other Cardiopulmonary Problems. Urinary System. Nursing and Collaborative Management Emergent Phase Airway Management Fluid Therapy Wound Care Other Care Measures Drug Therapy Analgesics and Sedatives. Tetanus Immunization. Antimicrobial Agents. Venous Thrombo-Embolism Prophylaxis. Nutritional Therapy Acute Phase Pathophysiological Changes Clinical Manifestations Laboratory Values Sodium. Potassium. Complications Infection. Cardiovascular and Respiratory Systems. Neurological System. Musculo-Skeletal System. Gastro-Intestinal System. Endocrine System. Nursing and Collaborative Management Acute Phase Wound Care Excision and Grafting Cultured Epithelial Autografts. Artificial Skin. Pain Management Physiotherapy and Occupational Therapy Nutritional Therapy Psychosocial Care Rehabilitation Phase Pathophysiological Changes and Clinical Manifestations Complications Nursing and Collaborative Management Rehabilitation Phase Age-Related Considerations Burns Emotional Needs of the Patient and Caregivers Special Needs of the Nursing Staff Review Questions References Resources Section 5 - Problems of Oxygenation: Ventilation 28. Nursing Assessment: Respiratory System Learning Objectives Key Terms Structures and Functions of the Respiratory System Upper Respiratory Tract Lower Respiratory Tract Surfactant. Blood Supply. Chest Wall Physiology of Respiration Ventilation. Elastic Recoil and Compliance. Diffusion. Oxygen–Hemoglobin Dissociation Curve. Arterial Blood Gases. Mixed Venous Blood Gases. Oximetry. Oxygen Delivery. Control of Respiration Chemoreceptors. Mechanical Receptors. Respiratory Defence Mechanisms Filtration of Air. Mucociliary Clearance System. Cough Reflex. Reflex Bronchoconstriction. Alveolar Macrophages. Age-Related Considerations Effects of Aging on the Respiratory System Assessment of the Respiratory System Subjective Data Important Health Information Past Health History. Medications. Surgery or Other Treatments. Current Health History. Objective Data Physical Examination. Nose. Mouth and Pharynx. Neck. Thorax and Lungs. Inspection. Palpation. Percussion. Auscultation. Diagnostic Studies of the Respiratory System Blood Studies Oximetry Sputum Studies Skin Tests Tuberculin Skin Testing. Radiological Studies Chest Radiography. Computed Tomography. Magnetic Resonance Imaging. Ventilation–Perfusion Scan. Pulmonary Angiography. Positron Emission Tomography. Endoscopic Examinations Bronchoscopy. Mediastinoscopy. Lung Biopsy Thoracentesis Pulmonary Function Tests Exercise Testing Review Questions References Resources 29. Nursing Management: Upper Respiratory Problems Learning Objectives Key Terms Structural and Traumatic Disorders of the Nose Deviated Septum Nasal Fracture Rhinoplasty Collaborative Care Nursing Management Nasal Surgery Epistaxis Nursing and Collaborative Management Epistaxis Inflammation and Infection of the Nose and Paranasal Sinuses Allergic Rhinitis Clinical Manifestations Nursing and Collaborative Management Allergic Rhinitis Acute Viral Rhinitis Nursing and Collaborative Management Acute Viral Rhinitis Influenza Clinical Manifestations Nursing and Collaborative Management Influenza Sinusitis Clinical Manifestations Nursing and Collaborative Management Sinusitis Obstruction of the Nose and Paranasal Sinuses Polyps Foreign Bodies Problems Related to the Pharynx Acute Pharyngitis Clinical Manifestations Nursing and Collaborative Management Acute Pharyngitis Peritonsillar Abscess Problems Related to the Trachea and Larynx Airway Obstruction Tracheostomy Nursing Management Tracheostomy Providing Tracheostomy Care Swallowing Dysfunction Use of the Voice With a Tracheostomy Tube Decannulation Laryngeal Polyps Head and Neck Cancer Clinical Manifestations Diagnostic Studies Collaborative Care Nutritional Therapy. Nursing Management Head and Neck Cancer Nursing Assessment Nursing Diagnoses Planning Nursing Implementation Health Promotion. Acute Intervention. Radiation Therapy. Surgical Therapy. Voice Rehabilitation. Stoma Care. Depression. Sexuality. Ambulatory and Home Care. Evaluation Review Questions References Resources 30. Nursing Management: Lower Respiratory Problems Learning Objectives Key Terms Acute Bronchitis Pneumonia Etiology Factors Predisposing to Pneumonia. Acquisition of Organisms. Types of Pneumonia Community-Acquired Pneumonia. Hospital-Acquired Pneumonia. Fungal Pneumonia. Aspiration Pneumonia. Opportunistic Pneumonia. Pathophysiology Clinical Manifestations Complications Diagnostic Studies. Collaborative Care Pneumococcal Vaccine. Drug Therapy. Nutritional Therapy. Nursing Management Pneumonia Nursing Assessment Nursing Diagnoses Planning Nursing Implementation Health Promotion. Acute Intervention. Ambulatory and Home Care. Evaluation. Tuberculosis Etiology and Pathophysiology Clinical Manifestations Complications Miliary Tuberculosis. Pleural Effusion and Empyema. Tuberculosis Pneumonia. Other Organ Involvement. Diagnostic Studies Tuberculin Skin Testing. Chest Radiographic Study. Bacteriological Studies. Collaborative Care Drug Therapy Active Disease. Latent Tuberculosis Infection. Vaccine. Nursing Management Tuberculosis Nursing Assessment Nursing Diagnoses Planning Nursing Implementation Health Promotion. Acute Intervention. Ambulatory and Home Care. Evaluation Atypical Mycobacteria Pulmonary Fungal Infections Collaborative Care Bronchiectasis Etiology and Pathophysiology Clinical Manifestations Diagnostic Studies Collaborative Care Nursing Management Bronchiectasis Lung Abscess Etiology and Pathophysiology Clinical Manifestations and Complications Diagnostic Studies Nursing and Collaborative Management Lung Abscess Environmental Lung Diseases Clinical Manifestations Collaborative Care Lung Cancer Etiology Pathophysiology Paraneoplastic Syndrome. Clinical Manifestations Diagnostic Studies Staging. Screening for Lung Cancer. Collaborative Care Surgical Therapy. Radiation Therapy. Stereotactic Radiotherapy. Chemotherapy. Biological Therapy. Other Therapies Prophylactic Cranial Radiation. Bronchoscopic Laser Therapy. Phototherapy. Airway Stenting. Cryotherapy. Nursing Management Lung Cancer Nursing Assessment Nursing Diagnoses Planning Nursing Implementation Health Promotion. Acute Intervention. Ambulatory and Home Care. Evaluation Other Types of Lung Tumours Chest Trauma and Thoracic Injuries Pneumothorax Types of Pneumothorax Closed Pneumothorax. Open Pneumothorax. Tension Pneumothorax. Hemothorax. Chylothorax. Clinical Manifestations Collaborative Care Fractured Ribs Flail Chest Chest Tubes and Pleural Drainage Chest Tube Insertion Pleural Drainage Heimlich Valves. Small Chest Tubes. Nursing Management Chest Drainage Complications Chest Tube Removal Chest Surgery Preoperative Care Surgical Therapy Video-Assisted Thorascopic Surgery. Postoperative Care Restrictive Respiratory Disorders Pleural Effusion Types Clinical Manifestations Thoracentesis Collaborative Care Pleurisy Atelectasis Interstitial Lung Disease Idiopathic Pulmonary Fibrosis Sarcoidosis Vascular Lung Disorders Pulmonary Edema Pulmonary Embolism Etiology and Pathophysiology Clinical Manifestations Complications Diagnostic Studies Collaborative Care Drug Therapy. Surgical Therapy. Nursing Management Pulmonary Embolism Nursing Implementation Health Promotion. Acute Intervention. Ambulatory and Home Care. Evaluation Pulmonary Hypertension Primary Pulmonary Hypertension Etiology and Pathophysiology Clinical Manifestations Collaborative Care Secondary Pulmonary Hypertension Cor Pulmonale Clinical Manifestations Collaborative Care Lung Transplantation Review Questions References Resources 31. Nursing Management: Obstructive Pulmonary Diseases Learning Objectives Key Terms Asthma Triggers of Asthma Attacks Allergens. Exercise. Respiratory Infections. Nose and Sinus Problems. Drugs and Food Additives. Gastro-esophageal Reflux Disease. Air Pollutants. Emotional Stress. Pathophysiology Clinical Manifestations Asthma Control and Severity Severe Acute Asthma and Life-Threatening Asthma. Diagnostic Studies for Asthma Collaborative Care General Management Approach. Acute Asthma Episode. Drug Therapy Anti-Inflammatory Drugs Corticosteroids. Antileukotrienes. Anti–Immunoglobulin E Antagonists. Bronchodilators. β2-Adrenergic Agonists. Anticholinergic Drugs. Methylxanthines. Patient Education Related to Drug Therapy. Nursing Management Asthma Nursing Assessment Nursing Diagnoses Planning Nursing Implementation Asthma Education. Environmental Control. Self-Monitoring and Action Plans. Evaluation. Chronic Obstructive Pulmonary Disease Causes Cigarette Smoking. Occupational Chemicals and Dusts. Infection. Heredity. Aging. Pathophysiology Clinical Manifestations Classification of Chronic Obstructive Pulmonary Disease. Complications Cor Pulmonale. Acute Exacerbations of Chronic Obstructive Pulmonary Disease. Acute Respiratory Failure. Depression, Anxiety, and Panic. Clinical Assessment Collaborative Care Smoking Cessation. Drug Therapy. Oxygen Therapy. Indications for Use. Methods of Administration. Humidification. Complications Combustion. Carbon Dioxide Narcosis. Oxygen Toxicity. Absorption Atelectasis. Infection. Long-Term Oxygen Therapy at Home. Surgical Therapy. Pulmonary Rehabilitation Programs. Breathing Exercises. Effective Coughing. Nutritional Therapy. Age-Related Considerations Chronic Obstructive Pulmonary Disease Nursing Management Chronic Obstructive Pulmonary Disease Nursing Assessment Nursing Diagnoses Planning Nursing Implementation Health Promotion. Education. Exercise. Energy-Conserving Strategies. Sexual Activity. Sleep. Psychosocial Considerations. End-of-Life Issues. Evaluation Cystic Fibrosis Etiology and Pathophysiology Clinical Manifestations Complications Diagnostic Studies Collaborative Care Nursing Management Cystic Fibrosis Nursing Assessment Nursing Diagnoses Planning Nursing Implementation Review Questions References Resources Section 6 - Problems of Oxygenation: Transport 32. Nursing Assessment: Hematological System Learning Objectives Key Terms Structures and Functions of the Hematological System Bone Marrow Blood Plasma. Blood Cells. Erythrocytes. Leukocytes. Granulocytes. Agranulocytes. Thrombocytes. Iron Metabolism Clotting Mechanisms Vascular Injury and Subendothelial Exposure. Platelet Plug Formation (Adhesion, Aggregation, Activation). Fibrin Clot Development. Clot Retraction and Dissolution. Spleen Lymph System Liver Age-Related Considerations Hematological System Assessment of the Hematological System Subjective Data Important Health Information Past Medical History. Medications. Surgery or Other Treatments. Approach to Obtaining a Hematological History Social and Occupational History. Self-Care History. Activities of Daily Living. Nutritional–Metabolic History. Elimination Pattern. Neurological History. Sleep History. Sexual–Reproductive History. Values and Beliefs. Objective Data Physical Examination. Lymph Node Assessment. Palpation of the Liver or the Spleen. Skin Assessment. Diagnostic Studies of the Hematological System Laboratory Studies Complete Blood Cell Count. Red Blood Cells. White Blood Cells. Platelet Count. Blood Typing and Rh Factor. Iron Metabolism. Radiological Studies Biopsy Bone Marrow Examination. Lymph Node Biopsy. Molecular Cytogenetics and Gene Analysis Review Questions References Resources 33. Nursing Management: Hematological Problems Learning Objectives Key Terms Anemia Definition and Classification Clinical Manifestations Integumentary Changes Cardiopulmonary Manifestations Nursing Management Anemia Nursing Assessment Nursing Diagnoses Planning Nursing Implementation Age-Related Considerations Anemia Anemia Caused by Decreased Erythrocyte Production Iron-Deficiency Anemia Etiology Clinical Manifestations Diagnostic Studies Collaborative Care Drug Therapy. Nursing Management Iron-Deficiency Anemia Thalassemia Etiology Clinical Manifestations Collaborative Care Megaloblastic Anemias Etiology Pernicious Anemia. Other Causes of Cobalamin Deficiency. Clinical Manifestations Diagnostic Studies Collaborative Care Folic Acid Deficiency Nursing Management Megaloblastic Anemia Anemia of Chronic Disease Aplastic Anemia Etiology Clinical Manifestations Diagnostic Studies Nursing and Collaborative Management Aplastic Anemia Anemia Caused by Blood Loss Acute Blood Loss Clinical Manifestations Diagnostic Studies Collaborative Care Nursing Management Acute Blood Loss Chronic Blood Loss Anemia Caused by Increased Erythrocyte Destruction Sickle Cell Disease Etiology and Pathophysiology Types of Sickle Cell Disease. Sickling Episodes. Clinical Manifestations Complications Diagnostic Studies Nursing and Collaborative Management Sickle Cell Disease Acquired Hemolytic Anemia Hemochromatosis Polycythemia Etiology and Pathophysiology Clinical Manifestations and Complications Diagnostic Studies Collaborative Care Nursing Management Polycythemia Vera Problems of Hemostasis Thrombo-Cytopenia Etiology and Pathophysiology Immune Thrombo-Cytopenic Purpura. Thrombotic Thrombo-Cytopenic Purpura. Heparin-Induced Thrombo-Cytopenia and Thrombosis Syndrome. Clinical Manifestations. Diagnostic Studies Collaborative Care Immune Thrombo-Cytopenic Purpura. Thrombotic Thrombo-Cytopenic Purpura. Heparin-Induced Thrombo-Cytopenia and Thrombosis Syndrome. Acquired Thrombo-Cytopenia From Decreased Platelet Production. Nursing Management Thrombo-Cytopenia Nursing Assessment Nursing Diagnoses Planning Nursing Implementation Health Promotion. Acute Intervention. Ambulatory and Home Care. Evaluation. Hemophilia and von Willebrand Disease Clinical Manifestations and Complications Diagnostic Studies Collaborative Care Nursing Management Hemophilia Nursing Implementation Health Promotion. Acute Intervention. Ambulatory and Home Care. Evaluation Disseminated Intravascular Coagulation Etiology and Pathophysiology Clinical Manifestations Diagnostic Studies Collaborative Care Nursing Management Disseminated Intravascular Coagulation Nursing Diagnoses Nursing Implementation Neutropenia Clinical Manifestations Diagnostic Studies Nursing and Collaborative Management Neutropenia Age-Related Considerations Thrombo-Cytopenia and Neutropenia Myelodysplastic Syndrome Etiology and Pathophysiology Clinical Manifestations Diagnostic Studies Nursing and Collaborative Management Myelodysplastic Syndrome Leukemia Etiology and Pathophysiology Classification Acute Myelogenous Leukemia. Acute Lymphocytic Leukemia. Chronic Myelogenous Leukemia. Chronic Lymphocytic Leukemia. Other Leukemias. Clinical Manifestations Diagnostic Studies Collaborative Care Drug Therapy Regimens. Hematopoietic Stem Cell Transplantation. Nursing Management Leukemia Nursing Assessment Nursing Diagnoses Planning Nursing Implementation Acute Intervention. Ambulatory and Home Care. Evaluation Lymphomas Hodgkin’s Lymphoma Etiology and Pathophysiology Clinical Manifestations Diagnostic and Staging Studies Nursing and Collaborative Management Hodgkin’s Lymphoma Non-Hodgkin’s Lymphoma Etiology and Pathophysiology Clinical Manifestations Diagnostic and Staging Studies Nursing and Collaborative Management Non-Hodgkin’s Lymphoma Multiple Myeloma Etiology and Pathophysiology Clinical Manifestations Diagnostic Studies Collaborative Care Nursing Management Multiple Myeloma Disorders of the Spleen Blood Component Therapy Administration Procedure Blood Transfusion Reactions Acute Transfusion Reactions Acute Hemolytic Reactions. Febrile Reactions. Allergic Reactions. Circulatory Overload. Sepsis. Transfusion-Related Acute Lung Injury. Massive Blood Transfusion Reaction. Delayed Transfusion Reactions. Infection. Autotransfusion Review Questions References Resources Section 7 - Problems of Oxygenation: Perfusion 34. Nursing Assessment: Cardiovascular System Learning Objectives Key Terms Structures and Functions of the Cardiovascular System Heart Structure. Blood Flow Through the Heart. Cardiac Valves. Blood Supply to the Myocardium. Conduction System. Electrocardiography. Mechanical System. Factors Affecting Cardiac Output. Cardiac Reserve. Vascular System Blood Vessels. Arteries and Arterioles. Capillaries. Veins and Venules. Regulation of the Cardiovascular System Autonomic Nervous System. Effect on the Heart. Effect on the Blood Vessels. Baroreceptors. Chemoreceptors. Blood Pressure Measurement of Arterial Blood Pressure. Pulse Pressure and Mean Arterial Pressure. Age-Related Considerations Effects of Aging on the Cardiovascular System Assessment of the Cardiovascular System Subjective Data Important Health Information History of Current Illness. Past Health History. Medications. Surgery or Other Treatments. Objective Data Physical Examination Vital Signs. Peripheral Vascular System Inspection. Palpation. Auscultation. Thorax Inspection and Palpation. Percussion. Auscultation. Diagnostic Studies of the Cardiovascular System Noninvasive Studies Chest Radiography. Electrocardiography. Ambulatory Electrocardiographic Monitoring. Transtelephonic Event Recorders. Exercise or Stress Testing. Echocardiography. Nuclear Cardiology. Cardiovascular Magnetic Resonance Imaging. Cardiac Computed Tomography. Blood Studies. Cardiac Biomarkers. C-Reactive Protein. Homocysteine. Cardiac Natriuretic Peptide Markers. Serum Lipids. Lipoprotein-Associated Phospholipase A2. Invasive Studies Cardiac Catheterization and Coronary Angiography. Intracoronary Ultrasonography. Fractional Flow Reserve. Hemodynamic Monitoring. Review Questions References Resources 35. Nursing Management: Hypertension Learning Objectives Key Terms Normal Regulation of Blood Pressure Sympathetic Nervous System Baroreceptors. Vascular Endothelium Renal System Endocrine System Hypertension Subtypes of Hypertension Etiology Primary Hypertension. Secondary Hypertension. Pathophysiology of Primary Hypertension Genes. Sodium and Water Retention. Altered Renin–Angiotensin–Aldosterone Mechanism. Stress and Increased Sympathetic Nervous System Activity. Insulin Resistance and Hyperinsulinemia. Endothelial Cell Dysfunction. Obesity. Clinical Manifestations Complications Hypertensive Heart Disease Coronary Artery Disease. Left Ventricular Hypertrophy. Heart Failure. Cerebro-vascular Disease. Peripheral Arterial Disease. Nephrosclerosis. Retinal Damage. Diagnostic Studies Ambulatory Blood Pressure Monitoring. Collaborative Care Risk Stratification. Lifestyle Modifications. Nutritional Therapy. Weight Reduction. Modification in Alcohol Consumption. Physical Activity. Avoidance of Tobacco Products. Stress Management. Drug Therapy. Patient Teaching Related to Drug Therapy. Resistant Hypertension. Nursing Management Primary Hypertension Nursing Assessment Nursing Diagnoses Planning Nursing Implementation Health Promotion. Individual Patient Evaluation. Screening Programs. Cardiovascular Risk Factor Modification. Ambulatory and Home Care. Physical Activity. Home Blood Pressure Monitoring. Patient Adherence. Evaluation Age-Related Considerations Hypertension Hypertensive Crisis Clinical Manifestations Nursing and Collaborative Management Hypertensive Crisis Review Questions References Resources 36. Nursing Management: Coronary Artery Disease and Acute Coronary Syndrome Learning Objectives Key Terms Coronary Artery Disease Etiology and Pathophysiology Developmental Stages Fatty Streak. Fibrous Plaque. Complicated Lesion. Collateral Circulation Risk Factors for Coronary Artery Disease Nonmodifiable Risk Factors Age, Sex, and Ethnicity. Major Modifiable Risk Factors Elevated Serum Lipid Levels. Hypertension. Tobacco Use. Physical Inactivity. Obesity. Modifiable Contributing Risk Factors Diabetes Mellitus. Metabolic Syndrome. Psychological States. Homocysteine. Substance Use. Health Promotion Identification of High-Risk People. Management of High-Risk People. Physical Activity. Health Education in Schools. Nutritional Therapy. Cholesterol-Lowering Drug Therapy Drugs That Restrict Lipoprotein Production. Drugs That Increase Lipoprotein Removal.