UNDERSTANDING Medical Surgical Nursing FIFTH EDITION

Preface NOTE TO THE STUDENT The Student Workbook for Understanding Medical Surgical Nursing has been written and edited by the authors to accompany the fifth edition of Understanding Medical Surgical Nursing. We have included exercises that not only help you review content, but also will help you develop your critical thinking abilities. It is essential for you to be able to think critically about the content as you prepare for the NCLEX-PN. We hope you will use this resource as well as your electronic study guide and the great resources on DavisPlus. SUGGESTIONS FOR USING THE STUDY GUIDE Checklists for Learning Success are provided at the beginning of each unit. You can use these checklists to track your study of the major topics. Each chapter includes: • An exercise to help you practice chapter vocabulary items. It is important to understand the underlying vocabulary before attempting to apply the terms to understand the remainder of the information in each chapter. • Basic matching, true/false, word scramble, and other exercises to allow you to practice and understand medical-surgical nursing information. These exercises are most helpful for developing knowledge and recall of material. • Critical thinking exercises to help you practice your new knowledge in patient situations and make good clinical judgments. We feel strongly that you must learn to think critically, rather than just memorize facts. The answers we provide for the critical thinking exercises are just some of the possibilities. You will come up with additional answers of your own as your knowledge base expands. • NCLEX-PN style questions to provide practice in applying your new knowledge. Rationale for why an answer is correct or incorrect has been included to strengthen your critical thinking and test-taking abilities. • Function and Assessment chapters also include a labeling exercise to help you review basic anatomy. STUDY GUIDE ANSWERS • To students: Study Guide answers are posted on the instructor’s DavisPlus site. Ask your instructor about accessing answers. • To instructors: Study Guide answers are posted on the instructor’s DavisPlus site. Students do not have access to Study Guide answers. Please provide answers to students according to your needs. We hope you find this study guide useful. Happy studying! PAULA D. HOPPER AND LINDA S. WILLIAMS v Contents UNIT ONE Understanding Health Care Issues 1 1 Critical Thinking and the Nursing Process 2 2 Evidence-Based Practice 5 3 Issues in Nursing Practice 8 4 Cultural Influences on Nursing Care 12 5 Complementary and Alternative Modalities 16 UNIT TWO Understanding Health and Illness 19 6 Nursing Care of Patients With Fluid, Electrolyte, and Acid-Base Imbalances 20 7 Nursing Care of Patients Receiving Intravenous Therapy 23 8 Nursing Care of Patients With Infections 26 9 Nursing Care of Patients in Shock 30 10 Nursing Care of Patients in Pain 34 11 Nursing Care of Patients With Cancer 37 12 Nursing Care of Patients Having Surgery 40 13 Nursing Care of Patients With Emergent Conditions and Disaster/Bioterrorism Response 45 UNIT THREE Understanding Life Span Influences on Health and Illness 49 14 Developmental Considerations in the Nursing Care of Adults 50 15 Nursing Care of Older Adult Patients 53 16 Nursing Care of Patients at Home 57 17 Nursing Care of Patients at the End of Life 60 UNIT FOUR Understanding the Immune System 63 18 Immune System Function, Assessment, and Therapeutic Measures 64 19 Nursing Care of Patients With Immune Disorders 68 20 Nursing Care of Patients With HIV Disease and AIDS 74 UNIT FIVE Understanding the Cardiovascular System 77 21 Cardiovascular System Function, Assessment, and Therapeutic Measures 78 22 Nursing Care of Patients With Hypertension 82 23 Nursing Care of Patients With Valvular, Inflammatory, and Infectious Cardiac or Venous Disorders 86 24 Nursing Care of Patients With Occlusive Cardiovascular Disorders 92 25 Nursing Care of Patients With Cardiac Dysrhythmias 96 26 Nursing Care of Patients With Heart Failure 102 UNIT SIX Understanding the Hematologic and Lymphatic Systems 107 27 Hematologic and Lymphatic System Function, Assessment, and Therapeutic Measures 108 28 Nursing Care of Patients With Hematologic and Lymphatic Disorders 112 UNIT SEVEN Understanding the Respiratory System 117 29 Respiratory System Function, Assessment, and Therapeutic Measures 118 30 Nursing Care of Patients With Upper Respiratory Tract Disorders 123 31 Nursing Care of Patients With Lower Respiratory Tract Disorders 126 UNIT EIGHT Understanding the Gastrointestinal, Hepatic, and Pancreatic Systems 131 32 Gastrointestinal, Hepatobiliary, and Pancreatic Systems Function, Assessment, and Therapeutic Measures 132 vii 33 Nursing Care of Patients With Upper Gastrointestinal Disorders 137 34 Nursing Care of Patients With Lower Gastrointestinal Disorders 141 35 Nursing Care of Patients With Liver, Pancreatic, and Gallbladder Disorders 144 UNIT NINE Understanding the Urinary System 149 36 Urinary System Function, Assessment, and Therapeutic Measures 150 37 Nursing Care of Patients With Disorders of the Urinary System 154 UNIT TEN Understanding the Endocrine System 159 38 Endocrine System Function and Assessment 160 39 Nursing Care of Patients With Endocrine Disorders 163 40 Nursing Care of Patients With Disorders of the Endocrine Pancreas 167 UNIT ELEVEN Understanding the Genitourinary and Reproductive System 171 41 Genitourinary and Reproductive System Function and Assessment 172 42 Nursing Care of Women With Reproductive System Disorders 177 43 Nursing Care of Male Patients With Genitourinary Disorders 180 44 Nursing Care of Patients With Sexually Transmitted Infections 183 UNIT TWELVE Understanding the Musculoskeletal System 187 45 Musculoskeletal Function and Assessment 188 46 Nursing Care of Patients With Musculoskeletal and Connective Tissue Disorders 192 UNIT THIRTEEN Understanding the Neurologic System 197 47 Neurologic System Function, Assessment, and Therapeutic Measures 198 48 Nursing Care of Patients With Central Nervous System Disorders 203 49 Nursing Care of Patients With Cerebrovascular Disorders 207 50 Nursing Care of Patients With Peripheral Nervous System Disorders 211 UNIT FOURTEEN Understanding the Sensory System 215 51 Sensory System Function, Assessment, and Therapeutic Measures: Vision and Hearing 216 52 Nursing Care of Patients With Sensory Disorders: Vision and Hearing 221 UNIT FIFTEEN Understanding the Integumentary System 225 53 Integumentary System Function, Assessment, and Therapeutic Measures 226 54 Nursing Care of Patients With Skin Disorders 229 55 Nursing Care of Patients With Burns 232 UNIT SIXTEEN Understanding Mental Health Care 235 56 Mental Health Function, Assessment, and Therapeutic Measures 236 57 Nursing Care of Patients With Mental Health Disorders 239 viii Contents Understanding Health Care Issues Critical Thinking Critical thinking traits Knowledge base Critical thinking skills Problem solving Role of the LPN/LVN Nursing process Data collection Documentation of data Nursing diagnosis Planning care Prioritizing care Identifying interventions Implementation Evaluation Evidence-Based Practice Evidence-based practice Use of evidence-based practice Identifying evidence Evidence-based practice process Six steps of evidencebased practice Evidence-based practice, quality and safety Quality and Safety Education for Nurses (QSEN) project Joint Commission’s 2014 National Patient Safety Goals Issues Health care delivery Economic issues Nursing/health team Leadership in nursing practice Career opportunities Ethics and values Ethical obligations and nursing Nursing code of ethics Building blocks of ethics Ethical theories Ethical decision making Legal concepts HIPAA Nursing liability and the law Cultural Influences Cultural diversity Communication Space Time orientation Social organization Environmental control Health care providers Biological variations Death and dying Cultural groups Culturally competent care Alternative/Complementary Alternative versus complementary therapies Allopathic/Western medicine Ayurveda Chinese medicine Chiropractic Homeopathy Naturopathy American Indian medicine Osteopathy Herbal therapy Relaxation therapies Massage therapy Aquatherapy Heat and cold Safety/effectiveness Role of LPN/LVN unit ONE CHECKLIST FOR LEARNING SUCCESS 2 Critical Thinking and the Nursing 1 Process VOCABULARY Define the following terms and use them in sentences. Nursing process Definition: Sentence: Critical thinking Definition: Sentence: Assessment Definition: Sentence: Objective data Definition: Sentence: Subjective data Definition: Sentence: Nursing diagnosis Definition: Sentence: Evaluation Definition: Sentence: Vigilance Definition: Sentence: SUBJECTIVE AND OBJECTIVE DATA Identify the following data as subjective (symptom) or objective (sign). 1. Pain 2. Shortness of breath 3. Edema (swelling) 4. Capillary refill 2 seconds 5. Nausea 6. Vomiting 7. Dizziness 8. Cyanosis 9. Numbness 10. Indigestion 11. Pale 12. Serum potassium 3.6 mEq/L 13. Palpitations (feeling of racing heart) 14. Blood pressure 130/82 mm Hg 15. White blood cell count 7000/mm3 CRITICAL THINKING Sometimes cognitive maps are used to organize thinking. Look at samples in any of the Function and Assessment chapters under Aging Changes. Some of the workbook chapters will ask you to make a cognitive map, so here is an opportunity to practice. Consider a time when you have had a headache or other discomfort. Fill in the spaces with information related to the WHAT’S UP? questions. See Chapter 1 Answers for one patient’s responses. Once you have the questions answered, you could go even further and make links with possible interventions. There is no one right way to make a cognitive map—use your imagination! Chapter 1 Critical Thinking and the Nursing Process 3 Patient's perception Where is it? Useful other data Quality Severity Timing Aggravating and alleviating factors Headache Choose the best answer unless directed otherwise. 1. Which one of the following is a nursing diagnosis? 1. Peptic ulcer 2. Pneumonia 3. Ineffective airway clearance 4. Myocardial infarction 2. Which one of the following is a medical diagnosis? 1. Hiatal hernia 2. Impaired mobility 3. Powerlessness 4. Anxiety