Brunner & Suddarth's Textbook of Medical-Surgical Nursing
Edition 15
1
,BRUNNER & SUDDARTH’S
TEXTBOOK OF
Medical-Surgical
Nursing
15TH EDITION
Janice L. Hinkle, PhD, RN, CNRN
Fellow
Villanova University M. Louise Fitzpatrick College of Nursing
Villanova, Pennsylvania
Kerry H. Cheever, PhD, RN
Professor Emerita
Helen S. Breidegam School of Nursing
Moravian University
Bethlehem, Pennsylvania
Kristen J. Overbaugh, PhD, RN, ACNS-BC, CHPN
Assistant Professor
School of Nursing and Health Sciences
La Salle University
Philadelphia, Pennsylvania
2
,3
,Vice President, Nursing Segment: Julie K. Stegman
Director, Nursing Education and Practice Content: Jamie Blum
Senior Acquisitions Editor: Jonathan Joyce
Senior Development Editor: Meredith L. Brittain
Freelance Development Editor: Rose G. Foltz
Senior Editorial Coordinator: Julie Kostelnik
Marketing Manager: Brittany Clements
Editorial Assistant: Molly Kennedy
Senior Production Project Manager: David Saltzberg
Manager, Graphic Arts and Design: Steve Druding
Art Director: Jennifer Clements
Manufacturing Coordinator: Margie Orzech
Prepress Vendor: Aptara, Inc.
15th Edition
Copyright © 2022 Wolters Kluwer
Copyright © 2018 Wolters Kluwer. Copyright © 2014, 2010 Wolters Kluwer Health | Lippincott
Williams & Wilkins. Copyright © 2008 by Lippincott Williams & Wilkins, a Wolters Kluwer business.
Copyright © 2004, 2000 by Lippincott Williams & Wilkins. Copyright © 1996 by Lippincott-Raven
Publishers. Copyright © 1992, 1988, 1984, 1980, 1975, 1970, 1964 by J. B. Lippincott Company. All
rights reserved. This book is protected by copyright. No part of this book may be reproduced or
transmitted in any form or by any means, including as photocopies or scanned-in or other electronic
copies, or utilized by any information storage and retrieval system without written permission from the
copyright owner, except for brief quotations embodied in critical articles and reviews. Materials
appearing in this book prepared by individuals as part of their official duties as U.S. government
employees are not covered by the above-mentioned copyright. To request permission, please contact
Lippincott Williams & Wilkins at Two Commerce Square, 2001 Market Street, Philadelphia, PA 19103,
via email at , or via our website at lww.com (products and services).
Nursing diagnoses in this title are ICNP® nursing diagnoses. ICNP® is owned and copyrighted by the
International Council of Nurses (ICN). Reproduced with permission of the copyright holder.
9 8 7 6 5 4 3 2 1
Printed in China
978-1-9751-6103-3
Library of Congress Cataloging-in-Publication Data available upon request
Library of Congress Control Number: 2021911700
This work is provided “as is,” and the publisher disclaims any and all warranties, express or implied,
including any warranties as to accuracy, comprehensiveness, or currency of the content of this work.
This work is no substitute for individual patient assessment based upon healthcare professionals’
examination of each patient and consideration of, among other things, age, weight, gender, current or
prior medical conditions, medication history, laboratory data and other factors unique to the patient. The
publisher does not provide medical advice or guidance and this work is merely a reference tool.
Healthcare professionals, and not the publisher, are solely responsible for the use of this work including
all medical judgments and for any resulting diagnosis and treatments.
Given continuous, rapid advances in medical science and health information, independent professional
verification of medical diagnoses, indications, appropriate pharmaceutical selections and dosages, and
treatment options should be made and healthcare professionals should consult a variety of sources.
When prescribing medication, healthcare professionals are advised to consult the product information
sheet (the manufacturer’s package insert) accompanying each drug to verify, among other things,
4
,conditions of use, warnings and side effects and identify any changes in dosage schedule or
contraindications, particularly if the medication to be administered is new, infrequently used or has a
narrow therapeutic range. To the maximum extent permitted under applicable law, no responsibility is
assumed by the publisher for any injury and/or damage to persons or property, as a matter of products
liability, negligence law or otherwise, or from any reference to or use by any person of this work.
shop.lww.com
5
,To our fellow nurses who provide comfort and care,
and who instill hope for a healthier world . . .
To our nursing faculty colleagues who nurture,
guide, and steer the future of our profession . . .
To nursing students who challenge themselves with
courage and conviction . . .
You inspire us!
6
,Contributors
Contributors to the 15th Edition
Marianne T. Adam, PhD, RN, FNP, CNE
Associate Teaching Professor of Nursing
Campus Coordinator, Nursing
Pennsylvania State University Schuylkill
Schuylkill Haven, Pennsylvania
Chapter 38: Assessment of Digestive and Gastrointestinal Function
Rachel Barish, RN, MSN, ANP-BC, AACC
Nurse Practitioner, Division of Cardiology
MedStar Georgetown University Hospital Physicians Group
Washington, District of Columbia
Chapter 24: Management of Patients with Structural, Infectious, and
Inflammatory Cardiac Disorders
Jennifer L. Bartlett, PhD, RN-BC, CNE, CHSE
Associate Professor
Georgia Baptist College of Nursing of Mercer University
Atlanta, Georgia
Chapter 39: Management of Patients with Oral and Esophageal Disorders
Susan Bartos, PhD, RN, CCRN
Adjunct Professor
Egan School of Nursing & Health Sciences
Fairfield University
Fairfield, Connecticut
Chapter 25: Management of Patients with Complications from Heart Disease
Cynthia Bautista, PhD, APRN, FNCS, FCNS
Associate Professor
Egan School of Nursing and Health Studies
Fairfield University
7
,Fairfield, Connecticut
Chapter 63: Management of Patients with Neurologic Trauma
Tricia Bernecker, PhD, RN
Associate Professor
DeSales University
Center Valley, Pennsylvania
Chapter 22: Management of Patients with Arrhythmias and Conduction
Problems
Lisa Bowman, RN, MSN, CRNP, CNRN
Nurse Practitioner
Jefferson Hospital for Neuroscience
Thomas Jefferson University Hospital
Philadelphia, Pennsylvania
Chapter 62: Management of Patients with Cerebrovascular Disorders
Carolyn Bradley, MSN, RN, CCRN
Heart & Vascular Center Nursing Professional Development Specialist
Yale New Haven Hospital
New Haven, Connecticut
Chapter 21: Assessment of Cardiovascular Function
Sherry Burrell, PhD, RN, CNE
Assistant Professor
Villanova University M. Louise Fitzpatrick College of Nursing
Villanova, Pennsylvania
Chapter 12: Oncologic Management
Theresa Capriotti, DO, CRNP, MSN, RN
Clinical Professor
Villanova University M. Louise Fitzpatrick College of Nursing
Villanova, Pennsylvania
Chapter 10: Fluid and Electrolytes
Chapter 33: Assessment and Management of Patients with Allergic Disorders
Jean Colaneri, ACNP-BC, CNN
Acute Care Nurse Practitioner
Albany Medical Center Hospital
8
,Albany, New York
Chapter 48: Management of Patients with Kidney Disorders
Linda Carman Copel, PhD, RN, PMHCNS, BC, CNE, ANEF, NCC, FAPA
Professor
Villanova University M. Louise Fitzpatrick College of Nursing
Villanova, Pennsylvania
Chapter 3: Health Education and Health Promotion
Chapter 5: Stress and Inflammatory Responses
Chapter 53: Assessment and Management of Patients with Male Reproductive
Disorders
Patricia Dillon, PhD, RN
Chair of Graduate, RN to BSN, and RN to MSN Programs, & Professor
School of Nursing and Health Sciences
La Salle University
Philadelphia, Pennsylvania
Chapter 56: Management of Patients with Dermatologic Disorders
Nancy Donegan, MPH, RN
Independent Consultant
Washington, District of Columbia
Chapter 66: Management of Patients with Infectious Diseases
Paulette Dorney, PhD, RN, CCRN-K
Associate Professor & Director, Accelerated BSN Program
Helen S. Breidegam School of Nursing
Moravian University
Bethlehem, Pennsylvania
Chapter 19: Management of Patients with Chest and Lower Respiratory Tract
Disorders
Phyllis Dubendorf, MSN, RN, CCNS, CNRN, ACNP-BC
Clinical Nurse Specialist
Hospital of the University of Pennsylvania
Philadelphia, Pennsylvania
Chapter 61: Management of Patients with Neurologic Dysfunction
Kimberly Silver Dunker, DNP, MSN, RN, CNE, CNEcl
9
, Dean of Nursing
Fortis Institute
Nashville, Tennessee
Unit-opening case studies
Elizabeth C. Evans, CNP, DNP
Nephrology Nurse Practitioner
Renal Medicine Associates
Albuquerque, New Mexico
Chapter 27: Assessment and Management of Patients with Hypertension
Janice Farber, PhD, RN, CNOR
Associate Professor
Helen S. Breidegam School of Nursing
Moravian University
Bethlehem, Pennsylvania
Chapter 4: Adult Health and Physical, Nutritional, and Cultural Assessment
Eleanor Fitzpatrick, DNP, RN, CCRN, AGCNS-BC, ACNP-BC
Clinical Nurse Specialist
Thomas Jefferson University Hospital
Philadelphia, Pennsylvania
Chapter 43: Assessment and Management of Patients with Hepatic Disorders
Chapter 44: Management of Patients with Biliary Disorders
Anessa M. Foxwell, MSN, CRNP, ACHPN
Predoctoral Fellow, NewCourtland Center for Transitions & Health
University of Pennsylvania School of Nursing
Nurse Practitioner, Clinical Practices of the University of Pennsylvania
Philadelphia, Pennsylvania
Chapter 13: Palliative and End-of-Life Care
Stacy M. Fusner, DNP, APRN, CNP
Assistant Professor of Clinical Practice
The Ohio State University College of Nursing
Columbus, Ohio
Chapter 58: Assessment and Management of Patients with Eye and Vision
Disorders
10
Edition 15
1
,BRUNNER & SUDDARTH’S
TEXTBOOK OF
Medical-Surgical
Nursing
15TH EDITION
Janice L. Hinkle, PhD, RN, CNRN
Fellow
Villanova University M. Louise Fitzpatrick College of Nursing
Villanova, Pennsylvania
Kerry H. Cheever, PhD, RN
Professor Emerita
Helen S. Breidegam School of Nursing
Moravian University
Bethlehem, Pennsylvania
Kristen J. Overbaugh, PhD, RN, ACNS-BC, CHPN
Assistant Professor
School of Nursing and Health Sciences
La Salle University
Philadelphia, Pennsylvania
2
,3
,Vice President, Nursing Segment: Julie K. Stegman
Director, Nursing Education and Practice Content: Jamie Blum
Senior Acquisitions Editor: Jonathan Joyce
Senior Development Editor: Meredith L. Brittain
Freelance Development Editor: Rose G. Foltz
Senior Editorial Coordinator: Julie Kostelnik
Marketing Manager: Brittany Clements
Editorial Assistant: Molly Kennedy
Senior Production Project Manager: David Saltzberg
Manager, Graphic Arts and Design: Steve Druding
Art Director: Jennifer Clements
Manufacturing Coordinator: Margie Orzech
Prepress Vendor: Aptara, Inc.
15th Edition
Copyright © 2022 Wolters Kluwer
Copyright © 2018 Wolters Kluwer. Copyright © 2014, 2010 Wolters Kluwer Health | Lippincott
Williams & Wilkins. Copyright © 2008 by Lippincott Williams & Wilkins, a Wolters Kluwer business.
Copyright © 2004, 2000 by Lippincott Williams & Wilkins. Copyright © 1996 by Lippincott-Raven
Publishers. Copyright © 1992, 1988, 1984, 1980, 1975, 1970, 1964 by J. B. Lippincott Company. All
rights reserved. This book is protected by copyright. No part of this book may be reproduced or
transmitted in any form or by any means, including as photocopies or scanned-in or other electronic
copies, or utilized by any information storage and retrieval system without written permission from the
copyright owner, except for brief quotations embodied in critical articles and reviews. Materials
appearing in this book prepared by individuals as part of their official duties as U.S. government
employees are not covered by the above-mentioned copyright. To request permission, please contact
Lippincott Williams & Wilkins at Two Commerce Square, 2001 Market Street, Philadelphia, PA 19103,
via email at , or via our website at lww.com (products and services).
Nursing diagnoses in this title are ICNP® nursing diagnoses. ICNP® is owned and copyrighted by the
International Council of Nurses (ICN). Reproduced with permission of the copyright holder.
9 8 7 6 5 4 3 2 1
Printed in China
978-1-9751-6103-3
Library of Congress Cataloging-in-Publication Data available upon request
Library of Congress Control Number: 2021911700
This work is provided “as is,” and the publisher disclaims any and all warranties, express or implied,
including any warranties as to accuracy, comprehensiveness, or currency of the content of this work.
This work is no substitute for individual patient assessment based upon healthcare professionals’
examination of each patient and consideration of, among other things, age, weight, gender, current or
prior medical conditions, medication history, laboratory data and other factors unique to the patient. The
publisher does not provide medical advice or guidance and this work is merely a reference tool.
Healthcare professionals, and not the publisher, are solely responsible for the use of this work including
all medical judgments and for any resulting diagnosis and treatments.
Given continuous, rapid advances in medical science and health information, independent professional
verification of medical diagnoses, indications, appropriate pharmaceutical selections and dosages, and
treatment options should be made and healthcare professionals should consult a variety of sources.
When prescribing medication, healthcare professionals are advised to consult the product information
sheet (the manufacturer’s package insert) accompanying each drug to verify, among other things,
4
,conditions of use, warnings and side effects and identify any changes in dosage schedule or
contraindications, particularly if the medication to be administered is new, infrequently used or has a
narrow therapeutic range. To the maximum extent permitted under applicable law, no responsibility is
assumed by the publisher for any injury and/or damage to persons or property, as a matter of products
liability, negligence law or otherwise, or from any reference to or use by any person of this work.
shop.lww.com
5
,To our fellow nurses who provide comfort and care,
and who instill hope for a healthier world . . .
To our nursing faculty colleagues who nurture,
guide, and steer the future of our profession . . .
To nursing students who challenge themselves with
courage and conviction . . .
You inspire us!
6
,Contributors
Contributors to the 15th Edition
Marianne T. Adam, PhD, RN, FNP, CNE
Associate Teaching Professor of Nursing
Campus Coordinator, Nursing
Pennsylvania State University Schuylkill
Schuylkill Haven, Pennsylvania
Chapter 38: Assessment of Digestive and Gastrointestinal Function
Rachel Barish, RN, MSN, ANP-BC, AACC
Nurse Practitioner, Division of Cardiology
MedStar Georgetown University Hospital Physicians Group
Washington, District of Columbia
Chapter 24: Management of Patients with Structural, Infectious, and
Inflammatory Cardiac Disorders
Jennifer L. Bartlett, PhD, RN-BC, CNE, CHSE
Associate Professor
Georgia Baptist College of Nursing of Mercer University
Atlanta, Georgia
Chapter 39: Management of Patients with Oral and Esophageal Disorders
Susan Bartos, PhD, RN, CCRN
Adjunct Professor
Egan School of Nursing & Health Sciences
Fairfield University
Fairfield, Connecticut
Chapter 25: Management of Patients with Complications from Heart Disease
Cynthia Bautista, PhD, APRN, FNCS, FCNS
Associate Professor
Egan School of Nursing and Health Studies
Fairfield University
7
,Fairfield, Connecticut
Chapter 63: Management of Patients with Neurologic Trauma
Tricia Bernecker, PhD, RN
Associate Professor
DeSales University
Center Valley, Pennsylvania
Chapter 22: Management of Patients with Arrhythmias and Conduction
Problems
Lisa Bowman, RN, MSN, CRNP, CNRN
Nurse Practitioner
Jefferson Hospital for Neuroscience
Thomas Jefferson University Hospital
Philadelphia, Pennsylvania
Chapter 62: Management of Patients with Cerebrovascular Disorders
Carolyn Bradley, MSN, RN, CCRN
Heart & Vascular Center Nursing Professional Development Specialist
Yale New Haven Hospital
New Haven, Connecticut
Chapter 21: Assessment of Cardiovascular Function
Sherry Burrell, PhD, RN, CNE
Assistant Professor
Villanova University M. Louise Fitzpatrick College of Nursing
Villanova, Pennsylvania
Chapter 12: Oncologic Management
Theresa Capriotti, DO, CRNP, MSN, RN
Clinical Professor
Villanova University M. Louise Fitzpatrick College of Nursing
Villanova, Pennsylvania
Chapter 10: Fluid and Electrolytes
Chapter 33: Assessment and Management of Patients with Allergic Disorders
Jean Colaneri, ACNP-BC, CNN
Acute Care Nurse Practitioner
Albany Medical Center Hospital
8
,Albany, New York
Chapter 48: Management of Patients with Kidney Disorders
Linda Carman Copel, PhD, RN, PMHCNS, BC, CNE, ANEF, NCC, FAPA
Professor
Villanova University M. Louise Fitzpatrick College of Nursing
Villanova, Pennsylvania
Chapter 3: Health Education and Health Promotion
Chapter 5: Stress and Inflammatory Responses
Chapter 53: Assessment and Management of Patients with Male Reproductive
Disorders
Patricia Dillon, PhD, RN
Chair of Graduate, RN to BSN, and RN to MSN Programs, & Professor
School of Nursing and Health Sciences
La Salle University
Philadelphia, Pennsylvania
Chapter 56: Management of Patients with Dermatologic Disorders
Nancy Donegan, MPH, RN
Independent Consultant
Washington, District of Columbia
Chapter 66: Management of Patients with Infectious Diseases
Paulette Dorney, PhD, RN, CCRN-K
Associate Professor & Director, Accelerated BSN Program
Helen S. Breidegam School of Nursing
Moravian University
Bethlehem, Pennsylvania
Chapter 19: Management of Patients with Chest and Lower Respiratory Tract
Disorders
Phyllis Dubendorf, MSN, RN, CCNS, CNRN, ACNP-BC
Clinical Nurse Specialist
Hospital of the University of Pennsylvania
Philadelphia, Pennsylvania
Chapter 61: Management of Patients with Neurologic Dysfunction
Kimberly Silver Dunker, DNP, MSN, RN, CNE, CNEcl
9
, Dean of Nursing
Fortis Institute
Nashville, Tennessee
Unit-opening case studies
Elizabeth C. Evans, CNP, DNP
Nephrology Nurse Practitioner
Renal Medicine Associates
Albuquerque, New Mexico
Chapter 27: Assessment and Management of Patients with Hypertension
Janice Farber, PhD, RN, CNOR
Associate Professor
Helen S. Breidegam School of Nursing
Moravian University
Bethlehem, Pennsylvania
Chapter 4: Adult Health and Physical, Nutritional, and Cultural Assessment
Eleanor Fitzpatrick, DNP, RN, CCRN, AGCNS-BC, ACNP-BC
Clinical Nurse Specialist
Thomas Jefferson University Hospital
Philadelphia, Pennsylvania
Chapter 43: Assessment and Management of Patients with Hepatic Disorders
Chapter 44: Management of Patients with Biliary Disorders
Anessa M. Foxwell, MSN, CRNP, ACHPN
Predoctoral Fellow, NewCourtland Center for Transitions & Health
University of Pennsylvania School of Nursing
Nurse Practitioner, Clinical Practices of the University of Pennsylvania
Philadelphia, Pennsylvania
Chapter 13: Palliative and End-of-Life Care
Stacy M. Fusner, DNP, APRN, CNP
Assistant Professor of Clinical Practice
The Ohio State University College of Nursing
Columbus, Ohio
Chapter 58: Assessment and Management of Patients with Eye and Vision
Disorders
10
