Kozier & Erb’s Fundamentals of Nursing: Concepts, Process, and Practice, Eleventh Edition
By Audrey Berman, Shirlee J. Snyder and Geralyn Frandsen
Contents:
About the Authors 4
Acknowledgments 6
Thank You 6
Preface 8
UNIT 1 The Nature of Nursing 27
CHAPTER 1 Historical and Contemporary Nursing Practice 28
Introduction 28
Historical Perspectives 28
Women’s Roles 28, Men’s Roles 29, Religion 30, War 30, Societal Attitudes 32, Nursing Leaders 33
Nursing Education 36
Types of Education Programs 37, Nursing Theories 39, Continuing Education 40
Contemporary Nursing Practice 41
Definitions of Nursing 41, Recipients of Nursing 41, Scope of Nursing
41, Settings for Nursing 42, Nurse Practice Acts 42,
Standards of Nursing Practice 42
Roles and Functions of the Nurse 43
Caregiver 43, Communicator 43, Teacher 43, Client Advocate
43, Counselor 43, Change Agent 43, Leader 43,
Manager 43, Case Manager 44, Research Consumer 44,
Expanded Career Roles 44
Criteria of a Profession 45
Specialized Education 45, Body of Knowledge 45, Service
Orientation 45, Ongoing Research 45, Code of Ethics 45,
Autonomy 45, Professional Organization 45
Professional Identity Formation 45
Factors Influencing Contemporary Nursing Practice 47
Nursing Workforce Issues and Challenges 47, Healthcare System
Reform 47, Quality and Safety in Healthcare 48, Consumer
Demands 48, Family Structure 48, Science and Technology 48,
Internet, Telehealth, and Telenursing 48, Legislation 49, Collective Bargaining 49, Nursing Associations 49
Nursing Organizations 49
CHAPTER 2 Evidence-Based Practice and Research in Nursing 53
Introduction 53
Evidence-Based Practice 53
Nursing Research 54
Approaches to Nursing Research 55, Overview of the Research
Process 57, Research-Related Roles and Responsibilities for Nurses 59
CHAPTER 3 Legal Aspects of Nursing 65
Introduction 65
General Legal Concepts 65
Functions of the Law in Nursing 66, Sources of Law 66, Types
of Laws 66, Kinds of Legal Actions 67, The Civil Judicial Process 67, Nurses as Witnesses 67
Regulation of Nursing Practice 67
Nurse Practice Acts 67, Credentialing 69, Standards of Care 70
Contractual Arrangements in Nursing 70
Legal Roles of Nurses 71, Collective Bargaining 72
Selected Legal Aspects of Nursing Practice 72
Informed Consent 72, Delegation 76, Violence, Abuse, and
Neglect 77, Discrimination 77, Controlled Substances 77,
Substance Use Disorder in Nursing 77, Sexual Harassment 78,
Abortions 79, Death and Related Issues 79
Areas of Potential Liability in Nursing 83
Crimes and Torts 83, Privacy of Clients’ Health Information 87, Social
Media 87, Loss of Client Property 88, Unprofessional Conduct 88
Legal Protections in Nursing Practice 88
Good Samaritan Acts 88, Professional Liability Insurance 89,
Carrying Out a Physician’s Orders 89, Providing Competent Nursing
Care 90, Documentation 90, The Incident Report 90
Reporting Crimes, Torts, and Unsafe Practices 91
Legal Responsibilities of Students 91
CHAPTER 4 Values, Ethics, and Advocacy 96
Introduction 96
Values 96
Values Transmission 97, Values Clarification 97
Ethics and Morality 98
Moral Development 99, Moral Frameworks 99, Moral Principles 100
Nursing Ethics 101
Nursing Codes of Ethics 101, Origins of Ethical Problems in Nursing 102,
Making Ethical Decisions 103, Strategies to Enhance Ethical Decisions and Practice 104
Specific Ethical Issues 104
AIDS 105, Abortion 105, Organ and Tissue Transplantation 106,
End-of-Life Issues 106, Allocation of Scarce Health Resources 107,
Management of Personal Health Information 107
Advocacy 107
The Advocate’s Role 107
UNIT 2 Contemporary Healthcare 112
CHAPTER 5 Healthcare Delivery Systems 113
Introduction 113
Types of Healthcare Services 113
Primary Prevention: Health Promotion and Illness Prevention 113,
Secondary Prevention: Diagnosis and Treatment 114, Tertiary Prevention:
Rehabilitation, Health Restoration, and Palliative Care 114
Types of Healthcare Agencies and Services 114
Public Health 114, Physicians’ Offices 115, Ambulatory Care Centers
115, Occupational Health Clinics 115, Hospitals 115, Subacute Care
Facilities 116, Extended (Long-Term) Care Facilities 116, Retirement and Assisted Living
Centers 117, Rehabilitation Centers 117, Home Healthcare Agencies 118, Day Care Centers 118, Rural Care 118, Hospice Services
118, Crisis Centers 118, Mutual Support and Self-Help Groups 118 Providers of Healthcare 118
Nurse 119, Alternative (Complementary) Care Provider 119, Assistive
Personnel 119, Case Manager 119, Dentist 119, Dietitian or
Nutritionist 119, Emergency Medical Personnel 119, Occupational
Therapist 120, Paramedical Technologist 120, Pharmacist 120,
Physical Therapist 120, Physician 120, Physician Assistant 120,
Podiatrist 120, Respiratory Therapist 120, Social
Worker 121, Spiritual Support Personnel 121
Factors Affecting Healthcare Delivery 121
Increasing Number of Older Adults 121, Advances in Technology 121,
Economics 122, Women’s Health 122, Uneven Distribution of Services 122, Access to Health Insurance 122,
The Homeless and the Poor 123, Health Insurance Portability and Accountability Act 124,
Demographic Changes 124
Frameworks for Care 124
Managed Care 124, Case Management 125, Differentiated Practice 125,
Case Method 125, Functional Method 125, Team Nursing 126,
Primary Nursing 126
Financing Healthcare 126
Payment Sources in the United States 126, Insurance Plans 128
CHAPTER 6 Community Nursing and Care Continuity 131
Introduction 131
The Movement of Healthcare to the Community 131
Primary Healthcare and Primary Care 132
Community-Based Healthcare 133
Community Health 134
Community-Based Frameworks 135, Community-Based Settings 136
Community-Based Nursing 137
Competencies Required for Community-Based Care 138,
Collaborative Healthcare 138
Continuity of Care 140
Care Across the Lifespan 140, Discharge Planning 140, Preparing
Clients to Go Home 141, Medication Reconciliation 141,
Home Healthcare Teaching 141, Referrals 142
CHAPTER 7 Home Health Nursing Care 145
Introduction 145
Home Health Nursing Care 145
Unique Aspects of Home Health Nursing Care 146
The Home Healthcare System 146
Referral Process 146, Home Healthcare Agencies 147,
Private Duty Agencies 147, Durable Medical Equipment
Companies 147, Reimbursement 147
Roles of the Home Healthcare Nurse 148
Advocate 148, Caregiver 148, Educator 148, Case Manager or
Coordinator 149
Perspectives of Home Healthcare Clients 149
Selected Dimensions of Home Healthcare Nursing 149
Client Safety 149, Home Healthcare Nurse Safety 150, Infection
Prevention 151, Caregiver Support 151
The Practice of Home Health Nursing Care 152
Establishing Health Issues 152, Planning and Delivering
Care 152, Resources for Home Healthcare Nursing 153
The Future of Home Healthcare 154
CHAPTER 8 Electronic Health Records and Information Technology 157
Introduction 157
General Concepts 157
Computer Systems 158
Management Information Systems 159, Hospital Information Systems 159
Technology in Nursing Education 160
Teaching and Learning 160, Testing 161, Student and Course Record
Management 161
Technology in Nursing Practice 162
Documentation of Client Status and Medical Record Keeping 162,
Electronic Access to Client Data 166, Practice Management 168,
Specific Applications of Computers in Nursing Practice 168
Technology in Nursing Administration 169
Human Resources 169, Medical Records Management 169, Facilities
Management 169, Budget and Finance 169, Quality Improvement and
Utilization Review 169, Accreditation 170, Data Mining 170
Technology in Nursing Research 170
Problem Identification 170, Literature Review 170, Research
Design 170, Data Collection and Analysis 170, Research Dissemination 171, Research Grants 171
UNIT 3 The Nursing Process 176
CHAPTER 9 Critical Thinking and Clinical Reasoning 177
Introduction 177
Purpose of Critical Thinking 177
Techniques of Critical Thinking 179
Applying Critical Thinking to Nursing Practice 180
Problem-Solving 181
Attitudes That Foster Critical Thinking 181
Independence 181, Fair-Mindedness 182, Insight into Egocentricity 182, Intellectual Humility 182, Intellectual Courage
to Challenge the Status Quo and Rituals 182, Integrity 182, Perseverance 182, Confidence 183, Curiosity 183
Components of Clinical Reasoning 183
Setting Priorities 183, Developing Rationales 184, Learning How to
Act 184, Clinical Reasoning-in-Transition 185, Responding to Changes
in the Client’s Condition 185, Reflection 185
Integration of Critical Thinking and Clinical Reasoning 185
Concept Mapping 186
Concept Mapping and Enhancing Critical Thinking and Clinical Reasoning 186
CHAPTER 10 Assessing 190
Introduction 190
Overview of the Nursing Process 190
Phases of the Nursing Process 190, Characteristics of the Nursing Process 192
Assessing 195
Collecting Data 196
Types of Data 198, Sources of Data 198, Data Collection Methods 199
Organizing Data 204
Conceptual Models and Frameworks 204, Wellness Models 206, Nonnursing Models 207
Validating Data 208
Documenting Data 209
CHAPTER 11 Diagnosing 212
Introduction 212
Nursing Diagnoses 212
Definitions 212, Status of the Nursing Diagnoses 213, Components
of a Nursing Diagnosis 213, Differentiating Nursing Diagnoses from
Medical Diagnoses 214, Differentiating Nursing Diagnoses from Collaborative Problems 215
The Diagnostic Process 216
Analyzing Data 216, Identifying Health Problems, Risks, and
Strengths 218, Formulating Diagnostic Statements 219, Avoiding
Errors in Diagnostic Reasoning 221
CHAPTER 12 Planning 225
Introduction 225
Types of Planning 225
Initial Planning 225, Ongoing Planning 225, Discharge Planning 226
Developing Nursing Care Plans 226
Standardized Approaches to Care Planning 226, Formats for
Nursing Care Plans 229, Multidisciplinary (Collaborative) Care Plans 229, Guidelines for Writing Nursing Care Plans 230
The Planning Process 231 Setting Priorities 231, Establishing Client Goals or Desired Outcomes 233,
Selecting Nursing Interventions and Activities 237, Writing Individualized Nursing Interventions 238,
Delegating Implementation 239
The Nursing Interventions Classification 239
CHAPTER 13 Implementing and Evaluating 245
Introduction 245
Implementing 245
Relationship of Implementing to Other Nursing Process Phases 245,
Implementing Skills 246, Process of Implementing 246
Evaluating 248
Relationship of Evaluating to Other Nursing Process Phases 248,
Process of Evaluating Client Responses 249, Evaluating the Quality of Nursing Care 252
CHAPTER 14 Documenting and Reporting 259
Introduction 259
Ethical and Legal Considerations 259
Ensuring Confidentiality of Computer Records 260
Purposes of Client Records 260
Communication 260, Planning Client Care 260, Auditing Health Agencies
260, Research 260, Education 260, Reimbursement 261,
Legal Documentation 261, Healthcare Analysis 261
Documentation Systems 261
Source-Oriented Record 261, Problem-Oriented Medical Record 261,
PIE 264, Focus Charting 264, Charting by Exception 265,
Computerized Documentation 267, Case Management 267
Documenting Nursing Activities 268
Admission Nursing Assessment 269, Nursing Care Plans 269,
Kardexes 269, Flow Sheets 269, Progress Notes 270,
Nursing Discharge and Referral Summaries 270
Long-Term Care Documentation 270
Home Care Documentation 271
General Guidelines for Recording 271
Date and Time 272, Timing 272, Legibility 272, Permanence 272
Accepted Terminology 272
Correct Spelling 272, Signature 272, Accuracy 273,
Sequence 274, Appropriateness 274, Completeness 274,
Conciseness 275, Legal Prudence 275
Reporting 275
Change-of-Shift Reports 275, Telephone Reports 277, Telephone
and Verbal Orders 277, Care Plan Conference 278, Nursing Rounds 278
UNIT 4 Integral Aspects of Nursing 283
CHAPTER 15 Caring 284
Introduction 284
Professionalization of Caring 284
Caring as “Helping the Other Grow” 284
Types of Knowledge in Nursing 284
Empirical Knowing: The Science of Nursing 285, Personal Knowing:
The Therapeutic Use of Self 285, Ethical Knowing: The Moral Component
285, Aesthetic Knowing: The Art of Nursing 285,
Developing Ways of Knowing 286
Nursing Theories of Caring 286
Caring, the Human Mode of Being (Roach) 286, Theory of Human Care
(Watson) 286, Theory of Caring (Swanson) 287
Caring Encounters 287
Knowing the Client 287, Nursing Presence 287, Empowering the
Client 288, Compassion 288, Competence 288
Maintaining Caring Practice 288
Caring for Self 288, Reflection on Practice 291
CHAPTER 16 Communicating 295
Introduction 295
Communicating 295
The Communication Process 296, Modes of Communication 297,
Factors Influencing the Communication Process 301, Therapeutic
Communication 304, Barriers to Communication 305
The Helping Relationship 308
Phases of the Helping Relationship 308, Developing Helping Relationships 310
Communication and the Nursing Process 310
Communication Among Health Professionals 313
Disruptive Behaviors 313, Responding to Disruptive Behaviors
314, Nurse and Physician Communication 315
CHAPTER 17 Teaching 321
Introduction 321
Teaching 321
Teaching Clients and Their Families 321, Teaching in the
Community 322, Teaching Health Personnel 322 Learning 323
Learning Domains 323, Learning Theories 323, Factors Affecting Learning 324
Technology and Health Information 327
Online Health Information 327, Older Adults and Use of the
Internet 328, Implications 328
Nurse as Educator 328
CHAPTER 18 Leading, Managing, and Delegating 345
Introduction 345
The Nurse as Leader and Manager 345
Leadership 346
Leadership Theory 346, Effective Leadership 349
Management 350
Levels of Management 350, Management Functions 350, Principles of
Management 351, Skills and Competencies of Nurse Managers 351
The Nurse as Delegator 354
UNIT 5 Health Beliefs and Practices 361
CHAPTER 19 Health Promotion 362
Introduction 362
Individual Health 362
Concept of Individuality 363, Concept of Holism 363, Concept of
Homeostasis 363, Assessing the Health of Individuals 365
Applying Theoretical Frameworks 365
Needs Theories 365, Developmental Stage Theories 366
Healthy People 2020 366
Healthy People 2030 366
Defining Health Promotion 367
Sites for Health Promotion Activities 369
Health Promotion Model 369
Individual Characteristics and Experiences 369, Behavior-Specific
Cognitions and Affect 370, Commitment to a Plan of Action 371,
Immediate Competing Demands and Preferences 371, Behavioral Outcome 371
Stages of Health Behavior Change 371
Precontemplation Stage 371, Contemplation Stage 372, Preparation
Stage 372, Action Stage 372, Maintenance Stage 372, Termination Stage 372
The Nurse’s Role in Health Promotion 372
The Nursing Process and Health Promotion 373
CHAPTER 20 Health, Wellness, and Illness 382
Introduction 382
Concepts of Health, Wellness, and Well-Being 382
Health 382, Wellness and Well-Being 384
Models of Health and Wellness 384
Clinical Model 384, Role Performance Model 384, Adaptive
Model 384, Eudaimonistic Model 384, Agent–Host–Environment
Model 384, Health–Illness Scales 385
Variables Influencing Health Status, Beliefs, and Behaviors 386
Internal Variables 386, External Variables 387
Health Belief Models 388
Health Locus of Control Model 388, Rosenstock and Becker’s Health
Belief Model 389
Healthcare Adherence 389
Illness and Disease 390
Illness Behaviors 391, Effects of Illness 393
CHAPTER 21 Culturally Responsive Nursing Care 397
Introduction 397
Cultural Concepts 397
Health Disparities 399
Demographics 401
Immigration 401
Cultural Models of Nursing Care 402
American Association of Colleges of Nursing Competencies 402,
Cultural Competence 402, HEALTH Traditions Model 403
Providing Culturally Responsive Care 404
Health Beliefs and Practices 404, Family Patterns 405,
Communication Style 406, Space Orientation 408, Time Orientation 409, Nutritional Patterns 409
CHAPTER 22 Complementary and Alternative Healing Modalities 418
Introduction 418
Basic Concepts 419
Holism 419, Humanism 420, Balance 420, Spirituality 420,
Energy 420, Healing Environments 420
Healing Modalities 421
Systematized Healthcare Practices 421, Botanical Healing 422,
Nutritional Therapy 424, Manual Healing Methods 425,
Mind–Body Therapies 426, Spiritual Therapy 429, Miscellaneous Therapies 429
UNIT 6 Lifespan Development 435
CHAPTER 23 Concepts of Growth and Development 436
Introduction 436
Factors Influencing Growth and Development 437
Genetics 437, Temperament 437, Family 438, Nutrition 438,
Environment 438, Health 438, Culture 438
Stages of Growth and Development 438
Growth and Development Theories 438
Biophysical Theory 438, Psychosocial Theories 438, Temperament
Theories 443, Attachment Theory 443, Cognitive Theory 443,
Behaviorist Theory 445, Social Learning Theories 446, Ecologic Systems
Theory 446, Theories of Moral Development 446, Theories of Spiritual Development 449
Applying Growth and Development Concepts to Nursing Practice 449
CHAPTER 24 Promoting Health from Conception Through Adolescence 454
Introduction 454
Conception and Prenatal Development 454
Health Promotion 455
Neonates and Infants (Birth to 1 Year) 456
Physical Development 456, Psychosocial Development 459, Cognitive
Development 459, Moral Development 460, Health Risks 460, Health
Assessment and Promotion 461
Toddlers (1 to 3 Years) 462
Physical Development 462, Psychosocial Development 463,
Cognitive Development 464, Moral Development 464, Spiritual
Development 464, Health Risks 464, Health Assessment and Promotion 465
Preschoolers (4 and 5 Years) 466
Physical Development 466, Psychosocial Development 466,
Cognitive Development 468, Moral Development 468, Spiritual
Development 468, Health Risks 468, Health Assessment and Promotion 468
School-Age Children (6 to 12 Years) 469
Physical Development 469, Psychosocial Development 470,
Cognitive Development 471, Moral Development 471, Spiritual Development
471, Health Risks 471, Health Assessment and Promotion 472
Adolescents (12 to 18 Years) 473
Physical Development 473, Psychosocial Development 473, Cognitive
Development 475, Moral Development 475, Spiritual Development
475, Health Risks 475, Health Assessment and Promotion 477
CHAPTER 25 Promoting Health in Young and Middle-Aged Adults 481
Introduction 481
Young Adults (20 to 40 Years) 482
Physical Development 482, Psychosocial Development 482, Cognitive
Development 483, Moral Development 483, Spiritual Development
483, Health Risks 484, Health Assessment and Promotion 486
Middle-Aged Adults (40 to 65 Years) 487
Physical Development 487, Psychosocial Development 488,
Cognitive Development 489, Moral Development 489, Spiritual
Development 489, Health Risks 489, Health Assessment and Promotion 490
CHAPTER 26 Promoting Health in Older Adults 494
Introduction 494
Characteristics of Older Adults in the United States 494
Demographics 494, Socioeconomic 495, Ethnicity 495, Health 496
Attitudes Toward Aging 496
Ageism 496, Myths and Stereotypes 496
Gerontological Nursing 497
Development 497, Roles 497
Care Settings for Older Adults 497
Acute Care Facilities 497, Long-Term Care Facilities 497,
Hospice 498, Rehabilitation 498, Community 498 Physiologic Aging 498
Integumentary 500, Neuromuscular 500, Sensory-Perceptual 503,
Pulmonary 504, Cardiovascular 505, Gastrointestinal 506,
Urinary 506, Genitals 506, Psychosocial Aging 507, Retirement 507,
Economic Change 508, Grandparenting 508, Relocation 509,
Maintaining Independence and Self-Esteem 509, Facing Death and Grieving 509
Cognitive Abilities and Aging 510
Perception 510, Cognitive Agility 510, Memory 510, Learning 511
Moral Reasoning 511
Spirituality and Aging 511
Health Problems 511
Injuries 511, Chronic Disabling Illness 512, Drug Abuse and Misuse 512,
Alcoholism 512, Dementia 513, Mistreatment of Older Adults 513
Health Assessment and Promotion 514
CHAPTER 27 Promoting Family Health 519
Introduction 519
Family Health 519
Functions of the Family 519, Types of Families in Today’s Society 520
Applying Theoretical Frameworks to Families 522
Systems Theory 522, Structural–Functional Theory 522
UNIT 7 Assessing Health 531
CHAPTER 28 Vital Signs 532
Introduction 532
Body Temperature 533
Regulation of Body Temperature 534, Factors Affecting Body
Temperature
534, Alterations in Body Temperature 535, Assessing
Body Temperature 537
SKILL 28.1 Assessing Body Temperature 540 Pulse 542
Factors Affecting the Pulse 543, Pulse Sites 543, Assessing the Pulse 544
SKILL 28.2 Assessing a Peripheral Pulse 546
Apical Pulse Assessment 548
SKILL 28.3 Assessing an Apical Pulse 548
SKILL 28.4 Assessing an Apical-Radial Pulse 551
Respirations 552 Mechanics and Regulation of Breathing 552, Assessing
Respirations 553, Factors Affecting Respirations 554
SKILL 28.5 Assessing Respirations 555
Blood Pressure 556
Determinants of Blood Pressure 556, Factors Affecting Blood
Pressure 557, Hypertension 557, Hypotension 557, Assessing Blood
Pressure 558, Common Errors in Assessing Blood Pressure 561
SKILL 28.6 Assessing Blood Pressure 561
Factors Affecting Oxygen Saturation Readings 565
SKILL 28.7 Assessing Oxygen Saturation 565
CHAPTER 29 Health Assessment 570
Introduction 571
Physical Health Assessment 571
Preparing the Client 572, Preparing the Environment 573, Positioning
573, Draping 573, Instrumentation 573, Methods of Examining 574
General Survey 577
Appearance and Mental Status 577
SKILL 29.1 Assessing Appearance and Mental Status 577
Vital Signs 579, Height and Weight 579
Integument 579
Skin 580
SKILL 29.2 Assessing the Skin 582
Hair 585
SKILL 29.3 Assessing the Hair 585
Nails 586
SKILL 29.4 Assessing the Nails 587
Head 588
Skull and Face 588
SKILL 29.5 Assessing the Skull and Face 588
Eyes and Vision 589
SKILL 29.6 Assessing the Eye Structures and Visual
Acuity 591
Ears and Hearing 595
SKILL 29.7 Assessing the Ears and Hearing 596
Nose and Sinuses 598
SKILL 29.8 Assessing the Nose and Sinuses 599
Mouth and Oropharynx 600
SKILL 29.9 Assessing the Mouth and Oropharynx 600
Neck 603
Thorax and Lungs 604
Chest Landmarks 604
SKILL 29.10 Assessing the Neck 605
Chest Shape and Size 608, Breath Sounds 610
SKILL 29.11 Assessing the Thorax and Lungs 611
Cardiovascular and Peripheral Vascular Systems 615
Heart 615, Central Vessels 616
SKILL 29.12 Assessing the Heart and Central Vessels 617
Peripheral Vascular System 620
SKILL 29.13 Assessing the Peripheral Vascular System 620
Breasts and Axillae 622
SKILL 29.14 Assessing the Breasts and Axillae 622
Abdomen 625
SKILL 29.15 Assessing the Abdomen 627
Musculoskeletal System 631
SKILL 29.16 Assessing the Musculoskeletal System 631
Neurologic System 633
Mental Status 633, Level of Consciousness 634, Cranial Nerves 634,
Reflexes 634, Motor Function 634 Sensory Function 634
SKILL 29.17 Assessing the Neurologic System 635
Female Genitals and Inguinal Area 642
SKILL 29.18 Assessing the Female Genitals and Inguinal Area 643
Male Genitals and Inguinal Area 645
SKILL 29.19 Assessing the Male Genitals and Inguinal Area 646
Anus 648
SKILL 29.20 Assessing the Anus 648
CHAPTER 30 Pain Assessment and Management 651
Introduction 651
The Nature of Pain 652
Types of Pain 652, Concepts Associated with Pain 653
Physiology of Pain 653
Nociception 654, Pain Management Models and Theories 656,
Responses to Pain 656
Factors Affecting the Pain Experience 657
Ethnic and Cultural Values 657, Developmental Stage 658,
Environment and Support People 659, Previous Pain Experiences 659,
Meaning of Pain 660 Emotional Responses to Pain 660
SKILL 30.1 Providing a Back Massage 680
UNIT 8 Integral Components of Client Care 692
CHAPTER 31 Asepsis and Infection Prevention 693
Introduction 693
Types of Infections 694
Nosocomial and Healthcare-Associated Infections 695
Chain of Infection 696
Etiologic Agent 696, Reservoir 696, Portal of Exit from Reservoir 696,
Method of Transmission 696, Portal of Entry to the Susceptible Host 697,
Susceptible Host 698
Body Defenses Against Infection 698
Nonspecific Defenses 698, Specific Defenses 699
Factors Increasing Susceptibility to Infection 700
Nursing Management 702
SKILL 31.1 Performing Hand Washing 706
SKILL 31.2 Applying and Removing Personal Protective
Equipment (Gloves, Gown, Mask, Eyewear) 712
SKILL 31.3 Establishing and Maintaining a Sterile Field 718
SKILL 31.4 Applying and Removing Sterile Gloves (Open Method) 722
Evaluating 724
CHAPTER 32 Safety 727
Introduction 727
Factors Affecting Safety 727
Age and Development 727, Lifestyle 727, Mobility and Health
Status 728, Sensory–Perceptual Alterations 728, Cognitive Awareness
728, Emotional State 728, Ability to Communicate 728,
Safety Awareness 728, Environmental Factors 728
Nursing Management 730
SKILL 32.1 Using a Bed or Chair Exit Safety Monitoring Device 739
SKILL 32.2 Implementing Seizure Precautions 740
SKILL 32.3 Applying Restraints 750
CHAPTER 33 Hygiene 756
Introduction 756
Hygienic Care 756
Skin 757
Nursing Management 757
SKILL 33.1 Bathing an Adult Client 763
SKILL 33.2 Providing Perineal-Genital Care 768
Feet 771
Developmental Variations 771
Nursing Management 771
SKILL 33.3 Providing Foot Care 773
Nails 775
Nursing Management 775
Mouth 775
Developmental Variations 776
Nursing Management 776
SKILL 33.4 Brushing and Flossing the Teeth 780
SKILL 33.5 Providing Special Oral Care for the Unconscious or Debilitated Client 783
Hair 784
Developmental Variations 785
Nursing Management 785
SKILL 33.6 Providing Hair Care 788
Eyes 789
Nursing Management 790
Ears 791
Cleaning the Ears 791, Care of Hearing Aids 791
SKILL 33.7 Removing, Cleaning, and Inserting a Hearing Aid 793
Nose 794
Supporting a Hygienic Environment 794
Environment 794, Hospital Beds 795, Mattresses 795, Side
Rails 795, Footboard or Footboot 796, Intravenous Rods 796
Making Beds 796
Unoccupied Bed 796
SKILL 33.8 Changing an Unoccupied Bed 797
Changing an Occupied Bed 799
SKILL 33.9 Changing an Occupied Bed 800
CHAPTER 34 Diagnostic Testing 804
Introduction 804
Diagnostic Testing Phases 804
Pretest 805, Intratest 805, Postest 805, Nursing Diagnoses 805
Blood Tests 805
Complete Blood Count 805, Serum Electrolytes 807, Serum Osmolality
807, Drug Monitoring 807, Arterial Blood Gases 808,
Blood Chemistry 808, Metabolic Screening 810, Capillary Blood Glucose 810
SKILL 34.1 Obtaining a Capillary Blood Specimen to Measure
Blood Glucose 812
Specimen Collection and Testing 814
Stool Specimens 814, Urine Specimens 816
SKILL 34.2 Collecting a Urine Specimen for Culture and
Sensitivity by Clean Catch 818
Sputum Specimens 822, Throat Culture 823
Visualization Procedures 823
Clients with Gastrointestinal Alterations 823, Clients with Urinary Alterations
824, Clients with Cardiopulmonary Alterations 824,
Computed Tomography 825, Magnetic Resonance Imaging 825,
Nuclear Imaging Studies 825
Aspiration and Biopsy 826
Lumbar Puncture 826, Abdominal Paracentesis 827, Thoracentesis 828,
Bone Marrow Biopsy 829, Liver Biopsy 830
CHAPTER 35 Medication Administration 836
Introduction 837
Drug Standards 838
Legal Aspects of Drug Administration 838
Effects of Drugs 839
Drug Misuse 840
Actions of Drugs on the Body 841
Pharmacodynamics 841, Pharmacokinetics 841
Factors Affecting Medication Action 842
Developmental Factors 842, Gender 842, Genetic and Cultural Factors
843, Diet 844, Environment 844, Psychologic Factors
844, Illness and Disease 844, Time of Administration 844
Medication Orders 844
Types of Medication Orders 845, Essential Parts of a Medication
Order 846, Communicating a Medication Order 847
Systems of Measurement 848
Metric System 848, Household System 848, Converting Units of
Weight and Measure 848, Methods of Calculating Dosages 849
Routes of Administration 852
Oral 852, Sublingual 852, Buccal 853, Parenteral 853, Topical 854
Routes for Opioid Delivery 854
Oral 854, Transnasal 854, Transdermal 854, Transmucosal 854,
Rectal 854, Subcutaneous 854, Intramuscular 855, Intravenous 855,
Intraspinal 855, Continuous Local Anesthetics 856
Administering Medications Safely 856
Medication Administration Errors 857, Medication Reconciliation 858,
Medication Dispensing Systems 859, Process of Administering
Medications 860, Developmental Considerations 862
Oral Medications 863
SKILL 35.1 Administering Oral Medications 864
Nasogastric and Gastrostomy Medications 868
Parenteral Medications 869
Equipment 869, Preparing Injectable Medications 875
SKILL 35.2 Preparing Medications from Ampules 877
SKILL 35.3 Preparing Medications from Vials 878
SKILL 35.4 Mixing Medications Using One Syringe 880
Intradermal Injections 881
SKILL 35.5 Administering an Intradermal Injection for Skin Tests 882
Subcutaneous Injections 883
SKILL 35.6 Administering a Subcutaneous Injection 884
Intramuscular Injections 886
SKILL 35.7 Administering an Intramuscular Injection 891
Intravenous Medications 893
SKILL 35.8 Administering Intravenous Medications Using IV Push 896
Topical Medications 898
SKILL 35.9 Administering Ophthalmic Instillations 900
SKILL 35.10 Administering Otic Instillations 902
SKILL 35.11 Administering Vaginal Instillations 905
Inhaled Medications 908
Irrigations 911
CHAPTER 36 Skin Integrity and Wound Care 915
Introduction 915
Skin Integrity 915
Types of Wounds 916
Pressure Injuries 916
Etiology of Pressure Injuries 917, Risk Factors 917, Stages of Pressure
Injuries 918, Risk Assessment Tools 918
Wound Healing 923
Types of Wound Healing 923, Phases of Wound Healing 923,
Types of Wound Exudate 924, Complications of Wound
Healing 924, Factors Affecting Wound Healing 925
Nursing Management 925
SKILL 36.1 Cleaning a Sutured Wound and Dressing a Wound with a Drain 934
SKILL 36.2 Irrigating a Wound 936
SKILL 36.3 Obtaining a Wound Drainage Specimen for Culture 941
CHAPTER 37 Perioperative Nursing 957
Introduction 957
Types of Surgery 958
Purpose 958, Degree of Urgency 958, Degree of Risk 958
Preoperative Phase 960
Preoperative Consent 960
Nursing Management 960
SKILL 37.1 Teaching Moving, Leg Exercises, Deep Breathing, and Coughing 963
SKILL 37.2 Applying Antiemboli Stockings 969
Intraoperative Phase 971
Types of Anesthesia 971
Nursing Management 972
Postoperative Phase 974
Immediate Postanesthetic Phase 975, Preparing for Ongoing Care of
the Postoperative Client 976
Nursing Management 976
SKILL 37.3 Managing Gastrointestinal Suction 984
UNIT 9 Promoting Psychosocial Health 991
CHAPTER 38 Sensory Perception 992
Introduction 992
Components of the Sensory Experience 992
Arousal Mechanism 993
Factors Affecting Sensory Function 993
Developmental Stage 993, Culture 994, Stress 994, Medications and
Illness 994, Lifestyle and Personality 994
Sensory Alterations 994
Sensory Deprivation 995, Sensory Overload 995, Sensory Deficits 995
Nursing Management 995
CHAPTER 39 Self-Concept 1012
Introduction 1012
Self-Concept 1012
Formation of Self-Concept 1013
Components of Self-Concept 1014
Personal Identity 1014, Body Image 1014, Role
Performance 1016, Self-Esteem 1016
Factors That Affect Self-Concept 1016
Stage of Development 1016, Family and Culture 1016, Stressors 1017,
Resources 1017, History of Success and Failure 1017, Illness 1017
Nursing Management 1017
CHAPTER 40 Sexuality 1025
Introduction 1025
Development of Sexuality 1025
Birth to 12 Years 1025, Adolescence 1027, Young and Middle
Adulthood 1028, Older Adulthood 1028
Sexual Health 1029
Components of Sexual Health 1030
Sexual Expression 1030
Sexual Orientation 1030, Gender Identity 1031, Sexual Practices 1032
Factors Influencing Sexuality 1032
Family 1032, Culture 1033, Religion 1033, Personal Expectations and Ethics 1033
Sexual Response Cycle 1034
Altered Sexual Function 1035
Past and Current Factors 1035, Sexual Desire Disorders 1036, Sexual
Arousal Disorders 1036, Orgasmic Disorders 1037, Sexual Pain
Disorders 1037, Problems with Satisfaction 1038
Nursing Management 1038
CHAPTER 41 Spirituality 1047
Introduction 1047
Spirituality and Related Concepts Described 1047
Spiritual Care or Spiritual Nursing Care? 1048, Spiritual Needs, Spiritual
Disruption, Spiritual Health, and Religious Coping 1048
Spiritual Development 1049
Spiritual Health and the Nursing Process 1050
Nursing Management 1050
Religious Practices That Nurses Should Know 1057
Holy Days 1058, Sacred Texts 1058, Sacred Symbols 1058, Prayer
and Meditation 1058, Beliefs Affecting Diet 1059, Beliefs About Illness
and Healing 1059, Beliefs About Dress and Modesty
1059, Beliefs Related to Birth 1060, Beliefs Related to Death 1060
Spiritual Self-Awareness for the Nurse 1061
CHAPTER 42 Stress and Coping 1067
Introduction 1067
Concept of Stress 1067
Sources of Stress 1067, Effects of Stress 1067
Models of Stress 1068
Stimulus-Based Models 1068, Response-Based Models 1068,
Transaction-Based Models 1069
Indicators of Stress 1070
Physiologic Indicators 1071, Psychologic Indicators 1071, Cognitive
Indicators 1072
Coping 1074
Nursing Management 1075
CHAPTER 43 Loss, Grieving, and Death 1085
Introduction 1085
Loss and Grief 1085
Types and Sources of Loss 1085, Grief, Bereavement, and
Mourning 1086, Stages of Grieving 1087, Manifestations of
Grief 1088, Factors Influencing the Loss and Grief Responses 1088
Nursing Management 1091
Dying and Death 1092
Responses to Dying and Death 1092, Definitions of Death 1094,
Death-Related Religious and Cultural Practices 1094,
Death-Related Legal Issues 1095
Nursing Management 1096
UNIT 10 Promoting Physiologic Health 1107
CHAPTER 44 Activity and Exercise 1108
Introduction 1108
Normal Movement 1109
Alignment and Posture 1109, Joint Mobility 1110,
Balance 1110, Coordinated Movement 1110
Factors Affecting Body Alignment and Activity 1110
Growth and Development 1110, Nutrition 1115, Personal Values
and Attitudes 1115, External Factors 1115, Prescribed Limitations 1115
Exercise 1115
Types of Exercise 1116, Benefits of Exercise 1117
Effects of Immobility 1119
Musculoskeletal System 1119, Cardiovascular System 1119,
Respiratory System 1120, Metabolism 1121, Urinary System 1121,
Gastrointestinal System 1122, Integumentary System 1122,
Psychoneurologic System 1122
Nursing Management 1123
SKILL 44.1 Moving a Client Up in Bed 1138
SKILL 44.2 Turning a Client to the Lateral or Prone Position in Bed 1139
SKILL 44.3 Logrolling a Client 1140
SKILL 44.4 Assisting a Client to Sit on the Side of the Bed (Dangling) 1141
SKILL 44.5 Transferring Between Bed and Chair 1144
SKILL 44.6 Transferring Between Bed and Stretcher 1146
SKILL 44.7 Assisting a Client to Ambulate 1151
CHAPTER 45 Sleep 1165
Introduction 1165
Physiology of Sleep 1165
Circadian Rhythms 1166, Types of Sleep 1167, Sleep Cycles 1167
Functions of Sleep 1168
Normal Sleep Patterns and Requirements 1168
Newborns 1168, Infants 1168, Toddlers 1168,
Preschoolers 1168, School-Age Children 1169, Adolescents 1169, Older Adults 1170
Factors Affecting Sleep 1170
Illness 1170, Environment 1171, Lifestyle 1172, Emotional
Stress 1172, Stimulants and Alcohol 1172, Diet 1172,
Smoking 1172, Motivation 1172, Medications 1172
Common Sleep Disorders 1173
Insomnia 1173, Excessive Daytime
Sleepiness 1174, Parasomnias 1175
Nursing Management 1176
CHAPTER 46 Nutrition 1187
Introduction 1187
Essential Nutrients 1187
Carbohydrates 1188, Proteins 1188, Lipids 1189,
Micronutrients 1190
Energy Balance 1191
Energy Intake 1191, Energy Output 1191
Body Weight and Body Mass Standards 1191
Factors Affecting Nutrition 1192
Development 1192, Sex 1192, Ethnicity and Culture 1192,
Beliefs About Food 1192, Personal Preferences 1193, Religious
Practices 1193, Lifestyle 1193, Economics 1193, Medications and
Therapy 1193, Health 1193, Alcohol Consumption 1194,
Advertising 1195, Psychologic Factors 1195
Nutritional Variations Throughout the Lifecycle 1195
Neonate to 1 Year 1195, Toddler 1196, Preschooler 1196,
School-Age Child 1196, Adolescent 1197, Young Adult 1197,
Middle-Aged Adult 1198, Older Adults 1198
Standards for a Healthy Diet 1200
Dietary Guidelines for Americans 1200, Recommended Dietary
Intake 1201, Vegetarian Diets 1202
Altered Nutrition 1202
Nursing Management 1203
SKILL 46.1 Inserting a Nasogastric Tube 1214
SKILL 46.2 Administering a Tube Feeding 1220
SKILL 46.3 Administering an Intermittent Gastrostomy or Jejunostomy Feeding 1223
SKILL 46.4 Removing a Nasogastric Tube 1226
CHAPTER 47 Urinary Elimination 1234
Introduction 1234
Physiology of Urinary Elimination 1234
Kidneys 1234, Ureters 1235, Bladder 1235, Urethra 1235, Pelvic
Floor 1235, Urination 1236
Factors Affecting Voiding 1237
Developmental Factors 1237, Psychosocial Factors 1237, Fluid and
Food Intake 1238, Medications 1238, Muscle Tone 1238, Pathologic
Conditions 1238, Surgical and Diagnostic Procedures 1238
Altered Urine Production 1238
Polyuria 1238, Oliguria and Anuria 1239
Altered Urinary Elimination 1239
Frequency and Nocturia 1239, Urgency 1239, Dysuria 1240,
Enuresis 1240, Urinary Incontinence 1240, Urinary Retention 1240
Nursing Management 1241
SKILL 47.1 Applying an External Urinary Device 1248
SKILL 47.2 Performing Indwelling Urinary
Catheterization 1253
SKILL 47.3 Performing Bladder Irrigation 1260
CHAPTER 48 Fecal Elimination 1271
Introduction 1271
Physiology of Defecation 1271
Large Intestine 1271, Rectum and Anal Canal 1272,
Defecation 1272, Feces 1273
Factors That Affect Defecation 1273
Development 1273, Diet 1273, Activity 1274, Psychologic
Factors 1274, Defecation Habits 1274, Medications 1275,
Diagnostic Procedures 1275, Anesthesia and Surgery 1275,
Pathologic Conditions 1275, Pain 1275
Fecal Elimination Problems 1275
Constipation 1275, Diarrhea 1277, Bowel Incontinence 1277,
Flatulence 1278
Nursing Management 1279
SKILL 48.1 Administering an Enema 1286
Bowel Diversion Ostomies 1290
Permanence 1290, Anatomic Location 1290, Surgical Construction of
the Stoma 1291, Ostomy Management 1292
SKILL 48.2 Changing a Bowel Diversion Ostomy Appliance 1294
CHAPTER 49 Oxygenation 1303
Introduction 1303
Structure and Processes of the Respiratory System 1304
Structure of the Respiratory System 1304, Pulmonary Ventilation 1305,
Alveolar Gas Exchange 1307, Transport of Oxygen and Carbon
Dioxide 1307, Systemic Diffusion 1307
Respiratory Regulation 1307
Factors Affecting Respiratory Function 1307
Age 1308, Environment 1308, Lifestyle 1308, Health Status 1308,
Medications 1308, Stress 1308
Alterations in Respiratory Function 1308
Conditions Affecting the Airway 1308, Conditions Affecting Movement
of Air 1309, Conditions Affecting Diffusion 1309, Conditions Affecting Transport 1309
Nursing Management 1309
SKILL 49.1 Administering Oxygen by Cannula, Face Mask, or Face Tent 1320
SKILL 49.2 Oral, Oropharyngeal, Nasopharyngeal, and Nasotracheal Suctioning 1330
SKILL 49.3 Suctioning a Tracheostomy or Endotracheal Tube 1334
SKILL 49.4 Providing Tracheostomy Care 1337
CHAPTER 50 Circulation 1349
Introduction 1349
Physiology of the Cardiovascular System 1349
The Heart 1349, Blood Vessels 1352, Blood 1353
Lifespan Considerations 1354
Factors Affecting Cardiovascular Function 1354
Risk Factors 1354
Alterations in Cardiovascular Function 1357
Decreased Cardiac Output 1357, Impaired Tissue Perfusion 1358,
Blood Alterations 1359
Nursing Management 1359
SKILL 50.1 Applying Sequential Compression Devices 1364
CHAPTER 51 Fluid, Electrolyte, and Acid–Base Balance 1369
Introduction 1369
Body Fluids and Electrolytes 1370
Distribution of Body Fluids 1370, Composition of Body Fluid 1370,
Movement of Body Fluids and Electrolytes 1371,
Regulating Body Fluids 1372, Regulating Electrolytes 1374
Acid–Base Balance 1376
Regulation of Acid–Base Balance 1376
Factors Affecting Body Fluid, Electrolytes, and Acid–Base Balance 1377
Age 1377, Sex and Body Size 1378, Environmental
Temperature 1378, Lifestyle 1378
Disturbances in Fluid Volume, Electrolyte, and Acid–Base Balances 1379
Fluid Imbalances 1379, Electrolyte Imbalances 1380, Acid–Base
Imbalances 1385
Nursing Management 1386
SKILL 51.1 Starting an Intravenous Infusion and Inserting a Short Peripheral Catheter 1405
SKILL 51.2 Monitoring an Intravenous Infusion 1413
SKILL 51.3 Changing an Intravenous Container and Tubing 1415
SKILL 51.4 Discontinuing an Intravenous Infusion and Removing a Short Peripheral Catheter 1416
SKILL 51.5 Changing a Short Peripheral Catheter to an Intermittent Infusion Device 1418
SKILL 51.6 Initiating, Maintaining, and Terminating a Blood Transfusion Using a Y-Set 1424
APPENDIX A Answers to Test Your Knowledge 1433
GLOSSARY 1467
INDEX 1493