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Medical-Surgical Nursing
Demystified
Demystified Series
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DOI: 10.1036/0071494502
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To the memory of Jim, Rose, and Margot
who always believed in me
To Dave
Who means more than he sometimes knows
To Kathleen and Jacqueline
who have the world in front of them
Mary DiGiulio, RN, MSN
To Ken
Thank you for loving me, believing in me, encouraging me, and running the race

Atrial Fibrillation 53
Asystole 56
For more information about this title, click here
viii
Medical-Surgical Nursing Demystified
Ventricular Fibrillation 58
Ventricular Tachycardia 59
Aortic Insufficiency (AI) 62
Mitral Insufficiency 63
Mitral Stenosis 65
Mitral Valve Prolapse 67
Tricuspid Insufficiency 69
Crucial Diagnostic Tests 71
Quiz 82
CHAPTER 2 Respiratory System 85
How the Respiratory System Works 86
Just the Facts 87
Acute Respiratory Distress Syndrome (ARDS) 87
Asbestosis 91
Asthma 93
Atelectasis 96
Bronchiectasis 99
Bronchitis 101
Cor Pulmonale 104
Emphysema 107
Lung Cancer 110
Pleural Effusion 113
Pneumonia 115
Pneumothorax 118
Respiratory Acidosis 120

Disseminated Intravascular Coagulation (DIC) 185
Hemophilia 187
Leukemia 189
Multiple Myeloma 192
Polycythemia Vera 194
Sickle Cell Anemia 197
Deep Vein Thrombosis (DVT) 199
Idiopathic Thrombocytopenic Purpura (ITP) 201
Crucial Diagnostic Tests 203
Quiz 206
CHAPTER 5 Nervous System 209
How the Nervous System Works 210
Just the Facts 212
Head Injury 212
Amyotrophic Lateral Sclerosis (ALS) 216
Bell’s Palsy 218
Brain Abscess 219
Brain Tumor 222
Cerebral Aneurysm 225
ix
Contents
Encephalitis 227
Guillain-Barré Syndrome 230
Huntington’s Disease (Chorea) 232
Meningitis 234
Multiple Sclerosis (MS) 237
Myasthenia Gravis 240
Parkinson’s Disease 243
Spinal Cord Injury 246
Stroke 249

Intestinal Obstruction and Paralytic Ileus 313
Pancreatitis 315
Peritonitis 317
Peptic Ulcer Disease (PUD) 319
Ulcerative Colitis 322
Crucial Diagnostic Tests 324
Quiz 329
CHAPTER 8 Endocrine System 331
How the Endocrine System Works 332
Just the Facts 333
Hypothyroidism (Myxedema) 333
Hyperthyroidism (Graves’ Disease) 335
Simple Goiter 338
Hypopituitarism 340
Hyperpituitarism (Acromegaly and Gigantism) 341
Hyperprolactinemia 343
Diabetes Insipidus 345
Syndrome of Inappropriate Antidiuretic Hormone
Secretion (SIADH) 346
Addison’s Disease 348
Cushing’s Syndrome 349
Primary Aldosteronism (Conn’s Syndrome) 351
Pheochromocytoma 353
Hypoparathyroidism 354
Hyperparathyroidism 356
Diabetes Mellitus 358
Metabolic Syndrome (Syndrome X/Dysmetabolic
Syndrome) 363
Crucial Diagnostic Tests 365
Quiz 370

Just the Facts 422
Hyponatremia 422
Hypernatremia 424
Hypocalcemia 426
Hypercalcemia 428
Hypokalemia 430
Hyperkalemia 432
Hypomagnesemia 434
Hypermagnesemia 436
Metabolic Acidosis 438
Metabolic Alkalosis 440
Hypophosphatemia 441
Hyperphosphatemia 443
Dehydration 444
Crucial Diagnostic Tests 446
Quiz 448
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Medical-Surgical Nursing Demystified
CHAPTER 12 Mental Health 451
A Look at Mental Health 452
Just the Facts 453
Anxiety 453
Panic Disorder 456
Depression 458
Bipolar Disorder 461
Schizophrenia 463
Anorexia Nervosa 465
Bulimia Nervosa 467
Delirium 469
Quiz 471

Labor & Delivery 522
Postpartum 524
Rh Incompatibility 526
Preeclampsia and Eclampsia 527
Crucial Diagnostic Tests 529
Quiz 531
CHAPTER 15 Pain Management 535
Pain 536
Just the Facts 537
Acute Pain 537
Chronic Pain 540
Peripheral Neuropathy 542
Phantom Limb Pain 544
Substance Use Disorders 545
Drug Addiction 550
Crucial Diagnostic Test 553
Quiz 553
Final Exam 557
Answers to Quiz and Exam Questions 577
Glossary 581
Index 589
xiv
Medical-Surgical Nursing Demystified
INTRODUCTION
Every patient knows to seek medical help when his or her aches and pains become
too much to bear, but how does the healthcare provider determine what is wrong and
what to do to restore the patient to good health? The answer depends on the patient’s
signs and symptoms and the results from medical tests. In this book you will learn
to identify these signs and symptoms, interpret the medical test results, and perform
the nursing interventions that will assist in solving or alleviating the patient’s med-

products to various organs for removal from the body. Failure of the cardiovascular
system has a compound effect because it interacts with the body’s other systems
causing a chain reaction of events. Healthcare providers need a thorough under-
standing of what can go wrong with the cardiovascular system; in this chapter you will
earn to recognize cardiovascular system disorders and to perform the interventions
that can assist in restoring its function.
CHAPTER 2 RESPIRATORY SYSTEM
The respiratory system interacts with cells in the body to exchange oxygen and car-
bon dioxide, enabling the oxygenation of all cells in the body. In this chapter you
will learn which diseases and disorders can disrupt the respiratory system, how to
recognize these conditions, and what steps you can take to assist in curing the res-
piratory system problems.
CHAPTER 3 IMMUNE SYSTEM
Remember the last time you experienced a bad cut. The site of the injury became
swollen and red and you might have felt feverish. This happened because your
immune system was trying to heal the wound by attacking the microorganisms that
were invading your body. However, the abilities to fight off disease and to heal a
wound are compromised when the immune system malfunctions. In this chapter you
will learn about immune system disorders and what actions the nurse can perform to
assist in the patient’s recovery,
CHAPTER 4 HEMATOLOGIC SYSTEM
The hematologic system produces and circulates blood cells throughout the body. Any
disorder of this system jeopardizes the functioning of every organ in the body. This
xvi
Medical-Surgical Nursing Demystified
chapter explores the hematologic system and its common disorders and discusses how
to care for patients who experience them.
CHAPTER 5 NERVOUS SYSTEM
The nervous system is the body’s command center that receives impulses and sends
an appropriate response. In this chapter you will learn about the disorders that cause

Fluids and electrolytes must be in balance for the body to properly function. An
imbalance causes the body to compensate in ways that can have a rippling effect
throughout other systems. In this chapter you will learn about fluids and electrolyte
disorders and how to intervene to restore their balance.
CHAPTER 12 MENTAL HEALTH
Disorders that affect the mind can interfere with daily activities and lead to self-
destructive behaviors. In this chapter, you will learn about mental health disorders, how to
recognize them, and steps that can be taken to minimize their influence on the patient.
CHAPTER 13 PERIOPERATIVE
Surgical intervention is a radical but, at times, necessary treatment for a patient’s
condition. However, surgery can expose the patient to a set of disorders that would
otherwise be avoided if no surgery had occurred. You will learn about these dis-
orders and how to handle them in this chapter.
CHAPTER 14 WOMEN’S HEALTH
The women’s health chapter covers a multitude of conditions that affect women.
Here you will learn how to recognize these conditions, the medication used to treat
them, and the interventions that can mitigate their ill effects on the patient.
CHAPTER 15 PAIN MANAGEMENT
Pain is associated with many disorders and must be successfully managed to re-
duce its disruptive affect on the patient’s well-being. You will learn the techniques
for managing pain in this chapter.
xviii
Medical-Surgical Nursing Demystified
ABOUT THE AUTHORS
Mary DiGiulio is an Adult Nurse Practitioner on the faculty in the School of Nursing at
UMDNJ in Newark, NJ and in practice in Teaneck, NJ. She has taught nursing at the
graduate, baccalaureate and pre-licensure levels and presented for RN and PN review
courses and nurse refresher courses.
Donna Jackson is an Adult Nurse Practitioner currently in practice in Teaneck, NJ. She
is on the Advisory Board of the nursing program at Saint Peter’s College in Jersey City,

Left Atrium
Pulmonary Vein
Mitral Valve
Papillary Muscle
Left Ventricle
Copyright © 2007 by The McGraw-Hill Companies, Inc. Click here for terms of use.
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Medical-Surgical Nursing Demystified
Learning Objectives
Key Terms
Aneurysm
Angina
Aortic valve
Atherosclerosis
Atria
Atrioventricular (AV) valves
Cholesterol
Diastolic
Embolism
Infarction
Ischemia
Mitral valve
Necrosis
Occlusion
Pericardium
Pulmonic valve
Septal wall
Stenosis
Systolic
Tamponade

Mitral valve prolapse (MVP)
Tricuspid insufficiency
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which is located in the right atrium. It initiates the heart beat, ranging between 60
to 100 beats per minute, every day, for a lifetime. The electrical current travels
across both atria, then converges on the atrio-ventricular (AV) node, where the cur-
rent slows, allowing the atria to repolarize. The AV node is located in the superior
portion of the ventricular septum. In the bottom portion are located the right and left
Bundle of His, which is a group of special cardiac muscles that sends an electrical
impulse to the ventricle to begin cardiac contractions. These end in the Purkinje
fibers and spread out through the ventricles. The current passing through these
fibers causes ventricular contraction, forcing the blood from the right ventricle to
the lungs and from the left ventricle to the aorta, and thus, the systemic circulation.