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Contents
Unit
1
Basic Concepts in Nursing Practice 2
1
Health Care Delivery
and Nursing Practice 4
THE HEALTH CARE INDUSTRY AND
THE NURSING PROFESSION 5
Nursing Defined 5
The Patient/Client: Consumer of Nursing and Health Care 5
Health Care in Transition 6
HEALTH, WELLNESS, AND HEALTH PROMOTION 6
Health 6
Wellness 6
Health Promotion 6
INFLUENCES ON HEALTH CARE DELIVERY 6
Population Demographics 7
Changing Patterns of Disease 7
Advances in Technology and Genetics 8
Economic Changes 8
Demand for Quality Care 8
Alternative Health Care Delivery Systems 9
ROLES OF THE NURSE 14
Practitioner Role 14
Leadership Role 15
Research Role 15
MODELS OF NURSING CARE DELIVERY 15
Team Nursing 15

Rationality and Insight 27
Components of Critical Thinking 27
Critical Thinking in Nursing Practice 27
ETHICAL NURSING CARE 28
DOMAIN OF NURSING ETHICS 28
Ethics Versus Morality 28
Ethics Theories 29
Approaches to Ethics 29
Moral Situations 30
Types of Ethical Problems in Nursing 30
PREVENTIVE ETHICS 33
Advance Directives 33
ETHICAL DECISION MAKING 34
STEPS OF THE NURSING PROCESS 34
USING THE NURSING PROCESS 34
Assessment 34
Diagnosis 37
Planning 37
Implementation 40
Evaluation 40
Documentation of Outcomes and Revision of Plan 41
4
Health Education
and Health Promotion 45
HEALTH EDUCATION TODAY 46
The Purpose of Health Education 46
ADHERENCE TO THE THERAPEUTIC REGIMEN 46
THE NATURE OF TEACHING AND LEARNING 47
Learning Readiness 47
The Learning Environment 48

Education and Occupation 63
Environment 63
Lifestyle 65
Physical or Mental Disability 65
Self-Concept 65
Sexuality 65
Risk for Abuse 66
Stress and Coping Responses 66
Other Health History Formats 66
PHYSICAL ASSESSMENT 67
Inspection 67
Palpation 68
Percussion 68
Auscultation 69
NUTRITIONAL ASSESSMENT 69
Body Mass Index 70
Biochemical Assessment 71
Clinical Examination 71
Dietary Data 71
Conducting the Dietary Interview 71
Evaluating the Dietary Information 72
Factors Influencing Nutritional Status in Varied Situations 72
Analysis of Nutritional Status 74
ASSESSMENT IN THE HOME AND COMMUNITY 74
Unit 2
Biophysical and Psychosocial
Concepts in Nursing Practice 78
6
Homeostasis, Stress, and Adaptation 80
STRESS AND FUNCTION 81

THE BRAIN AND PHYSICAL
AND EMOTIONAL HEALTH 100
EMOTIONAL HEALTH AND EMOTIONAL DISTRESS 101
FAMILY HEALTH AND DISTRESS 102
ANXIETY 103
POSTTRAUMATIC STRESS DISORDER 104
DEPRESSION 105
SUBSTANCE ABUSE 107
LOSS AND GRIEF 108
DEATH AND DYING 109
SPIRITUALITY AND SPIRITUAL DISTRESS 109
8
Perspectives in Transcultural Nursing 113
DEFINITIONS OF CULTURE 114
Subcultures and Minorities 114
TRANSCULTURAL NURSING 115
CULTURALLY COMPETENT NURSING CARE 115
Cross-Cultural Communication 115
CULTURALLY MEDIATED CHARACTERISTICS 116
Space and Distance 116
Eye Contact 117
Time 117
Touch 117
Communication 118
Observance of Holidays 118
Diet 118
Biologic Variations 119
Complementary and Alternative Therapies 119
CAUSES OF ILLNESS 119
Biomedical or Scientific 119

Prevalence and Causes of Chronic Conditions 147
THE CHARACTERISTICS OF CHRONIC CONDITIONS 149
The Problems of Managing Chronic Conditions 150
Implications for Nursing 151
Phases of Chronic Illness 151
Care by Phase: Applying the Nursing Process 152
PROMOTING HOME AND COMMUNITY-BASED CARE 155
Teaching Patients Self-Care 155
Continuing Care 155
Nursing Care for Special Populations With Chronic Illness 155
11
Principles and Practices
of Rehabilitation 158
AMERICANS WITH DISABILITIES ACT 159
RIGHT TO ACCESS TO HEALTH CARE
AND HEALTH PROMOTION 160
FOCUS OF REHABILITATION 160
THE REHABILITATION TEAM 161
AREAS OF SPECIALTY PRACTICE 162
ASSESSMENT OF FUNCTIONAL ABILITIES 163
Nursing Process: The Patient With Self-Care Deficit
in Activities of Daily Living 163
Nursing Process: The Patient With Impaired Physical Mobility 165
Nursing Process: The Patient With Impaired Skin Integrity 175
Nursing Process: The Patient With Altered Elimination Patterns 181
DISABILITY AND SEXUALITY ISSUES 183
FATIGUE 183
HOME AND COMMUNITY-BASED CARE 183
COMPLEMENTARY THERAPIES 184
CONTINUING CARE 184

Altered Systemic Response 211
Unit
3
Concepts and Challenges
in Patient Management 214
13
Pain Management 216
THE FIFTH VITAL SIGN 217
TYPES OF PAIN 217
Acute Pain 218
Chronic (Nonmalignant) Pain 218
Cancer-Related Pain 218
Pain Classified by Location 218
Pain Classified by Etiology 218
HARMFUL EFFECTS OF PAIN 218
Effects of Acute Pain 218
Effects of Chronic Pain 218
PATHOPHYSIOLOGY OF PAIN 220
Pain Transmission 220
Factors Influencing the Pain Response 223
NURSING ASSESSMENT OF PAIN 226
Characteristics of Pain 226
Instruments for Assessing the Perception of Pain 228
Nurse’s Role in Pain Management 230
PAIN MANAGEMENT STRATEGIES 232
Pharmacologic Interventions 232
Routes of Administration 237
Nonpharmacologic Interventions 240
NEUROLOGIC AND NEUROSURGICAL APPROACHES
TO PAIN MANAGEMENT 241

Significance of Magnesium 273
Magnesium Deficit (Hypomagnesemia) 273
Magnesium Excess (Hypermagnesemia) 274
Significance of Phosphorus 275
Phosphorus Deficit (Hypophosphatemia) 275
Phosphorus Excess (Hyperphosphatemia) 276
Significance of Chloride 277
Chloride Deficit (Hypochloremia) 277
Chloride Excess (Hyperchloremia) 277
ACID–BASE DISTURBANCES 278
Buffer Systems 278
Acute and Chronic Metabolic Acidosis
(Base Bicarbonate Deficit) 278
Acute and Chronic Metabolic Alkalosis
(Base Bicarbonate Excess) 279
Acute and Chronic Respiratory Acidosis
(Carbonic Acid Excess) 280
Acute and Chronic Respiratory Alkalosis
(Carbonic Acid Deficit) 281
Mixed Acid–Base Disorders 281
Compensation 281
Blood Gas Analysis 281
PARENTERAL FLUID THERAPY 282
Purpose 282
Types of IV Solutions 282
15
Shock and Multisystem Failure 295
SIGNIFICANCE OF SHOCK 296
CONDITIONS PRECIPITATING SHOCK 296
Classification of Shock 296

DIAGNOSIS OF CANCER AND RELATED
NURSING CONSIDERATIONS 323
Tumor Staging and Grading 323
MANAGEMENT OF CANCER 325
Surgery 325
Radiation Therapy 328
Chemotherapy 329
Bone Marrow Transplantation 343
Hyperthermia 345
Biologic Response Modifiers 345
Photodynamic Therapy 349
Gene Therapy 349
Unproven and Unconventional Therapies 349
Nursing Process: The Patient With Cancer 350
CANCER REHABILITATION 358
CARE OF THE PATIENT
WITH ADVANCED CANCER 360
Hospice 361
ONCOLOGIC EMERGENCIES 361
17
End-of-Life Care 369
NURSING AND END-OF-LIFE CARE 370
The Context for Death and Dying in America 370
Technology and End-of-Life Care 370
Sociocultural Context 371
SETTINGS FOR END-OF-LIFE CARE: PALLIATIVE
CARE PROGRAMS AND HOSPICE 373
Palliative Care 373
Hospice Care 374
NURSING CARE OF THE TERMINALLY ILL PATIENT 375

Informed Consent 402
Assessment of Health Factors That Affect
Patients Preoperatively 403
SPECIAL CONSIDERATIONS 407
The Ambulatory Surgery Patient 408
Elderly Patients 408
Obese Patients 408
Patients With Disabilities 408
Patients Undergoing Emergency Surgery 409
PREOPERATIVE NURSING INTERVENTIONS 409
Preoperative Teaching 409
Preoperative Psychosocial Interventions 412
General Preoperative Nursing Interventions 412
Immediate Preoperative Nursing Interventions 412
Nursing Process: Care of the Patient
in the Preoperative Period 414
19
Intraoperative Nursing Management 417
THE SURGICAL TEAM 418
The Patient 418
The Circulating Nurse 419
The Scrub Role 419
The Surgeon 419
The Registered Nurse First Assistant 419
The Anesthesiologist and Anesthetist 420
THE SURGICAL ENVIRONMENT 420
Principles of Surgical Asepsis 421
Health Hazards Associated
With the Surgical Environment 422
THE SURGICAL EXPERIENCE 423

Function of the Respiratory System 466
ASSESSMENT 471
Health History 471
Physical Assessment of the Upper Respiratory Structures 475
Physical Assessment of the Lower Respiratory Structures
and Breathing 476
Physical Assessment of Breathing Ability
in the Acutely Ill Patient 482
DIAGNOSTIC EVALUATION 483
Pulmonary Function Tests 483
Arterial Blood Gas Studies 484
Pulse Oximetry 484
Cultures 485
Sputum Studies 485
Imaging Studies 485
Endoscopic Procedures 486
Thoracentesis 488
Biopsy 488
22
Management of Patients With
Upper Respiratory Tract Disorders 494
UPPER AIRWAY INFECTIONS 495
Rhinitis 495
Viral Rhinitis (Common Cold) 496
Acute Sinusitis 497
Chronic Sinusitis 499
Acute Pharyngitis 500
Chronic Pharyngitis 501
Tonsillitis and Adenoiditis 501
Peritonsillar Abscess 502

ACUTE RESPIRATORY DISTRESS SYNDROME 546
PULMONARY HYPERTENSION 548
PULMONARY HEART DISEASE (COR PULMONALE) 549
PULMONARY EMBOLISM 550
SARCOIDOSIS 554
OCCUPATIONAL LUNG DISEASES: PNEUMOCONIOSES 554
Silicosis 555
Asbestosis 555
Coal Workers’ Pneumoconiosis 555
CHEST TUMORS 556
Lung Cancer (Bronchogenic Carcinoma) 556
Tumors of the Mediastinum 559
CHEST TRAUMA 559
Blunt Trauma 560
Penetrating Trauma: Gunshot and Stab Wounds 562
Pneumothorax 563
Cardiac Tamponade 564
Subcutaneous Emphysema 565
ASPIRATION 565
24
Management of Patients With Chronic
Obstructive Pulmonary Disorders 570
CHRONIC OBSTRUCTIVE PULMONARY DISEASE 571
Nursing Process: The Patient With COPD 580
BRONCHIECTASIS 583
ASTHMA 589
Status Asthmaticus 597
CYSTIC FIBROSIS 597
25
Respiratory Care Modalities 601

Anatomy of the Heart 647
Function of the Heart: Conduction System 649
Gender Differences in Cardiac Structure and Function 653
ASSESSMENT 653
Health History and Clinical Manifestations 654
Physical Assessment 661
DIAGNOSTIC EVALUATION 668
Laboratory Tests 668
Chest X-ray and Fluoroscopy 670
Electrocardiography 670
Cardiac Stress Testing 671
Echocardiography 672
Radionuclide Imaging 673
Cardiac Catheterization 675
Angiography 675
Electrophysiologic Testing 676
Hemodynamic Monitoring 677
27
Management of Patients
With Dysrhythmias and
Conduction Problems 682
DYSRHYTHMIAS 683
Normal Electrical Conduction 683
Interpretation of the Electrocardiogram 684
Analyzing the Electrocardiogram Rhythm Strip 687
Nursing Process: The Patient With a Dysrhythmia 698
ADJUNCTIVE MODALITIES AND MANAGEMENT 699
Pacemaker Therapy 700
Nursing Process: The Patient With a Pacemaker 703
Cardioversion and Defibrillation 705

VALVE REPAIR AND REPLACEMENT PROCEDURES 768
Valvuloplasty 768
Valve Replacement 770
Valvuloplasty and Replacement: Nursing Management 772
SEPTAL REPAIR 772
CARDIOMYOPATHIES 772
Nursing Process: The Patient With Cardiomyopathy 776
CARDIAC TUMOR AND TRAUMA SURGERY 778
Tumor Excision 778
Trauma Repair 778
INFECTIOUS DISEASES OF THE HEART 778
Rheumatic Endocarditis 778
Infective Endocarditis 780
Myocarditis 782
Pericarditis 783
Nursing Process: The Patient With Pericarditis 784
30
Management of Patients With
Complications From Heart Disease 787
CARDIAC HEMODYNAMICS 788
Noninvasive Assessment of Cardiac Hemodynamics 789
Invasive Assessment of Cardiac Hemodynamics 789
HEART FAILURE 789
Chronic Heart Failure 789
Nursing Process: The Patient With Heart Failure 801
Acute Heart Failure (Pulmonary Edema) 805
OTHER COMPLICATIONS 806
Cardiogenic Shock 806
Thromboembolism 808
Pericardial Effusion and Cardiac Tamponade 809

Aortic Aneurysm 835
Dissecting Aorta 839
Other Aneurysms 839
Arterial Embolism and Arterial Thrombosis 840
Raynaud’s Disease 841
MANAGEMENT OF VENOUS DISORDERS 842
Venous Thrombosis, Deep Vein Thrombosis (DVT),
Thrombophlebitis, and Phlebothrombosis 842
Chronic Venous Insufficiency 845
Leg Ulcers 846
Nursing Process: The Patient Who Has Leg Ulcers 848
Varicose Veins 849
CELLULITIS 850
MANAGEMENT OF LYMPHATIC DISORDERS 851
Lymphangitis and Lymphadenitis 851
Lymphedema and Elephantiasis 851
32
Assessment and Management
of Patients With Hypertension 854
HYPERTENSION DEFINED 855
PRIMARY HYPERTENSION 855
Nursing Process: The Patient With Hypertension 858
HYPERTENSIVE CRISES 865
Hypertensive Emergency 865
Hypertensive Urgency 865
33
Assessment and Management of
Patients With Hematologic Disorders 867
ANATOMIC AND PHYSIOLOGIC OVERVIEW 868
Blood 869

Nursing Process: The Patient With
Acute Leukemia 902
Agnogenic Myeloid Metaplasia (AMM) 905
THE LYMPHOMAS 906
Hodgkin’s Disease 906
Non-Hodgkin’s Lymphomas 907
Multiple Myeloma 908
BLEEDING DISORDERS 909
Primary Thrombocythemia 910
Secondary Thrombocytosis 911
Thrombocytopenia 911
Idiopathic Thrombocytopenic Purpura (ITP) 912
Platelet Defects 913
Hemophilia 913
Von Willebrand’s Disease 915
ACQUIRED COAGULATION DISORDERS 915
Liver Disease 915
Vitamin K Deficiency 915
Complications of Anticoagulant Therapy 916
Disseminated Intravascular Coagulation (DIC) 916
Nursing Process: The Patient With Disseminated
Intravascular Coagulation (DIC) 916
Thrombotic Disorders 919
THERAPIES FOR BLOOD DISORDERS 922
Splenectomy 922
Therapeutic Apheresis 923
Therapeutic Phlebotomy 923
Blood and Blood Component Therapy 923
Special Preparations 923
PROCURING BLOOD AND BLOOD PRODUCTS 924

Imaging Studies 949
Endoscopic Procedures 951
Manometry and Electrophysiologic Studies 954
Gastric Analysis, Gastric Acid Stimulation Test,
and pH Monitoring 955
Laparoscopy (Peritoneoscopy) 955
PATHOPHYSIOLOGIC AND
PSYCHOLOGICAL CONSIDERATIONS 956
35
Management of Patients With
Oral and Esophageal Disorders 958
DISORDERS OF THE TEETH 959
Dental Plaque and Caries 959
Dentoalveolar Abscess or Periapical Abscess 961
Malocclusion 962
DISORDERS OF THE JAW 962
Temporomandibular Disorders 962
DISORDERS OF THE SALIVARY GLANDS 963
Parotitis 963
Sialadenitis 963
Salivary Calculus (Sialolithiasis) 963
Neoplasms 964
CANCER OF THE ORAL CAVITY 964
Nursing Process: The Patient With
Conditions of the Oral Cavity 965
NECK DISSECTION 968
Nursing Process: The Patient Undergoing
a Neck Dissection 969
DISORDERS OF THE ESOPHAGUS 972
Dysphagia 972

a Tube Feeding 993
GASTROSTOMY 998
Nursing Process: The Patient With a Gastrostomy 999
PARENTERAL NUTRITION 1001
Establishing Positive Nitrogen Balance 1001
Clinical Indications 1002
Formulas 1002
Initiating Therapy 1002
Administration Methods 1002
Discontinuing Parenteral Nutrition 1004
Nursing Process: The Patient Receiving
Parenteral Nutrition 1004
37
Management of Patients With
Gastric and Duodenal Disorders 1010
GASTRITIS 1011
Nursing Process: The Patient With Gastritis 1011
GASTRIC AND DUODENAL ULCERS 1015
Nursing Process: The Patient With Ulcer Disease 1017
MORBID OBESITY 1021
GASTRIC CANCER 1022
Nursing Process: The Patient With Gastric Cancer 1023
GASTRIC SURGERY 1025
Nursing Process: The Patient Undergoing
Gastric Surgery 1025
38
Management of Patients With
Intestinal and Rectal Disorders 1028
ABNORMALITIES OF FECAL ELIMINATION 1029
Constipation 1029

Nursing Process: The Patient With an
Anorectal Condition 1068
Unit
8
Metabolic and
Endocrine Function 1072
39
Assessment and Management of
Patients With Hepatic Disorders 1074
ANATOMIC AND PHYSIOLOGIC OVERVIEW 1075
Anatomy of the Liver 1075
Functions of the Liver 1076
ASSESSMENT 1077
Health History 1077
Physical Examination 1078
DIAGNOSTIC EVALUATION 1078
Liver Function Tests 1078
Liver Biopsy 1078
Other Diagnostic Tests 1081
HEPATIC DYSFUNCTION 1081
Jaundice 1081
Portal Hypertension 1082
Ascites 1082
Esophageal Varices 1085
Hepatic Encephalopathy and Coma 1090
Other Manifestations of Liver Dysfunction 1093
MANAGEMENT OF PATIENTS WITH VIRAL
HEPATIC DISORDERS 1093
Viral Hepatitis 1093
Hepatitis A Virus (HAV) 1094

Cholelithiasis 1126
Nursing Process: The Patient Undergoing Surgery
for Gallbladder Disease 1133
DISORDERS OF THE PANCREAS 1135
Acute Pancreatitis 1135
Nursing Process: The Patient With
Acute Pancreatitis 1138
Chronic Pancreatitis 1142
Pancreatic Cysts 1143
Cancer of the Pancreas 1144
Tumors of the Head of the Pancreas 1145
Pancreatic Islet Tumors 1147
Hyperinsulinism 1147
Ulcerogenic Tumors 1147
41
Assessment and Management
of Patients With Diabetes Mellitus 1149
CLASSIFICATION OF DIABETES 1151
Overview 1151
Physiology and Pathophysiology of Diabetes 1151
Type 1 Diabetes 1153
Type 2 Diabetes 1153
Gestational Diabetes 1154
DIABETES MANAGEMENT 1155
Nutritional Management 1156
Exercise 1160
Monitoring: Glucose Levels and Ketones 1161
Pharmacologic Therapy 1163
NURSING MANAGEMENT 1171
Education 1171

MANAGEMENT OF PATIENTS WITH
PITUITARY DISORDERS 1209
Pituitary Function and Dysfunction 1209
Diabetes Insipidus 1211
Syndrome of Inappropriate Antidiuretic
Hormone Secretion 1212
MANAGEMENT OF PATIENTS WITH
THYROID DISORDERS 1212
Thyroid Function and Dysfunction 1212
Abnormal Thyroid Function 1215
Hypothyroidism 1215
Hyperthyroidism 1221
Nursing Process: The Patient With Hyperthyroidism 1224
Thyroiditis 1226
Thyroid Tumors 1226
Endemic (Iodine-Deficient) Goiter 1227
Nodular Goiter 1227
Thyroid Cancer 1228
MANAGEMENT OF PATIENTS WITH
PARATHYROID DISORDERS 1231
Parathyroid Function 1231
Hyperparathyroidism 1231
Hypoparathyroidism 1232
MANAGEMENT OF PATIENTS WITH
ADRENAL DISORDERS 1234
Adrenal Function 1234
Pheochromocytoma 1235
Adrenocortical Insufficiency (Addison’s Disease) 1237
Cushing’s Syndrome 1239
Nursing Process: The Patient With Cushing’s Syndrome 1240

Management of Patients
With Upper or Lower Urinary
Tract Dysfunction 1271
FLUID AND ELECTROLYTE IMBALANCES IN
RENAL DISORDERS 1272
DYSFUNCTIONAL VOIDING PATTERNS 1273
Congenital Voiding Dysfunction 1274
Adult Voiding Dysfunction 1274
Urinary Incontinence 1275
Urinary Retention 1278
Neurogenic Bladder 1280
DIALYSIS 1285
Hemodialysis 1285
Continuous Renal Replacement Therapies 1290
Peritoneal Dialysis 1291
Special Considerations: Care of the Hospitalized
Dialysis Patient 1297
KIDNEY SURGERY 1298
Preoperative Considerations 1298
Perioperative Concerns 1299
Postoperative Management 1299
Nursing Process: The Patient Undergoing
Kidney Surgery 1300
45
Management of Patients
With Urinary Disorders 1309
INFECTIONS OF THE URINARY TRACT 1310
Lower Urinary Tract Infections 1310
Nursing Process: The Patient With Lower Urinary
Tract Infection 1314

10
Reproductive Function 1366
46
Assessment and Management
of Female Physiologic Processes 1368
ROLE OF NURSES IN WOMEN’S HEALTH 1369
ANATOMIC AND PHYSIOLOGIC OVERVIEW 1370
Anatomy of the Female Reproductive System 1370
Function of the Female Reproductive System 1370
ASSESSMENT 1372
Health History and Clinical Manifestations 1372
Physical Assessment 1377
DIAGNOSTIC EVALUATION 1381
Cytologic Test for Cancer (Pap Smear) 1381
Colposcopy and Cervical Biopsy 1381
Cryotherapy and Laser Therapy 1381
Cone Biopsy and LEEP 1382
Endometrial (Aspiration) Biopsy 1382
Dilation and Curettage 1384
Endoscopic Examinations 1384
Other Diagnostic Procedures 1385
MANAGEMENT OF NORMAL AND ALTERED
FEMALE PHYSIOLOGIC PROCESSES 1385
Menstruation 1385
Perimenopause 1386
Menopause 1387
Premenstrual Syndrome 1389
Dysmenorrhea 1391
Amenorrhea 1391
Abnormal Uterine Bleeding 1392

Fistulas of the Vagina 1422
Pelvic Organ Prolapse: Cystocele, Rectocele, Enterocele 1422
Uterine Prolapse 1423
BENIGN DISORDERS 1425
MALIGNANT CONDITIONS 1429
Cancer of the Cervix 1429
Pregnancy-Related Neoplasm 1431
Cancer of the Uterus (Endometrium) 1432
Cancer of the Vulva 1432
Nursing Process: The Patient Undergoing
Vulvar Surgery 1433
Cancer of the Vagina 1435
Cancer of the Fallopian Tubes 1435
Cancer of the Ovary 1435
HYSTERECTOMY 1437
Preoperative Management 1437
Postoperative Management 1437
Nursing Process: The Patient
Undergoing a Hysterectomy 1437
RADIATION THERAPY 1439
Side Effects of Radiation Therapy 1439
Methods of Radiation Therapy 1440
48
Assessment and Management
of Patients With Breast Disorders 1445
ANATOMIC AND PHYSIOLOGIC OVERVIEW 1446
ASSESSMENT 1447
Health History and Clinical Manifestations 1447
Physical Assessment: Female Breast 1447
Physical Assessment: Male Breast 1450

With Breast Cancer 1469
Recurrent Breast Cancer 1475
RECONSTRUCTIVE BREAST SURGERY 1478
Reduction Mammoplasty 1479
Augmentation Mammoplasty 1479
Reconstructive Procedures After Mastectomy 1479
DISEASES OF THE MALE BREAST 1481
Gynecomastia 1481
Male Breast Cancer 1481
49
Assessment and Management of
Problems Related to Male
Reproductive Processes 1485
ANATOMIC AND PHYSIOLOGIC OVERVIEW 1486
Testicular Development 1486
Glandular Function 1487
ASSESSMENT 1487
Health History and Clinical Manifestations 1487
Physical Assessment 1488
DIAGNOSTIC EVALUATION 1489
Prostate-Specific Antigen Test 1489
Ultrasonography 1489
Prostate Fluid or Tissue Analysis 1489
Tests of Male Sexual Function 1489
DISORDERS OF MALE SEXUAL FUNCTION 1489
Erectile Dysfunction 1489
Ejaculation Problems 1491
INFECTIONS OF THE MALE GENITOURINARY TRACT 1491
CONDITIONS OF THE PROSTATE 1494
Prostatitis 1494

Anatomy of the Immune System 1521
Immune Function: Defenses and Responses 1521
ADVANCES IN IMMUNOLOGY 1530
Genetic Engineering 1530
Stem Cells 1530
Immunoregulation 1531
ASSESSMENT 1531
Health History 1531
Physical Examination 1535
DIAGNOSTIC EVALUATION 1535
51
Management of Patients
With Immunodeficiency 1537
PRIMARY IMMUNODEFICIENCIES 1538
Phagocytic Dysfunction 1538
B-Cell Deficiencies 1540
T-Cell Deficiencies 1541
Combined B-Cell and T-Cell Deficiencies 1542
Deficiencies of the Complement System 1542
SECONDARY IMMUNODEFICIENCIES 1543
NURSING MANAGEMENT FOR PATIENTS
WITH IMMUNODEFICIENCIES 1543
52
Management of Patients With HIV
Infection and AIDS 1547
HIV INFECTION AND AIDS 1548
Nursing Process: The Patient With AIDS 1565
EMOTIONAL AND ETHICAL CONCERNS 1576
53
Assessment and Management of

Assessment and Management of
Patients With Rheumatic Disorders 1605
RHEUMATIC DISEASES 1606
Nursing Process: The Patient With a Rheumatic Disease 1612
DIFFUSE CONNECTIVE TISSUE DISEASES 1620
Rheumatoid Arthritis 1621
Systemic Lupus Erythematosus 1623
Scleroderma 1625
Polymyositis 1626
Polymyalgia Rheumatica 1626
DEGENERATIVE JOINT DISEASE (OSTEOARTHRITIS) 1627
SPONDYLOARTHROPATHIES 1628
Ankylosing Spondylitis 1629
Reactive Arthritis (Reiter’s Syndrome) 1629
Psoriatic Arthritis 1629
METABOLIC AND ENDOCRINE DISEASES
ASSOCIATED WITH RHEUMATIC DISORDERS 1629
Gout 1630
FIBROMYALGIA 1631
ARTHRITIS ASSOCIATED WITH
INFECTIOUS ORGANISMS 1631
NEOPLASMS AND NEUROVASCULAR, BONE,
AND EXTRA-ARTICULAR DISORDERS 1631
MISCELLANEOUS DISORDERS 1632
Unit 12
Integumentary Function 1636
55
Assessment of
Integumentary Function 1638
ANATOMIC AND PHYSIOLOGIC OVERVIEW 1639

Herpes Zoster 1670
Herpes Simplex 1671
Orolabial Herpes 1671
Genital Herpes 1671
FUNGAL (MYCOTIC) INFECTIONS 1672
PARASITIC SKIN INFESTATION 1674
CONTACT DERMATITIS 1676
NONINFECTIOUS INFLAMMATORY
DERMATOSES 1676
Psoriasis 1676
Nursing Process: Care of the Patient
With Psoriasis 1679
Exfoliative Dermatitis 1681
BLISTERING DISEASES 1681
Pemphigus 1681
Bullous Pemphigoid 1682
Dermatitis Herpetiformis 1682
Herpes Gestationis 1682
Nursing Process: Care of the Patient
With Blistering Diseases 1683
Toxic Epidermal Necrolysis and
Stevens-Johnson Syndrome 1684
Nursing Process: Care of the Patient With Toxic
Epidermal Necrolysis 1685
ULCERATIONS 1686
BENIGN TUMORS OF THE SKIN 1686
MALIGNANT TUMORS OF THE SKIN:
SKIN CANCER 1687
Basal Cell and Squamous Cell Carcinoma 1688
Malignant Melanoma 1690

Emergent/Resuscitative Phase of Burn Care 1710
Acute or Intermediate Phase of Burn Care 1718
Disorders of Wound Healing 1726
Rehabilitation Phase of Burn Care 1735
BURN CARE IN THE HOME 1739
Unit
13
Sensorineural Function 1744
58
Assessment and Management of Patients
With Eye and Vision Disorders 1746
ANATOMIC AND PHYSIOLOGIC OVERVIEW 1747
ASSESSMENT 1750
Ocular Examination 1750
DIAGNOSTIC EVALUATION 1751
IMPAIRED VISION 1753
Refractive Errors 1753
Low Vision and Blindness 1753
GLAUCOMA 1757
CATARACTS 1761
CORNEAL DISORDERS 1764
Corneal Dystrophies 1764
Keratoconus 1765
Corneal Surgeries 1765
Refractive Surgeries 1766
RETINAL DISORDERS 1767
Retinal Detachment 1767
Retinal Vascular Disorders 1768
Macular Degeneration 1769
ORBITAL AND OCULAR TRAUMA 1771

ASSESSMENT 1793
Inspection of the External Ear 1793
Otoscopic Examination 1793
Evaluation of Gross Auditory Acuity 1795
DIAGNOSTIC EVALUATION 1795
HEARING LOSS 1797
CONDITIONS OF THE EXTERNAL EAR 1800
Cerumen Impaction 1800
Foreign Bodies 1800
External Otitis (Otitis Externa) 1800
Malignant External Otitis 1801
Masses of the External Ear 1801
Gapping Earring Puncture 1801
CONDITIONS OF THE MIDDLE EAR 1801
Tympanic Membrane Perforation 1801
Acute Otitis Media 1801
Serous Otitis Media 1802
Chronic Otitis Media 1802
Nursing Process: The Patient Undergoing Mastoid Surgery 1803
Otosclerosis 1805
Middle Ear Masses 1805
CONDITIONS OF THE INNER EAR 1806
Motion Sickness 1806
Ménière’s Disease 1807
Labyrinthitis 1808
Benign Paroxysmal Positional Vertigo 1808
Ototoxicity 1808
Acoustic Neuroma 1808
AURAL REHABILITATION 1812
Hearing Aids 1812

With Neurologic Dysfunction 1849
ALTERED LEVEL OF CONSCIOUSNESS 1850
Nursing Process: The Patient With an Altered
Level of Consciousness 1851
INCREASED INTRACRANIAL PRESSURE 1856
Nursing Process: The Patient With Increased ICP 1860
INTRACRANIAL SURGERY 1866
Nursing Process: The Patient Undergoing
Intracranial Surgery 1868
Transsphenoidal Surgery 1873
SEIZURE DISORDERS 1873
Seizures 1873
The Epilepsies 1874
Nursing Process: The Patient With Epilepsy 1877
Status Epilepticus 1880
HEADACHE 1881
62
Management of Patients
With Cerebrovascular Disorders 1887
ISCHEMIC STROKE 1880
Nursing Process: The Patient Recovering
from an Ischemic Stroke 1895
HEMORRHAGIC STROKE 1902
Nursing Process: The Patient With
a Hemorrhagic Stroke 1905
63
Management of Patients
With Neurologic Trauma 1910
HEAD INJURIES 1911
BRAIN INJURY 1913

65
Management of Patients With
Oncologic and Degenerative
Neurologic Disorders 1969
ONCOLOGIC DISORDERS OF THE BRAIN
AND SPINAL CORD 1970
Primary Brain Tumors 1970
Cerebral Metastases 1975
Nursing Process: The Patient With Cerebral
Metastases or Incurable Brain Tumor 1975
Spinal Cord Tumors 1977
DEGENERATIVE DISORDERS 1979
Parkinson’s Disease 1979
Nursing Process: The Patient With Parkinson’s Disease 1983
Huntington’s Disease 1986
Alzheimer’s Disease 1987
Amyotrophic Lateral Sclerosis 1988
Muscular Dystrophies 1989
Degenerative Disk Disease 1990
Herniation of a Cervical Intervertebral Disk 1992
Nursing Process: The Patient Undergoing a
Cervical Discectomy 1993
Herniation of a Lumbar Disk 1994
Post-Polio Syndrome 1996
Unit
15
Musculoskeletal Function 2000
66
Assessment of
Musculoskeletal Function 2002

Skeletal Traction 2028
Nursing Process: The Patient in Traction 2029
MANAGING THE PATIENT UNDERGOING
ORTHOPEDIC SURGERY 2031
Joint Replacement 2031
Total Hip Replacement 2032
Total Knee Replacement 2035
Nursing Process: Preoperative Care of the
Patient Undergoing Orthopedic Surgery 2039
Nursing Process: Postoperative Care of the
Patient Undergoing Orthopedic Surgery 2041
68
Management of Patients
With Musculoskeletal Disorders 2046
COMMON MUSCULOSKELETAL PROBLEMS 2047
Acute Low Back Pain 2047
Nursing Process: The Patient With Acute Low Back Pain 2048
COMMON PROBLEMS OF THE UPPER EXTREMITY 2052
Bursitis and Tendinitis 2052
Loose Bodies 2052
Impingement Syndrome 2052
Carpal Tunnel Syndrome 2052
Ganglion 2052
Dupuytren’s Contracture 2053
Nursing Process: The Patient Undergoing
Surgery of the Hand or Wrist 2053
COMMON FOOT PROBLEMS 2054
Plantar Fasciitis 2055
Corn 2055
Callus 2055

JOINT DISLOCATIONS 2076
SPORTS-RELATED INJURIES 2077
Rotator Cuff Tears 2078
Epicondylitis (Tennis Elbow) 2078
Lateral and Medial Collateral Ligament Injury 2078
Anterior and Posterior Cruciate Ligament Injury 2079
Meniscal Injuries 2079
Rupture of the Achilles Tendon 2079
FRACTURES 2079
FRACTURE HEALING AND COMPLICATIONS
(EARLY AND DELAYED) 2083
Shock (Early) 2083
Fat Embolism Syndrome (Early) 2083
Compartment Syndrome (Early) 2084
Other Early Complications 2085
Delayed Union and Nonunion 2085
Avascular Necrosis of Bone (Delayed) 2086
Reaction to Internal Fixation Devices (Delayed) 2086
Complex Regional Pain Syndrome (Delayed) 2086
Heterotrophic Ossification (Delayed) 2086
FRACTURES OF SPECIFIC SITES 2086
Clavicle 2087
Humeral Neck 2087
Humeral Shaft 2087
Elbow 2089
Radial Head 2089
Radial and Ulnar Shafts 2089
Wrist 2090
Hand 2091
Pelvis 2091

Nursing Process: The Patient With
Infectious Diarrhea 2130
SEXUALLY TRANSMITTED DISEASES 2132
Human Immunodeficiency Virus 2132
Syphilis 2133
Gonorrhea 2134
Chlamydia Trachomatis 2135
Nursing Process: The Patient With
a Sexually Transmitted Disease 2135
HOME-BASED CARE OF THE PATIENT
WITH AN INFECTIOUS DISEASE 2137
Reducing Risk 2137
Nursing Process: The Patient With an
Infectious Disease 2138
71
Emergency Nursing 2147
SCOPE AND PRACTICE OF EMERGENCY NURSING 2148
Issues in Emergency Nursing Care 2148
Emergency Nursing and the Continuum of Care 2150
PRINCIPLES OF EMERGENCY CARE 2150
Triage 2150
Assess and Intervene 2151
AIRWAY OBSTRUCTION 2151
HEMORRHAGE 2152
HYPOVOLEMIC SHOCK 2156
WOUNDS 2156
TRAUMA 2157
Intra-abdominal Injuries 2158
Crush Injuries 2159
Multiple Injuries 2159

72
Terrorism, Mass Casualty,
and Disaster Nursing 2183
Emergency Preparedness 2184
Initiating the Emergency Operations Plan 2186
Preparing for Terrorism 2188
Weapons of Terror 2189
Appendix A: Understanding Clinical Pathways 2199
Appendix B: Diagnostic Studies
and Interpretation 2213
Index I-1
xxxiv Contents
v
●
Contributors
●
Contributors
Sandra M. Annesi, RN, MSN
Assistant Professor
Nursing Program
Daytona Beach Community College
DeLand, Florida
Chapter 25: Respiratory Care Modalities
Judith C. Bautch, PhD, RN, CS
Professor
Department of Nursing
Winona State University
Winona, Minnesota
Chapter 54: Assessment and Management of Patients With
Rheumatic Disorders

Vascular Disorders
Chapter 29: Management of Patients With Structural, Infectious,
and Inflammatory Cardiac Disorders
Chapter 30: Management of Patients With Complications
From Heart Disease
Jill Cash, MSN, APRN, BC
Family Nurse Practitioner
Southern Illinois OB-GYN Associates, SC
Carbondale, Illinois
Chapter 59: Assessment and Management of Patients With Hearing
and Balance Disorders
Linda Carman Copel, PhD, RN, CS, CGP, DAPA
Associate Professor
Villanova University College of Nursing
Villanova, Pennsylvania
Chapter 4: Health Education and Health Promotion
Chapter 6: Homeostasis, Stress, and Adaptation
Chapter 7: Individual and Family Considerations Related to Illness
Juliet Corbin, RNC, DNS, FNP
Lecturer
School of Nursing
San Jose State University
San Jose, California
Chapter 10: Chronic Illness
Susanna G. Cunningham, RN, PhD, FAAN, FAHA
Professor
Department of Biobehavioral Nursing and Health Systems
University of Washington School of Nursing
Seattle, Washington
Chapter 32: Assessment and Management of Patients

Surgical ICU/Intermediate Surgical ICU
Thomas Jefferson University Hospital
Philadelphia, Pennsylvania
Chapter 39: Assessment and Management of Patients With
Hepatic Disorders
Chapter 40: Assessment and Management of Patients With Biliary
Disorders
Mary Beth Flynn, RN, MS
CNS/Clinical Educator
University of Colorado Hospital
Clinical Faculty
University of Colorado Health Science Center
Denver, Colorado
Chapter 15: Shock and Multisystem Failure
Kathleen K. Furniss, MSN, APN-C
Nurse Practitioner, Women’s Health
Women’s Health Initiative
University of Medicine and Dentistry of New Jersey and Associates in
Women’s Health Care
Newark, New Jersey
Chapter 46: Assessment and Management of Female
Physiologic Processes
Chapter 47: Management of Patients With Female
Reproductive Disorders
Paula Graling, RN, MSN, CNS
Clinical Nurse Specialist
Perioperative Services
Inova Fairfax Hospital
Falls Church, Virginia
Chapter 18: Preoperative Nursing Management

South San Francisco, California
Nurse Practitioner
Department of Radiation Oncology
Virginia Mason Medical Center
Clinical Instructor
University of Washington and Seattle University
Seattle, Washington
Chapter 49: Assessment and Management of Problems Related to Male
Reproductive Processes
Joyce Young Johnson, RN, PhD, CCRN
Assistant Chair
Department of Nursing
Georgia Perimeter College
Clarkston, Georgia
Chapter 1: Health Care Delivery and Nursing Practice
Chapter 2: Community-Based Nursing Practice
Chapter 3: Critical Thinking, Ethical Decision Making,
and the Nursing Process
Chapter 8: Perspectives in Transcultural Nursing
Rhonda Kyanko, RN, MS
Nursing Education Coordinator
National Rehabilitation Hospital
Washington, DC
Chapter 11: Principles and Practices of Rehabilitation
Pamela J. LaBorde, MSN, RN
Clinical Nurse Specialist, Patient Care Services
University of Arkansas Medical Sciences Center
Little Rock, Arkansas
Formerly, Clinical Nurse Specialist, Burn Unit
Orlando Regional Medical Center

Philadelphia, Pennsylvania
Chapter 41: Assessment and Management of Patients
With Diabetes Mellitus
Agnes Masny, RN, MPH, MSN, CRNP
Research Associate/Nurse Practitioner
Population Science Division, Family Risk Assessment Program
Fox Chase Cancer Center
Philadelphia, Pennsylvania
Chapter 9: Genetics Perspectives in Nursing
Lou Ann McGinty, MSN, RN
Nurse Science Clinical Specialist
Capitol Health System
Trenton, New Jersey
Chapter 64: Management of Patients With Infectious, Inflammatory,
and Autoimmune Neurologic Disorders
Nancy A. Morrissey, RN,C, PhD
Patient Care Director
Mental Health and Behavioral Center
Inova Alexandria Hospital
Alexandria, Virginia
Chapter 36: Gastrointestinal Intubation and Special
Nutritional Modalities
Martha A. Mulvey, RN, MS, CNS
Advanced Practice Nurse
Neurosciences
University of Medicine and Dentistry of New Jersey,
University Hospital
Newark, New Jersey
Chapter 14: Fluids and Electrolytes: Balance and Distribution
Victoria Navarro, RN, MAS, MSN

Postdoctoral fellow, Psychosocial Oncology
School of Nursing
University of Pennsylvania
Philadelphia, Pennsylvania
Chapter 17: End-of-Life Care
Susan A. Rokita, RN, MS, CRNP
Nurse Coordinator, Cancer Center
Oncology Clinical Nurse Specialist
Milton S. Hershey Medical Center of Pennsylvania State University
Hershey, Pennsylvania
Chapter 16: Oncology: Nursing Management in Cancer Care
Al Rundio, PhD, RN, ANP
Associate Professor
Medical College of Pennsylvania/Hahnemann University
College of Nursing and Health Professions
Philadelphia, Pennsylvania
Chapter 50: Assessment of Immune Function
Chapter 51: Management of Patients With Immunodeficiency
Chapter 53: Assessment and Management of Patients
With Allergic Disorders
Catherine Sackett, RN, BS, CANP
Ophthalmic Research Nurse Practitioner
Wilmer Eye Institute
Retinal Vascular Center
The Johns Hopkins Medical Institutions
Baltimore, Maryland
Chapter 58: Assessment and Management of Patients With Eye
and Vision Disorders
Linda Schakenbach, RN, CNS, MSN, CCRN, COCN, CWCN, CS
Clinical Nurse Specialist, Critical Care

Chapter 19: Intraoperative Nursing Management
Chapter 20: Postoperative Nursing Management
Mary Laudon Thomas, RN, MS, AOCN
Hematology Clinical Nurse Specialist
Veterans’ Administration, Palo Alto Health Care System
Palo Alto, California
Chapter 33: Assessment and Management of Patients
With Hematologic Disorders
Dorraine Day Watts, PhD, RN
Interim Director of Research and Education
Inova Health System
Falls Church, Virginia
Chapter 63: Management of Patients With Neurologic Trauma
Joan Webb, RN, MSN
Instructor
College of Nursing
Widener University
Chester, Pennsylvania
Chapter 40: Assessment and Management of Patients
With Biliary Disorders
Chapter 42: Assessment and Management of Patients
With Endocrine Disorders
Joyce S. Willens, RN, PhD
Assistant Professor
College of Nursing
Villanova University
Villanova, Pennsylvania
Chapter 13: Pain Management
Iris Woodard, RN-CS, BSN, ANP
Nurse Practitioner

Denise M. Ayers, MSN, RN
Assistant Professor, Nursing
Kent State University at Tuscarawas
New Philadelphia, Ohio
Valerie Benedix, BSN, RN
Nursing Instructor
Clovis Community College
Clovis, New Mexico
Ilene Borze, MS, CEN, RN
Director, Nursing Continuing Education
Faculty
Gateway Community College
Phoenix, Arizona
Donna Bowren, RN, MSN, CNOR, CRNFA
Interim Chairperson, Division of Nursing
and Allied Health
University of Arkansas Community College
at Batesville
Batesville, Arkansas
Pat Bradley, RN, MEd MS
Nursing Faculty
Grossmont College
El Cajon, California
Lynn Browning, RN, MSN BC
Assistant Professor of Nursing
Derry Patterson Wingo School of Nursing
Charleston Southern University
Charleston, South Carolina
Elizabeth Bruce, RN, MSN
St. Clair Community College

Poughkeepsie, New York
Sandra Edwards, BScN, RN
Instructor
Grant MacEwan College
Edmonton, Alberta, Canada
Mary Elliot, BScN, MEd, RN
Professor
Humber College of Applied Arts & Technology
Etobicoke, Ontario, Canada
Cheryl Fenton, BHSc, RN
Professor
Mohawk College
Burlington, Ontario, Canada
Kathie Folsom, RN, BSN, MS
Department Chair
Skagit Valley College
Oak Harbor, Washington
Donna Funk, MN/E ONC, RN
Professor of Nursing
Brigham Young University
Rexburg, Idaho
Vicki Garlock, BSN, MSN, RN
Professor, Nursing Department
Pensacola Junior College
Pensacola, Florida
Mary Catherine Gebhart, MSN, CRRN, RN
Instructor
Georgia State University
Atlanta, Georgia
Donna Gullette, DNS, RN

Syracuse, New York
Joan Ann Leach, MS, ME, RNC
Professor of Nursing
Capital Community College
Hartford, Connecticut
Gayle Lee, PhD, RN, CCRN
Faculty
Brigham Young University
Rexburg, Idaho
Brenda Lohri-Posey, EdD, RN
Assistant Dean of Learning, Nursing
& Program Coordination
Belmont Technical College
St. Clairesville, Ohio
Rhonda McLain, MN, RN
Assistant Professor of Nursing
Clayton College & State University
Morrow, Georgia
Pat Nashef, MHSc BA (CPMHN)c, RN
Professional Practice Clinician,
Mental Health Services
Halton Healthcare Services
Oakville, Ontario
Clinical Faculty
McMaster University School of Nursing
Hamilton, Ontario
Lauren O’Hare, MSN, EdD, RN
Assistant Professor of Nursing
Wagner College
Staten Island, New York

Associate Professor of Nursing
Del Mar College
Corpus Christi, Texas
Marsha Sharp, MSN, RN
Associate Professor
Elizabethtown Community College
Elizabethtown, Kentucky
Kelli Simmons, MS, CS, M-SCNS, RN
Cardiothoracic Clinical Nurse Specialist
University of Missouri Hospitals and Clinics
Columbia, Missouri
Terri Small, MSN, RN C
Assistant Professor of Nursing
Waynesburg College
Waynesburg, Pennsylvania
Darla R. Ura, MA, ANP-CS, RN
Clinical Associate Professor
Emory University
Atlanta, Georgia
Weibin Yang, MD
Assistant Professor of Physical Medicine and
Rehabilitation Medicine (PM&R)
University of Illinois
Chicago, Illinois
x
Consultants and Reviewers
▼ Plans of Nursing Care—
illustrate applications of the
nursing process to diseases
and disorders.

Gas Exchange
receives the
nursing diagnoses
and
and
secondary to
and
Teaching: Prescribed
Activity/Exercise
and
and
and
and
and
and
and
and
improves
outcomes in
improves
outcomes in
limits
improves
helps to
prevent
helps to
prevent
leads to
improved
reduces

lip breathing.
2. Encourage alternating activity with rest
periods. Allow patient to make some de-
cisions (bath, shaving) about care based
on tolerance level.
3. Encourage use of an inspiratory muscle
trainer if prescribed.
1. Helps patient prolong expiration time
and decreases air trapping. With these
techniques, patient will breathe more
efficiently and effectively.
2. Pacing activities permits patient to per-
form activities without excessive distress.
3. Strengthens and conditions the respira-
tory muscles.
•
Practices pursed-lip and diaphragmatic
breathing and uses them when short of
breath and with activity
•
Shows signs of decreased respiratory effort
and paces activities
•
Uses inspiratory muscle trainer as pre-
scribed
Nursing Diagnosis: Self-care deficits related to fatigue secondary to increased work of breathing and insufficient
ventilation and oxygenation
Goal: Independence in self-care activities
1. Teach patient to coordinate diaphragmatic
breathing with activity (eg, walking,

Goal: Improvement in breathing pattern
Nursing Diagnosis: Activity intolerance due to fatigue, hypoxemia, and ineffective breathing patterns
Goal: Improvement in activity tolerance
1. Support patient in establishing a regular
regimen of exercise using treadmill and
exercycle, walking, or other appropriate
exercises, such as mall walking.
a. Assess the patient’s current level of
functioning and develop exercise plan
based on baseline functional status.
b. Suggest consultation with a physical
therapist or pulmonary rehabilitation
program to determine an exercise pro-
gram specific
to the patient’s capability.
Have portable oxygen unit available if
oxygen is prescribed for exercise.
1. Muscles that are deconditioned consume
more oxygen and place an additional bur-
den on the lungs. Through regular, graded
exercise, these muscle groups become
more conditioned, and the patient can do
more without getting as short of breath.
Graded exercise breaks the cycle of
debilitation.
•
Performs activities with less shortness of
breath
•
Verbalizes need to exercise daily and

•
Expresses interest in a pulmonary rehabili-
tation program
Chart 16-5
Home Care Checklist
•
Chemotherapy Administration
At the completion of the home care instruction, the patient or caregiver will be able to:
•
Demonstrate how to administer the chemotherapy agent in the home. ✓✓
•
Demonstrate safe disposal of needles, syringes, IV supplies, or unused chemotherapy medications. ✓✓
•
List possible side effects of chemotherapeutic agents. ✓✓
•
List complications of medications necessitating a call to the nurse or physician. ✓✓
•
List complications of medications necessitating a visit to the emergency department. ✓✓
•
List names and telephone numbers of resource personnel involved in care (ie, home care nurse, infusion
services, IV vendor, equipment company). ✓✓
•
Explain treatment plan (protocol) and importance of upcoming visits to physician. ✓✓
Patient Caregiver