Concept-Based Clinical Nursing Skills Elsevier eBook on VitalSource, 1st Edition
Elsevier eBook on VitalSource
Are you looking for a new way of teaching skills? Do you want to help your students learn how to problem solve and think conceptually? Stein and Hollen’s Concept-Based Clinical Nursing Skills: Fundamental to Advanced covers over 250 nursing skills in an innovative concept-based format with excellent illustrations, concise rationales, and current evidence. Unlike any other text, Stein and Hollen incorporate an overarching framework of seven critical concepts — accuracy, client-centered care, infection control, safety, communication, evaluation, and health maintenance — to drive home the importance of these key themes in performing nursing skills. Each section balances need-to-know narrative with step-by-step skills, and every chapter includes a detailed case study with a concept map to help students apply knowledge and use clinical judgement in clinical situations involving nursing skills.
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Concept-Based Clinical Nursing Skills - Elsevier eBook on VitalSource
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- Over 250 step-by-step nursing skills with over 900 photos and illustrations.
- Language and concepts reflect those used on the NCLEX.
- Concept-based approach to skills education pairs well with the Giddens framework.
- Accuracy, Client-Centered Care, Infection Control, Safety, Communication, Evaluation, and Health Maintenance are reinforced throughout as Critical Concepts to skills performance.
- Case studies with concept maps depict patients with problems that might be experienced in the clinical setting and are followed by a series of critical thinking questions with every chapter.
- Application of the QSEN competencies: A question that challenges students to apply a QSEN competency is provided within the critical thinking questions of each case study.
- Lessons from the Evidence boxes highlight and summarize current research that can contribute to evidence-based clinical practice; Lessons from the Courtroom boxes summarize actual court cases related to the skills in the chapter in order to help students understand legal implications; and Lessons from Experience boxes use a storytelling format to share the experiences of more experienced nurses with students.
- Application of the nursing process: Nursing diagnoses that include specific examples of client outcomes and nursing interventions are presented within each section of the chapters.
- Uses an easy-to-understand, conversational writing style.
- Organized to present fundamental skills first, then intermediate acute care skills, and finally advanced skills often performed in critical care.
- Critical concepts align with the quality and safety framework of the QSEN competencies.
- Emphasis on safety and client centered care.
- Expect the Unexpected boxes use a storytelling format to present unexpected situations that could occur and explore appropriate responses to them.
- Home Care, Lifespan, and Cultural Considerations provided in each chapter.
- Performing an Assessment chapter details physical assessment skills.
- Evolve site for students features skills video clips, skills checklists for all skills, and NCLEX-style review questions.
- Evolve site for instructors includes TEACH for Nurses, Test Bank, PowerPoint slides, and an image collection.
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UNIT I Fundamental Nursing Skills
Foundations of Safe Client Care
SECTION 1 Identifying a Client
Application of the Nursing Process
Critical Concepts: Identifying the Client
SKILL 1.1 Identifying a Client
SECTION 2 Preventing Infection
Chain of Infection
Preventing the Transmission of Infection
Application of the Nursing Process
Critical Concepts: Preventing Infection
SKILL 1.2 Performing Hand Hygiene With an AlcoholBased Agent
SKILL 1.3 Performing Hand Hygiene With Soap and Water
SKILL 1.4 Applying and Removing Clean Gloves
SKILL 1.5 Applying and Removing Personal Protective Equipment
SECTION 3 Moving Clients Safely
Benefits of Proper Client Positioning and Repositioning
Ergonomics and Body Mechanics
Summary
Application of the Nursing Process
Critical Concepts: Moving the Client Safely
SKILL 1.6 Positioning a Client in Bed
SKILL 1.7 Moving a Client up in Bed
SKILL 1.8 Transferring a Client From Bed to Chair
SKILL 1.9 Using a Sling Lift to Move a Client
SKILL 1.10 Using a Sit-to-Stand Lift
SKILL 1.11 Transferring Clients Laterally (From Bed to Stretcher)
SKILL 1.12 Moving Clients Who Have Special Precautions (Logrolling)
SECTION 4 Using Restraints
Defining Restraints
Use of Securing Devices
Regulations Governing Use of Restraints
Application of the Nursing Process
Critical Concepts: Using Restraints
SKILL 1.13 Applying and Removing Restraints
SKILL 1.14 Applying a Mummy Restraint
CHAPTER 2 Personal Care and Hygiene
SECTION 1 Bathing a Client
Skin Assessment
Skin Care
Bathing an Adult
Bathing an Infant
Application of the Nursing Process
Critical Concepts: Bathing the Client
SKILL 2.1 Assisting an Ambulatory Client With Bathing
SKILL 2.2 Changing the Gown of a Client With an IV Line
SKILL 2.3 Bathing an Adult Client in Bed
SKILL 2.4 Providing Alternate Perineal Care
SKILL 2.5 Providing Foot Care
SKILL 2.6 Providing Nail Care
SKILL 2.7 Bathing an Infant
SECTION 2 Oral Hygiene
Dentures
Oral Care in the Acute Care Setting
Application of the Nursing Process
Critical Concepts: Providing Oral Care
SKILL 2.8 Providing Oropharyngeal Suctioning With a Round-Tip Suction Catheter (Yankauer)
SKILL 2.9 Providing Oral Hygiene for a Conscious Client
SKILL 2.10 Providing Oral Hygiene for an Unconscious Client
SKILL 2.11 Removing, Cleaning, and Inserting Dentures
SECTION 3 Providing Hair Care
Shaving
Lice
Application of the Nursing Process
Critical Concepts: Providing Hair Care
SKILL 2.12 Shampooing the Nonambulatory Client’s Hair
SKILL 2.13 Shampooing a Client With a Dry-Shampoo Cap
SKILL 2.14 Shaving a Client
SKILL 2.15 Caring for a Client With Lice
SECTION 4 Eye and Ear Care
Application of the Nursing Process
Critical Concepts: Eye and Ear Care
SKILL 2.16 Providing Eye Care for an Unconscious Client
SKILL 2.17 Removing and Cleaning Contact Lenses
SKILL 2.18 Removing, Cleaning, and Inserting an Artificial Eye
SECTION 5 Assisting With Elimination
Applying Concepts of Safety, Client-Centered Care, Collaboration, and Health Maintenance
Bedside Commode, Urinals, Bedpans, and Condom Catheters
Application of the Nursing Process
Critical Concepts: Assisting With Elimination
SKILL 2.19 Assisting a Client Using a Bedside Commode SKILL 2.20 Assisting a Client Using a Urinal
SKILL 2.21 Assisting a Client Using a Bedpan
SKILL 2.22 Applying a Condom Catheter
SECTION 6 Making Beds
Types of Beds
Types of Mattresses
Types of Bedding and Bed Making
Application of the Nursing Process
Critical Concepts: Changing a Bed
SKILL 2.23 Changing an Unoccupied Bed
SKILL 2.24 Making a Surgical Bed
SKILL 2.25 Changing an Occupied Bed
CHAPTER 3 Vital Signs and Vital Measurements
Vital Signs
SECTION 1 Assessing Temperature
Sites and Methods of Temperature Assessment Application of the Nursing Process
Critical Concepts: Assessing Temperature
SKILL 3.1 Measuring Temperature With an Electronic Thermometer
SKILL 3.2 Obtaining a Tympanic Temperature
SKILL 3.3 Obtaining a Temperature Using a Temporal Artery Thermometer
SECTION 2 Regulating Temperature
Regulating Temperature
Application of the Nursing Process
Critical Concepts: Regulating Temperature
SKILL 3.4 Using Conductive Cooling or Heating Therapy
SKILL 3.5 Using an Infant Radiant Warmer
SECTION 3 Assessing Pulses
Location and Differentiation of Pulses
Apical Pulse
Technique for Assessing Pulses
Alterations of the Client’s Pulse
Application of the Nursing Process
Critical Concepts: Assessing Pulses
SKILL 3.6 Obtaining a Radial Pulse Rate
SKILL 3.7 Assessing Carotid Pulses
SKILL 3.8 Assessing Peripheral Pulses
SKILL 3.9 Using a Doppler Ultrasound Device to Assess Pulses
SKILL 3.10 Obtaining an Apical Pulse
SKILL 3.11 Obtaining an Apical-Radial Pulse
SECTION 4 Assessing Respirations
Assessing Respirations in Pediatric Clients
Application of the Nursing Process
Critical Concepts: Assessing Respirations
SKILL 3.12 Obtaining a Respiratory Rate and Respiratory Assessment
SECTION 5 Assessing Blood Pressure
Classification of Hypertension
Factors Affecting Blood Pressure
Measuring Blood Pressure
Application of the Nursing Process
Critical Concepts: Assessing Blood Pressure
SKILL 3.13 Palpating a Systolic Blood Pressure
SKILL 3.14 Measuring a Systolic and Diastolic Blood Pressure by Auscultation
SKILL 3.15 Measuring Blood Pressure With an Automatic Oscillometric Monitor
SKILL 3.16 Using a Doppler Ultrasound Device to Hear Systolic Blood Pressure
Vital Measurements
SECTION 6 Assessing Oxygen Saturation
Obtaining an SpO2 Reading
Application of the Nursing Process
Critical Concepts: Assessing Oxygen Saturation
SKILL 3.17 Obtaining a Pulse Oximeter Measurement
SECTION 7 Assessing Blood Glucose
Application of the Nursing Process
Critical Concepts: Assessing Blood Glucose
SKILL 3.18 Obtaining Capillary Blood Glucose Measurements
CHAPTER 4 Performing an Assessment
The Assessment Process
SECTION 1 Collecting Subjective and Objective Data Collecting Subjective Data
Collecting Objective Data
Performing a Preliminary Survey
Summary
Critical Concepts: Collecting Subjective and Objective Data
SKILL 4.1 Performing a Preliminary Survey
SECTION 2 Performing a Head-to-Toe or SystemSpecific Assessment
Critical Concepts When Performing a Head-to-Toe or System-Specific Assessment
Performing a Rapid Head-to-Toe Bedside Assessment Performing a System-Specific Assessment
Summary
Critical Concepts: Performing a Head-to-Toe or SystemSpecific Assessment
SKILL 4.2 Performing a Rapid Head-to-Toe Bedside Assessment
SKILL 4.3 Assessing the Skin/Integumentary System
SKILL 4.4 Assessing the Head (HEENT) and Neck
SKILL 4.5 Assessing the Neurologic System
SKILL 4.6 Assessing the Thorax (Heart and Lungs)
SKILL 4.7 Assessing the Abdomen
SKILL 4.8 Assessing the Musculoskeletal System
SKILL 4.9 Assessing the Genitourinary System
CHAPTER 5 Nutrition and Gastrointestinal Tube TherapyEssential and Nonessential Nutrients
Macronutrients and Micronutrients
Digestion and Assimilation of Nutrients
Nutritional Guidelines
Alterations That Can Cause Nutritional Deficiencies
SECTION 1 Nutritional Assessment
Criteria Used for a Nutritional Screening or Assessment
Assessing and Monitoring a Client’s Food and Fluid Intake
Summary
Application of the Nursing Process
Critical Concepts: Nutritional Assessment
SKILL 5.1 Performing a Nutritional Screening
SECTION 2 Assisting Clients With Oral Nutrition
Types of Diets
Preparing A Client to Receive a Meal
Assisting A Client Who Has Difficulty Eating
Application of the Nursing Process
Critical Concepts: Assisting Clients With Oral Nutrition SKILL 5.2 Preparing a Client to Receive a Meal
SKILL 5.3 Assisting Clients With a Physical or Cognitive Impairment
SKILL 5.4 Assisting Clients With Dysphagia or Aspiration Risk
SECTION 3 Providing Gastric Tube Therapy
Nasogastric Sump Tube
Levin Tubes and Gastric Lavage Tubes
Placement and Care of a Nasogastric Sump Tube
Summary
Application of the Nursing Process
Critical Concepts: Providing Gastric Tube Therapy
SKILL 5.5 Placement and Care of a Nasogastric (NG) Sump Tube
SKILL 5.6 Initiating and Managing Nasogastric (NG) Sump Tube Suction
SKILL 5.7 Irrigating a Nasogastric (NG) Sump Tube
SKILL 5.8 Discontinuing a Nasogastric (NG) Sump Tube
SECTION 4 Providing Enteral Nutrition
Routes of Enteral Feeding
Daily Care for Clients With Gastrostomy, PEG, and Jejunostomy Tubes
Delivery Methods for Enteral Nutrition
Reducing Risks of Enteral Nutrition
Home Care Considerations
Providing Client-Centered Care During Enteral Nutrition
Summary
Application of the Nursing Process
Critical Concepts: Providing Enteral Nutrition
SKILL 5.9 Placement and Care of a Nasally Inserted Small-Bore Feeding Tube
SKILL 5.10 Providing Care for a Client With a Gastrostomy, PEG Tube, or Jejunostomy
SKILL 5.11 Administering a Tube Feeding (Intermittent or Continuous)
SKILL 5.12 Using a Kangaroo Feeding PumpCHAPTER 6 Supporting Mobility and Immobilization
SECTION 1 Supporting Mobility
Collaborative Care for Clients With Assistive Devices Range of Motion
Application of the Nursing Process
Critical Concepts: Mobility
SKILL 6.1 Assisting With Ambulation Using a Transfer Belt
SKILL 6.2 Teaching the Client to Use a Cane
SKILL 6.3 Teaching the Client to Use a Walker
SKILL 6.4 Teaching the Client to Use Crutches
SKILL 6.5 Performing Active and Passive Range-ofMotion (ROM) Exercises
SECTION 2 Supporting Immobilization
Supporting Immobilization of a Limb or Joint
Supporting Cervical Immobilization
Pin Care
Application of the Nursing Process
Critical Concepts: Immobilization
SKILL 6.6 Applying a Sling
SKILL 6.7 Applying Bandages
SKILL 6.8 Providing Cast Care
SKILL 6.9 Managing Traction
SKILL 6.10 Providing Pin-Site Care
SKILL 6.11 Applying a Cervical Collar
SKILL 6.12 Managing Halo Traction
SECTION 3 Caring for a Client With an Amputation Postoperative Care
Communication: Client Education and Collaboration Application of the Nursing Process
Critical Concepts: Client With an Amputation
SKILL 6.13 Exercising and Positioning the Residual Limb
SKILL 6.14 Applying a Compression Bandage and Commercial Shrinker to a Residual Limb
CHAPTER 7 Comfort Care
The Impact of Pain
Nociceptive and Neuropathic Pain
Acute and Chronic Pain
SECTION 1 Assessment of Pain and Discomfort Subjective and Objective Assessment of Pain
Examples of Pain Tools Used for Assessment of Pain
Assessment of Pain for Diverse Populations
Lifespan Considerations: Older Adults and Pediatric Clients
Summary of Best Practice Recommendations for Assessment of Pain
Summary of Application of Critical Concepts for Assessment of Pain
Application of the Nursing Process
Critical Concepts: Assessment of Pain and Discomfort SKILL 7.1 Performing a Pain Assessment
SECTION 2 Using Relaxation Measures to Promote Comfort
Enhancing the Client’s Environment
Controlled Breathing
Guided Imagery
Massage Therapy
Summary
Application of the Nursing Process
Critical Concepts: Using Relaxation Measures to Promote Comfort
SKILL 7.2 Enhancing a Client’s Environment
SKILL 7.3 Assisting a Client With Controlled-Breathing Exercises
SKILL 7.4 Assisting a Client With Guided Imagery Exercises
SKILL 7.5 Providing a Back Massage
SECTION 3 Using a TENS Unit to Promote Comfort
Application of the Nursing Process
Critical Concepts: Using a TENS Unit to Promote Comfort
SKILL 7.6 Applying and Discontinuing a TENS Unit
SECTION 4 Using Heat or Cold to Promote Comfort Safety Considerations and Precautions for Heat and Cold Therapy
Different Types of Heat and Cold Therapy
Summary
Application of the Nursing Process
Critical Concepts: Using Heat or Cold to Promote Comfort
SKILL 7.7 Using a Heat or Cold Pack (Instant or Reusable)
SKILL 7.8 Using an Ice Bag
SKILL 7.9 Using a Portable Sitz Bath
SKILL 7.10 Using Localized Circulating (Aqua) Heat or Cold Therapy
SECTION 5 Using Patient-Controlled Analgesia to Promote Comfort
Safety Considerations When Using PCA Therapy Summary
Application of the Nursing Process
Critical Concepts: Using Patient-Controlled Analgesia to Promote Comfort
SKILL 7.11 Assessing a Client for Appropriateness of PCA Therapy
SKILL 7.12 Initiating and Managing PCA Therapy
SKILL 7.13 Teaching the Client and Family About PCA Therapy
SKILL 7.14 Discontinuing PCA Therapy
SECTION 6 Using Epidural Analgesia to Promote Comfort
Safety Considerations for Epidural Catheters
Potential Complications of Epidural Catheters
Summary
Application of the Nursing Process
Critical Concepts: Using Epidural Analgesia to Promote Comfort
SKILL 7.15 Caring for a Client With an Epidural Catheter
SKILL 7.16 Assisting With Removal of an Epidural Catheter
CHAPTER 8 End-of-Life Care
Definition of End of Life
End-of-Life Care and Palliative Care
Nursing Initiatives and End-of-Life Care
SECTION 1 Bereavement and Spiritual Care
Caring for a Client and Family Who Are Grieving Theories of Grieving
Types of Grief
Children and Grief
Nurses and Grief
Providing Spiritual Care for a Client and Family
Summary
Application of the Nursing Process
Critical Concepts: Bereavement and Spiritual Care
SKILL 8.1 Caring for a Client and Family Who Are Grieving
SKILL 8.2 Providing Spiritual Care for a Client and Family
SECTION 2 Assisting a Client and Family With Advance Care Planning
Tools Used for Advance Care Planning
Application of the Nursing Process
Critical Concepts: Assisting With Advance Care Planning
SKILL 8.3 Assisting With Advance Directives and Do-NotResuscitate (DNR) Orders
SECTION 3 Caring for a Client Near the End of Life Application of the Nursing Process
Critical Concepts: Caring for a Client Near the End of Life SKILL 8.4 Providing Physical Care for a Client Who Is Dying
SECTION 4 Caring for a Client After Death
Application of the Nursing Process
Critical Concepts: Caring for a Client After Death
SKILL 8.5 Providing Postmortem Care
UNIT II Intermediate Nursing Skills
CHAPTER 9 Airway and Breathing
SECTION 1 Maintaining the Health of the Respiratory System
Deep Breathing and Coughing
Incentive Spirometry
Chest Physiotherapy
Respiratory System-Specific Assessment
Application of the Nursing Process
Critical Concepts: Maintaining the Health of the Respiratory System
SKILL 9.1 Instructing a Client in Deep-Breathing and Coughing Exercises
SKILL 9.2 Instructing a Client to Use Incentive Spirometry
SKILL 9.3 Performing Chest Physiotherapy (CPT)
SECTION 2 Administering Oxygen
Impaired Gas Exchange
Using a High-Pressure Oxygen Cylinder
Administering Supplemental Oxygen
Summary
Application of the Nursing Process
Critical Concepts: Administering Oxygen
SKILL 9.4 Using a High-Pressure Oxygen Cylinder
SKILL 9.5 Using an Oxygen Flowmeter
SKILL 9.6 Placing a Client on Oxygen by Nasal Cannula
SKILL 9.7 Placing a Client on Oxygen by Face Mask
SKILL 9.8 Placing a Client on Continuous Positive Airway Pressure (CPAP)
SECTION 3 Establishing and Maintaining an Open Airway
Oropharyngeal Airway
Nasopharyngeal Airway
Nasopharyngeal Suctioning
Tracheostomy
Suctioning an Artificial Airway
Collecting Sputum Samples
Summary
Application of the Nursing Process
Critical Concepts: Establishing and Maintaining an Open Airway
SKILL 9.9 Inserting an Oropharyngeal Airway
SKILL 9.10 Inserting a Nasopharyngeal Airway
SKILL 9.11 Performing Nasopharyngeal Suctioning
SKILL 9.12 Suctioning an Artificial Airway: Tracheostomy or Endotracheal Tube
SKILL 9.13 Obtaining a Sputum Sample From a Client With an Artificial Airway
SKILL 9.14 Cleaning a Tracheostomy and Replacing Tracheostomy Ties
CHAPTER 10 Sterile Technique
SECTION 1 Preparing a Sterile Field
Application of the Nursing Process
Critical Concepts: Preparing a Sterile Field
SKILL 10.1 Opening a Sterile Pack
SKILL 10.2 Applying and Removing Sterile Gloves
SKILL 10.3 Opening a Sterile Barrier and Setting Up a Sterile Field
SKILL 10.4 Adding Sterile Items to a Sterile Field and Draping a Sterile Field
SKILL 10.5 Pouring a Sterile Liquid
SECTION 2 Preparing to Enter a Sterile Perioperative Setting
Surgical Attire
Surgical Hand Antisepsis
Surgical Gowns and Gloves
Application of the Nursing Process
Critical Concepts: Preparing to Enter a Sterile Perioperative Area
SKILL 10.6 Performing a Surgical Handrub
SKILL 10.7 Performing a Surgical Hand Scrub
SKILL 10.8 Performing Surgical Gowning
SKILL 10.9 Performing Closed Surgical Gloving
CHAPTER 11 Medication Administration
Medication Safety Initiatives
Rights of Medication Administration
Safely Processing Medication Orders
Performing Preassessments
Safely Preparing and Distributing Medications
Performing Safety Checks
Safety Considerations for High-Alert Medications
Performing Dosage Calculation
SECTION 1 Administering Oral Medications
Types of Oral Medications
Crushing/Altering Oral Medications
Preparing and Administering Oral Medications
Best-Practice Recommendations
Pediatric Considerations
Home Care and Geriatric Considerations
Summary
Application of the Nursing Process
Critical Concepts: Administering Oral Medications
SKILL 11.1 Administering Oral Medications (Tablets, Capsules, or Liquids)
SECTION 2 Administering Enteral Medications
Application of the Nursing Process
Critical Concepts: Administering Enteral Medications
SKILL 11.2 Administering a Medication Through a Nasogastric (NG) Tube or Enteral Device
SECTION 3 Administering Mucous Membrane Applications
Sublingual and Buccal Medications
Nasal Instillations
Inhalers and Nebulizers
Rectal and Vaginal Administration
Application of the Nursing Process
Critical Concepts: Administering Mucous Membrane Applications
SKILL 11.3 Administering Sublingual or Buccal Medications
SKILL 11.4 Administering a Nasal Spray Medication
SKILL 11.5 Administering Inhaled Medications
SKILL 11.6 Administering Nebulized Medications
SKILL 11.7 Administering a Rectal Suppository
SKILL 11.8 Administering Vaginal Medications
SECTION 4 Administering Topical Medications
Topical Medications for Localized Effect
Transdermal Medications for Systemic Effect
Eye and Ear Medications
Application of the Nursing Process
Critical Concepts: Administering Topical Medications
SKILL 11.9 Applying a Transdermal Patch
SKILL 11.10 Administering an Eye Medication (Drops or Ointment)
SKILL 11.11 Irrigating the Eyes
SKILL 11.12 Instilling Ear (Otic) Drops
SECTION 5 Administering Parenteral Medications
Preparing Equipment for Injections
Components of a Needle and Syringe
Using Safety and Needleless Systems
Preparing Medications
Administering Injections
Administering Intradermal Injections
Administering Subcutaneous Injections
Administering Intramuscular Injections
Administering Insulin
Summary
Application of the Nursing Process
Critical Concepts: Administering Parenteral Medications
SKILL 11.13 Preparing a Medication From a Vial
SKILL 11.14 Preparing a Medication From an Ampule
SKILL 11.15 Preparing a Medication That Requires Reconstitution
SKILL 11.16 Administering an Intradermal Injection
SKILL 11.17 Administering a Subcutaneous Injection
SKILL 11.18 Administering an Intramuscular Injection
SKILL 11.19 Administering a Subcutaneous Insulin Injection
SKILL 11.20 Caring for a Client With a Subcutaneous Insulin Pump (External)
CHAPTER 12 Venous Access
SECTION 1 Collecting Venous Blood Specimens
Ensuring Accuracy
Selecting a Vein
Application of the Nursing Process
Critical Concepts: Collecting Venous Blood Specimens
SKILL 12.1 Selecting a Vein
SKILL 12.2 Obtaining Venous Blood Specimens
SECTION 2 Initiating, Dressing, and Discontinuing a Peripheral Intravenous Catheter
Selecting a Vein
Application of the Nursing Process
Critical Concepts: Initiating a Peripheral Intravenous Line
SKILL 12.3 Inserting and Dressing a Peripheral Intravenous Catheter
SKILL 12.4 Changing a PIV Dressing
SKILL 12.5 Discontinuing a Peripheral Intravenous Catheter
SECTION 3 Intravenous Fluids
Monitoring Intake and Output
Types of Intravenous Fluids
Infection Control
Safety and the Rights of Intravenous Fluid Administration
Intravenous Fluid Administration Sets
Priming Administration Sets and Bubble Management
Infusing Fluids
Application of the Nursing Process
Critical Concepts: Infusing Intravenous Fluids
SKILL 12.6 Managing a Saline Lock
SKILL 12.7 Preparing a Primary Intravenous Infusion SKILL 12.8 Replacing Intravenous Infusion Fluid
SECTION 4 Administering Intravenous Medications
Orders for Intravenous Medications
Nursing Responsibilities
Medication Preparation and Equipment
Complications of Intravenous Medication Administration
Application of the Nursing Process
Critical Concepts: Administering Intravenous Medications
SKILL 12.9 Administering Intermittent Intravenous Medication via Secondary Infusion
SKILL 12.10 Administering Intravenous Medication via Intravenous Push
SECTION 5 Administering a Blood Transfusion
Different Types of Blood Components
Types of Blood Transfusions
ABO Compatibility System
Safety Considerations
Equipment Used for a Blood Transfusion
Procedure for Administering a Blood Transfusion
Possible Complications
Application of the Nursing Process
Critical Concepts: Administering a Blood Transfusion
SKILL 12.11 Administering Packed Red Blood Cells (PRBCs)
CHAPTER 13 Central Venous Access
SECTION 1 Caring for a Client With a CVAD Tunneled Catheters
Nontunneled Catheters
Implanted Ports
Power-Injection Capable
Assisting With Insertion
Complications of CVADs
Drawing Blood From a CVAD
Care for a Client With a Subcutaneous Port: Accessing and Deaccessing
Discontinuing a CVAD
Critical Concepts and CVADs
Application of the Nursing Process
Critical Concepts: Caring for the Client With a CVAD
SKILL 13.1 Assisting With Insertion
SKILL 13.2 Flushing Central Venous Access Devices
SKILL 13.3 Changing the CVC or PICC Line Dressing
SKILL 13.4 Changing the Needleless Connectors for a CVC/PICC Line
SKILL 13.5 Collecting Blood Specimens/Blood Cultures SKILL 13.6 Managing Subcutaneous Ports: Accessing, Changing the Dressing, and Deaccessing
SKILL 13.7 Discontinuing a Central Line
SECTION 2 Infusing Fluids With a CVAD
Infusing Fluids
Application of the Nursing Process
Critical Concepts: Infusing Fluids Through a CVAD
SKILL 13.8 Infusing IV Fluids
SKILL 13.9 Initiating TPN and/or Lipids
CHAPTER 14 Bowel Management
SECTION 1 Supporting Healthy Bowel Elimination
Characteristics of Stool
Bowel Elimination Problems
Application of the Nursing Process
Critical Concepts: Supporting Healthy Bowel Elimination
SKILL 14.1 Performing Digital Stimulation and Evacuation
SKILL 14.2 Inserting Rectal Tubes
SKILL 14.3 Applying a Fecal Collection Pouch
SKILL 14.4 Setting Up a Fecal Management System
SECTION 2 Administering Enemas
Application of the Nursing Process
Critical Concepts: Administering Enemas
SKILL 14.5 Administering a Cleansing Enema
SKILL 14.6 Administering a Commercially Prepared Enema
SECTION 3 Collecting Specimens
Application of the Nursing Process
Critical Concepts: Collecting Specimens
SKILL 14.7 Collecting a Stool Specimen
SKILL 14.8 Obtaining a Stool Specimen for Occult Blood
SECTION 4 Caring for a Client With a Bowel Diversion
Care of the Stoma and Peristomal Skin
Irrigating a Colostomy
Cecostomy
Application of the Nursing Process
Critical Concepts: Caring for a Client With a Bowel Diversion
SKILL 14.9 Pouching a Stoma
SKILL 14.10 Irrigating an Ostomy
CHAPTER 15 Urine Elimination
Urine Elimination
SECTION 1 Collecting Urine Measurements and Specimens
Assessing Production and Volume of Urine
Collecting Specimens
Application of the Nursing Process
Critical Concepts: Obtaining Urine Measurements and Specimens
SKILL 15.1 Measuring and Recording Intake and Output SKILL 15.2 Measuring Urine Volume With a Portable Bladder Scanner
SKILL 15.3 Obtaining a Urine Specimen From a Closed Urinary Drainage System
SKILL 15.4 Obtaining a Urine Specimen Using the Clean-Catch Method
SKILL 15.5 Obtaining a 24-Hour Urine Specimen
SKILL 15.6 Obtaining a Bagged Urine Specimen From an Infant or Child
SECTION 2 Urine Elimination With a Transurethral Catheter
Types of Transurethral Catheters
Infection Control With Urinary Catheters
Communication and Urinary Catheters
Providing Client-Centered Care to Specific Populations
Bladder Irrigation
Application of the Nursing Process
Critical Concepts: Urine Elimination With a Transurethral Catheter
SKILL 15.7 Inserting and Removing a Straight Catheter in a Female Client
SKILL 15.8 Inserting and Removing a Straight Catheter in a Male Client
SKILL 15.9 Inserting an Indwelling Foley Catheter in a Female Client
SKILL 15.10 Inserting an Indwelling Foley Catheter in a Male Client
SKILL 15.11 Removing an Indwelling Foley Catheter
SKILL 15.12 Managing an Indwelling Foley Catheter
SKILL 15.13 Performing Intermittent Closed Bladder Irrigation
SKILL 15.14 Performing Continuous Closed Bladder Irrigation
SECTION 3 Urine Elimination With a Urinary Diversion
Suprapubic Catheter
Urinary Diversions
Application of the Nursing Process
Critical Concepts: Urine Elimination With a Urinary Diversion
SKILL 15.15 Providing Suprapubic Catheter Care
SKILL 15.16 Changing a Stoma Appliance on an Ileal Conduit
SKILL 15.17 Catheterizing and Irrigating a Continent Urostomy
CHAPTER 16 Wound Care
SECTION 1 Providing Wound Care
Wound Types
The Impact of Wounds
Client Considerations
Wound Assessment
Wound Care
Collecting Wound Specimens
Managing Complex Wounds
Dressing Selection and Application
Application of the Nursing Process
Critical Concepts: Providing Wound Care
SKILL 16.1 Dressing Change for a Primary-Intention Wound
SKILL 16.2 Collecting Wound Specimens
SKILL 16.3 Removing Sutures and Staples
SKILL 16.4 Dressing a Partial- or Full-Thickness Wound
SECTION 2 Managing Wound Drainage
Drains and Negative-Pressure Wound Therapy
Application of the Nursing Process
Critical Concepts: Managing Wound Drainage
SKILL 16.5 Managing a Penrose Drain
SKILL 16.6 Emptying a Jackson-Pratt (JP) Drain or Hemovac
SKILL 16.7 Negative-Pressure Wound Therapy (NPWT)
SECTION 3 Preventing and Treating Pressure Injury and Venous and Diabetic Ulcers
Pressure Injury
Venous Ulcers
Preventing Diabetic Ulcers
Application of the Nursing Process
Critical Concepts: Preventing and Treating Pressure Injury and Venous and Diabetic Ulcers
SKILL 16.8 Applying Compression Dressings or Unna Boot
SKILL 16.9 Foot Examination and Monofilament Testing
SKILL 16.10 Measuring the Ankle-Brachial Index (ABI)
CHAPTER 17 Perioperative Care
SECTION 1 Providing Preoperative Education and Care
Factors Affecting Surgical Risks
Nursing History and Physical Examination
Cultural Considerations
Informed Consent
Preoperative Teaching
Application of the Nursing Process
Critical Concepts: Preoperative Care
SKILL 17.1 Preparing a Client for Surgery
SKILL 17.2 Instructing Client on Thrombosis Prevention
SECTION 2 Providing Intraoperative Care
Roles of the Surgical Team
Surgical Verification
Client Positioning
Maintaining Safety: Latex Sensitivity/Allergy
Types of Anesthesia
Preparing the Client’s Skin
Closing the Wound
Application of the Nursing Process
SECTION 3 Managing Postoperative Care
Postoperative Nursing Care
Postoperative Assessment
Postoperative Teaching Application of the Nursing Process
Critical Concepts: Providing Postoperative Care
SKILL 17.3 Admitting a Postoperative Client
SKILL 17.4 Applying Pressure Dressings to Control Bleeding
SKILL 17.5 Applying and Removing Antiembolism Stockings
SKILL 17.6 Managing Sequential Compression Devices SKILL 17.7 Managing Continuous Passive Motion
UNIT III Advanced Nursing Skills
CHAPTER 18 Advanced Respiratory Management
SECTION 1 Caring for a Client With Invasive Mechanical Ventilation
The Airway: Endotracheal Tubes
Providing Mechanical Ventilation
Nursing Care for Clients Who Are Receiving Mechanical Ventilation
Reducing the Risk of Complications of Mechanical Ventilation
Application of the Nursing Process
Critical Concepts: Caring for a Client With Invasive Mechanical Ventilation
SKILL 18.1 Caring for a Client Receiving Mechanical Ventilation
Arterial Blood Gases
Acid–Base Imbalances
SECTION 2 Caring for a Client Who Requires Arterial Blood Gas Sampling
Indwelling Arterial Catheter Sampling
Arterial Puncture Sampling
Application of the Nursing Process
Critical Concepts: Arterial Blood Gas Sampling
SKILL 18.2 Obtaining Arterial Blood Gases From a Peripheral Arterial Line
SKILL 18.3 Obtaining Arterial Blood Gases From the Radial Artery
SECTION 3 Caring for a Client With a Chest Tube
Chest Drainage Systems
Caring for the Client With a Chest Tube and Chest Drainage System
Troubleshooting the Chest Tube and Drainage System
Application of the Nursing Process
Critical Concepts: Caring for a Client With a Chest Tube
SKILL 18.4 Assisting With Chest Tube Insertion
SKILL 18.5 Maintaining a Chest Tube System and Performing an Occlusive Dressing Change
SKILL 18.6 Assisting With Removal of a Chest Tube
CHAPTER 19 Advanced Cardiovascular Care Cardiovascular System
SECTION 1 Caring for a Client on Cardiac Monitoring
Cardiac Conduction System
The ECG Tracing
Equipment Used in ECG Monitoring
Lead Placement for ECG Monitoring
Types of ECG Monitoring
Performing a 12-Lead ECG
Possible Safety and Technical Issues With ECG Monitoring
Summary
Application of the Nursing Process
Critical Concepts: Caring for a Client on Cardiac Monitoring
SKILL 19.1 Placing a Client on a Continuous ECG Monitor (Hardwire or Telemetry)
SKILL 19.2 Performing a Diagnostic 12-Lead ECG
SECTION 2 Caring for a Client With a Dysrhythmia or Altered Cardiac Conduction
Dysrhythmias and Conduction Disorders
Using Synchronized Cardioversion
Summary
Application of the Nursing Process
Critical Concepts: Caring for a Client With a Dysrhythmia or Altered Cardiac Conduction
SKILL 19.3 Performing or Assisting With Elective Cardioversion
SECTION 3 Caring for a Client With a Cardiac Pacemaker
Cardiac Pacemakers
How a Pacemaker Works: Major Functions and Components
Types of Pacemakers
Temporary Pacemakers
Permanent Pacemakers
Possible Complications/Safety Issues With Pacemakers
Application of the Nursing Process
Critical Concepts: Caring for a Client With a Pacemaker
SKILL 19.4 Caring for a Client With a Transcutaneous Pacemaker (TCP)
SKILL 19.5 Caring for a Client With a Transvenous Pacemaker (TVP)
SECTION 4 Caring for a Client With a Cardiac Emergency
Caring for a Client With Ischemic Chest Pain
Emergency Cardiac Catheterization
Providing Emergency Defibrillation
Caring for a Client Who Is in Cardiac Arrest
Application of the Nursing Process
Critical Concepts: Caring for a Client With a Cardiac Emergency
SKILL 19.6 Providing Care for a Client With Acute Ischemic Chest Pain
SKILL 19.7 Caring for a Client After an Emergency Cardiac Catheterization
SKILL 19.8 Providing Emergency (Asynchronous) Manual Defibrillation
SKILL 19.9 Responding to a Client (Adult) in Cardiac Arrest
CHAPTER 20 Advanced Neurologic Care
Intracranial Processes
Major Neurologic Injuries: Traumatic and Nontraumatic
SECTION 1 Advanced Neurologic Assessment
Performing a Neurologic Assessment
Assessment of Level of Consciousness
Assessment of Pupillary Response and Function
Using a Pupillometer Device for Assessment of Pupils Assessment of Verbal Response and Function
Assessment of Motor and Sensory Function
Assessment of Deep Tendon Reflexes
Lifespan Considerations
Diagnostic Procedures
Summary
Application of the Nursing Process
Critical Concepts: Advanced Neurologic Assessment
SKILL 20.1 Performing a Neurologic Assessment
SKILL 20.2 Using a Pupillometer
SKILL 20.3 Assisting With a Lumbar Puncture
SECTION 2 Caring for a Client With Increased
Intracranial Pressure
Interventions for Clients With Increased ICP
Caring for a Client With an External Ventricular Drain and Performing ICP Monitoring
Summary
Application of the Nursing Process
Critical Concepts: Caring for a Client With Increased Intracranial Pressure
SKILL 20.4 Caring for a Client With an External Ventricular Drain (EVD) and Obtaining Intracranial Pressure (ICP) Readings
SECTION 3 Caring for a Client With a Neurologic Emergency
Caring for a Client Who Is Having a Seizure
Caring for a Client Who May Be Having an Acute Stroke
Summary
Application of the Nursing Process
Critical Concepts: Caring for a Client With a Neurologic Emergency
SKILL 20.5 Caring for a Client Who Requires Seizure Precautions
SKILL 20.6 Assessing a Client Who May Be Having an Acute Stroke
ILLUSTRATION CREDITS
INDEX
UNIT I Fundamental Nursing Skills
Foundations of Safe Client Care
SECTION 1 Identifying a Client
Application of the Nursing Process
Critical Concepts: Identifying the Client
SKILL 1.1 Identifying a Client
SECTION 2 Preventing Infection
Chain of Infection
Preventing the Transmission of Infection
Application of the Nursing Process
Critical Concepts: Preventing Infection
SKILL 1.2 Performing Hand Hygiene With an AlcoholBased Agent
SKILL 1.3 Performing Hand Hygiene With Soap and Water
SKILL 1.4 Applying and Removing Clean Gloves
SKILL 1.5 Applying and Removing Personal Protective Equipment
SECTION 3 Moving Clients Safely
Benefits of Proper Client Positioning and Repositioning
Ergonomics and Body Mechanics
Summary
Application of the Nursing Process
Critical Concepts: Moving the Client Safely
SKILL 1.6 Positioning a Client in Bed
SKILL 1.7 Moving a Client up in Bed
SKILL 1.8 Transferring a Client From Bed to Chair
SKILL 1.9 Using a Sling Lift to Move a Client
SKILL 1.10 Using a Sit-to-Stand Lift
SKILL 1.11 Transferring Clients Laterally (From Bed to Stretcher)
SKILL 1.12 Moving Clients Who Have Special Precautions (Logrolling)
SECTION 4 Using Restraints
Defining Restraints
Use of Securing Devices
Regulations Governing Use of Restraints
Application of the Nursing Process
Critical Concepts: Using Restraints
SKILL 1.13 Applying and Removing Restraints
SKILL 1.14 Applying a Mummy Restraint
CHAPTER 2 Personal Care and Hygiene
SECTION 1 Bathing a Client
Skin Assessment
Skin Care
Bathing an Adult
Bathing an Infant
Application of the Nursing Process
Critical Concepts: Bathing the Client
SKILL 2.1 Assisting an Ambulatory Client With Bathing
SKILL 2.2 Changing the Gown of a Client With an IV Line
SKILL 2.3 Bathing an Adult Client in Bed
SKILL 2.4 Providing Alternate Perineal Care
SKILL 2.5 Providing Foot Care
SKILL 2.6 Providing Nail Care
SKILL 2.7 Bathing an Infant
SECTION 2 Oral Hygiene
Dentures
Oral Care in the Acute Care Setting
Application of the Nursing Process
Critical Concepts: Providing Oral Care
SKILL 2.8 Providing Oropharyngeal Suctioning With a Round-Tip Suction Catheter (Yankauer)
SKILL 2.9 Providing Oral Hygiene for a Conscious Client
SKILL 2.10 Providing Oral Hygiene for an Unconscious Client
SKILL 2.11 Removing, Cleaning, and Inserting Dentures
SECTION 3 Providing Hair Care
Shaving
Lice
Application of the Nursing Process
Critical Concepts: Providing Hair Care
SKILL 2.12 Shampooing the Nonambulatory Client’s Hair
SKILL 2.13 Shampooing a Client With a Dry-Shampoo Cap
SKILL 2.14 Shaving a Client
SKILL 2.15 Caring for a Client With Lice
SECTION 4 Eye and Ear Care
Application of the Nursing Process
Critical Concepts: Eye and Ear Care
SKILL 2.16 Providing Eye Care for an Unconscious Client
SKILL 2.17 Removing and Cleaning Contact Lenses
SKILL 2.18 Removing, Cleaning, and Inserting an Artificial Eye
SECTION 5 Assisting With Elimination
Applying Concepts of Safety, Client-Centered Care, Collaboration, and Health Maintenance
Bedside Commode, Urinals, Bedpans, and Condom Catheters
Application of the Nursing Process
Critical Concepts: Assisting With Elimination
SKILL 2.19 Assisting a Client Using a Bedside Commode SKILL 2.20 Assisting a Client Using a Urinal
SKILL 2.21 Assisting a Client Using a Bedpan
SKILL 2.22 Applying a Condom Catheter
SECTION 6 Making Beds
Types of Beds
Types of Mattresses
Types of Bedding and Bed Making
Application of the Nursing Process
Critical Concepts: Changing a Bed
SKILL 2.23 Changing an Unoccupied Bed
SKILL 2.24 Making a Surgical Bed
SKILL 2.25 Changing an Occupied Bed
CHAPTER 3 Vital Signs and Vital Measurements
Vital Signs
SECTION 1 Assessing Temperature
Sites and Methods of Temperature Assessment Application of the Nursing Process
Critical Concepts: Assessing Temperature
SKILL 3.1 Measuring Temperature With an Electronic Thermometer
SKILL 3.2 Obtaining a Tympanic Temperature
SKILL 3.3 Obtaining a Temperature Using a Temporal Artery Thermometer
SECTION 2 Regulating Temperature
Regulating Temperature
Application of the Nursing Process
Critical Concepts: Regulating Temperature
SKILL 3.4 Using Conductive Cooling or Heating Therapy
SKILL 3.5 Using an Infant Radiant Warmer
SECTION 3 Assessing Pulses
Location and Differentiation of Pulses
Apical Pulse
Technique for Assessing Pulses
Alterations of the Client’s Pulse
Application of the Nursing Process
Critical Concepts: Assessing Pulses
SKILL 3.6 Obtaining a Radial Pulse Rate
SKILL 3.7 Assessing Carotid Pulses
SKILL 3.8 Assessing Peripheral Pulses
SKILL 3.9 Using a Doppler Ultrasound Device to Assess Pulses
SKILL 3.10 Obtaining an Apical Pulse
SKILL 3.11 Obtaining an Apical-Radial Pulse
SECTION 4 Assessing Respirations
Assessing Respirations in Pediatric Clients
Application of the Nursing Process
Critical Concepts: Assessing Respirations
SKILL 3.12 Obtaining a Respiratory Rate and Respiratory Assessment
SECTION 5 Assessing Blood Pressure
Classification of Hypertension
Factors Affecting Blood Pressure
Measuring Blood Pressure
Application of the Nursing Process
Critical Concepts: Assessing Blood Pressure
SKILL 3.13 Palpating a Systolic Blood Pressure
SKILL 3.14 Measuring a Systolic and Diastolic Blood Pressure by Auscultation
SKILL 3.15 Measuring Blood Pressure With an Automatic Oscillometric Monitor
SKILL 3.16 Using a Doppler Ultrasound Device to Hear Systolic Blood Pressure
Vital Measurements
SECTION 6 Assessing Oxygen Saturation
Obtaining an SpO2 Reading
Application of the Nursing Process
Critical Concepts: Assessing Oxygen Saturation
SKILL 3.17 Obtaining a Pulse Oximeter Measurement
SECTION 7 Assessing Blood Glucose
Application of the Nursing Process
Critical Concepts: Assessing Blood Glucose
SKILL 3.18 Obtaining Capillary Blood Glucose Measurements
CHAPTER 4 Performing an Assessment
The Assessment Process
SECTION 1 Collecting Subjective and Objective Data Collecting Subjective Data
Collecting Objective Data
Performing a Preliminary Survey
Summary
Critical Concepts: Collecting Subjective and Objective Data
SKILL 4.1 Performing a Preliminary Survey
SECTION 2 Performing a Head-to-Toe or SystemSpecific Assessment
Critical Concepts When Performing a Head-to-Toe or System-Specific Assessment
Performing a Rapid Head-to-Toe Bedside Assessment Performing a System-Specific Assessment
Summary
Critical Concepts: Performing a Head-to-Toe or SystemSpecific Assessment
SKILL 4.2 Performing a Rapid Head-to-Toe Bedside Assessment
SKILL 4.3 Assessing the Skin/Integumentary System
SKILL 4.4 Assessing the Head (HEENT) and Neck
SKILL 4.5 Assessing the Neurologic System
SKILL 4.6 Assessing the Thorax (Heart and Lungs)
SKILL 4.7 Assessing the Abdomen
SKILL 4.8 Assessing the Musculoskeletal System
SKILL 4.9 Assessing the Genitourinary System
CHAPTER 5 Nutrition and Gastrointestinal Tube Therapy
Essential and Nonessential Nutrients
Macronutrients and Micronutrients
Digestion and Assimilation of Nutrients
Nutritional Guidelines
Alterations That Can Cause Nutritional Deficiencies
SECTION 1 Nutritional Assessment
Criteria Used for a Nutritional Screening or Assessment
Assessing and Monitoring a Client’s Food and Fluid Intake
Summary
Application of the Nursing Process
Critical Concepts: Nutritional Assessment
SKILL 5.1 Performing a Nutritional Screening
SECTION 2 Assisting Clients With Oral Nutrition
Types of Diets
Preparing A Client to Receive a Meal
Assisting A Client Who Has Difficulty Eating
Application of the Nursing Process
Critical Concepts: Assisting Clients With Oral Nutrition SKILL 5.2 Preparing a Client to Receive a Meal
SKILL 5.3 Assisting Clients With a Physical or Cognitive Impairment
SKILL 5.4 Assisting Clients With Dysphagia or Aspiration Risk
SECTION 3 Providing Gastric Tube Therapy
Nasogastric Sump Tube
Levin Tubes and Gastric Lavage Tubes
Placement and Care of a Nasogastric Sump Tube
Summary
Application of the Nursing Process
Critical Concepts: Providing Gastric Tube Therapy
SKILL 5.5 Placement and Care of a Nasogastric (NG) Sump Tube
SKILL 5.6 Initiating and Managing Nasogastric (NG) Sump Tube Suction
SKILL 5.7 Irrigating a Nasogastric (NG) Sump Tube
SKILL 5.8 Discontinuing a Nasogastric (NG) Sump Tube
SECTION 4 Providing Enteral Nutrition
Routes of Enteral Feeding
Daily Care for Clients With Gastrostomy, PEG, and Jejunostomy Tubes
Delivery Methods for Enteral Nutrition
Reducing Risks of Enteral Nutrition
Home Care Considerations
Providing Client-Centered Care During Enteral Nutrition
Summary
Application of the Nursing Process
Critical Concepts: Providing Enteral Nutrition
SKILL 5.9 Placement and Care of a Nasally Inserted Small-Bore Feeding Tube
SKILL 5.10 Providing Care for a Client With a Gastrostomy, PEG Tube, or Jejunostomy
SKILL 5.11 Administering a Tube Feeding (Intermittent or Continuous)
SKILL 5.12 Using a Kangaroo Feeding Pump
CHAPTER 6 Supporting Mobility and Immobilization
SECTION 1 Supporting Mobility
Collaborative Care for Clients With Assistive Devices Range of Motion
Application of the Nursing Process
Critical Concepts: Mobility
SKILL 6.1 Assisting With Ambulation Using a Transfer Belt
SKILL 6.2 Teaching the Client to Use a Cane
SKILL 6.3 Teaching the Client to Use a Walker
SKILL 6.4 Teaching the Client to Use Crutches
SKILL 6.5 Performing Active and Passive Range-ofMotion (ROM) Exercises
SECTION 2 Supporting Immobilization
Supporting Immobilization of a Limb or Joint
Supporting Cervical Immobilization
Pin Care
Application of the Nursing Process
Critical Concepts: Immobilization
SKILL 6.6 Applying a Sling
SKILL 6.7 Applying Bandages
SKILL 6.8 Providing Cast Care
SKILL 6.9 Managing Traction
SKILL 6.10 Providing Pin-Site Care
SKILL 6.11 Applying a Cervical Collar
SKILL 6.12 Managing Halo Traction
SECTION 3 Caring for a Client With an Amputation Postoperative Care
Communication: Client Education and Collaboration Application of the Nursing Process
Critical Concepts: Client With an Amputation
SKILL 6.13 Exercising and Positioning the Residual Limb
SKILL 6.14 Applying a Compression Bandage and Commercial Shrinker to a Residual Limb
CHAPTER 7 Comfort Care
The Impact of Pain
Nociceptive and Neuropathic Pain
Acute and Chronic Pain
SECTION 1 Assessment of Pain and Discomfort Subjective and Objective Assessment of Pain
Examples of Pain Tools Used for Assessment of Pain
Assessment of Pain for Diverse Populations
Lifespan Considerations: Older Adults and Pediatric Clients
Summary of Best Practice Recommendations for Assessment of Pain
Summary of Application of Critical Concepts for Assessment of Pain
Application of the Nursing Process
Critical Concepts: Assessment of Pain and Discomfort SKILL 7.1 Performing a Pain Assessment
SECTION 2 Using Relaxation Measures to Promote Comfort
Enhancing the Client’s Environment
Controlled Breathing
Guided Imagery
Massage Therapy
Summary
Application of the Nursing Process
Critical Concepts: Using Relaxation Measures to Promote Comfort
SKILL 7.2 Enhancing a Client’s Environment
SKILL 7.3 Assisting a Client With Controlled-Breathing Exercises
SKILL 7.4 Assisting a Client With Guided Imagery Exercises
SKILL 7.5 Providing a Back Massage
SECTION 3 Using a TENS Unit to Promote Comfort
Application of the Nursing Process
Critical Concepts: Using a TENS Unit to Promote Comfort
SKILL 7.6 Applying and Discontinuing a TENS Unit
SECTION 4 Using Heat or Cold to Promote Comfort Safety Considerations and Precautions for Heat and Cold Therapy
Different Types of Heat and Cold Therapy
Summary
Application of the Nursing Process
Critical Concepts: Using Heat or Cold to Promote Comfort
SKILL 7.7 Using a Heat or Cold Pack (Instant or Reusable)
SKILL 7.8 Using an Ice Bag
SKILL 7.9 Using a Portable Sitz Bath
SKILL 7.10 Using Localized Circulating (Aqua) Heat or Cold Therapy
SECTION 5 Using Patient-Controlled Analgesia to Promote Comfort
Safety Considerations When Using PCA Therapy Summary
Application of the Nursing Process
Critical Concepts: Using Patient-Controlled Analgesia to Promote Comfort
SKILL 7.11 Assessing a Client for Appropriateness of PCA Therapy
SKILL 7.12 Initiating and Managing PCA Therapy
SKILL 7.13 Teaching the Client and Family About PCA Therapy
SKILL 7.14 Discontinuing PCA Therapy
SECTION 6 Using Epidural Analgesia to Promote Comfort
Safety Considerations for Epidural Catheters
Potential Complications of Epidural Catheters
Summary
Application of the Nursing Process
Critical Concepts: Using Epidural Analgesia to Promote Comfort
SKILL 7.15 Caring for a Client With an Epidural Catheter
SKILL 7.16 Assisting With Removal of an Epidural Catheter
CHAPTER 8 End-of-Life Care
Definition of End of Life
End-of-Life Care and Palliative Care
Nursing Initiatives and End-of-Life Care
SECTION 1 Bereavement and Spiritual Care
Caring for a Client and Family Who Are Grieving Theories of Grieving
Types of Grief
Children and Grief
Nurses and Grief
Providing Spiritual Care for a Client and Family
Summary
Application of the Nursing Process
Critical Concepts: Bereavement and Spiritual Care
SKILL 8.1 Caring for a Client and Family Who Are Grieving
SKILL 8.2 Providing Spiritual Care for a Client and Family
SECTION 2 Assisting a Client and Family With Advance Care Planning
Tools Used for Advance Care Planning
Application of the Nursing Process
Critical Concepts: Assisting With Advance Care Planning
SKILL 8.3 Assisting With Advance Directives and Do-NotResuscitate (DNR) Orders
SECTION 3 Caring for a Client Near the End of Life Application of the Nursing Process
Critical Concepts: Caring for a Client Near the End of Life SKILL 8.4 Providing Physical Care for a Client Who Is Dying
SECTION 4 Caring for a Client After Death
Application of the Nursing Process
Critical Concepts: Caring for a Client After Death
SKILL 8.5 Providing Postmortem Care
UNIT II Intermediate Nursing Skills
CHAPTER 9 Airway and Breathing
SECTION 1 Maintaining the Health of the Respiratory System
Deep Breathing and Coughing
Incentive Spirometry
Chest Physiotherapy
Respiratory System-Specific Assessment
Application of the Nursing Process
Critical Concepts: Maintaining the Health of the Respiratory System
SKILL 9.1 Instructing a Client in Deep-Breathing and Coughing Exercises
SKILL 9.2 Instructing a Client to Use Incentive Spirometry
SKILL 9.3 Performing Chest Physiotherapy (CPT)
SECTION 2 Administering Oxygen
Impaired Gas Exchange
Using a High-Pressure Oxygen Cylinder
Administering Supplemental Oxygen
Summary
Application of the Nursing Process
Critical Concepts: Administering Oxygen
SKILL 9.4 Using a High-Pressure Oxygen Cylinder
SKILL 9.5 Using an Oxygen Flowmeter
SKILL 9.6 Placing a Client on Oxygen by Nasal Cannula
SKILL 9.7 Placing a Client on Oxygen by Face Mask
SKILL 9.8 Placing a Client on Continuous Positive Airway Pressure (CPAP)
SECTION 3 Establishing and Maintaining an Open Airway
Oropharyngeal Airway
Nasopharyngeal Airway
Nasopharyngeal Suctioning
Tracheostomy
Suctioning an Artificial Airway
Collecting Sputum Samples
Summary
Application of the Nursing Process
Critical Concepts: Establishing and Maintaining an Open Airway
SKILL 9.9 Inserting an Oropharyngeal Airway
SKILL 9.10 Inserting a Nasopharyngeal Airway
SKILL 9.11 Performing Nasopharyngeal Suctioning
SKILL 9.12 Suctioning an Artificial Airway: Tracheostomy or Endotracheal Tube
SKILL 9.13 Obtaining a Sputum Sample From a Client With an Artificial Airway
SKILL 9.14 Cleaning a Tracheostomy and Replacing Tracheostomy Ties
CHAPTER 10 Sterile Technique
SECTION 1 Preparing a Sterile Field
Application of the Nursing Process
Critical Concepts: Preparing a Sterile Field
SKILL 10.1 Opening a Sterile Pack
SKILL 10.2 Applying and Removing Sterile Gloves
SKILL 10.3 Opening a Sterile Barrier and Setting Up a Sterile Field
SKILL 10.4 Adding Sterile Items to a Sterile Field and Draping a Sterile Field
SKILL 10.5 Pouring a Sterile Liquid
SECTION 2 Preparing to Enter a Sterile Perioperative Setting
Surgical Attire
Surgical Hand Antisepsis
Surgical Gowns and Gloves
Application of the Nursing Process
Critical Concepts: Preparing to Enter a Sterile Perioperative Area
SKILL 10.6 Performing a Surgical Handrub
SKILL 10.7 Performing a Surgical Hand Scrub
SKILL 10.8 Performing Surgical Gowning
SKILL 10.9 Performing Closed Surgical Gloving
CHAPTER 11 Medication Administration
Medication Safety Initiatives
Rights of Medication Administration
Safely Processing Medication Orders
Performing Preassessments
Safely Preparing and Distributing Medications
Performing Safety Checks
Safety Considerations for High-Alert Medications
Performing Dosage Calculation
SECTION 1 Administering Oral Medications
Types of Oral Medications
Crushing/Altering Oral Medications
Preparing and Administering Oral Medications
Best-Practice Recommendations
Pediatric Considerations
Home Care and Geriatric Considerations
Summary
Application of the Nursing Process
Critical Concepts: Administering Oral Medications
SKILL 11.1 Administering Oral Medications (Tablets, Capsules, or Liquids)
SECTION 2 Administering Enteral Medications
Application of the Nursing Process
Critical Concepts: Administering Enteral Medications
SKILL 11.2 Administering a Medication Through a Nasogastric (NG) Tube or Enteral Device
SECTION 3 Administering Mucous Membrane Applications
Sublingual and Buccal Medications
Nasal Instillations
Inhalers and Nebulizers
Rectal and Vaginal Administration
Application of the Nursing Process
Critical Concepts: Administering Mucous Membrane Applications
SKILL 11.3 Administering Sublingual or Buccal Medications
SKILL 11.4 Administering a Nasal Spray Medication
SKILL 11.5 Administering Inhaled Medications
SKILL 11.6 Administering Nebulized Medications
SKILL 11.7 Administering a Rectal Suppository
SKILL 11.8 Administering Vaginal Medications
SECTION 4 Administering Topical Medications
Topical Medications for Localized Effect
Transdermal Medications for Systemic Effect
Eye and Ear Medications
Application of the Nursing Process
Critical Concepts: Administering Topical Medications
SKILL 11.9 Applying a Transdermal Patch
SKILL 11.10 Administering an Eye Medication (Drops or Ointment)
SKILL 11.11 Irrigating the Eyes
SKILL 11.12 Instilling Ear (Otic) Drops
SECTION 5 Administering Parenteral Medications
Preparing Equipment for Injections
Components of a Needle and Syringe
Using Safety and Needleless Systems
Preparing Medications
Administering Injections
Administering Intradermal Injections
Administering Subcutaneous Injections
Administering Intramuscular Injections
Administering Insulin
Summary
Application of the Nursing Process
Critical Concepts: Administering Parenteral Medications
SKILL 11.13 Preparing a Medication From a Vial
SKILL 11.14 Preparing a Medication From an Ampule
SKILL 11.15 Preparing a Medication That Requires Reconstitution
SKILL 11.16 Administering an Intradermal Injection
SKILL 11.17 Administering a Subcutaneous Injection
SKILL 11.18 Administering an Intramuscular Injection
SKILL 11.19 Administering a Subcutaneous Insulin Injection
SKILL 11.20 Caring for a Client With a Subcutaneous Insulin Pump (External)
CHAPTER 12 Venous Access
SECTION 1 Collecting Venous Blood Specimens
Ensuring Accuracy
Selecting a Vein
Application of the Nursing Process
Critical Concepts: Collecting Venous Blood Specimens
SKILL 12.1 Selecting a Vein
SKILL 12.2 Obtaining Venous Blood Specimens
SECTION 2 Initiating, Dressing, and Discontinuing a Peripheral Intravenous Catheter
Selecting a Vein
Application of the Nursing Process
Critical Concepts: Initiating a Peripheral Intravenous Line
SKILL 12.3 Inserting and Dressing a Peripheral Intravenous Catheter
SKILL 12.4 Changing a PIV Dressing
SKILL 12.5 Discontinuing a Peripheral Intravenous Catheter
SECTION 3 Intravenous Fluids
Monitoring Intake and Output
Types of Intravenous Fluids
Infection Control
Safety and the Rights of Intravenous Fluid Administration
Intravenous Fluid Administration Sets
Priming Administration Sets and Bubble Management
Infusing Fluids
Application of the Nursing Process
Critical Concepts: Infusing Intravenous Fluids
SKILL 12.6 Managing a Saline Lock
SKILL 12.7 Preparing a Primary Intravenous Infusion SKILL 12.8 Replacing Intravenous Infusion Fluid
SECTION 4 Administering Intravenous Medications
Orders for Intravenous Medications
Nursing Responsibilities
Medication Preparation and Equipment
Complications of Intravenous Medication Administration
Application of the Nursing Process
Critical Concepts: Administering Intravenous Medications
SKILL 12.9 Administering Intermittent Intravenous Medication via Secondary Infusion
SKILL 12.10 Administering Intravenous Medication via Intravenous Push
SECTION 5 Administering a Blood Transfusion
Different Types of Blood Components
Types of Blood Transfusions
ABO Compatibility System
Safety Considerations
Equipment Used for a Blood Transfusion
Procedure for Administering a Blood Transfusion
Possible Complications
Application of the Nursing Process
Critical Concepts: Administering a Blood Transfusion
SKILL 12.11 Administering Packed Red Blood Cells (PRBCs)
CHAPTER 13 Central Venous Access
SECTION 1 Caring for a Client With a CVAD Tunneled Catheters
Nontunneled Catheters
Implanted Ports
Power-Injection Capable
Assisting With Insertion
Complications of CVADs
Drawing Blood From a CVAD
Care for a Client With a Subcutaneous Port: Accessing and Deaccessing
Discontinuing a CVAD
Critical Concepts and CVADs
Application of the Nursing Process
Critical Concepts: Caring for the Client With a CVAD
SKILL 13.1 Assisting With Insertion
SKILL 13.2 Flushing Central Venous Access Devices
SKILL 13.3 Changing the CVC or PICC Line Dressing
SKILL 13.4 Changing the Needleless Connectors for a CVC/PICC Line
SKILL 13.5 Collecting Blood Specimens/Blood Cultures SKILL 13.6 Managing Subcutaneous Ports: Accessing, Changing the Dressing, and Deaccessing
SKILL 13.7 Discontinuing a Central Line
SECTION 2 Infusing Fluids With a CVAD
Infusing Fluids
Application of the Nursing Process
Critical Concepts: Infusing Fluids Through a CVAD
SKILL 13.8 Infusing IV Fluids
SKILL 13.9 Initiating TPN and/or Lipids
CHAPTER 14 Bowel Management
SECTION 1 Supporting Healthy Bowel Elimination
Characteristics of Stool
Bowel Elimination Problems
Application of the Nursing Process
Critical Concepts: Supporting Healthy Bowel Elimination
SKILL 14.1 Performing Digital Stimulation and Evacuation
SKILL 14.2 Inserting Rectal Tubes
SKILL 14.3 Applying a Fecal Collection Pouch
SKILL 14.4 Setting Up a Fecal Management System
SECTION 2 Administering Enemas
Application of the Nursing Process
Critical Concepts: Administering Enemas
SKILL 14.5 Administering a Cleansing Enema
SKILL 14.6 Administering a Commercially Prepared Enema
SECTION 3 Collecting Specimens
Application of the Nursing Process
Critical Concepts: Collecting Specimens
SKILL 14.7 Collecting a Stool Specimen
SKILL 14.8 Obtaining a Stool Specimen for Occult Blood
SECTION 4 Caring for a Client With a Bowel Diversion
Care of the Stoma and Peristomal Skin
Irrigating a Colostomy
Cecostomy
Application of the Nursing Process
Critical Concepts: Caring for a Client With a Bowel Diversion
SKILL 14.9 Pouching a Stoma
SKILL 14.10 Irrigating an Ostomy
CHAPTER 15 Urine Elimination
Urine Elimination
SECTION 1 Collecting Urine Measurements and Specimens
Assessing Production and Volume of Urine
Collecting Specimens
Application of the Nursing Process
Critical Concepts: Obtaining Urine Measurements and Specimens
SKILL 15.1 Measuring and Recording Intake and Output SKILL 15.2 Measuring Urine Volume With a Portable Bladder Scanner
SKILL 15.3 Obtaining a Urine Specimen From a Closed Urinary Drainage System
SKILL 15.4 Obtaining a Urine Specimen Using the Clean-Catch Method
SKILL 15.5 Obtaining a 24-Hour Urine Specimen
SKILL 15.6 Obtaining a Bagged Urine Specimen From an Infant or Child
SECTION 2 Urine Elimination With a Transurethral Catheter
Types of Transurethral Catheters
Infection Control With Urinary Catheters
Communication and Urinary Catheters
Providing Client-Centered Care to Specific Populations
Bladder Irrigation
Application of the Nursing Process
Critical Concepts: Urine Elimination With a Transurethral Catheter
SKILL 15.7 Inserting and Removing a Straight Catheter in a Female Client
SKILL 15.8 Inserting and Removing a Straight Catheter in a Male Client
SKILL 15.9 Inserting an Indwelling Foley Catheter in a Female Client
SKILL 15.10 Inserting an Indwelling Foley Catheter in a Male Client
SKILL 15.11 Removing an Indwelling Foley Catheter
SKILL 15.12 Managing an Indwelling Foley Catheter
SKILL 15.13 Performing Intermittent Closed Bladder Irrigation
SKILL 15.14 Performing Continuous Closed Bladder Irrigation
SECTION 3 Urine Elimination With a Urinary Diversion
Suprapubic Catheter
Urinary Diversions
Application of the Nursing Process
Critical Concepts: Urine Elimination With a Urinary Diversion
SKILL 15.15 Providing Suprapubic Catheter Care
SKILL 15.16 Changing a Stoma Appliance on an Ileal Conduit
SKILL 15.17 Catheterizing and Irrigating a Continent Urostomy
CHAPTER 16 Wound Care
SECTION 1 Providing Wound Care
Wound Types
The Impact of Wounds
Client Considerations
Wound Assessment
Wound Care
Collecting Wound Specimens
Managing Complex Wounds
Dressing Selection and Application
Application of the Nursing Process
Critical Concepts: Providing Wound Care
SKILL 16.1 Dressing Change for a Primary-Intention Wound
SKILL 16.2 Collecting Wound Specimens
SKILL 16.3 Removing Sutures and Staples
SKILL 16.4 Dressing a Partial- or Full-Thickness Wound
SECTION 2 Managing Wound Drainage
Drains and Negative-Pressure Wound Therapy
Application of the Nursing Process
Critical Concepts: Managing Wound Drainage
SKILL 16.5 Managing a Penrose Drain
SKILL 16.6 Emptying a Jackson-Pratt (JP) Drain or Hemovac
SKILL 16.7 Negative-Pressure Wound Therapy (NPWT)
SECTION 3 Preventing and Treating Pressure Injury and Venous and Diabetic Ulcers
Pressure Injury
Venous Ulcers
Preventing Diabetic Ulcers
Application of the Nursing Process
Critical Concepts: Preventing and Treating Pressure Injury and Venous and Diabetic Ulcers
SKILL 16.8 Applying Compression Dressings or Unna Boot
SKILL 16.9 Foot Examination and Monofilament Testing
SKILL 16.10 Measuring the Ankle-Brachial Index (ABI)
CHAPTER 17 Perioperative Care
SECTION 1 Providing Preoperative Education and Care
Factors Affecting Surgical Risks
Nursing History and Physical Examination
Cultural Considerations
Informed Consent
Preoperative Teaching
Application of the Nursing Process
Critical Concepts: Preoperative Care
SKILL 17.1 Preparing a Client for Surgery
SKILL 17.2 Instructing Client on Thrombosis Prevention
SECTION 2 Providing Intraoperative Care
Roles of the Surgical Team
Surgical Verification
Client Positioning
Maintaining Safety: Latex Sensitivity/Allergy
Types of Anesthesia
Preparing the Client’s Skin
Closing the Wound
Application of the Nursing Process
SECTION 3 Managing Postoperative Care
Postoperative Nursing Care
Postoperative Assessment
Postoperative Teaching Application of the Nursing Process
Critical Concepts: Providing Postoperative Care
SKILL 17.3 Admitting a Postoperative Client
SKILL 17.4 Applying Pressure Dressings to Control Bleeding
SKILL 17.5 Applying and Removing Antiembolism Stockings
SKILL 17.6 Managing Sequential Compression Devices SKILL 17.7 Managing Continuous Passive Motion
UNIT III Advanced Nursing Skills
CHAPTER 18 Advanced Respiratory Management
SECTION 1 Caring for a Client With Invasive Mechanical Ventilation
The Airway: Endotracheal Tubes
Providing Mechanical Ventilation
Nursing Care for Clients Who Are Receiving Mechanical Ventilation
Reducing the Risk of Complications of Mechanical Ventilation
Application of the Nursing Process
Critical Concepts: Caring for a Client With Invasive Mechanical Ventilation
SKILL 18.1 Caring for a Client Receiving Mechanical Ventilation
Arterial Blood Gases
Acid–Base Imbalances
SECTION 2 Caring for a Client Who Requires Arterial Blood Gas Sampling
Indwelling Arterial Catheter Sampling
Arterial Puncture Sampling
Application of the Nursing Process
Critical Concepts: Arterial Blood Gas Sampling
SKILL 18.2 Obtaining Arterial Blood Gases From a Peripheral Arterial Line
SKILL 18.3 Obtaining Arterial Blood Gases From the Radial Artery
SECTION 3 Caring for a Client With a Chest Tube
Chest Drainage Systems
Caring for the Client With a Chest Tube and Chest Drainage System
Troubleshooting the Chest Tube and Drainage System
Application of the Nursing Process
Critical Concepts: Caring for a Client With a Chest Tube
SKILL 18.4 Assisting With Chest Tube Insertion
SKILL 18.5 Maintaining a Chest Tube System and Performing an Occlusive Dressing Change
SKILL 18.6 Assisting With Removal of a Chest Tube
CHAPTER 19 Advanced Cardiovascular Care Cardiovascular System
SECTION 1 Caring for a Client on Cardiac Monitoring
Cardiac Conduction System
The ECG Tracing
Equipment Used in ECG Monitoring
Lead Placement for ECG Monitoring
Types of ECG Monitoring
Performing a 12-Lead ECG
Possible Safety and Technical Issues With ECG Monitoring
Summary
Application of the Nursing Process
Critical Concepts: Caring for a Client on Cardiac Monitoring
SKILL 19.1 Placing a Client on a Continuous ECG Monitor (Hardwire or Telemetry)
SKILL 19.2 Performing a Diagnostic 12-Lead ECG
SECTION 2 Caring for a Client With a Dysrhythmia or Altered Cardiac Conduction
Dysrhythmias and Conduction Disorders
Using Synchronized Cardioversion
Summary
Application of the Nursing Process
Critical Concepts: Caring for a Client With a Dysrhythmia or Altered Cardiac Conduction
SKILL 19.3 Performing or Assisting With Elective Cardioversion
SECTION 3 Caring for a Client With a Cardiac Pacemaker
Cardiac Pacemakers
How a Pacemaker Works: Major Functions and Components
Types of Pacemakers
Temporary Pacemakers
Permanent Pacemakers
Possible Complications/Safety Issues With Pacemakers
Application of the Nursing Process
Critical Concepts: Caring for a Client With a Pacemaker
SKILL 19.4 Caring for a Client With a Transcutaneous Pacemaker (TCP)
SKILL 19.5 Caring for a Client With a Transvenous Pacemaker (TVP)
SECTION 4 Caring for a Client With a Cardiac Emergency
Caring for a Client With Ischemic Chest Pain
Emergency Cardiac Catheterization
Providing Emergency Defibrillation
Caring for a Client Who Is in Cardiac Arrest
Application of the Nursing Process
Critical Concepts: Caring for a Client With a Cardiac Emergency
SKILL 19.6 Providing Care for a Client With Acute Ischemic Chest Pain
SKILL 19.7 Caring for a Client After an Emergency Cardiac Catheterization
SKILL 19.8 Providing Emergency (Asynchronous) Manual Defibrillation
SKILL 19.9 Responding to a Client (Adult) in Cardiac Arrest
CHAPTER 20 Advanced Neurologic Care
Intracranial Processes
Major Neurologic Injuries: Traumatic and Nontraumatic
SECTION 1 Advanced Neurologic Assessment
Performing a Neurologic Assessment
Assessment of Level of Consciousness
Assessment of Pupillary Response and Function
Using a Pupillometer Device for Assessment of Pupils Assessment of Verbal Response and Function
Assessment of Motor and Sensory Function
Assessment of Deep Tendon Reflexes
Lifespan Considerations
Diagnostic Procedures
Summary
Application of the Nursing Process
Critical Concepts: Advanced Neurologic Assessment
SKILL 20.1 Performing a Neurologic Assessment
SKILL 20.2 Using a Pupillometer
SKILL 20.3 Assisting With a Lumbar Puncture
SECTION 2 Caring for a Client With Increased
Intracranial Pressure
Interventions for Clients With Increased ICP
Caring for a Client With an External Ventricular Drain and Performing ICP Monitoring
Summary
Application of the Nursing Process
Critical Concepts: Caring for a Client With Increased Intracranial Pressure
SKILL 20.4 Caring for a Client With an External Ventricular Drain (EVD) and Obtaining Intracranial Pressure (ICP) Readings
SECTION 3 Caring for a Client With a Neurologic Emergency
Caring for a Client Who Is Having a Seizure
Caring for a Client Who May Be Having an Acute Stroke
Summary
Application of the Nursing Process
Critical Concepts: Caring for a Client With a Neurologic Emergency
SKILL 20.5 Caring for a Client Who Requires Seizure Precautions
SKILL 20.6 Assessing a Client Who May Be Having an Acute Stroke
ILLUSTRATION CREDITS
INDEX
UNIT I Fundamental Nursing Skills
Foundations of Safe Client Care
SECTION 1 Identifying a Client
Application of the Nursing Process
Critical Concepts: Identifying the Client
SKILL 1.1 Identifying a Client
SECTION 2 Preventing Infection
Chain of Infection
Preventing the Transmission of Infection
Application of the Nursing Process
Critical Concepts: Preventing Infection
SKILL 1.2 Performing Hand Hygiene With an AlcoholBased Agent
SKILL 1.3 Performing Hand Hygiene With Soap and Water
SKILL 1.4 Applying and Removing Clean Gloves
SKILL 1.5 Applying and Removing Personal Protective Equipment
SECTION 3 Moving Clients Safely
Benefits of Proper Client Positioning and Repositioning
Ergonomics and Body Mechanics
Summary
Application of the Nursing Process
Critical Concepts: Moving the Client Safely
SKILL 1.6 Positioning a Client in Bed
SKILL 1.7 Moving a Client up in Bed
SKILL 1.8 Transferring a Client From Bed to Chair
SKILL 1.9 Using a Sling Lift to Move a Client
SKILL 1.10 Using a Sit-to-Stand Lift
SKILL 1.11 Transferring Clients Laterally (From Bed to Stretcher)
SKILL 1.12 Moving Clients Who Have Special Precautions (Logrolling)
SECTION 4 Using Restraints
Defining Restraints
Use of Securing Devices
Regulations Governing Use of Restraints
Application of the Nursing Process
Critical Concepts: Using Restraints
SKILL 1.13 Applying and Removing Restraints
SKILL 1.14 Applying a Mummy Restraint
CHAPTER 2 Personal Care and Hygiene
SECTION 1 Bathing a Client
Skin Assessment
Skin Care
Bathing an Adult
Bathing an Infant
Application of the Nursing Process
Critical Concepts: Bathing the Client
SKILL 2.1 Assisting an Ambulatory Client With Bathing
SKILL 2.2 Changing the Gown of a Client With an IV Line
SKILL 2.3 Bathing an Adult Client in Bed
SKILL 2.4 Providing Alternate Perineal Care
SKILL 2.5 Providing Foot Care
SKILL 2.6 Providing Nail Care
SKILL 2.7 Bathing an Infant
SECTION 2 Oral Hygiene
Dentures
Oral Care in the Acute Care Setting
Application of the Nursing Process
Critical Concepts: Providing Oral Care
SKILL 2.8 Providing Oropharyngeal Suctioning With a Round-Tip Suction Catheter (Yankauer)
SKILL 2.9 Providing Oral Hygiene for a Conscious Client
SKILL 2.10 Providing Oral Hygiene for an Unconscious Client
SKILL 2.11 Removing, Cleaning, and Inserting Dentures
SECTION 3 Providing Hair Care
Shaving
Lice
Application of the Nursing Process
Critical Concepts: Providing Hair Care
SKILL 2.12 Shampooing the Nonambulatory Client’s Hair
SKILL 2.13 Shampooing a Client With a Dry-Shampoo Cap
SKILL 2.14 Shaving a Client
SKILL 2.15 Caring for a Client With Lice
SECTION 4 Eye and Ear Care
Application of the Nursing Process
Critical Concepts: Eye and Ear Care
SKILL 2.16 Providing Eye Care for an Unconscious Client
SKILL 2.17 Removing and Cleaning Contact Lenses
SKILL 2.18 Removing, Cleaning, and Inserting an Artificial Eye
SECTION 5 Assisting With Elimination
Applying Concepts of Safety, Client-Centered Care, Collaboration, and Health Maintenance
Bedside Commode, Urinals, Bedpans, and Condom Catheters
Application of the Nursing Process
Critical Concepts: Assisting With Elimination
SKILL 2.19 Assisting a Client Using a Bedside Commode SKILL 2.20 Assisting a Client Using a Urinal
SKILL 2.21 Assisting a Client Using a Bedpan
SKILL 2.22 Applying a Condom Catheter
SECTION 6 Making Beds
Types of Beds
Types of Mattresses
Types of Bedding and Bed Making
Application of the Nursing Process
Critical Concepts: Changing a Bed
SKILL 2.23 Changing an Unoccupied Bed
SKILL 2.24 Making a Surgical Bed
SKILL 2.25 Changing an Occupied Bed
CHAPTER 3 Vital Signs and Vital Measurements
Vital Signs
SECTION 1 Assessing Temperature
Sites and Methods of Temperature Assessment Application of the Nursing Process
Critical Concepts: Assessing Temperature
SKILL 3.1 Measuring Temperature With an Electronic Thermometer
SKILL 3.2 Obtaining a Tympanic Temperature
SKILL 3.3 Obtaining a Temperature Using a Temporal Artery Thermometer
SECTION 2 Regulating Temperature
Regulating Temperature
Application of the Nursing Process
Critical Concepts: Regulating Temperature
SKILL 3.4 Using Conductive Cooling or Heating Therapy
SKILL 3.5 Using an Infant Radiant Warmer
SECTION 3 Assessing Pulses
Location and Differentiation of Pulses
Apical Pulse
Technique for Assessing Pulses
Alterations of the Client’s Pulse
Application of the Nursing Process
Critical Concepts: Assessing Pulses
SKILL 3.6 Obtaining a Radial Pulse Rate
SKILL 3.7 Assessing Carotid Pulses
SKILL 3.8 Assessing Peripheral Pulses
SKILL 3.9 Using a Doppler Ultrasound Device to Assess Pulses
SKILL 3.10 Obtaining an Apical Pulse
SKILL 3.11 Obtaining an Apical-Radial Pulse
SECTION 4 Assessing Respirations
Assessing Respirations in Pediatric Clients
Application of the Nursing Process
Critical Concepts: Assessing Respirations
SKILL 3.12 Obtaining a Respiratory Rate and Respiratory Assessment
SECTION 5 Assessing Blood Pressure
Classification of Hypertension
Factors Affecting Blood Pressure
Measuring Blood Pressure
Application of the Nursing Process
Critical Concepts: Assessing Blood Pressure
SKILL 3.13 Palpating a Systolic Blood Pressure
SKILL 3.14 Measuring a Systolic and Diastolic Blood Pressure by Auscultation
SKILL 3.15 Measuring Blood Pressure With an Automatic Oscillometric Monitor
SKILL 3.16 Using a Doppler Ultrasound Device to Hear Systolic Blood Pressure
Vital Measurements
SECTION 6 Assessing Oxygen Saturation
Obtaining an SpO2 Reading
Application of the Nursing Process
Critical Concepts: Assessing Oxygen Saturation
SKILL 3.17 Obtaining a Pulse Oximeter Measurement
SECTION 7 Assessing Blood Glucose
Application of the Nursing Process
Critical Concepts: Assessing Blood Glucose
SKILL 3.18 Obtaining Capillary Blood Glucose Measurements
CHAPTER 4 Performing an Assessment
The Assessment Process
SECTION 1 Collecting Subjective and Objective Data Collecting Subjective Data
Collecting Objective Data
Performing a Preliminary Survey
Summary
Critical Concepts: Collecting Subjective and Objective Data
SKILL 4.1 Performing a Preliminary Survey
SECTION 2 Performing a Head-to-Toe or SystemSpecific Assessment
Critical Concepts When Performing a Head-to-Toe or System-Specific Assessment
Performing a Rapid Head-to-Toe Bedside Assessment Performing a System-Specific Assessment
Summary
Critical Concepts: Performing a Head-to-Toe or SystemSpecific Assessment
SKILL 4.2 Performing a Rapid Head-to-Toe Bedside Assessment
SKILL 4.3 Assessing the Skin/Integumentary System
SKILL 4.4 Assessing the Head (HEENT) and Neck
SKILL 4.5 Assessing the Neurologic System
SKILL 4.6 Assessing the Thorax (Heart and Lungs)
SKILL 4.7 Assessing the Abdomen
SKILL 4.8 Assessing the Musculoskeletal System
SKILL 4.9 Assessing the Genitourinary System
CHAPTER 5 Nutrition and Gastrointestinal Tube Therapy
Essential and Nonessential Nutrients
Macronutrients and Micronutrients
Digestion and Assimilation of Nutrients
Nutritional Guidelines
Alterations That Can Cause Nutritional Deficiencies
SECTION 1 Nutritional Assessment
Criteria Used for a Nutritional Screening or Assessment
Assessing and Monitoring a Client’s Food and Fluid Intake
Summary
Application of the Nursing Process
Critical Concepts: Nutritional Assessment
SKILL 5.1 Performing a Nutritional Screening
SECTION 2 Assisting Clients With Oral Nutrition
Types of Diets
Preparing A Client to Receive a Meal
Assisting A Client Who Has Difficulty Eating
Application of the Nursing Process
Critical Concepts: Assisting Clients With Oral Nutrition SKILL 5.2 Preparing a Client to Receive a Meal
SKILL 5.3 Assisting Clients With a Physical or Cognitive Impairment
SKILL 5.4 Assisting Clients With Dysphagia or Aspiration Risk
SECTION 3 Providing Gastric Tube Therapy
Nasogastric Sump Tube
Levin Tubes and Gastric Lavage Tubes
Placement and Care of a Nasogastric Sump Tube
Summary
Application of the Nursing Process
Critical Concepts: Providing Gastric Tube Therapy
SKILL 5.5 Placement and Care of a Nasogastric (NG) Sump Tube
SKILL 5.6 Initiating and Managing Nasogastric (NG) Sump Tube Suction
SKILL 5.7 Irrigating a Nasogastric (NG) Sump Tube
SKILL 5.8 Discontinuing a Nasogastric (NG) Sump Tube
SECTION 4 Providing Enteral Nutrition
Routes of Enteral Feeding
Daily Care for Clients With Gastrostomy, PEG, and Jejunostomy Tubes
Delivery Methods for Enteral Nutrition
Reducing Risks of Enteral Nutrition
Home Care Considerations
Providing Client-Centered Care During Enteral Nutrition
Summary
Application of the Nursing Process
Critical Concepts: Providing Enteral Nutrition
SKILL 5.9 Placement and Care of a Nasally Inserted Small-Bore Feeding Tube
SKILL 5.10 Providing Care for a Client With a Gastrostomy, PEG Tube, or Jejunostomy
SKILL 5.11 Administering a Tube Feeding (Intermittent or Continuous)
SKILL 5.12 Using a Kangaroo Feeding Pump
CHAPTER 6 Supporting Mobility and Immobilization
SECTION 1 Supporting Mobility
Collaborative Care for Clients With Assistive Devices Range of Motion
Application of the Nursing Process
Critical Concepts: Mobility
SKILL 6.1 Assisting With Ambulation Using a Transfer Belt
SKILL 6.2 Teaching the Client to Use a Cane
SKILL 6.3 Teaching the Client to Use a Walker
SKILL 6.4 Teaching the Client to Use Crutches
SKILL 6.5 Performing Active and Passive Range-ofMotion (ROM) Exercises
SECTION 2 Supporting Immobilization
Supporting Immobilization of a Limb or Joint
Supporting Cervical Immobilization
Pin Care
Application of the Nursing Process
Critical Concepts: Immobilization
SKILL 6.6 Applying a Sling
SKILL 6.7 Applying Bandages
SKILL 6.8 Providing Cast Care
SKILL 6.9 Managing Traction
SKILL 6.10 Providing Pin-Site Care
SKILL 6.11 Applying a Cervical Collar
SKILL 6.12 Managing Halo Traction
SECTION 3 Caring for a Client With an Amputation Postoperative Care
Communication: Client Education and Collaboration Application of the Nursing Process
Critical Concepts: Client With an Amputation
SKILL 6.13 Exercising and Positioning the Residual Limb
SKILL 6.14 Applying a Compression Bandage and Commercial Shrinker to a Residual Limb
CHAPTER 7 Comfort Care
The Impact of Pain
Nociceptive and Neuropathic Pain
Acute and Chronic Pain
SECTION 1 Assessment of Pain and Discomfort Subjective and Objective Assessment of Pain
Examples of Pain Tools Used for Assessment of Pain
Assessment of Pain for Diverse Populations
Lifespan Considerations: Older Adults and Pediatric Clients
Summary of Best Practice Recommendations for Assessment of Pain
Summary of Application of Critical Concepts for Assessment of Pain
Application of the Nursing Process
Critical Concepts: Assessment of Pain and Discomfort SKILL 7.1 Performing a Pain Assessment
SECTION 2 Using Relaxation Measures to Promote Comfort
Enhancing the Client’s Environment
Controlled Breathing
Guided Imagery
Massage Therapy
Summary
Application of the Nursing Process
Critical Concepts: Using Relaxation Measures to Promote Comfort
SKILL 7.2 Enhancing a Client’s Environment
SKILL 7.3 Assisting a Client With Controlled-Breathing Exercises
SKILL 7.4 Assisting a Client With Guided Imagery Exercises
SKILL 7.5 Providing a Back Massage
SECTION 3 Using a TENS Unit to Promote Comfort
Application of the Nursing Process
Critical Concepts: Using a TENS Unit to Promote Comfort
SKILL 7.6 Applying and Discontinuing a TENS Unit
SECTION 4 Using Heat or Cold to Promote Comfort Safety Considerations and Precautions for Heat and Cold Therapy
Different Types of Heat and Cold Therapy
Summary
Application of the Nursing Process
Critical Concepts: Using Heat or Cold to Promote Comfort
SKILL 7.7 Using a Heat or Cold Pack (Instant or Reusable)
SKILL 7.8 Using an Ice Bag
SKILL 7.9 Using a Portable Sitz Bath
SKILL 7.10 Using Localized Circulating (Aqua) Heat or Cold Therapy
SECTION 5 Using Patient-Controlled Analgesia to Promote Comfort
Safety Considerations When Using PCA Therapy Summary
Application of the Nursing Process
Critical Concepts: Using Patient-Controlled Analgesia to Promote Comfort
SKILL 7.11 Assessing a Client for Appropriateness of PCA Therapy
SKILL 7.12 Initiating and Managing PCA Therapy
SKILL 7.13 Teaching the Client and Family About PCA Therapy
SKILL 7.14 Discontinuing PCA Therapy
SECTION 6 Using Epidural Analgesia to Promote Comfort
Safety Considerations for Epidural Catheters
Potential Complications of Epidural Catheters
Summary
Application of the Nursing Process
Critical Concepts: Using Epidural Analgesia to Promote Comfort
SKILL 7.15 Caring for a Client With an Epidural Catheter
SKILL 7.16 Assisting With Removal of an Epidural Catheter
CHAPTER 8 End-of-Life Care
Definition of End of Life
End-of-Life Care and Palliative Care
Nursing Initiatives and End-of-Life Care
SECTION 1 Bereavement and Spiritual Care
Caring for a Client and Family Who Are Grieving Theories of Grieving
Types of Grief
Children and Grief
Nurses and Grief
Providing Spiritual Care for a Client and Family
Summary
Application of the Nursing Process
Critical Concepts: Bereavement and Spiritual Care
SKILL 8.1 Caring for a Client and Family Who Are Grieving
SKILL 8.2 Providing Spiritual Care for a Client and Family
SECTION 2 Assisting a Client and Family With Advance Care Planning
Tools Used for Advance Care Planning
Application of the Nursing Process
Critical Concepts: Assisting With Advance Care Planning
SKILL 8.3 Assisting With Advance Directives and Do-NotResuscitate (DNR) Orders
SECTION 3 Caring for a Client Near the End of Life Application of the Nursing Process
Critical Concepts: Caring for a Client Near the End of Life SKILL 8.4 Providing Physical Care for a Client Who Is Dying
SECTION 4 Caring for a Client After Death
Application of the Nursing Process
Critical Concepts: Caring for a Client After Death
SKILL 8.5 Providing Postmortem Care
UNIT II Intermediate Nursing Skills
CHAPTER 9 Airway and Breathing
SECTION 1 Maintaining the Health of the Respiratory System
Deep Breathing and Coughing
Incentive Spirometry
Chest Physiotherapy
Respiratory System-Specific Assessment
Application of the Nursing Process
Critical Concepts: Maintaining the Health of the Respiratory System
SKILL 9.1 Instructing a Client in Deep-Breathing and Coughing Exercises
SKILL 9.2 Instructing a Client to Use Incentive Spirometry
SKILL 9.3 Performing Chest Physiotherapy (CPT)
SECTION 2 Administering Oxygen
Impaired Gas Exchange
Using a High-Pressure Oxygen Cylinder
Administering Supplemental Oxygen
Summary
Application of the Nursing Process
Critical Concepts: Administering Oxygen
SKILL 9.4 Using a High-Pressure Oxygen Cylinder
SKILL 9.5 Using an Oxygen Flowmeter
SKILL 9.6 Placing a Client on Oxygen by Nasal Cannula
SKILL 9.7 Placing a Client on Oxygen by Face Mask
SKILL 9.8 Placing a Client on Continuous Positive Airway Pressure (CPAP)
SECTION 3 Establishing and Maintaining an Open Airway
Oropharyngeal Airway
Nasopharyngeal Airway
Nasopharyngeal Suctioning
Tracheostomy
Suctioning an Artificial Airway
Collecting Sputum Samples
Summary
Application of the Nursing Process
Critical Concepts: Establishing and Maintaining an Open Airway
SKILL 9.9 Inserting an Oropharyngeal Airway
SKILL 9.10 Inserting a Nasopharyngeal Airway
SKILL 9.11 Performing Nasopharyngeal Suctioning
SKILL 9.12 Suctioning an Artificial Airway: Tracheostomy or Endotracheal Tube
SKILL 9.13 Obtaining a Sputum Sample From a Client With an Artificial Airway
SKILL 9.14 Cleaning a Tracheostomy and Replacing Tracheostomy Ties
CHAPTER 10 Sterile Technique
SECTION 1 Preparing a Sterile Field
Application of the Nursing Process
Critical Concepts: Preparing a Sterile Field
SKILL 10.1 Opening a Sterile Pack
SKILL 10.2 Applying and Removing Sterile Gloves
SKILL 10.3 Opening a Sterile Barrier and Setting Up a Sterile Field
SKILL 10.4 Adding Sterile Items to a Sterile Field and Draping a Sterile Field
SKILL 10.5 Pouring a Sterile Liquid
SECTION 2 Preparing to Enter a Sterile Perioperative Setting
Surgical Attire
Surgical Hand Antisepsis
Surgical Gowns and Gloves
Application of the Nursing Process
Critical Concepts: Preparing to Enter a Sterile Perioperative Area
SKILL 10.6 Performing a Surgical Handrub
SKILL 10.7 Performing a Surgical Hand Scrub
SKILL 10.8 Performing Surgical Gowning
SKILL 10.9 Performing Closed Surgical Gloving
CHAPTER 11 Medication Administration
Medication Safety Initiatives
Rights of Medication Administration
Safely Processing Medication Orders
Performing Preassessments
Safely Preparing and Distributing Medications
Performing Safety Checks
Safety Considerations for High-Alert Medications
Performing Dosage Calculation
SECTION 1 Administering Oral Medications
Types of Oral Medications
Crushing/Altering Oral Medications
Preparing and Administering Oral Medications
Best-Practice Recommendations
Pediatric Considerations
Home Care and Geriatric Considerations
Summary
Application of the Nursing Process
Critical Concepts: Administering Oral Medications
SKILL 11.1 Administering Oral Medications (Tablets, Capsules, or Liquids)
SECTION 2 Administering Enteral Medications
Application of the Nursing Process
Critical Concepts: Administering Enteral Medications
SKILL 11.2 Administering a Medication Through a Nasogastric (NG) Tube or Enteral Device
SECTION 3 Administering Mucous Membrane Applications
Sublingual and Buccal Medications
Nasal Instillations
Inhalers and Nebulizers
Rectal and Vaginal Administration
Application of the Nursing Process
Critical Concepts: Administering Mucous Membrane Applications
SKILL 11.3 Administering Sublingual or Buccal Medications
SKILL 11.4 Administering a Nasal Spray Medication
SKILL 11.5 Administering Inhaled Medications
SKILL 11.6 Administering Nebulized Medications
SKILL 11.7 Administering a Rectal Suppository
SKILL 11.8 Administering Vaginal Medications
SECTION 4 Administering Topical Medications
Topical Medications for Localized Effect
Transdermal Medications for Systemic Effect
Eye and Ear Medications
Application of the Nursing Process
Critical Concepts: Administering Topical Medications
SKILL 11.9 Applying a Transdermal Patch
SKILL 11.10 Administering an Eye Medication (Drops or Ointment)
SKILL 11.11 Irrigating the Eyes
SKILL 11.12 Instilling Ear (Otic) Drops
SECTION 5 Administering Parenteral Medications
Preparing Equipment for Injections
Components of a Needle and Syringe
Using Safety and Needleless Systems
Preparing Medications
Administering Injections
Administering Intradermal Injections
Administering Subcutaneous Injections
Administering Intramuscular Injections
Administering Insulin
Summary
Application of the Nursing Process
Critical Concepts: Administering Parenteral Medications
SKILL 11.13 Preparing a Medication From a Vial
SKILL 11.14 Preparing a Medication From an Ampule
SKILL 11.15 Preparing a Medication That Requires Reconstitution
SKILL 11.16 Administering an Intradermal Injection
SKILL 11.17 Administering a Subcutaneous Injection
SKILL 11.18 Administering an Intramuscular Injection
SKILL 11.19 Administering a Subcutaneous Insulin Injection
SKILL 11.20 Caring for a Client With a Subcutaneous Insulin Pump (External)
CHAPTER 12 Venous Access
SECTION 1 Collecting Venous Blood Specimens
Ensuring Accuracy
Selecting a Vein
Application of the Nursing Process
Critical Concepts: Collecting Venous Blood Specimens
SKILL 12.1 Selecting a Vein
SKILL 12.2 Obtaining Venous Blood Specimens
SECTION 2 Initiating, Dressing, and Discontinuing a Peripheral Intravenous Catheter
Selecting a Vein
Application of the Nursing Process
Critical Concepts: Initiating a Peripheral Intravenous Line
SKILL 12.3 Inserting and Dressing a Peripheral Intravenous Catheter
SKILL 12.4 Changing a PIV Dressing
SKILL 12.5 Discontinuing a Peripheral Intravenous Catheter
SECTION 3 Intravenous Fluids
Monitoring Intake and Output
Types of Intravenous Fluids
Infection Control
Safety and the Rights of Intravenous Fluid Administration
Intravenous Fluid Administration Sets
Priming Administration Sets and Bubble Management
Infusing Fluids
Application of the Nursing Process
Critical Concepts: Infusing Intravenous Fluids
SKILL 12.6 Managing a Saline Lock
SKILL 12.7 Preparing a Primary Intravenous Infusion SKILL 12.8 Replacing Intravenous Infusion Fluid
SECTION 4 Administering Intravenous Medications
Orders for Intravenous Medications
Nursing Responsibilities
Medication Preparation and Equipment
Complications of Intravenous Medication Administration
Application of the Nursing Process
Critical Concepts: Administering Intravenous Medications
SKILL 12.9 Administering Intermittent Intravenous Medication via Secondary Infusion
SKILL 12.10 Administering Intravenous Medication via Intravenous Push
SECTION 5 Administering a Blood Transfusion
Different Types of Blood Components
Types of Blood Transfusions
ABO Compatibility System
Safety Considerations
Equipment Used for a Blood Transfusion
Procedure for Administering a Blood Transfusion
Possible Complications
Application of the Nursing Process
Critical Concepts: Administering a Blood Transfusion
SKILL 12.11 Administering Packed Red Blood Cells (PRBCs)
CHAPTER 13 Central Venous Access
SECTION 1 Caring for a Client With a CVAD Tunneled Catheters
Nontunneled Catheters
Implanted Ports
Power-Injection Capable
Assisting With Insertion
Complications of CVADs
Drawing Blood From a CVAD
Care for a Client With a Subcutaneous Port: Accessing and Deaccessing
Discontinuing a CVAD
Critical Concepts and CVADs
Application of the Nursing Process
Critical Concepts: Caring for the Client With a CVAD
SKILL 13.1 Assisting With Insertion
SKILL 13.2 Flushing Central Venous Access Devices
SKILL 13.3 Changing the CVC or PICC Line Dressing
SKILL 13.4 Changing the Needleless Connectors for a CVC/PICC Line
SKILL 13.5 Collecting Blood Specimens/Blood Cultures SKILL 13.6 Managing Subcutaneous Ports: Accessing, Changing the Dressing, and Deaccessing
SKILL 13.7 Discontinuing a Central Line
SECTION 2 Infusing Fluids With a CVAD
Infusing Fluids
Application of the Nursing Process
Critical Concepts: Infusing Fluids Through a CVAD
SKILL 13.8 Infusing IV Fluids
SKILL 13.9 Initiating TPN and/or Lipids
CHAPTER 14 Bowel Management
SECTION 1 Supporting Healthy Bowel Elimination
Characteristics of Stool
Bowel Elimination Problems
Application of the Nursing Process
Critical Concepts: Supporting Healthy Bowel Elimination
SKILL 14.1 Performing Digital Stimulation and Evacuation
SKILL 14.2 Inserting Rectal Tubes
SKILL 14.3 Applying a Fecal Collection Pouch
SKILL 14.4 Setting Up a Fecal Management System
SECTION 2 Administering Enemas
Application of the Nursing Process
Critical Concepts: Administering Enemas
SKILL 14.5 Administering a Cleansing Enema
SKILL 14.6 Administering a Commercially Prepared Enema
SECTION 3 Collecting Specimens
Application of the Nursing Process
Critical Concepts: Collecting Specimens
SKILL 14.7 Collecting a Stool Specimen
SKILL 14.8 Obtaining a Stool Specimen for Occult Blood
SECTION 4 Caring for a Client With a Bowel Diversion
Care of the Stoma and Peristomal Skin
Irrigating a Colostomy
Cecostomy
Application of the Nursing Process
Critical Concepts: Caring for a Client With a Bowel Diversion
SKILL 14.9 Pouching a Stoma
SKILL 14.10 Irrigating an Ostomy
CHAPTER 15 Urine Elimination
Urine Elimination
SECTION 1 Collecting Urine Measurements and Specimens
Assessing Production and Volume of Urine
Collecting Specimens
Application of the Nursing Process
Critical Concepts: Obtaining Urine Measurements and Specimens
SKILL 15.1 Measuring and Recording Intake and Output SKILL 15.2 Measuring Urine Volume With a Portable Bladder Scanner
SKILL 15.3 Obtaining a Urine Specimen From a Closed Urinary Drainage System
SKILL 15.4 Obtaining a Urine Specimen Using the Clean-Catch Method
SKILL 15.5 Obtaining a 24-Hour Urine Specimen
SKILL 15.6 Obtaining a Bagged Urine Specimen From an Infant or Child
SECTION 2 Urine Elimination With a Transurethral Catheter
Types of Transurethral Catheters
Infection Control With Urinary Catheters
Communication and Urinary Catheters
Providing Client-Centered Care to Specific Populations
Bladder Irrigation
Application of the Nursing Process
Critical Concepts: Urine Elimination With a Transurethral Catheter
SKILL 15.7 Inserting and Removing a Straight Catheter in a Female Client
SKILL 15.8 Inserting and Removing a Straight Catheter in a Male Client
SKILL 15.9 Inserting an Indwelling Foley Catheter in a Female Client
SKILL 15.10 Inserting an Indwelling Foley Catheter in a Male Client
SKILL 15.11 Removing an Indwelling Foley Catheter
SKILL 15.12 Managing an Indwelling Foley Catheter
SKILL 15.13 Performing Intermittent Closed Bladder Irrigation
SKILL 15.14 Performing Continuous Closed Bladder Irrigation
SECTION 3 Urine Elimination With a Urinary Diversion
Suprapubic Catheter
Urinary Diversions
Application of the Nursing Process
Critical Concepts: Urine Elimination With a Urinary Diversion
SKILL 15.15 Providing Suprapubic Catheter Care
SKILL 15.16 Changing a Stoma Appliance on an Ileal Conduit
SKILL 15.17 Catheterizing and Irrigating a Continent Urostomy
CHAPTER 16 Wound Care
SECTION 1 Providing Wound Care
Wound Types
The Impact of Wounds
Client Considerations
Wound Assessment
Wound Care
Collecting Wound Specimens
Managing Complex Wounds
Dressing Selection and Application
Application of the Nursing Process
Critical Concepts: Providing Wound Care
SKILL 16.1 Dressing Change for a Primary-Intention Wound
SKILL 16.2 Collecting Wound Specimens
SKILL 16.3 Removing Sutures and Staples
SKILL 16.4 Dressing a Partial- or Full-Thickness Wound
SECTION 2 Managing Wound Drainage
Drains and Negative-Pressure Wound Therapy
Application of the Nursing Process
Critical Concepts: Managing Wound Drainage
SKILL 16.5 Managing a Penrose Drain
SKILL 16.6 Emptying a Jackson-Pratt (JP) Drain or Hemovac
SKILL 16.7 Negative-Pressure Wound Therapy (NPWT)
SECTION 3 Preventing and Treating Pressure Injury and Venous and Diabetic Ulcers
Pressure Injury
Venous Ulcers
Preventing Diabetic Ulcers
Application of the Nursing Process
Critical Concepts: Preventing and Treating Pressure Injury and Venous and Diabetic Ulcers
SKILL 16.8 Applying Compression Dressings or Unna Boot
SKILL 16.9 Foot Examination and Monofilament Testing
SKILL 16.10 Measuring the Ankle-Brachial Index (ABI)
CHAPTER 17 Perioperative Care
SECTION 1 Providing Preoperative Education and Care
Factors Affecting Surgical Risks
Nursing History and Physical Examination
Cultural Considerations
Informed Consent
Preoperative Teaching
Application of the Nursing Process
Critical Concepts: Preoperative Care
SKILL 17.1 Preparing a Client for Surgery
SKILL 17.2 Instructing Client on Thrombosis Prevention
SECTION 2 Providing Intraoperative Care
Roles of the Surgical Team
Surgical Verification
Client Positioning
Maintaining Safety: Latex Sensitivity/Allergy
Types of Anesthesia
Preparing the Client’s Skin
Closing the Wound
Application of the Nursing Process
SECTION 3 Managing Postoperative Care
Postoperative Nursing Care
Postoperative Assessment
Postoperative Teaching Application of the Nursing Process
Critical Concepts: Providing Postoperative Care
SKILL 17.3 Admitting a Postoperative Client
SKILL 17.4 Applying Pressure Dressings to Control Bleeding
SKILL 17.5 Applying and Removing Antiembolism Stockings
SKILL 17.6 Managing Sequential Compression Devices SKILL 17.7 Managing Continuous Passive Motion
UNIT III Advanced Nursing Skills
CHAPTER 18 Advanced Respiratory Management
SECTION 1 Caring for a Client With Invasive Mechanical Ventilation
The Airway: Endotracheal Tubes
Providing Mechanical Ventilation
Nursing Care for Clients Who Are Receiving Mechanical Ventilation
Reducing the Risk of Complications of Mechanical Ventilation
Application of the Nursing Process
Critical Concepts: Caring for a Client With Invasive Mechanical Ventilation
SKILL 18.1 Caring for a Client Receiving Mechanical Ventilation
Arterial Blood Gases
Acid–Base Imbalances
SECTION 2 Caring for a Client Who Requires Arterial Blood Gas Sampling
Indwelling Arterial Catheter Sampling
Arterial Puncture Sampling
Application of the Nursing Process
Critical Concepts: Arterial Blood Gas Sampling
SKILL 18.2 Obtaining Arterial Blood Gases From a Peripheral Arterial Line
SKILL 18.3 Obtaining Arterial Blood Gases From the Radial Artery
SECTION 3 Caring for a Client With a Chest Tube
Chest Drainage Systems
Caring for the Client With a Chest Tube and Chest Drainage System
Troubleshooting the Chest Tube and Drainage System
Application of the Nursing Process
Critical Concepts: Caring for a Client With a Chest Tube
SKILL 18.4 Assisting With Chest Tube Insertion
SKILL 18.5 Maintaining a Chest Tube System and Performing an Occlusive Dressing Change
SKILL 18.6 Assisting With Removal of a Chest Tube
CHAPTER 19 Advanced Cardiovascular Care Cardiovascular System
SECTION 1 Caring for a Client on Cardiac Monitoring
Cardiac Conduction System
The ECG Tracing
Equipment Used in ECG Monitoring
Lead Placement for ECG Monitoring
Types of ECG Monitoring
Performing a 12-Lead ECG
Possible Safety and Technical Issues With ECG Monitoring
Summary
Application of the Nursing Process
Critical Concepts: Caring for a Client on Cardiac Monitoring
SKILL 19.1 Placing a Client on a Continuous ECG Monitor (Hardwire or Telemetry)
SKILL 19.2 Performing a Diagnostic 12-Lead ECG
SECTION 2 Caring for a Client With a Dysrhythmia or Altered Cardiac Conduction
Dysrhythmias and Conduction Disorders
Using Synchronized Cardioversion
Summary
Application of the Nursing Process
Critical Concepts: Caring for a Client With a Dysrhythmia or Altered Cardiac Conduction
SKILL 19.3 Performing or Assisting With Elective Cardioversion
SECTION 3 Caring for a Client With a Cardiac Pacemaker
Cardiac Pacemakers
How a Pacemaker Works: Major Functions and Components
Types of Pacemakers
Temporary Pacemakers
Permanent Pacemakers
Possible Complications/Safety Issues With Pacemakers
Application of the Nursing Process
Critical Concepts: Caring for a Client With a Pacemaker
SKILL 19.4 Caring for a Client With a Transcutaneous Pacemaker (TCP)
SKILL 19.5 Caring for a Client With a Transvenous Pacemaker (TVP)
SECTION 4 Caring for a Client With a Cardiac Emergency
Caring for a Client With Ischemic Chest Pain
Emergency Cardiac Catheterization
Providing Emergency Defibrillation
Caring for a Client Who Is in Cardiac Arrest
Application of the Nursing Process
Critical Concepts: Caring for a Client With a Cardiac Emergency
SKILL 19.6 Providing Care for a Client With Acute Ischemic Chest Pain
SKILL 19.7 Caring for a Client After an Emergency Cardiac Catheterization
SKILL 19.8 Providing Emergency (Asynchronous) Manual Defibrillation
SKILL 19.9 Responding to a Client (Adult) in Cardiac Arrest
CHAPTER 20 Advanced Neurologic Care
Intracranial Processes
Major Neurologic Injuries: Traumatic and Nontraumatic
SECTION 1 Advanced Neurologic Assessment
Performing a Neurologic Assessment
Assessment of Level of Consciousness
Assessment of Pupillary Response and Function
Using a Pupillometer Device for Assessment of Pupils Assessment of Verbal Response and Function
Assessment of Motor and Sensory Function
Assessment of Deep Tendon Reflexes
Lifespan Considerations
Diagnostic Procedures
Summary
Application of the Nursing Process
Critical Concepts: Advanced Neurologic Assessment
SKILL 20.1 Performing a Neurologic Assessment
SKILL 20.2 Using a Pupillometer
SKILL 20.3 Assisting With a Lumbar Puncture
SECTION 2 Caring for a Client With Increased
Intracranial Pressure
Interventions for Clients With Increased ICP
Caring for a Client With an External Ventricular Drain and Performing ICP Monitoring
Summary
Application of the Nursing Process
Critical Concepts: Caring for a Client With Increased Intracranial Pressure
SKILL 20.4 Caring for a Client With an External Ventricular Drain (EVD) and Obtaining Intracranial Pressure (ICP) Readings
SECTION 3 Caring for a Client With a Neurologic Emergency
Caring for a Client Who Is Having a Seizure
Caring for a Client Who May Be Having an Acute Stroke
Summary
Application of the Nursing Process
Critical Concepts: Caring for a Client With a Neurologic Emergency
SKILL 20.5 Caring for a Client Who Requires Seizure Precautions
SKILL 20.6 Assessing a Client Who May Be Having an Acute Stroke
ILLUSTRATION CREDITS
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