UNIT 1 The Nature of Nursing… 2

CHAPTER 1 Historical and Contemporary Nursing Practice… 4

Historical Perspectives…5
Contemporary Nursing Practice…11
Roles and Functions of the Nurse…13
Criteria of a Profession…15
Socialization to Nursing…17
Factors Influencing Contemporary Nursing Practice…18
Nursing Organizations…21

CHAPTER 2 Nursing Education, Research, and EvidenceBased Practice… 25

Nursing Education…26
Types of Educational Programs…27
Nursing Research and Evidence-Based Practice…30
Critiquing Research Reports…36

CHAPTER 3 Nursing Theories and Conceptual Frameworks… 39

Introduction to Theories…40
The Metaparadigm for Nursing…41
Purposes of Nursing Theory…41
Overview of Selected Nursing Theories…43
Critique of Nursing Theory…49

CHAPTER 4 Legal Aspects of Nursing… 52

General Legal Concepts…53
Regulation of Nursing Practice…55
Contractual Arrangements in Nursing…58
Selected Legal Aspects of Nursing Practice…59
Areas of Potential Liability in Nursing…67
Legal Protections in Nursing Practice…72
Reporting Crimes, Torts, and Unsafe Practices…74
Legal Responsibilities of Students…74

CHAPTER 5 Values, Ethics, and Advocacy… 79

Values…80
Morality and Ethics…83
Specific Ethical Issues…90
Advocacy…93

UNIT 2 Contemporary Health Care… 98

CHAPTER 6 Health Care Delivery Systems… 100

Types of Health Care Services…101
Types of Health Care Agencies and Services…102
Providers of Health Care…105
Factors Affecting Health Care Delivery…107
Frameworks for Care…110
Financing Health Care…111

CHAPTER 7 Community Nursing and Care Continuity… 117

The Movement of Health Care to the Community…118
Community-Based Health Care…119
Community Health…120
Community-Based Nursing…124
Continuity of Care…126

CHAPTER 8 Home Care… 131

Home Health Nursing…132
The Home Health Care System…133
Roles of the Home Health Nurse…134
Perspectives of Home Care Clients…135
Selected Dimensions of Home Health Nursing…135
The Practice of Nursing in the Home…137
The Future of Home Health Care…139

CHAPTER 9 Nursing Informatics… 143

General Concepts…144
Computers in Nursing Education…147
Computers in Nursing Practice…149
Computers in Nursing Administration…154
Computers in Nursing Research…155

UNIT 3 The Nursing Process… 160

CHAPTER 10 Critical Thinking and the Nursing Process… 162

Critical Thinking…163
Skills in Critical Thinking…164
Attitudes that Foster Critical Thinking…165
Standards of Critical Thinking…166
Applying Critical Thinking to Nursing Practice…166
Developing Critical-Thinking Attitudes and Skills…169

CHAPTER 11 Assessing… 174

Overview of the Nursing Process…175
Assessing…179
Collecting Data…179
Organizing Data…187
Validating Data…191
Documenting Data…192

CHAPTER 12 Diagnosing… 195

NANDA Nursing Diagnoses…196
The Diagnostic Process…199
Ongoing Development of Nursing Diagnoses…205
CHAPTER 13 Planning… 210
Types of Planning…211
Developing Nursing Care Plans…212
The Planning Process…217
The Nursing Interventions Classification…225

CHAPTER 14 Implementing and Evaluating… 232

Implementing…233
Evaluating…235

CHAPTER 15 Documenting and Reporting… 245

Ethical and Legal Considerations…246
Purposes of Client Records…247
Documentation Systems…247
Documenting Nursing Activities…255
Long-Term Care Documentation…257
Home Care Documentation…258
General Guidelines for Recording…258
Reporting…262

UNIT 4 Health Beliefs and Practices … 268

CHAPTER 16 Health Promotion… 270

Individual Health…271
Applying Theoretical Frameworks…273
Healthy People 2010…275
Defining Health Promotion…276
Sites for Health Promotion Activities…277
Health Promotion Model…278
Stages of Health Behavior Change…280
The Nurses Role in Health Promotion…282
The Nursing Process and Health Promotion…283
NURSING MANAGEMENT…283

CHAPTER 17 Health, Wellness, and Illness… 294

Concepts of Health, Wellness, and Well-Being…295
Models of Health and Wellness…297
Variables Influencing Health Status, Beliefs, and Practices…300
Health Belief Models…302
Health Care Adherence…304
Illness and Disease…305

CHAPTER 18 Culture and Heritage… 311

National Agencies and Trends…312
Cultural Nursing Care…313
Concepts Related to Cultural Nursing Care…314
Heritage Consistency…315
Selected Parameters for Cultural Nursing Care…316
Providing Cultural Nursing Care…322
NURSING MANAGEMENT…322

CHAPTER 19 Complementary and Alternative Healing Modalities… 330

Basic Concepts…331
Healing Modalities…332

UNIT 5 Life Span Development … 346

CHAPTER 20 Concepts of Growth and Development… 348

Factors Influencing Growth and Development…349
Stages of Growth and Development…350
Growth and Development Theories…350
Applying Growth and Development Concepts to Nursing Practice…362

CHAPTER 21 Promoting Health from Conception through Adolescence… 366

Conception and Prenatal Development…367
Neonates and Infants (Birth to 1 Year)…368
Toddlers (1 to 3 Years)…373
Preschoolers (4 and 5 Years)…377
School-Age Children (6 to 12 Years)…380
Adolescents (12 to 18 Years)…384

CHAPTER 22 Promoting Health in Young and Middle-Aged Adults… 392

Young Adults (20 to 40 Years)…393
Middle-Aged Adults (40 to 65 Years)…397

CHAPTER 23 Promoting Health in Elders… 405

Characteristics of Elders in the United States…406
Attitudes Toward Aging…407
Gerontological Nursing…408
Care Settings for Elders…408
Physiological Aging…410
Psychosocial Aging…416
Cognitive Abilities and Aging…418
Moral Reasoning…419
Spirituality and Aging…419
Health Problems…419
Health Assessment and Promotion…422

CHAPTER 24 Promoting Family Health… 428

Family Health…429
Applying Theoretical Frameworks to Families…431
NURSING MANAGEMENT…433

UNIT 6 Integral Aspects of Nursing… 442

CHAPTER 25 Caring… 444

Professionalization of Caring…445
Nursing Theories on Caring…446
Types of Knowledge in Nursing…449
Caring Encounters…450
Maintaining Caring Practice…452

CHAPTER 26 Communicating… 459

Communicating…460
The Helping Relationship…472
Group Communication…475
Communication and the Nursing Process…476
NURSING MANAGEMENT…477
Communication Among Health Professionals…481

CHAPTER 27 Teaching… 486

Teaching…487
Learning…488
The Internet and Health Information…492
Nurse as Educator…493
NURSING MANAGEMENT…494

CHAPTER 28 Leading, Managing, and Delegating… 511

The Nurse as a Leader and a Manager…512
Leadership…513
Management…515
The Nurse as Delegator…517
Change…520

UNIT 7 Assessing Health … 524

CHAPTER 29 Vital Signs… 526

Body Temperature…527
Pulse…537
Respirations…546
Blood Pressure…551
Oxygen Saturation…558
SKILL 29-1 Assessing Body Temperature…534
SKILL 29-2 Assessing a Peripheral Pulse…540
SKILL 29-3 Assessing an Apical Pulse…543
SKILL 29-4 Assessing an Apical-Radial Pulse…545
SKILL 29-5 Assessing Respirations…550
SKILL 29-6 Assessing Blood Pressure…556
SKILL 29-7 Measuring Oxygen Saturation…559

CHAPTER 30 Health Assessment… 564

Physical Health Assessment…565
General Survey…571
The Integument…575
The Head…584
The Neck…605
The Thorax and Lungs…610
The Cardiovascular and Peripheral Vascular Systems…619
The Breasts and Axillae…627
The Abdomen…631
The Musculoskeletal System…639
The Neurologic System…642
The Female Genitals and Inguinal Area…654
The Male Genitals and Inguinal Area…656
The Rectum and Anus…660
SKILL 30-1 Assessing Appearance and Mental Status…572
SKILL 30-2 Assessing the Skin…578
SKILL 30-3 Assessing the Hair…581
SKILL 30-4 Assessing the Nails…583
SKILL 30-5 Assessing the Skull and Face…585
SKILL 30-6 Assessing the Eye Structures and Visual Acuity…587
SKILL 30-7 Assessing the Ears and Hearing…595
SKILL 30-8 Assessing the Nose and Sinuses…599
SKILL 30-9 Assessing the Mouth and Oropharynx…602
SKILL 30-10 Assessing the Neck…607
SKILL 30-11 Assessing the Thorax and Lungs…614
SKILL 30-12 Assessing the Heart and Central Vessels…621
SKILL 30-13 Assessing the Peripheral Vascular System…624
SKILL 30-14 Assessing the Breasts and Axillae…627
SKILL 30-15 Assessing the Abdomen…632
SKILL 30-16 Assessing the Musculoskeletal System…639
SKILL 30-17 Assessing the Neurologic System…644
SKILL 30-18 Assessing the Female Genitals and Inguinal Area…654
SKILL 30-19 Assessing the Male Genitals and Inguinal Area…658
SKILL 30-20 Assessing the Rectum and Anus…660

UNIT 8 Integral Components of Client Care… 666

CHAPTER 31 Asepsis… 668

Types of Microorganisms Causing Infections…670
Types of Infections…670
Nosocomial Infections…670
Chain of Infection…671
Body Defenses Against Infection…673
Factors Increasing Susceptibility to Infection…675
NURSING MANAGEMENT…679
Isolation Precautions…688
Isolation Practices…690
Sterile Technique…695
Infection Control for Health Care Workers…705
Role of the Infection Control Nurse…706
Evaluating…706
SKILL 31-1 Hand Washing…684
SKILL 31-2 Donning and Removing Personal Protective Equipment (Gloves, Gown, Mask,
Eyewear)…691
SKILL 31-3 Establishing and Maintaining a Sterile Field…697
SKILL 31-4 Donning and Removing Sterile Gloves (Open Method)…701
SKILL 31-5 Donning a Sterile Gown and Gloves (Closed Method)…703

CHAPTER 32 Safety… 710

Factors Affecting Safety…711
NURSING MANAGEMENT…713
SKILL 32-1 Using a Bed or Chair Exit Safety Monitoring Device…724
SKILL 32-2 Implementing Seizure Precautions…725
SKILL 32-3 Applying Restraints…734

CHAPTER 33 Hygiene… 741

Hygienic Care…742
Skin…742
NURSING MANAGEMENT…743
Feet…758
Nails…762
NURSING MANAGEMENT…758
NURSING MANAGEMENT…762
Mouth…763
NURSING MANAGEMENT…764
Hair…774
NURSING MANAGEMENT…774
Eyes…780
NURSING MANAGEMENT…780
Ears…783
Nose…785
Supporting a Hygienic Environment…785
Making Beds…787
SKILL 33-1 Bathing an Adult or Pediatric Client…749
SKILL 33-2 Providing Perineal-Genital Care…755
SKILL 33-3 Providing Foot Care…761
SKILL 33-4 Brushing and Flossing the Teeth…769
SKILL 33-5 Providing Special Oral Care for the Unconscious Client…772
SKILL 33-6 Providing Hair Care for Clients…777
SKILL 33-7 Shampooing the Hair of a Client Confined to Bed…778
SKILL 33-8 Removing, Cleaning, and Inserting a Hearing Aid…784
SKILL 33-9 Changing an Unoccupied Bed…788
SKILL 33-10 Changing an Occupied Bed…792

CHAPTER 34 Diagnostic Testing… 797

Diagnostic Blood Tests…799
Testing Phases…798
Specimen Collection…808
Visualization Procedures…817
Aspiration/Biopsy…819
SKILL 34-1 Obtaining A Capillary Blood Specimen to Measure Blood Glucose…806
SKILL 34-2 Collecting a Urine Specimen for Culture and Sensitivity by Clean Catch…811

CHAPTER 35 Medications… 829

Drug Standards…831
Legal Aspects of Drug Administration…832
Effects of Drugs…833
Drug Misuse…834
Actions of Drugs on the Body…834
Factors Affecting Medication Action…836
Routes of Administration…838
Medication Orders…840
Systems of Measurement…842
Administering Medications Safely…846
Oral Medications…852
Nasogastric and Gastrostomy Medications…856
Parenteral Medications…856
Respiratory Inhalation…895
Irrigations…897
SKILL 35-1 Administering Oral Medication…852
SKILL 35-2 Preparing Medications from Ampules…862
SKILL 35-3 Preparing Medications from Vials…863
SKILL 35-4 Mixing Medications Using One Syringe…865
SKILL 35-5 Administering an Intradermal Injection for Skin Tests…867
SKILL 35-6 Administering a Subcutaneous Injection…870
SKILL 35-7 Administering an Intramuscular Injection…876
SKILL 35-8 Adding Medications to Intravenous Fluid Containers…878
SKILL 35-9 Administering Intravenous Medications Using IV Push…882
SKILL 35-10 Administering Ophthalmic Instillations…887
SKILL 35-11 Administering Otic Instillations…890
SKILL 35-12 Administering Vaginal Instillations…893

CHAPTER 36 Skin Integrity and Wound Care… 902

Skin Integrity…903
Types of Wounds…903
Pressure Ulcers…904
Wound Healing…908
NURSING MANAGEMENT…912
SKILL 36-1 Obtaining a Wound Drainage Specimen for Culture…915
SKILL 36-2 Irrigating a Wound…925

CHAPTER 37 Perioperative Nursing… 939

Types of Surgery…940
Preoperative Phase…942
Inoperative Phase…953
NURSING MANAGEMENT…942
NURSING MANAGEMENT…954
Postoperative Phase…955
NURSING MANAGEMENT…957
SKILL 37-1 Teaching Moving, Leg Exercises, Deep Breathing, and Coughing…946
SKILL 37-2 Applying Antiemboli Stockings…951
SKILL 37-3 Managing Gastrointestinal Suction…965
SKILL 37-4 Cleaning a Sutured Wound and Applying a Sterile Dressing…968

UNIT 9 Promoting Psychosocial Health… 978

CHAPTER 38 Sensory Perception… 980

Components of the Sensory Experience…981
Sensory Alterations…982
Factors Affecting Sensory Function…983
NURSING MANAGEMENT…983

CHAPTER 39 Self-Concept… 1002

Self Concept…1003
Formation of Self-Concept…1003
Components of Self-Concept…1005
Factors that Affect Self-Concept…1006
NURSING MANAGEMENT…1008

CHAPTER 40 Sexuality… 1018

Development of Sexuality…1019
Varieties of Sexuality…1023
Factors Influencing Sexuality…1025
Sexual Response Cycle…1026
Altered Sexual Function…1027
NURSING MANAGEMENT…1030

CHAPTER 41 Spirituality… 1041

Spirituality Described…1042
Related Concepts…1044
Spiritual Development…1044
Spiritual Practices Affecting Nursing Care…1045
Spiritual Health and the Nursing Process…1048
NURSING MANAGEMENT…1048

CHAPTER 42 Stress and Coping… 1060

Concept of Stress…1061
Models of Stress…1061
Indicators of Stress…1064
Coping…1068
NURSING MANAGEMENT…1069
CHAPTER 43 Loss, Grieving, and Death… 1080
Loss and Grief…1081
NURSING MANAGEMENT…1086
Dying and Death…1090
NURSING MANAGEMENT…1092

UNIT 10 Promoting Physiologic Health… 1102

CHAPTER 44 Activity and Exercise… 1104

Normal Movement…1106
Exercise…1107
Factors Affecting Body Alignment and Activity…1116
Effects of Immobility…1117
NURSING MANAGEMENT…1121
SKILL 44-1 Moving a Client Up in Bed…1135
SKILL 44-2 Turning a Client to a Lateral or Prone Position in Bed…1137
SKILL 44-3 Logrolling a Client…1138
SKILL 44-4 Assisting the Client to Sit on the Side of the Bed (Dangling)…1139
SKILL 44-5 Transferring Between Bed and Chair…1142
SKILL 44-6 Transferring Between Bed and Stretcher…1144
SKILL 44-7 Assisting the Client to Ambulate…1149

CHAPTER 45 Sleep… 1163

Physiology of Sleep…1164
Functions of Sleep…1166
Normal Sleep Patterns and Requirements…1166
Factors Affecting Sleep…1169
Common Sleep Disorders…1171
NURSING MANAGEMENT…1174

CHAPTER 46 Pain Management… 1186

The Nature of Pain…1187
Physiology of Pain…1190
NURSING MANAGEMENT…1196
SKILL 46-1 Providing a Back Massage…1219

CHAPTER 47 Nutrition… 1231

Essential Nutrients…1232
Energy Balance…1235
Body Weight and Body Mass Standards…1236
Factors Affecting Nutrition…1237
Nutritional Variations Throughout the Life Cycle…1240
Standards for a Healthy Diet…1246
Altered Nutrition…1251
NURSING MANAGEMENT…1252
SKILL 47-1 Inserting a Nasogastric Tube…1266
SKILL 47-2 Removing a Nasogastric Tube…1269
SKILL 47-3 Administering a Tube Feeding…1272
SKILL 47-4 Administering a Gastrostomy or Jejunostomy Feeding…1274

CHAPTER 48 Urinary Elimination… 1284

Physiology of Urinary Elimination…1285
Factors Affecting Voiding…1288
Altered Urine Production…1290
Altered Urinary Elimination…1290
NURSING MANAGEMENT…1292
SKILL 48-1 Applying an External Catheter…1301
SKILL 48-2 Performing Urethral Urinary Catheterization…1304
SKILL 48-3 Performing Bladder Irrigation…1311

CHAPTER 49 Fecal Elimination… 1322

Physiology of Defecation…1323
Factors that Affect Defecation…1326
Fecal Elimination Problems…1328
Bowel Diversion Ostomies…1330
NURSING MANAGEMENT…1333
SKILL 49-1 Administering an Enema…1341
SKILL 49-2 Changing a Bowel Diversion Ostomy Appliance…1346

CHAPTER 50 Oxygenation… 1356

Structure and Function of the Respiratory
System…1357
Respiratory Regulation…1361
Factors Affecting Respiratory Function…1361
Alterations in Respiratory Function…1363
NURSING MANAGEMENT…1364
SKILL 50-1 Administering Oxygen by Cannula, Face Mask, or Face Tent…1376
SKILL 50-2 Oropharygneal, Nasopharygneal, and Nasotracheal Suctioning…1382
SKILL 50-3 Suctioning a Tracheostomy or Endotracheal Tube…1386
SKILL 50-4 Providing Tracheostomy Care…1390

CHAPTER 51 Circulation… 1401

Physiology of the Cardiovascular System…1402
Life Span Considerations…1408
Factors Affecting Cardiovascular Function…1408
Alterations in Cardiovascular Function…1411
NURSING MANAGEMENT…1413
SKILL 51-1 Sequential Compression Devices…1417

CHAPTER 52 Fluid, Electrolyte, and AcidBase Balance… 1423

Body Fluids and Electrolytes…1424
AcidBase Balance…1432
Factors Affecting Body Fluids, Electrolytes, and
AcidBase Balance…1434
Disturbances in Fluid Volume, Electrolyte, and AcidBase Balances…1435
NURSING MANAGEMENT…1443
SKILL 52-1 Starting an Intravenous Infusion…1461
SKILL 52-2 Monitoring an Intravenous Infusion…1467
SKILL 52-3 Changing an Intravenous Container, Tubing, and Dressing…1468
SKILL 52-4 Discontinuing an Intravenous Infusion…1470
SKILL 52-5 Changing an Intravenous Catheter to an Intermittent Infusion Lock…1471
SKILL 52-6 Initiating, Maintaining, and Terminating a Blood Transfusion Using a Y-Set…1475

APPENDIX A Answers to Anatomy & Physiology Review, Critical Thinking Possibilities,

and Answers to Test Your Knowledge…1484
APPENDIX B Measurement Scales Used in NOC…1529
APPENDIX C 20072008 NANDA-Approved Nursing Diagnoses…1530