,Study Guide for
Medical-Surgical Nursing:
Assessment and
Management of Clinical
Problems
Ninth Edition
Prepared by:
Susan A. Sandstrom, RN, MSN, BC, CNE
Associate Professor in Nursing, Retired
College of Saint Mary
Omaha, Nebraska
Sharon L. Lewis, RN, PhD, FAAN
Shannon Ruff Dirksen, RN, PhD, FAAN
Margaret McLean Heitkemper, RN, PhD, FAAN Linda
Bucher, RN, PhD, CEN, CNE
Reviewed by:
Charles D. Rogers, RN, MSN
Advanced Cardiac Life Support Provider
Assistant Professor of Nursing
Morehead State University
Morehead, Kentucky
Collin Bowman-Woodall, RN, MS
Assistant Professor
Samuel Merritt University
San Francisco Peninsula Campus
San Mateo, California
, St. Louis, Missouri 63043 3251
STUDY GUIDE FOR MEDICAL-SURGICAL NURSING: ISBN: 978-0-323-09147-3 Riverport Lane
ASSESSMENT AND MANAGEMENT OF CLINICAL PROBLEMS
Copyright © 2014 by Mosby, an imprint of Elsevier Inc. All rights reserved.
Copyright © 2011, 2007, 2004, 2000, 1996, 1992, 1987, 1983 by Mosby, Inc., an affiliate of Elsevier Inc.
All rights reserved. No part of this publication may be reproduced or transmitted in any form or by any means,
electronic or mechanical, including photocopy, recording, or any information storage and retrieval system, without
permission in writing from the publisher. Details on how to seek permission, further information about the
Publisher’s permissions policies and our arrangements with organizations such as the Copyright Clearance Center
and the Copyright Licensing Agency, can be found at our website: www.elsevier.com/permissions.
This book and the individual contributions contained in it are protected under copyright by the Publisher (other than
as may be noted herein).
Although for mechanical reasons all pages of this publication are perforated, only those pages imprinted with an Elsevier
Inc. copyright notice are intended for removal.
Notices
Knowledge and best practice in this field are constantly changing. As new research and experience broaden our
understanding, changes in research methods, professional practices, or medical treatment may become
necessary.
Practitioners and researchers must always rely on their own experience and knowledge in evaluating and using
any information, methods, compounds, or experiments described herein. In using such information or methods
they should be mindful of their own safety and the safety of others, including parties for whom they have a
professional responsibility.
With respect to any drug or pharmaceutical products identified, readers are advised to check the most current
information provided (i) on procedures featured or (ii) by the manufacturer of each product to be administered,
to verify the recommended dose or formula, the method and duration of administration, and contraindications. It
is the responsibility of practitioners, relying on their own experience and knowledge of their patients, to make
diagnoses, to determine dosages and the best treatment for each individual patient, and to take all appropriate
safety precautions.
To the fullest extent of the law, neither the Publisher nor the authors, contributors, or editors, assume any
liability for any injury and/or damage to persons or property as a matter of products liability, negligence or
otherwise, or from any use or operation of any methods, products, instructions, or ideas contained in the material
herein.
NANDA International Nursing Diagnoses: Definitions and Classifications 2012-2014; Herdman T.H. (ED);
copyright © 2012, 1994-2012 NANDA International; published by John Wiley & Sons, Limited.
ISBN: 9780323091473
Executive Content Strategist: Kristin Geen
Content Manager: Jamie Randall
Associate Content Development Specialist: Melissa Rawe
Publishing Services Manager: Jeff Patterson
Project Manager: Megan Isenberg
Design Direction: Maggie Reid
Cover Designer: Maggie Reid
, Printed in the United States of America
Last digit is the print number: 9 8 7
6 5 4 3 2 1
Contents
Section 1: Concepts in Nursing Practice
1 Professional Nursing Practice, 1
2 Health Disparities and Culturally Competent Care, 5
3 Health History and Physical Examination, 8
4 Patient and Caregiver Teaching, 11
5 Chronic Illness and Older Adults, 15
6 Complementary and Alternative Therapies, 19
7 Stress and Stress Management, 22
8 Sleep and Sleep Disorders, 26
9 Pain, 29
10 Palliative Care at End of Life, 33
11 Substance Abuse, 36
Section 2: Pathophysiologic Mechanisms of Disease
12 Inflammation and Wound Healing, 40
13 Genetics and Genomics, 44
14 Altered Immune Responses and Transplantation, 47
15 Infection and Human Immunodeficiency Virus Infection, 51
16 Cancer, 55
17 Fluid, Electrolyte, and Acid-Base Imbalances, 60
Section 3: Perioperative Care
18 Nursing Management: Preoperative Care, 66
19 Nursing Management: Intraoperative Care, 69 20 Nursing Management: Postoperative Care, 72
Section 4: Problems Related to Altered Sensory Input
21 Nursing Assessment: Visual and Auditory Systems, 75
22 Nursing Management: Visual and Auditory Problems, 80
23 Nursing Assessment: Integumentary System, 85
24 Nursing Management: Integumentary Problems, 88
25 Nursing Management: Burns, 92
Section 5: Problems of Oxygenation: Ventilation
26 Nursing Assessment: Respiratory System, 97
27 Nursing Management: Upper Respiratory Problems, 101
28 Nursing Management: Lower Respiratory Problems, 105
29 Nursing Management: Obstructive Pulmonary Diseases, 111
Section 6: Problems of Oxygenation: Transport
30 Nursing Assessment: Hematologic System, 117
31 Nursing Management: Hematologic Problems, 120
Section 7: Problems of Oxygenation: Perfusion
32 Nursing Assessment: Cardiovascular System, 127
33 Nursing Management: Hypertension, 134
34 Nursing Management: Coronary Artery Disease and Acute Coronary Syndrome, 138
35 Nursing Management: Heart Failure, 145
36 Nursing Management: Dysrhythmias, 149
Medical-Surgical Nursing:
Assessment and
Management of Clinical
Problems
Ninth Edition
Prepared by:
Susan A. Sandstrom, RN, MSN, BC, CNE
Associate Professor in Nursing, Retired
College of Saint Mary
Omaha, Nebraska
Sharon L. Lewis, RN, PhD, FAAN
Shannon Ruff Dirksen, RN, PhD, FAAN
Margaret McLean Heitkemper, RN, PhD, FAAN Linda
Bucher, RN, PhD, CEN, CNE
Reviewed by:
Charles D. Rogers, RN, MSN
Advanced Cardiac Life Support Provider
Assistant Professor of Nursing
Morehead State University
Morehead, Kentucky
Collin Bowman-Woodall, RN, MS
Assistant Professor
Samuel Merritt University
San Francisco Peninsula Campus
San Mateo, California
, St. Louis, Missouri 63043 3251
STUDY GUIDE FOR MEDICAL-SURGICAL NURSING: ISBN: 978-0-323-09147-3 Riverport Lane
ASSESSMENT AND MANAGEMENT OF CLINICAL PROBLEMS
Copyright © 2014 by Mosby, an imprint of Elsevier Inc. All rights reserved.
Copyright © 2011, 2007, 2004, 2000, 1996, 1992, 1987, 1983 by Mosby, Inc., an affiliate of Elsevier Inc.
All rights reserved. No part of this publication may be reproduced or transmitted in any form or by any means,
electronic or mechanical, including photocopy, recording, or any information storage and retrieval system, without
permission in writing from the publisher. Details on how to seek permission, further information about the
Publisher’s permissions policies and our arrangements with organizations such as the Copyright Clearance Center
and the Copyright Licensing Agency, can be found at our website: www.elsevier.com/permissions.
This book and the individual contributions contained in it are protected under copyright by the Publisher (other than
as may be noted herein).
Although for mechanical reasons all pages of this publication are perforated, only those pages imprinted with an Elsevier
Inc. copyright notice are intended for removal.
Notices
Knowledge and best practice in this field are constantly changing. As new research and experience broaden our
understanding, changes in research methods, professional practices, or medical treatment may become
necessary.
Practitioners and researchers must always rely on their own experience and knowledge in evaluating and using
any information, methods, compounds, or experiments described herein. In using such information or methods
they should be mindful of their own safety and the safety of others, including parties for whom they have a
professional responsibility.
With respect to any drug or pharmaceutical products identified, readers are advised to check the most current
information provided (i) on procedures featured or (ii) by the manufacturer of each product to be administered,
to verify the recommended dose or formula, the method and duration of administration, and contraindications. It
is the responsibility of practitioners, relying on their own experience and knowledge of their patients, to make
diagnoses, to determine dosages and the best treatment for each individual patient, and to take all appropriate
safety precautions.
To the fullest extent of the law, neither the Publisher nor the authors, contributors, or editors, assume any
liability for any injury and/or damage to persons or property as a matter of products liability, negligence or
otherwise, or from any use or operation of any methods, products, instructions, or ideas contained in the material
herein.
NANDA International Nursing Diagnoses: Definitions and Classifications 2012-2014; Herdman T.H. (ED);
copyright © 2012, 1994-2012 NANDA International; published by John Wiley & Sons, Limited.
ISBN: 9780323091473
Executive Content Strategist: Kristin Geen
Content Manager: Jamie Randall
Associate Content Development Specialist: Melissa Rawe
Publishing Services Manager: Jeff Patterson
Project Manager: Megan Isenberg
Design Direction: Maggie Reid
Cover Designer: Maggie Reid
, Printed in the United States of America
Last digit is the print number: 9 8 7
6 5 4 3 2 1
Contents
Section 1: Concepts in Nursing Practice
1 Professional Nursing Practice, 1
2 Health Disparities and Culturally Competent Care, 5
3 Health History and Physical Examination, 8
4 Patient and Caregiver Teaching, 11
5 Chronic Illness and Older Adults, 15
6 Complementary and Alternative Therapies, 19
7 Stress and Stress Management, 22
8 Sleep and Sleep Disorders, 26
9 Pain, 29
10 Palliative Care at End of Life, 33
11 Substance Abuse, 36
Section 2: Pathophysiologic Mechanisms of Disease
12 Inflammation and Wound Healing, 40
13 Genetics and Genomics, 44
14 Altered Immune Responses and Transplantation, 47
15 Infection and Human Immunodeficiency Virus Infection, 51
16 Cancer, 55
17 Fluid, Electrolyte, and Acid-Base Imbalances, 60
Section 3: Perioperative Care
18 Nursing Management: Preoperative Care, 66
19 Nursing Management: Intraoperative Care, 69 20 Nursing Management: Postoperative Care, 72
Section 4: Problems Related to Altered Sensory Input
21 Nursing Assessment: Visual and Auditory Systems, 75
22 Nursing Management: Visual and Auditory Problems, 80
23 Nursing Assessment: Integumentary System, 85
24 Nursing Management: Integumentary Problems, 88
25 Nursing Management: Burns, 92
Section 5: Problems of Oxygenation: Ventilation
26 Nursing Assessment: Respiratory System, 97
27 Nursing Management: Upper Respiratory Problems, 101
28 Nursing Management: Lower Respiratory Problems, 105
29 Nursing Management: Obstructive Pulmonary Diseases, 111
Section 6: Problems of Oxygenation: Transport
30 Nursing Assessment: Hematologic System, 117
31 Nursing Management: Hematologic Problems, 120
Section 7: Problems of Oxygenation: Perfusion
32 Nursing Assessment: Cardiovascular System, 127
33 Nursing Management: Hypertension, 134
34 Nursing Management: Coronary Artery Disease and Acute Coronary Syndrome, 138
35 Nursing Management: Heart Failure, 145
36 Nursing Management: Dysrhythmias, 149
