,Study Guide for
l l
Medical-
Surgical Nursing: Assessment
l l l
and Management ofClinicalPro
l l l l
blems
Ninth Edition
l
Preparedlby:
SusanlA.lSandstrom,lRN,lMSN,lBC,lCNElAs
sociatelProfessorlinlNursing,lRetiredlCollegel
oflSaintlMary
Omaha,l Nebraska
SharonlL.lLewis,lRN,lPhD,lFAANlShannonl
RufflDirksen,lRN,lPhD,lFAAN
MargaretlMcLeanlHeitkemper,lRN,lPhD,lFAANlLinda
lBucher,lRN,lPhD,lCEN,lCNE
Reviewedlby:
CharleslD.lRogers,lRN,lMSNlAdvancedl
CardiaclLifelSupportlProviderlAssistantlPr
ofessorloflNursinglMoreheadlStatelUnive
rsity
Morehead,l Kentucky
CollinlBowman-Woodall,lRN,lMS
AssistantlProfessorlSam
uellMerrittlUniversity
SanlFranciscolPeninsulalCampuslSanl
Mateo,lCalifornia
, 3251lRiverportlLane
St.lLouis,lMissouril63043
STUDYlGUIDElFORlMEDICAL-SURGICALlNURSING: ISBN:l978-0-323-09147-
3l ASSESSMENTlANDlMANAGEMENTlOFlCLINICALlPROBLEMS
Copyrightl©l2014lbylMosby,lanlimprintloflElsevierlInc.lAlllrightslreserved.
Copyrightl©l2011,l2007,l2004,l2000,l1996,l1992,l1987,l1983lbylMosby,lInc.,lanlaffiliateloflElsevierlInc.
Alllrightslreserved.lNolpartloflthislpublicationlmaylbelreproducedlorltransmittedlinlanylformlorlbylanylmeans,l electroni
clorlmechanical,lincludinglphotocopy,lrecording,lorlanylinformationlstoragelandlretrievallsystem,lwithoutl permissionlin
lwritinglfromlthelpublisher.lDetailslonlhowltolseeklpermission,lfurtherlinformationlaboutlthel Publisher’slpermissionslp
olicieslandlourlarrangementslwithlorganizationslsuchlaslthelCopyrightlClearancelCenterl andlthelCopyrightlLicensingl
Agency,lcanlbelfoundlatlourlwebsite:lwww.elsevier.com/permissions.
ThislbooklandlthelindividuallcontributionslcontainedlinlitlarelprotectedlunderlcopyrightlbylthelPublisherl(otherl thanl
aslmaylbelnotedlherein).
Althoughlforlmechanicallreasonslalllpagesloflthislpublicationlarelperforated,lonlylthoselpageslimprintedlwithlanl Else
vierlInc.lcopyrightlnoticelarelintendedlforlremoval.
Notices
Knowledgelandlbestlpracticelinlthislfieldlarelconstantlylchanging.lAslnewlresearchlandlexperiencelbroadenl ourl
understanding,lchangeslinlresearchlmethods,lprofessionallpractices,lorlmedicalltreatmentlmaylbecomel necessa
ry.
Practitionerslandlresearcherslmustlalwayslrelylonltheirlownlexperiencelandlknowledgelinlevaluatinglandl usi
nglanylinformation,lmethods,lcompounds,lorlexperimentsldescribedlherein.lInlusinglsuchlinformationlorl meth
odsltheylshouldlbelmindfullofltheirlownlsafetylandlthelsafetyloflothers,lincludinglpartieslforlwhomltheyl havelalp
rofessionallresponsibility.
Withlrespectltolanyldruglorlpharmaceuticallproductslidentified,lreaderslareladvisedltolchecklthelmostl current
linformationlprovidedl(i)lonlprocedureslfeaturedlorl(ii)lbylthelmanufacturerlofleachlproductltolbel administered,l
tolverifylthelrecommendedldoselorlformula,lthelmethodlandldurationlofladministration,landl contraindications.lI
tlislthelresponsibilityloflpractitioners,lrelyinglonltheirlownlexperiencelandlknowledgelofl theirlpatients,ltolmakel
diagnoses,ltoldetermineldosageslandlthelbestltreatmentlforleachlindividuallpatient,landl toltakelalllappropriatelsa
fetylprecautions.
Tolthelfullestlextentloflthellaw,lneitherlthelPublisherlnorlthelauthors,lcontributors,lorleditors,lassumelanyl liabil
itylforlanylinjuryland/orldamageltolpersonslorlpropertylaslalmatterloflproductslliability,lnegligencelorl otherwise
,lorlfromlanyluselorloperationloflanylmethods,lproducts,linstructions,lorlideaslcontainedlinlthel materiallherein.
NANDAlInternationallNursinglDiagnoses:lDefinitionslandlClassificationsl2012-
2014;lHerdmanlT.H.l(ED);l copyrightl©l2012,l1994-
2012lNANDAlInternational;lpublishedlbylJohnlWileyl&lSons,lLimited.
ISBN:l9780323091473
ExecutivelContentlStrategist:lKristinlGeen
ContentlManager:lJamielRandall
AssociatelContentlDevelopmentlSpecialist:lMelissalRawe
PublishinglServiceslManager:lJefflPatterson
ProjectlManager:lMeganlIsenberg
l DesignlDirection:lMaggielReidl
CoverlDesigner:lMaggielReid
PrintedlinlthelUnitedlStatesloflAmerica
Lastldigitlislthelprintlnumber:l l 9l l 8l l 7l l 6l l 5l l 4l l 3l l 2l l 1
, Contents
Sectionl1:lConceptslinlNursinglPractice
1 ProfessionallNursinglPractice,l1
2 HealthlDisparitieslandlCulturallylCompetentlCare,l5
3 HealthlHistorylandlPhysicallExamination,l8
4 PatientlandlCaregiverlTeaching,l11
5 ChroniclIllnesslandlOlderlAdults,l15
6 ComplementarylandlAlternativelTherapies,l19
7 StresslandlStresslManagement,l22
8 SleeplandlSleeplDisorders,l26
9 Pain,l29
10 PalliativelCarelatlEndloflLife,l33
11 SubstancelAbuse,l36
Sectionl2:lPathophysiologiclMechanismsloflDisease
12 InflammationlandlWoundlHealing,l40
13 GeneticslandlGenomics,l44
14 AlteredlImmunelResponseslandlTransplantation,l47
15 InfectionlandlHumanlImmunodeficiencylViruslInfection,l51
16 Cancer,l55
17 Fluid,lElectrolyte,landlAcid-BaselImbalances,l60
Sectionl3:lPerioperativelCare
18 NursinglManagement:lPreoperativelCare,l66
19 NursinglManagement:lIntraoperativelCare,l69
20 NursinglManagement:lPostoperativelCare,l72
Sectionl4:lProblemslRelatedltolAlteredlSensorylInput
21 NursinglAssessment:lVisuallandlAuditorylSystems,l75
22 NursinglManagement:lVisuallandlAuditorylProblems,l80
23 NursinglAssessment:lIntegumentarylSystem,l85
24 NursinglManagement:lIntegumentarylProblems,l88
25 NursinglManagement:lBurns,l92
Sectionl5:lProblemsloflOxygenation:lVentilation
26 NursinglAssessment:lRespiratorylSystem,l97
27 NursinglManagement:lUpperlRespiratorylProblems,l101
28 NursinglManagement:lLowerlRespiratorylProblems,l105
29 NursinglManagement:lObstructivelPulmonarylDiseases,l111
Sectionl6:lProblemsloflOxygenation:lTransport
30 NursinglAssessment:lHematologiclSystem,l117
31 NursinglManagement:lHematologiclProblems,l120
Sectionl7:lProblemsloflOxygenation:lPerfusion
32 NursinglAssessment:lCardiovascularlSystem,l127
33 NursinglManagement:lHypertension,l134
34 NursinglManagement:lCoronarylArterylDiseaselandlAcutelCoronarylSyndrome,l138
35 NursinglManagement:lHeartlFailure,l145
36 NursinglManagement:lDysrhythmias,l149
37 NursinglManagement:lInflammatorylandlStructurallHeartlDisorders,l156
38 NursinglManagement:lVascularlDisorders,l161
iii
l l
Medical-
Surgical Nursing: Assessment
l l l
and Management ofClinicalPro
l l l l
blems
Ninth Edition
l
Preparedlby:
SusanlA.lSandstrom,lRN,lMSN,lBC,lCNElAs
sociatelProfessorlinlNursing,lRetiredlCollegel
oflSaintlMary
Omaha,l Nebraska
SharonlL.lLewis,lRN,lPhD,lFAANlShannonl
RufflDirksen,lRN,lPhD,lFAAN
MargaretlMcLeanlHeitkemper,lRN,lPhD,lFAANlLinda
lBucher,lRN,lPhD,lCEN,lCNE
Reviewedlby:
CharleslD.lRogers,lRN,lMSNlAdvancedl
CardiaclLifelSupportlProviderlAssistantlPr
ofessorloflNursinglMoreheadlStatelUnive
rsity
Morehead,l Kentucky
CollinlBowman-Woodall,lRN,lMS
AssistantlProfessorlSam
uellMerrittlUniversity
SanlFranciscolPeninsulalCampuslSanl
Mateo,lCalifornia
, 3251lRiverportlLane
St.lLouis,lMissouril63043
STUDYlGUIDElFORlMEDICAL-SURGICALlNURSING: ISBN:l978-0-323-09147-
3l ASSESSMENTlANDlMANAGEMENTlOFlCLINICALlPROBLEMS
Copyrightl©l2014lbylMosby,lanlimprintloflElsevierlInc.lAlllrightslreserved.
Copyrightl©l2011,l2007,l2004,l2000,l1996,l1992,l1987,l1983lbylMosby,lInc.,lanlaffiliateloflElsevierlInc.
Alllrightslreserved.lNolpartloflthislpublicationlmaylbelreproducedlorltransmittedlinlanylformlorlbylanylmeans,l electroni
clorlmechanical,lincludinglphotocopy,lrecording,lorlanylinformationlstoragelandlretrievallsystem,lwithoutl permissionlin
lwritinglfromlthelpublisher.lDetailslonlhowltolseeklpermission,lfurtherlinformationlaboutlthel Publisher’slpermissionslp
olicieslandlourlarrangementslwithlorganizationslsuchlaslthelCopyrightlClearancelCenterl andlthelCopyrightlLicensingl
Agency,lcanlbelfoundlatlourlwebsite:lwww.elsevier.com/permissions.
ThislbooklandlthelindividuallcontributionslcontainedlinlitlarelprotectedlunderlcopyrightlbylthelPublisherl(otherl thanl
aslmaylbelnotedlherein).
Althoughlforlmechanicallreasonslalllpagesloflthislpublicationlarelperforated,lonlylthoselpageslimprintedlwithlanl Else
vierlInc.lcopyrightlnoticelarelintendedlforlremoval.
Notices
Knowledgelandlbestlpracticelinlthislfieldlarelconstantlylchanging.lAslnewlresearchlandlexperiencelbroadenl ourl
understanding,lchangeslinlresearchlmethods,lprofessionallpractices,lorlmedicalltreatmentlmaylbecomel necessa
ry.
Practitionerslandlresearcherslmustlalwayslrelylonltheirlownlexperiencelandlknowledgelinlevaluatinglandl usi
nglanylinformation,lmethods,lcompounds,lorlexperimentsldescribedlherein.lInlusinglsuchlinformationlorl meth
odsltheylshouldlbelmindfullofltheirlownlsafetylandlthelsafetyloflothers,lincludinglpartieslforlwhomltheyl havelalp
rofessionallresponsibility.
Withlrespectltolanyldruglorlpharmaceuticallproductslidentified,lreaderslareladvisedltolchecklthelmostl current
linformationlprovidedl(i)lonlprocedureslfeaturedlorl(ii)lbylthelmanufacturerlofleachlproductltolbel administered,l
tolverifylthelrecommendedldoselorlformula,lthelmethodlandldurationlofladministration,landl contraindications.lI
tlislthelresponsibilityloflpractitioners,lrelyinglonltheirlownlexperiencelandlknowledgelofl theirlpatients,ltolmakel
diagnoses,ltoldetermineldosageslandlthelbestltreatmentlforleachlindividuallpatient,landl toltakelalllappropriatelsa
fetylprecautions.
Tolthelfullestlextentloflthellaw,lneitherlthelPublisherlnorlthelauthors,lcontributors,lorleditors,lassumelanyl liabil
itylforlanylinjuryland/orldamageltolpersonslorlpropertylaslalmatterloflproductslliability,lnegligencelorl otherwise
,lorlfromlanyluselorloperationloflanylmethods,lproducts,linstructions,lorlideaslcontainedlinlthel materiallherein.
NANDAlInternationallNursinglDiagnoses:lDefinitionslandlClassificationsl2012-
2014;lHerdmanlT.H.l(ED);l copyrightl©l2012,l1994-
2012lNANDAlInternational;lpublishedlbylJohnlWileyl&lSons,lLimited.
ISBN:l9780323091473
ExecutivelContentlStrategist:lKristinlGeen
ContentlManager:lJamielRandall
AssociatelContentlDevelopmentlSpecialist:lMelissalRawe
PublishinglServiceslManager:lJefflPatterson
ProjectlManager:lMeganlIsenberg
l DesignlDirection:lMaggielReidl
CoverlDesigner:lMaggielReid
PrintedlinlthelUnitedlStatesloflAmerica
Lastldigitlislthelprintlnumber:l l 9l l 8l l 7l l 6l l 5l l 4l l 3l l 2l l 1
, Contents
Sectionl1:lConceptslinlNursinglPractice
1 ProfessionallNursinglPractice,l1
2 HealthlDisparitieslandlCulturallylCompetentlCare,l5
3 HealthlHistorylandlPhysicallExamination,l8
4 PatientlandlCaregiverlTeaching,l11
5 ChroniclIllnesslandlOlderlAdults,l15
6 ComplementarylandlAlternativelTherapies,l19
7 StresslandlStresslManagement,l22
8 SleeplandlSleeplDisorders,l26
9 Pain,l29
10 PalliativelCarelatlEndloflLife,l33
11 SubstancelAbuse,l36
Sectionl2:lPathophysiologiclMechanismsloflDisease
12 InflammationlandlWoundlHealing,l40
13 GeneticslandlGenomics,l44
14 AlteredlImmunelResponseslandlTransplantation,l47
15 InfectionlandlHumanlImmunodeficiencylViruslInfection,l51
16 Cancer,l55
17 Fluid,lElectrolyte,landlAcid-BaselImbalances,l60
Sectionl3:lPerioperativelCare
18 NursinglManagement:lPreoperativelCare,l66
19 NursinglManagement:lIntraoperativelCare,l69
20 NursinglManagement:lPostoperativelCare,l72
Sectionl4:lProblemslRelatedltolAlteredlSensorylInput
21 NursinglAssessment:lVisuallandlAuditorylSystems,l75
22 NursinglManagement:lVisuallandlAuditorylProblems,l80
23 NursinglAssessment:lIntegumentarylSystem,l85
24 NursinglManagement:lIntegumentarylProblems,l88
25 NursinglManagement:lBurns,l92
Sectionl5:lProblemsloflOxygenation:lVentilation
26 NursinglAssessment:lRespiratorylSystem,l97
27 NursinglManagement:lUpperlRespiratorylProblems,l101
28 NursinglManagement:lLowerlRespiratorylProblems,l105
29 NursinglManagement:lObstructivelPulmonarylDiseases,l111
Sectionl6:lProblemsloflOxygenation:lTransport
30 NursinglAssessment:lHematologiclSystem,l117
31 NursinglManagement:lHematologiclProblems,l120
Sectionl7:lProblemsloflOxygenation:lPerfusion
32 NursinglAssessment:lCardiovascularlSystem,l127
33 NursinglManagement:lHypertension,l134
34 NursinglManagement:lCoronarylArterylDiseaselandlAcutelCoronarylSyndrome,l138
35 NursinglManagement:lHeartlFailure,l145
36 NursinglManagement:lDysrhythmias,l149
37 NursinglManagement:lInflammatorylandlStructurallHeartlDisorders,l156
38 NursinglManagement:lVascularlDisorders,l161
iii
