,Study11Guide11for
Medical-
Surgical Nursing: Assessmen
11 11
t and Management of Clinical
11 11 11 11 11
Problems
Ninth11Edition
Prepared11by:
Susan11A.11Sandstrom,11RN,11MSN,11BC,11
CNE11Associate11Professor11in11Nursing,11
Retired11College11of11Saint11Mary
Omaha,11 Nebraska
Sharon11L.11Lewis,11RN,11PhD,11FAAN11S
hannon11Ruff11Dirksen,11RN,11PhD,11FAAN
Margaret11McLean11Heitkemper,11RN,11PhD,11FAA
N11Linda11Bucher,11RN,11PhD,11CEN,11CNE
Reviewed11by:
Charles11D.11Rogers,11RN,11MSN11Ad
vanced11Cardiac11Life11Support11Provide
r11Assistant11Professor11of11Nursing11M
orehead11State11University
Morehead,1 1 Kentucky
Collin11Bowman-Woodall,11RN,11MS
Assistant11Professor11Sa
muel11Merritt11University
San11Francisco11Peninsula11Campus
11San11Mateo,11California
, 325111Riverport11Lane
St.11Louis,11Missouri1163043
STUDY11GUIDE11FOR11MEDICAL-SURGICAL11NURSING: ISBN:11978-0-323-09147-
31 1 ASSESSMENT11AND11MANAGEMENT11OF11CLINICAL11PROBLEMS
Copyright11©11201411by11Mosby,11an11imprint11of11Elsevier11Inc.11All11rights11reserved.
Copyright11©112011,112007,112004,112000,111996,111992,111987,11198311by11Mosby,11Inc.,11an11affiliate11of11Elsevier11Inc.
All11rights11reserved.11No11part11of11this11publication11may11be11reproduced11or11transmitted11in11any11form
11or11by11any11means,1 1 electronic11or11mechanical,11including11photocopy,11recording,11or11any11information1
1storage11and11retrieval11system,11without1 1 permission11in11writing11from11the11publisher.11Details11on11how
11to11seek11permission,11further11information11about11the1 1 Publisher’s11permissions11policies11and11our11arra
ngements11with11organizations11such11as11the11Copyright11Clearance11Center1 1 and11the11Copyright11Licensin
g11Agency,11can11be11found11at11our11website:11www.elsevier.com/permissions.
This11book11and11the11individual11contributions11contained11in11it11are11protected11under11copyright11by11th
e11Publisher11(other1 1 than11as11may11be11noted11herein).
Although11for11mechanical11reasons11all11pages11of11this11publication11are11perforated,11only11those11pages1
1imprinted11with11an1 1 Elsevier11Inc.11copyright11notice11are11intended11for11removal.
Notices
Knowledge11and11best11practice11in11this11field11are11constantly11changing.11As11new11research11and11e
xperience11broaden1 1 our11understanding,11changes11in11research11methods,11professional11practices,11o
r11medical11treatment11may11become1 1 necessary.
Practitioners11and11researchers11must11always11rely11on11their11own11experience11and11knowledge11i
n11evaluating11and1 1 using11any11information,11methods,11compounds,11or11experiments11described11h
erein.11In11using11such11information11or1 1 methods11they11should11be11mindful11of11their11own11safety
11and11the11safety11of11others,11including11parties11for11whom11they1 1 have11a11professional11responsi
bility.
With11respect11to11any11drug11or11pharmaceutical11products11identified,11readers11are11advised11to11
check11the11most1 1 current11information11provided11(i)11on11procedures11featured11or11(ii)11by11the11
manufacturer11of11each11product11to11be1 1 administered,11to11verify11the11recommended11dose11or11fo
rmula,11the11method11and11duration11of11administration,11and1 1 contraindications.11It11is11the11respons
ibility11of11practitioners,11relying11on11their11own11experience11and11knowledge11of1 1 their11patients,1
1to11make11diagnoses,11to11determine11dosages11and11the11best11treatment11for11each11individual11patie
nt,11and1 1 to11take11all11appropriate11safety11precautions.
To11the11fullest11extent11of11the11law,11neither11the11Publisher11nor11the11authors,11contributors,11or11
editors,11assume11any1 1 liability11for11any11injury11and/or11damage11to11persons11or11property11as11a1
1matter11of11products11liability,11negligence11or1 1 otherwise,11or11from11any11use11or11operation11of11
NANDA11International11Nursing11Diagnoses:11Definitions11and11Classifications112012-
2014;11Herdman11T.H.11(ED);1 1 copyright11©112012,111994-
201211NANDA11International;11published11by11John11Wiley11&11Sons,11Limited.
ISBN:119780323091473
Executive11Content11Strategist:11Kristin11Geen
Content11Manager:11Jamie11Randall
Associate11Content11Development11Specialist:11Melissa11Rawe
Publishing11Services11Manager:11Jeff11Patterson
Project11Manager:11Megan11Isen
berg1 1 Design11Direction:11Mag
gie11Reid1 1 Cover11Designer:11
Maggie11Reid
Printed11in11the11United11States11of11America
Last11digit11is11the11print11number:1 1 1 1 91 1 1 1 81 1 1 1 71 1 1 1 61 1 1 1 51 1 1 1 41 1 1 1 31 1 1 1 21 1 1 1 1
, Contents
Section111:11Concepts11in11Nursing11Practice
1 Professional11Nursing11Practice,111
2 Health11Disparities11and11Culturally11Competent11Care,115
3 Health11History11and11Physical11Examination,118
4 Patient11and11Caregiver11Teaching,1111
5 Chronic11Illness11and11Older11Adults,1115
6 Complementary11and11Alternative11Therapies,1119
7 Stress11and11Stress11Management,1122
8 Sleep11and11Sleep11Disorders,1126
9 Pain,1129
10 Palliative11Care11at11End11of11Life,1133
11 Substance11Abuse,1136
Section112:11Pathophysiologic11Mechanisms11of11Disease
12 Inflammation11and11Wound11Healing,1140
13 Genetics11and11Genomics,1144
14 Altered11Immune11Responses11and11Transplantation,1147
15 Infection11and11Human11Immunodeficiency11Virus11Infection,1151
16 Cancer,1155
17 Fluid,11Electrolyte,11and11Acid-Base11Imbalances,1160
Section113:11Perioperative11Care
18 Nursing11Management:11Preoperative11Care,1166
19 Nursing11Management:11Intraoperative11Care,1169
20 Nursing11Management:11Postoperative11Care,1172
Section114:11Problems11Related11to11Altered11Sensory11Input
21 Nursing11Assessment:11Visual11and11Auditory11Systems,1175
22 Nursing11Management:11Visual11and11Auditory11Problems,1180
23 Nursing11Assessment:11Integumentary11System,1185
24 Nursing11Management:11Integumentary11Problems,1188
25 Nursing11Management:11Burns,1192
Section115:11Problems11of11Oxygenation:11Ventilation
26 Nursing11Assessment:11Respiratory11System,1197
27 Nursing11Management:11Upper11Respiratory11Problems,11101
28 Nursing11Management:11Lower11Respiratory11Problems,11105
29 Nursing11Management:11Obstructive11Pulmonary11Diseases,11111
Section116:11Problems11of11Oxygenation:11Transport
30 Nursing11Assessment:11Hematologic11System,11117
31 Nursing11Management:11Hematologic11Problems,11120
Section117:11Problems11of11Oxygenation:11Perfusion
32 Nursing11Assessment:11Cardiovascular11System,11127
33 Nursing11Management:11Hypertension,11134
34 Nursing11Management:11Coronary11Artery11Disease11and11Acute11Coronary11Syndrome,11138
35 Nursing11Management:11Heart11Failure,11145
36 Nursing11Management:11Dysrhythmias,11149
37 Nursing11Management:11Inflammatory11and11Structural11Heart11Disorders,11156
38 Nursing11Management:11Vascular11Disorders,11161
iii
Medical-
Surgical Nursing: Assessmen
11 11
t and Management of Clinical
11 11 11 11 11
Problems
Ninth11Edition
Prepared11by:
Susan11A.11Sandstrom,11RN,11MSN,11BC,11
CNE11Associate11Professor11in11Nursing,11
Retired11College11of11Saint11Mary
Omaha,11 Nebraska
Sharon11L.11Lewis,11RN,11PhD,11FAAN11S
hannon11Ruff11Dirksen,11RN,11PhD,11FAAN
Margaret11McLean11Heitkemper,11RN,11PhD,11FAA
N11Linda11Bucher,11RN,11PhD,11CEN,11CNE
Reviewed11by:
Charles11D.11Rogers,11RN,11MSN11Ad
vanced11Cardiac11Life11Support11Provide
r11Assistant11Professor11of11Nursing11M
orehead11State11University
Morehead,1 1 Kentucky
Collin11Bowman-Woodall,11RN,11MS
Assistant11Professor11Sa
muel11Merritt11University
San11Francisco11Peninsula11Campus
11San11Mateo,11California
, 325111Riverport11Lane
St.11Louis,11Missouri1163043
STUDY11GUIDE11FOR11MEDICAL-SURGICAL11NURSING: ISBN:11978-0-323-09147-
31 1 ASSESSMENT11AND11MANAGEMENT11OF11CLINICAL11PROBLEMS
Copyright11©11201411by11Mosby,11an11imprint11of11Elsevier11Inc.11All11rights11reserved.
Copyright11©112011,112007,112004,112000,111996,111992,111987,11198311by11Mosby,11Inc.,11an11affiliate11of11Elsevier11Inc.
All11rights11reserved.11No11part11of11this11publication11may11be11reproduced11or11transmitted11in11any11form
11or11by11any11means,1 1 electronic11or11mechanical,11including11photocopy,11recording,11or11any11information1
1storage11and11retrieval11system,11without1 1 permission11in11writing11from11the11publisher.11Details11on11how
11to11seek11permission,11further11information11about11the1 1 Publisher’s11permissions11policies11and11our11arra
ngements11with11organizations11such11as11the11Copyright11Clearance11Center1 1 and11the11Copyright11Licensin
g11Agency,11can11be11found11at11our11website:11www.elsevier.com/permissions.
This11book11and11the11individual11contributions11contained11in11it11are11protected11under11copyright11by11th
e11Publisher11(other1 1 than11as11may11be11noted11herein).
Although11for11mechanical11reasons11all11pages11of11this11publication11are11perforated,11only11those11pages1
1imprinted11with11an1 1 Elsevier11Inc.11copyright11notice11are11intended11for11removal.
Notices
Knowledge11and11best11practice11in11this11field11are11constantly11changing.11As11new11research11and11e
xperience11broaden1 1 our11understanding,11changes11in11research11methods,11professional11practices,11o
r11medical11treatment11may11become1 1 necessary.
Practitioners11and11researchers11must11always11rely11on11their11own11experience11and11knowledge11i
n11evaluating11and1 1 using11any11information,11methods,11compounds,11or11experiments11described11h
erein.11In11using11such11information11or1 1 methods11they11should11be11mindful11of11their11own11safety
11and11the11safety11of11others,11including11parties11for11whom11they1 1 have11a11professional11responsi
bility.
With11respect11to11any11drug11or11pharmaceutical11products11identified,11readers11are11advised11to11
check11the11most1 1 current11information11provided11(i)11on11procedures11featured11or11(ii)11by11the11
manufacturer11of11each11product11to11be1 1 administered,11to11verify11the11recommended11dose11or11fo
rmula,11the11method11and11duration11of11administration,11and1 1 contraindications.11It11is11the11respons
ibility11of11practitioners,11relying11on11their11own11experience11and11knowledge11of1 1 their11patients,1
1to11make11diagnoses,11to11determine11dosages11and11the11best11treatment11for11each11individual11patie
nt,11and1 1 to11take11all11appropriate11safety11precautions.
To11the11fullest11extent11of11the11law,11neither11the11Publisher11nor11the11authors,11contributors,11or11
editors,11assume11any1 1 liability11for11any11injury11and/or11damage11to11persons11or11property11as11a1
1matter11of11products11liability,11negligence11or1 1 otherwise,11or11from11any11use11or11operation11of11
NANDA11International11Nursing11Diagnoses:11Definitions11and11Classifications112012-
2014;11Herdman11T.H.11(ED);1 1 copyright11©112012,111994-
201211NANDA11International;11published11by11John11Wiley11&11Sons,11Limited.
ISBN:119780323091473
Executive11Content11Strategist:11Kristin11Geen
Content11Manager:11Jamie11Randall
Associate11Content11Development11Specialist:11Melissa11Rawe
Publishing11Services11Manager:11Jeff11Patterson
Project11Manager:11Megan11Isen
berg1 1 Design11Direction:11Mag
gie11Reid1 1 Cover11Designer:11
Maggie11Reid
Printed11in11the11United11States11of11America
Last11digit11is11the11print11number:1 1 1 1 91 1 1 1 81 1 1 1 71 1 1 1 61 1 1 1 51 1 1 1 41 1 1 1 31 1 1 1 21 1 1 1 1
, Contents
Section111:11Concepts11in11Nursing11Practice
1 Professional11Nursing11Practice,111
2 Health11Disparities11and11Culturally11Competent11Care,115
3 Health11History11and11Physical11Examination,118
4 Patient11and11Caregiver11Teaching,1111
5 Chronic11Illness11and11Older11Adults,1115
6 Complementary11and11Alternative11Therapies,1119
7 Stress11and11Stress11Management,1122
8 Sleep11and11Sleep11Disorders,1126
9 Pain,1129
10 Palliative11Care11at11End11of11Life,1133
11 Substance11Abuse,1136
Section112:11Pathophysiologic11Mechanisms11of11Disease
12 Inflammation11and11Wound11Healing,1140
13 Genetics11and11Genomics,1144
14 Altered11Immune11Responses11and11Transplantation,1147
15 Infection11and11Human11Immunodeficiency11Virus11Infection,1151
16 Cancer,1155
17 Fluid,11Electrolyte,11and11Acid-Base11Imbalances,1160
Section113:11Perioperative11Care
18 Nursing11Management:11Preoperative11Care,1166
19 Nursing11Management:11Intraoperative11Care,1169
20 Nursing11Management:11Postoperative11Care,1172
Section114:11Problems11Related11to11Altered11Sensory11Input
21 Nursing11Assessment:11Visual11and11Auditory11Systems,1175
22 Nursing11Management:11Visual11and11Auditory11Problems,1180
23 Nursing11Assessment:11Integumentary11System,1185
24 Nursing11Management:11Integumentary11Problems,1188
25 Nursing11Management:11Burns,1192
Section115:11Problems11of11Oxygenation:11Ventilation
26 Nursing11Assessment:11Respiratory11System,1197
27 Nursing11Management:11Upper11Respiratory11Problems,11101
28 Nursing11Management:11Lower11Respiratory11Problems,11105
29 Nursing11Management:11Obstructive11Pulmonary11Diseases,11111
Section116:11Problems11of11Oxygenation:11Transport
30 Nursing11Assessment:11Hematologic11System,11117
31 Nursing11Management:11Hematologic11Problems,11120
Section117:11Problems11of11Oxygenation:11Perfusion
32 Nursing11Assessment:11Cardiovascular11System,11127
33 Nursing11Management:11Hypertension,11134
34 Nursing11Management:11Coronary11Artery11Disease11and11Acute11Coronary11Syndrome,11138
35 Nursing11Management:11Heart11Failure,11145
36 Nursing11Management:11Dysrhythmias,11149
37 Nursing11Management:11Inflammatory11and11Structural11Heart11Disorders,11156
38 Nursing11Management:11Vascular11Disorders,11161
iii
