Front Matter
IFC
CONTENTS
Contents
Lewis’s Medical-Surgical Nursing ASSESSMENT AND MANAGEMENT OF CLINICAL PROBLEMS
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Lewis’s Medical-Surgical Nursing ASSESSMENT AND MANAGEMENTOF CLINICAL PROBLEMS
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ABOUT THE AUTHORS
JEFFREY KWONG, RN, DNP, MPH, ANP-BC, FAAN, FAANP
DEBRA HAGLER, PHD, RN, ACNS-BC, CNE, CHSE, ANEF, FAAN
COURTNEY REINISCH, RN, DNP, FNP-BC
CONTRIBUTORS
Authors of Teaching and Learning Resources
Case Studies (Interactive and Applying Clinical Judgment With Multiple Patients)
PowerPoint Presentations
TEACH for Nurses
NCLEX® Examination Review Questions
Study Guide
Clinical Companion
Evidence-Based Practice Boxes
Nursing Care Plans
PREFACE
SPECIAL FEATURES
LEARNING SUPPLEMENTS FOR STUDENTS
TEACHING SUPPLEMENTS FOR INSTRUCTORS
ACKNOWLEDGMENTS
CONTENTS
CONCEPT EXEMPLARS
SPECIAL FEATURES
Lewis’s Medical-Surgical Nursing ASSESSMENT AND MANAGEMENT OF CLINICAL PROBLEMS
1 -
Concepts in Nursing Practice
1 -
Professional Nursing
PROFESSIONAL NURSING PRACTICE
Domain of Nursing Practice
Definitions of Nursing
Nursing’s View of Humanity
Scope of Nursing Practice
Standards of Professional Nursing Practice
INFLUENCES ON PROFESSIONAL NURSING PRACTICE
Expanding Knowledge and Technology
Diverse Populations
Consumerism
Health Care Financing
Health Policy
Professional Nursing Organizations
Nursing Core Competencies
PATIENT-CENTERED CARE
Clinical Judgment
Clinical Practice Frameworks
Nursing Care Plans
Continuum of Patient Care
Delivery of Nursing Care
Supporting Caregivers
INTERPROFESSIONAL PARTNERSHIPS
Interprofessional Team
Coordinating Care
Communication
Clinical Pathways
Delegation and Assignment
SAFETY
Serious Reportable Events
National Patient Safety Goals
QUALITY IMPROVEMENT
National Database of Nursing Quality Indicators
INFORMATICS
Electronic Health Records
EVIDENCE-BASED PRACTICE
Steps of EBP Process
Step 1
Step 2
Step 3
Step 4
Step 5
Step 6
Implementing EBP
EVOLVE WEBSITE/RESOURCES LIST
REFERENCES
2 -
Social Determinants of Health
SOCIAL DETERMINANTS OF HEALTH
Neighborhood
Economic Stability
Health Care
Education
Community
HEALTH DISPARITIES AND HEALTH EQUITY
Factors and Conditions Leading to Health Disparities
Ethnicity and Race
Gender
Age
CULTURE
CULTURAL COMPETENCE
CULTURAL FACTORS AFFECTING HEALTH AND HEALTH CARE
Folk Healers and Traditions
Spirituality and Religion
Cross-Cultural Communication
Family Roles and Relationships
Personal Space
Touch
Nutrition
Immigrants and Immigration
Drugs
Psychologic Factors
Self-Assessment
Assessment
Implementation
Advocacy
Standardized Guidelines
Communication
EVOLVE WEBSITE/RESOURCES LIST
REFERENCES
3 -
Health History and Physical Examination
DATA COLLECTION
Medical Focus
Nursing Focus
Types of Data
Interview Considerations
Symptom Investigation
Data Organization
NURSING HISTORY: SUBJECTIVE DATA
Important Health Information
Health History
Medications
Allergies
Surgery and Other Treatments
Functional Health Patterns
Health Perception–Health Management Pattern
Nutritional-Metabolic Pattern
Elimination Pattern
Activity-Exercise Pattern
Sleep-Rest Pattern
Cognitive-Perceptual Pattern
Self-Perception–Self-Concept Pattern
Role-Relationship Pattern
Sexuality-Reproductive Pattern
Coping–Stress Tolerance Pattern
Value-Belief Pattern
PHYSICAL EXAMINATION: OBJECTIVE DATA
General Survey
Physical Examination
Techniques
. Inspection is the visual assessment of a part or region of the body to assess normal conditions or deviations. Inspection is m...
. Palpation is the assessment of the body using touch. Using light and deep palpation can yield information about masses, pulsat...
. Percussion is a technique that produces a sound and vibration to obtain information about the underlying area (Fig. 3.3). The ...
. Auscultation involves listening to sounds produced by the body with a stethoscope to assess normal and abnormal conditions. Th...
Equipment
Organization of Examination
Documentation
TYPES OF ASSESSMENT
Emergency Assessment
Comprehensive Assessment
Focused Assessment
Using Assessment Approaches
4 -
Patient and Caregiver Teaching
TEACHING-LEARNING PROCESS
Adult Learner
Adult Learning Principles
Models to Promote Health
Nurse as Teacher
Required Competencies
. Develop confidence as a teacher by becoming knowledgeable about the topic. For example, if you are teaching patients about man...
. Patient teaching depends on effective communication between you and the patient or caregiver. Medical jargon can be intimidati...
. Teaching patients and caregivers has many challenges, including (1) lack of time, (2) your own feelings as a teacher, (3) nurs...
Caregiver Support in the Teaching-Learning Process
Regulatory Mandates for Patient Teaching
PROCESS OF PATIENT TEACHING
Assessment
Physical Factors
Psychologic Factors
Sociocultural Factors
. Literacy is the ability to use printed and written information to function in society. Health literacy is the degree to which ...
. Cultural traditions influence our health practices, beliefs, and behavior. These traditions, which can affect patient teaching...
. Consider a variety of socioeco­nomic factors when preparing to teach patients. Knowing the patient’s present or past occupatio...
Learner Factors
. Learning needs are the new knowledge and skills that a person must have to meet a goal. Assess what the patient already knows ...
. Motivation and readiness to learn depend on multiple factors, such as perceived need, attitudes, and beliefs. When teaching ad...
. Each person has preferred styles of learning. The three general learning styles are (1) visual (reading, pictures), (2) audito...
Clinical Problems
Planning
Setting Goals
Choosing Teaching Strategies
. Use learning materials in multiple formats. Learn what resources are available in your agency and from support services and pr...
. Patients may use the Internet and other digital technology (e.g., smart phones) to obtain information and manage their health....
Implementation
Evaluation
REFERENCES
5 -
Chronic Illness and Older Adults
CHRONIC ILLNESS
Preventing and Managing a Crisis
Carrying Out Prescribed Treatment Plan
Controlling Symptoms
Reordering Time
Adjusting to Changes in the Course of Disease
Preventing Social Isolation
Attempting to Normalize Interactions With Others
Preventing Chronic Illness
ATTITUDES TOWARD AGING
BIOLOGIC AGING
AGE-RELATED PHYSIOLOGIC CHANGES
SPECIAL OLDER ADULT POPULATIONS
Chronically Ill Older Adults
Cognitively Impaired Older Adults
Rural Older Adults
Homeless Older Adults
Frail Older Adults
SOCIAL SUPPORT AND OLDER ADULTS
Family Caregivers
Elder Mistreatment
Self-Neglect
SOCIAL SERVICES FOR OLDER ADULTS
MEDICARE AND MEDICAID
CARE ALTERNATIVES FOR OLDER ADULTS
Adult Day Care and Adult Day Health Care
Home Health Care
Long-Term Care Facilities
Programs for All-Inclusive Care for the Elderly
Age-Friendly Health Systems
LEGAL AND ETHICAL ISSUES
?Health Promotion
?Acute and Ambulatory Care
. The time of a care transition to another setting (e.g., acute care hospital to rehabilitation) is challenging for many older a...
. The goal of rehabilitation is to help older adults adapt to or recover from disability or an acute functional decline. Rehabil...
. Consider the use of assistive devices as interventions for older adults. Using assistive devices such as dentures, glasses, he...
. Safety is crucial in maintaining an older adult’s health. When compared to younger adults, older adults are at higher risk for...
. Medication use in older adults requires thorough and regular assessment, care planning, and evaluation. Nonadherence to medica...
. Depression is not a normal part of aging. However, it is often an underrecognized problem in older adults. Around 15% of older...
. Physical restraints are devices, materials, and equipment that physically prevent persons from moving freely, such as walking,...
. Adequacy of sleep is often a concern for older adults because of altered sleep patterns. Older people have a marked decrease i...
?Evaluation
REFERENCES
6 -
Caring for Lesbian, Gay, Bisexual, Transgender, Queer or Questioning, and Gender Diverse Patients
LGBTQ+ HEALTH INEQUITIES
GERONTOLOGIC CONSIDERATIONS
ESTABLISHING INCLUSIVE ENVIRONMENTS
Establishing a Welcoming Environment
Health History and the Intake Process
Social History
Sexual and Reproductive Health History
PREVENTIVE HEALTH
GENDER AFFIRMATION THERAPY
Gender Affirming Hormone Therapy
Nonsurgical Gender Affirming Interventions
Gender Affirming Surgery
Chest Masculinization Surgery
Feminizing Breast Augmentation
?Assessment
Implementation
?Acute Care
?Ambulatory Care
Anchor 1015
REFERENCES
2 -
Problems Related to Comfort and Coping
7 -
Stress Management
WHAT IS STRESS?
Is Stress Bad or Good?
Factors Affecting Response to Stress
PHYSIOLOGIC RESPONSE TO STRESS
Nervous System
Cerebral Cortex
Limbic System
Reticular Formation
Hypothalamus
Endocrine System
Summary of Stress Response
Immune System
MIND-BODY-SPIRIT CONNECTION
EFFECTS OF STRESS ON HEALTH
COPING STRATEGIES
RELAXATION STRATEGIES
Relaxation Breathing
Biofeedback
Meditation
Imagery
Massage
Music
Prayer
?Nursing Management: Stress
?Assessment
?Clinical Problems
?Planning
?Implementation
REFERENCES
8 -
Sleep and Sleep Disorders
PHYSIOLOGIC SLEEP MECHANISMS
Sleep-Wake Cycle
Wake Behavior
Sleep Behavior
Circadian Rhythms
Sleep Architecture
NREM Sleep
REM Sleep
INSUFFICIENT SLEEP AND SLEEP DISTURBANCES
SLEEP DISTURBANCES IN THE HOSPITAL
Etiology and Pathophysiology
Clinical Manifestations
Diagnostic Studies
Self-Report
Actigraphy
Interprofessional Care
Cognitive-Behavioral Therapy for Insomnia
Drug Therapy
. Benzodiazepine-receptor agonists are considered first-line for pharmacologic treatment of insomnia. They act at GABA receptors...
. Suvorexant (Belsomra) and lemborexant (Dayvigo) promote sleep by blocking the wake-promoting effects of orexin. They should be...
. Ramelteon (Rozerem) is a prescription melatonin-receptor agonist. It has a rapid onset. Ramelteon is recommended for insomnia ...
. Certain tricyclic antidepressants (e.g., doxepin, amitriptyline) are used as sleep aids due to their side effect of sedation. ...
. Benzodiazepines activate GABA receptors to promote sleep. These drugs are not part of first-line therapy for insomnia. Only 2 ...
. Many people self-medicate with OTC sleep aids such as doxylamine (Unisom) and diphenhydramine. Diphenhydramine is in many “nig...
Complementary and Alternative Therapy
?Assessment
?Clinical Problems
?Implementation
OBSTRUCTIVE SLEEP APNEA
Clinical Manifestations
Diagnostic Studies
?Behavioral Treatment
?Medical Devices
?Surgical Treatment
PERIODIC LIMB MOVEMENT DISORDER
CIRCADIAN RHYTHM DISORDERS
NARCOLEPSY
PARASOMNIAS
REFERENCES
9 - Pain
EXTENT OF PAIN PROBLEM
DEFINITIONS AND DIMENSIONS OF PAIN
CLASSIFICATION OF PAIN
Nociceptive Pain
Neuropathic Pain
Acute and Chronic Pain
PAIN ASSESSMENT
Elements of a Pain Assessment
Pain Pattern
Location
Intensity
Quality
Associated Symptoms
Management Strategies
Impact of Pain
Patient’s Beliefs, Expectations, and Goals
Reassessment
PAIN TREATMENT
Basic Principles
Drug Therapy for Pain
Nonopioids
Opioids
. Opioids are categorized by their physiologic action (e.g., agonist, antagonist) and binding at specific opioid receptors (e.g....
. Some opioid analgesics have 2 distinct actions, or dual mechanisms. Tramadol (Ultram) is a weak mu agonist and inhibits the re...
. Some opioids should be avoided for pain relief because of limited efficacy and/or toxicities. The American Pain Society does n...
. Common side effects include constipation, nausea and vomiting, sedation, respiratory depression, and pruritus.12 With continue...
Adjuvant Analgesic Therapy
. Clonidine and tizanidine (Zanaflex) are the most widely used α2-adrenergic agonists. They likely work on the central inhibitor...
. TCAs enhance the descending inhibitory system by preventing the cellular reuptake of serotonin and norepinephrine. Higher leve...
. Antiseizure drugs affect peripheral nerves and the CNS in several ways. These include sodium channel modulation, central calci...
. Baclofen, an agonist at GABA receptors, can interfere with the transmission of nociceptive impulses. It helps manage muscle sp...
. Corticosteroids include dexamethasone, prednisone, and methylprednisolone (Medrol). They are used for managing acute and chron...
. Local anesthetics, such as bupivacaine and ropivacaine, can be given epidurally by continuous infusion or by intermittent or c...
. Cannabinoid-derived medications show promise in treating neuropathic pain, certain pain syndromes, and some symptoms.16 Synthe...
Administration
. Appropriate analgesic scheduling focuses on preventing or controlling pain, rather than providing analgesics only after the pa...
. Analgesic titration is dose adjustment based on assessment of the adequacy of analgesic effect versus the side effects produce...
. The term equianalgesic dose refers to a dose of one analgesic that is equivalent in pain-relieving effects to a given dose of ...
. We can deliver opioids and other analgesic agents by many routes. This flexibility allows the HCP to (1) target a particular a...
. Oral administration is the route of choice for the person with a functioning GI system. Most pain medications are available in...
. Although we have historically given morphine sublingually to people with cancer pain who have problems swallowing, little of t...
. Intranasal administration allows delivery of medication to highly vascular mucosa and avoids the first-pass effect. Butorphano...
. We often overlook the rectal route. It is especially useful when the patient cannot take an analgesic by mouth, such as with s...
. Transdermal patches offer systemic or local delivery. Fentanyl (Duragesic) is useful for the patient who cannot tolerate oral ...
. Parenteral routes include IV and subcutaneous administration. Single, repeated, or continuous dosing is possible with parenter...
. Intraspinal or neuraxial opioid therapy involves inserting a catheter into the subarachnoid space (intrathecal delivery) or th...
. Intraspinal catheters can be surgically implanted for long-term pain relief. The surgical placement of an intrathecal catheter...
. Patient-controlled analgesia (PCA) (demand analgesia) is a method that allows the patient to self-administer preset doses of a...
Interventional Therapy
Therapeutic Nerve Blocks
. Neuroablative interventions are done for severe pain that is unresponsive to all other therapies. They involve destroying nerv...
Neuroaugmentation
Nondrug Therapies for Pain
Physical Pain Relief Strategies
. Massage may be useful to alleviate certain types of acute and chronic pain.17 Many different massage techniques exist. These i...
. Exercise is an essential part of the treatment plan for patients with chronic pain, especially those with musculoskeletal pain...
. Transcutaneous electrical nerve stimulation (TENS) involves the delivery of an electric current through electrodes applied to ...
. Acupuncture is a technique of traditional Chinese medicine in which very thin needles are inserted into the body at designated...
. Heat therapy is the application of either moist or dry heat to the skin. Heat therapy can be either superficial or deep. We ca...
. Cold therapy involves the application of either moist or dry cold to the skin. Dry cold can be applied by using an ice bag. Mo...
Cognitive Therapies
. Distraction involves redirection of attention away from the pain and onto something.22 It is a simple but powerful strategy to...
. Hypnotherapy is a structured technique that enables a patient to achieve a state of heightened awareness and focused concentra...
. Relaxation strategies reduce stress, decrease acute anxiety, distract from pain, ease muscle tension, combat fatigue, promote ...
INSTITUTIONALIZING PAIN EDUCATION AND MANAGEMENT
MANAGING PAIN IN SPECIAL POPULATIONS
Older Adults
Patients Unable to Self-Report Pain
Patients in the Critical Care Unit
Patients With Substance Abuse Problems
REFERENCES
10 -
Palliative and End-of-Life Care
PALLIATIVE CARE
HOSPICE CARE
DOMAINS OF PALLIATIVE CARE
Domain 1: Care Structure and Processes
Domain 2: Physical Aspects of Care
Domain 3: Psychologic and Psychiatric Aspects
Domain 4: Social Aspects of Care
Domain 5: Spiritual, Religious, and Existential Aspects of Care
Domain 6: Cultural Care
Domain 7: Care of the Patient Nearing the End of Life
Domain 8: Ethical and Legal Aspects of Care
Advance Care Planning and Advance Directives
Organ and Tissue Donation
Euthanasia and Physician-Assisted Suicide
DEATH
Physical Manifestations at End of Life
Psychosocial Manifestations at End of Life
Bereavement and Grief
. Patients often show signs of anxiety and depression during the EOL period. Causes of anxiety and depression may include uncont...
. Anger is a common and normal response to grief. A grieving person cannot be forced to accept the loss. The surviving family me...
. Feelings of hopelessness and powerlessness are common during the EOL period. Encourage realistic hope within the limits of the...
. Fear is a typical feeling associated with dying. Specific fears include fear of pain, fear of shortness of breath, fear of lon...
?Physical Care
. After a patient is pronounced dead, you will need to prepare or delegate preparing the patient’s body for immediate viewing by...
SPECIAL NEEDS OF CAREGIVERS AND NURSES IN END-OF-LIFE CARE
Special Needs of Family Caregivers
Special Needs of Nurses
REFERENCES
11 -
Substance Use Disorders in Acute Care
DRUGS ASSOCIATED WITH SUBSTANCE USE DISORDER
Effects of Use and Complications
?Tobacco Cessation
ALCOHOL
Effects of Use and Complications
?Alcohol Toxicity
?Alcohol Withdrawal Syndrome
?Toxicity
?Withdrawal
DEPRESSANTS
Sedative-Hypnotics
Opioids
?Toxicity
?Sedative-Hypnotics
?Opioids
?Withdrawal
?Sedative-Hypnotics
?Opioids
INHALANTS
CANNABIS
CAFFEINE
?Assessment
?Clinical Problems
?Planning
?Implementation
?Health Promotion
?Acute Intervention
REFERENCES
3 -
Problems Related to Homeostasis and Protection
12 -
Inflammation and Healing
INFLAMMATORY RESPONSE
Vascular Response
Cellular Response
Neutrophils
Monocytes
Lymphocytes
Chemical Mediators
Complement System
Prostaglandins and Leukotrienes
Exudate Formation
Types of Inflammation
Clinical Manifestations
Fever
?Fever
?Drug Therapy
?RICE
. Rest, or immobilization, prevents further injury and gives the body time to heal. It decreases the tissues’ metabolic needs an...
. Cold application is usually best at the time of the initial trauma. Cold promotes vasoconstriction and decreases swelling, pai...
. Compression counters the vasodilation effects and development of edema. Compression by direct pressure over a laceration occlu...
. Elevating the injured extremity above the level of the heart reduces edema at the inflammatory site by increasing venous and l...
HEALING PROCESS
Regeneration
Repair
Primary Intention
. In the initial (inflammatory) phase, the edges of the incision are aligned and sutured (or stapled) in place. The incision are...
. The granulation phase is the second step. The components of granulation tissue include proliferating fibroblasts; proliferatin...
. The maturation phase, during which scar contraction occurs, overlaps with the granulation phase. It may begin 7 days after the...
Secondary Intention
Tertiary Intention
Wound Classification
Complications of Healing
?Clean Wounds
?Contaminated Wounds
?Drug Therapy
?Nutrition Therapy
?Infection Prevention and Control
?Psychologic Implications
?Patient Teaching
PRESSURE INJURIES
Etiology and Pathophysiology
Clinical Manifestations
?Nursing Management: Pressure Injuries
REFERENCES
13 -
Genetics
GENETICS AND GENOMICS
Basic Principles of Genetics
Chromosomes
Genes
DNA
RNA
Protein Synthesis
Mitosis
Meiosis
Genetic Mutations
Types of Mutations
Inheritance Patterns
Human Genome Project
GENETIC DISORDERS
Classification of Genetic Disorders
Single Gene Disorders
Multifactorial Inherited Conditions
. Epigenetics is the study of inheritable changes in gene expression that do not involve changes in the DNA sequence. There is a...
Chromosome Disorders
GENETIC SCREENING AND TESTING
Interpreting Genetic Test Results
Direct-to-Consumer Genetic Tests
Genetic Technology
DNA Fingerprinting
DNA Microarray (DNA Chip)
Genome-Wide Association Study (GWAS)
PHARMACOGENOMICS AND PHARMACOGENETICS
GENE THERAPY
STEM CELL THERAPY
REFERENCES
14 - Immune Responses and Transplantation
NORMAL IMMUNE RESPONSE
Antigens
Types of Immunity
Innate Immunity
Acquired Immunity
. Active acquired immunity results from the invasion of the body by foreign substances such as microorganisms and the subsequent...
. In passive acquired immunity, the host receives antibodies to an antigen rather than making them. This may take place naturall...
Lymphoid Organs
Cells Involved in Immune Response
Mononuclear Phagocytes
Lymphocytes
. B cells differentiate into plasma cells when activated. Plasma cells make antibodies (immunoglobulins) (Table 14.2)
. Cells that migrate from the bone marrow to the thymus differentiate into T lymphocytes (thymus-dependent cells). The thymus se...
. T cytotoxic (CD8) cells are involved in attacking antigens on the cell membrane of foreign pathogens and releasing cytolytic s...
. T helper (CD4) cells are involved in regulating cell-mediated immunity and the humoral antibody response. T helper cells diffe...
. Natural killer (NK) cells are involved in cell-mediated immunity. These cells are not T or B cells but are large lymphocytes w...
T Dendritic Cells
Cytokines
Comparison of Humoral and Cell-Mediated Immunity
Humoral Immunity
Cell-Mediated Immunity
?Gerontologic Considerations: Effects of Aging on the Immune System
ALTERED IMMUNE RESPONSE
Hypersensitivity Reactions
Type I: IgE-Mediated Reactions
. Anaphylaxis can occur when mediators are released systemically (e.g., after injection of a drug, after an insect sting). The r...
. Around 20% of the population is atopic. This means they have an inherited tendency to become sensitive to environmental allerg...
Type II: Cytotoxic and Cytolytic Reactions
. A classic type II reaction occurs when a recipient receives ABO-incompatible blood from a donor. Naturally acquired antibodies...
. Goodpasture syndrome is a disorder involving the lungs and kidneys. An antibody-mediated autoimmune reaction occurs involving ...
Type III: Immune-Complex Reactions
Type IV: Delayed Hypersensitivity Reactions
. Allergic contact dermatitis is an example of a delayed hypersensitivity reaction involving the skin. The reaction occurs when ...
. The classic example of a microbial cell-mediated immune reaction is the body’s defense against the tubercle bacillus. Tubercul...
ALLERGIC DISORDERS
Assessment
Diagnostic Studies
Skin Tests
. We can do skin testing by 3 different methods: (1) a scratch or prick test, (2) an intradermal test, or (3) a patch test. The ...
. In the scratch and intradermal tests, the reaction occurs in 5 to 10 minutes. In the patch test the patches must be worn for 4...
. A highly sensitive person is always at risk for developing an anaphylactic reaction to skin tests. Therefore, never leave a pa...
Interprofessional and Nursing Management
Anaphylaxis
Chronic Allergies
. You play a key role in helping the patient make lifestyle adjustments so that there is minimal exposure to offending allergens...
Drug Therapy
. Antihistamines are the best drugs for treating allergic rhinitis, itching, and hives (see Table 29.2). They are less effective...
. The major sympatho­mimetic drug is epinephrine. Epinephrine is made by the adrenal medulla and stimulates α- and β-adrenergic ...
. Nasal corticosteroid sprays are effective in relieving the symptoms of allergic rhinitis. Sometimes patients have such severe ...
. Antipruritic drugs provide relief from itching and protect the skin. They are most effective when applied topically to intact ...
. Cromolyn is a mast cell–stabilizing agent that inhibits the release of histamines, leukotrienes, and other agents from the mas...
. Leukotriene receptor antagonists (LTRAs) block leukotriene, a major mediator of the allergic inflammatory process. These medic...
Immunotherapy
. The IgE level is high in atopic people. When IgE combines with an allergen in a hypersensitive person, a reaction occurs, rele...
Method of administration
. Subcutaneous immunothe­rapy (SCIT) involves the subcutaneous injection of titrated amounts of allergen extracts biweekly or we...
. Sublingual immunotherapy (SLIT) involves allergen extracts taken under the tongue. Sublingual products include a 5-grass polle...
?Latex Allergies
?Types of Latex Allergies
?Latex-Food Syndrome
?Nursing Management: Latex Allergies
?Multiple Chemical Sensitivity
AUTOIMMUNITY
Autoimmune Diseases
Apheresis
Plasmapheresis
IMMUNODEFICIENCY DISORDERS
Primary Immunodeficiency Disorders
Secondary Immunodeficiency Disorders
HUMAN LEUKOCYTE ANTIGEN SYSTEM
Human Leukocyte Antigen and Disease Associations
ORGAN TRANSPLANTATION
Tissue Typing
HLA Typing
Panel of Reactive Antibodies
Crossmatch
Transplant Rejection
Hyperacute Rejection
Acute Rejection
Chronic Rejection
Immunosuppressive Therapy
Calcineurin Inhibitors
Mycophenolate Mofetil
Sirolimus
Monoclonal Antibodies
Polyclonal Antibodies
GRAFT-VERSUS-HOST DISEASE
REFERENCES
15 -
Infection
TYPES OF PATHOGENS
SPECIFIC TYPES OF INFECTIONS
Emerging Infections
Reemerging Infections
Antimicrobial-Resistant Infections
Health Care–Associated Infections
NURSING MANAGEMENT: INFECTION
Antimicrobial Therapy
Occupational Safety and Health Administration (OSHA) Guidelines
Infection Precautions
COVID-19
Pathophysiology
Clinical Manifestations and Complications
Diagnostic Tests
Interprofessional and Nursing Management
Vaccines
HUMAN IMMUNODEFICIENCY VIRUS INFECTION
HIV Transmission
Sexual Transmission
Contact With Blood and Blood Products
Perinatal Transmission
Pathophysiology
Clinical Manifestations and Complications
Acute Infection
Chronic HIV Infection
. The time between initial HIV infection and a diagnosis of AIDS is about 10 years in untreated infection. During the first seve...
. As the CD4 cell count declines closer to 200 cells/μL and the viral load increases, HIV advances to a more active stage. Sympt...
. A diagnosis of acquired immunodeficiency syndrome (AIDS) is made when a person with HIV meets criteria established by the CDC....
Diagnostic Studies
Interprofessional Care
Drug Therapy for HIV Infection
Drug Therapy for Opportunistic Diseases
?Nursing Management: HIV Infection
?Assessment
Biomedical Prevention
Behavior Modification
. Safe sexual activities eliminate the risk for exposure to HIV in semen and vaginal secretions. Abstaining from all sexual acti...
. The major risk for HIV related to using drugs involves sharing equipment or having unsafe sexual experiences while under the i...
. The best way to prevent HIV infection in infants is to prevent HIV infection in women. We should ask women with HIV about thei...
. The risk for infection from occupational exposure to HIV is small but real. OSHA requires employers to protect workers from ex...
. Around 14% of people with HIV in the United States do not know they are infected. They are more likely to transmit the infecti...
. Early intervention after detection of HIV infection can promote health and limit disability. Findings from the history, assess...
. Reactions to an HIV diagnosis are similar to the reactions of people who are diagnosed with any life-threatening, debilitating...
. Nursing care becomes more complex as the patient’s immune system declines and new problems arise to compound existing problems...
. As time passes, patients and their loved ones will be confronted with complex treatment decisions; feelings of loss, anger, po...
. Physical problems related to HIV or its treatment can interfere with the patient’s ability to maintain a desired lifestyle. Pe...
. Despite new developments in the treatment of HIV infection, many patients eventually have disease progression, disability, and...
REFERENCES
16 - Cancer
BIOLOGY OF CANCER
Defect in Cell Proliferation
Defect in Cell Differentiation
Development of Cancer
Initiation
. Carcinogens are cancer-causing agents capable of producing cell alterations. Many are detoxified by protective enzymes and har...
. Many chemicals are carcinogens (e.g., benzene, arsenic, formaldehyde). People exposed to these chemicals over time have a grea...
. Radiation can cause cancer in almost any body tissue. When cells are exposed to a source of radiation, damage occurs to DNA. A...
. Certain DNA and ribonucleic acid (RNA) viruses, termed oncogenic, can alter the cells they infect and induce malignant transfo...
Promotion
Progression
Role of the Immune System
Escape Mechanisms From Immunologic Surveillance
Oncofetal Antigens and Tumor Markers
BENIGN VERSUS MALIGNANT NEOPLASMS
CLASSIFICATION OF CANCER
Anatomic Site Classification
Histologic Classification
Extent of Disease Classification
Clinical Staging
TNM Classification System
PREVENTION AND DETECTION OF CANCER
Diagnosis of Cancer
Biopsy
Cure
Control
Palliation
PERSONALIZED CANCER MEDICINE
SURGICAL THERAPY
Prevention
Cure or Control
Supportive and Palliative Care
CHEMOTHERAPY
Effect on Cells
Classification of Chemotherapy Drugs
Chemotherapy Preparation
Methods of Administration
Regional Chemotherapy Administration
Intraarterial Chemotherapy
Intraperitoneal Chemotherapy
Intrathecal or Intraventricular Chemotherapy
Intravesical Bladder Chemotherapy
Effects of Chemotherapy on Normal Tissues
Treatment Plan
RADIATION THERAPY
Principles of Radiobiology
Simulation and Treatment Planning
Treatment
External Radiation
Internal Radiation
. Nausea and vomiting are common effects of chemotherapy and sometimes radiation therapy. Chemotherapy-induced nausea and vomiti...
. Diarrhea is a reaction of the bowel mucosa to radiation and some chemotherapy drugs. The patient can have an increase in frequ...
. Mucositis is irritation, inflammation, and/or ulceration of the mucosa. Like the bowel mucosa, the mucosal linings

lgrsnf/Lewis' Medical-Surgical Nursing 12th Edition.pdf

lgli/Lewis' Medical-Surgical Nursing 12th Edition.pdf

LEWIS'S MEDICAL-SURGICAL NURSING - 2-VOLUME SET : assessment and

Harding PhD RN FAADN CNE, Mariann M., Kwong DNP MPH RN ANP-BC FAAN FAANP, Jeffrey, Hagler RN PhD ACNS-BC CNE CHSE ANEF FAAN, Debra

Mariann M Harding; Jeffrey Kwong; Debra Hagler; Courtney Reinisch; Sharon Mantik Lewis

Mariann M. Harding, Jeffrey Kwong, Debra Hagler, Dottie Roberts, Courtney Reinisch

Mariann Harding; Jeffrey Kwong; Dottie Roberts; Debra Hagler; Courtney Reinisch

MARIANN M.. KWONG, JEFFREY HAGLER, DEBRA HARDING

Mosby, Incorporated

Twelve edition, St. Louis, Missouri, 2022

United States, United States of America

12, PT, 2022

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2023-01-22