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Brief Contents UNIT I 25 Airway Management, 624 26 Closed Chest Drainage Systems, 655 Supporting the Patient Through the Health Care 27 Emergency Measures for Life Support, 676 System 1 Using Evidence in Nursing Practice, 1 UNIT IX 2 Admitting, Transfer, and Discharge, 11 Fluid Balance 3 Communication, 28 4 Documentation and Informatics, 47 28 Intravenous and Vascular Access Therapy, 693 29 Blood Transfusions, 737 UNIT II Vital Signs and Physical Assessment UNIT X Nutrition 5 Vital Signs, 65 6 Health Assessment, 104 30 Oral Nutrition, 754 31 Enteral Nutrition, 775 UNIT III 32 Parenteral Nutrition, 796 Infection Control UNIT XI 7 Medical Asepsis, 166 Elimination 8 Sterile Technique, 181 33 Urinary Elimination, 809 UNIT IV 34 Bowel Elimination and Gastric Intubation, 842 35 Ostomy Care, 866 Activity and Mobility 9 Safe Patient Handling, Transfer, and Positioning, 197 UNIT XII 10 Exercise and Ambulation, 220 Care of the Surgical Patient 11 Orthopedic Measures, 249 12 Support Surfaces and Special Beds, 273 36 Preoperative and Postoperative Care, 880 37 Intraoperative Care, 908 UNIT V Safety and Comfort UNIT XIII Dressings and Wound Care 13 Safety and Quality Improvement, 295 14 Disaster Preparedness, 322 38 Wound Care and Irrigations, 920 15 Pain Assessment and Basic Comfort Measures, 345 39 Dressings, Bandages, and Binders, 942 16 Palliative Care, 375 40 Therapeutic Use of Heat and Cold, 976 UNIT VI UNIT XIV Hygiene Home Care 17 Personal Hygiene and Bed Making, 391 41 Home Care Safety, 994 18 Pressure Ulcer Care, 433 42 Home Care Teaching, 1015 19 Care of the Eye and Ear, 453 UNIT XV UNIT VII Special Procedures Medications 43 Specimen Collection, 1052 20 Safe Medication Preparation, 472 44 Diagnostic Procedures, 1097 21 Oral and Topical Medications, 492 22 Parenteral Medications, 538 Answer Key, 1129 UNIT VIII Appendix, 1153 Oxygenation Glossary, 1156 23 Oxygen Therapy, 587 24 Performing Chest Physiotherapy, 613 i This page intentionally left blank Clinical Nursing Skills & Techniques 8th Edition Anne Griffin Perry, RN, MSN, EdD, FAAN Associate Dean and Professor School of Nursing Southern Illinois University—Edwardsville Edwardsville, Illinois Patricia A. Potter, RN, MSN, PhD, FAAN Director of Research, Patient Care Services Barnes-Jewish Hospital St. Louis, Missouri Wendy R. Ostendorf, RN, MS, EdD, CNE Associate Professor of Nursing Neumann University Aston, Pennsylvania 3251 Riverport Lane St. Louis, Missouri 63043 CLINICAL NURSING SKILLS & TECHNIQUES ISBN 978-0-323-08383-6 Copyright © 2014 by Mosby, Inc., an imprint of Elsevier Inc. Copyright © 2010, 2006, 2004, 2002, 1998, 1994, 1990, 1986 by Mosby, Inc., an affiliate of Elsevier Inc. No part of this publication may be reproduced or transmitted in any form or by any means, electronic or mechanical, including photocopying, recording, or any information storage and retrieval system, without permis- sion 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). 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. International Standard Book Number: 978-0-323-08383-6 Proudly sourced and uploaded by [StormRG] Kickass Torrents | The Pirate Bay | ExtraTorrent Senior Content Strategist: Tamara Myers Managing Editor: Jean Sims Fornango Publishing Services Manager: Deborah L. Vogel Senior Project Manager: Jodi M. Willard Design Direction: Brian Salisbury Working together to grow libraries in developing countries Printed in Canada www.elsevier.com | www.bookaid.org | www.sabre.org Last digit is the print number: 9 8 7 6 5 4 3 2 1 As always, this book is dedicated to my children. To be their mother brings more joy, honor, and sense of pride than I could ever imagine. They and their loved ones are truly my shining stars. As they grow, things change, and I now dedicate this book to: My daughter, Rebecca Lacey Perry Bryan, her husband, Robert Donald Bryan, their three daugh- ters Cora Elizabeth Bryan, Amalie Mary Bryan, and Noelle Anne Bryan, and their son Shepherd Charles Bryan; and to my son, Horace Mitchell “Mitch” Perry and his partner Samuel Jacob Cox. Anne G. Perry I wish to dedicate this new edition of our text to the incredible friends, work colleagues, and scholars I have been so fortunate to associate with throughout my career. Patricia A. Potter For my husband, who believes in me, even when I do not believe in myself. Wendy R. Ostendorf About the Authors ANNE GRIFFIN PERRY, RN, MSN, EdD, FAAN Dr. Anne G. Perry, Professor and Asso- journals (Journal of Nursing Measurement, Intensive Care Medicine, ciate Dean for Academic Programs at AACN Clinical Issues, and Perspectives in Respiratory Nursing), Southern Illinois University—Edwards- and she was one of a few key consultants on Mosby’s Nursing ville, is a Fellow in the American Skills Videos, and Mosby’s Nursing Skills Online. Dr. Perry cur- Academy of Nursing. She received her rently serves on the NANDA board of directors and on the BSN from the University of Michigan, advisory board for Louis and Clark Community College School her MSN from Saint Louis University, of Nursing. and her EdD from Southern Illinois Dr. Perry has been involved in the front lines of nursing educa- University—Edwardsville. Dr. Perry is a tion since 1973, first as an instructor and then through various roles prolific and influential author and of leadership at Saint Louis University Hospital and School of speaker. Her work includes four major Nursing and now at Southern Illinois University—Edwardsville. textbooks (Basic Nursing, Fundamentals As a clinician and researcher, Dr. Perry’s contributions to pulmo- of Nursing, Nursing Interventions and Clinical Skills, and Clinical nary nursing and nursing language development involve both Nursing Skills and Techniques), 24 journal articles, 10 abstracts, research and policy making. She has investigated and published and 12 nursing research and education grants. She has presented findings regarding topics that include weaning from mechanical more than 50 papers at conferences across the United ventilation, uses of the therapeutic intervention scoring system, States. She has acted as an editorial board member of numerous critical care, and validation of nursing diagnoses. PATRICIA A. POTTER, RN, MSN, PhD, FAAN Dr. Patricia Potter received her BSN at Dr. Potter has devoted a lifetime to nursing education, practice, the University of Washington in Seattle, and research. She spent a decade teaching at Barnes Hospital and her MSN and PhD at Saint Louis School of Nursing and Saint Louis University. She entered into a University in St. Louis, Missouri. A variety of managerial and administrative roles, ultimately becom- groundbreaking author for more than 25 ing the director of nursing practice at Barnes-Jewish Hospital. In years, her work includes four major text- that capacity she sharpened her interest in the development of books (Basic Nursing, Fundamentals of nursing practice standards and the measurement of patient out- Nursing, Nursing Interventions and Clinical comes in defining nursing practice. Her most recent passion has Skills, and Clinical Nursing Skills and Tech- been in the area of nursing research, specifically cancer family niques) and more than 20 journal articles. caregiving, the cancer patient symptom experience, and the effects She has been an unceasing advocate of of compassion fatigue on nurses. Dr. Potter is currently a director evidence-based practice and quality improvement in her roles as of research for patient care services at Barnes-Jewish Hospital. administrator, educator and, more recently, director of research. WENDY R. OSTENDORF, RN, MS, EdD, CNE Dr. Wendy R. Ostendorf received her Nursing Interventions and Clinical Skills, and Clinical Nursing Skills BSN from Villanova University, her MS and Techniques. She has presented more than 25 papers at confer- from the University of Delaware, and her ences at the local, national, and international levels. EdD from the University of Sarasota. She Professionally, Dr. Ostendorf has a diverse background in pedi- currently serves as an associate professor atric and adult critical care. She has taught at the undergraduate of nursing in the Division of Nursing and and graduate level for 30 years. With decades of practice as a clini- Health Sciences at Neumann University cian, her educational experiences have influenced her teaching in Aston, Pennsylvania. She has contrib- philosophy and perceptions of the nursing profession. Dr. Osten- uted more than 20 chapters to multiple dorf’s current interests include the history and image of nursing as nursing textbooks and has served as it has been represented in film, which she has developed into an section editor for two major textbooks undergraduate nursing course. vi Contributors Nicole Bartow, RN, MSN Roberta L. Harrison, PhD, RN, CRRN Instructor/Director of the Essig Clinical Simulation Center Assistant Professor Sinclair School of Nursing School of Nursing University of Missouri Southern Illinois University—Edwardsville Columbia, Missouri Edwardsville, Illinois Aurelie Chinn, RN, MSN Lori Klingman, MSN, RN Academic Nursing Skills Specialist/Simulation Technician/ Faculty Instructor Ohio Valley Hospital School of Nursing Associate Degree Nursing Program McKees Rocks, Pennsylvania Cabrillo College Aptos, California Nancy Laplante, PhD, RN Assistant Professor Janice C. Colwell, RN, MSN, CWOCN, FAAN School of Nursing Advanced Practice Nurse Neumann University University of Chicago, Department of Surgery Aston, Pennsylvania Chicago, Illinois Nelda K. Martin, RN, CCNS, ANP-BC Charlene Compher, PhD, RD, CNSC, LDN, FADA Clinical Nurse Specialist/Adult Nurse Practitioner Associate Professor of Nutrition Science Barnes-Jewish Hospital, Heart and Vascular Program University of Pennsylvania School of Nursing St. Louis, Missouri Philadelphia, Pennsylvania Kristin L. Mauk, PhD, DNP, RN, CRRN, GCNS-BC, GNP-BC, FAAN Kelly Jo Cone, RN, PhD, CNE Professor of Nursing and Kreft Endowed Chair Professor, Graduate Program School of Nursing Saint Francis Medical Center College of Nursing Valparaiso University Peoria, Illinois Valparaiso, Indiana Pamela A. Cupec, RN, MS, ONC, CRRN, ACM Pamela L. Ostby, RN, MSN, OCN® Senior Professional Case Manager Affiliate Assistant Professor University of Pittsburgh Medical Center—Passavant Goldfarb School of Nursing Pittsburgh, Pennsylvania Barnes-Jewish College St. Louis, Missouri Ruth M. Curchoe, RN, MSN, CIC Infection Prevention Consulting Jeanne Marie Papa, MBE, MSN, ACNP-BC, CCRN Hilton, New York Professor of Nursing Neumann University Jane Fellows, MSN, RN, CWOCN Aston, Pennsylvania Wound/Ostomy CNS Duke University Health System Jacqueline Raybuck Saleeby, PhD, RN, BCCS Durham, North Carolina Associate Professor, Nursing School of Health Professions Susan Jane Fetzer, RN, BSN, MSN, MBA, PhD Maryville University Associate Professor St. Louis, Missouri College of Health and Human Services University of New Hampshire Phyllis Ann Schiavone, MSN, CRNP Durham, New Hampshire Nurse Practitioner Hospital of the University of Pennsylvania Cathy E. Flasar, MSN, APRN Philadelphia, Pennsylvania Family Nurse Practitioner (FNP) American Society for Pain Management Nurses Lois Schickles, MN, MBA, CPAN, CAPA St. Louis, Missouri Perianesthesia Consultant & Per Diem Bedside Nurse Exempla Lutheran Medical Center Kathleen Gerhart-Gibson, MSN, RN, CCRN Wheat Ridge, Colorado Nursing Instructor School of Nursing Neumann University Aston, Pennsylvania vii viii Contributors Paula Ann Stangeland, PhD, RN, CRRN Terry L. Wood, PhD, RN, CNE Assistant Professor Assistant Clinical Professor University of Texas Medical Branch School of Nursing Southern Illinois University—Edwardsville Galveston, Texas Edwardsville, Illinois E. Bradley Strecker, RN, PhD Patricia H. Worthington, MSN, RN, CNSC Associate Professor Nutritional Support Clinical Specialist Program Director Accelerated BSN Program Thomas Jefferson University Hospital, Department of Nursing MidAmerica Nazarene University Philadelphia, Pennsylvania Olathe, Kansas Rita Wunderlich, MSN, PhD Virginia Strootman, RN MS CRNI Assistant Professor Vice President of Clinical Services Goldfarb School of Nursing Specialty Pharmacy Nursing Network, Inc. Barnes-Jewish College Sarasota, Florida St. Louis, Missouri Donna L. Thompson, MSN, CRNP, FNP-BC, CCCN Valeria J. Yancey, PhD, RN, HNC, CHPN Nurse Practitioner—Continence Specialist Associate Professor Urology Health Specialist School of Nursing Drexel Hills, Pennsylvania Southern Illinois University—Edwardsville Edwardsville, Illinois Pamela E. Windle, MS, RN, NE-BC, CPAN, CAPA, FAAN Nurse Manager St. Luke’s Episcopal Hospital Houston, Texas CONTRIBUTORS TO PREVIOUS EDITIONS We would like to acknowledge the following people who contributed to previous editions of Clinical Nursing Skills & Techniques. Jeannette Adams, PhD, MSN, APRN, Cathy Flasar, MSN, APRN, BC, FNP Kathleen Mulryan, RN, BSN, MSN CRNI Marlene S. Foreman, BSN, MN, RNCS Lynne M. Murphy, RN, MSN Della Aridge, RN, MSN Carol P. Fray, RN, MA Elaine K. Neel, RN, BSN, MSN Elizabeth A. Ayello, PhD, MS, BSN, RN, Leah W. Frederick, RN, MS, CIC Meghan G. Noble, PhD, RN CS, CWOCN Paula Goldberg, RN, MS, MSN Marsha Evans Orr, RN, BS, MS, CS Sylvia K. Baird, BSN, MM Thelma Halberstadt, EdD, MS, BS, RN Dula F. Pacquiao, EdD, RN, CTN Margaret Benz, RN, MSN, CSANP Amy Hall, PhD, MS, BSN, RN Sharon Phelps, RN, BSN, MS Barbara J. Berger, MSN, RN Linda C. Haynes, PhD, RN Catherine A. Robinson, BA, RN Lyndal Guenther Brand, RN, BSN, MSN Diane Hildwein, RN, BC, MA Judith Roos, RN, MSN Peggy Breckinridge, RN, BSN, MSN, FNP Maureen B. Huhmann, MS, RD Mary Jane Ruhland, MSN, RN, BC Victoria M. Brown, RN, BSN, MSN, PhD Nancy C. Jackson, RN, BSN, MSN, CCRN Jan Rumfelt, RNC, MSN, EdD Gina Bufe, RN, BSN, MSN(R), PhD, CS Ruth L. Jilka, RD, CDE Jacqueline Raybuck Saleeby, PhD, RN, CS Gale Carli, MSN, MHed, BSN, RN Teresa M. Johnson, RN, MSN, CCRN Linette M. Sarti, RN, BSN, CNOR Ellen Carson, PhD Judith Ann Kilpatrick, RN, DNSC Kelly M. Schwartz, RN, BSN Maureen Carty, MSN, OCN Carl Kirton, RN, BSN, MA, CCRN, April Sieh, RN, BSN, MSN Mary F. Clarke, MA, RN ACRN, ANP Marlene Smith, RN, BSN, M.Ed. Janice C. Colwell, RN, MS, CWOCN Lori Klingman, MSN, RN Julie S. Snyder, MSN, RNC Kelly Jo Cone, RN, BSN, MS, PhD, CNE Marilee Kuhrik, RN, MSN, PhD Laura Sofield, MSN, APRN, BC Dorothy McDonnell Cooke, RN, PhD Nancy S. Kuhrik, RN, MSN, PhD Sharon Souter, MSN, BSN Eileen Costantinou, RN, BSN, MSN Diane M. Kyle, RN, BSN, MS Martha A. Spies, RN, MSN Sheila A. Cunningham, RN, BSN, MSN Nancy Laplante, PhD, RN Patricia A. Stockert, RN, BSN, MS, PhD Ruth Curchoe, RN, MSN, CIC Louise K. Leitao, RN(c), BSN, MA Sandra Ann Szekely, RN, BSN Rick Daniels, RN, BSN, MSN, PhD Gail B. Lewis, RN, MSN Lynn Tier, RN, MSN, LNC Mardell Davis, RN, MSN, CETN Ruth Ludwick, PhD, MSN, BSN, RNC, Nancy Tomaselli, RN, MSN, CS, CRNP, Carolyn Ruppel d’Avis, RN, BSN, MSN CNS CWOCN, CLNC Patricia A. Dettenmeier, RN, BSN, Mary Kay Macheca, MSN(R), RN, CS, Riva Touger-Decker, PhD, RD, FADA MSN(R), CCRN ANP, CDE Anne Falsone Vaughan, MSN, BSN, CCRN Wanda Cleveland Dubuisson, BSN, MN Jill Feldman Malen, RN, MS, NS, ANP Cynthia Vishy, RN, BSN Sharon J. Edwards, RN, MSN, PhD Mary K. Mantese, RN, MSN Pamela Becker Weilitz, MSN(R), RN, CS, Martha E. Elkin, RN, MSN Elizabeth Mantych, RN, MSN ANP Deborah Oldenburg Erickson, RN, BSN, Tina Marrelli, MSN, MA, RN Joan Domigan Wentz, MSN, RN MSN Nelda K. Martin, APRN, BC, CCNS, ANP Laurel Wiersema, RN, MSN Debra Farrell, BSN, CNOR Mary Mercer, RN, MSN Terry L. Wood, PhD, RN Linda Fasciani, RN, BSN, MSN Rita Mertig, MS, BSN, RNC, CNS Rita Wunderlich, PhD (Cand.), MSN(R), Jane Fellows, RN, MSN, CWOCN Norma Metheny, PhD, MSN, BSN, FAAN CCRN Susan Jane Fetzer, RN, BA, BSN, MSN, Mary Dee Miller, RN, BSN, MS, CIC Rhonda Yancey, BSN, RN MBA, PhD Sharon M.J. Muhs, MSN, RN Valerie Yancey, PhD, RN, HNC, CHPN