Handbook of  Medical‐Surgical Nursing     Fourth Edition 2006 Lippincott Williams & Wilkins Philadelphia 323 Norristown Road, Suite 200, Ambler, PA 19002-2756 1-58255-445-5 The clinical treatments described and recommended in this publication are based on research and consultation with nursing, medical, and legal authorities. To the best of our knowledge, these procedures reflect currently accepted practice. Nevertheless, they can't be considered absolute and universal recommendations. For individual applications, all recommendations must be considered in light of the patient's clinical condition and, before administration of new or infrequently used drugs, in light of the latest package-insert information. The authors and publisher disclaim responsibility for any adverse effects resulting from the suggested procedures, from any undetected errors, or from the reader's misunderstanding of the text. © 2006 by Lippincott Williams & Wilkins. All rights reserved. This book is protected by copyright. No part of it may be reproduced, stored in a retrieval system, or transmitted, in any form or by any means—electronic, mechanical, photocopy, recording, or other wise—without prior written permission of the publisher, except for brief quotations embodied in critical articles and reviews and testing and evaluation materials provided by publisher to instructors whose schools have adopted its accompanying textbook. Printed in the United States of America. For information, write Lippincott Williams & Wilkins, 323 Norristown Road, Suite 200, Ambler, PA 19002-2756. HBMSN4010805—D N O S A 07 06 05 10 9 8 7 6 5 4 3 2 1 Library of Congress Cataloging-in-Publication Data Handbook of medical-surgical nursing.—4th ed. p.; cm. Includes bibliographical references and index. 1. Nursing—Handbooks, manuals, etc. 2. Surgical nursing—Handbooks, manuals, etc. I. Lippincott Williams & Wilkins. [DNLM: 1. Perioperative Nursing—Handbooks. WY 49 H2357 2006] RT51.H352 2006 610.73—dc22 ISBN 1-58255-445-5 (alk. paper) 2005013692 Editor Elizabeth Jacqueline Mills Editorial Assistants Editor Linda K. Ruhf STAFF Editorial Assistants Barbara Hodgson Judith A. Schilling McCann RN, MSN Indexer Executive Publisher Contributors and consultants H. Nancy Holmes Editorial Director Mary Ann Boucher RN, ND, APRN, BC Joan M. Robinson RN, MSN Assistant Professor of Nursing University of Massachusetts, Dartmouth Clinical Director Arlene Putterman MaryAnn Edelman RN, MS, CNS Senior Art Director Assistant Professor Kingsborough Community College, Brooklyn, N.Y. Jennifer P. Kowalak Editorial Project Manager Ken W. Edmisson RNC, ND, EdD, FNP Tamara M. Kear RN, MSN, CNN Associate Professor Middle Tennessee State University, Murfreesboro Clinical Project Manager Elizabeth Jacqueline Mills Karen S. March RN, PhD(c), CCRN, APRN-BC Editor Assistant Professor of Nursing York College of Pennsylvania Linda Hager Grays Copy Editor Linda J. O'Connor RNC, MSN, CS Linda Jovinelly Franklin Geriatric Clinical Nurse Specialist North Shore University Hospital, Manhasset, N.Y. Design Project Manager Diane E. Paluba (Manager) Monica Narvaez Ramirez RN, MSN Digital Composition Services Nursing Instructor University of the Incarnate Word, School of Nursing and Health Joyce Rossi Biletz Professions, San Antonio, Tex. Digital Composition Services Bruce Austin Scott APRN, BC, MSN Donna S. Morris Nursing Instructor Digital Composition Services San Joaquin Delta College, Stockton, Calif. Patricia K. Dorshaw (Director) Cynthia C. Small RN, MSN, APRN, BC Manufacturing Nursing Instructor Beth J. Welsh Lake Michigan College, Benton Harbor, Mich. Manufacturing Denise R. York RNC, CNS, MS, MEd Megan L. Aldinger Professor Editorial Assistants Columbus (Ohio) State Community College Karen J. Kirk FOREWORD Nursing in the twenty-first century has seen tremendous advances in technology—a trend that continues in today's ever-changing health care arena. Whether in hospitals, long-term care facilities, or patients' homes, today's nurses are on the front line of patient care. While medical-surgical nursing remains one of the most demanding practices for nurses, it's also one of the most exciting and challenging. Now more than ever, nurses need effective, dependable tools when caring for their patients in today's complex health care environment. In its fourth edition, Handbook of Medical-Surgical Nursing continues to be such a tool. This new edition has has been fully revised yet retains its alphabetical organization and reliable, easy-to-use format. Each disorder entry includes a brief introduction followed by causes, complications, physical assessment findings, expected diagnostic results, treatment strategies, key nursing diagnoses and patient outcomes, and related nursing interventions, including monitoring and patient teaching. In the treatment entries, you'll see a similar organizational format, including a description of the procedure; possible complications; key nursing diagnoses and patient outcomes; nursing interventions for before, during, and after the procedure; and home-care instructions. This edition has been updated to succinctly cover disorders linked with bio-terrorism, such as anthrax, plague, and variola. New treatments also have been added, including cardiac resynchronization therapy. Special design icons are used throughout the text to highlight important information; they include Pediatric pointer, Alert, Collaboration, Expert geriatric care, Nursing priority, Health promotion tip, and Life-threatening complications as well as a new icon, Gender differences. Important appendices include an updated Quick-reference guide to laboratory test results, which now includes SI values; and the newly added Emergency responses to bioterrorism, chemical exposure, and radiation; Resources for professionals, patients, and caregivers; and English-Spanish quickreference guide. More than 500 illustrations, charts, diagrams, and flowcharts offer insight and provide an understanding of key concepts to help the medical-surgical nurse better meet her patient's needs. Handbook of Medical-Surgical Nursing, Fourth Edition, is packed with usable and pertinent information that's easily accessible, arming today's nurse with the vital knowledge needed to effectively care for patients across all spectrums of care and improve their outcomes. Indeed, this fourth edition of Handbook of Medical-Surgical Nursing continues to be an essential, cutting-edge resource in this ever-changing technologically advanced field. Hedi Indig Morgan Bednarz APRN, BC, MSN Clinical Instructor Wayne State University College of Nursing, Detroit Contents Author FOREWORD Contents A Abdominal Aneurysm Acquired Immunodeficiency Syndrome Acute Respiratory Distress Syndrome Acute Tubular Necrosis Adenoviral Infections Adrenalectomy Adrenal Hypofunction Adrenogenital Syndrome Allergic Purpura Alzheimer's Disease Amputation Amyloidosis Amyotrophic Lateral Sclerosis Anaphylaxis Angioplasty, Percutaneous Transluminal Coronary Ankylosing Spondylitis Anorectal Abscess and Fistula Aortic Insufficiency Aortic Stenosis Aplastic or Hypoplastic Anemias Appendectomy Appendicitis Arrhythmias Arterial Occlusive Disease Arthrocentesis Asthma Atelectasis B Basal Cell Epithelioma Benign Prostatic Hyperplasia Bladder Cancer Bone Marrow Transplantation Bone Tumors, Primary Malignant Botulism Bowel Resection With Anastomosis Bowel Resection With Rstomy Brain Tumors, Malignant Breast Cancer Bronchiectasis Bronchitis, Chronic C Calcium Imbalance Cancer Care Candidiasis Cardiac Catheterization Cardiac Tamponade Cardiogenic Shock Carpal Tunnel Syndrome Cataract Cellulitis Cerebral Aneurysm Cervical Cancer Chancroid Chemotherapy Chest Drainage Chlamydial Infections Chloride Imbalance Cholecystectomy Cholelithiasis, Cholecystitis, and Related Disorders Chronic Fatigue Immune Dysfunction Syndrome Cirrhosis Clostridium Difficile Infection Coal Worker's Pneumoconiosis Colorectal Cancer Common Variable Immunodeficiency Complement Deficiencies Conization Corneal Transplant Coronary Artery Bypass Grafting Coronary Artery Disease Cor Pulmonale Craniotomy Creutzfeldt-Jakob Disease Crohn's Disease Cryosurgery Cryptosporidiosis Cushing's Syndrome Cystectomy Cystic Fibrosis Cytomegalovirus Infection D Dehydration Diabetes insipidus Diabetes mellitus Dilatation and curettage or evacuation Diphtheria Disseminated intravascular coagulation Diverticular disease Dysfunctional uterinebleeding E Ebola Virus Infection Emphysema Encephalitis Endarterectomy Endocarditis Endometriosis Epididymitis Epilepsy Escherichia coli and other Enterobacteriaceae Infections Esophageal Cancer Esophageal Diverticula F Fanconi's Syndrome Femoral and Popliteal Aneurysms Fibrocystic Breast Changes Fibromyalgia Syndrome Folic Acid Deficiency Anemia G Gallbladder and Bile Duct Cancers Gastric Cancer Gastric Surgery Gastritis Gastroenteritis Gastroesophageal Reflux Gastrostomy Genital warts Glaucoma Glomerulonephritis, Acute Poststreptococcal Glomerulonephritis, Chronic Gonorrhea Goodpasture's Syndrome Gout Granulocytopenia and Lymphocytopenia Guillain-Barré Syndrome H Haemophilus Influenzae Infection Hantavirus Pulmonary Syndrome Head Injuries Heart Failure Heart Valve Replacement Hemodialysis Hemophilia Hemorrhoidectomy Hemorrhoids Hemothorax Hepatic Encephalopathy Hepatitis Hernia Repair Herniated Disk Herpes Simplex Herpes Zoster Hiatal Hernia Histoplasmosis Hodgkin's Disease Huntington's Disease Hydronephrosis Hyperaldosteronism Hyperlipoproteinemia Hyperparathyroidism Hyperpituitarism Hypersplenism Hypertension Hyperthyroidism Hypertrophic Cardiomyopathy Hypoglycemia Hypoparathyroidism Hypophysectomy Hypopituitarism Hypothyroidism Hypovolemic Shock Hysterectomy I Idiopathic Thrombocytopenic Purpura Immunoglobulin A Deficiency Implantable Cardioverter-Defibrillator Incision and Drainage Influenza Inguinal Hernia Intestinal Obstruction Intussusception Iron Deficiency Anemia Irritable Bowel Syndrome J Joint replacement K Kaposi's sarcoma Kidney Cancer Kidney Transplantation L Laminectomy and Spinal Fusion Laparoscopy and Laparotomy Laryngeal Cancer Latex Allergy Legionnaires' Disease Leukemia, Acute Leukemia, Chronic Granulocytic Leukemia, Chronic Lymphocytic Lithotripsy Liver Cancer Lumpectomy Lung Cancer Lupus Erythematosus Lyme Disease Lymphomas, Malignant M Magnesium Imbalance Mallory-Weiss Syndrome Mammoplasty Mastectomy Mastitis Medullary Sponge Kidney Melanoma, Malignant Meningitis Metabolic Acidosis Metabolic Alkalosis Methicillin-Resistant Staphylococcus Aureus Mitral Insufficiency Mitral Stenosis Mononucleosis Multiple Myeloma Multiple Sclerosis Muscular Dystrophy Myasthenia Gravis Myocardial Infarction Myocarditis N Necrotizing Fasciitis Nephrectomy Nephrotic Syndrome Neurogenic Bladder Neuropathic Arthropathy Norovirus O Obesity Ophorectomy and Salpingectomy Orchiopexy Osteoarthritis Osteomyelitis Osteoporosis Ovarian Cancer Ovarian Cysts PQ Pacemaker Insertion Paget's Disease Pancreatectomy Pancreatic Cancer Pancreatitis Parathyroidectomy Parkinson's Disease Pelvic Inflammatory Disease Peptic Ulcers Pericardiocentesis Pericarditis Peritoneal Dialysis Peritonitis Pernicious Anemia Pheochromocytoma Phosphorus Imbalance Pilonidal Disease Pituitary Tumors Platelet Function Disorders Pleural Effusion and Empyema Pleurisy Pneumocystis Carinii Pneumonia Pneumonia Pneumothorax Poliomyelitis Polycystic Kidney Disease Polycythemia, Secondary Polycythemia, Spurious Polycythemia Vera Porphyrias Potassium Imbalance Pressure Ulcers Proctitis Prostatectomy Prostatic Cancer Prostatitis Pseudomembranous Enterocolitis Pseudomonas Infections Pulmonary Edema Pulmonary Embolism Pulmonary Fibrosis Pulmonary Hypertension Pulmonic Insufficiency Pulmonic Stenosis Pyelonephritis, Acute R Radiation external Radiation, internal Radioactive iodine therapy Renal calculi Renal failure, acute Renal failure, chronic Renovascular hypertension Respiratory acidosis Respiratory alkalosis Respiratory failure, acute Respiratory syncytialvirus infection Retinal detachment Rheumatic fever and rheumatic heart disease Rheumatoid arthritis Rocky mountain spotted fever S Salmonella Infection Sarcoidosis Scleroderma Sclerotherapy Septic Arthritis Septic Shock Severe Acute Respiratory Syndrome Sickle Cell Anemia Silicosis SjÖgrens Syndrome Sodium Imbalance Spinal Injuries Spinal Neoplasms Splenectomy Squamous Cell Carcinoma Stomatitis and other Oral Infections Stroke Syndrome of Inappropriate Antidiuretic Hormone Secretion Syphilis T Testicular Cancer Tetanus Thalassemia Thoracentesis Thoracic aortic aneurysm Thoracotomy Thrombocytopenia Thrombolytic Therapy Thrombophlebitis Thyroid Cancer Thyroidectomy Toxic Shock Syndrome Toxoplasmosis Tracheotomy Traction Tricuspid Insufficiency Tricuspid Stenosis Tuberculosis U Ulcerative Colitis Urinary Diversion Surgery Urinary Tract Infection, Lower Urticaria and Angioedema Uterine Cancer V Vaginal Cancer Valvuloplasty, Balloon Vancomycin-Resistant Enterococcus Varicose Veins Vascular Repair Vasculitis Ventricular Aneurysm Volvulus WXYZ West Nile Encephalitis Whiplash Appendices QUICK-REFERENCE GUIDE TO LABORATORY TEST RESULTS A B C D E F G H I J K L M N O P Q R S T U V W X Y Z EMERGENCY RESPONSES TO BIOTERRORISM, CHEMICAL EXPOSURE, AND RADIATION RESOURCES FOR PROFESSIONALS, PATIENTS, AND CAREGIVERS ENGLISH-SPANISH QUICK-REFERENCE GUIDE SELECTED REFERENCES Index