Williams_FM_i-xxviii 12/10/02 11:16 AM Page i U NDERSTANDING M -S EDICAL URGICAL N URSING Williams_FM_i-xxviii 12/10/02 11:16 AM Page ii Williams_FM_i-xxviii 12/10/02 11:16 AM Page iii U NDERSTANDING M -S EDICAL URGICAL N URSING SECOND EDITION L S. W , INDA ILLIAMS MSC, RNC Professor of Nursing Jackson Community College Registered Nurse Care Coordinator W.A. Foote Memorial Hospital Jackson, Michigan P D. H , AULA OPPER MSN, RN Associate Professor of Nursing Jackson Community College On-call Case Manager W.A. Foote Memorial Hospital Jackson, Michigan F.A. DAVIS COMPANY / Philadelphia Williams_FM_i-xxviii 12/10/02 11:16 AM Page iv F. A. Davis Company 1915 Arch Street Philadelphia, PA 19103 Copyright © 2003 by F. A. Davis Company Copyright © 1999 by F. A. Davis Company. All rights reserved. This book is protected by copy- right. No part of it may be reproduced, stored in a retrieval system, or transmitted in any form or by any means, electronic, mechanical, photocopying, recording, or otherwise, without writ- ten permission from the publisher. Printed in the United States of America Last digit indicates print number: 10 9 8 7 6 5 4 3 2 1 Acquisitions Editor:Lisa B. Deitch Developmental Editors:Melanie J. Freely, Catherine Harold Designer:Paul Fry Cover Designer:Louis Forgione As new scientific information becomes available through basic and clinical research, recom- mended treatments and drug therapies undergo changes. The author(s) and publisher have done everything possible to make this book accurate, up to date, and in accord with accepted stan- dards at the time of publication. The authors, editors, and publisher are not responsible for er- rors or omissions or for consequences from application of the book, and make no warranty, ex- pressed or implied, in regard to the contents of the book. Any practice described in this book should be applied by the reader in accordance with professional standards of care used in regard to the unique circumstances that may apply in each situation. The reader is advised always to check product information (package inserts) for changes and new information regarding dose and contraindications before administering any drug. Caution is especially urged when using new or infrequently ordered drugs. ISBN 0-8036-1037-8 Authorization to photocopy items for internal or personal use, or the internal or personal use of specific clients, is granted by F. A. Davis Company for users registered with the Copyright Clear- ance Center (CCC) Transactional Reporting Service, provided that the fee of $.10 per copy is paid directly to CCC, 222 Rosewood Drive, Salem, MA 01923. For those organizations that have been granted a photocopy license by CCC, a separate system of payment has been arranged. The fee code for users of the Transactional Reporting Service is: 8036-1037 0 (cid:1)$.10. Williams_FM_i-xxviii 12/10/02 11:16 AM Page v To our students, who provide us with inspiration, motivation, and the joy of being a part of their learning experience. To Garland, with love, for his continued support and encouragement and many trips to the mailbox with manuscripts. To my daughter, son-in-law, and grandchildren who bring me joy. To my parents, who have always been supportive and encouraging through both editions of this text. LINDA WILLIAMS To Dave, with love, who still loves me after 25 years and two editions of this text. To my children, Dan and Libby, the two greatest young adults in the universe. To my mom, who taught me strength and integrity. I regret she did not live to see this second edition. And to my dad, whose pride in this project keeps me motivated when I get tired of writing. PAULA HOPPER Williams_FM_i-xxviii 12/10/02 11:16 AM Page vi Williams_FM_i-xxviii 12/10/02 11:16 AM Page vii Preface Welcome to the second edition of Understanding ■ Special features written by actual patients, called Patient Medical-Surgical Nursing! We are thrilled with Perspectives, have been added. These essays, focused on the enthusiastic feedback we received on the each patient’s experience with illness, help to make pa- first edition, and we have worked to make this second edi- tients’ thoughts and feelings more meaningful and per- tion even more student-friendly. To those of you who gave sonal for students. If you have stories you feel would us valuable suggestions on the first edition, thank you. We make valuable additions to the book, please share them have incorporated much of what you told us into this edi- with us as we prepare the third edition. tion while maintaining our original vision for the book. ■ Web links have been added to the text to help students We initially embarked on the first edition because we do further research on topics of interest. Every effort was were unsatisfied with the materials available for practical/ made to use only major established web sites that are un- vocational nursing students. There were texts with lots of likely to change in the near future. information, but very little attempt was made to help stu- ■ One of our most popular features—Critical Thinking dents understandwhy they were doing what they were doing. Exercises—have been expanded to help students prac- We have once again worked hard to provide a text written tice and think about what they are learning. We also at an understandable level, with features that help students added math calculations and documentation practice to understand, apply, and practice the challenging content re- Critical Thinking Exercises where applicable. These ex- quired to function as a practical/vocational nurse. ercises are provided throughout the book to foster criti- As in the first edition, this book uses the nursing process cal thinking and are followed by questions that require to provide a unifying framework. Within this framework, more than simple recall of material. emphasis is placed on understanding, critical thinking, and ■ Answers for the Critical Thinking Exercises and Review application. We believe that a student who learns to think Questions have been included. Research supports the critically will be better able to apply information to new sit- importance of immediate feedback to reinforce correct uations. We hope both students and instructors find this learning, so we feel strongly that students should have new book more valuable than ever for learning and under- access to correct answers while they are studying, with- standing medical-surgical nursing. out having to wait for their next instructor contact. Ob- viously there can be many answers to some of the criti- cal thinking questions. We have provided sample FEATURES OF THE BOOK answers to help stimulate students’ thinking. One of the most exciting features of this edition is a new de- We have also kept our most popular features from the sign and full-color contents. Naturally, all of the text has first edition: been updated to reflect current health care and nursing practice. And, based in part on user feedback, we have also ■ Pronunciation key for new words at the beginning of made a number of helpful changes and added exciting new each chapter features: ■ Review of anatomy and physiology at the beginning of ■ A new chapter on alternative and complementary ther- each unit apies has been added. ■ Information on the effects of aging on body systems ■ A full chapter on caring for patients with AIDS has been ■ Learning tips throughout the text added. ■ Word-building footnotes to break down complex words ■ Questions to Guide Your Reading have replaced Chapter ■ Comprehensive glossary of new words Objectives. In our experience, the standard objectives ■ Nursing care plans with geriatric considerations found in many textbooks have little meaning and pro- ■ Common laboratory and diagnostic tests vide little assistance to students who have much read- ■ Brief pathophysiology for each disorder ing to do in minimal time. The literature suggests that ■ Boxed presentations of Cultural Considerations, Geron- comprehension increases when students read guiding tological Issues, Home Health Hints, and Nutrition questions before reading the text. So we have provided Notes. (Ethical dilemmas have been moved to the In- a series of questions that students should keep in mind structor Guide because we believe this material is best as they read. These questions can be translated easily learned during instructor-guided discussion.) back into objectives by instructors who prefer this ■ Critical thinking exercises throughout the text format. ■ Review questions at the end of each chapter vii Williams_FM_i-xxviii 12/10/02 11:16 AM Page viii viii Preface As in the previous edition, we have included many fig- Supplemental Materials ures because we believe they enhance understanding and A Student Workbook is available to provide the student ad- readability. Most of the artwork and photographs are origi- ditional contact and practice with the material. Each chap- nal and specifically designed to support the text. Additional ter includes vocabulary practice, objective exercises, a case figures, tables and boxed materials are used to clarify com- study or other critical thinking practice and review ques- plex material. tions written in NCLEX-PN format. Answers are provided so students can solidify their understanding and learning Using the Features of This Book with immediate feedback. Rationales are provided for re- view question answers. As you begin each chapter, carefully read the section la- An Instructor’s Guide provides materials for use in the beled Questions to Guide your Reading.Then, when you are classroom. Each chapter has a chapter outline with sug- finished reading each chapter, go back and make sure you gested classroom activities. Also included are student activ- can answer each question. ities suitable for duplicating and using for individual prac- You will also find a list of new words and their pronunci- tice or for collaborative learning activities. These activities ations at the beginning of each chapter. These words appear help the student to interact with the material, understand in bold at their first use in the text, indicating that they also it, and apply it. Many of the activities are based on real pa- appear in the glossary at the end of the book. By learning tient cases and have been used with our own practical nurs- the meanings of these words as you encounter them, you ing students. Feedback from students has helped to refine will increase your understanding of the material. the exercises. We believe the use of collaborative learning You also will encounter other devices to increase your un- has greatly enhanced our students’ success in achieving derstanding and retention of the material, such as mnemon- their educational and licensure goals. Another benefit is the ics, acrostics, and learning tips. You may want to develop sense of community the students develop as a result of your own memory techniques in addition to those provided. working in groups. A brief introduction and guidelines for (If you think of a good one, send it to us and you may find it using collaborative learning techniques is included. in the next edition!) Many of the learning tips have been An expanded computerized test bank, available to in- developed and used in our own classrooms. We find them structors who adopt the textbook, provides test questions helpful in fostering understanding of complex concepts or as that assist students to prepare for State Board Examinations. memory aids. However, we want to stress that memorization These questions have been prepared according to test item is not the primary focus of the text but rather a foundation writing protocols. The questions are in multiple choice for- for understanding and thinking about more complex infor- mat, and test recall and application of material. Many of the mation. Understanding and application will serve you far test questions have been developed, used and refined by the better than memorization when dealing with new situations. authors in their own medical-surgical courses for practical Each chapter includes one or more case studies designed nursing students. The new test bank program for the second to help you apply material that has been presented. A series edition is easier to use and allows instructors to choose and of questions related to the case study will help you integrate modify the questions that best suit their classroom needs. the material with what you already know. These questions Finally, new for this edition is a comprehensive Power- emphasize critical thinking, which is based on a foundation Point program for classroom presentations. We have pro- of recall and understanding of material. To enhance your vided the basics; each unit presentation can be modified, learning, try to answer the questions before looking up the reduced, or expanded by individual instructors to suit their answers at the end of the chapter. needs. Review questions appear at the end of each chapter. These are written in a multiple-choice format to help you prepare for the NCLEX-PN. Again, to assess your learning, ACKNOWLEDGEMENTS try to answer the questions before looking up the answers at the back of the book. Many people helped us make this book a reality. First and A bibliography at the end of each unit provides sources foremost are our students, who provided us with the inspi- for additional reading material. Web sites have been in- ration to undertake this project. We hope that they con- cluded in many chapters. We believe it is important for you tinue to find this text worth reading. to interact with current technology to expand your infor- The F.A. Davis Company has been an exceptional pub- mational resources. lishing partner. We feel fortunate to have had their contin- Appendices are included for easy reference. They cover ued enthusiasm and confidence in our book. The staff at the following: F.A. Davis has guided us through this project from its in- ception to publication to help us create a student-friendly ■ Nursing diagnoses book that truly promotes understanding of medical-surgical ■ Lab values nursing. ■ Abbreviations F.A. Davis developmental editor Melanie Freely has ■ Common prefixes and suffixes to assist in learning word been our guide, cheerleader and supporter. We appreciate building techniques all she has done to support our book. Lisa B. Deitch, Williams_FM_i-xxviii 12/10/02 11:16 AM Page ix Preface ix acquisitions editor, also helped shepherd the process, as Contributors from across the United States and Canada, did Bette Haitsch and Bob Butler in Production. We including many well-known experts in their fields, brought thank them all for their assistance. Developmental editor expertise and diversity to the content. Their hard work is Catherine Harold and her assistant Connie Warren helped much appreciated. Reviewers from throughout the United us format the manuscript, meet deadlines and gave us help- States provided valuable insights that enhanced the quality ful advice and guidance. They were a great mix of kind un- of the text. derstanding and professionalism. Many of our co-workers have contributed to this book We thank the staff of Thomas Jefferson University Med- and given us ongoing encouragement and validation of the ical Center, in Philadelphia, and especially Ann Reynolds, worthiness of this project. Elizabeth Ackley, Marina- for assisting us in the photo shoot originally done for the Martinez Kratz, Sharon Nowak, Kathy Walsh, Gail Ladwig, first edition. Thanks also to Nanine Hartzenbusch, our pho- and Carroll Lutz were especially helpful in providing mate- tographer, who provided a wonderful human touch to the rial, advice, and encouragement. photography. We wish to thank everyone who played a role, however Graphic World Publishing Services production editor large or small, in helping us to provide a tool to help stu- Noelle Barrick did an outstanding job of coordinating the dents realize their dreams of becoming LPN/LVNs. We hope development of our manuscript into a book. Graphic World this book will help train nurses who can provide safe and Illustration Studio’s John Denk created the wonderful first expert care because they are able to think critically. edition artwork and updated it for the second edition.