Margins Study Assistant

Chapter 1

The Role of the Nurse in Comprehensive Care

Summary

They actively engage in health promotion , disease management, and support for individuals and communities. According to the ANA, nursing integrates the art and science of caring and focuses on the protection, promotion, and optimization of health and human functioning; prevention of illness and injury; facilitation of… In recent decades, the goals of nursing have further evolved to emphasize evidence-based practice, patient-centered care, and interdisciplinary collaboration. Nurses play critical roles in care coordination, healthcare leadership, and policy development.

Key terms

health promotion: empowering individuals, families, and communities to take control of their well-being and make positive choices
at-risk population: a group of individuals who are at higher risk of experiencing adverse health, social, or economic outcomes due to various factors
Roy’s adaptation model: a conceptual framework developed by nursing theorist Sister Callista Roy that is based on the belief that individuals strive to maintain balance and achieve a state of…
nursing metaparadigm: the four foundational concepts that are central to the discipline of nursing: person, environment, health, and nursing
system: a set of elements that are interrelated and work together to achieve a common goal
accountability: taking responsibility for one’s own actions and accepting all consequences, both personal and professional, that can result from these actions
assessment: a nursing process phase that involves gathering comprehensive data about the patient’s health status, including physical, psychological, social, and cultural aspects
collaborative nursing intervention: an action that the nurse carries out in collaboration with other health team members, such as physicians, social workers, respiratory therapists, physical therapists, and…

Chapter 2

The Evolution of the Nurse's Role

Read chapter 2 in the book

Summary

Future trends for nursing professionals include an emphasis on nursing self-care, the expansion of nursing roles in telehealth, and nursing advocacy Patient-centered care is a fundamental concept in nursing that places the patient at the forefront of healthcare delivery. Patient-centered care ultimately recognizes patient autonomy, or the concept that patients have the right to make decisions about their own health care. Patient-centered care has many benefits, including improved communication, increased trust between the patient and healthcare team, personalized care plans, and better outcomes.

Key terms

patient-centered care: a fundamental concept in nursing that places the patient at the forefront of healthcare delivery
telehealth: a method of using telecommunications technology to provide healthcare services remotely
advanced practice registered nurse (APRN): an APRN is a professional nurse with specialized, advanced education to provide health care to specific patient populations
moral distress: the emotional and psychological distress experienced when nurses are aware of the ethically right course of action but are constrained from pursuing it due to external factors or…
burnout: a psychological phenomenon characterized by emotional exhaustion, depersonalization, and a diminished sense of personal accomplishment related to one’s work
collaborative model: an approach to patient care that emphasizes the importance of interdisciplinary teamwork and effective communication among healthcare professionals to provide holistic…
compassion fatigue: the emotional and physical exhaustion that results from providing empathetic care to those experiencing trauma or suffering
delegation: the act of assigning a task to another person who has the appropriate knowledge, skills, and competence to perform that task

Chapter 3

Patient Communication and Interviewing

Read chapter 3 in the book

Summary

The four phases of a comprehensive interview are the preparatory phase , the introductory phase , the maintenance phase , and the termination phase . The process of therapeutic communication in nursing consists of several steps: develop communication goals, create the message, deliver the message, listen to the response, and seek clarification of the response. The primary characteristics of therapeutic communication are building trust through honesty, active listening , and respecting patients’ beliefs and values. To evaluate therapeutic communication, one must reflect on the patient’s response and compare the response to the desired communication goals

Key terms

introductory phase: nurses introduce themselves and begin to obtain essential information about patients as individuals with unique needs, values, beliefs, and priorities; during this phase, trust…
maintenance phase: majority of the nurse’s time with the patient; during this phase, nurses use active listening and begin by asking the reason the patient is seeking care; the answer helps to…
health literacy: an individual's ability to obtain, understand, and apply basic health information and services to make informed decisions about their health
therapeutic communication: the specific techniques and strategies used by nurses to establish a therapeutic relationship with patients and promote the patient’s well-being
termination phase: the final phase of a nurse-patient relationship; typically occurs at the end of a shift or upon discharge from care
active listening: listening with the intent of understanding and discerning
preparatory phase: happens before the face-to-face meeting with the patient
message: the thought or content that someone wishes to convey

Chapter 4

Obtaining a Complete Health History

Read chapter 4 in the book

Summary

The act of recording patient information discovered in a complete health history is called documenting. The nurse establishes a trusting relationship with the patient to elicit exact and detailed information to build the foundation of an accurate health record. The information gathered and documented is also used by the provider to diagnose and develop a plan of care based on current industry standards and best practice guidelines Once the nurse understands that the purpose of accurate documenting is to facilitate patient care among the healthcare team, then the nurse can identify what information to document.

Key terms

health history: taken from each patient and updated regularly
health record: collection of subjective and clinical information pertaining to a patient’s physical and mental health, compiled from a variety of sources
information gathered and documented: also used by the provider to diagnose and develop a plan of care based on current industry standards and best practice guidelines
information: valid and reliable and then use professional clinical judgment on the observations and data collected
collaborative problem: a certain physiological response the nurse monitors that can be addressed through nursing intervention and physician-prescribed treatments
electronic health record (EHR): digital format of a patient’s chart that contains data related to the patient’s medical history, diagnoses, medications, treatment plans, immunization dates, allergies, radiology…

Chapter 5

Cultural Competence and Assessment

Read chapter 5 in the book

Summary

Various cultures have their own traditional healing practices and beliefs, and many people still use these practices either alongside or in place of Western medicine. Culture is a set of beliefs, attitudes, and practices shared by a group of people or community that is accepted, followed, and passed down to other members of the group. Their culture informs how they view health and illness, how they view healthcare providers, and how receptive they are to treatment plans. Culture also determines who receives care and the quality of their care.

Key terms

cultural competence: applying evidence-based nursing in agreement with the cultural values, beliefs, worldview, and practices of patients to produce improved patient outcomes
culture: a set of beliefs, attitudes, and practices shared by a group of people or community which is accepted, followed, and passed down to other members of the group
traditional healing: various medicines and healing practices around the world that differ from the modern, Western healthcare system
Ayurveda: a traditional Hindu form of medicine from India that is based on the idea that disease is caused by an imbalance in the body
racism: the belief that races are distinct from one another and that there is a hierarchy to race, implying that races are unequal
stereotyping: the assumption that a person has the attributes, traits, beliefs, and values of a cultural group because they are a member of that group
curanderismo: a holistic practice rooted in beliefs that health is achieved through the right balance of mind, body, and spirit
ethnocentrism: the belief that one’s culture (or race, ethnicity, country) is better than and preferable to another’s

Chapter 6

Infection Prevention Techniques and Safety in the Clinical Setting

Read chapter 6 in the book

Summary

These six pieces are causative agent, reservoir , portal of exit , mode of transmission , portal of entry , and susceptible host . By understanding the conditions that foster the spread of infection, nurses can implement evidence-based interventions to break the cycle and stop the chain of infection . Nurses must have a thorough understanding of how to protect themselves and their patients from exposure to harmful pathogens. The human body’s immune system provides a mechanism for staying healthy through protection against harmful pathogens.

Key terms

susceptible host: the organism that is susceptible to or at risk for infection
chain of infection: the six stages of infection that must be present for the transmission of a pathogen from one place or person to another
reservoir: the habitat or source of the pathogen that provides a place for survival and growth
transmission: the method that a pathogen uses to spread from one host to another
pathogen: any type of microorganism that causes disease to its host
portal of entry: the site at which a pathogen enters the susceptible host
portal of exit: the path by which the pathogen leaves the reservoir
airborne precaution: a practice indicated for patients known or suspected to be infected with pathogens that are transmitted through droplet nuclei

Chapter 7

Hygiene

Read chapter 7 in the book

Summary

The lack of adequate hygiene practices may lead to various hygiene-related diseases or infections such as lice (body, hair, and pubic), tooth decay, scabies , pinworm infection, ringworm , trachoma , swimmer’s ear … There are various factors that impact a person’s personal hygiene . Hygiene measures can support health and prevent disease. Hygiene practices include but are not limited to the care of the skin, hair, nails, oral cavity, and perineal areas.

Key terms

hygiene: the measures or practices conducive to preserving health and preventing disease, particularly through cleanliness
pinworm: an intestinal worm that usually spreads when an infected individual scratches the anal area
scabies: a contagious skin infestation caused by a burrowing mite accompanied by extreme itching
tooth decay: visible cavities or holes in the outer surface of a tooth or enamel
personal hygiene: self-care measures one performs to preserve their own health
ringworm: a fungal infection of the skin or scalp
trachoma: a bacterial infection of the eyes
cultural sensitivity: recognizing and acknowledging that cultural differences exist among people and showing respect and appreciation for others' beliefs, values, practices, and perspectives

Chapter 8

Wound and Burn Assessment and Care

Read chapter 8 in the book

Summary

Wounds are classified in several ways and include intentional or un intentional wound s (i.e., from treatment/therapy or accidental), open or closed wound s (i.e., break in the skin or under the skin layers), acute or… Friction and shear are mechanical forces that tear and injure blood vessels and can contribute to the development of pressure injuries Risk factors for development of pressure injuries include exposure to excessive moisture, malnutrition and dehydration, and decreased mobility and cognition . Pressure injuries are localized ischemic lesions of the skin and underlying tissue caused by external pressure that impair blood and lymph flow.

Key terms

burn: an injury to the skin caused by thermal, electrical, chemical, or electromagnetic energy
wound: an injury that causes a disruption of normal skin or tissue integrity
cognition: the mental processes that take place in the brain such as thinking, language, learning, memory, perception, and attention
closed wound: a wound that does not have a break in the skin and occurs under the skin’s surface
friction: a force created by two surfaces rubbing against each other
intentional wound: a planned wound; the result of a treatment or therapy
shear: the sliding of one tissue layer over the other
superinfection: a secondary infection that is unrelated to the original infection and results from opportunistic colonization after immunosuppression

Chapter 9

Activity Assessment and Management

Read chapter 9 in the book

Summary

Assessing a patient’s functional status is important in planning care. Some exercises only require body weight such as isotonic and isometric exercises, and others may require minimal equipment, such as a resistance band, for isokinetic exercises This section identified key factors that affect mobility. There are many validated and standardized tools to assess the patient’s baseline status.

Key terms

functional status: a measurement of a patient’s ability to perform physical movements (e.g., walking, standing) and higher-level activities (e.g., ADLs, filling occupational and societal roles)
isometric exercise: a movement related to contractions of specific muscles or group of muscles and then their release
isokinetic exercise: a resistance-based exercises that provide variable resistance to a movement
mobility: the ability of a patient to change and control their body position
patient’s functional status: important in planning care
active-assisted ROM: a procedure performed with partial assistance from an external force; the patient is able to perform the ROM exercise but may need additional assistance when they encounter pain…
alternating pressure mattress: a mattress that is powered with air and can be programmed to inflate and deflate certain sections in a programmable cycle
internal factor: a factor that affects mobility that is specific to each individual and may impact an individual’s mobility in different ways

Chapter 10

Specimen Collection and Lab Testing

Read chapter 10 in the book

Summary

Common types of urine sample collections include clean-catch collection, twenty-four-hour urine collection, FMV collection, timed collection, catheter collection, suprapubic aspiration , pediatric bag collection, and… A urinalysis is a valuable tool that allows for diagnosing and monitoring certain medical conditions. Urine testing examines the physical, chemical, and microscopic composition of a sample of urine including the color, turbidity , presence or absence of particles, odor, pH, specific gravity, protein, ketones, glucose… The procedure for urine collection depends on the type of test ordered; however, regardless of the type of sampling, a sterile collection is essential for ensuring the sample is not contaminated.

Key terms

sterile collection: essential for ensuring the sample is not contaminated
suprapubic aspiration: invasive method involving using a needle and syringe to aspirate urine directly from the bladder through the abdominal wall
urinalysis: a valuable tool that allows for diagnosing and monitoring certain medical conditions
twenty-four-hour urine collection: collection of all urine produced over a twenty-four-hour period
bronchoscopy collection: invasive procedure where a thin, flexible tube with a camera is inserted into the airways, and sputum samples are collected from specific areas within the respiratory system
clean-catch urine sample: patient is instructed to start urinating into the toilet, stop briefly, and then continue urinating into the collection container; most common method of urine collection
nasopharyngeal swab: a swab is used to collect a sample from the nasopharynx, which is the upper part of the throat that connects to the back of the nasal cavity

Chapter 11

Principles of Medication Administration

Read chapter 11 in the book

Summary

Medication dosing typically utilizes three systems of measurement: the metric system, household system, and apothecary system. Drug calculations may be performed using a variety of methods, including dimensional analysis, formula method, or ratio proportion method. Of the three systems of measurement, the metric system provides the most accurate dose calculations. Nurses play a critical role in ensuring safe medication administration.

Key terms

ratio: comparison of one quantity to another, often described as a division problem
systems of measurement: collections of measurement units and how they are associated with one another
formula method: divides the desired amount by the amount on hand, then multiplies it by the quantity on hand to determine the dose
household system: utilizes everyday household items, such as measuring cups and tablespoons, to serve as the measuring device
ratio proportion method: sets the known ratio of drug amount to quantity equal to the desired amount to the unknown quantity
apothecary system: utilizes fractions as a part of the whole to measure weights and volumes
dimensional analysis: factor-label method for solving dosage calculations
metric system: decimal-based system based on units of 10

Chapter 12

Medication Administration Procedures

Read chapter 12 in the book

Summary

Oral medications may be administered via the oral, sublingual , buccal , or feeding tube route. By following the steps of oral medication administration , ensuring the medication “rights” are confirmed at the three checkpoints, and following appropriate delegation procedures, the nurse may ensure safe… Parenteral medications are injected directly into the tissues and circulatory system, thus bypassing the gastrointestinal tract. Administering medications parenterally eliminates the effects of first-pass metabolism, allows for faster onset, and provides stronger effects than oral medications.

Key terms

parenteral: a medication route that bypasses the gastrointestinal (GI) system, eliminating the effects of first-pass metabolism when they are digested in the GI tract
medication “rights”: confirmed at the three checkpoints, and following appropriate delegation procedures, the nurse may ensure safe…
buccal: placed between the gum and cheek
injector device: a spring-loaded syringe that delivers a single, preloaded dose of a medication when the device is firmly pressed against the body
prefilled syringe: a disposable syringe that is supplied with the necessary amount of the medication to be injected in a single dose
suspension: undissolved medication particles that are mixed with a liquid agent
needle: a hollow metal tube with a sharp pointed tip, called a bevel, and a hub that attaches the needle to the syringe or a needleless system

Chapter 13

Intravenous Administration

Read chapter 13 in the book

Summary

There are three main categories of IVs: PIVCs, midline catheter s, or CVCs. Midline catheters are longer than PIVCs and are used for patients with fragile veins or who require IV therapies for multiple days or weeks. When using the IV route, the nurse must monitor the patient for potential complications such as infection, damage to the vein and surrounding tissue, air emboli, blood clots, and fluid overload . With 100 percent of the solution being administered into the vein, therapies infused via the IV route have a quick onset, and providers have better control over dosage.

Key terms

midline catheter: used for long-term IV therapy; catheter is longer than a PIVC but does not extend to the vena cava
fluid overload: occurs when there is increased fluid retained in the intravascular compartment
IV route: an effective way to administer antibiotics, pain medications, emergency medications, chemotherapy, and immunoglobulins (IVIG)
PIVCs: the most common type of IV, and nurses routinely place them for short-term IV therapies
catheter: a small hollow tube placed in the vein
“butterfly” cannula: needle with flexible plastic wings on either side of the needle hub that serve to maneuver the needle during the venipuncture procedure; are manufactured with a short tubing…
extravasation: a condition that occurs when vesicant (an irritating solution or medication) is administered and inadvertently
tunneled central venous catheter: central line that is tunneled under the skin and then brought out through a separate incision site

Chapter 14

Miscellaneous Medication Administration

Read chapter 14 in the book

Summary

Medications administered via the ophthalmic route include eye drops , ointments, and medication disks. Ophthalmic medications are commonly used to treat allergies, dry eyes, viral or bacterial infections, and glaucoma . Eye drops are prepared in liquid solutions, ointments are greasy semisolids that melt after being placed in the eye, and disks are flexible medication disks that release medication over one week’s time and then must be… Medications administered via the eye should never be used if expired

Key terms

eye drops: liquid solutions intended for use in the eye
enema: a liquid solution placed in a disposable plastic squeeze bottle and then instilled into the rectum, or the solution is placed in a bag connected to tubing that is inserted in the…
medicated ear wick: a small cellulose wick placed in the ear canal, with the outer portion of the wick visible at the entrance of the ear canal; medication is then applied to the end of the wick…
Sims position: a posture where the patient is positioned on their left side with the upper leg flexed over the lower leg toward the waist
metered-dose inhaler: (MDI) a device that creates an aerosolized mist of medication that is inhaled through the mouth and into the lungs
dry powder inhaler (DPI): a device that delivers dry powder medications that are inhaled through a the mouth and into the lungs
anticholinergic spray: a medication that blocks the activity of acetylcholine and is used to treat symptoms of a runny nose

Chapter 15

General Survey, Anthropometric Measurement, and Vital Signs

Read chapter 15 in the book

Summary

Vital signs, height, and weight will be gathered during the initial encounter, providing objective data used to determine the patient’s current condition. During the nurse’s interactions with a patient, the nurse must be prepared to obtain vital data, assess the patient’s status, and communicate openly with the patient. The patient’s appearance, behavior, age, gender, culture, growth, and development will be rapidly assessed when meeting the patient. From these initial observations, the nurse should be able to ascertain if the patient requires immediate intervention or will need the help of additional health care by being able to distinguish between normal and…

Key terms

anthropometric measurement: noninvasive quantitative measurement of the human body; examples are height, weight, body mass index, body circumferences, and body fat measurements
vital sign: a marker of physiological homeostasis and essential in the analysis of monitoring patient progress; obtained by measuring body temperature, pulse, respiratory rate, and blood…
body mass index (BMI): a value that is calculated from an individual’s height and weight to provide as measurement relative to the standards for ideal body weight
demi-span: the preferred method of obtaining height for patients unable to stand; the technique involves measuring the distance in centimeters from the middle of the sternal notch to the…
Modified Early Warning Score (MEWS): measurement tool that analyzes vital sign data and level of consciousness, which are used to provide an early warning for deterioration in the patient’s status
accessory muscle use: sign of respiratory distress, using muscles other than the diaphragm and intercostal muscles to aid in the process of breathing
auscultatory gap: a brief absence of sound between the origin and disappearance of the Korotkoff sounds during obtainment of blood pressure
Cheyne-Stokes respiration: a cyclical breathing pattern involving periods of apnea and hyperventilation that often occurs at end of life

Chapter 16

Pain Assessment

Read chapter 16 in the book

Summary

The physiologic process of pain describes how the brain is alerted to painful stimuli and how it can modify and adjust the amount of pain that is felt in the body. The central nervous system can also determine which pain signals are allowed through to the brain. Pain can be classified and described in many different ways. The duration, location, and cause are all important factors when assessing and treating pain.

Key terms

brain: alerted to painful stimuli and how it can modify and adjust the amount of pain that is felt in the body
nociception: the process by which painful stimuli are detected by nociceptors and send the pain signals from the peripheral nervous system to the brain
first line therapy: medical treatment that is recommended as the best option for the initial treatment of a disease or medical condition
transmission of pain: the second step of the pain process when the pain signal is sent from the peripheral to the central nervous system
adjuvant analgesic: medication that is not classified as an analgesic but has been found to have an analgesic effect with opioids
cutaneous pain: pain that is perceived from the skin and caused by heat, cold, or mechanical or chemical stimuli
visceral pain: pain that is activated when internal organs such as the stomach and kidneys are damaged
affective response: the emotional interpretation of pain, such as how uncomfortable the pain is

Chapter 17

Nutrition Assessment

Read chapter 17 in the book

Summary

Good nutrition includes ingestion of quality macronutrients such as carbohydrates, proteins, and fats. Dietary patterns also need to include adequate water regulation to maintain hydration balance and sufficient quantities of micronutrients, like vitamins and minerals, to meet metabolic demands. Physiological factors also include environmental factors such as socioeconomic status, food insecurity , and lifestyle behaviors. These provide adequate calories to meet the body’s daily energy needs.

Key terms

mineral: essential to physiological processing; some are macronutrients, and some are micronutrients
micronutrient: nutrient found in small quantities within the body but still necessary for physiological functions
vitamin: essential micronutrient vital to biochemical regulation within the human body
macronutrient: nutrient consumed in large quantities to meet the body’s energy needs
carbohydrate: macronutrient used to fuel the immediate energy needs of the body
fat: large, complex molecule made up of fatty acids and glycerol
food insecurity: the state of having limited access to adequate food
protein: macronutrient made up of amino acids

Chapter 18

Oxygenation and Perfusion

Read chapter 18 in the book

Summary

Specifics as to the role this system plays in ventilation, how respiration and gas exchange transpire, and the role the lungs play in the renin-angiotensin-aldosterone system are presented. The functions of these structures have been categorized, relating specific components to the purpose relative to ventilation and perfusion . At the capillary-alveolar bed, the primary function of the respiratory system is gas exchange . This section has delved into the physiology of the respiratory system, and how it fits in the cardiopulmonary system .

Key terms

perfusion: vascular circulation powered by the pumping action of the heart that delivers oxygen and other nutrients to body tissues
cardiovascular system: structurally unique insofar as it contains the muscular four-chambered heart (the pump), fluid/blood volume (the tank), and the blood vessels (the pipes)
gas exchange: the transfer of oxygen and carbon dioxide; takes place at the alveolar-capillary bed
respiration: a general term for breathing and ventilation; composed of inhalation and exhalation
cardiopulmonary system: combination of cardiovascular and pulmonary systems
ventilation: the movement of air in and out of the lungs
crepitus: a popping or crackling sensation when the skin is palpated; it is a sign of air trapped under the subcutaneous tissues
bronchiectasis: a chronic condition where airways are dilated and the lung walls are thickened due to inflammation and infection

Chapter 19

Fluids, Electrolytes, and Elimination

Read chapter 19 in the book

Summary

Homeostasis is necessary for proper body functioning. An adequate fluid balance gives shape and size to cells and tissues, allows blood to perfuse to cells and tissues, and is a catalyst for hundreds of biochemical processes that keep our bodies alive. When the body systems function correctly and people consume adequate fluid and healthy foods, homeostasis in maintained. This section discussed why some systems fail to adequately regulate fluids and electrolytes and what manifestations will alert the nurse that a regulation system is not functioning correctly.

Key terms

homeostasis: the maintenance of equilibrium of two or more interdependent elements
fluid balance: the difference between intake and output
BUN to creatinine ratio: a comparison of BUN to creatinine to determine if alterations in BUN and creatinine are related to changes in fluid volume or kidney filtration
urge incontinence: an overactive bladder that contracts and causes urine leakage when the bladder is not full
hypotonic hyponatremia: serum sodium level is decreased due to dilution

Chapter 20

Psychosocial Assessment

Read chapter 20 in the book

Summary

This section reviewed the components of a mental health history and mental status examination . Nurses must understand their role in performing mental status examinations. Upon completion of this section, you should be able to verbalize considerations the nurse must use when assessing a patient for alcohol abuse and illicit drug use. The nurse must be able to identify factors that influence a mental health assessment, such as a patient’s culture, past experiences with mental health treatment, and communication barriers .

Key terms

mental status examination: an assessment of a patient’s level of consciousness and orientation, appearance and general behavior, speech, motor activity, affect and mood, thought and perception, attitude…
abuse: the act of causing physical, emotional, psychological, verbal, sexual, and financial harm to a person
at-risk population: a group of individuals who are at higher risk of experiencing adverse health, social, or economic outcomes due to various factors
controlled environment: an artificial setting that is carefully regulated and monitored to ensure maximum accuracy and precision
hallucination: false perception involving seeing, hearing, smelling, feeling, or tasting something that is not there
flat affect: significantly decreased or lack of expression of emotion, which is inappropriate for the situation
emotional abuse: nonphysical behavior that means to control, isolate, or frighten another person
euthymic: displaying a wide range of emotions that are appropriate for the situation

Chapter 21

Assessment of the Integumentary System

Read chapter 21 in the book

Summary

The epidermis, dermis , and hypodermis are the three distinct layers of the skin. The bottom layer, the hypodermis or subcutaneous tissue, anchors the skin to the underlying tissues. The epidermis is the outermost portion and is made up of stratified epithelial cells. The dermis is the second layer of skin that consists of elastic connective tissue made up of collagen.

Key terms

epidermis: the outermost portion and is made up of stratified epithelial cells
subcutaneous tissue: the subcutaneous fatty layer (hypodermis) beneath the dermis that separates the skin from the underlying tissue
hypodermis: the subcutaneous fatty layer beneath the dermis that anchors the dermis to the underlying tissues of the body
dermis: the layer of skin below the epidermis connected to the epidermis by dermal papillae
eczema: (atopic dermatitis) rash characterized by itchy, chronic inflammation of the upper skin layers and is associated with a heightened immune response
squamous cell carcinoma: the second most common type of skin cancer that generally develops on sun-exposed areas but can grow where sun exposure is limited
cystic acne: lesions that are usually large, red, painful, and pus-filled nodules that merge under the skin and often leave scars
basal cell carcinoma: the most common skin cancer that is generally found on the head or neck; it may be serious but is not usually fatal

Chapter 22

Assessment of the Head and Neck

Read chapter 22 in the book

Summary

Abnormalities of the head and neck include conditions such as headache, concussion, head injury , acromegaly, Cushing syndrome, scleroderma, Bell palsy, myxedema, and simple goiters The neck contains muscles, vertebrae, blood vessels , the thyroid gland, and lymph node s. The neck is a vital region of the body that supports head movement, breathing, swallowing, communication, circulation, and immune responses Nursing assessment of the head and neck includes inspecting and palpating structures of the head, face, and neck.

Key terms

neck: a vital region of the body that supports head movement, breathing, swallowing, communication, circulation, and immune responses
rod: photoreceptor that is responsible for vision in low-light conditions and for detecting movement
concussion: a type of traumatic brain injury (TBI) that occurs when the brain experiences a sudden and forceful movement within the skull
thyroid: a butterfly-shaped endocrine gland located in the front of the neck, just below the Adam’s apple (thyroid cartilage)
acromegaly: rare hormonal disorder that occurs when the pituitary gland produces an excessive amount of growth hormone (GH)
myxedema: severe form of hypothyroidism that occurs when the thyroid gland does not produce enough thyroid hormones
Bell palsy: neurological disorder characterized by the sudden onset of facial muscle weakness or paralysis
headache: a common and uncomfortable sensation of pain or discomfort in the head or upper neck area

Chapter 23

Assessment of the Thorax, Lungs, Breast, and Lymphatic System

Read chapter 23 in the book

Summary

The major structures of the thorax include the thoracic cage and the thoracic cavity. The thoracic cage is comprised of ribs, sternum , and clavicles; its function is to protect the thoracic cavity. The thoracic cavity is comprised of the trachea , lungs, and pleural membranes; its primary function is to support breathing. The muscles and structures of one’s thorax also play a big part in determining if a patient’s breathing is effective or efficient.

Key terms

lymphatic system: system of vessels, cells, and organs that carry excess fluids to the bloodstream and filter pathogens from the blood through lymph nodes
lymph: interstitial fluid that has entered the lymphatic system
thorax: the area of the body commonly known as the chest
thoracic cavity: comprised of the trachea , lungs, and pleural membranes; its primary function is to support breathing
trachea: the lowest structure of the upper airway, adjacent to the esophagus, that connects the lung bronchi and the larynx and provides a route for air to enter and exit the lungs; also…
sternum: the elongated bony structure that anchors the anterior thoracic cage
thoracic cage: the anatomical structure that includes the twelve ribs and sternum
pleura: the double-layered serous membrane that surrounds each lung

Chapter 24

Assessment of the Cardiovascular and Peripheral Vascular System

Read chapter 24 in the book

Summary

The cardiovascular system is essential for maintaining continuous blood circulation and oxygen and nutrient delivery throughout the body. Nurses, pivotal in identifying and addressing cardiovascular issues such as hypertension and arrhythmias, must comprehend the dynamics of heart structures, assess cardiac function accurately, and intervene effectively. The myocardium’s intricate muscle pattern, particularly in the left ventricle, plays a critical role in efficient pumping of blood to ensure all tissues and cells receive adequate supplies of oxygen and nutrients. The peripheral vascular system consists of arteries, veins, and capillaries.

Key terms

myocardium: muscles in the walls of all four chambers of the heart, though it is thicker in the ventricles and thinner in the atria
cardiovascular system: essential for maintaining continuous blood circulation and oxygen and nutrient delivery throughout the body
vein: a blood vessel that returns blood to the heart
arrhythmia: abnormal heart rate and rhythm
capillary exchange: the transfer of material between capillary blood and body tissues, which is essential for delivery of nutrients and removal of waste products
continuous capillaries: capillaries that are common in muscle, connective, and nervous tissues and have the lowest permeability capabilities of all capillaries
formed elements: cells and cell fragments suspended in the plasma. The three classes of formed elements are the erythrocytes (red blood cells), leukocytes (white blood cells), and thrombocytes…
isometric contraction: an event occurring early in systole during which the ventricles contract while all the heart valves are closed so blood volume in the heart does not change

Chapter 25

Assessment of the Musculoskeletal System

Read chapter 25 in the book

Summary

There are five musculoskeletal system functions: structure and support, movement, protection of vital organs, storage and supply of calcium and phosphate, and hematopoiesis The structure and function of the musculoskeletal system has been a focus of this section. Bones, muscles, tendons, ligaments, collagen, and other connective tissue are the major structures of this body system. Under normal circumstances and with normal abilities, the musculoskeletal system is a fine-tuned machine, delivering on its many functions flawlessly.

Key terms

musculoskeletal system: composed of bones, muscles, joints, tendons, ligaments, and cartilage that support the body, allow movement, and protect vital organs
skeletal system: the body system composed of bones and cartilage
tendon: band of fibrous collagenous tissue that provides a continuation of the muscle sheath to enable muscle attachment to the periosteum of bones
ligament: band of tissue that connects bones to one another, provides support and stability, and enhances joint movements
hematopoiesis: the production of blood cells
crepitus: a popping or crackling sensation when the skin is palpated; it is a sign of air trapped under the subcutaneous tissues
passive range of motion: the degree of range of motion demonstrated in a joint when the examiner is providing the movement
articular cartilage: smooth, white tissue that covers the ends of bones where they come together and allows the bones to glide over each other with very little friction

Chapter 26

Assessment of the Neurological System

Read chapter 26 in the book

Summary

The brain is the organ responsible for sensation , movement, emotions, responses, thought processing, communication, and memory. The CNS includes the brain and spinal cord and is responsible for receiving, processing, and responding to sensory information. The spinal cord sends motor commands from the brain to the peripheral body and also relays sensory information from sensory organs to the brain. The PNS includes the cranial nerves, spinal nerves, and autonomic nervous system .

Key terms

autonomic nervous system: the division of the nervous system that regulates the involuntary body functions to maintain and restore homeostasis
brain: the organ responsible for sensation , movement, emotions, responses, thought processing, communication, and memory
response: actions or changes triggered by sensory stimuli or input
sensation: receiving information about the environment
epilepsy: a chronic brain disorder characterized by recurrent (two or more) seizures that are not related to a reversible stressor and occur more than 24 hours apart
primary headache: occurs independently and is not caused by another medical condition
demyelination: the destruction of the protective myelin that surrounds nerve fibers in the brain and spinal cord that results in impairment of nerve impulse transmissions

Chapter 27

Assessment of the Abdomen

Read chapter 27 in the book

Summary

The external structure of the abdomen has dual functions: to assist the body in movement and to protect internal organs. The layers consist of skin, muscle, fat, and fascia . The abdomen is divided into four quadrants to provide a reference to the anatomic location of organs when signs and symptoms arise in the abdomen. Internal structures of the abdomen include vital organs and blood vessels that aid in digestion, metabolism, and overall body function

Key terms

abdomen: the anterior region of a person’s trunk between the diaphragm and pelvis
bloating: a feeling of fullness and tightness in the abdomen
fascia: thin, fibrous connective tissue
rebound tenderness: the clinician maintains pressure over an area of tenderness and then withdraws the hand abruptly; if the patient winces with pain upon withdrawal of the hand, the test is positive
rigidity: involuntary contraction of the abdominal musculature in response to peritoneal inflammation; it is a reflex the patient cannot control
nausea: the sensation of discomfort and unease in the stomach that is often accompanied by the urge to vomit
hollow viscera: organs that are hollow tubes or pouches
inferior vena cava (IVC): the body’s largest vein; carries blood to the heart from the bottom half of the body back to the heart; located in the posterior abdominal wall to the right of the aorta

Chapter 28

Clinical Judgment and Critical Thinking

Read chapter 28 in the book

Summary

Some of this growth was due to the development of the CJMM, a tool designed to measure critical thinking and clinical judgment in nursing students. Nursing involves several types of thinking, of which one of the most important is critical thinking. Historically, nursing was often viewed as a task-oriented career, but in recent years, the profession has grown in terms of autonomy and clinical judgment. This tool allows educators to assess the development of nursing student’s critical thinking skills to help ensure they are ready to practice as a nurse after graduation.

Key terms

clinical judgment: thought process that allows nurses to arrive at a conclusion based on objective and subjective information about a patient
critical thinking: reasoning about clinical issues such as teamwork, collaboration, and streamlining workflow
clinical judgment measurement model (CJMM): a model allowing nurse educators to teach, assess, and measure the development of clinical judgment skills of nursing students
clinical reasoning: a complex cognitive process that uses formal and informal thinking strategies to gather and analyze patient information, evaluate the significance of this information, and weigh…
cognitive thinking: mental processes and abilities a nurse uses to interpret, analyze, and evaluate information in their practice
critical thinking indicators (CTIs): certain behaviors that demonstrate the knowledge, skills, and attitudes that promote critical thinking
inductive reasoning: type of thinking that involves noticing cues, making generalizations, and creating hypotheses