Margins Study Assistant

Chapter 1

Professional Medical-Surgical Nursing

Summary

The nursing scope of practice is the range of activities a nurse is permitted to perform, as defined by state’s regulatory body The QSEN project focuses on six main competencies: patient-centered care, teamwork and collaboration, evidence-based practice, quality improvement, safety, and informatics Each year, The Joint Commission gathers information related to emerging patient-safety issues. Medical-surgical nurses provide care for adult patients of all ages who are preparing for or recovering from surgery.

Key terms

nursing scope of practice: the range of activities a nurse is permitted to perform, as defined by state’s regulatory body
scope of practice: range of activities a licensed person is permitted to perform as part of their work
The Joint Commission: independent, not-for-profit organization that sets standards for quality care, quality improvement, and patient safety for organizations and workers in the health-care industry
evidence-based practice: process of making clinical decisions on the basis of the best available evidence from the most up-to-date research
nursing research: inquiry that is systematically designed to provide knowledge for important issues relevant to the nursing profession
anonymity: state of being unknown; refers to a participant in a study whose identity is not disclosed
clinical judgment: process by which nurses make decisions about patient care on the basis of observations, assessments, and interpretations of relevant information
collaborative care model: approach to health care in which a team of providers works together to manage patient care more effectively and improve patient outcomes

Chapter 2

Culturally Competent Care

Read chapter 2 in the book

Summary

Embracing cultural competence as an ongoing journey is crucial for nurses to provide patient-centered care in an increasingly multicultural society Cultural humility takes cultural competence a step further. Culture consists of the characteristic beliefs, values, customs, behaviors, and artifacts shared by a particular group of people. Conversely, race is used to group people by certain physical or geographical characteristics, and it is a social construct

Key terms

culture: characteristic beliefs, values, customs, traditions, behaviors, and artifacts shared by a particular group of people
cultural competence: ability of health-care professionals to provide effective care to patients from diverse cultural backgrounds
race: social construct used to group people by certain physical, social, or geographic characteristics
ongoing journey: crucial for nurses to provide patient-centered care in an increasingly multicultural society
cultural humility: attitude of openness, self-reflection, and lifelong learning regarding cultural differences
stereotype: widely held but oversimplified assumption about a particular group of people
cultural safety: aim of creating an environment that is safe, respectful, and affirming for individuals of all cultures, particularly those from marginalized or oppressed backgrounds
cultural assessment: method for systematically gathering information about a patient’s cultural beliefs, values, practices, and perceptions as they relate to health care

Chapter 3

Health Promotion and Patient Education

Read chapter 3 in the book

Summary

Betty Neuman’s health continuum emphasizes the role of health-care workers in intervening at different stages to promote wellness and prevent illness. A positive health concept can impact a person’s well-being Health-promotion activities that consider social determinants and aim for health-care equity are essential. Using the World Health Organization’s social determinants of health, patients in need can be identified and targeted for health promotion

Key terms

health promotion: holistic and proactive process of prevention of health issues through which people are empowered to take control of their health-related choices and reach the best possible…
health: a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity
positive health concept: subjective view of one’s health status that allows a person to function at optimal levels, cope with life’s stressors, and maintain a feeling of satisfaction, even though they…
health-care equity: equal opportunity for people to achieve their desired health outcomes
wellness: goal of the health continuum, signifying peak holistic function
adverse effect: (also: complication ) medication-caused issue that is more serious, may be life threatening, and should be reported to the prescribing provider
medication reconciliation: prevention of common medication errors through a comparison process making sure the medications that the patient is taking are the medications that have been prescribed and…
nonmodifiable risk factor: disease risk factor that is out of a person’s control but increases the probability that the person will get the disease

Chapter 4

Clinical Judgment in the Nursing Process

Read chapter 4 in the book

Summary

The nursing process consists of assessment, diagnosis, planning, implementation, and evaluation The nursing process is a five-step process that serves as the foundation of nursing practice The nursing process typically moves in a forward direction, but at times the nurse must circle back to previous steps to gather more patient data or perform additional interventions This is a continuous process that allows the nurse to provide and evaluate care to promote optimal patient outcomes

Key terms

nursing process: a five-step process that serves as the foundation of nursing practice
Clinical Judgment Measurement Model (CJMM): nursing practice and education model that allows nurse educators to teach, assess, and measure the development of clinical judgment skills in nursing students
evaluation: systematic determination of a patient's progress toward the achievement of outcomes and goals set during the care-planning process
outcome: the desired result or goal after implementation of the patient’s individualized plan of care
assessment: systematic and dynamic process of collecting and analyzing data about a client’s health
subjective data: patient’s own descriptions of their symptoms, feelings, and perceptions, as well as relevant information obtained from friends and family members
inductive reasoning: type of thinking that involves noticing cues, making generalizations, and creating hypotheses
deductive reasoning: type of thinking that involves using a general standard or rule to create a strategy

Chapter 5

Ethical Decision Making

Read chapter 5 in the book

Summary

The principles outlined in the Nursing Code of Ethics are the foundation that guides nurses to provide high-quality, patient-centered care Common ethical principles include autonomy, beneficence, justice, nonmaleficence, and fidelity Clinical judgement is guided by ethical guidelines as outlined by the ANA Clinical judgement is based on nursing knowledge, critical thinking, and clinical reasoning which is then used to understand and interpret information related to the delivery of care and how it affects care outcomes

Key terms

Nursing Code of Ethics: the foundation that guides nurses to provide high-quality, patient-centered care
fidelity: duty to faithfully uphold one’s commitments
morality: person’s or society’s idea of what is right or wrong; usually associated with one’s behavior
health disparities: preventable differences that underserved populations experience related to disease, injury, or violence that can negatively impact health
ethics committee: appointed committee that provides support and guidance with ethical dilemmas to promote sound decision-making
self-determination: moral and legal right to determine what will be done with and to an individual’s person
health education: various learning experiences designed to promote behaviors that facilitate health
advocacy: act of pleading for a cause, idea, or policy

Chapter 6

Comprehensive Health Assessment and Physical Examination

Read chapter 6 in the book

Summary

Clinical judgment allows nurses to synthesize their knowledge, experience, and intuition with the available data to make informed, evidence-based decisions about patient care The nurse-patient relationship is unique and complex, and the nurse will draw on their critical thinking and communication skills to develop and maintain it Nurses must develop critical thinking skills to gather and analyze patient data. These skills lay the foundation for clinical judgment, which underlies the nursing process

Key terms

intuition: “sixth-sense” of knowing that largely comes from years of education and problem-solving in real-world patient situations
nurse-patient relationship: unique and complex, and the nurse will draw on their critical thinking and communication skills to develop and maintain it
medication reconciliation: process of reviewing a patient’s medications listed in their medical record and comparing that list to what the patient is actually currently taking at home
PERRLA: eye assessment that determines if pupils are equal, round, reactive to light and accommodation
positive: used to note when signs or symptoms in a system are present
negative: used to note when signs or symptoms in a system are absent
chief complaint: reason the patient is currently seeking care
comprehensive physical assessment: detailed, inclusive assessment of body systems to provide a big-picture, broad view of a patient’s overall health

Chapter 7

Pain Assessment and Management

Read chapter 7 in the book

Summary

Acute pain lasts up to three to six months, chronic pain lasts longer than six months, and breakthrough pain is a sudden onset of pain lasting for a short period of time Neuropathic pain is caused by damage to nerves or other parts of the nervous system, whereas nociceptive pain is caused by damage to the body tissue Pain is an uncomfortable or unpleasant sensation that signifies injury or illness. Pain is caused by receptors in the body sending a signal to the brain to let an individual know that they are in pain

Key terms

pain: uncomfortable or unpleasant sensation that typically signifies injury or illness
acute pain: short-term pain, typically lasting from minutes to up to three to six months
neuropathic pain: pain caused by damage to nerves or other parts of the nervous system
breakthrough pain: sudden increase in pain that lasts for a short time
nociceptive pain: pain caused by damage to body tissue
chronic pain: pain lasting longer than six months
cognitive behavioral therapy (CBT): psychological treatment in which patients are taught how to manage and cope with pain more effectively by changing their negative thought pattern, identifying and reducing…
critical-care pain observation tool (CPOT): standardized assessment tool used in critical-care settings to evaluate pain in critically ill patients who are unable to communicate their pain

Chapter 8

Stress and Stress-Related Disorders

Read chapter 8 in the book

Summary

Adaptation to stress is needed to maintain homeostasis. Positive adaptive behaviors can restore health, whereas maladaptive behaviors can further increase stress and produce negative outcomes Stressors can be perceived by the body as physical threats to its homeostasis Stress is a universal part of life, yet individuals may respond differently to the same stressor for a variety of reasons, including physical, emotional, and psychosocial factors

Key terms

stress: disruption to the body’s usual state
adaptation: process of adjusting to the environment as conditions change, either suddenly or over time
adaptive behavior: behavior that enables one to decrease distress; may be either positive or negative
stressor: event or stimulus that activates an individual’s stress response
maladaptive behavior: negative behavior performed to decrease distress
homeostasis: state of balance in the body
Stress Transactional Model: theory that stress is a transaction and cascade of events that occur in the body in response to a stressor
alternative: referring to health practices that are other methods not generally taught in Western medicine

Chapter 9

Management of Chronic Illness

Read chapter 9 in the book

Summary

Chronic diseases and illnesses affect more than half of the population and are the leading cause of death and disability in the United States Chronic disease is defined as a medical or health problem that lasts at least 1 year and requires ongoing medical attention or limits ADLs, whereas chronic illness refers to the human experience of living with a… More than one-fourth of individuals with chronic illness are diagnosed with comorbidity, or the presence of two or more chronic conditions simultaneously It is imperative that nurses provide patient-centered care that considers the specific preferences and needs of the patient diagnosed with a chronic disease

Key terms

chronic illness: human experience of living with a chronic disease
chronic disease: medical or health problem that lasts one year or more and requires ongoing medical attention or limits activities of daily living
population and: the leading cause of death and disability in the United States
disability: limitation in function or performance of everyday activities
polypharmacy: simultaneous use of multiple medications by a single patient
disease burden: total effects of a disease on an individual or a society
comorbidity: simultaneous presence of two or more medical conditions
Chronic Care Model: model developed to guide the reorganization of health care delivery to effectively care for patients with chronic conditions

Chapter 10

Fluid, Electrolyte, and Acid-Base Imbalances

Read chapter 10 in the book

Summary

To maintain homeostasis or stable internal equilibrium of physiological processes, the body must maintain appropriate balances of fluids, electrolytes, pH, acids, and bases The movement of fluid between intracellular and extracellular compartments is governed by several mechanisms, including hydrostatic pressure, oncotic pressure, and osmosis The body has many internal mechanisms in place that attempt to compensate for fluid, electrolyte, and acid-base imbalances When the body’s compensatory mechanisms are not able to completely correct these imbalances, medical intervention is warranted

Key terms

acid: byproduct of many metabolic processes in the body and forms hydrogen ions (H + ) when dissolved in water
base: forms hydroxide (OH - ) ions when dissolved in water
hypovolemia: state that occurs when fluid loss is greater than fluid intake, resulting in a deficient volume of fluid
pH: value that explains how much hydrogen is contained within a liquid and the activity of the hydrogen ion
electrolytes: ions dissolved in body fluid that play important roles in most physiological functions and assist in maintaining homeostasis
osmosis: movement of water through a semipermeable membrane from an area of lesser solute concentration to an area of greater solute concentration
oncotic pressure: pressure created by colloid in a fluid; prevents the movement of water from one solution to another

Chapter 11

Gas Exchange, Airway Management, and Respiratory System Disorders

Read chapter 11 in the book

Summary

During inhalation, air passes through the conducting zone and travels to the respiratory bronchiole and the alveolar sac. It is made up of the conducting zone and the respiratory zone The lungs are protected by the ribs and sternum and are covered in protective membranes called pleurae Ventilation refers to the movement of air into and out of the lungs.

Key terms

lungs: protected by the ribs and sternum and are covered in protective membranes called pleurae
conducting zone: all parts of the respiratory system that do not participate in gas exchange, the passageways for air to flow into and out of the lungs
ronchi: coarse, loud sounds that occur due to constriction in the larger airways due to mucus or fluid
respiratory zone: parts of the respiratory system that perform gas exchange
pleurae: protective membranes that encase the lungs
ventilation: movement of air into and out of the lungs
BiPAP: bilevel positive airway pressure, a form of noninvasive ventilation that uses a tight-fitting mask over the nose and/or mouth to increase oxygen levels and lower carbon dioxide…

Chapter 12

Cardiovascular System

Read chapter 12 in the book

Summary

Preload and afterload are terms that encompass the amount of stretch and force that is required prior to contraction and during contraction, respectively Cardiac output is how much blood is exiting the aorta each minute Stroke volume is the amount of blood that exits the left ventricle during systolic contraction The coronaries perfuse the myocardial tissue with oxygen-rich blood.

Key terms

stroke volume: amount of blood pumped out of the left ventricle during systolic contraction
afterload: amount of pressure the heart needs to exert during ventricular contraction
cardiac output: number of liters of blood that exit the aorta in a minute
preload: initial stretch of the cardiac cells prior to contraction
angiography: procedure in which a catheter is threaded into the femoral artery and fluoroscopy dye is injected into the patient’s coronaries to assess the presence of coronary blockages
atherosclerosis: form of arteriosclerosis in which there is narrowing and reduced blood flow through the arterial wall due to plaque formations
cardioversion: procedure performed by a machine or medicine that restores a normal heart rhythm when the heart is beating too fast or irregularly
coronary artery bypass graft (CABG): surgical procedure in which veins from other parts of the body are placed over diseased coronaries to restore blood flow

Chapter 13

Musculoskeletal System

Read chapter 13 in the book

Summary

Common clinical manifestations of osteoporosis include bone fractures, back pain, kyphosis, and a loss of total height over several years. Osteopenia, a decrease in bone mineral density, is the precursor condition to osteoporosis The underlying pathophysiology of osteoporosis involves too much resorption of small amounts of minerals from the bone over time. The gold standard diagnostic test for osteopenia and osteoporosis is the dual-energy x-ray absorptiometry (DEXA or DXA) scan, which uses low-dose radiation x-rays to determine bone density of the hip, wrist, or spine.

Key terms

resorption: breakdown and reabsorption over time of small amounts of minerals from the bone
kyphosis: excessive curvature of the upper spine
osteopenia: decrease in bone mineral density
external fixation: internal placement of screws on either side of a fracture by drilling pins into the bone and then connecting them to an external brace or bracket
osteoarthritis (OA): degenerative joint disease disorder that involves the wearing down of joint cartilage and tissue over time
compartment syndrome: condition caused by increased pressure within an area of tissue and resulting in muscle and nerve damage
Raynaud’s syndrome: condition that occurs when the fingers become pale when exposed to cold or stress states

Chapter 14

Integumentary System

Read chapter 14 in the book

Summary

The skin has three major layers: the dermis, epidermis, and hypodermis. Atopic dermatitis (eczema) occurs when a person has a dysfunctional skin barrier, allowing the body to be more susceptible to pathogens. Atopic dermatitis is linked to genetics, the immune system, and epidermal dysfunction.

Key terms

integumentary system: largest organ of the body, comprising skin, hair, and nails
hypodermis: (also: subcutaneous tissue ) bottom layer of skin that is made of adipose and areolar tissue that cushions the underlying organs
atopic dermatitis: chronic skin condition in which a person has a dysfunctional skin barrier that allows substances outside to penetrate the skin easily, causing dry and red areas of skin
dermis: middle layer of the skin, just below the epidermis, made up of connective tissue that supports the epidermis
psoriasis: chronic dermatological disorder, characterized by the proliferation of skin cells and chronic inflammation
epidermis: outermost layer of skin, made of epithelial cells
dermatitis: inflammation or irritation of the skin
plaque: raised lesion on the skin

Chapter 15

Cerebrovascular System

Read chapter 15 in the book

Summary

Different areas of the brain are perfused by different branches of the circle of Willis (CoW). The functions of brain cells are dependent on perfusion needs Treatment of CVA is targeted at rapidly restoring perfusion needs, since the longer the brain is without proper blood flow, the greater the damage The brain is a complex collection of vasculature and tissues.

Key terms

circle of Willis (CoW): location in the brain where cerebral arteries meet and divide in a way aimed to maintain perfusion
cranial nerves: responsible for the sensory and motor functions of the head and neck
longer the brain: without proper blood flow, the greater the damage
brain: a complex collection of vasculature and tissues
functions of brain cells: dependent on perfusion needs
penumbra: tissue that is immediately around an infarction, is receiving marginal blood flow, and is still salvageable with restoration of perfusion
ventriculostomy: procedure in which a hole is drilled through the skull and a catheter for measuring pressure is placed directly into the ventricle
thrombectomy: procedure in which a catheter is inserted through a vessel to physically remove a clot from the cerebral vasculature

Chapter 16

Hematopoietic Disorders and Regulation

Read chapter 16 in the book

Summary

Anemia is a deficiency of red blood cells (RBCs) or hemoglobin (Hb). The main diagnostic is a hemogram, a detailed analysis of a blood sample that examines not only the quantity of RBCs, WBCs, and platelets but also their size and color and the percentage of iron in them Clinical signs and symptoms of anemia include fatigue, weakness, pale skin, and shortness of breath. Pathophysiology of anemia includes nutritional deficiencies, chronic diseases, genetic factors, and chronic bleeding

Key terms

hemoglobin (Hb): protein in red blood cells that is key to the transport of oxygen from the lungs to cells and tissues
hemogram: detailed analysis of a blood sample that examines not only the quantity of red blood cells, white blood cells, and platelets but also their size, color, and percentage of iron
main diagnostic: a hemogram, a detailed analysis of a blood sample that examines not only the quantity of RBCs, WBCs, and platelets but also their size and color and the percentage of iro
anemia: medical condition characterized by deficient production of red blood cells or of hemoglobin
polycythemia vera: type of polycythemia that originates from the bone marrow and is caused by a genetic mutation; also called primary polycythemia
international normalized ratio (INR): standard measurement of prothrombin time that is used across different laboratories
ABO system: categorization of blood into four main types—A, B, AB, and O—based on the different antigens on the surface of red blood cells
acute hemolytic reaction: transfusion reaction due to an ABO mismatch, which can lead to serious signs and symptoms, including low blood pressure and shock, hemoglobinuria, nausea, vomiting, pain, chills…

Chapter 17

Nervous System and Chronic Diseases of the Nervous System

Read chapter 17 in the book

Summary

In neurology and neurosurgery, the Monro-Kellie doctrine establishes relationships among brain, blood, and cerebrospinal fluid (CSF) volumes within a skull’s rigid confines. Any increase or decrease in one of these components must be counterbalanced with an increase or decrease in one or both other components to maintain a stable intracranial pressure (ICP) in the brain Increased intracranial pressure (IICP) is a serious clinical issue that requires rapid assessment and intervention Decreased ICP, a less serious clinical issue (but still in need of treatment), may be due to dehydration, CSF leak, hemorrhage, or brain atrophy

Key terms

increased intracranial pressure (IICP): increase in intracranial pressure that occurs as a result of factors such as changes to blood volume, changes in the rates of CSF production and absorption, fluctuations in brain…
brain atrophy: loss of neurons and synapses sometimes caused by disorders such as MND, infections, and cerebral palsy
intracranial pressure (ICP): pressure within the rigid confines of a skull in which brain tissue, blood, and CSF exist together
Monro-Kellie doctrine: principle that intracranial volume remains constant while within rigid skull constraints
frontotemporal disorder: condition that occurs when the brain’s frontal and temporal lobe neurons are damaged; condition progressively gets worse and causes personality and behavior changes
Kernig’s sign: condition characterized by the inability to fully extend the knee when the hip is flexed at a 90-degree angle while the patient is supine
meningitis: (also: meningoencephalitis ) an inflammation of the meninges, which are the membranes covering both brain and spinal cord
nonpenetrating: relating to brain injuries that occur when the assault is strong enough to move the brain around inside the skull, but the skull is not broken

Chapter 18

Sensory Organs

Read chapter 18 in the book

Summary

Ocular disorders encompass a wide range of conditions that affect the eyes and visual system. Clinical symptoms of ocular problems include blurred vision, eye pain, redness, tearing, and vision changes Ocular disorders require collaborative care with ophthalmologists and optometrists . Medical treatments include protecting the eyes, administering medication, and educating the patient about eye hygiene, protection, and safety.

Key terms

open-angle glaucoma: type of glaucoma in which the drainage angle between the cornea and iris remains open but the fluid outflow is impeded
closed-angle glaucoma: type of glaucoma in which the drainage angle between the cornea and iris suddenly becomes blocked, leading to a rapid increase in intraocular pressure and other severe symptoms
keratoconjunctivitis sicca: (also: dry eye ) common ocular disorder characterized by insufficient tear production or poor tear quality, leading to dryness and discomfort of the eyes
otitis media: (also: middle ear infection ) prevalent condition caused by the invasion of microorganisms into the middle ear via the Eustachian tube
ototoxicity: toxic effects of certain medications or chemicals on the structures of the inner ear, leading to hearing loss, balance problems, or other auditory-related symptoms
keratoconus: progressive corneal disorder characterized by the thinning and distortion of the cornea, resulting in a conical shape
myopia: (also: nearsightedness ) the condition of seeing closer objects more clearly than distant objects
audiometry: comprehensive hearing test that measures a person’s response to frequencies and volumes of sound

Chapter 19

Gastrointestinal System and Disorders

Read chapter 19 in the book

Summary

Obesity is defined as abnormal or excess fat accumulation and a state of malnutrition by excess and is the result of having a chronic positive energy balance from consuming more calories than are being used by the body Diagnostics and laboratory studies for patients with obesity will generally focus on ruling out other comorbidities or health conditions Care for patients with obesity is individualized, according to any underlying causes of obesity and any comorbid conditions. Diet—both what you eat and how much you eat—has a dramatic impact on health.

Key terms

obesity: abnormal or excess fat accumulation and a state of malnutrition by excess characterized as having a BMI of 30 or greater
fecal impaction: blockage that occurs when stool accumulates in the rectum, usually due to the patient not feeling the presence of stool or not using the toilet when the urge is felt
malabsorption: occurs when the GI tract is unable to properly absorb nutrients, such as proteins, carbohydrates, fats, vitamins, minerals, or trace elements
vertical sleeve gastrectomy: weight loss surgery in which a portion of the stomach is removed and the size of the stomach is reduced to 3 to 4 ounces
stoma: opening on the abdomen that is connected to the gastrointestinal system to allow waste to be collected in a pouch
dental caries: one of the most common chronic oral cavity diseases, it is the breakdown or demineralization of tooth enamel
celiac disease: autoimmune disorder that is triggered by gluten ingestion, which causes damage to the small intestine
ileostomy: lower end of the small intestine (ileum) is attached to a stoma to bypass the colon, rectum, and anus

Chapter 20

Genitourinary and Reproductive Systems

Read chapter 20 in the book

Summary

Ovulation occurs when an egg is released from the ovary and generally occurs once a month The major organs of the male genitourinary system are the penis and testicles. Other structures in the genitourinary system are the bulbourethral glands and the prostate gland The major organs of the female genitourinary system are the uterus and ovaries.

Key terms

genitourinary system: encompasses the organs of both the reproductive and urinary systems
egg: released from the ovary and generally occurs once a month
ovulation: release of an egg from one of the ovaries
continuous bladder irrigation (CBI): procedure in which a three-way urinary catheter is used to constantly irrigate the bladder and allow for adequate urinary drainage
dialysis: use of a dialyzer machine to filter the blood and remove toxins when kidney function is decreased
sexually transmitted infection (STI): infection that is transmitted through close sexual contact
endometriosis: condition resulting in growth of uterine tissue in areas located outside of the uterus, resulting in severe pain and possible infertility
menstruation: process of a discharge of blood and other materials from the uterus through the vagina as part of the female menstrual cycle that lasts from puberty to menopause

Chapter 21

Endocrine System and Endocrine System Disorders

Read chapter 21 in the book

Summary

The endocrine system consists of cells, tissues, and organs that secrete hormones critical to homeostasis Endocrine glands are ductless glands that secrete hormones Endocrine communication involves chemical signaling via the release of hormones into the extracellular fluid. From there, hormones diffuse into the bloodstream and may travel to distant body regions, where they elicit a response in target cells.

Key terms

endocrine system: network of cells, tissues, and organs that secrete hormones as a primary or secondary function
hormone: chemical substance that travels throughout the body in the bloodstream and affects the activity only of its target cells
neural stimuli: release hormones in response to neural stimulation
adrenal glands: small, triangular-shaped endocrine glands located on top of each kidney that produce and release a variety of hormones that are essential for regulating several vital functions…
alarm reaction: first stage of GAS, in which a response to short-term stress is mediated by the hormones epinephrine and norepinephrine from the adrenal medulla via the SAM pathway; also called…
diabetes insipidus (DI): disorder in which water cannot be retained by the kidneys and is lost as urine; caused by chronic underproduction of ADH or a mutation in the ADH receptor; also known as arginine…
glucagon: hormone released when the body’s blood glucose is too low, triggering the liver to release stored glucose to raise glucose levels
thyroid: butterfly-shaped gland with two lobes that are connected by the isthmus

Chapter 22

Infection and Infectious Diseases

Read chapter 22 in the book

Summary

Additionally, it is important for nurses to understand the underlying functions and mechanisms of the human immune system, so they may better care for patients with infections The first step in the immune response is the body’s recognition of an antigen. Infection results when a pathogen is able to evade the immune response The immune response usually begins with the physical barriers that prevent pathogens from entering the body, destroy them after they enter, or flush them out before they can establish themselves as an infection.

Key terms

infectious disease: caused by pathogenic microorganisms—agents such as bacteria, viruses, parasites, or fungi—that enter a human host, multiply, and cause infection that can spread via direct or…
antigen: molecule on the cell surface of a pathogen that is recognized as an invader by the immune system
immune system: complex collection of cells and organs that destroy or neutralize pathogens that would otherwise cause disease or death
pathogen: agent such as a bacterium, virus, parasite, or fungus that enters a human host, multiplies, and causes infection
deoxyribonucleic acid (DNA): self-replicating material that is present in all living organisms and the main constituent of chromosomes; the focus of genetics
opportunistic infection: infection that arises from pathogens that would not normally cause infection in a healthy individual but occur when the immune system is not functioning optimally
oral thrush: infection caused by the fungus Candida albicans , which is found normally in the mouth but can become overgrown and pathological; also called oral candidiasis
ribonucleic acid (RNA): nucleic acid that is present in all living cells and that carries instructions from DNA for controlling protein synthesis

Chapter 23

Shock and Sepsis

Read chapter 23 in the book

Summary

During the initial stage of shock, clinical manifestations are not overtly apparent; however, changes occur at the cellular level In the compensatory stage of shock, cell hypoperfusion causes a drop in blood pressure, tachycardia, cool skin, increased respiratory rate, and a decrease in urine output In the progressive stage of shock, compensatory mechanisms fail and altered capillary permeability causes fluid to leak from the vascular system into the interstitial tissue Vital signs in the progressive stage of shock include low blood pressure, increased heart rate, low urine output, increased respiratory rate, and cool skin with discoloration of peripheral extremities with weak distal…

Key terms

shock: state of inadequate cellular perfusion, leading to hypoxia and cell death
sepsis: overreaction of the immune system to infection
compensatory stage: second stage of shock, characterized by a noticeable drop in blood pressure and causes stimulation of baroreceptors of the carotid and aortic bodies
initial stage: first stage of shock, when the body responds to hypotension with stimulation of the sympathetic nervous system (SNS) and the release of epinephrine and norepinephrine
progressive stage: third stage of shock, when profoundly decreased cellular perfusion results in a significant increase of capillary permeability, causing protein and fluid to leak out of the…
refractory stage: final stage of shock, characterized by extreme dysfunction of cellular processes in multiple body systems
hypermetabolic state: situation that occurs in response to injury and is characterized by increased blood pressure and heart rate, peripheral insulin resistance, and increased protein and lipid…
D-dimer: simple blood test that can help the health-care provider determine if a blood clotting condition is present

Chapter 24

Management of Patients with Allergic Disorders

Read chapter 24 in the book

Summary

Type IV, or delayed-type, hypersensitivity is a reaction where tissue damage is the result of T cell-dependent macrophage activation and inflammation Hypersensitivity is an abnormal heightened response to any type of stimulus; it does not normally occur after the initial exposure to an allergen Type I hypersensitivity, or anaphylactic response, is facilitated by IgE antibodies produced by the immune system in response to allergens like dust mites, animal dander, and pollens The most common type of respiratory allergy is allergic rhinitis

Key terms

allergic disorder: common pathological condition due to IgE-dependent immunological reactions to an allergen
allergy: inappropriate or exaggerated responses of the immune system to a foreign substance that is usually harmless
allergen: foreign substance that is usually harmless
T cell: cell that assists B cells in the immune response; also called T lymphocyte
reaction where tissue damage: the result of T cell-dependent macrophage activation and inflammation
hypersensitivity: abnormal heightened response to any type of stimulus
antibody: protein substance that protects against antigens
allergic rhinitis: localized allergic reaction in the sinuses

Chapter 25

Preoperative Care

Read chapter 25 in the book

Summary

The perioperative surgical experience includes the preoperative phase, intraoperative phase, and the postoperative phase The preoperative phase starts when the decision is made to proceed with a surgery or procedure and ends upon transfer to the operating room and is crucial to ensure patient safety The preoperative phase requires a nurse to possess strong communication, teamwork, and patient assessments skills to promote optimal outcomes and avoid errors or adverse events Preadmission care provides the nurse and anesthesia provider the opportunity to ensure that the patient is safe and in a stable condition prior to a procedure or surgery

Key terms

preoperative phase: begins when the decision is made to proceed with a surgery or procedure and ends when the patient arrives in the operating room
advance directive: document that allows a patient to convey, in writing, their wishes for care if they are unable to advocate for themselves due to a medical condition
malignant hyperthermia: serious genetic condition that causes a life-threatening elevation of body temperature and muscle spasms, among other severe symptoms
certified registered nurse anesthetist (CRNA): advanced practice RN who has received special training to administer anesthesia
morbidity: illness measured in prevalence or incidence within a population
sentinel event: unexpected event that leads to serious patient harm or death
incentive spirometer: tool used for breathing exercises to promote lung function
mortality: death measured within a population expressed as a ratio

Chapter 26

Intraoperative Care

Read chapter 26 in the book

Summary

The most common is an inpatient hospital operating room. Surgery can take place in various facilities. Others include ambulatory surgical centers, and specialty providers offices or clinics Surgical procedures can be organized into three categories: elective, urgent, and emergency.

Key terms

inpatient hospital operating room: most common surgical setting for patients
most common: an inpatient hospital operating room
elective surgery: non-emergent, planned procedure that is scheduled in advance based on the patient’s preference, surgical procedure, location of procedure, and surgeon’s availability
intraoperative phase: begins when the patient is transferred to the operating room bed and ends when the patient is transferred to the post-anesthesia care unit (PACU)
surgical environment: controlled and sterile setting in which surgical procedures are performed, including the operating room, associated equipment, and related practices and protocols designed to…
anesthesia awareness: (also: intraoperative awareness ) rare but potentially distressing phenomenon where a patient becomes partially or fully aware of their surroundings during surgery despite being…
anesthesiologist: highly trained medical professional responsible for administering anesthesia, monitoring the patient’s vital signs, airway, and managing the patient’s pain during surgery
epidural anesthesia: injection of local anesthetic agents into the epidural space surrounding the spinal cord, providing a controlled and prolonged analgesic effect

Chapter 27

Postoperative Care

Read chapter 27 in the book

Summary

Perioperative refers to the entire surgical experience from preoperative to surgery to postoperative within the postanesthesia care unit (PACU). Postoperative refers to the time after surgery and includes the monitoring and interventions from the interdisciplinary team PACU duties include stabilizing the airway and monitoring vital signs Nurses must intervene to manage PONV for patient comfort by administering medications, maintaining proper fluid balance through intravenous therapy, and educating patients

Key terms

postanesthesia care unit (PACU): hospital unit where patients are temporarily admitted after a surgery
postoperative phase: begins when the patient is transferred to the PACU and ends when the patient is transferred to another unit or discharged home
postoperative urinary retention (POUR): inability to urinate after surgery even when the bladder is full
phase I PACU: accommodates complex surgical and high-acuity patients; also known as main or primary PACU
durable medical equipment (DME): equipment such as elevated toilet seats, walkers, or ambulatory, mobility devices
phase II PACU: extended care units for patients who need less acute support after their surgery
postoperative nausea and vomiting (PONV): excessive nausea and vomiting that occurs as a result of anesthesia
inotropic: medications that impact the speed of cardiac contraction

Chapter 28

Inflammation and Healing

Read chapter 28 in the book

Summary

Understanding the four phases—hemostasis, inflammation, maturation, and remodeling—is important to understanding how to approach the wound and develop a comprehensive care plan The skin consists of three main layers: epidermis, dermis, and subcutaneous tissue. Each layer and its sublayers play an integral part in the external and internal roles of the skin Regardless of wound etiology, all wounds undergo the same biological repair process, which consists of four phases

Key terms

inflammation: second phase of wound healing, characterized by the movement of white blood cells to the wound bed
remodeling: final phase of wound healing, characterized by regrowth and reorganization of collagen
pressure injury: localized damage to the skin and underlying soft tissue, typically over a bony prominence or the site upon which a medical device was placed
surgical debridement: use of a scalpel, forceps, curette, scissors, or other instruments to remove necrotic tissue from the wound base; also known as sharp debridement
enzymatic debridement: selective method of debridement that uses an exogenous enzyme known as collagenase; also known as chemical debridement
proliferation: third phase of wound healing, characterized by epithelialization, angiogenesis, collagen formation, and contraction
hyperbaric oxygen therapy (HBOT): therapy in which patients breathe pure oxygen in a pressurized environment to help wound progression and healing
negative pressure wound therapy (NPWT): therapeutic technique that applies negative pressure to the wound bed to manage exudate and facilitate healing

Chapter 29

Immunological Function

Read chapter 29 in the book

Summary

The immune system is an intricate and complex system of specialized cells, organs, and tissues The main functions of the immune system are to recognize and destroy harmful substances or malignant cells, fight and remove disease-causing pathogens, and remove and destroy dead or damaged cells Natural (innate) immunity is nonspecific and present at birth. Acquired (adaptive) immunity develops after birth in response to specific pathogens

Key terms

immune system: an intricate and complex system of specialized cells, organs, and tissues
immunity: body’s specific, protective response to a foreign agent or organism
immunocompetent: state of having an efficient immune system that is able to carry out functions properly
primary immunodeficiency: immunodeficiency that is genetic and typically hereditary and present at birth
natural immunity: (also: innate or nonspecific immunity ) immunity that is present at birth
autoimmunity: disordered state in which the immune system mistakenly targets and attacks the body’s own healthy tissues, organs, and cells
genetic engineering: emerging field that uses recombinant deoxyribonucleic acid (DNA) technology to enable the replacement of defective or missing genes
secondary immunodeficiency: immunodeficiency that generally develops later in life, caused by another disorder or the use of various medications

Chapter 30

Genetics

Read chapter 30 in the book

Summary

Pharmacogenetics and pharmacogenomics are two very new terms in the realm of health care, which overall refer to an area of research examining how genes affect the response to medications Genetic conditions are conditions caused by a single gene mutation, such as sickle cell disease, whereas chromosomal conditions are caused by an incorrect number or structure of chromosomes, such as Down syndrome Genetics refers to the study of heredity, focused on patterns of inheritance of specific characteristics or traits, including variations of a trait within a population Genomics is the study of genes and how they interact with each other and the environment

Key terms

gene: basic functional unit of heredity found in the nucleus of every cell; composed of deoxyribonucleic acid (DNA) sequences located in an individual’s chromosomes
genetics: study of heredity focused on patterns of inheritance of specific characteristics or traits, including variations of a trait within a population
pharmacogenetics: study of the variability of therapeutic responses to medications, as influenced by variations in single genes
chromosome: structure made of protein and a single molecule of DNA that carries genetic information in the form of genes
pharmacogenomics: study of variations in multiple genes as associated with variable drug responses
genomics: study of genes and how they interact with each other and the environment
chromosomal condition: condition related to changes in chromosome structure or number
mutation: change in the DNA sequence of an organism’s genetic material

Chapter 31

Cancer

Read chapter 31 in the book

Summary

Cancer is thought to be caused by systemic issues, environmental exposures, and genetic determinants Cancer is characterized by uncontrolled and abnormal cell growth, which typically develops over years due to repeated insults to the cell’s genetic material Malignant growths are cancerous, grow uncontrollably, and invade other areas of the body. Preventable causes of mutations that may lead to cancer include smoking, alcohol consumption, poor nutrition, and viruses.

Key terms

cancer: disease caused by uncontrolled division of abnormal cells
brachytherapy: type of radiation treatment in which a radioactive source is placed in or near a tumor; it can be a wire, seed, disc, capsule, or implant
survivorship: state of surviving something that might have resulted in death; it applies to an individual from the time a cancer diagnosis is made throughout the remainder of their life
TNM system: method used for staging to describe the extent and spread of cancer based on the size of the tumor, whether or not the cancer has spread to nearby lymph nodes, and whether or not…
remission: period when an illness is less severe, or manifestations of the illness are not actively affecting the person
neutropenia: condition in which there is a low count of immature white blood cells called neutrophils
hyperviscosity syndrome: oncologic emergency in which the blood is so thick it will not flow properly
innate genetic factor: mutation that is inherited

Chapter 32

Palliative Care

Read chapter 32 in the book

Summary

Palliation and palliative care are designed to reduce or relieve symptoms for patients with serious illnesses that are no longer responding to treatment A do-not-resuscitate (DNR) order means the patient does not want CPR as a life-saving measure; a do-not-intubate (DNI) order means the patient does not want to be placed on a ventilator End-of-life care includes palliative care, which relieves or reduces symptoms related to a serious illness to preserve a patient’s quality of life, and hospice care, which provides comfort measures during the last six… Curative care or life-prolonging treatments can be continued along with palliative care

Key terms

palliative care: comfort care provided when a serious illness is no longer responding to treatment
do-not-intubate (DNI): order stating the patient does not want to be placed on a ventilator if they are unable to breathe independently
hospice care: specific type of palliative care for patients nearing the end of life, encompassing physical, psychological, emotional, and spiritual needs and desires
palliation: effort to alleviate suffering and enhance quality of life for patients with serious, often progressive, illnesses
do-not-resuscitate (DNR): order stating the patient does not want CPR conducted if their heart stops
durable power of attorney (DPOA): document enabling the patient to list a specific individual whom they entrust to make financial and health-care decisions when they are no longer able to do so
health-care proxy: person designated in a durable power of attorney document to make health-related decisions for a patient who is no longer able to make their own decisions
euthanasia: act by an individual to cause death, such as directly administering a lethal dose of a medication; illegal throughout the United States

Chapter 33

Emergency Care

Read chapter 33 in the book

Summary

The ACBDE assessment method is utilized to triage patients. The patient’s airway is assessed first, then breathing, circulation, neurological disability, and exposure ED nurses must triage and stabilize patients with the most life-threatening conditions first Subjective assessment findings, or symptoms, are those aspects of the patient’s condition that the patient feels or tells the nurse about and that cannot be directly observed or measured

Key terms

subjective assessment findings: (also: symptoms ) aspects of the patient’s condition that the nurse does not directly observe and are only reported by the patient
triage: process of prioritizing patients’ care based on initial assessment findings; life-threatening conditions are prioritized over less severe or non-life-threatening conditions
objective assessment findings: (also: signs ) aspects of the patient’s condition that the nurse directly observes and can be measured
patient’s airway: assessed first, then breathing, circulation, neurological disability, and exposure
ACBDE assessment method: utilized to triage patients
implied consent: approval is presumed and not obtained during an emergent situation due to the life-threatening nature of the situation
accidental poisoning: when a person accidentally exposes themselves to a substance that is harmful
psychiatric hold: when a patient is involuntarily admitted to a health-care facility under law

Chapter 34

Disaster and Recovery

Read chapter 34 in the book

Summary

Biological disasters like influenza, pandemics, and bioterrorism attacks present unique challenges for nurses. Land disasters like earthquakes, landslides, and fires can cause damage to facilities and make them inaccessible due to blocked roads Storms, thunderstorms, hurricanes, snow, floods, and tsunamis are just a few examples of water disasters that hospitals must be prepared for In the face of biological disasters, nurses must be equipped with knowledge of epidemiology, pathophysiology, and public health principles to effectively assess, triage, and treat patients

Key terms

bioterrorism: intentional release of a biological agent, such as bacteria, viruses, or toxins, intended to cause harm to individuals, populations, or economies
landslide: geological event characterized by the movement of a mass of rock, earth, or debris down a slope under the influence of gravity
tsunami: series of large ocean waves caused by the displacement of a large volume of water, typically as a result of an underwater earthquake, volcanic eruption, landslide, or meteorite…
earthquake: sudden and violent shaking of the ground caused by the movement of tectonic plates beneath the earth's surface
pandemic: outbreak of a disease that affects a high proportion of the population across a large geographic location
influenza: caused by influenza viruses, a contagious respiratory illness that affects the nose, throat, and lungs
biological disaster: wide range of events, such as an infectious disease outbreak, a pandemic, or a bioterrorism incident
technological disaster: broad range of events with far-reaching implications for public health and safety

Chapter 35

Nursing Care of the Critically Ill Patient

Read chapter 35 in the book

Summary

Technological supports such as ventilators and continuous renal replacement, and pharmacological supports such as vasopressors and sedatives are commonly encountered in the care of the critically ill patient The three main factors that affect stroke volume are preload, afterload, and contractility Assessment of cardiovascular insult typically requires the insertion of arterial catheters and pulmonary artery catheters, which monitor CO, cardiac index, and other hemodynamic parameters. Critical care nursing is a specialty of its own, requiring astute clinical judgement and critical thinking, due to the complexity of the patient’s medical challenges

Key terms

arterial catheter: small, flexible catheter that is inserted into an artery and connected to monitoring equipment to reflect continuous blood pressure measurements
vasopressors: medications that improve blood pressure and organ perfusion by constricting blood vessels
contractility: strength of the cardiac muscles during a contraction
hospital-acquired pressure injury (HAPI): pressure ulcers that are acquired during an inpatient hospital stay, most often related to pressure from medical devices or prolonged immobility
brain death: cessation of brain function due to irreversible brain damage that makes it impossible for the patient to remain alive without life-sustaining therapy
intra-aortic balloon pump (IABP): balloon pump inserted in the aorta that inflates during diastole to push blood into the coronary arteries and deflates during systole to push blood to the rest of the body
intubation: insertion of an artificial breathing tube into the airway to maintain patency and restore an effective breathing pattern, often with use of a mechanical ventilator
myocardial infarction (MI): occlusion of perfusion to the heart within the coronary arteries, resulting in eventual cardiac muscle death; also known as a “heart attack”

Chapter 36

Home Health Nursing and Rehabilitation

Read chapter 36 in the book

Summary

The role of the rehabilitation nurse is to manage complex medical conditions, therapeutic interventions, and coordination of care to produce improved patient outcomes, reduced hospital readmission rates, and an easier… Home health nurses serve an invaluable function within health-care systems, acting as intermediary communication channels between health-care providers, such as physicians and therapists, and patients Home health nurses conduct in-person home visits, which can involve a lot of planning. There are a number of steps nurses should take to prepare for their visit

Key terms

continuity of care: seamless communication between health-care professionals when a patient is transferring to a new setting
medication regimen: list of all medications the patient is currently taking
adaptive equipment: medical equipment, such as hearing aids or cochlear implants, used to help those with disabilities adapt to full function
ambulatory services: health-care services provided on an outpatient basis, wherein a patient receives care without needing hospital admission for an extended stay
community-based care: holistic approach that considers the emotional, physical, social, and environmental factors that impact an individual’s health
discharge planning: organized process designed to facilitate a safe transition for patients from health-care facilities, like hospitals or rehabilitation centers, back into their own home or a care…

Chapter 37

Trends in Health-Care Technology

Read chapter 37 in the book

Summary

Telemedicine enables remote health-care delivery using technology for diagnosis and treatment Artificial intelligence (AI) enables machines to solve problems and perform tasks that typically require human intelligence by leveraging the power of computer science and robust data sets (IBM, n.d.-a) AI enhances telemedicine by providing telemonitoring, diagnosis, treatment plans, patient engagement, and chronic disease management. The integration of AI and telemedicine can lead to improved quality of care, reduced costs, improved outcomes, optimized resources, and increased access to care.

Key terms

telemedicine: remote diagnosis and treatment of patients by means of telecommunications technology
artificial intelligence (AI): ability of machines, by applying computing power to large amounts of data, to solve complex problems and perform tasks that typically require human intelligence
augmented reality (AR): superimposition of a computer-generated environment onto the real world to create an interactive experience for the user
consumer health informatics: field of study and application that focuses on the use of information and communication technologies to empower individuals in managing their health and health care
digital transformation: comprehensive integration and adoption of digital technologies, processes, and strategies across an organization to fundamentally change how they operate and deliver value
incidence: number of new cases of a specific disease or health-related event that occur within a defined population during a specified time period; measures the risk of developing a condition

Chapter 38

Unfolding Case Study and NCLEX Preparation

Read chapter 38 in the book

Summary

Clinical judgment skills continue in licensed practice Successfully stabilizing a client’s anxiety, pain, or fear will enhance outcomes of care. In addition, nurses are likely to feel personally rewarded in their careers Critical thinking and clinical judgment develop in nursing practice over time and through models like the CJMM.