NCLEX-RN Medical-Surgical Nursing 1

1 MANAGEMENT AND LEGAL ISSUES 15
LEGAL ASPECTS OF NURSING 17
Board of Registered Nursing(BRN) 17
Legal Aspects of Management 17
Legal Issues 17
RN Management Duties 17
RN Delegationv 18
TYPES OF LAW 18
Key Legal Terms 19
RIGHTS AND CONSENT 20
Client’s Right to Privacy (Confidentiality) 21
The Client’s Bill of Rights 21
Informed Consent [to Receive Health Services] 22
Advance Directives 23
LEGAL ISSUES IN DRUG ADMINISTRATION 24
Regulation 24
Violation 24
LEGAL ISSUES IN PSYCHIATRIC NURSING 25
Statutes of Protection 25
Admission Procedures 25
Psychiatric Advance Directives (PAD) 25
RESTRAINTS 26
ORGAN DONATION 27
2 STRESS AND ADAPTATION 29
HOMEOSTASIS 31
Stress 31
Stress and Disease 31
Selye’s Theory of Stress 32
Psychological Stress 32
DEVELOPMENT THROUGH THE LIFE CYCLE 34
Early Adolescence 35
Adolescence to Young Adulthood 35
Adulthood 36
_ Developmental Tasks 36
_ Values of Adulthood 37
_ Parenting in Adulthood 37
_ Physiological Changes 37
_ Physiological Changes 38
The Aged 39
_ Developmental Tasks 39
_ Physiological Changes 39
_ Major Health Problems 39
_ Psychosocial Changes 40
CULTURAL SENSITIVITY 40
THE GRIEVING PROCESS 43
Stages of Grief 43
Counseling Guidelines 43
DEATH AND DYING 44
The Concept of Death in the Aging Population 44
Death and Children 44
Nursing Management 44
Pain Management 45
Theories of Pain 45
HUMAN SEXUALITY 46
Overview of Human Sexuality 46
Sexual Behavior 47
Sexual Behaviors Related to Health 49
Sexuality and Disability 49
Child Sexual Abuse 50
JOINT COMMISSION CLIENT SAFETY GOALS, 2008 50
ALTERNATIVE AND COMPLEMENTARY THERAPIES 51
3 PHARMACOLOGY 53
DRUG METABOLISM 55
Factors That Affect Drug Absorption 55
Common Sources of Drugs 56
Methods of Naming Drugs 56
DRUG CLASSIFICATION 57
Classification by Action 57
Classification by Body System 57
DOSAGE AND PREPARATION FORMS 60
Solids 60
Liquids 60
Routes of Administration 60
_ Oral Route 60
Rectal Route 60
_ Parenteral Route 60
_ Other Routes 61
_ Administration 61
DOCUMENTATION OF MEDICATIONS 62
Medication Orders 62
Types of Medication Schedules 62
Legal Implications of Medication Errors 63
ADMINISTERING MEDICATIONS 63
Oral Medication 63
Narcotic Medication 64
Patient-Controlled Analgesia (PCA) 64
Parenteral Medications 64
HERB-DRUG INTERACTIONS 67
GOVERNING LAWS 71
Federal Food, Drug, and Cosmetic Act of 1938 71
Harrison Narcotic Act of 1914 71
Controlled Substance Act of 1970 71
Prescription and Medication Orders 71
Informational Resources 72
4 INFECTION 73
THE INFECTIOUS PROCESS 75
CDC GUIDELINES 75
Standard Precautions 76
HEALTHCARE-ASSOCIATED INFECTIONS (HALs) 78
Nosocomial Infections 78
Risks of Hospitalization 78
Basic infection Control Measures 79
EMERGING VIRUSES 82
Biology of Infectious Disease 82
Marburg and Ebola Viruses 83
Hanta Virus 83
Lassa Fever 83
Dengue Fever 83
Severe Acute Respiratory Syndrome (SARS) 84
West Nile Virus 84
Avian (Bird) Influenza (H5NI) 85
IMMUNOSUPPRESSION 85
The immunosuppressed Client 85
Acquired Immunodeficiency Syndrome (AIDS) 88
Healthcare Workers’ Exposure to HIV 92
HIV-HBV Healthcare Worker Alert 92
SKIN 93
Anatomy and Physiology 93
_ Skin 93
_ Hair 93
_ Sweat Glands 93
_ Sebaceous Glands 94
Skin Lesions 96
_ Paronychia 96
_ Acne Vulgaris 96
_ Cellulitis 96
_ Impetigo 97
_ Furuncle (Boil) 97
_ Herpes Simplex 97
_ Herpes Zoster (Shingles) 97
Syphilis 98
Allergic Responses 98
_ Eczema (Atopic Dermatitis) 98
_ Contact Dermatitis 99
_ Poison Oak or Poison Ivy 99
Malignant Skin Tumors 99
Lupus Erythematosus 100
Lyme Disease 100
5 NUTRITION 103
MACRONUTRIENTS 105
Carbohydrates 105
Fats or Lipids 105
Proteins 105
Water 106
MICROUNUTRIENTS 106
Vitamins 106
Minerals 107
ASSIMILATION OF NUTRIENTS 107
The Accessory Organs 107
Diet Related to Heart Disease Risk 108
NUTRITIONAL PROBLEMS IN THE HOSPITAL 108
ADMINISTERING THERAPEUTIC DIETS 113
Preoperative and Postoperative Diets 118
Providing Nutrients through Enteral Feeding 119
_ Total Nutritional Alimentation (TNA) via Central Venous Catheter 122
_ Hyperalimentation for Children 124
6 PERIOPERATIVE CARE 125
PRE-OPERATIVE CARE 127
Preoperative Medications 127
INTRA-OPERATIVE CARE 128
POSTOPERATIVE CARE 130
Postanesthesia 130
Postoperative Medications 130
Common Postoperative complications 131
_ Respiratory complications 131
_ Wound Infections 133
_ Wound Dehiscence and Evisceration 133
FLUID REPLACEMENT THERAPY 134
SERUM ELECTROLYTE LEVELS 135
Potassium lmbalance 135
Sodium Imbalance 135
Calcium Imbalance 136
Magnesium Imbalance 137
TRANSFUSION ADMINISTRATION 138
Types of Blood Components 138
Transfusion Reactions 139
_ Hemolytic or Incompatibility Reaction 139
_ Allergic Reactions 139
_ Bacterial contamination 139
_ Circulatory Overload 140
7 ONCOLOGY NURSING 141
CANCER INCIDENCE AND TRENDS 143
IDENTIFIED CAUSES AND RISK FACTORS 143
Secondary Prevention-Early Detection 144
CANCER CLASSIFICATION 145
TREATMENT METHODS 146
Surgery 146
Radiation Therapy 148
Chemotherapy 150
PAIN IN CANCER 154
Treatment Methods 155
Psychosocial Implications 156
HOSPICE CARE 157
8 EMERGENCY NURSING 159
ASSESSING LIFE-THREATENING CONDITIONS 161
Initial Status Assessment 161
Secondary Status Assessment 161
COMMON EMERGENCIES 161
Wounds 161
Choking 162
Poisoning 162
Frostbite and Cold Exposure 163
Heat Exhaustion 163
Heatstroke 163
Burns 163
Fractures 164
Sprains 164
Strains 165
Dislocations 165
Snake Bite 165
Bee Sting 166
CARDIOPULMONARY RESUSCITATION (CPR) 166
CPR Algorithm 167
DISASTER 170
Introduction to Disaster Nursing 170
Triage 170
Treating Life-Threatening Conditions 172
Post-Triage Interventions 173
9 CARDIOVASCULAR SYSTEM 175
ANATOMY AND PHYSIOLOGY 177
Heart 177
_ Cardiac output 178
_ Conduction system of heart 180
Blood 181
_ Pulse 182
_ Structure and function of blood vessels 183
_ Capillaries 183
Lymphatic System 183
DIAGNOSTIC PROCEDURES 186
Blood Coagulation 188
_ Prothrombin Time (PT) 188
_ Activated partial Thromboplastin Time (APTT) 188
_ International Normailized Ration(INR) 188
Schilling Urine Test 189
Blood Lipid Tests 189
12-Lead Electrocardiography 189
Ambulatory Electrocardiographic Monitoring 190
Exercise Electrocardiography (Treadmill) 190
Echocardiography 191
Cardiac Catheterization/Coronary Angiography 191
Hemodynamic Monitoring 192
Central Venous Pressure (CVP) Monitoring 193
Scintigraphic (Nuclear Medicine) Studies 193
Cardiac Magnetic Resonance Imaging (MRI) 193
DRUGS FOR THE CARDIOVASCULAR SYSTEM 193
ACE Inhibitors 193
Beta-Adrenergic Blockers 194
Calcium-Channel Blockers(Ion Antagonists) 194
Angiotensin Receptor Blockers 194
Diuretics 194
Cardiac Glycosides 195
Antiarrhythmic Drugs 196
Antihyperlipidemic Agents 196
Sympathomimetic Agents 197
Platelet Inhibitors 198
Nitrates 198
Anticoagulant Therapy 199
_ Intravenous Anticoagulants 199
_Oral Anticoagulants 200
Thrombolytic Agents 200
MAJOR DISORDERS OF THE CIRCULATORY SYSTEM 201
Hypertension 201
_Hypertensive Crisis 202
Coronary Artery Disease (CAD) 202
_Coronary Atherosclerosis 202
_Types of Angina 203
_Unstable Angina 204
_Myocardial Infarction 205
Heart Failure 206
Shock 208
_ Hypovolemic Shock 208
_ Cardiogenic Shock 209
_ Distributive (Vasogenic) Shock 210
Disseminated Intravascular Coagulation (DIC) 212
Valvular Disease (Murmurs) 213
_ Mitral Stenosis 213
_ Mitral Insufficiency 213
_ Mitral Valve Prolapse 214
_ Aortic Valve Stenosis 214
_ Aortic Insufficiency 214
_ Tricuspid Stenosis 214
_ Tricuspid Insufficiency 214
_ Cardiomyopathy 215
Inflammatory Heart Disease 215
_ Inf1acterial) Endocarditis 215
_ Pericarditis 216
Peripheral Vascular Disorders 216
_ Thromboangitis Obliterans(Buerger’s Disease) 216
_ Raynaud’s Disease and Phenomenon 217
_ Deep Vein Thrombophlebitis(DVT) 217
_ Varicose Veins 218
Surgical Procedures 218
_ Angioplasty 218
_ Atherectomy 219
_ Coronary Stents 219
_ Pacemaker Insertion 219
_ Surgical Procedures 220
_ Surgical Interventions fof Vascular Disorders 220
Disorders of The Blood 221
_ Purpuras 221
_ Agranulocytosis 221
_ Polycythemia Vera 221
_ Iron-Deficiency Anemia 222
_ Megaloblastic Anemia (pernicious Anemia) 222
_ Aplastic Anemia 223
_ Thrombocytopenia 224
_ Rupture of the Spleen 224
_ Splenectomy 224
Malignancy of The Lymphatic System 225
_ Hodgkin’s Disease 225
_ Non-Hodgkin’s Lymphoma (NHL) 226
10 RESPIRATORY SYSTEM 229
ANATOMY OF RESPIRATORY SYSTEM 231
Upper Airway 231
Lower Airway 231
Respiration 233
Transportation of Respiratory Gases 234
Regulation of Respiration 236
System Assessment 236
DIAGNOSTIC PROCEDURES 238
Pulmonary Function Tests 238
Arterial Blood Studies 238
THERAPEUTIC PROCEDURES 239
Suctioning 242
Tracheostomy 243
Chest Drainage Systems 244
PULMONARY MEDICATIONS 247
Bronchodilators 247
Anti-inflammatory Agents 248
MAJOR DISEASE OF RESPIRATORY SYSTEM 251
Hypoxic Condition 251
11
Pneumonia 251
Legionnaires’ Disease 253
Atelectasis 253
Pulmonary Embolism 253
Fat Embolism Syndrome (FES) 254
Acute Pulmonary Edema 255
Acute Respiratory Distress Syndrome (ARDS) 256
Adult Respiratory Distress Syndrome (ARDS) 256
Asthma 257
Obstructive Pulmonary Disease (COPD) 257
CHRONIC OBSTRUCTIVE PULMONARY DISEASE(COPD) 261
_ Chronic Bronchitis 258
_ Bronchiectasis 258
_ Emphysema 259
Carbon Monoxide Poisoning 260
Pulmonary Tuberculosis 261
Thoracic Surgical Procedures 262
Cancer of the Larnyx 263
_ Laryngectomy 264
_ Radical Neck Dissection 265
Cancer of the Lung 265
Pleural Effusion 267
THORACIC INJURIES 271
_ Hemothorax or Pneumothorax 267
_ Open Wounds of the Chest 268
_ Fractured Ribs 268
_ Flail Chest 269
_ Cardiac Tamponade 269
11 GASTROINTESTINAL SYSTEM 271
ANATOMY AND PHYSIOLOGY 273
DIAGNOSTIC PROCEDURES 279
Roentgenography of the Gastrointestinal Tract 279
Endoscopy 279
Gastric Analysis 280
Stool Analysis 280
Liver Function Tests 281
Serum Protein Electrophoresis Test 281
MAJOR DISORDERS 281
Oral Infections 281
Disorder of the Salivary Glands 282
Malignant tumors of the Mouth 282
Gastroesophageal Reflux Disease (GERD) 283
Esophageal Varices 283
Esophageal Hernia (Hiatal Hernia) 284
Esophageal Lesions 285
Dyspepsia Indigestion 285
Anorexia Nervosa 285
Anorexia 286
Nausea and Vomiting 286
Constipation and Diarrhea 287
Acute Gastritis 298
Chronic Gastritis 288
Peptic Ulcer Disease (PUD) 288
Surgical Intervention 291
_ Gastric Cancer 291
_ Postoperative Period 291
Inflammatory Bowel Disease 292
_ Regional Enteritis (Regional Ileitis, Crohn’s Disease) 292
_ Ulcerative Colitis 293
Intestinal Disorders 294
_ Intestinal Malignant Tumors 294
_ Appendicitis 295
_ Intestinal Obstruction 296
_ Herniorrhaphy 297
_ Diverticulosis and Diverticulitis 297
_ Hemorrhoids 298
_ Anorectal Surgery 298
DISORDERS OF LIVER, BILIARY, AND PANCREATIC FUNCTION 299
Diagnostic Evaluation Studies 299
Disorders of Liver Biliary and Pancreas 299
_ Viral Hepatitis 300
_ Cirrhosis 302
_ Portal Hypertension 303
_ Hepatic Encephalopathy 304
_ Cholecystitis and Cholelithiasis 306
_ Acute Pancreatitis 308
_ Chronic Pancreatitis 309
12 NEUROLOGICAL SYSTEM 311
ANATOMY AND PHYSIOLOGY OF THE NERVOUS SYSTEM 313
Central Nervous System: Brain and Spinal Cord 313
Peripheral Nervous System 320
DIAGNOSTIC PROCEDURES 324
Skull Series 324
Myelography 324
Cerebral Angiography 324
Magnetic Resonance Imaging (MRI) 324
Computerized Tomography Scan (CT Scan) 325
Tomography 325
Positron Emission Tomography (PET) 325
Electroencephalography (EEG) 326
Electromyohraphy (EMG) 326
Lumbar Puncture (LP) 326
NEUROLOGICAL DISORDERS 327
Neurologic Dysfunction 327
Increased Intracranial Pressure (ICP) 329
Cerebral Edema 331
Hyperthermia 332
Seizure Disorders 333
_ Convulsions/Seizures 333
_ Epilepsy 333
Trauma 336
_ Head Injury 336
_ Spinal Cord Injury (SCI) 337
Infectious Processes 343
_ Brain Abscess 343
_ Meningitis 344
_ Encephalitis 344
_ Post-Polio Syndrome (PPS) 345
_ Creutzfeldt-Jakob Disease (CJD) 346
Altered Blood Supply to Brain 346
_ Brain Attack (Cerebrovascular Accident [CAV], Stroke) 346
_ Types of Stroke 349
_ Cerebral Aneurysm 349
Degenerative Disorders 350
_ Multiple Sclerosis (MS) 350
_ Myasthenia Gravis 351
_ Parkinson’s Disease 353
Cranial and Peripheral Nerve Disorders 355
_ Trigeminal Neuralgia (Tic Douloureux) 355
_ Bells’ Palsy (Facial Paralysis) 355
_ Ménièr’s Disease 356
_ Bulbal Palsy 356
_ Guillain-Barré Syndrome 357
_ Amyotrophic Lateral Sclerosis (Lou Gehrig’s Disease) 357
Surgical Intervention 358
_ General Preoperative Care 358
_ General Postoperative Care 358
_ Eye and Ear 359
_ Glaucoma 360
_ Cataracts 361
_ Ophthalmic Drugs 362
_ Retinal Detachment 363
_ Age-Related Macular Degeneration (ARMD) 364
_ Removal of Foreign Body from Eye 364
_ Stapedectomy 365
13 MUSCULOSKELETAL SYSTEM 367
ANATOMY AND PHYSIOLOGY 369
Bone Structure 369
Joints 370
System Assessment 370
JOINT AND NERVE DISEASES 371
Rheumatoid Arthritis 371
Osteoarthritis 372
Gout 373
Carpal Tunnel Syndrome 373
ORTHOPEDIC AND VASCULAR CONDITIONS 374
Osteoporosis 374
Compartment Syndrome 375 Osteomyelitis 375
Osteomalacia 376
Fractures 376
Traction 378
Fractured Ribs 384
Hip Conditions 384
KNEE SURGERY 386
Arthroscopy 386
Total Knee Arthroplasty 386
Amputation 387
Crutch Walking 388
SPINAL SURGERY 388
Laminectomy, Discectomy, Etc. 388
Spinal Fusion 390
FIBROMYALGIA (FMS) 391
14 GENITOURINARY SYSTEM 393
ANATOMY AND PHYSIOLOGY 395
Kidney Structure 395
Ureters 395
Urinary Bladder 396
Urethra 396
Structures of the Male Reproductive System 396
Kidney Function 397
RENAL REGULATION OF FLUID AND ELECTROLYTES 400
Composition of the Body 400
Dynamics of Intercompartmental Fluid Transfer 400
Fluid Imbalances 401
DIAGNOSTIC PROCEDURES 402
Renal Function Tests 402
Urine Analysis 403
Prostate-Specific Antigen (PSA) Test 404
GU Examination 405
MAJOR DISORDERS OF GENITOURINARY SYSTEM 405
Urinary Tract Infections 405
Cystitis 406
Pyelonephritis 407
Glomerulonephritis 407
Nephrotic Syndrome 408
Injuries to the Kidney 409
Renal Failure 409
Chronic Renal Failure 410
Uremic Syndrome (Uremia) 411
Male Genitourinary Disorders 411
Benign Prostatic Hypertrophy (BPH) 412
Cancer of the Prostate 412
Prostatectomy 412
SURGICAL INTERVENTIONS FOR THE RENAL SYSTEM 413
Cystostomy 413
Urolithiasis 414
Urinary Diversion 414
Nephrectomy 415
DIALYSIS 415
Peritoneal Dialysis 415
Hemodialysis 419
Dialysis Management 419
Renal Transplant 420
15 ENDOCRINE SYSTEM 423
ANATOMY AND PHYSIOLOGY 423
Structure 423
PITUITARY GLAND DISORDERS 427
Acromegaly (Anterior Pituitary Hyperfunction) 427
Gigantism (Anterior Pituitary Hyperfunction) 429
Hypophysectomy 429
Dwarfism (Anterior Pituitary Hypofunction) 430
Diabetes Insipidus (DI-Posterior Pituitary Hypofunction) 430
ADRENAL CORTEX DISORDERS 431
Addison’s Disease(Adrenocortical Insufficiency) 431
_ Addisonian Crisis 432
_ Cushing’s Syndrome (Adrenocortical Hyperfunction) 432
_ Primary Aldosteronism 433
Adrenal Medulla Disorders 433
_ Pheochromocytoma (Hyperfunciton) 433
_ Adrenalectomy 434
THYROID GLAND DISORDERS 435 Thyroid Function Tests 435
Thyroid-Stimulating Hormone (TSH) 435
T 3 and T 4 Resin Uptake Tests 435
TSH 436
Cretinism (Thyroid Hypofunction) 436
Hypothyroidism (Myxedema) 436
Myxedema Coma 437
Hashimoto’s Thyroiditis 437
Thyrotoxicosis/Hyperthyroidism/Graves’ Disease 437
Thyroidectomy 439
Thyroid Storm (Thyrotoxic Crisis) 439
PARATHYROID GLAND DISORDERS 440
Hypoparathyroidism 440
Hyperparathyroidism 440
Parathyroidectomy 440
PANCREATIC DISORDERS 442
Diabetes Mellitus (Type 1 and 2) 442
Random (Casual) Plasma Glucose Levels 444
Glucose Tolerance Test 444
Syndrome X-Metabolic Syndrome 448
COMPLICATIONS 448
Ketoacidosis (DKA) 448
Insulin Reaction/Hypoglycemia 449
Chronic Complications 450
Functional Hyperinsulinism/Hypoglycemia 451
16 GERONTOLOGICAL NURSING 453
GENERAL CONCEPTS OF AGING 455
Demographics 455
Healthecare Costs 455
Morbidity and Mortality 456
Theories on Aging 456
NURSING PROCESS IN CARING FOR THE AGED PERSON 456
System Assessment 456
System Implementation 457
THE AGING BODY 457
Physiological Implications 457
Psychological Implications 457
Developmental Tasks of Older Adults 457
Sociological Implications 458
Prescription for Long Life and Good Health 458
General Physiological Changes 459
Baseline Admission Assessment 459
Neurological System 460
Cardiovascular System 460
Respiratory System 461
Gastrointestinal System 461
Genitourinary System 463
Musculoskeletal System 464
Integumentary System 464
Endocrine System 465
Lab Values in Older Adults 465
PROBLEM AREAS FOR OLDER ADULT CLIENTS 466
Sensory Impairment 466
Nutrition 466
Medications 467
Pain in Older Adults 469
Drug-Food-Herb Interactions in Older Adults 469
COMMON PROBLEMS FROM IMMOBILITY 471
Pressure Ulcers 471
External Rotation of Hip 471
Footdrop 471
Contractures 472
Bladder Dysfunction 472
Bowel Dysfunction 472
Hypostatic Pneumonia 472
COMMON CONDITIONS IN THE AGED 473
Delirium 473
Dementia 473
Depression 474
Hip (Femoral Neck) Fracture 475
Urinary incontinence 476
Impaired Mobility/Disability 477
Infections in Older Adults 478
Elder Abuse and Neglect 479
APPENDIX 481
SYSTEMS OF MEASUREMENT 483
Apothecary System 483
Metric System 483
Household System 483
MATHEMATIC CONVERSIONS 483
Approximate Equivalents 483
Computation 483
Calculation of Dosages 484
Calculation of Solutions 484
ABBREVIATIONS AND SYMBOLS FOR ORDERS, PRESCRIPTIONS, AND LABELS PHARMACOLOGY 486
CONVERSION TABLES 486
MOST COMMONLY USED DRUGS 487
_ Medical - Surgical Nursing 487
_ Maternity Nursing 487
_ Pediatric Nursing 487
_ Psychiatric Nursing 487
DISASTERS 487
_ Natural Disasters 487
_ Weapons of Mass Destruction 488
_ Biological Agents and Antidotes 489
_ Anthrax 489
_ Plague 491
_ Botulism 491
_ Typhoidal Tularemia 492
_ Viral Hemorrhagic Fever (VHF) 492
_ Q Fever 493
_ Ricin Toxin 493
Smallpox : Agent of Terror 494
_ Smallpox Disease 494
_ Administering Smallpox Vaccine 495
Chemical Agent Exposure 497
Acute Radiation Syndrome 498
Personal Protection Equipment 499
Decontamination : General Protocol 500
_ Decontamination Procedures 501
_ Specific Decontamination Steps 502