Concept-Based Clinical Nursing Skills

UNIT I Fundamental Nursing Skills

Foundations of Safe Client Care

SECTION 1 Identifying a Client

Application of the Nursing Process

Critical Concepts: Identifying the Client

SKILL 1.1 Identifying a Client

SECTION 2 Preventing Infection

Chain of Infection

Preventing the Transmission of Infection

Application of the Nursing Process

Critical Concepts: Preventing Infection

SKILL 1.2 Performing Hand Hygiene With an AlcoholBased Agent

SKILL 1.3 Performing Hand Hygiene With Soap and Water

SKILL 1.4 Applying and Removing Clean Gloves

SKILL 1.5 Applying and Removing Personal Protective Equipment

SECTION 3 Moving Clients Safely

Benefits of Proper Client Positioning and Repositioning

Ergonomics and Body Mechanics

Summary

Application of the Nursing Process

Critical Concepts: Moving the Client Safely

SKILL 1.6 Positioning a Client in Bed

SKILL 1.7 Moving a Client up in Bed

SKILL 1.8 Transferring a Client From Bed to Chair

SKILL 1.9 Using a Sling Lift to Move a Client

SKILL 1.10 Using a Sit-to-Stand Lift

SKILL 1.11 Transferring Clients Laterally (From Bed to Stretcher)

SKILL 1.12 Moving Clients Who Have Special Precautions (Logrolling)

SECTION 4 Using Restraints

Defining Restraints

Use of Securing Devices

Regulations Governing Use of Restraints

Application of the Nursing Process

Critical Concepts: Using Restraints

SKILL 1.13 Applying and Removing Restraints

SKILL 1.14 Applying a Mummy Restraint

CHAPTER 2 Personal Care and Hygiene

SECTION 1 Bathing a Client

Skin Assessment

Skin Care

Bathing an Adult

Bathing an Infant

Application of the Nursing Process

Critical Concepts: Bathing the Client

SKILL 2.1 Assisting an Ambulatory Client With Bathing

SKILL 2.2 Changing the Gown of a Client With an IV Line

SKILL 2.3 Bathing an Adult Client in Bed

SKILL 2.4 Providing Alternate Perineal Care

SKILL 2.5 Providing Foot Care

SKILL 2.6 Providing Nail Care

SKILL 2.7 Bathing an Infant

SECTION 2 Oral Hygiene

Dentures

Oral Care in the Acute Care Setting

Application of the Nursing Process

Critical Concepts: Providing Oral Care

SKILL 2.8 Providing Oropharyngeal Suctioning With a Round-Tip Suction Catheter (Yankauer)

SKILL 2.9 Providing Oral Hygiene for a Conscious Client

SKILL 2.10 Providing Oral Hygiene for an Unconscious Client

SKILL 2.11 Removing, Cleaning, and Inserting Dentures

SECTION 3 Providing Hair Care

Shaving

Lice

Application of the Nursing Process

Critical Concepts: Providing Hair Care

SKILL 2.12 Shampooing the Nonambulatory Clients Hair

SKILL 2.13 Shampooing a Client With a Dry-Shampoo Cap

SKILL 2.14 Shaving a Client

SKILL 2.15 Caring for a Client With Lice

SECTION 4 Eye and Ear Care

Application of the Nursing Process

Critical Concepts: Eye and Ear Care

SKILL 2.16 Providing Eye Care for an Unconscious Client

SKILL 2.17 Removing and Cleaning Contact Lenses

SKILL 2.18 Removing, Cleaning, and Inserting an Artificial Eye

SECTION 5 Assisting With Elimination

Applying Concepts of Safety, Client-Centered Care, Collaboration, and Health Maintenance

Bedside Commode, Urinals, Bedpans, and Condom Catheters

Application of the Nursing Process

Critical Concepts: Assisting With Elimination

SKILL 2.19 Assisting a Client Using a Bedside Commode SKILL 2.20 Assisting a Client Using a Urinal

SKILL 2.21 Assisting a Client Using a Bedpan

SKILL 2.22 Applying a Condom Catheter

SECTION 6 Making Beds

Types of Beds

Types of Mattresses Types of Bedding and Bed Making

Application of the Nursing Process

Critical Concepts: Changing a Bed

SKILL 2.23 Changing an Unoccupied Bed

SKILL 2.24 Making a Surgical Bed

SKILL 2.25 Changing an Occupied Bed

CHAPTER 3 Vital Signs and Vital Measurements

Vital Signs

SECTION 1 Assessing Temperature

Sites and Methods of Temperature Assessment Application of the Nursing Process

Critical Concepts: Assessing Temperature

SKILL 3.1 Measuring Temperature With an Electronic Thermometer

SKILL 3.2 Obtaining a Tympanic Temperature

SKILL 3.3 Obtaining a Temperature Using a Temporal Artery Thermometer

SECTION 2 Regulating Temperature

Regulating Temperature Application of the Nursing Process

Critical Concepts: Regulating Temperature

SKILL 3.4 Using Conductive Cooling or Heating Therapy

SKILL 3.5 Using an Infant Radiant Warmer

SECTION 3 Assessing Pulses

Location and Differentiation of Pulses

Apical Pulse

Technique for Assessing Pulses

Alterations of the Clients Pulse

Application of the Nursing Process

Critical Concepts: Assessing Pulses

SKILL 3.6 Obtaining a Radial Pulse Rate

SKILL 3.7 Assessing Carotid Pulses

SKILL 3.8 Assessing Peripheral Pulses

SKILL 3.9 Using a Doppler Ultrasound Device to Assess Pulses

SKILL 3.10 Obtaining an Apical Pulse

SKILL 3.11 Obtaining an Apical-Radial Pulse

SECTION 4 Assessing Respirations

Assessing Respirations in Pediatric Clients

Application of the Nursing Process

Critical Concepts: Assessing Respirations

SKILL 3.12 Obtaining a Respiratory Rate and Respiratory Assessment

SECTION 5 Assessing Blood Pressure

Classification of Hypertension

Factors Affecting Blood Pressure

Measuring Blood Pressure

Application of the Nursing Process

Critical Concepts: Assessing Blood Pressure

SKILL 3.13 Palpating a Systolic Blood Pressure

SKILL 3.14 Measuring a Systolic and Diastolic Blood Pressure by Auscultation

SKILL 3.15 Measuring Blood Pressure With an Automatic Oscillometric Monitor

SKILL 3.16 Using a Doppler Ultrasound Device to Hear Systolic Blood Pressure

Vital Measurements

SECTION 6 Assessing Oxygen Saturation

Obtaining an SpO2 Reading

Application of the Nursing Process

Critical Concepts: Assessing Oxygen Saturation

SKILL 3.17 Obtaining a Pulse Oximeter Measurement

SECTION 7 Assessing Blood Glucose

Application of the Nursing Process

Critical Concepts: Assessing Blood Glucose

SKILL 3.18 Obtaining Capillary Blood Glucose Measurements

CHAPTER 4 Performing an Assessment

The Assessment Process

SECTION 1 Collecting Subjective and Objective Data Collecting Subjective Data

Collecting Objective Data

Performing a Preliminary Survey

Summary

Critical Concepts: Collecting Subjective and Objective Data

SKILL 4.1 Performing a Preliminary Survey

SECTION 2 Performing a Head-to-Toe or SystemSpecific Assessment

Critical Concepts When Performing a Head-to-Toe or System-Specific Assessment

Performing a Rapid Head-to-Toe Bedside Assessment Performing a System-Specific Assessment

Summary

Critical Concepts: Performing a Head-to-Toe or SystemSpecific Assessment

SKILL 4.2 Performing a Rapid Head-to-Toe Bedside Assessment

SKILL 4.3 Assessing the Skin/Integumentary System

SKILL 4.4 Assessing the Head (HEENT) and Neck

SKILL 4.5 Assessing the Neurologic System

SKILL 4.6 Assessing the Thorax (Heart and Lungs)

SKILL 4.7 Assessing the Abdomen

SKILL 4.8 Assessing the Musculoskeletal System

SKILL 4.9 Assessing the Genitourinary System

CHAPTER 5 Nutrition and Gastrointestinal Tube Therapy

Essential and Nonessential Nutrients

Macronutrients and Micronutrients

Digestion and Assimilation of Nutrients

Nutritional Guidelines

Alterations That Can Cause Nutritional Deficiencies

SECTION 1 Nutritional Assessment

Criteria Used for a Nutritional Screening or Assessment

Assessing and Monitoring a Clients Food and Fluid Intake

Summary

Application of the Nursing Process

Critical Concepts: Nutritional Assessment

SKILL 5.1 Performing a Nutritional Screening

SECTION 2 Assisting Clients With Oral Nutrition

Types of Diets

Preparing A Client to Receive a Meal

Assisting A Client Who Has Difficulty Eating

Application of the Nursing Process

Critical Concepts: Assisting Clients With Oral Nutrition SKILL 5.2 Preparing a Client to Receive a Meal

SKILL 5.3 Assisting Clients With a Physical or Cognitive Impairment

SKILL 5.4 Assisting Clients With Dysphagia or Aspiration Risk

SECTION 3 Providing Gastric Tube Therapy

Nasogastric Sump Tube

Levin Tubes and Gastric Lavage Tubes

Placement and Care of a Nasogastric Sump Tube

Summary

Application of the Nursing Process

Critical Concepts: Providing Gastric Tube Therapy

SKILL 5.5 Placement and Care of a Nasogastric (NG) Sump Tube

SKILL 5.6 Initiating and Managing Nasogastric (NG) Sump Tube Suction

SKILL 5.7 Irrigating a Nasogastric (NG) Sump Tube

SKILL 5.8 Discontinuing a Nasogastric (NG) Sump Tube

SECTION 4 Providing Enteral Nutrition

Routes of Enteral Feeding

Daily Care for Clients With Gastrostomy, PEG, and Jejunostomy Tubes

Delivery Methods for Enteral Nutrition

Reducing Risks of Enteral Nutrition

Home Care Considerations

Providing Client-Centered Care During Enteral Nutrition

Summary

Application of the Nursing Process

Critical Concepts: Providing Enteral Nutrition

SKILL 5.9 Placement and Care of a Nasally Inserted Small-Bore Feeding Tube

SKILL 5.10 Providing Care for a Client With a Gastrostomy, PEG Tube, or Jejunostomy

SKILL 5.11 Administering a Tube Feeding (Intermittent or Continuous) SKILL 5.12 Using a Kangaroo Feeding Pump

CHAPTER 6 Supporting Mobility and Immobilization

SECTION 1 Supporting Mobility Collaborative Care for Clients With Assistive Devices Range of Motion

Application of the Nursing Process

Critical Concepts: Mobility

SKILL 6.1 Assisting With Ambulation Using a Transfer Belt

SKILL 6.2 Teaching the Client to Use a Cane

SKILL 6.3 Teaching the Client to Use a Walker

SKILL 6.4 Teaching the Client to Use Crutches

SKILL 6.5 Performing Active and Passive Range-ofMotion (ROM) Exercises

SECTION 2 Supporting Immobilization

Supporting Immobilization of a Limb or Joint

Supporting Cervical Immobilization

Pin Care

Application of the Nursing Process

Critical Concepts: Immobilization

SKILL 6.6 Applying a Sling

SKILL 6.7 Applying Bandages

SKILL 6.8 Providing Cast Care

SKILL 6.9 Managing Traction

SKILL 6.10 Providing Pin-Site Care

SKILL 6.11 Applying a Cervical Collar

SKILL 6.12 Managing Halo Traction

SECTION 3 Caring for a Client With an Amputation Postoperative Care

Communication: Client Education and Collaboration Application of the Nursing Process

Critical Concepts: Client With an Amputation

SKILL 6.13 Exercising and Positioning the Residual Limb

SKILL 6.14 Applying a Compression Bandage and Commercial Shrinker to a Residual Limb

CHAPTER 7 Comfort Care

The Impact of Pain

Nociceptive and Neuropathic Pain

Acute and Chronic Pain

SECTION 1 Assessment of Pain and Discomfort Subjective and Objective Assessment of Pain

Examples of Pain Tools Used for Assessment of Pain

Assessment of Pain for Diverse Populations

Lifespan Considerations: Older Adults and Pediatric Clients

Summary of Best Practice Recommendations for Assessment of Pain

Summary of Application of Critical Concepts for Assessment of Pain

Application of the Nursing Process

Critical Concepts: Assessment of Pain and Discomfort SKILL 7.1 Performing a Pain Assessment

SECTION 2 Using Relaxation Measures to Promote Comfort

Enhancing the Clients Environment

Controlled Breathing

Guided Imagery

Massage Therapy

Summary

Application of the Nursing Process

Critical Concepts: Using Relaxation Measures to Promote Comfort

SKILL 7.2 Enhancing a Clients Environment

SKILL 7.3 Assisting a Client With Controlled-Breathing Exercises

SKILL 7.4 Assisting a Client With Guided Imagery Exercises

SKILL 7.5 Providing a Back Massage

SECTION 3 Using a TENS Unit to Promote Comfort

Application of the Nursing Process

Critical Concepts: Using a TENS Unit to Promote Comfort

SKILL 7.6 Applying and Discontinuing a TENS Unit

SECTION 4 Using Heat or Cold to Promote Comfort Safety Considerations and Precautions for Heat and Cold Therapy

Different Types of Heat and Cold Therapy

Summary

Application of the Nursing Process

Critical Concepts: Using Heat or Cold to Promote Comfort

SKILL 7.7 Using a Heat or Cold Pack (Instant or Reusable)

SKILL 7.8 Using an Ice Bag

SKILL 7.9 Using a Portable Sitz Bath

SKILL 7.10 Using Localized Circulating (Aqua) Heat or Cold Therapy

SECTION 5 Using Patient-Controlled Analgesia to Promote Comfort

Safety Considerations When Using PCA Therapy Summary

Application of the Nursing Process

Critical Concepts: Using Patient-Controlled Analgesia to Promote Comfort

SKILL 7.11 Assessing a Client for Appropriateness of PCA Therapy

SKILL 7.12 Initiating and Managing PCA Therapy

SKILL 7.13 Teaching the Client and Family About PCA Therapy

SKILL 7.14 Discontinuing PCA Therapy

SECTION 6 Using Epidural Analgesia to Promote Comfort

Safety Considerations for Epidural Catheters

Potential Complications of Epidural Catheters

Summary

Application of the Nursing Process

Critical Concepts: Using Epidural Analgesia to Promote Comfort

SKILL 7.15 Caring for a Client With an Epidural Catheter

SKILL 7.16 Assisting With Removal of an Epidural Catheter

CHAPTER 8 End-of-Life Care

Definition of End of Life

End-of-Life Care and Palliative Care

Nursing Initiatives and End-of-Life Care

SECTION 1 Bereavement and Spiritual Care

Caring for a Client and Family Who Are Grieving Theories of Grieving

Types of Grief

Children and Grief

Nurses and Grief

Providing Spiritual Care for a Client and Family

Summary

Application of the Nursing Process

Critical Concepts: Bereavement and Spiritual Care

SKILL 8.1 Caring for a Client and Family Who Are Grieving

SKILL 8.2 Providing Spiritual Care for a Client and Family

SECTION 2 Assisting a Client and Family With Advance Care Planning Tools Used for Advance Care Planning

Application of the Nursing Process

Critical Concepts: Assisting With Advance Care Planning

SKILL 8.3 Assisting With Advance Directives and Do-NotResuscitate (DNR) Orders

SECTION 3 Caring for a Client Near the End of Life Application of the Nursing Process

Critical Concepts: Caring for a Client Near the End of Life SKILL 8.4 Providing Physical Care for a Client Who Is Dying

SECTION 4 Caring for a Client After Death

Application of the Nursing Process

Critical Concepts: Caring for a Client After Death

SKILL 8.5 Providing Postmortem Care

UNIT II Intermediate Nursing Skills

CHAPTER 9 Airway and Breathing

SECTION 1 Maintaining the Health of the Respiratory System

Deep Breathing and Coughing

Incentive Spirometry

Chest Physiotherapy

Respiratory System-Specific Assessment

Application of the Nursing Process

Critical Concepts: Maintaining the Health of the Respiratory System

SKILL 9.1 Instructing a Client in Deep-Breathing and Coughing Exercises

SKILL 9.2 Instructing a Client to Use Incentive Spirometry

SKILL 9.3 Performing Chest Physiotherapy (CPT)

SECTION 2 Administering Oxygen

Impaired Gas Exchange

Using a High-Pressure Oxygen Cylinder

Administering Supplemental Oxygen

Summary

Application of the Nursing Process

Critical Concepts: Administering Oxygen

SKILL 9.4 Using a High-Pressure Oxygen Cylinder

SKILL 9.5 Using an Oxygen Flowmeter

SKILL 9.6 Placing a Client on Oxygen by Nasal Cannula

SKILL 9.7 Placing a Client on Oxygen by Face Mask

SKILL 9.8 Placing a Client on Continuous Positive Airway Pressure (CPAP)

SECTION 3 Establishing and Maintaining an Open Airway

Oropharyngeal Airway

Nasopharyngeal Airway

Nasopharyngeal Suctioning

Tracheostomy

Suctioning an Artificial Airway

Collecting Sputum Samples

Summary

Application of the Nursing Process

Critical Concepts: Establishing and Maintaining an Open Airway

SKILL 9.9 Inserting an Oropharyngeal Airway

SKILL 9.10 Inserting a Nasopharyngeal Airway

SKILL 9.11 Performing Nasopharyngeal Suctioning

SKILL 9.12 Suctioning an Artificial Airway: Tracheostomy or Endotracheal Tube

SKILL 9.13 Obtaining a Sputum Sample From a Client With an Artificial Airway

SKILL 9.14 Cleaning a Tracheostomy and Replacing Tracheostomy Ties

CHAPTER 10 Sterile Technique

SECTION 1 Preparing a Sterile Field

Application of the Nursing Process

Critical Concepts: Preparing a Sterile Field

SKILL 10.1 Opening a Sterile Pack

SKILL 10.2 Applying and Removing Sterile Gloves

SKILL 10.3 Opening a Sterile Barrier and Setting Up a Sterile Field

SKILL 10.4 Adding Sterile Items to a Sterile Field and Draping a Sterile Field

SKILL 10.5 Pouring a Sterile Liquid

SECTION 2 Preparing to Enter a Sterile Perioperative Setting

Surgical Attire

Surgical Hand Antisepsis

Surgical Gowns and Gloves

Application of the Nursing Process

Critical Concepts: Preparing to Enter a Sterile Perioperative Area

SKILL 10.6 Performing a Surgical Handrub

SKILL 10.7 Performing a Surgical Hand Scrub

SKILL 10.8 Performing Surgical Gowning

SKILL 10.9 Performing Closed Surgical Gloving

CHAPTER 11 Medication Administration

Medication Safety Initiatives

Rights of Medication Administration

Safely Processing Medication Orders

Performing Preassessments

Safely Preparing and Distributing Medications

Performing Safety Checks

Safety Considerations for High-Alert Medications

Performing Dosage Calculation

SECTION 1 Administering Oral Medications

Types of Oral Medications

Crushing/Altering Oral Medications

Preparing and Administering Oral Medications

Best-Practice Recommendations

Pediatric Considerations

Home Care and Geriatric Considerations Summary

Application of the Nursing Process

Critical Concepts: Administering Oral Medications

SKILL 11.1 Administering Oral Medications (Tablets, Capsules, or Liquids)

SECTION 2 Administering Enteral Medications

Application of the Nursing Process

Critical Concepts: Administering Enteral Medications

SKILL 11.2 Administering a Medication Through a Nasogastric (NG) Tube or Enteral Device

SECTION 3 Administering Mucous Membrane Applications

Sublingual and Buccal Medications

Nasal Instillations

Inhalers and Nebulizers

Rectal and Vaginal Administration

Application of the Nursing Process

Critical Concepts: Administering Mucous Membrane Applications

SKILL 11.3 Administering Sublingual or Buccal Medications

SKILL 11.4 Administering a Nasal Spray Medication

SKILL 11.5 Administering Inhaled Medications

SKILL 11.6 Administering Nebulized Medications

SKILL 11.7 Administering a Rectal Suppository

SKILL 11.8 Administering Vaginal Medications

SECTION 4 Administering Topical Medications

Topical Medications for Localized Effect

Transdermal Medications for Systemic Effect

Eye and Ear Medications

Application of the Nursing Process

Critical Concepts: Administering Topical Medications

SKILL 11.9 Applying a Transdermal Patch

SKILL 11.10 Administering an Eye Medication (Drops or Ointment)

SKILL 11.11 Irrigating the Eyes

SKILL 11.12 Instilling Ear (Otic) Drops

SECTION 5 Administering Parenteral Medications

Preparing Equipment for Injections

Components of a Needle and Syringe

Using Safety and Needleless Systems

Preparing Medications

Administering Injections

Administering Intradermal Injections

Administering Subcutaneous Injections

Administering Intramuscular Injections

Administering Insulin

Summary

Application of the Nursing Process

Critical Concepts: Administering Parenteral Medications

SKILL 11.13 Preparing a Medication From a Vial

SKILL 11.14 Preparing a Medication From an Ampule

SKILL 11.15 Preparing a Medication That Requires Reconstitution

SKILL 11.16 Administering an Intradermal Injection

SKILL 11.17 Administering a Subcutaneous Injection

SKILL 11.18 Administering an Intramuscular Injection

SKILL 11.19 Administering a Subcutaneous Insulin Injection

SKILL 11.20 Caring for a Client With a Subcutaneous Insulin Pump (External)

CHAPTER 12 Venous Access

SECTION 1 Collecting Venous Blood Specimens

Ensuring Accuracy

Selecting a Vein

Application of the Nursing Process

Critical Concepts: Collecting Venous Blood Specimens

SKILL 12.1 Selecting a Vein

SKILL 12.2 Obtaining Venous Blood Specimens

SECTION 2 Initiating, Dressing, and Discontinuing a Peripheral Intravenous Catheter

Selecting a Vein

Application of the Nursing Process

Critical Concepts: Initiating a Peripheral Intravenous Line

SKILL 12.3 Inserting and Dressing a Peripheral Intravenous Catheter

SKILL 12.4 Changing a PIV Dressing

SKILL 12.5 Discontinuing a Peripheral Intravenous Catheter

SECTION 3 Intravenous Fluids

Monitoring Intake and Output

Types of Intravenous Fluids

Infection Control

Safety and the Rights of Intravenous Fluid Administration

Intravenous Fluid Administration Sets

Priming Administration Sets and Bubble Management

Infusing Fluids

Application of the Nursing Process

Critical Concepts: Infusing Intravenous Fluids

SKILL 12.6 Managing a Saline Lock

SKILL 12.7 Preparing a Primary Intravenous Infusion SKILL 12.8 Replacing Intravenous Infusion Fluid

SECTION 4 Administering Intravenous Medications

Orders for Intravenous Medications

Nursing Responsibilities

Medication Preparation and Equipment

Complications of Intravenous Medication Administration

Application of the Nursing Process

Critical Concepts: Administering Intravenous Medications

SKILL 12.9 Administering Intermittent Intravenous Medication via Secondary Infusion

SKILL 12.10 Administering Intravenous Medication via Intravenous Push

SECTION 5 Administering a Blood Transfusion

Different Types of Blood Components

Types of Blood Transfusions

ABO Compatibility System

Safety Considerations

Equipment Used for a Blood Transfusion

Procedure for Administering a Blood Transfusion

Possible Complications

Application of the Nursing Process

Critical Concepts: Administering a Blood Transfusion

SKILL 12.11 Administering Packed Red Blood Cells (PRBCs)

CHAPTER 13 Central Venous Access

SECTION 1 Caring for a Client With a CVAD Tunneled Catheters

Nontunneled Catheters

Implanted Ports

Power-Injection Capable

Assisting With Insertion

Complications of CVADs

Drawing Blood From a CVAD

Care for a Client With a Subcutaneous Port: Accessing and Deaccessing

Discontinuing a CVAD

Critical Concepts and CVADs

Application of the Nursing Process

Critical Concepts: Caring for the Client With a CVAD

SKILL 13.1 Assisting With Insertion

SKILL 13.2 Flushing Central Venous Access Devices

SKILL 13.3 Changing the CVC or PICC Line Dressing

SKILL 13.4 Changing the Needleless Connectors for a CVC/PICC Line

SKILL 13.5 Collecting Blood Specimens/Blood Cultures SKILL 13.6 Managing Subcutaneous Ports: Accessing, Changing the Dressing, and Deaccessing

SKILL 13.7 Discontinuing a Central Line

SECTION 2 Infusing Fluids With a CVAD

Infusing Fluids

Application of the Nursing Process

Critical Concepts: Infusing Fluids Through a CVAD

SKILL 13.8 Infusing IV Fluids

SKILL 13.9 Initiating TPN and/or Lipids

CHAPTER 14 Bowel Management

SECTION 1 Supporting Healthy Bowel Elimination

Characteristics of Stool

Bowel Elimination Problems

Application of the Nursing Process

Critical Concepts: Supporting Healthy Bowel Elimination

SKILL 14.1 Performing Digital Stimulation and Evacuation

SKILL 14.2 Inserting Rectal Tubes

SKILL 14.3 Applying a Fecal Collection Pouch

SKILL 14.4 Setting Up a Fecal Management System

SECTION 2 Administering Enemas

Application of the Nursing Process

Critical Concepts: Administering Enemas

SKILL 14.5 Administering a Cleansing Enema

SKILL 14.6 Administering a Commercially Prepared Enema

SECTION 3 Collecting Specimens

Application of the Nursing Process

Critical Concepts: Collecting Specimens

SKILL 14.7 Collecting a Stool Specimen

SKILL 14.8 Obtaining a Stool Specimen for Occult Blood

SECTION 4 Caring for a Client With a Bowel Diversion

Care of the Stoma and Peristomal Skin

Irrigating a Colostomy

Cecostomy

Application of the Nursing Process

Critical Concepts: Caring for a Client With a Bowel Diversion

SKILL 14.9 Pouching a Stoma

SKILL 14.10 Irrigating an Ostomy

CHAPTER 15 Urine Elimination

Urine Elimination

SECTION 1 Collecting Urine Measurements and Specimens

Assessing Production and Volume of Urine

Collecting Specimens

Application of the Nursing Process

Critical Concepts: Obtaining Urine Measurements and Specimens

SKILL 15.1 Measuring and Recording Intake and Output SKILL 15.2 Measuring Urine Volume With a Portable Bladder Scanner

SKILL 15.3 Obtaining a Urine Specimen From a Closed Urinary Drainage System

SKILL 15.4 Obtaining a Urine Specimen Using the Clean-Catch Method

SKILL 15.5 Obtaining a 24-Hour Urine Specimen

SKILL 15.6 Obtaining a Bagged Urine Specimen From an Infant or Child

SECTION 2 Urine Elimination With a Transurethral Catheter

Types of Transurethral Catheters

Infection Control With Urinary Catheters

Communication and Urinary Catheters

Providing Client-Centered Care to Specific Populations

Bladder Irrigation

Application of the Nursing Process

Critical Concepts: Urine Elimination With a Transurethral Catheter

SKILL 15.7 Inserting and Removing a Straight Catheter in a Female Client

SKILL 15.8 Inserting and Removing a Straight Catheter in a Male Client

SKILL 15.9 Inserting an Indwelling Foley Catheter in a Female Client

SKILL 15.10 Inserting an Indwelling Foley Catheter in a Male Client

SKILL 15.11 Removing an Indwelling Foley Catheter

SKILL 15.12 Managing an Indwelling Foley Catheter

SKILL 15.13 Performing Intermittent Closed Bladder Irrigation

SKILL 15.14 Performing Continuous Closed Bladder Irrigation

SECTION 3 Urine Elimination With a Urinary Diversion

Suprapubic Catheter

Urinary Diversions

Application of the Nursing Process

Critical Concepts: Urine Elimination With a Urinary Diversion

SKILL 15.15 Providing Suprapubic Catheter Care

SKILL 15.16 Changing a Stoma Appliance on an Ileal Conduit

SKILL 15.17 Catheterizing and Irrigating a Continent Urostomy

CHAPTER 16 Wound Care

SECTION 1 Providing Wound Care

Wound Types

The Impact of Wounds

Client Considerations

Wound Assessment

Wound Care

Collecting Wound Specimens

Managing Complex Wounds

Dressing Selection and Application

Application of the Nursing Process

Critical Concepts: Providing Wound Care

SKILL 16.1 Dressing Change for a Primary-Intention Wound

SKILL 16.2 Collecting Wound Specimens

SKILL 16.3 Removing Sutures and Staples

SKILL 16.4 Dressing a Partial- or Full-Thickness Wound

SECTION 2 Managing Wound Drainage

Drains and Negative-Pressure Wound Therapy

Application of the Nursing Process

Critical Concepts: Managing Wound Drainage

SKILL 16.5 Managing a Penrose Drain

SKILL 16.6 Emptying a Jackson-Pratt (JP) Drain or Hemovac

SKILL 16.7 Negative-Pressure Wound Therapy (NPWT)

SECTION 3 Preventing and Treating Pressure Injury and Venous and Diabetic Ulcers

Pressure Injury

Venous Ulcers

Preventing Diabetic Ulcers

Application of the Nursing Process

Critical Concepts: Preventing and Treating Pressure Injury and Venous and Diabetic Ulcers

SKILL 16.8 Applying Compression Dressings or Unna Boot

SKILL 16.9 Foot Examination and Monofilament Testing

SKILL 16.10 Measuring the Ankle-Brachial Index (ABI)

CHAPTER 17 Perioperative Care

SECTION 1 Providing Preoperative Education and Care

Factors Affecting Surgical Risks

Nursing History and Physical Examination

Cultural Considerations

Informed Consent

Preoperative Teaching

Application of the Nursing Process

Critical Concepts: Preoperative Care

SKILL 17.1 Preparing a Client for Surgery

SKILL 17.2 Instructing Client on Thrombosis Prevention

SECTION 2 Providing Intraoperative Care

Roles of the Surgical Team

Surgical Verification

Client Positioning

Maintaining Safety: Latex Sensitivity/Allergy

Types of Anesthesia

Preparing the Clients Skin

Closing the Wound

Application of the Nursing Process

SECTION 3 Managing Postoperative Care

Postoperative Nursing Care

Postoperative Assessment

Postoperative Teaching Application of the Nursing Process

Critical Concepts: Providing Postoperative Care

SKILL 17.3 Admitting a Postoperative Client

SKILL 17.4 Applying Pressure Dressings to Control Bleeding

SKILL 17.5 Applying and Removing Antiembolism Stockings

SKILL 17.6 Managing Sequential Compression Devices SKILL 17.7 Managing Continuous Passive Motion

UNIT III Advanced Nursing Skills

CHAPTER 18 Advanced Respiratory Management

SECTION 1 Caring for a Client With Invasive Mechanical Ventilation

The Airway: Endotracheal Tubes

Providing Mechanical Ventilation

Nursing Care for Clients Who Are Receiving Mechanical Ventilation

Reducing the Risk of Complications of Mechanical Ventilation

Application of the Nursing Process

Critical Concepts: Caring for a Client With Invasive Mechanical Ventilation

SKILL 18.1 Caring for a Client Receiving Mechanical Ventilation

Arterial Blood Gases

Acid-Base Imbalances

SECTION 2 Caring for a Client Who Requires Arterial Blood Gas Sampling

Indwelling Arterial Catheter Sampling

Arterial Puncture Sampling

Application of the Nursing Process

Critical Concepts: Arterial Blood Gas Sampling

SKILL 18.2 Obtaining Arterial Blood Gases From a Peripheral Arterial Line

SKILL 18.3 Obtaining Arterial Blood Gases From the Radial Artery

SECTION 3 Caring for a Client With a Chest Tube

Chest Drainage Systems

Caring for the Client With a Chest Tube and Chest Drainage System

Troubleshooting the Chest Tube and Drainage System

Application of the Nursing Process

Critical Concepts: Caring for a Client With a Chest Tube

SKILL 18.4 Assisting With Chest Tube Insertion

SKILL 18.5 Maintaining a Chest Tube System and Performing an Occlusive Dressing Change

SKILL 18.6 Assisting With Removal of a Chest Tube

CHAPTER 19 Advanced Cardiovascular Care Cardiovascular System

SECTION 1 Caring for a Client on Cardiac Monitoring

Cardiac Conduction System

The ECG Tracing

Equipment Used in ECG Monitoring

Lead Placement for ECG Monitoring

Types of ECG Monitoring

Performing a 12-Lead ECG

Possible Safety and Technical Issues With ECG Monitoring

Summary

Application of the Nursing Process

Critical Concepts: Caring for a Client on Cardiac Monitoring

SKILL 19.1 Placing a Client on a Continuous ECG Monitor (Hardwire or Telemetry)

SKILL 19.2 Performing a Diagnostic 12-Lead ECG

SECTION 2 Caring for a Client With a Dysrhythmia or Altered Cardiac Conduction

Dysrhythmias and Conduction Disorders

Using Synchronized Cardioversion

Summary

Application of the Nursing Process

Critical Concepts: Caring for a Client With a Dysrhythmia or Altered Cardiac Conduction

SKILL 19.3 Performing or Assisting With Elective Cardioversion

SECTION 3 Caring for a Client With a Cardiac Pacemaker

Cardiac Pacemakers

How a Pacemaker Works: Major Functions and Components

Types of Pacemakers

Temporary Pacemakers

Permanent Pacemakers Possible Complications/Safety Issues With Pacemakers

Application of the Nursing Process

Critical Concepts: Caring for a Client With a Pacemaker

SKILL 19.4 Caring for a Client With a Transcutaneous Pacemaker (TCP)

SKILL 19.5 Caring for a Client With a Transvenous Pacemaker (TVP)

SECTION 4 Caring for a Client With a Cardiac Emergency

Caring for a Client With Ischemic Chest Pain

Emergency Cardiac Catheterization

Providing Emergency Defibrillation

Caring for a Client Who Is in Cardiac Arrest

Application of the Nursing Process

Critical Concepts: Caring for a Client With a Cardiac Emergency

SKILL 19.6 Providing Care for a Client With Acute Ischemic Chest Pain

SKILL 19.7 Caring for a Client After an Emergency Cardiac Catheterization

SKILL 19.8 Providing Emergency (Asynchronous) Manual Defibrillation

SKILL 19.9 Responding to a Client (Adult) in Cardiac Arrest

CHAPTER 20 Advanced Neurologic Care

Intracranial Processes

Major Neurologic Injuries: Traumatic and Nontraumatic

SECTION 1 Advanced Neurologic Assessment

Performing a Neurologic Assessment

Assessment of Level of Consciousness

Assessment of Pupillary Response and Function

Using a Pupillometer Device for Assessment of Pupils Assessment of Verbal Response and Function

Assessment of Motor and Sensory Function

Assessment of Deep Tendon Reflexes

Lifespan Considerations

Diagnostic Procedures

Summary

Application of the Nursing Process

Critical Concepts: Advanced Neurologic Assessment

SKILL 20.1 Performing a Neurologic Assessment

SKILL 20.2 Using a Pupillometer

SKILL 20.3 Assisting With a Lumbar Puncture

SECTION 2 Caring for a Client With Increased

Intracranial Pressure

Interventions for Clients With Increased ICP

Caring for a Client With an External Ventricular Drain and Performing ICP Monitoring

Summary

Application of the Nursing Process

Critical Concepts: Caring for a Client With Increased Intracranial Pressure

SKILL 20.4 Caring for a Client With an External Ventricular Drain (EVD) and Obtaining Intracranial Pressure (ICP) Readings

SECTION 3 Caring for a Client With a Neurologic Emergency

Caring for a Client Who Is Having a Seizure

Caring for a Client Who May Be Having an Acute Stroke

Summary

Application of the Nursing Process

Critical Concepts: Caring for a Client With a Neurologic Emergency

SKILL 20.5 Caring for a Client Who Requires Seizure Precautions

SKILL 20.6 Assessing a Client Who May Be Having an Acute Stroke

ILLUSTRATION CREDITS

INDEX

UNIT I Fundamental Nursing Skills

Foundations of Safe Client Care

SECTION 1 Identifying a Client

Application of the Nursing Process

Critical Concepts: Identifying the Client

SKILL 1.1 Identifying a Client

SECTION 2 Preventing Infection

Chain of Infection

Preventing the Transmission of Infection

Application of the Nursing Process

Critical Concepts: Preventing Infection

SKILL 1.2 Performing Hand Hygiene With an AlcoholBased Agent

SKILL 1.3 Performing Hand Hygiene With Soap and Water

SKILL 1.4 Applying and Removing Clean Gloves

SKILL 1.5 Applying and Removing Personal Protective Equipment

SECTION 3 Moving Clients Safely

Benefits of Proper Client Positioning and Repositioning

Ergonomics and Body Mechanics

Summary

Application of the Nursing Process

Critical Concepts: Moving the Client Safely

SKILL 1.6 Positioning a Client in Bed

SKILL 1.7 Moving a Client up in Bed

SKILL 1.8 Transferring a Client From Bed to Chair

SKILL 1.9 Using a Sling Lift to Move a Client

SKILL 1.10 Using a Sit-to-Stand Lift

SKILL 1.11 Transferring Clients Laterally (From Bed to Stretcher)

SKILL 1.12 Moving Clients Who Have Special Precautions (Logrolling)

SECTION 4 Using Restraints

Defining Restraints

Use of Securing Devices

Regulations Governing Use of Restraints

Application of the Nursing Process

Critical Concepts: Using Restraints

SKILL 1.13 Applying and Removing Restraints

SKILL 1.14 Applying a Mummy Restraint

CHAPTER 2 Personal Care and Hygiene

SECTION 1 Bathing a Client

Skin Assessment

Skin Care

Bathing an Adult

Bathing an Infant

Application of the Nursing Process

Critical Concepts: Bathing the Client

SKILL 2.1 Assisting an Ambulatory Client With Bathing

SKILL 2.2 Changing the Gown of a Client With an IV Line

SKILL 2.3 Bathing an Adult Client in Bed

SKILL 2.4 Providing Alternate Perineal Care

SKILL 2.5 Providing Foot Care

SKILL 2.6 Providing Nail Care

SKILL 2.7 Bathing an Infant

SECTION 2 Oral Hygiene

Dentures

Oral Care in the Acute Care Setting

Application of the Nursing Process

Critical Concepts: Providing Oral Care

SKILL 2.8 Providing Oropharyngeal Suctioning With a Round-Tip Suction Catheter (Yankauer)

SKILL 2.9 Providing Oral Hygiene for a Conscious Client

SKILL 2.10 Providing Oral Hygiene for an Unconscious Client

SKILL 2.11 Removing, Cleaning, and Inserting Dentures

SECTION 3 Providing Hair Care

Shaving

Lice

Application of the Nursing Process

Critical Concepts: Providing Hair Care

SKILL 2.12 Shampooing the Nonambulatory Clients Hair

SKILL 2.13 Shampooing a Client With a Dry-Shampoo Cap

SKILL 2.14 Shaving a Client

SKILL 2.15 Caring for a Client With Lice

SECTION 4 Eye and Ear Care

Application of the Nursing Process

Critical Concepts: Eye and Ear Care

SKILL 2.16 Providing Eye Care for an Unconscious Client

SKILL 2.17 Removing and Cleaning Contact Lenses

SKILL 2.18 Removing, Cleaning, and Inserting an Artificial Eye

SECTION 5 Assisting With Elimination

Applying Concepts of Safety, Client-Centered Care, Collaboration, and Health Maintenance

Bedside Commode, Urinals, Bedpans, and Condom Catheters

Application of the Nursing Process

Critical Concepts: Assisting With Elimination

SKILL 2.19 Assisting a Client Using a Bedside Commode SKILL 2.20 Assisting a Client Using a Urinal

SKILL 2.21 Assisting a Client Using a Bedpan

SKILL 2.22 Applying a Condom Catheter

SECTION 6 Making Beds

Types of Beds

Types of Mattresses Types of Bedding and Bed Making

Application of the Nursing Process

Critical Concepts: Changing a Bed

SKILL 2.23 Changing an Unoccupied Bed

SKILL 2.24 Making a Surgical Bed

SKILL 2.25 Changing an Occupied Bed

CHAPTER 3 Vital Signs and Vital Measurements

Vital Signs

SECTION 1 Assessing Temperature

Sites and Methods of Temperature Assessment Application of the Nursing Process

Critical Concepts: Assessing Temperature

SKILL 3.1 Measuring Temperature With an Electronic Thermometer

SKILL 3.2 Obtaining a Tympanic Temperature

SKILL 3.3 Obtaining a Temperature Using a Temporal Artery Thermometer

SECTION 2 Regulating Temperature

Regulating Temperature Application of the Nursing Process

Critical Concepts: Regulating Temperature

SKILL 3.4 Using Conductive Cooling or Heating Therapy

SKILL 3.5 Using an Infant Radiant Warmer

SECTION 3 Assessing Pulses

Location and Differentiation of Pulses

Apical Pulse

Technique for Assessing Pulses

Alterations of the Clients Pulse

Application of the Nursing Process

Critical Concepts: Assessing Pulses

SKILL 3.6 Obtaining a Radial Pulse Rate

SKILL 3.7 Assessing Carotid Pulses

SKILL 3.8 Assessing Peripheral Pulses

SKILL 3.9 Using a Doppler Ultrasound Device to Assess Pulses

SKILL 3.10 Obtaining an Apical Pulse

SKILL 3.11 Obtaining an Apical-Radial Pulse

SECTION 4 Assessing Respirations

Assessing Respirations in Pediatric Clients

Application of the Nursing Process

Critical Concepts: Assessing Respirations

SKILL 3.12 Obtaining a Respiratory Rate and Respiratory Assessment

SECTION 5 Assessing Blood Pressure

Classification of Hypertension

Factors Affecting Blood Pressure

Measuring Blood Pressure

Application of the Nursing Process

Critical Concepts: Assessing Blood Pressure

SKILL 3.13 Palpating a Systolic Blood Pressure

SKILL 3.14 Measuring a Systolic and Diastolic Blood Pressure by Auscultation

SKILL 3.15 Measuring Blood Pressure With an Automatic Oscillometric Monitor

SKILL 3.16 Using a Doppler Ultrasound Device to Hear Systolic Blood Pressure

Vital Measurements

SECTION 6 Assessing Oxygen Saturation

Obtaining an SpO2 Reading

Application of the Nursing Process

Critical Concepts: Assessing Oxygen Saturation

SKILL 3.17 Obtaining a Pulse Oximeter Measurement

SECTION 7 Assessing Blood Glucose

Application of the Nursing Process

Critical Concepts: Assessing Blood Glucose

SKILL 3.18 Obtaining Capillary Blood Glucose Measurements

CHAPTER 4 Performing an Assessment

The Assessment Process

SECTION 1 Collecting Subjective and Objective Data Collecting Subjective Data

Collecting Objective Data

Performing a Preliminary Survey

Summary

Critical Concepts: Collecting Subjective and Objective Data

SKILL 4.1 Performing a Preliminary Survey

SECTION 2 Performing a Head-to-Toe or SystemSpecific Assessment

Critical Concepts When Performing a Head-to-Toe or System-Specific Assessment

Performing a Rapid Head-to-Toe Bedside Assessment Performing a System-Specific Assessment

Summary

Critical Concepts: Performing a Head-to-Toe or SystemSpecific Assessment

SKILL 4.2 Performing a Rapid Head-to-Toe Bedside Assessment

SKILL 4.3 Assessing the Skin/Integumentary System

SKILL 4.4 Assessing the Head (HEENT) and Neck

SKILL 4.5 Assessing the Neurologic System

SKILL 4.6 Assessing the Thorax (Heart and Lungs)

SKILL 4.7 Assessing the Abdomen

SKILL 4.8 Assessing the Musculoskeletal System

SKILL 4.9 Assessing the Genitourinary System

CHAPTER 5 Nutrition and Gastrointestinal Tube Therapy

Essential and Nonessential Nutrients

Macronutrients and Micronutrients

Digestion and Assimilation of Nutrients

Nutritional Guidelines

Alterations That Can Cause Nutritional Deficiencies

SECTION 1 Nutritional Assessment

Criteria Used for a Nutritional Screening or Assessment

Assessing and Monitoring a Clients Food and Fluid Intake

Summary

Application of the Nursing Process

Critical Concepts: Nutritional Assessment

SKILL 5.1 Performing a Nutritional Screening

SECTION 2 Assisting Clients With Oral Nutrition

Types of Diets

Preparing A Client to Receive a Meal

Assisting A Client Who Has Difficulty Eating

Application of the Nursing Process

Critical Concepts: Assisting Clients With Oral Nutrition SKILL 5.2 Preparing a Client to Receive a Meal

SKILL 5.3 Assisting Clients With a Physical or Cognitive Impairment

SKILL 5.4 Assisting Clients With Dysphagia or Aspiration Risk

SECTION 3 Providing Gastric Tube Therapy

Nasogastric Sump Tube

Levin Tubes and Gastric Lavage Tubes

Placement and Care of a Nasogastric Sump Tube

Summary

Application of the Nursing Process

Critical Concepts: Providing Gastric Tube Therapy

SKILL 5.5 Placement and Care of a Nasogastric (NG) Sump Tube

SKILL 5.6 Initiating and Managing Nasogastric (NG) Sump Tube Suction

SKILL 5.7 Irrigating a Nasogastric (NG) Sump Tube

SKILL 5.8 Discontinuing a Nasogastric (NG) Sump Tube

SECTION 4 Providing Enteral Nutrition

Routes of Enteral Feeding

Daily Care for Clients With Gastrostomy, PEG, and Jejunostomy Tubes

Delivery Methods for Enteral Nutrition

Reducing Risks of Enteral Nutrition

Home Care Considerations

Providing Client-Centered Care During Enteral Nutrition

Summary

Application of the Nursing Process

Critical Concepts: Providing Enteral Nutrition

SKILL 5.9 Placement and Care of a Nasally Inserted Small-Bore Feeding Tube

SKILL 5.10 Providing Care for a Client With a Gastrostomy, PEG Tube, or Jejunostomy

SKILL 5.11 Administering a Tube Feeding (Intermittent or Continuous) SKILL 5.12 Using a Kangaroo Feeding Pump

CHAPTER 6 Supporting Mobility and Immobilization

SECTION 1 Supporting Mobility Collaborative Care for Clients With Assistive Devices Range of Motion

Application of the Nursing Process

Critical Concepts: Mobility

SKILL 6.1 Assisting With Ambulation Using a Transfer Belt

SKILL 6.2 Teaching the Client to Use a Cane

SKILL 6.3 Teaching the Client to Use a Walker

SKILL 6.4 Teaching the Client to Use Crutches

SKILL 6.5 Performing Active and Passive Range-ofMotion (ROM) Exercises

SECTION 2 Supporting Immobilization

Supporting Immobilization of a Limb or Joint

Supporting Cervical Immobilization

Pin Care

Application of the Nursing Process

Critical Concepts: Immobilization

SKILL 6.6 Applying a Sling

SKILL 6.7 Applying Bandages

SKILL 6.8 Providing Cast Care

SKILL 6.9 Managing Traction

SKILL 6.10 Providing Pin-Site Care

SKILL 6.11 Applying a Cervical Collar

SKILL 6.12 Managing Halo Traction

SECTION 3 Caring for a Client With an Amputation Postoperative Care

Communication: Client Education and Collaboration Application of the Nursing Process

Critical Concepts: Client With an Amputation

SKILL 6.13 Exercising and Positioning the Residual Limb

SKILL 6.14 Applying a Compression Bandage and Commercial Shrinker to a Residual Limb

CHAPTER 7 Comfort Care

The Impact of Pain

Nociceptive and Neuropathic Pain

Acute and Chronic Pain

SECTION 1 Assessment of Pain and Discomfort Subjective and Objective Assessment of Pain

Examples of Pain Tools Used for Assessment of Pain

Assessment of Pain for Diverse Populations

Lifespan Considerations: Older Adults and Pediatric Clients

Summary of Best Practice Recommendations for Assessment of Pain

Summary of Application of Critical Concepts for Assessment of Pain

Application of the Nursing Process

Critical Concepts: Assessment of Pain and Discomfort SKILL 7.1 Performing a Pain Assessment

SECTION 2 Using Relaxation Measures to Promote Comfort

Enhancing the Clients Environment

Controlled Breathing

Guided Imagery

Massage Therapy

Summary

Application of the Nursing Process

Critical Concepts: Using Relaxation Measures to Promote Comfort

SKILL 7.2 Enhancing a Clients Environment

SKILL 7.3 Assisting a Client With Controlled-Breathing Exercises

SKILL 7.4 Assisting a Client With Guided Imagery Exercises

SKILL 7.5 Providing a Back Massage

SECTION 3 Using a TENS Unit to Promote Comfort

Application of the Nursing Process

Critical Concepts: Using a TENS Unit to Promote Comfort

SKILL 7.6 Applying and Discontinuing a TENS Unit

SECTION 4 Using Heat or Cold to Promote Comfort Safety Considerations and Precautions for Heat and Cold Therapy

Different Types of Heat and Cold Therapy

Summary

Application of the Nursing Process

Critical Concepts: Using Heat or Cold to Promote Comfort

SKILL 7.7 Using a Heat or Cold Pack (Instant or Reusable)

SKILL 7.8 Using an Ice Bag

SKILL 7.9 Using a Portable Sitz Bath

SKILL 7.10 Using Localized Circulating (Aqua) Heat or Cold Therapy

SECTION 5 Using Patient-Controlled Analgesia to Promote Comfort

Safety Considerations When Using PCA Therapy Summary

Application of the Nursing Process

Critical Concepts: Using Patient-Controlled Analgesia to Promote Comfort

SKILL 7.11 Assessing a Client for Appropriateness of PCA Therapy

SKILL 7.12 Initiating and Managing PCA Therapy

SKILL 7.13 Teaching the Client and Family About PCA Therapy

SKILL 7.14 Discontinuing PCA Therapy

SECTION 6 Using Epidural Analgesia to Promote Comfort

Safety Considerations for Epidural Catheters

Potential Complications of Epidural Catheters

Summary

Application of the Nursing Process

Critical Concepts: Using Epidural Analgesia to Promote Comfort

SKILL 7.15 Caring for a Client With an Epidural Catheter

SKILL 7.16 Assisting With Removal of an Epidural Catheter

CHAPTER 8 End-of-Life Care

Definition of End of Life

End-of-Life Care and Palliative Care

Nursing Initiatives and End-of-Life Care

SECTION 1 Bereavement and Spiritual Care

Caring for a Client and Family Who Are Grieving Theories of Grieving

Types of Grief

Children and Grief

Nurses and Grief

Providing Spiritual Care for a Client and Family

Summary

Application of the Nursing Process

Critical Concepts: Bereavement and Spiritual Care

SKILL 8.1 Caring for a Client and Family Who Are Grieving

SKILL 8.2 Providing Spiritual Care for a Client and Family

SECTION 2 Assisting a Client and Family With Advance Care Planning Tools Used for Advance Care Planning

Application of the Nursing Process

Critical Concepts: Assisting With Advance Care Planning

SKILL 8.3 Assisting With Advance Directives and Do-NotResuscitate (DNR) Orders

SECTION 3 Caring for a Client Near the End of Life Application of the Nursing Process

Critical Concepts: Caring for a Client Near the End of Life SKILL 8.4 Providing Physical Care for a Client Who Is Dying

SECTION 4 Caring for a Client After Death

Application of the Nursing Process

Critical Concepts: Caring for a Client After Death

SKILL 8.5 Providing Postmortem Care

UNIT II Intermediate Nursing Skills

CHAPTER 9 Airway and Breathing

SECTION 1 Maintaining the Health of the Respiratory System

Deep Breathing and Coughing

Incentive Spirometry

Chest Physiotherapy

Respiratory System-Specific Assessment

Application of the Nursing Process

Critical Concepts: Maintaining the Health of the Respiratory System

SKILL 9.1 Instructing a Client in Deep-Breathing and Coughing Exercises

SKILL 9.2 Instructing a Client to Use Incentive Spirometry

SKILL 9.3 Performing Chest Physiotherapy (CPT)

SECTION 2 Administering Oxygen

Impaired Gas Exchange

Using a High-Pressure Oxygen Cylinder

Administering Supplemental Oxygen

Summary

Application of the Nursing Process

Critical Concepts: Administering Oxygen

SKILL 9.4 Using a High-Pressure Oxygen Cylinder

SKILL 9.5 Using an Oxygen Flowmeter

SKILL 9.6 Placing a Client on Oxygen by Nasal Cannula

SKILL 9.7 Placing a Client on Oxygen by Face Mask

SKILL 9.8 Placing a Client on Continuous Positive Airway Pressure (CPAP)

SECTION 3 Establishing and Maintaining an Open Airway

Oropharyngeal Airway

Nasopharyngeal Airway

Nasopharyngeal Suctioning

Tracheostomy

Suctioning an Artificial Airway

Collecting Sputum Samples

Summary

Application of the Nursing Process

Critical Concepts: Establishing and Maintaining an Open Airway

SKILL 9.9 Inserting an Oropharyngeal Airway

SKILL 9.10 Inserting a Nasopharyngeal Airway

SKILL 9.11 Performing Nasopharyngeal Suctioning

SKILL 9.12 Suctioning an Artificial Airway: Tracheostomy or Endotracheal Tube

SKILL 9.13 Obtaining a Sputum Sample From a Client With an Artificial Airway

SKILL 9.14 Cleaning a Tracheostomy and Replacing Tracheostomy Ties

CHAPTER 10 Sterile Technique

SECTION 1 Preparing a Sterile Field

Application of the Nursing Process

Critical Concepts: Preparing a Sterile Field

SKILL 10.1 Opening a Sterile Pack

SKILL 10.2 Applying and Removing Sterile Gloves

SKILL 10.3 Opening a Sterile Barrier and Setting Up a Sterile Field

SKILL 10.4 Adding Sterile Items to a Sterile Field and Draping a Sterile Field

SKILL 10.5 Pouring a Sterile Liquid

SECTION 2 Preparing to Enter a Sterile Perioperative Setting

Surgical Attire

Surgical Hand Antisepsis

Surgical Gowns and Gloves

Application of the Nursing Process

Critical Concepts: Preparing to Enter a Sterile Perioperative Area

SKILL 10.6 Performing a Surgical Handrub

SKILL 10.7 Performing a Surgical Hand Scrub

SKILL 10.8 Performing Surgical Gowning

SKILL 10.9 Performing Closed Surgical Gloving

CHAPTER 11 Medication Administration

Medication Safety Initiatives

Rights of Medication Administration

Safely Processing Medication Orders

Performing Preassessments

Safely Preparing and Distributing Medications

Performing Safety Checks

Safety Considerations for High-Alert Medications

Performing Dosage Calculation

SECTION 1 Administering Oral Medications

Types of Oral Medications

Crushing/Altering Oral Medications

Preparing and Administering Oral Medications

Best-Practice Recommendations

Pediatric Considerations

Home Care and Geriatric Considerations Summary

Application of the Nursing Process

Critical Concepts: Administering Oral Medications

SKILL 11.1 Administering Oral Medications (Tablets, Capsules, or Liquids)

SECTION 2 Administering Enteral Medications

Application of the Nursing Process

Critical Concepts: Administering Enteral Medications

SKILL 11.2 Administering a Medication Through a Nasogastric (NG) Tube or Enteral Device

SECTION 3 Administering Mucous Membrane Applications

Sublingual and Buccal Medications

Nasal Instillations

Inhalers and Nebulizers

Rectal and Vaginal Administration

Application of the Nursing Process

Critical Concepts: Administering Mucous Membrane Applications

SKILL 11.3 Administering Sublingual or Buccal Medications

SKILL 11.4 Administering a Nasal Spray Medication

SKILL 11.5 Administering Inhaled Medications

SKILL 11.6 Administering Nebulized Medications

SKILL 11.7 Administering a Rectal Suppository

SKILL 11.8 Administering Vaginal Medications

SECTION 4 Administering Topical Medications

Topical Medications for Localized Effect

Transdermal Medications for Systemic Effect

Eye and Ear Medications

Application of the Nursing Process

Critical Concepts: Administering Topical Medications

SKILL 11.9 Applying a Transdermal Patch

SKILL 11.10 Administering an Eye Medication (Drops or Ointment)

SKILL 11.11 Irrigating the Eyes

SKILL 11.12 Instilling Ear (Otic) Drops

SECTION 5 Administering Parenteral Medications

Preparing Equipment for Injections

Components of a Needle and Syringe

Using Safety and Needleless Systems

Preparing Medications

Administering Injections

Administering Intradermal Injections

Administering Subcutaneous Injections

Administering Intramuscular Injections

Administering Insulin

Summary

Application of the Nursing Process

Critical Concepts: Administering Parenteral Medications

SKILL 11.13 Preparing a Medication From a Vial

SKILL 11.14 Preparing a Medication From an Ampule

SKILL 11.15 Preparing a Medication That Requires Reconstitution

SKILL 11.16 Administering an Intradermal Injection

SKILL 11.17 Administering a Subcutaneous Injection

SKILL 11.18 Administering an Intramuscular Injection

SKILL 11.19 Administering a Subcutaneous Insulin Injection

SKILL 11.20 Caring for a Client With a Subcutaneous Insulin Pump (External)

CHAPTER 12 Venous Access

SECTION 1 Collecting Venous Blood Specimens

Ensuring Accuracy

Selecting a Vein

Application of the Nursing Process

Critical Concepts: Collecting Venous Blood Specimens

SKILL 12.1 Selecting a Vein

SKILL 12.2 Obtaining Venous Blood Specimens

SECTION 2 Initiating, Dressing, and Discontinuing a Peripheral Intravenous Catheter

Selecting a Vein

Application of the Nursing Process

Critical Concepts: Initiating a Peripheral Intravenous Line

SKILL 12.3 Inserting and Dressing a Peripheral Intravenous Catheter

SKILL 12.4 Changing a PIV Dressing

SKILL 12.5 Discontinuing a Peripheral Intravenous Catheter

SECTION 3 Intravenous Fluids

Monitoring Intake and Output

Types of Intravenous Fluids

Infection Control

Safety and the Rights of Intravenous Fluid Administration

Intravenous Fluid Administration Sets

Priming Administration Sets and Bubble Management

Infusing Fluids

Application of the Nursing Process

Critical Concepts: Infusing Intravenous Fluids

SKILL 12.6 Managing a Saline Lock

SKILL 12.7 Preparing a Primary Intravenous Infusion SKILL 12.8 Replacing Intravenous Infusion Fluid

SECTION 4 Administering Intravenous Medications

Orders for Intravenous Medications

Nursing Responsibilities

Medication Preparation and Equipment

Complications of Intravenous Medication Administration

Application of the Nursing Process

Critical Concepts: Administering Intravenous Medications

SKILL 12.9 Administering Intermittent Intravenous Medication via Secondary Infusion

SKILL 12.10 Administering Intravenous Medication via Intravenous Push

SECTION 5 Administering a Blood Transfusion

Different Types of Blood Components

Types of Blood Transfusions

ABO Compatibility System

Safety Considerations

Equipment Used for a Blood Transfusion

Procedure for Administering a Blood Transfusion

Possible Complications

Application of the Nursing Process

Critical Concepts: Administering a Blood Transfusion

SKILL 12.11 Administering Packed Red Blood Cells (PRBCs)

CHAPTER 13 Central Venous Access

SECTION 1 Caring for a Client With a CVAD Tunneled Catheters

Nontunneled Catheters

Implanted Ports

Power-Injection Capable

Assisting With Insertion

Complications of CVADs

Drawing Blood From a CVAD

Care for a Client With a Subcutaneous Port: Accessing and Deaccessing

Discontinuing a CVAD

Critical Concepts and CVADs

Application of the Nursing Process

Critical Concepts: Caring for the Client With a CVAD

SKILL 13.1 Assisting With Insertion

SKILL 13.2 Flushing Central Venous Access Devices

SKILL 13.3 Changing the CVC or PICC Line Dressing

SKILL 13.4 Changing the Needleless Connectors for a CVC/PICC Line

SKILL 13.5 Collecting Blood Specimens/Blood Cultures SKILL 13.6 Managing Subcutaneous Ports: Accessing, Changing the Dressing, and Deaccessing

SKILL 13.7 Discontinuing a Central Line

SECTION 2 Infusing Fluids With a CVAD

Infusing Fluids

Application of the Nursing Process

Critical Concepts: Infusing Fluids Through a CVAD

SKILL 13.8 Infusing IV Fluids

SKILL 13.9 Initiating TPN and/or Lipids

CHAPTER 14 Bowel Management

SECTION 1 Supporting Healthy Bowel Elimination

Characteristics of Stool

Bowel Elimination Problems

Application of the Nursing Process

Critical Concepts: Supporting Healthy Bowel Elimination

SKILL 14.1 Performing Digital Stimulation and Evacuation

SKILL 14.2 Inserting Rectal Tubes

SKILL 14.3 Applying a Fecal Collection Pouch

SKILL 14.4 Setting Up a Fecal Management System

SECTION 2 Administering Enemas

Application of the Nursing Process

Critical Concepts: Administering Enemas

SKILL 14.5 Administering a Cleansing Enema

SKILL 14.6 Administering a Commercially Prepared Enema

SECTION 3