223306008-All-In-One-Care-Planning-Resource-Medical-Surgical-Pediatric-Maternity-And-Psychiatric-Nur - Table of Contents Cover Image See What Nursing

223306008-All-In-One-Care-Planning-Resource-Medical-Surgical-Pediatric-Maternity-And-Psychiatric-Nur

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Unformatted text preview: Table of Contents Cover Image See What Nursing Students Have To Say About Contributors Reviewers Preface Chapter 1. Cancer Care Chapter 2. Pain Chapter 3. Perioperative Care Chapter 4. Prolonged Bedrest Chapter 5. Psychosocial Support Chapter 6. Psychosocial Support for the Patient's Family and Signifi cant Other Chapter 7. Older Adult Care Chapter 8. Palliative and End-of-Life Care Chapter 9. Chronic Obstructive Pulmonary Disease Chapter 10. Pneumonia Chapter 11. Pneumothorax/Hemothorax Chapter 12. Pulmonary Embolus Chapter 13. Pulmonary Tuberculosis Chapter 14. Respiratory Failure, Acute Chapter 15. Aneurysms Chapter 16. Atherosclerotic Arterial Occlusive Disease Chapter 17. Cardiac and Noncardiac Shock (Circulatory Failure) Chapter 18. Cardiac Surgery Chapter 19. Coronary Artery Disease Chapter 20. Dysrhythmias and Conduction Disturbances Chapter 21. Heart Failure Chapter 22. Hypertension Chapter 23. Pulmonary Hypertension Chapter 24. Venous Thrombosis/Thrombophlebitis Chapter 25. Benign Prostatic Hypertrophy Chapter 26. Chronic Kidney Disease Chapter 27. Care of the Patient Undergoing Hemodialysis Chapter 28. Care of the Patient Undergoing Peritoneal Dialysis Chapter 29. Renal Failure, Acute Chapter 30. Care of the Renal Transplant Recipient Chapter 31. Ureteral Calculi Chapter 32. Urinary Diversions Chapter 33. Urinary Tract Obstruction Chapter 34. General Care of Patients with Neurologic Disorders Chapter 35. Bacterial Meningitis Chapter 36. Guillain-Barré Syndrome Chapter 37. Intervertebral Disk Disease Chapter 38. Multiple Sclerosis Chapter 39. Parkinsonism Chapter 40. Seizures and Epilepsy Chapter 41. Spinal Cord Injury Chapter 42. Stroke Chapter 43. Traumatic Brain Injury Chapter 44. Diabetes Insipidus Chapter 45. Diabetes mellitus Chapter 46. Diabetic Ketoacidosis Chapter 47. Hyperosmolar Hyperglycemic Nonketotic Syndrome Chapter 48. Hyperthyroidism Chapter 49. Hypothyroidism Chapter 50. Syndrome of Inappropriate Antidiuretic Hormone Chapter 51. Abdominal Trauma Chapter 52. Appendicitis Chapter 53. Cholelithiasis, Cholecystitis, and Cholangitis Chapter 54. Cirrhosis Chapter 55. Crohn's Disease Chapter 56. Fecal Diversions: Colostomy, Ileostomy, and Ileal Pouch Anal Anastomoses Chapter 57. Hepatitis Chapter 58. Pancreatitis Chapter 59. Peptic Ulcers Chapter 60. Peritonitis Chapter 61. Ulcerative Colitis Chapter 62. Anemias of Chronic Disease Chapter 63. Disseminated Intravascular Coagulation Chapter 64. Polycythemia Chapter 65. Thrombocytopenia Chapter 66. Amputation Chapter 67. Fractures Chapter 68. Joint Replacement Surgery Chapter 69. Osteoarthritis Chapter 70. Osteoporosis Chapter 71. Rheumatoid Arthritis Chapter 72. Caring for Individuals with Human Immunodeficiency Virus Chapter 73. Managing Wound Care Chapter 74. Providing Nutritional Support Chapter 75. Asthma Chapter 76. Attention Deficit Hyperactivity Disorder Chapter 77. Bronchiolitis Chapter 78. Burns Chapter 79. Cerebral Palsy Chapter 80. Child Abuse and Neglect Chapter 81. Cystic Fibrosis Chapter 82. Diabetes Mellitus in Children Chapter 83. Fractures in Children Chapter 84. Gastroenteritis Chapter 85. Otitis Media Chapter 86. Poisoning Chapter 87. Sickle Cell Pain Crisis Chapter 88. Bleeding in Pregnancy Chapter 89. Cervical Insuffi ciency Chapter 90. Diabetes in Pregnancy Chapter 91. Hyperemesis Gravidarum Chapter 92. Postpartum Wound Infection Chapter 93. Preeclampsia Chapter 94. Preterm Labor Chapter 95. Preterm Premature Rupture of Membranes Chapter 96. Anxiety Disorders Chapter 97. Bipolar Disorder (Manic Component) Chapter 98. Dementia—Alzheimer's Type Chapter 99. Major Depression Chapter 100. Schizophrenia Chapter 101. Substance Abuse Disorders Appendix A. Infection Prevention and Control Appendix B. Laboratory Tests Discussed in This Manual: Normal Values Selected Bibliography Index See What Nursing Students Have To Say About All-in-One Care Planning Resource … “The care plans are extremely thorough and well-organized. The rationale feature is a great asset to nursing students developing critical thinking skills and good, sound clinical judgment.” Jeffrey Waddell, Pittsburgh State University, Pittsburgh, Kansas “Wonderful! Love the introductions that give you a complete picture of the signs and symptoms, assessments, and diagnostic tests you need to care for patients in clinicals.” Yvonne Gubersky, University of Arizona, Tucson, Arizona “Rationales are clear and easy to read. It has lab values, and the teaching is specific to each diagnosis. It has everything! A great way to see the whole picture.” Brianna Chavez, Belmont University, Nashville, Tennessee “I don't have to carry around four books anymore! This is one book with everything in it.” Leshia Gann, Belmont University, Nashville, Tennessee “WOW!! Very thorough and complete in all aspects of patient care. I especially like the description of the condition with expected signs and symptoms and lab values.” James Green, Columbus State University, Columbus, Georgia “The rationales that follow the interventions are great for planning your care and knowing why you are doing your interventions. Interventions and rationales are awesome! Patient and family teaching and discharge planning are very beneficial for clinical teaching.” Hattie McDowell, Truman State University, Kirksville, Missouri “Well organized and easy to read. The student's best guide through nursing school!” Jennifer Marler, Jacksonville University, Jacksonville, Florida “An excellent source for not only completing accurate care plans, but providing holistic care for patients in prioritizing their health needs. I wish I had been able to utilize such a fantastic resource like this during my long care-plan-making nights!” Nicole Colline, Quinnipiac University, Hamden, Connecticut “More detail in the rationales makes the interventions more understandable! I definitely got my money's worth—covered all areas of nursing in one care plan book.” Ashley Zerwekh, Gateway Community College, Phoenix, Arizona “I love how this book includes labs for specific disorders. It includes everything … a lot of good information! I wish I had this when I was a sophomore.” Vanessa Lincoln, Truman State University, Kirksville, Missouri “Very thorough. Covered all aspects of the physiologic and psychosocial problems as well as listing of resources to refer patients to.” Cindy Green, Columbus State University, Columbus, Georgia “I like the ‘related-to’ feature. And it's nice to have the lists of resources to send home with the families at discharge.” Suzanne Brown, Oklahoma State University, Oklahoma City, Oklahoma “It's very handy to have a book that's all-in-one!” Tanya Hentges, Truman State University, Kirksville, Missouri “I wish I had this book for my first semester of clinicals. The material … pulls together related information that would usually be found in several separate textbooks. Nursing students can lighten their backpack for clinicals with this one book that includes it all.” Julie Wilner, University of Michigan, Ann Arbor, Michigan Contributors MEDICAL-SURGICAL NURSING CARE PLANS Lolita M. Adrien-Dunlap, RN, MS, CNS, CWOCN Nursing Learning Specialist Contra Costa College San Pablo, California *Contributed care plans for Crohn's Disease, Fecal Diversions, and Ulcerative Colitis. Linda S. Baas, RN, PhD, ACNP, CCRN Professor and Director of Acute Care Graduate Program University of Cincinnati College of Nursing Cincinnati, Ohio *Contributed care plan for Prolonged Bedrest. Marianne Baird, RN, MN Clinical Nurse Specialist Saint Joseph's Hospital of Atlanta Atlanta, Georgia *Contributed Endocrine Care Plans. Marie Bakitas, ARNP, DNSc, FAAN Adult Nurse Practitioner, Palliative Care Dartmouth-Hitchcock Medical Center Lebanon, New Hampshire *Contributed care plan for Palliative and End-of-Life Care. Lynda K. Ball, RN, BS, BSN, CNN Quality Improvement Coordinator Northwest Renal Network Seattle, Washington *Contributed care plan for Care of the Renal Transplant Recipient. Kathleen Barnett, RN, MA, APRN, BC-PCM Palliative Care Nurse Educator – Project ENABLE II Dartmouth College/Dartmouth-Hitchcock Medical Center Lebanon, New Hampshire *Contributed care plan for Palliative and End-of-Life Care. Michelle T. Bott, RN, BScN, MN Director, Professional Practice Guelph General Hospital Guelph, Ontario *Contributed care plans for Acute Renal Failure, Chronic Kidney Disease, Hemodialysis, Peritoneal Dialysis, and Normal Laboratory Values appendix. Jennifer Dunscomb, RN, MSN, CCRN Clinical Nurse Specialist—Pulmonary, Cardiovascular, and Critical Care Columbus Regional Hospital Columbus, Indiana *Contributed care plans for Acute Respiratory Failure, Chronic Obstructive Pulmonary Disease, Pneumonia, Pneumothorax/Hemothorax, and Pulmonary Embolus. Karen Goff, RN, BSN Senior Applications Saint Joseph's Hospital of Atlanta Atlanta, Georgia *Contributed care plans for Appendicitis, Cholelithiasis, Cholecystitis, Cholangitis, Cirrhosis, Hepatitis, Pancreatitis, Peptic Ulcers, and Peritonitis. R. Mark Hovis, CRNA Nurse Anesthetist Washington University School of Medicine St. Louis, Missouri *Contributed care plan for Perioperative Care. Marguerite Jackson, RN, PhD, FAAN Director, Administrative Unit, National Tuberculosis Curriculum Consortium Associate Clinical Professor of Family and Preventive Medicine University of California San Diego San Diego, California *Contributed care plan for Pulmonary Tuberculosis and Infection Prevention and Control appendix. Patricia Jansen, APRN, MSN, CS Medical Surgical Clinical Nurse Specialist Regional Medical Center of San Jose San Jose, California *Contributed care plans for Benign Prostatic Hypertrophy, Older Adult Care, Ureteral Calculi, Urinary Diversions, and Urinary Tract Obstruction. Suzanne Jed, APRN-BC, MSN, FNP Clinical Education Coordinator Mountain Plains AIDS Education and Training Center Instructor, Division of Infectious Diseases, School of Medicine University of Colorado at Denver and Health Sciences Center Denver, Colorado *Contributed care plan for HIV. Ingrid B. Mroz, RN, MS, CCRN Clinical Nurse Specialist Adult Critical Care Dartmouth-Hitchcock Medical Center Lebanon, New Hampshire *Contributed care plan for Pain. Barbara D. Powe, RN, PhD Director, Underserved Populations Research American Cancer Society Atlanta, Georgia *Contributed care plan for Cancer Care, Psychosocial Support, and Psychosocial Support of the Patient's Family and Significant Others. Dottie Roberts, RN, MSN, MACI, CMSRN, OCNS-C Clinical Nurse Specialist Palmetto Health Baptist Columbia, South Carolina *Contributed Musculoskeletal Care Plans. Sandra Rome, RN, MN, AOCN Hematology/Oncology Clinical Nurse Specialist Cedars-Sinai Medical Center Assistant Clinical Professor, UCLA School of Nursing Los Angeles, California *Contributed Hematologic Care Plans. Nancy A. Stotts, RN, EdD, FAAN Professor of Nursing University of California San Francisco San Francisco, California *Contributed care plan for Managing Wound Care. Carol Monlux Swift, RN, BSN, CNRN Staff Nurse Critical Care Unit El Camino Hospital Mountain View, California *Contributed Neurologic Care Plans. Beth Taylor, RD, MS, CNSD, FCCM Nutrition Support Specialist Barnes-Jewish Hospital St. Louis, Missouri *Contributed care plan for Providing Nutritional Support. Mary Young, RN, ARNP, BC, MSN Nurse Practitioner, Cardiology Dartmouth-Hitchcock Medical Center Lebanon, New Hampshire *Contributed care plans for Abdominal Trauma and Cardiac Care Plans. Pediatric Nursing Care Plans Sherry D. Ferki, RN, MSN Adjunct Faculty, Pediatric Clinical Instructor College of the Albemarle, ADN Program Elizabeth City, North Carolina Adjunct Faculty, Pediatric Clinical Instructor Old Dominion University, School of Nursing Norfolk, Virginia Maternity Care Plans Deborah E. Swenson, MSN, ARNP OBSTETRIX Medical Group of Washington, Inc. Seattle, Washington Psychiatric Nursing Care Plans Verna Benner Carson, APRN/PMH, PhD National Director of RESTORE Family Behavioral Health Tender Loving Care Home Health Care Services Fallston, Maryland ReviewersJoAnn Acierno, RN, BSN Instructor Clarkson College Omaha, Nebraska Mike Aldridge, MSN, RN, CCRN, CNS Instructor in Clinical Nursing The University of Texas at Austin School of Nursing Austin, Texas Judith Ascenzi, RN, MSN Unit Educator for the Johns Hopkins Hospital Pediatric Intensive Care Unit Baltimore, Maryland Patricia W. Campbell, RN, MSN Nursing Faculty Carolinas College of Health Sciences School of Nursing Charlotte, North Carolina Corine K. Carlson, MS, RN Assistant Professor Luther College Decorah, Iowa Jo Anne Carrick, RN, MSN, CEN Instructor Pennsylvania State University School of Nursing Sharon, Pennsylvania Pattie G. Clark, RN, MSN, ABD Associate Professor of Nursing and Nursing Outreach Coordinator Abraham Baldwin College Tifton, Georgia Barbara Derwinski-Robinson, MSN, RNC Associate Professor Montana State University—Bozeman College of Nursing Billings, Montana Nancy Eksterowicz, RN, MSN Pain Services Coordinator University of Virginia Health Systems Afton, Virginia Janice J. Hoffman, RN, PhD Faculty Johns Hopkins University School of Nursing Baltimore, Maryland Suzanne Jed, MSN, APRN-BC, FNP Clinical Education Coordinator Mountain Plains AIDS Education and Training Center Instructor, Division of Infectious Diseases, School of Medicine University of Colorado at Denver and Health Sciences Center Denver, Colorado Susie Kampfert, MSN, CCRN Manager, Nursing Education Metropolitan Hospital Grand Rapids, Michigan Merita Konstantacos, RN, MSN Consultant Clinton, Ohio Lynn Woods Lowery, BSN, MSN Instructor, Senior Nursing Program Nurse Educator Charity Delgado School of Nursing New Orleans, Louisiana Sarah Reidunn Pool, RN, MS Nursing Education Specialist Cardiac Surgery Mayo Clinic Rochester, Minnesota Bruce Austin Scott, MSN, APRN, BC Nursing Instructor San Joaquin Delta College Clinical Nurse IV St. Joseph's Medical Center Stockton, California Phyllis Stout, MSN, APRN, BC Associate Professor St. John's College of Nursing of Southwest Baptist University Springfield, Missouri Allison J. Terry, RN, MSN, PhD Nurse Consultant Alabama Board of Nursing Montgomery, Alabama Susan Cook Vaughn, RN, MSN Home Care Specialist Gentiva Health Services Charlotte, North Carolina Lynette M. Wachholz, MN, ARNP, IBCLC Pediatric Nurse Practitioner; Lactation Consultant The Everett Clinic – Harbour Pointe Mukilteo, Washington Derek Wood, RN, BC, MS Instructor Aims Community College Thornton, Colorado Preface All-in-One Care Planning Resource is a one-of-a-kind book featuring nursing care plans for all four core clinical areas. The inclusion of pediatric, maternity, and psychiatric nursing in addition to medical-surgical nursing care plans allows students to use one book throughout the nursing curriculum. This unique presentation—combined with solid content, an open and accessible format, and clinically relevant features—makes this a must-have care plans book for nursing students. ORGANIZATION This book is organized into four separate sections for medical-surgical, pediatric, maternal, and psychiatric care plans. Within each section, care plans are listed alphabetically by disorder or condition (the medical-surgical nursing care plans are organized alphabetically within each body system). General information that applies to more than one disorder can be found in the General Care Plans section, where nursing diagnoses and interventions for perioperative care, pain, prolonged bedrest, cancer care, psychosocial support for patients, psychosocial support for the patient's family and significant others, older adult care, and end-of-life care are discussed. Each disorder uses the following consistent format: • Overview/Pathophysiology, includes a synopsis of the disorder and its pathophysiology, where appropriate • Health Care Setting, such as hospital, primary, community, or long-term care • Assessment, covering signs and symptoms and physical assessment • Diagnostic Tests • Nursing Diagnoses with Desired Outcomes • Nursing Interventions and Rationales in a clear two-column format • Related NIC Interventions and NOC Outcomes • Patient-Family Teaching and Discharge Planning This book is organized to provide the most important information related to various disorders. By providing a consistent format for each disorder, key information that a nurse needs to know is fully covered. For example, the rationales given for the interventions are supported by supplemental information provided in the “Overview/Pathophysiology” and “Assessment” sections. This really is the most complete care planning book available! FEATURES The care plans in this book were written by clinical experts in each subject area to ensure the most current and accurate information. In addition to reliable content, the book offers the following special features: • A consistent, easy-to-use format facilitates quick and easy retrieval of information. • The Health Care Setting is specified for each care plan, since these conditions are treated in various settings such as hospital, primary care, long-term care facility, community, and home care. • Outcome criteria with specific timelines assist in setting realistic goals for nursing outcomes and providing quality, cost-effective care. • Detailed, specific rationales for each nursing intervention apply concepts to clinical practice. • The Patient-Family Teaching and Discharge Planning section highlights key patient education topics, as well as resources for further information. • The new NANDA Taxonomy II nursing diagnoses are included in each care plan. • Related NIC (Nursing Interventions Classification) interventions and NOC (Nursing Outcomes Classification) outcomes are listed for each nursing diagnosis. • Separate care plans on Pain and End-of-Life Care focus on palliative care for patients with terminal illnesses, as well as relief of acute and chronic pain. • The newest infection prevention and control guidelines from the Centers for Disease Control and Prevention (CDC) are included in the appendix. • Normal laboratory values for adults are listed in the appendix, including separate tables for Complete Blood Count; Serum, Plasma, and Whole Blood Chemistry; and Urine Chemistry. Normal laboratory values for pediatric patients are included at the end of the Pediatric Nursing Care Plans section. This book was carefully prepared to meet the needs of today's busy nursing student. We welcome comments on how we can enhance its usefulness in subsequent editions. Pamela L. Swearingen Chapter 1. Cancer Care OVERVIEW/PATHOPHYSIOLOGY The term cancer refers to several disease entities, all of which have in common the proliferation of abnormal cells. To varying degrees, these cells have lost their ability to reproduce in an organized fashion, function normally, and die a natural death (apoptosis). As a result they may develop new functions not characteristic of their site of origin, spread and invade uncontrollably (metastasize), and cause dysfunction and death of other cells. Cancer continues to be the second leading cause of death in the United States after cardiac disease (American Cancer Society, 2006). It can cause damage and dysfunction at the site of origin, regionally, or metastasize and cause problems at more distant body sites. Eventually a malignancy may cause irreversible systemic damage and failure. HEALTH CARE SETTING Medical or surgical floor in acute care; primary care, hospice, home care, long-term care CARE OF PATIENTS WITH CANCER0 Lung cancer Lung cancer remains the most common cause of cancer death among men and women in the United States. American Cancer Society (ACS) statistics for 2004 indicate that 87% of lung cancer deaths may be attributed to smoking. Despite treatment advances in surgery, chemotherapy, and radiation therapy, the cure rate remains low. Although exposure to certain known carcinogens such as radon and asbestos may cause lung cancer, the g...
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