Fundamentals 2023-2024

2023–2024

Fundamentals Preparing students for Next Gen NCLEX ® success

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Davis Advantage for WILKINSON’S FUNDAMENTALS OF NURSING & BASIC NURSING

Two integrated solutions build the foundation for nursing education and practice.

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Davis Advantage for Wilkinson’s Fundamentals of Nursing and Davis Advantage for Basic Nursing are two complete, integrated solutions that combine the power of a student-friendly textbook with personalized learning, clinical judgment, and quizzing assignments. Together, they establish a structure that helps new nursing students learn how to think like a nurse, attain the foundational knowledge needed to develop clinical judgment, and begin to prepare for the Next Gen NCLEX®.

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§ eBook § Davis Advantage • Personalized Learning | Clinical Judgment | Quizzing § Additional Resources

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Prepare your students for the Next Generation NCLEX ®

Teach and test clinical judgment to shape the nurses they’ll become.

NGN Case Studies Clinical Judgment assignments present complex, real-life scenarios that mimic the new NGN format and align with the NCSBN Clinical Judgment Measurement Model. § Features a dynamic patient chart that expands with additional data as students progress through each case. § Includes new NGN item types such as extended drag-and-drop, grid/matrix, cloze, extended multiple response, and enhanced hot spot. § Delivers detailed feedback that identifies the cognitive skills practiced according to the Clinical Judgment Measurement Model. Learn more on page 12 NGN Stand-alone Questions * — NEW! Quizzing includes questions that mirror the stand-alone NGN item types. § Features brand-new questions in bowtie and trend formats. § Offers the ability to assign/grade questions or include them in a practice quiz. § Provides comprehensive rationales for both correct and incorrect responses. Learn more on page 14 NGN Test Bank Questions The Instructor Test Banks include NGN format questions that are unique from those in Davis Advantage, allowing you to separate exam and quizzing experiences. § Features complex questions that mirror the format of the NGN and the new item types. § Reflects content from the textbooks to further build a solid understanding. § Addresses multiple cognitive skills from the Clinical Judgment Measurement Model.

H H H H H “The Clinical Judgment activities have created an excellent opportunity to engage students in clinical reasoning and clinical judgment as well as introduce NGN

style questions and format early in the nursing program.”

—Jennifer T., Instructor, Maryville University

students have used Davis Advantage across the curriculum and experienced success OVER 275,000

*Included in new edition of Davis Advantage for Wilkinson’s Fundamentals of Nursing. Coming to Davis Advantage for Basic Nursing in the future. Contact us to learn more.

Two great ways to establish a solid foundation Whether your choice is Wilkinson’s Fundamentals of Nursing or Basic Nursing , your students will have a text that provides the evidence-based, foundational knowledge they need to become thinking, doing, and caring nurses. § NEW EDITION!

Prepares students for real-world practice with case studies and clinically focused exercises that reinforce the thinking, doing, and caring they will perform as nurses. § Develops the knowledge, skills, and experiences students need to build strong clinical judgment. § Emphasizes the important aspects of safe and effective care to ensure the best patient outcomes. § Guides students through over 230 illustrated, step-by-step procedures with detailed rationales to show exactly how to perform and master essential nursing skills. § Speaks directly to students in a clear and easy-to-understand style.

Basic Nursing , 3rd Edition 1 VOLUME Leslie S. Treas, PhD, RN, CPNP-PC, NNP-BC Karen L. Barnett, DNP, RN Mable H. Smith, PhD, JD, MN, NEA-BC

Wilkinson’s Fundamentals of Nursing , 5th Edition 2 VOLUMES Leslie S. Treas, PhD, RN, CPNP-PC, NNP-BC Karen L. Barnett, DNP, RN Mable H. Smith, PhD, JD, MN, NEA-BC

§ NEW! Increased focus on Clinical Judgment in updated Clinical Judgment chapter, reflecting the NCSBN Clinical Judgment Measurement Model (CJMM) and the relationships between the nursing process, critical thinking, clinical reasoning, and clinical judgment § NEW! “Example Client Conditions ” reflect the cognitive skills of the CJMM § NEW! “Social Determinants of Health” feature addresses the many conditions that affect health § NEW! COVID-19 and AACN Essentials content throughout § NEW & UPDATED! Photographs and graphics § UPDATED! Nursing Process chapters combined into a single chapter to better reflect the interconnectedness of each step in the Nursing Process

H H H H H “Easy to read, keeps information interesting, presented in a format that involves students in their learning. Smaller chunks with breaks/questions/ reviews allow student to take a breath and think about what they had just read and apply it.”

— Judith E., Instructor, Colorado Mountain College, Spring Valley

Ask us how our Fundamentals solutions align with the new AACN Essentials! !

NEW EDITION!

Wilkinson’s Fundamentals of Nursing , 5th Edition

Two-Volume Approach Volume 1 — The theoretical knowledge taught in class Volume 2 — The key Fundamentals procedures taught in the skills lab

CONTENTS

How Nurses Think 1. Evolution of Nursing Thought & Action 2. Clinical Judgment 3. The Steps of the Nursing Process 4. Evidence-Based Practice: Theory and Research 5. Ethics & Values for Nursing Practice 6. Life Span: Infancy Through Middle Adulthood 7. Life Span: Older Adults 8. Promoting Wellness: Health & Illness 9. Stress & Adaptation

10. Psychosocial Health & Illness 11. Promoting Family Health 12. Caring in Multicultural Healthcare Environments 13. Spirituality 14. Experiencing Loss III. Essential Nursing Interventions 15. Communicating & Therapeutic Relationships 16. Patient Education 17. Interprofessional Partnerships: Documenting & Reporting 18. Measuring Vital Signs

19. Health Assessment 20. Promoting Asepsis & Preventing Infection 21. Promoting Safety 22. Facilitating Hygiene 23. Administering Medications IV. Supporting Physiological Functioning 24. Nutrition

30. Sexual Health 31. Sleep & Rest 32. Skin Integrity & Wound Healing 33. Oxygenation 34. Circulation & Perfusion 35. Hydration & Homeostasis 36. Caring for the Perioperative Patient

II. Factors Affecting Health

V. The Context for Nurses’ Work

25. Urinary Elimination 26. Bowel Elimination 27. Sensation, Perception & Response 28. Pain 29. Physical Activity & Mobility

37. Community & Home Health Nursing 38. Informatics

39. Legal Accountability 40. Leading & Managing

Contents may vary upon publication.

One-Volume Approach The theoretical knowledge taught in class and t he key Fundamentals procedures taught in the skills lab

Basic Nursing , 3rd Edition

CONTENTS

How Nurses Think 1. Evolution of Nursing Thought & Action 2. Clinical Judgment 3. The Steps of the Nursing Process 4. Evidence-Based Practice: Theory & Research 5. Life Span: Infancy Through Middle Adulthood 6. Life Span: Older Adults 7. Experiencing Health and Illness 8. Stress & Adaptation 9. Psychosocial Health & Illness

10. Family Health 11. Caring in Multicultural

20. Promoting Asepsis & Preventing Infection 21. Safety 22. Facilitating Hygiene 23. Administering Medications IV. Supporting Physiological Functioning 24. Nutrition 25. Urinary Elimination 26. Bowel Elimination 27. Sensation, Perception, & Cognition 28. Pain 29. Activity & Immobility 30. Sexual Health

31. Sleep & Rest 32. Skin Integrity & Wound Healing 33. Oxygenation 34. Circulation & Perfusion 35. Hydration & Homeostasis 36. Caring for the Surgical Patient V. The Context for Nursing Judgment

Healthcare Environments

12. Spirituality 13. Experiencing Loss III. Essential Nursing Interventions 14. Promoting Health

II. Factors Affecting Health

15. Communication & Therapeutic Relationships 16. Patient Education 17. Documenting & Reporting

37. Community & Home Health Nursing 38. Nursing Informatics 39. Legal Accountability 40. Leading & Managing [Online] 41. Ethics & Values [Online]

18. Measuring Vital Signs 19. Physical Assessment

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Healing

drainage. ➤ Review the major complications of wound healing. ➤ Explain the factors involved in the development of pressure injury. ➤ Use the Braden scale to assess risk for pressure injury. ➤ Assess and categorize pressure injuries based on the staging system. ➤ Provide nursing care that limits the risk of pressure injury development. Have the patient stay in bed with the knees bent to minimize strain on the incision. ■ Do not put a binder on the patient. ■ Notify the surgeon and ready the patient for surgery (see Chapter 36 for care of the surgical patient). Fistulas found in wounds. ➤ Discuss when and how to use absorbent dressings, alginate dressings, collagen dressings, gauze dressings, transparent films, hydrocolloids, hydrogels, and foam and antimicrobial dressings. ➤ Describe guidelines to follow when applying heat or cold therapy. ➤ Demonstrate bandage and binder application. William Harmon is a 78-year-old man who fell and frac- tured his left hip 3 days ago.After being admitted to the hospital, he underwent an open reduction and internal fixation (ORIF) of the left hip.Today is his second postop- erative day. He is unable to roll or pull himself up in the bed. Mr. Harmon’s weight on admission was 140 lb (63.64 kg). His height is 73 in (185.42 cm). His family reports that he has been steadily losing weight. He expresses little interest in eating and says he has suffered depression since his wife died last year. A fistula is an abnormal passage connecting two body cavities or a cavity and the skin. Fistulas often result from infection or debris left in the wound. Fistulas can occur after bowel surgery, especially in compromised patients. It can also occur spontaneously and is associ- ated with certain diseases, such as inflammatory bowel disease (IBD) and cancer (McNichol et al., 2021). An abscess forms, which breaks down surrounding tissue and creates the abnormal passageway. Chronic drain- age from the fistula may lead to skin breakdown and delayed wound healing. The most common sites of fis- tula formation are the gastrointestinal and genitouri- nary tracts. Figure 32-9 illustrates a fistula between the rectum and vagina. A large dressing covers the incision on Mr. Harmon’s left hip. During your assessment, you loosen the dressing and see that the staples are intact at the incision site, and there is a min- imal amount of sero- sanguineous drainage on the bandage. As you Meet Your Patient

common in the gastrointestinal and genitourinary tracts.

STUDENT RESOURCES The questions and exercises in this book allow you to practice the kind of thinking you will use as a full-spectrum nurse. Critical-thinking questions usually have more than one right answer, so we do not provide “correct” answers for these features. Try to answer these questions yourself. It is more important to develop your nursing judgment than to just cover content. You will learn more by discussing the questions with your peers. If you are still unsure, see the Davis Advantage chapter resources for suggested responses. Teaching students to be thinking, doing and caring nurses

Two types of case studies illustrate key points and bring concepts to life, connecting what students read to what they will see and do in practice. As a nurse, you will care for many patients who have wounds or who are at risk for skin break- down. The remainder of the chapter explains how to 2 to 4 weeks may be considered chronic. A pressure injury is a type of chronic wound. To learn about pres- sure injuries, see the Example Client Condition: Pres- sure Injury and Figures 32-10 and 32-11. Practical Knowledge knowing how Key Concepts Skin integrity Wound Wound healing Related Concepts See the Concept Map on Davis Advantage. Example Client

To explore learning resources for this chapter,

Go to www.DavisAdvantage.com and find:

Answers and Suggested Responses for all questions in this chapter Concept Map Knowledge Map References and Bibliography

Condition Pressure injury

(Continued)

1 Caring for the Williams Family Kayla Robinson, Stanley and Nadine Williams’ 3-year-old grandchild, fell at the neighborhood playground. She has abrasions on her knees, a deep puncture wound on her left hand, and a laceration on her scalp. Mr. and Mrs.Williams bring her to the clinic for assessment. She is crying loudly and moving all extremities. No treatment has been given. 6/22/23 4:52 PM Mobility and activity Sensation

Time and pressure

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Knowledge Check 32-5 ■ Describe four types of wound closures. ■ Identify five types of wound complications. ■ Describe three signs of internal hemorrhage. ■ Compare dehiscence and evisceration.

Pressure injury

Intrinsic factors

• Nutrition • Age

Tissue tolerance

Think Like a Nurse 32-2: Clinical Judgment in Action

• Circulation • Underlying

health status

658 Recall the case of Mr. Harmon (Meet Your Patient).What form of wound healing (primary, secondary, or tertiary) is he undergoing? How long would you expect it to take before his wounds heal?

Think Like a Nurse: Clinical Judgment in Action questions put students in the nurse’s role to begin developing their clinical judgment skills from day one. Extrinsic factors

• Friction • Shearing •Moisture

4798_Ch32_658-704.indd 658 CHRONIC WOUNDS A chronic wound is one that has not healed within the expected time frame. Wounds that do not heal within

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Uncorrected page proofs subject to change upon publication.

FIGURE 32-10 Several factors contribute to the development of a pressure injury.

Compare changes in the exudate with the patient’s pre- vious status. ■ Amount. Describe the amount as none, light, moder- ate, or heavy. Drainage amounts vary according to the type of wound (i.e., venous stasis ulcers usually pro- duce more drainage than arterial ulcers). ■ Drains. If a drain is present, measure the amount of fluid in the collection container. ■ Color. Describe the color or consistency as serous or clear, serosanguineous, sanguineous, purulent, or seropurulent (composed of serum and pus).

■ Odor. Describe odor as absent, faint, moderate, or strong. ■ Clean the wound of all exudate or foreign material before assessing for odor because odor characteris- tics vary depending on wound moisture, organisms present, amount of nonviable tissue, and types of dressings used. ■ Odor may indicate fistula formation or bacterial con- tamination. For example, if a patient has an abdom- inal wound that was odorless but begins to smell of bile or feces, you should carefully assess for the pres- ence of a fistula. If confirmed, notify the provider. service providers, including names and contact information, that are appropriate resources for the patient. Having easily accessible information about reliable care would lessen the burden on the patient. Think about it. ➤ What considerations are important when building an interprofessional team? ➤ What practical challenges may need to be addressed within the context of a wound care team? ➤ How can technology play a role in effective implementation of wound care teams? Source : Buggy,A., & Moore, Z. (2017).The impact of the multidisciplinary team in the management of individuals with diabetic foot ulcers:A systematic review. Journal of Wound Care, 26 (6), 324–339. https://doi. org/10.12968/jowc.2017.26.6.324; Moore, Z., Butcher, G., Corbett, L. Q., McGuiness,W., Snyder, R. J., & van Acker, K. (2014).AAWC,AWMA, EWMA position paper: Managing wounds as a team. International Journal of Wound Care, 23 (5), S1–S38. https://doi.org/10.12968/jowc.2014.23.Sup5b.S1

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CHAPTER 7 Life Span: Older Adults

Safe, Effective Nursing Care boxes emphasize how to provide safe and effective care by highlighting an example of a competency expressed in practice.

EXAMPLE CLIENT CONDITION: Elder Abuse Key Point: Like domestic violence, elder abuse is seen in all cultures and socio- economic groups. Abuse Types Abuse takes many forms: Physical Emotional Sexual Financial Neglect Abandonment Risk Factors CLIENT CONDITION

Risk Factors Mental illness Alcoholism or drug abuse in patient or caregiver Dependence on others Past history of abusive relationships Depression Low self-esteem Poor health of patient or caregiver Caregiver stressed or frustrated with difficult caregiving tasks Social Determinants of health: Ageism Social isolation or poor social network Low-income status Financial or other family problems (of patient or caregiver) Inadequate or unsafe housing Lack of health insurance

Improving Wound Care With Interprofessional Teams Key Concept: Wound Healing Competency: Collaborate with the interprofessional healthcare team Interprofessional collaboration is essential to providing quality patient care and strengthening the healthcare system.The use of a team approach in treating both acute and chronic wounds, including diabetic foot ulcers, venous stasis ulcers, and pressure injuries, has been a topic of research.Within this model, the patient remains central, with care efforts being provided based on patient needs and desires. Characteristics such as trust, effective communication, role clarity, and mutual respect are needed to create high-functioning teams.

Key Point: The risk of abuse is higher for women and those with physical and cognitive vulnerabilities. Advanced age Physical, functional, or cognitive impairment

Key Point: If an older adult has an injury such as maxillofacial trauma, dental trauma, subdural hematomas, periorbital and laryngeal trauma, rib fractures, or upper extrem- ity injuries, along with a wasted and unkempt appearance, it is possible that the injury was inflicted. Elder abuse takes many forms, including the following: • Battering • Inappropriate use of drugs and physical restraints • Force-feeding, physical punishment • Nonconsensual sexual contact • Treating an older person like an infant, including infantilizing communication (also referred to as elderspeak ) • Giving an older person the “silent treatment” • Enforced social isolation • Demeaning an older adult • Neglect • Abandonment • Financial or material exploitation, such as illegal or improper use of an older adult’s funds, property, assets, or Social Security checks • Assess older adults for abuse anytime there is a possibility that an injury may have been inflicted rather than accidental. • Assess for social determinants, risk factors, and etiology of the abuse. • For a screening tool and a procedure to aid you in assessing for abuse,

RECOGNIZING CUES

The World Health Organization suggests a “wound navigator” as a wound care team leader.The navigator functions as a patient advocate, focusing on patient-perceived needs and involving the expertise of healthcare professionals.The wound navigator collaborates with other professionals to determine the best plan of care for each patient, using a referral and follow-up system. For example, the wound navigator could provide each patient with a list of care/

UNIT 4 Supporting Physiological Function

ANANLYZING CUES/ DIAGNOSING

6/22/23 4:52 PM pain. Key Point: The mo tion is normal saline. B occur as soon as 24 hour Sterile water may also larly when other solutio Ideally, the irrigation Isotonic to prevent in Nonhemolytic to pre Nontoxic to healing impair wound hea Transparent to allow bed. Inexpensive for frequ volume of solution Warmed to room temp Selecting an Irriga following are common m ■ Piston syringe for irr posable syringe has a mize hand slippage a elongated tip is able to gation fluid.

32-1

Go to Procedure 6-1 in Volume 2.

contamination from biofilm in the hospital setting and in patients with a higher risk of acquiring infec- tion (compromised immune system, other comorbid- ities). Biofilm (a coating of bacteria that adheres to a surface) forms in hospital water delivery systems. Biofilms impede wound healing by reducing the effectiveness of fibroblasts in repairing the wound bed. This substance also reduces the effectiveness of antimicrobials. Skin Integrity and Wound Healing ■ Scenario 1— Mary is caring for Mrs. Skylar, a 62-year-old patient with diabetes and venous stasis ulcers on her legs. Since developing these venous stasis ulcers, Mrs. Skylar has become very self-conscious and embarrassed about her legs.When taking Mrs. Skylar to x-ray, Mary covers Mrs. Skylar’s legs with a bath blanket for comfort and privacy. Mary was not only providing comfort and protecting privacy. She was also aware of Mrs. Skylar’s feelings and cared enough to respond to them. ■ Scenario 2— Mr. Robert Brown is an 18-year-old paraplegic who has developed a stage 4 sacral pressure ulcer with a foul odor. He is expecting sFome of his friends from school for a visit. Ken, his nurse, while nonchalantly cleaning up the room, makes sure to remove the garbage liner with the old dressings in it. He also brings in some fresh-cut flowers and a cup of wet coffee grounds. Both the flowers and the coffee grounds are natural odor eliminators. Mr. Brown has a great visit with his friends from school.

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200

UNIT 11 Factors Affecting Health

• Low self-esteem related to physical abuse and demeaning communication • Risk for Injury related to physical or psychological abuse

PRIORITIZING HYPOTHESES

EXAMPLE CLIENT CONDITION: Elder Abuse—cont’d

(continued)

Key Point: Prevention is key: listen, intervene, educate. Prevention Measures • Screen for social determinants and risk factors associated with elder abuse. • Observe for injuries indicative of elder abuse. • Determine congruence of injury and the description of cause. • Remove patient from dangerous situation. • Notify appropriate authorities of suspected abuse.

GENERATING SOLUTIONS

Stop Elder Abuse: REPORT IT. • Suspicion of elder abuse must be reported to adult protective services and/or the authority designated by law in each state to investigate and prosecute elder abuse. • Call the police or 9-1-1 immediately if someone you know is in immediate, life-threatening danger. Elder Abuse Resources • The National Center on Elder Abuse (NCEA) (https://ncea.acl.gov/) • Clearinghouse on Abuse and Neglect of the Elderly (CANE) (https://www.nsvrc.org/ organizations/133)

TAKING ACTION

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• Remains safe and free from physical and/or psychological harm • Maintains dignity • Verbalizes positive self-worth

EVALUATING OUTCOMES

remain alert to early signs or symptoms of cognitive impairment (for example, problems with memory or language) and evaluate as appropriate. Assessing the mental status of older adults can help guide decisions about when it may be appropriate to screen for cogni- tive impairment in the primary care setting. Also see the Example Client Condition: Dementia. For a step-by-step procedure for a complete assess- ment of mental status, Go to Procedure 19-16, Assessing the Sensory-Neurological System, in Volume 2. Assessing Functional Status Functional status is the ability to perform self-care and other ADLs and IADLs. ■ Activities of Daily Living. You can use the Katz Index of Independence in Activities of Daily Living to rate a

environment, for example, shopping, using the tele- phone, housekeeping, managing money, preparing food, and managing one’s medications. Loss of ability to per- form IADLs frequently marks a need for assisted living, nursing home placement, or the aid of family or home- maker services to allow an older adult to age in place. Assessing for Depression For more information about depression in older adults, see the box Example Client Condition: Depression in Chapter 10. To assess for depression, you may wish to use the Geriatric Depression Scale (GDS), a 30-item questionnaire that screens for depression. It is tailored to the concerns that older adults face. To learn more: Go the The Geriatric Depression Scale (GDS): http://www. stanford.edu/~yesavage/GDS.html AU: please verify cross- reference

Example Client Conditions are graphically driven exemplars that tie together key concepts within a chapter, and reflect the cognitive skills of the NCSBN Clinical Judgment Measurement Model. iCare boxes and icons highlight the important role of caring in nursing by modeling behaviors and conversations that demonstrate how a nurse can provide compassionate care. Request preview access • Schedule a walkthrough • Learn more | Contact us at Hello@FADavis.com or visit FADavis.com/DavisAdvantage

The use of a bulb increases the risk of aspira ing granulation tissue.

■

7 ■ Commercial irrigatio agitators, whirlpool h isters, and pulsed lav an uninterrupted stre wound’s surface. Puls

homes (Zonfrillo et al., 2018).

NEW! Wilkinson’s Fundamentals of Nursing features Social Determinants of Health boxes and icons that introduce students to the many conditions that impact health. 212 UNIT 11 Factors Affecting Health Social Determinants of Health 8-1 Economic Stability ■ Employment ■ Food insecurity ■ Housing instability ■ Poverty Education Access and Quality ■ Early childhood education and development ■ Enrollment in higher education Carbon Monoxide Exposure Carbon monoxide (CO) is a colorless, tasteless, odor- less toxic gas. Exposure can cause headaches, weakness, nausea, and vomiting; prolonged exposure leads to sei- zures, dysrhythmias, unconsciousness, brain damage, and death. Each year in the United States, CO poisoning causes approximately 350 unintentional deaths (CDC, 2017a). ■ Most CO exposures occur at home. ■ Most CO exposures involve females, children under the age of 17 years, and adults aged 18 to 44 years. ■ High school graduation ■ Language and literacy Social and Community Context ■ Civic participation ■ Discrimination ■ Incarceration ■ Social cohesion Health Care Access and Quality ■ CO poisoning accounts for a majority of deaths at the scene of fires and is also a relatively common cause of death by suicide. ■ Many CO deaths occur during cold weather among older adults and the poor who seek nonconventional heat sources (e.g., gas ranges and ovens) to stay warm. Scalds and Burns The following are common causes of scalds and burns: ■ Scald injuries (e.g., from hot water, steam, or grease) are the most common cause of burns in children younger than age 3. Scalding burns (especially on both feet or both hands) and cigarette burns in children and vulnerable older adults should always prompt you to assess for abuse (see Procedure 6-1). ■ Access to health care ■ Access to primary care ■ Health literacy Neighborhood and Built Environment ■ Access to foods that support healthy eating patterns ■ Crime and violence ■ Environmental conditions ■ Quality of housing Source: U.S. Department of Health and Human Services, Office of Disease Prevention and Health Promotion. n.d. Healthy People 2030, https://health.gov/healthypeople/objectives-and-data/social- determinants-health ■ Warming food or formula in the microwave may cause the food to become hotter than intended, lead- ing to burns in infants and young children. HOW DO PEOPLE EXPERIENCE WELLNESS, HEALTH, AND ILLNESS? In envisioning health and illness as a continuum, full-spectrum nurses promote wellness regardless of the circumstances a client faces now or in the future. This approach requires the holistic understanding that health is multidimensional. The following are some of the many dimensions of health that we experience along the is greater in the presence of such heating devices as kerosene heaters, wood-burning stoves, and home sauna heating elements. People may use these as heat ■ Sunburn can cause a first- or second-degree burn. ■ Contact burns may occur from contact with metal surfaces and vinyl seats when cars are parked in the sun. The risk of contact burns in all age-groups older misused opioids in the past year (Substance Abuse and Mental Health Services Administration [SAMHSA], 2022). ■ Treatment choice depends on the poison ingested. For most poisonings, the most effective intervention is professional administration of activated charcoal orally or via gastric tube. However, charcoal is not effective for ethanol, alkali, iron, boric acid, lithium, methanol, or cyanide. Depending on the situation, other options for medical treatment include gastric lavage, dialysis, administration of antidotes (i.e., Narcan), and forced diuresis.

CHAPTER 32 Skin Integrity & Wound Healing Poisoning Poisoning death rates have more than quadrupled in the past 20 years. Although young children are frequent victims, the increase has been mainly among adults. In many cases, the person does not die but becomes ill or suffers other effects. Poisoning exposure accounts for more than 2 million emergency department visits per year in the United States (CDC, 2022). 701 ■ Young children are poisoned most often by improper storage of household chemicals, medicines and vita- mins, and cosmetics (see Box 21-1). The use of lead in paint has been banned since 1978, but lead-based paint can still be found in older homes and toys produced in some foreign countries. Some soil (which young children often put in their mouths) contains high levels of lead. In the United States, poor, urban, and immigrant populations are at higher risk for lead exposure than other groups. ■ Older children and adolescents may attempt suicide by overdosing with medicines or be poisoned acci- dentally when experimenting with recreational or prescription drugs. ■ Adults experience poisoning as a result of illegal drug use or misuse or abuse of prescription drugs, especially narcotic medications, tranquilizers, and antidepressants.

CLINICAL REASONING

Applying the Full-Spectrum Nursing Model

PATIENT SITUATION Tio Santos is a 66-year-old man with obesity, diabetes, and hypertension. He is being seen for a wound on his right foot that doesn’t seem to be healing. He injured his foot when repairing drywall at home. He is otherwise relatively sedentary at home. The wound is oozing, swollen, tender, and warm to the touch. Mr. Santos is now running a low-grade fever of 100.4°F (38°C) at home. He tells you his foot is very painful, especially with any weight bearing, and throbs when he is sitting or lying still. You measure the wound bed to be 6 cm x 4 cm and note purulent exudate at the distal edge. He is referred to an outpatient wound care center for treatment.

breast cancer. cancer has bee inherit a tende Sex Many than in anothe oporosis, and individuals, w cancer are mo Age and opmental stag Certain health mental stage. F cancer cases a age 50. As ano higher rates o the general p risk-taking be and developm ■ Developme opmental st cope with st illness end o are ill, frigh of experien standing to ress through understandi ■ Developme disease, loss age than exp event and m ing skills t example, a that of an old count the im period of a p For e traum a you one h loss, whethe

THINKING 1. Theoretical Knowledge: a. What is the Braden scale and why might it be used for Mr. Santos?

b. What risk factors for delayed wound healing does Mr. Santos have?

2. Critical Thinking (Considering Alternatives, Deciding What to Do): a. To care for Mr. Santos’ wound, should you use sterile gloves, clean nonsterile gloves, or no gloves? Explain your thinking.

DOING 3. Practical Knowledge (Assessment): a. What symptoms of infection does Mr. Santos have?

b. To be certain the wound is infected, what would you need to know or do?

CARING 4. Self-Knowledge: Imagine you are Mr. Santos and have had a wound on your foot for 6 weeks. What would be the most troublesome symptom in your daily life? What would concern you the most? Critical Thinking and Clinical Judgment 1. You are caring for a 22-year-old man with paralysis from the waist down secondary to a motor vehicle accident. He has been admitted to the hospital with a urinary tract infection manifested by a fever of 102°F (39°C) and lethargy. His family reports he has been withdrawn and sits in his wheelchair looking at his phone all day. a. What risk factors does this patient have for skin breakdown? BOX 21-1 ■ Poisonous Agents Commonly Ingested by Children

■ Household cleansers, including oven cleaner, drain cleaner, toilet bowl cleaner, and furniture polish ■ Medicines, including cough and cold preparations, vitamins, pain medications, antidepressants, anticonvulsants, and iron tablets, which may look like candies to children ■ Indoor houseplants, including poinsettia, Dieffenbachia, Philodendron, and many others ■ Cosmetics, hair relaxer, nail products, mouthwash ■ Kerosene, gasoline, lighter fluid, paint thinner, lamp oil, antifreeze, windshield washer fluid, lighter fluid, and other chemicals ■ Alcoholic beverages

b. What locations of his body should you be most concerned for the formation of pressure injury?

c. What actions should you take to decrease the risk of pressure injury for your patient? What further information do you need?

2. A 63-year-old male patient is admitted to your unit after an emergency appendectomy. His appendix was ruptured, and the surgeon has left the wound open to heal by secondary intention. A Jackson–Pratt drain is in place in the wound bed. A moderate amount of purosanguineous drainage is visible in the drain. The surgeon has ordered saline-moistened gauze packing every 4 hours. a. What actions should you take as you prepare to do the first dressing change?

b. How will you secure the dressing?

■ Wild plants and mushrooms ■ Pesticides, rodent poisons

Applying the Full-Spectrum Nursing Model and Critical Thinking and Clinical Judgment exercises guide students in applying their critical-thinking and clinical-reasoning skills to real-world patient scenarios.

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691

CHAPTER 32 Skin Integrity & Wound Healing

690

UNIT 4 Supporting Physiological Functioning

The drain will need to be evaluated to be sure it remains intact, which it mostly likely will. Drainage tubing is secured under the

skin surface and will probably not be dis- lodged with shortening.

Procedure 32-13 ■ Shortening a Wound Drain ➤ For steps to follow in all procedures, refer to the Universal Steps for All Procedures on the inside back cover.

What if . . . ■ I shorten the drain too much? Immediately notify the surgeon who placed the drain.

the tube (e.g., if the tube diameter is not sufficient size to handle drainage output) or, more likely, an obstruction within the tubing. ■ Assess the characteristics of the drainage, including color, volume of drainage, presence of blood, odor, pus, and any change in the type or amount of drainage through the tubing. A sudden decrease in drainage might indicate a blocked drain. Pres- ence of fresh blood might be a sign of irritation within the wound. Pus and odor in the drainage could indicate wound infection. ■ Check the suction apparatus to be sure it is functioning properly. A self-suction apparatus might need to be recompressed from time to time to maintain effective vacuum. Electric suction units can fail, delivering too much suction, which can lead to injury.Too little suc- tion can contribute to insufficient drainage, which can lead to pres- sure on sutures if present, or cause the wound to become infected or heal more slowly.

Equipment ■ Nonsterile gloves ■ Sterile gloves ■ Sterile scissors ■ Two safety pins or other clips (sterile) ■ Sterile gauze

Evaluation ■ Assess the local area of skin around the drain after manip- ulating it. ■ Note the patency of the drain after shortening it. ■ Be sure the drain is secure after shortening. ■ Evaluate for complications occurring related to shortening procedure. Patient Teaching ■ Patients should not shorten their own drains. Consult a healthcare provider if concerned about the length of tubing or drains. Documentation ■ Record the intervention. ■ Note the amount and characteristics of the drainage.

■ Document the appearance of the wound. ■ Note any complications that occur with shortening a drain (e.g., manipulation of tubing causes bleeding or drainage at the site). Sample Documentation mm/dd/00/00/0000 0930 Penrose shortened 2.0 cm by postop orders. Drain intact. Pt tolerated procedure without complication. —M. Garcia, RN

Delegation Assessment of the incision line or wound and the drain is a registered nurse’s responsibility and cannot be delegated.This procedure should not be delegated to a UAP. The risk for accidently losing the drain into the body or pulling it out of the wound is too high. Preprocedure Assessment ■ Inspect the site around the drain, noting skin excoriation, tenderness, erythema, warmth to the touch, and drainage seeping from the wound. Could indicate a wound infection or irritation of the drain at the skin site. Excoriation can be the result of seeping drainage around

Thinking About the Procedure

The video Shortening a Wound Drain, along with questions and suggested responses, is available on the Davis’s Nursing Skills Videos Web site on FADavis.com.

➤ When performing the procedure, always identify your patient according to agency policy, using two identifiers, and be attentive to standard precautions, hand hygiene, patient safety and privacy, body mechanics, and documentation.

Procedure 32-14 ■ Emptying a Closed-Wound Drainage System ➤ For steps to follow in all procedures, refer to the Universal Steps for All Procedures on the inside back cover.

Procedure Steps 1. Perform hand hygiene and don nonsterile gloves. Remove wound dressings. 2. Remove soiled gloves and discard in a moisture-proof biohazard collec- tion container. Perform hand hygiene. 3. Open sterile supplies (scissors, etc.). 4. Don sterile gloves; use sterile scis- sors to cut halfway through a sterile gauze dressing (for later use) or use a sterile precut drain dressing. 5. If the drain is sutured in place, use sterile scissors to cut the suture. 6. Firmly grasp the full width of the drain at the level of the skin and pull it out by the prescribed amount (e.g., 5 cm [2 in.]). 7. Insert a sterile safety pin or clamp through the drain at the level of the skin. Hold the drain tightly between your fingers and insert another pin above your fingers.

9. Cleanse the wound, using ster- ile gauze swabs and the prescribed cleaning solution. In some situa- tions, you may use sterile forceps to manipulate the swabs. 10. Apply precut sterile gauze around the drain; then redress the wound.

The pin or clamp keeps the drain from dis- appearing into the wound.

Equipment ■ Drainage container with graduated markings ■ Nonsterile gloves ■ Disposal sink for biomedical material ■ Biohazard disposal receptacle

Preprocedure Assessment ■ Assess the appearance of the drainage tube site and sutures, if in place. ■ Inspect for warmth, edema, redness, or pus where tubing penetrates the skin. ■ Check to be sure the closed-wound drainage system is securely fastened at the connections and within the wound. ■ Determine whether suction (electric, portable, or manual) is working properly.

Delegation This procedure may be delegated to a UAP who is trained in the skill. Assessment of the wound and drainage characteris- tics is a licensed professional’s responsibility and cannot be delegated.

8. Using sterile scissors, cut the drain about 2.5 cm (1 in.) above the skin and pin.

11. Remove gloves and discard in a biohazard container. Perform hand hygiene. 12. Leave the patient in a safe and comfortable position.

Over 230 step-by-step procedures with rationales teach students how to perform and master essential nursing skills.

4798_Ch32_658-704.indd 691 What if... sections pose questions about special situations, and explain alternate ways to perform procedures to aid students in knowing what to do.

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Request preview access • Schedule a walkthrough • Learn more | Contact us at Hello@FADavis.com or visit FADavis.com/DavisAdvantage

STUDENT EXPERIENCE

Davis Advantage uses a unique and proven approach across a Learn-Apply-Assess continuum to engage students and help them make the connections to key topics. Aligned with our content, this innovative online solution meets each student’s individual needs with Personalized Learning Plans that reflect their learning styles and areas of strength and weakness.

LEARN Engaging today’s student beyond the book

Each Personalized Learning assignment begins with a Pre-Assessment quiz that gauges the student’s comprehension of the content. Topic by topic, students then work through their assignments by watching videos and completing dynamic activities to reinforce learning and practice applying their knowledge.

Animated mini-lecture videos connect with all learning styles to make must-know concepts more relatable and easier to understand.

HHHHH “My grades have improved; my understanding about topics is much clearer; and overall, it has been the total package for what a nursing student needs to succeed.”

—Hannah, Student, Judson University

After students have watched the video and completed the activity, a Post-Assessment evaluates how well they understand the content. The results feed into their Personalized Learning Plan to track their progress and highlight areas that need additional study. !

Interactive learning activities check students’ understanding and expand their knowledge.

Comprehensive rationales help students understand why their responses are correct or incorrect.

The Student Dashboard provides an at-a-glance look into performance, time spent, and participation for all three assignment types. It also provides a snapshot of the student’s strengths and the topic areas where they need to focus their study time.

DID YOU KNOW? 94% of students using Davis Advantage said it improved their scores.

Online content subject to change. Screenshots shown reflect content from Davis Advantage for Medical-Surgical Nursing, but functionality is identical in every course area.

APPLY Developing clinical judgment skills with Next Gen NCLEX ® cases Clinical Judgment assignments challenge students to think critically and make informed decisions to achieve the best patient outcomes. Real-world case studies mirror the complexities they will encounter in a variety of settings, helping them to build the skills they need to be practice-ready nurses and prepare for the Next Gen NCLEX ® .

Case Study Topics 1. Promoting Asepsis & Preventing Infection 2. Pain Interventions 3. Skin Integrity and Wound Healing 4. Medicating Patients: Administration 5. Caring for the Surgical Patient 6. Urinary Elimination

Each case study presents all the information students need to assess the situation and the client data; synthesize their knowledge and experience; prioritize and take action; and evaluate outcomes.

The Patient Chart displays tabs for History and Physical Assessment, Nurses’ Notes, Vital Signs, and Laboratory Results. As the case progresses, the chart expands and populates with additional data.

Students are guided through an analysis of their responses that includes detailed rationales . The feedback encourages them to consider what data is important and how to prioritize the information, while reinforcing thought patterns that result in safe and effective nursing care . !

You answered 2 out of 6 questions correctly.

Question 1 of 6

NGN format questions that align with the cognitive areas of the NCSBN Clinical Judgment Measurement Model require careful analysis, synthesis of the data, and multi-step thinking.

Test-taking tips provide important context for the higher levels of knowledge and understanding that underlie clinical judgment. They also offer strategies for how to consider the structure of each question type when answering. Each question identifies the cognitive skills practiced according to the NCSBN Clinical Judgment Measurement Model and includes page references to the text for further remediation.

ASSESS Improving scores and building confidence with NCLEX ® -style questions Quizzing assignments provide the additional practice students need to improve their scores on classroom and certification exams. Questions cover the same topics and concepts as the textbook to assess students’ comprehension of course material.

Brand New! Next Gen NCLEX® bowtie & trend stand-alone questions provide students with even more practice answering these new, individual item types.

High-quality, NCLEX-style questions challenge students to think critically and test their knowledge.

The nurse is caring for a 52-year-old client coming to the emergency department with peripheral edema, periorbital edema, flank pain, and shortness of breath. The nurse is preparing to notify the provider of the client’s status. Complete the below using the dropdown choices.

MEDS2-RDC-16

Renal Disorders

Vital Signs

Clinical Judgment, Elimination, Fluid and Electrolytes, Oxygenation Perfusion

antihypertensive

Evaluation [Evaluating]

Chapter 62: Coordinating Care for Patients with Renal Disorders

Vital Signs

pp. 1452-1459

antihypertensive

Rationale: The client is demonstrating signs of acute kidney injury, oliguric phase. This is identified by low urine output, edema, shortness of breath, hypertension, hyperkalemia, elevated BUN/creatinine, anemia, and hyponatremia. It is anticipated that this client has a compromised GFR due to risk factors of poorly controlled diabetes and reoccurring UTIs. The risks for developing acute kidney injury include infection and medications. Fever, elevated WBCs, flank pain are signs of a kidney infection, and extended to excessive use of NSAIDS will impair kidney function, leading to injury. In evaluating the client data, the nurse should be most concerned about the changing vital signs, including a rising temperature, heart rate, respiratory rate, and blood pressure, as the SpO2 decreases. This indicates a deterioration of oxygenation and perfusion. Priority medical management is the delivery of oxygen and an antihypertensive to prevent tissue hypoxia and stroke. The nurse should also notify the provider about the hyperkalemia, hyperglycemia, anemia, renal impairment shown in the lab results, and the assessment findings of oliguria, edema, crackles, and bounding pulses.

Navigate the EHR trends by looking at how the cues presented relate to each other. Make the connection between the information to reach priority conclusions.

Immediate Feedback with comprehensive rationales provides students with on-the-spot remediation that explains why their responses are correct or incorrect. Page-specific references direct them to relevant content in their text, while Test-Taking Tips improve exam skills.

Students can easily create their own practice quizzes to focus on the topic areas where they are struggling or to use as a study tool to prepare for an upcoming exam.

Three assignment types. One personalized plan. Personalized Learning Plans monitor students’ performance on each Personalized Learning, Clinical Judgment, and Quizzing assignment to highlight areas of strength and weakness.

DID YOU KNOW? 98% of students said Davis Advantage helped them make the connections to key topics.

Students can toggle between Personalized Learning, Clinical Judgment, and Quizzing tabs to view their analytics for all assignments.

Personalized Learning Plans provide students with a snapshot of their progress across all their assignments, track- ing their successes and identifying areas where they need to focus their studies.

Online content subject to change.

INSTRUCTOR EXPERIENCE

Supporting educators with tools to ensure success Whether you are teaching in-person or virtually, Davis Advantage makes teaching personal, responding to the unique challenges you face and the needs of your students. Actionable analytics enable you to track your students’ progress, assess their strengths and weaknesses, and provide content-focused remediation in real time while promoting an active and engaging learning environment.

Track participation and performance on each Personalized Learning , Clinical Judgment , and Quizzing assignment .

Use your Dashboard to track your class’s overall performance . View average participation , time spent , and strengths and weaknesses . You can also quickly access individual assignments and your teaching plans.

Monitor mastery of content at both the individual and classroom levels. View your class’s performance at a glance, or drill down to see individual student progress .

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