Fundamentals Brochure 2025-2026

2025–2026

Fundamentals

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

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Two comprehensive 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, quizzing and simulation 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, improve practice readiness, and begin to prepare for the Next Gen NCLEX. ®

1 VOLUME

2 VOLUMES

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Two options to meet your course needs

NEW EDITION!

Printed Text About 1,818 pages 1,184 illustrations Hard cover | Fall 2025 About $213.95 (US) ISBN-13: 978-1-7196-5109-7 Access Card About $193.95 (US) ISBN-13: 978-1-7196-5111-0 Or purchase online access at FADavis.com

Printed Text 2,304 pages │ Hard cover | 2024 $213.95 (US) ISBN-13: 978-1-7196-4801-1 Access Card $193.95 (US) ISBN-13: 978-1-7196-4800-4 Or purchase online access at FADavis.com

Leslie S. Treas, PhD, RN, CPNP-PC, NNP-BC Karen L. Barnett, DNP, RN Mable H. Smith, PhD, JD, MN, NEA-BC

1 Volume

2-Volume Set

§ The Theoretical knowledge taught in class and the Practical knowledge taught in the skills lab

§ Volume 1: Theoretical knowledge taught in class § Volume 2: Practical knowledge taught in the skills lab

Format

Contextual approach

Concise approach

§ §

Approach

More narrative explanation

More visual, streamlined presentation

Davis Advantage • Personalized Learning • Clinical Judgment • Quizzing • Sims (NEW!)

Online Resources

Integrated eBook

§ §

Instructor and Student Resources

Teaching students to become thinking, doing, caring nurses

NEW EDITION!

New to Basic Nursing, 4th Edition § NEW & UPDATED! Streamlined, more visual presentation of content to enhance understanding, with inclusive and contemporary terminology throughout § NEW! “Social Determinants of Health” feature to introduce students to the many conditions that impact health § NEW! Coverage of sexual assault and human trafficking § NEW! The Williams Family now featured in the ongoing chapter case studies § UPDATED! Reorganized chapters for simpler navigation and refreshed icons throughout to support learning

1 VOLUME

2 VOLUMES

Whether your choice is Wilkinson’s Fundamentals of Nursing, 5th Edition or Basic Nursing, 4th Edition , your students will have a text that provides the evidence-based, foundational knowledge they need to become thinking, doing, and caring nurses. Both textbooks are organized around a Full-Spectrum Nursing Model, helping students learn how to develop, understand, and apply nursing knowledge, the nursing process, and clinical judgment to patient situations to deliver safe and effective care. § 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.

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 AACN Essentials ! !

Wilkinson’s Fundamentals of Nursing , 5th 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. Ethics & Values 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 Function 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 Surgical Patient 37. Community & Home Health Nursing 38. Nursing Informatics 39. Legal Accountability 40. Leading & Managing

II. Factors Affecting Health

V. Nursing Functions

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

NEW EDITION!

Basic Nursing , 4th 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 Wellness: Health & Illness 8. Stress & Adaptation 9. Psychosocial Health & Illness

10. Promoting Family Health 11. Caring in Multicultural Healthcare Environments 12. Spirituality 13. Experiencing Loss

19. Promoting Asepsis & Preventing Infection 20. Safety 21. Facilitating Hygiene 22. Medication Safety and Administration 24. Urinary Elimination 25. Bowel Elimination 26. Sensation, Perception, and Response 27. Pain 28. Physical Activity & Immobility 29. Sexual Health

30. Sleep & Rest 31. Skin Integrity & Wound Healing 32. Oxygenation 33. Circulation & Perfusion 34. Hydration & Homeostasis 35. Caring for the Perioperative Patient 36. Community & Home Health Nursing 37. Informatics 38. Legal Accountability 39. Ethics & Values 40. Leading & Managing [Online]

III. Essential Nursing Actions

IV. Supporting Physiological Health 23. Nutrition

II. Factors Affecting Health

V. The Context for Nurses’ Work

14. Communicating & Therapeutic Relationships 15. Patient Education 16. Interprofessional Partnerships: Documenting & Reporting 17. Measuring & Interpreting Vital Signs 18. Physical Assessment

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safety needs of clients with seizures. ➤ Discuss strategies to enhance communication with clients with sensory deficits, sensory overload, and confusion.

➤ Identify environmental, social, physical, and psychological factors that affect sensory stimulation. ➤ Assess clients for cues of altered sensory perception.

Sensory Deprivation Sensory Overload Sensory Deficits Visual and Hearing Olfactory and Gustatory Tactile and Kinesthetic Seizures

Build a solid foundation with either text

Meet Your Patients Joshua is a 28-year-old patient in the intensive care unit (ICU). He had a car accident 3 weeks ago and has had several surgeries to repair a fractured femur, ruptured spleen, and intracranial bleeding. He was ventilated mechanically for 10 days and has had numerous invasive procedures.The nurses report that he is very confused and has been hallucinating. Richard is a 90-year-old man who has been a resident at a skilled nursing facility for 10 years. He has no visitors, never leaves his room, has no television or radio in the room, and no longer speaks. He does not respond to verbal or tactile stimulation.When staff members try to move

him, he moans and howls. Consider how these patients are similar and how their care might overlap. It seems hard to imagine

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.

that these patients could have much in common.What similarities can you see? What differences? As you read this chapter, follow these cases and other examples illustrating the effects of altered sensory or perceptual function.

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CHAPTER 23 Nutrition

Caring for the Williams Family Stanley Williams has been diagnosed with hypertension, type 2 diabetes mellitus, obesity, osteoarthritis, and tobacco abuse.Assad Johnson, FNP-BC, has advised an 1,800-kcal consistent carbohydrate (CCHO) diet with no added salt

and a daily brisk 30-minute walk. Mr.Williams discusses these challenges with his daughter Jayden Robinson.

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A. Why might Assad have selected this diet plan? Discuss the rationale for each component (i.e., 1,800-kcal, CCHO diet, no added salt). B. Mr.Williams’s diet is complex. He tells you he is overwhelmed by the many changes asked of him. How might Assad streamline his instructions about Mr. Williams’s diet?

C. Mr.Williams asks what the best way is for him to monitor his weight loss progress and how Assad will monitor his progress. How would you respond? D. Identify teaching tools that might help Mr.Williams understand his diet.

Think Like a Nurse 23-7: Clinical Judgment in Action The Nutrition Screening Initiative (NSI) is completed for a 70-year-old patient. ■ What major indicator on the NSI would indicate impaired nutritional status? ■ What minor indicator would you likely see? ■ What would malnourishment look like in the adult? ■ What type of anthropometric findings would be typical of an older adult with poor nutrition patterns? ■ What type of laboratory values would support impaired nutritional status?

4/18/2025 9:04:12 PM For Underweight/Malnutrition: Same as for obesity/overweight, except for weight loss behavior. You could choose other NOC outcomes based on the patient’s nursing diagnosis. For example: For situational low self-esteem related to obesity, you might use self-esteem.

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For Frailty Syndrome: Behavior: will to live Knowledge: health

Nutritional status: food and fluid intake Self-care status

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. Applying the Full-Spectrum Nursing Model

Individualized Goals/Outcome Statements Statements you might identify for a patient with nutrition-related prob- lems include the following: Loses 2 lb per week until ideal weight is attained. Follows the prescribed modified diet that, at a minimum, meets the DRIs.

NURSING DIAGNOSIS/ANALYZING CUES For clients who have no symptoms of or risk factors for nutri- tion problems, use the diagnostic label readiness for enhanced nutrition.

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CHAPTER 7 Life Span: Older Adults

Promoting 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

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UNIT 3 Essential Nursing Interventions

Preventing Ventilator-Associated Pneumonia (VAP) Chapter Key Concepts: Infection Prevention and Control Competencies: Provide safe, quality client care; Collaborate with the interprofessional healthcare team You and your colleagues can help improve the quality of patient care.Think about the following project and consider what Thinking, Doing, and Caring skills are required for its success.

3. The result. Incidence of VAP declined 72%, and after changing the tooth cleanser to chlorhexidine gluconate, VAP declined by 90% (Hutchins et al., 2009). Other researchers interested in preventing VAP reviewed 28 clinical trials in the scientific literature.They found that chlorhexidine rinses, gels, and swabs also lower the risk for HAIs for patients receiving mechanical ventilation (Datta, 2024; El-Rabbany et al., 2015;Yusef, 2013; Zhao et al., 2020). Think about it: Reflect on the following and discuss the questions with your peers: ➤ What information did nurses and team members need before changing the care of patients on ventilators? ➤ How does the intervention improve patient comfort? ➤ How significant do you think the team’s work was? How will their efforts affect patients? ➤ What do you think the team should measure to determine whether the intervention worked?

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

Scenario. Nurses and physicians at the Mercy Medical Center wanted to reduce the rate of VAP in the ICU. 1. They collected data to establish the current VAP rate of 12.6 cases per 1,000 ventilator days. 2.Then they developed and implemented an intervention. Nurses provided oral care with cetylpyridinium chloride using a suction toothbrush every 4 hours.After that, they cleaned the patient’s mouth with a hydrogen peroxide– treated suction swab, performed deep oropharyngeal suctioning, and applied mouth moisturizer.

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ANANLYZING CUES/ DIAGNOSING

CHAPTER 19 Promoting Asepsis & Preventing Infection

hands and rub until dry. This should take 20 to 30 seconds. In a surgical setting, wash for 2 to 6 minutes, depending on the soap or other product used. ■ Water. Use warm water and rinse off soap completely. ■ Soap and Antimicrobial Products. Use agency-approved soap. The CDC (2022) recommends using a 60% alcohol- based solution (rubs, sprays, gels) for routine hand cleansing and plain or antimicrobial soap and water when hands are visibly dirty (Boyce & Pittet, 2002). Iodine compounds are also effective, but they are usually too irritating for regular hand hygiene. ! If there is a potential for contact with bacterial spores (e.g., when caring for a client with a C. difficile infection), you must wash your hands with soap and water; alcohol-based solutions are not effective against spores. ■ Friction. Rub all surfaces of the hands and wrists vigorously, including the backs of the hands and between the fingers. Remove jewelry and clean areas underneath. Clean thor- oughly underneath the fingernails using a brush or nail pick. ■ Drying. Use single-use towels or hand dryers to remove all moisture after washing the hands. If using antimicrobial hand gels, apply and rub hands until dry. (continued) 24/03/23 5:17 PM

disposable basins and cloths with 2%–4% chlorhexidine glu- conate (CHG) to reduce colonization of specific bacteria and infections with MDROs (American Association of Critical-Care Nurses, 2013; Chapman et al., 2021; Musuuza et al., 2019; Petlin et al., 2014; Siegel et al., 2017, last update).Apply emollients after bathing to prevent dry skin. Rest and Sleep Advise patients that 6 to 9 hours per night is considered fully restorative for most people. However, sleep needs and patterns vary. Rest and sleep conserve energy needed for healing. Exercise and Activity Emphasize that exercise is just as important as rest and sleep. Too little activity causes circulation to slow and the lungs to supply less oxygen. Excessive exercise leads to fatigue and joint injury. Chapters 28 and 30 provide in- depth discussion of rest, sleep, activity, and exercise. Stress Reduction Inform clients of the need to reduce stress. Laughing increases immune responses, improves oxy- genation, and promotes body movement. In contrast, physical or mental stress decreases the body’s immune defense. Studies demonstrate a correlation between stress and disease (Cous- ins, 1979; Franco et al., 2003; Wang et al., 2022). See Chapter 8 if you want additional details about stress. Immunizations Encourage clients to follow recommenda- tions for immunizations (e.g., via vaccination) to protect against several common infectious diseases (e.g., COVID-19, measles, mumps, pertussis, polio, pneumonia, influenza, smallpox, and shingles). Unfortunately, some pathogens, such as the common cold virus, mutate too rapidly for an immunization to be devel- oped. KEY POINT: For most diseases, at least 85% of the popula- tion must be immunized in order to protect the entire population from the disease. Refer to the CDC for recommended vaccination schedules for infants, children, adolescents, and adults; during pregnancy; and prior to international travel. Knowledge Check 19-5 What actions improve the host’s ability to prevent infection?

Go to Procedure 6-1 in Volume 2.

PRACTICING MEDICAL ASEPSIS Asepsis is a term that refers to the absence of contamination by disease-causing microorganisms. Medical asepsis (“clean technique”) refers to procedures that decrease the potential for the spread of infection. You likely already practice medical asepsis in other settings without realizing it. For example, at home, you wash your hands before and after handling food. In the healthcare setting, medical asepsis includes hand hygiene, environmental cleanliness, standard precautions, and protec- tive isolation. Infection prevention and the patient’s safety depend on nurses’ ability to follow the principles of asepsis rigorously and consistently. When you are hurrying, you may be tempted to take shortcuts or forget to follow a guideline. KEY POINT: Cutting corners can put your patient, and possibly yourself, at risk for a serious infection. Maintaining Clean Hands KEY POINT: Hand hygiene is the single most important activ- ity for preventing and controlling infection. The WHO (2011) chose the reduction of HAIs as the first “global patient safety challenge,” with the theme “clean care is safer care.” Hand hygiene is the cornerstone strategy because it is simple, standardized, low cost, and based on solid scien- tific evidence. Although you may think you already know how to wash your hands, decisions about the type of hand hygiene to use, how long to wash, when to wash, and so on are based on the amount of contact you have with patients or contaminated objects, as well as the patient’s infection status and susceptibil- ity to infection. Hand washing involves five key factors: time, water, soap, friction, and drying.

About Protecting Patients From the Spread of Infection Care enough to: ■ Be knowledgeable about your organization’s policy and procedures. ■ Spend the time for thorough hand washing and strict aseptic technique when needed. ■ Never use shortcuts when it comes to hand hygiene and asepsis. ■ Remind others about diligent hand hygiene and the use of PPE and sterile techniques. ■ Be bold and call people out on breaks in aseptic technique when violations occur. ■ Caring is being an advocate for infection prevention. ♥ iCare Box 19-1

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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

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

■ Time. In a nonsurgical setting, wash the hands vigorously for at least 20 seconds for a soap-and-water scrub, longer if hands are visibly soiled. When using an alcohol-based hand rub, apply the antimicrobial product to all surfaces of the 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 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 . 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. 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 specific details, guidelines, and step-by-step instructions for hand hygiene, see Clinical Insight 19-1: Guide- lines for Hand Hygiene, and Procedure 19-1: Hand Hygiene . KEY POINT: Failure to perform standards of care (e.g., hand hygiene) constitutes medical negligence and can result in harm to the patient. Despite the importance of clean hands, research demonstrates that clinical staff members do not consistently observe hand hygiene guidelines (Pittet et al., 2017). You can 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 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 2. Intermediate-level disinfection kills bacteria, mycobacteria, and most viruses. 3. Low-level disinfection kills some viruses and bacteria. Semi- and Noncritical Items Disinfection is used for semicritical and noncritical items: ■ Semicritical items are those that contact mucous membranes or nonintact skin. They must be free of all microorganisms except bacterial spores, so they must at least be disinfected and sometimes sterilized. Examples: Reusable devices, such as flexible endoscopes

overwhelmed by the many changes asked of him. How might Assad streamline his instructions about Mr. Williams’s diet?

understand his diet. homes (Zonfrillo et al., 2018).

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.

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). ■ 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.

Applying the Full-Spectrum Nursing Model

PATIENT SITUATION Mrs. Ong is a 75-year-old retired schoolteacher who suffered a stroke 8 months ago. After leaving the hospital, she has been living in a nursing home. Mrs. Ong has residual weakness on the right side—her dominant side—and has not mastered the use of tableware with her left hand. On admission to the nursing home 7 months ago, she weighed 150 pounds. Today she weighs only 125 pounds. Mrs. Ong refuses to go to the dining room for meals. The UAPs report that she eats a few bites of most foods but never eats more than half of anything. THINKING 1. Theoretical Knowledge: a. Based on Mrs. Ong’s sex, age, and activity level, make a rough estimate of the number of kcal/day she needs. b. What are two other more precise ways you could determine Mrs. Ong’s ideal body weight? 2. Critical Thinking (Considering Alternatives): What are some possible explanations for why Mrs. Ong is not eating all her food? a. Suppose you have decided to use the general ideal weight guide to determine Mrs. Ong’s ideal weight. What, specifically, would you need to do? You do not need to calculate; just list the action steps. b. Suppose you have decided to determine Mrs. Ong’s BMI. What equipment would you need? c. What is the formula for calculating BMI from the height and weight? 4. Nursing Process (Nursing Diagnosis/Analyzing Cues): Write a nursing diagnosis for Mrs. Ong. Use just the data provided in the situation. Assume her BMI is 20. CARING 5. Self-Knowledge: What would you be feeling if you were in Mrs. Ong’s situation? 6. Ethical Knowledge: What are one or two things you would do to help Mrs. Ong feel cared for and cared about? DOING 3. Practical Knowledge: 958 UNIT 4 Supporting Physiological Function

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. 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

Critical Thinking and Clinical Judgment

■ 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 BOX 21-1 ■ Poisonous Agents Commonly Ingested by Children

Because these are critical-judgment questions, they usually do not have a single right answer. Discuss the questions with your peers—discussion can stimulate critical thinking. 1. Recall the employees (Isaac Schwartz and Sujing Lee) interviewed in the Meet Your Patient scenario. In addition, you now have two more patients, Wakenda Pierre and Luceno Jarin. Their information is in the following paragraphs: ■ Isaac Schwartz, a 65-year-old accountant, works long hours. He describes a sedentary lifestyle, no tobacco use, infrequent alcohol use, no medical problems, and a nutrition history of skipping meals and daily consumption of restaurant food. You measure his height as 69 in. and weight as 245 lb. ■ Sujing Lee, a 29-year-old project manager, regularly works 65 hours per week. Sujing is 30 weeks pregnant. She does not smoke or drink and has never been hospitalized or had surgery. She has gained a total of 25 lb after becoming pregnant. Her diet consists mainly of traditional Asian food. She eats three meals a day and always brings lunch from home. Lately, she has been feeling “tired all the time.” At the screening, she weighs 126 lb and is 63 in. tall. ■ Wakenda Pierre is a 38-year-old administrative assistant. She exercises at the gym 4 or 5 days per week, smokes an occasional cigarette, has 2 or 3 drinks every night before dinner, struggles with keeping her blood pressure under control, and eats fast food for breakfast and lunch every day. She is 72 in. tall and weighs 165 lb.

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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. ■ Luceno Jarin is a 65-year-old business executive. He tells you he was diagnosed with type 2 diabetes mellitus 5 years ago. He is struggling to follow his prescribed diet. He drinks alcohol sporadically and walks briskly 30 minutes every day of the week. He is 67 in. tall and weighs 205 lb. a. Determine each client’s BMI. Based on these results, what conclusions can you make about their weight status? b. What are the likely causes of each person’s weight status? c. What additional work-up would be recommended for each client? d. What indications would lead you to believe that each client has adopted a healthier lifestyle? 2. Three clients are admitted to the medical-surgical unit of your local hospital. On their admission, the primary nurse collected this information: ■ Wild plants and mushrooms ■ Pesticides, rodent poisons

CLIENT 1

CLIENT 2

CLIENT 3

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UNIT 3 Essential Nursing Interventions

What if... sections pose questions about special situations and explain alternate ways to perform procedures to aid students in knowing what to do.

Procedure 19-3 ■ Removing Personal Protective Equipment (PPE) ➤ For steps to follow in all procedures, refer to the Universal Steps for All Procedures on the inside back cover. For this procedure, also refer to Clinical Insights 19-2 and 19-3 if you need more information.

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CHAPTER 19 Promoting Asepsis & Preventing Infection

KEY POINT: Considered contaminated: front areas, sleeves, mask, and gloves of the PPE, and head and shoe covers, if you are wearing them.

KEY POINT: Considered clean: inside of the gown, gloves, ties on the mask and at the back of the gown, and the inside of the head and shoe covers, if you are wearing them.

5. Remove your mask or face shield unless the mask is a respirator. In that case, remove it after leaving the patient room and closing the door. a. Untie the lower ties first. b. Untie the upper ties next, being careful not to let go of the ties. c. Touch only the ties; do not touch the front of the mask. d. Dispose of the mask by holding on to the ties and placing it in a desig- nated waste container. Ties are considered clean. Touching the outside of the mask would con- taminate your hands. 6. Remove your hair covering. a. Slip your bare fingers under the edge of the hair cover, being care- ful not to touch the outside of it. b. Lift it up and away from your hair. c. Touching only the inside of it, place it in a designated waste container. The inside of the hair covering is con- sidered clean, so you may touch it with your bare hands. 7. Remove shoe covers. Be careful to touch only the insides of the covers. 8. Perform hand hygiene immediately after removing PPE.

Folding the gown prevents contamina- tion of your hands, the clothing, and the environment.

Even if wearing gloves, hands may become contaminated. 9. Close the door. Keeping the door closed contains con- taminants and makes signage more visible. What if . . . ■ The gown is tied in front? Untie the front gown ties before removing your gloves; then remove the gloves and untie any back ties (e.g., at the neck). (This would be an unusual circumstance.) Because the front of the gown (including a front tie) is considered contaminated, once you remove your gloves, you could not use your bare hands to untie a front tie. ■ I am wearing two gowns (top one tied in back, inner one tied in front)? Remove gloves; untie waist ties of outer gown, remove the gown, and fold it inside out. Remove the inner gown by untying it in front. Fold inner gown inside out. Take off goggles and face mask or shield. !

➤ 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 Steps 1. Remove gloves first (unless the gown ties in front; in that case, see “What if . . .”). Gloves are the most contaminated PPE and must be removed first to avoid con- tamination of clean areas of the PPE during their removal. a. Remove the first glove: 1) Grasp the outside cuff of the glove with the opposite gloved hand. 2) Pull downward so that the glove turns inside out. 3) Do not touch the skin of your wrist or hand with your gloved hand.

3) Pull the glove off, inside out, over the glove that hand is holding. Do not touch the out- side of the soiled glove with your bare fingers. The insides of gloves are consid- ered clean because they have not been in contact with the client or contaminated surfaces. Therefore, you can touch the insides with your bare hands.

b. Slip your hands inside the neck and peel the gown away from the shoulders. 1) Reach inside to pull off the cuff; remove your arm from the sleeve. 2) Repeat the maneuver to remove the second sleeve. 3) Do not touch the front of the gown, even if it is not visibly soiled. The inside of the gown is clean and will not contaminate your hands. The front of the gown and the sleeves are considered contaminated.

4. Remove goggles. a. Grasp only the earpieces (or headband) of the goggles and pull off the face. b. If the goggles are not disposable, place in the container provided for disinfection. Earpieces are considered clean. Some goggles are cleaned and reused.

The outside of both gloves is con- taminated. To prevent contam- ination, touch only the outside (contaminated) surface of first glove to outside (contaminated) sur- face of second glove.“Dirty touches dirty” and “clean touches clean.”

Patient Teaching See Procedure 19-2.

Practice Resources AORN (2024); CDC (n.d.b; 2022, October 3, reviewed); Cowperthwaite & Holm (2015); Ortega et al. (2015); Siegel et al. (2023, May, updated);Tomas et al., 2015;WHO (2015, January 28).

c. Dispose of gloves in a designated waste container, keeping them away from your body. 2. Remove the gown: a. Release the waist ties and the neck ties of the gown, bending slightly forward to allow the gown to fall forward. Allowing the gown to fall forward exposes the clean area for the hands to grasp more readily.

Home Care See Procedure 19-2.

Thinking About the Procedure

Documentation The removal of PPE is generally assumed and does not require documentation.

To practice applying clinical reasoning to this procedure, the video Removing Personal Protective Equipment (PPE), along with questions and suggested responses, is available on the Davis’s Nursing Skills Videos Web site on DavisPlus.

3. Fold the gown so the inside of the gown is to the outside. Holding the gown away from your uniform, roll it up with the contaminated front and sleeves in the center, and place in the designated waste container.

b. Remove the second glove: 1) Hold the removed glove in the palm of your gloved hand. 2) Slip two ungloved fingers inside the cuff of the remaining glove.

Procedure 19-4 ■ Surgical Hand Washing:Traditional Method ➤ For steps to follow in all procedures, refer to the Universal Steps for All Procedures on the inside back cover. For this procedure, also refer to Clinical Insights 19-2, 19-3, and 19-4 if you need more information.

Equipment ■ Antimicrobial soap (FDA-approved for surgical hand asepsis)

■ Deep sink with foot or knee controls or motion-sensor faucet ■ Surgical shoe covers, cap, and face mask ■ Sterile gloves of the correct size ■ Surgical pack containing a sterile towel (continued on next page)

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

■ Soft, nonabrasive scrub sponge ■ Disposable single-use nail cleaner

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STUDENT EXPERIENCE

Davis Advantage uses a unique and proven approach across a Learn-Apply-Assess-Simulate 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.

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

Hydration & Homeostasis: Fluid & Fluid Imbalances

Online content subject to change.

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 ¡ Promoting Asepsis & Preventing Infection ¡ Administering Medications ¡ Urinary Elimination ¡ Pain Interventions ¡ Skin Integrity & Wound Healing ¡ Caring for the Perioperative Patient

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.

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

Bowtie and trend questions prepare students for the individual, stand-alone item types on the Next-Gen NCLEX®.

Clinical Judgment

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Oxygenation

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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.

NEW!

SIMULATE Immersing students in realistic clinical scenarios

NEW for 2025! Simulation Assignments § Measuring Vital Signs § Nutrition § Oxygenation § Circulation & Perfusion

Sims assignments challenge students to make clinical decisions based on simulation videos that portray realistic nurse-patient interactions in a hospital setting, enabling them to earn clinical hours while practicing clinical judgment in a safe space.

Immersive videos provide verbal and nonverbal cues about the patient and the situation and emphasize the importance of therapeutic communication and proper skill technique. Students must recognize cues, analyze cues, and prioritize hypotheses.

EHRs evolve based on the choices students make as they progress through the simulation.

Each question is a decision point . The questions require students to have a strong foundational understanding, assess the individual patient’s needs and specifics, and exercise careful clinical judgment. Each question is mapped to the cognitive skills in the Clinical Judgment Measurement Model.

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