homes (Zonfrillo et al., 2018).
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.
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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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