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Medical-Surgical NURSING
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Davis Advantage for MEDICAL-SURGICAL NURSING
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Medical-Surgical Nursing Making Connections to Practice, 3rd Edition Janice J. Hoffman, PhD, RN, ANEF | Nancy J. Sullivan, DNP, RN, CHSE
A fresh, student-friendly approach connects concepts from the written word to the real world The 3rd Edition continues its groundbreaking approach, helping students make the connections between concepts and patient care to ensure they understand the important relationships between the pathophysiology, clinical presentation, and management of the diseases and disorders they are most likely to encounter in practice. § NEW! “Making Connections to Clinical Judgment” features brand-new questions aligning the chapter unfolding case studies to the six steps of the NCSBN Clinical Judgment Measurement Model. § NEW! Online “Making Connections to Clinical Judgment” tables provide a visual clinical judgment analysis of the chapter case studies, connecting the steps of the Clinical Judgment Measurement Model to practice. § NEW! Disorders added include COVID-19, chronic venous insufficiency, Huntington’s disease, thyroid cancer, and bowel obstruction. § NEW! “Medication” tables outline treatment options for selected disorders, and include priority nursing implications. § EXPANDED! Safety content § REVISED & UPDATED! Coverage of current and important topics in nursing education and practice includes Healthy People 2030, and COVID-19. § Emphasizes need-to-know information in a concise and consistent manner. § Provides clear nursing care guidance, identifying and reinforcing what the nurse’s responsibilities are within the interprofessional care team. § Presents Nursing Management consistently using the nursing process; prioritizes Nursing Interventions according to the ABCs and Maslow’s Hierarchy; and includes bulleted rationales directing back to the underlying pathophysiology to explain the ‘hows’ and ‘whys’ of treatment. § Incorporates chapters dedicated to critical care content important for new nurses.
Student Resources § eBook § Davis Advantage
• Personalized Learning • Clinical Judgment • Quizzing • Sims – Coming 2025!
Instructor Resources § Test Bank with NGN Questions
§ PowerPoints § Image Bank § Implementation Guide § Clinical Judgment Debriefing Guidelines § AACN Essentials Mapped to Davis Advantage Printed Text 1,904 pages | 830 Illustrations | Hard cover | 2024 $214.95 (US) ISBN-13: 978-1-7196-4736-6 Access Card $194.95 (US) ISBN-13: 978-1-7196-4738-0 Or purchase directly at FADavis.com
HHHHH “The focus on common disorders helps make the content more concise and pertinent to students. Nursing care and implications are clearly identified and presented with nursing interventions front and center.” — Cathy R., Eastern Mennonite University
The must-have, quick-access, clinical companion! Davis’s Diseases and Disorders A Nursing Therapeutics Manual
Speak with your Educational Consultant to learn more.
Ask us how this solution aligns
with the AACN Essentials! !
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CONTENTS I. PROFESSIONAL FOUNDATIONS OF MEDICAL-SURGICAL NURSING 1. Foundations for Medical-Surgical Nursing 2. Interprofessional Collaboration and Care Coordination 3. Cultural Considerations 4. Ethical Concepts 5. Palliative Care and End-of- Life Issues II. CLINICAL PRINCIPLES OF MEDICAL-SURGICAL NURSING 6. Geriatric Implications for Medical-Surgical Nursing 7. Oxygen Therapy Management 8. Fluid and Electrolyte Management 9. Acid-Base Balance 10. Overview of Infusion Therapies 11. Pain Management 12. Complementary and Alternative Care Initiatives 13. Overview of Cancer Care 14. Overview of Shock and Sepsis* III. MANAGING THE SURGICAL EXPERIENCE 15. Priorities for the Preoperative Patient 16. Priorities for the Intraoperative Patient 17. Priorities for the Postoperative Patient IV. PROMOTING HEALTH IN PATIENTS WITH IMMUNE DISORDERS 18. Assessment of Immune Function 19. Coordinating Care for Patients With Immune Disorders 20. Coordinating Care for Patients With Connective Tissue Disorders 21. Coordinating Care for Patients With Multidrug-Resistant Organism Infectious Disorders 22. Coordinating Care for Patients With HIV V. PROMOTING HEALTH IN PATIENTS WITH OXYGENATION DISORDERS 23. Assessment of Respiratory Function 24. Coordinating Care for Patients With Infectious Respiratory Disorders 25. Coordinating Care for Patients With Upper Airway Disorders 26. Coordinating Care for Patients With Lower Airway Disorders 27. Coordinating Care for Critically Ill Patients With Respiratory Dysfunction* VI. PROMOTING HEALTH IN PATIENTS WITH CIRCULATORY OR PERFUSION DISORDERS 28. Assessment of Cardiovascular Function 29. Coordinating Care for Patients With Cardiac Dysrhythmia 30. Coordinating Care for Patients With Cardiac Disorders 31. Coordinating Care for Patients With Vascular Disorders 32. Coordinating Care for Critically Ill Patients With Cardiovascular Dysfunction* VII. PROMOTING HEALTH IN PATIENTS WITH HEMATOLOGICAL DISORDERS 33. Assessment of Hematological Function 34. Coordinating Care for Patients With Hematological Disorders VIII. PROMOTING HEALTH IN PATIENTS WITH NEUROLOGICAL DISORDERS 35. Assessment of Neurological Function 36. Coordinating Care for Patients With Brain Disorders
37. Coordinating Care for Patients With Spinal Cord Disorders 38. Coordinating Care for Patients With Peripheral Nervous System Disorders 39. Coordinating Care for Critically Ill Patients With Neurological Dysfunction* IX. PROMOTING HEALTH IN PATIENTS WITH ENDOCRINE DISORDERS 40. Assessment of Endocrine Function 41. Coordinating Care for Patients With Pituitary Disorders 42. Coordinating Care for Patients With Adrenal Disorders 43. Coordinating Care for Patients With Thyroid and Parathyroid Disorders 44. Coordinating Care for Patients With Diabetes Mellitus X. PROMOTING HEALTH IN PATIENTS WITH SENSORY SYSTEM DISORDERS 45. Assessment of Visual Function 46. Coordinating Care for Patients With Visual Disorders 47. Assessment of Auditory Function 48. Coordinating Care for Patients With Hearing Disorders XI. PROMOTING HEALTH IN PATIENTS WITH INTEGUMENTARY DISORDERS 49. Assessment of Integumentary Function 50. Coordinating Care for Patients With Skin Disorders 51. Coordinating Care for Patients With Burns* XII. PROMOTING HEALTH IN PATIENTS WITH MUSCULOSKELETAL DISORDERS 52. Assessment of Musculoskeletal Function 53. Coordinating Care for Patients With Musculoskeletal Disorders 54. Coordinating Care for Patients With Musculoskeletal Trauma XIII. PROMOTING HEALTH IN PATIENTS WITH GASTROINTESTINAL DISORDERS 55. Assessment of Gastrointestinal Function 56. Coordinating Care for Patients With Oral and Esophageal Disorders 57. Coordinating Care for Patients With Stomach Disorders 58. Coordinating Care for Patients With Intestinal Disorders 59. Coordinating Care for Patients With Hepatic Disorders 60. Coordinating Care for Patients With Biliary and Pancreatic Disorders XIV. PROMOTING HEALTH IN PATIENTS WITH RENAL DISORDERS 61. Assessment of Renal and Urinary Function 62. Coordinating Care for Patients With Renal Disorders 63. Coordinating Care for Patients With Urinary Disorders XV. PROMOTING HEALTH IN PATIENTS WITH REPRODUCTIVE DISORDERS 64. Assessment of Reproductive Function 65. Coordinating Care for Female Patients With Reproductive and Breast Disorders 66. Coordinating Care for Male Patients With Reproductive and Breast Disorders 67. Coordinating Care for Patients With Sexually Transmitted Infection XVI. PROMOTING HEALTH IN SPECIAL POPULATIONS
68. Managing Care for the Adult Patient With Obesity 69. Emergency, Trauma, and Environmental Injuries* 70. Substance Use Disorders in the Adult Population 71. Disasters, Mass Casualty Incidents, and Complex Emergencies*
*Denotes chapters dedicated to critical care.
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EXPANDED! Abundant Safety Alerts focus on potential hazardous or high-risk issues. ers require very high doses. Pharmacogenetics is the study of how a person’s genes affect responses to med- ications. With scientific advances, genetic testing can now be used to determine responsiveness. In the case of warfarin, some patients are genetically fast metaboliz- ers, which can result in an increased risk of clotting and the need for higher or more frequent doses. In contrast, slow metabolizers have an increased risk of bleeding and require lower or less frequent doses. Patients who are fast or slow metabolizers may also respond similarly to other types of medications. Pharmacogenetic testing is not widely used due to availability, clinician knowledge, and regulatory and reimbursement issues, but it may be valuable. A more invasive surgical treatment is coronary artery bypass grafting (CABG) . With CABG, blockages in coronary arteries are bypassed using other arteries from the chest or arm or veins from the legs. In the traditional CABG, patients undergo general anesthesia. A large inci- sion through the sternum is made, and a cardiopulmonary bypass (CPB) is begun through large catheters in the vena cava or right atrium and aorta. A CPB provides continuous CONCEPTS a. Coronary artery disease b. Infective endocarditis a. Coronary artery disease b. Infective endocarditis
transluminal coronary angioplasty ( Pericardial effu Pericardiocent Pericarditis Prinzmetal’s/v angina Pulmonary ede Orthopnea Regurgitation Stable angina Stenosis Tamponade Transcatheter valve replace Unstable angin
Atherosclerosis Cardiac rehabilitation Compensatory mechanism Coronary artery bypass graft (CABG) Coronary artery disease (CAD) Ejection fraction Embolization Exercise stress test
nonobstructive CAD is being studied. Statins, angiotensin- converting enzyme (ACE) inhibitors, and beta blockers may be beneficial.
the workload on the heart and decrease myocardial oxygen consumption. • Administer beta blockers. Beta blockers decrease the sympathetic response (heart rate), thus reducing myocardial oxygen consumption. • Administer inotropic agents. Enhance contractility • Administer sodium glucose cotransporter 2 inhibitors (STGLC2i) Promote fluid excretion l Fluid and sodium restriction To prevent fluid overload ■ Teaching l Medication management Understanding and adhering to the medication treatment plan are essential for effective medication treatment. l Maintain activity as tolerated. Alternate rest and activity periods. To reduce muscle wasting and functional losses; to decrease workload on the heart l Low-salt diet To prevent fluid retention and exacerbation of HF l Daily weight at home at the same time each day, preferably in the morning after voiding Evaluate fluid retention and need to call provider l Cardiac rehabilitation Cardiac rehabilitation reduces mortality, improves functional status, reduces hospitalization, and improves quality of life. l Signs and symptoms of worsening HF checklist (edema, SOB, fatigue, and orthopnea) Knowing the symptoms can expedite treatment and reduce hospitalizations. l Immunization needs Patients with HF are vulnerable to communicable diseases such as influenza, COVID, and pneumonia. l Oxygenation l Perfusion Friction rub Heart failure Infective endocarditis (IE) Ischemia Aortic stenosis Atherosclerosis Cardiac rehabilitation Compensatory mechanism Coronary artery bypass graft (CABG) Coronary artery disease (CAD) Ejection fraction Embolization Exercise stress test Murmur Myocardial tissue Myocarditis Percutaneous transluminal coronary
plan should include frequent assessment, comprehensive patient education, and self-management. A well-managed patient has reduced dyspnea and fatigue, is able to actively participate in activities of daily living, and has reduced hospitalizations.
c. Myocarditis d. Pericarditis e. Valvular disease f. Heart failure 3. Describing the diagnostic results used to confirm the diagnosis of cardiac disorders 4. Discussing the interprofessional management of: ESSENTIAL TERMS Acute coronary syndrome Angina
Medication Safety Alert: Nitroglycerin LEARNING OUTCOMES Content in this chapter is designed to assist in: 1. Describing the epidemiology of cardiac disorders 2. Correlating clinical manifestations to pathophysiological processes of:
Safety Alert
Making Connections
Nitroglycerin is a treatment for angina. Patients should be instructed to take this medication as prescribed, typically one tablet or spray under the tongue not to exceed three doses taken 5 minutes apart. If the symptom of angina (chest pain) is not relieved with three doses or if the pain worsens, they should be instructed to call emergency personnel. In addition, patients using medications such as sildenafil citrate (i.e., Revatio, Viagra) should be educated on the increased risk of hypotension with coadministration with nitroglycerin. a. Coronary artery disease b. Infective endocarditis
CASE STUDY: WRAP-UP Mr. Thompson’s ECG reveals atrial fibrillation with a heart rate of 130 to 140 bpm. His blood pressure continues to be high at 185/102 mm Hg. His respirations are still slightly labored and fast at 40 per minute. He continues on oxygen at 4 L/min via nasal cannula, with an oxygen saturation of 95%. The results of Mr. Thompson’s diagnostic tests reveal the following: • A chest x-ray indicates LV hypertrophy. • A transthoracic echocardiogram indicates an EF of 30%. • Cardiac biomarkers are negative for ischemia, with troponin I less than 0.1 ng/ml. • Renal function tests reveal borderline failure, with a creatinine of 1.5 mg/dL and a BUN of 30 mg/dL. • His BNP value is elevated to 500 pg/mL. Friction rub Heart failure Infective endocarditis (IE) Ischemia • Serum electrolytes reveal elevated potassium at 6.0 mEq/L. It is determined that Mr. Thompson is in HF, and he begins treat- ment. A diuretic is administered; an ACE inhibitor and a beta blocker are ordered. His SOB and color begin to improve. His transient chest pain resolves with treatment. Case Study Questions 1. The nurse has received the following orders for Mr. Thomp- son. Which order should the nurse implement first? A. Furosemide (Lasix) 40 mg IV B. Insert a Foley catheter C. Low-sodium, low-fat diet D. Apply sequential compression device 2. The nurse correlates which finding with Mr. Thompson’s atrial fibrillation with a heart rate of 120 to 140 beats per minute? A. Acute decompensation requiring immediate cardioversion B. Loss of atrial kick requiring fluid resuscitation C. Increased workload of the heart requiring beta blockers D. Cardiac ischemia requiring immediate cardiac catheterization 3. The nurse understands that Mr. Thompson’s sublingual nitro- glycerin decreases chest pain through which mechanism of action? A. Dilating the coronary arteries to improve blood flow B. Decreasing preload to relieve symptoms of dyspnea C. Decreasing heart rate to decrease cardiac workload D. Converting atrial fibrillation into sinus rhythm 4. Which statement by Mr. Thompson indicates that teaching about hyperkalemia has been effective? A. “The water pill makes my potassium level high.” B. “I should eat bananas because they make my potassium go down.” C. “My liver is not working, so it holds on to the potassium.” D. “My kidneys are not working, which makes my potassium high.” 5. The nurse providing care for Mr. Thompson should include which of the following in the discharge teaching plan? (Select all that apply.) A. Sodium restriction B. Daily weight C. Medication teaching D. Vigorous daily exercise E. Carbohydrate counting Making Connections to Clinical Judgment 1. Recognizing Cues: What clinical findings of heart failure does Mr. Thompson have? 2. Analyzing Cues: How do the physical findings relate to the pathophysiology of heart failure? 3. Prioritizing Hypotheses: What are the highest priority findings that need to be addressed? Why? 4. Generating Solutions: What interventions would best address Mr. Thompson’s respiratory needs? 5. Taking Actions: What are the nursing intervention priorities? 6. Evaluating Outcomes: What are the findings related to fluid balance that would indicate an effective response?
angioplasty (PTCA) Pericardial effusion Pericardiocentesis Pericarditis Prinzmetal’s/variant angina Pulmonary edema Orthopnea Regurgitation Stable angina Stenosis Tamponade Transcatheter aortic valve replacement Unstable angina
c. Myocarditis d. Pericarditis e. Valvular disease f. Heart failure 3. Describing the diagnostic results used to confirm the diagnosis of cardiac disorders 4. Discussing the interprofessional management of:
Unfolding Case Studies help students make the connections to practice. Finding Connections introduces a patient related to the chapter content, and then students follow the scenario as it unfolds throughout the chapter. Making Connections provides a wrap-up of the case and concludes with questions that require students to apply their knowledge. c. Myocarditis d. Pericarditis e. Valvular disease f. Heart failure 5. Developing a comprehensive plan of nursing care for patients with cardiac disorders 6. Designing a teaching plan that includes pharmacological, dietary, and lifestyle considerations for patients with cardiac disorders
a. Coronary artery disease b. Infective endocarditis
l Caring l Infection l Inflammation c. Myocarditis d. Pericarditis e. Valvular disease f. Heart failure 5. Developing a comprehensive plan of nursing care for patients with cardiac disorders 6. Designing a teaching plan that includes pharmacological, dietary, and lifestyle considerations for patients with cardiac disorders
Percutaneous transluminal coronary angioplasty (PTCA) is the procedure most commonly performed to relieve symptoms caused by atherosclerotic changes in the coronary vessels. During this procedure, after the patient receives monitored anesthesia care (MAC), a catheter
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Unit VI Promoting Health in Patients With Circulatory or Perfusion Disord
5 rounding the h manifestation is include an elec cardiac comput resonance ima pain control w ties include pai of treatment an of pericardial e priorities includ heart attack to e appropriately w Valvular dise of the innermos heart valves ar transthoracic ec ing the presenc IV antibiotics. I biotic therapy c ment. Nursing especially for th of ongoing acut nance of good provider about procedure. Myocarditis dium most com mune diseases. dysrhythmias, d failure. Medica heart failure, d that may occur includes medica Pericarditis factors for CAD are used to rule ing CAD is a co with CAD is o ping the aggreg endothelium, (b of the endothel neous translum most commonly care priorities i and administeri factors and relie understanding t lifestyle to limit Infective end 05/
Finding Connections
05/04/23 4:58 PM being nonadherent with his meds because “I feel okay.” He reports he was in his usual state of health until about 3 weeks ago. At that point, he reports feeling short of breath and fatigued unrelated to physical activity. Over the past 3 weeks, his symptoms have pro- gressed to the point where he sleeps in his recliner every night. He is admitted to the step-down unit for further management.
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CONCEPTS
l Caring l Infection l Inflammation
l Oxygenation l Perfusion
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CASE STUDY: EPISODE 1 Follow this patient throughout the chapter.
Mr. Walter Thompson is a 57-year-old man with no significant past medical history except high blood pressure. He admits to being nonadherent with his meds because “I feel okay.” He reports he was in his usual state of health until about 3 weeks ago. At that point, he reports feeling short of breath and fatigued unrelated to physical activity. Over the past 3 weeks, his symptoms have pro- gressed to the point where he sleeps in his recliner every night. He is admitted to the step-down unit for further management. ..
Finding Connections
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CASE STUDY: EPISODE 1 Follow this patient throughout the chapter.
Mr. Walter Thompson is a 57-year-old man with no significant past medical history except high blood pressure. He admits to
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NEW! Making Connections to Clinical Judgment presents brand-new questions applying the six steps of the NCSBN Clinical Judgment Measurement Model to practice, using the patient from the unfolding case study.
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NEW! Making Connections to Clinical Judgment tables* provide a clinical judgment analysis of the chapter case study, visually connecting each step of the Clinical Judgment Measurement Model with the Making Connections to Clinical Judgment questions in book.
*Online in Davis Advantage
CHAPTER SUMMARY
Myocarditis is the most frequent cause of dilated cardio- myopathy. Heart failure, cardiogenic shock, and dysrhyth- mias, including sudden cardiac death, especially in young persons, are also complications. Nursing Management Assessment and Analysis Clinical manifestations of myocarditis, such as SOB, chest pain, fatigue, and dysrhythmias typical of the manifesta- tions of heart failure, are due to the weakened or damaged heart muscle. Nursing Diagnosis/Problem List l Risk for decreased cardiac output related to myocar- dial dysfunction l Pain l Dysrhythmias Nursing Interventions ■ Assessments l Vital signs Hypotension, hypertension, tachycardia, tachypnea, and hypoxia are signs of heart failure. Fever is indicative of infection. l Cardiac rhythm Dysrhythmias are a common and dangerous clinical manifes- tation and must be identified and treated promptly. l Assess for crackles, edema, jugular vein distention (JVD), weight gain, and decreased urine output. These are evidence of the weakened heart muscle seen with heart failure. ■ Actions l Administer antivirals, antimicrobials, immunosuppres- sives, and immunoglobulins as ordered. Medications are administered depending on the cause of myocarditis. l Administer heart failure medications as needed. Heart failure is a common manifestation and must be treated to optimize cardiac output and tissue perfusion. l Provide emotional support. The diagnosis of myocarditis can cause fear and anxiety. ■ Teaching l Complete the full medication treatment regimen. Patients should continue to take medications as directed even if feeling better to ensure an effective/positive result. l Avoid strenuous activities. Athletes should not par- ticipate in competitive sports while inflammation is present and need to be reevaluated in no less than 3 to 6 months before resuming sport. Activity restrictions may reduce the risk of sudden cardiac death. Nursing Diagnoses/Problem List
PERICARDITIS Epidemiology
Pericarditis , inflammation of the pericardium, is diag- nosed in about 0.2% of cardiovascular-related admissions and 5% of emergency department patients with chest pain not related to ischemia. About 80% of cases are idio- pathic (unknown etiology) or are presumed to occur after a viral infection. Acute pericarditis is common following MI, occurring in about 15% to 20% of post-MI patients. The true prevalence of pericarditis is difficult to deter- mine because persons with mild cases (subclinical) do not seek treatment. Some studies show that pericarditis occurs more in male individuals and young and middle-aged persons. Recurrence is common, with 20% to 30% of persons having an additional episode. Pericarditis can be categorized as infectious (viral, bacterial, fungal, or para- sitic), noninfectious (autoimmune, neoplastic, metabolic, trauma, drug or radiation related), and idiopathic. Peri- carditis can also be described as acute, chronic, or recur- rent. The prognosis is generally good, with an in-hospital mortality rate of 1.1%. Pathophysiology The heart is surrounded by the two-layered pericardium, which protects the heart, reduces friction with surrounding structures, and helps to determine chamber size and pres- sure. The tough, fibrous outer wall is the parietal pericar- dium; the inner is the visceral pericardium, or epicardium. The space between contains approximately 20 to 60 mL of pericardial fluid. This fluid acts as a lubricant to prevent friction between the two layers. When the pericardium becomes inflamed, it is termed pericarditis (Fig. 30.5). Clinical Manifestations The most common clinical manifestation of pericarditis is pleuritic chest pain. This occurs in 85% to 90% of cases and can be differentiated from MI chest pain because it tends to be relieved by sitting up and leaning forward and worsens with inspiration or coughing. Friction rubs , scratchy sounds that occur with each heartbeat, may be auscultated in 30% of cases. Box 30.1 describes how to assess for a friction rub. Other clinical manifestations include the following: l New or worsening pericardial effusion (60%) l ECG changes: diffuse ST-segment elevations or PR depression (60%) l Low-grade fever Increase LDL breakdown by blocking the action of a protein that destroys receptor cells in the liver that aid in eliminating cholesterol Cholesterol absorption inhibitors Inhibit the absorption of cholesterol through the small intestine Fibric acids Reduce cholesterol production and remove LDL cholesterol by reducing the liver’s production of very-low-density lipoproteins (VLDLs) and by speeding the clearance of triglycerides from the blood. Medication Classification Mechanism of Action HMG-CoA reductase inhibitors (statins) Statins reduce cholesterol synthesis in the liver and increase clearance of LDL from the blood. PCSK9 inhibitors (Statins)
Nursing Management provides clear and well-defined nursing care guidance using a Nursing Process approach. Each chapter is consistently presented the same way, with easily identifiable sections to help students understand the nurse’s role.
For easy reference, Nursing Interventions are formatted into Assessments , Actions , and Teaching categories with bulleted rationales that explain the `hows’ and `whys’ of treatment and direct students back to the underlying pathophysiology.
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Chapter 30 Coordinating Care for Patients With Cardiac Disorders
Table 30.2 Medications Used in the Treatment of Coronary Artery Disease
Exemplars
Nursing Implications
Atorvastatin (Lipitor) Simvastatin (Zocor)
Monitor: l Cholesterol levels l For side effects such as muscle pain, cramping, and weakness. Severe side effects include liver failure and rhabdomyolysis. Monitor: l Liver function l Urine output amount and color l Myoglobin levels Administered via subcutaneous injections every 2–4 weeks. An alternative for patents who cannot take statins. Teach self-administration technique. Monitor: l Cholesterol levels l For side effects such as back pain, cold/flu symptoms
Evolocumab (Repatha)
Ezetimibe (Zetia)
Monitor: l Cholesterol levels Monitor: l Cholesterol levels
Gemfibrozil (Lopid)
Should not be initiated in patients on statin therapy because of an increased risk for muscle symptoms or rhabdomyolysis. Contraindicated in breastfeeding women as it is excreted in breast milk Baseline hepatic transaminases, fasting blood glucose, and uric acid should be obtained before initiation, and again during up-titration.
NEW! Medication tables outline the medications used in the treatment of disorders, detailing Medication Classification, Mechanism of Action, Exemplars, and Nursing Implications.
Nicotinic acid
Reduces the production of triglycerides and VLDLs and increases HDL levels
Niacin (Niaspan)
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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.
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After students have watched the video and completed the activity, a Post-Assessment evaluates how well they understood 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 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? 93% of students said Davis Advantage helped them retain information.
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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.
Fluids and Fluid Imbalances
2. 3. 4. 5. 6. 7. 8. 9.
Shock
Postoperative Care
MDRO: Multi Drug-Resistant Organisms
COPD
Myocardial Infarction
Leukemia
Stroke
Diabetes Mellitus
10. Burns 11. Cirrhosis 12. Renal Failure
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.
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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.
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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.
Bowtie and trend questions prepare students for the individual, stand-alone item types on the Next-Gen NCLEX®.
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.
9/11/2024
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.
9/25/2024
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.
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COMING SOON!
SIMULATE Immersing students in realistic clinical scenarios Sims assignments provide a safe space for students to practice clinical judgment and also earn clinical hours. Questions challenge students to make safe and effective clinical decisions and know the proper technique for any intervention. Coming in 2025!
Realistic videos provide verbal and nonverbal cues about the patient and the situation, allowing students to recognize cues, analyze cues, and prioritize hypotheses. The immersive scenarios also help students understand the importance of therapeutic communication and proper skill technique.
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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Four assignment types. One personalized plan. Personalized Learning Plans monitor students’ performance on each 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, Quizzing, and Sims (Coming Soon!) tabs to view their analytics for all assignments.
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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.
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Online content subject to change.
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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 and assess their strengths and weaknesses, while Personalized Teaching Plans provide content-focused remediation and promote an active and engaging learning environment.
Track participation and performance on each Personalized Learning , Clinical Judgment , Quizzing , and Sims (Coming Soon!) assignment .
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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 .
LEARN MORE! Hello@FADavis.com • FADavis.com/DavisAdvantage
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Personalized Teaching Plans for each topic provide everything you need to save time and ensure student success, including turnkey learning activities, discussion topics, small group work, and case studies. Engage students for higher level learning.
Curriculum Analytics Monitor performance at the institutional level for valuable insights.
Curriculum Analytics offers Deans, Directors, and Educators valuable insights into aggregate and cross-course data. Visual and easy to interpret, these analytics allow programs who are using multiple Davis Advantage products to easily track individual and cohort performance across the curriculum.
Contact Us to Learn More! Hello@FADavis.com
HHHHH “The Personalized Teaching Plans is probably the feature I LOVE the best. This actually helps me as a nursing instructor to use active learning techniques to engage the students!” —Deborah R., Troy University
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ADOPTION SERVICES YOUR PARTNER IN SUCCESS!
“I love the Davis Advantage platform. It is reliable and the customer support for faculty and students is outstanding.”
—Diana Boling, Instructor, Xavier University
FREE , ONLINE CONSULTATIONS are available for instructors using our products. You will have access to a dedicated Digital Implementation Consultant who can suggest the best ways to use our products in your course and share best practices and strategies for success.
Direct access to a specialist to answer any questions Personalized onboarding to help set up your course Resource library with support materials to make implementation easy Collaboration on curriculum strategies to ensure the best outcomes
Let us help! Email Hello@FADavis.com or visit FADavis.com/DavisAdvantage
Learn how Davis Advantage can be customized to meet your needs and the needs of your class.
Interested in integrating Davis Advantage throughout your curriculum? CONTACT US Hello@FADavis.com
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