11 Jan Mr. Les Brown has been diagnosed with COPD 10 years ago. He has been increasingly shortness of breath doing activities of daily living, needing to rest more frequently and feels he is
Unit 2-Discussion- COPD. 1300w. due 1-13-23. 4 references.
Using the attached book CHAPTER 22 Chronic Obstructive Pulmonary Disease 137 complete the following.
Read the following case study and answer the posed questions:
Mr. Les Brown has been diagnosed with COPD 10 years ago. He has been increasingly shortness of breath doing activities of daily living, needing to rest more frequently and feels he is coughing more often.
1. Explain the pathophysiology behind the signs and symptoms of COPD
2. What relationship do you see with Mr. Brown's vital signs – 26 RR, 91% oxygen saturation, temp: 37.8, HR: 93 BP: 150/70
3. Describe the goals of care for Mr Brown. Make sure to use the COPD gold standards of care( https://goldcopd.org/wp-content/uploads/2018/02/WMS-GOLD-2018-Feb-Final-to-print-v2.pdf Links to an external site.) for your plan.
4. How would you follow up on your proposed plan of care?
5. What are preventative measures and treatment options for patients with COPD?
6. What are non-pharmacological for COPD patients.
7. What impact does COPD have on patients with mental illnesses?
Responses need to address all components of the question, demonstrate critical thinking and analysis, and include peer reviewed journal evidence to support the student’s position.
Please be sure to validate your opinions and ideas with citations and references in APA format.
Please review the rubric to ensure that your response meets the criteria.
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RN ADULT MEDICAL SURGICAL NURSING I
RN Adult Medical Surgical Nursing REVIEW MODULE EDITION 11.0
Contributors Honey C. Holman, MSN, RN
Debborah Williams, MSN, RN
Sheryl Sommer, PhD, RN, CNE
Janean Johnson, MSN, RN, CNE
Brenda S. Ball, MEd, BSN, RN
LaKeisha Wheless, MSN, RN
Peggy Leehy, MSN, RN
Terri Lemon, DNP, MSN, RN
Consultants Greta Lucinda Baldwin Mason, MSN, RN
Christi Blair, DNP, RN
Tracey Bousquet, BSN, RN
Valerie S. Eschiti, PhD, RN, AHN-BC, CHTP, CTN-A
Penny Fauber, PhD, MS, BSN, RN
Sara Hoffmann, MSN, RN
Tomekia Luckett, PhD, RN
Donna Russo, RN, MSN, CCRN, CNE
Melanie P. Schrader, PhD, RN
INTELLECTUAL PROPERTY NOTICE ATI Nursing is a division of Assessment Technologies Institute®, LLC.
Copyright © 2019 Assessment Technologies Institute, LLC. All rights reserved.
The reproduction of this work in any electronic, mechanical or other means, now known or hereafter
invented, is forbidden without the written permission of Assessment Technologies Institute, LLC. All of the
content in this publication, including, for example, the cover, all of the page headers, images, illustrations,
graphics, and text, are subject to trademark, service mark, trade dress, copyright, and/or other intellectual
property rights or licenses held by Assessment Technologies Institute, LLC, one of its affiliates, or by
third parties who have licensed their materials to Assessment Technologies Institute, LLC.
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II CONTENT MASTERY SERIES
IMPORTANT NOTICE TO THE READER Assessment Technologies Institute, LLC, is the publisher of this publication. The content of this publication is for
informational and educational purposes only and may be modified or updated by the publisher at any time. This
publication is not providing medical advice and is not intended to be a substitute for professional medical advice,
diagnosis, or treatment. The publisher has designed this publication to provide accurate information regarding the
subject matter covered; however, the publisher is not responsible for errors, omissions, or for any outcomes related to
the use of the contents of this book and makes no guarantee and assumes no responsibility or liability for the use of the
products and procedures described or the correctness, sufficiency, or completeness of stated information, opinions, or
recommendations. The publisher does not recommend or endorse any specific tests, providers, products, procedures,
processes, opinions, or other information that may be mentioned in this publication. Treatments and side effects described
in this book may not be applicable to all people; likewise, some people may require a dose or experience a side effect
that is not described herein. Drugs and medical devices are discussed that may have limited availability controlled by
the Food and Drug Administration (FDA) for use only in a research study or clinical trial. Research, clinical practice,
and government regulations often change the accepted standard in this field. When consideration is being given to use
of any drug in the clinical setting, the health care provider or reader is responsible for determining FDA status of the
drug, reading the package insert, and reviewing prescribing information for the most up-to-date recommendations
on dose, precautions, and contraindications and determining the appropriate usage for the product. Any references
in this book to procedures to be employed when rendering emergency care to the sick and injured are provided solely
as a general guide. Other or additional safety measures may be required under particular circumstances. This book
is not intended as a statement of the standards of care required in any particular situation, because circumstances
and a patient’s physical condition can vary widely from one emergency to another. Nor is it intended that this book
shall in any way advise personnel concerning legal authority to perform the activities or procedures discussed. Such
specific determination should be made only with the aid of legal counsel. Some images in this book feature models.
These models do not necessarily endorse, represent, or participate in the activities represented in the images. THE
PUBLISHER MAKES NO REPRESENTATIONS OR WARRANTIES OF ANY KIND, WHETHER EXPRESS OR IMPLIED, WITH
RESPECT TO THE CONTENT HEREIN. THIS PUBLICATION IS PROVIDED AS-IS, AND THE PUBLISHER AND ITS AFFILIATES
SHALL NOT BE LIABLE FOR ANY ACTUAL, INCIDENTAL, SPECIAL, CONSEQUENTIAL, PUNITIVE, OR EXEMPLARY
DAMAGES RESULTING, IN WHOLE OR IN PART, FROM THE READER’S USE OF, OR RELIANCE UPON, SUCH CONTENT.
Director of content review: Kristen Lawler
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Project management: Tiffany Pavlik, Shannon Tierney
Coordination of content review: Honey C. Holman, Debborah Williams
Copy editing: Kelly Von Lunen, Bethany Phillips, Kya Rodgers
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Online media: Brant Stacy, Ron Hanson, Britney Fuller, Barry Wilson
Cover design: Jason Buck
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RN ADULT MEDICAL SURGICAL NURSING User’s GUide III
User’s Guide Welcome to the Assessment Technologies Institute® RN Adult Medical Surgical Nursing Review Module Edition 11.0. The mission of ATI’s Content Mastery Series® Review Modules is to provide user-friendly compendiums of nursing knowledge that will:
● Help you locate important information quickly. ● Assist in your learning efforts. ● Provide exercises for applying your nursing knowledge. ● Facilitate your entry into the nursing profession as a
newly licensed nurse.
This newest edition of the Review Modules has been redesigned to optimize your learning experience. We’ve fit more content into less space and have done so in a way that will make it even easier for you to find and understand the information you need.
ORGANIZATION This Review Module is organized into units covering the foundations of nursing care (Unit 1), body systems and physiological processes (Units 2 to 13), and perioperative nursing care (Unit 14). Chapters within these units conform to one of three organizing principles for presenting the content.
● Nursing concepts ● Procedures ● System disorders
Nursing concepts chapters begin with an overview describing the central concept and its relevance to nursing. Subordinate themes are covered in outline form to demonstrate relationships and present the information in a clear, succinct manner.
Procedures chapters include an overview describing the procedure(s) covered in the chapter. These chapters provide nursing knowledge relevant to each procedure, including indications, nursing considerations, interpretation of findings, and complications.
System disorders chapters include an overview describing the disorder(s) and/or disease process. These chapters address assessments, including risk factors, expected findings, laboratory tests, and diagnostic procedures. Next, you will focus on patient-centered care, including nursing care, medications, therapeutic procedures, interprofessional care, and client education. Finally, you will find complications related to the disorder, along with nursing actions in response to those complications.
ACTIVE LEARNING SCENARIOS AND APPLICATION EXERCISES
Each chapter includes opportunities for you to test your knowledge and to practice applying that knowledge. Active Learning Scenario exercises pose a nursing scenario and then direct you to use an ATI Active Learning Template (included at the back of this book) to record the important knowledge a nurse should apply to the scenario. An example is then provided to which you can compare your completed Active Learning Template. The Application Exercises include NCLEX-style questions, such as multiple-choice and multiple-select items, providing you with opportunities to practice answering the kinds of questions you might expect to see on ATI assessments or the NCLEX. After the Application Exercises, an answer key is provided, along with rationales.
NCLEX® CONNECTIONS To prepare for the NCLEX-RN, it is important to understand how the content in this Review Module is connected to the NCLEX-RN test plan. You can find information on the detailed test plan at the National Council of State Boards of Nursing’s website, www.ncsbn. org. When reviewing content in this Review Module, regularly ask yourself, “How does this content fit into the test plan, and what types of questions related to this content should I expect?”
To help you in this process, we’ve included NCLEX Connections at the beginning of each unit and with each question in the Application Exercises Answer Keys. The NCLEX Connections at the beginning of each unit point out areas of the detailed test plan that relate to the content within that unit. The NCLEX Connections attached to the Application Exercises Answer Keys demonstrate how each exercise fits within the detailed content outline. These NCLEX Connections will help you understand how the detailed content outline is organized, starting with major client needs categories and subcategories and followed by related content areas and tasks. The major client needs categories are:
● Safe and Effective Care Environment ◯ Management of Care ◯ Safety and Infection Control
● Health Promotion and Maintenance ● Psychosocial Integrity ● Physiological Integrity
◯ Basic Care and Comfort ◯ Pharmacological and Parenteral Therapies ◯ Reduction of Risk Potential ◯ Physiological Adaptation
An NCLEX Connection might, for example, alert you that content within a unit is related to:
● Reduction of Risk Potential ◯ Diagnostic Tests
■ Monitor the results of diagnostic testing and intervene as needed.
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IV User’s GUide CONTENT MASTERY SERIES
QSEN COMPETENCIES As you use the Review Modules, you will note the integration of the Quality and Safety Education for Nurses (QSEN) competencies throughout the chapters. These competencies are integral components of the curriculum of many nursing programs in the United States and prepare you to provide safe, high-quality care as a newly licensed nurse. Icons appear to draw your attention to the six QSEN competencies.
Safety: The minimization of risk factors that could cause injury or harm while promoting quality care and maintaining a secure environment for clients, self, and others.
Patient-Centered Care: The provision of caring and compassionate, culturally sensitive care that addresses clients’ physiological, psychological, sociological, spiritual, and cultural needs, preferences, and values.
Evidence-Based Practice: The use of current knowledge from research and other credible sources, on which to base clinical judgment and client care.
Informatics: The use of information technology as a communication and information-gathering tool that supports clinical decision-making and scientifically based nursing practice.
Quality Improvement: Care related and organizational processes that involve the development and implementation of a plan to improve health care services and better meet clients’ needs.
Teamwork and Collaboration: The delivery of client care in partnership with multidisciplinary members of the health care team to achieve continuity of care and positive client outcomes.
ICONS Icons are used throughout the Review Module to draw your attention to particular areas. Keep an eye out for these icons.
This icon is used for NCLEX Connections.
This icon indicates gerontological considerations, or knowledge specific to the care of older adult clients.
This icon is used for content related to safety and is a QSEN competency. When you see this icon, take note of safety concerns or steps that nurses can take to ensure client safety and a safe environment.
This icon is a QSEN competency that indicates the importance of a holistic approach to providing care.
This icon, a QSEN competency, points out the integration of research into clinical practice.
This icon is a QSEN competency and highlights the use of information technology to support nursing practice.
This icon is used to focus on the QSEN competency of integrating planning processes to meet clients’ needs.
This icon highlights the QSEN competency of care delivery using an interprofessional approach.
This icon appears at the top-right of pages and indicates availability of an online media supplement, such as a graphic, animation, or video. If you have an electronic copy of the Review Module, this icon will appear alongside clickable links to media supplements. If you have a hard copy version of the Review Module, visit www.atitesting.com for details on how to access these features.
FEEDBACK ATI welcomes feedback regarding this Review Module. Please provide comments to [email protected]
As needed updates to the Review Modules are identified, changes to the text are made for subsequent printings of the book and for subsequent releases of the electronic version. For the printed books, print runs are based on when existing stock is depleted. For the electronic versions, a number of factors influence the update schedule. As such, ATI encourages faculty and students to refer to the Review Module addendums for information on what updates have been made. These addendums, which are available in the Help/FAQs on the student site and the Resources/eBooks & Active Learning on the faculty site, are updated regularly and always include the most current information on updates to the Review Modules.
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RN ADULT MEDICAL SURGICAL NURSING TABLe OF CONTeNTs V
Table of Contents
NCLEX® Connections 1
UNIT 1 Foundations of Nursing Care for Adult Clients 3
CHAPTER 1 Health, Wellness, and Illness 3
CHAPTER 2 Emergency Nursing Principles and Management 7
NCLEX® Connections 15
UNIT 2 Neurologic Disorders 17 SECTION: Diagnostic and Therapeutic Procedures 17
CHAPTER 3 Neurologic Diagnostic Procedures 17
CHAPTER 4 Pain Management 25
SECTION: Central Nervous System Disorders 31
CHAPTER 5 Meningitis 31
CHAPTER 6 Seizures and Epilepsy 35
CHAPTER 7 Parkinson’s Disease 41
CHAPTER 8 Alzheimer’s Disease 47
CHAPTER 9 Brain Tumors 53
CHAPTER 10 Multiple Sclerosis 59
CHAPTER 11 Headaches 63
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VI TABLe OF CONTeNTs CONTENT MASTERY SERIES
SECTION: Sensory Disorders 67
CHAPTER 12 Disorders of the Eye 67
CHAPTER 13 Middle and Inner Ear Disorders 73
SECTION: Neurologic Emergencies 81
CHAPTER 14 Head Injury 81
CHAPTER 15 Stroke 87
CHAPTER 16 Spinal Cord Injury 95
NCLEX® Connections 103
UNIT 3 Respiratory Disorders 105 SECTION: Diagnostic and Therapeutic Procedures 105
CHAPTER 17 Respiratory Diagnostic Procedures 105
CHAPTER 18 Chest Tube Insertion and Monitoring 111
CHAPTER 19 Respiratory Management and Mechanical Ventilation 115
SECTION: Respiratory System Disorders 125
CHAPTER 20 Acute Respiratory Disorders 125
CHAPTER 21 Asthma 133
CHAPTER 22 Chronic Obstructive Pulmonary Disease 137
CHAPTER 23 Tuberculosis 143
SECTION: Respiratory Emergencies 149
CHAPTER 24 Pulmonary Embolism 149
CHAPTER 25 Pneumothorax, Hemothorax, and Flail Chest 155
CHAPTER 26 Respiratory Failure 161
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RN ADULT MEDICAL SURGICAL NURSING TABLe OF CONTeNTs VII
NCLEX® Connections 167
UNIT 4 Cardiovascular Disorders 169 SECTION: Diagnostic and Therapeutic Procedures 169
CHAPTER 27 Cardiovascular Diagnostic and Therapeutic Procedures 169
CHAPTER 28 Electrocardiography and Dysrhythmia Monitoring 179
CHAPTER 29 Pacemakers and Implantable Cardioverter/Defibrillators 185
CHAPTER 30 Invasive Cardiovascular Procedures 191
SECTION: Cardiac Disorders 199
CHAPTER 31 Angina and Myocardial Infarction 199
CHAPTER 32 Heart Failure and Pulmonary Edema 205
CHAPTER 33 Valvular Heart Disease 213
CHAPTER 34 Inflammatory Disorders 219
SECTION: Vascular Disorders 223
CHAPTER 35 Peripheral Vascular Diseases 223
CHAPTER 36 Hypertension 233
CHAPTER 37 Hemodynamic Shock 239
CHAPTER 38 Aneurysms 247
NCLEX® Connections 253
UNIT 5 Hematologic Disorders 255 SECTION: Diagnostic and Therapeutic Procedures 255
CHAPTER 39 Hematologic Diagnostic Procedures 255
CHAPTER 40 Blood and Blood Product Transfusions 259
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VIII TABLe OF CONTeNTs CONTENT MASTERY SERIES
SECTION: Hematologic Disorders 265
CHAPTER 41 Anemias 265
CHAPTER 42 Coagulation Disorders 271
NCLEX® Connections 275
UNIT 6 Fluid/Electrolyte/Acid‑Base Imbalances 277 CHAPTER 43 Fluid Imbalances 277
CHAPTER 44 Electrolyte Imbalances 283
Sodium imbalances 283
Potassium imbalances 285
Other electrolyte imbalances 288
CHAPTER 45 Acid‑Base Imbalances 293
NCLEX® Connections 299
UNIT 7 Gastrointestinal Disorders 301 SECTION: Diagnostic and Therapeutic Procedures 301
CHAPTER 46 Gastrointestinal Diagnostic Procedures 301
CHAPTER 47 Gastrointestinal Therapeutic Procedures 309
SECTION: Upper Gastrointestinal Disorders 319
CHAPTER 48 Esophageal Disorders 319
CHAPTER 49 Peptic Ulcer Disease 327
CHAPTER 50 Acute and Chronic Gastritis 333
SECTION: Lower Gastrointestinal Disorders 339
CHAPTER 51 Noninflammatory Bowel Disorders 339
CHAPTER 52 Inflammatory Bowel Disease 347
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RN ADULT MEDICAL SURGICAL NURSING TABLe OF CONTeNTs IX
SECTION: Gallbladder and Pancreas Disorders 355
CHAPTER 53 Cholecystitis and Cholelithiasis 355
CHAPTER 54 Pancreatitis 359
SECTION: Liver Disorders 365
CHAPTER 55 Hepatitis and Cirrhosis 365
NCLEX® Connections 373
UNIT 8 Renal Disorders 375 SECTION: Diagnostic and Therapeutic Procedures 375
CHAPTER 56 Renal Diagnostic Procedures 375
CHAPTER 57 Hemodialysis and Peritoneal Dialysis 379
CHAPTER 58 Kidney Transplant 385
SECTION: Renal System Disorders 391
CHAPTER 59 Polycystic Kidney Disease, Acute Kidney Injury, and Chronic Kidney Disease 391
CHAPTER 60 Infections of the Renal and Urinary System 399
CHAPTER 61 Renal Calculi 407
NCLEX® Connections 413
UNIT 9 Reproductive Disorders 415 SECTION: Female Reproductive Disorders 415
CHAPTER 62 Diagnostic and Therapeutic Procedures for Female Reproductive Disorders 415
CHAPTER 63 Female Physiologic Processes 423
CHAPTER 64 Disorders of Female Reproductive Tissue 429
SECTION: Male Reproductive Disorders 435
CHAPTER 65 Diagnostic Procedures for Male Reproductive Disorders 435
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X TABLe OF CONTeNTs CONTENT MASTERY SERIES
CHAPTER 66 Benign Prostatic Hyperplasia, Erectile Dysfunction, and Prostatitis 439
NCLEX® Connections 445
UNIT 10 Musculoskeletal Disorders 447 SECTION: Diagnostic and Therapeutic Procedures 447
CHAPTER 67 Musculoskeletal Diagnostic Procedures 447
CHAPTER 68 Arthroplasty 453
CHAPTER 69 Amputations 459
SECTION: Musculoskeletal Disorders 463
CHAPTER 70 Osteoporosis 463
CHAPTER 71 Musculoskeletal Trauma 469
CHAPTER 72 Osteoarthritis and Low‑Back Pain 479
NCLEX® Connections 487
UNIT 11 Integumentary Disorders 489 SECTION: Diagnostic and Therapeutic Procedures 489
CHAPTER 73 Integumentary Diagnostic Procedures 489
SECTION: Integumentary Disorders 493
CHAPTER 74 Skin Disorders 493
CHAPTER 75 Burns 499
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RN ADULT MEDICAL SURGICAL NURSING TABLe OF CONTeNTs XI
NCLEX® Connections 509
UNIT 12 Endocrine Disorders 511 SECTION: Diagnostic and Therapeutic Procedures 511
CHAPTER 76 Endocrine Diagnostic Procedures 511
SECTION: Pituitary Disorders 519
CHAPTER 77 Pituitary Disorders 519
SECTION: Thyroid Disorders 525
CHAPTER 78 Hyperthyroidism 525
CHAPTER 79 Hypothyroidism 531
SECTION: Adrenal Disorders 535
CHAPTER 80 Cushing’s Disease/Syndrome 535
CHAPTER 81 Addison’s Disease and Acute Adrenal Insufficiency (Addisonian Crisis) 541
SECTION: Diabetes Mellitus 545
CHAPTER 82 Diabetes Mellitus Management 545
CHAPTER 83 Complications of Diabetes Mellitus 555
NCLEX® Connections 559
UNIT 13 Immune System and Connective Tissue Disorders 561 SECTION: Diagnostic and Therapeutic Procedures 561
CHAPTER 84 Immune and Infectious Disorders Diagnostic Procedures 561
CHAPTER 85 Immunizations 565
SECTION: Immune Disorders 571
CHAPTER 86 HIV/AIDS 571
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XII TABLe OF CONTeNTs CONTENT MASTERY SERIES
SECTION: Connective Tissue Disorders 577
CHAPTER 87 Lupus Erythematosus, Gout, and Fibromyalgia 577
CHAPTER 88 Rheumatoid Arthritis 585
SECTION: Cancer‑Related Disorders 591
CHAPTER 89 General Principles of Cancer 591
CHAPTER 90 Cancer Screening and Diagnostic Procedures 597
CHAPTER 91 Cancer Treatment Options 601
CHAPTER 92 Cancer Disorders 611
CHAPTER 93 Pain Management for Clients Who Have Cancer 645
NCLEX® Connections 651
UNIT 14 Nursing Care of Perioperative Clients 653 CHAPTER 94 Anesthesia and Moderate Sedation 653
Anesthesia 653
Moderate sedation 656
CHAPTER 95 Preoperative Nursing Care 659
CHAPTER 96 Postoperative Nursing Care 665
Active Learning Templates A1 Basic Concept A1
Diagnostic Procedure A3
Growth and Development A5
Medication A7
Nursing Skill A9
System Disorder A11
Therapeutic Procedure A13
Concept Analysis A15
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RN ADULT MEDICAL SURGICAL NURSING NCLeX® CONNeCTiONs 1
NCLEX® Connections
When reviewing the following chapters, keep in mind the relevant topics and tasks of the NCLEX outline, in particular:
Health Promotion and Maintenance HEALTH PROMOTION/DISEASE PREVENTION Identify risk factors for disease/illness.
Educate the client on actions to promote/ maintain health and prevent disease.
HEALTH SCREENING: Apply knowledge of pathophysiology to health screening.
Physiological Adaptation HEMODYNAMICS: Intervene to improve the client’s cardiovascular status.
ILLNESS MANAGEMENT: Educate client about managing illness.
MEDICAL EMERGENCIES: Apply knowledge of pathophysiology when caring for a client experiencing a medical emergency.
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2 NCLeX® CONNeCTiONs CONTENT MASTERY SERIES
RN ADULT MEDICAL SURGICAL NURSING CHAPTER 1 HeALTH, WeLLNess, ANd iLLNess 3
UNIT 1 FOUNDATIONS OF NURSING CARE FOR ADULT CLIENTS
CHAPTER 1 Health, Wellness, and Illness
Health and wellness combine to form a state of optimal physical functioning and a feeling of emotional and social contentment. Wellness involves the ability to adapt emotionally and physically to a changing state of health and environment.
illness is an altered level of functioning in response to a disease process. disease is a condition that results in the physiological alteration in the composition of the body.
Nurses must understand the variables affecting health, wellness, and illness, and how they relate to clients’ individual perceptions of health needs.
Health and wellness The level of health and wellness is unique to each individual and relative to the individual’s usual state of functioning. For example, a person who has rheumatoid arthritis, a strong support system, and positive outlook might consider himself healthy while functioning at an optimal level with minimal pain.
VARIABLES ● Modifiable: Can be changed, such as smoking,
nutrition, access to health education, sexual practices, and exercise
● Non-modifiable: Cannot be changed, such as sex, age, developmental level, and genetic traits
ASPECTS OF HEALTH AND WELLNESS ● Physical: Able to perform activities of daily living ● Emotional: Adapts to stress; expresses and
identifies emotions ● Social: Interacts successfully with others ● Intellectual: Effectively learns and disseminates
information ● Spiritual: Adopts a belief that provides meaning to life ● Occupational: Balances occupational activities with
leisure time ● Environmental: Creates measures to improve standards
of living and quality of life
ENVIRONMENT ● A client’s state of health and wellness is constantly
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