ADVANDCED PRACTICE NURSING EMPHASIZING COMMON RULES

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Advanced Practice Nursing:
Emphasizing Common Roles
Edition 2
Joan M. Stanley, PhD, RN, CRNP
Director of Education Policy
American Association of Colleges of Nursing
Washington, DC
F.A. Davis Company • Philadelphia


F. A. Davis Company
1915 Arch Street
Philadelphia, PA 19103
www.fadavis.com
Copyright © 2005 by F. A. Davis Company
Copyright © 2005 by F. A. Davis Company. All rights reserved. This book is protected by copyright. No
part of it may be reproduced, stored in a retrieval system, or transmitted in any form or by any means,
electronic, mechanical, photocopying, recording, or otherwise, without written permission from the publisher.
Printed in the United States of America
Last digit indicates print number: 10 9 8 7 6 5 4 3 2 1
Acquisitions Editor: Joanne Patzek DaCunha, RN, MSN
Developmental Editor: Kristin L. Kern
Design Manager: Joan Wendt
As new scientific information becomes available through basic and clinical research, recommended treatments
and drug therapies undergo changes. The author(s) and publisher have done everything possible
to
make this book accurate, up to date, and in accord with accepted standards at the time of publication.
The
author(s), editors, and publisher are not responsible for errors or omissions or for consequences
from
application of the book, and make no warranty, expressed or implied, in regard to the contents of
the
book. Any practice described in this book should be applied by the reader in accordance with professional
standards of care used in regard to the unique circumstances that may apply in each situation. The
reader
is advised always to check product information (package inserts) for changes and new information
regarding dose and contraindications before administering any drug. Caution is especially urged
when
using new or infrequently ordered drugs.
Library of Congress Cataloging-in-Publication Data
Advanced practice nursing : emphasizing common roles / [edited by] Joan M. Stanley.—2nd ed.
p. ; cm.
Includes bibliographical references and index.
ISBN 0-8036-1229-X (hardcover : alk. paper)
1. Nurse practitioners. 2. Midwives. 3. Nurse anesthetists.
[DNLM: 1. Nurse Clinicians. 2. Nurse Practitioners. 3. Nurse Midwives. WY 128 A2445 2005] I.
Stanley, Joan M.
RT82.8.A37 2005
610.73′06′92—dc22
2004001938
Authorization to photocopy items for internal or personal use, or the internal or personal use of specific
clients, is granted by F. A. Davis Company for users registered with the Copyright Clearance Center
(CCC) Transactional Reporting Service, provided that the fee of $.10 per copy is paid directly to CCC,
222 Rosewood Drive, Danvers, MA 01923. For those organizations that have been granted a photocopy
license by CCC, a separate system of payment has been arranged. The fee code for users of the
Transactional Reporting Service is: 8036-1229/05 0 $.10.

Contents
Foreward  . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .V
Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .XIX
CHAPTER 1
The Evolution of Advanced Practice in Nursing  . . . . . . . . . . . . . . . . . . . . . . . .1
Pauline Komnenich, PhD, RN
Certified Nurse Midwives, 4
Nurse Anesthetists, 14
Clinical Nurse Specialists, 22
Nurse Practitioners, 27
Joining Forces: Role Parameters and Concerns, 33
CHAPTER 2
Advanced Practice Nursing in the Current Sociopolitical Environment  . . . . .46
Lucille A. Joel, EdD, RN, FAAN
The American People and Their Health, 48
The Health Care Delivery System: Origins of Change, 54
Dominant Trends in American Health Care, 55
The Advanced Practice Nurse and the Emergent Delivery System, 56
Barriers to Advanced Nursing Practice, 57
Summary, 66
CHAPTER 3
The American Health Care System: Implications for Advanced
Practice Nursing . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .70
Mary Knudtson, MSN, NP
The American Health Care System, 72
Financing Health Care, 74
The Evolution of Managed Care, 88
Implications for Advanced Practice Nursing, 90

CHAPTER 4
Selected Theories and Models for Advanced Practice Nursing  . . . . . . . . . . . .93
Michelle Walsh, PhD, RN, CPNP, Linda A. Bernhard, PhD, RN
Theories of Leadership, 96
Theories of Change, 102
Models of Health Promotion, 107
Models of Advanced Practice Nursing, 113
Summary, 119
CHAPTER 5
Primary Care and Advanced Practice Nursing: Past, Present,
and Future  . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .122
Catherine L. Gilliss, DNSc, RN, FAAN, Linda Lindsey Davis, PhD, RN
Health Care in the Twentieth Century, 124
Health Care in the Twenty-First Century, 124
The Nature of Primary Care, 125
Primary Care Providers in the Twenty-First Century, 131
Policy Issues Influencing Advanced Practice in Emerging Primary
Care Systems, 137
Summary, 142
CHAPTER 6
Advanced Practice Nurses in Non-Primary Care Roles: The Evolution
of Specialty and Acute Care Practices  . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .146
Dennis J. Cheek, PhD, RN, FAHA, Karol S. Harshaw-Ellis, MSN, RN, A/GNP, ACNP-CS
Advanced Practice Nursing Roots in Acute Care, 148
Evolution of NPs in Neonatal and Acute Care, 149
Hospitalist/Acute Care Nurse Practitioner Model, 152
Non-Primary Care Roles: Growing Specialties, 154
Summary, 155
CHAPTER 7
Formulation and Approval of Credentialing and Clinical Privileges  . . . . . . .158
Geraldine “Polly” Bednash, PhD, RN, FAAN, Judy Honig, EdD, CPNP, Linda Gibbs, BSN, RN, MBA
Regulation: Professional and Public, 160
Professional Certification for APNs, 169
Clinical Practice and Institutional Privileges, 174
Summary, 183
CHAPTER 8
Reimbursement for Expanded Professional Nursing Practice Services  . . . . .187
Michael J. Kremer, DNSc, CRNA, FAAN, Margaret Faut-Callahan, DNSc, CRNA, FAAN
The Economic System, 191
Criteria for an Economic System in Relation to Health Care, 191
Types of Economic Systems, 192
Market Competition, 194
Disequilibrium, 196
Supplier-Induced Demand, 197
The Effects of Changes in Price, Supply, and Demand for Health Care, 199
Cost Considerations in Provision of Care and Reimbursement for Physicians and APNs, 201
Key Terms in Finance and Reimbursement, 210
Reimbursement for Specific APN Groups, 214
Summary, 223
CHAPTER 9
Marketing the Role: Formulating, Articulating, and Negotiating
Advanced Practice Nursing Positions  . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .226
Christine E. Burke, PhD, CNM
The Traditional Marketing Approach: The 4 Ps, 228
Knowledge of Personal Values, Professional Skills, and Practical Necessities, 230
Knowledge of Practice Regulations, 232
Knowledge of Existing Services, 232
Knowledge of Clients’ Health Care Needs and Desires, 233
Knowledge of the Target Population’s Understanding of the Role and Scope
of Practice of the APN, 234
Knowledge of the Utilization and Cost-Effectiveness of and Satisfaction with
APN Services, 234
Knowledge of Specific Marketing Elements, 235
Communication Skills, 237
Evaluation of Job Opportunities, 246
Close of the Deal, 248
Mentors and Career Advancement, 250
Summary, 252
CHAPTER 10
Caring for a Diverse Population: Ensuring Cultural Competency
in Advanced Practice Nursing  . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .255
Pier Angeli Broadnax, PhD, RN
Diversity, 258
Commonly Used Culture-Related Terms, 259
Principles of Cultural Competency, 260
Cultural Assessment Models, 261
Healthy People 2010, 264
Culturally Sensitive Life Events, 264
Summary, 273
CHAPTER 11
Clinical Research in the Advanced Practice Role . . . . . . . . . . . . . . . . . . . . . .277
Julie Reed Erickson, PhD, RN, FAAN, Christine Sheehy, PhD, RN
APNs as Consumers of Research, 282
APNs as Researchers, 293
Summary, 297
CHAPTER 12
Publishing Scholarly Works  . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .304
Suzanne Hall Johnson, MN, RN,C, CNS
Avoiding the “School Paper” Style Rejection, 307
Adapting the Thesis Style for Publication, 313
Summary, 320
CHAPTER 13
Legal and Ethical Aspects of Advanced Practice Nursing  . . . . . . . . . . . . . . .322
Linda Callahan, PhD, CRNA, Mary Jeannette Mannino, JD, CRNA
Nurse Practice Acts, 324
Professional Negligence (Malpractice), 327
Malpractice Insurance, 331
The Patient and the APN, 332
Professional Ethics, 332
CHAPTER 14
Advanced Practice Nursing and Global Health . . . . . . . . . . . . . . . . . . . . . . . .351
Katherine Crabtree, DNSc, FAAN, APRN, BC, Anita Hunter, PhD, RN, CNS, CPNP
Global Health Challenges, 354
Globalization of Advanced Practice Nursing, 355
Education Competencies for NP Practice in the U.S. and Abroad, 357
Advanced Practice Nursing in Other Developed Nations, 361
Advanced Practice in Developing Nations, 364
Ethics and Spiritual and Cultural Competence in a Global Environment, 367
Opportunities for Advanced Practice Outside the United States, 367
Preparing APNs with a Global Perspective, 369
Summary, 371
CHAPTER 15
Advanced Practice Nursing and Health Policy  . . . . . . . . . . . . . . . . . . . . . . . .374
Eileen T. O’Grady, PhD, RN, NP
Tensions Among Health Care Costs, Quality, and Access, 376
The American Health Policy Process, 379
The APN Health Policy Agenda, 384
APN Political Competence, 388
Important Health Policy Websites, 392
CHAPTER 16
Creating Excellence in Practice  . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .395
Marla J. Weston, MS, RN, Vicki L. Buchda, MS, RN, Debra Bergstrom, MS, RN, FNP
Attributes of Excellence, 398
Summary, 409
Index . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .413

ANXIETY MANAGEMENT IN ADULT DAY SURGERY A NURSING PERSPECTIVE

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Anxiety Management in
Adult Day Surgery
A Nursing Perspective
Mark Mitchell BA, MSc, PhD, RGN, NDNCert, RCNT, RNT
University of Salford, Greater Manchester, UK

© 2005 Whurr Publishers Ltd
First published 2005
by Whurr Publishers Ltd
19b Compton Terrace
London N1 2UN England and
325 Chestnut Street, Philadelphia PA 19106 USA
All rights reserved. No part of this publication may be
reproduced, stored in a retrieval system, or transmitted in any form
or by any means, electronic, mechanical, photocopying, recording or
otherwise, without the prior permission of Whurr Publishers Limited.
This publication is sold subject to the conditions that it shall not, by
way of trade or otherwise, be lent, resold, hired out, or otherwise
circulated without the publisher’s prior consent in any form of
binding or cover other than that in which it is published and
without a similar condition including this condition being imposed
upon any subsequent purchaser.
British Library Cataloguing in Publication Data
A catalogue record for this book
is available from the British Library.
ISBN 1 86156 463 5

Contents
Preface vii
Chapter 1 Twenty-first century: a time for change 1
Growth of day surgery 1
Psychoeducational management 5
Summary 10
Chapter 2 Day surgery: patients’ perceptions 12
Advancements in surgical practice 12
Preassessment and patient teaching 13
Information provision 15
Patient experiences on the day of surgery 23
Patient recovery 28
Conclusion 46
Summary 48
Chapter 3 Patient anxiety and elective surgery 50
Patient anxiety 50
Conclusion 73
Summary 73
Chapter 4 Psychological approaches to coping 75
Broad psychological approaches 75
Specific psychological approaches 80
Conclusion 95
Summary 96
Chapter 5 Information selection 98
Information categories 98
Conclusion 115
Summary 115
Chapter 6 Information Delivery 117
Information provision and elective surgery 117
Conclusion 141
Summary 142
Chapter 7 Anxiety management in day surgery 144
Preoperative psychoeducational care 144
Implementation 156
Conclusion 169
Summary 171
Chapter 8 Twenty-first century elective surgical nursing 173
Day-surgery innovation 173
Conclusion 191
Summary 192
Glossary 194
References 205
Index 235


Preface
This book is centrally concerned with the formal management of preoperative
anxiety.
The vast majority of patients experience varying degrees
of
anxiety when entering hospital for surgery and yet little formal intervention
is commonly provided. This is the first book of its kind to be
written
for nurses exclusively concerning the complete formal pre- and
postoperative
management of anxiety in relation to modern, elective,
adult
day surgery.
During the early 1970s
classic nursing studies suggested
information provision to be crucial for effective inpatient preoperative
anxiety
management. However,
following such early recommendations
no
other formal aspects of psychoeducational care have impacted on
mainstream
surgical nursing intervention. Physical aspects of care have
dominated
proceedings for the last three decades or more, whereas psychoeducational
aspects have largely remained informal, marginal issues.
Both
surgery and anaesthesia have changed dramatically during this period
and nursing intervention must now do likewise.
The domination of physical nursing intervention is, however, slowly
changing as the continuous global rise in elective ambulatory surgery has
highlighted the need for more structured psychoeducational approaches
to patient care. The psychological theories to aid preoperative anxiety
management have been available for many years. However, they have not
succeeded in making an impact within the clinical surgical setting,
because they have not previously been constructed into a coherent, clinically
realistic plan of care. The purpose of this book is therefore (1)
to
consider
the relevant psychological concepts that can inform and guide
modern
surgical nursing practices, (2)
to provide a comprehensive map of
the
wider evidence available and (3)
to introduce clinically realistic nursing
interventions necessary for the complete psychoeducational
management of adult patients undergoing elective, ambulatory surgery.
On a philosophical level, I hope to communicate with a wide audience
of nurses working in the field of adult ambulatory surgery or studying
modern surgical nursing practices. We need to re-evaluate nursing
knowledge for this new surgical era so that compelling nursing evidence
can help to guide practice and not remain in the shadows of medical
advances. This book is intended to provoke debate within the profession,
present the case for change and, above all, demonstrate the ability of
nursing knowledge to make a significant contribution to the care required
by patients experiencing modern ambulatory surgery. Much evidence,
within the nursing domain, is widely available to help guide important
global nursing issues in ambulatory surgery.
The political reforms currently running through the National Health
Service in the UK have resulted in nursing knowledge largely becoming
marginalized. The utilization of nurses and their skills features widely in
these reforms, but not the utilization of nursing skills based on nursing
knowledge. Surgical self-preparation and self-recovery are now implicit
aspects of the modern surgical patients’ experience. Patients and their relatives
did not request this new,
essential role although most now welcome
the
social convenience and swift treatment that day surgery affords. Such
advances
have, however,
guaranteed that many of yesterday’s
professional
nursing interventions have become today’s
layperson interventions.
Much
physical surgical nursing is increasingly becoming obsolete because
it
can now be undertaken by laypeople. I am hopeful that this book will
add
to the debate about the future of modern surgical nursing intervention,
because the trend of surrendering much pre- and postoperative care
to
relatives and replacing it with interventions that once were the domain
of
junior doctors must not remain unchallenged. ‘New’ nursing knowledge
has much to offer the ambulatory surgery patient and we must
robustly
demonstrate how our professional knowledge can make this contribution.
Professional knowledge and its application are powerful,
liberating
and motivating forces. I hope that this book empowers, liberates
and motivates all who read it and that you find it as stimulating to
read
as I have found it to write.
Mark Mitchell

ATLAS OF HUMAN ANATOMY THIEME 2000

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Pocket Atlas of
Human Anatomy
Based on the International Nomenclature
Heinz Feneis
Professor
Formerly Institute of Anatomy
University of Tübingen
Tübingen, Germany
Fourth edition, fully revised
800 illustrations by Gerhard Spitzer
Thieme
Stuttgart · New York 2000
Wolfgang Dauber
Professor
Institute of Anatomy
University of Tübingen
Tübingen, Germany
Feneis, Pocket Atlas of Human Anatomy © 2000 Thieme


Contents
Bones ...................................... 2
Sutures, joints and ligaments ................ 54
Muscles .................................... 74
Muscles, synovial bursae and sheaths ........ 100
Digestive system ............................ 108
Digestive and respiratory system ............ 134
Urogenital system ........................... 154
Peritoneum ................................. 176
Endocrine glands ............................ 182
Heart ....................................... 184
Arteries .................................... 190
Veins ....................................... 230
Lymphatic system ........................... 254
Spleen, meninges ........................... 268
Meninges ................................... 268
Spinal cord ................................. 272
Brain ....................................... 278
Cranial nerves .............................. 320
Spinal nerves ............................... 334
Autonomic nervous system .................. 348
Sense organs ................................ 354
Skin and its appendages ..................... 390
General terms .............................. 396
References .................................. 409
Index ....................................... 412
Feneis, Pocket Atlas of Human Anatomy © 2000 Thieme

ATLAS OF MEDICAL HELMINTOLOGY AND PROTOZOOLOGY

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ATLAS OF NEURO ANATOMY AND NEURO PHYSIOLOGY FRANK H NETTER

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Atlas of
Neuroanatomy and
Neurophysiology
Selections from the Netter Collection of Medical Illustrations
Illustrations by
Frank H. Netter, MD
John A. Craig, MD
James Perkins, MS, MFA
Text by
John T. Hansen, PhD
Bruce M. Koeppen, MD, PhD

Atlas of Neuroanatomy and Neurophysiology
Selections from the Netter Collection of Medical Illustrations
Copyright ©2002 Icon Custom Communications. All rights reserved.
The contents of this book may not be reproduced in any form without written
authorization from Icon Custom Communications. Requests for permission
should be addressed to Permissions Department, Icon Custom Communications,
295 North St., Teterboro NJ 07608, or can be made at www. Netterart.com.
NOTICE
Every effort has been taken to confirm the accuracy of the information presented.
Neither the publisher nor the authors can be held responsible for errors or for any
consequences arising from the use of the information contained herein, and make
no warranty, expressed or implied, with respect to the contents of the publication.
Printed in U.S.A.

Foreword
Frank Netter: The Physician, The Artist, The Art
This selection of the art of Dr. Frank H. Netter on neuroanatomy and neurophysiology is drawn
from the Atlas of Human Anatomy and Netter’s Atlas of Human Physiology. Viewing these pictures
again prompts reflection on Dr. Netter’s work and his roles as physician and artist.
Frank H. Netter was born in 1906 in New York City. He pursued his artistic muse at the Sorbonne,
the Art Student’s League, and the National Academy of Design before entering medical school at
New York University, where he received his M.D. degree in 1931. During his student years, Dr.
Netter’s notebook sketches attracted the attention of the medical faculty and other physicians, allowing
him
to
augment
his
income
by
illustrating
articles
and
textbooks.
He
continued
illustrating
as
a
sideline
after
establishing
a
surgical
practice
in
1933,
but
ultimately
opted
to
give
up
his
practice
in
favor
of

a full-time commitment to art. After service in the United States Army during the Second
World War, Dr. Netter began his long collaboration with the CIBA Pharmaceutical Company (now
Novartis Pharmaceuticals). This 45-year partnership resulted in the production of the extraordinary
collection of medical art so familiar to physicians and other medical professionals worldwide.
When Dr. Netter’s work is discussed, attention is focused primarily on Netter the artist and only
secondarily on Netter the physician. As a student of Dr. Netter’s work for more than forty years, I can
say that the true strength of a Netter illustration was always established well before brush was laid to
paper. In that respect each plate is more of an intellectual than an artistic or aesthetic exercise. It is
easy to appreciate the aesthetic qualities of Dr. Netter’s work, but to overlook its intellectual qualities
is
to
miss
the
real
strength
and
intent
of
the
art.
This
intellectual
process
requires
thorough
understanding
of
the
topic,
as
Dr.
Netter
wrote:
“Strange
as
it
may
seem,
the
hardest
part
of
making
a
medical
picture
is
not
the
drawing
at
all.
It
is
the
planning,
the
conception,
the
determination
of
point
of
view
and
the
approach
which
will
best
clarify
the
subject
which
takes
the
most
effort.”

Years before the inception of “the integrated curriculum,” Netter the physician realized that a
good medical illustration can include clinical information and physiologic functions as well as anatomy.

In pursuit of this principle Dr. Netter often integrates pertinent basic and clinical science elements

in his anatomic interpretations. Although he was chided for this heresy by a prominent
European anatomy professor, many generations of students training to be physicians rather than
anatomists have appreciated Dr. Netter’s concept.
The integration of physiology and clinical medicine with anatomy has led Dr. Netter to another,
more subtle, choice in his art. Many texts and atlases published during the period of Dr. Netter’s
career depict anatomy clearly based on cadaver specimens with renderings of shrunken and shriveled
tissues
and
organs.
Netter
the
physician
chose
to
render
“live”
versions
of
these
structures—not
shriveled,
colorless,
formaldehyde-soaked
tissues,
but
plump,
robust
organs,
glowing
with
color!

The value of Dr. Netter’s approach is clearly demonstrated by the plates in this selection.
John A. Craig, MD
Austin, Texas


Part 1 Neuroanatomy
Cerebrum—Medial Views. . . . . . . . . . . . . . . . . 2
Cerebrum—Inferior View. . . . . . . . . . . . . . . . . . 3
Basal Nuclei (Ganglia). . . . . . . . . . . . . . . . . . . . 4
Thalamus . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5
Cerebellum . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6
Brainstem . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7
Fourth Ventricle and Cerebellum . . . . . . . . . . . 8
Accessory Nerve (XI) . . . . . . . . . . . . . . . . . . . . 9
Arteries to Brain and Meninges . . . . . . . . . . . 10
Arteries to Brain: Schema . . . . . . . . . . . . . . . . 11
Arteries of Brain: Inferior Views . . . . . . . . . . . 12
Cerebral Arterial Circle (Willis) . . . . . . . . . . . 13
Arteries of Brain: Frontal View and Section . . 14
Arteries of Brain:
Lateral and Medial Views. . . . . . . . . . . . . . . 15
Arteries of Posterior Cranial Fossa . . . . . . . . . 16
Veins of Posterior Cranial Fossa . . . . . . . . . . . 17
Deep Veins of Brain. . . . . . . . . . . . . . . . . . . . . 18
Subependymal Veins of Brain . . . . . . . . . . . . . 19
Hypothalamus and Hypophysis . . . . . . . . . . . 20
Arteries and Veins
of Hypothalamus and Hypophysis . . . . . . . . 21
Relation of Spinal Nerve Roots to Vertebrae . . . 22
Autonomic Nervous System:
General Topography. . . . . . . . . . . . . . . . . . . 23
Spinal Nerve Origin: Cross Sections. . . . . . . . 24
Olfactory Nerve (I): Schema . . . . . . . . . . . . . . 25
Optic Nerve (II)
(Visual Pathway): Schema . . . . . . . . . . . . . . 26
Oculomotor (III), Trochlear (IV)
and Abducent (VI) Nerves: Schema. . . . . . . 27
Trigeminal Nerve (V): Schema . . . . . . . . . . . . 28
Facial Nerve (VII): Schema . . . . . . . . . . . . . . . 29
Vestibulocochlear Nerve (VIII): Schema. . . . . 30
Glossopharyngeal Nerve (IX): Schema . . . . . . 31
Vagus Nerve (X): Schema . . . . . . . . . . . . . . . . 32
Accessory Nerve (XI): Schema . . . . . . . . . . . . 33
Hypoglossal Nerve (XII): Schema . . . . . . . . . . 34
Nerves of Heart . . . . . . . . . . . . . . . . . . . . . . . . 35
Autonomic Nerves
and Ganglia of Abdomen. . . . . . . . . . . . . . . 36
Nerves of Stomach and Duodenum . . . . . . . . 37
Nerves of Stomach
and Duodenum (continued) . . . . . . . . . . . . 38
Nerves of Small Intestine . . . . . . . . . . . . . . . . 39
Nerves of Large Intestine . . . . . . . . . . . . . . . . 40
Nerves of Kidneys,
Ureters and Urinary Bladder . . . . . . . . . . . . 41
Nerves of Pelvic Viscera: Male . . . . . . . . . . . . 42
Nerves of Pelvic Viscera: Female . . . . . . . . . . 43
Median Nerve . . . . . . . . . . . . . . . . . . . . . . . . . 44
Ulnar Nerve . . . . . . . . . . . . . . . . . . . . . . . . . . . 45
Radial Nerve in Arm
and Nerves of Posterior Shoulder . . . . . . . . 46
Radial Nerve in Forearm . . . . . . . . . . . . . . . . . 47
Sciatic Nerve and Posterior
Cutaneous Nerve of Thigh . . . . . . . . . . . . . . 48
Tibial Nerve . . . . . . . . . . . . . . . . . . . . . . . . . . . 49
Common Fibular (Peroneal) Nerve. . . . . . . . . 50

BASIC OF BLOOD

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Basics of Blood
Management
Petra Seeber
MD
Department of Anesthesiology
Critical Care Medicine
Pain Management, Emergency Medicine
HELIOS Klinik Blankenhain
Wirthstr. 5
99444 Blankenhain
Germany
Aryeh Shander
MD, FCCM, FCCP, Chief
Department of Anesthesiology, Critical Care Medicine
Pain Management and Hyperbaric Medicine
Englewood Hospital and Medical Center
350 Engle Street
Englewood, NJ 07631
and
Clinical Professor of Anesthesiology, Medicine and Surgery
Mount Sinai School of Medicine, Mount Sinai Hospital,
New York
first edition

C

2007 Petra Seeber and Aryeh Shander
Published by Blackwell Publishing
Blackwell Publishing, Inc., 350 Main Street, Malden, Massachusetts 02148-5020, USA
Blackwell Publishing Ltd, 9600 Garsington Road, Oxford OX4 2DQ, UK
Blackwell Publishing Asia Pty Ltd, 550 Swanston Street, Carlton, Victoria 3053,
Australia
The right of the Author to be identified as the Author of this Work has been asserted in
accordance with the Copyright, Designs and Patents Act 1988.
All rights reserved. No part of this publication may be reproduced, stored in a retrieval
system, or transmitted, in any form or by any means, electronic, mechanical,
photocopying, recording or otherwise, except as permitted by the UK Copyright,
Designs and Patents Act 1988, without the prior permission of the publisher.
First published 2007
1 2007
Library of Congress Cataloging-in-Publication Data
Seeber, Petra.
Basics of blood management / Petra Seeber, Aryeh Shander. – 1st ed.
p. ; cm.
Includes bibliographical references and index.
ISBN: 978-1-4051-5131-3
1. Transfusion-free surgery. 2. Blood–Transfusion. 3. Bland banks.
I. Shander, Aryeh. II. Title.
[DNLM: 1. Blood Substitutes–therapeutic use. 2. Blood Banks–organization &
administration. 3. Blood Loss, Surgical–prevention & control.
4. Blood Transfusion. WH 450 S451b 2008]
RD33.35.S44 2008
617–dc22
2007005030
ISBN: 978-1-4051-5131-3
A catalogue record for this title is available from the British Library
Set in 9.25/11.5 Minion by Aptara Inc., New Delhi, India
Printed and bound in Singapore by Fabulous Printers Pte Ltd
Development Editor: Rebecca Huxley
Commissioning Editor: Maria Khan
Editorial Assistant: Jennifer Seward
Production Controller: Debbie Wyer
For further information on Blackwell Publishing, visit our website:
http://www.blackwellpublishing.com
The publisher’s policy is to use permanent paper from mills that operate a sustainable
forestry policy, and which has been manufactured from pulp processed using acid-free
and elementary chlorine-free practices. Furthermore, the publisher ensures that the text
paper and cover board used have met acceptable environmental accreditation standards.
Blackwell Publishing makes no representation, express or implied, that the drug
dosages in this book are correct. Readers must therefore always check that any product
mentioned in this publication is used in accordance with the prescribing information
prepared by the manufacturers. The author and the publishers do not accept
responsibility or legal liability for any errors in the text or for the misuse or
misapplication of material in this book.

Contents
Preface to the first edition, vii
Acknowledgments, viii
Introduction, ix
1 History and organization of blood management, 1
2 Physiology of anemia and oxygen transport, 9
3 Anemia therapy I: erythropoiesis stimulating proteins, 21
4 Anemia therapy II (hematinics), 35
5 Growth factors, 50
6 Fluid therapy, 65
7 The chemistry of hemostasis, 77
8 Recombinant blood products, 96
9 Artificial blood components, 110
10 Oxygen therapy, 125
11 Preparation of the patient for surgery, 139
12 Iatrogenic blood loss, 160
13 The physics of hemostasis, 172
14 Anesthesia—more than sleeping, 191
15 The use of autologous blood, 200
16 Cell salvage, 211
17 Blood banking, 227
18 Transfusions. Part I: cellular components and plasma, 243
19 Transfusions. Part II: plasma fractions, 265
20 Law, ethics, religion, and blood management, 287
21 Step by step to an organized blood management program, 299
Appendix A: Detailed information, 322
Appendix B: Sources of information for blood management, 329
Appendix C: Program tools and forms, 334
Appendix D: Teaching aids: research and projects, 346
Appendix E: Address book, 350
Index, 376


Preface to first edition
The benefit-to-risk ratio of blood products needs constant
evaluation. Blood products, as therapeutic agents,
have had the test of time but lack the evidence we expect
from other medicinals. Blood, an organ, is used as
a pharmaceutical agent by the medical profession, due to
the achievements in collection, processing, banking, and
distribution. The fact that the most common risk of blood
transfusion is blood delivery error supports the notion that
blood is handled as a pharmaceutical agent. Over the last
few decades, the risk of blood transfusion and associated
complications has raised concerns about safety of blood
by both the public and health-care providers. At the same
time, experience with patients refusing blood and data on
blood conservation brought to light the real possibility of
other modalities to treat perisurgical anemia and to avoid
it with blood conservation methods. In addition to risks
and complications, data became available demonstrating
the behavioral aspect of transfusion practice versus an
evidence-based practice. In this book, the authors address
many aspects of modern transfusion medicine, known
blood conservation modalities, and new approaches to the
treatment of perisurgical anemia, as well as special clinical
considerations. This approach, now termed “blood management”
by the Society for the Advancement of Blood
Management, incorporates appropriate transfusion practice
and blood conservation to deliver the lowest risk and
highest benefit to the patient. In addition, it brings all
these modalities to the patient’s bedside and above all is a
patient-centered approach. Blood management is a multidisciplinary,
multimodality concept that focuses on the
patient by improving patient outcome, making it one of
the most intriguing and rewarding fields in medicine.
The benefit-to-risk ratio of blood products needs constant
evaluation. Blood products, as therapeutic agents,
have had the test of time but lack the evidence we expect
from other medicinals. Blood, an organ, is used as
a pharmaceutical agent by the medical profession, due to
the achievements in collection, processing, banking, and
distribution. The fact that the most common risk of blood
transfusion is blood delivery error supports the notion that
blood is handled as a pharmaceutical agent. Over the last
few decades, the risk of blood transfusion and associated
complications has raised concerns about safety of blood
by both the public and health-care providers. At the same
time, experience with patients refusing blood and data on
blood conservation brought to light the real possibility of
other modalities to treat perisurgical anemia and to avoid
it with blood conservation methods. In addition to risks
and complications, data became available demonstrating
the behavioral aspect of transfusion practice versus an
evidence-based practice. In this book, the authors address
many aspects of modern transfusion medicine, known
blood conservation modalities, and new approaches to the
treatment of perisurgical anemia, as well as special clinical
considerations. This approach, now termed “blood management”
by the Society for the Advancement of Blood
Management, incorporates appropriate transfusion practice
and blood conservation to deliver the lowest risk and
highest benefit to the patient. In addition, it brings all
these modalities to the patient’s bedside and above all is a
patient-centered approach. Blood management is a multidisciplinary,
multimodality concept that focuses on the
patient by improving patient outcome, making it one of
the most intriguing and rewarding fields in medicine.

CARDIOTORACIC SURGICAL NURSING

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CARING FOR CHILDREN AND FAMILIES (WILEY SERIES IN NURSING)

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Caring for Children
and Families
Edited by
I. PEATE
L. WHITING

Copyright © 2006 John Wiley & Sons Ltd
The Atrium, Southern Gate, Chichester,
West Sussex PO19 8SQ, England
Telephone (+44) 1243 779777
Email (for orders and customer service enquiries): cs-books@wiley.co.uk
Visit our Home Page on www.wiley.com
All Rights Reserved. No part of this publication may be reproduced, stored in a retrieval
system or transmitted in any form or by any means, electronic, mechanical, photocopying,
recording, scanning or otherwise, except under the terms of the Copyright, Designs and Patents
Act 1988 or under the terms of a licence issued by the Copyright Licensing Agency Ltd, 90
Tottenham Court Road, London W1T 4LP, UK, without the permission in writing of the
Publisher. Requests to the Publisher should be addressed to the Permissions Department, John
Wiley & Sons Ltd, The Atrium, Southern Gate, Chichester, West Sussex PO19 8SQ, England, or
emailed to permreq@wiley.co.uk, or faxed to (+44) 1243 770620.
Designations used by companies to distinguish their products are often claimed as trademarks.
All brand names and product names used in this book are trade names, service marks,
trademarks or registered trademarks of their respective owners. The Publisher is not associated
with any product or vendor mentioned in this book.
This publication is designed to provide accurate and authoritative information in regard to the
subject matter covered. It is sold-on the understanding that the Publisher is not engaged in
rendering professional services. If professional advice or other expert assistance is required, the
services of a competent professional should be sought.
Other Wiley Editorial Offices
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Wiley also publishes its books in a variety of electronic formats. Some content that appears in
print may not be available in electronic books.
Library of Congress Cataloging-in-Publication Data
Caring for children and families / edited by Ian Peate, Lisa Whiting.
p. ; cm.
Includes bibliographical references and index.
ISBN-13: 978-0-470-01970-2 (pbk. : alk. paper)
ISBN-10: 0-470-01970-0 (pbk. : alk. paper)
1. Pediatric nursing. I. Peate, Ian. II. Whiting, Lisa. [DNLM: 1. Pediatric
Nursing – methods. 2. Family.
WY 159 C2767 2006]
RJ245.C37 2006
618.92′00231 – dc22
2006004385
A catalogue record for this book is available from the British Library
ISBN-13 978-0-470-01970-2
ISBN-10 0-470-01970-0
Typeset by SNP Best-set Typesetter Ltd., Hong Kong
Printed and bound in Great Britain by TJ International Ltd, Padstow, Cornwall
This book is printed on acid-free paper responsibly manufactured from sustainable forestry in
which at least two trees are planted for each one used for paper production.


Contents
About the Editors ix
About the Contributors xi
Acknowledgements xvii
1 Introduction 1
Ian Peate and Lisa Whiting
2 Children and their Families 7
Lisa Whiting
3 Communicating with Children and Families 25
Peter Vickers
4 Working as a Member of the Child Health Team 49
Lisa Whiting and Ian Peate
5 Health Promotion: A Child-centred Approach 73
Sue Miller
6 Biological Aspects of Child Health Care 91
Pat Harwood
7 Assessment and Monitoring of Children 125
Liz Gormley-Fleming
8 The Importance of Play 155
Mary Donnelly and Julie Robinson
9 Maintaining Safety 171
Cathy Cairns and Liz Gormley-Fleming
10 Accident Prevention 203
Mary Donnelly and Billie Kell
11 Safeguarding Children 221
Dee Harris and Helen Russell-Johnson
12 Legal Concerns 243
Helen Russell-Johnson and Dee Harris
13 Future Aspirations 263
Lyn Karstadt
Glossary of Terms and Abbreviations 279
Index 283

CARING FOR TEH PERIOPERATIVE PATIENTS

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Caring for the
Perioperative Patient
Paul Wicker
Programme Leader
Diploma of Higher Education in Operating
Department Practice
Edge Hill College of Higher Education,
Liverpool
AND
Joy O’Neill
Training and Development Co-ordinator
Theatre Department, Royal Oldham Hospital
Pennine Acute NHS Hospital Trust

© 2006 by Paul Wicker and Joy O’Neill
Blackwell Publishing Ltd
Editorial offices:
Blackwell Publishing Ltd, 9600 Garsington Road, Oxford OX4 2DQ, UK
Tel: +44 (0)1865 776868
Blackwell Publishing Inc., 350 Main Street, Malden, MA 02148-5020, USA
Tel: +1 781 388 8250
Blackwell Publishing Asia Pty Ltd, 550 Swanston Street, Carlton, Victoria
3053, Australia
Tel: +61 (0)3 8359 1011
The right of the Author to be identified as the Author of this Work has
been asserted in accordance with the Copyright, Designs and Patents Act
1988.
All rights reserved. No part of this publication may be reproduced, stored
in a retrieval system, or transmitted, in any form or by any means,
electronic, mechanical, photocopying, recording or otherwise, except as
permitted by the UK Copyright, Designs and Patents Act 1988, without the
prior permission of the publisher.
First published 2006 by Blackwell Publishing Ltd
ISBN-10: 1-4051-2802-X
ISBN-13: 978-1-4051-2802-5
Library of Congress Cataloging-in-Publication Data
Caring for the perioperative patient / Paul Wicker and Joy O’Neill.
p. ; cm.
Includes bibliographical references and index.
ISBN-13: 978-1-4051-2802-5 (alk. paper)
ISBN-10: 1-4051-2802-X (alk. paper)
1. Operating room nursing. 2. Preoperative care. 3. Postoperative care.
I. Wicker, Paul. II. O’Neill, Joy.
[DNLM: 1. Perioperative Care–nursing. 2. Perioperative
Nursing–methods. WY 161 C2778 2005]
RD32.3.C37 2005
2005017356
A catalogue record for this title is available from the British Library
Set in 9 on 11 pt Palatino
by SNP Best-set Typesetter Ltd., Hong Kong
Printed and bound in India
by Replika Press, Pvt Ltd
The publisher’s policy is to use permanent paper from mills that operate a
sustainable forestry policy, and which has been manufactured from pulp
processed using acid-free and elementary chlorine-free practices.
Furthermore, the publisher ensures that the text paper and cover board
used have met acceptable environmental accreditation standards.
For further information on Blackwell Publishing, visit our website:
www.blackwellnursing.com

Contents
Foreword vi
Preface vii
Acknowledgements xii
Section 1 Core Issues 1
1 Perioperative homeostasis 2
2 Managing perioperative equipment 50
3 Perioperative pharmacology 91
4 Perioperative communication 126
5 Managing perioperative risks 160
Section 2 Perioperative Care 195
6 Aroute to enhanced competence in perioperative car
Authored by the NES Perioperative Working Party
7 Preoperative preparation of perioperative patients 8 Patient care during anaesthesia 243
9 Patient care during surgery 297
10 Patient care during recovery 335
Index 366

CLINICAL ANATOMY

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Clinical Anatomy
Arevision and applied anatomy
for clinical students
HAROLD◊ELLIS
CBE, MA, DM, MCh, FRCS, FRCP, FRCOG, FACS (Hon)
Clinical Anatomist, Guy’s, King’s and
St Thomas’ School of Biomedical Sciences;
Emeritus Professor of Surgery, Charing Cross
and Westminster Medical School, London;
Formerly Examiner in Anatomy, Primary FRCS (Eng)
ELEVENTH EDITION

© 2006 Harold Ellis
Published by Blackwell Publishing Ltd
Blackwell Publishing, Inc., 350 Main Street, Malden, Massachusetts 02148-5020, USA
Blackwell Publishing Ltd, 9600 Garsington Road, Oxford OX4 2DQ, UK
Blackwell Publishing Asia Pty Ltd, 550 Swanston Street, Carlton, Victoria 3053,
Australia
The right of the Author to be identified as the Author of this Work has been asserted
in accordance with the Copyright, Designs and Patents Act 1988.
All rights reserved. No part of this publication may be reproduced, stored in a
retrieval system, or transmitted, in any form or by any means, electronic,
mechanical, photocopying, recording or otherwise, except as permitted by the UK
Copyright, Designs and Patents Act 1988, without the prior permission of the
publisher.
First published 1960 Seventh edition 1983
Second edition 1962 Revised reprint 1986
Reprinted 1963 Eighth edition 1992
Third edition 1966 Ninth edition 1992
Fourth edition 1969 Reprinted 2000
Fifth edition 1971 Tenth edition 2002
Sixth edition 1977 Reprinted 2003, 2004
Reprinted 1978, 1980 Greek edition 1969
Eleventh edition 2006
1 2006
Library of Congress Cataloging-in-Publication Data
Data available
ISBN-13: 978-1-4051-3804-8
ISBN-10: 1-4051-3804-1
Acatalogue record for this title is available from the British Library
Set in 9/12 Palatino by SNP Best-set Typesetter Ltd., Hong Kong
Printed and bound in India by Replika Press Pvt Ltd
Commissioning Editor: Martin Sugden
Editorial Assistant: Ellie Bonnett
Development Editor: Mirjana Misina
Production Controller: Kate Charman
For further information on Blackwell Publishing, visit our website:
http://www.blackwellpublishing.com
The publisher’s policy is to use permanent paper from mills that operate a
sustainable forestry policy, and which has been manufactured from pulp processed
using acid-free and elementary chlorine-free practices. Furthermore, the publisher
ensures that the text paper and cover board used have met acceptable
environmental accreditation standards.
Blackwell Publishing makes no representation, express or implied, that the drug
dosages in this book are correct. Readers must therefore always check that any
product mentioned in this publication is used in accordance with the prescribing
information prepared by the manufacturers. The author and the publishers do not
accept responsibility or legal liability for any errors in the text or for the misuse or
misapplication of material in this book.

Contents
Preface, xiii
Acknowledgements, xiv
Part 1:◊The Thorax
Surface anatomy and surface markings, 3
◊◊Surface markings of the more important thoracic contents, 3
The thoracic cage, 7
◊◊The thoracic vertebrae, 7
◊◊The ribs, 7
◊◊The costal cartilages, 10
◊◊The sternum, 11
◊◊The intercostal spaces, 11
◊◊The diaphragm, 14
◊◊The pleurae, 18
The lower respiratory tract, 19
◊◊The trachea, 19
◊◊The bronchi, 23
◊◊The lungs, 23
The mediastinum, 28
◊◊The pericardium, 28
◊◊The heart, 29
◊◊The superior mediastinum, 42
◊◊The oesophagus, 42
◊◊The thoracic duct, 45
◊◊The thoracic sympathetic trunk, 47
On the examination of a chest radiograph, 49
◊◊Radiographic appearance of the heart, 50
Part 2:◊The Abdomen and Pelvis
Surface anatomy and surface markings, 55
◊◊Vertebral levels, 55
◊◊Surface markings, 55
The fasciae and muscles of the abdominal wall, 58
◊◊Fasciae of the abdominal wall, 58
◊◊The muscles of the anterior abdominal wall, 58
◊◊The anatomy of abdominal incisions, 61
◊◊The inguinal canal, 63
Peritoneal cavity, 65
◊◊Intraperitoneal fossae, 68
◊◊The subphrenic spaces, 69
The gastrointestinal tract, 70
◊◊The stomach, 70
◊◊The duodenum, 75
◊◊Small intestine, 77
◊◊Large intestine, 78
◊◊The appendix, 79
◊◊The rectum, 81
◊◊Arterial supply of the intestine, 86
◊◊The portal system of veins, 87
◊◊Lymph drainage of the intestine, 88
◊◊The structure of the alimentary canal, 88
◊◊The development of the intestine and its congenital abnormalities, 90
The gastrointestinal adnexae: liver, gall-bladder and its
ducts, pancreas and spleen, 93
◊◊The liver, 93
◊◊The biliary system, 98
◊◊The gall-bladder, 99
◊◊The pancreas, 101
◊◊The spleen, 104
The urinary tract, 105
◊◊The kidneys, 105
◊◊The ureter, 109
◊◊The embryology and congenital abnormalities of the kidney and
ureter, 110
◊◊The bladder, 112
◊◊The urethra, 115
The male genital organs, 116
◊◊The prostate, 116
◊◊The scrotum, 119
◊◊Testis and epididymis, 119
◊◊Vas deferens (ductus deferens), 123
◊◊The seminal vesicles, 124
The bony and ligamentous pelvis, 124
◊◊The os innominatum, 124
◊◊The sacrum, 125
◊◊The coccyx, 126
◊◊The functions of the pelvis, 126
◊◊Joints and ligamentous connections of the pelvis, 127
◊◊Differences between the male and female pelvis, 128
◊◊Obstetrical pelvic measurements, 128
◊◊Variations of the pelvic shape, 130
The muscles of the pelvic floor and perineum, 132
◊◊The anterior (urogenital) perineum, 133
◊◊The posterior (anal) perineum, 134
The female genital organs, 136
◊◊The vulva, 136
◊◊The vagina, 137
◊◊The uterus, 139
◊◊The Fallopian tubes, 144
◊◊The ovary, 145
◊◊The endopelvic fascia and the pelvic ligaments, 146
◊◊Vaginal examination, 147
◊◊Embryology of the Fallopian tubes, uterus and vagina, 148
The posterior abdominal wall, 149
◊◊The suprarenal glands, 151
◊◊Abdominal aorta, 151
◊◊Inferior vena cava, 153
◊◊Lumbar sympathetic chain, 153
Part 3:◊The Upper Limb
The female breast, 159
◊◊Structure, 159
◊◊Blood supply, 159
◊◊Lymphatic drainage, 159
◊◊Development, 161
Surface anatomy and surface markings of the
upper limb, 162
◊◊Bones and joints, 163
◊◊Muscles and tendons, 164
◊◊Vessels, 166
◊◊Nerves, 167
The bones and joints of the upper limb, 168
◊◊The scapula, 168
◊◊The clavicle, 168
◊◊The humerus, 169
◊◊The radius and ulna, 171
◊◊The bones of the hand, 174
◊◊The shoulder, 176
◊◊The elbow joints, 180
◊The wrist joint, 183
◊◊The joints of the hand, 184
The arteries of the upper limb, 186
◊◊The axillary artery, 186
◊◊The brachial artery, 187
◊◊The radial artery, 187
◊◊The ulnar artery, 188
The brachial plexus, 189
◊◊The segmental cutaneous supply of the upper limb, 191
The course and distribution of the principal nerves of the
upper limb, 191
◊◊The axillary nerve, 191
◊◊The radial nerve, 192
◊◊Branches, 194
◊◊The musculocutaneous nerve, 194
◊◊The ulnar nerve, 194
◊◊The median nerve, 195
The anatomy of upper limb deformities, 197
The spaces of the hand, 200
◊◊The superficial pulp space of the fingers, 200
◊◊The ulnar and radial bursae and the synovial tendon sheaths of the
fingers, 201
Part 4:◊The Lower Limb
The anatomy and surface markings of the lower limb, 207
◊◊Bones and joints, 207
◊◊Bursae of the lower limb, 207
◊◊Mensuration in the lower limb, 208
◊◊Muscles and tendons, 211
◊◊Vessels, 211
◊◊Nerves, 214
The bones and joints of the lower limb, 216
◊◊The os innominatum, 216
◊◊The femur, 216
◊◊The patella, 220
◊◊The tibia, 223
◊◊The fibula, 224
◊◊Anote on growing ends and nutrient foramina in the long bones, 225
◊◊The bones of the foot, 225
◊◊The hip, 226
◊◊The knee joint, 229
◊◊The tibiofibular joints, 233
◊◊The ankle, 233
◊◊The joints of the foot, 234
◊◊The arches of the foot, 235
◊◊The anatomy of walking, 237
Three important zones of the lower limb—the femoral
triangle, adductor canal and popliteal fossa, 237
◊◊The femoral triangle, 237
◊◊The fascia lata, 238
◊◊The femoral sheath and femoral canal, 238
◊◊Femoral hernia, 239
◊◊The lymph nodes of the groin and the lymphatic drainage of the lower
limb, 241
◊◊The adductor canal (of Hunter) or subsartorial canal, 242
◊◊The popliteal fossa, 242
The arteries of the lower limb, 244
◊◊Femoral artery, 244
◊◊Popliteal artery, 246
◊◊Posterior tibial artery, 246
◊◊Anterior tibial artery, 246
The veins of the lower limb, 247
◊◊Clinical features, 249
The course and distribution of the principal nerves of the
lower limb, 249
◊◊The lumbar plexus, 250
◊◊The sacral plexus, 251
◊◊The sciatic nerve, 253
◊◊The tibial nerve, 255
◊◊The common peroneal (fibular) nerve, 255
◊◊Segmental cutaneous supply of the lower limb, 256
Part 5:◊The Head and Neck
The surface anatomy of the neck, 261
◊◊The fascial compartments of the neck, 262
The thyroid gland, 264
◊◊The parathyroid glands, 267
The palate, 270
◊◊The development of the face, lips and palate with special reference to
their congenital deformities, 270
The tongue and floor of the mouth, 272
◊◊The tongue, 272
◊◊The floor of the mouth, 276
The pharynx, 277
◊◊The nasopharynx, 277
◊◊The oropharynx, 278
◊◊The palatine tonsils, 279
◊◊The laryngopharynx, 280
◊◊The mechanism of deglutition, 282
The larynx, 284
◊◊Blood supply, 287
◊◊Lymph drainage, 287
◊◊Nerve supply, 288
The salivary glands, 289
◊◊The parotid gland, 289
◊◊The submandibular gland, 292
◊◊The sublingual gland, 293
The major arteries of the head and neck, 294
◊◊The common carotid arteries, 294
◊◊The external carotid artery, 294
◊◊The internal carotid artery, 296
◊◊The subclavian arteries, 298
The veins of the head and neck, 301
◊◊The cerebral venous system, 301
◊◊The venous sinuses of the dura, 301
◊◊The internal jugular vein, 303
◊◊The subclavian vein, 305
The lymph nodes of the neck, 306
The cervical sympathetic trunk, 308
The branchial system and its derivatives, 310
◊◊Branchial cyst and fistula, 310
The surface anatomy and surface markings of the head, 31
The scalp, 312
The skull, 314
◊◊Development, 316
The accessory nasal sinuses, 318
◊◊The frontal sinuses, 318
◊◊The maxillary sinus (antrum of Highmore), 319
◊◊The ethmoid sinuses, 320
◊◊The sphenoid sinuses, 321
The mandible, 321
◊◊The temporomandibular joint, 322
◊◊The teeth, 323
The vertebral column, 324
◊◊The cervical vertebrae, 325
◊◊The thoracic vertebrae, 327
◊◊The lumbar vertebrae, 327
◊◊The sacrum, 327
◊◊The coccyx, 327
◊◊The intervertebral joints, 328
Part 6:◊The Central Nervous System
The spinal cord, 333
◊◊Age differences, 333
◊◊Structure, 333
◊◊Descending tracts, 334
◊◊Ascending tracts, 336
◊◊The membranes of the cord (the meninges), 337
The brain, 339
◊◊The medulla, 339
◊◊The pons, 342
◊◊The cerebellum, 342
◊◊The midbrain, 344
◊◊The diencephalon, 346
◊◊The hypothalamus, 346
◊◊The pituitary gland (hypophysis cerebri), 347
◊◊The thalamus, 349
◊◊The cerebral hemispheres, 349
◊◊The cerebral cortex, 349
◊◊The insula, 352
◊◊The connections of the cerebral cortex, 352
◊◊The basal ganglia, 353
◊◊The long ascending and descending pathways, 354
◊◊The membranes of the brain (the meninges), 360
◊◊The ventricular system and the cerebrospinal fluid circulation, 361
The cranial nerves, 364
◊◊The olfactory nerve (I), 364
◊◊The optic nerve (II) and the visual pathway, 365
◊◊The oculomotor nerve (III), 366
◊◊The trochlear nerve (IV), 368
◊◊The trigeminal nerves (V), 369
◊◊The abducent nerve (VI), 374
◊◊The facial nerve (VII), 375
◊◊The auditory (vestibulocochlear) nerve (VIII), 377
◊◊The glossopharyngeal nerve (IX), 379
◊◊The vagus nerve (X), 379
◊◊The accessory nerve (XI), 381
◊◊The hypoglossal nerve (XII), 381
The special senses, 383
◊◊The nose, 383
◊◊The ear, 384
◊◊The eye and associated structures, 388
The autonomic nervous system, 393
◊◊Visceral afferents, 396
◊◊The sympathetic system, 396
◊◊The sympathetic trunk, 396
◊◊The parasympathetic system, 399
Glossary of eponyms, 403
Index, 409

CLINICAL APPLICATION OF NURSING DIAGNOSIS

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NURSING DIAGNOSES
ACCEPTED FOR USE AND RESEARCH (2007-2008)
Activity Intolerance [specify level], 283
Activity Intolerance, risk for, 283
Airway Clearance, ineffective, 292
Allergy Response, latex, 70
Allergy response, latex, risk for, 70
Anxiety [specify level], 530
Anxiety, death, 548
Aspiration, risk for, 136
Attachment, risk for impaired
parent/infant/child, 659
Autonomic Dysreflexia, 299
Autonomic Dysreflexia, risk for, 299
Body Image, disturbed, 541
Body Temperature, risk for imbalanced, 139
Bowel Incontinence, 236
Breastfeeding, effective, 144
Breastfeeding, ineffective, 148
Breastfeeding, interrupted, 152
Breathing Pattern, ineffective, 307
Cardiac Output, decreased, 313
Caregiver Role Strain, 618
Caregiver Role Strain, risk for, 618
Communication, impaired verbal, 626
Communication, readiness for enhanced, 626
Conflict, parental role, 463
Confusion, acute, 454
Confusion, risk for acute, 454
Confusion, chronic, 454
Constipation, 240
Constipation, perceived, 240
Constipation, risk for, 240
Coping, defensive, 771
Coping, ineffective, 772
Coping, readiness for enhanced, 767
Coping, ineffective community, 756
Coping, readiness for enhanced community, 756
Coping, compromised family, 760
Coping, disabled family, 760
Coping, readiness for enhanced family, 767
Death Syndrome, risk for sudden infant, 111
Decisional Conflict (specify), 463
Denial, ineffective, 781
Dentition, impaired, 155
Development, risk for delayed, 353
Diarrhea, 248
Disuse Syndrome, risk for, 321
Diversional Activity, deficient, 327
Energy Field, disturbed (revised), 36
Environmental Interpretation Syndrome,
impaired, 469
Failure to Thrive, adult, 127
Falls, risk for,
336
Family Processes: alcoholism, dysfunctional, 635
Family Processes, interrupted, 635
Family Processes, readiness for enhanced, 635
Fatigue, 340
Fear (specify focus), 553
Fluid Balance, readiness for enhanced, 158
[Fluid Volume, deficient hyper/hypotonic]
Fluid Volume, deficient [isotonic], 161
Fluid Volume, excess, 167
Fluid Volume, risk for deficient, 161
Fluid Volume risk for imbalanced, 173
Gas Exchange, impaired, 346
Grieving, 646
Grieving, complicated, 654
Grieving, risk for complicated, 654
Growth, risk for disproportionate, 353
Growth & Development, delayed, 353
Health Maintenance, ineffective, 42
Health-Seeking Behaviors (specify), 49
Home Maintenance, impaired, 360
Hope, readiness for enhanced, 523
Hopelessness, 562
Hyperthermia, 176
Hypothermia, 182
Identify, disturbed personal, 575
Infant Behavior, disorganized, 365
Infant Behavior, organized, readiness
for enhanced, 365
Infant Behavior, risk for disorganized, 365
Infant Feeding Pattern, ineffective, 186
Infection, risk for, 54
Injury, risk for, 59
Injury, risk for perioperative positioning, 96
Intracranial Adaptive Capacity, decreased, 450
Knowledge, deficient [Learning Need]
[specify], 474
Knowledge [specify], readiness for enhanced, 474
Lifestyle, sedentary, 381
Loneliness, risk for, 569
Memory, impaired, 482
Mobility, impaired bed, 304
Mobility, impaired physical, 373
Mobility, impaired wheelchair, 415
Nausea, 189
Noncompliance, [Adherence, ineffective]
[specify], 80
Nutrition, less than body requirements,
imbalanced, 194
Nutrition, more than body requirements,
imbalanced, 204
Nutrition, readiness for enhanced, 193
Nutrition, more than body requirements, risk for
imbalanced, 204
Oral Mucous Membrane, impaired, 216
Pain, acute, 483
Pain, chronic, 483
Parenting, impaired, 662
Parenting, readiness for enhanced, 662
Parenting, risk for impaired, 662
Perioperative Positioning, risk for, 96
Peripheral Neurovascular Dysfunction, risk for, 370
Poisoning, risk for, 60
Post-Trauma Syndrome [specify stage], 785
Post-Trauma Syndrome, risk for, 785
Powerlessness [specify level], 579
Powerlessness, risk for, 579
Protection, ineffective, 100
Rape-Trauma Syndrome, 717
Rape-Trauma Syndrome: compound reaction, 717
Rape-Trauma Syndrome: silent reaction, 717
Religiosity, impaired, 802
Religiosity, risk for impaired, 802
Religiosity, readiness for enhanced, 807
Relocation Stress Syndrome, 673
Relocation Stress Syndrome, risk for, 673
Role Performance, ineffective, 678
Self-Care Deficit: bathing/hygiene, 386
Self-Care Deficit: dressing/grooming, 386
Self-Care Deficit: feeding, 386
Self-Care Deficit: toileting, 386
Self-Care, readiness for enhanced, 386
Self-Concept, readiness for enhanced, 586
Self-Esteem, chronic low, 590
Self Esteem, situational low, 590
Self Esteem, risk for situational low, 590
Self-Mutilation, 598
Self-Mutilation, risk for, 598
Sensory Perception, disturbed: (specify: visual,
auditory, kinesthetic, gustatory, tactile,
olfactory), 497
Sexual Dysfunction, 725
Sexuality Pattern, ineffective, 731
Skin Integrity, impaired, 216
Skin Integrity, risk for impaired, 216
Sleep, readiness for enhanced, 437
Sleep Deprivation, 425
Social Interaction, impaired, 684
Social Isolation, 688
Sorrow, chronic, 695
Spiritual Distress, 812
Spiritual Distress, risk for, 818
Spiritual Well-Being, readiness for enhanced, 824
Stress Overload, 740
Suicide, risk for, 791
Surgical Recovery, delayed, 107
Swallowing, impaired, 209
Therapeutic Regimen Management, effective, 75
Therapeutic Regimen Management, ineffective, 80
Therapeutic Regimen Management, ineffective
community, 80
Therapeutic Regimen Management, ineffective
family, 80
Therapeutic Regimen Management, readiness for
enhanced, 92
Thermoregulation, ineffective, 213
Thought Processes, disturbed, 506
Tissue Integrity, impaired, 216
Tissue Perfusion, ineffective (specify type: cerebral,
cardiopulmonary, renal, gastrointestinal,
peripheral), 396
Transfer Ability, impaired, 406
Unilateral Neglect Syndrome, 514
Urinary Elimination, readiness for enhanced, 252
Urinary Incontinence, functional, 254
Urinary Incontinence, reflex, 254
Urinary Incontinence, stress, 254
Urinary Incontinence, total, 254
Urinary Incontinence, urge, 255
Urinary Incontinence, risk for urge, 255
Urinary Retention [acute/chronic], 263
Ventilation, impaired spontaneous, 393
Ventilatory Weaning Response, dysfunctional, 332
Violence, [actual/] risk for other-directed, 700
Violence, [actual/] risk for self-directed, 700
Walking, impaired, 408
Wandering [specify sporadic or continual], 411
[ ] author recommendations
Used with permission from NANDA International:
Definitions and Classification, 2007-2008. NANDA,
Philadelphia, PA 2007
New from NANDA 2007-2008
Blood Sugar, risk for unstable
Comfort, readiness for enhanced
Contamination
Contamination, risk for
Decision-Making, readiness for enhanced
Glucose, risk for unstable level
Health Behavior, risk prone
Human Dignity, risk for compromised
Immunization Status, readiness for enhanced
Insomnia
Liver Function, risk for impaired
Moral Distress
Power, readiness for enhanced
Suffocation, risk for
Trauma, risk for
Urinary Elimination, impaired
Urinary Incontinence, overflow

GORDON’S FUNCTONAL
HEALTH PATTERNS*
HEALTH PERCEPTION-HEALTH
MANAGEMENT PATTERN
Disturbed energy field, 36
Effective therapeutic regimen management, 75
Health-seeking behaviors (specify), 49
Ineffective community therapeutic regimen
management, 80
Ineffective family therapeutic regimen
management, 80
Ineffective health maintenance, 42
Ineffective protection, 100
Ineffective therapeutic regimen management, 80
Noncompliance (specify), 80
Readiness for enhanced immunization status, 30
Readiness for enhanced therapeutic regimen
management, 92
Risk for falls, 336
Risk for infection, 54
Risk for injury (trauma), 59
Risk for perioperative positioning injury, 96
Risk for suffocation, 60
Risk for poisoning, 60
Sudden infant death syndrome, 111–115
NUTRITIONAL-METABOLIC PATTERN
Adult failure to thrive, 127
Deficient fluid volume, 161
Effective breastfeeding, 144
Excess fluid volume, 167
Hyperthermia, 176
Hypothermia, 182
Imbalanced nutrition: more than body
requirements, 204
Imbalanced nutrition: less than body
requirements, 194
Impaired dentition, 155
Impaired oral mucous membrane, 216
Impaired skin integrity, 216
Impaired swallowing, 209
Impaired tissue integrity (specify type), 216
Ineffective breastfeeding, 148
Ineffective infant feeding pattern, 186
Ineffective thermoregulation, 213
Interrupted breastfeeding, 152
Latex allergy response, 70
Nausea, 189
Readiness for enhanced fluid balance, 158
Readiness for enhanced nutrition, 193
Risk for aspiration, 136
Risk for deficient fluid volume, 161
Risk for imbalanced fluid volume, 173
Risk for imbalanced body temperature, 139
Risk for imbalanced nutrition: more than body
requirements, 204
Risk for impaired skin integrity, 216
Risk for latex allergy response, 70
ELIMINATION PATTERN
Bowel incontinence, 236
Constipation, 240
Diarrhea, 248
Functional urinary incontinence, 254
Perceived constipation, 240
Readiness for enhanced urinary elimination, 252
Reflex urinary incontinence, 254
Risk for constipation, 240
Risk for urge urinary incontinence, 255
Stress urinary incontinence, 254
Total incontinence, 254
Urge urinary incontinence, 255
Urinary retention, 263
ACTIVITY-EXERCISE PATTERN
Activity intolerance, 283
Autonomic dysreflexia, 299
Decreased cardiac output, 313
Decreased intracranial adaptive capacity, 450
Deficient diversonal activity, 327
Delayed growth and development, 353
Delayed surgical recovery, 107
Disorganized infant behavior, 365
Dysfunctional ventilatory weaning response, 331
Fatigue, 340
Impaired spontaneous ventilation, 393
Impaired bed mobility, 304
Impaired gas exchange, 346
Impaired home maintenance, 360
Impaired physical mobility, 373
Impaired transfer ability, 406
Impaired walking, 408
Impaired wheelchair mobility, 415
Ineffective airway clearance, 292
Ineffective breathing pattern, 307
Ineffective tissue perfusion (specify), 396
Readiness for enhanced organized infant behavior, 365
Readiness for enhanced self care, 386
Risk for delayed development, 353
Risk for disorganized infant behavior, 365
Risk for disproportionate growth, 353
Risk for activity intolerance, 283
Risk for autonomic dysreflexia, 299
Risk for disuse syndrome, 321
Risk for peripheral neurovascular dysfunction, 370
Sedentary lifestyle, 381
Self-care deficit (specify: bathing/hygiene,
dressing/grooming, feeding, toileting), 386
Wandering, 411
SLEEP-REST PATTERN
Disturbed sleep pattern, 431
Readiness for enhanced sleep, 437
Sleep deprivation, 425
COGNITIVE-PERCEPTUAL
PATTERN
Acute confusion, 454
Acute pain, 483
Chronic confusion, 454
Chronic pain, 483
Decisional conflict (specify), 463
Deficient knowledge (specify), 474
Disturbed sensory perception (specify), 497
Disturbed thought processes, 506
Impaired environmental interpretation
syndrome, 469
Impaired memory, 480
Readiness for enhanced knowledge (specify), 474
Risk for acute confusion, 454
Unilateral neglect, 514
SELF-PERCEPTION AND SELFCONCEPT
PATTERN
Anxiety, 527
Body image disturbed, 541
Chronic low self-esteem, 590
Death anxiety, 548
Disturbed personal identity, 575
Fear, 553
Hopelessness, 562
Powerlessness, 579
Readiness for enhanced hope, 523
Readiness for enhanced self-concept, 586
Risk for loneliness, 569
Risk for violence, self-directed, 700
Risk for powerlessness, 579
Risk for situational low self-esteem, 590
Situational low self-esteem, 590
ROLE-RELATIONSHIP PATTERN
Anticipatory grieving, 654
Caregiver role strain, 618
Chronic sorrow, 695
Dysfunctional family processes: alcoholism, 635
Dysfunctional grieving, 654
Impaired parenting, 662
Impaired social interaction, 684
Impaired verbal communication, 626
Ineffective role performance, 678
Interrupted family processes, 635
Parental role conflict, 662
Readiness for enhanced communication, 626
Readiness for enhanced family processes, 635
Readiness for enhanced parenting, 662
Relocation stress syndrome, 673
Risk for caregiver role strain, 618
Risk for violence directed at others, 700
Risk for dysfunctional grieving, 654
Risk for impaired parent/infant/child
attachment, 659
Risk for impaired parenting, 662
Risk for relocation stress syndrome, 673
Social isolation, 688
SEXUALITY-REPRODUCTIVE PATTERN
Ineffective sexuality patterns, 731
Rape-trauma syndrome, 717
Rape-trauma syndrome: compound reaction, 717
Rape-trauma syndrome: silent reaction, 717
Sexual dysfunction, 718
COPING-STRESS TOLERANCE
PATTERN
Compromised family coping, 760
Defensive coping, 771
Disabled family coping, 760
Impaired adjustment, 747
Ineffective community coping, 756
Ineffective coping, 772
Ineffective denial, 781
Post-trauma syndrome, 785
Readiness for enhanced community coping, 756
Readiness for enhanced coping, 767
Readiness for enhanced family coping, 767
Risk for self-mutilation, 598
Risk for suicide, 791
Risk for post-trauma syndrome, 785
Self-mutilation, 598
Stress overload, 740
VALUE-BELIEF PATTERN
Impaired religiosity, 804
Readiness for enhanced religiosity, 808
Readiness for enhanced spiritual well-being, 824
Risk for impaired religiosity, 804
Risk for spiritual distress, 818
Spiritual distress, 812
*Modified by Marjory Gordon, 2007, with permission.
†New from NANDA 2007-2008
Contamination
Risk for exposure to contamination
Risk for impaired liver function
Risk for unstable blood glucose
Impaired urinary elimination
Overflow urinary incontinence
Readiness for enhanced comfort
Readiness for enhanced decision-making
Readiness for enhanced power
Risk for compromised human dignity
Moral distress


COX’S CLINICAL
APPLICATIONS OF
NURSING DIAGNOSIS

COX’S CLINICAL
APPLICATIONS OF
NURSING DIAGNOSIS
Adult, Child, Women’s, Mental Health,
Gerontic, and Home Health Considerations
Susan A. Newfield, PhD, RN, APRN, BC
Associate Professor
West Virginia University
Morgantown, West Virginia
Mittie D. Hinz, MSN, MBA, RNC
Partner
DXT Consulting
San Antonio, Texas
Program Administrator
Hamot For Women
Hamot Medical Center
Erie, Pennsylvania
Donna Scott Tilley, RN, PhD, CNE
Associate Professor
Texas Christian University
Fort Worth, Texas
Kathryn L. Sridaromont, RN, C, MSN
Assistant Professor
Texas Tech University Health Sciences Center
Lubbock, Texas
Patricia Joy Maramba, MSN, RN, APRN, BC
Senior Lecturer
West Virginia University
Morgantown, West Virginia

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Library of Congress Cataloging-in-Publication Data
Cox’s clinical applications of nursing diagnosis : adult, child, women’s, mental health,
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Rev. ed. of: Clinical applications of nursing diagnosis. 4th ed. c2002.
Includes bibliographical references and index.
ISBN-13: 978-0-8036-1655-4
ISBN-10: 0-8036-1655-4
1. Nursing diagnosis. 2. Nursing assessment. 3. Nursing. I. Cox, Helen C. II. Newfield, Susan A.
III. Clinical applications of nursing diagnosis. IV. Title: Clinical applications of nursing diagnosis.
[DNLM: 1. Nursing Diagnosis. 2. Nursing Process. WY 100.4 C879 2007]
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PREFACE TO THE FIFTH EDITION
Although the fifth edition of this book has seen many author changes, our commitment
and direction was clearly stated by, Dr. Helen Cox, in the preface to the fourth edition. We
continue our commitment to providing a nursing focus to the process of nursing care.
The fifth edition reflects seventeen new and six revised diagnoses accepted by
NANDA in 2003 and 2005 and updated information in each chapter. The chapter formats
remain the same. We have revised the integration of NANDA, NIC, and NOC terminology
to assist with understanding their integration. NANDA, NIC, and NOC concepts are
placed in charts which identify the linkages that can be found at the beginning of each
chapter. Evaluation guidance has also been revised. We provided a master evaluation flow
chart in Chapter 1 rather than providing one at the end of each care plan.
Two significant trends have impacted the practice of nursing since the fourth edition;
decreasing length of stay and increased emphasis on evidence based practice. The length
of stay continues to decrease and this is reflected in our revision of goals, interventions,
and discharge planning. As we developed care plans, current average length of stay for the
setting was the litmus test for our selection of interventions. The interventions for each
diagnosis reflect both current research in the area and recommended NIC interventions.
If you are new to nursing diagnosis, we encourage you to begin your journey with
reading Chapter 1. Taking a few minutes to do this will provide you with an understanding
of the authors’ thought processes that will facilitate your use of the book.
We continue to appreciate the comments from nursing faculty, staff and students
who use the book. Your thoughtful comments have inspired each edition and we urge you
to continue to support us in this way. It is our sincerest wish that this book will continue
to provide a map for your journey in providing excellent client care.
Susan A. Newfield, PhD, RN, APRN, BC

CONTENTS
CHAPTER 1INTRODUCTION 1
WHY THIS BOOK?   2
THE NURSING PROCESS   2
Purpose   2
Definition   3
Role in Planning Care   3
Care Plan versus Planning of Care   5
NURSING PROCESS STEPS   5
Assessment   5
Diagnosis   7
Planning   8
Implementation   9
Documentation   11
Evaluation   13
NURSING PROCESS AND CONCEPTUAL
FRAMEWORKS   14
Nursing Models   14
Patterns   14
VALUE PLANNING OF CARE AND
CARE PLANS   22
SUMMARY   23
CHAPTER 2HEALTH PERCEPTION–
HEALTH MANAGEMENT PATTERN 25
PATTERN DESCRIPTION   26
PATTERN ASSESSMENT   26
CONCEPTUAL INFORMATION   26
DEVELOPMENTAL CONSIDERATIONS   29
APPLICABLE NURSING DIAGNOSES   36
Energy Field, Disturbed   36
Health Maintenance, Ineffective   42
Health-Seeking Behaviors (Specify)   49
Infection, Risk for   54
Injury, Risk for   59
Latex Allergy Response, Risk for and Actual   70
Management of Therapeutic Regimen,
Effective   75
Management of Therapeutic Regimen
(Individual, Family, Community), Ineffective   80
Management, Readiness for Enhanced
Therapeutic Regimen    92
Perioperative-Positioning Injury, Risk for   96
Protection, Ineffective   100
Surgical Recovery, Delayed   107
Sudden Infant Death Syndrome,
Risk for   111
CHAPTER 3NUTRITIONAL–METABOLIC
PATTERN 119
PATTERN DESCRIPTION   120
PATTERN ASSESSMENT   120
CONCEPTUAL INFORMATION   121
DEVELOPMENTAL CONSIDERATIONS   123
APPLICABLE NURSING DIAGNOSES   131
Adult Failure to Thrive   131
Aspiration, Risk for   135
Body Temperature, Imbalanced,
Risk for   139
Breastfeeding, Effective   144
Breastfeeding, Ineffective   148
Breastfeeding, Interrupted   152
Dentition, Impaired   155
Fluid Balance, Readiness for Enhanced  158
Fluid Volume, Deficient, Risk for
and Actual   161
Fluid Volume, Excess   167
Fluid Volume, Imbalanced,
Risk for   173
Hyperthermia   176
Hypothermia   182
Infant Feeding Pattern, Ineffective   186
Nausea   189
Nutrition, Readiness for Enhanced   192
Nutrition, Imbalanced, Less Than Body
Requirements   194
Nutrition, Imbalanced, More Than Body
Requirements, Risk for and Actual   204
Swallowing, Impaired   209
Thermoregulation, Ineffective   213
Tissue Integrity, Impaired   216
CHAPTER 4ELIMINATION
PATTERN 229
PATTERN DESCRIPTION   230
PATTERN ASSESSMENT   230
CONCEPTUAL INFORMATION   230
DEVELOPMENTAL CONSIDERATIONS   233
APPLICABLE NURSING DIAGNOSES   236
Bowel Incontinence   236
Constipation, Risk for, Actual, and Perceived   240
Diarrhea   248
Readiness for Enhanced Urinary Elimination   252
Urinary Incontinence   254
Urinary Retention   263
CHAPTER 5ACTIVITY–EXERCISE
PATTERN 269
PATTERN DESCRIPTION   270
PATTERN ASSESSMENT   270
CONCEPTUAL INFORMATION   271
DEVELOPMENTAL CONSIDERATIONS   272
APPLICABLE NURSING DIAGNOSES   283
Activity Intolerance, Risk for and Actual   283
Airway Clearance, Ineffective   292
Autonomic Dysreflexia, Risk for and Actual   299
Bed Mobility, Impaired   304
Breathing Pattern, Ineffective   307
Cardiac Output, Decreased   313
Disuse Syndrome, Risk for   321
Diversional Activity, Deficient   327
Dysfunctional Ventilatory Weaning Response
(DVWR)   331
Falls, Risk for   336
Fatigue   340
Gas Exchange, Impaired   346
Growth and Development, Delayed;
Disproportionate Growth, Risk for; Delayed
Development, Risk for   353
Home Maintenance, Impaired   360
Infant Behavior, Disorganized, Risk
for and Actual, and Readiness for Enhanced
Organized   365
Peripheral Neurovascular Dysfunction,
Risk for   370
Physical Mobility, Impaired   373
Sedentary Lifestyle   381
Self-Care Deficit (Feeding, Bathing-Hygiene,
Dressing-Grooming, Toileting)   386
Spontaneous Ventilation, Impaired   393
Tissue Perfusion, Ineffective (Specify Type: Renal,
Cerebral, Cardiopulmonary, Gastrointestinal,
Peripheral)   396
Transfer Ability, Impaired   406
Walking, Impaired   408
Wandering   411
Wheelchair Mobility, Impaired   415
CHAPTER 6SLEEP–REST
PATTERN 421
PATTERN DESCRIPTION   422
PATTERN ASSESSMENT   422
CONCEPTUAL INFORMATION   422
DEVELOPMENTAL CONSIDERATIONS   423
APPLICABLE NURSING DIAGNOSES   425
Sleep Deprivation   425
Sleep Pattern, Disturbed   431
Sleep, Readiness for Enhanced   437
CHAPTER 7COGNITIVE–PERCEPTUAL
PATTERN 441
PATTERN DESCRIPTION   442
PATTERN ASSESSMENT   442
CONCEPTUAL INFORMATION   442
DEVELOPMENTAL CONSIDERATIONS   443
APPLICABLE NURSING DIAGNOSES   450
Adaptive Capacity, Intracranial,
Decreased   450
Confusion, Acute and Chronic   454
Decisional Conflict (Specify)   463
Environmental Interpretation Syndrome,
Impaired   469
Knowledge, Deficient (Specify)   474
Knowledge, Readiness for Enhanced   479
Memory, Impaired   482
Pain, Acute and Chronic   486
Sensory Perception, Disturbed (Specify: Visual,
Auditory, Kinesthetic, Gustatory, Tactile,
Olfactory)   497
Thought Process, Disturbed   506
Unilateral Neglect   514
CHAPTER 8SELF–PERCEPTION AND
SELF–CONCEPT PATTERN 519
PATTERN DESCRIPTION   520
PATTERN ASSESSMENT   520
CONCEPTUAL INFORMATION   520
DEVELOPMENTAL CONSIDERATIONS   523
APPLICABLE NURSING DIAGNOSES   530
Anxiety   530
Body Image, Disturbed   541
Death Anxiety   548
Fear   553
Hopelessness   562
Loneliness, Risk for   569
Personal Identity, Disturbed   575
Powerlessness, Risk for and Actual   579
Self-Concept, Readiness for
Enhanced   586
Self-Esteem, Chronic Low, Situational Low, and
Risk for Situational Low   590
Self-Mutilation, Risk for and Actual   598
CHAPTER 9ROLE—RELATIONSHIP
PATTERN 605
PATTERN DESCRIPTION   606
PATTERN ASSESSMENT   606
CONCEPTUAL INFORMATION   607
DEVELOPMENTAL CONSIDERATIONS   608
APPLICABLE NURSING DIAGNOSES   618
Caregiver Role Strain, Risk for and Actual   618
Communication, Impaired Verbal and Readiness
for Enhanced   626
Family Processes, Interrupted, and Family
Processes, Dysfunctional: Alcoholism and
Readiness for Enhanced   635
Grieving, Anticipatory   646
Grieving, Dysfunctional, Risk for and Actual   654
Parent, Infant, and Child Attachment, Impaired,
Risk for   659
Parenting, Impaired, Risk for and Actual,
Readiness for Enhanced and Parental Role
Conflict   662
Relocation Stress Syndrome, Risk for and
Actual   673
Role Performance, Ineffective   678
Social Interaction, Impaired   684
Social Isolation   688
Sorrow, Chronic   695
Violence, Self-Directed and Other-Directed, Risk
for   700
CHAPTER 10 SEXUALITY–
REPRODUCTIVE PATTERN 713
PATTERN DESCRIPTION   714
PATTERN ASSESSMENT   714
CONCEPTUAL INFORMATION   714
DEVELOPMENTAL CONSIDERATIONS   715
APPLICABLE NURSING DIAGNOSES   717
Rape-Trauma Syndrome: Compound Reaction and
Silent Reaction   717
Sexual Dysfunction   725
Sexuality Patterns, Ineffective   731
CHAPTER 11 COPING–STRESS
TOLERANCE PATTERN 739
PATTERN DESCRIPTION   740
PATTERN ASSESSMENT   740
CONCEPTUAL INFORMATION   740
DEVELOPMENTAL CONSIDERATIONS   742
APPLICABLE NURSING DIAGNOSES   747
Adjustment, Impaired   747
Community Coping, Ineffective and Readiness for
Enhanced   756
Family Coping, Compromised and Disabled   760
Family Coping, Readiness for Enhanced   767
Coping, Ineffective and Readiness for
Enhanced   771
Post-Trauma Syndrome, Risk for and Actual   785
Suicide, Risk for   791
CHAPTER 12 VALUE–BELIEF
PATTERN 799
PATTERN DESCRIPTION   800
PATTERN ASSESSMENT   800
CONCEPTUAL INFORMATION   800
DEVELOPMENTAL CONSIDERATIONS   802
APPLICABLE NURSING DIAGNOSES   804
Religiosity, Impaired   804
Religiosity, Readiness for Enhanced   808
Religiosity, Risk for Impaired   811
Spiritual Distress,   812
Spiritual Distress, Risk for   818
Spiritual Well-Being, Readiness for
Enhanced   824
APPENDIX A: NANDA’S AXES
DEFINITIONS 829
A
PPENDIX B: ADMISSION ASSESSMENT
FORM AND SAMPLE 831
INDEX 853