KOZIERAND ERB'S FUNDAMENTALS OF

FIRST AUSTRAlIAN EDITION

VOLUME ONE Cover art Roben 5lUurman is a Noongar from Western Australia who does Aboriginal an as a result of meet­ ing hi s birth mother in 1994. He is from th e Stolen Generations. The cover of this book is adapted from one of his paintings called Pathways th rough the Sea. Thi painting shows that knowing o ne's ability in un environment reflects knowing what to do in situoti ons and circumstances-in thi s case kn owi ng the seasons and cycles of the sea. Starfish indicate a form of tenaciousness, because when one of their arms is cul off it grows back agai n. This tenaciollsness for life is a lso I'e fl ecte cl in the amOllnl of clot work thm is inrlic:nive of thi ~ slOry. Tenacity and persistence is also reflected in the fi eld of nursing. Due to nurses' willingness to make a difference to promote li fc, in many respects they are the unsung heroes that stay true to their pathway. Much like the pathway of tbe sea, they are always there. Thjs book cover is dedicated to would-be nurses who read thi s book and to the ones out in remote places that have had to make do with little.

Robert Stuurman, artist KOZIERAND ERB'S FUNDAMENTALS OF NURSING FIRST AUSTRALIAN EDITION

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AUDREY 13Er.MAN NICHOLE HArNEY

SHIRLEE J. SNYDEr. YONI LUXFORD 13AR13ARA KOZIEr. LORNA MOXHAM GLENORA Er.13 TANYA PARK mACY LEVEn-JONES 13AR13ARA PARKEr.

mUDY DWYEr. KEr.RY REID-SEARL MAJELLA HALES DAVID STANLEY Copyright «:l Pearson Auslralia (a division of Pearson Australia Group Pty Ltd) 2010 Pca~u Australia Unit 4, Level 3 14 Aquatic Drive Frenchs Forest NSW 2086 wwwpearson com pu

Authorised ndnpl:uion from The United ST:lT("$. eliitinn p. nTi tletl Knt.;pr ~ F.rb'.f F'",u}nIllPlltnls of Nur, ~ ;" g . Rt h edition. ISRN 0111714686 by Berman, Audrey; Snyder, Shirlee; Kozicr, Barbara; Erb, Glenora, published by PCtmQn Education, Inc, publishing as Prentice Hall, Copyright @ 2008.

1st adaptation editJon publiShed by Pearson AUStralla. Copyright 192010.

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National LibfW)' of Australia Cllt~ l ogui ns-in-Pub l ic:tlio n Data Title: Kozier and Erb's Fundamentals of Nursing/Berman, Audrey [et al.]. Ed ition: 1st Australian ed. ISBN: 978144250469 1 (pbk: Voll) ~7tsl4425U47U7 (pbk: Vol 2) 9781442504714 (pbk: Vol 3) Notes: Includes index. Subjects: Nursin2. . Nursing Care. Other AuthOrs/Contributors: Bet tnan, AuJley. Kozier. Barbara. Erb, Glenora Lea. Dewey Number: 6 10.73

Every effort has been made to lrace and acknowledge copyright. However. should any infringement have occurred. the publishers tender lheir apologies and invite copyright owners to contact them.

Pearson Australia is a division of PEARSON-- VOLUME 1 VOLUME 2 UNIT 1 UNIT 6 THE NATURE OF NURSING 1 INTEGRAl ASPECTS OF CHAPTER I Hjstorical and Contemporary Nursing NURSING 46:5 Practice 2 CHAPTER 25 Caring 464 CHAPTER 2 , Research and CHAPTER 26 Communicating 482 Evidence-Based Practice 23 CHAPTER 27 Teaching 517 CHAPTER 3 Nursing Theories and Conceptual CHAPTER 28 Leading, Managing and Delegating 546 Frameworks 38 UNIT 7 CHAPTER 4 Legal Aspects of Nursing 55 ASSESSING HEALTH 561 CHAPTER 5 Values, Ethics and Advocacy 86 CHAPTER 29 Vital Signs 562 UNIT 2 CHAPTER 30 Health Assessment 607 CONTEMPORARY 105 UNIT 8 CHAPTER 6 Health Care Delivery Systems 106 INTEGRAL COMPONENTS OF CHAPTER 7 Community Health Nursing l22 CUENTCARE 699 CHAPTER 8 Home Care 133 CHAPTER 3 1 Asepsis 700 CHAPTER 9 Nursing Informatics 147 CHAPTER 32 Safety 744 UNIT3 CHAPTER 33 Hygiene 780 THE NURSING PROCESS 167 CHAPTER 34 Diagnostic Testing 839 CHAPTcK IU Critical 'flunking and the Nursing CHAPTER 35 Medications 875 Process 168 CHAPTER 36 Skin Integrity and Wound Care 949 CHAPTER II Assessing 18 1 CHAPTER 37 Peri operative Nursing 987 CHAPTER 12 Diagnosi ng 202 CHAPTER 13 Planning 218 VOLUME J CHAPTER 14 Implementing and Evaluating 241 UNIT9 Documenting and Reporting 254 CIIAPTERI5 PROMOTING PSYCHOSOCIAL UNIT4 HEALTH 1031 HEALTH BEUnS AND CHAPTER 38 Sensory Perception 1032 PRACTICES 277 CHAPTER 39 Self-Concept 1056 CHAPTER 16 Health Promotion 278 CHAPTER 40 Sexuality J073 CHAPTER 17 Health, Wellness and Illness 305 CHAPTER 41 Spirituality 1098 CHAPTER 18 Cultures and Nursing 323 CHAPTER 42 Stress and Coping 11 18 CHAPTER 19 Complementary and Alternative CHAPTER 43 Loss, Grieving and Death 1139 Therapies 343 UNIT 10 UNIT 5 PROMOTING PHYSIOLOGIC UFESPAN DEVELOPMENT 361 HEALTH 1163

Glossary G I In dex 11 ABOUT THE ORIGINATING AUTHORS XIII Contractual Arrangements in Nursing 67 Selected L egal Aspects of Nursing Practice 7 1 ABOUT THE AUSTRALIAN AUTHORS xv Areas of Potential Liability in Nursing 76 PREFACE TO THE FIRST AUSTRALIAN EDITION XVII Legal Protections in Nursing Practice 80 CONTRIBUTORS XXIV Reporting Crimes, Torts and Unsafe Practices K2 Legal Responsibilities of Students 82

VOLUME 1 CHAPTERS VALUES, ETHICS AND ADVOCACY 86 UNIT 1 Values 87 THE NATURE OF NURSING 1 Morality and Ethics 90 Nursing Ethics 92 Specific Ethica1 Issues 95 CHAPTER 1 Advocacy 99 HISTORICAL AND CONTEMPORARY NURSING PRACTICE 2 UNIT 2 Historical Perspectives 3 CONTEMPORARY HEALTH CARE lOS Cnntp.mpnr:1ry Nllrsine Pr::tcticp. q Roles and Functions of the Nurse II Criteria of a Profession 13 CHAPTER 6 SociaLisalion to Nun:iing 15 HEALTH CARE DELIVERY SYSTEMS 106 Factors Influencing Contemporary Nursing Practice IS Types of Health Care Services 107 Nursing Orga ni sations 18 Types of Health Care Agencies and Services 108 Providers of Health Care III CHAPTER 2 Factors Affecting Heal th Care Delivery 11 3 NURSE EDUCATION, RESEARCH AND EVIDENCE-IJASED PRACTICE 23 The Australian Hca ltJl Syste m 11 4 Frameworks for Care 117 Nurse Education 24 Financing Health Care 11 8 Types of Educational Programs 25 and Evidence-Based Practice 28 CHAPTER 7 Critiquing Research Repol1s 34 COMMUNITY HEALTH NURSING 122 Health Care Reform 123 CHAPTER 3 Community-Based Health Care 124 NURSING THEORIES AND CONCEPTUAL Community Health 125 FRAMEWORKS 38 Commun ity Health and Primary Care 126 lntroductlOn to Theories 39 Community-Based Nursing 129 The Metaparadigm for Nursing 40 Purposes of 41 CHAPTER 8 Overview of Selected Nursing Theories 42 HOME CARE 133 Nursing Theorists in A ustralia 49 Home Health N ursing 134 Critique of Nursing Theorv 49 The Home Health Care System in Australia 136 Roles of the Home Health Nurse 138 CHAPTER 4 Perspectives of Home Care Clients 13Y LEGAL ASPEGS OF NURSING 55 Selected Dimensions of Home Health Nurs ing 139 Legal Aspects of Nursing 56 The Practice of Nursing in the Home 142 Regu lation of Nursing Practice 64 The Future of Home Health Care 143 Contents VII

CHAPTER 9 CHAPTER 15 NURSING INFORMATICS 147 DOCUMENTING AND REPORTING 254 General Concepts 148 Ethical and Legal Considerations 255 CompUlers in Nursing and Midwifery Practice 153 Pu rposes of Patient Records 255 Co mputers in Nursi ng and M.idwifery Ed ucation 159 Documentarian Systems 256 Computers in Nursing Admini stration 16 1 Documenting Nursi ng Activi ties 264 Computers in Nursing and Midwifery Research 162 Documentation in Residential Aged Care Facilities 266 Home Care Documentation 267 UNIT 3 General Guidelines for Recording 267 THE NURSING PROCESS 167 Reporting 270

CHAPTER 10 UNIT 4 CRITICAL THINKING AND THE NURSING PROCESS 168 HEAlTH BELIEFS AND PRACTICES 277 C ritical Thjnking 169 Skill s in Critical Thinking 170 Attitudes that Foster Critical Thinking I7l CHAPTER 16 Standards of Critical Thinking 173 HEALTH PROMOTION 278 Applying Critical Thinking to Nursing Practice 173 Individual Health 279 Developing Critical-Thinki ng Attitudes and Skill s 176 Applyi ng Theoretical Frameworks 280 CHAPTER 11 Defining Health Promotion 285 ASSESSING 181 Sites for Health Promotion Activities 285 Overview of the Nursing Process [82 Health Promotion Model 287 Assessing 186 Stages of Health Behaviour Cbange 289 Cullt::t,.:tiJ 'g D aLa t86 The Nurse's Role in Health Promotion 291 Organising Data 195 292 Validating Data 198 Documenting Data 199 CHAPTER 17 CHAPTER 12 HEALTH, WELLNESS AND ILLNESS 305 DIAGNOSING 202 Concepts of H ealth , Wellness and WeUbeing 3U6 NANDA-I: The Australian Context 203 Models of Health and Wellness 308 NANDA-I Nursing Diagnoses 203 Variables Influencing Health Status, Beliefs and The Diagnostic Process 206 Practices 3 11 Ongoing Development of Nursing Diagnoses 213 Health Beljef Models 313 Health Care Concordance 316 CHAPTER 13 Ill ness and Disease 317 PLANN ING 218

The C lassifi catjo ll System in Austra lia 219 CHAPTER 18 Types of Planning 219 CULTURES AND NURSING 323 Developing Nursing Care Plans 220 324 The Planning Process 225 Naliullal Organisidions and Trends 325 The Nursing Interventions Classifi cati on 233 Cultural Nursing Care Concepts Related to Cultural Nursing Care 326 CHAPTE R 14 Heritage Consistency 328 IMPLEMENTING AND EVALUATING 241 Selected Parameters for Cultural Nursing Care 329 Implementing 242 Providing Cultural Nursing Care 334 Evaluati ng 245 NURSING MANAGEMENT 33<1 VI Ll Contents

C HAPTER 19 CHAPTE R 24 COMPLEMENTARY AND ALTERNATIVE THERAPIES 343 PROMOTI NG FAMI LY HEALTH 448 Basic Concepts 344 Fami ly Healtb 449 Ethnocentrism and M edical Intransigence 346 Applying Theoretical Frameworks to Families 451 NURSING MANAGEMENT 453

UNIT 5 LIFESPAN DEVELOPMENT 361 VOLUME 2 UNIT 6 INTEGRAl ASPECTS OF NURSING 463 C HAPTE R 20 CONCEPTS OF GROWTH AND DEVELOPMENT 362 Factors lnfl uencing Growth and Development 363 CHAPTER 25 Stages of Growth and Development 364 CARING 464 Growth and Development Theories 364 Professionalisation of Caring 465 Applying Growth and Development Concepts to Nursing Practice 376 Nursing Theories on Caring 465 Types or Knowledge I II Nurslllg 470 C HAPTER 21 Caring Encounters 47 1 PROMOTING HEALTH FROM CONCEPTION Maintaining Caring Practice 473 THROUGH TO ADOlESCENCE 381 CHAPTER 26 Conception and Prenatal Development 382 COMMUNICATING 482 Neonates and Infants (Birth to I Year) 384 Toddlers ( I to 3 Years) 390 Communjcating 483 Preschoolers (4 and S Years) 393 Therapeutic Relation hips 497 School-Age Children (6 to 12 Years) 396 Group and Team Communication 502 Adolescents (12 to 18 Years) 399 Communication and the Nursing Process 504 NURSING MANAGEMENT 505 C HAPTER 22 Communication Among Health Professionals 508 PROMOTING HEALTH IN YOUNG AND MIDDLE-AGED ADULTS 409 C l lAPTE R 27 Young Adults (20 to 40 Years) 410 TEACHING 517 Middle-Agen Anult< (40 10 65 Years) 415 Teaching 518 Learning 521 CHAPTER 23 The Internet and Health lnformation 526 PROMOTI NG HEALTH IN OLDER ADU LTS 423 Nurse as Educator 527 Characteristics of Older Adults in Australia 424 NURSING MANAGEMENT 527 Attitudes Toward Ageing 425 426 C HAPTE R 28 Care Settings for Older Adults 427 LEADING, MANAGING AND DELEGATING 546 Physjulu~i~al Ageillg 429 111e: Nurse as Leader and Manager 547 Psychosocial Ageing 435 Leadership 547 Cognitive Abilities and Ageing 438 Management 550 Moral Reasoning 438 Clinical Governance 554 Spirituality and Ageing 439 The Nurse as Deiegalor 554 Health Problems 439 Change 555 Health A sessment and Promotion 442 Types of Change 556 Contents IX

UNIT 7 The Neurologic System 679 ASSESSING HEALTH 561 SKI LL 30.17 Assessing the Neurologic System 680 The Female G enitals and Ln guinal Area 687 SKI LL 30.18 Assessing the Female Genitals and In guinal Area 687 CHAPTER 29 The Male Genitals and In guinal Area 689 VITAL SIGNS 562 SKI LL 30.19 Assessing the Male Genitals and Body Temperature 563 Inguinal Area 691 SKI Ll29.1 Assessing Body Temperature 573 The Rectum and Anus 693 Pulse 575 SKI LL 30.20 Assessing the Rectum and Anus 693 SKJ Ll29.2 Assessing a Peri pheral Pulse 580 SKILL 29.3 Assessing an Api cal Pulse 582 SKILL 29.4 Assessing an Api cal-Radial Pulse 584 UNIT 8 Kes pi ra ti ons 5Mb INTEGRAL COMPONENTS OF SKI Ll29.5 Assessing Respirations 589 CLIENT CARE 699 Blood Pressure 591 SKILL 29.6 Assessing Blood Pressure 596 Oxygen Saturation 599 CHAPTER 31 SKI LL 29.7 Measuring Oxygen Saturalion 601 ASEPSIS 700 CHAPTER 30 Types of Infections 702 HEALTH ASSESSMENT 607 -Acquired infections 702 Physical Health Assessment 608 Chain of Infection 703 General Assessment 615 Body Defen ces Against Infection 705 SKI LL30.1 Assessing Appearan ce and Mental Status 616 Factors Increasing Susceptibility to Infection 707 The Integument 619 NURSING MANAGEMENT 711 SKI LL 30.2 Assessin g the Skin 023 SKILL31.1 Hand Washing 7 16 SKI LL 30.3 Assessing the Hair 625 Isolation Precautions 720 SKI LL 30.4 Assessing the Nail s 629 Isolation Practi ces 723 The Head 630 S Kl Ll 31.2 Donning and Removing Personal Protective SKILL 30.5 Assessing the Skull and Face 630 Equipment (Gloves, Gown, Mask, Eyewear) 724 SKI LL30.6 Asses ing the Eye Structures and Steril e Technique 728 Vi sual Acuity 633 SKILL 31.3 EstabUshing and Maintaining a Steril e SKI LL 30.7 Assessing the Ears and Hearing 638 Field 730 SKI LL 30.8 Assessing the Nose and Sinuses 641 SKI LL 31.4 Donning and Removing Steri le Gl oves (Upen Method) 734 SKI LL30.9 Assessing th e Mouth and Oropharynx 643 SKI LL 31.5 Donning a Steril e Gown and Gloves The Neck 646 (Closed Method) 736 SKILL JO.JO Assessing the Neck 647 Infection Control for Health Care Workers 737 The Thorax and Lungs 649 Role of the Infection Control Nurse 738 SKI Ll30.1! Assessing the Thorax and Lungs 652 EV:l IIiMing 738 The Cardiovascul ar and Peripheral Vasc ul ar Systems 656 SKILL 30.12 Assessing the Heart and Central Vessels 658 CHAPTER 32 SKI LL 30.13 Assessin g the Peripheral Vascular System 661 SAFETY 744 The Breasts and Axillae 663 Factors Affecting Safety 745 SKI LL 30.14 Assessing the Breasts and Ax illae 664 NURSING MANAGEMENT 748 The Atxlomen 667 SKI LL 31.1 Using a Bed or Chair exit Safety SKI LL 30.15 Assessing th e Abdomen 668 Monitoring Device 761 The Musc ul oskeletal System 672 SKI LL 32.2 Implementing Seizure Precauti ons 763 SKILL 30.16 Assessing the Musc ul oskeletal System 673 SKI LL32.3 Applying Restraints 77 1 X Contents

CHAPTER 33 Drug Misuse 880 HYGIENE 780 Actions of Drugs on the Body 88 1 883 Hyg ieni c Care 781 FaClOrs Affecting Medication AClioll Skin 78 1 ROlltes of Administration 884 NURSING MANAGEMENT 787 Medication Orders 886 888 SKI LL 33.:1 Bathing an Adult or Paediatric Client 786 Systems of Measurement SKI LL 33.2 Providing Perineal-Geniwl Care 795 Admi ni stering Medications Safely 892 Feel 797 OraJ Medicati ons 898 NURSING MANAGEMENT 798 SKI LL 35.1 Administering Oral Medications 898 SKILL 33.3 Providing Foot Care 80 1 Nasogastric and Gastrostomy Medication 902 Nail s 802 Parenteral Medications 902 NURSING MANAGEMENT 802 SKI LL 35.2 Prepari ng Medications from Ampoule 908 Mouth ROl SKI LL 35.3 Preparing Medications from Vials 909 NURSING MANAGEMENT 804 SKI LL 35.4 Milling Medications Using One Syringe 9 11 SKILL 33.4 Brushing an d Flossing the Teeth 809 SKI LL 35.5 Administering an Intraderm al Inj ection SKlll 33.5 Prov iding SpeciaJ OraJ Care rur lbe for Skin Test" 913 Unconscious Client 812 SKI LL 35.6 Administering a Subcutaneous Injection 9 16 Hair 8 14 SKI LL 35.7 Administering an Int ram usc ular Injection 922 NURSING MANAGEMENT 814 SKI lL 35.8 Adding Medications La IlllfavellUus F luitl SKI LL 33.6 Providing Hair Care for Cl ients 817 Containers 925 SKI LL 33.7 Shampooing the Hair of a Client SKILL 35.9 Administering Intrave nous Medications IV Confined 10 Bed 818 Using Push 929 Eyes 820 SKI LL 35.10 Administering Ophthalmic Instillations 933 NURSING MANAGEMENT R20 SKI LL 35.11 Administering Otic Instill at ions 936 Ears 824 SKI LL 35.12 Adminislering Vaginal Instillations 940 SKI LL 33.8 Removing, Cleaning and Inserting a Respiratory Inhalation 942 lleari ng Aid 825 Irrigations 944 Nose 826 CHAPTER 36 Supporting a Hyg ieni c Environment 826 SKIN INTEGRITY AND WOUND CARE 949 Making Beds 828 SKI LL 33.9 Changing an Unoccupied Bed 829 Skin lntegrity 950 SKI LL 33.10 Chan ging an Occupied Bed 833 Types of Wounds 950 Pressure Ulcers 951 CHAPTER 34 Wound HeaHng 955 DIAGNOSTIC TESTING 839 NURSING MANAGEMENT 958 Diagnosti c Testing Phases 840 SKI LL 36.1 Obtaining a Wound Drainage Specimen Blood Tests 84 1 for Culture 960 SKJ Ll34.l OlJWillillg A Capillaly Blood Specimen lO SKlLL 36.2 Irrigating a Wound 973 Meas ure Blood Glucose 848 CHAPTER 37 Specimen Collection 85 1 PERI OPERATIVE NURSING 987 SKI LL 34.2 Co ll ecting a Urine Sample for Culture and Sensitivity by Mid-stream Specimen of Urine (MSU) 855 Types of Surgery 988 Visuali sation Proced ure 86 1 Preoperative Phase 990 Aspiration/Biopsy 863 NURSING MANAGEMENT 991 SKILL 37.1 Teaching Moving, Leg Exercises, Deep CHAPTER 35 Breathing and Coughing 995 MEDICATIONS 875 SKI LL 37.2 Applyin g Antiembo li Stockings 1000 Drug Standards 876 In traoperative Ph ase 1003 Legal Aspects of Drug Administrati on 877 NURSING MANAGEMENT 1004 Effects of Drugs 879 Postoperative Phase 1005 Contents XI

NURSING MANAGEMENT 1007 Indicators of Stress 1122 SKILL 37.3 Managing Gastrointestinal Suction 1015 Coping 1126 S KJ LL 37.4 Cleaning a Sutured Wouml dllli ApjJlying NURSING MANAGEMENT 1127 a Sterile Dressing 1019 CHAPTER 43 VOLUME 0 LOSS, GRIEVING AN D DEATH 1139 Loss and Grief 1I40 UNIT 9 NURSING MANAGEMENT 1146 PROMOTlNG PSYCHOSOCiAL Dying and Death 1149 HEALTH 1031 NURSING MANAGEMENT 1152 UNIT 10 CHAPTER 38 PROMOTING PHYSIOLOGIC SENSORY PERCEPT ION 1032 HEALTH 1163 Components of the Sensory Experience 1033 Se.nsory Alterations 1033 Factors Affecting Sensory Function 1035 CHAPTER 44 NURSING MANAGEMENT 1036 AGIVITY AN D EXERCIS E 1164 CHAPTER 39 Normal Movement 1166 SELF-CONCEPT 1056 Exercise 1I71 Self-Concept IU57 Factors Affecting Body A lignment and Activity 1175 Formation of Sel f-Concept 1057 Effects of Immobility 1177 Components of Self-Concept 1059 NURSING MANAGEMENT 1181 Factors that Affect Self-Concept 1060 SKILL 44.1 Client-Assisted Bed Slide: One Nurse 1196 NURSING MANAGEMENT 1062 SKILL 44.2 Bed S.lide: Two Nurses 1196 SKILL 44.3 Lateral Shift and Roll : Two Nurses 11 97 CHAlJTER40 SKI LL 44.4 Logroll ing a Client: Two to Four Nurses 11 98 SEXUALITY 1073 SKILL 44.5 Bed to Chair Slide: One Or Two Nurses 1198 Development of Sexuality 1074 SKI LL 44.6 Bed to Chair (4-Poinl Frame): Sexual Health 1077 Two Nurses 1199 Varieties of Sex uality 1079 SKILL 44.7 Assisting the Client to Sit on the Side of Factors Influencing Sexuality 1080 the Bed 11 99 Sexual Response Cycle 108 1 SKI LL 44.8 Assisti ng the Client to Ambulate 1205 Altered Sexual Function 1083 CHAPTER 15 NURSING MANAGEMENT 1086 SLEEP 1220 CHAPTER 41 Phys iology of Sleep 1221 SP IRITUA LITY 1098 Fu nctions of Sleep 1223 Spi ritu ality Described 1099 Normal Sleep Patterns and Requirements 1223 Related Concepts 1100 Factors Affecting Sleep 1226 Spiritu al Development 1102 Co mmon Sleep Disorders 1228 Spiritual Practices Affecting Nursing Care 1102 NURSING MANAGEMENT 1231 Spiritua l Health and the Nursing Process 11 06 CHAPTER 46 NURSING MANAGEMENT 1106 PA IN MANAG EMENT 1246 CHAPTER 42 The Nature of Pain 1247 STRESS AND COPING 1118 Physiology of Pain 1249

Concepl of Stres ~ 111 9 NURSING MANAGEMENT 1257 Models of Stress 1120 SKI LL 46.1 Providing a Back Massage 1280 Xl [ Contents

CHAPTER 47 Factors Affecting Respiratory Function 1426 NUTRITION 1292 Alterations in Respiratory Function 1428 Essential Nutrients 1293 NURSING MANAGEMENT 1129 Energy Balance 1296 SKI LL 50.1 Administering Oxygen by Cannula, Face Mask, Non-rebreather Mask or Face Tent 1441 Body Weight and Body Mass Standards 1297 SKILL 50.2 Oropharyngeal and Nasopharyngeal Factors Affecting Nutrition 1299 Suclioning 1448 Nutritional Variations Throughout the Life Cycle 1303 SKILL 50.3 Suctioning a Tracheostomy or Standards for a Healthy Di~l 1307 Endotracheal Tube 1452 Altered N utriti on 1313 SKI LL 50.4 Providing Tracheostomy Care 1455 NURS ING MANAGEMENT 1313 SKI LL 47.1 Inserting a Nasogaslric Tube 1327 CHAPTERS1 SKI LL 47.2 Removing a Nasogastric Tube 1329 CIRCULATION 1467 SKI Ll47.3 Admjnistcring u Tube Feeding 1333 Physiology of the Cardiovascul ar System 1468 SKI LL 47.4 Administering a Gastrostomy or Lifespan Considerations 1473 Jej unostomy Feed ing 1335 Faclors Affecting Cardiovascular Function 1474 CHAPTER 48 Alterations in Cardiovascular Function 1477 URINARY ELIMINATION 1345 NURS ING MANAGEMENT 1479 SKI LL 51.1 Sequential Compression Devices 1484 Physiology of Urinary Elimi nation 1346 Factors Affecting Voiding 1348 CHAPTER 52 Altered Urine Production 135 1 FLUID, ELECTROLYTE AND ACID-OASE OALANCE 1492 Altered Uri nary Elimination 1352 Body Fluids and Electrolytes 1493 NURS ING MANAGEMENT 1354 Acid- Base Balance 1501 SKlll48.1 Applyin g a Uri dome (Uri sheath) Catheter 1364 Factors Affecting Body Fluid, Electrolytes and SKI LL 48.2 Performing Urinary Catheterisation 1367 Acid-Base Balance 1502 SKI LL 48.3 Performing Bladder Irrigation 1375 Disturbances in Fluid Volume, Electrolyte and Acid- Base Balances 1503 CHAPTER 49 NURS ING MANAGEMENT 1511 FAECAL ELIMINATION 1386 SKJ II 52 1 Starting an Jntravenotls Infusion 1530 Physiology of Defecation 1387 SKILL S2.2 Monitoring an Intravenous Infusion 1537 Factors that Affect Defecation 1389 SKILL 52.3 Changing an Intravenous Co ntainer, Faecal Elimination Problems 139 1 Tubillg i:lmJ DrclS~ill~ 1539 Bowel Diversion Ostomies 1395 SKI LL 52.4 Discontinuing an Intravenolls NURS ING MANAGEMENT 1398 Infusion 1540 SKI LL 49.1 Adm inistering an Enema 1406 SKILL 52.5 Changing an In travenous Ca nnul a to an SKILL 49.2 Changing a Bowel Diversion Stoma Intermittent Infusion Lock 154 1 Applhmce 14 11 SKILL 52.6 Initiating, Maintaining and Terminating a Blood Transfusion 1545 CHAPTER SO OXYGENATION 1422 GLOSSARY G1 Structure and Function of the Respiratory System 1422 Respiratory Regu lation 1426 INDEX 11 - ... • # .'.~.: '. '.' eo '... '. t " '0, • • •••. • .•. ", .'. • '"0 " .•• , •..• '" ~. •• • • •• . •• .•.•( ...... :~.~~ f;.~;.. ,~ .:~ •.~.!! ~ 0' .... ~ ••j. ••••.•• ~~ ... .:.:.;. :•.•• ~•• { •• !.:{H. '. : •.•:: .. ; .•: ..... ;::::.::;.! ...... :·:.:··~ .. ··:·:·;·1.:· r ••• _. • ••••:::.: ~'." :0" .:...... : "'.:":- ··:: ... •• ..•• •• :.:"·r·::.::· ..'~! .. :···: '0 ...... '0 ::~.·:·~:~:· •••• t.·~:;.f • '0' \ •••: .... ~ , .. • • • •• . :"':" " ••!"':. 't .:•••• e' ~.. .,~; . ~.... : ••••:.; ••• ~ ••• :.:...... • '0 : ,0: .: ~ !':.,.; ····:···:~.:.i· . •••• •• ••.••• • ••••••: .t •• -".: •• : •••••~. ,0 : •••••••••••••• : •• h' . 0° • ••••••••• • •••••• " ::•• ' :o,~.... '.J. -:• ...... Ab.· . . :" tl1 rG···tr···"' ·~ ·'··(j·t·· " .' ...... ~ ...... ,'.. ... ·Ou··:•. ··•e ····.'0 : .' .. :" t 0" •5 ':•••••••• .. ;'/".. ' . . • ...... :... .,.Y.-)\l ~ •••••• :". ..::.. ' . . ..: JI,: ... ":"':"'" :... 9 Xl Jo.~ti .J~, ... ' J.. f ..::···. ".:,, ' J':\:~' :·\i··~::r;... ( '.

Audrey Berman received her nursin g at Samuel Merritt College

her MS in physiologic nursing and wana4 Australia. Japan and Brazil. She serves on the board of ber PhD in nursing. Her dissena­ directors for the Bay Area Tumor Institute. Sbe is a member of the tion, was entitled Sailing a Course American Nurses Association and and is a site throltRIz chemotherapy; The ex- visitor for the Commission on Collegiate Nursing Education. She periellce of women with breast has twice panicipated as an NCLEX-RN item writer for the cancer. She worked in oncology at National Council of State Boards of Nursing. She is cenified as an Samuel Merritt Hospital prior to advanced oncology nurse and as an AIDS educator and has pre­ beginning her teaching career in the program at ented locally, nationally and internationally on topics related to Samuel Merritt Hospital School of Nursing in 1976. As a nu rsing education, breast cancer and technology in health care. facu lty member, she participated in the transition of that pro­ Dr Bennan authored the scri pts for more than 35 nursing gram into a baccalau reate degree and in the development of ski lls videotapes in the I 990s. She was a co-author of the sixth the master of science in nu rs ing program. Over the years, she and seventh editions of Fundamentals of nursing and, with has taught a vari ety of medical-surgical nursin g courses in the Shirlee Snyder, co-author of the fifth edition of Kozier & Erb's prelicensure programs. She currently serves as the dean of techniques in cli"icalllursing.

Shirlee J. Snyder graduated from assessment testing for student learning. She presented locally Columbia Hospital School of and nationally on topics related to using multimedia in the Nursing in Milwaukee, Wi sconsin, classroom and promoting etbnic and minority student success. and subsequently received a bach­ Another career opponunity in t998 ted her to the Commu­ elor of science in nursing from nity Coll ege of Southern Nevada in Las Vegas, Nevada, where University of Wisconsin- Milwau­ Dr Snyder was the nurs ing program director with responsibili­ kee:. Bt:cause of an inLt:rest in car­ Lies fur the associate degree and practical nursing programs diac nursing and teaching, she for five years, During thi s time she became involved in co­ earned a master of science in nurs­ authoring the fifth edition of Kozier & Erb 's techniques ill ing with a minor in cardiovascular clillicalllursi1l8 with Audrey Berman. clinical speciali st and teaching from In 2003, Dr Snyder returned to baccalaureate nursing educa­ the University of Alabama in Binningham. A move to California ti on. She embraced the opponunity to be one of the nursing resulted in becoming a faculty member at Samuel Merritt Hospi­ faculty teaching the first nursing c lass in the baccalaureate tal School of Nursing in Oakland, California, Shirlee was fonu­ nu.rsing program at the first state college in Nevada, which nate to be involved in the phas ing out of the diploma and ADN opened in 2002, She is currentl y the Associate Dean of the program s :mrl development of a baccalaureate intercoll egiate School of Nurs.ing at Nevada State Coll ege in Henders.on, nursing program. She held numerous poSitions during her 15· Nevada. year tenure at Samuel Menitt College, including cuniculum co­ Dr Snyder is an advisory board member for lbe Nevada ordinator. assistant director-instruction. dean of instruction and Geriatric Education Center and a member of the American associate dean of Ule Intercollegiate Nursing Program. She is an Nu rses Association, Sigma Theta Tau, and a variety of task associate professor alumnus at Samuel Menitt College. Her groups addressing the Southern Nevada nursi ng shonage, She interest and experiences in nursing education resulted in Shirlee has been a site visitor for the National League for Nursing obtaining a of education focused in curriculum and Accrediting Commission and the Nonhwest Association of instruction from the University of San Francisco. Schools and Coll eges. Dr Snyder moved to Portland, Oregon, in 1990 and taught in Dr Snyder'S experiences in nursing education and teaching the ADN program at Ponland Community Coll ege for eight keep her current in nursing and nu rsi ng education. She appreci­ years. During this teaching ex perience she became interested in ales all she has learnt from the students she has taught and her computer-assisted in struction (CAl) and initiated web-based past and present facu lty coll eagues. XIV About the Originating Authors

Barbara Kozier was educated In laught medical and surgical nursmg. . psychi­ Vancouver, British Columbia, atric nursing and community nurs ing courses at the Vancouver Canada. After obtaining a bachelor General Hospital School of Nursing. Ms Kozier then enrolled at arts degree from the University at the University or Washington where she studied for two of British Col umbia, she entered years, taught prot time and obtained her master of nursing Lhe nursing program at thal institu­ title. tiOll. After tour years of study she Barbara is a member ot three honollr societies: Sigma Theta graduated with a bachelor's degree Tau (nursing), Pi Lambda Theta (education) aDd Delta Sigma in nursing. She obtained a position Pi (Canadian Honor Society fo r University Women). Barbara at HeUa Hella, an aborigi naJ seltle- was a member and a chair of many nurs in g and government ment on the nonhem coast of British committees. She wrote a number of texts and collaborated with Columbia. She then nursed with the Victorian Order of Nurses Glenora Erb on four books: Techlliques of clillical lIursing , prov iding home care. Following a position with a large general Fundamentals of nursing. Concepts and Issues II/nursing prac­ hospital as an acute care nurse in a medical-surgical unit, she tice and Esselltials of nursing practice.

Glenoro Leo Erb was born in and New Zealand, Ms Erb returned to Vancouver and taught Calgary, Alberta, Canada. All her nursing at St Paul 's Hospital Schoo l of Nursing, and later schooling took place in Calgary m a 2-year program at the British Columbia Institute of and, with her identical twin sister, Technology. At thi s time she also coauth ored tex tbooks on she attended the of FUlldal/lellta/s of nursing, Techniques of clinical nursing, CaJgary General Hosp ital. She was Concepts and issues in nursing pracIfce and Essemiais of awarded a gold medal when she lIursing practice. graduated and was recognised as Glen died at home on 24 December 2001 of breast cancer. an outstanding bedside nurse. Her death has meant (ha( nursing has lost a hi ghl y skilled clini­ Following two years travelling cal nurse and her friends and fami ly have lost a sensitive and in Asia, Europe, Ind ia, Australi a giving person. The authors li sted below are the Unit coordinators for the first Australian edition of FlIndamentals oj Nursing. For a complete list or contributors, see page xxiv.

Tracy Levett-Jones is th e Deputy chapters and is the co-author of the hi ghl y successful SllIdenr Head of School (Teachi ng and nurse: Clinical survival gllide. Learning) at the School of Nursi ng and Midwifery at the University of Majella Holes works at the Aus­ Newcastle. Her research interests trali an Catholic Uni versity in Bris­ include the phenomenon of bane. Originally hospita l trained, 'belonging ', clinica l education, she completed a post-regi stration information and communicating Bachelor of Nursing, Master's of technology (JCT) in health care, Applied Science (Research), and a clinical reasoning and simu lati on. Graduate Certificate in Higher Tracy's doctoral research explored the clinical learning experi­ Education. She is currently en­ ences of students in Au stralia and the United Kingdom. She has rolled in a PhD investigating simu­ a broad clinical background and pri or to her academic career lation in nursing education. MajeUa worked as a women's health nurse, and new lectures primarily in the science graduate program coord inator. She is a co-author of the book "and nUr.iing units uf lh~ ulJ(J~rgrwJ ua t ~ Hursi llg tl ~g n:: e. Sht! is Th e c1iniclll placemelll: All essential guide for IlLlfsing slltdellts, pa ssionate about teaching and learni ng and al so offers critical the 2007 recipient of the NS W Minister fo r Ed ucati on Quality care electives and online education for postgraduate students Tt:a<.: hing Award amJ il 2008 n:~dpi~m uCall Aus Lralian Tei.lt.: hing enroll ed in eardiothoraeie nnd emergency specialties. and Learnin g Council Ci tation for Outstanding Contri butions With a long hi story in emergency and cardi othorac ic in ten­ to Student Learning. sive care, she has also been a mem ber of teams providing crit i­ cal care and education assistance to Solomon Islands, Fiji and Trudy Dwyer completed a Brazil. hospital-based nursing program at the RnckhAmpton H m:piIHI . Q ueens­ Nichole Harvey has been a regis­ land, where she developed a tered nurse si nce 1988 and an pa ss ion for endorsed midwife since 1995. and travel. Working her way around Ni chole's qualifications include a Australia she completed a Post­ Critical Care Certificate, Trauma Basic 1.00ensive Care course and a Nursing Cert ificate, Non-Medical Bachelor of Health Science degree. Vaccinator's Cert ificate, Bachelor j After seven years trave ll ing, she of Nursing , Master of Nursing returned to Rockharnpton to work as a nurse academic with St udies and a Graduate Certificate Central Queensland University (CQU) and nurse clini cian at in Ed ucation (Tertiary Teaching). the Rockhamplon Hospital iJl iIllensive care. She then com­ Nichole has extensive clinical ex­ pleted a Graduate Certi ficate of Flexible Learni ng, a Master's perience, having worked in both large city and ru ral and remote of Clinical Ed ucation from the Un iversity of New South Wa les locations, as well as overseas . Her main area of clinical exper­ and a PhD. ror the past 2U years she has been an active member tise is emergency and trauma nursing with a special in terest in of the Australian College of Critical Care Nurses and was the midwifery. foundation president of the Central Queensland sub-branch of Nichole has held an academic role with the School of tile ACCCN. Nursing, Midwifery and Nuuilion, James Cuuk Ulli\'cr:sily, :siu<.:t: Trudy is currently a Senior Lecturer of Nursing in the 2000. Since that time Nichole has been involved in the develop­ Faculty of Sciences. Engineering and Health at CQU. Trudy ment and teaching of both nursing and midwifery curricula. Nic­ has a long career as a nu.rse academic, coordinating hole is a fC.viewer for tht: Australian Journal of Rural alld Remote undergraduate and postgraduate nursing courses and the Health, a past panel member for the Queensland Nursing Coun­ Honou rs program . She is also a supervi sor of Master's and cirs Midwifery Review Panel and a member of a number of local PhD reseureh students. Her researc h in terests inc lude and state nursing and midwifery conunjuees/organisations. N ich­ re uscitation, clinical educati on and popul ation health. She has ole is undertaking her PhD to investigate the u·iage and manage­ published in international refereed scholarly journals, book ment of pregnant women in emergency departments. XVI About the Australian Authors

Yoni Luxford is a Seni or Lecturer Health Nurses and rev iewer for the Imernational Jot/mal oj in Nursing in the School of Health Mental Health Nursing. at the University of New En gland. Armidale, NSW. Ilarbara Parker has worked ex­ Yoni has written a number of tensively in the clinical environ­ publications. and is co-auth or (with ment, specificall y in the areas of Anderson) of Women gmwill g anaesthetics and recovery and older: A health Gnti wellness man­ orthopaedic and urology surgical ualforworkin g with womanamwuJ nursing. She has published in th e 60 years & over, published by the area of obesity and diabetes and Southern Women's Health and has expertise in gastrointestinal Community Centre. and nutritional physiology as well as expertise ill programs in obesity, Lorna Moxham actively contrib­ impaired glucose tolerance and diabetes in both pharmacologi­ utes to the nu rsing profession at cal and li fes tyle interventi ons. Dr Parker is a Program Director state. national and intern ational in the School of Nursin g and Midwifery and teaches witllin levels as well as to the broader the undergraduate nursing program at the Uni versity of South community in numerous ways. Australia. Lorna has served on numerous ministerial committees as a mem­ Kerry Reid-Searl is a Senior ber and chair and has held Lecturer at Centra.1 Queensland several leadership and governance Uni versily. Ke lTY first compl eteu roles both within the terti ary edu­ her nursin g qual ifications in Tas­ cation sector and in industry. These currently include Chair of mania. Since then she has gained the CQU ni versity HREC and Chmr of the Koc kll ampton and ~x.pt;::.ri~ n \:t;::. in Qut;::.t;::. lI slallu as a r~­ District Health Community Council (HCC). As the current mote area nurse, a generali st nurse, chair of the mental health peer review panel and a member of a midwife and in more recent years the education committee, Lorna's involvement in nurse regu la­ slit; has wurk..eu LlI Ule cLi uical ill ea tion and licensure via the QNC enables her to actively contrib­ of paediatrics. Kerry has over ute to on-going professional integrity and development. 17 years experience in undergraduate nursing education. She Passionate about nursing, its past, present and future, Lorna holds a Bachelor of Health Science degree, a Master's qualiJi­ has an extensive publication record and has led and been an cation in Clinical Education and a PhD. Kerry has a strong in­ investigator in many research projects. A fellow of the Austra­ terest in clinical education, wound care and medi cation safety. li an CoUege of Memal Health Nurses idemifies her di scipline expertise and passion. David Stanley began hi s nursing career in the days when nurses Tanya Pork is a . an wore hugc belt bucklcs and funny endorsed mental health nurse, an hats. He 'trained' as a registered endorsed midwife and a creden­ nu rse and midwife in South Au st­ tiaJl cd mcntal hcalth nursc. Hcr ralia and workcd through hi s nursing experi ence includes private formati ve career in a number of and publ ic settings (in rural, remote and clinical environments and urban ccntrcs) including crisis, in Australia. In 1993 he completed community and emergency mental a Bachelor of Nursing at Flinders health services. She joined the University, Adelaide (for which he was awarded the University School of Nursing, Midwifel), & Medal) and after a number of years of volunteer work in A fri ca Nub'ilion at he moved to th e United Kingdom and worked as the Co­ in 2005 and has had the opportunity to teach both undergraduate ordinator of Chi ldre n's Services and as a nurse prac titioner. He and postgraduate students. She is currently undertaking her PhD completed a Master's of Health Science degree at Birmingham to investigate the 'Prevention of weight gain with second genera­ University. For a short time he worked in Central Australi a for tion antipsychotics: a nurse-led intervention'. She is a Member Remote Health Services, before returning to the Un ited King­ of the A ustralian College of Mental Health Nurses, vice-presi­ dom to complete hj s nursing doctorate, researching in the area dent and member of the Management Committee for the Mental of clinical leadership. He is currently teaching undergraduate Hlness Fellowship North Queensland, Secretary for the North and postgraduate nursing at Curtin Uni versi ty of Technology, Queensland Sub-Branch of the Austral ian College of Mental Western Australia. Contemporary nursing in Australia and internationally is chal­ in recognition of the broadening global scope of its member­ lenging, complex, dynamic and very rewarding. Many of our ship. The NANDA-I taxonomy provides nu rses with a shared cl ients are older ~U1d sicker that they were a decade ago, often language of diagnostic terminology and is particularly useful with complex health and psychosocial needs. Thi s means that for the beginning nurse, and thus we have incorporated it into nurses today must be clinically competent, flexible and knowl­ our text. We do acknowledge, however, that Australi an nurses edgeable. They must have a broad and deep knowledge of often adapt rhe NANDA-I terminology 10 meet their own con­ physiology, pathophysiology, pharmacology, epidemiology, text and specific client needs. th erapeutics, culture, ethi cs and law, as well as an understand­ ing of evidence-based practice. Today's nurses have many roles and function s--ciinician, ed ucator, manager, researcher, to ORGANISATION OF THE BOOK name just a few. They must be highly skilled with the ability The detailed table of contents at the beginning of the book to problem solve and they must possess sophisticated c ri tical provides a clear structural map to the content incl uded in the thinking skills. They must be life-long learn ers and confident in to un its and 54 chapters. the use of informati on and communication technology. Nurses Unit 1, The Nature of Nursing, clusters five chapters that must he ah le to communicate effectively, with their dip.nts . pruvitle comprehensive coverage of introduclolY cOll(;epts of with each other and with other members of the health care team. nursing. The hi story of nursing in Australia and the Australi an Above all , they mu st care for their patients in ways that signify legal system provide a contextual backdrop to the chapters that respect, acceptance, empathy, connectedness, cul tural sensitiv­ foll ow. ity and genuine concern. In Unit 2, Contemporary Healtb Care, four chapters focus Against this background, the first Australian editi on of on contemporary health care topics such as health care delivery Kozier and Erb's fundamentals of nursing will be of immense syste-,ms, commllni ty-bflsP.n CMf':, home: ~Mf': finn th e: 1I ~f': of in­ benefit to both beginning students and those who are more formation and communication technology in healtb care. advanced. This comprehensive textbook, with its unique Aus­ Unit 3 is The Nursing Process. Six chapters introduce stu ­ tralian perspective, introduces the reader to vitally important dents to this important framework. with each chapter dedicated nurs ing issues, concepts, practices and theories. The book will to a specific step of the nursing process. Chapter 10 outlines prepare students for practice in a range of diverse clinical set­ critical thinking and the nursing process. A Nu rsing in Acti on tings and help them understand what it means to be a competent case study is used as the frame of reference for applying content professional nu rse in the twenty-first century. in all phases of the nursing process in Chapter 11 , Assessing, Chapter 12, Diagnosing, Chapter 13, Planning, and Chapter 14, LANGUAGE AND TERMINOLOGY lmplementing and Evaluating. Chapter 15 covers documenting and reporting. Patient, clients and health care consumers Startin g in this un it and incorporated throughout the book, [n developing thi s text we have used terminology that is famil­ we refer to the new NANDA International (NANDA-I) nursing iar and appl icable to most Australi ans. To achieve this, we have diagnoses. used the terms 'client', 'patient' and 'health care consumer' In Unit 4, Health Beliefs and Practices, four chapters cover throughout the text, applying each according to its context. This health-related beliefs and practices for individuals and fa milies remains consistent with the term inology set out in the Code Of from a variety of different cultural backgrounds. This Unit ethics/or nurses in Austrctiia, published by the Australian Nurs­ emphasises the importance of cultural sensiti vity when caring ing and Midwifery Council (ANMC 2005). for clients from different backgrounds and it has a particular focus on ln digenous Australian people-a focus that continues Indigenous Austrolians throughout the book. Practical issues related to nursing management is an additional strength of this unit. Throughout the text we have integrated issues relevant to the Unit 5, Lifespan Development. consists of five c hapter~ Indigenous Australian popu lation. In covering the issues we have that discuss development from concepti on to old age. Chapter acknowledged the importance of usi ng non-discriminatory and 23 is a new chapter devoted specifically to the care of the older appropri ate language to describe groups of people, policies and adult. events, and have thus followed the gu.idelines as set out by NS W Unit 6, Integral Aspects of Nursing, di scusses topics such Health in its pubHcation Communicating positively: A guide to as caring. communicating, teaching, leading, managing and appropriate Aboriginal terminology. delegating. These topics are all crucial elements for providing competent nursing care. Nursing Diagnoses Unit 7, Assessing Health, covers vital signs and health [n 2002, the North American Association assessment in two separate chapters, so beginning students can (NANDA) was changed to NANDA-lnternational (NANDA-l), understand nonnal assessment techniques and tindings. xv [[ 1 Preface

Chapter 29, Vital Signs, introduces students to the health assess­ Sensory perception, self-concept, sexuality, spirituality, stress mem skills that are crucial to competent professional practice. and loss are all things that a nurse needs to consider to properly In Unit 8, Integra l CUiuponents of Client Cal"C, lht: [ul:wo.l can: fur a clicnl. shifts La those issues of relevance to all clients: asepsis, safety, Unit 10, Promoting Physiologic Health, discusses a vari­ hygiene, diagnostic testing. medications, wound care and pre­ ety of physiologic concepts that provide the foundations for u~.ralivt: (';iUt!. lIur~ ill~ care. These include activity and exercise; sleep; pain: Unit 9, Promoting Psychosocial Health, includes six chap­ nutrition; eLimination; oxygenation; circulation ; and fluid, elec­ ters that cover a wide range of areas that affect one's health. trolYle and acid- base balance. Preface XIX

FEATURES

For years, theAmerican edition of Kozier & Erb's Fundamentals appl ication for Austral ian students, nursi ng academics from of Nursing has been a gold standard that helps students embark across Australia were invited to review and comments on each of on their careers in nursing. This first Australian edition retains the 52 chapters. Their delailerl fp.p.dh~ck has ensured that Kozier many of the features tilat have made thi s tex tbook the number­ & Erb 's Fundamentals of nursing: Firs! Australian edition is a one choice of nursing students and lecturers. To further enhance current, engaging and uniquely A ustralian textbook that will heJp this popular fundamentaJs textbook and ensure its appropriate students succeed in their nursing studies.

Anatomy C:r Physiology Reviews provides students with a "'-.-_.- :~...=':':..:.~.=.'!= r" ' ;.... " ~ • ~. ~ ...... ~--~ :--.. ---...... ----..~ --.. quick review of the human .-.. _-_-_--_ .. ...,, - ...... , ---_.. - ... -.-_... _- bioscience that is fundamental to .....-- ~ ...... =::.:...."':!":------_-----... .. -._- -- c:o mpeJp.nt pr~cti ce ...... _-....__ ...... _.. ._-., __ ... ~~- '------"''''''-_- . -~-.... --..-- ._._'=::.------...... -_...... - :::"'==::"'::"::=:'-:': .~ - _ ' ...... _...... __- ....~-=:::::.."':'""-=-:- .. - . ~~~.::::= .... :... .,:;--- ... ---- .~--_-_.. -.. _-_.... - .. --­ ~=--=----.. - :E .....!:':.!-:.._MZ'-~ ...... Assessment Interviews show -- -_..-----...... _ ----.. ~-...... -.------_----'"'"'------...---_ __ .. - students how to ask appropriate g~,.;:;;::~;:,:,- ==-=:.-:.... .= ..::::::: =: , ..-.- ...... -..-_- ...... _ -.. --~ __ questions in their clinical ... "'---- =--=:.=-===-= encounters. ---§.~=.:.:S--=.. _-- .=--__-----.. _ .-_-_-...... _... -.... =:.:::e.==:....: =.:e.::::.:::;::!.=.=-== :::"''''':'':,::,:,::.: ..''':::::':: :,:--..::.:-...::::::-:::.=-.::::-: =::!~:.:"~~_w::; ...... - ...... ---~--- _.----_...... _.- -

Client Teaching gives students a ... .. · _ __...... ~ ...._--­ _ ... __M __ ...... --- . -~ ...... -.-..------.. _------.---- _...... _.... _-- =-=~.=-~...... -::.:::- ..: ·:=:::::::---.:::::=::: _ n~ '" ... _-­ guide for what to say when ---...,-_ _- ----_ .. .------...... - .... --"""'I~-- .... --_----...... ---... _-...... -"... '-"'..... -.--"----.... ~ -----.. _._.. - --- ... educating clients. ._--.,..-~------..- _---_.... .------...- --.- --"""- "---- .--.__-_ .. _... _- _-­- ~-"";::..-:-~ ... --- ~"'='-==!:...~-- --~.----... - ... =.!-"":.~"':'~--;:o.::: .::;-._-_=:::.-_ _...... -.. _---.. ... ----~ _ .._._...... -.-... _.. ---_-.... - ...... _--.. -.. _ ...... -.. ---_,,_ .. _-_--- .:::::- ... - --- .. - .------.­_-_.-_... '_...... _- -_._._ _--.. - ·._---_.-_...- _ ~....- -_Or_ ...... _- - ...... _ ...... -.-- .. - ,-_----­ ...... _ _ .. .. _._- .:=:..":...- ... :=:===-.:: -..... -_.-.... ._ ...... --.~--...... - .., .- - __ .. _... - __ ; EE~ ..:;,~;;: .-- ...... __ _._ ..... - Clinical Alerts highlight special .= .. -... __..... _ .. ------_.. _ - : t:'==":!!.."!:,- ~~~~=...:..;:; .·;.:=--=~"'":!..';.":..-=--_ .. __ .. ... - -- ; ~=-~.=".=.-=:;--..- .... ___ ... _-- information such as safety issues. ==-~~'::'.::..."""=.== --~---_ .. .. -~-­ :='='=1:..':.r:.!:.':':!:"- ...... --_ ---.--' ...~" - ' .=:.,.""::..------.- -:;::::::::::= .. . .. _.__.. "-- ...... -.-.. - ...... -~--.-.. .. ::~ ... :::.:::..-:--=..-= ._-----­ _-...... __ ..... _.. - .:::::-.. _....., ... _.. -- : ~-::::.-=s:=-...!::':.= ------­ -- ._---_ .... _. :...... ~..:=::::.:..=;: ...... _...... -· ::.-:.:=::..::=== .. ... -_.. _- :Z:-="=::::::::'_-= --: ~=-~=~:=: xx Preface

_._-._- .. - ..~::'t':-----.- .. .. Drug Capsules boxes help -- _.- ...... : __ _._ _-- • !::..~=-.::.:--'-=--.:--_...... !:== ~ - ._-­ ---.".... --...... --.. ------_._._-.. --~-...,...... - student learn the implications of ---_ _- .:..~=.:?:'..:=..:::: ...... ::.:=-'------_._-... - .---.. certain medications that they may -- ... - ---__------.. - ---.._ ...... -...... ------_...... --~ : ~~:;~~~ ~ _,,-----_ __ _--- --==-...- - ~ -- ==:::---- ~ee in their clinical encounters. "_"."-~:-:=:=: ...... _.__ _., --....4.10 _ .. _ .. -____...... __ _ ._-- ...- _--.­ .. "'=: :.=__,_.. _..' .::=t-:.::::r .. _.. .. _ _.. .- --- - .....__ _-...... ~... :;:::" ..e- -::•:: .=-- = --..-=- .. .:.:;,":",.4': ---_ _- Home Care Considerations :::....-=.-~~ :"f';;:':='=- ... - .. - instruct students to consider '::.. -:'=---_"_' adaptation for performing the slcill :...;:... -;:~-~ in the home...... ' ot.A(MTO,ALMlDICA -.-.. _~.._------... --_----­.. ---....- =~..:'.=::==::!.. --_:::=-~_:"'.r::.. _------.. __.. --_--_ .. _--- -

Practice Guidelines provide s lllllll1arjc~ ii • ,, __ c,,,. ~ in Slalll ur dillical -"'- - "" dos and don'ts. --

.._---_ .. _. -----.----__------­ .. --- Critical Thinking Checkpoints provide brief case studie followed by questions that encourage students to analyse, compare, contemplate, interpret =- and c.::.va luale infurmatiun.

Concept Maps reinforce the steps of the nursing process by ~ ':"---..---- . using different colours and by ± mf'pping difficult concepts ~l~~ diagramaticail y.

Step-by-step Skill. help slUdems - --_... _ - understand techniques and .---;:::==:::-EE:- '-'" practice sequence. They include a .----_ ... _-.. -__-_ ._­ .. _­ complete equipment list and full­ :=,:!..,- --_.- colour photos and illustrations for critical steps . ---______.. _ n._.... _.. ..._'::====!.*';'::~'= .. _----­ ...... - .. -__.. - __.. __... _-" ...... - -:--":---_:'="--- .. _-""- :::~---_._•• ~. .'=: .. ~~"':':!::.:_- =-~~..:::.~ =.. .----_------_. ::0-=------Preface XX I

... Lifespan Considerations alert ---_ _- -- ~ ::,."';:'.. ":;'::1- - --- students to the needs of clients of ---..- .-.....-"-".-~." ~--,----"-'-- different ages. ------__----­...... -_... _ .... __.__._._- .__---- - :-'::=:,.::;::'==---==:...... _ __ _ .. _---__ ._ -_ ...... ------... -.... -~-_--_ --._-_._._.,:::::: .• -"-""-' .. - .. --.. -.' -_._...... -...... ::..-;.::.-...... ------_- ----,-_ Real·World Practice --_ _ - provides :.:==-:::'..'::~'":.:..":.="..:: __ =...... - ...... -.. - ...... __ _--_._-- .. _-----_­. _ students with a real-worid ~------.-. perspective of practice...... __ ...... - ._ .... _------..----__ _--_ .... __-- ... ----_---_.. -._ .. _-- ... _-- ... .=-==--=---... _--- ::'!::_._:::'.:!.~=~=-.!~~ ... _-_ ... _- ~ : ..?"--""-""'- ----~-,-.. :'::':=:':::"":-"':"''7':::_--- '. --~.---'-'-'­ ,..._-_ .... _._ ...... --.. ::0...... - _

Research Notes introduce .. ~ ...... _0-..... , •• , _ _...... __ __--_. .. _...... - students to the concept of ::::.::-...... ----- evidence-based nursing practice by reviewing relevant nursing research and discussing the implications for nursing practice.

_._._. __ ._ ... - ,.------'-_ ...... ~.=l.~""===...... _--­... __ .- -__-_ ...... _-_ -- .. _.. ---.... - .. -'''-=.::;;~~=;;:'---'-.. XXII Preface

SUPPLEMENTS FOR STUDENTS AND EDUCATORS To supplement the textbook and facil itate active student learning, we iJ1Ciude a variety of teaching and learnlllg aids in our compre­ hensive suppl ements package.

MYNURSlNGKIT glossary, case studies, care plan activilies and application MyN ursingKit is designed to help students apply concepts acti vities, as weU as a full eBook. Instructors can use grade In the book. Each chapter contains learning outcornes, a tracker to monitor student progress.

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Welcome to f'.1yNurslngKitl Book Resources ) You can find everything you need to be successful In the dassroom, In dlnlcals ) and ultimately on the NCLEX. In MyNurslm;;JKit.

...... ) MyNurslnoKit j~ en onlone supplement thet offen students book-soet;ifj~ leamlng objectives, chapter summanes and practice tests as well as video case Studies ) dies and activities to aid student leamino and comprehension. ) MyNur51f'101C1t also provides Instructors with easy and convenIent access to Smulaic:rl Important teachino resources indUdino lecture slides, Classroom Response Questions, te"t-benj.;, end mOr8,

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I PEA RSO N Ie> laID f'ea'5(IfIE.oi.ation ~as Ptlll"ltte tW · l~ Notice· Pm-«y Policy- ~

NURSING SKILLS VIDEOS offer students th e essential POWERPOINT SLIDES and DIGITAL [MAGE foundation for competency in performing c linical nursing LIDRARY. To fac ilitate classroom presentation, this dynamic, skilJ s, The volumes in this seri es consist of comprehensive Illultimedia resource pairs key points covered in the chapters procedures, demonstrated in hundreds of realistic video clips, with images from the textbook to encourage effective lectures animations, illustrations nnd photographs. Throughout the vi d and c lassroom discussions. eos, student will experi ence the real-li fe as pects of therapeutic communication between the nurse and the patient, patients' COMPUTERISED TEST BANK. The test bank allows reaction to invasivp: skills, and issues related to culture, gender edl1 cators to c ustomise the bank of qllf': ~ tions to meet specific and age. teaching needs and add/revise questions as needed. It consists of more than 2,000 true-false, multiple-choice, short-answer, LNSTRUCTORS' MANUAL. This manual contains a essay and matching questions complete with solutions. Using wealth of material to help instructors with the planning of Pearson's TestGen software, educators can create professional­ curricul a, particularl y for first-year nursing programs, [t looking exams in just minutes by building tests from the existing includes chapter overvi ews, detailed lecture suggesti ons and database of questions, editing questions, or adding their own. outlines, learning outcomes, teaching tips, and more, for each TestGen also allows instructors to prepare printed, network and chapter. online tests. Preface XXI II

ACKNOWLEDGMENTS We extend a sincere th ank-yo u to the talented team i_nvolved in pictures team including Loui se Burke and Emma Gaulton. the first Australian edition of thi s book: the contributors and Many of the new photos in the I st edition were photographed reviewers who provided co ntent an d very helpful feedback; the by Beau Lark and overseen by Clara Williams, director of pho­ nursing students, for their questioning mi nds and motivat ion; tography for Corbis, on site at Centra l Queensland University, and the nursing academics, who provided many va luable sug­ and ably hosted by our terrific authors Dr Lorna Moxham and gestions for th is ed ition. We also th ank the editorial team at Dr Trudy Dwyer. Pearson, including Michelle Aarons, acq uisitions editor, for commissioning thi s project and putting a stellar team of authors Tracy Levett-Jones, Trudy Dwyer, Majella Hales, together; Mi chael Stone, development editor, for keeping our Nichole Harvey, Yoni Luxford, Lorna Mox ham, noses to the grindstone; Katie Millar, sen ior project editor, for Tanya Park, Barbara Parker, Kerry Reid-Searl and producing th is book with precision; and the copyright and David Stanley

REVIEWERS We also wish to thank the foll owin g reviewers: Pam McCrorie Ed ith Cowan Uni ve rsity Renee M cGill Charl es Stull University Kasia Bail Uni vers ity of Canberra Helene Metcalfe Edith Cowan U niversity Jan Barling Southern Cross University lonathan Mould Ed ith Cowan Univers ity lngrid Belan Flinders University Sl eve Parker Fli nders U niversilY Karyn Bentl ey University of South A ustralia A nn Paterson RMlT University Julie Bradshaw Central Queensland Uni versity Carol Pi ercey Curtin University of Technology Jo McDonnali Deakin University Maryanne Pod ham Charles Stull U niversity Debra Nizetle Australi an Catholic University Robin Ray James Cook University Tracey Thornley Uni versity of Sydney Lyn Raymond Uni versity of Notre Dame Sharon Bourgeois Universiry of Western Sydney Cobie J Rudd Edith Cowan Universiry Jenn i Brackenreg Charles Stllrt University Catherine Stokes University of Canberra Marc Broadbent Central Queensland Uni ve rsity Peter Thomas University of Wollongong Stephanie Burnip Southern Cross U ni versiry Neal Tolley AusrraJian Catholic Universiry To ny Bush RMIT Univers ity Marion Tower Griffith Uni versi ty Maureen Chapman Central Queensland Unive rsity Caroline Vafeas Edith Cowan University Liesa Clague A ustra li an Carholi c University Jane Walker Deakin University Karen Clark- Bu rg University of Notre Dame Matthew Walsh University of Newcastle Leonie Cox Queensland Un iversity of Catheri ne Ward Curtin University of Technology Technology Paul 'Varner Chru'les SlUll Univers ity Carol Crevacore Edith Cowan Uni versi ty Julie Watkinson University of South AustraLia Annie Das Uni verSity of Notre Dame Louise Wells Charles Stu n University Clare Harvey Flinders Universi ty Kerre Willsher University of SQ UIh Australia Noelene Hickey U ni versity of Newcastl e Melanie Zil embo Ed ith Cowan U niversi ty Elspeth Hillman James Cook University Michele Zolezzi University of Notre Dame - ... .,; .'; -~ ~ '.0 ...· . . _ ~ ·...... 0·· . '.,. ., "...... 0...... '0'- .... 0°' ',' .0'" ..... - l te. • • ...... o.!- ;.· ... O.'! ...... ~ ••• -'•••• : ••••••••••••• ',.':.' ".:, • • ••••; • to,: •.•• !.: • '0" ••••• :.: .; " •••• • • .•:.:,"::':' ...... :.' ':.• -:': .. ~ •• : .....:!: ...... ~.:•• : •.: ...:.: .• :.~ .. : .••: '0 :' •••• '0 ::~:... ~:~: .....~ •• ~.;:. .. . ' "0' -:'" " .\ Ie. . -. . ..! ...... :~. '.. ,.(0': .•: ..~:: .••• , :~"'?~t.,;"..... : ....·.::t:.:~::r :·{·· :... :.,.:. :.i.~.:·."···: ..... ::: ..:~.:::. .. :t .. : ~" . 1:. .t. .. ·oJ·... :<· •• • '.{'" •'. • c ··~····':. tdb":1 : 1:'l;_~ ,~ . . ", '0...... :.J•• ".o ...... ,~ ...... ". o. 0'=..... •"...... 0' ...... "I'...... ,' .'• ""-"0 • ...... '- .:.·.. ... :.....0 " -.. ., .. ~.. ~.' . ~ ~ .. ~ · .. :r.! • :';,., •. ~: ...... ~ ~.:~.~:·.:.:· .. t •• :.;~:·· ..... r ;.' ...... :.:.... : ...... ;:: ..~. . .~' ~·~.t::: ...... ". ' . 0..\0·.. .. ,...... :... : ,~ ":: ... ~ . .. :...... :;;::"~:,,:...... "...... :.::.;....:.~ '...... ,. ~...... 0:.,..' '"; ••• ,.', '.:. • . ...- ' ..:' ...... :... . .'_;'-!.':,:"I .., '.. •••.. ~

Wendy Madsen Antllea Fagan BA, RN, MHSc, PhD, GCFL RN, BN, Grad Dip Neuroscience Nursing, MN CQUniversity Australia Un iversity of New England Chapter J Historical and COl1temporQl)1 Nursillg Practice Chapter 12 Diagllosing

Lorna Moxham Becky Ingh~lm-Broomnt!ld RN, MHN, PhD, DAS (Nsg), BHSc, MEd, CerLO H&S , Cert RN, Cert Ed, DipN (Lon), BSc, MSc. PhD candidate Qual Mgmt, Cert IV (Training & Assessment), FACMHN, University of New England MAQNL Chapter 13 Planning CQUniversity Australi a Chapter 2 Nurse Education, Research alltl Evidence-based Penny Paliadelis Practice PhD, RN, EN, MN(Hons) Chapter 44 Activity and Exercise University of New England Chapter 14 Implementing and Evalualing Sandra Walker RN, RM , Neonatal Intensive Care Cen, BN, BEd, MNS, PhD Glenda Parmenter CQUni versity Australia PhD, RN, BSocSc, MLitt, MRCNA, MPCA, MAAG Chapter 3 Nursing Theories and Conceptual Frameworks Uni versity of New England Chapter 52 Fluid, Electrolyte alld Acid-Base Baltlllce Chapter 15 DOCllmelllillg and Reporting

Julie Zetler Natarla Brooks RN , BA, LLB , LLM, Master's of Bio, Urad <':e11 ArbItration BSc (NurSing), Post Grad CenTI and Mediation Formerly Curtin University Macquarie University Chapter 16 Health Promotioll Chaprer 4 Legal A~pecrs uf Nur::;ing David Stanley Keri Chater NursD, MSc, BA Ng, Dip HE (Nursing), RN, RM , TF, RN, BA (Sciences), MN, PhD Gerontic Cert Royal Institute of Technology Cunin Uni versity Chapter 5 Vailles, Ethics alld Advocacy Chapter 17 Health, Welb,ess and IIIlIess Chapter 19 Complemelllary alld Allemative Healing Judy Gonda Modalities RN, RM , B App Sci Adv Nsg (Educat ion), MN, PhD Australian Catholic University, McAuley Campus Roianne West Chapter 6 Health Care Delivery Systems RN,BN, MMHN James Cook Un ive rsity Majella Hales Chapter 18 Cultures alld Nursing RN, BN, Grad Cert HE, MAppSci, PhD candidate Australi an Catholic University, McAuley Campus Jennifer Lapsley Chapter 7 Community Health Nursing RN, BAppSc, MSC (Nsg) Chapter 8 Home Care CUI1in Uni versity Chapter 9 Nursing In/ormatics Chapter /8 Cultures and Nursing

Yoni Luxfo.-d Adele Baldwin PhD, RN, RM, BSW, Grad Dip PHC, Grad Cert Tertiary Ed RN, EM , MNSt University of New England James Cook University Chapter 10 Critical Thinking and the Nursing Process Clwpler 20 ConcepTs ofCrmlith and DevelopmenT Chapter 11 Assessing Chapter 43 Loss, Grieving alld Death

Alan Avery Nichole Harvey RN, BCom(Econ), BHSc(Nursing), MEd, Coronary Care RN. EM, CritCareCert, BN (Post Reg), MNSr, Grad Cen Ed NurseCert. MCN, EdD (TI), PhD candidate University of New England James Cook University Chapter 10 Critical Thinkillg alld the Nursing Process Chapter 18 Cullures ami Nursing Contributors XXV

ChapTer 21 PromoTing HealTh/rom ConcepTion Through TO Tom Laws Adolescence RN , RM , Ophthalmic Nursing Dip, BEe, Grad Dip Ed, ChapTer 38 Sensory PercepTion lirad Dip Public Health University of South Australia Amanda Fillingham ChapTer 31 Asepsis RON. RMW. RHV, BA(Hons), MA ChaplPr 37 Perioperalive Nursing James Cook University ChapTer 22 PromOTing HealTh in Young and Middle-Aged AdulTS Maria Fedoruk Chnpll!r 42 Stress and COpin8 Orad Con Ed (Hi gher Ed), PhD, Grad Dip Mgt, MHA, BAppSc (Nsg Admin), CCRN, RN , GAICD Sue Brown University of South Australia RN, 0 HthSc, M HthSc, Orad C~n (Tf), ON Chapter 32 Safety James Cook University ChapTer 23 PromOTing HealTh in Older AdulTS Barbara Pa rker CltulJ/er 24 Promori"g Family Health R , BSc(Hon ), Grad Cen Ed (Higher Ed), PhD University of South Australi a Sha ron Bourgeois Chapter 33 Hygiene RN, PhD, MA, MEd, BA , FRCNA, FCN University of Western Sydney Angela Kucia ChapTer 25 Caring Coronary Care Cert. Prof Cert Pharmacology for Nurses, BN, MA (Sc and Tech Studies), Grad Cer! Ed (Higher Ed ), PhD Pa mela Va n der Riet University of South Australi a RN , PhD, MEd. BA (Soc Science). Dip Ed (Nursing), Chapler 34 Diagllostic Tes/ins ICUI CCU Cen, Dip Remedial Massage University of Newcastle Pamela Aide ChapTer 25 Caring BA (Ling), BN (Hons), PhD Candidate ChapTer 27 Teaching University of South Australia Chapter 23 Prom OTing Health ill Older Adults Tracy Levett-Jones C/wprer 35 Medicaliolls RN, PhD, MEd & Work, BN, Dip AppSc (Nursing) University of Newcastl e C raig Phillips Chapler 26 Communicating Dip AppSc (Nursi ng), BN , MN (Advanced Practice), ChapTer 27 Teaching PhD candidate University of South Australia Jeuny Day ChapTer 36 Skinllllegrity ant! Wound Care RN , ADClfN, BHSc (Nursing), MEd (Adult Ed) University of Newcastle Trmya Park Chapler 26 Communicating RN, EM, EMHN, BNSc, Grad Dip MHN, MMid, Grad Cen Ed (TI), PhD candidate Teresa Stone James Cook University RN , Reg Psychiauic Nurse, BA, MA Health Management ChapTer 18 Culll/res and Nursing University of Newcastle ChapTer 39 Self-ConcepT Chapter 28 Delegating, Managing and Leading Chapter 40 Sexuo!;ry

Matthew Walsh RN, MN (Clinical Practice), BN, BSe (Biomedical Sc) K ristin Wicking University of Newcastle RN , BSN, MSN, Grad cen Ed (n '), PhD candidate ChapTer 29 ViTal Siglls James Cook University Chapter 41 SpiriTuality Lynne Slater RN , RM , Grad Dip HSc (Primary Health Care). MMid, MN, Peter Reaburn MRCNA BHMS(Erl)(Holl <) , PhD. Grad Cert Flex Leom University of Newcastle CQ University Australia Chapter 30 HealTh AssessmenT Chapter 44 Activity alld Exercise XXVI Contributors

Judith Applegarth Trudy Dwyer RN EM BHSc (Nsg), Grad Cert Child & Family Health , Grad RN , lCUNsgCert, BHlthScn (Nsg), Grad Cer! FlexLearn, Dip Ilealth Admjn & Info Systems, MClin Practice (Nc;:g) MClinEdu. PhD CQUniversity Australia CQUnive rsity Australia Chapler 45 Sleep Chapler 50 Oxygellation Chapter 46 fbi" MwwgcmcnI Chapler 51 Circulation

Susan Lee Williams Sandra Walker RN, DIlSc(N.g), Grad Cerl SpNUl, Grad D;p HllmNul RN. RM. Neonatal Intensive Care Cert, B ,BEd, MNS, PhD CQUniversity Australia CQUniversity Cht/Pler 47 N",ritioll Chapler 52 Fillid, Elec/roly/e alld Acid-Base Balallce

Kerry Reid-Searl RN, RM, BHSc (Nsg), MClinEdu, PhD, MRCNA, FCN CQUnivcrsity Australia Chapler 48 Urillary Eliminatioll Chapler 49 Faecal Elimination