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NURSING

Nadia R. Singh, BSN, RN, is a registered nurse practicing in a medical oncology unit at the Jupiter Medical Center, Jupiter, Florida. Prior to this, she worked as a medical–surgical nurse in Boston, Massachusetts, and Florida. She is certified in IV infusion, telemetry, and pressure ulcer care (ANA), and in BLS/ACLS by the American Red Cross, and she is licensed to practice in Massachusetts, New York, and Florida. Ms. Singh graduated in 2008 with a bachelor of science in nursing (BSN) from Simmons College School of Nursing in Boston, Massachusetts, and is currently working toward her master's degree in nursing (MSN). She speaks to new nursing students at universities throughout southern Florida.

NURSING The Ultimate Study Guide Second Edition Nadia R. Singh, BSN, RN

Copyright © 2016 Springer Publishing Company, LLC 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 Springer Publishing Company, LLC, or authorization through payment of the appropriate fees to the Copyright Clearance Center, Inc., 222 Rosewood Drive, Danvers, MA 01923, 978-750-8400, fax 978-646-8600, [email protected] or on the Web at www.copyright.com. Springer Publishing Company, LLC 11 West 42nd Street New York, NY 10036 www.springerpub.com Acquisitions Editor: Elizabeth Nieginski Production Editor: Kris Parrish Composition: S4Carlisle Publishing Services ISBN: 978-0-8261-3022-8 e-book ISBN: 978-0-8261-3023-5 15 16 17 18 / 5 4 3 2 1 The author and the publisher of this Work have made every effort to use sources believed to be reliable to provide information that is accurate and compatible with the standards generally accepted at the time of publication. Because medical science is continually advancing, our knowledge base continues to expand. Therefore, as new information becomes available, changes in procedures become necessary. We recommend that the reader always consult current research and specific institutional policies before performing any clinical procedure. The author and publisher shall not be liable for any special, consequential, or exemplary damages resulting, in whole or in part, from the readers’ use of, or reliance on, the information contained in this book. The publisher has no responsibility for the persistence or accuracy of URLs for external or third-party Internet websites referred to in this publication and does not guarantee that any content on such websites is, or will remain, accurate or appropriate. Library of Congress Cataloging-in-Publication Data Singh, Nadia R., author. Nursing : the ultimate study guide / Nadia Singh.—Second edition. p. ; cm. Includes bibliographical references and index. ISBN 978-0-8261-3022-8—ISBN 978-0-8261-3023-5 (e-book) I. Title. [DNLM: 1. Nursing Care. 2. Nursing. WY 100.1] RT51 610.73—dc23 2015009944 Special discounts on bulk quantities of our books are available to corporations, professional associations, pharmaceutical companies, health care organizations, and other qualifying groups. If you are interested in a custom book, including chapters from more than one of our titles, we can provide that service as well. For details, please contact: Special Sales Department, Springer Publishing Company, LLC 11 West 42nd Street, 15th Floor, New York, NY 10036-8002 Phone: 877-687-7476 or 212-431-4370; Fax: 212-941-7842 E-mail: [email protected] Printed in the United States of America by McNaughton & Gunn.

I dedicate this book to Ayden.

CONTENTS

Preface xi Acknowledgments

xiii

1. Fundamentals of Nursing 1 History of Nursing 2 Therapeutic Communication 2 The Nursing Process (Nursing Care Plans) Patient Education 6 Functional Health Patterns 8 Cultural Differences 9 Nutrition 9 Urinary and Bowel Function 10 Vital Signs 11 Skin Integrity and Immobility 16 Oxygenation 19 Acid–Base Imbalances 20 Fluids and Electrolytes 22 Intravenous Fluids 26 Intravenous Sites 26 Medication Administration 27 Infection Control and Prevention 28 The Surgical Experience 29 Blood Transfusions 30 See You Later Fundamentals! 31 2. Health Assessment 33 Skin, Hair, and Nails 34 Head, Ears, and Nose 36 Mouth and Lips 38 Neck and Nodes Assessment 39 Neurological System and Cranial Nerves Thorax and Lungs 41 Heart and Peripheral Vascular Assessment Musculoskeletal Assessment 43 Breast Assessment 44 Abdominal Assessment 45

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39 42

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CONTENTS

3. Medical–Surgical Nursing 47 Important Lab Values 48 Cardiovascular Disorders 49 Respiratory Disorders 61 Neurological Disorders 71 Endocrine Disorders 82 Gastrointestinal Disorders (GI) 91 Genitourinary Disorders (GU) 99 Musculoskeletal Disorders 105 Integumentary Disorders 110 Immunological Disorders 113 Oncological Disorders 115 Hematological Disorders 120 4. Emergency Nursing 123 Cardiac Arrest 123 Septic Shock 124 Hypertensive Crisis 124 Perforated Bowel 124 Gastrointestinal Bleed 125 Ileus 125 Diabetic Ketoacidosis 125 Respiratory Failure 126 5. Pharmacology 127 A Little Pharmacology Advice 128 Safe Medication Administration 128 Pharmacokinetics 129 Pharmacodynamics 130 Cardiovascular Medications 130 Respiratory Medications 138 Neurological Medications 143 Endocrine Medications 146 Gastrointestinal Medications 152 Genitourinary Medications 155 Musculoskeletal Medications 157 Integumentary Medications 159 Immunological Medications 160 Pain Management 166

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6. Pediatric Nursing 167 Pediatric Physical Assessment Cardiovascular Disorders 174 Respiratory Disorders 179 Neurological Disorders 183 Endocrine Disorders 188

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CONTENTS

Gastrointestinal Disorders 190 Genitourinary Disorders 196 Musculoskeletal Disorders 200 Hematological Disorders 203 Pediatric Cancers 205 Ear, Eye, and Throat Disorders 208 Infectious Disorders 209 Immunizations 213 7. Women’s Health 215 Fetal Development 216 The Prenatal Experience 216 Labor and Delivery 222 The Postpartum Experience 228 The Newborn Assessment 231 Maternity Pharmacology 239 8. Psychiatric Nursing 243 Disorders in the Elderly Population Psychiatric Medications 249 9. Decreasing Test Anxiety

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257

10. What to Expect in Nursing School

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261

11. NCLEX Tips

263

12. Conclusion

Appendix A: Abbreviations

265

Appendix B: NCLEX Question Formats Appendix C: Basic EKG Rhythm Examples Bibliography Index

267 279

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ix

PREFACE

In this second edition of Nursing: The Ultimate Study Guide, my goal is to continue to help students succeed in their nursing program. In this edition, I provide the most up-to-date information for each nursing course, with three new chapters—“What to Expect in Nursing School,” “Decreasing Test Anxiety,” and “Emergency Nursing.” The medical field is continually changing; every year medications and lab values are updated, and new disorders or viruses identified. Providing students with the most up-to-date information is key to helping them succeed in their nursing studies. As a recent graduate, I know how difficult and stressful the nursing program can be. Long nights, difficult tests, clinicals, and the struggle to maintain a social life can feel like an overwhelming burden. The intention of this study guide is to provide you with the most frequently tested information based on my experience, class notes, and previous exams. There is an abundance of information to learn in a short time; use your textbooks and class notes along with this study guide to help you. The format of this study guide is simple, short, and to the point—a tiny study guide with a big punch. Each chapter represents a nursing course, with highlighted information and flags in the margin identifying the most frequently tested information. Chapters are short and to the point and, in contrast to many other study guides, highlight only the most important and tested information. Do not be surprised by the short chapters; each one is packed with useful information in an easy-to-read format. This study guide can be used from the first course, fundamentals of nursing, to the last course, which is helping you prepare for the NCLEX. Nursing programs are difficult, but with hard work and a positive attitude, you will graduate and become a great nurse. Be proud of yourself: Nursing is one of the most rewarding jobs. You have been accepted into a nursing program, which is the first big step, and that is a huge accomplishment! This book will help you through your nursing program to further your xi

PREFACE xii

accomplishments, giving you tips for test taking and preparing you for the NCLEX. I will also share some personal stories of my experience in a nursing program. So grab some coffee, go to a comfy study spot, and let's get started! Welcome to the world of nursing!

ACKNOWLEDGMENTS

First, I would like to acknowledge my family for all their love and support: my mom, Shabbena Singh, who continues to this day to support me in my nursing career; my father, Wayne Singh, for opening the doors of opportunity that contributed to my success; Asiff, for giving me all of his love and support while I was writing this book; and Ayden, my joy, who never stops smiling. Simmons College, thank you for the education and the foundation that helped me create this study guide and become the nurse I am today. To the staff at Springer Publishing Company, thank you for believing in this book and for all your help with editing, publication, and creativity. I am especially thankful to Margaret Zuccarini and Elizabeth Nieginski for believing in me and this book. To the nurses and fellow coworkers, who continue to educate and help me grow in the field of nursing, I am so thankful! To all the nurses in the field, you are greatly appreciated, and those whose lives you have changed will never forget you.

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ONE

FUNDAMENTALS OF NURSING

W

elcome to the beginning of your nursing education! Fundamentals of Nursing is the first nursing class you will take to begin the nursing program. The skills you learn in this course will provide the foundation for the many nursing responsibilities you will assume throughout your career as both a nurse and a student. As you review the syllabus for this course, you might say to yourself, “OMG, how on earth am I supposed to learn all of this in a semester.” Stay calm and take it one day (and one section) at a time. It will take some time to adjust to the demands of the nursing program. Over time, you will develop study skills and confidence, and before you know it, you will be a pro at studying. Let’s chat a little about what this course is all about. Fundamentals of nursing introduces you to the thorough assessment of patients, the nursing process, communication between nurse and patient, cultural differences, functional health patterns, and the overall framework of nursing practice. Think of it this way: When you build a house, you start with the foundation and then move to the framework, walls, and so on. I think you get the point. This class is the foundation for nursing, the beginning point. It gives you an overview of what to expect when working as a nurse. It will take some time to learn the skills needed to assess patients; do not feel discouraged if you do not grasp the concepts right away. I found myself struggling at the beginning of the course. I felt overwhelmed, my mind was on overload from all the information, and I was nervous about performing the assessments in front of my classmates. I was not one for failure, but boy, did I feel like one at the beginning of this class. My test scores were poor, and my nervousness was undermining my assessment skills. I began to change my thinking. I studied day and night, went to study groups, and my grades began to improve. It is like the old saying: “Hard work does pay off.” I developed my study skills during this course, which helped me through the other courses, as well. You, too, will develop and improve your study skills as you progress through the course. So let’s jump to it and get started! We will begin with the history of nursing.

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FUNDAMENTALS OF NURSING

HISTORY OF NURSING We could talk all day about the history of nursing. Many books have been written describing the great works of the nurses who built the foundation for the nursing profession. Without their knowledge and perseverance, we would not have the growing field we do today. This chapter covers only a few details from the history of nursing. To be honest, very little of this historical information was tested, and I would not spend too much time trying to remember dates and exact timelines. Follow your professors’ key points and highlight any information they emphasize. You will be required to know the influence of Florence Nightingale and her role in nursing. • Florence Nightingale laid the foundation for professional nursing practice through her work in the Crimea in the 1850s. She later established her own nursing school. Through her teaching and empha-

Therapeutic Communication

sis on sanitary care of patients, the nursing field progressed. • Nightingale was the first nurse epidemiologist. • The Civil War (1860–1865) furthered the expansion of the nursing field. Nurses were needed to tend to patients’ wounds, and the field began to grow as additional women were trained. It was also during this time that the American Red Cross was founded. • Between 1860 and 1900, Nightingale established 400 nursing training schools and helped improve the conditions of hospital-based care. • In 1956, the first Health Amendment Act gave nurses the financial aid needed for training and school.

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This short outline summarizes the points to focus on when studying nursing history. The most frequently tested information was on Florence Nightingale and her influence. Refer to your classroom notes and what the professor highlights for more in-depth information. The following chapters will focus directly on patient care and assessments.

THERAPEUTIC COMMUNICATION E-mails, text messages, Instagram, Facebook, WhatsApp, and Twitter are all forms of communication that we use in our daily lives. When communicating one on one with a patient, we must use compassion and care. Also, take into consideration the age and culture of the patients. It is unlikely that your 88-year-old patient will know the new lingo of “LOL” or “OMG.” However, this may be just what is needed to connect

culture also plays a role in communication, which will be discussed in further detail in the next section. Phases of Communication

There are three basic phases of communication: (a) introductory, (b) working, and (c) termination. You will use these three phases to understand your patient’s problems and come up with solutions. In the introductory phase, you will introduce yourself, discuss any problems, and establish a relationship with your patient. Remember not every patient is cheery and upbeat. You will also have patients who are scared, angry, or discouraged. It will be your job to think of ways to establish an amicable relationship. Also, if a language barrier is present, this would be the best time to contact a translator. The working phase is where you identify the patient’s problem. For example, suppose the patient diagnosis is abdominal pain. In this phase, you would look further into why the patient is having abdominal pain using labs, scans, or physician notes. You would look for any resolution to the problems. Did the doctor prescribe pain medications? Was a CT scan performed? Is surgery necessary? The working phase is where the problem is identified and measures are taken to help the patient. The last phase, the termination phase, is where the problem is being resolved. In the preceding example, if the patient was given pain medication as ordered and the problem has resolved, the nurse’s communication with the patient would come to an end. When thinking about the phases of communication, consider how you communicate when chatting with a friend, family member, or coworker who has a problem. They call you and state their problem. You talk about the problem and figure out ways to make it better. By the end of the conversation, your friend feels better because a resolution has been achieved or is in the making. Similarly, your patients are talking with you in the role of their problem solver, the one who makes them better. For all of you nervous nellies who are uncomfortable speaking

FUNDAMENTALS OF NURSING

There are two types of communication: (a) verbal, which involves speaking to the patient, and (b) nonverbal, which involves the use of facial expressions, eye contact, and therapeutic touch. Remember,

Therapeutic Communication

with your younger patients. Communication in nursing is so important. Patients and families are often scared or worried, and you are often their source of information and comfort. When entering a patient’s room, smile and introduce yourself to both the patient and the patient’s family. Make them feel comfortable and well taken care of.

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FUNDAMENTALS OF NURSING

with people, now is the time to practice and muster up some confidence. Communication is the key to nursing; it involves constant talking with patients, families, and physicians. Tips on What Not to Do During Communication

When communicating with patients, there are some pitfalls you need to avoid. Do not be judgmental or abrupt, or speak down to patients. Avoid leading questions that may discourage or embarrass the patient. Do not crack jokes or speak about topics that may cause a patient to become offended. If language barriers are present, do not ignore these patients because you cannot understand them: Use an interpreter to communicate with the patient and try to avoid using family members to translate. Developing Communication Skills

The Nursing Process (Nursing Care Plans)

There are several ways to create a great relationship with patients. Most important is to provide privacy when speaking with the patient—for example, by closing the door or shutting the curtain. Introducing yourself is the next step. Sit down, if possible, when talking—patients feel more comfortable when you are speaking to them at eye level. Listen carefully, and strive to make a comfortable environment for the patient.

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Use open-ended questions. Avoid yes/no answers to encourage your patients to give you details when discussing their health problems. You want as much information as possible, including anything about their past medical history.

Be compassionate. Being in the hospital is scary for both patients and families. Emotional support is often needed. For patients who are confused or unable to respond, the use of touch is therapeutic. As a nurse, you will create ways of your own to make communication comfortable for you and the patient.

THE NURSING PROCESS (NURSING CARE PLANS) Along with communication techniques, nurses rely on the nursing process when caring for patients. The nursing process is a five-step systematic approach to problem solving. It allows the nurse to obtain both subjective and objective information to determine the health care problem. The five steps are (a) assessment, (b) diagnosis, (c) planning, (d) implementation, and (e) evaluation, which can be remembered using the mnemonic “ADPIE (A Delicious PIE).” Based on these steps a care plan is conducted for each patient.

FUNDAMENTALS OF NURSING

Assessment

Begin your assessment by asking the patient about the problem, signs, and symptoms that he or she has been experiencing. If the patient is unable to speak, ask a fam...