LEWIS'S MEDICAL-SURGICAL NURSING : assessment and management of clinical problems, single volume

Front Matter IFC CONTENTS Contents Lewis’s Medical-Surgical Nursing ASSESSMENT AND MANAGEMENT OF CLINICAL PROBLEMS Half Title Lewis’s Medical-Surgical Nursing ASSESSMENT AND MANAGEMENTOF CLINICAL PROBLEMS Copyright ABOUT THE AUTHORS JEFFREY KWONG, RN, DNP, MPH, ANP-BC, FAAN, FAANP DEBRA HAGLER, PHD, RN, ACNS-BC, CNE, CHSE, ANEF, FAAN COURTNEY REINISCH, RN, DNP, FNP-BC CONTRIBUTORS Authors of Teaching and Learning Resources Case Studies (Interactive and Applying Clinical Judgment With Multiple Patients) PowerPoint Presentations TEACH for Nurses NCLEX® Examination Review Questions Study Guide Clinical Companion Evidence-Based Practice Boxes Nursing Care Plans PREFACE SPECIAL FEATURES LEARNING SUPPLEMENTS FOR STUDENTS TEACHING SUPPLEMENTS FOR INSTRUCTORS ACKNOWLEDGMENTS CONTENTS CONCEPT EXEMPLARS SPECIAL FEATURES Lewis’s Medical-Surgical Nursing ASSESSMENT AND MANAGEMENT OF CLINICAL PROBLEMS 1 - Concepts in Nursing Practice 1 - Professional Nursing PROFESSIONAL NURSING PRACTICE Domain of Nursing Practice Definitions of Nursing Nursing’s View of Humanity Scope of Nursing Practice Standards of Professional Nursing Practice INFLUENCES ON PROFESSIONAL NURSING PRACTICE Expanding Knowledge and Technology Diverse Populations Consumerism Health Care Financing Health Policy Professional Nursing Organizations Nursing Core Competencies PATIENT-CENTERED CARE Clinical Judgment Clinical Practice Frameworks Nursing Care Plans Continuum of Patient Care Delivery of Nursing Care Supporting Caregivers INTERPROFESSIONAL PARTNERSHIPS Interprofessional Team Coordinating Care Communication Clinical Pathways Delegation and Assignment SAFETY Serious Reportable Events National Patient Safety Goals QUALITY IMPROVEMENT National Database of Nursing Quality Indicators INFORMATICS Electronic Health Records EVIDENCE-BASED PRACTICE Steps of EBP Process Step 1 Step 2 Step 3 Step 4 Step 5 Step 6 Implementing EBP EVOLVE WEBSITE/RESOURCES LIST REFERENCES 2 - Social Determinants of Health SOCIAL DETERMINANTS OF HEALTH Neighborhood Economic Stability Health Care Education Community HEALTH DISPARITIES AND HEALTH EQUITY Factors and Conditions Leading to Health Disparities Ethnicity and Race Gender Age CULTURE CULTURAL COMPETENCE CULTURAL FACTORS AFFECTING HEALTH AND HEALTH CARE Folk Healers and Traditions Spirituality and Religion Cross-Cultural Communication Family Roles and Relationships Personal Space Touch Nutrition Immigrants and Immigration Drugs Psychologic Factors Self-Assessment Assessment Implementation Advocacy Standardized Guidelines Communication EVOLVE WEBSITE/RESOURCES LIST REFERENCES 3 - Health History and Physical Examination DATA COLLECTION Medical Focus Nursing Focus Types of Data Interview Considerations Symptom Investigation Data Organization NURSING HISTORY: SUBJECTIVE DATA Important Health Information Health History Medications Allergies Surgery and Other Treatments Functional Health Patterns Health Perception–Health Management Pattern Nutritional-Metabolic Pattern Elimination Pattern Activity-Exercise Pattern Sleep-Rest Pattern Cognitive-Perceptual Pattern Self-Perception–Self-Concept Pattern Role-Relationship Pattern Sexuality-Reproductive Pattern Coping–Stress Tolerance Pattern Value-Belief Pattern PHYSICAL EXAMINATION: OBJECTIVE DATA General Survey Physical Examination Techniques . Inspection is the visual assessment of a part or region of the body to assess normal conditions or deviations. Inspection is m... . Palpation is the assessment of the body using touch. Using light and deep palpation can yield information about masses, pulsat... . Percussion is a technique that produces a sound and vibration to obtain information about the underlying area (Fig. 3.3). The ... . Auscultation involves listening to sounds produced by the body with a stethoscope to assess normal and abnormal conditions. Th... Equipment Organization of Examination Documentation TYPES OF ASSESSMENT Emergency Assessment Comprehensive Assessment Focused Assessment Using Assessment Approaches 4 - Patient and Caregiver Teaching TEACHING-LEARNING PROCESS Adult Learner Adult Learning Principles Models to Promote Health Nurse as Teacher Required Competencies . Develop confidence as a teacher by becoming knowledgeable about the topic. For example, if you are teaching patients about man... . Patient teaching depends on effective communication between you and the patient or caregiver. Medical jargon can be intimidati... . Teaching patients and caregivers has many challenges, including (1) lack of time, (2) your own feelings as a teacher, (3) nurs... Caregiver Support in the Teaching-Learning Process Regulatory Mandates for Patient Teaching PROCESS OF PATIENT TEACHING Assessment Physical Factors Psychologic Factors Sociocultural Factors . Literacy is the ability to use printed and written information to function in society. Health literacy is the degree to which ... . Cultural traditions influence our health practices, beliefs, and behavior. These traditions, which can affect patient teaching... . Consider a variety of socioeco­nomic factors when preparing to teach patients. Knowing the patient’s present or past occupatio... Learner Factors . Learning needs are the new knowledge and skills that a person must have to meet a goal. Assess what the patient already knows ... . Motivation and readiness to learn depend on multiple factors, such as perceived need, attitudes, and beliefs. When teaching ad... . Each person has preferred styles of learning. The three general learning styles are (1) visual (reading, pictures), (2) audito... Clinical Problems Planning Setting Goals Choosing Teaching Strategies . Use learning materials in multiple formats. Learn what resources are available in your agency and from support services and pr... . Patients may use the Internet and other digital technology (e.g., smart phones) to obtain information and manage their health.... Implementation Evaluation REFERENCES 5 - Chronic Illness and Older Adults CHRONIC ILLNESS Preventing and Managing a Crisis Carrying Out Prescribed Treatment Plan Controlling Symptoms Reordering Time Adjusting to Changes in the Course of Disease Preventing Social Isolation Attempting to Normalize Interactions With Others Preventing Chronic Illness ATTITUDES TOWARD AGING BIOLOGIC AGING AGE-RELATED PHYSIOLOGIC CHANGES SPECIAL OLDER ADULT POPULATIONS Chronically Ill Older Adults Cognitively Impaired Older Adults Rural Older Adults Homeless Older Adults Frail Older Adults SOCIAL SUPPORT AND OLDER ADULTS Family Caregivers Elder Mistreatment Self-Neglect SOCIAL SERVICES FOR OLDER ADULTS MEDICARE AND MEDICAID CARE ALTERNATIVES FOR OLDER ADULTS Adult Day Care and Adult Day Health Care Home Health Care Long-Term Care Facilities Programs for All-Inclusive Care for the Elderly Age-Friendly Health Systems LEGAL AND ETHICAL ISSUES ?Health Promotion ?Acute and Ambulatory Care . The time of a care transition to another setting (e.g., acute care hospital to rehabilitation) is challenging for many older a... . The goal of rehabilitation is to help older adults adapt to or recover from disability or an acute functional decline. Rehabil... . Consider the use of assistive devices as interventions for older adults. Using assistive devices such as dentures, glasses, he... . Safety is crucial in maintaining an older adult’s health. When compared to younger adults, older adults are at higher risk for... . Medication use in older adults requires thorough and regular assessment, care planning, and evaluation. Nonadherence to medica... . Depression is not a normal part of aging. However, it is often an underrecognized problem in older adults. Around 15% of older... . Physical restraints are devices, materials, and equipment that physically prevent persons from moving freely, such as walking,... . Adequacy of sleep is often a concern for older adults because of altered sleep patterns. Older people have a marked decrease i... ?Evaluation REFERENCES 6 - Caring for Lesbian, Gay, Bisexual, Transgender, Queer or Questioning, and Gender Diverse Patients LGBTQ+ HEALTH INEQUITIES GERONTOLOGIC CONSIDERATIONS ESTABLISHING INCLUSIVE ENVIRONMENTS Establishing a Welcoming Environment Health History and the Intake Process Social History Sexual and Reproductive Health History PREVENTIVE HEALTH GENDER AFFIRMATION THERAPY Gender Affirming Hormone Therapy Nonsurgical Gender Affirming Interventions Gender Affirming Surgery Chest Masculinization Surgery Feminizing Breast Augmentation ?Assessment Implementation ?Acute Care ?Ambulatory Care Anchor 1015 REFERENCES 2 - Problems Related to Comfort and Coping 7 - Stress Management WHAT IS STRESS? Is Stress Bad or Good? Factors Affecting Response to Stress PHYSIOLOGIC RESPONSE TO STRESS Nervous System Cerebral Cortex Limbic System Reticular Formation Hypothalamus Endocrine System Summary of Stress Response Immune System MIND-BODY-SPIRIT CONNECTION EFFECTS OF STRESS ON HEALTH COPING STRATEGIES RELAXATION STRATEGIES Relaxation Breathing Biofeedback Meditation Imagery Massage Music Prayer ?Nursing Management: Stress ?Assessment ?Clinical Problems ?Planning ?Implementation REFERENCES 8 - Sleep and Sleep Disorders PHYSIOLOGIC SLEEP MECHANISMS Sleep-Wake Cycle Wake Behavior Sleep Behavior Circadian Rhythms Sleep Architecture NREM Sleep REM Sleep INSUFFICIENT SLEEP AND SLEEP DISTURBANCES SLEEP DISTURBANCES IN THE HOSPITAL Etiology and Pathophysiology Clinical Manifestations Diagnostic Studies Self-Report Actigraphy Interprofessional Care Cognitive-Behavioral Therapy for Insomnia Drug Therapy . Benzodiazepine-receptor agonists are considered first-line for pharmacologic treatment of insomnia. They act at GABA receptors... . Suvorexant (Belsomra) and lemborexant (Dayvigo) promote sleep by blocking the wake-promoting effects of orexin. They should be... . Ramelteon (Rozerem) is a prescription melatonin-receptor agonist. It has a rapid onset. Ramelteon is recommended for insomnia ... . Certain tricyclic antidepressants (e.g., doxepin, amitriptyline) are used as sleep aids due to their side effect of sedation. ... . Benzodiazepines activate GABA receptors to promote sleep. These drugs are not part of first-line therapy for insomnia. Only 2 ... . Many people self-medicate with OTC sleep aids such as doxylamine (Unisom) and diphenhydramine. Diphenhydramine is in many “nig... Complementary and Alternative Therapy ?Assessment ?Clinical Problems ?Implementation OBSTRUCTIVE SLEEP APNEA Clinical Manifestations Diagnostic Studies ?Behavioral Treatment ?Medical Devices ?Surgical Treatment PERIODIC LIMB MOVEMENT DISORDER CIRCADIAN RHYTHM DISORDERS NARCOLEPSY PARASOMNIAS REFERENCES 9 - Pain EXTENT OF PAIN PROBLEM DEFINITIONS AND DIMENSIONS OF PAIN CLASSIFICATION OF PAIN Nociceptive Pain Neuropathic Pain Acute and Chronic Pain PAIN ASSESSMENT Elements of a Pain Assessment Pain Pattern Location Intensity Quality Associated Symptoms Management Strategies Impact of Pain Patient’s Beliefs, Expectations, and Goals Reassessment PAIN TREATMENT Basic Principles Drug Therapy for Pain Nonopioids Opioids . Opioids are categorized by their physiologic action (e.g., agonist, antagonist) and binding at specific opioid receptors (e.g.... . Some opioid analgesics have 2 distinct actions, or dual mechanisms. Tramadol (Ultram) is a weak mu agonist and inhibits the re... . Some opioids should be avoided for pain relief because of limited efficacy and/or toxicities. The American Pain Society does n... . Common side effects include constipation, nausea and vomiting, sedation, respiratory depression, and pruritus.12 With continue... Adjuvant Analgesic Therapy . Clonidine and tizanidine (Zanaflex) are the most widely used α2-adrenergic agonists. They likely work on the central inhibitor... . TCAs enhance the descending inhibitory system by preventing the cellular reuptake of serotonin and norepinephrine. Higher leve... . Antiseizure drugs affect peripheral nerves and the CNS in several ways. These include sodium channel modulation, central calci... . Baclofen, an agonist at GABA receptors, can interfere with the transmission of nociceptive impulses. It helps manage muscle sp... . Corticosteroids include dexamethasone, prednisone, and methylprednisolone (Medrol). They are used for managing acute and chron... . Local anesthetics, such as bupivacaine and ropivacaine, can be given epidurally by continuous infusion or by intermittent or c... . Cannabinoid-derived medications show promise in treating neuropathic pain, certain pain syndromes, and some symptoms.16 Synthe... Administration . Appropriate analgesic scheduling focuses on preventing or controlling pain, rather than providing analgesics only after the pa... . Analgesic titration is dose adjustment based on assessment of the adequacy of analgesic effect versus the side effects produce... . The term equianalgesic dose refers to a dose of one analgesic that is equivalent in pain-relieving effects to a given dose of ... . We can deliver opioids and other analgesic agents by many routes. This flexibility allows the HCP to (1) target a particular a... . Oral administration is the route of choice for the person with a functioning GI system. Most pain medications are available in... . Although we have historically given morphine sublingually to people with cancer pain who have problems swallowing, little of t... . Intranasal administration allows delivery of medication to highly vascular mucosa and avoids the first-pass effect. Butorphano... . We often overlook the rectal route. It is especially useful when the patient cannot take an analgesic by mouth, such as with s... . Transdermal patches offer systemic or local delivery. Fentanyl (Duragesic) is useful for the patient who cannot tolerate oral ... . Parenteral routes include IV and subcutaneous administration. Single, repeated, or continuous dosing is possible with parenter... . Intraspinal or neuraxial opioid therapy involves inserting a catheter into the subarachnoid space (intrathecal delivery) or th... . Intraspinal catheters can be surgically implanted for long-term pain relief. The surgical placement of an intrathecal catheter... . Patient-controlled analgesia (PCA) (demand analgesia) is a method that allows the patient to self-administer preset doses of a... Interventional Therapy Therapeutic Nerve Blocks . Neuroablative interventions are done for severe pain that is unresponsive to all other therapies. They involve destroying nerv... Neuroaugmentation Nondrug Therapies for Pain Physical Pain Relief Strategies . Massage may be useful to alleviate certain types of acute and chronic pain.17 Many different massage techniques exist. These i... . Exercise is an essential part of the treatment plan for patients with chronic pain, especially those with musculoskeletal pain... . Transcutaneous electrical nerve stimulation (TENS) involves the delivery of an electric current through electrodes applied to ... . Acupuncture is a technique of traditional Chinese medicine in which very thin needles are inserted into the body at designated... . Heat therapy is the application of either moist or dry heat to the skin. Heat therapy can be either superficial or deep. We ca... . Cold therapy involves the application of either moist or dry cold to the skin. Dry cold can be applied by using an ice bag. Mo... Cognitive Therapies . Distraction involves redirection of attention away from the pain and onto something.22 It is a simple but powerful strategy to... . Hypnotherapy is a structured technique that enables a patient to achieve a state of heightened awareness and focused concentra... . Relaxation strategies reduce stress, decrease acute anxiety, distract from pain, ease muscle tension, combat fatigue, promote ... INSTITUTIONALIZING PAIN EDUCATION AND MANAGEMENT MANAGING PAIN IN SPECIAL POPULATIONS Older Adults Patients Unable to Self-Report Pain Patients in the Critical Care Unit Patients With Substance Abuse Problems REFERENCES 10 - Palliative and End-of-Life Care PALLIATIVE CARE HOSPICE CARE DOMAINS OF PALLIATIVE CARE Domain 1: Care Structure and Processes Domain 2: Physical Aspects of Care Domain 3: Psychologic and Psychiatric Aspects Domain 4: Social Aspects of Care Domain 5: Spiritual, Religious, and Existential Aspects of Care Domain 6: Cultural Care Domain 7: Care of the Patient Nearing the End of Life Domain 8: Ethical and Legal Aspects of Care Advance Care Planning and Advance Directives Organ and Tissue Donation Euthanasia and Physician-Assisted Suicide DEATH Physical Manifestations at End of Life Psychosocial Manifestations at End of Life Bereavement and Grief . Patients often show signs of anxiety and depression during the EOL period. Causes of anxiety and depression may include uncont... . Anger is a common and normal response to grief. A grieving person cannot be forced to accept the loss. The surviving family me... . Feelings of hopelessness and powerlessness are common during the EOL period. Encourage realistic hope within the limits of the... . Fear is a typical feeling associated with dying. Specific fears include fear of pain, fear of shortness of breath, fear of lon... ?Physical Care . After a patient is pronounced dead, you will need to prepare or delegate preparing the patient’s body for immediate viewing by... SPECIAL NEEDS OF CAREGIVERS AND NURSES IN END-OF-LIFE CARE Special Needs of Family Caregivers Special Needs of Nurses REFERENCES 11 - Substance Use Disorders in Acute Care DRUGS ASSOCIATED WITH SUBSTANCE USE DISORDER Effects of Use and Complications ?Tobacco Cessation ALCOHOL Effects of Use and Complications ?Alcohol Toxicity ?Alcohol Withdrawal Syndrome ?Toxicity ?Withdrawal DEPRESSANTS Sedative-Hypnotics Opioids ?Toxicity ?Sedative-Hypnotics ?Opioids ?Withdrawal ?Sedative-Hypnotics ?Opioids INHALANTS CANNABIS CAFFEINE ?Assessment ?Clinical Problems ?Planning ?Implementation ?Health Promotion ?Acute Intervention REFERENCES 3 - Problems Related to Homeostasis and Protection 12 - Inflammation and Healing INFLAMMATORY RESPONSE Vascular Response Cellular Response Neutrophils Monocytes Lymphocytes Chemical Mediators Complement System Prostaglandins and Leukotrienes Exudate Formation Types of Inflammation Clinical Manifestations Fever ?Fever ?Drug Therapy ?RICE . Rest, or immobilization, prevents further injury and gives the body time to heal. It decreases the tissues’ metabolic needs an... . Cold application is usually best at the time of the initial trauma. Cold promotes vasoconstriction and decreases swelling, pai... . Compression counters the vasodilation effects and development of edema. Compression by direct pressure over a laceration occlu... . Elevating the injured extremity above the level of the heart reduces edema at the inflammatory site by increasing venous and l... HEALING PROCESS Regeneration Repair Primary Intention . In the initial (inflammatory) phase, the edges of the incision are aligned and sutured (or stapled) in place. The incision are... . The granulation phase is the second step. The components of granulation tissue include proliferating fibroblasts; proliferatin... . The maturation phase, during which scar contraction occurs, overlaps with the granulation phase. It may begin 7 days after the... Secondary Intention Tertiary Intention Wound Classification Complications of Healing ?Clean Wounds ?Contaminated Wounds ?Drug Therapy ?Nutrition Therapy ?Infection Prevention and Control ?Psychologic Implications ?Patient Teaching PRESSURE INJURIES Etiology and Pathophysiology Clinical Manifestations ?Nursing Management: Pressure Injuries REFERENCES 13 - Genetics GENETICS AND GENOMICS Basic Principles of Genetics Chromosomes Genes DNA RNA Protein Synthesis Mitosis Meiosis Genetic Mutations Types of Mutations Inheritance Patterns Human Genome Project GENETIC DISORDERS Classification of Genetic Disorders Single Gene Disorders Multifactorial Inherited Conditions . Epigenetics is the study of inheritable changes in gene expression that do not involve changes in the DNA sequence. There is a... Chromosome Disorders GENETIC SCREENING AND TESTING Interpreting Genetic Test Results Direct-to-Consumer Genetic Tests Genetic Technology DNA Fingerprinting DNA Microarray (DNA Chip) Genome-Wide Association Study (GWAS) PHARMACOGENOMICS AND PHARMACOGENETICS GENE THERAPY STEM CELL THERAPY REFERENCES 14 - Immune Responses and Transplantation NORMAL IMMUNE RESPONSE Antigens Types of Immunity Innate Immunity Acquired Immunity . Active acquired immunity results from the invasion of the body by foreign substances such as microorganisms and the subsequent... . In passive acquired immunity, the host receives antibodies to an antigen rather than making them. This may take place naturall... Lymphoid Organs Cells Involved in Immune Response Mononuclear Phagocytes Lymphocytes . B cells differentiate into plasma cells when activated. Plasma cells make antibodies (immunoglobulins) (Table 14.2) . Cells that migrate from the bone marrow to the thymus differentiate into T lymphocytes (thymus-dependent cells). The thymus se... . T cytotoxic (CD8) cells are involved in attacking antigens on the cell membrane of foreign pathogens and releasing cytolytic s... . T helper (CD4) cells are involved in regulating cell-mediated immunity and the humoral antibody response. T helper cells diffe... . Natural killer (NK) cells are involved in cell-mediated immunity. These cells are not T or B cells but are large lymphocytes w... T Dendritic Cells Cytokines Comparison of Humoral and Cell-Mediated Immunity Humoral Immunity Cell-Mediated Immunity ?Gerontologic Considerations: Effects of Aging on the Immune System ALTERED IMMUNE RESPONSE Hypersensitivity Reactions Type I: IgE-Mediated Reactions . Anaphylaxis can occur when mediators are released systemically (e.g., after injection of a drug, after an insect sting). The r... . Around 20% of the population is atopic. This means they have an inherited tendency to become sensitive to environmental allerg... Type II: Cytotoxic and Cytolytic Reactions . A classic type II reaction occurs when a recipient receives ABO-incompatible blood from a donor. Naturally acquired antibodies... . Goodpasture syndrome is a disorder involving the lungs and kidneys. An antibody-mediated autoimmune reaction occurs involving ... Type III: Immune-Complex Reactions Type IV: Delayed Hypersensitivity Reactions . Allergic contact dermatitis is an example of a delayed hypersensitivity reaction involving the skin. The reaction occurs when ... . The classic example of a microbial cell-mediated immune reaction is the body’s defense against the tubercle bacillus. Tubercul... ALLERGIC DISORDERS Assessment Diagnostic Studies Skin Tests . We can do skin testing by 3 different methods: (1) a scratch or prick test, (2) an intradermal test, or (3) a patch test. The ... . In the scratch and intradermal tests, the reaction occurs in 5 to 10 minutes. In the patch test the patches must be worn for 4... . A highly sensitive person is always at risk for developing an anaphylactic reaction to skin tests. Therefore, never leave a pa... Interprofessional and Nursing Management Anaphylaxis Chronic Allergies . You play a key role in helping the patient make lifestyle adjustments so that there is minimal exposure to offending allergens... Drug Therapy . Antihistamines are the best drugs for treating allergic rhinitis, itching, and hives (see Table 29.2). They are less effective... . The major sympatho­mimetic drug is epinephrine. Epinephrine is made by the adrenal medulla and stimulates α- and β-adrenergic ... . Nasal corticosteroid sprays are effective in relieving the symptoms of allergic rhinitis. Sometimes patients have such severe ... . Antipruritic drugs provide relief from itching and protect the skin. They are most effective when applied topically to intact ... . Cromolyn is a mast cell–stabilizing agent that inhibits the release of histamines, leukotrienes, and other agents from the mas... . Leukotriene receptor antagonists (LTRAs) block leukotriene, a major mediator of the allergic inflammatory process. These medic... Immunotherapy . The IgE level is high in atopic people. When IgE combines with an allergen in a hypersensitive person, a reaction occurs, rele... Method of administration . Subcutaneous immunothe­rapy (SCIT) involves the subcutaneous injection of titrated amounts of allergen extracts biweekly or we... . Sublingual immunotherapy (SLIT) involves allergen extracts taken under the tongue. Sublingual products include a 5-grass polle... ?Latex Allergies ?Types of Latex Allergies ?Latex-Food Syndrome ?Nursing Management: Latex Allergies ?Multiple Chemical Sensitivity AUTOIMMUNITY Autoimmune Diseases Apheresis Plasmapheresis IMMUNODEFICIENCY DISORDERS Primary Immunodeficiency Disorders Secondary Immunodeficiency Disorders HUMAN LEUKOCYTE ANTIGEN SYSTEM Human Leukocyte Antigen and Disease Associations ORGAN TRANSPLANTATION Tissue Typing HLA Typing Panel of Reactive Antibodies Crossmatch Transplant Rejection Hyperacute Rejection Acute Rejection Chronic Rejection Immunosuppressive Therapy Calcineurin Inhibitors Mycophenolate Mofetil Sirolimus Monoclonal Antibodies Polyclonal Antibodies GRAFT-VERSUS-HOST DISEASE REFERENCES 15 - Infection TYPES OF PATHOGENS SPECIFIC TYPES OF INFECTIONS Emerging Infections Reemerging Infections Antimicrobial-Resistant Infections Health Care–Associated Infections NURSING MANAGEMENT: INFECTION Antimicrobial Therapy Occupational Safety and Health Administration (OSHA) Guidelines Infection Precautions COVID-19 Pathophysiology Clinical Manifestations and Complications Diagnostic Tests Interprofessional and Nursing Management Vaccines HUMAN IMMUNODEFICIENCY VIRUS INFECTION HIV Transmission Sexual Transmission Contact With Blood and Blood Products Perinatal Transmission Pathophysiology Clinical Manifestations and Complications Acute Infection Chronic HIV Infection . The time between initial HIV infection and a diagnosis of AIDS is about 10 years in untreated infection. During the first seve... . As the CD4 cell count declines closer to 200 cells/μL and the viral load increases, HIV advances to a more active stage. Sympt... . A diagnosis of acquired immunodeficiency syndrome (AIDS) is made when a person with HIV meets criteria established by the CDC.... Diagnostic Studies Interprofessional Care Drug Therapy for HIV Infection Drug Therapy for Opportunistic Diseases ?Nursing Management: HIV Infection ?Assessment Biomedical Prevention Behavior Modification . Safe sexual activities eliminate the risk for exposure to HIV in semen and vaginal secretions. Abstaining from all sexual acti... . The major risk for HIV related to using drugs involves sharing equipment or having unsafe sexual experiences while under the i... . The best way to prevent HIV infection in infants is to prevent HIV infection in women. We should ask women with HIV about thei... . The risk for infection from occupational exposure to HIV is small but real. OSHA requires employers to protect workers from ex... . Around 14% of people with HIV in the United States do not know they are infected. They are more likely to transmit the infecti... . Early intervention after detection of HIV infection can promote health and limit disability. Findings from the history, assess... . Reactions to an HIV diagnosis are similar to the reactions of people who are diagnosed with any life-threatening, debilitating... . Nursing care becomes more complex as the patient’s immune system declines and new problems arise to compound existing problems... . As time passes, patients and their loved ones will be confronted with complex treatment decisions; feelings of loss, anger, po... . Physical problems related to HIV or its treatment can interfere with the patient’s ability to maintain a desired lifestyle. Pe... . Despite new developments in the treatment of HIV infection, many patients eventually have disease progression, disability, and... REFERENCES 16 - Cancer BIOLOGY OF CANCER Defect in Cell Proliferation Defect in Cell Differentiation Development of Cancer Initiation . Carcinogens are cancer-causing agents capable of producing cell alterations. Many are detoxified by protective enzymes and har... . Many chemicals are carcinogens (e.g., benzene, arsenic, formaldehyde). People exposed to these chemicals over time have a grea... . Radiation can cause cancer in almost any body tissue. When cells are exposed to a source of radiation, damage occurs to DNA. A... . Certain DNA and ribonucleic acid (RNA) viruses, termed oncogenic, can alter the cells they infect and induce malignant transfo... Promotion Progression Role of the Immune System Escape Mechanisms From Immunologic Surveillance Oncofetal Antigens and Tumor Markers BENIGN VERSUS MALIGNANT NEOPLASMS CLASSIFICATION OF CANCER Anatomic Site Classification Histologic Classification Extent of Disease Classification Clinical Staging TNM Classification System PREVENTION AND DETECTION OF CANCER Diagnosis of Cancer Biopsy Cure Control Palliation PERSONALIZED CANCER MEDICINE SURGICAL THERAPY Prevention Cure or Control Supportive and Palliative Care CHEMOTHERAPY Effect on Cells Classification of Chemotherapy Drugs Chemotherapy Preparation Methods of Administration Regional Chemotherapy Administration Intraarterial Chemotherapy Intraperitoneal Chemotherapy Intrathecal or Intraventricular Chemotherapy Intravesical Bladder Chemotherapy Effects of Chemotherapy on Normal Tissues Treatment Plan RADIATION THERAPY Principles of Radiobiology Simulation and Treatment Planning Treatment External Radiation Internal Radiation . Nausea and vomiting are common effects of chemotherapy and sometimes radiation therapy. Chemotherapy-induced nausea and vomiti... . Diarrhea is a reaction of the bowel mucosa to radiation and some chemotherapy drugs. The patient can have an increase in frequ... . Mucositis is irritation, inflammation, and/or ulceration of the mucosa. Like the bowel mucosa, the mucosal linings