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x Detailed Table of Contentsf,!jThe IntegumentVOLUME 2UNIT 6 Integral Aspects of Nursing49126 Caring492643SKILL 31.2 ASSESSING THE SKIN646SKILL 31.3 ASSESSING THE HAIR651SKILL 31.4 ASSESSING THE NAILS653The HeadSKILL 31.5 ASSESSING THE SKULL AND FACE654654Professionalisation of Caring493Nursing Theories on Caring493VISUAL ACUITY657Types of Knowledge in Nursing498SKILL 31.7 ASSESSING THE EARS AND HEARING662Ethical Knowing: The Moral Component499SKILL 31.8 ASSESSING THE NOSE AND SINUSES665Developing Ways of Knowing499Caring Encounters500Maintaining Caring Practice50127 Communicating and Relating509SKILL 31.6 ASSESSING THE EYE STRUCTURES ANDSKILL 31.9 ASSESSING THE MOUTH AND OROPHARYNXThe NeckSKILL 31.10 ASSESSING THE NECKThe Thorax and LungsSKILL 31.11 ASSESSING THE THORAX AND LUNGSCommunicating510The Cardiovascular and Peripheral Vascular SystemsTherapeutic Relationships523SKILL 31.12 ASSESSING THE HEART AND CENTRALCommunication and the Nursing Process528VESSELSNURSING MANAGEMENT529Group and Team Communication532Communication with Colleagues53428 Teaching and LearningTeaching544SYSTEMThe Breasts and AxillaeSKILL 31.14 ASSESSING THE BREASTS AND AXILLAEThe Abdomen545SKILL 31.15 ASSESSING THE ABDOMENLearning548Learning Theories549SKILL 31.16 ASSESSING THE MUSCULOSKELETAL SYSTEMThe Internet and Health Information553The Neurological System553SKILL 31.17 ASSESSING THE NEUROLOGICAL SYSTEMNURSING MANAGEMENT29 Leading, Managing and DelegatingThe Nurse as Leader and Manager553570571671672676678681SKILL 31.13 ASSESSING THE PERIPHERAL VASCULARThe Musculoskeletal SystemNurse as Educator667669The Female Genitals and Inguinal Area683685686689690694694699702706SKILL 31.18 ASSESSING THE FEMALE GENITALS ANDINGUINAL AREAThe Male Genitals and Inguinal AreaLeadership571SKILL 31.19 ASSESSING THE MALE GENITALS ANDManagement574INGUINAL AREACultural Diversity578The Rectum and AnusClinical Governance579SKILL 31.20 ASSESSING THE RECTUM AND ANUSChange579707709710712712UNIT s Integral Components of Individualised Care71732 Infection Prevention and Control718UNIT 7 Assessing Health58530 Vital Signs586Micro-organisms719589Pathogens: Colonisation and Infection720Respiration592Types of Infection721Oxygen Saturation593Chain of Infection721SKILL 30.2 MEASURING OXYGEN SATURATION595Body Defences Against Infection724Factors Increasing Susceptibility to Infection727Measures to Reduce or Eliminate Infectious Agents731Standard Precautions732SKILL 30.1 ASSESSING RESPIRATIONBlood PressureSKILL 30.3 ASSESSING BLOOD PRESSUREPulse or Heart Rate596602606Asepsis and Aseptic Technique738SKILL 30.4 ASSESSING A PERIPHERAL PULSE609SKILL 30.5 ASSESSING AN APICAL PULSE611Health Care Associated Infections (HA )I742SKILL 30.6 ASSESSING AN APICAL-RADIAL PULSE613NURSING MANAGEMENT746SKILL 32.1 HAND WASHING TECHNIQUE750Body TemperatureSKILL 30.7 ASSESSING BODY TEMPERATURE31 Health Assessment614620631Physical Health Assessment632General Assessment639SKILL 31.1 ASSESSING APPEARANCE AND MENTAL STATUS640SKILL 32.2 DONNING AND REMOVING PERSONALPROTECTIVE EQUIPMENT (GLOVES, GOWN, MASK,EYEWEAR)Aseptic Fields753755SKILL 32.3 ESTABLISHING AND MAINTAINING ACRITICAL ASEPTIC FIELD756

Detailed Table of Contents xiSKILL32.4 DONNING AND(OPENSKILL32.5(CLOSED36 MedicationsREMOVING STERILE GLOVESMETHOD)760DONNING A STERILE GOWN AND GLOVESMETHOD)762Infection Control for Health Care Workers764Role of the Infection Control Nurse76433 Safety770Factors Affecting Safety772777NURSING MANAGEMENTSKILL33.1SKILLSKILL33.2 IMPLEMENTING SEIZUREPRECAUTIONS33.3 APPLYING RESTRAINTS34 HygieneLegal Aspects of Drug Administration902Effects of Drugs904Drug Misuse905Actions of Drugs on the Body905Factors Affecting Medication Action907Routes of Administration909Medication Orders911Systems of Measurement916Administering Medications Safely920792Oral Medications926803811ADMINISTERING ORAL MEDICATIONS926Nasogastric and Gastrostomy Medications930Parenteral Medications931SKILLHygienic Care812Skin812813SKILLNURSING MANAGEMENTSKILL34.1 BATHING ANADULT, CHILD OR YOUNGPERSONSKILL34.2PROVIDING PERINEAL-GENITAL CAREFeetSKILL34.3PROVIDING FOOT CARENails34.5PROVIDING SPECIAL ORAL CARE FOR THEUNCONSCIOUS PERSONHairSKILL34.6 PROVIDINGSKILL34.7HAIR CAREEyesNURSING MANAGEMENTEarsSKILL34.836.5ADMINISTERING AN INTRADERMAL938940SKILL36.7ADMINISTERING AN NG MEDICATIONS TO INTRAVENOUS951FLUID CONTAINERSSKILL36.9ADMINISTERING INTRAVENOUS956MEDICATIONS USING IV PUSHSKILL36.10ADMINISTERING STERING OTIC INSTILLATIONS36.12 ADMINISTERING VAGINALINSTILLATIONS963966Respiratory Inhalation969Irrigations97137 Skin Integrity and Wound Care976Skin Integrity977Types of Wounds977849Pressure Ulcers978849Wound Healing982852853985NURSING MANAGEMENTSKILLREMOVING, CLEANING AND INSERTINGA HEARING AID937INJECTIONSHAMPOOING THE HAIR OF A PERSONCONFINED TO BEDFROM VIALSMIXING MEDICATIONS USING ONE SYRINGE827842NURSING MANAGEMENT36.3 PREPARING MEDICATIONS36.4ADMINISTERING A SUBCUTANEOUS INJECTION831SKILLSKILLSKILL36.6832BRUSHING AND FLOSSING THE TEETH936SKILLMouth34.4FROM AMPOULESINJECTION FOR SKIN TESTSNURSING MANAGEMENTSKILL36.2 PREPARING MEDICATIONSSKILL824831NURSING MANAGEMENT36.1816826NURSING MANAGEMENT901790USING A BED OR CHAIR EXIT SAFETYMONITORING DEVICE900Drug Standards37.1OBTAINING A WOUND DRAINAGE SPECIMEN988FOR CULTURESKILL37.21000IRRIGATING A WOUNDNose855Supporting a Hygienic Environment855Making Beds856The Perioperative Workforce1014857Standards and Guidelines1015861Types of Surgery1015Preoperative Phase1017SKILL34.9SKILL34.10CHANGING AN UNOCCUPIED BEDCHANGING AN OCCUPIED BED35 Diagnostic Testing867Diagnostic Testing Phases868Blood Tests868SKILL35.1OBTAINING A CAPILLARY BLOOD SPECIMENTO MEASURE BLOOD GLUCOSESpecimen CollectionSKILL35.287810131018NURSING MANAGEMENTSKILL38.1TEACHING MOVING, LEG EXERCISES, DEEP1021BREATHING AND COUGHINGSKILL87638.2 APPLYING ANTIEMBOLISTOCKINGSlntraoperative PhaseNURSING MANAGEMENTPostoperative PhaseCOLLECTING A URINE SAMPLE FORCULTURE AND SENSITIVITY BY MIDSTREAM SPECIMENOF URINE (MSU)38 Perioperative NursingNURSING MANAGEMENT882Visualisation Procedures887Aspiration/Biopsy890SKILL38.3MANAGING GASTROINTESTINAL SUCTIONSKILL38.4CLEANING A SUTURED WOUND ANDAPPLYING A STERILE DRESSING1026102810291030103310401043

xii Detailed Table of Contentsf,,fjVOLUME 3UNIT 9 Promoting Psychosocial Health105539 Sensory Perception1056Treatments in Mental Health1202Mental Health Care Models1203Recoveryvs Rehabilitation1206UNIT 10 Promoting Physiological Health46 Activity and Exercise12111212Components of the Sensory Experience1057Factors Affecting Sensory Function1058Normal Movement12151059Exercise1221Sensory AlterationsNURSING MANAGEMENT106040 Self-Concept1077Self- Concept1078Factors Affecting Body Alignment and Activity1225Effects of Immobility1227NURSING MANAGEMENT1232SKILL 46.1 PERSON-ASSISTED BED SLIDE: ONE NURSE12471247Formation of Self- Concept1078SKILL 46.2 PERSON-ASSISTED BED SLIDE: TWO NURSESComponents of Self- Concept1080SKILL 46.3 PERSON-ASSISTED LATERAL SHIFT ANDFactors that Affect Self- Concept1081ROLL: TWO NURSES1247SKILL 46.4 LOGROLLING: TWO TO FOUR NURSES1248NURSING MANAGEMENT41 SexualityDevelopment of Sexuality108310931094SKILL 46.5 PERSON-ASSISTED BED TO CHAIR SLIDE:ONE OR TWO NURSESSexual Health1097TWO NURSESVarieties of Sexuality1099SKILL 46.7 ASSISTING THE PERSON TO SIT ON THEFactors Influencing Sexuality1100Sexual Response Cycle1101Altered Sexual Function1103NURSING MANAGEMENT110642 Spirituality11171249SKILL 46.6 BED TO CHAIR (4-POINT FRAME) :1249SIDE OF THE BED1250SKILL 46.8 ASSISTING THE PERSON TO AMBULATE125447 Sleep1269Physiology of Sleep1270Functions of Sleep1272Normal Sleep Patterns and Requirements1272Factors Affecting Sleep1275Common Sleep Disorders1278Spirituality and Religion Contrasted1118Related Concepts1120Spiritual Development1121Spiritual Self-Awareness for the Nurse1121Spiritual Practices Affecting Nursing Care112248 Pain Management1292Spiritual Health and the Nursing Process1125The Nature of Pain12931126Physiology of Pain1296NURSING MANAGEMENT43 Stress and Coping1137Concept of Stress1138Models of Stress1138Indicators of Stress1141Coping1145NURSING MANAGEMENT44 Loss, Grieving and DeathLoss and GriefNURSING MANAGEMENTDying and DeathNURSING MANAGEMENT45 Mental Health Nursing114611581159116511681171NURSING MANAGEMENT1280NURSING MANAGEMENT1302SKILL 48.1 PROVIDING A BACK MASSAGE132549 Nutrition1336Essentia I Nutrients1337Energy Balance1340Body Weight and Body Mass Standards1342Factors Affecting Nutrition1343Nutritional Variations Throughout the Life Cycle1348Standards for a Healthy Diet1352Altered Nutrition1359NURSING MANAGEMENT1359SKILL 49.1 INSERTING A NASOGASTRIC TUBE13721182SKILL 49.2 REMOVING A NASOGASTRIC TUBE1375Holistic Mental Health Care1183SKILL 49.3 ADMINISTERING A TUBE FEEDING1378Mental Health and Mental Illness1183SKILL 49.4 ADMINISTERING A GASTROSTOMY ORThe Role of the Mental Health Nurse1188Mental Health Nursing in Practice1188Mental Health Legislation1190Physiology of Urinary Elimination1391Mental State Assessment ( M SA)1194Factors Affecting Voiding1393Types of Mental Illness1196Altered Urine Production1397Suicide1200Altered Urinary Elimination1397JEJUNOSTOMY FEEDINGSO Urinary Elimination13801390

Detailed Table of Contents xiiiNURSING MANAGEMENT1400SKILL 50.1 URINALYSIS1402SKILL 50.2 APPLYING AN EXTERNAL URINARY SHEATH1412SKILL 50.3 PERFORMING URINARY CATHETERISATION1416SKILL 50.4 PERFORMING BLADDER IRRIGATION142351 Faecal Elimination1434The Digestive System1435Large Intestine1435Rectum and Anal Canal1436Physiology of Defecation1437Factors that A f fect Defecation1439Faecal Elimination Problems1441NURSING MANAGEMENT1445SKILL 51.1 ADMINISTERING AN ENEMABowel Diversion Ostomies14541458SKILL 51.2 CHANGING A BOWEL DIVERSION STOMAAPPLIANCE52 OxygenationStructure and Function of the Respiratory System14621471147253 CirculationPhysiology o f the Cardiovascular SystemLifespan Considerations15221523Alterations in Cardiovascular Function1529SKILL 53.1 SEQUENTIAL COMPRESSION DEVICES153454 Fluid, Electrolyte and Acid-Base BalanceBody Fluids and Electrolytes15421550Factors A ffecting Body Fluid, Electrolytes andAcid-Base BalanceAcid-Base BalancesNURSING MANAGEMENT15791585SKILL 54.3 CHANGING AN INTRAVENOUS CONTAINER,TUBING AND DRESSINGSKILL 52.2 OROPHARYNGEAL AND NASOPHARYNGEALSUCTIONING1498SKILL 52.3 SUCTIONING A TRACHEOSTOMY OR1587SKILL 54.4 DISCONTINUING AN INTRAVENOUSTO AN INTERMITTENT INFUSION LOCK15891590SKILL 54.6 INITIATING, MAINTAINING ANDTERMINATING A BLOOD TRANSFUSION14921560SKILL 54.2 MONITORING AN INTRAVENOUS INFUSIONINFUSIONSKILL 52.1 ADMINISTERING OXYGEN BY CANNULA,1552SKILL 54.1 STARTING AN INTRAVENOUS INFUSIONSKILL 54.5 CHANGING AN INTRAVENOUS CANNULAFACE MASK, NON-REBREATHER MASK OR FACE TENT1551Disturbances in Fluid Volume, Electrolyte and147614791541Acid-Base Balance147614771526NURSING MANAGEMENTRespiratory RegulationNURSING MANAGEMENT1517Factors Affecting Cardiovascular FunctionFactors Affecting Respiratory FunctionAlterations in Respiratory Function15161593 Appendix: Mapping to the National CompetencyStandards for the Registered NurseENDOTRACHEAL TUBE1502GlossarySKILL 52.4 PROVIDING TRACHEOSTOMY CARE1505IndexA 1-G-11- 1I

AUDREY BERMAN received her Bachelor of Science Nursing from the Universityof California, San Francisco, and later returned to that campus to obtain her Masterof Science Nursing in physiological nursing and her PhD in nursing. Her dissertationwas entitled Sailing a course through chemotherapy: The experience of women withbreast cancer. She worked in oncology at Samuel Merritt Hospital prior to beginningher teaching career in the diploma program at Samuel Merritt Hospital School ofNursing in 1976. As a faculty member, she participated in the transition of thatprogram into a baccalaureate degree and in the development of the master ofscience in nursing program. Over the years, she has taught a variety of medical surgical nursing courses in the prelicensure programs. She currently serves as theDean of Nursing at Samuel Merritt College (an affiliate of Sutter Health).Dr Berman has travelled extensively, visiting nursing and health care institutions in Australia,Botswana, Brazil, Germany, Israel, Japan, Korea, the Philippines, the Soviet Union and Spain.She serves on the board of directors for the Bay Area Tumor Institute. She is a member of theAmerican Nurses Association and Sigma Theta Tau and is a site visitor for the Commissionon Collegiate Nursing Education. She has twice participated as an NCLEX-RN item writerfor the National Council of State Boards of Nursing. She has presented locally, nationallyand internationally on topics related to nursing education, breast cancer and technology inhealth care.Dr Berman authored the scripts for more than 35 nursing skills videotapes in the 1990s. Shehas been a co-author of Kozier and Erb's Fundamentals of Nursing since the sixth edition and,with Shirlee Snyder, co-author of the fifth and sixth editions of Skills in Clinical Nursing.Audrey Berman dedicates this edition to Bo-Gunnar Edvard Dahlstrom without whom it would not havebeen possible. There are few people on earth who can simultaneously challenge and support me-even withall my sharp edges-and he is one. I am grateful for his intellect and English skills, which exceed my own.He loves three nurses unconditionally: his sister, his daughter and me.Shirlee J. Snyder graduated from Columbia Hospital School of Nursing inMilwaukee, Wisconsin, and subsequently received a Bachelor of Science in Nursingfrom University of Wisconsin-Milwaukee. Because of an interest in cardiac nursingand teaching, she earned a Master of Science in Nursing with a minor in cardiovascularclinical specialist and teaching from the University of Alabama in Birmingham. Amove to California resulted in her becoming a faculty member at Samuel MerrittHospital School of Nursing in Oakland, California. Shirlee was fortunate to beinvolved in the phasing out of the diploma and ADN programs and development of abaccalaureate intercollegiate nursing program . She held numerous positions duringher 15-year tenure at Samuel Merritt College, including curriculum coordinator,assistant director-instruction, dean of instruction and associate dean of the IntercollegiateNursing Program. She is an associate professor alumnus at Samuel Merritt College. Her interestand experiences in nursing education resulted in Shirlee obtaining a doctorate of educationfocused on curriculum and instruction from the University of San Francisco.Dr Snyder moved to Portland, Oregon, in 1990 and taught in the ADN program at PortlandCommunity College for eight years . During this teaching experience she became interested incomputer-assisted instruction (CAI) and initiated web-based assessment testing for studentlearning. She has presented locally and nationally on topics related to using multimedia in theclassroom and promoting ethnic and minority student success.

About the Authors xvAnother career opportunity in 1998 led her to the Community College of Southern Nevada inLas Vegas, Nevada, where Dr Snyder was the nursing program director with responsibilities forthe associate degree and practical nursing programs for five years. During this time she becameinvolved in co-authoring the fifth edition of Skills in Clinical Nursing with Audrey Berman.In 2003, Dr Snyder returned to baccalaureate nursing education. She embraced the opportunityto be one of the nursing faculty teaching the first nursing class in the baccalaureate nursingprogram at the first state college in Nevada, which opened in 2002. She is currently theAssociate Dean of the School of Nursing at Nevada State College in Henderson, Nevada.Dr Snyder enjoyed travelling to the Philippines ( M anila and Cebu) in 2009 to present all day seminars to approximately 5000 nursing students and 200 nursing faculty. She is anadvisory board member for the Clinical Simulation Center of Las Vegas, a member of theAmerican Nurses Association Sigma T heta Tau, Nevada Organization of Nurse leaders, andNevada Nursing Education and Practice Alliance, which is a statewide group that addressesprofessional nursing issues in Nevada. She has been a site visitor for the National League forNursing Accrediting Commission and the Northwest Association of Schools and Colleges.Dr Snyder's experiences in nursing education and teaching keep her current in nursing andnursing education. She appreciates all she has learnt from the students she has taught andher past and present faculty colleagues.Shirlee Snyder dedicates this edition in loving memory of her late mother, Jean Snyder, and to her husband,Terry J. Schnitter, for his unconditional love and support.Barbara Kozier was educated in Vancouver, British Columbia, Canada. Afterobtaining a Bachelor of Arts degree from the University of British Columbia, sheentered the nursing program at that institution. After four years of study shegraduated with a bachelor's degree in nursing. She obtained a position at BellaBella, an aboriginal settlement on the northern coast of British Columbia. Shethen nursed with the Victorian Order of Nurses providing home care. Following aposition with a large general hospital as an acute care nurse in a medical-surgicalunit, she taught medical and surgical nursing, paediatric nursing, psychiatricnursing and community nursing courses at the Vancouver General Hospital Schoolof Nursing. Ms Kozier then enrolled at the University of Washington where shestudied for two years, taught part time and obtained her Master of Nursing title.Barbara is a member of three honour societies: Sigma Theta Tau (nursing), Pi Lambda Theta(education) and Delta Sigma Pi (Canadian Honor Society for University Women). Barbara wasa member and a chair of many nursing and government committees. She wrote a numberof texts and collaborated with Glenora Erb on four books: Techniques of Clinical Nursing,Fundamentals of Nursing, Concepts and Issues in Nursing Practice and Essentials of NursingPractice.Glenora Lea Erb was born in Calgary, Alberta, Canada. All her schooling tookplace in Calgary and, with her identical twin sister, she attended the Nursing Schoolof Calgary General Hospital. She was awarded a gold medal when she graduatedand was recognised as an outstanding bedside nurse.Following two years travelling in Asia, Europe, India, Australia and New Zealand,Ms Erb returned to Vancouver and taught nursing at St Paul's Hospital Schoolof Nursing, and later at a two-year program at the British Columbia Instituteof Technology. At this time she also co-authored textbooks on Fundamentals ofNursing, Techniques of Clinical Nursing, Concepts and Issues in Nursing Practice andEssentials of Nursing Practice.Glen died at home on 24 December 2001 of breast cancer. Her death has meant that nursinghas lost a highly skilled clinical nurse and her friends and family have lost a sensitive andgiving person.

The authors listed below are the Unit coordinators for the third Australian edition of Kozierand Erb's Fund

Authorised adaptation from the United States edition entitled Kozier & Erb's Fundamentals of Nursing, 9th edition, ISBN 0138024618 by Berman, Audrey; Snyder, Shirle