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Foundations And Adult Health Nursing, 7th Edition Solution Manual

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    Cooper and Gosnell: Foundations and Adult Health Nursing, 7th Edition Chapter 0 7 : Asepsis and Infection Control Answer Keys - Critical Thinking Questions Nursing Care Plan 7 - 1 : The Patient with an Infection 1. Mr. R. has a peripheral IV infusing and reports discomfort at the site of insertion. What should the nurse do? The nurse should immediately assess the IV site for obvious dislod gment of the IV catheter, edema, erythema , or increased warmth or coolness. Coolness may indicate IV infi ltration; the other signs may indicate irritation (possibly from a previously administered medication or as an adverse effect of it) or infection. In general, if an IV site is obviously infi ltrated, nursing judgment is sufficient to determine whether to stop the IV infusion and/or remove the infi ltrated IV catheter. Warm compresses may generally be applied per nursing judgment as well. (F acility policies must be verified .) The health care provider must be notifi ed so that the determination can be made regarding the necessity to restart a new intravenous access site. 2. Mr. R. has a urinary catheter connected to continuous drainage. He reports burning at the site of insertion and the nurse note s dark, concentrated urine in the tubing. What should the nurse do next? The nurse should assess the site of the catheter insertion for any signs of edema, erythema, or exudate . The nurse should then take the patient’s vital signs, noting any change s in temperature and pulse. C ompare the data obtained with patient’s previous vital signs. ? Following these nursing actions, the nurse should obtain urine samples for urinalysis and culture and sensitivity (using aseptic technique), in anticipation of the health care provider ’s orders to come . All of the above should then be reported to the patient’s health care provider as promptly as possible. The nurse should also encourage the patient to increase his fl uid intake. Make additional fl uids available to him, if not contraindicated. 3. The nurse note s on the sheet of lab oratory results for Mr. R. that his WBC count is 524. Why is this a concern , and what is recommended as a precautionary measure? This indicates a severely compromised immune system, placing the patient at very high risk for infection. The patient is especially susceptible to microorganisms that normally do not pose a signifi cant threat to a healthy immune system. A healthy immune system will destroy or

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    Answer Keys - Critical Thinking Questions 7 - 2 deactivate most pathogens before they can multiply into greater numbers. If a patient is immunocompromised, even weaker or opportunistic pathogens (herpes varicella virus or CMV) can become established and cause infection or disease. O ften this is in a more severe form because the patient also cannot initiate an effective immune response to combat it. Mr. R. should be placed on neutropenic precautions (formerly known as reverse isolation or Protective Isolatio n ). The intent of neutropenic precautions is to minimize threats to the patient’s compromised immune status; for instance, protecting the patient from his or her environmen t. Most facilities have specifi c protocols for implementing neutropenic precautions. These generally involve a private room with the door to remain closed; limiting visitors; no obviously infected visitors; no fresh fruit, fl owers, or raw vegetables; and no open containers (juices, water, etc.) which can serve as reservoirs for environmental pathogens.

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    Cooper and Gosnell: Foundations and Adult Health Nursing, 7th Edition Chapter 8 : Body Mechanics and Patient Mobility Answer Keys - Critical Thinking Questions Nursing Care Plan 8 - 1 : The Patient with Activity Intolerance 1. The nurse is in the process of transferring Mr. D. from his bed to a chair using a mechanical lift. The nurse has prepared the chair and placed it near the bed. The nurse turns Mr. D. to his side, places the sling under Mr. D. to ensure adequate support of his head, returns Mr. D. to his back, and slowly begins to lift Mr. D. from his bed. What has the nurse forgotten to do, and why is it important? The nurse has forgotten to fold Mr. D. ’ s arms across his chest to prevent them from becoming injured during the lift. 2. The patient has a trapeze bar across the bed, trochanter rolls, and a footboard. Explain the rationale for each of these devices in maintaining proper body alignment. A trapeze bar allows the patient to use his upper body to move around in bed. T rochanter rolls stabilize the hip joint when placed firmly beside it, and prevent the hip from rolling outward. A footboard prevents permanent, abnormal plantar fl exion (footdrop) resulting from injury to the fl exor muscles.

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    Cooper and Gosnell: Foundations and Adult Health Nursing, 7th Edition Chapter 9 : Hygiene and Care of the Patient ’ s Environment Answer Keys - Critical Thinking Questions Nursing Care Plan 9 - 1 : The Patient Needing Skin Care 1. Mr. P. has a poor a ppetite and his chemistry profi le reveals low protein, low albumin, and a low anion gap ( A/G ) ratio. Explain why poor nutrition predisposes the patient to impairment of skin integrity and poor tissue healing. Proteins, which are synthesized by the liver, are required for tissue repair and proper immune system function. The only source of proteins is through dietary intake. If a patient is undernourished, he will be unable to produce adequate protein for metabolic processes , such as tissue repair and healing, and fi ghting infection. 2. With Mr. P. ’s history of diarrhea, explain the possible complication that could evolve if dry, intact skin develops an open lesion. It is possible that an open lesion in this anatomic region may become contaminated and infected with bacteria normally found in the intestines, notably E scherichia coli . This type of situation is often diffi cult to treat with antibiotics. As a further consequence of Mr. P. ’s poor nutritional status, his immune system will be weakened and may not be able to effectively combat pathogens, making the infection even more diffi cult to manage.

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    Cooper and Gosnell: Foundations and Adult Health Nursing, 7th Edition Chapter 10 : Safety Answer Keys - Critical Thinking Questions Nursing Care Plan 10 - 1 : Patient Safety 1. The nurse walking down the hall hear s a patient calling out for help. The nurse assess es the situation and realize s that the patient does not remember how to use the call light. What factors could contribute to the patient’s inability to remember, and how sh ould the nurse teach the patient to use the call bell? A patient’s memory and cognitive function can be affected by a variety of factors, such as medications, anxiety, pain, disorientation, and dementia. Sensory perceptions should be assessed by the nurse as thoroughly as possible, with information and education being provided to patients and family/visitors appropriate to level of comprehension. Reinforcement of information should be provided as necessary. Demonstrations of the use of equipment (in this case, the call light) by the nurse and return demonstrations by the patient may be appropriate in some situations, particularly if the patient is in new or unfamiliar surroundings. It is also often helpful in this type of situation if the nurse checks the patient frequently, both to assess the patient’ s status and to reassure patients that they have not been left alone. Patients may need to be reoriented to surroundings frequently, especially if mental status changes are a concern. It is often helpful for a patient with sensory or cognitive impairment to be in a room close to the nurses’ station. 2. The nurse enter s the patient’s room to answer the call bell and see s the patient frantically pointing to the trash can next to the bed. The nurse smells smoke and sees small fl ames. What can be done to help prevent fires, and what sh ould the nurse do in this situation? The priority in this situation is to ensure patient safety. The nurse should call for assistance and implement the facility’s RACE protocol: R escue/ R emove the patient from the area; initiate the A larm process; C ontain the fi re (close fi re doors, patient room doors, etc.); E xtinguish the fi re, if realistic; and E vacuate the other patients, if necessary. Patients and visitors should be educated about facility safety policies: reinforce the no smoking policy ; and the use of equipment and personal items (hair dryers, electric shavers, lamps, etc.,) only if they meet appropriate facility codes. Safety reviews are generally conducted with facility personnel to ensure awareness of potential risks and proper safety procedures.

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    Cooper and Gosnell: Foundations and Adult Health Nursing, 7th Edition Chapter 15 : Specimen Collection and Diagnostic Testing Answer Keys - Critical Thinking Questions Nursing Care Plan 15 - 1 : Specimen Collection or Diagnostic Examination 1. A male patient has been very quiet during his morning care. When you attempt a conversation , he is obviously not interested. What is a way the nurse might initiate a conversation to encourage him to relate his concerns regarding his upcoming bronchoscopy? The nurse might say something such as, “You seem preoccupied this morning,” or “It looks like something is on your mind this morning.” A statement like or similar to this often opens channels of therapeutic communication with the nurse and results in patients expressing their concerns. If more encouragement is needed, the nurse might be more direct by asking, “What has your doctor told you about your test this morning?” or “What questions do you have about your test today?” 2. The patient is scheduled for an intravenous pyelogram (IVP). During the nurse’s preparation of this patient, he remarks that he once had a reaction while eating shellfi sh. What sh ould the nurse do next? Shellfi sh, iodine, or contrast dye (as is used in many diagnostic procedures, such as CT scans and MRIs) “reactions” can indicate sensitivity or an allergy to iodine - based substances , and they should be followed up with the health care provider immediately. The nurse should obtain as much additional information from the patient and his documented medical his tory on fi le. Certain effects of the contrast dye medium used are considered responses to it (i.e., sensations of warmth, total body fl ushing, nausea) and not allergic reactions. The health care provider should be notifi ed and the patient’s direct statements should be noted. All of these actions should be documented in the patient’s medical record. In some cases an alternate contrast medium will be used during the diagno stic procedure . In some cases the original iodine - based dye will still be used; the patient will receive antihistamines as part of his preprocedure preparation to minimize the possibility of a severe adverse reaction to it. 3. The patient is obviously quite anxious about his upcoming magnetic resonance imaging (MRI) scan . He breaks out in a cold sweat, is breathing rapidly, and when assessing his pulse the nurse note s tachycardia. How sh ould the nurse respond to this patient?

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    Answer Keys - Critical Thinking Questions 15 - 2 The nurse needs to ascertain exactly why this patient is so anxious, and then relieve his anxiety if possible . This situation is very similar to one discussed previously (please refer to Critical Thinking Question No. 1), and the same basic approach is indicated. Starting with statements such as, “You seem worried (nervous, etc.) this morning,” often allow a patient the opportunity to express his fears and concerns safely. In addition to the nurse’s therapeutic responses, the patient should be asked if he would fi nd it helpful to ask some questions , have the nurse offer information about his upcoming diagnostic test, or speak with his health care provider . Some patients may be claustrophobic and this can be ascertained when discussing the patient’s concerns. The nurse should use simple language and explanations, bec a u s e people exhibiting anxiety at this level will generally be unable to comprehend or process detailed or large amounts of information.

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    Cooper and Gosnell: Foundations and Adult Health Nursing, 7th Edition Chapter 16 : Care of Patients Experiencing Urgent Alterations in Health Answer Keys - Critical Thinking Questions Nursing Care Plan 16 - 1 : The Patient with a Laceration 1. Ms. T. ’s wound was superfi cial. In contrast, w hat would be the nurse’s actions if the wound appeared to be deep or was spurting blood? Firm, direct pressure must be applied to the area (the nurse should be wearing gloves) and the patient must be observed for signs and symptoms of shock. The health care provider should be notifi ed immediately by another nurse. 2. What safety measures are indicated to ensure Ms. T. is not injured again? Ms. T. may require more assis tan ce or supervision during mealtimes than she did previously . For example, she may need her food cut up , perhaps before the meal is served to her (to prevent embarrassment).

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    Cooper and Gosnell: Foundations and Adult Health Nursing, 7th Edition Chapter 17: Complementary and Alternative Therapies Answer Keys - Critical Thinking Questions Nursing Care Plan 17 - 1 : The Patient Using Complementary and Alternative Therapies 1. Ms. L. complains of feeling fatigued and tense. List some nonpharmacologic methods of bring ing about a state of physical and mental tranquility that may be helpful. Why might each of these methods be helpful for Ms. L. ? Have Ms. L. try d rinking some nonstimulating herbal tea , accepting a thera peutic massage, or positioning for comfort and relaxation . D ecreas e the stimulation of the environment by lowe ring the intensity of the lighting and listening to soothing music or nature sounds (especially rhythmic ones, such as waves or gentle rain). 2. Ms. L. turns on her light and she is crying. She complains of feeling helpless and inadequate to assume responsibility for caring for her children and husband when she is discharged. What are some t herapeutic interventions t hat will promote her feelings of stability and validation of her anxiety ? A llow and encourage Ms. L. to express her concerns and feelings. This may result in Ms. L. verbalizing more specifi c concerns regarding her perceived inability to assume her role in the family. A nswering any questions she may have and offering information regarding the usual healing process may help to alleviate some of her anxiety.

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    Cooper and Gosnell: Foundations and Adult Health Nursing, 7th Edition Chapter 18 : Pain Management, Comfort, Rest, and Sleep Answer Keys - Critical Thinking Questions Nursing Care Plan 18 - 1 : The Patient with Chronic Pain 1. During the morning ADLs, Mr. J. states, “I feel so useless. I can’ t even place the urinal for myself.” What would be the nurse’s most therapeutic response? Mr. J. should be encouraged to verbalize his concerns and frustrations. “It sounds like this is very diffi cult for you,” “You sound frustrated. Is that how you are feeling?” or “Why don’t you tell me more about how you’re feeling?” may help him to feel he can safely express himself. As part of his ongoing care, Mr. J. should also be allowed as much choice and control over his nursing care and treatment regimen as possible , and should be given adequate time to perform those ADLs and self - care measures he can manage. 2. What would be the most useful nursing intervention t o achieve the goal of reduc ed pain during Mr. J. ’s assisted ambulation ? Mr. J. should receive analgesia adequate to allow him enough relief from his pain to enable him greater mobility (i.e., ambulation) without sedative effects or impaired judgment. The analgesic should be administered 30 minutes before the scheduled activity if the drug is given IV ; 45 minutes to 1 hour before if the drug is given oral ly . 3. Which comfort measures could the nurse perform to ensure that Mr. J. has several hours of restorative sleep? Position and reposition Mr. J. as comfortably and as frequently as possible . P rovid e pain - relief measures preferred by the patient, as appropriate (analgesia, relaxation therapy) before retiring for the night . M inimiz e env ironmental stimulation. 4. Mr. J. complains of his eyes burning and feeling dry and the lights annoying him. What measures are most likely to help relieve his symptoms? Keep the patient’s eyes free from irritants and crusting by providing warm or cool soaks (as patient prefers) to eyes . R educe corneal drying by administering artifi cial tears . D ecrease lighting while Mr. J. is in bed or in a chair, but be sure to perform appropriate nursing assessments frequently with regard to Mr. J. ’s safety.

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    Cooper and Gosnell: Foundations and Adult Health Nursing, 7th Edition Chapter 24 : Loss, Grief, Dying, and Death Answer Keys - Critical Thinking Questions Nursing Care Plan 24 - 1 : The Patient Experiencing Complicated Grieving (Unresolved Grief) 1. Ms. S. is admitted to the medical unit for severe weakness, weight loss, and chronic depression. She is reluctant to get out of bed to dress and have meals. How could the nurse facilitate progression through the grieving process ? Encourage and assist Ms. S. with ADLs, allowing her as much control as is reasonable. The nurse needs to be aware that too many choices or too much detail can be overwhelming for a patient who is depressed. Choices should be kept as simple as possible; for example, “Would you like me to help you bathe now, or would you rather I come back in 10 minutes?” It is also important for the nurse to be especially consistent in this type of situation. If “10 minutes” is the time frame offered, the nurse should make every effort to adher e to it. Inconsistency can accentuate a depressed patient’s feeling that she is not “worth the trouble.” Ms. S. also needs to feel that she can safely express her emotions. She should be allowed ample time and opportunity to talk about her concerns, encouraged by accepting, nonjudgmental responses from the nurse; for example, “You seem sad, Ms. S . How can I help you?” 2. Ms. S. appears thin, with poor tissue turgor. How could the nurse and dietitian encourage improvement of her nutritional status ? Ascertain Ms. S. ’s food preferences and attempt to incorporate them into her diet as much as possible. Offering frequent, small meals and snacks may also be indicated. A larger meal may seem overwhelming and require too much energy for a depressed individual. Nutritional supplements may also be an option. Monitor the patient’s i ntake and output , and record periodic weights to determine whether nutritional status is improving. 3. The nursing assessment for Ms. S. revealed a flat affect, little verbalization, and poor personal hygiene. Which therapeutic nursing interventions would help achieve patient goals/expected outcomes ? Encourage and assist Ms. S. with ADLs, and offer acceptable choices to her (for example, “Would you like a tub bath or a shower today?”).

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    Answer Keys - Critical Thinking Questions 24 - 2 Attempts to “cheer up” the patient should not be made. These may be perceived by Ms. S. as the nurse’s inability to understand her feelings and attempts to minimize the signifi cance of her emotional pain. This can result in further withdrawal and isolation of the patient. Nursing Care Plan 10 - 2 : The Patient Facing Death 1. Ms. B. complains of severe bone pain and nausea. She appears cachexic and extremely weak. What are some nursing interventions t o decrease Ms. B. ’s symptoms ? Administ e r and a ssess the effect of analgesic and antinausea medications required for increased comfort; give supplemental oxygen as ordered. Administ e r sips or drops of oral fl uids (using a syringe without a needle) to decrease some of the dehydration symptoms that accompany cachexia, although this may not be desired by Ms. B . Mouth care and ice chips may help decrease dehydration as well, but Ms. B. ’s nausea must be managed fi rst. 2. “I want to go home to die. I don’t want to stay in the hospital. All I want to do is go home and be with my family,” says Ms. B . How can t he hospice team most benefi cially assist the patient? Evaluat e Ms. B. ’s situation to determine if hospice home care services can be realistically delivered. This will include assessing her home and family/support system as well. 3. When the nurse enters Ms. B. ’s room to begin ADLs, she notes the patient’s extreme fatigue and lethargy. What are some nursing interventions t o conserve Ms. B. ’s strength ? Minimiz e environmental stimulation , perform only necessary physical care and gentle repositioning for comfort , and assess Ms. B. ’s need for analgesia (which will decrease metabolic demands and can therefore provide relaxation, as well) . E xplain all nursing actions to Ms. B .

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    Cooper and Gosnell: Foundations and Adult Health Nursing, 7th Edition Chapter 25: Health Promotion and Pregnancy Answer Keys - Critical Thinking Questions Nursing Care Plan 25 - 1 : The Patient with a Normal Pregnancy 1. How sh ould the nurse respond to Ms. P. if she expresses concern about her dietary practices and their effect on her baby? What suggestions can the nurse give her to ensure that her diet is adequate to support the pregnancy? There is a strong correlation between maternal diet and fetal health that can be explained to Ms. P . Her concern for her baby should be viewed as a positive occurrence. Determin e Ms. P. ’s food preferences and eating habits by ask ing her to keep a food diary for a few days and to bring it with her for review at her next visit. It is important that Ms. P. be assured that this will be for her and her baby’s benefi t only. The nurse must take special care not to appear judgmental regarding Ms. P. ’s eating habits and choices. The nurse can review Ms. P. ’s nutritional needs during pregnancy and suggest ways to meet them. She will need basic nutritional education (the USDA ’ s new My Plate plan) with modifi cations addressing her vegetarian choices. Since she does eat fi sh, she can be encouraged to have at least three servings of tuna, salmon, halibut, fl ounder, or mackerel (not fried ) a week . Advise her not skip any meals. Additionally, peas, beans, and lentils and green leafy vegetables all also contain nutrients vital to normal fetal development. Ms. P. should be encouraged to increase these foods, which are staples of the vegetarian diet. It may also be easier for her to tolerate small, frequent meals rather than the usual three meals per day. Ms. P. may fi nd it helpful to speak with a dietitian (a WIC referral is appropriate, if the eligibility criteria are met). 2. Ms. P. states that she is concerned about having to reduce her activity schedule, particularly tennis, which she enjoys. She is worried she will begin to resent her baby because of the need to alter her activities. How sh ould the nurse respond to her concerns? What suggestions sh ould the nurse give her? The goal of exercise during pregnancy is maintenance of fi tness, but strenuous exercise should be avoided. Ms. P. should be reassured that once medically cleared by her obstetrician or midwife after the birth , she will be able to gradually resume her activities to her former levels. Ms. P. is also processing through Rubin’s four maternal tasks. She should be reassured that feelings of ambivalence are normal. Ms. P. is expressing valid concerns and should be encouraged to continue to do so.

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    Cooper and Gosnell: Foundations and Adult Health Nursing, 7th Edition Chapter 26: Labor and Delivery Answer Keys - Critical Thinking Questions Nursing Care Plan 26 - 1 : The Patient with Spontaneous Rupture of Membranes 1. Ms. G. ’ s labor is progressing normally with continuous monitoring. Suddenly the fetal heart rate drops to 90 b pm with late decelerations with each contraction. What sh ould the nurse do now? Explain the reason for these actions. Reposition the mother to prevent supine hypotension . A dminister oxygen via mask to increase the amount of oxygen in the mother’s blood . I ncrease maintenance IV fl uid to expand blood volume and make more available to the placenta . S top oxytoci n infusion because it intensifi es contractions and reduces placental blood fl ow , and administer tocolytic drugs to decrease uterine contractions. The health care provider should be notifi ed after these initial steps are taken to correct the decelerations. 2. Ms. G. and her coach have been working well together to manage her labor, using a focal point, breathing techniques, and guided imagery. Suddenly she becomes irritable and tells her coach, “Don’t touch me!” Her coach is bewildered by this change in behavior. How sh ould the nurse explain Ms. G. ’s behavior to her coach? How can the nurse help the coach continue to be effective during this time? Ms. G. ’s behavior indicat es she is approaching transition. During this phase of labor, the cervix dilates from 7 to 10 cm (full dilation) and it becomes completely effaced. Ms. G. is fatigue d; she may request medication but fears losing control and is obviously demonstrating irritability, all expected during this phase. The nurse can best support the coach by explaining all of this and reassuring both Ms. G. and her coach that these signs indicat e that labor is progressing normally. The coach should be encouraged to accept any negative comments from Ms. G. to be part of this process and to try not to take them personally. The coach should continue to encourage breathing and relaxation techniques, praise and reassure Ms. G. , and maintain a positive approach. Even though coaches are usually reluctant to leave the laboring woman’s side, Ms. G. ’ s coach should be encouraged to take rest or snack breaks periodically to best assist Ms. G .

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    Cooper and Gosnell: Foundations and Adult Health Nursing, 7th Edition Chapter 27: Care of the Mother and Newborn Answer Keys - Critical Thinking Questions Nursing Care Plan 27 - 1 : The Mother with a Newborn 1. Even though Baby C. is nursing well at each feeding, Ms. P. is anxious about her ability to successfully breastfeed. She asks how she will know whether Baby C. is getting enough breast milk and whether she should supplement with formula, juice, or cereal. How sh ould the nurse answer her? Signs that Ms. P. is successfully breastfeeding are that her breasts feel full before feedings and soften afterward; the “letd own” refl ex occurs; Baby C. nurses at each breast for 10 to 15 minutes, 8 to 10 times per day; Ms. P. hears an audible swallow as Baby C. sucks; Baby C. demands his feeding and appears relaxed after feeding; Baby C. has 6 to 8 wet diapers per day and passes stools several times per day; and Baby C. steadily gains weight and grows in length according to standardized growth charts. Supplementation with formula is not necessary if these are regular occurrences, but additional water can be offered, if Ms. P. desires. Adding juices or cereals is generally not recommended for several months, but Ms. P. should check with her pediatric health care provider for specifi c recommendations. 2. A Gomco circumcision is performed on Baby C . After the procedure is completed, Baby C. is returned to his mother’s room. What do you tell Ms. P. in response to her questions regarding diaper changes and care of the circumcision? How sh ould the nurse describe the expected appearance of the circumcised penis? Petrolatum jelly or petrolatum jelly – impregnated gauze may be applied to the end of Baby C. ’s penis to prevent sticking to the diaper; the area should be checked for signs or symptoms of bleeding, irritation, or infection ( exudate , with or without odor). Baby C. ’s ability to urinate should be monitored (checking diapers and noting saturation and odor). Since during circumcision , the foreskin of the penis is removed, the head of Baby C. ’s penis will be visible and should appear pink. It may also appear slightly swollen from the recent circumcision.

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