Foundations And Adult Health Nursing, 7th Edition Solution Manual

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Cooper and Gosnell: Foundations and Adult Health Nursing, 7th EditionChapter07:Asepsis and Infection ControlAnswer Keys-Critical Thinking QuestionsNursing Care Plan7-1:The Patient with an Infection1.Mr.R.has a peripheral IV infusing andreportsdiscomfort at the site of insertion. Whatshouldthe nursedo?The nurse should immediately assess the IV site for obviousdislodgment of the IV catheter,edema, erythema,or increased warmth orcoolness. Coolness may indicate IVinfiltration; theother signs may indicate irritation (possiblyfrom a previously administered medication or as anadverse effect of it) or infection.In general,if an IV site is obviously infiltrated, nursingjudgment is sufficient todeterminewhether to stopthe IV infusionand/or remove the infiltrated IV catheter.Warm compresses maygenerally be applied per nursingjudgment as well. (Facility policies must be verified.)Thehealth care providermust be notified sothatthe determinationcan be made regarding thenecessity to restart a newintravenous access site.2.Mr.R.has a urinary catheter connected to continuousdrainage. Hereportsburning at the siteof insertionandthe nursenotesdark, concentrated urine in the tubing. Whatshould the nurse donext?The nurse should assess the site of the catheter insertionfor any signs ofedema, erythema, orexudate. The nurseshould then take the patient’s vital signs, notingany changes in temperatureand pulse. Compare thedata obtained withpatient’s previousvital signs.?Following these nursing actions, the nurse shouldobtain urine samples for urinalysis and cultureandsensitivity (using aseptic technique), in anticipation of thehealth care provider’s orders tocome.All of the above should then be reported to thepatient’shealth care provideras promptly aspossible. The nurseshould also encouragethe patient to increase his fluidintake. Makeadditional fluids available to him, if notcontraindicated.3.The nursenoteson the sheet of laboratoryresults forMr.R.that hisWBCcount is 524. Why isthisa concern,and whatis recommended as a precautionary measure?This indicates a severely compromised immune system,placing the patient at very high risk forinfection. Thepatient is especially susceptible to microorganisms thatnormally do not pose asignificant threat to a healthyimmune system. A healthy immune system will destroy or

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Answer Keys-Critical Thinking Questions7-2deactivate most pathogens before they can multiply intogreater numbers. If a patient isimmunocompromised,even weaker or opportunistic pathogens (herpes varicella virus or CMV)can become establishedand cause infection or disease. Oftenthis isin a more severe formbecause the patient also cannot initiate an effective immuneresponse to combat it.Mr.R.should be placed on neutropenic precautions(formerly known asreverse isolationorProtectiveIsolation). The intent of neutropenic precautions is tominimize threats to the patient’scompromised immunestatus; for instance, protecting the patient from his or herenvironment.Most facilities have specific protocols forimplementing neutropenic precautions. Thesegenerallyinvolve a private room with the door to remain closed;limiting visitors; no obviouslyinfected visitors; no freshfruit, flowers, or raw vegetables; and no open containers(juices, water,etc.) which can serve as reservoirs forenvironmental pathogens.

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Cooper and Gosnell: Foundations and Adult Health Nursing, 7th EditionChapter8:Body Mechanics and Patient MobilityAnswer Keys-Critical Thinking QuestionsNursing Care Plan8-1:ThePatient withActivity Intolerance1. The nurse is in the process of transferring Mr.D.from hisbed to a chair using a mechanicallift. The nurse has preparedthe chair and placed it near the bed. The nurse turnsMr.D.to hisside, places the sling under Mr.D.to ensureadequate support of his head, returns Mr. D. to hisback, andslowly begins to lift Mr.D.from his bed. What has the nurseforgotten to do, and whyis it important?The nurse has forgotten to fold Mr.D.’sarms across hischest to prevent them from becominginjured during thelift.2. The patient has a trapeze bar across the bed, trochanterrolls, and a footboard. Explain therationale for each of thesedevices in maintaining proper body alignment.A trapeze bar allows the patient to use his upper body tomove around in bed. Trochanter rollsstabilize the hip jointwhen placed firmly beside it, and prevent the hip fromrolling outward. Afootboard prevents permanent, abnormalplantar flexion (footdrop) resulting from injury totheflexor muscles.

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Cooper and Gosnell: Foundations and Adult Health Nursing, 7th EditionChapter9:Hygiene and Care of thePatient’sEnvironmentAnswer Keys-Critical Thinking QuestionsNursing Care Plan9-1:The Patient NeedingSkin Care1. Mr.P.has a poor appetite and his chemistry profile revealslow protein, low albumin, andalowanion gap (A/G)ratio. Explain whypoor nutrition predisposes the patient to impairment ofskinintegrity and poor tissue healing.Proteins,which aresynthesized by the liver, are required for tissuerepair and proper immunesystem function. The onlysource of proteins is through dietary intake. If a patient isundernourished, he will be unable to produce adequateprotein for metabolic processes,such astissue repair andhealing, and fighting infection.2. With Mr.P.’s history of diarrhea, explain the possiblecomplication that could evolve if dry,intact skindevelopsanopen lesion.It is possible that an open lesion in this anatomic regionmay become contaminated and infectedwith bacterianormally found in the intestines, notablyEscherichiacoli.This type of situation isoften difficult to treat with antibiotics.As a further consequence of Mr.P.’s poor nutritionalstatus, his immune system will beweakened and may notbe able to effectively combat pathogens, making the infectioneven moredifficult to manage.

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Cooper and Gosnell: Foundations and Adult Health Nursing, 7th EditionChapter10:SafetyAnswer Keys-Critical Thinking QuestionsNursing Care Plan10-1:PatientSafety1.The nursewalking down the hall hearsa patient callingout for help.The nurseassessesthesituation and realizesthat thepatient does not remember how to use the call light. Whatfactorscould contribute to the patient’s inability to remember,and howshouldthe nurseteach thepatient to use the call bell?A patient’s memory and cognitive function can be affectedby a variety of factors, such asmedications, anxiety, pain,disorientation, and dementia. Sensory perceptions shouldbe assessedby the nurse as thoroughly as possible, withinformation and education being provided to patientsand family/visitors appropriate to level of comprehension.Reinforcement of information shouldbe provided asnecessary.Demonstrations of the use of equipment (in thiscase, the call light) by the nurse and returndemonstrationsby the patient may be appropriate in some situations,particularly if the patient isin new or unfamiliarsurroundings. It is also often helpful in this type ofsituation if the nursechecks the patient frequently, both toassess the patient’s status and to reassure patients that theyhave not been left alone.Patients may need to be reoriented to surroundingsfrequently, especially if mental status changesarea concern. It is often helpful for a patient with sensoryor cognitive impairment to be in aroom closeto thenurses’ station.2.The nurseentersthe patient’s room to answer the call bell and seesthe patient franticallypointing to the trash can next to thebed.The nurse smells smoke and sees small flames. Whatcan bedone to help prevent fires, and whatshouldthe nursedo in thissituation?The priority in this situation is to ensure patient safety.The nurse should call for assistance andimplement thefacility’sRACEprotocol:Rescue/Remove the patient fromthe area; initiate theAlarm process;Contain the fire (closefire doors, patient room doors, etc.);Extinguish the fire, ifrealistic; andEvacuate the other patients, if necessary.Patients and visitors should be educated about facilitysafety policies:reinforce the no smokingpolicy; andtheuse of equipment and personal items(hair dryers, electric shavers, lamps, etc.,)only if theymeet appropriate facility codes. Safety reviews are generallyconducted with facilitypersonnel to ensure awarenessof potential risks and proper safety procedures.

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Cooper and Gosnell: Foundations and Adult Health Nursing, 7th EditionChapter15:Specimen Collection and DiagnosticTestingAnswer Keys-Critical Thinking QuestionsNursing Care Plan15-1:Specimen Collection orDiagnostic Examination1.A malepatient has been very quiet during his morning care.When you attempt a conversation,he is obviously not interested.What is a way the nurse mightinitiate a conversation toencouragehim to relate his concernsregardinghis upcoming bronchoscopy?The nurse might say something such as, “You seem preoccupiedthis morning,” or “It looks likesomething is onyour mind this morning.” A statementlike or similar to thisoften openschannels of therapeutic communication withthe nurse and results in patients expressing theirconcerns.If more encouragement is needed, the nurse mightbe more direct by asking, “What has yourdoctor told youabout your test this morning?” or “What questions do youhave about your testtoday?”2.Thepatient is scheduled for an intravenous pyelogram(IVP). Duringthe nurse’spreparationof this patient, he remarksthat he once hada reaction while eating shellfish. Whatshouldthenursedo next?Shellfish, iodine, or contrast dye (as is used in manydiagnostic procedures, such as CT scans andMRIs) “reactions”can indicate sensitivity oranallergy to iodine-basedsubstances,andtheyshould be followed up with thehealth care providerimmediately.The nurse should obtain as much additional informationfrom the patient and his documentedmedicalhistory on file. Certain effects of the contrast dye mediumused are considered responsesto it (i.e., sensations ofwarmth, total body flushing, nausea) and not allergic reactions.Thehealth care providershould be notified and the patient’sdirect statements should be noted.All of these actionsshould be documented in the patient’s medical record.In some cases an alternate contrast medium willbe used during the diagnostic procedure. Insome casesthe original iodine-baseddye will still be used; the patient will receive antihistaminesas part of his preprocedure preparation to minimizethe possibility of a severe adverse reaction toit.3. The patient is obviously quite anxious about his upcomingmagnetic resonance imaging (MRI)scan. He breaks out in a cold sweat, is breathingrapidly, and when assessing his pulsethe nursenotestachycardia.Howshouldthe nurserespond to this patient?

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Answer Keys-Critical Thinking Questions15-2The nurse needs to ascertain exactly why this patient isso anxious, and then relieve his anxietyifpossible. This situation isvery similar to one discussed previously (please refer toCriticalThinking QuestionNo.1), and the same basic approachis indicated. Starting with statementssuch as, “Youseem worried (nervous, etc.) this morning,” often allow apatient the opportunityto express his fears and concernssafely.In addition to the nurse’s therapeutic responses, thepatientshould be asked if he would find ithelpful to asksome questions,have the nurse offer information abouthis upcoming diagnostictest,or speak with hishealth care provider.Some patients may be claustrophobic and this can beascertained when discussing the patient’s concerns.The nurse should use simple language and explanations,becausepeople exhibiting anxiety at thislevel will generallybe unable to comprehend or process detailed or largeamounts ofinformation.

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Cooper and Gosnell: Foundations and Adult Health Nursing, 7th EditionChapter16:Care of Patients Experiencing Urgent Alterations in HealthAnswer Keys-Critical Thinking QuestionsNursing Care Plan16-1:ThePatient with a Laceration1. Ms.T.’s wound was superficial.In contrast, what would be the nurse’sactions if the woundappeared to be deep or was spurtingblood?Firm, direct pressure must be applied to the area (thenurse should be wearing gloves) and thepatientmust beobservedfor signs and symptoms of shock. Thehealth care providershould benotified immediately by another nurse.2. What safety measuresare indicatedto ensure Ms.T.is notinjured again?Ms.T.may require more assistance or supervision duringmealtimes than she did previously.Forexample, shemay needherfood cutup, perhaps before the meal isserved to her (to preventembarrassment).

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Cooper and Gosnell: Foundations and Adult Health Nursing, 7th EditionChapter 17:Complementary and Alternative TherapiesAnswer Keys-Critical Thinking QuestionsNursing Care Plan17-1:ThePatient Using Complementaryand Alternative Therapies1. Ms.L.complains of feeling fatigued and tense.List somenonpharmacologic methodsofbringingabout a state of physical and mental tranquilitythat may be helpful. Why might each ofthese methods be helpful for Ms.L.?Have Ms.L.try drinking some nonstimulating herbal tea,accepting atherapeutic massage, orpositioning forcomfort and relaxation.Decreasethe stimulation of the environmentbyloweringthe intensity of the lighting and listening tosoothing music or nature sounds (especially rhythmicones, such as wavesorgentle rain).2. Ms.L.turns on her light andsheis crying. She complains offeeling helpless and inadequateto assume responsibility forcaring for her children and husband when she is discharged.Whatare some therapeutic interventions that willpromote her feelings of stabilityand validation ofher anxiety?Allow and encourage Ms.L.to express her concernsand feelings. This may result in Ms.L.verbalizing morespecific concerns regarding her perceived inability to assumeher role in thefamily.Answering any questions she may have andoffering information regarding the usual healingprocessmay help to alleviate some of her anxiety.

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Cooper and Gosnell: Foundations and Adult Health Nursing, 7th EditionChapter18:Pain Management, Comfort, Rest, and SleepAnswer Keys-Critical Thinking QuestionsNursing Care Plan18-1:ThePatient with Chronic Pain1. During the morning ADLs, Mr.J.states, “I feel so useless. Ican’t even place the urinal formyself.” What would be thenurse’smost therapeutic response?Mr.J.should be encouraged to verbalize his concerns andfrustrations. “Itsounds like this is verydifficult for you,”“You sound frustrated. Is that how you are feeling?” or“Why don’t you tellme 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 beallowed as much choice and control over hisnursing careand treatment regimen as possible,and should be givenadequate time to performthose ADLs and self-care measureshe can manage.2.What would be the most useful nursing intervention to achieve the goal of reduced pain duringMr.J.’sassistedambulation?Mr.J.should receive analgesia adequate to allow him enough relieffromhis pain to enable himgreater mobility(i.e., ambulation) without sedative effects or impairedjudgment. The analgesicshould be administered 30 minutes beforethescheduled activity ifthe drug is givenIV; 45minutes to 1hour before ifthe drug is givenorally.3. Which comfort measures could the nurse perform to ensurethat Mr.J.has several hours ofrestorative sleep?Position and reposition Mr.J.as comfortably andas frequently as possible.Providepain-reliefmeasurespreferred bythepatient, as appropriate (analgesia, relaxationtherapy) before retiringfor the night.Minimizeenvironmental stimulation.4. Mr.J.complains of his eyes burning and feeling dry andthe lights annoying him. Whatmeasuresare most likelytohelprelieve his symptoms?Keepthe patient’seyes free from irritantsandcrusting by providingwarm or cool soaks (aspatient prefers) to eyes.Reducecornealdrying by administering artificial tears.Decreaselightingwhile Mr.J.is in bed or in a chair,but be sure to performappropriatenursing assessmentsfrequentlywithregardtoMr.J.’ssafety.

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Cooper and Gosnell: Foundations and Adult Health Nursing, 7th EditionChapter24:Loss, Grief, Dying, and DeathAnswer Keys-Critical Thinking QuestionsNursing Care Plan24-1:The PatientExperiencingComplicatedGrieving (UnresolvedGrief)1. Ms.S.is admitted to the medical unit for severe weakness,weight loss, and chronicdepression. She is reluctant to getout of bed to dress and have meals.How could the nursefacilitate progressionthrough the grieving process?Encourage and assist Ms.S.with ADLs, allowing her asmuch control as is reasonable. Thenurse needs to beaware that too many choices or too much detail can beoverwhelming for apatient who is depressed. Choicesshould be kept as simple as possible; for example, “Wouldyoulike me to help youbathenow, or would you ratherI come back in 10 minutes?”It is also important for the nurse to be especiallyconsistent in this type of situation. If “10minutes” is thetime frame offered, the nurse should make every effortto adhere to it.Inconsistency can accentuate a depressedpatient’s feeling that she is not “worth the trouble.”Ms.S.also needs to feel that she can safely expressher emotions. She should be allowed ampletime andopportunity to talk about her concerns, encouraged byaccepting, nonjudgmentalresponses fromthenurse; forexample, “You seem sad, Ms.S.How can I help you?”2. Ms.S.appears thin, with poor tissue turgor.How could the nurse and dietitianencourageimprovement of her nutritional status?Ascertain Ms.S.’s food preferences and attempt to incorporatethem into her diet as much aspossible. Offeringfrequent, small meals and snacks may also be indicated.A larger meal mayseem overwhelming and require toomuch energy for a depressed individual. Nutritionalsupplements may also be an option.Monitor the patient’s intake and output,andrecordperiodic weights to determinewhethernutritional status is improving.3. The nursing assessment for Ms.S.revealed a flat affect, littleverbalization, and poor personalhygiene.Whichtherapeutic nursing interventionswouldhelpachieve patientgoals/expectedoutcomes?Encourage and assist Ms.S.with ADLs,andoffer acceptablechoices to her (for example,“Would you like atubbath orashower today?”).

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Answer Keys-Critical Thinking Questions24-2Attempts to “cheer up” the patient should not bemade. These may be perceived by Ms.S.as thenurse’sinability to understand her feelings and attempts tominimize the significance of heremotional pain. This canresult in further withdrawal and isolation of the patient.Nursing Care Plan 10-2:The PatientFacing Death1. Ms.B.complains of severe bone pain and nausea. Sheappears cachexic and extremely weak.What are somenursing interventionsto decrease Ms.B.’ssymptoms?Administer and assesstheeffect ofanalgesic andantinausea medications required for increasedcomfort;givesupplemental oxygen as ordered. Administer sips or drops oforal fluids (using asyringewithout a needle)todecrease some of the dehydrationsymptomsthataccompanycachexia,althoughthismay not bedesired by Ms.B. Mouth careandice chipsmay helpdecrease dehydration as well, but Ms.B.’s nausea must bemanaged first.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 andbe with my family,” says Ms.B.How can thehospice team most beneficially assistthe patient?EvaluateMs.B.’s situation to determine if hospice homecare services can be realisticallydelivered. This will includeassessing her home and family/support system as well.3. When the nurse enters Ms.B.’s room to begin ADLs, shenotesthe patient’sextreme fatigueand lethargy.What are somenursing interventionsto conserve Ms.B.’sstrength?Minimizeenvironmental stimulation,performonly necessary physical care and gentlerepositioning forcomfort, andassess Ms.B.’s need for analgesia (which willdecrease metabolicdemands and can therefore provide relaxation,as well).Explain all nursing actions to Ms.B.

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Cooper and Gosnell: Foundations and Adult Health Nursing, 7th EditionChapter 25:Health Promotion and PregnancyAnswer Keys-Critical Thinking QuestionsNursing Care Plan25-1:ThePatient with a NormalPregnancy1. Howshouldthe nurserespond to Ms.P.if she expresses concernabout her dietarypracticesand their effect on her baby? Whatsuggestions canthe nursegive her to ensure that her diet isadequateto support the pregnancy?There is a strong correlation between maternal diet andfetal healththatcan be explained to Ms.P. Her concernfor her baby should be viewed as a positive occurrence.DetermineMs.P.’s food preferences and eatinghabitsbyasking herto keep a food diary forafew days and to bring it with her for review at her nextvisit. It is important that Ms.P.beassured that this will befor her and her baby’s benefit only. The nurse must takespecial care notto appear judgmental regarding Ms.P.’seating habits and choices.The nurse can review Ms.P.’snutritional needs duringpregnancy and suggest ways to meetthem. Shewill need basic nutritional education (theUSDA’snewMyPlateplan) withmodifications addressing her vegetarianchoices. Since she does eat fish, she can be encouragedto have at least three servings of tuna, salmon, halibut,flounder, or mackerel (not fried)a week.Advise hernot skip any meals.Additionally, peas, beans, and lentils and green leafyvegetables all also contain nutrients vital tonormal fetaldevelopment. Ms.P.should be encouraged to increasethese foods, which arestaples of the vegetarian diet. Itmay also be easier for her to tolerate small, frequent mealsratherthan the usual three meals per day.Ms.P.may find it helpful to speakwith a dietitian (a WIC referral is appropriate, if the eligibilitycriteria are met).2. Ms.P.states that she is concerned about having to reduceher activity schedule, particularlytennis, which she enjoys. She is worried she will begin to resent her babybecause of the need toalter her activities. Howshouldthe nurserespond toher concerns? What suggestions shouldthenursegiveher?The goal of exercise during pregnancy is maintenanceof fitness, but strenuous exercise shouldbe avoided.Ms.P.should be reassured that once medicallycleared by her obstetrician ormidwifeafter the birth,she will be able togradually resume her activities to her former levels.Ms.P.is also processing throughRubin’s four maternal tasks. She should be reassured thatfeelings of ambivalence are normal. Ms.P.is expressingvalid concerns and should beencouraged to continue todo so.

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Cooper and Gosnell: Foundations and Adult Health Nursing, 7th EditionChapter 26:Labor and DeliveryAnswer Keys-Critical Thinking QuestionsNursing Care Plan26-1:ThePatient with SpontaneousRupture of Membranes1. Ms.G.’s labor is progressing normally with continuous monitoring.Suddenly the fetal heartrate drops to 90 bpmwith late decelerations with each contraction. Whatshouldthe nursedonow? Explainthereason fortheseactions.Reposition the mother to prevent supine hypotension. Administer oxygen via mask to increasethe amount ofoxygen in the mother’s blood. Increase maintenance IVfluid to expand bloodvolume and make more available tothe placenta.Stop oxytocin infusion because it intensifiescontractionsand reduces placental blood flow,and administertocolytic drugs to decrease uterinecontractions.The healthcare provider should be notified aftertheseinitialsteps are taken to correct thedecelerations.2. Ms.G.and her coach have been working well together tomanage her labor, using a focalpoint, breathing techniques,and guided imagery. Suddenly she becomes irritableand tells hercoach, “Don’t touch me!” Her coach is bewilderedby this change in behavior. HowshouldthenurseexplainMs.G.’s behavior to her coach? How canthe nursehelp the coachcontinue to beeffective during this time?Ms.G.’sbehavior indicatesshe is approachingtransition. During this phase of labor, the cervixdilates from 7to10 cm (full dilation) anditbecomescompletelyeffaced.Ms.G.is fatigued; shemay request medicationbut fears losing control and is obviously demonstratingirritability, allexpected during this phase.The nurse can best support the coach by explainingall of this and reassuring both Ms.G.and hercoachthat these signs indicatethat labor is progressingnormally. The coach should beencouraged to accept anynegative comments from Ms.G.to be part of this processand to try notto take them personally. The coach shouldcontinue to encourage breathing and relaxationtechniques,praise and reassure Ms.G., and maintain a positiveapproach.Even though coaches are usually reluctant to leavethe laboring woman’s side, Ms.G.’s coachshould be encouragedto take rest or snack breaks periodically to best assist Ms.G.

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Cooper and Gosnell: Foundations and Adult Health Nursing, 7th EditionChapter 27:Care of the Mother and NewbornAnswer Keys-Critical Thinking QuestionsNursing Care Plan27-1:TheMother with a Newborn1. Even thoughBabyC.is nursing well at each feeding, Ms.P.isanxious about her ability tosuccessfully breastfeed. She askshow she will know whetherBabyC.is getting enough breastmilk and whether she should supplement with formula,juice, or cereal. Howshouldthe nurseanswer her?Signs that Ms.P.is successfully breastfeeding are that herbreasts feel full before feedings andsoften afterward; the“letdown” reflex occurs;BabyC.nurses at each breast for10to15 minutes,8to10 times per day; Ms.P.hears an audibleswallow asBabyC.sucks;BabyC.demands hisfeeding andappears relaxed after feeding;BabyC.has 6to8 wet diapersper day and passesstools several times per day; andBabyC.steadily gains weight and grows in length according tostandardized growth charts.Supplementation with formula is not necessary ifthese are regular occurrences, but additionalwater canbe offered, if Ms.P.desires. Adding juices or cereals isgenerally not recommendedfor several months, but Ms.P.should check with herpediatric health care provider for specificrecommendations.2. A Gomco circumcision is performed onBaby C. After theprocedure is completed,BabyC.isreturned to his mother’sroom. What do you tell Ms.P.in response to her questionsregardingdiaper changes and care of the circumcision? Howshouldthe nursedescribe the expectedappearance of the circumcisedpenis?Petrolatum jelly or petrolatum jelly–impregnated gauzemay be applied to the end ofBabyC.’spenis to preventsticking to the diaper; the area should be checked for signsor symptoms ofbleeding, irritation, or infection (exudate,with or without odor).BabyC.’s ability to urinateshould be monitored (checking diapers and noting saturationand odor).Since during circumcision,the foreskin of the penisis removed, the head ofBabyC.’s penis willbe visible andshould appear pink. It may also appear slightly swollenfrom the recentcircumcision.

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