Medical-Surgical Nursing (2 Volumes) Kochuthresiamma Thomas
INDEX
Page numbers followed by f refer to figure, fc refer to flowchart, and t refer to table.
Page numbers followed by f refer to figure, fc refer to flowchart, and t refer to table.
A
Abdomen 184, 185, 241
four regions of 185f
lower 356
nine regions of 185f
X-ray 262
Abdominal
discomfort 183, 308
incision 263, 328f
magnetic resonance imaging 215
pathologic conditions, chronic 345
ultrasonography 187
Abdominoperineal resection 232f
ABG analysis 42
Abscess 104, 266, 268
subphrenic 262
Absorbable sutures 67
Acalculous cholecystitis 261
Accident proneness 22
Acetazolamide 267
Acetylcholinesterase 436
Achalasia 195, 195f
causes 195
symptoms 195
Acid 51
base balance 51
control of 51
regulation of 306
base imbalance 51, 58t, 337
type of 51
secretion 203
lack of 201
Acidosis 336
Acquired immunodeficiency syndrome 299
Acromegaly 276, 276f
Acupuncture 181
Addison's disease 49, 299, 300, 300f
Adenoid 107
Adhesive tapes 69
Administer phenothiazine medications 101
Adrenal
cortex 273
crisis 300
gland 272, 273f
disorders of 294
insufficiency 50
signs of 95
medulla 272
Adrenalectomy 302
Adrenocorticotropic hormone 271, 272
ectopic production of 166
Adverse drug reaction classification 38
Agnosia 374
Air circulation 61
Airway
guardian of 107
obstruction 126
Akinetic seizures 383
Alanine aminotransferase 241, 251
Albumin level 215
Albuminuria 308
Alcohol 230, 271, 439
cessation of 201
Alcoholism 22, 50, 136, 266
Aldosterone
influence of 44
section 46
Alkaline phosphatase 215
Allergic
disorders 5, 27
reaction 39, 93, 192
effects of 32
rhinitis 30
diagnostic tests 30
pathophysiology 30
signs 30
symptoms 30
shiners 30
Allergy 22, 93, 117, 184
Allopurinol 421, 426
Aloprim 426
Alpha-fetoprotein 259
Alpha-glucosidase inhibitors 292
Alveolar collapse 104
Alveoli 108
Alzheimer's disease 413, 413f, 435
American Nurses Association 3
Amikacin 154
Amylolytic enzymes 212
Anal
fissure 236, 236f, 237f
etiology 236
management 236
pathophysiology 236
fistula 237, 237f
etiology 237
management 237
Analgesics, administration of 329
Anaphylactic attack 32
Anaphylaxis 31, 39
pathophysiology of 31, 31f
signs 31
symptoms 31
Anemia 338340
treatment of 340
Anesthesia 97, 198
beginning 99
fear of 94
gas 61
general 97, 116
local 97
promotes, type of 97
regional 97, 98
surgical 99
types of 98
Anesthetic, classification of 98, 99fc
Angina 431
Angiogenesis 232
Ankylosing spondylitis 423
complications 423
etiology 423
management 423
pathophysiology 423
Anomalies, congenital 319
Anorectal abscess 237, 237f
diagnosis 237
etiology 237
management 237
Anorectal problems 234
etiology 234
management 235
pathophysiology 234
Anorexia 45, 46, 241, 259
Anoscopy 189
Antacids 201, 206, 267
Anthropometric methods 15
Anthropometry, advantages of 16
Antiandrogen drugs 363
Antibacterial therapy 366
Antibiotics 31, 94, 204, 313
drugs, variety of 312
therapy 206
Antibodies, disease-specific 215
Antibody-mediated immunity 27
Anticholinergic drugs 207
Anticipate thrombolytic therapy 389
Anticoagulants 162
Antidepressants 94
Antidiuretic hormone 46, 166, 272
aid of 306
imbalance 274
Antifibrinolytics 392
Antigens 26
Antihypertensive drugs, administration of 340
Antimicrobial therapy 128, 367
Antineutrophil cytoplasmic antibodies 215
Antinuclear antibody 29, 416
Antipyretics, administration of 133
Antirheumatic drugs, disease modifying 420
Antituberculosis drugs 154t
Antitussives, administration of 133
Anuria 356
Anus 184, 186
Anxiety 32, 43, 204, 442
assess level of 24
causes of 6
feelings of 328
reducing 95, 205
relieving 326
Aphasia 374
Appendectomy 227
Appendicitis 226, 226f
complications 227
etiology 226
nursing management for 228t
pathophysiology 226
treatment of 229
Appetite
disorders 22
lack of 54
Apraxia 374
Arginine vasopressin 274
Arrhythmias, severe 163
Arterial blood
gas analysis 113, 114t
pressure drops 306
Arteriovenous
fistula 349, 349f
internal 349
graft 349, 349f
malformation 378
Artherosclerotic vascular disease 355
Arthralgia 34, 241
Arthritis 427, 431
Arthrodesis 422
Articular symptoms 419, 423
Ascites 253, 255, 259
development of 253fc
management of 254
pancreatic 268
Aspartate aminotransferase 241, 251
Aspergillus 131
Aspiration pneumonia 131
Aspirin 230, 392, 421
Asthma 22, 117, 146, 431
pathophysiology of 140, 141fc
signs 141f
Atelectasis 104, 127, 138, 139f
Atonic seizures 383
Atopic dermatitis 30
diagnostic tests 30
pathophysiology 30
signs 30
symptoms 30
Atopic disorders 27
Atraumatic hemostatic forceps 69
Atrophic glossitis 192
Atrophy 19
Autoclaves 90
Autoimmune disease 5, 278
alternative therapy 429
Autonomic nervous system 371
Axonal injuries, diffuse 400
Azotemia 360
B
B cells 26
Bacillocid sterilization 89
Bacillus cereus 209
Bacteria 396
Bacterial
infection 123, 261
pneumonia 131
atypical 131
prostatitis, chronic 367
Bakers cyst 419
Balloon tamponade 255
Barium
enema 187, 214, 230
swallow 187
Barrel chest 113
Basophils 28
Bell's palsy 414, 414f
Bent-Fork deformity 419
Bethanechol 226
Bevacizumab 232
Bicarbonate 44, 306
excretion 56
prolonged ingestion of 50
Bile
ducts 241
obstruction
sign of 262
symptoms of 262
peritonitis 262
reflux gastritis 206
Bilevel positive airway pressures 120
Biliary
cirrhosis 250, 262, 263
disorders 261
drainage 264
function 240
sludge 261
stricture 244
tract
disease 266
obstruction 268
Biochemical assessment 16
Biopsy 274, 358
invasive 29
site of 116
Bird flu 124
Bismuth salts 204
Bisphosphonates 439
Bladder 304
cancer of 323
emptying of 344
irrigation 362f
neck 307
outlet obstruction, symptoms of 360
pain 307
specimen 367
stone 360
training 441
trauma 323
traumatic rupture of 323
wall 304
Bleeding
cause of 338
esophageal varices 252, 255t
severe 42
tendencies 338
Blood 63
culture 133
findings 420
glucose
levels, high 293t
self-monitoring of 291
unstable 302
levels of creatinine 310
loss of 350
pressure 44, 101
measurements 349
regulation of 306
sugar level monitoring 63
test 113, 310
transfusion 96
urea nitrogen 41, 310
volume 44
depletion 306
Body
defence mechanisms of 19
fluids 40
composition of 41
shape 433
touch 239
water 338
weight 340
wrap 120
ventilator 120f
Bone 45, 433
marrow 26, 215
Bordetella pertussis 125
Bouchard's node 417, 417f
Boutonniere deformity 419, 419f
Bowel
disease, inflammatory 214, 217
motility 46
resection 231, 232f
twisting of 222
Bowman's capsule 305
structure of 305f
Brain 369
abscess 396, 398
anatomy 369f
injury 388f
traumatic 399, 436
tissue 386
tumors 404
types of 405f
Brainstem 370
Breath 201
shortness of 43
sounds 113
abnormal 113
auscultation of 52, 113
tests 187
Breathing 101
deep 24
mechanics of 109, 110f
pattern 161
retraining 148
Brivaracetam 384
Bronchi 108
Bronchial asthma 140, 142t
pathogenesis of 141f
Bronchiectasis 117, 126, 127f, 128t, 130, 130t, 136
Bronchioles 108
Bronchitis 125, 130, 130t
acute 125, 130
chronic 117, 125, 126f, 146, 147, 147t
Bronchodilators 128
Bronchoscopy 115, 115f
complications of 116
rigid 116
Bronchus 108
Brudzinski's sign 397
Buccal mucosa 185
Burns 42, 261
Burr hole 379
Butazolidin 421
C
Caffeine 439
Calcitonin 45
Calcium 44, 338, 439
balance, regulation of 45
deficit 48, 332
excess 49
gastrointestinal absorption of 332
imbalance 47
ion homeostasis 45
supplements 50
Calculus cholecystitis 261
Cancer 22
pancreatic 244
stage of 358
Candida 131
Cannula method 172t
Carafate 207
Carbamazepine 384
Carbolization 87
Carbon
13 urea breath test 204
tetrachloride 244
Carbonic anhydrase inhibitor 267
Carcinoembryonic antigen 231
Carcinoma 263
Cardiac
arrhythmias 50
cirrhosis 250
dysfunction, prevention of 278
dysrhythmias 213
failure 46
function 10, 46
Cardiomyopathy 50
Cardiovascular
disease 436
status 93
system 44, 338, 403, 434
Cell
mediated 27t
immune response 27
types of 306f
Cellular
adaptation 19, 19t
differentiation, degree of 323
injury 19
Cellulitis 104
Central
nervous system 169, 369, 434
venous pressure 101, 380
Cerebellum 370
Cerebral
aneurysm 378
angiography 375, 388
circulation 371, 372f
cortex, lobes of 369f
edema 46
functions, special 374
perfusion 390
Cerebrospinal fluid 277, 370
analysis 374
Cerebrovascular accident 385
Cerebrum 369
Cervical spondylosis 422
management 422
Charaka 1f
Cheilosis 184
Chemical
digestion 200
mediators, release of 20
pneumonia 131
Chemotherapy 259, 265
Chenodeoxycholic acid 263
Chest
drainage 179, 179f
pain 111, 197
physiotherapy 127, 175
radiography 117
trauma 159, 161
tube insertion 178f
X-ray 133
Chills 123, 241
Chlamydia trachomatis 131
Chloride 44, 45, 306
Chloroform 244
Cholangitis 262, 263
Cholecystectomy 263, 263f
Cholecystitis 261
Cholecystostomy 263
Choledocholithiasis 263, 264
Choledocholithotomy 263
Cholelithiasis 262, 262f
Cholinesterase inhibitors 226
Chovostek's sign 48
Chronic bronchitis, pathophysiology of 147
Chronic kidney diseases, symptoms of 339
Chronic obstructive pulmonarydisease 95, 117, 126, 136, 146
Cilia 108
Cimetidine 201, 267
Ciprofloxacin 313
Cirrhosis 244, 250f, 253fc
of liver, symptoms of 250f, 251f
postnecrotic 250
types of 250
Clamps, vascular 69
Clobazam 384
Clonazepam 384
Clostridium perfringens 209
Cluster headache 381
Cobblestone appearance 216f
Cognitive stress responses 22
Colchicine 421, 426
Cold 21, 42
common 122
intolerance 279
Colectomy 220f
Colicky pain 262
Collagen disorders 416
Colon cancer 230f
Colonoscopy 188, 214
Colorectal cancer 230
etiology 230
pathophysiology 230
Colostomy 232f
care 234
double-barrel 221f
irrigations 234
Coma 45
Communication 11, 14, 388
Community acquired pneumonia 132f
Complete blood count 357
Complex partial seizures 383
Computed tomography 188, 274, 312, 375
scan 215, 242, 323
Conduction nerve block, type of 98
Confusion 54
Congestive cardiac failure 43
Connective tissue 416
disease 416
disorders 416
Consciousness
altered level of 376
level of 100, 376
loss of 97, 99
monitor level of 161
Constipation 42, 183, 203, 225, 440
etiology 225
management 225
nutritional therapy 226
pathophysiology 225
treatment 226
Contact dermatitis 35
classification 35
delayed-type 39
etiology 35
pathophysiology 35
Contagion, theory of 4
Continent ileal urinary reservoir 324
Contraceptives 46
Convulsions 46, 48
Coronavirus 170
Corrective osteotomy 422
Cortex 304
Corticosteroids 46, 93, 217, 421, 428
therapy 378
Corticotropin releasing hormone 271
Costovertebral tenderness 320
Cough
acute 113
chronic 113, 126, 197
features of 113t
productive 127
sub-acute 113
types of 113t
Coup-countrecoup brain injury 400f
Crampy pain 222
Cranial
nerves 371
surgery, types of 379
Craniectomy 379
Cranioplasty 379
Craniotomy 379, 379f
C-reactive protein 94, 227
Creatinine clearance test 309
Creutzfeldt-Jakob disease 435
Crohn's disease 214, 215, 215f, 216, 216f
Cryosurgery 260, 358
Cryotherapy 235
Cryptococcus neoformans 396
Crystals, mass of 319
Cushing's syndrome 301, 301f, 302
Cushing's triad 377, 377f
Cutaneous ureterostomy 324, 325
Cyanosis 27, 111
Cylinder manifold room 61
Cystic
fibrosis 262, 266
swelling, aspiration of 357
Cystoscopy 357
Cystostomy, suprapubic 367
Cysts 266
Cytomegalovirus 133, 200
Cytoprotective drug therapy 207
Cytotoxic hypersensitivity 32
D
Daily livings, activities of 249
Dead space volume 110
Death, fear of 94
Decerebrate posturing 373, 374f
Decorticate posturing 373, 374f
Degenerative joint disease 416
Dehydration 42
signs of 42f
Dementia 432, 436
mild 436
moderate 436
severe 436
stages of 436
type of 435
vascular 435
Dental
caries 193
plaque 193
Deoxyribonucleic acid 315, 340
Depression 22, 431
Diabetes 22, 136
complications of 291
insipidus 42, 46, 274, 275
mellitus 262, 288, 289, 295t, 308
pathogenesis 288f
uncontrolled 50
types of 289, 289f, 289t
Diabetic ketoacidosis 46, 292, 296
Dialysis 333, 340
general principles of 340
Diaphoresis 261, 262
Diarrhea 36, 42, 46, 49, 50, 183, 203, 210, 212, 213, 217
complications 213
etiology 212
medical management 213
pathophysiology 212
secretory 212
types of 212
Digestive tract, upper 189f
Digital subtraction angiography 388
Dihydroxycholecalciferol 307
Diplococcus pneumoniae 133
Directly observed therapy-short course 153
Discectomy 407
Disequilibrium syndrome 350
Disseminated intravascular coagulation 170, 266
Diuresis 42
Diuretic 46, 191
therapy 46
Divalproex 384
Diverticular disease 219, 219f, 225
medical management 220
nursing management 220
pathophysiology 219
surgical management 220
Diverticulitis 221f
complications of 220
Doxepin 207
D-pencillamine 420
Drainage
systems 323
tubes, management of 329
tubing 179
Drowsiness 50
Drug 271
abuse 22
induced hepatitis 248
therapies 145, 201, 206, 267, 313, 314, 339, 384, 389
Dumping syndrome 199, 206
Duodenal ulcer 202, 202f, 266
symptoms 202t
Duodenum 190
Duplex venous ultrasound 162
Dyspepsia 184, 195, 208, 241, 261
Dysphagia 184, 194, 195
signs 194
symptoms 194
treatments 194
Dyspnea 32, 46, 52, 53, 111, 147, 317
Dysrhythmias 46
Dysuria 307, 356
E
Ectopic hormone production 166
Eczema 30
Edema 43
management of 318
Edematous pancreatitis 266
Ejaculatory ducts 305
Electric boiler fumigation method 88
Electrocardiogram 286, 332
Electrodiagnostic studies 94
Electroencephalography 376
Electrographic studies 376
Electrolyte 10, 41, 44, 133, 215, 336, 337
balance 44
imbalance 45, 51, 51t
Electromyography 376
Elevated serum magnesium level 50
Emboli 161
Emphysema 117, 141, 144f, 145147, 147f, 147t
causes of 144
diagnosis of 145
pathophysiology of 144f
Empyema 127, 133, 137f
complex 137
Encephalitis 396, 396f, 397t, 398
Encephalopathy 50
Endemic goiter 282
Endocrinal disorder, management of 240
Endocrine
disorders 273t
disturbances 251
functions 307
glands 272t
system 271f, 273, 339
anatomy 271
physiology 271
Endoscopic
examinations 214
mucosal resection 197, 198f
retrograde cholangiopancreatography 263
stent placement 265
ultrasound 189, 241
Endoscopy 94, 197, 204
Endotracheal
intubation 119, 119f
tube, parts of 119f
Enflurane 98
Enteritis, regional 214
Enterococci 265
Enuresis 308
Eosinophils 28
Epidemic parotitis 190
Epidemiological triad, theory of 5
Epididymis 356
Epididymitis 366
Epidural
anesthesia 98, 98f, 99t
hematoma 401f
Epigallocatechin gallate 430
Epigastric pain 241
Epiglottis 107
Epilepsy 382, 385
Epinephrine 32
Epstein-Bar virus 418
Erythema 27
Erythrocyte sedimentation rate 28, 215, 416
Erythropoietin, biogenesis of 307
Escherichia coli 209, 312
Esophageal
cancer 197
types of 196
sphincter
lower 190, 195
upper 190
ulcer 202
varices 252, 252f, 259
management of 252
Esophagectomy 197, 197f
Esophagogastroduodenoscopy 188, 204, 214
Esophagomyotomy 195
Esophagus 184, 190
cancer 196, 196f
signs of 197
symptoms of 197
Ethionamide 154
Ethmoid sinusitis 123
Ethosuximide 384
Ethylene oxide sterilization 89
Euthanasia, passive 444
Exocrine pancreatic disorders 265
Exogenous estrogen 358
Expiratory reserve volume 110
External beam radiation 363
Extracellular fluid 40, 41
volume 338
Extracorporeal shock wave lithotripsy 321, 321f
Extracranial-intracranial bypass 389
Extrahepatic obstructions 244
Extremities 241
Eyes 293, 373
F
Face 433
Facial paralysis 414
Famotidine 195
Fasting plasma glucose level 290
Fat
emulsion intravenous infusions 333
intolerance 261
Fatalistic theory 4
Father of Indian Medicine 1
Father of Indian Surgery 1, 1f
Father of Medicine 2
Father of Surgery 2
Fatigue 46, 54, 241, 279, 429
generalized 123
Faye Abdella's 21 nursing problems 9
Febuxostat 426
Fecal
immunochemical test 231
incontinence
medical management 219
nursing management 219
pathophysiology 218
occult blood test 186, 231
Fever 42, 123, 241, 261
unexplained 259
Fiberoptic bronchoscopy 133
Fibrinolytic therapy 389
Fibromyalgia 424
etiology 424
Fibrosis 250
Finger to finger test 374
Finger to nose test 374
Finger, clubbing of 111, 127
Fissure 184
Fistula 262
pancreatic 268
Flail chest 160, 161f
Flank pain 312
Flat jugular vein 42
Fluid 10, 404
and electrolyte
balance 40, 44
imbalance 40, 93
compartments 40, 40f
intake 43
management of 95
movement of 41, 340
overload 163
requirement 17
retention occurs 332
volume 101, 317
deficit 41, 42, 43f
excess 43, 332
Fluothane 98
Follicle stimulating hormone 272
Food
additives 31
allergy 36
cause 36
signs 36
symptoms 36
frequency questionnaire 17
Foot care tips 294
Forceps, types of 70f
Formaldehyde fumigation 88
Fowler's position 65, 66f, 121
Fractures, frontal 399
Freezing hepatic tumor 260
Fresh frozen plasma 102
Fulminate liver failure 260
Fumigation procedure 88
Functional residual capacity 111
Fundus 199
Fungal pneumonia 131
Funnel chest 113
G
Galen's theory 4
Gallbladder 182, 240
cancer of 265, 265f
rupture of 262
Gallstones 241, 261, 266
formation of 262f
Gamma-glutamyl transferase 251
Gamma-glutamyl transpeptidase 241
Gas
exchange 106, 108
forming foods 325
sterilization 89
transport 110
Gastric 202t
analysis 189
cancer 209
juice
composition of 199
functions of 199
secretion of 200
surgery, types of 205f
ulcer 202
Gastritis 200, 201
acute 201
causes of 200
chronic 201
diet of 200
drugs of 200
pathophysiology 200
Gastroduodenal mucosa 202
Gastroduodenostomy 204
Gastroenteritis 209, 210t
Gastroesophageal
junction 190
reflux 194
disease 195
Gastrointestinal
complications 264
disorders 239
management of 182
fluid loss 34
hemorrhage 268, 308
study
lower 187
upper 187
suction 42
symptoms 307, 308
system 182, 186, 338, 403
tract 182, 183f, 434
disorders of lower 211
Gastrojejunostomy 204
Gastroparesis 294
Gastrostomy 237, 239f
Gene testing 28, 29
General adaptation syndrome 22, 22f
Genitourinary system 434
Germ theory 4
Gestational diabetes mellitus 289
Gingival hyperplasia 385
Gingivitis 193
causes 193
signs 193
symptoms 193
Glasgow coma scale 100, 373, 373t
Glomerular
filtration rate 305, 306, 336
nephritis, acute 318t
Glomerulonephritis 315, 315f, 317, 319t
chronic 317
clinical manifestations of 316fc
manifestations 316f
pathogenesis of 315fc
pathophysiology of 316fc
Glossitis 184, 192
acute 192
causes 192
chronic 192
medications 192
symptoms 192
treatment for 192
types of 192
Glottis 107
Glutathione 180
Glycogen rich epithelial cells 312
Glycohemoglobin 290
Glycosuria 289
Goiter 282, 282f
toxic 282
Goitrogens 282
Gonorrhea 319
Gout 424, 425
pathogenesis of 426fc
signs of 425, 425f
symptoms of 425, 425f
Gouty arthritis
acute 426
chronic 426
Graft versus host disease 37
signs 37
symptoms 37
Gram stain 133
Growth 10
hormone 272
deficiency 275, 276
stage of 323
Guillain-Barré syndrome 412
Gum 185
disease 193
H
Haemophilus influenzae 123, 131, 133
Halitosis 194
management 194
Hallux valgus 419f
Halothane 98, 248
Hand osteoarthritis 417
Handwashing technique 62
steps of 63f
Hay fever 30
Head 113
injury, types of 399, 399f
trauma 398
Headache 22, 45, 54, 123, 241, 381, 397
management of 382
primary 381
types of 381
Health
care system 11
general signs of 357
Heart 44
attack 117
severe 163
beat, irregular 116
failure 332
rate 46, 54
valve, abnormal 163
Heartburn 261
Heberden's node 417, 417f
Helicobacter pylori 200, 201f, 203
infection 201
pathogenesis 203f
Hematemesis 184, 203
Hematologic disorder 332, 427
Hematoma, subdural 401
Hematuria 308, 356, 359, 360
painless 323
recurrent 360
Hemodialysis 340, 349, 350
complications of 350
procedure 350f
Hemoglobin 114, 205
Hemolytic
jaundice 244
reaction, acute 33f
transfusion reaction 33
Hemopneumothorax 160
Hemopoetic stem cell transplantation 37
Hemopoietic function 212
Hemoptysis 111, 127
Hemorrhage 102, 203, 205
Hemorrhagic pancreatitis, acute 266
Hemorrhoidectomy 235
Hemorrhoids 184, 234, 235f
Hemothorax 160, 160f
Hepatic
carcinoma 244
encephalopathy 253
management of 254
function 93
assessment of 240
Hepatitis 244, 245, 249t, 271, 350
A, community prevention of 246
B 245
causes of 350
immune globulin 248
vaccine 247, 248
C
causes of 350
virus 247
D 247
delta 247
E 247
toxic 248
type A 245, 246
Hepatobiliary scan 242
Hepatocellular jaundice 244
Hepatorenal syndrome 254
Hernia 184, 222
Hiatal hernia 194, 194f
management for 195
Hip 417
circumference 15
Hippocrates 2f
theory of 4
Histamine
H2-receptors antagonists 267
receptor blockers 206
Homeostasis 40
Höpfner's hemostatic forceps 69
Hormonal
disturbances 43
function 212
therapy 363
Hormone 31, 272t
replacement therapy 439
tests 273
Hospital acquired
infections 312
pneumonia 131
Human
body 182
chorionic gonadotropin 357, 358
herpes virus 418
leukocyte antigen 26, 354
monoclonal antibody 428
papillomavirus 357
stomach, sections of 190f
Humidity 61
Humoral immunity 27, 27t
Huntington's disease 414
Hydrocele 367
Hydrochloric acid 199
Hydrogen
breath test 187
reabsorption 56
Hydrolytic function 212
Hydrostatic pressure 41
Hyperactive deep tendon reflex 48
Hyperaldosteronism 50
Hypercalcemia 49, 56
causes of 49f
Hypercapnia 52
Hyperchromic anemia 215
Hyperglycemia 291
Hyperinsulinemia 337
Hyperkalemia 47, 47f, 339
Hypermagnesemia 50
Hypernatremia 46
manifestation of 46f
Hyperosmolar hyperglycemic nonketotic syndrome 296
Hyperparathyroidism 49, 287, 288t
Hyperphosphatemia 50
Hyperplasia 19
Hypersensitivity reaction 30t, 3134
Hypertension 308, 338
portal 251, 259
treatment of 340
Hypertensive emergency 163
Hyperthermia 42, 281
Hyperthyroid disorders 95
Hyperthyroidism 50, 280, 281
symptoms of 278t
therapy for 278
Hypertrophy 19
Hyperventilation 42
Hypocalcemia 48, 48f
Hypocapnia 53
Hypoglycemia 292
postprandial 206
Hypokalemia 46, 47f, 56
Hypomagnesemia 49
Hyponatremia 45
Hypoparathyroidism 48, 50, 286, 288t
Hypophosphatemia 48, 50
Hypophysectomy 277
Hypoproteinemia 48
Hypostatic pneumonia 131
Hypotension 42, 50, 95, 350
orthostatic 45
postural 46
Hypothalamic hypothyroidism 277
Hypothyroidism 277, 279, 280
primary 48, 277
secondary 277
signs of 278f
symptoms of 278f, 278t
Hypotonic hydration 42
Hypovolemia 42
Hypoxia 52, 53, 95
I
Iatrogenic pneumothorax 160
Ibuprofen 421
Idiopathic glossitis 192
Ileal conduit urinary diversion 324, 324f
Ileocolitis 214
Ileostomy 233
Imbalanced nutrition 204, 209, 279, 281
Imipramine 207
Immune system 26, 28, 29t, 216
nursing assessment of 27
organs of 26f
tests for 28t
Immunity 26
mechanisms of 27
natural 27
passive 247
types of 27
Immunoglobulin 26, 245
Immunologic disorder 427
Immunosuppressive therapy 104, 355, 422
Impaired fasting glucose 290
Inappropriate antidiuretic hormone, symptoms of 274
Incisional hernia 104
Incisura angularis 199
Indigestion 183, 261
Indomethacin 421
Induction room 60
Indwelling urinary catheter 96
Ineffective tissue perfusion 33
Infantile spasms 383
Infection 42, 308, 338
recurrent 127, 360
spread of 350
Inflammation 5, 20, 126, 313
pathogenesis of 21f
signs of 20
symptoms of 20
Inflammatory bowel disease, types of 214
Influenza 123
Injury 403
mechanics of 401
secondary 400
Inspiratory reserve volume 110
Insulin 94
degradation of 307
dependent diabetes mellitus 288
injection sites 291f
pumps 291
Integumentary system 339, 403
Intermittent positive pressure breathing 121
International Diabetes Federation 288
Interstitial cell stimulating hormone 272
Intestinal
gas 183
glands 211
malabsorption syndrome 49
obstruction 221
causes of 222f, 222t
pathophysiology of 223fc
tuberculosis 217, 217f
Intestine 327
Intracellular fluid 41
Intracranial
aneurysm 379f
bleeding 378
pressure 376
surgery 378
tumors 378
Intradermal injections 63
Intraluminal pressure 219
Intrapleural pressure 109
Intravenous pyelogram 312, 358
Iodine deficiency 278
Ions 44t
Iron
levels, low 192
lung 120, 120f
Irritable bowel syndrome 213, 214, 217
nursing management 214
pathophysiology 214
signs 214
symptoms 214
Irritant contact dermatitis 35
Irritation, signs of 327
Ischemic stroke 389
Isoniazid 154
Itching 36
J
Jackknife position 66, 66f
Jaundice 54, 244, 250, 259, 261
obstructive 244
types of 244
Jejunostomy 237
devices 237
feeding 239f
Jejunum 237
Joint 416, 433
disease, inflammatory 416
pain 34, 425
realignment 417
replacement 422
stiffness 50
Jugular vein distension 43
K
Kayexalate 333
Kegel's exercises 441
Kernig's sign 397
Ketoacidosis 290
Kidney 45, 56, 294, 304
disease 294
chronic 331, 332, 336, 336f, 337fc, 339, 340t
progression of 317
function 331
normal 313f, 315f
pain 307
stones, removal of 322f
structure of 305f
surgery 328
transplant recipient 354
transplantation 354, 354f
Klebsiella 265, 312
pneumoniae 131, 367
Knee 419
chest position 65, 66f
joint 417
Knowledge deficit 228, 326, 442
Kraegel model of patient needs 8t
Kussmaul's respirations 293
Kyphoscoliosis 113
L
Lactic dehydrogenase 241
Laennec's cirrhosis 250
alcoholic 250
nutritional 250
Laminectomy 407, 407f
Lansoprazole 201
Laparotomy 261
Large bowel obstruction 224, 224f, 225, 225t
pathophysiology 224
Large intestine 212, 229f
polyps of 229
Laryngeal edema 32
Laryngitis 124, 124f
Laryngopharynx 107
Larynx 107
Laser surgery 358
Latex allergy 38
signs 38
symptoms 38
Leflunomide 420
Lethargy 45
Leukocyte esterase 312
Levifloxacin 154
Lieberkuhn, crypts of 211
Life saving therapy, chronic 121
Limp muscle weakness 45
Linezolid 154
Lingering discomfort 425
Lingual tonsils 107
Lipolytic enzymes 212
Lipoproteins
high-density 337
low-density 337
Lips 185
Lithotomy position 65
Lithotripsy 320, 321f
Liver 240, 250f, 271
abscess 260
anatomy of 240f
biopsy 242
site for 243f
cancer 259, 259f
changes 250f
cirrhosis of 46, 248, 257t
disease 43
severity of 251t
function 240t
test 37, 94, 262
injury 261
non-operative management of 261
investigations of 241t
lobectomy of 260f
normal 250f
transplant 260, 261
trauma 260
Lobe, frontal 369
Lobectomy 128, 167, 259
Local adaptation syndrome 20
Loop stoma 233
Low blood glucose levels 293t
Lower respiratory tract 106
disorders 125
Lower thoracic esophagus 197
Lower urinary tract symptoms 359
Lumbar discectomy 407f
Lumbar puncture 389
site for 375f
Lumbodorsal incision 329f
Lung 34, 108
abscess 136, 164, 164f
cancer 165, 165f
causes 166f
originate 165
stages of 166t
types 165f
fibrosis 117
function tests 145
injury, acute 169
structure of 109f
surgery, types of 167f
transplantation 167
volumes 111t
Lupus erythematosus 428t
Luteinizing hormone 272
Luteotropic hormone 272
Lymph node 26, 357
lymph of 324
Lymph vessels 26
Lymphocytes 26, 28
Lysozyme enzymes 106
M
Macrolides, administration of 133
Macrovascular complications 293
Magnesium 44, 45, 306, 338
imbalance 49
Magnetic resonance imaging 118, 118f, 188, 274, 333, 375
Malabsorptive disorders 212
Malaise 123, 241
Male genitalia, examination of 356
Male reproductive system, assessment of 356
Malignant polyp 229f
Malnutrition 48
Mask 171, 172
method procedure 173t
Maslow's hierarchy 7f
Mass conversion 44
Massive pulmonary embolism 162f
Maxillary sinus 123
McBurney's point 226, 227f
Mechanical ventilation 119, 121
Mediastinum 108
Medical-Surgical Nurses, academy of 3
Medulla 304
Melanocyte stimulating hormone 272
Melena 184, 203
Membranous urethra 305
Memory, loss of 97
Meninges 372
layers of 372f
Meningitis 396, 396f, 397t
Meningococcal meningitis 396
Mental changes 50
Mental status examination 374
Metabolic acidosis 51, 54, 55f, 55t, 58, 332, 333, 337, 338
causes of 54
Metabolic alkalosis 51, 54, 57t, 58
manifestations 57f
Metabolic
disorder, management of 240
disturbances 337
functions 307
syndrome 289
system 435
Metaplasia 19
Metastasis 260
absence of 323
Methotrexate 420
Methoxyflurane 98
Methyl tertiary terbutyl ether 263
Metoclopramide 226
Micturition, changes of 356
Migraine headache 381
Milk alkali syndrome 49
Mirabegron 441
Mohs microsurgery 358
Monitor fluid losses 46
Monitor respiratory rate 32, 52
Monitor serum sodium level 46
Monitor vital signs 236, 390
Monitoring vital signs 100
Mono amine oxidase inhibitors 94
Monocytes 28
Monofilament 67
suture 67
Mood changes 50
Morbidity, cause of 355
Motilium 196
Motor strength 378
Mouth 185, 190
care 193
trauma 192
Mucosa 190
Mucus membrane 42
dry 46
Multifactorial theory 5
Multifilament suture 67
Multiple abdominal surgical procedure 345
Multiple blood transfusions 261
Multiple sclerosis 411
Mumps 191f
symptoms of 191f
Muscle 182, 433
cramps 46, 48, 350
pain 50
relaxants 97, 407
weakness 46, 50, 411
Muscular dystrophies 415
Musculoskeletal system 339, 434
Music therapy 24
Myalgia 123, 397
Myasthenia gravis 411
Mycobacterium 200
tuberculosis 152, 218
Mycoplasma pneumoniae 125, 131
Myelography 375
Myoclonic seizures 383
Myxedema 49
N
Nasal
cannula 171
catheter 171
prongs 171f
samples 114
septum 106
Nasogastric
suction 46, 49
tube 96
Nasopharyngeal swab 114
Nasopharynx 107
National League of Nursing Education 3
Natural killer cells 26
Nausea 45, 183, 184, 241, 259, 261, 397
Neck 113
Needles
classification of 68
types of 68f
Neisseria meningitides 396
Neoplasm 5
Neostigmine 226
Nephrectomy 329f
types of 328
Nephron, structure of 306f
Nephropathy symptoms 425
Nephrostomy 324
drainage 329
Nephrotic syndrome 48, 317, 319t
pathophysiology of 318fc
treatment of 318
Nerve
complications 294
conduction 376
Nervous system, cells of 370
Neuralgia 413
Neuro motor alterations 388
Neurocognition 10
Neuroglial cells 371
Neurologic
disorders, management of 381
dysfunctions, management of 376
infection 396
status 390
assessment 100
system 338
assessment of 369, 372
Neurological disorders 369
Neurological trauma 398
Neuromuscular irritability 48
Neuron 370
structure of 371f
Neuropathy 294
Neutrophils 28
Nissen fundoplication 196f
Nizatidine 195
N-methyl-d-aspartate 436
Nocturia 46, 289, 307
Nodular liver 184
Noise 21
Non-absorbable sutures 67
Nonelectrolytes 41
Non-invasive negative pressure ventilators 120
Nonrespiratory air movements 109
Nonsteroidal anti-inflammatory drugs 318, 420, 426, 428
Nonsystemic antacids 207
Nose 106
bleeding 116
Nostrils 106
Nuclear scanning 274
Numbered stroke method 64
Nursing care 261, 282, 366
plan 12
Nutrition 10, 43, 101, 145
management of 95
promotion of 429
therapy 290
Nutritional
assessment 14
methods of 15
Nutritional
balance 404
disorders 212
history 183
status 93, 264
Nutritional therapy 207, 253, 268, 322, 333, 378
protein restriction 340
O
Obesity 230
Observe respiratory rate 309
Odor control 327
Odynophagia 184, 194, 195
Oliguria 308, 356
Omega-3 fatty acids 430
Omeprazole 201
Open esophagectomy 197
Open pneumothorax 160
Operation theater technique 59
Oral
cholecystography 242, 262
glucocorticoids 426
hypoglycemic
agents 292t
medication 291
Orbital fractures 399
Orchidectomy 359
bilateral 363
Orchitis 366
Oropharynx 107
Osmotic
diarrhea 213
pressure 41
Osteitis fibrosa cystica 339
Osteoarthritis 416, 422
pathophysiology of 417, 417fc
type of 422
Osteomalacia 339
Osteoporosis 438, 439
classification of 438
Osteotomy 417
Ostomy
appliance, management of 327
surgery 233
types 233
types of 233f
Oxygen 171
administration of 133, 172t, 173t
body 171
concentration 173t
lack of 116
lines 96
mask 171
saturation test 114
supply 108
therapy 145, 171
hazards of 172
indications of 172
Ozone therapy 418
P
Paget's disease 49
Pain 21, 123, 183, 307, 312, 330
acute 204, 236, 263, 313
characteristics of 308
controlling 217
fear of 94
level 329
management 96, 178
abdominal 268
moderate to severe 261
nature of 356
prevention of 97
relief of 322, 429
relieving 205, 263, 418
ureteral 307
Palate 106
hard 106
Palatine tonsils 107
Palpation, deep 186
Pancreas 34, 240, 270f, 273
inflammatory lesion of 266f
Pancreatitis 50, 262, 265, 266f, 269t
acute 48, 266
chronic 268
Para-aminosalicylic acid 154
Paracentesis 255, 255f
abdominal 255, 256t
Paradoxical breathing 161
Paralytic ileus 222, 308
Paranasal sinuses 106
Parasympathetic nervous system 371
Parathyroid
glands 272
disorders of 286
hormone 272, 286, 332
Paresthesia 50
Parietal lobe 370
Parkinsonism 412, 412f
Parotitis 190, 191f
appearance of 366
Pectus excavatum 113
Pelvic
cancer, advanced 325
floor muscle exercises 441
Pelvis 304
Penile cancer 357
signs of 357
Penthrane 98
Peptic ulcer 202, 203fc
causes of 203
classification 202
disease 202204
skin diseases 22
Percutaneous
endoscopic gastrostomy tube 238f
liver biopsy 243t
nephrolithotomy 321f
transhepatic
biliary drainage 265
cholangiography 242, 262
Perennial allergic rhinitis 30
Perineal prostatectomy 361
Perineal resection, abdominal 232
Periodontal disease 193
Peripheral ascites 253
Peripheral edema 253, 259
Peripheral nerve
blocks 98
trauma 414
Peripheral nervous system 369, 371
Peripheral neuropathy 251
Peripheral vasodilators 392
Peritoneal dialysate fluid 337
Peritoneal dialysis 340, 344, 345f, 346t
complications of 345
long-term 337
methods 350
Peritonitis 263, 345
Persistent urinary incontinence 440
Petitmal seizures 382
Pharyngeal reflex 101
Pharyngeal tonsil 107
Pharyngitis 123
Pharyngotympanic tube 107
Pharynx 106
regions of 107, 107f
Phenothiazine 94
Pheochromocytoma 294, 299, 299f
Phosphate 306, 338
alternations 338
excess 332
excessive intake of 50
metabolism 339
movement of 50
Phosphorus 44, 244
absorption of 50
Photophobia 241
Pituitary
gland 271
anterior 271
posterior 272
hypothyroidism 277
tumor 276, 277f
Plaque 184
Plasma, osmolar concentration of 337
Pleural effusion 138, 138f, 166, 268
Pleural fluid 108
tapping of 173f
Pleural membrane 108
Pleurisy 138
Pleuritis 138
Pneumonectomy 128, 167
Pneumonia 104, 127, 130, 131, 131f, 132f, 134t
complications of 133
pathophysiology of 132f
ventilator associated 122, 131
Pneumothorax 116, 160f
closed 160
traumatic 160
types of 160
Podagra 425
Polymorphonuclear 267
Polymyositis 424
signs 424
symptoms 424
Polyp 230f
benign 229f
location of 229f
types of 229, 229f
Polyphagia 289
Polytetrafluoroethylene 349
Polyuria 42, 46, 289, 308, 356
Portal hypertension 252f
pathogenesis of 252fc
Positive airway pressure 120
Positive end-expiratory pressure 170
Positive pressure ventilators 120
Positron emission tomography 118, 166, 274, 375
Post void residual urine 360
Postanesthesia care unit 60, 100
Poststreptococcal glomerulonephritis, acute 316
Potassium 44, 46, 306
balance, regulation of 45
excess 332
excessive loss of 46
permanganate method 88
restriction 340
Prealbumin 215
Prediabetes 289
Prednisone 421
Preexisting vertebral disease 345
Prenisolone 421
Proctoscopy 189
Proctosigmoidoscopy 214
Prostaglandins, synthesis of 307
Prostate 361
cancer of 362
specific antigen 357
transurethral
incision of 360
resection of 361f
Prostatectomy, suprapubic 361
Prostatic
hyperplasia, benign 314, 359, 359f
secretions 366
stent 362f
Prostatitis 367
nonbacterial 367
Protein
energy malnutrition 50
intake, low 43
loss 349
Proteinuria 308
Proteolytic enzymes 212
Prothrombin time 241, 392
Proton pump inhibitors 204, 206
Pseudocyst 268
pancreatic 268
Pseudomonas aeruginosa 131
Psychogenic non-epileptic seizures 383
Psychosocial domain 10
Public water supplies, fluoridation of 193
Pulmonary
angiography 114, 162
complications 104, 345
congestions 43
edema 139, 139f, 163, 164, 170, 332
acute 52
causes of 163
embolism 161, 162
fibrosis 140
function
studies 133
tests 117
infection 126
rehabilitation 145
status 333
ventilation 109
Pulse
oximetry 114, 133
rate 101
Pupils 378
Pure chronic bronchitis 147f
Pure emphysema 147f
Purulent nasal discharge 123
Pyelonephritis 313f
acute 313
chronic 314
complications of 314
Pyloric canal 199
Pyloric obstruction 204
Pyloroplasty 204
Pylorus 199
Pyorrhea 184, 193
signs 193
symptoms 193
Pyrazinamide 154
Pyrosis 184, 195
R
Radiation, complications of 363
Radical nephrectomy 328f
Radical prostatectomy 362
Radioactive iodine 274, 281
Radioallergosorbent test 30
Raloxifene hydrochloride 439
Random plasma glucose 290
Range of motion 285, 380
Ranitidine 195, 201, 267
bismuth citrate 201
Rectal biopsy 214
Rectum 184, 186
Recurrent kidney disease, symptoms of 336
Recurrent urinary tract infection 308
Red blood cell 28, 315
count 114
Reflexes 374, 404
Regional enteritis, acute 215
Relaxation techniques 24, 25
Removing polyps, procedure of 231f
Renal
abscess 331
calculi 319, 322t
circulation 307
cyst 330, 330f
disease 48
end-stage 294, 336, 337
pain of 307
disorder 427
management of 304
excretion 50
failure 43, 46, 331
acute 50, 331, 331t
chronic 331t, 334t
function 93, 95, 355
tests 94
osteodystrophy 340
types of 339
pelvis 329
regulation 51
stones
location of 319f
manifestations of 320f
tubular dysfunction 355
Renin-angiotensin aldosterone system 306
Reproductive system 305, 434
Respiration 50
external 109, 110
rate 101
Respiratory
acidosis 51, 52f, 52t, 58
alkalosis 51, 52, 53f, 54t, 58
capacities 110
care modalities 171
control 51
disorders 179
classification of 122, 122f
distress syndrome, acute 169
failure 169, 170
pathophysiology, acute 169
acute 50
function 10, 106
assessment of 111
gas transport 109
infection 117
upper 125
intensive care unit 119
measures 133
mucosa 106
pattern 43, 112f
sounds 113
status 93, 263
syndrome, severe acute 170
system 106, 114t, 338, 403, 434
anatomy of 107f
tract 108
upper 106
volumes 110
zone 108
Retrograde pyelography 320
Retropubic prostatectomy 361
Reverse Trendelenburg position 66, 66f
Rheumatic diseases 421t
Rheumatoid arthritis 136, 418, 422
etiology 418
pathophysiology of 418, 418fc
stages 418
Rheumatoid factor 28
Rhinitis 122
Ribavirin 171
Ribonucleic acid 245
Rifabutin 154
Rifapentine 154
Romberg test 374
Rovsing's sign 226
Rubber band ligation 235
S
Salicylate 203, 421
Saliva 63
Salmonella 209
SARS coronavirus 171f
Scalp lacerations 399
Scar tissue 250
Sclera 241
Scleroderma 424
types 424
Sclerotherapy 235, 236f
Scrotum
redness of 356
tenderness of 366
Scrub 62
nurse 90, 97
room 61
Sedimentation rate 94
Segmental resection 128
Seizure 45, 382
attack 382
classification of 382t
disorders 384
generalized 382
type of 383
Selective estrogen receptor modulators 439
Selective vagotomy 204
Semi-Fowler's position 65
Sengstaken-Blakemore tube 256, 256f
Senile dementia 435
Sensation, loss of 97
Senses 433
Sensitivity 313
Sensory deprivation 404, 443, 443t
Sepsis 350
Serositis 427
Serum
ammonia 241
calcium 94
creatinine
measurements 359
test 310
electrolyte 310
levels 42
glutamate pyruvate transaminase 251
glutamic-oxaloacetic transaminase 251
hormone levels 273
iron levels 215
prostate specific antigen 359
sickness 34
diagnostic tests 34
etiology 34
pathophysiology 34
signs 34
symptoms 34
sodium 46
thyroid-stimulating hormone test 278
Sexual harassment 21
Shigella 209
Shock
neurogenic 403
symptoms of 101
Sigmoid colon, resection of 232f
Sigmoid colostomy 233
Sigmoidoscopy 189, 214
Simple empyema 137
Sims’ position 66
Sinusitis 123
frontal 123
Skin 34, 241, 433
care 262
dry 279
integrity 32, 102
lesions 250
removal of 97
problems 441
testing 29
turgor 42
Skull fracture 378, 399
basal 399
signs of 400
symptoms of 400f
Sleep 10
Small bowel obstruction 222, 225
pathophysiology 222
Small intestine 45, 211, 211f
functions of 212
three parts of 211f
Smooth muscle layers 305
Smooth tongue 184
Sodium 44, 338, 340
balance, regulation of 44
bicarbonate 333
diet 46
low 46
high intake of 46
polystyrene sulfonate 333, 339
water balance 44
Soft palate 106
Sore throat 123
Spermatic cord 356
Spinal
anesthesia 98, 98f, 99t
cord 370, 370f
injury 401, 402f
trauma 401, 406, 406f
disorders 406
nerves 370f, 371
shock 403
Spine 416, 417
Spleen 26
Sputum 63
culture 114
cup 63
production 111, 147
Staphylococcus aureus 131, 133, 136, 190, 209
Status
asthmaticus 140
epilepticus 383
Steatorrhea 184
Sterilization 90
Steriotaxis 379
Steroid 392, 420
administration 46
bolus of 93
medications, use of 95
therapy 43
Stoma, double-barreled 234
Stomach 190, 199, 202f
anatomy of 199
body of 199
cancer 207
etiology 207
pathophysiology 207
capacity of 199
cramping 45
functions of 200
parts of 199, 199f
physiology of 199
shape of 199
Stomatitis 191
treatment for 192
Stones 319
classification of 320t
Stool tests 186
Straight mosquito forceps 69f
Streptococcus 312
pneumoniae 131, 132f, 396
Streptomycin 154
Stress 20, 22
adaptation of 21
elements of 20
incontinence 308, 441
management techniques 23
reduction and rest 204
responses 21
severe 43
sources of 21
three stages of 22f
ulcers 404
Stroke 388, 391t
classification of 386fc
early signs of 387f
prevention 389
scale 389t
sites 386f
types of 385
warning signs of 386
Sucralfate 207
Sulfamethoxazole 313
Sulfasalazine 420
Superior vena cava syndrome 166
Surgery, scrubbing for 97
Surgical biliary bypass 265
Surgical dressings, sterilization of 89
Surgical management 259, 360, 405
Surgical needle 6769
parts of 68, 69f
Surgical procedures, categories of 93t
Surgical scrub techniques 64
Surgical suture 67
Surgical therapy 204, 267, 321, 389
Suture materials, classification of 67
Swan-neck deformity 419, 419f
Sweating 42
Swelling 123, 356
Swine flu 124
Synovial fluid analysis 420
Systemic antacids 207
Systemic inflammatory response syndrome 397
Systemic lupus
erythematosus 427
etiology 427
signs 427
symptoms 427
treatment 427
T
T cells 26
Tachycardia 43, 52, 53, 262, 317
Tachypnea 52, 53
Tandearil 421
Tandem walking test 374
Taxonomy, hierarchy of 10
Teeth 185
Temporal lobe 369
Temporary stents 361
Temporary urinary incontinence 440
Tendon reflexes 45
Tenesmus 184, 216
Tensile strength 67
Tension
feeling of 22
headache 381
pneumothorax 160
Testicular cancer 358
etiology of 358
Testicular tumors 358
Testing cranial nerve function 371t
Testis, removal of 363
Theater sterile supply unit 61
Thermoregulation 101
Thick barium solution 187
Thoracentesis 173
Thoracic
surgery 167
vertebra, fifth 107
Thoracoabdominal incision 328f
Thoracotomy 137
Thorax 113
Throat 106
culture 114
Thrombocytosis 215
Thromboembolism 104
Thromboplastin time, activated partial 392
Thymus 26
Thyroid 34
antibodies 278
cartilage 107
gland 272, 272f
atrophy of 278
cancer of 282
disorders of 277
hormone 272, 276
scan 274
stimulating hormone 271, 272
Thyroiditis 283t
postpartum 278
Thyrotoxic crisis 280, 283
Thyrotoxicosis 50, 95
Thyrotropin releasing hormone 271
Thyroxine 272
levels 339
Tidal volume 110, 111
Timed scrub method 64
Tissue
biopsies 94
integrity 10
plasminogen activator 390
unifying instruments 69
Tofranil 207
Tongue 36, 182, 185
dry 46
Tonic-clonic seizures 382
Tonsillitis 123, 124f
Tooth enamel 193
Topical chemotherapy 323
Total parenteral nutrition 170, 268
Towel clamps 69
Trachea 107
anatomy of 107f
Tracheobronchial tree 108, 108f
Traditional alternative medicine 239
Tranquilizers 94, 191
Transcranial Doppler ultrasonography 388
Transient ischemic attack 385
Transmission, mode of 131
Transplantation rejection, complications of 355
Transurethral
needle ablation 361
prostatectomy 360
Transverse colostomy 233
Trauma 266, 356
acute 42
severe 261
Trendelenburg position 66, 66f
Tricyclic antidepressants 207
Trigger anaphylactic reactions 31t
Triglycerides 337
Triiodothyronine 272, 339
Trimethoprim 313
Trousseau's sign 48, 48f
True vocal cords 107
Tuberculosis 152, 152f, 154, 155t
pathogenesis of 153f
Tubular
cells 306
secretion 306
Tumor 92, 222, 270f
pancreatic 270
Turbulent blood flow 309
U
Ulcer 184
acute 202
Ulcerative colitis 215f, 216
symptom 216
Ultrasound 215, 274
scan 320
Upper gastrointestinal disorders, management of 189
Urea
breath tests 187
clearance test 309
Urecholine 196
Uremia 336
Ureterosigmoidostomy 324, 325, 325f
Ureters 304
Urethra 304, 305, 307
cystoscopy 360
Urethral
discharge 366
injuries, complications of 323
insert 441
meatus 307
specimen 367
strictures 319
Urethritis 314
causes of 314
Urge incontinence 441
Uricosuric
agents 421
drugs 426
Urinalysis 309, 359
Urinary
analgesic 313
bladder 356
bottle 63
catheterization 312
complications 104
disorders, management of 304
diversion 324, 324f
types of 324f
dysfunction 307
elimination 330
frequency 307
function
assessment of 307, 308
management of 326
incontinence 308, 360, 440, 442
causes 440
obstructions 319
outflow 331
problems 308
retention 104
acute 360
stricture, diminished 319
system 403
anatomy of 304
organs of 304f
physiology of 305
tract
disease 307
infection 311313, 360, 440, 441
obstruction 322
Urination 312
Urine 46, 63, 201
color of 356
culture 309, 366
flow of 319
odor of 327
output, low 46
protein test 309
reflex of 312
sensitivity 309
stasis of 312
stream of 356
studies 94
tests 273, 309
Urolithiasis 319
V
Vaginal lactobacilli 312
Vagotomy 204
syndrome 199
Valsalva maneuvers 225
Vanillylmandelic acid 299
Varicocele 366
Vascular volume, removal of 350
Vasopressin 272
Vein filter 163
Venepuncture 63
Venoms 31
Ventilation 110
Ventilators, classification of 120
Ventriculoperitoneal shunt 379f
Venturi mask 171, 171f, 172
Vertebral column 372
Vesicostomy 324
Vesicular breathing sounds 113
Vetriculoperitoneal shunt 379
Video-assisted thoracic surgery 137
Video-assisted thoracoscopic surgery 167
Viral
hepatitis 245, 245t
types of 248t
infections 124, 266
pneumonia 131
causes of 131
Virginia Henderson's theory 8
Virus 396
isolation 171
Visceral pleura 108
Viscosupplementation 418
Vital capacity 110
forced 111
Vital signs 378
Vitamin 429
D 430, 439
deficiency 36, 48
supplements 422
Vocal cord injury 116
Voice box 107
Volatile liquid anesthetics 98
Volvulus 222, 225
Vomiting 36, 45, 46, 50, 183, 184, 197, 203, 241, 259, 261, 397
severe 42
W
Waist circumference 15
Waist-hip ratio 16
Waste products, accumulation of 332
Water
balance 41
disorders of 42
excessive loss of 46
intake, regulation of 41
output, regulation of 41
restriction 340
seal drainage 176
Weight
gain 43
loss 42, 197, 241, 340
Wernicke-Korsakoff syndrome 435
Wheeze 113
White blood cell 26, 28, 113, 114, 312
World Asthma Day 140
World Liver Day 271
Wound
dehiscence 104
drainage 42
healing 104
infection 104, 327
Wrap instruments 90
Wrist 419
X
Xanthine oxidase inhibitors 426
Z
Zyloprim 421, 426
A
ABC test 699
Abciximab 463
Abdomen 562
Abrasion 640
Abscess, drainage of 735
Absolute neutrophil count 558
Acetabulum, replacement of both 611
Acid 797
Acne 642
vulgaris 642
Acquired immunodeficiency syndrome 736, 744t, 758, 759
Activated partial thromboplastin time 532
Acupuncture 575
Acyclovir 648
Adenoidectomy 728
anesthesia 728
contraindications 728
indications 728
Adrenal hyperplasia, congenital 642
Adrenocortical steroid inhibitor 552
Advanced cardiac life support 489
Aedes aegypti 786
Aedes mosquito 753, 760f
Age-related macular degeneration 692
Air
conditioner 712
conduction hearing aid 701
Airborne 647
Airway obstruction 788
complete 788
pathophysiology 788
Aldosterone antagonists 482
Alkaline 797
Alkylating agents 553
Allergic
fungal sinusitis 721
rhinitis 791
Allergy 642, 709, 791
complications 791
etiology 791
management 791
signs of 593
symptoms 791
Allogeneic transplant 562
Allograft 660
Alopecia 559, 645
areata 645, 645f
Aluminium finger 635
splint 635
Ambulatory chemotherapy services 554
American Joint Committee on Cancer System 629
American Society for Testing and Materials 557
Amikacin 701
Amoebiasis 772
control 772
epidemiology 772
pathogenesis of 772, 773f
treatment 772
Amoxicillin 707
Ampicillin 706
Amputate limb 597
Amputation 625, 627t, 630
Analgesics 463, 656, 715, 727
injection 597
Anaphylactic reaction 790
causes 790
prevention 791
signs 791
symptoms 791
Ancylostoma duodenale 784
Anemia 480, 522, 523, 526, 558, 657
causes of 522
classification of 523fc
hemolytic 522
iron deficiency 522
symptoms of 523, 523f
Anesthesia 681, 717, 720, 724, 725, 727
Aneurysms 514
types of 515, 515f
Angina 458
pain of 461t
pectoris 456, 458t
stable 456
types of 456
unstable 456
Angiography 453, 630
Angioplasty 517
Angiotensin converting enzyme 457, 468, 471, 480, 481, 498
inhibitors 457, 481
Angiotensin receptor
antagonists 471
blocker 468, 481
Ankles 650
Anosmia 719
Anthracyclines 553, 556
Anti DNA antibody complement 594
Antibiotics 526, 595, 642, 656, 701, 727, 797
antistaphylococcal 647
antitumor 553
Anticholinergics 797
Antiemetic therapies 559
Antihistamines 646
Anti-inflammatory drugs 597
Anti-larval measures 761
Antimalarial medications 643
Antimicrobial drugs 715
Antinuclear antibody 594
Antiplatelets 458
Antiretroviral
agents 742
therapy 736, 743
drug 736
Antiviral agents 640
Antral irrigation 716
Aortic aneurysm 515
abdominal 515, 515f
formation of 734
types of 515f
Aortic regurgitation 499, 499f
Aortic stenosis 498, 498f
Aplastic anemia 523, 726
Aqueous deficiency 673
Arboviral disease 761
Areola 579
Aromatherapy 575
Arterial
blood gases 463, 479, 502
disease, lower extremity 511
thrombosis 510
Arteriosclerosis 454
Artery 449
stent, coronary 466
Arthritis, gonococcal 596
Arthrocentesis 594
Arthroscopy 594
Articulations 590
Ascariasis 783
Aseptic meningitis 757
Asphyxia 800
complications 801
management 801
pathophysiology 801
Aspiration 541
Asthma 721
Astigmatism 688
types of 688f
Asystole rules 490
Atherosclerosis 454, 455f, 455t, 458
Athlete's foot 649
Atrial contraction
premature 486, 486f
rules, premature 486
Atrial fibrillation 487, 488f
rules 487
Atrial flutter 487, 487f
rules 487
Atrophic rhinitis 669
Attack, acute 599
Audiometry 701
Auditory meatus, tumor of external 711
Autografts 656, 660
Autoimmune disorders 524
Autologous transplant 562
Automated lamellar keratectomy 688
Avascular necrosis 625
Azelaic acid 642
B
Back pain, low 597
Bacteria 639
Neisseria gonorrhoeae 596
pathogenic 797
Bacterial
conjunctivitis 670
infection 640, 676, 770
skin infections 646
Bacterium, types of 764
Bacteroides fragilis 706
Balanced suspension traction 614
Balloon
angioplasty 466, 466f
valvuloplasty 497f
Basal cell carcinoma 547
Beating heart surgery 466
Bee and wasp stings 794
management 794
Benzene hexachloride 651
Benzoyl peroxide 642, 642f
Beta-adrenergic blockers 481
Betadine 656
Binocular indirect ophthalmoscopy 683
Biologic
grafts 656
therapy 645
Biological disasters 805
precautions 805
Biopsy 584, 630
surgical 584
Bisphosphonates 568
Bladder management 633
Bleeding 657
gums 525
internal 789
primary 789
reactionary 789
secondary 789
signs of internal 789
source of 789
symptoms of internal 789
Blepharitis 665, 665f
Blindness 527, 691, 691f
causes of 692, 692f
week campaign, prevention of 692
Blood 519, 534f
cell
count, complete 502, 517, 523, 742
reduced number of 563
circulation of 449
contaminated 759
disorders of 722
flow, coronary 448
investigations 594
lipids 452
normal 534f
pressure 450, 467t, 469
products 759
spinal cord barrier 598
studies 452, 655
tests 521, 525, 595
normal values 452t
transfusions 525
urea nitrogen 481, 532, 566
vessels 449, 579, 722
size of 664
Blurry vision 678
Bockhart's impetigo 646
Body ringworm 649
Bone
classification of 590, 590f
conditions of 606
hearing aid 701
death 596
flat 590
forming cells 590
fracture, classification of 606f
functions of 589
infection 624
long 590
marrow 558
biopsy 521, 525, 541
disorders 522
stimulants 526
transplant 536, 562
mineral density measurements 593
nonunion of 623
scan 593, 630
secondary malignancies of 629
short 590
Bowel management 633
Brain metastasis 569
Brainstem evoked audiometry 700
Braun's splint 635
Breast
anatomy of 579
biopsy 584
cancer 562, 580
diagnosis of 582
inflammatory 580
stages of 581t
symptoms of 581
types of 580
conditions
benign 579
classification of 579
conserving procedures 584
density 581
disorders 579
examination 547, 582
imaging-reporting and data system 582
lipomas 583
parts of 579f
physiology of 579
reduction plasty 660
self-assessment 582
self-examination 583f
support 579
surgery 585
Breath, shortness of 525, 559, 561
Bronchodilators 656
Brown-Séquard syndrome 631
Brugia
malayi 779
timori 779
Bubonic plague 776, 776f
bacillus of 776f
Buccal mucosa 639
Buck's extension traction 622, 622f
Buck's traction 623
Budwig diet protocol 576
Buerger's disease 514, 514f
Bullae 640
Burn 652654, 655f
causes of 652
classification of 653f
clinical 795
complications of 657
extent of 654
first degree 653
fourth degree 653
injury 655f
scar 657
second degree 653
seizures, post 657
shock 653
superficial 654
surgery 660
third degree 653, 654
C
Caisson's disease 722
Calcipotriol 644
Calcium channel blocker 457, 468, 643, 797
Caldwell-Luc operation 716
Callus formation 607
Caloric test 710
Campylobacter jujeni 770
Canal of Schlemn 679
Cancer 548f, 560, 575, 575f, 741
causing agents, classification of 548
cells 545, 546f, 546t
epidemiology 548
etiology risk factors 549
first line treatment of 551
histological types of 550
larynx 728
diagnostic tests 729
etiology 729
pathophysiology 728
prevention 729
signs 729
symptoms 729
pathogenesis of 551f
prevention 547
rehabilitation
services 573
team 574
signs of 549, 549t
staging of 581
symptoms of 549, 549t
types of 550, 573
warning signs of 547, 549, 549f
Candida albicans 741
Candidiasis
signs of 741
symptoms of 741
Cannula site, selection of 557
Captopril 643
Carbon monoxide 797
poisoning 799
signs 799
symptoms 799
Carbonic anhydrase inhibitors 678
Carbuncle 646, 647
Carcinogenic breast conditions 580
Carcinogens, physical 548
Carcinoma 550, 580, 657, 713
intraductal 580
Card cardiopulmonary bypass 500
Cardiac
arrest 469, 800
biomarkers 452
catheterization 453, 453f
computed tomography 457
conduction
pathway 449, 449f
system 482
cycle 449, 482, 483f
components of 483
disorders, infectious 503
exercise 467
failure, congestive 469
muscle 592
output 449, 468
pacemaker 491, 492f
rehabilitation 467
rhythms, interpretation of 484
stress test 451
surgery 501, 504t
potential complications of 506t
toxicity 559
troponin 453
valve repairs 500
valvular disorder 494, 501
Cardiovascular
disease 447, 645
system 447, 451, 657, 722
assessment of 449
disorders of 454
Cardioversion 494t
Cartilage 591
tears 593
Casts, types of 635
Cataract 680, 684
causes of 680
complicated 680, 688
congenital 680
extraction, extracapsular 681
symptoms of 681
traumatic 680
types of 680
Catheter ablation 488
Cauda equina syndrome 631
Causative organism 764
Cell
cycle 552, 552f
normal 545
Cellulitis 717
Centers for Disease Control and Prevention 596
Central cord syndrome 631
Central nervous system 550, 689
Cephalosporins 646
Cerebral
centers affecting vomiting 558f
edema 800
Cerebrospinal fluid 553
Cerebrovascular accident 469
Cerumen impaction 703
causes 703
diagnosis 704
treatment 704
Cervical
cancer, development of 736
instability 631
spine fracture 631
Cetirizine 643
Chalazion 666, 666f
Chancre 735t
Chancroid 734, 735t
Cheek, redness of 715
Chemical carcinogens 548
Chemical disaster 805
precautions 805
Chemical injuries 652
Chemonucleolysis 599
Chemoprophylaxis 777
Chemotherapeutic drugs
classification of 552
dose calculation of 553
Chemotherapy 535, 551, 553, 554, 555t, 560t, 584586, 630, 645, 652
adjuvant 552
consolidation 551
drugs 557, 558
induction 551
principles of 552
side effects of 554, 563
treatments 524
trigger zone 558
types of 551
Chest
muscle 579
pain 450, 480
syndrome, acute 527
Cheyne-Stokes respiration 480
Chickenpox 647, 748, 749, 749t, 750
complications 749
epidemiology 749
virus 749f
Chikungunya
fever 760f, 762
epidemiology 762
prognosis 763
treatment 763
pathogenesis of 762, 762f
Chiropractic therapy 575
Chlamydia
injections 670
trachomatis 671, 671f
Chlorpheniramine 643
Cholera 771
epidemiology 771
pathogenesis of 772f
signs of 772f
symptoms of 772f
treatment 772
Chorioretinitis 674
Choroid 662
Choroiditis 674
Christmas disease 722
Chronic obstructive pulmonary disease 457, 530
Ciliary body 662
Cleft lip surgery 660
Clobetasol 645
Clostridium 798
botulinum 798
tetani 766, 767f
Coagulation tests 521
Cochlear otosclerosis 708
Cock-up splint 635
Cold 639
compress, procedure of 695
Colles fracture 609, 609f, 610f
Colloid carcinoma 580
Color blindness 690
Communicable diseases 748
classification 748
Compartment syndrome 625, 657
Compression
control symptoms of 570
fracture 612f
intrinsic 568
Computed tomography, abdominal 541
Conductive hearing loss
acquired causes for 700
causes of 700
Conjunctiva 639
conditions of 669
Conjunctivitis
acute epidemic hemorrhagic 670
spread of 671
Connective muscle 579
Connective tissue disorders 508
Consciousness, level of 450
Constipation 559, 565
Contact lens 686, 687
use of 675
Conus medullaris syndrome 631
Cord syndrome
anterior 631
posterior 631
Core biopsy 584
Cornea 662
conditions of 675
inflammation of 676
junction of 662
Corneal
abrasions 675
foreign body, removal of 696
scraping 676
ulceration 676
Coronary artery 460f
bypass graft 466, 466f
disease 456, 458, 469
right 460
Corticosteroids 559, 640, 645
injections 645
Corynebacterium diphtheriae 764f
Cosmetic surgery 660
Cotton-wool test 714
Cough 480
Craniofacial
structures 659
surgery 659
Craniomaxillofacial surgery 660
C-reactive protein 452, 455, 538
Creatine kinase 452
Crohn's disease 645
Crush injuries 793
management 793
pathophysiology 793
signs 793
symptoms 793
Crusts, removal of 665
Crutch gait 633
Cryosurgical technique 727
Cryotherapy 637, 652
Crypts 725
Crystal lens, absence of 687
Culex 762
Curling's ulcer 657
Cyanide 797
Cyanosis 480, 501, 639
Cyclitis 674
Cyclophosphamide 553
Cyclosporine 644
Cyst 713
simple 579
Cystic fibrosis 721
Cystitis, hemorrhagic 559
Cytomegalovirus infection 741
Cytotoxic cells 742
D
Dacryocystitis 668, 668f
Daily living, activities of 479, 501, 508, 523, 592, 623
Daunorubicin 553
Deafness, family health history of 699
Deep frostbite 800
management 800
prevention 800
signs 800
symptoms 800
Defibrillation 493, 494t
Dengue 760f
fever 760
classical 760
epidemiology 760
hemorrhagic fever 760
shock syndrome 760
Denham pin 623
Dense connective tissue, types of 591
Dental infections 715
Deoxyribonucleic acid 545
Depression 645, 657
Dermatitis, atopic 642
Dermatosis 640
Dermis 639
Dermoid, congenital 713
Desmopressin acetate, administration of 507
Diabetes mellitus 467, 663
Diabetic eye disease complications 684
Diarrhea 559, 566, 595
Diarrheal diseases 770
acute 770
Diazepam 710
Dicloxacillin 646
Diet 463, 512, 642, 644, 758
Diethylcarbamazine 780
Digital hearing aids 701
Digital mammography 582
Digital rectal examination 547
Dimethyl
fumarate 644
sulfoxide 556
Diphenhydramine 643
Diphtheria 764
complications 765
control 765
diagnosis 765
epidemiology 764
prevention 765
treatment 765
types of 765
Direct skin-to-skin contact 647
Disaster 787
impact 804
management 803, 806
cycle 803, 803f
phases of 803
manmade 803, 805
mitigation 803
natural 803
non 787
nursing 803
prevention 803
types of 803
warning, channels used for 804
Disk herniation
lateral 598
posterolateral 598
Disk replacement, total 599
Diskectomy 599, 600
Disodium phosphate 796
Dissecting aneurysm 515f
Disseminated intravascular coagulation 531, 532t
District Blindness Control Society 693
Diuretics 481, 701, 710
Dizziness 525
Docosahexaenoic acid 691
Dopamine receptor antagonist 559
Dose intensive therapy 552
DPT vaccine 768
Droplet infection 781
Drugs 722
therapy 481, 609
Dry appearance 654
Dry eye 673, 674
Dual energy X-ray absorptiometry 593
Ductal carcinoma
in situ 580, 581
invasive 580
Dust mites 643
Dysarthria 798
Dysphagia 724, 798
Dyspnea 450, 479, 501, 654, 724
Dysrhythmias 485, 485, 495t
interpretation 484
E
Ear 653
anatomy of 698, 698f
canals 631
causes, external 703
diagnosis, external 703
examination of 699
treatment, external 703
disorders of 698
examination 699f
infection, middle 719
irrigation 704
equipment 704
prevention 704
procedure of 704
middle 698, 700
normal 706f
physiology of 698
problem, prevention of 708
speculum 699
tumor of 711
external 711
middle 711
Earache 724
Earthquake 804
effects 805
types 805
Ebola
prevention 753
symptoms 753
treatment 753
virus
disease 753, 753f
signs of 753f
symptoms of 753f
Ecchymosis 525, 639, 640
Echocardiogram 451
Ecthyma 646
Ectropion 667
Eczema 642, 791
allergy connection 643
causes of 643
Edema 480
cheek 715
face 541
lids 716
neck 541
upper eyelid 716
Eitching 643
Elastic cartilage 592
Elbow 650
crutch 633
Electrical injuries 652
Electrocardiogram 451, 483, 451, 469
Electrolytes 453
Electromyogram 594
Embolectomy 516
Emphysema, surgical 727
Encephalopathy, hypoxic 800
Endarterectomy 516
Endocarditis 508f, 510t
infectious 505
infective 503, 508
prevention of 500
Endogenous infection 674
Endoscopic coronary artery bypass surgery, totally 467
Endoscopic sinus surgery 718, 722
Endothelial cell dysfunction 598
Endotracheal intubation 656
Entamoeba histolytica 772f
Enterotoxins 798
Entropion 667
Enzyme-linked immunosorbent assay test 759
Enzymes 712
Epidermis 639
Epistaxis 719, 722, 723
anterior 723, 723t
causes of 722
classification of 723
management of 723
posterior 723, 723t
treatment of 723
Epstein-Barr virus 647
Eptifibatide 463
Erythema 640
infectiosum 647
multiforme 640, 651
Erythematous, widespread 647
Erythrocyte sedimentation rate 453, 594
Escherichia coli 706, 770
Esophageal varices 522
Estrogen receptor 584
Ethambutol 775
Ethmoid sinuses 714
Ethmoid sinusitis
acute 716
chronic 717
etiology 716
treatment, acute 716
Ethmoidectomy
external 717
extranasal 722
intranasal 717, 721, 722
Eustachian tube 706
Excision, surgical 666
Extravasation
management of 556
prevention of 554
Eye 653
accessory structures of 663
anatomy of 662, 662f
Bank Association of India 694
Banking and Eye Donation 693
care 695
disorders 662, 663, 694
donation procedure 694
drops 669
irrigation, procedure of 695
normal 677f, 688
ointment 695
physiology of 662
problems 678
safety 689
structure of 662
surgery 681, 684
Eyeball, interior of 662
Eyelid
cool compress 695
glands of 667f
lower 695
reveal, palpation of 666
upper 695
F
Face washing 672
Facial
edema 727
trauma 718
Famciclovir 648
Fat 579
embolism 625
Fatigue 450, 479, 525, 541, 560, 561, 605
Feco-oral contamination 784
Fever 647
persistent low-grade 541
Fexofenadine 643
Fiber foods, low 566
Fibrin degradation products 532
Fibroadenolipoma 583
Fibroadenomas 580
Fibrous
cartilage 592
layer, outer 662
Filarial parasite, lifecycle of 780f
Filariasis 779
epidemiology 779
vectors of 780
Fine needle aspiration cytology 630
Fire accidents 805
precautions 805
First aid 697, 723
management 608
measures 655, 789, 795
Fixation, external 608
Fixed red papules 640
Flood 804
causes 804
management 804
Flu 755
Fluconazole 649, 650
Fluid intakes 594
Fluid replacement 656
Flu-like illness 755
Fluocinonide 645
Fluorescein angiography 664
Folic acid antagonist 552
Follicular conjunctivitis
acute 670
chronic 670
Folliculitis 646
Food poisoning 797
bacteria 798
causes 797
Foreign body, removal of 676
Four point gait 634
Fracture 592, 605, 608, 609, 615t, 654
classification of 606
complex 610
complicated 606
complications of 624
dislocation 613, 613f
external 610
extracapsular 611
femoral shaft 612
fibula 612f
healing 607
hematoma 607
hip 611
humerus 610, 610f
line, direction of 606, 606f
management of 632
principles of 608
nasal septum 718
of long bone, open 625
pathological 605
pelvis 610, 610f
stable nondisplaced 610
tibia 612, 612f
types of 606, 607f, 608f
uncomplicated 606
Frontosphenoethmoidectomy 717
Frostbites 800
management 800
pathophysiology 800
risk factors 800
signs 800
symptoms 800
Fungal infection 676
Fungi 510
Furazolium 656
Furuncle 646, 646f
G
Galactoceles 583
Gallstones 527
Gammaglobulin, intravenous 651
Gastrointestinal infections 741
Gene 642, 643
replacing mutated 563
therapy 563
tumor suppressor 550
Genital herpes 737t
Genitalia 650
Gentleman's magazine 659
German measles 647
Gerson diet 576
Gerson therapy 576
Glaucoma 677, 677f, 684
types of 679t
Glucose control 463
Glycerol test 710
Glycoprotein 463
Gonioscopy 665, 678
Gonorrhea 733, 782, 783
Graft
advantages of 656
types of 656
versus host disease 563
Granulation tissue 607
Granuloma inguinale 735
Gummatous syphilis 734
Guttate 644
H
Haemophilus influenzae 715
Halitosis 724
Hand
and feet, painful swelling of 527
lymphedema of 540f
rule of 654
surgery 659, 660
Head
cover 557
elevation 569
injury 654
ringworm 649
Headache 525, 647, 678, 715, 719
frontal 715
Hearing
aids 704
types of 701
deficit 702
loss 700, 702, 710, 724
causes 700
conductive 699, 700
management of conductive 701
management of sensorineural 701
permanent 702
types of 700
tests 699
Heart
block 490
four types of 491f
types of 491t
disease 722
coronary 447
failure 477, 477f, 478t, 479t
acute 478
chronic 479
complications of 481
congestive 477, 487
pathophysiology of 478fc
gross anatomy of 448f
layers of 505f
normal 477f, 496f, 498f
rate 484
irregular 525
structure of 447
surgery 466
valve
replacement 500
types of 501f
Heat stroke 799
causes 799
management 799
prevention 799
signs 799
symptoms 799
Helicobacter pylori 543, 547
Hematologic disorders 447, 522
Hematoma 660
Hemianopia, contralateral homonymous 689
Hemoglobin 519, 527
concentration 521
Hemophilia 523, 532, 533, 534t, 726
Hemorrhage 788
choroidal 688
classification 789
control 792
management 789
primary 727
reactionary 727
secondary 727
Hemorrhagic disorders 531
Heparin 797
Hepatic toxicity 559
Hepatitis B virus 549
Herniation
central 598
types of 598
Herpes 736
simplex virus 648, 733
virus 652
zoster 647f
virus 647
Herpetiform vesicles 647
Heterografts 656
High blood pressure symptoms 469f
Highly active antiretroviral therapy 736, 742, 759
Hip
fracture 611f
knee ankle foot prosthesis 626
replacement, total 611
spica cast 635
Histamine drip 710
Hodgkin's
disease 540, 540f, 541f, 543t
lymphoma 581
Homicidal poisoning 796
Homocysteine 452
Homografts 656
Hookworm
infection 523, 784
lifecycle of 784f
Hormone 642, 553
receptor test 584
therapy 585
Hospital cornea retrieval program 694
Hot fomentation 715
Human epidermal growth factor receptor-2 test 584
Human immunodeficiency virus 510, 529, 643, 736, 738, 739f, 744t, 758
acquisition 733
antibody tests 742
exposure 740
infection
primary 647
progression of 739
prevention 740
signs of 740, 741f
symptoms of 740f, 741f
transmission 740, 740f
reduce risk of 740
with neurocognitive disorder 741
Human papillomavirus 547, 549
infection 733
Hump nose 717
Hyaline cartilage 592
Hydration, maintain 798
Hydrops, endolymphatic 709
Hydrotherapy 656
Hydroxycarbamide 644
Hypercalcemia 566
causes of 568
Hyperesthesia 654
Hyperkalemia 653
Hypermetabolism 653
Hypermetropia 686
pathological 687
simple 687
Hypertension 467, 470t, 472t, 501, 657
complications of 469
essential 468
impact of 471f
isolated systolic 468
pathophysiology of primary 468fc
primary 468
secondary 468
Hypnosis 575
Hypodermis 639
Hypomagnesemia 453
Hypoparathyroidism 680
Hypoperfusion 653
Hypopharynx 724, 725
Hyposmia 713
Hypothyroidism 523
I
Idiopathic thrombocytopenic purpura 529
Immunity 778
Immunization, passive 768
Immunoglobulin 712
E 643
Immunotherapy 560, 645
types of 560
Impetigo 646
contagiosa 646
prevention of 646
symptoms of 646
Implantable chemotherapy treatments 554
Incision 594
India's National Aids Control Organization 738
Indian Cancer Registry Programme 689
Indian Council of Medical Research 545
Ineffective airway, risk for 730
Infarction, anterior wall 460f
Infection 547, 594, 623, 660, 714, 722, 727
exogenous 674
opportunistic 741, 742, 746t
process cycle 748, 748f
reservoir of 749
signs of 597
source of 749, 750, 755
spread of 671
Inflammation 594, 665, 714
balls of 734
Inflammatory dermatosis, acute 640
Influenza 755
complications 755
incubation period 755
period of communicability 755
prevention of 756
reservoir 755
virus 755
Injury
abdominal 792
depth of 656
mechanism of 592
Inner ear, disorders of 709
Inner nervous tissue layer 662
Insect bites 793
Integumentary system, disorders of 639
Intensive care unit 479, 502
Interferential therapy 637
International Agency for Prevention of Blindness 693
International Agency for Research on Cancer 548
International Normalized Ratio 462, 500, 511
Intestinal disorders 522
Intracapsular cataract extraction 681
Intracapsular fracture 611
Intraconazole 650
Intracranial pressure 689
Intramuscular benzathine penicillin 646
Intraocular
lens 681
pressure 675
Intraoperative ophthalmic nursing care 684
Intraperitoneal route 554
Intrapleural route 554
Intravesicular route 554
Invasive therapies 512
Iridocyclitis 674
Iridotomy, laser 679
Iris 662
Iritis 674
Iron 797
Iron-binding capacity, total 525
Ischemia 460, 490
Isoniazid 597, 775, 797
Itching 647, 649
Itraconazole 649, 650
J
Japanese encephalitis 761
control 762
epidemiology 761
prognosis 761
treatment 761
Jaundice 541, 639
Jock itch 650
Joint
capsule 611
puncture of 594
cartilaginous 591, 592f
fibrous 591, 591f
fluid analysis 595
trauma 595
Jugular venous distention 479
K
Kala-azar 786
epidemiology 786
Kaposi sarcoma 652
epidemic 652
types of 652
Keloid 640
Keratitis 676
exposure 676
Keratoconjunctivitis sicca 673
Keratotomy, astigmatic 688
Kidney disease 523, 722
Klebsiella
granulomatis 735
pneumoniae 715
Knee dislocation 605f
Knuckle bender splint 635
Kyphoplasty 614f
L
Laceration repair 660
Lacrimal apparatus 663, 663f
Lacrimal sac 668
syringing of 676
Lactate dehydrogenase 453
Laminectomy 599, 600f, 601, 602f
Laryngeal
cancer 729
diphtheria 765
Laryngectomy 730, 730f
tube 731
Laryngopharynx 726
examination of 725
Laryngoscopy 726
direct 723, 725
technique, indirect 726
Larynx 724, 725, 726
examination of 725
movements of 725
widening of 725
Leg
cast
long 635
short 635
filariasis of 779f
lymphedema of 540f
ulcers 527
Legamentous damage 623
Leishmania donovani 786
Lens 663
cataract of 696
Lensectomy 681
Leprosy 781
Leptospirosis 777
epidemiology 777
treatment of 777
Leukemia 523, 533, 534f, 536, 537t, 550, 726
acute 533
lymphocytic 533
chronic 534
lymphocytic 534
myelogenous 534
myeloid 566
distribution of 535f
signs of 535f
symptoms of 535f
Lid
abnormality 674
hygiene 666
lesions 689
redness of 668
scrub 695
Ligament 579, 591
tears 593
Limb
ablatic surgery 630
fractures, management of lower 623
lower 626
upper 626
Lingual tonsil, hypertrophy of 728
Lions clubs international 693
Lip 639
palate surgery 660
Lipid deficiency 674
Lipoproteins
high-density 452, 455
low-density 452, 455
Lithium 643
Liver 541
conditions 690
disease 722
Lizard bites 795
investigations 795
management 795
Lobules 579
Loratadine 643
Lower airway, protection of 712
Lumbar puncture 553
Lumbosacral disk prolapse 599
Lumpectomy 584
Lund-Browder chart 655f
Lund-Browder method 654
Lung complications 728
Lymph node 520, 579
biopsy 522
Lymphangiography 522
Lymphangitis 539
infectious 539
Lymphatic
disorders 539
system 520, 521, 521t
anatomy 519
physiology 519
vessels 520
Lymphedema 652
therapist 574
Lymphocyte count 742
Lymphogranuloma venereum 735
Lymphoma 542t, 550, 645
Lysozyme 712
M
Macular degeneration 690
Macules 640
Magnesium 453
citrate 796
Malaria 778
control of 779
epidemiology 778
pathogenesis of 778, 778f
signs of 779f
symptoms of 779f
Malnutrition 481
Mammogram 582
Mammography 582
Mantoux tuberculin skin test 742
Marital status 782
Marjolin's ulcer 657
Mass 725
drug administration 781
Massage, purpose of 576
Massive cell destruction hyponatremia 653
Mastectomy
partial 584
segmental 584
total 584
Mastoidectomy
cortical 708
simple 708
Mastoiditis 707
complications 707
diagnostic tests 707
etiology 707
medical management 707
Maxillary sinusitis
acute 715
chronic lymphocytic 716
etiology, acute 715
Measles 647, 750
agent 750
complications 751
control of 751
host factors 750
incubation period 750
mode of transmission 750
prevention of 751
rashes 751f
source of infection 750
vaccine 751
virus 750f
Mebendazole 785
Mediastinal compression 722
Medullary carcinoma 580
Meibomian cyst 666
Melanocytes 639
Melanoma, malignant 645
Membrane 725
Meniere's disease 709, 709f, 710, 711t
etiology 709
Menstrual bleeding 522
Mental status 481
Mesothelioma 550
Metabolic cataract 680
Metastases 551
Methicillin-resistant Staphylococcus aureus 647
Methotrexate 552, 644
Microsuction 704
Microvascular surgery 660
Microwave diathermy 637
Middle ear, disorders of 705
Middle turbinate, swelling of 716
Milk ducts 579
Minimally invasive coronary artery bypass grafting 466
Mitigation measures 805
Mitral
regurgitation 497
stenosis 496
value stenosis 498f
valve
disease 723
prolapse 494
regurgitation 498f
stenosis 496f
Mixed density hamartomas 583
Modified radical mastectomy 584
Moist skin 654
Moisture 639, 640, 650
Mole 640
Monitoring stoma 564
Monoclonal antibodies 560
Mononucleosis, infectious 647
Mosquito
control 761, 762
repellents 761
Motion sickness 709
etiology 709
management 709
Mucin deficiency 673
Mucociliary mechanism 712
Mucosa, color of 713
Multibacillary 782
Multidrug-resistant tuberculosis 775
Multiple myeloma 536, 537f, 539, 539t
Multisinusitis 714
Mumps 752, 752f
complications 752
control 752
epidemiology 752
incubation period 752
source of infection 752
treatment 752
Muscles
contour of 593
contraction 605
extraocular 663
of external ear 698
size of 593
smooth 592
spasm of 767
types of 592
Muscular system 592
Musculoskeletal
disorders 589
injuries 792
system, assessment of 592
Myalgia 647
Myambutol 775
Mycobacterium
avium complex 741, 742
leprae 781, 781f
tuberculosis 742
Mycoses 648
Myeloablative therapy 552
Myeloblastic leukemia 534
Myelogenous leukemia, acute 534
Myelogram 593
Myelography 599
Myeloid leukemia, acute 566
Myeloma 550
Myelosuppression 558
Myocardial infarction 451, 459, 461t, 462f, 464t, 477, 485
complications of 465t
pathophysiology of 461fc
Myocarditis 509, 510f, 510t
Myocardium 459
Myoglobin 453
Myopia 687
optical treatment of 688
pathological 687
simple 687
Myringoplasty 701
Myringotomy 706, 708
N
Nail fungus-onchomycosis 650
Narcotics 656
Nasal
cavity 715
cycle 712
decongestant drops 715
deformities 717
diphtheria 765
discharge 716
endoscopy, diagnostic 714
fracture 712
infections 714
packing
anterior 723
posterior 723
passage 713
polyps 721, 721f
etiology 721
pathogenesis 721
pathology 721
signs 721
symptoms 721
treatment 721
reflexes 713
septum 718
deviated 718, 718f
vestibule, diseases of 717
Nasopharynx 722
disease of 714
examination of 714
National Blindness Control Program 692, 693
National Disaster Management Act, 2005 807
National Disaster Management Structure 806fc
National Rural Health Mission 693
National Tuberculosis Statistics of India 775
Nausea 558, 595, 793
types of 558
Neck
motion, limitation of 598
pain, complaints of 598
Necrosis 459
Needle aspiration 595
Neisseria gonorrhoeae 596, 734
Neoadjuvant chemotherapy 552
Neomycin 656, 701
Neonatal tetanus, prevention of 768
Neoplasm
benign 545
malignant 545
Nephrotoxicity 559
Nerve
damage 660
pain 541
supply 698, 712
Nervous system 657
Neurogenic shock 790
Neurological
injuries 792
status 798
toxicity 559
Neurosyphilis 734
Neutropenia 558
Neutropenic sepsis 566
Nevus 640
Night blindness 690
congenital 690
Night sweats 541
Nipple 579
Nitroglycerin 456, 463
Nocturia 480
Nodules 520
Noise 700
Non-accidental poisoning 796
Non-communicable disease 447
Non-governmental organizations 807
Non-Hodgkin's lymphoma 542, 543t
Nonsteroidal anti-inflammatory drugs 509, 599, 643, 648
Nonulcerative keratitis 676
Nose 722
anatomy of 712
blood supply of 722
disorder 698
examination of 713, 714
external 712, 713
floor of 713
functional examination of 714
internal 712
neoplasms of 722
parts of external 712f
physiology of 712
Nuclear accidents 805
Nurse in maintaining airway, role of 788
Nursing care plan 464t, 495t, 501, 504t, 508, 512t, 517t, 518, 534t, 537t, 539t, 542t
Nutrition 750
Nutritional cataract 680
O
Obesity 547, 640, 650
Ocular
burns 696
emergencies 696
malignant tumor 689
trauma 696
tumor 689
benign 689
Oculobulbar symptoms 798
Odynophagia 724
Office headache 715
Olfaction 713
Ommaya reservoir 553
Oncogenes 550
Ophthalmic assistants, refresher training of 693
Ophthalmoscopic examination 683
Ophthalmoscopy 678
indirect 664
Opiates 797
Opisthotonus position in tetanus 767f
Optic
disc 662
nerve 662
Optical treatment 687
Oral
hygiene 727
mucositis 559f
polio vaccine 758
psoriasis 644
rehydration therapy 770, 771
tobacco 547
Organ
damage 527, 661
hypofunctioning 653
injuries, internal 625
Organophosphorus 797
Oropharynx 659, 726
examination of 724
Orthomyxovirus 755
Orthopedic assist devices, use of 633
Orthopnea 501
Ossiculoplasty 701
Osteocartilaginous framework 713
Osteomyelitis 593, 596
Osteonecrosis 596
Ostomies, types of 563
Otitis externa 702, 702f, 703t
causes 702
diagnosis 703
prevention 703
treatment 703
Otitis media 706, 706f
diagnosis of 707
serous 706
tuberculosis 707
diagnosis 707
treatment 707
types 706
Otosclerosis 708
etiology 708
histologic 708
types 708
Otoscopy 699
procedure 699
Ototoxic drugs 701
history of 701
Oxygen 463, 482
therapy 481, 578
Oxymetazolinne 706
P
Pacemaker implantation, permanent 492
Paddles, position of 493, 493f
Paget disease of nipple 580
Pain 630, 639, 647, 715, 716
causes of 592
chronic 626
duration of 592
episodes of 527
excessive 661
extreme 654
lack of 625
location of 592
management 656
severity of 450, 735
treatment of 573
types of 592
Painful ulceration 736
Palate, soft 725
Palliative chemotherapy 552
Palmar method 654
Palpation 639
Pan uveitis 674
Pancreatic proteolytic enzyme 577
Pancytopenia 523
Papillary carcinoma 580
Papilloma 713
intraductal 580
Papules 640, 650
Paracetamol 797
Paralysis 450, 609, 687, 757
Paralytic
ileus 653, 657
poliomyelitis 757
Paranasal sinuses 722
examination of 714
Parasites 510
Parasitic infection 665
Parenteral transmission 740
Paresthesia 450, 609, 647
Parkland formula 656
Parotitis, infective 752
Paroxysmal nocturnal dyspnea 480, 501
Pars plana vitrectomy 683
Parvovirus 647
Patchy erythema 647
Patella-sesamoid bone 590f
Paucibacillary 782
Pectoral muscle 579
Pediculosis 651
capitis 651
corporis 651
Pelvic fractures 625
Pelvis 562
Pemphigus 651
foliaceus 651
vulgaris 651, 651f
Percutaneous transluminal angioplasty 512
Pericarditis 508, 508f, 510, 510t
Perinatal transmission 740
Periostomal skin care 564
Peripheral
arterial
disease 511
occlusive disorder 512t
edema 501
vascular
disease 626
disorders 510
resistance 477
Peritonsillar abscess 726
Pertussis 765
Petechiae 525, 639, 640
Phlyctenular keratoconjunctivitis 670
Photophobia 647
Pisiform bone 591f
Placenta, anoxia of 680
Plague 775
control 777
epidemiology 775
treatment 776
types of 776
Plasma 519
Plasmodium
falciparum 778, 779
malariae 778
ovale malaria 778
vivax 778
Plaster cast 635
application of 635
removal of 636
Plastic surgery 659
Platelets 520, 525
Pneumatic
bones 590, 590f
retinopexy 683, 683f
Pneumocystis jiroveci pneumonia 742
Pneumonia, hypostatic 657
Pneumonic plague 776, 776f
Pneumotoscopy 707
Poison 701, 796
absorption of 796
of specific antidote 797
Polio vaccine, injectable 758
Poliomyelitis 757
epidemiology 757
prognosis 757
Pollen 643
Polycystic ovary syndrome 642
Polycythemia 530
vera 530
Polypectomy 721
Pop bandages 635
Popliteal spaces 650
Postanesthesia care unit 502
Postherpetic neuralgia 647
Postmastectomy exercises 585, 587f
Post-traumatic stress disease 572
Potassium 566, 655
Potential gastrointestinal complications 653
Pott's disease 597
Povidone-iodine 656
Pregnancy 522, 524
Preherpetic neuralgia 647
Pressure 639
sores 633
causes of 633
Priapism 527
Progressive weakness 525
Prophylaxis, pre-exposure 739
Propionibacterium acnes 642
Prostaglandins 679
Prostate specific antigen 630
Prosthesis 626
Prosthetic joint 596
Proteolytic enzyme therapy 576, 577
Proteus mirabilis 706
Prothrombin time 500, 511, 532
Pruritus 640, 651
Psoriasis 643
plaques of 644f
vulgaris 644
Psoriatic
arthritis 644, 645
erythroderma 644
Psychological trauma 657
Pterygium 672
Ptosis 669
Pulmonary
edema 478, 800
hypertension 527
injuries 653
toxicity 559
Pulse polio immunization 758
Pupillary examination 664
Pure tone audiometry 710
Purpura 726
Pustular psoriasis 644f
Pustule 640
Pylon prosthesis 629
Pyoderma 646
Pyrazinamide 775
R
Rabies 763
control of 764
epidemiology 763
pathogenesis of 763f
prevention 764
treatment 764
Radiation 524, 560, 639, 652
external 585
injury 652
simulation 560
therapy 536, 560, 561, 581, 584, 630, 645
side effects of 562, 585
Radical mastectomy 584
Radiotherapy 560, 570
treatment procedure 561
Range of motion 592
Rash 640
Raynaud's disease 513, 513f
Raynaud's phenomenon 514f
Reconstructive surgery 659, 660
Red blood cell 479, 501, 517, 519, 522, 525
disorders of 522
Red ribbon 738, 738f
symbolizes 738
Reed-Sternberg cell 540, 540f
Refractive error 686, 686f
types of 687
Regional
lymph nodes 551, 629
lymphadenopathy 647
Rehabilitation 574, 608, 632, 657, 700
Renal failure 657
Renal replacement therapy, continuous 507
Renin angiotensin aldosterone system 468
Reproductive history 581
Respiratory
failure 657, 798, 800
infection, acute 755
management 632
support 796
system 657, 657t
weakness 798
Resuscitation, cardiopulmonary 489
Retina 662
diseases of 682
tumor of 689
Retinal detachment 682, 682f, 688
exudative 682
stages of 682f
types of 682
Retinal separation 682
Retinitis pigmentosa 690
Retinoids 642, 644
Retinopathy 684
Retinoscopy 665
Rhegmatogenous retinal detachments 682
Rheumatic fever 510
Rheumatoid arthritis 595
Rhinolalia clausa 728
Rhinoscopy technique
anterior 713
posterior 713
Rhinosinusitis, chronic 721
Rhythm, regularity of 484
Ribonucleic acid 545, 739
Ribonucleotide reductase inhibitor 552
Rifadin 7775
Rifampicin 597, 775
Rifampin 775
Rimactane 775
Rinne test 699
Rituximab 651
Rose's position 727f
Rotavirus 770
Roundworm 783
lifecycle of 784f
Rubella 647, 754
complications 754
congenital 755
environmental factors 754
epidemiology 754
incubation period 754
source of infection 754
vaccine 755
Rule of five 654
Rule of nines 654, 654f
Russell traction 621, 621f, 623
S
Sacroiliac joint 597
Saddle nose 717
Salmonella 770
enteritidis 798
typhi 769f
Salvage
chemotherapy 552
procedures 630
Sandfly 786
Sarcoma 550
Sarcoptes
hominis 650
scabiei 650
Scabies 650, 650f
Scale 640, 645
Scapular pain, medial 598
Scar 640, 713
repair 660
Scleral buckling 683
Scorpion sting 793
management 794
prevention 794
Semi-Fowler's position 730
Senile
cataract 680
ptosis 669
Sensation
lack of 625
of heat, permits 639
Sensorineural hearing loss type, causes of 699, 700, 702
Septal
abscess 720
hematoma 719, 720
complications 719
etiology 719
treatment 719
Septic
arthritis 594, 595f, 596
treatment of 596f
shock 790
Septicemic plague 776
Septoplasty 719, 720, 720f
contraindications 720
indications 720
postoperative complications 720
Septum 713
Seroconversion illness 759
Serotonin antagonists 559
Sesamoid bones 590
Sexual
rehabilitation 633
route 758
transmission 740
Sexually transmitted
diseases 733, 782
infection 549, 648, 733
Shigella 770
Shock 789, 800
anaphylactic 790
cardiogenic 481, 790
classification of 789
hypovolemic 625, 657, 789
management 790
signs 790
symptoms 790
Short wave diathermy 636
Shoulder
dislocation 605f
pain 598
stiffness 561
Sickle cell 526f
anemia 526, 529, 529t
complications of 528f
pathophysiology of 526f
disease 527
Silver
nitrate 656
sulfadiazine 656, 657
Sinoatrial node 485
Sinus 713
bradycardia 485, 485f
rules 485
disease 718
drainage 715
rhythm
normal 485, 485f
tachycardia 485, 486f
rules 486
Sinusitis 717, 719
acute 714, 715
chronic 716
complications of 717
etiology of 714
pathology of 715
pathophysiology, chronic 716
surgery for chronic 716
Skeletal
muscle 592
system 589
division of 589
voluntary muscle of 592
traction 614, 622, 622f, 623
uses of 623
Skin 713
biopsy 651
cancer 596, 652
care 633
diseases 640
fragility 595
functions of 639
fungal infections of 648
infections 640
lesions, types of 641f
neoplasms 652
pale 525
problems 561
rash 525
life-threatening 651f
reactions 562
redness of 725
structure of 639f
tissues 736
traction 614, 621
Smallpox 748, 749t
Smell
disorders of 713
sense of 714
Smith's fracture 610f
Smoke poisoning 799
signs 799
symptoms 799
Snake 794
bite 794
complications 794
local symptoms 794
management 795
prevention 795
systemic symptoms 794
Sneezing 712
Snellen chart 664
Snoring 724
Sodium 566, 655
replacement 566
Solid ankle and cushion heal foot 626
Sore throat 724
Spasticity, incidence of 633
Spatula test 714
Speech
audiometry 710
language pathologist 574
Spider bites 795
management 795
Spinal
cord
compression 569, 569f, 570
paralysis, types of 631
syndromes 631
fractures 612
fusion 599
injury, mechanism of 630
Spine
injury 630
normal 612f
tuberculosis of 597
X-ray of 632
Spleen 520
biopsies 541
Splenectomy 543
Splenic disorders 543
Spoilage bacteria 797
Sprain 592, 601
Spreader bars 621
Squamous cell carcinoma 547
Stapedectomy 709
Stapedial otosclerosis 708
Staphylococcus
aureus 594, 640, 646, 668, 715, 717, 798
epidermidis 500, 670
Steam inhalation 715
Steinmann pin 623
Stem cell 562
donation 563
transplant 525, 562
Steroid 597, 656
Stevens-Johnson syndrome 651
Stings 793
Stoma 564f
care of 563
locations 563f
pouch, application of 564
therapy 563
Stomach 562
Strabismus 685, 686f
Strangulation 801
Streptococcus
pneumoniae 715
pyogenes 715
viridans 500
Streptomycin 701
Stress 592, 642
financial 572
fracture 605
Stridor 654, 724
Stroke 527
Submucous resection operation 719
Subungual hyperkeratosis 650
Sudden cardiac death 460
Suppurative otitis media
acute 706
chronic 706
Surgery 546, 686
radiation therapy 584
Sushruta samhita 659
Suture joints 591
Swallowed poisons 797
management 797
signs 797
symptoms 797
Swelling 725
Swimming 714
Swine flue 756
complications 756
control 756
epidemiology 756
incubation period 756
Sympathetic nervous system 481
Syndesmosis 591f
joints 591
Synovial joint 590, 591f
Syphilis 734, 735, 782, 783
cardiovascular 734
congenital 782
pathogenesis of 734fc
primary 782
secondary 782
tertiary 782
Systemic lupus erythematosus 510
T
Tachycardia 480
Tears
film abnormality 673
physiology of 673
supplementation of 674
Tendon sheaths 591
Terbinafine 649, 650
Tetanus 766
control 768
epidemiology 766
pathogenesis of 767f
prophylaxis 656
signs of 767, 768f
symptoms of 767, 768f
toxoid 656
administer injection 676
vaccine 768
Therapeutic ultrasonic therapy 637
Thermal injuries 626, 652
Thermography 594
Thomas splint 635
Thoracic disk prolapse 598
Thoracolumbar
fracture 632
sacral orthosis 613
Throat
disorders of 698, 723
recurrent infections of 726
Thrombectomy 516
Thrombin time 532
Thromboangiitis obliterans 514
Thrombocytopenia 530, 558
Thrombophlebitis 657
Thromboplastin time, partial 462, 511, 532
Thymus 520
Tinea
capitis 649
corporis 649
cruris 650
pedis 649, 649f
unguium 650
Tinnitus 708, 710
Tirofiban 463
TNM staging system 551
Toe splint 635
Tonometry 678
Tonsillar diphtheria 765
Tonsillectomy 726, 726f
Topical corticosteroids 646
Topoisomerase inhibitors 552
Toxic
cataract 680
chemicals 524
retinopathies 684
shock syndrome 720
Toxicity, lead 510
Toxins 639, 798
reduce absorption of 798
Trabeculectomy 679
Trabeculoplasty, laser 679
Tracheostomy 728t, 730
tube, insertion of 729f
Trachoma 671, 673t
Traction 614
apparatus 621
retinal detachment 682
system, failure of 623
types of 621
Transantral ethmoidectomy 722
Transarterial chemoembolization 554
Transcutaneous electrical nerve stimulation 636
Trauma 597, 626, 718, 722, 792
causes of 592
management 792
Travel accidents 805
precautions 805
Treponema pallidum 734
Triaging system 787
Trichophyton rubrum 649
Tricyclic antidepressants 648
Tropical ulcer 646
Tuberculosis 675, 742, 773
Tumor 593, 629
lysis syndrome 566
nodes 551
Tympanic membrane 698
causes 705
diagnosis 705
pathophysiology 705
perforation of 705
Tympanogram 700
Tympanometry 707
Tympanoplasty 705
Typhoid fever 768
complications 769
diagnosis 769
epidemiology 768
pathogenesis of 769f
prognosis 769
U
Ulcer 640, 725
Ultraviolet light 645
exposure 644
Upper airway obstruction, causes of 788
Urinary
alkalinization 797
system 657
tract infection 657
Urticaria 640, 643
Uveitis 674
anterior 674
posterior 674
types of 674
V
Valacyclovir 648
Valve replacement, complications of 501
Valvular heart disease 726
Varicella 748
virus 647
zoster virus 647, 748, 749f
reactivation 741
types 749
Varicose veins 517, 518f
Variola 748
Vascular
bypass surgery 516f
layer, middle 662
necrosis, diagnosis of 593
neurosis 624
retinopathy 684
surgery 516, 517t
complications of 517
Vasospastic angina 456
Veins 449
Vena cava syndrome, superior 568, 569f
Venereal disease research laboratory 675
Venous thromboembolism 625
Ventilation 788
Ventricular
asystole 490f
contraction, premature 488, 488f, 489f
dysrhythmias 488
fibrillation 489, 490f
rules 490
tachycardia 489, 489f
rules 489
Verbal communication 731
Vertebral compression fractures 612
Vertigo 710
Vesicle 640, 650
Vessels 579
Vestibular sedatives 710
Vestibulitis 718
Vibrio cholerae 771f
Vinca alkaloids 556
Vincristine 552
Viral
conjunctivitis 670, 671
infection 524, 647, 676, 755
load testing 742
proteins, adherence of 743
rash, nonspecific 647
Visceral leishmaniasis 786
Vision
dimness of 663
gradual loss of 663
loss of 678, 680
painless unilateral loss of 684
problems 527
Visual acuity 664, 674
Vitamin
A 674
deficiency 690
B12 deficiency 522
C chelation 577
rich foods 577
D3 577
Vitrectomy 683, 683f
Vitreous hemorrhage 688
Vocal cords, loss of 731
Voice, hoarseness of 654
Volkmann's splint 635
Vomiting 558, 595, 793
types of 558
W
Water, drink plenty of 528
Weak immune system 595
Weber test 699
Weils disease 777
Wheezes 480
Whisper test 700
White blood cell 453, 509, 520, 522
disorders of 533
Whooping cough 765, 766
complications 766
control 766
epidemiology 766
prevention 766
treatment 766
World Cancer Day 545
World Sight Day 693
Wound
care 789
case, local 794
coverings 656
healing, promotion of 656
infection 657
open 596
sepsis 657
Wrists 650
Wuchereria bancrofti 779
X
Xenografts 660
Xenopsylla cheopis 776
Xerophthalmia 690
Y
Yellow fever 785
epidemiology 785
Yersinia pestis 775f
Z
Zika virus disease 753, 754f
causes 753
complications 753
prevention 754
symptoms 753
treatment 754
Zinc deficiency 690
Zoonotic disease 763
×
Chapter Notes

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Volume I

IntroductionCHAPTER 1

Medical-surgical nursing is a nursing specialty area concerned with the care of adult patients in a wide range of clinical setting. Medical-surgical nursing deals with the nursing care of adults who are at risk or experiencing pathophysiologic disorders who may require therapeutic medical or surgical interventions. It deals with any illness or disease that affects the physiology of adults. When the illness interferes with the normal physiology, the patient is said to have a medical problem and called as a medical patient. When the problem is treated with surgery, the individual becomes a surgical patient
Psychosomatic illness is an important aspect of medical-surgical nursing because physical illness lead to psychological and social problems and vice versa.
Medical-surgical nursing is a fast developing specialty and its practice is different from other nursing disciplines. It is a very vast and complex specialty covering from head to foot. There are numerous super specialties and sub specialties under medical-surgical nursing.
 
EVOLUTION OF MEDICINE AND SURGERY
It is believed that medicine was conceived in sympathy and born out of necessity and the first doctor was the first man and the first woman, the first nurse. During the Vedic period in India two medical systems originated namely—Ayurveda and Siddha. Ayurveda was founded by Dhanvanthary (God of Medicine) as written in Atharvaveda, one among the four Vedas. In Ayurveda, Athreya (800 BC) Charaka (200 BC) and Susrutha (800–400 AD) were the famous scholars. Charaka wrote Charaka Samhitha which contains the description of more than 500 drugs (Fig. 1.1). He was considered as the Father of Indian Medicine. Susrutha (Fig. 1.2) compiled in his book various methods of excision of tumors amputations, cataract surgery, repair of hernia and plastic surgery. He is considered as the Father of Indian Surgery.
According to the theory of Ayurveda, human body has three doshas (vata, pitta and kapha). Imbalance of these three doshas give rise to various diseases. Allopathic system of medicine originated from greek medicine. Asclepius was the leader of Greek Medicine and flourished from 450 to 136 BC (Fig. 1.3). In Greek mythology the rod/staff of Asclepius consisting of a serpent coiled around a rod is the ancient Greek symbol associated with medicine. The snake symbolizes rejuvenation and renewal of youth as it casts off its skin. He had two daughters namely Hygeia and Panacea. Hygeia was considered as the Goddess of Health (Fig. 1.4) and Panacea as the Goddess of Medicine.
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Fig. 1.1: Charaka
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Fig. 1.2: Susrutha was the Father of Indian Surgery
2
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Fig. 1.3: Statue of Asclepius with rod
The Greek physician Hippocrates (460–370 BC) known as Father of Medicine challenged the tradition of magic in medicine and implicated application of clinical methods in medicine (Fig. 1.5). During the middle ages (500–1500 AD) the practice of medicine reverted back to primitive medicine and hence this period is called the ‘dark ages of medicine’. The spread of Christianity lead to the establishment of religious institution known as monasteries which rendered active medical and nursing care to the sick.
The period following 1500 AD was marked by revolutions. Dr Ambroise Pare French Army Surgeon advanced the art of surgery and earned the title The Father of Surgery. The 17th and 18th centuries witnessed many discoveries like William Harvey's discovery of circulation of blood (1628), Antony van Leeuwenhoek microscope (1670) and Edward Jenner's vaccination against smallpox (1796). The great sanitary awakening in the mid nineteenth century was a historic milestone in the development of medicine which lead to the enactment of the Public Health Act of 1848.
In 1873, Louis Pasteur put forward germ theory of disease and it was followed by the golden age of bacteriology. The later part of 19th century was marked by discoveries in preventive medicine.
Towards the end of the 19th century two branches of medicine namely curative and preventive medicine was evolved. Thereafter medicine moved faster towards specialization and a scientific approach to disease.
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Fig. 1.4: Hygeia was the Goddess of Good Health
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Fig. 1.5: Hippocrates
Recent advances in each branch of medicine and surgery are given under the respective chapters.
 
HISTORY OF MEDICAL-SURGICAL NURSING
Traditionally medical-surgical nursing was the first level position that most nurses viewed as a stepping stone to specialty areas. It is the foundation of all nursing practice. Many years ago majority of the nurses worked in general medical and surgical wards of the hospital and everyone was a medical surgical nurse.3
Today medical-surgical nursing has evolved from an entry level position to a distinct speciality. It is viewed as the foundation and backbone of every hospital. It has become one of the most challenging and demanding nursing speciality.
Medical surgical nurses are the largest group of practicing professionals. They work in a variety of settings—inpatient clinics, emergency departments, surgical centers, home health care, critical care units, rehabilitation centers, etc. Medical-surgical nurses also known as adult health nurses specialized in the care of adults with a known or potential physiologic alteration. Comprehensive total patient care rather than a focus on a particular organ or problem is an important aspect of this speciality.
National League of Nursing Education (NLNE) curriculum guide considered medical nursing, surgical nursing and disease prevention as separate topics. But during 1930 it was recommended that medical and surgical nursing be taught as a single disciplinary course because the division of the two was considered an artificial distinction.
In 1937, the NLNE guide recommended for a combined course of medical and surgical nursing. In 1960, the nursing curriculum emphasized the interdisciplinary study and practice of medical and surgical nursing.
During 1960's and 1970's nursing care standards were developed for many speciailties. The American Nurses Association (ANA) published standards of medical-surgical nursing practice in 1974. In 1980, ANA published a statement on the scope of medical-surgical nursing practice. In 1991, the Academy of Medical-Surgical Nurses (AMSN) was formed which is an independent professional organization for medical-surgical nurses. In 1996, AMSN published its own scope and standards of medical-surgical nursing practice which was revised in 2000.
Both ANA and AMSN documents recommended that not only clinical nurse specialist, but a medical surgical nurses also participate in research and utilize research findings in their practice.
 
CARING FOR MEDICAL-SURGICAL PATIENTS
 
Role and Functions of the Nurse
Medical-surgical nurse have a vast set of skills:
  • They are knowledgeable in all aspects of adult health.
  • They have excellent assessment, organizational, technical and prioritization skills.
  • They educate patients, families and peers about self-care practices and promotion of health.
  • Collaborates with other health team, members in planning and delivering comprehensive care to patients.
  • Serve as patient advocate.
  • Understand the importance of assessing and improving the quality of care delivered.
  • Support and guide patients to identify what is best for them.
  • Manage the care of patients with multiple medical and surgical diagnosis.
  • Updates knowledge and skill through continuing education.
 
Expanding Roles of Medical-Surgical Nurses
  • Critical care nursing: Nurses specialized in this field deal with patients having life-threatening problems. The nurses often handle sophisticated equipment. High tech–high touch care is expected from the critical care nurses.
  • Geriatric nursing: Geriatric nurses take care of the elderly patients. They have extensive knowledge about special care needed in rehabilitating and maintaining the health of the elderly.
  • Informatics nursing: Informatics nurses combines nursing science with information management. They work in clinical area ensuring that the nurse are provided with complete and accurate information about patients’ health needs and nursing requirement.
  • Disaster nursing: It is concerned with the adaptation of nursing skills in recognizing and meeting the needs and problems resulting from a disaster.
  • Flight or transport nursing: Specially trained nurses provide intensive nursing care to critically ill patients transporting by helicopter or ambulance.
  • Trauma nursing: Nurses specialized in trauma care units work in close collaboration with skilled trauma professionals.
  • Forensic nursing: Nurses specialized with field work with law enforcement officials and forensic department to aid in the investigation of crimes, accidental death, etc.
  • Tele nursing: It is sharing information using electronic means, e.g. through teleconferencing or video conferencing.
  • Wound and ostomy nursing: Ostomy nurses provide care to patients with stoma, vascular and pressure wounds draining wounds and fistulas.
  • Space nurses: The first nurse at NASA was Dolores O'Hara. An international organization called the Space Nursing Society was formed in 1991. Space nurses are responsible for setting up the armed Lab and dedicated the examine and monitor astronaut's health. Other roles include:
    • Infusion nursing
    • HIV or STD nursing4
    • Dialysis nursing
    • Cardiac cath lab nursing
    • Diabetic nursing
    • Palliative or hospice nursing
    • Transplant nursing
    • Toxicology nursing
    • Genetic nursing.
 
Advanced Practice Roles
 
Ambulatory Practice
  • Ambulatory care is one arena for nursing practice outside hospitals. The term ambulatory care is applied to day care centers that serve walk in clients who return to their homes or workplace at the end of the visit. Education, health counseling, health maintenance, prevention and primary care are the main functions of the ambulatory care nurse.
  • Clinical nurse specialists are the largest group of advanced practice nurses. They function as educators, practitioners, researchers, consultants and mangers.
  • Managed care and clinical pathway.
A recent trend in medical-surgical nursing is managed care which is a method of organizing health care delivery and coordinating the care by various members of the health care team in a timely manner.
Clinical pathways serve as an interdisciplinary care plan and a tool for assessing the progress of patients. The pathway indicates the major events of care such as the investigations, medical treatment, nursing intervention, etc. that must occur within specific time frames. The care received are continually assessed from admission till discharge and also in home care and community settings.
 
THEORIES OF CAUSATION OF ILLNESS
 
Supernatural Theories of Disease
In ancient days medicine was dominated by magic and religious beliefs. As the knowledge of the primitive man was limited he believed that diseases are caused due to wrath of gods and goddesses (deistic theory), the influence of stars, planets and fate (fatalistic theory) and so on. All these theories are called supernatural theories.
 
Theory of Hippocrates
Hippocrates was a great Greek Physician who lived during the period 370–460 BC. His writings were compiled into a book named Hippocratism which is the basis for the present allopathic medical system.
A great saying of Hippocrates is ‘where there is love for mankind there is love for the art of mankind’. According to his theory, the human body is composed of four substances which he called the four humors: blood, phlegm, yellow bile and black bile. If there is any imbalance in these four humors, it leads to illness. The ancient Greek atomic theory identified only 4 atoms. They were atom of earth, air, fire and water. Each atom possessed two or the four qualities of wetness, dryness, warmth and coldness. Earth was cold and dry, air was hot and wet, water was cold and wet and fire was hot and dry. According to Hippocrates, each humor was made up of one type of atom. Thus blood was made up of air and possessed the properties of being hot and wet, phlegm was made up of water, yellow bile of fire and black bile of earth.
 
Galen's Theory
Hippocrates theory was elaborated by Galen, a Roman Physician. Galen added two new humors to Hippocrates's four humors. There two elements were named as temperament and procatarctic factors. Procatarctic factors refers to the lifestyles of the person. According to Galen an excess of each of the humors was associated not only with particular disease but also with a particular personality type.
For example, person with an inborn excess of blood is said to have a sanguine temperament, characterized by cheerful manner and optimistic attitude. Similarly, the phlegmatic person over supplied with cold watery phlegm is passive and dull. An excess of black bile produced a melancholic temperament sadness and depression. Yellow bile is excess produced a choleric personally, i.e. easily aroused to anger, hot temper and irritability.
Galen said that disease is due to three factors.
  1. Predisposing factors
  2. Exciting factors
  3. Environmental
 
Theory of Contagion
Fracastorius (1483–1553 AD): An Italian physician proposed the theory of contagion. He recognized that syphilis was transmitted from persons to person through sexual contact.
 
Vector Theory
In India Ronald Ross (British surgeon) demonstrated the presence of Plasmodium in the gut of mosquitos. He proposed a theory that same diseases are spread by vectors mosquitos, housefly, etc. Nineteenth century was considered as the golden period of bacteriology.
 
Germ Theory
Germ theory was formulated by Louis Pasteur. He found that diseases are due to invasion of microorganism in the human body. During the period of Louis Pasteur, a lot of microorganisms were discovered, Gonococci (1847), Typhoid bacilli (1880), Tuberculosis bacillus (1882), Vibrio 5cholera (1853), Diphtheria (1884). According to germ theory there is one single specific cause for every disease. It refers one-to-one relationship between causative agent and disease.
 
Theory of Epidemiological Triad
This triad consists of the agent, host and the environment.
  • Agent harmful organisms or organic or inorganic substances which causes the disease.
  • Host in the human body. Disease occurs when agent invades the body. Everyone exposed to the agent need not get the disease.
  • If the environment is favorable and conducive, it facilitates the interaction between host and environment.
This theory is not applicable to the causation of non-communicable diseases like hypertension, cardiovascular disease, diabetes, etc.
 
Multifactorial Theory
A variety of factors are identified for the causation of a disease.
  • Genetic: Some diseases are genetic in origin and they are linked to the genes. Down's syndrome and thalassemia are few examples of inherited genetic defect. Hemophilia is a disease linked to the ‘X’ chromosomes in the cell and transmitted from one generation to the other. Heredity is a non-modifiable risk factor in diseases like hypertension, diabetic mellitus and heart disease.
  • Congenital: Individuals are born with a particular disease, e.g. congenital heart disease, cleft palate and cleft lip.
  • Inflammation: Conditions caused due to response of body cells and tissues to injury occurring at any part of the body, e.g. sprain, friction on the skin, etc.
  • Accidents and disasters: Disasters are natural and man-made. Natural disasters include flood, hurricane, lightening, cyclone and thunder. Bomb blast is an example of manmade disaster.
  • Degenerative: Diseases are caused due to the degeneration of body cells and tissues. Such diseases begin in early middle age and progress to old age, e.g. neurologic disorders, osteoarthritis.
  • Metabolic causes: Diseases are caused due to deficiency of enzymes and hormones or due to over activity of hormones, e.g. endocrine disorders.
  • Neoplasm: Diseases are also caused due to abnormal growth of cells, e.g. tumor—benign and malignant.
  • Allergic disorders: Disorders are caused due to reaching of the body to a foreign proton substance.
  • Autoimmune disease: In some individuals the body produce antibodies which affect its own body, e.g. rheumatoid arthritis, systemic lupus erythematosus.
  • Psychosomatic illness: Certain diseases affect the body and mind, e.g. anxiety and stress can lead to certain skin conditions, gastric conditions, etc.
  • Iatrogenic illness: Means physician induced illness. In some people use of certain drugs like cortisone will lead to certain other diseases.
  • Lifestyle factors: They are also called modifiable risk factors. Unhealthy lifestyle practices like smoking, alcoholism, obesity sedentary lifestyle, fast food culture can lead to diseases like hypertension, heart disease and diabetes mellitus.
 
THE CONCEPT OF ILLNESS
 
Definition
Illness is a deviation from a normal state of health, a deviation from normal functioning. Illness is a condition of the body or some part or organ of the body in which its function are disrupted or deranged.
—Oxford English Dictionary
 
Types of Illness
Illness can be classified into two major categories namely acute and chronic illness.
  1. Acute illness: Acute illness occurs suddenly and has a short duration. The condition usually gets cured if specific treatment is given immediately. In acute illness the recovery is very fast.
    Acute respiratory infections like common cold sinusitis, pharyngitis, laryngitis, gastritis are examples of acute illness. Acute illness may become chronic.
  2. Chronic illness: The signs and symptoms develop gradually. The disease has a long duration. In chronic illness, there may be impairment or disability which requires long-term rehabilitation. The patient may have only a partial recovery.
    For example, chronic obstructive pulmonary disease, diabetes mellitus, heart disease, etc. Diseases such as asthma, rheumatoid arthritis are characterized by periods of recurrence.
 
Stages of Illness Behavior
Stage 1: Onset of symptoms: During the first stage of illness the person experience certain symptoms which are not usually seen in a normal healthy individual, e.g. pain, fever, cough, rashes, nausea, vomiting are the symptoms, which last for short time and are relieved by first aid and self-care, no further action is taken. If the symptoms are persisting the person enters the next stage.6
Stage 2: Assuming sick role: During this stage the person accepts that he is sick and seeks medical assistance. Normal activities and social activities are avoided so that the person can take rest and concentrate on getting well.
State 3: Assuming a dependent role: During this stage the person may require assistance in carrying out the activities of daily living and follows the treatment plan given by the physician.
Stage 4: Stage of recovery and rehabilitation: Person gradually return to normal activities and tries to become independent. The person has to modify his lifestyle and make adjustments in functioning for leading a normal life.
 
Illness and Family
Reaction to illness may vary among individuals. Illness affects not only the individuals but also the whole family. An illness will disrupt the family routines, and role of family. The impact of illness on the family depends on the family member, who is ill, the seriousness and duration of the illness and the sociocultural influences of the family. If the chief earning member of the family is sick there is a serious threat to the financial resources. If the parents become sick, the reversal in the parent child roles is difficult for both parents and children. In case of chronic illness the entire family become strained. There will be feelings of frustration and grief in the family.
 
Causes of Anxiety in the Hospitalized Patient
  • Strange environment: The hospital environment is totally different from that of his home. Patient has to wear hospital dress. He stays in a room or cubicle away from his near ones. In a general ward, patient has to use common toilets and bathrooms.
  • Fear of unknown: Worried about the disease and its prognosis. Has to undergo various tests and investigation which are quite new.
  • Restriction of visitors: Friends and members of family.
  • Change in routines: Patient has to follow hospital routines.
  • Strange people: Patient has to meet many people doctors, nurses, paramedical staff, etc. who are not familiar to him.
 
Nurses Responsibilities
 
Meeting Psychological Needs
Meeting psychological needs of patients is one of the most important aspects of nursing care, which if often neglected. Illness and hospitalization will add to the stress of an individual. The nurse should be able to identify and meet these needs.
  • Relieve anxiety and fear of the patient by proper explanation of procedures, treatment, etc.
  • Provide privacy while doing procedures.
  • Explain hospital routines and policies, visiting time, food timings, etc.
  • Provide support to the patient as he undergoes hospitalization.
  • Encourage patient to express the feelings of anxiety.
  • Be a good listener. Be sensitive to the needs of patients with different disease conditions.
 
NURSING PROCESS: REVIEW
 
Introduction
Nursing is basically a caring profession based on a humanistic philosophy. Nursing is caring with commitment, compassion, confidence, conscience, competence and courage. Nursing has been described as an art and science. The science of nursing is the knowledge base for the care that is given and the art of nursing is the skilled application of that knowledge to reach maximum health and quality of life.
Nursing is a profession undergoing rapid changes. These changes are related to the changes in the society and health care. Nursing is not only concerned with care of sick or ill but also includes prevention of illness, promotion and maintenance of health for individuals, families and communities.
 
History of Nursing Process
Nursing process can be seen throughout the history of nursing. Since the beginning of mankind each individual needed nurturing which was provided primarily by the mother of the family. During the time of Hippocrates when the profession of medicine evolved the profession of nursing evolved simultaneously because every ill person needed someone to nurture him or her back to health.
Nursing was first described as a process by American nurse Lydia Hall in 1955.
 
Purpose of Nursing Process
  • Provide a systematic methodology for nursing practice
  • Helps to provide individualized nursing care
  • It unifies and standardizes nursing practice
  • Give direction, guidance and meaning to nursing care
  • Provide for continuity of care and reduce omissions
  • Enhances communication and collaboration of health team members
  • Promote creativity and flexibility in nursing practice
  • Facilitates documentation of data
  • Facilitates health, promotion, maintenance and restoration
  • Evaluates the efficiency and effectiveness of care.7
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Fig. 1.6: Steps of nursing processSource: pinrest.com
 
Steps of Nursing Process (Fig. 1.6)
  • Assessment: Collects client health data.
  • Nursing diagnosis: Analyzes assessment data to determine diagnoses.
  • Planning: Develops plan of care and prescribes interventions to attain expected outcomes.
  • Implementation: Implenents the interventions (action types) in the pain of care.
  • Evaluation: Evaluates client's attainment of outcomes.
 
Characteristics of Nursing Process
  • Patient centered
  • Goal directed
  • Systematic and provides an organized approach to nursing
  • Based on scientific principles
  • Adaptable to any practice setting
  • Applicable to individuals, families and community groups
  • Based on nurse-client relationship
  • Provides continuous and ongoing evaluation.
Nursing process is the core and essence of nursing. It is a problem-solving approach that enable the nurse to provide care in an organized and scientific manner.
 
Definition
Nursing process has been defined and described in many different way by various authors.
Fuerest and Wolf: Nursing process is a set of actions or series of steps taken by the nurse to determine plan and implement nursing care.
Ann Marriner: Nursing process is the application of scientific problem-solving to nursing care. It is used to identify patients problems systematically and implement nursing care plan and evaluate the outcome of the care provided.
Luckman and Sorensen: Nursing process is defined as a system of interrelated and interdependent problem-solving steps directed towards meeting the needs of patients and the significant others.
Steps: The steps of nursing process are assessment, diagnoses, planning, implementation, documentation and evaluation.
Assessment involves collection of subjective and objective data from the patient, family, significant others, medical records, lab reports and other care providers, interview is used to obtain an objective picture of the patients personal and family health history. Physical examination uses inspection palpation percussion and auscultation to collect objective data about the patient.
 
Identification of Patients’ Needs and Problems
To be effective in identifying patients’ needs, the nurse must understand what the basic human needs are. Various theorists have put forward models to explain what the basic human needs are and to organize them in ways that encompass the whole human being. Studying these models can provide a framework within which to identify needs and can help in planning nursing care.
Maslow: A well-known model is the hierarchy of basic human needs developed by Abraham Maslow (Fig. 1.7). Maslow described a hierarchy, or pyramid, of needs with primary or physiologic needs at the base and secondary or nonphysiologic needs at the higher levels. Maslow states that the basic human needs are organized into a hierarchy of relative prepotency. Expressed simply, this means that new needs emerge when those lower on the hierarchy have been relatively well gratified.
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Fig. 1.7: Maslow's hierarchy of needs theory
8In other words, human behavior is to a large extent motivated by a system of needs.
While all needs are present at all times, a person will attempt to satisfy those needs lower on the hierarchy to at least a minimal degree before focusing on those higher up.
The needs described in Maslow's model are in ascending order:
  • Physiological needs
    • Survival needs, e.g. food, air, water, temperature, elimination, rest, pain avoidance.
    • Stimulation needs, e.g. sex, activity, exploration, manipulation, novelty.
  • Safety and security needs, e.g. safety, security, protection.
  • Love needs, e.g. love, belonging, closeness, and intimacy.
  • Esteem needs, e.g. value and respect from others, value and respect of self (self-esteem).
  • Self-actualization needs, e.g. the process of making maximum use of one's abilities.
    • Cognitive needs, e.g. seeking knowledge, discovering things, working with ideas, knowing and understanding.
    • Aesthetic needs, e.g. the desire for beauty.
 
Kraegel
Kraegel and her associates developed a model of patient needs which they used in studying a system for providing patient care. This model identifies 22 needs within three broad classifications: physical, sociopsychological, and environment. Physical and sociopsychological needs are grouped as patient health needs (Table 1.1).
 
Virginia Henderson's Theory of Basic Human Needs
Henderson's definition states not only what nursing is but also gives some indication of how nursing should be practiced. The goal of nursing practice is always to encourage and facilitate patient independence.
Components of basic nursing (Virginia Henderson's 14 needs).
Assisting the patient with these functions or providing conditions that will enable him to:
  1. Breathe normally
  2. Eat and drink adequately
  3. Eliminate by all avenues of elimination
  4. Move and maintain desirable posture (walking, sitting, standing and lying)
  5. Sleep and rest
  6. Select suitable clothing, dress and undress
  7. Maintain body temperature within normal range
  8. Keep the body clean and well groomed and protect the skin
  9. Avoid dangers in the environment and avoid injuring others
  10. Communicate with others in expressing emotions, needs and fears
  11. Worship according to faith
  12. Work at something that provides a sense of accomplishment
  13. Play or participate in various form of recreation
  14. Learn, discover or satisfy the curiosity that leads to normal development and health.
Table 1.1   Kraegel model of patient needs
  • Air
  • Rest
  • Sleep
  • Food
  • Fluids
  • Elimination
  • Maintenance of body heat
  • Maintenance of Integument
    • Physical Hygiene
    • Bodily Safety
  • Quiet
  • Mobility
  • Freedom from pain and discomfort
  • Sensory stimulation
  • Autonomy (Choice, Control)
  • Challenge and Achievement
  • Security
  • Cognitive Clarity (Knowledge upon which to Act)
    • Orientation
    • Health Education
    • Communication
  • Humanism (Recognition, Acceptance, Respect, Approval)
    • Status
    • Success
    • Self-Esteem
    • Dignity
    • Identity
    • Kindly Concern by others
    • Privacy
      Physical
      Information
→ Physiological
→ Socio Psychological
→ Patient Health Needs
  • Reliability
  • Simplicity
  • Flexibility
  • Cost
    • Economic
    • Societal
  • Safety to Human agents
→ Environmental Needs
 
Comparison of Models
As you study these models, you will notice some similarities in them. Compare the three models carefully and identify their similarities and differences.9
Table 1.2   Comparison of nursing models
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Maslow, Henderson, and Kraegel are describing the same things. Each of their models are attempts to describe the elements of existence that are common to and necessary for all human beings. Basic human needs are conditions that must be either supplied or relieved. While methods of fulfilling may vary from person to person, and even from circumstance to circumstance in the same individual, the fact that all human beings have certain common needs remains true (Table 1.2).
Nursing problem is a term describing an obstacle that prevents a patient from experiencing satisfaction of a basic human need. Nursing action is directed toward the solution of nursing problems. The source of obstacles to need satisfaction are various.
 
Faye Abdella's 21 Nursing Problems
  1. To maintain good hygiene and physical comfort.
  2. To promote rest, sleep and optimum activity.
  3. To promote safety to prevention of accidents, injury or trauma, spread of infection.
  4. To maintain good body mechanics and prevent and correct deformities.
  5. To facilitate and maintain supply of oxygen.
  6. To facilitate and maintain nutrition.
  7. To facilitate and maintain elimination.
  8. To facilitate and maintain fluid and electrolyte balance.
  9. Recognize by physiological responses of the body to disease condition.
  10. Maintenance of regulatory mechanisms and its function.
  11. Maintenance of sensory function.
  12. Identify and accept the positive and negative reactions.
  13. Identify the interrelationship of emotional and organic illness.
  14. To facilitate and maintain effective verbal and nonverbal communication.
  15. To promote and maintain interpersonal relationship.
  16. To facilitate achievement of personal and spiritual goals.
  17. Create and maintain therapeutic environment.
  18. To facilitate awareness of self as an individual.
  19. To accept optimum possible needs in the light of both physical and emotional limitations.
  20. Use community resources to solve problem arising from illness.
  21. To understand the role of social problems as influencing factors in the causation of disease.
 
Nursing Diagnosis
Nursing diagnosis is defined as the judgment or conclusion which occurs as a result of nursing assessment. It includes nursing problems that can be managed by independent nursing intervention.
Nursing diagnosis, the first taxonomy developed in nursing have fostered autonomy and accountability in nursing. NANDA International (NANDA-1) 2012 formerly known as North American Nursing Diagnosis Association is the official organization responsible for the formulation of the taxonomy of nursing diagnosis.
Diagnoses are developed through a peer-reviewed process requiring standardised levels of evidence, 10definitions, defining characteristics, related factors and/or risk factors that enable nurses to identify potential diagnoses in the course of a nursing assessment. NANDA-I believes that nurses are required to utilize standardized languages that provide not just terms (diagnoses) but the knowledge from clinical practice and research that provides diagnostic criteria (definitions, defining characteristics) and the related or etiologic factors upon which nurses intervene. NANDA-I terms are developed and refined for actual (current) health responses, for risk situations, as well as providing diagnoses to support health promotion. Diagnoses are applicable to individuals, families, groups and communities. The taxonomy is published and being used worldwide.
The ICNP (International Classification for Nursing Practice) published by the International Council of Nurses has been accepted by the WHO (World Health Organization). ICNP is a nursing language which can be used by nurses to diagnose.
The NANDA-I system of nursing diagnosis provides for four categories.
  1. Actual diagnosis: A clinical judgment about human experience/responses to health conditions/life processes that exist in an individual, family, or community. An example of an actual nursing diagnosis is: Sleep deprivation.
  2. Risk diagnosis: Describes human responses to health conditions/life processes that may develop in a vulnerable individual/family/community. It is supported by risk factors that contribute to increased vulnerability. An example of a risk diagnosis is: Risk for shock.
  3. Health promotion diagnosis: A clinical judgment about a person's, family's or community's motivation and desire to increase well-being and actualize human health potential as expressed in the readiness to enhance specific health behaviors, and can be used in any health state. An example of a health promotion diagnosis is: Readiness for enhanced nutrition.
  4. Syndrome diagnosis: A clinical judgment describing a specific cluster of nursing diagnosis that occur together, and are best addressed together and through similar interventions. An example of a syndrome diagnosis is: Relocation stress syndrome.
The hierarchy of taxonomy of nursing practices is as follows.
 
Hierarchy of Taxonomy in Nursing Practice: A Unified Structure of Nursing Language
 
The Functional Domain
The functional domain includes diagnoses, outcomes, and interventions that promote basic needs and includes the following eight classes:
  1. Activity/exercise: Physical activity, including energy conservation and expenditure.
  2. Comfort: A sense of emotional, physical, and spiritual well-being and relative freedom from distress.
  3. Growth/development: Physical, emotional, and social growth and developmental milestones.
  4. Nutrition: Processes related to taking in, assimilating, and using nutrients.
  5. Self-care: Ability to accomplish basic and instrumental activities of daily living.
  6. Sexuality: Maintenance or modification of sexual identity and patterns.
  7. Sleep/rest: The quantity and quality of sleep, rest, and relaxation patterns.
  8. Values/beliefs: Ideas, goals, perceptions, and spiritual and other beliefs that influence choices or decisions.
 
The Physiologic Domain
The physiologic domain includes diagnoses, outcomes, and interventions to promote optimal biophysical health and includes the following ten classes:
  1. Cardiac function: Cardiac mechanisms used to maintain tissue perfusion.
  2. Elimination: Processes related to secretion and excretion of body wastes.
  3. Fluid/electrolyte: Regulation of fluid/electrolytes and acid-base balance.
  4. Neurocognition: Mechanisms related to the nervous system and neurocognitive functioning including memory, thinking, and judgment.
  5. Pharmacologic function: Effects (therapeutic and adverse) of medications or drugs and other pharmacologically active products.
  6. Physical regulation: Body temperature, endocrine, and immune system responses to regulate cellular processes.
  7. Reproduction: Processes related to human procreation and birth.
  8. Respiratory function: Ventilation adequate to maintain arterial blood and gases within normal limits.
  9. Sensation/perception: Intake and interpretation of information through the senses including seeing, hearing, touching, tasting, and smelling.
  10. Tissue integrity: Skin and mucous membrane, protection to support secretion, excretion, and healing.
 
The Psychosocial Domain
The psychosocial domain includes diagnoses, outcomes, and interventions to promote optimal mental and emotional health and social functioning and includes the following seven classes:
  1. Behavior: Actions that promote, maintain or restore health.11
  2. Communication: Receiving, interpreting and expressing spoken, written, and nonverbal messages.
  3. Coping: Adjusting or adapting to stressful events.
  4. Emotional: A mental state of feeling that may influence perceptions of the world.
  5. Knowledge: Understanding and skill in applying information to promote, maintain, and restore health.
  6. Roles/relationships: Maintenance and/or modification of expected social behaviors and emotional connectedness with others.
  7. Self-perception: Awareness of one's body and personal identity.
 
The Environmental Domain
The environmental domain includes diagnoses, outcomes, and interventions that promote and protect the environmental health and safety of individuals, systems, and communities and includes the following three classes:
  1. Health care system: Social, political, and economic structures and processes for delivery of health care services.
  2. Populations: Aggregates of individuals or communities having characteristics in common.
  3. Risk management: Avoidance or control of identifiable health threats.
 
Diagnosis Statement (PES Format)
P – The problem
E – Etiology
S – The signs and symptoms/defining characteristics
The cause of the problem is usually stated using the term related to (due to can be used if the etiology is very sure).
S component can be connected to E statement through the use of the phrase as evidenced by, e.g. pain related to surgery as evidenced by facial expression, oral comments, body posture. Self care deficit related to decreased activity tolerance as evidenced by pain or discomfort depression, immobility.
For example, ineffective breathing pattern related to bronchospasm.
 
Comparison of Medical Diagnosis and Nursing Diagnosis (Commonalities and Differences)
  • Medical diagnosis focus on the disease process, e.g. pneumonia, myocardial infarction where an nursing diagnosis focus on the patients response to the disease, e.g. pain related to cough, chest pain related to myocardial is chewing.
  • Physicians place primary emphasis on identifying the current problem whereas in nursing diagnosis. Both the current and potential problems are also identified.
  • The purpose of making a medical diagnosis and a nursing diagnosis is the same, i.e. planning the care of the patient.
  • The same basic procedures are used to decide the diagnosis, i.e. physical assessment, interviewing, etc.
  • There may be only one medical diagnosis each medical diagnosis will have a number of nursing diagnosis.
 
Guidelines for Writing a Nursing Diagnosis
  • The nursing diagnosis is clear and concise. Clarity and conciseness facilitates communication among the health of the team members. The following terms are helpful in writing the diagnosis.
    For example: Alteration of, impairment of, lack of, difficulty in, deficit in, inadequate, diminished, inability, discomfort, potential for, failure to, insufficient, disturbance in. Adjectives that may be helpful in clarifying are severe, acute, chronic, intermittent, mild, maximum, minimum, moderate complete, partial.
  • The nursing diagnosis is client centered, specific and accurate.
  • The nursing diagnosis may be a descriptive statement, e.g. inability to sleep.
  • The nursing diagnosis may be expressed as an etiological statement. One health problem may be related to several etiological factors, e.g. inability to sleep may be related to many factors.
  • The nursing diagnosis provides direction for nursing interventions, e.g. impaired bowel movement related to decreased fluid intake/inactivity.
  • Each diagnosis should confirm only problem.
 
Planning
It is the act of determining what can be done to assist the patient to solve his problem. It involves the development of a nursing plan based on the nursing diagnosis.
 
Planning is a Continuous Process
Planning involves the following activities:
  • Setting priority
  • Establishing objectives—short-term and long-term
  • Determining nursing intervention.
 
Setting Priority
Once the problems are identified they are placed in the order of importance. It is not possible to attend all the problems at the same time. So we have to decide which problem should be attended first. Actual and life threatening problems are given high priority. Maslow's hierarchy of needs provides one framework for prioritizing problems with importance being given first to physical needs. Once the basic needs are met, the higher level needs can be addressed.12
 
Establishing Objectives
The identification of patients problems lead to the development of goals or expected outcome to be attained by the patient. The goals should be realistic and attainable. The goals are patient centered and stated in terms of expected outcome. The expected outcome describe the behavior the patient is expected to obtain.
Short-term goals may be attained immediately whereas long-term goals takes a period of time.
A nursing objective is a short statement that describes in detailed behavioral terms, the expected outcome towards which specified nursing intervention is planned.
 
Characteristics of Objectives
  • Nursing objectives are specific to a particular patient at a particular time
  • Objectives are patient centered written in terms of patients behavior
  • Objectives are written in simple, clear and concise language
  • Objectives are known to the patient.
After establishing objectives the next step is to determine the nursing interventions which will help the patient to attain the expected outcome.
Nursing interventions (nursing orders) are planned nursing actions, recorded in the nursing care plan which will help to solve the patient's problems and to achieve the nursing objectives. Nursing orders should include a specific description (what, where, when, how much, how long,) and how the order should be carried out.
Nursing care plan is a written document that states the nursing interventions planned for a particular patient. A nursing care plan is written to facilitate the implementation of the nursing interventions.
There is no single correct format for nursing care plan. Format is developed suitable to the situation in which they are to be used.
Guidelines for writing nursing care plans
  • Nursing care plans should focus on nursing problems and have a nursing approach.
  • Nursing care plans are short and concise.
  • It shows the patients’ needs and problems.
  • The plan is dated and contain the signature of the responsible nurse.
  • The nursing orders are renewed and updated periodically.
  • The nursing interventions should be appropriate to the expected outcome.
  • Plan should be flexible and subject to revision if the approaches are to be effective.
  • Plans are written in terms of patient behavior.
  • Plan includes preventive promotional and rehabilitative aspects of care, e.g. preventive turn the patient every 2 hours to prevent bedsore.
Promotive: Teach the patient about balanced diet to maintain adequate nutrition.
Rehabilitative: Assist the patient to ROM exercise in every 2 hours.
Plans for the patient's future are included. Discharge plan, health education, etc.
 
Advantages of Writing Nursing Care Plan
  • A well written plan gives direction and guidance to nursing action.
  • It is a source of information take who are concerned with the care of a patient
  • It provides for continuity of care
  • Facilitates individualized patient care
 
Implementation
The implementation phase is the execution of the proposed plan of nursing care.
  • Factors that must be considered for implementation
    • Based on scientific principles and theory
    • Must be individualized
    • Provide for safety and comfort
    • Provide for privacy
    • Provide for patient participation.
  • Areas of nursing implementation includes
    • Health maintenance, health promotion, prevention of illness
    • Restoration of health and rehabilitation.
  • Types of nursing actions includes
    • Dependent actions
    • Interdependent actions
    • Independent actions.
  • Types of implementation: Although many nursing actions are independent, others are interdependent such as carrying out prescribe treatments, administering medication and the therapies and collaborating with other health care team members.
    • The intervention include direct patient care.
    • Supervision of care, coordination of care. Health teaching counseling and providing safety and comfort and referral services.
 
Documentation
It is an important component of the nursing process. Patient assessments, observations and all nursing interventions should be charted as a permanent part of the patient's medical record, which is a legal record. Documentation helps to achieve continuity of care because it provides for communication among caregivers and is a 13record of the patient's progress. In addition, documentation provides a legal record of care provided and a means to verify services rendered for insurance payments.
The following should be documented:
  • All treatments and care given, including medications
  • Diagnostic procedures performed at the bedside, on the unit, or inside or outside the facility
  • The patient's reaction to therapeutic and diagnostic procedures
  • Observations of the patient
  • Subjective and objective signs and symptoms experienced by the patient
  • Evidence of changes in the patient's physical, psychosocial, and spiritual needs and status. Any unusual incidents such as falls or injuries that occur during the patient's stay in the health care facility.
Documentation should be factual, current, complete, organized, and accurate. Each page of the patient care sheet should have the patient's name and the date and time should be noted for each entry. Writing should be legible, using proper grammar, punctuation, and spelling. Fill all spaces, leaving no empty lines. Chart as soon after care is given as possible (never before care). Observations should be stated objectively, describing only what was seen, heard, felt, or smelled. Direct quotations from the patient regarding symptoms are very appropriate. Each time an entry is made, sign with your full name and title. Use only permanent ink, and make no use of erasers. If you make an error in charting, cross out the entry and write ‘error’ or ‘mistaken entry,’ followed by your initials. Increasingly,(patient records are entered and maintained in computerized charting systems. Some systems like COW (computer on wheels) allow documentation at the patient's bedside. Nurses’ notes may be composed by selecting from a menu of options related to the plan of care. Advantages of computerized charting include standardization of patient data, ease of retrieving data, and convenient storage. One disadvantage is the risk of information access by unauthorized persons.
 
Documentation Formats
Various formats are used for the documentation of patient care, including nurses’ notes, flow sheets, and problem-oriented medical records (POMR). Nurses’ notes traditionally consisted of pages of narrative recordings containing assessment data, interventions carried out by the nurse, and evaluation data collected.
The POMR is a method of record keeping that focuses on the patients problems. The data from the history, physical examination, diagnostic tests and medical diagnosis provide a foundation for problems formulated in the POMR.
SOAPIER is one format for charting.
S – Subjective information, how the patient perceives the problem.
O – Objective information, what the nurse observes about the patient.
A – Assessment, why the patient has the problem.
P – Plan or how the intervention is to be carried out.
I – Intervention or what specific care is given.
E – Evaluation, how effective was the plan or intervention.
R – Revision, what changes should be made in the original plan of care.
PIE charting is another common format which include problem, intervention and evaluation.
 
Evaluation
Nursing evaluation is a planned systematic comparison of the patient's health status with the defined goals and objectives. It is an ongoing deliberate activity, involving the patient, the nurse and other health members.
Possible outcomes of evaluation:
  • The patient has responded as expected
  • Short-term goals are achieved, but long-term goals are not yet
  • Goals are not attained
  • New problems have raised.
 
Guidelines for Evaluation
  • The nurse continuously monitors and reassess the client's response to nursing actions.
  • The client's response to nursing implementation is compared with the objectives to determine the extent to which the objectives have been achieved.
  • The clients progress or lack of progress toward goal attainment is determined
  • The nursing care plan is revised when the objectives are not adequately met (on the basis of evaluation).
 
Areas/Aspects to be Evaluated
Structure: Refers to the physical facilities, equipment, services, organizational pattern etc. Assess the facilities of the unit are adequate to provide the nursing care, whether staff is adequate and competent, whether equipment, adequate materials and supplies are available.
Process: Focuses on the nurses activities. Nursing actions within each component of the nursing process are to be evaluated. The following questions can be asked.
  • Was the nursing actions appropriate?
  • Was the techniques effective?
  • Were the nursing action implemented efficiently?
  • The nurse's activities are judged by observing nurses performance, reviewing nurse's notes and asking the clients outcome.14
Outcome: Refers to the changes in the clients behavior which include
  • Psychological responses
  • Knowledge gained as a result of education.
NURSING ASSESSMENT
 
INTRODUCTION
Health assessment of patients falls under the purview of both physicians and nurses.
 
GENERAL HEALTH ASSESSMENT
The nursing health assessment is an incredibly valuable tool nurses have in their collection of skills. Health assessment helps to identify, patient's symptoms and to discover any associated physical findings that will aid in the development of differential diagnoses. Assessment uses both subjective and objective data. Subjective assessment factors are those that are reported by the patient. Objective assessment data includes that which is observable and measurable.
 
Types of General Health Assessments
In general, there are four fundamental types of assessments that nurses perform:
  1. A comprehensive or complete health assessment: A comprehensive or complete health assessment usually begins with obtaining a thorough health history and physical examination. This type of assessment is usually performed in acute care settings on admission, once your patient is stable, or when a new patient presents to an outpatient clinic.
  2. An interval or a brief assessment: If the patient has been under your care for some time, a complete health history is usually not indicated. Nurses perform an interval or short assessment at this time. These assessments are usually performed at subsequent visits in an outpatient setting, at change of shift, when returning from tests, or upon transfer into the unit from another in-house unit.
  3. A problem-focused assessment: The third type of assessment is a problem-focused assessment. The problem-focused assessment is usually indicated after a comprehensive assessment has identified a potential health problem.
  4. An assessment for special populations: The fourth type of assessment is the assessment for special populations, including:
    • Pregnant women
    • Infants
    • Children
    • The elderly.
 
Assessment Techniques
Four basic techniques during physical examinations: inspection, auscultation, percussion, and palpation. These techniques should be used in an organized manner from least disturbing or invasive to most invasive to the patient.
 
Health History
The purpose of obtaining a health history is to assess patient's symptoms and how they developed. A complete history will serve as a guide to help identify potential or underlying illnesses or disease states. In addition to obtaining data about the patient's physical status, you will obtain information about many other factors that impact your patient's physical status including spiritual needs, cultural idiosyncrasies, and functional living status. The basic components of the complete health history (other than biographical information) include:
  • Chief complaint
  • Present health status
  • Past health history
  • Current lifestyle
  • Psychosocial status
  • Family history
  • Review of systems.
 
Communication and IPR
Communication during the history and physical examination must be respectful and performed in a culturally-sensitive manner. Privacy is vital, and the healthcare professional needs to be aware of posture, body language, and tone of voice while interviewing the patient.
A review of systems can be incorporated during physical examination. While examining each body system, it is appropriate to ask certain questions that pertain to that system.
 
Nutritional Assessment
Nutritional assessment is the systematic process of collecting and interpreting information in order to make decisions about the nature and cause of nutrition related health issues that affect an individual.
The nutritional status of an individual is often the result of many inter-related factors. It is influenced by food intake, quantity and quality, and physical health. The spectrum of nutritional status spread from obesity to severe malnutrition.
 
Objectives of Nutritional Assessment
  • Identify individuals or population groups at risk of becoming malnourished
  • Identify individuals or population groups who are malnourished15
  • To develop health care programs that meet the community needs which are defined by the assessment
  • To measure the effectiveness of the nutritional programs and intervention once initiated.
 
Methods of Nutritional Assessment
Nutrition is assessed by two types of methods; direct and indirect.
The direct methods deal with the individual and measure objective criteria, while indirect methods use community health indices that reflects nutritional influences.
 
Direct Methods of Nutritional Assessment
These are summarized as ABCD
  • Anthropometric methods
  • Biochemical, laboratory methods
  • Clinical methods
  • Dietary evaluation methods.
 
Indirect Methods of Nutritional Assessment
These include three categories:
  • Ecological variables including crop production
  • Economic factors, e.g. per capita income, population density and social habits
  • Vital health statistics particularly infant and under 5 mortality and fertility index.
 
ANTHROPOMETRIC METHODS
Anthropometry is the measurement of body height, weight and proportions.
It is an essential component of clinical examination of infants, children and pregnant women.
It is used to evaluate both under and over nutrition.
The measured values reflects the current nutritional status and do not differentiate between acute and chronic changes.
 
Anthropometric Measurements
  • Mid-arm circumference
  • Skin fold thickness
  • Head circumference
  • Head/chest ratio
  • Hip/waist ratio.
 
Measurements for Adults
 
Height
The subject stands erect and bare footed on a stadiometer with a movable head piece. The head piece is leveled with skull vault and height is recorded to the nearest 0.5 cm.
 
Weight Measurement
  • Use a regularly calibrated electronic or balanced-beam scale. Spring scales are less reliable.
  • Weigh in light clothes, no shoes
  • Read to the nearest 100 g (0.1 kg).
 
Nutritional Indices in Adults
  • The international standard for assessing body size in adults is the body mass index (BMI)
  • BMI is computed using the following formula: BMI = Weight (kg)/ Height (m2)
  • Evidence shows that high BMI (obesity level) is associated with type 2 diabetes and high risk of cardiovascular morbidity and mortality
  • BMI (WHO - Classification)
  • BMI < 18.5 = Underweight
  • BMI 18.5–24.5= Healthy weight range
  • BMI 25–30 = Overweight (grade 1 obesity)
  • BMI > 30–40 = Obese (grade 2 obesity)
  • BMI > 40 =Very obese (morbid or grade 3 obesity)
  • Waist/hip ratio
Waist circumference is measured at the level of the umbilicus to the nearest 0.5 cm.
The subject stands erect with relaxed abdominal muscles, arms at the side, and feet together.
The measurement should be taken at the end of a normal expiration.
 
Waist Circumference
Waist circumference predicts mortality better than any other anthropometric measurement.
It has been proposed that waist measurement alone can be used to assess obesity, and two levels of risk have been identified.
Males
Females
Level 1
> 94 cm
> 80 cm
Level 2
> 102 cm
> 88 cm
Level 1 is the maximum acceptable waist circumference irrespective of the adult age and there should be no further weight gain.
Level 2 denotes obesity and requires weight management to reduce the risk of type 2 diabetes and CVS complications.
 
Hip Circumference
It is measured at the point of greatest circumference around hips and buttocks to the nearest 0.5 cm.
The subject should be standing and the measurer should squat beside him.
Both measurement should be taken with a flexible, non-stretchable tape in close contact with the skin, but without indenting the soft tissue.16
 
Interpretation of Waist-hip Ratio (WHR)
  • High risk WHR = > 0.80 for females and > 0.95 for males, i.e. waist measurement > 80% of hip measurement for women and > 95% for men indicates central (upper body) obesity and is considered high risk for diabetes and CVS disorders.
  • A WHR below these cut-off levels is considered low risk.
 
Advantages of Anthropometry
  • Objective with high specificity and sensitivity.
  • Measures many variables of nutritional significance [height (Ht), weight (Wt), mid-arm circumference (MAC), head circumference (HC), skin fold thickness, waist and hip ratio and BMI].
  • Readings are numerical and gradable on standard growth charts.
  • Readings are reproducible.
  • Non-expensive and need minimal training.
 
Biochemical Assessment
  • Initial laboratory assessment
    • Hemoglobin estimation is the most important test, and useful index of the overall state of nutrition. Beside anemia it also tells about protein and trace element nutrition.
    • Stool examination for the presence of ova and/or intestinal parasites
  • Urine dipstick and microscopy for albumin, sugar and blood
  • Specific lab tests
    • Measurement of individual nutrient in body fluids (e.g. serum retinol, serum iron, urinary iodine, vitamin D)
    • Detection of abnormal amount of metabolites in the urine (e.g. urinary creatinine/hydroxyproline ratio)
    • Analysis of hair, nails and skin for micro-nutrients.
 
CLINICAL ASSESSMENT
It is an essential features of all nutritional surveys.
  • It is the simplest and most practical method of ascertaining the nutritional status of a group of individuals. It utilizes a number of physical signs, (specific and non-specific), that are known to be associated with malnutrition and deficiency of vitamins and micronutrients.
  • General clinical examination, with special attention to organs like hair, angles of the mouth, gums, nails, skin, eyes, tongue, muscles, bones, and thyroid gland.
  • Detection of relevant signs helps in establishing the nutritional diagnosis.
 
Clinical History
A person's disease state may increase the risk of malnutrition due to increased energy requirements; reduced energy intake; or increased nutritional losses. Examples of diseases/conditions where this may occur include:
  • Cancer
  • Chronic obstructive pulmonary disease
  • Heart failure
  • Gastrointestinal disorders such as Crohn's disease, liver disease, coeliac disease
  • Neurological conditions such as stroke, Motor Neurone Disease, Parkinsons Disease, multiple sclerosis, dementia
  • Burns, surgery or trauma
  • Mental health conditions (such as depression).
Symptoms that may impact on a person's nutritional status either through reducing nutritional intake or increasing nutritional losses include:
  • Altered bowel movements, e.g. diarrhea, constipation
  • Upper gastrointestinal upset, e.g. reflux, bloating, nausea, and vomiting
  • Early satiety
  • Dysphagia
  • Lethargy.
 
DIETARY ASSESSMENT
Good nutritional history should be obtained. An estimation of the total daily calorie intake, as well as overall quality of diet should be assessed. Asking the patient (or their family/care giver if patient unable) about their daily dietary intake will help understand patterns of eating, portion sizes, cooking methods and types of food and drink taken. Consider asking the following questions to help form a better understanding of the patients’ overall diet:
  • What is the patients’ typical food and fluid intake? This can be recorded using food record charts; 24-hour recall; 3-day food diary; or typical day diet history.
  • Is the patient eating 3 meals a day?
  • Do they have dessert after at least one meal per day?
  • Are they eating snacks in between meals?
  • Are they eating smaller meals than they used to when they were feeling well?
  • Are they having regular drinks, at least 6–8 glasses of fluid/day?
  • Are they having nutritious drinks such as milky tea/coffee, fruit juice, milky drinks?
  • Are they having carbohydrate foods (bread, potatoes, pasta, rice, breakfast cereals, etc.) and protein foods (meat, cheese, beans, egg, fish, milk and yoghurt) at each meal time? Portion sizes should be at least the size of the patient's fist and amount to 1/3 each on the plate (carbohydrate, protein, vegetables).17
  • Are they eating at least one portion of fruit or vegetable each day?
  • If food is being blended, are they adding nutritious liquids such as milk, cream or gravy to aid blending, rather than water?
  • Are they able to cook for themselves?
  • Do they have a hot/cooked meal each day?
  • Are they taking any nutritional supplements? Do they take them as recommended? Do they like them?
Nutritional intake of humans is assessed by five different methods. These are:
  1. 24 hours dietary recall
  2. Food frequency questionnaire
  3. Dietary history since early life
  4. Food dairy technique
  5. Observed food consumption
 
24 Hours Dietary Recall
A trained interviewer asks the subject to recall all food and drink taken in the previous 24 hours.
It is quick, easy, and depends on short-term memory, but may not be truly representative of the person's usual intake.
 
Food Frequency Questionnaire
In this method the subject is given a list of around 100 food items to indicate his or her intake (frequency and quantity) per day, per week and per month.
 
Dietary History
It is an accurate method for assessing the nutritional status.
The information should be collected by a trained interviewer.
Details about usual intake, types, amount, frequency and timing needs to be obtained.
Cross-checking to verify data is important.
 
Food Dairy
Food intake (types and amounts) should be recorded by the subject at the time of consumption.
The length of the collection period range between 1–7 days.
Reliable but difficult to maintain.
 
Observed Food Consumption
  • The most unused method in clinical practice, but it is recommended for research purposes.
  • The meal eaten by the individual is weighed and contents are exactly calculated.
  • The method is characterized by having a high degree of accuracy but expensive and needs time and efforts.
  • Interpretation of Dietary Data.
 
Qualitative Method
  • Using the food pyramid and the basic food groups method.
  • Different nutrients are classified into 5 groups (fat and oils, bread and cereals, milk products, meat-fish-poultry, vegetables and fruits)
  • Determine the number of serving from each group and compare it with minimum requirement.
 
Quantitative Method
  • The amount of energy and specific nutrients in each food consumed can be calculated using food composition tables and then compare it with the recommended daily intake.
  • Evaluation by this method is expensive and time consuming, unless computing facilities are available.
 
Fluid Requirement
Aged >60 years = 30 mL/kg body weight
Aged <60 years = 35 mL/kg body weight (Todorovic and Micklewright, 2011)
 
CONCLUSION
To conclude the nursing process is a road map for planning and providing comprehensive nursing care. It is the critical thinking ability of the nurse that makes the nursing process scientifically sound, flexible appropriate and individualized.
Obtaining a concise and effective health history and physical exam takes practice. It is not enough to simply ask questions and perform a physical exam. As the patient's nurse, you must critically analyze all of the data you have obtained, synthesize the data into relevant problem focuses, and identify a plan of care for your patient based upon this synthesis.
As the plan of care is being carried out, reassessments must occur on a periodic basis. The frequency of reassessments is unique to each patient based upon their diagnosis.
The ability of the nurse to efficiently and effectively obtain the health history and physical exam will ensure that appropriate plan of care will be enacted for all patients.18
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