Chapter Highlights (Chapter 1-8)
Critical Thinking – pg. lxviii
Independent nursing judgments and decisions evolve from a sound knowledge base and the
ability to synthesize information within the context in which it is presented.
Critical thinking enhances clinical decision making, helping to identify patient needs and the
best nursing actions that will assist patients in meeting those needs.
Ethical Nursing Care – pg. lxviii
Advance directives are legal documents that specify a person’s wishes before hospitalization
and provide valuable information that may assist health care providers in decision making. A
living will is one type of advance directive. Typically, living wills are limited to situations in
which the patient’s medical condition is deemed terminal. Because it is difficult to define
terminal accurately, living wills are not always honored. Another potential drawback is that
living wills are frequently written while people are in good health. It is not unusual for people to
change their minds as an illness progresses; therefore, patients retain the option to nullify
these documents.
Nursing Process: The Patient with Self-Care Deficits in Activities of Daily Living – pg. 37
An ADL program is started as soon as the rehabilitation process begins, because the ability to
perform ADLs is frequently the key to independence, return to the home, and transition into
the community.
Additional assessment should include gaining an understanding of the patient’s and family
members’ perspectives on the patient’s condition and how it affects functional ability. The
nurse should also be aware of the patient’s medical conditions or other health problems, the
effect that they have on the ability to perform ADLs, and the family’s involvement in the
patient’s ADLs. This information is valuable in setting goals and developing the plan of care to
maximize self-care.
Nursing Process: The Patient with Impaired Physical Mobility – pg. 48
An important goal of rehabilitation is to assist the patient to return to the home environment
after learning to manage the disability. A referral system maintains continuity of care when the
patient is transferred to the home or to a long-term care facility. The plan for discharge is
formulated when the patient is first admitted to the hospital, and discharge plans are made
with the patient’s functional potential in mind.
Home Health Nursing – pg. 51
The initial assessment includes evaluating the patient, the home environment (Chart 2-8), the
patient’s self-care abilities or the family’s ability to provide care, and the patient’s need for
additional resources.
Nursing Implications of Health Promotion – pg. 68
By virtue of their expertise in health and health care and their long-established credibility with
consumers, nurses play a vital role in health promotion. In many instances, they initiate health
promotion and health screening programs or participate with other health care personnel in
developing and providing wellness services in various settings.
Culturally Mediated Consideration – pg. 93
However, family members in some cultural backgrounds may believe that it is their
responsibility to protect and spare the patient (their loved one) knowledge about a terminal
illness. In some cultures, the head of the family group, older adult, or husband is expected to
receive all information and make decisions.
Research reveals that people from the United States, Canada, and Great Britain require the
most personal space between themselves and others, whereas those from Latin America,
Japan, and the Middle East need the least amount of space and feel comfortable standing close
to others
Culturally Mediated Consideration – pg. 94
For example, some Asians, Native Americans, Indo-Chinese, Arabs, and Appalachians may
consider direct eye contact impolite or aggressive, and they may avert their own eyes when
talking with nurses and others whom they perceive to be in positions of authority. Some Native
Americans stare at the floor during conversations—a cultural behavior conveying respect and
indicating that the listener is paying close attention to the speaker. Some Hispanic patients
maintain downcast eyes as a sign of culturally appropriate deferential behavior toward others
on the basis of age, gender, social position, economic status, and position of authority
However, for patients from some cultures, time is a relative phenomenon, with little attention
paid to the exact hour or minute.
In some cultures (e.g., Hispanic, Arab), male health care providers may be prohibited from
touching or examining certain parts of the female body. Similarly, it may be inappropriate for
females to care for males.
Among many Asians, it is impolite to touch a person’s head because the spirit is believed to
reside there.
Psychological Responses to Stress – pg. 100
Primary appraisal results in the situation being identified as either nonstressful or stressful.
Secondary appraisal is an evaluation of what might and can be done about the situation.
Reappraisal—a change of opinion based on new information—may occur.
The appraisal process contributes to the development of an emotion. Negative emotions such
as fear and anger accompany harm/loss appraisals, and positive emotions accompany
challenge.
Genetic Screening – pg. 127
Preconception/preimplantation screening Preconception screening may be done to test for
autosomal recessive inherited genetic conditions that occur with greater frequency among
individuals of certain ethnic groups; furthermore, through the use of in vitro fertilization,
embryos may be tested for specific genetic or chromosomal abnormalities Cystic fibrosis—all
couples, but especially northern European Caucasian and Ashkenazi Jewish Tay-Sachs disease—
Ashkenazi Jewish Sickle cell disease—African American, Puerto Rican, Mediterranean, Middle
Eastern Alpha-thalassemia—Southeast Asian, African American
Genetic and Genomics in Health Assessment – pg. 135
For example, a history of familial hypercholesterolemia would alert the nurse to assess for
symptoms of hyperlipidemias (xanthomas, corneal arcus, and abdominal pain of unexplained
origin). A family history of neurofibromatosis type 1, an inherited condition involving tumors of
the central nervous system, would prompt the nurse to carry out a detailed assessment of
closely related family members. Skin findings such as café-au-lait spots, axillary freckling, or
tumors of the skin (neurofibromas) would warrant referral for further evaluation, including
genetic evaluation and counseling