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NurseThink ® for Students The NoteBook 3 rd Edition Tim J. Bristol PhD, RN, CNE, ANEF, FAAN Karin J. Sherrill RN, MSN, CNE, ANEF, FAADN Next Gen Learning for Clinical Judgment Create a Habit of Prioritizing Care and Integrating Safety Clinical-Based Learning Helps Save Time Studying Clinical judgment is the action that comes after applying critical thinking and clinical decision making. The NoteBook teaches students at all levels to develop habits of clinical judgment. Note Taking for Every Class, Lab/Sim, and Clinical SAMPLE ONLY – Not for Use/Resale

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NurseThink® for Students

The NoteBook3rd Edition

Tim J. Bristol PhD, RN, CNE, ANEF, FAANKarin J. Sherrill RN, MSN, CNE, ANEF, FAADN

Next Gen Learning for Clinical Judgment

Create a Habit of Prioritizing Care and Integrating Safety

Clinical-Based Learning

Helps Save Time Studying

Clinical judgment is the action that comes after applying critical thinking and clinical decision making. The NoteBook teaches students at all levels to develop habits of clinical judgment.

Note Taking for Every Class, Lab/Sim, and Clinical

SAMPLE O

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Use

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ale

The NoteBook

NurseThink.comNurseThink.com/adopt

NurseThink.com/samplesFollow us on Facebook and Instagram!

NurseThink® for Students The NoteBook

Note Taking That Works!3rd Edition

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Tim Bristol, PhD, RN, CNE, ANEF, FAAN Faculty - Walden University

Minneapolis, Minnesota

Karin J. Sherrill, MSN, RN, CNE, ANEF, FAADNFaculty - Maricopa Community Colleges

Phoenix, Arizona

*Faculty—For information on adopting The NoteBook as a required or recommended text, contact [email protected]. Adoptions are available for all levels of the nursing program.SAMPLE

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4Learn Right the First TimeNurseThink.com

Copyright © 2019 by NurseTim, Inc. All rights reserved. No reproduction or distribution allowed.

The NoteBookADAPTATION – STRESS, COPING, ADDICTION, VIOLENCE . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11

Child Abuse . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13 Crisis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 15

Domestic Violence. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 17Eating Disorders . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 19

Anorexia. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 21Bulimia Nervosa. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 23

Elder Abuse . . . . . . . . . . . . . . . . . . . . . . . 25Obsessive-Compulsive Disorder . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 27Post-Traumatic Stress Disorder (PTSD) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 29Rape and Sexual Assault. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 31Substance Abuse . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 33

Alcohol Abuse. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 35Drug Abuse . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 37Nicotine Abuse !Q . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 39Prescription Medication Abuse . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 41

Workplace Violence . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 43

CIRCULATION – PERFUSION, CLOTTING . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 45Arterial Disease

Arteriosclerosis. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 47Buerger’s/Raynaud’s Q . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 49

Coagulation DisordersDisseminated Intravascular Coagulation (DIC) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 51Embolic Stroke . . . . . . . . . . . . . . . . . . . . . 53Hemorrhagic Stroke . . . . . . . . . . . . . . . 55Pulmonary Embolism . . . . . . . . . . . . . . 57

Heart Disease !Acute Coronary Syndrome . . . . . . . . . . . . . . . . . . . . . . 59Atherosclerosis ! . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 61Cardiomyopathy Q. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 63Heart Failure !Q . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 65Hypertension !Q . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 67Myocardial Infarction Q. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 69Valve Disease Q . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 71

Peripheral Vascular DiseaseDeep Vein Thrombosis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 73

ShockCardiogenic Shock . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 75Hypovolemic Shock. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 77Septic Shock . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 79

CLIENT PREFERENCE AND PROFILE – CULTURE, SPIRITUALITY, DEVELOPMENT, DYNAMICS. . . . . . . . . . . . . . . . . . . . 81 Culture . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 83 Diversity. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 85

Family Dynamics . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 87Growth and Development

Infant ! . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 89Toddler . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 91Preschool Child . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 93School-Age Child . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 95Adolescent . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 97

Health Promotion . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 99 Spirituality . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 101

COGNITION – FUNCTION, PSYCHOSIS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .103

CONTENTS

!= High Frequency Patient Alerts from AARP, AHRQ, CDC and Healthy People 2030 Q = NurseThink® Quick!

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The NoteBook CONTENTS

Acute and Chronic DisordersConfusion Q . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 105Dementia and Alzheimer’s !Q . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 107Psychosis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 109

COMFORT – PAIN, TISSUE INTEGRITY . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .111 Pain

Acute Pain !. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 113Chronic Pain ! . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 115

Rest !Fatigue . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 117Sleep Disorders . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 119

SkinContact Dermatitis Q . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 121

WoundsBurns . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 123Pressure Ulcers Q . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 125

EMOTION – MOOD, ANXIETY, GRIEF . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .127 Grief

Bereavement . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 129 Loss

Death and Dying . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 131Psychobiological Disorders

Bipolar Disorder . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 133Depression ! . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 135Psychosis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 137Schizophrenia . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 139

HOMEOSTASIS – ACID-BASE, FLUID, ELECTROLYTES Q . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .141Acid-Base Imbalance

Metabolic Acidosis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 143Metabolic Alkalosis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 145Respiratory Acidosis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 147Respiratory Alkalosis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 149

Electrolytes ImbalanceHyper/Hypocalcemia Q . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 151Hyper/Hypokalemia Q . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 153Hyper/Hypomagnesemia. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 155Hyper/Hyponatremia Q . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 157Hyper/Hypophosphatemia . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 159

Fluid ImbalanceDehydration. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 161Fluid Overload . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 163

MOVEMENT – MOBILITY, SENSORY, NERVE CONDUCTION Q . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .165Musculoskeletal Disorders

Amputation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 167Carpal Tunnel Q . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 169Fractures !Q . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 171Osteoarthritis ! . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 173Osteoporosis ! . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 175Restless Leg Q. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 177

Nervous System DisordersAmyotrophic Lateral Sclerosis Q . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 179Attention-Deficit/Hyperactivity Disorder . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 181

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The NoteBook CONTENTS

Cerebral Palsy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 183Guillain-Barre’ . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 185Multiple Sclerosis Q . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 187Myasthenia Gravis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 189Parkinson’s Disease Q . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 191Peripheral Neuropathy. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 193Seizures Q . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 195Spina Bifida. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 197Trigeminal Neuralgia. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 199

SensoryCataracts !Q . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 201Conjunctivitis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 203Glaucoma ! . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 205Hearing Impairment ! . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 207Labyrinthitis/Meniere’s . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 209Macular Degeneration !. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 211Otitis Media . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 213

PROTECTION – IMMUNITY, INFLAMMATION, INFECTION. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .215Gastrointestinal Disorders

Appendicitis Q . . . . . . . . . . . . . . . . . . . . 217Gallbladder Disease Q . . . . . . . . . . . . 219Inflammatory Bowel Disease . . . . . . 221Pancreatitis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 223

General Infections and ComplicationsInfluenza . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 225

Septicemia ! . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 227 Healthcare-Associated Infections ! . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 229

Methicillin-Resistant Staphylococcus Aureus . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 231 Vancomycin-Resistan Ent terococci . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 233

Hypersensitivity Reactions Q . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 235Immune Disorders

Fibromyalgia . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 237HIV/AIDS !Q . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 239Lupus Q . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 241Rheumatoid Arthritis !Q . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 243

Kidney Urinary DisordersCystitis. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 245Polycystic Kidney . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 247Pyelonephritis. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 249Urinary Tract Infection !Q . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 251

Nervous System DisordersMeningitis/Encephalitis. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 253

Respiratory System DisordersBronchiolitis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 255Epiglottitis. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 257Pneumonia !Q. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 259Tuberculosis Q . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 261Upper Respiratory Infections ! . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 263

Skin and Bone DisordersCellulitis ! . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 265Gout Q . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 267

REGULATION I – THERMOREGULATION, CELLULAR REGULATION, INTRACRANIAL REGULATION . . . . . . . . . . . . .269Blood Cell Disorders !

Iron Deficiency Anemia . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 271

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The NoteBook ALPHABETICAL INDEX

Abruptio Placentae and Placenta Previa ...............................383Acute Pain ..........................................................................................113Acute Coronary Syndrome ............................................................59Acute Kidney Injury .......................................................................361ADAPTATION – STRESS, COPING, ADDICTION, VIOLENCE ..............................................................................................11Addison’s Syndrome/Disease ....................................................317Adolescent ...........................................................................................97Alcohol Abuse .....................................................................................35Amputation .......................................................................................167Amyotrophic Lateral Sclerosis ...................................................179Anorexia ................................................................................................21Appendicitis ......................................................................................217Arteriosclerosis ...................................................................................47Asthma ................................................................................................371Atherosclerosis ...................................................................................61Attention-Deficit/Hyperactivity Disorder .............................181Benign Prostatic Hypertrophy ...................................................363Bereavement ....................................................................................129Bipolar Disorder...............................................................................133Blood Administration ....................................................................421Bone Cancer ......................................................................................281Brain Tumor .......................................................................................283Breast Cancer ....................................................................................285Breastfeeding ...................................................................................409Bronchiolitis ......................................................................................255Buerger’s/Raynaud’s .........................................................................49Bulimia Nervosa .................................................................................23Burns ....................................................................................................123Cancer .................................................................................................279Cardiogenic Shock ............................................................................75Cardiomyopathy ................................................................................63Carpal Tunnel ...................................................................................169Cataracts.............................................................................................201Cellulitis ..............................................................................................265Central Line .......................................................................................423Cerebral Palsy ...................................................................................183Child Abuse ..........................................................................................13Chest Tube .........................................................................................425Chlamydia ..........................................................................................413Chronic Pain ......................................................................................115Chronic Kidney Disease/End Stage Renal Disease ............365Chronic Obstructive Pulmonary Disease ..............................373CIRCULATION – PERFUSION, CLOTTING ...................................45Cirrhosis ..............................................................................................311Cleft Lip or Palate ............................................................................355CLIENT PREFERENCE AND PROFILE – CULTURE, SPIRITUALITY, DEVELOPMENT, DYNAMICS ..............................81Clinical Hand-off (SBAR) ...............................................................427CLOTTING..............................................................................................45COGNITION – FUNCTION, PSYCHOSIS....................................103Colon Cancer ....................................................................................287Colostomy / Ileostomy..................................................................429COMFORT – PAIN, TISSUE INTEGRITY ......................................111Confusion ...........................................................................................105Conjunctivitis ...................................................................................203Contact Dermatitis .........................................................................121Crisis ........................................................................................................15

Crohn’s ................................................................................................321Culture ...................................................................................................83Cushing’s Syndrome/Disease .....................................................319Cystic Fibrosis ...................................................................................375Cystitis .................................................................................................245Death and Dying .............................................................................131Deep Vein Thrombosis .....................................................................73Dehydration ......................................................................................161Dementia and Alzheimer’s ..........................................................107Depression ........................................................................................135Diabetes Insipidus ..........................................................................347Diabetes Mellitus – Insulin Dependent .................................335Diabetes Mellitus – Non-Insulin Dependent .......................337Diabetic Ketoacidosis ....................................................................339Disseminated Intravascular Coagulation (DIC) ......................51Diversity .................................................................................................85Diverticular Disease .......................................................................323Domestic Violence.............................................................................17Drug Abuse ..........................................................................................37Dystocia ..............................................................................................397Eating Disorders .................................................................................19Elder Abuse ..........................................................................................25Embolic Stroke ....................................................................................53EMOTION – MOOD, ANXIETY, GRIEF .......................................127Epiglottitis .........................................................................................257Erectile Dysfunction ......................................................................395Fall Prevention .................................................................................431Family Dynamics ................................................................................87Fatigue ................................................................................................117Feeding Tube ....................................................................................433Fibromyalgia .....................................................................................237First Trimester ...................................................................................385Fluid Overload .................................................................................163Fourth Stage of Labor ...................................................................405Fractures .............................................................................................171Gallbladder Disease .......................................................................219Gastroesophageal Reflux/Gastritis ..........................................357Glaucoma ...........................................................................................205Gout .....................................................................................................267Growth and Development ......................................................89-99Guillain-Barre’ ...................................................................................185Health Promotion ..............................................................................99Healthcare-Associated Infections ............................................229Hearing Impairment ......................................................................207Heart Failure ........................................................................................65Postpartum Hemorrhage ............................................................411Hemorrhagic Stroke .........................................................................55Hepatitis .............................................................................................313HIV/AIDS .............................................................................................239Hodgkin’s ...........................................................................................289HOMEOSTASIS – ACID-BASE, FLUID, ELECTROLYTES........141Human Papillomavirus .................................................................415Hyper/Hypocalcemia ....................................................................151Hyper/Hypokalemia ......................................................................153Hyper/Hypomagnesemia ............................................................155Hyper/Hyponatremia ....................................................................157Hyper/Hypophosphatemia ........................................................159Hyperosmolar Hyperglycemic Nonketotic Syndrome .....341

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The NoteBook ALPHABETICAL INDEX

Hyperparathyroidism ....................................................................343Hypersensitivity Reactions .........................................................235Hypertension.......................................................................................67Hypertensive Disorders ................................................................391Hyperthermia ...................................................................................305Hyperthyroidism .............................................................................351Hypoparathyroidism .....................................................................345Hypothermia ....................................................................................307Hypothyroidism ..............................................................................353Hypovolemic Shock ..........................................................................77Increased Intracranial Pressure .................................................303Infant ......................................................................................................89Inflammatory Bowel Disease .....................................................221Influenza .............................................................................................225Intestinal Obstruction ...................................................................325Intravenous Therapy ......................................................................435Iron Deficiency Anemia ................................................................271Irritable Bowel ..................................................................................327Labor and Delivery ................................................................397-407Labyrinthitis/Meniere’s .................................................................209Leukemia ............................................................................................291Liver Disease .....................................................................................315Lung Cancer ......................................................................................293Lupus ...................................................................................................241Lymphoma ........................................................................................295Macular Degeneration ..................................................................211Medication Administration .........................................................437Meningitis/Encephalitis ...............................................................253Metabolic Acidosis .........................................................................143Metabolic Alkalosis ........................................................................145Metabolic Syndrome .....................................................................333Methicillin-Resistant Staphylococcus Aureus .....................231MOVEMENT – MOBILITY, SENSORY, NERVE CONDUCTION ..................................................................................165Multiple Myeloma ..........................................................................297Multiple Sclerosis ............................................................................187Myasthenia Gravis ..........................................................................189Myocardial Infarction .......................................................................69Newborn Care ..................................................................................407Nicotine Abuse ...................................................................................39Obesity ................................................................................................329Obsessive-Compulsive Disorder .................................................27Osteoarthritis ...................................................................................173Osteoporosis.....................................................................................175Otitis Media .......................................................................................213OXYGENATION .................................................................................369Pancreatitis ........................................................................................223Parkinson’s Disease ........................................................................191Pediatrics .............................................................................. 87-99, 407Peptic Ulcer .......................................................................................359PERFUSION ...........................................................................................45Peripheral Neuropathy .................................................................193Pneumonia ........................................................................................259Polycystic Kidney ............................................................................247Polycythemia ....................................................................................273Postoperative ...................................................................................439Post-Traumatic Stress Disorder (PTSD) ......................................29Pregnancy .................................................................................385-389

Preoperative .....................................................................................441Preschool Child ...................................................................................93Prescription Medication Abuse ....................................................41Pressure Ulcers .................................................................................125Preterm Labor ..................................................................................399Prostate Cancer ...............................................................................299PROTECTION – IMMUNITY, INFLAMMATION, INFECTION .........................................................................................215Psychosis (COGNITION–FUNCTION)........................................109Psychosis (EMOTION–Psychobiological) ...............................137Pulmonary Embolism.......................................................................57Pulmonary Hypertension ............................................................377Pyelonephritis ..................................................................................249Rape and Sexual Assault .................................................................31REGULATION I – THERMOREGULATION, CELLULAR REGULATION, INTRACRANIAL REGULATION ........................269REGULATION II – GLUCOSE REGULATION, METABOLISM, NUTRITION, ELIMINATION .............................309RESPIRATION – OXYGENATION, GAS EXCHANGE ...............369Respiratory Acidosis ......................................................................147Respiratory Alkalosis .....................................................................149Restless Leg .......................................................................................177Rheumatoid Arthritis.....................................................................243SAFETY: PROCEDURES ..................................................................419Schizophrenia ..................................................................................139School-Age Child ...............................................................................95Second Stage of Labor .................................................................401Second Trimester ............................................................................387Seizures ...............................................................................................195Septic Shock ........................................................................................79Septicemia .........................................................................................227Severe Acute Respiratory Syndrome ......................................379SEXUALITY – REPRODUCTION ...................................................381Sickle Cell Anemia ..........................................................................275Skin Cancer ........................................................................................301Sleep Disorders ................................................................................119Spina Bifida .......................................................................................197Spirituality .........................................................................................101Spontaneous Abortion .................................................................393Substance Abuse ...............................................................................33Suctioning .........................................................................................443Syndrome Inappropriate Antidiuretic Hormone ...............349Syphilis ................................................................................................417Third Stage of Labor ......................................................................403Third Trimester .................................................................................389Thrombocytopenia ........................................................................277Toddler ...................................................................................................91Tracheostomy...................................................................................445Trigeminal Neuralgia .....................................................................199Tuberculosis ......................................................................................261Ulcerative Colitis .............................................................................331Upper Respiratory Infections .....................................................263Urinary Catheter ..............................................................................447Urinary Tract Infection ..................................................................251Valve Disease .......................................................................................71Vancomycin-Resistant Enterococci .........................................233Wilms Tumor .....................................................................................367Workplace Violence ..........................................................................43

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The NoteBookRelated Concepts Related Exemplars/Diseases

Reading/Resources - Clinical Judgment

Priority Potential & Actual Complications

1

Class/Lab/Clinical – Clinical Judgment

Priority Collaborative Goals

1

Priority Assessments or Cues

1

2

3

Priority Labs & Diagnostics

1

2

3

Priority Nursing Interventions

1

2

3

Priority Medications

1

2

3

Concept: Circulation – Perfusion, Clotting

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46Learn Right the First TimeNurseThink.com

Copyright © 2019 by NurseTim, Inc. All rights reserved. No reproduction or distribution allowed.

The NoteBook

Peer Review: Faculty Review:

NurseThink® Quick

NEXT GEN LEARNING – NCLEX® TEST PLAN

QUALITY AND SAFETY COMPETENCIES

Safe and Effective Care: Management of Care, Coordinated Care, Safety and Infection Control

Health Promotion and Maintenance

Psychosocial Integrity

Physiological Integrity: Basic Care and Comfort, Pharmacological and Parenteral Therapies, Reduction of Risk Potential, and Physiological Adaptation

Patient-Centered Care

Teamwork and Collaboration

Evidence-Based Practice

Quality Improvement

Safety

Informatics

Grade Tracker

Concept: Circulation – Perfusion, Clotting

Abdominal Aortic Aneurism: Symptoms4A’sAsymptomaticAbdominal mass Abdominal pulse Aches in low back

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383Learn Right the First TimeNurseThink.com

Copyright © 2019 by NurseTim, Inc. All rights reserved. No reproduction or distribution allowed.

The NoteBookRelated Concepts Related Exemplars/Diseases

Reading/Resources - Clinical Judgment

Priority Potential & Actual Complications

1

Class/Lab/Clinical – Clinical Judgment

Priority Collaborative Goals

1

Priority Assessments or Cues

1

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Priority Labs & Diagnostics

1

2

3

Priority Nursing Interventions

1

2

3

Priority Medications

1

2

3

Abruptio Placentae and Placenta Previa

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384Learn Right the First TimeNurseThink.com

Copyright © 2019 by NurseTim, Inc. All rights reserved. No reproduction or distribution allowed.

The NoteBook

Peer Review: Faculty Review:

NurseThink® Quick

NEXT GEN LEARNING – NCLEX® TEST PLAN

QUALITY AND SAFETY COMPETENCIES

Safe and Effective Care: Management of Care, Coordinated Care, Safety and Infection Control

Health Promotion and Maintenance

Psychosocial Integrity

Physiological Integrity: Basic Care and Comfort, Pharmacological and Parenteral Therapies, Reduction of Risk Potential, and Physiological Adaptation

Patient-Centered Care

Teamwork and Collaboration

Evidence-Based Practice

Quality Improvement

Safety

Informatics

Grade Tracker

Abruptio Placentae and Placenta Previa

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NurseThink® for Students

The NoteBookNext Gen Clinical Judgment — Saves Time Studying

Learning how to learn is essential to the success of every nursing student. Since it is impossible to remember every fact, a clear and consistent process for managing information helps the student develop a deep understanding that applies in any clinical situation. NurseThink® for Students: The NoteBook is an easy-to-manage tool that applies clinical judgment when learning course content. This unique tool is ideal for class, reading, studying, collaboration, and lab and clinical preparation.

As a student begins using the NurseThink® NoteBook, they will use clinical judgment skills to prioritize information that is essential to obtain the desired client outcomes. Through a carefully designed process of application and analysis, long-term retention and, more importantly, the ability to adjust to a variety of situations, students create a habit of clinical judgment.

Finally, the NurseThink® NoteBook saves students and faculty time and energy. Having concepts visibly organized and quickly accessible allow for better outcomes. Time-savings is a necessity, and this system allows for more focused study.

Student Success Tools Include:

ý Best-Practice Study Tips

ý Strategies That Apply Prioritization Power

ý Client Needs Categories From the NCLEX® Test Plan

ý Next Gen Learning From NCLEX®

ý Quality and Safety Competencies

ý NurseThink® Quick Mnemonics

ý Class/Lab/Clinical — Clinical Judgment

ý Over 20 Nursing Concepts

ý Over 175 Disease Processes and Exemplars

ý High-Frequency Patient Alerts: AARP, AHRQ, CDC, NPSG, and Healthy People 2030

Learn Right the First Time.Save Time and Succeed!

Bonus Chapter focusing on safety using nationally recognized patient safety goals and standards.

9 780998 734767

90000ISBN 978-0-9987347-6-7

NurseThink® for Students: The NoteBook tutorials, videos, and additional resources are available at NurseThink.com. If you ever need help with your NurseThink® NoteBook, email [email protected].

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