Lewis’s Medical–Surgical Nursing Assessment and Management of Clinical Problems 3rd edition
BdhWn ^hVc^beg^cid[:ahZk^Zg :ahZk^Zg6jhigVa^V#68C%%&%%'(*, VY^k^h^dcd[GZZY>ciZgcVi^dcVa7dd`h6jhigVa^VEinAiY IdlZg&!),*K^Xidg^V6kZcjZ!8]VihlddY!CHL'%+, I]^hZY^i^dc'%&':ahZk^Zg6jhigVa^V &hiZY^i^dc'%%*0'cYZY^i^dc'%%-:ahZk^Zg6jhigVa^V I]^hejWa^XVi^dc^hXdeng^\]i#:mXZeiVhZmegZhhanegdk^YZY^ci]Z8deng^\]i6Xi&.+- VcYi]Z8deng^\]i6bZcYbZci9^\^iVa6\ZcYV6Xi'%%%!cdeVgid[i]^hejWa^XVi^dc bVnWZgZegdYjXZY!hidgZY^cVcngZig^ZkVahnhiZbdgigVchb^iiZYWnVcnbZVch^cXajY^c\ ZaZXigdc^X!bZX]Vc^XVa!b^XgdXden^c\!e]didXden^c\!gZXdgY^c\dgdi]Zgl^hZl^i]djieg^dg lg^iiZceZgb^hh^dc[gdbi]ZejWa^h]Zg# :kZgnViiZbei]VhWZZcbVYZidigVXZVcYVX`cdlaZY\ZXdeng^\]i!Wji^chdbZXVhZh i]^hbVncdi]VkZWZZcedhh^WaZ#I]ZejWa^h]ZgVedad\^hZh[dgVcnVXX^YZciVa^c[g^c\ZbZci VcYldjaYlZaXdbZVcn^c[dgbVi^dcidgZYgZhhi]Zh^ijVi^dc# I]^hejWa^XVi^dc]VhWZZcXVgZ[jaangZk^ZlZYVcYX]ZX`ZYidZchjgZi]Vii]ZXdciZci^hVh VXXjgViZVcYXjggZciVhedhh^WaZVii^bZd[ejWa^XVi^dc#LZldjaYgZXdbbZcY!]dlZkZg!i]Vi i]ZgZVYZgkZg^[nVcnegdXZYjgZh!igZVibZcih!Ygj\YdhV\ZhdgaZ\VaXdciZciYZhXg^WZY^ci]^h Wdd`#CZ^i]Zgi]ZVji]dg!i]ZXdcig^Wjidgh!cdgi]ZejWa^h]ZgVhhjbZVcna^VW^a^in[dg^c_jgn VcY$dgYVbV\ZideZghdchdgegdeZginVg^h^c\[gdbVcnZggdg^cdgdb^hh^dc[gdbi]^hejWa^XVi^dc# CVi^dcVaA^WgVgnd[6jhigVa^V8ViVad\j^c\"^c"EjWa^XVi^dc9ViV TTTTTTTTTTTTTTTTTTTTTTTTTTTTTTTTTTTTTTTTTTTTTTTTTTTTTTTTTTTTTTTTTTT AZl^h¼hbZY^XVa"hjg\^XVacjgh^c\VhhZhhbZciVcYbVcV\ZbZci d[Xa^c^XVaegdWaZbh$9^VcZ7gdlc0=ZaZc:YlVgYh# (gYZY# .,-%,'.*(..*&]W`# >cXajYZh^cYZm# Cjgh^c\# Hjg\^XVacjgh^c\# 7gdlc!9^VcZ# :YlVgYh!=ZaZc# +&%#,( TTTTTTTTTTTTTTTTTTTTTTTTTTTTTTTTTTTTTTTTTTTTTTTTTTTTTTTTTTTTTTTTTTT EjWa^h]Zg/A^WWn=djhidc 9ZkZadebZciVa:Y^idg/:a^oVWZi]8dVYn EjWa^h]^c\HZgk^XZhBVcV\Zg/=ZaZcV@a^_c :Y^idg^Va8ddgY^cVidg/CViVa^Z=VbVY :Y^iZYWn8Vgda^cZ=jciZg Egdd[gZVYWnI^bAZVgcZg >cYZmZYWnB^X]VZa;ZggZ^gV 8dkZgVcY^ciZgcVaYZh^\cWn9VgWZc9Zh^\c IneZhZiWnB^YaVcYIneZhZiiZgh Eg^ciZY^c8]^cVWn8]^cVIgVchaVi^dcVcYEg^ci^c\HZgk^XZh
Contents The ‘Suite’ 00 Navigate by Colour/How to use this Book 00 Preface 00 Acknowlegdements 00 Contributors 00 Reviewers 00
;jcY^c\ ,+ 8VgZVaiZgcVi^kZh[dgdaYZgVYjaih ,, AZ\VaVcYZi]^XVa^hhjZh ,8jaijgVaanXdbeZiZciXVgZ/daYZgVYjaih ,. Cjgh^c\bVcV\ZbZci/daYZgVYjaih -%
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Teri A Murray (US); Debbie Kralik (ANZ) ;VXidgh^cÅjZcX^c\X]Vc\Z^ci]Z]ZVai]XVgZhnhiZb .( 8dbbjc^in"WVhZYcjgh^c\ .* 8dbbjc^inXVgZhZii^c\h .+ 8a^ZciXVgZ .. 8dbbjc^in"WVhZYcjgh^c\h`^aahVcYViig^WjiZh &%' =dhe^XZXVgZ &%'
SECTION ONE Concepts in nursing practice Paul Morrison 1
The importance of nursing 2 Patricia Graber O’Brien (US); Mary FitzGerald, John Field (ANZ) I]ZZkdaji^dcd[cjgh^c\VhVcZhhZci^VahZgk^XZ^c6jhigVa^V VcYCZlOZVaVcY ( Egd[Zhh^dcVaiZVbldg` ) Cjgh^c\`cdlaZY\Z . Cjgh^c\gZhZVgX] &' Cjgh^c\XVgZeaVcc^c\ &) 8dcXajh^dc &.
2
3
8
9
Health promotion and patient education 49
Palliative care 158 Margaret McLean Heitkemper, Cheryl Ross Staats (US); Ann Harrington, Meg Hegarty (ANZ) >cigdYjXi^dc &*EVaa^Vi^kZXVgZYZÄc^i^dch &*EVaa^Vi^kZXVgZXdciZmih &*. E]nh^XVabVc^[ZhiVi^dchVii]ZZcYd[a^[Z &+% EhnX]dhdX^VabVc^[ZhiVi^dchVii]ZZcYd[a^[Z &+& Y^deVi]^XejabdcVgnÄWgdh^h ++( HVgXd^Ydh^h ++( Vascular lung disorders 663 EjabdcVgndZYZbV ++( EjabdcVgnZbWda^hb ++( Cjgh^c\bVcV\ZbZci/ejabdcVgnZbWda^hb +++ Pulmonary hypertension 666 Eg^bVgnejabdcVgnVgiZg^Va]neZgiZch^dc +++ HZXdcYVgnejabdcVgn]neZgiZch^dc ++8dgejabdcVaZ ++Ajc\igVcheaVciVi^dc ++.
Nursing management: burns 543 Judy A Knighton (US); Joy Fong (ANZ) =ZVai]egdbdi^dc *)( IneZhd[Wjgc^c_jgn *)( 8aVhh^ÄXVi^dcd[Wjgc^c_jg^Zh *)+ Phases of burn management 548 EgZ"]dhe^iVaXVgZ *):bZg\Zcie]VhZ *)Cjgh^c\VcYXdaaVWdgVi^kZbVcV\ZbZci/ZbZg\Zci e]VhZ **' 6XjiZe]VhZ **. Cjgh^c\VcYXdaaVWdgVi^kZbVcV\ZbZci/VXjiZe]VhZ *+& GZ]VW^a^iVi^dce]VhZ *+) Cjgh^c\VcYXdaaVWdgVi^kZbVcV\ZbZci/gZ]VW^a^iVi^dc e]VhZ *+* :bdi^dcVacZZYhd[i]ZeVi^ZciVcY[Vb^an *++ HeZX^VacZZYhd[i]Zcjgh^c\hiV[[ *++
SECTION FIVE Problems of oxygenation: ventilation Bridie Kent 25
Nursing assessment: respiratory system 572 Jane Steinman Kaufman (US); Bridie Kent (ANZ) HigjXijgZhVcY[jcXi^dchd[i]ZgZhe^gVidgnhnhiZb *,' 6hhZhhbZcid[i]ZgZhe^gVidgnhnhiZb *-% 9^V\cdhi^XhijY^Zhd[i]ZgZhe^gVidgnhnhiZb *-.
26
Nursing management: upper respiratory tract problems 597 Valerie Bender Howard (US); Jane Clarke (ANZ) Structural and traumatic disorders of the nose 597 9Zk^ViZYcVhVahZeijb *., CVhVa[gVXijgZ *., G]^cdeaVhin *.Cjgh^c\bVcV\ZbZci/cVhVahjg\Zgn *.:e^hiVm^h *.Cjgh^c\VcYXdaaVWdgVi^kZbVcV\ZbZci/Ze^hiVm^h *.Inflammation and infection of the nose and paranasal sinuses 599 6aaZg\^Xg]^c^i^h *.. Cjgh^c\VcYXdaaVWdgVi^kZbVcV\ZbZci/VaaZg\^Xg]^c^i^h *.. 6XjiZk^gVag]^c^i^h +%' Cjgh^c\VcYXdaaVWdgVi^kZbVcV\ZbZci/VXjiZk^gVa g]^c^i^h +%' >cÅjZcoV +%' Cjgh^c\VcYXdaaVWdgVi^kZbVcV\ZbZci/^cÅjZcoV +%( H^cjh^i^h +%) Cjgh^c\VcYXdaaVWdgVi^kZbVcV\ZbZci/h^cjh^i^h +%) Diseases and disorders of the paranasal sinuses 605 Edaneh +%* ;dgZ^\cWdY^Zh +%* Problems related to the pharynx 605 6XjiZe]Vgnc\^i^h +%* Cjgh^c\VcYXdaaVWdgVi^kZbVcV\ZbZci/VXjiZ e]Vgnc\^i^h +%* EZg^idch^aaVgVWhXZhh +%* DWhigjXi^kZhaZZeVecdZV +%* Cjgh^c\VcYXdaaVWdgVi^kZbVcV\ZbZci/haZZeVecdZV +%+ Problems related to the trachea and larynx 607 6^glVndWhigjXi^dc +%, IgVX]Zdhidbn +%, Cjgh^c\bVcV\ZbZci/igVX]Zdhidbn +%, AVgnc\ZVaedaneh +&)
Nursing management: lower respiratory tract problems 625
28
Nursing management: obstructive pulmonary diseases 673 Jane Steinman Kaufman (US); Bridie Kent (ANZ) 6hi]bV +,( Cjgh^c\bVcV\ZbZci/Vhi]bV +-. 8]gdc^XdWhigjXi^kZejabdcVgnY^hZVhZ +.( Cjgh^c\bVcV\ZbZci/8DE9 ,&( 8nhi^XÄWgdh^h ,&. Cjgh^c\bVcV\ZbZci/Xnhi^XÄWgdh^h ,'' 7gdcX]^ZXiVh^h ,'( Cjgh^c\bVcV\ZbZci/WgdcX]^ZXiVh^h ,')
SECTION SIX Problems of oxygenation: transport Maryanne Hargraves 29
Nursing assessment: haematological system 730 Brenda K Shelton, Sandra Irene Rome, Sharon L Lewis (US); Maryanne Hargraves (ANZ) HigjXijgZhVcY[jcXi^dchd[i]Z]VZbVidad\^XVahnhiZb ,(% 6hhZhhbZcid[i]Z]VZbVidad\^XVahnhiZb ,(, 9^V\cdhi^XhijY^Zhd[i]Z]VZbVidad\^XVahnhiZb ,)(
CONTENTS ix
30
Sandra Irene Rome (US); Maryanne Hargraves (ANZ) 6cVZb^V ,*& Cjgh^c\bVcV\ZbZci/VcVZb^V ,*( Anaemia caused by decreased erythrocyte production 755 >gdc"YZÄX^ZcXnVcVZb^V ,** Cjgh^c\bVcV\ZbZci/^gdc"YZÄX^ZcXnVcVZb^V ,*, I]VaVhhVZb^V ,*, BZ\VadWaVhi^XVcVZb^Vh ,*Cjgh^c\bVcV\ZbZci/bZ\VadWaVhi^XVcVZb^Vh ,*. 6cVZb^Vd[X]gdc^XY^hZVhZ ,+% 6eaVhi^XVcVZb^V ,+% Cjgh^c\VcYXdaaVWdgVi^kZbVcV\ZbZci/VeaVhi^X VcVZb^V ,+& Anaemia caused by blood loss 761 6XjiZWaddYadhh ,+& Cjgh^c\bVcV\ZbZci/VXjiZWaddYadhh ,+' 8]gdc^XWaddYadhh ,+' Anaemia caused by increased erythrocyte destruction 762 H^X`aZXZaaY^hZVhZ ,+' Cjgh^c\VcYXdaaVWdgVi^kZbVcV\ZbZci/h^X`aZXZaa Y^hZVhZ ,+* 6Xfj^gZY]VZbdani^XVcVZb^V ,++ =VZbdX]gdbVidh^h ,++ EdanXni]VZb^V ,+, Cjgh^c\bVcV\ZbZci/edanXni]VZb^V ,+Problems of haemostasis 768 I]gdbWdXnideZc^V ,+Cjgh^c\bVcV\ZbZci/i]gdbWdXnideZc^V ,,' =VZbde]^a^VVcYkdcL^aaZWgVcY¼hY^hZVhZ ,,) Cjgh^c\bVcV\ZbZci/]VZbde]^a^V ,,, 9^hhZb^cViZY^cigVkVhXjaVgXdV\jaVi^dc ,,, Cjgh^c\bVcV\ZbZci/Y^hhZb^cViZY^cigVkVhXjaVg XdV\jaVi^dc ,-% CZjigdeZc^V ,-% Cjgh^c\VcYXdaaVWdgVi^kZbVcV\ZbZci/cZjigdeZc^V ,-' BnZadYnheaVhi^XhncYgdbZ ,-) Cjgh^c\VcYXdaaVWdgVi^kZbVcV\ZbZci/bnZadYnheaVhi^X hncYgdbZ ,-) AZj`VZb^V ,-) Cjgh^c\bVcV\ZbZci/aZj`VZb^V ,-Lymphomas 790 =dY\`^c¼hanbe]dbV ,.% Cjgh^c\VcYXdaaVWdgVi^kZbVcV\ZbZci/=dY\`^c¼h anbe]dbV ,.& Cdc"=dY\`^c¼hanbe]dbVh ,.( Cjgh^c\VcYXdaaVWdgVi^kZbVcV\ZbZci/cdc"=dY\`^c¼h anbe]dbV ,.) Bjai^eaZbnZadbV ,.* Cjgh^c\bVcV\ZbZci/bjai^eaZbnZadbV ,.+ 9^hdgYZghd[i]ZheaZZc ,., 7addYXdbedcZcii]ZgVen ,.,
SECTION SEVEN Problems of oxygenation: perfusion Robyn Gallagher 31
Nursing assessment: cardiovascular system 808 Angela J DiSabatino, Linda Bucher (US); Linda Soars (ANZ) HigjXijgZhVcY[jcXi^dchd[i]ZXVgY^dkVhXjaVghnhiZb -%6hhZhhbZcid[i]ZXVgY^dkVhXjaVghnhiZb -&( 9^V\cdhi^XhijY^Zhd[i]ZXVgY^dkVhXjaVghnhiZb -'&
32
Cjgh^c\bVcV\ZbZci/eg^bVgn]neZgiZch^dc -)+ =neZgiZch^kZXg^h^h -*% Cjgh^c\VcYXdaaVWdgVi^kZbVcV\ZbZci/]neZgiZch^kZ Xg^h^h -*&
Nursing management: haematological problems 751
Nursing management:hypertension 831 Elisabeth G Bradley (US); Robyn Gallagher (ANZ) CdgbVagZ\jaVi^dcd[WaddYegZhhjgZ -(' =neZgiZch^dc -()
33
Nursing management: coronary artery disease and acute coronary syndrome 854 Linda Griego Martinez, Linda Bucher (US); Robyn Gallagher (ANZ) Coronary artery disease 854 G^h`[VXidgh[dgXdgdcVgnVgiZgnY^hZVhZ -** Cjgh^c\VcYXdaaVWdgVi^kZbVcV\ZbZci/XdgdcVgnVgiZgn Y^hZVhZ -+( 8a^c^XVabVc^[ZhiVi^dch -+Bjai^Y^hX^ea^cVgnXVgZ -,% 9^V\cdhi^XhijY^Zh -,( Acute coronary syndrome 874 8a^c^XVabVc^[ZhiVi^dch -,* 9^V\cdhi^XhijY^Zh -,, Bjai^Y^hX^ea^cVgnXVgZ -,Cjgh^c\bVcV\ZbZci/X]gdc^XhiVWaZVc\^cVVcYVXjiZ XdgdcVgnhncYgdbZ --' Sudden cardiac death 890 Cjgh^c\VcYXdaaVWdgVi^kZbVcV\ZbZci/hjYYZcXVgY^VX YZVi] -.%
34
Nursing management: heart failure 894 Mary Ann House-Fancher, Hatice Y Foell (US); Linda Soars (ANZ) =ZVgi[V^ajgZ -.) Cjgh^c\VcYXdaaVWdgVi^kZbVcV\ZbZci/VXjiZ]ZVgi[V^ajgZ VcYejabdcVgndZYZbV .%& Cjgh^c\bVcV\ZbZci/X]gdc^X]ZVgi[V^ajgZ .%* 8VgY^VXigVcheaVciVi^dc .&%
35
Nursing management: ECG monitoring and arrhythmias 914 Linda Bucher (US); Robyn Gallagher (ANZ) G]ni]b^YZci^ÄXVi^dcVcYigZVibZci .&) :8c[ZXi^kZZcYdXVgY^i^h .(. Cjgh^c\bVcV\ZbZci/^c[ZXi^kZZcYdXVgY^i^h .)( 6XjiZeZg^XVgY^i^h .)* Cjgh^c\bVcV\ZbZci/VXjiZeZg^XVgY^i^h .), 8]gdc^XXdchig^Xi^kZeZg^XVgY^i^h .)Cjgh^c\VcYXdaaVWdgVi^kZbVcV\ZbZci/X]gdc^XXdchig^Xi^kZ eZg^XVgY^i^h .)BndXVgY^i^h .)Cjgh^c\bVcV\ZbZci/bndXVgY^i^h .). G]ZjbVi^X[ZkZgVcY]ZVgiY^hZVhZ .). Cjgh^c\bVcV\ZbZci/g]ZjbVi^X[ZkZgVcY]ZVgiY^hZVhZ .*& Valvular heart disease 952 B^igVakVakZhiZcdh^h .*( B^igVagZ\jg\^iVi^dc .*) B^igVakVakZegdaVehZ .*) 6dgi^XhiZcdh^h .** 6dgi^XgZ\jg\^iVi^dc .** Ig^Xjhe^YVcYejabdc^XkVakZY^hZVhZ .** Cjgh^c\bVcV\ZbZci/kVakjaVgY^hdgYZgh .*, Cardiomyopathy 959 9^aViZYXVgY^dbndeVi]n .+% Cjgh^c\VcYXdaaVWdgVi^kZbVcV\ZbZci/Y^aViZY XVgY^dbndeVi]n .+' =neZgigde]^XXVgY^dbndeVi]n .+(
x CONTENTS Cjgh^c\VcYXdaaVWdgVi^kZbVcV\ZbZci/]neZgigde]^X XVgY^dbndeVi]n .+( GZhig^Xi^kZXVgY^dbndeVi]n .+) Cjgh^c\VcYXdaaVWdgVi^kZbVcV\ZbZci/gZhig^Xi^kZ XVgY^dbndeVi]n .+)
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SECTION EIGHT Problems of ingestion, digestion, absorption and elimination Ann Framp Nursing assessment: gastrointestinal system 998 Anne Croghan (US); Marie Verschoor (ANZ) HigjXijgZhVcY[jcXi^dchd[i]Z\Vhigd^ciZhi^cVahnhiZb ..6hhZhhbZcid[i]Z\Vhigd^ciZhi^cVahnhiZb &%%* 9^V\cdhi^XhijY^Zhd[i]Z\Vhigd^ciZhi^cVahnhiZb &%&'
39
Nursing management: nutritional problems 1023 Peggi Guenter (US); Di Brown (ANZ) Cjig^i^dc &%'( CdgbVacjig^i^dc &%'( HeZX^VaY^Zih/kZ\ZiVg^VcY^Zi &%', BVacjig^i^dc &%'Cjgh^c\bVcV\ZbZci/bVacjig^i^dc &%(( IneZhd[heZX^Va^hZYcjig^i^dchjeedgi &%(, Cjgh^c\bVcV\ZbZci/idiVaeVgZciZgVacjig^i^dc &%)+ :Vi^c\Y^hdgYZgh &%)8jaijgVaanXdbeZiZciXVgZ/cjig^i^dc &%).
40
Nursing management: obesity 1052 Jennifer Kretzschmar, Paula Blackwell, Sharon L Lewis (US); Brighid McPherson (ANZ) DWZh^in &%*' =ZVai]g^h`hVhhdX^ViZYl^i]dWZh^in &%*+ Cjgh^c\bVcV\ZbZci/i]ZdWZhZeVi^Zci &%*, Bjai^Y^hX^ea^cVgnXVgZ &%*. 8daaVWdgVi^kZhjg\^XVai]ZgVen &%+( Cjgh^c\bVcV\ZbZci/i]ZdWZhZeVi^ZcijcYZg\d^c\ hjg\Zgn &%+, BZiVWda^XhncYgdbZ &%+. Cjgh^c\VcYXdaaVWdgVi^kZbVcV\ZbZci/bZiVWda^X hncYgdbZ &%,%
Nursing management: upper gastrointestinal problems 1073 Margaret McLean Heitkemper (US); Ann Framp (ANZ) CVjhZVVcYkdb^i^c\ &%,( Cjgh^c\bVcV\ZbZci/cVjhZVVcYkdb^i^c\ &%,* DgVa^cÅVbbVi^dchVcY^c[ZXi^dch &%,DgVaXVcXZg &%,. Cjgh^c\bVcV\ZbZci/dgVaXVcXZg &%-% Oesophageal disorders 1081 gg^iVWaZWdlZahncYgdbZ &&(( 6WYdb^cVaigVjbV &&(( Cjgh^c\VcYXdaaVWdgVi^kZbVcV\ZbZci/VWYdb^cVa igVjbV &&(* Inflammatory disorders 1135 6eeZcY^X^i^h &&(* Cjgh^c\bVcV\ZbZci/VeeZcY^X^i^h &&(+ EZg^idc^i^h &&(+ Cjgh^c\bVcV\ZbZci/eZg^idc^i^h &&(, cÅVbbVidgnWdlZaY^hZVhZ &&(, Cjgh^c\bVcV\ZbZci/^cÅVbbVidgnWdlZaY^hZVhZ &&)* >ciZhi^cVadWhigjXi^dc &&)Cjgh^c\bVcV\ZbZci/^ciZhi^cVadWhigjXi^dc &&*% Edanehd[i]ZaVg\Z^ciZhi^cZ &&*% 8dadgZXiVaXVcXZg &&*' Cjgh^c\bVcV\ZbZci/XdadgZXiVaXVcXZg &&*+ Dhidbnhjg\Zgn &&*, Cjgh^c\bVcV\ZbZci/dhidbnhjg\Zgn &&*. 9^kZgi^Xjadh^hVcYY^kZgi^Xja^i^h &&+* Cjgh^c\VcYXdaaVWdgVi^kZbVcV\ZbZci/Y^kZgi^Xjadh^hVcY Y^kZgi^Xja^i^h &&++ =Zgc^Vh &&++ Cjgh^c\VcYXdaaVWdgVi^kZbVcV\ZbZci/]Zgc^Vh &&+, Malabsorption syndrome 1167 8dZa^VXY^hZVhZ &&+-
CONTENTS xi AVXiVhZYZÄX^ZcXn &&,% H]dgi"WdlZahncYgdbZ &&,% ciZghi^i^VaXnhi^i^h$eV^c[jaWaVYYZghncYgdbZ &'*Cjgh^c\bVcV\ZbZci/^ciZghi^i^VaXnhi^i^h$eV^c[jaWaVYYZg hncYgdbZ &'*. GZcVaijWZgXjadh^h &'*. Immunological disorders of the kidney 1259 cÅVbbVidgnVcY^c[ZXi^djhegdWaZbh &*)8dc\Zc^iVaegdWaZbh &*)6Xfj^gZYegdWaZbh &*)IZhi^XjaVgXVcXZg &*). Cjgh^c\VcYXdaaVWdgVi^kZbVcV\ZbZci/iZhi^XjaVg XVcXZg &*). Sexual functioning 1550 KVhZXidbn &**% :gZXi^aZYnh[jcXi^dc &**& Cjgh^c\bVcV\ZbZci/ZgZXi^aZYnh[jcXi^dc &**) >c[Zgi^a^in &**)
55
6hhZhhbZcid[i]ZcZgkdjhhnhiZb &*,) 9^V\cdhi^XhijY^Zhd[i]ZcZgkdjhhnhiZb &*-%
59
Nursing management: delirium, dementia and Alzheimer’s disease 1678 Virginia Shaw, Sharon L Lewis (US); Wendy Moyle (ANZ) 9Za^g^jb &+,8daaVWdgVi^kZVcYcjgh^c\bVcV\ZbZci/YZa^g^jb &+,. 9ZbZci^V &+-% 8daaVWdgVi^kZVcYcjgh^c\bVcV\ZbZci/YZbZci^V &+-' 6ao]Z^bZg¼hY^hZVhZ &+-' Cjgh^c\bVcV\ZbZci/6ao]Z^bZg¼hY^hZVhZ &+-. Di]ZgcZjgdYZ\ZcZgVi^kZY^hZVhZh &+.)
60
Nursing management: peripheral nerve and spinal cord problems 1698 Linda Laskowski-Jones (US); Anna Brown (ANZ) Cranial nerve disorders 1698 Ig^\Zb^cVacZjgVa\^V &+.Cjgh^c\bVcV\ZbZci/ig^\Zb^cVacZjgVa\^V &,%%
xiv CONTENTS 7Zaa¼heVahn &,%& Cjgh^c\bVcV\ZbZci/7Zaa¼heVahn &,%' Polyneuropathies 1703 c[ZXi^dc &,+. 8dbeVgibZcihncYgdbZ &,+. KZcdjhi]gdbWdh^h &,,& ;ViZbWda^hbhncYgdbZ &,,& Types of fractures 1772 8daaZh¼[gVXijgZ &,,' ;gVXijgZd[i]Z]jbZgjh &,,' ;gVXijgZd[i]ZeZak^h &,,' ;gVXijgZd[i]Z]^e &,,( Cjgh^c\bVcV\ZbZci/]^e[gVXijgZ &,,( ;ZbdgVah]V[i[gVXijgZ &,,* ;gVXijgZd[i]Zi^W^V &,,* HiVWaZkZgiZWgVa[gVXijgZh &,,+ ;VX^Va[gVXijgZh &,,+ BVcY^WaZ[gVXijgZ &,,, Cjgh^c\bVcV\ZbZci/bVcY^WjaVg[gVXijgZ &,,, 6bejiVi^dc &,,Cjgh^c\bVcV\ZbZci/VbejiVi^dc &,,. Common joint surgical procedures 1782 >cY^XVi^dch[dg_d^cihjg\Zgn &,-' IneZhd[_d^cihjg\Zgn &,-' Cjgh^c\bVcV\ZbZci/_d^cihjg\Zgn &,-*
Nursing management: musculoskeletal problems 1789 Colleen R Walsh (US); Aileen Wyllie (ANZ) DhiZdbnZa^i^h &,-. Cjgh^c\bVcV\ZbZci/dhiZdbnZa^i^h &,.& 7dcZijbdjgh &,.( Cjgh^c\bVcV\ZbZci/WdcZXVcXZg &,.* BjhXjaVgYnhigde]n &,.+ Low back pain 1796 6XjiZadlWVX`eV^c &,., Cjgh^c\bVcV\ZbZci/VXjiZadlWVX`eV^c &,., 8]gdc^XadlWVX`eV^c &-%% >ciZgkZgiZWgVaajbWVgY^hXYVbV\Z &-%% Cjgh^c\bVcV\ZbZci/he^cVahjg\Zgn &-%) Neck pain 1805 Foot disorders 1805 Cjgh^c\bVcV\ZbZci/[ddiY^hdgYZgh &-%+ Metabolic bone diseases 1807 DhiZdbVaVX^V &-%, DhiZdedgdh^h &-%Cjgh^c\VcYXdaaVWdgVi^kZbVcV\ZbZci/dhiZdedgdh^h &-%. EV\Zi¼hY^hZVhZ &-&&
Nursing assessment: musculoskeletal system 1734 Dottie Roberts (US); Aileen Wyllie (ANZ) HigjXijgZhVcY[jcXi^dchd[i]ZbjhXjadh`ZaZiVa hnhiZb &,() 6hhZhhbZcid[i]ZbjhXjadh`ZaZiVahnhiZb &,(. 9^V\cdhi^XhijY^Zhd[i]ZbjhXjadh`ZaZiVahnhiZb &,)(
62
63
SECTION TWELVE Nursing care in specialised settings Thomas Buckley and Christopher Gordon 65
Nursing management: critical care environment 1858 Linda Bucher, Maureen A Seckel (US); Thomas Buckley (ANZ) 8g^i^XVaXVgZcjgh^c\ &-*8jaijgVaanXdbeZiZciXVgZ/Xg^i^XVaXVgZeVi^Zcih &-+) =VZbdYncVb^Xbdc^idg^c\ &-+)
CONTENTS xv Cjgh^c\bVcV\ZbZci/]VZbdYncVb^Xbdc^idg^c\ &-,) 8^gXjaVidgnVhh^hiYZk^XZh &-,) Cjgh^c\bVcV\ZbZci/X^gXjaVidgnVhh^hiYZk^XZh &-,, 6gi^ÄX^VaV^glVnh &-,, Cjgh^c\bVcV\ZbZci/Vgi^ÄX^VaV^glVn &--% BZX]Vc^XVakZci^aVi^dc &--+ Cjgh^c\bVcV\ZbZci/bZX]Vc^XVakZci^aVi^dc &-.)
66
Nursing management: shock and multiple organ dysfunction syndrome 1898 Kathleen M Geib (US); Margherita Murgo (ANZ) H]dX` &-.Cjgh^c\bVcV\ZbZci/h]dX` &.&+ HnhiZb^X^cÅVbbVidgngZhedchZhncYgdbZVcYbjai^eaZ dg\VcYnh[jcXi^dchncYgdbZ &.'% Cjgh^c\VcYXdaaVWdgVi^kZbVcV\ZbZci/hnhiZb^X ^cÅVbbVidgngZhedchZhncYgdbZVcYbjai^eaZdg\Vc Ynh[jcXi^dchncYgdbZ &.'&
67
69
Nursing management: emergency care situations 1950 Linda Bucher (US); Elizabeth Leonard (ANZ) 6hhZhhbZcid[i]ZZbZg\ZcXneVi^Zci &.*%
Chronic illness and complex care 1979 Linda Soars, Robyn Gallagher (ANZ) 8]gdc^X^aacZhh &.,. I]ZXdbeaZm^ind[X]gdc^X^aacZhh &.,. EVi^ZciVcY[Vb^anVhhZhhbZci &.-& BVcV\ZbZcid[X]gdc^X^aacZhh &.-& 9ZkZade^c\i]Z]ZVai]ldg`[dgXZidbZZiX]gdc^X^aacZhh cZZYh &.-. 8dcXajh^dc &..&
Nursing management: respiratory failure and acute respiratory distress syndrome 1926 Richard B Arbour (US); Christopher Gordon (ANZ) 6XjiZgZhe^gVidgn[V^ajgZ &.'+ Cjgh^c\VcYXdaaVWdgVi^kZbVcV\ZbZci/VXjiZgZhe^gVidgn [V^ajgZ &.() 6XjiZajc\^c_jgn$VXjiZgZhe^gVidgnY^higZhhhncYgdbZ &.)& Cjgh^c\VcYXdaaVWdgVi^kZbVcV\ZbZci/VXjiZgZhe^gVidgn Y^higZhhhncYgdbZ &.)*
68
Environmental emergencies 1958 =ZVi"gZaViZYZbZg\ZcX^Zh &.*. :ck^gdcbZciVa]neZgi]Zgb^V &.*. :ck^gdcbZciVa]nedi]Zgb^V &.+& AdXVa^hZYXdaY^c_jgn &.+' HjWbZgh^dc^c_jg^Zh &.+( 7^iZhVcYhi^c\h &.+) :ckZcdbVi^dc &.+* Ed^hdc^c\h$idm^Xdad\n &.+. BV_dg^cX^YZciVcYY^hVhiZgegZeVgZYcZhh &.,' 8]Zb^XVa!W^dad\^XVaVcYgVY^Vi^dc]VoVgYh &.,)
APPENDICES A
Cardiopulmonary resuscitation and basic life support 1995
B
Nursing diagnoses 2001
C
Answer key to review questions 2003
Picture credits 2005 Index 0000
Chapter 68
NURSING MANAGEMENT:
emergency care situations Written by Linda Bucher Adapted by Elizabeth Leonard LEARNING OBJECTIVES
KEY TERMS
1 Understand the principles of patient assessment in the emergency department, 2 3 4 5 6 7 8
including triage, primary survey and secondary survey. Differentiate between the various types and victims of violence: accidental versus abuse (domestic violence and children at risk). Recognise the significance of ‘mechanism of injury’ and initial signs and symptoms for identifying actual or potential traumatic injury. Describe the pathophysiology, assessment and multidisciplinary care of select environmental emergencies, including hyperthermia, hypothermia and submersion injury. Identify a selection of Australia’s venomous creatures and discuss the principles of management for envenomation. Explain the principles of care for select toxicology emergencies. Explore the strategies of preparedness for the management of major incidents, emergency and/or disaster. Describe the toxic agents and the principles of management for chemical, biological and radiation hazards.
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chemical, biological and radiation (CBR) hazards, p 1974 children at risk, p 1956 disaster, p 1972 domestic violence, p 1956 emergency, p 1972 envenomation, p 1965 frostbite, p 1962 heat cramps, p 1959 heat exhaustion, p 1960 heat stroke, p 1961 hyperthermia, p 1959 hypothermia, p 1961 jaw-thrust or chin-lift manoeuvre, p 1953 major incident, p 1972 mechanism of injury, p 1956 primary survey, p 1951 rapid-sequence induction, p 1953 secondary survey, p 1954 submersion injury, p 1963 toxicology, p 1969 triage, p 1950
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CHAPTER 68
NURSING MANAGEMENT: emergency care situations 1973 bdkZbZci![addY!hidgb!idgcVYd!XnXadcZ!hZg^djh [^gZ!aZV`V\Zdghe^aaV\Zd[VcnYVc\Zgdjh\Vhdg hjWhiVcXZ!iZX]cdad\^XVa[V^ajgZ!^c[ZhiVi^dc!eaV\jZ! Ze^YZb^X![V^ajgZd[dgY^hgjei^dcidVcZbZg\ZcXn hZgk^XZdgVa^[Za^cZji^a^in!dgVXijVadg^bb^cZci ViiVX`dglVga^`ZVXi0VcY WXVjhZhdgbVnXVjhZadhhd[a^[Zdg^c_jgndg^aacZhhdg Y^higZhhdg^cVcnlVnZcYVc\Zghi]ZhV[Zind[i]Z ejWa^XdgegdeZgin^cCZlOZVaVcYdgVcneVgid[CZl OZVaVcY0VcY XXVccdiWZYZVail^i]WnZbZg\ZcXnhZgk^XZh!dg di]Zgl^hZgZfj^gZhVh^\c^[^XVciVcYXddgY^cViZY gZhedchZjcYZgi]Z6Xi#P89:B6Xi'%%'hZXi^dc)R*,
EMERGENCY SERVICES
Figure 68-8 Transferring an injured person to hospital. Source: Photolibrary.
Figure 68-9 Severe crush injuries may result from the damage caused by an earthquake, such as the recent Christchurch earthquake. Source: Photolibrary.
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Figure 68-10 Emergency management of victims from the Bali terrorist attack. Source: Used with permission. Royal Darwin Hospital, Clinical Photo Library.
1974 SECTION 12 Nursing care in specialised settings
Figure 68-11 Patient injuries from the Bali terrorist attack. Note triage assessment.
Figure 68-12 Penetrating wounds received as a result of a bomb blast.
Source: Used with permission. Royal Darwin Hospital, Clinical Photo Library.
Source: Used with permission. Royal Darwin Hospital, Clinical Photo Library.
Chemical, biological and radiation hazards Chemical, biological and radiation (CBR) hazards bVn gZhjai [gdb^cYjhig^VaVXX^YZcih!Ze^YZb^XhdgV\g^XjaijgVaeZhi^X^YZ ZmedhjgZ#>cVYY^i^dcidVXX^YZciVaZmedhjgZ!i]ZldgaYXjggZcian [VXZhi]Zi]gZVid[iZggdg^hb#IZggdg^hb^ckdakZhdkZgiVXi^dch! hjX] Vh i]Z Y^heZch^c\ d[ Y^hZVhZ eVi]d\Zch dg di]Zg V\Zcih Z#\#X]Zb^XVa!W^dad\^XVaVcY$dggVY^dad\^XVaVhlZVedch[dg i]ZZmegZhhejgedhZd[XVjh^c\]Vgb#EgdbeigZXd\c^i^dcVcY ^YZci^[^XVi^dc d[ ediZci^Va ]ZVai] ]VoVgYh ^h ZhhZci^Va ^c i]Z egZeVgZYcZhhd[]ZVai]XVgZegd[Zhh^dcVah#*( 8]Zb^XVahV\Zcihi]ViedhZbV_dg]ZVai]g^h`hVgZXViZ\dg^hZY VXXdgY^c\ id i]Z^g iVg\Zi dg\Vc dg Z[[ZXi hZZ IVWaZ +-"&%# 6\Zcih^cXajYZ/ cZgkZV\ZcihZ#\#dg\Vcde]dhe]ViZh Wa^hiZgV\ZcihZ#\#bjhiVgY\Vh!aZl^h^iZVcYe]dh\ZcZ dm^bZ X]d`^c\$ejabdcVgnV\ZcihZ#\#X]adg^cZ!e]dh\ZcZ WaddYV\ZcihZ#\#]nYgd\ZcXnVc^YZ# :kZci]dj\]i]ZhZX]Zb^XVahbVnWZjhZY^cYjhig^Vaan!i]Zn Vahd]VkZi]ZediZci^VaidWZjhZY^ciZggdg^hiVXih# GVY^Vi^dc ZmedhjgZ bVn dXXjg i]gdj\] dXXjeVi^dcVa ZmedhjgZ!Y^V\cdhi^XegdXZYjgZhhjX]VhM"gVnVcY8IhXVch dgcjXaZVgbZY^X^cZ!igZVibZcihhjX]Vhi]dhZjhZY^cgVY^Vi^dc dcXdad\ndgk^VgVY^dVXi^kZbViZg^VahjhZY^clVgdgiZggdg^hi VXi^dch# :medhjgZ id gVY^Vi^dc bVn dg bVn cdi ^cXajYZ h`^c XdciVb^cVi^dcl^i]gVY^dVXi^kZbViZg^Va#>[ZmiZgcVagVY^dVXi^kZ XdciVb^cVcihVgZegZhZci!YZXdciVb^cVi^dcegdXZYjgZhbjhiWZ ^c^i^ViZY#6XjiZgVY^Vi^dchncYgdbZYZkZadehV[iZgVhjWhiVci^Va
Figure 68-13 Chest X-ray showing ball-bearing bomb injury. Source: Used with permission. Royal Darwin Hospital, Clinical Photo Library.
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TABLE 68-10 Chemical agents of terrorism by target organ or effect Nerve
Blood
Pulmonary
Blister/vesicants
Sarin (isopropyl methylphosphonofluoridate) Tabun (ethyl N,N-dimethylphosphoramidocyanidate) Soman (pinacolyl methylphosphonofluoridate) GF (cyclohexyl methylphosphonofluoridate) VX (O-ethyl S-[2-diisopropylaminoethyl] methylphosphonothiolate)
Hydrogen cyanide Cyanogen chloride
Phosgene Chlorine Vinyl chloride
Nitrogen and sulfur mustards Lewisite (an aliphatic arsenic compound, 2-chlorovinyldichloroarsine) Phosgene oxime
None
None
Signs and symptoms
Time of onset Critical period Organ system
‘Manifest illness’ (obvious illness)
0%
Mortality
0%
2 weeks None
Moderate leucopenia
5–50% 3–6 h cY^\Zcdjh 6jhigVa^Vch! Bādg^ VcY EVX^ÄX >haVcYZgh VgZ hig^`^c\an dkZggZegZhZciZY^cVaaX]gdc^X^aacZhhYViV^c6jhigVa^VVcY CZlOZVaVcY!hj\\Zhi^c\i]ZegZhZcXZd[bjai^eaZg^h`[VXidgh VcY]^\]a^\]i^c\ediZci^Va^hhjZhl^i]Zfj^inVcYVXXZhhid ]ZVai]XVgZVcYXdcXZgchVWdji]ZVai]a^iZgVXn^c>cY^\Zcdjh edejaVi^dch#'!( I]^hgZ^c[dgXZhi]ZcZZY[dgegZkZci^dchigViZ\^ZhiddXXjg ViWdi]i]Z^cY^k^YjVaVcYi]ZedejaVi^dcaZkZa#6gZXZci*"nZVg hijYn [djcY i]Vi V a^b^iZY cjbWZg d[ Xdhi"Z[[ZXi^kZ ejWa^X ]ZVai]^ciZgkZci^dchXVc]VkZVaVg\Z^beVXi dc^begdk^c\V edejaVi^dc¼h]ZVai]hiVijh#I]ZhZ^ciZgkZci^dch^cXajYZ/ iVm^c\idWVXXd!VaXd]daVcYjc]ZVai]n[ddYh eaVX^c\bVcYVidgna^b^ihdci]ZVbdjcid[hVaiVYYZY Yjg^c\egdYjXi^dcd[i]gZZWVh^X[ddY^iZbhWgZVY! XZgZVahVcYbVg\Vg^cZ
care coordination, p 1986 care navigation, p 1985 case management, p 1989 chronic illnesses, p 1979 disease management, p 1982 exacerbation, p 1979 self-efficacy, p 1985 self-management, p 1982 social cognitive theory, p 1982
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The complexity of chronic illness 8]gdc^X ^aacZhh ^h d[iZc VhhdX^ViZY l^i] XdbeaZm^in ^c ^ih XVjhZh!Z[[ZXihVcYXdchZfjZcXZh#I]ZgZVgZi]gZZbV^c[VXidgh i]Vi Xdcig^WjiZ id i]^h XdbeaZm^in# ;^ghi! X]gdc^X ^aacZhh ^h X]VgVXiZg^hZY Wn eZg^dYh d[ exacerbation0 hZXdcY! Vh i^bZ eVhhZh! V X]gdc^X ^aacZhh VcY ^ih igZVibZcih bVn \ZcZgViZ [jgi]Zg^hhjZh0VcYi]^gY!i]Z^cY^k^YjVal^i]X]gdc^X^aacZhh bVnZmeZg^ZcXZjcZfjVaVXXZhhidXVgZVcYhjeedgi# 8]gdc^X^aacZhhZhd[iZc]VkZVXjiZZmVXZgWVi^dch^cl]^X] i]Z^cY^k^YjVabdkZh[gdbVaZkZad[dei^bjb[jcXi^dc^c\! l^i] i]Z ^aacZhh ^c \ddY Xdcigda! id V eZg^dY d[ ^chiVW^a^in l]ZgZi]Z^cY^k^YjVabVncZZYVhh^hiVcXZ#8]gdc^X^aacZhhZh XVc WZ YZhXg^WZY Vh [daadl^c\ V igV_ZXidgn hZZ ;^\ +."&
1979
Chapter 69
Chronic illness and complex care
1980 SECTION 12 Nursing care in specialised settings Health Acute Comeback
Onset Stable
Stable
Crisis
Downward
Com
ebac k
Stable
Stable
g
in Dy
Illness
Months TIME
Figure 69-1 The chronic illness trajectory is a theoretical model of chronic illness. The trajectory model of chronic illness recognises that chronic illness will have many phases (see Table 69-1).
TABLE 69-1 Chronic illness trajectory Phase Onset Stable Acute
Comeback Crisis Unstable
Downward
Dying
Description v Signs and symptoms are present v Disease diagnosed v Illness course/symptoms controlled by regimen v Individual maintains everyday activities v Active illness with severe and unrelieved symptoms or complications v Hospitalisation required for management v Gradual return to an acceptable way of life v Life-threatening situation occurs v Emergency services are necessary v Unable to keep symptoms/disease course under control v Life becomes disrupted while working to regain stability v Hospitalisation not required v Gradual and progressive deterioration in physical/mental status v Accompanied by increasing disability and symptoms v Continuous alterations in everyday life activities v Individual has to relinquish everyday life interests and activities, let go and die peacefully v Immediate weeks, days, hours preceding death
Source: Woog P. The chronic illness trajectory framework: the Corbin and Strauss nursing model. New York: Springer; 1992.
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CHAPTER 69
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Maintaining a ‘normal’ life I]Z hZa["bVcV\ZbZci h`^aah cZZYZY id bV^ciV^c V gZaVi^kZan cdgbVaYV^ana^[Zl^i]^ci]ZWdjcYVg^Zhd[X]gdc^X^aacZhh^cXajYZ bVcV\^c\gZ\jaVgVheZXihd[a^[ZhjX]Vh]djhZ`ZZe^c\![ddY ejgX]Vh^c\VcYegZeVgVi^dc!hdX^VagdaZhVcYgZaVi^dch]^eh#&*>i^h ^bedgiVcii]Vii]Z^cY^k^YjVaaZVgchVWdjii]ZeViiZgcd[Y^hZVhZ hnbeidbhhjX]Vhine^XVadchZi!YjgVi^dcVcYhZkZg^inhdi]Vi a^[ZhinaZeViiZgchXVcWZX]Vc\ZYVXXdgY^c\an# 6`ZnXdbedcZcid[bV^ciV^c^c\VgZaVi^kZancdgbVaYV^an a^[Z ^h Zchjg^c\ \ddY \ZcZgVa ]ZVai]! l]^X] XVc WZ VX]^ZkZY Wn[daadl^c\V]ZVai]nY^ZiVcYiV`^c\ZmZgX^hZ#8dch^YZgVWaZ egdWaZb"hdak^c\h`^aahbVnVahdWZgZfj^gZYidWVaVcXZ^aacZhh bVcV\ZbZcigZfj^gZbZcihVcYi]Zhnbeidbhi]VidXXjgdcV YV^anWVh^h!VcYid\VgcZggZhdjgXZhVcYhjeedgi#;dgZmVbeaZ! Vc^cY^k^YjVal^i]8DE9bVneaVci]Z^gYVnkZgnXVgZ[jaanid hegZVYdjiZcZg\n"Xdchjb^c\VXi^k^i^Zh^cdgYZgidVkd^Y^ciZchZ eZg^dYhd[YnhecdZV#I]ZnbVn]VkZidVggVc\ZigVchedgil^i]V [g^ZcYdg[Vb^anbZbWZgidVhdX^VaZkZciidb^c^b^hZlVa`^c\ VcY id Vkd^Y ZmedhjgZ id ediZci^Va hdjgXZh d[ ^c[ZXi^dc dc ejWa^XigVchedgi#6aad[i]ZhZVXi^k^i^ZhYZeZcYdci]Z^gVW^a^in idcZ\di^ViZVcYbVcV\Zi]Z^geaVchl^i][Vb^anVcY[g^ZcYh#
Dealing with emotions EZdeaZ l^i] X]gdc^X ^aacZhh bVn ViiZbei id cdgbVa^hZ i]Z^g ^ciZgVXi^dchl^i]di]ZghWnbVcV\^c\i]Z^ghnbeidbhVcY]^Y^c\ i]Z^gY^hVW^a^indgY^h[^\jgZbZci#.I]ZnbVnignidYZbdchigViZ i]Vii]ZnXVc[jcXi^dci]ZhVbZVhhdbZdcZl^i]djiVY^hVW^a^in dgX]gdc^X^aacZhh¸VXdbbdcZmVbeaZd[i]^h^hi]Z^cY^k^YjVa l^i] X]gdc^X ajc\ Y^hZVhZ l]d hideh lVa`^c\ id XViX] i]Z^g WgZVi]WjiVeeZVghidWZ^cheZXi^c\VeaVcidgadd`^c\^cVh]de l^cYdl#BVcV\^c\X]gdc^X^aacZhhgZfj^gZbZcihVcYh`^aah^h YZbVcY^c\¸i]ZbdgZhdl]ZcXdbedjcYZYWni]ZX]Vc\^c\ Zbdi^dchi]VieZdeaZZmeZg^ZcXZl^i]X]gdc^XY^hZVhZ#I]ZhZ Zbdi^dch VgZ a^`Zan id ^cXajYZ hVYcZhh! ^hdaVi^dc! Vc\Zg VcY [gjhigVi^dc#6c^bedgiVcihZa["bVcV\ZbZcih`^aa^hi]ZVW^a^in
1984 SECTION 12 Nursing care in specialised settings Heart & lung health team
Multidisciplinary community chronic heart care plan Patient name ______________________________________________ Date of birth _______________ AUTHORITY TO PROCEED WITH CARE PLAN: My GP/health professional has explained the purpose of a care plan. I give my permission to prepare a care plan and discuss my medical history and diagnosis with the members of a multidisciplinary team. I do/do not request specific medical or other information to be withheld from other participants (noted in medical records). I am aware that there is a fee for the preparation of this care plan and a Medicare rebate will be payable. Patient signature ___________________________________________ Date _____________________ Assessment of health needs
Management goals
Action required
Provider
Symptom management
To understand and encourage self-management of symptoms
v Education about heart failure v Symptom monitoring v Refer to cardiologist for assessment for cardiac rehabilitation v Flexible diuretic regimen
General practitioner, clinical nurse specialist and heart & lung health team
Management of fluid retention
To encourage self-monitoring of increased fluid retention
Education about v daily weights v decreased sodium intake v fluid restriction
Dietician, clinical nurse specialist and heart & lung health team
Modification of activities of daily living (ADLs)
To encourage independence in ADLs
v Occupational therapy assessment v Community nursing assessment
Occupational therapist and community nurse
Medication management
To understand and comply with medication regimen
v Community pharmacist or specialist nurse assessment
General practitioner and pharmacist
Psychosocial support
To manage anxiety and avoid significant depression
v Counselling v Refer to positive living group
Social worker and group coordinator
Increase physical activity
To gradually increase activity tolerance
v Education about daily graded exercise v Refer to CCF/COPD group
Exercise physiologist, clinical nurse specialist and heart & lung health team
Patient health goals and motivation
Patient to provide health goals in own words
v Discuss and write patient’s goals to allow measurement over time
Exercise physiologist, clinical nurse specialist and heart & lung health team
Review date
Additional needs
I agree to the above care plan and understand the recommendations. Patient signature ___________________________________________ GP signature _______________________________________________ Date __________________________ SERVICE PROVIDERS: I have received and agree with this care plan. Name and contact details __________________________________________________________________________________________________ Date ___________________________________________ Name and contact details __________________________________________________________________________________________________ Date ___________________________________________ Name and contact details __________________________________________________________________________________________________ Date ___________________________________________ Name and contact details __________________________________________________________________________________________________ Date ___________________________________________ Copy to patient YES/NO Copy to service providers YES/NO CARE PLAN REVIEW DATE ____________________________
Figure 69-2 Sample care plan for a patient with chronic heart disease.
CHAPTER 69
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SELF-EFFICACY IN SELF-MANAGEMENT I]ZXdcXZeid[hZa["Z[[^XVXn^chdX^VaXd\c^i^kZi]Zdgn]Zaehid ZmeaV^c]dl^cY^k^YjVahYZkZadei]ZXdbeaZmhZa["bVcV\ZbZci h`^aahgZfj^gZYidbVcV\Zi]Z^gX]gdc^X^aacZhh!l]Vii]ZnVgZ egZeVgZYidYdid]Zaei]ZbhZakZhVcYi]Z^geZgh^hiZcXZ^ci]Z [VXZd[VYkZgh^in#Ideji^ih^bean! self-efficacy^hl]VieZdeaZ i]^c`i]ZnXVcYdl^i]i]Z^g`cdlaZY\Z!h`^aahVcYZmeZg^ZcXZ ^cVkVg^Zind[X^gXjbhiVcXZh#HZa["Z[[^XVXn^hcdiXdc[^YZcXZ# >igZaViZhidheZX^[^XYdbV^ch¸[dgZmVbeaZ!VeZghdcXVcWZ kZgnXdbeZiZci^cYg^k^c\VXVgWjicZZYVhh^hiVcXZ^cYg^k^c\ idi]ZXdggZXiadXVi^dc#I]jhi]ZncZZYhjeedgil^i]YZkZade^c\ hZfjZcXZY h`^aah i]Vi aZVY id ^cYZeZcYZci Yg^k^c\ WZ]Vk^djg# L^i]VcjcYZghiVcY^c\d[hZa["Z[[^XVXn!cjghZhXVchjeedgii]Z eVi^Zci¼h YZkZadebZci d[ hZa["bVcV\ZbZci h`^aah l^i] i]Z^g X]gdc^X^aacZhh# I]ZgZVgZ[djglVnhi]Vi^cY^k^YjVahYZkZadehZa["Z[ÄXVXn/ &WnZmeZg^ZcX^c\hjXXZhh0'hZZ^c\di]ZghZmeZg^ZcXZhjXXZhh! ZheZX^Vaan[daadl^c\[V^ajgZh0(WZ^c\eZghjVYZYi]Vii]ZnXVc hjXXZZY0)VcYZmeZg^ZcX^c\i]Ze]nh^XVaVcYZbdi^dcVa[ZZa^c\h i]ViVXXdbeVcnh`^aaYZkZadebZci#'-CjghZhXVc]ZaeeVi^Zcih l^i]X]gdc^X^aacZhhidZmeZg^ZcXZhjXXZhhWnWgZV`^c\Ydlci]Z XdbedcZcihd[hZa["bVcV\ZbZci^cidVX]^ZkVWaZjc^ihVcYWn egdk^Y^c\edh^i^kZ[ZZYWVX`l]ZcVX]^ZkZbZcihdXXjg#CjghZh XVcVahdegdk^YZedh^i^kZgdaZbdYZahi]gdj\]hjeedgi\gdjeh!hd i]VieVi^ZcihXVcaZVgcWnlViX]^c\i]ZZ[[dgih!XdggZXi^dchVcY hjXXZhhZhd[di]Zghl^i]h^b^aVg^aacZhhZh#EZdeaZl^i]X]gdc^X ^aacZhh \Vj\Z i]Z^g hZa["Z[ÄXVXn dc ]dl i]Zn [ZZa e]nh^XVaan VcYZbdi^dcVaanl]Zci]Zni]^c`VWdjidgjcYZgiV`ZVcVXi^dc# >i^hi]ZcjghZ¼hgdaZid]Zae\j^YZi]ZhZ^ciZgegZiVi^dch#6hVc ZmVbeaZ!i]Z^cXgZVhZYYnhecdZVi]VidXXjghl^i]ZmZgX^hZXVc WZ^ciZgegZiZYVhVedh^i^kZ^cY^XVi^dcd[Z[[dgigVi]Zgi]Vcegdd[ d[YZXa^cZ^c[jcXi^dc# >i^h^bedgiVci[dgcjghZhidWZVaZgi[dgcZ\Vi^kZeZghjVYZgh! WZXVjhZhdX^VaeZghjVh^dcXVc]VkZVedlZg[jacZ\Vi^kZZ[[ZXi dc hZa["Z[ÄXVXn# >c VYY^i^dc! \^kZc i]Z ^bedgiVci gdaZ d[ ^ciZgegZi^c\Zbdi^dc^cWj^aY^c\gZh^a^ZcihZa["Z[ÄXVXn!^i^hk^iVa i]ViYZegZhh^dc^hYZiZXiZYVcYbVcV\ZYegdbeian#9ZegZhh^dc aZVYh id bdgZ cZ\Vi^kZ ^ciZgegZiVi^dch d[ i]Z YZkZadebZci d[ hZa["bVcV\ZbZci h`^aah VcY i]Z ^beVXi d[ i]ZhZ h`^aah dc djiXdbZh#'-9ZegZhh^dcYZXgZVhZhi]Zbdi^kVi^dcidZc\V\ZVcY bV`Zi]ZZ[[dgigZfj^gZYWdi]idaZVgchZa["bVcV\ZbZcih`^aah VcYidhZa["bVcV\Z#
ENCOURAGING SELF-MANAGEMENT HZa["bdc^idg^c\higViZ\^Zh[dgeVi^Zcih^cXajYZYZkZade^c\Vc ZVgan lVgc^c\ hnhiZb! hjX] Vh YV^an lZ^\]ih id YZiZXi [aj^Y dkZgadVY [dg eVi^Zcih l^i] ]ZVgi [V^ajgZ# HZa["bdc^idg^c\ higViZ\^Zhldg`l]Zci]ZeVi^Zci`cdlhi]ZgVc\Zd[i]Ze]nh^XVa Viig^WjiZi]ZnVgZbZVhjg^c\Z#\#WaddYhj\VgaZkZaVcY]VhVc VXi^dceaVci]ViVhh^hih^c^ciZgegZi^c\i]ZgZhjaihVcYegdk^Y^c\ Veegdeg^ViZVXi^dcidbVcV\ZVcnkVg^Vi^dc[gdbi]ZgZ[ZgZcXZ gVc\ZZ#\#Vg^hZ^cWaddYhj\VgaZkZa#;^\jgZ+."(XdciV^ch VcZmVbeaZd[VXVgZeaVcidZcXdjgV\ZhZa["bVcV\ZbZcid[ WaddYhj\VgaZkZah# 6gVc\Zd[eVi^ZcihZa["bdc^idg^c\VXi^k^i^ZhXVcWZgZedgiZY WVX` id i]Z heZX^Va^hi cjghZ ^c Z^i]Zg V Xa^c^X dg V egVXi^XZ hZii^c\VcYbVnWZZc]VcXZYWniZaZ]ZVai]jh^c\XdbejiZgh! iZaZe]dcZdgY^gZXi[ZZYWVX`[gdbi]ZYZk^XZidi]ZhjeZgk^h^c\ ]ZVai]egVXi^i^dcZg#HZa["bdc^idg^c\VXi^k^i^ZhXVcWZhjeedgiZY
Chronic illness and complex care 1985
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CARE NAVIGATION Care navigation^hVhnhiZbd[XVgZi]Vi^hYZh^\cZYid^begdkZ
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1986 SECTION 12 Nursing care in specialised settings Patient name ___________________________________________________________________ Date of birth ___________________________ AUTHORITY TO PROCEED WITH CARE PLAN: My GP/health professional has explained the purpose of a care plan. I give my permission to prepare a care plan and discuss my medical history and diagnosis with the members of a multidisciplinary team. I do/do not request specific medical or other information to be withheld from other participants (noted in medical records). I am aware that there is a fee for the preparation of this care plan and a Medicare rebate will be payable. Patient signature _________________________________________________________________ Date __________________________ Assessment of health needs
Management goals
Action required
Provider
Discuss patient selfmanagement goals for diabetes
To define the patient’s goals
v Discuss current health plan v Write patient’s health goals
Diabetes nurse or general practitioner
Assess patient’s confidence and skills to manage diabetes
To observe the patient’s skill set for diabetes management tasks
v Assist to set test frequency and ranges for blood sugar level
Diabetes nurse or general practitioner
Assess patient’s lifestyle risks (SNAPW: smoking, nutrition, alcohol intake, physical activity, weight)
To set goals to manage identified risks
v Discuss plan and timeframe to manage each risk identified
Diabetes nurse or general practitioner
Assess patient’s coping skills—emotional impact and social support
To measure anxiety and depression levels
v Discuss treatment plans v Access psychological services
Psychologist/ counsellor
Prepare multidisciplinary team care plan as needed
To define the needs for allied health services to support the plan
v Refer to allied health workers to collaborate with the care plan
General practitioner
Appointment date
I agree to the above care plan and understand the recommendations. Patient signature ________________________________ GP signature _________________ Date __________________________ SERVICE PROVIDERS: I have received and agree with this care plan. Name and contact details __________________________________________________________________________________________________ Date ___________________________________________ Name and contact details __________________________________________________________________________________________________ Date ___________________________________________ Name and contact details __________________________________________________________________________________________________ Date ___________________________________________ Name and contact details __________________________________________________________________________________________________ Date ___________________________________________ Copy to patient YES/NO Copy to service providers YES/NO CARE PLAN REVIEW DATE ____________________________
Figure 69-3 Sample self-management care plan for blood sugar levels.
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CARE COORDINATION Care coordination^hV`ZnViig^WjiZd[hjXXZhh[jaXVhZbVcV\ZbZci#
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CHAPTER 69 Care navigation—guided to the right point of care Community-based rehab and education
Chronic disease self-care Family and carers
Chronic disease team
High-risk patient with chronic and complex disease
General practitioner Social and personal support services
Acute hospital services Seek out alternative pathways to hospital admission
Emergency department
Assertive discharge planning for hospital-in-the-home services, transitional care services
Figure 69-4 The care navigation process.
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Community Resources and policies Selfmanagement support
Informed, active patient
Health systems Organisation of healthcare Delivery system design
Decision support
Productive interactions
Clinical information systems
Prepared, proactive practice team
Improved outcomes
Figure 69-5 The chronic care model. Source: The Group Health Research Institute. Available at www. improvingchroniccare.org/index.php?p=The_Chronic_Care_Model&s=2, accessed 14 January 2011.
Chronic illness and complex care 1987
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1988 SECTION 12 Nursing care in specialised settings BOX 69-3 Hospital Admission Risk Profile (HARP) calculator Part A: clinical assessment
Part B: factors impacting on self-management
1. Presenting clinical symptoms
5. Psychosocial factors and demographic issues
Diagnosis of chronic respiratory condition (1) Diagnosis of chronic cardiac condition (1) Diagnosis of complex care needs in frail aged, such as dementia, falls or incontinence (1) Diagnosis of complex care needs in people less than 55 years of age, such as mental health illness (1) Comorbid diagnosis of diabetes and/or renal failure and/or liver disease (1) Score: /5
Mental health (depression, anxiety or psychiatric problems) Y/N Disability (intellectual, physical, visual, hearing) Y/N Access to suitable transport to care services Y/N Financial issues (inability to afford health services and/or medications) Y/N CALD or Aboriginal health beliefs Y/N Illiterate and/or limited English Y/N Unstable living environment Y/N Socially isolated Y/N Drug and alcohol problems Y/N Rate the impact these combined factors have on the person’s ability to self-manage their condition: No impact (on ability to self-manage) (0) Low impact (on ability to self-manage) (7) High impact (on ability to self-manage) (15) Score /15
2. Service access profile
Acute admission/presentation (more than once in the last 12 months) (4) No regular GP follow up (regular medical check-ups 2 times a year) (3) Reduced ability to self-care (to the extent it impacts on disease management) (3) Score: /10 3. Risk factors
Smoking (1) Overweight (guide BMI 26–35) (1) Underweight (guide BMI 5.5 mmol/L, HDL 2.0 mmol/L) (1) High blood pressure (>140/90 mmHg or on medication for high blood pressure) (1) Physical inactivity (less than 30 mins/day and 4 days/week) (1) Polypharmacy (>5 medications with difficulty managing them) (1) Score: /7 4. Extenuating factors
Use of services previously (1) Carer stress issues (1) No carer available (1) Cognitive impairment (1) Change to drug regimen (1) Chronic pain (1) Compromised skin integrity (e.g. wounds, pressure area, cellulitis) (1) Exposure to triggers for asthma (1) Score: /8 Total score clinical assessment (A) /30
6. Readiness to change assessment (choose one only)
No capacity for self-management (cognitive impairment, end-stage disease) (4) Pre-contemplation (not ready for change) (3) Contemplation (considering but unlikely to change soon) (3) Preparation (intending to take action in the immediate future) (2) Action (actively changing health behaviours but having difficulties maintaining plan) (1) Maintenance (maintained behaviour for >6 months) (1) Relapse (a return to the old behaviour) (3) Score: /4 Total score for self-management impact (B) /19 Overall risk: add part A and part B /49 The higher the score, the higher the risk of readmission.
Source: Taylor S, Bestall J, Cotter S, Falshaw M, Hood S et al. Clinical service organisation for heart failure. Cochrane Database Syst Rev 2005; (2).
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BOX 69-4 Planning for discharge: essential attributes of discharge interventions that can potentially reduce readmissions
r Early and complete assessment of discharge needs and medication reconciliation.
r Enhanced patient (and carer) education and counselling specifically focused on gaining an understanding of the patient’s condition and its self-management. r Timely and complete communication of management plan between clinicians at discharge when patient care is transferred from hospital staff to primary care teams. r Early post-acute follow-up within 24–72 h for high-risk patients with either doctor or nurse. r Early post-discharge nurse (or pharmacist) phone calls or home visits to confirm understanding of management and follow-up plans in high-risk patients. r Appropriate referral for home care and community support services when needed. Source: Scott I. Preventing the rebound: improving care transition in hospital discharge processes. Australian Health Review 2010; 34:445–451.
CHAPTER 69
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Conclusion CjghZh eaVn V kVajVWaZ gdaZ ^c Vhh^hi^c\ eVi^Zcih id bVcV\Z i]Z^g X]gdc^X ^aacZhhZh# EVi^Zcih VcY i]Z^g XVgZgh gZfj^gZ V kVg^Zind[aZkZahd[hjeedgi!ZbedlZgbZciVcYZYjXVi^dc[gdb cjghZh Yjg^c\ i]Z Y^[[ZgZci e]VhZh d[ i]Z^g X]gdc^X ^aacZhhZh# EVi^Zcihl]dgZfj^gZhjeedgi^caZVgc^c\]dlidhZa["bVcV\Z i]Z^g XdcY^i^dc bV`Z je ,%·-% d[ i]Z edejaVi^dc l^i] X]gdc^X XdcY^i^dch# CjghZh XVc YZkZade i]Z^g dlc h`^aah VcY XdbeZiZcX^Zh id ZcVWaZ eVi^Zcih VcY i]Z^g XVgZgh id iV`Z dc Z[[ZXi^kZ hZa["bVcV\ZbZci# =^\]"g^h` eVi^Zcih l^i] XdbeaZm X]gdc^X^aacZhhZhl]dcZZYi]Z^gXdcY^i^dcVXi^kZanbVcV\ZY idegZkZci[jgi]ZgXdbea^XVi^dchVcYegdbdiZlZaaWZ^c\bVn cZZY heZX^Va^hi Y^hZVhZ bVcV\ZbZci [gdb bjai^Y^hX^ea^cVgn iZVbh#)+EVi^Zcihl^i]XdbeaZmVcYbjai^eaZXdcY^i^dchcZZY ]^\]"fjVa^in!Zk^YZcXZ"WVhZYXVhZbVcV\ZbZci^cl]^X]i]Z^g cZZYh VgZ ^YZci^[^ZY VcY bZi Wn h`^aaZY egVXi^i^dcZgh! d[iZc cjghZh!ldg`^c\l^i]^cVc^ciZ\gViZYXVgZhnhiZb#
Chronic illness and complex care 1991 CASE STUDY
The patient with chronic illness Patient background Mrs Clare Giardini is a 69-year-old woman who has had three presentations in the last several months with shortness of breath. She lives in her own home with her 2 adult children, one of whom is a specialist paediatric nurse. Mrs Giardini has a history of osteoarthritis, non-insulin-dependent diabetes and asthma. A recent echocardiogram showed systolic dysfunction and a poor left ventricular ejection fraction, and Mrs Giardini is noted to have chronic controlled atrial fibrillation. Objective data r Temperature: 36.8oC r Heart rate: 116 beats per min r Blood pressure: 92/60 mmHg r Cardiac rhythm: atrial fibrillation r Cardiac system: S1 and S2 present, no murmurs r Respirations: 32 shallow r Lung sounds: crackles in both bases r Daily weight: increased by 5 kg over last 2 days
CRITICAL THINKING QUESTIONS 1. What social factors and assessment questions or tools would be useful to use with this patient? 2. Identify the community health and support services that are available in your health district for this patient. 3. What planning and assessments around the transition process from hospital to home would allow this patient to effectively self-manage her conditions at home?
Review questions 1. Vos and Carter found that a large impact on improving a population’s health can be achieved by: A taxation of tobacco, alcohol and unhealthy foods B mandatory limits on salt added during production of three basic food items (bread, cereals and margarine) C gastric banding for severe obesity D all of the above 2. Many factors contribute to chronic disease complexity and these are characterised by: A periods of exacerbation B the chronic illness and its treatments generating further issues C the individual with chronic illness experiencing unequal access to care and support D all of the above 3. Australian and New Zealand evidence suggests that most of the recent gain in life expectancy for individuals: A is a result of better preschool education and preparation-for-life classes B is spent accompanied by disability in the final years, and that much of the extra life years gained are spent with a profound or severe core activity limitation C is needed to expand the taxation base to pay for healthcare D is expected by the population due to their higher taxes
4. Depression frequently accompanies or may precipitate chronic illness. Depression makes recovery and management more difficult because it can make it harder for people: A to find the energy to eat healthily B to exercise or take medication regularly C as it can reduce initiative and affect adherence and compliance with health action plans D all of the above 5. Measuring carer strain and completing social care assessments are an important part of assessing the impact of these factors for different phases of the chronic illness journey. This is because: A carers have become too focused on their own needs and have neglected those of the patients under assessment B there are so many government programs for patient social support that a different assessment has to be completed for each one C a review of the domestic support needs and carer factors enables the case manager to effectively plan interventions that meet the patient’s goals and needs D all of the above
1992 SECTION 12 Nursing care in specialised settings 6. A holistic assessment tool for the patient with chronic illness needs to: A include standardised assessment of the range of carer and social aspects in the patient’s circle of support B account for the conflicting symptoms and strategies of multiple illnesses C be determined by the case manager over time to establish and advise the patient of priority steps in their health action plan D all of the above 7. Self-management is an umbrella term that encompasses: A self-care, the specific tasks that people carry out on a day-to-day basis to manage their condition B disease management provided by specialist health staff to control palliative symptoms C the use of health interventions, such as medications, without the need to consider the prescriber’s intentions D only natural therapies that are known to treat the illness 8. Preventing and managing a crisis are vital skills to develop and the patient and family are expected to: A understand how a health crisis can alter their usual health state B know ways to prevent or modify a threat to their health C adhere to a prescribed medical regimen D all of the above 9. People with chronic illnesses need to know the signs and symptoms of the onset of a health crisis. Depending on the chronic illness, these signs and symptoms may include: A seizures in a patient with seizure disorder B heart failure in a patient with untreated hypertension C a change in sputum colour to yellow/green in a person with emphysema D all of the above 10. Self-monitoring strategies include the development of an early warning system such as: A calling or visiting the medical practitioner daily in case something is wrong B measuring daily weights to detect fluid overload for people with heart failure C not measuring the blood sugar level when feeling well D all of the above
References LdgaY=ZVai]Dg\Vc^oVi^dcL=D#8]gdc^XY^hZVhZh#6kV^aVWaZ Villl#l]d#^ci$ide^Xh$X]gdc^XTY^hZVhZh$Zc$!VXXZhhZY'-?VcjVgn '%& '#6jhigVa^Vc>chi^ijiZd[=ZVai]LZa[VgZ6>=L#6jhigVa^V¼h ]ZVai]!'%%-#I]ZZaZkZci]W^Zcc^Va]ZVai]gZedgid[i]Z6jhigVa^Vc >chi^ijiZd[=ZVai]LZa[VgZ#8VcWZggV/6>=L0'%%-# (#CZlOZVaVcYB^c^hignd[=ZVai]COBD=#9ViVVcYhiVi^hi^Xh# 6kV^aVWaZVilll#bd]#\dki#co$bd]#ch[$^cYZmb]$YViVVcYhiVi^hi^Xh" hjW_ZXih!VXXZhhZY'%;ZWgjVgn'%& )#6jhigVa^Vc>chi^ijiZd[=ZVai]LZa[VgZ6>=L#8]gdc^XY^hZVhZh VcYVhhdX^ViZYg^h`[VXidgh^c6jhigVa^V!'%%+#8VcWZggV/6>=L0 '%%+# *#7g^ii=8!=Vgg^hdc8B!B^aaZg=LWjaaZi^ccd# '(#8VcWZggV/6>=L0'%%,#6kV^aVWaZVilll#V^]l#\dk#Vj$ ejWa^XVi^dch$^cYZm#X[b$i^iaZ$&%)&-!VXXZhhZY'-?VcjVgn'%& &)#7ZndcYWajZ#8]gdc^X^aacZhhVcYYZegZhh^dcVcYVcm^Zin#6kV^aVWaZ Villl#WZndcYWajZ#dg\#Vj$^cYZm#Vhem4a^c`T^Y2)#&&,)!VXXZhhZY &%;ZWgjVgn'%& &*#Adg^\@!=dabVch=!HdWZa9!AVjgZci9!
Chronic illness and complex care 1993
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