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deWit’s Fundamental Concepts
and Skills for Nursing

FIFTH EDITION

Patricia Williams, MSN, RN, CCRN

Nursing Instructor, De Anza College, Cupertino, California
Table of Contents

Cover image

Title page

Copyright

Dedication

Contributors and Reviewers

LPN Advisory Board

To the Instructor

To the Student

Acknowledgments
Unit I. Introduction to Nursing and the Health Care
System

chapter 1. Nursing and the Health Care System

Historical Overview
 The Art and Science of Nursing

Nursing Education Pathways

Delivery of Nursing Care

Practice Settings

Today’s Health Care System

The Patient Protection and Affordable Care Act

Get Ready for the NCLEX Examination!

chapter 2. Concepts of Health, Illness, Stress, and Health Promotion

Health and Illness

Traditional Views of Health and Illness

Current Views of Health and Illness

The Consumer Concept of Health and Illness

The Holistic Approach

Homeostasis

Health Promotion and Illness Prevention

Get Ready for the NCLEX Examination!

chapter 3. Legal and Ethical Aspects of Nursing

Source of Law

Civil and Criminal Law

Laws Related to Nursing Practice and Licensure

Laws and Guidelines Affecting Nursing Practice

Legal Documents
 Violations of Law

Ethics in Nursing

Get Ready for the NCLEX Examination!

Unit II. The Nursing Process

chapter 4. The Nursing Process and Critical Thinking

The Nursing Process

Critical Thinking

Critical Thinking in Nursing

Priority Setting and Work Organization

Application of Problem Solving and Clinical Reasoning

Get Ready for the NCLEX Examination!

chapter 5. Assessment, Nursing Diagnosis, and Planning

Assessment (Data Collection)

Nursing Diagnosis

Planning

Get Ready for the NCLEX Examination!

chapter 6. Implementation and Evaluation

Implementation

Interdisciplinary Care

Evaluation

Evaluation in Long-Term Care

 Evaluation in Home Health Care

Revision of the Nursing Care Plan

Quality Improvement

Constructing a Nursing Care Plan

Get Ready for the NCLEX Examination!

Unit III. Communication in Nursing

chapter 7. Documentation of Nursing Care

Purposes of Documentation

Documentation and the Nursing Process

The Medical Record

Methods of Documentation (Charting)

The Documentation Process

Get Ready for the NCLEX Examination!

chapter 8. Communication and the Nurse-Patient Relationship

The Communication Process

Therapeutic Communication Techniques

Blocks to Effective Communication

Interviewing Skills

The Nurse-Patient Relationship

Nurse-Patient Communication

Communication within the Health Care Team

Communication in the Home and Community

 Get Ready for the NCLEX Examination!

chapter 9. Patient Education and Health Promotion

Purposes of Patient Education

Modes of Learning

Assessment of Learning Needs

The Patient Education Plan

Coordination with Discharge Planning

Get Ready for the NCLEX Examination!

chapter 10. Delegation, Leadership, and Management

The Chain of Command

Leadership Styles

Keys to Effective Leadership

Leadership Roles

Management Skills for the Licensed Practical Nurse/Licensed Vocational

Nurse

Risk Management

Get Ready for the NCLEX Examination!

Unit IV. Developmental, Psychosocial, and Cultural
Considerations

chapter 11. Growth and Development: Infancy Through Adolescence

Overview of Structure and Function

Age Groups
 Theories of Development

Principles of Growth and Development

Prenatal Development

Infants

Young Children

Middle and Older Children

Adolescents

Get Ready for the NCLEX Examination!

chapter 12. Adulthood and the Family

Adulthood as Continuing Change

Theories of Development

Families

Young Adults

Middle Adulthood

Get Ready for the NCLEX Examination!

chapter 13. Promoting Healthy Adaptation to Aging

Overview of Aging

Physical Changes

Cognitive Aspects of Aging

Psychosocial Aspects of Aging

When a Parent Needs Help

Get Ready for the NCLEX Examination!

chapter 14. Cultural and Spiritual Aspects of Patient Care
Transcultural Care

Major Religions in the United States and Canada

Developing Cultural Competence

Cultural Differences

Nursing Process in Transcultural Nursing

Get Ready for the NCLEX Examination!

chapter 15. Loss, Grief, and End-of-Life Care

Nurses’ Attitudes Toward End-of-Life Care

Change, Loss, and Grief

Death and Dying

Nursing and the Dying Process

Application of the Nursing Process

Signs of Impending Death

Legal and Ethical Aspects of Life-and-Death Issues

Postmortem (After Death) Care

Get Ready for the NCLEX Examination!

Unit V. Basic Nursing Skills

chapter 16. Infection Prevention and Control: Protective Mechanisms

and Asepsis
Infectious Agents

Process (Chain) of Infection

 Body Defenses Against Infection

Asepsis and Control of Microorganisms

Sepsis in the Home Environment

Infection Control Surveillance

Get Ready for the NCLEX Examination!

chapter 17. Infection Prevention and Control in the Hospital and

Home
Infection

Infection Prevention and Control

Personal Protective Equipment

Application of the Nursing Process

Get Ready for the NCLEX Examination!

chapter 18. Safely Lifting, Moving, and Positioning Patients

Overview of the Structure and Function of the Musculoskeletal System

What are the Functions of Bones for Positioning and Moving Patients?

What are the Functions of Muscles for Positioning and Moving Patients?

What Changes in the System Occur with Aging?

Principles of Body Movement for Nurses

Principles of Body Movement for Patients

Application of the Nursing Process

Get Ready for the NCLEX Examination!

chapter 19. Assisting With Hygiene, Personal Care, Skin Care, and
the Prevention of Pressure Injuries
Overview of the Structure and Function of the Integumentary System

Application of the Nursing Process

Get Ready for the NCLEX Examination!

chapter 20. Patient Environment and Safety

Factors Affecting the Environment

Patient Unit

Safety

Protective Devices

Get Ready for the NCLEX Examination!

chapter 21. Measuring Vital Signs

Overview of Structure and Function Related to the Regulation of Vital Signs

Measuring Body Temperature

Application of the Nursing Process

Measuring the Pulse

Application of the Nursing Process

Measuring Respirations

Measuring the Blood Pressure

Application of the Nursing Process

Pain, the Fifth Vital Sign

Automated Vital Sign Monitors

 Documenting Vital Signs

Get Ready for the NCLEX Examination!

chapter 22. Assessing Health Status

Data Collection and Assessment

Application of the Nursing Process

Get Ready for the NCLEX Examination!

chapter 23. Admitting, Transferring, and Discharging Patients

Types of Admissions

Admission Process

Patient Transfer to Another Hospital Unit

Discharging the Patient

Death of a Patient

Get Ready for the NCLEX Examination!

chapter 24. Diagnostic Tests and Specimen Collection

Diagnostic Tests and Procedures

Application of the Nursing Process

Get Ready for the NCLEX Examination!

Unit VI. Meeting Basic Physiologic Needs

chapter 25. Fluid, Electrolyte, and Acid-Base Balance

Composition of Body Fluids

Distribution of Body Fluids

 Fluid and Electrolyte Imbalances

Acid-Base Balance

Acid-Base Imbalances

Application of the Nursing Process

Get Ready for the NCLEX Examination!

chapter 26. Concepts of Basic Nutrition and Cultural Considerations

Overview of the Structure and Function of the Gastrointestinal System

Dietary Guidelines

Protein

Vegetarian Diets

Carbohydrates

Fats (Lipids)

Vitamins

Minerals

Water

Factors that Influence Nutrition

Cultural Influences on Nutrition

Nutritional Needs Throughout the Life Span

Application of the Nursing Process

Get Ready for the NCLEX Examination!

chapter 27. Nutritional Therapy and Assisted Feeding

The Goals of Nutritional Therapy
 The Postoperative Patient

Health Issues Related to Nutrition

Disease Processes that Benefit from Nutritional Therapy

Assisted Feeding

Application of the Nursing Process

Get Ready for the NCLEX Examination!

chapter 28. Assisting with Respiration and Oxygen Delivery

Overview of the Structure and Function of the Respiratory System

Hypoxemia

Airway Obstruction and Respiratory Arrest

Clearing Respiratory Secretions

Oxygen Administration

Artificial Airways

Chest Drainage Tubes

Application of the Nursing Process

Get Ready for the NCLEX Examination!

chapter 29. Promoting Urinary Elimination

Overview of Structure and Function of the Urinary System

Normal Urinary Elimination

Alterations in Urinary Elimination

Application of the Nursing Process

Get Ready for the NCLEX Examination!

chapter 30. Promoting Bowel Elimination
Overview of the Structure and Function of the Intestinal System

Characteristics of Stool

Hypoactive Bowel and Constipation

Hyperactive Bowel and Diarrhea

Fecal Incontinence

Application of the Nursing Process

Rectal Suppositories

Enemas

Rectal Tube

Fecal Impaction

Bowel Training for Incontinence

Bowel Ostomy

Get Ready for the NCLEX Examination!

chapter 31. Pain, Comfort, and Sleep

Pain and Discomfort

Application of the Nursing Process

Sleep

Application of the Nursing Process

Get Ready for the NCLEX Examination!

chapter 32. Complementary and Alternative Therapies

Complementary and Alternative Medicine
 Mind and Body Interventions

Natural Products

Other Complementary Interventions

The Nurse’s Role in Complementary and Alternative Therapies

Get Ready for the NCLEX Examination!

Unit VII. Medication Administration

chapter 33. Pharmacology and Preparation for Drug Administration

Pharmacology

Medication Administration and Safety

Application of the Nursing Process

Get Ready for the NCLEX Examination!

chapter 34. Administering Oral, Topical, and Inhalant Medications

Nursing Responsibilities in Medication Administration

Medication Orders

Medication Administration Systems

Topical Drugs

Application of the Nursing Process

Medication Errors

Get Ready for the NCLEX Examination!

chapter 35. Administering Intradermal, Subcutaneous, and

Intramuscular Injections
Principles of Parenteral Injections
Contributors and Reviewers
CONTRIBUTORS

Karen V. Anderson, MSN, RN, Associate Dean of Nursing,

Nursing Department, Kaplan College, San Diego, San Diego,
California

8 Communication and the Nurse-Patient

Relationship

17 Infection Prevention and Control in the Hospital

and Home

34 Administering Oral, Topical, and Inhalant

Medications

36 Administering Intravenous Solutions and

Medications

39 Promoting Musculoskeletal Function

Shelley Eckvahl, BSN, MSN, Professor, Nursing, Chaffey
Community College, Rancho Cucamonga, California

3 Legal and Ethical Aspects of Nursing

5 Assessment, Nursing Diagnosis, and Planning

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