Nursing Care Plans and Documentation: Nursing Diagnosis and Collaborative Problems / Edition 4

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A comprehensive, market-leading nursing care planning and documentation text for undergraduate nursing students. This one-of-a-kind resource can be used conjunctively with Nursing Diagnosis and Handbook of Nursing Diagnosis, both by the same author. Content includes nursing care plans for the care of all adults regardless of their clinical situation; detailed care plans for specific clinical problems; collaborative problems and nursing diagnoses; and a strong emphasis on documentation. It also includes research validated identification of frequently encountered nursing diagnoses and collaborative problems.

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Editorial Reviews

Emphasis in these care plans is on efficient documentation. The author provides interventions and rationales for both nursing diagnoses and collaborative problems and identifies diagnostic clusters that group the most likely diagnoses and problems for each clinical situation. Annotation c. Book News, Inc., Portland, OR (
From The Critics
Reviewer: Amy McClune, PhD, RN(Edinboro University of Pennsylvania)
Description: This fifth edition of a respected work describes important components in the nursing process and presents detailed care plans for a host of medical diagnoses that can be individualized for care.
Purpose: This well known resource includes recent evidence to support the nursing process. A new chapter focuses on a new diagnosis, moral distress.
Audience: It is written for both practicing and student nurses. It is also promoted as a care planning resource for healthcare institutions. The author shows her expertise by updating and augmenting her ongoing work related to nursing diagnosis.
Features: The book begins with an overview of the Validation Project completed in the mid-1990s that laid the foundation. The first section is dedicated to reviewing components critical to planning, evaluating, documenting, and communicating nursing care. Using the Bifocal Clinical Practice Model, Bandura's Self Efficacy Model, and various other theories, the author links care planning to a strong theoretical basis. Nursing interventions focus on independent nursing care and link diagnoses to potential complications.
Assessment: With this fifth edition, the author continues to build on the nursing process from both a theoretical and a practical viewpoint. This edition includes updated evidence and examples for planning nursing care and continues to be a key resource for care planning.
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Product Details

  • ISBN-13: 9780781739061
  • Publisher: Lippincott Williams & Wilkins
  • Publication date: 7/1/2003
  • Edition description: Fourth Edition
  • Edition number: 4
  • Pages: 1120

Table of Contents

U N I T 1: Introduction to Care Planning 1
C H A P T E R 1: The Bifocal Clinical Practice Model 3
C H A P T E R 2: Documentation of Nursing Care 9
C H A P T E R 3: 11 Steps to Care Planning 27
C H A P T E R 4: The Ill Adult: Issues and Responses 33
C H A P T E R 5: Response to the Surgical Experience 41

U N I T I I: Clinical Nursing Care Plans 57

S E C T I O N 1: Medical Conditions 63
Generic Medical Care Plan for the Hospitalized Adult Client 65
Cardiovascular and Peripheral Vascular Disorders 91
Congestive Heart Failure 93
Deep Venous Thrombosis 98
Hypertension 105
Myocardial Infarction 112
Peripheral Arterial Disease (Atherosclerosis) 126
Respiratory Disorders 135
Asthma 137
Chronic Obstructive Pulmonary Disease 147
Pneumonia 163
Metabolic and Endocrine Disorders 173
Cirrhosis 175
Diabetes Mellitus 186
Hepatitis (Viral) 210
Hypothyroidism 216
Obesity 225
Pancreatitis 234
Gastrointestinal Disorders 247
Gastroenterocolitis/Enterocolitis 249
Inflammatory Bowel Disease 255
Peptic Ulcer Disease 272
Renal and Urinary Tract Disorders 279
Acute Kidney Failure 281
Chronic Kidney Disease 289
Neurologic Disorders 311
Cerebrovascular Accident (Stroke) 313
Guillain-Barré Syndrome 333
Multiple Sclerosis 342
Myasthenia Gravis 356
Neurogenic Bladder 363
Parkinson’s Disease 379
Seizure Disorders 386
Spinal Cord Injury 393
Sensory Disorders 421
Glaucoma 423
Hematologic Disorders 431
Sickle Cell Disease 433
Integumentary Disorders 443
Pressure Ulcers 445
Thermal Injuries 456
Musculoskeletal and Connective-Tissue Disorders 481
Fractures 483
Inflammatory Joint Disease (Rheumatoid Arthritis, Infectious Arthritis) 491
Osteomyelitis 510
Osteoporosis 514
Infectious and Immunodeficient Disorders 521
Human Immunodeficiency Virus/Acquired Immunodeficiency Syndrome 523
Systemic Lupus Erythematosus 547
Neoplastic Disorders 555
Cancer: Initial Diagnosis 557
Cancer: End Stage 572
Leukemia 594
Clinical Situations 605
Alcohol Withdrawal 607
Immobility or Unconsciousness 620
Sexual Assault 630

S E C T I O N 2: Surgical Procedures 639
Generic Care Plan for the Surgical Client 641
Generic Care Plan for the Ambulatory Surgical Client 664
Abdominal Aortic Aneurysm Resection 680
Amputation 686
Arterial Bypass Grafting in the Lower Extremity 701
Breast Surgery (Lumpectomy, Mastectomy) 709
Carotid Endarterectomy 720
Cataract Extraction 726
Colostomy 736
Coronary Artery Bypass Grafting 757
Cranial Surgery 774
Enucleation 788
Fractured Hip and Femur 799
Hysterectomy 813
Ileostomy 821
Laminectomy 843
Laryngectomy 851
Neck Dissection 854
Nephrectomy 867
Radical Prostatectomy 873
Thoracic Surgery 883
Total Joint Replacement (Hip, Knee, Shoulder) 897
Urostomy 906

S E C T I O N 3: Diagnostic and Therapeutic Procedures 921
Anticoagulant Therapy 923
Casts 929
Chemotherapy 938
Corticosteroid Therapy 955
Enteral Nutrition 966
Hemodialysis 977
Long-Term Venous Access Devices 984
Mechanical Ventilation 993
Pacemaker Insertion (Permanent) 1001

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