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Nursing Interventions & Clinical
Skills

SEVENTH EDITION

ANNE GRIFFIN PERRY, RN, MSN,

EdD, FAAN
Professor Emerita
School of Nursing
Southern Illinois University—Edwardsville
Edwardsville, Illinois

PATRICIA A. POTTER, RN, MSN,

PhD, FAAN
Formerly, Director of Research
Patient Care Services
Barnes-Jewish Hospital
St. Louis, Missouri
WENDY R. OSTENDORF, RN, MS,
EdD, CNE
Contributing Faculty
Master's of Science in Nursing
Walden University
Minneapolis, Minnesota
Table of Contents

Cover image

Title Page

Copyright

About the Authors

Contributors

Reviewers

Acknowledgments

Notes From the Authors

Preface to the Instructor

Key Features

New to This Edition

Ancillaries

Unit 1 Quality and Safety in Nursing Practice

1 Using Evidence in Nursing Practice

Introduction

Steps in the EBP Framework

Safe and Effective Nursing Skills and Procedures

Practice Standards

Practice Standards

Benefits of EBP

Practice Reflections

Clinical Review Questions

References

2 Communication and Collaboration

SKILL 2.1 Discharge Planning and Transitional Care

SKILL 2.2 Workplace Violence and Safety

Clinical Review Questions

References

3 Documentation and Informatics

Introduction

Practice Standards

Electronic Health Record

 Evidence-Based Practice

Safety Guidelines

Confidentiality

Legal Guidelines in Documentation

Standards

Guidelines for Quality Documentation

Special Considerations

Practice Reflections

Clinical Review Questions

References

4 Patient Safety and Quality Improvement

SKILL 4.1 Fall Prevention in a Health Care Setting

SKILL 4.2 Designing a Restraint-Free Environment

SKILL 4.3 Applying Physical Restraints

SKILL 4.4 Seizure Precautions

Clinical Review Questions

References

5 Infection Control

SKILL 5.1 Hand Hygiene

 SKILL 5.2 Applying Personal Protective Equipment

SKILL 5.3 Caring for Patients Under Isolation Precautions

SKILL 5.4 Preparing a Sterile Field

SKILL 5.5 Sterile Gloving

Clinical Review Questions

References

6 Disaster Preparedness

SKILL 6.1 Care of a Patient After Biological Exposure

SKILL 6.2 Care of a Patient After Chemical Exposure

SKILL 6.3 Care of a Patient After Radiation Exposure

Clinical Review Questions

References

Unit 2 Patient Assessment Skills

7 Vital Signs

SKILL 7.1 Measuring Body Temperature

SKILL 7.2 Assessing Apical Pulse

SKILL 7.3 Assessing Radial Pulse

SKILL 7.4 Assessing Respirations

SKILL 7.5 Assessing Blood Pressure

 Clinical Review Questions

References

8 Health Assessment

SKILL 8.1 General Survey

SKILL 8.2 Assessing the Head and Neck

SKILL 8.3 Assessing the Thorax and Lungs

SKILL 8.4 Cardiovascular Assessment

SKILL 8.5 Assessing the Abdomen

SKILL 8.6 Assessing the Genitalia and Rectum

SKILL 8.7 Musculoskeletal and Neurological Assessment

Clinical Review Questions

References

9 Specimen Collection

SKILL 9.1 Urine Specimen Collection—Midstream (Clean-

Voided) Urine, Sterile Urinary Catheter

SKILL 9.2 Testing for Gastrointestinal Alterations—Gastroccult

Test, Stool Specimen, and Hemoccult Test

SKILL 9.3 Collecting Nose and Throat Specimens

SKILL 9.4 Collecting a Sputum Specimen

SKILL 9.5 Collecting Wound Drainage Specimens

 SKILL 9.6 Blood Glucose Monitoring

SKILL 9.7 Collecting Blood and Culture Specimens by

Venipuncture (Syringe and Vacutainer Method)

Clinical Review Questions

References

10 Diagnostic Procedures

SKILL 10.1 Intravenous Moderate Sedation

SKILL 10.2 Contrast Media Studies: Arteriogram (Angiogram),

Cardiac Catheterization, Intravenous Pyelogram

SKILL 10.3 Care of Patients Undergoing Aspirations: Bone

Marrow, Lumbar Puncture, Paracentesis, Thoracentesis

SKILL 10.4 Care of Patients Undergoing Bronchoscopy

SKILL 10.5 Care of Patients Undergoing Gastrointestinal

Endoscopy

SKILL 10.6 Obtaining a 12-Lead Electrocardiogram

Clinical Review Questions

References

Unit 3 Basic Human Needs

11 Bathing and Personal Hygiene

SKILL 11.1 Complete or Partial Bed Bath

 SKILL 11.2 Performing Mouth Care for an Unconscious or
Debilitated Patient

Clinical Review Questions

References

12 Care of the Eye and Ear

SKILL 12.1 Eye Irrigation

SKILL 12.2 Ear Irrigation

Clinical Review Questions

References

13 Promoting Nutrition

SKILL 13.1 Dysphagia Screening and Assisting With Oral

Nutrition

SKILL 13.2 Aspiration Precautions

SKILL 13.3 Insertion and Removal of a Small-Bore Feeding

Tube

SKILL 13.4 Verifying Placement and Irrigating a Feeding Tube

SKILL 13.5 Administering Enteral Nutrition: Nasogastric,

Nasointestinal, Gastrostomy, or Jejunostomy Tube

Clinical Review Questions

References
14 Parenteral Nutrition

SKILL 14.1 Administering Central Parenteral Nutrition

SKILL 14.2 Administering Peripheral Parenteral Nutrition With

Lipid (Fat) Emulsion

Clinical Review Questions

References

15 Pain Management

SKILL 15.1 Pain Assessment and Basic Comfort Measures

SKILL 15.2 Nonpharmacological Pain Management

SKILL 15.3 Pharmacological Pain Management

SKILL 15.4 Patient-Controlled Analgesia

SKILL 15.5 Epidural Analgesia

SKILL 15.6 Local Anesthetic Infusion Pump for Analgesia

SKILL 15.7 Moist and Dry Heat Application

SKILL 15.8 Cold Application

Clinical Review Questions

References

16 Promoting Oxygenation

SKILL 16.1 Oxygen Administration

 SKILL 16.2 Airway Management: Noninvasive Positive-Pressure
Ventilation

SKILL 16.3 Airway Management: Suctioning

SKILL 16.4 Care of Artificial Airways

SKILL 16.5 Managing Closed Chest Drainage Systems

Clinical Review Questions

References

Unit 4 Activity and Mobility

17 Safe Patient Handling

SKILL 17.1 Transfer Techniques

SKILL 17.2 Moving and Positioning Patients in Bed

Clinical Review Questions

References

18 Exercise, Mobility, and Immobilization Devices

SKILL 18.1 Assisting With Ambulation (Without Assist Devices)

SKILL 18.2 Use of Canes, Crutches, and Walkers

SKILL 18.3 Care of a Patient With an Immobilization Device

Clinical Review Questions

References
Unit 5 Promoting Elimination

19 Urinary Elimination

SKILL 19.1 Applying a Male Incontinence Device

SKILL 19.2 Insertion of a Straight or Indwelling Catheter

SKILL 19.3 Care and Removal of an Indwelling Catheter

SKILL 19.4 Suprapubic Catheter Care

SKILL 19.5 Performing Catheter Irrigation

Clinical Review Questions

References

20 Bowel Elimination and Gastric Decompression

SKILL 20.1 Administering an Enema

SKILL 20.2 Insertion, Maintenance, and Removal of a

Nasogastric Tube for Gastric Decompression

Clinical Review Questions

References

21 Ostomy Care

SKILL 21.1 Pouching a Bowel Diversion

SKILL 21.2 Pouching a Urostomy

SKILL 21.3 Catheterizing a Urostomy

 Clinical Review Questions

References

Unit 6 Medication Administration

22 Preparation for Safe Medication Administration

Introduction

Practice Standards

Evidence-Based Practice

Safety Guidelines

Pharmacokinetics

Drug Actions

Types of Medication Action

Administering Medications

Distribution Systems

Medication Administration Record

Seven Rights of Medication Administration

Medication Preparation

Nursing Process

Reporting Medication Errors

Patient and Family Caregiver Teaching

 Handling of Special Medications

Special Considerations

Practice Reflections

Clinical Review Questions

References

23 Nonparenteral Medications

SKILL 23.1 Administering Oral Medications

SKILL 23.2 Administering Medications Through a Feeding Tube

SKILL 23.3 Applying Topical Medications to the Skin

SKILL 23.4 Instilling Eye and Ear Medications

SKILL 23.5 Using Metered-Dose Inhalers

SKILL 23.6 Using Small-Volume Nebulizers

Clinical Review Questions

References

24 Parenteral Medications

Introduction

Practice Standards

Evidence-Based Practice

Safety Guidelines
Needlestick Prevention

SKILL 24.1 Preparing Injections: Vials and Ampules

Assessment

SKILL 24.2 Administering Subcutaneous Injections

Assessment

SKILL 24.3 Administering Intramuscular Injections

Injection Sites

Assessment

SKILL 24.4 Administering Intradermal Injections

Assessment

SKILL 24.5 Administering Medications by Intravenous Bolus

Assessment

SKILL 24.6 Administering Intravenous Medications by Piggyback

and Syringe Pumps

Assessment

SKILL 24.7 Administering Medications by Continuous

Subcutaneous Infusion

Assessment

Special Considerations

Practice Reflections

Clinical Review Questions

 References

Unit 7 Dressings and Wound Care

25 Wound Care and Irrigation

SKILL 25.1 Performing a Wound Irrigation

SKILL 25.2 Managing Wound Drainage Evacuation

SKILL 25.3 Removing Sutures and Staples

SKILL 25.4 Negative-Pressure Wound Therapy

Clinical Review Questions

References

26 Pressure Injury Prevention and Care

SKILL 26.1 Risk Assessment, Skin Assessment, and Prevention

Strategies

SKILL 26.2 Treatment of Pressure Injuries and Wound

Management

Clinical Review Questions

References

27 Dressings, Bandages, and Binders

SKILL 27.1 Applying a Gauze Dressing (Dry and Damp-to-Dry)

SKILL 27.2 Applying a Pressure Bandage

 SKILL 27.3 Applying Hydrocolloid, Hydrogel, Foam, or Alginate
Dressings

Clinical Review Questions

References

Unit 8 Complex Nursing Interventions

28 Intravenous and Vascular Access Therapy

SKILL 28.1 Insertion of a Short-Peripheral Intravenous Device

SKILL 28.2 Regulating Intravenous Infusion Flow Rates

SKILL 28.3 Maintenance of an Intravenous Site

SKILL 28.4 Managing Central Vascular Access Devices

SKILL 28.5 Transfusion of Blood Products

Clinical Review Questions

References

29 Preoperative and Postoperative Care

SKILL 29.1 Preoperative Assessment

SKILL 29.2 Preoperative Teaching

SKILL 29.3 Patient Preparation Before Surgery

SKILL 29.4 Providing Immediate Anesthesia Recovery in the

Postanesthesia Care Unit (PACU)
 SKILL 29.5 Providing Early Postoperative (Phase II) and
Convalescent Phase (Phase III) Recovery

Clinical Review Questions

References

30 Emergency Measures for Life Support in the Hospital Setting

SKILL 30.1 Inserting an Oropharyngeal Airway

SKILL 30.2 Using an Automated External Defibrillator

SKILL 30.3 Code Management

Clinical Review Questions

References

Unit 9 Supportive Nursing Interventions

31 End-of-Life Care

SKILL 31.1 Supporting Patients and Families in Grief

SKILL 31.2 Symptom Management at End of Life

SKILL 31.3 Care of the Body After Death

Clinical Review Questions

References

32 Home Care Safety

SKILL 32.1 Home Environment Assessment and Safety

 SKILL 32.2 Adapting the Home Setting for Clients With
Cognitive Deficits

SKILL 32.3 Medication and Medical Device Safety

Clinical Review Questions

References
Appendixes

Appendix A Integrative Practice Reflections

Gerontological Focus

Home Care Focus

Appendix B Abbreviations and Equivalents

Abbreviations for Conversion Using Household Measures

Standard Equivalents, Abbreviations, and Conversions

Symbols

Abbreviations

Answers to Clinical Review Questions

Index

Index of Skills
Copyright
NURSING INTERVENTIONS AND CLINICAL SKILLS, SEVENTH
EDITION ISBN: 978-0-323-54701-7

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About the Authors
Anne Griffin Perry RN, MSN, EdD, FAAN

Dr. Anne G. Perry is Professor Emerita and Former

Interim Dean and Associate Dean of Nursing at Southern Illinois
University—Edwardsville. Dr. Perry was also a Professor and taught
at Saint Louis University School of Nursing for over 30 years and is a
Fellow in the American Academy of Nursing. She received her BSN
from the University of Michigan, her MSN from Saint Louis
University, and her EdD from Southern Illinois University at
Edwardsville. Dr. Perry is a prolific and influential author and
speaker. Her work includes four major textbooks (Essentials for
Nursing Practice, Fundamentals of Nursing, Nursing Interventions and
Clinical Skills, and Clinical Nursing Skills and Techniques), multiple
journal articles abstracts, and nursing research and education grants.
She has presented multiple papers at conferences across the United
States. She has acted as an editorial board member of numerous
journals (Journal of Nursing Measurement, Intensive Care Medicine,
AACN Clinical Issues, and Perspectives in Respiratory Nursing), and she
was one of a few key consultants on Mosby's Nursing Skills Videos
and Mosby's Nursing Skills Online.
Patricia A. Potter RN, MSN, PhD, FAAN
 Dr. Patricia Potter received her diploma in nursing
from Barnes School of Nursing; her BSN at the University of
Washington in Seattle, Washington; and her MSN and PhD at Saint
Louis University in St. Louis, Missouri. A ground-breaking author
for more than 30 years, her work includes four major textbooks
(Essentials for Nursing Practice, Fundamentals of Nursing, Nursing
Interventions and Clinical Skills, and Clinical Nursing Skills and
Techniques) and multiple journal articles. She has been an unceasing
advocate of evidence-based practice and quality improvement in her
roles as administrator, educator, and researcher.
Dr. Potter has devoted a lifetime to nursing education, practice,
and research. She spent a decade teaching at Barnes Hospital School
of Nursing and Saint Louis University. She entered into a variety of
managerial and administrative roles, ultimately becoming the
director of nursing practice for Barnes-Jewish Hospital. In that
capacity she sharpened her interest in the development of nursing
practice standards and measurement of patient outcomes in defining
nursing practice. Her most recent passion has been in the area of
nursing research, specifically cancer family caregiving, the effects of
compassion fatigue on nurses, and fall prevention. Dr. Potter was
most recently the Director of Research for Patient Care Services at
Barnes-Jewish Hospital in St. Louis, Missouri, before her retirement
in 2017.
Wendy R. Ostendorf RN, MS, EdD, CNE
 Dr. Wendy R. Ostendorf received her BSN from
Villanova University, her MS from the University of Delaware, and
her EdD from the University of Sarasota. She currently serves as a
contributing faculty in the Master's of Science in Nursing at Walden
University. She has contributed over 26 chapters to multiple nursing
textbooks and has served as co-author for Clinical Nursing Skills and
Techniques and Nursing Interventions & Clinical Skills. She has
presented over 25 papers at conferences at the local, national, and
international levels.
Professionally, Dr. Ostendorf has a diverse background in
pediatric and adult critical care. She has taught at the
undergraduate, master's, and doctoral level for over 30 years. With
decades of practice as a clinician, her educational experiences have
influenced her teaching philosophy and perceptions of the nursing
profession. Dr. Ostendorf's current interests include the history and
image of nursing as it has been represented in film, as well as the use
of dedicated units and preceptors on students’ transition to practice.
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