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Accounting Principles: A Business Perspective

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Uses annual reports of real companies to illustrate many of the accounting concepts in use in business today. Gaining an understanding of accounting terminology and concepts, however, is not enough to ensure your success. You also need to be able to find information on the Internet, analyze various business situations, work effectively as a member of a team, and communicate your ideas clearly. This text was developed to help you develop these skills.

Material Type: Textbook

Authors: James D. Edwards, Roger H. Hermanson

Money and Banking

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The financial crisis of 2007-8 has already revolutionized institutions, markets, and regulation. Wright's Money and Banking V 2.0 captures those revolutionary changes and packages them in a way that engages undergraduates enrolled in Money and Banking and Financial Institutions and Markets courses. Minimal mathematics, accessible language, and a student-oriented tone ease readers into complex subjects like money, interest rates, banking, asymmetric information, financial crises and regulation, monetary policy, monetary theory, and other standard topics. Numerous short cases, called "Stop and Think" boxes, promote internalization over memorization. Exercise drills ensure basic skills competency where appropriate. Short, snappy sections that begin with a framing question enhance readability and encourage assignment completion. The 2.0 version of this text boasts substantive revisions (additions, deletions, rearrangements) of almost every chapter based on the suggestions of many Money and Banking instructors.

Material Type: Textbook

Author: Robert E. Wright

Introduction to Financial Accounting: U.S. GAAP Adaptation

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This textbook, originally by D. Annand and H. Dauderis, was intended for a first course in introductory financial accounting. It was extensively edited by Athabasca University to reflect current International Financial Reporting Standards (IFRS). This most recent revision by D. Marchand converted the text from IFRS to reflect the Generally Accepted Accounting Principles of the United States (U.S. GAAP). A corporate approach is utilized versus beginning with a sole proprietorship emphasis and then converting to a corporate approach.

Material Type: Assessment, Homework/Assignment, Textbook

Authors: D. Annand, Donna L. Marchand, H. Dauderis

Principles of Managerial Accounting

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Principles of Managerial Accounting is an innovative video eText that is intended to be watched as much as it is read. Users learn fundamental managerial accounting principles by reading about the concepts in the text immediately followed by watching short videos where the concepts are applied in demonstration problems. Each chapter contains detailed written explanations of fundamental managerial accounting concepts such as cost behavior, cost classifications, cost volume profit analysis, incremental decision making, budgeting, and variance analysis. Video Illustrations are embedded within the written text to actively demonstrate the accounting concepts. Each chapter is concluded with a series of comprehensive Practice Video Problems in which the concepts are applied to unique business situations. This video eText is particularly suited for distance education courses, hybrid courses, personal interest self-study, or any other circumstance in which users don’t receive the educational benefits from traditional, in-person lectures.

Material Type: Textbook

Author: Patricia Goedl

Principles of Accounting I

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Introduces accounting principles with respect to financial reporting. Demonstrates how decision makers use accounting information for reporting purposes. Focuses on the preparation of accounting information and its use in the operation of organizations, as well as methods of analysis and interpretation of accounting information.

Material Type: Textbook

Financial Accounting

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This book is suitable for an undergraduate or MBA level Financial Accounting course. The authors bring their collective teaching wisdom to bear in this book not by changing "the message"(financial accounting content), but by changing "the messenger" (the way the content is presented). The approach centers around utilizing the Socratic method, or simply put, asking and answering questions. The reason that this approach continues to be glorified after thousands of years is simple - it engages students and stresses understanding over memorization. So this text covers standard topics in a standard sequence, but does so through asking a carefully constructed series of questions along with their individual answers.

Material Type: Textbook

Authors: C. J. Skender, Joe Ben Hoyle

Principles of Financial Accounting

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The University of North Georgia Press and Affordable Learning Georgia bring you Accounting I. Well-written and straightforward, Principles of Financial Accounting is a needed contribution to open source pedagogy in the business education world. Written in order to directly meet the needs of her students, this textbook developed from Dr. Christine Jonick’s years of teaching and commitment to effective pedagogy.

Material Type: Textbook

Author: Christine Jonick

OpenStax Introduction to Business

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Introduction to Business covers the scope and sequence of most introductory business courses. The book provides detailed explanations in the context of core themes such as customer satisfaction, ethics, entrepreneurship, global business, and managing change. Introduction to Business includes hundreds of current business examples from a range of industries and geographic locations, which feature a variety of individuals. The outcome is a balanced approach to the theory and application of business concepts, with attention to the knowledge and skills necessary for student success in this course and beyond.

Material Type: Textbook

Authors: Amit Shah, Bethann Talsma, Carl McDaniel, James C. Hyatt, Lawrence J. Gitman, Linda Koffel, Monique Reece

Fundamentals of Business

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Fundamentals of Business (2016) is an openly licensed (CC BY NC SA 3.0) textbook designed for use in Virginia Tech’s Pamplin College of Business introductory level business course, MGT1104 Foundations of Business. This work is a project of University Libraries and the Pamplin College of Business, Virginia Tech. A new version of this book was released in August 2018. See http://hdl.handle.net/10919/84848 for more details. If you are an instructor reviewing, adopting, or adapting this textbook, please help us understand a little more about your use by filling out this form http://bit.ly/business-interest See also the faculty sharing portal at: https://www.oercommons.org/groups/fundamentals-of-business-user-group/1379

Material Type: Textbook

Author: Stephen J. Skripak

Testbank for Fundamentals of Business

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The testbank includes 377 peer-reviewed, multiple-choice questions which correspond to topics taught in introductory-level business open textbook, "Fundamentals of Business." "Fundamentals of Business" is a freely available, openly licensed resource available at: http://hdl.handle.net/10919/84848 . Between 11-29 multiple-choice items are available for each of the following topics: Teamwork in Business, Foundations of Business, Economics and Business, Ethics and Social Responsibility, Business in a Global Environment, Forms of Business Ownership, Entrepreneurship: Starting a Business, Management and Leadership, Structuring Organizations, Operations Management, Motivating Employees, Managing Human Resources, Union/Management Issues, Marketing: Providing Value to Customers, Pricing Strategy, Hospitality and Tourism, Accounting and Financial Information, and Personal Finances. The testbank is available to any instructor who has adopted Fundamentals of Business in their course. Please complete the four steps listed at http://hdl.handle.net/10919/93404 to request access to the testbank. 1. View and test the "sample" files at http://hdl.handle.net/10919/93404 in the left hand column to determine which format works best for you. Additional information about each format type is available below under FORMATS. 2. Indicate requested files by clicking on any of the testbank files at http://hdl.handle.net/10919/93404 on the left (marked "permission required") add a note and press submit to request access. 3. Email a copy of the course syllabus to openeducation@vt.edu 4. Complete and submit the User Verification Process Form https://forms.gle/ueaihc96LgNrE9uf9. You will receive a copy of your request via email. Requested files will be released via email when steps two through four have been completed and reviewed. Note that access approvals are processed only during regular business hours. Please visit: http://hdl.handle.net/10919/93404 for Terms of Use, license information, and to view or report errata. SAMPLE QUESTIONS Sample questions are available for those who wish to test various formats and assess the suitability of the testbank as part of their course material adoption decision-making process. Sample questions are provided in the same formats (XLS, Canvas IMS QTI 1.1.3, XML QTI, and Blackboard formats) as the permission-only testbank files. Sample questions have been removed from the electronically secure testbank. FORMATS The testbank and portions thereof are available in multiple formats. Links to external sites regarding uploading different types of QTI files are here: Canvas | Blackboard or on the help pages for your respective learning management system by searching for "QTI". Files marked "IMS QTI 1.1.3" and have been tested to successfully import into Canvas but may work with other LMS/VLE systems. Please use the sample files to determine if one of the export formats will work for your specific situation. Please note that we are unable to provide additional file types, support for uploading, or assistance with reformatting files. Please contact your local learning management system (LMS) manager for additional support. Distribution The information in the testbank is of a proprietary nature, produced by or for faculty of public institutions of higher education as a result of collaborative study, research, and peer review. Because it is intended to be used in student assessment the information has not been publicly released or published. If you become aware of public distribution of the testbank or portions thereof shared outside of a secure electronic environment, assessment context, or other security breach please inform us at: openeducation@vt.edu LIABILITY The testbank and testbank items are provided "as is." Users of this resource assume all risks and further agree to hold Virginia Tech, the Commonwealth of Virginia and their employees and agents, and project contributors harmless from any and all actions related to use of this program.

Material Type: Assessment

Authors: Bamgarner Sarah, Cortes Anastasia, Futyma Frank, Goodwin Thomas, Hertweck Bryan, Manfred Michelle, Poff Ron, Tuttle Mallory, Walz Anita, Watters Sheila

Exploring Business

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The author's goals in writing Exploring Business were simple: (1) introduce students to business in an exciting way and (2) provide faculty with a fully developed teaching package that allows them to do the former. Toward those ends, the following features are included in this text:1- Integrated (Optional) Nike Case Study: A Nike case study is available for instructors who wish to introduce students to business using an exciting and integrated case. Through an in-depth study of a real company, students learn about the functional areas of business and how these areas fit together. Studying a dynamic organization on a real-time basis allows students to discover the challenges that it faces, and exposes them to critical issues affecting the business, such as globalization, ethics and social responsibility, product innovation, diversity, supply chain management, and e-business.2- A Progressive (Optional) Business Plan: Having students develop a business plan in the course introduces students to the excitement and challenges of starting a business and helps them discover how the functional areas of business interact. This textbook package includes an optionalintegrated business plan project modeled after one refined by the author and her teaching team over the past ten years.3- AACSB Emphasis: The text provides end-of-chapter questions, problems, and cases that ask students to do more than regurgitate information. Most require students to gather information, assess a situation, think about it critically, and reach a conclusion. Each chapter presents ten Questions and Problems as well as five cases on areas of skill and knowledge endorsed by AACSB: Learning on the Web, Career Opportunities, The Ethics Angle, Team-Building Skills, and The Global View. More than 70% of end-of-chapter items help students build skills in areas designated as critical by AACSB, including analytical skills, ethical awareness and reasoning abilities, multicultural understanding and globalization, use of information technology, and communications and team oriented skills. Each AACSB inspired exercise is identified by an AACSB tag and a note indicating the relevant skill area.4- Author-Written Instructor Manual (IM): For the past eleven years, Karen Collins has been developing, coordinating and teaching (to over 3,500 students) an Introduction to Business course. Sections of the course have been taught by a mix of permanent faculty, graduate students, and adjuncts.

Material Type: Case Study, Textbook

Author: Karen Collins

Nursing Pharmacology

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This open access Nursing Pharmacology textbook is designed for entry-level undergraduate nursing students. It explains basic concepts of pharmacology and describes common medication classes. This book is not intended to be used as a drug reference book, but direct links are provided to DailyMed, which provides trustworthy information about marketed drugs in the United States. This textbook is aligned with the Wisconsin Technical College System (WTCS) statewide nursing curriculum for the Nursing Pharmacology course (543-103). The project is supported by a $2.5 million Open Resources for Nursing (Open RN) grant from the Department of Education and is licensed under a Creative Commons Attribution 4.0 International License. This book is available for download in multiple formats, but the online version is required for interaction with the adaptive learning activities included in each chapter.

Material Type: Reading, Textbook

CMA 130 - Introduction to Pharmacology I

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This course is designed to prepare you to comprehend, interpret, and respond to legal and ethical situations in the healthcare setting with diverse populations in a culturally competent way. NOTE: This is an ethics class, which inherently requires meaningful conversations with other people. As a student in this class, you will be required to regularly meet with other individuals to discuss ethical questions that occur in healthcare. Be aware that you will be required to facilitate a group discussion for most Modules. Plan ahead as you prepare to take this course, and have a pool of individuals available who are willing to have ethical discussions with you. Class Outcomes: 1. Demonstrate respect for diversity in approaching patients and families. 2. Identify the role of self-boundaries in the healthcare environment. 3. Recognize the role of patient advocacy in the your professional practice. 4. Discuss legal scope of practice for medical assistance and coders. 5. Explore issue of confidentiality as it applies to the medical assistant and to coders. 6. Describe the implications of HIPAA for the medical assistant and the coder in various medical settings. 7. Discuss licensure and certification as it applies to healthcare providers. 8. Describe liability, professional, personal injury, and third party insurance. 9. Compare and contrast physician, medical assistant, and coder roles in terms of standard of care. 10. Compare criminal and civil law as it applies to practicing medical assistant and coders. 11. Provide an example of tort law as it would apply to a medical assistant and coders. 12 Explain how the following impact the healthcare practice and give examples: Negligence. 13. Explain how the following impact the healthcare practice and give examples: Malpractice. 14. Explain how the following impact the healthcare practice and give examples: Statute of Limitations. 15. Explain how the following impact the healthcare practice and give examples: Good Samaritan Act(s). 16. Explain how the following impact the healthcare practice and give examples: Uniform Anatomical Gift Act. 17. Explain how the following impact the healthcare practice and give examples: Living Will/Advanced directives. 18. Explain how the following impact the healthcare practice and give examples: Medical durable power of attorney. 19. Identify how the Americans with Disabilities Act (ADA) applies to the medical assisting and coding profession. 20. List and discuss legal and illegal interview questions. 21. Discuss all levels of governmental legislation and regulation as they apply to medical assisting practice, including FDA and DEA regulations. 22. Describe the process to follow if an error is made in patient care Respond to issues of confidentiality. 23. Perform within scope of practice. Apply HIPAA rules in regard to privacy/release of information. 24. Practice within the standard of care for a medical assistant and/or coder. 25. Incorporate the Patient's Bill of Right's into personal practice. and medical office policies and procedures. 26. Complete an incident report. 27. Document accurately in the patient record. 28. Apply local, state and federal healthcare legislation appropriate to the medical assisting and coding practice setting. 29. Demonstrate sensitivity to patient rights. 30. Demonstrate awareness of the consequences of not working within the legal scope of practice. 31. Recognize the importance of local, state and federal legislation and regulations in the practice setting. 32. Differentiate between legal, ethical, and moral issues affecting healthcare. 33. Compare personal, professional and organizational ethics. 34. Discuss the role of cultural, social and ethnic diversity in ethical performance in the healthcare practice. 35. Identify where to report illegal and/or unsafe activities and behaviors that affect health, safety and welfare of others. 36. Identify the effect personal ethics may have on professional performance. 37. Report illegal and/or unsafe activities and behaviors that affect health, safety and welfare of others to proper authorities. 38. Develop a plan for separation of personal and professional ethics. 39. Apply ethical behaviors, including honesty, integrity in the performance of medical assisting and coding practice. 40. Examine the impact personal ethics and morals may have on the individual's practice. 41. Demonstrate awareness of diversity in providing patient care.

Material Type: Full Course

Author: Linn Benton Virtual College

Davis's Drug Guide For Nurses® - 17th Ed. (2021)

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To access this resource you will need to use your STAT!Ref User ID and Password.  If you need a STAT!Ref User ID and Password speak with your administrator. DAVIS'S DRUG GUIDE FOR NURSES® - 17th Ed. (2021) Front Matter Title Page Davis's DRUG GUIDE FOR NURSES® SEVENTEENTH EDITION APRIL HAZARD VALLERAND, PhD, RN, FAAN Distinguished Professor College of Nursing Alumni Endowed Professor of Nursing Wayne State University College of Nursing Detroit, Michigan CYNTHIA A. SANOSKI, BS, PharmD, FCCP, BCPS Chair, Department of Pharmacy Practice Thomas Jefferson University Jefferson School of Pharmacy Philadelphia, Pennsylvania Contributing Editor: Courtney Quiring, BSP, BCGP Lecturer College of Pharmacy and Nutrition University of Saskatchewan Saskatoon, SK, Canada [Inline Image] F.A. DAVIS COMPANY • Philadelphia Copyright Page F. A. Davis Company 1915 Arch Street Philadelphia, PA 19103 www.fadavis.com Copyright © 2021 by F. A. Davis Company Copyright © 1988, 1991, 1993, 1995, 1997, 1999, 2001, 2003, 2005, 2007, 2009, 2011, 2013, 2015, 2017, 2019, 2020 by F. A. Davis Company. All rights reserved. This book is protected by copyright. No part of it may be reproduced, stored in a retrieval system, or transmitted in any form or by any means, electronic, mechanical, photocopying, recording, or otherwise, without written permission from the publisher. Printed in the United States of America Last digit indicates print number 10 9 8 7 6 5 4 3 2 1 Editor-in-Chief, Nursing: Jean Rodenberger Acquisitions Editor: Megan Klim Content Project Manager: Amanda M. Minutola NOTE: As new scientific information becomes available through basic and clinical research, recommended treatments and drug therapies undergo changes. The authors and publisher have done everything possible to make this book accurate, up to date, and in accord with accepted standards at the time of publication. However, the reader is advised always to check product information (package inserts) for changes and new information regarding dose and contraindications before administering any drug. Caution is especially urged when using new or infrequently ordered drugs. Library of Congress Cataloging-in-Publication Data Names: Vallerand, April Hazard, author. | Sanoski, Cynthia A., author. Title: Davis's drug guide for nurses / April Hazard Vallerand, Cynthia A. Sanoski. Other titles: Drug guide for nurses Description: Seventeenth edition. | Philadelphia, PA : F.A. Davis Company, [2021] | Includes bibliographical references and index. Identifiers: LCCN 2020000824 | ISBN 9781719640053 (hardback) | ISBN 9781719641135 (ebook) Subjects: MESH: Pharmaceutical Preparations--administration & dosage | Drug Therapy--nursing | Pharmacology, Clinical--methods | Handbook | Nurses Instruction Classification: LCC RM301.12 | NLM QV 735 | DDC 615.102/4613--dc23 LC record available at https://lccn.loc.gov/2020000824 Authorization to photocopy items for internal or personal use, of specific clients, is granted by F. A. Davis Company for users registered with the Copyright Clearance Center (CCC) Transactional Reporting Service, provided that the fee of $.25 per copy is paid directly to CCC, 222 Rosewood Drive, Danvers, MA 01923. For those organizations that have been granted a photocopy license by CCC, a separate system of payment has been arranged. The fee code for users of the Transactional Reporting Service is 978-1-7196-4005-3/20 0 (US) and 978-1-7196-4007-7/20 0 (Canadian) + $.25. Dedication and Acknowledgments DEDICATION To my son, Ben, whose sensitivity and sense of humor make even the toughest day easier. To my daughter, Katharine, whose dedication and passion in seeking her goals I admire. Watching you both grow to become wonderful young adults gives me such pride and joy. Your support of my work inspires me. Thank you for sharing so much of your lives with me. I love you. AHV To my wonderful mother, Geraldine, who has provided her continual love, support, and wisdom as I continue to pursue all of my personal and professional goals. CAS ACKNOWLEDGMENTS We offer our thanks to the students and nurses who have used our book for more than 30 years. We hope our book provides you with the current knowledge of pharmacotherapeutics you need to continue to give quality care in our rapidly changing health care environment. April and Cindy Consultants Jamie Crawley, PhD, RN Assistant Professor University of Windsor Faculty of Nursing Windsor, ON, Canada Wanda Edwards, PMHCNS-BC, NP Instructor (Clinical) Wayne State University College of Nursing Detroit, MI Linda Felver, PhD, RN Associate Professor Oregon Health & Science University School of Nursing Portland, OR Althea DuBose-Hayes, RD Renal Dietitian Greenfield Health System, a division of Henry Ford Health System Southfield, MI Debbie Richmond, NP-C, ACRN Wayne State University Detroit, MI Gladdi Tomlinson, RN, MSN Professor of Nursing Harrisburg Area Community College Harrisburg, PA Past Consultants Debra Abraham, MSN, RN Lecturer University of Pennsylvania School of Nursing Philadelphia, PA Angela Ann Boggs, PharmD Clinical Pharmacist University of Maryland Baltimore Springfield Hospital Center Sykesville, MD Douglas Lee Boggs, PharmD, MS, BCPP Research Associate Maryland Psychiatric Research Center University of Maryland School of Medicine Baltimore, MD Hedy Cohen, RN, BSN, MS Clinical Consulting Nurse Institute for Safe Medication Practices Huntingdon Valley, PA Jane Vincent Corbett, RN, Ed.D Professor Emerita University of San Francisco School of Nursing San Francisco, CA Deborah A. Ennis, RN, MSN, CCRN Harrisburg Area Community College Harrisburg, PA Margaret Falahee, APRN-BC Clinical Assistant Professor Wayne State University College of Nursing Detroit, MI Charlene C. Gyurko, PhD, RN, CNE Assistant Professor Purdue University, North Central School of Nursing Westville, IN Susan M. Hasenau, PhD, MSN, BSN Professor-Retired Madonna University School of Nursing Livonia, MI Emily Karwacki-Sheff, MS, CMSRN, FNP-BC Lecturer and Clinical Instructor Massachusetts General Hospital Institute of Health Professions Charlestown, MA Clinical Instructor Boston College Chestnut Hill, MA Janeen Kidd, RN, BN Instructor/School Placement Project Coordinator University of Victoria School of Nursing Victoria, BC, Canada Laura G. Leahy, MSN, PMH-CNS/FNP, BC Psychiatric Advanced Practice Nurse Clinical Associate Faculty/Lecturer University of Pennsylvania School of Nursing Philadelphia, PA Stuart Levine, PharmD Informatics Specialist Institute for Safe Medication Practices Huntingdon Valley, PA Ginette A. Pepper, PhD, RN, FAAN Helen Lowe Bamberger Colby Presidential Endowed Chair in Gerontological Nursing Associate Dean for Research & PhD Programs Salt Lake City, UT Director University of Utah Hartford Center of Geriatric Nursing Excellence Salt Lake City, UT Norma Perez, BSN, RN Nursing Faculty & Clinical Coordinator Ivy Tech Community College School of Nursing Valparaiso, IN Dorie Schwertz, PhD, RN, FAAN, FAHA Associate Professor University of Illinois-Chicago College of Nursing Department of Medical Surgical Nursing and Adjunct Professor of Pharmacology Chicago, IL Kim Subasic, MSN, RN The University of Scranton Scranton, PA Marcella Williams, RN, MS, AOCN® Adjunct Faculty Lansing Community Hospital Staff Nurse, Sparrow Health System Lansing, MI F. A. Davis Pharmacologic Publications Advisory Board Shamim Tejani, PharmD, CPHQ Director of Quality Improvement Adelante Healthcare Phoenix, AZ Debra Abraham, MSN, RN Lecturer University of Pennsylvania School of Nursing Philadelphia, PA Angela Ann Boggs, PharmD Clinical Pharmacist University of Maryland Baltimore Springfield Hospital Center Sykesville, MD Douglas Lee Boggs, PharmD, MS, BCPP Research Associate Maryland Psychiatric Research Center University of Maryland School of Medicine Baltimore, MD Hedy Cohen, RN, BSN, MS Clinical Consulting Nurse Institute for Safe Medication Practices Huntingdon Valley, PA Jane Vincent Corbett, RN, Ed.D Professor Emerita University of San Francisco School of Nursing San Francisco, CA Margaret Falahee, APRN-BC Clinical Assistant Professor Wayne State University College of Nursing Detroit, MI Susan M. Hasenau, PhD, MSN, BSN Professor Madonna University School of Nursing Livonia, MI Emily Karwacki-Sheff, MS, CMSRN, FNP-BC Lecturer and Clinical Instructor Massachusetts General Hospital Institute of Health Professions Charlestown, MA Clinical Instructor Boston College Chestnut Hill, MA Laura G. Leahy, MSN, PMH-CNS/FNP, BC Psychiatric Advanced Practice Nurse Clinical Associate Faculty/Lecturer University of Pennsylvania School of Nursing Philadelphia, PA Stuart Levine, PharmD Informatics Specialist Institute for Safe Medication Practices Huntingdon Valley, PA Ginette A. Pepper, PhD, RN, FAAN Helen Lowe Bamberger Colby Presidential Endowed Chair in Gerontological Nursing Associate Dean for Research & PhD Programs Salt Lake City, UT Director University of Utah Hartford Center of Geriatric Nursing Excellence Salt Lake City, UT Rosemary C. Polomano, PhD, RN, FAAN Associate Professor of Pain Practice University of Pennsylvania School of Nursing Philadelphia, PA Debbie Richmond, NP-C, ACRN Wayne State University Detroit, MI Dorie Schwertz, PhD, RN, FAAN, FAHA Associate Professor University of Illinois-Chicago College of Nursing Department of Medical Surgical Nursing and Adjunct Professor of Pharmacology Chicago, IL F.A. Davis Canadian Advisory Board Anan Ahmed, BSP Pharmacist, Shopper's Drug Market MSC Candidate, University of Saskatchewan Saskatoon, Saskatchewan Andrea M. Brandt, BScN, MS Pharmacology Instructor, Lead Faculty, Nursing Georgian College Barrie, Ontario Melanie Deveau, MN-ANP, RN, NP Nurse Practitioner, Cardiovascular Program Adjunct Lecturer Dalhousie University - Yarmouth Site Yarmouth, Nova Scotia Lisa Keeping-Burke, RN, PhD. (McGill) Assistant Professor, Department of Nursing and Health Sciences, UNB Adjunct Assistant Professor, School of Nursing, Queen's University Saint John, New Brunswick Duncan (Stewart) MacLennan, MN, NP Faculty Lecturer, Faculty of Nursing University of Alberta Edmonton, Alberta Kerry Mansell, BSP, PharmD Assistant Dean and Associate Professor of Pharmacy University of Saskatchewan Saskatoon, Saskatchewan Craig Miller, Instructor - PN Assiniboine Community College Brandon, Manitoba Wendy Neander, PhD (c), MN, BScN, BScv Assistant Teaching Professor, School of Nursing University of Victoria Nanaimo, British Columbia Aroha Page, RN, BA, BScN, Grad.Dip Health Sci, M.Phil(N), PhD(UCSF)FRCNA Associate Professor, School of Nursing Nipissing University Faculty of Applied & Professional Studies North Bay, Ontario Vincent Salyers, Ed. D, MSN, BA Associate Dean, Faculty of Health & Community Studies Mount Royal University Calgary, Alberta Michael Scarcello, RN, HBScN, MA Clinical Nurse Specialist Program Coordinator, Practical Nursing Program Confederation College Thunder Bay, Ontario Jeff Taylor, BSP, MSc, PhD Professor of Pharmacy University of Saskatchewan Saskatoon, Saskatchewan Jim Wohlgemuth, RN, MN, CTN-B Instructor, Nursing Education & Health Studies Grande Prairie Regional College Grande Prairie, Alberta Canadian Reviewers Anan Ahmed, BSP, MSc, CDE Pharmacist University of Saskatchewan Saskatoon, Saskatchewan Duncan (Stewart) MacLennan, MN, PhD(c), NP Assistant Teaching Professor and Nurse Practitioner University of Alberta Edmonton, Alberta Kerry Mansell, BSP, PharmD, BA, MBA Professor of Pharmacy College of Pharmacy and Nutrition University of Saskatchewan Saskatoon, Saskatchewan Wendy Neander, PhD (c), MN, BScN, BScv Assistant Teaching Professor School of Nursing University of Victoria Nanaimo, British Columbia Jim Wohlgemuth, RN, MN, CTN-B Instructor, Nursing Education & Health Studies Grande Prairie Regional College Grande Prairie, Alberta Contents How To Use Davis's Drug Guide for Nurses… 1 Evidence-based Practice and Pharmacotherapeutics: Implications for Nurses… 6 Pharmacogenomics… 9 Medication Errors: Improving Practices and Patient Safety… 12 Detecting and Managing Adverse Drug Reactions… 18 Overview of Risk Evaluation and Mitigation Systems (REMS)… 22 Special Dosing Considerations… 23 The Pediatric Patient… 23 The Older Adult Patient… 23 The Patient of Reproductive Age… 24 Renal Impairment… 24 Hepatic Impairment… 24 Heart Failure… 24 Body Size… 24 Drug Interactions… 25 The Cytochrome P450 System: What Is It and Why Should I Care?… 26 Educating Patients About Safe Medication Use… 29 Classifications… 31 Anti-alzheimer's Agents… 31 Antianemics… 32 Antianginals… 33 Antianxiety Agents… 34 Antiarrhythmics… 35 Antiasthmatics… 36 Anticholinergics… 37 Anticoagulants… 39 Anticonvulsants… 40 Antidepressants… 41 Antidiabetics… 43 Antidiarrheals… 45 Antiemetics… 46 Antifungals… 47 Antihistamines… 48 Antihypertensives… 50 Anti-infectives… 51 Antineoplastics… 53 Antiparkinson Agents… 55 Antiplatelet Agents… 56 Antipsychotics… 57 Antipyretics… 59 Antiretrovirals… 60 Antirheumatics… 61 Antituberculars… 62 Antiulcer Agents… 63 Antivirals… 65 Beta Blockers… 66 Bone Resorption Inhibitors … 68 Bronchodilators… 69 Calcium Channel Blockers … 70 Central Nervous System Stimulants … 72 Corticosteroids… 73 Diuretics… 75 Hormones… 77 Immunosuppressants… 78 Laxatives… 79 Lipid-lowering Agents… 80 Minerals/Electrolytes/Ph Modifiers… 81 Natural/Herbal Products… 82 Nonopioid Analgesics… 82 Nonsteroidal Anti-inflammatory Agents … 84 Opioid Analgesics… 85 Sedative/Hypnotics… 87 Skeletal Muscle Relaxants … 88 Thrombolytics… 89 Vaccines/Immunizing Agents … 91 Vascular Headache Suppressants … 92 Vitamins… 93 Weight Control Agents… 94 Drug Monographs In Alphabetical Order By Generic Name… 95-1298 Drugs Approved In Canada Natural/Herbal Products Medication Safety Tools… 1349 Appendices… 1367 Appendix A. Recent Drug Approvals… 1369 Appendix B. Combination Drugs… 1379 Appendix C. Ophthalmic Medications… 1398 Appendix D. Medication Administration Techniques… 1406 Appendix E. Administering Medications To Children… 1409 Appendix F. Formulas Helpful For Calculating Doses… 1410 Appendix G. Pediatric Dosage Calculations… 1412 Appendix H. Normal Values of Common Laboratory Tests… 1413 Appendix I. Controlled Substance Schedules… 1415 Appendix J. Equianalgesic Dosing Guidelines… 1418 Appendix K. Food Sources For Specific Nutrients… 1421 Appendix L. Insulins and Insulin Therapy… 1423 Appendix M. Differences In U.S. and Candian Pharmaceutical Practices… 1425 Appendix N. Routine Pediatric and Adult Immunizations… 1427 Bibliography… 1434 Comprehensive Generic/Trade/Classifications Index How To Use Davis's Drug Guide for Nurses Davis's Drug Guide for Nurses provides comprehensive, up-to-date drug information in well-organized, nursing-focused monographs. It also includes extensive supplemental material in 14 appendices, thoroughly addresses the issue of safe medication administration, and educates the reader about 50 different therapeutic classes of drugs. In this 17th edition, we have continued the tradition of focusing on safe medication administration by including Medication Safety Tools and even more information about health care's most vulnerable patients: children, the elderly, pregnant women, and breast feeding mothers. Look for more Pedi, Geri, OB, and Lactation headings throughout the monographs. We have also included a BEERS label at the top of applicable drug monographs for those medications listed in the Beers Criteria developed by the American Geriatrics Society. These medications are considered to be potentially inappropriate for use in older adults because they are associated with more risk than benefit in this patient population. In addition, we've included information relevant to Canadian students and nurses. You'll find an appendix comparing Canadian and U.S. pharmaceutical practices, more Canada-only combination drugs in the Combination Drugs appendix, and additional Canadian brand names in the drug monographs. To help you find this information quickly, we've also added a maple leaf icon ([Inline Image]) in the index next to each Canadian entry. We have added pharmacogenomic information throughout numerous monographs to guide the nurse in selecting and monitoring various drug therapies. To help you find this information quickly, we've added a double helix icon ([Inline Image]) to denote this information as it applies to specific drugs. Use this book to enhance your competence in implementing and evaluating medication therapies. The following sections describe the organization of Davis's Drug Guide for Nurses and explain how to quickly find the information you need.

Material Type: Reading

Bioethical Decision Making in Nursing - 5th Ed. (2015)

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To access this resource you will need to use your STAT!Ref User ID and Password.  If you need a STAT!Ref User ID and Password speak with your administrator. BIOETHICAL DECISION MAKING IN NURSING - 5th Ed. (2015) Front Matter Title Page Bioethical Decision Making in Nursing Fifth Edition Gladys L. Husted PhD, MSNEd, RN James H. Husted Carrie J. Scotto PhD, RN Kimberly M. Wolf PhD, PMHCNS-BC [Inline Image] Copyright Page Copyright © 2015 Springer Publishing Company, LLC All rights reserved. No part of this publication may be reproduced, stored in a retrieval system, or transmitted in any form or by any means, electronic, mechanical, photocopying, recording, or otherwise, without the prior permission of Springer Publishing Company, LLC, or authorization through payment of the appropriate fees to the Copyright Clearance Center, Inc., 222 Rosewood Drive, Danvers, MA 01923, 978-750-8400, fax 978-646-8600, info@copyright.com or on the Web at www.copyright.com. Springer Publishing Company, LLC 11 West 42nd Street New York, NY 10036 www.springerpub.com Acquisitions Editor: Joseph Morita Composition: Graphic World Inc. ISBN-13: 978-0-8261-7143-6 ISBN-10: 0-8261-7143-5 e-book ISBN: 978-0-8261-7144-3 Instructors Manual: 978-0-8261-3014-3 Instructors Materials: Qualified instructors may request supplements by e-mailing textbook@springerpub.com: 14 15 16 17 / 5 4 3 2 1 The author and the publisher of this Work have made every effort to use sources believed to be reliable to provide information that is accurate and compatible with the standards generally accepted at the time of publication. Because medical science is continually advancing, our knowledge base continues to expand. Therefore, as new information becomes available, changes in procedures become necessary. We recommend that the reader always consult current research and specific institutional policies before performing any clinical procedure. The author and publisher shall not be liable for any special, consequential, or exemplary damages resulting, in whole or in part, from the readers' use of, or reliance on, the information contained in this book. The publisher has no responsibility for the persistence or accuracy of URLs for external or third-party Internet websites referred to in this publication and does not guarantee that any content on such websites is, or will remain, accurate or appropriate. Library of Congress Cataloging-in-Publication Data Husted, Gladys L., author. Bioethical decision making in nursing / Gladys L. Husted, James H. Husted, Carrie J. Scotto, Kimberly M. Wolf. -- Fifth edition. p.; cm. Preceded by Ethical decision making in nursing and health care / by James H. Husted, Gladys L. Husted. 4th ed. c2008. Includes bibliographical references and index. ISBN 978-0-8261-7143-6 -- ISBN 978-0-8261-7144-3 (e-book) I. Scotto, Carrie J., author. II. Wolf, Kimberly M., author. III. Husted, James H. Ethical decision making in nursing and health care. Preceded by (work): IV. Title. [DNLM: 1. Ethics, Nursing--Case Reports. 2. Decision Making--ethics--Case Reports. 3. Models, Theoretical-- Case Reports. WY 85] RT85 174'.2--dc23 2014036197 Special discounts on bulk quantities of our books are available to corporations, professional associations, pharmaceutical companies, health care organizations, and other qualifying groups. If you are interested in a custom book, including chapters from more than one of our titles, we can provide that service as well. For details, please contact: Special Sales Department, Springer Publishing Company, LLC 11 West 42nd Street, 15th Floor, New York, NY 10036-8002 Phone: 877-687-7476 or 212-431-4370; Fax: 212-941-7842 E-mail: sales@springerpub.com Printed in the United States of America by McNaughton & Gunn. Contents List of Case Study Dilemmas… vi List of Figures and Tables… viii Preface… ix Acknowledgments… xv SECTION I: THE BASICS OF BIOETHICAL DECISION MAKING 1. Ethical Foundations… 1 2. The Ethical Journey Taken by the Patient and Nurse… 11 3. The Nurse-Patient Agreement… 29 4. The Bioethical Standards and Their Role as Preconditions of the Agreement… 51 5. The Nature of the Ethical Context… 71 6. Contemporary Ethical Systems… 91 7. Nursing Practice Intersections: Legal Decision Making Within a Symphonological Ethical Perspective… 113 Suzanne Edgett Collins 8. Practice-Based Ethics and the Bioethical Standards as Lenses… 131 9. Moral Distress… 149 SECTION II: BEYOND THE BASICS—AN EXTENDED PERSPECTIVE 10. The Power of Analysis Through Extremes… 167 11. Elements of Human Autonomy… 183 12. Virtues as Resources… 209 SECTION III: CASE STUDY ANALYSES Analyses of Dilemmas… 223 Glossary… 259 Appendix… 273 Index… 279 About the Editors GLADYS L. HUSTED, PhD, MSNEd, RN, is professor emeritus of nursing at Duquesne University, Pittsburgh, Pennsylvania. She received a master's in nursing education from the University of Pittsburgh, where she also completed her PhD in curriculum and supervision. She was awarded the title of School of Nursing Distinguished Professor in 1998. She has retired from full-time employment at Duquesne University but continues to teach part time in the MSN and PhD programs. Her main area of expertise is in bioethics. She continues to write and consult. Her other areas of expertise are in curriculum design, instructional strategies, and theory development. Dr. Husted's website can be accessed at www.duq.edu/nursing/faculty/husted JAMES H. HUSTED is an independent scholar. He is a member of the American Philosophical Association and the North American Spinoza Society. He has been a member of the high IQ societies, Mensa and Intertel. He was the philosophy expert for Dial-An-M for Mensa, as well as the philosophy editor of Integra, the journal of Intertel. CARRIE J. SCOTTO, PhD, RN, is an associate professor at the University of Akron School of Nursing, where she teaches pathophysiology and pharmacology. She earned her BSN and MSN from the University of Akron and her PhD from Duquesne University. As an educator and clinician, she has a vested interest in bioethics. She has served more than 20 years at the bedside as a critical care nurse. Her research related to adherence to prescribed treatment for cardiac patients and therapeutic clinical interventions for critically ill patients has been presented nationally and is published in professional journals. She is a member of Sigma Theta Tau International, American Association of Critical-Care Nurses, American Association of Cardiovascular and Pulmonary Rehabilitation, and Preventive Cardiovascular Nurses Association. KIMBERLY M. WOLF, PhD, PMHCNS-BC, is a psychiatric-mental health clinical nurse specialist at Hennepin County Medical Center, Minneapolis, Minnesota, and the psychiatric-mental health nurse practitioner track director at the University of North Dakota, Grand Forks, North Dakota. She also teaches part time as an adjunct faculty in the nursing department at Duquesne University, Pittsburgh, Pennsylvania. She received a master's degree in science in advanced practice psychiatric-mental health nursing from the University of North Dakota. She received a PhD from Duquesne University in 2013. She enjoys her work as a full-time provider in the busy urban county hospital but also values actively teaching in master's and doctoral programs. Her interest areas are bioethics, cultural competency, and psychiatric-mental health advanced practice nursing. Contributor SUZANNE EDGETT COLLINS, JD, PhD, MPH, RN, is a nurse-attorney with experience in the areas of medical and nursing malpractice, legal and bioethics education of allied health care practitioners, and consultation practice in licensure defense, health law/policy, and health care risk management. She is a professor in the Department of Nursing at the University of Tampa. Her particular areas of expertise focus on the intersections of law, ethics, health policy/economics, and nursing. Her research interests include issues of nursing law and ethics, patient safety and nursing error, and social and behavioral issues among nurses, including topics such as rule bending, practice act violations, and facilitators/barriers to new nurse retention. She has published on the topics of nursing law and ethics and has been a presenter at educational conferences. List of Case Study Dilemmas* 3.1 Patient's Conflict About Her Own Care 34 3.2 The Demands of an Agreement 47 4.1 Compulsory Obligation to Others 56 4.2 Family's Desires or Patient's Wishes 57 4.3 The Demands of Promise Keeping 59 4.4 Deception or Truth 62 5.1 Right to Choose an Unhealthy Lifestyle 73 5.2 Making a Decision Against Facility Policy 74 5.3 Embryo Ownership 76 5.4 Suspected Child Abuse 82 5.5 Right to Refuse Disfiguring Interventions 83 5.6 Rights of a Homosexual Partner 85 6.1 Duty or Saving a Life? 95 6.2 Implied Consent or Violation of One's Rights? 99 6.3 Telishment 100 6.4 Right to One's Own Body 104 6.5 Nurse's Conflicted Emotions 106 6.6 Benevolence or Paternalism? 107 8.1 What Is to Be Done When Intrafamily Coercion Is Suspected? 133 8.2 Family Dispute Over Donating a Child's Organs 137 8.3 To Tell or Not to Tell the Findings of Surgery 143 8.4 Going Against the Physician's Order for a Dying Man 146 9.1 Patient's Benefit Versus Family's Desires 152 9.2 The Demands of Justice 153 9.3 Physician's Orders Versus Benefit to the Patient—A Nurse's Dilemma 157 11.1 Playing the Odds or Betting on a Sure Thing 185 11.2 Trauma Versus Treatment 188 11.3 Rights of Children 191 11.4 The Right to Be One's Own Agent 192 11.5 Refusing Treatment in the Context of Loss of Hope 202 12.1 Is It Ever Right to Sell One's Organs? 211 12.2 The Rights of a Confused Patient 215 12.3 Rights of a Patient With a Psychiatric Diagnosis 217 12.4 Who Gets the Donor Heart? 219 12.5 Desires of a Patient Versus Family's Request for Life-Sustaining Treatment 220 * See Section III: Analysis of Dilemmas. List of Figures and Tables Figure 2.1 The Journey 13 Figure 3.1 The Agreement 36 Figure 4.1 Husteds' Symphonological Bioethical Decision-Making Model I 68 Figure 5.1 The Interweaving of Contexts 81 Figure 6.1 Duty Rules 95 Figure 6.2 Numbers Rule 101 Figure 6.3 Society Rules 105 Figure 6.4 Emotions Rule 107 Figure 7.1 Legal and Professional Regulation of Nurses 117 Figure 7.2 Ethical-Legal Conflict Resolution Pathway 124 Figure 8.1 Intelligible Causal Sequences 135 Figure 8.2 Lenses In and Out of Focus 143 Figure 8.3 Only apparently bent 145 Figure 9.1 Burnout 158 Figure 10.1 Extremes 169 Figure 11.1 Husteds' Symphonological Bioethical Decision-Making Model II 205 Table 2.1 Enhancement of Human Life 22 Table 5.1 The Three Elements of Context 80 Table 5.2 The Five Rights of Bioethical Analysis 86 Table 7.1 Ethical-Legal Decision Making 120 Table 7.2 Ethical-Legal Response to Savior Sibling 123 Table 7.3 Ethical-Legal Response to Rule Bending 127 Preface Focus of a Field of Study Every science and every art arises from imagination and reason. Each is inspired by need and curiosity to serve a purpose. Human beings desired to navigate the seas, and someone created celestial navigation. Curious about living things, someone created biology. Someone created mathematics for the purpose of computation. Someone created medicine from a need to alleviate suffering and to bring about healing. Everyday Ethics We make so many decisions in any given day—how we perform at work, how we engage with others, and so on—and virtually never stop to think about whether these decisions are ethical. Many such decisions are not dilemmas, meaning that the choice is clear-cut because you know what you should do, but they are ethical decisions nevertheless. The ethical decisions of everyday life are not the subject of this book, but it is important that everyone becomes more aware of the pervasiveness of ethics in one's daily life. The purpose of this book is to help nurses and all health care professionals recognize the importance of ethics to their professions and know how to resolve ethical dilemmas when the choice is not clear. The Origin of Ethics and the Underpinnings of Symphonology Ethics originally was meant to be a search for, or a science of, the good life or the successful life. The first major ethicist of the Western world, Socrates (464-399 BC), described ethics as an examination of life, as a way of making life worth living. Socrates's ethical work was twofold: (a) to establish and define ethical terms to provide a common language in which ethics could be discussed and (b) to understand ethics as contextualized, meaning we should recognize that actions that are right in one circumstance may be wrong in another. For example, violence against another for no purpose is wrong, whereas self-defense against an attack is justifiable. Thus, a blanket condemnation of violence is a mistake. The context determines its ethical quality. After Socrates, Plato (427-347 BC) shifted the theme of ethics away from identifying the good life—a life worth living—to identifying the "good," that is, the true nature of goodness itself. Ultimately, this shift displaced concern for the good life, nearly driving it out of ethics. This issue persists today as many health care decisions focus on what should be done as opposed to what should be done for this patient in these circumstances. Concern for life is central to the health care setting—the realm of bioethics. Concern for the good life is central to human existence—the realm of ethics—and to achievement of life goals and flourishing. Fortunately, Aristotle (483-322 BC) brought the concerns of human life back as the central subject matter of ethics. His focus on the golden mean and virtue contributed greatly to the theory of symphonology. Aristotle's theory of ethics as a science of successful living and Socrates's emphasis on context provided a strong foundation for a practice-based ethic. It is unfortunate that the interest of Socrates and Aristotle in defining, understanding, and living by the meaning of ethical terms has largely been forgotten in modern ethical systems while Plato's quixotic theory of ethics as a search for an unknown and unknowable "good" has become the almost exclusive concern of ethics. Benedict Spinoza (1632-1697) contributed the virtue of desire as the essence of the human person. He asserted that if desires are directed by an objective awareness, this will establish the intelligible sequences that characterize a life lived according to the nature of a living rational being. Bioethics Bioethics is the branch of ethics that investigates problems arising from medical and biological research and clinical practice. It includes issues of individual care and broader concerns such as access to health care, confidentiality, genetic testing, and resource allocation (Johnson, 2011). This book presents a system to guide health care professionals in providing ethically sound care. Symphonia is a Greek word meaning "agreement." Symphonology is the study of agreements and the elements necessary to form agreements. Within the health care arena, symphonology is the study of agreements between health care professionals and patients and the ethical implications of those agreements. Symphonology is a practice-based ethical system appropriate for practicing health care professionals. It is a normative approach to ethics that looks at how people should act within a given context and contributes to the value of character. Symphonology is in opposition to a descriptive approach, which is more scientific, and studies what people think is right. Symphonology delineates standards of professional behavior based on the preconditions necessary for professional agreement and interaction. These standards are then applied within a contextual understanding. The goal is to bring about optimal interactions in the health care setting that result in optimal patient care outcomes. Achieving optimal care for patients is central to the purpose of all health care professionals and institutions and is, therefore, indispensable to professional bioethics. Within the realm of symphonology, excellent patient care is only one aspect of the outcome. It is the nature of an agreement that both parties will benefit. Symphonology, which is based on agreements, promotes the welfare of both the patient and the health care professional. A high degree of personal and professional development is fostered through the use of sound bioethics in practice. As the patient receives optimal care, the professional matures in knowledge, skill, and professional satisfaction. This dual benefit is achieved through a symphonological ethic. Although ethical problems faced by nurses are the primary focus here, symphonology can be applied to any heath care professional. The only adjustment required is consideration of the education, experience, and role of each professional involved. The theory is also applicable to any patient population, regardless of age, disease, competency, and cultural background. The Return to Life and Flourishing In this book, we turn away from seeking an unobtainable good and return to a concern for life. Like the ethicists of the past, we are concerned not only with life but with a flourishing life and the achievement of happiness. We approach life as it is experienced, as a journey accompanied by tears and smiles, by conflict and harmony. We begin amid life in all its complexity, discussing what we bring to life's journey: human virtues, their relation to the health care setting, their development, and what they make possible. We discuss individual rights, the necessary foundation for an ethic of human life. Human virtues and individual rights are the foundations for ethical actions. As individuals, a majority of our achievements come to us through cooperation with others. This cooperation occurs through agreement (thus, the name symphonology). The professional agreement between a nurse and patient perfectly illustrates the achievement that results from cooperation. For each, nurse and patient, great value is achieved from cooperation as each brings his or her virtues and considers the rights of the other. From this vantage point, we analyze the decline of ethics from an individual pursuit into an exclusively social context, where societal standards dictate whether something is right or wrong. We then examine the absurd, but commonly held, idea that the emotions of an individual can provide guidance for the resolution of complex ethical dilemmas. We will see that the emotional response of one or a few is often the basis for ethical decisions even at the expense of virtue and human rights. Here, ethics has reached a dead end. Because of "the increasingly complex nature of care and provider demands in health care settings, the potential for ethical conflicts for nurses and nursing students continues to rise" (Hutchinson, Shedlin, Gallo, Krainovich-Miller, & Fulmer, 2014, p. 58). Add this to the current state of bioethics and clinical practice and it becomes essential for all health care professionals to understand their own ethical beliefs. If you do not understand why you consider one action right and another action wrong, your disadvantage is obvious. You will not be able to interact on an equal footing with your colleagues, whose rationalizations can seem plausible. You will not be able to objectively and effectively defend the actions you take. You will have no objective means of moral self-defense. We have included numerous dilemmas in this book as a way of providing practice in ethical decision making. We offer resolutions to most of these dilemmas, realizing that being in an actual situation may change the information sought and therefore alter the resolution found. However, in the Study Guide that appears at the end of Chapters 3 through 12, there will be one case for which the analysis appears only in the instructor's manual. In this book, we examine a variety of bioethical dilemmas from patients' conflicts about their own care to withdrawing all life supports. We demonstrate the relevance of bioethical standards to these, and by extension to all, bioethical dilemmas. We examine how to define and understand bioethical standards in different contexts in order to use them effectively in ethical decision making. In this way, even the novice health care professionals will have the tools to examine and manage ethical issues with their patients. Because all the key concepts listed in the chapters are terms that require precise definitions, we have provided a glossary for your use. Notes 1. The pronoun she is used to designate the health care professional. This convention is for the reader's ease of understanding and to keep understanding in context. The singular is preferred to the plural because professionals are individuals, and a practice-based ethic is, and ought to be, an individualistic ethic. On the other hand, we almost invariably use the pronoun he to designate the patient, again for the same reason. 2. There are certain subjects we will return to numerous times. This is especially true of virtue, individual rights, and bioethical standards. The reason for this is that these facts serve different functions in different aspects of the nurse-patient interaction—and because this will make discussions in later chapters easier to understand. 3. Case studies will be used throughout the book to show how to apply concepts and also to illuminate pertinent concepts that recur in health care. (For those who have used the book before, you will notice that self-assertion is no longer discussed. We have incorporated self-assertion into freedom, including short-term, single events; the here and now control of one's actions; and extended sequences of events, including those sequences that extend over a lifetime.) 4. Four humorous vignettes are included throughout the book. It is important that the reader recognize the seriousness of humor and the lessons that can be learned from these vignettes. In the case of these vignettes, the learning takes place effortlessly if the mind is open to the lesson behind the humor. All of them will have a certain designation so that they are easily recognized. The humor reveals the obvious from the obscure. 5. Although the aspects of context are very important and need to be considered in each analysis of what one is to do in the situation, we have not isolated these aspects in the resolutions except for one case in Chapter 5 to show how it could be done. The reason for not doing each analysis with the aspects of the context illuminated is that, with the analysis of the standards, the context is revealed through the standards. For educators, you may want to propose that students isolate these aspects in their discussion of the standards. Digital Supplement There will be a continuation of a digital supplement for educators who adopt this book for classroom use. It has been expanded and increased in ways to teach the concepts and relate them to the health care setting. This online instructor's manual, which can be obtained from Springer Publishing Company, LLC, by e-mailing textbook@springerpub.com, provides a wealth of information for instructors to plan their teaching activities and to enhance active learning for students. It will assist faculty in preparing for class and decrease preparation time. The online instructor's manual includes: • Chapter Summaries: To assist faculty in quickly identifying chapter themes and purposes. • Major Focus Areas: To help in identifying key elements in each chapter and to pinpoint content essential to classroom instruction. • Classroom Activities: To enhance active engagement of the learner through classroom activities (two to four activities are included per chapter that can be used in a traditional or online class format). Directions are included for conducting these activities. • Unresolved Cases: At the end of Chapters 3 through 12, there will be one case whose resolution will appear only in the instructor's manual, which is new to this edition. • Test Bank: To enhance the evaluative process by providing test questions for each chapter. The test bank questions at the end of each chapter use the two types of questions that now appear on the NCLEX exam: single answer and select all that apply. How faculty use this information, especially the activities, depends on classroom variables: level of students, time available, and what fits best with class discussions. References Hutchinson, K., Shedlin, M. G., Gallo, B., Krainovich-Miller, B., & Fulmer, T. (2014). Ethics in-the-round: A Guided peer approach for addressing ethical issues confronting nursing students. Nursing Education Perspectives, 35(1), 58-60. Johnson, L. (2011). A life-centered approach to bioethics: Biocentric ethics. New York, NY: Cambridge University Press. Spinoza, B. (1949). Ethics. (J. Gutmann, Ed.). New York, NY: Hafner Publishing. (Original work published 1675.) Acknowledgments I, Gladys, wish to acknowledge my gratitude to the following people: My daughter, her husband, and my two granddaughters, who bring me an abundance of joy and constant support. My many friends who have supported me through this process, but especially Carroll Miller, my long-time colleague and friend. My former students, now my friends and coauthors, for taking the theory to the next level and for being such great partners with whom to write. ______________ I, Carrie, wish to acknowledge my gratitude to the following people: My husband, Mark; my daughter, Kelly; and my son, Kevin, who always believe the best about me. ______________ I, Kim, wish to acknowledge my gratitude to the following people: My four children, my daughter-in-law, and my grandson, who are the true loves of my life. My boyfriend and his two daughters, my parents, my friends, and my coworkers, who have supported me through this process. ______________ We wish to thank: The students who, over the years, have served as crucibles for refining the dominant ideas in this book. Joe Morita for his editorial assistance. And most of all to my (Gladys's) husband, James Husted, with whom we conceived, brought to life, and nurtured the theory of symphonology so that it has become an essential guideline for human life and interaction. Jim has gifted us with his astounding intelligence and his boundless wit. His good humor has created a place where one may fearlessly consider the more and the better in life. He has lived well and inspires us to do the same. And finally to Charlie-Charlie, to whom this book is dedicated.

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Labor and Delivery Nursing: A Guide to Evidence-Based Practice - 2nd Ed. (2021)

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To access this resource you will need to use your STAT!Ref User ID and Password.  If you need a STAT!Ref User ID and Password speak with your administrator. LABOR AND DELIVERY NURSING: A GUIDE TO EVIDENCE-BASED PRACTICE - 2nd Ed. (2021) Front Matter Title Page Labor and Delivery Nursing: A Guide to Evidence-Based Practice Second Edition Michelle L. Murray, PhD, RNC-OB Gayle M. Huelsmann, BSN, RNC-OB, C-EFM Springer Publishing Company Copyright Page Copyright © 2021 Springer Publishing Company, LLC All rights reserved. First Springer Publishing Company edition 2008 No part of this publication may be reproduced, stored in a retrieval system, or transmitted in any form or by any means, electronic, mechanical, photocopying, recording, or otherwise, without the prior permission of Springer Publishing Company, LLC, or authorization through payment of the appropriate fees to the Copyright Clearance Center, Inc., 222 Rosewood Drive, Danvers, MA 01923, 978-750-8400, fax 978-646-8600, info@copyright.com or on the Web at www.copyright.com. Springer Publishing Company, LLC 11 West 42nd Street, New York, NY 10036 www.springerpub.com connect.springerpub.com/ Acquisitions Editor: Elizabeth Nieginski Compositor: S4Carlisle Publishing Services ISBN-13: 978-0-8261-8475-7 ISBN-10: 0-8261-8475-8 eISBN-13: 978-0-8261-8476-4 eISBN-10: 0-8261-8476-6 DOI: 10.1891/9780826184764 20 21 22 23 / 5 4 3 2 1 The author and the publisher of this Work have made every effort to use sources believed to be reliable to provide information that is accurate and compatible with the standards generally accepted at the time of publication. Because medical science is continually advancing, our knowledge base continues to expand. Therefore, as new information becomes available, changes in procedures become necessary. We recommend that the reader always consult current research and specific institutional policies before performing any clinical procedure or delivering any medication. The author and publisher shall not be liable for any special, consequential, or exemplary damages resulting, in whole or in part, from the readers' use of, or reliance on, the information contained in this book. The publisher has no responsibility for the persistence or accuracy of URLs for external or third-party Internet websites referred to in this publication and does not guarantee that any content on such websites is, or will remain, accurate or appropriate. Library of Congress Cataloging-in-Publication Data Names: Murray, Michelle (Michelle L.), author. | Huelsmann, Gayle, author. Title: Labor and delivery nursing : a guide to evidence-based practice / Michelle L. Murray, Gayle M. Huelsmann. Description: Second edition. | New York : Springer Publishing Company, [2021] | Includes bibliographical references and index. Identifiers: LCCN 2020018446 (print) | LCCN 2020018447 (ebook) | ISBN 9780826184757 (paperback) | ISBN 9780826184764 (ebook) Subjects: MESH: Obstetric Nursing--methods | Delivery, Obstetric--nursing | Evidence-Based Nursing | Labor, Obstetric Classification: LCC RG951 (print) | LCC RG951 (ebook) | NLM WY 157 | DDC 618.2/0231--dc23 LC record available at https://lccn.loc.gov/2020018446 LC ebook record available at https://lccn.loc.gov/2020018447 Publisher's Note: New and used products purchased from third-party sellers are not guaranteed for quality, authenticity, or access to any included digital components. Printed in the United States of America. Dedication Knowledge comes from learning. Wisdom comes from experience. — Anonymous About the Editors Michelle L. Murray, PhD, RNC-OB, is an international educator, author, journal editor, and expert in obstetric nursing. She has taught nursing students and nurses in the United States, Canada, and Bahrain. Dr. Murray has spent the majority of her career as a labor and delivery nurse and as an educator of nursing students and practicing labor and delivery nurses, certified nurse midwives, family medicine physicians, and obstetricians. She is a recognized obstetric nursing expert. Dr. Murray's company, Learning Resources International, Inc., produces clinical and continuing education products for labor and delivery nurses. Her work has been published in journals such as the International Journal of Childbirth as the editor in chief; Birth: Issues in Perinatal Care; The American Journal of Maternal Child Nursing (MCN); Journal of Perinatology; Journal of Nursing Care Quality; and Journal of Obstetric, Gynecologic, and Neonatal Nursing (JOGNN). Dr. Murray was also a contributor to the Association of Women's Health, Obstetric and Neonatal Nurses (AWHONN) publication, Nursing Management of the Second Stage of Labor. Her best-selling books include Antepartal and Intrapartal Fetal Monitoring (Third Edition) and Essentials of Fetal and Uterine Monitoring (Fifth Edition). Her books and products are available at www.fetalmonitoring.com or directly from Springer Publishing Company. Dr. Murray has been an active member and officer of the AWHONN as well as the American Nurses Association's New Mexico Nurses Association. She is an award winner in education from AWHONN (formerly the Nurses Association of the American College of Obstetricians and Gynecologists), and from the nursing honor society, Sigma Theta Tau. Gayle M. Huelsmann, BSN, RNC-OB, C-EFM, is certified in inpatient obstetrics and holds a certificate of added qualification in electronic fetal monitoring from the National Certification Corporation in Chicago, Illinois. She has been an antepartal nurse and a labor and delivery staff nurse for 35 years. During her 21 years as a maternal air transport nurse with fixed wing and rotor wing aircraft, she was awarded the PRIDE nurse distinction from Presbyterian Hospital for her exemplary contribution to patient care. Ms. Huelsmann has published on a variety of topics related to labor and delivery nursing and is the coauthor of Essentials of Fetal and Uterine Monitoring (Fifth Edition) and the monograph on Uterine Hyperstimulation: Physiologic and Pharmacologic Causes With Results From a Survey of 1000 Nurses with Dr. Michelle L. Murray. Ms. Huelsmann is an experienced Lean Six Sigma Green Belt for quality and performance improvement projects in healthcare organizations. Disclaimer This book is not intended to replace your hospital's policies, procedures, guidelines, or protocols. It is not intended to dictate a standard of care. We recommend that the reader always consult current research and specific institutional policies before performing any clinical procedure. This book is intended for use during the process of orientation of nurses in the labor and delivery setting, and to bring experienced nurses up to date with regard to current practice and research findings. It can also be used as a reference or as a study guide by nurses preparing to take a certification examination in the field of inpatient obstetrics or labor and delivery. This book does not include directions for equipment use or specific tests. These must be learned in the hospital setting, preferably with a mastery-based skills checklist. In addition, care should be individualized to the patient. True/false questions appear at the end of each chapter as a complement to the learning process. Each chapter contains the information necessary to answer the questions. The content of this book was based on the best available research at the time it was written. Some studies may appear dated and may have been the only study on the subject that was readily available at the time of this publication. Every attempt was made to provide current information that is evidence-based. Neither the author nor the publisher shall be liable for any special, consequential, or exemplary damages resulting, in whole or in part, from the readers' use of, or reliance on, the information contained in this book. The publisher has no responsibility for the persistence or accuracy of URLs for any external or third-party Internet websites referred to in this publication and does not guarantee that any content on such websites is, or will remain, accurate or appropriate. Contents Preface… ix Acknowledgments… xiii 1. Advocacy, Communication, Chain of Command, and Evidence-Based Practice… 1 2. Assessment to Create an Individualized Plan of Care and Informed Consent… 25 3. Labor and Birth… 65 4. Pain, Pain Reduction, and Evidence-Based Practice… 115 5. Positions for Labor and Birth… 147 6. The Passageway, Passenger, Placenta, and the Umbilical Cord… 161 7. Passenger-Passageway Problems… 199 8. Presentation, Position, and Station… 225 9. Powers: Force and Physiology… 243 10. Psyche During Pregnancy, Childbirth, and Postpartum… 275 Appendix A: Abbreviations… 301 Appendix B: Abbreviations to Avoid in Documentation… 309 Appendix C: Hospital Labor and Delivery Orientation Fundamentals… 311 Appendix D: Orientation Checklist… 315 Appendix E: Orientation Log Chart… 321 Glossary… 325 Index… 335 Preface The interests of the patient are the only interests to be considered. — William Mayo Learning about labor and birth requires effort. Reading books such as this one is one way to learn evidence-based concepts. In addition, learning about childbearing care practices that will keep patients safe and optimize outcomes can also occur from decades of experience prior to confirmation by research. Nurses with decades of experience know, for example, that the chain of command involves communication that can take many forms. For example, notifying a nursing leader of your patient's vital sign abnormalities is a form of the chain of command. When the nursing leader comes to the bedside to confirm that and any other abnormalities and assists the primary nurse in formulating a plan of care to optimize maternal and fetal outcomes, that is also part of the chain of command. To be an effective care provider, nurses must have courage, confidence, and competence. They must communicate with the patient, nursing leadership, and the obstetric care providers. In some cases, there may be barriers to their patient advocacy. That is why the courage to speak up and base care on evidence-based concepts, including physiology, is critical to patient safety. All healthcare providers need to be aware of their cognitive biases and keep an open mind and an accepting attitude. They need hands-on skills and a broad and deep understanding of the research related to pregnancy, labor, and birth. That means they are lifelong learners and their work environment allows them to provide evidence-based practice (Scott-Findlay, 2007). The best care will be evidence based and result in good outcomes. Therefore, the goal of this book is to provide you with the information to develop an evidence-based practice of labor and delivery nursing. Labor and delivery nursing requires critical thinking, constant caring, listening to your inner voice, anticipation of the needs of many, teamwork, communication, and collaboration (see Box 1). Translators are often family members or friends who speak the language of the childbearing woman. They are not certified interpreters. It is also important to listen to significant others who accompany the childbearing woman and may have important information to share. Proper surveillance and care of the fetus and mother during labor and delivery depend on comprehensive data acquisition, attention to detail, adequate knowledge to properly understand and interpret the meaning of data, verbal and nonverbal cues, and teamwork. This book was created with these elements in mind. Figure 1 illustrates the nursing process from admission to delivery. If possible, review the patient's prenatal record before she arrives. Table Thumbnail Box 1. Some characteristics of a critical thinker Labor and delivery nurses provide patient-centered individualized care. Care is both "high tech" and "high touch" and can occur in settings such as a family birthing center with labor-delivery-recovery-postpartum rooms, a labor-delivery-recovery room, or simply a labor room. It can occur in a large room with stretchers or beds separated by a curtain or even in one large room with multiple laboring women on mats on the floor. Labor and delivery nurses are masters of anticipation, supporters of natural childbirth, and monitors of safety practices because they are the first line of defense in preventing injury. They must understand maternal and fetal physiology, know the purpose and physiologic impact of their actions, and be able to evaluate their patients' responses to those actions. In addition, effective intrapartal nurses are fearless when advocating for their patients. Modern obstetrics requires both high-touch and high-tech skills. "High-touch" care can be thought of as "labor support," empathy, and use of touch. Labor support may play a part in shortening a woman's labor, decreasing her use of analgesia and anesthesia, labor augmentation, possibly decreasing the need for an operative vaginal delivery or a cesarean delivery, and increasing satisfaction with the birthing experience. Labor and delivery nursing or intrapartal nursing is part of the culture of obstetrics and this culture has its own myths, taboos, artifacts, and traditions. Nurses need the knowledge and skills to properly use different types of machines and equipment. For example, the high-tech aspect of labor and delivery includes tests to confirm the rupture of membranes; the use of the electronic fetal monitor and its components (such as a spiral electrode); insertion of an IV catheter and administration of IV fluids, blood, or blood products; use of suction and oxygen equipment; and procedures such as amnioinfusion. This book is not intended to be a procedure or equipment manual, nor was it designed to replace hands-on bedside training. Instead, it is our hope that the information gained from reading this book will help labor and delivery nurses make wise decisions in their choices of interventions, in the creation of patient-centered plans of care, and in their communications with other members of the obstetrics team. Figure Thumbnail Figure 1. The nursing process from admission until delivery. Documentation should reflect each step of this process. For those beginning their career as a labor and delivery nurse, Ray Spooner, RN, BSN, an experienced labor and delivery nurse, has suggested, "Be yourself. Especially, do not feign knowledge. It is better to ask a stupid question than to make a stupid mistake" (Spooner, 1995). In addition to this book, we hope nurses becoming oriented to the practice of labor and delivery nursing will read the philosophy, policies, procedures, and protocols of their facility. We encourage new nurses to ask for guidance, information, and demonstrations of procedures when they need help. We also encourage open communication with patients and other healthcare providers. Often the patients are the only ones who have the answers to your questions. Benjamin Franklin once said, "The best investment is in the tools of one's own trade." Intrapartal nurses need to own equipment that aids them in their patient care (see Box 2). It is helpful to have a fetoscope in your locker, especially for those times when a patient refuses the fetal monitor or there is a power failure. As your career develops, you may find other tools that enhance your ability to meet your patient's needs. Table Thumbnail Box 2. Some "tools" of the labor and delivery nurse Our combined nursing experience totals more than 50 years. The majority of our clinical time has been spent in labor and delivery settings. We hope that our experience and education as intrapartal nurses and educators will be transmitted to you in this book and that it will provide you with the information you need to make informed decisions and provide evidence-based care. Michelle L. Murray, PhD, RNC-OB Gayle M. Huelsmann, BSN, RNC-OB, C-EFM References Scott-Findlay, S. (2007). Fostering evidence-based practice: Strategies for nurse leaders. Nursing for Women's Health, 11(3), 250-252. doi:10.1111/j.1751-486x.2007.00155.x Spooner, R. (1995). Gentle reminder. American Journal of Maternal Child/Nursing, 20, 166. doi:10.1097/00005721-199505000-00018 Acknowledgments We were helped in writing this book about concepts that are core to the nurses who work in a labor and delivery setting. Our reviewers are thoughtful nurses who dedicated their work to the safe care of women during the childbirth process. Each of these reviewers provided feedback on chapters in this book's first edition or second edition. They are listed below in alphabetical order: Jennifer L. Atkisson, RNC-OB, MSN Clinical Nurse Leader and Clinical Educator Women and Children's; Providence Willamette Falls Medical Center Oregon City, Oregon Susan Mocsny Baker, RNC-OB Staff Nurse University of Massachusetts Memorial Medical Center Worcester, Massachusetts Darcie Beckwith, RNC-OB, MSN Clinical Practice Specialist The Birthing Inn Inova Loudoun Hospital Leesburg, Virginia Lynne Brengman, RNC-OB, BSN, MBA Education Department PeaceHealth St. Joseph Hospital Bellingham, Washington Cindy Curtis, RNC-OB, IBCLC, CCE Staff Nurse and Director of the Lactation Center Culpeper Regional Hospital Family Birth Center Culpeper, Virginia Garla DeWall, MSN, RNC-OB Manager, Patient Experience Presbyterian Hospital Albuquerque, New Mexico Becky Dunham, RNC-OB Staff Nurse, Labor and Delivery Dublin Methodist Hospital Dublin, Ohio Donna McAfee Frye, RN, MN Clinical Director Women's and Children's Clinical Services Nashville, Tennessee Hannah Furie, RN, BSN Care Manager Albuquerque, New Mexico Aurora Gumamit, RN, MSN, CNS Charge Nurse, Labor and Delivery Corona Regional Medical Center Corona, California Julie Holden, RN, BSN, MA Nurse Manager Beverly Hospital Beverly, Massachusetts Theresa Hyland, RNC-OB Yale New Haven Hospital New Haven, Connecticut Wanda Jeavons, RNC-OB, MSN, PNNP Perinatal Outreach Coordinator Andrews Women's Hospital Baylor All Saints Medical Center Fort Worth, Texas Suzanne Ketchem, RNC-OB, CNS, MSN Senior Director, Women and Children's Service Line Poudre Valley Hospital - Medical Center of the Rockies Fort Collins, Colorado Reta M. King, RNC-OB, BSN Staff Nurse, Labor and Delivery University of New Mexico Medical Center Albuquerque, New Mexico Nanci Koperski, RNC-OB, LNCC, MBA, MHSA Legal Nurse Consultant Phoenix, Arizona Alexandra Sam Lee, RN, BSN Trilingual nursing professional Mills-Peninsula Health Services Family Birth Center Burlingame, California Michelle McEwen-Campbell, RNC-OB, DNP, FNP, LNC, CNE Lecturer School of Nursing University of North Carolina Wilmington Wilmington, North Carolina Debra Mills, RN, CNS, BSN, MSN Clinical Nurse Specialist, Family Birth Center Methodist Hospital Sacramento, California Jeanne M. Mitchell, RNC-OB, CCE, BSN OB Nurse Director and Director of Education AMITA Health Adventist Glen Oaks Hospital Glendale Heights, Illinois Angela Murphy, RNC-OB Charge Nurse, Family Birthing Center Presbyterian Hospital Albuquerque, New Mexico Sarah Patel, RN, C-EFM, MSN Undergraduate Student Success Coordinator and Lecturer University of New Mexico College of Nursing Albuquerque, New Mexico Nancy Powell, RNC-OB, PhD, MSN, CNM Director of Professional Development AtlantiCare Regional Medical Center Pomona, New Jersey Linda M. Shinn, RNC-OB, MAS, BSN, C-EFM Adjunct Clinical Faculty, School of Nursing California State University San Marcos San Marcos, California Wendy Sinanan, RN Former Staff Nurse and Charge Nurse, Labor and Delivery Mt. Sinai Hospital Toronto, Ontario, Canada Ann Weed, RNC-OB, CNS, MSN Clinical Nurse Specialist Mary Washington Hospital Fredericksburg, Virginia Diana Wigham, RNC-OB, MSN Staff Nurse, Labor and Delivery Saint Francis Medical Center Hartford, Connecticut Copyright © 2021 Springer Publishing Company, LLC. All rights reserved.

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Fundamentals of Musculoskeletal Imaging - 4th Ed. (2014)

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To access this resource you will need to use your STAT!Ref User ID and Password.  If you need a STAT!Ref User ID and Password speak with your administrator. FUNDAMENTALS OF MUSCULOSKELETAL IMAGING - 4th Ed. (2014) Front Matter Title Page Fundamentals of Musculoskeletal Imaging Fourth Edition Lynn N. McKinnis PT, OCS Butler, Pennsylvania Concordia Visiting Nurses Staff Physical Therapist Cabot, Pennsylvania St. Francis University Adjunct Instructor Department of Physical Therapy Loretto, Pennsylvania University of Montana Faculty Affiliate School of Physical Therapy & Rehabilitation Science Missoula, Montana University of South Florida Affiliate Instructor School of Physical Therapy and Rehabilitation Sciences Tampa, Florida F.A. Davis Company • Philadelphia Copyright Page F. A. Davis Company 1915 Arch Street Philadelphia, PA 19103 www.fadavis.com Copyright © 2014 by F. A. Davis Company All rights reserved. This product is protected by copyright. No part of it may be reproduced, stored in a retrieval system, or transmitted in any form or by any means, electronic, mechanical, photocopying, recording, or otherwise, without written permission from the publisher. Printed in the United States of America Last digit indicates print number: 10 9 8 7 6 5 4 3 2 1 Library of Congress Cataloging-in-Publication Data McKinnis, Lynn N. Fundamentals of musculoskeletal imaging / Lynn N. McKinnis. — Fourth edition. p.; cm. Includes bibliographical references and index. ISBN 978-0-8036-3821-1 (alk. paper) I. Title. [DNLM: 1. Musculoskeletal Diseases—diagnosis. 2. Diagnostic Imaging—methods. 3. Musculoskeletal System—injuries. 4. Physical Therapy Modalities. WE 141] RC925.7 616.7'075—dc23 2013022256 Editor-in-Chief: Margaret M. Biblis Senior Acquisitions Editor: Melissa A. Duffield Senior Developmental Editor: Jennifer A. Pine Manager of Content Development: George W. Lang Art and Design Manager: Carolyn O'Brien As new scientific information becomes available through basic and clinical research, recommended treatments and drug therapies undergo changes. The author(s) and publisher have done everything possible to make this book accurate, up-to-date, and in accord with accepted standards at the time of publication. The author(s), editors, and publisher are not responsible for errors or omissions or for consequences from application of the book and make no warranty, expressed or implied, in regard to the contents of the book. Any practice described in this book should be applied by the reader in accordance with professional standards of care used in regard to the unique circumstances that may apply in each situation. The reader is advised always to check product information (package inserts) for changes and new information regarding dose and contraindications before administering any drug. Caution is especially urged when using new or infrequently ordered drugs. Authorization to photocopy items for internal or personal use, or the internal or personal use of specific clients, is granted by F. A. Davis Company for users registered with the Copyright Clearance Center (CCC) Transactional Reporting Service, provided that the fee of $.25 per copy is paid directly to CCC, 222 Rosewood Drive, Danvers, MA 01923. For those organizations that have been granted a photocopy license by CCC, a separate system of payment has been arranged. The fee code for users of the Transactional Reporting Service is: 978-0-8036-3821-1/14 0 + $0.25. ISBN-13: 978-0-8036-3821-1 ISBN-10: 0-8036-3821-3 Contemporary Perspectives in Rehabilitation [Inline Image] Steven L. Wolf, PT, PhD, FAPTA, Editor-in-Chief Vestibular Rehabilitation, 3rd Edition Susan J. Herdman, PT, PhD, FAPTA Richard A. Clendaniel, PT, PhD Pharmacology in Rehabilitation, 4th Edition Charles D. Ciccone, PT, PhD Modalities for Therapeutic Intervention, 4th Edition Susan L. Michlovitz, PT, PhD, CHT, and Thomas P. Nolan, Jr., PT, MS, OCS Wound Healing: Alternatives in Management, 3rd Edition Joseph M. McCulloch, PT, PhD, CWS, FAPTA Luther C. Kloth, PT, MS, CWS, FAPTA Spinal Cord Injury Rehabilitation Edelle Field-Fote, PT, PhD For more information on each title in the Contemporary Perspectives in Rehabilitation series, go to www.fadavis.com. Dedication This book is dedicated with love to my Mom, who finds joy in her work to my Dad, who takes pride in his work to my husband, Dave, who lives his work and to our children, Jesse and Ann, for whom I wish all these things. Foreword Many of us tend to measure time in units that seem to accelerate as a function of our own aging processes. It is hard to believe that this fourth edition of Fundamentals in Musculoskeletal Imaging by Lynn McKinnis spans 17 years since the first edition was published. At that time we approached this project with some trepidation since we questioned the receptivity of educators, students, and clinicians to the relevance and importance of this content for the armamentarium of health-care providers in general and physical therapists and physical therapy assistants in particular. However, our apprehension has been more than allayed with respect to musculoskeletal pathologies. Inevitably the need to familiarize health-care professional students and clinicians with visualizations of the musculoskeletal system has been prompted by continuous advances in imaging technology. Moreover, educators and clinicians have discovered that imaging can be used as a vehicle to facilitate communication with referring or collaborating physicians and other health professionals or as a conduit for evidence to demonstrate the relationship of intervention to improvement. Such evidence serves to facilitate decisions from third party payers regarding numbers of treatment sessions. The mounting sophistication and clarity with which we understand the pathologies of our patients have emerged from enhanced imaging. This evolution has gained recognition and our past readers have developed an insatiable thirst for more knowledge in the use and understanding of advanced imaging procedures. Undoubtedly, this strong inquiry process has contributed substantially to the emerging popularity of this text. Accordingly, it is not surprising that today most education programs use this text for their students and many practitioners consider it a "fundamental" document for their libraries. A considerable effort has been undertaken to make this fourth edition even better than the third. Each clinical chapter follows a logical sequence in which basic osteology and connective tissue structures are outlined and labeled. This effort serves as a foundation upon which more sophisticated imaging procedures, including computerized tomography (CT) scans and magnetic resonance imaging (MRI) are added. Specific pathologies with which students and clinicians will then deal follow immediately thereafter. These building blocks are craftily structured so that irrespective of which anatomical region the reader first embarks, their assimilation of the developing content will make comprehension of subsequent chapters easier. As Lynn McKinnis points out so cleverly within her preface when she employs a swimming analogy, the depth and comprehension are progressive. Security acquired in the shallow end will build confidence in deeper waterswhile all the time the instructor is there to coach. In implementing this process, she has maintained the tradition so much a part of the entire Contemporary Perspectives in Rehabilitation serieschallenging the reader to problem solve while updating relevant references and source materials. This effort is supported through many changes including the addition of approximately 300 new line drawings and images, expanded imaging evaluations for almost all clinical chapters, and conversion of the bound-in student CD to an expanded and enhanced online resource that includes additional questions, an expanded searchable glossary, and, for the first time, a feature permitting the viewer to analyze MRI sequences. Consumer expectations from the therapists who so dutifully dedicate services continue to rise. As we strive for more respect and participation in decision-making for our patients, there is a growing need for us to understand all aspects of the patient history on the one hand and foster our confidence in conveying our knowledge and impressions to referral sources on the other. One of the most obvious vehicles for achieving success in this endeavor is through communications regarding the meaning of the pictures we and our patients are shown. The growth in information accessibility amongst our consumers and their abilities to use electronic resources to better understand this information has become evident and will only escalate. This emerging sophistication in assimilating information is in its infancy, and our ability to not only anticipate their inquiry but respond confidently and comprehensively has become a presumed expectation. While our learning curve to do so within categories such as genomics, bioengineering, and regenerative rehabilitation continues to grow, perhaps we have reached a point where this responsibility can be achieved in the field of imaging, particularly when musculoskeletal diagnoses are involved. If this premise is correct, then let Fundamentals in Musculoskeletal Imaging serve as our compass. STEVEN L. WOLF, PT, PhD, FAPTA, FAHA Series Editor, Contemporary Perspectives in Rehabilitation series Preface A Letter to the Reader, a Nonradiologist In 1997, the first edition of this book posed the question: What is to be gained in patient care if rehabilitation clinicians have an understanding of radiology? By 2005, the second edition had drawn on the experiences of educators, students, and clinicians to provide concrete examples of the answer: The correlation of imaging findings to clinical findings can result in more comprehensive patient evaluations, more specific treatment plans, and better patient outcomes. Now, in 2014, the inclusion of imaging content in all physical therapy curriculums in the United States is verification of that answer. And now, in this new century, in this fourth edition of the book, that answer is even more critical as the profession struggles to encompass and adapt to the new politics and economics of how health care is delivered. Imaging is a science, a product, and a tool that drives patient care—either directly, or in its overutilization (well documented in the last decades), or in its underutilization (due to insurance regulations). It is an understatement to say we now live in a transitional era: transitional between a wealth of imaging technology and a dearth of equitable distribution of services, between a wealth of specialists on the health-care team and a dearth of interprofessional communication, between a wealth of insurance regulations and a dearth of enlightened decision making. "Imaging" is no longer a niche topic tangent to those interested in orthopedics. Knowledge of imaging is prerequisite to being a valuable player on the health-care team, to negotiating for preauthorizations for our patients, to being able to communicate effectively with other medical professionals, and to being able to intelligently inform insurance professionals, as well as our own professional and political colleagues. Overwhelmed? Don't be. Remember—you are not the radiologist—you are a member of the health-care team who has to learn enough about imaging to function competently and collaboratively. Collaboration requires an understanding of what the other parties have to offer. This text strives to be an excellent primer—the place to gain an overview of musculoskeletal imaging interwoven with your knowledge of anatomy and clinical pathology. Imaging will then become one more brick in your foundation to build clinical work upon. If you have no background in imaging, this text will introduce it to you in logical steps. I want all students to feel as though they are learning to swim in the shallow end of the pool instead of being thrown into the deep end! So, it is desirable to wade through these chapters in the order intended. Read the first three chapters to gain a foundation in radiologic science, search patterns, and common pathological and fracture characteristics on radiograph. Read the next three chapters to understand advanced imaging modalities. After that, you can paddle around the next eleven anatomy chapters at your leisure. Each anatomy chapter has a similar organization. First, a brief anatomy review to refamiliarize yourself with the joint structures. Next, the routine radiologic evaluation is explained in detail. Radiologic observations are taught for each projection with illustrations to point out anatomic relationships. The tracings of the radiographs are most valuable for teaching you to "see" radiographic anatomy. Ideally, you will make your own tracings of the radiograph with a transparency sheet and marker, and then compare their results to the printed tracing. Drawing is an invaluable intellectual exercise for teaching anatomy and will enhance your perception of radiographic anatomy in a dimension not afforded by point-and-click exercises. After the routine radiographic section is completed, the advanced imaging protocols for CT and MRI are presented. The order of this content is significant: The value of learning the routine radiographic exam prior to advanced imaging is that radiographs serve as anatomical "road maps" to help you understand the orthogonal planes of sectional imaging. The advanced imaging protocols are organized to allow you to see each advanced imaging exam "at a glance" on a two-page spread. Basic observations are listed for each orthogonal plane. Finally, the remainder of each anatomy chapter covers the trauma and pathologies most often seen at that body region. Brief descriptions, etiologies, treatments, and prognoses are accompanied by images that encompass that condition. Each chapter concludes with a Summary of Key Points to help reinforce main ideas and Self-Tests using unknown images to challenge the reader's visual interpretation skills. Of curious note in the anatomy chapters is Chapter 10, "The Chest Radiograph and Cardiopulmonary Imaging." I do recognize this anatomy is not part of our musculoskeletal system, strictly speaking! However, this material was requested by educators. And, after being included in the last edition, it has made perfect sense, and continues to make sense—especially now in light of our more integrated role in the health-care team. The chest radiograph is the most commonly made radiograph on any given day in any country in the world. It is undeniably a standard tool of basic health care. In that respect, it is easily covered with the other radiologic fundamentals of this book, especially following the related anatomy of the thoracic spine/sternum/ribs in Chapter 9. In another respect, the results of the chest radiograph will determine what treatment we can do safely with our patients—whether it is musculoskeletal or cardiopulmonary in nature. The final consensus is that it is very fitting for physical therapy students and clinicians to understand the language and the fundamentals of the chest radiograph. The book wraps up appropriately with the final chapter, "Integration of Imaging into Physical Therapy Practice." This content is important in understanding the increasing role of nonphysician clinicians as first-access providers and referral sources. It also explores some practical issues and evolving issues regarding practice environments and how they relate to ordering imaging in the military, in civilian roles, and outside the United States. To conclude, this fourth edition preserves the vision of the original edition: to provide an organized introduction to the fundamentals of musculoskeletal imaging. By the time you get to the end of this book, my hope is that you have (1) an awareness of the capabilities and limitations of the different imaging modalities, (2) an understanding of the information given on the radiologist's report, and (3) the ability to look at images yourself and appreciate what you can see. Viewing the image independently can be a critical skill, especially if you are seeking information not provided on the radiologist's report, which is written from and to a medical physician's perspective. The information the rehabilitation clinician seeks can be of a different nature. So, it is the wish of this author that you find satisfaction in gaining a new vision with which to see anatomy and the potential to develop the skill of correlating imaging findings with clinical findings. It is hoped that this skill will become a valuable tool that contributes to the rehabilitation of patients, helps you collaborate with the other professionals, and furthers your individual growth. Best Wishes, LYNN MCKINNIS, PT, OCS 119 Kemar Drive Butler, Pennsylvania 16002 Contributors Hilmir Agustsson, PT, PhD, MTC, CFC Assistant Professor University of St. Augustine for the Health Sciences St. Augustine, FL J. Bradley Barr, PT, DPT, OCS Associate Professor of Physical Therapy Creighton University Omaha, NE Ellen J. Pong, DPT, MOTR/L Adjunct Instructor University of St. Augustine for Health Sciences St. Augustine, FL Occupational and Physical Therapist Sacred Heart Health System Rehabilitation Center at Pace Pace, FL Physical Therapist Clinical Research Group Gulf Breeze, Florida Reviewers Michael E. Mulligan, MD Professor of Radiology and Nuclear Medicine Musculoskeletal Radiology Fellowship Program Director University of Maryland School of Medicine Chief of Radiology, Kernan Hospital, University of Maryland Medical System Alex D. Freitas, MD Renaissance Imaging Medical Associates Formerly Assistant Professor of Radiology, Department of Radiological Sciences UCLA/Wadsworth VA Formerly Chief of Musculoskeletal Imaging, Tripler Army Medical Center, Hawaii. Acknowledgments This fourth edition is enhanced by new MRI and CT images that were provided by Michael Mulligan, MD, an excellent radiologist and teacher. I am forever grateful that he has been willing to share his knowledge and time for the advancement of this textbook throughout the past three editions. His meticulous approach as a reviewer ensured the content was accurate and current. Above all, his enthusiastic collaboration on a textbook for physical therapy students speaks volumes about the professional philosophy of this physician. He values all clinicians who participate in the care of the patient. By generously sharing his expertise, we gain the opportunity to advance our knowledge base, broaden our understanding of the patient's condition, and communicate more effectively with other professionals. We hope we will continue to extend the favor he has done for us by improving our care of the patient and by reaching out to mentor those who follow us in our profession. Thank you also to another radiologist and teacher, Alex Freitas, MD, who has helped to demystify MRI for students via his website that condenses musculoskeletal MRI protocols to their basics. He kindly offered the use of his images, answered many e-mail questions, and also gave his time to serve as a content reviewer. Grateful appreciation is extended to my indefatigable colleague Hilmir Agustsson, PT, PhD, MTC, CFC, for sharing his ideas, enthusiasm, and labor of love for teaching imaging. His four chapters tackle the most difficult material with clarity and grace. His contributions in this text and in his own university courses have brought advanced imaging principles to the next generation of students with authority. And this authority can only come from a true love of anatomy, of technology, and of the infinite complexity of patient problems. He approaches his work with seriousness, joy, perseverance, and patience. It has simply been an enchanting privilege to work with this gentleman. The exceptional Ellen J. Pong, DPT, MOTR/L, always produced more than expected and became invaluable for her research, Focus On papers, Glossary compilations, as well as her enduring friendship and moral support. I met Ellie when she was a grad student in my first seminar at the University of St. Augustine. Since then she has become clinician, teacher, author, researcher, and mother extraordinaire. This is no surprise. She was truly a gift as a student and now as a colleague and friend. Many thanks to J. B. Barr, PT, DPT, OCS, for his closing chapter on the integration of imaging in daily practice, and to his students in Creighton University's DPT program, 2000-2004, whose coursework generated the case studies throughout the text. Also, thanks to a new Chatham University graduate, Stephanie Fitzsimmons, DPT, for assisting in literature searches. Lastly, the fourth edition is modernized with new patient positioning photographs, made under the tutelage of my coworker, Libby Carlini, RT. Never underestimate the value of a good radiology technician. They are the workhorses of radiology, dealing with the injured patients, the heavy equipment, the endless data entry, the stat orders. Despite this, Libby made time to answers my questions and stepped up to run the photo shoot. Her attention to detail and precise positioning ensured each photo example was technically accurate. The fourth edition stands on the shoulders of each earlier edition. I am indebted to the kindness of many exceptional professionals who helped build each edition, brick by brick—or image by image! The third edition expanded due to the generosity of Nick Oldnall at xray2000.co.uk; John C. Hunter, MD, at the University of California, Davis School of Medicine; Laughlin Dawes, MD, of Perth, Australia, and his images at radpod.org; and Morten Weibye at medcyclo.com by GE Healthcare. The second edition was enhanced by the advanced images of Drs. Cliff Spohr, A. Graham-Smith, John Lin, and the craniocervical images of Professor Mariano Rocobado, DPT. Corlia van Rooyen, MPT, RHT, lent her expertise as a hand therapist and truly advanced the chapter on the hand and wrist. Finally, the very first edition was made possible due to the generosity of the following radiologists and hospital radiology staffs: Arthur Nussbaum, MD, and Peter Fedyshin, MD, at the University of Pittsburgh Medical Center (UPMC) Passavant; Jeffrey Towers, MD, at UPMC Montefiore; Lance Cohen, MD, formerly of Children's Hospital in Pittsburgh; Margie Brindl, retired Administrator of Undergraduate Medical Education in Radiology at the University of Pittsburgh; Linda Barto, RTR, formerly of Butler Memorial Hospital, Butler, PA; Sarah Hample, RTR, private practice; and to my first boss and lasting mentor, Charles W. Etter, PT, who teaches by example what it is to be your best. Thank you to the dedicated staff at F. A. Davis, and especially to Margaret Biblis, Editor-in Chief, Jennifer Pine, Senior Developmental Editor, and Melissa Duffield, Senior Acquisitions Editor, for their devotion, expertise, diplomacy, and sense of humor during the long journey of four editions. They were the best of traveling companions. Heartfelt thanks to my family. To my parents, Francis and Berniece Nowicki, for a lifetime of love and support in all endeavors and for pointing me toward physical therapy in the beginning. And to Jesse and Ann, for their happy spirits, love, patience, and unflagging belief that Mom's book is pretty neat. Jesse's beautiful pencil drawings have been carried forward to this edition's chapter title pages. These drawings depict people engaged in everyday activities and exude a warmth that reminds us imaging begins and ends with the patient. Ann was the model of good cheer as she put up with being the poked and prodded positioning model in a long photo shoot. And many thanks to her uncle, the photographer, Mark Konezny, for his sense of perfection through the lens. And thanks to my best friend and husband, David Lindsey McKinnis, MEd, PT, who taught me how to teach, how to write, and how to achieve. His most tangible contribution to the book was drawing the original line art. These drawings simplified difficult material and greatly enhanced the practical use of the text. His most intangible contribution was in giving me the belief in myself that I could write it. Table of Contents Chapter 1 General Principles of Musculoskeletal Imaging… 1 Why Study Imaging?… 1 What Is Radiology?… 2 What Is Musculoskeletal Imaging?… 2 Historical Perspective… 2 Turn-of-the-Century Sensationalism… 2 The 1910s and 1920s… 3 The 1930s and 1940s… 3 The 1950s and 1960s… 3 The 1970s and 1980s… 4 The 1990s to the 21st Century… 4 Essential Science… 4 What Is a Radiograph?… 4 What Is Radiation?… 5 Units of Measure in Radiologic Science… 5 What Are X-rays?… 6 How Are X-rays Produced?… 6 How Do X-rays Interact With the Patient?… 6 How Is the Image Made?… 7 Basic Requirements for Any X-ray Imaging System… 7 Image Receptors: Different Ways to Capture the X-Rays… 7 The Gold Standard: Film/Screen Radiography… 7 Will Film Become Obsolete?… 8 Fluoroscopy… 8 Computed Radiography… 9 Digital Radiography… 9 Comparing Computed and Digital Radiography… 10 Understanding the Image… 10 What Is Radiodensity?… 10 Radiographic Density… 10 Radiopaque and Radiolucent… 10 Radiodensity as a Function of Composition: Anatomy in Four Shades of Gray… 11 Two More Shades of Gray… 11 Radiodensity as a Function of Thickness… 12 How Many Dimensions Can You See?… 13 Angles of Projection Over Straight Planes… 13 Angles of Projection Over Curved Planes… 13 One View Is No View… 13 The Perception of a Third Dimension… 14 Radiodensity in a Rose… 15 More to the Radiograph… 15 Radiographic Terminology… 15 Position… 15 Projection… 16 Anteroposterior, Lateral, and Oblique Projections… 16 Viewing Radiographs… 16 Identification Markers… 19 Image Quality Factors… 19 Radiographic Density… 19 Radiographic Contrast… 20 Recorded Detail… 21 Radiographic Distortion… 22 Electronic Image Processing… 22 The Routine Radiographic Examination… 24 The Radiologist as the Imaging Specialist… 25 Other Common Studies in Musculoskeletal Imaging… 25 Contrast-Enhanced Radiographs… 26 Arthrography… 26 Myelography… 26 Conventional Tomography… 26 Computed Tomography… 26 Nuclear Imaging… 28 Methods of Imaging… 29 Radionuclide Bone Scan… 30 Magnetic Resonance Imaging… 31 Ultrasonography… 31 Interventional Techniques… 31 Epidural Steroid Injections… 32 Spinal Nerve Blocks… 33 Radiofrequency Ablation… 33 Diskography… 33 Percutaneous Needle Biopsy of the Spine… 33 Percutaneous Vertebroplasty, Kyphoplasty, and Cementoplasty… 34 Automated Percutaneous Lumbar Diskectomy… 34 Intradiscal Electrothermal Therapy… 34 The Imaging Chain… 34 Summary of Key Points… 35 Self-Test… 37 Chapter 2 Radiologic Evaluation, Search Patterns, and Diagnosis… 39 Where Does Radiologic Image Interpretation Begin?… 39 What Are the Pitfalls of Image Interpretation?… 39 What Can the Nonradiologist Offer to Image Interpretation?… 39 Search Pattern: The ABCs of Radiologic Analysis… 40 A: Alignment… 41 1. General Skeletal Architecture… 41 2. General Contour of Bone… 42 3. Alignment of Bones Relative to Adjacent Bones… 43 B: Bone Density… 43 1. General Bone Density… 43 2. Textural Abnormalities… 44 3. Local Density Changes… 44 C: Cartilage Spaces… 44 1. Joint Space Width… 45 2. Subchondral Bone… 45 3. Epiphyseal Plates… 45 S: Soft Tissues… 46 1. Muscles… 46 2. Fat Pads and Fat Lines… 47 3. Joint Capsules… 47 4. Periosteum… 48 5. Miscellaneous Soft Tissue Findings… 49 Radiologic Diagnosis of Skeletal Pathology… 50 Categories of Skeletal Pathology… 50 Distribution of the Lesion… 50 Predictor Variables… 51 Behavior of the Lesion… 51 Bone or Joint Involved… 51 Locus Within a Bone… 51 Age, Gender, and Race… 51 Margin of Lesion… 53 Shape of Lesion… 53 Joint Space Crossed… 53 Bony Reaction… 53 Matrix Production… 54 Soft Tissue Changes… 54 History of Trauma or Surgery… 54 Radiologic Characteristics of Common Pathologies… 54 Adult Rheumatoid Arthritis… 55 Radiologic Features of Rheumatoid Arthritis… 55 Osteoarthritis (Degenerative Joint Disease)… 58 Radiologic Features of Osteoarthritis… 58 Additional Findings: Soft Tissue Swelling… 61 Osteoporosis… 61 Imaging for Fracture Risk: DXA… 61 Etiology… 61 Radiologic Features of Osteoporosis… 62 The Pathology Problem: Image Quality Versus Disease… 62 Musculoskeletal Infections… 65 Overview of Imaging Musculoskeletal Infections… 65 Radiologic Features of Osteomyelitis… 65 Radiologic Features of Infectious Arthritis… 65 Radiologic Features of Cellulitis… 66 Bone Tumors… 67 Classification and Terminology… 67 Clinical Signs and Symptoms… 68 Imaging of Bone Tumors… 69 Bone Biopsy… 69 Radiographic Features of Tumors… 71 The Radiologic Report… 71 Heading… 71 Clinical Information… 72 Findings… 72 Conclusions… 73 Recommendations… 73 Signature… 73 Radiologic Report Example… 73 Heading:… 73 Clinical Information:… 73 Findings:… 73 Conclusions:… 73 Recommendations:… 73 Signature:… 73 Summary of Key Points… 73 Self-Test… 75 Chapter 3 Radiologic Evaluation of Fracture… 77 Trauma, the Most Common Disorder… 77 Trauma Radiology… 77 Imaging in the Primary Trauma Survey… 78 Radiographic Positioning for Trauma… 78 What Is a Fracture?… 78 Biomechanics of Bone… 78 Definition of Fracture… 79 Elements of Fracture Description… 79 Anatomic Site and Extent of the Fracture… 80 Type of Fracture: Complete or Incomplete… 80 Alignment of Fracture Fragments… 81 Direction of Fracture Lines… 82 Presence of Special Features… 83 Impaction Fractures… 83 Avulsion Fractures… 83 Associated Abnormalities… 85 Fractures Due to Abnormal Stresses or Pathological Processes… 85 Stress Fractures… 85 Pathological Fractures… 86 Periprosthetic Fractures… 86 Bone Graft Fractures… 87 Fractures in Children… 87 Location Description… 87 Difficulties in Assessment of Immature Bone… 88 Elements of Fracture Description… 88 Incomplete Fractures… 88 Epiphyseal Fractures… 89 Healing Factors… 90 Remodeling Considerations… 90 Anticipating Future Longitudinal Growth… 91 Skeletal Maturity… 91 Reduction and Fixation of Fractures… 91 Reduction… 91 Closed Reduction… 91 Open Reduction… 91 Fixation… 92 Stress Sharing/Shielding… 92 Fracture Healing… 93 Cortical Bone Healing… 93 Cancellous Bone Healing… 93 Surgically Compressed Bone Healing… 93 Radiologic Evaluation of Healing… 94 Time Frame for Fracture Healing… 94 Factors That Influence Rate of Fracture Healing… 94 Age of the Patient… 94 Degree of Local Trauma… 95 Degree of Bone Loss… 95 Type of Bone Involved… 95 Degree of Immobilization… 95 Infection… 95 Local Malignancy… 95 Nonmalignant Local Pathological Conditions… 95 Radiation Necrosis… 95 Avascular Necrosis… 95 Hormones… 95 Exercise and Local Stress About the Fracture… 95 Radiologic Examination Intervals During Fracture Healing… 95 Complications in Fracture Healing… 96 Complications at Fracture Site… 96 Delayed Union… 96 Slow Union… 96 Nonunion… 96 Malunion… 96 Pseudoarthrosis… 96 Osteomyelitis… 96 Avascular Necrosis… 96 Late-Effect Complications of Fracture… 96 Complex Regional Pain Syndrome… 96 Bone Length Discrepancy… 97 Associated Complications in Other Tissues… 97 Soft Tissue Injuries… 97 Arterial Injury… 98 Nerve Injury… 98 Compartment Syndrome… 98 Life-Threatening Complications… 99 Hemorrhage… 100 Fat Embolism… 100 Pulmonary Embolism… 100 Gas Gangrene… 100 Tetanus… 100 Commonly Missed Fractures… 100 Why Are Fractures Missed on Radiographs?… 100 Importance of the Clinical History and Evaluation… 100 Rule of Treatment in Fracture Management… 101 Which Fractures Are Missed?… 101 Commonly Missed Fractures of the Spine… 101 Commonly Missed Fractures of the Upper Extremity… 101 Commonly Missed Fractures of the Lower Extremity… 101 Summary of Key Points… 103 Case Study… 104 Self-Test… 107 Appendix: Fracture Eponyms… 108 Chapter 4 Computed Tomography… 113 Hilmir Agustsson, MHSc, DPT, MTC, CFC Computed Tomography… 113 History… 113 Principles of CT… 113 Elements of a CT Scanner… 114 The Gantry… 114 The X-Ray Source… 114 The Collimators… 114 The Detectors… 114 The Data Acquisition System… 114 The Operator Console and CT Computer… 114 Making the CT Image… 114 Scanning Process… 114 Converting the Data… 114 Different Forms of CT… 115 Three-Dimensional CT… 115 CT Myelogram… 115 Cone Beam Computed Tomography (CBCT)… 116 Viewing CT Images… 116 Radiodensities… 116 The Image… 116 Volume Averaging… 117 Viewing the Patient's Images… 117 Selective Imaging—Windowing… 118 Bone Window Versus Soft Tissue Window… 118 Quality of the Image… 118 Factors Degrading Image Quality… 119 Slice Thickness… 119 Clinical Uses of C

Material Type: Reading

Hola a Todos: Elementary Spanish I

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This is a preliminary Open Textbook composed of original instructional materials created for the OER-based course, and the team is working to create a full open textbook at a later date. Separate files are included in the Additional Files section in a compressed .zip format for editing and quicker uploads/downloads within classes. Grammar and vocabulary pre-class activities, lectures, and post-class homework are included within these seven chapters:

Material Type: Textbook

Authors: Elizabeth Combier, Mariana Stone

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