Taylor's Handbook of Clinical Nursing Skills PDF, Second Edition

 Thank you for purchasing this e-book. To receive special offers and news about our latest products, sign up below. Sign Up Or visit LWW.com Taylor’s Handbook of Clinical Nursing Skills Second Edition Pamela Lynn, MSN, RN...

 Thank you for purchasing this e-book. To receive special offers and news about our latest products, sign up below. Sign Up Or visit LWW.com Taylor’s Handbook of Clinical Nursing Skills Second Edition Pamela Lynn, MSN, RN Instructor Frances M. Maguire School of Nursing and Health Professions Gwynedd Mercy University Gwynedd Valley, Pennsylvania Publisher: Lisa McAllister Executive Editor: Sherry Dickinson Product Developmental Editor: Christine Abshire Editorial Assistant: Dan Reilly Marketing Manager: Dean Karampelas Production Project Manager: Cynthia Rudy Design Coordinator: Holly Reid McLaughlin Illustration Coordinator: Jennifer Clements Manufacturing Coordinator: Karin Duffield Production Services: Aptara, Inc. 2nd Edition Copyright © 2015 by Wolters Kluwer Copyright © 2011 by Wolters Kluwer Health | Lippincott Williams & Wilkins. All rights reserved. This book is protected by copyright. No part of this book may be reproduced or transmitted in any form or by any means, including as photocopies or scanned-in or other electronic copies, or utilized by any information storage and retrieval system without written permission from the copyright owner, except for brief quotations embodied in critical articles and reviews. Materials appearing in this book prepared by individuals as part of their official duties as U.S. government employees are not covered by the above-mentioned copyright. To request permission, please contact Wolters Kluwer at Two Commerce Square, 2001 Market Street, Philadelphia, PA 19103, via email at [email protected], or via our website at lww.com (products and services). 9 8 7 6 5 4 3 2 1 Printed in China Library of Congress Cataloging-in-Publication Data Lynn, Pamela (Pamela Barbara), 1961- author. Taylor’s handbook of clinical nursing skills / Pamela Lynn. — Second edition. p. ; cm. Handbook of clinical nursing skills Abridgement of: Taylor’s clinical nursing skills : a nursing process approach / Pamela Lynn. 4th ed. 2015. Includes bibliographical references. ISBN 978-1-4511-9363-3 (alk. paper) I. Lynn, Pamela (Pamela Barbara), 1961- Taylor’s clinical nursing skills. Abridgement of (work): II. Title. III. Title: Handbook of clinical nursing skills. [DNLM: 1. Nursing Process–Handbooks. 2. Clinical Medicine–methods–Handbooks. 3. Nursing Care–methods–Handbooks. WY 49] RT51 610.73—dc23 2014021540 This work is provided “as is,” and the publisher disclaims any and all warranties, express or implied, including any warranties as to accuracy, comprehensiveness, or currency of the content of this work. This work is no substitute for individual patient assessment based upon healthcare professionals’ examination of each patient and consideration of, among other things, age, weight, gender, current or prior medical conditions, medication history, laboratory data and other factors unique to the patient. The publisher does not provide medical advice or guidance and this work is merely a reference tool. Healthcare professionals, and not the publisher, are solely responsible for the use of this work including all medical judgments and for any resulting diagnosis and treatments. Given continuous, rapid advances in medical science and health information, independent professional verification of medical diagnoses, indications, appropriate pharmaceutical selections and dosages, and treatment options should be made and healthcare professionals should consult a variety of sources. When prescribing medication, healthcare professionals are advised to consult the product information sheet (the manufacturer’s package insert) accompanying each drug to verify, among other things, conditions of use, warnings and side effects and identify any changes in dosage schedule or contradictions, particularly if the medication to be administered is new, infrequently used or has a narrow therapeutic range. To the maximum extent permitted under applicable law, no responsibility is assumed by the publisher for any injury and/or damage to persons or property, as a matter of products liability, negligence law or otherwise, or from any reference to or use by any person of this work. LWW.com With love, to John, Jenn, and Anna. You fill every day with joy! Contributors and Reviewers CONTRIBUTOR TO Freda Lynn McAllister, RN, PREVIOUS EDITION BSN, MSN Nursing Program Head Lynn Burbank, RN, CPNP, MSN Dabney S. Lancaster Community Learning Resource Coordinator College Dixon School of Nursing Clifton Forge, Virginia Abington Memorial Hospital Abington, Pennsylvania Diane McPhillips, RN, MSN, Medications CNE, CNS Associate Professor REVIEWERS University of Cincinnati Blue Kamomilani Anduha Wong, Ash College MSN, FNP-BC, APRN Cincinnati, Ohio Assistant Professor College of Nursing and Health Delia G. Meyer, MSN, RN, CE Sciences Instructor Hawaii Pacific University Ila Faye Miller School of Nursing Kaneohe, Hawaii University of the Incarnate Word San Antonio, Texas Jennifer Douglas Pearce, MSN, Michelle Natrop, MSN RN, CNE Normandale Community College Professor Bloomington, Minnesota University of Cincinnati Blue Ash College Linda Lee Phelps, MSN, RN Blue Ash, Ohio Assistant Professor—Adjunct Faculty David Dunham, DHEd, MS, Ivy Tech Community College CRNI, RN Indianapolis, Indiana Associate Professor Director, Clinical Laboratories Milena P. Staykova, EdD, College of Nursing and Health FNP-BC Sciences Assistant Professor Hawaii Pacific University Jefferson College of Health Kaneohe, Hawaii Sciences Roanoke, Virginia Kimbra Gabhart, MSN-BC ADN Nursing Faculty Amber Young-Brice, MSN, RN Elizabethtown Community and Clinical Instructor Technical College Marquette University Elizabethtown, Kentucky Milwaukee, Wisconsin iv Preface Taylor’s Handbook of Clinical Nursing Skills is a quick-reference guide to basic and advanced nursing skills. It outlines step-by-step instructions and reinforces the cognitive and technical knowledge needed to perform skills safely and effectively. The convenient handbook format is helpful for student review in the lab or clinical setting and as a reference for graduate nurses in practice. LEARNING EXPERIENCE This text and the entire Taylor Suite have been created with the student’s experience in mind. Care has been taken to appeal to all learning styles. The student-friendly writing style ensures that students will comprehend and retain information. The extensive art program enhances understand- ing of important actions. In addition, each element of the Taylor Suite, which is described later in the Preface, coordinates the information to provide a consistent and cohesive learning experience. ORGANIZATION In general, the content of this book provides streamlined skills consis- tent with those in Taylor’s Clinical Nursing Skills, 4th Edition. Skills are organized alphabetically, based on the main word(s) of the skill, allow- ing the user to access the information about the desired skill quickly and easily. FEATURES Step-by-step skills. Each skill is presented in a concise, straight- forward, and simplified two-column format to facilitate competent performance of nursing skills. The nursing process framework is used to integrate related nursing responsibilities for each of the five steps.* Scientific rationales accompany each nursing action to promote a deeper understanding of the basic principles supporting nursing care. Documentation guidelines direct students and graduate nurses in accurate documentation of the skill and their findings. Delegation considerations assist students and graduate nurses in developing the critical decision-making skills necessary to transfer responsibility for the performance of an activity to another individual and to ensure safe and effective nursing care. Delegation decision- making information is provided in each skill, using delegation guide- lines based on American Nurses Association (ANA) and National Council of State Boards of Nursing (NCSBN) principles and recom- mendations (Appendix A). Photos. Key steps are clarified and reinforced with pictures. General considerations, which explain the varying needs of patients across the lifespan and in various settings, are available on. v vi Preface TAYLOR SUITE RESOURCES From traditional texts to video and interactive products, the Taylor Fundamentals/Skills Suite is tailored to fit every learning style. This integrated suite of products offers students a seamless learning experi- ence not found elsewhere. The following products accompany Taylor’s Handbook of Clinical Nursing Skills: Fundamentals of Nursing: The Art and Science of Person- Centered Nursing Care, 8th Edition, by Carol Taylor, Carol Lillis, and Pamela Lynn. This traditional Fundamentals text promotes nurs- ing as an evolving art and science, directed to human health and well-being. It challenges students to focus on the four blended skills of nursing care, which prepare students to combine the highest level of scientific knowledge and technologic skill with responsible, car- ing practice. The text includes engaging features to promote critical thinking and comprehension. Taylor’s Clinical Nursing Skills, 4th Edition, by Pamela Lynn, cov- ers all of the Skills and Guidelines for Nursing Care identified in Fundamentals of Nursing, Eighth Edition—plus additional skills—at the basic, intermediate, and advanced levels, each following the nurs- ing process format. Features include Skill Variations, which present alternate techniques; Documentation Guidelines and Samples; Unexpected Situations and Associated Interventions; Delegation Considerations; and Special Considerations. Taylor’s Video Guide to Clinical Nursing Skills. With more than 12 hours of video footage, this updated series follows nursing students and their instructors as they perform a range of essential nursing procedures. Institutions can purchase the videos on enhanced DVD or access them online. Contact your sales representative or check out LWW.com/Nursing for more details and ordering information. Guide to Icons Used in This Book IDENTIFY THE PATIENT Identifying the patient ensures the right patient receives the right treatment or intervention and helps prevent errors. The patient should be identified using at least two methods (TJC, 2013) whenever you are administering medications or blood products, taking blood samples and other specimens for clinical testing, or providing any other treatments or procedures. For example: Check the patient’s name and identification number, birth date, or social security number on the patient’s identification band. This is the most reliable method. Ask the patient to state his or her name. This requires a response from the patient. Be aware that illness and strange surroundings often cause patients to be confused. DO NOT USE the name on the door or over the bed (these may be inac- curate) or the patient’s room number.** PERFORM HAND HYGIENE Hand hygiene is the most effective way to help prevent the spread of organisms. The term hand hygiene applies to either the use of antiseptic hand rubs, including alcohol-based prod- ucts; handwashing with soap and water; or surgical hand anti- sepsis. The Centers for Disease Control (CDC), the government agency responsible for investigating, preventing, and controlling disease, issued guidelines for hand hygiene in health care settings. If the health care worker’s hands are not visibly soiled, alcohol- based handrubs are recommended because they save time, are more accessible and easy to use, and reduce bacterial count on the hands. The following are clinical situations when an alcohol-based handrub can be used to decontaminate hands: Before direct contact with patients After direct contact with a patient’s skin After contact with body fluids, mucous membranes, nonintact skin, and wound dressings if hands are not visibly soiled After removing gloves Before inserting urinary catheters, peripheral vascular catheters, or invasive devices that do not require surgical placement Before donning sterile gloves prior to an invasive procedure (e.g., inserting a central intravascular catheter) vii viii Guide to Icons Used in This Book If moving from a contaminated body site to a clean body site during patient care After contact with objects (including equipment) located in the patient’s environment Handwashing with either antimicrobial soap or non-antimicrobial soap and water is required if a health care worker’s hands are visibly soiled or contaminated with blood or body fluids. Handwashing is also required before eating and after using the restroom. Handwashing is also required if exposure to certain organisms, such as Clostridium difficile, is known or suspected.*** Pamela Lynn, MSN, RN *Material related to nursing diagnoses from Nursing Diagnoses—Definitions and Clas- sification 2012–2014. Copyright © 2014, 2009, 2007, 2005, 2003, 2001, 1998, 1996, 1994 by NANDA International. Used by arrangement with Wiley-Blackwell-Publishing, a company of John Wiley & Sons, Inc. To make safe and effective judgments using NANDA-I nursing diagnoses, it is essential that nurses refer to the definitions and defin- ing characteristics of the diagnoses listed in this work. **Source for Patient Identification Guidelines: The Joint Commission (TJC). (2013). National patient safety goals. Available http://www.jointcommission.org/standards_ information/npsgs.aspx. ***Source for Hand Hygiene Guidelines: Joint Commission.. National patient safety goals. Available http://www.jointcommission.org/standards_information/npsgs. aspx; Centers for Disease Control and Prevention (CDC). (2002). Guideline for hand hygiene in health-care settings. Morbidity and Mortality Weekly Report 2002, 51(RR16), 1–45; Centers for Disease Control and Prevention.. Hand hygiene in healthcare settings. Available http://www.cdc.gov/handhygiene/; and Institute for Healthcare Improvement (IHI). (2011). How-to guide: Improving hand hygiene. Avail- able http://www.IHI.org. Acknowledgments This edition is the work of many talented people. I would like to acknowledge the hard work of all who have contributed to the comple- tion of this project. Thanks to Carol Taylor and Carol Lillis for offering generous support and encouragement. You have been excellent mentors. The work of this book was skillfully coordinated by my dedicated Product Developmental Editor, Christine Abshire, in the Nursing Education division of Wolters Kluwer. I am grateful to you for your patience, sup- port, unending encouragement, and total commitment. My thanks to Sherry Dickinson, Executive Editor, for her hard work and guidance throughout the project. Thank you to the members of the Production Department, who patiently pulled everything together to form a completed book: Cindy Rudy, Production Project Manager; Holly Reid McLaughlin, Design Coordinator; and Jennifer Clements, Illustration Coordinator. A special thanks to my colleagues at Gwynedd Mercy University, who offer unending support and professional guidance. Finally, I would like to gratefully acknowledge my family, for their love, understanding, and encouragement. Their support was essential during the long hours of research and writing. Pamela Lynn, MSN, RN ix Contents A 1 Ambulation, Assisting a Patient With.................... 1 2 Ambulation Using a Cane, Assisting a Patient With......... 5 3 Ambulation Using Crutches, Assisting a Patient With...... 10 4 Ambulation Using a Walker, Assisting a Patient With....... 15 5 Arterial Catheters, Peripheral, Removing................ 19 B 6 Back Massage, Giving............................... 24 7 Bandage, Applying a Figure-Eight..................... 28 8 Bath: Bed, Providing................................ 32 9 Bath: Shower or Tub, Assisting With.................... 43 10 Bath: Sitz, Assisting With............................ 48 11 Bed Making, Occupied.............................. 51 12 Bed Making, Unoccupied............................ 56 13 Bed Scale, Using................................... 63 14 Bedpan, Assisting With the Use of..................... 68 15 Bladder Irrigation, Continuous Closed Bladder Irrigation (CBI), Administering........................ 75 16 Bladder Volume: Assessing Using an Ultrasound Bladder Scanner.................................... 80 17 Blood Glucose Testing, Obtaining a Capillary Sample...... 84 18 Blood Pressure, Assessing Brachial Artery Auscultated..... 89 19 Blood Pressure, Assessing Using a Doppler Ultrasound..... 95 20 Blood Pressure, Assessing Using an Electronic Automated Monitor................................ 100 21 Blood Sample, Obtaining from Arterial Catheter......... 104 22 Blood Sample, Using Venipuncture for Routine Testing.... 111 23 Blood Specimen: Culture and Sensitivity............... 119 24 Blood Specimen, Obtaining for Arterial Blood Gas Analysis................................ 127 25 Blood Transfusing, Administering..................... 135 C 26 Cardiac Monitor, Applying.......................... 141 27 Cardiopulmonary Resuscitation (CPR), Performing....... 148 28 Cast Application, Assisting With...................... 153 29 Cast Care........................................ 158 30 Catheter Irrigation, Closed Intermittent, Performing...... 162 31 Central Venous Access Device (CVAD): Accessing an Implanted Port.................................. 166 32 Central Venous Access Device (CVAD): Changing Site Dressing and Flushing.............................. 172 x  Contents xi 33 Central Venous Access Device (CVAD): Deaccessing an Implanted Port.................................... 179 34 Central Venous Access Device (CVAD): Removing a Peripherally Inserted Central Catheter (PICC)........... 183 35 Cervical Collar, Applying a Two-Piece................. 186 36 Chest Drainage System, Providing Care for a............ 190 37 Chest Tube, Assisting With Removal of a............... 197 38 Cold Therapy, Applying............................. 201 39 Colostomy, Irrigating............................... 205 40 Comfort, Promoting Patient.......................... 210 41 Commode, Bedside: Assisting With Use................ 219 42 Compress, Applying a Warm......................... 223 43 Condom Catheter, Applying......................... 227 44 Contact Lenses, Removing.......................... 232 45 Continuous Passive Motion Device (CPM), Applying..... 237 D 46 Deep Breathing Exercises, Coughing and Splinting, Teaching................................ 241 47 Defibrillation, Performing Automated External (Emergency).............................. 245 48 Defibrillation, Performing Manual External (Emergency, Asynchronous)......................... 251 49 Denture Care, Providing............................ 257 50 Drain: Hemovac, Caring for......................... 260 51 Drain: Jackson-Pratt, Caring for...................... 265 52 Drain: Penrose, Caring for........................... 271 53 Drain: T-tube, Caring for............................ 276 54 Dressing: Changing a Peripheral Venous Access......... 283 55 Dressing: Cleaning a Wound and Applying a Dry, Sterile... 287 56 Dressing: Hydrocolloid, Applying..................... 293 57 Dressing: Saline-Moistened, Applying................. 299 E 58 Ear Drops, Instilling............................... 305 59 Ear Irrigation, Administering......................... 311 60 Eating, Assisting a Patient With....................... 316 61 Electrocardiogram (ECG), Obtaining.................. 320 62 Endotracheal Tube, Securing......................... 327 63 Endotracheal Tube: Closed System, Suctioning.......... 334 64 Endotracheal Tube: Open System, Suctioning........... 341 65 Enema: Large-Volume Cleansing, Administering......... 348 66 Enema: Retention, Administering..................... 355 67 Enema: Small-Volume Cleansing, Administering......... 360 68 Epidural Analgesia, Caring for a Patient Receiving....... 365 69 External Fixation, Caring for a Patient With............. 371 70 Eye Drops, Instilling............................... 376 71 Eye Irrigation, Administering........................ 383 xii Contents F 72 Fall Prevention.................................... 386 73 Fecal Incontinence Pouch, Applying................... 392 74 Fiber Optic Intracranial Catheter, Caring for a Patient With...................................... 396 G 75 Gastric Tube Feeding, Administering a................. 399 76 Gastrostomy Tube, Caring for a....................... 409 77 Gloves: Putting on Sterile and Removing Soiled......... 413 78 Graduated Compression Stockings, Applying and Removing.................................... 417 H 79 Hand Hygiene: Performing Using an Alcohol-Based Hand Rub........................... 422 80 Hand Hygiene: Performing Using Soap and Water (Handwashing).............................. 424 81 Heating Pad, Applying an External.................... 426 82 Hemodialysis Access (Arteriovenous Fistula or Graft), Caring for........................................ 431 83 Hypothermia Blanket, Using......................... 434 I 84 Incentive Spirometer, Teaching a Patient to Use.......... 439 85 Inhaler: Dry Powder, Administering Medication via....... 443 86 Inhaler: Metered-Dose, Administering Medication via..... 449 87 Injection: Intradermal, Administering.................. 456 88 Injection: Intramuscular, Administering................ 463 89 Injection: Subcutaneous, Administering................ 471 90 Insulin Pump, Administering Continuous Subcutaneous Infusion via...................................... 479 91 IV Infusion: Changing an IV Solution Container and Administration Set................................. 486 92 IV Infusion: Monitoring an IV Site and Infusion......... 492 L 93 Leg Exercises, Teaching............................ 497 94 Logrolling a Patient................................ 501 M 95 Medication: Administering Oral...................... 505 96 Medication: Administering via a Gastric Tube........... 511 97 Medication: Administering via Small-Volume Nebulizer..... 518 98 Medication: IV Infusion, Administering a Piggyback Intravenous of Medication........................... 524  Contents xiii 99 Medication: IV Infusion, Administering an Intermittent Intravenous Infusion of Medication via a Mini-Infusion Pump.............................. 531 100 Medication: IV Infusion, Administering an Intermittent Intravenous Infusion of Medication via a Volume-Control Administration Set................................. 538 101 Medication: IV Infusion, Administering Medications by Intravenous Bolus or Push Through an Intravenous Infusion............................... 545 102 Medication: Mixing Medications From Two Vials in One Syringe...................................... 552 103 Medication: Removing From an Ampule............... 558 104 Medication: Removing From a Vial................... 563 105 Medication: Transdermal Patch, Applying.............. 569 106 Montgomery Straps, Applying....................... 575 107 Moving a Patient Up in Bed With Assistance............ 580 N 108 Nail Care, Providing............................... 584 109 Nasal Spray, Administering.......................... 588 110 Nasal Swab, Obtaining............................. 594 111 Nasogastric Tube, Inserting a........................ 599 112 Nasogastric Tube, Irrigating......................... 606 113 Nasogastric Tube, Removing......................... 611 114 Nasopharyngeal Airway, Inserting..................... 614 115 Nasopharyngeal Swab, Obtaining..................... 618 116 Negative Pressure Wound Therapy, Applying............ 623 O 117 Oral Care, Assisting the Patient....................... 629 118 Oral Care, Providing for the Dependent Patient.......... 633 119 Oropharyngeal Airway, Inserting...................... 637 120 Ostomy Appliance, Changing and Emptying............ 641 121 Oxygen, Administering by Mask...................... 649 122 Oxygen, Administering by Nasal Cannula.............. 652 123 Oxygen Administration, Using an Oxygen Hood......... 655 124 Oxygen Tent, Using................................ 659 P 125 Pacemaker: Applying and Monitoring an External (Transcutaneous)........................... 662 126 Pain Management, Continuous Wound Perfusion......... 669 127 Patient-Controlled Analgesia (PCA), Caring for a Patient Receiving.................................. 674 128 Peripheral Venous Access Device: Capping for Intermittent Use and Flushing........................ 680 129 Peripheral Venous Access Device: Initiating............. 684 xiv Contents 130 Peritoneal Dialysis Catheter: Caring for a............... 694 131 Personal Protective Equipment (PPE), Using............ 699 132 Pneumatic Compression Devices, Applying............. 703 133 Postoperative Patient Care, Providing when Patient Returns to Room............................ 707 134 Pulse, Apical: Assessing by Auscultation............... 715 135 Pulse, Peripheral: Assessing by Palpation............... 719 136 Pulse, Peripheral: Assessing Using a Portable Doppler Ultrasound................................ 722 137 Pulse Oximeter, Using.............................. 726 R 138 Range-of-Motion Exercises, Providing................. 731 139 Rectal Suppository, Administering.................... 736 140 Respiration, Assessing.............................. 742 141 Restraint, Applying an Elbow........................ 744 142 Restraint, Applying an Extremity..................... 749 143 Restraint, Applying a Mummy....................... 753 144 Restraint, Applying a Waist.......................... 758 145 Restraints, Alternatives to the Use of, Implementing...... 763 146 Resuscitation: Using a Handheld Bag and Mask.......... 767 S 147 Seizure Precautions and Management.................. 771 148 Shampooing a Patient’s Hair in Bed................... 776 149 Shaving, Assisting the Patient........................ 781 150 Sling, Applying................................... 785 151 Sputum Specimen for Culture, Collecting............... 788 152 Staples, Removing Surgical.......................... 794 153 Sterile Field: Adding Sterile Items.................... 798 154 Sterile Field: Preparing Using a Commercially Prepared Sterile Kit or Tray.......................... 802 155 Sterile Field: Preparing Using a Packaged Sterile Drape... 806 156 Stoma Appliance on an Ileal Conduit, Emptying and Changing..................................... 809 157 Stool Specimen for Culture, Collecting................. 816 158 Stool, Digital Removal of........................... 820 159 Stool: Testing for Occult Blood....................... 824 160 Suctioning the Nasopharyngeal and Oropharyngeal Airways............................. 830 161 Sutures, Removing................................. 839 T 162 Temperature, Assessing Body........................ 844 163 Temperature, Regulating, Using an Overhead Radiant Warmer................................... 851 164 TENS Unit, Applying and Caring for Patient Using....... 854  Contents xv 165 Tracheostomy Care, Providing....................... 858 166 Tracheostomy Care, Open System, Suctioning........... 870 167 Traction: Halo, Caring for a Patient in................. 878 168 Traction: Skeletal, Caring for a Patient in............... 883 169 Traction: Skin, Applying Skin Traction and Caring for a Patient in.................................... 888 170 Transferring a Patient From the Bed to a Chair........... 894 171 Transferring a Patient From the Bed to a Stretcher........ 900 172 Transferring a Patient Using a Powered Full-Body Sling Lift............................... 905 173 Turning a Patient in Bed, Assisting.................... 911 U 174 Urinal, Assisting With the Use of..................... 916 175 Urinary Catheter: Female, Catheterizing the Urinary Bladder................................... 920 176 Urinary Catheter: Indwelling Catheter, Removing an...... 930 177 Urinary Catheter: Male, Catheterizing the Urinary Bladder................................... 933 178 Urinary Catheter: Suprapubic, Caring for............... 943 179 Urine Specimen, Collecting (Clean Catch, Midstream) for Urinalysis and Culture.............................. 947 180 Urine Specimen: Indwelling Urinary Catheter, Obtaining From................................... 955 V 181 Vaginal Cream, Administering....................... 959 182 Ventriculostomy, External (Closed Fluid-Filled System), Caring for a Patient With............................ 967 W 183 Warming Device, Applying a Forced-Air............... 972 184 Wound Culture, Collecting.......................... 975 185 Wound Irrigation, Performing........................ 981 Appendix A............................................ 987 Bibliography........................................... 990