Thank You
A special thank you to all of the nurse educators and practicing nurses who have spent their time reviewing and contributing to this new edition.
CONTRIBUTORS TO CURRENT AND PREVIOUS EDITIONS
Theresa Britt, rn, msn Director of Nursing, Lab and Clinical Assessment University of Tennessee Health Science Center Memphis, TN
Brian Busk, msn, rn Faculty and Assistant Director of Nursing, College of the Siskiyous Yreka, CA
Shirley S. Chang, rn, ms, phd Professor, Evergreen Valley College San Jose, CA
Janet W. Cook, rn, ms formerly Assistant Professor, University of North Carolina Greensboro, NC
REVIEWERS
Patricia Ahearn, bs, msn
Saint Peter’s University Jersey City, NJ
Traci Ashcraft, bsn, rn, bc Ruby Memorial Hospital Morgantown, WV
Lawrette Axley, phd, rn, cne University of Memphis Memphis, TN
Katherine Balkema, mm, bsn, ba, rrt, rn, cmsrn Holland Hospital Holland, MI
Mitzi Bass, msn, rn Baltimore City Community College Baltimore, MD
Michelle Beckford, bsn, msn, dmh Saint Peter’s University Jersey City, NJ
Billie E Blake, EdD, msn, bsn, rn
St. John’s River Community College Orange Park, FL
Deborah Denham, rn, ms, phd Critical Care Sequoia Hospital Redwood City, CA
Jacqueline Dowling, rn, ms Professor, University of Massachusetts Lowell, MA
Lou Ann Emerson, rn, msn Assistant Professor, University of Cincinnati Cincinnati, OH
Rachel Faiano, rn, ms
Clinical Simulation Coordinator, Salinas Valley Memorial Healthcare System Salinas, CA
Janis Laiacona, msn, rn, pmhcns-bc Director of Accreditation and Clinical Support, John Muir Behavioral Health Center, Concord, CA Nursing Programs Assistant Director, College of the Siskiyous Weed, CA
Patricia J. Rahnema, rn, msn, fnp Nurse Practitioner, Southwest Cardiovascular Associates Bullhead City, AZ
Sally Talley, rn ET Specialist in Enterostomal Therapy San Jose, CA
Jean O. Trotter, rn, c, ms Assistant Professor, University of Maryland Baltimore, MD
Cynthia M. Bork, edd, rn Winona State University Winona, MN
Staci M. Boruff, phd, rn Walters State Community College Morristown, TN
Katherine Brashears University of Central Oklahoma Edmond, OK
Cody Bruce, msn, rn
Texas A&M Bryan, TX
Michelle Bussard, msn, rn, ancs-bc, cne
Firelands Regional Medical Center Sandusky, OH
Barbara Callahan, med, rn, ncc, chse
Lenoir Community College Kinston, NC
Barbara Celia, edd, rn, msn Drexel University Philadelphia, PA
Victor Ching, md, mba, facs Loma Linda School of Medicine Loma Linda, CA
Ann-Marie Cote, msn, rn, cen Plymouth State University Plymouth, NH
Melissa Culp, msn-ed, bsn, rn University of South Florida Tampa, FL
Mary Davis, rn, msn, mpa, crni
Hartnell College Salinas, CA
Michelle DeLima Delgado Community College New Orleans, LA
Erin Heleen Discenza, msn, rn Cuyahoga Community College— Metropolitan Cleveland, OH
Denise R. Doliveira, rn, msn Community College of Allegheny County—Boyce Monroeville, PA
Bernadette Dragich, phd, rn Bluefield State College Bluefield, WV
Mary Farrell, msn-ed, rn Huron School of Nursing East Cleveland, OH
Cindy Fong, rn, msn Loma Linda Hospital Loma Linda, CA
Mary A. Gers, msn, cns, rnc Northern Kentucky University Highland Heights, KY
Theresa A. Glanville, rn, ms, cne
Springfield Technical Community College Springfield, MA
Jeanine Goodin, msn, bsn University of Cincinnati Cincinnati, OH
Susan Growe, dnp, rn, coi Nevada State College Henderson, NV
Jennifer Hatley, rn, msn Vernon College Vernon, TX
Katherine Houle, rn, bsn, cns Gillette Children’s Specialty Healthcare St. Paul, MN
Kathleen Hudson, rn, msn Illinois Eastern Community College Olney, IL
Paula Hutchings, msn, rn Hill College Lamar Hillsboro, TX
Denise Isibel, rn, msn Old Dominion University Norfolk, VA
Kathleen C. Jones, msn, rn, cns Walters State Community College Morristown, TN
Fran Kamp, rn, msn Mercer University Atlanta, GA
Patricia Ketcham, msn, rn Oakland University Rochester, MI
PHOTO CONSULTANTS
June Brown, rn, bsn
Arnold Failano, rn, bsn
Wendy Ogden, rn, ms
Vicky Keys, msn, dnp Texas A&M University Bryan, TX
Susan M. Koos, ms, rn, cne Heartland Community College Normal, IL
Cheryl M. Lantz, phd, rn Dickinson State University Dickinson, ND
Lori Lioce, bsn, dnp University of Alabama Huntsville, AL
Carol List, rn, bsn
Hutchinson Community College Hutchinson, KS
Rosemary Macy, phd, rn, cne, chse Boise State University Boise, ID
Kathleen McManus, rn, msn, cne Central Maine Community College Auburn, ME
Joshua Meringa, mpa, mha, bsn, rn, onc
Spectrum Health Hospitals Grand Rapids, MI
Juleann H. Miller, rn, phd St. Ambrose College Davenport, IA
Patricia Novak, rn, bsn, msn Gateway Community College New Haven, CT
Linda Olsen, bsn, msn Mid-State Technical College Wisconsin Rapids, WI
Rebecca Otten, edd, ms, ba Mount Saint Mary’s University Los Angeles, CA
Amanda Pierce, dnp, rn Texas Tech University El Paso, TX
Janice Ramirez, msn, bs, adn, ccrn, rn-bc, cne North Idaho College Coeur d’Alene, ID
Nancy Renzoni, rn, ms Trocaire College Buffalo, NY
Mark Reynolds, msn, rn University of Alabama Huntsville, AL
Kathy Rogers, msn, rn, cne Ursuline College Pepper Pike, OH
Shielda Glover Rodgers, phd, rn
The University of North Carolina Chapel Hill, NC
Deanna Schaffer, msn, rn, cne, acns-bc
Drexel University Philadelphia, PA
Vicki Simpson rn, msn, ches, phd Purdue University West Lafayette, IN
Kristen Smith, msn, rnc-nc Northern Michigan University Marquette, MI
Charlotte Stephenson, rn, dsn, clnc
Texas Woman’s University Houston, TX
Patricia Taylor, rn, msn ed Kapiolani Community College Honolulu, HI
Jennifer M. Thayer, ms, arnp, pnp-bc University of South Florida Tampa, FL
Elaine Tobias, rn, bsn, ibclc
The Women’s Place at Heart of Lancaster Regional Medical Center Lititz, PA
Cheryl Tveit, rn Gillette Children’s Specialty Healthcare St. Paul, MN
Donna Woshinsky, rn, msn, cne Springfield Technical Community College Springfield, MA
Cathy Patton, rn, bsn, ma
Diana Soria, rn, bsn
Constance Troolines, rn, bsn
Virginia Williams, rn, ms
. . . for Accurate and Safe Skill Performance!
LEGAL ALERT
Nurses’ Negligence
The client had transthoracic vagotomy. The doctor ordered vital signs q 15 minutes × 1 hour and q hour for 10 hours. Vital signs were recorded four times for 1 day. The next day the client’s temperature was 102°F (38.9°C) and it remained there until the day after, when it was 105°F (40.6°C). The nurse administered aspirin when it rose to 106°F (41°C). The nurse then contacted the doctor who found signs of serious wound infection. The client suffered organic brain syndrome as a direct result of the continued high temperature. The court found that the nurses breached standard of care when they failed to notify the doctor of the client’s high temperature.
Legal Alert boxes highlight legal pitfalls and make nurses aware of legal malpractice.
New Trends boxes present new equipment and systems that are being incorporated in 21st-century nursing care.
10/18/15 4:29 PM
A new electronic stethoscope is now available. It measures a client’s blood pressure via Bluetooth-enabled Cardioscan and sends the results directly into the client’s computer record for immediate evaluation.
Nursing Diagnoses
The following nursing diagnoses may be appropriate to include in a client care plan when the components are related to establishing and maintaining a nurse–client relationship.
NURSING DIAGNOSISRELATED TO . . .
Impaired Communication: Verbal Psychologic barrier, inability to speak dominant language, impaired cognition, lack of privacy
Powerlessness Perceived lack of control resulting in dissatisfaction
Impaired Social InteractionLack of motivation, anxiety, depression, lack of self-esteem, disorganized thinking, delusions, hallucinations
Social Isolation Hospitalization, terminal illness
Source: Herdman, T. H. & Kamitsuru, S. (Eds.) Nursing Diagnoses – Definitions and Classification 2015-2017. Copyright © 2014, 1994–2014 by NANDA International. Used by arrangement with John Wiley & Sons Limited. Companion website: www.wiley.com/go/nursingdiagnoses. In order to make safe and effective judgments using NANDA-I nursing diagnosis it is essential that nurses refer to the definitions and defining characteristics of the diagnoses listed in this work.
Nursing Diagnoses for each chapter give quick and clear guidelines for appropriate use of nursing diagnoses in client care plans.
Nursing Process Data Unit 10.2
ASSESSMENT Database
• Assess appropriate site to obtain pulse.
• Check pulse with health status changes, as ordered by healthcare provider, or before administering certain medications.
• Assess for rate, rhythm, volume, and quality.
• Assess an apical pulse on clients with irregular rhythms or those on cardiac medications.
• Obtain baseline peripheral pulses with initial assessment or in any client undergoing cardiac or vascular surgery. Also obtain pulse for medical clients with diabetes, arterial occlusive diseases, atherosclerosis, or aneurysm, or any color or temperature changes in the periphery.
• Obtain an apical–radial pulse when deficits occur between apical and radial measurements.
• Assess the need to monitor pulses with an ultrasound or electronic device.
PLANNING Objectives
• To determine whether the pulse rate is within normal range and if the rhythm is regular
• To evaluate the quality (amount of blood pumped through peripheral arteries) of arterial pulses
• To determine whether peripheral pulses are equal in amplitude when compared with corresponding pulses
• To determine presence of peripheral pulses with ultrasound device when palpation is ineffective
• To monitor and evaluate changes in the client’s health status
• To determine apical pulse rate before heart medications are administered
IMPLEMENTATION Procedures
• Skill 10.2.1 Palpating a Radial Pulse 273
• Skill 10.2.2 Taking an Apical Pulse 274
• Skill 10.2.3 Taking an Apical–Radial Pulse 275
• Skill 10.2.4 Palpating a Peripheral Pulse 276
• Skill 10.2.5 Monitoring Peripheral Pulses With a Doppler Ultrasound Stethoscope 277
Note: See also Skill 30.3.2, Using Pulse Oximetry, page 1187
DOCUMENTATION AND EVALUATION
Expected Outcomes
• Pulse is palpated without difficulty.
• Pulse rate is within normal range and rhythm is regular.
• All peripheral pulses are equal in amplitude when compared bilaterally and when compared with the next proximal site.
• Apical pulse is easily detected and counted.
Unexpected Outcomes/Alternative Actions
Pearson Nursing Student Resources
Find additional review materials at nursing.pearsonhighered.com. Prepare for success with NCLEX®-style practice questions and Skill Checklists.
Within each chapter, Units open with a complete overview of the Nursing Process Data that applies to the Procedures.
Online Nursing Student Resources for each unit contain competency checklists for each procedure. (Visit nursing.pearsonhighered.com.)
272
Step-by-Step Skills. More than 1,100 full-color photographs, line drawings, charts, and tables depict step-by-step nursing procedures. Clear, concise skills with helpful rationales enable nurses of all levels to visualize, perform, and evaluate skills in any clinical setting.
11. Check to see that client is comfortable.
12. Perform hand hygiene and clean stethoscope.
13. Document apical pulse rate, rhythm, and intensity.
CLINICAL ALERT
The best practice for taking a pulse for infants or children is to listen to the heart itself, rather than palpating the pulse. Too much pressure may obliterate it, and inadequate pressure may not detect it.
EVIDENCE-BASED PRACTICE
Effect of Music on Vital Signs
One hundred and fifteen clients who were scheduled to undergo ophthalmic procedures and who were exposed to live classical piano music showed a statistically significant decrease (P < 0.0001) in blood pressure, heart rate, and respiratory rate.
Source: Camara, Ruskowskis, & Worak, (2008)
Skill 10.2.3 | Taking an Apical–Radial Pulse
Equipment Watch with sweeping second hand Stethoscope
Another nurse to assist with procedure (optional)
Procedure
1. Gather equipment.
2. Perform hand hygiene.
3. Clean stethoscope bell and diaphragm with alcohol swab or equivalent.
4. Check two forms of client ID. Introduce self.
5. Provide privacy.
6. Explain procedure to client, especially if two nurses are taking the pulse. ➤ Rationale: Clients may be apprehensive
when two nurses are at the bedside, so a full explanation helps allay fears.
7. Assist client to a supine position and expose chest area.
8. Place watch where clearly visible to both nurses.
➤ Rationale: Both nurses count pulse rates within the same time span, preferably using one watch.
9. Warm stethoscope in palm of your hand. ➤ Rationale: This prevents startling the client with cold stethoscope.
10. Locate radial pulse. The second nurse locates apical pulse at the fifth intercostal space left of sternum at the midclavicular line and firmly places diaphragm of stethoscope on the site. ❶ ➤ Rationale: Firm application helps transmit high-pitched heart sounds.
insert covered and lubricated probe ¼–1½ in. (0.5–3.75 cm), depending on the client’s age, through anal sphincter. ➤ Rationale: Taking in a deep breath relaxes the sphincter, and the lubrication prevents tissue trauma.
e. Position probe to side of rectum to ensure contact with tissue wall. ➤ Rationale: This ensures probe is in contact with large vessels of rectal wall.
f. Remove probe when audible signal occurs. Client’s temperature is now registered on the screen.
under front of sublingual vessels in the temperature. should close at probe. temperature.
❸ Slide probe under front of tongue to sublingual pocket.
SAFETY ALERT
The temperature of an unconscious client is never taken by mouth. The rectal, tympanic, or scanner method is preferred.
Rectal Temperature
a. Perform hand hygiene.
b. Identify client with two forms of ID.
c. Don clean gloves. ➤ Rationale: This prevents exposure to feces.
❶ Electronic thermometer unit with digital probe. ❷ Cover probe of thermometer before taking temperature.
d. Position client on side facing away from you, separate buttocks, instruct client to take in a deep breath, and insert covered and lubricated probe ¼–1½ in. (0.5–3.75 cm), depending on the client’s age, through anal sphincter. ➤ Rationale: Taking in a deep breath relaxes the sphincter, and the lubrication prevents tissue trauma. Position probe to side of rectum to ensure contact with This ensures probe is in contact
EVIDENCE-BASED PRACTICE
g. Discard probe cover into trash.
h. Wipe anal area with tissues to remove lubricant and stool.
i. Discard tissue and gloves. ➤ Rationale: Proper disposal prevents transmission of microorganisms.
6. Assist client to comfortable position.
7. Perform hand hygiene.
8. Record temperature.
Clinical Alerts and Safety Alerts call attention to safety issues, essential information, nursing judgment, and actions that require critical decision making.
CLINICAL ALERT
Only use client’s own dedicated electronic thermometer (including rectal and oral) if diagnosis includes Clostridium difficile-associated diarrhea because of the potential for spreading the bacteria and increasing the risk of transmitting an HAI to other clients.
Accuracy of Temporal Artery Thermometers
Remove probe when audible signal occurs. Client’s temperature is now registered on the screen.
A recent study by Emergency Nurses Association (ENA) on temporal artery thermometer accuracy found that among the pediatric participants (N = 52), temporal artery temperatures were within the acceptable range set by the experts to use as a noninvasive substitute for core body temperatures (Reynolds et al., 2014).
Wipe anal area with tissues to remove lubricant and stool. Rationale: Proper disposal prevents transmission of microorganisms.
❷ After releasing scan button, note the reading in the window.
6. Assist client to comfortable position.
7. Perform hand hygiene.
8. Record temperature.
Skill 10.1.6 | Using a Heat-Sensitive Wearable Thermometer
CLINICAL ALERT
Equipment
Wearable thermometer, chemical strip tape, or liquid crystal thermometer
Procedure
1. Check orders for continuous-reading thermometer and identify client with two forms of ID. Introduce self.
LEGAL ALERT
Expanded! Evidence-Based
Practice boxes present specific scientific studies that validate skill protocols.
10.4 Documentation and Evaluation
DOCUMENTATION for Blood Pressure
• Two phases of Korotkoff sounds (e.g., 120/80) and site
• Three phases of Korotkoff sounds (e.g., 130/110/80) and site
• Response to alternative nursing actions
• Response to position changes
• Document vital signs in chart, in addition to attaching digital readouts
Nurses’ Negligence
The client had transthoracic vagotomy. The doctor ordered vital signs q 15 minutes × 1 hour and q hour for 10 hours.
Each unit ends with Documentation and Evaluation.
2. Dry forehead or axilla area, if necessary.
Only use client’s own dedicated electronic thermometer (including rectal and oral) if diagnosis includes Clostridium difficile-associated diarrhea because of the potential for spreading the bacteria and increasing the risk of transmitting an HAI to other clients.
3. Place strip on forehead ❶ or deep in client’s axilla ❷—may stay in place for 2 days.
4. Read correct temperature by checking color changes or dots that turn from green to black.
5. Record temperature on appropriate form or record.
• The Documentation section focuses on important data to record regarding the skills, outcomes, and client responses.
• The Evaluation/Critical Thinking section reviews Expected Outcomes and provides Alternative Actions to take when Unexpected Outcomes occur.
EVALUATION/Critical Thinking
Expected Outcomes
Vital signs were recorded four times for 1 day. The next day the client’s temperature was 102°F (38.9°C) and it remained there until the day after, when it was 105°F (40.6°C). The nurse administered aspirin when it rose to 106°F (41°C). The nurse then contacted the doctor who found signs of serious wound infection. The client suffered organic brain syndrome as a direct result of the continued high temperature. The court found that the nurses breached standard of care when they failed to notify the doctor of the client’s high temperature. ❶
axilla.
• Blood pressure readings provide information regarding the overall health status of the client.
• Major changes from prior assessments are documented.
• Accurate readings are taken by using the correct cuff size and procedure.
• Beginning and disappearance of Korotkoff sounds during a blood pressure reading are evaluated and documented.
• The presence of factors that can alter blood pressure readings is identified.
Unexpected Outcomes Alternative Actions
• Blood pressure reading is abnormally high without apparent physiologic cause.
• Check if arm was unsupported.
• Check if cuff was not snug.
• Check if cuff was deflated too slowly or reinflated during deflation, causing venous engorgement and abnormally high diastolic readings.
• Ask if client has pain, was anxious (white coat syndrome), or had just exercised, eaten, or smoked. Recheck pressure as indicated.
• Check blood pressure on both arms. The normal difference from arm to arm is usually no more than 5 mmHg.
• Check if insufficient rest before assessment.
• Assess if cuff is too wide.
• Blood pressure reading is very low and there are no significant clinical indicators.
• Blood pressure cannot be measured on upper extremity due to casts or other causes of inaccessibility.
• Check if client’s arm was above heart level.
• Check if inflation was too slow. This reduces intensity of Korotkoff sounds.
• Assess if Korotkoff sounds were barely audible. Raise client’s arm, and then recheck. Sounds should be louder.
• Identify if stethoscope was misplaced and was not on brachial artery.
• Take blood pressure 3 minutes after client rises from supine to standing if postural hypotension is suspected.
• Use lower extremity to obtain blood pressures.
(continued)
Liquid crystal thermometer is placed against lower forehead for 15 seconds.
Place a continuous-reading, wearable thermometer deep in the client’s
Skill 10.1.5 | Using a Temporal Thermometer (Infrared) (continued)
Chapter Wrap-Up Helps Tie Everything Together!
Chapter Wrap-Up
GERONTOLOGIC Considerations
Cardiac Status—Changes
• Changes in cardiovascular status with aging are often insidious and may become apparent when system is stressed and there is increased demand for cardiac output (which may occur with illness and hospitalization). Nursing care assessment should focus on client’s cardiovascular status, even when diagnosis does not include a cardiac condition.
• Blood pressure measurement should take age into account. If client has severe joint stiffness, pseudohypertension may be present. If this is suspected, raise the cuff pressure above the systolic blood pressure and, if the radial pulse remains palpable, the reading may show 10–15 mm Hg in error.
• Postural hypotension is common in the older adult (positional drop of less than 20 mm Hg); nurses should take note when helping a client out of bed. Hypertension is also common in this age group.
• A rise in blood pressure may be associated with reduced cardiac output, vasoconstriction, increased blood volume, or fluid overload.
• Pulse changes, particularly an irregular pulse, can be related to hypoxia, airway obstruction, or electrolyte imbalance.
• The arteries in older adult clients may feel stiff and knotty due to decreased elasticity. Excessive pressure to site when taking pulse may obliterate it. The normal rate is 60–90 beats/min.
• If pulses are not palpated, a Doppler may need to be used.
MANAGEMENT Guidelines
Each state legislates a Nurse Practice Act for RNs and LPN/ LVNs. Healthcare facilities are responsible for establishing and implementing policies and procedures that conform to their state’s regulations. Verify the regulations and role parameters for each healthcare worker in your facility.
Delegation
• Taking vital signs for clients may be assigned to any healthcare worker provided they have been assessed for competency in the procedure. This includes LPN/LVN, unlicensed assistive personnel (UAP), and EMT.
• The registered nurse must identify parameters for which the healthcare worker is to notify the nurse (i.e., blood pressure above or below a certain reading, pulse rate, or irregular pulse).
Respiratory Status—Changes
• Changes in the respiratory system may be subtle and gradual with the older adult: Oxygen saturation is decreased to 93%–94%; there is often poor cough response and incomplete lung expansion—all of which leads to increased risk of pulmonary infection when the older adult client is hospitalized.
• Slightly irregular breathing patterns are not unusual in the older adult.
Temperature—Changes
• With the older adult, temperature may be as low as 95°F (35°C). Because they may be easily dehydrated with increased temperature, nursing assessment should include baseline temperature at admission and continued monitoring during hospitalization.
• Older adults with acute infections may have a subnormal temperature.
• Increased temperatures can lead to increased metabolism, thus increasing the body’s demand for oxygen. This causes the heart to work harder.
• Oral temperatures are the preferred method for obtaining the older adult client’s temperature.
Gerontologic Considerations help nurses consider special adaptations for care of older adults.
Management Guidelines include two sections. A Delegation section teaches nurses to delegate tasks within safe, legal, and appropriate parameters. An Interprofessional Communication section helps nurses prioritize and communicate relevant client information to members of the healthcare team, in order to ensure consistent quality of care.
• The nurse must provide detailed explanations and/ or demonstrate alterations in the procedure or specific methods of obtaining the vital signs to UAP, or EMTs.
• Obtaining peripheral pulses by use of the Doppler is the responsibility of the RN or LPN/LVN. A UAP is not responsible for using the Doppler.
294 Chapter 10 Vital Signs
vital sign sheet at the nurses’ desk, or give the results to the nurse?
• The UAP may monitor blood pressure using the noninvasive monitoring device; however, the UAP is not responsible for initiating the procedure or setting the alarms.
• The registered nurse must evaluate all abnormal or changed vital signs identified by the healthcare workers. The nurse maintains total responsibility for client care
Interprofessional Communication
• Directions must be given to healthcare workers on documentation procedures. Do they complete the graphic record, enter data into the EHR, write the findings on a
CASE STUDY Applications
Scenario 1
Mr. Trager (age 92) has been admitted to your unit with a temperature of 103°F (39.4°C), BP 140/90, P 114, and R 30 and labored. He reports a history of 3 days of diarrhea and fever and asks you for something to drink.
Case Study Applications
provide case scenarios that help nurses develop clinical reasoning skills.
1. From your analysis of the admission data, determine the following: a. Appropriate nursing diagnosis in order of priority for this client.
b. The metabolic effects of fever on pulse and respiration.
c. Age factors that contribute to the existing problem.
2. What are the other assessment findings indicative of the diagnosis established from primary admitting data?
3. Develop a plan of care for this client.
4. Describe the evaluative outcomes for problem resolution.
Scenario 2
Mr. Sondheim is admitted to the hospital with unstable hypertension for evaluation. He has a family history of
NCLEX® Review Questions
Unless otherwise specified, choose only one (1) answer.
1. During a shift assessment, the nurse notes that the client’s peripheral pulses are absent. What would the next intervention be?
A. Palpate the peripheral pulse.
B. Use a Doppler to assess peripheral pulse.
C. Notify the healthcare provider.
D. Administer O2 as ordered.
2. When a pulse deficit is detected in a client, what would the nurse expect the client is experiencing?
A. Premature ventricular beats
B. Bradycardia
C. Tachycardia
D. Heart block
3. A client’s temperature remains elevated despite the administration of antipyretic drugs. What would be the first intervention after determining this condition?
A. Administer a cool bath.
B. Assess all remaining signs.
even though someone else performs the task of taking the vital signs.
• The registered nurse must ensure that the healthcare workers know the parameters for reporting unusual vital signs. Periodic checks with the workers may be necessary.
hypertension and heart disease. The nurse will complete a physical exam and a history.
1. What information is missing in the family history that the nurse will want to elicit from the client?
2. Which questions regarding lifestyle would be appropriate to ask?
3. Which aspects of client teaching would the nurse want to cover before Mr. Sondheim is discharged?
Scenario 3
You are caring for a client, and when checking his vital signs, you are unable to palpate his radial pulse.
1. What would be your follow-up intervention?
2. When you still cannot find a pulse clear enough to document, what would be your next intervention?
3. What parameters of the pulse will you pay attention to when assessing and recording a client’s pulse?
C. Request orders for a cooling blanket.
D. Obtain an order for a blood culture.
4. When taking a client’s blood pressure that has been within normal limits, the nurse gets a reading that is very low without any significant clinical indicators. Which intervention would be appropriate?
A. Assess if the BP cuff is too narrow.
B. Assess if the BP cuff is too wide.
C. Assess if the client’s arm was positioned below heart level.
D. Notify the healthcare provider.
5. When taking a client’s blood pressure, the nurse finds the reading very different from previous readings recorded on the chart. What is the first intervention?
A. Recheck the blood pressure with different equipment.
B. Notify the healthcare provider.
C. Validate the reading with another nurse.
D. Check the client’s circulatory status.
82 Chapter 4 Communication and Nurse–Client Relationship NCLEX® Review Questions
Unless otherwise specified, choose only one (1) answer.
1. Which intervention is most useful when communicating with an aphasic client?
A. Use correct medical terminology when teaching or explaining.
B. Ask open-ended questions to obtain information.
C. Repeat the same word until the client understands.
D. Provide frequent praise and encouragement.
2. A psychiatric client rapidly improves and is scheduled to be discharged tomorrow. Which of the following responses demonstrates that the nurse has a good understanding of termination of a relationship?
A. “You have worked really hard the last three weeks. Good-bye and good luck.”
B. “Stop by and let us know how things are going.”
C. “You’ve done some good work here. I hope you are able to follow through with it.”
D. “Good-bye and good luck. Hopefully, we won’t be seeing you here again.”
3. One characteristic of a nurse–client relationship is that it is a professional one. What does this imply about the nurse?
A. The nurse should be primarily concerned with implementing the policies of the hospital.
B. The nurse views the client’s needs as her or his primary concern.
C. The nurse maintains a distance between self and client.
D. The nurse establishes boundaries, formulate goals, and maintain the boundaries of a professional relationship.
4. One day a client with terminal cancer says to the nurse, “Well, I’ve given up all hope. I know I’m going to die soon.” Which is the most therapeutic response?
A. “Now, one should never give up hope. We are finding new cures all the time.”
B. “We should talk about dying.”
C. “You’ve given up all hope?”
D. “Your doctor will be here soon. Why don’t you talk to him about your feelings?”
5. Which of the following statements would be best to stimulate conversation with a client about his or her social history?
A. “Are you married?”
B. “Do you have any children?”
C. “Tell me about your family.”
D. “Is your role in the family important?”
6. A client is admitted to CCU with a diagnosis of anterior myocardial infarction. Shortly after admission, he states: “I might as well have died because now I won’t be able to do anything.” Which is the most appropriate response by the nurse?
A. “Don’t worry, everything will turn out all right.”
B. “What do you mean, not able to do anything?”
C. “Take one day at a time and it will all work out.”
D. “You shouldn’t be thinking like this, because you are doing well now.”
7. A male client is becoming increasingly angry and verbally abusive. Which of these is the appropriate intervention?
A. Send the client back to his room.
B. Ask the healthcare provider for an order for restraints.
C. Summon assistance from a male staff member.
D. Set firm limits on the abusive behavior.
8. Which of the following components would you include in a cultural assessment?
Select all that apply.
A. Cultural background
B. Nutritional practices
C. Beliefs and perceptions of health
D. Age of the client
E. Belief in God
F. Communication patterns
G. Health practices, including alternative
9. A client you are assigned to care for is hearing impaired.
Which is the most effective way to communicate with this client?
A. Use a writing pad and gestures.
B. Speak clearly and slowly.
C. Use nonverbal communication.
D. Describe loudly and carefully what you are doing.
10. Which nursing intervention would be the highest priority when caring for a client who is depressed?
A. Form a good nurse–client relationship.
B. Encourage the client to talk about his feelings of depression.
C. Suggest that the client do an activity.
D. Assess the client frequently for potential suicide.
QSEN Activity These activities help train students to think about the knowledge, skills, and attitudes that are integral to Quality and Safety Education for Nurses.
Bibliography Opportunities for further research are provided at the end of each chapter.
NCLEX® Review Questions. NCLEX®-style questions have been included at the end of each chapter and reflect the Practice Analysis of newly Licensed Registered Nurses upon which the NCLEX® is based. Answers with complete rationales are in the Answers Appendix.
QSEN Activity
Domain: Communication
KSA: Attitude
Activity:
Have student(s) identify a particular clinical situation where the communication was not very effective, and perhaps the student wished it had gone another way. The scenario can be any dyad:
Bibliography
Agency for Healthcare Research and Quality (AHRQ). (n.d.). TeamStepps: National implementation. Retrieved from http:// teamstepps.ahrq.gov/ Amato-Vealey, E. J., Barba, M. P., & Vealey, R. J. (2008, Nov.). Hand-off communication: A requisite for perioperative patient safety. AORN Journal, 88 (5), 763–770. Baker, D. P., Gustafson, S., Beaubien, J. M., Salas, E., & Barch, P. (n.d.). Medical team training programs in health care. Retrieved from http://www.ahrq.gov/professionals/quality-patient-safety/ patient-safety-resources/resources/advances-in-patient-safety/ vol4/Baker.pdf
Blumenthal, J. A., Smith, P., & Benson, H. (2012, Jul.–Aug.). Opinion and evidence: Is exercise a viable treatment for depression? ACSM’s Health & Fitness 16 (4), 14–21. doi: 10.1249/01.FIT.0000416000.09526.eb Brown, A. (2014). U.S. Hispanic and Asian populations growing, but for different reasons. Pew Research Center. Retrieved from http:// www.pewresearch.org/fact-tank/2014/06/26/u-s-hispanic-andasian-populations-growing-but-for-different-reasons/ Census. (2012). http://www.census.gov/newsroom/releases/ archives/population/cb13-112.html
• Student nurse and client
• Student nurse and family member
• Student nurse and preceptor
• Student nurse and provider
Have the group reflect on how it could have been more effective. Role-play effective communication within the classroom using the techniques identified within the chapter.
Chen, K., Ku, Y., & Yang, H. (2012, Mar.). Violence in the nursing workplace—A descriptive correlational study in a public hospital. Journal of Clinical Nursing, 22(5–6), 798–805. doi:10.1111/ j.1365-2702.2012.04251 Downey, L., Zun, L., & Burke, T. (2012). What constitutes a good hand off in the emergency department: A patient’s perspective. International Journal of Healthcare Quality Assurance, 26 (8), 760–767. Office of Minority Health. (2012). National Standards for Culturally and Linguistically Appropriate Services (CLAS standards). Retrieved from https://www.thinkculturalhealth.hhs.gov/CLAS/ Clas_Overview.asp Schenker, Y., Karter, A. J., Schillinger, D. Warton, E. M., Adler, N. E., Moffet, H. H., & Fernandez, A. (2010, Nov.). The impact of limited English proficiency and physician language concordance on reports of clinical interactions among patients with diabetes: The DISTANCE study. Patient Education and Counseling, 81(2), 222–228. Spector, R. E. (2013). Cultural Diversity in Health and Illness (8th ed.). Hoboken, NJ: Prentice Hall.
4 Communication and Nurse–Client
9 Personal Hygiene
Skill
Clients Earthquake Safety 481
Skill 15.1.3 Preventing Diarrhea-Related Diseases After a Natural Disaster 482
Unit 15.2 Bioterrorism Agents, Antidotes, and Vaccinations
Skill 15.2.1 Identifying Agents of Biological Terrorism
Skill 15.2.2 Identifying Chemical Agent Exposure
484
Skill 15.2.3 Triaging for Chemical Agent Exposure 489
Skill 15.2.4 Managing Care After Chemical Agent Exposure 490
Skill 15.2.5 Identifying Acute Radiation Syndrome 490
Skill 15.2.6 Dealing With a Nuclear Disaster 491
Unit 15.3 Personal Protective Equipment and Decontamination 493 Nursing Process Data 493 Procedures 493
Skill 15.3.1 Implementing Hospital Infection Control Protocol 494
Skill 15.3.2 Decontaminating via Triage 496
Skill 15.3.3 Choosing Protective Equipment for Biological Exposure 497
Skill 15.3.4 Choosing Protective Equipment for Chemical Exposure 498
Skill 15.3.5 Choosing Protective Equipment for Radiological Attack 499
Skill 15.3.6 Decontaminating Victims After a Biological Terrorist Event 499
Skill 15.3.7 Decontaminating Victims After a Chemical Terrorist Event 500
Skill 15.3.8 Decontaminating Victims After Radiation Exposure 501
Skill 15.3.9 Controlling Radiation Contamination 502
Unit 15.4 Triage, Treatment, and a Communication Matrix 504
Skill 16.2.5 Teaching PCA to a Client 533
Skill 16.2.6 Monitoring a Client Receiving An Epidural Infusion 534
Unit 16.3 Nonpharmacologic Pain Relief 538
Nursing Process Data 538 Procedures 538
Skill 16.3.1 Alleviating Pain Through Touch (Massage) 538
Skill 16.3.2 Using Relaxation Techniques 539
GERONTOLOGIC Considerations 540
MANAGEMENT Guidelines 541
CASE STUDY Applications 541
NCLEX® Review Questions 542
QSEN Activity
17 Alternative Therapies and Stress
Unit 17.1 Stress and Adaptation 559
Nursing Process Data 559 Procedures 559
Skill 17.1.1 Determining the Effect of Stress 560
Skill 17.1.2 Determining Response Patterns 560
Skill 17.1.3 Managing Stress 561
Skill 17.1.4 Manipulating the Environment to Reduce Stress 561
Skill 17.1.5 Teaching Coping Strategies 561
Skill 17.1.6 Managing Stress Using a Holistic Model 562
Skill 17.1.7 Teaching Controlled Breathing 563
Skill 17.1.8 Teaching Body Relaxation 563
Skill 17.1.9 Using Meditation as an Alternative Therapy 564
GERONTOLOGIC Considerations 565
MANAGEMENT Guidelines 565
CASE STUDY Applications 566
NCLEX® Review Questions 566
QSEN Activity 567 Bibliography 567
Administering Ophthalmic Ointment 592
Skill 18.3.6 Irrigating the Eye 593
Skill 18.3.7 Administering Otic Medications 593
Skill 18.3.8 Irrigating the Ear Canal 594 Unit 18.4 Mucous
Skill 18.4.7 Administering Rectal Suppositories 602
Skill 18.4.8 Administering Vaginal Suppositories 602
Unit 18.5 Parenteral Medication
Skill 18.5.1 Preparing Injections
Skill 18.5.2 Administering Intradermal Injections
Skill 18.5.3 Administering Subcutaneous Injections 611
Skill 18.5.4 Preparing Insulin Injections 612
Skill 18.5.5 Using an Insulin Pen 615
Skill 18.5.6 Administering Subcutaneous Anticoagulants (Heparin, Low-Molecular-Weight Heparin [LMWH]) 617
Skill 18.5.7 Administering Intramuscular (IM) Injections 619
Skill 18.5.8 Using Z-Track Method
Skill
Skill
Skill 19.1.3 Restricting Mineral Nutrients (Sodium, Potassium)
Skill 19.1.4 Providing Consistent Carbohydrate Diets
Skill
Skill
19 Nutritional Management and Enteral
Skill 19.2.2 Assisting the Visually Impaired Client to
Skill 19.2.3 Assisting the Dysphagic Client to Eat
Skill
(NG) Tube
Skill 19.3.2 Flushing and Maintaining Nasogastric (NG)
Skill 19.3.5 Removing an NG or Nasointestinal (NI) Tube
an Intermittent Feeding via
Skill 19.4.2 Determining Gastric pH
Skill 19.4.3 Dressing the Gastrostomy Tube Site
Skill 19.4.4 Inserting a Small-Bore Feeding Tube
Skill 19.4.5 Providing Continuous Feeding via Small-Bore Nasointestinal or Jejunostomy Tube
Blood Tests
681
Cultures 682
Unit 20.1 Urine Specimens 684
Nursing Process Data 684
Procedures 684
Skill 20.1.1 Collecting Midstream Urine 685
Skill 20.1.2 Collecting 24-Hour Urine Specimen 685
Skill 20.1.3 Collecting a Specimen From an Infant 686
Skill 20.1.4 Teaching Clients to Test for Urine Ketone Bodies 687
Unit 20.2 Stool Specimens 689
Nursing Process Data 689
Procedures 689
Skill 20.2.1 Collecting Adult Stool Specimen 690
Skill 20.2.2 Collecting Stool for Ova and Parasites 690
Skill 20.2.3 Collecting Child or Infant Stool Specimen 691
Skill 20.2.4 Testing for Occult Blood 691
Skill 20.2.5 Collecting Stool for Bacterial Culture 692
Skill 20.2.6 Teaching Parents to Test for Pinworms 692
Unit 20.3 Blood Specimens 694
Nursing Process Data 694
Procedures 694
Skill 20.3.1 Withdrawing Venous Blood (Phlebotomy)— Needle & Syringe Method 695
Skill 20.3.2 Using Vacutainer System 696
Skill 20.3.3 Withdrawing Arterial Blood 698
Skill 20.3.4 Collecting a Blood Specimen for Culture 699
Skill 20.3.5 Calibrating a Blood Glucose Meter (One Touch Ultra) 700
Skill 20.3.6 Obtaining Blood Specimen for Glucose Testing (Capillary Puncture) 700
Unit 20.4 Sputum Collection 703
Nursing Process Data 703
Procedures 703
Skill 20.4.1 Obtaining Sputum Specimen 704
Skill 20.4.2 Using Suction Trap 705
Unit 20.5 Swab Specimens 705
Nursing Process Data 705
Procedures 705
Skill 20.5.1 Obtaining a Throat Specimen 708
Skill 20.5.2 Obtaining a Gum Swab for HIV Antibodies 708
Skill 20.5.3 Obtaining Wound Specimen for Aerobic Culture 709
Skill 20.5.4 Obtaining Wound Specimen for Anaerobic Culture 709
Skill 20.5.5 Collecting an Ear Specimen 710
22 Urinary Elimination
Related to Aldosterone and Antidiuretic Hormone
Alterations
Skill 22.2.1 Applying a Condom Catheter for Urine Collection
Skill 22.2.2 Attaching Urine Collection Condom Catheter to Leg Bag
Skill 22.3.1 Using a Bladder Scanner
Skill 22.3.2 Inserting a Straight Catheter (Female) 775
Skill 22.3.3 Inserting a Straight Catheter (Male) 778
Skill 22.3.4 Inserting an Indwelling Catheter (Female) 779
Skill 22.3.5 Inserting an Indwelling Catheter (Male) 782
Skill 22.3.6 Providing Catheter Care 786
Skill 22.3.7 Removing an Indwelling Catheter 786 Unit 22.4 Bladder Irrigation
Skill 22.4.1 Maintaining Continuous Bladder Irrigation 791 Unit 22.5 Suprapubic Catheter Care 793 Nursing Process Data
Skill 22.5.1 Providing Suprapubic Catheter Care 794
Unit 22.6 Specimens from Closed Systems
Skill 23.1.2 Providing Digital Stimulation 828
Skill 23.1.3 Developing a Regular Bowel Routine 828
Skill 23.1.4 Administering a Suppository 829
Skill 23.1.5 Inserting a Rectal Tube 830
Skill 23.1.6 Instructing Client in Colostomy Irrigation 831
Skill 23.1.7 Instructing Home Care Client in Colostomy Care 832
Unit 23.2 Enema Administration 835
Nursing Process Data 835 Procedures 835
Skill 23.2.1 Administering a Large-Volume Enema 836
Skill 23.2.2 Administering an Enema to a Child 838
Skill 23.2.3 Administering a Small-Volume Enema 839
Skill 23.2.4 Administering a Retention Enema 839
Skill 23.2.5 Administering a Return Flow Enema 840
Unit 23.3 Fecal Ostomy Pouch Application 843
Nursing Process Data 843 Procedures 843
Skill 23.3.1 Applying a Fecal Ostomy Pouch 843
GERONTOLOGIC Considerations 850
MANAGEMENT Guidelines 850
CASE STUDY Applications 850
NCLEX® Review Questions 851
QSEN Activity 852
Bibliography 852
24 Heat and Cold Therapies 854 LEARNING OBJECTIVES 854
CHAPTER OUTLINE 854
Overview
Temperature Regulation 855 Processes of Heat Transfer 856
Conditions Affecting Temperature Regulation 856 Fever 856
Hyperthermia (Body Temperature Exceeding 41.1°C [106°F]) 857
Hypothermia (Body Temperature Below 36°C [96.8°F]) 857
The Inflammatory Response 857
Local Heat Therapies (Thermotherapy) 857
Local Cold Therapies (Cryotherapy) 859
Induced Hypothermia 859
Cultural Awareness 860
Unit 24.1 Local Heat Therapies (Thermotherapy) 861
Nursing Process Data 861
Procedures 861
Skill 24.1.1 Applying a Commercial Heat Pack 861
Skill 24.1.2 Applying an Aquathermic Pad 862
Skill 24.1.3 Applying a Hot Moist Pack 863
Skill 24.1.4 Assisting With a Sitz Bath 864
Skill
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Skeleton cartilaginous or ossified. Body with medial and paired fins, the hinder pair abdominal. Gills free, rarely partially attached to the walls of the gill-cavity. One external gill-opening only on each side; a gill-cover. Air-bladder with a pneumatic duct. Ova small, impregnated after exclusion. Embryo sometimes with external gills.
To this order belong the majority of the fossil fish remains of palæozoic and mesozoic age, whilst it is very scantily represented in the recent fauna, and evidently verging towards total extinction. The knowledge of the fossil forms, based on mere fragments of the hard parts of the body only, is very incomplete, and therefore their classification is in a most unsatisfactory state. In the following pages only the most important groups will be mentioned.
[For a study of details we have to refer to Agassiz, “Poissons Fossiles;” Owen, “Palæontology,” Edinb. 1861, 8vo; Huxley, “Preliminary Essay upon the Systematic Arrangement of the Fishes of the Devonian Epoch,” in Mem. Geolog. Survey, Dec. 10; Lond. 1861, and “Illustrations of the Structure of Crossopterygian Ganoids,” ibid. December 12, 1866; Traquair, “The Ganoids of the British Carboniferous Formations,” part I. “Palæoniscidæ.” Palæontogr. Soc. Lond 1877 ]
Eight suborders may be distinguished at present.
FIRST SUB-ORDER—PLACODERMI
Extinct. The head and pectoral region of the body encased in great bony, sculptured plates, with dots of enamel; the remainder of the body naked, or with ganoid scales; skeleton notochordal.
Comprises the oldest vertebrate remains, from Devonian and Carboniferous formations. Pterichthys: (Figs. 135 and 136), tail tapering, covered with small ganoid scales, without caudal fin; the cephalic shield was probably moveably joined to the cuirass of the trunk, and both were composed of several pieces; the abdominal shield consisted of one single median plate, and two pairs of lateral plates, a third small pair being sometimes observed detached in front of the anterior pair; pectoral exceedingly long, consisting of two pieces movably connected with each other; tail scaly, and short; a small dorsal fin placed on the tail; a pair of small ventrals; jaws small,
with confluent denticles. Several species have been distinguished in remains found in the strata of Caithness and other localities in Scotland. Coccosteus (Fig. 137, p. 354): all the bony plates are firmly united, no pectoral spines; tail naked and long; a dorsal and anal fin supported by interneural and interhæmal spines. Dentition unknown. Dinichthys: a gigantic fish from the Devonian of North America (estimated at from 15 to 18 feet in length), with the dermal covering very similar to that of Coccosteus, but with a simple arched dorsal shield. As in this latter genus the caudal extremity does not possess external or internal bony parts, and the ventral plastron of both genera corresponds in every particular; the dentition is so singularly like that of Lepidosiren, that Newberry (Geolog. Survey of Ohio, vol. ii. part 2) considers this genus to be in genetic relation to the Dipnoi. The following genera have been united in a separate family, Cephalaspidæ; viz. Cephalaspis: head covered by a continuous shield with tubercular surface, produced into a horn at each posterior corner; a median dorsal backward prolongation bears a spine; heterocercal. Auchenaspis and Didymaspis: allied to the preceding, but with the cephalic shield divided into a larger anterior and smaller posterior piece. Pteraspis: with the cephalic shield finely striated or grooved, composed of seven pieces. Scaphaspis and Cyathaspis: with the surface of the head-shield similarly sculptured as in Pteraspis, but simple in the former, and composed of four pieces in the latter. Astrolepis: attained to the gigantic size of between twenty and thirty feet; its mouth was furnished with two rows of teeth, of which the outer ones were small, the inner much larger.
Fig 135 Dorsal surface of Pterichthys, after Pander d, Dorsal fin; c, pectoral member; 2–10, headbucklers; 11–13, dorsal bucklers
Fig. 136. Ventral aspect of Pterichthys, after Pander. 15, mandible (?); 16–21, ventral bucklers.
Fig 137 Coccosteus, after Pander A, Anal fin; D, Dorsal fin; C, Heterocercal tail; c, notochord; n, neurals; h, hæmals; 6–24, bucklers
[See Ray Lankester, A. Monograph of the Fishes of the Old Red Sandstone of Britain. Part I. Cephalaspidæ. Lond. 1868 and 1870. 4to.]
SECOND SUB-ORDER—ACANTHODINI.
Extinct. Body oblong, compressed, covered with shagreen; skull not ossified; caudal heterocercal. Large spines, similar to those of
Chondropterygians, in front of some of the median and paired fins. The spines are imbedded between the muscles, and not provided with a proximal joint.
Acanthodes, Chiracanthus, from Devonian and Carboniferous formations.
THIRD SUB-ORDER DIPNOI.
Nostrils two pairs, more or less within the mouth; limbs with an axial skeleton. Lungs and gills. Skeleton notochordal. No branchiostegals.[38]
F F —S .
Caudal fin diphycercal; no gular plates; scales cycloid. A pair of molars, above and below, and one pair of vomerine teeth.
L . Body eel-shaped, with one continuous vertical fin. Limbs reduced to cylindrical filaments, without fringe. Vomerine teeth conical, pointed. Each dental lamina or molar with strong cusps, supported by vertical ridges. No external branchial appendages; five branchial arches, with four intervening clefts. Conus arteriosus with two longitudinal valves. Ovaries closed sacs.
One species only is known from the system of the River Amazons (L. paradoxa). It must be very locally distributed, as but a few specimens have been brought to Europe, and all recent endeavours to obtain others have been unsuccessful. Natterer, by whom this most interesting fish was discovered, states that he obtained two specimens, one on the Madeira River, near Borba; the other in a backwater of the Amazons, above Villa Nova. The natives of the former place called it Carámurú, and considered it very scarce. The larger individual was nearly four feet long. It is said to produce a sound not unlike that of a cat, and to feed on the roots of mandioca and other vegetables. But, to judge from the dentition, this fish is much more likely to be carnivorous, like the following. It is one of the greatest desiderata of Natural History Collections.
[Natterer, “Annalen des Wiener Museum’s,” 1839, ii.; Bischoff. “Annales des Sciences Naturelles,” 1840. xiv.]
P .—Very similar in the general form of the body and dentition to Lepidosiren. Pectoral and ventral filaments with a fringe containing rays. Three small branchial appendages above the small gill-opening; six branchial arches, with five intervening clefts. Conus arteriosus with two longitudinal valves. Ovaries closed sacs.
Protopterus annectens is the “Lepidosiren” which is commonly found in Zoological collections. It is usually imported from the west coast of Africa, where it abounds in many localities; but it is spread over the whole of tropical Africa, and forms in many districts of the central parts a regular article of food.
Fig 138 Protopterus annectens g, Branchial filaments; v, vent
During the dry season, specimens living in shallow waters which periodically dry up, form a cavity in the mud, the inside of which they line with a protecting capsule of mucus, and from which they emerge again when the rains refill the pools inhabited by them. Whilst they remain in this torpid state of existence, the clay-balls containing them are frequently dug out, and if the capsules are not broken, the fishes imbedded in them can be transported to Europe, and released by being immersed in slightly tepid water. Protopterus is exclusively carnivorous, feeding on water-insects, frogs, and fishes, and attains a length of six feet.
[Owen, “Trans. Linn. Soc.” 1841, xviii.]
C Body elongate, compressed, with one continuous vertical fin Limbs paddle-shaped, with broad, rayed fringe Vomerine teeth incisor-like; molars with flat, undulated surface, and lateral
prongs. No external branchial appendages. Conus arteriosus with transverse series of valves Ovaries transversely lamellated [39]
Fig. 139. Ceratodus miolepis.
Two species, C. forsteri and C. miolepis, are known from fresh waters of Queensland. The specimens hitherto obtained have come from the Burnett, Dawson, and Mary rivers, some from the fresh waters of the upper parts, others from the lower brackish portions. The fish is said to attain to a weight of twenty pounds and to a length of 6 feet. Locally, the settlers call it “Flat-head,” “Burnett- or DawsonSalmon,” and the aborigines “Barramunda,” a name which they appear to apply also to other large-scaled freshwater fishes, as the Osteoglossum leichardti. In the stomach there is generally found an enormous quantity of the leaves of plants growing on the banks of rivers, evidently eaten after they had fallen into the water and when in a decomposing condition. The flesh of the fish is salmon-coloured, and much esteemed as food.
The Barramunda is said to be in the habit of going on land, or at least on mud-flats; and this assertion appears to be borne out by the fact that it is provided with a lung. However, it is much more probable that it rises now and then to the surface of the water in order to fill its lung with air, and then descends again until the air is so much deoxygenised as to render a renewal of it necessary. It is also said to make a grunting noise, which may be heard at night for some distance. This noise is probably produced by the passage of the air through the œsophagus when it is expelled for the purpose of renewal. As the Barramunda has perfectly developed gills, beside the lung, we can hardly doubt that, when it is in water of normal composition, and sufficiently pure to yield the necessary supply of
oxygen, these organs are sufficient for the purpose of breathing, and that the respiratory function rests with them alone. But when the fish is compelled to sojourn in thick muddy water charged with gases, which are the products of decomposing organic matter (and this must be the case very frequently during the droughts which annually exhaust the creeks of tropical Australia), it commences to breathe air with its lung in the way indicated above. If the medium in which it happens to be is perfectly unfit for breathing the gills cease to have any function; if only in a less degree the gills may still continue to assist in respiration. The Barramunda, in fact, can breathe by either gills or lungs alone, or by both simultaneously. It is not probable that it lives freely out of the water, its limbs being much too flexible for supporting the heavy and unwieldy body, and too feeble generally to be of much use in locomotion on land. However, it is quite possible that it is occasionally compelled to leave the water, although we cannot believe that it can exist without it in a lively condition for any length of time.
Of its propagation or development we know nothing, except that it deposits a great number of eggs of the size of those of a newt, and enveloped in a gelatinous case. We may infer that the young are provided with external gills, as in Protopterus and Polypterus.
Fig 140 Tooth of fossil Ceratodus from Aust , near Bristol, natural size
The discovery of Ceratodus does not date farther back than the year 1870, and proved to be of the greatest interest, not only on account of the relation of this creature to the other living Dipnoi and Ganoidei, but also because it threw fresh light on those singular fossil teeth which are found in strata of Triassic and Jurassic formations in various parts of Europe, India, and America. These teeth, of which there is a great variety with regard to general shape
and size, are sometimes two inches long, much longer than broad, depressed, with a flat or slightly undulated, always punctated crown, with one margin convex, and with from three to seven prongs projecting on the opposite margin.
Fig. 141. Dipterus macrolepidotus.
S F —C .
Caudal fin heterocercal. Gular plates. Scales cycloid. Two pairs of molars and one pair of vomerine teeth.
Extinct. Dipterus (Ctenodus), Heliodus from Devonian strata.
T F —P .
Caudal fin diphycercal; vertical fin continuous. Gular plates. Scales cycloid. Jaws with a series of minute conical teeth on the margin.
Extinct. Phaneropleuron from Devonian formations, and the carboniferous Uronemus are probably generically identical.
FOURTH SUB-ORDER—CHONDROSTEI.
Skeleton notochordal; skull cartilaginous, with dermal ossifications; branchiostegals few in number or absent. Teeth minute or absent. Integuments naked or with bucklers. Caudal fin heterocercal, with fulcra. Nostrils double, in front of the eyes.
F F —A .
Body elongate, sub-cylindrical, with five rows of osseous bucklers. Snout produced, subspatulate or conical, with the mouth at its lower surface, small, transverse, protractile, toothless. Four barbels in a transverse series on the lower side of the snout. Vertical fins with a single series of fulcra in front. Dorsal and anal fins approximate to the caudal. Gill-membranes confluent at the throat and attached to the isthmus. Branchiostegals none. Gills four; two accessory gills. Air-bladder large, simple, communicating with the dorsal wall of the œsophagus.
Fig 142 —Tail of Acipenser a, Fulcra; b, osseous bucklers
Sturgeons are, perhaps, the geologically youngest Ganoids, evidence of their existence not having been met with hitherto in formations of older date than the Eocene clay of Sheppey. They are exclusively inhabitants of the temperate zone of the Northern Hemisphere, being either entirely confined to fresh water, or passing, for the purpose of spawning, a part of the year in rivers. They grow to a large size, and are the largest fishes of the fresh waters of the Northern Hemisphere, specimens 10 feet long being of common occurrence. The ova are very small, and so numerous that one female has been calculated to produce about three millions at one season; therefore their propagation, as well as their growth, must be very rapid; and although in many rivers their number is annually considerably thinned by the systematic manner in which they are caught when they ascend the rivers in shoals from the sea, no diminution has been observed. Wherever they occur they prove to be most valuable on account of their wholesome flesh. In Russia,
besides, two not unimportant articles of trade are obtained from them, viz. Caviare, which is prepared from their ovaries, and Isinglass, which is made from the inner coats of their air-bladder. True Sturgeons are divided into two genera, Acipenser and Scaphirhynchus.
A . The rows of osseous bucklers are not confluent on the tail. Spiracles present. Caudal rays surrounding the extremity of the tail.
About twenty different species of Sturgeons may be distinguished from European, Asiatic, and American rivers. The best known are the Sterlet (A. ruthenus) from Russian rivers, celebrated for the excellency of its flesh, but rarely exceeding a length of three feet; the Californian Short-snouted Sturgeon (A. brachyrhynchus); the Hausen (A. huso), from rivers, falling into the Black Sea and the Sea of Azow (rare in Mediterranean), sometimes 12 feet long, and yielding an inferior kind of isinglass; the Chinese Sturgeon (A. sinensis); the Common Sturgeon of the United States (A. maculosus), which sometimes crosses the Atlantic to the coasts of Great Britain; Güldenstædt’s Sturgeon (A. güldenstædtii), common in European and Asiatic rivers, which yields more than one-fourth of the caviare and isinglass exported from Russia; the Common Sturgeon of Western Europe (A. sturio), which attains to a length of 18 feet, and has established itself also on the coasts of Eastern North America.
S Snout spatulate; posterior part of the tail attenuated and depressed, so that it is entirely enveloped by the osseous scutes Spiracles none The caudal rays do not extend to the extremity of the tail, which terminates in a filament.
Four species are known: one (S. platyrhynchus) from the riversystem of the Mississippi, and the three others from Central Asia; all are exclusively freshwater fishes; their occurrence in so widely distant rivers is one of the most striking instances by which the close affinity of the North American and North Asiatic faunas is proved.
S F —P .
Body naked, or with minute stellate ossifications. Mouth lateral, very wide, with minute teeth in both jaws. Barbels none. Caudal fin with fulcra. Dorsal and anal fins approximate to the caudal. Four gills and a half; no opercular gill or pseudobranchia.
P (S ) The snout is produced into an exceedingly long, shovel-like process, thin and flexible on the sides Spiracles present. Gill-cover terminating in a very long tapering flap. One broad branchiostegal. Each branchial arch with a double series of very long, fine, and numerous gill-rakers, the two series being divided by a broad membrane. Air-bladder cellular. Upper caudal fulcra narrow, numerous.
The single species, P. folium, occurs in the Mississippi, and grows to a length of about six feet, of which the rostral shovel takes about one-fourth; in young examples it is comparatively still longer.
P differs from Polyodon in having the rostral process less depressed and more conical. The gill-rakers are comparatively short, in moderate number, and distant from one another. Upper caudal fulcra enormously developed, and in small number (six).
Psephurus gladius inhabits the Yan-tse-Kiang and Hoangho, the distribution of the Polyodontidæ being perfectly analogous to that of Scaphirhynchus. It grows to an immense size, specimens of 20 feet in length being mentioned by Basilewsky The function of the rostral process in the economy of these fishes is not yet sufficiently explained. Martens believes that it serves as an organ of feeling, the water of those large Asiatic and American rivers being too turbid to admit of the Sturgeon seeing its prey, which consists of other fishes. The eyes of Psephurus, as well as Polyodon, are remarkably small. Both fishes are used as food.
Fig. 143. Psephurus gladius.
Allied to the Polyodontidæ, and likewise provided with a paddleshaped production of the fore part of the head, is the fossil genus
Chondrosteus, remains of which occur in the Lias.
FIFTH SUB-ORDER POLYPTEROIDEI.
Paired fins with axial skeleton, fringed; dorsal fins two or more. Branchiostegals absent, but generally gular plates. Vertebral column diphycercal or heterocercal. Body scaly.
F F —P .
Scales ganoid; fins without fulcra. A series of dorsal spines, to each of which an articulated finlet is attached; anal placed close to the caudal fin, the vent being near the end of the tail. Abdominal portion of the vertebral column much longer than the caudal.
P . Teeth rasp-like, in broad bands in the jaws, on the vomer and palatine bones; jaws with an outer series of closely-set, larger, pointed teeth. Caudal fin surrounding the extremity of the vertebral column; ventral fins well developed. A spiracle on each side of the parietal, covered with an osseous plate. A single large gular plate. Air-bladder double, communicating with the ventral wall of the pharynx.
This Ganoid is confined to tropical Africa, occurring in abundance in the rivers of the west coast and in the Upper Nile; but it has not been found in the river-systems belonging to the Indian Ocean. It is scarce in the Middle and Lower Nile, and the specimens found below the Cataracts have been carried down, from southern latitudes, and do not propagate their species in that part of the river. There is only one species known, Polypterus bichir (“Bichir” being its vernacular name in Egypt), which varies in the number of the dorsal finlets, the
Fig 144 Polypterus bichir
lowest being eight, the highest eighteen. It attains to a length of four feet. Nothing is known of its mode of life, and observations thereon are very desirable.
C Distinguished from Polypterus by its greatly elongate form, and the absence of ventral fins
C. calabaricus, a dwarf form from Old Calabar.
S F —S .
Scales ganoid, smooth like the surface of the skull. Two dorsal fins; paired fins obtusely lobate. Teeth conical. Caudal heterocercal.
Extinct. Diplopterus, Megalichthys, and Osteolepis from Devonian and Carboniferous formations.
T F —C .
Scales cycloid. Two dorsal fins, each supported by a single twopronged interspinous bone; paired fins obtusely lobate. Air-bladder ossified; notochord persistent, diphycercal.
Extinct. Coelacanthus from carboniferous strata; several other genera, from the coal formations to the chalk, have been associated with it—Undina, Graphiurus, Macropoma, Holophagus, Hoplopygus, Rhizodus.
F F —H .
Scales cycloid or ganoid, sculptured. Two dorsal fins; pectorals narrow, acutely lobate; dentition dendrodont.
Extinct. In this family a peculiar type of dentition is found—the jaws are armed with two kinds of teeth, small ones serially arranged, and much larger fang-like teeth disposed at long intervals. Both kinds show at their base in transverse sections a labyrinthic complexity of structure, numerous fissures radiating from the central mass of vasodentine which fills up the pulp cavity, and sending off
small ramifying branches. Genera belonging to this family are Holoptychius, Saurichthys, Glyptolepis, Dendrodus, Glyptolaemus, Glyptopomus, Tristichopterus, Gyroptychius, Strepsodus, from Devonian and Carboniferous strata.
SIXTH SUB-ORDER PYCNODONTOIDEI
Body compressed, high and short or oval, covered with rhombic scales arranged in decussating pleurolepidal lines. Notochord persistent. Paired fins without axial skeleton. Teeth on the palate and hinder part of the lower jaw molar-like. Branchiostegals, but no gular plates.
Extinct. The regular lozenge-shaped pattern of the integuments of these fishes is described by Sir P. Egerton thus: “Each scale bears upon its inner anterior margin a thick solid bony rib, extending upwards beyond the margin of the scale, and sliced off obliquely, above and below, on opposite sides, for forming splices with the corresponding processes of the adjoining scales. These splices are so closely adjusted that, without a magnifying power or an accidental dislocation, they are not perceptible. When in situ, and seen internally, these continuous lines decussate with the true vertebral apophyses.” In some genera the “pleurolepidal” lines are confined to the anterior part of the side.
F F —P .
Homocercal. Body less high. Fins with fulcra.
Pleurolepis and Homoeolepis from the Lias.
S F —P .
Homocercal. The neural arches and ribs are ossified; the roots of the ribs are but little expanded in the older genera, but enlarged in the tertiary forms, so as to simulate vertebræ. Paired fins not lobate. Obtuse teeth on the palate and the sides of the mandible; maxilla
toothless; incisor-like teeth in the intermaxillary and front of the mandible. Fulcra absent in all the fins.
These fishes abound in Mesozoic and Tertiary formations. Gyrodus, Mesturus, Microdon, Coelodus, Pycnodus, Mesodon, are some of the genera distinguished by palæontologists. (See Fig. 102, p. 201.)
SEVENTH SUB-ORDER LEPIDOSTEOIDEI
Scales ganoid, rhombic; fins generally with fulcra; paired fins not lobate. Præ- and inter-operculum developed; generally numerous branchiostegals, but no gular plate.
F F —L .
Scales ganoid, lozenge-shaped. Skeleton completely ossified; vertebræ convex in front and concave behind. Fins with fulcra; dorsal and anal composed of articulated rays only, placed far backwards, close to the caudal. Abdominal part of the vertebral column much longer than caudal. Branchiostegals not numerous, without enamelled surface. Heterocercal.
Lepidosteus. Body elongate, sub-cylindrical; snout elongate, spatulate, or beak-shaped; cleft of the mouth wide; both jaws and palate armed with bands of rasp-like teeth and series of larger conical teeth. Four gills; no spiracles; three branchiostegals. Air-bladder cellular, communicating with the pharynx.
145 —Lepidosteus viridis
Fishes of this genus existed already in Tertiary times; their remains have been found in Europe as well as North America. In our
Fig
period they are limited to the temperate parts of North America, Central America, and Cuba. Three species can be distinguished which attain to a length of about six feet. They feed on other fishes, and their general resemblance to a pike has given to them the vernacular names of “Gar-Pike,” or “Bony Pike.”
S F —S .
Body oblong, with ganoid scales; vertebræ not completely ossified; termination of the vertebral column homocercal; fins generally with fulcra. Maxillary composed of a single piece; jaws with a single series of conical pointed teeth. Branchiostegals numerous, enamelled, the anterior broad gular plates.
Extinct. Numerous genera occur in Mesozoic formations; one with the widest range is Semionotus, with distichous fulcra, from the Lias and Jura; Eugnathus, with large posteriorly serrated scales, and fulcra on nearly all fins; Cephenoplosus from the Upper Lias; Macrosemius from the Oolite; Propterus, Ophiopsis, Pholidophorus, Pleuropholis, Pachycormus, Oxygnathus, Ptycholepis, Conodus, Eulepidotus, Lophiostomus, etc.
T F —S
Body rhombic or ovate, with ganoid scales; vertebræ not completely ossified; termination of the vertebral column homocercal; fins with fulcra. Maxillary composed of a single piece; jaws with several series of teeth, the outer ones equal, styliform. Dorsal fin very long, extending to the caudal. Branchiostegals numerous.
Extinct. Tetragonolepis from the Lias (see Fig. 103, p. 207).
F F —S .
Body oblong, with rhombic ganoid scales; vertebræ ossified, but not completely closed; homocercal; fins with fulcra. Maxillary
composed of a single piece; teeth in several series, obtuse; those on the palate globular. Dorsal and anal fins short. Branchiostegals.
Extinct. The type genus of this family is Lepidotus, so named from its large rhombic, dense, and polished scales. The dorsal is opposite to the anal, and all the fins are provided with a double row of fulcra. This genus ranges from the Lias to the Chalk; one species would seem to have survived into tertiary times, if it should not prove to be a Lepidosteus.
F F —A .
Body elongate, with ganoid scales; jaws prolonged into a beak; termination of the vertebral column homocercal. Fins with fulcra; a series of enlarged scales along the side of the body Dorsal fin opposite to the anal.
Fig. 146.—Aspidorhynchus fisheri, from the Purbeck beds; m, mandible; a, presymphyseal bone.
Extinct; mesozoic. Aspidorhynchus has the upper jaw longer than the lower; very peculiar is the occurrence of a single, solid, conical bone, situated in front of the symphysis of the lower jaw, to which it is joined by a suture. Belonostomus with both jaws of equal length.
S F —P .
Body fusiform, with rhombic ganoid scales. Notochord persistent, with the vertebral arches ossified. Heterocercal. All the fins with fulcra; dorsal short. Branchiostegals numerous, the foremost pair forming broad gulars. Teeth small, conical, or cylindrical.
Extinct. Many genera are known; from the Old Red Sandstone— Chirolepis and Acrolepis; from Carboniferous rocks— Cosmoptychius, Elonichthys, Nematoptychius, Cycloptychius, Microconodus, Gonatodus, Rhadinichthys, Myriolepis, Urosthenes; from the Permian—Rhabdolepis, Palæoniscus, Amblypterus and Pygopterus; from the Lias—Centrolepis, Oxygnathus, Cosmolepis, and Thrissonotus.
[See Traquair, “The Ganoid Fishes of the British Carboniferous Formations.” Part I. Palæoniscidæ.]
S F —P .
Body generally high, compressed, covered with rhombic ganoid scales arranged in dorso-ventral bands. Notochord persistent, with the vertebral arches ossified. Heterocercal; fins with fulcra; dorsal fin long, occupying the posterior half of the back. Branchiostegals numerous. Teeth tubercular or obtuse.
Extinct. From Carboniferous and Permian formations— Eurynotus, Benedenius, Mesolepis, Eurysomus, Wardichthys, Chirodus (M’Coy), Platysomus.
[See Traquair, “On the Structure and Affinities of the Platysomidæ”, in “Trans. Roy. Soc.,” Edinb., vol. xxix.]
EIGHTH SUB-ORDER AMIOIDEI.
Vertebral column more or less completely ossified, heterocercal. Body covered with cycloid scales. Branchiostegals present.
F F —C .
Notochord persistent, with partially ossified vertebræ; homocercal; fins with fulcra. Teeth in a single series, small, pointed.
Extinct. Caturus from the Oolite to the Chalk.
Fig 147 Platysomus gibbosus
