Critical Thinking Cases in Nursing PDF

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Brief Contents PART ONE MEDICAL-SURGICAL CASES, 1 Chapter 1 Cardiovascular Disorders, 1 Chapter 2 Respiratory Disorders, 83 Chapter 3 Musculoskeletal Disorders, 149 Chapter 4 Gastrointestinal Disorders, 189 Chapter 5 Genitourinary Disorders, 235 Chapter 6 Neurologic Disorders, 273 Chapter 7 Endocri...

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Brief Contents PART ONE MEDICAL-SURGICAL CASES, 1

Chapter 1 Chapter 2 Chapter 3 Chapter 4 Chapter 5 Chapter 6 Chapter 7 Chapter 8 Chapter 9

Cardiovascular Disorders, 1 Respiratory Disorders, 83 Musculoskeletal Disorders, 149 Gastrointestinal Disorders, 189 Genitourinary Disorders, 235 Neurologic Disorders, 273 Endocrine Disorders, 341 Immunologic Disorders, 367 Oncologic and Hematologic Disorders, 393

PART TWO PEDIATRIC, MATERNITY, AND PSYCHIATRIC CASES, 439

Chapter 10 Chapter 11 Chapter 12 Chapter 13

Pediatric Disorders, 439 Maternal and Obstetric Disorders, 505 Women's Health Disorders, 533 Psychiatric Disorders, 559

PART THREE OTHER/ADVANCED CASES, 591

Chapter 14 Alternative Therapies, 591 Chapter 15 Patients with Multiple Disorders, 599 Chapter 16 Emergency Situations, 625 Appendix: Abbreviations and Acronyms, 663 Illustration Credits, 669

5TH EDITION

Critical Thinking Cases In Nursing Winningham's

Medical-Surgical, Pediatric, Maternity, and Psychiatric

MARIANN HARDING, MSN, RN

Associate Professor Department of Nursing Kent State University at Tuscarawas New Philadelphia, Ohio

JULIE S. SNYDER, MSN, RN-BC

Adjunct Faculty School of Nursing Old Dominion University Norfolk, Virginia

BARBARA A. PREUSSER†, PHD, FNPC

Family Nurse Practitioner Veterans Administration Medical Center Salt Lake City, Utah Deceased

†

3251 Riverport Lane St. Louis, Missouri 63043 WINNINGHAM'S CRITICAL THINKING CASES IN NURSING: MEDICAL-SURGICAL, PEDIATRIC, MATERNITY, AND PSYCHIATRIC

ISBN: 978-0-323-08325-6

Copyright © 2013 by Mosby, Inc., an affiliate of Elsevier Inc. No part of this publication may be reproduced or transmitted in any form or by any means, electronic or mechanical, including ­photocopying, recording, or any information storage and retrieval system, without permission in writing from the publisher. Details on how to seek permission, further information about the Publisher's permissions policies and our arrangements with organizations such as the Copyright Clearance Center and the Copyright Licensing Agency, can be found at our website: www.elsevier.com/permissions. This book and the individual contributions contained in it are protected under copyright by the Publisher (other than as may be noted herein). Notices Knowledge and best practice in this field are constantly changing. As new research and experience broaden our understanding, changes in research methods, professional practices, or medical treatment may become necessary. Practitioners and researchers must always rely on their own experience and knowledge in evaluating and using any information, ­methods, compounds, or experiments described herein. In using such information or methods they should be mindful of their own safety and the safety of others, including parties for whom they have a ­professional responsibility. With respect to any drug or pharmaceutical products identified, readers are advised to check the most current information provided (i) on procedures featured or (ii) by the manufacturer of each product to be administered, to verify the recommended dose or ­formula, the method and duration of administration, and contraindications. It is the responsibility of practitioners, relying on their own ­experience and knowledge of their patients, to make diagnoses, to determine dosages and the best treatment for each individual patient, and to take all appropriate safety precautions. To the fullest extent of the law, neither the Publisher nor the authors, contributors, or editors, assume any ­liability for any injury and/or damage to persons or property as a matter of products liability, negligence or ­otherwise, or from any use or operation of any methods, products, instructions, or ideas contained in the ­material herein. Previous editions copyrighted 2009, 2005, 2001, 1996 Library of Congress Cataloging-in-Publication Data Harding, Mariann.   Winningham's critical thinking cases in nursing : medical-surgical, pediatric, maternity, and psychiatric / Mariann Harding, Julie S. Snyder, Barbara A. Preusser. – 5th ed.    p. ; cm.   Critical thinking cases in nursing   Rev. ed. of: Critical thinking in medical-surgical settings / Maryl L. Winningham and Barbara A. Preusser. 2nd ed. c2011.   Includes bibliographical references.   ISBN 978-0-323-08325-6 (pbk. : alk. paper)   I. Snyder, Julie S. II. Preusser, Barbara A. III. Winningham, Maryl Lynne, 1947–2001. Critical thinking in medical-surgical settings. IV. Title. V. Title: Critical thinking cases in nursing.   [DNLM: 1. Nursing Process–Case Reports. 2. Nursing Process–Problems and Exercises. 3. Nursing Care– Case Reports. 4. Nursing Care–Problems and Exercises. WY 18.2]  610.73–dc23 2012003221 Executive Content Strategist: Lee Henderson Content Development Specialist: Jacqueline Twomey Publishing Services Managers: Hemamalini Rajendrababu & Deborah L. Vogel Project Managers: Anitha Sivaraj & John W. Gabbert Design Direction: Karen Pauls

Printed in the United States of America Last digit is the print number: 9 8 7 6 5 4 3 2 1

To Drs. Maryl L. Winningham and Barbara A. Preusser Drs. Winningham and Preusser, authors of this text for the previous four editions, dedicated their lives to the care of others and the pursuit of excellence in nursing practice. They have bequeathed a nursing heritage of integrity, excellence, courage, and service to their students, ­colleagues, and readers.

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Contributors Ann Campbell, RN, MSN, CPNP Faculty School of Nursing Old Dominion University Norfolk, Virginia

Sara B. Forbus, MSN, RN

Faculty School of Nursing Old Dominion University Norfolk, Virginia

Contributors to Previous Editions Elizabeth Jane Bell, MSN, ANPc Lesley A. Black, BSN, MS, ANPc, CWOCN Kent Blad, MS, FNPc, ACNP-C, FCCM Jamie Clinton-Lont, BSN, FNPc Susan L. Croft, BSN, MS Joyce Foster, PhD, CNM, FACNM, FAAN Shellagh Gutke, BSN, CWOCN Nancy Hayden, MSN, FNPc Sondra Heaston, MS, FNPc, CEN Janice Hulbert, RN, MS Lisa Jensen, BSN, MS, APRN, CS Stephanie C. Kettendorf, MS, RN, CNS, NCBF Julie Killebrew, BSN, MS Karen Kone, BSN, ACRN Kathleen Kuntz, MSN, APRN, SANE

Janet G. Madsen, PhD Debra Ann Mills, RN, MS Jeanie O'Donnell, MSN Deb Plasman-Coles, PAc Laura Lee Scott, MSN, FNPc Mary Seegmiller, MSN Sandra Smeeding, MS, FNPc Deborah D. Smith, BSN Ann Speirs, BSN Ronald Ulberg, BSN, MSN Kristy Vankatwyk, MSN, FNPc Annette S. Wendel, BSN Wendy Whitney, MSN, FNPc, CANP Mary Youtsey, BSN, CDE

Copyright © 2013 by Mosby, an affiliate of Elsevier Inc. Copyright © 2009, 2005, 2001, 1996, by Mosby, Inc. an affiliate of Elsevier Inc. All rights reserved.

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Reviewers Diane K. Daddario, MSN, ACNS-BC, RN, BC, CMSRN Nurse Specialist Geisinger Medical Center Danville, Pennsylvania; Staff Nurse Evangelical Community Hospital Lewisburg, Pennsylvania; Nursing Instructor Pennsylvania College of Technology Williamsport, Pennsylvania

Jennifer Duhon, RN, MS

Director of Health Services Lutheran Senior Services Peoria, Illinois

Sara B. Forbus, MSN, RN

Faculty School of Nursing Old Dominion University Norfolk, Virginia

Mimi Haskins, MS, RN, CMSRN

Nursing Staff Development Instructor Roswell Park Cancer Institute Buffalo, New York

Suzanne Jed, MSN, APRN-BC

Clinical Instructor, Family Medicine Keck School of Medicine University of Southern California Los Angeles, California

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Jamie Lynn Jones, MSN, RN

Assistant Professor, Nursing University of Arkansas at Little Rock Little Rock, Arkansas

Tamara M. Kear, PhD, MSN, RN

Assistant Professor of Nursing Villanova University Villanova, Pennsylvania

Cheryl A. Lehman, PhD, RN, CNS-BC, RN-BC, CRRN

CNS Program Coordinator Department of Health Restoration & Care Systems Management (HRCSM) Clinical Associate Professor The University of Texas Health Science Center at San Antonio San Antonio, Texas

Casey Norris, MSN, BSN

Adjunct Instructor, Nursing South College Pulmonary Clinical Nurse Specialist East Tennessee Children's Hospital Knoxville, Tennessee

Brenda K. Shelton, MS, RN, CCRN, AOCN

The Sidney Kimmel Cancer Center at Johns Hopkins Baltimore, Maryland

Copyright © 2013 by Mosby, an affiliate of Elsevier Inc. Copyright © 2009, 2005, 2001, 1996, by Mosby, Inc. an affiliate of Elsevier Inc. All rights reserved.

Introduction There is an urgent need for nurses with well-practiced critical thinking skills. As new graduates, you will make decisions and take actions of an increasingly sophisticated nature. You will encounter problems you have never seen or heard about during your classroom and clinical experiences. You are going to have to make complex decisions with little or no guidance and limited resources. We want you to be exposed to as much as possible during your student days, but more importantly, we want you to learn to think. You cannot memorize your way out of any situation, but you can think your way out of any situation. We know that students often learn more and faster when they have the freedom to make mistakes. This book is designed to allow you to experiment with finding answers without the pressure of someone's life hanging in the balance. We want you to do well. We want you to be the best. It is our wish for you to grow into confident, competent professionals. After all, someday we will be one of those people you care for, and when that day comes, we want you to be very, very good at what you do!

What Is Critical Thinking? Critical thinking is not memorizing lists of facts or the steps of procedures. Instead, critical thinking is an analytical process that can help you think through a problem in an organized and efficient manner. Five steps are involved in critical thinking. Thinking about these steps may help you when you work through the questions in your cases. Here are the five steps with an explanation of what they mean.  1. Recognize and define the problem by asking the right questions: Exactly what is it you need to know? What is the question asking?  2. Select the information or data necessary to solve the problem or answer the question: First you have to ask whether all the necessary information is there. If not, how and where can you get the additional information? What other resources are available? This is one of the most difficult steps. In real clinical experiences, you rarely have all of the information, so you have to learn where you can get necessary data. For instance, patient and family interviews, nursing charting, the patient medical chart, laboratory data on your computer, your observations, and your own physical assessment can help you identify important clues. Of course, information can rapidly become outdated. To make sure you are accessing the most current and accurate information, you will occasionally need to use the Internet to answer a question.  3. Recognize stated and unstated assumptions; that is, what do you think is or is not true? Sometimes answers or solutions seem obvious; just because something seems obvious doesn't mean it is correct. You may need to consider several possible answers or solutions. Consider all clues carefully and do not dismiss a possibility too quickly. Remember, “You never find an answer you don't think of.”

Copyright © 2013 by Mosby, an affiliate of Elsevier Inc. Copyright © 2009, 2005, 2001, 1996, by Mosby, Inc. an affiliate of Elsevier Inc. All rights reserved.

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INTRODUCTION

 4. Formulate and select relevant and/or potential decisions. Try to think of as many possibilities as you can. Consider the pros and cons of the consequences of making each decision. What is the best answer/solution? What could go wrong? This requires considering many different angles. In today's health care settings, decision-making often requires balancing the wellbeing needs of the patient, the preferences and concerns of the patient and caregiver, and financial limitations imposed by the reimbursement system. In making decisions, you need to take into account all relevant factors. Remember, you may need to explain why you rejected other options.  5. Draw a valid, informed conclusion: Consider all data; then determine what is relevant and what makes the most sense. Only then should you draw your conclusion. It may look as if this kind of thinking comes naturally to instructors and experienced nurses. You can be certain that even experienced professionals were once where you are now. The rapid and sound decision-making that is essential to good nursing requires years of practice. The practice of good clinical thinking leads to good thinking in clinical practice. This book will help you practice the important steps in making sound clinical judgments until the process starts to come naturally. The practice of good clinical thinking leads to good thinking in clinical practice.

The “How to” of Case Studies When you begin each case, read through the whole story once, from start to finish, getting a general idea of what it is about. Write down things you have to look up. This will help you move through the case smoothly and get more out of it. How much you have to look up will depend on where you are in your program, what you know, and how much experience you already have. Preparing cases will become easier as you advance in your program.

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Copyright © 2013 by Mosby, an affiliate of Elsevier Inc. Copyright © 2009, 2005, 2001, 1996, by Mosby, Inc. an affiliate of Elsevier Inc. All rights reserved.

Acknowledgments We would like to express our appreciation to the editorial Elsevier staff—Kristen Geen, Lee Henderson, Jamie Horn, and Jacqueline Twomey—for their professional support and contributions in guiding this text to publication. We extend a special thanks to our reviewers who gave us helpful suggestions and insights as we developed this edition. Mariann's gratitude goes to the most important people in her life—her husband, Jeff, and her daughters, Kate and Sarah—for their giving of love, support, and time during the months of writing. She gives a special thanks to her students, colleagues, and patients; each has taught her much and fueled her passion for nursing and education. Finally, Mariann gives her thanks to God, who made all things possible. Julie thanks her husband, Jonathan, for his love, support, and patience during this project. She is grateful for the encouragement from daughter Emily, son-in-law Randy, and parents Willis and Jean Simmons. Julie appreciates the hard work of colleagues Ann Campbell and Sara Forbus as contributors to this edition. She is especially thankful to the students, whose eagerness to learn is an inspiration. Most importantly, Julie gives thanks to God, our source of hope and strength.

Copyright © 2013 by Mosby, an affiliate of Elsevier Inc. Copyright © 2009, 2005, 2001, 1996, by Mosby, Inc. an affiliate of Elsevier Inc. All rights reserved.

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Contents PART ONE   Medical-Surgical Cases, 1

1

2

3

Cardiovascular Disorders, 1 Case Study 1,  1 Case Study 2,  5 Case Study 3,  11 Case Study 4,  17 Case Study 5,  21 Case Study 6,  25 Case Study 7,  31 Case Study 8,  35 Case Study 9,  39 Case Study 10,  43 Case Study 11,  47 Case Study 12,  53 Case Study 13,  57 Case Study 14,  63 Case Study 15,  67 Case Study 16,  73 Case Study 17,  79 Respiratory Disorders,  83 Case Study 18,  83 Case Study 19,  87 Case Study 20,  91 Case Study 21,  95 Case Study 22,  101 Case Study 23,  105 Case Study 24,  109 Case Study 25,  113 Case Study 26,  117 Case Study 27,  123 Case Study 28,  127 Case Study 29,  133 Case Study 30,  139 Case Study 31,  143 Musculoskeletal Disorders,  149 Case Study 32,  149 Case Study 33,  153 Case Study 34,  155

Case Study 35,  Case Study 36,  Case Study 37,  Case Study 38,  Case Study 39,  Case Study 40,  Case Study 41, 

159 165 169 173 177 181 185

4

Gastrointestinal Disorders,  189 Case Study 42,  189 Case Study 43,  193 Case Study 44,  197 Case Study 45,  201 Case Study 46,  207 Case Study 47,  211 Case Study 48,  217 Case Study 49,  221 Case Study 50,  225 Case Study 51,  229

5

Genitourinary Disorders,  235 Case Study 52,  235 Case Study 53,  239 Case Study 54,  243 Case Study 55,  247 Case Study 56,  251 Case Study 57,  257 Case Study 58,  261 Case Study 59,  265 Case Study 60,  269

6

Neurologic Disorders,  273 Case Study 61,  273 Case Study 62,  277 Case Study 63,  281 Case Study 64,  285 Case Study 65,  289 Case Study 66,  293 Case Study 67,  299

Copyright © 2013 by Mosby, an affiliate of Elsevier Inc. Copyright © 2009, 2005, 2001, 1996, by Mosby, Inc. an affiliate of Elsevier Inc. All rights reserved.

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CONTENTS

Case Study 68,  Case Study 69,  Case Study 70,  Case Study 71,  Case Study 72,  Case Study 73,  Case Study 74,  Case Study 75, 

7

8

303 307 311 317 323 327 331 337

Immunologic Disorders,  367 Case Study 82, 367 Case Study 83, 371 Case Study 84,  375 Case Study 85, 379 Case Study 86, 383 Case Study 87, 387

Endocrine Disorders,  341 Case Study 76,  341 Case Study 77,  345 Case Study 78,  349 Case Study 79,  353 Case Study 80,  359 Case Study 81,  363

9

Oncologic and Hematologic Disorders,  393 Case Study 88, 393 Case Study 89, 397 Case Study 90, 401 Case Study 91, 405 Case Study 92, 409 Case Study 93, 413 Case Study 94, 419 Case Study 95, 425 Case Study 96, 429 Case Study 97, 433

PART TWO   Pediatric, Maternity, and Psychiatric Cases, 439

10

Pediatric Disorders,  439 Case Study 98, 439 Case Study 99, 441 Case Study 100, 447 Case Study 101, 451 Case Study 102,  455 Case Study 103, 459 Case Study 104, 465 Case Study 105, 471 Case Study 106, 475 Case Study 107, 479 Case Study 108, 483 Case Study 109, 487 Case Study 110, 491 Case Study 111, 497 Case Study 112, 501

11

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12

Women’s Health Disorders,  533 Case Study 120, 533 Case Study 121, 537 Case Study 122, 541 Case Study 123, 547 Case Study 124, 551 Case Study 125, 555

13

Maternal and Obstetric Disorders,  505 Case Study 113, 505 Case Study 114, 509 Case Study 115, 513 Case Study 116, 517

Case Study 117, 521 Case Study 118, 525 Case Study 119, 529

Psychiatric Disorders,  559 Case Study 126, 559 Case Study 127, 563 Case Study 128, 567 Case Study 129, 571 Case Study 130, 575 Case Study 131, 579 Case Study 132, 583 Case Study 133, 587

Copyright © 2013 by Mosby, an affiliate of Elsevier Inc. Copyright © 2009, 2005, 2001, 1996, by Mosby, Inc. an affiliate of Elsevier Inc. All rights reserved.

   Contents

PART THREE   Other/Advanced Cases, 591

14

Alternative Therapies,  591 Case Study 134,  591 Case Study 135, 595

15

Patients with Multiple Disorders, 599 Case Study 136, 599 Case Study 137, 605 Case Study 138, 609 Case Study 139, 615 Case Study 140, 619

16

Emergency Situations,  625 Case Study 141, 625 Case Study 142, 629 Case Study 143, 633 Case Study 144, 635 Case Study 145, 639 Case Study 146, 643 Case Study 147, 647 Case Study 148, 651 Case Study 149, 655 Case Study 150, 659

APPENDIX:  Abbreviations and Acronyms, 663 ILLUSTRATION CREDITS, 669

Copyright © 2013 by Mosby, an affiliate of Elsevier Inc. Copyright © 2009, 2005, 2001, 1996, by Mosby, Inc. an affiliate of Elsevier Inc. All rights reserved.

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