Medical-Surgical Nursing: Critical Thinking in Patient Care (5th Edition)

Book Preface

Why We Wrote this Book

Medical-Surgical Nursing: Critical Thinking in Patient Care is based on our philosophy that nursing care is provided for the whole person, and not just for a malfunction of one or more body systems.

Therefore, our text is structured by functional health patterns. Functional health patterns, as defined by Dr. Marjorie Gordon, include several important components: patterns of behavior, nursing assessment, and nursing diagnoses. Patterns indicate a sequence of recurring behavior and are interrelated, interactive, and interdependent. Health behaviors may be functional or dysfunctional. Dysfunctional patterns of health are indicated by manifestations of an illness or trauma, or may be risk factors for illness or injury. Both functional and dysfunctional patterns of health are identified by assessment and are given labels (nursing diagnoses) to direct care within the nursing process.

We revised and updated the fifth edition of Medical-Surgical Nursing: Critical Thinking in Patient Care to provide the knowledge and skills needed to care for adult patients to promote health, facilitate recovery from illness and injury, and provide support when coping with disability or loss. Throughout the text, we make every effort to communicate that both nurses and patients may be male or female; and that patients require holistic, individualized care regardless of their age, gender, or racial, cultural, or socioeconomic background. Our goal is to provide the knowledge and resources that ensure a solid base for critical thinking and clinical judgment and that can be applied to provide safe, individualized, and competent clinical nursing care. We use understandable language and a consistent format, and students overwhelmingly report that they actually like reading our text. We have developed multiple learning strategies to facilitate success—audio, illustrations, teaching tips, and video and animation media.

Starting with the first edition, we have held fast to our vision that this textbook

• maintains a strong focus on nursing care as the essential element in learning and doing nursing, regardless of the gender, age, race, culture, or socioeconomic background of the patient or the setting for care.
• provides a balance of pathophysiology, pharmacology, and interdisciplinary care to support dependent, interdependent, and independent nursing interventions.
• emphasizes the nurse’s role as a caregiver, educator, advocate, leader and manager, and as an essential member of the interdisciplinary healthcare team.
• uses functional health patterns and the nursing process as the structure for providing nursing care in today’s world by prioritizing nursing diagnoses and interventions specific to altered responses to illness.
• fosters critical thinking and decision-making skills as the basis for safe, knowledgeable, individualized clinical practice.

ORGANIZATION

The book is organized into 50 chapters in six major parts, organized by functional health patterns. Each part opens with a concept map illustrating the relationship of a specific functional health pattern to possible nursing diagnoses. The parts are then divided into units based on alterations in human structure and function. Each unit with a focus on altered health states opens with an assessment chapter.

This chapter draws upon the student’s prerequisite knowledge, and serves to reinforce basic principles of anatomy and physiology as applied to assessment in both health and illness. To increase student learning, each chapter in the book includes key terms, learning outcomes and clinical competencies, chapter highlights (not included in the assessment chapters), test yourself NCLEX-type questions, and a bibliography that provides additional reading. Following the assessment chapter in each unit, the nursing care chapters provide information about major illnesses and traumatic injuries. Each of the nursing care chapters follows a consistent format, including three key components:

PATHOPHYSIOLOGY The discussion of each major illness or injury begins with incidence and prevalence, risk factors, and an overview of pathophysiology, followed by manifestations (signs and symptoms) and complications. Selected Focus on Cultural Diversity boxes demonstrate how race, age, and gender affect differences inincidence, prevalence, and mortality. Pathophysiology Linkage tables provide the pathophysiologic basis for manifestations. Throughout Pathophysiology Illustrated and Multisystem Effects of Illness art brings changes in physiologic processes to life. Manifestation boxes summarize specific subjective and objective manifestations.

INTERDISCIPLINARY CARE Interdisciplinary care considers diagnosis and treatment by the healthcare team. The section includes information, as appropriate, about specific tests necessary for diagnosis, medications, surgery and other treatments, fluid management, dietary management, and complementary and alternative therapies. Specific information with related nursing care is highlighted in Medication Administration boxes, Nursing Care of Patients (such as those having a specific treatment or surgery) boxes, and Procedure boxes describing care for advanced procedures.

NURSING CARE Because illness prevention is critical in health care today, health promotion information introduces the nursing care discussion of major illnesses or injuries. Selected major illnesses also include Evidence for Nursing Care boxes with resources for additional review in applying evidence to practice. We discuss nursing assessment and care within a context of priority nursing diagnoses and interventions, with rationales provided for each intervention. Boxes throughout each illness discussion section present information essential to patient care. These features include Nursing Care, Nursing Care of the Older Adult, Meeting Individualized Needs, Practice Alerts, Safety Alerts, Moving Evidence into Action (a summary of a nursing study with critical thinking questions), and NANDA, NIC, and NOC Linkages. Last, for 80 major disorders or trauma, we provide a narrative Case Study & Nursing Care Plan. Critical thinking questions specific to the care plan conclude with a section called Evaluate Your Response that provides additional guidance for critical thinking (with suggestions for decisions provided in the appendix). The nursing care section ends with information about community-based care with suggestions for referrals and additional patient resources.