Preface

This manual is not about how to make a medical or nursing diagnosis. However, it is about critical thinking and the diagnostic reasoning process that occurs from the moment the patient presents for help in the emergency department (ED) to his or her admission or discharge from the hospital. Organizing this reasoning process by health system acuity and nursing diagnoses assists the nurse in making life-or-death decisions about patient care even when the etiology is unclear. The authors of these case studies have been selected because of their expertise in emergency care and diagnostic reasoning. The case study format has been chosen because it lends itself to "thinking" through the major considerations for each patient type. Although protocols may vary from hospital to hospital or among prehospital care regions, rationale are provided for the specific interventions that are used in this manual based on an understanding of the etiology and pathophysiology of disease and the current standard of care for patients with similar complaints.

The cases included here are not intended to be all-inclusive of the myriad of patient complaints that are seen in the ED setting. The case studies here were selected to represent high-risk situations that may be encountered in any ED. These cases are fairly representative of situations encountered with high frequency in a selected urban setting. In other EDs across the country these conditions may be present but volume or frequency may not be the same.

However, the process of patient assessment and determination of acuity by presenting symptoms and the application of nursing diagnoses with an understanding of the etiology and pathophysiology of the presenting complaint can be applied to any patient situation and drive decision making for appropriate nursing intervention. Hopefully, this manual sets the stage for that process in any clinical setting. The reader is referred to other volumes in this series for case studies in trauma and critical care that are part of this framework of thinking.

I would be remiss if I did not take this opportunity to thank a few key people who helped make this production possible—Susan Glover for thinking of us: Diann for her tolerance of all my last minute changes; Shannon, who did not know she could type; and my husband Dan for his endless patience. A very special thank you is due to all those doctors, nurses, and pre-hospital providers who are out there daily, trying to make a difference.

Barbara Mlynczak -Callahan, RN, MS, CCRN