ISSN:1079-0713    

出版商:OVID    

年代:1997

数据来源: OVID

摘要:

Diagnostic reasoning is a dynamic thinking process that leads to the identification of a hypothesis that beat explains the clinical evidence. Nurses in advanced practice today frequently diagnose the origin of medical and nursing problems that develop in acutely and critically Ill adults. Inherent in the specialty fields of acute and critical care are unique factors that can affect the quality of diagnostic reasoning and can potentially complicate the process. An understanding of the basic principles underpinning diagnostic reasoning and the associated common errors is essential for clinicians and students to improve their diagnostic skills.

ISSN:1079-0713    

出版商:OVID    

年代:1997

数据来源: OVID

摘要:

Advanced parctice nurses are responsible for diagnosing and treating patlents with acute onset hypotension. The potential diagnositc hypotheses for hypotension are related to a wide variety of pathophysiologic processes. These processes are represented by the acronym VINDICATE—Vascular (and cardiac), Inflammatory, Neoplastic, Degenerative, Intoxication/Iatrogenic, Congential, Allergic/Autoimmune, Traumatic, Endocrine/Metabolic However, acute onset hupotension experienced by the adult patient in the hospital is likely to be caused by the vascular (and cardiac) Processes of absolute hypovolemia, relative hypovolemia, and pump failure. Developing the differential diagnosis for acute onset huypotension involves making a series of clinical decisions in a stepwise manner. The clinician bases these decisions on information contained in a subjective and objective database and on recognizing patterns in the central findings. Hewever, treatment of hypotension may be necessary before or during the diagnostic process, depending on the severity of the patients's symptoms.

ISSN:1079-0713    

出版商:OVID    

年代:1997

数据来源: OVID

摘要:

Acute changes in mental status can occur in any hospital setting. Clinicians are often at a loss to define accurately the course of a change in mental status, because of poor differentiation in the terminology surrouding this difficult diagnosis. A clear understanding of the differences among several levels of altered mental status is needed to evaluate, accurately diagnose, and treat those patients with altered mental states. The differential diagnosis of altered mental status is diffuse and includes supratentorial mass lesions, infratentorial mass lesion, and metabolic disorders. Development of an individualized differential diagnosis and diagnostic approach of cases of altered mental status represents a challenge to all levels of clinicians.

ISSN:1079-0713    

出版商:OVID    

年代:1997

数据来源: OVID

摘要:

Agitation is afrequent clinical problem that adds significant morbidity ot the hospital course. Agitation is usually part of an ambiguous constellation of cognitive and psychiatric symptoms, with a fluctuating clinical course. Observation of vastly different symptoms occurring at different times leads to misdiagnosis or underrecognition of serious underlying disorders. The most common causes of agitation include delirium, dementia, and acute psychosis, Risk factors attributable to hospitalization inclde pain, anxiety, and stressors endemic to intensive care. Agitated states may have multiple causes, and each potential contributor must be pursued and treataed independently. Definitive diagnosis is dependent on a comprehensive history, patient observation, physical examination, and selective diagnostic studies.

ISSN:1079-0713    

出版商:OVID    

年代:1997

数据来源: OVID

摘要:

Fever is a host defense response that provides a sign of an ongoing process related to infection, inflammation, drug reactions, neoplasms, autoimmune diseases, and vascular disorders. The most frequent causes of fever in acutely ill patients are infection and inflammation, but fever may be caused by one or more of a long list of pathophysiologic processes.

ISSN:1079-0713    

出版商:OVID    

年代:1997

数据来源: OVID

摘要:

Hypothermia in the hospitalized adult may be a primary process, as in exposure, or a result of a multitude of disease processes or iatrogenic factors. The condition affeacts virtually every metabolic process in the body. A thorough understanding of the pathophysiology of hypothermia enables the clinician to differentiate between the hypothermic syndrome and uderlying illness and can assist in the detection and mangement of clinical sequelae. A reliable patient history is the most helpful diagnostic tool, but careful physical examination and laboratory studies are also important for detection of primary or secondary illness.

ISSN:1079-0713    

出版商:OVID    

年代:1997

数据来源: OVID

摘要:

Chest pain is the intial symptom of many life-threatening disease processes. Pain may arise from any structure located in the thoracic cavity. Cardiac causes of chest pain usually have anginal symptoms. Noncardiac causes have a variety of chest pain characteristics. Diseases that require immediate attention and intervention are myocardial infarction/unstable angina, dissecting aorlic aneurysm, pericarditis, pulmonary emboilsm, pneumothorax, pneumonia, and acute chest syndrome. In order to evaluate a patient with the complaint of chest pain, the advanced practice nurse must be familiar with the differential diagnosis approach to acute chest pain.

ISSN:1079-0713    

出版商:OVID    

年代:1997

数据来源: OVID

摘要:

Acute dyspnea is a common symptom in the adult patient in the hospital and often requires rapid assessment and intervention. This sensation accompanies a variety of disorders, including an exacerbation of underlying chronic pulmonary disease, acute pulmonary disease, abnormalities in gas exchange, cardiac disease, neuromuscular dysfunction, and anxiety disorders.

ISSN:1079-0713    

出版商:OVID    

年代:1997

数据来源: OVID

摘要:

The finding of a pulmonary infiltrate on chest radiograph may represent a spectrum of pathologic entities in the acutely ill hospitalized adult. Timely intervention depends on the advanced practice nurse's ability to devise a differential diagnosis based on the characteristics of the infiltrate and the clinical setting. Pulmonary infiltrates are described as interstitial or alveolar, diffuse or local. Their presentation may be chronic or acute in nature. Understanding the nuances of chest radiographic interpretation provides the foundation on which the infiltrate is described and is therefore the first step in establishing the differential diagnosis. Thorough clinical assessment and thougtful requisition of diagnostic studies are used to discriminate the disorders found in the differential diagnosis. Using an organized approach to describe the radiographic abnormality and define its clinical context, the advanced practice nurse can efficiently establish a diagnosis so that the work of treatment may begin.

ISSN:1079-0713    

出版商:OVID    

年代:1997

数据来源: OVID