Diseases and Disorders, 6th Edition
Diseases and Disorders: A Nursing Therapeutics Manual. 6th Edition. © 2019 F.A. Davis
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Marilyn Sawyer Sommers, PhD, RN, FAAN
University of Pennsylvania School of Nursing
Consultants for 6th Edition
Christopher Cali, PhDc
University of Pennsylvania Cell & Molecular Biology
Genetics and Epigenetics Program
Gloria H. Coats, RN, MSN, FNP
Family Nurse Practitioner and Professor of Nursing
Modesto Junior College
Consultants from Previous Edition
Blair B. Madison, PhD
University of Pennsylvania
Amy E. McKeever, PhD, RN, WHNP-BC
Clinical Assistant Professor
Ehriel Fannin, PhDc, RN, CNL
University of Pennsylvania School of Nursing
Lynn D. Phillips, MSN, RN, CRNI
Nursing Education Consultant
Ruth A. Wittmann-Price, PhD, RN, CNE, Perinatal CNS
Drexel University College of Nursing and Health Professions
The first five editions of this book were conceived to provide distilled, up-to-date information to nursing students and staff nurses about the many conditions and diagnoses encountered in nursing practice. It was my intent that the book would respond to the ever-increasing need for nurses to understand the scientific basis of their practice by emphasizing the pathophysiology and genetic bases of diseases and disorders as well as the scientific advances that guide disease and symptom management. Evidence-based practice is a value that underlies the goal of all entries in this book and relies on three important principles. Nursing practice is based on the best available research evidence that supports whether a treatment is successful or not. It also relies on the clinical judgment of clinicians and recognizes patient preferences, values, and participation in their care. Throughout the first five editions, I held true to the initial purpose: to provide a ready source of information for nurses in a time of short staffing, brief lengths of stay, and increasing patient acuity in the hospital, in nursing homes, in rehabilitation centers, and in the home.
With the sixth edition, I have tried to respond to the changing global healthcare environment as well as to the recommendations of our readers that more information is needed to guide evidence-based care. I have updated the section titled Global Health Considerations to reflect a global society where many families migrate to, travel to, and live on multiple continents. This section acknowledges that the health of world populations becomes as important as the health of a neighborhood. Cardiovascular disease, poor nutrition, violence, and injury cause death and disability around the world. Infectious diseases such as tuberculosis, HIV disease, measles, malaria, and pneumococcal diseases threaten multiple populations. Human papillomavirus and Trichomonas vaginalis infections are threatening the health of a generation of young women. By cultivating a global perspective, students and practicing nurses can prepare themselves for the next decades of healthcare. In the section Evidence-Based Practice and Health Policy, I have chosen specific research studies or policy briefs that relate to each entry and provide current information to guide nursing practice. The cited studies were selected because of their timeliness, relationship to nursing practice, and introduction of innovative therapies to improve health. I am also indebted to Christopher Cali, a geneticist at the University of Pennsylvania, who worked with me to update and expand the Genetic Considerations sections. As the volume of material about the genetic basis of disease proliferates, and as our understanding increases about how genetic and environmental factors relate to health and disease, this content has become essential to nursing practice.
Each entry begins with the Diagnosis Related Group (DRG) category. DRGs were initiated by the Health Care Financing Administration to serve as an organizing framework to group related conditions and to stabilize reimbursements. Because they provide a convenient standard to evaluate hospital care, DRGs are used by institutions and disciplines to measure utilization and to allocate resources. I have included DRGs to indicate the expected norms in average length of hospital stay for each entry (Mean LOS). In addition, entries begin with the background information on epidemiology and physiology, causation, and considerations including genetics, gender, race/ethnicity, life span, and global health. I recognize that race, ethnicity, and gender are social and political constructs. Just as there are many races, there are also many genders and categorizing people into groups, including a gender binary of male and female, does not represent the individuals for whom we provide care. I have tried to consider issues of race, ethnicity, and gender without stereotyping, but rather to inform nursing care. I will continue to work toward a goal of health equity in coming editions. Each entry follows the nursing process, with assessment information incorporated in the History and Physical Assessment sections, Psychosocial Assessment, and Diagnostic Highlights. Based on requests from our readers and reviewers, I have supplemented information on diagnostic testing to provide normal and abnormal values for the most important diagnostic tests. I have also added a section to explain the rationale for the test. These detailed, specific sections provide the foundation needed to perform a comprehensive assessment of the patient’s condition so that a Primary Nursing Diagnosis can be formulated that is appropriate to the patient’s specific needs. The Planning and Implementation section is divided into Collaborative and Independent interventions. The intent of the Collaborative section is to detail the goals of a multidisciplinary plan of care to manage the condition or disease. As in the first five editions, there is an expanded section on Pharmacologic Highlights that explores commonly used drugs, along with their doses, mechanisms of action, and rationales for use. The Independent section focuses on independent nursing interventions that demonstrate the core of the art and science of nursing. Each entry then finishes with Evidence-Based Practice and Health Policy, Documentation Guidelines, and Discharge and Home Healthcare Guidelines to help nurses evaluate the outcomes of care and to prepare hospitalized patients for discharge.
As with each preceding edition, the team at F. A. Davis has made the revision of the book much easier, and I am grateful to Rob Allen, Terri Allen, and Amy Romano for their patience, support, and assistance. I am also particularly grateful to Gloria Coats, an expert in gynecological and obstetrics nursing, who made an important contribution to the revision of the sixth edition. The entire reason to revise this book is to provide practicing nurses a concise yet current and scientifically sound text to guide the professional practice of nursing. The provision of nursing care in the 21st century presents us with overwhelming challenges, and yet nursing is the discipline of choice for millions of practitioners. I hope this book honors the science of nursing and makes it easier to practice the art of nursing.
Marilyn (Lynn) S. Sommers
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