Advanced Assessment Interpreting Findings and Formulating Differential Diagnoses FOURTH EDITION
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Advanced Assessment Interpreting Findings and Formulating Differential Diagnoses FOURTH EDITION
Mary Jo Goolsby, EdD, MSN, NP-C, FAANP, FAAN Principal, Institute for NP Excellence, LLC Augusta, GA
Laurie Grubbs, PhD, ARNP-C Professor of Nursing Florida State University College of Nursing Tallahassee, Florida
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F.A. Davis Company 1915 Arch Street Philadelphia, PA 19103 www.fadavis.com
Copyright © 2019 by F. A. Davis Company Copyright © 2019 by F. A. Davis Company. All rights reserved. This book is protected by copyright. No part of it may be reproduced, stored in a retrieval system, or transmitted in any form or by any means, electronic, mechanical, photocopying, recording, or otherwise, without written permission from the publisher. Printed in the United States of America Last digit indicates print number: 10 9 8 7 6 5 4 3 2 1
Editor-in-Chief, Nursing: Jean Rodenberger Manager of Project and eProject Management: Cathy Carroll Senior Content Project Manager: Shana Murph Design Manager: Carolyn O’Brien As new scientific information becomes available through basic and clinical research, recommended treatments and drug therapies undergo changes. The author(s) and publisher have done everything possible to make this book accurate, up-to-date, and in accord with accepted standards at the time of publication. The author(s), editors, and publisher are not responsible for errors or omissions or for consequences from application of the book, and make no warranty, expressed or implied, in regard to the contents of the book. Any practice described in this book should be applied by the reader in accordance with professional standards of care used in regard to the unique circumstances that may apply in each situation. The reader is advised always to check product information (package inserts) for changes and new information regarding dose and contraindications before administering any drug. Caution is especially urged when using new or infrequently ordered drugs. Library of Congress Cataloging-in-Publication Data Names: Goolsby, Mary Jo, editor. | Grubbs, Laurie, editor. Title: Advanced assessment : interpreting findings and formulating differential diagnoses / [edited by] Mary Jo Goolsby, Laurie Grubbs. Description: Fourth edition. | Philadelphia, PA: F.A. Davis Company, [2019] | Includes bibliographical references and index. Identifiers: LCCN 2018039856 (print) | LCCN 2018041376 (ebook) | ISBN 9780803690059 | ISBN 9780803668942 (pbk.) Subjects: | MESH: Nursing Assessment--methods | Diagnosis, Differential | Nurse Practitioners Classification: LCC RC71.5 (ebook) | LCC RC71.5 (print) | NLM WY 100.4 | DDC 616.07/5--dc23 LC record available at https://lccn.loc.gov/2018039856
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Preface A growing body of literature addresses the risks associated with clinical decision making. In 2015, the National Academy of Medicine (formerly, Institute of Medicine) identified diagnostic error as the “blind spot” in health-care delivery. The original idea for this book arose from our recognition that the many health assessment texts available lacked an essential component—content on how to narrow a differential diagnosis when a patient presented with one of the almost endless possible complaints. The response to the earlier editions of this text supported belief in the need for a text that addressed the lack of content designed to support expertise in the assessment and diagnostic process. We hope that this updated edition will continue to aid advanced practice students, new practitioners, and experienced practitioners faced with new presentations. In spite of the growth in available diagnostic technology and studies, expertise in correctly performing assessment skills, obtaining valid data, and interpreting the findings accurately is fundamental to the provision of the safe, high-quality, patient-centered, and cost-effective practice for which NPs are known. Even once these skills are accomplished, accurate diagnosis remains a difficult aspect of practice. Novice practitioners often spend much energy and time narrowing their differential diagnosis when they have no clear guidance that is driven by the patient or complaint. For this reason, our aim was to develop a guide in the assessment and diagnostic process that is broad in content and suitable for use in varied settings. Advanced Assessment: Interpreting Findings and Formulating Differential Diagnoses has been designed to serve as both a textbook during advanced health assessment course work and subsequent clinical courses and as a quick reference for practicing clinicians. We believe that studying the text will help students develop proficiency in performing and interpreting assessments, recognizing the range of conditions that can be indicated by specific findings. Once in practice, we believe that the text will aid individualized assessment and narrowing of differential diagnosis. The book consists of three parts. Part I provides a summary discussion of assessment and some matters related to clinical decision making. In addition to discussing the behaviors involved in arriving at a definitive diagnosis, each chapter covers some pitfalls that clinicians often experience and the types of evidence-based resources that are available to assist in the diagnostic process. This section includes a unique chapter on conducting a genetic assessment. This component of health assessment has great potential, with recent advances in the information and technology related to genetics and genomics. It is critical that clinicians be able to address the potential of hereditary diseases and genetic variations that may affect their patients. This chapter, like the one on clinical decision making, is relevant to the content of all subsequent chapters. Part II serves as the core of the book and addresses assessment and diagnosis using a system and body region approach. Each chapter in this part begins with an overview of the comprehensive history and physical examination of a specific system, as well as a discussion of common
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