Table Of ContentBrief Contents
PART ONE MEDICAL-SURGICAL CASES, 1
Chapter1
Cardiovascular Disorders, 1
Chapter2
Respiratory Disorders, 83
Chapter3
Musculoskeletal Disorders, 149
Chapter4
Gastrointestinal Disorders, 189
Chapter5
Genitourinary Disorders, 235
Chapter6
Neurologic Disorders, 273
Chapter7
Endocrine Disorders, 341
Chapter8
Immunologic Disorders, 367
Chapter9
Oncologic and Hematologic Disorders, 393
PART TWO PEDIATRIC, MATERNITY, AND PSYCHIATRIC CASES, 439
Chapter10
Pediatric Disorders, 439
Chapter11
Maternal and Obstetric Disorders, 505
Chapter12
Women's Health Disorders, 533
Chapter13
Psychiatric Disorders, 559
PART THREE OTHER/ADVANCED CASES, 591
Chapter14
Alternative Therapies, 591
Chapter15
Patients with Multiple Disorders, 599
Chapter16
Emergency Situations, 625
Appendix:
Abbreviations and Acronyms, 663
Illustration Credits,
669
5
TH EDITION
Critical
Winningham's
Thinking Cases
In Nursing
Medical-Surgical, Pediatric,
Maternity, and Psychiatric
MARIANN HARDING, MSN, RN
Associate Professor
Department of Nursing
Kent State University at Tuscarawas
New Philadelphia, Ohio
JULIE S. SNYDER, MSN, RN-BC
Adjunct Faculty
School of Nursing
Old Dominion University
Norfolk, Virginia
BARBARA A. PREUSSER†, PHD, FNPC
Family Nurse Practitioner
Veterans Administration Medical Center
Salt Lake City, Utah
†Deceased
3251 Riverport Lane
St. Louis, Missouri 63043
WINNINGHAM'S CRITICAL THINKING CASES IN NURSING:
MEDICAL-SURGICAL, PEDIATRIC, MATERNITY, AND PSYCHIATRIC ISBN: 978-0-323-08325-6
Copyright © 2013 by Mosby, Inc., an affiliate of Elsevier Inc.
No part of this publication may be reproduced or transmitted in any form or by any means, electronic or
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This book and the individual contributions contained in it are protected under copyright by the Publisher
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Notices
Knowledge and best practice in this field are constantly changing. As new research and experience broaden
our understanding, changes in research methods, professional practices, or medical treatment may become
necessary.
Practitioners and researchers must always rely on their own experience and knowledge in evaluating and
using any information, methods, compounds, or experiments described herein. In using such information
or methods they should be mindful of their own safety and the safety of others, including parties for whom
they have a professional responsibility.
With respect to any drug or pharmaceutical products identified, readers are advised to check the most cur-
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and to take all appropriate safety precautions.
To the fullest extent of the law, neither the Publisher nor the authors, contributors, or editors, assume any liability
for any injury and/or damage to persons or property as a matter of products liability, negligence or otherwise, or
from any use or operation of any methods, products, instructions, or ideas contained in the material herein.
Previous editions copyrighted 2009, 2005, 2001, 1996
Library of Congress Cataloging-in-Publication Data
Harding, Mariann.
Winningham's critical thinking cases in nursing : medical-surgical, pediatric, maternity, and psychiatric /
Mariann Harding, Julie S. Snyder, Barbara A. Preusser. – 5th ed.
p. ; cm.
Critical thinking cases in nursing
Rev. ed. of: Critical thinking in medical-surgical settings / Maryl L. Winningham and Barbara A. Preusser. 2nd
ed. c2011.
Includes bibliographical references.
ISBN 978-0-323-08325-6 (pbk. : alk. paper)
I. Snyder, Julie S. II. Preusser, Barbara A. III. Winningham, Maryl Lynne, 1947–2001. Critical thinking in
medical-surgical settings. IV. Title. V. Title: Critical thinking cases in nursing.
[DNLM: 1. Nursing Process–Case Reports. 2. Nursing Process–Problems and Exercises. 3. Nursing Care–
Case Reports. 4. Nursing Care–Problems and Exercises. WY 18.2]
610.73–dc23 2012003221
Executive Content Strategist: Lee Henderson
Content Development Specialist: Jacqueline Twomey
Publishing Services Managers: Hemamalini Rajendrababu & Deborah L. Vogel
Project Managers: Anitha Sivaraj & John W. Gabbert
Design Direction: Karen Pauls
Printed in the United States of America
Last digit is the print number: 9 8 7 6 5 4 3 2 1
To Drs. Maryl L. Winningham and Barbara A. Preusser
Drs. Winningham and Preusser, authors of this text for the previous four editions,
dedicated their lives to the care of others and the pursuit of excellence in nursing practice.
They have bequeathed a nursing heritage of integrity, excellence, courage, and service
to their students, colleagues, and readers.
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Contributors
Ann Campbell, RN, MSN, CPNP Sara B. Forbus, MSN, RN
Faculty Faculty
School of Nursing School of Nursing
Old Dominion University Old Dominion University
Norfolk, Virginia Norfolk, Virginia
Contributors to Previous Editions
Elizabeth Jane Bell, MSN, ANPc Janet G. Madsen, PhD
Lesley A. Black, BSN, MS, ANPc, CWOCN Debra Ann Mills, RN, MS
Kent Blad, MS, FNPc, ACNP-C, FCCM Jeanie O'Donnell, MSN
Jamie Clinton-Lont, BSN, FNPc Deb Plasman-Coles, PAc
Susan L. Croft, BSN, MS Laura Lee Scott, MSN, FNPc
Joyce Foster, PhD, CNM, FACNM, FAAN Mary Seegmiller, MSN
Shellagh Gutke, BSN, CWOCN Sandra Smeeding, MS, FNPc
Nancy Hayden, MSN, FNPc Deborah D. Smith, BSN
Sondra Heaston, MS, FNPc, CEN Ann Speirs, BSN
Janice Hulbert, RN, MS Ronald Ulberg, BSN, MSN
Lisa Jensen, BSN, MS, APRN, CS Kristy Vankatwyk, MSN, FNPc
Stephanie C. Kettendorf, MS, RN, CNS, NCBF Annette S. Wendel, BSN
Julie Killebrew, BSN, MS Wendy Whitney, MSN, FNPc, CANP
Karen Kone, BSN, ACRN Mary Youtsey, BSN, CDE
Kathleen Kuntz, MSN, APRN, SANE
Copyright © 2013 by Mosby, an affiliate of Elsevier Inc.
Copyright © 2009, 2005, 2001, 1996, by Mosby, Inc. an affiliate of Elsevier Inc. All rights reserved. v
Reviewers
Diane K. Daddario, MSN, ACNS-BC, RN, Jamie Lynn Jones, MSN, RN
BC, CMSRN Assistant Professor, Nursing
Nurse Specialist University of Arkansas at Little Rock
Geisinger Medical Center Little Rock, Arkansas
Danville, Pennsylvania;
Tamara M. Kear, PhD, MSN, RN
Staff Nurse
Evangelical Community Hospital Assistant Professor of Nursing
Lewisburg, Pennsylvania; Villanova University
Nursing Instructor Villanova, Pennsylvania
Pennsylvania College of Technology
Cheryl A. Lehman, PhD, RN, CNS-BC,
Williamsport, Pennsylvania
RN-BC, CRRN
Jennifer Duhon, RN, MS CNS Program Coordinator
Director of Health Services Department of Health Restoration &
Lutheran Senior Services Care Systems Management (HRCSM)
Peoria, Illinois Clinical Associate Professor
The University of Texas Health Science
Sara B. Forbus, MSN, RN Center at San Antonio
Faculty San Antonio, Texas
School of Nursing
Casey Norris, MSN, BSN
Old Dominion University
Norfolk, Virginia Adjunct Instructor, Nursing
South College
Mimi Haskins, MS, RN, CMSRN Pulmonary Clinical Nurse Specialist
Nursing Staff Development Instructor East Tennessee Children's Hospital
Roswell Park Cancer Institute Knoxville, Tennessee
Buffalo, New York
Brenda K. Shelton, MS, RN, CCRN, AOCN
Suzanne Jed, MSN, APRN-BC The Sidney Kimmel Cancer Center at Johns
Clinical Instructor, Family Medicine Hopkins
Keck School of Medicine Baltimore, Maryland
University of Southern California
Los Angeles, California
Copyright © 2013 by Mosby, an affiliate of Elsevier Inc.
vi Copyright © 2009, 2005, 2001, 1996, by Mosby, Inc. an affiliate of Elsevier Inc. All rights reserved.
Introduction
There is an urgent need for nurses with well-practiced critical thinking skills. As new graduates,
you will make decisions and take actions of an increasingly sophisticated nature. You will encoun-
ter problems you have never seen or heard about during your classroom and clinical experiences.
You are going to have to make complex decisions with little or no guidance and limited resources.
We want you to be exposed to as much as possible during your student days, but more impor-
tantly, we want you to learn to think. You cannot memorize your way out of any situation, but you
can think your way out of any situation. We know that students often learn more and faster when
they have the freedom to make mistakes. This book is designed to allow you to experiment with
finding answers without the pressure of someone's life hanging in the balance. We want you to do
well. We want you to be the best. It is our wish for you to grow into confident, competent profes-
sionals. After all, someday we will be one of those people you care for, and when that day comes, we
want you to be very, very good at what you do!
What Is Critical Thinking?
Critical thinking is not memorizing lists of facts or the steps of procedures. Instead, critical think-
ing is an analytical process that can help you think through a problem in an organized and efficient
manner. Five steps are involved in critical thinking. Thinking about these steps may help you when
you work through the questions in your cases. Here are the five steps with an explanation of what
they mean.
1. Recognize and define the problem by asking the right questions: Exactly what is it you need
to know? What is the question asking?
2. Select the information or data necessary to solve the problem or answer the question: First
you have to ask whether all the necessary information is there. If not, how and where can
you get the additional information? What other resources are available? This is one of the
most difficult steps. In real clinical experiences, you rarely have all of the information,
so you have to learn where you can get necessary data. For instance, patient and family
interviews, nursing charting, the patient medical chart, laboratory data on your computer,
your observations, and your own physical assessment can help you identify important clues.
Of course, information can rapidly become outdated. To make sure you are accessing the
most current and accurate information, you will occasionally need to use the Internet to
answer a question.
3. Recognize stated and unstated assumptions; that is, what do you think is or is not true?
Sometimes answers or solutions seem obvious; just because something seems obvious doesn't
mean it is correct. You may need to consider several possible answers or solutions. Consider
all clues carefully and do not dismiss a possibility too quickly. Remember, “You never find an
answer you don't think of.”
Copyright © 2013 by Mosby, an affiliate of Elsevier Inc.
Copyright © 2009, 2005, 2001, 1996, by Mosby, Inc. an affiliate of Elsevier Inc. All rights reserved. vii
INTRODUCTION
4. Formulate and select relevant and/or potential decisions. Try to think of as many possibilities
as you can. Consider the pros and cons of the consequences of making each decision. What is
the best answer/solution? What could go wrong? This requires considering many different
angles. In today's health care settings, decision-making often requires balancing the well-
being needs of the patient, the preferences and concerns of the patient and caregiver, and
financial limitations imposed by the reimbursement system. In making decisions, you
need to take into account all relevant factors. Remember, you may need to explain why you
rejected other options.
5. Draw a valid, informed conclusion: Consider all data; then determine what is relevant and
what makes the most sense. Only then should you draw your conclusion.
It may look as if this kind of thinking comes naturally to instructors and experienced nurses.
You can be certain that even experienced professionals were once where you are now. The rapid and
sound decision-making that is essential to good nursing requires years of practice. The practice of
good clinical thinking leads to good thinking in clinical practice. This book will help you practice
the important steps in making sound clinical judgments until the process starts to come naturally.
The practice of good clinical thinking leads to good thinking in clinical practice.
The “How to” of Case Studies
When you begin each case, read through the whole story once, from start to finish, getting a general
idea of what it is about. Write down things you have to look up. This will help you move through
the case smoothly and get more out of it. How much you have to look up will depend on where you
are in your program, what you know, and how much experience you already have. Preparing cases
will become easier as you advance in your program.
Copyright © 2013 by Mosby, an affiliate of Elsevier Inc.
viii Copyright © 2009, 2005, 2001, 1996, by Mosby, Inc. an affiliate of Elsevier Inc. All rights reserved.
