Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Nsg 101 > Ch 16 > Flashcards

Ch 16 Flashcards

You may prefer our related Brainscape-certified flashcards:
Physics 101 flashcards Psychology 101 flashcards Chemistry 101 flashcards Biology 101 flashcards Organic Chemistry 101 flashcards Sociology 101 flashcards
1
Q

What is clinical judgement?

A

A conclusion drawn about pt needs and appropriate actions to take.
Helps:
Make informed and timely decisions
Deliver holistic, patient centered care

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

What is Nursing process?

A

•5 step process
• applies critical thinking skills
•application of evidence- based practice

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

What are the 5 steps I. The nursing process?

A

A-assessment
D-diagnosis
P-planning
I-implementation
E-evaluation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Clinical judgement steps

A

6 steps
•recognizing cues
•analyze cues
•prioritize hypotheses
•generate solutions
•take action
•evaluate outcomes

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Recognize cues

A

Identifying relevant & important info from different sources(medical history, vital signs)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Analyze cues

A

Organizing & linking the recognized cues to the clients clinical presentation
-what client conditions are consistent w/the cues?

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Prioritize hypotheses

A

Evaluating & ranking hypotheses according to priority(urgency, likelihood, risk, difficulty, time, etc)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Generate solutions

A

Identifying expected outcomes and using hypotheses to define a set of interventions for the expected outcomes.
-what are the desirable outcomes

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Take action

A

Implementing the solutions that address the highest priorities

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Evaluate outcomes

A

Comparing observed outcomes against expected outcomes.
-what signs point to improving/decking/unchanged status?
-were the interventions effective

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

What is assessment?

A

Gathering of information

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Assessment steps

A

-collect data
-interpret information

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

What helps you identify meaningful patterns

A

Cues you see

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Applications of critical thinking

A

5— knowledge base
Environment
Experience
Standards
Attitudes

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Types of assessment

A

There are 2
-patient centered interview:
•patient history-acute or chronic issue
• main complaint
•review medication
-periodic assessments
•conducted ongoing
• assessing each time you enter the room

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Subjective data

A

What the patient tells you

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

Objective data

A

What you see; measurable output
- vital signs

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

Primary data

A

The patient provides

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

Secondary data

A

Information from family, friends, nurses, or anything in the medical records.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

Patient centered interview

A

Orientation: introduction; tells the pt why you are there
Working phase: talking, collecting data, setting a mutual goal
Termination phase: summarizing the data/info to ensure it is accurate

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

Assessment barriers

A

Setting
Time
Task complexity
Interruptions

22
Q

Examples of cues

A

-Incision red, draining pus, edges separated
-Tearful. Stated father died of a heart attack.

23
Q

Examples of inferences

A

•incision is infected
•anxious about scheduled cardiac catherization
•patient is angry and suicidal
(Assuming, trying to diagnose)

24
Q

Obtaining a health history

A

• biographical data
-name, gender, address
•chief concerns/why they are seeking care:
- how long has this been going on
•patient expectations
•present illness of health concern
(P) provokes
(Q) quality
(R) radiate
(S) severity
(T) time

25
Q

Analyze cues(nursing diagnosis)

A

-2nd step in nursing process
-links assessment to all steps that follow
- describes pts PRESENT health status

26
Q

Medical diagnosis

A

Comes from the physician

27
Q

Nursing diagnosis

A

Comes from the nurse; is a potential health issue

28
Q

Collabrative problem

A

Involves nurses and physicians interventions

29
Q

Types of nursing diagnosis

A

• Problem focused:
This is actually going on w/patient.
• Risk
What could potentially happen.

30
Q

Problem focused

A

Evidence (cues) proven issues (symptoms)

31
Q

Risk

A

Possibilities; has not occurred

32
Q

3 part nursing a diagnosis (actual problem)

A

Problem+etiology+symptoms

33
Q

2part nursing diagnosis(risk or potential problem)

A

Problem+etiology

34
Q

Maslo es hierarchy of needs

A

5 levels
- physiological needs
- safety & security
- love&belonging
- esteem
- self-actualizacion

35
Q

What to put in care plan?

A

-basic needs & activities of daily living (ADLs)
-Medical.multidisciplinary treatment
-nursing diagnoses & collaborative problems
-special discharge needs or teaching

36
Q

Expected outcome

A

Willa always be opposite of diagnosis

37
Q

Patient centered goals

A

Highest level of function goals for patient

38
Q

SMART GOALS

A

S-specific
M-measurable
A- achievable
R- realistic
T- timely

39
Q

Components of a goal statement

A

Have 3 things
-subject
-action verb
-performance criteria
-target time
-special conditions
Ex:
The pt will walk to the doorway w/the help of one person by 11/21/17

40
Q

Take action (implementation)

A
  • 4th step in the nursing process
    -begins after plan of care is developed
    -Puts the plan into action to promote positive pt outcome
41
Q

Evaluate outcomes (evaluation)

A

5th step in the nursing process

42
Q

Nursing interventions

A

5 nursing interventions
Direct care interventions
Indirect care interventions
Dependent interventions
Independent interventions
Other provider interventions

43
Q

Direct care interventions

A

Directly helping patient; bedside
(Oral care)

44
Q

Indirect care interventions

A

What you do on behalf of the patient away from bedside
Advocating, giving report

45
Q

Dependent intervention

A

Waiting on physician to give order
(Medication, o2)

46
Q

Independent interventions

A

You do not need a physicians order
(Keeping head of bed elevated)

47
Q

Other provider interventions

A

Collaborative intervention, giving patient medication, then turning patient

48
Q

Evaluation measures

A

Physical: listening to lungs, looking for physiological changes
Behavioral: going by what the patient tells you; relying on what is told

49
Q

Discontinuing a care plan

A

A care plan is discontinued once it is effective and has worked

50
Q

Modifying a care plan

A

A care plan is modified when it has not work and need a reevaluation

Nsg 101 (11 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions