Exam 1 Important Stuff Flashcards
Define critical thinking
The ability to think in a systematic and logical manner with openness to question and reflect on the reasoning process
List the critical thinking skills:
Interpretation
Analysis
Inference
Evaluation
Explanation
Self-reflection
Which CT skill?
Be orderly in collecting patient data
Interpretation
Which CT skill?
Apply reasoning while looking for patterns to emerge
Interpretation
Which CT skill?
Categorize the data
Interpretation
Which CT skill?
Gather additional data and clarify any uncertain data
Interpretation
Which CT skill?
Be open-minded as you look at a pt’s info
Analysis
Which CT skill?
Do not make careless assumptions
Analysis
Which CT skill?
Does the data reveal a problem or trend that you believe is true, or are there other options?
Analysis
Which CT skill?
Look at the meaning and significance of findings
Inference
Which CT skill?
Are there relationships among findings?
Inference
Which CT skill?
Does pt data help you see that a problem exists?
Inference
Which CT skill?
Look at all situations objectively
Evaluation
Which CT skill?
Use criteria to determine results of nursing actions
Evaluation
Which CT skill?
Reflect on your own behavior
Evaluation
Which CT skill?
Support your findings and conclusions
Explanation
Which CT skill?
Use knowledge and experience to choose strategies to use in care of patients
Explanation
Which CT skill?
Reflect on your experiences
Self reflection
Which CT skill?
Be responsible for connecting your actions with outcomes
Self reflection
Which CT skill?
Identify the ways you can improve your own performance
Self reflection
Which CT skill?
What will make you believe that you have been successful?
Self reflection
Define reflection
Part of critical thinking that involves purposefully reviewing a situation to discover its purpose or meaning
Define validation
Comparison of data with another source to determine data accuracy
Define interpretation
Critically interpret assessment data to determine whether abnormal findings are present (cues & inferences)
List the critical thinking attitudes
Confidence
Independent thinking
Fairness
Responsibility/accountability
Risk taking
Discipline
Perseverance applications
Creativity
Curiosity
Integrity
Humility
Which CT attitude?
Speak with conviction
Confidence
Which CT attitude?
Be prepared before performing a nursing activity
Confidence
Which CT attitude?
Encourage the pt to ask questions
Confidence
Which CT attitude?
Be open-minded about different interventions
Independent thinking
Which CT attitude?
Talk with other nurses and share ideas
Independent thinking
Which CT attitude?
Listen to both sides of a discussion
Fairness
Which CT attitude?
Assume care of all patient with openness
Fairness
Which CT attitude?
Ask for help
Responsibility / accountability
Which CT attitude?
Refer to policy & procedure manual
Responsibility / accountability
Which CT attitude?
Report problems
Responsibility / accountability
Which CT attitude?
Follow standards of care
Responsibility / accountability
Which CT attitude?
If your knowledge causes you to question a healthcare provider, do so
Risk taking
Which CT attitude?
Be willing to recommend alternative approaches to colleagues
Risk taking
Which CT attitude?
Be thorough
Discipline
Which CT attitude?
Use scientific and practice-based criteria
Discipline
Which CT attitude?
Manage time effectively
Discipline
Which CT attitude?
Be cautious of easy answers that avoid uncomfortable situations
Perseverance applications
Which CT attitude?
If facts seem to be missing, clarify info
Perseverance applications
Which CT attitude?
Look for different approaches if intervention isn’t working
Creativity
Which CT attitude?
Always ask why
Curiosity
Which CT attitude?
Be willing to challenge tradition
Curiosity
Which CT attitude?
Explore and learn more about patient to make appropriate clinical judgements
Curiosity
Which CT attitude?
Recognize when your opinions conflict with those of a patient
Integrity
Which CT attitude?
Do not compromise nursing standards or honesty in delivering nursing care
Integrity
Which CT attitude?
Recognize when you need more info to make a decision
Humility
Which CT attitude?
Ask for orientation when you are new
Humility
Which CT attitude?
Ask experienced RNs for assistance with approaches to care
Humility
Which CT attitude?
Ask for orientation when you are new to a unit
Humility
What should you do after you finish a care plan?
Must document it in pt’s chart to share it with care team
By identifying accurate nursing problems, your care plan communicates a patient’s health care responses to the healthcare team
List the types of nursing interventions
Independent
Dependent
Collaborative
What is an independent nursing intervention?
One that can be done without supervision or orders
What is a dependent nursing intervention?
One that is initiated by the health care provider and requires an order
Difference between a goal and an outcome
Goals are broad and outcomes are specific and follow SMART
What does SMART stand for?
Singular
Measurable
Attainable
Realistic
Timed
List the steps of the nursing process in order
Assess
Diagnose
Plan
Implement
Evaluate
List the steps of the CJMM in order
Recognize cues
Analyze cues
Prioritize hypothesis
Generate solutions
Take action
Evaluate outcomes
Which part of the nursing process/CJMM?
Gather info about a patient’s condition
Assess / Recognize cues
Which part of the nursing process/CJMM?
Identify patient’s problems
Diagnose / Analyze cues & Prioritize hypothesis
Which part of the nursing process/CJMM?
Set goals & outcomes
Plan / generate solutions
Which part of the nursing process/CJMM?
Identify appropriate nursing actions
Plan / generate solutions
Which part of the nursing process/CJMM?
Perform nursing actions
Implement / Take action
Which part of the nursing process/CJMM?
Determine if goals and outcomes are achieved
Evaluate / Evaluate outcomes
What happens if goals or outcomes are not met?
Modify the plan by:
- Redefine diagnosis
- Revise goals / expected outcomes
- Revise interventions
What to remember when drawing up insulin
Roll cloudy insulin in hands
Can only mix regular and intermediate insulin
Regular first (clear) before intermediate (cloudy)
Never mix insulin glargine or insulin detemir
List the types of nursing problems
Problem-focused
Risk problem
Health promotion
What is a problem-focused nursing problem?
Identifies an undesirable human response to existing problems or concerns of a patient
What is a risk nursing problem?
Increased potential for a patient to develop a problem or complication
What is a health promotion nursing problem?
Identifies the desire or motivation to improve health status through positive behavioral change
List the types of nursing care interventions
Direct care interventions
Indirect care interventions
What should you do if a patient refuses a medication?
1st: assess patient by asking questions about why
2nd: educate patient
3rd: if pt still refuses, don’t give med and document
What do you do if you find an error in a medication order?
Call the physician and verify it
What do the colors of wrist bands mean?
Yellow = fall risk
Purple = DNR
Red = allergies
Signs of fall risk patients
Bedside commode
Gait belt
Rubber-soled shoes or slippers
Safety bars in bathroom
What do the letters of RACE stand for?
Rescue and remove all patient in immediate danger
Activate alarm
Confine fire (close doors/windows, turn off oxygen and electronics)
Extinguish fire
What is the major safety change brought about by the National Patient Safety Goals?
Barcoding
For med, pt ID band, and nurse ID badge
When should restraints be used?
Distraction techniques should be used first
Restraints are last resort
Physiologic changes associated with aging
Visual and hearing alterations
Slowed reaction time
Decreased ROM, flexibility, & strength
What should you do if you have a patient that falls?
Get them back to their bed and make sure they are stable, then call provider
Best site for IM injection of antibiotics
Ventrogluteal
Best site for vaccinations?
Deltoid
Best site for injections on babies?
Vastus lateralis
What are standing orders?
Orders that are carried out until provider cancels it with another order or prescribed number of days elapse
What are single/one time orders?
When a med is given only once (ex: preoperational)
List safety principles to reduce needle stick injuries
- Needles systems
- Do not recap needles after med administration
- Plan safe handling and disposal of needle before beginning procedure
- Immediately dispose of used needles into sharps
- Maintain sharps safety log that reports: type and brand of needle, location in building, description of incident, privacy of the employees who have sharps injuries
- Attend educational offerings about blood borne pathogens
- Follow recommendations for infection prevention
- Get hep B vaccine
- Report all needle stick injuries immediately
- Participate in selection of needles with safety devices
What do you do if a med error occurs?
- Assess and examine patient
- Notify provider ASAP
- Once patient is stable, report incident to appropriate agency
- File incident report
List the 3 levels of critical thinking
Basic critical thinking
Complex critical thinking
Commitment
What is basic critical thinking?
Focuses on performing skills and organizing nursing care activities.
This level trusts that experts have all the answers.
What is complex critical thinking?
Begin to rely less on experts and trust their own decisions more
Find original solutions
What is commitment critical thinking?
Anticipate when to make choices without assistance from others
Accepts accountability for decisions made
What are the 3 critical thinking competencies?
General CTC
Specific CTC
Nursing process
What are the parts of General CTC?
Scientific method - methodical way to solve problems
Problem solving - obtain info, suggest solutions, try solutions over time
Decision making - face problem, choose course of action from several options
What are the parts of Specific CTC?
Diagnostic reasoning - figuring out why
Clinical decision making - CT that resolves a patient’s problem
Knowing the patient - in depth knowledge about a patient’s patterns of responses within clinical situation and knowing the patient as a person
What is the nursing process in relation to CTC?
Combines use of general CTC and specific CTC
What is the difference between intellectual and professional standards?
Intellectual brings for knowledge and boundary setting
Professional are criteria that needs to be met
(Both need CT)
What are intellectual standards?
Guidelines or principles for rational thought
That use: preciseness, accuracy, and consistency
What are professional standards?
Ethical criteria for nursing judgements
Evidence-based criteria for evaluation
Criteria for professional responsibility
List the 3 ways to develop CT skills
Reflective journaling
Meet with colleagues
Concept mapping
What is reflective journaling
Written record of clinical experiences
How do you develop CT skills meeting with colleagues?
Discuss and examine work experiences
Validate outcomes
What is concept mapping?
Visual of patient problems and interventions
List the types of assessments
Patient-centered interview
Periodic assessments
Physical examination
List the phases of the interview
Orientation and setting an agenda
Working phase (collecting data)
Termination phase
Example of a leading question
you said you have pain below the knee, tell me more about that
Example of probing
Tell me more about that
What does it mean to interpret while interviewing a patient?
Repeat what you have heard to confirm patient’s meaning
How should you document present illness?
Using PQRST
What does PQRST stand for?
Provokes
Quality
Radiate
Severity
Time
Which areas do we look at then identifying a nursing problem?
Pathophysiological - disease/disorder
Treatment-related - (dialysis, anticoagulant therapy)
Personal - (dying, divorced)
Environmental - (over-crowded school, safety barriers at home)
Maturational - (peer pressure, parenthood)
How are nursing problems prioritized?
Using Maslow’s Hierarchy of Needs
What are the different levels of priorities for nursing problems?
High: physiological needs, safety
Intermediate: not life threatening
Low: for pt’s future wellbeing
List Maslow’s Hierarchy needs in order from the base to the top
Physiological (ABCs)
Safety
Love/belonging
Esteem
Self-actualization
What is the most important principle of planning?
Individualization of patient-centered care
What does the implementation process always begin with?
Reassessing patient
List the things to consider when preparing for implementation
Time management
Equipment
Personnel
Environment
Patient
List the implementation skills
Cognitive: decision making & critical thinking
Interpersonal: communication with patients and their families
Psychomotor: integrate cognitive and motor skills
